Middle East North Africa Countries Research Articles

Blueprints for resilience: Middle East/North Africa countries' disaster risk reduction education through experts' eyes

Abstract Background: All the existing frameworks of Health-Emergency Disaster Risk Management have put great emphasis on the use of educational strategies to be used as a mean of disaster risk reduction (DRR). Thus, this study was conducted to formulate experts' consensus on DRR educational strategies for Middle East/North Africa (MENA) countries. Methods: A Delphi study on expert's opinion for DRR educational strategies was carried out through surveys in two consecutive rounds through convenient sampling technique. Results: A total of 60 responses were included in this study. Most of the participants were Saudi nationals, physicians (36.7% vs. 33.3% in round 1 and round 2, respectively), and males (73.3%) with experience in disaster management (56.7%) of 5-10 years (60% vs. 53.3% in round 1 and round 2, respectively). Around 80% participants suggested that graduate health professional education should be through problem based learning (PBL) approach (36.7%) (P-value = 0.007). Universal Design for Learning (UDL) framework implementation required provision of multiple means of engagement as priority (P-value = 0.007). Best learning situation category was institution based (60%) with best approach for DRR learning as planned scheduled learning (P-value = 0.000). It was found that best learning situations were lectures and small group sessions (73.3% each) (P-value = 0.165) that were delivered through learning management system (90%) (P-value = 0.103), while the major stakeholders that should be involved in national DRR educational planning were Ministry of Health (90%) (P-value = 0.881). Conclusion: Experts have consensus opinion on DRR Educational strategies in MENA countries.

Blueprints for resilience: Middle East/North Africa countries' disaster risk reduction education through experts' eyes

Abstract Background: All the existing frameworks of Health-Emergency Disaster Risk Management have put great emphasis on the use of educational strategies to be used as a mean of disaster risk reduction (DRR). Thus, this study was conducted to formulate experts' consensus on DRR educational strategies for Middle East/North Africa (MENA) countries. Methods: A Delphi study on expert's opinion for DRR educational strategies was carried out through surveys in two consecutive rounds through convenient sampling technique. Results: A total of 60 responses were included in this study. Most of the participants were Saudi nationals, physicians (36.7% vs. 33.3% in round 1 and round 2, respectively), and males (73.3%) with experience in disaster management (56.7%) of 5-10 years (60% vs. 53.3% in round 1 and round 2, respectively). Around 80% participants suggested that graduate health professional education should be through problem based learning (PBL) approach (36.7%) (P-value = 0.007). Universal Design for Learning (UDL) framework implementation required provision of multiple means of engagement as priority (P-value = 0.007). Best learning situation category was institution based (60%) with best approach for DRR learning as planned scheduled learning (P-value = 0.000). It was found that best learning situations were lectures and small group sessions (73.3% each) (P-value = 0.165) that were delivered through learning management system (90%) (P-value = 0.103), while the major stakeholders that should be involved in national DRR educational planning were Ministry of Health (90%) (P-value = 0.881). Conclusion: Experts have consensus opinion on DRR Educational strategies in MENA countries.

Exploring financial inclusion in MENA countries: an entropy weight approach

PurposeResearch on financial inclusion (FI) in Islamic countries has evolved and gained prominence. This study aims to construct an extensive multidimensional FI index to ascertain the level of inclusion and trends in the Middle East/North Africa (MENA) countries. Additionally, this study examines the potential role of Islamic finance in improving access to financial services.Design/methodology/approachData for the study were collected from databases covering MENA countries for the period 2010–2020. An inclusion index has been constructed using the entropy method.FindingsKey findings indicate that the overall FI has improved in Islamic countries. However, it should be noted that all MENA countries fall within the low or medium levels of the inclusion index. It was observed that insurance access and penetration savings were poor in the Islamic MENA countries.Social implicationsThe authors recommend that policymakers focus on insurance access and saving behaviour in their respective countries. Based upon these observations, policymakers should promote the economic benefits of Islamic finance, which will help improve FI and economic development in Islamic countries. This study emphasises the necessity of policy framework reform to provide Islamic financial services to the poorest in society at low or no cost for better economic benefits.Originality/valueMost studies tend to overlook important indicators such as insurance, savings and credit penetration while calculating the index. These indicators add value to the existing literature. The majority of prior studies used United Nation Development Programme methodology or principal component analysis for Inclusion Index measurements. The adoption of the entropy weighting method is the novelty of this study.

