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This study used a quantitative approach to evaluate the application of the performance management and development system in the Eastern Cape Department of Health, from the perspective of employees. The evaluation report has three sections that are designed as interrelated but stand-alone documents. Section One is written as a report directed to the Eastern Cape Department of Health. Section Two is a review of the relevant literature that was conducted to review the existing literature related to the application of performance management and development systems, and underpinned the construction of the questionnaire. Section Three provides a description and justification of the design of the research, as well as describing the research procedure followed. Pertinent components of Sections Two and Three are extracted from these sections and included in the report in Section One. The literature review focused on the following areas: the purpose of performance management, components of the performance management process, challenges/ criticism of performance management systems, integration of performance management with other systems and the effectiveness of performance management system. The results revealed that about 74% of employees disagree that management is committed towards the successful application of the performance management system. This finding concurs with the literature. For example, De Waal and Counet (2009:367) argue that one of the problems in the application of performance management system is that the management lacks commitment to the implementation of a performance management system. Systematic sampling (Leedy and Ormrod, 2010) was used to select 120 participants in three Departmental programmes or clusters from grade levels six to 15. The researcher distributed the questionnaires to every fifth person of the population electronically using SurveyBob, which is an on line survey tool. The collected data was then analyzed using Excel software. The findings indicated that although overall employees are not satisfied with the application of the PMDS system in the Eastern Cape Department of Health, there were some successes. Nevertheless, the challenges outweighed successes of the system. The challenges that resulted in the failure of the system include poor communication, a lack of understanding of the system by the employees and a lack of knowledge with regards to the integration of PMDS with other initiatives and plans already in place. Page 4 There were positive views with enabling factors and these were work plans that are mutually agreed upon between the employee and their supervisors and are aligned to departmental strategic priorities. Constraining factors included the low levels of commitment of the management to the application of the PMDS processes, review meetings not being undertaken on a quarterly basis, and a lack of written outcome reviews. The majority of the study participants believe that the PMDS lacks fairness in its implementation. Recommendations were made on the basis of the gaps that were identified so as to improve the application of the performance management system in the Eastern Cape Department of Health. It is therefore recommended that the Department should ensure that training and development of employees on the PMDS takes place to enhance manager’s understanding of the policy. This will enable managers to understand the important role played by performance management in their day to day activities. A performance management and development system needs to be integrated with all other processes to be effective. On-going communication of the PMDS policy should be considered. Accountability of managers to the Accounting Officer and submission of quarterly reports are imperative to ensure their compliance. In conclusion, dissatisfaction outweighs satisfaction of the employees with regards to the implementation of the PMDS system.

In an effort to bridge the gap between public health practice and academia, the Health Resources and Services Administration (HRSA)-funded Tennessee Public Health Training Center (LIFEPATH) has supported establishment of an Academic Health Department (AHD) involving the East Tennessee State University (ETSU) College of Public Health (COPH) and the Sullivan County Regional Health Department (SCRHD). The SCRHD identified a need to increase internal capacity to conduct ongoing community health assessments and community-oriented practice. Similarly, the COPH recognized the need to expand field-based public health practice opportunities for students. Personnel from SCRHD, LIFEPATH, and COPH developed a formal AHD memorandum of understanding during the summer of 2012, launching the program in fall 2012. The COPH/SCRHD model addresses financial barriers experienced by other AHDs by competitively awarding the Coordinator position to a Doctor of Public Health (DrPH) student from the COPH, demonstrating investment in the model by the COPH. The DrPH student gains valuable leadership experience through project management, coordination of the local health council, and day-to-day facilitation of undergraduate and master's student interns. SCRHD benefits from formally trained graduate-level interns dedicated to long-term work within the community. This AHD offers a unique opportunity for doctoral-level students to develop practical leadership skills in a functioning health department, while enhancing the capacity of SCRHD and COPH to serve their community and stakeholders.

Foodborne illness is a serious and preventable public health problem affecting 1 in 6 Americans with cost estimates over $50 billion annually. Local health departments license and inspect restaurants to ensure food safety and respond to reports of suspected foodborne illness. The City of St. Louis Department of Health adopted the HealthMap Foodborne Dashboard (Dashboard), a tool that monitors Twitter for tweets about food poisoning in a geographic area and allows the health department to respond. We evaluated the implementation by interviewing employees of the City of St. Louis Department of Health involved in food safety. We interviewed epidemiologists, environmental health specialists, health services specialists, food inspectors, and public information officers. Participants viewed engaging innovation participants and executing the innovation as challenges while they felt the Dashboard had relative advantage over existing reporting methods and was not complex once in place. This study is the first to examine practitioner perceptions of the implementation of a new technology in a local health department. Similar implementation projects should focus more on process by developing clear and comprehensive plans to educate and involve stakeholders prior to implementation.

