Paul Mkandawire

‘Abandoning’ farms in search of food: food remittance and household food security in Ghana

This paper examines the important place of food remittances in the context of household food security in the Upper West Region (UWR) of Ghana against a backdrop of rapid environmental change and accelerating rural poverty. Findings from in-depth interviews conducted in the UWR show a tendency toward increased dependence of rural poor families on food remittance as a strategy for coping with chronic household food insecurity amidst poverty, changing patterns of rainfall and declining soil fertility. In addition, the study also shows that while food remittance entailed spatial dispersion of the household in a context where certain household members migrate to distant agricultural-rich hinterlands, engage in migrant farming and remit agricultural produce back home, the strategy nonetheless leads to the strengthening of familial and kinship ties. The study concludes by making relevant policy recommendations that would improve household livelihood security.

“You Either Pay More Advance Rent or You Move Out”: Landlords/Ladies’ and Tenants’ Dilemmas in the Low-income Housing Market in Accra, Ghana

Policy-makers world-wide are concerned about severe housing problems experienced in cities of the developing world. This paper examines the rental housing situation in Accra, Ghana. It presents findings of a qualitative investigation of the experiences of property owners (n = 21) and tenants (n = 23) in an informal private housing market that caters to the housing needs of an expanding section of Accra residents but lacks an institutional framework for regulating landlord/lady–tenant relations. The specific focus of the investigation is on perceptions of an intensifying tenancy management practice called the advance rent system. Overall, the findings reveal severe rental housing pressures and conflicting relations between renters and property owners rooted in asymmetrical perceptions regarding this system. The paper describes the conditions that shape landlords/ladies’ behaviours towards renters and their reactions to what are generally perceived as fraudulent tenure terms that property owners arbitrarily impose on tenants in this market. The paper concludes by suggesting policy recommendations to mitigate constraints plaguing a dysfunctional rental market system.

Hepatitis B in Ghana's upper west region: a hidden epidemic in need of national policy attention.

Like many countries in Sub-Saharan Africa, Hepatitis B virus (HBV) is highly prevalent in Ghana. Using qualitative methods, this paper draws from the political ecology of health theoretical framework to examine perceptions and understandings of HBV in the Upper West Region of Ghana. The findings reveal that extremely low levels of knowledge and pervasive lay misconceptions about the disease within this geographic context are shaped by large scale structural influences. Furthermore, in this context there is essentially no access to HBV immunizations, testing or treatment services which reinforces potential routes for the spread of HBV. An explosive spread of HBV is brewing with the potential to diffuse across space and time while, within the institutional contexts, it is the HIV epidemic that is largely consuming both policy attention and intervention.

Orphan Status and Time to First Sex Among Adolescents in Northern Malawi

This study examines the effects of orphanhood status on the timing of first sexual intercourse among youth in Malawi. Log-normal models were applied to survey data collected between May and August 2009 from 1,214 adolescents aged 12–18 in Mzuzu, Northern Malawi. Results of this study show that orphanhood is a significant predictor of age at first sex. Male double orphans experienced first sexual intercourse earlier than their male non-orphan peers. Similarly, female maternal and paternal orphans had their sexual debut faster than their non-orphan counterparts. The introduction of social support variables accounted for the orphanhood disadvantage. These findings suggest that in order to delay sexual initiation and reduce HIV risk among orphans in Malawi, policy efforts should focus on enhancing factual knowledge about HIV/AIDS, household food security, social support, and other measures that will strengthen existing social support networks and connectedness of surviving family members.ResumenEste estudio examina los efectos del primer encuentro sexual en jóvenes huérfanos en Malawi. Modelos con distribución logarítmica normal fueron utilizados en los datos de este estudio colectados en el periodo de Mayo a Agosto de 2009 provenientes de 1,214 adolescentes de 12-18 años en Mzuzu, al norte de Malawi. Los resultados de este estudio demuestran que los datos provenientes de los huérfanos son significativos para la predicción de la edad del primer encuentro sexual. Huérfanos masculinos de ambos padres experimentaron el primer encuentro sexual a una edad temprana comparado con sus contrapartes de la misma edad pero sin ser huérfanos. De manera similar, huérfanas de ambos padres tuvieron su primer encuentro sexual a una edad mas joven comparadas con las no huérfanas. La aplicación de variables de soporte social pudieron explicar las desventajas de los huérfanos. Los resultados anteriores sugieren que con el fin de retrasar el primer encuentro sexual y reducir el riesgo de contraer VIH entre huérfanos en Malawi, la política a seguir consistiría en esfuerzos enfocados en incrementar el conocimiento sobre VIH/SIDA, seguridad en alimentación domestica, soporte social, entre otras medidas las cuales reforzaran las redes existentes de soporte social y la conectividad de los miembros de familia.

