La santé des enfants demeure une question prioritaire en Afrique sub-saharienne. Les disparités en matière de mortalité entre pays et au sein des pays persistent et se sont fortement accrues durant la dernière décennie. En dépit de solides arguments théoriques voulant que les variables contextuelles soient des déterminants importants de la santé des enfants, ces facteurs, et particulièrement les influences du contexte local, ont été étudiées beaucoup moins souvent que les caractéristiques individuelles. L'objectif principal de la présente thèse est d’identifier les déterminants individuels et contextuels associés à la mortalité des enfants de moins de 5 ans en Afrique sub-saharienne. L’analyse systématique est basée sur les données les plus récentes des enquêtes démographiques et de santé (DHS/EDS). Deux questions spécifiques sont examinées dans cette thèse. La première évalue la mesure dans la quelle le contexte local affecte la mortalité infanto-juvénile, net des caractéristiques individuelles. La seconde question est consacrée à l’examen de l’effet du faible poids à la naissance sur le risque de décès avant 5 ans. Par rapport à la première question, les analyses multi-niveaux confirment pour plusieurs pays étudiés l’importance simultanée de l’environnement familial et du contexte local de résidence dans l’explication des différences de mortalité infanto-juvénile. Toutefois, par comparaison au contexte familial, l’ampleur de l’effet de l’environnement local paraît assez modeste. Il apparaît donc que le contexte familial reste un puissant déterminant de la mortalité des enfants de moins de 5 ans en Afrique sub-saharienne. Les résultats indiquent en outre que certains attributs du contexte local de résidence influencent le risque de décès des enfants avant 5 ans, au-delà des facteurs individuels dans plusieurs pays. Cette thèse confirme l’effet contextuel de l’éducation sur la mortalité des enfants. Cet effet s’ajoute, dans certains pays, à l'effet positif du niveau individuel d’éducation de la mère sur la survie de l'enfant. Les résultats montrent aussi que le degré d’homogénéité ethnique de la localité influence fortement la probabilité de mourir avant 5 ans dans certains pays. Globalement, les résultats de cette thèse suggèrent que le défi de réduire la mortalité des enfants va au-delà des stratégies visant uniquement les facteurs individuels, et nécessite une meilleure compréhension de l’influence des facteurs contextuels. Par rapport à la deuxième question, les résultats montrent également que les facteurs individuels restent aussi très importants dans l’explication des différences de mortalité des enfants dans plusieurs pays étudiés. Nos résultats indiquent que les différences de mortalité selon le poids à la naissance sont significatives dans tous les pays inclus dans l’analyse. Les enfants nés avec un faible poids (moins de 2500 grammes) courent presque 2 à 4 fois plus de risques de mourir au cours des cinq premières années de vie que les enfants de poids normal, même après correction pour l’hétérogénéité non observée. Ce résultat suggère qu’en plus des mesures visant à réduire la pauvreté et les inégalités de revenus, la réduction de l’incidence du faible poids à la naissance pourrait apporter une contribution majeure aux Objectifs du Millénaire pour le développement; spécialement comme une stratégie efficace pour réduire le niveau de mortalité parmi les enfants de moins de cinq ans. / Child health remains a priority area for health policy in sub-Saharan Africa. Disparities in child mortality between and within countries have persisted and widened considerably during the last few decades. While researchers have devoted considerable attention to the impact of individual-level factors on child mortality, less is known about how community characteristics and institutions affect health outcomes for children, even though they have a prominent role in theoretical models. The aim of this thesis is to identify individual and contextual effects of child mortality by using data from the latest round of Demographic Health Surveys for all countries in sub-Saharan Africa. Two sets of questions are addressed in this research. First, we evaluate the impact of contextual factors on the risk of dying before age 5 net of the effect of individual factors. The results indicate that some attributes of the community influence the mortality risks of children, over and above the intermediate factors included in this investigation. For instance, in half of the countries under study a 1% increase in the proportion of children fully immunized in the community is associated with a decrease of 17-79% in the odds of dying before age 5. The proportion of women in the community completing secondary school also significantly increases child survival. This effect is, in some countries, in addition to the positive individual-level effect of the child’s own mother being educated. Net of individual and household characteristics, higher community-level ethnic homogeneity is associated with decreased odds of dying before age 5 in some countries. Overall, the results of this study therefore suggest that the challenge to reduce under-five mortality goes beyond addressing individual factors, and requires a better understanding of contextual factors. Second, the study exploits recent national survey data for nine countries in sub-Saharan Africa to investigate the association of LBW and mortality not only in infancy but also during childhood, using a standardized methodology to adjust missing birth weight data from household surveys while accounting for unobserved family-level factors (genetic or behavioral) that may modify the relationship between birth weight and under-five-years mortality. We find evidence of the impact of birth weight on the risk of dying not only in infancy but also during childhood, which remains strong and significant in all countries even after controlling for potential confounding factors. The main policy implication of our findings is that reducing the incidence of LBW may be an important prevention strategy to combating child mortality in sub-Saharan Africa countries.

