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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.
281

Le financement basé sur la performance au Cameroun : analyse de son émergence, sa mise en œuvre et ses effets sur la disponibilité des médicaments essentiels

Sieleunou, Isidore 02 1900 (has links)
L'accès aux médicaments essentiels (ME) est un élément clé de la qualité des soins dans un système de santé. Par ailleurs, le financement basé sur la performance (FBP) attire de plus en plus l'attention des décideurs comme une intervention pour améliorer la prestation des services de santé, y compris l’accès aux ME, dans les pays à faible et moyen revenus (PFMR). Malgré l’intérêt croissant de la recherche sur le FBP, très peu d’étude ont porté sur la mise à l’agenda d’une telle réforme ou son maintien à l’ordre du jour au fil du temps, encore moins sur l’influence de celle-ci sur l’accès aux ME dans les PFMR. A travers une analyse du programme de FBP au Cameroun, la présente thèse vise à faire avancer les connaissances en examinant les questions suivantes : qu’est-ce qui explique l’apparition du FBP au niveau de la politique nationale de la santé et quel est l’impact de ce programme sur l’accès aux ME? Le devis de recherche est celui d’une étude de cas et la démarche analytique s’appuie sur la combinaison des données qualitatives, à travers des entrevues réalisées auprès des acteurs clés du programme FBP au Cameroun, et quantitatives, issues de l’évaluation d’impact de ce programme. La perspective conceptuelle est celle des cycles de politique, du cadre de transfert des politiques et de la recherche interventionnelle. Les résultats sont structurés en quatre articles scientifiques. La mise du FBP à l’agenda au Cameroun s’est construite à partir des rapports et événements identifiant l'absence d'une politique de financement de la santé adaptée comme une question importante à laquelle il fallait s'attaquer (article 1). L'évolution du discours politique vers une plus grande responsabilisation a permis de tester de nouveaux mécanismes. Un groupe d'entrepreneurs politiques de la Banque mondiale, par le biais de nombreuses formes d'influence (financière, conceptuelle, fondée sur la connaissance et les réseaux) et en s'appuyant sur plusieurs réformes en cours, a collaboré avec de hauts fonctionnaires du gouvernement pour mettre le programme FBP à l'ordre du jour. Des organisations non gouvernementales internationales ont été recrutées au début du programme pour assurer sa mise en œuvre rapide. Toutefois, il a fallu transférer ce rôle aux organisations nationales pour assurer la pérennité, l'appropriation et l'intégration de l'intervention du FBP dans le système de santé (article 2). L'expérience de ce transfert montre que les éléments favorisant la réussite d’un tel processus incluent des directives structurées, une appropriation et planification conjointe de la transition par toutes les parties, et un soutien post-transition aux nouveaux acteurs. Les données qualitatives suggèrent que la mise en œuvre du programme FBP influence l’accès aux médicaments essentiels par l’entremise de plusieurs facteurs, notamment une plus grande autonomie des formations sanitaires, une régulation appliquée des équipes cadre de santé, une plus grande responsabilisation des acteurs du médicament et la libéralisation du système d’approvisionnement (article 3). Cependant, le programme a eu un impact très limité sur la disponibilité des ME (article 4). L'intervention n’a été associée à aucune réduction des ruptures de stock de ME, sauf pour la planification familiale (PF), avec