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Policy makers and academics alike have mistakenly promoted an agenda which takes well-governed democratic and consolidated 'Weberian' states as the model for the world and the goal of development programs. Whilst Western industrial democracies are the exception, areas of limited statehood where state institutions are weak and ineffective, are everywhere, and, this books argues, can still be well-governed. Three factors explain effective governance in areas of limited statehood: Fair and transparent institutions 'fit for purpose,' legitimate governors accepted by the people, and social trust among the citizens. Effective and legitimate governance in the absence of a functioning state is not only provided by international organizations, foreign aid agencies, and non-governmental organizations but also by multi-national companies, rebel groups and other violent non-state actors, 'traditional' as well as religious leaders, and community-based organizations. Börzel and Risse base their argument on empirical findings from over a decade of research covering Latin America, the Middle East, Sub-Saharan Africa, and Asia.
If political circumstances are an important cause of unemployment in the Middle East, does this tend to attenuate the influence of economic infrastructure? I approach this question by building a geospatial dataset of the West Bank, an area with high unemployment arguably linked to political problems. I find Israeli army road obstacles, deployed during the Second Intifada, obstructed peri-urban Palestinian commuters from accessing commercial centers and border crossings, inflicting employment losses that were substantially offset by employment gains among their more centrally located Palestinian competitors. The findings suggest that marginal economic interventions, such as removing obstacles or paving roads, have a good chance of altering the spatial distribution of unemployment, but may struggle to reduce overall unemployment levels absent political reform.
Local Content and Sustainable Development in Global Energy Markets analyses the topical and contentious issue of the critical intersections between local content requirements (LCRs) and the implementation of sustainable development treaties in global energy markets including Africa, Asia, Europe, North America, Latin America, South America, Australasia and the Middle East While LCRs generally aim to boost domestic value creation and economic growth, inappropriately designed LCRs could produce negative social, human rights and environmental outcomes, and a misalignment of a country's fiscal policies and global sustainable development goals. These unintended outcomes may ultimately serve as disincentive to foreign participation in a country's energy market. This book outlines the guiding principles of a sustainable and rights-based approach – focusing on transparency, accountability, gender justice and other human rights issues – to the design, application and implementation of LCRs in global energy markets to avoid misalignments.
Developing countries face the daunting challenge of stimulating innovation-intensive sectors to increase their participation in the knowledge economy. In this context, two pressing questions arise: What types of state-business relations foster the adoption of industrial upgrading policies? And, what are the mechanisms through which some state-business relations configurations shape the likelihood of policy adoption under more democratic and open conditions? Bridging developmental state and business politics literature, this paper presents a novel framework that posits that the levels of bureaucratic quality and business cohesion generate diverse industrial upgrading policymaking patterns, and thus outcomes. An in-depth case study of the software sector and a cross-case comparison of the aerospace sector in Mexico during the 2000s illustrate and refine the framework. This article makes three main contributions. First, it expands extant political economy theories of industrial upgrading in developing democracies. Second, it improves our understanding of the private sector by carefully analyzing sectoral business cohesion. And third, the paper specifies the mechanisms through which bureaucrats and firms in democratic developing countries collaborate to enact programs that spur high-tech industries in the twenty-first century.
Because of the high burden of untreated mental illness in humanitarian settings and low- and middle-income countries, scaling-up effective psychological interventions require a cultural adaptation process that is feasible and acceptable. Our adaptation process incorporates changes into both content and implementation strategies, with a focus on local understandings of distress and treatment mechanisms of action.
Building upon the ecological validity model, we developed a 10-step process, the mental health Cultural Adaptation and Contextualization for Implementation (mhCACI) procedure, and piloted this approach in Nepal for Group Problem Management Plus (PM+), a task-sharing intervention, proven effective for adults with psychological distress in low-resource settings. Detailed documentation tools were used to ensure rigor and transparency during the adaptation process.
