Дисертації з теми "Couverture universelle de santé"
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Cortes, Antoine. "Une vision socialiste de la politique contemporaine de santé : la couverture maladie universelle." Thesis, Aix-Marseille, 2014. http://www.theses.fr/2014AIXM1095.
Повний текст джерелаThe law of the bearing July 27th, 1999 creation of the universal health coverage intervened within the framework of a general policy of fight against exclusion. In order to improve the access to the care of a growing number of poor people, the Socialists worked out a device comprising two facets. The first facet aimed at the generalization of the health insurance, by allowing the affiliation the general scheme on a subsidiary criterion of residence. The second facet had as an ambition to offer a complementary coverage health, to the million people who did not profit from it. This service being subjected to the respect of a condition of residence and a condition of resources. The whole of the device founded by law CMU replaced for the departmental medical assistance and the personal insurance. The extent of the inequalities of health, concerning initially the poorest individuals and most isolated from the society, led to general warm welcome of law CMU. However, although regarded as a great law of public health, certain measurements were the theatre of debates and oppositions, as well on the political scene as in the society. That in particular was the case concerning the effect of threshold induced by the introduction of a ceiling of resources, the risk of deresponsabilisation of the recipients having access free to the device, rules of financing primarily based on public taxes and contributions, the choice of a partnership management between social security and private partners with in particular the organizations of complementary health, or concerning the reserve of a minority of health professionals with regard to the device leading to refusal of care
Leduc, Sacha. "Les ressentiments de la société du travail : la Couverture Maladie Universelle en quête de légitimité." Paris 10, 2008. http://www.theses.fr/2008PA100091.
Повний текст джерелаThe “Couverture Maladie Universelle” (universal health care), which came into effect on January 1rst, 2000, completes the extension of health care to the whole population. If the CMU means, by nature, the abolition of inequalities, it also operates a significant change in collective solidarity. Disconnected from any work activity, the CMU breaks with the French principle of “Sécurité sociale” (social insurance), namely inter-professional and inter-generational solidarity guaranteed by the contribution. If some perceives this service as a major breakthrough, the agents providing it might have doubts about its legitimacy. Observations carried out within many different payment centers of the Health Insurance Services thus revealed that much of the insurance staff felt strong ressentiment towards the beneficiaries of these health care services not based on any work activity. These ressentiments sometimes lead to informal or even illegal controls that rely on a subjective and moral perception of the population benefitting from these rights. Based on an analysis of the concept of the CMU right, the work of CMU providers, the sociopolitical context and logics of discriminations, this thesis focuses on the ressentiment factors. From suspicion to ordinary racism, ressentiment varies according to the social background of the agents. Therefore it appears as an individual expression of collective fears regarding the meaning of work in our society
Pélissier, Aurore. "Activités et efficicience des établissements de santé dans le contexte de la couverture universelle de santé : études sur données d'enquêtes au Cambodge et en Chine." Thesis, Clermont-Ferrand 1, 2012. http://www.theses.fr/2012CLF10432.
Повний текст джерелаUniversal health coverage is at the heart of health financing. In such context, the development of insurance mechanisms and the improvement of efficiency are major stakes to insure equity in access and financing of health care services. In Cambodia, the transition to universal health coverage relies on a combination of health equity funds and community-based health insurance while in China it relies on the development of community-based health insurance with the New Rural Cooperative Medical Scheme. The composition of health financing evolves and thus, the utilization of resources becomes a central issue. So, as it proposed in this thesis, we have to examine the efficiency in the context of universal health coverage. The chapter I analyses the issues of health financing in developing countries in the context of universal health coverage and underlines why the efficiency is the central issue. The thesis then concentrates on the study of efficiency through three chapters. Chapter II details the data envelopment analysis to estimate technical efficiency. Chapters III and IV respectively study the activity and efficiency of health centers of Takeo province in Cambodia and townships hospitals of Weifang prefecture in China, in the context of reforms oriented to universal health coverage
Revil, Héléna. "Le "non-recours" à la Couverture maladie universelle : émergence d'une catégorie d'action et changement organisationnel." Thesis, Grenoble, 2014. http://www.theses.fr/2014GRENH033/document.
Повний текст джерелаThis thesis analyzes the emergence, in France, of the issue of non take-up of Free Supplementary Health Insurance Coverage (“Couverture maladie universelle complémentaire” or “CMU-C”) and Assistance for Private Health Insurance (“Aide complémentaire santé” or “ACS”), as well as its institutionalization within the Health branch of the Social Security system. The CMU-C and the ACS have been created to limit the inequalities in access to healthcare. These have indeed risen with the continuous increase of health expenses left payable by the patients. At the crossroads of socio-history, sociology of public action and sociology of organizations, the process of institutionalization of non take-up is studied chronologically, through sequences of action which have: brought to attention the phenomenon; positioned its challenges in light of the health care restructurings for the most destitute; built representations and structured a plan of action to treat it. Problematized primarily around the challenge of operativity of the CMU-C and ACS benefits, the non take-up has gradually become an operational tool for the correction of inequalities in access to healthcare, which was defined as a priority in the management of health issues. Addressing it has committed the health system to profound changes in its practices and work organization. Overarching it, a transformation of the institution's relationship to its vulnerable nationals has been set into motion, to ensure that the destitute populations are brought closer to their benefits. In this respect, the institutionalization of non take-up is part of a movement that seeks to concentrate the resources and actions of the Health branch on the populations considered vulnerable. An approach of public action by the non take-up of benefits thus appears relevant for understanding how the integration of emerging problems, less visible or deliberately ignored, their sensegiving by public actors and the institution of new categories of action, come to challenge the bureaucratic administrations in their most entrenched functioning, logic and standards of intervention. The approach by the non take-up is, as it happens, an indicator of change operated with regard to public action beneficiaries
Brunat, Marion. "Analyse économique de l'accessibilité des soins primaires en France : la question de l'organisation de l'offre de services de santé ambulatoires." Grenoble, 2010. http://www.theses.fr/2010GRENE008.
Повний текст джерелаThe objective of this work is to bring to bear a critical reflection on the choices of public policy in the fight against health inequalities, through the utilisation of the concept of " real possibilities for access " as applied to both preventive and curative care. In a neo-institutional economic approach, we develop an analysis of the accessibility of medical care recognising the importance of the financial aspect and integrating the structural characteristics of cane supply and professional practice. We stress the limits of the CMU-C provision in an unchanged institutional and organisational system. An econometric study of logistical regression on the bases of medical consumption in 2007 by beneficiaries of CMU-C supports the position we take. Thus we stress the need for a reflection on the benefits and ways of developing an integrated and pluri-professional supply of health services (health centres and " maisons de santé "). We make use of documentation provided by semi-directive interviews with several persons of the whole health sector. These differing forms of organisation are a fruitful avenue to explore to improve coordination, continuity and global healthcare service. Nevertheless, their development depends on internal choices of organisations to achieve an economic gain in terms of the cooperation of professionals. It depends also on the rules and perceptions pertaining to the system at the institutional level. Their emergence as structured ways of supplying primary health care as a means of reducing health inequalities depends on the development of new organisational forms of outpatient healthcare supply as well as their adequate institutional recognition
Foe, Ndi Christophe. "La mise en oeuvre du droit à la santé au Cameroun." Thesis, Avignon, 2019. http://www.theses.fr/2019AVIG2064.
Повний текст джерелаThe State of Cameroon has ratified numerous international instruments to guarantee the rightto health of its people. Further, it has created institutions with the aim of making this righteffective. Even though some gaps can still be observed between international norms andlegislative as well as administrative measures taken at the national level, the task now is toevaluate the capability of these national measures together with that of the institutionscharged with implementing them, in ensuring efficacy in the realization of the right to health.This approach therefore leads us to question the guarantee of this right no more in terms ofeffectiveness of norms and institutions, but rather in terms of their efficacy in preventinginfringements to the health of people.The efficacy-approach adopted in this evaluation brings us to acknowledge the fact that legaland non-legal mechanisms contribute in a relative manner in the guarantee of the right tohealth. However, the evaluation of the strategies and actions taken at the national level leadsto the conclusion that there still exists in various aspects, huge gaps with internationalstandards laid down in order to fully implement the right to health. Thus, it flows from whathas been mentioned above that even though the legal and institutional framework regardingthe right to health is rich, the State of Cameroon nevertheless does not succeed in protectingwith efficacy the health of its populations. To overcome this problem, some reforms arenecessary in the Cameroonian health system.Firstly, the Cameroonian health system needs to adopt a proactive rather than only a reactiveapproach in designing measures aimed at protecting people’s health. In addition, this systemshould take more into consideration health determinants, thus including the preventivedimension, and not only relying on the curative dimension of health’s protection. Secondly, itseems nowadays essential to put in place universal health coverage in order to fight againstthe exclusion of poor and vulnerable people. In the same vein of ensuring people’saccessibility to health care services, the integration of traditional medicine in the Cameroonianhealth system will deeply contribute to the reduction of medical deserts and to reduce thecosts of health services
Alenda-Demoutiez, Juliette. "Les mutuelles de santé dans l’extension de la couverture maladie au Sénégal : une lecture par les conventions et l’économie sociale et solidaire." Thesis, Lille 1, 2016. http://www.theses.fr/2016LIL12003/document.
