Introduction

This chapter examines the challenges facing health policy implementation and the health delivery system in Zimbabwe. It argues that the present health system in Zimbabwe tends not to effectively preserve the health of the citizens of the country. This is because the nation's healthcare system and funding mechanism do not recognize the citizens’ rights to affordable health and other protected interests. The chapter uses a value-based health service conceptual framework to explain how the nation could adopt high-quality health services to improve its citizens’ health safety and cost efficiency. The findings of the research conducted reveal that citizen of Zimbabwe suffers from a high rate of communicable and noncommunicable diseases. The nation's citizens also suffer from severe clean water and sanitation crises. Despite these health challenges, the nation's health system also faces a shortage of healthcare staff, limited access to healthcare facilities by citizens, high out-of-pocket expenses, exceptionally low funding for healthcare delivery, high congestion at healthcare facilities, and poor-quality healthcare services. In addition, citizens and residents of Zimbabwe especially those living in the rural regions do not have good access to any medical insurance. This is because access to medical insurance differs by area of residence and level of wealth. The chapter recommends that the deteriorating health challenges in Zimbabwe require an immediate review of the nation's health insurance system, as well as appropriate reinvigoration of the healthcare system. The Government of Zimbabwe must ensure that universal health coverage policies are adopted to improve the healthcare of all its citizens. The nation's government must also consider taking steps to better equip the hospitals with state-of-the-art equipment and other health infrastructure, as well as make more pragmatic efforts to retain highly qualified health practitioners as well as discourage the flight of nurses and physicians from the country.

Brief History of Zimbabwe

Zimbabwe is a country located in Southeast Africa. The country was formally called Southern Rhodesia before it became an independent country in 1980 (Makumbe 2006) The nation has no direct access to the Indian Ocean hence it is often referred to as a landlocked nation.

Introduction

On 24 February 2022, after two years of the pandemic, Russia invaded Ukraine. It began a war that still has not ended, and many of its edges are shaking the planet: the form of the War, the modification of the bidding of the great powers, the evident transformation of energy supplies, especially in Europe and inflation on a global scale, among others.

In this context, I want to present here one of the most outstanding impacts of the War in the first part of 2022, the second year of the second decade of the beginning of the twenty-first century: the definitive ‘presentation in society’ of what we are going to call trans-globalisation.

From Montesquieu through Lenin and arriving at Wallerstein, there have been numerous approaches to a central idea to understand the world as we knew it until this century, the one referring to the fact that we live on a common planet and that the social systems we build are interconnected. All these explanations take up the fact of interdependence, the processes of connectivity and the expansion of a ‘common morality’.

In the last two decades of the last century, a set of proposals were developed to understand what began to be called globalisation, ‘worldarisation’ or planetarisación.

Perhaps one of the most cited has been the proposal of Manuel Castells in his work ‘The Information Age’ (1996) in three volumes that begins in his prologue as follows:

Information technologies, the rhythm of change and the equation economy, state and society are perceived as the key components of modifying the planetary scale.

Another look at globalisation was provided by Alberto Melucci, who, within the framework of his vision of complex societies, identity modifications and collective actions, maintained the existence of the structuring of a planetary society.

The things which one can see and hear in the din and chaos of the world's greatest war are many, lurid, picturesque, quaint, humorous, heroic, and horrible but by themselves and without inquiry as to where they came from or to what they are leading, they are not of first consequence.

From the fighting front much detail of modern war is seen as through a microscope, and from the capitals of the nations the broad canvas of international struggle is seen as through a telescope. But having gone to scenes of this conflict and having been among its terrible mysteries, I know that from afar - in America - may be collected the most detail, because of the flood of written description, photographs and moving pictures from all sources, and that as from a mountaintop, without the prejudices of the arena itself, America may see with clearer perspective the great and changing picture.

I have seen men who had been shot to pieces in barbed wire entanglements, and I was with Lord Robert Cecil in the British Foreign Office when the news of the execution in Belgium of Miss Cavell came in, and later I dis-cussed with prominent Englishmen the effect which the execution would have upon the sympathies and opinions of the world. I cannot see that I gained anything by being present at either occasion. The spinster on a New England farm can imagine perfectly how dead men look when piled up in a gully; the New York elevator boy could estimate more correctly than Berlin or London the effect upon the opinions of the world of the execution of Miss Cavell.

Well it is that these things are chronicled and pictured; but I did not go to Europe, and especially to Russia, without a wish to do more than to chronicle and picture. Primarily I went to see what war is doing to the hearts of men and the spirit of nations. Russia, I believed, was the place where the war would work the greatest changes.

