Health Studies / D. Litt. et Phil. (Advanced Nursing Science)

The historical evolution of South Africa’s health sector, dating back to the 17th century, is significantly different from that of other African countries. Throughout the four centuries of development there have been numerous advances in health policy, legislative instruments and health system progress. Against this background this dissertation critically analysed the management of records in public health care institutions in South Africa. The study did this by addressing three objectives: assess the legislative, policy and regulatory contextual framework of South Africa’s health care system; assess the effectiveness of records management within public health care institutions; and identify appropriate interventions to address the challenges facing records management in the health care system. The study used purposive sampling to identify respondents with diverse expertise in three main sectors: the public sector, the private sector as well as in academic and research institutions. Using interview research technique the study solicited data that was analysed in order to provide a composite picture in addressing the research objectives. The analysis of data revealed three overarching themes. First, there is substantial legislative and regulatory dissonance in the management of health records in the country. While there are extensive legislative, regulatory and policy instruments that could be used to manage records, many lack coherence with records management issues such as records retention. Second, understanding the complex interplay of different legal and regulatory instruments is a critical first step, but it remains the beginning of the process towards building a sophisticated implementation process. For this process to be successful, study respondents argued that records compliance would have to be the backbone of all other compliance processes. Third, while there were substantial areas of weakness in the management of records in South Africa’s public health sector, there have been a number of pockets of excellence. These include the efforts towards complying to access to information legislation by the Limpopo Department of Health and Social Development as well as the successful introduction of Enterprise Content Management systems in health care institutions by the Western Cape Department of Health / Information Science / D. Litt. et Phil. (Information Science)

職業災害調查係為勞動檢查之一環，係發生重大職業災害後，所執行之行政調查，為判斷重大職業災害過失責任關係、分析事故發生因素、防範再度發生之預防措施，不僅可以讓勞工及其家屬了解職業災害事故始末，也可透過調查報告書讓有過失責任者受到應有之懲罰，對受職業災害之勞工及其家屬可謂非常重要。職業災害調查通常具備強制性行政調查權，但在調查過程中，並無權限封鎖重大職災現場來保持證據的完整性，本文將探討目前職業災害調查制度之成效？以及目前法院對職業災害調查報告書之見解為何？此外並探討美、日兩國之職業災害調查制度？以上為本文探討重點。 本文發現我國職業災害調查制度雖有不足之處，但目前勞動法令授與勞動檢查員強制性行政檢查權、停工權…等權限，已賦予執行職業災害調查之基本權限，規劃出職業災害調查制度的雛形，本文認為目前雖有不足之處，但已能處理大多數的重大職業災害案件，至於勞動法令是否應讓勞動檢查員，於發生重大職業災害下，得執行特別司法警察官權限進行調查的問題，本文綜觀美、日兩國制度及相關文獻後，認為目前尚不需授與特別司法警察官權限，但必須要加強勞動檢查員與警察、消防機關之職務聯繫及協助，並賦予勞動檢查員行政封鎖之權限，使職業災害調查制度更加完善，能夠妥善處理每一件重大職業災害案件。並提出下列建議： 一、建立職業災害事故現場的行政封鎖制度 二、加強與其他機關的職務協助關係 三、縮短雇主通報義務時間 四、強化專業分工與在職訓練 五、釐清勞動派遣之雇主關係 六、加強雇主預防責任