Bien que la relation entre l’état de santé perçu et les mesures de santé physique et mentale soit bien documentée dans les pays développés, très peu d’études ont examiné cette association dans le monde en développement, particulièrement en Afrique subsaharienne. De même, les études menées dans divers contextes sociaux ont documenté que les femmes et les personnes de plus faible statut socioéconomique (SSÉ) sont les plus susceptibles de porter un lourd fardeau des incapacités et de la mauvaise santé perçue, mais il n’est pas connu si ces associations existent aussi dans les pays africains. L'objectif général de cette recherche doctorale était d’aboutir à une meilleure compréhension de la stratification sociale de la santé en Afrique subsaharienne. Plus spécifiquement, cette étude visait à: 1) Examiner les associations entre la santé perçue et les mesures de santé physique et mentale (maladies chroniques, incapacités et dépression) parmi les adultes à Ouagadougou, Burkina Faso, et évaluer comment ces associations varient selon le sexe, le niveau d’éducation et l'âge; 2) Analyser les différences en matière d’incapacité cognitive et physique entre les hommes et les femmes âgés de 50 ans et plus à Ouagadougou et évaluer la mesure dans laquelle les différences observées pourraient être attribuables aux inégalités de genre en matière de conditions sociales et de santé à travers le cycle de vie; 3) Examiner la relation entre le SSÉ et une multitude de mesures d’incapacités parmi les adultes âgés de 18 ans et plus dans 18 pays d’Afrique subsaharienne et déterminer si les différences socioéconomiques dans les incapacités sont caractérisées par une divergence, convergence ou stabilité à travers l’âge. Les résultats de nos analyses sont présentés sous forme de trois articles scientifiques, qui se sont appuyés sur les données de l'Enquête santé réalisée en 2010 dans l'Observatoire de Population de Ouagadougou (OPO) et de la World Health Survey réalisée en 2002-2004 par l’OMS. Dans le premier article, nous avons trouvé que la mauvaise santé perçue était fortement associée aux maladies chroniques et aux incapacités, mais pas à la dépression. L’effet des incapacités sur la mauvaise santé perçue s’intensifiait avec l’âge et avec la diminution du niveau d’éducation. Par contre, l’effet des maladies chroniques semblait diminuer avec l’âge. Aucune variation selon le sexe n’était observée dans les associations de la santé perçue avec les maladies chroniques, les incapacités et la dépression. Ces résultats suggèrent que les différentes sous-populations définies selon le niveau d'éducation et l'âge pondèrent différemment les composantes de santé dans la santé perçue à Ouagadougou. Les résultats du second article indiquaient que le genre féminin était positivement associé à des niveaux plus élevés de détérioration cognitive et de mobilité réduite. L'excès des femmes dans ces incapacités était seulement partiellement expliqué par les inégalités de genre dans l’état nutritionnel, le statut matrimonial et, dans une moindre mesure, l'éducation. Ces résultats suggèrent que l’amélioration de l'état nutritionnel et des opportunités d'éducation à travers le cycle de vie pourrait prévenir la détérioration cognitive et la mobilité réduite et réduire partiellement l'excès féminin dans ces incapacités. Dans le troisième article, nous avons montré que le manque d'éducation était positivement associé à des niveaux plus élevés d'incapacités, et le différentiel d’état de santé fonctionnel entre les différents niveaux d'éducation restait stable à travers l'âge. Ces résultats suggèrent qu’en Afrique subsaharienne, comparativement aux