Повний текст джерелаThis thesis addresses the idea of mutual health organizations (MHOs) as a foundation for health protection in Africa. Current health coverage schemes in West and Central Africa, inherited from Western models, include only a small part of the population, the so-called formal sector. The governments of these countries have engaged in expanding coverage to provide universal access to health care. For two decades, MHOs have developed in this area and have become, in some countries, the pillar of this expansion. But, in light of observed trends, there are significant problems restricting the development of mutual insurance. The literature mainly focuses on operational and financial aspects. In the context of Senegal, our thesis is to show that this vision is restrictive and ignores the political and socio-cultural dimensions. Building on the literature from institutions, academic literature, semi-structured interviews and case studies, we highlight two main explanations for the stagnation of MHOs in this country: a lack of support of the population due to a deficiency in understanding their perception about mutuality and health; and the influence of power between the various actors involved in the health coverage expansion. Mobilizing the economy of conventions and literature on the SSE, we put these obstacles into perspective and show that MHOs should not result from a "turnkey" process
Ramdane, Dabia. "L'accès aux soins des plus démunis." Paris 8, 2007. http://www.theses.fr/2007PA083608.
Повний текст джерелаThe law 1998/07/29 relating to struggle against exclusions has for goal effective access to fundamental rights by promotion of chance’s equality. It is an orientation law in which the exclusion is considered in entirety. The reference of health care access is central. However the law 1999/07/27 write down the creation of CMU is beneficial to specific answer. Indeed the aim I to put the health exclusion right so that the right to health become a reality for all. The CMU satisfy a request concerning volume and structure’s health by limitation of renunciation because of financing by exemption medical cost. So, it is a positive measure as regards health and social affairs. The exclusion constitue a patogenic situation. In fact, the excluded often haven got abrupt successive changes leading to deteriorate their health. The living conditions are a favourable ground development of various illness. The medical take charge is risky and the use of preventive is unusual. So that appareance expensive and serious pathologies for the community. Protection health population is a state duty recognized by the constitutional council as a principle especially necessary for our days. The PRAPS aim to improvement excluded health. It is an instrument of their rehabilitation into the health system. The PASS has for purpose to make easier the insertion at hospital. The ASV integrate health in the city policy. This context of proximity able to organize so as to be pertinent the health promotion of all in a locally development. The make use of a strategy for health promotion in direction of the excluded rest on a transversal public action. The law 2002/03/04 recommend preventive and education for health inscription as part of a coherent policy in order to be considered in global way. The law 2004/08/09 confirm this orientation. Indeed preventive, information and education are conditions of reducing health inequality. European union take too the global way for community’s health action in additional national policies to safeguard values of solidarity and justice so that reinforcing fundamental rights
Ousseini, Abdoulaye. "Les politiques publiques de financement de l'accès aux soins : la fabrication et la mise en oeuvre d'une exemption de paiement dans le système de recouvrement des coûts au Niger." Paris, EHESS, 2014. http://www.theses.fr/2014EHES0583.
Повний текст джерелаThis thesis focuses on a specific public health policy in Niger, namely the fee exemption. It examines the design and the implementation of the policy, the reasons put forward to legitimizeit, the practices and representations of the actors involved in the process, and the new ad-hoc intitutional arrangements that are set up to lead the process. The study is grounded in a socio-anthropological approach that relies heavily on empirical data gathered from the views of the actors involved and observation in situ. It combines two approaches to public policies - from below and from abnove - that complement each other. A closer look at the introduction of the policy shows both hastiness and unpreparedness in the formulation of public health policies. The inconsistencies and significant gaps between the political commitment and the actual implementation in addition to the daily practices of health services and their users are understood as some of the challenges to equal access to health care in Niger. This thesis introduces a debate on the implementation of health care policies as they aim to achieve universal coverage in Niger
Asomaning, Antwi Abena. "The pathway of achieving the universal health coverage in Ghana : the role of social determinants of health and “health in all policies”." Thesis, Lille, 2019. http://www.theses.fr/2019LIL1A002.
Повний текст джерелаThe Universal Health Coverage (UHC) has become a globally accepted concept and medium of providing healthcare to populations equitably and it’s a goal from the third Sustainable Development Goals (SDG), to be achieved by 2030. It has been described as one of the most progressive concepts to transform lives. Ghana in 2003 initiated its own form of the UHC through the establishment of the National Health Insurance Scheme (NHIS) and the continuation of the Community Health-Based Planning and Services (CHPS) implementation. It was a political decision which brought together different interest groups. The implementation of this decision saw healthcare expenditure shoot up to 10.6 percent as a share of Gross Domestic Product (GDP) in 2007. After more than a decade, the UHC (NHIS) has stagnated in growth. This study looks at the NHIS’ implementation from the point of view of the Social Determinants of Health (SDH) and what it could mean for growth if the Health in All Policies (HiAP) concept was applied. Through the use of Kingdon’s theoretical framework in terms of multiple-streams framework and agendas, alternatives and public policies, the policy process and environment are assessed. The research method used was qualitative case study. Some of the research outcomes were that there are undercurrents of tensions existing between a purely voluntary approach to the implementation of the UHC policy and the quasi-compulsory approach adopted by the country. In conclusion, the research finds that financially, it is not feasible to continue with the current strategy. There is the need to seek better institutional complementarities in pursuant of the UHC and adoption of the SDH
Mourgues, Audrey. "L'accès aux soins." Montpellier 1, 2009. http://www.theses.fr/2009MON10051.
Повний текст джерелаBarroy, Hélène. "Toward Universal Health Coverage : Assessing Health Financing Reforms in Low and Middle Income Countries." Thesis, Clermont-Ferrand 1, 2014. http://www.theses.fr/2014CLF10459.
Повний текст джерелаUniversal Health Coverage (UHC) is to ensure that everyone can use the health services they need without risk of financial ruin or impoverishment. While the UHC concept offers a powerful framework for a nation, all countries, irrespective of their income level, are struggling with achieving or sustaining universal coverage. In this context, generating evidence about countries’ experiences and sharing lessons on key constraints and strategic choices used to overcome technical barriers would likely enable low-and-middle countries to move forward and make faster progress toward UHC. The thesis provides a comparative analysis of policy instruments used by five selected country cases (Niger, Vietnam,Bangladesh, Gabon and France), to expand health coverage and financial coverage. Analysis shows that single interventions, like user fee removal (Niger) or community-based insurance (Bangladesh), can increase service utilization for the most disadvantaged groups but face strong limitations toward greater ambitions. More articulated reforms have demonstrated significant gains in expanding health coverage but also face challenges in finding the adequate fiscal space (Gabon) and in strengthening system’s efficiency and equity (Vietnam). Finally, the thesis analyzed the effects of different reforms used to sustain gains of UHC in mature health systems, like France. Overall, the thesis demonstrated that the reform agenda for universal coverage is large, complex and perpetual but that certain pathways can ensure success
De, Pauw Caroline. "Prise en charge des personnes précaires en médecine générale : un levier dans la lutte contre les inégalités sociales de santé ?" Thesis, Lille 1, 2012. http://www.theses.fr/2012LIL12014.
