Submitted by Aline Batista (alinehb.ufpel@gmail.com) on 2018-05-21T17:25:38Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Francine_Silva_dos_Santos.pdf: 1838087 bytes, checksum: 700caaad2ff94f716df68f1b0a742656 (MD5) / Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2018-05-21T20:14:07Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Francine_Silva_dos_Santos.pdf: 1838087 bytes, checksum: 700caaad2ff94f716df68f1b0a742656 (MD5) / Approved for entry into archive by Aline Batista (alinehb.ufpel@gmail.com) on 2018-05-21T20:14:14Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Francine_Silva_dos_Santos.pdf: 1838087 bytes, checksum: 700caaad2ff94f716df68f1b0a742656 (MD5) / Made available in DSpace on 2018-05-21T20:14:14Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Francine_Silva_dos_Santos.pdf: 1838087 bytes, checksum: 700caaad2ff94f716df68f1b0a742656 (MD5) Previous issue date: 2016-07-15 / Sem bolsa / A alimentação na primeira infância tem implicações nos demais ciclos da vida de um indivíduo. Contudo, evidenciam-se orientações inadequadas por parte dos profissionais de saúde em relação à alimentação complementar e práticas inadequadas das famílias durante este período. Entende-se que os agentes comunitários de saúde, devido suas características e atribuições, possam ser interlocutores, melhorando a alimentação complementar, em todo território nacional. Com isso, este trabalho teve por objetivo descrever o conhecimento dos agentes comunitários de saúde e os recursos que a unidade básica oferece para que estes tenham conhecimento sobre alimentação complementar. Foi realizado estudo transversal descritivo na cidade de Pelotas, RS, nas unidades básicas da zona urbana com Estratégia Saúde da Família ou Estratégia de Agentes Comunitários de Saúde. Dois instrumentos foram utilizados: um questionário proposto ao serviço de saúde e outro destinado aos agentes comunitários de saúde, dividido em duas partes, sendo a primeira aplicada por entrevistador treinado e a outra autopreenchida, compreendendo um teste de conhecimentos sobre alimentação complementar, obtendo escores de conhecimento geral e para cada módulo do instrumento. O conhecimento dos agentes de saúde para os módulos de conhecimento geral e de alimentação complementar apresentou associação estatística positiva com idade, tempo de profissão, visitas domiciliares a crianças com até 24 meses, realizar orientações, buscar informações sobre alimentação complementar, e receber treinamento apenas com o escore geral. Verificou-se desacordo entre as respostas do serviço de saúde e dos profissionais entrevistados quanto aos treinamentos, materiais governamentais e acompanhamento do crescimento infantil. Portanto, a unidade básica deve não só respaldar, mas facilitar o acesso a recursos que possibilitem o conhecimento sobre o assunto, como um fator importante na educação alimentar e nutricional da comunidade. / The feeding in early childhood has implications in other cycles of life of an individual. However, evidence is inadequate guidance by health professionals in relation to complementary feeding and practices inadequate household during this period. It is understood that the community health workers, due to its features and functions, can be interlocutor, improving complementary feeding, throughout the country. Therefore, this study aimed to describe the knowledge of community health workers and resources that the basic unit offers so that they have knowledge about complementary feeding. We conducted a descriptive cross-sectional study in the city of Pelotas, RS, in the basic units of the urban area with Family Health Strategy and Strategy Community Health Agents. Two instruments were used: a questionnaire proposed to the health service and another for the community health workers, divided into two parts, the first being applied by a trained interviewer and the other filled by the respondent comprising a knowledge test about complementary feeding, obtaining knowledge scores general and for each instrument module. Knowledge of health workers to the general knowledge modules and complementary feeding showed positive statistical association with age, occupation time, home visits to children up to 24 months, conduct guidelines, seek information about complementary feeding, and receive training only the general score. There was disagreement between the responses of the health service and the professionals interviewed about the training, government materials and monitoring of child growth. Therefore, the basic unit must not only endorse but facilitate access to resources that enable knowledge of the subject as an important factor in food and nutrition education community.

