There is lively debate concerning the influence of development assistance ('aid') on corruption in recipient countries; however, to date, few studies have systematically examined the subject subnationally. This study estimates the association between sub-national aid levels and citizens' perceptions and experiences of local corruption in Malawi. Overall, we find that individuals in districts receiving high amounts of aid are no more likely to view local leaders as corrupt than those in districts receiving lower amounts of aid. However, higher levels of aid are associated with more experiences of bribe solicitation. We also find evidence that aid channeled through NGOs may have different effects than government-implemented aid, as it is associated with better perceptions of local corruption and reduced bribe solicitation. The findings suggest that, in aggregate, corruption resulting from receiving aid may not be of sufficient magnitude or visibility to change citizens' broader beliefs about government performance or legitimacy.
Development aid comprises a significant share of government budgets in many resource-poor countries and is a significant source of funding for health and social service delivery. Yet little is known about the strategies that political actors in these countries use to determine the geographic allocation of aid resources or how such allocation patterns affect the political behavior and attitudes of citizens. Poor aid reporting and a lack of transparency in budget processes have made it extremely difficult to track the sub-national allocation of aid projects. As a result, much of what we know about its political impact comes from longitudinal cross-national studies that mask large in-country variation in allocation and that tell us little about in-country political decision-making. This dissertation explores these issues, using newly available, geo-coded aid data to conduct a statistical analysis of sub-national aid allocation patterns, public opinion, and electoral outcomes in Malawi.The first paper uses a two-part model strategy to estimate separately the probability of an area being selected to receive an aid project in a given year and the determinants of aid funding levels once an area has been selected to receive aid. It finds that in aggregate, aid allocation in Malawi exhibits little association with local need. Rather, to the extent that it is a significant factor in the study models, need tends to be negatively associated with both aid project placement and funding levels. In the models, the proportion of residents that share the President's ethnicity has no influence on the probability of an area being selected to receive aid and is negatively associated with the amount of aid funding received. Instead, areas with high proportions of smaller, non-aligned ethnic groups have higher probabilities of being selected to receive aid projects and receive disproportionately high levels of funding once selected. There is tenuous evidence that past electoral support for the incumbent party increases the probability of an area being selected to receive social services-related aid projects. However, support for the incumbent party has either no influence on the amount of aid dollars an area receives, or exhibits a slightly negative association. These results suggest that the area selection process in aid allocation decisions might be more prone to political targeting than the determination of aid funding levels and that in this targeting, political leaders might be using aid resources primarily to build cross-ethnic coalitions with non-aligned ethnic groups.When I examine the electoral effectiveness of aid allocation, i.e., whether it mobilizes citizens to vote or induces them to support the ruling party, I find that higher aid levels are associated with increased incumbent vote share and higher voter turnout. The positive impact of aid on turnout is strongest in areas that have been electorally competitive in the past. This suggests that in Malawi, aid allocation has the potential to entrench incumbent political parties. In the third essay, I report the results of a multinomial logistic regression model that I developed to estimate the association between aid levels and citizens' perceptions of corruption in their local leaders. I find respondents in districts receiving relatively high amounts of aid dollars no more likely to view local leaders as corrupt than those in lower aid districts. Instead, there is a tendency for districts that have more project activity to perceive low local corruption even though there is strong evidence that actual corruption, in the form of bribe solicitations, is positively associated with aid levels. The relationship between corruption perceptions and aid varies over the study period, becoming more positive over time. The negative association between aid and perceptions of corruption is less pronounced for those who share the President's ethnicity and those with strong ethnic attachments.The results of these three studies suggest that citizens in Malawi value aid projects and may see them as a sign of fairness and competence in government. Governments that provide aid resources are rewarded with votes and may be viewed relatively favorably by citizens. These studies add nuance to our understanding of distributive politics in sub-Saharan African democracies by highlighting a case in which political leaders seemed to have used resources not only to shore up support in narrow core constituencies based on shared ethnicity but also to win over opposition voters and ethnic groups with weak partisan attachments. Such a case may be relevant to other competitive, open, electoral democracies in sub-Saharan Africa. The study highlights the value of having detailed, project-level, location-specific data on aid projects in order to allow this kind of research.
