In this study a field study on the implementation of the United Nations Convention on Combating Desertification (UNCCD) in Tigray, Ethiopia has been carried out. The objective of this thesis is to study in general the implementa-tion of the UNCCD in Ethiopia. This thesis consequently focuses on how these issues are executed in practice at different levels, thus national, regional, district and community levels. However the focus is on some of the highly prioritised action programs that are presumed to facilitate the implementation of the UNCCD, which are the Action Programs for promoting awareness and participation, Action programs to improve institutional organisation and ca-pacity as well as Action program for empowerment of women. These action programs are studied in how they are presented at the National Action Plan (NAP) and Regional Action Plan (RAP) as well as how they are executed at different levels, i.e. at the Federal, Regional, district and Community levels. For this purpose the region of Tigray is chosen. The result of this study shows that the vast majority of the respondents in the study areas indicated an awareness of desertification in regard to land degradation. The implementation of NAP at this stage, hasn’t reach all the regions around the country however, three regions in Ethiopia, thus the Afar, Tigray and Amhara regions have been chosen as pilot projects in attempt to implement the NAP at regional level and preparation are made to implement the con-vention at different community levels. Officially these regions have been chosen to launch pilot projects since they are situated in the dryland areas and they match the definition of the UNCCD for severely affected areas. At the re-gional level several pilot projects mainly conservation activities that involved the community members are launched in different parts of Tigray. Many opportunities to increase awareness of the land degradation and empower people are created in order to combat desertification, however the success of these activities varies from district to district and community to community and is dependent on the authorities’ intention, ambition, determination and interest as well as the relation they posses with the community members in the society.

Introduction: Ensuring access to universal primary health care is essential to secure a safe and pleasant motherhood and to provide compassionate care for mothers and newborns.However, inequalities in the access to maternal health services still remain a prominent problem in many countries. As part of reducing inequalities, Ethiopia launched the Health Extension Program (HEP) in 2003. The HEP is a community based program designed with a defined package of essential promotive, preventive and basic curative services targeting households, particularly mothers and children. Despite the construction of over 600 health posts and deploying more than 1200 Health Extension Workers (HEWs), preliminary data suggests a low utilization of maternal health care services. This thesis explores the HEP contribution in improving women’s access to maternal health care, and the reasons for the low use of maternal health care services from the perspectives of the involved actors in the Tigray region in Ethiopia. The five dimensions of access were used as a framework to explore the access to maternal health care utilization in this setting. Methods: A total of four districts were included in the study. Both quantitative and qualitative methods were applied. In the first sub-study, we assessed the HEP and its association with change in the utilization of antenatal, delivery and postnatal care services. Retrospective longitudinal data for 10 years was extracted from three selected districts and checked