individus hautement éduqués, les personnes faiblement éduquées ont moins de ressources économiques et sociales et de saines habitudes de vie qui ont des effets bénéfiques, constants sur la santé fonctionnelle selon l’âge. / Although the relationship between self-rated health (SRH) and physical and mental health is well documented in developed countries, very few studies have analyzed this association in the developing world, particularly in sub-Saharan Africa. Furthermore, research in various social contexts has documented that disability and poor SRH are more common among women and persons with lower socioeconomic status (SES), but it is unclear whether these associations also hold in sub-Saharan African settings. The general objective of the present thesis was to better understand the social stratification in health in sub-Saharan Africa. More specifically, this study aimed to: 1) To examine the associations of SRH with measures of physical and mental health (chronic diseases, functional limitations, and depression) among adults in Ouagadougou, Burkina Faso, and how these associations vary by sex, education level, and age; 2) To analyze differences in cognitive impairment and mobility disability between older men and women in Ouagadougou, Burkina Faso, and to assess the extent to which these differences could be attributable to gender inequalities in life course social and health conditions; 3) To examine the relationship between SES and multiple disability measures among adults aged 18 and older in 18 sub-Saharan African countries and to determine whether socioeconomic differences in disability are characterized by an increase, decrease or stability with increasing age. The results of our analyses are in three scientific research articles, which rest upon data taken from a cross-sectional interviewer-administered health survey conducted in 2010 in areas of the Ouagadougou Health and Demographic Surveillance System, and the World Health Survey conducted in 2002-2004 by the World Health Organization (WHO). In the first article, poor SRH was strongly associated with chronic diseases and functional limitations, but not with depression. The effect of functional limitations on poor SRH intensified with age and with decreasing education level. In contrast, the effect of chronic diseases appeared to decrease with age. No variation by sex was observed in the associations of SRH with chronic diseases, functional limitations, and depression. These findings suggest that different subpopulations delineated by age and education level weight the components of health differently in their self-rated health in Ouagadougou. The results of the second article indicated that female gender was positively associated with higher levels of cognitive impairment and mobility disability. The female excess in these disabilities was only partially explained by gender differences in nutritional status, marital status and, to a lesser extent, education. These results suggest that enhancing nutritional status and educational opportunities throughout life span could prevent cognitive impairment and mobility disability and partly reduce the female excess in these disabilities. In the third article, we found that the lack of education was positively associated with poorer functional health, and the health gap between educational levels remains static with increasing age. These findings suggest that, in sub-Saharan Africa, compared to the well educated, the undereducated have fewer economic and social resources and health-promoting behaviors which have beneficial, albeit constant effects on functional health over the life course.