Esta pesquisa apresenta um novo conceito de comunicação: a comunicação terapeutizante. O novo termo é fruto da investigação da aplicabilidade das tecnologias de comunicação em rádio vivenciadas pelos usuários da saúde mental, participantes do Projeto Maluco Beleza, localizado no Serviço de Saúde Dr. Cândido Ferreira, na cidade de Campinas, interior de São Paulo. A comunicação terapeutizante tem demonstrado ser uma importante ferramenta de (re)significação de sentido de vida para os portadores de sofrimento mental inseridos no projeto de comunicação do Ponto de Cultura Maluco Beleza. Após participarem do projeto, os usuários se capacitam para a comunicação, para expressarem suas ideias por meio do rádio. Esse processo os incentiva a retomarem as redes de conexão que estavam esquecidas, ou não acionadas, e restabelecerem novos meios de convívio social, dentro do contexto de Reforma Psiquiátrica pelo qual passa a instituição pesquisada. A pesquisa tem como objetivo a investigação da nova possibilidade de comunicação aplicada, como dispositivo aos cuidados da saúde mental alternativa e complementar. O recurso comunicacional, disponibilizado no Projeto Maluco Beleza, representa uma forma de ressarcimento do direito de expressão, que, por longos anos, foi negado aos portadores de sofrimento mental, confinados nos pátios dos manicômios e privados dos direitos fundamentais para a construção de uma vida minimamente digna. A comunicação empregada nos programas produzidos para a veiculação na Rádio Educativa de Campinas e na Rádio Maluco Beleza online, revela uma alternativa complementar à rede de cuidados aos usuários da saúde mental, com efeitos terapeutizantes na vida dos participantes, que, na maioria das vezes, retomam eixos norteadores de suas vidas, num processo de (re)significação de suas trajetórias. A pesquisa é legitimada pela narração do saber militante do pesquisador implicado nesse processo, por meio da utilização da metodologia cartográfica. A cartografia, aplicada na vida de uma das participantes do projeto, revelou a importância que a comunicação possui em sua história. Outros participantes do projeto, como usuários, funcionários e pessoas da comunidade, também colaboraram com depoimentos que corroboram para os efeitos terapeutizantes dessa nova aplicabilidade de comunicação, por meio da retomada do sentido e da (re)significação de vida, que se dá pela comunicação. / This research features a new communication concept: the therapeutic communication. This new term is a result of the investigation of the applicability of radio communication technologies experienced by mental health patients also called as users that are participants in the Maluco Beleza Project, located in the Dr. Cândido Ferreira Health Department, in Campinas, São Paulo. The therapeutic communication has proven to be an important tool for giving, once again, meaning of life to mental patients that are participants in the Ponto de Cultura Maluco Belezas communication project. After participating, the users are trained to communicate and express their ideas through radio broadcast. This process encourages them to resume the network connections that were forgotten, or not activated, and re-establish new ways of social interaction inside the context of psychiatric reform which institution is going through. The researchs goal is to investigate this new possibility of communication used as a device to an alternative and complementary mental health care. The communication resource, available at the Maluco Beleza Project, represents a way to compensate the lack freedom of speech that for many years was denied to mental patients, who were confined in mental hospitals courtyards and who had their fundamental rights to build a dignified life taken away. The communication used in the programs produced for broadcasting on Radio Educativa de Campinas (local radio station) and Maluco Beleza online (online radio station), reveals a complementary alternative to the mental user health cares network with therapeutic effects in participants\' lives, which in most cases, incorporate guiding principles for their lives, a process of giving them new meanings. The research is legitimized by the knowledge description given by the militant researcher involved in this process through the mapping methodology. The mapping, applied in one of the participants life showed the importance that communication has in his history. Other project participants, such as users, staff and people from the community, also cooperated with statements that support this new communications therapeutic effects applicability, through the resumption of giving meaning and new meanings of life, given by communication.

