24. Sub-Saharan Africa

2018 ◽  
pp. 384-400 ◽  
Author(s):  
Michael Bratton
Keyword(s):  
Political Action ◽  
Party Politics ◽  
Sub Saharan Africa ◽  
Weak States ◽  
Political Actors ◽  
Regime Changes ◽  
Transitions To Democracy ◽  
Sub Saharan ◽  
The Cold War

This chapter examines efforts to introduce multi-party politics into Sub-Saharan Africa during the 1990s. It first considers regime changes in the region and shows that they result from the ‘conjuncture’ of various forces. Some of these forces are structural—such as the decline of African economies, the end of the Cold War—but political actors produce others, like incumbents’ concessions, opposition protests, and military withdrawals from politics. With reference to various African examples, the chapter emphasizes the important role played by certain structural conditions in transitions to democracy during the 1990s, but suggests that outcomes more often hinged on purposive political action. It also analyses the quality of resultant African regimes and concludes by identifying several fundamental constraints on further democratization including endemic poverty and weak states.

22. Sub-Saharan Africa

2009 ◽  
Author(s):  
Michael Bratton
Keyword(s):  
Political Action ◽  
Party Politics ◽  
Sub Saharan Africa ◽  
Weak States ◽  
Political Actors ◽  
Regime Changes ◽  
Transitions To Democracy ◽  
Sub Saharan ◽  
The Cold War

This chapter examines efforts to introduce multi-party politics into Sub-Saharan Africa during the 1990s. It first considers regime changes in the region and shows that they result from the ‘conjuncture’ of various forces. Some of these forces are structural — such as the decline of African economies, the end of the Cold War — but political actors produce others, like incumbents’ concessions, opposition protests, and military withdrawals from politics. With reference to various African examples, the chapter emphasizes the important role played by certain structural conditions in transitions to democracy during the 1990s, but suggests that outcomes more often hinged on purposive political action. It also analyses the quality of resultant African regimes and concludes by identifying several fundamental constraints on further democratization including endemic poverty and weak states.

Reconsidering African Elections

2019 ◽  
Author(s):  
Carolien van Ham ◽  
Staffan Lindberg
Keyword(s):  
Cold War ◽  
Significant Contribution ◽  
Civil Liberties ◽  
Sub Saharan Africa ◽  
Considerable Progress ◽  
Coup D'etat ◽  
Sub Saharan ◽  
The Cold War

The quality of elections in Africa demonstrates considerable progress from the early attempts in the 1950s and 1960s to the increasingly democratic era following the end of the Cold War. In terms of scope, 46 of 49 countries in sub-Saharan Africa now select the most powerful public offices (i.e., the executive and/or legislature) via elections, and reserved power domains have become relatively uncommon. In terms of choice, single-party elections, once so common across Africa, have now all but vanished from the continent. However, the integrity of elections still varies widely, ranging from elections with serious irregularities to elections that are fully free and fair. Even so, considerable progress is apparent over the last three decades. A full 47% of countries in sub-Saharan Africa now hold elections that are free and fair or only involve minor irregularities. Equally important, electoral interruptions in the form of coup d’état, civil war, or annulment of elections have become very rare. Africa is also a continent where the contemporary trend of elections generating broader democratization is particularly palpable. By providing opportunities for citizens to remove incumbents from office and generating expansion of civil liberties after elections are over, stimulating citizens and other actors to increase pressure for more democratic freedoms, elections seem on average to have been conducive to democratic developments in Africa. Elections also increasingly lead to turnovers, especially elections of high electoral integrity, where on average 34% are associated with alternations in power. Taking a long-term view on developments from 1960 until 2017, African elections have seen an impressive increase in quality over time, and provide a much more significant contribution to democratization in sub-Saharan Africa than is often acknowledged in the literature.

scholarly journals Quality of care in the free maternal healthcare era in sub-Saharan Africa: a scoping review of providers’ and managers’ perceptions

