Determinants of utilisation of health services by women in rural and urban areas in Ghana

The paper examines the factors that influence the utilisation of health services by women in the rural and urban areas in Ghana. The systematic sampling procedure was used to draw the sample from women aged 18 and above with diverse backgrounds from Ahafo-Ano South district, representing the rural districts and Kumasi metropolis, representing the urban districts. The research instruments used for data collection were the questionnaire and formal interviews. Multiple regression was the main tool for analysis. The research reveals that the key factors that impact significantly on the utilisation of health services by women in the Ahafo-Ano South district are, distance, income and family size (number of children) while for Kumasi metropolis they are education, distance and marital status. Whereas it is clear that distance is a common problem facing women in both rural and urban areas in Ghana in the utilisation of health services, marital status and number of children have emerged as contrasting factors influencing utilisation of health services by women in rural and urban Ghana. Recommendations to improve utilisation include the location of maternal and child health services within easy reach in the rural areas, intensification of family planning education in the rural areas, the empowerment of women through access to formal education and vocational training for income generation activities and the full implementation of the National Health Insurance Scheme (NHIS). A model of utilisation of health services by women in the rural and urban areas has emerged.     

[Without Title]

The paper examines the factors that influence the utilisation of health services by women in the rural and urban areas in Ghana. The systematic sampling procedure was used to draw the sample from women aged 18 and above with diverse backgrounds from Ahafo-Ano South district, representing the rural districts and Kumasi metropolis, representing the urban districts. The research instruments used for data collection were the questionnaire and formal interviews. Multiple regression was the main tool for analysis. The research reveals that the key factors that impact significantly on the utilisation of health services by women in the Ahafo-Ano South district are, distance, income and family size (number of children) while for Kumasi metropolis they are education, distance and marital status. Whereas it is clear that distance is a common problem facing women in both rural and urban areas in Ghana in the utilisation of health services, marital status and number of children have emerged as contrasting factors influencing utilisation of health services by women in rural and urban Ghana. Recommendations to improve utilisation include the location of maternal and child health services within easy reach in the rural areas, intensification of family planning education in the rural areas, the empowerment of women through access to formal education and vocational training for income generation activities and the full implementation of the National Health Insurance Scheme (NHIS). A model of utilisation of health services by women in the rural and urban areas has emerged.     

Intergenerational relations and the power of the cell phone: Perspectives on young people’s phone usage in sub-Saharan Africa

Cell phones present new forms of sociality and new possibilities of encounter for young people across the globe. Nowhere is this more evident than in sub-Saharan Africa where the scale of usage, even among the very poor, is remarkable. In this paper we reflect on the inter-generational encounters which are embedded in young people’s cell phone interactions, and consider the wider societal implications, not least the potential for associated shifts in the generational balance of power. An intriguing feature of this changing generational nexus is that while many young people’s phone-based interactions, from their mid-teens onwards, are shifting away from the older generation towards friendship networks in their own age cohort, at the same time they are repositioning themselves – or becoming repositioned – as family information hubs, as a consequence of their phone expertise. The paper draws on mixed-methods research with young people aged c. 9–25 years and in-depth interviews with older age-groups in 24 sites (ranging from high density poor urban to remote rural) across Ghana, Malawi and South Africa.     

Mobile phones and safety in developing countries: Evidence from Sub-Saharan Africa

This paper is concerned with the relationship between safety and mobile phones with particular reference to Sub-Saharan Africa; and looks at a range of geographical contexts: non-violent, conflict and post-conflict situations. The main part of the paper reports on recent findings of extensive field-work into the use of mobile phones in 11 countries in Sub-Saharan Africa. The findings are important partly because from a welfare view, it is use rather than mere adoption that generates actual benefits to consumers. What the survey finds is that use of the mobile phone is mainly for safety-related purposes and that the countries that fare highest in terms of usage are drawn from the richest and poorest members of the sample. In explaining these results I draw heavily on the relationships and interactions between poverty, inequality and crime. For example, the dominance of Southern African countries is ascribed to their exceptionally high levels of inequality, which, in turn, are due partly to the unequal effects of resource abundance.     

Farming as a livelihood source for the urban poor of Nakuru, Kenya

Farming among urban dwellers in Sub-Saharan Africa is a common phenomenon. The present study, carried out in a medium-sized town in Kenya, not only confirmed this but also showed that farming by urban dwellers in the rural areas was even more important for these households’ livelihoods than farming in town. However, those who could benefit most from farming, i.e. the urban poor, appeared to be underrepresented among urban farming households and those urban poor who did farm, either in urban or in rural areas, performed worse than the farming non-poor. The importance of farming as a livelihood source is illustrated by the fact that in years with very little or no harvest due to drought, many of the poor farming households faced food shortages.     

