Šio magistro baigiamojo darbo tikslas buvo išanalizuoti sveikatos priežiūros žmogiškųjų išteklių politiką ir jos įgyvendinimo ypatumus Lietuvoje. Suformuluotų uždavinių pagalba darbe siekiama pateikti teorinį sveikatos priežiūros žmonių išteklių politikos įgyvendinimo modelį: atskleisti SPŽI politikos sampratą, apibrėžti SPŽI politikos priemones ir įvertinti jų reikalingumą. Remiantis pateiktu teoriniu modeliu, toliau darbe analizuojama sveikatos priežiūros žmogiškųjų išteklių politika Lietuvoje: interpretuojama politikos samprata, apibrėžiamos jos priemonės ir poreikis. Darbe taipogi pateikiami kokybinio tyrimo, kuriuo buvo siekta nustatyti ir įvertinti pagrindines Lietuvos sveikatos priežiūros žmonių išteklių politikos įgyvendinimo problemas, rezultatai. Taip pat tyrimo metu surinkta informacija įgalino nustatyti galimas SPŽI politikos įgyvendinimo problemų priežastis. Tyrimo analizė buvo konstruojama, remiantis Sveikatos apsaugos ministerijos atstovų vertinimais egzistuojančių SPŽI problemų bei įgyvendinamų SPŽI politikos priemonių atžvilgiu. Be to, išryškinami sveikatos priežiūros žmogiškųjų išteklių anketinės apklausos rezultatai, atskleidę specialistų vertinimus politikos priemonių reikalingumo bei optimalumo atžvilgiu. Tyrimo rezultatų interpetacija atskleidė egzistuojančias politikos įgyvendinimo problemas bei leido pateikti rekomendacines priemones, optimizuojančias politikos įgyvendinimo procesą. / The major goal of this paper work was to analize Human Resources for Health Policy and it’s implementation mechanism in Lithuania. The specific objectives were to introduce the comprehensive analytical human resources for health policy framework, which descibes the theoretical concept of human resources for health policy and it’s development measures. This paper, by means of the proposed framework and other primary and secondary sources, identifies the key problems, facing human resources for health in Lihuania. The relevance of those problems suggest the increasing necessity to be paid to the development of human resources for health policy in Lithuania. The paper also represents the consept of Lithuanian human resource for health policy by examining the tools being implemented of Lithuanian administrative institutions in response to important human resources for health imbalances. The research was done in order to identify the main problems, arising in policy implementation process. A key measure of this examination was an assessment of the chosen governmental institutons representative’s and the particular health care providers position to the subject of the research. The research analysis proved the existence of the problems and showed the necessity to improve current administrative measures.

Overview: A global shortage of over 7.2 million health workers poses a threat to service delivery particularly in sub-Saharan Africa. Sub-Saharan Africa bears a quarter of the global burden of disease; yet, it only has three percent of all health workers. Maldistribution and migration both to urban and international destinations pose persistent challenges to service delivery particularly to rural and remote populations. In Kenya, the health human resources are mostly concentrated in urban areas, and in some cases as high 70% of the health workers are serving only 20% of the population. Literature to date, particularly in the context of Kenya, has focused on doctors and more recently nurses. There has been a gap in analysis in exploring mid-level cadres such as clinical officers, a cadre of non-physician clinicians. Research objectives: The objectives of the research were to: 1) conduct a contextual analysis of human resources for health in Kenya; 2) understand the migration perspectives of Kenyan health professionals including doctors, nurses and clinical officers through an online survey; 3) explore the role of mid-level health worker cadre of clinical officers as a promising practice for Kenya. The thesis is presented in three papers congruent with the three research objectives. I interrogated these areas at a macro, meso and macro level using systems thinking theory. Findings: The first paper found significant developments in the policy context of managing health professionals in Kenya all of which have improved the working conditions for health professionals. International migration was found to have decreased over the past decade and was not deemed be a policy priority by government and development partner stakeholders. Health professional representatives, on the other hand, asserted that they continue to be disgruntled with the current situation and would not hesitate to migrate given the opportunity. The second paper found that the factors that discourage health professionals from staying in Kenya are similar to those available in the literature and include: dissatisfaction with remuneration, governance, working conditions and living conditions. Among health professionals considering migration, few had made short-term plans to leave. Family ties and fear of the unknown were found to be strong factors for continuing to work as health professionals in Kenya. Job security was found to be high in the government while recruitment agencies were not found to play a significant role in migration decisions of health professionals. The third paper found that there was general support for the scale of up clinical officers to enhance the Kenyan health workforce. Barriers to scale-up included resistance from medical doctors, who felt that clinical officers were not competent enough to handle complicated cases, and a lack of employment opportunities given a surplus of about 3,000 unemployed clinical officers in Kenya, who could potentially fill in the health workforce gaps. Conclusion: Overall policy developments have been implemented since 2007 presenting a promising future to the management of human resources for health (HRH) in Kenya. Although few health professionals are making concrete steps to migrate out of Kenya they continue to be dissatisfied with the current living and working conditions. Maldistribution and overall shortages of health professionals continue to hamper service delivery to vulnerable rural populations. Mitigating factors include the potential of scaling up the clinical officer cadre particularly through the surplus of 3000 unemployed clinical officers, a process that requires sufficient political and professional will. A holistic multi-level approach to health system planning is crucial to ensure that any new investments are well coordinated and involve an overall scale-up of health professionals.

