The private health sector in Pakistan has been expanding rapidly, largely unregulated and partly at the expense of the public sector. While there have been previous attempts at formulating policies for the regulation of this sector, these have not always been based on ground realities, with the result that they never reached the stage of implementation. The objectives of the thesis were: 1) to describe and evaluate the existing regulatory framework governing health care provision in general and private health care provision in particular both at federal & provincial levels; 2) to explore the views and perceptions of key stakeholders regarding existing regulations and the reasons for their effectiveness/non-effectiveness; 3) to identify whether and how regulatory mechanisms can be made to work effectively; and 4) to explore the views of stakeholders regarding the potential for alternative mechanisms for ensuring the quality of formal private medical services, including the role of information dissemination to service users/the public. The methods adopted to achieve the stated objective were mapping of the existing legislations and a stakeholder analysis. The results showed that the existing legislations on regulation of health care provision were scanty, weak and inadequate and required radical re-structuring. The stakeholder analysis demonstrated the conflicting interests of the state and the private providers, the role of the powerful medical community and the views of the service users, who were shown to be the ultimate victims. Avenues for alternative regulatory mechanisms, including one based on information dissemination were explored and their feasibility discussed. It is hoped that the information gained from this study, by reflecting the views of the various actors in this process, will contribute towards the formulation of a policy for regulation of private health care provision in Pakistan, which is realistic, feasible and sustainable.

Community care has been an explicit policy goal in the United Kingdom since the end of the 1940s. The policy had traditionally taken the form of the provision of help and support in non-institutional settings, usually in the individual's own home. The services provided are intended to keep the individual in the community and out of institutions. Statistical data would suggest that there has been a huge expansion in domiciliary welfare provision. However, recent studies of such services suggest that the real gains made have not increased to the same degree as the per capita expansion in-services might suggest. Alongside the observations about the outcomes of the explicit policy goal for community care there has been a growing awareness that policy implementation is not simply a continuation of the process of policy formulation ie implementation starts where policy stops. It has been argued that policy may be a response to pressures and problems experienced on the ground and it is essential, therefore, to look at implementation not solely in terms of putting policy into effect but also in terms of observing what actually happens or gets done and to seek to understand how and why. The development of domiciliary services over the years has relied largely on professional judgments but despite this there has been relatively little research into decision-making related to the provision of the services and the closely related service of residential care. For this reason two case studies were conducted which examined, inter alia, the home help service and residential care decision-making processes. Fieldwork for the study was carried out in the area of the Western Health and Social Services Board during 1982. Data collection involved interviews with the senior staff involved in the management and supervision of the social work assistants responsible for the provision of the home help service, the distribution of self-completion questionnaires to social work assistants in respect of recipients of the home help service and to officers-in-charge of old people's homes in respect of the residents in those homes. In addition information was also collected from the files of people newly admitted to old people's homes. The study raises questions about current Government policy, the rationing of services and the targeting of services to particular groups of the population.

No description available.

The purpose of the research described in this thesis is to develop useful and acceptable methods for assessing the effects and value of off-the-job middle management training in the National Health Service. The Preamble describes the background of this need in the NHS, where a rapid growth of management training courses has not been accompanied by any systematic means of securing evidence on the consequences of the training in individual and organisational work performance. Seeing this situation as one which embraces both the classroom and the workplace, the early chapters offer a conceptual framework for the study of management development, built up from theoretical prespectives on the nature of organisations and their management on the one hand, and the nature of human and managerial learning on the other. These concepts are related specifically to the management of health care organisations. The consequent view of management development emphasises considerations of contingency and choice, and is placed in its historical context in the NHS. The characteristics of evaluation are then examined in terms of a comparison of effects with objectives, and a valuing of that comparison, taking place within a particular local system which needs to be understood. The attempt to do so in fieldwork within the Wessex and Oxford NHS regions between 1974 and 1978 is then described, together with the methodology developed to secure and feed back Information about the working of the system to the interested parties. Lastly, the findings of the research are described and discussed in relation to the hypotheses tested and to a multivariate analysis of the influence of course learning, individual and organisational factors on subsequent work performance. The Sequel outlines the present state and future prospects for this research in further developing and testing evaluation strategies and methods for management training in the NHS. "He" and "his" stand for male and female genders throughout the thesis.