I went to Russia not to look back too much upon old Russia, but forward a little at Russia as a great potentiality. I wished that I might stand without wobbling between yesterday and tomorrow, and if my book has any reason for being, it lies in this attempt.

Introduction

This chapter examines how the Government of Kenya has made substantial process in addressing the various health challenges that the nation has been facing. The chapter covers how communicable diseases such as lower respiratory infection, diarrhea, and vaccine-preventable diseases have been controlled to a positive level. It presents an argument that healthcare policy formulation alone cannot postulate positive health outcomes, increase the socioeconomic status of citizens as well as improve sanitation, water quality, and effective regulations to propel better air quality. An additional mechanism is needed in the country to accomplish the positive health needs of both urban and rural citizens of Kenya. Health policies that advocated the expansion of services for immunization to children and the outcomes are also discussed. Analysis of citizens’ healthcare needs and their desire to have access to healthcare services show that there are major disparities across regions of the nation. The chapter also provides a clear basis for the assessment of the nation's healthcare system. It is anticipated that the policy analyses and recommendations could help guide the adoption of appropriate healthcare policies to prevent the lives of citizens from danger and the spread of noncommunicable and communicable diseases in Kenya in the future.

Brief History of Kenya

The Republic of Kenya is a country in East Africa. It has a boundary with the Indian Ocean to the east, the Republic of Ethiopia to the north, Somalia to the northeast, and Tanzania to the south. Other countries having boundaries with Kenya are South Sudan to the northwest and Uganda to the west. Lake Victoria is located southwest of the country. According to the World Bank (2022), Kenya has a population of about 44.86 million people. The gross domestic product (GDP) of Kenya was US$132.4 billion in 2022 (World Bank 2022; GlobalEdge 2022).

The East African territory now called the Republic of Kenya was inhabited by Cushitic-speaking people around 2000 AD. The Bantu ethnic extraction who were hunters migrated from West Africa and settled in the region in the first millennium (Askwith 1995). Other groups such as the Nilo-Saharan and Afro-Asiatic ethno-linguistic people also migrated to settle in the Kenya region (Askwith 1995; Embassy of the Republic of Kenya Japan 2023; Frontera-Rial & Ogot 1978).

Introduction

This chapter investigates the nature of healthcare policy and administration effectiveness in Uganda. It also explores the extent to which the public sector uses healthcare policy and other means to influence the private sector's decision making and practices for the purpose of achieving a lesser burden of communicable and noncommunicable diseases. The chapter provides a detailed description of the key role of the public and private sectors with respect to effectively implementing healthcare policies to address the needs of the citizens and residents of Uganda. It argues that the Government of Uganda and its policies are crucial for the appropriate attainment of effective healthcare delivery services in the country. It uses data derived from primary and secondary sources to analyze the current healthcare system impact in Uganda. The findings indicate that while there have been past weaknesses in the relationship between government and business in the healthcare delivery system in Uganda due to inadequate enforcement of policies, the relationship in both sectors has improved over two decades. In addition, government policies have not been able to effectively address the disparity in healthcare delivery in both urban and rural regions of the nation. The chapter recommends that national and appropriate collaboration with the private sector could effectively impact healthcare administration and life expectancy in Uganda in the future.

Brief History of Uganda

Uganda is a landlocked country located in Eastern Africa. The country has a boundary with the Republic of South Sudan to the north, the Democratic Republic of the Congo to the southwest, Kenya, to the east, Tanzania to the south, and Rwanda to the southwest. The country's southern section is covered by Lake Victoria, which is also shared by the Republic of Tanzania, and Kenya. Uganda has a population of 47.3 million people (World Bank 2023).

The territory now called the Republic of Uganda was previously inhabited by farmers who migrated from central Sudan and the Kuliak-speaking ethnic people who were herders over 3,000 years ago. According to some history scholars, the Bantu ethnic group also migrated from the south to the region, while the Nilotic ethnic group also started migrating to the northeast region about 1,500 AD (Mwakikagile 2009; Schoenbrun 1993).

Introduction

There are many theories that are related to health policies and healthcare service delivery. Many factors often affect a particular healthcare policy initiative that may have little to do with the merit or validity of any enacted health policy. Therefore, theories could help readers and scholars to better understand, the environmental conditions, and events that may escape the detailed explanation and impacts (McGain et al. 2020; Birkland 2016). According to Anderson (2011) and Kraft and Furlong (2024), theories could illustrate vital correlations between important variables as well as explain the significant effects of government actions that often affect the day-to-day lives of all citizens in a country.

