Objetivo. Investigar as transformações ocorridas com a descentralização da política de saúde, nos municípios do Estado de São Paulo, após a implantação da Norma Operacional Básica- NOB/96, no que diz respeito a aspectos de recursos financeiros e humanos. Metodologia. O universo de estudo constituiu-se de 416 municípios, sendo 311 em condição de Gestão Plena de Atenção Básica, 90 em Gestão Plena do Sistema e 15 não habilitados nas condições da NOB/96. Foram observadas as variações ocorridas, entre 1997 e 1999, no volume, composição das fontes de recursos e tipo das despesas realizadas em saúde, e no volume, composição dos recursos humanos e existência de política de recursos humanos. Resultados. Observou-se aumento nos recursos gastos em saúde, sendo que a maior taxa correspondeu ao grupo em Gestão Plena do Sistema, que também apresentou o maior valor de despesa em saúde per capita (R$ 138, em 1999). Houve incremento no valor dos recursos próprios e federais nos municípios habilitados. Para os não habilitados ocorreu redução significativa (55 por cento) nas despesas realizadas com recursos federais e aumento nas efetuadas com recursos próprios (17 por cento). Quanto aos recursos humanos, verificou-se mudanças na quantidade e na composição do quadro de pessoal da saúde. Observou-se expansão de 15,5 por cento nos postos de trabalho em saúde das prefeituras habilitadas, sendo de 10,4 por cento para os profissionais universitários e de 19,7 por cento para os não universitários. As prefeituras em Plena do Sistema realizaram mais ações de política de recursos humanos do que aquelas em Plena da Atenção Básica, com incremento em todos os itens, destacando-se a valorização da dedicação exclusiva e a contratação por concurso público, nos municípios em Plena do Sistema, e a existência de plano de cargos e salários e concursos públicos, para aqueles em Plena da Atenção Básica Em 1999, 3 7,2 por cento das Prefeituras informaram ter tido dificuldade em contratar profissionais de saúde, sendo maior nos municípios em Gestão Plena do Sistema Predomina a dificuldade de contratar pessoal de nível universitário, especialmente médicos, enfermeiros e farmacêuticos. Entre os profissionais não universitários, a dificuldade concentra-se em pessoal de enfermagem. Conclusões. Os dados apresentados evidenciaram os efeitos do processo de descentralização da política de saúde, onde ressalta-se o maior volume de recursos financeiros gerenciados pelas prefeituras e o seu papel na geração de postos de trabalho. / Purpose. To investigate the changes taken place after the descentralization of the health policy, in the municipalities of the State of São Paulo, in the period following the implement of the Basic Operational Norm. NOB/96, concerning the aspects of financiai and human resources. Methods. The study universe consisted of 416 municipalities, of those 311 in the condition of \"Full Management of Basic Care\" (Gestão Plena da Atenção Básica), 90 in \"Full Management of the System\" (Gestão Plena do Sistema) and 15 not qualified in the conditions of the NOB/96. The variations taken place between 1997 and 1999 were verified, about the arnount, composition o f the sources o f income and type o f expenditures carried into effect in health, as well as the arnount, composition o f the human resources and the existence of a human resources policy. Results. A increase in expenses in health was verified, the biggest raise corresponding the group that was under \"Full Management of the System\". This group also presents the biggest per capita expenditure in health (R$ 138, in 1999). It occurred an increment in the value offederal and municipal avaiable resources, in the qualified cities. As for the non qualified ones it occurred a significant reduction (55 per cent) in the expenditures carried through with federal resources and an increase in those effected by means of proper resources (17 per cent). As for the human resources, changes were verified in the arnount and composition ofthe health staff. An increase of 15.5 per cent in the work positions in health arnong the qualified municipalities was verified, increasing 10.4 per cent for university degree professionals and 19.7 per cent for the non university graduated professionals. The municipalities in \"Full Managernent of the System\" accomplished the human resources policy better than those in \'\'Full Management of Basic Care \", with na increment in ali itens, notably the exclusive job dedication and new hirings by means o f public compention, in the municipalities in \"Full Management of the System\", and the existence of official wage and job prospects in addition to public competitions, for those in \"Full Management of Basic Care\". For the year 1999, 37,2 per cent of the municipalities informed to have the difficulties in contracting health professionals, being that problem worse for the municipalities in \"Full Management ofthe System\". The prevailing difficulty is to contract staff with university degreelevel, especially doctors, nurses and pharmacists. Among the non university degree professionals, the difficulty remains in contracting nursing staff. Conclusions. The data presented indicated the effect of the decentralization process in the health policy. The largert amount of financiai resources managed by the municipalities and their role in generating work positions is emphasized.