Is better to be a kayayei than to be unemployed: reflecting on the role of head portering in ghana’s informal economy

The implementation of neoliberal economic reforms with its resultant effects on rural agricultural economies has facilitated the migration of young girls from northern to southern Ghana to seek for alternative livelihoods in the urban informal economy as head porters (Kayayei). Using semi-structured questionnaires and interviews with 45 Kayayei in Makola and Agbogbloshie Markets, Accra, this study examines how migration as a livelihood strategy contributes to an improvement in the living conditions of young girls and their families. The paper also looks more closely into the pathways through which the livelihoods of these young female migrants may contribute to local economic development. The study highlights that Kayayei contribute to local economic development through market exchange and revenue generation, also there is significant perceived positive impact of head portering on standard of living of these young girls through improved access to income, health care and asset accumulation while their families benefit from remittances. The study concludes by advocating for the need to provide access to credit and skills training in enhancing the livelihood of Kayayei.     

Land use and urban travel in Kumasi,Ghana

Globally, transport literature indicates a strong effect of land use on urban travel as people living in low density suburban areas tend to travel more by car than people living in high density urban areas. This is because in dense areas, public transport is organised more efficiently and travellers tend to travel shorter distances. However, this assertion is frequently based on locations with efficient integration of transport within the land use planning framework. In Ghana and many African countries, it remains unknown whether the effect of land use on urban travel is strong as reported in developed countries and elsewhere. This research examines the effect of land use on urban travel in Ghana using Kumasi, the second largest city in Ghana, as a case study. Simple questionnaire survey with urban residents, semi-structured interviews with agencies and secondary data analysis were used for this research. Results indicate negative effect of land use on urban travel as there has been increased congestion in all the major road arterials in the city resulting in difficulty in commuting using motorised transport. Findings further show a weak effect of land use on urban travel, as areas experiencing change of land use have poor locational accessibility. The paper recommends innovative ways of meeting the growing travel demand of residents in the city such as the development of a light rail and bus rapid transit systems to help ease congestion and improve public transportation.     

The co-production of livelihoods and land use change: Case studies from South Africa and Ghana

Land use change and livelihood systems are often analyzed separately or with one “driving” the other. This “driver-feedback” relationship has been buttressed by approaches to social process that are often far too static. Actors are confronted with a bundle of choices that they must negotiate as they create pathways of change. These choices are always bound up in relations of power and the knowledges that are the conditions for and results of these relations. We suggest that land uses and livelihood are different manifestations of the social processes by which individuals and groups negotiate the everyday conditions that shape their lives. We propose a framework that extends current understandings of the relationship between land use change and livelihoods by treating social relations of power as the entry point into this complex relationship. We underpin our arguments with empirical examples from South Africa and Ghana that locate power/knowledge relations in the context of social change in both study areas.     

Staying connected: Exploring mobile phone use amongst older adults in the UK

In this paper we examine the ways in which mobile phones are becoming integrated into the everyday life of older adults in the UK by drawing on research funded as part of the British New Dynamics of Ageing programme. Specifically we draw on a digital engagement survey and the life history narratives of older men and women resident in the East Midlands of England to illuminate the challenges of remaining digitally engaged in old age focusing specifically on mobile phone use, with particular reference to maintaining social connections with spatially dispersed family and friends. Growing numbers of older adults possess a mobile phone, but the degree to which mobile phone use has been integrated into everyday practices is variable. For episodic users a mobile phone is used to complement a landline, to keep in touch with family and friends when out of the house. For confident users the mobile phone is used in multiple ways, via a range of applications, it is an integral part of numerous aspects of everyday life.     

To process or not to process? Factors enabling and constraining shea butter production and income in Burkina Faso

Processing of environmental products by rural households in developing countries is often considered a way to lift poor natural resource-dependent households out of poverty by increasing the returns to labour of their harvesting activities. Still, the bulk of environmental products in developing countries is commercialised unprocessed. This paper examines the factors enabling and constraining the processing of shea nuts into shea butter in Burkina Faso. Our analysis is based on socio-economic survey data collected from 536 households in the Zoundwéogo and Cascades provinces of Burkina Faso, as well as qualitative interview data collected from 74 shea butter producers in the province of Sissili. The factors affecting the selection of shea butter production as a livelihood activity as well as the economic success of this activity are analysed using a Heckman selection model. Moreover, we study the effect of locality of residence, defined as place of residence along the rural–urban continuum, on shea butter processing and income. We demonstrate that, among members of a shea butter producer Union, women living in urban areas produce significantly larger quantities of shea butter for sale to the Union and earn superior revenues from these sales than their rural counterparts. We relate these urban–rural discrepancies to the physical and socio-economic conditions that characterise life in different localities and propose policy recommendations based on our findings.     