The impact of institutions' quality and information availability on capital inflows volatility in selected MENA countries

PurposeThis paper aims to discuss the main characteristics of the Middle East North Africa (MENA) region's capital inflows volatility. It also examines the effect of institutional quality and information availability on capital inflows volatility in selected MENA countries (Bahrain, Egypt, Israel, Jordan, Kuwait, Libya, Morocco, Oman, Saudi Arabia and Tunisia) in the period 1996–2017.Design/methodology/approachThe study's assessments are based on the International Country Risk Guide (ICRG) and globalization indices. It also employs an updated data set of balance of payments indicators released by the International Monetary Fund. Moreover, the study uses econometric panel modeling of random effect model, with Driscoll-Kraay robust standard error, to analyze the relationship between capital inflows volatility, institutional quality and information availability.FindingsThe paper finds that both institutional quality and information availability are in an inverse relationship with the total capital inflows volatility in the MENA region. However, the findings vary across the different components of total capital inflows. For example, the volatility of foreign direct investment (FDI) declines, like total capital flows, as the two factors improve. However, the volatility of foreign portfolio investment (FPI) is negatively related to institutional quality but does not have any significant relationship with information availability. While the volatility of foreign other investments (FOI) decreases with the availability of information, but does not have any significant relationship with institutional quality.Originality/valueThis paper expands the limited literature regarding the determinants of capital inflows volatility. Furthermore, it is the first study that investigates the effect of institutional quality and information availability on capital inflows volatility in the MENA region.

On the political economy of trade agreements: A de jure and de facto analysis of institutions

This paper examines the effect of the quality of institutions on the membership in trade agreements from de jure and de facto perspectives, with a special focus on the Middle East North Africa (MENA) countries. First, for the de jure aspect, we analyze how the quality of domestic institutions in a country affects its likelihood of joining a trade agreement. Moreover, for the de facto aspect, this paper examines how the difference in quality of institutions among trading partners and enforceability degree affects the volume of trade among them. Our main findings show that the larger the difference in the quality of institutions, among MENA countries and their trade partners, the less likely they sign a trade agreement (deep compared to a shallower one). Moreover, the higher the enforcement degree of the agreement is, the greater the positive effect on trade flows. This result holds for the enforcement of the aspects related to the World Trade Organization provisions (WTOP) and those not related to it (WTOX). Yet, this positive effect of enforceability differs according to the content of legally enforceable provisions. Finally, our results hold even when we control for the selection bias related to joining a trade agreement, the endogeneity of enforcement and the way we measure both institutions and enforcement.

The Status of Insulin Access in Middle East-North Africa Region

Background and Objective: The current situation in the Middle East-North Africa (MENA) region makes it very difficult for many countries to have an effective policy to ensure the availability and affordability of different insulin types for many individuals with diabetes mellitus in any individual country. This article comprehensively reviews the possible barriers to insulin access in countries of this region and provides some solutions to mitigate these barriers. Materials and Methods: The framework for understanding the life-cycle of medicines of the World Health Organization (WHO) was adopted for this review with country-specific modifications. PubMed was used as an initial search builder using the country name and insulin as query terms in (title/abstract) for articles written in (English and French) which dealt with humans only between (2000–2022). Out of (578) published articles, only (42) articles were relevant and dealt with insulin access. Additional search through references of these articles and the websites of international health organizations added additional (32) references to have (79) references for the review. Review (Results): The countries in the MENA are lagging in the (Research, Development, and Innovation) and production of insulin and insulin delivery systems. There are some attempts by some countries to develop their national plan with the help of some big insulin manufacturers, with a suboptimal outcome. The local insulin production in some countries did not reach full national coverage. The difficult regional economic and political situations in many countries in the MENA imposed negatively on their citizens’ insulin access, availability, affordability, cost, and insurance plans. Conclusions: There is a suboptimal level of insulin access for individuals with diabetes in the MENA countries, especially in the low-resourced countries. There is an urgent need to adopt country-specific healthcare policies to ensure uninterrupted insulin access and improved availability, with a lower affordable cost for individuals with diabetes from the public and private sectors.