Magister Public Health - MPH / This study investigated the challenges facing a category of community health workers (Health Surveillance Assistants) in rural Malawi district of Nkhatabay following the expansion of their programme funding from the Global Funding to fight AIDS, Tuberculosis and Malaria (GFATM). The study has noted that HSAs are facing serious accommodation problems due to the lack of involvement of communities in their selection and that many HSAs are recruited from outside their catchment areas. The study has put forward some recommendations to the Ministry of Health and other stakeholders like United Nations Children's Fund (UNICEF) and the World Health Organization (WHO) to consider in making the HSAs programme in Nkhatabay district effective. Some of the recommendations made are that supervision of the HSAs by the EHOs and the ECHNs should be intensified and that infrastructure support should be provided to the HSAs for them to be able to deliver the EHP. Infrastructure like buildings and equipment like refrigerators and bicycles should be provided to HSAs and ensure that there is a plan for their maintenance. / South Africa

Magister Public Health - MPH / Background: Globally, neonatal mortality (i.e. deaths occurring during the first month of life) accounts for 44% of the 11 million infants that die every year (Lawn, Cousens Zupan, 2005). Early detection of illness and referral of mothers and infants during the peri-natal period to higher levels of care can lead to substantial reductions in maternal and child mortality in developing countries. Establishing effective referral systems from the community to health facilities can be achieved through greater utilization of community health workers and improved health seeking behaviour. Study design: The Good Start Saving Newborn Lives study being conducted in Umlazi, KwaZulu-Natal, is a community randomized trial to assess the effect of an integrated home visit package delivered to mothers during pregnancy and post delivery on uptake of PMTCT interventions and appropriate newborn care practices. The home visit package is delivered by community health workers in fifteen intervention clusters. Control clusters receive routine health facility antenatal and postpartum care. For any identified danger signs during a home visit, community health workers write a referral and if necessary refer infants to a local clinic or hospital. The aim of this study was to assess the effectiveness of this referral system by describing community health worker referral completion rates as well as health-care seeking practices and perceptions of mothers. A cross- sectional survey was undertaken using a structured questionnaire with all mothers who had been referred to a clinic or hospital by a community health worker since the start of the Good Start Saving Newborn Lives Trial. Data collection: Informed consent was obtained from willing participants. Interviews were conducted by a trained research assistant in the mothers home or at the study offices. Road to Health Cards were reviewed to confirm referral completion. Data was collected by means of a cell phone (mobile researcher software) and the database was later transferred to Epi-info and STATA IC 11 for analysis. Descriptive analysis was conducted so as to establish associations between explanatory factors and referral completion and to describe referral processes experienced by caregivers. Significant associations between categorical variables were assessed using chi square tests and continuous variables using analysis of variance. Results: A total of 2423 women were enrolled in the SNL study and 148 had received a referral for a sick infant by a CHW by June 2010. The majority (95%) of infants were referred only once during the time of enrolment, the highest number of which occurred within the first 4 weeks of life (62%) with 22% of these being between birth and 2 weeks of age. Almost all mothers (95%) completed the referral by taking their child to a health facility. Difficulty in breathing and rash accounted for the highest number of referrals (26% and 19% respectively). None of the six mothers who did not complete referral recognised any danger signs in their infants. In only 16% of cases did a health worker give written feedback on the outcome of the referral to the referring CHW. Conclusion: This study found high compliance with referrals for sick infants by community health workers in Umlazi. This supports the current primary health care re-engineering process being undertaken by the South African National Department of Health (SANDOH) which will involve the establishment of family health worker teams including community health workers. A key function of these workers will be to conduct antenatal and postnatal visits to women in their homes and to identify and refer ill children. Failure of mothers to identify danger signs in the infant was associated with non-completion of referral. This highlights the need for thorough counseling of mothers during the antenatal and early postnatal period on neonatal danger signs which can be reinforced by community health workers. Most of the referrals in this study were neonates which strengthens the need for home visit packages delivered by community health workers during the antenatal and post-natal period as currently planned by the South African National Department of Health.Recommendations: This study supports the current plans of the Department of Health for greater involvement of CHWs in Primary Health Care. Attention should be given to improving communication between health facilities and CHWs to ensure continuity of care and greater realization of a team approach to PHC. / South Africa

