Governments In Sub-Saharan Africa Research Articles

Closer together or farther apart: are there club convergence in ecological footprint?

This study empirically tests whether there is evidence of convergence in ecological footprint among 189 countries for the period 1990-2017. Using the novel log (t) regression model that accommodates likely transitional heterogeneity in the panel, the results provide evidence for the divergence of ecological footprint (EF) for the world sample. A similar empirical outcome was obtained for sub-Saharan Africa (SSA), Europe and Central Asia (ECA), East Asia and Pacific (EAP), Latin America and the Caribbean (LAC), and Middle East and North Africa (MENA). Nevertheless, the study found three convergence clubs for the world sample, SSA, ECA, and LAC, while two clubs were found for EAC and MENA. Further empirical results from the ordered logit and probit model suggest initial EF and natural resource utilization are the most critical driver of club membership in SSA. Since we established three club formations, the study recommends different environmental protection policies should be adopted for the countries in these convergence clubs. It is also important for SSA governments to implement strong environmental regulations in respect of the exploitation of resources.

Access to and Affordability of World Health Organization Essential Medicines for Cancer in Sub-Saharan Africa: Examples from Kenya, Rwanda, and Uganda.

Cancer mortality is high in sub-Saharan Africa (SSA), partly due to inadequate treatment access. We explored access to and affordability of cancer treatment regimens for the top 10 cancers utilizing examples from Kenya, Uganda, and Rwanda. Population, healthcare financing, minimum wage, and cancer incidence and mortality data were obtained from the WHO, World Bank, public sources, and GLOBOCAN. National Essential Medicines List (NEML) alignment with 2019 WHO EML was assessed as a proportion. Cancer regimen pricing was calculated using public and proprietary sources and methods from prior studies. Affordability through universal healthcare coverage (UHC) was assessed as 1-year cost <3× gross national income per capita; and to patients out-of-pocket (OOP), as 30-day treatment course cost <1 day of minimum wage work. A total of 93.4% of the WHO EML cancer medicines were listed on the 2019 Kenya NEML, and 70.5% and 41.1% on Uganda (2016) and Rwanda (2015) NEMLs, respectively. Generic chemotherapies were available and affordable to governments through UHC to treat non-Hodgkin's lymphoma, cervical, breast, prostate, colorectal, ovarian cancers, and select leukemias. Newer targeted agents were not affordable through government UHC purchasing, while some capecitabine-based regimens were not affordable in Uganda and Rwanda. All therapies were not affordable OOP. All cancer treatment regimens were not affordable OOP and some were not covered by governments. Newer targeted drugs were not affordable to all 3 governments. UHC of cancer drugs and improving targeted therapy affordability to LMIC governments in SSA are key to improving treatment access and health outcomes.

The economic burden of treating uncomplicated hypertension in Sub-Saharan Africa: a systematic literature review

Background and ObjectivesHypertension is one of the leading cardiovascular risk factors with high numbers of undiagnosed and untreated patients in Sub Saharan Africa (SSA). The health systems and affected people are often overwhelmed by the social and economic burden that comes with the disease. However, the research on the economic burden and consequences of hypertension treatment remains scare in SSA. The objective of our review was to compare different hypertension treatment costs across the continent and identify major cost drivers.Material and MethodsSystematic literature searches were conducted in multiple databases (e.g., PubMed, Web of Science, Google Scholar) for peer reviewed articles written in English language with a publication date from inception to Jan. 2022. We included studies assessing direct and indirect costs of hypertension therapy in SSA from a provider or user perspective. The search and a quality assessment were independently executed by two researchers. All results were converted to 2021 US Dollar.ResultsOf 3999 results identified in the initial search, 33 were selected for data extraction. Costs differed between countries, costing perspectives and cost categories. Only 25% of the SSA countries were mentioned in the studies, with Nigeria dominating the research with a share of 27% of the studies. We identified 15 results each from a user or provider perspective. Medication costs were accountable for the most part of the expenditures with a range from 1.70$ to 97.06$ from a patient perspective and 0.09$ to 193.55$ from a provider perspective per patient per month. Major cost drivers were multidrug treatment, inpatient or hospital care and having a comorbidity like diabetes.ConclusionHypertension poses a significant economic burden for patients and governments in SSA. Interpreting and comparing the results from different countries and studies is difficult as there are different financing methods and cost items are defined in different ways. However, our results identify medication costs as one of the biggest cost contributors. When fighting the economic burden in SSA, reducing medication costs in form of subsidies or special interventions needs to be considered.Trial registrationRegistration: PROSPERO, ID CRD42020220957.