Impact of governance and globalization on natural resources volatility: The role of financial development in the Middle East North Africa countries

Developing countries have experienced persistent increases in population growth and surging supply-demand gaps in natural resources. The growing resource gap has exposed fragile economies to a volatile environment when prices move rapidly upward. This study attempts to assess the role of macroeconomic policy indicators in determining the frequent and rapid price changes of natural resources by using data from 1996 to 2020. Neo-Classic growth theories have considered prices of natural resources as an exogenous factor affecting various macroeconomic variables; however, this study attempts to explore the long-run impact of governance and globalization on natural resource prices and acknowledge it as an endogenous factor. Second-generation methods have been used to assess heterogeneity and unit root in this study. Westerlund and Edgerton co-integration test results show the presence of co-integration among the study variables. This study has empirically estimated long-run elasticities and maintained the positive impact of globalization and governance on the volatility of natural resource prices for the Middle East North Africa countries. However, financial development and income reduce natural resource price volatility in these countries. This study also suggests policy implications based on empirical analysis.

The Real Effect and Consequence of Regulation Reform in Corporate Finance and Banking

In order for a country to grow economically, it needs a stable, efficient, and well-functioning banking system. The province should examine systematically and comprehensively its regulations, and examine how to improve the quality of these regulations, reduce their administrative burden, and remove the confusion they sometimes create. Several studies have pointed to the importance of financial regulation to the performance and safety of banks. The reform of regulatory policies and practices makes businesses more competitive and decreases regulatory costs, boosting efficiency, bringing down prices, stimulating innovation, as well as making economies more adaptable and competitive. We investigated how banking regulations affected financial development in MENA (Middle East-North Africa) countries. We measured bank regulation by proxies like foreign banks, capital levels, and liquidity liabilities. We measured financial development by proxies like private credit, z-scores, and private credit. Similarly, a tool to measure bank supervision includes supervisory power, independence, private monitoring, and moral hazard in addition to the size, activity, and stability of the financial sector. In terms of financial development, regulation of banks made a positive and significant contribution. A major contribution of the study is to demonstrate that reform supervision is also an important component of bank regulation, so that banks can achieve their regulatory objectives and impact financial development as strongly as possible. For MENA countries, this benefit is particularly significant, since an analysis of the data shows that more emphasis is placed on regulation than supervision in financial sector reform.

A review on waste management and compost production in the Middle East-North Africa region.

Over the last two decades, solid waste management in the Middle East-North Africa (MENA) region has been one of the major challenges due to increasing solid waste quantities and poor waste management practices. With the tremendously increasing amounts of organic waste, MENA countries are under great pressure and are facing the threats of acute air pollution, contamination of water bodies and climate change. As a result, these countries are adopting different methods to cope with this rising challenge of waste management, including composting. This review reports on the different MENA countries' organic waste quantities, disposal methods, organic waste management practices and challenges, along with the potential use and demand of compost, where information is available. The reported data are from 2009 to 2021, with the bulk of the papers being from 2014 and onwards. The total amount of municipal waste collected in the 21 countries ranged from 0.56 million tons in Mauritania to 90 million tons in Egypt, with an average of 16.42 million tons, equivalent to 1.08 kg per capita waste generation per day. Around 55% of this material is biogenous. Many treatments and repurposing methods of this material are adopted in the MENA region, mainly through composting, as it presents one of the most sustainable solutions that lead to immediate climate change mitigation. This article also presents the biotic and abiotic stressors faced by this region, which in turn affect the successful implementation of composting solutions, and proposes some solutions based on different studies conducted.

Renewable Energies and Energy Efficiency Adoption’s Impact on the Environmental Quality of Middle East North Africa Countries

Environmental challenges in MENA countries deserve more attention as they are pursuing economic growth and expanding urbanization and the geographical position of these countries make them more exposed to the outcomes of climate change. In this context, this paper focuses on the proposed solutions for the climate change problem that are renewable energies and the use of fossil fuel effectively in the context of growing urbanization in the MENA region. Indeed, using the GMM estimator for 18 MENA countries during the period 2000-2018, we try to quantify the magnitude of the impact of population, economic prosperity, urbanization, fossil fuels, energy efficiency, and renewable energies, especially solar, wind, and hydropower energies on CO2 emissions. Results allow the environmental Kuznets curve validation and highlight the contribution of energy efficiency in improving the environment. However, the used proportion of renewables in the energy mix does not significantly affect environmental quality. Moreover, solar energy contributes to emissions reduction. While the adopted level of wind and hydropower energy does not allow these countries to improve their environment.