Magister Public Health - MPH / In 2007, at its 52nd Conference in Polokwane, the African National Congress (ANC) called for the implementation of a National Health Insurance (NHI) scheme. The announcement resulted in much debate, with critics voicing concerns about the state of the public health system, lack of consultation and the expense of a NHI scheme. However, little attention has been paid to the human resource (HR) needs, despite the fact that 57% of recurrent expenditure on health1 is on HR. This research aimed to identify the HR requirements to support the implementation of an effective and equitable health system funded by a NHI in South Africa. An overview of the current burden of disease and distribution of HR is provided. Through interviewing key stakeholders the study attempted to elicit information about factors which will hamper or assist in developing such a health system, specifically looking at the HR situation and needs. The research explores HR odels and proposes key HR requirements for implementation of a health system funded by a NHI in South Africa, including skills mix and projected numbers of health workers and proposes ways to improve the deficient HR situation. Exploratory qualitative research methods were used comprising in-depth individual interviews, with a purposive sample of key informants, including: public health professionals and health managers (working in rural and urban areas); researchers; academics and NGO managers. The contents of the interviews were analysed to identify common responses about and suggestions for HR requirements within the framework of a NHI. 1 Personal communication Dr Mark Blecher, Director Social Services (Health), National Treasury, 17 July 2009 The literature review includes policy documents, position papers and articles from journals and bulletins. Key informants were asked to identify literature and research material to support recommendations. The research findings indicate that despite the South African Government’s expressed commitment to Primary Health Care (PHC), the National Department of Health has continued to support and sustain a clinical model of health service delivery (Motsoaledi, 2010), primarily utilising doctors and nurses. The clinic based services are limited in their ability to reach community level, and, being focused on curative aspects, are often inadequate with regard to prevention, health promotion and rehabilitation services. While the curricula of health professionals have been through some changes, the training has continued to be curative in focus and the clinical training sites have not been significantly expanded to include peripheral sites. While there are many Community Health Workers in the country, they remain disorganised and peripheral to the public health system. The mid level worker category has not been fully explored. Finally there are no clear strategies for recruitment and retention of health workers in rural and under-resourced areas. In addition to the continued use of a clinical model, transformation of the health system hasbeen hampered by inadequate numbers of health workers, particularly in the rural and periurban townships and informal settlements. There is no clear strategy for addressing the critical health worker shortage in under-resourced areas, particularly rural areas. The last section makes recommendations, which will be submitted to the relevant task teams working on the NHI. It is intended that recommendations arising out of the research will influence the process and decisions about HRH within a NHI funded health system. / South Africa

Magister Public Health - MPH / Antiretroviral therapy (ART) improves the quality of lives of people living with HIV/AIDS by suppressing HIV replication and improving the patient’s immunity. An improved immunity will help prevent patients from contracting opportunistic infections. Adherence to ART is vital to obtain good clinical outcome for patients. Defaulting ART leads to increase in viral load, decreased host immunity, development of HIV drug resistant strains, exposure to opportunistic infections and ultimately death. HIV positive patients who are on ART face many challenges in adhering to their medications, these challenges act as barriers to their adherence to treatment. This study explores the barriers that adult patients in a hospital in Eastern Cape of South Africa face while on treatment. These barriers include individual factors, socio-economic factors, health service factors, medical regimen factors.