The aetiological diagnosis of recessive non-syndromic hearing loss poses a challenge owing to marked heterogeneity and the lack of identifying clinical features. The finding that up to 50% of recessive non-syndromal genetic hearing loss among Caucasians was due to mutations in GJB2, the gene encoding Connexin 26 (Cx26) was a breakthrough, whose value as a diagnostic tool has been limited by the significant variation in the prevalence of deafness genes and loci among population groups. The significant association of the GJB6-D13S1830 deletion among individuals with one mutant GJB2 allele highlighted the need to explore population specific genetic mutations for NSHL. Although data from Sub-Saharan Africa is limited, reported studies found a high prevalence of R143W GJB2 mutation among Ghanaian, the 35delG mutation in 5 out of 139 Sudanese and a low prevalence of GJB2 variations among 385 Kenyan deaf children. The mutation spectrum of Waardenburg Syndrome (WS) in Africans has not been documented. During a visit to a School for the Deaf in the Limpopo Province of South Africa in 1997, it was noted that a high number of students came from Nzhelele sub-district. All had childhood onset hearing loss with no associated anomalies or disorders. The question arose as to whether there was a high-risk area for deafness in the Limpopo Province and what the aetiology of this hearing loss was.The main aim of this study was to investigate the role of GJB2, the GJB6-D13S1830 deletion, and the four common mitochondrial mutations, A1555G, A3243G, A7511C and A7445G, in the African hearing-impaired population of Limpopo province in South Africa, and to identify the mutation spectrum of the deafness genes found. The type and degree of hearing loss in this hearing impaired population would also be assessed. Secondly, this study sought to identify the mutations in a sibling pair with 2 clinical WS and to use the findings in a future study to establish the mutation spectrum of WS in the African population of the Limpopo province and of South Africa in general. The study was designed as a two phase study, in which phase 1 was used for hypothesis formulation and phase 2 was for hypothesis testing. While phase 1 was a descriptive retrospective case study, phase 2 was a combination of sample survey and prospective descriptive case study. In phase 1, demographic data of 361 students in two schools of the deaf in the Limpopo province was analyzed for evidence of areas of high risk populations for deafness in the province. In phase 2, a group of 182 individuals with genetic non-syndromic hearing loss (NSHL) and two siblings with clinical WS from two schools for the Deaf in the Limpopo Province of South Africa were investigated. A thorough clinical examination, audiological evaluation and urinalysis were done. Mutational screening was carried out in all 184 subjects using genomic DNA using single-strand conformation polymorphism (SSCP), multiplex polymerase chain reaction (PCR), and direct sequencing for GJB2, and Restriction Fragment-Length Polymorphism (PCR–RFLP) analysis for GJB6, and SSCP, hetero-duplex analysis, and direct sequencing of the first 8 exons of PAX3 and all of MITF for Waarenburg syndrome. Data analysis was by geographical mapping, frequency tables, tests of association with calculation of odds ratios, and binary logistic regression analysis using STATA and GIS mapping systems. The results indicate that there seem to be areas of genuine populations at risk for hearing loss in the Limpopo province of South Africa, namely Mutale and parts of Makhado and Thulamela municipalities. In Thulamela (NP343) wards 11-15, 26-30 and 31-35, and in Mutale (NP 344) wards 6-10, together accounted for 67 (18%) of participants in phase 1, and 33 (18%) of the participants in phase 2 of the study. Mutale municipality in the Vhembe 3 district gave with a projected prevalence of at least 13.14 deaf children per 100,000 African population attending the local school for the deaf. The observed hearing loss is a genetic, non-syndromic form, which is mainly severe and severe to profound, although without any clear defining configuration or shape. It is a stable, non-progressive and prelingual form of hearing loss, implying that this may be a recessive form of deafness. No identifiable environmental confounding factors or associations were identified. The deafness is not linked the common known auditory gene mutations in GJB2, the GJB6-D13S1830 deletion, or the common mitochondrial mutations A1555G, A3243G, A7511C and A7445G. Severe and profound levels of hearing loss were found in 22.8% and 75% of the cohort respectively, with the majority exhibiting flat (70.1%) or sloping (23.4%) audiograms that were commonly symmetrical (81.5%). However, as indicated, there was no clear pattern in the audiological findings overall. None of the 184 hearing impaired individuals exhibited any of the reported disease causing mutations of GJB2, including 35delG. There was, however, a high prevalence of two variants, the C>T variant at position g.3318-15 and the C>T variant at position g.3318-34, occurring in 21.4% and 46.2% of the deaf cohort respectively. The same variants were found to occur in 35% and 42.6% of a normal hearing control group (n = 63) respectively, indicating that these variations are polymorphisms. In three subjects (1.63% of the cohort), a T>A homozygous variation at position g.3318-6 was detected. Its significance in the causation of NSSNHL is yet to be determined. The GJB6-D13S1830 deletion was not detected in any of the participants. None of the four mitochondrial mutations screened for were found. 