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Good institutions were pivotal to the emergence of capitalism and hence the creation of wealth, prosperity and development in the world. In this paper, the authors argue that one of the reasons for the poverty and underdevelopment in sub-Saharan Africa is the weak institutional framework which exists in these countries. The laws, rules and regulations governing businesses and entrepreneurial activities are either too weak or ineffective, and could be riding roughshod over any political interest or individual. The paper presents evidence from the literature to amplify the view that strong and effective institutions are fundamental to reinvigorating economic growth and development. Finally, the authors suggest that a complete overhaul and rejuvenation of the institutional framework which exists in the countries of sub-Saharan Africa is crucial to the creation of jobs, and the alleviation of poverty and underdevelopment. [ABSTRACT FROM AUTHOR]

This paper examines the impact of the Highly Indebted Poor Countries (HIPC) Initiative on under five mortality rate (U5MR) in Sub-Saharan Africa. The HIPC Initiative involves debt forgiveness and the redirection of funds that were meant to service external debt towards the provision of social services and poverty reduction in eligible countries. The Initiative is akin to a natural experiment since some countries benefited while some did not, and the timing of debt forgiveness varied across countries. We exploit these variations to identify the impact of HIPC Initiative on child mortality using a dynamic panel data estimator. We find that participation in HIPC Initiative is associated with statistically significant decreases in U5MR. On the other hand, the impact of actual debt cancelled is statistically insignificant. [ABSTRACT FROM AUTHOR]

Objective: To characterize the impact of widespread inventory management policies on stock-outs of essential drugs in Zambia’s health clinics and develop related recommendations. Methods: Daily clinic storeroom stock levels of artemether-lumefantrine (AL) products in 2009–2010 were captured in 145 facilities through photography and manual transcription of paper forms, then used to determine historical stock-out levels and estimate demand patterns. Delivery lead-times and estimates of monthly facility accessibility were obtained through worker surveys. A simulation model was constructed and validated for predictive accuracy against historical stock-outs, then used to evaluate various changes potentially affecting product availability. Findings: While almost no stock-outs of AL products were observed during Q4 2009 consistent with primary analysis, up to 30% of surveyed facilities stocked out of some AL product during Q1 2010 despite ample inventory being simultaneously available at the national warehouse. Simulation experiments closely reproduced these results and linked them to the use of average past monthly issues and failure to capture lead-time variability in current inventory control policies. Several inventory policy enhancements currently recommended by USAID | DELIVER were found to have limited impact on product availability. Conclusions: Inventory control policies widely recommended and used for distributing medicines in sub-Saharan Africa directly account for a substantial fraction of stock-outs observed in common situations involving demand seasonality and facility access interruptions. Developing central capabilities in peripheral demand forecasting and inventory control is critical. More rigorous independent peer-reviewed research on pharmaceutical supply chain management in low-income countries is needed. [ABSTRACT FROM AUTHOR]

This paper reflects critically on the potential of four parallel ethical gold certification schemes to empower people engaged in poverty-driven artisanal and small-scale mining (ASM) activities in sub-Saharan Africa. It reviews the literature on empowerment to broaden understanding of which groups of miners these certification schemes are targeting and capable of supporting. The industry-led schemes implemented to date seem ideally-suited for multinational companies, whilst NGO-led schemes appear neither capable of breaking down the institutional structures that marginalise ASM operators nor readily adaptable to the African context. No scheme seems truly focused on – and capable of – empowering miners who are suffering extreme hardship and struggling to accumulate earnings. None of the ethical gold certification schemes reviewed here appears capable of sufficiently altering the social dimensions of power, agency and the institutional environment needed in order to empower artisanal and small-scale miners. [ABSTRACT FROM AUTHOR]

The adoption of the shared prosperity goal by the World Bank in 2013 and Sustainable Development Goal 10, on inequality, by the United Nations in 2015 should strengthen the focus of development interventions and cooperation on the income growth of the bottom 40 percent of the income distribution. This paper contributes to the incipient literature on within-country allocations of development institutions and assesses the geographic targeting of World Bank projects to the bottom 40 percent. Bivariate correlations between the allocation of project funding approved over 2005–14 and the geographical distribution of the bottom 40 as measured by survey income or consumption data are complemented by regressions with population and other potential factors affecting the within-country allocations as controls. The correlation analysis shows that, of the 58 countries in the sample, 41 exhibit a positive correlation between the shares of the bottom 40 and World Bank funding, and, in almost half of these, the correlation is above 0.5. Slightly more than a quarter of the countries, mostly in Sub-Saharan Africa, exhibit a negative correlation. The regression analysis shows that, once one controls for population, the correlation between the bottom 40 and World Bank funding switches sign and becomes significant and negative on average. This is entirely driven by Sub-Saharan Africa and not observed in the other regions. Hence, the significant and positive correlation in the estimations without controlling for population suggests that World Bank project funding is concentrated in administrative areas in which more people live (including the bottom 40) rather than in poorer administrative areas. Furthermore, capital cities receive disproportionally high shares of World Bank funding on average. [ABSTRACT FROM AUTHOR]

Aims The alcohol beverage industry has been expanding its corporate social responsibility and other business activities in sub-Saharan Africa. The aim of this paper is to evaluate the effects of these activities on the physical, economic, psychological and social availability of alcohol in the region. Methods Narrative review. Source materials came from the business press, industry sources (websites, annual reports, press releases, conference proceedings) and the scientific literature published since 2000. Results The alcohol industry has intensified its activities in the African region, through their funding of social aspect organizations, technical publications, policy workshops and other corporate social responsibility activities. Marketing campaigns, new product designs and the development of industry-civil society partnerships have increased. There is evidence that the alcohol industry also engages in lobbying, information dissemination and legal action to thwart effective public health measures. Conclusions The corporate social responsibility activities of the global alcohol industry have provided a vehicle to promote industry-favorable policies and increase the physical, economic, social and psychological availability of alcohol. [ABSTRACT FROM AUTHOR]

