This thesis consists of three essays that address various aspects of the economics of maternal health care. The first two essays examine the determinants of utilization of maternal health care services in low-income countries, while the third essay examines the determinants of utilization of prenatal ultrasonography in Canada. The first essay examines the influence of prenatal attendance (as well as a wide array of observed individual-, household- and community-level characteristics) on a woman’s decision to give birth at a health facility or at home for thirty-two low-income countries (across Asia, Sub-Saharan Africa and Latin America). This empirical investigation employs the Demographic and Health Surveys (DHS) data and a two-level random intercept model. The results show that prenatal attendance has a substantial influence on the use of facility delivery in all three geographical regions. Women having four prenatal visits were 7.3 times more likely to deliver at a health facility than those with no prenatal care. The second essay addresses two related questions: what factors determine a woman’s decision to seek prenatal care; and are those the same factors that determine the frequency of care? This investigation also utilizes Demographic and Health Surveys (DHS) data for thirty-two low-income countries (across Asia, Sub-Saharan Africa and Latin America) and applies a two-part and multi-level model to that data. The results suggest that, though a wide range of factors influence both decisions, that influence varies in magnitude across the two decisions, as well as across the three geographical regions. The third essay examines the influence of various socioeconomic and demographic factors on the frequency of prenatal ultrasounds in Canada, while controlling for maternal risk profiles. This investigation utilizes data from the Maternity Experience Survey (MES) of the Canadian Perinatal Surveillance System and employs a count data regression model (the Poisson distribution) to estimate the effect of various factors on the number of prenatal ultrasounds. The results of this investigation suggest that, even after controlling for maternal risk factors, the type of health-care provider, province of prenatal care, and timings of first ultrasound are the strongest predictors of number of ultrasounds.

The global burden of injury is severely underappreciated and disproportionately affects low-income countries. With timely, appropriate orthopaedic treatment disability and mortality can be prevented, yet appropriate health resources are seldom available. Without orthopaedic medical devices (OMDs), quality of orthopaedic care suffers and the burden of preventable injury is exacerbated. A qualitative case study of 45 key informant interviews was conducted in Uganda to explore accessibility of OMDs, such as plaster, external fixators and implants. Data analysis elicited four major themes as barriers preventing access to OMDs in Uganda: 1) Poor leadership in government and corruption; 2) inadequate human resources; 3) inefficient and insufficient health care infrastructure; and 4) high costs of OMDs and poverty. Potential solutions for improving access to orthopaedic care were categorized as policies prioritizing orthopaedic services, training more orthopaedic specialists and creating incentives for them to work in underserviced areas, and innovative strategies funding for orthopaedic services.

The global burden of injury is severely underappreciated and disproportionately affects low-income countries. With timely, appropriate orthopaedic treatment disability and mortality can be prevented, yet appropriate health resources are seldom available. Without orthopaedic medical devices (OMDs), quality of orthopaedic care suffers and the burden of preventable injury is exacerbated. A qualitative case study of 45 key informant interviews was conducted in Uganda to explore accessibility of OMDs, such as plaster, external fixators and implants. Data analysis elicited four major themes as barriers preventing access to OMDs in Uganda: 1) Poor leadership in government and corruption; 2) inadequate human resources; 3) inefficient and insufficient health care infrastructure; and 4) high costs of OMDs and poverty. Potential solutions for improving access to orthopaedic care were categorized as policies prioritizing orthopaedic services, training more orthopaedic specialists and creating incentives for them to work in underserviced areas, and innovative strategies funding for orthopaedic services.

Children with disabilities (CWD) in East Africa experience occupational injustice in its most severe forms. A number of complex and dynamic factors contribute to this injustice including cultural beliefs about disability, a significant gap between policy adaptation and policy implementation, and physical barriers as a result of poverty. Uwezo is the Swahili word for ability, a name suitable for a program created to empower CWD in low-income countries (LIC) and lower-middle income countries (LMIC) to achieve their maximum potential. Uwezo is a community-owned and community-run vocational education program for CWD that will originate in East Africa with the intent to expand globally to serve additional communities in need. Children with disabilities ages 3-16 will learn three categories of classroom and experiential instruction including: education for everyday living, life skills and vocational study. Designed with sustainability as a priority, the program will be presented to community members as a template, intended to be carefully tailored according to the community’s unique priorities and needs. Ultimately, Uwezo has the potential to rapidly shift cultural perception about disability, enhance the local economy, inspire grassroot advocacy efforts, and improve the and quality of life for children and persons with disabilities.

