Background Nearly all countries with fertility levels of more than five children per woman are in Sub-Saharan Africa. Prestige, insurance in old age, and replacement in case of child deaths are related to preferences for large families. In this paper, we examine the association between women’s empowerment and fertility preferences of married women aged 35 years and above in four high fertility Francophone Sub-Saharan Africa (FSSA) countries, namely Burkina Faso, Mali, Niger and Chad. Method The ideal number of children among married women and their ability to have the desired number of children are used to measure fertility preferences. We used principal component analysis to construct a multidimensional empowerment index. We then estimated negative binomial and logistic regression models to examine the association between women’s empowerment and fertility preferences. Data are from the most recent Demographic and Health Surveys (DHS) conducted in the countries included in the analysis. Results Regardless of the country, more empowered women desire significantly fewer children compared with their less empowered counterparts. The first step to having fewer children is formulating programs to improve economic empowerment of women. The specific elements of women’s empowerment that were important for fertility preferences included education, skills development, decision-making power, and control over household resources. In addition, familial empowerment matters more than other dimensions of empowerment in influencing women’s ability to achieve the desired number of children in the FSSA countries included in the study. Conclusion Paid employment and access to and control over resources are factors which, if improved upon, could significantly reduce the ideal number of children. By taking necessary steps, mass media can be used much more adequately to reduce ideal number of children in FSSA countries. In addition, the desire for many children could also be due to their participation in income-generating activities to improve the household’s socio-economic status. The findings suggests that improvement of women’s ability to have the desired number of children is a big challenge to which policy makers must pay careful attention.

BackgroundIn Togo, about half of health care costs are paid at the point of service, which reduces access to health care and exposes households to catastrophic health expenditure (CHE). To address this situation, the Togolese government introduced a National Health Insurance Scheme (NHIS) in 2011. This insurance currently covers only employees and retirees of the State as well as their dependents, although plans for extension exist. This study is the first attempt to examine the extent to which Togo’s NHIS protects its members financially against the consequences of ill-health.MethodsData was obtained from a cross-sectional representative households’ survey involving 1180 insured households that had reported illness in the household in the 4 weeks preceding the survey or hospitalization in the 12 months preceding the survey. The incidence and intensity of CHE were measured by the catastrophic health payment method. A logistic regression was used to analyse determinants of CHE.ResultsThe results indicate that the proportion of insured households with CHE varies widely between 3.94% and 75.60%, depending on the method and the threshold used. At the 40% threshold, health care cost represents 60.95% of insured households’ total monthly non-food expenditure. This study showed that the socioeconomic status, the type of health facility used, hospitalization and household size were the highest predictors of CHE. Whatever the chosen threshold, care in referral and district hospitals significantly increases the likelihood of CHE. In addition, the proportion of households facing CHE is higher in the lowest income groups. The behaviour of health care providers, poor quality of care and long waiting time were the main factors leading to CHE.ConclusionA sizable proportion of insured households face CHE, suggesting gaps in the coverage. To limit the impoverishment of insured households with low income, policies for free or heavily subsidized hospital services should be considered. The results call for an equitable health insurance scheme, which is affordable for all insured households.

BackgroundIn developing countries, health shock is one of the most common idiosyncratic income shock and the main reason why households fall into poverty. Empirical research has shown that in these countries, households are unable to access formal insurance markets in order to insure their consumption against health shocks. Thus, in this study, are the poor and uninsured households more vulnerable from health shocks? We investigate the factors that lead to welfare loss from health shocks, and how to break the vulnerability from health shocks in three Sub-Saharan Africa (SSA) countries, namely, Burkina Faso, Niger and Togo.MethodsThis study focusses on 1597 households in Burkina Faso, 1342 households in Niger and 930 households in Togo. A three-step Feasible Generalized Least Squares (FGLS) method was used to estimate vulnerability to poverty and to model the effects of health shocks on vulnerability to poverty.ResultsThe estimates of vulnerability show that about 39.04%, 33.69%, and 69.03% of households are vulnerable to poverty, in Burkina Faso, Niger, and Togo respectively. Both interaction variables, ‘health shocks and wealth’ and ‘health shocks and access to health insurance’ had a significant negative effect on reducing household’s vulnerability to poverty. Poverty is the leading cause of economic loss from health shocks as the poorer cannot afford the purchase of sufficient quantities of quality food, preventive and curative health care, and education. We found that lack of health insurance coverage had a significant effect by increasing the incidence of welfare loss from health shocks. Moreover, household size, type of health care used, gender, education and age of the head of the household as well as the characteristics of housing affect vulnerability to poverty.ConclusionOur findings suggest that for the poor households, reduction of user fees of health care at the point of service or expansion of health insurance could mitigate vulnerability to poverty. Other challenges—birth control policy, adequate sanitation facilities and a universal basic education program—need to be addressed in order to reduce significantly the effects of health shocks on vulnerability to poverty in SSA.

Sub-Saharan Africa (SSA) experiences an acute dearth of well-trained and skilled researchers. This dearth constrains the region’s capacity to identify and address the root causes of its poor social, health, development, and other outcomes. Building sustainable research capacity in SSA requires, among other things, locally led and run initiatives that draw on existing regional capacities as well as mutually beneficial global collaborations. This paper describes a regional research capacity strengthening initiative—the African Doctoral Dissertation Research Fellowship (ADDRF) program. This Africa-based and African-led initiative has emerged as a practical and tested platform for producing and nurturing research leaders, strengthening university-wide systems for quality research training and productivity, and building a critical mass of highly-trained African scholars and researchers. The program deploys different interventions to ensure the success of fellows. These interventions include research methods and scientific writing workshops, research and reentry support grants, post-doctoral research support and placements, as well as grants for networking and scholarly conferences attendance. Across the region, ADDRF graduates are emerging as research leaders, showing signs of becoming the next generation of world-class researchers, and supporting the transformations of their home-institutions. While the contributions of the ADDRF program to research capacity strengthening in the region are significant, the sustainability of the initiative and other research and training fellowship programs on the continent requires significant investments from local sources and, especially, governments and the private sector in Africa. The ADDRF experience demonstrates that research capacity building in Africa is possible through innovative, multifaceted interventions that support graduate students to develop different critical capacities and transferable skills and build, expand, and maintain networks that can sustain them as scholars and researchers.

Introduction: Despite improvements in health care in Togo, the maternal mortality rate remains high, and regional antenatal care and facility-based deliveries are limited. The aim of this study is to measure socioeconomic inequality in maternal health care (MHC) utilization during pregnancy and delivery. Method: The data were obtained from the last two rounds of the 1998 and 2013 Togo Demographic and Health Survey. Concentration index, concentration curve and logistic regression were used to measure and examine socioeconomic inequality in antenatal care and facility-based deliveries. Results: The concentration indices for antenatal visits and facility-based deliveries were 0.142 and 0.246 in 1998 and 0.129 and 0.159 in 2013, indicating inequality bias towards the rich in both. Household wealth status and women's education were the most significant contributors to inequality in antenatal visits and facility-based deliveries. In 2013, household economic status contributed approximately 75.66% of the inequality in facility-based deliveries, while mothers' education significantly contributed approximately 18.22% to the inequality in antennal visits. Additionally, universal health coverage should be considered as one of the main vehicles for reducing inequalities in the use of MHCs.