Health and well-being are the central concerns for most African people. If health and well-being (utano) is the top priority for most Africans, the general and almost complete breakdown of the Zimbabwean public health care system in the past decade (2000-2010) has had far-reaching repercussions on the whole populace. Whereas African theology and religious studies have expended considerable energy in addressing the theme of health and well-being, there have been limited attempts at developing indigenous theologies. This study plugs the gap in the available scholarly literature by proposing a Karanga theology of health and well-being paying particular attention to a specific community‘s responses to the health delivery systems in Zimbabwe. Through an examination of indigenous responses to health and well-being and critiquing the collapse of the health delivery systems in the period 2000-2010, the study argues that understanding health agency in contemporary Zimbabwe enables appreciating the centrality of utano (health and well-being). This study also seeks to establish the agency of the community in responding to the national health care crisis, focusing specially on the Karanga community in Murinye district. It explores the Karanga healthworlds and documents the agency of the Karanga health-seekers and health-care providers in responding to the health-care crisis. The major focus of the study is to establish how the Karanga navigate the existing religious and medical facilities (Modern scientific bio-medicine; Traditional healing and Faith-healing) in their search for healing by conducting fieldwork research which entailed the use of interviews and participant observation. The study was also influenced by oral theology based on the community‘s underlying faith experiences. It also relied upon the life history approach and narrative theology to establish trends and patterns in the Karanga medical system. The study concludes by exploring some useful and life-giving Karanga indigenous resources that can be utilized in constructing a Karanga theology of health and well-being in contemporary Zimbabwe. A Karanga theology of utano places emphasis on a liberative motif which is life-giving and life-enhancing. This includes acknowledging the agency of health-seekers who are actively involved in their own welfare. It argues that utano is achieved when, on the basis of indigenous beliefs and Christian beliefs regarding health, individuals and families invest in refusing to accept ill-health. Information drawn from study participants demonstrated how they sought the opinions of traditional healers, prophet healers and modern health practitioners whenever they felt that their condition was compromised. The study foregrounds the fact that for the Karanga people, issues of health and well-being cannot be separated from their religious perspectives. There are diverse religious traditions among the Karanga people and these inform their understanding of utano. As such, the three health delivery systems should not be viewed as competitors for clients but more importantly, they should be viewed as complementing each other. / Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2013.

Control of tuberculosis has often been managed as a simple issue, the belief being that activities to care for people affected by tuberculosis can be uniformly standardised and centred on the diagnosis and treatment of tuberculosis. The DOTS strategy has been the most concrete illustration of this approach. It is undeniable that this has been successful in re-organising unstructured and very inefficient national TB control programmes.<p>Today, many countries’ programmes are better organised and have reached case detection and cure rates close to the targets set by WHO (i.e. 70% of cases effectively detected and 85% of detected cases cured). There are mounting arguments to enlarge the scope of activities to care for people affected by TB beyond the classical standardised strategies for diagnostic and treatment of tuberculosis. Indeed, it has become widely accepted that to increase further coverage of diagnosis and treatment of TB, it is necessary to address the economic and psychosocial problems of the people affected by tuberculosis, particularly for those having the least access to and worse quality of care. This will be possible only if, additionally to the current approaches, customised care can be developed after analysis to capture the complexity of care and interventions that take the specificity of local systems in their context into consideration. In chapter 1-2, we illustrate this through the review of the recent customisation of Directly Observed Treatment (DOT) as its naturally evolve in various contexts world-wide. <p><p>Developing an analysis that captures complex issues in PATB care means having a proper understanding of the interactions between parts of the local care systems to people affected by TB and identifications of the important patterns of these interactions. That is possible only if information different than the usual quantitative indicators is generated. We illustrate this in the part 2. We took the case of Nicaragua’s TB control programme, which is renowned for its performance in America. In that context, we illustrated the limits of a classical approach to TB control programme evaluation (chapter 2-3) and gave four examples of care process analysis that illustrated the economic and psychosocial problems of people affected by tuberculosis (PATB) (chapter 2-4 to 2-7). <p>Developing customised system-sensitive interventions to improve the care process means recognising that the interventions cannot be isolated from the organisational context and social dynamics during changes. Thinking must therefore move beyond the design of universal, standardised tool kits. We illustrate specifically in the part 3 the importance of combined local, national and international processes in improving the care process for people affected by TB in Nicaragua: lessons from successful and unsuccessful local and customised processes of implementing interventions in four local health systems (chapter 3-4) can be an opportunity for a health system research unit in a public health school to build a strategic process of care improvement at national level (through scaling up and through the building of a conducive environment) (chapter 3-5). <p>As a conclusion of this work, we propose in part 4 a three-level reflection through discussion of patterns emerging from the analysis done in the previous chapters: (1) patterns of care and (2) of organisation of health care system are presented in the form of an analytical framework; (3) patterns of regulation and management to improve care for PATB are presented together with a strategy to work on it. <p> / Doctorat en Sciences de la santé publique / info:eu-repo/semantics/nonPublished