Development aid is commonly advocated as one of the most effective instruments to reduce international migration. Nevertheless, empirical evidence shows that push factors do not automatically result in massive migrations and that aid policies systematically fail to meet their stated objectives. Recently, several contributions have argued that an increase in sending countries' wealth may lead to a rise in migration, rather than to a reduction, because it enables people to assume the costs and risks of migrating. However, despite the growing number of studies on this phenomenon, the role played by Official Development Assistance (ODA) has not received attention yet. This paper aims at providing empirical evidence on this specific issue. In particular, we investigate the relation between ODA and international migration rates of sub-Saharan countries. We argue that ODA may have a positive effect on migration decisions for two reasons. First, ODA improves workers' ability to cover the costs of migration, by providing new job opportunities and in turn increasing incomes in the recipient country. Second, ODA, which is often associated with development programs in education, communication services, and business opportunities, may also stimulate mobility aspirations of potential migrants. We develop an econometric analysis in order to investigate this hypothesis. Specifically, we perform a three-stage least square estimation on a sample of 48 sub-Saharan countries. We build a two-equation model, so as to allow for endogeneity of ODA, and find that ODA has a positive and statistically significant effect on migration outflows. Thus, as our main contribution, we argue that development aids are not substitute for migration and that the traditional aid policies (such as those of the European Union), aimed at curbing migration by providing international financial aids, might need to be reconsidered. [ABSTRACT FROM AUTHOR]

Improved technologies are increasingly promoted to farmers in sub-Saharan Africa to address low agricultural productivity. There is, however, a lack of evidence on how adoption affects farmers’ labour use, gender roles and profitability. This paper analyses the farm level impacts of the recently introduced row planting technology in teff production in Ethiopia. Using a randomised controlled trial, we show that row planting significantly increases the total labour requirement and allocation but not teff yields, resulting in a substantial drop in labour productivity. There is no significant profitability effect at the farm level, seemingly explaining the limited success in upscaling the programme. [ABSTRACT FROM AUTHOR]

Purpose The purpose of this paper is to examine the impact of external debt and corruption on economic growth in the selected five Sub-Saharan African (SSA) countries, from 1990 to 2015.Design/methodology/approach Panel unit root and panel cointegration tests are employed to test for stationarity of the series and the long-run relationship, respectively. Fully modified OLS and dynamic OLS techniques are also employed to examine the long-run coefficients of the variables of the model, as well as panel Granger causality test, in order to examine the direction of causality among the variables.Findings The results indicate that there is a negative relationship between external debt and economic growth, as well as a bi-directional causality between the two variables. The findings also indicate a positive relationship between corruption and economic growth, as well as a uni-directional causality running from economic growth through corruption.Research limitations/implications The study recommends that the governments of the selected countries should address the menace of rising external debt through the adoption of other sources of capital for investment. Such include more openness of the economy for more capital, by easing restrictions on genuine imports and exports of valuable goods and services. It also suggests that the issue of corruption be tackled head-on, by such penalties that tend to make corruption less attractive.Originality/value While the relationship between economic growth and external debt, on the one hand, and corruption and economic growth, on the other hand, have received considerable attentions, the trio of external debt, corruption and economic growth have not been found combined in a model, to the best of the authors’ knowledge. Also, the countries under consideration, who jointly account for about 47 percent of the entire SSA countries’ stock of external debt, have not been jointly found in any recent panel studies involving the selected variables. [ABSTRACT FROM AUTHOR]

Abstract: This paper studies the role played by the quality of property rights in the linkages of international capital flows into sub‐Saharan African (SSA) economies. Using panel data of 36 SSA countries over the period 1996–2015 and the ARDL procedure with the Pooled Mean Group regression method appropriate for non‐stationary panel data estimation, we account for the joint effects of property rights quality and openness to foreign capital flows on economic growth. We uncover the existence of a property rights quality threshold beyond which property rights either amplifies the spillovers effects or attenuates the negative effect of capital flows on economic growth. For instance, it takes a level of property rights of at least 60 to have a positive long‐term impact of capital flows on economic growth in natural resource‐poor African countries. The quality of property rights matters more to obtain spillover effects of capital flows on growth in natural resource‐poor countries than in their peer natural resource‐rich countries. Finally, with regard to the countries' income levels, capital flows have significant long‐term spillovers effects on economic growth in advanced African economies than in their low‐income peers. [ABSTRACT FROM AUTHOR]

Purpose The purpose of the paper is to examine the extent and trends of income inequality as well as the contribution of household and community-level factors in explaining inequality within north and south in Ghana.Design/methodology/approach The study employs both descriptive and regression methods. The study adopts the methodology by Fields (2002) to assess the importance of household and community attributes in explaining the level of inequality within the north and the south.Findings The findings of the study show that household characteristics such as urban location, no education, public and private formal economic activities, and not covered by National Health Insurance Scheme are major determinants of inequality within the north and the south. Specifically, within the north, the 20-34 year age group is the most prominent contributor to inequality. Within the south, the most important determinant of inequality is the completion of junior high school. The contribution of community-level features shows that, within the north, access to banks is the most vital factor to inequality, whereas within the south, access to electricity and public transport is the most important community factor.Practical implications The study provides an understanding of the underlying household and community factors driving the observed inequality patterns within the north and the south in Ghana. Policy options are identified for achieving the sustainable development goals.Originality/value The study uses the latest round of the Ghana Living Standards survey, GLSS 6, which covers new data on a nationally representative sample of 18,000 households in 1,200 enumeration areas. [ABSTRACT FROM AUTHOR]

With the expansion of antiretroviral treatment programmes, many children and adolescents with HIV in sub-Saharan Africa could expect to live healthy lives. Yet adolescents have the highest levels of poor antiretroviral adherence and of loss to follow-up compared with other age groups. This can lead to increased morbidity and mortality, to the development of drug-resistant strains, and to high societal costs. While financial incentives have been extensively used to promote medication adherence among adults, their use among adolescents remains rare. And while there is a large body of ethical literature exploring financial incentives among adults, little philosophical thought has gone into their use among adolescents. This paper explores three oft-mentioned ethical worries about financial incentives for health behaviours and it asks whether these concerns are more serious in the context of incentives for improving adolescent adherence. The three worries are that such incentives would unduly coerce adolescents' decision-making, would compromise distributive justice and would crowd out intrinsic motivations and non-monetary values. Our tentative conclusion is that more empirical investigation of these concerns is necessary, and that at this point they are not compelling enough to rule out trials in which adolescents are incentivised for antiretroviral adherence. [ABSTRACT FROM AUTHOR]