The mhCACI is a 10-step process: (1) identify mechanisms of action, (2) conduct a literature desk review for the culture and context, (3) conduct a training-of-trainers, (4) translate intervention materials, (5) conduct an expert read-through of the materials, (6) qualitative assessment of intervention population and site, (7) conduct practice rounds, (8) conduct an adaptation workshop with experts and implementers, (9) pilot test the training, supervision, and implementation, and (10) review through process evaluation. For Group PM+, key adaptations were harmonizing the mechanisms of action with cultural models of ‘tension’; modification of recruitment procedures to assure fit; and development of a skills checklist.
A 10-step mhCACI process could feasibly be implemented in a humanitarian setting to rapidly prepare a psychological intervention for widespread implementation.
To explore the impact of COVID-19 public health restrictions on the lives of older adults living in Uganda.
Qualitative semi-structured interview study.
Older adults living in Uganda (aged 60+).
Older adults in Uganda were interviewed over the phone and asked about their lives before and since COVID-19, and how public health restrictions have affected their lives. Semi-structured interviews were audio-recorded, transcribed and translated into English. Transcripts were thematically analyzed and themes generated in discussion.
In total, 30 older adults participated in the study. Five themes were identified: (1) economic impacts; (2) lack of access to basic necessities; (3) impact on healthcare utilization; (4) social impacts and (5) violent reinforcement of public health restrictions. COVID-19 public health restrictions had severe impacts on their lives, with many people having not enough food to eat due to lack of income, and being unable to pay their grandchildren’s school fees. Steep rises in public transport fares and an overall avoidance of transport also resulted in a lack of access to healthcare services and difficulty in getting food. Restrictions were violently reinforced by security guards.
Public health restrictions have a severe impact not only on older adults but also on the whole family in Uganda. Governmental strategies to contain the virus need to provide more support to enable people to get basic necessities and live as normal a life as possible.
There is a growing recognition that African firms are innovating and these innovations are important to African economies. This chapter provides a general introduction to the book by introducing the broad objectives, the research design and methods as well as the research questions tackled in each of the subsequent chapters of the book. In addition, the chapter presents the structure of the book and summarizes the major findings in each chapter.
This chapter summarizes the findings from this book and develops the framework for the analysis of under-the-radar innovation and its nature, sources and impact, as well as the policy implications from the research. It argues that Africa cannot leapfrog the 4th Industrial Revolution with the under-the-radar type of innovation. Therefore, policy responses at the national and international levels are needed to address these challenges and to build an inclusive global community. Limitations of the study and areas for future research are discussed at the end of the chapter.
Sierra Leone is one of the least developed low-income countries (LICs), slowly recovering from the effects of a devastating civil war and an Ebola outbreak. The health care system is characterized by chronic shortage of skilled human resources, equipment, and essential medicines. The referral system is weak and vulnerable, with 75% of the country having insufficient access to essential health care. Consequently, Sierra Leone has the highest maternal and child mortality rates in the world. This manuscript describes the implementation of a National Emergency Medical Service (NEMS), a project aiming to create the first prehospital emergency medical system in the country. In 2017, a joint venture of Doctors with Africa (CUAMM), Veneto Region, and Research Center in Emergency and Disaster Medicine (CRIMEDIM) was developed to support the Ministry of Health and Sanitation (MOHS) in designing and managing the NEMS system, one of the very few structured, fully equipped, and free-of-charge prehospital service in the African continent. The NEMS design was the result of an in-depth research phase that included a preliminary assessment, literature review, and consultations with key stakeholders and managers of similar systems in other African countries. From May 27, 2019, after a timeframe of six months in which all the districts have been progressively trained and made operational, the NEMS became operative at national level. By the end of March 2020, the NEMS operation center (OC) and the 81 ambulances dispatched on the ground handled a total number of 36,814 emergency calls, 35,493 missions, and 31,036 referrals.
