Search

Higher education operates in a quickly changing, progressively more globalized, cosmopolitan, and interconnected world (Bauman, 2000 , Globalization: The Human Consequences. New York/Chichester: Columbia University Press; Appiah, 2006 , Cosmopolitanism: Ethics in a World of Strangers. New York: W.W. Norton & Co; Zuckerman, 2013 , Rewire: Digital Cosmopolitans in the Age of Connection. New York: W. W. Norton & Company). At the same time, substantive inequalities between people and places mean that this connectivity and knowledge is unevenly spread (Hallberg Adu, 2014 , What is the opposite of a knowledge society? A critical reflection from Ghana. In Amoah, L. (ed.), Impacts of the Knowledge Society on Economic and Social Growth in Africa. IGI Global). For our students, the future leaders of this unequal world, critical reasoning becomes a key skill, and perhaps especially so for students in the Global South. This paper argues that digital humanities (DH) can provide both a theoretical framework for decolonizing the academy and technological solutions to hurdles in this process. The paper argues that assignments, their theoretical underpinnings, and implementation are key to decolonizing higher education. It describes three accessible technology-driven assignments with DH pedagogy created for diverse classrooms at Ashesi University in Ghana and discusses their outcomes. [ABSTRACT FROM AUTHOR]

During the early years following Ghana's political independence from British rule, calls were made for university education to have 'an African character'. As a field steeped in Eurocentric narratives, how did the Classics survive, and how did classicists respond to the politics of Africanization? This paper draws on the political contexts under which secondary and tertiary education in Ghana underwent reforms to discuss the threats and challenges these reforms posed to the sustenance of the field of Classics, and the decolonization strategies classicists adopted during the calls for Africanization in university education. The paper suggests that the idea of 'world civilization' which does not consider one civilization as superior over another cemented decolonization efforts in the early post-independent era, and helped classicists meet the conditions of 'relevance' in the African context through comparative studies. Current attempts at decolonizing Classics in Africa would benefit from these strategies if applied to both research and curriculum development. [ABSTRACT FROM AUTHOR]

This editorial has been written by programme leads at the Liverpool School of Tropical Medicine in the UK to condense the learning shared across articles. Articles within this supplement have been written and led by authors in Nigeria and Liberia, and informed by learnings from across the partnership including from our partners in Ghana and Cameroon and articles previously published. Early career researchers were supported throughout the COU NTD OWN programme to publish evidence and lead the production of impactful papers. Decision makers and local implementers from each context are also authors on the papers within the supplement and were supported to engage with the writing process. [ABSTRACT FROM AUTHOR]

Matched sampling methodology (MSM) has been used in remittance studies to understand remittance transfers. However, a detailed examination of the role of trust as a central element in producing reliable and valid research conclusions when a matched sample methodology is used has been missing in the literature. This paper fills this lacuna by arguing that cultivating trust in matched sampling research on remittance transfers, a sensitive subject matter, between African immigrants and their relatives presents a more nuanced narrative of remittance transfers. This approach shows that not only do African immigrants in the 'Global North' send remittances back home, but immigrants also receive remittances (reverse remittances) from their relatives on the continent. Using remittance research conducted among Ghanaian immigrants in the UK and their relatives in Ghana, this article identifies three 'avenues of trust'—'public avenues of trust', 'intermediate avenues of trust', and 'private avenues of trust'—to highlight the processes and challenges that researchers encounter while establishing contact with research participants and the role that trust plays in gathering accurate information. Focusing on the role of trust in MSM is in line with recent theoretical paradigms of remittance research that call for soliciting information from both origin and destination countries. [ABSTRACT FROM AUTHOR]

Substandard and falsified (SF) medical products pose a major threat to public health and socioeconomic development, particularly in low- and middle-income countries. In response, public education campaigns have been developed to alert consumers about the risks of SF medicines and provide guidance on 'safer' practices, along with other demand- and supply-side measures. However, little is currently known about the potential effectiveness of such campaigns while structural constraints to accessing quality-assured medicines persist. This paper analyses survey data on medicine purchasing practices, information and constraints from four African countries (Ghana, Nigeria, Sierra Leone and Uganda; n  > 1000 per country). Using multivariate regression and structural equation modelling, we present what we believe to be the first attempt to tease apart, statistically, the effects of an information gap vs structural constraints in driving potential public exposure to SF medicines. The analysis confirms that less privileged groups (including, variously, those in rural settlements, with low levels of formal education, not in paid employment, often women and households with a disability or long-term sickness) are disproportionately potentially exposed to SF medicines; these same demographic groups also tend to have lower levels of awareness and experience greater levels of constraint. Despite the constraints, our models suggest that public health education may have an important role to play in modifying some (but not all) risky practices. Appropriately targeted public messaging can thus be a useful part of the toolbox in the fight against SF medicines, but it can only work effectively in combination with wider-reaching reforms to address higher-level vulnerabilities in pharmaceutical supply chains in Africa and expand access to quality-assured public-sector health services. [ABSTRACT FROM AUTHOR]

Few studies exist on the early care and education (ECE) of children who are deaf in low-to-middle-income countries, and none examine the roles of deaf adults in such provision. A research base is needed to inform contextually sensitive "deaf-infused" models of ECE in such contexts that build on indigenous deaf community experience, knowledge, and local expertise. This paper discusses the development of ECE in Ghana in sub-Saharan Africa focusing specifically on the perspectives of deaf adults on their roles in ECE support and leadership. Seventeen deaf adults with different leadership and advocacy roles in Ghana were interviewed about their perceptions of ECE priorities in this context, and the role of deaf adults in the development and delivery of early support. The participants expressed diverse views on ECE for the children and their families and suggested ways of building capacity and leadership among deaf adults to support ECE for the children and their families. [ABSTRACT FROM AUTHOR]

Objectives: This study evaluates structures that determine the quality of medicines procured through the pooled procurement program (PPP) in the National Catholic Health Service (NCHS) using the Donabedian model. The challenges faced in the PPP are also revealed. Method: A qualitative multiple case study was used to collect information from twenty top- and middle-level administrators in the NCHS through in-depth interviews. After the data transcription, it was then analysed using the thematic content analysis approach. Key findings: The study found that the structures for quality of services in the health facilities are moderately satisfactory. The structures of the NCHS included experienced healthcare workers, adequate physical infrastructures, functional Drug and Therapeutic Committees (DTCs) and a rapid-testing laboratory facility to ensure that medicines procured were of high-quality. This paper established that suppliers of medicines to the health facilities in the NCHS had to register with the NCHS subject to annual renewal. Suppliers are also required to have the Pharmacy Council (PC) and the Food and Drug Authority (FDA), certification to supply medicines to health facilities. However, the predominant challenges that confronted the health facilities were delays in health insurance claims processing and payments, and lack of management commitment in implementing the PPP. Conclusion: The study contributes to the pharmaceutical health services literature in the context of the pooled procurement approach in the sourcing of medical goods in the health sector. Significant implications for research and management are also presented. [ABSTRACT FROM AUTHOR]