Validation of the Arabic Maternal Breastfeeding Evaluation Scale (MBFES-A) among Lebanese women

BackgroundMaternal satisfaction with the breastfeeding experience is an important determinant of breastfeeding success. There is currently no valid tool to measure perceived maternal satisfaction with breastfeeding in the Arab context.MethodsThis cohort study tested the Maternal Breastfeeding Evaluation Scale (MBFES) on 450 healthy Lebanese mothers for internal consistency reliability and construct validity. Participants were recruited between April 2018 and February 2020.ResultsThe Cronbach’s alpha reliability coefficient of the Arabic MBFES (MBFES-A) was 0.87. Exploratory factor analysis revealed that it has three components: Infant Satisfaction/Growth, Maternal Enjoyment/Role Attainment, and Lifestyle/Body Image with reliability coefficients of 0.88, 0.87, and 0.68, respectively. Four items were deleted because of low factor loadings and three items were relocated to the Infant Satisfaction/Growth subscale based on their factor loadings. Participants who were exclusively breastfeeding at one and/or 3 months had higher mean MBFES-A total and Infant Satisfaction/Growth and Maternal Enjoyment/Role Attainment subscale scores than participants who were partially breastfeeding, and significantly higher mean scores than mothers who were not breastfeeding (all p values < 0.001), findings that support the scale’s construct validity. Moreover, scores on the Infant Satisfaction/Growth subscale correlated with exclusive breastfeeding at one (r = 0.37, p < 0.001) and 3 months (r = 0.31, p < 0.001). The MBFES-A score had positive modest correlations with maternal attitude towards breastfeeding (r = 0.30, p < 0.001), exclusive breastfeeding at one (r = 0.27) and at 3 months (r = 0.26, p < 0.001 for both), as well as with the longest previous exclusive breastfeeding (r = 0.27, p < 0.001).ConclusionsThe 26-item MBFES-A is a reliable and valid instrument to use in future breastfeeding research in Middle East North Africa countries. There is a need for replication of our findings in other Arab contexts using new constructs to establish stronger construct validity.

Design and implementation of the European-Mediterranean Postgraduate Programme on Organ Donation and Transplantation (EMPODaT) for Middle East/North Africa countries.

This prospective study reports the design and results obtained after the EMPODaT project implementation. This project was funded by the Tempus programme of the European Commission with the objective to implement a common postgraduate programme on organ donation and transplantation (ODT) in six selected universities from Middle East/North Africa (MENA) countries (Egypt, Lebanon and Morocco). The consortium, coordinated by the University of Barcelona, included universities from Spain, Germany, Sweden and France. The first phase of the project was to perform an analysis of the current situation in the beneficiary countries, including existing training programmes on ODT, Internet connection, digital facilities and competences, training needs, and ODT activity and accreditation requirements. A total of 90 healthcare postgraduate students participated in the 1-year training programme (30 ECTS academic credits). The methodology was based on e-learning modules and face-to-face courses in English and French. Training activities were evaluated through pre- and post-tests, self-assessment activities and evaluation charts. Quality was assessed through questionnaires and semi-structured interviews. The project results on a reproducible and innovative international postgraduate programme, improvement of knowledge, satisfaction of the participants and confirms the need on professionalizing the activity as the cornerstone to ensure organ transplantation self-sufficiency in MENA countries.

Revisiting the natural resource curse: A cross-country growth study

This paper revisits the original natural resource curse study conducted by Sachs and Warner to investigate the relationship between natural resource dependence and per capita growth in recent data consisting of 68 developing countries that includes 14 Middle East & North Africa (MENA) and 6 Gulf Cooperative Council (GCC) countries between 1994–2014. Using a cross-country data and modeling we find robust evidence of a negative association between per capita growth and natural resource dependence. This negative affect is especially prominent in oil-rich MENA countries. The presence of a natural resource curse presents challenges to policymakers especially in countries who have been taking measures to diversify their income-base.