The Arab world has historically had limited descriptive representation for women, although that is changing. Will having more women officeholders lead women citizens to become more engaged? Or could it depress engagement due to pervasive gender biases? To answer these questions, this paper uses a nationally-representative experiment in Tunisia. Unexpectedly, people were less likely to want to contact their representatives when primed to think of a mixed-gender group of officeholders compared to an all-women group. This pattern did not vary according to respondents’ gender. Further analyses reveal that the effect was concentrated among Islamists, which is consistent with some Islamists’ support for gender segregation. This finding encourages research examining women's political presence in conservative environments where gender segregation is common.
To investigate the prevalence and socio-economic inequalities in breast milk, breast milk substitutes (BMS) and other non-human milk consumption, by children under 2 years in low- and middle-income countries (LMIC).
We analysed the prevalence of continued breast-feeding at 1 and 2 years and frequency of formula and other non-human milk consumption by age in months. Indicators were estimated through 24-h dietary recall. Absolute and relative wealth indicators were used to describe within- and between-country socio-economic inequalities.
Nationally representative surveys from 2010 onwards from eighty-six LMIC.
394 977 children aged under 2 years.
Breast-feeding declined sharply as children became older in all LMIC, especially in upper-middle-income countries. BMS consumption peaked at 6 months of age in low/lower-middle-income countries and at around 12 months in upper-middle-income countries. Irrespective of country, BMS consumption was higher in children from wealthier families, and breast-feeding in children from poorer families. Multilevel linear regression analysis showed that BMS consumption was positively associated with absolute income, and breast-feeding negatively associated. Findings for other non-human milk consumption were less straightforward. Unmeasured factors at country level explained a substantial proportion of overall variability in BMS consumption and breast-feeding.
Breast-feeding falls sharply as children become older, especially in wealthier families in upper-middle-income countries; this same group also consumes more BMS at any age. Country-level factors play an important role in explaining BMS consumption by all family wealth groups, suggesting that BMS marketing at national level might be partly responsible for the observed differences.
Chronic suppurative otitis media is a major cause of disabling childhood hearing loss, especially in low-income countries. Estimates on its prevalence in sub-Saharan Africa range from the lowest to the highest in the world (less than one per cent to more than five per cent). However, the prevalence of chronic suppurative otitis media in Zimbabwe is largely unknown. This study aimed to determine the prevalence of paediatric chronic suppurative otitis media and other middle-ear pathology in rural Zimbabwe.
A cross-sectional study was performed in primary school children aged 4–13 years from the rural province of Mashonaland East. Participants underwent video otoscopy and tympanometry.
Out of 451 examined children, two (0.4 per cent) had chronic suppurative otitis media. Acute otitis media was present in one (0.2 per cent), otitis media with effusion was present in five (1.1 per cent) and scarring was present in 69 (15.3 per cent).
Chronic suppurative otitis media and otitis media sequelae were surprisingly uncommon in this sample of rural primary school children in Zimbabwe. More studies, preferably population-based, are needed to enable more precise estimates of chronic suppurative otitis media prevalence in Zimbabwe.
The international community has acknowledged that international trade can be an effective means of helping to achieve the 2030 Agenda for Sustainable Development and its 17 Sustainable Development Goals (SDGs). Traditionally, preferential trade agreements (PTAs) were designed to promote trade flows. PTAs have become more comprehensive and now also cover non-economic policy areas, such as the environment. This chapter examines whether the inclusion of environmental provisions in PTAs changes the observed overall positive contribution that PTAs make to economic outcomes and thereby to the economic objectives of the SDGs. Specifically, we ask whether the inclusion of environmental provisions in PTAs reduces export flows between PTA partner countries. Using a novel data set on environmental provisions in PTAs, we estimate gravity type panel regressions. We find that membership in PTAs including more environmental provisions is associated with less trade among trade partners compared to PTAs that include less or no environmental provisions. This negative effect of environmental provisions is fully driven by the negative effect on South–North trade flows, i.e. exports from developing to high-income countries.