une hétérogénéité des effets entre les régions et les zones urbaines et rurales. Ces résultats sont la conséquence d'un échec partiel de la mise en œuvre de ce programme, allant de la perturbation et de l'interruption des services à une autonomie limitée des formations sanitaires dans la gestion des décisions et à un retard considérable dans le paiement des prestations. / Access to essential medicines (EM) is a key element of quality of care in a health system. Accordingly, performance-based financing (PBF) is increasingly attracting the attention of policy makers as a promising intervention to improve health service delivery, including access to essential medicines, in low and middle-income countries (LMICs). Despite the growing interest in PBF research, very few studies have focused on how such a reform has been put on the agenda or how it has been maintained over time, much less how it has influenced access to EMs in low- and middle-income countries. Through an analysis of the PBF program in Cameroon, this thesis aims to advance knowledge by examining the following questions: What explains the emergence of PBF at the level of national health policy and what is the impact of this program on access to EMs? The research design is a case study and the analytical approach is based on a combination of qualitative data, through interviews conducted with key actors of the PBF program in Cameroon, and quantitative data from the impact evaluation of this program. The conceptual perspective is that of policy cycles, the policy transfer framework and intervention research. The results are structured into four scientific articles. Putting the PBF on the agenda in Cameroon was built from reports and events identifying the lack of an appropriate health financing policy as a critical issue that needed to be addressed (article 1). The evolution of political discourse towards greater accountability made it possible to test new mechanisms. A group of political entrepreneurs from the World Bank, through many forms of influence (financial, conceptual, knowledge-based and networked) and building on several ongoing reforms, worked with senior government officials to put the PBF reform on the agenda. International non-governmental organizations were recruited at the beginning of the programme to ensure its rapid implementation. However, this role had to be transferred to national organizations to ensure sustainability, ownership and integration of the PBF intervention into the health system (Article 2). The experience of this transfer shows that the elements for the success of such a process include structured guidelines, joint ownership and planning of the transition by all parties, and post-transition support to new actors. The implementation of the PBF programme influences access to essential medicines through several factors, including greater autonomy of health v facilities, enforced regulation of district medical teams, greater accountability of drug stakeholders and liberalization of the supply system (Article 3). However, the programme had a very limited impact on the availability of EMs (Article 4). The intervention was not associated with any reduction in EM stock-outs, except for family planning (FP), where the reduction was 34% (P = 0.028), with a heterogeneity of effects between regions and urban and rural areas. These poor results were likely the consequence of partial implementation failure, ranging from disruption and discontinuation of services to limited facility autonomy in managing decision‐making and considerable delay in performance payment.
282

