Décentralisation et allocation des ressources : les détours de la municipalisation du système de santé brésilien.

Dans cette thèse, nous avons analysé le déroulement d’un processus de municipalisation du système de santé, effectué au Rio Grande do Norte (RN), un des états fédérés du nord-est du Brésil. En tenant compte des contextes historiques d’implantation, nous avons centré notre attention sur la contribution des acteurs impliqués dans ce processus, spécialement dans l’allocation des ressources financières du système. Les croyances, perceptions, attentes, représentations, connaissances, intérêts, l’ensemble des facteurs qui contribuent à la constitution des capacités cognitives de ces acteurs, favorise la réflexivité sur leurs actions et la définition de stratégies diverses de façon à poursuivre leurs objectifs dans le système de santé. Ils sont vus ainsi comme des agents compétents et réflexifs, capables de s’approprier des propriétés structurelles du système de santé (règles et ressources), de façon à prendre position dans l’espace social de ce système pour favoriser le changement ou la permanence du statu quo. Au cours du processus de structuration du Système unique de santé brésilien, le SUS, la municipalisation a été l’axe le plus développé d’un projet de réforme de la santé. Face aux contraintes contextuelles et de la dynamique complexe des espaces sociaux de la santé, les acteurs réformistes n’ont pas pu suivre le chemin de l’utopie idéalisée; quelques détours ont été parcourus. Au RN, la municipalisation de la santé a constitué un processus très complexe où la triade centralisation/décentralisation/recentralisation a suivi son cours au milieu de négociations, de conflits, d’alliances, de disputes, de coopérations, de compétitions. Malgré les contraintes des contextes successifs, des propriétés structurelles du système et des dynamiques sociales dans le système de santé, quelques changements sont intervenus : la construction de leaderships collectifs; l’émergence d’une culture de négociation; la création des structures et des espaces sociaux du système, favorisant les rencontres des acteurs dans chaque municipalité et au niveau de l’état fédéré; un apprentissage collectif sur le processus de structuration du SUS; une grande croissance des services de première ligne permettant d’envisager une inversion de tendance du modèle de prestation des services; les premiers pas vers la rupture avec la culture bureaucratique du système. Le SUS reste prisonnier de quelques enjeux institutionnalisés dans ce système de santé : la dépendance du secteur privé et de quelques groupes de professionnels; le financement insuffisant et instable; la situation des ressources humaines. Les changements arrivés sont convergents, incrémentiels, lents; ils résultent d’actions normatives, délibérées, formalisées. Elles aussi sont issues de l’inattendu, de l’informel, du paradoxe; quelques-unes plus localisées, d’autres plus généralisées, pour une courte ou une plus longue durée.

Health in Ireland: Key Trends 2015

Health in Ireland Key Trends gives us insights into trends in demographics, population health, hospital and primary care and health service employment and expenditure. The presentation of trend data over the last decade in the 2015 report highlights the many significant achievements that Ireland has made in terms of key outcomes relating to the health and wellbeing of the population. However, it also highlights the challenges that persist in terms of the accessibility of timely healthcare and in the context of financial constraints. In the last decade alone, there has been an increase of two and a half years in life expectancy. These gains are driven largely by reductions in mortality rates from principal causes of deaths such as those from heart disease and cancer. Another striking feature is the growth in the number of people aged over 65. Each year this cohort increases by 20,000 people. This trend is set to continue into the future and will have implications for future planning and health service delivery. Ireland will see the largest proportional increases in the population aged 85 years and older. Ageing of the population in conjunction with lifestyle-related health threats continue to present major challenges now and into the future in sustaining and further improving health and health services in Ireland. Although difficult to quantify, the contribution of modern health services to these improvements in health outcomes and in life expectancy have been significant. Ireland’s fertility rates are still among the highest in Europe but the birth rate has fallen to its lowest rate for the last decade.  However, Ireland currently has the highest proportion of children and young people in our population among EU countries.  

Working with Students to Shape Library Services at The Hive

The Hive represents a completely new vision for libraries and, since opening in 2012, has helped us constantly review and change our approach to service delivery. Our most recent work is around student engagement, where we are changing our relationship with students moving from passive recipients of services to active participants in service design, evaluation and delivery. This presentation will cover some examples of our student engagement work, the benefits it brings and some of the challenges that we face.