Повний текст джерелаAs they urge the medical professionals to pay special attention to vulnerable populations, public policies set a general goal for which no scope of action or intervention is predefined. In the absence of an explicit common reference table, GPs, are left to wonder which populations are targeted and for which care. This thesis focused on consultation conditions in general medicine. 8 doctors practicing in areas diverse in their population took part in this sociological research. These data were collected through an ethnographic study of medical offices. I was able to observe 879 patients during their waiting time and 698 actual consultations. These data were supplemented by informal discussions and conducting semi-structured interviews with each generalist practitioner.The analysis shows that doctors are at loss regarding the care for vulnerable people. Uncertainty and the lack of rules lead to heterogeneous practices with heavy consequences for patients. For instance, an appropriate waiting-room or consulting room layout would help in creating a favourable state of mind in patients before the actual examination takes place. Moreover, the study reveals a great diversity in the medical care as regards prescriptions, referring to other health professionals or involving social partners. Practices are correlated with how GPs perceive their activity, in particular the doctor-patient relationship, but also with the representations and emotions they associate with vulnerable people. GP behaviours would either reduce or further increase social inequality in healthcare and are of particular interest as they are not based on the medical curriculum. Therefore, I strived to identify them as a good reflection of the values and experience of medical practitioners
Jirakiattikul, Sopin. "Poverty and social protection : the case of Thailand." Thesis, Montpellier 1, 2010. http://www.theses.fr/2010MON10008.
Повний текст джерелаIn the last four decades, Thailand's economic development has been accompanied with great reductions in absolute poverty but not relative poverty. After the Asian financial crisis in 1997, social protection in Thailand emerged as a policy framework employed to tackle poverty and vulnerability. In particular the policy entitled Universal health coverage for all was initiated and had broad effects on the quality of life of Thai people. The goal of this thesis is to understand how social and welfare policies have shaped income distribution in a context of rapid economic growth. To carry out this scope, we concentrate on three questions: (1) Does economic development in the early stages lead to increase inequalities? (2) How does economic growth affect poverty? And (3) Can social protection alleviate the poverty? This thesis is grounded in the concepts of the theories of inequality and social exclusion. It connects the multidimensional aspects of both poverty concepts and measures with the different conceptual bases of social protection. Using series drawn from socio-economic surveys, international databases, field studies, and the assessment of social protection in health, the inequality and social impacts which affect various groups of the poor are explored. State policies targeting the poor are also included in the study. The results show that the pattern of economic growth is not "pro-poor" anymore, as it has been in some periods in the past. Mechanisms of poverty reduction, such as social welfare policies, are threatened, thus the looming economic crisis could be particularly hard on the poor. Social health protection in the last fifteen years has relied on the universal healthcare coverage policy, which is aimed at relieving the pressure of health expenditures. However, the inaccessibility of health services remains a problem for vulnerable populations. Indeed, the allocation of public resources targeting the poor stays is centralized and subject to influence from special interests
Makhloufi, Khaled. "Towards universal health coverage in Tunisia : theoretical analysis and empirical tests." Thesis, Aix-Marseille, 2018. http://www.theses.fr/2018AIXM0025/document.
Повний текст джерелаThis thesis explores, in a four paper format, the possibility of extending social health insurance (SHI) schemes towards Universal Health Coverage (UHC) in presence of structural economic obstacles.The average treatment effects of two insurance schemes, MHI and MAS, on the utilization of outpatient and inpatient healthcare are estimated. The current Tunisian SHI schemes, despite improving utilization of healthcare services, are nevertheless incapable of achieving effective coverage of the whole population for needed services. Attaining the latter goal requires a strategy that targets the “trees” not the “forest”.Chapter two gets around major challenges to extending health insurance coverage and proposes an original approach by targeting informal workers and unemployed. A cross-sectional Contingent valuation (CV) study was carried out in Tunisia dealing with willingness-to-join and pay for two mandatory health and pension insurance schemes.Results support the hypotheses that the proposition of a voluntary affiliation to mandatory insurance schemes can be accepted by the majority of non-covered and that the WTP stated are substantial.Finally in chapter three we focus on methodological aspects that influence the value of the WTP. Our empirical results show that the voluntary affiliation to the formal health insurance scheme could be a step towards achieving UHC in Tunisia. Overall, we highlight the importance of taking into account protest positions for the evaluation of progress towards UHC
Martin, Pascal. "Les métamorphoses de l'État social : la réforme managériale de l'assurance maladie et le nouveau gouvernement des pauvres." Paris, EHESS, 2012. http://www.theses.fr/2012EHES0077.
Повний текст джерелаBetween 1995 and 2008 the reform of the health insurance system in France deeply transformed the social state. From the apex of the state downwards various apparatuses (institutional structures, training programs, work organization) induced new (or renewed) thought categories and practices that penetrated the representations and work of institutional agents. The role of the state was reinforced and managerial policies incorporating a new governance system were introduced. In the course of this transformation, the training programs aimed at different categories of agents were reformatted to fit both the new political orientations of the health system and the discourse of "quality service" with its managerial tools. The implementation in January 2000 of a universal health coverage programme called CMU (Couverture Maladie Universelle), the aim of wich was to protect precarious populations, has been empirically observed. The influx of "assisted" population groups claiming CMU or AME (state medical aid for certain foreign populations) benefits led to a reorganisation of the system, evidence in the way in wich users of the health system are treated at the reception at local level. The managerial rationalisation allowed a classification of users ranging from "good" insured clients to the "assisted" and the imposition of strictly quantitative objectives (norms of "quality"), rationalised work time and work organisation measuring such items as "client" time spent in waiting lines on the length of interviews. At the same time, however, arbitration over the attribution of conditional CMU or AME coverage was left to the discretionary appreciation of health service employees
Ba, Zrampieu Sarah. "Qualité et accessibilité aux services de soins maternels et infantiles dans un contexte d’exemption de paiement : cas de la Côte-d’Ivoire." Thesis, Lille 1, 2017. http://www.theses.fr/2017LIL12012.
Повний текст джерелаFrom April 2011, Ivorian authorities decided adoption of the exemption from payment of medical fees for users of public health institutions and community based. In February 2012, measure of total exemption from payment of medical fees takes end and leaves room to free care, targeted to pregnant women and children under five. This targeted free represents transitional step toward the establishment of universal health coverage. Also, since its adoption in February 2012, the policy of exemption of direct payment targeted to pregnant women and children under five is applied in Côte-d’Ivoire? What are the consequences of the implementation of this policy on the quality and accessibility of maternal and child care in Côte-d’Ivoire? These are the question to which our research will try to answer from a theoretical framework, mainly based on economic theories. These theories are theory of informational asymmetry, Lancasterian theory and approach by capabilities. In order to meet our research questions, we have achieved quantitative analysis of data from surveys of living standards of households carried out by National Institute of Statistics of Côte-d’Ivoire in 2008 and 2015. On the other hand, we realized structured and in-depth interviews, during May 2016 and January 2017, with patients, health providers, and individuals who live close to health centres selected. The main results of our analyses concern partial application of exemption from direct payment, maintaining quality and accessibility to maternal and child healthcare services, and finally, difficult transition to universal health coverage
Guthmuller, Sophie. "L'accès aux soins des populations modestes en France : études micro-économétriques des comportements de recours à la complémentaire santé et aux soins." Thesis, Paris 9, 2013. http://www.theses.fr/2013PA090052.
Повний текст джерелаThe purpose of this research is to study the financial access to complementary health insurance (CHI) and to health care of low-income populations in France. We are particularly interested in evaluating a subsidized health insurance program (ACS) introduced to encourage households whose resources are just above the free means-tested complementary health insurance program (CMUC), to purchase a CHI plan. In implementing a randomized experiment and in using a sample of eligible households for these programs, we are able to enhance the knowledge base on three issues: (i) Understanding and reducing the ACS non-take-up. (ii) The take-up of CHI plan and the health care use of low-income populations. (iii) The existence of a CMUC threshold effect. Results of this thesis provide some important tracks to improve the effectiveness of these programs and more generally that of future public policies aiming to improve equity in access to health care
Bertho, Laurent Senand Rémy. "Vécu et ressenti des patients bénéficiaires de la couverture maladie universelle." [S.l.] : [s.n.], 2004. http://theses.univ-nantes.fr/thesemed/MEDbertho.pdf.
Повний текст джерелаDiallo, Elhadj Mamadou Saliou. "Three essays on progress towards universal health coverage in developing countries." Electronic Thesis or Diss., Université Clermont Auvergne (2021-...), 2021. http://www.theses.fr/2021UCFAD034.