English

Recent agricultural and economic growth has been impressive in sub Saharan Africa (SSA), and explained in part by decades of donor investments. Sustaining recent progress will hence require a fundamental reshaping of SSA host country government policy priorities, which traditionally underinvest in agricultural research. This article investigates country-specific factors that explain government&rsquo;s tendencies towards policy bias across three important policy dimensions: cash versus food crops, imports versus exports, and agriculture versus non-agriculture sectors. Policy bias was measured using rates of assistance indices across the three policy dimensions based on panel data, from 26 years (1955-2011) and across 26 SSA countries. Results indicate that overall policy orientation of SSA governments are biased against agriculture, but within the specific policy dimensions there was a significant bias towards cash over food crops and exports over imports. The result also shows the level of government assistance in resource rich countries decreased as rural population share increased above 57%. Key words: Agriculture assistance, sub Saharan Africa, policy bias, trade bias index.

Asserting public health interest in acting on commercial determinants of health in sub-Saharan Africa: insights from a discourse analysis

The actors influencing the commercial determinants of health (CDOH) in sub-Saharan Africa (SSA) have different interests and lenses around the costs and benefits of market influences in health. We analysed...

Statism and the Growth of Authoritarianism in Sub-Saharan Africa

Statism or Realism proffers that the State is the main actor in politics, and, therefore, the Referent Object. This belief appears to be the predominate basis of governance in Sub-Saharan Africa, despite the region’s efforts towards mainstreaming democratic principles in governance. There are several other progressive schools of thought that inure society with authority superior to that of the State on the basis of Rule of law. The resulting polarity of power presents problems for aligning State Security influenced by realist securitization theories and Societal Security influenced by the United Nations Development Program’s Human Development Report since 1994 and the Welsh School of Security Studies. In this analytical, correctional research approach, I will show that the States seem to apply mechanical and substantive modalities through authoritarian control over society, since the State is the sole provider of security, making the citizens less significant in the eyes of the ruling elite, Security Forces and Police Services with delegated State powers. Although the Constitutional frameworks of the common law, English Language speaking nations in Africa provide that sovereignty emanates from the citizens and, therefore, the repository and custodians of all laws, the concept of Statism or Realism ignores such provisions analytically, legislatively and constructively. There is considerable disregard for the citizens as the custodians of power which has led the State to create National Security institutions, backed by legislation and public policy, whose primary pre-occupations are the rendition of protective and intelligence services to perpetuate the regime’s control over the citizens. There are also researchers and political scientists that seem to legitimize the emasculation of the larger members of Society, since they are deemed as part of the existential and imminent threats to State power. The history of democracy in Sub-Saharan Africa provides to date, blatant lack of the Rule of Law, Justice and Equal Protections, where citizens compete against the State interests. This introductory study contextually teases out from the literature on security studies, the thrust of the Copenhagen and the Welsh School’s approaches towards governance; to demonstrate that, the pursuit of authoritarian rule in Africa is rather a deviation from both Schools of Security Studies, with recommendations for change towards a more measurable deliverables of the Human Development Report of 1994 and its progeny of progressive international development policies.

Robert Home, Land Issues for Urban Governance in Sub-Saharan Africa

Robert Home, Land Issues for Urban Governance in Sub-Saharan Africa

Water policy and resilience of potable water infrastructure to climate risks in rural Malawi