Workforce Patterns and the Prevention of Mother-to-Child Transmission of HIV Option B Cascade in Côte d'Ivoire

Thesis (Master's)--University of Washington, 2016-08

Professionalizing school governance: the disciplinary effects of school autonomy and inspection on the changing role of school governors

Since the 1980s, state schools in England have been required to ensure transparency and accountability through the use of indicators and templates derived from the private sector and, more recently, globally circulating discourses of ‘good governance’ (an appeal to professional standards, technical expertise, and performance evaluation as mechanisms for improving public service delivery). The rise of academies and free schools (‘state-funded independent schools’) has increased demand for good governance, notably as a means by which to discipline schools, in particular school governors – those tasked with the legal responsibility of holding senior leadership to account for the financial and educational performance of schools. A condition and effect of school autonomy, therefore, is increased monitoring and surveillance of all school governing bodies. In this paper, I demonstrate how these twin processes combine to produce a new modality of state power and intervention; a dominant or organizing principle by which government steer the performance of governors through disciplinary tools of professionalization and inspection, with the aim of achieving the ‘control of control’. To explain these trends, I explore how various established and emerging school governing bodies are (re)constituting themselves to meet demands for good governance.

The Role of Perceived Social Support, Resilience, and Depression on Communicative Participation in Head and Neck Cancer Survivors

Thesis (Master's)--University of Washington, 2016-08

Tying it Together: Education-Focused Community Change Initiatives

Policymakers make many demands of our schools to produce academic success. At the same time, community organizations, government agencies, faith-based institutions, and other groups often are providing support to students and their families, especially those from high-poverty backgrounds, that are meant to impact education but are often insufficient, uncoordinated, or redundant. In many cases, these institutions lack access to schools and school leaders. What’s missing from the dominant education reform discourse is a coordinated education-focused approach that mobilizes community assets to effectively improve academic and developmental outcomes for students. This study explores how education-focused comprehensive community change initiatives (CCIs) that utilize a partnership approach are organized and sustained. In this study, I examine three research questions: 1. Why and how do school system-level community change initiative (CCI) partnerships form? 2. What are the organizational, financial, and political structures that support sustainable CCIs? What, in particular, are their connections to the school systems they seek to impact? 3. What are the leadership functions and structures found within CCIs? How are leadership functions distributed across schools and agencies within communities? To answer these questions, I used a cross-case study approach that employed a secondary data analysis of data that were collected as part of a larger research study sponsored by a national organization. The original study design included site visits and extended interviews with educators, community leaders and practitioners about community school initiatives, one type of CCI. This study demonstrates that characteristics of sustained education-focused CCIs include leaders that are critical to starting the CCIs and are willing to collaborate across institutions, a focus on community problems, building on previous efforts, strategies to improve service delivery, a focus on education and schools in particular, organizational arrangements that create shared leadership and ownership for the CCI, an intermediary to support the initial vision and collaborative leadership groups, diversified funding approaches, and political support. These findings add to the literature about the growing number of education-focused CCIs. The study’s primary recommendation—that institutions need to work across boundaries in order to sustain CCIs organizationally, financially, and politically—can help policymakers as they develop new collaborative approaches to achieving educational goals.

Os sentidos do trabalho na tutoria a distância: buscando compreensões à luz da educação ambiental

