In this thesis I examine the influence of economic, political and socio-cultural factors on the development of health services in Saudi Arabia. There are four main parts and a conclusion. In Part One I review the situation in developing countries. Many commentators have argued that economic factors, and to some extent political factors, are the main determinant of health services development in developing countries. Socio-cultural factors are generally neglected in these analysis. In this thesis I redress the balance by examining the relationship between economic, political and socio-cultural factors in the development of the Saudi health care system.In Part Two I analyse the Saudi resource situation. Although the health service is not considered a priority in the overall Saudi development strategy, the government provides generous financial resources for its development. However, non-financial resources remain a problem. Relatively abundant financial resources can provide a short-term solution to some of the resource shortages, such as the lack of skilled manpower, but the use of expatriate health personnel may have unanticipated negative consequences.In Part Three I examine the resource allocation process. The Saudi political system contains a mixture of modern and traditional elements, and the decision making process is affected by traditional social relationships. The King and public bureaucrats play a key role in the allocation process, but local leaders and Governors have wide scope to influence their decisions. While health provision is not a political issue in the country, it contributes to the social cohesion between the government and the general public.In Part Four I examine the influence of socio-cultural factors on the development of the Saudi health service. In the Saudi society socio-cultural factors affect the behaviour of individuals in their interaction with the health system. For example, the annual pilgrimage to Mecca by millions of moslems from all over the world presents a formidable challenge to health authorities. Health authorities accept the importance of socio-cultural factors, and respond by compromising policies. In the conclusion I consider the policy and theoretical implications of the study. In particular I examine the need for the formal recongnition and incorporation of socio-cultural factors into health policy decision making. This would lead to the generation of alternative policy options which complement other options based on economic and political considerations. The socio-cultural oriented approach can contribute significantly to the improvement of the long term prospect for health services in Saudi Arabia, and developing countries generally.

In this dissertation, I examine and compare the influence of the following regime characteristics -strength, stability, ideology, democracy and survival/maintenance - on post-colonial health human resources policy processes within one sub-region: the Commonwealth Caribbean; with special reference to Guyana, Jamaica and Trinidad and Tobago (hereinafter called Trinidad) between 1970 to 1990. As I want to comparatively assess the role of these characteristics in post-colonial policy processes, I shall in this chapter place my study within the context of colonial regime characteristics, society and reform processes, assessing its possible influences on post-colonial political developments. This forms the basis of my analysis of policy within these three `post-colonial' states during the 1970s and 1980s. Section One describes the paradox of health and health human resources status in the Commonwealth Caribbean during the 1970s and 1980s. In Section Two, I describe the area under study. In Section Three, I examine possible linkages with the nature of power and reform under colonial regimes. In Section Four, I analyse the influence of regime characteristics on policy processes by assessing health policy outcomes of postwar reform. I begin with an examination of the contradictory status of Commonwealth Caribbean health and health human resources development in the 1970s and 1980s.

This thesis examines women's treatment seeking behaviour for their own illnesses and that of children underfive in Kamwokya . The focus is on the extent to which women's access to money and time use patterns affect treatment seeking. It has been argued that women's treatment seeking behaviour is influenced more by their time use than their access to and availability of money.The findings obtained through the use of case histories and in-depth interviews indicate that though women in Kamwokya have access to their own money, mainly through participation in income generating activities (business), illness management for children under-five and even more for the women themselves, remains problematic. Women are overworked and manage fragile businesses that require their personal attention and presence. Hence, treatment seeking is done in a manner that will ensure minimal disruption of businesses. Consequently children's health, and even more so, that of women , is compromised for the sake of other family needs.This thesis demonstrates that illness management is not context free, and that no one factor can explain the whole process ; it both affects and is affected by other things happening in the family. Due to the multiple roles women have to fulfil, "time use "is found to be the organising and central factor in illness management for both women and children in Kamwokya, whether from rich or poor households.The thesis concludes by suggesting that policy makers, health care providers and professionals ought to take into account the daily routines of family life in their plans and programmes. Strengthening of private sector health providers, health education programmes and increased awareness raising of male responsibilities towards their families are recommended as a way of improving the health of women and children in Uganda.

