Institutions In Sub-Saharan Africa Research Articles

The Role of Minimally Invasive Gynecologic Surgery in Sub Saharan Africa

Minimally invasive gynecologic surgery (MIGS) is now firmly established in developed countries where there has been a trend away from traditional open surgery towards laparoscopy given proven benefits of faster recovery time and better cosmesis for patients. However, this same trend has not been observed in regions like sub Saharan Africa (SSA) where resources are limited. Lack of human and material resources, need for technological support, and challenges with training have been postulated as major limitations for wide spread introduction and expansion of MIGS in SSA. Nonetheless, a few institutions in sub Saharan Africa have been able to surmount these challenges to develop MIGS in SSA. This paper reviews the current state of minimally invasive surgery in sub Saharan Africa. We review the role and benefits of expanding minimally invasive surgery in sub Saharan Africa with a focus on management of gynecologic conditions. Finally, we review the challenges associated with MIGS in SSA and provide recommendations on the way forward. There are several published studies on the successful development of minimally invasive surgery in sub -Saharan Africa with similar benefits of shorter hospital stay, quicker recovery, and better cosmesis for patients. These studies also report the challenges with human and material resources and training. There is a large role and need for expansion of minimally invasive surgery in sub Saharan Africa. The challenges of lack of resources, personnel, and training can be surmountable through ingenuity, modeling based on experiences from other low to middle income countries and commitment to the advancement of MIGS for the benefit of women’s health globally.

Determinants of Property Rights Protection in Sub-Saharan Africa

This article complements existing literature by assessing determinants of property rights protection with particular emphasis on history, geography and institutions in Sub-Saharan Africa. The empirical evidence is based on a sample of 47 countries for the period 2000-2007. Random effects GLS regressions are employed using property rights measurements from the Mo Ibrahim and Heritage foundations. The results broadly show that ethnic fractionalisation, Polity IV and GDP per capita have positive effects on property rights institutions while the following have negative effects: military rule, the Protestant religion, maturity from colonial independence and population density. The findings have relevant policy implications for countries in the sub-region currently on the path to knowledge-based economies.

Rural electrification, electrification inequality and democratic institutions in sub-Saharan Africa

While it is commonly believed that democracy influences public service provision, comparably few studies have assessed how recent democratisation in developing countries has impacted tangible public service outcomes for economically deprived population shares. Using panel data from 46 sub-Saharan African countries between 1990 and 2010 as well as qualitative country case examples from Ghana, Swaziland, Uganda, Senegal and Rwanda, this paper examines considerable and growing rural electrification variations in terms of political, economic and demographic variables. The analyses suggest that democracy is strongly associated with rural electrification increases and rural versus urban electrification inequality decreases in sub-Saharan Africa. This result is robust to a variety of political, economic and demographic control variables as well as different econometric modelling assumptions. The paper further presents novel multi-variant evidence supporting that contested elections with strong oppositions as well as effective policy implementing institutions may act as intervening institutional mechanisms that explain a part of democracy's association with rural electricity provision. Higher income per capita, national savings and population densities may further foster rural electrification, while high foreign aid shares of GDP and rural population percentages may pose challenges to access equality.

Growth and Institutions: A Potential Medicine for the Poor in Sub-Saharan Africa

The conventional wisdom is that growth is a precondition for poverty reduction. Paying particular attention to the level of growth, poverty and institutions in sub-Saharan Africa (SSA), this paper investigates the effect of GDP per capita growth and sectoral growth on poverty and explores whether the growth-poverty link can be strengthened by institutions. Using the panel dataset of 41 SSA countries over the period 1981–2010 and dynamic two-step system generalized method of moment (GMM) estimator; it is found that GDP per capita growth is an important instrument for poverty reduction. Also, the growth of agriculture and the service sectors have direct poverty-reducing effects. The paper further reveals that good and accountable government, bureaucratic quality and sound policies and regulations are important ingredients in sustaining the growth-poverty link in SSA.