for accuracy. Segmented linear regression technique was used to control the secular trends adjusted for correlation of the data. For the second sub-study, we conducted a cross sectional survey with 1115 women (aged 15-49 years who had given birth within five years prior to the survey period) to determine the prevalence of antenatal care and institutional delivery utilization and explore their determinant factors of low utilization. For the third sub-study, we conducted six focus group discussions (FGDs) with a total of 51 women to explore women’s experiences of childbirth and maternal care. An interview with eight HEWs and four midwives were carried out to capture health workers’ perspective on access to maternal health care services in the fourth sub-study. Grounded theory for the former, and thematic analysis for the latter were used for the analysis. Main findings: The finding of the first sub-study showed a statistically significant upward trend for delivery care (DC) and postnatal care (PNC) in all facilities during the HEP late implementation period (July 2008-June 2012). In addition, a substantial trend of antenatal care (ANC) service use was observed at health centres after the intervention. In the second sub-study, the determinant predictors for ANC utilization were: proximity to health facilities, to be married, ≥5 years of education and having non-farming husbands. The last three factors were also significantly associated with institutional delivery, but also lower parity, previous history of obstructed/prolonged labour and ANC counselling. Findings from the qualitative studies pointed out that elderly women influenced women’s decision making about where to give birth. Women were mostly positive about giving birth at health facilities, but were concerned about the poor quality of care, inaccessibility and unavailability of transport. From the health workers’ perspective: specialized performance of hospital services, community assistance during referral and an increased awareness among women regarding the benefits of giving birth at a health facility were perceived as facilitators for institutional deliveries. Poor perceived competence of HEWs, poor conditions of health care facilities and inaccessibility of transportation, among others, were perceived as barriers for giving birth at health facilities. Conclusion: Overall, this research revealed a considerable contribution of the HEP in improving the access and coverage of maternal health services (ANC, DC and PNC). However, cultural traditions, scattered localities, mountainous roads without adequate transportation and low quality of care are still the major obstacles to accessing the services. Mechanisms need to be designed to enable health facility access of safe delivery for women in hard to reach areas, improving the proficiency of health workers and introducing a women centered approach that enhances acceptability of the services. / ሽፋን መሰረታዊ ክንክን ጥዕና ምዕባይ ድሕንነት ኣዴታትን ህፃናትን ንኽረጋገፅ ዝለዓለ ተራ ከምዘለዎ ይፍለጥ፡፡ ይኹንደኣምበር ግልጋሎት ጥዕና ኣዴታት ብማዕረ ኣብ ምብፃሕን ብምዕሩይ ኣገባብ ኣብ ምሃብን ብዙሓት ሃገራት እናተፀገማ እየን፡፡ ነዚ ዘይምዕሩይን ማዕረ ዘይኾነን ኣዋህባ ግልጋሎት ጥዕና ንምምሕያሽ ኣብ ሃገርና (ኢትዮጵያ) ብ1994-1995 (ብአቆፃፅራ ግእዝ) ዝተኣታተወ ፕሮግራም ምግፋሕ ጥሙር ጥዕና ቤተሰብ (Health Extension Program/HEP) 10 ዓመታት ኣሕሊፉ ይርከብ፡፡ ፕሮግራም ምግፋሕ ጥሙር ጥዕና (HEP)፣ ሕብረተሰብ መሰረት ዝገበረ-ምክልኻል ሕማማትን ምስጓም ጥዕናን - ምትእትታው ግልጋሎት ሕክምና ቀለልቲ ሕማማትን ብፍላይ ድማ ንኣዴታትን ህፃናትን ትኹረት ብምግባር ስድራ ቤት ብምሕቋፍ ዝንቀሳቐስ ፕሮግራም እዩ፡፡ እዚ ፕሮግራም ንምትግባር ኣብ ክልል ትግራይ ልዕሊ 600 ኬላታት ጥዕና ተሃኒፀን፡፡ ልዕሊ 1200 ሞያተኛታት ጥሙር ጥዕና እውን ሰልጢነን እየን፡፡ ክልተ ሞያተኛታት ኣብ ሓደ ኬላ ጥዕና ተመዲበን ካብ 5000-7000 በዝሒ ንዘለዎ ሕብረተሰብ ግልጋሎት እናሃባ ይርከባ፡፡ እንተኾነ ግን ዝተፈላለዩ መፅናዕታታት ከምዘመላኽትዎ ግልጋሎት ኣዴታት ጥዕና (ወሊድን ድሕሪ ወሊድን) ትሑት ሽፋን ከምዘለዎ ይሕበር፡፡ ዕላማ እዚ ዝገበርናዮ መፅናዕቲ እውን ኩነታት እቲ ግልጋሎት ብኣሃዝ ንምዕቃንን ከምኡ እውን ምኽንያታት እቲ ትሑት ግልጋሎት ንምድህሳስን