Este estudo teve como objetivo desenvolver um instrumento para a avaliação formativa dos Agentes Comunitários de Saúde (ACS) das Unidades de Saúde com Estratégia de Saúde da Família (ESF) no âmbito do projeto Telessaúde/RS. Trata-se de um estudo descritivo, de abordagem mista, realizado no contexto do programa Telessaúde/RS. Foram convidados a participar do estudo 45 enfermeiros e 45 Agentes Comunitários de Saúde. Para a coleta de dados, utilizou-se a técnica Delphi online. Na primeira etapa foi enviado aos participantes um questionário com base no referencial de competências profissionais do ACS do Ministério da Saúde e os mesmos, de acordo com seus conhecimentos e experiências, puderam excluir ou modificar as competências listadas, bem como acrescentar competências. Na segunda etapa o questionário constou dos esquemas de competências resultantes da primeira etapa, adicionadas de uma escala de Likert com valores de 1 (discordo muito) a 5 (concordo muito), para que manifestassem seu grau de concordância. Nesta etapa foram adicionadas ao instrumento questões a respeito da periodicidade para a realização da avaliação e indicação de critérios para a avaliação. Com base nos resultados obtidos na 1ª e 2ª etapas, foi elaborado o instrumento para avaliação formativa dos ACS. Na 3ª etapa o instrumento foi enviado aos participantes para a validação. Em cada etapa do estudo o número de participantes variou, na primeira etapa participaram 40, na segunda 30 e na terceira 35. Em um primeiro momento, realizou-se uma análise qualitativa das modificações, sugestões ou comentários dos participantes e, após, a análise estatística dos dados. Os resultados evidenciaram a preocupação dos participantes com a escolaridade dos ACS, a capacitação para o trabalho, e formação técnica, sua inserção na equipe, a supervisão realizada pela enfermeira, bem como o grau de autonomia, o espaço e a especificidade do seu trabalho e a valorização do ACS como membro da equipe da ESF. A realização deste estudo possibilitou desenvolver um Instrumento de Avaliação Formativa para os ACS, e proporcionou uma avaliação inicial das competências estabelecidas pelo Ministério da Saúde e uma revisitação às atribuições e competências do ACS na ESF. / This study aimed to develop a tool for formative assessment of Community Health of the Health Units with the Family Health Strategy within the Telessaúde/RS project. This is a descriptive study, the mixed approach, carried out in the context of Telessaúde/RS program. Were invited to participate in the study 45 nurses and 45 ACS. To collect data, we used the Delphi technique online. The first stage was a questionnaire sent to participants based on the benchmark of professional skills of the ACS Health Ministry and the same according to their knowledge and experience could delete or modify the powers listed, as well as additional capabilities. In the second stage the questionnaire consisted of schemes resulting powers the first stage, added a Likert scale with values from 1 (strongly disagree) to 5 (strongly agree), to manifest their degree of concordance. This step was added to the instrument questions about periodicity for conducting the assessment and indication criteria for evaluation. With basis of results obtained in 1st phase and 2nd instrument for formative assessment of ACS was prepared. In Step 3 the instrument was sent to the participants for validation. At each stage of the study the number of participants varied in the first stage, 40 in the second 30 and the third 35. At first, we carried out a qualitative analysis of the changes, suggestions or comments from participants and after the statistical analysis of data. The results showed the concern of the participants with the education of ACS, the job training, and technical training, their inclusion in the team, supervision by the nurse, and the degree of autonomy, the scope and specificity of their work and recovery ACS as a member of the ESF team. / Este estudio tuvo como objetivo desarrollar una herramienta para la evaluación formativa de Salud Comunitaria de las Unidades de Salud de la Estrategia de Salud de la Familia en el proyecto de Telessaúde/RS. Se trata de un estudio descriptivo, el enfoque mixto, llevado a cabo en el contexto del programa de Telessaúde/RS. Fueron invitados a participar en el estudio 45 enfermeros y 45 ACS. Para recopilar los datos, se utilizó la técnica Delphi en línea. La primera etapa consistió en un cuestionario enviado a los participantes en base al índice de referencia de las competencias profesionales del Ministerio de Salud de la ACS y de la misma de acuerdo con sus conocimientos y experiencia podría borrar o