Purpose: The study focused on investigating the uses of the term “public participation” to clarify an important public policy concept for health governance as a firm foundation for theory building, policy and practice. Key questions concerned: What counts as participation? Who counts as a participant? And, is there legitimated space for dissent within this concept? Method: A combined methodology (Rodrigues, 2006) for the concept analysis of public participation use was adopted after three methods were extensively studied. Procedures were detailed for a systematic, random sampling of the professional, academic, theoretical and empirical literature from 1990 to 2012. Four disciplinary literatures (social work, sociology, political studies, and nursing) relevant to the field of health were surveyed. The databases furnished 336 documents, out of which 120 were randomly selected for study. Each document was read for construct definitions to ascertain the essential features and the contextual basis of the concept. Two distinct analysis phases were performed. Documents were divided by content into either theoretical or empirical studies, then, sorted into use areas. Findings: Analysis found three typical uses (intended, borderline, and contrary) characterized as prudent, spurious, and pernicious types of public participation. Pernicious types account for 40% of the literature surveyed, spurious types account for 37%, followed by prudent types at 23% (though most were failed examples). Normalized inconsistencies between purported ideals and their application were found across all the disciplines. A suggested polarization between theory and practice was strongest in the social work literature, while the nursing literature was striking for its consolidation of spurious and pernicious types. In short, a probability sampling of the literature suggests marginal and contrary uses of the concept predominate in the field. A Trichotomy of Public Participation Use is presented based on the determining criteria found, indicating the need to: affirm constituency interest in participant constructions for open negotiation, not just discussion; admit conflict and dissent as indicators of a healthy functioning democracy; privilege the interests of the poor in public participation designs and practice; and secure commitment from authorities to tie public participation mechanisms to the policy process in representative systems. Implications: The scope of this concept has contracted and continues narrowing by way of normalized contradictions that are well circulated within major discourses. Unless we are prudent with our thinking and theory building, the conceptual architecture for public participation is merely repackaging the master narrative to more effectively disseminate the logics of neoliberalism.

This thesis contributes to debates on the role of civil society organizations (CSOs) in global governance by asking if their participation in the global response to HIV/AIDS has been transformative – with transformation conceptualized as change towards a more equitable order. Adopting a critical International Relations approach, and applying qualitative methods, it analyzes how CSOs used the initial failure of biomedical responses to the epidemic to advance a human rights frame, which justified their participation in global governance. This frame complemented conceptions of AIDS exceptionalism, and has recently shifted in response to an increased focus on key populations. CSOs continue to advance the rights frame in global institutions – the focus here being on how they have done so within UNAIDS and the Global Fund to Fight AIDS, Malaria and Tuberculosis. However, rigid bureaucracies and dominant power relationships limit CSOs’ ability to transform these institutions to be more responsive to and representative of those affected by the epidemic. CSOs have further struggled to influence the largest global donors of the HIV/AIDS response – the Global Fund and PEPFAR – to direct greater resources to rights-based initiatives, despite CSO participation in resource mobilization. Though CSO participation has been restricted by donor state power, bureaucratic structures, and changes in the political economy of global health, CSOs have continued to promote potentially transformative alternatives, and so have continued to represent the interests of those most affected by the epidemic. This allows potential for further transformative alternatives.