Background: Road safety has been receiving increased attention through the United Nations Decade of Action on Road Safety, and is also now specifically addressed in the sustainable development goals 3.6 and 11.2. In an effort to enhance the response to Road Traffic Injuries (RTIs), this paper aims to examine the cost effectiveness of proven preventive interventions and forms part of an update of the WHO-CHOICE programme. Methods: Generalized cost-effectiveness analysis (GCEA) approach was used for our analysis. GCEA applies a null reference case, in which the effects of currently implemented interventions are subtracted from current rates of burden, in order to identify the most efficient package of interventions. A population model was used to arrive at estimates of intervention effectiveness. All heath system costs required to deliver the intervention, regardless of payer, were included. Interventions are considered to be implemented for 100 years. The analysis was undertaken for eastern sub-Saharan Africa and Southeast Asia. Results: In Southeast Asia, among individual interventions, drink driving legislation and its enforcement via random breath testing of drivers at roadside checkpoints, at 80% coverage, was found to be the most cost-effective intervention. Moreover, the combination of "speed limits + random breath testing + motorcycle helmet use", at 90% coverage, was found to be the most cost-effective package. In eastern sub-Saharan Africa, enforcement of speed limits via mobile/handheld cameras, at 80% coverage, was found to be the most cost-effective single intervention. The combination of "seatbelt use + motorcycle helmet use + speed limits + random breath testing" at 90% coverage was found to be the most cost-effective intervention package. Conclusion: This study presents updated estimates on cost-effectiveness of practical, evidence-based strategies that countries can use to address the burden of RTIs. The combination of individual interventions that enforces simultaneously multiple road safety measures are proving to be the most cost-effective scenarios. It is important to note, however, that, in addition to enacting and enforcing legislation on the risk factors highlighted as part of this paper, countries need to have a coordinated, multi-faceted strategy to improve road safety. [ABSTRACT FROM AUTHOR]

This paper uses an instrumental variables approach to estimate the relationship between trade openness and economic growth in Sub-Saharan Africa. Instrumental variables estimates show that economic growth has a significant negative contemporaneous effect on trade openness, while trade openness has a significant positive effect on economic growth. A 1 percentage point increase in the ratio of trade over GDP is associated with a short-run increase in growth of approximately 0.5% in a given year; the cumulative long-run effect on the level of GDP per capita is larger, reaching about 2%. [ABSTRACT FROM AUTHOR]

Deaths from non-communicable diseases are increasing worldwide. Low and middle-income countries, particularly those in sub-Saharan Africa (SSA), are projected to see the most rapid increase over the next two decades. While non-communicable diseases such as diabetes and cardiovascular disease increasingly contribute to mortality in SSA, communicable diseases such as malaria and HIV/AIDS remain major causes of death in this region, leading to a double burden of disease. In this paper, we use World Health Organization data and life table techniques to: (1) delineate the magnitude and toll of the double burden of disease in four SSA countries: Ghana, Gabon, Botswana, and Kenya, and (2) scrutinize assumptions linking changes in disease patterns to economic development and modernization. Our findings suggest that non-communicable and communicable diseases warrant equal research attention and financial commitment in pursuit of health equity. [ABSTRACT FROM AUTHOR]

Sub-Saharan Africa is generally one of the most electricity deprived regions in the world. Since the 1990s, the World Bank and other relevant and respected multilateral organisations have consistently advocated that the required finance to develop sub-Saharan Africa's essential electricity capacity should be sourced from the private sector. However, despite this ongoing advocacy, the private sector has been unenthusiastic to answer this call. Much of the literature attributes this reticence to a lack of 'good governance': principally negative behaviours such as corruption. Instead, in this paper we argue that this is too simplistic an explanation, as private investment has still been able to thrive in other locations where such negative behaviours have existed. To support this argument, we utilise an interdisciplinary approach to review three separate academic governance perspectives, to deliver a more comprehensive view. These are: 1) Financial Investment Governance , the private sector investor's perspective, which focuses on the rules and institutions (or lack of) that directly influence the financial investment environment; 2) Political Governance, the political economy perspective, which relates to the negative, indirect investment consequences resulting from the way that governments govern; and 3) Technological Governance, a 'systems' perspective, which encompasses how the standard structure and organisation of the wider electricity delivery system in each country, negatively impacts such investment. In discussion and conclusion, we find that if the development policy perspective for delivering electricity access to the region is to be successfully constructed around private investment, as the multilateral development community advocates, it will need to accommodate 15 distinct issues that can be identified from this comprehensive review of governance. • Sub-Saharan Africa is one of the most electricity deprived regions in the world. • The private sector has been unenthusiastic and reluctant to channel investment towards electricity infrastructure. • This study utilises three different academic approaches to explain why. • These are: 1) Financial Investment Governance , 2) Political Governance, and 3) Technological Governance. • A synthesis identifies 15 distinct governance issues that need overcome to better govern energy poverty and development. [ABSTRACT FROM AUTHOR]

Policymakers in Sub-Saharan Africa face several choices to increase levels of access to electricity under severe budget constraints. First, they need to prioritise technologies that can supply electricity at a low cost. Second, they need to design and implement appropriate policies to attract private investment. On the first choice, renewable energy is becoming increasingly competitive with fossil fuels. Moreover, it contributes to energy security and environmental sustainability, while providing access to new sources of (sustainable) finance. On the second choice, developing countries typically face a multitude of constraints to attract investment to their energy sector. It can be daunting and expensive to address them all at once. This paper presents a new methodology to support policymakers to better target policies for the promotion of commercial-scale renewable energy investment. The methodology, which we call “Green Investment Diagnostics” draws upon the Growth Diagnostics framework, extensively used in the field of Development Economics to identify the binding constraints to economic growth. It is operationalised with a decision tree analysis that builds cumulative evidence to prioritise some constraints over others, through the review of indicators and validation through expert interviews. We apply this approach to Kenya and Ghana, finding that Ghana’s key constraints to investment in renewable energy are an unreliable off-taker, macroeconomic imbalances, regulatory uncertainty, pressures to keep prices low, as well as insufficient and costly domestic finance. Kenya instead offers generous returns to investment in renewables but faces a low demand, a lack of networking infrastructure and problems of governance and social acceptance, exacerbated by uncertain land property rights and rent-seeking. [ABSTRACT FROM AUTHOR]