This paper examines policies and practices of inclusive education for young deaf children in Ghana. Though existing Government policy promotes the principles and implementation of educational inclusion of all children in Ghana, caregivers often encounter significant challenges ensuring access to early years' education for their deaf children. We used Bronfenbrenner's (2005) bioecological systems theory and interviewed 15 educators of deaf children and 9 hearing-health clinicians, to capture different knowledge, experience, and perspectives on policy, practice, and inclusive approaches to deaf children's education. We ask: (a) How do teachers, clinicians, and caregivers connect to promote early childhood care education (ECCE) for young deaf preschoolers in Ghana? and (b) What resources and precarities are available to educators of deaf children and hearing-health clinicians in sustaining inclusive educational practices across urban and rural contexts in Ghana? We address these unanswered questions about the potential pathway to bring about changes in policy and practice in promoting successful inclusive education for deaf children in Ghana. Implications for national and international policy and practice of ECCE for deaf children are discussed and recommendations are made. [ABSTRACT FROM AUTHOR]

Access to safe drinking water is critical in improving health and well-being. It is estimated that >40% of urban households in Ghana do not have access to safe drinking water. Although the willingness and ability of community members to collectively take local initiatives are essential to curtailing inequities in water access in Ghana, the determinant of collective action is less explored. This paper explores determinants of collective action in water-insecure neighbourhoods and examines how perceived inequities in access to water and trust mediate the relationship between lack of access to water and collective action in urban Ghana. The results show that the urban poor OR = 12.047 (p = 0.000) were more likely to participate in water-related collective action compared to wealthy individuals. Primary decision-makers were 1.696 times more likely to participate in collective (p = 0.02). We also found that perceived inequities OR = 0.381 (p = 0.00) significantly predict participation in collective action to address water insecurity. Water service providers should be subjected to a rigid state-level framework that ensures inclusivity, fairness and justice in their distribution systems. [ABSTRACT FROM AUTHOR]

One of the central premises of the literature on financialisation is that we have been living in a new era of capitalism, characterised by a historical shift in the finance-production nexus. Finance has expanded to a disproportionate economic size and, more importantly, has divorced from productive economic pursuits. In this paper, we explore these claims of 'expansion' and 'divorce' based on a longue durée analysis of the link between finance and production in Senegal and Ghana. As such, we de-centre the dominant approach to financialisation. Seen from the South, we argue that although there has been expansion of financial motives and practices the 'divorce' between the financial and the productive economy cannot be considered a new empirical phenomenon having occurred during the last decades and even less an epochal shift of the capitalist system. The tendency for finance to neglect the needs of the domestic productive sector has been the structural operation of finance in many parts of the Global South over the last 150 years. Therefore, one cannot put forward a theory of the evolution of finance under capitalism without taking these crucial historical insights into account. [ABSTRACT FROM AUTHOR]

Social media misinformation is widely recognized as a significant and growing global problem. Yet, little is known about how misinformation spreads across broader media ecosystems, particularly in areas with varying internet access and connectivity. Drawing on research in northern Ghana, we seek to address this gap. We argue that 'pavement media'—the everyday communication of current affairs through discussions in marketplaces, places of worship, bars, and the like and through a range of non-conversational and visual practices such as songs, sermons, and graffiti—is a key link in a broader media ecosystem. Vibrant pavement and traditional media allow for information from social media to quickly cross into offline spaces, creating a distinction not of the connected and disconnected but of first-hand and indirect social media users. This paper sets out how social, traditional, and pavement media form a complex and deeply gendered and socio-economically stratified media ecosystem and investigates its implications for how citizens differentially encounter, process, and respond to misinformation. Based on the findings, we argue that efforts intended to combat the spread of misinformation need to move beyond the Western-centred conception of what constitutes media and take different local modalities of media access and fact-checking into account. [ABSTRACT FROM AUTHOR]

Health system responsiveness (HSR) has been identified as one of the intrinsic goals of health systems for improvement in health and well-being of population. The HSR deals with the non-medical, legitimate expectations of a population in its interaction with the health system. It becomes essential in case of vulnerable groups like older adults with disability, who are more sensitive and risk-prone to the adversities of healthcare challenges. This paper uses data from the Study on Global Ageing and Adult Health conducted in China, Ghana, India, Mexico, Russia and South Africa during 2007-10 and examines the disability-based disparity in outpatient HSR among the older adults in the above-mentioned countries. Disability and HSR scores have been constructed using Item Response Theory Partial Credit Model. Also, the paper uses bivariate and multivariate analysis and finds that the HSR is significantly and substantially lower among the disabled and severely disabled older adults in all the study countries (except Ghana) as compared with those older adults who are not (or mildly) suffering from any form of disability. The policy efforts in the studied countries should focus on monitoring and reducing these disparities for improving HSR in order to make it inclusive. [ABSTRACT FROM AUTHOR]

Using a randomized survey experiment in urban Ghana, this paper demonstrates that the length of the reference period and the interview modality (in-person or over the phone) affect how people respond in labor surveys, with impacts varying markedly by job type. Survey participants report significantly more self-employment spells when the reference period is shorter than the traditional one week, with the impacts concentrated among those in home-based and mobile self-employment. In contrast, the reference period has no impact on the incidence of wage-employment. The wage-employed do report working fewer days and hours when confronted with a shorter reference period. Finally, interviews conducted on the phone yield lower estimates of employment, hours worked, and days worked among the self-employed who are working from home or a mobile location as compared to in-person interviews. [ABSTRACT FROM AUTHOR]

This article investigates the impact of Ghana's World Trade Organization (WTO) accession on firm-level product and labor market imperfections. The article exploits a rich dataset of firm-level information to estimate markups and the degree of monopsony power enjoyed by manufacturing firms. The results indicate that price-cost margins declined while the degree of monopsony power increased in the wake of WTO accession. These diverging dynamics suggest that firms compress real wages to offset loss of market power in the product market due to increased international competition. This gives rise to an increase in the market imperfection gap, which gradually erodes the pro-competitive gains from trade. The article contributes to the literature by identifying channels through which allocative inefficiencies and misallocation can persist even after trade liberalization. [ABSTRACT FROM AUTHOR]

