Dissertations / Theses on the topic 'National public health policy'
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Douglas, Flora. "National public health policy and its local implementation." Thesis, University of Aberdeen, 2010. http://digitool.abdn.ac.uk:80/webclient/DeliveryManager?pid=165977.
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Translation of national public health policy into local action is poorly understood. This thesis explores this issue using: (a) independent evaluation data of the government-funded Well Men’s Services Pilots Programme (WMS); and (b) an analytical framework derived from ‘rational’ health planning models; particularly the PRECEDE PROCEED (PP) model. A mixed-methods study was conducted, comprising: (i) a review of the health planning literature; (ii) an interpretative documentary analysis of policy documentation and local intervention plans; and (iii) a secondary analysis of 42 semi-structured interviews with local managers and professionals responsible for developing interventions in response to the policy. The research findings (ii&iii) were considered in light of this review. This thesis concluded that rationalist health planning approaches and frameworks are not sufficient to guide the implementation of public health policy to an effective conclusion, and has argued that there is a need to develop new ways of thinking about public health issues that have become ‘policy problems’ deemed in need of intervention and resolution. This new thinking needs to acknowledge the complex and contested nature of health problems. This include accepting: (1) that a range of different perspectives and interpretations of public health policy problems and associated notions of their solutions will reside amongst those individuals and organisations tasked with transforming policy into practice; (2) the inevitability of imperfect and contested evidence; (3) future uncertainties, and; (4) the existence of bureaucratic barriers that will constrain direct engagement of the intended beneficiaries, by policy implementers, in the process of developing interventions.
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Currie, Margaret Rosetta. "Social policy and public health measures in Bedfordshire, within the national context, 1904-1938." Thesis, University of Bedfordshire, 1998. http://hdl.handle.net/10547/295747.
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This thesis examines some social policies and public health measures in the small county of Bedford, within the national context, 1904-38. No other such study exists which covers these aspects; it will, therefore, fill a gap in the body of knowledge. At this time, national and imperial needs for a healthy British race were paramount in the minds of politicians and social reformers, particularly in the face of competition for industrial and military supremacy from other powers, including Germany and the United States of America. Certain key themes permeated this era: the changing functions of local and central government, the role of the state and voluntary sectors, and a medical profession divided between those employed in preventive medicine, and those in private practice. However, war, the preparation for war and its after effects have been found to be the most significant factors. George Newman (1870-1948), figures large, because he played a major part in public health initiatives, firstly, as part-time County Medical Officer of Health to Bedfordshire County Council (1900-07), and then at central government level, as Chief Medical Officer of the Board of Education (1907-35), and of the Ministry of Health (1919-35). Two methodological tools were used in this thesis. Historical research was carried out using, mainly, primary source material, and an empirical study was undertaken using a descriptive case study approach. These methods enabled the collection of quantitative and qualitative data and helped to determine both the final content, and the form in which the research was presented. Chapter 1, the Introduction, provides a background to the key figures and themes discussed and describes the intra-county differences in Bedfordshire. Chapter 2 concerns infant mortality, as it is an indicator of the health ofthe whole community. Chapter 3 describes the health of school children, because the Government was particularly anxious about their condition, as they would be needed for industrial and imperial expansion, and in the event of war. Chapter 4 concerns the welfare of children. It provides examples of how the state and voluntary sectors strove to preserve child life, despite problems such as orphanhood and cruelty, and yet still attempted to meet the needs of the British Empire for labour. Chapter 5 discusses women's health, as it was relatively neglected by central government in this period. It takes the form of a case study and makes use of oral testimony from a cohort of 84 women who lived in Bedfordshire in the inter-war years. Chapter 6, the conclusion, examines the effect of war, the role played by the voluntary and state sectors, and the divided medical profession. It also considers the extent to which Bedfordshire led, or lagged behind national social policies and public health measures, and the progress made towards a healthier nation until 1938, the last full year of peace in Europe before the outbreak of World War II.
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Johnson, Taylon M. "Autism Policy: State and National Legislation Analysis." Scholarship @ Claremont, 2012. http://scholarship.claremont.edu/cmc_theses/278.
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This research thesis is a policy assessment of the factors that contribute to the current status in treating autism. The policy assessment begins with a description of the key components that that influence policy outcomes in regard to autism.
After developing a policy model that outlines various components of issues and approaches to the policy has on Autism, the paper examines several issues with regard to Autism policy, including the lack of insurance coverage, state legislation, waiting lists, evidence vs. non evidence treatments, and the high price for treatments. The paper also examines current approaches to Autism, and potential solutions. Solution analysis on current policy alternatives is provided and, this suggests that increasing knowledge and awareness of the affects of autism on society needs further attention along with proper funding for early treatment.
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Wood, Aileen J. "Towards a national library and information services policy in public sector healthcare in the United Kingdom." Thesis, University of Brighton, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.275086.
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Narayan, Thelma. "A study of policy process and implementation of the National Tuberculosis Programme in India." Thesis, London School of Hygiene and Tropical Medicine (University of London), 1998. http://researchonline.lshtm.ac.uk/682263/.
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TB, a major public health problem in India since the 1900s, has a current prevalence of 14 million and an estimated annual mortality of 500,000 persons. Nation-wide government sponsored anti-TB public health measures introduced in 1948, developed into the National TB Programme in 1962. Despite gains, implementation gaps between programme goals and performance, over 35 years, have been of a magnitude sufficient to cause concern. This study aimed to understand explanatory factors underlying the implementation gap. A policy analysis approach was adopted, focusing on the policy process and specifically on implementation, at national, state, district and local levels. It undertook a historical review with a two-tiered framework covering the period 1947-97. In the first tier the historical narrative is woven around a framework of context, content, process and actors. The nature of the problem and policy relevant technical dimensions of intervention measures are discussed, as are effects of pharmaceutical policies and financial resource flows on TB policy. The second tier applies a framework of implementation factors to national policy development and implementation at state and district level. Interviews were conducted with TB patients, elected representatives, front-line health workers, doctors, district and state staff, national programme managers, researchers and representatives from international agencies. Documents were reviewed. Thus the study incorporated an integrative bottom-up cum top-down approach. Findings highlight that interests of patients, medical and allied professionals, pharmaceutical and diagnostic industries and the state are interdependent, but often conflictual. Unequal societal relations affect not only the development and transmission of TB, but also the implementation of control programmes, particularly for the impoverished, among whom high levels of indebtedness due to the disease and difficulties accessing private services were noted. Techno-managerial approaches to TB control often mask societal and policy process factors accounting for the implementation gap. The importance of leadership, institutional development, capacity at the patient provider interface and accountability and need for sustained policies were noted, within an affirmative framework embodying social justice and safeguarding the interests of the majority of patients.
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Wright, Jessica Ann. "Implications of a Universal Healthcare System in the United States: Why Individual Health Is Now of National Concern." Thesis, Virginia Tech, 2014. http://hdl.handle.net/10919/49385.
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In 2010, the Patient Protection and Affordable Care Act (ACA) was signed into law. This paper explores the implications of these new healthcare policies in the United States, given that a universal healthcare system has already being put in place. More specifically, it explores the question "Does the new 'universal healthcare' system bring with it obligations for citizens participating within the system to be more conscientious about their health and lifestyle choices? And if so, on what grounds?". I argue that individuals have strong social and moral obligations within a universal healthcare system to take the minimal provisions required for staying healthy (eating healthy, exercising, getting vaccinations, smoking cessation, and attending routine "check-ups" in order to not burden others with easily avoidable healthcare costs. These new obligations are grounded in the duty of fair play stemming from the fact that health insurance is a cooperative scheme. Furthermore this paper will show that when a universal healthcare scheme is in place, the healthcare resources become a 'common good' which is susceptible to a collective action problem known as 'the tragedy of the commons', and thus also give recommendations for its solution. The solutions that I endorse, although designed to address the free-rider problem recognized David Winkler, shows that Winkler's solution goes too far by indiscriminately punishing every unhealthy individual within a universal healthcare system.Master of Arts
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Jean-Louis, Angela. "Influencing American Health Policy: An Analysis of the Role of National Black Women-Led Organizations." DigitalCommons@Robert W. Woodruff Library, Atlanta University Center, 2017. http://digitalcommons.auctr.edu/cauetds/73.
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Through a multiple case study approach, this dissertation outlined patterns of activism, examined the factors that assist in decision-making strategies used for the political mobilization of black women, and assessed the role and influence their organizations have in the health policy arena. Building on the belief that the intersectionality of race, gender, and class guides the activism of black women, the study acknowledges the importance of analyzing the political conditions of black women that are different from black men and white women. Furthermore, the research offered an argument for the need of a theoretical framework that provides a multidimensional analysis of black women’s political representation. For that reason, the theory developed in this study was a Black Women’s Activism Theoretical Framework. Expanding on black feminist thought, the framework reveals ways in which black female activists have mobilized for self-representation and building of their own collective self, vision, and voice.
A mixed research method and holistic case studies of five national black women- led organizations in the areas of breast cancer, cardiovascular disease, and HIV/AIDS were applied. The qualitative data were quantified, coded, and placed on outcome, legislative, and perception success scales to gauge the level of successfulness achieved by the organizations from 2001 to 2015. The data were analyzed with a Black Women’s Activism model. With this analytical tool, the role and level of successfulness of black women-led organizations in the health policy arena were examined within the context of socioeconomic factors and historical barriers due to the intersectionality of their race, gender, and class, thus validating that the shared experiences of black women characterize their organizational behavior. Moreover, this study challenges the traditional definitions of activism, opting instead to place black women as political actors independent of the dominate group. The findings reveal that there are multiple pathways leading to the attainment of the ability to influence health policy and that black women-led organizations have played a pivotal role in doing so. Dispelling the myth that the political activism of black women should be through the lens of victimhood, the utilization of a Black Women’s Activism model has the potential to assist researchers in increasing their accuracy when assessing the extent in which black women-led organizations have been able to exercise a critical voice within the prevailing political culture.
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Garcia, Lucas Aaron. "Fire Training Fatalities and Firefighter Adherence to National fire Protection Association Standards." ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6204.
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Sudden cardiac arrest continues to be a major cause of firefighter deaths during training due to a lack of individual firefighter adherence to National Fire Protection Association (NFPA) standards. These standards identify requirements for fire departments to create and maintain fitness programs. Existing research has not identified any relationships between training fatalities and individual firefighter adherence to NFPA 1583, Standard on Health-Related Fitness Programs for Fire Department Members. Using self-determination theory as the foundation, the purpose of this cross-sectional correlation study was to investigate whether individual firefighter adherence to NFPA 1583 has a measurable effect on training fatalities. Survey data were collected from 441 paid firefighters from 7 fire departments located in a rural county in a southern U.S. state. Data were analyzed using multiple linear regression. Results indicated that adherence to NFPA 1583 has a statistically significant relationship with reduced firefighter training fatalities (p = .000). Recommendations include examining adherence policies to all elements of the NFPA 1583 standard, not just chapters 5 through 8 in the publication. These include chapter 1 administration, chapter 2 referenced publications, chapter 3 definitions, and chapter 4 program organization specifications. The study results may be used by fire department training divisions to improve the health and safety of firefighters.
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Lim, Sang Hun. "Regulation of the pharmaceutical market in the South Korean National Health Insurance." Thesis, University of Oxford, 2011. http://ora.ox.ac.uk/objects/uuid:0866cb3c-9939-4ccf-9d1f-d16c7f689f41.
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This thesis explores the implications of democratisation on the regulation of health care providers. It examines the reforms in relation to two regulatory policies in the pharmaceutical market of the National Health Insurance (NHI) in South Korea – the separation of prescribing and dispensing (SPD) and the pharmaceutical pricing policy – conducted in two periods – the 1980s under the authoritarian regime and the 1990s under the democratised regime. The misuse and overuse of drugs had long been recognised as a problem for the NHI, and the tight regulation of the SPD and pharmaceutical pricing as potential solutions. Democratisation seems unlikely to tighten the government’s regulation of the SPD and pharmaceutical prices. On the one hand, the Korean authoritarian regime was known as being capable of conducting top-down regulation of societal groups, and democratisation as having liberalised the government-society relationship. On the other, pharmaceutical regulation is a sophisticated and detached issue, which restricts the ability of laypeople to mobilise and exert bottom-up pressure for regulation. Nevertheless, the authoritarian government failed to tighten, and even loosened these regulations, whereas the democratised government tightened them. This thesis explains this puzzle by focusing on the features of the agenda-setting process and the articulation of policy issues therein. In the 1980s, the SPD and the pharmaceutical reimbursement pricing policy were administrative issues, discussed exclusively between bureaucrats and the central associations of health care providers, which resulted in loose regulation. In contrast, in the 1990s, reform-oriented professionals and NGOs raised these issues and put them on the political agenda, which motivated the government to conduct tighter regulation. This thesis suggests some general implications of democratisation on the politics of regulation. The hierarchical and exclusive authoritarian policy network aims to realise policy goals set by ruling elites; however, for other policy issues, societal partners can utilise this network to promote their preferred policies. Democratisation, which promotes competitive elections and political rights, allows previously excluded policy actors to participate in policy-making networks. These new actors include professionals and activists who are able to understand regulatory issues and articulate them in ways that are salient to politicians and the general public, which will motivate the government to tighten the regulation governing its traditional policy partners.
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Choi, Jong-Kyun. "Democratisation and the politics of welfare reform : the development of public pensions and national health insurance in Korea, 1961-2002." Thesis, University of Kent, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.270682.
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DeGroff, Amy S. "New Public Management and Governance Collide: Federal-Level Performance Measurement in Networked Public Management Networks." Atlanta, Ga. : Georgia Institute of Technology, 2009. http://hdl.handle.net/1853/29654.
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Thesis (Ph.D)--Public Policy, Georgia Institute of Technology, 2009.Committee Chair: Theodore H. Poister, Ph.D.; Committee Member: Gordon Kingsley, Ph.D.; Committee Member: John Thomas, Ph.D.; Committee Member: Judith Ottoson, Ph.D.; Committee Member: Patricia Reeves, Ph.D. Part of the SMARTech Electronic Thesis and Dissertation Collection.