L'ordre et la sécurité publics dans la construction de l'Etat au Cameroun

Belomo Essono, Pélagie Chantal 06 February 2007 (has links) (PDF)
L'ordre et la sécurité constituent le fondement de l'ordre politique au Cameroun. La création, l'« instauration » et la « restauration » de l'ordre représentent la mission essentielle de cet Etat. Dès lors, cette thèse vise à comprendre comment ces deux concepts construisent l'Etat du Cameroun et comment leur décomposition le déconstruit tout en le construisant. Ainsi, ce processus de fabrication de l'ordre sécuritaire et partant de l'Etat s'opère à trois niveaux. Primo, il se bâtit à partir de la collision et de la collusion entre l'endogène et l'exogène. D'une part, l'histoire coloniale (et du pacte colonial qui s'ensuit) structure sa constitution. Dans cette perspective, la coopération militaire France-Cameroun (grâce aux schèmes, aux cadres cognitifs en termes de doctrine et de formation militaires, aux dispositifs sécuritaires français) constitue le socle de la défense et de la sécurité de ce pays. D'autre part, la sécurité du Cameroun se construit au gré de l'ordre international; « la guerre contre le terrorisme », des jeux, des enjeux stratégiques et géostratégiques des puissances à l'œuvre dans le golfe de Guinée, le bassin du Congo, ainsi que de la sécurité nationale et intérieure de ces puissances. Enfin, sur le plan régional, les guerres qui travaillent l'Afrique médiane influencent et agissent sur les modes d'actions sécuritaires du Cameroun. En effet, la formulation, la formalisation de la politique étrangère et la pensée militaire de cet Etat sont fortement imprégnées par la « conflictogénie » qui modèle l'Afrique centrale. Secundo, les mécanismes de fabrication du « dedans » tentent de traduire les modalités de fabrication « endogéinisées » (c'est-à-dire récupérées et intégrées dans le corpus, la pratique sécuritaires internes) et endogènes de la sécurité. La production de l'ordre sécuritaire est un processus dont les forces de sécurité et politiques, dans leurs interactions ou leur déploiement, et les politiques publiques qui en découlent présentent une constance historique qui est le rapport de force, la domination et l'antagonisme dont la finalité est la perpétuation du système autoritaire, la préservation, la reproduction et la pérennisation du pouvoir des gouvernants. Tertio, l'action publique sécuritaire donne à voir une multitude d'acteurs en l'occurrence privés nationaux, étrangers, sociaux et étatiques impliqués dans le marché de la sécurité, dont les actions aboutissent à des mécanismes de sharing, de straddling et de privatisation sécuritaires. Dans ce cadre, loin de présenter une incapacité de l'Etat du Cameroun à gérer sa fonction ontologique et régalienne qu'est la sécurité, il s'agit plutôt d'un nouveau management, d'une reconfiguration de celui-ci et d'une nouvelle « gouvernementalité ».
283

