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1. Moving on Up: Multilevel Monitoring and Advocacy for Health Rights

Author:
Abrehet Gebremedhin
Publication Date:
01-2023
Content Type:
Working Paper
Institution:
Accountability Research Center (ARC), American University
Abstract:
Multilevel approaches to monitoring and advocacy are often used by international development practitioners, particularly in civil society, in efforts to hold governments—from the national to the local—to account for policy implementation. However, such approaches are not yet well understood or identified by many scholars in the social accountability field. This evidence review addresses this gap through a cross-case comparison of multilevel approaches in ten health rights programs across Africa, Asia, and Latin America. It draws on published evaluations, working papers, and peer-reviewed journal articles, as well as insights shared by implementers and researchers. Cases were selected to illustrate health rights initiatives that included monitoring or advocacy activity at a minimum of two different levels: local health facility, district, regional, provincial or national. Four significant findings emerge from this review of evidence: Vertical integration is a relatively common feature of multilevel monitoring and advocacy in these ten cases and is most likely to take place at the lower ends of the health system. However, it is largely implicit, and often not articulated in project design or theories of change. Horizontal organizing—the coordination of civil society action across districts or geographies—is a less visible feature of multilevel approaches to health rights programming than vertical integration. Despite the multilevel nature of health monitoring and advocacy in these ten cases, less than half reported working at the regional or provincial level, indicating a ‘missing middle’ between local and national activity. Escalation—the process by which citizens’ unaddressed claims move upwards to those with greater decision- making powers—is an important mechanism for accountability and one way in which vertical integration can happen. However, escalation is not clearly articulated in much of the gray literature, and therefore merits further research. The findings from this evidence review have implications for strategy, including: the importance of explicitly identifying multilevel tactics for monitoring and advocacy; theorizing the process by which unaddressed claims can be addressed, particularly moving up beyond the local level; emphasizing the importance of the ‘middle’ and ensuring regional and provincial decision-making is leveraged; and looking to link vertical integration with opportunities for horizontal organizing.
Topic:
Civil Society, Health, Accountability, Advocacy, and Monitoring
Political Geography:
Africa, Asia, and Latin America

2. Does Project-Level Aid for Water and Sanitation Improve Child Health Outcomes? Evidence from Household Panel Data in Uganda

Author:
Lynda Pickbourn, Raymond Caraher, and Léonce Ndikumana
Publication Date:
03-2023
Content Type:
Working Paper
Institution:
Political Economy Research Institute (PERI), University of Massachusetts Amherst
Abstract:
Empirical studies on the effectiveness of aid to the water, sanitation, and hygiene sector (WASH aid) have focused primarily on access to these services as the benchmark for evaluating the effectiveness of aid in this sector. Given the importance of WASH services for public health outcomes, the effectiveness of WASH aid should also be evaluated in terms of its impact on health outcomes. This is especially important in low- and middle-income countries where achieving sustained improvements in child health outcomes remains a challenge. This paper uses geocoded sub-national data on the location of WASH aid projects in Uganda in conjunction with six waves of nationally representative household-level panel survey data to examine the impact of aid-funded WASH projects on the probability of stunting among Ugandan children and infants. Analysing aid effectiveness at the sub-national level avoids the problems of cross-country heterogeneity in aid effectiveness that plagues other studies. Results of the difference-in-differences regression analysis suggest that proximity to an aid-funded WASH project reduces the probability of stunting by 14–21 per cent. The results suggest that scaling up aid to the WASH sector can help improve child health outcomes in the country.
Topic:
Health, Humanitarian Aid, Water, Sanitation, and Child Care
Political Geography:
Uganda and Africa