L’accessibilité à des soins de santé pour une population habitant une région éloignée au Québec représente un défi de taille pour le Ministère de la santé et des services sociaux. Des solutions, telles que la télésanté, ont été présentées afin de pallier ce problème. Le RUIS McGill a ainsi développé un programme de téléobstétrique afin de desservir une population de femmes inuites à grossesse à risque élevé (GARE) habitant le Nunavik. L’objectif de ce mémoire fut de comprendre l’impact du service de téléobstétrique du RUIS McGill sur la santé des femmes et de leur nouveau-né ainsi que sur les coûts de santé et l’utilisation des services suite à son implantation au Centre de santé et de services sociaux Inuulitsivik sur la côte de la baie d’Hudson. Les femmes inuites à grossesse à risque élevé et leurs enfants de la région de la baie d’Hudson du Nunavik, éloignés des services obstétriques spécialisés, sont visés. Le service de téléobstétrique permet un accès aux obstétriciens du RUIS McGill localisés à Montréal. Un devis quasi-expérimental est utilisé pour examiner trois hypothèses portant sur l’état de santé des mères et des enfants, sur l’utilisation des services de santé et sur leurs coûts. Le service de téléobstétrique est devenu fonctionnel en 2006, offrant la possibilité de constituer une étude avant-après à deux groupes de femmes, soit celles ayant accouché avant 2006 (prétest) et celle ayant accouché après 2012 (post-test). La collecte de donnée se fit, dans son intégralité, par l’entremise des dossiers médicaux papier des participantes permettant l’analyse de 47 dossiers pour le prétest et de 81 dossiers pour le post-test. L’exécution d’analyse de covariance, de régression logistique et du test non paramétrique de Mann-Witney permit de conclure que le prétest et le post-test ne différent que sur deux variables, soient le poids à la naissance, plus faible dans le post-test et la pression artérielle de la mère à la naissance, plus élevée dans le post-test. Pour l’ensemble des autres variables portant sur les trois hypothèses à l’étude, les résultats de ce mémoire ne démontrent aucune différence significative entre les deux groupes démontrant ainsi qu’une même qualité de soins a été conservée suite à l’implantation du programme de téléobstétrique. Sur la base des résultats, ce mémoire recommande de revoir et modifier les objectifs du programme; de partager les bornes de communication de télésanté avec d’autres spécialités; d’entreprendre une évaluation du programme axée sur les coûts; de suivre rigoureusement l’utilisation du programme pour en maximiser l’efficacité et le potentiel; d’établir un tableau de bord; et d’entreprendre une étude évaluative comparative dans un service de téléobstétrique comparable. / Health care accessibility to the population located in a remote region of Quebec represents a challenge for the Ministère de la santé et des services sociaux. Solution such as telemedicine has been used to mitigate this issue. Therefore RUIS McGill has developed a teleobstetric program helping Inuit women in Nunavik with their risky pregnancy. This thesis’s objective is to understand the impact of the RUIS McGill teleobstetric program on the mother and her new born health plus the cost and utilization of health services following its implementation in the Inuulitsivik Health & and Social Services Centre located on Hudson Bay Shore. Inuit women at high risk pregnancy and their children in the region of Nunavik's Hudson Bay, who are far away from specialist in obstetric, are targeted. The teleobstetric program provides access to the RUIS McGill obstetricians located in Montreal. A quasi- experimental design was used to examine three hypotheses about the mothers and their children health, the use of health services and their costs. The teleobstetric program became operational in 2006, providing the ability to be a before-after study with two groups of women, those who delivered before 2012 (pre-test) and those who delivered after 2006 (post-test). The data collection took place, in its entirety, through paper medical records of the participants allowing the analysis of 47 cases for the pre-test and 81 cases for the post-test. Variance and covariance’s analysis, logistical regression and the non-parametric Mann-Witney test has allowed to conclude that the pre-test and post-test are different for only two variables which is the weight at birth, lower in the post-test and for the blood pressure of the mother at birth, higher in the post-test. For all other variables based on the three hypothesis of this thesis, results show no significate difference between pre-test and post-test, illustrating that the same level of quality has been conserved after the implementation of the teleobstetric program. Based on results, this thesis recommends reviewing and modifying the program’s objectives; sharing telehealth communication terminals with other specialties; undertaking an assessment of the cost-based program; strictly monitor the use of the program to maximize efficiency and potential; establishing a dashboard; and undertaking a comparative evaluation study in a comparable teleobstetric service.

Foi descrita e analisada a implantação de um processo de gestão da qualidade total na Divisão de Laboratório Central entre 1996 e 97. O sistema de garantia da qualidade com descrição e análise efetuadas, apoiou-se na Norma ISO 9002. Seu desempenho foi monitorizado por indicadores, tendo as suas repercussões discutidas. Os resultados indicaram que processos similares são viáveis em laboratórios clínicos públicos. Demonstrando-se um envolvimento dos funcionários, com diminuição do absenteísmo e do número de licenças do trabalho. A produtividade e o faturamento aumentaram, mantendo-se o custo médio por exame. As pesquisas de opinião apontaram mudanças no conceito dos médicos sobre o laboratório e mais satisfaçào dos pacientes com os serviços prestados. Este sistema obteve reconhecimento externo em 1997 / The implementing process of a total quality management system in the DLC was described and analyzed from 1996-97. A quality assurance system was established base don the rules of the ISO 9002. The steps of the establishing process were described, analyzed and a set of the indicators were used in order to monitor the performance of the introduced system, through the analysis of its follow-up. The results demonstrated that employees´ commitment resulted in a decrease in absenteeism, leave of absence and accidents related to work. There was an increase in productivity and billing with the upkeep of the cost per exam. Public opinion polls disclosed a better concept of the laboratory by the clinical staff and the patients. This system got external certification in 1997