One of the commonly cited obstacles to firms' operations in developing economies is inadequate access to electricity. This paper explores the impact of electricity outages on firm productivity using arguably exogenous variation in outages, induced by an electricity rationing program, across small and medium-sized Ghanaian manufacturing firms. The results indicate that eliminating outages in this setting could lead to an increase in firm productivity. Further analyses of the strategies firms use to cope with outages show that changing the firm's product mix to favor less electricity-intensive products mitigates the negative impacts of outages on productivity. However, using a generator, a common strategy in many parts of the world, is unable to insulate firms from the negative impacts of outages on productivity. [ABSTRACT FROM AUTHOR]

For the past 10 years the Ghana Government has been trying to replace the old user fee system with an overall health insurance scheme, but one problem of the old system continues to bedevil the new policy: exemption of the poor. This paper presents data from empirical fieldwork and also puts forward an opinion. It discusses how past experiences of user fee exemptions for the poor can inform exemptions under the new ‘National Health Insurance Scheme’ (NHIS) as a means to ensuring equity in health care. Drawing on a study of exemptions in the three regions of northern Ghana, and utilizing both qualitative and quantitative methods and data, the findings show that exemptions were applied in favour of under-fives, antenatal care, the aged and public servants to the disadvantage of the poor. As a result, the poor had very little access to exemptions. Exemptions therefore failed to address equity concerns in health care, the very reason for which they were introduced. Thus, although the paper acknowledges that provision for the enrolment of the poor into the NHIS is a step in the right direction, it underscores that effective enrolment will be essential for attaining the equity goal of the policy. Informed by past experiences that undermined the equity goal of exemptions, three policy recommendations are put forward for improving exemptions for the poor under the NHIS. These are: (1) effective community education for enhancing premium paying enrolments into the NHIS alongside education on exemptions for the poor; (2) reviewing and clarifying policy guidelines for guiding local-level identification of the poor based on communities’ own understanding of poverty; and (3) providing the requisite resources to enable the Department of Social Welfare to discharge its core mandate of identifying the poor for exemptions. [ABSTRACT FROM AUTHOR]

Background Female genital mutilation (FGM) is commonly practiced in sub-Saharan Africa and results in adverse pregnancy outcomes among affected women. This paper assessed the prevalence and effects of FGM on pregnancy outcomes in a rural Ghanaian setting. Methods We analyzed 9306 delivery records between 2003 and 2013 from the Navrongo War Memorial Hospital. Multivariable logistic regression analyses were used to determine the effects of FGM on pregnancy outcomes such as stillbirth, birth weight, postpartum haemorrhage, caesarean and instrumental delivery. We also assessed differences in the duration of stay in the hospital by FGM status. Results A greater proportion of mothers with FGM (24.7%) were older than 35 years compared with those without FGM (7.6%). FGM declined progressively from 28.4% in 2003 to 0.6% in 2013. Mothers with FGM were nearly twice as likely to have caesarean delivery (adjusted odds ratios = 1.85 with 95%CI [1.72, 1.99]) and stillbirths (1.60 [1.21, 2.11]) compared with those without. Similarly, they had a 4-fold increased risk of post-partum haemorrhage (4.69 [3.74, 5.88]) and more than 2-fold risk lacerations/episiotomy (2.57 [1.86, 3.21]) during delivery. Average duration of stay in the hospital was higher for mothers with FGM from 2003 to 2007. Conclusions Despite significant decline in prevalence of FGM, adverse obstetric outcomes are still high among affected women. Increased public health education of circumcised women on these outcomes would help improve institutional deliveries and heighten awareness and prompt clinical decisions among healthcare workers. Further scale-up of community level interventions are required to completely eliminate FGM. [ABSTRACT FROM AUTHOR]

Although the search for appropriate methodology in educating and training rural community populations is on going, previous efforts have yielded few results, some of which have not been successful with consequences for scarce resources. This paper, based on field reports from the Population Communication Project in Ghana, demonstrates that community learning theory can offer understanding of appropriate methodology in rural learning, education and training. The report shows steps used in educating people in Wusuta (a rural community) on health and environmental issues in the community using a mix of traditional and modern approaches. The result shows that the community internalized learning activity and were able to relate their learning experiences to existing traditional values and the need for action. The paper thus offers the method as a solution to rural population training and learning methodology. [ABSTRACT FROM AUTHOR]

This paper describes the initiatives taken by the Republic of Ghana to enact an Affirmative Action (Gender Equality) Bill that is in consonance with the 1992 Fourth Republican Constitution to meet the demand for increased participation of women in governance and decision-making positions and takes into account the international obligations of the Republic of Ghana. The paper examines the strategies proposed in the context of legislation to meet the challenges of enforcement in an environment where the paternalistic traditions of men persist. The paper also outlines measures to effectively redress social, economic, and educational gender imbalances in Ghana in a legal framework to remove the impediments to sustainable national development and create a situation where gender equity prevails and women have equal rights, equal responsibilities, and equal access to every aspect of national life. [ABSTRACT FROM AUTHOR]

In some cultures, migrants bear an obligation to bring gifts from the foreign country for their relations when returning to their homeland. Why, and to what end? We examine the reasons for these transnational gift obligations in a multisite study of Ghanaian migrants in the United States and Australia, as well as people in Ghana with migrant relations living overseas. We adopt a wealth-centered perspective that problematizes the underexplored mutual impact of migrants and their gifts on social hierarchies within societies and transnational spatial hierarchies between societies. We show how the concepts of wealth in people and wealth in place connect with local gift economies to explain transnational gifting obligations. Specifically, informants use transnational gifts that embody wealth in place to acknowledge "being wealth" to people and to acquire wealth in others. We highlight the wealth in things that are exchanged as gift objects and the wealth in people who are exchanged as gift subjects between here and there. Our findings implicate a "glocal" gift economy that results from the global flows of things and people as gifts within transnational places of differing statuses. We discuss how this glocal gift economy (re)produces transnational spatial hierarchies and local (national) status hierarchies. [ABSTRACT FROM AUTHOR]

