Orientadores: Claudia Maria Bauzer Medeiros, André Santanchè / Tese (doutorado) - Universidade Estadual de Campinas, Instituto de Computação / Made available in DSpace on 2018-08-25T03:19:51Z (GMT). No. of bitstreams: 1 Vilar_BrunoSiqueiraCamposMendonca_D.pdf: 3275725 bytes, checksum: 4ccdd82eebca5b8da9748c7c515ea4c1 (MD5) Previous issue date: 2014 / Resumo: Sistemas de Gerenciamento de Workflows (WfMS -- em inglês) são usados para gerenciar a execução de processos, melhorando eficiência e eficácia de procedimentos em uso. As forças motrizes por trás da adoção e do desenvolvimento de um WfMS são aplicações científicas e de negócios. Esforços conjuntos de ambos resultaram em mecanismos consolidados, além de padrões e protocolos consensuais. Em particular, um WfMS científico (SWfMS -- \textit{Scientific WfMS}) auxilia cientistas a especificar e executar experimentos distribuídos. Ele fornece diferentes recursos que suportam atividades em um ambiente experimental, como prover flexibilidade para mudar o projeto de workflow, manter a proveniência e suportar reproducibilidade de experimentos. Por outro lado, apesar de poucas iniciativas de pesquisa, WfMSs não fornecem suporte apropriado à personalização dinâmica e baseada em contexto durante a execução; adaptações em tempo de execução normalmente requerem intervenção do usuário. Esta tese se concentra em superar essa deficiência, fornecendo a WfMSs um mecanismo de ciente do contexto para personalizar a execução de workflows. Como resultado, foi projetado e desenvolvido o DynFlow -- uma arquitetura de software que permite tal personalização aplicada a um domínio: planejamento de saúde. Este domínio foi escolhido por ser um ótimo exemplo de personalização sensível ao contexto. Procedimentos de saúde constantemente sofrem mudanças que podem ocorrer durante um tratamento, como a reação de um paciente a um medicamento. Para suprir a demanda, a pesquisa em planejamento de saúde desenvolveu técnicas semi-automáticas para suportar mudanças rápidas dos passos de fluxos de tratamento, de acordo com o estado e a evolução do paciente. Uma dessas técnicas é \textit{Computer-Interpretable Guidelines} (CIG), cujo membro mais proeminente é \textit{Task-Network Model} (TNM) -- uma abordagem baseada em regras capaz de construir um plano em tempo de execução. Nossa pesquisa nos levou a concluir que CIGs não suportam características necessárias por profissionais de saúde, como proveniência e extensibilidade, disponíveis em WfMSs. Em outras palavras, CIGs e WfMSs têm características complementares e são direcionadas à execução de atividades. Considerando os fatos citados, as principais contribuições desta tese são: (a) especificação e desenvolvimento do DynFlow, cujo modelo associa características de TNMs e WfMS; (b) caracterização das principais vantagens e desvantagens de modelos CIGs e WfMSs; (c) implementação de um protótipo, baseado em ontologias e aplicadas ao domínio da saúde e enfermagem / Abstract: Workflow Management Systems (WfMS) are used to manage the execution of processes, improving efficiency and efficacy of the procedure in use. The driving forces behind the adoption and development of WfMSs are business and scientific applications. Associated research efforts resulted in consolidated mechanisms, consensual protocols and standards. In particular, a scientific WfMS helps scientists to specify and run distributed experiments. It provides several features that support activities within an experimental environment, such as providing flexibility to change workflow design and keeping provenance (and thus reproducibility) of experiments. On the other hand, barring a few research initiatives, WfMSs do not provide appropriate support to dynamic, context-based customization during run-time; on-the-fly adaptations usually require user intervention. This thesis is concerned with mending this gap, providing WfMSs with a context-aware mechanism to dynamically customize workflow execution. As a result, we designed and developed DynFlow ¿ a software architecture that allows such a customization, applied to a specific domain: healthcare planning. This application domain was chosen because it is a very good example of context-sensitive customization. Indeed, healthcare procedures constantly undergo unexpected changes that may occur during a treatment, such as a patient¿s reaction to a medicine. To meet dynamic customization demands, healthcare planning research has developed semi-automated techniques to support fast changes of the careflow steps according to a patient¿s state and evolution. One such technique is Computer-Interpretable Guidelines (CIG), whose most prominent member is the Task-Network Model (TNM) -- a rule based approach able to build on the fly a plan according to the context. Our research led us to conclude that CIGs do not support features required