Essays on the Provision of Health and Education

This thesis consists of three independent chapters that all deal with questions relevant for the provision of health and education and contribute to the field of economic theory. Both Chapter 1 and Chapter 2 address the broad problem of public provision of scarce and indivisible goods. Therein, the role of wealth distribution and the impact wealth has on the assignment of the goods is of particular interest. Chapter 3 addresses quality concerns for the provision of health services that occur if quality cannot be observed precisely and cannot be contracted on.

Carers in the welfare state : on informal care and support for carers in Sweden

  The general aim of this dissertation is to describe and analyse patterns of informal care and support for carers in Sweden. One specific aim is to study patterns of informal care from a broad population perspective in terms of types of care and types of carer. A typology of four different care categories based on what carers do revealed that women were much more likely than men to be involved at the ‘heavy end’ of caring, i.e. providing personal care in combination with a variety of other caring tasks. Men were more likely than women to provide some kind of practical help (Study I). Another aim is to investigate which support services are received by which types of informal caregiver. Relatively few informal caregivers in any care category were found to be receiving any kind of support from municipalities or voluntary organizations, for example training or financial assistance (Study II). The same study also examines which kinds of help care recipients receive in addition to that provided by informal carers. It appears that people in receipt of personal care from an informal caregiver quite often also receive help from the public care system, in this case mostly municipal services. However, the majority of those receiving personal, informal care did not receive any help from the public care system or from voluntary organizations or for-profit agencies (Study II). The empirical material in studies I and II comprises survey data from telephone interviews with a random sample of residents in the County of Stockholm aged between 18 and 84. In a number of countries there is a growing interest among social scientists and social policymakers in examining the types of support services that might be needed by people who provide informal care for older people and others. A further aim of the present dissertation is therefore to describe and analyse the carer support that is provided by municipalities and voluntary organizations in Sweden. The dissertation examines whether this support is aimed directly or indirectly at caregivers and discusses whether the Swedish government’s special financial investment in help for carers actually led to any changes in the support provided by municipalities and voluntary organisations. The main types of carer support offered by the municipalities were payment for care-giving, relief services and day care. The chief forms of carer support provided by the voluntary organizations were support groups, training groups, and a number of services aimed primarily at the elderly care recipients (Study III). Patterns of change in municipal carer support could be discerned fairly soon. The Swedish government’s special allocation to municipalities and voluntary organisations appears to have led to an increase in the number of municipalities providing direct support for carers, such as training, information material and professional caregiver consultants. On the other hand, only minor changes could be discerned in the pattern of carer support services provided by the voluntary organizations. This demonstrates stability and the relatively low impact that policy initiatives seem to have on voluntary organizations as providers (Study IV). In studies III and IV the empirical material consists of survey data from mail questionnaires sent to municipalities and voluntary organizations in the County of Stockholm. In the fields of social planning and social work there appears to be a need to clarify the aims of support services for informal carers. Should the support be direct or indirect? Should it be used to supplement or substitute caregivers? In this process of reappraisal it will be important to take the needs of both caregivers and care recipients into account when developing existing and new forms of support. How informal caregivers and care recipients interact with the care system as a whole is undeniably a fertile field for further research.

Aspectos médicos e sociais no atendimento oftalmológico de urgência

Purpose: A survey was carried out on one hundred patients of the Emergency Service of the Ophthalmology Department of the Hospital das Clinicas of the University of Campinas (UNICAMP), in order to analyze the personal characteristics and the barriers against getting resolving ophthalmologic assistance. Variables, were the following: sex, age, home town, average distance between the place of initial symptoms and first visit to the hospital, time spent between the first examination (if performed in any other service) and the examination performed at the Hospital das Clinicas of University of Campinas, diagnosis, veracity of emergency, need to refer patients previously seen in other services to our Service and possibility of assistance and treatment at a secondary level. Methods: The sample showed the following characteristics: distances between 20 and 100 kilometers covered by 50.0% of the patients to be seen at University of Campinas. 75.0% of those patients needed someone to stay with them and 67.0% came from other municipalities. The long distances covered meant additional expenses for the treatment of diseases which should be treated locally. Results: Among the patients referred to University of Campinas by ophthalmologists of other services, 87.5% could have their diseases treated at a secondary level of assistance and 66.7% of real emergencies and 60% of false emergencies took longer than 7 days to reach the emergency room of University of Campinas. This shows the poor infrastructure of secondary services regarding excellence of emergency care and education of patients. Conclusions: We recommend education of general physicians and ophthalmologists for emergency eye care and also the supply of both secondary and tertiary public services or medicare, strategically setup in the whole state of Sao Paulo.

