In recent years, much focus has been put on the sustainability of water and sanitation development projects. Experts in this field have found that many of the projects of the past have failed to achieve sustainability because of a lack of demand for water and sanitation interventions at a grassroots level. For years projects looked to create this demand through various subsidy schemes, with the "software" of behavior change and education taking a backseat to the "hardware" of infrastructure provision. Community-Led Total Sanitation (CLTS) is a fairly new way of looking at the issues of increasing basic sanitation coverage, promoting good hygiene practices, and facilitating the change in behaviors that is necessary for a level of basic sanitation coverage to be sustained for any significant length of time. CLTS looks to get people to come to the realization that open defecation is dangerous, and that they have to power to stop this practice. The purpose of this research study was to assess the water, sanitation, and hygiene situation on the ground in villages that through CLTS have achieved open defecation free (ODF) status in the Mopti region of Mali, West Africa. This assessment was done through a willingness-to-pay study, that showed how important sanitation infrastructure was in the daily lives of villagers in this region of Mali. This research study also examines any possible correlations between certain socioeconomic data and willingness-to-pay. A questionnaire was developed and completed with 95 household heads spread across 6 of the 21 ODF villages in the region. The results of this research study show that the behavior change brought about by CLTS was sustained. Every household in the study had at least one latrine (total latrines = 186), or had access to a neighbor's latrine because theirs had recently collapsed. Of these latrines 82.3% were reported as meeting the Malian nation government requirements of basic sanitation. 89.3% of the observed latrines were built by the participant families themselves using predominately materials that could be found in or harvested from the local environment (e.g., mud, rocks, sticks). Fifty-three percent of the latrines were built completely free of cost, and of the 88 latrines that were paid for in part or in whole the average cost was about US $13.00. The majority of the participants (64.2%) in the research study reported making improvements and maintaining their latrines, clearly showing the importance of sanitation infrastructure in the 6 study villages. The average cost of this maintenance was about US $1.50. Alongside of willingness-to-pay data, more qualitative data were collected on the relative importance of sanitation infrastructure in the daily lives of people in ODF villages in Mopti. This study found that on average throughout the 6 study villages, about 13% of discretionary funds are saved for or spent on maintenance and improvements to sanitation infrastructure on a monthly basis. When sanitation infrastructure investments were compared with other infrastructure and livelihood investments, on the average it was ranked 7th out of the possible 10. These data seem to indicate that future investment in sanitation infrastructure was not a high priority for the participants. This could be stem from the fact that many of the participants had not directly experienced the need for continued investments, because their original latrines were still functional. The willingness-to-pay regression analysis produced very few statistically valid results. Only a few of the correlations found between willingness-to-pay data and socioeconomic characteristics of the sample were found to be statistically valid. For example, the correlation coefficient between willingness-to-pay for pit maintenance, including emptying when full or covering the pit with top soil, digging a new one, and reconstruction, and education level of the participants was about 1.2 and was statistically valid with a t-statistic of about 2.2. Indicating that the more educated a participant was, the more they would be willing to pay for pit maintenance. None of the overall regressions explained enough of the variability in willingness-to-pay data to be considered statistically valid. Regressions for two scenarios, constructing a cement slab as an improvement to an existing latrine and sealing/lining the pit on an existing latrine with cement, explained 10.3% and 10.4% of the variability in willingness-to-pay data respectively. However, this did not meet the minimum criteria of 15%. While the willingness-to-pay data would have been useful to study partners that are piloting a Sanitation Marketing program in Mali, the main research objective of assessing the CLTS intervention was still met.

This case study investigates gender-sensitive institutional reforms in post-war Liberia. It applies key concepts developed by the Research Network on Gender Politics and the State to explore the extent to which the emergent theory of state feminism might be applicable to countries outside of the West. Preliminary findings suggest that Liberia is a feminist state insofar as both the women’s machinery and the Sirleaf Administration are allied with feminist and women’s movement actors outside the state, and that they grant these actors access to policymaking fora. Policy content also appears to reflect many of the goals identified by women’s movement actors. However, given the lack of state capacity and the degree of state penetration by international organizations, it is difficult to determine the drivers of ostensibly state-led gender equity initiatives in the country. Because multi-level governance is the norm in areas where the capacity of the state is severely circumscribed, this research introduces the concept of “supra-state feminism” to demonstrate the major limitation of state feminist theory in Liberia. This notion of feminist policy transfer in areas of limited statehood adds to the comparative literature on engendering political transitions in sub-Saharan Africa.

No description available.

