Regional Economic Integration and Incomes Convergence: A Case Study of the Economic Community of West African States

With a view to taking advantage of the region’s economic potentials,  a group of  15  West African countries signed  a treaty  in  Lagos, Nigeria on 28th May , 1975,  leading to the establishment of the Economic Community of West African States ( ECOWAS ). The principal objective was to promote co-operation and integration in economic, political social and cultural activities in the fifteen West African States. This study, therefore, aim at assessing the extent to which regional integration in West Africa has promoted incomes convergence in the region. The study utilizes two approaches of measuring incomes convergence, namely, sigma and conditional Beta Convergence.  The results from the sigma convergence regression indicate no convergence in income per capita but rather growth in income per capita amongst ECOWAS member states. This is because; the coefficient of the trend variable is positive and significantly different from zero. From the Conditional Beta Convergence regression, the results show that the speed of incomes convergence for  ECOWAS member states is approximately 17% per annum, implying that any short-run shock that puts the economies of the sub-region into disequilibrium may take a longer period to attain the steady state . This thus calls for further action in accelerating the pace with which member states meet the ECOWAS convergence criteria . Keywords: regional integration,  incomes, convergence , West Africa, economies, criteri

Analyzing the Economic Consequences of an Epidemic Outbreak: Experience from the 2014 Ebola Outbreak in West Africa

The Ebola virus disease has been infection countries in Africa since its first emergence in Zaire in 1976. However, the 2014 Ebola outbreak in West Africa has been unanimously described as the World’s most devastating outbreak in history and the first ever witnessed in West Africa. The devastating nature of the 2014 Ebola epidemic made the international community becoming increasing worried as the disease continued to spread across borders. This stud therefore, aimed at evaluating the economic impact of the epidemic in West African countries affected by the outbreak. The study adopted an innovative methodology that scientifically captures the contemporaneous impact of the outbreak on key socioeconomic variables of interest. The results from the study revealed that in addition to the adverse impact of the Ebola outbreak on economic growth, commodity prices and government budget deficits, the isolation of countries hardest hit by the epidemic contributed significantly in worsening the socioeconomic conditions faced by these countries. By way of policy recommendations, the study noted the need to strengthen health care systems in the region, training of more health care workers, and avoidance of actions restriction the movement of persons and goods from epidemic affected areas and the need for regional coordination efforts for the effective combating of epidemic outbreaks in the future. Keywords:  Ebola, epidemic, outbreak, devastating, West African, health care, growt

Behavioral surveillance during and after the 2014–2016 Ebola outbreak in Sierra Leone

Background: The first documented case of Ebola Virus Disease (Ebola) in Sierra Leone was confirmed in May 2014 in Kailahun district after cases had been reported in Guinea and Liberia. Ebola is transmitted through contact with infected blood, stool, and other bodily fluids. Transmission risk in West Africa was driven by traditional burials involving physical contact with corpses, caring for infected persons without adequate protection, and delaying medical care. Sexual transmission due to viral persistence in the semen of male survivors posed an additional risk. Experimental Ebola vaccine candidates were implemented to curb transmission among health workers and other high–risk individuals. Reporting of all deaths to a national toll–free line (1–1–7 system) was mandated so that burials could be handled by teams trained in infection prevention and control. Aim: To understand trends in population–level Ebola knowledge, attitudes and prevention practices throughout different stages of the outbreak, acceptability of experimental Ebola vaccines at the peak of the outbreak and reporting of deaths after the outbreak ended. Methods: Four cross–sectional household surveys (N=10,603) were conducted using multi– stage cluster sampling in August 2014, October 2014, December 2014, and July 2015 to measure trends in Ebola–related knowledge, attitudes, and prevention practices (KAP). In– depth interviews (N=31) and focus group discussions (N=35) were conducted with health workers, frontline workers, and community members between December 2014 and January 2014 to understand acceptability of Ebola vaccine. Population–level demand for Ebola vaccine was assessed in a national household survey in December 2014 (N=3,540). After the outbreak ended, in 2017, motivations and barriers related to death reporting were assessed through a national telephone survey (N=1,291) and in–depth interviews (N=32). Quantitative data were analyzed using multilevel and ordered logistic regression modeling to examine various associations. Content analysis was used to identify cross–cutting themes in the qualitative data. Results: Ebola–related knowledge, attitudes, and prevention practices improved throughout the outbreak, especially in high–transmission regions. For example, when comparing before and after the peak of the outbreak, avoidance of physical contact with suspected Ebola patients nearly doubled in high–transmission areas (adjusted odds ratio (aOR) 1.9 [95% confidence interval 1.4–2.5]). Acceptability of Ebola vaccine was discouraged by safety related concerns but encouraged by altruistic motivation to help end the outbreak. Nationally, 74% of the public expressed high demand for Ebola vaccine, which was associated with wanting to be the first to get the vaccine compared to wanting politicians to be the first to get the vaccine (aOR 13.0; [7.8–21.6]). The number of deaths reported to the 1–1–7 system nationally in 2017 after the outbreak had ended represented nearly 12% of the expected deaths in the country versus almost 34% in 2016 and as much as 100% in 2015; albeit not accounting for potential duplicate reporting. After the Ebola outbreak, motivation to report deaths was greater if the decedent experienced one or more Ebola–like symptoms compared to none (aOR 2.3 [1.8–2.9]. Barriers to reporting deaths after the outbreak were driven by the lack of awareness to report all deaths, lack of reciprocal benefits linked to reporting, and negative experiences from the outbreak. Conclusions: Ebola prevention practices improved nationally during the outbreak in Sierra Leone, but the magnitude of improvement was greater in high–transmission regions compared to low–transmission regions. Understanding the drivers of Ebola vaccine acceptability and demand was important to inform ethical and cultural considerations in the implementation of experimental Ebola vaccines. While the 1–1–7 system was ramped up to capture nearly all deaths during the outbreak, reporting substantially declined after the outbreak ended. Failure to report deaths after the outbreak was due to lack of awareness to report all deaths and lack of perceived benefits to report in the post–Ebola–outbreak setting. Nevertheless, knowledge and experiences from the Ebola outbreak increasingly motivated people to report deaths that exhibited Ebola–like symptoms. Post–Ebola–outbreak settings offer an opportunity to implement routine mortality surveillance, however, substantial social mobilization efforts may be required to optimize reporting

