Este estudo de inspiração genealógica, inserido na vertente pós-estruturalista, objetivou problematizar o acontecimento da atenção domiciliar, para conhecer os saberes e as condições de possibilidade que sustentam sua rede discursiva. O material empírico foi constituído por documentos legais como: políticas públicas, decretos, portarias, resoluções que se referiram a atenção domiciliar em saúde, publicados no Diário Oficial da União, desde o início do século XX. A primeira etapa para organização do material se constituiu na busca de documentos que se referiam à atenção domiciliar no sitio Jus Brasil, sendo encontradas 1059 páginas que mencionavam atenção domiciliar. A leitura do material selecionado buscava identificar a relação dos documentos com o tema e foi organizada em pastas identificadas pelo ano de publicação. Na segunda etapa, após leitura aprofundada, os excertos que teriam poder de fazer circular determinadas verdades foram organizados em planilha eletrônica, com informações sobre a referência do documento, quem falava e os procedimentos de limitação. A terceira etapa consistiu na leitura da planilha para identificação das relações de poder e saber. Na quarta etapa, as unidades analíticas foram construídas, sendo utilizadas para a análise documental algumas ferramentas propostas por Michel Foucault, como forma de martelar o pensamento, tais como: poder, governamento, biopolítica, saber, discurso, norma e dispositivo. Foram organizadas quatro unidades analíticas: Vigilância no domicílio: tecnologia disciplinar; Serviço médico domiciliar e a população operária: nascimento da biopolítica; Saúde para todos: tecnologia regulamentadora da vida e Melhor em Casa: dispositivo de segurança. A primeira unidade trata da vigilância do doente no domicílio. Tendo em vista a incidência da tuberculose, foi organizado um serviço de enfermeiras visitadoras que produziam saberes registrados em relatórios acerca das pessoas e suas doenças naquele período. A segunda unidade foi organizada acerca do Serviço de Assistência Médico Domiciliar, que teve como condições de possibilidade a mobilização dos operários e a organização dos sindicatos a partir da segunda década do século XX. Tal medida, a partir da medicalização do corpo do operário, se constituiu em uma estratégia de controle do absenteísmo. A terceira unidade aborda o Sistema Único de Saúde como estratégia da biopolítica, que teve como condições de possibilidade as lutas contra um modelo de saúde centrado no hospital, na tecnologia, e era excludente, já que incluía apenas os contribuintes da previdência social. Tal sistema público e democrático previa a participação de todos, em oposição ao sistema anterior que contemplava apenas os trabalhadores. A atenção domiciliar como dispositivo de segurança, a partir dos anos 2000, teve como condições de possibilidade o aumento das doenças crônico-degenerativas e a “crise” no hospital, que pretende liberar leitos para a alta tecnologia, prestando atendimento ao paciente com condições crônicas e incuráveis no domicílio, apontando a casa como lugar mais seguro e melhor para o paciente que fica próximo da família e longe do risco de infecção hospitalar. Ao longo deste estudo genealógico, apresento as descontinuidades e diferentes configurações que a atenção domiciliar apresentou no Brasil, apontando que a prioridade destas políticas não foram as pessoas, mas a Economia. / This study of genealogical inspiration, inserted in the poststructuralist area of knowledge, aimed to problematize the event of home care to know the knowledge and the conditions of possibility that support its discursive network. The empirical material was constituted by legal documents, such as: public policies, decrees, ordinances, dictums that refer to the home care in health, which were published in the Diário Oficial da União, since the beginning of century XX. The first step to the organization of material was constituted on searching documents that referred themselves to home care in the Jus Brasil place, which enabled the finding of 1059 pages that mentioned home care. The material selected through reading, which focused on identifying the relation from the document with the issue, was organized in folders identified by the year of publication. In the second step, with a deep reading, excerpts that would have power to make circulating determined truths were organized in electronic charts, which had information about reference from the document, the excerpt, who was talking about, and procedures of limiting. The third step constituted on the reading of the chart to the identification of power and knowledge relations. In the fourth step, the analytical unities were being construed, and for the documental analysis was used some tools from Michel Foucault, as a way to hammer the thought, such as: power, governmentality, biopolitics, knowledge, discourse, norm, and dispositive. Four analytical unities were formed: surveillance at home: disciplinary technology; Home Medical Assistance and the worker population: birth of biopolitics; health for everybody: a statutory technology of life and The Best at Home: security dispositive. The first unity is about the oversight of the sick at home. Having the focus on tuberculosis, it was organized a services of nurses who were visitors, and that produced knowledge recorded about people and their diseases in that period. The second one was organized about the Home Medical Assistance, which had as conditions of possibility the mobilization of workers and the organization of syndicates from the century XX. This step, through the medicalization of the worker body, constituted in a control strategy of absenteeism. The third one approaches the Unique Health System as a strategy of biopolitic, which had as conditions of possibility to fight against a model of health centralized on hospital, on technology, and it was exclusionary, since it included just the contributors of welfare. This public and democratic system wanted the participation of everybody, which was opposite to the previous system, which attained just the workers. The home care as a security dispositif, after 2000, had as conditions of possibility the chronic-degenerative diseases, due to the increase of life expectancy; the “crisis” in the hospital, which aims to release beds to the high technology, assisting the patient with chronic and incurable conditions at home. Therefore, the discourse constitutes house as the safer place, and the best for the patient, who stays in their home, close to the family, far away from the risk of hospital infection. During the performance of this genealogical study, I present the discontinuities and different configurations that home care presented in Brazil, which states that the priority of these polices weren’t people, but the economy. / Este estudio de inspiración genealógica, inserido en la vertiente pos-estructuralista, objetivó problematizar el acontecimiento de la atención domiciliaria, para conocer los saberes y las condiciones de posibilidad que sustentan su red discursiva. El material empírico fue constituido por documentos legales como: políticas públicas, decretos, portarías, resoluciones, que refirieran a la atención domiciliaria en salud, publicados en el Diário Oficial da União, desde el inicio del siglo XX. La primera etapa para la organización del material se constituyó en la busca realizada en mayo de 2013, siendo encontradas 1059 páginas que mencionaban atención domiciliaria en el sitio Jus Brasil, siendo encontradas 1059 páginas que mencionaban la atención domiciliaria. El material seleccionado a partir de la lectura, que buscaba identificar la relación del documento con el tema, fue organizado en pastas identificadas por el año de publicación. En la segunda etapa, con lectura profundada, extractos que habían de tener poder para hacer circular determinadas verdades fueron organizados en planilla electrónica, con informaciones sobre la referencia del documento, extracto, quién hablaba, y procedimientos de limitación. La tercera etapa consistió en la lectura de la planilla para identificación de las relaciones de poder y saber. En la cuarta etapa, las unidades analíticas fueron siendo construidas, y para el análisis documental se utilizó algunas herramientas de Michel Foucault, como forma de martillar el pensamiento, como: poder, gobernamiento, biopolítica, saber, discurso, norma y dispositivo. Fueron formadas cuatro unidades analíticas: vigilancia del enfermo en domicilio: tecnología disciplinar; Asistencia medico domiciliaria y la población operaria: el nacimiento de la biopolitica; salud para todos: una tecnología reguladora de la vida; Mejor en Casa: dispositivo de seguranza. La primera unidad trata de la vigilancia del enfermo en el domicilio. Teniendo en vista la incidencia de la tuberculosis, fue organizado un servicio de enfermerías visitadoras que producían saberes registrados en informes acerca de las personas y sus molestias en aquel periodo. La segunda, acerca del Servicio de Asistencia Medico-Domiciliaria, que tuve como condiciones de posibilidad las movilizaciones de los operarios y la organización de los sindicatos a partir de la segunda década del siglo XX. Tal medida, a partir de la medicalización del cuerpo del operario, se constituyó en una estrategia de controle del absentismo. La tercera aborda la visita domiciliaria en el Sistema Único de Salud, como estrategia de la biopolitica, que tuve como condiciones de posibilidad las peleas contra un modelo oneroso de salud, centrado en el hospital e en la tecnología; las peleas contra un modelo de salud excluyente que incluía a penas los contribuyentes de la previdencia social; los ideales de un sistema público de salud, democrático, con participación de todos, en oposición al que la dictadura militar había proporcionado. La atención domiciliaria como dispositivo de seguridad, a partir de los años 2000, tuve como condiciones de posibilidad las molestias crónico-degenerativas debido al aumento de la expectativa de vida; la “crisis” en el hospital, que pretende liberar camas para la alta tecnología, prestando atendimiento al paciente en casa como lugar más seguro y mejor para el paciente, que quedase en su casa, próximo de la familia, lejos del risco de infección hospitalaria. Al pasar de este estudio genealógico, presento las discontinuidades y distintas configuraciones que la atención domiciliaria presentó en Brasil, apuntando que la prioridad de estas políticas no fueran las personas, pero la Economía.

