Dissertationen zum Thema „Science indigène“
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De, Souza Ruiz Maria Auxiliadora. „La construction de la force indigène : éducation et formation des leaderships indigènes du Haut Rio Negro“. Versailles-St Quentin en Yvelines, 2006. http://www.theses.fr/2006VERS011S.
Der volle Inhalt der QuelleThis thesis contributes to the discussion on the processes of training of the indigenous leaderships of Brazilian Amazonia – specifically of Alto Rio Negro – by analysing the education programs of the governmental institutions of the Amazonas state. The research addresses the main orientations of the indigenous educational policy: What is the true meaning of an autonomous, suitable, specific and differentiated indigenous school? How can autonomy be reached by associating the indigenous school to present and future projects? Which elements contribute to unifying the indigenous leaderships? Which forms participation of the movements take in the constitution processes of the indigenous leaderships? The answers to these questions suggest the description of the phases of education of the various indigenous people and ethno-groups integrated into the national society. The link between traditional and contemporary indigenous leaderships also take an important place in the examination of social demands and the political action aspiring to power holding
VOLPI, LAURA. „LA SELVA INSTABILE. INTERPRETAZIONI INDIGENE E USI LOCALI DELLA SCIENZA GENETICA NELL¿ALTA AMAZZONIA PERUVIANA“. Doctoral thesis, Università degli Studi di Milano, 2020. http://hdl.handle.net/2434/731513.
Der volle Inhalt der QuelleLavergne, Roger. „Plantes médicinales indigènes : tisanerie et tisaneurs de la Réunion“. Phd thesis, Université Montpellier II - Sciences et Techniques du Languedoc, 1989. http://tel.archives-ouvertes.fr/tel-00978928.
Der volle Inhalt der QuelleHejdova, Eva. „L’entrepreneur indigène, la crevette et le jeu politique : la construction du « complexe aquacole » aux Philippines“. Paris, EHESS, 2011. http://www.theses.fr/2011EHES0487.
Der volle Inhalt der QuelleOur thesis proposes the study of the social, economic and political dynamics induced by the development of aquaculture and the emergence of new entrepreneurs in the Pampagna province of the Philippines. The objective is to show the conditions in which this entrepreneurship has been set up, its impact on society and inversely the manner in which society has formed entrepreurial has been set up, iots impact on society and inversely the manner in which society has formes entrepreneurial activities. The work stems from the theory that the construction of aquacultural entrepreneurship rests, in its diversity, on the entanglement of different logics: economic, social, political and symbolic at local, regional and national levels. First of all the thesis questions the innovative and at the same time risky nature of aquaculture which conditions entrepreneurial construction and social transformation in rural society. Afterwards by exmining the conditions of access to the resources necessary for aquaculture, the work underlines social embeddedness of entrepreneurial practices in social rules, in strongly personalised bilateral relationships, in the social network that the entrepreneurs build up and maintain both in the aquaculture complex and within local society. Finally this study shows that aquacultural entrepreneurs are also the actors of political and social change, able to act and influence decisions and political actions. The analysis of the different symbolic strategies shows the way in which the entrepreneurs build up and maintain their power within the local society and thus reinforce their ventures
Moukodoumou, Midepani Eric. „Les indigènes évolués dans l'oeuvre romanesque de Tchicaya U Tam'Si“. Paris 12, 2006. https://athena.u-pec.fr/primo-explore/search?query=any,exact,990002485580204611&vid=upec.
Der volle Inhalt der QuelleMesserer, Carmen. „Les relations administratives entre le clergé indigène et les autorités en Égypte romaine d'Auguste à Constantin“. Phd thesis, Université de Strasbourg, 2013. http://tel.archives-ouvertes.fr/tel-01057830.
Der volle Inhalt der QuelleRigottier-Gois, Lionel. „Recherche d'une acquisition par des rhizobium leguminosarum bv. Viciae génétiquement modifiés introduits dans un champ d'éléments génétiques en provenance de la population indigène“. Dijon, 1996. http://www.theses.fr/1996DIJOS031.