Generally, organisations mobilise information from varying sources on which policies, plans, objectives and organisational management are predicated. indeed, everyone within organisation needs information to perform tasks, it is thus indispensable and its use so pervasive that a methodical approach for collection and processing is imperative. In health care organisations, involved with people and life, this is even of greater significance, in many instances allowable margin of error is narrow and can be devastating.Accurate and reliable information in clinical care for example cannot be compromised.On the other hand, adequate assessment of health services quality,effectiveness and efficiency depends on quality of information generated by the system, that is, accurate, relevant, timely, understandable and complete information. To achieve this, appropriate system design and operation is essential. Adoption of primary health care (PHC), in many developing countries in response to the Global 2000, necessitated establishment of chanisms for monitoring and evaluating effectiveness of services and programmes.Accordingly, in 1986 PHC was adopted in Nigeria, concomitantly, system monitoring and evaluation or the PHC Management Information System was effexted.The information system was envisaged to ameliorate the lack of reliable health information that has persisted since nception of modern health services in Nigeria. Findings in this and other studies indicate that existing health information systems have failed to provide accurate and reliable information, systems of data generation and processing are ineffective.The aim of this was to identify and understand factors that have contributed to the seemingly intractable and insalubrious information problem within the Nigerian health care system. It would be a herculean task for a lone researcher to undertake study of the entire health system, within resource and time limitations, data collection was therefore narrowed to the PHC level. Quality of the PHC management information system was assessed, with Bama Local Government as a case study. Focus was on understanding the information system's structure from a broad perspective to include, policies, objectives,established procedures; physical, material and human resources, in terms of their quality and quantity.Data collection was carried out using both qualitative and quantitative techniques. The structure, process and outcome models provided a framework for in-depth data collection, through observation, interview, review of records and administration of questionnaire, as well as for organisation and analysis of research data. The PHC MIS was followed through, from the village, health facility, local government, state and national levels.Study results suggest general ineffectiveness due to pervasive incongruity in the information system. In the first instance design of the MIS did not reflect information needs of community health workers and the community in general,who to the most part limited appreciation of the MIS structure, objectives to be achieved. Local and regional information need was not delineated, data collected had little relevance to local information needs, resource for systems operation was abysmal, skilled personnel and training provided severely inadequate.Consequently, data collection and processing was hampered, information produced often inaccurate, untimely, immense, irrelevant and unreliable. Data collected were neither analysed nor utilised. The information system was short of being integrated since 60% of functional units within the PHC department as well as related health organisations in the community ran parallel information systems.Research data point to serious incongruity in the organisation and management of the information system. Incongruity that resulted from factors within the organisation as well derived from events within the wider social environment, which however culminated in an effective and dysfunctional information system.Chapters one to three of the thesis deal with conceptual issues related to management information systems, organisational design and quality respectively. In chapter four methodological issues surrounding data collection were discussed. Empirical data and analysis are presented are presented in chapters five to seven. In chapter eight, an attempt was made to develop a model of organisational incongruity, applied to explicate research findings.Chapter nine focuses on measures toward establishment of an effective PHC information system in Nigeria, contributions of this study and suggestions for future research.

