Thesis (M.A.)--Carleton University, 2008. / Includes bibliographical references (p. 118-130). Also available in electronic format on the Internet.

Text in English / South Africa is currently in the process health care reform as the Government has undertaken the task of providing universal health care to all South Africans through the implementation of the National Health Insurance Scheme (NHI). This study took an in-depth look at the history and progression of the post-1994 South African health care policy, and applied the Power Resources Theory to the political economy of the current health care reform process in South Africa. Through a comparative study of the pivotal elements in the phases of health reform in Canada and Sweden this study drew lessons for the design and implementation of universal public health care provision in South Africa. This study found that a strong culture of care, strong political will, active civil society participation and a focus on equality as opposed to poverty in the creation of policy is essential to a successful implementation of universal health care. / Sociology / M.A. (Sociology)

Made available in DSpace on 2015-07-22T20:50:24Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-07-29 / Introdução: Uma política de saúde não é um processo técnico independente e sim uma negociação comprometida com a escolha entre posições conflitantes, sendo fruto de fatores históricos, sociais e econômicos que precisam ser levados em conta no processo de avaliação. Objetivos: Avaliar a política de saúde mental vigente no país, destacando seus pontos fortes e fraquezas e o cumprimento dos objetivos propostos. Métodos: Utilizou-se o WHO-AIMS, instrumento desenvolvido pela OMS para sistematizar a descrição dos recursos e processos envolvidos no sistema de saúde mental. As fontes de dados foram os bancos de dados governamentais, (DATASUS e CNES); entrevistas com a Coordenação Geral de Saúde Mental, do Ministério da Saúde; um questionário para informantes qualificados; além de uma revisão da legislação, documentação governamental e estudos ligados ao sistema de saúde mental brasileiro e a chamada reforma da atenção psiquiátrica empreendida nas ultimas décadas. Resultados: A política brasileira de saúde mental logrou obter apoio social e governamental para empreender uma ampla reforma do atendimento em saúde mental. A construção do SUS, que acontece no mesmo período foi fundamental para ditar princípios e gerar investimentos para a política de saúde mental. O sistema baseia-se no principio de cuidado na comunidade, havendo uma centralização das ações no âmbito do CAPS. Houve uma significativa redução de leitos em hospitais psiquiátricos e internos de longa permanência têm contado com o programa de residências terapêuticas e de bolsa reabilitação. A integração nas ações da atenção básica, bem como no hospital geral estão muito aquém do necessário. Há uma carência de profissionais formados para o novo modelo e uma aposta na equipe multiprofissional, que apesar de diminuir a dependência da figura do psiquiatra, de formação mais cara e demorada e quase ausente fora dos grandes centros urbanos, também trás o risco de falta de especificidade das ações e baixa qualidade no cuidado. O sistema de informação, essencial para guiar o planejamento das ações em saúde mental ainda necessita ser aperfeiçoado, havendo falta de dados em diversos setores estratégicos à política de saúde mental. Conclusões: Os dados mostram que a reforma do sistema de saúde mental brasileiro apresentou nas duas ultimas décadas intensa mudança no modelo de assistência, no destino dos recursos financeiros, e no arcabouço legislativo. O sistema de saúde mental no Brasil apóia-se sobre uma política híbrida, que avança sobre uma constante tensão entre concepções diferentes da reforma da atenção psiquiátrica, a chamada psiquiatria comunitária tradicional e a fortemente influenciada pela reforma psiquiátrica italiana, por vezes gerando contradições e falta de clareza no planejamento da política de saúde mental. / Introduction: A health policy is not an independent technical process, but a compromised negotiation with the choice between conflicting positions that steam from historical, social and economical factors that need to be taken into account in an evaluation process. Objectives: The aim of this paper is to evaluate the mental health policy in use nowadays in Brazil, calling attention to its advantages and disadvantages and how efficient it is in relation to its aims. Methods: We have used the WHO-AIMS, an instrument developed by WHO to systematize the description of resources and processes involved in the health care system. The data sources were extracted from the following sources: governmental data sets, (DATASUS and CNES); interviews with the Mental Health Coordination, the Health Ministry; a questionnaire to qualified informants; in addition to a legislation review, governmental documentation and studies linked to the Brazilian mental health system and the reform of psychiatric attention that took place in the last decades. Results: The Brazilian mental health policy was successful in obtaining social and governmental support to make a reform in mental health care. The advent of the SUS (Unified Health System), which happened at the same time, was fundamental to generate principles and investments to the mental health policy. The system is based in the principle of community care, with action centralized in the Psychosocial Community Centers (CAPS). There was a significant reduction of psychiatric hospital beds, and many long-stay patients have had access to a therapeutic residence program as well as a monthly rehabilitation benefit. Both the integration in the basic attention actions and in the general hospital is too far from what is needed. There is a small number of professionals well trained for the new model and the ideal of multi-professional team that, even though it is less dependent on the psychiatrist figure (a long and expensive formation, almost inexistent away from the great urban centers), it also brings the risk of actions lacking specialized knowledge and low quality care. The information system, essential to guide action planning in mental health, still needs to be improved, for its lack of data in many areas that are strategic to the mental health policy. Conclusion: The data shows that the mental health system reform presented, in the last two decades, intense chances in the psychiatric care model, in financial resources destination, and in the legislative framework. The mental health system in Brazil is based on a hybrid policy that moves in constant tension between different conceptions of psychiatric care reform: the traditional communitarian psychiatry and the one strongly influenced by the Italian psychiatric reform, sometimes generating contradictions and lack of clarity in the mental health policy planning. / TEDE / BV UNIFESP: Teses e dissertações

