Magister Public Health - MPH / Background: Actions on addressing the social determinants of health are necessary for reducing health inequities and improving health outcomes. These actions can, however, fall outside the scope of the health sector alone and require collaborative actions across sectors. Through the Western Cape Government’s stated commitment to following a whole-of-society approach to increase the wellness of people, this Province has committed to exploring intersectoral collaboration and action for health. This study is therefore aimed at exploring the experiences and perceptions of intersectoral collaboration and action for health amongst mid-level and frMethodology: The study design was qualitative and explorative in nature, using non-probability sampling to deliberately select study participants that were both relevant to the study and represented a diversity of views. Semi-structured interviews were conducted with seven health managers and non-participant observation of one intersectoral meeting was utilised to observe interactions that were relevant to the study. A thematic coding analysis approach was followed to inductively determine themes and analyse the data.ontline health managers working at the primary health care level in two sub-districts within the City of Cape Town, Western Cape Province. Results: Intersectoral collaboration for health at the primary health care level tends to take the form of collaborations between government departments, between the department of health and non-governmental organisations, between the public and private health sectors and between the Department of Health and the communities it serves. These collaborations overwhelmingly focus on expanding health services provision rather than addressing the social determinants of health. Conclusion: The concept of intersectoral collaboration and partnerships at the primary health care level in two sub-districts of the City of Cape Town, Western Cape, is perceived by health managers as being critical in addressing the social determinants of health. In practice, however, intersectoral collaboration and partnerships tend to focus on expanding health service provision and have limited value for addressing social determinants of health.

Previous research has shown that institutional logics are the frame of reference used by individuals to make sense of their everyday life. This thesis aims to understand how such logics are displayed by actors in the public, private and non-profit sector and how they influence the construction of intersectoral collaboration for social innovation in a Swedish context. The aim is fulfilled through the research questions (i) How are institutional logics expressed by the informants? (ii) Do the interpretations of the ideal institutional logics influence the construction of boundary work? This is analyzed through the framework of boundary work.  This qualitative study was conducted through in-depth interviews with ten actors working in different sectors all participating in a coalition hosted by Mötesplats Social Innovation. The empirics demonstrate that the respondents display logics through four sub-themes; economic resources, incentives for activities through meaningfulness, source of authority and salient values. Various logics in the three sectors result in differences between the sectors. These differences lead to an advantage for intersectoral collaboration; thus, sectors hold different competencies and resources, resulting in fruitful collaboration, but also come with disadvantages such as unclear responsibilities, causing hindrance to collaborate. Actors base their actions in accordance with prevailing characteristics within the logic of their sector. Some characteristics overlap between sectors, and this answers research question two. Similar sectors tend to collaborate more than others, in this case, the public and non-profit, based on similar salient values and incentives for activities through meaningfulness but also due to a dependency from the non-profit sector’s side on the public sector for achieving economic resources. Further, logics create hindrances for intersectoral collaboration through its material attributes and lack of financial resources seems as the main hindrance to collaborate intersectoral for social innovation.

Intersectoral collaboration has been established as essential in the work on climate change adaptation at the municipal level, but the municipalities face several institutional constraints to working across sectors. Because climate change adaptation is situated in a multilevel governance system, the national level has a role to play in institutional change at the municipal level. This thesis focuses on knowledge as an influential tool and sets out to investigate the potential of the national level to support collaborative action at the municipal level that challenges current institutions characterised by working in separate sectors. This is done by analysing the work of the National Knowledge centre for Climate Change Adaptation as they play a central role in the knowledge production on climate change adaptation at the national level. The findings of this thesis contribute to a better understanding of the barriers and opportunities that faces a national authority when supporting the municipalities through knowledge. These are mainly connected to the efficiency of the multilevel governance system, where increased horizontal and vertical interaction could facilitate the knowledge production to better support institutional change. The findings indicate that the regional level have a key role to play in enabling interaction across the system. Furthermore, national authorities must find ways to support collaborative municipal action without encroaching on the municipal autonomy. The findings give indications on what form knowledge could take to achieve this.