Organisations are increasingly deploying and using computer technology in various ways, involving the allocation of large amounts of capital and human resources. However, in many cases, computer deployment has been accompanied by failure, particularly in health care services. Therefore, information technology has raised grave questions, misunderstanding, fears, and hostility. This study emphasises the importance of computer deployment and development in developed and developing countries' health care services with examples from advanced and less advanced nations. It describes strategy development for IT/ISs using information system methodologies and explores the development of ISs strategy in the NHS in the light of fundholding and the internal market. A number of problems that commonly influence the success or failure of computer deployment and development are identified. These issues are explained through two case studies: the Omani health system and General Practices (GPRs) in the UK, which have introduced computers. The research focuses on five main sets of issues related to computer deployment and utilisation in health care: strategic planning; computer utilisation; computer fears; computer impact; and computer technical problems and performance. Users' overall satisfaction with systems in use is also considered. Data collection was carried out using two surveys. One survey was conducted in GPRs in Humberside and the other conducted in Royal Hospital and Sultan Qaboos University Hospital in Oman. Data sources included observations, review of relevant documents, such as reports, research papers and manuals, structured and non-structured interviews with selected users and a questionnaire. A number of conclusions can been drawn from this study: firstly, computer deployment, utilisation and development still faces problems in both the systems studied, more especially the Omani system. Secondly, GPRs have carried out strategic planning for computer deployment and utilisation and are prepared to use information system methodology for IT/IS strategy and there is a plan to use this for competitive advantage but Omani hospitals did not set a constructive strategic plan for their systems. Thirdly, the main problems of computer failure are related to human issues rather technical issues. The most important of these human issues are the style of the leadership planning, poor utilisation of computer applications, lack of skills and poor training. Finally, the results of the survey suggested that though the respondents were aware of the potential of computer technology, the problems of computer fears, training and lack of skills were experienced, and often, few individuals possessed computing knowledge. The author suggests several points to be considered: 1) that any thinking about computer deployment and development should employ appropriate information system development methodologies; 2) the decisions on computer deployment, use and development should be made by a special committee that has expertise in IT matters; 3) good strategic planning for computer deployment, use and development; should be connected to the organisation's overall strategy and 4) there is a need of mandate review for such development and planning. With these points in mind the researcher presents a diagram to help improving strategic planning and development of IT/IS methods with particular emphasis on the Omani environment.

The lecturer practitioner role in nursing is widely seen as offering hope for the future of nurse education, by overcoming the 'theory-practice gap', and establishing and maintaining effective links at many different levels between education and practice. It is clear, however, that there are a number of issues of concern about the role. These can be summarised as: lack of role clarity about overcoming the theory-practice gap; varying conceptions of the role and unclear job descriptions; and role conflicts and overload, from the conflicting demands of service and education settings Despite current political support for strengthening the links between higher education institutions and practice settings, a new governmental emphasis on the support of students in practice, and a growing in-depth evaluative literature about the role, there is no research examining its systematic development, or measuring and addressing aspects of lecturer practitioners' occupational stress and burnout. Initial project planning work found that lecturer practitioners perceived themselves as 'adding value' to education provision, with personal and professional gains for postholders. However, their key concerns were: absence of role clarity; absence of effective joint review/appraisal;a bsenceo f formal support In, order to develop and address aspects of lecturer practitioners' work roles and their employment position, this action research project was established. Using a spiral methodological framework, and a multi-methods approach to data collection to triangulate the findings, new knowledge about lecturer practitioner roles was uncovered, and employment practices were developed as a result. The project established three new mechanisms, and these outcomes can be summarised as: joint appraisal policies and materials; orientation/induction policies and materials; group support network. In addition, previously validated measures of occupational stress and burnout were used to meas. ure those conceptsi n this group of lecturer practitioners, and the impact of the project. They were found to be generally no more stressed or burnt out than comparable workers, and the project was unable to demonstrate statistically significant differences in beforeand after-scores. Synthesis of quantitative and qualitative findings indicates that these LPs were 'thriving rather than just surviving'.