South Africa has a complex healthcare system. The provision and financing of health care in South Africa occur within two fundamentally different systems: the public healthcare sector and non-governmental not-for-profit organisations, on the one hand, and the private healthcare system, on the other hand. The socioeconomic status of an individual in South Africa is the primary determinant of the system through which he or she will receive access to healthcare. The healthcare services provided by the public and private sectors are perceived to be unequal. The introduction of healthcare reforms by the South African government through the National Health Insurance (NHI) aims to address these disparities. The primary objective of this study was to contribute to the successful implementation of the proposed South African NHI by identifying critical success factors that would impact such implementation. A sample of managerial representatives of the following healthcare institutions in the Nelson Mandela Bay Municipality (NMBM) was drawn: Large private hospitals groups; Eastern Cape Department of Health; Independent medical practitioners groups; South African Dental Association; Pharmacy Association of South Africa; Optometrist Association of South Africa. A total of 250 questionnaires were distributed among these institutions and approximately 233 usable questionnaires were returned (response rate 93.2 percent). A literature review was conducted to identify the various viewpoints (critical success factors, as well as positive and negative perceptions) on NHIs in other countries, as well as the proposed one in South Africa. About 43 of such viewpoints were identified. The 233 respondents were surveyed on these 43 viewpoints. The empirical results revealed the following three critical success factors for the successful implementation of the South African NHI: The projected benefits for stakeholders, with specific reference to medical aid schemes; the projected benefits to the private healthcare sector in servicing the public sector; and strategic leadership. The empirical results also showed that the healthcare managers, who serve the poor versus the affluent geographical areas of the NMBM, differ with regard to their projected success of the NHI. Finally, the study highlighted these health managers’ general perceptions about the envisaged benefits and shortcomings of the NHI.

This study places the intended creation and implementation of an inter-professional education strategy at the intersection of three networks. The networks in question are cultural historical activity theory (CHAT), actor network theory (ANT), and a complex healthcare organisation (NHSX). CHAT and ANT, whilst both socio-material in origin, afford quite different readings of NHSX: therefore, the former has been used to identify, distil, and decompose the organisational activity systems, and the latter has been used to problematise them. The strategy was created in 2005 and had ceased to exist by 2010. This study therefore employs CHAT and ANT accounts to trace the lifespan of the strategy through the organisation, in particular through organisational working, learning, and boundary crossing, in an attempt to explain its untimely demise. It is envisaged that this study will provide an aid to framing how socio-material approaches can be combined to support inter-professional policy construction and implementation in a way that will allow flexibility for others to adapt to their own distinctive circumstances

