Proportions of facility births are increasing throughout sub-Saharan Africa, but obstetric services vary within the health system. In Tanzania, advanced management of childbirth complications ... Show moreProportions of facility births are increasing throughout sub-Saharan Africa, but obstetric services vary within the health system. In Tanzania, advanced management of childbirth complications (comprehensive emergency obstetric care) is offered in hospitals, while in frontline, primary health care (PHC) facilities (health centres and dispensaries) mostly only routine childbirth care is available. With over half (54%) of rural births in facilities, we hypothesized the presence of socio-economic inequity in hospital-based childbirth uptake in rural Tanzania and explored whether this relationship was modified by parity. This inequity may compound the burden of greater mortality among the poorest women and their babies. Records for 4456 rural women from the 2015-16 Tanzania Demographic and Health Survey with a live birth in the preceding 5years were examined. Proportions of births at each location (home/PHC/hospital) were calculated by demographic and obstetric characteristics. Multinomial logistic regression was used to obtain crude and adjusted odds ratios of home/PHC and hospital/PHC births based on household wealth, including interaction between wealth and parity. Post-estimation margins analysis was applied to estimate childbirth location by wealth and parity. Hospital-based childbirth uptake was inequitable. The gap between poorest and richest was less pronounced at first birth. Hospital-based care utilization was lowest (around 10%) among the poorest multiparous women, with no increase at high parity (>= 5) despite higher risk. PHC-based childbirth care was used by a consistent proportion of women after the first birth (range 30-51%). The poorest women utilized it at intermediate parity, but at parity >= 5 mostly gave birth at home. In an effort to provide effective childbirth care to all women, context-specific strategies are required to improve hospital-based care use, and poor, rural, high parity women are a particularly vulnerable group that requires specific attention. Improving childbirth care in PHC and strengthening referral linkages would benefit a considerable proportion of women. Show less
We use three years of household panel data to analyze the effects of ill-health on household economic outcomes in rural Ethiopia. We examine the immediate effects of various ill-health measures on... Show moreWe use three years of household panel data to analyze the effects of ill-health on household economic outcomes in rural Ethiopia. We examine the immediate effects of various ill-health measures on health expenditure and labor supply, the subsequent coping responses, and finally the effect on income and consumption. We find evidence of substantial economic risk in terms of increased health expenditure and reduced agricultural productivity. Households are able to smooth consumption by resorting to intra-household labor substitution, borrowing and depleting assets. However, maintaining current consumption through borrowing and depletion of assets is unlikely to be sustainable and displays the need for health financing reforms and safety nets that reduce the financial consequences of ill-health. Show less
This thesis contains four empirical studies on the effects of social protection. In the first two studies, I use administrative microdata and employ quasi-experimental methods in which I compare... Show moreThis thesis contains four empirical studies on the effects of social protection. In the first two studies, I use administrative microdata and employ quasi-experimental methods in which I compare a treatment group with a control group. Study 1 concludes that mandatory activation programs for young welfare recipients do not contribute to employment or to enrollment in education during an economic downturn, but are harmful to income protection. Study 2 concludes that the unemployment shock of a male partner has a large and persistent effect on household income and only 2-5% of this income loss is compensated by increases in female partner’s earnings from work. The last two studies use OECD panel data and employ international comparative research methods. Study 3 concludes that constitutional rights to social security have a positive effect on social expenditure, which is larger for expenditure targeted at the unemployed, a group that is perceived as less deserving by the public opinion compared to the elderly or disabled. Study 4 concludes that Social expenditure reduces poverty and inequality without being harmful for GDP growth. Targeted schemes are most effective in reducing poverty, while social expenditure types with a universal character are more effective in reducing inequality. Show less
While the inclusion of extreme poor people is a noble and necessary objective, it is challenging. Attempts to include extreme poor people in development interventìons have often been disappointing.... Show moreWhile the inclusion of extreme poor people is a noble and necessary objective, it is challenging. Attempts to include extreme poor people in development interventìons have often been disappointing. This book addresses the challenge of including the poorest people. lt provides deeper understanding of the mechanisms of in- and exclusion of extreme poor people, the structural causes of extreme poverty and the desirability of a univocal definition of extreme poverty. The book contributes to such an understanding through an analysis of extreme poor and marginalised people and their multiple dimensions of wellbeing. Furthermore, this book sheds light on the discourses and practices applied by development agencies in order to draw lessons about how the extreme poor can be sustainably included in development interventions. This is based on original field research - using a partipatory approach - carried out in Bangladesh, Benin, and (rural and urban) Ethiopia. Show less
Reinders, S.; Dekker, M.; Kesteren, F. van; Oudenhuijsen, L.W. 2019
In what ways do norms and expectations about the actual processes of saving and borrowing create a disjuncture between the formal sector and indigenous experiences? Bridging this divide between... Show moreIn what ways do norms and expectations about the actual processes of saving and borrowing create a disjuncture between the formal sector and indigenous experiences? Bridging this divide between every day and formal financial concepts and practices is part of the key to being able to develop more appropriate products and services that will support financial inclusion. This insights brief brings together findings from two over-lapping research projects that address this question. Both studies examined indigenous practices of resource exchange through saving, lending and gifts. In the first, research examined the language used for the core financial concepts of savings and borrowing, and explored some of the social and cultural practices that these concepts involved. This was undertaken in Kitui and dealt specifically with Kikamba terminology. While this was a very focused study, it raised issues that resonated with the second study and which therefore have wider relevance. The second study delved in more depth into the nature of inter-personal transactions involved in financial and other resource transfers in a bid to understand their social dynamics and meaning for those involved. It was undertaken in three areas: Mathira, Kitui and Nyamira. Show less
This book provides an overview of the conditions facing the urban poor in Khartoum, Sudan and explores the opportunities and constraints people of different genders, ages, wealth and social... Show moreThis book provides an overview of the conditions facing the urban poor in Khartoum, Sudan and explores the opportunities and constraints people of different genders, ages, wealth and social origins face in the pursuant of their livelihoods. Using an in-depth analysis, it argues that the livelihoods of poor people have been severely constrained by both formal and informal institutions that have not allowed them to access capitals and choose the way they utilize those they have. Muna A. Abdalla was born in August 1966 in Khartoum, the Capital of Sudan. After completing primary and secondary education in Sudan, she pursued her university education in Egypt, University of Zagazig, where she obtained her BSC in Science and Education. In 1989 she obtained an Advanced Diploma in Development and Adult Education, Post Graduate College, University of Khartoum, then a M.Ed. in Education, University of Manchester, UK, 1991. She worked as consultant/researcher on Africa's development challenges, poverty, gender and capacity building issues with ILO, OSSREA and the Ford Foundation in different countries. She coordinated and assisted in implementing and managing projects for UNECEF in Sudan, and worked for the Sudan Broadcasting Services and DPMF in Ethiopia. Show less
