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This paper examines how gender, poverty, and spatial location intersect to shape health access in Northern Nigeria. Using a political economy lens, it shows how structural inequalities and power relations constrain equitable service use and health system responsiveness.

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Access to health care in the global South is shaped not only by income constraints but by the intersection of multiple, reinforcing inequalities. This paper analyses how gender, poverty, and spatial disparities jointly influence access to health services in Northern Nigeria, a region characterised by high poverty rates, entrenched gender norms, and pronounced rural–urban divides. Drawing on a development economics and political economy framework, the study moves beyond single-axis explanations of health inequality to examine how power relations embedded in households, markets, and public institutions structure health-seeking behaviour and service provision.

Using secondary survey data and contextual evidence from Northern Nigeria, the paper explores disparities in service utilisation, financial protection, and access to maternal and primary health care. It highlights how women in poor and remote communities face compounded barriers arising from limited economic resources, restrictive gender norms, weak infrastructure, and under-resourced health facilities. These constraints are further exacerbated by governance failures and uneven public health financing, which tend to privilege urban centres and politically connected populations.

The findings suggest that policies focused solely on expanding coverage or introducing technological solutions risk reproducing existing inequalities if underlying power asymmetries are not addressed. The paper argues for an intersectional approach to health policy that centres gender equity, spatial justice, and community agency in the design of financing and governance reforms. By grounding the analysis in Northern Nigeria, the study contributes to broader debates on reimagining equitable and resilient health systems in uncertain futures across the global South.

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Digital health is reshaping public health in Nigeria through mobile platforms, electronic records, biometrics, and others. This paper examines how these technologies intersect with power, inequality, and governance, assessing the beneficiaries, the excluded, and their impact on Africa's future.

Paper long abstract

Digital health technologies are increasingly central to public health reform across Africa. In Nigeria, mobile health applications, telemedicine, electronic health records, biometric identification systems, and data-driven surveillance are promoted as solutions to weak health infrastructure, workforce shortages, and limited financing. These developments reflect a broader shift towards data-driven and technology-mediated public health governance.

This paper critically examines the rise of digital health in Nigeria through the lens of power, inequality, and uncertain futures. Rather than viewing technology as neutral, it situates digital health within Nigeria’s political economy, marked by deep social inequalities, uneven state capacity, donor dependence, and fragmented health systems. The paper asks who designs and governs digital health technologies, who benefits from them, and who is excluded.

It argues that while digital health holds potential to expand access and improve efficiency, its implementation often reinforces existing inequalities. Access remains uneven across gender, income, geography, age, literacy, and connectivity, excluding rural communities, informal settlements, older populations, and people with disabilities. The paper also interrogates the political economy of digital health governance, highlighting concerns around data ownership, accountability, surveillance, and external influence. It concludes by calling for more equitable, locally grounded, and accountable digital health governance that prioritises inclusion, data sovereignty, and community participation in Nigeria and across Africa.

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Drawing on NFHS-5 (2019–2020) data, this study explores caste-based disparities in Indian women’s perception of distance as a barrier to healthcare. Results show gaps largely driven by mobility and financial constraints, with persistent ST disadvantage pointing to deeper structural marginalization.

Paper long abstract

Despite significant improvements in health infrastructure and policy reforms under Indian Public Health Standard (IPHS), caste-based disparities in Indian women’s access to healthcare continue to persist. Drawing on NFHS-5 (2019-2020) data, this study shows differences in women’s perception of distance to health facilities as a barrier, focusing on SC, ST, OBC, and General caste groups. Sequential logistic regression and decomposition analyses reveals that SC, ST, and OBC women have higher odds of reporting distance as a barrier compared to General caste women. These gaps reduce substantially after adjusting for socioeconomic status, access to enabling resources and exposure to structural barriers. In fully adjusted models, disparities for SC and OBC women are fully mediated by mobility, financial, and supply-side barriers, while ST women continue to face residual disadvantage. Decomposition results identify transport-related barriers as the primary driver of caste gaps, accounting for over half of the SC–General difference and nearly two-fifths of the ST–General gap. On balance, the findings indicate that caste inequalities in perceived distance are driven primarily by mobility and socio-economic constraints, while the persistent disadvantage among ST women highlights deeper structural and spatial marginalization beyond observable barriers.