Adverse effects of climate risks on access to potable water are increasingly being acknowledged in sub Saharan Africa. Resilient infrastructure supported by appropriate governance arrangements, is therefore central to water security under these extreme weather events. For several decades, governments in sub Saharan Africa have developed governance arrangements including infrastructure and legislation to ensure water security. However, the effectiveness of policy consideration in resilience of potable water infrastructure to climate risks/extreme weather events as well as their seasonality has been a neglected area. Using Zomba rural in Southern Malawi as a case study, this study was therefore aimed at addressing this gap by assessing the effectiveness of local water policy responses to extreme weather events using the 2015 flooding effects on potable water in Zomba rural in Southern Malawi as a case study. The study firstly analysed rainfall and extremes indices for evidence of trends of climate risks in Zomba during the period from 1982 to 2015. To understand the effects of the 2015 flooding on water infrastructure and access to potable water as well as evaluate policy provisions for responses to climate risks, the study further applied a qualitative approach through policy document review, key informant interviews, focus group discussions. The results suggest a generally decreasing annual rainfall pattern with high variability by seasons and frequent occurrences of droughts and flooding. The annual rainfall decrease was not statistically significant at α = 0.05 level, whereas the extremes indices were statistically significant. However, the study found that current policy frameworks are more biased towards drought preparedness as compared to flooding preparedness. For instance, the 2015 floods destroyed vital water supply infrastructure and the responsible institutions could not rehabilitate the damaged infrastructure, leaving communities with intermittent and no supply of potable water for over six months. On the other hand, during dry seasons and drought conditions, the intakes are above the water level. These results show that the present rural water infrastructure is vulnerable and not resilient enough to extreme weather events. In addition, the water institutions are especially not prepared to handle flooding events and their impacts. In this regard, water legislation and infrastructure designs do not adequately take into consideration the effects of extreme events on access to potable water, making water security a challenge in rural Malawi.

Uptake, Barriers, and Determinants of e-Learning Among University Students in Selected Low Income Countries in Sub-Saharan Africa Amidst the COVID-19 Disruption: An Online Survey.

BackgroundThe Coronavirus pandemic has affected educational systems worldwide, leading to the widespread closure of schools in the affected countries with a phased reopening over time. The objective of this study was to determine the uptake, barriers, and determinants of e-learning among university students in Uganda and Nigeria following the COVID-19 disruption in 2020.MethodologyA total of 240 respondents comprising University students participated in this survey. It was a cross-sectional descriptive study using a self-administered structured online questionnaire using Google documents. Data were analyzed using IBM SPSS v.21 with statistical significance set at p<0.05.ResultsThe modal age group was 21–25 years at 128 (53.3%) participants, uptake of e-learning was 159 (66.3%). The majority of respondents used a smartphone (98.8%) for the internet, with WhatsApp platform (63.7%) as the most frequently used for e-learning. Barriers to e-learning, as self-reported by respondents, were the cost of internet services (82.1%), internet inaccessibility (68.8%), lack of institutional support (47.1%), and lack of training (40.8%). Determinants of e-learning were age (p<0.001) and sex (p=0.026).ConclusionTwo thirds of the university students had ever been taught online before the lockdown. Barriers to e-learning were mainly the cost of internet services and internet inaccessibility. Age and sex of respondents were determinants of e-learning use among University students. It is recommended that students be trained and facilitated by the Universities to adopt e-learning effectively. Governments in sub-Saharan Africa and the relevant sectors in the economy should improve the ICT infrastructure, internet accessibility, and facilitate reduction in the cost of services.

Studying Muslim Minorities in Subsaharan Africa: Preliminary Remarks

Abstract The introduction to the special issue on Muslim minorities in Subsaharan Africa argues that a focus on the circumstances and challenges faced by them opens up productive lines of inquiry into forms of religious coexistence and plurality, in Subsaharan Africa and elsewhere. Starting from a conceptual reflection on different forms of religious plurality, the article enters a plea for more a sustained reflection on the effects of state regulation of religious coexistence and how it is lived in everyday life. To this effect, the introduction invites readers to take the different case studies of the special issue as a way to assess and compare the genealogies and legacies of state regimes of religious governance in Subsaharan Africa.