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Virk, Amrit Kaur. "Expanding health care services for poor populations in developing countries : exploring India's RSBY national health insurance programme for low-income groups." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:3e65305c-ba60-408a-8c0a-8957767f6596.
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Health is deemed central to a nation’s development. Accordingly, health care reform and expansion are key policy priorities in developing countries. Many such nations are now testing various methods of funding and delivering health care to local disadvantaged populations. Similarly, India launched the Rashtriya Swasthya Bima Yojana (RSBY) national health insurance programme for low-income groups in 2008. The RSBY intends preventing catastrophic health-related expenditure by improving recipients’ access to hospital-based care. This thesis is an in-depth qualitative evaluation of the RSBY in Delhi state. It examines the RSBY’s effectiveness in fulfilling its goals and meeting local health care needs. Walt and Gilson’s (1994) actors-content-process-context model informs the research design and an actor-centred “responsive” (Stake 1975) or “constructivist” approach guides data analysis. Three research questions are examined: (i). Why was a health insurance programme launched and why now? Why was this model favoured over alternate methods of service expansion? (ii). Is the RSBY delivered as intended? If not, why? (iii) How does the RSBY affect patients’ access to services? The findings are based on documentary sources, observation of implementation sites and activities and 164 semi-structured interviews with RSBY policymakers, insurers, NGOs, doctors, and patients. The results show improved access to curative and surgical care for RSBY patients. However, RSBY’s focus on hospitalisation and omission of primary and outpatient services had undesired negative effects. The lack of ambulatory facilities led RSBY patients to self-medicate or use dubious quality informal providers. By only allowing inpatient care, the RSBY also seemingly encouraged the substitution of outpatient care with costlier hospitalisations. In effect, the RSBY’s design contributed to cost increases and poor patient outcomes. While more funds and human resources were needed to improve RSBY implementation, the performance of frontline agencies could potentially improve through more stable, longer-term contracts. Similarly, modifying RSBY’s monetary incentives for doctors may lead to better service delivery by them. By evaluating the RSBY’s strong points and shortcomings, this thesis provides key lessons on strengthening policy design and health service delivery in developing countries. Thereby, it makes a broader contribution to understanding the determinants of successful policymaking.
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Sang, Hilla I. "National Estimates and Complex Sample Regression Modeling of the Financial Burden of Health Care Among the U.S. Nonelderly Population." Kent State University / OhioLINK, 2019. http://rave.ohiolink.edu/etdc/view?acc_num=kent1563283247018918.
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Dell'Aera, Anthony D. "Prescription drug regulation and the art of the possible : reconciling private interest and public good in American health care policy." View abstract/electronic edition; access limited to Brown University users, 2008. http://gateway.proquest.com/openurl?url_ver=Z39.88-2004&rft_val_fmt=info:ofi/fmt:kev:mtx:dissertation&res_dat=xri:pqdiss&rft_dat=xri:pqdiss:3318305.
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Gibson, Brendan John Joseph, and brendan gibson@health gov au. "From Transfer to Transformation: Rethinking the Relationship between Research and Policy." The Australian National University. National Centre for Epidemiology and Population Health, 2004. http://thesis.anu.edu.au./public/adt-ANU20040528.165124.
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The most common and enduring explanation for the way research is used (or abused or not used) in policy is the two communities theory. According to this theory, the problematic relationship between research and policy is caused by the different cultures inhabited by policy makers and researchers. The most common and enduring types of strategies that are put forward to increase research use in policy involve bridging or linking these two communities. This study challenges this way of thinking about the relationship between research and policy. Four case studies of national public health policy in Australiabreast cancer screening, prostate cancer screening, needle and syringe programs in the community, and needle and syringe programs in prisonsare used to present the context, events, processes, research, and actors involved in policy making. Three theories are deployed to explore the relationship between research and policy in each of the cases individually and across the cases as a whole. These theories bring different determinants and dynamics of the relationship to light and each is at least partially successful in increasing our understanding of the relationship between research and policy. The Advocacy Coalition Framework (ACF) understands the relationship in terms of a power struggle between competing coalitions that use research as a political resource in the policy process. The Policy Making Organisation Framework (PMOF) understands the relationship in terms of institutional and political factors that determine the way data is selected or rejected from the policy process. The Governmentality Framework (GF) understands the relationship in terms of the Foucauldian construct of power/knowledge that is created through discourse, regimes of truth and regimes of practices found in public health policy and research. This study has found that in three of the four case studies, public health policy was strongly influenced by research, the exception being NSP in prisons. In all cases, however, it is not possible to construct a robust and coherent account of the policy process or the policy outcome without considering the multifaceted role of research. When these theories are explored at a more fundamental level they support the argument that when research influences policy it is transformed into knowledge-for-policy by being invested with meaning and power. This process of transformation occurs through social and political action that mobilises ideal structures (such as harm minimisation and the World Health Organisations principles for evaluating screening programs) and material structures (such as medical journals and government advisory bodies) to resolve meta-policy problems (such as how to define complex public health problems in a way that makes them amenable to empirical research and practical action). This study provides good evidence that the notion of research transfer between two communities is a flawed way of understanding the researchpolicy relationship. Rethinking the relationship between research and policy involves building an enhanced theoretical repertoire for understanding this complex social interaction. This step is essential to the success of future efforts to make public health policy that is effective, just and emancipatory. This study makes a contribution to this task.
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Mpanza, Naledi. "Youth participation in public policy making : critical analysis of young people’s involvement in the National Health Insurance policy submissions using Societal Constitutionalism as a theoretical framework." Diss., University of Pretoria, 2004. http://hdl.handle.net/2263/72648.
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Youth engagement in public policy is a widely trumpeted notion supported by participatory democracy as espoused in various legislative and policy instrument; however, the interventions associated with this commitment do not easily produce the progress sought. This can be seen in the concerns that continue to be raised regarding youth participation in development. The National Health Insurance (NHI) policy in South Africa is one such development venture with a low youth presence which – although having implications on the social reality of the young people of today and into the future – appears to not include them as key stakeholders in the consultation process.
The aim of this research study is to unpack the participation of young people in public policy making and strengthening in South Africa, with specific reference to the NHI commentary process. To achieve this goal the following key texts and informants were drawn upon: qualitative in-depth interviews with a majority of the 20 contributors to the Young People’s Recommendations (YPR) on South Africa’s NHI White Paper; and detailed, qualitative document reviews of the Dullah Omar Institute’s report titled ‘Decision Making on Health in South Africa – What Can We Learn from National Health Insurance (NHI); as well as the Department of Planning, Monitoring and Evaluation’s report titled ‘Socio-Economic Impact Assessment System’s Final Impact Assessment (Phase 2): White Paper on NHI’. Triangulating between these sources and other key texts and accounts, the study unveils important influences behind the quality and extent of youth participation in public policy.
This study shows that the absence of young people in the conversation around NHI is not due to a lack of knowledgeable input and effort from young people, but rather a cocktail of influences that have to do with the blatant – but ill-acknowledged – politics within the health policy consultation process. Chapter Four contains the bulk of these voices and my analysis of this activism. The theory of societal constitutionalism that this study employs assisted in uncovering the reality that these young professionals are capable, knowledgeable, informed, concerned, and resilient – and that they are still determined to act within the space of public health. This finding directly contradicts the perception that the youth are vulnerable people that can only be theorised “upon” and “about”, not “with”.
After detailed analysis of the data from and by youthful people collected for this thesis, the Conclusion of this study shows that it is not a lack of policy that impedes youth participation in policy making and sustenance; it is the marginalising attitudes and ideologies which then influence how the youth are considered in the conversation. This observation highlights the disconnect between policy and practice which can be addressed through interrogating both policy and process, especially through critical engagement with the practised reality.Mini Dissertation (MSocSci)--University of Pretoria, 2019.
Sociology
MSocSci
Unrestricted
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Farquhar, MaryBeth Anne. "Actor Networks in Health Care: Translating Values into Measures of Hospital Performance." Diss., Virginia Tech, 2008. http://hdl.handle.net/10919/28312.
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The health care system within the United States is in a state of transition. The industry, confronted with a variety of new technologies, new ways of organizing, spiraling costs, diminishing service quality and new actors, is changing, almost on a daily basis. Reports issued by the Institute of Medicine raise quality issues such as avoidable errors and underuse/overuse of services; other studies document regional variation in care. Improvement in the quality of care, according to health care experts is accomplished through measuring and comparing performance, but there are a number of disparate actors involved in this endeavor. Through a network of both public and private actors, collaboration on the development of a set of national performance measures is underway. Organizations such as the National Quality Forum (NQF), the Agency for Healthcare Research and Quality (AHRQ), the Centers for Medicare & Medicaid Services (CMS) and other have formed networks to develop and standardize performance measurement systems that can distinguish between quality services and substandard ones. While there is some available research about the processes involved in performance measurement system design, there is little known about the factors that influence the development and work of the network, particularly the selection of hospital performance measures. This dissertation explored the development of a national performance measurement system for hospitals, using an institutional rational choice perspective and actor-network theory as frameworks for discussion. Through qualitative research methods such as direct observation, interviews, participant observations and document review, a theoretically informed case study of the NQFâ s Hospital Steering Committee was performed, to address the following questions: How is a national performance measurement system developed and what is the role of federal agencies (e.g., AHRQ and CMS) in the process?Ph. D.
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Nair, Manisha. "Effect of the Mahatma Gandhi National Rural Guarantee Act on infant malnutrition : a mixed methods study in Rajasthan, India." Thesis, University of Oxford, 2013. http://ora.ox.ac.uk/objects/uuid:1e6100e1-1499-48b6-8b89-5880b37fe95f.
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Background Malnutrition is a major risk factor of infant mortality in India. Policies targeting poverty and food insecurity may reduce infant malnutrition. The Mahatma Gandhi National Rural Employment Guarantee Act (MGNREGA), a wage-for employment policy of the Indian Government, targets deprivation and food insecurity in rural households. MGNREGA could prevent infant malnutrition by improving household food security or increase the risk of malnutrition by reducing the time devoted to infant care if mothers are employed. This study analyzed the effect and the pathways of effect of households' and mothers' participation in MGNREGA on infant malnutrition. Methods A community based mixed methods study using cross-sectional survey and focus group discussions (FGDs) was conducted in Dungarpur district of Rajasthan, India. Cross-sectional study included 528 households with 1,056 participants who were infants 1 to <12 months and their mothers/caregivers. Selected households were divided into MGNREGA-households and non-MGNREGA-households based on participation in MGNREGA between August-2010 and September-20ll. Anthropometric indicators of infant malnutrition-underweight, stunting, and wasting (WHO criteria) were the outcomes. Eleven FGDs with 62 mothers were conducted. Results Of 528 households, 281 participated in MGNREGA (53%). Mothers were employed in 51 (18%) households. Prevalence of wasting was 39%, stunting 24%, and underweight 50%. Households participating in MGNREGA were less likely to have wasted infants (OR 0' 57, 95% Cl 0•37-0'89; p=O'014) and underweight infants (OR 0'48,95% Cl 0•30-0'76; p=0'002) than non-participating households. Stunting did not differ significantly between groups. Although MGNREGA reduced starvation, it did not confer food security to the participating households because of lower than standard wages and delayed payments. Results from path analysis did not support an effect through household food security and infant feeding, but suggested a pathway of effect through birth-weight. Mothers' employment had no significant effect on the outcomes in the cross-sectional study, but the qualitative study indicated that it could compromise infant feeding and care. Conclusion Participation in MGNREGA was associated with reduced infant malnutrition possibly mediated indirectly via improved birth-weight rather than improved infant feeding. Providing child care facilities at worksites could mitigate the negative effects of mother's participation in MGNREGA. Further, improving mothers' knowledge of appropriate feeding practices in conjunction with providing employment (to address deprivation and food insecurity) is key in the efforts to reduce infant malnutrition.
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Sandberg, Johanna. "Institutionally Shaped Response to the Introduction of National Guidelines : Case Studies in the Swedish Regional Health Policy Arena." Licentiate thesis, Linköpings universitet, Avdelningen för hälso- och sjukvårdsanalys, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:liu:diva-152648.
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The purpose of this thesis is to explore the institutionally shaped response to the introduction of the national guidelines on the Swedish regional health policy arena. The thesis consists of two case studies. Adapting a qualitative approach, the data is based on individual interviews and these were analysed thematically. The first paper explores the response by four Swedish regional health authorities to the introduction of the National Guidelines for Cardiac Care, while the second paper aims to broaden the understanding of how the national guidelines are used for strategic purposes among politicians. As illustrated in this thesis, organizations will respond, adjust and react to external pressure according to conditions shaped by the institutional context. Key findings here are that the national guidelines are a complex policy instrument that, beyond being able to be used in an instrumental fashion by the medical managment, can also serve a legitimizing function for political decision-makers. The goals of the national guidelines, i.e. equal and efficient care, and the uncertainty about who, among multiple stakeholders, is responsible for the guidelines in the regional health authority, is a source of ambiguity and potential conflict. Those who are potentially responsible represent different rationales – a political rationale and a scientific rationale. The dominating scientific rationale of the national guidelines can create instability, when pushing towards the use of explicit priority-setting. Priority-setting in the institutional setting of a regional health authority has strong elements of becoming “wicked problems” since the dilemma of prioritization remains regardless of ambitions to apply a “technocratic fix”. A wicked problem is characterized by high complexity and being persistently hard to solve (Williams et al. 2012). A recurring dilemma is that priority-setting still contains many wicked problems, as social values and political considerations remain important parts of the policy process. One weakness of the national guidelines, identified in this thesis, is that the guidelines discuss each service area separately, and thereby reinforce a silo mentality in the Swedish health policy arena. To sum up, the national guidelines create a multifaceted and complex response in the Swedish health policy arena where different rationalities collide, and where conflicts appear and are dealt with within the regional health authorities.
