In Alberta, decision-making in the health system has been devolved to seventeen Regional Health Authorities (RHAs). This thesis undertakes a broad analysis of the values that underlie this regionalization. Divided into two parts, the first half of the thesis develops a liberal egalitarian theory for the distribution of resources in society that turns on the importance of providing all people with the basic resources required to plan for, develop and achieve their life goals. Four requirements for any health system that seeks to uphold the values inherent in this theory are then articulated. These requirements include the need for the health system to be sensitive to the broader determinants of health, and the need for understanding the concepts of health and disease within the context of the social and cultural communities that the system is meant to serve. Part One concludes with an argument suggesting that expressions of Canadian values cohere with the normative theory developed. In Part Two the evolution of Alberta's regionalized healthcare system is traced. The values implicit in the regionalization of the health system in this province are then examined for their congruence with the four requirements developed in Part One. Following this, the ethical difficulties faced by RHAs are considered. The thesis culminates with thoughts on the ethical challenges Alberta's regionalized healthcare system must confront, offering recommendations for how some of these challenges may be addressed. It is concluded in the thesis that while a regionalized health system is not necessary for meeting the requirements elucidated, these standards can be met with a regionalized approach. However, at least in the case of the Alberta experience, a number of important changes would have to take place for this to occur. Among these changes is a paradigm shift in the way health and disease are understood towards a more evaluative approach; the recentralization of public health initiatives to the provincial level; and an overall change in governmental health policy recognizing that many areas of society, and consequently the policies of government agencies beyond a disease-based healthcare system, impact health and well-being. / Arts, Faculty of / Philosophy, Department of / Graduate

Health promotion research and practice reveal that goal setting and monitoring have gained increased acceptance at international, national, provincial/state, regional and local levels as a means to guide health planning, promote health-enhancing public policy, monitor reductions in health inequities, set health priorities, facilitate resource allocation, support accountability in health care, and track the health of populations. The global adoption of health goals as a strategy for population health promotion has occurred even though few protocols or guidelines to support the health goals development process have been published; and limited study has occurred on the variation in approach to health goals planning, or on the complex, multiple forces that influence the development process. This is an exploratory and descriptive case study that endeavours to advance knowledge about the process and contribution of health goals development as a strategy for population health promotion. This study seeks to track the pathways to health goals in British Columbia (BC) and to uncover influential factors in rendering the final version of health goals adopted by the government of BC. Specifically, this study explores the forces that obstructed and facilitated the formulation and articulation of health goals. It considers also implications of health goals development for planning theory, research and health promotion planning. Data collection consisted of twenty-three semi-structured interviews with key participants and systematic review of BC source documents on health goals. Data analysis uncovered nearly 100 factors that facilitated or obstructed the BC health goals initiative, organized around three phases of health goals development. Key factors influencing the premonitory phase included (a) government endorsement of health goals that addressed the multiple influences on health, (b) expected benefits of health goals combined with mounting concern about return on dollars invested in health, and (c) effective leadership by a trusted champion of health goals. Key influencing factors in the formulation phase included (a) the positioning of the health goals as a government-wide initiative versus a ministry-specific initiative, (b) the "conditioning" of the health goals process through the use of pre-established health goals and "orchestrated" consultation sessions, and (c) the make-up and degree of autonomy of the health goals coordinating mechanism. The articulation phase of health goals development revealed several influencing factors in relation to two chief issues that characterized this phase: (a) the lack of specificity of the health goals, and (b) the variable portrayal of the "health care system" as a priority area in the BC health goals. This study also revealed several concessions and trade-offs that characterized the BC health goals process. For example, the formulation of health goals that addressed the broader health determinants yielded health goals without the capacity for measurement, (b) the operational and bureaucratic autonomy of the health goals coordinating mechanism led to feelings of alienation from the health goals process and product among some branches of the Ministry of Health and some established health interests, and (c) the use of pre-determined health goals and the delivery of educative sessions based on the determinants of health generated claims of bias and a lack of trust and fairness in consultation processes and mechanisms. / Graduate and Postdoctoral Studies / Graduate

