Problématique : Implanté en 2004 au Bénin, le programme national de prévention de la transmission du VIH de la mère à l’enfant (PTME) semble globalement bien implanté. Toutefois une enquête, en 2005, révèle certaines difficultés, particulièrement au niveau de la couverture du programme: seulement 70 à 75 % des femmes enceintes vues en consultations prénatales ont été dépistées et 33 % des 1150 femmes dépistées séropositives ont accouché suivant le protocole de PTME. En outre, d’un site à un autre, on relève une grande variation dans la couverture en termes de dépistage et de suivi des femmes enceintes infectées. Cette faiblesse dans la couverture nous a amené à questionner le contexte organisationnel dans lequel le programme est implanté. Objectif : L’objectif général de cette thèse est d’analyser l'implantation de la PTME au Bénin. Le premier objectif spécifique consiste à identifier et comprendre les enjeux reliés à la façon de rejoindre les femmes enceintes dans le cadre du dépistage. Le second consiste à comprendre le contexte d’implantation et son influence sur la mise en œuvre de la PTME. Méthodologie : Cette recherche évaluative s’appuie sur une étude de cas. Six maternités ont été sélectionnées avec le souhait de représenter les différents contextes d’organisation des services. Les données ont été collectées par observation non participante, entrevues semi-dirigées (n=41) réalisées avec des prestataires de services, analyse documentaire des rapports d’activités des maternités et par questionnaires administrés aux femmes enceintes en consultations prénatales (n=371). Résultats : Le premier article a permis d'apprécier le caractère libre et éclairé du consentement au dépistage. Une majorité des femmes enceintes, suivies dans les centres privés, ont été dépistées sans être effectivement informées de la PTME alors que les femmes fréquentant les autres maternités connaissent mieux les composantes de la PTME. Le caractère volontaire du consentement des femmes est généralement respecté sur tous les sites. Le deuxième article porte sur l'analyse de la qualité du conseil pré-test. Seulement 54% des femmes enceintes ont participé à un conseil en groupe et 80% à un conseil individuel. Dans les centres où sont dispensées des séances d'information de groupe, la qualité est meilleure que dans les centres qui dispensent un conseil individuel exclusif. Le troisième article analyse l'influence du contexte d'implantation sur la mise en œuvre du programme. Parmi les facteurs qui contribuent favorablement à la mise en œuvre on relève la proximité d’un centre de référence et la coordination des activités de PTME dans une zone géographique, la responsabilisation du prestataire dédié à la PTME, la supervision formative régulière accompagnée de séances de discussion collective et l’implication des médiatrices dans la recherche active des perdues de vues. A l’opposé, la responsabilisation des médiatrices pour la réalisation du conseil individuel et du dépistage ne favorise pas une bonne mise en œuvre de la PTME. Conclusion : Nos résultats montrent qu'il est possible de jouer sur l'organisation des services de santé dans le cadre du programme du PTME pour améliorer la façon dont le programme est implanté tant dans les centres privés que publics, sans que cela ne représente un ajout net de ressources. C'est le cas de l’amélioration de la qualité du conseil et du dépistage, de l’implantation du processus interne d’apprentissage organisationnel et de la coordination des services. / Problem: Launched in 2004 in Benin, the national program for prevention of mother-to-child transmission (PMCTC) of HIV appears to have been well implemented. Nevertheless, a 2005 survey revealed certain problems, particularly with respect to the program’s coverage: only 70% to 75% of pregnant women seen in prenatal consultation were screened, and only 33% of the 1,150 women found to be HIV-infected were delivered according to the PMCTC protocol. In addition, there was great variation in coverage from one site to another in terms of screening and of follow-up for infected pregnant women. This inadequate coverage raised questions about the organizational context in which the program is implemented. Objectives: The overall objective of this thesis is to analyze the implementation of the PMTCT program in Benin. The first specific objective is to identify and understand the issues related to how pregnant women are contacted as part of the screening process. The second is to understand the implementation context and its influence on how the PMTCT program is carried out. Methodology: This evaluative research is based on a case study. Six maternity units were selected in order to provide a representative sample of the different service organization settings. Data were collected through non-participant observation, semi-structured interviews (n=41) with service providers, documentary analysis of the maternity centres’ activity reports, and questionnaires administered to pregnant women at prenatal consultations (n=371). Results: The first article, whose objective was to appreciate the free and informed nature of consent to screening, revealed differences between maternity. A majority of pregnant women followed in private centres were screened without being adequately informed about the PMTCT program, whereas the women in others centres were better informed about