This dissertation focuses on the findings of a multi-case study centered around two public-private partnership (P3s) projects in Ontario: the Royal Ottawa Hospital and the Brampton Civic Hospital. Partnerships have become particularly important as a part of infrastructure procurement for all levels of government in Canada. While infrastructure public-private partnerships have grown in popularity, they remain a controversial means of procuring public assets. Considerable questions remain as to whether the mechanisms related to partnerships with the private sector represent a sufficient response to the challenges facing health care systems. As such, major avenues exist for contributions in the form of evidence-based examinations to the field of knowledge pertaining to hospital procurement. A body of research literature and review of public-private partnerships, including those with a particular focus on health-sector projects in Canada, has grown over the past two decades. This study contributes an analysis of the relationship between public and private partners to that literature, utilizing a conceptual lens developed out of complex evolutionary systems theory. The study is intended to examine the capacity of public managers entering into a public-private partnership arrangement to successfully activate agents and utilize the skill and knowledge of these agents, conduct joint fact finding and consensus building, and better understand how they have arranged and organized joint interactions between the public and private sector. The two case studies demonstrate the key inputs into the decision-making processes for what were formative health infrastructure partnership projects in Ontario, providing an assessment of the degree to which the government of Ontario was successful in managing a cooperative decision-making process that stressed inclusion and horizontal steering. Results find that public managers struggled in some ways to leverage an effective horizontal management style and engage in smart interventions to utilize expert knowledge to address knowledge gaps, contributing to stagnating negotiations and driving up transaction costs for the projects. Some noteworthy successes were experienced in the case of the Royal Ottawa Hospital in leveraging private-sector knowledge to develop performance metrics, and the approach to stakeholder engagement in this case presents positive lessons-learned for future P3 infrastructure projects.

<p>Public health infrastructure (PHI) serves as the core foundation for essential public health and its services. However, the U.S. PHI has been weakened by understaffing, underfunding, limited resources and partnerships, and outdated data and information systems over the past few decades. The recent COVID-19 pandemic exacerbated its vulnerability and weakened nature, resulting in increased health disparities and worse health outcomes in general for the nation. The goal of this study was to identify elements of local PHI that are associated with the completion of 20 key public health activities while adjusting for state differences. Cross-sectional secondary data were acquired and linked from two national surveys of local health departments, the National Profile of Local Health Departments survey and the National Longitudinal Survey of Public Health Systems. In total, 20 multivariable logistic regression models were created to analyze the relationships between variables. State fixed effects were used in multivariable models to control for state differences. It was found that state differences affected the correlations of infrastructure variables. Several staffing elements, abilities to provide certain services, and participation in certain types of actions were strongly correlated with the completion of best practice activities. These findings will add to the discussion of what the minimum necessary elements of PHI may be.</p>

In 2010 Medicaid financed approximately 48% of all births in the United States and nearly 30% of all births in Virginia. Due to strict state-specific eligibility criteria, many low-income women qualify for Medicaid coverage exclusively as a result of pregnancy status. As the nation moves forward with the Patient Protection and Affordable Care Act (PPACA), state-elected Medicaid expansion has the potential to expand services to women of reproductive age that would precede pregnancy events and offer continuous access to care postpartum. Despite this potential influx of newly insured women, little is known about how this population may make decisions regarding reproductive healthcare services and if these selections influence process and outcome measures. This study examines two research aims that provide insight into these knowledge gaps. First, utility theory and discrete choice modeling is used to examine clinic and patient level factors associated with clinic type choice. Specifically, this study examines the role of high risk pregnancy status and travel distance to clinic as associated with clinic selection. Second, Donabedian’s Structure, Process, Outcome framework provides a conceptual lens to examine if clinic selection is associated with maternal and infant measures. The linear probability model and logistic regression models are employed to examine two process measures, including prenatal care inadequacy and postpartum visit nonattendance, and three outcome measures including maternal long acting reversible contraceptive method (LARC) use and infant birthweight and gestational age. Results examining clinic type selection reveal significant associations between independent and dependent variables. Women experiencing a high risk pregnancy are significantly more likely to select a hospital based clinic for care, compared to women experiencing a normal risk pregnancy. However, when specifically examining women experiencing their first pregnancy, this association is no longer significant. Additionally, as distance to clinic type increase, women are significantly less likely to select that clinic type for prenatal care. Clinic selection was found to be significantly associated with maternal measures, but not significantly associated with infant outcomes. Selecting a public health department or Federally Qualified Health Center for prenatal care services was associated with a significant decrease in inadequate prenatal care, postpartum visit nonattendance, and non-LARC use compared to a private physician office. Clinic type selection, however, was not found to be significantly associated with infant outcomes including preterm birth and low birthweight babies. Results from Research Aim 1 have a variety of implications for clinic and public policy and offer guidance for future research. Clinics that seek to provide care to pregnant Medicaid beneficiaries should examine local residential patterns of current and potential future pregnant Medicaid recipients and consider how these might affect decisions about future clinic locations. Results suggest that women are more likely to attend clinic types closer to their area of residence, and this close proximity may have additional implications beyond shorter travel time to clinic including the minimization of transportation and childcare issues. Results from Research Aim 2 analyses offer a variety of public policy implications and guidance for future research. This research provides evidence that public health facilities including public health departments and FQHCs have improved prenatal care adequacy and postpartum visit attendance compared to private physician offices, providing evidence that public funding should continue for these facility types. As the United States moves forward with PPACA, healthcare organization administration should turn to the public facilities in their communities to learn how to manage and improve the health of these patient populations and ultimately aim to improve access and quality care among the nation’s most vulnerable populations.

