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För att åstadkomma ett effektivt utvecklingsarbete är det av yttersta vikt att undersöka vilka faktorer som leder till stärkt kvinnlig egenmakt. Med hjälp av ekonometrisk analys jämför denna uppsats kvinnlig egenmakt i Rwanda år 2000 respektive 2010. Trots Rwandas omfattande ekonomiska och jämställdhetsfrämjande reformer kan denna uppsats inte visa på mer än marginella ökningar vad gäller kvinnlig egenmakt. Ökningen hittas endast för kvinnor med hög utbildning. I linje med tidigare forskning indikerar resultatet att Rwandas utveckling i många avseenden främst verkar ha gynnat en mer privilegierad minoritet. Inte heller verkar utbildning vara det självskrivna tillvägagångssätt för att öka kvinnors egenmakt som man hade kunnat förvänta sig.

Background: The World Health Organization estimates that there are 517 million people in the world who are visually impaired due to uncorrected presbyopia. Equal sphere ready-made bifocal and single vision reading spectacles are an inexpensive alternative to custom made spectacles. Methods: A visual satisfaction questionnaire was administered before patients were examined at an outreach clinic and again after ready-made bifocals or reading spectacles were dispensed. The results of both sets of questions along with presenting acuities, corrected acuities, refractive data, and willingness to pay were analyzed. Results: There was an unmet need of 38% (of the 338 subjects that needed glasses only 208 had them). There was no gender bias; the unmet need was higher in the rural areas (47% rural, 36% urban). Those who could not read were 3.4 times less likely to have the glasses they needed than the literate. Unmet need decreased with every level of education. Those without any schooling showed 77% prevalence of unmet need and those with university education had an unmet need rate of 32%. Ready-made spectacles were dispensed to 89.5% of those examined. The ready-made bifocals were very well accepted, with the percentage of subjects giving the highest satisfaction rating improving from a presenting value of 11% to 89.4% with the bifocals at distance and from 6.6% to 89.4% at near. Distance visual acuity of 20/40 or better improved from the presenting value of 60% to 84.5% and near vision of 20/40 or better improved from the presenting value of 44% to 97%. With ready-made single vision readers, functionally good near vision (20/40 or better) improved from a presenting value of 38% to 97%. The highest ranking for near satisfaction improved from 6.3% to 86.6%. The subjects indicted that they would be willing to pay US$18.39 to replace the bifocals and US$16.67 to replace the readers. Conclusion: There is a high unmet need for vision correction in the population over age 35 in Nicaragua. Dissatisfaction with distance and near vision is very high. Although custom made glasses are ideal, ready-made bifocals and ready-made single vision readers are an acceptable and affordable alternative.

Low vision impacts on Quality of Life (QoL). Thus, low vision services are essential to enhance the QoL of people with functional low vision. However, of the estimated 70 out of the 124 million people with low vision who require services, approximately 5-10% has access to services. The demands for low vision services will continue to grow due to the emerging global trends in ageing populations and changes in the epidemiology of vision impairment. While critical data and information are available for other forms of vision impairment, there is a paucity of information on the distribution, needs, and priorities for improving low vision service delivery at the national, regional, and global levels. / This thesis addressed the problem by first developing and distributing a survey to Vision 2020 contacts, government, and non government organisations in 195 countries during 2006-2008 to assess the current situation of low vision services globally. The survey was first pilot tested leading to improvements in the length, layout, and content of its form. Specifically, the survey topics included: epidemiology, policies, human resources, service provision, barriers, equipment, and monitoring and evaluation. / The Classification Analysis and Regression Tree (CART), logistic regression methodology and grounded theory analysis were used to present the findings and identify the critical success factors of low vision service coverage. The qualitative component consisted of case studies in three countries (India, Ghana, and Cameroon) during November 2007 and 2008. A total of 101 interviews were carried out. The case studies provided an overview and historical perspective of services, effectiveness, cost, efficiency, acceptability, access, equity, sustainability, and ideal situations as recommended by interviewees. Qualitative findings from the case studies were produced with the assistance of the NVivo software. / The primary results are that the majority (80%) of countries have poor (≤10%) coverage. Key issues pertinent to the current situation of service coverage are: human resources (number and combination of disciplines), funding (sustainability and arrangements), type of services provided (comprehensive and multidisciplinary) and its locations (NGOs or government facilities), and the sociodemographic and economic barriers (costs, awareness, and rural areas) to accessing services. / The critical success factors found in this research are represented by the ‘FRAME’: Funding (sustainable source, public and private mix), Rehabilitation workers (e.g., adequate numbers of multidisciplinary personnel), Access to low vision devices, Multidisciplinary services; and External contextual influences in which low vision services operate in. The case studies identified seven major themes that further build on the FRAME: sustainability, governance, advocacy, human resources, access, awareness, and service delivery. / The conclusion of the thesis is that a global picture of the current situation of low vision services was acquired and it is now known which countries have poor (≤10%) and better (>10%) coverage. It also found the critical success factors that will assist the WHO Low Vision Working Group and Vision 2020 to improve the current models of service delivery, future planning, training curriculum development, and priorities setting. Specifically, these need to be achieved through three areas of action: human resources development, sustainability, and advocacy.