Submitted by Maike Costa (maiksebas@gmail.com) on 2016-07-12T13:46:38Z No. of bitstreams: 1 arquivo total.pdf: 1054749 bytes, checksum: 52b1647508cd9d3526407e2d98e94627 (MD5) / Made available in DSpace on 2016-07-12T13:46:38Z (GMT). No. of bitstreams: 1 arquivo total.pdf: 1054749 bytes, checksum: 52b1647508cd9d3526407e2d98e94627 (MD5) Previous issue date: 2014-09-03 / This is a documentary research work, including the analysis of the available scientific literature on the portal BIREME, with the keywords "State Reform", "privatization", "outsourcing", "Health Care Reform", "modernization of the Public Sector, "and" Third Party Services ". In addition we sought documentation produced in articles, newspapers and websites on the case of the Hospital de Emergência e Trauma Senator Humberto Lucena in João Pessoa, Paraíba. The analysis of the literature showed that there is an ideological divide in production, even academic, where it is possible to delineate two distinct camps. A field that follows in defense of necessity as a defense management state machine, this field coach who preaches and makes use of successful experiences for their defense model. Another field, in line with the thinking of the Health Reform follows the questioning of reform and prosecution of the impediments that the reform has imposed on the Unified Health System Without falling into a paralyzing nihilism, the author notes that the ideological issue is prominent in academic production on the matter. / Trata-se de um trabalho de pesquisa documental, tendo sido analisado a literatura disponível no portal científico da BIREME, tendo como palavras-chaves “Reforma de Estado”, “Privatização”, “Terceirização”, “Reforma dos Serviços de Saúde”, “Modernização do Setor Público”, e “Serviços de Terceiros”. Além disso buscou-se a documentação produzida em artigos, jornais e sites sobre o caso do Hospital de Emergência e Trauma Senador Humberto Lucena, em João Pessoa, Paraíba. A análise de literatura demonstrou que há uma divisão ideológica na produção, mesmo acadêmica, onde é possível se delimitarem dois campos distintos. Um campo que segue em defesa da terceirização e privatização como necessidade de gestão da máquina estatal, campo este que se apregoa técnico e faz uso de experiências exitosas para sua defesa de modelo. Outro campo, consonante com o pensamento da Reforma Sanitária segue no questionamento da reforma e na acusação dos empecilhos que a reforma tem imposto ao Sistema Único de Saúde. Sem cair num niilismo paralisante, o autor constata que a questão ideológica está fortemente presente na produção acadêmica sobre a matéria.

