L’analyse de l’introduction du changement dans les systèmes de santé des pays en développement : le cas d’un système de surveillance épidémiologique en Haïti

Les systèmes de santé des pays en développement font face à de nombreux enjeux organisationnels pour améliorer l’état de santé de leur population. Au nombre de ces enjeux, il est fréquemment mentionné la présence d’organisations internationales ayant des objectifs et caractéristiques peu convergents et qui interviennent de façon non nécessairement coordonnée. Cette thèse explore la thématique de l’introduction du changement dans ces systèmes de santé en mettant un accent spécifique sur l’enjeu lié à la présence de ces organisations internationales. La méthodologie utilisée est une analyse de concept. Cette approche méthodologique consiste à effectuer des revues critiques de la littérature sur des concepts, à mobiliser de nouvelles approches théoriques pour clarifier ces concepts et à réaliser des études de cas pour leur mise à l’épreuve empirique. En nous appuyant sur la théorie de l’action sociale de Parsons, la théorie de la complexité ainsi que les expériences d’introduction du changement dans différents systèmes de santé, nous avons développé un cadre théorique d’analyse de l’introduction du changement dans les systèmes de santé des pays en développement (1er concept). Ce cadre théorique, qui suggère de concevoir le processus d’introduction du changement comme un système d’action sociale complexe et émergent, a été appliqué à l’analyse de l’introduction d’un système de surveillance épidémiologique en Haïti. Plus précisément, nous avons analysé une étape ainsi que certains aspects du mécanisme sous-jacent au processus d’introduction du changement. Ce faisant, nous avons analysé, dans les deux premiers articles de la thèse, l’étape d’adoption du système de surveillance épidémiologique (2ème concept) ainsi que les déterminants de la collaboration entre les organisations impliquées dans le processus d’introduction du changement (3ème concept). Les résultats de ces analyses nous ont permis d’objectiver de faibles niveaux d’adoption, ainsi qu’une faible articulation des déterminants de la collaboration entre les différentes organisations impliquées dans le processus d’introduction du changement. Partant de ces constats, nous avons pu mettre en évidence, dans le troisième article, une phase de « chaos » dans le fonctionnement du système de santé d’Haïti. Cette phase de « chaos », qui pourrait expliquer les difficultés liées à l’introduction du changement dans les systèmes de santé des pays en développement en général et plus particulièrement en Haïti, était caractérisée par la présence d’un ordre sous-jacent au désordre apparent dans le fonctionnement de certaines composantes du système de santé d’Haïti, l’existence d’une instabilité, d’une imprédictibilité ainsi que d’une invariance structurelle aux différents niveaux de gouvernance. Par ailleurs, cette recherche a également permis de démontrer que les caractéristiques du « chaos » sont entretenues par la présence de trois groupes de systèmes d’action sociale bien articulés et bien cohérents à tous les échelons de la pyramide sanitaire en Haïti. Il s’agissait des systèmes d’action liés aux agences de coopération bilatérale, ceux liés aux initiatives ou fondations internationales de lutte contre le sida et finalement ceux associés aux organisations onusiennes. Ces systèmes d’action sociale sont en outre associés à d’autres systèmes d’action plus complexes qui sont situés à l’extérieur du système de santé d’Haïti. Au regard de ces résultats, nous avons proposé une nouvelle approche permettant de mieux appréhender l’introduction du changement dans les systèmes de santé des pays en développement et qui s’inscrit dans une logique permettant de favoriser une plus grande variété et une plus grande diversification. Cette variété et cette diversification étant soutenue par la création et la mise en place de plusieurs interconnections entre tous les systèmes d’action en présence dans les systèmes de santé qu’ils soient d’appartenance nationale, internationale ou qu’ils agissent au niveau central, départemental ou local. La finalité de ce processus étant l’émergence de propriétés systémiques issues non seulement des propriétés des groupes de systèmes d’action individuels qui interviennent dans la constitution du système émergent, mais aussi d’autres propriétés résultant de leur mise en commun.

Transdisciplinaridade em saúde: uma análise integrativa da literatura

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Interações metodológicas e interrelações humanas: alicerçando a transdisciplinaridade no campo da saúde no trabalho

This article provides reflections and discussions about the importance of human interactions and methodological interrelations to substantiate the integrity in the transdisciplinary process in teams that operate in health area. Should be taken as reference the Complexity Theory of Edgar Morin, the logic transdisciplinary of Basarab Nicolescu and the formation groups principles based on the Socionomic Theory of Jacob Levy Moreno. It was concluded that the complexity of the methodologies in the field of workplace health, are influenced by factors that intersect between the scientific interaction and human interrelationships, which allow the transdisciplinary construction. However, the constructions requires the development of professionals in their areas and in their relationship with others as a way of supporting the perspective of transdisciplinarity, ie, interaction, in which different individuals are interrelated with the methodologies and providing articulations and coconstructions from which actualize the transformations.

