An analysis of well-being in urban Nigeria

Improving the well-being of Nigerians is the aim of Nigeria Vision 20:2020, the key development policy document in Nigeria. However, as well-being is an emerging and contested concept, this article explores how the well-being of urban citizens is understood in Nigeria, and identifies key trends affecting urban well-being as expressed by a selection of strategic elite stakeholders in Nigerian society. These included senior civil servants and politicians, and various senior members of civil society groups and academia. The analysis also reveals characteristics underpinning policies for urban well-being.     

Assessment of the Livelihood Empowerment Against Poverty programme in Karaga district,Ghana

This article assesses the contribution of the Livelihood Empowerment Against Poverty (LEAP) programme in reducing rural poverty in the Karaga district of Northern Ghana, using a mixed research design to compare the livelihoods of beneficiaries and non-beneficiaries. It concludes that the programme is contributing to poverty reduction among the poor and vulnerable, and recommends that school children benefiting from LEAP should be exempted from paying extra expenses such as examination and PTA fees. There should also be a system to provide subsidies for agriculture inputs to enable beneficiaries to engage in agriculture to promote longer term poverty alleviation.     

Private health insurance in Uganda: bridging the gap in public health provision?

This article discusses two organisations currently providing voluntary private health insurance in Uganda and considers their contributions to bridging the gap in provision in the country's public health sector.     

Reconciling cultural practices and progress: childbirth in Dove,Ghana

Women are forbidden from giving birth within the community in Dove, Ghana because it is against their culture. Such cultural practice is scarce in contemporary societies so studies on the impact of the practice are currently limited in development literature. This article uses key informant interviews and focus group discussion guides to gather data. Findings reveal that the Chief, the Queenmother, and other community members maintain that the practice is not negatively affecting the socio-economic development of Dove as they have strategies to mitigate the practice.     

Mining revenue and access to health care in Africa: could the revenue drawn from well-managed mining sectors finance exemption from payment for health?

Various reforms undertaken during the 1980s significantly reduced the capacity of states to regulate health systems. Of the many policies implemented since then to increase access to health care, policies of exemption from direct payment are among the most important. These can be very effective in a well-funded and managed context. Beyond political will, are African states unable to afford policies of exemption from payment for health care? Our analysis, based mostly but not exclusively on research carried out in West Africa, leads us to suggest the importance of a well-managed extractive sector in Africa as a potential source to finance policies of exemption from payment for health care. This could come about if all actors concerned, whether from the private sector or the donor community, were required to follow the same rules and requirements of transparency and accountability being asked of the countries concerned.     

Utilisation of maternal health services in Ethiopia: a key informant research project

This article explores the application of key informant research to examine barriers and facilitators to maternal health services in rural and pastoralist Ethiopia. The key informants were health extension workers (HEWs) who assist women with birth preparedness and facilitate timely referral to health centres for birth. While women encounter many barriers to giving birth in health facilities, where HEWs are supported by their communities and health centre staff, they can effectively encourage women to travel to health centres to give birth with skilled birth attendants rather than at home with unskilled relatives or traditional birth attendants.     

Using Rwandan traditions to strengthen programme and policy implementation

Implementing change is far harder than making policy pronouncements that call for change. Rwanda, in the 20 years since the 1994 genocide, has made substantial progress in turning around its economy and in meeting key Millennium Development Goals (MDGs). Real GDP in Rwanda grew at a rate of over 8% per year in the past years, the percentage of the people living in poverty has dropped by 14%, and UNDP reports that Rwanda is on track to meeting many but not all MDGs by 2015. Rwanda's progress in economic and social spheres stands out in Africa, where many countries, despite commitments to the MDGs, lag behind on performance. The difference in Rwanda is the leadership's attention to implementation, and the incorporation of endogenous practices, particularly into planning and accountability. This article is based on observations of practice at national and community levels and of policy design and implementation. It is a by-product of a study of the impact of different approaches to community health delivery systems in Rwanda, completed as part of the author's doctoral dissertation, and also of the author's experience working within the government in Rwanda.     