Objectifs: Cette étude a documenté la collaboration intersectorielle entre les agents de santé communautaires (ASC) et les enseignants visant à combattre la violence à l’égard des femmes et des filles à Vulindlela, une communauté rurale Sud-Africaine. La collaboration entre ces acteurs, les facteurs qui influencent leur collaboration et les avenues possibles pour une amélioration de cette collaboration ont été explorés. Méthodes: Six ASC et cinq enseignants ont pris part à cette recherche participative qui a inclut l'utilisation du dessin comme méthodologie visuelle. La collecte de données a été réalisée en quatre phases, avec un total de huit entretiens de groupes. La stratégie d’analyse principale a inclus une approche dirigée du contenu narratif et une approche de comparaison constante. Résultats: Le système de collaboration entre les enseignants et les ASC manque de définition et ces acteurs ne peuvent donc en faire l’utilisation. Par conséquent la collaboration actuelle entre ces acteurs a été jugée peu développé, impromptue et informelle. De nombreuses contraintes à la collaboration ont été identifiées, y compris le manque de motivation de la part des enseignants, la nature des relations entre les acteurs, et la capacité individuelle limitée des ASC. Conclusion: Compte tenu des nombreuses contraintes à la collaboration entre ces ASC et les enseignants, il n'est pas évident que cette collaboration conduira aux résultats espérés. Dans l'absence de motivation suffisante et d’une prise de conscience réaliste des défis par les acteurs eux-mêmes, les initiatives externes pour améliorer la collaboration sont peu susceptibles de succès. / Objectives: This study had for objective to document intersectoral collaboration (ISC) between community health workers (CHWs) and teachers aimed at addressing violence against women and girls (VAW/G) in Vulindlela, a rural South African community. The current collaborative paths bringing CHWs and teachers together, the factors that influence their collaboration and potential avenues for future improvement of this collaborative were explored. Methods: A total of six CHWs and five teachers took part in this participatory research which included the use of drawing as a visual methodology. Data collection was divided into four phases and included a total of eight group interviews. The analysis of group interviews utilized a directed approach to narrative data analysis, and a constant comparative approach was used in the analysis of the participants` drawings. Results: There are no well-defined collaborative systems that CHWs and teachers are able to make use of. Consequently teacher-CHW collaboration was found to be poorly developed, unplanned and informal. Numerous barriers were identified as impeding collaboration including the teachers’ lack of motivation to collaborate, the nature of the relationships between these groups of actors and the CHWs’ overall lack of individual capacity. Conclusion: Given the numerous challenges facing collaboration between these CHWs and teacher, it is not clear that such collaboration would necessarily lead to effective outcomes. In the absence of sufficient motivation and a realistic awareness of the challenges from the actors themselves, external initiatives to foster collaboration are unlikely to be successful.

