No description available.

The purpose of this study is to examine the relationship between trade liberalization, measured using the Heritage Foundation’s Trade Freedom indicator, and human development, measured using the United Nations Development Program’s Human Development Index, in subSaharan Africa’s Least Developed Countries between 1990 and 2011 as data allows. In addition to exploring the relationship between these two variables, alternative factors that influence human development are examined in bivariate correlations with human development as well as used as control variables in a multiple regression analysis. Namely, this study includes government effectiveness, the percentage of the labor force employed in the agricultural sector, the percent of Gross Domestic Product made up of the sale of agricultural products, geography, and armed conflict as control variables. By conducting a cross-national bivariate correlation analysis as well as a cross-national multiple regression analysis for the years between 1990 and 2011, this study highlights how, when included in a model with control variables, trade liberalization goes from being a statistically significant predictor of human development index scores to losing its significance altogether. The results from this study indicate that trade liberalization, government effectiveness, and geography, more specifically being landlocked or not, do not have statistically significant effects on human development for LDCs in the region. However, this study finds that for every unit increase in the percentage of the labor force working in agriculture as well as the percentage of GDP made up by agricultural products, a lower human development score can be expected. Armed conflict also has a statistically significant, negative effect on human development.

This report seeks to describe the status of kidney disease and renal replacement therapy in lower-resource settings, particularly sub-Saharan Africa. Acute kidney injury and transplantation are included on a limited basis because it is impossible consider the renal replacement therapy landscape at the exclusion of either. As in the rest of the developing world, chronic kidney disease and end-stage renal disease place a sizable and rapidly growing burden on sub-Saharan Africa, and Africans face a double-burden of disease from communicable and non-communicable diseases. Meanwhile, renal replacement therapy and the subspecialty of nephrology are expanding in sub-Saharan Africa, from non-existence in many countries to a limited, tentative subsistence, largely with the support of international organizations and the dedication of local nephrologists. Hemodialysis is the most common form of renal replacement therapy in sub-Saharan Africa, but peritoneal dialysis services, particularly for acute kidney injury, are growing and renal transplants are performed in a few sub-Saharan countries. Nonetheless, in the majority of sub-Saharan Africa, maintenance dialysis is still only available to the wealthy urban few. Although peritoneal dialysis may seem more feasible in the developing world than hemodialysis for multiple reasons, it is still fraught with challenges that make widespread implementation presently unadvisable. As renal replacement therapy is costly and currently unaffordable on a large scale for most of these countries, emphasis must be on identifying at-risk populations through screening and low-cost treatment or management of risk factors to mitigate chronic kidney disease.

Climate change is today an urgent threat, posing grave danger and requiring immediate attention. In order to adapt to the changes, policies, plans, and programmes have been created all over the world, such as the National Adaptation Plans (NAPs). Several authors and organisations have advocated for the importance of integrating a gender perspective into such climate change documents (Skinner, 2011; Bee, Biermann, and Tschakert, 2013; Lau et al., 2021). Nevertheless, at the time of writing, research is missing on NAPs in regard to gender. Therefore, the purpose of this thesis is to fill this gap through an analysis of the NAPs with a focus on gender. The sample is 12 countries, all from Sub-Saharan Africa because of the area’s high relevance regarding climate change. The objective of the thesis is to analyse the content of the selected NAPs regarding the integration of gender considerations. Using the theoretical framework of Gender and Development (GAD), the thesis aims to offer a comprehensive understanding of how the chosen NAPs address gender-related concerns. The methodology is a qualitative abductive desk study through qualitative content analysis. The findings suggest that gender considerations are not very well integrated into the NAPs and that women are primarily framed as vulnerable and very rarely as having key capacities or being agents of change. Additionally, from the perspective of GAD, several shortcomings are identified.

No description available.

The global migration crisis has brought to light many issues related to integrating migrants intotheir host countries. Employment is a critical component of integration, as it provides individualswith financial stability, a sense of purpose, and a means of contributing to their new society.However, employment outcomes for migrants vary widely depending on factors such as theircountry of origin, education level, language skills, and discrimination. In Sweden, MiddleEastern and Sub-Saharan African migrants face significant barriers to employment, which canlimit their ability to integrate into Swedish society. This thesis focused on and explored theemployment outcomes for Middle Eastern and Sub-Saharan African migrants in Malmo, Sweden.In a qualitative design and purposive sampling, 20 participants from Middle Eastern and Sub-Saharan African living in Malmo were interviewed using semi-structured interviews in threeweeks. The findings revealed that the means of finding employment, discrimination, skillsrecognition, and social networks as key factors influencing employment among immigrants inMalmo, Sweden. A short overview of the challenges and policies implemented to improve theiremployment prospects was presented.