Magister Public Health - MPH / Background: Adequate human resources for health play a crucial role in improving access to services and quality of care. Human resources for health are often inequitably distributed between rural and urban areas within countries. In Rwanda, almost 88% of physicians and 58% of nurses in the country work in urban areas, despite the fact that 82% of the population lives in rural areas. Kabaya is located in a remote rural area in Ngororero District; its health facilities consist of one hospital and four health centers. Living and working conditions are poor for health workers. This results in constant migration out of health workers, which has negative impacts on service delivery and quality of care provided to the population. Aim and Objectives: This study aimed to assess factors that influence the intention to stay in Kabaya amongst health workers currently in Kabaya's health facilities. The specific objectives were to analyze the associations between the following factors and intention to stay among health workers in Kabaya: socio-demographic and job characteristics; working and living conditions; and financial and non-financial incentives. Study design: An analytical, cross-sectional survey of all health workers from five facilities in Kabaya was conducted. Methods: A self-administered questionnaire, adapted from one used in a study in Uganda (Hagopian, Zuyderduin, Kyobutungi & Yunkella, 2006), was used to collect data. Data were entered in Epi- Info 3.4 and analyzed using SPSS 16.0. Descriptive analyses and inferential statistics (Chisquare,Fisher‟s Exact) were done to test for associations with the main outcome, intention to stay. Results Out of 155 employees working in Kabaya‟s health facilities, 111 (72%) accepted to participate in the study. Of the 111 respondents, 34 (31%) indicated they intended to stay working in Kabaya indefinitely. Intention to stay (bivariate analysis) was associated with:  employment category (p=0.001) and age (p<0.001);  rural background - born in Kabaya (p<0.001); and born (p=0.001), grew up (p=0.001) and studied in a rural area (p<0.001); good quality supervision - encouraging employee development (p=0.029), caring for the employee as a person (p=0.011), and competent and committed facility managers(p=0.039);  presence of workplace friends (p<0.001);  conducive work and living environments - manageable workloads (p<0.001); good infrastructure (p<0.001); access to safe and clean water at work (p<0.001); adequate housing at home (p<0.001); having time to take lunch at work (p=0.001); access to adequate transportation to work (p=0.004); adequate shopping and entertainment(p=0.001);  adequate incentives - sufficient salary (p<0.001); recognition for doing a good work(p<0.001); and adequate training (p<0.001). The small study sample precluded multi-variate analyses and it was therefore not possible to control for potential confounders such as age, sex and profession in the analysis of workplace factors. Conclusions: Intention to stay in Kabaya appears to be influenced by a complex set of factors that include: individual (age, profession, rural background), workplace, human, social, career and salaryrelated factors. Promoting retention in Kabaya‟s health facilities requires multi-faceted interventions, without which the majority of the employees are likely to continue to migrate away from the area.