In 2013, Peru initiated a reform process under the premise of recognizing the nature of health as a right that must be protected by the state. This reform aimed to improve health conditions through the elimination or reduction of restrictions preventing the full exercise of this right, and the consequent approach aimed to protect both individual and public health and rights within a framework characterized by strengthened stewardship and governance, which would allow system conduction and effective responses to risks and emergencies. The reform led to an increase in population health insurance coverage from 64% to 73%, with universalization occurring through the SIS affiliation of every newborn with no other protection mechanism. Health financing increased by 75% from 2011, and the SIS budget tripled from 570 to 1,700 million soles. From 2012 to May 2016, 168 health facilities have become operational, 51 establishments are nearing completion, and 265 new projects are currently under technical file and work continuity with an implemented investment of more than 7 billion soles. Additionally, this reform led to the approval of the Ministry of Health intervention for health emergencies and strengthened the health authority of the ministry to implement responses in case of risks or service discontinuity resulting from a lack of regional or local government compliance with public health functions. / In 2013, Peru initiated a reform process under the premise of recognizing the nature of health as a right that must be protected by the state. This reform aimed to improve health conditions through the elimination or reduction of restrictions preventing the full exercise of this right, and the consequent approach aimed to protect both individual and public health and rights within a framework characterized by strengthened stewardship and governance, which would allow system conduction and effective responses to risks and emergencies. The reform led to an increase in population health insurance coverage from 64% to 73%, with universalization occurring through the SIS affiliation of every newborn with no other protection mechanism. Health financing increased by 75% from 2011, and the SIS budget tripled from 570 to 1,700 million soles. From 2012 to May 2016, 168 health facilities have become operational, 51 establishments are nearing completion, and 265 new projects are currently under technical file and work continuity with an implemented investment of more than 7 billion soles. Additionally, this reform led to the approval of the Ministry of Health intervention for health emergencies and strengthened the health authority of the ministry to implement responses in case of risks or service discontinuity resulting from a lack of regional or local government compliance with public health functions.

The South African Health Care environment is in state of reform. Government strategy and change in legislation have been the catalyst for the development of new business models in South Africa. This report deals with the feasibility of a proposed model which is to be implemented by the Eastern Cape Department of Health at the Provincial Hospital in Uitenhage. The fundamental challenge in South Africa is the shortage of resources to support the health care industry from a public perspective. The point of departure for this research was to understand the complexity of this industry and investigate models that have evolved in South Africa and internationally. The literature research covers funding mechanisms from both a public and private perspective and takes into account the role the government plays in providing equitable health care for all. The literature provided the foundation to develop the model which is to be piloted at the hospital in Uitenhage. In terms of the research objective, a single case study methodology approach was conducted. Triangulation technique was used to gain insight from different perspectives and to test the model for validity. The core of this research focuses on the viability of the proposed model and the integration of this into the government health reform plan. The research revealed that in comparison to the existing PPP models in South Africa, this model is feasible. As a result of the analysis and the development of the proposed model, the research is concluded by offering suggestions for further research.

The aim of my thesis is to review current and approchable types of insurance in Czech republic with an emphasis on the health insurance. The thesis should result in a summary of possible reform or stabilization arrangements that are solving unfavourable prognosis in Czech republic in the long term.