the specifics of the program. The voluntary nature of the consent was generally respected. The second article analyzes the quality of the pre-test counselling. Only 54% of the pregnant women in our sample participated in group pre-test counselling sessions and 80% in individual counselling. In centres, which organize group information sessions, the quality is better than in centres, where counselling is provided exclusively to individuals. The third article analyzes the influence of the implementation context on how the program is carried out. Among the factors that contribute positively to implementation are: the proximity of a referral centre and the coordination of PMTCT activities within a geographic area; designating a care provider to oversee the PMTCT program; conducting regular formative supervision with group discussion sessions; and involving mediators—HIV-positive women hired by the program to provide psychological accompaniment—in actively seeking out women who have been lost to follow-up. Conversely, putting mediators in charge of individual counselling or of screening does not foster good implementation of the PMTCT program. Conclusion: Our results show that it is possible to adjust the organization of healthcare services for the PMTCT program in order to improve implementation in both the private and public sectors with no net increase in resources. This is the case for improving the quality of counselling and of screening, the implementation of the internal process of organizational learning, and the coordination of services.

Dans un contexte de crise des Ressources Humaines pour la santé dans le monde, la fidélisation des professionnels de santé constitue un défi important pour les organisations de santé des pays d’Afrique Subsaharienne. Dans la mesure où les recherches existantes suggèrent de développer des politiques RH appropriées (Lucas, 2005) pour venir à bout de cette crise, notre étude examine l’influence que peuvent avoir les perceptions des pratiques de GRH et des facteurs de contexte organisationnel dans lequel ces pratiques sont déployées sur la fidélité des employés à leur organisation. En mobilisant la théorie de l’échange social (Blau, 1964), deux études ont été réalisées : une première effectuée via 27 entretiens semi-directifs et dont les données ont été analysées à l’aide du Logiciel NVIVO 11 et une seconde conduite par questionnaires auprès d’un échantillon de 225 médecins et dont les données ont été traitées à l’aide des logiciels SPSS 23 et AMOS 23. Les principaux résultats révèlent d’abord l’existence des effets positifs directs des pratiques de GRH sur le soutien organisationnel perçu (SOP) et sur la justice procédurale perçue qui à leur tour affectent positivement l’implication organisationnelle affective des médecins et négativement leur l’intention de quitter volontairement l’organisation d’une part, et que la performance individuelle n’est ni associée au soutien organisationnel perçu ni à la justice procédurale perçue, d’autre part. Ils indiquent ensuite que les facteurs de contexte organisationnel interne (la satisfaction à l’égard des équipements, la satisfaction à l’égard de l’environnement physique de travail) influencent positivement le SOP par les médecins (1), sont tous associés à leur implication organisationnelle affective et leur intention de départ volontaire (2) et que les facteurs de contexte externe (la satisfaction à l’égard du niveau d’accès aux soins des patients et la satisfaction à l’égard des conditions de vie socio-économique) sont associés à l’intention de départ volontaire des médecins (3). Enfin, les tests des effets indirects basés sur des analyses en bootsrap (Preacher et Hayes, 2008; Hayes, 2013) révèlent que les effets des pratiques de gestion de carrières sur l’implication organisationnelle sont à la fois médiatisés par le SOP et par la justice procédurale perçue par les médecins tandis que le SOP exerce un rôle médiateur des effets des pratiques de rémunération et des facteurs de contexte interne sur leur implication organisationnelle affective et sur leur intention de départ volontaire. / In the context of the human resources for health crisis, the development of healthcare professionals’ loyalty is an important challenge for healthcare organizations in the Sub-Saharan African Region. To overcome the crisis, the existing researches have suggested the relevance of focusing on and developing adequate HR policies (Lucas, 2005). Thus, our study examines the influence that HRM practices perceptions and the organizational context’s factors might have on employees’ loyalty toward their organization. The social exchange theory (Blau, 1964) was mobilized and two studies were undertaken. First, 27 semi-structured interview were conducted in the qualitative phase and data were analyzed using NVIVO 11 software. A questionnaire was then designed and filled in by a sample of 225 physicians; data were analyzed using SPSS 23 and AMOS 23 software. The main results reveal firstly, the existence of the direct positive effects of HRM practices on the perceived organizational support (POS) and on the perceived procedural justice, both affect positively the affective commitment and negatively the voluntary leaving intention. It can be concluded that the physician’s individual performance is neither associated with their perceived organizational support (POS) nor