To achieve Sustainable Development Goal 3 in developing countries, Good health and wellbeing for all, the health workforce is vital however the unpopularity of rural medical practice results in widening healthcare inequalities between urban and rural areas. This study determined the heterogeneity in valuations for rural facility attributes by final year medical students at one South African public university to inform cost-effective recruitment policy recommendations. Focus groups conducted identified facility attributes, a D-efficient design was generated with 15 choice sets, each with two rural hospital alternatives and no opt-out option. An online, unlabelled discrete choice experiment (DCE) was conducted, the results effects coded, and mixed logit models applied. The final sample size was 193 (86,16% of the class), majority female 130 (66.33%), with urban origins 176 (89.80%), unmarried 183 (93.37%) and without children 193 (98.47%). Most had undergraduate rural medicine exposure 110 (56.12%) and intended to specialise 109 (55.61%). The main-effects mixed logit found advanced practical experience, hospital safety, correctly fitted personal protective equipment (PPE) and availability of basic resources the highest weighted attributes with their mean utilities increasing by 0.82, 0.64, 0.62 and 0.52 respectively (p=0.000). In contrast, increases in rural allowance and the provision of housing provided smaller mean utility increases of 0.001 (p<0.01) and 0.09 (p<0.05) respectively. The interaction terms; female, general practise and prior rural medicine exposure, were associated with higher weighting for hospital safety, mean utility increases 1.59, 1.82, 1.42 respectively (p=0.000). Participants were willing to pay ZAR 2636.45 monthly (95%CI: 1398.55;3874.355) to gain advanced practical experience (equivalent to 65.91% of current rural allowance). Medical students’ facility preferences have been found to be influenced by their gender, career aspirations and prior experienced with rural medicine. The policy recommendations derived from this research include publicising rural health facility “draw-cards” among medical graduates, such as the opportunity to gain practical experience, improving the physical and occupational safety at rural health facilities and providing greater transparency about rural facility attributes to medical graduates.

O objetivo deste estudo foi o de analisar a inserção no mercado de trabalho dos egressos do Programa de Aprimoramento Profissional PAP, gerenciado pela Fundação do Desenvolvimento Administrativo - Fundap, das áreas de enfermagem, fisioterapia e psicologia, provenientes dos anos de 1997 e 2002. Trata-se de uma pesquisa de caráter descritivo, cujo caminho metodológico se delineou por meio da caracterização do perfil sócio-demográfico dos egressos, sua situação acadêmica e profissional além de conhecer a influência do PAP em sua atividade profissional. De um universo de 541 egressos obteve-se o retorno de 153 respondentes (28,28%), sendo: 24 enfermeiros, 51 fisioterapeutas e 78 psicólogos. Constatou-se que na maioria eram mulheres, solteiras, com idade de 31 a 40 anos e residentes na cidade de São Paulo. O perfil acadêmico revelou que mais da metade proveio de escolas privadas e que 70,59% (108) continuaram seus estudos. Profissionalmente, 91,50% (140) estavam empregados, 49,67% (76) trabalhando em instituições de natureza pública, assalariados e na maioria membros de equipe. Os psicólogos foram os que mais possuíam vínculos empregatícios informais, seguidos pelos fisioterapeutas. Apenas dois enfermeiros possuíam vínculos desse tipo. No que tange ao PAP, a maioria dos respondentes (92,15% (141)), considerou a formação recebida importante e muito importante para a realização das atividades realizadas e 96,73% (148) o recomendariam para um colega de profissão. Evidenciou-se que os resultados apontaram para um número expressivo de 37,25% (57) de respondentes que se encontra em instituições de natureza privada. As alegações para a não permanência no setor público pautaram-se na falta de concursos, poucas vagas e baixos salários. Desse modo, supõe-se que mesmo com a importância atribuída ao PAP e com a continuação dos estudos após a conclusão do Programa, o setor público vem perdendo espaço para o setor privado, no que tange à absorção e retenção de profissionais que ele mesmo financiou para aprimorar. / The objective of this study was to examine the insertion into the labour market of ex scholarships of the Health Professional Practice Program - PAP, managed by the Administrative Development Foundation - Fundap, from the areas of nursing, physiotherapy and psychology, from the years 1997 and 2002. It is a description research, which is outlined methodological way through the characterization of socio-demographic profile of ex-scholarships, their academic and professional situation than to know the influence of the PAP in their professional activity. In a universe of 541 ex-scholarships returned to the return of 153 respondents (28.28%): 24 nurses, 51 physiotherapists and 78 psychologists. It appeared that the majority were women, singles, aged 31 to 40 years and residents in the city of Sao Paulo. The academic profile showed that more than half came from private schools and that 70.59% (108) continued their studies. Professionally, 91.50% (140) were employed, 49.67% (76) working in public institutions, employees and the majority of team members. The psychologists were those who had work link more informal, followed by physiotherapists. Only two nurses had such links. With respect to PAP, the majority of respondents (92.15% (141)), considered the training received important and very important to carry out the activities and 96.73% (148) to recommend to a colleague of profession. There was that the results pointed to a number of 37.25% (57) of respondents is in private institutions of nature. The argument for not stay in the public sector refered to the lack of contests, few vacancies and low wages. Thus, it seems that even with the importance attached to the PAP and the continuation of studies after completion of the programme, the public sector is losing space for the private sector, with regard to the absorption and retention of professionals that it even financed to improve.

