Political accountability and public service provision in Africa: evidence from Ghana

Clark Gibson

Political accountability and public service provision in Africa: evidence from Ghana

Annals of Global Health, 2016

GOVERNANCE “Elite child athletes are our future” - cardiac adaptation to monoﬁn training in prepubertal Egyptian athletes Magdy Abouzeid, Nancy Abouzeid, Afaf Salem; College of Sport Education, University of Alexandria, Egypt Background: The elite child athletes are one who has superior athletic talent. Monoﬁn (a single surface swim ﬁn) swimming already proved to be the most efﬁcient method of swimming for human being. This is a novel descriptive study examining myocar- dial function indices in prepubertal monoﬁn children. The aim of the present study was to determine the inﬂuence of long-term monoﬁn training (LTMT), 36 weeks, 6 times per week, 90 min per unit on Myocardial function adaptation in elite child monoﬁn athletes. Methods: 14 elite monoﬁn children aged 11.95 years (Æ 1.09 yr) took part for (LTMT). All subjects underwent two-dimension, M-mode, and Doppler echocardiography before and after training to evaluate cardiac dimensions and function; septal and posterior wall thickness. Statistical methods of SPSS, means Æ SD and paired t test, % of improvement were used. Findings: There was signiﬁcant difference (p<0.01) and % improvement for all echocardiography parameter after (LTMT). Inter ventricular septal thickness in diastole and in systole increased by 27.9 % and 42.75 %. Left ventricular end systolic dimension and diastole increased by 16.81 % and 42.7 % respectively. Posterior wall thickness in systole very highly increased by 283.3 % and in diastole increased by 51.78 %. Left ventricular mass in diastole and in systole increased by 44.8 % and 40.1 % respectively. Stroke volume (SV) and resting heart rate (HR) signiﬁcant changed (sv) 25 %, (HR) 14.7 %. Interpretation: the unique swim ﬁn tool and create propulsion and overcome resistance. Further researches are needed to determine the effects of monoﬁn training on right ventricular in child athletes. Abstract #: 1.001_GOV How immigrant women living in Ontario experience culturally competent care during pregnancy E. Amoako 1 , L. Kapiriri 2 ; 1 University of Toronto, Ontario, Canada, 2 McMaster University, Ontario, Canada Background: The experience of poorer birth outcomes for many immigrant women living in Canada can only be enhanced when “effective prenatal care integrates the best available information into a shared model of decision making” (Kirkham et al 2005 pg 1307) between the pregnant woman and the health care worker, and this can only begin at the point during the delivery of services, when cultural competent care is being provided. Methods: A qualitative ethnographic study with eight in depth one on one interviews with immigrant women, sampled from a church and a prenatal program from Unison Community Health Centre in Toronto, Ontario. The women had more than one child, but no more than four children, and were between the ages of 30-50 years old, and lived in Canada between 2 to 37 years. Findings: The participants within this study acknowledged the presence of prenatal care and services being provided by the health care system, though the majority did not attend prenatal classes. The immigrant women from this study discussed a need for larger social support networks during and after pregnancy, and health care professionals that took the initiative to understand their cultural needs and wants on an individualistic level. The participants highly preferred midwifery as a form of prenatal care, and they did not rely much on what was culturally appropriate and competent care, but rather relied on their personal cultural networks. Interpretation: The research concluded that different measures of care were needed other than the prenatal care/services that are provided through Ontario. Four ﬁnal recommendations were made according to the ﬁndings to provide a platform for future progression towards the enhancement of prenatal care and services so that it reﬂects the needs of the immigrant women population. Funding: None. Abstract #: 1.002_GOV Political accountability and public service provision in Africa: evidence from Ghana J. Asunka 1 , P. Afulani 2 ; 1 University of California, Los Angeles, CA, USA, 2 University of California, San Francisco, CA, USA Background: The quantity and quality of public services, notably basic health services, vary substantially within and across countries in Africa. Why are some governments much better at providing public services to citizens than others? We investigate the political sources of weak public services in Africa using Ghana as a case study. We argue that partisan attachment of voters plays a key role. Methods: We use a unique dataset from a UNICEF project in 2014 on public service provision by local governments in Ghana. Under this project, all the 216 local governments in the country