Le Comité international de la Croix-Rouge en Afrique centrale à la fin du XXe siècle : cas du Cameroun, du Congo Brazzaville, du Congo Kinshasa et du Gabon de 1960 à 1999 / The ICRC in Central Africa in the end of the 20 th century : Case study of Cameroon, Congo-Brazzaville, RDCongo and Gabon, from 1960 up to 1999

Bounda, Sosthène 20 March 2015 (has links)
Le comité international de la Croix-Rouge en abrégé CICR est une organisation humanitaire fondée en 1863 par le Comité de cinq citoyens suisses: Gustave Moynier, Henri Dunant, Guillaume Dufour, Louis Appia, Théodore Maunoir. Crée à la base pour secourir et venir en aide aux victimes de guerre, sur une initiative d'Henri Dunant d'après un souvenir de la Guerre de Solferino, le CICR élargira son champ d'action après la Convention de Genève de 1949. En effet, le CICR est l'ONG la plus représentée dans le monde et c'est à juste titre qu'elle fut Prix-Nobel de la paix en 1901 remis à Henri Dunant, en 1917, 1944, 1963, pour son effort lors des différents conflits, mais aussi le prix Balzan pour l'humanité, la paix et la fraternité entre les peuples en 1996. Elle s'est établie progressivement dans tous les continents après la seconde Guerre Mondiale. Avant cela, elle n'était qu'une ONG essentiellement européenne. En Afrique Centrale, la délégation de la Croix-Rouge Internationale était basée à Yaoundé au Cameroun et comprenait les pays d'Afrique Centrale tels que le Congo, la RD Congo, le Gabon, la Guinée Equatoriale et le Sao-Tomé. Dans ces pays l'oeuvre du CICR varie selon les besoins Humanitaires des uns et des autres. En effet, plus un Etat est en guerre, plus l’intervention du CICR est importante. Cette intervention se fait dans le respect des règles établies lors des différentes Conventions de Genève, de la Haye et bien d’autres encore. De ces différentes conférences est né le Droit international humanitaire qui codifie l’action du CICR sur le terrain, surtout en temps de guerre, mais aussi celles des autres ONG, y compris les entités onusiennes. Le Droit international est le respect des Droits de l’homme et son environnement en période de conflit armé. Ainsi l’action du CICR en Afrique Centrale a été plus importante en République Démocratique du Congo qu’au Gabon qui est resté sans conflits guerriers depuis 1960, date de départ de notre borne chronologique. Les pays qui font l’objet de notre étude ont connu diverses péripéties : la guerre de Bakassi pour le Cameroun, la guerre civile du Congo Brazzaville et la guerre à multiples facettes interminable en République Démocratique du Congo. L’intervention du CICR en temps de paix est souvent confiée aux Sociétés nationales qui doivent former les secouristes, diffuser le Droit international humanitaire, entre autres de leurs activités quotidiennes de supplier les gouvernements dans leurs missions de santé, d’hygiène. Même cette mission du CICR en temps de paix vise la limitation des dégâts en temps de guerre. / The International Committee of the Red Cross ICRC abstract is a humanitarian organization founded in 1863 by the Committee of five Swiss citizens: Moynier, Henry Dunant, Guillaume Dufour, Louis Appia, ThéodoreMaunoir. Creates the basis for the relief and assistance to victims of war, an initiative of Henry Dunant from a memory of the War of Solferino, the ICRC will extend its scope after the Geneva Convention of 1949. In Indeed, the ICRC is the NGO most represented in the world and it is appropriate that it was price-Nobel Peace Prize in 1901 awarded to Henri Dunant, in 1917, 1944, 1963 for his effort during the different conflicts, but also the Balzan Prize for humanity, peace and brotherhood among peoples in 1996. It was established gradually in all continents after the Second World War. Before that, she was a mostly European NGOs. In Central Africa, the delegation of the International Red Cross is based in Yaounde, Cameroon and includes the Central African countries such as Congo, DR Congo, Gabon, Equatorial Guinea and Sao Tome. In these countries the work of the ICRC varies Humanitarian needs of each other. The more a country is at war, most of the ICRC's intervention is important. This procedure is done in accordance with the rules established in the various Geneva Conventions, the Hague and many others. Of these conferences was born on international humanitarian law that codifies the ICRC's work in the field, especially in time of war, but also those of other NGOs, including UN entities. International law is respect for human rights and the environment in times of armed conflict. Thus the ICRC's work in Central Africa was greater in Democratic Republic of Congo and Gabon, which remained without military conflicts since 1960, starting date of our chronological terminal. The countries that are the subject of our study experienced various vicissitudes: Bakassi war for Cameroon, the civil war in Congo Brazzaville and war multifaceted ending in the Democratic Republic of Congo. The intervention of the ICRC in time of peace is often left to National Societies must train rescuers dissemination of international humanitarian law, including their daily activities to beg governments in their health missions, hygiene. Even the ICRC mission in peacetime is damage limitation in time of war.
284

