Regionalism and Urban Development Planning in Africa: Towards A Collaborative Framework for Decentralized Planning in Ghana

The development planning and management of cities have evolved in theory and practice. Decentralized planning and regionalism are among such evolved concepts. With Ghanaian cities rapidly urbanizing, the transcendence nature of urbanization challenges continues to tests the responsiveness of the nation’s decentralized planning system-after its implementation more than two decades ago. Key among such tests is how the decentralized planning system can effectively promote collaborative planning among contiguous urbanizing local planning jurisdictions. This demands not only the regional coordination of development plans but also responsive “regionalism” among neighboring local planning and/or government authorities for them to; identify common development challenges, the impacts of their individual planning decisions on each other, and how to collaborate to mitigate the impacts of their decisions on each other. After examining the decentralized planning drawbacks and the Ghana’s urbanization challenges, this paper ends with a framework for effective   regional planning collaboration among neighboring urbanizing local government areas. Keywords: Urbanization, Centralized and Decentralized Planning, Regionalism, Regional Planning, Collaborative Plannin

Resourcing local government in Ghana: the potential of volunteering to deliver basic services

Both local and foreign volunteers have been involved in community development activities in Ghana. However, there is a dearth of research on the perceived and real impacts of volunteers in delivering services, reasons for volunteering, the potential of volunteering to supplement the human and financial resources of local governments in Ghana, and the conditions required for more successful outcomes. This qualitative study examined volunteering activities across 15 communities of the Komenda-Edina-Eguafo-Abirem (KEEA) Municipality in Ghana’s Central Region. It found that volunteering empowered the people, triggered self-help initiatives and improved local people’s knowledge on health and environmental issues. However, there are challenges in finding political and social space for volunteers within the current local government system. The study recommends efforts to address that issue

Revenue Mobilisation by Local Governments in Ghana: The Potentials of Investment in Metal Souvenirs for Tourists

The study looks at how local government authorities struggling to mobilise sufficient local revenues can turn to tourism given its potential to offer more stable local revenues. Previous studies have supported tourism as an important revenue source but do not provide the form in which local governments can leverage on tourism to enhance their local revenues. This study employs both quantitative and qualitative approaches to look at popular tourist sites in the Ashanti Region of Ghana -the Manhyia Palace museum, Okomfo Anokye sword, Bobiri butterfly sanctuary and Lake Bosomtwe. The study interviewed 400 tourists, 20 manufacturers of metal souvenirs, 3 local government officials, 2 officials of the Ghana Tourist Authority and 4 tour guides. The study revealed that investing in the production of metal souvenirs for specific tourist attractions can help local governments raise revenue due to increased tourist arrivals and high demand for metal souvenirs by tourists yet this avenue is under explored. The study proffers that local governments invest in the production of souvenirs by supporting the local artisans through partnership arrangements for them to produce for the Assemblies to supply to tourists at the various tourist sites

How informal ties matter: encroachment on road reservations along the Kumasi–Accra highway in Ghana

A failure of urban planning in many developing countries is evidenced by encroachment on road reservations. Urban planning literature suggests that such encroachment is largely explained by poverty and urban growth. But how do encroachers find space in the road reservations? This paper examines encroachment along the Anloga Junction to Ejisu section of the Kumasi–Accra highway in Ghana. It argues that formal rules are not effective in governing the road reservations: informal rules rooted in social networks of reciprocity matter more. The research involved interviews with encroachers, senior officials from government institutions and traditional authorities. It emerged that encroachers invoked mainly ethnic and political party ties with public officials to secure space in the road reservations. This occurred in an environment of non-enforcement of relevant laws, weak formal collaboration among public institutions, and inadequate political commitment. There is a need for effective application of the principles and methods of multi-stakeholder governance, linking improved legal regulation with informal processes, to achieve better outcomes

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Flood vulnerability and responses in urban informal communities in Accra, Ghana