Effective livelihood adaptation to climate change disturbance: Scale dimensions of practice in Mozambique

Natural resource-dependent societies in developing countries are facing increased pressures linked to global climate change. While social-ecological systems evolve to accommodate variability, there is growing evidence that changes in drought, storm and flood extremes are increasing exposure of currently vulnerable populations. In many countries in Africa, these pressures are compounded by disruption to institutions and variability in livelihoods and income. The interactions of both rapid and slow onset livelihood disturbance contribute to enduring poverty and slow processes of rural livelihood renewal across a complex landscape. We explore cross-scale dynamics in coping and adaptation response, drawing on qualitative data from a case study in Mozambique. The research characterises the engagements across multiple institutional scales and the types of agents involved, providing insight into emergent conditions for adaptation to climate change in rural economies. The analysis explores local responses to climate shocks, food security and poverty reduction, through informal institutions, forms of livelihood diversification and collective land-use systems that allow reciprocity, flexibility and the ability to buffer shocks. However, the analysis shows that agricultural initiatives have helped to facilitate effective livelihood renewal, through the reorganisation of social institutions and opportunities for communication, innovation and micro-credit. Although there are challenges to mainstreaming adaptation at different scales, this research shows why it is critical to assess how policies can protect conditions for emergence of livelihood transformation.     

Moving from rhetoric into action: effectiveness of state–civil society synergy for healthcare delivery in rural Ghana

The issue of extending healthcare to marginalized underserved rural population remains a cardinal rhetoric policy of the Ghana Government. Meanwhile we note a growing inequity in terms of access and utilization of quality and affordable healthcare between urban and rural areas of the country. The Government of Ghana through its various policy initiatives in 2002 collaborated with civil societies with the aim of bringing healthcare to the doorsteps of rural folks in the country. Using a mixed method approach through a semi structured interviews and questionnaire administration, and focusing on the Community-based Health Planning and Services (CHPS) programme in Nsanfo community in the Mfanstiman municipal area, this study assesses the effectiveness and challenges confronting state–civil society partnership in co-producing a public good (healthcare). We found that synergy between the state (Mfanstiman Municipal Health Directorate) and the civil society (community health volunteers) has yielded positive results in bringing healthcare to the door steps as well as improving the health conditions of the local people in the study area. Nonetheless, certain challenges such as lack of volunteer motivation, deplorable state of the CHPS compound and logistics threaten the very existence of this collaboration. Our study has far reaching implications for healthcare planning in Ghana.     

‘Where is the life in farming?’: The viability of smallholder farming on the margins of the Kalahari, Southern Africa

This paper investigates the ways in which national and regional policies relate to farming activities and concerns amongst the rural population in an area of southern Africa. The struggle to make a living through farming was a common theme to emerge from research about changing livelihoods in response to both variability in the environment and changes in policy. This local discourse echoed regional debates about land and agrarian reform in post-apartheid South Africa and the uncertain future of mixed farming in Botswana. It also raised broader questions about the viability of the future of small-medium-scale farming systems in rural areas in Africa, especially those within dynamic dryland environments such as the Kalahari. This paper looks specifically at the links between poverty and asset holding and aims to identify the ways in which people are or are not able to utilise or mobilise these assets in times of need. We argue that this can vary significantly between seemingly similar settlements, and similar households and that understanding this complexity is the key to recognising how future interventions many impact upon people’s lives. Too often, in the quest to produce understandings of poverty and livelihoods, the complexity, incongruity and reality of day-to-day practices are overlooked. Thus we seek to draw out the interactions between policy and natural resource use, and the capital asset changes involved in these interactions, which influence the sustainability of livelihoods and the differing levels of poverty and vulnerability.     

Policy responses to informality in urban Africa: the example of Maputo,Mozambique

In the global South informality constitutes one of the leading issues for urban policy makers. The planning challenges around informality are particularly relevant in urban Africa as most Africans make their livelihoods in the informal economy. This paper examines issues of state policy responses to informality through the lens of street traders. Under scrutiny are policy responses towards street trading in Mozambique’s capital, Maputo, a city that has experienced the advance of informalization. It is argued that the dominant approach towards informal trading across urban Africa is of a ‘sanitising’ policy response by the local state which is rooted upon traditions of modernist urban planning in search of ‘ordered development’. The research discloses that in Maputo national and municipal authorities have adopted a more tolerant approach to the informal economy, mainly because it provides a livelihood to so many of the city’s poor and because of potential social unrest likely to be triggered by a repressive approach. In Maputo the core narrative is of an urban informal economy viewed by officials as an important livelihood for the city’s poor, albeit one which is subject both to periodic harassment and encouragement to ‘formalize’. The analysis represents a contribution to the expanding corpus of writings on Africa’s informalising cities and specifically concerning policy responses towards street trading.     