This research examined intersectoral relationships and community participation in policy processes across the mental health and housing sectors. The focus was on the development of suitable housing options for people with a psychiatric disability. The study period covered five years of mental health system reform in South Australia (2000-2005). The research found a shortage of housing and support options for people with psychiatric disability and lack of significant strategic policy coordination or ongoing cross-sectoral programmes. The problems faced by people in gaining access to housing and disability support services and the ways in which families provide housing or support in the absence of public services are documented. This case study used qualitative research methods which were triangulated across four stages: 1) a thematic analysis of national and state policies in the health, housing and disability sectors; 2) participant observation of NGO activity, a thematic analysis of NGO documents, and interviews and focus groups with NGOs; 3) interviews and focus groups with consumer and carer representatives and a thematic analysis of the minutes from state-level groups; 4) interviews with professionals from the health, housing and disability sectors The housing situation for people with psychiatric disability was explained in terms of a number of key issues in the policy environment; „X The overarching neo-liberal policy context synonymous with a decline in public housing resources and increasing tension between NGOs service provider and advocacy roles. „X The political nature of the local mental health policy context and lack of political commitment to ongoing resources. Broad community stigma reflected in the media and government, affecting ongoing political commitment to mental health and housing and the introduction and progress of housing ¡¥projects¡¦. „X The slow development of peak NGO and consumer organisations and alliances in South Australia which affected access to policy networks and contributed to the dominance of professional interests within policy processes. „X The separation of health, housing and disability policy and networks within and across levels of government. This was associated with bilateral agreements (between Australian and state governments) tied to resources within departments, the programme objectives and the goals of bureaucrats. „X The separation of policy networks by sector was also connected to the dominance of bio-medical discourses and interventions and associated professional interests in the health policy sector. Medical discourses on health and disability and ¡¥consumerist¡¦ discourses on participation also led to social determinants of health such as housing being overlooked within policy processes. „X Governance reform at a state level contributed to organisational instability within departments, causing some problems for cross-sectoral initiatives and protocols. Kingdon¡¦s (2003) multiple streams analysis of policy helped to explain what missed or reached political agendas within each policy sector of the case study. Kingdon predicts that the unity of policy networks is important for the realization of policy solutions, and the lack of unity in policy sectors was an obstacle to policy agendas on housing for people with a psychiatric disability. However, the way in which problems were being represented (Bacchi 1999) was also important to understanding this policy environment. For example, a medical discourse on disability (Fulcher 1989) tied to the health sector led to a narrow focus on clinical mental health services. Similarly, neo-liberal discourse (Dean 1999) supported private housing solutions and resources or NGOs advocating ¡¥within sectors¡¦ for the types of services they already provided or wished to provide. The case study suggested strategies for ¡¥policy change¡¦ need to address a number of factors across service delivery, policy and political realms. Firstly, better recognition is warranted of the difficulty experienced by many people with psychiatric disability in achieving stable housing, and the need for indicators on housing access and stability for this group. Secondly, processes to address stigma (particularly that perpetuated in the media) will be instrumental for policy change and political commitment. Thirdly, ongoing cross sectoral advocacy and alliances require development at both a national and state level and support by a political culture which encourages advocacy. Developing processes for working across sectors such as policy learning forums involving both experts and community groups could counter problems arising from professional culture and territories that were documented in this study. Finally, the cross-sectoral development of policy, programmes and accountability mechanisms and the stability of policy networks will be important to ensuring stable housing for people with psychiatric disability.