Submitted by Leoná Rodrigues (leonarodrigues@id.uff.br) on 2017-06-20T17:42:48Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Analise da Cooperacao tecnica - Eduardo Mazzaroppi.pdf: 1349734 bytes, checksum: 0f4da5f948735609b59c156a33e1a187 (MD5) / Approved for entry into archive by Biblioteca da Faculdade de Direito (bfd@ndc.uff.br) on 2017-07-20T19:27:52Z (GMT) No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Analise da Cooperacao tecnica - Eduardo Mazzaroppi.pdf: 1349734 bytes, checksum: 0f4da5f948735609b59c156a33e1a187 (MD5) / Made available in DSpace on 2017-07-20T19:27:52Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Analise da Cooperacao tecnica - Eduardo Mazzaroppi.pdf: 1349734 bytes, checksum: 0f4da5f948735609b59c156a33e1a187 (MD5) / O projeto de pesquisa “Análise da cooperação técnica Brasil-Moçambique como estratégia de governança global da saúde” discute, a partir da análise da parceria Fiocruz-Moçambique, a cooperação técnica internacional em saúde como estratégia pós-nacional de governança global da saúde. Defende-se a cooperação técnica internacional (CTI), principalmente a cooperação Sul-Sul estruturante em saúde, como instituição consonante com a noção de pós-nacionalidade, participando ela da governança global da saúde. O presente estudo opera uma análise interpretativa de aspectos macro e micro estruturais da governança global. Começa-se discorrendo acerca das noções contemporâneas de pós-nacionalidade e de governança global. Em seguida, passa-se à discussão acerca da cooperação técnica, enquanto instituto afeito às Relações Internacionais (RI), ao Direito e à governança em saúde na atualidade. Finalmente, analisa-se o caso da cooperação Brasil-Moçambique estabelecida entre a Fundação Oswaldo Cruz (FIOCRUZ) e o Ministério da Saúde de Moçambique, notadamente quanto aos entraves e gargalos enfrentados nos últimos anos. Conclui-se sugerindo alternativas e indicando caminhos para a superação dessas dificuldades, sob um enfoque pós-nacionalista, considerando-se a cooperação técnica poderoso instrumento de construção de um modelo de cidadania e de governança global. / The research project "Analysis of technical cooperation Brazil-Mozambique as global governance of health strategy" discusses, from the analysis of Fiocruz-Mozambique partnership, international technical cooperation in health and post-national strategy for global health governance. It supports international technical cooperation, mainly structuring South-South cooperation in health, as consonant institution with the notion of post-nationality, taking part into global health governance. This study operates an interpretive analysis of macro and microstructural aspects of global governance. It starts discoursing contemporary notions of post-nationalism and global governance. Then it situates technical cooperation in international relations, law and governance on health in the present. Finally, it is analyzed the Brazil-Mozambique`s cooperation on health, which was established between the Oswaldo Cruz Foundation (FIOCRUZ) and the Ministry of Health of Mozambique, especially considering current obstacles and bottlenecks. It concludes by suggesting alternatives and indicating ways to overcome these difficulties, in a post-nationalist approach, considering the technical cooperation a powerful tool toward a model of citizenship and global governance

Magister Public Health - MPH / In South Africa, governance structures in the form of clinic committees, hospital boards and district health councils are intended to provide expression to the principle of community participation at a local and district level. They are meant to act as a link between communities and health services and to provide a conduit for the health needs and aspirations of the community to be represented at various local, districts, provincial and national levels. This study aimed to assess the functioning of health governance structures in the form of clinic committees. Specifically, the study sought to ascertain the number of clinic committees associated with public health facilities in three provinces in South Africa namely the Eastern Cape, Free State and KwaZulu Natal and to identify the factors that are perceived by clinic committee members to either facilitate or impede the effective functioning of clinic committees. / South Africa

No description available.

This thesis contributes to debates on the role of civil society organizations (CSOs) in global governance by asking if their participation in the global response to HIV/AIDS has been transformative – with transformation conceptualized as change towards a more equitable order. Adopting a critical International Relations approach, and applying qualitative methods, it analyzes how CSOs used the initial failure of biomedical responses to the epidemic to advance a human rights frame, which justified their participation in global governance. This frame complemented conceptions of AIDS exceptionalism, and has recently shifted in response to an increased focus on key populations. CSOs continue to advance the rights frame in global institutions – the focus here being on how they have done so within UNAIDS and the Global Fund to Fight AIDS, Malaria and Tuberculosis. However, rigid bureaucracies and dominant power relationships limit CSOs’ ability to transform these institutions to be more responsive to and representative of those affected by the epidemic. CSOs have further struggled to influence the largest global donors of the HIV/AIDS response – the Global Fund and PEPFAR – to direct greater resources to rights-based initiatives, despite CSO participation in resource mobilization. Though CSO participation has been restricted by donor state power, bureaucratic structures, and changes in the political economy of global health, CSOs have continued to promote potentially transformative alternatives, and so have continued to represent the interests of those most affected by the epidemic. This allows potential for further transformative alternatives.