እዩ፡፡ ኣብዚ መፅናዕቲ እዚ ምኽንያታት ትሑት ሽፋን ግልጋሎት ክንክን ጥንሲ ወሊድን ድሕረ ወሊድን እንታይ ምዃኑ ካብ ሕሉፍ ልምዲ (ተሞክሮ) ኣዴታትን ሰብ ሞያ ጥዕናን ብዝርዝር ብምድህሳስ - ፕሮግራም ምግፋሕ ጥሙር ጥዕና ንቐረብ ግልጋሎት ኣዴታት ጥዕና ንምምሕያሽ ዘለዎ ኣስተዋፅኦ እንታይ ከምዝመስል ተተንቲኑ ቐሪቡ ኣሎ፡፡ እቲ ቀረብ ግልጋሎት ጥዕና ሓሙሽተ መዐቀኒታት ብዘለዎ ፍሬም ዎርክ እዩ ተዳህሲሱ እቶም ሓሙሽተ መመዘኒታት 1. ቅርበት ትካል ጥዕናን ሰብ ሞያ ጥዕናን ንተገልገልቲ 2. ህልውነት ሰብ ሞያ ጥዕናን ናውትን ድሌት ተገልገልትን 3. ሰብ ሞያ ጥዕና ብተገልገልቲ ዘለዎም ተቐባልነት 4. ትካል ጥዕና ንድሌት ተገልገልቲ ንምዕጋብ ዘለዎ ድልውነት 5. ተገልገልቲ ወፃኢታት ሕክምና ንምሽፋን/ንምኽፋል ዘለዎም ድሌትን ዓቕምን እዮም፡፡ እዞም ሓሙሽተ መዐቀኒታት መሰረት ዝገበሩ ኣርባዕተ ዓይነታዊን አሃዛዊን ሜላታት ብምጥቃም ዝተኻየዱ መፅናዕትታት ኣብ ኣብ 4ተ ወረዳታት ትግራይ እዮም ተኻይዶም፡፡ ኣብቲ ቀዳማይ መፅናዕቲ ፕሮግራም ምግፋሕ ጥሙር ጥዕና ቤተሰብ (HEP) ኣብ ምምሕያሽ ክንክን ጥንሲ-ወሊድን-ድሕረ ወሊድን ግልጋሎት ዘምፅኦ ለውጢ ኣብ ሰለስተ ወረዳታት (ጋንታአፈሹም፤ ክልተ ኣውላዕሎ፣ ሕንጣሎ ዋጅራት) ንዝሓለፉ 10 ዓመታት ኣብ ዝተዋህበ ግልጋሎት ብምድራኽ እዩ ዳህሰሳ ተኻይዱ፡፡ ትኽክለኛነት እቲ ፀብፃብ እውን ካብ ትካላት ጥዕና ዝተልኣኸ ወርሓዊ ኣብ ወረዳ ምስ ዘሎ ፀብፃብ ብምንፅፃር ንኽረጋግፅ ተገይሩ እዩ፡፡ እቲ ካልኣይ መፅናዕቲ ኣብ ወረዳ ሰሓርቲ ሳምረ ካብ 19 ጣብያታት ካብ ዝተመረፃ 30 ቑሸታት ዕድሚአን ካብ 15-49 ዓመት ምስ ዝኾና 1115 ደቂኣንስትዮ ኣስታት 30 ደቓይቕ ዝወደአ ቃለ መሕትት ብምኽያድ እዩ ዳህሰሳ ተኻይዱ፡፡ ኣብ ወሊድ ግልጋሎት ዘሎ ልምድን ተሞክሮን ንምድህሳስ 51 ኣዴታት ዝተሳተፋሉ ሽዱሽተ ጉጅላዊ ምይይጥ በቲ ሳልሳይ መፅናዕቲ ምርምር ዝተፈፀመ እንትኾን ምስ ሸሞንተ ሞያተኛታት ጥሙር ጥዕናን ኣርባዕተ ነርስ መዋልዳንን ቃለ መሕትት ብምኽያድ እቲ 4ይ ምርምር/መፅናዕቲ ተፈፂሙ እዩ፡፡ ውፅኢት ቀዳማይ መፅናዕታዊ ፅሑፍ ኣብዚ ቐዳማይ መፅናዕቲ እቶም ዝተአከቡ መረዳእታት ኣብ ሰለስተ ደረጃታት - ቅድመ ፕሮግራም-ፕሮግራም-ድሕረ ፕሮግራም ብዝብል ዝተመቐሉ እዮም፡፡ እቲ ቐንዲ ዕላማ ፕሮግራም ምግፋሕ ጥሙር ጥዕና ድሕሪ ምጅማር ዝተራእየ ለውጢ ንምፍታሽ እዩ፡፡ ኣብ ድሕሪ እቲ ፕሮግራም ካብ 2001-2004 ዓ/ም ብዝተኻየዱ ንጥፈታት ጥዕና ግልጋሎት ወሊድን ድሕረ ወሊድን ኣብ ኩለን ትካላት ጥዕና ካብ ዓመት ናብ ዓመት ልዑል ኣዝማሚያ እናርኣየ ከምዝኸደ ብስታቲስቲካዊ መረዳእታ ንምርግጋፅ ተኻኢሉ እዩ፡፡ ብተመሳሳሊ ኣብዚ ወቕቲ እዚ ኣዝማሚያ ግልጋሎት ክንክን ጥንሲ ኣብ ጥዕና ጣቢያታት ጥራሕ እናለዓለ ከምዝኸደ ውፅኢት እቲ መፅናዕቲ የረድእ፡፡ እቲ መፅናዕቲ ከም ዘረድኦ ሽፋን ክንክን ጥንሲ ብ1995 ካብ ዝነበሮ 28.2% ብ2004 ናብ 46.7 ክምዝለዓለ፤ ግልጋሎት ወሊድ ብ1995 ካብ ዝነበሮ 5% ዝነበረ ናብ 23% ከምዝደየበ ድሕረ ወሊድ ግልጋሎት እውን 11% ዝነበረ ናብ 41% ከምዝለዓለ ንምርዳእ ተኻኢሉ ኣሎ፡፡ ውፅኢት ካልኣይ መፅናዕታዊ ፅሑፍ ኣዴታት ግልጋሎት ክንክን ጥንሲ ኣብ ጥዕና ጣቢያ ንኽጥቀማ ቅርበት ትካላት ጥዕና ንመንበሪ ገዛውቲ፣ ሓዳር ምግባር፣ ልዕሊ 5 ዓመት ስሩዕ ትምህርቲ ምምሃርን ካብ ሕርሻ ወፃኢ ኣብ ካልእ ስራሕቲ ዝተዋፈሩ ሰብ ሓዳር ምህላው ወሰንቲ ኣካላት ምዃኖም በቲ ዝተገብረ ካልኣይ መፅናዕቲ ተረጋጊፁ፡፡ ብተመሳሳሊ ኣብ እዋን ክንክን ጥንሲ ንኣዴታት ምኽሪ ግልጋሎት ምሃብ ቅድመ ታሪኽ ዝንጉዕ ሕርሲ ወይ ሃልኪ ምንባር እውን ኣብ ትካላት ጥዕና ወሊድ ግልጋሎት ንኽመሓየሽ ወሰንቲ ኩነታት ከምዝኾኑ በቲ መፅናዕቲ ተረጋጊፁ፡፡ ብሓፈሻ ፕሮግራም ምግፋሕ ጥሙር ጥዕና ቤተሰብ (HEP) ቀረብ ግልጋሎት ጥዕናን ሽፋን ክንክን ጥንሲ ወሊድን ድሕረ ወሊድ ግልጋሎትን ኣብ ምምሕያሽ ዝተፃወቶ ተራ ትርጉም ዘለዎ ምዃኑ በቲ ዝገበርናዮ መፅናዕቲ ንምርዳእ ተኻኢሉ ኣሎ፡፡ እንተኾነ ግን ባህላዊን ልማዳዊን ኩነታት (ኣብ ገዛ ክትወልድ ምድላይ- ነፍሰፁር ዓይኒሰብ ከይረኽባ ኢልካ ምእማን) - ተበቲኖም ዝሰፈሩ ነበርቲ ምህላው - ኣፀገምቲን ዓቐብ ቁልቁልን ጎቦታትን ዝበዝሖም መንገድታትን እኹል መጉዓዝያ ዘይምህላውን ቀንዲ ሃልኪታትን ዕንቅፋታትን እቲ ዝወሃብ ግልጋሎት ምዃኖም ኣብዚ መፅናዕቲ ተገሊፁ እዩ፡፡ ብተወሳኺ ኣብ ላዕለዎት ትካላት ጥዕና ዘይብሩህ ገፅን ሰሓባይ ኣቀራርባ ሰብ ሞያ ጥዕና ዘይምህላውን ተቐባልነት ዘይብሎም ባህሪያት ምንፅብራቕን ነቲ ግልጋሎት ዝዓዘዘ ዕንቅፋት ከምዘለዎ በቲ መፅናዕቲ ንምርዳእ ተኻኢሉ እዩ፡፡ ማይን መብራህትን ዝኣመሰሉ ትሕቲ ቕርፂ ኣብ ኬላታት ጥዕና ዘይምህላዉ ኣዴታት ኣብ ቀረበአን ዘሎ ትካል ጥዕና ንኽወልዳ ዘየተባብዕ ከምዝኾነ እውን ተሓቢሩ እዩ፡፡ ውፅኢት ሳልሳይን ራብዓይን መፅናዕታዊ ፅሑፍ ኣብ ሳልሳይ መፅናዕቲ ምስ ኣዴታት ብዝተገበረ ምይይጥ - ኣደ እትወልደሉ ቦታ ባዕላ ንኽትውስን ከምእነሓጎታት ዝመሰላ ዕድመ ዝደፍኣ ኣዴታትን ፀቕጢ (ተፅእኖ) ከምዝግበረላ እቶም መፅናዕቲታት ይሕብሩ፡፡ ዋላ አኳ ኣብ ትካል ጥዕና ብዛዕባ ምውላድ ኣዎንታዊ ኣረኣእያ ኣዴታት ዝዓዘዘ እንተኾነ ብዛዕባ ድኹም ኣዋህባ አገልግሎት ጥዕና ኣዝዩ ከምዘተሓሳስበን እቲ መፅናዕቲ ይገልፅ፡፡ ትካል ጥዕና ናብ መንበሪ ኣዴታት ዘለዎ ርሕቐትን መጓዓዓዚ ዘይምርካብ ዝኣመሰሉ ፀገማት ከምዘገድስወን እውን እቲ መፅናዕቲ ይሕብር፡፡ ኣብቲ ራብዓይ መፅናዕቲ ብወገን ሞያተኛታት ጥሙር ጥዕናን ነርስ መዋልዳንን ብዝተገበረ ምይይጥ - ኣብ ሆስፒታል ዝዋሃቡ ዝሐሹ ግልጋሎት ኣዴታት ካብ ታሕተዋይ ትካል ጥዕና ናብ ሆስፒታላት ሪፈር እንትበሃላ ኣብ ምጉዕዓዝ ብሕብረተሰብ ዝግበር ምትሕግጋዝ ከምኡ እውን እናዓበየ ዝኸይድ ዘሎ ግንዛበ ሕብረተሰብ ኣዴታት ኣብ ትካል ጥዕና ንኽወልዳ መሳለጢ ከምዝኾነ እቲ ፅንዓት የረድእ፡፡ ዓቕሚ ምንኣስ ሞያተኛታት ጥሙር ሞያተኛታት ጥሙር ጥዕናን ነርስ መዋልዳንን - ድኹም ኩነታት ትካል ጥዕናን (ሕፅረት ናውቲ ጥዕና ምህላዉ - ትሕቲ ቅርፂ ዘይምምላእ) ፀገም መጉዓዝያን እውን ኣዴታት ኣብ ትካል ጥዕና ንኸይወልዳ ዕንቅፋታት ከምዝኾነ እቲ ፅንዓት የመላኽት፡፡ መጠቓለሊ እቶም ዝተጠቐሱ ዕንቅፋታትን ፀገማትን ብምንካይ ቀረብ ወሊድ ግልጋሎት ጥዕና ንምዕባይ እዞም ዝስዕቡ ፃዕሪታት ምክያድ ይግባእ፡፡ ኣብ ጎቦታትን ኣዝዩ ርሑቕን ኣፀገምትን ዝሰፈረ ሕብረተሰብ ካብቲ ልሙድ ዝተፈለየ ቀረብ ግልጋሎት ጥዕና ምሃብ (ንኣብነት ካብ ጥዕና ጣቢያ ኣዝየን ዝርሕቓ ኬላታት ጥዕና ክእለት ዘለወን ነርስ መዋልዳን (midwives) ምምዳብ - ኣደ ማእኸል ዝገበረ ግልጋሎት ንኽወሃብ ሰብ ሞያ ጥዕና ብዓቕሚ ንኽዓብዩ ምግባርን ነቶም ሓሙሽተ መዐቀኒታት ቀረብ ግልጋሎት ብምምላእ ኣብቲ ሕብረተሰብ ተቐባልነት እቲ ግልጋሎት ክዓቢ ምግባርን፡፡

