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Item Health justice for all : the development of alternative health system capabilities in the conflict-affected context of Shan State, Myanmar : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Development Studies at Massey University, Manawatū, New Zealand(Massey University, 2018) Bell, Sharon MargaretAs the 2030 Agenda for Sustainable Development advances, it is vital to determine how conflict impacts on the achievement of the Sustainable Development Goals (SDGs) in conflict-affected contexts. The United Nations (UN) regards conflict as the leading risk to development progress as these contexts have high rates of poverty and limited access to crucial healthcare services. Shan State, Myanmar is one such context, facing a critical shortage in its health workforce, considered one of the building blocks of an effective health system. Approaches to building health workforce capabilities can meaningfully contribute towards meeting SDG 3 – ‘to ensure healthy lives and promote well-being for all at all ages’, and consequently, health justice for conflict-affected communities. This research aims to understand how the approaches taken by an international nongovernmental organisation (INGO) support the development of alternative health system capabilities in a conflict-affected context. A global development agenda of state- and peace-building has meant that INGOs have been criticised for undermining state legitimacy. Meanwhile, non-state armed groups (NSAGs) in areas like Shan State, Myanmar, have established alternative regimes which seek self-determination as well as attempting to provide for the social and economic wellbeing of their people. However, little is known about how a partnership between an INGO and a NSAG contributes toward enabling alternative health system development in these contexts. This research contributes to new ways of understanding this through the development of a capabilities framework for health system development in conflict-affected contexts. This was used to analyse findings from the qualitative case study of an INGO’s health workforce training programme on the Myanmar-Thailand border. The research found that a positive partnership between the INGO and the NSAG has played a crucial role in enabling the workforce capabilities of the alternative health system, leading to promising improvements in health outcomes in communities. However, the effectiveness of the programme is restricted by the INGO’s reliance on volunteerism for staffing, where expatriate medical volunteers are selected based on their availability, rather than the appropriate skills and experience for this context. The international aid community has also reduced its funding for cross-border development programmes in Myanmar which has constrained the activities of the INGO and the NSAG. For Myanmar to achieve health justice and SDG 3, supporting health system development that focuses on improving health outcomes needs to be a priority for the international community.Item The gender dimensions of environmental change : an exploration of the experiences and perceptions of rural men and women in Zimbabwe : a thesis submitted in partial fulfilment of the requirements for the degree of Doctor of Philosophy in Development Studies at Massey University, Manawatu, New Zealand(Massey University, 2016) Shumba, Dorcas Stellah TsitsiProcesses of environmental change have taken place for centuries both as a result of natural variability and anthropogenic forces. As a concept however, environmental change continues to be used narrowly to refer to environmental changes which are biophysical in nature, and mostly those with global precedence. In recent times incidences of environmental change have become more complex as new patterns of change are threatening the livelihoods of those living in developing countries, undoing many development gains. As such, there is an increasing desire to understand the implications of environmental changes, particularly for those whose livelihoods are natural resource dependent, many of whom live in rural areas, and many of whom are poor. Despite this growing interest, rural people and especially the rural poor are little seen or heard; their environmental change experiences are thus misunderstood, and solutions proposed do not take into consideration the local context or experiences. There remains also a normative perspective which positions women as automatically vulnerable to environmental change, specifically vis-à-vis men. In doing so women’s experiences of environmental change are homogenised and men’s experiences are rendered invisible. Drawing on the case of Zimbabwe this study critically considers the experiences and perceptions of rural men and women to environmental change so as to ascertain gendered impacts and differential vulnerabilities. To capture fully the subjective lived experience of both men and women to environmental change, this study lends itself to qualitative research. Thus research methods such as semi-structured interviews, focus group discussions and gender analysis are central to the methodology. In terms of findings, this study argues against looking at environmental change as a technocratic subject accessible only from a global frame and accessed only by a technocratic few, proposing that the people experiencing environmental change at a local level should determine the environmental changes of