Thesis (Ph.D.)--University of the Witwatersrand, Faculty of Commerce, Law and Management, Wits School of Governance, 2016 / CEOs of public hospitals in South Africa are often held responsible when their institutions fail to deliver good quality care and are associated with poor health outcomes. Negative perceptions prevail and particularly in the National Department of Health it is held that the CEOs are generally not adequately qualified, inexperienced, incompetent and often inappropriately appointed. This study attempts to articulate the CEOs views (their side of the story) and in particular how they perceive the challenges that they face and what solutions they proffer in improving the running of their institutions. This research is viewed through the lens of the New Public Management paradigm (NPM), in terms of Public Sector Reform and in particular Health Sector Reform in South Africa. Thirty CEOs of public hospitals in South Africa responded to a survey of their opinions. The majority (86%) of them felt they were unable to manage their institutions effectively. A subsequent qualitative study of CEOs and experts in public management using in depth interviews and further focus group discussions with CEOs and senior hospital managers revealed that the major challenges that the CEOs faced were financial, human resources and operational management issues. Procurement and information challenges were linked to financial and human resources deficiencies, lack of accountability mechanisms and the presence of corruption. The Performance Management System currently in place did not work appropriately and was driven by perverse incentives. Political interference was also a pervasive problem. Their recommendations were that they needed clear and unambiguous delegations and the appropriate resources so that they can take full responsibility of their institutions. Clear accountability structures were paramount in achieving better health service management and care according to the advice of experts in public management as well as that of senior hospital managers. This requires the creation of enabling legislation and an appropriate accountability framework. The blanket application of NPM principles is also questioned. Selective application of the tools of NPM should be tested and consideration be given to the dimension of added public value in the South African public hospital context. / GR2018

No description available.

Attacks on public administration are commonplace in today’s anti-bureaucratic approach to government. The legitimacy of public administration has long been questioned. Public administration is not one of the three branches of government explicitly formed by the Constitution. Further, public administrators are not elected by the people. Numerous attempts have been made to develop an idea of legitimacy that is grounded in the Constitution and that renders public administration consistent with the representative character of American government. A recent attempt presents public administration as an institution of governance that is derived from, and grounded in, the Agency Perspective. This perspective provides a new foundation stone for the legitimacy of public administration. Central to the perspective is public administration’s ability to evoke dialogue in a way that takes into account the public interest and brings about communities of shared meaning. This literature, however, does not provide a specific enough perspective, i.e., a perspective that has been given a practical specification. Simply exhorting public administrators to evoke dialogue is not sufficient. Public administrators who are encouraged in this general manner will have no choice but to look to what they know: interest group liberalism. Public administration needs a more specific alternative to interest group liberalism and a new methodology from which public administrators can work. In the research at hand, a new methodology is developed and demonstrated. The outline of the new methodology can be seen through the lens of principled negotiation. This literature maintains that negotiation from the positions of the various parties involved in a conflict, as is characteristic of interest group liberalism, is inefficient. Principled negotiation, on the other hand, recognizes that vital interests, not positions, are the key to creating consensus and achieving collaboration. The difficulty with this approach is that people, either as individuals or as role occupants in organizations, typically are unaware of their vital interests. Therefore, it is the task of the negotiator or, in this case, the public administrator to help surface these deeper interests. The new methodology is grounded in the literature of structuralism. Structuralism is a social theory and a method of inquiry (Gibson, 1984:2) that provides a means of looking beneath the surface of events or issues to identify patterns of meaning that are not evident at the surface. The work of linguist Ferdinand de Saussure served as the basis for modern structuralism (Sturrock, 1988:6). Working from Saussure’s writings, Claude Levi-Strauss "treats all forms of cultural expression as language and he assumes that like language it is all [structured] by unconscious laws that constitute a grammar for each" (White, 1983:12). In a similar vein, the structuralist undertaking in this research views the vital interests of the related groups and role occupants as the "underlying grammar" that structures the various approaches to policy formulation. This research employs a case study design to which the theory of structuralism and the technique of structural analysis have been applied. The case study is that of national long-term care policy. Role occupants from 23 national organizations involved in long-term care policy were interviewed. The role occupants are key people involved in long-term care policy formulation for the organizations for which they work. The organizations' long-term care position papers were obtained. Using a process of structural analysis, the position papers and interview transcripts were analyzed to identify vital interests. An analysis of linguistic elements such as metaphors and other figures of speech, justifications, preferred meanings, and recurrent terms was conducted. In addition, content analysis was carried out with the aid of a computer program. The vital interests identified through these analyses served as the basis for the development of a strategy to shape the national long-term care policy debate. / Ph. D.