Submitted by admin tede (tede@pucgoias.edu.br) on 2017-10-19T12:30:52Z No. of bitstreams: 1 JÉSSICA LAYANNE APARECIDA PINHO MOREIRA.pdf: 3491128 bytes, checksum: 8e17052eb70613a936fe4812b2d681da (MD5) / Made available in DSpace on 2017-10-19T12:30:52Z (GMT). No. of bitstreams: 1 JÉSSICA LAYANNE APARECIDA PINHO MOREIRA.pdf: 3491128 bytes, checksum: 8e17052eb70613a936fe4812b2d681da (MD5) Previous issue date: 2017-04-03 / The research object that integrates the Master's thesis presented to the Post- Graduation Program in Social Work of the Pontifical Catholic University of Goiás is the relationship between work and outsourcing in public health, in the management model of Social Organizations (OS) adopted by the State Government of Goiás. The study, when examining the contracting / bidding implications made by the State Government of Goiás for granting the management of hospital units to the Social Organizations - OS, develops a critical approach on how outsourcing works in politics Public health, its limitations, its advances, its strategies and, mainly, it apprehends aspects of the reality and working conditions of the workers of a hospital unit. To that end, the work reality of the technical-administrative workers of the Governor Otávio Lage de Siqueira Emergency Hospital - HUGOL in Goiânia-GO was selected as the field of investigation, a unit that, since its installation in 2015, has outsourced management. The dissertation analyzes the labor relations in the public health policy in the context of the socio-historical transformations of the world of work, with a focus on outsourcing / privatization. Work and outsourcing are analyzed in the context of the neoliberal state in its socio-juridical aspects, and the historical transformations addressed in the determinations that affect outsourcing. In this sense, the world of work is metamorphosed by the logic of outsourcing. The conditions and labor relations in outsourced public health are examined, considering the strategies of the State Government of Goiás before the privatization of the management of public hospitals. In the analysis of the historical transformations of the work and the working class, the work category is prioritized as a historical and theoretical construction, and the outsourcing in the management of health policy related to labor rights. The present study compiles the examination of the working and health conditions of the outsourced worker based on the field research related to the precariousness of work, the socio-legal aspects of outsourcing and the conflicts between the legality and the illegality of the outsourcing of the final activities. The profile of the reference unit and the profile of the identified subjects in end-activities and middle-activities were considered. The study focused on the implications of outsourced management, via O.S., in a public institution, seizing the conditions of the outsourced worker, the effects of this work condition and their physical and mental health. In summary, this dissertation is part of the analysis that seeks to understand how capital responds to its structural crisis, how it works with transformations in the world of work, among them, outsourcing. The pattern of flexible accumulation characterized by the intensification and precariousness of relations and working conditions intensifies the increase in structural unemployment, subjects the worker to illegal working conditions and demands a specific, multi-skilled, passive and specialized profile. The working class is harmed both in terms of working conditions and labor rights. / O objeto de pesquisa que integra a dissertação de Mestrado apresentada ao Programa de Pós-graduação em Serviço Social da Pontifícia Universidade Católica de Goiás se configura na relação entre trabalho e terceirização na saúde pública, via modelo de gestão das Organizações Sociais (OS) adotado pelo Governo do Estado de Goiás. O estudo, ao examinar as implicações da contratação/licitação efetivada pelo Governo de Estado de Goiás para a concessão da gestão de unidades hospitalares para as Organizações Sociais – OS, desenvolve uma aproximação crítica sobre como funciona a terceirização na política social pública de saúde, suas limitações, seus avanços, suas estratégias e, principalmente, apreende aspectos da realidade e condições laborais dos trabalhadores de uma unidade hospitalar. Para tanto, foi selecionada como campo de investigação a realidade de trabalho dos trabalhadores técnico-administrativos do Hospital de Urgência Governador Otávio Lage de Siqueira – HUGOL de Goiânia-GO, unidade que, desde sua instalação, em 2015, possui gestão terceirizada. Na dissertação, são analisadas as relações de trabalho na política de saúde pública no contexto das transformações sóciohistóricas do mundo do trabalho, com foco na terceirização/privatização. O trabalho e as terceirizações são analisados no contexto do estado neoliberal em seus aspectos sociojurídicos, e as transformações históricas abordadas nas determinações que incidem sobre as terceirizações. Nesse sentido, o mundo do trabalho se encontra metamorfoseado pela lógica das terceirizações. Examinam-se as condições e as relações de trabalho na saúde pública terceirizada, considerando as estratégias do Governo do Estado de Goiás frente à privatização da gestão dos hospitais públicos. Na análise das transformações históricas do trabalho e da classe trabalhadora, prioriza-se a categoria trabalho como uma construção histórica e teórica, e a terceirização na gestão da política de saúde relacionada aos direitos trabalhistas. Compõe o presente estudo o exame das condições de trabalho e de saúde do trabalhador terceirizado a partir de pesquisa de campo relacionada à precarização do trabalho, aos aspectos sociojurídicos da terceirização e aos conflitos entre a legalidade e a ilegalidade da terceirização das atividades-fim. Foram considerados o perfil da unidade de referência e o perfil dos sujeitos identificados em atividades-fim e atividades-meio. O estudo incidiu sobre as implicações da gestão terceirizada, via O.S., em uma instituição pública, apreendendo as condições laborais do trabalhador terceirizado, os efeitos dessa condição de trabalho e a sua saúde física e mental. Em síntese a presente dissertação se inscreve no campo das análises que visam apreender o modo como o capital responde à sua crise estrutural, como opera com transformações no mundo do trabalho, entre essas, a terceirização. O padrão de acumulação flexível, caracterizado pela intensificação e a precarização das relações e condições de trabalho, intensifica o aumento do desemprego estrutural, submete o trabalhador a condições de trabalha ilegais e deles exige um perfil específico, polivalente, multiprofissional, passivizado e especializado. A classe trabalhadora é lesada tanto com relação às condições de trabalho quando aos direitos trabalhistas.

Esse trabalho apresenta a relação estabelecida entre os atores sociais envolvidos no campo da saúde em Porto Alegre, ao longo das décadas de oitenta e noventa. O estudo focou, especificamente, a relação entre (a) lideranças do movimento popular e dos usuários do Sistema Único de Saúde (SUS) das regiões Glória Cruzeiro e Cristal (b) profissionais e trabalhadores em saúde da área de planejamento da gerência distrital Glória/Cruzeiro/Cristal (GD5) e (c) gestores públicos municipais. Procurou-se verificar quais os fatores que determinaram a ação governamental nas regiões que compõem a GD5, a partir da (a) organização popular e participação, (b) existência de uma policy community reformista regional na área da saúde e (c) sensibilidade e resposta política dos gestores municipais. Para isso realizou-se um estudo qualitativo, baseado em entrevistas e análise documental. A utilização dessa abordagem permitiu identificar a forma peculiar como os atores sociais foram constituindo estratégias de lutas, disputas, conflitos e negociações no campo da saúde que resultaram em ampliação e melhoria dos bens e serviços disponíveis nas regiões da GD5. / This work presents the relationship established between social actors in health area in Porto Alegre, during the eighties e nineties. The study focuses, specifically, the relationship between (a) popular movement's leaderships and the Sistema Único de Saude's users from the region Glória Cruzeiro e Cristal, (b) health workers of the area covered by gerência distrital Glória/Cruzeiro/ Cristal (GD5) and (c) public managers. To do that, one tried to check the possible reasons why determined the government action in the GD5, in term of(a) intensity of organization and popular participation, (b) existence o f a reformist and regional po licy community in that medical area and (c) responsiveness of public managers municipal. To do so, one accomplished a qualitative study, based on interviews and analysis of documents. This approach, made possible identified the peculiar way these agents were constructing strategies of fights, disputes, conflicts and negotiations in the medical area that end up widening and improving the health services available in the regions of GDS.