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Monica Ansu-Mensah ◽  
Frederick Inkum Danquah ◽  
Vitalis Bawontuo ◽  
Peter Ansu-Mensah ◽  
Tahiru Mohammed ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Research Question ◽  
Healthcare Providers ◽  
Poor Quality ◽  
Sub Saharan Africa ◽  
Healthcare Financing ◽  
Maternal Healthcare ◽  
Sub Saharan ◽  
The Impact

Abstract Background Free maternal healthcare financing schemes play an essential role in the quality of services rendered to clients during antenatal care in sub-Saharan Africa (SSA). However, healthcare managers’ and providers’ perceptions of the healthcare financing scheme may influence the quality of care. This scoping review mapped evidence on managers’ and providers’ perspectives of free maternal healthcare and the quality of care in SSA. Methods We used Askey and O’Malley’s framework as a guide to conduct this review. To address the research question, we searched PubMed, CINAHL through EBSCOhost, ScienceDirect, Web of Science, and Google Scholar with no date limitation to May 2019 using keywords, Boolean terms, and Medical Subject Heading terms to retrieve relevant articles. Both abstract and full articles screening were conducted independently by two reviewers using the inclusion and exclusion criteria as a guide. All significant data were extracted, organized into themes, and a summary of the findings reported narratively. Results In all, 15 out of 390 articles met the inclusion criteria. These 15 studies were conducted in nine countries. That is, Ghana (4), Kenya (3), and Nigeria (2), Burkina Faso (1), Burundi (1), Niger (1), Sierra Leone (1), Tanzania (1), and Uganda (1). Of the 15 included studies, 14 reported poor quality of maternal healthcare from managers’ and providers’ perspectives. Factors contributing to the perception of poor maternal healthcare included: late reimbursement of funds, heavy workload of providers, lack of essential drugs and stock-out of medical supplies, lack of policy definition, out-of-pocket payment, and inequitable distribution of staff. Conclusion This study established evidence of existing literature on the quality of care based on healthcare providers’ and managers’ perspectives though very limited. This study indicates healthcare providers and managers perceive the quality of maternal healthcare under the free financing policy as poor. Nonetheless, the free maternal care policy is very much needed towards achieving universal health, and all efforts to sustain and improve the quality of care under it must be encouraged. Therefore, more research is needed to better understand the impact of their perceived poor quality of care on maternal health outcomes.

State Failure and Challenges to Democratization in Africa

2009 ◽  
Vol 7 (2) ◽  
pp. 361-363 ◽  
Author(s):  
James D. Fearon
Keyword(s):  
National Level ◽  
Commodity Price ◽  
Political Conflict ◽  
Sub Saharan Africa ◽  
International Pressure ◽  
Land Disputes ◽  
Oil Shock ◽  
Sub Saharan ◽  
The Cold War ◽  
Public Revenues

When Things Fell Apart manages to be wonderfully concise but still compelling. The thing Robert Bates seeks to explain is the secular trend in sub-Saharan Africa toward civil war, although he often characterizes this in broader terms, as a trend toward “political conflict” or “political disorder.” He explains the trend as follows: Public revenues fell in the 1970s and 1980s as a result of commodity price declines, effects of the second oil shock, and bad economic policy choices that overtaxed farmers so that politicians could dispense patronage to smaller, politically more important urban constituencies. The decline in public revenues led elites to become more predatory, which caused an increase in political conflict by mobilizing opposition. Popular demands for political reform, along with increased international pressure for the same at the end of the Cold War, heightened elite insecurity and led to more predation. This had the effect of “provoking their citizens to take up arms” (p. 109). Further, state decline and national-level conflicts exacerbated simmering subnational conflicts, typically in the form of land disputes between locals and migrants from other tribes.

scholarly journals Aging, Health, and Quality of Life for Older People Living With HIV in Sub-Saharan Africa: A Review and Proposed Conceptual Framework

2017 ◽  
Vol 31 (1) ◽  
pp. 109-138 ◽  
Author(s):  
Mark J. Siedner
Keyword(s):  
Quality Of Life ◽  
Conceptual Framework ◽  
Care Delivery ◽  
Sub Saharan Africa ◽  
People Living With Hiv ◽  
Sub Saharan ◽  
Living With Hiv ◽  
The Impact