The Intergovernmental Panel on Climate Change 2018 highlights the importance of short-lived greenhouse gasses to combat global warming. This study explores the relationship between Gross Domestic Product per capita and methane per capita. The relationship is explored in relation to the Environmental Kuznets Curve theory where the subjects to examination used are High Income Countries and Low Income Countries based on United Nation classifications in 2019. In total 47 countries are examined where 30 countries are High Income Countries and 17 are Low Income Countries. The relationships are examined for the time periods 1970 to 2017 through Fixed Effect Models. To improve accuracy additional control variables are added: Population in agriculture (% of total employment), balance of payments and forest areas. With the added control variables, the time frame used in Fixed Effect Models changes to 1991 to 2017. The different Fixed Effect Models provide inverted U-shaped relationships for Low Income Countries and uncertain results for High Income Countries according to the Environmental Kuznets Curve.

Zugl.: Sankt Gallen, University, Diss., 2009.

The purpose of research aid is to contribute to development in different ways through the use of research. Sarec (the Swedish Agency for Research Cooperation with Developing Countries) was one of the pioneers within state research aid, and existed between 1975 and 2008. This dissertation studies Sarec’s policy from a historical perspective with the help of official documents and interviews with former directors. Discourse theory together with concepts from Science and Technology Studies comprise the theoretical framework of the study. One of the central questions asked is how the view of the relationship between research and development has changed over time. One of the conclusions is that there are two main policy discourses that are established early on and that can be traced throughout the entire period studied. The two discourses share the starting point that modern science can contribute to development and that national research capacity is an important component in this. The localist discourse represents a more multifaceted view of how research can contribute to development, and what that development consist of. It is more explicitly anti-colonialist and to a greater degree prioritizes the local context as basis for decisions regarding support. The universalist discourse places less emphasis on where knowledge is produced since it can be used anywhere, as long as the right structures and priorities are in place. The discourses reflect different views of knowledge and development. Some decades one discourse dominates over the other, and other decades they are more equal. / Forskningsbistånd har som syfte att bidra till att forskning på olika sätt leder till utveckling. Sarec (the Swedish Agency for Research Cooperation with Developing Countries) var en av pionjärerna inom statligt forskningsbistånd och existerade mellan 1975 och 2008. I denna avhandling studeras Sarecs policy ur ett historiskt perspektiv med hjälp av offentliga dokument och intervjuer med före detta chefer. Diskursteori tillsammans med begrepp från teknik- och vetenskapsstudier utgör det teoretiska ramverket för studien. Frågor som ställs är till exempel hur synen på relationen mellan forskning och utveckling har förändrats över tid. En av slutsatserna är att det finns två stora policydiskurser som etableras tidigt och som går att följa under hela perioden. Båda innefattar en stark tro på modern vetenskap och dess möjlighet att bidra till utveckling, samt på att forskningskapacitet är en viktig komponent i detta. Den lokalistiska diskursen representerar en mer mångfacetterad syn på hur forskning kan bidra till utveckling samt vad denna utveckling är. Den är mer explicit antikolonialistisk i sin ansats och prioriterar i högre grad den lokala kontexten som grund för beslut kring stöd. Den universalistiska diskursen betonar att det spelar mindre roll var kunskapen produceras eftersom den kan nyttjas varsomhelst, bara rätt strukturer och prioriteringar finns på plats. Diskurserna speglar olika syn på kunskap och utveckling. Vissa årtionden dominerar en diskurs över den andra, och andra årtionden är de mer jämbördiga.