PSY59 - ORPHAN DRUGS PRICES COMPARISON IN MIDDLE EAST NORTH AFRICA (MENA) REGION

The aim of this study was to compare annual prices of Orphan Drugs (ODs) available in five Middle East North Africa (MENA) countries: Lebanon, Morocco, Saudi Arabia, Turkey, and the United Arab Emirates (UAE). Ex-factory prices of ODs available in the 5 countries of the scope were extracted from IHS POLI database. The posology and treatment duration were used to calculate the ODs annual prices. Annual prices were adjusted using gross domestic product (GDP) per capita. Median as well as mean prices per country were calculated. The UAE had the highest number of ODs with available prices (n=42) followed by Turkey (n=28), Lebanon (n=25), Saudi Arabia (n=21), and Morocco (n=4). The UAE also had the highest median annual prices of ODs (mean=150,436$ and median=70,046$), whereas Turkey had the lowest median annual prices (mean=26,539$ and median=15,664$). Compared to the UAE, OD prices ratios varied between 0.31 (Turkey) and 0.86 (Morocco). However, adjusting prices using GDP per capita showed that the countries with the lower purchasing power, Morocco and Lebanon, had nearly four to ten times higher relative costs (14.46, 6.95 respectively) than higher GDP countries (1.86 in UAE, 1.44 in Turkey and 2.5 in Saudi Arabia). Our results confirmed the ODs affordability issue. The heterogeneity observed in OD prices within MENA countries may be explained by the difference in pricing policies (especially external price referencing) and specific countries’ economic climates. The risk of parallel trade may also drive prices higher in low GDP countries. Harmonization processes by reviewing the external price referencing and differential pricing may be potential solutions to improve the access of ODs and treatment of rare diseases in the MENA countries.

Do restrictive regulatory policies matter for telecom performance? Evidence from MENA countries

The past decade has witnessed a significant transformation in trade and regulatory policies of the telecom sector across the Middle East North Africa (MENA) region. Many countries committed to opening up their telecom sector for trade and investment under WTO commitments. However, these commitments do not always reflect actual policies. Although some MENA countries started alleviating telecom market restrictions and tended to adopt more open policies, other countries are still reluctant to change and adopt highly restrictive policies limiting foreign ownership and control in the market. This paper assesses the impact of telecom restrictions on landline and mobile sector performance in MENA countries using the World Bank Services Trade Restrictiveness database (STRD). We use three-stage least squares-seemingly unrelated regression (3SLS-SUR) to test for the effect of restrictions and the level of competition in the telecom sector on selected performance indicators. Our findings suggest that restrictive policies in the telecom sector are rather likely to affect landline than mobile communications. Moreover, being a MENA country affects the level of competition in the landline market. MENA countries are very protective to their incumbent operators, irrespective of the stipulated market regulations in place.

Specific risks and profitability of Islamic Banks in MENA region

Islamic banks offer Sharia-compliant financial products. In addition to conventional risks, these banks face specific risks which will have negative effects. We investigate the effects of specific risks on the performance and the stability of a sample of 53 Islamic banks located in 11 Middle East North Africa countries including five oil-rich monarchies. Data are drawn from the Bankscope database and the annual reports of these banks over the period of 1998-2014. Using Data Envelopment Analysis, first of all, we designed a series of composite indicators to quantify specific risks of non-Sharia-compliance. In the second step, we applied correlation analysis, Spearman and Kendall correlation tests and a panel analysis in order to address the relationship between the performance and specific risks upon a subsample. According to the results, the relationship between performance and specific risks is significantly positive whereas the impact of each partial indicator remains ambiguous.

Competition, concentration and risk taking in Banking sector of MENA countries

This paper tests the relationship between competition and bank stability for 356 banks operating in the Middle East North Africa (MENA) countries during the period 2005–2012. Our results show that for the overall sample, a U-shaped relationship between competition and banks’ risk taking for MENA banks. The negative linear relationship between Z-Score and H-statistics in Gulf countries shows that an increase in competition leads to a reduction in the level of financial stability. In the case of other non-Gulf countries, the increase of competition in uncompetitive markets can lead to an increase in stability. The results confirm the importance of the market structure as an explanatory factor for financial stability, but also indicate that concentration is not associated with uncompetitive markets.