Government, private sector, and nongovernmental organizations (NGOs) are essential components of healthcare delivery systems in many African countries. This is because healthcare is very significant in the African continent, and everybody needs it in other to live a better life with less painful stress and injuries. According to Patel and Rushefsky (2015) and Patashnik et al. (2020), the government and the private sectors in many countries around the world provide healthcare to the citizens. Healthcare could be related to preventing disease, illness, or injury, and treating people who are sick (Kraft and Furlong 2024; Grad 2002). Governments of various African countries engage in many activities to influence public and private institutions in making the right decisions in the management and regulation of healthcare systems for all citizens ( Janati et al. 2018; Johnson & Stoskopf 2010). Governments also decide how to help their citizens get access to healthcare and other human needs such as water supply, sanitation, and waste remover (Kraft and Furlong (2024). Without these services, the health of human beings will be deplorable in modern societies. Although medicine plays a major part in healthcare-related models, there are other services such as the Food and Drug Administration, the Center for Disease Control and Prevention, and the National Institute of Health in any nation that is critical for facilitating a better health system (Luciano et al. 2019). In addition, all public healthcare delivery services and the production or importation of medicines are regulated and funded by the government.

Modern Political Philosophy

The very idea of a common good puzzles us. We all have views of the good of individuals. We might wonder about details and about how objective such views can ever be. Human lives, though, certainly vary in happiness, and we have views on the reasons.

The term “common good,” in contrast, rings of sermons and stump speeches. It conjures up vague images of solidarity, unity and interdependence. In what sense, though, could a group of people share a good that goes beyond each member's personal good? While cooperation can benefit all involved individuals, such as when we pool resources to realize a project that none of us could fund alone, the good furthered here still is that of every individual considered separately. Everyone achieves a personal benefit, only through collective action.

Our puzzlement has its roots, I believe, in a significant shift in political thought since the Renaissance. Plato (Republic, 369a–374a) and Aristotle (Politics, 1253a) described the state as the end of human development, in the chronological sense that it develops from simpler communities as well as in the teleological sense that it is the stage of full realization of human nature. Citizens share in some good that only exists as a joint good and that is, in some to be further specified sense, constitutive of their personal good.

Most modern philosophers, from Thomas Hobbes to Carl Schmitt, offer an entirely different picture. They conceive the relation between state and citizen as instrumental. Either the state is a mere means to advance the citizen's personal good or this citizen is a mere means to advance the community's good.

I call these views “privatism” and “collectivism,” respectively. Privatism understands the common good of a community as the sum of the personal goods of its members. Collectivism understands it as separate from the personal goods and as superseding these. Other names for the first view have been “atomism” and “individualism,” along with “totalitarianism” and “holism” for the second. Both views are summarized in Table 1.1. The rest of the current chapter will discuss them in detail.

Introduction

The Federal Republic of Nigeria is a country in West Africa. It has boundaries with the Republic of Niger in the northwest and the Republic of Chad in the northeast. The Republic of Cameroon is located to the east of Nigeria. While the Republic of Benin is located in the west of Nigeria. The Atlantic Ocean is located in the southern part of Nigeria. The population of Nigeria is estimated to be 223.8 million in 2023, while the gross domestic product (GDP) was US$1.115 trillion in the same year (World Bank Indicator 2023; World Economics 2023).

This chapter examines the perception of the healthcare system's effectiveness in Nigeria by citizens and residents of the country. It specifically researched the positive and negative benefits that citizens are deriving from the current healthcare system. It argues that the Nigerian government needs to adopt more pragmatic healthcare policies that could be effectively implemented. The chapter uses quantitative and qualitative data derived from a questionnaire survey administered to 3,202 Nigerian citizens and residents including professional medical staff at federal state and local government levels in the country. Interviews of 600 citizens, officials of public and private sectors as well as foreign NGO stakeholders were conducted. The secondary data consisted of the review of related government reports, government websites, and academic and professional journals. Data were analyzed to determine the impacts of perception and challenges facing the healthcare system administration in Nigeria. The conceptual framework is based on strategic doing, benchmarking, stewardship leadership theory, and an integrated healthcare system model. Recommendations were provided on how to reform and galvanize the healthcare system in Nigeria in the future.

Health Challenges in Nigeria

According to Asakitikpi (2019), Balogun (2022), and Sotunde et al. (2020), the health system in Nigeria health system has been confronted with many challenges over the past decade. The health system has been characterized having deteriorating medical infrastructure, inadequate control of the circulation of fake drugs, massive engagement of the elite medical tourism, lack of enough funding, corruption, poor working condition, poor supply chain of medicine to health facilities, poor compensation of physicians and nurses, and mass emigration of skilled healthcare workers to foreign countries (Aljazeera 2020; Balogun 2022; Oloribe et al. 2018; International Trade Administration 2023).