Reflections on mentoring experiences for evidence-informed decision-making in South Africa and Malawi

This article is based on the consensus that the availability and utilisation of research enhances policy discussions. The article reflects on the experiences within one approach: capacity building through mentoring. The UJ-BCURE programme aimed to increase the capacity of decision-makers to use evidence in decision-making via mentoring models. Mentoring is described as an interactive, facilitated process that promotes learning. The features of the models that have contributed to the programme’s success are orientation workshops with mentees combined with participatory, needs-led, and flexible approaches. UJ-BCURE experiences are relevant to the field of evidence-informed decision-making in an African government context.     

Does women’s empowerment increase accessibility to healthcare among women facing domestic violence?

This article aims to understand whether women’s empowerment increases access to healthcare among women facing domestic violence within the Indian context. It reports on a multi-centre cross-sectional study covering 18 states of India, with 14,405 women respondents through a systematic multi-stage sampling strategy. Both quantitative and qualitative methods were used. Despite substantive possession of the existing attributes of empowerment, women fail to receive necessary healthcare services. This reflects a situation of biased policy processes and institutional frameworks, which are a manifestation of existing patriarchal norms and which result in the piecemeal processes of entitlements.     

Increasing access to rural maternal health services in Zambia through demand-side interventions

This paper examines a demand-side intervention that significantly increased access to maternal health services in rural Zambia in a context where skilled birth attendance rates had been stagnant for over two decades. Aspects of the intervention design that were crucial to the programme's success were the participatory and adult learning-centred approach used to mobilise intervention communities, the use of a community volunteer model, and the design's sensitivity and responsiveness to underlying social factors and problems. The demand-side intervention is already being scaled up in six districts, and is highly suitable for national level scale-up.     

Donor-induced depoliticisation of development implementation: the case of Ghana’s Compact I

Based on empirical evidence from a donor-funded project in Ghana, this article demonstrates that when development implementation is depoliticised, targets will likely be achieved within budget and on time. Funded and supervised by the Millennium Challenge Corporation of the United States, Ghana Compact I has been recommended as a model for future development implementation. This article is an attempt to explain this success, compared to select social programmes. It argues that Compact I was implemented successfully because it was insulated from political interference, and suggests that donor-induced depoliticisation offers a route to successful development implementation in recipient countries.     

Indigenous languages and Africa's development dilemma

Most African states like The Gambia use European languages for state activities and formal education. Africa has been a global pilot site for “transplanted” development initiatives with apparently consistent outcomes: failure, medium triumph, or unsustainable “success stories”. Its natural resources have been fully exploited, perhaps at the expense of resources like mother-tongue languages. Sidelining mother-tongue languages as the medium for the translation of the voice of the state, explains the gap in cultural relevance of many borrowed development initiatives, but also the neglect of workable endogenous practices. Africa must look inwards and exploit its indigenous language assets to benefit sustained development.     

“Empowered patient” or “doctor knows best”? Political economy analysis and ownership

Efforts to incorporate “political thinking” into policy-making and practice in OECD-DAC development agencies have increasingly focused on the use of “political economy analysis” (PEA) frameworks and tools. While recognising the fundamental value of promoting politically informed programming, this article nevertheless highlights how contemporary efforts to this end have largely ignored another central development agenda: the ownership paradigm. Emphasising the highly donor-centric nature of PEA design and methodology, we explore critiques and justifications of this state of affairs, ultimately arguing that donors would benefit from embracing a more flexible and context-specific understanding of ownership.     

Pro-poor budget analysis of Kenya's free primary education policy

This practical note outlines Concern's approach to pro-poor budget analysis using the case of the Kenya Free Primary Education (FPE) policy. Analysis conducted on the outcomes of the FPE policy for Nairobi's urban slum-based poor suggests that the policy is not being implemented evenly within the city. The reasons stem from poor allocation and planning approaches, to political interference and unwillingness of teachers to work in slum-based schools. These have the unintended effect of increasing inequities for the urban poor, the reverse of the policy intention. The note outlines the pitfalls and practicalities of conducting this type of analysis.     

“Yes we are here,living, but malaria is surrounding us”: sustainable livelihoods and malaria in Tanzania

This paper examines connections between sustainable livelihoods and the ability to deal with health risks, in the Kilombero Valley in Tanzania where rates of mortality and morbidity from malaria remain high. Application of the Sustainable Livelihoods Approach (SLA) to a narrative of daily lives demonstrates that villagers have experienced a reduction in assets, income, and capital, which limits their ability to follow health promotion advice. The focus on livelihoods highlights possible local developmental interventions that could have a significant impact on improving the health and well-being of the villagers, with potential relevance to other places in the Global South.     