Low vision impacts on Quality of Life (QoL). Thus, low vision services are essential to enhance the QoL of people with functional low vision. However, of the estimated 70 out of the 124 million people with low vision who require services, approximately 5-10% has access to services. The demands for low vision services will continue to grow due to the emerging global trends in ageing populations and changes in the epidemiology of vision impairment. While critical data and information are available for other forms of vision impairment, there is a paucity of information on the distribution, needs, and priorities for improving low vision service delivery at the national, regional, and global levels. / This thesis addressed the problem by first developing and distributing a survey to Vision 2020 contacts, government, and non government organisations in 195 countries during 2006-2008 to assess the current situation of low vision services globally. The survey was first pilot tested leading to improvements in the length, layout, and content of its form. Specifically, the survey topics included: epidemiology, policies, human resources, service provision, barriers, equipment, and monitoring and evaluation. / The Classification Analysis and Regression Tree (CART), logistic regression methodology and grounded theory analysis were used to present the findings and identify the critical success factors of low vision service coverage. The qualitative component consisted of case studies in three countries (India, Ghana, and Cameroon) during November 2007 and 2008. A total of 101 interviews were carried out. The case studies provided an overview and historical perspective of services, effectiveness, cost, efficiency, acceptability, access, equity, sustainability, and ideal situations as recommended by interviewees. Qualitative findings from the case studies were produced with the assistance of the NVivo software. / The primary results are that the majority (80%) of countries have poor (≤10%) coverage. Key issues pertinent to the current situation of service coverage are: human resources (number and combination of disciplines), funding (sustainability and arrangements), type of services provided (comprehensive and multidisciplinary) and its locations (NGOs or government facilities), and the sociodemographic and economic barriers (costs, awareness, and rural areas) to accessing services. / The critical success factors found in this research are represented by the ‘FRAME’: Funding (sustainable source, public and private mix), Rehabilitation workers (e.g., adequate numbers of multidisciplinary personnel), Access to low vision devices, Multidisciplinary services; and External contextual influences in which low vision services operate in. The case studies identified seven major themes that further build on the FRAME: sustainability, governance, advocacy, human resources, access, awareness, and service delivery. / The conclusion of the thesis is that a global picture of the current situation of low vision services was acquired and it is now known which countries have poor (≤10%) and better (>10%) coverage. It also found the critical success factors that will assist the WHO Low Vision Working Group and Vision 2020 to improve the current models of service delivery, future planning, training curriculum development, and priorities setting. Specifically, these need to be achieved through three areas of action: human resources development, sustainability, and advocacy.

D. Litt et Phil. (Literature and Philosophy) / Eye health promotion is an important aspect of VISION 2020 campaign that aims to eliminate unwarranted cases of avoidable blindness worldwide by the year 2020. Most developing countries, including South Africa, have a serious burden of eye diseases and unwarranted causes of visual impairment and blindness. The purpose of this research therefore was to highlight the lack of an integrated eye health promotion policy in the South African primary health care system which can play a major role in the elimination of this burden of disease and also to make proposals for eye health promotion policy development in South Africa. A combination of quantitative and qualitative research methods was used in this study. Questionnaires and interviews were conducted with all national and provincial health managers of portfolios relevant to eye care. Also, various health policy documents were requested from the National and Provincial Department of Health to ascertain claims of any existing guidelines on eye care. The policy documents and guidelines obtained had no specific reference to eye health promotion. Only 11 (23%) of the managers of provincial health directorates reported that they have integrated vision screening in their health promotion programmes as part of eye health promotion strategies. Eye care managers in the provinces reported that school visits accounted for 75% of eye health promotion programmes target areas. Also, apart from the Northern Cape Province which has no eye care manager and consequently no eye health promotion programmes, the Western Cape Province also does not have eye health promotion programmes and relies mostly on private sector for eye care services. The lack of an integrated eye health promotion policy and most probably the lack of a dedicated directorate that deals with eye health promotion issues may be a contributing factor to the overwhelming lack of integrated eye health promotion activities in South Africa. It is therefore recommended that an integrated eye health promotion model be developed and be part of the South African primary health care system. / Health Studies