In July 1980, the Barren River District Health Department (BRDHD), serving eight counties (combined population approximately 204,000) in Southcentral Kentucky, was selected as a demonstration site under the auspices of the federal Health Education Risk Reduction (HERR) Program. With continued HERR funding for eight years, the BRDHD developed several successful health promotion projects. Major components of these projects include: 1) community health promotion, which serves to identify high -risk groups in the community and provide them with health education-health promotion services, 2) school health education which included the development of a preschool health education curriculum, 3) teacher education workshop, which instructs primary and secondary public school teachers in health education methods, 4) smoking cessation. and 5) a large industrial wellness program. This study reports on an eight year program evaluation of the HERR demonstration. Overall, the program evaluation suggests an increase in health knowledge and some attitude and behavior change for many of the participants ii BRDHD programs.

Esta pesquisa apresenta um novo conceito de comunicação: a comunicação terapeutizante. O novo termo é fruto da investigação da aplicabilidade das tecnologias de comunicação em rádio vivenciadas pelos usuários da saúde mental, participantes do Projeto Maluco Beleza, localizado no Serviço de Saúde Dr. Cândido Ferreira, na cidade de Campinas, interior de São Paulo. A comunicação terapeutizante tem demonstrado ser uma importante ferramenta de (re)significação de sentido de vida para os portadores de sofrimento mental inseridos no projeto de comunicação do Ponto de Cultura Maluco Beleza. Após participarem do projeto, os usuários se capacitam para a comunicação, para expressarem suas ideias por meio do rádio. Esse processo os incentiva a retomarem as redes de conexão que estavam esquecidas, ou não acionadas, e restabelecerem novos meios de convívio social, dentro do contexto de Reforma Psiquiátrica pelo qual passa a instituição pesquisada. A pesquisa tem como objetivo a investigação da nova possibilidade de comunicação aplicada, como dispositivo aos cuidados da saúde mental alternativa e complementar. O recurso comunicacional, disponibilizado no Projeto Maluco Beleza, representa uma forma de ressarcimento do direito de expressão, que, por longos anos, foi negado aos portadores de sofrimento mental, confinados nos pátios dos manicômios e privados dos direitos fundamentais para a construção de uma vida minimamente digna. A comunicação empregada nos programas produzidos para a veiculação na Rádio Educativa de Campinas e na Rádio Maluco Beleza online, revela uma alternativa complementar à rede de cuidados aos usuários da saúde mental, com efeitos terapeutizantes na vida dos participantes, que, na maioria das vezes, retomam eixos norteadores de suas vidas, num processo de (re)significação de suas trajetórias. A pesquisa é legitimada pela narração do saber militante do pesquisador implicado nesse processo, por meio da utilização da metodologia cartográfica. A cartografia, aplicada na vida de uma das participantes do projeto, revelou a importância que a comunicação possui em sua história. Outros participantes do projeto, como usuários, funcionários e pessoas da comunidade, também colaboraram com depoimentos que corroboram para os efeitos terapeutizantes dessa nova aplicabilidade de comunicação, por meio da retomada do sentido e da (re)significação de vida, que se dá pela comunicação. / This research features a new communication concept: the therapeutic communication. This new term is a result of the investigation of the applicability of radio communication technologies experienced by mental health patients also called as users that are participants in the Maluco Beleza Project, located in the Dr. Cândido Ferreira Health Department, in Campinas, São Paulo. The therapeutic communication has proven to be an important tool for giving, once again, meaning of life to mental patients that are participants in the Ponto de Cultura Maluco Belezas communication project. After participating, the users are trained to communicate and express their ideas through radio broadcast. This process encourages them to resume the network connections that were forgotten, or not activated, and re-establish new ways of social interaction inside the context of psychiatric reform which institution is going through. The researchs goal is to investigate this new possibility of communication used as a device to an alternative and complementary mental health care. The communication resource, available at the Maluco Beleza Project, represents a way to compensate the lack freedom of speech that for many years was denied to mental patients, who were confined in mental hospitals courtyards and who had their fundamental rights to build a dignified life taken away. The communication used in the programs produced for broadcasting on Radio Educativa de Campinas (local radio station) and Maluco Beleza online (online radio station), reveals a complementary alternative to the mental user health cares network with therapeutic effects in participants\' lives, which in most cases, incorporate guiding principles for their lives, a process of giving them new meanings. The research is legitimized by the knowledge description given by the militant researcher involved in this process through the mapping methodology. The mapping, applied in one of the participants life showed the importance that communication has in his history. Other project participants, such as users, staff and people from the community, also cooperated with statements that support this new communications therapeutic effects applicability, through the resumption of giving meaning and new meanings of life, given by communication.