with their perceived procedural justice, at the other hand. The respondents indicate that internal organizational context’s factors (the satisfaction towards the hospital’s work equipment, the satisfaction towards the physical working environment) influence positively the perceived organizational support (1), are associated to their affective commitment and their voluntary leaving intention (2) and that the external context’s factors (the satisfaction towards the healthcare access of the population visiting public hospitals and the physicians’ satisfaction towards the socioeconomic living conditions) are associated to the voluntary leaving intention of the doctors (3). Finally, the tests of the indirect effects based on bootstrap analysis (Preacher & Hayes, 2008; Hayes, 2013) reveal that the effects the career management practices have on the affective commitment are mediated by the POS as well as by the perceived procedural justice (1) whereas the POS mediates the effects the reward practices and the internal organizational context’s factors have on the affective commitment and the voluntary leaving intention (2).

De nombreux constats contemporains s’alarment du malaise récurrent des ressources humaines hospitalières, particulièrement à l’endroit des médecins et des soignants, et par conséquent du risque de mauvaise qualité de prise en charge des patients. Adoptant une approche plus optimiste, des chercheurs américains en soins infirmiers ont mis en évidence depuis le début des années 1980 l’existence d’hôpitaux dits magnétiques, parce qu’attractifs et fidélisateurs, et où il ferait bon travailler et se faire soigner. Cette thèse vise à approfondir le concept de Magnet Hospital, à éclairer sa définition et sa portée pour la gestion des ressources humaines hospitalières en France. Suivant une démarche hypothético-déductive, la conceptualisation, fondée sur un état de l’art, débute par une appropriation du modèle synthétique du Magnet Hospital. Empruntant une perspective psychosociale, notre modèle original de recherche se focalise sur la perception, à l’échelle des unités de soins, des attributs managériaux du magnétisme hospitalier (leadership transformationnel, empowerment perçu de la participation et climat relationnel collégial entre médecins et soignants) et ses conséquences attitudinales positives (satisfaction, implication, intention de rester, équilibre émotionnel travail/hors travail et efficacité collective perçue). Une méthodologie quantitative interroge au moyen de 8 échelles ad hoc un échantillon représentatif de 133 médecins, 361 infirmières et 362 aides-soignantes de 36 services de médecine polyvalente français. Une série de modélisations par équations structurelles, selon l’algorithme Partial Least Squares, teste la nature et l’intensité des relations directes et indirectes du magnétisme managérial perçu. Les résultats statistiques indiquent une bonne qualité des construits et d’ajustement des modèles. Un contexte managérial magnétique produit son principal effet positif sur l’efficacité collective perçue. Des différences catégorielles existent quant à la perception de sa composition et à la transmission de ses effets par la médiation de l’efficacité collective perçue, signalant le caractère contingent du magnétisme. Ces résultats ouvrent des perspectives managériales et scientifiques, en soulignant l’intérêt des approches positives de l’organisation hospitalière. / Many contemporary findings are alarmed of the recurring discomfort of hospital human resources, especially against doctors and nurses, and consequently against risk of poor quality of care for patients. Adopting a more optimistic approach, American nursing scholars have highlighted since the 1980s, some magnet hospitals, able to attract and retain, and with good working and care conditions. This thesis aims to explore Magnet Hospital concept, to inform its definition and scope for hospital human resource management in France. According to a hypothetico-deductive approach, based on a review of the literature, the conceptualization begins with appropriation of synthetic Magnet Hospital model. Under a psychosocial perspective, our original research model focuses on perception of managerial magnetic attributes (transformational leadership, perceived empowerment of participation, collegial climate between doctors and nurses) and their consequences on positive job attitudes (satisfaction, commitment, intent to rest, emotional equilibrium work/family, perceived collective efficacy), at wards level. A quantitative methodology proceeds by a questionnaire of 8 ad hoc scales and interviews 133 doctors, 361 nurses, 362, auxiliary nurses, in 36 French medicine units. A set of structural equations modeling, according to Partial Least Squares, tests nature and intensity of direct and indirect relationships of perceived managerial magnetism. The statistical results show a good validity of constructs and a good fit of models. The major positive effect of magnetic managerial context is on perceived collective efficacy. Some professional differences exist about perceptions of composition and transmission of magnetic effects (via mediation of perceived collective efficacy), indicating the contingency of magnetism. These findings open managerial and scientific opportunities, emphasizing the interest for positive organizational approach of hospital.