Abstract Background: Maternal mortality is one of the most sensitive indicators of the health disparities between poorer and richer nations. It is also one of the most difficult health outcomes to measure reliably. In many settings, major challenges remain in terms of both measuring and reducing maternal mortality effectively. This thesis aims to quantify overall levels, identify specific causes, and evaluate local interventions in relation to efforts to reduce maternal mortality in Tigray Region, Northern Ethiopia, thereby providing a strong empirical basis for decision making by the Tigray Regional Health Bureau using methods that can be scaled at national level.   Methods: This study employed a combination of community-based study designs to investigate the level and determinants of maternal mortality in six randomly selected rural districts of Tigray Region. A census of all households in the six districts was conducted to identify all live births and all deaths to women of reproductive age occurring between May 2012 and September 2013. Pregnancy-related deaths were screened through verbal autopsy with the data processed using the InterVA-4 model, which was used to estimate Maternal Mortality Ratio. To identify independent determinants of maternal mortality, a case-control study using multiple logistic regression analysis was done, taking all pregnancy-related deaths as cases and a random sample of geographical and age matched mothers as controls. Uptake of ambulance services in the six districts was determined retrospectively from ambulance logbooks, and the trends in pregnancy-related death were analyzed against ambulance utilization, distance from nearest health center, and mobile network coverage at local area level. Lastly, implementation of the Family Folder paper health register, and its potential for accurately capturing demographic and health events, were evaluated using a capture-recapture assessment.   Results: A total of 181 deaths to women of reproductive age and 19,179 live births were documented from May 2012 to April2013. Of the deaths, 51 were pregnancy-related. The maternal mortality ratio for Tigray region was calculated at 266 deaths per 100,000 live births (95% CI 198-350), which is consistently lower than previous “top down” MMR estimates. District–level MMRs showed strong inverse correlation with population density (r2 = 0.86). Direct obstetric causes accounted for 61% of all pregnancy–related deaths, with hemorrhage accounting for 34%. Non-membership in the voluntary Women’s Development Army (AOR 2.07, 95% CI 1.04-4.11), low husband or partner involvement during pregnancy (AOR 2.19, 95% CI 1.14-4.18), pre-existing history of other illness (AOR 5.58, 95% CI 2.17-14.30), and never having used contraceptives (AOR 2.58, 95% CI 1.37-4.85) were associated with increased risk of maternal death in a multivariable regression model. In addition, utilization of free ambulance transportation service was strongly associated with reduced MMR at district level. Districts with above-average ambulance utilization had an MMR of 149 per 100,000 LB (95% CI: 77-260) compared with 350 per 100,000 (95% CI: 249-479) in districts with below average utilization. The Family Folder implementation assessment revealed some inconsistencies in the way Health Extension Workers utilize the Family Folders to record demographic and health events.   Conclusion: This work contributes to understanding the status of and factors affecting maternal mortality in Tigray Region. It introduces a locally feasible approach to MMR estimation and gives important insights in to the effectiveness of various interventions that have been targeted at reducing maternal mortality in recent years.