MPM / Oliver Tambo Institute of Governance and Policy Studies

MPM / Oliver Tambo Institute of Governance and Policy Studies

MPH / Department of Public Health / See the attached abstract below

According to the Ministry of Health (1996:26), the most common chronic/terminal illnesses were cardiovascular disorders, diabetes, cancer, mental disorders, HIV/AIDS, tuberculosis and asthma. Long term treatment and care and the growing incidence of these conditions necessitated the introduction of home-based care (HBC). Consequently, family care givers play a major role in the provision of care to chronically/terminally ill patients and professional health care providers adopt a supervisory role. This study examined the quality of home care services provided in Botswana. The availability and accessibility of home-based care services and resources have a direct bearing on the quality of home-based care delivery system. The researcher used systems theory was used as the conceptual framework for this study. The study aimed to • determine the accessibility and availability of home-based care services in Molepolole East • investigate what the perspectives and experiences of family care givers, patients and professional health care providers of Botswana home-based care are • determine the roles of professionals health care providers, patients, and family care givers and their relationships in the context of home- based care • identify the needs of chronically/terminally ill patents and family care givers • determine the type of support given to family care givers and patients by professional health care providers and make recommendations for the improvement of home-based care • develop a model to prepare family care givers The research design combined quantitative and qualitative research methods. A sample of convenience was used to obtain information from patients' family care givers and professional health care providers. Interviews and questionnaires were used. A proposed care giving preparedness model is presented to meet needs of the family care givers. The study found that family care givers needs are neither known nor catered for by the professional health care provider. The family care givers were not adequately prepared before adopting the care-giving role. It is recommended that • The proposed preparedness care giving training model is considered for training of patients and family care givers before discharge and during HBC. • Increase patients and family care givers decision-making / Health Studies / D.Litt. et Phil. (Health Studies)