Objective: The number of people living with HIV (PLWH) over 50 years old in sub-Saharan Africa is predicted to triple in the coming decades, to 6-10 million. Yet, there is a paucity of data on the determinants of health and quality of life for older PLWH in the region. Methods: A review was undertaken to describe the impact of HIV infection on aging for PLWH in sub-Saharan Africa. Results: We (a) summarize the pathophysiology and epidemiology of aging with HIV in resource-rich settings, and (b) describe how these relationships might differ in sub-Saharan Africa, (c) propose a conceptual framework to describe determinants of quality of life for older PLWH, and (d) suggest priority research areas needed to ensure long-term gains in quality of life for PLWH in the region. Conclusions: Differences in traditional, lifestyle, and envirnomental risk factors, as well as unique features of HIV epidemiology and care delivery appear to substantially alter the contribution of HIV to aging in sub-Saharan Africa. Meanwhile, unique preferences and conceptualizations of quality of life will require novel measurement and intervention tools. An expanded research and public health infrastructure is needed to ensure that gains made in HIV prevention and treamtent are translated into long-term benefits in this region.

scholarly journals The prevalence of scabies in Monrovia, Liberia: a population-based survey

2020 ◽  
Author(s):  
Shelui Collinson ◽  
Joseph Timothy ◽  
Samuel K Zayay ◽  
Karsor K Kollie ◽  
Eglantine Lebas ◽  
...  
Keyword(s):  
Public Health ◽  
Quality Of Life ◽  
Health Problem ◽  
Public Health Problem ◽  
Sub Saharan Africa ◽  
Quality Data ◽  
Local Health ◽  
Sub Saharan ◽  
The Impact

AbstractBackgroundScabies is known to be a public health problem in many settings but the majority of recent data is from rural settings in the Pacific. There is a need for high quality data from sub-Saharan Africa and peri-Urban settings to inform scale up of scabies control efforts. There have been anecdotal reports of scabies being a public health problem in Liberia but robust data are lacking.MethodsWe conducted a cross-sectional cluster-randomised prevalence survey for scabies in a peri-urban community in Monrovia, Liberia in February-March 2020. Participants underwent a standardised examination conducted by trained local health care workers. Health related quality of life (HRQoL) was assessed using age-appropriate dermatology life quality indices (DLQIs). Prevalence estimates were calculated accounting for clustering at community and household levels and associations with key demographic variables assessed through multivariable random-effects logistic regression.Results1,318 participants from 477 households were surveyed. The prevalence of scabies prevalence was 9.3% (95% CI: 6.5-13.2%), across 75 (19.7%) households; impetigo or infected scabies prevalence was 0.8% (95% CI: 0.4-1.9%). The majority (52%) of scabies cases were classified as severe. Scabies prevalence was lower in females and higher in the youngest age group; no associations were found with other collected demographic or socio-economic variables. DLQI scores indicated a very or extremely large effect on HRQoL in 29% of adults and 18% of children diagnosed with scabies.ConclusionsOur study indicates a substantial burden of scabies in this peri-Urban population in Liberia. This was associated with significant impact on quality of life, highlighting the need for action to control scabies in this population. Further work is needed to assess the impact of interventions in this context on both the prevalence of scabies and quality of life.Plain English summaryScabies is an infestation with a microscopic mite which affects many people living in low-resource tropical countries. It causes intense itching, which can lead to complications through bacterial infection and poor quality of life. To help develop global scabies control programmes, we need a better understanding of how common it is across different tropical settings. We conducted a survey to assess the burden of scabies and bacterial skin infection in a random sample of people living in a community in Monrovia, Liberia. Information about participants and their household were collected and their skin was examined; those with skin conditions were asked about its impact on quality of life.We examined 1,318 participants and found that almost 10% of people had scanies. Scabies was more common in young children, and was more common in male children than female children. We found that there was a large impact on quality of life due mostly to the itching that scabies causes and to people feeling embarrassed or sad because of their skin condition. This scabies survey is one of the first conducted across all age groups in recent years in sub-Saharan Africa and indicates a substantial burden and impact on quality of life. More work is needed to understand how common scabies is in different settings and the impact that different treatment strategies may have.

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