The effects of the coronavirus disease (COVID-19) pandemic cuts across every facet of a nation's life. The near collapse of economies with the attendant job losses has brought forth the need for effective social policies, particularly in developing countries, that can serve citizens in dire need. Consequently, many of these countries have had to craft emergency social policies to help their citizens. Ghana is no exception. While measures to control the spread of the pandemic, such as lockdowns and restrictions on movement and gathering, were timely, they negatively impacted the poor, most of whom work in the informal sector and depend on daily survival activities such as buying and selling basic goods. As a result, some of the measures were ignored as people feared they would die from hunger rather than from the pandemic. Thus, governmental response to the pandemic was highlighted by policy layering and exposed the fragile social support systems in existence. The challenges of responding adequately to the pandemic underscore the importance of a transformative social welfare regime in ensuring the protection of citizens. This paper, based on desk research, explores the limitations of the existing social policy framework, which became manifest during the implementation of Ghana's pandemic policies. Policy layering by government continues to weaken Ghana's social welfare system, and this affected the official response with respect to the social issues that have emerged due to the pandemic. [ABSTRACT FROM AUTHOR]

The contestations over land and pasture redefine broad complex boundaries between three groups: autochthone farmers of Agogo, Fulani sedentary herders, and Fulani nomads. The broad boundaries have emerged into sub-categories between the sedentary Fulani and Fulani nomads who belong to the same ethnic group of Fulbe in West Africa. With growing population pressures and shrinking resources, the competition for land and livelihoods has fuelled tensions among these groups, feeding a cycle of recurring violence. Extended qualitative fieldwork conducted in six communities in the forest transitional zone of Ghana reveals how these tensions are connected to emerging forms of self-categorisation and othering: developing positive attitudes of in-groups, while viewing others less favourably. This has produced a triadic relationship with varied claims to authority, space, and residential superiority. The indigenous farmers claim ownership of the land and demand the evacuation of both sedentary Fulani and Fulani nomads from the area. The sedentary Fulani claim they are not the troublemakers but that they are blamed for the encroachment and destruction of farms. The Fulani nomads resist assertions that they are dangerous and unapproachable, but intentionally remain aloof and outside, at the margins of Ghana's legal authority. [ABSTRACT FROM AUTHOR]

It is believed that low wages are an important reason why doctors and nurses in developing countries migrate, and this has led to a call for higher wages for health professionals in developing countries. In this paper, we provide some of the first estimates of the impact of raising health workers’ salaries on migration. Using aggregate panel data on the stock of foreign doctors in 16 Organization for Economic Cooperation and Development countries, we explore the effect of a wage increase programme in Ghana on physician migration. We find evidence that 6 years after the implementation of this programme, the foreign stock of Ghanaian doctors abroad had fallen by approximately 10% relative to the estimated counterfactual. This result should be interpreted with caution, however, given the sensitivity of the results to changes in model specification. [ABSTRACT FROM AUTHOR]

Although the population of Ghana is young and generally youthful, there is evidence of rapid increases in the size of the elderly cohort. Although demographic projections estimate that the proportion of the population younger than 15 years will experience continuous decline overtime due in part to decline in fertility, the rise in the elderly population is expected to also continue due to declining mortality rates resulting in longevity. Unfortunately, the growth in the elderly proportion of the population is occurring at the same time traditional systems of protection and care for the aged are breaking down on account of urbanization, socioeconomic development, and globalization. This has implications for public policy and the overall wellbeing of the elderly. This paper provides a snapshot overview of the demographic dynamics of Ghana focusing on the characteristics of aging, the challenges confronting the elderly, policy interventions, and gaps, as well as some pertinent issues including emerging research that are shaping deliberations about the elderly in the country. [ABSTRACT FROM AUTHOR]

This paper examines perspectives on the recent proliferation of sargassum (free-floating seaweed) in the oil-producing region of Ghana. The shores of many fishing villages surrounding Ghana's Jubilee Oil Field are now covered with decomposing sargassum, which, in addition to releasing offensive smells, clogs the fishing nets and boat engines of local fishermen, in turn, disrupting livelihoods considerably. Fishermen from villages such as Cape Three Points have linked the ‘blackened’ colour of rotting sargassum to the recent commencement of oil production, calling on the government to discipline Tullow, the main company operating in the Jubilee Oil Field, and to compensate them accordingly. Representatives from the government and Tullow have countered by stating that the growing presence of sargassum, which is an important source of food for numerous aquatic species, has more to do with local fishing habits: that it is a result of overfishing, not oil production. Whether this phenomenon is coincidental or not, the response of both policy-makers and government officials to mounting grievances over sargassum has been woefully inadequate, and fairly symptomatic of the approach being taken overall to foster development in communities affected by oil production in Ghana and the wider sub-region. [ABSTRACT FROM PUBLISHER]

Research on African mediumistic experiences is usually subsumed under "possessions," with no distinction made to differentiate the various degrees and categories of mediumship experiences. This paper makes one such distinction that mediumship experiences among the Akan are aptly described as alighting or alightment. After years of austere training, Akan mediums or Akomfo learn to control, discipline, and refine their initial uncontrolled "insane" experiences. The evidence shows, that the Akomfo are clergy wholly, deriving their vocational authority from a continuum of priests, mediums, doctors, etc., making them essential to Akan religious practices. Entrusted with sacred rites, the Akomfo preserve and protect for posterity the religious and cultural traditions of their ancestors in order to insure ritual continuity and sameness. Focusing on the clergy from three communities in the Central Region of Ghana, the paper follows them from the time that they are "called" to their ordinations as Akomfo, and observes mediumistic practices. [ABSTRACT FROM AUTHOR]

There is increasing advocacy for community-based health insurance (CBHI) schemes as part of a broader solution to health care financing problems in low-income countries, but to date there is very limited understanding of how CBHI schemes interact with other elements of a health care financing system. This paper aims to set out a preliminary conceptual framework for understanding such interactions, and highlights the kind of research questions raised by such a framework. A basic conceptual map of a CBHI scheme is developed, and extensions added to this map that incorporate (1) effects upon non-members of schemes, (2) government subsidies to providers, (3) government subsidies to schemes, and (4) issues raised by the existence of multiple risk-pooling schemes in a particular context. The utility of a broader approach to analyzing/assessing CBHI schemes is illustrated through examination of two policy issues, namely (1) coordination of CBHI risk pools and government risk pools, and (2) equity implications of CBHI schemes and the role of government subsidies in such schemes. It is concluded that there is a strong need for empirical work to explore how CBHI schemes and the broader health care financing system interact, and that even if individual schemes achieve their own objectives (in terms of equity, efficiency etc.), this does not necessarily imply that such objectives will be achieved at the system level. [ABSTRACT FROM AUTHOR]

This paper presents insights from a gender sensitization workshop organized by a non-governmental organization in a community where both men and women are under-educated but in which a gender gap could still be discerned. It explores the perceptions of community members regarding the importance of education generally, but girl-child education in particular. The project sought to challenge cultural values and beliefs concerning women in the community. The first part of the paper makes a case for interventions to ensure that the gender disparity in education is addressed. The second revisits the gender sensitization workshop, whilst the third part looks at lessons drawn from the workshop. [ABSTRACT FROM AUTHOR]