Population ageing has motivated policy makers around the world to focus on how best to organise health and social care services to meet an aniticipated growing demand on services. Two popular initiatives are reablement and telecare. Reablement is an approach within homecare that enables older individuals with social care needs to improve their functional performance and live independently. Telecare, on the other hand, involves use of devices to monitor individuals' health and safety, and provide response when needed. This thesis investigates the effectiveness of reablement and telecare by conducting a comprehensive review of the literature and undertaking three empirical studies. It is composed of six chapters. The first chapter presents a theoretical model that links the demand for reablement and telecare to various outcomes. The model is estimated using a strategy that controls for the effects of confounding variables and unobservable factors, and is general in the sense that it nests several other estimation strategies and study designs as special cases. The next chapter contains the literature review. Chapters 3, 4 and 5 present the three empirical studies. The first study investigates the effect of telecare on independent living at home; the second study determines the relationship between the use of telecare and admission to hospital, while the third study determines the relationship between telecare use and the length of stay in hospital. Chapter 6 concludes the thesis and provides some suggestions for further research. Unlike the results of the previous studies, the findings from this thesis suggest that the treatment effects are not homogenous across the poulation and also vary depending on the type of telecare device under consideration.

The Scottish Heart Health Study was conducted in response to a report by a Working Group of the Chief Scientist Organisation and followed an initial of the Cardiovascular Epidemiology Unit. The aims of the study were to establish the levels of coronary risk factors in Scotland, to determine the extent to which these risks factors explained the geographical variation in coronary heart disease, and their relative contribution to the prediction of coronary heart disease in a cohort of men and women.The Scottish Heart Health Study is a study of lifestyle and coronary heart disease risk factors in 10 359 men and women aged 40-59 years, in 22 districts of Scotland. The study was conducted in 1984-86, when Scotland had the highest national coronary mortality reported by the World Health Organisation. The study employed standardised methods emphasing quality e4 control based on a World Health Organisation protocol to allow comparisons in place and time, and therefore to provide a definitive baseline against which interventions can be assessed. The cross sectional aspect of the study has been analysed and addresses the first two study objectives. The third objective will only be achieved when sufficient prospective coronary events have occurred.Current cigarette smokers constitute 39% of men and 38% of women, higher levels than those reported in England but lower than previous Scottish reports. Considerable variation in smoking was noted across the study districts from 29% to 52% in men. Mean blood pressure levels were 134/84 mmHg for men and 131/81 mmHg in women, these levels are lower than previous studies in Britain and there was a narrow range of levels across the districts. Mean levels of blood cholesterol were 6.4 mmol/l in men and 6.6 mmol/l in women - as high as other British studies and high by international standards. There was little geographical variation in blood cholesterol noted.High levels of blood cholesterol and cigarette smoking provide a classical explanation for the excess coronary deaths in Scotland, justifying action, but other factors, such as dietary deficiencies, also merit further investigation. The geographical variation in coronary mortality can best be explained by a group of risk factors which all show a social gradient and these include cigarette smoking, physical activity, blood pressure, and the consumption of alcohol, fruit and green vegetables.

No description available.

The aim of this study was to construct a theory for women's managerial career development that explained how women in health care services and health science faculties achieved senior management positions and developed their careers. It sought to discover the main barriers to career progress and achievement of senior level positions by women in health related organisations and to identify how women managers dealt with obstacles. In-depth interviews with 35 women managers in senior positions in 19 different organisations from three different cultural regions formed the major data source; observations, field notes, personal and operational journals, documents, and literature supplemented this data.This research was conducted in two phases. In phase one a descriptive approach was used to develop propositions about women managers and their careers. These propositions formed the guidelines for phase two. The second phase used grounded theory methods, incorporating feminist and interpretative perspectives to identify the previously inarticulated core problem shared by participants. The barriers that women encountered were the contradictory, inconsistent and incompatible assumptions about their potential to have long term careers and ability to move into senior level management positions.These assumptions had been received during their life and educational experiences, as well as from their organisations. The gendered context of health care organisations and university educational institutions contributed to the limited career aspirations and career progress of women with health professional qualifications. By applying grounded theory strategies for analysis of the data, it was discovered that the women managers dealt with this problem through a core process, labelled metamorphosis, a four stage process for overcoming assumptions. This core variable was the way these women ++ / managers moved from managing without confidence to managing with confidence and assurance.This process occurred over time having four stages, each involving different activities and strategies. The progressive spiral stages were: being in a quandary (struggling with incompatible and contradictory assumptions); observing, examining and reflecting (on the impact of internal and external assumptions on their behaviour in organisational contexts, then realising that opportunities existed); learning and reframing (the managerial skills in order to re-frame their assumptions about the traditional characteristics of a manager); and finally change and transformation into being confident managers, so developing women's presence in management.The findings generated a theory which proposed a managerial career development model for enabling women to manage with confidence and assurance. The outcome was a theoretical model which recognised the dynamic interaction between contexts (professional, organisational, political, economic, cultural, and research); a picture of women managers (personal beliefs, skills, characteristics, attributes of life long learning, relationship between life and career roles, and ways of changing contexts); and the inner energy force creating women's presence in health related organisations (core process and power of their metamorphosis).Contributing to the development of this theory of metamorphosis was the recognition that being and doing research with women involved valuing the personal learning process. This thread has been integrated into the research fabric to strengthen the reflective and personal experiences of research. Using and valuing women's stories enabled their voices and visibility to be taken out of the shadows and demonstrated that they can be pioneers in their own lives. The sense of collaboration in research, education, and community ++ / healing will gain from encouraging women to aspire to leadership and management positions.

