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Ethiopia is a food insecure country in the Horn of Africa. A wide body of literature in the 1980s and early 1990s justifiably associated food insecurity and famine in Africa and Ethiopia with centralised governance and weaknesses in national early warning systems, which were argued to have had an enduring influence on the outcomes of early warning and famine/food security interventions. Among this wide body of research, however, little attention has been devoted to the socio-spatial dimensions of the problem and the resulting effect on interventions aimed at addressing vulnerability to food insecurity at the household level. In this thesis it is argued that social processes, inherent in the structure of societies and institutions, combine globally, nationally and locally to undermine the treatment of vulnerability to food insecurity as a variable, place-based phenomenon. The arguments are developed with reference to food policy and vulnerability assessments in Ethiopia during the 1990s. Specific references are made to the findings from interviews with national early warning system staffs carried out in 1997 and 1998 and to food security surveys in Delanta Dawint, Ethiopia carried out in 1998.

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Carers who look after family members on an unpaid basis often experience negative impacts from their caring role due to the lack of value placed upon care more widely in society. Casework with carers, ‘the individualised support work undertaken by a practitioner with a newly identified carer’, offers a means to support carers. This thesis considers the research question ‘Casework with carers: what works and why?’. The study places an original focus upon the work of third sector carer organisations upon which there has been very little other research. A comparative perspective is taken to consider this together with the casework with carers undertaken by third sector condition specialist organisations and through statutory carer assessment. The study uses the realist evaluation framework, grounded in critical realism, to identify the outcomes of casework, the mechanisms explaining these and the contextual factors influencing this. A longitudinal research design involving thirty seven qualitative case studies of individual carers’ experiences enabled original findings about change in outcomes over time to be identified and provided a unique insight into the long term impacts of casework. Separate carer and practitioner interviews at timed intervals, supported by audio-recording of the first main contact of casework, provided a comprehensive insight into casework. The findings have been used to develop a new and original model of casework with carers. This identifies how outcomes can be achieved through a number of different types of mechanisms consisting of: psychological support to recognise the value of caring and carer needs; expression of feelings; development of knowledge and skills about caring and about resources and how to access these; and carer action including to access secondary services. It also identifies how a range of contextual factors, including carer characteristics and practitioners’ characteristics and approach to casework, influence outcomes. The study illustrated that third sector carer and condition specialist organisations were potentially well placed as relatively accessible and visible services to achieve varied positive outcomes with carers. However, the findings also showed that casework was of limited help to some carers who continued to have serious unmet needs principally because of barriers in terms of the availability of appropriate secondary services or the reluctance of the person receiving care to use such services. Interpreting the findings through the theoretical frameworks of the ethic of care and carer empowerment highlighted how the nature of the casework practised constrained its potential to support carers. The lack of integrated and ongoing support limited the ethic of care achieved, but perhaps the personalisation of services might help towards overcoming this. The mainly administrative approach of casework (rather than a therapeutic or empowerment based approach) limited the achievement of carer empowerment. Substantial changes in casework practice would be required to address this.

This thesis analyses the issue of competition for hospital services, introduced in the UK by the NHS reform in 1991. The work is structured around two main questions: whether efficient contracts for hospital services can be devised by economic theory, and whether efficiency and productivity have actually changed since the introduction of the reform. For data reasons, the focus of this second part is on Scotland only. Chapter 1 is a general introduction to the work. Chapter 2 performs the theoretical analysis. The economic literature on hospital contracts in discussed first, and a model is then developed which takes into consideration the existence of waiting time and its effect on patients’ utility. The conclusions cast some doubts on the possibility of defining an optimal contract, and emphasise the possible drawbacks of the prospective payment systems suggested by the reform. Chapters 3 to 5 are devoted to the empirical analysis. As one of the main aims of the reform was to improve efficiency, this is the focus of the research, and the approach is the estimation of production frontiers, reviewed in Chapter 3. The data are a sample of 53 acute hospitals in Scotland between 1991/92 and 1996/97 (the beginning and the end of the reform). Two methods of estimation are used because of their complementarity: the non- parametric DEA and Malmquist indexes are the subject of Chapter 4; the econometric estimation of stochastic distance functions is in Chapter 5. The results show an improvement in productivity whereas the improvement in technical efficiency is controversial and not related to the working of the reform (represented by hospitals’ trust status). Furthermore, a change in the technology of production and in what hospitals produce is found, which casts some doubts on the beneficial effects of the reform. The general conclusions are in Chapter 6.

