Background: In many developing countries, maternal deaths occur mainly as a result of unsafe abortions, a situation reflecting the inaccessibility of safe abortion services in such countries. In Ethiopia, unsafe abortion accounts for 32% of maternal deaths and almost 60% of gynaecological admissions, and is one of the top ten causes of general hospital admissions. Purpose: The purpose of this study was to assess the views of women about the accessibility of safe abortion services in governmental health centres. Methods: A quantitative cross-sectional descriptive and non-experimental study using structured questionnaires was conducted. 342 women who had received abortion care services in governmental health centres participated. Findings: 46.8% of the participants do not know about the penal code regarding safe abortion care. 52.9% of the participants viewed safe abortion care as inaccessible because there are various and competing factors which make abortion service to be viewed as accessible or inaccessible and these include distance to nearest health centre, the time it takes to receive the service, the cost of the service, and the lack of appropriate skills in the service providers. Conclusion: An improvement in the accessibility of abortion services will prevent deaths resulting from unsafe abortions / Health Studies / M.A. (Public Health)

The majority of women's health nurses in this study work in generalist community health centres. They have developed their praxis within the philosophy and policies of the broader women's health movement and primary health care principles in Australia. The fundamental assumption underlying this study is that women's health nurses possess a unique body of knowledge and clinical wisdom that has not been previously documented and explored. The epistemological base from which these nurses' operate offers important insights into the substantive issues that create and continually shape the practice world of nurses and their clients. Whether this represents a (re)construction of the dominant forms of health care service delivery for women is examined in this study. The study specifically aims at exploring the practice issues and experience of women's health service provision by women's health nurses in the context of the provision of cervical cancer screening services. In mapping this particular group of nurses practice, it sets out to examine the professional and theoretical issues in contemporary nursing and women's health care. In critically analysing the powerful discourses that shape and reshape nursing work, the study raises the concern that previous analyses of pursing work tend to universalise the structural and social subordination of nurses and nursing knowledge. This universalism is most often based on examples of midwifery and nursing work in hospital settings, and subsequently, because of these conceptualisations, all of nursing is too often deemed as a dependent occupation, with little agency, and is analysed as always in relation to medicine, to hospitals, to other knowledge forms. Denoting certain discourses as dominant proposes a relationship of power and knowledge and the thesis argues that all work relations and practices in health are structured by certain power/knowledge relations. This analysis reveals that there IX are many competing and complimentary power/knowledge relations that structure nursing, but that nursing, and in particular women's health nurses, also challenge the power/knowledge relations around them. Through examining theories of power and knowledge the analysis, argues that theoretical eclecticism is necessary to address the complex and varied nature of nursing work. In particular it identifies that postmodern and radical feminist theorising provide the most appropriate framework to further analyse and interpret the work of women's health nurses. Fundamental to the position argued in this thesis is a feminist perspective. This position creates important theoretical and methodological links throughout the whole study. Feminist methodology was employed to guide the design, the collection and the analysis. Intrinsic to this process was the use of the 'voices' of women's health nurses as the basis for theorising. The 'voices' of these nurses are highlighted in the chapters as italicised bold script. A constant companion along the way in examining women's health nurses' work, was the reflexivity with feminist research processes, the theoretical discussions and their 'voices'. Capturing and analysing descriptive accounts of nursing praxis is seen in this thesis as providing a way to theorise about nursing work. This methodology is able to demonstrate the knowledge forms embedded in clinical nursing praxis. Three conceptual threads emerge throughout the discussions: one focuses on nursing praxis as a distinct process, with its own distinct epistemological base rather than in relation to 'other' knowledge forms; another describes the medical restriction and opposition as experienced by this group of nurses, but also of their resistance to medical opposition. The third theme apparent from the interviews, and which was conceptualised as beyond resistance, was the description of the alternative discourses evident in nursing work, and this focused on notions of being a professional and on autonomous nursing praxis. This study concludes that rather than accepting the totalising discourses about nursing there are examples within nursing of resistance—both ideologically and X in practice—to these dominant discourses. Women's health nurses represent an important model of women's health service delivery, an analysis of which can contribute to critically reflecting on the 'paradigm of oppression' cited in nursing and about nursing more generally. Reflecting on women's health service delivery also has relevance in today's policy environment, where structural shifts in Commonwealth/State funding arrangements in community based care, may undermine women's health programs. In summary this study identifies three important propositions for nursing: • nursing praxis can reconstruct traditional models of health care; • nursing praxis is powerful and able to 'resist' dominant discourses; and • nursing praxis can be transformative. Joining feminist perspectives and alternative analyses of power provides a pluralistic and emancipatory politics for viewing, describing and analysing 'other' nursing work. At the micro sites of power and knowledge relations—in the everyday practice worlds of nurses, of negotiation and renegotiation, of work on the margins and at the centre—women's health nurses' praxis operates as a positive, productive and reconstructive force in health care.