<p>The understanding and practice of leadership in Sub-Saharan Africa, in all spheres, is at the heart beat of this work. Questions and concerns over the quality of leadership in most countries in this particular region are reasons which have led to revisit and investigate the formative training of the current cohort of African leadership with a special focus on the ethical aspect of leadership. It is an assumption, in this thesis, that the contemporary cohort of African leadership received their formative training especially in the 1960s and 1970s and that they were deeply influenced by the black consciousness movement and, in association with that, by the emergence of black theology. In this respect, this research project explores the notions of ethics and leadership with a view to determine ways in which an appropriate leadership ethos was portrayed and articulated in the writings of selected exponents of the black theology movement, namely ML King (Jr), Desmond Tutu and Allan Boesak. The purpose of this work is therefore mainly descriptive: to map discourse on a leadership ethos in the context especially of black theology.</p>

Le Bénin et le Togo sont deux pays partageant plusieurs similitudes : ils ont tous les deux été colonisés par la France; leur niveau de développement économique est équivalent; leur histoire postcoloniale est marquée par les coups d’états et, à la fin des années 1980, par des vagues de revendications démocratiques. Celles-ci se sont soldées dans chaque cas par une conférence nationale et l’organisation d’élections générales. Malgré cette trajectoire similaire, seul le Bénin est devenu une démocratie consolidée. Pour expliquer cette différence, ce mémoire se penche sur l’influence des stratégies de l’opposition et sur les processus de transition. Ce mémoire démontre que le degré de cohésion des groupes d’opposition et les accords de ces derniers avec les gouvernements en place ont eu une profonde influence sur le succès ou l’échec des transitions démocratiques. / Benin and Togo have much in common: both countries are former French colonies; throughout the 20th century, both have achieved a comparable level of economic development; both are characterized by a postcolonial history marked by coups d’états and waves of protestations in favour of democracy in the 1980s. Moreover, in both cases, these waves of protestations resulted in National Conferences and multiparty elections in the early 1990s. Yet, in spite of these similarities, only Benin has succeeded in establishing a democratic state. This thesis attempts to determine why this is the cases. By examining the influence of the opposition parties’ strategies in the overall transition process of Benin and Togo, one concludes that the degree of unity among opposition groups and the various compromises made with the government exerts a critical influence on the success or failure of democratic transitions.

The purpose of this study is to examine how the health care system in Babati meets the increasing need for control, treatment and prevention of diabetes and hypertension. By defining what kind of specific problems and obstacles that exists in this area, the result of the research can contribute to creation and adoption of improved policies and interventions. Field studies were conducted in Babati, Tanzania for three weeks in February and March 2014. This is a qualitative study with data collected through semi-structured interviews with informants from different levels of the health system, based on the pyramidal structure of Tanzania's health care system. The theoretical framework for the study is based on aspects that corresponding to critical functions of health systems. The type of problem being treated affects the adoption and diffusion of new health interventions and the extent to which they are integrated into critical health systems functions. The study shows that diabetes and hypertension is an increasing problem in Babati. In relation to the burden, resources are lacking at all investigated levels. Therefore it is difficult to meet the increasing needs for diabetes and hypertension. To meet the future challenges, a number of cost effective strategies with focus to improve the prevention, control and reduce modifiable risk factors is suggested. / Syftet med studien är att undersöka hur hälso-och sjukvården i Babati möter det ökande behovet för kontroll, behandling och förebyggande åtgärder för diabetes och högt blodtryck. Genom att definiera vilka typer av specifika problem och hinder som finns, kan resultat från studien bidra till att skapandet och antagandet av förbättrade strategier och åtgärder. Fältstudier genomföres i Babati, Tanzania under tre veckor i februari och mars 2014. Detta är en kvalitativ studie med data insamlat genom semistrukturerade intervjuer med informanter från olika nivåer inom sjukvårdsystemet baserat på den pyramidala struktur Tanzanias sjukvårdssystem bygger på. Det teoretiska ramverket för studien baseras på aspekter som motsvarar kritiska funktioner för sjukvårdssystem. Antagandet och spridning av nya hälsointerventioner och i vilken mån de är integrerade i kritiska hälso- systemfunktioner påverkas av den typ av problem som behandlas. Studien visar att diabetes och högt blodtryck är ett ökande problem i Babati. I relation till hur sjukdomsbördan ser ut, saknas det resurser på samtliga undersökta nivåer. Därför är det svårt att möta de ökande behov som finns för att hantera diabetes och högt blodtryck. För att möta de framtida utmaningarna i Babati har ett antal kostnadseffektiva strategier med fokus att förbättra förebyggande, kontroll och minska påverkbara riskfaktorer föreslagits.