Prior 1994 South Africa had a fragmented health system designed along racial lines. One system was highly resourced and benefitted the few and the other was under-resourced and was for the black majority. Attempts to deal with these disparities did not fully address the inequities. The objective of the NHI is to address the inequalities by ensuring that all South African have access to affordable, quality healthcare services regardless of their socio-economic status. The majority of the participants do not understand the meaning and the implications of the national health insurance. Among the health professionals that were interviewed, there were no consultations before the implementation of the NHI. The health economists verbalized that it will be too expensive as the majority of citizens do not pay taxes. More roadshows need to be done to make communities aware of the planned strategy which will benefit all. / Health Studies

Thesis (MBA)--Stellenbosch University, 2012. / Railit Total Transportation (RTT) is a multinational corporation whose core business is to be a logistics and distribution partner to other multinational corporations. Many of RTT’s key clientele are in the healthcare and pharmaceutical industry, with various key relationships and networks being developed over many years of operation. RTT set the trend by becoming one of the first large South African companies to participate in and profit from the rest of the African continent at a time when it was not popular to do so. On a similar motivation, the current CEO of the RTT Group, Dr Iain Barton, believes that it is a strategic imperative to participate in the Base of the economic Pyramid (BoP), both for economic and developmental reasons. The BoP is not a new market, but recent interest in its potential profitability has being sparked in the business community by the works of management gurus such as the late C.K. Prahalad and the current sustainability champion Stuart Hart. This dissertation presents a case study that will analyse the phenomenon of developing a business model that targets the primary healthcare (PHC) needs of poor South Africans. This study will also extract lessons learnt from the case study in the context of existing BoP theory, primary healthcare in South Africa, and a similar initiative implemented in Kenya in the form of the Child and Family Wellness Clinics (CFW). The case study presents the reader with the pilot phase of RTT’s Unjani Clinic project, and contrasts the findings and lessons learnt from the two main pilot sites in Johannesburg’s Etwatwa and Wattville peri-urban BoP communities. This study also explores a smaller business model concept among Cape Town’s informal traders, also known as spaza shops. The data collection for the case study was undertaken in the qualitative research methodological format with a comprehensive set of interviews that aimed to triangulate the views of management, operational staff, community participants and patient participants. The strength of the case study findings is enhanced by the inclusion of comprehensive case study data, which includes verbatim transcripts of all interview participants and focus group participants. The database can be found at the end of this research report. Many lessons emerged that were both expected and unexpected, with three major themes coming to the fore: • The strategic funding of Unjani, within the dichotomy of profit and non-profit hybrid models • Challenges in achieving operational scale and efficiencies within the BoP • Marketing the value proposition to the BoP. RTT’s management has already begun to implement many of the lessons that have emerged. This includes the marketing mix that requires greater appreciation at a detailed ethnographic level of the dynamics of non-traditional BoP markets. The research report also provides other recommendations to stimulate demand in BoP markets as well as suggestions for the ideal funding and business partners to move this project forward. This research is unique in exploring the challenges of business model development specifically to service the healthcare needs of poor South Africans, and to contribute a small but significant part in the broader understanding of doing business in the South African BoP.