Since the 1990 the use of Electronic Patient Records (EPR) in health services has become increasingly prevalent world wide. EPR has become an important aspect of the continuous improvement of patient care. Transferring all patient records from paper based to electronic is now a priority for many health services. The research reported in this thesis is sponsored by Hamad Medical Corporation (HMC) to provide opportunity to explore the potential role for EPR in the Medical Records Department. The study has been designed to gain better understanding of the users perspectives with regard to the use of patient records. In order to analyse and understand the complex dynamic involved in the management and use of patient records, it was recognised that systems thinking offered an appropriate framework for this research. Soft System Methodology (SSM) was therefore applied to the analysis of the data and used to inform the development of a conceptual model. Using SSM in combination with the structured questionnaire survey and telephone semi-structured interview, triangulation of methods was achieved. Use of these generated rich data revealing for example the general dissatisfaction expressed with the existing manual patient records system, the lack of confidentiality, poor legibility, shortage of space and the frequent misfiling of records. The need to address these problems has informed the strategic plan for the development and implementation of EPR for HMC. The research has successfully addressed the stated aims and research questions and guided the formulation of proposals for improvements.

Thesis (Ph. D.)--University of Texas Health Science Center at Houston, School of Public Health, 1994. / Typescript. Includes bibliographical references (leaves 143-154).

The concept of Shifting the Balance of Care was first introduced to NHS Scotland in 2005 through the Kerr Report. The key messages from the report were to: ensure sustainable and safe local services, which are supported by the right skills, change the emphasis of care into the community, provide preventative reactive care, and fully integrate the system to tackle the changes, use technology more effectively, and involve the public in finding solutions to change. Following the report, a framework was developed which highlighted and prioritised eight areas of improvement. These areas for improvement are the focus by which this research examines if Operational Research (OR), specifically OR models, can have a positive impact in Shifting the Balance of Care. The research utilises underlying OR methodologies and methods and provides evidence from the literature of the ability of nine selected models to facilitate the Shift in the Balance of Care. A contributing factor to the research is the barriers to implementation of OR models into the NHS. With reference to the literature, the common barriers to implementation of OR models are categorised and used to provide direction to modellers where implementation barriers are more prevalent in some models than in others. The research also provides empirical evidence of three selected models’ (the Lean Methodology, Process Mapping and Simulation, developed over two Case Studies) ability to address and influence the prioritised Improvement Areas, with the addition of a newly developed model: SoApt. The development of SoApt follows the Principles of Model Development derived as a guide to modellers who wish to develop a new model. SoApt is also empirically explored in a Case Study and provides some evidence of the models ability to aid Decision-makers, faced with limited budgets, to choose between options which will Shift the Balance of Care. OR methods and methodologies are examined to ascertain the Roles of Models for each model explored in the Case Studies. Examination of the Roles of Models against the Improvement Areas provided evidence of a models’ ability to address more than one of the priority areas and that models can be used together or sequentially. In addition, with reference to OR methods and methodologies, a theoretical Evaluation Framework is proposed which suggests the User and User Satisfaction is key to the evaluation of a model’s success; positive experiences of the User and Use of the model may help to eliminate some of the barriers to implementation.