Methodological investigations on vegetation typology and phytogeography of rain forests of tropical Africa

Senterre, Bruno B.M.L. 17 June 2005 (has links)
I. An original methodological discussion is proposed on the problem of the typology of tropical rain forest’s plant communities, based on the study of forest types across gradients of continentality and elevation, within Atlantic central Africa. These investigations were based on the statement that the main problems in forest typology are related to the non-zonal or zonal character of the different vegetation types and to non considering the relations and differences between forest strata. II. Field data consisted in phytosociological homogeneous sample plots localized within different recognized phytogeographical entities, in a region of tropical Africa where these entities are known to be well conserved. A total of 37 such plots were inventoried in the region extending from the littoral forests of Ndoté, Equatorial Guinea, which are wet evergreen forests, to the continental forests of the Dja, Cameroon, known as evergreen seasonal forests. The studied region also included the oriental Atlantic forests of Equatorial Guinea, known as moist evergreen forests or caesalp forests. In various parts of this continentality gradient, some plots were localized within climax non-zonal formations, namely the submontane rain forests. The emphasis was put on the vegetation of the Monte Alén National Park. The sampling methodology was willing to be as "complete ", including all strata, "quantitative ", enumerating all individuals, and "representative ", within each stratum, as possible. These multi-layers plots were realised using nested sub-plots, with a sampling size of 100 individuals for every ligneous stratum recognized (dominant trees, dominated trees and shrubs) and a sampling size of 200m² for the herbaceous and suffrutex stratum. Forest types were defined independently for each stratum and the differences were analysed. A method was proposed for the simultaneous analysis of all floristic data, converting and standardizing the values from ligneous strata, on the one hand, and from understorey strata, on the other hand. III. Ten forest types were described using IndVal and discussed in the general context of the guineo-congolian region, from a syntaxonomic view point (agglomerative classification) and from a phytogeographical view point (divisive classification). Homologies between these two approaches are described. The proposed phytogeographical system is based on an "open " conception of hierarchical classifications, combining advantages of agglomerative and divisive classifications. In concrete terms, the non-zonal criteria, for example the submontane variants, are categorised separately and in analogy with the zonal criteria, related to the usual phytochoria. Analysis of ecological relationships for the 10 communities showed that the main variables related to the floristic variability in our mainland rain forests are elevation, rainfall, hygrometry (estimated using bryophytes cover levels) and distance to the ocean. The two extremes on the vertical microclimatic gradient, dominant trees stratum and herbaceous stratum, give similar typologies, however canonical analysis showed that for the herbaceous layer, non-zonal variables (hygrometry and elevation) were gaining more importance when the influence of the two zonal variables was attenuated. In every case, spatial autocorrelation was less important than the environment in explaining floristic variability but its role increased in the spatial arrangement of understorey species, whose dispersal capacity is generally lower than canopy trees. The phytosociological, phytogeographical and ecological description of forest types is accompanied by a physiognomical description using biological types spectrum, as well as architectural models, leaf sizes, etc. With regard to diversity, we have demonstrated that species richness was higher from upper to lower strata because of the accumulation in lower strata of species from various strata. On the other hand, the proper stratum diversity, i.e. the structural set, decreased from dominant trees to shrubs. The proper diversity of the herb layer showed relatively high figures mainly due to the higher individual density in relation to the existence of microstrata. Within the 37 sample plots, 1,050 taxa have been identified to species or morpho-species levels, for a total of 25,750 individuals. These taxa represent 442 genus among 104 families. The richest forest type is found on the foothills of the Niefang range, on the windward side. This forest type is also characterised by a high number of oligotypic genus and by species belonging to functional types indicators of glacial refuges. These functional types are defined on the basis of the dispersal capacity and on kind of stand needed for effective germination. We formulated the hypothesis that this kind of "foothills refuge ", characterised by his zonal nature, could have been one of the rare refuges for species from mainland rain forests, while montane and fluvial refuges would mainly have preserved species from non-zonal forest types: (sub)montane and riverine. Based on indicator species of submontane forests, a potential distribution map of this forest type has been realised at the Atlantic central African scale. More than 400 submontane forest localities have been mapped. These forests begin at 400m of altitude near the ocean, and progressively at higher altitude for increasing distance to the ocean. Many lowland localities also comprised submontane species, which could indicate the existence of ecological transgressions. These transgressions would allow migratory tracks for submontane species between isolated mountain ranges, not only during glacial periods, through heights at the northern and southern borders of the congo basin, but also contemporarily through the lowland riverine forest network, in the centre of this basin. Finally, a special attention has been attributed to littoral forests and to some cases of choroecological transgressions, coupled to the ecological equalization phenomenon.
285

Recherches méthodologiques pour la typologie de la végétation et la phytogéographie des forêts denses d'Afrique tropicale