4 These results indicate that GJB2 is not a significant deafness gene in the African population of the Limpopo Province of South Africa and that significant genes for non-syndromic recessive hearing loss in this population are yet to be found. The geographical clustering of deafness found in this study, combined with the lack of identifiable common associated clinical features among the subjects of this study (excluding the WS sibling pair), suggests that these subjects have a genetic recessive non-syndromal type of hearing loss. In the context of historical and cultural evidence of consanguinity in this population, a founder effect cannot be ruled out. A rare mutation, R223X, previously identified only once out of 470 WS patients, was identified in the PAX3 gene among the WS sibling pair. A novel silent change GGG>GGT at amino acid 293, was also identified. These identical findings document, for the first time, a molecular defect in WS in an African sibling pair, and confirm WS Type I in this family, which could be found in other WS type I South Africans in the Limpopo Province of South Africa. The current study demonstrated that parents of genetically hearing impaired children in these areas are able to detect hearing loss at an early age, with over 60% suspecting their children’s hearing loss below 6 months of age. A child-centered management model encompassing all the areas relevant to childhood deafness/hearing impairment, which takes into consideration the prevailing logistical and financial constraints of the available healthcare system, is proposed. The implementation of this model requires a paradigm shift from the current fragmented model of service delivery to a cohesive patient-centered approach, based on concrete data from appropriate community based research, in which all the relevant parties communicate and share resources. 5 It would achieve the goals of early detection and intervention, as well as inclusive education for all. The relevant health and education policies are already in place and the posts funded. Equitable implementation of these policies would require appropriate community based research, as well as improved communication and consultation between the various stakeholders to ensure an efficient and affordable quality healthcare service for all hearing impaired South Africans.

L’évolution économique et sociale comparée de deux régions sénégalaise dans le processus de décolonisation : Le Boundou et le Gadiaga 1885-1980Ce travail est le diagnostic de l’évolution interne du Boundou et du Gadiaga (Sénégal oriental) dont les économies respectives n’ont suscité que peu d’intérêt pour le pouvoir colonial et les élites postcoloniales. Le processus et les mécanismes de leur marginalisation sont jusqu’ici mollement signalés pour ce qui concerne le Gadiaga et ne sont pas envisagés dans le cas du Boundou ; d’ailleurs, les travaux antérieurs sont exclusivement circonscrits dans la période de la domination coloniale, et n’établissent aucune "passerelle" entre les manifestations coloniales et postcoloniales de la marginalisation.Cette exclusion de l’économie globale du Sénégal en toute époque est la résultante de l’orientation des politiques économiques et de la faible opportunité offertes par les politiques publiques à certaines régions. Les facteurs de la marginalisation du Boundou et du Gadiaga sont pour ainsi dire d’ordre structurels (absence d’investissement digne de ce nom et de solutions économiques durables) et non conjoncturels. Sur le plan social, les conséquences économiques sont lourdement ressenties, avec la genèse de phénomènes tels l’exode rural, l’émigration massive et organisée de travail et le bouleversement des structures sociales, ce qui accentue à rebours le retard économique. Il se produit à terme une sorte de cercle vicieux de la marginalisation puisque l’accentuation du retard économique par les phénomènes sociaux, encourage les autorités publiques à différer les investissements, voire à y renoncer, en prenant parfois pour seul prétexte la régression démographique dont sont victimes toutes les "périphéries".La similarité de la situation économique entre le « temps partagé » colonial et le « temps propre » postcolonial et les comportements sociaux considérés comme leurs effets induits ne permettent-elle pas de dire que le schéma de gestion de l’État moderne du Sénégal est simplement le rejeton de la politique coloniale. / The economic and social