Prevalence and determinants of maternal healthcare utilisation among young women in sub-Saharan Africa: cross-sectional analyses of demographic and health survey data

BackgroundMaternal health constitutes high priority agenda for governments across the world. Despite efforts by various governments in sub-Saharan Africa (SSA), the sub-region still records very high maternal mortality cases. Meanwhile, adequate utilization of maternal healthcare (antenatal care [ANC], skilled birth attendance [SBA], and Postnatal care [PNC]) plays a vital role in achieving improved maternal health outcomes. We examined the prevalence and determinants of maternal healthcare utilization among young women in 28 sub-Saharan African countries using data from demographic and health surveys.MethodsThis was a cross-sectional study of 43,786 young women aged 15–24 years from the most recent demographic and health surveys of 28 sub-Saharan African countries. We adopted a multilevel logistic regression analysis in examining the determinats of ANC, SBA, and PNC respectively. The results are presented as adjusted Odds Ratios (aOR) for the logistic regression analysis. Statistical significance was set at p < 0.05.ResultsThe prevalence of maternal healthcare utilisation among young women in SSA was 55.2%, 78.8%, and 40% for ANC, SBA, and PNC respectively with inter-country variations. The probability of utilising maternal healthcare increased with wealth status. Young women who were in the richest wealth quintile were, for instance, 2.03, 5.80, and 1.24 times respectively more likely to utilise ANC (95% CI = 1.80–2.29), SBA (95% CI = 4.67–7.20), and PNC (95% CI = 1.08–1.43) than young women in the poorest wealth quintile. Young women who indicated having a barrier to healthcare utilisation were, however, less likely to utilise maternal healthcare (ANC: aOR = 0.83, 95% CI = 0.78–0.88; SBA: aOR = 0.82, 95% CI = 0.75–0.88; PNC: aOR = 0.88, 95% CI = 0.83–0.94).ConclusionWhile SBA utilisation was high, we found ANC and PNC utilisation to be quite low among young women in SSA with inter-country variations. To accelerate progress towards the attainment of the Sustainable Development Goal (SDG) targets on reducing maternal mortality and achieving universal health coverage, our study recommends the adoption of interventions which have proven effective in some countries, by countries which recorded low maternal healthcare utilisation. The interventions include the implementation of free delivery services, training and integration of TBAs into orthodox maternal healthcare, improved accessibility of facilities, and consistent public health education. These interventions could particularly focus on young women in the lowest wealth quintile, those who experience barriers to maternal healthcare utilisation, uneducated women, and young women from rural areas.

Institutional Change and Entrepreneurial Governance in Sub-Saharan Africa: Implications for Inclusive Growth and Development

A key focus for entrepreneurial development strategies for many economies is to facilitate sustainable and inclusive growth that will create jobs and reduce poverty. Sub-Saharan Africa (SSA) is confronted with institutional challenges in bringing these objectives into fruition. We draw from institutionalism and entrepreneurial governance theory to explore institutional context and challenges to entrepreneurial development and inclusive growth in Africa. We theorize that entrepreneurial governance and public policy must focus on policy direction, enterprise enabling institutions for nascent entrepreneurs, seed funding and local embeddedness to eliminate institutional voids. We provide a dynamic view of institutional context and offer a policy framework to uncover challenges to entrepreneurial emergence and sustainable development in Africa. The study submits that enabling entrepreneurial activities for inclusive growth and sustainable development in Sub-Saharan Africa requires the right institutional and supporting ecosystem.

The Nature of Local Revenue Decisions within the Decentralized Structures in Kenya

Fiscal decentralization is widely recognized to bring leaders and decisions makers closer to the citizens resulting in better delivery of public services. Underperformance in the revenue collection has a significant effect on the ability of the sub-national governments (SNGs) to deliver services to its citizens. Due to these challenges, this study sought to examine the state of the local revenue decisions among sub-national(county) governments with a focus on Kiambu, Vihiga and Baringo Counties in Kenya. The study was descriptive in nature and used interviews with purposefully directors from budget, finance and planning departments and secondary data collected from Commission on Revenue Allocation (CRA) and Kenya National Bureau of Statistics (KNBS). Data obtained was analyzed thematically and descriptively. The analysis shows that the revenue collection by the SNGs in Kenya have increased marginally since the establishment of the devolved structures but have stagnated when they are adjusted for inflation. The revenue collection figures of the SNGs are underperforming and are drawn from a relatively small base. User charges, business licenses and property tax are the main revenue bases contributing about 86 per cent with user fees contributing more than half of the revenues. The effective own source revenue (OSR) to budget funding indicates that six counties can fulfil the requirements for devolution of at least 10 per cent effective OSR to budget. This scenario impeded the attainment of the objectives of devolution and increases dependence on fiscal transfers. The study recommends the following; the county governments should give realizable estimates of local revenues, improve on the management and control of the current revenue bases and lastly integrate new revenue bases. The study contributes to the existing knowledge by delving more into the elements of revenue decentralization and recommends further studies on how other elements of revenue decentralization impact the performance of the subnational governments in sub-Saharan Africa

