Thesis (M.B.A.)-Business Studies Unit, Durban University of Technology, 2006 xv, 200 leaves / Imbalance in the health workforce is a major challenge for health policy-makers, since human resources are the most important of the health systems input (Sanders & Lloyd) Several developed nations are increasingly relying on immigration as a means of coping with domestic shortages of health care professionals (Vujicic et al. 2004). The extent of migration and other losses of professional skills are difficult to quantify. However, the effects of these are multifaceted and have far reaching consequences for both the economy and the maintenance of health services in the country. The effects of this “brain drain” limit service delivery and limit the general population’s access to health services. The purpose of this study is to determine the effectiveness of contracting bursary students to the Department of Health (KwaZulu-Natal) as a specialist skills retention strategy. / M

University of Macau / Faculty of Social Sciences. / Department of Government and Public Administration

University of Macau / Faculty of Social Sciences. / Department of Government and Public Administration

Submitted by Filipe dos Santos (fsantos@pucsp.br) on 2018-12-17T11:53:45Z No. of bitstreams: 1 Saulo Tavares da Mota.pdf: 1743608 bytes, checksum: f423cfc2c3563cada41f4825b99efc94 (MD5) / Made available in DSpace on 2018-12-17T11:53:45Z (GMT). No. of bitstreams: 1 Saulo Tavares da Mota.pdf: 1743608 bytes, checksum: f423cfc2c3563cada41f4825b99efc94 (MD5) Previous issue date: 2018-11-27 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / The aim of this study is to analyze how Vulnerability emerged as a problem and an intervention object for Public Health policies in Brazil, and the ways it has been used by professionals of Primary Health Care in the city of São Paulo - SP. The notion of Vulnerability was adopted in Brazil by the Ministry of Health as one of the fundamental intervention objects of the National Health Promotion Policy (NHPP), producing profound changes in the way of defining, identifying, intervening and prioritizing the population to be served, producing changes in the practices of public health professionals and users in the country. As a research method, we start with the genealogy developed by Michel Foucault. As an analytical of the modes of subjectivity, the genealogy allowed us to glimpse the historical conditions of the production of knowledge, sets of rules and ways in which health professionals recognize situations of vulnerability and use this notion in their practices. The research was developed from the analysis of archives and documents of the field of Public Health policies, participant observation of activities by professionals carried out in Primary Health Care units, as well as interviews with such professionals. It was verified that the notion of vulnerability was not used to give meaning to a complex reality, but to a concrete action on the problems that it names and proposes. Historically different uses and strategic functions have been produced for the notion of vulnerability in Brazil amidst disputes, confrontations, transformations and resistances. If, on the one hand, the emergence of such a notion in the field of HIV/AIDS care in Brazil constituted resistance and problematization of the concept of health risk, on the other hand, its spread and its use in other public health fields suffered appropriations that acted out different strategic functions and moved away from the initial critical stance. The process of constitution of the notion of vulnerability as a problem and object of intervention in public health historically involved control strategies and resistance practices. In the quotidian of the practices of the professionals of the Primary Attention to Health of São Paulo articulate, on the one hand, strategies of governmentality through institutions, procedures, analyzes, calculations and tactics that allow establishing relations of power over the population, with the intention to make it useful and participative, through a neoliberal rationality, interested in increasing capacities and security strategies, controlling and avoiding risks. On the other hand, in this same context, the practices of recalcitrance move these strategies with resistances, oppositions, elusive, inversions of positions. Each actor seeks to affirm ways of living that are often inconsistent with preestablished performance guidelines. In agreement with Judith Butler, we understand that attention to the situation of violence and precariousness to which many people are exposed is fundamental, but it is also necessary to refuse policies that victimize or stigmatize these people with the argument of protection or salvation, so that they offer resources for their strengthening and empowering their ways of living / O objetivo deste estudo é analisar o modo como a Vulnerabilidade se tornou um problema e um objeto de intervenção para as políticas de Saúde Pública no Brasil, e os modos como vem sendo usada por profissionais da Atenção Básica à Saúde no município de São Paulo - SP. A noção de Vulnerabilidade foi adotada no Brasil pelo Ministério da Saúde como um dos objetos de intervenção fundamentais da Política Nacional de Promoção da Saúde (PNPS), produzindo mudanças profundas no modo de definir, identificar, intervir e priorizar a população a ser atendida, produzindo alterações nas práticas dos funcionários e dos usuários de serviços de Saúde Pública no país. Como método de pesquisa, partimos da genealogia desenvolvida por Michel Foucault. Enquanto analítica dos modos de subjetivação, a genealogia permitiu entrever as condições históricas da produção de saberes, conjuntos de regras e modos pelos quais profissionais de saúde reconhecem situações de vulnerabilidade e usam essa noção em suas práticas. A pesquisa foi desenvolvida a partir da análise de arquivos e documentos do campo das políticas de Saúde Pública, observação participante de atividades por profissionais realizadas em unidades de Atenção Básica à Saúde, além de entrevistas com tais profissionais. Verificou-se que a noção de vulnerabilidade é usada não somente para dar sentido a realidades complexas, mas para a ação concreta sobre os problemas que ela nomeia e propõe. Historicamente produziram-se usos e funções estratégicas diferentes para a noção de vulnerabilidade no Brasil, em meio a disputas, confrontos, transformações e resistências. Se, por um lado, a emergência de tal noção no campo da atenção ao HIV/AIDS no Brasil se constituiu como resistência e problematização do conceito de risco em saúde, por outro lado, sua propagação e seu uso em outros campos da saúde pública sofreram apropriações que agenciaram funções estratégicas diferentes e que se afastaram da inicial postura crítica. O processo de constituição da noção de vulnerabilidade como problema e objeto de intervenção na saúde pública historicamente envolveu estratégias de controle e práticas de resistência. No cotidiano das práticas dos profissionais da Atenção Básica à Saúde de São Paulo articulam-se, por um lado, estratégias de governamentalidade por meio de instituições, procedimentos, análises, cálculos e táticas que permitem estabelecer relações de poder sobre a população, com o intuito de torná-la útil e participativa, por meio de uma racionalidade neoliberal, interessada no incremento das capacidades e de estratégias de segurança, controlando e evitando riscos. Por outro lado, nesse mesmo contexto, as práticas de recalcitrância deslocam essas estratégias com resistências, contraposições, esquivas, inversões de posicionamentos e afirmam de modos de viver muitas vezes inconformes às diretrizes de atuação preestabelecidas. Em consonância com Judith Butler entendemos que é fundamental a atenção à situação de violência e precariedade a que muitas pessoas estão expostas, porém também é necessário a recusa de políticas que vitimizem ou estigmatizem essas pessoas com o argumento da proteção ou salvação, de modo que ofereçam recursos para seu fortalecimento e potencializando seus modos de viver