Senterre, Bruno 17 June 2005 (has links)
I. An original methodological discussion is proposed on the problem of the typology of tropical rain forest’s plant communities, based on the study of forest types across gradients of continentality and elevation, within Atlantic central Africa. These investigations were based on the statement that the main problems in forest typology are related to the non-zonal or zonal character of the different vegetation types and to non considering the relations and differences between forest strata.<p><p>II. Field data consisted in phytosociological homogeneous sample plots localized within different recognized phytogeographical entities, in a region of tropical Africa where these entities are known to be well conserved. A total of 37 such plots were inventoried in the region extending from the littoral forests of Ndoté, Equatorial Guinea, which are wet evergreen forests, to the continental forests of the Dja, Cameroon, known as evergreen seasonal forests. The studied region also included the oriental Atlantic forests of Equatorial Guinea, known as moist evergreen forests or caesalp forests. In various parts of this continentality gradient, some plots were localized within climax non-zonal formations, namely the submontane rain forests. The emphasis was put on the vegetation of the Monte Alén National Park.<p><p>The sampling methodology was willing to be as "complete ", including all strata, "quantitative ", enumerating all individuals, and "representative ", within each stratum, as possible. These multi-layers plots were realised using nested sub-plots, with a sampling size of 100 individuals for every ligneous stratum recognized (dominant trees, dominated trees and shrubs) and a sampling size of 200m² for the herbaceous and suffrutex stratum.<p><p>Forest types were defined independently for each stratum and the differences were analysed. A method was proposed for the simultaneous analysis of all floristic data, converting and standardizing the values from ligneous strata, on the one hand, and from understorey strata, on the other hand.<p><p>III. Ten forest types were described using IndVal and discussed in the general context of the guineo-congolian region, from a syntaxonomic view point (agglomerative classification) and from a phytogeographical view point (divisive classification). Homologies between these two approaches are described. The proposed phytogeographical system is based on an "open " conception of hierarchical classifications, combining advantages of agglomerative and divisive classifications. In concrete terms, the non-zonal criteria, for example the submontane variants, are categorised separately and in analogy with the zonal criteria, related to the usual phytochoria.<p><p>Analysis of ecological relationships for the 10 communities showed that the main variables related to the floristic variability in our mainland rain forests are elevation, rainfall, hygrometry (estimated using bryophytes cover levels) and distance to the ocean. The two extremes on the vertical microclimatic gradient, dominant trees stratum and herbaceous stratum, give similar typologies, however canonical analysis showed that for the herbaceous layer, non-zonal variables (hygrometry and elevation) were gaining more importance when the influence of the two zonal variables was attenuated. In every case, spatial autocorrelation was less important than the environment in explaining floristic variability but its role increased in the spatial arrangement of understorey species, whose dispersal capacity is generally lower than canopy trees. The phytosociological, phytogeographical and ecological description of forest types is accompanied by a physiognomical description using biological types spectrum, as well as architectural models, leaf sizes, etc.<p><p>With regard to diversity, we have demonstrated that species richness was higher from upper to lower strata because of the accumulation in lower strata of species from various strata. On the other hand, the proper stratum diversity, i.e. the structural set, decreased from dominant trees to shrubs. The proper diversity of the herb layer showed relatively high figures mainly due to the higher individual density in relation to the existence of microstrata. Within the 37 sample plots, 1,050 taxa have been identified to species or morpho-species levels, for a total of 25,750 individuals. These taxa represent 442 genus among 104 families. The richest forest type is found on the foothills of the Niefang range, on the windward side. This forest type is also characterised by a high number of oligotypic genus and by species belonging to functional types indicators of glacial refuges. These functional types are defined on the basis of the dispersal capacity and on kind of stand needed for effective germination. We formulated the hypothesis that this kind of "foothills refuge ", characterised by his zonal nature, could have been one of the rare refuges for species from mainland rain forests, while montane and fluvial refuges would mainly have preserved species from non-zonal forest types: (sub)montane and riverine.<p><p>Based on indicator species of submontane forests, a potential distribution map of this forest type has been realised at the Atlantic central African scale. More than 400 submontane forest localities have been mapped. These forests begin at 400m of altitude near the ocean, and progressively at higher altitude for increasing distance to the ocean. Many lowland localities also comprised submontane species, which could indicate the existence of ecological transgressions. These transgressions would allow migratory tracks for submontane species between isolated mountain ranges, not only during glacial periods, through heights at the northern and southern borders of the congo basin, but also contemporarily through the lowland riverine forest network, in the centre of this basin. Finally, a special attention has been attributed to littoral forests and to some cases of choroecological transgressions, coupled to the ecological equalization phenomenon.<p> / Doctorat en sciences agronomiques et ingénierie biologique / info:eu-repo/semantics/nonPublished

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