Nos últimos 40 anos, o modelo de atenção em saúde mental sofreu profundas modificações, sendo que desde a década de 70 diversos movimentos sociais e profissionais impulsionaram a Reforma Psiquiátrica e o processo de desinstitucionalização. Este, pregava o fim do modelo asilar vigente, responsável pela exclusão e cronificação de doentes, para dar lugar a criação de um novo modelo guiado por serviços extra-hospitalares e mais humanitários, tendo como principal representante os Centros de Atenção Psicossocial (CAPS). Esses serviços foram considerados a porta de entrada da rede de atenção à saúde mental e tem como responsabilidade estabelecer iniciativas conjuntas de levantamento de dados relevantes sobre os principais problemas e necessidades de saúde mental no território. Para tanto, necessitam de uma forma de coletar, armazenar e disponibilizar esses dados, de modo a gerar informações que possam auxiliar no processo de gestão e tomada de decisão, para garantir a qualidade do cuidado prestado. A entrada de dados e obtenção dessas informações poderiam ser feitas por meio de um sistema eletrônico, no entanto, percebe-se a ausência de sistema de armazenamento e manipulação de dados com informações técnicas e gerenciais acerca da saúde mental no Sistema Único de Saúde (SUS) e a carência de instrumentos de avaliação e de indicadores para aferir a efetividade do serviço prestado, inclusive no Departamento Regional de Saúde XIII do Estado de São Paulo (DRS XIII), que é o foco desse projeto. Dessa maneira, torna-se necessário o desenvolvimento de um sistema informatizado, que auxilie os CAPS dessa região nessa coleta e armazenamento de dados e na geração de indicadores e relatórios que se mostrem eficazes para a melhoria do serviço como um todo. Dessa forma, no presente projeto, como resultados foram descritos os fluxos de atendimento pelo qual é submetido o paciente em cada CAPS do DRS XIII, foram analisados alguns instrumentos de coleta de dados utilizados pelos mesmos, como o projeto terapêutico e a entrevista psicossocial e ainda, visando melhorar futuramente o armazenamento de dados no sistema, foram feitas sugestões para representação de conceitos na área de saúde mental por meio de arquétipos no padrão openEHR. Além disso, o sistema web foi desenvolvido e está em fase de testes. / In the last 40 years, the mental health care system has undergone profound changes, and since the 70s, various social and professional movements boosted the psychiatric reform and the deinstitutionalization process. This, preached the end of the current asylum model, responsible for the exclusion and chronicity of patients, and made way for a new model driven by more humanitarian outpatient services, wherein the main representatives were the Community Mental Health Services (Centros de Atenção Psicossocial, CAPS). These services are considered the entrance to the mental health network and they have the responsibility for establishing joint initiatives for data collection on key issues and on mental health needs in the territory. To achieve this, they need a way to collect, store and make this data available in order to generate information that can assist in the management and in the decision making process, ensuring the quality of care provided. The data entry and the obtainment of this information could be made through an electronic system, however, we can notice the absence of a system to store and manipulate technical and managerial information about mental health in the Unified Health System (Sistema Único de Saúde, SUS). In addition, there is a lack of assessment tools and indicators to measure the effectiveness of the services, including in the XIII Regional Health Department of the São Paulo State (Departamento Regional de Saúde XIII, DRS XIII), which is the focus of this project. In this way, it becomes necessary to develop a computerized system, which would help CAPS from that region in the data collection and storage of relevant information and in the generation of indicators and reports that may be effective to improve the network as a whole. In this dissertation, as an initial process for the creation of the system, the study of the flow of care a patient is subjected in each CAPS from the DRS XIII is described. Besides that, is also described the study of data collection instruments used by them, such as the therapeutic project and psychosocial interview. Finally, aiming to improve future data storage in the system, suggestions are made for the representation of concepts in the mental health area through archetypes in the openEHR standard.