communal concern. This study also highlights the importance of understanding the vulnerabilities of rural men and women within a well-conceived notion of context, taking into account rural disadvantage resulting from colonialism, and the current Zimbabwean crisis.Item Involving young men in preventing violence against women : a case study of Instituto Promundo's Program H : a research report presented in partial fulfilment of the requirements for the degree of Master of International Development at Massey University, Manawatū, New Zealand(The Author, 2016) Rose, Courtney-JaneIntimate partner violence among youth is recognised as a public health concern, an obstacle to economic development, and a gross violation of human rights. This research found that intimate partner violence against women is closely linked to inequitable gender attitudes. In order to combat violence related to these gender attitudes, prevention interventions have particularly targeted young men in recent years. However, in aiming to solve this issue, violence prevention has often heavily focused on reducing the risk of negative behaviour, rather than positively empowering youth participation and growth. Approaches that instead view youth as resources to be developed, rather than simply as risks to society, are recommended. This research is focusing specifically on Instituto Promundo as an example of an organisation that seeks to fulfil youth rights in practice and improve youth behaviour and attitudes relating to gender within the Brazilian context. Promundo’s ‘Program H’ works to empower young men to rewrite harmful traditional masculinities and ultimately prevent violence through engagement in both individual and community activities. This report utilised a Positive Youth Development framework to investigate Program H, and found that the initiative has the potential to simultaneously prevent the risk of violence while also promoting positive youth behaviour. Program H significantly contributes to changing inequitable gender norms amongst young men, with potential positive and empowering flow-on effects to the young people of Brazil and the wider Latin American region.Item Building community resilience in mine impacted communities : a study on delivery of health services in Papua New Guinea : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Development Studies at Massey University, Palmerston North, New Zealand(Massey University, 2016) Kuir-Ayius, Dora DauThe purpose of this study was to explore the building of Community Resilience in mine-impacted communities in Papua New Guinea (PNG). The study aimed to establish the general relationship between community resilience, community capitals and the delivery of health services. It investigated the delivery of health services in three mining communities in PNG to see how these services contribute to or detract from the building of resilience. The study investigated relevant models of community resilience from the literature, and how the way policy functions in PNG can be related to these models. The study also developed a way of quantifying the impact of mining on health service delivery (through the use of community capitals) and the building of resilience in these communities. Furthermore, the thesis develops an indigenous, Melanesian-centric ‘Bilum Framework’ approach to resilience to create greater understanding of how resilience in the mining communities can be strengthened through improved access to health services. Three mining communities were selected as case studies, each representing a different stage of mining: (i) the beginning; (ii) the operational; and, (iii) post-mine closure. A mixed method approach comprising both quantitative and qualitative methods was used to collect data for this study. A survey questionnaire was designed to collect views of community members who accessed health services in their respective communities. Results from the survey questionnaire were converted to proxy indicators and led to the development of a Community Resilience Index (CRI) to provide a measure of resilience in each community. The qualitative research methods included document analysis, semi-structured interviews, and purposive observations. Document analysis was important in reviewing relevant policy documents and other literature to link theories to the experiences of the people while the latter methods contributed to describing people’s encounters in accessing health services. Analysis showed inconsistencies in the levels of resilience in these communities that varied with the stages of mining: both the beginning and post- mine closure stages demonstrated significantly lower levels of community resilience than the operational phase. Findings from the research indicated a lack of access to health services – a key influence in building resilience – is the result a range of factors including insufficient finances, weak sector governance, and the need for infrastructure and transport. The Bilum Framework is proposed as an approach that allows decision-makers to target assistance to strengthen and support specific community capitals and hence more effectively build community resilience in the mining communities in PNG.Item Satisfaction with life and social comparison among older people : a thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy in Health Science at Massey University, Manawatu, New Zealand(Massey University, 2015) Rodgers, Vivien KayeIntroduction: In a