Der volle Inhalt der QuelleSchoebel, Isabelle. „Moving beyond Coloniality : The decolonial program of the French party Les Indigènes de la République“. Thesis, Malmö universitet, Malmö högskola, Institutionen för globala politiska studier (GPS), 2020. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-18617.
Der volle Inhalt der QuelleBianca, Monica. „Nymphes exotiques, indigènes victimes ou créatures vulgaires. Images des femmes grande-colombiennes d'après les voyageurs du XIXe siècle“. Phd thesis, Ecole normale supérieure de lyon - ENS LYON, 2013. http://tel.archives-ouvertes.fr/tel-00849177.
Der volle Inhalt der QuelleMoreno, Yánez Segundo E., und de Moreno Christiana Borchart. „Los Andes ecuatoriales: entre la estética y la ciencia : Las catorce láminas relativas al Ecuador en la obra ; Vues des Cordillères et Monumens des Peuples Indigènes de l’Amérique de Alexander von Humboldt“. Universität Potsdam, 2010. http://opus.kobv.de/ubp/volltexte/2010/4294/.
Der volle Inhalt der QuelleEhrentraut, Stefan. „Challenging Khmer citizenship : minorities, the state, and the international community in Cambodia“. Phd thesis, Universität Potsdam, 2013. http://opus.kobv.de/ubp/volltexte/2014/7035/.
Der volle Inhalt der QuelleIn der politischen Theorie und Praxis liberaler Demokratien hat sich die Idee eines explizit liberalen Multikulturalismus etabliert. Die internationale Gemeinschaft verbreitet diese Idee weltweit durch Völkerrechtsnormen und internationale Organisationen. Auf der Grundlage umfangreicher Feldforschung untersucht die vorliegende Dissertation die Internationalisierung von Minderheitenrechten am Beispiel Kambodschas. Dazu werden die Situation und Aspirationen von Kambodschas ethnischen Vietnamesen, Bergvölkern, islamischen Cham, ethnischen Chinesen und Laoten und das Verhältnis zwischen diesen Gruppen und dem Staat analysiert. Alle kambodschanischen Regimes seit der Unabhängigkeit haben Staatsbürgerschaft über die Ethnizität der Khmer Mehrheit definiert und diese Konzeption durch den Versuch der Assimilation der Bergvölker und Cham und den Ausschluss ethnischer Vietnamesen und Chinesen aktiv und oft gewaltsam zu verwirklichen versucht. Auch die aktuelle Verfassung definiert Mitgliedschaft im Gemeinwesen ethnisch. Das Streben des Staates nach der kulturellen ‚Khmerisation‘ der Bevölkerung privilegiert Mehrheitsmitglieder und marginalisiert Mitglieder kultureller Minderheiten politisch, wirtschaftlich und sozial. Trotz vielfältiger Initiativen ist die internationale Gemeinschaft daran gescheitert, in Kambodscha die Anwendung internationaler Minderheitenrechte zu erreichen. Die Analyse erklärt dieses Scheitern mit einer Reihe von Faktoren, darunter Kambodschas neo-patrimonialem Regierungssystem, den geo-politischen Ängsten einer ‚minoritisierten’ Khmer Mehrheit, dem Fehlen effektiver regionaler Sicherheitsinstitutionen, dem fehlenden Zugang von Minderheiten zu politischen Entscheidungsprozessen, den erheblichen Unterschieden zwischen internationalen und kambodschanischen Konzeptionen von moderner Staatlichkeit und Staatsbürgerschaft sowie der zunehmenden Bedeutung Chinas als Kambodschas wichtigstem bilateraler Geber und Investor. Auf der Grundlage dieser Analyse entwickelt die Arbeit Empfehlungen, wie die internationale Gemeinschaft mit einem sequenzierten Ansatz die schrittweise Annäherung an internationale Normen und deren langfristige Einhaltung erreichen kann.
Coulibaly, Tiémoko. „Élites "évoluées" et populations "indigènes" en Côte-d'Ivoire pendant la colonisation (1946-1960) : les valeurs paradoxales d'une mobilisation politique“. Paris 1, 1997. http://www.theses.fr/1997PA010590.