Made available in DSpace on 2014-12-17T15:43:49Z (GMT). No. of bitstreams: 1 GlaudeniaAM_DISSERT.pdf: 2134728 bytes, checksum: f418d9786b3ab74e5c06ca33dab9e66a (MD5) Previous issue date: 2012-12-19 / The Psychiatric Reform has brought profound changes in assistance to people affected by mental disorders and behavior. In this context, mental health workers have played decisive roles of great impact, acting driving the process. Objective: To evaluate the impact felt by working professionals, because of the daily work with people who have psychiatric disorders. Methodology: This is a search field, a quantitative approach, sectional, descriptive and applied. Data collection occurred through the Assessment Scale Impact of Working in Mental Health Services (IMPACT-BR) applied to mental health researchers city Mossor? - RN. Results: Participants in this study 87 professionals, mostly female married, which took charge of higher education, working on a single service, working in the area for more than six years, aged between 25 and 64 years. There were a low effect of overloading the professionals surveyed. Discussion: Our results corroborate findings in other surveys conducted previously, not identifying large impact load at work among professionals of mental health teams studied. Subscales studied the highest score was observed in measuring the impact of work on team functioning. It was observed that the greater age and duration of action, reduced the emotional impact at work, suggesting that the experience enhances safety in decisions made and the possibility of greater control over the demands of work. Final Thoughts: The work presented showed that the interactive relationships between professionals and users are not the causes of greatest impact in the workplace, although it revealed overload in relation to specific aspects such as: fear of being assaulted by a patient and the feeling of physical exhaustion the end of the workday. Further investigations should be conducted on this topic in order to contribute to the implementation of psychiatric reform proposed by advances both in terms of assistance to individuals and the quality of life in the work of the professionals involved / A Reforma Psiqui?trica trouxe profundas modifica??es na assist?ncia ?s pessoas acometidas por transtornos mentais e de comportamento. Nesse contexto, os trabalhadores de sa?de mental desempenharam pap?is decisivos de grande repercuss?o, atuando de forma impulsionadora do processo. Objetivo: Avaliar o impacto laboral sentido pelos profissionais de sa?de, em virtude do trabalho di?rio com pessoas que apresentam dist?rbios psiqui?tricos. Metodologia: Trata-se de uma pesquisa de campo, numa abordagem quantitativa, seccional, descritiva e aplicada. A coleta de dados ocorreu por meio da Escala de Avalia??o do Impacto do Trabalho em Servi?os de Sa?de Mental (IMPACTO-BR), aplicada aos profissionais de Sa?de Mental da cidade de Mossor? - RN. Resultados: Participaram desse estudo 87 profissionais, em sua maioria do sexo feminino casados, que assumiam cargo de n?vel superior, trabalhando em um ?nico servi?o, atuando na ?rea h? mais de seis anos, com idade entre 25 e 64 anos. Foi observado um baixo efeito de sobrecarga nos profissionais pesquisados. Discuss?o: Os resultados encontrados corroboram com resultados encontrados em outras pesquisas realizadas anteriormente, n?o identificando grande carga de impacto no trabalho entre os profissionais das equipes de sa?de mental estudadas. Das subescalas estudadas a maior pontua??o foi observada na que mede o impacto do trabalho no funcionamento da equipe. Observou-se que quanto maiores a idade e o tempo de atua??o, menor o impacto emocional no trabalho, o que sugere que a experi?ncia aumenta a seguran?a nas decis?es tomadas e a possibilidade de um maior controle sobre as demandas de trabalho. Considera??es finais: O trabalho apresentado demonstrou que as rela??es interativas entre os profissionais e os usu?rios n?o s?o as causas de maior impacto no trabalho, embora tenha revelado sobrecarga em rela??o a aspectos pontuais como: receio de ser agredido por um paciente e a sensa??o de cansa?o f?sico ao fim do expediente. Novas investiga??es nessa tem?tica devem ser realizadas a fim de colaborar para a efetiva??o dos avan?os propostos pela Reforma Psiqui?trica tanto no que se refere ? assist?ncia aos sujeitos quanto na qualidade de vida no trabalho dos profissionais envolvidos