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Leon, de la Barra Sophia. "Building research capacity for indigenous health : a case study of the National Health and Medical Research Council : the evolution and impact of policy and capacity building strategies for indigenous health research over a decade from 1996 to 2006." University of Sydney, 2007. http://hdl.handle.net/2123/3538.
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Master of PhilosophyAs Australia’s leading agency for funding health research (expending over $400 million in 2006), the National Health and Medical Research Council (NHMRC) has a major responsibility to improve the evidence base for health policy and practice. There is an urgent need for better evidence to guide policy and programs that improve the health of Indigenous peoples. In 2002, NHMRC endorsed a series of landmark policy changes to acknowledge its ongoing role and responsibilities in Indigenous health research—adopting a strategic Road Map for research, improving Indigenous representation across NHMRC Council and Principal Committees, and committing 5% of its annual budget to Indigenous health research. This thesis examines how these policies evolved, the extent to which they have been implemented, and their impact on agency expenditure in relation to People Support. Additionally, this thesis describes the impact of NHMRC policies in reshaping research practices among Indigenous populations.
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Baker, Timothy Alan. "Oregon Primary Care Physicians' Support for Health Care Reform." PDXScholar, 1994. https://pdxscholar.library.pdx.edu/open_access_etds/4755.
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This dissertation studies Oregon primary care physicians' attitudes toward health care reform. Two models of reform are examined: one, health care rationing such as that proposed by the Oregon Health Plan (OHP); and, two, support for national health insurance (NHI).
This work examines the necessity for changing the present health care system, traced from the early origins of the medical profession to the present day health care "crisis." The high cost of health care is examined and an overview of the OHP is provided, including citations from John Kitzhaber, M.D., author of the plan.
Overall, Oregon primary care physicians overwhelmingly supported health care rationing policies. Just under 75 percent of the physicians expressed support for health care rationing policies such as that proposed by the Oregon Health Plan. However, just under 48 percent of the same physicians expressed support for national health insurance (NHI). Internal medicine physicians were most supportive of health care rationing policies and OB/GYN physicians were least supportive. Conversely, pediatricians were most supportive of NHI and OB/GYN physicians were least supportive.
Regression analyses explained 11.5 percent of variation in support for health care rationing policies and 20.9 percent of their support for national health insurance (NHI).
While strong support measures were found for health reform such as that proposed by the Oregon Health Plan (OHP), no similar measures of support for NHI emerged. Almost universal support for health care reform such as the OHP was found among primary care physicians across the state, however similar patterns were not found for NHI. It appears from the research's findings that attempts to change the health care system that include the physician's ability to ration care would be more successful than a more systematic change such as would occur under a national health insurance program.
This dissertation points out that physicians represent strong supporting forces and/or opposing forces for health care reform. Their attitudes toward such reform must be considered if successful change is to occur in the U.S. health care system.
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Kim, Jungbu. "Do Different Expenditure Mechanisms Invite Different Influences? Evidence from Research Expenditures of the National Institutes of Health." Diss., Available online, Georgia Institute of Technology, 2007, 2007. http://etd.gatech.edu/theses/available/etd-07022007-131256/.
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Thesis (Ph. D.)--Public Policy, Georgia Institute of Technology, 2008.Katherine Willoughby, Committee Member ; Juan Rogers, Committee Member ; John Clayton Thomas, Committee Member ; Gregory B. Lewis, Committee Member ; Robert J. Eger, III, Committee Chair.
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Charalampopoulos, Vasilis. "The practice and ideology of New Public Management (NPM) : the Greek NHS at a time of financial austerity." Thesis, University of Stirling, 2017. http://hdl.handle.net/1893/25701.
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This study explores the practical and ideological implications of the New Public Management (NPM) paradigm as introduced in Greece by the so-called “Troika”, a sobriquet referring to a triumvirate comprising representatives of the IMF, the European Union, and the European Central Bank. In the past, attempts had been made by Greek officials to implement managerial practices within the Greek National Health Service (NHS) and the hospital sector in particular, albeit at a more leisurely pace than that of other countries’. On arrival to Greece the Troika imposed a number of changes to improve the country’s public services; and set a brisk pace to accelerate their implementation. The present doctoral thesis seeks to critically evaluate the issue of whether those reforms, especially those salient to the Greek NHS system, are true manifestations of a shift in the NPM paradigm or whether they represent yet another archetypal Greek public sector restructuring. It will also evaluate responses to and outcomes of the successive reforms in the Greece’s NHS system, ascertain the factors contributing to and/or impeding the adoption of those reforms, and identify new opportunities for growth. In order to gain access to a more profound insight into the Greek context, the collection of secondary data provides, among other things, an historical background of Greece’s public healthcare system; reviews the system’s characteristics in terms of healthcare policies, and probes into the state of working conditions within public hospitals. The heightened managerial spirit prevalent in Greece at the moment and brought about by the Troika’s tenure, has made it necessary for the literature review of the present work to focus on the ways that managerial practices and ideologies are imposed on other countries so that their public sector dysfunctionalities may be rectified. Drawing on the literature reviewed, the study develops an integrated analytical framework anchored in NPM, so as to test it in the Greek case and contribute to understanding the Greek NHS organisational realities as well as to evaluating how the new changes have been evolving and faring within Greece’s healthcare organisations. The framework is comprised of a review of the NPM paradigm so as to contextualise the Greek reforms in terms of ideology and practices; a review of Principal-Agent Theory (PAT) for illuminating the interrelationships and involvement of the key actors with the reforms; and a review of Critical Realism (CR) for assisting to reveal the underlying mechanisms and structures that bind the actors with the organisations and their development. Apart from providing the conceptual basis of the thesis, the framework also serves in informing its methodological design (i.e., generating the interview schedule), analysing the findings, and steering the discussion. The study adopts an in-depth, qualitative research approach that views social life within organisations in terms of processes, events, actions, and activities between key actors as factors unfolding over time. To that purpose, semi-structured interviews were conducted with the key stakeholders of the Greek NHS system: State hospital doctors, hospital managers, and policymakers. The contribution of the study is an in-depth analysis of reform implementation as carried out in Greece’s medical system which now stands, within a turbulent economic and political context. By means of that analytical framework, it is shown that Greece is a sui generis case whose context and historical background are altogether different than those of other countries’. Moreover, the framework demonstrates that, despite the fact that NPM is firmly ensconced, as far as practice and ideology go, it is too soon to be drawing any conclusions: NPM is still in its infancy and reforms to the Greek NHS system have yet to be finalised as they continuously stumble on the inefficiencies and blunders of the past which hinder them from functioning properly. Last, the thesis does possess one more unique feature: it delves into the thinking, manoeuvres, and behaviour of the Greek healthcare professionals as a group, a world rarely if ever explored by empirical studies.
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Bakiev, Erlan. "Determinants of interpersonal trust, organizational commitment for performance within Kyrgyz National Police." Doctoral diss., University of Central Florida, 2011. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/4841.
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Improving organizational performance is an essential goal for any type of organization. This process involves varieties of methods, polices and strategies. One of the important elements of organizational performance is trust-building process which deeply depends on leadership efforts of ranked employees and managers. Literature has enough empirical evidence on influence of trust and trusted work environment on organizational performance. Aftermath of recent riots and clashes in Kyrgyzstan Kyrgyz National Police (KNP) officers are demoralized by the actions of both previous and current governments which bear corruption, bribery and clan type of ruling. These facts led to untrustworthy environments and relationships among officers with concentration of power on the top. In order to provide trusted environments and trust among officers, there is need for more linear type of management, especially in terms of supervisor-subordinate relationships. There is urgent need for reforms at KNP which would focus more on governance and collaborative management style administration. Organizational social capital and organizational citizenship behavior develop strong foundation for trusted relationships and committed actions in communities and organizations. These two concepts were examined in public organization setting in this study. Organizational social capital is a source for trust building process where participative decision-making, feedback on performance, empowerment and interpersonal trust among employees are important elements of this phenomenon. On the other hand, organizational citizenship behavior is a source for entrepreneurship and organizational commitment. The measurement models of four dimensions of organizational social capital (participation, feedback on performance, empowerment and interpersonal trust) and organizational citizenship behavior represented by organizational commitment were examined in this study.; The influence of organizational social capital and organizational citizenship behavior on perceived organizational performance of KNP is observed by utilizing structural equation modeling (SEM) technique. Moreover, all possible correlations among all dimensions of organizational social capital with each other and with organizational commitment were tested. This study utilizes the data accomplished in 7 regions of Kyrgyzstan and a capital of Bishkek. The total number of respondents participated in the survey were 267 KNP officers from different KNP departments. This study tested eleven hypotheses where nine of them were statically supported. The results of this study indicate that the dimensions of organizational social capital (participation, feedback and empowerment) have statistically significant relationships with perceived organizational performance through mediating variable of interpersonal trust. However, the relationship of participation and feedback with perceived organizational performance through mediating variable of organizational commitment was insignificant. On the other hand, results indicated positive correlations among the three dimensions organizational social capital with high factor loadings. Overall, the results suggest that organizational social capital with its dimensions is the main source of trust-building process which enormously influences perceived organizational performance. Moreover, by practicing empowerment it is possible to increase number of committed officers which is also an important factor in improving organizational performance.ID: 030422941; System requirements: World Wide Web browser and PDF reader.; Mode of access: World Wide Web.; Thesis (Ph.D.)--University of Central Florida, 2011.; Includes bibliographical references (p. 197-208).
Ph.D.
Doctorate
Public Affairs
Health and Public Affairs
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Hammond, Terry Richard. "Feasible Models of Universal Health Insurance in Oregon According to Stakeholder Views." PDXScholar, 2012. https://pdxscholar.library.pdx.edu/open_access_etds/500.
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This study collects the views of 38 health policy leaders, answering one open-ended question in a 1-hour interview: What state-level reforms do you believe are necessary to implement a feasible model of universal health insurance in Oregon? Interviewees represented seven groups: state officials, insurers, purchasers, hospitals, physicians, public interest, and experts. About 370 coded arguments in the interview transcripts were condensed into 95 categorical topics. A code outline was constructed to present a dialogue among stakeholders in one comprehensive narrative. Topical sections include the cost imperative, politics, model systems, insurance, purchasing, delivery system, practice management, and finance. Summary results show the prevalence of group attention to each topic, group affinities, and proximity correlations of different arguments mentioned by individuals. The most common arguments related to problems of low-value care and delivery system reform. There was a generally felt imperative to control costs. Regarding universal health insurance, stakeholders were split between two main alternatives. One model, favored mostly by insurer and purchaser groups, supported the state-sponsored individual mandate. This plan, embodied in the current Oregon Action Plan to implement universal health insurance, involved managed competition for insurers and clinical governance over professional practice. A separate set of arguments, favored mostly by expert and physician groups, emphasized the need for a unified public system, or utility model, possibly with centralized funds and regional global budgets. The ability of the individual mandate plan to control costs or manage quality appears doubtful, which strengthens opposition. The utility model is more likely to work at cost control and governance, but it disrupts the status quo and its details are vague, which strengthens opposition. Neither model is endorsed by a majority of the stakeholders, and political success for either one alone is not promising. Possibly, a close analysis of the two models could find a way to combine them and generate unified support.
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Kula, Sedat. "Occupational stress and work-related wellbeing of Turkish National Police (TNP) members." Doctoral diss., University of Central Florida, 2011. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/4957.
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Previous studies suggest that the organizational dynamics of police organizations and the nature of police work contribute to law enforcement stress, which in turn reduces job satisfaction and increases burnout. It is also well documented that undesirable organizational factors are more hazardous to the well-being of employees than are the stressors due to nature of police work. The present study examines whether, and to what degree, organizational and operational stresses in law enforcement are associated with job satisfaction, work-related burnout, and supervisor support, holding the effects of age, rank, education, gender, tenure, and shift type constant in the analysis. A total of 538 Turkish National Police (TNP) employees from seven cities in Turkey, comprising 407 regular police officers and 131 ranked police officers, completed the study survey. The influence of organizational and operational stresses on the work-related well-being of TNP employees as measured by job satisfaction and work-related burnout was analyzed by structural equation modeling (SEM) under the theoretical framework of Kahn and Byosiere's (1992) causal theory. The results of the study indicate that TNP employees' perceived organizational stress has a statistically significant positive effect on work-related burnout and a negative effect on job satisfaction. The more TNP employees experience their organization as stress inducing, the lower their job satisfaction levels and the higher their burnout levels. Perceived operational stress of TNP employees was found to be significantly associated with their work-related burnout, but not with their job satisfaction. This study suggests that there is an indirect causal effect of both organizational and operational stresses on job satisfaction via supervisor support as mediator.; Supervisor support fully mediates the relationship between operational stress and job satisfaction, and partially mediates the relationship between organizational stress and job satisfaction. After controlling the influence of several demographic variables, job satisfaction made a statistically significant contribution to predicting work-related burnout. This finding suggests that as job satisfaction of TNP employee increases, their work-related burnout decreases. The findings of the study revealed that among the six demographic variables, only education level of TNP employees and rank make statistically significant contribution to their job satisfaction levels. As rank and education level of TNP employees increase, their job satisfaction also increases. The predictor variables of organizational stress, operational stress, and supervisor support, along with education and rank collectively, explain 56% of the total variation in job satisfaction. On the other hand, organizational stress, operational stress, job satisfaction, and supervisor support together account for 34% of the total variance in work-related burnout. Overall, the findings of this study illustrate a need for internal policy reform and managerial change in how the executives of TNP organize their agencies and policies, since organizational stressors are the most prevalent factors determining the work-related well-being of TNP employees.ID: 030422877; System requirements: World Wide Web browser and PDF reader.; Mode of access: World Wide Web.; Thesis (Ph.D.)--University of Central Florida, 2011.; Includes bibliographical references (p. 225-247).
Ph.D.
