This thesis focuses on the development of a malaria vaccine as an avenue to explore global health partnerships. In the last twenty years, public-private partnerships have become a prominent organizational form in global health. Hundreds of large transnational collaborations and countless smaller collaborations between the public, private and non-profit sectors have been established. Partnerships have been supported by the large increase of donor funding for research and control of infectious diseases in impoverished countries and many aim to develop or provide vaccines, medicines or interventions. Analysts generally agree that partnerships are saving many lives and revolutionizing drug and vaccine development for infectious diseases. However, while partnership is a notion that connotes equity and mutuality, often global health partnerships operate in contexts that involve vast disparities in power and resources and there is little known about the impacts of partnerships on the places where they operate. This raises the questions: How do global health partnerships operate in practice? What are their impacts in the places where they operate? Addressing these questions, this thesis examines a partnership established to develop the most advanced malaria vaccine, named RTS,S. Based on 17 months of ethnographic research in Tanzania and interviews with representatives of partnering organizations in Belgium and the United States, I trace the development of the RTS,S vaccine from laboratories to its clinical trials across Africa. I explore the social relationships formed between private companies, philanthropic institutions and non-profit organizations in the North, and research institutions and communities in north-eastern Tanzania, where a malaria vaccine clinical trial was conducted. Analyzing the impacts of the malaria vaccine partnership, I focus on community development, construction of infrastructure, the building of human capacity, provision of health care and extraction of data. The focus on partnerships is intended to improve understanding about this ever-increasing social, political and economic formation in global health, and contributes to discussions and debates about how partnerships operate and their role in international development, global health governance and transnational medical research.

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<p>This thesis focuses on two important areas of health economics: health dynamics during pre-adulthood, and physician behaviour. The first two essays seek to explore the important factors that determine the health production process during the period of pre-adulthood. The third chapter then turns the focus to physician labour and service provision behaviours.</p> <p>The first chapter examines the impact of family social economic status (SES) and neighbourhood environment on the dynamics of child <em>physical</em> health development. It examines the distribution of health outcomes and health transitions and explores the determinants of these distributions by estimating the contributions of family SES, neighbourhood status, unobserved heterogeneity and pure state dependence.</p> <p>The second chapter extends the research on health development in pre-adulthood by examining the roles of family SES, early childhood life-events, unobserved heterogeneity and pure state dependence in explaining the distribution of depression among adolescents and young adults. It also explicitly models the depression dynamics and quantifies both the mobility and persistence of this type of <em>mental</em> health problem from adolescence to early adulthood.</p> <p>The third chapter examines whether and how pay-for-performance (P4P) payments can motivate physician service provision to improve the quality of health care. It exploits a natural experiment in the province of Ontario, Canada to identify empirically the impact of P4P incentives on the provision of targeted primary care services, and whether physicians’ responses differ by age, practice size and baseline compliance level.</p> / Doctor of Philosophy (PhD)

Fizinio aktyvumo stebėsena yra reikalinga norint tiksliau įvertinti organizmo atsaką į fizinius krūvius, dozuoti fizinius krūvius, o taip pat norint išvengti rimtų širdies ir kraujagyslių sistemos ligų, kadangi mirtingumas nuo šių ligų yra didžiausias ne tik Lietuvoje, bet ir daugelyje pasaulio šalių. Šio darbo tikslas buvo įvertinti judėjimo aktyvumo ir ŠKS funkcinių rodiklių informatyvumą vertinant organizmo reakcijas į atliekamą fizinį aktyvumą natūralių lokomocijų metu, panaudojat mobilų asmeninį EKG monitorių “Heart Guard”. Darbe buvo sprendžiami trys uždaviniai: 1 – nustatyti judėjimo aktyvumo kaitos matavimo tikslumą registravimui panaudojant pagreičio jutiklius; 2 – nustatyti triašio pagreičio jutiklio erdvinės orientacijos įtaką judėjimo aktyvumo matavimo tikslumui; 3 – palyginti fizinio aktyvumo vertinimus pagal judėjimo intensyvumą ir pagal ŠKS reakciją, atliekant ėjimo ir bėgimo užduotis. Visi tyrimai buvo atlikti LKKA Kineziologijos laboratorijoje. Tyrimuose dalyvavo sportuojantys ir nesportuojantys asmenys. Vertinamų rodiklių tarpe reikšmingiausi rodikliai leidžiantys daryti išvadas buvo santykinis judėjimo galingumas (W/kg), širdies susitraukimų dažnis ir išskaičiuojamas rodiklis – biologinės krūvio vertės rodiklis. Mūsų surinkti tyrimų duomenys ir darbo patirtis liudija, kad sukurtoji sistema galėtų būti adaptuota ir pritaikyta sportinės treniruotės valdymo problemoms spręsti, tame tarpe didelio meistriškumo sportininkų treniruočių proceso individualizavimui... [toliau žr. visą tekstą] / The watching of physical activity is very important if you need to test the organism reaction to the physical activity, to do physical activity proportional, and also to avoid cardiovascular illnesses, because the mortality of cardiovascular illnesses is the biggest not only in Lithuania, but in all the world too. The purpose of this job was to test the intensity of movement and cardiovascular functional rates educational testing the organism reaction to the physical activity when you are going or running, using the mobile individual EKG monitor “Heart Guard”. In this job we hade three tasks: 1 – to test dimensional precision of physical activity using acceleration electrodes; 2 – to test the triaxial acceleration electrode influence for the physical activity; 3 – compose evaluation of physical activity by physical intensity cardiovascular system reaction when you are walking and running. All test where done in kinesiology laboratory of Lithuanian Physical academy. We where testing the trained and untrained peoples. The most importance rate, from which we can do the conclusions, was relative movement power (Wkg), heart rate and enumerated rate – biologial load value rate. The facts of our tests shows, that the made program can be adapted and used to solve the problems in sports training and to individualized the training process for elite athletes. The results shows, that the registered accelerometer graph of triaxial acceleration rate let us to appreciate the changes of... [to full text]