The National Health Insurance Scheme in Ghana's Upper West Region: a gendered perspective of insurance acquisition in a resource-poor setting.

Ghanas National Health Insurance Scheme (NHIS) was designed as a pro-poor strategy to create wider access to health care. While recent studies have shown that wealth is an important factor in enrolment in the scheme, there is little understanding of its interlinkages with the geographical divisions and deep-seated deprivation in the northern region. In response to the nexus of poverty, gender and access to health care, this research took place in Ghanas Upper West Region (UWR), one of the poorest regions and yet paradoxically touting the highest enrolment rates. Using data from a population survey (n = 2119) collected between May to December 2011, we used multinomial regression to examine factors that influence enrolment, controlling for theoretically relevant covariates. Findings reveal that although wealth and desire for health insurance are contributing factors, education was the primary determinant in both never enrolling and in dropping out, and that these factors impact men and women differently. The study also shows that Muslims were less likely to enrol and also women living in non-nuclear households were far more likely to dropout. Our results demonstrate clear gendered divisions in accessing the NHIS, and raised serious equity concerns in the UWR. By focussing on the context of the UWR, we show the importance of understanding intra-household bargaining and resource allocation via the gender dynamics related to health insurance procurement and maintenance, and discuss associated policy implications.

“I was on the way to the hospital but delivered in the bush”: Maternal health in Ghana's Upper West Region in the context of a traditional birth attendants' ban

This study examines perceptions and experiences of mothers, traditional birth attendants (TBA), and skilled birth attendants (SBA) regarding Ghanas recent policy that forbids TBAs from undertaking deliveries and restricts their role to referrals. In the larger context of Ghanas highly underdeveloped and geographically uneven health care system, this study draws on the political ecology of health framework to explore the ways global safe motherhood policy discourses intersect with local socio-cultural and political environments of Ghanas Upper West Region (UWR). This study reveals that futile improvements in maternal health and the continued reliance on TBAs illustrate the governments inability to understand local realities marked by poor access to SBAs or modern health care services. Using focus group discussions (FGDs) (n = 10) and in-depth interviews (IDIs) (n = 48) conducted in Ghanas UWR, the findings suggest that mothers generally perceive TBAs as better placed to conduct deliveries in rural isolated communities, where in most cases no SBAs are present or easily accessible. The results indicate that by adhering to the World Health Organizations guidelines, the local government may be imposing detrimental, unintended consequences on maternal and child health in remote rural locations. In addition, the findings suggest that the new policy has resulted in considerable confusion among TBAs, many of whom remain oblivious or have not been officially notified about the new policy. Furthermore, participant accounts suggest that the new policy is seen as contributing to worsening relations and tensions between TBAs and SBAs, a situation that undermines the delivery of maternal health services in the region. The study concludes by suggesting relevant policy recommendations.

Management challenges of urban biosolids: narratives around facility siting in rural Ontario

The emerging challenge of managing increasing volumes of urban sewage has resulted in municipalities pursuing sustainable ways to manage urban biosolids and their by-products. Using content analysis of public debates, and situating the debate within science, policy and facility siting literature, this study examines claims and counterclaims relating to the siting of a biosolid processing facility in rural Ontario. The equivocal evidence on the health and environmental effects of biosolids resulted in a heated “expert versus lay” debate. The study critically evaluates the importance of trust and the shifting role of scientific evidence in politicised settings, while making relevant policy recommendations.

