The first essay considers the relative effectiveness of government and non-governmental organizations (NGOs) as channels to allocate resources. I use a catastrophic climate-related shock--Hurricane Mitch--to examine the political economy of these channels of aid distribution at the micro level. I combine extensive data on aid received by Nicaraguan households with data on municipal election outcomes and an exogenous, precipitation-based measure of hurricane impact. I find that the hurricane had long-lasting effects on the aid received by households from both NGOs and the government. In the short term, however, the government did not provide aid according to the objective measure of hurricane damage but instead provided aid along political lines. The second essay presents estimates of a relationship between extreme hot temperatures during gestation and a child's subsequent physical well-being in a sample of children in Peru, thus extending existing evidence constructed from U.S. data. Estimates are constructed using high-resolution gridded climate data and geo-coded household surveys. The results suggest that a period of extreme heat (a month whose average temperature is more than 2 standard deviations above the local average) in the period 1 to 3 months before birth is associated with lower weight at birth and a reduction in height (measured 1 to 59 months after birth) that cannot be fully explained by birth weight. There is no evidence of differential maternal investment, as measured by duration of breastfeeding, according to a child's exposure to extreme heat during gestation. The third essay asks whether improved treatment of HIV/AIDS in Africa can be achieved simply by paying health workers to do more. I present estimates of the impact of financial incentives paid to individual workers at public health facilities in Mozambique. The results suggest that piece-rate incentives increased the delivery of five out of fourteen health services for which treatment effects can be identified, with estimated increases ranging from 34 to 157 percent, depending on the particular service. I find no evidence of a corresponding decrease in the delivery of services that are not financially incentivized, suggesting that there is no "crowding out" of intrinsic motivation.

<p>This MSc thesis contributes with new information on how vulnerability to tropical cyclone (TC) induced flooding has evolved at two coastal lowland study sites in the town of Corinto in Nicaragua over a period of 50 years. The research was done through rain station data analyses, semi-structured interviews, and focus group discussions. Analyses of changing poverty, human mobility, housing conditions, and occurrence of flood-related diseases were used as additional indicators supporting the overall vulnerability assessment.</p><p>The recent increase in the North Atlantic TC activity can not be seen in the data from Corinto. The both studied neighborhoods built on dump-sites and mangrove marsh have clearly become less exposed, less sensitive, and more resilient to external stress brought by TCs. These two sites have been developing into different directions since one has reached a more prosper status whereas the other is still rather marginal. The former has been supported by the local government while the latter has been growing in a less regulated way.</p><p>This thesis suggests that there are coastal communities in developing countries, which are able to cope with and adapt to extreme climate events even though this kind of vulnerability has been predicted to increase due to global warming.</p>

This MSc thesis contributes with new information on how vulnerability to tropical cyclone (TC) induced flooding has evolved at two coastal lowland study sites in the town of Corinto in Nicaragua over a period of 50 years. The research was done through rain station data analyses, semi-structured interviews, and focus group discussions. Analyses of changing poverty, human mobility, housing conditions, and occurrence of flood-related diseases were used as additional indicators supporting the overall vulnerability assessment. The recent increase in the North Atlantic TC activity can not be seen in the data from Corinto. The both studied neighborhoods built on dump-sites and mangrove marsh have clearly become less exposed, less sensitive, and more resilient to external stress brought by TCs. These two sites have been developing into different directions since one has reached a more prosper status whereas the other is still rather marginal. The former has been supported by the local government while the latter has been growing in a less regulated way. This thesis suggests that there are coastal communities in developing countries, which are able to cope with and adapt to extreme climate events even though this kind of vulnerability has been predicted to increase due to global warming.