Der volle Inhalt der QuelleThis thesis is about the paradox of the so called "advanced" colonized African elites that celebrate french colonisation and that mobilize through the creation of political parties and the defense of colonial ideology they were taught in colonial schools for the purpose of domesticating endigenous populations who impatiently put up with colonial oppression and are at the same time tempted by rebellion. Hence forth the political mobilisation of colonized masses by the "advanced" elites becomes a challenge due to the paradoxical nature of the political at stake. These values that function in this case as the powerful ideological and political determinism are analysed from the standpoint of the political vocabulary of the era. At first, the training of this "advanced" elite in french colonial schools, its aspirations to the political and cultural assimilation by the colonizer who is seen as a model, its denial of any political independence for the colony are exposed. In Côte d'Ivoire, the personality of Houphouët-Boigny, the charismatic leader is predominant. Then the analysis deals with the "indigenes" subdued with the attempt to encompass the political aspirations and their hidden or expressed claims. Third, the impossibility of interactions meant to mobilize "advanced" elites and "indigenes" has been underlined because of the incompatibility of their political aspirations and the profound contempt of the colonized elite toward "indigenes". But ultimately the "advanced" elite of cote d'ivoire will be compelled to assume the political independence imposed by a french colonial power confronted with numerous rebellions colonized masses in Asia and North Africa and which can no longer achieve its old imperial dream. Throughout this thesis the official history that portrays Houphouët-Boigny and his party as hereon anti-colonialists is questionable considering the archives
Yahiel-Eriksson, Véronique. „Une micro-ethnographie indigène au sein d'un dispositif de validation d'acquis dans l'académie de Montpellier : A travers les méandres, franchissant les écluses, ainsi coule la reconnaissance de l'expérience“. Phd thesis, Université Rennes 2, 2007. http://tel.archives-ouvertes.fr/tel-00189640.
Der volle Inhalt der QuelleTruffin, Barbara. „Représentations et pratiques du "Droit" en Amazonie équatorienne: la garantie constitutionnelle des droits des peuples indigènes en contexte“. Doctoral thesis, Universite Libre de Bruxelles, 2004. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/211099.
Der volle Inhalt der QuelleLe, Masne Camille. „Les dynamiques spatiales sur la façade caraïbe de l'Amérique centrale : pouvoirs et formation des territoires dans un espace de marges“. Phd thesis, Université Paris-Diderot - Paris VII, 2010. http://tel.archives-ouvertes.fr/tel-00601148.
Der volle Inhalt der QuelleBrunet-La, Ruche Bénédicte. „"Crime et châtiment aux colonies" : poursuivre, juger, sanctionner au Dahomey de 1894 à 1945“. Phd thesis, Université Toulouse le Mirail - Toulouse II, 2013. http://tel.archives-ouvertes.fr/tel-00979289.
Der volle Inhalt der QuelleNespoulous-Phalippou, Alexandra. „Traditions indigènes et hellénisme en Égypte lagide : le décret de l'an 23 de Ptolémée Épiphane et les décrets des synodes sacerdotaux de son règne (204-180 a.C)“. Thesis, Montpellier 3, 2011. http://www.theses.fr/2011MON30082.