Orientador: Maria Teresa Miceli Kerbauy / Banca: Ruy Sardinha Lopes / Banca: Maximiliano Martin Vicente / Resumo: A compreensão das mudanças na sociedade contemporânea passa pela leitura dos fenômenos e práticas comunicacionais. Portanto, pensar a sociabilidade é entender como o campo comunicativo com suas lógicas e práticas afetam as relações sociais. Nesse sentido, a presente pesquisa apresenta contribuições conceituais e metodológicas, a partir de estudo de caso exploratório, sobre essa relação constitutiva da comunicação com as experiências participativas representadas nos conselhos gestores de políticas públicas - espaços que se consolidam na cena democrática brasileira, a partir da redemocratização. O estudo da natureza e dos fluxos informativos, bem como o do modelo e práticas de comunicação no contexto do Conselho Estadual de Saúde de Mato Grosso do Sul na perspectiva da Comunicação Pública, procura discutir como os protocolos comunicativos entre Estado e a Sociedade acompanham a consolição da configurada democracia participativa no Brasil. Além disso, pontua-se os desafios teórico-epistêmico e normativos para o campo da Comunicação Pública em meio a esse cenário de demanda por poarticipação na formulação, implementação e avaliação das políticas públicas. As possibilidades de pensar as políticas de comunicação para o controle e participação da gestão pública presumem considerar as práticas comunicativas em uma perspectiva crítica e constitutiva diante do campo político e, particularmente, fortalecer a compreensão da comunicação como mais uma dimensão interdependente de análise das experiências participativas / Abstract: The coprehension of the changes in the contemporaru society passes through the reading of communication phenomena and practices. However, thinking the sociability is understanding how the communicative field with its logics and pratices affect the social relationship. In this sense, the current research presents conceptual and methodological contributions, from a exploratory case study, about this constitutive relationship of the communication with the participative experiences represented in the management councils of public policies - spaces which are consolidated in the Brazilian democratic scene, from the redemocratization. The study of the nature and informative fluxes, as well as the patern and practices of communication in the context of the State Health Council from Mato Grosso do Sul in the perspective of Public Communication, tries to discuss how the communicative protocols between States and Society accomphish the consolidation of the configured participative democracy in Brazil. Besides, highlight the theoretical-epistemic and normative challenges to the Public Communication field in this scenery of demand for participation in the formulation, implementation and evaluation of the public policies. The possibilities of thinking the communication policies for the control and participation of public management assume to considerate the communicative pratices in a critical and constitutive perspective related to the politic field and, privately, to strenghten the comprehension of the communication as one more interdependent dimension of the analyses of participative experiences / Mestre

The purpose of this thesis is to ethnographically explore the social life of health reform policy. This thesis focuses on the Ponce Center, a safety net HIV clinic in Atlanta. The thesis engages with a fragmented healthcare world, and the inhabitants of these worlds who are charged with rectifying the fragmentation and make care possible. They are, in technical language, service providers, whether they are policy-makers, patients, or political activists. In order to make the healthcare and policy worlds functional, the AIDS community in Atlanta perceive their first task as attempting to connect aspects of the fragmented healthcare assemblage that are otherwise disparate. The core theme of this thesis is articulations, translations, and piecing together aspects of everyday life particularly with regard to various ways of contending with fragmentation. This thesis explores the relationship between the affective, ideological, physical and structural dynamics of inequality, poverty, vulnerability, identity, and a sense of community and belonging. This thesis is about the policy processes. It does not focus on policy-making, but policy interpretation, implementation, and enactment in Atlanta, Georgia. The thesis tracks the appropriation and contestation of the Affordable Care Act (ACA) as a site of interaction between the experience of HIV as a pre-existing condition, inequitable access to treatment through health insurance, and larger social policy and poverty discourses. Finally, it considers the processes by which major policy reforms draw in disparate actors, who are embedded in complex networks of power and resource relations - assemblages - and inevitably play a role in reshaping society.