The aim of this study was to investigate the inclusion of visually-impaired learners in Ethiopian secondary schools. To conduct the study a mixed methods research multiple case study research design was used. The study was conducted in two secondary schools of the capital city of Tigray Regional State of Ethiopia. In the selection of the schools and research participants, a purposive sampling method was employed. The data were collected from 2 school principals, 35 teachers and 24 learners of grade 9 and 10. To collect the data, interviews (for principals and teachers), focus group discussions (for learners), observation, and questionnaires (for teachers), were used. The primary data for this research were the data gathered from interviews, focus group discussion and observation whereas the data gathered from the questionnaire were used to compare, triangulate and supplement. Data by the instruments were analysed under different themes using a constructivist/interpretive approach. The findings of the study revealed that the nature of school inclusivity regarding visually-impaired learners in Tigray Secondary Schools of Ethiopia is poor and visually-impaired learners are excluded. As a result, the exclusive nature of the schools is affecting the implementation and actualisation of inclusive education. Based on the findings, the study calls schools, communities, governmental and non-governmental organisations to take action for the implementation and realisation of inclusive education and the inclusion of all learners, such as visually-impaired learners. / Inclusive Education / D. Ed. (Inclusive Education)

This study provides an account of the agendas, participation and influence of management, teachers, students and parents at a primary school in Tigray, Ethiopia. A literature review revealed gaps in the knowledge of these stakeholders’ involvement in school leadership structures in the current national policy context. A broader review of the major traditions of school research informed the design of this ethnographic case study. Fieldwork at ‘Ketema School’ took place over an eight-month period in 2014, and involved participant observation, informant-led interviews, and the collection of institutional documents. Data collection focused on the meetings of various bodies, and the activities of a single class in Grade 6 and 7. Inductive analysis of the case data was supported by Atlas.ti. The study reveals a convergence of understandings about the purposes and processes of the school consistent with the state-authorised model of schooling for national development. Structures and processes of surveillance and control incentivise and normalise compliance with government directives. These include positions of distributed leadership and mechanisms of mutual surveillance and internal accountability through which teachers and students share responsibility for supervising peers and colleagues. For example, the student leaders of the ‘one-to-five’ networks perform an academic support and behavioural control function in relation to their peers; and gim gima is a practice of public critique used for exposing misconduct. Meetings and other participative spaces enable members of the school community to share their views on conditions in school according to their interests and priorities; however, these forums are dominated by management agendas, and school-level decisions are restricted by a strong external policy context. This study extends knowledge of school leadership practices in Ethiopia and informs wider debates around community participation, accountability and school autonomy in developing countries. Recommendations are made for sharing and strengthening democratic practices and for future research.