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This paper examines how overlapping crises—pandemics, economic shocks, and climate risks—worsen health inequalities in India. It highlights governance gaps, the role of AYUSH in accessible care, and calls for equitable, accountable systems that empower vulnerable populations.

Paper long abstract

In an era of polycrisis—where economic instability, geopolitical tensions, and recurring pandemics overlap—health governance in the Global South faces growing pressure. These interconnected crises don't occur in isolation; instead, they reinforce one another, placing disproportionate strain on already fragile health systems and deepening existing health inequalities. Low-income and marginalised populations are most affected, experiencing disruptions in healthcare access, higher disease burdens, and worsening social determinants of health.

This paper examines how overlapping crises such as financial shocks, COVID-19, and climate-related health risks have exposed weaknesses in global and national health governance, particularly in resource-constrained settings. It highlights how unequal financing, limited institutional capacity, and crisis-driven decision-making often prioritise short-term responses over long-term equity and system resilience. Against this backdrop, paper brings attention to the role of traditional-medicine systems in the Global South, with a specific focus on India’s AYUSH framework. During periods of crisis, AYUSH and other traditional-medicine systems have contributed to accessible, affordable, and culturally accepted healthcare, especially in rural and underserved areas where biomedical services are limited or overstretched. Their emphasis on prevention, community-level care, and locally available resources can help reduce health inequalities during complex emergencies.

The paper argues that building equitable and resilient health systems under conditions of polycrisis requires governance frameworks that recognise plural medical systems while addressing underlying power asymmetries in financing, regulation, and decision-making. Moving beyond crisis-driven interventions, it calls for health governance that centres justice, institutional accountability, and the agency of vulnerable populations in shaping health futures in the Global South.

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There are persistent health inequities in Global South that are shaped by asymmetrical power structures in health financing, governance, and implementation. This paper examines maternal health governance in India through the lens of community agency, focusing on the role of Accredited Social Health Activist as an intermediary between state policy and lived realities. Reduction of the Maternal Mortality Ratio is a core commitment under the United Nations SDGs, yet India underperforms relative to global targets, with subnational disparities. Madhya Pradesh illustrates how structural poverty, gendered inequalities, and uneven public health financing constrain maternal health outcomes.

The analysis is grounded in the reproductive justice framework, which situates maternal health within intersecting structures of gender, caste, class, and state power, moving beyond biomedical or rights-based approaches. It also draws on James C. Scott’s concept of everyday forms of resistance to examine how ASHAs negotiate policy mandates through informal practices, selective compliance, and community mediation. These negotiations generate differential policy outcomes and unviels the limits of top-down health governance.

Methodologically, the study adopts a qualitative design based on a case study of two districts in Madhya Pradesh, Rewa and Agar Malwa, identified respectively as lower- and higher-performing districts using indicators from the National Family Health Survey- 5. Primary insights derive from focus group discussions with 150 ASHAs and are triangulated with secondary sources, including government reports, programme guidelines, national datasets, and scholarly literature. The paper argues that MMR reduction requires maternal health governance that recognises and strengthens community agency rather than instrumentalising it.

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This study highlights the relationship between parental loss and household economic vulnerability among children. Paternal orphans have higher representation in the low vulnerability category, whereas maternal and double orphans are more likely to experience medium to high vulnerability.