Swat, ‘the Switzerland of the East’, connotes a remarkable geo-strategic location that adjoins South Asia, Central Asia and East Asia (China). The historical context traces back to 327 BCE, when the present-day Udigram (Ora) and Barikot (Bazira) were captured by Alexander (of Macedonia) (Rome, 2008). However, there is a negative account of the social status of women in the archaeological evidence of Buddhist remains in Swat, because his-story (history) followed the androcentric theories (women invisibility) to the negligence of women for their biological differences and allocation of duties that are predominantly patriarchal in nature. The concept of goddess in the Buddhist civilisation gradually declined, and women's status was followed eventually by the decline of goddesses and the rise to the supremacy of gods (Khan, 2014).

The Buddhist relics in Swat reveal the esteemed position of women in the region in ancient times. Archaeologists have suggested that the culture and society of Udyana and Suvastu (ancient names of Swat) were predominantly women-centred, as highlighted by the presence of mother-goddess figures in the Swat Museum. Buddhist artefacts testify to a gradual influence on surrounding civilisations, such as Gandhara. The excavated jewellery from the ancient sites of Udigram reflects women's wealth and chic lifestyle. However, the rule of the Hindu Shahis after the made women invisible in historical accounts until the invasion of Mahmud of Ghazna (AD 1000).

The Yusufzai Afghans occupied the land in the sixteenth century CE. However, they did not form a government but followed the centuries-old Pukhtu (honour) or Pukhtunwali. Their lifestyle remained tribal, divided into two blocks (dalah). After the Punjab occupation (1849) by the British, Sayyad Akbar Shah of Sitana was nominated as a king (1849–57). He was succeeded by his son, but he could not sustain his position for long, and hence the Swat state came to an end. In the course of time, the Khan of Dir occupied the right bank of Swat Valley. However, rebellion against his rule took place and a local jirgah (council) opted for Abdul Jabbar Shah (as king) in April 1915 with which Swat state again came into being, but he was removed by the same jirgah from his position after a short period of two years in 1917.

Nawal (Jinnah College)

Nawal was 18 years old. She was studying for her BSc (two years) at Jinnah College for Women. Her father was a doctor (general practitioner) while her mother was a housewife. She was living with her parents and grandparents. She has three brothers and two sisters. They resided in a luxurious bungalow in the University Town, one of the posh areas of Peshawar city. It is located opposite side of the University of Peshawar. Her family was Pukhtun, therefore Pukhtu was her mother tongue, but she was very fluent in English and Urdu languages as well. Apparently, they were liberal Pukhtun Muslims. She wore a loose shawl (three-quarters) like her mum to go out of her house. Most of her uncles and aunties were living in the same street as her house.

Gulalai (Home Economics College)

The word ‘Gulalai’ means pretty like a flower. She was 19 years old and beautiful like her name. She was studying her BSc (two years) Home Economics in Home Management. Her father was a professor at the University of Peshawar. As mentioned earlier, the College of Home Economics is located within the premises of the University of Peshawar campus. They were living in the Professor Colony, a private residential area which was reserved only for the University of Peshawar professors. Gulalai was the only sister of three brothers. She belonged to a Pukhtu-speaking Pukhtun family, but her fluency was not limited to her mother tongue only; she was fluent in her second languages Urdu and English too. She was a Practising Muslimah of cultured Islam. Her family women were mostly educated but had limited Islamic knowledge.

Aiman (Frontier College)

Aiman was a slim and smart 18-year-old girl. She was a student of BA at Frontier College for Women. Her father was a shopkeeper and her mother was a housewife. Her mother was a famous tailor in her area. Therefore, lots of women gathered in her house to collect and drop their clothes for stitching. It is also an extra source of income for her family.

This chapter examines the long-misunderstood 1922 novel focused not on the character Claudine but on Colette's mother as a key to her writing and its pervasive incest taboo. The misleading title—the result of the author's and publisher's desire to capitalize on the series’ popularity—is not the primary reason for the misunderstanding at the heart of the narrative, as I will explain. This close reading of La Maison de Claudine shows for the first time how the metaphors of sewing and the voice link the narrator, mother, daughter, and gay actor, gradually revealing how the desire for the maternal figure poses serious challenges for self-knowledge and psychological health. In unrelated episodes, especially those dealing with these characters, Sido, Bel-Gazou, and Marcel d’Avricourt, Colette probes the conflicts arising from sexual drives both straight and gay.

