Is Medical Tourism Really Unethical? An Alternate Perspective for Developing Countries

This article makes a case for leveraging medical tourism (MT) from the perspective of improving healthcare access in developing countries. The expansion of MT at an unprecedented rate has given rise to a number of ethical concerns in both home and destination countries. Ethical debates in this field have transcended the realm of global public health and have emerged across various disciplines including development, social justice, legal, trade and policy studies. Much of the academic literature in these domains has categorically held MT responsible for commodification of healthcare, creating a duality in healthcare systems of developing countries and making healthcare inaccessible and unaffordable for the disadvantaged sections of the population. While all these claims normatively seem justified, this article asserts that despite the several ethical concerns that have been raised, MT may not necessarily exacerbate healthcare equity issues in developing countries. In fact, MT may benefit destination countries by creating a highly specialised private sector which may provide services not only to foreign patients but also to wealthier domestic patients. Voluntary opting-out of domestic patients from public healthcare will result in decongestion of public healthcare facilities, which in turn could be accessed to a greater extent by the underprivileged population at affordable cost. In addition to contributing to the limited academic literature on this particular aspect of MT, this article presents an alternate view to promote MT in developing countries from the perspective of addressing challenges related to healthcare access.

Dynamic Effects of Exchange Rate Movements on Productivity Levels: New Evidence From Nigeria Based on NARDL

The dynamic relationship between exchange rate movements (appreciation and depreciation) and macroeconomic fundamentals had preoccupied the minds of researchers across the globe. Consequently, extensive research works have been conducted to unravel the puzzle; however, the findings remain inconclusive. The inconclusiveness of these researches may not be unconnected with the choice of model, the omission of key variables and erroneous assumption of symmetric interrelationships of the variables. To mitigate such error and fill the observed research gaps, this study leveraged on the non-linear autoregressive distributed lag to trace the possible asymmetric pass-through of the exchange rate to output growth in Nigeria. The study made use of monthly time series for the period 2000M1–2018M12 for empirical estimations. The empirical findings reveal an asymmetric pass-through from exchange rate to productivity. Exchange rate depreciation led to output retardation in the short run, but neither appreciation nor depreciation of the exchange affected output in the long run. The findings highlight that exchange rate depreciation of the local currency does not improve the country’s productivity. This reveals a disconnection and misalignment between exchange and productivity in Nigeria. The findings call for proper alignment of the Naira exchange rate with the U.S. dollar for improved productivity in the economy.

A Bivariate Analysis of the Spatial Distributions of Stunting and Wasting Among Children Under-Five in Nigeria

Stunting and wasting are major malnutrition issues among children under five years of age and have continued to remain unacceptably high in Nigeria leading to high rates of child morbidity and mortality. Evidence-based strategies are required by government and non-governmental agencies to mitigate the suffering of these children, and this could be realised when the association between the determinants and the geographical distributions are fully understood. Using data from four waves of the Nigerian Demographic and Health Survey, we employed a distributional bivariate probit model to examine the geographical distributions of the levels and linear association between acute and chronic malnutrition in Nigeria after accounting for possible observed determinants. Bayesian inference was based on Markov chain Monte Carlo simulation. The findings reveal substantial spatial variations in stunting and wasting among under-five children in Nigeria, indicating a north–south divide. The findings show negative linear association between the two malnutrition indicators among children in some northern fringe states but positive for Akwa Ibom, Ebonyi and Anambra. The correlation also peaks around age 20 months indicating that during the first 2 years of life, the children have an increasing likelihood of suffering from stunting and wasting.

Determining the Nexus between National Policies and Local Practices in the Promotion of Businesses for Local Economic Development in Tanzania

National governments set policies that affect local level development and influence the pace and content of development initiatives. Local economic development (LED) initiatives require a more robust focus on issues that places local government authorities at centre stage. For decades, at the local government authority level, much effort has been seen in the social development arena shadowing efforts to promote local businesses through business development services. National level organs set to promote businesses and to support the business agenda are expected to be the change catalysts and to propagate supportive policies for sustainable local economic development objectives. Nonetheless, the desired integration of efforts between national and local authorities and the civil society is yet to be observed. Additionally, frequent policy changes affecting the balance of power and authority between the national and local level authorities impact less positively local capacity to promote businesses despite the national efforts in infrastructure development. It is observed that better integration of efforts between the different actors, increased capacity of local authorities and implementation of local initiatives to surmount local challenges while working on policy attributed gaps, are necessary for promoting businesses at the local authority level.