The implementation of educational reform in the United Arab Emirates (UAE) imposes a change agent role on secondary school department heads however the assistance-intensive process is inhibited by the current educational structure. As the concept of teacher empowerment becomes accepted, some department heads have the ability to develop a professional learning community while others are unable to do so. The present study considers the present and ideal role of the department head as a change agent facilitating the implementation of educational reform in the UAE. A sequential mixed method mode of inquiry with two phases was employed. In phase one, department heads were profiled from a self, superior and subordinate perspective and a conceptual framework related to patterns of effective change agent behaviour was developed. Findings show that effective change agent characteristics of department heads included priorities related to change implementation and teacher support, a collaborative leadership style, seven strategies related to a participatory, supportive and facilitative approach and ten skills that motivate, energise and encourage teachers. The identification of two ineffective department heads by teacher informants in phase one provided an opportunity to study the work of effective and ineffective department heads as cases in-depth. Case study findings confirm the conceptual framework because effective heads were rated high for all characteristics identified, while ineffective heads were rated low. All department heads accepted the change agent role unofficially with no additional time release, but effective heads took ownership of the process and empowered teachers while ineffective heads provided assistance on request. Effective heads used interpersonal skills and asserted themselves as technical experts while ineffective heads were passive and were considered to be traditional teachers. Strategies and skills employed by effective heads included resource linking, collaborative problem solving, facilitation, support and administration/organisation while ineffective department heads used resolution giving and providing technical assistance. Time constraints, restrictive school schedules and role ambiguity were identified as major impediments to the change agent role of department heads in his study. Nevertheless, the new curriculum is being implemented in all of the departments studied verifying that the department head is an untapped resource in the change process. / Educational Studies / D.Ed (Education Management)

The implementation of educational reform in the United Arab Emirates (UAE) imposes a change agent role on secondary school department heads however the assistance-intensive process is inhibited by the current educational structure. As the concept of teacher empowerment becomes accepted, some department heads have the ability to develop a professional learning community while others are unable to do so. The present study considers the present and ideal role of the department head as a change agent facilitating the implementation of educational reform in the UAE. A sequential mixed method mode of inquiry with two phases was employed. In phase one, department heads were profiled from a self, superior and subordinate perspective and a conceptual framework related to patterns of effective change agent behaviour was developed. Findings show that effective change agent characteristics of department heads included priorities related to change implementation and teacher support, a collaborative leadership style, seven strategies related to a participatory, supportive and facilitative approach and ten skills that motivate, energise and encourage teachers. The identification of two ineffective department heads by teacher informants in phase one provided an opportunity to study the work of effective and ineffective department heads as cases in-depth. Case study findings confirm the conceptual framework because effective heads were rated high for all characteristics identified, while ineffective heads were rated low. All department heads accepted the change agent role unofficially with no additional time release, but effective heads took ownership of the process and empowered teachers while ineffective heads provided assistance on request. Effective heads used interpersonal skills and asserted themselves as technical experts while ineffective heads were passive and were considered to be traditional teachers. Strategies and skills employed by effective heads included resource linking, collaborative problem solving, facilitation, support and administration/organisation while ineffective department heads used resolution giving and providing technical assistance. Time constraints, restrictive school schedules and role ambiguity were identified as major impediments to the change agent role of department heads in his study. Nevertheless, the new curriculum is being implemented in all of the departments studied verifying that the department head is an untapped resource in the change process. / Educational Studies / D.Ed (Education Management)

Eye health promotion is an important aspect of VISION 2020 campaign that aims to eliminate unwarranted cases of avoidable blindness worldwide by the year 2020. Most developing countries, including South Africa, have a serious burden of eye diseases and unwarranted causes of visual impairment and blindness. The purpose of this research therefore was to highlight the lack of an integrated eye health promotion policy in the South African primary health care system which can play a major role in the elimination of this burden of disease and also to make proposals for eye health promotion policy development in South Africa. A combination of quantitative and qualitative research methods was used in this study. Questionnaires and interviews were conducted with all national and provincial health managers of portfolios relevant to eye care. Also, various health policy documents were requested from the National and Provincial Department of Health to ascertain claims of any existing guidelines on eye care. The policy documents and guidelines obtained had no specific reference to eye health promotion. Only 11 (23%) of the managers of provincial health directorates reported that they have integrated vision screening in their health promotion programmes as part of eye health promotion strategies. Eye care managers in the provinces reported that school visits accounted for 75% of eye health promotion programmes target areas. Also, apart from the Northern Cape Province which has no eye care manager and consequently no eye health promotion programmes, the Western Cape Province also does not have eye health promotion programmes and relies mostly on private sector for eye care services. The lack of an integrated eye health promotion policy and most probably the lack of a dedicated directorate that deals with eye health promotion issues may be a contributing factor to the overwhelming lack of integrated eye health promotion activities in South Africa. It is therefore recommended that an integrated eye health promotion model be developed and be part of the South African primary health care system. / Health Studies / D. Litt et Phil. (Health Studies)