rapidly greying world, successful ageing is an important concept and goal. While this remains poorly-defined in the literature, there is wide agreement that satisfaction with life is a major contributor, together with health and functional ability. It has been suggested that the perception of satisfaction with life might be affected by social comparison, but little is known about this relationship, particularly among older people. Consequently, this study investigates the impact of health-related and social comparison variables on the perception of satisfaction with life at various stages of old age. Methods: A cross-sectional survey of 542 community-dwelling people aged 65+ was conducted to measure health (physical and mental), functional ability, satisfaction with life and social comparison dimensions. Participants were randomly selected from the general electoral role of the Manawatu region of New Zealand. The Short Form-12 Health Survey measured perceived physical and mental health, the Groningen Activity Restriction Scale measured functional ability, the Satisfaction With Life Scale measured life satisfaction and the Iowa-Netherlands Comparison Orientation Measure assessed social comparison. Additional demographic information was collected. Age groups (65-74, 75-84, 85+) were compared. Results: A marked difference was found in satisfaction with life before and after age 85 years, that was not explained by health (physical or mental), functional ability, demographic factors or comparison frequency. The oldest participants (aged 85+) consistently reported the highest levels of satisfaction with life. This same group reported predominantly making downward social comparisons (with those doing worse). Conclusions: Important links were found between satisfaction with life and downward social comparison. Better understanding of comparison drivers across older age will progress the discussion on what impacts the perceptions of satisfaction with life and contributes to successful ageing.Item How have women been empowered by gender-focussed development projects in post-Taliban Afghanistan? : reviewing the literature which incorporates the critical consideration of two gender focussed development projects : a research report presented in partial fulfilment of the requirements for the degree of Master of International Development in Development Studies at Massey University, Palmerston North, New Zealand(The Author, 2014) McMillan, Robert MelvilleThis research report examines the empowerment approach within the Gender and Development (GAD) discussion, providing an emphasis on women’s empowerment as an instrument of post-conflict reconstruction in post-Taliban Afghanistan. Utilising a comprehensive literature review, the report establishes the framework of Naila Kabeer as a consistent base for the comparing and contrasting of two gender-focussed development programmes in Afghanistan. The contextual background of empowerment programmes pursued over the past decade in Afghanistan are presented with an examination of the challenges and opportunities encountered pursuing women’s political, economic, social and psychological empowerment. A specific consideration of the New Zealand-led Provincial Reconstruction Team in Bamyan Province, Afghanistan, and the Community Development Council initiative within the Afghanistan National Solidarity Programme is undertaken. The report concludes that while there have been enormous symbolic advances for women’s political empowerment in the national sphere, the more private and local the sphere examined: the less decision-making agency Afghani women are empowered to exercise. While seeking to provide opportunities for women’s economic empowerment the programmes have made little practical change to women’s income or financial agency. The two gender-focussed programmes examined have made significant compromises to the extremities of the local context, and are considered ‘gender accommodating’ rather than ‘gender transformative’. The large body of literature concerning Afghanistan substantiates that the road to gender equity will stretch across the generations and is necessarily gradual to remain sustainable. As Afghanistan enters further political turmoil, the empowerment attained by Afghani women in the past decade must be expressly guarded.Item International approaches to literacy for gender empowerment : a review of the literature and analysis in relation to Timor-Leste : a research project presented in partial fulfilment of the requirements for the degree of Master of International Development, Development Studies, Massey University, Manawatu, New Zealand(The Author, 2012) Martins, Sandra GusmaoAfter 400 years of colonial rule and illegal occupation Timor-Leste gained independence (World Bank, 2004). However, in the wake of this, as they sought to rebuild the country, the newly founded government was faced with numerous development challenges, such as wide spread illiteracy and a non-existent education system. Given this non-existent education system and the extent of illiteracy noted more in the rural areas and in relation to women, part of the solution to addressing the issue was to implement informal literacy programmes. It was argued that increasing women?s literacy was an important strategy for increasing women?s social, political and economic participation and achieving empowerment (Olufunke, 2011). However there are also debates contesting that participation