are scored, using objective performance indicators in health, educa- tion, water, governance, and security services. We combine data from this project and electoral data for each district to investigate the impact of political accountabilitydmeasured by the distribution of voter attachment to political partiesdon supply of and demand for basic services. Supply is measured by rural water coverage and a composite score of public services supply called the District League Table (DLT) score. Demand is measured by percent of women delivering with a skilled birth attendantdthe most critical interven- tion to reduce maternal mortality. We use simple linear regression analysis. Findings: We ﬁnd that supply and demand of public services is much lower in districts where voters are strongly attached to political parties. Controlling for other factors, strongly partisan districts score about 10 percentage points lower in rural water coverage and the DLT score than weakly partisan districts; deliveries by skilled Annals of Global Health ª 2016 Icahn School of Medicine at Mount Sinai VOL. 82, NO. 3, 2016 ISSN 2214-9996/$36.00

attendants is also about 10 percentage points lower in strongly partisan districts. Interpretation: Strong voter attachment to political parties under- mines the quality of democratic elections as a mechanism for enhancing electoral accountability. Where voters evince strong attachment to political parties, elections fail to discipline poor performance of public ofﬁcials. Because strong partisan attachment is associated with weak supply and poor quality of public services, demand for essential services is also lower in these places. Initiatives that create public awareness about governments’ performance on public services provision could pressure poor performers to improve. It could also spur collective action efforts to demand better services from government. Funding: None. Abstract #: 1.003_GOV Anticipatory governance of technological innovation in global health as seen in Canadian newspapers Shyrose Aujla 1 , Gregor Wolbring 2 ; 1 Bachelor of Health Sciences, Cum- ming School of Medicine, Health and Society, University of Calgary, Calgary, Canada, 2 Department of Community Health Sciences, Specialization in Community Rehabilitation and Disability Studies, University of Calgary, Calgary, Canada Purpose: Newspapers are a source of knowledge for the public (1), as diffusion of knowledge through printed media is essential to the fabric of society, enabling social participation (2), and sustaining political freedom. The discussion in media may pertain to new and emerging scientiﬁc or technological development in the ﬁeld of global health. Anticipatory governance strives to discuss foresight into the emergence of a given technological product in order to facilitate capacity for the society in which it is introduced(3); as such, we posit it as important for technological innovation within global health to be mentioned in a way that the reader is equipped to participate in antic- ipatory governance. The objective of the study was to ﬁnd and analyze discourse regarding anticipatory governance of technological innova- tion within global health in Canadian newspapers, to compare this discourse to that which is found in existing literature on the topic, and to understand the consequences of such coverage for society. Methods: We downloaded every article (1970- 2015) from The Globe and Mail and National Post, and the Calgary Herald, and keyword searched the phrase “global health” in the text (n¼1135 articles). We coded for “innovation” (n¼70 articles) “technology” (n¼346 articles) and “governance” (n¼43 articles). Each article was read within context to decipher the nature of discourse, and co-accordance of certain terms to terms identiﬁed in existing litera- ture on the topic were noted and analyzed. Results: There was an evident discrepancy between the terms mentioned within existing literature on global health innovation, and the discourse presented in the media sources studied. The concepts of global health, technology, and innovation often occu- pied a ﬁnancial context, with little regard to the social context associated. Identiﬁed issues associated with global health innovation received little visibility within the media. Non-state actors involved in global health governance(4) very rarely showed up in co-occurrence with “innovation” or “governance.” Outcomes: We posit that the lack of discourse around anticipatory governance in global health and technological innovation is due to the excessive prevalence of a ﬁnancial context, the lack of consider- ation given to the social aspect of innovation, and the narrowness of information leading to an absence of insight into different social contexts present in the global community. Going Forward: Our ﬁndings show that a reader of the Canadian newspapers studied would not be equipped to participate in the anticipatory governance of technological innovation in the ﬁeld of global health. References: 1. Chapman S, Lupton D. The ﬁght for public health: prin- ciples and practice of media advocacy: British Med. Assoc.; 1996. 