The Global Fund to Fight AIDS, Tuberculosis & Malaria (GF) offers new approaches and challenges in international aid for health. Little research is available exploring the experiences of individuals and communities working within the confines of GF policies in Latin America. The study fills this gap through a qualitative exploration of local experiences with tuberculosis (TB) services and the GF in Nicaragua. <p>This study sought to examine local stakeholders (administrators, health personnel and persons affected by TB) experiences related to GF policies relevant to TB services in Nicaragua. The study drew from a population health perspective and was informed by an ethnomethodological approach. Key themes focused on TB control, health systems and health rights. Data collection involved contextual analysis, participant observation, in-depth interviews and focus groups. The study involved 6 months of fieldwork in Nicaragua from November 2005-April 2006. Fieldwork was conducted with the support, participation and assistance of the Centre for Health Research and Studies, the Damian Foundation and the National Tuberculosis Control Program. <p>Analysis of findings shows various internal and external challenges in communication/procedural and disbursement/execution aspects of the GF grant. In TB control, participants identified private sector participation, case detection & reduced abandonment as improvements resulting from the GF project, though sustainability was a key concern. In health systems, concerns of efficiency and efficacy in the use of funds were commonly expressed. The focus on human resource development via the GF was considered a strength of the project. Community participation and the reduction of stigma, two facets of health rights, were perceived to have improved through the GF grant; however, remain identified as key issues for improving the context of TB in Nicaragua. The experiences of people working to implement or receiving TB services and GF activities in Nicaragua offer valuable insight into the strengths and challenges of this country-driven approach to aid for health. The GF needs to give more attention to such experiences a resource for improving flexibility and assuring sustainability in program strengthening and human resource development.

Reducing health disparities requires intervention on the social determinants of health, as well as a means to monitor and evaluate these actions. Indicators are powerful evaluation tools that can support these efforts, but they are often developed without the input of those being measured and invariably reflect the value judgments of those who create them. This is particularly evident in the measurement of subjective social constructs such as gender equity, and the participation and collaboration of the intended beneficiaries are critical to the creation of relevant and useful indicators. These issues are examined in the context of a study to develop indicators to measure gender equity in the Nicaraguan Fair Trade coffee cooperative PROCOCER. Recent studies report that Fair Trade cooperatives are not adequately addressing the needs of its women members. Indicators can provide cooperatives with a consistent means to plan, implement, and sustain actions to improve gender equity. This study used participatory and feminist research methods to develop indicators based on focus groups and interviews with women members of PROCOCER, the cooperative staff, and external experts. The findings suggest that the cooperative has a role in promoting gender equity not only at the organizational level, but in the member families as well. Moreover, gender equity requires the empowerment of women in four broad dimensions of measurement: economic, political, sociocultural, and wellbeing. The indicator set proposes 22 objective and subjective indicators for immediate use by the cooperative and 7 indicators for future integration, mirroring its evolving gender strategy. The results also highlight salient lessons from the participatory process of indicator development, where the selected indicators were inherently shaped by the organizational context, the emerging research partnership, and the unique study constraints. These findings speak to the need for continued efforts to develop a critical awareness and organizational response to gender inequities, as well as the importance of providing spaces for women to define their own tools of evaluation.