This study examines recall bias in farm labor through a randomized survey experiment in Ghana, comparing farm labor estimates from an end-of-season recall survey with data collected weekly throughout the agricultural season. Recall households report 10 percent more farm labor per person-plot, which can be explained by recall households' underreporting of "marginal" plots and household workers. This "selective" omission by recall households, denoted as listing bias, alters the composition of plots and workers across treatment arms and inflates average farm labor hours per person-plot in the recall group. Since listing bias, in this setting, dominates other forms of recall bias at higher levels of aggregation (i.e. when farm labor per person-plot is summed at the plot, person, or household level), farm labor productivity is overestimated for recall households. Consistent with the notion that recall bias is linked to the cognitive burden of reporting on past events, there is no recall bias among more educated households. [ABSTRACT FROM AUTHOR]

In this paper, we examine patterns of self-reported diagnosis of noncommunicable diseases (NCDs) and prevalences of algorithm/measured test-based, undiagnosed, and untreated NCDs in China, Ghana, India, Mexico, Russia, and South Africa. Nationally representative samples of older adults aged ≥50 years were analyzed from wave 1 of the World Health Organization's Study on Global Ageing and Adult Health (2007-2010; n = 34,149). Analyses focused on 6 conditions: angina, arthritis, asthma, chronic lung disease, depression, and hypertension. Outcomes for these NCDs were: 1) self-reported disease, 2) algorithm/measured test-based disease, 3) undiagnosed disease, and 4) untreated disease. Algorithm/measured test-based prevalence of NCDs was much higher than self-reported prevalence in all 6 countries, indicating underestimation of NCD prevalence in low- and middle-income countries. Undiagnosed prevalence of NCDs was highest for hypertension, ranging from 19.7% (95% confidence interval (CI): 18.1, 21.3) in India to 49.6% (95% CI: 46.2, 53.0) in South Africa. The proportion untreated among all diseases was highest for depression, ranging from 69.5% (95% CI: 57.1, 81.9) in South Africa to 93.2% (95% CI: 90.1, 95.7) in India. Higher levels of education and wealth significantly reduced the odds of an undiagnosed condition and untreated morbidity. A high prevalence of undiagnosed NCDs and an even higher proportion of untreated NCDs highlights the inadequacies in diagnosis and management of NCDs in local health-care systems. [ABSTRACT FROM AUTHOR]

Background In malaria–endemic countries, the absence of parasitological confirmation of malaria infection potentially results in overtreatment of non-malaria febrile illness with antimalarial drugs; this may lead to healthcare workers (HCW) missing other treatable illness or wastage of resources. This paper presents results from nationally representative assessments of malaria diagnostic accuracy, quality and capacity in Ghana and the Republic of Benin. Methods Cross-sectional surveys were conducted in December 2012 among a representative sample of health facilities (n=30 per country), using a modified service provision assessment, followed by HCW observations and interviews. To analyze the data we used χ2 statistics and logistic regression. Results Malaria microscopy and rapid diagnostic test interpretation was accurate most of the time in both countries. Drugs were generally prescribed in line with positive malaria test results (Ghana: 85.4%, 95% CI: 72.2–98.7; Benin: 83.6%, 95% CI: 68.7–98.4), although some patients with negative malaria test results still received treatment (Ghana: 30.1%, 95% CI: 11.1–49.0; Benin: 37.8%, 95% CI: 22.6–53.0). Conclusions Diagnostics for malaria are often performed adequately and accurately in Ghana and Benin, although diagnostic coverage within facilities remains incomplete and some individuals who test negative for malaria receive antimalarial drugs. [ABSTRACT FROM AUTHOR]

Background Sickle cell disease (SCD) describes a group of multisystem, genetic and stigmatising blood conditions that are prevalent in sub-Saharan Africa. Health-related stigma is a negative experience or adverse social judgement about a group based on an enduring feature conferred by a particular health problem. Literature shows that stigmatisation is experienced by people with SCD with negative implications on their lives. This study investigated self-reported views and lived experiences of young adults in Accra, Ghana, regarding SCD-related stigma and its impact on their lives. Methods Data were collected from 19 males and females with SCD using semi-structured individual interviews and focus group discussions. Transcripts were analysed using Braun and Clark's framework for thematic analysis. Results Five themes were identified: exclusion; status loss; SCD misconceptions; internalised stigma; and stigma and health outcomes. Overall, interpersonal and institutional levels of stigma were evident throughout the data with a lack of public education, limited specialist care and religion acting as determinants of SCD-related stigma. Conclusions Stigma has detrimental consequences for young adults with SCD. Multilevel stigmatisation of SCD at interpersonal and institutional levels should be addressed through multipronged approaches including increased public education, investment in specialist healthcare and collaboration with socioreligious institutions. Further research is needed to investigate the experiences of young adults in rural Ghana. [ABSTRACT FROM AUTHOR]

Background Community health workers in Dangme-West district, Ghana, treated children aged 2–59 months with fever with either artesunate–amodiaquine (AAQ) or AAQ plus amoxicillin (AAQ + AMX) within a cluster-randomized controlled trial (registration no. TDR/UNDP Trial registration A: 20189). The intervention was introduced in a stepped-wedge manner. The aim of the study was reduction of mortality. This paper reports on the reduction of morbidity, notably anaemia, severe anaemia and severe illness. Clusters of 100 children were randomized in to AAQ, AAQ + AMX and pre-intervention arms. Six months later the pre-intervention clusters were randomized in to the AAQ and AAQ + AMX arms. Methods Data were collected in eight cross-sectional surveys. Using stratified sampling, 10 clusters were randomly selected per survey. Blood samples were taken to assess haemoglobin. Caregivers were interviewed about diseases (signs and symptoms) among their children in the preceding 14 days. Multivariate logistic regression analysis was used to determine the impact on anaemia, severe anaemia and severe illness. Results Compared with the pre-intervention clusters, anaemia was reduced in the AAQ (OR = 0.20, 95% CI 0.12–0.33) and AAQ + AMX (OR = 0.23, 95% CI 0.15–0.36) clusters, severe anaemia was reduced in the AAQ (OR = 0.20, 95% CI 0.09–0.45) and AAQ + AMX (OR = 0.12, 95% CI 0.04–0.31) clusters and severe illness was reduced in the AAQ (OR = 0.46, 95% CI 0.26–0.80) and AAQ + AMX (OR = 0.38, 95% CI 0.22–0.63) clusters. No significant differences were found in outcome variables between the AAQ and AAQ + AMX clusters. Conclusions Treating fever with antimalarials significantly reduced the prevalence of anaemia, severe anaemia and severe illness. We found no significant reduction in outcomes when the AAQ and AAQ+AMX clusters were compared. [ABSTRACT FROM PUBLISHER]