In this paper, we argue that the answer to the question of whether the impact of corruption on development is homogenous, is no. Our optimism rest on how development may be conceptualised. When equated to a narrow measure in economic-wise which fundamentally ignores critical issues, then there is a possibility the outlook could be positive. But when conceptualised using a broad-based approach such as sustainable development, then the outlook could be negative. We assess a panel of 22 economies in Sub-Sahara Africa with the most recent dataset (1996-2013) from the World Bank and other reputable agencies. Our finding is quite robust. It holds in pooled OLS, Fixed effects and GMM within IV settings; and it also holds for different measures of institutions and different measures of development using growth per capita GDP and genuine wealth per capita, respectively. Taking stock of major policy blue-prints of selected countries in the region on the fight against corruption, we are able to point out that institutions play important role in insulating citizens against the devastation caused by corruption. Overall, through this comparison, we are able to signal that both incidental and systematic corruption poses a long-term threat to sustainable development. [ABSTRACT FROM AUTHOR]

South African household savings rates have been declining steadily over the last five decades, raising concerns that the population structurally under-saves. Against the background of new saving-enhancing policy initiatives, this paper asks to what extent the concern is founded, and whether the measurement of saving is really appropriate to guide economic policy. Comparing different macroeconomic concepts and measurements of saving, we show that the measure of saving in the national accounts (the residual between income and expenditure) understates the household savings rate compared to other measures. Specifically, an alternative measure from the balance sheets (the change in wealth) yields a significantly higher and non-declining figure. While households have not been 'putting aside' their incomes, they have nevertheless grown richer, driven largely by the appreciation of asset valuations. We also examine the impact of taking non-financial saving and wealth into account, and conclude that household sector saving on the aggregate is significantly higher than the national accounts suggest. However, these adjusted measures are most relevant for the upper tail of the income and wealth distribution, raising important distributional concerns. [ABSTRACT FROM AUTHOR]

Background: The efficacy of low- and middle-income countries’ (LMIC) national drug policies in managing antiretroviral (ARV) pharmaceutical prices is not well understood. Though ARV drug prices have been declining in LMIC over the past decade, little research has been done on the role of their national drug policies. This study aims to (i) analyse global ARV prices from 2004 to 2013 and (ii) examine the relationship of national drug policies to ARV prices.Methods: Analysis of ARV drug prices utilized data from the Global Price Reporting Mechanism from the World Health Organization (WHO). Ten of the most common ARV drugs (first-line and second-line) were selected. National drug policies were also assessed for 12 countries in the South African Development Community (SADC), which self-reported their policies through WHO surveys.Results: The best predictor of ARV drug price was generic status—the generic versions of 8 out of 10 ARV drugs were priced lower than branded versions. However, other factors such as transaction volume, HIV prevalence, national drug policies and PEPFAR/CHAI involvement were either not associated with ARV drug price or were not consistent predictors of price across different ARV drugs.Conclusion: In the context of emerging international trade agreements, which aim to strengthen patent protections internationally and potentially delay the sale of generic drugs in LMIC, this study shines a spotlight on the importance of generic drugs in controlling ARV prices. Further research is needed to understand the impact of national drug policies on ARV prices. [ABSTRACT FROM AUTHOR]

This study is a contribution to the empirics of climate change and its effect on sustainable economic growth in Sub-Saharan Africa (SSA). Using data on two climate variables: temperature and precipitation, and employing panel cointegration econometric technique of the long- and short-run effects of climate change on growth, we establish that temperatures beyond 24.9 °C would significantly reduce economic performance in SSA. Furthermore, we show that the relationship between real GDP per capita on one hand and temperature on the other is intrinsically nonlinear. [ABSTRACT FROM AUTHOR]

This paper investigates the relationship between oil prices and exchange rates in three African countries using a Vector AutoRegressive (VAR) model. We use daily data on nominal exchange rates, oil prices and short term interbank interest rates from 01/12/2003 to 02/07/2014. The results suggest that the exchange rate of the three selected countries behavior is different in the event of an oil price shock, not only before and after the oil peak of July of 2008, but also between each other. Therefore, no general rule can be made for net oil importing sub-Saharan countries, such as Botswana, Kenya and Tanzania. We conclude that after an oil price peak, the Botswanan pula clearly appreciates against the US dollar, the Kenyan and Tanzanian shilling. [ABSTRACT FROM AUTHOR]

This paper examines the relationship between Foreign Direct Investment (FDI) and the real exchange rate for low-income countries of Sub-Saharan Africa, using a panel data approach and Two-Stage Least Squares (2SLS) method. The results show that while the depreciation of the real exchange rate draws more FDI to Sub-Saharan African countries, the real exchange rate volatility causes greater instability in FDI inflows to these countries. The results are robust across different measures and model specifications. In addition, we conclude that the use of the pegged exchange rate as an incentive to attract FDI inflow, in the presence of increasing real exchange rate instability, creates greater price instability, as a result, FDI inflows are largely influenced by the real exchange rate. [ABSTRACT FROM AUTHOR]

This paper uses panel data techniques to investigate the locational determinants of US outward foreign direct investment (FDI) into 23 countries of Sub-Saharan Africa (SSA) for 1996-2010. The findings revealed that US outward FDI into SSA is influenced by the availability of crude oil and natural gas, infrastructure development, market size and completion rates in primary education. Conversely, labor force (of those aged 15+) and inflation deter US FDI, while political instability, corruption, and the exchange rate have an insignificant negative relationship with US FDI. These findings suggest that US investors investing in SSA are significantly influenced by resource and market seeking factors but not by efficiency seeking factors. The study therefore suggests that credible policies for attracting US investors into SSA countries should be relentlessly pursued through education, training and skills acquisition, inflation targets, trade openness (especially in the natural resource sector), corruption control and political stability. [ABSTRACT FROM AUTHOR]