In Alberta, decision-making in the health system has been devolved to seventeen Regional Health Authorities (RHAs). This thesis undertakes a broad analysis of the values that underlie this regionalization. Divided into two parts, the first half of the thesis develops a liberal egalitarian theory for the distribution of resources in society that turns on the importance of providing all people with the basic resources required to plan for, develop and achieve their life goals. Four requirements for any health system that seeks to uphold the values inherent in this theory are then articulated. These requirements include the need for the health system to be sensitive to the broader determinants of health, and the need for understanding the concepts of health and disease within the context of the social and cultural communities that the system is meant to serve. Part One concludes with an argument suggesting that expressions of Canadian values cohere with the normative theory developed. In Part Two the evolution of Alberta's regionalized healthcare system is traced. The values implicit in the regionalization of the health system in this province are then examined for their congruence with the four requirements developed in Part One. Following this, the ethical difficulties faced by RHAs are considered. The thesis culminates with thoughts on the ethical challenges Alberta's regionalized healthcare system must confront, offering recommendations for how some of these challenges may be addressed. It is concluded in the thesis that while a regionalized health system is not necessary for meeting the requirements elucidated, these standards can be met with a regionalized approach. However, at least in the case of the Alberta experience, a number of important changes would have to take place for this to occur. Among these changes is a paradigm shift in the way health and disease are understood towards a more evaluative approach; the recentralization of public health initiatives to the provincial level; and an overall change in governmental health policy recognizing that many areas of society, and consequently the policies of government agencies beyond a disease-based healthcare system, impact health and well-being. / Arts, Faculty of / Philosophy, Department of / Graduate

The purpose of this study was to explore and describe the perceptions of health professionals on the changes brought about by health system reforms in Zimbabwe. Qualitative, explorative and descriptive research was conducted to identify concerns of health care provision, as described by health professionals in Zimbabwe, and to provide awareness for future reforms. Data collection was done using semi-structured interviews. Ten health professionals from two study sites participated in the research. The findings revealed that health professionals have an understanding of health system reforms and how these have changed the way health services have been delivered over the years. There is a general outcry among health professionals regarding the deteriorating provision of quality health care amidst the challenges that the health system is facing under a collapsing economic situation. The study recommends inclusion of health professionals in policy making as well as timely dissemination of any information regarding changes in policy. The study also recommends further research on the same topic with a larger diverse group of participants. / Health Studies / M. P. H.

Following cultural anthropological inquiry, this dissertation examines the adoption of shamanic healing techniques into Western medicine and the resultant hybrid modality of health care fostered by two disparate healing traditions. As the U.S. populace increasingly turns to alternative forms of healing in conjunction with, or in lieu of, conventional Western medicine, shamanic healing has been added to the list of recognized non-conventional therapies. Shamanism, once prevalent throughout most of the world in various cultural forms, is purported to be the oldest healing modality, dating back to the Upper Paleolithic in Siberia. Historical excoriation and extermination from religious and political dogma have plagued shamanic cultures for centuries while their healing practices have been rebuked by Western concepts emergent from the Scientific Revolution--whereupon the Cartesian Split and a corporeal view of the body transformed the field of medicine. In the United States, over the last decade, a new and growing subculture of health care practitioners, including "Western" educated medical practitioners, is seeking out shamanic training for personal and professional development. This study examines how the adoption of a healing paradigm borne out of indigenous cultures oriented toward communal living and local economies is adapted to a Western culture steeped in individualism, commercialization, and commodification. Through surveys, interviews, and ethnographic research, the investigator provides numerous examples and analysis of the practice of shamanic healing techniques in medical clinics, health care centers, and hospitals. In particular, this study will focus on the shamanic training of health care practitioners, their motivations, the manner in which they incorporate shamanic healing techniques into their treatment protocols, as well as patient/colleague/administrative responses and institutional barriers. A comparative analysis provides discussion on both the metamorphosis of shamanic healing traditions appropriated within a biomedical framework as well as the influence of spiritually-based healing practices upon the established medical culture in the United States today. Through the lens of highlighted individual experiences, the investigator offers insight into an emerging hybrid healing modality embedded in cultural contrasts that also serves as a catalyst for the renegotiation of the meaning of healing.