by health professionals, such as distributed execution, provenance and extensibility, which are available from WfMSs. In other words, CIGs and WfMSs have complementary characteristics, and both are directed towards execution of activities. Given the above facts, the main contributions of the thesis are the following: (a) the design and development of DynFlow, whose underlying model blends TNM characteristics with WfMS; (b) the characterization of the main advantages and disadvantages of CIG models and workflow models; and (c) the implementation of a prototype, based on ontologies, applied to nursing care. Ontologies are used as a solution to enable interoperability across distinct SWfMS internal representations, as well as to support distinct healthcare vocabularies and procedures / Doutorado / Ciência da Computação / Doutor em Ciência da Computação

This study addresses the healthcare needs of employees and their families living in the Kruger National Park (KNP). A quantitative, explorative, descriptive research design was used to interview respondents who comprised of 75 male and female employees with children of various ages. The findings revealed that physical, psychological, environmental, socio-cultural, and behavioural needs of the employees and their families living in the KNP is probably unattainable as healthcare services are poorly distributed throughout the KNP, being mostly concentrated in the main camp of Skukuza. A number of respondents indicated that they required consultations about psychological and socio-cultural stresses in their lives. These services are not available in the KNP. / Health Studies / M.A. (Health Studies)

The concept of youth activity centre (YAC) has not yet been evaluated. The purpose of this study was to evaluate the YAC in Botswana. Accordingly, the researcher explored and described the lived experience of young people utilising the YAC as well as the perceptions of service providers at the Mochudi Centre in the Kgatleng District, in Botswana. Furthermore, the objective was to develop and describe guidelines for the facilitation of youth-friendly services (YFS) at YAC. A phenomenological, qualitative, explorative, descriptive and contextual research design was used to extract young people’s experiences and perceptions of service providers. Thirty-two young people and 27 service providers (peer educators and service delivery officers [SDOs]) were purposefully selected. Methods of data collection used were unstructured individual in-depth interviews, focus group discussions and observations in the forms of field notes. The data, mainly tape-recorded interviews and field notes were transcribed verbatim for data analysis. Tesch’s eight-step data analysis model (Creswell 1994:155) was used. One major theme, youth friendliness emerged with three categories, namely: physical, administrative, and psychological aspects of youth-friendly services. All the respondents indicated that they benefited and affirmed they were empowered and better people after using the facility. However, limited access to the facility by the target group due to location, cost of reaching the facility, and attitudes of service providers as well as failure to implement planned activities due to financial and staff shortage were obstacles to youth friendliness of the YAC. Based on the findings and literature review, the researcher developed guidelines to facilitate YFS and improved access to the YAC. Recommendations made are for practise in the YAC, education of SDOs and for further research. / Health Studies / D. Litt. et Phil. (Health Studies)

This study applied the theory of reasoned action (TRA) and its extension, the theory of planned behaviour (TPB) to the design of a workplace HIV/AIDS health promotion programme. The purpose of the study was to determine if the variables of the TRA and TPB would predict intentions to change HIV/AIDS health behaviour, whether a theory-based intervention would result in health behaviour change over time and if there would be any significant health behaviour differences among participants who received a theory-based intervention and those who received an information-only intervention. In a longitudinal, quasi-experimental study, 170 government employees were divided into two groups. One group comprised 92 employees who participated in a HIV/AIDS health promotion workshop based on the theories of reasoned action and planned behaviour. The other group comprised 78 employees who took part in an educational information session about HIV and AIDS. An elicitation study was conducted with a sample of 38 employees from the research population two months prior to the commencement of the study. The findings of the elicitation study informed the design of research questionnaires and an intervention workshop. Both groups of participants (theory-based