<p> This praxis develops a comprehensive performance measuring model to help government policy makers in Sub-Saharan African (SSA) countries identify and evaluate their performance in online outsourcing (OO). After assessing different efficiency measurement methods, data envelopment analysis (DEA) was selected for this study. </p><p> Metrics from the World Bank&rsquo;s proposed framework for assessing countries&rsquo; competitiveness in OO are used to develop the DEA model in this research. Due to the presence of missing values in some of the variables in the dataset, a technique called multiple imputation by chained equations (MICE) is used to estimate these missing values. The DEA model is applied to 23 OO input variables and a single output variable called Information and Communication Technology (ICT) service exports. ICT service exports revenues are used by the World Bank to measure a country&rsquo;s performance in OO. </p><p> Empirical results from the eight SSA countries studied validate that there is a meaningful relationship between ICT service exports revenue and DEA technical efficiency scores. Further analysis indicates that six out of the eight SSA countries are efficient in OO, while two are inefficient in OO. In addition to the efficiency scores, the DEA model produces benchmark information in the form of an efficiency reference set (ERS). The ERS for an inefficient country consists of an efficient country with which it shares similar levels of input and output factors. Thus, through peer comparison, policy makers in inefficient countries will be able to identify factors that may contribute to improving their performance. </p><p> The results from the proposed DEA model demonstrate the actual possibilities of determining the technical efficiencies of countries participating in OO; the use of this model is therefore not limited to SSA countries but can be applied to various world regions identified by the World Bank.</p><p>

<p> Protracted conflict and development in South Sudan: A feminist analysis of women&rsquo;s subjugation in the making of a nation argues that international interventions in South Sudan from the period of British colonization to present day South Sudan perpetuate and [re]inscribe formations of women&rsquo;s oppression and agency. Foreign presence affects identity constructions, conflict, and governance. I demonstrate how international interventions, militarization, and protracted conflict, compromise women&rsquo;s rights, health, and self-determination as they permeate understandings of gender, sex, reproduction, and security. I integrate an analysis of customary and civil law to establish how the expression and implementation of law and rights inform relationships to women&rsquo;s freedom and justice. Further, I investigate techniques the United Nations and NGOs used to influence cultural shifts that reproduce structural inequities based on gender, body, class, and nation. Foregrounding power, politics, and local knowledges, my ethnography is a practice of emancipatory anthropology to excavate techniques and procedures of normalizing gender, reproductive and sexual health, and biopolitical governance (Foucault 2008, 4). Informed by an ethnography of United Nations and NGO staff, I argue that international interventions in South Sudan introduce formations of biopolitical governance mediated by donor-driven, development agendas, by superimposing relationships to sex, gender, reproduction, and health, which are both culturally contested and unsustainable.</p><p>

Abstract not available.

The EFA conference in Dakar 2000 ushered in new momentum for ensuring universal access to education and advocacy for improved educational quality in all aspects (UNESCO, 2000). While significant progress has been made in expanding access in sub-Saharan Africa, particularly for girls, efforts to ensure improved educational quality in terms of learning, have not matched the drive for universal educational access. Rather, educational quality in most countries in sub-Saharan Africa has been seriously compromised by rapid expansion given the limited resources. In many attempts to ensure the delivery of quality education in developing countries, the thrust of delivery strategies has focused on increased allocation of inputs/resources to infrastructure development and supply of textbooks. However, the literature on the effect of such resources on student achievement is rather mixed and inconclusive with many studies noting that resources make little or no difference. While such approaches may be theoretically sound, most fail to focus on microelements at the school or classroom level such as capturing the teaching and learning experiences of both students and teachers and students. In an attempt to fill this gap, a new line of research has emerged which looks more closely at how resources are used by schools to support and improve instruction. This study follows this trend and examines the extent to which the Rehabilitation of the Basic Education Project (REBEP) in Sierra Leone contributed to improved learning and academic performance of students in five target schools after a series of interventions. Using a case study approach, the study revealed that while REBEP contributed to a significant increase in educational access, particularly for girls, performance in the terminal National Primary School Examination (NPSE) did not improve despite huge investments in the target schools. The study concludes that, in the context of Sierra Leone, and perhaps in many more countries in sub-Saharan Africa, unless and until critical school-level factors are appropriately and comprehensively addressed by policy makers, educational standards and quality will continue to be eroded particularly in terms of learning and that achievement of critical EFA goals and MDG by 2015 would remain an unfulfilled dream.

This dissertation examines the factors that account for the variation in policy choices and implementation among sub-Saharan African countries that pursued neoliberal economic reforms since the 1980s. It shows that governments’ response varied both across time and policy areas. Using process tracing and cross-case analysis, this dissertation examines the influence of both international and domestic level factors regarding neoliberal policy choices and implementation in Ghana, Kenya, Zimbabwe, and Botswana. While the strength of the various explanations varies across cases, the empirical evidence shows that crisis, interest groups, and epistemic community are more powerful in explaining governments’ policy choices. Domestic institutions and epistemic community offer the strongest support for policy implementation. Since the epistemic community variable is strong in explaining both policy choice and implementation, these findings are more supportive of the Constructivist explanation for policy reforms. The evidence shows that neoliberal economic reforms in Ghana have been successful while those in Kenya and Zimbabwe have been less successful. Botswana, however, does not fit the crisis-driven conceptual model adopted in this dissertation and therefore requires further examination.