evolution compared by two regions of Senegal in the process of decolonisation: Boundou and Gadiaga on 1885-1980This thesis is the analysis of the internal evolution of Boundou and Gadiaga (Eastern Senegal) whose economies have been little entitled to the colonial and postcolonial elites. The processes and mechanisms of marginalisation are so far softly reported regarding the Gadiaga’s area but this has not been considered in the case of Boundou, and indeed previous work exclusively restricted to the period of colonial domination and makes no “link” between the colonial and postcolonial manifestations of marginalisation.This exclusion of the overall economy of Senegal in many ways and any time is the result of the orientation of economic policies and low opportunities offered by public policies in certain areas. The factors of marginalisation of Boundou Gadiaga are basically structural order (lack of substantial investment and lack of vision and strategy on long run but weakness of sustainable economic approaches) and non-cyclical economic mechanism. Along the social aspects, the population undergoes heavily the economic consequences of the lackluster of the region, and the conditions entail the mass movement of population from rural to urban area (rural exodus) and the disruption of social structures, which increase the pressure of the economic on backwardness. It occurs on short run vicious circle of marginalisation since the accentuation of economic backwardness by social phenomena, encourages public authorities to push back investment’s programs or cancel it, by spotlighting the pretext of the declining population.The similarity of the economic condition between the “shared time” colonial and “owned time” postcolonial and the social behaviours considered induced effects does not allow the scheme management of the modern state of Senegal is simply the offshoot of colonial policy.

This study examined the effect of real exchange rate misalignments on economic growth in sub-Saharan Africa (SSA) by employing 15 countries. The sample is subdivided into 7 lowincome countries and 8 middle-income countries. The dataset spans 41 years covering the period 1970-2010. The study examined this broad issue in piecewise fashion. In the first part, the study examined the validity of the Balassa-Samuelson Hypothesis (BSH) using a simplified regression model and within-effects estimations. The study found a negative and highly significant coefficient of the relative productivity term for the two subsamples (i.e. low-income SSA countries and middle-income SSA countries), in addition to the full sample. Thus, the study found a well-established BSH for the SSA countries considered. Second, the study examined the impact of the real exchange rate undervaluation on economic growth using a standard regression model with key control variables. The study constructed an index of undervaluation, following Rodrik (2008). The study also constructed a Hodrick- Prescott based undervaluation index in order to evaluate the robustness of the main undervaluation index. Generally, the study found undervaluation to promote growth and overvaluation to reduce it. The study found the effect of undervaluation on economic growth to weaken as countries migrate from the low-income bracket to the middle-income bracket. Moreover, the study examined whether the choice of the undervaluation measure mattered. The study found the choice of the undervaluation measure to matter. The Rodrik-type index appeared to overestimate the size of the impact of undervaluation on economic growth. Finally, the study examined whether the impact of undervaluation on growth was linear. The evidence showed that the impact of undervaluation on growth was linear, at least, for this study. The linear impact of real exchange rate movements on economic growth implied that undervaluation enhanced economic growth just as overvaluation hindered it. / Economics / D. Phil. (Economics)

Research in organizational identity as pioneered by Albert and Whetten (1985) provides that organizational identity is central, enduring and distinctive. As Gioia et al. (2013) put it, “what we know about organizational identity, including its dynamic aspects, is based on the study of organizations located within a single and uniform geographic market (U.S./European) and/or stable institutional environment (developed markets)” (p. 180). This study thus carries research in organizational identity forward by locating it at an integrated food manufacturing company, Feed Me Ventures Limited, in the non-western, developing country, Nigeria. As businesses expand globally, it becomes pertinent for global organizations and managers in organizations outside the West to become aware of possibly divergent forms of organizational identity and formation processes that may exist. Nigeria is a community faced with unstable and corrupt leadership, a volatile economy directly impacted by its own created as well as global instabilities as well as a culture that is very different from