3. The Guinea Worm, President Carter and Me: A Journey Through Health Diplomacy

Author:
Lisa Rotondo
Publication Date:
05-2023
Content Type:
Journal Article
Journal:
American Diplomacy
Institution:
American Diplomacy
Abstract:
In September 2001, just days before 9/11, I arrived in Pissila, Burkina Faso for my Peace Corps assignment. I was eager to get to work helping my new home community do surveillance for a neglected tropical disease (NTD) called dracunculiasis, or Guinea worm disease. As a Peace Corps Volunteer in rural Burkina Faso, I biked from village to village, asking community members if they were aware of anyone with Guinea worm disease, an infection that has impacted both humans and animals since ancient times. Thanks, in part, to the work of volunteers before me, I never actually saw a person with Guinea worm disease during my two years as a volunteer. Burkina Faso was on the brink of eliminating the disease, and I remember thinking that the children in my community would never know the word for Guinea worm in their language, Moorè; it would not be in their vocabulary because they would never have to worry about it. I’ve reflected on that more than once during my career in public health. Knowing that we are truly making diseases history has been the drive underlying my efforts for the last two decades.
Topic:
Diplomacy, Health, Memoir, and Public Health
Political Geography:
Africa, United States of America, and Burkina Faso

4. Evaluating The Social and Economic Consequences of Global Warming On African Women

Author:
Eyesiere-Hope Essien
Publication Date:
04-2023
Content Type:
Policy Brief
Institution:
Women of Color Advancing Peace, Security and Conflict Transformation (WCAPS)
Abstract:
By Eyesiere-Hope Essien of the Climate Change Working Group Global warming is significantly impacting developing countries and the effects are far-reaching which is having a devastating impact on African women and their communities, leading to adverse social and economic consequences. Climate change has resulted in an increase in temperature, more extreme weather events, rising sea levels, and a decrease in water availability. As a result, African women are facing a growing number of challenges related to food insecurity, water scarcity, and healthcare access. They are at greater risk of poverty, displacement, and exploitation. These issues can be further exacerbated by a lack of access to education and employment opportunities. It is essential to understand the nature of these impacts and to take action to mitigate them and ensure African women have the resources and skills to adapt to the changing environment.
Topic:
Climate Change, Development, Health, Water, Women, and Food Security
Political Geography:
Africa

5. Analysis of the Healthcare Sector in Africa and Its Policy Implications for Korea

Author:
Young Ho Park, Munsu Kang, Yejin Kim, Kyu Tae Park, and Young-Chool Choi
Publication Date:
03-2022
Content Type:
Policy Brief
Institution:
Korea Institute for International Economic Policy (KIEP)
Abstract:
One of the main changes in Korea’s foreign affairs in recent years is the expansion of official development assistance (ODA), among which Africa is showing particularly rapid growth. Korea’s ODA to Africa accounted for 15% of its total ODA budget in 2010, and rose to 25% in 2019 as Korea emphasized its role in international development. Korea ranks 11th in terms of the cumulative size of ODA to the African healthcare sector between 2011–2019, totaling 674 million USD. As Korea’s expansion of ODA and solidarity in international development aid to respond to COVID-19 are related, the expansion of ODA in the African healthcare sector is anticipated to continue. This study analyzes features of the healthcare sector in Africa in an effort to suggest various plans for development cooperation, based on an evaluation of Korea’s ODA project design to enable the effective provision of ODA.
Topic:
Foreign Policy, Development, Health, Economic Growth, COVID-19, and Foreign Assistance
Political Geography:
Africa, Asia, and South Korea

6. India–East Africa: A Not So Healthy Relationship?

Author:
Isabelle Saint-Mezard and Françoise Nicolas
Publication Date:
02-2022
Content Type:
Special Report
Institution:
Institut français des relations internationales (IFRI)
Abstract:
Due to historical as well as geographical reasons, India and East Africa have long been close partners. In the recent period however, and even more so since the early 2000s, these ties have tightened as a result of combined efforts by the government of India and its business community. The presence of communities of Indian origin in several East African countries has also acted as a catalyst. East Africa is perceived as a valuable partner both by Indian authorities and by Indian private companies. Although the two types of Indian players may not explicitly coordinate their actions, their interests dovetail nicely in this particular region. The health sector sticks out as one major sector on which Indian actors focus in East Africa. It provides a striking example of the multilayered complementarity between India and East Africa, on the one hand, and between public and private Indian players’ interests on the other. However, India’s activism in the health sector is not necessarily perceived positively by the East African host countries. Despite some technology transfers and efforts by the Indian actors, be they public or private, to promote capacity-building, East African countries find themselves in a situation of dependence as a result of Indian companies exporting and producing drugs, building hospitals, improving hospital management and Information Technology (IT) infrastructure, or digitalizing healthcare. However, the major point of tension pertains to the promotion of medical tourism. Although offshore healthcare comes with many benefits, it is unlikely to be sustainable for the East African economies in the long run. Moreover, the money spent on medical tourism could arguably be used more usefully to develop local medical facilities and competence. The recent developments in the context of the pandemic have made the associated risk very clear. The challenge in the coming years will be for the two parties to find a way to better balance their relationship and set it on firmer ground – in other words, to make it healthier.
Topic:
Foreign Policy, Health, Bilateral Relations, and Partnerships
Political Geography:
Africa, South Asia, and India