Den mänskliga resursen är en organisations viktigaste tillgång då organisationen är beroende av mänsklig aktivitet för att existera. Chefer blir i avseendet viktiga då de kan ses som organisationens företrädare samt då de bidrar till och formar processer och arbetsförhållanden. Det blir därav av vikt att skapa förutsättningar för dem att hantera sin roll och vilja stanna i den. Tidigare forskning visar att organisatoriska förutsättningar påverkar chefsrollen, men inte specifikt hur den organisatoriska kontexten får betydelse för deras intention att stanna i rollen. Syftet med den här studien är att undersöka hur första linjens chefers intention att stanna i rollen kan förstås utifrån den organisatoriska kontexten. Vidare är syftet att skapa förståelse för hur cheferna upplever sina förutsättningar att hantera rollen. För att besvara syftet har en kvalitativ metod i form av semistrukturerade intervjuer med första linjens chefer inom vården i offentlig sektor legat till grund för empiri. Resultatet visar att chefsrollen är komplex med förväntningar från flera håll, vilket tydliggör varför den organisatoriska kontexten är betydelsefull för att förstå chefernas upplevelser och deras intention att stanna i rollen. Ur chefernas berättelser kan uttydas att arbetstillfredsställelse och organisatoriskt engagemang är betydelsefullt, vilket främst härleds till den kliniska verksamheten och medarbetarna. Vidare framgår att organisatoriska förutsättningar som samspel, kommunikation och stöd får betydelse för hur de hanterar krav och förväntningar. Sammantaget bidrar studien till en ökad förståelse för hur en organisation, genom den organisatoriska kontexten, kan verka för att behålla första linjens chefer. / The human resource is an organization's most important asset as the organization depends on human activity to exist. In this reference, managers become important as they can be seen as the organization's representatives as well as they contribute to and shape processes and working conditions. It therefore becomes important to create an environment for them to manage their role and a will to stay in it. Previous research shows that organizational conditions affect the managerial role, but not specifically how the organizational context will have an impact on their intention to stay in the role. The aim of this study is to investigate how the first-line managers' intention to stay in their position can be understood from the organizational context. Furthermore, the aim is to develop an understanding of how the managers experience their ability to handle the role. To answer the aim, a qualitative method in the form of semi-structured interviews with first-line managers in public healthcare sector has been the source for empirical data. The result shows that the managerial role is complex with expectations from several directions, which explains why the organizational context is important for understanding the managers' experiences and their intention to stay in their position. From the managers' stories it can be read that job satisfaction and organizational commitment are important, which is mainly attributed to the clinical activities and the employees. Furthermore, it appears that organizational conditions such as interaction, communication and support will have an impact on how they handle requirements and expectations. In summary, the study contributes to an increased understanding of how an organization, through the organizational context, can work to retain first-line managers.