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

Cette thèse étudie l’histoire des médecins au XVIIIe siècle, à travers les docteurs régents de la faculté de médecine de Paris. Partageant une même formation médicale donnant accès à la qualité de « régent », les docteurs sont les membres d’un corps puissant -la Faculté- dirigé par son doyen. Enseignants et chercheurs, ils investissent les institutions savantes, participent à la modernisation, à la circulation et au contrôle des savoirs médicaux non seulement auprès des professionnels de la santé mais aussi auprès des profanes. Également médecins libéraux, les docteurs régents prennent position dans le marché thérapeutique avec les autres professionnels de santé et les « charlatans ». Les inventaires après décès montrent l’adaptation de leur cadre de vie à leurs besoins professionnels (choix du quartier d’installation, possession d’un cabinet-bibliothèque, de carrosses et chevaux). Ils révèlent aussi combien leur activité, lucrative, les intègre dans la bonne bourgeoisie parisienne. Enfin, les actes notariés permettent d’identifier la clientèle des docteurs régents et de reconstituer leurs échanges avec les patients-clients, de la nature des services médicaux proposés aux honoraires. Les docteurs régents apparaissent aussi comme des conseillers techniques et des administrateurs des services de santé publique. La monarchie, soucieuse de l’encadrement sanitaire des populations, au quotidien et en temps de crise, les mobilise ici et là. En raison de leur expertise, ils sont mobilisés pour la transformation de l’hôpital, à l’organisation d’un système d’assistance dans la capitale, mais aussi dans les espaces ruraux et militaires, dans les colonies.Les docteurs régents conjuguent logiques corporatives et liberté professionnelle pour étendre leurs espaces d’intervention et demeurer au sommet de la hiérarchie des professions de santé. / This thesis studies the history of Paris doctors to the XVIIIe siècle, through the case of that of the “doctors regents” of its medical faculty. Doctors shared the same medical formation necessary to gain access to the quality of “regent” and to affiliation to a powerful community, under the supervision of its senior member. As teachers and researchers, they got access to erudite institutions, took part in the modernization, circulation and control of the medical knowledge not only in relation with the other medical practitioners but also with the neophytes. Considering their private clientele, the doctors regents took a stand in the therapeutic market with other health-related occupations and “charlatans”. The inventories after death show the adaptation of their living environment to their professional needs (choice of occupational location, ownership of cabinet-libraries, carriages and horses). They reveal also how much their profitable employment contributed to their integration to the upper Parisian bourgeoisie. Lastly, notarial deeds helps documenting the “docteurs-régents” customers and reconstituting their exchanges with the patient-customers, of the nature of the medical services covered by medical fees. The doctors regents also acted as technical advisors and administrators of the public health services. The monarchy, concerned by its subjects’ medical control, on an everyday basis and in times of crisis, mobilized them here and there. Due to their expertise, they are required for the transformation of hospitals, and for the organization of medical assistance not only in the capital city, but also in the rural and military areas and in the colonies. The “docteurs-régents” combined professional strategies and occupational freedom to extend their realms of agency and to remain at the summit of medical occupations’ hierarchy.