<p>In community health promotion intersectoral collaboration is essential. Important actors are the governmental health system, the civil society and Non-Governmental organisations (NGOs). The aim of this qualitative thesis was to examine what kind of cooperation existed in a rural community in Mozambique and to describe the actor’s experiences of collaboration and how it can be improved. This was done by conducting interviews. The result of the study showed that different ways of cooperation existed, intersectoral as well as side by side and intrasectoral. The extent of intersectoral collaboration was fairly loose, such as networks, alliances or partnership. All the informants were positive to collaboration, they had experienced that people had been helped and their knowledge in health issues was improved as an effect of joint efforts. The experience among the actors was that the collaboration had improved and that they had become closer together over the years. Problems to cooperation that were mentioned concerned dropouts and financial issues. The informants were unanimous that it was necessary to broaden the collaboration. They were concerned over the sustainability in the different projects as well as the sustainability in cooperation itself.</p> / <p>Para a promoção da saúde em comunidade a colaboração intersetorial é essencial. O sistema público de saúde, a sociedade civil e as organisações não governamentais (ONGs) são importantes agentes. O objetivo desta tese qualitativa foi examinar qual tipo de cooperação existiu em uma comunidade rural em Moçambique e descrever as experiências de colaboração dos agentes e como ela pode ser melhorada. Isto foi feito através de entrevistas. O resultado do estudo mostrou que existiram diferentes modos de colaboração: intersetorial assim como intrasetorial de forma paralela. O nível da colaboração intersetorial foi relativamente informal assim como redes de contato, alianças e parcerias. Todos os entrevistados foram positivos a colaborar e experienciaram que as pessoas tinham sido auxiliadas e que seus conhecimentos acerca de assuntos de saúde foi melhorado como resultado da união de esforços. A experiência entre os agentes foi de que a colaboração foi melhorada e que eles se tornaram mais próximos através dos anos. Problemas acerca de colaboração que foram mencionados foram devidos a desistências e questões financeiras. Os entrevistados foram unânimes sobre a necessidade de aumento do nível de colaboração. Eles estavam preocupados sobre a sustentabilidade de diferentes projetos assim como a sustentabilidade da cooperação em sí própria.</p>

In community health promotion intersectoral collaboration is essential. Important actors are the governmental health system, the civil society and Non-Governmental organisations (NGOs). The aim of this qualitative thesis was to examine what kind of cooperation existed in a rural community in Mozambique and to describe the actor’s experiences of collaboration and how it can be improved. This was done by conducting interviews. The result of the study showed that different ways of cooperation existed, intersectoral as well as side by side and intrasectoral. The extent of intersectoral collaboration was fairly loose, such as networks, alliances or partnership. All the informants were positive to collaboration, they had experienced that people had been helped and their knowledge in health issues was improved as an effect of joint efforts. The experience among the actors was that the collaboration had improved and that they had become closer together over the years. Problems to cooperation that were mentioned concerned dropouts and financial issues. The informants were unanimous that it was necessary to broaden the collaboration. They were concerned over the sustainability in the different projects as well as the sustainability in cooperation itself. / Para a promoção da saúde em comunidade a colaboração intersetorial é essencial. O sistema público de saúde, a sociedade civil e as organisações não governamentais (ONGs) são importantes agentes. O objetivo desta tese qualitativa foi examinar qual tipo de cooperação existiu em uma comunidade rural em Moçambique e descrever as experiências de colaboração dos agentes e como ela pode ser melhorada. Isto foi feito através de entrevistas. O resultado do estudo mostrou que existiram diferentes modos de colaboração: intersetorial assim como intrasetorial de forma paralela. O nível da colaboração intersetorial foi relativamente informal assim como redes de contato, alianças e parcerias. Todos os entrevistados foram positivos a colaborar e experienciaram que as pessoas tinham sido auxiliadas e que seus conhecimentos acerca de assuntos de saúde foi melhorado como resultado da união de esforços. A experiência entre os agentes foi de que a colaboração foi melhorada e que eles se tornaram mais próximos através dos anos. Problemas acerca de colaboração que foram mencionados foram devidos a desistências e questões financeiras. Os entrevistados foram unânimes sobre a necessidade de aumento do nível de colaboração. Eles estavam preocupados sobre a sustentabilidade de diferentes projetos assim como a sustentabilidade da cooperação em sí própria.

