Person: Cammett, Melani
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Cammett
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Melani
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Cammett, Melani
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Publication Political Context, Organizational Mission, and the Quality of Social Services: Insights from the Health Sector in Lebanon(Elsevier BV, 2017-10) Cammett, Melani; Şaşmaz, AytuğNon-state actors are important providers of social welfare. In parts of the Middle East, South Asia, sub-Saharan Africa, and other regions, religious charities and parties and NGOs have taken on this role, with some preceding independent statehood and others building parallel or alternative welfare infrastructure alongside the modern state. How well do these groups provide welfare goods? Do some exhibit a “welfare advantage,” or a demonstrated superiority in the quality and efficiency of providing social services? In this paper, we explore whether distinct organizational types are associated with different levels of the quality of care. Based on a study in Greater Beirut, Lebanon, where diverse types of providers operate health centers, we propose and test some hypotheses about why certain organizations might deliver better services. The data indicate that secular NGOs, rather than religious, political or public sector providers, the other main types of providers in the charitable sector, exhibit superior measures of health care quality, particularly with respect to objective provider competence and subjective measures of patient satisfaction. In Lebanon, where religious and sectarian actors dominate politics and the welfare regime and command the most extensive resources, this appears to be a counterintuitive finding. Our preliminary explanation for this outcome emphasizes the ways in which the socio-political context shapes the choices of more qualified or professional doctors to select into secular providers, in part because of their organizational missions, and why citizens might perceive these providers to be better, irrespective of the actual quality of services delivered.Publication Sectarianism and the Ambiguities of Welfare in Lebanon(University of Chicago Press, 2015) Cammett, MelaniNonstate providers are often more important in the everyday lives of the poor than outposts of the state. In this essay, I focus on one type of provider, sectarian organizations, which are an integral component of politics and welfare regimes in parts of the Middle East and other developing regions. Focusing on Lebanon, I describe how sectarian welfare providers emerge from and help to constitute political sectarianism while tracing what is at stake for the poor. First, by holding public offices and dominating informal channels that mediate access to public benefits, these actors mediate the experience of accessing the “rights” of citizenship. Second, while they provide benefits and services that might not otherwise be available, the modes of allocating welfare by sectarian parties can be discriminatory, notably along partisan and religious lines. Third, sectarian groups politicize the process of accessing social benefits while undercutting the political voice of the poor by weakening alternative channels of claim making. Finally, the crosscutting effects of sectarian organizations in welfare regimes suggest additional challenges to boosting local participation in development policy: while they are deeply embedded in the communities they serve, they produce and reinforce social inequalities.Publication Informal politics and inequity of access to health care in Lebanon(BioMed Central, 2012) Chen, Bradley; Cammett, MelaniIntroduction: Despite the importance of political institutions in shaping the social environment, the causal impact of politics on health care access and inequalities has been understudied. Even when considered, research tends to focus on the effects of formal macro-political institutions such as the welfare state. We investigate how micro-politics and informal institutions affect access to care. Methods This study uses a mixed-methods approach, combining findings from a household survey (n = 1789) and qualitative interviews (n = 310) in Lebanon. Multivariate logistic regression was employed in the analysis of the survey to examine the effect of political activism on access to health care while controlling for age, sex, socioeconomic status, religious commitment and piety. Results: We note a significantly positive association between political activism and the probability of receiving health aid (p < .001), with an OR of 4.0 when comparing individuals with the highest political activity to those least active in our sample. Interviews with key informants also reveal that, although a form of “universal coverage” exists in Lebanon whereby any citizen is eligible for coverage of hospitalization fees and treatments, in practice, access to health services is used by political parties and politicians as a deliberate strategy to gain and reward political support from individuals and their families. Conclusions: Individuals with higher political activism have better access to health services than others. Informal, micro-level political institutions can have an important impact on health care access and utilization, with potentially detrimental effects on the least politically connected. A truly universal health care system that provides access based on medical need rather than political affiliation is needed to help to alleviate growing health disparities in the Lebanese population.Publication Building Resilient Health Systems: A Proposal for a Resilience Index(BMJ, 2017-05-23) Kruk, Margaret; Ling, Emilia; Bitton, Asaf; Cammett, Melani; Cavanaugh, Karen; Chopra, Mickey; el-Jardali, Fadi; Macauley, Rose Jallah; Muraguri, Mwihaki Kimura; Konuma, Shiro; Marten, Robert; Martineau, Frederick; Myers, Michael; Rasanathan, Kumanan; Ruelas, Enrique; Soucat, Agnes; Sugihantono, Anung; Warnken, HeikoThe 2014 west African Ebola epidemic shone a harsh light on the health systems of Guinea, Liberia, and Sierra Leone. While decades of domestic and international investment had contributed to substantial progress on the Millennium Development Goals, national health systems remained weak and were unable to cope with the epidemic. Routine care of the population also deteriorated during the outbreak. Surveillance systems did not function effectively, allowing Ebola to spread within and between the countries. Global institutions were slow to respond to the crisis, squandering an opportunity to stem its course.Publication Development and Underdevelopment in the Middle East and North Africa(Oxford University Press, 2017-01-10) Cammett, MelaniThis article examines the trajectories of economic development and underdevelopment in the Middle East and North Africa (MENA). It first considers the empirical record of development in the region, paying particular attention to standard measures of GDP, industrialization, and social development. The article contextualizes the region’s development trajectory in a larger set of cross-regional comparisons and looks at the region’s record of economic growth and development in different periods after World War II. It also evaluates a number of factors that account for economic performance in the region—such as colonialism, Islam, social relations, corruption and crony capitalism, authoritarianism, and populism—before offering an alternative account. It argues that the MENA’s suboptimal economic performance is associated with the particular manifestation of business–government relations in the region.