Doctorate
Public Affairs
Health and Public Affairs
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Martino, Luiz Vicente Souza. "A política nacional de saúde bucal em municípios da região metropolitana de São Paulo, na primeira década do século XXI." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/6/6135/tde-26012012-112537/.
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Na transição do regime autoritário para o Estado democrático de direito, consagrado na Constituição de 1988, o federalismo brasileiro passou a descentralizar as políticas públicas, atribuindo aos Estados, aos Municípios e ao Distrito Federal a sua co-gestão. No campo da saúde, uma característica inovadora nesse período foi a criação do Sistema Único de Saúde (SUS) e o desenvolvimento de processos participativos de gestão e controle das políticas. Este trabalho analisa o caso da Política Nacional de Saúde Bucal (PNSB) que, aprovada pelos conselhos nacionais de saúde, de secretarias estaduais e municipais de saúde, passou a integrar o Plano Nacional de Saúde (2004). O estudo aborda a implementação de Programas de Saúde Bucal, autonomia decisória municipal frente à PNSB, os mecanismos de coordenação da PNSB e suas características de alocação de recursos nos 39 municípios da Região Metropolitana de São Paulo (RMSP). Foram utilizados dados secundários, disponíveis em bancos de dados de acesso público, no período de 2006 a 2009, concentrando-se a análise no indicador Primeira Consulta Odontológica Programática (PCOP) no SUS, empregado para avaliar o acesso à assistência odontológica. As características do acesso bem como a adesão à PNSB foram analisadas buscando-se verificar possíveis associações com o porte do orçamento municipal, aferido pelas receitas disponíveis, PIB per capita, despesa total com saúde e filiação partidária do prefeito. Constatou-se que em 21 municípios houve tendência de diminuição nos valores do PCOP. Em 18 municípios houve tendência de alta no PCOP. Em 11 municípios a média do PCOP registrou valores acima do registrado para o estado de São Paulo (10,43 por cento ) de 2006 a 2009. Em relação à implementação das Políticas de Saúde Bucal, constatou-se ausência de correlação entre o acesso aos serviços de Saúde Bucal e PIB per capita, Receita Disponível per capita e Despesa Total com Saúde. Quanto à adesão à PNSB, 10 cidades não o fizeram. Não houve correlação entre adesão à PNSB e riqueza municipal e capacidade de gasto dos municípios. A adesão à PNSB ocorreu na totalidade dos municípios (sete) em que o prefeito era filiado ao Partido dos Trabalhadores, o mesmo do Presidente da República, em 2004. Além do fato de os municípios terem suas prioridades para as políticas públicas, deve-se considerar que, previamente ao surgimento da PNSB, tinham suas próprias definições para intervenção nessa área. Em tais situações, implementar a PNSB implica reorientações que podem colidir com suas possibilidades e suas agendas. O fato de a PNSB ser financiada com base em incentivos financeiros específicos para essa modalidade assistencial, transferidos da União, e também dos Estados, para os Municípios poderia exercer influência como indutor da adesão à PNSB, porém o cálculo dos governos municipais não levou só esta variável em consideração. Além disso, mesmo quando não há colisão de diretrizes e os incentivos federais não geram dilemas quanto ao que fazer, reorientações em práticas sociais requerem tempo e recursos até que seus efeitos sejam sentidos. Neste estudo constatou-se que na RMSP, sob os critérios adotados, a PNSB encontrou constrangimentos expressivos para se implantar e consolidar, com os incentivos federais não sendo suficientes para alterar a situação vigente na regiãoIn the transition from authoritarian rule to the democratic State of law, as enshrined in the Constitution of 1988, the Brazilian federalism began to decentralize the public policies, attributing to the States, municipalities and the Federal District its comanagement. In the field of health, an innovative feature in this period was the creation of the Unified Health System (SUS) and the development of participatory processes for the management and control of the policies. This paper analyzes the case of a National Policy of Oral Health (PNSB) that was approved by national councils of health, state and municipal health secretariats, was included in the National Plan for Health (2004). The study deals with the implementation of programs for Oral Health, decision-making autonomy municipal front of PNSB, the mechanisms for the coordination of PNSB and their characteristics to the allocation of resources in the 39 municipalities in the Metropolitan Region of São Paulo. We used secondary data, available in data banks of public access, in the period from 2006 to 2009, concentrating the analysis in the indicator \"First Dental Assessment Program\" (PCOP) on the SUS, used to evaluate access to dental care. The characteristics of the access as well as the membership of the PNSB were analyzed in an attempt to verify possible associations with the size of the municipal budget, as measured by the revenue available, per capita GDP, total expenditure on health and party affiliation of the prefect. They found that in 21 cities there was a tendency of decrease in the values of the PCOP. In 18 municipalities there was a tendency for high in PCOP. In 11 municipalities to average the PCOP recorded values above that recorded for the state of São Paulo (10.43 per cent ) from 2006 to 2009. With respect to the implementation of the Policies of Oral Health, it was found absence of correlation between access to the services of Oral Health and GDP per capita, Recipe Available per capita and Total Expenditure on Health. As to the membership of the PNSB, 10 cities did not. There was no correlation between membership of the PNSB and wealth municipal and capacity of expense of municipalities. The membership of the PNSB occurred in all of the municipalities (seven) in which the mayor was affiliated to the Workers\' Party, the same as that of President of the Republic, in 2004. In addition to the fact that the municipalities have their priorities for public policies, it must be considered that, before the onset of PNSB, had their own definitions for intervention in this area. In such situations, to implement the PNSB implies reorganizations that may conflict with their possibilities and their agendas. The fact of the PNSB be funded on the basis of specific financial incentives for this modality assistencial, transferred from the Union, and also the States, to the Municipalities could have an influence as inducer of membership of the PNSB, however the calculation of municipal governments did not take only this variable into account. In addition, even when there is a collision of guidelines and the federal incentives do not generate dilemmas regarding what to do, shifts in social practices require time and resources to which its effects are felt. In this study it was found that, in the Metropolitan Region, the PNSB found constraints expressive to deploy and consolidate, with the federal incentives are not sufficient to change the situation prevailing in the region
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Possa, Lisiane Bôer. "Políticas públicas : os efeitos no subsistema de provisão de serviços hospitalares do Sistema Único de Saúde." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2013. http://hdl.handle.net/10183/69839.
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Esta tese analisou os efeitos das políticas públicas sobre o subsistema de provisão hospitalar do Sistema Único de Saúde (SUS) no Brasil, entre os anos de 1990 e 2012. O foco da investigação foi o impacto das políticas de descentralização, regionalização da saúde e políticas específicas para a área hospitalar na configuração de atores societais e estatais envolvidos com hospitais, suas ideias, interesses e estratégias de ação. A pesquisa foi um estudo de caso do setor hospitalar do SUS. O referencial teórico das políticas públicas foi o quadro analítico escolhido para responder à problemática dessa tese. Observou-se que as políticas públicas de saúde, ao longo da história do Brasil, foram decisivas para a organização do subsistema de provisão hospitalar. As regras exaradas pelo Estado constituíram a rede de hospitais existente, influenciaram o processo de medicalização dessas entidades e contribuíram para a organização dos atores estatais e societais, sociais e de mercado, que participam do setor hospitalar. As políticas de descentralização e regionalização do sistema de saúde, implementadas entre 1990 e 2012, influenciaram diretamente a reconfiguração do subsistema de provisão hospitalar do SUS. Ampliou a participação dos atores estatais de estados e municípios na condução das políticas, bem como a relação desses gestores com os atores societais, sociais e de mercado, do setor hospitalar. Desfez-se a aliança entre a burocracia estatal federal e os representantes do setor hospitalar privado lucrativo, que constituía uma comunidade de política influente, em especial na década de 1970, anterior à Reforma do Sistema de Saúde brasileiro, ocorrida após 1988. A partir de 1990, diversificaram-se os atores do setor hospitalar que participam do subsistema. Foi possível, com esse trabalho, explicitar as diferenças de ideias, interesses e estratégias dos diversos segmentos hospitalares que, usualmente, eram tratados como homogêneos. Por fim, observou-se que a implementação de políticas públicas contribui para produzir novos atores, bem como para potencializar a organização de atores coletivos que influenciarão as políticas futuras. Os atores alteram suas ideias e estratégias, buscando adaptar-se às novas regras do jogo, para manter seus interesses, mas também os modificam. Adotam propostas de outros atores, refazendo alianças e acordos para se manterem atuantes na arena política.This thesis analyzed the effects of public policies on the provision of the hospital subsystem of the National Health System (SUS) in Brazil between the years of 1990 and 2012. The focus of the investigation was the impact of political decentralization, regionalization of health and specific policies for the hospital area in the configuration of state and societal actors involved with hospitals – their ideas, interests and action strategies. The research was a case study of the hospital sector of SUS. The theoretical referential of public policies was the chosen analytical framework to respond to the problems of this thesis. It was observed that public health policies, throughout the history of Brazil, were decisive for the organization of the hospital provision subsystem. The rules printed by the state constituted the existing network of hospitals, influenced the process of medicalization of these entities and contributed to the organization of state, societal, social and market actors participating in the hospital sector. The policies of decentralization and regionalization of the health system, implemented between 1990 and 2012, directly influenced the reconfiguration of the hospital provision subsystem of the SUS. They expanded the involvement of state actors of states and municipalities in implementing policies, as well as the relationship of these managers with societal, social and market actors of the hospital sector. The alliance broke up between federal state bureaucracy and representatives of the profitable private hospital sector, which constituted an influential political community, especially in the 1970s, prior to the Reformation of the Brazilian Health System, which occurred after 1988. Since 1990, the hospital sector actors that participate in the subsystem diversified. It was possible, with this work, to explicitate the differences of ideas, interests and strategies of the various hospital segments that usually were treated as homogeneous. Finally, it was observed that the implementation of public policies contributed to produce new actors as well as to potentialize the organization of collective actors that will influence future policies. The actors change their ideas and strategies, seeking to adapt to the new rules of the game to keep their interests, but also modify them. They adopt proposals of other actors, redoing alliances and agreements to remain active in the political arena.
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Tagoe, Ishmael. "The Ghana National School Feeding Program: Peoples' Perceptions about the Program's Impact on School Enrolment, Attendance and Completion." Bowling Green State University / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=bgsu1521682869298246.
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Andersen, Kenneth, and Marie Larsson. "Hur har de nationella målområdena för folkhälsa implementerats i Skånes kommuner?" Thesis, Malmö högskola, Fakulteten för hälsa och samhälle (HS), 2006. http://urn.kb.se/resolve?urn=urn:nbn:se:mau:diva-26658.
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Syftet med denna studie är att kartlägga hur Skånes 33 kommuner har implementerat de nationella målområdena för folkhälsa. Studien har genomförts som en enkätundersökning samt intervjuer med folkhälsosamordnare i ett urval av dessa kommuner.Resultaten i studien visar att prioriteringen av målområdena primärt ligger på strukturella faktorer. Dock är målområde 11 (Minskat bruk av tobak och alkohol, ett samhälle fritt från narkotika och dopning samt minskade skadeverkningar av överdrivet spelande) det målområde som är högst prioriterat i Skåne.Kartläggningen visar att 18 av Skånes kommuner har en anställd folkhälsosamordnare. Resultatet visar att 17 av Skånes kommuner har en verksamhetsplan/folkhälsoplan, varav 14 av dessa kommuner har en anställd folkhälsosamordnare. Större delen av dessa har även implementerat de nationella målområdena för folkhälsa i kommunens folkhälsoplan. Enligt propositionen Mål för folkhälsan 2002/03:35 är det av största vikt att ställa upp folkhälsoplaner för att få ett sektorsövergripande och långsiktigt fungerande folkhälsoarbete.Studiens resultat visar även att endast ett fåtal kommuner har utarbetat välfärdsbokslut, men samtidigt finns det en stark vilja att påbörja arbetet med att ta fram lokala välfärdsbokslut.The purpose of this study has been to map how Skanes 33 municipalities have implemented the 11 national public health objective aims. The study has been performed as a questionnaire together with interviews with public health coordinators chosen from these municipalities.The results from this study show that the main priorities lay within structural factors. Yet it also shows that the 11th objective aim (Reduced use of tobacco and alcohol, a society free from illicit drugs and doping and a reduction in the harmful effects of excessive gambling) bears the highest priority in Skane.The mapping shows that 18 of Skanes municipalities have public health coordinators. The result shows that 17 of Skanes municipalities have a public health plan and 14 of them also have public health coordinators. The majority of these municipalities have also implemented the 11 national public health objectives within their public health plan. According to the proposition (Mål för folkhälsan 2002/03:35) Aims for public health it is important to prepare a public health plan in order to achieve a comprehensive long-term well functioning of public health activity.The results from the study also show that only a few municipalities have prepared a welfare annual account, but that there is a strong urge to initiate their introduction on a more widespread scale.
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Tongur, Aykut. "Organizational support, organizational citizenship behavior, and perceived performance analysis of crime scene investigation units of Turkish National Police." Doctoral diss., University of Central Florida, 2011. http://digital.library.ucf.edu/cdm/ref/collection/ETD/id/5070.