Does Stock Market Capitalization Influences Economic Growth in Africa? : Evidence from Panel Data

The question as to whether stock markets play a significantly positive role in influencing the rate at which economies grow has been seriously debated by economists as well as policymakers. The bone of contention, however, is the fact that the prevailing empirical evidences on the nexus between stock market capitalization and economic growth is still mixed. This study, therefore, aims at providing further evidence on the relationship between stock market capitalization and economic growth using recent data from a sample of African countries with well-functioning stock markets. A dynamic panel estimation approach is employed with a view to assessing the relative impact of stock market capitalization on economic growth in Africa. The results from the study reveal that raising stock market capitalization by a marginal average of 10% induces growth on average by 5.4% in countries studied. The positive and significant relationship between stock market capitalization and economic growth as found in this study provides encouraging signals for African countries to explore stock markets as a potential avenue for expediting economic growth. There is therefore a dire need for policymakers in Africa to direct attention towards the implementation of policy measures that will encourage the development of stock markets with a view to promoting economic growt

How and why progress in public financial management reforms vary in in post-conflict anglophone Liberia and Sierra Leone

After almost two decades of implementing New Public Financial Management (NPFM) reforms, progress in reforming Public Financial Management (PFM) systems, processes and institutions in developing countries has been limited and uneven. This is in spite of the substantial financial and technical support from Development Partners. However, there is a lack of empirical evidence and often the evidence cited is anecdotal about the specific role of non-technical drivers in in explaining the state of PFM reforms in developing countries. This is in part, because each of the approach used to study PFM reforms has focused mainly on addressing only limited aspects of PFM, leaving many critical aspects unaddressed in the reform strategy. In response to the many challenges and shortcomings of current approaches, this study adopts a holistic approach, using case studies and the process-tracing method to investigate the cumulative contributions of the underlying drivers to understand why progress in PFM reforms is limited and uneven in post-conflict Liberia and Sierra Leone. This evidence-based study reveals the substantial progress made in upstream reforms is not enough to deliver on the promise of PFM reforms and has not trickled down to downstream service delivery elements of PFM. Partial implementation of reform initiatives has been typical in post-conflict Anglophone countries. The untypical progress made in some downstream reforms, such as Integrated Financial Management Information Systems is partly because politicians and civil servants have found ways to bypass core control and accountability mechanisms. It is easier to align the interests of International Partners and Country Governments in upstream and de jure reforms, but downstream and deconcentrated reforms areas remain the challenge. They are deeply rooted in the interests, incentives and power-relations of Political Leaders and their appointees. The implications of this study, therefore suggest that strategic nuancing of PFM reform programming, through the holistic approach is needed, capable of addressing both the low-hanging fruits and more far-reaching reforms by expanding the reform space, engaging wider stakeholders and deepening reform of downstream service delivery units

'Once there is life, there is hope' Ebola survivors' experiences, behaviours and attitudes in Sierra Leone, 2015.