The first chapter examines donors’ motives for allocating foreign health aid. Do donor countries allocate foreign aid according to their economic interests or the needs of recipient countries?”. This paper analyzes the relevance of the donor country’s government ideology – namely, where it fits on the political spectrum – on how much its aid agencies can be influenced by industrial interest groups. Specifically, I follow Suzuki (2020) and consider to what extent countries with large pharmaceutical sectors structure aid so that recipient countries buy more pharmaceuticals. However, I allow results to differ not only on how autonomous aid agencies are in the donor countries but on whether the ruling government is left or right/center. Using a fractional logit model, the result shows that neither government ideology nor the structure of aid agencies is sufficient on its own in determining health aid allocation (either for economic interest or for the needs of the recipient countries). The allocation of foreign aid is dependent on the combination of government ideology and the structure of the aid agency. Also, regardless of the structure of the aid agency, a government with a right/center political ideology allocates more aid to basic needs than a left party. In the second Chapter, the paper considers to what extent infant mortality lessens for those near a facility financed by development aid. Using geocodes, the study matches household-level data taken from the Bangladesh Demographic and Health Surveys to the location of these aid-backed facilities. Therefore, this paper investigates if proximity to an aid-financed facility enhances the chances of infant survival at the sub-national level. Using a difference-in-difference strategy, the results indicate that geographical proximity to active aid projects reduces infant mortality. In addition, there is evidence of biases in the allocation of aid as the study shows that aid projects are established in areas that on average have lower infant mortality than non-aid locations. The result concludes that while aid is effective in reducing infant mortality in areas where development aid projects are established, there are biases in the allocation as aid is not reaching those that need it the most. The third chapter examines to what extent foreign direct investments worsen environmental pollution. Many see Foreign Direct Investment (FDI) as a source of economic development, income growth, and employment in developing countries. However, FDI could also cause pollution, hurting the environment and harming health. According to past studies, there appears to be no consensus on whether FDI has a positive or negative effect on the host’s environment in developing countries. Using a panel of 48 Sub-Saharan African (SSA) countries, this study examines to what extent inflows of FDI lead to greater pollution using carbon dioxide as a measure of pollution. To the best of my knowledge, this is the first attempt to study this issue for a group of sub-Saharan African countries from 1990 to 2018. The results from fixed effects models show that FDI has no effect on pollution in Sub-Saharan African Countries. These results do not support the Pollution Haven Hypothesis, suggesting that polluting industries leave countries where environmental regulations are strict to re-establish themselves in countries with lax environmental oversight. Given that many African countries are deemed to have ineffective governance (and so presumably less able to enforce environmental standards), the lack of a positive association is especially striking. However, the results show a significant positive relationship between FDI and pollution in more democratic countries while FDI pollutes less in countries that are less democratic.

Background: Maternal and child health initiatives are embracing the use of electronic or mobile technology, a branch of digital health popularly referred to as eHealth or mHealth. While digital health can offer extensive benefits, it has raised various challenges. For instance, digital health programs are not often designed with a focus on equity in distribution nor are they designed from a gender equity standpoint. Although digital health interventions for maternal healthcare focuses predominantly on women as beneficiaries, few studies explore gendered power relations and how they impact the success of maternal and child health projects in African contexts such as Nigeria. This gap in literature risks excluding women from engaging in the digital space and can worsen the negative and unintended consequences of participating in digital health. This thesis examines the impact and implications of digital health interventions for maternal health in sub-Saharan Africa. -- Method: Two secondary and three primary studies described the various implications of digital health in sub-Saharan Africa more broadly and in rural Edo State, Nigeria, specifically. The secondary studies involved a review and a systematic review of the literature, the primary studies involved focus group discussions and in-depth interviews with pregnant or postpartum women who were beneficiaries of a digital health program and their community members. -- Results: The first paper illustrated exclusionary practices of digital health programs in sub-Saharan Africa, the second paper showed how digital health programs can challenge and redress harmful and unequal gender norms, roles, and power relations that privilege men over women. Observations from the third paper indicate that while mHealth programs are helpful to women in many ways, they are not enough on their own to undo entrenched systems of power through which men control women's reproductive lives. The fourth paper affirms that a community-centered approach to implementing digital health programs enhances women's acceptance and sustained use of digital health. The fifth paper shows how women navigate patriarchal environments through negotiation, collaboration and maneuvering to yield the best possible maternal health outcomes. -- Conclusion: At the core of all the studies was the need to understand and redress overarching factors contributing to ill health and exacerbating health inequities in maternal health through gender transformative approaches. Potentially unintended consequences, side effects, and negative effects of digital health impedes its many benefits, therefore, to achieve meaningful impact, gender and digital inclusion must remain a priority in the development, implementation, and evaluation of digital health. This thesis illuminated the needs of those with the greatest barriers to health technologies for maternal health thereby contributing to the discussion on digital health social justice with overarching themes on how to achieve equitable opportunities for all women and girls to access, use and benefit from digital health for maternal health.