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Policing is more difficult than ever before in today's world since types of crime and criminal profiles change as a result of technological development and globalization. Police organizations should review their organizational and operational strategies to improve the fight against contemporary crimes and criminals. Behaviors and performance of police officers are very important in fighting crime. In this struggle, especially today, officers should exhibit organizational citizenship behaviors and perform better. One of the most important factors affecting these two concepts in organizations is organizational support. The literature stresses the social exchange cycle and reciprocity rules in the relationships of organizations and their members. In this cycle, if the organization cares about its members and if members perceive that the organization is supportive, they feel obliged to behave positively, perform better, and help the organization to reach its goals and objectives. If they don't perceive organizational support, they won't care about the organization, either. Hypotheses were developed based on these assumptions in the literature. This study tested these assumptions in Crime Scene Investigation units of the Turkish National Police (TNP). Structural Equation Modeling (SEM) was used to analyze the relationships among variables of Perceived Organizational Support (POS), Organizational Citizenship Behavior (OCB), and Perceived Performance (PP). Measurement models for these three latent constructs were developed by deriving the indicators from the literature. Most earlier studies tried to figure out reasons of the OCB. This study has a different perspective that investigates both reasons and results of OCB. A survey was developed to measure the latent variables of the study, and 405 of approximately 3,000 Crime Scene Investigators in the Turkish National Police responded to the survey.; Results of the study showed that the relationship between POS and OCB is positive and significant. This is consistent with the literature. The relationship between OCB and PP is also positive and significant, and this is also consistent with the literature. However, the relationship between POS and PP is negative and insignificant. This result contradicts the results of previous studies in the literature and can be attributed to the subjective nature of measuring individuals' perceptions. According to the literature, perceptions are subjective rather than objective; therefore, data coming from reports of individual perceptions may not reflect the actual situation. Demographic information of the participants served as the control variables of the study. Information about the education level, rank, age, gender, size of the unit, and tenure of the respondents was collected by way of the conducted survey, and the effects of these variables were analyzed on the endogenous variable of the study, Perceived Performance. This study found no significant relationships between these control variables and Perceived Performance. Therefore, all these control variables were removed from the Structural Equation Model of the study. This study revealed that the TNP needs to be more supportive toward its members in order to have officers show organizational citizenship behavior and perform better. The TNP should revise its policies, especially regarding rotations from one province to another, working hours, rewards, and overtime pay. These are all indicators of organizational support and will result in a higher performance level among officers.ID: 030422782; System requirements: World Wide Web browser and PDF reader.; Mode of access: World Wide Web.; Thesis (Ph.D.)--University of Central Florida, 2011.; Includes bibliographical references (p. 132-143).
Ph.D.
Doctorate
Public Affairs
Health and Public Affairs
Public Affairs
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Kline, James Jeffrey. "Star Academics: Do They Garner Increasing Returns?" PDXScholar, 2016. https://pdxscholar.library.pdx.edu/open_access_etds/2713.
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This study examines the criteria which help academics receive National Institute of Health funds (NIH). The study covers 3,092 NIH recipients and non-recipients in the same department or institute at twenty-four universities. The universities are drawn from those below the top twenty in terms of receipt of NIH funds. With regards to performance, non- recipients have lower performance than recipients. A key determinant of the receipt of NIH funds is individual performance, as measured by the number of articles published and average citations per article in the two years immediately prior to the grant application. Professors receive more NIH money than do associates and assistant professors. Other positive contributors are the field of study, whether the academic has both a PhD. and Medical degree, and has licensed an innovation, been involved in the start of a new business and patented an invention through the university. To the extent that individual performance criteria represent the quality of the research proposal, allocation of NIH funds is based on merit.
A Tobit model indicates that being highly cited does not guarantee increasing returns. Likewise, career citations have only a small statistically significant impact. In addition, a negative coefficient associated with the second derivatives of both articles published in 2006-07 and their associated citations indicate diminishing marginal returns.
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Pereira, Jamile Peixoto. "Da paternidade responsável à paternidade participativa? representações de paternidade na Política Nacional de Atenção Integral à Saúde do Homem (PNAISH)." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2015. http://hdl.handle.net/10183/132926.
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Nesta dissertação, problematizo as representações de paternidade veiculadas, atualizadas e (re)produzidas na Política Nacional de Atenção Integral à Saúde do Homem (PNAISH), política pública atual do governo federal brasileiro que tem como objetivo promover a melhoria da saúde de homens, facilitando o acesso aos serviços de assistência integral à saúde. O estudo inscreve-se no referencial teórico-metodológico dos Estudos de Gênero e dos Estudos Culturais, situando-se no campo da Saúde Coletiva. Utilizo a pesquisa documental para reunir o conjunto de materiais examinados na perspectiva da análise cultural, a fim de descrever e analisar os ensinamentos da política aos homens-pais, operando com os conceitos de gênero, representação, cultura, poder, política pública, saúde e saúde coletiva. Analiso como os homens passam a ser convocados a participar e integrar as rotinas de cuidado com os/as filhos/as e como os profissionais de saúde, no âmbito do SUS, buscando-se promover e/ou incluir a participação dos homens-pais nos espaços de saúde. A PNAISH atua como um artefato cultural que incide sobre representações de paternidade, envolvendo-se com a nomeação, a classificação e a socialização dos homens-pais em meio às disputas travadas desde a construção, implantação e implementação de tal política. Discuto outros significados atribuídos à paternidade no âmbito da PNAISH, indicando um deslizamento analítico que permite uma provável ampliação de uma “Paternidade Responsável” para uma “Paternidade Participativa”. Desse modo, a investigação realizada permite-me argumentar que o direcionamento dado aos homens-pais, por meio dos materiais da política, busca consolidar a representação de um pai participativo, que necessita integrar-se às rotinas cotidianas dos/as filhos/as, compartilhando responsabilidades e assumindo atribuições, a fim de posicioná-lo como um sujeito integrante do processo de cuidado. Assim, os sentidos atribuídos à participação dos homens-pais vão sendo reconstruídos em redes de significados que reafirmam, atualizam e deslocam representações de paternidade vigentes no Brasil contemporâneo.In this essay I problematize the paternity representations transmitted, updated and (re) produced in the National Policy of Integral Attention to Men's Health - PNAISH, current public policy of the Brazilian federal government that aims to encourage improvements in the health of the male population, facilitating access to comprehensive health care services. The study is part of the referential theoretical methodological of Gender Studies and Cultural Studies, situated in the field of Collective Health. I use the documentary research to gather all materials examined from the perspective of cultural analysis in order to describe and analyze the lessons of politics men parents, operating with the concepts of gender, representation, culture, power, public policy, health and collective health. I analyze how men come to be called to participate and integrate care routines with the children and how health professionals, within the "SUS", seek to promote and / or include the participation of men parents in health space. The PNAISH acts as a cultural artifact that focuses on parenting representations, involving the nomination, classification and socialization of men parents among the disputes waged since its construction, deployment and implementation. I discuss other meanings attributed to paternity within the PNAISH, indicating an analytical slip that allows a likely extension of a "Responsible Parenthood" to a "Participatory Parenthood." Thus, the investigation allows me to argue that the direction given to men parents, through political materials, seeks to strengthen the representation of a participatory father, who needs to integrate the daily routines of the children, sharing responsibilities and assuming powers in order to position him as an integrant member of the care process. Therefore, the meanings attributed to the participation of men parents are being reconstructed in networks of meanings that reaffirm, update and move paternity representations prevailing in contemporary Brazil.
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Assumpção, Sandro Martins de. "Financiamento e acesso a medicamentos no âmbito da assistência farmacêutica básica no município de Aracaju entre os anos de 2008 a 2012." Pós-Graduação em Ciências Farmacêuticas, 2014. https://ri.ufs.br/handle/riufs/3959.
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The Pharmaceutical Services are an integral part of the health system and it has in the drug a essential ingredient in the actions in the promotion, protection and recovery of health. Increased access of population to the health system have required changes in the distribution and financing of drugs in order to increase coverage and minimize costs. The present study aimed to evaluate the relationship between the Brazilian governmental financing and assurance the population's access to Drugs, Essential of the Component of Primary Pharmaceutical Care in the city of Aracaju. This is an observational descriptive
study of an exploratory nature, the case study type, evaluating the period between the years 2008 and 2012. Work begins rescuing briefly the history of Pharmaceutical Services in the Brazilian Health System and its funding mechanisms in the process of decentralization of health. Proceeds to the analysis
of semi -structured interviews conducted by the Pharmaceutical Care`s Municipal Manager, Management Annual Reports of the municipality , reports prepared by Municipal Pharmaceutical Assistance Management and of the deposits made to the account of the Fund allocated to the Municipal Health Component Basic pharmaceutical services and discusses the results. After evaluating the results, it was found that, for the study period, there was sufficient resources to serve all
municipal demand for medication of this component, however, it could be seen that there was discontinuity in the supply and consequently, access to these drugs. It is therefore concluded that there was no relationship between sufficiency and ensuring access to Drugs,Essential in the city of Aracaju during the survey period.A Assistência Farmacêutica é parte integrante do sistema de saúde e tem no medicamento, o insumo essencial em ações voltadas à promoção, proteção e recuperação da saúde. A ampliação do acesso da população ao sistema de saúde exigiu mudanças na distribuição e no financiamento de medicamentos, de maneira a aumentar a cobertura e minimizar os custos. O presente estudo se propôs a avaliar a relação entre o financiamento tripartite da Assistência Farmacêutica Básica e a garantia ao acesso da população aos medicamentos do Componente Básico da Assistência Farmacêutica no município de Aracaju. Tratase de um estudo observacional descritivo, de cunho exploratório, do tipo Estudo de Caso, avaliando o período compreendido entre os anos de 2008 e 2012. Iniciase o trabalho com um breve resgate da história da Assistência Farmacêutica no Brasil, seus mecanismos de financiamento e o processo de descentralização da saúde. Procede-se à análise das entrevistas semi-estruturadas realizadas junto ao gestor Municipal de Assistência Farmacêutica, dos Relatórios Anuais de Gestão do município, dos relatórios elaborados pela coordenação Municipal de Assistência Farmacêutica e dos depósitos realizados na conta do Fundo Municipal de Saúde destinada ao Componente Básico da Assistência Farmacêutica e discutem-se os resultados encontrados. Após avaliação dos resultados, verificou-se que, para o período da pesquisa, existiu suficiência de recursos para atender toda a demanda municipal por medicamentos desse componente, entretanto, pôde-se perceber que, houve descontinuidade no abastecimento e, consequentemente, no acesso a esses medicamentos. Concluise assim, que não existiu relação entre suficiência financeira e garantia de acesso a medicamentos do Componente Básico da Assistência Farmacêutica no município de Aracaju durante o período da pesquisa.
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Talavera, Jhonny. "Crime Prevention at Municipal Level : A qualitative study about municipal official’s experience of the implementation of the national crime prevention program “Tillsammans mot brott”." Thesis, Mälardalens högskola, Akademin för hälsa, vård och välfärd, 2021. http://urn.kb.se/resolve?urn=urn:nbn:se:mdh:diva-55090.
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Background: In Sweden, organized crime has become more varied and cross-border which has led to change in the nature and the scope of organized crime. The national crime prevention program – Tillsammans mot brott (TMB) was presented by the Government of Sweden to increase security and prevent crime. Aim: The aim of the study is to investigate how municipal officials experience barriers and facilitators regarding the implementation of the national crime prevention program at local level. Methods: A qualitative method was used to gain in-depth knowledge about the study aim. A purposive sampling method was used, and a semi-structed interviews were conducted with eight participants from eight different municipalities. An inductive content analysis was used, and an ecological framework was applied to analyze the collected data. Result: The result showed that the municipality officials’ experience of barriers and facilitators regarding the implementing TMB could be divided into two categories; (i) internal work processes for implementing crime prevention initiatives, and (ii) external work direction within crime prevention collaboration. Conclusion: A public health approach enables to tackle innovative and holistic the occurrence and consequences of crimes since it involves working evidence-based with a range of stakeholders to address the multicausal origins of crimes
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Melo, Flávio Adriano Borges. "Análise de implicação profissional: um dispositivo disparador de processos de educação permanente em saúde." Universidade de São Paulo, 2017. http://www.teses.usp.br/teses/disponiveis/22/22133/tde-01032018-194200/.