O objetivo deste estudo foi o de analisar a inserção no mercado de trabalho dos egressos do Programa de Aprimoramento Profissional PAP, gerenciado pela Fundação do Desenvolvimento Administrativo - Fundap, das áreas de enfermagem, fisioterapia e psicologia, provenientes dos anos de 1997 e 2002. Trata-se de uma pesquisa de caráter descritivo, cujo caminho metodológico se delineou por meio da caracterização do perfil sócio-demográfico dos egressos, sua situação acadêmica e profissional além de conhecer a influência do PAP em sua atividade profissional. De um universo de 541 egressos obteve-se o retorno de 153 respondentes (28,28%), sendo: 24 enfermeiros, 51 fisioterapeutas e 78 psicólogos. Constatou-se que na maioria eram mulheres, solteiras, com idade de 31 a 40 anos e residentes na cidade de São Paulo. O perfil acadêmico revelou que mais da metade proveio de escolas privadas e que 70,59% (108) continuaram seus estudos. Profissionalmente, 91,50% (140) estavam empregados, 49,67% (76) trabalhando em instituições de natureza pública, assalariados e na maioria membros de equipe. Os psicólogos foram os que mais possuíam vínculos empregatícios informais, seguidos pelos fisioterapeutas. Apenas dois enfermeiros possuíam vínculos desse tipo. No que tange ao PAP, a maioria dos respondentes (92,15% (141)), considerou a formação recebida importante e muito importante para a realização das atividades realizadas e 96,73% (148) o recomendariam para um colega de profissão. Evidenciou-se que os resultados apontaram para um número expressivo de 37,25% (57) de respondentes que se encontra em instituições de natureza privada. As alegações para a não permanência no setor público pautaram-se na falta de concursos, poucas vagas e baixos salários. Desse modo, supõe-se que mesmo com a importância atribuída ao PAP e com a continuação dos estudos após a conclusão do Programa, o setor público vem perdendo espaço para o setor privado, no que tange à absorção e retenção de profissionais que ele mesmo financiou para aprimorar. / The objective of this study was to examine the insertion into the labour market of ex scholarships of the Health Professional Practice Program - PAP, managed by the Administrative Development Foundation - Fundap, from the areas of nursing, physiotherapy and psychology, from the years 1997 and 2002. It is a description research, which is outlined methodological way through the characterization of socio-demographic profile of ex-scholarships, their academic and professional situation than to know the influence of the PAP in their professional activity. In a universe of 541 ex-scholarships returned to the return of 153 respondents (28.28%): 24 nurses, 51 physiotherapists and 78 psychologists. It appeared that the majority were women, singles, aged 31 to 40 years and residents in the city of Sao Paulo. The academic profile showed that more than half came from private schools and that 70.59% (108) continued their studies. Professionally, 91.50% (140) were employed, 49.67% (76) working in public institutions, employees and the majority of team members. The psychologists were those who had work link more informal, followed by physiotherapists. Only two nurses had such links. With respect to PAP, the majority of respondents (92.15% (141)), considered the training received important and very important to carry out the activities and 96.73% (148) to recommend to a colleague of profession. There was that the results pointed to a number of 37.25% (57) of respondents is in private institutions of nature. The argument for not stay in the public sector refered to the lack of contests, few vacancies and low wages. Thus, it seems that even with the importance attached to the PAP and the continuation of studies after completion of the programme, the public sector is losing space for the private sector, with regard to the absorption and retention of professionals that it even financed to improve.