A presente pesquisa está vinculada à linha Educação Ambiental: Ensino e Formação de Educadores(as) (EAEFE), do Programa de Pós-Graduação em Educação Ambiental - PPGEA/FURG. O estudo foi realizado com cinco tutoras a distância que atuaram no curso de Especialização em Educação de Jovens e Adultos na Diversidade, oferecido na modalidade a distância pela Universidade Federal do Rio Grande - FURG, a partir do Programa Universidade Aberta do Brasil, entre os anos de 2010 e 2012. A pesquisa buscou compreender que sentidos atribuem ao trabalho de tutoria, realizado no referido curso de especialização, os tutores a distância que dele fizeram parte. Assim, justifica-se por propor debate acerca da situação a que estão sujeitos esses profissionais, estando inseridos em um contexto de exploração, terceirização e prestação de serviços em educação, visto que a Educação a Distância, que não é institucionalizada, contribui para a manutenção do Sistema Capitalista, reproduzindo a precarização do trabalho docente. Este estudo caracteriza-se como uma pesquisa qualitativa, sendo os dados produzidos por meio de diálogo dirigido com questões que versavam a respeito das experiências das tutoras com a Tutoria a Distância. Para realizar a análise dos dados coletados, foi utilizada a Análise Textual Discursiva (ATD) (Moraes e Galiazzi, 2007), metodologia que possibilitou a compreensão dos discursos dos sujeitos. Os diálogos traçados entre os relatos das tutoras e teóricos como Antunes (2009), Mattar (2012), Loureiro (2004), entre outros, possibilitaram a construção de compreensões sobre o trabalho dos tutores no contexto do Modo de Produção Capitalista, vinculando, assim, a pesquisa ao campo de discussões da Educação Ambiental. Neste estudo, três categorias emergiram do processo de análise, denominadas: Tutoria a distância - questões que influenciam as condições de trabalho; Os sentidos do tempo na Tutoria a Distância - limites do tempo dentro e fora do trabalho; Tutoria a distância e o relacionamento com os estudantes - desafios do trabalho e da aprendizagem na EaD. Nesse sentido, foram tecidas reflexões sobre o trabalho na sociedade capitalista a partir da teoria marxista e suas relações com a organização da Educação a Distância, pensando na posição que ela assume no cenário educacional brasileiro e considerando as implicações do modo de produção capitalista na organização do trabalho da tutoria em EaD. Nas três categorias, os sujeitos elencaram desafios, dificuldades e as satisfações relacionadas com as experiências vivenciadas na tutoria a distância. Os resultados mostraram que os sujeitos da pesquisa consideram-se pertencentes ao processo de aprendizagem, desempenhando ações educativas que as caracterizam como professoras, pois como tutoras desempenham funções docentes no processo de formação dos educandos. Também fica evidente que as tutoras não identificam o trabalho na tutoria como um trabalho precarizado, embora essa atividade esteja constituída na lógica de exploração e terceirização da mão de obra trabalhadora. Além disso, houve a confirmação de que a realização das atividades de tutoria intensifica a jornada de trabalho e de que ele é organizado em cima do tempo livre das tutoras.

Marketing relacional: satisfação na formação da lealdade do cliente

A revisão de literatura tem revelado grande interesse na lealdade do cliente e enfatizado cada vez mais a sua importância no sucesso de uma empresa. Simultaneamente, durante décadas, a satisfação tem sido mencionada como um importante determinante da lealdade. Paralelamente, o conceito marketing relacional tem assumido grande relevância ao nível da prestação de serviços, sustentando a ideia de que as empresas podem maximizar os seus ganhos com relações duradouras com os seus clientes, passando a gestão dessas relações a estar associada à satisfação e à consequente lealdade. Neste contexto, o presente estudo examina o efeito do grau de satisfação na formação do grau de lealdade do cliente, através de um estudo de caso de uma loja de desporto da região da Aveiro. Os dados recolhidos, a uma amostra de 220 inquiridos, por meio de um questionário, suportam a teoria de que estes dois constructos estão relacionados entre si. Desta forma, esta investigação permitiu aferir o grau de satisfação geral e de lealdade geral dos clientes para com a loja, fornecendo evidência empírica da existência de uma relação positiva (moderada) entre os mesmos. Foi, ainda, possível afirmar que o grau de lealdade não varia significativamente consoante determinadas características do perfil dos clientes inquiridos, contudo constituem características importantes para a tomada de decisão neste contexto específico.