2. Nord DP. A republican literature: A study of magazine reading and readers in late eighteenth-century New York. American Quarterly. 1988:42-64. 3. Guston DH. Understanding ‘anticipatory governance’. Social Studies of Science. 2014;44(2):218-42. 4. Ng NY, Ruger JP. Global health governance at a cross- roads. Global health governance: the scholarly journal for the new health security paradigm. 2011;3(2):1. Abstract #: 1.004_GOV What explains the distribution of community-based health organizations in Malawi? an analysis of 15-year trends S. Burrowes 1 , X. Mai 1 , S. Sarkizzadeh 1 , A. Harawa 2 , K. Greenberg 3 , J. Willard 3 ; 1 Touro University California, Vallejo, CA, USA, 2 Invest in Knowledge Initiative, Zomba, Malawi, 3 AidData, William and Mary University, VA, USA Background: In many sub-Saharan African countries, non- governmental and community-based organizations (NGOs an CBOs) deliver a signiﬁcant proportion of health services. Yet, despite their importance, we know little about the dynamics of CBO forma- tion or the determinants of their geographic distribution. To address this gap, we examine the changing geographic distribution of health- related CBOs in Malawi over a 15-year period. Our research questions are: (1) Where are health CBOs concentrated in Malawi? (2) How stable are they over time? (3) What socio-economic factors are associated with their formation and persistence? Method: We recorded, categorized, and mapped 5,176 organiza- tion-locations using information collected through in-country reviews of Ministry records; web searches of district reports and NGO repositories; reviews of National AIDS Commission reports; and the compilation of data from previous mapping exercises. CBO information was then merged with district-level data on need, aid ﬂows, social capital, and voting behavior. Data are analyzed graph- ically to determine trends. Negative binomial models are used to estimate factors associated with district-level CBO activity. Results: There are 3,004 unique organizations in our dataset, of which 2,442 are CBOs or faith-based organizations. Almost all CBOs (89%) are primarily involved in HIV/AIDS activity although the exact nature of this work is difﬁcult to discern. Only a small minority (8.33%) are involved in direct service provision, fewer Annals of Global Health, VOL. 82, NO. 3, 2016 Governance May eJune 2016: 332 – 338 333

Annals of Global Health VOL. 82, NO. 3, 2016 ª 2016 Icahn School of Medicine at Mount Sinai ISSN 2214-9996/$36.00 GOVERNANCE “Elite child athletes are our future” - cardiac adaptation to monoﬁn training in prepubertal Egyptian athletes no more than four children, and were between the ages of 30-50 years old, and lived in Canada between 2 to 37 years. Magdy Abouzeid, Nancy Abouzeid, Afaf Salem; College of Sport Education, University of Alexandria, Egypt Findings: The participants within this study acknowledged the presence of prenatal care and services being provided by the health care system, though the majority did not attend prenatal classes. The immigrant women from this study discussed a need for larger social support networks during and after pregnancy, and health care professionals that took the initiative to understand their cultural needs and wants on an individualistic level. The participants highly preferred midwifery as a form of prenatal care, and they did not rely much on what was culturally appropriate and competent care, but rather relied on their personal cultural networks. Background: The elite child athletes are one who has superior athletic talent. Monoﬁn (a single surface swim ﬁn) swimming already proved to be the most efﬁcient method of swimming for human being. This is a novel descriptive study examining myocardial function indices in prepubertal monoﬁn children. The aim of the present study was to determine the inﬂuence of long-term monoﬁn training (LTMT), 36 weeks, 6 times per week, 90 min per unit on Myocardial function adaptation in elite child monoﬁn athletes. Methods: 14 elite monoﬁn children aged 11.95 years ( 1.09 yr) took part for (LTMT). All subjects underwent two-dimension, M-mode, and Doppler echocardiography before and after training to evaluate cardiac dimensions and function; septal and posterior wall thickness. Statistical methods of SPSS, means SD and paired t test, % of improvement were used. Findings: There was signiﬁcant difference (p<0.01) and % improvement for all echocardiography parameter after (LTMT). Inter ventricular septal thickness in diastole and in systole increased by 27.9 % and 42.75 %. Left ventricular end systolic dimension and diastole increased by 16.81 % and 42.7 % respectively. Posterior wall thickness in systole very highly increased by 283.3 % and in diastole increased by 51.78 %. Left ventricular mass in diastole and in systole