in literacy programmes automatically leads to the empowerment of women, rather the programmes on offered need to be understood in the context of the place where they are being delivered (Stromquist, 2002). With this in mind this research project seeks to critically explore firstly, international approaches to adult literacy with a specific focus on gender and empowerment, and secondly, the relevance of these international approaches to adult literacy as an empowering tool in relation to women in Timor-Leste. This desk-based exploration unpacks four international approaches to adult literacy, which come under the umbrella of critical literacy approaches, these are: „New Literacy Studies? (NLS), „Real Literacies Approach? (RLA), the „REFLECT? Method, and the „Community Literacy Approach? (CLA). These four approaches are critically discussed in relation to women?s empowerment focusing specifically on debates by Rowlands (1995, 1997) and Kabeer (1999), who draw on Freire?s (1970) concept of empowerment, conscientization. Having interrogated these four approaches I then reflected upon them in terms of the Timor-Leste situation, focusing specifically on issues of effectiveness and appropriateness. I conclude that rural women can experience empowerment through participation in adult literacy programmes. In considering the REFLECT Method, the common empowerment dimensions experienced are the personal sphere or dimension (Rowlands, 1995, 1997), the achievement dimension (Kabeer, 1999), with evidence of „conscientization? or critical consciousness (Freire, 1970). The REFLECT Method is thus considered to be the most appropriate and effective approach to adult literacy and gender in Timor-Leste. However, this approach can also be combined with other approaches (in particular the RLA), which is implemented nationwide in Timor-Leste. However it is important to note that literacy itself does not guarantee empowerment, there is a need to think beyond literacy and how (within) this process women can access their fundamental rights, as well as possibilities of power (Archer, 2002).Item Sport as a vehicle for development in Vanuatu : a review of the literature and analysis of the Women's Island Cricket Project : a research project presented in partial fulfilment of the requirements for the degree of Masters of International Development, Development Studies, Massey University, Palmerston North, New Zealand(The Author, 2014) Farrell, Julie AnnApproaches to development delivery have changed significantly post World War II. Current development delivery practices are often referred to as the 4th paradigm of aid delivery. A focus on the concept of empowerment through the delivery of aid has become very popular, especially in relation to women’s development (Cornwall & Brock, 2005, Batliwala, 2007). The 3rd Millennium Development Goal with an aim to empower women is a good example of the increased international focus on and support for, the development of women around the world. This popularity has also surfaced within the new and emerging Sport-for-Development paradigm. The marrying of Sport for Development and empowerment seem to be synonymous in a number of aid projects. However due to the fact that empowerment is a multi-faceted and contested term, there are issues concerning implementation and effectiveness of Sports for Development projects. Monitoring and evaluating Sport for Development projects continues to be an issue many writers lament about. As many have empowerment as an end goal, this is something that causes disquiet in the development field. With the above-mentioned in mind, this research project aimed to investigate, via a desk-based study and field observations, in what ways the Women’s Island Cricket Project in Vanuatu has contributed to women’s empowerment and identify what some of the consequences of this empowerment of participants were at the personal, family and community level. Using Kabeer’s (1999, 2005) notion that empowerment is about the ability to make choices to improve one’s life, and transform one’s life, I consider whether the women involved in the cricket project had acquired agency – the ability to transform – and whether the women have changed the way they feel about themselves and have been able to improve their own self-efficacy. My research identified that Island cricket has considerable ‘buy-in’ by the participants of the Women’s Island Cricket Project and their families. I conclude that this project has been successful, resulting in empowerment-type behavioural change for participants. Whilst paternalistic attitudes towards women exist in Vanuatu, on Ifira Island, the project has challenged and transformed some of these historical attitudes. Development Alternatives for Women of a New Era’s idea that women’s solidarity adds to empowerment (Sen & Grown, 1988) was observed by me when attending the Women’s Island Cricket Committee meeting. Whilst Vanuatu women who play cricket are the focus of this aid project, the reality is that despite sport for women not being equal with empowerment opportunities available to male sports people, well-planned and well-organised Sport for Development projects that involve local women in the planning, implementation and evaluation, are meritorious and provide considerable scope to transform participant’s lives.Item Māori women, health care, and contemporary realities : a critical reflection : a thesis presented in partial fulfillment