workshop and information-only workshop) were measured on HIV/AIDS health behaviour intentions and HIV/AIDS health behaviour (condom use, seeking HIV testing and monogamy) across three measurement periods over a six month period. The results of the study showed that the combined theoretical variables predicted intentions to use condoms and to seek HIV testing, with attitudes having the main effect on intentions. There was, however, no significant health behaviour change across the three measurement periods. There were also no health behaviour differences between the two intervention conditions at one month and six months post-intervention. The study concludes that the intervention based on the theories of reasoned action and planned behaviour did not produce health behaviour change. The study also identified barriers to AIDS health behaviour in the South African context that the theories of reasoned action and planned behaviour cannot explain. Ways in which the theories of reasoned action and planned behaviour can be adapted to HIV/AIDS education in collectivist cultures are proposed. / Psychology / Thesis (D. Phil. (Psychology))

Teoretiese navorsing is onderneem om 'n model vir kurrikulumontwikkeling vir die Diploma vir Registrasie as Verpleegkundige (algemene, psigiatriese, gemeenskaps-) en Vroedvrou te ontwikkel. Twee hooffaktore beinvloed verpleegonderwys. Op globale vlak word verpleegonderwys beinvloed deur die realiteite van 'n inligtingtegnologie-gedrewe samelewing. Dit noodsaak die ontwikkeling van kritiese denke, aanpasbaarheid ten opsigte van konstante sosiale verandering en 'n verbintenis tot lewenslange leer. Op nasionale vlak word verpleegonderwys beinvloed deur 'n nasionale gesondheidstelsel wat gekwalifiseerde verpleegkundiges vereis, wat in staat is om omvattende gesondheidsorg te lewer. 'n Situasie-analise het gelei tot die identifisering van twee hoofkonsepte wat die verpleegkundekurrikulum beinvloed, naamlik lcritiese denke en omvattende gesondheidsorg. Vorige navorsing dui daarop dat verpleegdosente nie paraat is ten opsigte van verwikkelinge in die onderwys nie. Dit kan negatiewe gevolge he vir innoverende kurrikulumontwikkeling in verpleegkunde ten einde die professie strategies te posisioneer om te voldoen aan die eise van die komende eeu. Die navorser het beoog om die leemte te oorbrug deur middel van navorsing wat gemik was op die daarstelling van 'n omvattende kurrikulumontwikkelingstrategie wat kan dien as praktiese riglyn vir die implementering van kurrikulumontwikkeling in verpleegkunde. Op grond van 'n analise van die konsep kurri/culum, 'n situasie-analise en die interpretering daarvan, is die Model vir Kurrikulumontwikkeling in Verpleegkunde gekonseptualiseer. Die model kan verpleegdosente in staat stel om fundamentele kurrikulumverandering te bewerkstellig en 'n relevante kurrikulum daar te stel, deur gespesifiseerde kurrikulumontwikkelingstake stelselmatig af te handel. Die implikasies van die konsepte lcritiese denke en omvattende gesondheidsorg vir die verpleegkundekurrikulum, is uitgespel deur kriteria vir die nuwe verpleegkundekurrikulum te formuleer / The researcher undertook theoretical research to develop a curriculum development model for the Diploma for Registration as a Nurse (General, Psychiatric, Community) and Midwife. There are two main tendencies that influence nursing education. On a global level nursing education is influenced by realities that are inherent in an information technology-driven world. This requires the development of critical thinking skills, adaptability to constant social change and a commitment to life-long learning. Nationally, nursing education is influenced by a national health system requiring trained nurses who are able to render comprehensive health care. A situation analysis resulted in the identification of two main concepts that influence the nursing curriculum namely, critical thinking and comprehensive health care. Previous research indicates that nurse educators are outdated in terms of developments in education. This can have negative consequences for innovative curriculum development in nursing in order to position the nursing profession strategically to meet the demands of the next century. This limitation prompted the researcher to conduct research that was aimed at designing a comprehensive curriculum development strategy to serve as a practical guideline on how to implement curriculum development in nursing. Based on an analysis of the concept curriculum, a situation analysis and the interpretation thereof: the researcher conceptualized the Curriculum Development Model for Nursing. The model will enable nurse educators to effect fundamental curriculum change and the development of a relevant curriculum by completing specified curriculum development tasks systematically. The implications of the concepts critical thinking and comprehensive health care for the nursing curriculum, were elucidated by formulating criteria for a new nursing curriculum. Key terms: curriculum; curriculum development; curriculum foundation; curriculum structure; curriculum design; situation analysis; critical thinking; reflective practice; comprehensive health care; comprehensive nursing curriculum; community based curriculum; problem based learning; media assisted learning; ~ve learning; reflective learning; experiential learning; mediated learning. / Health Studies / D.Litt. et Phil. (Advanced Nursing Science)