Der volle Inhalt der QuellePublished in the early century by G. Daressy, the two stones from the Cairo Museum (RT 2/3/25/7 and JE 44901) are the only known copies to-date of Ptolemy Epiphanes’ decree written in year 23 BC ; although exclusively written in hieroglyphic text, they clearly present formal and phraseological similarities with the decrees from the priestly synods of that reign, decrees which some of them were published in the three used kinds of writing (hieroglyphic, greek and demotic). This study aims to provide a normalized version following a synoptic version of those two monuments. It is accompanied by a critical apparatus, a translation, philological commentaries, photographs and facsimiles. Also, in order to present an accurate philological study of the texts, an upto- date translation of the three previous decrees (Decree of Memphis II and the two other said “Decrees of Philae”) is provided, based on the hieroglyphic version.This official epigraphic documentation, specific to the Ptolemaic period, forms a strong knowledge base that provides valuable insights on the political events which occurred at the end of Ptolemy Epiphanes’ reign (204-180 BC). The understanding of the relationship evolution between the Alexandrian Crown and the indigenous clergies relates to two problems. On one hand, the heterogeneity of the corpus acts these synodal decrees are part of. On the other hand, the paradox that constitutes this Ptolemaic dynast’s reign, presented as a key factor in the decline of the Alexandrian authority (in Egypt as well as in the Eastern Mediterranean regions), when numerous decrees were published stating the openhandeness towards the divinities and the Egyptian people
Vanhoenacker, Maxime. „"Suis moi et tu seras autonome!" Ethnographie de la citoyenneté dans le scoutisme laïque des EEDF“. Phd thesis, Ecole des Hautes Etudes en Sciences Sociales (EHESS), 2012. http://tel.archives-ouvertes.fr/tel-00862668.
Der volle Inhalt der QuelleCottereau, Claire Marie. „Modernités plurielles : construire des espaces différenciés. Négociations, adaptations et résistances des Indiens Guarani du littoral de Santa Catarina au Brésil“. Thesis, Pau, 2013. http://www.theses.fr/2013PAUU1006/document.
Der volle Inhalt der QuelleThe purpose of this political geography thesis is to analyse the negotiations processes undertaken by some Indians, the Guarani to make space for themselves in a modern State, Brazil. This space, considered as a place for living as well as political commitment, implies of course the recognition of their traditional territories, the respect of their cultures and their real participation to the elaboration of plural modernities, inside a changing Brazilian modernity. Today, most of them enclosed in insufficient spaces and in precarious economical situations, the Guarani try to reconstruct a viable cultural autonomy according to their cultural and territorial ideals. The construction of their autonomy is obtained by a better control of the exchanges with the Brazilian society and by a better formulation of kind of life they wish. In fact, these choices are nowadays much better claimed in all State organisations and scales thanks to the creation of political organizations suited for Its vertical structure. By questioning the creative process of the new political organization of the Guarani Indians from the Santa Catarina coast in Brazil, two processes are particularly questioned : on one hand, the creation effects of these new organizations on traditional organization as well as on the modification of the leaders’ role ; on the other hand, this organizations’ capacities of redesigning the scales of the political action of the State’s indigenist organizations. The analysis of these mechanisms rests on a seven years period of observation with the Guarani communities of the coast and on a panel of interviews essentially carried out with Guarani leaders. The comings and goings between the different scales of observation are one of the keys to understand these phenomena, in its permanent scale recompositions. Considering the economical development, health or education, the different way to get involved in the formulation of the public politics concerning Indians, modifies the parameters of the social control and the real participation of the latter in choices that directly concern them. Nowadays, being confronted to a political context more and more hostile to Indians, these must show even stronger mobilizations in order to obtain the respect of their rights registered in the Brazilian Constitution and most of all, their land, the resources of which are extremely coveted
Pesses, Abigaël. „Les Karen : Horizons d'une population frontière. Mises en scène de l'indigénisme et écologie en Thaïlande“. Phd thesis, Université de Nanterre - Paris X, 2004. http://tel.archives-ouvertes.fr/tel-00370779.
Der volle Inhalt der QuelleMasumbuko, Céphas Ndabaga. „Ecologie de Sericostachys scandens, liane envahissante dans les forêts de montagne du Parc national de Kahuzi-Biega, République démocratique du Congo“. Doctoral thesis, Universite Libre de Bruxelles, 2011. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209962.
Der volle Inhalt der QuelleDepuis environ une décennie, la liane indigène Sericostachys scandens Gilg & Lopr. (Amarantaceae) se répand rapidement dans les forêts de montagne au PNKB. L’extension de cette liane, et ses conséquences supposées sur la biodiversité et la régénération de la forêt inquiètent les gestionnaires du Parc.
Le travail a examiné trois aspects de l’écologie de l’invasion par S. scandens dans le Parc.