While Julia Kristeva's Colette is an exception, earlier scholarship as well as the commonplace view of the novel, for example, on blogs such as those of WordPress, fail to acknowledge the threat posed by such conf licts, distorting it as a nostalgic, idyllic recreation of a happy childhood. This includes that of the brilliant novelist Doris Lessing in her forward to Andrew Brown's uneven translation published by Hesperus in 2005. Here, I explode most earlier interpretations with special emphasis on a female psychology very different from that identified by Lessing as well as by other critics whose take on the novel as idealized memories is similar. While it is true that Colette celebrates to a considerable extent the mother figure Sido especially and also the daughter who vividly conveys the precious imagination of the child, the novel as a whole stages a complex confrontation with illicit drives, particularly the incest taboo, a drama missing in the criticism.

This interpretation led to my new, forthcoming translation, which in turn contributed to discoveries confirming my sense of the novel. A careful reading of the original uncovers the incest taboo and a bisexual voice central to the spirit of La Maison de Claudine. My goal was to recreate it in my tongue.

Gender comes from the French word ‘genre’. This, in turn, came from the Latin word ‘genus’. Both words mean ‘kind’, ‘type’ or ‘sort’. Sometimes the word ‘sex’ is used as an alternative to ‘gender’ in society, but feminist theory uses ‘sex’ to refer to our biological characteristics and ‘gender’ to our social roles. Thomas (1990: 17) argues that by the 1970s, radical feminists had begun using the word ‘gender’ to describe their theory of human nature, ‘because the term sex no longer sufficiently described the sociological aspect of gender and power relationships’.

By the end of the decade, there was an agreement among the radical feminists regarding their theory that

Furthermore, gender is the result of socially constructed ideas about the behaviour, actions and roles of a particular sex. The beliefs, values and attitudes adopted and exhibited by them are in line with the agreeable norms of society (Sandy, 1980: 347). Increasingly, scholars (Bourdieu and Passeron, 1997) have recognised that men and women do not need to submissively adopt their sex-associated gender characteristics because men and women are socialised due to social reproduction. In other words, under this non-essentialist view, gender is culturally constructed rather than being a biological or innate quality (Peach, 2000).

Bornstein (1994: 51–2) suggests that ‘gender can have ambiguity and fluidity’. She also suggests that society plays a vital role in assigning gender-specific roles and characteristics. ‘Gender indistinctness’ means that an individual has the freedom of choice to construct their own personality without being obligated to take up the characteristics traditionally assigned to their birth gender. While ‘gender fluidity’ is used to describe someone who does not accept the rigidly defined genders ‘male’ and ‘female’ and believes in the freedom to choose any kind of gender with no rules, no defined boundaries and no requirement to fulfil any expectations associated with any gender (Bornstein, 1994: 51–2). This idea is very foreign to the traditional society of Pukhtunkhwa, where both males and females have rigidly defined gender roles that limit their opportunities and expectations in social life.

Introduction

This chapter examines the nature of health policies in Rwanda and how the nation's government has been effective in improving mobility, and mortality rates over the past two decades. It argues that there is a need for policymakers in other African countries to acknowledge the complexity and dynamics of the health system factors that may affect the fabric of their respective societies and culture of good healthcare delivery management. The research method used for collecting data for this chapter includes the review of secondary data from government documents from the World Health Organization and several academic journals. The research analysis reveals that enhancing the healthcare delivery system in Rwanda will require shifting resources such as funds and political commitment to address the needs of the citizens of the country. The Republic of Rwanda has effectively formulated and implemented healthcare policies to accomplish the highest percentage of enrolment into the health insurance system in the African continent. The finding of the research analysis also reveals that a vibrant community health insurance system, universal health coverage, and enhanced health workers’ capacity as well as high-quality assurance mechanism and managerial skills, which were adopted, constitute the major factors that have contributed to the nation's remarkable healthcare delivery accomplishments. The research also reveals that a universal health system could be a prominent political and most compatible coalition ideology that other African nations could use to shape their social protection and health delivery system. This is because some of the administrative and intervention techniques, which were implemented, require more comprehensive and holistic techniques. Thus, it is paramount for health administrators and policymakers as well as workers to be mindful of the complexity of health systems and the dynamics of any society or nation that may be planning to adopt such health insurance scheme. Some recommendations were provided on how to galvanize the culture of performance management in the health sector of Rwanda.

Brief History of Rwanda

The Republic of Rwanda is a country located in the Great Rift Valley of Central Africa. The country is regarded as a landlocked nation because it does not have access to the Atlantic Ocean.