A Feminist Action Research methodology was used as a collaborative process with five ACT Health social workers based at the Community Health Centres and four at the Woden Valley Hospital. The primary purpose of the study was to investigate, both through critical reflection and action in their work setting, the participants' relevance or otherwise to Aboriginal people in the ACT and region. Behind this is the question of how encapsulated social work is by racism. The impetus for the study arose from my unresolved concerns regarding these issues, having been a social worker in ACT Health for 6 years, to 1990. Decisions on how to proceed involved a process of ongoing consultation between the participant social workers and myself. Exploratory meetings were held in March and April, with an ongoing program being held 2-3 weekly from June to September, followed by a review in December. Most gatherings were specific to the Woden Valley Hospital or Community Health settings. However two half-day workshops were held for all the participants. All the sessions from June were taped. Aboriginal leaders were consulted, as were several managers in ACT Health. The phenomena of institutional, cultural and personal racism were addressed by the social workers through discussion, exercises, and anti-racist initiatives in their work setting. They found that significant time restraints presented an example of institutional racism working against their good intentions. Another dimension arose from implicitly racist education in social work courses when most of the participants undertook their undergraduate courses in the 1960s and 1970s. Aspects related to professionalism such as its language and separation of a personal and professional self were indicative of cultural racism. Stories of personal racism were shared, in the context of raised awareness leading to changing those attitudes and behaviours. The fact that the study took place in 1993 - a watershed year for Aboriginal/white relations in Australia - seemed to lead to greater momentum for the project. The social workers found that participation in this study increased their knowledge of, and their confidence - both actual and potential - in interaction with Aboriginal people. However, they also understood these to be just small steps towards greater justice for the indigenous people. An outcome of the project has been involving some colleagues in similar anti-racist actions to those the social workers participated in during the time of the study. The action research project has continued on in different ways, beyond 1993, despite my withdrawal as 'the researcher' who took the initiative.

Bakgrund: Av alla telefonsamtal från föräldrar till vårdcentralen får hälften av dessa egenvårdsråd till sina barn, vilket kan främja hälsa, förhindra och förebygga sjukdom. Om förmågan till egenvård sviktar hos föräldrarna har distriktssköterskorna en viktig roll i att stötta och undervisa. Syfte: Att beskriva distriktssköterskors erfarenheter av att ge egenvårdsråd till föräldrar i telefonrådgivning på vårdcentral. Metod: Studien genomfördes med kvalitativ metod med induktiv ansats. Datainsamlingen bestod av 12 semistrukturerade intervjuer med distriktssköterskor på vårdcentral. Materialet analyserades med hjälp av en kvalitativ innehållsanalys och tre kategorier och nio subkategorier framkom. Resultat: Tre kategorier framkom i resultatet. Verktyg för samtalet med underkategorierna kommunikation, undervisning, stöd och hjälpmedel. Nyttan med egenvårdsråd med underkategorierna stärkt föräldraroll, tillgänglig som samtalskontakt och färre vårdbesök. Utmaningen med egenvårdsråd med underkategorierna komplexiteten i telefon, föräldrar är olika och kulturella olikheter och språksvårigheter. Distriktssköterskorna erfor att föräldrarna fick stöttning, råd och hjälp med sin oro i telefonsamtalen. Det fanns svårigheter i telefonsamtalet som att inte kunna se barnet och stressen när samtal drog ut på tiden. Slutsats: Distriktssköterskorna arbetade personcentrerat och stöttade föräldrarna till egenvård så att de kunde verka för god hälsa och förebygga sjukdom hos sina barn. Undervisning i egenvårdsråd stärkte föräldrarollen samt minskade deras oro. / Background: Of all telephone calls to the health care centres, half come from parents’ who receive self-care advice for their children, which can promote health and prevent illness in children. If the parents’ ability to self-care fails, the district nurse has an important role in supporting and teaching. Aim: To describe district nurses’ experiences to provide self-care advice to parents in telephone counselling in health care centrals.     Method: The study was implemented with a qualitative method with an inductive approach. The data collection consisted of 12 semi-structured interviews with district nurses at health care centres. The material was analysed with a qualitative content analysis that resulted in three categories and nine subcategories. Results: Three categories emerged in the result. Tools for the conversation with the subcategories communication, teaching, support and aids. The benefit of self-care advice with the subcategories strengthened parenting role, available as a conversational contact and fewer care visits. The challenge with self-care advice with the subcategories of the complexity of the telephone, parents are different and cultural differences and language difficulties. The district nurses experienced that the parents received support, advice and help with their concerns in the telephone conversations. There were difficulties in the phone call such as not being able to see the child and the stress when the call dragged on. Conclusion: District nurses worked person-centered and supported parents in self-care so they could work for good health and prevent illness in their children. Teaching in self-care advice strengthened the parental role and reduced their worries.