Safety and complexity: the inter-departmental threats to patient safety in the operating department

Purpose: Current thinking about ‘patient safety’ emphasises the causal relationship between the work environment and the delivery of clinical care. This research draws on the theory of Normal Accidents to extend this analysis and better understand the ‘organisational factors’ that threaten safety. Methods: Ethnographic research methods were used, with observations of the operating department setting for 18 month and interviews with 80 members of hospital staff. The setting for the study was the Operating Department of a large teaching hospital in the North-West of England. Results: The work of the operating department is determined by inter-dependant, ‘tightly coupled’ organisational relationships between hospital departments based upon the timely exchange of information, services and resources required for the delivery of care. Failures within these processes, manifest as ‘breakdowns’ within inter-departmental relationships lead to situations of constraint, rapid change and uncertainty in the work of the operating department that require staff to break with established routines and work with increased time and emotional pressures. This means that staff focus on working quickly, as opposed to working safely. Conclusion: Analysis of safety needs to move beyond a focus on the immediate work environment and individual practice, to consider the more complex and deeply structured organisational systems of hospital activity. For departmental managers the scope for service planning to control for safety may be limited as the structured ‘real world’ situation of service delivery is shaped by inter-department and organisational factors that are perhaps beyond the scope of departmental management.

Décentralisation et allocation des ressources : les détours de la municipalisation du système de santé brésilien

Dans cette thèse, nous avons analysé le déroulement d’un processus de municipalisation du système de santé, effectué au Rio Grande do Norte (RN), un des états fédérés du nord-est du Brésil. En tenant compte des contextes historiques d’implantation, nous avons centré notre attention sur la contribution des acteurs impliqués dans ce processus, spécialement dans l’allocation des ressources financières du système. Les croyances, perceptions, attentes, représentations, connaissances, intérêts, l’ensemble des facteurs qui contribuent à la constitution des capacités cognitives de ces acteurs, favorise la réflexivité sur leurs actions et la définition de stratégies diverses de façon à poursuivre leurs objectifs dans le système de santé. Ils sont vus ainsi comme des agents compétents et réflexifs, capables de s’approprier des propriétés structurelles du système de santé (règles et ressources), de façon à prendre position dans l’espace social de ce système pour favoriser le changement ou la permanence du statu quo. Au cours du processus de structuration du Système unique de santé brésilien, le SUS, la municipalisation a été l’axe le plus développé d’un projet de réforme de la santé. Face aux contraintes contextuelles et de la dynamique complexe des espaces sociaux de la santé, les acteurs réformistes n’ont pas pu suivre le chemin de l’utopie idéalisée; quelques détours ont été parcourus. Au RN, la municipalisation de la santé a constitué un processus très complexe où la triade centralisation/décentralisation/recentralisation a suivi son cours au milieu de négociations, de conflits, d’alliances, de disputes, de coopérations, de compétitions. Malgré les contraintes des contextes successifs, des propriétés structurelles du système et des dynamiques sociales dans le système de santé, quelques changements sont intervenus : la construction de leaderships collectifs; l’émergence d’une culture de négociation; la création des structures et des espaces sociaux du système, favorisant les rencontres des acteurs dans chaque municipalité et au niveau de l’état fédéré; un apprentissage collectif sur le processus de structuration du SUS; une grande croissance des services de première ligne permettant d’envisager une inversion de tendance du modèle de prestation des services; les premiers pas vers la rupture avec la culture bureaucratique du système. Le SUS reste prisonnier de quelques enjeux institutionnalisés dans ce système de santé : la dépendance du secteur privé et de quelques groupes de professionnels; le financement insuffisant et instable; la situation des ressources humaines. Les changements arrivés sont convergents, incrémentiels, lents; ils résultent d’actions normatives, délibérées, formalisées. Elles aussi sont issues de l’inattendu, de l’informel, du paradoxe; quelques-unes plus localisées, d’autres plus généralisées, pour une courte ou une plus longue durée.

Reforming the public sector: personalised activation services in the UK

This paper highlights the degree of flexibility and personalisation in the UK’s welfare to work programmes. The Labour Government’s New Deals as originally designed were meant to provide personalised and tailor-made services and to meet the needs of individuals. The programmes have evolved and become more personalised and promote flexible service delivery. The chapter explores the Personal Adviser model and focuses on the development of New Deal for Young People and New Deal 25 Plus. In recent years a number of factors appear to have encouraged the development of more personalised activation services in the UK.