Philosophiae Doctor - PhD / The HIV/AIDS epidemic remains an unbeaten challenge that affects all parts of the global population. Since the identification of the epidemic in the early 1980s, nearly 58 million people have become infected with the virus and 25 million people have died of HIV-related complications. This study aimed to elucidate individual and community level factors associated with the uptake of antenatal care (ANC), health facility delivery, HIV Counselling and Testing (HCT), and Prevention of Mother-to-Child Transmission of HIV (PMTCT) services by implementing a hierarchical (multilevel) methodological approach. This study used a cross-sectional, multistage sampling design in which health facilities were first selected (stage 1), followed by recruitment of post-partum women who came for child immunization from each health facility (stage 2), in Tigray region. Structured interview guides were developed for interviews. Four-fifths (80.0%) of mothers used antenatal services at least once during their most recent pregnancy and of these 74.6% of women accessed HCT. Sixty nine percent of women had delivered at a health facility, 79% of mothers and 55.7% of their children had received PMTCT services. Place of residence was significantly associated with ANC attendance and place of delivery, with women living in urban areas almost 2 times (OR=1.75, 95% CI 1.06, 2.92) more likely to deliver at a health facility. With the addition of one health facility per 25000 people, the likelihood of delivering at a health facility increased by 2.45 fold (OR=2.45, 95% CI 1.04, 5.78). Attending ANC (OR=4.54; 95%CI 2.82,7.33) and getting support from husband (OR=1.97; 95%CI 1.25,3.10) were significantly associated with HCT, at the individual level. At the community-level, for the addition iii of one health facility and HCT site for every 25000 people increase the likelihood of HCT utilization by 2.1 and 2.4 fold respectively. Mothers who delivered at a health facility were 18 times (OR=18.21; 95%CI 4.37,75.91) and children born at a health facility were 5 times (OR=4.77; 95%CI 1.21,18.83) more likely to receive PMTCT services, compared to mothers delivering at home. With the addition of one nurse per 1500 people, the likelihood of getting PMTCT services for a mother increases by 7.22 fold (OR=7.22; 95% CI 1.02,51.26). Community-level random-effects were also significant and there was confirmation of nesting at the community-level even after controlling for individual and communitylevel variables. Findings also showed that HCT utilization was nested according to district of residence, contributing 11.3% of the variance. In addition, the variation of mothers getting PMTCT services between districts was only 0.6%, but was 27.2% for children. Conclusion: Factors influencing utilization of maternal health services work at different levels, individual and community. Hierarchical models reveal these differences in ways that single-level (individual or community) models do not. Interventions are needed to increase spouse involvement in ANC utilization, and explore effective ways of increasing health facility delivery among poor women with little formal education in rural areas and increasing the number of health facility per people are important. The government should focus on increasing ANC access, educating couples on the importance of health services utilization, increasing the number of health facilities and HCT sites per population to improve HCT utilization. In addition to these, programmes should focus on increasing health facility delivery, training traditional birth attendants to understand the need for PMTCT and increasing iv HCT coverage to advance getting PMTCT services for mothers at the individual level and for children at both individual and community level. Permission to conduct the study was granted from the Ethics Committee of the University of the Western Cape and from Tigray Region Health Bureau. Verbal informed consent was obtained from each participant in the health facility based interview.

This thesis examines the international community's meager response – despite the Responsibility to Protect (R2P) – to the conflict in Tigray. Why was the response minimal, and what could be done to make R2P more efficacious in the future? The R2P framework describes the responsibilities to protect populations around the world against mass atrocity crimes, as stated in Article 5 of the Rome Statute. The study shows that R2P as a framework is flawed, and proposes the creation of an R2P ombudsman to monitor conflicts, focus the international community's attention and assist states that are struggling or failing to protect vulnerable people. The thesis draws upon a theory of political realism but also highlights the sometime significance of shared ethical norms and values.