This paper provides a critical analysis of the recent developments in the incomplete contracts theory and its conclusions for privatisation of public services. Drawing on a case study of management contract for urban water services in Ghana and highlighting the flaws in the theory, the article argues that contractual incompleteness does not provide a uniform guidance on efficient forms of ownership. We argue that methodological individualism utilised in the theory is particularly ineffective for its application to public services where direct or indirect contractual role of the state cannot be eliminated. The sterility of the theory with respect to political, institutional and distributional context of public service delivery is identified as an important weakness. [ABSTRACT FROM PUBLISHER]

Introduction: Country-level evidence from Africa on the prevalence of tobacco use and the role played by both demographic and socioeconomic factors, as influences on the use of tobacco products, is sparse. This paper analyzes the determinants of tobacco use in Ghana and explores the association between tobacco use and poverty in the country. Methods: Data from the 2008 Ghana Demographic and Health Survey, a nationally representative survey of households (n = 12,323), were used to generate descriptive statistics and characterize tobacco use in the country. A logistic regression model was used to evaluate the relationships between tobacco use and age, place of residence, region, education status, wealth, marital status, alcohol use, and whether the person has children. Unadjusted and adjusted odds ratios were calculated for tobacco users and nonusers on the likelihood of their purchase of selected commodities indicative of living standards. Results: Tobacco use was significantly higher among those living in poverty stricken regions, those with less education, lower levels of wealth, parents, and alcohol users. Tobacco use was significantly higher among men (7%) than women (0.4%), and it increased to a peak age of 41.4 years before it declined. Using tobacco was also associated with a lower likelihood of purchasing health insurance. Discussion: Tobacco use is inextricably related to poverty in Ghana. Policies should be formulated to target populations and regions with higher tobacco prevalence to combat both poverty and tobacco use simultaneously. [ABSTRACT FROM AUTHOR]

Objective This paper identifies, ranks and compares perceptions of insured and uninsured households in Ghana on health care providers (quality of care, service delivery adequacy, staff attitudes), health insurance schemes (price, benefits and convenience) and community attributes (health ‘beliefs and attitudes’ and peer pressure). In addition, it explores the association of these perceptions with household decisions to voluntarily enrol and remain in insurance schemes.Methods First, data from a household survey of 3301 households and 13 865 individuals were analysed using principal component analysis to evaluate respondents’ perceptions. Second, percentages of maximum attainable scores were computed for each cluster of perception factors to rank them according to their relative importance. Third, a multinomial logistic regression was run to determine the association of identified perceptions on enrolment.Results Our study demonstrates that scheme factors have the strongest association with voluntary enrolment and retention decisions in the National Health Insurance Scheme (NHIS). Specifically these relate to benefits, convenience and price of NHIS. At the same time, while households had positive perceptions with regards to technical quality of care, benefits of NHIS, convenience of NHIS administration and had appropriate community health beliefs and attitudes, they were negative about the price of NHIS, provider attitudes and peer pressure. The uninsured were more negative than the insured about benefits, convenience and price of NHIS.Conclusions Perceptions related to providers, schemes and community attributes play an important role, albeit to a varying extent in household decisions to voluntarily enrol and remain enrolled in insurance schemes. Scheme factors are of key importance. Policy makers need to recognize household perceptions as potential barriers or enablers to enrolment and invest in understanding them in their design of interventions to stimulate enrolment. [ABSTRACT FROM AUTHOR]

BACKGROUND Given the high value placed on children in sub-Saharan Africa, previous research suggests that infertility increases the risk of psychological distress and marital conflict, encourages risky sexual behavior and deprives infertile individuals and couples of an important source of economic and social capital. This paper explores the implications of infertility for women in Ghana, West Africa. METHODS Semi-structured interview data collected from 107 women (aged 21–48 years, mean 33 years) seeking treatment in gynecological and obstetric clinics in Accra, Ghana, are analyzed. Based on iterative open coding of the interviews, the focus of the analysis is on mental health, marital instability, social interaction and gendered experiences. RESULTS Infertile women report facing severe social stigma, marital strain and a range of mental health difficulties. Many women feel that they shoulder a disproportionate share of the blame for infertility and, by extension, face greater social consequences than male partners for difficulties conceiving. Women who do not self-identify as infertile corroborate these findings, asserting that the social consequences of infertility are severe, particularly for women. CONCLUSIONS Infertility in Ghana has important consequences for social interactions, marital stability and mental health. These consequences are not perceived to be shared equally by Ghanaian men. [ABSTRACT FROM PUBLISHER]

This paper combines recent livelihoods approaches to refugee studies with a social resilience framework to explore the interlinkages between refugee-host relations and refugee coping strategies in the Buduburam camp in Ghana. The reported experiences of camp residents and of the people with whom they interact in their efforts to make a living (NGO staff, government officials, traders etc.) illustrate the complex interplay between personal networks, livelihoods and broader relations between refugee and host populations. We draw particular attention to language skills, diaspora linkages and the impact of illicit and/or innovative livelihood strategies of refugees. Despite the enormous emphasis refugees in the camp place on earning their own living, some groups are less able or less willing than others to build the social networks to the host population that might allow them access to regular employment. Other factors, including the massive size of the camp population, the deep poverty of Gomoa district where the camp is situated, and the mismatch between the urban character of the majority of the refugee population and local (agricultural) labour demand, contribute to less than optimal relations with the host population. [ABSTRACT FROM AUTHOR]

The role of the media, both state-owned and private, is an important and often overlooked component of any election, particularly those occurring in developing countries. Unfortunately, the existing academic literature on the subject is thin, especially concerning the recent flurry of democratic elections in Africa. This article briefly reviews the history of the media in Ghana's Fourth republic and then examines the crucial role the media played in Ghana's historic 2000 presidential and parliamentary elections. It details how the media contributed to the general success of the elections in which John Kufuor's New Patriotic Party defeated Jerry Rawlings' incumbent National Democratic Congress. Then, drawing on untapped public opinion survey data from the Ghana Centre for Democratic Development, the Afrobarometer in Ghana, and the University of Ghana, it demonstrates how the various forms of the mass media are 'consumed' by Ghanaians, and how they affect citizens differently. Despite persistent romanticizing of the role of the media in many quarters, it concludes that, while the media are extremely important to certain segments of the Ghanaian population, they are virtually irrelevant to others. [ABSTRACT FROM AUTHOR]

