The Institute for Global Health and Development
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Item Agency and wellbeing in the context of early marriage: A qualitative inquiry into the northern Nigerian context(Queen Margaret University, Edinburgh, 2018) Zasha, DoosuurAccording to the literature, early marriage remains a problem due to the limitations it places on the educational and economic opportunities of the young girls involved, as well as the variety of health complications they suffer as a result of this. Although early marriage is prevalent in Nigeria, regional differences indicate the northern part of the country as having a higher percentage of girls who marry before the age of 18 compared to the south. Most research and advocacy efforts, as well as related programmes and policies, rightfully focus on the prevention of early marriage but neglect the adolescent girls who are already married. This study focuses on the lives of young married girls, highlighting the process through which they get married as told from their own perspective, and explores their accounts of life after marriage particularly illuminating their health needs and overall wellbeing. Using semi-structured interviews, focus group discussions participatory techniques, and participant observations, 24 young married girls between the ages of 15-25 from Nasarawa state in Nigeria, were recruited for this study, adopting a mixture of principles borrowed from ethnography and grounded theory. The analysis highlights the personal agency exercised by some of the girls in their decisions to get married but also demonstrates how said agency is constrained by the context in which it is exercised. Analysis further reveals the underlying influences behind the constructions of health and illness held by young girls and explores ways in which they primarily seek to address their health and wellbeing. The accounts of these girls also point to strong associations between their wellbeing, economic factors, relationships and experiencing self-worth. This dissertation will contribute to knowledge around early marriage in Nigeria and Sub-Saharan Africa and highlight nuances around the decision-making process at the time of marriage. It also offers insights as to how young girls construct wellbeing in the context of marriage hereby contributing to knowledge around wellbeing in poorer populations in Nigeria and arguably, similar African contexts.Item Understanding the power relations in health policy implementation in Pakistan(Queen Margaret University, Edinburgh, 2016) Bajwa, FatimaPolicy implementation is a complex, technical and political process. It is shaped by the capacity of the government, political patronage, influence of diverse actors, power relationships, role of the state, nature of the political systems and their mechanisms for participation in the policy subsystem. Tackling the implementation gap is a health policy concern in Low and Middle Income Countries (LMICs). In these countries, governments frequently fail to achieve effective policy implementation. The government of Pakistan has over six decades introduced many health initiatives and plans to improve the health status of its population. Still, the implementation process remains arduous. To identify the implementation gaps and their drivers, forty-two semi-structured interviews were conducted with the key policy actors from general political sphere and health policy subsystem in Pakistan, to explore their knowledge, perspectives and experience. The key informants were mainly politicians, bureaucrats, health ministry officials, and technocrats from Islamabad, Punjab, Khyber Pakhtunkhwa and Sind provinces in Pakistan. The data was analysed using thematic analysis. This qualitative exploratory study using an inductive approach draws on the concepts of power, policy networks and path dependency. Findings suggest that the factors influencing the policy-action relationship in the health sector in Pakistan operate at two levels: actors and institutional or structural. Political history as a part of the structure plays an important role as well. The power relations within the health sector are a complex interplay of ideas, interests and incentives resulting in policy networks or iron triangles at different levels. The underlying power relations remain the same and policy implementation process is path dependent. Due to this, most health policies remain in long periods of stasis or equilibrium. The stalemate over these policies was seen because of the elitist system of interest groups' hold over policy choices. Frequently, policies are caught in a web of interests.