Objective: The overall aim of the work is to contribute to a better understanding of the dynamics between health sector reform policies and practices as well as the factors that determine and shape the thinking about global public health; and to try out a framework for understanding the inter-linkages and interactions between the determinants for and the elements of health sector reforms and their implementation. Methods: The object of study was a contemporary phenomenon, consisting of a diverse array of interventions in many different directions and fields within a complex political, social and economic environment. It is difficult to attribute the effects of the reforms to any single intervention or to establish exact boundaries between the phenomenon and the context. Therefore, a multi-stage case study research strategy, based on the work of R.K.Yin, was chosen. The study involved two major sub-units of analysis, i.e., the macro and the micro level. Each of these involved several sub-units of analysis. The analysis of the micro level further comprised a cross-case analysis of 10 individual case studies conducted in six developing countries. Results: Clear linkages were found between the greater societal processes and the shape and results of reforms during the decade. The reforms had not been completed in any of the countries studied, but appeared to be stuck with undesired effects, lacking energy to move forward. Contributing to this was the diminishing role of the state, which bordered abdication from public health in most of the countries, leaving the drive to the market and individual demands and interests. The net effect could well be a reversal of some of the public health achievements of the past - however, it was also found that reverting to dedicated disease control programmes would not be the answer, as these were found unsustainable and undermining the health systems. Conclusion: There is a divide between libertarian and utilitarian values on the one side and communitarian and egalitarian values on the other. Thus, it is not just about public health practitioners not being good enough to implement, it is more so about what we want to achieve and what it acceptable respectively not acceptable and reaching compromises. This place the societal processes at centre-stage for public health. However, it is also about implementation, it is about how public health policy-makers and reformers can effectively dialogue and facilitate achieving consensus and translate the societal 'wants' and 'want nots' into managerial bites. Implementation becomes a process of constant adjustment and readjustment oscillating between political and technocratic levels

El texto completo de este trabajo no está disponible en el Repositorio Académico UPC por restricciones de la casa editorial donde ha sido publicado. / In Peru, the health service has had certain problems in the attention of users. The emergency service of clinics has been saturated due to changes in the needs of people and demand, exposing the prestige of health entities that have this unit and generating risks for the health of users, this is reflected in the low level of satisfaction with regard to care. Based on the Lean philosophy, a model is developed using SMED, Kanban and pull tools to reduce waiting times. The application of this model of pilot in the Clinic reduces the waiting time for the first attention in 30% thereby reducing the number of fines imposed by the corresponding regulatory entity and the desertion in emergency, achieving an average time of 37 min.

Purchase management of medical supplies is a critical and important process that affects the services provision quality. Nonetheless, it is facing a growing pressure to provide visibility and traceability of the purchase, to reduce fraud, to improve flexibility and to ensure communication between everyone involved. Currently, private health institutions in Peru choose to implant different software products within the same company with restricted visibility access to other concerned parties and based on information from a single source. A new alternative is Blockchain technology, since it provides a single source of shared truth to all participants and ensures that the information cannot be altered, thus offering high levels of transparency that, together with IoT technology, creates not only visibility about where things are, but also traceability, showing the current state of things. / Revisón por pares

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This study focuses on records management in support of service delivery in the public health sector of Limpopo Province, South Africa. The study sought to investigate whether the current records-keeping practices support or undermine service delivery and the e-health readiness level. Mixed methods were used for the survey. Questionnaires, observation and interviews were used to collect data. Purposive sampling method was used to identify interview participants and stratified random sampling for questionnaire participants. The total population of the study was 324 from which 210 participants were sampled. The response rate was 77% (162). The study discovered that records management negatively affected timely and effective health care services. This resulted in long patient waiting times and patients being treated without their medical history records. The study recommended the introduction of an electronic records management system capable of capturing and providing access to a full patient record and tracking paper record movement. / Information Science