New estimates of economic flows by age combined with population projections show that in the coming decades (1) global GDP growth could be slower by about 1 percentage point per year, declining more sharply than population growth; (2) GDP will shift toward sub‐Saharan Africa more than population trends suggest; (3) living standards of working‐age adults may be squeezed by high spending on children and seniors; (4) changing population age distribution will raise living standards in many lower‐income nations; (5) changing economic life cycles will amplify the economic effects of population aging in many higher income economies; and (6) population aging will likely push public debt, private assets, and perhaps productivity higher. Population change will have profound implications for national, regional, and global economies. [ABSTRACT FROM AUTHOR]

A review of the article "Targeting an alcohol intervention cost-effectively to persons living with HIV/AIDS in East Africa" by J. Kessler, K. Ruggles, A. Patel, and others, which appeared in the journal "Alcoholism: Clinical and Experimental Research" on November 2015, is presented.

Aim: This research aims to identify response strategies that non-profit organizations (NPOs) can apply to overcome the barriers that hamper the sustainable use of mobile health (mHealth) interventions in low-resource environments (LREs), such as in Sub-Saharan Africa (SSA). Subject and method: A qualitative study on mHealth initiatives in SSA is conducted through semi-structured interviews with 15 key informants of NPOs that operate and manage mHealth interventions in this region. The interviews focus on identifying existing barriers and response strategies that NPOs apply to enable sustainable and long-term running interventions. Results: Building on grounded theory techniques, the collected data guided us towards a process model that identifies four aggregated categories of challenging areas that require response strategies (economy, environment, technology, and user acceptance). Conclusion: This study provides contributions from and implications for NPOs and researchers. Health practitioners are provided with a knowledge base of what barriers to expect and how to overcome them, to strive for sustainable implementation from the very beginning of an intervention. A process model is identified that structures the response strategies in a time-based agenda of mHealth initiatives and thus makes a theoretical contribution. Overall, this study addresses the need for a theoretical consideration of the "pilotitis" phenomenon, which currently hampers the sustainable implementation and scaling up of mHealth initiatives. While the focus is specifically on mHealth initiatives, the overall findings help prevent discontinuance of projects in the future after the pilot, and help facilitate LREs on their way to sustainable health interventions and universal health coverage. [ABSTRACT FROM AUTHOR]

The main function of the immune system is to protect the human body from disease. Drawing upon the case of HIV/AIDS, this article will argue that the immune system is not solely relegated to the realm of biomedical, individual bodies. Rather, immune systems are also intrinsically political-economic—and this argument will go beyond the notion of the immune system solely standing in as a metaphor for politics. Further, this article will argue that a particular immunopolitics, which will be termed here as 'queerphobic immunopolitics', and one that is characterized by the intersection of neoliberal, capitalist ideology and practices with queerphobia as an ongoing, harmful legacy of British colonialism, amongst other things—exemplifies the ongoing HIV/AIDS epidemic in Sub-Saharan Africa. In addition, this queerphobic immunopolitics not only exemplifies the ongoing HIV/AIDS epidemic in Sub-Saharan Africa—it is also a major contributing factor to Sub-Saharan Africa continuing to bear the disproportionate burden as the most HIV/AIDS affected region in the world. Following the work of Rahul Rao, this article will also argue that what also cannot be ignored is that this imported homophobia has also been appropriated and resignified to have an indigenous dimension. In its exploration, this article will also consider a recently published Human Rights Watch report on anti-LGBT[Q] repression in Tanzania and access to health, specifically in relation to HIV/AIDS. [ABSTRACT FROM AUTHOR]

Innovating is vital to farmers in sub-Saharan Africa, to adapt to challenges and benefit from opportunities. Stakeholders' decisions to engage in innovation programmes are influenced by their perceptions. This article uses the Q-method application to investigate these perceptions along the swine value chain in Benin. Fifty-five statements were established with local stakeholders and then graded by 25 interviewees on an 11-grade scale. Three main discourses were identified: an optimistic discourse tied to an endogenous vision of innovation, and a pessimistic one to a top-down, exogenous vision. A third discourse highlighted more nuanced redistributive effects of innovation. Innovation platform projects, stimulating local innovation, should rest on and reinforce the first optimistic discourse. [ABSTRACT FROM AUTHOR]

The quantitative evidence on whether extractive industries generate economic wealth at the local level is far from conclusive. In line with recent studies highlighting the moderating role of institutions and governance structures in the resource–development nexus, we argue that the effect of mining on local economic well-being is largely driven by different control rights regimes. We claim that domestic mineral production stimulates local income more than internationally controlled extraction, since national mining companies promote more backward economic linkages and have higher incentives to engage in local capacity building. To test our micro-level arguments, we combine information on districts' economic well-being as well as individual's assessments of their personal economic situation with our own dataset on the control rights of copper, gold, and diamond mines. Relying on these data, we perform district- and individual-level analyses of sub-Saharan Africa covering the period from 1997 to 2015. Our instrumental variable estimations and fixed effects models show that the presence of domestic mining companies is associated with increased local wealth. Multinational firms, by contrast, are linked to increased regional unemployment. They largely fail to promote subnational economic well-being. [ABSTRACT FROM AUTHOR]

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Key words: Cash transfers, impact evaluation, labor supply, livelihoods, productive impacts, risk Able to hire labor at the going wage, obtain A critical level of cash they reduce labor supply, All occupations -0.033** (see ag wage) (see ag wage) (see ag wage) Adult men 0.005 HH participation (%): 0.035 HH participation (%): 0.017 Cash transfers, impact evaluation, labor supply, livelihoods, productive impacts, risk management, sub-Saharan Africa. [Extracted from the article]

Economic growth and development have improved human health in many regions, while sub-Saharan Africa continues to lag behind. Economic theory and the existing empirical evidence suggest that development may not generate large reductions in the leading cause of adult mortality in the region, HIV/AIDS, and may increase risky sexual behaviour. We examine the association between schooling/material standard of living and HIV risk using data from more than 500,000 respondents in 32 sub-Saharan African countries. The results of our descriptive analysis suggest that the rapid increase in primary school completion without improvements in living standards or secondary school completion might not mitigate HIV transmission. [ABSTRACT FROM AUTHOR]