Made available in DSpace on 2017-07-10T14:17:12Z (GMT). No. of bitstreams: 1 F NODARI SHAILA.pdf: 1566917 bytes, checksum: aa575cfc81a4edc2aacd495396775d52 (MD5) Previous issue date: 2015-07-03 / OBJECTIVE:iIdentify and analyze the characteristics and the geographic distribution of the Work Force in Health on Basic Attention on Macro-region West of Parana. METHODOLOGY: the research is characterised as exploratory, descriptive and documentary, held in the period of March of 2014 to March of 2015, using as data collection source the National Register of Health Establishments and the Brazilian Institute of geography and statistics. The area of coverage of the research was the macro-region West of Parana, formed by four Region of Health (8ª, 9ª, 10ª and 10ª), bringing a total of 79 cities and a population of 1.592543 habitants. Was included 7.775 links of work that were registered in establishments of Basic Attention like: health station, health center/ basic unit, health family support center, polo academy of health, drugstore, being all the public establishments belonging at municipal administrative domains, state and federal. The workers were rated according to the level of formation in: workers with higher level of graduation in health area; workers of health without higher level of graduation; workers with higher level of graduation without formation in health area; and workers without identification of the level of graduation. The weekly hours was grouped of: one to 10 hours, 11 to 20 hours, 21 to 30 hours, 31 to 40 hours and more than 40 hours. The links of work were organized based on the existence of social protection and legal cover like: protected links, precarious links and links without information. The size of the cities was classified as: small size 1 (until 20.000 habitants), small size 2 (20.001 until 50.000 habitants), medium size (50.001 until 100.000 habitants), big size (100.001 until 500.000 habitants). To the analysis of the data was used methods of the descriptive statistics. The project was submitted to the CEP and approved by rule number 535.238. RESULTS: the results suggest prevalence of links of protected work (82,2%) and low variety of links on the Basic Attention (5,1%). The bigger quantity of precarious links is in the cities of small size (13,5%), among workers of higher level graduation (76,93%) and for the links with less hours of work. Identify predominance of health workers without higher level of graduation (56,48%), community agents of health (29,54%)and workers with higher level of graduation in health (34,40%), standing out the doctors (13,22%). For the workers of health without higher level of graduation predominate higher hours of work, 31-40 hours (89,89%), and for the workers with higher level of graduation in health less hours of work, 1-20 hours (45,30%), standing out the doctors (64,22%) and dentists (47,52%). FINAL REMARKS: the found informations indicate the necessity of policies of appreciation of the work and of the worker to improve the work relations, reducing the precarious links in order to facilitate the creation of durable relations with the community and improve the provided attention, as well as, a policy oriented to the development the integrated work, interdisciplinary, through the formation of multiprofessional teams, once that the team of AB, still find polarized among the doctors and community agents of health, with low inclusion of others professions of higher level of graduation in health. / OBJETIVO: identificar e analisar as características e a distribuição geográfica da Força de Trabalho em Saúde na Atenção Básica na Macrorregião Oeste do Paraná. METODOLOGIA: a pesquisa caracteriza-se como exploratória, descritiva e documental, realizada no período de março de 2014 a março de 2015, tendo como fonte de dados o Cadastro Nacional de Estabelecimentos de Saúde e o Instituto Brasileiro de Geografia e Estatística. A área de abrangência foi a Macrorregião Oeste do Paraná, formada por quatro Regiões de Saúde (8ª, 9ª, 10ª e 20ª), totalizando 79 municípios e população de 1.592.543 habitantes. Foram incluídos 7.775 vínculos de trabalho que estavam cadastrados em estabelecimentos de Atenção Básica como: posto de saúde, centro de saúde/unidade básica, centro de apoio à saúde da família, polo academia da saúde e farmácia, sendo todos estabelecimentos públicos, pertencentes às esferas administrativas municipais, estaduais ou federais. Os trabalhadores foram classificados de acordo com o nível de formação em: trabalhadores com formação de nível superior na área da saúde; trabalhadores de saúde sem formação de nível superior; trabalhadores de nível superior sem formação na área de saúde; e trabalhadores sem identificação do nível de formação. A carga horária semanal foi agrupada de: uma a 10 horas, 11 a 20 horas, 21 a 30 horas, 31 a 40 horas e mais de 40 horas. Os vínculos de trabalho foram organizados como: vínculos protegidos, vínculos precários e vínculos sem informação. O porte dos municípios foi classificado como: pequeno porte 1 (até 20.000 habitantes), pequeno porte 2 (20.001 até 50.000 habitantes), médio porte (50.001 até 100.000 habitantes) e grande porte (100.001 até 500.000 habitantes). Para a análise dos dados foi utilizada estatística descritiva. RESULTADOS: os resultados indicam prevalência de vínculos de trabalho protegidos (82,2%) e baixa multiplicidade de vínculos na Atenção Básica (5,1%). A maior quantidade de vínculos precários está nos municípios de pequeno porte (13,5%), entre trabalhadores de nível superior (76,9%) e para os vínculos com cargas horárias menores. Identifica-se predominância de trabalhadores da saúde sem formação de nível superior (56,48%), destacando-se os agentes comunitários de saúde (29,54%) e trabalhadores com formação de nível superior em saúde (34,40%), destacando-se os médicos (13,22%). Para os trabalhadores de saúde sem formação de nível superior, 89,89% apresentam carga horária entre 31 a 40 horas semanais. Para os trabalhadores com formação de nível superior em saúde 45,30% apresentam carga horária entre 1 a 20 horas semanais, destacando-se os médicos (64,22%) e dentistas (47,52%). CONSIDERAÇÕES FINAIS: as informações encontradas indicam a necessidade de políticas de valorização do trabalho e do trabalhador para melhorar as relações de trabalho, reduzindo os vínculos precários a fim de facilitar a criação de relações duradouras com a comunidade e melhorar a atenção prestada; assim como, uma política voltada para o desenvolvimento do trabalho integrado, interdisciplinar, através da formação de equipes multiprofissionais, já que a equipe de Atenção Básica ainda encontra-se polarizada entre médicos e agentes comunitários de saúde, com baixa inserção de outras profissões de nível superior com formação em saúde.