Flood events affect millions of poor people living in precarious conditions in African cities every year. However, to date understandings of and responses to flood vulnerability in African cities have been conceptually and practically limited. A dominant focus on the geophysical and biophysical causes of flood events restricts the analyses to the source of flood events and does not pay critical attention to the internal actors, dynamics and processes of informal urbanization where the burden of flood impacts usually fall. Equally problematic is the approach of city authorities in African countries who focus on the informality and illegality of housing and building as the source of the problem. City authorities have used flooding to justify forced evictions, and often limit their response to the distribution of relief items. This thesis challenges both these analyses and approaches to flood vulnerability by approaching the problem of flood vulnerability through an understanding of informal urbanization. In doing so, the thesis argues that vulnerability to flood hazards in urban informal settlements in developing countries is a product of a complex assemblage of the socio-economic factors, political alliances, state activities and local actions that together produce informal urban space. Using the three case studies from Accra, Ghana of Agbogbloshie, Old Fadama and Glefe, I explore how flood vulnerability and responses in these hazard-prone places have been produced and shaped through an assemblage of processes, actors and socio-materialities within the city. The study therefore draws on urban assemblage as the theoretical framework for understanding how flood vulnerabilities and responses are continuously produced through informal urbanisation, political engagements, accumulation of knowledge and capacities by residents and relevant state institutions. Using a mix of qualitative methods including community focus group discussions, interviews with hazard victims and institutional consultations/surveys, the study reveals that flood vulnerability and responses in the three communities have co-evolved with their historical development, dynamics of urban land management, dwelling processes and the role of state and non-state actors. The thesis therefore recommends three important entry points in understanding and addressing flood vulnerability in cities of the global south. First, a rethink of the overall urban planning and development process which places great emphasis on legality and security of tenure, at the expense of land management, housing provision and access to infrastructure. Second is to harness the emerging and accumulated knowledge and capacities of informal communities for flood vulnerability management. And lastly, the study recommends a re-examination of the roles of city authorities and emerging non-state actors through participatory urban governance and improved rights to urban citizenship.

Flood vulnerability and responses in urban informal communities in Accra, Ghana

Flood events affect millions of poor people living in precarious conditions in African cities every year. However, to date understandings of and responses to flood vulnerability in African cities have been conceptually and practically limited. A dominant focus on the geophysical and biophysical causes of flood events restricts the analyses to the source of flood events and does not pay critical attention to the internal actors, dynamics and processes of informal urbanization where the burden of flood impacts usually fall. Equally problematic is the approach of city authorities in African countries who focus on the informality and illegality of housing and building as the source of the problem. City authorities have used flooding to justify forced evictions, and often limit their response to the distribution of relief items. This thesis challenges both these analyses and approaches to flood vulnerability by approaching the problem of flood vulnerability through an understanding of informal urbanization. In doing so, the thesis argues that vulnerability to flood hazards in urban informal settlements in developing countries is a product of a complex assemblage of the socio-economic factors, political alliances, state activities and local actions that together produce informal urban space. Using the three case studies from Accra, Ghana of Agbogbloshie, Old Fadama and Glefe, I explore how flood vulnerability and responses in these hazard-prone places have been produced and shaped through an assemblage of processes, actors and socio-materialities within the city. The study therefore draws on urban assemblage as the theoretical framework for understanding how flood vulnerabilities and responses are continuously produced through informal urbanisation, political engagements, accumulation of knowledge and capacities by residents and relevant state institutions. Using a mix of qualitative methods including community focus group discussions, interviews with hazard victims and institutional consultations/surveys, the study reveals that flood vulnerability and responses in the three communities have co-evolved with their historical development, dynamics of urban land management, dwelling processes and the role of state and non-state actors. The thesis therefore recommends three important entry points in understanding and addressing flood vulnerability in cities of the global south. First, a rethink of the overall urban planning and development process which places great emphasis on legality and security of tenure, at the expense of land management, housing provision and access to infrastructure. Second is to harness the emerging and accumulated knowledge and capacities of informal communities for flood vulnerability management. And lastly, the study recommends a re-examination of the roles of city authorities and emerging non-state actors through participatory urban governance and improved rights to urban citizenship

Landscape Transformations in Rapidly Developing Peri-urban Areas of Accra, Ghana: Results of 30 years

Beyond the loss of peri-urban agricultural and forested land as a result of built-up expansion, not much information exists on the changes in the structure of the peri-urban landscape in Ghana. The aim of this paper is to examine the extent to which urban expansion is driving changes in landscape structure of the peri-urban fringes of Accra. We submit that rapid peri-urbanisation will fragment the existing agricultural and forested landscape with consequent ecological, socio-economic and urban governance implications. Using Landsat satellite images for the years 1985, 1991, 2002 and 2015 the study area was classified into four land cover classes. The study adopted the use of Urban Intensity Index (UII) and the Annual Rate of Urbanization (R) as measures of urbanization. Edge density (ED), largest patch index (LPI) and Aggregation index (AI) were used as proxies to measure landscape structural transformations. The study reveals substantial reductions and fragmentation in agricultural lands, riverine and open forests, while there has been over 200 percent increase in built-up areas. Beyond these revelations in spatiotemporal changes in landscape structure, the paper points to the ecological implications of the changes, and three key socio-economic and urban governance implications