Paper long abstract

Household economic vulnerability remains a persistent development challenge in Nigeria, particularly as shocks such as parental loss exacerbate existing socio-economic fragilities. Although prior research in Sub-Saharan Africa documents links between orphanhood and child welfare, the pathways through which parental death translates into broader household economic vulnerability remain insufficiently understood. Drawing on microdata from the 2024 Nigeria Standard Demographic and Health Survey (DHS) with a sample size of 176,045, this study estimates how maternal, paternal, and double orphanhood influence household economic vulnerability. A set of Ordinary Least Squares (OLS) and interaction-effect models were estimated, controlling for socio-demographic characteristics that may shape vulnerability outcomes. Results show that maternal orphanhood increases the likelihood of high household vulnerability by 11.2%, while double orphans experience a 6.4% reduction in the chance of low vulnerability. Gender interactions reveal that male paternal orphans face a 36% higher household vulnerability, female paternal orphans a 22% increase, and male double orphans a 31% increase, highlighting the compounded risks for boys in fatherless households. Household characteristics such as education of the head, urban residence, mobile phone use, and bank account ownership significantly reduce vulnerability. This study makes three unique contributions: (1) it quantifies the gender-differentiated impact of parental death on household economic vulnerability in Nigeria; (2) it highlights the disproportionate economic risk faced by double orphans; and (3) it identifies sociodemographic factors that buffer vulnerability. It is recommended that social protection programs that prioritize orphaned children, especially double orphans and girls should be enacted.

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Accessing healthcare is not only an economic phenomenon but also depends upon deeply rooted structural inequalities, gendered roles, and autonomy. The study aims to construct a multidimensional Women's Healthcare Access Vulnerability Index for women experiencing non-communicable diseases in India.

Paper long abstract

Women, due to their reproductive roles, have higher healthcare needs than men. Most existing indices prioritise the reproductive health of women; however, a need arises to focus on the often-ignored chronic non-communicable diseases (NCDs) that affect women's well-being. Due to the combined impact of vulnerabilities, women who are suffering from NCDs are less likely to access healthcare facilities in developing countries. Therefore, the study aims to construct a multidimensional Women's Healthcare Access Vulnerability Index (WHAVI) specifically for women experiencing non-communicable diseases (NCDs) at the state level in India. The study uses the latest fifth round of the National Family Health Survey of India. Using the Alkire-Foster methodology, WHAVI comprises four dimensions: educational and informational deprivation, financial deprivation, decision-making deprivation, and gendered barriers to healthcare access. Results show that 54.7% (H=0.547) of women with NCDs are vulnerable to at least one deprivation, while among the deprived, 47.9% (A=0.479) suffer from multiple deprivations on average. Further, approximately 26.2% of the overall women with NCDs experience multidimensional vulnerabilities (the adjusted headcount ratio (M0= 0.262)) in accessing healthcare services in India. States like Kerala, Tamil Nadu, Punjab, and Himachal Pradesh have lower multidimensional health vulnerability of women, while Madhya Pradesh, Odisha, West Bengal, and Bihar have the highest. The study aims to address the existing gap in women's health-related indices. Using our WHAVI, researchers in developing countries can formulate target-based interventions that not only address disease incidence but also capture the intensity and severity of disease due to structural barriers.

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This paper examines the problematic issues or policy failures which South Africa and Kenya need to address with regards capacity and capability for local manufacturing of innovative MedTech. We unpack the importance of politics for establishing linkages between health and industrial policies.

Paper long abstract

The Covid 19 pandemic revealed the extent of fragility of global value chains for essential MedTech innovations in Sub-Saharan Africa. The impact of this on health systems has been tremendous. Thousands of deaths could have been avoided if MedTech products such as ventilators and in vitro diagnostics such as rapid lateral flow test kits had been manufactured locally and procured by public and private healthcare providers across the region. In this paper we examine the specific problematic issues or policy failures which South Africa and Kenya governments need to address with regards capacity and capability building for local manufacturing of innovative MedTech. Drawing on empirical evidence, we unpack the importance of politics for establishing linkages between health and industrial policies. We argue that preparedness for the next pandemic depends on political recognition of local MedTech as a key factor for meeting health needs and the advocacy for policies which can remove financial and regulatory barriers for local manufacturing.

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This article examines the Queen Mamohato Memorial Hospital PPP in Lesotho and analyses factors behind the agreement’s premature termination. Drawing on field research conducted in 2024, it identifies design and implementation flaws that led to the cancellation of the PPP contract in 2021.