Knowledge and perceptions of quality of obstetric and newborn care of local health providers: a cross-sectional study in three districts in Malawi

Aim Quality of service delivery for maternal and newborn health in Malawi is influenced by human resource shortages and knowledge and care practices of the existing service providers. We assessed Malawian healthcare providers’ knowledge of management of routine labour, emergency obstetric care and emergency newborn care; correlated knowledge with reported confidence and previous study or training; and measured perception of the care they provided. Methods his study formed part of a large-scale quality of care assessment in three districts (Kasungu, Lilongwe and Salima) of Malawi. Subjects were selected purposively by their role as providers of obstetric and newborn care during routine visits to health facilities by a research assistant. Research assistants introduced and supervised the self-completed questionnaire by the service providers. Respondents included 42 nurse midwives, 1 clinical officer, 4 medical assistants and 5 other staff. Of these, 37 were staff working in facilities providing Basic Emergency Obstetric Care (BEMoC) and 15 were from staff working in facilities providing Comprehensive Emergency Obstetric Care (CEMoC). Results Knowledge regarding management of routine labour was good (80% correct responses), but knowledge of correct monitoring during routine labour (35% correct) was not in keeping with internationally recognized good practice. Questions regarding emergency obstetric care were answered correctly by 70% of respondents with significant variation depending on clinicians’ place of work. Knowledge of emergency newborn care was poor across all groups surveyed with 58% correct responses and high rates of potentially life-threatening responses from BEmOC facilities. Reported confidence and training had little impact on levels of knowledge. Staff in general reported perception of poor quality of care. Conclusion Serious deficiencies in providers’ knowledge regarding monitoring during routine labour and management of emergency newborn care were documented. These may contribute to maternal and neonatal deaths in Malawi. The knowledge gap cannot be overcome by simply providing more training.

Conocimientos, actitudes y prácticas del personal médico y de enfermería de la sala de partos del Hospital José Carrasco Arteaga, en la aplicación de las normas de Bioseguridad en la atención del recién nacido, Cuenca 2015

Antecedentes. La ejecución de las Normas de Bioseguridad, es una responsabilidad de la institución donde se incluye a todos los funcionarios. En el servicio de partos existen elementos nocivos o potencialmente peligrosos, como los productos biológicos provenientes de los pacientes y los reactivos químicos de diferente naturaleza. Es necesario reconocer estos peligros para establecer y aplicar medidas de prevención y seguridad (1). Objetivo: Determinar los conocimientos, actitudes y prácticas del personal médico y de enfermería en la sala de partos del hospital José Carrasco Arteaga, en la aplicación de las normas de bioseguridad en la atención del recién nacido, Cuenca 2015. Material y métodos: Se realizó un estudio cuantitativo - descriptivo, la muestra estaba constituida por 50 profesionales de la sala de partos del Hospital José Carrasco Arteaga. Las técnicas de investigación fueron la encuesta, la observación y la revisión bibliográfica, los instrumentos utilizados fueron ficha de registro, y la encuesta. Los resultados fueron analizados en tablas simples y de contingencia mediante los programas de Word. Excel y SPSS versión 21. Resultados: el 98% del personal desecha correctamente el material corto punzantes, el 86% del personal siempre lava sus manos antes y después de atender a la madre. Conclusiones: Al finalizar podemos decir que el 98% de los profesionales conoce lo que es bioseguridad, pero el 80% de los profesionales no aplica estas normas en el servicio. Para mejorar esto se debe elaborar y mejorar estrategias de capacitación.

South Carolina State Plan on Aging 2017-2021

The Lieutenant Governor’s Office on Aging hereby submits the Federal Fiscal Year 2017 – 2021 State Plan on Aging for the State of South Carolina to the Assistant Secretary on Aging of the United States Department of Health and Human Services. The plan is effective for the period of October 1, 2016 through September 30, 2020. This document lays out a long-term strategic blueprint that focuses on how the state will modernize its service delivery system, while expanding the service options available for older South Carolinians, adults with disabilities, and their families. It also sets goals for consumer choice, and person centered and self-directed services. It addresses marketing, outreach, and advocacy issues, as well as the development of initiatives geared toward promoting evidence-based, consumer-directed, and community-based long-term services and supports.