This dissertation examines three health and development issues in Sub-Saharan Africa. It analyzes the impact of policy changes and interventions on child mortality, household food consumption and cesarean section births. The study is motivated by the Millennium Development Goals and policies which could affect their achievement. In the first essay, I investigate the impact of debt relief on under-five mortality rate. A dynamic panel data estimator is employed in the analysis. The result shows that debt relief is associated with a statistically significant reduction in under-five mortality rate. I conclude that conditionality of debt relief or development aid can yield positive outcomes. The second essay examines the impact of private hospitals on the likelihood of cesarean section births in Uganda. The study is motivated by the increase in cesarean section births following the proliferation of private hospitals. The main method of estimation is a bivariate probit model. The results show that delivery at private hospitals increases the probability of cesarean section births, thus there is need to monitor private hospitals so that expectant mothers are protected from physician induced demand for avoidable cesarean section births. The final essay studies the impact of agricultural extension services on household food consumption in Uganda. The study exploits the variation in participation in the NAADS to estimate the impact of the program on household food consumption. I find that NAADS membership and training are associated with an increase in household food consumption, hence agricultural extension services can be used to reduce food insecurity. Policy recommendations and future studies are explored.

Philosophiae Doctor - PhD / While the term participation is widely used by development agencies and government alike, its meaning is still widely contested. An emerging consensus on citizens' participation is the active involvement of the people in the planning process, the communication of their preferences, demands, interests, needs, and collective problems and aspirations in relation to those in charge of democratic development policies. For many, particularly in the rural areas, citizen participation has proved problematic as it is often tied up to the implementation of development projects conceptualized and spearheaded by outsiders. Participatory approaches provide few insights as to how to go about resolving the contradictions and paradoxes that participation unveils when introduced into systems with long histories of top-down approaches to decision-making. In Uganda, the National Resistance Movement (NRM) government introduced a participatory development programme of National Agriculture Advisory Services (NAADS) which entails contracting Agricultural Extension Services (AES). This was done to boost participation, expand coverage andimprove agricultural performance in rural areas. The objective of this dissertation was to analyse elites and grassroots understandings of democracy and citizen participation using the case study of NAADS programme. To achieve this objective, a variety of research assessment criteria – qualitative and quantitative interviews with elites and grassroots – were employed. The results demonstrate that Uganda has made strides towards encouraging inclusive and meaningful participation through NAADS in Bushenyi district. Yet the research also illustrates that there are salient mismatches in terms of perceptions that exist between elites and grassroots conceptualisations of citizen participation in NAADS. The majority of elites interviewed were concerned with getting NAADS programme right as required by the legislative frameworks, rather than creating ties with grassroots with a view to promoting participatory development and empowering grassroots communities. The grassroots communities exhibited willingness to participate in the NAADS programme, although the research findings illustrate that it has been implemented in a top-down fashion. There is also proof to show that NAADS participants were barely consulted in making decisions and no effective mechanisms are in place to handle complaints inclusively. Although there is evidence to show participation in the NAADS programme improves the socioeconomic reality of farmers elsewhere in Uganda, this has not been consistently the case in Bushenyi. The dissertation concludes by underlining the benefits of democracy and citizen participation, but cautions that the findings show that the discourse on democracy and citizen participation, like any other discourse, contains many practical limits. / Flemish Inter-University Council (VLIR)

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