L’une des principales sources de changement dans le système de santé est actuellement la numérisation et la mise en réseau technique, se traduisant par le développement de la télémédecine. Si cette « médecine à distance », utilisant les TIC, a pu se résumer en quelques expérimentations menées essentiellement dans le cadre hospitalier, le gouvernement entend lui donné une nouvelle impulsion. Elle doit constituer un facteur clé d’amélioration de la performance du système de santé. Son usage dans les territoires doit incarner une réponse organisationnelle et technique aux nombreux défis épidémiologiques, démographiques et économiques auxquels fait face le système de santé aujourd’hui. Cette recherche apour but de contribuer à établir le sens social et politique du développement de la télémédecine. Il s’agit de cerner de façon systématique et dans leur ensemble les dynamiques qui conduisent ce changement, tout en mettant en avant les conséquences dans la démarche de soin classique au niveau des usagers. Analyse des politiques publiques et étude du changement technologique se fondent dans l’approche choisie de la sociologie politique des usages. Ancrée au confluent du modèle des politiques publiques et de la sociologie de l’innovation, la recherche a permis d’identifier et d’expliquer les principales dynamiques conditionnant le processus de développement de la télémédecine, en partant des politiques publiques jusqu’à la mise en place des technologies. La télémédecine est la fois le moteur et le résultat de la réformede la modernisation du système de santé. Son référentiel est fortement imprégné par les exigences de rationalisation et de gestion du réseau socio-sanitaire et demeure principalement légitimé par des critères de rentabilité et de performance qui sont probablement incompatibles avec l’efficience clinique et thérapeutique des services de soins. La télémédecine pourrait rendre de nombreux services dans la gestion des activités humaines et professionnelles, par une gestion davantage réfléchie, concertée et planifiée du changement technologique / One the main source of change in the health service system is the digitization and Networking technique wich can be seen in the development of telemedicine. If this « medicine at distance », using ITC, could be summed up in a few experiments in the hospital field, the government wants to give it a new impulse. It must be the key to improve the health service system. Its use in the territories must embody an organizational and technical answer epidemiological, demographic and economic numerous challenges, to wich the health system has to face nowadays. This investigation is aimed at contributing to settle the social and political meaning of telemedicine development. One has to identify systematically and in the whole the forces which lead to this change, while at the same time highlighting the consequences in users the classical approach. The analysis of the public politics and the study of the technological change convey in the political sociology uses. Anchored between the public politic model and the sociological innovation, the investigation has allowed to identify and explain the main dynamics which influence the telemedicine development process, starting by the public policies to the implémentation of technologies. The telemedicine is both the impulse and the result of the health service system modernization reform. Itsrepository is strongly influenced by the rationalizing of the requirements and the management of the health and social network and remains mainly legitimized by profitability and performance criterias which are probably incompatible with clinical and therapeutic efficiency of health services. The telemedicine could make many services in the management of human and Professional activities, thank to a management more thought, concerted, planed of the technologic change