This dissertation investigates labor demand constraints and labor supply barriers to informal employment opportunities in Johannesburg using a micro-macro linkage methodology. Existing literature often characterizes the “informal sector” as voluntarist, or as the result of rationing due to labor market imperfections. Such models acknowledge no explicit role for macroeconomic factors to affect employment outcomes. I argue that, far from being structurally disconnected, both formal and informal employment conditions, including those in street trading, are shaped by the macroeconomic environment. The results highlight mechanisms through which conditions in the informal economy, in which traders operate and make decisions, are shaped by macroeconomic policies, and how these policies affect employment security. Based on qualitative field research on self-employed street traders conducted in 2008, I develop an analysis of trading from the level of the macroeconomy, through the retail sector, to traders and their households. The macroeconomic analysis estimates a consumption function to model impacts of alternative fiscal policy to that adopted in the post-apartheid years. The analysis uses an input-output model to isolate the impact of deficit spending on consumption by industrial sector and assess earnings and employment effects in the retail sector. Interview-based survey data enrich and contextualize the analysis, incorporating traders’ experiences and perceived challenges to self-employment. I find evidence of multiple interacting constraints on labor demand and labor supply, which helps make sense of the South African paradox of high unemployment coincident with a small informal economy. Street traders have limited profitability due, in part, to constrained consumption demand, which provides some explanation for the persistence of the paradox despite low barriers to entry. Further, constraints have disproportionate impacts on certain groups: female traders perceive their self-employment as significantly more threatened by demand constraints because their households tend to rely more on trading income than do male traders' households.

This study sought to examine health care decisions and choices that women make during pregnancy and childbirth in selected low-income and poor urban communities in Ghana. Specifically, it examined women's and community members' knowledge and perceptions about pregnancy and childbirth; existing forms of health care available to women during pregnancy and childbirth; and factors that influence preference for the type of health care that women use during pregnancy and childbirth. The study employed a two-phased data collection strategy involving in-depth interviews and focus group discussions to examine maternal health care seeking behavior of the target population. The findings revealed that the poor urban women have a wide range of perceptions and knowledge about pregnancy including knowledge about what constitutes a successful pregnancy and risk factors of pregnancy and childbirth complications. The study found that three major forms of health care exist for pregnant women: biomedical care; herbal-traditional birth attendant care; and spiritual care. While some women use or prefer to use either solely medical care or herbal-traditional birth attendant care for their pregnancy and delivery, others combine two or all the three forms of health care. Pregnant women seek traditional birth attendants (TBAs) and spiritual care for spiritual protection against death, due to affection and cultural attachment to TBAs, fears about medical care and health facilities, and due to cost of seeking medical care. Long waiting time and early reporting time at antenatal clinic were identified as partly limiting the use of medical care during pregnancy. Intimate partners of pregnant women were identified as negative normative influence since most of them do not support their wives during pregnancy. Quality and safety of care were the major reasons why pregnant mothers seek biomedical care other than other forms of care. However, majority of women who seek biomedical care do not seek timely antenatal care. Only 42 percent made their first antenatal visit in the first trimester. These findings have implications for policies and programs that are likely to help increase the use of skilled attendance and improve maternal health outcomes in the study population and other similar low-income urban communities in Ghana.

Master of Arts / Department of Sociology, Anthropology, and Social Work / Matthew R. Sanderson / Food crises in Kenya are recurring phenomena. Despite widespread and perennial famines, Kenya is exporting food while importing food aid. This study focuses on the concept and question of food security in Kenya. If Kenya can produce and even export food products, why does the country still import food aid every year? Why is the country classified as food insecure? And why does the country still suffer from recurrent famines? Drawing on social science theory from the political economy of food and agriculture, this study postulates that the contradiction between exporting food and importing food aid is related to Kenya‟s subordinate position in the world economy. Using a comparative-historical, in-depth case study research design, this research descriptively explores the relationship between trends in food aid, trade, production and food security. The study finds that the relationship between food trade and aid with food security is mixed in Kenya. Aid and trade have not strongly enhanced food security in Kenya, but food insecurity in Kenya has not gotten markedly worse.

