Category: Africa

Source: The Conversation – Africa – By Michael Wahman, Professor, Public Affairs, The University of Texas at Austin

Malawi’s constitutional court annulled the 2019 presidential election. The 2020 re-run brought an extraordinary transfer of power from the ruling Democratic Progressive Party to the opposition Malawi Congress Party, raising hopes for economic and political renewal.

However, the new government came to preside over a period of deep economic crisis and growing public discontent driven by a series of overlapping shocks.

The COVID-19 pandemic disrupted supply chains. Russia’s invasion of Ukraine in 2022 pushed up the cost of key imports like fuel, fertiliser and maize. Malawi has also endured successive floods, droughts and cyclones. Severe shortages of foreign currency, fuel and electricity compounded the effects of poor harvests.

By 2025, the World Food Programme estimated that nearly one-third of Malawians faced acute food insecurity. This meant that Malawi’s 2025 parliamentary election took place against the backdrop of profound political and economic turmoil.

We are researchers of Malawian politics, and in collaboration with the Westminster Foundation for Democracy’s Cost of Politics programme, we sought to understand how an economic crisis can shape an election campaign. Collecting new data from 2025, we were able to make interesting comparisons with the 2019 poll.

We found that the cost of running for parliament in Malawi has risen dramatically from an average of US$20,000 per candidate in 2019 to US$51,000 in the 2025 poll.

The economic crisis intensified candidates’ reliance on electoral clientelism. This is the exchange of benefits like cash or goods for political support, usually votes.

Malawi has one of the four highest poverty rates in the world, and for many people living in acute poverty, elections provided an opportunity to secure much-needed relief.

Clientelism, therefore, continues to play an important role in electoral competition, with weak political parties relying on well-resourced parliamentary candidates to finance campaigns.

Further, the oversight of campaign finance remains limited and weakly enforced. And the rising cost of campaigns has made it even harder for less well-resourced groups, particularly women and young people, to access political office.

The result is that politics excludes more people, and well-funded independent candidates can compete successfully against party nominees.

A heavy reliance on personal wealth distorts political competition. It also creates incentives for corruption, as MPs seek to get their money back once elected.

The cost of a seat in parliament

Malawi introduced new regulations in 2019 to curb this kind of politics. Before the 2025 election, there was further reform. Most notably, the Office of the Registrar of Political Parties was established a year earlier to enforce political finance rules, including a ban on material handouts during campaigns.

However, the office is under-resourced and understaffed. Though handouts are not legal, the office could not investigate every allegation.

We sounded the alarm about the cost of Malawi’s parliamentary campaigns in 2019.

Our earlier survey found that the average parliamentary candidate spent around US$20,000 (in 2019’s exchange rate) on their campaign. This is an astonishing sum in one of the world’s poorest countries. Most of the money came from candidates’ personal savings, according to our survey of self-reported campaign spending.

Candidates invested in sinking boreholes, building bridges or even buying ambulances. They also provided personal goods, including cloth, money or food, to voters. A lot of this spending happened during election rallies.

Yet campaign spending in 2019 pales in comparison with the costs incurred during the 2025 election.

In nominal terms (without taking into account staggering inflation of 238% between elections in 2019 and 2025), we found that average spending rose by 500%. Even after adjusting for inflation, campaign spending increased by 78% in real terms.

On average, candidates spent about US$51,000 on their campaigns in 2025 (in 2025’s exchange rate). Among candidates who received more than 20% of the vote, average spending reached US$95,500.

We attribute the increase in spending to two factors:

• a very competitive election environment – in 2019, candidates from the government party far outspent the competition; in 2025, candidates from both the ruling party and the opposition were able to spend large sums of money

• the economic crisis, which increased the demand for handouts.

The drivers

Money-fuelled politics is one of the thorniest and stickiest issues in Malawian democracy.

Our research revealed confusion about the law around election handouts among both candidates and voters.

Politicians have raised questions about whether banning campaign handouts was ever realistic in a political environment where they are expected.

Further, candidates said Malawi’s economic crisis created pressures to provide handouts.