Paper long abstract

The attainment of Universal Health Coverage (UHC) is a central objective of both the 2030 Agenda for Sustainable Development and the African Union’s Agenda 2063. In this context, greater private-sector involvement in health financing is often promoted as a means of complementing insufficient public resources. Public-private partnerships (PPPs) in health have been identified as a promising strategy to mobilise private finance without increasing public debt. However, existing research suggests that health PPPs risk diverting public and development funds toward the private sector, with significant implications for health equity. This article examines the lessons that can be drawn from Africa’s first PPP hospital, the Queen Mamohato Memorial Hospital (QMMH) in Lesotho. In 2008, the International Finance Corporation advised the Government of Lesotho to enter into a PPP agreement with a South African healthcare company to design, build and operate a 425-bed referral hospital in Maseru. Promoted by the IFC as a ‘model PPP’, the project was expected to improve access to healthcare while enhancing efficiency and quality of service delivery. In practice, however, the PPP absorbed a significantly larger share of national resources than anticipated and was prematurely terminated by the Government of Lesotho in March 2021. Drawing on field research conducted in Lesotho in June 2024, this article analyses the design and implementation flaws that contributed to the project's discontinuation. It highlights how contractual complexity, fiscal rigidity, and governance challenges undermined the sustainability of the PPP, offering broader lessons for the use of health-sector PPPs in low-income contexts.

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This paper examines how transdisciplinary approaches can operationalise community agency in pandemic preparedness, challenging dominant technical-biomedical frameworks. Drawing on participatory research, it demonstrates how communities exercise epistemic power in co-producing knowledge and systems.

Paper long abstract

Global pandemic preparedness systems remain dominated by technical-biomedical approaches that marginalise community knowledge and agency, despite rhetoric emphasising community engagement. This paper interrogates power relations embedded in epidemic and pandemic response systems across sub-Saharan Africa, examining how transdisciplinary methodologies can operationalise meaningful community agency rather than tokenistic participation.

Drawing on research across 6 sub-Saharan African countries (2012-2023), this paper presents a critical analysis of social science contributions to epidemic preparedness and response. It demonstrates how communities exercise epistemic agency when genuine transdisciplinary approaches create space for co-production of knowledge, challenging extractive research practices and donor-driven priorities that perpetuate inequities.

The paper positions communities as knowledge producers rather than data sources. Through examining case studies (e.g. Ebola response in Sierra Leone and zoonotic disease surveillance in Zambia), it reveals how communities innovate protection mechanisms and navigate structural constraints that formal health systems fail to address.

This analysis foregrounds three critical dimensions: First, how power asymmetries between global health actors and communities are reproduced through research and intervention designs; second, how transdisciplinarity can disrupt these dynamics by centering local epistemologies; and third, how community-led innovations challenge narrow efficiency frameworks in health systems strengthening.

By reimagining transdisciplinarity beyond methodological pluralism toward genuine epistemological equity, this paper contributes to panel debates about whose interests shape health systems. It demonstrates that equitable, resilient health systems require fundamental restructuring of power relations in knowledge production, not merely technical fixes or increased financing within existing structures.

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This study examines how early marriage increases women’s risk of emotional, physical, and sexual abuse in Nigeria.Using DHS data, it finds that poverty, controlling partners, and social norms drives violence, highlighting the need for gender-sensitive policies and community support.

Paper long abstract

Early marriage remains a persistent challenge in Nigeria,especially in the northern part of the country, where socio-cultural norms, poverty, and perceptions of female propriety drives the practice. Globally recognized as a human rights violation, early marriage exposes girls to disrupted education, constrained economic opportunities, and increased vulnerability to intimate partner violence (IPV). Different research has explored the link between early marriage and physical or sexual IPV. Yet, the association with emotional abuse which is an insidious and are often under-reported form of violence remains under examined in Nigeria.This study uses 2024 Demographic and Health Survey data to examine how marriage before age 18 intersects with emotional, physical, and sexual IPV among young girls.In Nigeria, nearly 44% of women aged 20–24 were married before 18, and about 19% of ever-married women report experiencing emotional violence by their partners. Seemingly Unrelated Regression (SUR) models revealed the comprehensive estimates across the three violence domains, accounting for correlations between outcomes. The findings revealed that early marriage alone does not always predict violence, but young brides are disproportionately vulnerable to emotional abuse especially in contexts of poverty, partner alcohol consumption, and restrictive social norms. Emotional violence undermines self-worth, autonomy, and resilience, yet remains normalized in many communities. The study recommends the need for gender-sensitive interventions such as community-based support programs, enforcement of legal frameworks, educational empowerment, and campaigns challenging harmful norms. The research also emphasizes justice, and inclusive governance as an essential to improving women’s wellbeing and resilience in Global South.