those of the communities in which organizational identity has traditionally been studied. To accomplish the goals of this study, an inductive analysis is conducted using ethnographic observation, document analysis and grounded theory interviewing. This method is deemed most appropriate as this is an exploratory study to find what organizational identity may look like in Nigeria. Findings provide that while the conceptualization of organizational identity in the literature hold true, the environment greatly affects organizational identity. The founder of Feed Me Ventures Limited had developed organizational identity in direct opposition to societal values thereby emphasizing the distinctiveness dimension of organizational identity more than would normally be expected. Also, there is an adaptational dimension to organizational identity at Feed Me Ventures Limited which allows it to adapt to different needs in the environment in order to survive and retain its core identity. This is similar to adaptive instability which is already established in the literature except that at Feed Me Ventures Limited, when new identity dimensions are adapted in reaction to the environment, these dimensions only serve to help the organization retain its core identity. Furthermore, the relationship between organizational identity claims and organizational identity understanding among organizational members revealed the existence of an organizational identity gap (OI gap). This refers to a situation where claims about “who we are” from senior management does not align with understanding of “who we are” by organizational members. Also interesting is that social constructionist views about organizational identity being developed through the interactions of organizational members is found to be true at Feed Me Ventures Limited where organizational members, in their social interactions, begin to form notions of “who we are” that are not derived from claims about “who we are” from management. This study concludes that it is important for organizational leaders to acknowledge environment variables, engage in organizational diagnosis to find OI gaps and consider further this concept of adaptation and how this might serve organizations in environments similar to Nigeria.

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La question du développement inclusif dans les pays en développement est au cœur de cette thèse. Cette dernière s'articule autour de quatre chapitres sur les questions de politique fiscale et les questions liées à la croissance inclusive. Le chapitre 1 explore comment la politique fiscale de l’Etat affecte l'inclusivité de la croissance dans les pays en développement. Nous observons que la politique fiscale affecte la croissance inclusive de manière significative si et seulement si les pays ont de fortes qualités institutionnelles. En outre, notre résultat montre qu'il existe un seuil optimal au-delà duquel toute augmentation du taux d'imposition négativement la croissance inclusive. Le chapitre 2 examine les effets des composantes des dépenses publiques sur l'équité et la croissance dans les pays d’Afrique subsaharienne, notamment s'il est possible de concevoir des dépenses publiques en vue de promouvoir une société plus équitable sans sacrifier la croissance économique. Notre étude a permis de montrer que l’investissement en infrastructure a contribué à une croissance plus inclusive en Afrique subsaharienne que d'autres dépenses publiques. Ces résultats suggèrent que des programmes temporaires et bien ciblés devraient être mis en place pour aider ceux qui sont laissés pour compte par le processus de croissance. Le chapitre 3 cherche à savoir si les problèmes d’inégalités de revenus se sont posés ou non dans les périodes d'ajustement budgétaire en Côte d'Ivoire au cours de la période 1980-2014. Nos résultats montrent une amélioration de la performance de croissance après les épisodes de consolidation budgétaire, mais aussi des diminutions de l'écart de revenu dans les périodes suivantes les années d’ajustements budgétaires. Enfin, le chapitre 4 évalue la crédibilité des prévisions budgétaires et leurs effets sur le bien-être social dans les pays de la CEMAC et de l'UEMOA. Nous sommes aboutis aux résultats que l'inefficacité des prévisions budgétaires se produit dans la plupart des cas parce que les erreurs de prévisions sont proportionnelles à la prévision elle-même, mais aussi parce que les erreurs passées sont répétées dans le temps. En outre, une partie des erreurs de prévision des recettes peut s'expliquer par des chocs aléatoires survenus dans l'économie. Par conséquent, ces erreurs dans les prévisions de revenus considérées comme des chocs de politique budgétaire ont un effet négatif sur la croissance inclusive. / The issue of inclusive development in developing countries is at the heart of this thesis. The latter revolves around four chapters on fiscal policy issues and inclusive growth-related matters. Chapter 1 explores how government tax policy affects the inclusiveness