Essays on State-Building and Sectarian Violence

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This dissertation seeks to explain the role of governmental and non-governmental actors in increasing/reducing the emergence of intergroup conflict after war, when group differences have been a salient aspect of group mobilization. This question emerges from several interrelated branches of scholarship on self-enforcing institutions and power-sharing arrangements, group fragmentation and demographic change, collective mobilization for collectively-targeted violence, and conflict termination and the post-conflict quality of peace. This question is investigated through quantitative analyses performed at the sub-national, national, and cross-national level on the effect of elite competition on the likelihood of violence committed on the basis of group difference after war. These quantitative analyses are each accompanied by qualitative, case study analyses drawn from the American Reconstruction South, Iraq, and Cote d'Ivoire that illustrate and clarify the mechanisms evaluated through quantitative analysis.

Shared findings suggest the correlation of reduced political competition with the increased likelihood of violence committed on the basis of group difference. Separate findings shed light on how covariates related to control over rent extraction and armed forces, decentralization, and citizenship can lead to a reduction in violence. However, these same quantitative analyses and case study analysis suggest that the control of the state can be perceived as a threat after the end of conflict. Further, together these findings suggest the political nature of violence committed on the basis of group difference as opposed to ethnic identity or resource scarcity alone.

Together, these combined analyses shed light on how and why political identities are formed and mobilized for the purpose of committing political violence after war. In this sense, they shed light on the factors that constrain post-conflict violence in deeply divided societies, and contribute to relevant academic, policy, and normative questions.

Measuring the impact of a quality improvement collaboration to decrease maternal mortality in a Ghanaian regional hospital.

OBJECTIVE: To evaluate the performance of a continuous quality improvement collaboration at Ridge Regional Hospital, Accra, Ghana, that aimed to halve maternal and neonatal deaths. METHODS: In a quasi-experimental, pre- and post-intervention analysis, system deficiencies were analyzed and 97 improvement activities were implemented from January 2007 to December 2011. Data were collected on outcomes and implementation rates of improvement activities. Severity-adjustment models were used to calculate counterfactual mortality ratios. Regression analysis was used to determine the association between improvement activities, staffing, and maternal mortality. RESULTS: Maternal mortality decreased by 22.4% between 2007 and 2011, from 496 to 385 per 100000 deliveries, despite a 50% increase in deliveries and five- and three-fold increases in the proportion of pregnancies complicated by obstetric hemorrhage and hypertensive disorders of pregnancy, respectively. Case fatality rates for obstetric hemorrhage and hypertensive disorders of pregnancy decreased from 14.8% to 1.6% and 3.1% to 1.1%, respectively. The mean implementation score was 68% for the 97 improvement processes. Overall, 43 maternal deaths were prevented by the intervention; however, risk severity-adjustment models indicated that an even greater number of deaths was averted. Mortality reduction was correlated with 26 continuous quality improvement activities, and with the number of anesthesia nurses and labor midwives. CONCLUSION: The implementation of quality improvement activities was closely correlated with improved maternal mortality.