To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure no-reply@cambridge.org
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
Blockchain is frequently proposed as a solution to tenure insecurity, administrative inefficiencies, and corruption, where conventional land reforms have fallen short. However, evidence of its institutional effectiveness remains limited. Drawing on Williamsonian transaction cost economics and an analytical autoethnographic research design, we undertake a comparative analysis of blockchain’s ability to curb opportunism and safeguard the interests of land-transacting parties relative to Ghana’s customary and statutory land-governance structures. Our findings show that while blockchain performs well at some ex ante safeguards, it offers no clear advantage over existing governance structures at the ex post stage. Of the seven identified forms of post-transaction opportunism that buyers often face, blockchain was superior only in minimising hold-up risks. We conclude with implications for policymakers and technologists considering blockchain adoption.
Inaugurated in 1948 with initially 23 signatories, the General Agreement on Tariffs and Trade (GATT) constituted a vital part of the post-war economic architecture. While traditionally the founding of the GATT has been strongly identified with the role of US hegemonic power and free trade enthusiasm, this article reframes the GATT’s origins by highlighting how (anti-)imperial dynamics shaped negotiations over its basic elements, including participation, membership, and permissible exceptions to most-favoured nation principles. Drawing on sources from the GATT archives and government documents from the United Kingdom and the United States, it highlights how empires sought to preserve key elements of imperial economic relations, including by incorporating imperial authority structures, preserving colonial preference systems, and creating other exceptions to trade liberalization. It also shows how developing countries leveraged the trade negotiations to loosen the grip of empires, expand participation, and promote regional and developmental cooperation. Consequently, the final GATT outcome represents a hybrid and transitionary organization, with the organization preserving key elements of imperial economic relations even as it incorporated some demands for the equality of states and economic justice.
This chapter introduces the reader to the basic structure and history of the international legal system, including the relationship between law and politics and the nature of the international legal order. It is intended to put the reader in a position to understand the role played by international law within the system of international relations. The historical development of international law from its early origins in, for example, the ancient Middle East, through Roman law and the concept of the jus gentium (law of peoples), and the Renaissance to the founders of modern international law, such as Vittoria and Grotius, and onto the nineteenth century and later is surveyed. The chapter refers to the concepts of positivism and naturalism and looks at communist theories of international law in Russia and China. The chapter concludes with a brief survey of the role and position of Developing Countries (Third World; Global South).
This chapter examines the relationship between trade and development. Centring the heterogeneity of developing states within the World Trade Organization (WTO), the chapter briefly analyses some of the trade law interests that are most important to these different types of developing country. It then turns to a question: how has international trade law accommodated the needs of different types of developing country through special and differential treatment? The chapter contends that the rules of the global economic order and the WTO in relation to trade were developed and are being implemented in the shadow of a fiercely contested geopolitical power struggle. Despite the flexibilities in the WTO, developing and small island developing states’ trade interests are significantly marginalised in the rules’ implementation. Without fundamentally reimagining the inequities in our international trade regime, mere ‘window dressing’ or adoption of new rules of trade would only further marginalise the trade interests of the developing countries and SIDS in a non-inclusive way.
This chapter discusses the history and evolution of international intellectual property rights (IPRs) protection, focusing on the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement. It examines the justifications for and debates surrounding the extension of developed country-style IPRs to developing nations, as well as the TRIPS provisions themselves. The chapter also addresses the conflicts between TRIPS and other international regimes, such as the Convention on Biological Diversity, and the significant public health concerns raised by TRIPS, particularly regarding access to essential medicines. Finally, it concludes by analysing the distributive impact of TRIPS and the challenges posed by emerging technologies like artificial intelligence.
Mental health conditions represent a major global burden. However, minimally adequate treatment coverage for common mental disorders remains critically low. Task-sharing solutions using non-specialist providers are promising, but successful implementation requires understanding local culture and context. This study explored facilitators and barriers to implementing non-specialist mental health interventions in Senegal. We conducted in-depth qualitative interviews with 53 stakeholders, including social protection program facilitators, beneficiaries and community members. Data were analyzed using thematic analysis. Four primary themes were constructed: (1) implementation barriers, (2) facilitating factors, (3) health-seeking beliefs and practices and (4) community recommendations. Key barriers include strong preferences for family-based problem-solving, stigma and financial constraints. Facilitators included recognition of the therapeutic benefit of interpersonal dialogue, empathetic values towards helping those with mental health conditions and community enthusiasm for mental health interventions. Culturally adapted interventions need to navigate cultural norms and leverage existing community strengths in interpersonal support. The coexistence of stigma and empathy, alongside both resistance and openness to non-specialist services, highlights a dynamic tension that not only challenges implementation but also presents an opportunity for change. These findings contribute essential formative evidence for designing effective, sustainable non-specialist mental health interventions in Senegal and the sub-Saharan African region.