BACKGROUND: In Sierra Leone, over 4000 individuals survived Ebola since the outbreak began in 2014. Because Ebola survivorship was largely unprecedented prior to this outbreak, little is known about survivor experiences during and post illness. METHODS: To assess survivors' experiences and attitudes related to Ebola, 28 in-depth interviews and short quantitative surveys with survivors from all four geographic regions of Sierra Leone were conducted in May 2015. RESULTS: Survivor experiences, emotions and attitudes changed over time as they moved from disease onset to treatment, discharge and life post-discharge. Survivors mentioned experiencing acute fear and depression when they fell ill. Only half reported positive experiences in holding centres but nearly all were positive about their treatment centre experiences. Survivor euphoria on discharge was followed by concerns about their financial situation and future. While all reported supportive attitudes from family members, about a third described discrimination and stigma from their communities. Over a third became unemployed, especially those previously engaged in petty trade. Survivor knowledge about sexual transmission risk reflected counselling messages. Many expressed altruistic motivations for abstinence or condom use. In addition, survivors were strongly motivated to help end Ebola and to improve the healthcare system. Key recommendations from survivors included improved counselling in holding centres and long-term government support for survivors, including opportunities for participation in Ebola response efforts. CONCLUSIONS: Survivors face myriad economic, social and health challenges. Addressing survivor concerns, including the discrimination they face, could facilitate their reintegration into communities and their contributions to future Ebola responses

IVUmed: A Nonprofit Model for Surgical Training in Low-Resource Countries

Background: Low- and middle-income countries (LMICs) face both training and infrastructural challenges for surgical care, particularly for specialty care, such as for urology. Practitioners charged with caring for these patients have few options for basic or advanced training. Objectives: IVUmed, a nonprofit organization, has for 20 years supported urological educational programs in 30 LMICs by coordinating a network of US and international academic and private providers, institutions, industry partners, and professional societies. Methods: IVUmed's motto, “Teach One, Reach Many” has emphasized a teach-the-teacher approach. Program partners, such as Hopital General de Grand Yoff in Dakar, Senegal, have advanced from little urological subspecialty availability to having the capacity to treat a wide range of conditions while also teaching surgeons from Senegal and neighboring countries. Conclusions: Long-term program commitments; effective communication; and a shared vision among the program site, the coordinating nongovernmental organization, and supporting organizations facilitate the development of thriving surgical teaching programs capable of serving local communities and conducting outreach training

Reasons to pursue a career in medicine: a qualitative study in Sierra Leone.

BACKGROUND: Many low-income and crises-affected countries like Sierra Leone struggle with the recruitment and retention of their health professionals, particularly nurses and doctors. There are multiple factors that influence the 'recruitment to retention' pipeline. The first stage of an exploration into the issues influencing the availability of qualified health care workers may focus on the aspects which influence their entry into relevant educational programmes. This paper explores the reasons given by junior doctors in Sierra Leone for wanting to become a doctor. It also describes entry procedures into undergraduate medical education. METHODS: In-depth interviews were conducted with purposively sampled junior doctors (n = 15) from the only medical school in Sierra Leone in October 2013. Digital diaries and two follow-up interviews were used to explore their evolving career experiences and aspirations until November 2016. In addition, semi-structured interviews with key informants (n = 20), including senior teaching staff at the medical school (n = 7), were conducted. Thematic analysis was used to explore linkages and themes across cases. RESULTS: Six themes were identified. The most commonly mentioned reasons for wanting to become a doctor were a desire to help (theme 4) and the influence of family and friends, via role modelling (theme 2) and verbal encouragement (theme 3). Other motives were an interest from a young age (theme 1), being attracted by the job prospects (theme 5), and having an intellectual and science capacity (theme 6). Junior doctors gave at least two and up to six reasons for applying to enter the medical profession. Doctors were allowed entry to the medical school largely based on their previous academic performance. CONCLUSIONS: This study showed that multiple reasons underlie the decision to apply for entrance to medical school and the decision to enter medicine is complex. These findings may inform the review of future admission procedures by the medical school in Sierra Leone and similar settings, which is a crucial step in addressing the human resource needs for healthcare that currently exist

Plastic Surgery of Male External Genitalia after a Trauma Caused by a Mill in Rural Area

The trauma of the external genital organs is a common urological emergency that can affect the patient's functional and psychosocial prognosis as well as his family. We report a case of direct trauma of the external genitalia of a 27-year-old by a mill, requiring a recover plastic surgery in rural area. The examination at admission revealed a significant damage of penile and scrotal skin, denuding testes and cavernous bodies. A cover plastic surgery was performed. After a year of follow up, the outcome was good