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This paper examines how power dynamics and community agency shape digital health adoption in Ghana. It shows how digital tools can widen or bridge gaps and proposes an equity-focused, community-driven approach to building resilient health systems.

Paper long abstract

Efforts to strengthen health systems across the global south intersect with questions of power, digitalisation, and community agency. While digital health innovations promise to expand access and efficiency, their implementation often reproduces existing inequities in financing, governance, and voice, particularly for marginalised populations. This paper examines how power dynamics shape the adoption, use, and governance of digital health technologies in Ghana, with a focus on patient-centred care, community empowerment, and the pursuit of Universal Health Coverage (UHC). Drawing on qualitative evidence from frontline health workers and local administrators, the study analyses how digital tools such as feedback management and electronic medical records are interpreted and negotiated within everyday practice.

The study finds that weak accountability structures, fragmented financing arrangements, and limited community participation can amplify disparities. The study argues that digitalisation does not automatically democratise health systems; rather, its benefits depend on the distribution of digital literacy, infrastructural resources, and decision-making authority. Simultaneously, the study highlights emergent forms of community-led innovation, ranging from informal digital navigation support to locally adapted teleconsultation practices that reassert agency at the margins.

By situating these dynamics within broader debates on governance and health system resilience, the paper proposes an equity-oriented framework for designing and governing digital health interventions in low-resource settings. It recommends shifting from technology-centred approaches to models that emphasize community agency, redistribution of power, and co-creation with service users. This reframing ultimately offers pathways to more inclusive and resilient health systems in an increasingly digital and interconnected global health landscape.

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This paper analyses how donor project design shapes power and agency in gender-transformative health aid. Using qualitative comparative analysis of 100 health projects, it identifies conditions under which gender-transformative ambitions translate into outcomes across Global South health systems.

Paper long abstract

Despite strong rhetorical commitments to gender-transformative approaches, women’s health aid often fails to alter underlying power relations in Global South health systems. This raises a critical question for global public health governance: under what institutional and design conditions does gender-transformative health aid move beyond discourse to generate meaningful change?

This paper addresses this question through a comparative analysis of 100 donor-funded women’s health projects across Global South contexts. Drawing on qualitative comparative analysis, the study examines how specific combinations of donor institutional support, gender analysis, health system alignment, and participatory design features shape the translation of gender-transformative ambitions into practice.

The analysis focuses on donor-side governance choices visible in project documentation, including financing horizons, accountability requirements, partnership arrangements, and the extent to which gender objectives are embedded within health system interventions. Rather than treating agency as an assumed attribute, the paper conceptualises agency as structurally enabled or constrained through donor design and governance decisions.

Findings show that gender-transformative outcomes are not driven by single factors, but by distinct configurations of institutional commitment, financing structures, and health system integration. Projects that combine long-term financing horizons, embedded accountability mechanisms, and linkages to public health systems are more likely to support transformative shifts than fragmented or technocratic approaches.

By reframing gender-transformative health aid as a problem of public health governance and political economy, this paper contributes to debates on power, inequality, and empowerment in global health and offers practical insights for reimagining health aid design amid fiscal uncertainty and contested global health priorities.

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This study shows that stronger local governance, not infrastructure alone, shaped India’s health system response to COVID-19, highlighting the role of governance in managing crises using a systems-based approach.