Like many African countries, Malawi is a place of stark economic inequality. Those seeking elected office usually belong to the country’s economic elite. For ordinary people facing severe hardship, elections became an opportunity to seek short-term economic assistance.

Candidates reported being asked to fund community development projects, pay school fees, and cover funeral expenses and medical bills. They were also expected to provide voters with cash, food and other basic necessities.

The Malawi Electoral Commission was praised for substantial improvements in its management of the election, but there has been little progress in addressing the role of money in politics.

This undermines electoral competition and weakens political representation.

What next

In fragile economic environments, democracies become more vulnerable to politics where money buys votes.

Policymakers need to make reforms that reduce candidates’ reliance on this exchange. Our research suggests that it may be necessary to:

• change to a more party centred system where individual candidates are less pressured to provide private resources

• create protected pathways for women to contest elections

• invest in the enforcement of campaign finance regulation

• enhance the role of civil society to oversee intra-party candidate selections

• introduce spending caps for parliamentary campaigns.

Such reforms will be essential if African democracies are to become more resilient during periods of economic crisis.

David Kayuni, Lingalierini Mihowa and Nandini Patel contributed to this article.

– Running for parliament in Malawi costs a fortune: economic crisis undermines democracy
– https://theconversation.com/running-for-parliament-in-malawi-costs-a-fortune-economic-crisis-undermines-democracy-288240

Source: The Conversation – Africa – By Tanya Doherty, Professor and Chief specialist scientist, South African Medical Research Council

Every woman has the right to be treated with dignity, compassion and respect when giving birth. Yet for many South African women childbirth in public health facilities can be marked by poor communication, neglect, lack of privacy and, in some cases, verbal or physical mistreatment from health workers.

In a few cases, exposure to severe, disrespectful and abusive behaviour can lead to long-term psychological distress, affecting women and their families.

Efforts to improve respectful maternity care in South Africa have focused mainly on training individual healthcare workers through short courses. Training is important. But it often overlooks a crucial factor: the organisational culture in which health professionals work.

Health workers don’t operate in isolation. Their behaviour is influenced by heavy workloads, staff shortages, workplace hierarchies, team relationships and leadership practices. Providing more respectful care means addressing these underlying organisational factors.

We have spent more than two decades designing and implementing health systems research to improve care for women, newborns and children. Our recent study, conducted in nine rural district hospitals in South Africa’s KwaZulu-Natal province, explored whether improving teamwork, learning and workplace culture could improve women’s experiences of maternity care.

This is the first study to assess the feasibility and effects of an intervention addressing both organisational culture and women’s experience of care.

After the intervention, we found improvements in key aspects of care: particularly in communication, autonomy and supportive care experienced during childbirth. Importantly, the largest gains were observed among women from poorer households and those who had attended fewer antenatal visits, who may be more vulnerable. It also improved organisational learning culture and health worker teams.

A different approach

We developed and carried out an intervention called Strengthening Teamwork and Respect (STAR) over a one-year period. The intervention did not focus solely on how staff treated women. It also encouraged teams to examine their own working environments, communication patterns and professional relationships.

The approach involved:

• participaton: multidisciplinary teams of nurses, midwives, doctors, managers and non-clinical staff met approximately monthly. They reflected on challenges in their maternity units and developed locally relevant “change projects”.

• leadership by local staff champions selected from within each maternity unit. The champions received a two-day training.

• the use of structured activities to encourage reflection, dialogue, teamwork and problem-solving.

What we found

We surveyed more than 1,800 women who had recently given birth, as well as over 200 maternity healthcare workers, before and after the intervention.

Our main findings included an improvement in overall person-centred maternity care. Scores increased from 61.5 out of 100 before the intervention to 65.7 afterwards.

The greatest improvements were in areas related to communication and autonomy. More women reported that healthcare providers explained procedures, sought consent before examinations, involved them in decisions about their care, and allowed them greater choice during labour.

Supportive care also improved. Women reported shorter waiting times, greater trust in healthcare providers and a more positive overall experience.