<p> <b>Background:</b> As the world becomes more urban and slums continue to grow in developing countries, research is needed to measure utilization of health services, health outcomes, and access to health care providers among urban slum residents. Estimating trends in urban health among slum residents relative to other urban inhabitants provides evidence of health disparities for priority-setting by program implementers and policy-makers. Research on the negative effects of slum environments on human health has started to emerge, yet there remains a paucity of evidence on morbidity trends over time and inequalities between slum residents and other urban residents. The goal of this study is to quantify maternal and child health care access, utilization and outcomes among urban slum dwellers in selected countries in sub-Saharan Africa and South Asia over time. These three areas are addressed in three separate dissertation manuscripts. </p><p> <b>Methods:</b> This dissertation offers an in-depth analysis of household and health facility data to measure trends in maternal and child health care utilization and health outcomes among slum residents over time, as well as inequalities in access, utilization and outcomes between other urban and rural populations. Manuscripts 1 and 2 apply a unique spatial inequality approach to existing population-based household data from the Demographic and Health Surveys (DHS) to identify a sample of slum residents. Manuscript 1 assesses trends in maternal and child health care (MCH) utilization and health outcomes using DHS data in Bangladesh, Ethiopia, Kenya, Malawi, Nepal, Nigeria and Tanzania between 2003 and 2011. In Manuscript 2, a trend analysis is performed in Kenya to examine diarrheal disease and acute respiratory infection (ARI) in children under-five in both slums and other urban and rural areas during the roll-out of a national slum upgrading program. Manuscript 3 further explores local-level dimensions of health care access from two slums in Kenya, generating evidence on service availability and readiness in slums. In this section, we analyze health facility data collected using a modified version of the World Health Organization&rsquo;s (WHO) Service Availability and Readiness Assessment (SARA). </p><p> <b>Results:</b> Manuscript 1 reports significant disparities between slum dwellers and other urban residents&rsquo; utilization of key maternal health interventions&mdash;appropriate antenatal care (ANC), tetanus toxoid vaccination, and skilled delivery&mdash;in Bangladesh, Ethiopia, Kenya and Nigeria. In addition, child health outcomes examined in Manuscript 1 suggest that the prevalence of diarrheal disease in children under-five is declining among other urban and rural residents, but not significantly among slum residents. Nigeria was the only exception, with significant declines in diarrheal disease prevalence in slums over the study period. Because ARI improvements are found across populations, the data suggests this condition is not unique to slum settings. The trend analysis in Manuscript 2 supports these findings&mdash;ARI is declining steadily over time not only among slum residents, but also among other urban and rural residents as well. Diarrheal disease prevalence, on the other hand, has not changed significantly over time, with stable levels among slum dwellers between 1993 and 2014. In Manuscript 3, analysis of general service availability and readiness in two locations&mdash;the Nyalenda slum of Kisumu and the Langas slum of Eldoret&mdash;reveals that slums perform far below recommended benchmarks set by WHO. When we compare service availability and readiness indicators with regional, urban, and national averages, in general slums in Kisumu and Eldoret perform poorly. However, there were some instances&mdash;typically involving standard precautions for infection control&mdash;where Kenyan slums actually performed better than comparison sites. </p><p> <b>Conclusions:</b> This research provides a comprehensive view of health systems dimensions in urban slums in sub-Saharan Africa and South Asia. Manuscript 1 confirms evidence of an urban penalty and emphasizes a need to focus on maternal health care utilization in slums. Manuscript 2 detects little improvement in child health outcomes among slum dwellers in Kenya during the roll-out of the country&rsquo;s national slum upgrading program. An integrated approach to health and urban policy development is recommended based on these results. Manuscript 3 identifies areas of service availability and readiness in two Kenyan slums that fall below global targets and are in need of improvement in order to achieve desired health outcomes. Taken together, this study makes a significant contribution to the crucial demand for research on growing marginalized urban populations in developing countries.</p>

<p> Men in sub-Saharan Africa are less likely than women to use HIV services and, thus, are more likely to die from AIDS. While much of the literature argues that men&rsquo;s views of masculinity keep them from services, I use the theory of gendered organizations to provide another perspective. In this dissertation, I use a mixed methods approach to examine the gendered organization of facility-based HIV testing services in southern Malawi and how the organization of services creates additional barriers to men&rsquo;s use of care. </p><p> I combine four types of data: (1) survey data with facility clients to assess if quality of care differs by sex of client; (2) in-depth interviews with healthcare providers and policy makers to examine perceptions of men as clients; (3) participant observation in health facilities to understand how institutional protocols are enacted at the local level; and (4) international and national policy documents to situate local health institutions within broader global constructs of gender and HIV priorities. </p><p> I find that heterosexual men have become an invisible category within both international and national HIV policy. When they are included, they are described as the problem, not part of the solution to HIV epidemics. On the ground, the organization of HIV testing services has followed suit. </p><p> Health institutions, like other organizations, are not gender-neutral. Men in southern Malawi were not recruited for health services, were less likely than women to receive health education when they did attend a facility, and were less likely to have access to HIV testing because services were, at times, only offered during hours for antenatal services. Furthermore, HIV testing was often located near antenatal services, again contributing to the perception that testing was designed for women &ndash; because it was. Based on these findings, I argue that HIV testing is gendered across three levels of the health institution: (1) the organizational HIV policies; (2) the physical environment in which testing occurs; and (3) interactions within facilities that require clients to enact qualities typically viewed as feminine in order to successfully receive care (e.g., waiting long hours, being compliant, and being a caregiver).</p>