Gendered Inequalities within Ghana's National Health Insurance Scheme: Are Poor Women Being Penalized with a Late Renewal Policy?

This article addresses the implications of the mandatory delay in coverage for individuals residing in the Upper West Region (UWR) of Ghana who have dropped out of the National Health Insurance Scheme (NHIS) but later attempt to reenroll. Using data collected in 2011 in Ghana’s UWR, we use a negative log-log model (n=1,584) to compare those who remain enrolled in the scheme with those who have dropped out. Women with unreliable incomes, who reported being food-insecure and those living with young children were more likely to drop out (OR range: 1.22–1.79, p<.05). Men, in contrast, were 50% more likely to drop out of the NHIS for being unsatisfied with services provided (OR range: 1.25–1.62, p<.01). Contrary to the original mandate of the NHIS, our study reveals clear gender differences in the factors contributing to dropouts, pointing to a bias in the impact of the block-out policy that is penalizing women for being poor.

Circumcision status and time to first sex among never-married young men in Malawi: evidence from the Demographic and Health survey.

This study examines the association between circumcision status and the timing of first sexual intercourse among adolescents in Malawi. Results of survival models applied to nationally representative sample of never-married young men aged between 15 and 24 obtained from the Demographic and Health Survey data show that being circumcised is associated with earlier initiation of sexual activity in Malawi. Young men who reported being circumcised experienced their first sexual intercourse earlier in life than their uncircumcised counterparts. Although the introduction of theoretically relevant knowledge, socio-cultural, demographic, and socioeconomic variables in the multivariate models attenuated the association between circumcision and earlier sexual initiation, the relationship nonetheless remained robust. The study concludes by discussing the implications of these findings and suggests relevant policy recommendations.ResumenEste estudio examina la relación entre la circuncisión y la edad al primer contacto sexual de jóvenes en Malawi. Los resultados muestran una asociación entre el estado de circuncisión y el primer encuentro sexual en jóvenes de temprana edad en Malawi. Los resultados previos provienen de Encuestas Demográficas y de Salud aplicadas a modelos de sobrevivencia en muestras representativas de jovenes previamente nocasados entre 15 y 24. Hombres jóvenes quienes reportaron ser circuncidados experimentaron el primer encuentro sexual a una temprana edad comparado con sus contrapartes sin circuncidar. La relación entre la circuncisión y el primer contacto sexual en los modelos multivariados persistió a pesar de la introducción de variables atenuadoras tales como el conocimiento socioeconómico y sociodemográfico. El estudio discute las implicaciones de los resultados y las recomendaciones de relevancia política las cuales podrían hacer a los hombres circuncidados más susceptibles a la prevención de VIH en Malawi.

Persistent misconceptions about HIV transmission among males and females in Malawi

BackgroundThe prevalence of HIV in Malawi is one of the highest in sub-Saharan Africa, and misconceptions about its mode of transmission are considered a major contributor to the continued spread of the virus.MethodsUsing the 2010 Malawi Demographic and Health Survey, the current study explored factors associated with misconceptions about HIV transmission among males and females.ResultsWe found that higher levels of ABC prevention knowledge were associated with lower likelihood of endorsing misconceptions among females and males (OR = 0.85, p < 0.001; OR = 0.85, p < 0.001, respectively). Compared to those in the Northern region, both females and males in the Central (OR = 0.54, p < 0.001; OR = 0.53, p < 0.001, respectively) and Southern regions (OR = 0.49, p < 0.001; OR = 0.43, p < 0.001, respectively) were less likely to endorse misconceptions about HIV transmission. Moreover, marital status and ethnicity were significant predictors of HIV transmission misconceptions among females but not among males. Also, household wealth quintiles, education, religion, and urban–rural residence were significantly associated with endorsing misconceptions about HIV transmission.ConclusionBased on our findings, we recommend that education on HIV transmission in Malawi should integrate cultural and ethnic considerations of HIV/AIDS.