increased by 44.8 % and 40.1 % respectively. Stroke volume (SV) and resting heart rate (HR) signiﬁcant changed (sv) 25 %, (HR) 14.7 %. Interpretation: the unique swim ﬁn tool and create propulsion and overcome resistance. Further researches are needed to determine the effects of monoﬁn training on right ventricular in child athletes. Abstract #: 1.001_GOV How immigrant women living in Ontario experience culturally competent care during pregnancy E. Amoako1, L. Kapiriri2; 1University of Toronto, Ontario, Canada, 2 McMaster University, Ontario, Canada Background: The experience of poorer birth outcomes for many immigrant women living in Canada can only be enhanced when “effective prenatal care integrates the best available information into a shared model of decision making” (Kirkham et al 2005 pg 1307) between the pregnant woman and the health care worker, and this can only begin at the point during the delivery of services, when cultural competent care is being provided. Methods: A qualitative ethnographic study with eight in depth one on one interviews with immigrant women, sampled from a church and a prenatal program from Unison Community Health Centre in Toronto, Ontario. The women had more than one child, but Interpretation: The research concluded that different measures of care were needed other than the prenatal care/services that are provided through Ontario. Four ﬁnal recommendations were made according to the ﬁndings to provide a platform for future progression towards the enhancement of prenatal care and services so that it reﬂects the needs of the immigrant women population. Funding: None. Abstract #: 1.002_GOV Political accountability and public service provision in Africa: evidence from Ghana J. Asunka1, P. Afulani2; 1University of California, Los Angeles, CA, USA, 2University of California, San Francisco, CA, USA Background: The quantity and quality of public services, notably basic health services, vary substantially within and across countries in Africa. Why are some governments much better at providing public services to citizens than others? We investigate the political sources of weak public services in Africa using Ghana as a case study. We argue that partisan attachment of voters plays a key role. Methods: We use a unique dataset from a UNICEF project in 2014 on public service provision by local governments in Ghana. Under this project, all the 216 local governments in the country are scored, using objective performance indicators in health, education, water, governance, and security services. We combine data from this project and electoral data for each district to investigate the impact of political accountabilitydmeasured by the distribution of voter attachment to political partiesdon supply of and demand for basic services. Supply is measured by rural water coverage and a composite score of public services supply called the District League Table (DLT) score. Demand is measured by percent of women delivering with a skilled birth attendantdthe most critical intervention to reduce maternal mortality. We use simple linear regression analysis. Findings: We ﬁnd that supply and demand of public services is much lower in districts where voters are strongly attached to political parties. Controlling for other factors, strongly partisan districts score about 10 percentage points lower in rural water coverage and the DLT score than weakly partisan districts; deliveries by skilled Governance Annals of Global Health, VOL. 82, NO. 3, 2016 M a y eJ u n e 2 0 1 6 : 3 3 2 – 3 3 8 attendants is also about 10 percentage points lower in strongly partisan districts. Interpretation: Strong voter attachment to political parties undermines the quality of democratic elections as a mechanism for enhancing electoral accountability. Where voters evince strong attachment to political parties, elections fail to discipline poor performance of public ofﬁcials. Because strong partisan attachment is associated with weak supply and poor quality of public services, demand for essential services is also lower in these places. Initiatives that create public awareness about governments’ performance on public services provision could pressure poor performers to improve. It could also spur collective action efforts to demand better services from government. Funding: None. Abstract #: 1.003_GOV Anticipatory governance of technological innovation in global health as seen in Canadian newspapers Shyrose Aujla1, Gregor Wolbring2; 1Bachelor of Health Sciences, Cumming School of Medicine, Health and Society, University of Calgary, Calgary, Canada, 2Department of Community Health Sciences, Specialization in Community Rehabilitation and Disability Studies, University of Calgary, Calgary, Canada Purpose: Newspapers are a source of knowledge for the public (1), as diffusion of knowledge through printed media is essential to the fabric of society, enabling social participation (2), and sustaining political freedom. The discussion