modificar los poderes enumerados, así como capacidades adicionales. En la segunda etapa, el cuestionario consta de esquemas resultantes poderes de la primera etapa, añadió una escala Likert con valores de 1 (muy en desacuerdo) a 5 (muy de acuerdo), para manifestar su grado de concordancia. Este paso se añadieron a las preguntas del instrumento sobre la periodicidad de la realización de la evaluación y los criterios de indicación para la base evaluación. Con los resultados obtenidos en la primera fase y la segunda de instrumentos para la evaluación formativa de ACS se preparó. En el paso 3 del instrumento fue enviado a los participantes para su validación. En cada etapa del estudio, el número de participantes varió en la primera etapa, 40 en la segunda 30 y la tercera 35. En primero, se realizó un análisis cualitativo de los cambios, sugerencias o comentarios de los participantes y después del análisis estadístico de datos. Los resultados mostraron la preocupación de los participantes con la educación de ACS, la capacitación laboral y formación técnica, su inclusión en el equipo, la supervisión de la enfermera, y el grado de autonomía, el alcance y la especificidad de su trabajo y la recuperación ACS como un miembro del equipo de la ESF. Este estudio hizo posible el desarrollo de un Instrumento de Evaluación Formativa para ACS, y proporcionó una primera evaluación de las competencias establecidas por el Ministerio de Salud y revisitando los deberes y atribuciones de la ACS en el ESF.

Made available in DSpace on 2016-07-18T17:54:28Z (GMT). No. of bitstreams: 1 DISSERTACAO.pdf: 130882 bytes, checksum: 6474309186b9887314770f165730f9fc (MD5) Previous issue date: 2005-12-01 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The present study has as aim analyzing the educational practices developed by the Health Community Agents from two of the Presidente Prudente s Family Health Teams. This programme is considered a new model on basic health attention and contains a more humanized approach with greater influencing power on the family environment, in addition to promoting social-reality-transforming practices. The theoretical reference which gives this study support is the popular health education. It has been chosen the qualitative approach, through a case study, making use of bibliographic living and recorded sources. It consists on documents analysis which verse about the implementation of the programme in the municipality and on semi-structured interviews, whose material was grouped in common topics and interpreted from a theoretical referential viewpoint raised to the analysis of the problem. It highlights, as main results, information that many Community Agents are introduced to their occupations possessing precarious training and the scarce process of continued education; the educational actions described, which range from individual follow-up during home visits to interventions with groups of hypertension patients, diabetics, pregnant women, remaining the focus of these interventions still much too attached to the programmes standardized by health authorities, with prescribing obliquity. It was verified that users of the programme compliment the teams proximity to the community, acknowledge the importance of their job, but request more doctors, more medicines and less disassembling in the groups, since there is a great potion of ill people in Brazil who protest for assistance and quality in the service. It concludes that when it comes to group activities there is concern towards the programmes in the agenda, lacking of integrality in the educational actions, since these latter are reduced to lecturing. These are insufficient actions, when promoting the population s autonomy and understanding is the aim. However it is observed that the Health Community Agent can promote social support to the user, favoring new contacts, helping in the access to health services. The Health Community Agent enlarges the patients Social Network with empathy and solidarity, making possible better living and health conditions to people, contributing, consequently, to the humanization of the Family Health Programme. / A presente pesquisa tem como objetivo analisar as ações educacionais desenvolvidas pelos Agentes Comunitários de Saúde de duas Equipes de Saúde da Família de Presidente Prudente. Esse programa é considerado um novo modelo de atenção básica à saúde e tem uma abordagem mais humanizada e com maior poder de penetração no universo familiar, além de promover práticas transformadoras da realidade social. O referencial teórico que dá sustentação a esse estudo é o da educação popular em saúde. Optou-se pelo enfoque