Health Studies / D. Litt. et Phil. (Advanced Nursing Science)

Text in English / The purpose of this study was to explore and describe the experiences of community members regarding their participation in hospital boards in Dr Kenneth Kaunda district, North West Province. A qualitative exploratory-descriptive research was conducted on a purposively selected sample of community members who served in the board for a minimum period of two years. Data were collected by means of individual interviews and analysed by means of thematic data analysis. Three themes that emerged from data analysis were creation of opportunities, benefits and challenges. A mix of positive and negative experiences was expressed by community representatives regarding their participation in hospital boards. Participants described their experiences as enjoyable and empowering while others described it as a learning experience through which they acquired knowledge and new skills. The challenges experienced whilst serving in hospital boards included ineffective communication, poor relations and role conflict as a result of lack of role clarification. The findings from the study may be used to enhance the effectiveness of hospital governing boards through the participation of community members. / Health Studies / M.A. (Public Health)

O PSF emerge para reordenar o modelo de atenção à saúde. Os objetivos deste trabalho são o de estimar o consumo dos serviços de saúde e identificar a capacidade de oferta de serviços da USF. Foram realizadas entrevistas sobre o consumo de serviços de saúde por amostragem na população adscrita a equipe 01 da USF Jd Pirituba no Município de São Paulo. A procura por serviço de saúde nos 15 dias que precederam a entrevista foi de 22%. O local mais procurado foi o Centro de saúde. O principal motivo de procura foi a consulta clínica (51%). A descrição e análise do consumo efetivo da população adscrita às equipes de PSF pode servir como um importante instrumento para o planejamento das ações da USF / Brazil still has a National Health System unable to meet the needs of the population. Since the year 2001 the city of São Paulo established the Family Health Care Program as a structural strategy for the municipal health system. The hypothesis of this research is that the Family Health Care Program, as the other models of health care, offers services without matching the people utilization of health supplies. To stimate the utilization of health care supplies of a population visited by the Family Program (1360 families) and to identify the care services provided by a Family Health Care team are the objetives of this survey. A community inquiry were carried out among a sample from the population assisted by a family health care team in the Distritct of Pirituba located in the north-west of the city of São Paulo. The supervisor and the general phisicyan were also interviewed in order to estimate the services provided by the health team. The results showed an adult population, low level of literacy and low income. Thirthy-one percent was the population having a supplementary private health insurances. Twenty-two percent of the population seek the care of a professional within 15 days before the interview. The primary care services has the skill to be a portal of entry to the health System. People suffering from hypertension, heart disease and depression use more health services than healthy population. Searching for a physician appointment was 51% of the reasons to go to a health service, showing a poor interdiciplinary teamwork culture. Self-medication was very high for those medicine causing important side-effects. Referring patients to a specialist, having access to high-technology procedures and finding a place at hospitals were the main dificultties found by the family health care team. The health care coverage of the family health care team do not consider the utilization of health services by tha area served by them keeping the old fashion way of planning health services. The services they provide are not enough to meet the needs of the population they visit. The metodology of measuring the needs of the population to be attended is one of the ways to organize and plan a better population-based halth care system.