Although Fair Trade provides better trading mechanisms and a set of well-documented tangible benefits for small-scale coffee producers in the Global South, large inequities persist within Fair Trade certified cooperatives. In particular, gender equity and womens empowerment are considered to be integral considerations of this system but visible gender inequities within certified cooperatives persist. Responding to this apparent contradiction, local partners in Nicaragua articulated a need to better understand how gender equity is understood and acted upon and thus this research projectan exploration of implemented gender equity-promoting processes at three different organizational levels (a national association of small-scale coffee producers, a second-tier cooperative, and a base cooperative)emerged. Drawing on feminist and social determinants of health approaches to research, the study was informed by semi-structured key informant interviews and document revision. Both the interviews and the documents revealed that although gender work is being considered at all three levels, each organizations approach and interpretation is unique, which exposes different challenges, tensions, and experiences.<p> Notably, results indicate that there is no clear definition of gender equity amongst the different organizational levels. As a result, these groups appear to be interpreting gender equity, and therefore initiating equity-promoting processes based on different criteria. Interviews also revealed that although there is no evidence of active discrimination or exclusion of women within cooperatives, gender equity work is nonetheless constrained by a constellation of socio-cultural and organizational challenges that women face. Examples of socio-cultural challenges revealed through the interviews include illiteracy, ascribed child-rearing responsibilities, household chores, machista culture, land tenure arrangements and gendered power relations in terms of decision-making, while organizational challenges include the attitudes and influence of leaders, a lack of gender mainstreaming in the cooperatives work and the fact that becoming a member requires an input of resources that most women do not have access to.<p> In eliciting experiences and perspectives from various levels of organizations in the Fair Trade coffee sector, the research revealed numerous tensions between rhetoric and practice. These tensions reflect blind spots in Fair Trade marketing and research wherein existing rhetoric does not reflect the experiences of the women, cooperatives, and organizations shared in this research. The three most predominant tensions that are explored in this study are: empowerment and organizational autonomy versus standardization; the subordination of gender work to commercial interests and; the concentration of power within democratically-organized cooperatives. The study acknowledges that it is not the primary role of Fair Trade to solve gender inequities, but does suggest that through some basic changes, including most notably a stronger consideration of local contexts, Fair Trade and local cooperatives can effectively support local gender work and contribute to womens empowerment and health.

This thesis examines the concept of masculinity as it concerns a group of male community leaders from impoverished neighbourhoods of Léon, Nicaragua. In collaboration with the non-governmental organization, Centro de Información y Servicios de Asesoría en Salud (CISAS) and utilizing person-centred ethnography, it explores masculinity in Nicaragua as reflected at the level of the individual. The work proposes that masculinities in Nicaragua are not as simple as some have suggested. Moreover, it relies on a Foucauldian analysis of disciplinary power to explicate the foundations of said conceptions as well as to develop new understandings of the idea of machismo.<p> Following analysis of an interview series and a thorough review of relevant literature, this thesis places Nicaraguan conceptions of masculinity as being discrete according to individuals. Moreover, the work deconstructs the notion of machismo as being nothing more than an individuated subject, most likely imposed on Nicaragua and, by extension, various other Latin American cultures, by forces exogenous to Latin America. Finally, this thesis discusses the tie that masculinity and health have as well as the influence that CISAS has on the personal lives of the research participants as well as their work in their communities.

Dans l'actuel contexte de la globalisation économique, les zones franches industrielles (ZFI) prennent de plus en plus d'importance dans la région de l'Amérique Centrale. Au Nicaragua, les ZFI sont apparues dans les années 90s et elles sont devenues, au niveau national, une source importante de travail dans le secteur formel de l'économie. Ce secteur absorbe une quantité considérable de la main d'oeuvre d'un pays ou près de 50% de la population vit dans la pauvreté, où le taux de chômage officiel est de 12% de la population économiquement active (PEA) et celui de sous-emploi est de 38.2%. Pour les travailleurs et particulièrement pour les femmes qui constituent 70% de la main d'oeuvre dans des ZFS, ces emplois sont la seule ou la meilleure option de travail disponible au Nicaragua. Malgré certains progrès récents, les restrictions à la liberté syndicale, les bas salaires, l'interdiction du droit de grève, les heures supplémentaires forcées sont monnaie courante dans les maquilas. De plus, le taux d'affiliation aux organisations syndicales dans les ZFS est très bas, non seulement à cause de la répression syndicale mais aussi en raison du niveau de politisation qui existe dans ces organisations. Les syndicats ne se sont pas encore adaptés au nouveau contexte économique du pays. Ils n'ont pas développé de nouvelles stratégies de lutte et de revendication des droits de travailleurs face à ce processus d'ouverture du marché. Et bien que la législation du travail au Nicaragua offre «sur papier» un haut degré de protection des droits des travailleurs, le système d'inspection au travail et l'intervention du Ministère sont faibles et peu efficaces en la matière. Le manque de ressources monétaires, mais aussi le manque de volonté politique d'appliquer ces normes et de veiller à ce que les entreprises les respectent expliquent largement l'écart entre le droit et la réalité. C'est dans ce contexte que le concept de travail décent peut jouer un rôle important dans l'amélioration des conditions de vie et de travail dans les ZFI. Ce concept s'inscrit dans la recherche générale d'une meilleure protection de la dignité humaine, de l'élimination de tout type de discrimination et de la promotion du développement humain. Cette recherche propose de jeter un regard juridique et social sur la situation des maquilas. Nous intégrons ici des éléments théoriques et pratiques à partir d'une analyse documentaire et d'une enquête de terrain que nous aidera à déterminer, à partir de la perception des travailleurs, des fonctionnaires publics, des acteurs économiques, des syndicats et d'autres organisations quels sont les problèmes rencontrés dans les ZFI pour faire face au déficit du travail décent au Nicaragua. Nous pourrons alors apprécier le niveau réel de réalisation du travail décent et également déterminer les défis encourus et la viabilité de ce concept en prenant en compte le niveau du développement, les conditions socio-économiques du pays et le rôle de l'État et des autres acteurs non étatiques. Finalement, nous souhaitons établir de nouvelles pistes de recherche sur l'application effective des normes et des programmes qui visent la protection et la réalisation effective des droits des travailleurs, et encore plus celui des travailleuses, dans un contexte d'égalité, de justice, de non discrimination et de protection sociale.