Повний текст джерелаMany efforts and tremendous progress has been made in recent years by low- and middle-income countries towards universal health coverage. It is achieved when all individuals have access to quality health care when they need it, without incurring financial hardship. This thesis aims to measure the progress made by low- and middle-income countries in universal health coverage, deduce their determinants, and highlight the effects of universal health coverage on health outcomes. The thesis is organized around three chapters. The first chapter shows the effect of out-of-pocket expenditures on poverty. The analysis aims to show the necessity to move towards universal health coverage by highlighting the effect of out-of-pocket expenditures on poverty. The second chapter aims to show the factors that explain the progress made by some countries in universal health coverage and analyzing the specific effect of government revenue. In addition, this chapter, unlike other studies, deduces the minimum level of government revenue as a share of GDP that low and middle-income countries should mobilize to make significant progress towards universal health coverage. Finally, chapter three examines the effect of progress towards universal health coverage on health status
Perronnin, Marc. "Effet de l'assurance complémentaire santé sur les consommations médicales, entre risque moral et amélioration de l'accès aux soins." Phd thesis, Université Paris Dauphine - Paris IX, 2013. http://tel.archives-ouvertes.fr/tel-01018486.
Повний текст джерелаTapsoba, Palingwindé Yann. "Sustainable health financing for progress towards universal health coverage in low- and middle-income countries." Thesis, Université Clermont Auvergne (2017-2020), 2017. http://www.theses.fr/2017CLFAD022/document.
Повний текст джерелаThis thesis focuses on the sustainability issues in health financing in low-and middle –income countries. It is articulated around four chapters. The two first chapters propose to respectively explore the determinants of technical efficiency of health expenditures and their level per capita in low-and middle –income countries. The first chapter analyzes trade openness effect on the technical efficiency of health expenditures. The second chapter investigates air pollution effect on health expenditures. In the two last chapters, we focus on Sub-Saharan African countries. The third chapter studies the role that plays prepayment health financing for health improvement in households whereas the fourth one sets the goal to analyze the determinants of prepayment health expenditures, by particularly focusing on political instability
André, Olivier. "La couverture maladie aux États-Unis : contribution à l'étude des systèmes de protection sociale." Thesis, Aix-Marseille, 2019. http://www.theses.fr/2019AIXM0534.
Повний текст джерелаNearly a decade after the adoption of the Affordable Care Act, better known as “Obamacare,” health coverage remains an extremely controversial issue in the United States. Although healthcare management has been profoundly redesigned, it is still not based on a single-payer system. The creation of platforms in each State to facilitate health plan subscription and the introduction of binding legislation are not intended to replace the market but to improve it. This market-based approach is embodied in the enactment of a general obligation for companies to cover their employees (employer mandate) and, especially, a personal obligation to maintain coverage (individual mandate). However, universalizing coverage, by reconciling a rudimentary form of solidarity with individualistic values of American society, has not been easily achieved. The generalizing dynamic expected from the 2010 reform has been deeply thwarted. Legal, political and social challenges have disrupted its implementation. The resulting extraordinary judicial litigation is testament to the American reluctance to establish universal health coverage. And yet, the ACA reforms would have respected the market dimension of insurance and respected the individual States through a very conciliatory approach to their sovereignty. The surprising mobilization against this legislation, which has not undermined the private insurance system, highlights determinants that still hinder universal health coverage in the United States. Most Western countries have already achieved the objective of universal healthcare
Legal, Renaud. "Les déterminants de la demande individuelle de couverture complémentaire santé en France." Paris 9, 2008. https://bu.dauphine.psl.eu/fileviewer/index.php?doc=2008PA090028.
Повний текст джерелаWhile the insurance demand is very well documented in other countries, French research in this area is scarce, mainly because of the difficulty to have access to detailed data. This PhD uses data provided by a major health insurance company. We first build a joint modelling for both insurance and healthcares demands; we then study insurance premium differences between administrative French areas. These data, that have never been analyzed in France before, allow us to estimate the sensitivity of insurance demand to several variables such as price level. We also take into account the specificities of the insurance supply to analyse separately demand for outpatientcares coverage and dental/optic coverage. Finally, we estimate bivariate probit models to model demand for both healthcares and insurance, which leads to measure moral hazard and selection effects, on a case-by-case basis. Thus, our work allows to describe more precisely the French policyholders’ behaviour with complementary health insurance
Ralaidovy, Ambinintsoa Haritiana. "Efficiency in health ressource allocation : three empirical studies in Eastern Sub-Sahara Africa and Southeast Asia." Thesis, Université Clermont Auvergne (2017-2020), 2019. http://www.theses.fr/2019CLFAD016.
Повний текст джерелаPriority setting in health, in the context of Universal Health Coverage, emphasizes three values: improving population health, ensuring equity in access to and quality of services and avoiding impoverishment or underutilization of services as a result of out-of-pocket expenditures. Allocative efficiency can be measured with respect to any one of these values, or with respect to all together by different variants of Cost-Effectiveness Analysis. In this thesis, we use the Generalized Cost-Effectiveness Analysis, a standardized approach developed by the World Health Organization’s programme, ‘Choosing Interventions that are Cost-Effective’ (WHO-CHOICE) that can be applied to all interventions in different settings. This thesis provides a quantitative assessment of allocative efficiency within three health categories: communicable diseases, noncommunicable diseases, and road traffic injuries, focusing on two economically and epidemiologically diverse regions: Eastern sub-Saharan Africa and Southeast Asia. Our objectives are to inform health policy debates, improve the world’s body of knowledge on the cost-effectiveness of different interventions by providing more information on the allocative efficiency in those three disease groups and contribute to discussions on Universal Health Care packages
Pierre, Aurélie. "Assurance maladie complémentaire : régulation, accès aux soins et inégalités de couverture." Thesis, Paris Sciences et Lettres (ComUE), 2018. http://www.theses.fr/2018PSLED031/document.
Повний текст джерелаThis thesis deals with the place of private health insurance in the overall health insurance scheme in France, focusing on social inequalities and on solidarity between healthy individuals and sick patients. It particular, it addresses the role of private health insurance on access to health care, mutualization of health expenditure, and welfare. The results of this thesis reveal the key role of private health insurance to access to care postponed over time for financial reasons. However, our results also show that generalizing complementary health insurance in the current health insurance scheme does not allow pursuing equity goals nor increasing welfare. They finally reveal that the mutualization induced by private health insurance appears relatively weak, compared to the one induced by public health insurance. They therefore encourage a change in the role of private health insurance in funding medical care
Awawda, Sameera. "A roadmap to attain universal health coverage in developing countries : a microsimulation-based dynamic general equilibrium model." Thesis, Aix-Marseille, 2019. http://theses.univ-amu.fr.lama.univ-amu.fr/190925_AWAWDA_480wiwc30esmfbi673fafoz83y_TH.pdf.
Повний текст джерелаUniversal Health Coverage (UHC) has received during the last decade a revived interest by policy-makers, international organizations and researchers worldwide. There has been hitherto no theoretical-empirical work that can enable to assess the feasibility of UHC and its potential effects at both micro- and macro-economic levels. This thesis presents an operationalizing theoretical framework that is capable of addressing the above issues using dynamic stochastic general equilibrium (DSGE) model and microsimulation technique. The first chapter presents the DSGE model that is calibrated to capture the salient features of an archetype developing economy. Results illustrate how the degree of financial-risk protection can vary with the financing-mix used to implement the UHC reform. The second chapter assesses the macro-fiscal conduciveness of UHC reforms and its impact on welfare and public finance in the particular context of Palestine. Results show that while UHC can enhance welfare, a parallel expansion of the breadth and width of coverage may not be feasible unless a policy adjustment is undertaken. The third chapter examines the potential impact of UHC reforms on intergenerational inequalities in view of fiscal sustainability. The question of who bears the burden of the UHC is addressed using an overlapping generation model, while a convenient measure to assess the social impact of UHC-financing strategies is proposed. Results show that under conditions of limited fiscal space, the choice between deferred-debt and current UHC-financing implies a trade-off between fiscal sustainability against intergenerational inequality, with which the policy-maker will have to confront
Robert, Emmanuelle. "La situation de l'allaitement maternel en Wallonie et à Bruxelles au travers d'enquêtes de couverture vaccinale." Doctoral thesis, Universite Libre de Bruxelles, 2016. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/234997.
Повний текст джерелаDoctorat en Santé Publique
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Gaillard, Pierre. "Etude de la couverture vaccinale d'une population d'enfants hospitalisés dans un service de pédiatrie : à propos de 502 dossiers." Bordeaux 2, 1992. http://www.theses.fr/1992BOR2M154.