One particularly striking finding concerned birth companions. Before STAR, almost nine out of 10 women said they were not allowed a companion of their choice to stay with them during labour. After the intervention, access to companionship increased substantially.

Many of the participating hospitals had chosen to make birth companionship one of their change projects. STAR teams developed ways to make it possible to have birth companions – things like name badges for companions, written confidentiality agreements, and informing security staff.

Perhaps the most encouraging finding was that the largest improvements occurred among women who often face the greatest barriers to good care. Women from the poorest households experienced greater gains than women from wealthier households. Similarly, women who had attended fewer antenatal visits showed larger improvements than those with more frequent antenatal care.

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Read more: Burnout and bias can lead to poor care during childbirth – we created a project in Kenya that helps health workers

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Our research also measured changes in organisational learning culture. We measured the extent to which workplaces encouraged learning, dialogue, innovation and shared problem-solving.

Healthcare workers reported stronger continuous learning cultures, greater openness to feedback, better systems for sharing lessons, and stronger leadership support. One of the greatest improvements was staff feeling more empowerment to initiate positive changes.

In highly hierarchical healthcare environments this can be transformative. When staff feel empowered, they are more likely to identify problems and work collaboratively to solve them.

Challenges remain

The improvements we observed were modest rather than dramatic.

Many longstanding challenges remain. Staffing shortages, workload pressures and service delivery demands often limited participation in the intervention. Attendance varied across professional groups. Maintaining momentum required ongoing support.

Our study was also conducted without a comparison group. This means we cannot definitively attribute all observed changes to the STAR intervention alone.

Nevertheless, the findings provide important evidence that respectful maternity care is not only about changing individual behaviour. It is also about creating work environments that support learning, teamwork, reflection and accountability.

Lessons for the future

Healthcare systems around the world are under pressure. The instinctive response is often to introduce more training, guidelines or policies. But respectful care cannot simply be instructed from above.

Women’s experiences are shaped by the culture of the facilities where they give birth. Improving those experiences requires creating workplaces that support the people who provide care.

The success of STAR suggests that healthcare workers themselves can be powerful agents of change when given the tools, support and space to lead.

For policymakers, the message is clear: dignity and respect during childbirth needs investment in the culture of the workplaces where care happens.

– Respectful maternity care starts with improving hospital culture: lessons from rural South Africa
– https://theconversation.com/respectful-maternity-care-starts-with-improving-hospital-culture-lessons-from-rural-south-africa-288230

Source: The Conversation – Africa – By Bismark Aha, Senior Lecturer in Real Estate, Nottingham Trent University

For years, Ghana’s housing debate has revolved around one headline figure: a national shortage commonly estimated at about 1.8 million homes. The number is useful. It signals that housing supply has failed to keep pace with population growth, urbanisation and household formation.

But it tells only part of the story. A household may have a roof over its head and still live without adequate sanitation, safe waste-disposal arrangements, clean cooking fuel, durable construction or enough space. Counting the homes that are missing does not tell us whether the homes that already exist are healthy, safe and adequately serviced.

In our recently published research, we examined this less visible side of the housing challenge. We used Ghana’s 2021 Population and Housing Census to analyse 836,515 households across all 261 districts. We asked a straightforward question: how adequate are the homes in which Ghanaians already live?

To answer it, we developed a Multidimensional Housing Quality Index that combined nine housing conditions recorded in the census. These covered structural durability, room crowding, drinking water, electricity, toilet and bathing facilities, cooking fuel and space, and waste disposal.

The findings indicate that Ghana’s housing policy must ask not only how many homes are missing, but also where existing homes fail to provide safe and adequate living conditions, which deficits occur together, and what combination of interventions is needed.

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Read more: Why Accra’s property boom hasn’t produced affordable housing

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A home can exist and still be inadequate

Each condition was assessed against a minimum adequacy threshold. The nine indicators were then combined and rescaled to a 0–100 index using a statistical method suited to indicators that record whether a standard is met. Higher scores indicate better material and service-related housing conditions.