Abstract in English, Southern Sotho and Xhosa / Global poverty remains one of the significant challenges of human beings in the twenty-first century, despite the United Nation’s declaration that all people have the right to education, work, health, well-being; a healthier environment and equal opportunities. The active role of business organisations is vital and necessary to tackle this challenge. One of the mechanisms that can ensure the participation of business organisations in tackling the challenges of human beings is corporate social responsibility (CSR). Accordingly, the primary purpose of the study was to explore CSR initiatives in Ethiopia, focusing on the small and medium enterprises (SMEs) of the Tigrai Regional State. More specifically, the study aimed at assessing the perceptions SME owners and managers’ perceptions of CSR regarding their economic, legal, ethical, environmental and philanthropic responsibilities. The aim was also to investigate their CSR initiatives and to analyse the driving forces of and barriers to CSR interventions. An exploratory survey research design and a mixed method approach were followed to achieve these objectives. A probability sampling technique was applied to select the 400 sample respondents. A convenient sampling technique was applied to select 15 participants for interviews. Questionnaires, key-informant interviews and secondary documents were used as a means of data collection. Descriptive statistics such as percentages, means, and standard deviations were applied to analyse the quantitative data. The qualitative data was analysed using content analysis where items were transcribed, and emergent themes were identified. The findings of this study are that the SMEs surveyed have an appreciable level of CSR initiatives. They have care and concern towards their employees; the local community and the environment. Furthermore, the SMEs relatively protect the health and safety of their employees, protect against substance abuse and harassment of employees in the workplace; strive to provide professional training to their employees, and arrange orientation programmes, to mention but a few. SMEs have energy and water measurement systems and carry out philanthropic activities that can protect the well-being of the environment, but they are weak in recycling and energy conservation and in creating environmentally friendly new products. At community level, SMEs assist sports activities, road construction, religious organisations and local government. Furthermore, they create gainful employment opportunities. However, they give minimal attention to helping the disabled, war veterans, women, education, and similar areas. The quest for image building, keeping the well-being of the environment, ethical reasons and improving customer relations and loyalty were among the prime factors that motivated SMEs to participate in CSR initiatives. However, the concerted efforts of the enterprises’ participation in CSR activities were constrained by factors such as shortage of finance, lack of skilled and educated workforce who can implement the CSR initiatives and lack of training and information about CSR. To alleviate these constraints, thereby making SMEs the major actors in CSR initiatives, interventions by government and other stakeholders such as NGOs is essential. Furthermore, SMEs should follow a culture-oriented, ethics primary, motivated and collaborative approach rather than profit-oriented CSR. / Ubuhlwempu ehlabathini busengomnye umngeni onzima eluntwini kule nkulungwane yamashumi amabini ananye, nangona iZizwe Ezimanyeneyo zibethelela ukuba bonke abantu banelungelo lokufumana imfundo, umsebenzi, impilo, intlalontle, okusingqongileyo okunempilo namathuba alinganayo. Indima edlalwa ngamaqumrhu orhwebo ingundoqo nesidingo esibalulekileyo ekuhlaseleni lo mngeni. Enye indlela yokuqinisekisa ukuthatha inxaxheba kwamaqumrhu ezorhwebo ekulweni imingeni yoluntu kukulandela inkqubo yoXanduva Lwamaqumrhu Eluntwini, eyaziwa ngokuba yicorporate social responsibilityokanye eshunqulelwa ngokuba yiCSR. Ngoko ke injongo ephambili yolu phando yayikukuqwalasela imizamo yeCSR kwilizwe lase-Ethiopia, kugxininiswa kumashishini amancinci naphakathi (iiSME) kwiphondo eliyiTigrai Regional State. Ngokuthe gca, uphando lwalujolise ekuvavanyeni izimvo zabanini nabaphathi beeSMEngeCSR malunga noxanduva kwezoqoqosho, ezoMthetho, iinqobo zokuziphatha, ezendalo engqongileyo nezenzo zenceba. Enye injongo yayikukufumanisa ngamalinge eCSR nokuhlalutya iimeko eziphembelela nezithibaza imizamo yeCSR. Kwaqala kwenziwa uhlolo zimvo ekutshayeleleni uphando, kwalandeliswa ngomxube weendlela zophando ukuze kuphunyezwe iinjongo. Isampulu yabathathi nxaxheba abangama-400 yayingabantu abakhethwe nje kungajongwanga mpawu zithile. Kwabuya kwakhethwa isampulu yabathathi nxaxheba abali-15 kubantu ababekufuphi nabafumaneka lula ukuze kuqhutywe udliwano ndlebe nabo. Kwaqokelelwa iinkcukacha zolwazi/idatha ngokusebenzisa uluhlu lwemibuzo, udliwano ndlebe nabantu abaphambili nemibhalo eseyikade ikho ngalo mbandela. Ekuhlalutyeni idatha esekelwe kumanani kwenziwa ubalo ngokucacisa amanani anika iipesenti, imindilili neyantlukwano yezibalo ezifunyenweyo nomndilili. Idatha esekelwe kwingxoxo nokuzathuza yahlalutywa ngokuphengulula iziqulatho apho kwabhalwa ulwazi, kwaza kwachongwa imixholo ethile edulayo. Olu phando lufumanise ukuba iiSME zinamalinge eCSR ancomekayo. Zibonakalisa inkathalo kubaqeshwa bazo; kubahlali bendawo nakwindalo ezingqongileyo. Ngaphezulu, iiSME ziyazama ukuyiqaphela impilo nokhuseleko lwabaqeshwa bazo, ziyabakhusela ekusebenziseni gwenxa iziyobisi nasekuphathweni gadalala emsebenzini; zizama nokuqhuba uqeqesho olusemgangathweni kubasebenzi nokucwangcisa iinkqubo