Rural women and technology in South Africa: Case studies from KwaZulu-Natal Province

This article contributes to a greater understanding of the linkages between women's roles, responsibilities and their use of technology in poor rural communities. The ways in which poor rural women conceptualize technology is examined. Furthermore, how they use their knowledge and skills to develop, modify and adapt the techniques and technical processes in which they are involved are also explored. Additionally, the links between indigenous and modern technologies in relation to gender considerations in poor rural contexts are examined. This article draws from findings of primary research undertaken in two marginalized rural communities in Kwazulu-Natal, South Africa. The study reveals that the use of technologies are highly gendered and differentiated among women. Poor rural women utilize a range of technologies in both productive and reproductive activities which are central to their livelihood strategies, especially at the household level. Furthermore, although women are adapting and innovating technologies their expertise remains largely unrecognized. A range of problems and constraints exist which limit women's access to and use of technologies. A key tension identified in the study is that between the use of locally-based, indigenous technologies and modern, external technologies. This revised version was published online in July 2006 with corrections to the Cover Date.     

The Internet, mobile phone and space-time constraints

While the implications of information and communication technologies (ICTs) for daily travel and activities have been studied extensively, there is only scant attention paid to the relations between ICTs and space-time constraints. This study therefore explores the extent to which the Internet and mobile phone increase the spatial and temporal flexibility of everyday activities through a review of the literature and empirical research with data from Columbus (Ohio, USA) and Utrecht (The Netherlands). The analysis suggests that the implications of the Internet and mobile phone are complex and dependent on the type of activity, persons involved, technologies and socio-physical context in which they are embedded. Various regularities can, however, be detected. For the study participants, the Internet and mobile phone relax temporal constraints to a stronger degree than they enhance spatial flexibility. There are also space-time constraints that seem to persist or have come about because of ICT adoption. Finally, it appears that the Internet and mobile phone at best consolidate differences between men and women in the space-time constraints associated with everyday activities.     

“I Still Have the Old Tradition”: The co-production of sweetgrass basketry and coastal development

Scholars working around the world have drawn attention to the physical and social changes associated with rural gentrification. Case studies from the United States have focused on how these patterns lead to the cultural displacement and replacement of land-based livelihoods, including non-timber forest product (NTFP) practices. Scholars have also documented the persistence of culturally and economically important NTFP practices in urban and suburban areas. We reconcile these disparate outcomes, displacement on the one hand and persistence on the other, by focusing on the social relationships that co-produce land use and livelihood change. Our case investigates how African American sweetgrass basketmakers in Mount Pleasant South Carolina negotiate the complex terrain of a rapidly urbanizing and gentrifying landscape.Analysis of interviews with basketmakers and participant observation at public meetings suggests that gathering materials and selling baskets occur across spaces not typically considered important for NTFP practices. Access to these sites depends upon continually reinforced and negotiated social relationships between a variety of actors. Findings illustrate that, by themselves, development and gentrification are insufficient for explaining livelihood and land use patterns that emerge in places experiencing intensive development. Using a co-production framework, we acknowledge the wide variety of complex trajectories and local power dynamics shaping land use and livelihoods. Findings also have implications for connecting global research on housing, employment, and demographic transitions associated with rural gentrification, to international NTFP research, which is increasingly turning to rural–urban interfaces for insights on how livelihoods are linked to land development and migration.     

Transitions to adulthood among young entrepreneurs in the informal mobile telephony sector in Accra,Ghana

The rapid expansion of the mobile telephony sector in African countries has been accompanied by the establishment of a wide range of informal support businesses, mostly run by young people. Little is known, however, about the lived experiences of young entrepreneurs working in this rapidly changing, technologically-driven sector. Drawing on qualitative research conducted in Accra, this paper explores young people's experiences of running informal businesses within the mobile telephony sector, including the sale of mobile phones and accessories, repair and technical support services, and the sale of airtime and mobile money services. Fateful and critical moments relating to personal and family events, as well as social networks and structural factors, are shown to mediate young entrepreneurs' chances of success in this new ‘niche' economic sub-sector. Despite the challenges they face, the paper illustrates how many of these young people have been able to achieve financial independence, afford rental accommodation, provide support for family members, and establish and sustain households. The mobile telephony sector is shown to be offering young people the opportunity to carve out a living, facilitate transitions into adulthood, and even enable some to move up the social ladder. By highlighting the agency of this group of young people, and for some their success in achieving the status of adulthood through their hard work and ingenuity, this study offers an important counter balance to images of young people in sub-Saharan Africa as being ‘stuck' or in ‘waithood'.