Made available in DSpace on 2016-08-03T16:34:46Z (GMT). No. of bitstreams: 1 WELLINGTON DONIZETI SILVERIO.pdf: 592436 bytes, checksum: 7390e9c9c072bf3ac1d4280c9ae2a68a (MD5) Previous issue date: 2008-08-25 / n high-pressure environment, competition and need for the creation of consistent differential that may contribute to the longevity of organizations, there is the search, and sometimes radical changes in patterns of business management and management of the human being in the business. At the core of the current studies on human behaviour and its relations with the various institutions in which man can be seen inserted include efforts aimed at understanding the role and value of the contribution of human beings to working environment and strengthening of organizations. Increasing have shown the concern and understanding about the factors that impact the general welfare, the well-being at work, workers' health and emotional variables from interpersonal relations common to the whole social body. The combination of emerging themes and rich in significance as well-being at work, satisfaction and involvement with the work, organizational commitment affective, emotions, affections and feelings, point out as a wide field and instigating the search for a broader adaptation of organizational environment to human being. This study aimed to submit to test the empirical relationship between emotional experiences in the organizational context and three dimensions of well-being at work - satisfaction at work, involvement with the organizational work and emotional commitment. The sample was composed of 253 employees of a metallurgical industry of the great Sao Paulo, 213 males and 29 females, most at the age between 26 to 30 years old, distributed between unmarried and married. For data collection it was used a questionnaire for self-fulfillment with four scales that evaluated positive and negative affects, satisfaction at work, involvement with the organizational work and emotional commitment. Data analysis was performed using the SPSS, version 16.0 and various sub-programs that led to calculate descriptive analyses and multiple regression analysis for evaluating the impact of positive and negative affects on well-being at work. The results of this study revealed that the main predictor of the dimensions of well-being at work were the positive affects. Thus, it seems appropriate to say that well-being at work is a psychological state supported particularly by the experience of positive emotions in organizational context. It is suggested that the promotion of health and well-being within organizations are hotbeds of future studies, representing valuable contribution to the fields of knowledge of the psychology of health and organizational psychology, and the consequent strengthening of links between business and workers.(AU) / Em ambiente de elevada pressão, competição e necessidade de criação de diferenciais consistentes que venham contribuir com a longevidade das organizações, nota-se a busca e, às vezes, radicais transformações nos modelos de gestão de negócios e gestão do ser humano no meio empresarial. No campo central dos estudos atuais acerca do comportamento humano e de suas relações com as diversas instituições em que o homem se vê inserido, figuram os esforços voltados à compreensão do papel e valor da contribuição do ser humano ao ambiente de trabalho e fortalecimento das organizações. Crescentes se mostram a preocupação e o entendimento sobre os fatores que impactam o bem-estar geral, o bem-estar no trabalho, a saúde dos trabalhadores e as variáveis emocionais oriundas das relações interpessoais comuns a todo organismo social. A combinação de temas emergentes e ricos em significância como bem-estar no trabalho, satisfação e envolvimento com o trabalho, comprometimento organizacional afetivo, emoções, afetos e sentimentos, caracterizam-se como um vasto e instigante campo de pesquisa para uma adaptação mais ampla do ser humano ao ambiente organizacional. O presente estudo teve como objetivo submeter ao teste empírico as relações entre experiências afetivas no contexto organizacional e três dimensões de bem-estar no trabalho - satisfação no trabalho, envolvimento com o trabalho e comprometimento organizacional afetivo. A amostra foi composta por 253 profissionais de uma indústria metalúrgica de autopeças na grande São Paulo, sendo 213 do sexo masculino e 29 do sexo feminino, com maior freqüência na faixa etária compreendida entre 26 a 30 anos, distribuída entre solteiros e casados. Para a coleta de dados foi utilizado um questionário de auto-preenchimento com quatro escalas que avaliaram afetos positivos e negativos, satisfação no trabalho, envolvimento com o trabalho e comprometimento organizacional afetivo. A análise dos dados foi feita por meio do SPSS, versão 16.0 e diversos sub-programas permitiram realizar análises descritivas bem como calcular modelos de regressão linear para verificar o impacto de afetos positivos e negativos sobre bem-estar no trabalho. Os resultados deste estudo revelaram que o principal preditor das dimensões de bem-estar no trabalho foram os afetos positivos. Assim, parece ser adequado afirmar que bem-estar no trabalho seja um estado psicológico sustentado, em especial, pela vivência de emoções positivas no contexto organizacional. Sugere-se que a promoção da saúde e do bem-estar dentro das organizações sejam focos de estudos futuros, representando valiosa contribuição aos campos de conhecimento da psicologia da saúde e da psicologia organizacional, bem como ao conseqüente fortalecimento dos vínculos entre empresa e trabalhadores.(AU)