zokuqhelisa abafiki emsebenzini – le yimigudu nje embalwa eyenziwa ziiSME. Ezi SME zineenkqubo zokumeta/zokulinganisela amanzi nombane kwaye zenza imisebenzi yenceba yokukhusela indalo ezingqongileyo kodwa zibuthathaka ekusebenziseni kaninzi iimveliso, ekongeni umbane nasekwenzeni iimveliso ezintsha nezingayonakalisiyo indalo engqongileyo. Ekuhlaleni, iiSME zinceda kwezemidlalo, ekwakhiweni kweendlela, kwimibutho yezenkolo naseburhulumenteni bendawo. Ngaphezulu, zidala amathuba omsebenzi aluncedo. Noxa kunjalo, aziniki ngqwalasela yaneleyo ekuncedeni amagqala emfazwe, abafazi, ezemfundo neminye imiba eyeleleyo. Ukunxanelwa ukwakha igama elihle, ukugcina indalo engqongileyo, ukuphucula intsebenziswano nokuthembeka kwabaxumi yaba zezinye izinto ezikhuthaza ukuba iiSME zithathe inxaxheba kumalinge eCSR. Noxa kunjalo, imizamo ezinikeleyo yenkampani kwimisebenzi yeCSR yayithityazwa zizinto ezifana nokunqaba kwemali, ukungabikho koqeqesho nolwazi ngeCSR, ukunqongophala kwabasebenzi abafundileyo nabanezakhono ababenokwazi ukuqhuba imisebenzi yeCSR. Ukususa le miqobo nokwenza iiSME zibe ngabadlali abaphambili kwimigudu yeCSR, kunyanzelekile ukuba urhulumente angenelele, ngokunjalo nabanye abathathi nxaxheba abafana namaqumrhu angengowaseburhulumenteni (iiNGO). Ngaphaya koko iiSME kufuneka zilandele indlela yokusebenza ethathela ingqalelo inkcubeko, iinqobo zokuziphatha, inkuthazo nentsebenziswano ngaphezu kokwenza ingeniso yeCSR. / Tlala lefatsheng e dula e le nngwe ya diphephetso tsa bohlokwa ho batho selemo-kgolong sa bomashome a mabedi a motso o le mong, ho sa natswe phatlalatso ya mokgatlo wa Matjhaba a Kopaneng wa hore batho bohle ba na le tokelo ya thuto, mosebetsi, bophelo bo botle, boiketlo; tikoloho e phetseng hantle le menyetla e lekanang. Tshebetso e matla ya mekgatlo ya kgwebo e bohlokwa mme e ya hlokeha ho sebetsana le bothata bona. E nngwe ya ditsela tse ka netefatsang bonkakarolo ba mekgatlo ya kgwebo ho lwantsheng diphephetso tsa batho ke boikarabello ba mekgatlo setjhabeng (CSR). Kahoo, morero wa sehlooho wa phuputso e ne e le ho batlisisa matsholo a CSR Ethiopia, re tsepame hodima dikgwebo tse nyane le tse mahareng (diSME) tsa Tigrai Regional State. Ka ho toba ho feta, phuputso e reretswe ho lekanya maikutlo a beng ba diSME le maikutlo a baokamedi mabapi le CSR ka boikarabello ba bona ba moruo, molao, boitshwaro, tikoloho le boikarabello ba ho thusa ba bang. Sepheo e ne boetse e le ho batlisisa matsholo a bona a CSR le ho manonna ditshumetso le dithibelo tsa matsholo a CSR. Ho latetse moralo wa kutullo wa dipatlisiso hammoho le katamelo ya mekgwa e fapaneng ho fihlella dipheo tsena. Tekgeniki ya ho etsa sampole ya monyetla e sebedisitswe ho kgetha sehlopha sa baarabi ba 400. Tekgeniki ya ho etsa sampole e bonolo e sebedisitswe ho kgetha bankakarolo ba 15 ba diinthavu. Ho sebedisitse mathathamo a dipotso, diinthavu tsa ditsebi tsa bohlokwa le ditokomane tsa bobedi jwalo ka mokgwa wa pokeletso ya tlhahisoleseding. Dipalopalo tse hlalosang tse jwalo ka diperesente, dikakaretso, le dikgeloho tse tlwaelehileng di sebedisitswe ho manolla tlhahisoleseding ya bongata. Tlhahisoleseding ya boleng e manollotswe ka tshebediso ya manollo ya dikateng moo dintho di ileng tsa ngolwa fatshe kamora kgatiso mme hwa hlwauwa ditema tse hlahellang. Diphetho tsa phuputso ena ke hore diSME tse fupuditsweng di na le boemo bo amohelehang ba matsholo a CSR. Di hlokomela le ho tsotella bahiruwa ba tsona; setjhaba sa lehae hammoho le tikolohoh. Ho feta moo, ka kakaretso diSME di sireletsa bophelo bo botle le polokeho ya basebetsi ba tsona,di sireletsa kgahlano le tlhekefetso ya dithethefatsi le tlhekefetso ya basebetsi sebakeng sa tshebetso;di sitlalletsa ho fana ka thupelo ya seporofeshenale ho basebetsi ba tsona, le ho hlophisa mananeo a tsebiso sebakeng, ho qolla tse mmallwa feela. DiSME di na le merero ya tekanyo ya matla le metsi hape di etsa mesebetsi ya ho thusa baahi e ka sireletsang boiketlo ba tikoloho, empa dia fokola ha ho tluwa ho tshebediso hape ya dintho le poloko ya matla le ho hlahiseng dihlahiswa tse ntjha tse bolokang tikoloho. Boemong ba setjhaba, diSME di thusa ditshebetsong tsa dipapadi, kahong ya ditsela, mekgatlong ya bodumedi le ho mmuso wa lehae. Ho feta moo, di fana ka menyetla ya mesebetsi ya bohlokwa. Leha ho le jwalo, ha di shebane haholo le ho thusa ba nang le bokowa, masole a kgale, basadi, thuto, le dibaka tse jwalo ka tseo. Telekiso ya ho aha seriti, ho boloka boiketlo ba tikoloho, mabaka a boitshwaro le ho ntlafatsa maqhama a bareki le botshepehi e ne le a mang a mabaka a mantlha a kgannelang diSME ho nka karolo matsholong a CSR. Empa, maiteko a matla a dikgwebo tsena a ho nka karolo mesebetsing ya CSR a ne a thibelwa ke dintlha tse ka reng ho fokola ha tjhelete, tlhokeho ya basebetsi ba nang le tsebo le thuto ba ka kenyang matsholo a CSR tshebetsong le tlhokeho ya thupelo le lesedi mabapi le CSR. Ho hlola mathata ana, e le ho etsa diSME dibapadi tsa mantlha matsholong a CSR, ho hlokeha hore mmuso le baamehi ba bang ba jwalo ka mekgatlo ya diNGO ba kene dipakeng. Hapehape, diSME di lokela ho latela katamelo ya setso, boitshwaro, tjantjello le tshebedisano ho ena le CSR e shebaneng le phaello. / Graduate School of Business Leadership / D. B. L.

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