Problématique : Alors que l’on connaît depuis plusieurs décennies les conséquences dramatiques des injustices sociales sur la santé, il existe un profond problème d’application des connaissances pour informer les pratiques et/ou les politiques. Au-delà d’un manque de prise en compte des connaissances pour l’action, il semblerait que la difficulté à lutter contre les inégalités soit plutôt liée à l’enracinement des systèmes de production et d’utilisation des connaissances dans des structures injustes. Approche théorique et cadre conceptuel : Cette thèse s’inscrit dans la quatrième vague de recherche sur le transfert de connaissances qui consiste à mieux comprendre les caractéristiques sociales des connaissances. En d’autres mots, il s’agit d’intégrer une approche d’épistémologie sociale dans la recherche sur le transfert de connaissances. Nous nous intéressons spécifiquement au concept d’oppression épistémique qui consiste en la répétition dans la durée de trois degrés d’exclusions épistémiques. L’exclusion de troisième degré représente un mode de vie épistémique qui est dirigé par des groupes sociaux dominants, qui ne permet pas de prendre en compte d’autres systèmes de pensée et de connaissances que les leurs. L’exclusion de second degré est le fait, pour des individus déjà opprimés socialement, de devoir utiliser des ressources qui ne sont pas les leurs, pour pouvoir participer à la construction de nouvelles ressources communes dans ce système. L’exclusion de premier degré concerne l’impossibilité, pour des individus, d’être considéré comme des « connaisseur·ses » du fait de préjugés à leur encontre. Cette thèse vise à analyser comment les pratiques quotidiennes et le contexte de la santé mondiale favorisent une oppression épistémique. Méthodologie : Nous étudions trois phénomènes correspondant aux trois degrés d’exclusion épistémique, en suivant une échelle d’analyse à trois niveaux (macroscopique, mésoscopique, microscopique) qui rappellent les trois branches de l’épistémologie sociale (système, groupe, individus). Pour cela, nous étudions en premier lieu la construction d’une ressource épistémique commune en santé mondiale à un niveau macroscopique : la couverture santé universelle (CSU) grâce à une revue critique des écrits. En deuxième lieu, nous étudions l’appropriation de cette ressource épistémique à un niveau mésoscopique, et la manière dont un groupe de scientifiques prend ou non en compte des voix dissidentes, en promouvant une définition différente de la CSU. Pour cela, nous réalisons une étude de cas d’un programme de recherches interventionnelles sur la CSU. En troisième lieu, nous étudions le rôle de la source des connaissances sur leur perception grâce à une expérimentation en santé mondiale. Résultats : À travers l’avènement de la CSU, nous observons la présence d’un pouvoir productif qui, tout en donnant l’impression d’une approche ancrée dans les droits humains et inclusive, favorise une conception marchande de la santé, menée par un « centre » de la santé mondiale. Nous avons également observé que l’appropriation de la CSU dans un programme de recherches interventionnelles n’a pas permis de créer une définition dissidente de la CSU. Plusieurs alliances épistémiques, c’est-à-dire des affiliations entre membres partageant la même orientation des études pour analyser la CSU sont apparues : une alliance santé publique, une alliance économique, une alliance anthropologique et une alliance critique. Cette dernière, qui proposait une réflexion globale sur la déconstruction et la gouvernance de la CSU, a été manquée, du fait d’inégalités concomitantes. Enfin, nous avons pu voir à un niveau microscopique que le « messager » peut être plus important que le « message » et participer à invisibiliser ou diminuer certaines voix dans la gouvernance globale en santé. Discussion et valeur ajoutée de la thèse : Les trois degrés d’exclusion épistémiques peuvent s’entrevoir de façon complémentaire. Du fait de la proximité des mondes scientifique et politique, et de la volonté de produire des connaissances pour l’action en santé mondiale, l’avènement de la CSU peut influencer la manière dont les scientifiques s’approprient ce concept. Cela peut limiter les possibilités de diversité épistémique et favoriser l’exclusion de certaines voix. À l’inverse, le sentiment d’exclusion peut conduire à se limiter dans sa contribution intellectuelle. Partant du postulat dont chacun·e de nous peut participer à changer les structures qui créent les injustices, en résistant à l’oppression épistémique, nous proposons un continuum d’actions pour lutter contre les inégalités dans la gouvernance globale en santé. / Background: The dramatic consequences of social injustice on health have been known for several decades, but social injustice also has an impact on knowledge translation. Rather than relating to a lack of knowledge uptake for action, the difficulty in addressing inequalities connects to knowledge production and use systems rooted in unjust structures. Theoretical approach and conceptual framework: This thesis aims to better understand the social characteristics of knowledge, and explores the integration of a social epistemology approach into knowledge translation research. We specifically focus on epistemic oppression, which consists of the repetition over time of three types of mutually reinforced epistemic exclusion. One type applies to an epistemic way of life led by dominant social groups, who prevent new systems of thought and knowledge, different from their own, to surface. A second type relates to socially oppressed individuals who must use resources they do not own to contribute to the construction of new common resources within the dominant system. The last type of epistemic exclusion consists of the impossibility of individuals being recognized as "knowers" because of prejudices that make them appear illegitimate. This thesis aims to analyze how everyday practices and the global health context foster epistemic oppression. Methodology: We study three processes, each related to a type of epistemic exclusion and following a three-level scale of analysis (macroscopic, mesoscopic and microscopic), which also covers the three branches of social epistemology (system, group and individual). First, we focus on the construction of an epistemic resource in global health at a macroscopic level, namely, universal health coverage (UHC), through a critical review of the literature. Secondly, we study the appropriation of this epistemic resource at a mesoscopic level, and how a group allows or does not allow dissenting voices, thus promoting a different definition of UHC. To this end, we conduct a case study of an interventional research program on UHC. Finally, we elaborate on the role of knowledge sources on the perception of knowledge through an experiment in global health. Results: The case of UHC demonstrates the existence of a productive power that, while giving the impression of an inclusive human approach, favours a market-based conception of health led by a global health "centre". We also observed that the appropriation of UHC in an interventional research program did not create a dissident; unorthodox definition of UHC. Several epistemic alliances (i.e. affiliations between members sharing the same orientation of studies to analyse UHC), emerged: a public health alliance, an economic alliance, an anthropological alliance, and a critical alliance. The latter, which suggested a global reflection on the deconstruction and governance of the UHC, did not occur because of concomitant inequalities. Finally, at a microscopic level, we showed that the "messenger" can be more important than the "message" when disseminating knowledge. Discussion and research value: The three types of epistemic exclusion can be read complementarily. Due to the proximity of the scientific and political worlds, and the desire to produce knowledge for action in global health, the social construction of UHC may influence how scientists appropriate this concept. It may limit the possibilities of epistemic diversity, and thus promoting the exclusion of some voices and points of view. A feeling of exclusion can, in turn, lead to self-limitation. Based on the premise that everyone can contribute to changing the structures that create injustice by resisting epistemic oppression, we propose a continuum of actions to address inequalities in global health governance.