Orientador: Gastão Wagner de Sousa Campos / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-26T19:35:47Z (GMT). No. of bitstreams: 1 Massuda_Adriano_D.pdf: 9511997 bytes, checksum: fa15df610be3df36d06f7e6c1aaeea1d (MD5) Previous issue date: 2014 / Resumo: A elaboração da presente dissertação ocorreu acompanhando o trabalho de formulação e implementação de mudanças no âmbito da secretaria de saúde de Curitiba, durante o ano de 2013. O trabalho fundamentam-se na produção teórica desenvolvida por Campos: o Método Paidéia e o modo de pensar e agir baseado na práxis, combinada a referenciais da área do Planejamento e Gestão em Saúde, da Análise Institucional e da Organização e Gestão de Sistemas, Redes e Práticas em Saúde. É feita análise histórica da organização da saúde no Município e dos referenciais utilizados para organização do modelo de atenção e estruturação da Secretaria Municipal de Saúde. O cenário atual também é descrito, destacando a situação de saúde, estrutura física, recursos existentes e dados de produção da rede municipal. Em seguida, são apresentadas as bases para construção das mudanças no SUS Curitiba, a formação de uma nova equipe dirigente, a elaboração do planejamento estratégico, a implantação do Apoio à gestão num desenho macrorregional e a reorganização administrativa; bem como o desenho de novo Modelo-Conceitual e a utilização de Conceitos-Operativos. Por fim, são apresentadas estratégias utilizadas para construção de mudanças na Atenção Primária em Saúde, Urgência e Emergência, Atenção Especializada, Saúde Mental, Controle Avaliação e Auditoria e Vigilância em Saúde. O produto do trabalho pode servir para análise do momento vivido na política de saúde do país: limites e reformulações necessárias. O sistema de saúde ganhou diversos pontos de atuação e grande complexidade, o que demanda estratégias de gestão, que fortaleçam a participação de usuários e trabalhadores e ao mesmo tempo torne possível a unidade da rede, a garantia da integralidade e do acesso. Neste sentido, a experiência de Curitiba poderá ser emblemática na medida em que puder articular ações regulatórias, gestão participativa e apoio institucional. Além disso, a potência de uma experiência deve ser medida pela expressão dos quadros que ela permite que surjam. Neste cenário nacional que aponta para a grande fragilização da representatividade dos movimentos sociais, uma das maiores contribuições do que vivemos em Curitiba pode ser ajudar a nos reinventarmos como agentes da reforma / Abstract: The preparation of this dissertation occurred following the work of formulation and implementation changes under the health department of Curitiba, during the year 2013. The work are based on the theoretical work developed by Campos: the Paideia method and way of thinking and acting based on praxis , combined with the reference area of Planning and Management in Healthcare , Institutional Analysis and Organization and Management Systems, Networks and practices in Health historical analysis of the health organization is made in the city and the references used for organizing and structuring the attention of the Municipal Health the current scenario is also described model , highlighting the health status , physical structure , existing resources and production data from the municipal network. Then , we present the basis for construction of SUS changes in Curitiba , the formation of a new management team , the development of strategic planning , implementation of management support in a macro-regional design and administrative reorganization , as well as the design of new - model conceptual and use of Operating Concepts . Finally , we present strategies used to construct changes in Primary Health Care , Emergency Department , Specialized Care , Mental Health , Evaluation and Audit Control and Surveillance in Health 's work product can be used to analyze the time lived in policy health of the country : limits and necessary reformulations . The health system has gained several points of action and great complexity, demand management strategies , to strengthen the participation of users and workers and at the same time makes it possible to drive the network , ensuring the integrity and access . In this sense , the experience of Curitiba may be emblematic in that it can articulate regulatory actions , participatory management and institutional support . In addition, the power of an experiment should be measured by the expression of the frames that it enables emerge. In this national scene that points to the great weakening of the representativeness of the social movements, one of the greatest contributions that we¿re living in Curitiba can help reinvent ourselves as agents of reform / Doutorado / Política, Planejamento e Gestão em Saúde / Doutor em Saude Coletiva

Orientador: Rosana Teresa Onocko Campos / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-27T03:54:20Z (GMT). No. of bitstreams: 1 Trape_ThiagoLavras_D.pdf: 1150057 bytes, checksum: cd5b0c8d322745cb955c2d2d47b4f53c (MD5) Previous issue date: 2015 / Resumo: O desenvolvimento das políticas de saúde mental em países com sistemas nacionais de saúde se constituíram a partir de princípios relativos aos seus diferentes processos históricos , mas com diversos pontos de aproximação que são hoje consensos: ampliação das práticas comunitárias, fechamento progressivos dos hospitais psiquiátricos, diversificação de pontos de atenção, aumento do orçamento próprio, trabalho em rede, etc... Os estudos comparados nos permitem analisar realidades em paralelo para evidenciar aspectos convergentes e divergentes diante de organizações distintas, mas com objetivos comuns, possibilitando organizar matrizes que analise os avanços e desafios da rede de atenção à saúde mental. Este estudo pretende analisar e comparar as redes de atenção à saúde mental do Brasil e da Catalunha através dos componentes macro estruturais da política de cada território. Trata-se de uma tese apresentada em modelo alternativo, com 3 artigos com metodologia e resultados, próprios ancorados em revisão narrativa, análise documental e análise de indicadores de saúde. Ambos territórios possuem Leis que sustentam o modelo de saúde mental de base comunitária, Na Catalunha a política é construída de modo mais técnico e verticalizado, influenciado pelas OMS, enquanto no Brasil a construção é ascendente com ampla participação social na definição das ações. O financiamento na Catalunha é maior tanto na saúde global quanto especifico da saúde mental, no SUS a saúde mental é área subfinanciada dentro de um sistema subfinanciado. Em ambas o foco do financiamento vem se alterando, com maior investimento em serviços comunitários, mas a Catalunha ainda despende maior parte do financiamento para os hospitais. O modelo de gestão dos serviços é distinto, no Brasil ainda é fundamentalmente de gestão direta e na Catalunha indireto. O modelo de Governança regional da Catalunha é mais adequada que o municipalismo brasileiro, pois reduz a fragmentação sistêmica e possibilita organização em redes mais integradas. Ambos possuem uma rede ampla e diversificada de serviços, mas com necessidade em lidar com o contingente amplo de moradores de Hospitais Psiquiátricos e avançar em mecanismos avaliativos que respondam a complexidade da política / Abstract: The development of mental health policies in countries with national health systems constituted from principles concerning their different historical processes, but with different points that are now consensus: expansion of community practices, progressive closure of psychiatric hospitals, diversification points of attention, increase the budget itself, networking, etc ... The comparative studies allows us to analyze realities in parallel to highlight convergent and divergent aspects in different organizations, but with common goals, which allows us to organize arrays to analyze progress and challenges of mental health care network. This study aims to analyze and compare the care networks to mental health in Brazil and Catalonia through macro structural components of the policy of each territory. This is a thesis presented in alternative model, with 3 items with methodology and results, themselves anchored in narrative review, document analysis and analysis of health indicators. Both territories have laws that support the mental health community-based model, in Catalonia politics are built of more technical and vertical mode, influenced by WHO, while in Brazil the construction is up with broad social participation in the definition of actions. Funding in Catalonia is greater both in global and specific health mental health, the SUS mental health is underfunded area within a system underfunded. In both cases the focus of the funding is changing, with greater investment in community services, but Catalonia still spends most of the funding in hospitals. The management model of services is different in each country, in Brazil is still fundamentally direct management and in Catalonia, is indirect. The regional governance model of Catalonia is more appropriate than the Brazilian municipal model because it reduces systemic fragmentation and enables the organizations in more integrated networks. Both have a wide and diverse network services, but need to deal with the large number of residents of psychiatric hospitals and advance evaluation mechanisms that respond to the complexity of the policy / Doutorado / Política, Planejamento e Gestão em Saúde / Doutor em Saude Coletiva