Повний текст джерелаCyr, Linda. "Apport des indices de végétation pour l'évaluation de la couverture du sol en vue d'une modélisation spatiale de l'érosion." Mémoire, Université de Sherbrooke, 1993. http://hdl.handle.net/11143/11136.
Повний текст джерелаSemegan, Barthélémy. "Impact des facteurs organisationnels sur la couverture sanitaire des populations et sur la viabilité financière des complexes communaux de santé au Bénin." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1999. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape9/PQDD_0002/MQ44959.pdf.
Повний текст джерелаDiallo, Ibrahima. "Analyse d’une politique publique de santé destinée aux personnes âgées au Sénégal. La mise en œuvre du système d’assistance « SÉSAME »." Mémoire, Université de Sherbrooke, 2013. http://savoirs.usherbrooke.ca/handle/11143/61.
Повний текст джерелаAragon, Jean-Claude. "La place de la protection sociale complémentaire dans la couverture des risques vieillesse et maladie." Thesis, Toulouse 1, 2018. http://www.theses.fr/2018TOU10014.
Повний текст джерелаWhereas the Social Security is facing recurring financial difficulties and the quality of its benefits is affected by several reforms, the spread of supplementary social protection schemes is reaching new levels. The latter constitute a complex set of institutions and operators, combining collective and individualized forms of solidarity. The framework of this evolution has historically been structured around notions of « employees’ supplementary collective guaranties », their minimal level and management. To domestic law has been added EU law’s influence through regulatory intervention in matters relating to competition, classification schemes, solvency of operators, equal treatment or free movement of workers. This research focuses on supplementary protection for the two risks that are by far the heaviest financially speaking : old-age pensions and health insurance. The singular organization of their different levels of complementary protection, composed of mandatory and optional schemes, is continually being called on by several issues. These include administration costs, access to entitlements, portability and readability for both insured and companies, as well as the high number of actors involved in the functioning of the system. Successive parametric reforms have enabled the adaption of the system to its moving environment with acceptable results and compatibility with the principle of solidarity, encouraging to pursue on this path. The complexity, weak readability and financial sustainability oft he system however tip the scale in favor of an re-organization of its structure. Should successive and some what isolated reforms of a complex system be pursued at the expense of ever-higher political costs ? Conversely, should we substitute « systemic » reforms to a logic of successive « parametric » ones ? Would it respond to growing financing needs ? Answers to these questions will shorty be provided by the government, expected to address the issue in 2019
Ronchetti, Jérôme. "Contributions à l'analyse de la diversité d'impacts des complémentaires santé." Thesis, Le Mans, 2017. http://www.theses.fr/2017LEMA2002/document.
Повний текст джерелаThis thesis focuses on the assessment of health risks and the modelisation of the health expenditures decisions. The aim is to realize the link between the agent behaviors concerning his health investments and her situation on the labor market. This work will be sharing around two axis. On the one hand, it will be necessary to use econometrics methods to evaluate healths risks, health expenditures and their heterogeneity within the population. In other words, this part connects inequalities about health expenditures and those on the labor market,for estimate willingness to pay a health coverage. The determinants of purchasing a complementary will be highlighted. On the other hand,a structural model with individual choices will be etablished, based on the empirical works. An equilibrium model confronting the sum of interdependent decisions of workers - health expenditures, careers and assets choices - in a uncertainty environment should allows us to represent stylized facts and to propose economic policies. We emphasize more precisely on the link between health expenditures, careers choices and retirement
Lee, Ho-Chul. "Étude des différences géographiques sur le développement de la sécurité sociale." Paris 1, 1991. http://www.theses.fr/1991PA010001.
Повний текст джерелаThe main purpose of this thesis is to verify the existence of geographic differences and to analyse the reasons of these continental disparities in the development of the social security. To this end, we have completed a discriptive approach and empirical tests on 105 countries. We observe, in consequence, geographic differences in every aspect of social security: in its historical evolution, in the level of benefits and coverage rates and so on. . . And these continental differences are due to differences in cultural and political factors
Molinier, Muriel. "La voie de l'inclusion par la médiation au musée des beaux-arts : des publics fragilisés au public universel." Thesis, Montpellier 3, 2019. http://www.theses.fr/2019MON30039.
Повний текст джерелаWe study museums as a privileged place of inclusion for the audiences weakened by medical, social or medico-social issues. Our infocommunicational approach is based in the relationship between museum, audience and third party mediator, in museum education (mediation). Firstly, the museum's social roots and its desire for democratization make it relevant to the issue of museum and social inclusion. Secondly, vulnerable audiences are presented through the representations that surround them, the terms that describe them, the status of their accompanying persons in the museum, and that of culture in social work and health. Thirdly, museum education (mediation), through devices and museum educators (mediators), as well as by mobilizing museum-health relations, defines mediational approaches aimed at vulnerable audiences, between integration, inclusion and involvement. Our comprehensive research method allowed us to extract three target audiences (people : with Alzheimer's disease, learning French, visually impaired) in order to globalize the approaches. Six target museums (musée des Augustins in Toulouse, musée du Louvre-Lens in Lens, musée du Louvre in Paris, musée Fabre in Montpellier, Montreal museum of fine arts in Montréal, Museum of Modern Art in New-York) have allowed us to produce corpuses and interviews. Our thoughts for entering the path of inclusion are to think : on the one hand, a transversality of fragility leading to increase the universality of a mediation in universal design and to consider a single universal audience; on the other hand, the merger of the mediator / special educator partnership through a new hybrid museum-health operator : the remediator
Teodorescu, Daniela Iulia. "Le point de vue des Roumains sur le don d'organes, les décisions de fin de vie et la couverture sociale : trois études d'éthique de soin Le point de vue des Roumains et des professionnels de la santé concernant le don d'organes vivants Le point de vue des roumains et des professionnels de santé concernant le Suicide Médicalement Assisté Le point de vue des roumains concernant la couverture sociale." Thesis, Toulouse 2, 2018. http://www.theses.fr/2018TOU20100.
Повний текст джерелаOur research investigates the views of Romanians lay people’s and health professionals regarding living organ donation (LOD), physician-assisted suicide (PAS) and health insurance program. Our work is based on N.H. Anderson's Functional Theory of Information Integration (1981). With regard to the first study: 263 adults (including 51 health professionals) rated the LOD's acceptability of the 42 realistic scenarios resulting from the combination of five factors: A) type of organ, B) whether it could have been obtained from a cadaver, C) donor-recipient relationship, D) donor's level of autonomy, E) financial compensation, to which we added factor F) patient’s level of responsibility for their illness. For the second study: 212 lay people’s and 52 health professionals judged the acceptability of PAS in 36 realistic vignettes composed of all combination of four factors: A) the patient’s age, B) the level of the incurability of the illness, C) the type of suffering, and D) the patient’s request for PAS. Regarding the third study: 271 adults (including 40 health professionals and 33 business managers) judged the acceptability of the health insurance program in 51 realistic scenarios resulting from the combination of five factors: A) Employers contribution, B) Workers contribution, C) Medical and dental coverage, D) Coverage of chronic or severe illness, E) Beneficiaries. Results: Regarding LOD, seven qualitatively different judgment positions were found: Never Acceptable (12%), Free Market (44%), Compensation (12%), Altruism (6%), Always Acceptable (16%), Patient’s responsibility (4%) and Undetermined (6%). For the second study, the results show that the majority of lay people (51%) and health professionals (85%) were opposed to the PAS, regardless of the conditions. Regarding our third study the results show that most participants (78%) favored the existence of a health insurance program
Izambert, Caroline. "Soigner les étrangers ? L’État et les associations pour la couverture maladie des pauvres et des étrangers en France des années 1980 à nos jours." Thesis, Paris Sciences et Lettres (ComUE), 2018. http://www.theses.fr/2018PSLEH127.
