Le financement basé sur la performance (FBP) a amplement voyagé en Afrique. Une analyse des entretiens avec des acteurs clefs et de la littérature grise montre que sa mise en œuvre au Burundi répond à un usage stratégique, comme outil de réalisation de la politique de gratuité partielle des soins, et renforce une élite technocratique au ministère de la Santé. Saisir cette reterritorialisation politique et stratégique est fondamental pour la compréhension des modèles voyageurs dans la santé globale.
Access to justice is often described as key for building and consolidating peace and enhancing socio-economic development in fragile and post-conflict states. Since the 2000s, legal empowerment has been one of the most popular approaches to improve such access, and a growing literature has presented mixed evidence on the quality of its outcomes. We evaluate and discuss the impact of a locally provisioned legal aid program on justice-seekers' use of dispute resolution fora, legal agency, and trust in judicial institutions. The program was implemented between 2011 and 2014 in 26 municipalities of rural Burundi. We consider its effects on 486 beneficiaries using various propensity score-matching methods and data on non-beneficiaries from two distinct control groups (n = 3,267). Forty-eight interviews with key informants help discuss judicial practices. We find that the program increased the use of courts but not trust in the judiciary. It had no significant impact on the use of alternative dispute resolution mechanisms. Qualitative and quantitative evidence suggests that justice-seekers' perception of the treatment they received in courts, also known as procedural justice, shaped their perception of accessing justice. Qualitative evidence also points to a possible 'watchdog effect': in some cases, the presence of a legal adviser may have pushed judges to better comply with procedures. While legal aid programs can improve access to courts, it does not necessarily mean an erosion of judicial 'forum shopping' or that trust in state institutions is reinforced and rights fully realized.
This paper provides evidence that the COVID-19-related mortality rate of national government ministers and heads of state has been substantially higher than that of people with a similar sex and age profile in the general population, a trend that is driven by African cases (17 out of 24 reported deaths worldwide, as of 6 February 2021). Ministers' work frequently puts them in close contact with diverse groups, and therefore at higher risk of contracting SARS-CoV-2, but this is not specific to Africa. This paper discusses five non-mutually exclusive hypotheses for the Africa-specific trend, involving comorbidity, poorly resourced healthcare and possible restrictions in accessing out-of-country health facilities, the underreporting of cases, and, later, the disproportionate impact of the so-called 'South African' variant (501Y.V2). The paper then turns its attention to the public health and political implications of the trend. While governments have measures in place to cope with the sudden loss of top officials, the COVID-19-related deaths have been associated with substantial changes in public health policy in cases where the response to the pandemic had initially been contested or minimal. Ministerial deaths may also result in a reconfiguration of political leadership, but we do not expect a wave of younger and more gender representative replacements. Rather, we speculate that a disconnect may emerge between the top leadership and the public, with junior ministers filling the void and in so doing putting themselves more at risk of infection. Opposition politicians may also be at significant risk of contracting SARS-CoV-2.
AbstractThis paper explores the role of savings groups in resilience to urban climate-related disasters. Savings groups are a rapidly growing phenomenon in Africa. They are decentralized, non-institutional groups that provide millions of people excluded from the formal banking sector with a trusted, accessible, and relatively simple source of microfinance. Yet there is little work on the impacts of savings groups on resilience to disasters. In this paper, we use a combination of quantitative and qualitative evidence from Dar es Salaam (Tanzania) to shed new light on the role that savings groups play in helping households cope with climate-related shocks. Drawing on new data, we show that approximately one-quarter of households have at least one member in a group, and that these households recover from flood events faster than those who do not. We further argue that the structure of savings groups allows for considerable group oversight, reducing the high costs of monitoring and sanctioning that often undermine cooperative engagement in urban areas. This makes the savings group model a uniquely flexible form of financing that is well adapted to helping households cope with shocks such as repeated flooding. In addition to this, we posit that they may provide a foundation for community initiatives focusing on preventative action.
IntroductionTraditional, complementary and alternative medicine (TCAM) providers are central for many when seeking healthcare. Internally Displaced Persons (IDPs) are no exception. This paper seeks to better understand the use of TCAM by IDPs and its connection with the local integration of IDPs into the social fabric of the communities where they have taken refuge. We compare IDPs and non-IDPs access to TCAM providers and their level of confidence in having their healthcare needs met by these sources in Uvira and Kabare territories of South Kivu, Democratic Republic of Congo (DRC).MethodsWe draw from a mixed method, social connections design comprised of participatory workshops with 111 participants; a survey with 847 participants capturing exploring access and trust of TCAM and other wealth and demographic indicators; 24 interviews with traditional healthcare providers; and 56 in-depth life history interviews with IDPs. Collected data were analysed using both qualitative and quantitative approaches. Descriptive statistics (mean, percentage, and standard deviation) and statistical tests (proportions test and t test) were used as quantitative analysis tools whereas thematic content analysis was used for qualitative data.ResultsWe show that IDPs use TCAM more than non IDPs. Access to and trust in traditional healers seems dependent on the exact nature of the services they offer, which varies across our sample. As such, processes of recognition and integration of both IDPs and TCAM providers into formal healthcare systems should be treated cautiously with an understanding of the socio-economic rationales that displaced people and TCAM providers operate under. While many of these TCAM providers are not highly trusted sources in South Kivu, their highly valued treatment of certain conditions such as what is locally known as "mulonge" (and bears similarities with the Buruli ulcer) suggest there may be potential specific areas where collaboration could be successful between biomedical health workers and TCAM providers.