Premièrement, on a examiné les traits fonctionnels susceptibles d’expliquer une aptitude élevée à l’invasion chez S. scandens. Une approche comparative avec trois espèces de lianes non envahissantes coexistant dans le même habitat montre que S. scandens présente une allocation de biomasse aux diaspores significativement plus élevée. En plus, elle combine une reproduction sexuée intense et une capacité de reproduction végétative. Cette liane se distingue également des trois autres par un taux de ramification plus élevé. Par contre, les traits foliaires ne sont pas systématiquement différents. De même, le taux de germination des graines de S. scandens ne diffère pas significativement de ceux des autres lianes étudiées. Cependant, il est significativement plus élevé en canopée ouverte qu’en canopée fermée, et en forêt ombrophile qu’en forêt de bambous. L’ensemble des traits qui caractérisent S. scandens peut contribuer à expliquer sa plus grande capacité d’invasion, comparativement aux trois autres lianes.
Deuxièmement, on a examiné les attributs des écosystèmes susceptibles de les rendre vulnérables à l’invasion. Les résultats suggèrent que les perturbations favorisent les invasions dans les écosystèmes. Les perturbations (coupes, feu, …) qui ont accompagné les conflits dans la zone du Parc sont, très probablement, le facteur ayant déclenché l’invasion.
Enfin, le travail a examiné les impacts de l’invasion sur la biodiversité et la régénération des forêts. Les résultats montrent que, effectivement, S. scandens a un impact négatif, et que cet impact pourrait contribuer à renforcer le succès invasif de S. scandens (feed-back positif).
Le travail aboutit à des recommandations pour la gestion du Parc. La gestion doit avant tout être préventive, c’est-à-dire i) empêcher de nouveaux déboisements et ii) éliminer S. scandens au tout début de son installation dans un site perturbé.
Doctorat en Sciences
info:eu-repo/semantics/nonPublished
Maass, Petra. „The cultural context of biodiversity conservation“. Doctoral thesis, Göttingen Univ.-Verl. Göttingen, 2007. http://hdl.handle.net/11858/00-1735-0000-000D-F23A-C.
Der volle Inhalt der QuellePagani, C. „POLITICHE DI RICONOSCIMENTO NEI MUSEI DI ETNOGRAFIA E DELLE CULTURE NEL XXI SECOLO“. Doctoral thesis, Università degli Studi di Milano, 2014. http://hdl.handle.net/2434/237459.
Der volle Inhalt der QuelleThrough a genealogical approach and in the context of theories on multiculturalism, this work intends to analyse museums as public institutions, builders of identity, nation-state instruments and venues for the exercise of politics of recognition. The following research focuses on ethnographic and cultural museums, which have subject to criticism since the 1980's due to their colonial legacy and anachronic mission in today's global and post-colonial world. Thanks to indigenous people movements and the development by European institutions and UN agencies such as UNESCO of international norms on cultural diversity and return of cultural property, museums have turned into theatres where indentities are built and claims for recognition are negotiated. As a result, new institutional strategies have been adopted in order to go beyond the ethnographic approach. The principle of recognition is key to understand this paradigm shift. Following a pluridisciplinary approach and through case studies in Europe and in the United States, this work aims at building a bridge between political philosophy and museum studies. It proposes an analysis of various institutions based on four principles of recognition in relation to indigeneous peoples, universalism, colonial history and globalisation.