Background: To address the huge human resources for health (HRH) crisis that Zambia and other low and middle income countries (LMICs) are experiencing, most LMICs have engaged the services of small scale community-based health worker (CBHW) programmes. However, several challenges affect the CBHWs’ ability to deliver services. Integration of national CBHW programmes into health systems is an emerging innovative strategy for addressing the challenges. Integration is important because it facilitates recognition of CBHWs in the national primary health care system. However, the integration process has not been optimal, and a more comprehensive understanding of the factors that shape the integration process is lacking. This study aimed at addressing this gap by analysing the integration process of national CBHW programmes in health systems in LMICs, with a special emphasis on Zambia. Methodology: This was a qualitative study that used case study and systematic review study designs. The case study focused on Zambia and analysed the integration processes of Community Health Assistants (CHAs) into the health system at district level (Papers I-III). Data collected using key informant interviews, participant observation, in-depth interviews and focus group discussions were analysed using thematic analysis. The systematic review analysed, using thematic and pathways analysis, the integration process of national CBHWs into health systems in LMICs (Brazil, Ethiopia, India and Pakistan)-(Paper IV). The framework on the integration of health innovations into health systems guided the overall analysis. Results: Factors that facilitated the integration of CHAs into the health system in Zambia included the HRH crisis which triggered the willingness by the Ministry of Health to develop and support implementation of the integration strategy-the CHA strategy. In addition, the attributes of the CHA strategy, such as the perceived competence of CHAs compared to other CBHWs, enhanced the community’s confidence in the CHA services. Involvement of the community in selecting CHAs also increased the community’s sense of programme ownership. However, health system characteristics such as limited support by some support staff, supply shortages as well as limited integration of CHAs into the district governance system affected CHAs’ ability to deliver services. In other LMICs, as in Zambia, the HRH problems necessitated the development of integration strategies. In addition, the perceived relative advantage of national CBHWs with regard to delivering health services compared to the other CBHWs also facilitated the integration process. Furthermore, the involvement of community members and some politicians in programme processes enhanced the perceived legitimacy, credibility and relevance of programmes in other LMICs. Finally, the integration process within the existing health systems enhanced programme compatibility with health system elements such as financing. However, a rapid scale-up process, resistance from other health workers, ineffective incentive structures, and discrimination of CBHWs based on social, gender and economic status inhibited the integration process of national CBHWs into the health systems. Conclusion: Strengthening the integration process requires fully integrating the programme into the district health governance system; being aware of the factors that can influence the integration process such as incentives, supplies and communication systems; clear definition of tasks and work relationships; and adopting a stepwise approach to integration process.

Orientador: Aguinaldo Gonçalves / Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Educação Fisica / Made available in DSpace on 2018-08-06T05:35:18Z (GMT). No. of bitstreams: 1 Moura_AnaClaudiadaSilva_M.pdf: 2428626 bytes, checksum: 6a9d551fc4a3bb50536388a68a9130c1 (MD5) Previous issue date: 2006 / Resumo: A VIII Conferência Nacional de Saúde, de 1988, maior instância de participação popular na área, concebeu saúde como ¿direito de todos e dever do Estado¿. Além disso, reafirmou a importância da ação interdisciplinar no âmbito da saúde e no trabalho multiprofissional para a integralidade das ações e serviços em saúde. Neste cenário, nove anos após, os profissionais de Educação Física são reconhecidos como membros da equipe de saúde, dentre treze cursos de nível superior. Também, ocorre a divulgação do documento síntese das Diretrizes Curriculares Nacionais para graduação para discussão da comunidade, pelo Ministério da Educação, reforçando tais compromissos. Apesar da ação política, Faculdades e Instituições de Ensino Superior, públicas e particulares, passaram a reelaborar seus projetos pedagógicos de acordo com o documento, sem oportunizar experiência e reflexão no ensino. Contudo, destaca-se a Faculdade de Educação Física - FEF/UNICAMP, pioneira na introdução da Saúde Coletiva no seu currículo, desde 1997. No âmbito exploratório desta pesquisa, busca-se gerar informações que possam contribuir para o processo de construção de modelos de estudos em Saúde Coletiva e Performance Humana. Especificamente, procura-se descrever e analisar o desenvolvimento de uma edição da disciplina homônima na FEF/UNICAMP, com vistas a isolar e aprofundar questões fundamentais de categorias temáticas