Повний текст джерелаIn France, the healthcare costs of undocumented foreign nationals are covered by a specific welfare benefitcalled State Medical Aid (Aide médicale d’État). This benefit was created in 2000, as part of the law onUniversal Medical Insurance (Couverture médicale universelle) which enables French nationals andundocumented foreign nationals to benefit from the state health insurance scheme (Assurance maladie) as longas they are resident in France. This thesis explores the origins of a measure created exclusively for people whosepresence on French territory is judged illegal and the impact of the existence of this particular healthcarecoverage.The approach brings together a history of public policy and an ethnography of care settings and reception centresfor undocumented foreign nationals.Part One retraces the stages involved in opening up access to the state health insurance scheme from the mid-1980s onwards. It focuses on the way in which a distinction progressively emerged between the public healthissue of undocumented people accessing healthcare, and that of poor people accessing healthcare. The role ofhumanitarian associations, notably Doctors without Borders and Doctors of the World, who opened freehealthcare centres in France from 1986 onwards, is underscored, as are their links with movements defending therights of foreigners. These processes are located within a longer history of debates about access to welfare forthe poorest going back to the nineteenth century, and the subordination of social policy to the objectives ofcontrolling migratory flows.Part Two, based on research carried out in a hospital and in a health rights organization, analyses theconsequences of the introduction of immigration administrative categories into the healthcare system as well asthe emergence of a degraded form of social citizenship for people living illegally in France
Diongué, Birahime. "Les niveaux et les facteurs explicatifs de la santé au Sénégal de 1960 à 1982." Clermont-Ferrand 1, 1986. http://www.theses.fr/1986CLF10018.
Повний текст джерелаThe purpose of this thesis is first to study the health levels of Senegalese people and secondly to analyze the factors explaining their health standard. In the first part, we used the result indicators such as morbidity rates, based on the ministry of public health data only, since they are no epidemiologic surveys. The trends analysis indicated a strong prevalence of certain diseases, such as malaria, with nevertheless important disparity between the regions. However, despite the eradication of big endemics such as plague, small pox, sleeping disease, others diseases such as malaria, tuberculosis leprosy, sexually transmissible diseases, nutritional and diarrheal diseases, measles, whooping cough, consequences of abortions and deliveries, represent the most important plagues. But the morbidity data do not correspond to the Senegalese reality: in fact, the health infrastructures are almost exclusively settled in towns and consequently, they benefit only to urban population. Moreover, the attraction of traditional medicine is not to be neglected, but it is the opposite. All the reasons led us to believe that the morbidity is not really known and consequently that the indicator can not constitute a study base of the health (or levels) in Senegal. That is why we choose the mortality, which is a incontestable evidence and a more known indicator. We analyzed in a second part the health factors and, in order to so, we used 17 health and socio-economic variables supposed to explain the levels of infant mortality (explained variables). We went on with a differential econometric analysis, at first at the national level, then with a pooling-data analysis including only 6 regions and finally with a model applied to Dakar, then to Ngayokheme. The demographic variables, the availability of the coverage of beds, as much as the schooling rate have been the main explanatory factors of health status in the regions and in Dakar the income per capita did not reveal itself as a significate variable. But, in terms of personnel in Dakar the medical and paramedical (midwives) coverage have been significate variables, when at the region level, the population per nurse indicator only prove significate
Mwembo, Tambwe-a.-nkoy Albert. "Optimisation de la couverture opérationnelle de la prévention de la transmission mère-enfant du VIH à Lubumbashi, République Démocratique du Congo: quelle stratégie adopter ou renforcer ?" Doctoral thesis, Universite Libre de Bruxelles, 2012. http://hdl.handle.net/2013/ULB-DIPOT:oai:dipot.ulb.ac.be:2013/209670.
Повний текст джерелаLa majorité des enfants contaminés par le VIH se retrouve dans les pays en développement. Pour prévenir la transmission verticale les femmes doivent d’abord connaître leur statut sérologique au VIH. En République Démocratique du Congo, le problème posé par la transmission mère-enfant est préoccupant. Pour lutter contre cette transmission verticale, la Prévention de la Transmission du VIH de la Mère à l’Enfant (PTME) est intégrée dans le paquet minimum d’activités de la CPN. Comme dans d’autres pays, la couverture reste toujours insuffisante.
Objectifs :
Spécifiquement ce travail visait à :(1) déterminer la proportion des femmes qui n’ont pas fait l’objet du dépistage du VIH parmi les accouchées des maternités de Lubumbashi ;(2) évaluer le niveau de connaissance du personnel travaillant dans des maternités en matière des recommandations de la PTME à Lubumbashi ;(3) déterminer l’acceptabilité du dépistage rapide du VIH en salle de travail ;(4) Mettre sur pieds une stratégie pouvant contribuer à atteindre une couverture opérationnelle optimale de la PTME dans des contextes similaires à la ville de Lubumbashi.
Méthodologie:
C’est une approche de recherche-action réalisée au niveau du système de santé, des prestataires de soins, parturientes et accouchées dans les maternités de Lubumbashi. Pour ce faire deux études transversales et une intervention ont été réalisées à partir d’avril 2010 à février 2011 :les études transversales ont permis de déterminer la proportion des accouchées avec du statut sérologique VIH inconnu et d’évaluer le niveau de Connaissances, Attitudes et Pratiques (Niveau de CAP) des prestataires de soins de salles de travail face aux recommandations de la PTME. L’intervention a consisté à faire le dépistage rapide du VIH chez les parturientes admises en salles de travail.
Résultats:
Parmi les accouchées, 52,5 % ignoraient leur statut sérologique. Parmi elles, 62,9 % accepteraient de faire le test VIH à la maternité. La proportion des femmes avec un statut sérologique inconnu au VIH était significativement plus élevée chez celles qui n’avaient pas suivi de CPN (Odds Ratio ajusté [ORa] = 5,8; Intervalle de Confiance [IC] 95 % :1,7-19,0) et chez celles qui avaient un bas niveau d’instruction (ORa = 1,5 ;IC 95% :1,1-2,1).
Le niveau de CAP de la PTME des prestataires des maternités à Lubumbashi etait suffisant dans seulement 8,5 % des cas. La proportion de prestataires avec un niveau CAP suffisant était significativement plus élevée chez les universitaires que chez les non universitaires (ORa = 8,6; Intervalle de Confiance [IC] 95 % :1,6-47,5) et dans les maternités où la PTME était intégrée (OR = 4,5 ;IC 95 % :1,3-18,4).
Sur 474 parturientes, 433 (91,4 % ;IC 95 % :88,4-93,7 %) ont bénéficié d’un dépistage du VIH en salle de travail après counseling. La prévalence du VIH chez les parturientes examinées était de 4,8 %. L’acceptabilité du dépistage rapide du VIH était significativement plus élevée lorsque la durée du counseling était inferieure ou égale à 5 minutes (ORa = 5,8 ;IC 95 % :2,6-13); chez les parturientes qui avaient déclaré ne pas avoir l’objet de dépistage aux CPN (ORa = 3,8 ;IC 95 % :2-7,8) et chez celles qui étaient en début de travail d’accouchement (ORa = 2,3 ;IC 95 % :1,2-4,7).
Conclusion :
La proportion de femmes qui accouchent sans connaître leur statut sérologique au VIH est encore importante, malgré le fait que le dépistage du VIH soit proposé lors des CPN. C’est un besoin non couvert et une deuxième opportunité manquée. Etant donné qu’il existe à Lubumbashi des structures sanitaires offrant le service de PTME, nous proposons l’approche opt out du dépistage rapide du VIH en salle de travail pour cette catégorie de femmes. Cette stratégie contribuerait à optimiser la couverture opérationnelle du service au moindre coût.
Background:
The majority of children infected with HIV are found in developing countries. To prevent vertical transmission women must first know their HIV status. In the Democratic Republic of Congo, the problem of mother to child transmission is a concern. To fight against vertical transmission, national policy has included the Prevention of HIV Transmission from Mother to Child Transmission (PMTCT) in the package of activities of the Antenatal care. As in other countries, coverage is still insufficient.
Objective:
Specifically this study aims to: (1) determine the proportion of women who did not receive HIV testing among women who gave birth in maternity units in Lubumbashi, (2) assess the level of knowledge of staff working in maternity units in the recommendations of PMTCT in Lubumbashi, (3) determine the acceptability of rapid HIV testing in the labor room, (4) develop a strategy to improve the operational coverage of PMTCT in similar contexts to the city of Lubumbashi.
Methods:
This is an approach to action research conducted at the health system, care providers and parturients and women gave birth in maternity birth in the maternity Lubumbashi. To get two successive cross-sectional studies and intervention was conducted from April 2010 to the end of February 2011: cross-sectional studies have determined the proportion and determinants of birth with unknown HIV status and to evaluate the Level of Knowledge, Attitudes and Practices (KAP level) providers care delivery room in the PMTCT recommendations.
The intervention consisted in the rapid HIV testing in parturient admitted to labor wards.