of growth in developing countries. Evidence is shown that tax policy affects significantly inclusive growth if and only if the countries have a strong institution quality like low corruption and a good bureaucratic policy. In addition, our result shows that there is an optimal tax beyond which, any increase in the personal income tax rate should have negative impact on inclusive growth. The Chapter 2 examines the effects of government expenditure components on both equity and growth in sub-Saharan countries, especially whether it is possible to design public spending to promote a more equitable society without sacrificing economic growth. We find that investment in infrastructure contributed to more inclusive growth in Sub-sub Saharan African economies than others government spending. These results suggest that temporary and well-targeted programs should be implemented to help those being left out by the growth process. The Chapter 3 investigates whether income inequality matters in the periods of fiscal adjustments in Côte d’Ivoire over the period 1980-2014. The results show an improvement in growth performance after fiscal consolidations episodes, but also income gap decreases in the periods ahead fiscal adjustments. Lastly, Chapter 4 assesses the credibility of fiscal forecasts and their social effects in CEMAC and WAEMU countries. We obtain evidence that the inefficiency of fiscal forecast occurs in most time because the forecast deviation is proportional to the forecast itself, but also because the past errors are repeated in the present. Furthermore, a part of revenue forecast errors can be explained by random shocks to the economy. Therefore, these errors in revenue forecast considered as fiscal policy shocks has a detrimental effect on inclusive growth.

La thèse démontre que l'environnement protectionniste en Inde a contribué à bâtir une industrie pharmaceutique solide. L'arrivée simultanée de l'Accord ADPIC et de la libéralisation économique a créé des « push factors » à la fois compétitifs et favorables, obligeant les firmes pharmaceutiques indiennes (FPI) à chercher de nouvelles voies de croissance à l’étranger. Les politiques des pays africains en faveur des génériques, l’action des organisations internationales et la nouvelle gouvernance des marchés financés par les bailleurs de fonds ont aussi induits des « pull factors » permettant aux FPI de s'engager davantage sur ces marchés. Cette thèse montre à travers le cas du Mali que le marché en Afrique de l’Ouest francophone est divisé en quatre segments – le marché public financé par l'État et par des donateurs et le marché privé formel et informel – avec des réglementations différentes. Les FPI n'utilisent que l'exportation dans ces pays, mais leurs organisations varient selon le segment dans lequel elles souhaitent opérer. Enfin, ce travail utilise l’étude du Synriam, un nouvel antipaludéen pour montrer que Ranbaxy a utilisé le partenariat avec Medicines for Malaria Venture pour développer ses capacités, accéder à de nouveaux marchés et gagner en légitimité. Cette étude met en évidence que les organisations internationales peuvent créer des barrières institutionnelles et influencer les stratégies d'entrée des firmes. En conclusion, cette thèse illustre la richesse et la complexité du marché pharmaceutique africain et démontre également que les stratégies d'entrée sur le marché et d'exploitation des FPI sont influencées par l'environnement institutionnel sous-jacent. / This dissertation first shows that the early protectionist environment in India helped build a robust indigenous pharmaceutical industry. The simultaneous arrival of TRIPS and economic liberalization created both competitive and supportive push factors forcing Indian firms to look for new avenues of growth beyond national boundaries. Generic supporting policies of African countries, the action of international organizations and the new governance of donor-funded markets also acted as pull factors for Indian firms to engage in these markets.Next, taking the case of Mali, the thesis shows that the pharmaceutical market in Francophone West African countries is divided into four specific segments – government and donor-funded public and formal and informal private markets – with different regulatory characteristics. Indian firms are using only export to operate in these countries, but the organization of export varies according to the segment in which a firm intends to operate. Lastly, it takes the case of Synriam, a new antimalarial to show that Ranbaxy used the partnership with Medicines for Malaria Venture for developing capabilities, accessing new markets and gaining legitimacy. The case also reflects that international organizations may create institutional barriers and influence the market entry strategy of firms. To conclude, this thesis illustrates the richness and complexities of the African pharmaceutical market and shows that market entry and operation strategies of Indian firms are influenced by the underlying institutional environment.