Is economic development a prerequisite for concern over environmental issues? The existing literature has yet to reach an empirical consensus on this question. To revisit this important topic, we offer new experimental evidence by conducting online survey experiments in one developed country (the United States) and one developing country (India). We investigate how providing information on the negative environmental costs of foreign direct investment (FDI) affects people’s support of FDI, and how these effects differ between residents of the United States and India. The results of our experiment show that among residents of the United States, being presented with information about the environmental costs of FDI sharply reduces support for FDI, while a substantially weaker effect of the environmental costs of FDI was observed among residents of India. Also, respondents from the United States are more concerned about environmental damage caused by FDI in their own city than in a distant location, while this pattern is not observed among respondents from India. These results are consistent with the claim that economic prosperity and wealth are prerequisites for environmental concern.
This study supplements spatial panel econometrics techniques with qualitative GIS to analyse spatio-temporal changes in the distribution of integrated conservation–development projects relative to poaching activity and unauthorized resource use in Volcanoes National Park, Rwanda. Cluster and spatial regression analyses were performed on data from ranger monitoring containing > 35,000 combined observations of illegal activities in Volcanoes National Park, against tourism revenue sharing and conservation NGO funding data for 2006–2015. Results were enriched with qualitative GIS analysis from key informant interviews. We found a statistically significant negative linear effect of overall integrated conservation–development investments on unauthorized resource use in Volcanoes National Park. However, individually, funding from Rwanda's tourism revenue sharing policy did not have an effect in contrast to the significant negative effect of conservation NGO funding. In another contrast between NGO funding and tourism revenue sharing funding, spatial analysis revealed significant gaps in revenue sharing funding relative to the hotspots of illegal activities, but these gaps were not present for NGO funding. Insight from qualitative GIS analysis suggests that incongruity in prioritization by decision makers at least partly explains the differences between the effects of revenue sharing and conservation NGO investment. Although the overall results are encouraging for integrated conservation–development projects, we recommend increased spatial alignment of project funding with clusters of illegal activities, which can make investment decision-making more data-driven and projects more effective for conservation.
Corruption is one of the most destructive and pervasive wicked problems, present in commercial enterprises, governmental agencies and Non-Government Organisations (NGOs). The reduction of corruption is prominent amongst the United Nation's Sustainable Development Goals, but research on corruption in the context of NGOs in developing countries is scarce, particularly relating to the identification and management of corruption in this context. This paper adds new insights to this under-researched field by providing a rich description of a single, longitudinal ethnographic case study of one NGO in Bangladesh, which has successfully identified and managed (out) complex, entrenched corruption through a simple sustainable intervention: expanding and improving information channels for stakeholders.
In order to design, enact, and protect poverty alleviation policies in developing countries, we must first understand the psychology of how the poor react to their plight, and not just the psychology of the privileged called upon for sacrifice. This book integrates social and psycho-dynamic psychology, economics, policy design, and policy-process theory to explore ways to follow through on successful poverty-alleviation initiatives, while averting destructive conflict. Using eight case studies across Latin America, Southeast Asia, and South Asia, William Ascher examines successes and failures in helping the poor through affirmative action, cash transfers, social-spending targeting, subsidies, and regional development. In doing so, he demonstrates how social identities, attributions of deservingness, and perceptions of the policy process shape both the willingness to support pro-poor policies and the conflict that emerges over distributional issues.