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Esta tese teve por objetivo geral analisar a implicação profissional com os apoiadores de humanização e os articuladores de Educação Permanente em Saúde (EPS) dos municípios do Departamento Regional de Saúde (DRS) de Araraquara/São Paulo. Trata-se de uma pesquisa-intervenção Socioclínica, de abordagem qualitativa, realizada com os apoiadores de humanização e os articuladores de EPS dos 24 municípios que compõem o DRS em questão. Foram realizadas entrevistas individuais com 07 sujeitos que desenvolviam ambas as funções em seus municípios e 12 entrevistas grupais, sendo 11 compostas pelo apoiador e articulador e 01 composta por um grupo de 06 apoiadores do município. Portanto, 35 apoiadores e articuladores participaram da pesquisa-intervenção em questão. Foram também utilizados enquanto dispositivos analíticos para a produção dos dados desta pesquisa-intervenção: dez encontros mensais com os apoiadores e articuladores; sete encontros de planejamento e análise e o diário de pesquisa. As entrevistas e os encontros com os apoiadores e articuladores foram transcritos e as apreensões feitas nos encontros de planejamento e análise foram redigidos no diário de pesquisa. Todo esse material, bem como outras anotações feitas em diário, foi analisado a partir dos princípios da Socioclínica Institucional, sendo que um deles corresponde aos momentos de restituição, possibilitando um aprofundamento coletivo das análises realizadas. Os resultados foram apresentados a partir das dimensões libidinal, ideológica e organizacional que compõem a implicação profissional. Dessa forma, identificamos e analisamos com os apoiadores e articuladores os atravessamentos que a profissão inicial (enfermeiro, dentista, psicólogo, etc.) exerce sobre o fazer apoio; a contradição em se pensar em um perfil pronto para o desenvolvimento dessa função; os sentimentos de desânimo, pessimismo e otimismo enquanto componentes da dimensão ideológica que também atravessam o fazer apoio e a articulação de EPS; o tempo, o modo de fazer a gestão e o poder político enquanto analisadores da dimensão organizacional dos apoiadores e dos articuladores; e a ausência/presença do desejo, a vontade de agradar os profissionais de saúde, desenvolvendo uma relação harmônica no trabalho enquanto pistas analisáveis da dimensão libidinal dos apoiadores e dos articuladores. Na medida que o trabalho de análise com os apoiadores e articuladores prosseguiu, mudanças nos modos de se pensar e fazer apoio às equipes de saúde e também o pensar sobre o trabalho de apoiar e articular a EPS foi se modificando, fazendo com que esses profissionais entrassem, eles mesmos, em processos de EPS, refletindo e interrogando o próprio trabalho. O pesquisador ao realizar a análise de implicação também se colocou em processo de interrogação de sua prática, experienciando também a EPS em ato. Concluímos que a análise de implicação profissional consiste em um potente dispositivo disparador de processos de EPSThis thesis had as general objective to analyze the professional implication with the humanization supporters and the articulators of Permanent Health Education (PHE) of the municipalities of the Regional Department of Health (RDH) of Araraquara/São Paulo. It is a Socioclinic intervention research, with a qualitative approach, carried out with the humanization supporters and the articulators of PHE of the 24 municipalities that compose the mentioned RDH. Individual interviews were carried out with 07 participants who performed both functions in their municipalities and 12 group interviews, of which 11 were composed of the supporter and articulator and 01 were composed of a group of 06 supporters of the municipality. Therefore, 35 supporters and articulators participated in the intervention research in question. They were also used as analytical devices for the production of the data of this intervention research: ten monthly meetings with the supporters and articulators; seven planning and analysis meetings and the research diary. The interviews and meetings with the supporters and articulators were transcribed and the apprehensions made in the planning and analysis meetings were written in the research diary. All this material, as well as other diary entries, were analyzed based on the principles of Socioclinic Institutional, one of which corresponds to the moments of restitution, allowing a collective deepening of the analyzes carried out. The results were presented from the libidinal, ideological and organizational dimensions that make up the professional implication. In this way, we identify and analyze with the supporters and articulators the crossings that the initial profession (nurse, dentist, psychologist, etc.) exercises on making support; the contradiction in thinking of a ready profile for the development of this function; the feelings of discouragement, pessimism and optimism as components of the ideological dimension that also cross the support and articulation of PHE; time, management and political power as analysts of the organizational dimension of supporters and articulators; and the absence/presence of desire, the willingness to please health professionals, developing a harmonious relationship at work as analysable clues to the libidinal dimension of supporters and articulators. As the work of analysis with the supporters and articulators continued, changes in ways of thinking and supporting health teams and also thinking about the work of supporting and articulating the PHE was changing, causing these professionals to enter, themselves, in processes of PHE, reflecting and questioning the work itself. The researcher, when performing the implication analysis, also put himself in the process of interrogating his practice, also experiencing PHE in action. We conclude that the professional implication analysis consists of a powerful device triggering PHE processes
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Saffore, Lateef Yusef PhD. "What Factors Influence Medicare Reimbursement Payments for Healthcare Providers that Admit Diabetic Patients?" University of Akron / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=akron1303145384.
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Silveira, Perolah Caratta Macedo Portella. "Comunicação, promoção da saúde e espaço social alimentar: um estudo exploratório na ECA-USP." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/27/27154/tde-12012016-095017/.
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Esta dissertação explora as interfaces e possíveis articulações entre os conceitos de Comunicação, Promoção da Saúde e Espaço Social Alimentar. Por meio de revisão bibliográfica, traça-se a história do conceito da Promoção da Saúde no mundo e no Brasil. Em seguida, debate-se o papel do profissional de Comunicação como possível agente de mobilização social, destacando-se a Comunicação Pública como conceito essencial para o desenvolvimento da cidadania. Pautando-se no pensamento da Escola de Montreal, aborda-se a Comunicação Organizacional e suas interfaces com a Comunicação Pública. Propõe-se os modelos comunicacionais de Haswani e de Jaramillo López, como alicerce teórico para ações de Comunicação Interna. A análise da Política Nacional de Promoção da Saúde (PNPS) e da Política Nacional de Alimentação e Nutrição (PNAN) expõe a importância de práticas alimentares adequadas e saudáveis para a promoção da saúde. Elas são contextualizadas, em relação ao estudo exploratório realizado com os funcionários da Escola de Comunicações e Artes da Universidade de São Paulo (ECA-USP), sobre suas práticas alimentares. A metodologia de Jean Pierre Poulain, da Sociologia da Alimentação, pauta o estudo exploratório. A pesquisa pretende ser o primeiro passo para a estruturação de um banco de dados sistematizado sobre fatores condicionantes e determinantes da saúde dos funcionários desta instituição. Este banco proverá dados essenciais para a elaboração e implementação de políticas e ações que visem a Promoção da Saúde na Escola no futuro.This dissertation explores the commonalities and possible interactions between the concepts of Communication, Health Promotion and Food Social Space. The literature review retraces the historic evolution of Health Promotion as a concept worldwide and regionally in Brazil. It then correlates that field with the current state of Public Communication research in Brazil, defending the notion that Communication professionals have a role to play as health promoters. Based on the theories of the School of Montreal, this paper connects Organizational Communication and Public Communication concepts, with the goal of establishing a path for action that corroborates the defended thesis of the role of the Communication professional in Health Promotion. Lopez and Haswani\'s Public Communication models are used as the theoretical basis for action. The analysis of two public policies (on \"Health Promotion\" and \"Food and nutrition\") lays the ground for the empirical study developed with the employees of ECA-USP. Jean-Pierre Poulain\'s Sociology of Food methodology is adopted in the study of the food practices of the aforementioned public. This dissertation seeks to be a first step in structuring a database with information that can guide future organizational action and programs aimed towards the promotion of employees\' health.
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Kameda, de Figueiredo Carvalho Koichi. "Testing the Nation : Healthcare policy and innovation in diagnostics for infectious diseases in Brazil." Thesis, Paris, EHESS, 2019. http://www.theses.fr/2019EHES0196.
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Le diagnostic in vitro (DIV) est un segment des biotechnologies de santé pour lequel les principaux acteurs se situent dans les pays développés. Parallèlement, le paysage actuel a contraint les compagnies multinationales à transformer leur modèle économique, tout en obligeant les pays non-occidentaux à devenir de nouveaux marchés et des lieux où de nouveaux savoirs et technologies pourraient être produits. Non seulement le Brésil est un marché important en ce qui concerne les produits de santé, mais il possède aussi une longue histoire en matière de fabrication de produits biologiques et pharmaceutiques. Dans ce contexte que les acteurs brésiliens se sont engagés dans production de DIV pour les maladies infectieuses. Ces initiatives articulent la santé publique et les politiques économiques industrielles, soit l’approche qui a été privilégiée dans le cadre du courant néo-développementaliste (neo-desenvolvimentismo) prôné de 2003 à 2016 dans ce pays. Cette thèse a pour objectif d’éclairer le travail des acteurs qui ont organisé la production et l’innovation de DIV dans un monde en mouvement, et dont le positionnement se situe au croisement de questions relevant de la santé publique, de l’autonomie technologique et de l’économie nationale brésilienne. Cette recherche se fonde sur un travail de terrain conduit entre 2014 et 2017, qui inclut des stages dans deux laboratoires rattachés à la fondation Oswaldo Cruz, ainsi que des entretiens avec de nombreux acteurs impliqués dans la production de ces tests diagnostics nationauxIn vitro diagnostics (IVD) is a segment of the health biotechnology industry for which the major players are situated in developed countries. At the same time, the contemporary landscape has compelled multinational companies to transform their business models and non-Western countries to become both new markets and places where new knowledge and technology can be produced. Not only is Brazil an important market for healthcare products, but it also has a long-standing history of producing pharmaceutical and biological innovations. It is in this context that Brazilian actors have engaged in the manufacturing of IVD for infectious diseases. These initiatives articulate public health and industrial economy policies, a preferred approach of the new developmentalism (neo-desenvolvimentismo) that prevailed in the country from 2003 to 2016. This thesis aims to shed light on how these actors organize IVD production and innovation in such a changing world, and at the crossroads of public health, technological autonomy and the national economy in Brazil. The research draws on fieldwork conducted between 2014 and 2017, which involved internships in two biotechnology laboratories linked to the Oswaldo Cruz Foundation, and on interviews with the various actors involved in the initiatives to produce national diagnostic tests
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Maia, Leila Senna. "O processo de consolidação da Política Nacional de Saúde Bucal: a atenção terciária como desafio da segunda década da política de saúde bucal do SUS." Universidade do Estado do Rio de Janeiro, 2014. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=7064.
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Esta tese tem por objeto descrever e analisar o processo de desenvolvimento da Política Nacional de Saúde Bucal (PNSB) no terceiro nível de atenção. Para entender esse desenvolvimento, foram realizados três macroprocessos de pesquisa. O primeiro grupo de pesquisas procurou mapear a distribuição espacial dos hospitais com disponibilidade de leitos/SUS nos país e saber, dentre estes, quantos contam com serviços de atenção à saúde bucal cadastrados no Sistema de Cadastro Nacional de Estabelecimentos de Saúde (SCNES). O segundo grupo de pesquisas se ocupou em levantar junto ao DATASUS, através das ferramentas de consulta TABNET e TABWIN, dados nacionais relativos ao movimento das Autorizações de Internação Hospitalar (AIH) voltadas para procedimento de código 041402041-3 cuja descrição é Tratamento Odontológico para Pacientes com Necessidades Especiais em todas as unidades hospitalares que apresentaram este tipo de produção no país no biênio 2011/12. Foram consideradas 15 categorias de análise. O terceiro grupo de pesquisas buscou levantar junto ao site do Ministério da Saúde dados das Comissões Intergestores Regionais (CIR) existentes no Brasil até dezembro de 2012 assim como os Planos Diretores de Regionalização (PDR) e os Planos Estaduais de Saúde (PES) dos 26 estados e do Distrito Federal. Os resultados da pesquisa foram cotejados com aqueles verificados no TABWIN acerca do local de internação e de residência dos usuários SUS que se submeteram ao procedimento pesquisado. A fim de permitir uma análise comparativa deste processo numa perspectiva internacional, também foram levantados dados acerca da assistência hospitalar pública em saúde bucal levada a termo nos três países da América do Norte e em 31 países da Europa. Os resultados das pesquisas revelaram o caráter focalizador da atual ação da PNSB, em contraste com a atenção à saúde bucal hospitalar realizada na grande maioria dos países estudados. Entre outros resultados, as pesquisas permitiram concluir que: somente 32% dos hospitais que apresentaram AIH para os fins pesquisados possuía serviço de atenção à saúde bucal cadastrado SCNES; 1% das AIH apresentadas está relacionado ao atendimento de pacientes internados por motivos médicos; e 44% dos estados brasileiros preveem em seus instrumentos de gestão a atenção à saúde bucal em nível hospitalar. Assim, são apresentadas algumas sugestões tanto para o aperfeiçoamento da normatização da PNSB no que diz respeito à gestão da Rede de Cuidados à Pessoa com Deficiência, como para a expansão e extensão dos cuidados assistenciais em saúde bucal a todos os pacientes internados ou em tratamento ambulatorial nos hospitais do SUS.This thesis aims to describe and analyze the development process of the National Oral Health Policy (PNSB) in the third level of assistance. To understand it, three research processes were performed. The first sought to map the spatial distribution of Brazilian hospitals with available beds in the public sector and check how many were registered for oral health assistance in the National Health Services Registry System (SCNES). The second used statistics tabulation tools (TABNET and TABWIN) from the Ministry of Healths data department (DATASUS) to search for the registration of Hospital Admission Authorization (AIH) with procedure code 041402041-3 (Dental treatment for patients with special needs) in the country in the biennium 2011/12. Fifteen analysis categories were considered. The third examined the Ministry of Healths website for the existing Regional Management Commissions (CIR) in Brazil until December 2012 as well as for the Master Regionalization Plans (PDR) and the State Health Plans (PES) of the 26 Brazilian states and the Federal District. These results were compared to the ones produced by the TABWIN tool regarding hospital and residence venues of the users who have undergone the searched procedure in the Brazilian National Health System (the so-called SUS). In order to allow a comparative analysis of this process in an international perspective, three countries in North America and 31 European countries were surveyed on the oral health care procedures available in their public hospitals. The results revealed the current focalizing character of the PNSB in contrast to the hospital oral health care practiced in most studied countries. Among other results, the research showed that: Only 32% of the hospitals with AIH for the studied procedure have its oral care service registered in the SCNES; 1% of AIH is related to patients hospitalized for medical reasons; and 44% of the Brazilian states provide oral health care in hospitals in their management documents. Thus, some suggestions are presented for both PNSB normalization improvement, regarding the management of the health services network for the care of people with disabilities, and for the expansion and extension of oral health care for all inpatients or outpatients in SUS hospitals.
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LIMA, Mônica Maria Paiva. "Avaliação da Política Nacional de Transplantes no Ceará: atuação da Central Estadual e das Comissões Intra-hospitalares." www.teses.ufc.br, 2011. http://www.repositorio.ufc.br/handle/riufc/2330.