The Comparative Economics of Globalisation and Governance in Sub-Saharan Africa

The Comparative Economics of Globalisation and Governance in Sub-Saharan Africa

Private Sector Investment in Infrastructure in Sub-Saharan Africa Post-COVID-19: The Role of Law.

Sub-Saharan Africa (SSA) is the lowest income region of the world with a considerable number of low-income countries. The region is challenged by a massive infrastructure deficit. In recent years, the governments of the countries in the region have expressed the desire to bridge the huge gap in infrastructure assets through a partnership with the private sector using the public-private partnership model. However, the advent of the Coronavirus (COVID-19) pandemic which has resulted in unplanned public sector expenditure poses a new kind of hurdle to climb for states in the region. As such, there is a need for governments in SSA to create and sustain efficient opportunities for private sector investment in infrastructure procurement and maintenance. This article adopted the doctrinal legal research method as well as review of literature in the examination of the role of law in creating a healthy and sustainable business environment for private sector participation in infrastructure financing and operation in a post-COVID-19 era in the SSA region. The article recommends among others, the enactment of legislation to create an enabling environment for raising domestic capital for the purposes of private sector–led public infrastructure procurement as well as the implementation of strategies suited for developing economies to attain successful outcomes in private sector backed infrastructure procurement.

Non-Response to Population Aging in Sub-Saharan Africa: A Survey of Gerontology Scholars

Life expectancy is increasing globally, with the biggest gains expected in sub-Saharan Africa. In fact, most of the population growth globally in the next few decades will occur in sub-Saharan Africa. Using an online survey we investigated the perspectives of gerontology scholars on the challenges of aging in sub-Saharan Africa as well as the assets of elders. Respondents (n=72) from 17 countries, primarily in Africa, and representing 16 disciplines, identified the top issues facing African elders as: poverty, lack of trained professionals, food insecurity, disability/health issues, and long-term care. Older adults’ unique strengths were noted as indigenous knowledge systems, being holders of cultural heritage, and their contributions to development. Respondents’ biggest concerns about older adults in sub-Saharan Africa were the lack of government attention to aging issues (63%) and a lack of social services targeted to elders’ needs (57%). Government funding (77.8%) and international partnerships (38.9%) were noted as resources needed to support aging research in sub-Saharan Africa. The response or non-response of governments in sub-Saharan Africa will determine whether the growing number of older adults will increasingly experience unmet needs and whether their assets will be considered in development efforts. Establishing professional networks of gerontology scholars in the region will help to document the challenges faced by elders, to plan for the coming demographic shift, and to empower elders to thrive as valued community members.

Microfinance institutions' risk and governance in Sub-Saharan Africa

PurposeThe purpose of this study is to explore the impact of MFI-level governance on microfinance institutions' (MFIs’) risk in Sub-Saharan Africa (SSA).Design/methodology/approachThe study uses data from a sample of 151 MFIs operating in 21 SSA countries during 2005–2014. The Feasible Generalized Least Squares (FGLS) regression model is applied to investigate the relationship between MFI level governance mechanisms and risk.FindingsThe study provides new evidence that board characteristics have differential effects on for-profit (FP) and not-for-profit (NFP) MFI risk. Board independence reduces credit risk of NFP MFIs. Foreign director presence increases MFI failure risk. Furthermore, greater female director representation reduces (increases) FP (NFP) financial risk whereas female CEOs are associated with higher (lower) FP (NFP) financial risk.Originality/valueThe paper contributes to existing literature on microfinance governance and risk, by exploring the impact of governance on MFI risk based on MFIs profit orientation. In addition, the study uses three different risk measures unlike previous microfinance studies.