MPH / Department of Public Health

The creation of the National Health Service is treated, analytically and historically, as a planning process involving major changes in the social organisation of health as a part of the larger set of social and economic reconstruction policies undertaken by the wartime Coalition and postwar Labour governments. Definitions of 'health' are considered as relative both to social expectations and ideology, and to theoretical models of the organisation of health services. These models are identified with certain socio-political agents or interests in the providing and consuming of health services: professional groups, public and private authorities, non-professional workers, and the public. The models of the health service advocates and of the medical profession are considered as reference points. A framework is presented for the analysis of the representation of these interests, by the state, in the planning and operation of the NHS, and as beneficiaries of its services. Through a detailed historical consideration of internal health service planning documents of the major interests, including the medical profession, the health service advocates representing the Labour party and trade unions, and recently released documents of the Ministry of Health and the Coalition and Labour Cabinets, the interaction of the interests with the two governments and with each other is traced, and the reconciliation by the state of the health service models proposed by them is analysed. It is argued that the changes wrought in the social organisation of health in Britain can be described according to certain principles of the organisation of pre- and post-NHS health services: principles of public access, structure of services, structure of administrative control and structure of planning representation. Tne major interests were represented differentially by the state with respect to each of these criteria; similarities and differences between the approaches of the two governments to the representation of interests are examined, and it is concluded that, although the health service advocates and the public benefited from a free and universal scheme, the public and non-professional health workers enjoyed considerably less representation than the medical profession in the particular services provided by the NHS and in its planning and administration.

Dans le contexte social actuel, l’identification et la compréhension de la représentation que les intervenants ont des soins palliatifs constituent l’un des points d’ancrage de l’agir professionnel, de la formation et des modifications de structures de soins. Le but de cette étude était de décrire et de comprendre la représentation qu’un groupe d’intervenants travaillant en CLSC a des soins palliatifs, puis de proposer des interventions éducatives et organisationnelles susceptibles de favoriser une plus forte adhésion à la philosophie qui sous-tend ce type particulier de soins. Des entretiens semi dirigés et une analyse de contenu ont révélé un univers de représentations à la fois similaires et différents dans chaque sous-groupe. On constate que chaque thème exploré peut prendre des sens divers. On peut dire que la représentation des soins palliatifs chez le groupe de professionnels de CLSC ayant participé à la présente étude constitue un ensemble de savoirs à portée pratique très élevée faisant intervenir en grande majorité des savoirs de sens commun. Un point se révèle crucial : celui de la formation dans l’appropriation de la philosophie des soins palliatifs qui devrait être à la base de cette pratique; une formation qui doit prendre en compte les multiples composantes non scientifiques et les ambiguïtés du travail quotidien en soins palliatifs comme faisant partie intégrante des dynamiques du processus d’appropriation de la philosophie des soins palliatifs. / In the present social context, the identification and the comprehension of palliative care workers representations is at the base of their professional education and behaviours as well as of the many changes occurring in health care institutions. The aim of the present research is to describe and better comprehend the representations of a group of health care professionals working in a continuum of palliative care services in the Quebec health care and social services network. It is also to propose educational and organizational interventions in order to bring workers closer to the palliative care philosophy. Semi directed interviews and a content analysis revealed a large variety of representations that were both similar and different in each group as well as in the different groups. Many different meanings were given to each theme explored. The health care workers palliative care representations contain a variety of highly practical knowings and knowledges that bring together a vast majority of common sense meanings. One point is crucial: palliative care philosophy education should be at the base of palliative care interventions. The education content should take into account the multiple non scientific and ambiguous components of daily work in a palliative care settings since they are part of the process conducting to the appropriation of the palliative care philosophy.