Magister Economicae - MEcon / Knowledge is recognised as a crucial resource in the knowledge-based economy; and it is believed to drive sustainable success in organizations. Knowledge management (KM) helps organizations identify, create, organize, distribute and transfer vital knowledge among employees within and across organizations. The underlying premise is that good KM leads to efficiency and effectiveness, which in turn, influences the total performance in an organization. Therefore, this study investigates the role of KM practices as they relate to projects in a South African government organisation. The problem was dwelt with by establishing research questions and objectives. In order to answer the research questions, a literature search was conducted in the area of KM to establish the KM enablers, barriers, and processes known to facilitate or hinder successful KM in organizations. This led to the identification of five enablers, including organizational culture, structure, technology, strategy and leadership, as well as the resources believed to be fundamental in the success of KM practices. Barriers to KM were identified as individual, organizational and technological. The study established four KM processes: acquisition, conversion, application and protection that were found to concur with good KM practices. A conceptual model was developed around these areas. The model assisted in developing qualitative and quantitative questions. In order to investigate the proposed research questions, the study identified a single directorate within the department of public works that is directly involved with the delivery of health infrastructure. The methodology used, which was mainly qualitative research, was conducted by using multiple-data evidences, namely: semi-structured interviews, document review; these were sourced from primary and secondary sources, as well as similar organizational best practices in KM. A total of nine interviews were conducted with individuals in managerial positions. A total of 7 of the 30 e-mailed questionnaires were completed and the data were used to supplement the qualitative data. This study used the Content-Analysis Technique approach to analyse the text data obtained from the interviews. It was established that successful KM implementation requires the promotion of an enabling environment. The results from the findings revealed that organizational culture, structure, leadership and strategy, ICT, as well as KM resources form, a foundation for the KM environment. KM processes, such as knowledge-retention, creation, capture, transfer and iv sharing, were found to be fundamental for KM practices to occur. Barriers to effective KM occurred largely due to the lack of awareness and time. To capitalize on knowledge, an organization must be prepared to balance its KM enablers and processes. The existing challenges impeding KM success should be identified and dealt with, in order to realize the KM benefits. The study, therefore, proposes a KM conceptual model to be integrated with the decision-making framework, as an implementation strategy for KM in the public sector. This would ensure an embedded knowledge-intensive environment in the Department, and hence the improvement of infrastructural delivery. This study is limited, since only a single case was used, which plainly suggests that there is a possibility that the results cannot be generalized beyond the researched organisation – without conducting any further study. It is recommended that for future research, this study be replicated through several other directorates, or even departments at various government levels (e.g. national, provincial). Also, quantitative analysis, together with qualitative analysis, should be used to create a triangulation between the two approaches.

Agriculture is the backbone of the Haitian economy and provides employment 80% employment to the Haitian population (Lundahl, 1992). Also 85% of people in rural areas generate money from agricultural activities (IFAD, 2008). In the rural areas, men and women participate in agricultural production. However, the women play a vital role in the whole process starting from land preparation to crop sale (Gaspard, 2013). The Haitian women, despite of their function in crop productions (Dor, 2016), face different health issues, which have influence over Haitian agricultural system. Therefore, the research purposed was to investigate the impact of women heath issues on agricultural production Fondwa. A qualitative case study was used to investigate ten women farmers in the community of Fondwa, which is a small farming area in southwest part of Haiti. An interview questionnaire was used for data collection. Findings of the study showed that the women's contribution to farming is vital for promoting agricultural production, and they face different health issues that are linked to the environment and water pollution. Lastly, the women health problems influence agricultural production in the Fondwa area by preventing them from doing their daily agricultural activities, which have a direct impact over family and country's income. / MSLFS / Fondwa is a small mountainous community village in the Southwest department of Haiti with a population of approximately 10,000 people. Corn, beans, and vegetables are the dominant crops in the area of Fondwa. In Fondwa, women play an important role in crop production and agricultural sale. However, these women, despite of their role in farming, face many health issues due to the lack of health infrastructure. The purpose of this study was to investigate the impact of women’s health issues on agricultural production in Fondwa. For this study, a sample of ten women from nine areas were selected for this study and these participants live in Fondwa. A qualitative method was used to conduct the research and interview questionnaire was used to gather information from the participants. The interview process was done via Skype meetings with the women. Results of the study showed that the 1) Fondwa women farmers play an important role in crop production in the community of Fondwa because they plant, harvest, and sale crops, which helps take care of their family. 2) The women have difficulty to receive healthcare service due to infrastructure problems in the community. 3) The women’s health issues are related to water and environmental issues. 4) The agricultural production in Fondwa will slow down without the women’s presence. The participants showed passion and dedication for agriculture despite of their health problems.

В 2018 году пройдет Чемпионат мира по футболу в России. Несомненно, организация такого мероприятия сопровождается не только большим уровнем затрат, но и возможностью привлечения инвестиций в города, принимающие матчи Чемпионата Мира. Задачей администрации города и правительства области становится создание условий для эффективного использования наследия Чемпионата мира. Оценкой эффективности данного наследия может стать инвестиционная привлекательность города после проведения Чемпионата мира. Попытке определить инвестиционную привлекательность спортивного мегасобытия и посвящена данная работа. / In 2018 will be the World Cup in Russia. Undoubtedly, the organization of this event is accompanied by not only a high level of cost, but also by ability to attract investment in the host cities of the World Cup matches. Creation of conditions for effective use of heritage of the World Cup becomes a problem of a city administration and the government of the region. Investment appeal of the city after holding the World Cup can become an efficiency evaluation of this heritage. This work is also devoted to attempt to determine investment appeal of a sports Mega-event.