OBJECTIVES: Mexico and Chile implemented sugar-sweetened beverage (SSB) taxes in 2014. This study aimed to trace and compare the SSB tax policy process, and examine the role and perspectives of outside government stakeholders in the process. METHODS: Qualitative study design using key informant (KI) interviews and document review. We interviewed 24 KIs involved in the SSB tax policy process (16 researchers, 5 civil society organizations (CSOs), and 3 food and beverage industries, F&BI) to examine perceptions on the tax process, effectiveness and future. Two independent coders analyzed the transcripts, using emergent and a priori codes. The results were triangulated with a document review, including research and newspaper articles, and reports covering the pre- and post-tax periods (n = 347). RESULTS: In Mexico, the tax on beverages with added sugars (1 peso/liter, or a 10% tax) stemmed from a longer process, compared to Chile, where the tax resulted from a pre-existing one applied to beverages with more than 6.25 g of sugar/100 ml (increased from 13 to 18%). In both countries, CSOs and the F&BI had direct influence on policy makers. CSOs were key in facing F&BI opposition before and after implementation. Researchers' influence was indirect, providing evidence for or against the tax. There was agreement that the SSB tax alone was insufficient to address noncommunicable diet-related chronic diseases (NDCs). KIs noted needed tax improvements (e.g., increasing the rate, modifying the tax basis, and using revenue for public health initiatives). KIs against the tax argued for nutrition education as a better option to change SSB demand to encourage F&BI product reformulation. The results will examine the taxes within other public health initiatives in the countries and political considerations. CONCLUSIONS: While often touted as nutrition policy win, SSB taxes are one part of a larger nutrition policy toolbox. The study contributes to past research examining the Chilean and Mexican taxes, individually ...
BACKGROUND: Cervical cancer is the second most commonly diagnosed cancer among Ethiopian women, killing an estimated 4700 women each year. As the government rolls out the country's first national cancer control strategy, information on patient and provider experiences in receiving and providing cervical cancer screening, diagnosis, and treatment is critical. METHODS: This qualitative study aimed to assess the availability of cervical cancer care; explore care barriers and sources of delay; and describe women's and providers' perceptions and experiences of care. We analyzed data from 45 informants collected at 16 health centers, district hospitals and referral hospitals in East Gojjam Zone and a support center in Addis Ababa. Thirty providers and ten women receiving care were interviewed, and five women in treatment or post-treatment participated in a focus group discussion. Deductive and inductive codes were used to thematically analyze data. RESULTS: Providers lacked equipment and space to screen and treat patients and only 16% had received in-service cervical cancer training. Consequently, few facilities provided screening or preventative treatment. Patients reported low perceptions of risk, high stigma, a lack of knowledge about cervical cancer, and delayed care initiation. All but one patient sought care only when she became symptomatic, and, pre-diagnosis, only half of the patients knew about cervical cancer. Even among those aware of cervical cancer, many assumed they were not at risk because they were not sexually active. Misdiagnosis was another common source of delay experienced by half of the patients. Once diagnosed, women faced multiple-month waits for referrals, and, once in treatment, broken equipment and shortages of hospital beds resulted in additional delays. Barriers to therapeutic treatment included a lack of housing and travel funds. Patient-provider communication of cancer diagnosis was often lacking. CONCLUSIONS: In-service provider training should be intensified and should include ...
AbstractAbstractPandemic response takes place in distributed, uncertain, and high‐tempo environments. These conditions require public health agencies to rapidly generate and roll out publicly accountable responses in the face of incomplete and ambiguous evidence. To perform under these conditions, public health organizations have devised several tools to support decision making and response. This article examines two such tools that debuted during the 2009 H1N1 outbreak—the 2005 International Health Regulations and influenza pandemic planning. Relying on an international network of researchers who gained access to lead public health agencies in advance of the 2009 pandemic, this study draws on several forms of data—primary documentation, interviews, and an extended workshop with key officials—that were collected as the pandemic unfolded. With this unique dataset, we analyze the performance of the International Health Regulations and pandemic influenza plans from a "sensemaking" perspective. We find that insufficient attention to both the complexities and time horizons involved with adequate sensemaking limited the ability of both tools to fully meet their goals. To improve organizational performance during global pandemics, the sensemaking perspective calls attention to the importance of informal venues of information‐sharing and to the need for decisionmakers to continually update planning assumptions.