Il s’agit d’un étude sur la régionalisation de la santé sous l’optique des acteurs municipaux, régionaux et de l’Etat, engagés en la gestion de la santé de treize Municipes de la ‘‘Moitié- Sud’’ du ‘‘Rio Grande do Sul’’, des instances régionales et relatives aux Etats, aussi que le pouvoir qui se constitue dans les espaces décisoires. Il est inséré dans le projet intitulé : ‘‘Les flux et l’utilisation des services de santé, la mobilité des utilisateurs et les nouveaux défis pour la Santé Publique’’. La thématique de l’étude a son structure basée en trois axes : le politique (comme l’organisateur de l’espace décisoire), l’espace géographique (comme celui qui fait l’implantation du procès de décision) et les acteurs sociaux (comme les executeurs du procès) en employant le rapport théorique de Carlos Matus et de Mario Testa. Elle objective analyser les stratégies et la configuration du pouvoir, lesquelles s’établissent dans le plant relative à la régionalisation compris dans l’espace géographique des Municipes qui composent l’ ‘‘ASSEDISA Centre-Sud’’, dans l’Etat du ‘‘Rio Grande do Sul’’, sous l’optique des acteurs institués et ceux de la gestion gouvernementale. La recherche possède une abordage qualificative et elle a eté développée avec les acteurs des treize Municipes qui appartiennent à l’ ‘‘ASSEDISA Centre-Sud’’ et ceux qui sont engagés au procès de régionalisation dans la Région et l’Etat. L’identification des catégories empiriques a eté réalisée par moyen de l’analyse thématique et, après, on est parti pour l’analyse stratégique proposée par Matus et Testa. Pour cela on a utilisé les variables de cette analyse : l’acteur, les apérations, les moyens stratégiques, le temps et, encore, les catégories : le pouvoir, l’espace de decision, les stratégies institutionelles et programatiques. Par l’analyse des résultats ont été signés le financement en Santé specialement en complexité moyenne et l’organisation du Système, comme les principaux problèmes qui ont fait face les acteurs du Municipe, pendant le procès de descentralisation en Santé. On a observé, aussi, leur difficulté d’accepter la responsabilité, sauf de la gestion de l’attention basique, et le crainte de l’acroissement de leur responsabilité par la signature du Pacte de Gestion, car ils repassaient déjà, en plus que le minimun constitutionnel. La discussion des fixes et des fluxes, qui passent le territoire de Santé, montre les difficultés qui les découpures spacieuses et les dessins des résaux ‘‘platrés’’ imposaient aux Municipes. De cette forme, ils utilisaient la capacité instalée de ‘‘Porto Alegre’’ pour les consultations et les procédés specialisés, au-delà des services de l’Association Intermunicipale Centre-Sud et ils envisageaient la complexité moyenne dans la Région, dans quelques hôpitaux. Le Programme Pactué et Intégré, le règlement en Santé et les analyses parvenues du Pacte de Gestion ont été considerées des mécanismes qui indiquaient l’execution des fluxes, lesquels, avec les fixes, ont de l’influence et sont influencés par le jeu politique où survient la distribution du pouvoir politique. Par cet étude a été indiquée la force des autres espaces décisoires sour les Municipes, specialement de la part du Ministère de la Santé qui a été consideré le protagoniste de l’arène décisoire et le guide de l’axe des Politiques Publiques, au Brésil. On conclut la necessité de répenser la consolidat / Trata-se de um estudo sobre a regionalização da saúde sob a ótica de atores municipais, regionais e estaduais, envolvidos com a gestão em saúde de treze Municípios da “Metade Sul” do Rio Grande do Sul, instâncias regionais e estaduais, bem como o poder que se constitui nos espaços decisórios. Está inserido no projeto intitulado “Fluxos e utilização de serviços de saúde: a mobilidade de usuários e os novos desafios para a Saúde Pública”. A temática do estudo se estrutura em três grandes eixos: o político (como organizador do espaço decisório), o espaço geográfico (como operacionalizador do processo de decisão) e os atores sociais (como executores do processo), utilizando-se do referencial teórico de Carlos Matus e de Mario Testa. Objetiva analisar as estratégias e a configuração de poder que se estabelecem no planejamento relativo à regionalização, compreendido no espaço geográfico dos Municípios que compõem a ASSEDISA Centro-Sul no Estado do Rio Grande do Sul, sob a ótica de atores institucionais e da gestão governamental. Possui abordagem qualitativa e foi desenvolvido junto a atores municipais dos treze Municípios pertencentes à ASSEDISA Centro-Sul e a atores regionais e estaduais envolvidos no processo de regionalização na Região e no Estado. A identificação das categorias empíricas foi realizada por meio da análise temática e, após, partiu-se para a análise estratégica proposta por Matus e Testa. Para tanto, utilizou-se das variáveis de análise estratégica: ator, operações, meios estratégicos e tempo e, a categoria poder, espaço de decisão, estratégias institucionais e programáticas. Pela análise dos resultados foi apontado o financiamento em Saúde, especialmente, em média complexidade, e a