This exploratory study examines the relationship between the work-life balance and organisational culture of medical doctors and nurses in Nigeria. There has been an overwhelming majority of work-life balance studies undertaken in Western countries. This leaves Africa, most notably Nigeria, an understudied area of investigations. In order to achieve this objective, this study applies a qualitative research method. Semi-structured qualitative interviews were carried out with 62 medical doctors and 29 nurses across the six geopolitical zones of Nigeria. Drawing on the data collected, this thesis makes two important contributions to this field of research. Empirically, the study enhances the work-life balance database most especially in the specific context of Nigeria, by revealing that the traditional culture of Nigerian health organisations has an enormous influence on the employees’ abilities to use work-life balance policies and practices. In other words, there is an overarching relationship between organisational culture and the use of work-life balance policies and practices by doctors and nurses in the Nigerian health sector. The findings also reveal that Nigerian doctors and nurses struggle to cope with the demanding nature of their jobs and their aspirations to fulfil their non-work responsibilities. Theoretically, the study identifies an important shift in the construct and application of border theory. Border theory explains how employees negotiate their daily movements across work and family domains, but fails to recognise that family is by no means the only non-work duty that is important to employees. Also, border theory does not deal with factors that determine employees’ movements across the border. These shortcomings are alarming, especially now that Generation X employees (workers born after 1963) prefer work arrangements that also cater for their non-work duties and responsibilities. Following these shortcomings, and with the data collected, a work-life border control model was developed. Practically, the developed model (work-life border control model) extends work-life border theory by incorporating other non- ii working live activities including familial duties and outlines factors that determine employees’ movement across the border. Also, the findings of this study provide a valuable insight into the reality of work-life balance practices in Nigeria. This study thus provides an important and timely understanding about the working and non-working lives of Nigerian doctors and nurses and provides feasible and practicable recommendations for the relevant authorities.

Magister Public Health - MPH / Background Antibiotic resistance is a phenomenon that occurs naturally and is accelerated by use. There have been no studies looking at trends in antibiotic consumption in the public health sector in Namibia, which provides services to 85% of the population. Aim This study described the pattern of antibiotic consumption in the Namibian public health sector based on distribution of antibiotics from Central Medical Stores (CMS) to the 13 regions in the country. Methodology Antibiotic consumption data from distribution records at the Central Medical Store (CMS), public health sector wholesaler, between 1 January 2010 and 31 December 2016 was collated and analysed to describe trends and usage patterns in the public health sector of Namibia. For the purpose of this study DDD per 1000 inhabitants per day (DID) was used as an indicator so as to be comparable with previously conducted studies. DIDs provide information about the proportion of the selected population using a particular medicine per day. The World Health Organization (WHO) recommended anatomical therapeutic classification (ATC)/daily defined dose (DDD) methodology be used to analyse the data and evaluate the consumption. Data was presented using stacked bar charts to demonstrate the variation in consumption by ATC classes in each region and over time.

En el Perú, la calidad de los servicios de salud es un requisito constante para la población como también una prioridad. “El 49% de los peruanos considera que los servicios de salud son muy malos, mientras que el 47% piensa que son regulares y únicamente el 4% asegura que sí son buenos”. (Datum Internacional S.A, 2017) Por ello, se considera que los grandes problemas del sector salud están en la prestación de servicios y no realmente en el financiamiento del sector; esto produce que los procesos de atención médica sean poco sostenibles. Adicional a ello, La Encuesta Nacional de Satisfacción de Usuarios en Salud del 2015 reveló que existen problemas muy críticos que resolver, como por ejemplo manifiesta que “El tiempo de espera para ser atendido en un consultorio, ha aumentado con respecto a 2014 cuando se registró un tiempo promedio de 81 minutos de espera, ahora el tiempo es de 104 minutos”. (Gestión, 2016) En base a la información mencionada anteriormente, se propone mejorar el servicio de atención ambulatoria mediante un modelo tecnológico de servicio de información farmacológica ambulatoria utilizando una plataforma cloud; esta propuesta permitirá brindar información, administrar los datos de enfermedades comunes y migrarlos a la nube para integrarlos mediante una interfaz desarrollada en una plataforma cloud. Con esta solución se estima reducir la asistencia a los servicios de salud y minimizar los tiempos de espera a una respuesta de una enfermedad común, ya que la información será expuesta en una aplicación móvil. / In Peru, the quality of health services is a constant requirement and a priority for the population. "49% of Peruvians believe that health services are very bad, while 47% think they are good." (Datum International S.A., 2017) Therefore, we confirm that the main problems in the health sector are in the quality of services and not how much can they spend in the sector; this makes health care processes unsustainable. In addition, the National Health Users Satisfaction Survey of 2015 revealed that there are very critical problems that need to be resolved, for example, by stating that "the waiting time to be treated in a clinic has increased compared to 2014 when an average of time of 81 minutes waiting, now the time is 104 minutes. "(Gestión, 2016) Based on the information mentioned above, the best ambulatory care service is offered through an ambulatory mobile pharmacological information service application using the platform cloud; this proposal is useful because we can manage common disease data and migrates to the cloud to integrate into a platform developed in platform cloud. With this solution, it is possible to reduce attendance to health services and minimize waiting times for the response of a common disease, since the information was exposed in a mobile application. / Tesis