Gross Capital Formation, Institutions and Poverty in Sub-Saharan Africa

The conventional wisdom is that rapid economic growth is driven by investment. Paying particular attention to the state of gross fixed capital formation (gfcf), poverty and institutions in sub-Saharan Africa, this paper investigates the effect of gfcf on poverty and explores whether the gfcf and poverty relationship can be strengthened by institutions. Using the panel data-set of 41 sub-Saharan African countries over the period 1981–2010 and dynamic two-step system generalised method of moment estimator, it is found that gfcf reduces poverty and institutions reinforce the gfcf and poverty link.

When Are Mobile Phones Useful for Water Quality Data Collection? An Analysis of Data Flows and ICT Applications among Regulated Monitoring Institutions in Sub-Saharan Africa.

Water quality monitoring is important for identifying public health risks and ensuring water safety. However, even when water sources are tested, many institutions struggle to access data for immediate action or long-term decision-making. We analyzed water testing structures among 26 regulated water suppliers and public health surveillance agencies across six African countries and identified four water quality data management typologies. Within each typology, we then analyzed the potential for information and communication technology (ICT) tools to facilitate water quality information flows. A consistent feature of all four typologies was that testing activities occurred in laboratories or offices, not at water sources; therefore, mobile phone-based data management may be most beneficial for institutions that collect data from multiple remote laboratories. We implemented a mobile phone application to facilitate water quality data collection within the national public health agency in Senegal, Service National de l’Hygiène. Our results indicate that using the phones to transmit more than just water quality data will likely improve the effectiveness and sustainability of this type of intervention. We conclude that an assessment of program structure, particularly its data flows, provides a sound starting point for understanding the extent to which ICTs might strengthen water quality monitoring efforts.

Institution-level collaboration in cardiovascular research in sub-Saharan Africa.

The contribution of sub-Saharan Africa to scientific knowledge on cardiovascular disease (CVD) prevention and care is very limited compared to other regions of the world. This underlies the challenge of understanding and addressing the high prevalence of risk factors for CVD in sub-Saharan Africa. The patterns of collaboration between institutions in the region in the area of cardiovascular research are not well documented, although there is evidence of significant collaboration in health research between Africa-based researchers and those in countries outside the region. This study focuses on mapping the linkages between institutions in this region using co-authorship of publications in cardiovascular research from 2005 to 2014. The key institutions in sub-Saharan Africa which engaged in collaboration are identified and the potential of these networks for stimulating the growth of research capacity in this field is discussed.

Terms of Trade Instability, Economic Vulnerability and Economic Growth: The Role of Institutions in Sub-Saharan Africa

Economists have a long argue that institutions and implementation of good governance are important for economic growth. The main objective of this research is to demonstrate that one of positive institutions effects is its ability to mitigate the negative effect of economic vulnerability linked to terms of trade fluctuations on economic growth. The impact of the economic vulnerability and implementation of good governance is estimated for a panel of 15 Sub-Saharan-Africa countries over the period 1996-2011. The results show that good institutional quality helps to undermine the negative effects of economic vulnerability on economic growth. It is also clear from this analysis that the interaction terms between trade openness and institutions can reduce the negative effects of economic vulnerability and that trade openness has a positive effect on economic growth only until a certain level of institutional quality.

Can Crop Purchase Programs Reduce Poverty and Improve Welfare in Rural Communities? Evidence from the Food Reserve Agency in Zambia

The last decade has seen a resurgence of parastatal crop marketing institutions in sub-Saharan Africa, many of which cite improving food security and incomes as key goals. However, there is limited empirical evidence on the welfare effects of these programs. This article considers one such program, the Zambian Food Reserve Agency (FRA), which purchases maize from smallholder farmers at a pan-territorial price that typically exceeds maize market prices in surplus production areas. Using both fixed effects and an instrumental variables approach combined with correlated random effects, we estimate the effects of the FRA's maize marketing activities on smallholder farm household welfare. Results suggest that FRA activities have positive direct welfare effects on the small minority of smallholder households that are able to sell to it. However, the results also suggest negative indirect FRA effects, as higher levels of FRA activity in a district are associated with higher levels of poverty.