Self-organization and complexity theory to support evolvable production systems

Dissertação apresentada na Faculdade de Ciências e Tecnologia da Universidade Nova de Lisboa para obtenção do grau de Mestre em Engenharia Electrotécnica e de Computadores

Strong isomorphism reductions in complexity theory

We give the first systematic study of strong isomorphism reductions, a notion of reduction more appropriate than polynomial time reduction when, for example, comparing the computational complexity of the isomorphim problem for different classes of structures. We show that the partial ordering of its degrees is quite rich. We analyze its relationship to a further type of reduction between classes of structures based on purely comparing for every n the number of nonisomorphic structures of cardinality at most n in both classes. Furthermore, in a more general setting we address the question of the existence of a maximal element in the partial ordering of the degrees.

Complexity theory and planning: examining 'fractals' for organising policy domains in planning practice

This article examines selected methodological insights that complexity theory might provide for planning. In particular, it focuses on the concept of fractals and, through this concept, how ways of organising policy domains across scales might have particular causal impacts. The aim of this article is therefore twofold: (a) to position complexity theory within social science through a ‘generalised discourse’, thereby orienting it to particular ontological and epistemological biases and (b) to reintroduce a comparatively new concept – fractals – from complexity theory in a way that is consistent with the ontological and epistemological biases argued for, and expand on the contribution that this might make to planning. Complexity theory is theoretically positioned as a neo-systems theory with reasons elaborated. Fractal systems from complexity theory are systems that exhibit self-similarity across scales. This concept (as previously introduced by the author in ‘Fractal spaces in planning and governance’) is further developed in this article to (a) illustrate the ontological and epistemological claims for complexity theory, and to (b) draw attention to ways of organising policy systems across scales to emphasise certain characteristics of the systems – certain distinctions. These distinctions when repeated across scales reinforce associated processes/values/end goals resulting in particular policy outcomes. Finally, empirical insights from two case studies in two different policy domains are presented and compared to illustrate the workings of fractals in planning practice.

Metaphors in complexity theory and planning

This article reviews the use of complexity theory in planning theory using the theory of metaphors for theory transfer and theory construction. The introduction to the article presents the author's positioning of planning theory. The first section thereafter provides a general background of the trajectory of development of complexity theory and discusses the rationale of using the theory of metaphors for evaluating the use of complexity theory in planning. The second section introduces the workings of metaphors in general and theory-constructing metaphors in particular, drawing out an understanding of how to proceed with an evaluative approach towards an analysis of the use of complexity theory in planning. The third section presents two case studies – reviews of two articles – to illustrate how the framework might be employed. It then discusses the implications of the evaluation for the question ‘can complexity theory contribute to planning?’ The concluding section discusses the employment of the ‘theory of metaphors’ for evaluating theory transfer and draws out normative suggestions for engaging in theory transfer using the metaphorical route.

Articulating ‘public interest’ through complexity theory

The ‘Public interest’, even if viewed with ambiguity or scepticism, has been one of the primary means by which various professional roles of planners have been justified. Many objections to the concept have been advanced by writers in planning academia. Notwithstanding these, ‘public interest’ continues to be mobilised, to justify, defend or argue for planning interventions and reforms. This has led to arguments that planning will have to adopt and recognise some form of public interest in practice to legitimise itself.. This paper explores current debates around public interest and social justice and advances a vision of the public interest informed by complexity theory. The empirical context of the paper is the poverty alleviation programme, the Kudumbashree project in Kerala, India.

The interlanguage development in the spanish learning as foreign language in Teletandem under the View of the Complexity Theory

This article presents, under the perspective of Complexity Theory, the characteristics of the learning process of Spanish as a foreign language in Teletandem. Data were collected from two pairs of Portuguese-Spanish interagents, who were engaged in a systematic and regular interaction, based on the tandem principles. It was found that the learning experience is developed with the peculiarities that arise from the context, agents, members and their nuances, which revealed the presence of a shallow space between the systems of native and foreign languages.

Probabilistic Recursion Theory and Implicit Computational Complexity

In this thesis we provide a characterization of probabilistic computation in itself, from a recursion-theoretical perspective, without reducing it to deterministic computation. More specifically, we show that probabilistic computable functions, i.e., those functions which are computed by Probabilistic Turing Machines (PTM), can be characterized by a natural generalization of Kleene's partial recursive functions which includes, among initial functions, one that returns identity or successor with probability 1/2. We then prove the equi-expressivity of the obtained algebra and the class of functions computed by PTMs. In the the second part of the thesis we investigate the relations existing between our recursion-theoretical framework and sub-recursive classes, in the spirit of Implicit Computational Complexity. More precisely, endowing predicative recurrence with a random base function is proved to lead to a characterization of polynomial-time computable probabilistic functions.

Theory of mind and relational complexity

Cognitive complexity and control theory and relational complexity theory attribute developmental changes in theory of mind (TOM) to complexity. In 3 studies, 3-, 4-, and 5-year-olds performed TOM tasks (false belief, appearance-reality), less complex connections (Level 1 perspective-taking) tasks, and transformations tasks (understanding the effects of location changes and colored filters) with content similar to TOM. There were also predictor tasks at binary-relational and ternary-relational complexity levels, with different content. Consistent with complexity theories: (a) connections and transformations were easier and mastered earlier than TOM; (b) predictor tasks accounted for more than 80% of age-related variance in TOM; and (c) ternary-relational items accounted for TOM variance, before and after controlling for age and binary-relational items. Prediction did not require hierarchically structured predictor tasks.