The Global Fund to Fight AIDS, Tuberculosis & Malaria (GF) offers new approaches and challenges in international aid for health. Little research is available exploring the experiences of individuals and communities working within the confines of GF policies in Latin America. The study fills this gap through a qualitative exploration of local experiences with tuberculosis (TB) services and the GF in Nicaragua. <p>This study sought to examine local stakeholders (administrators, health personnel and persons affected by TB) experiences related to GF policies relevant to TB services in Nicaragua. The study drew from a population health perspective and was informed by an ethnomethodological approach. Key themes focused on TB control, health systems and health rights. Data collection involved contextual analysis, participant observation, in-depth interviews and focus groups. The study involved 6 months of fieldwork in Nicaragua from November 2005-April 2006. Fieldwork was conducted with the support, participation and assistance of the Centre for Health Research and Studies, the Damian Foundation and the National Tuberculosis Control Program. <p>Analysis of findings shows various internal and external challenges in communication/procedural and disbursement/execution aspects of the GF grant. In TB control, participants identified private sector participation, case detection & reduced abandonment as improvements resulting from the GF project, though sustainability was a key concern. In health systems, concerns of efficiency and efficacy in the use of funds were commonly expressed. The focus on human resource development via the GF was considered a strength of the project. Community participation and the reduction of stigma, two facets of health rights, were perceived to have improved through the GF grant; however, remain identified as key issues for improving the context of TB in Nicaragua. The experiences of people working to implement or receiving TB services and GF activities in Nicaragua offer valuable insight into the strengths and challenges of this country-driven approach to aid for health. The GF needs to give more attention to such experiences a resource for improving flexibility and assuring sustainability in program strengthening and human resource development.

This thesis examines the concept of masculinity as it concerns a group of male community leaders from impoverished neighbourhoods of Léon, Nicaragua. In collaboration with the non-governmental organization, Centro de Información y Servicios de Asesoría en Salud (CISAS) and utilizing person-centred ethnography, it explores masculinity in Nicaragua as reflected at the level of the individual. The work proposes that masculinities in Nicaragua are not as simple as some have suggested. Moreover, it relies on a Foucauldian analysis of disciplinary power to explicate the foundations of said conceptions as well as to develop new understandings of the idea of machismo.<p> Following analysis of an interview series and a thorough review of relevant literature, this thesis places Nicaraguan conceptions of masculinity as being discrete according to individuals. Moreover, the work deconstructs the notion of machismo as being nothing more than an individuated subject, most likely imposed on Nicaragua and, by extension, various other Latin American cultures, by forces exogenous to Latin America. Finally, this thesis discusses the tie that masculinity and health have as well as the influence that CISAS has on the personal lives of the research participants as well as their work in their communities.