本研究主要在探討離島兩家公立醫院，在政府醫療整合政策下合併是否真能妥善利用當地有限資源並提升當地之醫療品質與醫療滿意度。本研究以澎湖醫療大樓落成啟用引進三軍總醫院及署立澎湖醫院醫事人力作為時間點，蒐集整理醫院經營管理資料，比較醫療大樓使用前後，醫療資源利用情形，對於民眾關切之四項議題：（一）醫療整合政策與提升當地醫療品質的關係。（二）醫療整合政策與成本效益的關係。（三）醫療整合政策與組織管理的關係。（四）醫療整合政策與民眾滿意度的關係之探討，採以質性田野調查方式作深入剖析與辯證，另對醫療品質滿意度觀察部分，則以門診就醫病患為調查對象，與質性調查結果作交叉驗證，分析探討整體社會對醫療服務品質滿意度之觀感。試圖從不同層面與角度來詮釋、剖析醫療整合政策與民眾對醫療服務品質滿意度間有無存在背後深層的意義及潛在的社會意涵。 / 本研究發現（一）政府的整合醫療政策，目的是將離島有限的資源作有效的運用，在方向上是正確的。，醫療大樓要做到何種規模須視其未來的定位與所開的床位數而定，若要求持續提供一定品質的醫療服務，政府常態性的預算補助是必要的。（二）假日緊急醫療需求無法在地圓滿解決，是澎湖地區長期以來醫療服務主要的缺口，兩院整合後目前仍未能解決該問題，是造成澎湖整體社會對醫療品質觀感不若預其的原因。（三）病患與醫療專業人員對醫療品質的認知是有差距的，這代表醫、病雙方所能掌握的醫療品質資訊是不對稱的，病患不瞭解醫界對醫療品質的評核標準，只能用直接的感受來體驗，是造成雙方在衡量醫療服務品質時出現落差的原因。（四）在組織重整過程中，「同工同酬」問題因不同公務體制無法於第一時間解決，造成員工內心不滿與不安，亦是影響整體社會對醫療服務觀感不若預其的因素。（五）在基本人口特質中，軍人、家人同住多者及醫療服務使用率較高者，這三類群體對醫療服務品質的認知有較客觀的認定，應與其對醫療服務的體驗有較多之經驗有關。（六）以模擬醫事人力供需情境分析，澎湖地區並非是一個醫事人力不足或醫療資源缺乏的地區，而是在健保制度下形成醫療資源分配不均的問題。本研究建議健保醫療給付應配合政府公共政策才是解決離島醫療問題有效的方式。（七）離島醫療成本相當昂貴，以侷限的地域、不足的消費人口及健保總額支付制度限制下，要發展在地醫療或提升至區域級醫療服務品質宜審慎考慮，建議遠距醫療合作、空中轉診後送結合軍方穩定的醫療人力支援，可能仍是最佳解決問題的模式。 / The purpose of this study is to explore how two public hospitals on Penghu Island can really make good use of limited local resources to improve medical quality and patient’s satisfaction under nation wide integration of health care policy. This study adopts qualitative research and interview method on the following four items that are of great concerns to the local general public: (1) the relationship between the integrated medical policy and improvement of local medical quality (2) the relationship between the integrated medical policy and hospital performance (3) the relationship between the integrated medical policy and organizational management (4) the relationship between the integrated medical policy and patient’s satisfaction. As to the observation of client satisfaction of medical treatment, the targets are out-patients with analysis of their satisfaction with the medical services. This study also intends to interpret from different aspects and perspectives the real social meaning presented by the relationship between the integrated medical policy and client satisfaction. / This study has discovered the following: (1) The decision of the integrated medical policy with purpose of effectively deploying limited resources on off-shore islands is correct. However to what extent a medical building should provide its service is dependent on its hospital beds capacity and the definition of its role. Regular budgetary support from the government is necessary if stable quality of medical services is desired. (2) One of the main reason about people’s satisfaction with overall medical services provided on Penghu has not met the expectation is that there still did not provide a good resolution to the urgent medical support on Holiday after the integration of two hospitals medical resources. (3) There is a gap between professional medical services providers and patients in recognizing the quality of medical services. This means that the information obtained by both parties regarding the quality of medical services is asymmetric. Patients do not understand the criteria used to review the quality of medical services and as a result, they depend on very direct feeling or experience to make the judgment, thus causing the gap. (4) During the process of reorganization, the issue of “equal work with equal compensation” did not receive appropriate attention and was not resolved properly by different governmental bureaucratic systems which led to the fact that the quality of medical services is not as good as expected. (5) Three fundamental elements of population, military personnel, families with most of their members living together, and frequent users of medical services, have possessed more objective recognition of the quality of medical services due to their more sufficient experience in using medical services. (6) a simulated analysis of demand and supply of medical services has indicated that Penghu Island shall not be regarded a region lack of medical personnel or barren of medical resources. This study suggests that the compensation provided under the National Health Insurance System must go hand in hand with government public policies to provide an effective way to resolve medical problems on off-shore islands. (7) The cost of medical services on off-shore islands is high. Under the conditions of limited population in limited areas and the per-quota-compensation provided by the National Health Insurance System, we need to carefully consider how to develop or upgrade its quality level. It is, therefore, suggested that distant medical cooperation, aerial medical transport together with stable supply of medical personnel from the military provides probably the best model for resolution of the problems.