abstract: The biohacker movement is an important and modern form of activism. This study broadly examines how positive-activist-oriented biohackers emerge, organize, and respond to social crises. Despite growing public awareness, few studies have examined biohacking's influence on prevailing notions of organizing and medicine in-context. Therefore, this study examines biohacking in the context of the 2016 EpiPen price-gouging crisis, and explores how biohackers communicatively attempted to constitute counter-narratives and counter-logics about medical access and price through do-it-yourself (DIY) medical device alternatives. Discourse tracing and critical case study analysis are useful methodological frameworks for mapping the historical discursive and material logics that led to the EpiPen pricing crisis, including the medicalization of allergy, the advancement of drug-device combination technologies, and role of public health policy, and pharmaceutical marketing tactics. Findings suggest two new interpretations for how non-traditional forms of organizing facilitate new modes of resistance in times of institutional crisis. First, the study considers the concept of "pop-up maktivism" to conceptualize activism as a type of connective activity rather than collective organizing. Second, findings illustrate how activities such as participation and co-production can function as meaningful forms of institutional resistance within dominant discourses. This study proposes “mirrored materiality” to describe how biohackers deploy certain dominant logics to contest others. Lastly, implications for contributions to the conceptual frameworks of biopower, sociomateriality, and alternative organizing are discussed. / Dissertation/Thesis / Doctoral Dissertation Communication 2019

The following paper explores the relationship between the tobacco industry and the United States government. Through an extensive literature review, I conclude that the government is perpetuating the tobacco crisis in the United States by aligning their policymaking actions with the interests of the industry in exchange for receiving campaign support. I find that the primary method of support the industry provides is through monetary contributions, essentially bribing legislators to assist them on tobacco control regulations. I argue that this mode of persuasion is most effective because the tobacco industry is appealing to the egos of the legislators by bolstering their finances which in turn greatly enables them to sustain their power in office. For future research, I recommend analyzing this relationship regarding the rising trend of e-cigarettes and vaping, especially among adolescents.

This study examined if physician assistants (PAs) are cost-beneficial to employers. In an era of cost accountability, questions arise about whether a visit to a PA for an episode of care differs from a visit to a physician, and if PAs erode their cost-effectiveness by the manner in which they manage patients. Four common acute medical conditions seen by PAs and physicians within a large health maintenance organization were identified to study. An episode approach was undertaken to identify all laboratory, imaging, medication and provider costs for these diagnoses. Over 12,700 medical office visits were analyzed and assigned to each type of provider and medical department. Patient variables included age, gender, and health status. A multivariate analysis identified significant cost differences in each cohort of patients. In every condition managed by PAs, the total cost of the visit was less than that of a physician in the same department. This was significant for episodes of shoulder tendinitis, otitis media, and urinary tract infections. In no instance were PAs statistically different from physicians in use of laboratory and imaging costs. In each instance the total cost of the episode was less when treated by a PA. Sometimes PAs ordered fewer laboratory tests than physicians. There were no differences in the rate of return visits for a diagnosis between physicians and PAs. Patient differences were held constant for age, gender, and health status. This study affirms that PAs are not only cost-effective from a labor standpoint but are also cost-beneficial to those who employ them. In most cases, they order resources for diagnosis and treatment in a manner similar to physicians for an episode of care, but the cost of an episode of an illness is more economical overall when the P A delivers the care. This study validates the federal policy of support for primary care P A education and suggests that PA employment should be expanded in many sectors of the health care system. These findings and the results of this cost-benefit model are evidence of its validity in predicting health care costs.