The New South Wales Medical Board established a Health Programme for the assessment and rehabilitation of doctors whose clinical performance was impaired by alcohol or psychoactive substance use, mental or physical illness. This programme was developed to be individualized to the needs of each registrant. The present study has three aims: 1. To describe those doctors who participated in the Board???s Health Programme. 2. To chart the duration of involvement of these doctors through the programme. 3. To examine the outcomes associated with this programme. The study is based on the prospective cohort of all 181 impaired doctors who participated in the Health Programme between July 1st 1993 and April 30th 2001. Information on each registrant was collected at the time of the initial assessment and at each review conducted as part of the programme. Additional qualitative data was also collected and supplemented by a file audit conducted in August and September 2001. One hundred and eighty-one doctors were prospectively monitored as part of this study. The largest source of impairment was psychiatric illness (45.3%), 77% of the doctors were male. The average age of the cohort was 41.6 (sd 11.1) years. Impaired doctors were more likely to be working in emergency medicine or psychiatry and be based in a rural area. Of those who had finished their involvement in the programme, successful graduates participated for a mean of 38.2 (sd 22.3) months. In general outcomes of involvement were positive, 64 of 113 (56.6%) of doctors successfully graduated from the programme. One hundred and ten of 168 (65.5%) improved during the period of their involvement and 111 of 126 (88.1%) were working in medicine. Five, 2.8% of the participants died during the period of this study. Measures of registrant insight and support tended to increase during the period of involvement with the Health Programme. Future studies will need to establish evidence for the most appropriate interventions with impaired doctors. This process would be strengthened by the collection of standardized data across intervention programmes, supplemented with functional assessments and the collection of qualitative data.

Bibliography: leaves 494-519. / ix, 519 leaves ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Examines the influence of the medical profession on health policy in Australia. Case studies of policy struggles under Federal Labor governments since 1983 illustrate both the nature and scope of that influence. / Thesis (Ph.D.)--University of Adelaide, Dept. of Politics and Dept. of Community Medicine, 1994

Includes bibliographical references. / iv, 398 leaves ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / The government of South Australia has developed a Primary Health Care Policy (1989) and Draft Implementation Plan (1992) in order to focus its health promotion efforts. The thesis demonstrates that implementation of these concepts will be facilitated by a clear understanding of idealogical and political issues to be faced in bringing about such change. / Thesis (Ph.D.)--University of Adelaide, Dept. of Community Medicine, 1995

"April, 2004." / Includes bibliographical references. / 2 v. : ill (some col.), photos ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Seeks to make visible some of the effects on nursing practice and the nursing profession of the political and organisational changes in the New Zealand health reforms in 1995. / Thesis (Ph.D.)--University of Adelaide, Dept. of Clinical Nursing, 2004