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LIMA, M. M. P. Avaliação da Política Nacional de Transplantes no Ceará: atuação da Central Estadual e das Comissões Intra-Hospitalares. 2011. 120f. Dissertação (Mestrado em Avaliação de Políticas Públicas) – Universidade Federal do Ceará, Pro - Reitoria de Pesquisa e Pós-Graduação, Programa de Pós-Graduação em Avaliação de Políticas Públicas, Fortaleza, 2011.Submitted by Ana Paula Paula (mappufce@gmail.com) on 2012-03-21T19:19:48Z No. of bitstreams: 1 2011_Di_ MonicaMPLIMA.pdf: 1422237 bytes, checksum: 6e0ef28dacd03092b4f154837d396356 (MD5)
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In recent decades, the transplants have had a profound impact on the care of end-stage patients with several kinds of diseases. In Brazil, public policies regarding people who need transplants require thorough assessments. This research aimed to evaluate the performance of the Organ Notification, Harvesting and Distribution Center of the State of Ceará (CNCDO) and Intra-hospital Commission on Organ and Tissue Donation for Transplant (CIHDOTTs) from Fortaleza, instances considered decisive in the operationalization of the National Transplant Policy in the State of Ceará. The research was conducted by using secondary and primary data, both quantitative and qualitative, developed from July 2010 to February 2011. The president of CNCDO was interviewed. It was applied a form to be filled out by 12 coordinators of CIHDOTTs and structured observations were accomplished in three CIHDOTTs. The following results had been highlighted: CIHDOTTs with reduced teams and nurse predominance; CNCDO overloaded and performing activities which belong to the CIHDOTTs; CIHDOTTs working essentially in an active search for potential donors; the family members refusal is largely responsible for the non-confirmation of a significant number of donations; it was identified fragility in campaign, qualification and joint planning actions between CNCDO and CIHDOTTs; CNCDO and CIHDOTTs resent greater support from health professionals and hospital managers and also the lack of equipment and appropriate physical space; the great expenditure of energy of CNCDO and CIHDOTTs result in an insignificant number of effective donations; there are difficulties in the process of identifying likely potential donor, delay in the diagnosis of brain death and in the beginning of the hemodynamic maintenance of the possible donor. The indication that greater results are obtained from the campaigns which favor the regional language confirms the initial assumption that educational initiatives, due to their immediate impact on the population, has the potential to leverage the transplant process. We conclude that human, structural and technological factors pose serious obstacles to the implementation of the National Transplant Policy in the State of Ceará, with little significant impact on the sole waiting list in the country. We suggest actions on several fronts: to redirect the dissemination campaigns towards approaches which are more culturally related to the region and closer to people; to offer more frequent courses to raise awareness and to improve the skills of health professionals; to develop strategies to raise awareness of professionals and managers regarding the noble task of CNCDO and CIHDOTTs; to employ more professionals and train them to perform the detection and diagnosis of brain death faster and to ensure the accomplishment of the hemodynamic maintenance efficiently
Nas décadas recentes, os transplantes tiveram um profundo impacto no cuidado dos pacientes em estágio final de diversos tipos de doenças. No Brasil, as políticas públicas relacionadas com as pessoas que necessitam de transplante carecem de avaliações aprofundadas para desenvolvimento e aplicação de políticas públicas. A presente pesquisa teve como objetivo avaliar a atuação da Central de Notificação de Transplantes do Estado do Ceará (CNCDO) e das Comissões Intra-Hospitalares de Doação de Órgãos e Tecidos para Transplantes (CIHDOTTs) de Fortaleza, instâncias consideradas decisivas na operacionalização da Política Nacional de Transplantes no território do Ceará. A pesquisa foi realizada utilizando dados secundários e primários, tanto quantitativos quanto qualitativos, sendo desenvolvida no período de julho de 2010 a fevereiro de 2011. Foi realizada entrevista com a presidente da CNCDO, aplicado um formulário com 12 coordenadoras das CIHDOTTs e realizadas observações estruturadas em três CIHDOTTs. Destacam-se entre os resultados: CNCDO sobrecarregada e realizando atividades da alçada das CIHDOTTs; CIHDOTTs com equipes reduzidas e predomínio de enfermeiras, atuando essencialmente na busca ativa de potenciais doadores; a recusa dos familiares sendo a grande responsável pela não confirmação de significativo número de doações; identificadas fragilidades nas ações de campanha, qualificação e planejamento conjunto da CNCDO com as CIHDOTTs; ambas ressentem-se de maior apoio dos profissionais de saúde e dos gestores dos hospitais e também da falta de equipamentos e espaço físico apropriado; o grande dispêndio de energia da CNCDO e das CIHDOTTs resulta em números ínfimos de efetivas doações; há dificuldades no processo de identificação de provável potencial doador, demora no diagnóstico de morte encefálica e em iniciar a manutenção hemodinâmica do possível doador. A indicação de que são maiores os resultados obtidos com as campanhas que privilegiam a linguagem regional confirma o pressuposto inicial de que ações educativas, por impactarem imediatamente na população, têm potencial para alavancar o processo de transplante. Concluímos que fatores humanos, estruturais e tecnológicos representam sérios entraves à execução da Política Nacional de Transplante no Estado do Ceará, com impacto pouco significativo na fila de espera, que é única para o País. Indicamos ações em diversas frentes: redirecionar as campanhas de divulgação para abordagens mais identificadas com a cultura regional e mais próxima às pessoas; cursos mais frequentes para maior sensibilização e qualificação dos profissionais de saúde; desenvolvimento de estratégias para maior sensibilização dos profissionais e gestores quanto às nobres tarefas da CNCDO e das CIHDOTTs; maior número de profissionais e capacitação mais frequente deles para que realizem a detecção e diagnóstico de morte encefálica de forma precoce e mais agilmente e que assegurem a realização da manutenção hemodinâmica de quantos potenciais doadores sejam identificados.
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Santo, Carla Katz. "A judicialização da saúde no município de Pelotas no ano de 2012: aproximações iniciais." Universidade Catolica de Pelotas, 2014. http://tede.ucpel.edu.br:8080/jspui/handle/tede/354.
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Previous issue date: 2014-08-12This study has as main objective to characterize the behavior of the Judicial Power regarding the demand for medicaments in the city of Pelotas instated in the State Courts in the second semester of 2012. This research was structured upon a literature review, where we attempted to observe the behavior adopted by the Brazilian judiciary and its implications in public health policies. The data were obtained through analysis of judgments issued by the State Courts in order to identify whether there is interference from the Judiciary in relation to the access to medicines in the city of Pelotas, trying to rescue awareness of the judges of this district about the National Drug Policy, checking whether the medicines pleaded are inserted in the official lists and if that produces any legal consequence to the detriment of the right to health that is part of the right to life itself. Starting from the evoked rights it was extremely important to analyze what are the criteria adopted by the Judiciary in granting or not the pleaded medicines and finally be able to note the implications of judgments in the National Drug Policy in Pelotas. Among the obtained results, the research demonstrated that the Judiciary is bound to the law itself, the letter of the law, disregarding, in most cases, the existing health public policies
O presente trabalho tem como objetivo principal caracterizar o comportamento do Poder Judiciário frente às demandas por medicamentos no Município de Pelotas, ingressadas na Justiça Estadual no segundo semestre de 2012. Esta pesquisa foi estruturada a partir de uma revisão de literatura, onde se buscou observar o comportamento adotado pelo Judiciário brasileiro e suas implicações nas políticas de saúde pública. Os dados foram obtidos através da análise das sentenças judiciais expedidas pela Justiça Estadual, visando identificar se existe a interferência do Poder Judiciário em relação ao acesso a medicamentos no Município de Pelotas, procurando resgatar o conhecimento dos juízes desta comarca sobre a Política Nacional de Medicamentos, verificando se os medicamentos pleiteados estão inseridos nas listas oficiais e se isso produz alguma consequência jurídica em detrimento do direito à saúde que faz parte do direito à própria vida. Partindo dos direitos evocados foi de extrema relevância analisar quais os critérios adotados pelo Poder Judiciário na concessão ou não dos medicamentos pleiteados e enfim, poder constatar as implicações das decisões judiciais na política nacional de medicamentos no município de Pelotas. Dentre os resultados obtidos, a pesquisa demonstrou que o Poder Judiciário se vincula ao direito em si, a letra da lei, desconsiderando, na maior parte das vezes, as políticas públicas de saúde existentes
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Paiva, MÃnica Maria dos Santos. "AvaliaÃÃo da PolÃtica Nacional de Transplantes no CearÃ: AtuaÃÃo da Central Estadual e das ComiÃÃes Intra-Hospitalares." Universidade Federal do CearÃ, 2011. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=6252.
Full textAbstract:
nÃo hÃNas dÃcadas recentes, os transplantes tiveram um profundo impacto no cuidado dos pacientes em estÃgio final de diversos tipos de doenÃas. No Brasil, as polÃticas pÃblicas relacionadas com as pessoas que necessitam de transplante carecem de avaliaÃÃes aprofundadas para desenvolvimento e aplicaÃÃo de polÃticas pÃblicas. A presente pesquisa teve como objetivo avaliar a atuaÃÃo da Central de NotificaÃÃo de Transplantes do Estado do Cearà (CNCDO) e das ComissÃes Intra-Hospitalares de DoaÃÃo de ÃrgÃos e Tecidos para Transplantes (CIHDOTTs) de Fortaleza, instÃncias consideradas decisivas na operacionalizaÃÃo da PolÃtica Nacional de Transplantes no territÃrio do CearÃ. A pesquisa foi realizada utilizando dados secundÃrios e primÃrios, tanto quantitativos quanto qualitativos, sendo desenvolvida no perÃodo de julho de 2010 a fevereiro de 2011. Foi realizada entrevista com a presidente da CNCDO, aplicado um formulÃrio com 12 coordenadoras das CIHDOTTs e realizadas observaÃÃes estruturadas em trÃs CIHDOTTs. Destacam-se entre os resultados: CNCDO sobrecarregada e realizando atividades da alÃada das CIHDOTTs; CIHDOTTs com equipes reduzidas e predomÃnio de enfermeiras, atuando essencialmente na busca ativa de potenciais doadores; a recusa dos familiares sendo a grande responsÃvel pela nÃo confirmaÃÃo de significativo nÃmero de doaÃÃes; identificadas fragilidades nas aÃÃes de campanha, qualificaÃÃo e planejamento conjunto da CNCDO com as CIHDOTTs; ambas ressentem-se de maior apoio dos profissionais de saÃde e dos gestores dos hospitais e tambÃm da falta de equipamentos e espaÃo fÃsico apropriado; o grande dispÃndio de energia da CNCDO e das CIHDOTTs resulta em nÃmeros Ãnfimos de efetivas doaÃÃes; hà dificuldades no processo de identificaÃÃo de provÃvel potencial doador, demora no diagnÃstico de morte encefÃlica e em iniciar a manutenÃÃo hemodinÃmica do possÃvel doador. A indicaÃÃo de que sÃo maiores os resultados obtidos com as campanhas que privilegiam a linguagem regional confirma o pressuposto inicial de que aÃÃes educativas, por impactarem imediatamente na populaÃÃo, tÃm potencial para alavancar o processo de transplante. ConcluÃmos que fatores humanos, estruturais e tecnolÃgicos representam sÃrios entraves à execuÃÃo da PolÃtica Nacional de Transplante no Estado do CearÃ, com impacto pouco significativo na fila de espera, que à Ãnica para o PaÃs. Indicamos aÃÃes em diversas frentes: redirecionar as campanhas de divulgaÃÃo para abordagens mais identificadas com a cultura regional e mais prÃxima Ãs pessoas; cursos mais frequentes para maior sensibilizaÃÃo e qualificaÃÃo dos profissionais de saÃde; desenvolvimento de estratÃgias para maior sensibilizaÃÃo dos profissionais e gestores quanto Ãs nobres tarefas da CNCDO e das CIHDOTTs; maior nÃmero de profissionais e capacitaÃÃo mais frequente deles para que realizem a detecÃÃo e diagnÃstico de morte encefÃlica de forma precoce e mais agilmente e que assegurem a realizaÃÃo da manutenÃÃo hemodinÃmica de quantos potenciais doadores sejam identificados.
In recent decades, the transplants have had a profound impact on the care of end-stage patients with several kinds of diseases. In Brazil, public policies regarding people who need transplants require thorough assessments. This research aimed to evaluate the performance of the Organ Notification, Harvesting and Distribution Center of the State of Cearà (CNCDO) and Intra-hospital Commission on Organ and Tissue Donation for Transplant (CIHDOTTs) from Fortaleza, instances considered decisive in the operationalization of the National Transplant Policy in the State of CearÃ. The research was conducted by using secondary and primary data, both quantitative and qualitative, developed from July 2010 to February 2011. The president of CNCDO was interviewed. It was applied a form to be filled out by 12 coordinators of CIHDOTTs and structured observations were accomplished in three CIHDOTTs. The following results had been highlighted: CIHDOTTs with reduced teams and nurse predominance; CNCDO overloaded and performing activities which belong to the CIHDOTTs; CIHDOTTs working essentially in an active search for potential donors; the family members refusal is largely responsible for the non-confirmation of a significant number of donations; it was identified fragility in campaign, qualification and joint planning actions between CNCDO and CIHDOTTs; CNCDO and CIHDOTTs resent greater support from health professionals and hospital managers and also the lack of equipment and appropriate physical space; the great expenditure of energy of CNCDO and CIHDOTTs result in an insignificant number of effective donations; there are difficulties in the process of identifying likely potential donor, delay in the diagnosis of brain death and in the beginning of the hemodynamic maintenance of the possible donor. The indication that greater results are obtained from the campaigns which favor the regional language confirms the initial assumption that educational initiatives, due to their immediate impact on the population, has the potential to leverage the transplant process. We conclude that human, structural and technological factors pose serious obstacles to the implementation of the National Transplant Policy in the State of CearÃ, with little significant impact on the sole waiting list in the country. We suggest actions on several fronts: to redirect the dissemination campaigns towards approaches which are more culturally related to the region and closer to people; to offer more frequent courses to raise awareness and to improve the skills of health professionals; to develop strategies to raise awareness of professionals and managers regarding the noble task of CNCDO and CIHDOTTs; to employ more professionals and train them to perform the detection and diagnosis of brain death faster and to ensure the accomplishment of the hemodynamic maintenance efficiently.
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Alves, Terezinha Noemides Pires. "Política Nacional de Medicamentos: análise a partir do contexto, conteúdo e processos envolvidos." Universidade do Estado do Rio de Janeiro, 2009. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=3537.