No description available.

La lutte contre les fléaux sanitaires enregistre un nombre pléthorique d’acteurs, opérant avec des instruments et des stratégies différents. Cette pluralité d’acteurs et d’instruments affecte la cohérence du cadre organico-fonctionel de protection du droit à la santé et pose un véritable défi de coordination. Notre étude axée sur le cas spécifique du Sénégal, interroge les mécanismes actuels de coordination qui ont montré leurs limites à l’épreuve de la pratique, tant au niveau national qu’international. Dans l’ordre interne sénégalais, l’impératif de coordination des actions sanitaires est plus affirmé que traduit dans la réalité. Au niveau international, les multiples dispositifs de coordination se caractérisent par une approche statique, largement dépassée par les réalités complexes du droit de la santé. Cette thèse se propose de dépasser l’approche statique pour une stratégie dynamique de la coordination, centrée sur le mécanisme de régulation. Plus adaptée aux déséquilibres qui caractérisent le cadre de protection du droit à la santé, la coordination-régulation que nous avons retenue, s’attachera à assurer une bonne articulation entre le principe de la responsabilité et la gouvernance sanitaire pour une plus grande efficacité des actions sanitaires dans les États en développement, à travers l’exemple du Sénégal.Mots clés : Coordination, Sénégal, OMS, fragmentation des actions sanitaires, droit à la santé, ONG, approche verticale, approche systémique, efficacité, efficience, gouvernance sanitaire, responsabilité sanitaire, régulation, déséquilibres, médecine traditionnelle, approche dynamique, fléaux sanitaires, politiques nationales, télémédecine. / Strategies. This plurality of actors and instruments affects the coherence of the organic-functional framework for the protection of the right to health and poses a real coordination challenge. Our study focuses on the specific case of Senegal, questions the current coordination mechanisms that have shown their limits to the test of practice, both nationally and internationally. In the Senegalese internal order, the imperative coordination of health actions, although present in speeches and texts, is insufficiently translated into reality. At the international level, the multiple coordination mechanisms are characterized by a static approach that has been largely overtaken by the new realities of health law. This thesis offers to go beyond a static approach for a dynamic strategy of coordination, centered on the regulation mechanism. More adapted to the imbalances that characterize the framework of protection of the right to health, the coordination -regulation will seek to ensure a good articulation between the principle of the responsibility and the sanitary governance for a greater effectiveness of the sanitary actions in the States in development, through the example of Senegal;