7. Health and ethnic inequalities in Mozambique with special reference to leprosy

Author:
Isabel Maria Casimiro and Júlio Machele
Publication Date:
05-2022
Content Type:
Working Paper
Institution:
United Nations University
Abstract:
The subject of this paper is health and ethnic inequalities in Mozambique, with special reference to leprosy. It is argued that the health policies and strategies adopted in the colonial and post-colonial periods led to an unequal distribution not only of certain diseases but also of health infrastructures. The colonial regime, by neglecting and creating ineffective leprosaria in central and northern Mozambique, ‘ethnicized’ Lazarus disease, a fact corroborated by its current unequal distribution. In turn, post-colonial health policies and health coverage failed to take this inequality into account. The current National Leprosy Control Program aims to end leprosy and thus eliminate its identification with the ethnolinguistic groups in northern and central Mozambique. This qualitative study, which draws on reports from the Ministry of Health and NGOs, statistics, and observations, falls within the scope of the social sciences, with an emphasis on the comparative historical-sociological method.
Topic:
Health, Inequality, Ethnicity, and Leprosy
Political Geography:
Africa and Mozambique

8. Health of nations: How Europe can fight future pandemics

Author:
Anthony Dworkin
Publication Date:
02-2022
Content Type:
Policy Brief
Institution:
European Council on Foreign Relations (ECFR)
Abstract:
As the crisis phase of covid-19 recedes, there is a chance to improve international cooperation on global health – but also a danger that competing reform proposals will lead to inaction. The EU can best support reform of pandemic preparedness and response if it takes account of the concerns of different global powers. The union should combine a push for reform of and increased funding for the WHO with support for a new fund for health emergencies, overseen by a representative group of countries. The EU should promote a new global compact on health, matching countries’ commitment to surveillance and reporting of pathogens with support for stronger healthcare systems and greater equity in the allocation of countermeasures. The EU-Africa relationship offers a chance to pioneer such an approach, but the EU will need to go further in this than it has so far. The EU should promote African vaccine manufacturing, including by pressing European pharmaceutical companies to transfer knowledge and technology to Africa.
Topic:
Health, European Union, Pandemic, and COVID-19
Political Geography:
Africa, Russia, China, Europe, India, and United States of America