Pattern of Development Spending and Its Impact on Human Development Index and Gross State Domestic Product in Low-income States in India

The paper empirically examines the pattern and impact of development spending (DS) on human development index (HDI) and gross state domestic product (GSDP) in the low-income states (LIS), for the period of 1993–94 to 2014–15 for seven LIS states. Further analysing the sectoral impact of DS, panel unit root test and co-integration test were performed to analyse stationarity and panel long-run association among DS, GSDP and HDI. The paper finds that the share of DS in recent years for LIS is higher than the major states (MS), implying emphasis on social sector development. It also highlights the lagging behind a few LIS such as Uttar Pradesh, Jharkhand and Rajasthan. The paper sheds light on the long-run co-integrating relationship among DS, HDI and GSDP. It finds that the DS has a significant and positive influence on GSDP but not on HDI in the long run. Sector-specific analysis suggests a long-run equilibrium relationship between DS and all three sectors of economy. Though the coefficient of DS did not emerge to be significant for the HDI indicator, sector-specific analysis suggests that increased health spending is associated with better health outcomes. Prioritising on education, health and skill development, and other DS will help in economic advancement. Proper implementation of schemes may bring change in HDI outcomes.

COVID-19 and Digital Primary Education: Impact and Strategies for Sustainable Development

The present study is based on primary data of 720 students from primary schools in West Bengal, India. With adherence to the Logistic Regression Model, the study investigates and analyses the factors that influence digital learning of primary students during the COVID-19 pandemic situation. Further with the application of Welch’s t-test, comparative study have been conducted based on parameters as village and city school students, private and government school students and gender discrimination. The findings conclude that the school structure; willingness of the school and teachers to conduct virtual classes; availability and accessibility of high-speed internet and economic capability of parents to bear the exorbitant internet charges are significant dimensions in virtual learning of primary section students. The study also confirms that during the pandemic girl students and students from village government schools are the worst hit in comparison to boys who are from city-based schools and private schools respectively.

Evidence-based Policy in India: Crossing the Long, Uphill Bridge

The evidence-based-policy ecosystem, and its arsenal of approaches and techniques need course-correction to adequately respond to complex and practical policymaking contexts. Experimental findings do not resonate in scale implementation, particularly in large and diverse contexts like India’s. Causal empiricism leaves out investigation of complex pathways and impact mechanisms, while ‘evidence’ often disengages political economy considerations. Surmounting the methodological constrictions—which limit the utility and uptake of such evidence for a decisionmaker—requires being able to sufficiently account for institutional factors, social norms, politics, and stakeholder incentives among other related influences in policymaking. This may be possible through robust use of qualitative nuances, and integration of political economy analysis towards adopting a realist approach in evidence generation. It is important to acknowledge that measurement alone should qualify as neither evaluation or research. The state of research, its guiding principles, approaches and methods are often directed by current influences and preferences of stakeholders who are in a position to shape discourse. Interjections by more stakeholders are urgently needed to orient evidence generation to ‘real world’ realities and respond to the non-linear complexities of developmental change pathways.

Do the Heterogeneous Determinants of Repayment Affect Differently across Borrowers of Diverse Credit Sources in Rural Assam? A Double Hurdle Approach

This study made an attempt to answer the question: Do the heterogeneous determinants of repayment affect the borrowers of diverse credit sources differently? The study is based on data collected from 240 households from three districts in the lower Brahmaputra valley of Assam through a carefully designed primary survey. Besides, the study uses the double hurdle approach and the instrumental variable probit model to reduce possible selection bias. It observes better repayment performance among formal borrowers, followed by semiformal borrowers, while occupation wise it is prominent among organised employees. It has been found that in general, the household characteristics, loan characteristics and location-specific characteristics significantly affect repayment performance of borrowers. However, the nature of impact of the factors influencing repayment performance is remarkably different across credit sources. It ignores the role of traditional community-based organisations in rural Assam while analysing the determinants of repayment performance. The study also recommends for ensuring productive opportunities and efficient market linkages in rural areas of Assam. The study is based on an original data set that has specially been collected to examine question that—do the heterogeneous determinants of repayment affect the borrowers of diverse credit sources differently in the lower Brahmaputra valley of Assam—which has not been studied before.

Cyberspace at the Grassroots: E-Governance and Citizen/Stakeholder Perceptions at the Local Level in Bangladesh

Bangladesh has experimented with e-governance since the early 2000s and currently ranks among the top 10 least developed countries. The deployment of e-governance at the local level has provided benefits to the rural people, with local councils increasingly using information and communications technology (ICT) to expand community-based delivery systems and augment rural service delivery. One-stop cyber centres provide a range of services that are user-friendly, cost-effective and less time-consuming. This study focuses on five sub-districts to inquire about the range of services provided by the e-service centres there. It has recorded citizen perceptions and the level of their satisfaction and the observations of service providers about the e-service mechanism. It also identifies key challenges in service delivery. Citizen satisfaction was measured using 12 indicators, while the service provider observations focused on social issues, governance, resource and technical issues. The study found several issues requiring attention to consolidate the e-governance system in the country.