Can Crop Purchase Programs Reduce Poverty and Improve Welfare in Rural Communities? Evidence from the Food Reserve Agency in Zambia

The last decade has seen a resurgence of parastatal crop marketing institutions in sub-Saharan Africa, many of which cite improving food security and incomes as key goals. However, there is limited empirical evidence on the welfare effects of these programs. This article considers one such program, the Zambian Food Reserve Agency (FRA), which purchases maize from smallholder farmers at a pan-territorial price that typically exceeds maize market prices in surplus production areas. Using both fixed effects and an instrumental variables approach combined with correlated random effects, we estimate the effects of the FRA's maize marketing activities on smallholder farm household welfare. Results suggest that FRA activities have positive direct welfare effects on the small minority of smallholder households that are able to sell to it. However, the results also suggest negative indirect FRA effects, as higher levels of FRA activity in a district are associated with higher levels of poverty.

Extension education strategy for minimizing aflatoxin impact on sub-Saharan African agriculture and food systems

Sub-Saharan Africa (SSA) is the most vulnerable region of the world to all aflatoxin-related problems including food insecurity, ill health and reduced foreign exchange earnings. Aflatoxin-contaminated maize, groundnuts (peanuts), sorghum and other crops reduce human access to adequate calories from these staples; consumption of aflatoxin-contaminated foods results in severe health conditions, including liver cancer, that deny the region a significant amount of otherwise productive man-hours; while the reduction of grain quality below the international standards due to aflatoxin contamination drastically reduces income in foreign exchange earnings. Scientific knowledge of the causes of aflatoxins in agricultural systems and their mitigation abounds in research institutions in SSA and internationally, but most of this knowledge is unavailable to farmers, food consumers and policy makers in useful form due to poor extension education and ineffective extension services. A paradigm shift in the approach to extension in SSA is proposed, one driven by a sustainable mechanism that is sensitive to the needs of the people and proactive (rather than reactive) in providing solutions to aflatoxin-related problems the local community and policy makers have to deal with. This paper argues that such sustainable mechanism may only be found in a University-based and University-run ‘land grant’ type extension services adapted appropriately to SSA conditions.

Dermatopathology in sub-Saharan Africa: a systematic 5-year analysis of all histopathological diagnoses from the Regional Dermatology Training Centre (RDTC) in Moshi, Tanzania.

Proper diagnosis of skin diseases relies on dermatopathology, the most important diagnostic technique in dermatology. Unfortunately, there are few dermatopathology institutions in sub-Saharan Africa, where little is known about the spectrum of histopathological features observed. To investigate the spectrum of dermatopathological diagnoses made in a sub-Saharan African reference centre of a large, mainly rural area. To retrospectively evaluate all dermatopathological diagnoses made over a period of 5 years at the Regional Dermatology Training Centre (RDTC) in Moshi, Tanzania. There were a total of 1554 skin biopsy specimens. In 45% of cases, there were inflammatory diseases, most frequently lichenoid conditions. Cutaneous neoplasms represented 30.4% of all diagnoses, with Kaposi's sarcoma (KS) and, less frequently, squamous cell carcinoma (SCC) being the two most common neoplastic conditions. The latter also reflected the intensive management of persons with albinism in the RDTC. The distribution of histological diagnoses seemed to correlate with the overall clinical spectrum of cutaneous diseases managed in the RDTC. In this African study inflammatory conditions are the main burden of skin diseases leading to a diagnostic biopsy. Our findings provide further evidence that KS, primarily related to the high prevalence of HIV infection is an epidemiological problem. Both SCC and basal cell carcinoma represent another relatively common malignant cutaneous neoplasms, reflecting the presence of specific populations at risk. The challenging spectrum of histological diagnoses observed in this specific African setting with basic working conditions shows that development of laboratory services of good standards and specific training in dermatopathology are urgently needed.