Nos últimos 40 anos, o modelo de atenção em saúde mental sofreu profundas modificações, sendo que desde a década de 70 diversos movimentos sociais e profissionais impulsionaram a Reforma Psiquiátrica e o processo de desinstitucionalização. Este, pregava o fim do modelo asilar vigente, responsável pela exclusão e cronificação de doentes, para dar lugar a criação de um novo modelo guiado por serviços extra-hospitalares e mais humanitários, tendo como principal representante os Centros de Atenção Psicossocial (CAPS). Esses serviços foram considerados a porta de entrada da rede de atenção à saúde mental e tem como responsabilidade estabelecer iniciativas conjuntas de levantamento de dados relevantes sobre os principais problemas e necessidades de saúde mental no território. Para tanto, necessitam de uma forma de coletar, armazenar e disponibilizar esses dados, de modo a gerar informações que possam auxiliar no processo de gestão e tomada de decisão, para garantir a qualidade do cuidado prestado. A entrada de dados e obtenção dessas informações poderiam ser feitas por meio de um sistema eletrônico, no entanto, percebe-se a ausência de sistema de armazenamento e manipulação de dados com informações técnicas e gerenciais acerca da saúde mental no Sistema Único de Saúde (SUS) e a carência de instrumentos de avaliação e de indicadores para aferir a efetividade do serviço prestado, inclusive no Departamento Regional de Saúde XIII do Estado de São Paulo (DRS XIII), que é o foco desse projeto. Dessa maneira, torna-se necessário o desenvolvimento de um sistema informatizado, que auxilie os CAPS dessa região nessa coleta e armazenamento de dados e na geração de indicadores e relatórios que se mostrem eficazes para a melhoria do serviço como um todo. Dessa forma, no presente projeto, como resultados foram descritos os fluxos de atendimento pelo qual é submetido o paciente em cada CAPS do DRS XIII, foram analisados alguns instrumentos de coleta de dados utilizados pelos mesmos, como o projeto terapêutico e a entrevista psicossocial e ainda, visando melhorar futuramente o armazenamento de dados no sistema, foram feitas sugestões para representação de conceitos na área de saúde mental por meio de arquétipos no padrão openEHR. Além disso, o sistema web foi desenvolvido e está em fase de testes. / In the last 40 years, the mental health care system has undergone profound changes, and since the 70s, various social and professional movements boosted the psychiatric reform and the deinstitutionalization process. This, preached the end of the current asylum model, responsible for the exclusion and chronicity of patients, and made way for a new model driven by more humanitarian outpatient services, wherein the main representatives were the Community Mental Health Services (Centros de Atenção Psicossocial, CAPS). These services are considered the entrance to the mental health network and they have the responsibility for establishing joint initiatives for data collection on key issues and on mental health needs in the territory. To achieve this, they need a way to collect, store and make this data available in order to generate information that can assist in the management and in the decision making process, ensuring the quality of care provided. The data entry and the obtainment of this information could be made through an electronic system, however, we can notice the absence of a system to store and manipulate technical and managerial information about mental health in the Unified Health System (Sistema Único de Saúde, SUS). In addition, there is a lack of assessment tools and indicators to measure the effectiveness of the services, including in the XIII Regional Health Department of the São Paulo State (Departamento Regional de Saúde XIII, DRS XIII), which is the focus of this project. In this way, it becomes necessary to develop a computerized system, which would help CAPS from that region in the data collection and storage of relevant information and in the generation of indicators and reports that may be effective to improve the network as a whole. In this dissertation, as an initial process for the creation of the system, the study of the flow of care a patient is subjected in each CAPS from the DRS XIII is described. Besides that, is also described the study of data collection instruments used by them, such as the therapeutic project and psychosocial interview. Finally, aiming to improve future data storage in the system, suggestions are made for the representation of concepts in the mental health area through archetypes in the openEHR standard.

Background: Policy, systems and environmental (PSE) approaches can sustainably improve opportunities for healthy eating (HE) and active transportation (AT). PSEs require cross-sector collaboration. Adopting and implementing PSEs is complex and not well understood. Methods: First, using a national probability survey dataset of US local health departments (LHD), inclusion of HE and AT PSE strategies in local community health improvement plans (CHIPs) was examined. Next, a content analysis of current CHIP documents provided data for multilevel latent class analyses to identify classes of CHIPs based on patterns of PSE-strategy alignment with six key activities that facilitate change. Lastly, semi-structured interviews informed a qualitative exploration of early stage Complete Streets policy implementation in Worcester, Massachusetts. Results: Less than half of US LHDs reported developing a CHIP containing any HE policy (32%) or AT (46%) strategies. Two classes of CHIPs were identified: CHIPs in Class A (HE: 71%; Physical Activity (PA): 79%) simply identified a PSE solution; Class B CHIPs (HE: 29%; PA 21%) mostly included PSE strategies that comprehensively addressed multiple key activities. Six themes emerged as factors for early Complete Streets implementation. Conclusions: This mixed methods study provides a novel understanding of the status, development and implementation of PSE strategies in relation to collaborative strategic health improvement planning efforts. CHIPs are underutilized to promote PSE strategies and few CHIPs in our study developed strategies that comprehensively address the process of PSE-change. Among other factors, CHIPs may provide a guiding structure for policy adoption and implementation.