The experience of repeated fatherhood during adolescence

Objective: to examine how adolescent fathers experience recurring parenthood. Design: qualitative study with a social phenomenological focus. Participants: five fathers between 16 and 19 years of age, each with two children. Findings: the participants perceived themselves as mature, responsible, worried about the care and education of their children, and desiring a secure future life. These factors made them seek employment, their own home, marital stability, construction of a family and return to school. They experienced the ambivalence of desiring one reality and living another, given that, as adolescent parents, they regretted the loss of their freedom. Key conclusions: recurring parenthood in adolescence is a complex phenomenon, with many possible perceptions. The diverse experiences depend on the social context that is defined by the wishes, plans, possibilities and meanings of each distinct social class. Implications for practice: care delivery to these adolescents should consider not only theoretical and chronobiological aspects, but also the experiences of these young people and the psychosocial and cultural factors involved in their fatherhood. (c) 2008 Elsevier Ltd. All rights reserved.

Primeiros anos da carreira docente : diálogos com professoras iniciantes na educação infantil

Esta pesquisa focaliza o início da carreira docente na Educação Infantil. No reconhecimento da especificidade da primeira etapa da Educação Básica e na compreensão de que o início da carreira é fundamental para a trajetória profissional dos professores, tem o objetivo de compreender a constituição do início da carreira docente de professoras que têm na Educação Infantil suas primeiras vivências profissionais. O trabalho se estrutura por princípios teórico-metodológicos bakhtinianos (BAKHTIN, 2003), contextualiza o desenvolvimento da docência na Educação Infantil no Brasil e a complexidade no início da carreira, dialogando, deste modo, com os conceitos de saberes docentes (TARDIF, 2002) e desenvolvimento profissional (MARCELO GARCÍA, 1999). A abordagem é qualitativa do tipo exploratória e se apoia no princípio de interação dialógica (BAKHTIN, 2003). Dispõe como fonte de produção de dados entrevistas individuais e coletivas com um grupo de professoras no segundo ano de atuação profissional na Educação Infantil. Nesse movimento, a dialogia orienta a análise das enunciações das professoras sobre início de carreira, no intuito de conhecer as vivências dos novos processos formativos. A análise dos dados produzidos indica que o início da carreira docente na Educação Infantil se constitui em complexas condições e transições de emprego, nas quais residem as principais dificuldades de desenvolvimento profissional. Paralelo às dificuldades encontradas, o aprendizado da docência na Educação Infantil ocorre por meio do desenvolvimento de parcerias com professoras mais experientes e também por meio do reconhecimento das necessidades de cuidado e educação de cada criança. Logo, é evidenciado que as professoras iniciantes reformulam suas perspectivas didáticas e modos de saber fazer em função das especificidades que envolve cada contexto no qual estão inseridas.

Epidemiologic transition in northern Angola: discussion of cumulative results from CISA (Health Research Centre of Angola)

The 41 years of armed conflict (1961 to 2002) resulted in a poor development of the health care and education infrastructures, and forced the relocation of people to safer places, namely major urban cities like Luanda. This phase was characterized by typical demographic, nutritional and epidemiological profiles. With the end of this period Angola has been repeatedly ranked as one of the three fastest growing economies in the world, and along with the social stabilization and globalization, the country is facing the introduction of new medical technologies, improvement of health sys-tems and services, better access to them, and overall better quality of life. These changes could also be translating into socio-cultural, demographic and nutritional changes which in turn may leading to changes in the epidemiological profile of the country. Thus, the emergence of non-communicable diseases are likely to become an increasingly im-portant public health problem in Angola. Also, considering that several infectious diseases persist, our weakened health system will have to face a double burden. Thus, disease surveillance data on non-communicable diseases to determine their prevalence and impact, along with the major behavioural risk factors like consumption of tobacco, alcohol, diets and physical inactivity are urgently needed.