Because of the increasing adoption and use of technology in primary health care (PHC), public health informatics competencies (PHIC) are becoming essential for public health workers. Unfortunately, no studies have measured PHIC in resource-limited setting. This paper describes the process of developing and validating Public Health Informatics Competencies for Primary Health Care (PHIC4PHC), an instrument for measuring PHC workers’ competencies in public health informatics. Method: This study developed a questionnaire that had three stages: the Delphi technique, a pretest, and field test. Eleven academicians from a university and 13 PHC workers joined 2 rounds of group discussion in the first stage. The second stage comprised two pilot studies with 75 PHC workers in Semarang Municipality. The third stage involved validating the questionnaire with 462 PHC workers in Kendal District. This study used Pearson’s product-moment correlation for the validity check and Cronbach’s alpha coefficient for determining the internal consistency. This study used the K-means algorithm for clustering the results of the PHIC4PHC questionnaire. Results and Conclusion: PHIC4PHC is the first comprehensive PHIC questionnaire administered in a resource-limited setting, consisting of 11 indicators and 42 measurement items concerning knowledge of health information systems, skills required for health data management, ethical aspects of data sharing and health information literacy. The final results of PHIC4PHC were clustered into three classes based on the K-means algorithm. Overall, 45.7% PHC workers achieved medium competency, whereas 25.6% and 27.7% achieved low and high competency, respectively. Men had higher competency than women. The higher the worker’s level of education, the higher the PHIC level; the longer the worker’s work experience, the lower the PHIC score; and the greater the worker’s age, the lower the PHIC score. Measuring and monitoring PHIC is vital to support successful health IT adoption in PHC.
Traumatic brain injuries (TBIs) are an important cause of mortality and disability around the world. Early intervention and stabilization are necessary to obtain optimal outcomes, yet little is written on the topic in low- and middle-income countries (LMICs). The aim is to provide a descriptive analysis of patients with TBI treated by Service d’Aide Medicale Urgente (SAMU), the prehospital ambulance service in Kigali, Rwanda.
What is the incidence and nature of TBI seen on the ambulance in Kigali, Rwanda?
A retrospective descriptive analysis was performed using SAMU records captured on an electronic database from December 2012 through May 2016. Variables included demographic information, injury characteristics, and interventional data.
Patients with TBIs accounted for 18.0% (n = 2,012) of all SAMU cases. The incidence of TBIs in Kigali was 234 crashes per 100,000 people. The mean age was 30.5 (SD = 11.5) years and 81.5% (n = 1,615) were men. The most common mechanisms were road traffic incidents (RTIs; 78.5%, n = 1,535), assault (10.7%, n=216), and falls (7.8%, n=156). Most patients experienced mild TBI (Glasgow Coma Score [GCS] ≥ 13; 83.5%, n = 1,625). The most common interventions were provision of pain medications (71.0%, n = 1,429), placement of a cervical collar (53.6%, n = 1,079), and administration of intravenous fluids (48.7%, n = 979). In total, TBIs were involved in 67.0% of all mortalities seen by SAMU.
Currently, TBIs represent a large burden of disease managed in the prehospital setting of Kigali, Rwanda. These injuries are most often caused by RTIs and were observed in 67% of mortalities seen by SAMU. Rwanda has implemented several initiatives to reduce the incidence of TBIs with a specific emphasis on road safety. Further efforts are needed to better prevent these injuries. Countries seeking to develop prehospital care capacity should train providers to manage patients with TBIs.
The WTO SPS Agreement sets a framework of rules that encourages harmonization through international standards. However, there is a lack of empirical research at the macro-level on how such international standards affect trade flows. This study conducts a general impact analysis on one of the most widely used food-related international standards in the world, the ISO22000, accounting for the different product types and country groups. The Codex Alimentarius Commission, one of three sister organizations of the SPS Agreement, notably participated in developing this standard that is based on its Food Code, harmonizing the Hazard Analysis and Critical Control Points (HACCP) and Good Manufacturing Practice (GMP). This study employs recent developments in using the gravity model, along with uniquely employed additional specifications to enhance further the reliability of the estimates. Results show that ISO22000 diffusion negatively affects the exports of processed products that are the major export goods of developed countries. Primary and semi-processed products that compose the majority of developing country exports are not significantly affected, providing evidence against the concerns for the compliance burdens of developing countries when being certified to the standard. The burdens may depend more on the degree of processing of the exported goods rather than on a country's development status.