Civic Agency: an Invisible Health Determinant

This paper extends a cross-country analysis of health determinants with a civil society variable. The reason is that next to government and households and the level of economic development, civil society agency is likely to play a role in health care as well. This role refers to community care, political pressure, and demands for accountability of health care providers. We use the ISD index of civic activism to measure the agency of civil society. The panel regression results for developing counties indicate that civic activism contributes to the reduction of child mortality and maternal mortality. The size effect is larger than that of almost all other variables, except those for health expenditures. This implies that in times of severe financial constraints, civic activism may be the relatively most feasible factor stimulating better health outcomes

Status, distribution and determinants of poverty in the COMESA region: A review of existing knowledge

Poverty and vulnerability are among the major problems in Eastern and Southern Africa (ESA). To design appropriate poverty reduction initiatives for the region, it is not only important to understand the distribution of poverty but also the determinants. Various reports have documented information on the status, distribution and determinants of poverty in each of the countries. Nonetheless, not much information has been documented in a form that is easily accessible to decision makers and planners involved in designing and implementing programmes for addressing poverty reduction and food insecurity at the regional level. This paper reviews the existing knowledge on the status, distribution and determinants of poverty in the ESA region to fill that knowledge gap. It emerges from the literature that poverty in the region differs across socio-economic groups and across space. The existing poverty maps suggests that most districts and provinces whose poverty rates are lower than the national averages are located in rain fed mixed crop–livestock systems and that the highest proportion of them are in the humid and sub humid systems. High poverty rates also occur in the livestock only systems. About half of the poor provinces and districts fall in areas with short growing periods; this affects their agricultural potential. The areas are also constrained by market access. Investment in irrigation, improved water management and improved market access would play a vital role in these regions. The review suggests that household level determinants of poverty in the region include, but are not limited to: household characteristics—family composition, size and structure, age and marital status of head, gender of the head, education and other human capital capabilities; access to basic services such as social amenities, water and sanitation, credit and infrastructure; employment, occupation and incomes; asset ownership; access to remittances; burden of disease; variations in agricultural production; and declining food stocks and high food prices. Community/regional/country level determinants include: geography and related factors such as market access, agro-ecological zones, climate and ethnicity; the environment; population density; area of residence (rural vs. urban); income, growth and inequality; conflict, insecurity and political instability; and governance and corruption. However, it is difficult to separate the determinants of community level poverty from the determinants at the household level. The review further suggests that the determinants of poverty are fairly robust across many COMESA countries. This suggests the need for a consultative approach to poverty reduction in the region

Household welfare, investment in soil and water conservation and tenure security: Evidence from Kenya

In Kenya, conservation and sustainable utilization of the environment and natural resources form an integral part of national planning and poverty reduction efforts. However, weak environmental management practices are a major impediment to agricultural productivity growth. This study was motivated by the paucity of literature on the poverty-environment nexus in Kenya, since poverty, agricultural stagnation and environmental degradation are issues of policy interest in the country¿s development strategy. The paper builds on the few existing studies from Kenya and explores the impact of household, farm and village characteristics as well as the development domain dimensions on household welfare and investment in soil and water conservation. The results show that strengthening the tenure security improves household welfare. Further, soil quality, topography and investments in soil and water conservation affect household welfare. Agroecological potential, which is related to environmental conservation, is also a key correlate of poverty. Results for investment in water and soil conservation confirm the importance of tenure security in determining adoption and also the intensity of SWC investments. We also find that household assets, farm characteristics, presence of village institutions and development domain dimensions are important determinants of adoption and intensity of soil and water conservation investments. The results for both poverty and investment in soil and water conservation suggest the existence of a strong poverty-environment link in our sample. The results also suggest that rural poverty can be alleviated by policies that improve environmental conservation and strengthen land tenure security. The study also underscores the importance of village institutions in both investment adoption of soil and water conservation and in improving household welfare

Using a community-based definition of poverty for targeting poor households for premium subsidies in the context of a community health insurance in Burkina Faso

Background: One of the biggest challenges in subsidizing premiums of poor households for community health insurance is the identification and selection of these households. Generally, poverty assessments in developing countries are based on monetary terms. The household is regarded as poor if its income or consumption is lower than a predefined poverty cut-off. These measures fail to recognize the multi-dimensional character of poverty, ignoring community members? perception and understanding of poverty, leaving them voiceless and powerless in the identification process. Realizing this, the steering committee of Nouna's health insurance devised a method to involve community members to better define `perceived? poverty, using this as a key element for the poor selection. The community-identified poor were then used to effectively target premium subsidies for the insurance scheme. Methods: The study was conducted in the Nouna's Health District located in northwest Burkina Faso. Participants in each village were selected to take part in focus-group discussions (FGD) organized in 41 villages and 7 sectors of Nouna's town to discuss criteria and perceptions of poverty. The discussions were audio recorded, transcribed and analyzed in French using the software NVivo 9. Results: From the FGD on poverty and the subjective definitions and perceptions of the community members, we found that poverty was mainly seen as scarcity of basic needs, vulnerability, deprivation of capacities, powerlessness, voicelessness, indecent living conditions, and absence of social capital and community networks for support in times of need. Criteria and poverty groups as described by community members can be used to identify poor who can then be targeted for subsidies. Conclusion: Policies targeting the poorest require the establishment of effective selection strategies. These policies are well-conditioned by proper identification of the poor people. Community perceptions and criteria of poverty are grounded in reality, to better appreciate the issue. It is crucial to take these perceptions into account in undertaking community development actions which target the poor. For most community-based health insurance schemes with limited financial resources, using a community-based definition of poverty in the targeting of the poorest might be a less costly alternative

A comparative analysis of socioeconomic inequities in stunting: A case of three middle-income African countries

: Despite increased economic growth and development, and existence of various policies and interventions aimed at improving food security and nutrition, majority of countries in sub-Saharan Africa have very high levels of child malnutrition. The prevalence of stunting, an indicator of chronic malnutrition, is especially high. In this paper, we use Demographic and Health Survey datasets from three countries in the region that obtained middle-income status over the last decade (Ghana, Kenya and Zambia), to provide a comparative quantitative assessment of stunting levels, and examine patterns in stunting inequalities between 2007 and 2014