Results:
The analyses of our results showed that among mothers, 52.5% were unaware of their HIV status. Among them, 62.9 % would be tested for HIV to motherhood. The proportion of women with unknown HIV status to HIV was significantly higher in those who had not attended ANC (adjusted odds ratio [aOR] = 5.8, Confidence Interval [CI] 95%: 1.7 - 19) and among those with a low education (aOR 1.5, 95% CI: 1.1 to 2.1).
The level of CAP PMTCT providers of maternity was sufficient to Lubumbashi in only 8.5% of cases. The proportion of claimants with a sufficient level CAP was significantly higher among academics than among non-academic (aOR = 8.6, confidence interval [CI] 95%: 1.6 to 47.5) and in maternity wards where PMTCT was integrated (OR = 4.5, 95% CI: 1.3 to 18.4).
Among 474 parturients, 433 (91.4% confidence interval [CI] 95%: 88.4 to 93.7%) were voluntary testing for HIV in the labor ward after counseling. HIV prevalence among parturients examined was 4.8%.The acceptability of rapid HIV testing was significantly higher when the duration of counseling was less than or equal to 5 minutes (aOR = 5.8, 95% CI: 2.6 to 13) in parturients who reported not doing this testing for EIC (aOR = 3.8, 95% CI: 2 to 7.8) and among those who were in early labor delivery (aOR = 2.3, 95% CI: 1.2 - 4.7). By cons, it was lower among adolescents than among adults (aOR = 0.1; [CI] 95%: 0.0-0.7).
Conclusion:
The proportion of women who give birth without knowing their HIV status is still important, despite the fact that HIV testing be made available when the antenatal care. This is an unmet need and would be a missed opportunity. Since there Lubumbashi health facilities offering PMTCT service, we offer the opt-out approach of rapid HIV testing in the labor ward for such women, to optimize coverage of operational service at the lowest cost.
Doctorat en Santé Publique
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Collange, Fanny. "L’hésitation vaccinale et les professionnels de santé : étude des attitudes et pratiques des médecins généralistes, des pédiatres et des pharmaciens vis-à-vis de la vaccination." Thesis, Aix-Marseille, 2019. http://www.theses.fr/2019AIXM0082/document.
Повний текст джерелаThis work aimed to identify, characterize, quantify health professionals’ vaccine hesitancy and investigate its potential geographical variations, as well as to study the adherence of certain health professionals to the extension of their role in the field of vaccination. Based on quantitative data collected in a panel of general practitioners in 2014, we estimated the prevalence of moderate to high vaccine hesitancy at 14% in this population; we found that it was higher among general practitioners in Southeastern France than in the rest of France. Based on quantitative data from a survey of pediatricians in the département “Bouches-du-Rhône” in 2016, we observed their very high engagement in vaccinating their patients, and their low level of vaccine hesitancy; we also found some uncertainties regarding the Rotavirus vaccine. Our qualitative data collected in 2016-17 among pharmacists in Southeastern France, show that some of them are also hesitant about certain vaccines. Moreover, not all of pharmacists supported the extension of their vaccination role and some had concerns about general practitioners and nurses reactions. Overall, our results suggest that health professional experiences of vaccine-preventable diseases and adverse vaccine reactions, their perception of the benefit/risk balance of vaccines, their trust in health authorities and confidence in their capabilities (self-efficacy), can influence their recommendations of vaccines to their patients; vaccine controversies in the past decades have had an impact on their perceptions of vaccines
Riedel, Marc. "Approche chronobiologique et chronopsychologique de la profession de sapeur-pompier : vers une chronoprévention des risques." Thesis, Tours, 2016. http://www.theses.fr/2016TOUR2009.
Повний текст джерелаThe aim of this study was to assess the impact of biological and psychological rhythms on the firefighters (FF) activity. The 1st part of our study was performed on FF’s interventions databases. 24-h pattern of lag time (LT), duration in min between a call and departure of service vehicle for out-of-hospital cardiac arrest (OHCA), and 24 pattern of relative risk of work-related injuries (WRIRR) of FF (which takes into account the number of at-risk FF/unit time), were assessed on a 4y span.. This analysis revealed a 24-h variation in LTOHCA and in WRIRR, with both a nocturnal peak. The stability of the LTOHCA rhythm between years and seasons and its weak relationship with the OHCA 24-h pattern favored the hypothesis of an endogenous component or origin. Moreover, for the same FF population, LTOHCA and WRIRR patterns were positively correlated : the hypothesis of a common mechanism linking performance and accidents seemed to be validated. The 2cd part assessed the differences in τ, of 16 coexisting rhythms of 30 healthy FF of mostly comparable average age, body mass index, career duration, chronotype—morningness/eveningness. Data of the self-assessed 16 circadian rhythms were gathered continuously throughout two 8-d spans, in winter and in summer. The desynchronization ratio (DR: nb of variables with τ≠24.0h/nb of variables x100) served to ascertain coexistence of rather strong and weak circadian oscillators, fro which the gradient reflects interindividual differences in FF’s DR. These différences are consistent with the hypothesis of an inherited origin of a differential propensity to circadian desynchronization. It pointed also the fact that, although a nocturnal trough of WRIRR and LTOHCA was confirmed, the rhythms of performance were inexistants for most of the FF of our study, refuting the classical hypothesis of a standalone link between variations of performance and accidents. These results also put into perspective new possible explanations of black time. We propose the 24 h pattern of WRIRR, particularly of FFs and other highly skilled self-selected cohorts, is more strongly linked to circadian rhythms of fatigue and sleepiness than cognitive performance. Other possible explanations –suppressed expression of circadian rhythms and/or unmasking of ultradian periodicities in cognitive performance in specific circumstances, e.g., highly stressful work, competitive, or life-threatening settings, are also discussed. Furthermore, the whole study allows to consider new paths in chronoprevention of risks in the FF profession, based upon the study of biological, psychological and social rhythms. This study was supported by the Fire Departement of Saône et Loire (France), the French National Fund for the Prevention of Occupational Accidents and Diseases of the French National Pension Fund for Administrative Division Officials, and was approoved by a regular ethics comittee
Fortin, Bernard. "La conception du conservatisme du Times de Londres, 1957-1963." Master's thesis, Université Laval, 2004. http://hdl.handle.net/20.500.11794/17837.
Повний текст джерелаMsefer-Laroussi, Souad. "Analyse du système de couverture des services dentaires au Québec." Thèse, 2007. http://hdl.handle.net/1866/18214.
Повний текст джерелаVigan, Medji Doreen Peggy Rose. "Analyse de l’implantation du régime d’assurance maladie universelle (RAMU) au Bénin : obstacles et facteurs facilitants." Thèse, 2017. http://hdl.handle.net/1866/20566.
Повний текст джерелаSanou, Aboubakary. "Évaluation du processus : analyse de l’évaluabilité et de la mise en œuvre d’une stratégie d’amélioration de la couverture vaccinale au Burkina Faso." Thèse, 2012. http://hdl.handle.net/1866/10325.
Повний текст джерелаImmunization is one of the most important subjects in public health despite constant on-going controversies. In the context of this research it is more its accessibility that is at issue. This particular research is situated in the perspective of the comprehensive approaches to evaluation and analyses an immunization improvement strategy using a three steps process evaluation after documenting its context. The perceptions and factors influencing immunization coverage before the intervention are assessed, as well as the conceptual and theoretical foundations of the intervention, the implementation and reception of the intervention and mechanisms used to attain the results. The results indicate that immunization is integrated into the local strategies used for protection and grounded in the local concept of risk. Results show also that the context associated with socioeconomic factors and the relations between parents and health services contribute to explain the relatively low complete immunization coverage rate (50.3%) before the intervention. The exploratory analysis indicates that the intervention had an implicit theory and a philosophy. Although the intervention was adequate for an evaluation, discrepancies in the implantation compromised the possibilities of validating its initial theory and philosophy. The descriptive analysis showed that more than 95% of the recipients were reached by the intervention and the received dose of intervention was acceptable indicating that the intervention is a workable strategy that needs to be improved. The complete immunization coverage after the intervention was 87.3%; it was influenced positively by factors including parents’ level of knowledge and the fact that the child was born in a health center, and negatively by the long distances from household to immunization place. The strategies involved in the attainment of the results used parents’ knowledge improvement as a principal procedure. This contains an underlying mechanism mainly related to the perception of the opportunities that immunization permits for preventing various health, social and economic risks. However, complementary approaches tend to maximize intervention outcome by using the power given to female community immunization facilitators and social coercion. The research contributes to highlight the relationship between evaluability assessment and process evaluation, to propose a new conceptual and operational understanding of dose of intervention administered and dose of intervention received. On practical grounds, this research recommended the improvement of the immunization activities staff profile and the widespread adoption of the strategy after it improvement. Indications are provided to improve the intervention and to inform founding agencies.