Water tariff conflict resolution through indigenous participation in tri-water sector partnerships: Dalun cluster communities in northern Ghana

The paper examines how the perceived ownership of a water resource negatively influenced local people's attitudes towards payment of potable water tariffs and exacerbated conflicts between water users and service providers in the Dalun community of the northern region of Ghana. The paper presents a case study of how community participation and endogenous approaches to conflict resolution contributed to payment of water tariffs. The findings show that the establishment of a tri-water sector partnership (TWSP), consisting of the Ghana Water Company Ltd (GWCL), private sector development practitioners, and community water boards, led to positive mediation of water tariff conflicts using the institution of chieftaincy. Alternative, endogenous conflict resolution methods combined with modern methods in a tripartite partnership showed promise as an approach to managing conflicts in water projects and in broader poverty reduction efforts.     

Using technology to deliver social protection: exploring opportunities and risks

Providing cash transfers to vulnerable groups reduces vulnerability and chronic poverty; but delivering cash to remote, rural locations can be expensive and insecure. Alternative delivery systems using technology are thus being piloted. This article uses examples from southern Africa to highlight the opportunities and risks involved in using technology to deliver social protection, with particular focus on two schemes in Malawi. It concludes that there is great potential for the use of technology in delivering social protection, especially if employed at a national scale and taking advantage of the full spectrum of uses to ensure cost-efficiency.     

When development breeds contempt: case examples of community-driven health systems initiatives

This article discusses case examples of community-led initiatives triggered by the introduction of an external development programme in Senegal and Mali. These are community initiatives that learn from projects initiated and funded by an external donor organisation, and transform interventions to better meet their own needs. The circumstances leading to the demand for, and successful establishment of, health infrastructure are examined to understand the triggers. These breakthroughs demonstrate unintended benefits of development, and the need to leverage donor-led initiatives. Therefore, community involvement, participation, and empowerment are key in establishing local ownership in development projects.     

Community health workers – motivation and incentives

The Community Health Worker (CHW) literature is expansive, covering more than 30 years of interest in the concept. Despite this, understanding of CHW motivation and the effectiveness of monetary incentives is limited. Using self-determination theory (SDT) as an explanatory framework, the article outlines some of the roles and functions that CHWs have filled within health and community systems, CHW motivation, and how different factors either enhance or detract from this.

Agents de santé communautaires – motivation et incitations

Les documents portant sur les agents de santé communautaires (ASC) sont nombreux et couvrent plus de 30 ans d'intérêt dans ce concept. En dépit de cela, la compréhension de la motivation des ASC et de l'efficacité des incitations monétaires est limitée. En utilisant la théorie de l'autodétermination (TAD) comme cadre explicatif, cet article présente quelques-uns des rôles et des fonctions que les ASC ont remplis dans le cadre de systèmes sanitaires et communautaires, la motivation des ASC et la manière dont différents facteurs soit la renforcent soit l'affaiblissent.

Trabajadores de salud comunitarios - motivación e incentivos

Existen numerosas investigaciones sobre los trabajadores de salud comunitarios (tsc), que abarcan los más de 30 años durante los cuales el concepto ha sido objeto de estudio. A pesar de lo anterior, las motivaciones de los tsc y la eficacia de los incentivos monetarios no son ampliamente comprendidas. Con el apoyo de la teoría de la autodeterminación como marco analítico, el presente artículo expone algunos de los roles y de las funciones desempeñados por los tsc en los sistemas de salud comunitarios, así como las motivaciones que los impulsan, analizando, a la vez, los distintos factores que alientan o desincentivan tales motivaciones.

Trabalhadores comunitários da saúde – motivação e incentivos

A literatura sobre Trabalhadores Comunitários da Saúde (TCSs) é extensa, abrangendo mais de 30 anos de interesse no conceito. Apesar disto, o entendimento sobre a motivação dos TCSs e da efetividade de incentivos monetários é limitado. Utilizando a Teoria da Auto-Determinação (TAD) como estrutura explicativa, o artigo apresenta algumas das tarefas e funções que os TCSs têm realizado dentro dos sistemas de saúde e comunidade, a motivação dos TCSs e como fatores diferentes melhoram ou agravam a partir disto.