Thesis (MPH) --University of Limpopo, 2011 / Since 1994, the post apartheid government and the Department of Health have developed and implemented a number of policies and pieces of legislation that impacted directly and indirectly on the delivery of health services such as the general public health, health personnel, financial matters, transportation of medicines and foodstuffs. These policies were timeously received by the hospitals from National Office, Provincial Departments and Local Government, but were not implemented due to numerous challenges. This study explores the health policy implementation challenges facing implementers in the public health sector in the Capricorn district in Limpopo that constrain them from rendering their managerial functions effectively and thus, impact negatively on policy implementation and service delivery. The objective of the study is to explore the challenges with a view of describing the nature and causes of the challenges, explore and document them, develop suggestions for minimizing these challenges and subsequently suggesting possible solutions. The study focused on the Capricorn district in Limpopo Province. The district is the biggest among the five districts and has eight functional hospitals which are under the leadership of Chief Executive Officers (CEO). The researcher used both qualitative and quantitative (mixed) research methods. The methodology entailed the distribution of self-administered questionnaires containing closed and open ended questions to the management of Capricorn district hospitals. The results obtained in this study revealed that there are numerous challenges that constrain policy implementers from implementing health policies effectively and efficiently in their work environments. These challenges range between poor incentives, lack of equipment, lack of office space, lack of dedicated transport for outreach, budget constraints, shortage of resources – human and physical, lack of career mobility, poor working conditions, communication problems and poor supervision style. These challenges impact negatively on policy implementation.It is therefore recommended that the comprehensive strategy to maximize the health workers’ motivation in the health sector has to involve a mix of financial and non-financial incentives, the provincial department of health and Social Development should open some communication lines with the service providers at grass root level in order to address some of the issues before they become chronic challenges, there should also be regular meetings where feedback about provincial and national issues are addressed to the service providers. The current system of dissemination of information from the province and national government to the hospitals is apparently not clear.

Thesis (MPA) --University of Limpopo, 2010 / The research was undertaken to determine the challenges in the design and implementation of the youth and adolescent health policy. Special attention was focused on the design of the policy and people involved in policy development and implementation. Literature indicates that development and implementation of youth and adolescent health policy is a multisectoral, complex dynamic process. The study was undertaken to establish to what extent was the multisectoral approach implemented in Sekhukhune district, Limpopo province. The aim of the study was twofold: To study the problem of implementation of the youth and adolescent health policy and recommend ways of improving implementation; and to establish the appropriate model of implementation of the youth and adolescent health policy. The objectives of the study, were to determine the role of delegated officials regarding the implementation of the youth and adolescent health policy in Sekhukhune district. To establish if the delegated officials had the knowledge and skills to implement the youth and adolescent health policy as laid out by the National Department of Health, and to establish the extent to which interest groups such as School Governing Bodies, Non-Governmental organisations and traditional leaders were involved and participated in implementing the youth and adolescent health policy. The significance of the study was to assist in assessing the extent to which the youth and adolescent health policy was implemented in Sekhukhune district in Limpopo province. The research methodology was qualitative interviews. The Department of Health, district office, health institutions (health centres and clinics, and hospitals) were visited by the researcher. Structured interviews were conducted on the selected sample of health workers and youth. The sample size was 50: 40 were health workers and 10 youths in the area where the research was conducted, represented the youth. One office in the Department of health, Limpopo province, Sekhukhune district office, 3 hospitals, 5 municipal offices (health offices) 15 primary health care facilities(clinics) were visited and one to one interview, using a questionnaire, was conducted in order to ensure confidentiality. The findings were that there were health workers who were not aware of the availability of the youth and adolescent health policy. The Department of health did not have guidelines/policies on how to implement National health policies. Health workers at health institutions (hospitals) were interested in knowing more about the youth and adolescent health policy. The youth made suggestions for the improvement of recreation facilities and that health services for the youth should be more accessible, by separating the youth from adults at primary health care facilities. Most health workers expressed the need for training on the implementation of the youth and adolescent health policy.