A multidimensional study of public satisfaction with the healthcare system: a mixed-method inquiry in Ghana

BackgroundMany governments in sub-Saharan Africa have recently sought to improve their health systems by increasing investment in healthcare facilities and introducing social insurance programmes. However, little is known about the impact of these intended improvements on public perceptions about the healthcare systems. This article examines whether and why people of different socioeconomic and ideological backgrounds are satisfied (or not) with the current healthcare system in Ghana from a social ecological perspective.MethodData were elicited from a cross-sectional mixed-method study conducted in four regions in Ghana in 2018. We used ordinal logistic regression and thematic analysis techniques to analyse the data.ResultsSatisfaction with the healthcare system was generally low. From our quantitative study, intrapersonal factors (e.g., being older and having good health and well-being status); interpersonal factors (e.g., linking social capital); community factors (e.g., living in rural areas); and organisational and public policy factors (e.g., trust in the health system, favouring welfare policies, and being interested in politics) were positively associated with satisfaction with the healthcare system. These were corroborated by the qualitative study, which showed that poor attitudes of health personnel, financial constraints, perceived poor health facilities, and perceived inefficacy of services contribute to dissatisfaction with the healthcare system.ConclusionStrategies to improve satisfaction with the healthcare system in Ghana should incorporate ecological perspectives by considering factors such as demographic profile, health needs, political orientation, issues of trust in the healthcare system, and the dynamics and impact of social relationships of populations concerned.

Accelerating Sustainable Development Goals for South African adolescents from high HIV prevalence areas: a longitudinal path analysis

BackgroundAdolescents experience a multitude of vulnerabilities which need to be addressed in order to achieve the Sustainable Development Goals (SDGs). In sub-Saharan Africa, adolescents experience high burden of HIV, violence exposure, poverty, and poor mental and physical health. This study aimed to identify interventions and circumstances associated with three or more targets (“accelerators”) within multiple SDGs relating to HIV-affected adolescents and examine cumulative effects on outcomes.MethodsProspective longitudinal data from 3401 adolescents from randomly selected census enumeration areas in two provinces with > 30% HIV prevalence carried out in 2010/11 and 2011/12 were used to examine six hypothesized accelerators (positive parenting, parental monitoring, free schooling, teacher support, food sufficiency and HIV-negative/asymptomatic caregiver) targeting twelve outcomes across four SDGs, using a multivariate (multiple outcome) path model with correlated outcomes controlling for outcome at baseline and socio-demographics. The study corrected for multiple-hypothesis testing and tested measurement invariance across sex. Percentage predicted probabilities of occurrence of the outcome in the presence of the significant accelerators were also calculated.ResultsSample mean age was 13.7 years at baseline, 56.6% were female. Positive parenting, parental monitoring, food sufficiency and AIDS-free caregiver were variously associated with reductions on ten outcomes. The model was gender invariant. AIDS-free caregiver was associated with the largest reductions. Combinations of accelerators resulted in a percentage reduction of risk of up to 40%.ConclusionPositive parenting, parental monitoring, food sufficiency and AIDS-free caregivers by themselves and in combination improve adolescent outcomes across ten SDG targets. These could translate to the corresponding real-world interventions parenting programmes, cash transfers and universal access to antiretroviral treatment, which when provided together, may help governments in sub-Saharan Africa more economically to reach their SDG targets.

The impact of foreign direct investment and international remittances on poverty: evidence from Sub-Saharan African Countries in 1996–2017

This paper investigates the causal relationship between Foreign Direct Investment, remittances and poverty in Sub-Saharan African countries using simultaneous equations models over the period 1996–2017. Global panel results showed that there is a bi-directional causal relationship between remittances and poverty as well as FDI and remittances. However, there is unidirectional causality from FDI to poverty. The results suggest that there is a bidirectional causality between remittances and poverty in Sub-Saharan Africa, West, East and South Africa, while unidirectional causality from remittances to poverty in Central Africa. Other results show that in Central, East and South Africa, there is a bidirectional causality between FDI and poverty, while unidirectional causality from FDI to poverty in Sub-Saharan Africa and West Africa. Policy implications of this study suggest that essential for governments in Sub-Saharan Africa give great importance to increase the inflow of remittances to support the achievement of Sustainable Development Goals for 2030.