Low insurance uptake in developing countries poses a strong obstacle to financial resilience and poverty reduction. Although behavioural biases, such as ambiguity aversion, myopia and distrust, are acknowledged as key barriers, their combined effects are not directly observed. Therefore, this study relies on regulatory and administrative proxies linked to these biases. This study goes beyond analysing these proxies separately to explore how they co-occur in shaping insurance outcomes. Using a novel crisp-set Qualitative Comparative Analysis (csQCA) on a sample of 40 developing countries across Africa, Asia, Central and Eastern Europe and the Americas, we identify multiple, equifinal configurations of regulatory and institutional conditions associated with higher insurance uptake. Our necessity analysis reveals that transparent pricing is central to regulatory environments associated with insurance uptake. In addition, product suitability and design standards, as well as deposit insurance coverage, are sufficient regulatory requirements when combined. The csQCA results show that no condition works in isolation; outcomes are associated with specific combinations of regulatory and institutional conditions. The findings indicate that interventions should be interpreted as configurational regulatory packages.
Bipolar disorder (BD) is associated with substantial disability and caregiver burden. In Pakistan, prevalence is unusually high, and limited mental health services place families at the center of care. Cultural and religious beliefs strongly shape how the illness is recognized, understood and managed. This study explored how individuals living with BD and their caregivers understand and navigate the illness within this context. Semi-structured interviews were conducted with 12 adults diagnosed with BD (type I or II) and 12 caregivers recruited through a national registry. Open-ended questions explored illness understanding, caregiving challenges, cultural influences and preferences for family intervention. Interviews were conducted in Roman Urdu, audio-recorded, transcribed verbatim and analyzed using Braun and Clarke’s reflexive thematic analysis. Purposive and snowball sampling ensured diversity in gender, socioeconomic status and residence. Patients described blended biomedical and cultural explanations of BD, symptom-related disruption, treatment barriers, stigma and coping through routines and religious practices. Caregivers reported confusion at illness onset, financial and emotional burden, inconsistent support and the need to navigate biomedical and spiritual care pathways. Both groups emphasized the need for accessible, family-inclusive interventions. The findings support development of culturally tailored, scalable and faith-sensitive family interventions.
Perinatal depression and anxiety are major contributors to maternal morbidity, with a disproportionate burden in low- and middle-income countries. In Pakistan, common and modifiable biological risks, including anemia and vitamin D deficiency, may interact with psychosocial factors to influence perinatal mental health. This cohort study enrolled 152 pregnant women from a public hospital in Islamabad; 147 completed baseline assessments (12–32 weeks gestation) and 100 were followed at 6–8 weeks postpartum. Validated Urdu versions of the EPDS, GAD-7, and MSPSS were used alongside hemoglobin and vitamin D assessments at both time points. Longitudinal analyses were conducted using generalized linear mixed models, supplemented by cross-sectional and mediation analyses.Depression was prevalent antenatally (41.5%) and increased postpartum (57.0%), while anxiety declined from 25.2% to 12.0%. Higher hemoglobin was protective against antenatal depression (OR = 0.66) and anxiety (OR = 0.65), but not in longitudinal models. Vitamin D deficiency predicted postnatal depression (OR = 3.15), while sufficiency was associated with remission. Social support showed a strong protective effect (OR = 0.24) and mediated 40% of the hemoglobin–depression association. Baseline symptom severity was the strongest predictor of postpartum outcomes. These findings highlight a substantial burden and point to modifiable nutritional and psychosocial targets for intervention.
Global migration is reshaping mental healthcare, creating challenges and opportunities that demand intercultural dialogue. In 2021 the World Psychiatry Exchange Program was launched under the auspices of the World Psychiatric Association to promote global collaboration and mutual learning. Its third call for applications, opened in October 2023, received 162 applications from 68 individuals, more than double the number from the second edition. Applicants represented a diverse geographical distribution (Asia 58.8%, Africa 22.1%, Europe 10.3%, South America 5.9% and North America 2.9%), with ages ranging from 25 to 52 years (mean 34 years). Just over half (53%) were early career psychiatrists within 7 years of specialising, while 47% were psychiatry trainees. Following a competitive selection process, 15 psychiatrists undertook exchanges in 2024 across Europe, Africa and Asia, with placements in Croatia, India, Iran, Malaysia, Tunisia, Spain and the United Kingdom. Evaluation data showed consistently positive feedback: 82% strongly endorsed the clarity and ease of the application process, and all participants reported feeling well supported by local coordinators.As psychiatry responds to global demographic change, investment in intercultural competencies and flexible training pathways is essential. The psychiatrist of the future is a global psychiatrist, equipped to deliver care, education, and leadership globally.