Over the past few decades, the Swedish welfare system has undergone a process of marketization, characterized by the implementation of choice reforms. In order for citizens to be able to utilize their freedom of choice, a set of requirements have to be met. However, while it is argued in the literature that the conditions for choice reforms are worse in rural areas compared to urban areas, there is a lack of empirical studies examining these requirements in a rural Swedish context. Therefore, this study aims to investigate the market diversity requirement and the overproduction requirement in rural Swedish municipalities that have set up a system of choice for home care services in accordance with The Act on Systems of Choice (LOV). The results show that out of the sixteen municipalities included in the study, both requirements for functioning freedom of choice were fulfilled in four rural municipalities. Most commonly, the market diversity requirement was violated because of the absence of multiple established home care service providers. In some municipalities, the same requirement was also violated because providers failed to offer a variety of services. Further, the study shows that because some providers have restricted their operations to certain geographical areas within some municipalities, the ability for rural citizens to utilize their freedom of choice can differ within a municipality. All providers were able to accept new elderly clients, meaning that the overproduction requirement was fulfilled in all sixteen rural municipalities.

The focused of this study is the role of capacity building in Community Home Based Care (CHBC) for HIV/AIDS patients. The study forms part of my Master's in Development Administration programme, undertaken through UNISA. The dissertation was accomplished by studying the TASO community initiative in Sseeta-Nazigo, Mukono District, Uganda. It explores the concept of capacity building and its applicability to CHBC. The primacy data was gathered by conducting Key Infonnant Interviews (KIIs) and Focus Group Discussions (FGD). The secondary data was gathered by reviewing literature to augment the primary data. In addition, data was gathered through observations within the community. The fmdings have identified seven critical components of capacity building: community mobilisation, skills development, Information, Education and Communication (IEC) Voluntary Counselling and Testing (VCT), networking and collaboration, support and supervision, Monitoring and Evaluation (M&E). The study observed that capacity built in the above areas resulted in three outcomes: skills development, improvement in procedures, and institutional development. Informed recommendations were subsequently made related to the seven componentsof capacity building in CHBC / Development Studies / M. A. (Development Studies)

South African health systems are struggling to cope with the HIV/AIDS pandemic. Home based care has become an invaluable resource that relieves overburdened and under-resourced hospitals. Home based carers provide basic nursing care and support to patients and their families, in the patient's home. Little is know about what motivates home based carers. Minimal research has been undertaken to investigate the expectations and experiences of these noble voluntary helpers. This study was conducted with a sample of home based carers at Community Outreach Centre, St Mary's, Mariannhill. Being field focused it used a qualitative research approach and participatory action research methodology. Focus group discussions were conducted with home based carers to explore their needs, motivations and expectations of Community Outreach Centre. The study enlightens us about issues related to home based care that directly affect them. Despite the painful realities of their lives, they appeared positive about serving as volunteer home based carers. / Social work / M.A. Social Science (Social Work)

The study sought to explore professional nurses' perceptions of the roles of home and community-based carers in the Capricorn district of the Limpopo province as well as the problems they experienced and make recommendations to improve the quality of home and community-based care. A qualitative approach with non-probability, purposeful sampling was used in this study. The sample consisted of professional nurses serving as focal points for home-based care in the area of the study. The findings indicated that professional nurses believe that carers have a role in providing care to the community and serve as the extended hands of their services. However, challenges exist, which impact on the quality of service delivery. Recommendations included the strengthening of existing elements, such as improving relationships, communication, and the care of carer's programme, carer training, reporting, and monitoring and carer distribution. / Health Studies / M.A. (Health Studies)

South African health systems are struggling to cope with the HIV/AIDS pandemic. Home based care has become an invaluable resource that relieves overburdened and under-resourced hospitals. Home based carers provide basic nursing care and support to patients and their families, in the patient's home. Little is know about what motivates home based carers. Minimal research has been undertaken to investigate the expectations and experiences of these noble voluntary helpers. This study was conducted with a sample of home based carers at Community Outreach Centre, St Mary's, Mariannhill. Being field focused it used a qualitative research approach and participatory action research methodology. Focus group discussions were conducted with home based carers to explore their needs, motivations and expectations of Community Outreach Centre. The study enlightens us about issues related to home based care that directly affect them. Despite the painful realities of their lives, they appeared positive about serving as volunteer home based carers. / Social work / M.A. Social Science (Social Work)