À partir d’une approche généalogique et à la lumière des théories sur le multiculturalisme, ce travail analyse le musée en tant qu’institution publique nationale, fabrique d’identités, instrument de l’État-nation et lieu d’exercice des politiques de reconnaissance. L’objet de cette recherche est le musée d’ethnographie et des cultures qui depuis les années ’80 a été témoin de nombreuses critiques et d’une crise d’identité, du fait notamment de son héritage colonial et de sa mission anachronique dans le contexte du monde postcolonial et globalisé d’aujourd’hui. Suite aux mouvements des peuples autochtones et au développement des normes internationales relatives à la diversité culturelle et au retour des biens culturels promues par différentes agences des Nations Unies comme l’UNESCO ainsi que par les institutions européennes, les musées d’ethnographie sont devenus des théâtres où se négocient et se construisent des identités et où s’arbitrent les demandes de reconnaissance. De nouvelles stratégies institutionnelles ont ainsi été adoptées afin de dépasser le modèle ethnographique. Le principe de reconnaissance est notamment une clé de lecture essentielle pour interpréter et comprendre ce changement de paradigme. En suivant une perspective pluridisciplinaire et à travers des études de cas en Europe et aux États-Unis, ce travail vise à établir une passerelle entre la philosophie politique et la muséologie. Il propose ainsi une analyse de différentes institutions selon quatre principes de reconnaissance concernant le cas des peuples autochtones, le rapport à l’universalisme, la relation à l’histoire coloniale et la globalisation.
BRAGA, ANIKA. „INTERVENTI NEL PROCESSO DI PRODUZIONE DELLE BEVANDE FERMENTATE PER UN MIGLIORAMENTO GUSTO - OLFATTIVO E IGIENICO - SANITARIO DEI PRODOTTI“. Doctoral thesis, Università Cattolica del Sacro Cuore, 2009. http://hdl.handle.net/10280/421.
Der volle Inhalt der QuelleSelected microrganisms are important as agents of the main processes of transformation of the raw materials in fermented product but also as responsible of the improvement in the shelf-life, texture, taste, aroma, as well as safety and nutritional value. The market globalization made us to consider not only popular food and/or beverage in Europe but also in non European countries. In this research I consider wine and cassava products. As regards wine the aim is to improve the Ortrugo wine typicalness by Saccaromyces cerevisiae autochtonous strains. In spontaneous fermentations the yeasts vary according to geography location, climatic conditions and/or grape variety. Some researchers believe that each micro-environment is characterised by specific Saccaromyces cerevisiae that may enhance the grape flavours. Unfortunately spontaneous fermentations may cause off-flavours and fermentation stuck. The selected yeast inoculum in must is one of the consolidated practices to eliminate the risks of spontaneous fermentation, but these yeast are not able to emphasise the characters of grape variety because they are from different ecosystems. Autochthonous yeasts e.g. yeasts isolated from a definite micro-environment are adapted to operate in a must whose characteristics are determined by the variety of the grapes and the “terroir” and, therefore, they able to enhance the peculiarities of a wine. As regards the cassava (Manihot esculenta Crantz) selected microorganisms will be used to reduce the cyanogenic glucosides (mainly linamarin and lotaustralin) toxic molecules. Consumption of cassava and its products may cause cyanide poisoning with symptoms of vomiting, nausea, dizziness, stomach pains, weakness, headache and diarrhoea and occasionally death. Cyanide intake from cassava is almost certainly the cause of Konzo (irreversible paralysis of the legs) in eastern, central and southern Africa. The World Health Organisation (WHO) has set the safe level of cyanogens in cassava flour at 10 ppm (FAO/WHO, 1991).
BRAGA, ANIKA. „INTERVENTI NEL PROCESSO DI PRODUZIONE DELLE BEVANDE FERMENTATE PER UN MIGLIORAMENTO GUSTO - OLFATTIVO E IGIENICO - SANITARIO DEI PRODOTTI“. Doctoral thesis, Università Cattolica del Sacro Cuore, 2009. http://hdl.handle.net/10280/421.