Since third sector research emerged as a fully fledged inter-disciplinary academic field during the late 1980s, a separation has usually been maintained—in common with many other social science disciplines—between communities of researchers who are primarily concerned with the study of the third sector in rich Western countries and those who work on the third sector in the so-called ‘developing world’. While internationally focused researchers tend to use the language of ‘non-governmental organizations’, those in domestic settings usually prefer the terms ‘non-profit organization’ or ‘voluntary organization’, even though both sub-sectors share common principles and are equally internally diverse in terms of organizations and activities. While there has long been common-sense logic to distinguishing between wealthier and poorer regions of the world based on differences in the scale of human need, the ‘developed’ versus ‘developing’ category can also be criticized as being rather simplistic and unhelpfully ideological. As the categories of ‘developing’ and ‘developed’ countries become less clear-cut, and global inter-connectedness between third sectors and their ideas grows, this paper argues that we need to reconsider the value of maintaining these parallel worlds of research, and instead develop a more unified approach.
This article analyses the influence of national context on civil society strength based on four key dimensions: level of democracy, political stability, rule of law and economic development. Whereas existing studies mainly focus on Western and post-communist countries, we explicitly include developing countries in our analysis. We use associational membership as proxy for civil society strength and include data of 53 countries. Rule of law, economic development and (to a lesser extent) political stability emerge from our multilevel regression models as the main factors affecting civil society membership. Unlike previous studies, we show that these relations are quadratic instead of linear. This means that where existing theories predict a drop in memberships in developing countries, we find a rise. In other words, harsh conditions actually strengthen civil society in terms of membership levels. We argue that this could be the case because reasons for CSO membership are essentially different in the developed and in the developing world. Contrary to theoretical assumptions, democratic rights do not appear critically important for civil society membership.
In this article, the probability of opening to trade is related to a country's propensity to learn from other countries in its region. It is argued that countries have different motivations to learn, depending upon the responsiveness and accountability of their political regimes. Whereas democracies cannot afford to be dogmatic, authoritarian regimes are less motivated to learn from the experience of others, even if they embrace policies that fail. Using data on trade liberalisation for 57 developing countries in the period 1970–1999, it is found that democracies confronting economic crises are more likely to liberalise trade as a result of learning; among democracies, presidential systems seem to learn more, whereas personalist dictatorial regimes are the most resistant to learning from the experience of others.
The non-NGO literature provides evidence that employees’ perceptions about their organization’s support to them influences their commitment to the organization. NGOs, which have an increasing presence in developing countries, have not been a target for this type of organizational research. This cross-sectional study, based in a health NGO in Pakistan, examined relationship between employees’ perceived organizational support (POS) and their organizational commitment, and relationship between perceptions about organizational fairness, supervisor support, and job conditions with POS. The current organizational commitment literature guided the design of the survey tool. Focus group discussions were carried out at another health NGO to identify NGO and developing country specific items for inclusion in the survey tool. A total of 249 employees participated in the study, yielding a response rate of 96%. Factor analysis of the survey items indicated that the current scales used for measuring the study variables in the non-NGO sector were valid for the NGO sector as well. In addition, three new variables, namely female supportiveness, personal supportiveness, and favorableness of work conditions were assessed. Findings revealed that POS was significantly related with organizational commitment and actions, such as organizational fairness, supervisor support, and extrinsically satisfying job conditions. Female and personal supportiveness, which are generally ignored in developing countries on the pretext of limited resources and lack of organizational capacity to address them, were also found to be important in influencing POS.
Many volunteer organizations offer short-term international voluntary service (IVS) opportunities as an avenue for participants to provide aid and humanitarian relief in international communities. This study empirically examines four potential antecedents of IVS performance among short-term IVS participants in developing countries: IVS participants’ intention to serve in similar IVS roles in the future, whether their IVS is at their preferred geographic location, IVS participants’ prior experience in the host country, and their performance in the sending organization’s trainings prior to the IVS. Utilizing both analyses of variance and OLS regression analysis of 147 IVS participants across 18 developing countries, we find evidence that short-term IVS performance is positively associated with future intentions to participate in IVS, previously having visited the host country, and performance during pre-travel trainings. Further, we analyze 158 blog posts written by 19 sample IVS participants, which provides a unique ‘inside look’ into the relationship between host country language skills and IVS performance.