qualitativo, por meio de um estudo de caso, utilizando fontes bibliográficas, documentais e vivas. Consta de análise de documentos que versam sobre a implantação do programa no município e de entrevistas semi-estruturadas, cujo material foi agrupado em temas comuns e interpretado à luz do referencial teórico levantado para análise do problema. Aponta, como principais resultados, a informação de que muitos Agentes Comunitários são lançados a sua jornada de trabalho, com treinamentos precários e escasso processo de educação continuada; as ações educativas descritas, que vão desde o acompanhamento individual nas visitas domiciliares a intervenções com grupos de hipertensos, diabéticos, gestantes, ficando o foco das mesmas ainda muito preso aos programas padronizados pelas instâncias superiores do setor de saúde, com um viés prescritivo. Verificou-se que os usuários elogiam a aproximação da equipe à comunidade, reconhecem a importância do trabalho, mas solicitam mais médicos, mais remédios e menos desmontes nas equipes, já que há uma grande parcela de pessoas doentes no Brasil, que clamam por assistência e qualidade no atendimento. Conclui que, quando se reporta a atividades grupais, há uma preocupação com os programas em pauta, faltando integralidade nas ações educativas, já que essas são reduzidas a palestras. São ações insuficientes, quando se quer promover a autonomia e a conscientização da população. No entanto observa-se que o Agente Comunitário de Saúde pode promover apoio social ao usuário, favorecer-lhe novos contatos, ajudá-lo no acesso a serviços de saúde. Amplia a Rede Social do paciente com empatia e solidariedade, possibilitando melhores condições de vida e saúde às pessoas, colaborando, conseqüentemente, na humanização do Programa Saúde da Família.

Introducción: La Atención Primaria de Salud (APS) es la asistencia sanitaria esencial accesible a todos los individuos y comunidades. Uno de los desafíos de la APS renovada es el fortalecimiento de competencias de los equipos de APS. Las competencias son los conocimientos, habilidades y actitudes, que se manifiestan cuando se ejecuta una tarea y están relacionadas con el desempeño exitoso de esta. Uno de los grupos vulnerables afectado por la falta de competencias adecuadas para abordar sus problemas de salud es la población indígena. Por ello, es fundamental conocer las competencias que estas comunidades consideran importantes, de manera que se pueda capacitar al personal sanitario en base a estos hallazgos. Objetivo: Sintetizar la evidencia reportada en la literatura sobre las competencias del personal sanitario en APS renovada, desde el punto de vista de la población indígena y del personal sanitario. Métodos: Revisión sistemática cualitativa de la literatura publicada durante el periodo 2005 – actualidad. Se realizó la búsqueda electrónica en bases de datos y se identificaron 24 estudios que evaluaban las percepciones del personal de salud y la población indígena sobre las competencias del personal sanitario para trabajar con comunidades indígenas. Se extrajeron y sintetizaron los datos utilizando la síntesis temática como metodología de síntesis cualitativa. La confianza de los hallazgos se evaluó utilizando el enfoque GRADE – CERQual. Resultados: Se analizaron 24 estudios, de los cuales 23 procedían de países de ingresos altos y 1 de ingresos medios. Se identificaron las competencias del personal sanitario clasificándolas en conocimientos, habilidades y actitudes. Entre los hallazgos relacionados a los conocimientos se evidenciaron temas como la formación cultural insuficiente y la estigmatización por parte del personal de salud. En cuanto a las habilidades se mencionó la barrera del idioma, la adaptación del lenguaje, la atención orientada a las características individuales, el tiempo de consulta, la aceptación de creencias y la inclusión de la fuerza laboral aborigen. Las actitudes más valoradas fueron la amabilidad, el respeto, la presencia de un ambiente de apoyo y el interés en aprender sobre la cultura aborigen. Conclusiones: Las competencias son elementos fundamentales de los Equipos de Atención primaria de la salud, sobre todo en el abordaje de los problemas de salud de las comunidades aborígenes, puesto que permiten una mayor aceptación por parte de estas. Esta revisión muestra extractos de estudios primarios sobre aquellas competencias que ayudan al proveedor de salud a lograr un mayor entendimiento acerca de las necesidades de la población indígena. / Introduction: Primary Health Care (PHC) is essential healthcare accessible to all individuals and communities. One of the challenges of the renewed PHC is the strengthening of competencies