Sustainability and the penetration of new markets beyond developed industries are two topics that are gaining increasing attention both in research and in business practice. As Western industries are becoming saturated, companies are looking for further business alternatives and are focusing on North-South opportunities, among others. Therefore, bottom-of-the-pyramid markets are often mentioned as promising mass markets. However, market access remains a challenge, as bottom-of-the-pyramid contexts are characterized by low incomes, resource constraints, and infrastructural barriers. In addition, sustainable practices are a challenge. Since the introduction of the Sustainable Development Goals by the United Nations, which apply to all countries, companies are required to address aspects of sustainability in their business practices. However, they have to cope with conflicting dimensions inherent to sustainability such as improving economic and social aspects, which are usually accompanied by higher resource demands and environmental degradation. Previous literature started to address these issues by focusing on innovative approaches such as frugal innovation, social innovation, or resource-constrained innovation. In the last decade, research on frugal innovations has particularly focused on how to address the challenges of low-income and resource-constrained contexts, often with aspects of sustainability in mind. However, to address these low-income contexts, having a suitable innovation is not enough; businesses must actually reach the target group, such as by overcoming accessibility issues in rural areas. Initial research has examined the value chains of frugal innovations and ways to engage the consumer, which also leads to social improvements. Building on this research, this dissertation combines four themes – frugal innovation, sustainability, inclusive business, and Scrum – to illustrate how innovations can address the needs of target groups in bottom-of-the-pyramid contexts and how these innovations can be implemented by engaging target customers. The first paper illustrates the links between frugal innovation and sustainability based on a new sustainability evaluation framework. All cases considered contribute to sustainability, with social improvements being most notable. New employment and income opportunities are key social improvements. They reflect inclusive business approaches, which are the focus of the second paper. The case examples of the second paper show how frugal innovation can be implemented in accordance with inclusive business, which leads to customer involvement and thus mutually supports frugal innovation. The Inclusive Business Link Model for Frugal Innovation was built to show connections of frugal innovation and inclusive business and to provide application possibilities. A key finding was that for the cases considered a high level of customer integration can be achieved through frugal innovations with modular designs and is supported by knowledge transfer and partnerships. To address knowledge transfer and partnerships in particular, the last paper applies Scrum as an agile approach at the execution level for inclusive business. In developing the conceptual model Inclusive Business Scrum Approach, inclusive business is considered as the 'what' and Scrum as the 'how' in engaging low-income consumers. With regard to all three papers and the four included topics, this dissertation achieves several outcomes and contributes to a broader view of how low-income consumers can be addressed. First, each paper illustrates benefits of combining the concepts that could be valuable when addressing the bottom-of-the-pyramid context. Thereby, the papers build on each other and include previous results. Second, aspects of social sustainability are addressed mainly by combining frugal innovation and inclusive business. Third, each paper develops a model or framework intending to support practical applicability. Finally, an outline is provided for how combining frugal innovation, inclusive business, and Scrum positively could impact partnerships, knowledge transfer, and the empowerment of the target group, which could culminate in an approach that addresses challenges experienced when entering the Bottom of the Pyramid that also considers sustainability. The new management options developed begin at a general level and end at an execution level and thus contribute to holistic perspectives on innovations, approaches, and implementation options for organizations intending to address the Bottom of the Pyramid.:Abstract 1 Table of Contents 3 List of Abbreviations 6 List of Tables 7 List of Figures 8 1 Introduction 9 2 Theoretical background 15 2.1 Defining sustainability 15 2.2 The BoP as target group 18 2.3 Frugal innovation 20 2.4 Inclusive business 22 2.5 The agile approach Scrum 25 2.6 Contribution of the investigations and the current relevance of topics 28 3 Methodology 30 4 Papers 32 4.1 Publication 1: Introducing a Sustainability Evaluation Framework based on the Sustainable Development Goals applied to Four Cases of South African Frugal Innovation 32 4.1.1 Introduction 33 4.1.2 Theoretical background and research context 34 4.1.3 Methodology 38 4.1.4 Developing an evaluation framework 40 4.1.5 Limitations 44 4.1.6 Introducing the frugal cases 44 4.1.7 Findings 45 4.1.8 Discussion 48 4.1.9 Conclusion 49 4.2 Publication 2: How Frugal Innovation and Inclusive Business Are Linked to Tackle Low-income Markets 51 4.2.1 Introduction 51 4.2.2 Literature review 55 4.2.3 Methods 62 4.2.4 Results 66 4.2.5 Cross case analysis 75 4.2.6 Inclusive business integration stair model 77 4.2.7 Development of propositions 82 4.2.8 Discussion 84 4.2.9 Research implications 86 4.2.10 Managerial implications 87 4.2.11 Concluding remarks and future research 88 4.3 Publication 3: Boosting Inclusive Businesses’ Opportunities Through the Adoption of Scrum: an Execution Strategy to Enter Low-end Markets 91 4.3.1 Introduction 92 4.3.2 Theoretical background 94 4.3.3 Conceptual model: Inclusive Business Scrum Approach 99 4.3.4 Challenges 106 4.3.5 Summary of key facts and propositions 108 4.3.6 Conclusion 111 4.3.7 Research implications 112 4.3.8 Managerial implications 113 4.3.9 Limitations and future research ideas 114 5 Discussion 116 5.1 Social sustainability 117 5.2 Partnerships 118 5.3 Knowledge transfer 118 5.4 Empowering the target group 119 5.5 Context challenges 119 6 Critical considerations and additional thoughts 121 6.1 Definition and contributions of frugal innovation 121 6.2 Sustainability of initiatives at the BoP and inclusive business 122 6.3 Aspects of leadership theories in Scrum 124 7 Methodological limitations 126 8 Research implications and future research ideas 128 9 Managerial implications 131 10 Conclusion 133 11 References 135 11.1 List of interviews 171 11.2 Further references used in Publication 2, anonymized form 171