Societal concerns on the environmental impact of manufacturing activities in developing economies have intensified over the past decade. Open innovation (OI) has emerged as a promising approach to mitigate these adverse effects without compromising sustainable performance (SP). This primary aim of this study is to examine and evaluate the current state of research on OI and SP practices for further empirical studies in developing economies. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework, we systematically reviewed and analysed 108 articles from Scopus, Web of Science, Google Scholar, and ScienceDirect databases related to OI and SP practices. Our study highlights significant knowledge gaps in the relationship between OI and SP in manufacturing, noting a predominant focus on developed countries. This research contributes to the existing literature by identifying critical contextual and theoretical gaps, providing valuable insights and theoretical implications for future OI and SP research agendas in developing countries.
Developing countries (a term often used interchangeably with low- and middle-income countries) account for the overwhelming majority of the world’s population. There is a huge burden of mental illness coupled with deficits in mental healthcare resources and infrastructure that perpetuates a high treatment gap in most developing countries. Good quality scientific research can help in understanding the challenges and evaluating solutions to improve mental healthcare delivery. However, there is a substantial scarcity of research from developing countries. This chapter discusses the unique nature of strengths and challenges with respect to mental health and provides examples of successful scientific mental health research with public health implications from developing countries. The feasible solutions to improve mental healthcare research across individual, organisational, and national level in developing countries given the unique strengths and deficits are discussed in detail.
Negotiations by more than 180 States during the Intergovernmental Negotiating Committee (INC) session 5.2 to develop a legally binding instrument with the purpose to end plastic pollution have, once again, concluded without a treaty. This is especially disastrous for developing States and marginalized peoples (such as indigenous communities and waste pickers), who are disproportionately suffering from plastic pollution. In this article, we show that developing States were underrepresented at the INC-5.2 negotiations in Geneva: Their delegations were on average only half as large (~5 delegates) when compared to delegations from Western European States (~13 delegates) and those from States with a high and very high Human Development Index (~10 delegates). In addition, more than 230 industry representatives participated in INC-5.2, exerting influence in diverse ways, both during official negotiations and through side events, organized by lobbying organizations. Finally, we discuss the importance of how treaty negotiations were organized: Simultaneously occurring negotiation formats (such as contact groups and informal meetings) put smaller delegations at a disadvantage, causing procedural injustice, which falls under the responsibility of the INC Secretariat.
This study aimed to adapt and validate the Mental Health Support Scale (MHSS) for Chile and Argentina, hypothesising that it would correlate positively with mental health literacy, negatively with stigma measures, and differ by mental health first aid (MHFA) training history. The MHSS involves the ‘Intended’ scale (assessing intended support) and the ‘Provided’ scale (evaluating actual help), capturing recommended and not-recommended actions. The scales were translated into Spanish, piloted with 17 adults to explore cultural relevance, and validated with 554 Chilean and Argentinian adults using concurrent measures of stigma, social distance and mental health literacy. Factor analysis of the MHSS-Intended identified a recommended factor (16 items) and a not-recommended factor (5 items). The recommended factor correlated positively with mental health literacy (r = 0.19) and negatively with weak-not-sick stigma (r = −0.16) and social distance (r = −0.16). Support scores significantly discriminated between participants with and without MHFA training (recommended d = 0.99, not-recommended d = 1.35) and within participants pre- and post-MHFA training (recommended d = 0.90, not recommend d = 0.47). Overall, the adapted MHSS demonstrates acceptable psychometric properties and is a promising tool for evaluating mental health first aid support in Chile and Argentina.
Value frameworks play a crucial role in bridging the gap between evidence and decision making in health care, particularly in settings with limited resources as low- and middle-income countries (LMIC). In this study, we present the development of a value framework (VF) targeted to provide coverage recommendations in rapid health technology assessment reports (rHTA) as well as its first 5 years of implementation.
Methods
We performed an exhaustive literature search with the aim to identify existing VFs and their dimensions followed by the generation of a VF proposal through a mixed methods, qualitative–quantitative approach including a Delphi panel to weigh the criteria and correlate them with the subsequent recommendations. To describe its implementation, we present the results of 264 rHTA reports from 2017 to 2022.
Results
The value framework has three main domains (quality of evidence, net benefit, and economic impact). We adapted widely used methodologies for quality of evidence and net benefit domains. The economic impact domain was the most complex to assess, so an ad hoc method was developed. Analysis of 265 HTAs revealed the distribution of recommendations across different criteria and technology types. Most were for drugs (40.5 percent) or therapeutic procedures (36 percent). With a five-category final recommendation, 0.8 percent were favorable, 19.7 percent were uncertain, and 44 percent were unfavorable.
Conclusion
The VF demonstrated its versatility and practicality in meeting the needs of rHTA audience, and can facilitate evidence-informed decision making. This VF serves as a valuable tool for conducting adaptive rHTAs and supports decision-making processes in Argentina and similar LMIC contexts.