Background: Performance-based financing (PBF) is a healthcare reform that is widely adopted in low- and middle-income countries (LMICs). PBF is an intervention designed to strengthen healthcare systems in LMICs. It represents a fundamental shift towards improving healthcare amongst the most vulnerable, with a focus on maternal and child health services. Broadly, there are gaps regarding PBF’s effect on healthcare systems and various aspect of healthcare, including efforts to implement universal healthcare coverage. PBF introduced an innovative component—the PBF equity instrument—geared towards achieving universal health coverage. The effect of this equity instrument has not been studied. There is significant gap regarding how it is defined and implemented in various context. Cameroon has one of the highest maternal mortality rates in sub–Saharan Africa and with high out-of-pocket expenses that impede access to maternal health services. PBF was introduced in Cameroon in 2012 with a focus on maternal health services and was adopted in 2017 as a national strategy towards achieving universal coverage, however, the definition and implementation of the PBF equity elements remain a gap in Cameroon and sub-Saharan Africa. This dissertation is focused on studying the PBF equity elements in Cameroon in order to get a broader perspective on the effect of the PBF equity elements as a policy tool in improving the lives of the most vulnerable population to ensure no one is left behind in the efforts towards achieving universal health coverage. Objectives: This dissertation aimed (1) to investigate and characterize the effect of the PBF equity elements in improving equity in access to selected maternal services (2) to understand how the equity elements is defined and implemented in Cameroon; and (3) to generate a framework that will facilitate the identification of gaps and challenges, in turn informing policy development that is relevant to PBF equity elements in Cameroon and PBF research on equity in other countries; and (4) to explore health providers experiences before and after the introduction of PBF in Cameroon. Methods: This dissertation employed a mixed methods approach to address the above objectives, involving the use of multiple frameworks and triangulation across and within objectives. First, to investigate the effect of PBF on equity in improving access to maternal services, I designed a systematic review with a focus on one of the equity elements—subsidizing user fees to reduce out-of-pocket expenses to improve access to maternal health services. The aim was to get a broader overview of the PBF equity element and to understand the effect of PBF on out-of-pocket expenses in improving access to selected maternal health services in sub–Saharan Africa. Second, I narrowed the assessment to a specific context-Cameroon. Given the heterogenous nature of care delivery in Cameroon, I investigated the effect of PBF on out-of-pocket expenses in improving access to selected maternal health services across healthcare sectors using a before-and-after study design. The rationale was to address the limitations of an earlier PBF impact evaluation in Cameroon, in particular, potential heterogeneity across settings and sectors which had not been considered. Third, to describe and define the implementation of the PBF equity elements in Cameroon, I conducted a grounded theory study -given that it is a new policy that has not been well studied -to understand the social processes and actions from health facilities, health providers, PBF managers and the community, and generated a theoretical framework to inform the challenges and gaps in the implementation process. Finally, as a newly adopted health reform, I conducted an in-depth qualitative study to understand the experiences of health care provides before -and-after the implementation of PBF and its equity elements and the potential for sustainability of the policy especially the equity strategies in Cameroon. Findings: The findings provide an overarching understanding on the effect of one of the PBF equity elements in improving access to maternal health services in sub–Saharan Africa, and in particular, an understanding of the effect of the PBF equity elements in improving access and utilization of selected maternal services in Cameroon. At the health system level, the findings provide an understanding of the focus of the equity elements within the context of Cameroon and further insight on the gaps and limitations in the implementation of the PBF equity elements and the potential challenges in sustainability towards achieving universal health coverage. At the health facility level, it provides an understanding on how the PBF equity elements is understood, defined, and implemented and provides directions on the challenges to inform policy and to guide research. At the individual level, it provides an overview of the expectations of health care providers from a supply side perspective and the potential effect it has on demand creation from women and households in improving access to maternal health services. Overall, the findings provide insight on how the equity elements are defined and implemented but also provides opportunity and areas of improvement and detailed how PBF equity elements can be further assessed and how delays in payment of PBF incentives can potentially affect the realization of the equity elements in improving access and utilization of maternal health services amongst the poor and vulnerable. Conclusion: Equity is central and essential to the delivery of services to achieve universal health coverage. The adoption of PBF in Cameroon is a step toward achieving universal health coverage with the recognition that universal health coverage cannot be effectively implemented in an institution without good governance. The PBF initiative is viewed as an entry point for universal health coverage, in order to evaluate the level of preparedness of health facilities to embrace universal health coverage in terms of quality of health care, production, good managerial skills, and financial management. However, due to administrative bottlenecks, the government has yet to accept some of the established principles of PBF—this in turn causes delays in payment and this hampers the effective implementation of some of the PBF equity strategies. Therefore, though PBF is a national policy, the actors at the central level, i.e., the Ministry of Public Health, are not playing their role effectively in enabling full implementation of PBF best practices and theories.

No description available.