Suboptimal Utilisation of Resources in Sub-Saharan African Higher Education Institutions: the Case of Teaching Space at Makerere University

Many higher education institutions in Sub-Saharan Africa are underfunded.Consequently, they are operating with encumbering resources constraints that threaten quality assurance. Accordingly, they are working to expand the availability of these resources. Notwithstanding, it is taken for granted that once available, these resources are optimally utilized and that, in instances expanding their availability is not possible, compromising on some elements of the quality of higher education is inevitable. The problem is that this presumption could disguise inadequacies in the utilization of the resources, with the consequence that the institutions’ need for the resources is exaggerated. Preoccupation with expanding the availability of resources could also stifle the innovation of creative ways of making the best use of the resources available. This means that the institutions need to evaluate their utilization of these resources—to pinpoint their need for the resources and potential for quality assurance. This paper reports the findings of a study that responded to this need, taking the case of teaching space at Makerere University. The objective ofthe study was to verify the hypothesis that the University is teaching space constrained. The findings were that the resource is overly underutilized albeit this was disguised by occasional overutilization of the same space, a concomitance that only multidimensional evaluation could unearth. Accordingly, the study gives credence to the hypothesis that shortages of resources at the University, and similar institutions, are ostensible. Therefore, it is recommended that these institutions subject their utilization of resources to rigorous evaluation.Keywords · Resources management · Higher education funding · Educational administration

Perspective

One of the major needs for medical schools and health systems in less affluent countries is system strengthening through the training and development of faculty, doctors, nurses, and other skilled health care workers. Partnering with medical schools in more affluent countries such as the United States is one potential approach for medical schools in underresourced areas, such as Sub-Saharan Africa. Most commonly, these partnerships have focused on research agendas or limited educational exchanges. In this perspective, the authors present an approach to strengthening collaborative relationships between three medical schools in the United States and four in Sub-Saharan Africa. The approach is explicitly focused on achieving partnerships that enable institutions to improve care. It developed from an initiative to fund partnerships or "collaboratives" that address 10 key learning questions determined to be central to focusing efforts on strengthening education systems and, in turn, improving health in Sub-Saharan Africa. The leaders of the schools involved in these partnerships met multiple times across three years to discuss how their collaboratives could address the ten learning questions including what is the best approach and what are the key ingredients for creating effective, multidimensional collaborations between academic institutions in the North and institutions in Sub-Saharan Africa. Collaboratively, they defined a framework of evidence that can be used for evaluating their current initiatives and, potentially, for structuring future partnerships.

Trends in health policy and systems research over the past decade: still too little capacity in low-income countries.

BackgroundThe past decade has seen several high-level events and documents committing to strengthening the field of health policy and systems research (HPSR) as a critical input to strengthening health systems. Specifically, they called for increased production, capacity to undertake and funding for HPSR. The objective of this paper is to assess the extent to which progress has been achieved, an important feedback for stakeholders in this field.Methods and FindingTwo sources of data have been used. The first is a bibliometric analysis to assess growth in production of HPSR between 2003 and 2009. The six building blocks of the health system were used to define the scope of this search. The second is a survey of 96 research institutions undertaken in 2010 to assess the capacity and funding availability to undertake HPSR, compared with findings from the same survey undertaken in 2000 and 2008. Both analyses focus on HPSR relevant to low-income and middle-income countries (LMICs). Overall, we found an increasing trend of publications on HPSR in LMICs, although only 4% were led by authors from low-income countries (LICs). This is consistent with findings from the institutional survey, where despite improvements in infrastructure of research institutions, a minimal change has been seen in the level of experience of researchers within LIC institutions. Funding availability in LICs has increased notably to institutions in Sub-Saharan Africa; nonetheless, the overall increase has been modest in all regions.ConclusionAlthough progress has been made in both the production and funding availability for HPSR, capacity to undertake the research locally has grown at a much slower pace, particularly in LICs where there is most need for this research. A firm commitment to dedicate a proportion of all future funding for research to building capacity may be the only solution to turn the tide.

Unequal ‘Partners’. AIDS, Academia, and the Rise of Global Health

The last decade has seen the proliferation of departments, centers, programs, and majors across top research universities in North America and Europe. This trend has been particularly pronounced in the United States, where it is connected to America′s new role as a major sponsor of HIV treatment in Africa. This paper describes the rise of as a research, funding, and training priority within U.S. academic medicine, and the increasing desirability of health with institutions in sub-Saharan Africa. Leading spokespersons emphasize that partnership with poor nations is central to the mission of global health, an ethic that distinguishes it from older, more paternalistic traditions of international health and tropical medicine. However, at the same time, the field of academic global health depends on steep inequalities for its very existence, as it is the opportunity to work in impoverished, low-tech settings with high disease burdens that draws North American researchers and clinicians to global health programs and ensures their continued funding. This paradox – in which inequality is both a form of suffering to be redressed and a professional, knowledge-generating, opportunity to be exploited – makes the partnerships to which global health aspires particularly challenging.