of PHC teams. Competencies are the knowledge, skills, and attitudes that are manifested when a task is performed and are related to its successful performance. One of the vulnerable groups affected by the lack of adequate skills to address their health problems is the indigenous population. Therefore, it is essential to know the competencies that these communities consider important so that health personnel can be trained based on these findings. Objective: To synthesize the evidence reported in the literature on the competencies of health personnel in renewed PHC, from the point of view of the indigenous population and health personnel. Methods: Qualitative systematic review of the literature published during the period 2005 - present. An electronic search was carried out in databases and 24 studies were identified that evaluated the perceptions of health personnel and the indigenous population about the competencies of health personnel to work with indigenous communities. Data were extracted and synthesized using thematic synthesis as a qualitative synthesis methodology. The confidence of the findings was assessed using the GRADE - CERQual approach. Results: 24 studies were analyzed, of which 23 were from high-income countries and 1 from middle-income countries. The competencies of health personnel were identified by classifying them in knowledge, skills and attitudes. Among the findings related to knowledge, issues such as insufficient cultural training and stigmatization by health personnel were evidenced. Regarding skills, the language barrier, language adaptation, attention oriented to individual characteristics, consultation time, acceptance of beliefs and inclusion of the Aboriginal workforce were mentioned. The most valued attitudes were kindness, respect, the presence of a supportive environment and an interest in learning about Aboriginal culture. Conclusions: Competencies are fundamental elements of Primary Health Care Teams, especially in addressing the health problems of aboriginal communities, since they allow greater acceptance by them. This review shows excerpts from primary studies on those competencies that help the health provider to achieve a greater understanding about the needs of the indigenous population. / Tesis

Includes bibliographical references (p. 51-57). / Exclusive breastfeeding (mother's milk only, with the exclusion of all other food or drink) reduces breast milk transmission of HIV compared with mixed feeding. This study was part of formative work for a community-based un-blinded randomised controlled trial (RCT) in an urban township with high antenatal HIV prevalence in KwaZulu-Natal (KZN), South Africa. The RCT sought to determine whether an integrated package of home-based care delivered by community health workers (CHWs) increases uptake of prevention of mother-to-child-transmission (PMTCT) interventions and improves neonatal outcomes. One example of where counselling is used is in Behaviour Change Communication (BCC) approaches. A counselling booklet, used by CHWs during home visits, was part of the integrated package. The primary objective of this study was to document the socio-cultural context in which infant feeding and caring decisions were made. The secondary objective was to field test the draft counselling booklet for the RCT. Methods This qualitative study used focus groups (n=8 groups) and individual interviews (n=6). All participants, of unknown HIV status, were purposively sampled from the study site. The focus group participants included, in separate groups, eight MRC researchers; 14 pregnant women (two separate groups of seven each); six non-pregnant women; eight older women; five men and 15 CHWs (separated into two groups). Results Data showed that socio-cultural factors, like the lack of social support systems; uncertainty regarding the role of men in infant feeding and caring issues; local beliefs and practices that encouraged risky infant caring practices; the lack of supply of formula and CHWs' lack of breastfeeding knowledge and experience; and HIV-related stigma may directly or indirectly, drive mothers to practice non-exclusive infant feeding. BCC principles acknowledge that people are affected greatly by social pressures exerted not only by their peers, but also by their larger communities (Bentley et al., 1999). For vi example, with regard to the support systems, both pregnant as well as younger women felt that feeding and caring decisions regarding their infants were mostly made by older women ' their husbands were seldom involved in such decisions. In relation to HIV-related stigma, many pregnant women felt that some clinics were not very