Food Prices and the Politics of Hunger: Beneath Market and State

What accounts for the persistence of hunger and undernutrition in political and administrative systems which might be otherwise sensitive to the risk of food price volatility and market failure? If pre?empting food price volatility has a political constituency why is there not a similar constituency for preventing vulnerability to hunger? The policy response to globally?driven food price volatility in Pakistan was largely successful in achieving its proximate goals, and price spirals and market shortages in 2008 were aberrations from which lessons were drawn effectively. Research for the Life in a Time of Food Price Volatility project shows that the food economy of the poorest is relatively insulated from price fluctuations, and vulnerability to hunger is mostly driven by idiosyncratic shocks. The poorest often operate beneath the market, or at the lowest rung of a highly segmented market, and their expectations with respect to rights and entitlements to food correspond with their prevailing sources of informal social support

Evaluating quality of contraceptive counseling: An analysis of the method information index

The Method Information Index (MII) is calculated from contraceptive users\u27 responses to questions regarding counseling content-whether they were informed about methods other than the one they received, told about method-specific side effects, and advised what to do if they experienced side effects. The MII is increasingly reported in national surveys and used to track program performance, but little is known about its properties. Using additional questions, we assessed the consistency between responses and the method received in a prospective, multicountry study. We employed two definitions of consistency: (1) presence of any concordant response, and (2) absence of discordant responses. Consistency was high when asking whether users were informed about other methods and what to do about side effects. Responses were least consistent when asking whether side effects were mentioned. Adjusting for inconsistency, scores were up to 50 percent and 30 percent lower in Pakistan and Uganda, respectively, compared to unadjusted MII scores. Additional questions facilitated better understanding of counseling quality

Virtual Incubation in Industrial Clusters: A Case Study in Pakistan

経済学 / EconomicsIn industrial clusters, transaction costs are kept low and free riding is discouraged by a community mechanism developed through dense and repeated interactions among entrepreneurs. In such environments, new entrants without established reputations and connections are put at a distinct disadvantage. This negative effect on new entry must be neutralized for an industrial cluster to expand. Using enterprise level data from Pakistan, this study finds that personal networks are indeed important for successful enterprise operation, which works to the advantage of incumbents, but that subcontracting plays the role of virtual incubation in nurturing new enterprises, reinforcing the cluster’s dynamism.JEL Classification Codes: O14, O53http://www.grips.ac.jp/list/jp/facultyinfo/sonobe_tetsushi

Prevention of non-communicable diseases in Pakistan: an integrated partnership-based model

Development and implementation of non-communicable disease (NCD) prevention polices in the developing countries is a multidimensional challenge. This article highlights the evolution of a strategic approach in Pakistan. The model is evidence-based and encompasses a concerted and integrated approach to NCDs. It has been modelled to impact a set of indicators through the combination of a range of actions capitalizing on the strengths of a public-private partnership. The paper highlights the merits and limitations of this approach. The experience outlines a number of clear imperatives for fostering an enabling environment for integrated NCD prevention public health models, which involve roles played by a range of stakeholders. It also highlights the value that such partnership arrangements bring in facilitating the mission and mandates of ministries of health, international agencies with global health mandates, and the non-profit private sector. The experience is of relevance to developing countries that have NCD programs running and those that need to develop them. It provides an empirical basis for enhancing the performance of the health system by fostering partnerships within integrated evidence-based models and permits an analysis of health systems models built on shared responsibility for the purpose of providing sustainable health outcomes

Gendered immobility: influence of social roles and local context on mobility decisions in Pakistan

This paper examines the instances of one-day immobility in Pakistan and reports its socio-demographic determinants using the nationally representative dataset of the 2007 Pakistan Time Use Survey. Of 37,830 time diary respondents, nearly 30% did not report travel during the diary day. Homemakers and those out of the workforce were more likely to be immobile than employed or student respondents. Immobility rates were very high among women (55%) as compared to men (4%). Among women, those between 20 and 34 years of age, married, with children, having better education, dependent on other household members and those living in higher income households were more likely to be immobile. The excessive gender nature of immobility seems to be triggered by a gender-based sociocultural environment, which restricts female mobility due to family honor concerns. Other than this, those living in the provinces of Sindh and Khyber Pakhtunkhwa or in urban areas were more likely to be immobile than those living in Punjab and Sindh provinces or in rural areas. The significant geographic effect at broader spatial scale is caused by the demographic structure as well as due to differences in the social and cultural context of these areas. Finally, questions regarding the measurement of immobility and the potential implications of increased female immobility are discussed