Combating infectious diseases and poverty are hot topics on the world development agenda. The vicious cycle of ill health and poverty is reinforced by a “medical poverty trap” relating to households being impoverished due to escalating illness-related out-of-pocket costs, especially in combination with loss of income due to incapacity to work. Evidence-based knowledge on the impacts of ill health on household welfare is essential to design adequate interventions and evaluate their efficiency. This thesis presents the findings of a critical review of studies assessing the impacts of infectious diseases on households’ ability to utilize their resources and generate income in rural Sub-Saharan Africa. The review revealed a dearth of relevant studies (merely 15), poor methodological quality in short-term geographically limited surveys, and large diversity in study design obstructing comparison of results and extraction of general conclusions. Major research obstacles are discussed and recommendations for coordination, standardization and scaling up of data collection that allows adequate impact assessment are suggested. Experimental intervention studies are recommended to improve quality and efficiency of interventions and guide prioritizing processes prior to large scale implementations to avoid waste of time and resources. The linkages between infectious diseases and poverty are complex and multifaceted and thus imply multi- and interdisciplinary research approaches. Collaboration between various disciplines like health sciences, economics, geography and sociology give opportunities of linking data in innovative ways to provide new insights and perspectives that have the potential to analyse the impacts of infectious diseases on poverty in a more comprehensive manner. Methodological standardisation and consensus will enable us to accumulate comparable results and scale up research and thereby contribute to foundation of efficient interventions to accomplish sustainable improvements in health and significant reductions in poverty. / Kampen mot infeksjonssykdommer og fattigdom er høyt prioritert på den globale agenda. Dårlig helse og fattigdom utgjør en ond sirkel som forsterkes av en ”medisinsk fattigdomsfelle” grunnet økende sykdomsrelaterte utgifter kombinert med tap av inntekt fordi sykdom hindrer en i å arbeide. Evidensbasert kunnskap om sykdommenes konsekvenser for husholdenes velferd er påkrevet for å utarbeide adekvate intervensjoner og evaluere deres effektivitet. Denne masteroppgaven presenterer resultatene av en kritisk gjennomgang av publiserte studier som analyserer effekter av infeksjonssykdommer på rurale husholds evne til å nyttiggjøre seg av sine ressurser og generere inntekt i afrikanske land sør for Sahara. Litteraturgjennomgangen avdekket få relevante studier (bare 15), svak metodologisk kvalitet i geografisk begrensede studier og stor diversitet i studiedesign. Diversiteten gjorde det nesten umulig å sammenlige resultater og sammenfatte generelle konklusjoner. De viktigste forskningsmessige hindringene diskuteres og det foreslås anbefalinger for koordinering, standardisering og oppskalering av datainnsamling som muliggjør adekvat konsekvensanalyse. Eksperimentelle intervensjonsstudier anbefales både som ledd i prioriteringsprosesser, for å bedre intervensjoners kvalitet og effektivitet og for å unngå sløsing med tid og ressurser før stor-skala implementeringer. Sammenhengen mellom infeksjonssykdommer og fattigdom er kompleks og mangesidig og innbyr dermed til flerfaglige og tverrfaglige tilnærminger. Samarbeid mellom ulike fagområder som medisin, økonomi, sosiologi og geografi åpner for muligheter til å kombinere data på innovative måter for å frembringe nye perspektiver og innsikter med potensiale til å analysere infeksjonssykdommers effekt på hushold mer omfattende og helhetlig. Metodologisk standardisering og konsensus åpner for oppskalering av forskningen og for akkumulering av sammenlignbare resultater. Slik kan investeringer i forskning bidra til å få kontroll med infeksjonssykdommer og legge forholdene bedre tilrette for økonomisk vekst i utviklingsland / <p>ISBN 978-91-85721-07-8</p>

<p>The dissertation examines three military interventions in Sub-Saharan Africa which took place in the mid and late 1990s in Rwanda, the DRC and Lesotho. These interventions took place despite high expectations of international and regional peace on the part of most analysts after the collapse of cold war in 1989. However, interstate and intrastate conflicts re-emerged with more intensity than ever before, and sub-Saharan Africa proved to be no exception.</p> <p><br /> The study sets out to analyse the motives and/or causes of military interventions in Rwanda in 1990, the DRC in 1996-7, and the DRC military rebellion and the Lesotho intervention in 1998. In analysing these interventions, the study borrows extensively from the work of dominant security theorists of international relations, predominantly realists who conceptualise international relations as a struggle for power and survival in the anarchic world. The purpose of this analysis is fourfold / firstly, to determine the reasons for military interventions and the extent to which these interventions were conducted on humanitarian grounds / secondly, to investigate the degree to which or not intervening countries were spurred by their national interests / thirdly, to assess the roles of international organisations like Southern African Development Community (SADC), the Organisation of African Unity (OAU) and the United Nations, in facilitating these interventions / as well as to evaluate the role of parliaments of intervening countries in authorising or not these military interventions in terms of holding their Executives accountable. In this context, the analysis argues that the intervening countries / Angola, Botswana, Burundi, Chad, Namibia, Rwanda, Sudan, South Africa, Uganda and Zimbabwe appeared to have used intervention as a realist foreign policy tool in the absence of authorisation from the United Nations and its subordinate bodies such as the OAU and SADC.</p>