Objectifs: Cette étude a documenté la collaboration intersectorielle entre les agents de santé communautaires (ASC) et les enseignants visant à combattre la violence à l’égard des femmes et des filles à Vulindlela, une communauté rurale Sud-Africaine. La collaboration entre ces acteurs, les facteurs qui influencent leur collaboration et les avenues possibles pour une amélioration de cette collaboration ont été explorés. Méthodes: Six ASC et cinq enseignants ont pris part à cette recherche participative qui a inclut l'utilisation du dessin comme méthodologie visuelle. La collecte de données a été réalisée en quatre phases, avec un total de huit entretiens de groupes. La stratégie d’analyse principale a inclus une approche dirigée du contenu narratif et une approche de comparaison constante. Résultats: Le système de collaboration entre les enseignants et les ASC manque de définition et ces acteurs ne peuvent donc en faire l’utilisation. Par conséquent la collaboration actuelle entre ces acteurs a été jugée peu développé, impromptue et informelle. De nombreuses contraintes à la collaboration ont été identifiées, y compris le manque de motivation de la part des enseignants, la nature des relations entre les acteurs, et la capacité individuelle limitée des ASC. Conclusion: Compte tenu des nombreuses contraintes à la collaboration entre ces ASC et les enseignants, il n'est pas évident que cette collaboration conduira aux résultats espérés. Dans l'absence de motivation suffisante et d’une prise de conscience réaliste des défis par les acteurs eux-mêmes, les initiatives externes pour améliorer la collaboration sont peu susceptibles de succès. / Objectives: This study had for objective to document intersectoral collaboration (ISC) between community health workers (CHWs) and teachers aimed at addressing violence against women and girls (VAW/G) in Vulindlela, a rural South African community. The current collaborative paths bringing CHWs and teachers together, the factors that influence their collaboration and potential avenues for future improvement of this collaborative were explored. Methods: A total of six CHWs and five teachers took part in this participatory research which included the use of drawing as a visual methodology. Data collection was divided into four phases and included a total of eight group interviews. The analysis of group interviews utilized a directed approach to narrative data analysis, and a constant comparative approach was used in the analysis of the participants` drawings. Results: There are no well-defined collaborative systems that CHWs and teachers are able to make use of. Consequently teacher-CHW collaboration was found to be poorly developed, unplanned and informal. Numerous barriers were identified as impeding collaboration including the teachers’ lack of motivation to collaborate, the nature of the relationships between these groups of actors and the CHWs’ overall lack of individual capacity. Conclusion: Given the numerous challenges facing collaboration between these CHWs and teacher, it is not clear that such collaboration would necessarily lead to effective outcomes. In the absence of sufficient motivation and a realistic awareness of the challenges from the actors themselves, external initiatives to foster collaboration are unlikely to be successful.

This master thesis investigates the subject of Corporate Social Responsibility (CSR) in Kazakhstan and selected states of European Union (EU). Successful implementation of CSR depends on a number of factors influencing it. Firstly, CSR is regarded as a part of market strategic decision making. Thus, there should be certain level of awareness about CSR on this particular market. Secondly, CSR is highly dependent on the states' public policies and activities of civic sector organizations (CSOs). In this thesis I examine the interaction of the state, the market and civic sector in influencing and creating conditions for the development of CSR in Kazakhstan. One chapter is dedicated to CSR in Kazakhstan's oil and gas sector. This thesis also investigates and compares major differences regarding CSR in Kazakhstan and selected EU states. The aim of this thesis is to present current situation of CSR development in Kazakhstan and formulate recommendations for the successful development of CSR in this country.

Submitted by Rosina Valeria Lanzellotti Mattiussi Teixeira (rosina.teixeira@unisantos.br) on 2019-01-23T16:37:04Z No. of bitstreams: 1 Ana Gonçalez.pdf: 1703059 bytes, checksum: a04fbb3e23e280d09e42e7b689c1218f (MD5) / Made available in DSpace on 2019-01-23T16:37:04Z (GMT). No. of bitstreams: 1 Ana Gonçalez.pdf: 1703059 bytes, checksum: a04fbb3e23e280d09e42e7b689c1218f (MD5) Previous issue date: 2018-08-09 / A obesidade na criança e adolescente é uma doença crônica, epidêmica, de alta prevalência, multicausal e de complexa abordagem a qual envolve vários profissionais de saúde. Muitas pesquisas apontam para as dificuldades no enfrentamento da doença, no entanto, raros discorrem sobre as experiências dos profissionais de saúde que atuam no serviço público prestando cuidados a essas crianças e adolescentes, sobretudo a respeito das práticas