e metodológicas representativas que a compõe. O grupo populacional de referência neste estudo será representado pelo conjunto de alunos matriculados na graduação em Educação Física da FEF/UNICAMP, que satisfaçam os pré-requisitos para cursar a disciplina no primeiro semestre letivo, período diurno e noturno. O protocolo desta pesquisa foi aprovado pelo Comitê de Ética em Pesquisa em Seres Humanos da UNICAMP. Realizou-se pesquisa-ação, método que implica o pesquisador estar envolvido operacionalmente com seu objeto de pesquisa e participar nos problemas investigados. Procedeu-se à observação participante com anotações em diário de campo conforme roteiro de registro, que inclui componentes descritivos e reflexivos. A sistematização dos dados segue a racionalidade dos blocos temático-metodológicos do desenvolvimento do curso, quais sejam: i) Construção do modelo de intervenção; ii) Avaliando o suposto conhecido; iii) Operando o ¿cyberspace¿; iv) Visão e apreciação da bibliografia básica; v) Epidemiologia das Capacidades Físicas. Obtivemos associação de diferentes abordagens (qualitativas e quantitativas). Reconheceu-se no diário etnográfico o registro metodológico dos dados. Procedeu-se à análise de conteúdo, conforme Bardin, para investigação de categorias explicativas dos respectivos componentes do curso. Trataram-se das avaliações discentes com os recursos estatísticos das medidas de centralidade e dispersão. Apresentam-se resultados e discussões, destacadamente, nas seguintes perspectivas: i) Telemática no ensino universitário; ii) Outros aspectos relevantes, a saber, produção acadêmica em grupo, realizada pelo GSCEAF durante todo o processo de planejamento, operacionalização, apresentações dialogadas e avaliação na disciplina; Saúde Coletiva e Atividade Física como campo de conhecimento a ser explorado pelos profissionais da Educação Física / Abstract: The VIII Health National Conference, which is considered to be the most popular participation event, was held in 1988 and it declared health as ¿a right to everyone and duty from the State¿. Besides, it also claimed the importance of interdisciplinary action concerning health and the multiprofessional work has to integrate all the actions and services in health. According to this new scenario, nine years later, the physical education professionals are known as health team members within thirteen college courses. Also, there is a publication of the document regarding the National Curriculum Guidelines to graduation courses that have to debate community matters which reinforce the commitment derived from new task. In spite of the political action, Colleges and Universities, private or public, are asked to reorganize their pedagogical projects according to the document without prioritizing experience and reflection about teaching. Yet, FEF-UNICAMP the Physical Education College has been the pioneer in the field of Health Community Group in its curriculum since 1997. In the explanatory scope of this research, it is aimed to provide information which can contribute to the building process of application models in Health Community Group and Human Performance. Specially, it aims to describe and analyze the development of an homonymous education subject publication at FEF/UNICAMP in order to isolate and deepen fundamental issues in thematic and methodological which make part of it. The reference population group of this research is represented by a team of Unicamp students enrolled in the graduation course of physical education. They have to meet the requirements to course daily or nightly this discipline in the first semester of 2004.The protocol of this research has been approved by the Committee of Ethics in College Research of Medical Science ¿ UNICAMP ¿ by the conception 629/2004. An action research has been carried out ¿ method which implicates the researcher to become committed operationally with his research purpose/subject and also with his participation in the investigated problems. There has been a constant observation together with daily notes regarding specific areas - a record has been done which includes descriptive and reflective components. The systematization of the data follows the rationality of the thematic and methodological note groups of the course development such as: i) building an intervention model, ii) evaluating what is supposed to know, iii) operating the ¿cyberspace¿, iv) seeing and appreciating the basic bibliography., v) epidemiology of the physical capacities. We had different approaches (qualitative and quantitative). The methodological data register was acknowledged in the ethnographical diary. A content analysis was proceeded regarding Bardin in order to investigate the explicative categories of the respective course components. They were about student evaluations done with statistical resources of the concentration and dispersion measures. The results are as follows: i) the thematic of academic teaching, ii) other relevant aspects such as Community Group Health and Physical Education as knowledge field to be analyzed in the curriculum of Physical Education; academic Production in group carried out by GSCEAF during the whole planning, operational, typed presentation and discipline evaluation processes / Mestrado / Mestre em Educação Física