Der volle Inhalt der QuelleSelected microrganisms are important as agents of the main processes of transformation of the raw materials in fermented product but also as responsible of the improvement in the shelf-life, texture, taste, aroma, as well as safety and nutritional value. The market globalization made us to consider not only popular food and/or beverage in Europe but also in non European countries. In this research I consider wine and cassava products. As regards wine the aim is to improve the Ortrugo wine typicalness by Saccaromyces cerevisiae autochtonous strains. In spontaneous fermentations the yeasts vary according to geography location, climatic conditions and/or grape variety. Some researchers believe that each micro-environment is characterised by specific Saccaromyces cerevisiae that may enhance the grape flavours. Unfortunately spontaneous fermentations may cause off-flavours and fermentation stuck. The selected yeast inoculum in must is one of the consolidated practices to eliminate the risks of spontaneous fermentation, but these yeast are not able to emphasise the characters of grape variety because they are from different ecosystems. Autochthonous yeasts e.g. yeasts isolated from a definite micro-environment are adapted to operate in a must whose characteristics are determined by the variety of the grapes and the “terroir” and, therefore, they able to enhance the peculiarities of a wine. As regards the cassava (Manihot esculenta Crantz) selected microorganisms will be used to reduce the cyanogenic glucosides (mainly linamarin and lotaustralin) toxic molecules. Consumption of cassava and its products may cause cyanide poisoning with symptoms of vomiting, nausea, dizziness, stomach pains, weakness, headache and diarrhoea and occasionally death. Cyanide intake from cassava is almost certainly the cause of Konzo (irreversible paralysis of the legs) in eastern, central and southern Africa. The World Health Organisation (WHO) has set the safe level of cyanogens in cassava flour at 10 ppm (FAO/WHO, 1991).
Tietgen, Jörn. „Indigene Bewegung und "Identitätspolitik" in Ecuador“. Master's thesis, 2008. http://hdl.handle.net/11858/00-1735-0000-0006-AEF5-D.
Der volle Inhalt der QuelleTurcotte-Tremblay, Anne-Marie. „The unintended consequences of a complex intervention combining performance-based financing with health equity measures in Burkina Faso“. Thesis, 2020. http://hdl.handle.net/1866/24272.
Der volle Inhalt der QuelleBackground: Poor quality and low utilization of healthcare services contribute to high levels of morbidity and mortality in many low- and middle-income countries (LMICs). In response, the government of Burkina Faso tested an innovative intervention that combines performance-based financing (PBF) with health equity measures. Healthcare facilities received unit fees for targeted services and bonuses conditional upon the quality of care. To reduce inequities in access to care, community-based committees selected indigents, i.e., the poorest segment of the population, to offer them user fee exemptions. Facilities were also paid more for services delivered to indigents. Despite the potential of this type of intervention, many global health actors argue that it could lead to important unintended consequences that influence its overall impact. Yet, little attention has been given to studying the unintended consequences of this complex intervention. Objective: This thesis aims to increase the scientific knowledge on the unintended consequences of PBF combined with health equity measures in a low-income setting. Methods: We developed a conceptual framework based on the diffusion of innovations theory. Using a multiple case study design, we selected nine healthcare facilities in Burkina Faso. Over five months of fieldwork, we collected multiple sources of qualitative data including 104 semi-structured interviews, 266 recorded observation sessions, informal conversations and documentation. Participants included a wide range of stakeholders, such as providers, patients, and PBF verifiers. Data were coded using QDA miner to conduct a thematic analysis. We also used secondary data from the PBF routine management system to describe the evolution of services and triangulate results. Results: Interactions between the nature and implementation of the intervention, the nature of the social system, and its members’ characteristics led to important unintended consequences, most of which were undesirable. Providers were fixated on performance measures rather than on underlying objectives, falsified medical registers, and taught trainees improper practices to increase subsidies and bonuses. As a desirable unintended consequence, we found that some facilities limited the sale of non-prescribed medication to encourage patients to consult. Community verifications, in which patients are traced to verify the authenticity of reported services and patient satisfaction, also led to unintended consequences, such as the falsification of verification data, the loss of patient confidentiality, and fears among patients, although some were pleased to share their views. Lastly, health equity measures also triggered changes that were not intended by program planners. For example, providers limited the free services and medication delivered to indigents, which led to conflicts between parties. Discussion: This thesis contributes to the development of scientific knowledge on how PBF interventions, combined with equity measures, can trigger unintended consequences in a low-income setting. The results are useful to inform effective implementation and refine interventions, particularly in the health financing sector. More broadly, this thesis demonstrates the feasibility and added value of using a conceptual framework to study the unintended consequences of complex health interventions. This thesis can inspire and guide future researchers to broaden their analytical horizons to capture both intended and unintended consequences of health interventions.