Paper long abstract

This study applies the Complex Adaptive Systems (CAS) perspective, integrated with the Control Knobs framework, to examine how health systems adapt to large-scale health shocks. Using India as a case study, it explores the non-linear dynamics that arise during crises such as the COVID-19 pandemic. The paper has two main objectives. First, it empirically assesses the relationship between the strength of local governments, their capacity to deliver health services, and health outcomes during the early phase of COVID-19. Three hypotheses are tested: (i) stronger local governments are associated with more robust healthcare infrastructure; (ii) stronger local governance leads to a more effective initial pandemic response; and (iii) stronger infrastructure alone does not ensure improved outcomes. Second, a theoretical model supported by simulation illustrates how baseline capacity, service delivery, and disease burden interact to produce complex system behaviour. The results confirm that health systems exhibit non-linear and adaptive characteristics, which intensify under crisis conditions. Evidence supports the first two hypotheses, highlighting that governance strength, rather than infrastructure alone, enhances resilience. The study underscores the importance of local governance in risk management and demonstrates the utility of systems-based modelling for understanding and strengthening disaster and health system resilience.

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Kwashiorkor’s etiology remains unknown after 90 years. The paper asks if diet is overstressed as a causative factor & analyzes the role of adverse childhood experiences. The mortality rates from kwashiorkor & life-long consequences for survivors say it’s time to reimagine causes.

Paper long abstract

After more than 90 years, the exact etiology of kwashiorkor is still unknown. Despite the first description of the condition in a specific social and environmental context in the Gold Coast (Ghana), subsequent research has largely focused on dietary and biochemical factors in rather narrow contexts. This paper raises the question of whether poor diet been overstressed as a causative factor in kwashiorkor. It looks at the reasons why some malnourished children, even in the same family, develop marasmus while others develop kwashiorkor, which has a much poorer prognosis. The mortality rate from kwashiorkor can exceed 40 per cent. Kwashiorkor likely arises from a constellation of genetic, biological, social and environmental factors; thus, deepening understanding calls for a broad syndemic approach. Here, based on a very wide-ranging review, plus empirical data from Zimbabwe, questions are posed about the relationship between adverse childhood experiences (ACEs) and the onset of kwashiorkor. Specifically, what is the role of the gut-brain axis in mediating the link between ACEs and gastrointestinal conditions? Are ACEs, such as stress or trauma, good predictors of the onset of kwashiorkor? Given the continuing high mortality rates associated with kwashiorkor and the life-long consequences for survivors, it is past time for attention to be redirected toward its causes.

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Why did Kenya adopt SHI in 2023, having rejected a similar reform in 2004? Using interviews and documents, this paper shows how executive control and populist framing aligned the problem, policy and politics streams – enabling rapid reform adoption.

Paper long abstract

Kenya adopted a major social health insurance (SHI) reform in 2023 after a similar bill in 2004 was vetoed, despite broadly comparable constraints. What changed, and what does this show about power and agency in health policymaking?

Drawing on 48 elite interviews (2024), and documentary analysis (Hansard, media, and policy documents), this paper uses comparative process tracing, guided by Kingdon’s Multiple Approach. It argues that 2023 reform was not an ‘accidental’ alignment of streams, but a deliberate political work. It was pushed by presidential populism that helped ‘couple’ the streams together in three ways.

First, the Executive moralised and reframed health financing inequities as an urgent crisis affecting “ordinary people,” and used this to build political pressures. Second, a familiar contributory insurance design was repackaged as a ‘bottom-up’, pro-poor reform, making it easier to sell politically. And third, decision-making was centralised in State House, which narrowed public debate, weakened bureaucratic and legislative veto points and delegitimised opponents as “cartels” blocking change. Populist strategy linked a crisis narrative (problem stream), a packaged reform design (policy stream), and a mobilised governing settlement (politics stream), ensuring stream convergence. Alongside these strategies, elite support shifted in 2023 (notably Treasury, donors, and private sector), reducing resistance that proved decisive in 2004.

This account speaks to debates on reimagining development, by showing how reimagining public health can also mean reworking power. Reform adoption can expand social policy on paper while tightening control over participation and accountability.