The study was an assessment to determine the health rehabilitation interventions employed by Zimbabwe health actors between 2009 and 2011. It also was to ascertain the extent to which the interventions met criteria for effective rehabilitation, and that includes, health rehabilitation should ease the transition between health humanitarian and health development. Data was collected through interviewing health actors and review of policy documents while a vulnerability analysis approach was applied. The study revealed that, while the implemented health recovery interventions resulted in halting the health crisis, their role in facilitating progress towards health development was marginal. There were clear humanitarian residual issues and evidence of weak areas of the health system. A clear pathway needed to be mapped by actors, particularly policy makers to ensure effective rehabilitation. However, this seemed to lack in some areas. There were numerous overlapping and repetitive policies with little detailed guidelines. / Development Studies / M.A. (Development Studies)

The study was an assessment to determine the health rehabilitation interventions employed by Zimbabwe health actors between 2009 and 2011. It also was to ascertain the extent to which the interventions met criteria for effective rehabilitation, and that includes, health rehabilitation should ease the transition between health humanitarian and health development. Data was collected through interviewing health actors and review of policy documents while a vulnerability analysis approach was applied. The study revealed that, while the implemented health recovery interventions resulted in halting the health crisis, their role in facilitating progress towards health development was marginal. There were clear humanitarian residual issues and evidence of weak areas of the health system. A clear pathway needed to be mapped by actors, particularly policy makers to ensure effective rehabilitation. However, this seemed to lack in some areas. There were numerous overlapping and repetitive policies with little detailed guidelines. / Development Studies / M.A. (Development Studies)

This study was concerned with the health implications of new forms of gambling such as casinos, pokie machines and internet gambling for Māori women and their families in Auckland and the Bay of Plenty region of Aotearoa (New Zealand). It set out to discover what culturally appropriate services were available and the extent to which Māori women gamblers were utilising them. The literature documenting Māori perceptions of gambling shows that Māori women gamblers and their partner/whānau members and gambling service providers have been little studied previously. These goals translated into the following specific aims: 1) to study how Māori women problem gamblers, their partner or whānau members and key informants perceived gambling, what it meant to them and why they did it; 2) to investigate the consequences of gambling for Māori women, whānau and service providers in dealing with the effects of gambling; 3) to report on how these three groups dealt with the effects of gambling; and 4) to discover what helped to bring about positive changes for the three groups. All of the aims were achieved. A Māori approach (Kaupapa Māori), combined with a naturalistic approach to data collection, was adopted. Qualitative methods are most appropriate to use when working with some Māori, as there is a growing realisation that research with Māori needs to be interactive. A Māori research procedure modelled on the ritual ceremony of encounter (Pōwhiri) provided an appropriate structure for the development and presentation of the research process. The major focus was on the qualitative data obtained from semi-structured interviews in two locations - Rotorua and Auckland. The interviews were conducted with twenty Māori women gamblers, sixteen whānau members including partners and ten interviews with staff involved in services that provided help for problem gamblers. The three interview schedules were based on a number of broad themes and open-ended questions to obtain meaningful descriptive data. The interviews were audio recorded and used to produce transcripts that were then sent back to the participants for feedback. Qualitative data analysis was conducted on the returned documents. The findings from this study revealed major impacts of the women's socio-economic, familial and societal circumstances on gambling behaviour and its effects, which are areas of concern for mental health professionals and researchers. The mythical Māori canoes on which Māori voyaged from their place of origin (Hawaiiki) to Aotearoa, the Waka, provided an appropriate metaphor to present the interrelationship between the pull and push factors toward gambling, and its implications for society. This is illustrated as a spinning waka, Te Waka Hūrihuri. On the other hand, Te Waka Māia (courageous) demonstrates the relationships between the variables that help Māori women gamblers to cope and helpful strategies found to assist them to modify or stop their gambling behaviour. It is recommended that the government limit the proliferation of gaming venues and continue to encourage development of emerging Māori services. Moreover, a coordinated approach is essential, as Māori women gamblers, partners and whānau members need to heal together for positive outcomes for Māori health development in Aotearoa. The main implication of this study is that a wide range of further research into Māori and gambling is required. Recommendations on ways in which the current delivery of services in Rotorua and Auckland could be improved are: That the Ministry of Health purchase services that establish support groups for Māori people with problem gambling and their whānau, and That non-Māori provider services and organisations support the development of emerging Māori services. Heeding the outcome of this research should help improve New Zealand's existing health policy and capacity for Māori women's health development. It should also enrich our understanding of the adaptation patterns of Māori whānau member/s, and thus should have implications, not only for Māori health policies, but also relevance for the wider field of international cross-comparative research on indigenous gambling and mental health issues. Limitations of this study included a small, localised sample that means the findings can only tentatively be generalised to the wider population of Māori women gamblers. Nonetheless, information gained from the study contributes to understanding of the adaptation patterns of Māori women gamblers, their whānau member/s, and those who are trying to help them. It is hoped that the study will make it at least a little less true that every day is a war day for Māori women and their whānau trying to deal with the problem of gambling.