in media may pertain to new and emerging scientiﬁc or technological development in the ﬁeld of global health. Anticipatory governance strives to discuss foresight into the emergence of a given technological product in order to facilitate capacity for the society in which it is introduced(3); as such, we posit it as important for technological innovation within global health to be mentioned in a way that the reader is equipped to participate in anticipatory governance. The objective of the study was to ﬁnd and analyze discourse regarding anticipatory governance of technological innovation within global health in Canadian newspapers, to compare this discourse to that which is found in existing literature on the topic, and to understand the consequences of such coverage for society. Methods: We downloaded every article (1970- 2015) from The Globe and Mail and National Post, and the Calgary Herald, and keyword searched the phrase “global health” in the text (n¼1135 articles). We coded for “innovation” (n¼70 articles) “technology” (n¼346 articles) and “governance” (n¼43 articles). Each article was read within context to decipher the nature of discourse, and co-accordance of certain terms to terms identiﬁed in existing literature on the topic were noted and analyzed. Results: There was an evident discrepancy between the terms mentioned within existing literature on global health innovation, and the discourse presented in the media sources studied. The concepts of global health, technology, and innovation often occupied a ﬁnancial context, with little regard to the social context associated. Identiﬁed issues associated with global health innovation received little visibility within the media. Non-state actors involved in global health governance(4) very rarely showed up in co-occurrence with “innovation” or “governance.” 333 Outcomes: We posit that the lack of discourse around anticipatory governance in global health and technological innovation is due to the excessive prevalence of a ﬁnancial context, the lack of consideration given to the social aspect of innovation, and the narrowness of information leading to an absence of insight into different social contexts present in the global community. Going Forward: Our ﬁndings show that a reader of the Canadian newspapers studied would not be equipped to participate in the anticipatory governance of technological innovation in the ﬁeld of global health. References: 1. Chapman S, Lupton D. The ﬁght for public health: principles and practice of media advocacy: British Med. Assoc.; 1996. 2. Nord DP. A republican literature: A study of magazine reading and readers in late eighteenth-century New York. American Quarterly. 1988:42-64. 3. Guston DH. Understanding ‘anticipatory governance’. Social Studies of Science. 2014;44(2):218-42. 4. Ng NY, Ruger JP. Global health governance at a crossroads. Global health governance: the scholarly journal for the new health security paradigm. 2011;3(2):1. Abstract #: 1.004_GOV What explains the distribution of community-based health organizations in Malawi? an analysis of 15-year trends S. Burrowes1, X. Mai1, S. Sarkizzadeh1, A. Harawa2, K. Greenberg3, J. Willard3; 1Touro University California, Vallejo, CA, USA, 2Invest in Knowledge Initiative, Zomba, Malawi, 3AidData, William and Mary University, VA, USA Background: In many sub-Saharan African countries, nongovernmental and community-based organizations (NGOs an CBOs) deliver a signiﬁcant proportion of health services. Yet, despite their importance, we know little about the dynamics of CBO formation or the determinants of their geographic distribution. To address this gap, we examine the changing geographic distribution of healthrelated CBOs in Malawi over a 15-year period. Our research questions are: (1) Where are health CBOs concentrated in Malawi? (2) How stable are they over time? (3) What socio-economic factors are associated with their formation and persistence? Method: We recorded, categorized, and mapped 5,176 organization-locations using information collected through in-country reviews of Ministry records; web searches of district reports and NGO repositories; reviews of National AIDS Commission reports; and the compilation of data from previous mapping exercises. CBO information was then merged with district-level data on need, aid ﬂows, social capital, and voting behavior. Data are analyzed graphically to determine trends. Negative binomial models are used to estimate factors associated with district-level CBO activity. Results: There are 3,004 unique organizations in our dataset, of which 2,442 are CBOs or faith-based organizations. Almost all CBOs (89%) are primarily involved in HIV/AIDS activity although the exact nature of this work is difﬁcult to discern. Only a small minority (8.33%) are involved in direct service provision, fewer

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Political accountability and public service provision in Africa: evidence from Ghana