La résistance bactérienne aux antibiotiques est un problème de santé publique majeur, touchant plus particulièrement les enfants dans les pays en développement (PED).Nous avons effectué une revue systématique de la littérature pour quantifier le niveau de résistance aux antibiotiques chez les enfants âgés de moins de 2 ans dans les PED. De manière générale, les données sur la résistance aux antibiotiques dans la population étudiées sont rares. Selon les publications identifiées, Staphylococcus aureus, Escherichia coli, et Klebsiella spp. apparaissent comme les causes les plus fréquentes d’infections néonatales sévères. Chez les enfants âgés de 1 à 24 mois, Streptococcus pneumoniae et Salmonella spp. apparaissent comme les causes les plus fréquentes d’infections bactériennes invasives.Dans une seconde revue systématique, nous avons examiné les méthodologies actuelles utilisées pour mesurer la consommation d’antibiotiques dans les PED.Nos résultats montrent qu’aucunes des méthodologiesne permet, à elle seule, de répondre aux besoins de ces pays en terme de données.Nous avons conduit une enquête en population à Madagascar et au Sénégal afin d’examiner les modalités de consommation d’antibiotiques chez des enfants de moins de 2 ans. Dans les 2 pays, la plupart des antibiotiques étaient achetés en pharmacie sur présentation d’une ordonnance. Une proportion élevée des antibiotiques était utilisée pour le traitement d’infections probablement d’origine virale. Des facteurs tels que la disponibilité de centres de santé, de pharmacies, l’existence de programmes de remboursement ou encore la formation du personnel pourraient influencer la fréquence de consommations d’antibiotiques au niveau national.Les résultats issus de ces travaux de recherche ajoutent des données essentielles à la littérature existante et mettent en évidence des leçons importantes pour la lutte contre la résistance aux antibiotiques dans les PEDs. / Antimicrobial resistance is a growing threat across the world and is likely to disproportionately affect children in low-income countries (LICs).To estimate the burden of antibiotic resistance in the community among children under two in LICs we undertook a review of published literature. Common isolates in neonatal sepsis cases included Staphylococcus aureus, Escherichia coli, and Klebsiella. Among children 1 mo. to 2 yrs., Streptococcus pneumonia and Salmonella were most often reported. Information on antibiotic resistance was sparse and often relied on few isolates.We reviewed methods to measure antibiotic consumption in LICs from published literature and showed that current techniques used in isolation are insufficient to respond to all the data needs in LICs. Integrating study techniques and starting with community surveys may respond more adequately to this issue in LICs and lead to more actionable results.To investigate patterns of antibiotic consumption and related factors among children under two in Madagascar and Senegal we undertook community surveys in two sites in Madagasgar (Antananarvo and Moramanga) and one site in Senegal. Results showed relatively high levels of antibiotic use among children. The majority of antibiotics were purchased in pharmacies with a prescription in both countries. Data suggest a high proportion of use for likely viral infections. Local contexts including the availability of health care facilities, availability of pharmacies, national payment schemes, and provider training seemed to play a role in country usage rates.Results from this work add essential data to the literature where relatively little data exists and reveal important lessons about studying and combating antibiotic resistance in LICs.

Cette thèse propose une analyse empirique de deux stratégies majeures du financement du développement; les annulations de dette et la mobilisation des ressources domestiques. Les trois premiers chapitres tentent d'analyser les effets des annulations de dette du début des années 2000 sur les finances publiques et les possibilités de réendettement des gouvernements bénéficiaires. Nos résultats montrent que les annulations de dette concédées via les initiatives PPTE et IADM ont permis d'améliorer significativement la composition budgétaire des gouvernements récipiendaires et de diversifier leurs sources de financement. Néanmoins, d'autres résultats mettent en lumière l'existence d'un aléa moral induit par ces initiatives, nécessitant ainsi une surveillance accrue des politiques budgétaires, notamment une fois l'annulation de dette octroyée. Enfin, le quatrième chapitre tente de revisiter la relation entre fiscalité et croissance en adoptant une approche macro-micro à l'aide de données de firmes. Notre analyse montre que la fiscalité est bénéfique à l'activité des entreprise, en particulier celles des pays à faible revenu. Par ailleurs, d'autres résultats suggèrent que cet effet est renforcé lorsque ces mêmes firmes font face à une faible corruption, réitérant ainsi la nécessité pour les pays en développement d'établir un environnement économique et politique sain. / This thesis aims at investigating empirically the effects of two financing strategies for low-income countries; debt relief and taxation. The first three chapters focus on the consequences of debt relief for public finance and new external financing. Results show that cancellations granted under the multilateral debt relief initiatives have been beneficial for recipient countries by significantly improving the composition of their budget and widening financing opportunities. However, findings also underline the risk of moral hazard stemming from these initiatives which thus calls for continuous sound fiscal management, especially after debt relief. Lastly, the fourth chapter revisits the taxation-growth nexus adopting a macro-micro approach. Using firm-level data in developing countries our findings suggest that taxation is favorable to firms' activity, especially when firms operate in poor countries characterized by a significant lack of infrastructure. Moreover, this effect of taxation seems to be maximal in the absence of corruption, hence reaffirming the need for healthy and enabling economic and political environments in developing countries.