Background The aim was to explore behavioral factors relating to the prescription and communication of prescription-adherence messages for patients with acute febrile illness, from which to develop a training-and-communication (T&C) intervention to be delivered as part of a clinical trial. Methods The study undertook a content analysis of primary, qualitative data collection using in-depth interviews and focus group discussions, informed by the Capability, Opportunity, Motivation (COM-B) theory of behavior, the Theoretical Domains Framework (TDF), and Behavior Change Wheel (BCW) approach, in health facilities (39 health workers) and communities (66 community members) in the Shai-Osudoku District of Ghana. Results Health workers perceive that prescribers' and dispensers' communication with patients is influenced by the following factors: patient's educational level, existing disease conditions, health worker's workload, patient's religion, language barrier between health worker and patient, outcome of laboratory results, and medicine availability. Community members' adherence to prescription was influenced by the availability of money and affordability of medicine (outside of provision by the national health insurance scheme), the severity of the condition, work schedule, and forgetfulness. Conclusions Our study contributes to knowledge on nesting qualitative methods in a clinical trial and reveals factors that affect the antibiotic prescription communication process. Tailored messages for patient-specific needs can shape antibiotic prescription adherence behavior and ultimately contribute to decreasing the incidence of antibiotic resistance. [ABSTRACT FROM AUTHOR]

The recent Chinese involvement in small-scale gold mining in Ghana has received wide publicity and scholarly attention. While the literature has focused on environmental sustainability, political accountability, and institutional reforms, it is yet to examine local adoption of Chinese technology and its impact on Ghana's rural economy. We argue that it is in the interstices between the formal economy and entrepreneurship within the informal economy that opportunities for Chinese interventions emerge. Using evidence from Manso Akropong in the Ashanti region and Bole in the Savannah region, this article shows that, while Chinese technology's impact is transformative, the outcomes are divergent in different regions. In Manso Akropong, the intensification of mining backed by Ghanaian–Chinese collaborations has led to the environmental destruction, creating competition between gold mining and cocoa farming that had underpinned Ghana's rural prosperity. In Bole, where less aggressive Chinese technology such as Changfa and rubber mats are incorporated without direct Chinese participation, a more sustainable pattern of growth has emerged. This comparative study suggests that besides the large-scale projects and state-led training programmes, grassroots actors like informal artisanal miners are at the forefront of technology transfer in the China–Africa encounter. [ABSTRACT FROM AUTHOR]

Background: Cross-sectional studies are usually adopted to assess the one-year period prevalence of dracunculiasis. They depend upon a recall period of up to one year. This paper aims to examine the degree of accuracy with which villagers in an endemic region recall the occurrence of dracunculiasis during the 12 months prior to a cross-sectional survey.Methods: Two types of study were conducted in Tolon, a village in Northern Ghana--retrospective and prospective. Data from people interviewed in a bimonthly survey throughout 1990 were compared with the results of a cross-sectional retrospective study conducted in early 1991.Results: The results showed that retrospective studies using a recall period of up to one year to measure dracunculiasis prevalence gave only 59.9% of the actual cases, but there were roughly equal numbers of 'false positive' and 'false negative' cases, so that overall prevalence obtained was very close to the correct figure.Conclusions: Cross-sectional surveys may be of use to obtain estimates of the one-year period prevalence of dracunculiasis, but are not likely to be reliable enough for more detailed study. [ABSTRACT FROM AUTHOR]

Schistosomiasis is endemic in most sub-Saharan African countries, including Ghana, where the need for effective control involving preventive chemotherapy was indicated by the WHO. Mass drug administration commenced in 2008 and has continued since then in Ghana, but the country remains highly endemic. Here, we review the literature on schistosomiasis to identify research and knowledge gaps potentially affecting disease control. A total of 100 Ghana-related schistosomiasis literature sources were reviewed, showing that most studies were conducted on epidemiology, control of transmission and diagnosis. By contrast, many aspects of this disease remain neglected, including livestock schistosomiasis and its zoonotic potential, recent distribution of disease vectors or widely overlooked genital schistosomiasis. Stratified by region, the highest number of studies focus on Greater Accra, while studies are limited or absent for several other regions. Although this review shows apparent progress in terms of schistosomiasis research and control, a considerable amount of work remains to achieve at least a reduction in the prevalence of the disease, which affects a significant proportion of the population. National epidemiological data based on a nationwide survey, integrated control and improved monitoring and evaluation must be ensured. [ABSTRACT FROM AUTHOR]

The measures put in place by energy policymakers and regulators to reduce CO2 emissions encourage the switch from fossil fuels to the use of low-carbon fuels, particularly renewables. The research starts with a detailed content analysis of the climate change policies of Ghana within the electricity sector as well as a doctrinal analysis of the laws passed to implement climate change policies. The article then examines the energy transition measures implemented in Ghana over the years even though Ghana has just launched its National Energy Transition (NET) Framework. The article confirms that Ghana has implemented a variety of measures to promote energy transition although Ghana did not have a comprehensive energy transition policy. The research shows that fossil fuels dominate the electricity market but the patronage of renewables is vigorously promoted. In the wake of the transition from fossil fuel to low-carbon, the subsistence of the employment of workers in the energy sector comes under immense pressure with some employees becoming redundant. Employing empirical research methods, this article examines the employment transition during the energy transition, particularly in the electricity sector of Ghana. This article corroborates the fact that the introduction of renewables has created new jobs in the electricity sector but there is no clear link between the gradual energy transition from 2011 to 2021 on employment losses. In addition, the research shows that more women were employed in the electricity sector within the period installed renewable energy capacity increased although there is no direct link between the two. The article concludes that the new NET Framework will vigorously promote renewables in the energy sector but fossil fuels will provide the majority of the jobs in the Ghanaian energy sector for a while, therefore capacity building is needed to accelerate a sustainable employment transition during the energy transition. [ABSTRACT FROM AUTHOR]