9. Consumption of New and Emerging Tobacco and Nicotine Products in Zambia: Implications for Policy

Author:
Shimukunki Manchishi, Edna Kabala, and Mulenga Chonzi Mulenga
Publication Date:
04-2022
Content Type:
Working Paper
Institution:
Zambia Institute for Policy Analysis and Research (ZIPAR)
Abstract:
The global economy has in recent years observed a rapid increase in the consumption of New and Emerging Tobacco and Nicotine Products (NETNPs). Consumers of the NETNPs in Zambia and elsewhere justify consumption of these products on grounds that they are less harmful and expose them to fewer health risks compared to traditional tobacco smoke. However, studies have shown that these NETNPs do not entirely filter out harmful chemicals from tobacco as presumed by many people, and in some cases may even expose smokers to more smoke over longer periods of time as is the case of water pipe (shisha). This study investigated the consumption and taxation of NETNPs in Zambia to generate knowledge and come up with evidence-based policy recommendations aimed at informing appropriate stakeholders on the consumption and taxation of NETNPs. The study employed a mixed methodology encompassing a desk review, a survey of 400 respondents and key informant interviews. In terms of the consumption of NETNPs, the study revealed that a majority of those surveyed consume water pipe, which ranked highest among the NETNPs consumed in Zambia. Other NETNPs commonly consumed include bidis, e-cigarettes and dry snuff (nsunko). The consumption of these products varied according to the economic status of the consumers, with products such as snus and e-cigarettes being much more preferred and consumed by those in employment because they can afford more costly products. Meanwhile, products such as water pipe and bidis were the products of choice among those not employed and this could also be attributed to the relatively lower cost of the products. Regarding the socio-demographic characteristics of the surveyed sample, the study established that most of the consumers of NETNPs were young, unmarried males. A notable finding in the study was that those who had attained tertiary level of education were the biggest consumers of NETNPs. With regards to taxation of NETNPs, the study has found that there is potential to increase taxes substantially based on consumers’ willingness to pay which would require very high tax levels to deter consumption. This would require the government to considerably increase excise taxes on these products which would ultimately increase their price and hence curtail their consumption. The study has established that the taxation of all tobacco products in Zambia is the sole responsibility of the ZRA which draws its mandate from various provisions of the Zambian law. Broadly there are eight categories used to classify tobacco and nicotine products based on the HS codes. This broad classification forms the basis for taxation of tobacco and nicotine products in Zambia. The study has established that there are four main taxes applied on tobacco products in Zambia, these include: a 25% customs duty levied on the value of the product imported; a VAT of 16% on the value of the product; a 5% surtax; and excise duty of 145% of the value for duty purposes (VDP) or K355 per kg for all tobacco products.
Topic:
Health, Digital Economy, Business, Tax Systems, Public Policy, Tobacco, Public Health, and Gender
Political Geography:
Africa and Zambia

10. CPLP: the first twenty-five years

Author:
Joseph Marques
Publication Date:
07-2022
Content Type:
Journal Article
Journal:
Conjuntura Austral: Journal of the Global South
Institution:
Conjuntura Austral: Journal of the Global South
Abstract:
The decision by Conjuntura Austral to dedicate a special issue to the 25th anniversary of the establishment of the Community of Portuguese Language Countries (CPLP) is to be commended. The uniqueness of the organization justifies a timely review of a small sample of its activities to date. Created in 1996, the CPLP adopted three main vectors of activity:1) the promotion and dissemination of the Portuguese language; 2) cooperation in a wide array of domains (i.e., education, health, science and technology, defense, agriculture, public administration, communication, justice, public safety, culture, sport and social communication, sustainable development, etc.); and 3) political and diplomatic coordination, especially in multilateral forums. The organization also agreed to adhere to several fundamental political principles such as the respect of the sovereignty of each member country; non-interference in domestic issues; reciprocal treatment; peace, democracy, rule of law, human rights, and social justice; territorial integrity of each member state; and the commitment to the promotion of development and cooperation. In addition to a common language and shared cultural heritage, the uniqueness of the CPLP results from the union of nine non-contiguous member states into a privileged geocultural space – the lusosphere – dedicated to the active promotion of its three main goals across four continents. It is a privileged forum for a “pluricontinental dialogue” in Portuguese. In addition, each country contributes by bringing its history, its unique interpretation of the “lusosphere” as well as its regional context (i.e., membership in the European Union, Mercosur, Southern African Development Community, Economic Community of West African States, etc.) as well as economic opportunities to the group. By joining, member countries reinforce the group’s collective projection onto the world stage as well as the opportunity to expand each member country’s diplomatic footprint. While each member had different reasons to join (i.e., maximize politicaldiplomatic cooperation, language promotion, widen access to technical cooperation, etc.), all believe that the CPLP can bolster the group’s overall political and diplomatic prestige while enhancing their collective and individual prospects. This special issue consists of six articles ranging from language to health, security and defense issues, business negotiations and civilian-military relations. It covers but a few topics from a long list of issues which, after the first twentyfive years of this new international organization, warrant the attention and critical review of academic scholars.
Topic:
Security, Foreign Policy, Defense Policy, Diplomacy, Health, Business, Language, Indigenous, and Civil-Military Relations
Political Geography:
Africa, Europe, Brazil, South America, Southeast Asia, and Community of Portuguese Language Countries (CPLP)