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OBJECTIVES In Nepal, where difficult geography and an under-resourced health system contribute to poor health care access, the government has increased the number of trained skilled birth attendants (SBAs) and posted them in newly constructed birthing centres attached to peripheral health facilities that are available to women 24h a day. This study describes their views on their enabling environment. METHODS Qualitative methods included semi-structured interviews with 22 SBAs within Palpa district, a hill district in the Western Region of Nepal; a focus group discussion with ten SBA trainees, and in-depth interviews with five key informants. RESULTS Participants identified the essential components of an enabling environment as: relevant training; ongoing professional support; adequate infrastructure, equipment and drugs; and timely referral pathways. All SBAs who practised alone felt unable to manage obstetric complications because quality management of life-threatening complications requires the attention of more than one SBA. CONCLUSIONS Maternal health guidelines should account for the provision of an enabling environment in addition to the deployment of SBAs. In Nepal, referral systems require strengthening, and the policy of posting SBAs alone, in remote clinics, needs to be reconsidered to achieve the goal of reducing maternal deaths through timely management of obstetric complications. [ABSTRACT FROM AUTHOR]

ABSTRACT Small island states are increasingly characterised by the growing role of international migration and remittances as components of national and household incomes. Recent household-level survey data on migration and remittances in two Pacific island states, Fiji and Tonga, demonstrate that where formal social protection systems are largely absent, migration and remittances can perform a similar function informally, contributing significantly to development objectives. Remittances also have a positive effect on poverty alleviation and wealth creation, although the impacts on income distribution are mixed. From a policy perspective, these informal social protection and poverty alleviation mechanisms may be more effective in promoting development than policies designed to incorporate remittances into the formal financial systems. Migration and remittances play an increasingly valuable role in small states where domestic development opportunities are limited. Copyright © 2013 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

We estimate the impacts of remittances on poverty in Tonga, a poor Pacific island country highly dependent on migrants' remittances. Using household survey data, we apply Propensity Score Matching (PSM) to estimate without-remittances incomes of migrant households from which counterfactual poverty rates are derived. We compare these with poverty rates from observed income including remittances to gauge their effects on poverty. We find that remittances reduce the incidence of poverty by 31 per cent and depth of poverty by 49 per cent. The results are robust both to alternative specifications of the PSM model and to use of an alternative counterfactual income estimation method. [ABSTRACT FROM AUTHOR]