Stanton-Jean, Michèle. "La Déclaration universelle sur la bioéthique et les droits de l'homme : une vision du bien commun dans un contexte mondial de pluralité et de diversité culturelle?" Thèse, 2010. http://hdl.handle.net/1866/5181.
Повний текст джерелаIn October 2005 the General Assembly of UNESCO adopted the Universal Declaration on Bioethics and Human Rights. This declaration was produced by the International Bioethics Committee in consultation with the Intergovernmental Bioethics Committee, Member States, Interagency Committee of the United Nations, governmental and non governmental organisations, national bioethics committees and many actors involved in bioethics. This declaration had been preceded by two other declarations adopted in 1997 and 2003: The Universal Declaration on the Human Genome and Human Rights and the International Declaration on Human Genetic Data. The ethical questions posed by the scientific and technological developments and globalization had prompted the organization to prepare normative instruments susceptible of being endorsed and used by all nations, especially developing ones. Being the only global organization with a specific mandate in ethics UNESCO wanted to give its Member States a normative framework that could help them in the formulation of their legislations and guidelines. Having been involved in that process as the Chair of the International Bioethics Committee, we asked ourselves this question: In the context of globalization, is it possible to have a bioethics based on a universal common good vision that could take into account cultural diversity and pluralism? The example of the elaboration of the Universal Declaration on Bioethics and Human Rights? Common good is a concept that is often mentioned without any specific definition. It appeared to us that it would be interesting to trace back its history and conception and to develop a conceptual framework that would serve after to study and find the meaning given to its basic concepts in the elaboration of the declaration. The first chapter of this work present the context and the problematic. The second chapter present a review of the literature, and the conceptual framework. The third chapter presents the theoretical perspective, the methodology and the data that have been analysed. The fourth chapter offers a detailed analysis of the different steps and the different versions of the declaration by looking at what was said about the concepts included in the conceptual framework. The fifth chapter presents the scope and the limits of the declaration and the sixth chapter offers a conclusion. We conclude that the declaration in going through a process of deliberation, consultation and pragmatic consensus offers a text that presents a renewed universal vision of the common good susceptible to take into account cultural diversity and pluralism, thus offering an instrument that can be used by all nations in different contexts its text being flexible and adaptable at the global level. That declaration offers a general framework of principles able to be used by all nations, specially the developing ones, in a globalized context because its flexible architecture and its willingness to not categorize the principles but to use them complementarily, presents us with a text that can be adaptable at the global level. This work will contribute to the enrichment of the thinking of international organizations involved in bioethics. It will also provide some ideas to the researchers in political sciences and laws when they are looking at new models of governance and at new ways of building legislations and norms, or at ways of facing human rights new challenges.
Fusco, Nina Marie. "Media coverage outside the courtroom : public opinion of restrictions imposed on news journalists and psychological effects on crime victims." Thèse, 2011. http://hdl.handle.net/1866/6051.
Повний текст джерелаAs media coverage has been shown to influence virtually everyone that it reaches, from its consumers to jurors in cases with pretrial publicity to eyewitnesses, the two studies that comprise the present dissertation respectively investigated the public’s opinion on imposing restrictions on the media in courthouses and the impact of media coverage on the mental health of crime victims. The Quebec government recently imposed restrictions on the media in courthouses in order to reduce the interference of journalists and cameramen. While the issue reached the Supreme Court of Canada, the public were found to be largely in favour of these restrictions in a preliminary study (Sabourin, 2006). The first part of this dissertation sought to further investigate this topic with a more representative sample of the population. Two hundred forty-three participants in six experimental groups filled out questionnaires that measured their opinion of these restrictions. There were two conditions with audiovisual clips showing either a media circus-like atmosphere or relatively calm proceedings in Quebec courthouses. A third control group did not view any audiovisual clips. There were also two versions of the twenty-item questionnaire where the questions were presented in reverse order. This study also found overwhelming support for the restrictions; nearly 79 percent of participants supported restricting media presence in courthouses. Interestingly, one experimental group did not – the control group that read statements that supported an absence of restrictions first. The second component of this dissertation examined the impact of the media on crime victims. Crime victims have been shown to be especially susceptible to mental health problems. Indeed, they are three times as likely as the general population to develop Post-traumatic Stress Disorder (PTSD). One study confirmed this finding and found that crime victims who had negative impressions of the media coverage of their cases had the highest rates of PTSD (Maercker & Mehr, 2006). In the present study, twenty-three crime victims were interviewed using a narrative technique and completed two questionnaires that respectively measured their PTSD symptoms and anxiety. A great proportion of participants were found to have mental health symptoms and high scores on the Impact of Events Scale-Revised (IES-R). The majority of the narratives of these participants were negative. The most common themes included in these narratives were self-blame and suspiciousness of others. Media coverage did not appear to be related to any mental health symptoms, although individual factors may explain why some participants were favourable towards the coverage and others were not. The findings of these two studies suggest that the public approves of restricting media presence in courthouses and that individual factors may explain how media coverage impacts crime victims. These results add to the literature that calls current practices used by the media to gain coverage into question.
Helbig, Manuel. "Thawing permafrost and land-atmosphere interactions of boreal forest-wetland landscapes in northwestern Canada." Thèse, 2017. http://hdl.handle.net/1866/19533.
Повний текст джерелаBoreal forests store large amounts of organic carbon and are an important component of the regional and global climate systems. Climate and land surface are closely coupled through the land-atmosphere exchange of greenhouse gases, such as CO2 and CH4, and of energy and water vapor. In lowlands of the North American sporadic permafrost region, thaw-induced surface subsidence leads to expansion of permafrost-free wetlands at the expense of boreal forests underlain by permafrost. However, the spatial extent of these land cover changes and their implications for land-atmosphere interactions are unknown. In this study, I analyze eddy covariance flux measurements from an organic-rich boreal forest-wetland landscape in the southern Taiga Plains, NT, Canada. I combine these measurements with flux footprint modeling, satellite remote sensing data, paleoecological records, and downscaled climate projections to characterize how thaw-induced land cover change affects land-atmosphere interactions and climate. In the Taiga Plains ecozone, thaw-induced boreal forest loss currently transforms the composition and structure of the boreal zone in North America and is of equal importance for tree cover dynamics as wildfire disturbance. Forest loss modifies landatmosphere energy fluxes through changes in aerodynamic and ecophysiological land surface properties. On the one hand, increasing albedo decreases total turbulent energy fluxes (i.e., sensible (H) and latent heat (LE) flux), and on the other hand decreasing surface roughness and increasing wetness enhances LE at the expense of H. The resulting maximum summer air temperatures and humidity would be substantially colder (1-2 C) and wetter (2 mmol mol-1) in a hypothetical permafrost-free wetland landscape, as indicated by planetary boundary layer model simulations. In contrast to the regional biophysical climate cooling impact of thaw-induced land cover change, wetland expansion and related increases in landscape CH4 emissions induce a net global biogeochemical climate warming impact. At the current rate of wetland expansion in the southern Taiga Plains of 0.26 % yr-1, landscape CH4 emissions increase by 0.034 g CH4 m-2 yr-1. Typical rates of long-term net CO2 uptake in these landscapes are too small to neutralize the associated climate warming effect until the end of the 21st century. The rapidly thawing boreal forest-wetland landscape still acts as a net CO2 sink taking up 74 g CO2 m-2 yr-1. Wetland expansion does not affect landscape-level net CO2 uptake as changes in gross primary productivity (GPP) and ecosystem respiration (ER) are of similar magnitude. The negligible thaw-induced effects on net CO2 fluxes are contrasted by larger direct climate change impacts of warming air temperatures and reduced incoming shortwave radiation. For a high warming scenario (RCP8.5), increases in modeled ER outpace the increasing GPP significantly. For a moderate warming scenario (RCP4.5), ER and GPP increase are of similar magnitude. Thaw-induced land cover change in the Taiga Plains causes thus biophysical and biogeochemical climate impacts of opposite sign and at contrasting scales of impacts (regional vs. global). In an increasingly warmer climate, thawing permafrost alters how boreal landscapes interact with climate highlighting the need to incorporate thaw-induced land cover changes into global Earth system models.