“It’s a complicated situation”. Harm in everyday experiences with technology. A qualitative study with school-aged children

Tese de Doutoramento em Ciências da Educação (Especialidade de Tecnologia Educativa)

Situation et enjeux sanitaires aux Seychelles en 2012

Off the coast of Kenya, the Seychelles, home to 87,400 inhabitants mostly of African origin, have largely completed their demographic and epidemiologic transitions. Major investments in infrastructure and social services have fostered steady economic growth. Health care and education are free. The predominance of chronic non-communicable diseases and rapid aging of the population nonetheless present significant challenges for public health and the health system. Like the other small island states in the region, the Seychelles continue to be threatened by arbovirus outbreaks. Health indicators are good, but the geographic isolation, the small and aging population, and limited resources make a major challenge maintaining and sustaining an effective workforce of health professionals, a constantly evolving technical platform, and increasing amount of medications particularly in view of the increasing burden of chronic diseases.

Best Practices of Sport For Development: A Case Study of An African Organization

Sport-for-development is the active practice of achieving social ideals through the use of sport and other traditional development programs. The purpose of this thesis was to evaluate SFD best practices from the context of an African organization development project. The case was a development organization in Zambia, Africa that was utilizing sport within its strategy. The data collection and analysis framed using Curado and Bontis (2007) MIC Matrix, the Sport For Development International Working Group’s (2007) best practices model, and B. Kidd’s (2011) Sport-in-Development Logic Model. The research supports that a SFD project is multi-faceted and should include the employment of strategic community programming on the basis of collaborative and integrative sport, health care and education. Further, the researcher found that the best practices include setting specific goals and objectives, as well as instituting regular monitoring and evaluation strategies

Histoire d'une profession disparue: les puéricultrices du Québec, 1925-1985

Ce mémoire porte sur l’évolution de la profession de puéricultrice au Québec entre 1925 et 1985. Il cherche plus spécifiquement à éclairer les raisons de la disparition de cette profession. Celle-ci prend racine dans le contexte de la lutte contre la mortalité infantile et de la médicalisation croissante de la maternité, ce dernier phénomène connaissant de profondes modifications au cours du XXe siècle. En parallèle, les systèmes de santé et d’éducation québécois connaissent d’importants bouleversements. Comment la profession de puéricultrice évolue-t-elle devant ces changements ? Comment tentera-t-elle de faire sa place dans le monde des spécialistes des soins et de l’enfance ? Par ailleurs, quelle place la société, plus spécifiquement le monde médical et l’État, lui réservera-t-elle au fil du temps et pour quelles raisons ? Qu’est-ce qui explique sa disparition ? Voilà les questions auxquelles ce mémoire cherche à répondre. Afin de bien ancrer les origines de la profession, notre analyse s’est d’abord penchée sur les raisons de la création des premières formations en puériculture et des stratégies de professionnalisation des puéricultrices. Notre recherche s’est ensuite intéressée aux discours des acteurs s’étant prononcés sur le sort des puéricultrices à la suite des grandes réformes des années 1960-1970 ainsi qu’au discours des puéricultrices qui cherchent à s’inscrire dans ce nouveau système de santé étatisé. Nous émettons l’hypothèse que la profession de puéricultrice a été victime de plusieurs facteurs dont les multiples réorganisations du système de santé ainsi que de la compétition entre les professions de la santé, mais plus profondément d’une conception de la maternité qui se modifie considérablement au cours de la période étudiée.

Estudio de la interacción docente-estudiante como factor de apropiación de conocimientos en educación de primera infancia colombiana

La interacción docente-estudiante es un elemento primordial en el proceso de formación de los niños de primera infancia. Los cambios del rol docente en dicho proceso de formación están ligado al tipo de modelo pedagógico que lo defina, por esto desde un análisis tradicional este cumple un papel más de emisor de información, caso contrario al establecido en el modelo constructivista, en el que el docente es quien provee los medios y la metodologías para la construcción del conocimiento. Con el fin de analizar la interacción entre estos dos actores, se parte definiendo el término de primera infancia para posteriormente abordar los tipos de modelos pedagógicos existentes y los cambios de los mismos en la educación colombiana, haciendo énfasis en el constructivismo en primera infancia. De igual forma se estudia la apropiación de las teorías constructivistas por parte de los docentes de primera infancia, teniendo en cuenta que estos son uno de los actores principales que hacen parte del proceso de formación, a partir de lo cual finalmente se estudia la interacción docente-estudiante de primera infancia para la apropiación del conocimiento.