Orientador: Eduardo Fagnani / Dissertação (mestrado) - Universidade Estadual de Campinas, Instituto de Economia / Made available in DSpace on 2018-08-27T06:35:34Z (GMT). No. of bitstreams: 1 Pegoraro_AnaPaulaAndreotti_M.pdf: 1055106 bytes, checksum: 1fe71a3602f26ef254770eb3e5986ac2 (MD5) Previous issue date: 2015 / Resumo: Esta dissertação tem por objetivo delinear as relações entre os setores público e privado no que diz respeito à assistência à saúde no Brasil, destacando que os avanços formais da Constituição Federal de 1988 foram sobrepostos por um contexto político e econômico hostil que se abre a partir de 1990, que limitou o fortalecimento do setor público em favor da contínua expansão do setor privado. Este trabalho está dividido em duas partes, a primeira destaca os determinantes históricos e as relações entre Estado e mercado na saúde no período anterior à Constituição de 1988. Sublinha a forte predominância do setor privado no país desde os primórdios da formação do sistema de saúde brasileiro num contexto marcado pelo vigoroso viés conservador da sociedade e suas rígidas estruturas de um capitalismo tardio e dependente, marcado pela segregação social e dependência externa. Ressalta-se também o movimento de modernização conservadora dos bens e serviços públicos durante os 21 anos de governo militar, bem como os avanços sociais da Constituição de 1988. Na segunda parte discute-se a introdução do neoliberalismo no Brasil a partir dos anos de 1990, após ganhar força nos países centrais e subdesenvolvidos durante as décadas de 1970 e 1980. O trabalho sublinha o antagonismo desta corrente com os princípios do Sistema Unico de Saúde recém-implantado em 1988, com destaque para as diretrizes e orientações políticas do Banco Mundial no incentivo à expansão da iniciativa privada na oferta de serviços de saúde. Esse movimento político e econômico mais amplo era antagônico aos princípios estabelecidos pela Carta de 1988 e contribuíram, em grande medida, para que o processo de consolidação do SUS fosse permeado por diversas contramarchas que abriram novas brechas para a expansão do setor privado na saúde / Abstract: This paper aims to outline the relationships between the public and private sectors in health care on Brazil, noting that the formal advances of the Federal Constitution of 1988 were superimposed by a hostile political and economic context that was imposed in the 90's, that limited the strength of the public sector in favor of continued expansion of the private sector. This work is divided into two parts, the first shows the historical determinants and the relationship between state and market in health in the period prior to the 1988 Constitution. This part underlines the strong predominance of the private sector in the country since the beginning of formation of the Brazilian health system in a context characterized by strong conservative bias of society and its rigid structures of late and dependent capitalism. Also points up the conservative modernization movement of goods and public services during the 21 years of military government and the social advances of the 1988 Constitution. The second part discusses the introduction of neoliberalism in Brazil from the 90's, after gaining strength in the central and developing countries during the 70's and 80's. This work emphasizes the antagonism of this current with the principles of the Unified Health System (SUS) recently implemented in 1988, highlighting the guidelines and political directives of the World Bank encouraging the expansion of the private sector in the supply of health services. This broader political and economic movement was antagonic to the principles established by the 1988 constitution and contributed largely to the SUS consolidation process was impeded by several setbacks that have opened new spaces for the expansion of the private sector in health / Mestrado / Economia Social e do Trabalho / Mestra em Desenvolvimento Econômico

This master’s thesis consists of two separate sections – theoretical and practical. Theoretical part of the thesis concentrates on the description of occupational safety and health systems as well as the major accidents prevention system. In addition, this part deals with the major accidents prevention legislation. Moreover, there are some serious industrial accidents described in the theoretical part. Practical part of the thesis considers an audit of major accidents prevention system in an industrial enterprises as well as its evaluation and improvement mechanisms recommendation. The audit is based on legislative demands for major accidents prevention systems.