The rhetoric of primary health care, health promotion and health service integration is ubiquitous in health policy development in post-apartheid South Africa. However the form in which oral health promotion elements have actually been incorporated into other areas of health care in South Africa and the extent to which they have been implemented, remains unclear. The central aim of this research was to critically analyse oral health promotion elements in health policies in South Africa and determine the extent to which they have been implemented. The study set out to test the hypothesis that oral health promotion is fully integrated into South African health policy and practice.

Submitted in fulfillment of the requirements for the degree of Master of Technology: Emergency Medical Care, Durban University of Technology, Durban, South Africa, 2013. / Background In the Emergency Medical Services (EMS), paramedics play a vital role in the treatment of critically ill or injured patients, as they are often the first link or point of contact for the patient in the healthcare setting. They may therefore also play a vital role in the prevention and control of the transmission of communicable diseases, provided that proper infection control measures are in place. The objectives of the study There is presently no national policy on communicable diseases and infection control that is specifically designed for use in the South African prehospital environment. Given the paucity of research in the area, qualitative multiple case studies were conducted to develop an ambulance specific disinfection protocol and to evaluate its effectiveness in the public sector EMS in the eThekwini District of KwaZulu-Natal. Methodology The study comprised of three phases. In the first phase focus group discussions were conducted to identify the factors needed to develop a disinfection protocol. The study population consisted of both operational and management staff from the EMS under study. The first four focus groups consisted of eight to ten EMS operational staff each and the fifth focus group consisted of five EMS management staff. Thereafter, the information gathered was used in conjunction with internationally accepted guidelines to develop an ambulance specific disinfection protocol (Phase Two). The third phase entailed the implementation of the protocol at seven ambulance bases in the eThekwini health district and the evaluation of the protocol with the use of an open-ended questionnaire at two weeks and four weeks after implementation. A single ambulance crew and their immediate supervisor from each base were utilized in this phase. Conclusion and recommendations An ambulance specific disinfection protocol was developed and implemented in the EMS under study. During the development, implementation and evaluation of the protocol, many themes with regard to infection control in EMS were identified. These themes were used to better understand the present situation in EMS in relation to infection control and in the formulation of recommendations to assist in the improvement of the present situation. The researcher recommended that all EMS staff require training and education with regard to infection control and prevention. The development and implementation of a protocol and policy document for infection control specifically for EMS is required. There is a need for the deployment of more ambulances and the employment of more operational EMS staff together with the appointment of Infection Control Supervisors at all ambulance bases. Without adequate infrastructure needed to meet infection control and prevention requirements, there may be a serious risk to both staff and the patients they serve. / M