Development of corporate governance codes in the GCC: an overview

Purpose – This paper aims to discuss and compare the corporate governance codes in Gulf Cooperation Council (GCC) countries. Design/methodology/approach – The development of corporate governance codes in the GCC is considered using an analytical approach. Findings – Efforts and initiatives are underway in the GCC towards improving the corporate governance environment and coping with international developments. Although most GCC codes are comprehensive compared to those of other Middle East North Africa (MENA) countries, and are similar to international codes, as with almost all countries in the region, there is room for development. Updated codes that address the unique nature of these countries could enhance corporate governance. Research limitations/implications – This comparison between GCC corporate governance codes provides opportunities to empirically compare the corporate governance status in these countries through indices or checklists based on the current comparison. Practical implications – The research facilitates future evaluations of corporate governance in Gulf countries. In other words, different stakeholders, including investors and analysts, can utilise this paper during decision-making. Moreover, comparing GCC codes to others in the MENA region would help to assess the GCC’s position in the region regarding these codes, and also alert firms to corporate governance reforms occurring in the region. Originality/value – The paper analyses the corporate governance codes issued in the GCC, which represents a group of countries with similar characteristics that are thus studied separately from other MENA countries, and compares the corporate governance codes issued for non-financial listed companies.

Water Shortage in MENA Region: An Interdisciplinary Overview and a Suite of Practical Solutions

The chronic water shortage in the Middle East North Africa (MENA) region is a perplexing issue, undoubtedly because various operational sectors, multi-institutions and stakeholders are inextricably interconnected. In the light of climate variability and the unprecedented population growth rate, the per capita water resources and biocapacity will continue plummeting, and the demand-gap will seriously expand. Existing water quantification agreements have been deemed inefficient to solve the problem of naturally diminishing water resources and thus require immediate re-assembling. Most scholarly endeavors, including key international organizations, NGOs, and “Think Tank” policy briefs have limitedly addressed water shortage in contexts of regional politics, mass media, and, importantly, from social psychology perspectives. Therefore, a thorough analysis and interdisciplinary approach is required to find a feasible and suitable framework of solutions and from a multi-perspective podium. A synthesis of cross-sectorial bottlenecks that are crucial to water management is presented, and a suite of practical recommendations are introduced to water authorities and governments. This study argues that in the shadow of the region’s political instability, the clash of ideologies and its repercussions, and issues of national security and sovereignty, regional cooperation on water issues remain prognostications. In this essence, governments of MENA countries are urged to develop measures to substantially increase the water supply through innovative approaches. Such measures include enhancing the capacities of water harvesting, maximizing the storage capacities of the built dams, and deploying groundwater recharge techniques. Furthermore, seawater and brackish water desalination through clean energy technologies is a contemporary solution with socio-economic and multiple benefits. Multi-billion water projects might not be suitable approach in the absence of external funding and the aforementioned hurdles. Further research is required to address the social economics, and environmental aspects of desalination and the socio-economic feasibility of privatizing drinking water utilities and price polarization.

Overview of existing water and energy policies in the MENA region and potential policy approaches to overcome the existing barriers to desalination using renewable energies

Most countries in the Middle East & North Africa (MENA) region currently face water scarcity and rising water demand. In order to respond to these challenges, many MENA countries proceed to the use of desalination. As desalination processes are highly energy-intensive, the use of conventional energy for the operation of desalination plants contributes to climate change through greenhouse gas emissions, with negative impacts on the water cycle. The use of renewable energy sources to supply desalination plants with electricity can be a more sustainable and environmentally friendlier option to bridge the water demand gap. The present paper outlines the main barriers to desalination using renewable energies (referred to in short as ‘renewable energy desalination’, RED) in most MENA countries, gives an overview of main features of the water and energy policies in the MENA region, and compares them to the framework conditions in Australia or Spain. Supportive policy approaches to overcome the existing barriers and to promote RED are highlighted. The paper advocates the importance of adopting a more consistent legal framework to foster the deployment of RED and thereby reduce the effects of climate change and water scarcity.