The following study explores the relation between psychosocial work environment and individual health. The purpose is to examine how female employees in the occupational health sector experience their own psychosocial work environment, focusing on different influencing factors in both the workplace and their private life regarding the employees own health. The study applies a hermeneutic approach in which qualitative interviews constitute the empirical data. Previous research on this particular subject has focused on the following themes: the combination of work-family life, demand/control model and flexibility in the workplace in relation to health and stress. The theoretical framework used in this study integrates relevant concepts, specifically SOC, poor leadership and flexibility. The main findings of this study are three fundamental themes prevalent in the employees experience of health and stress: meeting the demands of the psychosocial work environment, the psychosocial work environment related to balance in everyday life  and the managements role of the psychosocial work environment. One major contribution on the research on psychosocial work environment and work-life balance is that the results presented underline the importance of a female perspective on welfare and individual wellness.

Syftet med föreliggande studie var att undersöka anknytningsteorin i relation till arbetslivet. Anknytningsteorin behandlar samspelet mellan omvårdnad och anknytning. Teorin omfattas av olika anknytningsstilar: trygg, undvikande och ängslig, som människan utvecklar beroende på hur de behandlas av sin primära vårdnadsgivare under uppväxten. Det huvudsakliga syftet var att undersöka om trygg anknytningsstil genererar hög arbetstillfredsställelse. Studien utgick från Self Determination Theory som bygger på att behoven autonomi, kompetens och samhörighet bör uppfyllas för att skapa motivation och därmed nå högre tillfredsställelse. Teorin omfattas även av två olika motivationsformer: autonom och kontrollerad, vilka i föreliggande studie undersöktes i relation till anknytningsstilarna. Populationen var vårdanställda (n = 88) i en kommun i södra Sverige. Deskriptiv data visade att anställda inom vården har en övervägande trygg anknytningsstil. Resultatet i denna studie visade att det fanns ett signifikant samband mellan hög arbetstillfredsställelse och hög nivå av trygg anknytningsstil (p = .006). Resultatet visade inga signifikanta skillnader i motivationsform mellan de olika anknytningsstilarna. Den huvudsakliga slutsatsen i föreliggande studie var att trygg anknytningsstil kan predicera hög arbetstillfredsställelse (p = .007). / The purpose of this study was to examine Attachment Theory in relation to working life. Attachment Theory deals with the interaction between nursing and attachment. The theory includes different attachment styles: secure, avoidant and anxious that people acquire depending on how they are treated by their primary caregiver while growing up. The main purpose was to investigate whether a secure attachment style generates high job satisfaction. The study was based on Self Determination Theory which states that the needs for autonomy, competence and relatedness should be met to create motivation and achieve higher satisfaction. The theory also contains two different forms of motivation: autonomous and controlled, which in the present study were investigated in relation to the attachment styles. The population was health care workers (n = 88) in a municipality in southern Sweden. Descriptive data showed that health care workers have a predominantly secure attachment style. The results of this study showed that there was a significant correlation between high job satisfaction and high level of secure attachment style (p = .006). The results showed no significant differences in motivation between the various attachment styles. The main conclusion in this study was that secure attachment style can predict high job satisfaction (p = .007).