e desafios enfrentados por eles durante o manejo desta doença nos diversos componentes de saúde. Este estudo buscou compreender, na perspectiva dos profissionais de saúde, como estes percebem suas práticas e respectivos desafios na assistência a esse público no serviço e entre os componentes de saúde. Trata-se de uma pesquisa qualitativa, mediante entrevista semiestruturada com profissionais de saúde que atuam no SUS na assistência com obesidade na criança e no adolescente de duas regiões da cidade de São Paulo. A captação da população foi por intermédio de indicação em bola de neve, de forma que contemplasse diversidades entre às formações profissionais, bem como à atuação nos diferentes componentes de atenção. Para a composição final da população deste estudo foi usado o critério de saturação teórica e o percurso analítico foi norteado pela análise de conteúdo temático. A captação encerrou-se com 16 profissionais, sendo 5 da atenção primária, 4 da secundária, 6 da terciária e um gestor da rede. Eles revelaram que as relações de trabalho com a equipe multiprofissional do respectivo serviço são positivas; o manejo da obesidade em crianças e adolescentes é complexo e desafiador pois o sistema de saúde apresenta problemas e não funciona na sua plenitude; quanto ao conhecimento sobre diretrizes que contemple a obesidade neste público, a maioria disse desconhecer e despontaram que suas atividades são baseadas em normas da instituição onde atuam assim como em suas práticas; a maioria não se articulava adequadamente entre os diferentes componentes de saúde; revelaram falhas no fluxo de referência e contra referência; disseram haver lacunas nos registros pois, as informações referentes a saúde do paciente não são integradas entre os diversos componentes de saúde; os profissionais não perceberam diferenças nas atribuições e competências por nível de atenção. Concluiu-se, a partir da prática e percepção desses profissionais de saúde, que eles enfrentam muitas adversidades os quais, por vezes, interferem em suas práticas gerando serviços nem sempre com a qualidade e articulação desejadas. Há diversidade de materiais e instrumentos norteadores para o manejo da obesidade, mas, poucos deixam claro condutas e fluxos que deverão ser seguidos, pois, são genéricas e não consideram as singularidades da criança e do adolescente. / Child and teenage obesity is a chronic, epidemic, high prevalence, multicausal and hard to approach disease, which involves multiple health professionals. Many researches show difficulties in facing the disease, but very few discourse on the experiences of the health professionals that work on the public service taking care of these youngsters, especially about the practices and challenges faced by them during the management of this disease in the different components of healthcare. This study aims to comprehend, through the perspective of the health professionals, how they perceive their practices and the respective challenges in the assistance to this public in the health system and in it¿s components of care. This is a qualitative research, conceived through semi structured interview with health professionals that act in SUS in the assistance of obese children and teenagers in two regions of São Paulo. The captation of the population was fulfilled by means of snowball indication, in such a way that it included diversity of professional formation and fields of actuation. To the final composition of the population, it was used the theoretical saturation criteria and the analytical path was guided by means of thematic content. The captation finished with 16 professionals, being 5 from the primary care, 4 from the secondary, 6 from the tertiary and one network manager. They revealed positive work relationships with the multiprofessional team of their respective level of care; the management of obesity in children and teenagers is complex and challenging because the health system presents problems and doesn¿t work in it¿s plenitude; regarding the awareness of the guidelines that cover obesity in this public, most of them declared not to have knowledge and pointed that their activities and practices are based on the norms of the institutions they work at; most didn¿t articulate well between the different components of healthcare, revealing reference/counter reference flow failures and gaps in the records due to the non integration of the patient's information about their health among the different levels of healthcare; the professionals didn¿t point differences between the attributions and competences of different levels of care. It was then concluded, from the practices and perceptions of these health professionals that act on the public network in the treatment of obese children and teenagers, that they face many adversities that, sometimes, interfere with their practices, resulting in services that may not reach the desired quality and articulation. There is a wide range of materials and instruments that guide the handling of obesity, but few are clear on the conducts and flows to be taken with obese children and teenagers as they are generic and don¿t consider the particularities of this public.