Objective The article explores stakeholders' engagement before the implementation of the pooled procurement program (PPP) and the challenges encountered by the National Catholic Health Service (NCHS). Method The article used a qualitative research approach and a multiple case study design to solicit the views of healthcare service providers and policymakers within the NCHS. Key findings The article revealed that the National Catholic Health Secretariat (the secretariat) advocated through the Ghana Catholic Bishops Conference through the bishop responsible for health. Subsequently, the Diocesan Directors, managers, accountants, suppliers and storekeepers of all health facilities were engaged to understand their respective roles before implementing the PPP. The challenges faced came from all institutions that played a crucial role in the smooth running of the PPP. These institutions were the hospitals, suppliers, Food and Drugs Authority (FDA), National Health Insurance Scheme (NHIS) and the secretariat. The findings indicated that some managers in the hospitals were not committed to the program. Whereas, some suppliers purposely weakened the position of some other suppliers after awarding tenders by carrying their commodities directly to the hospitals and reducing the price marginally. The challenge from the NHIS perspective was the payment delays. The FDA was not proactive with post-market surveillance to check substandard commodities in the hospitals. However, in the secretariat, the deficiency was the weak systems to monitor real-time activities of the PPP at the hospitals. Conclusion The article suggests that to ensure the right synergies to meet organizational objectives, the NCHS is advised to increasingly focus on identifying and sustaining the PPP by communicating with other stakeholders to achieve their mutual needs. Such a process would allow the more knowledgeable design of resource needs and allocation of scarce resources to their areas of interest. [ABSTRACT FROM AUTHOR]

Background Typhoid intestinal perforation (TIP) remains the most serious complication of typhoid fever. In many countries, the diagnosis of TIP relies on intraoperative identification, as blood culture and pathology capacity remain limited. As a result, many cases of TIP may not be reported as typhoid. This study demonstrates the burden of TIP in sites in Burkina Faso, Democratic Republic of Congo (DRC), Ethiopia, Ghana, Madagascar, and Nigeria. Methods Patients with clinical suspicion of nontraumatic intestinal perforation were enrolled and demographic details, clinical findings, surgical records, blood cultures, tissue biopsies, and peritoneal fluid were collected. Participants were then classified as having confirmed TIP, probable TIP, possible TIP, or clinical intestinal perforation based on surgical descriptions and cultures. Results A total of 608 participants were investigated for nontraumatic intestinal perforation; 214 (35%) participants had surgically-confirmed TIP and 33 participants (5%) had culture-confirmed typhoid. The overall proportion of blood or surgical site Salmonella enterica subspecies enterica serovar Typhi positivity in surgically verified TIP cases was 10.3%. TIP was high in children aged 5–14 years in DRC, Ghana, and Nigeria. We provide evidence for correlation between monthly case counts of S. Typhi and the occurrence of intestinal perforation. Conclusions Low S. Typhi culture positivity rates, as well as a lack of blood and tissue culture capability in many regions where typhoid remains endemic, significantly underestimate the true burden of typhoid fever. The occurrence of TIP may indicate underlying typhoid burden, particularly in countries with limited culture capability. [ABSTRACT FROM AUTHOR]

Beginning in the late 1960s, the Nigerian and Ghanaian governments staged a series of massive forced removals of one another's nationals. The first was in Ghana in 1969, and the largest was Nigeria's 1983 deportation of over one million Ghanaians. A further expulsion from Nigeria happened in 1985, and smaller ones took place in the years that followed. Each was an enactment of the state's sovereign right to define its national community — and a devastating blow to the principle of free movement in Africa. Using records from Nigeria and elsewhere, 'Ghana Must Go' places the expulsions in the longer history of law and nationality policy in the British Empire. Mass expulsions were made possible by colonial-era jurisprudence that tied political membership to indigeneity, often through codified, neo-traditional 'customary' laws. The mass deportations of the 1960s–1980s were underwritten by this jurisprudence, even though their immediate causes lay in economic resentment, the failure of regional co-operation, and Ghana and Nigeria's rocky diplomatic relationship. [ABSTRACT FROM AUTHOR]

Background Soil-transmitted helminths (STHs) pose a formidable health risk to school-age children in resource-limited settings. Unfortunately, mass deworming campaigns have been derailed since the onset of the coronavirus disease 2019 pandemic. The present study assessed the cross-sectional associations between STHs, nutritional status and academic performance of schoolchildren in the Banda District of Ghana. Methods Schoolchildren (5–16 y of age; n=275) were recruited through both school and household visits by community health workers using a multistage cluster sampling technique. In addition to school microscopy, anthropometric records were also taken. Results The prevalence of geohelminthiasis was 40.4% (95% confidence interval 34.6 to 46.2). STHs targeted for elimination by the World Health Organization and national programmes were detected among schoolchildren. Children with intestinal parasite infection (53.7 [standard deviation {SD} 11.5]) had lower mean academic scores compared with uninfected children (59.6 [SD 16.9]) (p=0.034). In multiple regression analysis, intestinal parasite infection status and z-scores for weight-for-age showed a collective significant effect on the academic score (F1117=8.169, p<0.001, R2=0.125). Conclusions Schoolchildren with STHs had poorer academic performance compared with uninfected children, despite their nutritional status. In addition to school feeding programmes, school-based mass drug administration campaigns may be critical for improving learning outcomes in young schoolchildren. [ABSTRACT FROM AUTHOR]

Despite increasingly programmatic politics and competitive elections, political clientelism remains an enduring feature of African politics. More so, while politicians rarely deliver on political promises, citizens continue to demand and participate in patron–client relations. While moral economy and instrumentalist accounts offer insight into the puzzling persistence of political clientelism, we offer an additional framework based on demands for social recognition. Beyond expectations of materialist exchange or the performance of cultural norms, citizens expect their political leaders to recognize them as dignified human beings and members of an identity group. Drawing on evidence from three diverse African contexts—urban Ghana, rural Senegal, and coastal Kenya—we argue that citizens engage in political clientelism as a vehicle for demanding three dimensions of social recognition: (i) To be seen and heard by leaders, (ii) to be respected as agents in the political process, and (iii) to be politically included and protected from harm. By providing new insights into the enduring logics of clientelism, citizen strategies amidst unequal power relationships, and the role of emotions in democratic politics, we aim to reconcile existing approaches and bring them into a more unified framework. [ABSTRACT FROM AUTHOR]

Using court records of legal disputes over transfers of land, this article explores the way transfers of landed property have impacted social relationships and the governance of land rights in Ghana in the twentieth and early twenty-first centuries. As urbanization, commercial agriculture, and natural resource extraction pushed up the value of land, disputes over land ownership have multiplied. In adjudicating such disputes, courts are often confronted with claims based on unverifiable oral histories invoking events of the distant past. Rather than simply dismiss such forms of evidence as hearsay, judges have often supplemented them with documentary and/or oral evidence on recent histories of land use. By doing so, they have tended to sustain customary forms of ownership, effectively recognizing the authority of landholding collectivities such as families and stools alongside that of individual owners. In effect, they are inferring ownership from land use, inverting the standard economic argument. [ABSTRACT FROM AUTHOR]