University of Macau / Faculty of Social Sciences and Humanities / Department of Government and Public Administration

University of Macau / Faculty of Social Sciences and Humanities / Department of Government and Public Administration

This dissertation analyses public health service delivery at the Sir Seewoosagur Ramgoolam National Hospital (S.S.R.N.H.) in Mauritius. Particular emphasis is laid on the historical development of public health service delivery at S.S.R.N.H. Public health service delivery has been approached from the view points of its nature and scope. The core components of the research survey have been on some major obstacles and flaws in effective public health service delivery at S.S.R.N.H. The measuring instrument used for the research survey was a self­ administered questionnaire. The main findings were discussed especially absenteeism, personnel turnover, stress, burnout, morale, sexual harassment, lethargy and disobedience, nepotism, shirking responsibility, alcohol and drug abuse, active political interference, bribery and corruption, dishonesty and retaliation and neglect of duty. Attention was also devoted on the current national health policy for improving public health service delivery at S.S.R.N.H., inter-alia, the National Policy for Public Heath Act 17 of 2000 and the White Paper on Health Sector Development and Reform of December 2003. The public health environment is constantly altering. Therefore, it is essential to adjust to the changing health environment. This dissertation has addressed the future challenges in the micro health environment and macro health environment of S.S.R.N.H. Ultimately, a holistic instead of a parochial approach to addressing shortcomings identified in public health service delivery at S.S.R.N.H. has been advocated in this dissertation. / Public Administration and Management / M.Admin. (Public Admin)

Made available in DSpace on 2010-04-20T20:51:57Z (GMT). No. of bitstreams: 2 61060100584.pdf: 6451200 bytes, checksum: 63eee7ad33f7a0fc2a857e79c9ad14f7 (MD5) 1_61060100584.pdf: 11952670 bytes, checksum: 7f4c7ef60278d0e661201f688d83933f (MD5) Previous issue date: 2008-08-18T00:00:00Z / Esta pesquisa é um estudo de caso que analisa a experiência realizada pela Federação das Organizações Indígenas do Rio Negro - FOIRN, em convênio com a Fundação Nacional de Saúde - FUNASA, na gestão do sistema de serviços de saúde para a população indígena do alto rio Negro - Amazonas, no período de 2002 a 2006. Foram realizadas entrevistas com atores-chave por meio de roteiro semi-estruturado e analise de documentos. Os resultados indicam uma falta de articulação entre as conveniadas. Verificou-se que não houve transparência de decisões entre as partes, ou preocupação com a qualificação para tratar de uma questão tão complexa quanto a saúde dos indígenas do rio negro. Ainda, os recursos eram transferidos de maneira irregular e em volume insuficiente, causando descontinuidade e problemas de gestão da política. Conclui-se que ainda exista um caminho a ser percorrido pelas organizações que se submeteram a executar a gestão da saúde indígena dos povos rio-negrinos para a obtenção de um serviço de qualidade em razão de suas especificidades e a da complexidade da gestão. / This research is a case study that analyzes the experience endured by the Federação das Organizações Indígenas do Rio Negro - FOIRN, in accord with the Fundação Nacional de Saúde - FUNASA, in the management of the system of services of health for the indigenous population of the Black river, in the Amazon, from 2002 till 2006. Interviews with key-actor using of half-structuralized questionnaires had been carried through and also analyze of documents. The results indicate a lack of coordination between the covenant parts. It was verified that the decisions on one of the covenant organizations were not transparent to the other. Also, there was no concern with the qualification in order to deal with such a complex question as the health of the indigenous inhabitants of the Black river. Still, the resources were transferred with irregularity and in insufficient amount, causing discontinuity and problems for managing the policy. One concludes that there is a long way to be covered by the organizations disposed to implement effective health policies for the indigenous people at the Black river due to its cultural uniqueness and complexity.

Health Studies / D. Litt. et Phil. (Advanced Nursing Science)