of the requirements for the degree of Doctor of Philosophy (Health) at Massey University, Wellington, New Zealand(Massey University, 2015) Parton, Beverley MayMāori women, health care and contemporary realities is a critical reflection on the context of my nursing practice, a Pākehā nurse employed by Kokiri Marae Health and Social Services (KMHSS), Lower Hutt, Aotearoa New Zealand. In addressing the disparities Māori experience KMHSS has the motto, “Committed to the holistic development of whānau, hapū, and iwi”. The research aimed to explore from the experiences of urban Māori women, influences on their health and health care engagement. Kawa Whakaruruhau, the critical nursing theory of cultural safety for Māori health care, informs a qualitative approach, a human rights perspective, with its categories of difference, power, and subjective assessment. In turn, whiteness theory, with its categories of white (and not so white) power and privilege, informs Kawa Whakaruruhau. The women’s stories were received in an unstructured interview method and analysed thematically. The historical, social, cultural, economic, political, racial and gendered factors contributing to Māori women’s health and health care engagement are presented as a geography of health, and as landscapes past, present and future. Landscapes past tell of the disruption of the whakapapa connections of land, language and health by the historical and ongoing processes of colonisation. Landscapes present tell of health care places and spaces that by their policies, cultures, structures, and health professional practice, network and connect to include or to exclude Māori women and their families. Landscapes future are envisioned by the women as they remember what is and has been, and then imagine for themselves and at times succeeding generations, what they require as Indigenous to be central to health care. The women imagine what they need to parent for their children to have a good life; they imagine a therapeutic landscape. (In)authentic identities are presented as chronicities of risk, inhabiting disease and poverty. The women expressed authentic mana wāhine identity uniquely and heterogeneously. Recommendations have been made for nursing practice, research site and research.Item Vitamin D status and relationship between vitamin D and risk factors of metabolic syndrome : a study in Taiyuan City in China : a thesis presented in partial fulfillment of the requirements for the degree of Master of Science in Human Nutrition at Massey University, Manawatu, Palmerston North, New Zealand(Massey University, 2014) Yan, XiaoningBackground Vitamin D deficiency is widespread, and the residents in Taiyuan City in China seem to be at high risk of vitamin D deficiency. The situation might be because the city is located in north China and air pollution in the city is heavy. Meanwhile, emerging evidence suggests that vitamin D deficiency may be associated with prevalence of metabolic syndrome (MetS), which usually progress to diabetes and increases the risk of cardiovascular disease. MetS has been becoming much more common in China, and even affects younger people. Objectives This study investigated the vitamin D status of non-manual workers living in Taiyuan City; and explored the relationship between vitamin D status and markers of MetS in 200 participants attending the Health 100 Check-up Center in Taiyuan City for their usual health check. Methods In this cross-sectional study; 200 non-manual workers aged 20-80 years old, living in Taiyuan City were recruited. The participants had their serum vitamin D levels measured and were asked questions about their lifestyle, including daily exercise, alcohol use and smoking. The Check-up Center provided data relating to MetS of the participants. These data included anthropometrics (height, weight and body circumferences), biochemical data (lipid profiles and fasting glucose from blood samples taken for the check-up) and blood pressure. Results Seventy eight percent of participants had vitamin D values less than 50 nmol/L. The women’s serum 25-hydroxyvitamin D (25(OH)D) status (median; 32.70 nmol/L (upper and lower quartile; 25.80, 43.80)) was significantly lower than that of the men (44.00 nmol/L (32.30, 55.40)) (p<0.01). In females aged younger than 40 years vitamin D status (29.25 nmol/L (24.05, 40.85)) was significantly lower than older participants (age>65). In the present study, multiple linear regressions showed the determinants of the vitamin D status were female gender, smoking, and increased fasting glucose (p<0.05). The prevalence of MetS, or abdominal obesity between the groups with and without vitamin D insufficiency were not significantly different (p=0.08; p=0.07). Multiple logistic regression analysis showed that vitamin D status was not associated with MetS. Conclusions Vitamin D insufficiency was highly prevalent in non-manual workers in Taiyuan City in China during the winter season. Vitamin D status in the women was lower than the men. Among the females, younger women had worse vitamin D status than the older women. So, in the present study, female gender, increased fasting glucose, and smoking were significant determinants for vitamin D insufficiency. Vitamin D insufficiency was not associated with the risk factors for MetS in the present study. However, female gender, increased waist circumference (WC), and raised serum triglycerides were associated with higher risk of MetS.