Philosophiae Doctor - PhD / The continuum of care is a public health framework for improving maternal health outcomes by providing comprehensive health services, at different levels of the health system and across the lifecycle. The framework emphasizes the importance of interventions to address the social determinants of health as well, alongside healthcare services. Although the framework is useful for visualizing service organization, it has not been adequately integrated into policy and practice in South Africa. In addition, there is currently no comprehensive approach to monitor and evaluate service provision along the continuum of care. The current approach is fragmented across programs and sectors and focuses on only a handful of indicators. This research explores an approach for measurement and monitoring of a comprehensive continuum of care for maternal health in South Africa, with implications for application in other low- and middle-income countries (LMICs).

In this dissertation System Dynamics is used as a modelling approach to model health care systems to gain a better understanding of the system’s behaviour. This improved understanding can be used to better manage the system and in turn will translate to improved health outcomes. The characteristics of complex systems were reviewed to define a health system as a complex system. Four appropriate modelling approaches was studied that could be used to model complex systems. These modelling approaches included: Monte Carlo Simulation, Discrete Event Simulation, System Dynamics and Agent Based Modelling. System Dynamics was identified as being the most appropriate modelling methodology to be used for the framework. Before the framework was developed health system performance measurement was reviewed to further the understanding of health system measurement. The framework was developed according to the insights gained from the previous reviews. Specifically the elements identification was customised to the health care environment based on available health indicators. The framework was applied in a case study where a section of the South Africa health care system was modelled to focus interventions for human immunodeficiency virus (HIV). The outcomes of the case studies delivered an increased understanding of the system behaviour and also showed appropriates of the framework. / Dissertation (MEng)--University of Pretoria, 2012. / Industrial and Systems Engineering / unrestricted

A thesis submitted in fulfilment of the requirements for the degree of Doctor of Philosophy in the Department of Communication Science at the University of Zululand, South Africa, 2012. / The under-resourced and overused public health sector of South Africa has been the subject of national policy reform initiatives and frequent government led investigations. Subsequently, in October 1997, the government introduced eight Batho Pele principles to serve as acceptable policy and legislative framework regarding service delivery in the public service. However the media has constantly criticised the public health system for their pathetic service delivery. Hospitals and clinics have been portrayed as being overburdened and under-productive. Multiple efforts by the government to remedy (and rescue) the situation have not decreased nor diminished the problems. The primary goal of this study is to examine the current quality of service offered by the public health system in South Africa especially in terms of service delivery proposed by the Batho Pele principles. More importantly, how the Batho Pele principles are communicated to the external publics will be evaluated to ascertain the challenges key government sectors face in the adoption and application of these principles. The participation of patients and staff members of two public health facilities in KwaZulu-Natal provided this study with valuable information on which this study is based. The data was collected through the use of structured interviews of in-patients and questionnaires for both outpatients and staff members. A total of 255 patients and 92 staff members participated in this study. Further, the study exposes provocative and controversial issues in the public health system and hopes to stir awareness amongst its respective leaders and its publics. This study demonstrates how challenges faced by the public health organisations through poor ineffective communication techniques caused it to fail to meets its intended purpose. This study also exposes provocative and controversial challenges which place our health care system at risk of total annihilation if left unattended. The study speaks to issues of accountability such as: planning, budgeting and decision making and the plight of the people of our nation.

No description available.

Philosophiae Doctor - PhD / Oral diseases are a major public health problem in the Seychelles, amidst a contracting budget coupled by a lack of national oral health policy and strategic plan to promote oral health. The oral disease burden is attributed to numerous determinants operating at different levels –macro, population and community, and at the person level. The study set out to examine the determinants that contribute to poor oral health in the Seychelles through an exploration of the social, cultural, economic and environmental factors influencing the oral health of adults. The purpose of the study was to develop an evidence-based theoretical framework that would inform future policy and practice for oral health. Set in the mixed research paradigm, a qualitative and quantitative research approach was used to obtain a deeper understanding of the pathways and mechanisms operationalizing determinants. Using a purposive sampling approach, individual and group interviews were conducted with patients, dental staff and a representative of the upper management.