Background Studies on course and outcome of schizophrenia coming from low income countries are increasingly becoming important to challenge the existing dogma claiming good outcome in these countries. Besides clinical course and outcome, mortality is considered a very important outcome measure for schizophrenia. Culture and tradition play a significant role in the manifestations of severe mental illnesses (SMI). Khat is a culturally accepted plant endemic to Eastern Africa, which is chewed by people for its stimulating effect. It is believed that Khat influences the course and outcome of schizophrenia although systematic studies are scarce. Patients with SMI continue to chew khat despite advice from their doctors to desist. Reasons for this behavior were not fully investigated before. Objectives              -     To describe the 5-year clinical course and outcome and mortality of schizophrenia in Butajira. -       To explore traditional views on psychosis in the semi-nomadic Borana population. -       To describe the perceived causes and preferred treatment for SMI in the semi-nomadic Borana population -       To explore reasons for khat chewing behavior in people with SMI in Butajira. Methods The studies were done in two sites: Butajira and Borana. The Butajira study involved screening, using CIDI and Key Informants (KIs), of more than 68,000 adults aged 15-49. Of these, 321 people were diagnosed with schizophrenia and were followed-up for five years to look into their clinical course and outcome, including mortality. A qualitative study involving 37 men with SMI and 30 female caregivers was conducted in Butajira to study reasons why patients continue to chew khat despite their physicians’ advice against it. The Borana study of a remote semi-nomadic population in southern Ethiopia, used qualitative methods involving 56 KIs to identify descriptions of psychosis, perceived causes and preferred treatment in the community. Cases identified by the KIs also underwent SCAN interview for confirmatory diagnosis.   Results The five year follow-up of schizophrenia patients showed that 45% of participants were continuously symptomatic with 30.3% having had continuous psychotic episode. About 20% had experienced continuous remission. Being single (OR = 3.41, 95% CI = 1.08-10.82, P = 0.037), on antipsychotic treatment for at least 50% of follow up time (OR = 2.28, 95% CI = 1.12-4.62, P = 0.023), and having a diagnosis of paranoid subtype of schizophrenia (OR = 3.68, 95% CI = 1.30-10.44, P = 0.014) were associated with longer period of remission. A total of 38 (12.4%) patients, thirty four men (11.1%) and four women (1.3%) died during the 5-year follow-up period. The mean age (SD) of the deceased for both sexes was 35 (7.35): 35.3 (7.4) for men and 32.3 (6.8) for women. The most common cause of death was infection, 18/38 (47.4%) followed by severe malnutrition, 5/38 (13.2%) and suicide 4/38 (10.5%). The overall SMR was 5.98 (95% CI = 4.09 to 7.87): 6.27 (95% C I = 4.16 to 8.38) for men and 4.30 (95% CI = 1.02 to 8.52) for women. Patients residing in rural areas had lower mortality with adjusted HR of 0.30 (95% CI = 0.12-0.69) but those with insidious onset had higher mortality with adjusted HR 2.37 (95% CI = 1.04-5.41). Treatment with antipsychotics for less than 50% of the follow-up time was also associated with higher mortality, adjusted HR 2.66 (1.054-6.72). In the Borana study, the incongruity between local and psychiatric concepts in the CIDI lay mainly in the fact that KIs described characteristics of marata (madness) in terms of overt behavioral symptoms instead of thought disturbances. Following the focus group discussions, participants identified 8 individuals with schizophrenia and 13 with a psychotic mood disorder, confirmed by SCAN interview. Supernatural causes such as possession by evil spirits, curse, bewitchment, ‘exposure to wind’ and subsequent attack by evil spirits in postnatal women; bio-psycho-social causes such as infections (malaria), loss, ‘thinking too much’, and alcohol and khat abuse were mentioned as causes of SMI. The preferred treatments for severe mental illness included mainly traditional approaches, such as consulting Borana wise men or traditional healers, prayer, holy water treatment and, finally, seeking modern health care. Regarding khat and SMI in Butajira, reasons given by patients as well as caregivers were more or less congruent: social pressure, a means for survival by improving function, combating medication side effects, to experience pleasure and curbing appetite.  Conclusion Schizophrenia runs a chronic and non-remitting course and was associated with very high premature mortality in Butajira. Continued treatment with antipsychotics has been a consistent predictor of favorable outcome and reduced mortality. Case identification in studies of psychotic disorders in traditional communities are likely to benefit from combining structured interviews with the key informant method. Planning mental health care in traditional communities needs to involve influential people and traditional healers to increase acceptability of modern mental health care. Patients with SMI chewed khat for some important reasons that clinicians need to consider in their management.

Thesis (Dr.P.H.)--University of Texas Health Science Center at Houston, School of Public Health, 2006. / Includes bibliographical references (leaves 114-126).