This doctoral thesis is a feminist ethnographic study of psychiatric patients in the State of Sarawak, East Malaysia. The study took place at a psychiatric hospital located in the capital city of Kuching, commencing in 1997. Although Hospital Sentosa is a small institution it is the only psychiatric institution in the State and therefore constitutes an important mental health resource in this region. This ethnographic study primarily concentrates on the lives of women patients in keeping with my chosen methodological approach and seeks to explore the 'culture' of the hospital setting through facets such as daily interactions, activities and relationships. The feminist approach has not however precluded the accounts of male patients whose experiences are utilised in a comparative exercise with those of women counterparts. In addition the views of staff of both sexes and all ranks are considered in relation to their attitudes towards the care of psychiatric patients and the broader area of work-related concerns including collegial support and occupational hazards. In keeping with an ethnographic approach themes developed in the thesis are drawn through an analysis of findings as noted by observation methods as well as through interviews with participants. Furthermore a self-reflexive approach has been an important aspect of analysis commensurate with feminist methodology, in which my role as a researcher is considered in relation to issues of culture, gender and class as well as some of the difficulties of research in a post-colonial and unfamiliar cultural context. Although some avenues of inquiry in the study have not easily lent themselves to an analysis of gender, this thesis primarily argues that the hospital reproduces oppressive policies and practices that impact with greater severity on women patients. Oppressive practices in relation to gender and ethnicity at the hospital are viewed against a backdrop of contemporary psychiatric care as enacted on wards. It is argued that these practices can be viewed in turn as being, for the most part, historically premised upon imported British models of care replicated through colonialism in Malaya and by extension at a later period in the multicultural State of Sarawak.

Telehealth is defined by Jocelyne Picot as "the use of communications and information technology to deliver health and health care services and information over large and small distances" (Telehealth Industry 1). Current research in telehealth focuses on the evaluation of applications and projects, on the competitiveness of the telehealth industry, and on its role in international development. In contrast, this dissertation contextualizes telehealth in social history and theory. In so doing, it adopts an analytical, cultural studies approach rather than an empirical one. It also studies the extent of citizen involvement in current telehealth initiatives in Canada. More specifically, the dissertation examines whether the forms of involvement promoted by telehealth initiatives empower Canadian citizens. The examination is conducted through a five-step process. The first four steps involve an overview of the following: (1) histories of medical technology; (2) critiques of medical technology; (3) history and critique of the Canadian health care system; (4) critiques of information and communications technology and policy. The fifth step consists in mapping out the current state of telehealth development in Canada, including policy, applications and projects, as well as distinguishing the main roles of citizens in such initiatives. In closing, ways of achieving citizen empowerment through telehealth are suggested, whether it is found to be achieved in recent initiatives or not. Theoretical frameworks with the aim of positioning new technology in order that it may accomplish social change and citizen empowerment are put forward as an innovative means of evaluating current telehealth applications and projects in Canada.

Mode of access: World Wide Web. / Thesis (Ph. D.)--University of Hawaii at Manoa, 2004. / Includes bibliographical references (leaves 289-337). / Electronic reproduction. / Also available by subscription via World Wide Web / 337 leaves, bound ill., maps 29 cm

This research was designed to see whether the clinical method espoused by Moira Stewart et al in the book "Patient-Centered: Transforming The Clinical Method" is appropriate for Pakeha general practitioners to use in clinical consultations with Maori patients. This thesis uses qualitative methodology. One of my supervisors and I selected from the kuia (old women) and kaumatua (old men) of Hauraki those whom I would approach to be involved. Nearly all responded in the affirmative. The kuia and kaumatua talked about their tikanga, about the basis of tikanga, about the spirituality of their Maori worldview. They talked about the need to maintain their tikanga, about qualities that they respect. They described different roles within Maoridom, especially those of the kuia, whaea (mothers) and Tohunga (experts). They refer to a GP as a Tohunga because of the GP�s special expertise. The GP is able to use his or her special expertise to heal Maori patients, but needs to be able to get through barriers to do so. They are also clear that Maori and Pakeha live in two different worlds which can merge in some circumstances. I came to two conclusions. The first is that the elements of Patient-Centered Medicine are relevant to the consultation of a Pakeha GP and Maori patient, and provides a framework that is productive. The second conclusion is that there is a better framework for working with Maori patients, within which Patient-Centered Medicine can be practiced more effectively. Maori already have a framework (tikanga) in which they function, and if in their settings, especially the marae, he or she is welcomed and has a place in their world; tikanga accommodates the GP as a Tohunga and Maori respond to him or her as such. In summary, a Pakeha GP who has some knowledge of tikanga or Maori culture and who has a basic knowledge of the Maori language of tikanga of Maori culture and who has a basic knowledge of the Maori language can work very well for his or her Maori patients by working within the framework of Tikanga Maori and by being patient-centered in consultation.