organização do Sistema como os principais problemas enfrentados pelos atores municipais no processo de descentralização em saúde. Por outro lado, observou-se a dificuldade que estes tinham em aceitar sua responsabilidade, além da gestão da atenção básica, e o receio do aumento da responsabilidade pela assinatura do Pacto de Gestão, pois os mesmos já vinham repassando além do mínimo constitucional. A discussão de fixos e fluxos que perpassam o território de Saúde demonstra as dificuldades que os atuais recortes espaciais e desenhos de redes “engessados” vinham impondo aos Municípios. Dessa forma, esses utilizavam a capacidade instalada de Porto Alegre para consultas e procedimentos especializados, além dos serviços do Consórcio Intermunicipal Centro-Sul e focavam a média complexidade na Região, em alguns hospitais regionais. Já a Programação Pactuada e Integrada, a regulação em Saúde e as análises oriundas do Pacto de Gestão foram considerados mecanismos que apontavam para a efetivação dos fluxos. Tanto os fixos quanto os fluxos influenciam e são influenciados pelo jogo político, sendo que nesse ocorre a distribuição do poder político. O presente apontou a força dos demais espaços decisórios sobre os Municípios, especialmente, por parte do Ministério da Saúde que foi apontado como o protagonista da arena decisória e orientador do eixo das políticas públicas no Brasil. Conclui-se a necessidade de se repensar a consolidação da microrregião, a partir da análise situacional, local e regional, bem como a reorganização do Sistema de Saúde. / This is a study on the regionalization of health service under the optics of municipal, regional and state actors involved with the health management of thirteen municipalities in the "southern half" of Rio Grande do Sul, regional and state bodies, as well as the power which is constituted in decision-making spaces. The present study is part of a project entitled "Flows and Utilization of Health Services: Mobility of Users and New Challenges for Public Health". The theme of the study is structured around three main axes: the politic space (as organizer of the decision-making space), the geographic space (as operator in the decision-making process), and the social actors (as executors of the process), using the theoretical referential of Carlos Matus and Mario Testa. It had the objective of analyzing the strategies and the configuration of power which are established in planning related to regionalization included in the geographical area of the municipalities that compose the Center-South ASSEDISA in the State of Rio Grande do Sul from the viewpoint of institutional actors as well as government managers. It used a qualitative approach and was developed with municipal actors of the thirteen mentioned municipalities which belong to Center-South ASSEDISA and the regional and state actors involved in the process of regionalization, both in the region and in the state. The identification of empirical categories was pursued through the thematic analysis and then it as done a strategic analysis proposed by Matus and Testa. To do so, it was used the variables of strategic analysis: actor, operations, strategic resources and time; and the categories of power, decision-making space as well as institutional and programmatic strategies. By the analysis of the results, the health financing – especially the one of average complexity, and the organization of the system were appointed as the main problems faced by local actors in the process of decentralization of health. On the other hand, it was noted the difficulty they had to accept their own responsibility, besides the management of basic care, and the fear of increasing responsibility by signing the Pact of Management because they had already been offering subsidies beyond the constitutional minimum. The discussion of ‘fixed’ and ‘flows’ that permeate the territory of Health shows the difficulties that today’s spatial records and drawings of "plastered" networks were imposing to the municipalities. In this way, they used the installed capacity of Porto Alegre for health service and specialized procedures, besides the services of Inter-municipal Center-South Consortium and focused the average complexity in the region, in some regional hospitals. Both ‘fixed’ and ‘flows’ influence and are influenced by the political game, being notorious the distribution of political power. This study pointed to the strength of other decision-making spaces on the municipalities, especially, by the Ministry of Health which was appointed as the protagonist of decision-making arena and public policy axis guiding in Brazil. It is concluded the need of rethinking the consolidation of micro-region, from the situational, local and regional analysis as well as the reorganization of the Health System. / Se trata de un estudio sobre la regionalización de la salud bajo la óptica de actores municipales, regionales y estaduales, involucrados con la gestión en salud de trece Municipios de la “Mitad Sur” del Río Grande del Sur, instancias regionales y estaduales, bien como el poder que se constituye en los espacios