Information technology (m has become crucial to the functioning of modern hospitals. It includes a range of human elements, infornlation, equipment, knowledge and systems. It is important to hospitals, as these are complex environments including many systems with diversity of functions, sub-systems, and professionals. The adoption of technology can be explained by four general theories: economic, political, social and globalization theory. Based on these theories five sets of reasons can account for the adoption of IT in a hospital environnlent. They are, practical; to solve existing problems, economic/business; to achieve d profit or reduce costs or both, rational; to achieve efficienL1' and effectiveness, social; to respond to pressure from society for political reasons and to increase positive image, and supply driven forces by which IT producers seek to sell their products and services. However, no one theory or set of reasons can by itself explain the precise drive for use of IT because nluch depends on each hospital's needs and surrounding drcunlStances. The purposes of this research are to investigate the extent to which IT is being used in Gulf Corporation Council (GCC) public hospitals, why IT has been adopted, and the impact of IT on hospital managementThe methods used in conducting this research were based lllainly on three established methods for searching and collecting infomlation; a literature review, the surveyor questionnaire, intervie,,'s and case studies. Five case studies in Qatar, the United Arab Emirates (UAE) and Bahrain were undertaken to cover Gee hospitals and medical centres populations. Most health and medical services in Gee Countries are provided by public hospitals which account for approximately 64% of total hospital provision, employ most medical professionals, mainly expatriates, and contain most patient beds. In Gee hospitals, IT is still in the early stages of implementation. IT has been found to be adopted at a low level due to reasons such as lack of awareness, other priorities in health policy strategies, and the low level of funding allocated. IT can provide hospitals with many benefits, solve many problems and has many inlpacts on human and functional systems, internal power balances and on the social status of hospitals. The benefits are found to be mostly in the areas of processing work. Therefore, the areas which were given priority for IT implementation were medical records, finance, and personnel areas. No significant impacts v"ere found on hospital structure, chain of conlllland, span of control and nUlllber of employees, however, itwas found that IT increased management power, hospitals' social in1age and hospital political power, while there were disagreements about IT impacts on employees' social relations. The evaluation of IT impacts on Gee hospital management shows that the impacts were not at the same level of intensity or direction, for example, sonle impacts ,",'ere positive and some negative; some significant, moderate or nurunlal, some ambiguous or obvious, were some were slow and some fast. Some efforts at Gee States level were made to develop a model of adopting IT but no real results were detected. However, the future role of IT in Gee public hospitals will be increasing perhaps at a slower pace, but two strategic issues should be given proper consideration; first; the role of the education system, research centers, and industrictl foundation, and the second strategy concerns hospital systems and services structure. This later is related to increased privatization of medical services, economic pressure, and changes in governments' employment strategy. The importance of this thesis is to draw the attention of decisionmakers to the role of IT as an efficient managerial tool in some respects and to provide a foundation for future studies

This thesis identifies the constraints to FP utilisation at the policy, service, community and household levels based on the perspectives of policy makers, providers of services, and men and women in different communities of Jordan. It contributes strategies to widen access to FP that are transferable to other countries of the Middle East and the developing world. The policy environment is analysed to assess whether it encourages or deters FP utilisation. The National Population Strategy is highlighted. Improving co-ordination between the different policy players is a major challenge faced in its implementation. FP utilisation is portrayed in four clinics using different models of provision. Service statistics, clinic observations, in-depth interviews, focus and natural group discussions are used to compare the degree of access to FP. Strengthening co- ordination mechanisms between the service providers is an important strategy to increase FP utilisation. The findings suggest that FP decisions are mostly influenced by men who remain concerned, to a varying degree, with the permissibility of FP utilisation in Islam. A culturally competent strategy proposed to increase utilisation is to communicate to men that FP is permissible in Islam. Religious men are proposed vehicles for implementing this communication strategy, basing their discourse on socio-cultural tradition, namely Islamic jurisprudence. The thesis has three sections introduction, findings and conclusions. Chapter One explores the literature. Chapter Two reviews the Jordanian setting. Chapter Three sets out the methods used in this research. Chapter Four examines the policy environment and policy makers' perspectives. Chapters Five to Eight explore the models of service provision concluding with an evaluation of the strengths and weaknesses of the different models. Chapter Nine elaborates on the community's perspectives. Chapter Ten is the concluding chapter that sets out strategies to widen access to FP, by utilising the socio-cultural context of the region.

The thesis presents a person-centred ethnographic study of individuals' experiences following first-episode psychosis as they received treatment and support from the OPUS early intervention programme in Copenhagen, Denmark. It describes individuals' struggles to come to terms with overwhelming experiences during their psychosis, and their engagement in identity work as they reconstructed individual life projects. Examining individual-society relations, it is a study of health and social policy in practice, from an existential and cultural phenomenological perspective. The researcher took an active membership role - as evaluator - in the programme, and fifteen key informants described their situations and experiences during in-depth interviews and through written narratives. The longitudinal design allowed for individuals' changes in attitudes and life circumstances to be described, and for a dialogical approach. The study explores the community intervention programme from the recipients' perspectives, examining individual processes of transformation in the event of serious psychiatric diagnosis. It describes their social roles in their relationship to treatment staff, their views on medication, and the workings of the therapeutic interventions through psycho-education, multiple-family groups, and social skills training groups. Processes of recovery are analysed as symbolic healing. The OPUS organisation, as well as the general Danish welfare system and the labour market, determined the life choices available to these individuals and their possibilities for social integration. Informants' experiences of mental illness and mental healthcare constituted existential crises in which their senses of ontological security were suspended as their lives were disrupted. -While some informants chose a strategy of 'sealing over' their experiences others 'integrated' them in various ways: either by dogmatically endorsing one particular explanation or by combining different systems of explanation from the cultural repertoire in a creative analytical and theory-building work of bricolage. Re-establishing a sense of biographical continuity - connecting the individual's past, present and future - was crucial to each person's sense of self and experience of recovery.

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No description available.