Investigating socio-economic-demographic determinants of tobacco use in Rawalpindi, Pakistan

<p>Abstract</p> <p>Background</p> <p>To investigate the socio-economic and demographic determinants of tobacco use in Rawalpindi, Pakistan.</p> <p>Methods</p> <p>Cross sectional survey of households (population based) with 2018 respondent (1038 Rural; 980 Urban) was carried out in Rawalpindi (Pakistan) and included males and females 18–65 years of age. Main outcome measure was self reported daily tobacco use.</p> <p>Results</p> <p>Overall 16.5% of the study population (33% men and 4.7% women) used tobacco on a daily basis. Modes of tobacco use included cigarette smoking (68.5%), oral tobacco(13.5%), hukka (12%) and cigarette smoking plus oral tobacco (6%). Among those not using tobacco products, 56% were exposed to Environmental tobacco smoke.</p> <p>The adjusted odds ratio of tobacco use for rural residence compared to urban residence was 1.49 (95% CI 1.1 2.0, p value 0.01) and being male as compared to female 12.6 (8.8 18.0, p value 0.001). Illiteracy was significantly associated with tobacco use. Population attributable percentage of tobacco use increases steadily as the gap between no formal Education and level of education widens.</p> <p>Conclusion</p> <p>There was a positive association between tobacco use and rural area of residence, male gender and low education levels. Low education could be a proxy for low awareness and consumer information on tobacco products. As Public health practitioners we should inform the general public especially the illiterate about the adverse health consequences of tobacco use. Counter advertisement for tobacco use, through mass media particularly radio and television, emphasizing the harmful effects of tobacco on human health is very much needed.</p

Understanding mobility characteristics and needs of older persons in urban Pakistan with respect to use of public transport and self-driving

Since 1990, Pakistan's demographic transition has been increasing life spans with a steady rise in the number of older persons. Pakistan faces many challenges in caring for its older population. The proportion of the population aged 60 years and above is estimated to increase from 5.8% in 2000 to 12.4% in 2050. A study was conducted to understand the existing mobility characteristics of the elderly, their perceived needs and constraining factors. Data was collected using convenient sampling from 450 people aged 60 years or older in nine towns within Lahore City. Older people were approached around urban facilities (shops, banks, terminals) and asked to respond to survey questions. Within-residence interviews were also conducted, mainly for those women who declined interviews in public places. Descriptive and comparative analyses were performed, including Pearson's chi squared test for independence. The results are discussed in terms of mode choice, public transport preferences, self-driving issues and the relative benefits of formal and informal public transport options. The study found lower levels of weekly trip-making compared to those reported for older people in China, South Korea and USA. Vehicle ownership (mainly carsand motorcycles) and socio-demographic factors were found to significantly affect trip making. There were large gender differences in trip making and vehicle ownership, suggesting further research and policy action targeting the mobility needs of elderly women. Older persons were concerned about safety issues concerning public transport and self-driving, and also the behavior of transport crews, and this has informed several of the concluding policy recommendations

Good on paper: the gap between programme theory and real-world context in Pakistan's Community Midwife programme

Objective To understand why skilled birth attendance—an acknowledged strategy for reducing maternal deaths—has been effective in some settings but is failing in Pakistan and to demonstrate the value of a theory-driven approach to evaluating implementation of maternal healthcare interventions. Design Implementation research was conducted using an institutional ethnographic approach. Setting and population National programme and local community levels in Pakistan. Methods Observations, focus group discussions, and in-depth interviews were conducted with 38 Community Midwives (CMWs), 20 policymakers, 45 healthcare providers and 136 community members. A critical policy document review was conducted. National and local level data were brought together. Main outcomes Alignment of programme theory with real-world practice. Results Data revealed gaps between programme theory, assumptions and reality on the ground. The design of the programme failed to take into account: (1) the incongruity between the role of a midwife and dominant class and gendered norms that devalue such a role; (2) market and consumer behaviour that prevented CMWs from establishing private practices; (3) the complexity of public–private sector cooperation. Uniform deployment policies failed to consider existing provider density and geography. Conclusions Greater attention to programme theory and the ‘real-world’ setting during design of maternal health strategies is needed to achieve consistent results in different contexts