Unequal ‘Partners’. AIDS, Academia, and the Rise of Global Health

The last decade has seen the proliferation of "global health" departments, centers, programs, and majors across top research universities in North America and Europe. This trend has been particularly pronounced in the United States, where it is connected to America′s new role as a major sponsor of HIV treatment in Africa. This paper describes the rise of "global health" as a research, funding, and training priority within U.S. academic medicine, and the increasing desirability of "global health partnerships" with institutions in sub-Saharan Africa. Leading spokespersons emphasize that "partnership" with poor nations is central to the mission of global health, an ethic that distinguishes it from older, more paternalistic traditions of international health and tropical medicine. However, at the same time, the field of academic global health depends on steep inequalities for its very existence, as it is the opportunity to work in impoverished, low-tech settings with high disease burdens that draws North American researchers and clinicians to global health programs and ensures their continued funding. This paradox – in which inequality is both a form of suffering to be redressed and a professional, knowledge-generating, opportunity to be exploited – makes the partnerships to which global health aspires particularly challenging.

Review of Public Forestry Administrations and Related Institutions in Sub-Saharan Africa

The main findings of a study on forest administration and related institutional arrangements (PFA) are highlighted. The relevance and changing roles of PFA in Sub-Saharan African (SSA) countries are covered in the context of new paradigm for sustainable forest management (SFM). The current weak capacities and low profiles of PFA in SSA countries are addressed and some recommendations are made on actions for positive changes. It is recommended that SSA countries should take appropriate steps to stabilize and strengthen their PFAs through improved governance and to actively participate in the emerging initiative on African forest law enforcement and governance (AFLEG). It is recommended that SSA countries should take immediate steps to mobilize additional resources for PFAs through forest income retention schemes, national forest funds/trusts and through collaboration with nongovernmental organizations (NGOs) and the private sector. It is also recommended that SSA countries should mobilize resources through continental and/or regional initiatives on capacity building for PFA.

Traditional property rights, common property, and mobility in semi-arid African pastoralist systems

ABSTRACTTraditional pastoralist land management institutions in sub-Saharan Africa have been stressed by an increasing human population and related forces, including private enclosure of grazing land; government-sponsored privatization; and the increasing prevalence of violent conflicts and livestock theft. We model the incompleteness and flexibility of traditional grazing rights using fuzzy set theory. We compare individual and social welfare under the traditional system to individual and social welfare under a private property system and a common property system. Whether the traditional system is preferred to private property depends on whether the value of mobility, as defined by the traditional system, is more valuable than the right of exclusion inherent in private property. We find that under some conditions the imprecision which characterizes traditional rights can result in higher social returns than a common property regime characterized by complete symmetric rights across all members of the user group and complete exclusion of non-members.

Stigma of People with HIV/AIDS in Sub-Saharan Africa: A Literature Review.

The aim of this literature review is to elucidate what is known about HIV/AIDS and stigma in Sub-Saharan Africa. Literature about HIV/AIDS and stigma in Sub-Saharan Africa was systematically searched in Pubmed, Medscape, and Psycinfo up to March 31, 2009. No starting date limit was specified. The material was analyzed using Gilmore and Somerville's (1994) four processes of stigmatizing responses: the definition of the problem HIV/AIDS, identification of people living with HIV/AIDS (PLWHA), linking HIV/AIDS to immorality and other negative characteristics, and finally behavioural consequences of stigma (distancing, isolation, discrimination in care). It was found that the cultural construction of HIV/AIDS, based on beliefs about contamination, sexuality, and religion, plays a crucial role and contributes to the strength of distancing reactions and discrimination in society. Stigma prevents the delivery of effective social and medical care (including taking antiretroviral therapy) and also enhances the number of HIV infections. More qualitative studies on HIV/AIDS stigma including stigma in health care institutions in Sub-Saharan Africa are recommended.