The national average is 62.2. This figure should not be read as a pass mark. Its main value is comparative: it reveals how sharply housing conditions differ across places and population groups. Urban households score 73.1 on average, compared with 45.3 for rural households. That difference of almost 28 points is too large to be treated as an urban advantage. It reveals a sharp geographical divide in access to housing-related infrastructure and services.

We also used a multidimensional poverty method to identify households facing overlapping housing deficits. A household is classified as housing poor when its deficits account for at least one-third of the total indicator weight. Severe housing poverty is when they account for at least one-half. On this basis, 56.5% of Ghanaian households are housing poor and 37.2% are severely housing poor. These are housing-specific measures, not estimates of income poverty. They show how many households experience a sufficiently broad or intense combination of inadequate housing conditions.

Progress in one service can hide deficits in another

Some of the most revealing results concern the uneven distribution of access across basic services. Electricity meets the study’s adequacy threshold for 86.2% of households, while 82.4% meet the threshold for safe drinking water. These services are comparatively widespread.

But only 37.3% of households use clean cooking fuel, 42.9% have an improved toilet facility and 33.4% use an adequate waste disposal method. In other words, the relatively high access to electricity and safe drinking water has not been matched by comparable access to sanitation, clean household energy and waste disposal.

Housing quality is produced by a bundle of conditions working together. Electricity cannot compensate for unsafe sanitation. A durable structure does not compensate for reliance on polluting cooking fuels. Improving one service while neglecting the others can leave households exposed to overlapping risks.

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Read more: Ghana’s new rental scheme won’t fix the real problem: a housing shortage

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The national average hides local issues

The housing divide is often described as a contrast between the better-served south and the poorer northern regions. Our results confirm a strong north-south pattern, but they also show why regional averages are not enough.

Greater Accra, where the capital is located, has the highest regional score at 78.5, while Savannah Region, in northern Ghana, has the lowest at 36.1. Yet substantial differences also appear within regions. In Ashanti, home to the second city of Kumasi, district scores range from 24.3 to 84.1. Greater Accra’s districts range from 51.0 to 86.7.

This means a region that performs relatively well overall can still contain districts facing severe housing inadequacy. Conversely, a national programme aimed only at the lowest-performing regions may overlook deprived localities elsewhere.

Neighbouring districts also tend to have similar housing outcomes. This clustering is consistent with the influence of shared infrastructure networks, environmental conditions, settlement patterns and the uneven reach of public services, alongside differences in household resources.

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Read more: Ghana’s informal settlements are not all the same – social networks make a difference in community development

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What housing policy should do differently

The Multidimensional Housing Quality Index is not a replacement for the housing deficit. The two measures answer different questions. The deficit asks how many additional homes are needed. The index asks where the existing stock falls short, which deficits overlap and which services should be prioritised.

Using both would produce a more realistic housing policy. A district where the main problem is weak structural quality requires different intervention from one where homes are structurally adequate but sanitation and waste services are poor. Another district may need clean cooking support, electricity extension or improved water access.

A single national housing remedy will not address these differences. District housing profiles should inform the location and design of investment. Housing policy must also be coordinated with sanitation, waste management, energy, water, local government and spatial planning. These sectors jointly determine whether a dwelling is genuinely habitable.

The district estimates could support a housing quality atlas or public dashboard, allowing national agencies, assemblies and development partners to compare local conditions and track which deficits are changing. Future censuses and nationally representative surveys could then show whether housing deprivation is falling, persisting or changing in composition.

What the index cannot tell us

No single index measures every aspect of adequate housing. The census does not provide direct measures of housing affordability, tenure security, service reliability, neighbourhood safety or residents’ own assessments of their homes. The Multidimensional Housing Quality Index therefore measures observable material and service conditions, not the full meaning of housing adequacy.

That limitation is important, but it is not an argument for continuing to rely on the housing deficit alone. Ghana already collects detailed housing information through its census. The opportunity now is to use those data in an integrated way that can guide local decisions.

– Ghana’s housing problem goes beyond numbers – it’s also about quality
– https://theconversation.com/ghanas-housing-problem-goes-beyond-numbers-its-also-about-quality-288139