Background: Achieving Universal Health Coverage (UHC) by improving financial protection and effective service coverage is target 3.8 of the Sustainable Development Goals. Little is known, however, about the extent to which paying bribes within healthcare acts as a financial barrier to access and, thus, UHC. Methods: Using survey data in adults from 32 sub-Saharan African countries in 2014–2015, we constructed a multilevel model to evaluate the relationship between paying bribes and reported difficulties of obtaining medical care. We controlled for individual-, region-, and country-level variables. Results: Having paid bribes for medical care significantly increased the odds of reporting difficulties in obtaining care by 4.11 (CI: 3.70–4.57) compared to those who never paid bribes, and more than doubled for those who paid bribes often (OR = 9.52; 95% CI: 7.77–11.67). Respondents with higher levels of education and more lived poverty also had increased odds. Those who lived in rural areas or within walking distance to a health clinic had reduced odds of reporting difficulties. Sex, age, living in a capital region, healthcare expenditures per capita, and country Corruption Perception Index were not significant predictors. Conclusions: We found that bribery in healthcare is a significant barrier to healthcare access, negatively affecting the potential of African countries to make progress toward UHC. Future increases in health expenditures—which are needed in many countries to achieve UHC—should be accompanied by greater efforts to fight corruption in order to avoid wasting money. Measuring and tracking health sector-specific corruption is critical for progress toward UHC. [ABSTRACT FROM AUTHOR]

This article documents recent trends in science funding support in Sub-Saharan Africa (SSA). We analyse these trends at the SSA regional level alongside a summary of four case studies of science funding in four Science Granting Councils (SGCs) in East Africa. Our findings support the literature on science funding in SSA regarding low levels of funding, cross-country engagement, and the need for capacity building. However, we also find there are tensions among funding and policy actors around the perceived ways in which investment in science will benefit society. We argue that the narratives and logics of science funders and their roots in 'Republic of Science' vs. 'Embedded Autonomy' rationales for SGC activity must be more transparent to enable critical engagement with the ideas being used to justify spending. [ABSTRACT FROM AUTHOR]

Background: Long acting reversible and permanent contraception (LARPs) offer promising opportunities for addressing the high and growing unmet need for modern contraception and helps to reduce unintended pregnancies and abortion rates in sub-Saharan Africa (SSA). This study examines the contextual factors that influence the use of long acting reversible and permanent contraception among married and fecund women in Ethiopia. Method: We use data from the 2016 Ethiopian Demographic and Health Survey to examine the contextual factors that influence choice of long acting reversible and permanent contraception among married, non-pregnant and fecund women. The DHS collects detailed information on individual and household characteristics, contraception, and related reproductive behaviors from women of reproductive age. In addition, we created cluster level variables by aggregating individual level data to the cluster level. Analysis was done using a two-level multilevel logistic regression with data from 6994 married (weighted = 7352) women residing in 642 clusters (communities). Results: In 2016, 12% of married, non-pregnant and ‘fecund’ women were using long-acting reversible and permanent methods of contraception in Ethiopia. A higher proportion of women with secondary and above education (17.6%), urban residents (19.7%), in the richest wealth quintile (18.3%) and in paid employment (18.3%) were using LARP methods compared to their counterparts. Regression analysis showed that community level variables such as women’s empowerment, access to family planning information and services, region of residence and knowledge of methods were significantly associated with use of LARP methods. Age, wealth status, employment status and women’s fertility preferences were among the individual and household level variables associated with choice of LARP methods. With regards to age, the odds of using LARP methods was significantly lower among adolescents (OR, 0.53; 95% CI, 0.32–0.85) and women over the age of 40 (OR, 0.63; 95% CI, 0.44–0.90) compared to women in their 20’s. Conclusion: The findings of this study indicate that the demand for long-acting reversible and permanent contraception is influenced not only by women’s individual and household characteristics but also by the community’s level of women’s empowerment, socio-economic development, as well as access and exposure to family planning information and services. Thus, improving knowledge of long-acting reversible and permanent methods, improving women’s decision making autonomy and upgrading the capacity and skills of health workers particularly the midlevel providers and community health extension workers on the provision of LARP methods and rights-based approach is important to improve the uptake of LARP methods. [ABSTRACT FROM AUTHOR]

The major causes of newborn deaths in sub-Saharan Africa are well-known and countries are gradually implementing evidence-based interventions and strategies to reduce these deaths. Facility-based care provides the best outcome for sick and or small babies; however, little is known about the cost and burden of hospital-based neonatal services on parents in West Africa, the sub-region with the highest global neonatal death burden. To estimate the actual costs borne by parents of newborns hospitalised with birth-associated brain injury (perinatal asphyxia) and preterm/low birth weight, this study examined economic costs using micro-costing bottom-up approach in two referral hospitals operating under the nationwide social health insurance scheme in an urban setting in Ghana. We prospectively assessed the process of care and parental economic costs for 25 out of 159 cases of perinatal asphyxia and 33 out of 337 cases of preterm/low birth weight admitted to hospital on the day of birth over a 3 month period. Results showed that medical-related costs accounted for 66.1% (IQR 49% - 81%) of out-of-pocket payments irrespective of health insurance status. On average, families spent 8.1% and 9.1% of their annual income on acute care for preterm/LBW and perinatal asphyxia respectively. The mean out-of-pocket expenditure for preterm/LBW was $147.6 (median $101.8) and for perinatal asphyxia was $132.3 (median $124). The study revealed important gaps in the financing and organization of health service delivery that may impact the quality of care for hospitalised newborns. It also provides information for reviewing complementary health financing options for newborn services and further economic evaluations. [ABSTRACT FROM AUTHOR]