Interest in child care has grown dramatically, yet little is known about how families manage to ensure appropriate child care. In a secondary analysis of data from 642 employed mothers representing a wide range of income levels, this research identified the factors contributing most to mothers' satisfaction with child care arrangements. The study used an ecological model with accessibility, affordability, quality, and workplace flexibility as characteristics of the exosystem, and household income, presence of a spouse or partner, and age of the youngest child as characteristics of the microsystem. The research explored how individual family characteristics combine with environmental characteristics to impact parental satisfaction. Three questions guided the study: (a) How do accessibility, affordability, quality of child care arrangements, and workplace flexibility affect parental satisfaction with child care arrangements? (b) How do income, household structure, and child's age affect parental satisfaction with child care arrangements? (c) How do these characteristics combine to affect parental satisfaction with child care arrangements? As proposed, the study found that for most mothers in the study, accessibility and quality combine with income and household structure to impact satisfaction with child care arrangements. Poorer women who pay a greater percentage of household income had more concerns about quality and were more dissatisfied with their child care arrangement than women paying a lower percentage of income for care. Despite concerns about quality for mothers paying a greater percentage of income for care, affordability contributed more than quality to satisfaction with child care. The data provided evidence of a different trade-off for lower income families. The results of this study have relevance for policies which address the needs of families at all income levels. The policy principles based on the results of the study include: 1. Basic health and safety regulations are important to quality and stability of care for all parents. 2. Financial assistance with the cost of child care is important, especially for those working families just above the poverty level. 3. Public support of services to improve child care is important to addressing the needs of all employed mothers, regardless of income status. / Graduation date: 1996

This research evaluated the importance of select competencies in the area of human behavior, important to home-based caregivers employed independently and/or within a service agency in the State of Alaska. Data were gathered from respondents working in home-based care (N=76), and from those working in a related field (N=38). Data were collected on a forty-three (43) item instrument, using a five-point Likert type scale. The instrument was validated by a consensus of panelists using the Delphi technique. The reliability of the instrument was determined to be +0.893, using the Hoyt-Stunkard method. Analysis of variance tests were completed for each of the forty-three (43) competencies and for two work status characteristics to determine differences between responses of those working in home-based care and those working in a related field. Factor analysis, using the R-mode, provided for clustering of competencies and constituted the major analysis procedure for the study. The purpose of the study was to provide curriculum planning direction for postsecondary training in human behavior-related competencies for home-based caregivers. The results of the study indicated the presence of five (5) clusters of content considered basic to training curriculum for all home-based caregivers. The clusters included: One Family systems (8 competencies); Two - Nutrition and food management (6 competencies); Three - Human development (13 competencies); Four Home safety and accessibility (9 competencies); and Five Organization and interpersonal skills (8 competencies). Overall competency means ranged from 2.986 to 4.522. Significance tests showed thirteen (13) rejected hypotheses for the forty-three (43) competencies. The mean scores for twelve (12) of those rejected were slightly higher for those working in home-based care than for those working in a related field. The results of the study present direction for postsecondary vocational curriculum development in human behavior-related competencies important to home-based caregivers. / Graduation date: 1993