supportive regarding HIV disclosure. In terms of health system factors, CHWs said that they were sometimes ill-equipped to deal with issues of disclosure due to a lack of training and confusion around the key feeding and caring messages. With regard to infant caring practices, the data revealed risky practices (using soap enemas and inappropriate hand washing practices), even amongst CHWs. Participants said they would share the booklet with others in the community as it taught them important lessons regarding infant feeding and caring practices. For some, the pictures in the booklet enhanced their understanding of 'old' messages. Participants identified several weaknesses in the booklet and suggested that it be less repetitive; that voluntary counselling and testing (VCT) be given priority in earlier rather than later visits; that unfamiliar terms is explained; more pictures included; and the general tone of messages improved. Literacy rates were low among older women and some men in the study. Conclusion and Recommendations Socio-cultural factors drive mothers to practice non-exclusive feeding and care for their infants in ways that may unwittingly increase the risk of HIV transmission. There is a need for CHWs to include family members in discussions about feeding so that they can change their thinking around infant-feeding and caring issues. The data suggests that VCT is not given priority in the counselling booklet and support is lacking in some clinics, therefore policy makers should ensure that support for VCT becomes a priority in the future. Furthermore, some CHWs were confused about the messages they are disseminating, therefore, the training that facility managers give to CHWs should be adapted to suit socio-cultural contexts so that CHWs are better equipped to communicate messages pertaining to infant feeding and caring appropriately to mothers. With the data revealing general acceptability of risky infant caring practices, even amongst CHWs, the vii health system needs to look at how it will effectively change health-related practices among health professionals. With literacy rates being low among older women and some men in the study, it was therefore recommended that gaining skills in materials design and improving CHWs' understanding of the BCC process, booklets such as this one needs to be designed together with the primary user in mind.

Problems of the Russian rural healthcare are considered in the master’s dissertation in light of the conducted reforms and transformations for the relationship health workers and patients. The dissertation presents the modern approach of the system of rural healthcare, which identified the several subsystems: interaction of the social communalities, medical service, medical institutions, management of the healthcare, norms and sanctions. Dissertation’s author described the results of the survey conducted in the villages of Dalmatovo district of Kurgan region. The study is based on the methodology of American philosopher R. Veatch, who classified the relations of health workers and patients on the four models: engineering, paternalistic, collegial and contract. The research identified the problems and contradictions in the system of rural healthcare. The dissertation can be used as a textbook for a university’s students training on the course and specialty “Sociology”. It’s interest for graduate students, university’s teachers, academics of the field of social sciences and humanities. / В магистерской диссертации рассматриваются проблемы сельского здравоохранения России в свете проводившихся реформ и преобразований на предмет взаимоотношений медицинских работников и пациентов. Представлена современная трактовка системы сельского здравоохранения, в которой выделено несколько подсистем: взаимодействия социальных общностей, медицинского обслуживания, медицинских учреждений, управления в сфере здравоохранения, норм и санкций. Автор диссертации описал результаты социологического исследования, проводившегося в селах Далматовского района Курганской области. Исследование методологически основано на концепции американского философа Р. Витча, который классифицирует взаимоотношения медицинских работников и пациентов на четыре модели: инженерная, патерналистская, коллегиальная, контрактная. В ходе исследования были выявлены проблемы и противоречия, возникшие в системе сельского здравоохранения. Магистерская диссертация может быть использована в качестве учебного пособия для студентов высших учебных заведений, обучающихся по направлению и специальности «Социология». Она представляет интерес для аспирантов, преподавателей, ученых в области социально-гуманитарных наук.