Voluntary medical male circumcision (VMMC) prevalence in priority countries in sub-Saharan Africa, particularly among men aged ≥20 years, has not yet reached the goal of 80% coverage recommended by the World Health Organization. Determining novel strategies to increase VMMC uptake among men ≥20 years is critical to reach HIV epidemic control. We conducted a systematic review to analyze the effectiveness of economic compensation and incentives to increase VMMC uptake among older men in order to inform VMMC demand creation programs. The review included five qualitative, quantitative, and mixed methods studies published in peer reviewed journals. Data was extracted into a study summary table, and tables synthesizing study characteristics and results. Results indicate that cash reimbursements for transportation and food vouchers of small nominal amounts to partially compensate for wage loss were effective, while enrollment into lotteries offering prizes were not. Economic compensation provided a final push toward VMMC uptake for men who had already been considering undergoing circumcision. This was in settings with high circumcision prevalence brought by various VMMC demand creation strategies. Lottery prizes offered in the studies did not appear to help overcome barriers to access VMMC and qualitative evidence suggests this may partially explain why they were not effective. Economic compensation may help to increase VMMC uptake in priority countries with high circumcision prevalence when it addresses barriers to uptake. Ethical considerations, sustainability, and possible externalities should be carefully analyzed in countries considering economic compensation as an additional strategy to increase VMMC uptake. [ABSTRACT FROM AUTHOR]

Reducing food losses and waste (FLW) is one of the sustainable ways of closing the food requirement gap in developing countries. However, there is not yet adequate knowledge on the extent of FLW by commodity type and stage of the food supply chain (FSC). Focusing on ten agrarian countries in Africa and building mainly on the Food and Agriculture Organization’s Food Balance Sheets (FBSs), this study generates some new insights on the level of FLW by country, FSC and food type. Across the FSC, we find that these countries lose a cumulative amount equivalent to 28% (641 kilocalories per capita per day – kcal/cap/day) of the current calorie intake. Within the FSC, the production and post-harvest handling stages contribute the greater shares of the total losses with 38% or 244 kcal/cap/day and 34% or 218 kcal/cap/day, respectively. Our results also show that farm incomes would increase by 20% if the avoidable losses and waste were recovered. These results are troublesome given the level of poverty and food insecurity in these countries and suggest inefficient and unsustainable use of natural resources (water and cropland) associated with the FSC losses. [ABSTRACT FROM AUTHOR]

Background: In 2015, 3,674 new HIV diagnoses were notified in Germany; 16% of those newly diagnosed cases originated from sub-Saharan Africa (sSA). One quarter of the newly diagnosed cases among migrants from sSA (MisSA) are notified as having acquired the HIV infection in Germany. In order to reach MisSA with HIV testing opportunities, we aimed to identify which determinants influence the uptake of HIV testing among MisSA in Germany. Methods: To identify those determinants, we conducted a quantitative cross-sectional survey among MisSA in Germany. The survey was designed in a participatory process that included MisSA and other stakeholders in HIV-prevention. Peer researchers recruited participants to complete standardized questionnaires on HIV knowledge and testing. We conducted multivariable analyses (MVA) to identify determinants associated with ever having attended voluntary HIV testing; and another MVA to identify determinant associated with having had the last voluntary HIV test in Germany. Results: Peer researchers recruited 2,782 participants eligible for inclusion in the MVA. Of these participants, 59.9% (1,667/2,782) previously had an HIV test. For each general statement about HIV that participants knew prior to participation in the study, the odds of having been tested increased by 19% (OR 1.19; 95%-CI: 1.11–1.27). Participants reporting that HIV is a topic that is discussed in their community had 92% higher odds of having been tested for HIV (OR 1.92; 95%-CI: 1.60–2.31). Migrants living in Germany for less than a year had the lowest odds of having had their last HIV test in Germany (OR 0.17; 95%-CI: 0.11–0.27). Additionally, MisSA 18 to 25 years (OR 0.55; 95%-CI: 0.42–0.73) and participants with varied sexual partners and inconsistent condom use (OR 0.75; 95%-CI: 0.44–0.97) had significantly lower odds of having had their last HIV test in Germany. Discussion: Through participatory research, we were able to show that knowledge about HIV and discussing HIV in communities increased the odds of having attended HIV testing among MisSA. However, recent migrants and young sexually active people are among the least reached by testing offers in Germany. Community-based interventions may present opportunities to reach such migrants and improve knowledge and increase discussion about HIV. [ABSTRACT FROM AUTHOR]

This article views death in battle as an opportunity cost whose size is determined by the number of years a rebel would have lived as a civilian. As civilian life expectancy declines, this opportunity cost does too, increasing the probability of rebellion. This theory is tested with a tragic natural experiment: the HIV/AIDS epidemic in sub-Saharan Africa. Using male circumcision rates as an instrument for life expectancy, the analysis shows that a one-year increase in life expectancy decreases the probability of civil war by 2.6 percentage points. This supports the theory that opportunity costs are important determinants of conflict onset and that nonpecuniary opportunity costs should be taken into account. This article concludes by noting that cost-benefit analyses of public health interventions should include decreases in the probability of civil war, and the attendant benefits in terms of lives saved and material damage prevented, in their calculations. [ABSTRACT FROM AUTHOR]

Little information exists on the cost structure of routine infant immunization services in low- and middle-income settings. Using a unique dataset of routine infant immunization costs from six countries, we estimated how costs were distributed across budget categories and programmatic activities, and investigated how the cost structure of immunization sites varied by country and site characteristics. The EPIC study collected data on routine infant immunization costs from 319 sites in Benin, Ghana, Honduras, Moldova, Uganda, Zambia, using a standardized approach. For each country, we estimated the economic costs of infant immunization by administrative level, budget category, and programmatic activity from a programme perspective. We used regression models to describe how costs within each category were related to site operating characteristics and efficiency level. Site-level costs (incl. vaccines) represented 77-93% of national routine infant immunization costs. Labour and vaccine costs comprised 14-69% and 13-69% of site-level cost, respectively. The majority of site-level resources were devoted to service provision (facility-based or outreach), comprising 48-78% of site-level costs across the six countries. Based on the regression analyses, sites with the highest service volume had a greater proportion of costs devoted to vaccines, with vaccine costs per dose relatively unaffected by service volume but non-vaccine costs substantially lower with higher service volume. Across all countries, more efficient sites (compared with sites with similar characteristics) had a lower cost share devoted to labour. The cost structure of immunization services varied substantially between countries and across sites within each country, and was related to site characteristics. The substantial variation observed in this sample suggests differences in operating model for otherwise similar sites, and further understanding of these differences could reveal approaches to improve efficiency and performance of immunization sites. [ABSTRACT FROM AUTHOR]