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Políticas públicas são estruturadas com a finalidade de ser uma resposta dada pelo poder público para as diversas demandas, problemas e tensões geradas na sociedade. Devem ter magnitude e relevância social, bem como possuir poder de
barganha suficiente para fazer parte da agenda de prioridades de um determinado órgão fomentador de políticas. Desta forma, uma política é constituída pelo seu propósito, diretrizes e definição de responsabilidades das esferas de Governo e dos
órgãos envolvidos. Assim, a política de medicamentos brasileira, inserida na Política de Saúde, constitui um dos elementos fundamentais para a implementação de ações capazes de promover melhoria nas condições de saúde. Preconiza a garantia da disponibilidade, do acesso e do uso racional de medicamentos por todos os setores da população, conforme seu perfil de morbimortalidade. Nessa perspectiva, o presente trabalho pretendeu fazer uma análise da Política Nacional de
Medicamentos (PNM) para compreender os dados encontrados. Com base na abordagem qualitativa, levando em consideração o que explicita o documento fundador da PNM, além de uma revisão da literatura foram feitos o mapeamento e a análise dos referidos dados, gerando categorias (contexto, conteúdo e processos envolvidos). Este estudo permitiu concluir que a PNM não abrange muitos dos problemas relacionados ao uso do medicamento, como também não conseguiu ferramentas suficientes para dar todas as respostas governamentais necessárias para muitos dos problemas por ela levantados ou até mesmo daqueles existentes e que não foram por ela contemplados. Os governos, tanto o que a formulou quanto os
que o sucederam, avançaram em suas diretrizes ou continuam envidando esforços para tal, no sentido de contribuir para a efetivação do direito à assistência terapêutica integral.Public policies are structured with the objective of being a response given by the public power to the various demands, problems and tensions generated in the society. They must have magnitude and social relevance, as well as having enough bargain power to take part in the agend of priorities of a certain organ that foments the policies. This way, a policy is constituted by its purposes, directrixes and the definition of the responsibilities of the government spheres and the organs that are involved. Therefore, the brazilian policy of drugs, inserted in the Health Policy, constitutes one of the fundamental elements for the implementation of actions capable of promoting improvement in the health conditions. It institutes the guarantee of availability, access and rational use of the drugs by all of the sectors of the population, according to their profile of morbimortality. Within this perspective, the present work intended to make an analysis of the National Drug Policy (NDP) in order to comprehend the data found. Based on the qualitative approach, taking into consideration what the document that has founded the NDP says, besides a review of the literature, the mapping and analyses of such data have been done, generating categories (context, content and involved processes). This study has let us conclude that the NDP does not hold many of the problems related to the use of drugs as well as that it has not obtained the tools to give all the necessary governmental responses to many of the problems arisen by it or even the existing ones that have not been contemplated by it. The governments, both the one which has formulated it and the ones which have succeed it, have advanced in their directrixes or kept on endeavoring for so, to contribute to the effectuation of the right of integral therapeutic assistance.
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Gleeson, J. A. "Using policy analysis to explore the reciprocal impact of health policy on public health nursing and public health nursing on policy." Thesis, Bournemouth University, 2013. http://eprints.bournemouth.ac.uk/21387/.
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The overall aim of this study was to explore the reciprocal impact of health policy on public health nursing and public health nursing on policy. This study uses a new approach to considering public health nurses’ engagement in policy: one which puts public health nurses, as actors in the policy process, at the centre of the investigation. The overall philosophical lens through which the research was conducted was critical social theory and the methodology was a grounded theory influenced research design. The study adopted a three stage data collection and analysis process: primary data (questionnaires and interviews), detailed policy analyses of two specific White Papers and secondary data (extant documents). The data were collected and analysed through a grounded theory approach in order to answer four research questions: 1. What do public health nurses know about policy, specifically in relation to two English Department of Health White Papers: Creating A Patient-Led NHS (DOH 2005) and Our Health, Our Care, Our Say (DOH 2006)? 2. How do they engage in the policy process? 3. What affects their implementation of policy? 4. Is there a policy-practice gap? A triangulated approach to data collection and analysis was used. Primary data were collected through questionnaires and follow up telephone interviews with public health nurses (health visitors and school nurses) in four PCTs and one social enterprise in five different geographical areas of England. Further data from detailed policy analyses using frameworks by Popple and Leighninger (2008) and Walt and Gilson (1994) were also considered. Finally, secondary data from extant documents including newspapers, websites and organisational documents were reviewed. At the end of the research process, it was possible to answer the four research questions. In addition to this, new knowledge and theory emerged around three main themes: i) A proposal for a new combined framework for policy analysis which leads to a comprehensive and analytical account of policy content and context combined with a detailed consideration of the role of public health nurses as actors in the policy process. ii) Theories as to why and how public health nurses lack influence in the policy process. iii) Analysis of the effect of lack of resources on inhibiting practice innovation in response to policy agendas. Consideration of these theories led to several recommendations for practice. Throughout the research process, there was continued interaction between the three phases of data collection, analysis and theory development.
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Tsampiras, Carla Zelda. "Politics, polemics and practice: a history of narratives about, and responses to, AIDS in South Africa, 1980-1995." Thesis, Rhodes University, 2013. http://hdl.handle.net/10962/d1001653.
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The ongoing urgency of addressing AIDS in South Africa has kept academics and activists focussed primarily on the immediate crises of AIDS ‘in the present’. This thesis, covering the period 1980 – 1995, examines narratives about, and responses to, AIDS ‘in the past’ and explores the interplay between these narratives and elites in medical and political communities trying to address AIDS during a period of political transition. The thesis begins by examining the hegemonic medico-scientific narratives about AIDS that featured in the South African Medical Journal, an important site of enquiry as AIDS was primarily conceived of as a ‘medical issue’. The SAMJ narratives, which often relied on constructed ‘AIDS avatars’, framed understandings of the syndrome and influenced responses to it by medical and political communities. The first community that the thesis explores is the African National Congress (ANC) in exile, which had to address AIDS in exile communities and prepare health strategies for ‘the new South Africa’. Secondly, the thesis analyses government responses to AIDS and argues that four phases of response can be identified. These phases were characterised by minimum concerns about obtaining information and providing health advice; efforts to gather infection data while exploiting political and public fear; attempts to extend health education and (belatedly) encourage broader engagement; and finally, consultative, democratic ideals. The thesis then examines the National Medical and Dental Association (NAMDA) a progressive medical organisation that worked with the ANC on influential health (and AIDS) strategies. NAMDA members ‘crossed over’ between various medical and political communities and both reinforced and challenged hegemonic AIDS narratives. Finally, the thesis moves from the abstract, via the practical, to the personal and concludes with a detailed account of the experiences of two sexuality activists at the intersections of these communities and narratives. By focussing on these medical and political communities, and analysing the relationships between these communities, the existing AIDS narratives, and individuals, the thesis also reveals the constructions of morality, ‘race’, gender, and sexuality that infused them. In doing this it shows how polemic and politics combined to influence practical responses to, and personal experiences of, AIDS.
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Grill, Kalle. "Anti-paternalism and Public Health Policy." Doctoral thesis, KTH, Filosofi och teknikhistoria, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:kth:diva-10947.
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This thesis is an attempt to constructively interpret and critically evaluate the liberal doctrine that we may not limit a person’s liberty for her own good, and to discuss its implications and alternatives in some concrete areas of public health policy. The thesis starts theoretical and goes ever more practical. The first paper is devoted to positive interpretation of anti-paternalism with special focus on the reason component – personal good. A novel generic definition of paternalism is proposed, intended to capture, in a generous fashion, the object of traditional liberal resistance to paternalism – the invocation of personal good reasons for limiting of or interfering with a person’s liberty. In the second paper, the normative aspect of this resistance is given a somewhat technical interpretation in terms of invalidation of reasons – the blocking of reasons from influencing the moral status of actions according to their strength. It is then argued that normative anti-paternalism so understood is unreasonable, on three grounds: 1) Since the doctrine only applies to sufficiently voluntary action, voluntariness determines validity of reasons, which is unwarranted and leads to wrong answers to moral questions. 2) Since voluntariness comes in degrees, a threshold must be set where personal good reasons are invalidated, leading to peculiar jumps in the justifiability of actions. 3) Anti-paternalism imposes an untenable and unhelpful distinction between the value of respecting choices that are sufficiently voluntary and choices that are not. The third paper adds to this critique the fourth argument that none of the action types typically proposed to specify the action component of paternalism is such that performing an action of that type out of benevolence is essentially morally problematic. The fourth paper ignores the critique in the second and third papers and proposes, in an anti-paternalistic spirit, a series of rules for the justification of option-restricting policies aimed at groups where some members consent to the policy and some do not. Such policies present the liberal with a dilemma where the value of not restricting people’s options without their consent conflicts with the value of allowing people to shape their lives according to their own wishes. The fifth paper applies the understanding of anti-paternalism developed in the earlier papers to product safety regulation, as an example of a public health policy area. The sixth paper explores in more detail a specific public health policy, namely that of mandatory alcohol interlocks in all cars, proposed by the former Swedish government and supported by the Swedish National Road Administration. The policy is evaluated for cost-effectiveness, for possible diffusion of individual responsibility, and for paternalistic treatment of drivers. The seventh paper argues for a liberal policy in the area of dissemination of information about uncertain threats to public health. The argument against paternalism is based on common sense consequentialist considerations, avoiding any appeal to the normative anti-paternalism rejected earlier in the thesis.QC 20100714
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Santos, Fernanda Flores Silva dos. "Adaptação do Indicador de Salubridade Ambiental (ISA) para análise do saneamento básico na cidade de Brejo Grande/SE." Universidade Federal de Sergipe, 2016. https://ri.ufs.br/handle/riufs/4207.
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In Brazil, to serve the population with total sanitation services is still a challenge. Despite of
the visible progress indicators that show the expansion of the sanitation sector in Brazil
pointed to by the last census of the IBGE (2010), the shares still performed insufficiently
reached the real needs of the population. Public policies aimed at achieving the universality of
this sector in the country, thus obtain positive impacts on public health and is necessary to
have preventive actions involving the health of the environment. In the municipality of Brejo
Grande deficiencies in sanitation combined with the cultural habits conducted by the
population in water bodies, such as washing clothes, bathing and farming, and the very
economic conditions of the same, certainly exposes to health disorders. To achieve
satisfactory levels through health becomes key measure levels of environmental indicators in
a certain locality. Thus, this study aimed to analyze the sanitation conditions in the seat of the
municipality of Brejo Grande/SE and its influence on public health, through the adaptation of
the Environmental Health Indicator (ISA). The adaptation was necessary because the research
focus is based on the analysis of sanitation in the study area, as well as the need to obtain
information to assess the health status of the population. The ISA was called to this work as
ISA/BG, as it is specific to this location. Their analysis took place from the Sub-water supply
indicator, Sub-Solid Waste Indicator, Sub-Sewage indicator, Sub-Drainage indicator Urban
and Sub-Public Health Indicator. For this study, a descriptive exploratory and qualitative and
quantitative nature was developed. The data used to feed the ISA/BG and interpret the results
were collected in the field with the community and government agencies of federal, state and
municipal levels. From the results it was found that the existing sanitation infrastructure in
urban Brejo Grande, negatively interfere with the health of the population. And that despite
the actions taken and in progress by the municipality of Brejo Grande, carried out in order to
fulfill determined by the National Sanitation Policy, the difficulties they pass the sanitation
sector in the country, are reflected in the locality of study.No Brasil, atender a população em sua totalidade com os serviços de saneamento básico ainda é um desafio. Apesar dos avanços visíveis dos indicadores que demonstram a ampliação no setor de saneamento no Brasil apontado pelo último censo do IBGE (2010), as ações executadas ainda não atingiram suficientemente as reais necessidades da população. As políticas públicas voltadas para alcançar a universalização deste setor no país, obterão consequentemente impactos positivos na saúde pública, sendo necessário haver ações preventivas que envolvam a salubridade do meio. No município de Brejo Grande as deficiências do saneamento básico aliado aos hábitos culturais realizados pela população nos corpos d’água, como a lavagem de roupas, banhos e atividade agrícola, e as próprias condições econômicas das mesmas, certamente, a expõe aos agravos de saúde. Para alcançar níveis satisfatórios de salubridade do meio torna-se fundamental mensurar os níveis dos indicadores ambientais de determinada localidade. Desta forma, esta pesquisa teve como objetivo geral analisar as condições do saneamento básico na sede do município de Brejo Grande/SE e sua influência na saúde pública, através da adaptação do Indicador de Salubridade Ambiental (ISA). A adaptação se fez necessária em virtude do foco da pesquisa está baseada na análise do saneamento básico da área estudada, bem como da necessidade de se obter informações para a avaliação do estado de saúde da população. O ISA foi denominado para este trabalho como ISA/BG, visto que é específico para esta localidade. Sua análise decorreu a partir do Sub- Indicador de Abastecimento de Água, Sub- Indicador de Resíduos Sólidos, Sub-Indicador de Esgotamento Sanitário, Sub-Indicador de Drenagem Urbana e Sub-Indicador de Saúde Pública. Para a realização deste estudo, foi desenvolvida uma pesquisa descritiva de caráter exploratório e de natureza quali-quantitativa. Os dados utilizados para alimentar o ISA/BG e para interpretar os resultados foram coletados em campo junto à comunidade e aos órgãos públicos de âmbito federal, estadual e municipal. A partir dos resultados obtidos verificou-se que a infraestrutura de saneamento básico existente na área urbana de Brejo Grande, interfere negativamente na saúde da população. E apesar das ações desenvolvidas e em andamento pelo município de Brejo Grande, realizadas a fim de se cumprir o determinado pela Política Nacional do Saneamento Básico, as dificuldades pelas quais passam o setor de saneamento no país, se refletem na área de estudo.
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Jones, Mary J. "A 21st century national public health system." Thesis, Monterey, Calif. : Naval Postgraduate School, 2008. http://edocs.nps.edu/npspubs/scholarly/theses/2008/Sept/08Sep%5FJones.pdf.
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Thesis (M.A. in Security Studies (Homeland Security and Defense))--Naval Postgraduate School, September 2008.Thesis Advisor(s): Bellavita, Christopher. "September 2008." Description based on title screen as viewed on November 5, 2008. Includes bibliographical references (p. 121-126). Also available in print.
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Pathak, Amit. "Forecasting Models to Predict EQ-5D Model Indicators for Population Health Improvement." Ohio University / OhioLINK, 2016. http://rave.ohiolink.edu/etdc/view?acc_num=ohiou1480959312370497.
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