decisorios. Está inserido en el proyecto intitulado “Flujos y utilización de servicios de salud: la movilidad de usuarios y los nuevos retos para la Salud Pública”. La temática del estudio se estructura en tres grandes ejes: el político (como organizador del espacio decisorio), el espacio geográfico (como operacionalizador del proceso de decisión) y los actores sociales (como ejecutores del proceso), utilizándose del referencial teórico de Carlos Matus y de Mario Testa. Objetiva analizar las estrategias y la configuración de poder que se establecen en el planteamiento relativo a la regionalización, comprendido en el espacio geográfico de los Municipios que componen la ASSEDISA Centro-Sur en el Estado del Río Grande del Sur, bajo la óptica de actores institucionales y de la gestión gubernamental. Posee abordaje cualitativo y fue desarrollado junto a actores municipales de los trece Municipios pertenecientes a la ASSEDISA Centro-Sur y a actores regionales y estaduales involucrados en el proceso de regionalización en la Región y en el Estado. La identificación de las categorías empíricas fue realizada por medio del análisis temático y, luego, se partió para el análisis estratégico propuesto por Matus y Testa. Para tanto, se utilizó de las variables de análisis estratégico: actor, operaciones, medios estratégicos y tiempo y, la categoría poder, espacio de decisión, estrategias institucionales y programáticas. Por el análisis de los resultados fue apuntado el financiamiento en Salud, especialmente, en mediana complexidad, y la organización del Sistema como los principales problemas enfrentados por los actores municipales en el proceso de descentralización en salud. Por otro lado, se observó la dificultad que éstos tenían en aceptar su responsabilidad, además de la gestión de la atención básica, y el recelo del aumento de la responsabilidad por la firma del Pacto de Gestión, pues los mismos ya venían repasando además del mínimo constitucional. La discusión de fijos y flujos que pasan el territorio de Salud demuestra las dificultades que los actuales recortes espaciales y dibujos de redes “enyesados” venían imponiendo a los Municipios. De esa forma, ésos utilizaban la capacidad instalada de Porto Alegre para consultas y procedimientos especializados, además de los servicios del Consorcio Intermunicipal Centro-Sur y enfocaban la media complexidad en la Región, en algunos hospitales regionales. Ya la Programación Pactuada e Integrada, la regulación en Salud y el análisis oriundos del Pacto de Gestión fueron considerados mecanismos que señalaban para la efectuación de los flujos. Tanto los fijos cuanto los flujos influencian y son influenciados por el juego político, siendo que en ése ocurre la distribución del poder político. El presente señaló la fuerza de los demás espacios decisorios sobre los Municipios, especialmente, por parte del Ministerio de la Salud que fue apuntado como el protagonista de la arena decisoria y orientador del eje de las políticas públicas en el Brasil. Se concluye la necesidad de se repensar la consolidación de la microrregión, a partir del análisis situacional, local y regional, bien como la reorganización del Sistema de Salud.

The concept of youth activity centre (YAC) has not yet been evaluated. The purpose of this study was to evaluate the YAC in Botswana. Accordingly, the researcher explored and described the lived experience of young people utilising the YAC as well as the perceptions of service providers at the Mochudi Centre in the Kgatleng District, in Botswana. Furthermore, the objective was to develop and describe guidelines for the facilitation of youth-friendly services (YFS) at YAC. A phenomenological, qualitative, explorative, descriptive and contextual research design was used to extract young people’s experiences and perceptions of service providers. Thirty-two young people and 27 service providers (peer educators and service delivery officers [SDOs]) were purposefully selected. Methods of data collection used were unstructured individual in-depth interviews, focus group discussions and observations in the forms of field notes. The data, mainly tape-recorded interviews and field notes were transcribed verbatim for data analysis. Tesch’s eight-step data analysis model (Creswell 1994:155) was used. One major theme, youth friendliness emerged with three categories, namely: physical, administrative, and psychological aspects of youth-friendly services. All the respondents indicated that they benefited and affirmed they were empowered and better people after using the facility. However, limited access to the facility by the target group due to location, cost of reaching the facility, and attitudes of service providers as well as failure to implement planned activities due to financial and staff shortage were obstacles to youth friendliness of the YAC. Based on the findings and literature review, the researcher developed guidelines to facilitate YFS and improved access to the YAC. Recommendations made are for practise in the YAC, education of SDOs and for further research. / Health Studies / D. Litt. et Phil. (Health Studies)