Introduction: The 2016 World Health Organization (WHO) consolidated guideline recommends lifelong antiretroviral therapy (ART) for all HIV-infected pregnant and breastfeeding women for preventing mother-to-child HIV transmission (PMTCT). Ambiguity remains about the cost-effectiveness of this strategy in resource-limited developing countries. Areas covered: We reviewed model-based studies on the cost-effectiveness of lifelong ART (formerly Option B+) relative to previous WHO guidelines for PMTCT. Our search using PubMed, Medline and Google Scholar for articles on Option B+ resulted in the final inclusion of seven studies published between 2012 and 2016. The Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist was used to assess the quality of reporting. Outcomes of interest, which included infant infections averted, maternal quality and length of life, and the Incremental Cost Effectiveness Ratio (ICER), were used in comparing cost-effectiveness. Expert commentary: Despite most model-based studies favouring lifelong ART (Option B+) in terms of its cost-effectiveness in comparison to Options A and B, inclusiveness of the evidence remains weak for generalization. This is largely because setting specificity for providing lifelong ART to all pregnant and breastfeeding women may differ significantly in each setting. Consequently, future cost-effectiveness studies should be robust, setting-specific, and endeavor to assess the willingness and ability to pay of each setting. [ABSTRACT FROM AUTHOR]

Introduction:Sub-Saharan African health systems must balance shifting disease burdens with desires for robust institutions. Stated-preference methods have been applied extensively to elicit health care workers’ preferences and priorities for rural practice. This systematic review characterizes the range of their applications to African health systems problems. Areas covered:A PRISMA protocol was submitted to PROSPERO. Six databases were queried for peer-reviewed articles using quantitative stated-preference methods to evaluate a health systems-related trade-off. Quality was assessed using the PREFS checklist. Seventy-seven articles published between 1996 and 2017 met review criteria. Methods were primarily choice-based: discrete-choice experiments (n = 46), ranking/allocation techniques (n = 21), conjoint analyses (n = 7), and best-worst scaling (n = 3). Trade-offs fell into six ‘building blocks’: service features (n = 27), workforce incentives (n = 17), product features (n = 14), system priorities (n = 14), insurance features (n = 4), and research priorities (n = 1). Five countries dominated: South Africa (n = 11), Ghana (n = 9), Malawi (n = 9), Uganda (n = 9), and Tanzania (n = 8). Discrete-choice experiments were of highest quality (mean score: 3.36/5). Expert commentary:Stated-preference methods have been applied to many health systems contexts throughout sub-Saharan Africa. Studies examined established strategic areas, especially primary health care for women, prevention and treatment of infectious diseases, and workforce development. Studies have neglected the emerging areas of non-communicable diseases. [ABSTRACT FROM PUBLISHER]

Introduction: Although the relationship between mortality and self-rated health has been demonstrated in sub-Saharan Africa, information in this area is rudimentary. In Senegal, no study has been undertaken comparing self-rated health between urban and rural areas. The objective of this study is therefore to compare self-rated health and its main predictors in Dakar and in a rural isolated area, Tessekere municipality, taking into account socio-demographic and economic factors, social relations, as well as measures of physical and mental health. Material and methods: This study was carried out in 2015 on a population sample of 1000 individuals living in Dakar and 500 individuals living in the municipality of Tessekere, constructed using the quota method. Self-rated health, health variables, psychosocial, sociodemographic and economic characteristics were collected during face-to-face interviews. Statistical analyses used were Chi-square tests and binary logistic regressions. Results: Results show that self-rated health in Senegalese urban area (Dakar) is better than in rural area (Tessekere), but the determinants of self-rated health partly differ between these two environments. Age and gender play a fundamental role in self-rated health as much in Dakar as in Tessekere but diabetes and social support play a role in self-rated health only in urban environment, whereas economic well-being is associated to self-rated health only in rural area. Conclusion: The analyses carried out in these two environments show that despite the existence of common determinants (age, gender, stress), the determinants for formulating an answer to the question of self-rated health differ. People’s social and cultural environments thus play a fundamental role in the process of rating one’s health and, in the short and long term, in the mortality rate. [ABSTRACT FROM AUTHOR]

Irrigation development in Sub-Saharan Africa has lagged significantly behind that in other developing countries. Consequently, economic development and food security are also lagging behind. Since the mid-2000s there has been a resurgence in the willingness to invest in irrigation, and Sub-Saharan Africa has the largest potential of any developing region to benefit from it. However, to gain from new investment in irrigation without repeating past failures, it is critical to develop a business model for small-scale irrigation schemes. This article explores the barriers that such a model needs to address to be successful and the opportunities this represents for irrigators’ profitability. [ABSTRACT FROM PUBLISHER]

A number of new crops have been developed that address important traits of particular relevance for smallholder farmers in Africa. Scientists, policy makers, and other stakeholders have raised concerns that the approval process for these new crops causes delays that are often scientifically unjustified. This article develops a real option model for the optimal regulation of a risky technology that enhances economic welfare and reduces malnutrition. We consider gradual adoption of the technology and show that delaying approval reduces uncertainty about perceived risks of the technology. Optimal conditions for approval incorporate parameters of the stochastic processes governing the dynamics of risk. The model is applied to three cases of improved crops, which either are, or are expected to be, delayed by the regulatory process. The benefits and costs of the crops are presented in a partial equilibrium that considers changes in adoption over time and the foregone benefits caused by a delay in approval under irreversibility and uncertainty. We derive the equilibrium conditions where the net-benefits of the technology equal the costs that would justify a delay. The sooner information about the safety of the technology arrive, the lower the costs for justifying a delay need to be i.e. it pays more to delay. The costs of a delay can be substantial: e.g. a one year delay in approval of the pod-borer resistant cowpea in Nigeria will cost the country about 33 million USD to 46 million USD and between 100 and 3,000 lives. [ABSTRACT FROM AUTHOR]