Corrupción y delitos contra la administración pública especial referencia a los delitos cometidos en la contratación

La corrupción sigue siendo uno de los principales problemas del Estado de Derecho en el siglo XXI. Su incidencia reduce la eficacia de la inversión, aumenta el valor de los bienes y servicios, reduce la competitividad de las empresas, vulnera la confianza de los ciudadanos en el ordenamiento jurídico y sobre todo condena a la miseria a quienes deben ser destinatarios de las políticas públicas.Sin embrago, la lucha que han realizado muchos gobiernos y funcionarios judiciales contra este fenómeno ha modificado sus formas de aparición, pues es cada vez menos frecuente la apropiación directa de los caudales públicos o la entrega de sobornos a los funcionarios, prefiriéndose métodos mucho más sutiles como los sobrecostos, la subcontratación masiva o la constitución de complicadas sociedades, en las cuales tienen participación los funcionarios públicos o sus familias.Este libro constituye un esfuerzo por el estudio jurídico y criminológico de la corrupción y los delitos contra la administración pública en Europa y Latinoamérica y reúne la selección de los temas penales más relevantes de la tesis doctoral del profesor Carlos Guillermo Castro Cuenca, denominada Aproximación a la Corrupción en la contratación pública y defendida en la universidad de Salamanca en febrero de 2008, con lo cual obtuvo la calificación de sobresaliente por unanimidad.

Asistencia a Educación Preescolar y Desempeño Escolar en el Largo Plazo, Evidencia para Colombia

Reconociendo la importancia que tienen las inversiones durante los primeros años del ciclo de vida, en este documento se estima el efecto de la asistencia a preescolar sobre el desempeño escolar de largo plazo, medido a través del puntaje en las áreas de lenguaje y matemáticas de la prueba Saber 11 en Colombia. Para ello, se realiza la aproximación empírica a través de la metodología de variables instrumentales. Los resultados indican que la asistencia a un año adicional de educación preescolar reduce en 0.121 desviaciones estándar el puntaje obtenido en el área de lenguaje. No obstante, se identifica un efecto diferenciado a partir de variables que dan cuenta del estatus socioeconómico de los individuos.

Proposta de aceleração da oferta de vagas em creches na cidade de São Paulo

Este trabalho apresenta como objetivo principal a construção de proposta que vise acelerar a oferta de vagas em creches na Cidade de São Paulo. Desenvolvido a partir de Termo de Referência organizado pela Secretaria Municipal de Educação de São Paulo (SME), tem como objeto a política pública de creches nesse município, que atende a cerca de 190 mil crianças, mas enfrenta o expressivo déficit de aproximadamente 127 mil vagas frente a um universo de 736 mil crianças entre 0 e 3 anos. À luz da base teórica e empírica da área da gestão e políticas públicas, contextualizamos o problema e indicamos alternativas para a expansão. Inicialmente, buscou-se percorrer a contextualização histórica e o marco legal referente à provisão de creches. Com base em entrevistas com especialistas e levantamento de dados secundários, foi avaliado o atual desenho e implementação da política de creches. A partir desse diagnóstico, identificamos como principais gargalos a serem superados: (i) a aceleração da expansão da quantidade de vagas em creches; (ii) a equalização da distribuição da expansão de acordo com a vulnerabilidade socioeconômica; (iii) o aumento da qualidade do atendimento das entidades e redução da desigualdade de padrões de qualidade entre as modalidades direta e conveniada; (iv) o aprimoramento da capacidade gerencial e de planejamento da SME; e (v) a constituição de visão integrada da política de primeira infância para o município de São Paulo. A proposta sugere, portanto, investimentos para ampliação da capacidade gerencial da SME – incluindo o potencial de articulação com outras entidades e atores –, mudanças no atual desenho da política de creches, e ferramentais de planejamento, acompanhamento e avaliação da política. Foi elaborada, para fins ilustrativos, a simulação da concretização de planejamento estratégico para a política de creches, que abrange dois conjuntos de medidas alternativas para a expansão de vagas e suas necessidades orçamentárias associadas.

Social Panorama of Latin America 2004

Includes bibliography