Improving the implementation of family planning through integration with HIV services is vital to reduce maternal and child morbidity and mortality that has been a concern especially in developing countries like Ethiopia (UNFPA 2016). The aim of this study was to develop a strategic plan that could facilitate the implementation of an integrated family planning and HIV services at the public health centre level. The researcher utilized an explanatory sequential mixed method design with quantitative data collected in the first phase and qualitative data collected in the second phase. Data were collected from 403 clients in face-to-face structured interviews and from 305 service providers by means of a self-administered questionnaire. Descriptive analysis was applied to describe the findings of the study. Significance testing between variables was computed by odds ratio, p-value and 95% confidence interval. Bivariate and multi-variate logistic regressions were used for the analysis. In Phase 1, awareness of family planning methods, male involvement, marital status, client satisfaction, family income, waiting time, training, awareness of policies/guideline and transport availability were statistically significant challenges identified by clients and service providers. The client and service provider respondents identified previous use of family planning, men’s involvement, client satisfaction, availability of behavioural change communication materials, accessibility, budget, infrastructure and medical resources as opportunities. In phase 2, the researcher utilized the nominal group technique (NGT) to collect qualitative data from programme officers. Twenty-four programme officers from 10 sub city health offices, city and national level participated in two nominal groups, consisting of 12 participants each. Multiple group analysis was used to analyse the data from the nominal groups. The five strategies ranked as the most important were leadership and management; capacity building; implementation of policies and guidelines; advocacy/awareness, and infrastructure. The findings in phase 1 and phase 2 formed the basis for the development of a strategic plan using the process planning model. The strategic plan was developed and validated with the active participation and involvement of programme officers. The plan is intended to be implemented by service providers and programme officers to facilitate the implementation of integrated family planning and HIV services at the public health centre level. / Health Studies / D. Litt et. Phil. (Health Studies)

The purpose of this study was to explore the level of integration of health promotion and disease prevention services with the curative care provided at hospitals and health centres in Addis Ababa, and to propose recommendations that could improve such an integrated health service. A quantitative approach, using an exploratory and descriptive design was applied at 22 public health facilities in Addis Ababa followed by the Delphi technique to reach consensus on ways to improve the integration of health promotion, preventive and curative care. An integrated health service (IHS) framework was used as the conceptual framework upon which the study was based. Multistage sampling involving stratified simple random sampling was applied to select hospitals and health centres while a systematic sampling technique was used to sample patients from the outpatient and inpatient medical departments. Data was collected by means of two questionnaires from patients and health service managers, respectively, following which two Delphi rounds with experts resulted in agreement on a contextually accepted integrated framework. The findings revealed that promotive and preventive services for chronic diseases were not optimally integrated in the routine health care services of the health facilities. Most health facilities lacked skilled health professionals, adequate medication and equipment to provide a comprehensive integrated service. The study emphasized the need for health service providers to undergo a paradigm shift and additional training in order to provide a comprehensive, patient-centred, integrated health service instead of only treating patients’ complaints. To assist this approach, the study affirmed the Integrated Health Service (IHS) framework as a tool which comprehensively demonstrates the cause, effect and progression of chronic diseases and the appropriate interventions which health professionals can apply in managing diseases or their risk factors. Recommendations for effective, integrated promotive and preventive health care, included the development of guidelines, protocols and policy documents for cultivating a healthy lifestyle, adopting effective disease prevention approaches, re-designing medical school curriculums, and staffing health facilities with trained and specialized staff, capacitating health facilities with the necessary equipment, medication and supplies that would enable the provision of an integrated health care service. / Health Studies / D. Litt. et Phil. (Health Studies)

No description available.