This study explores the practical and ideological implications of the New Public Management (NPM) paradigm as introduced in Greece by the so-called “Troika”, a sobriquet referring to a triumvirate comprising representatives of the IMF, the European Union, and the European Central Bank. In the past, attempts had been made by Greek officials to implement managerial practices within the Greek National Health Service (NHS) and the hospital sector in particular, albeit at a more leisurely pace than that of other countries’. On arrival to Greece the Troika imposed a number of changes to improve the country’s public services; and set a brisk pace to accelerate their implementation. The present doctoral thesis seeks to critically evaluate the issue of whether those reforms, especially those salient to the Greek NHS system, are true manifestations of a shift in the NPM paradigm or whether they represent yet another archetypal Greek public sector restructuring. It will also evaluate responses to and outcomes of the successive reforms in the Greece’s NHS system, ascertain the factors contributing to and/or impeding the adoption of those reforms, and identify new opportunities for growth. In order to gain access to a more profound insight into the Greek context, the collection of secondary data provides, among other things, an historical background of Greece’s public healthcare system; reviews the system’s characteristics in terms of healthcare policies, and probes into the state of working conditions within public hospitals. The heightened managerial spirit prevalent in Greece at the moment and brought about by the Troika’s tenure, has made it necessary for the literature review of the present work to focus on the ways that managerial practices and ideologies are imposed on other countries so that their public sector dysfunctionalities may be rectified. Drawing on the literature reviewed, the study develops an integrated analytical framework anchored in NPM, so as to test it in the Greek case and contribute to understanding the Greek NHS organisational realities as well as to evaluating how the new changes have been evolving and faring within Greece’s healthcare organisations. The framework is comprised of a review of the NPM paradigm so as to contextualise the Greek reforms in terms of ideology and practices; a review of Principal-Agent Theory (PAT) for illuminating the interrelationships and involvement of the key actors with the reforms; and a review of Critical Realism (CR) for assisting to reveal the underlying mechanisms and structures that bind the actors with the organisations and their development. Apart from providing the conceptual basis of the thesis, the framework also serves in informing its methodological design (i.e., generating the interview schedule), analysing the findings, and steering the discussion. The study adopts an in-depth, qualitative research approach that views social life within organisations in terms of processes, events, actions, and activities between key actors as factors unfolding over time. To that purpose, semi-structured interviews were conducted with the key stakeholders of the Greek NHS system: State hospital doctors, hospital managers, and policymakers. The contribution of the study is an in-depth analysis of reform implementation as carried out in Greece’s medical system which now stands, within a turbulent economic and political context. By means of that analytical framework, it is shown that Greece is a sui generis case whose context and historical background are altogether different than those of other countries’. Moreover, the framework demonstrates that, despite the fact that NPM is firmly ensconced, as far as practice and ideology go, it is too soon to be drawing any conclusions: NPM is still in its infancy and reforms to the Greek NHS system have yet to be finalised as they continuously stumble on the inefficiencies and blunders of the past which hinder them from functioning properly. Last, the thesis does possess one more unique feature: it delves into the thinking, manoeuvres, and behaviour of the Greek healthcare professionals as a group, a world rarely if ever explored by empirical studies.

The Pharmaceutical Services are an integral part of the health system and it has in the drug a essential ingredient in the actions in the promotion, protection and recovery of health. Increased access of population to the health system have required changes in the distribution and financing of drugs in order to increase coverage and minimize costs. The present study aimed to evaluate the relationship between the Brazilian governmental financing and assurance the population's access to Drugs, Essential of the Component of Primary Pharmaceutical Care in the city of Aracaju. This is an observational descriptive study of an exploratory nature, the case study type, evaluating the period between the years 2008 and 2012. Work begins rescuing briefly the history of Pharmaceutical Services in the Brazilian Health System and its funding mechanisms in the process of decentralization of health. Proceeds to the analysis of semi -structured interviews conducted by the Pharmaceutical Care`s Municipal Manager, Management Annual Reports of the municipality , reports prepared by Municipal Pharmaceutical Assistance Management and of the deposits made to the account of the Fund allocated to the Municipal Health Component Basic pharmaceutical services and discusses the results. After evaluating the results, it was found that, for the study period, there was sufficient resources to serve all municipal demand for medication of this component, however, it could be seen that there was discontinuity in the supply and consequently, access to these drugs. It is therefore concluded that there was no relationship between sufficiency and ensuring access to Drugs,Essential in the city of Aracaju during the survey period. / A Assistência Farmacêutica é parte integrante do sistema de saúde e tem no medicamento, o insumo essencial em ações voltadas à promoção, proteção e recuperação da saúde. A ampliação do acesso da população ao sistema de saúde exigiu mudanças na distribuição e no financiamento de medicamentos, de maneira a aumentar a cobertura e minimizar os custos. O presente estudo se propôs a avaliar a relação entre o financiamento tripartite da Assistência Farmacêutica Básica e a garantia ao acesso da população aos medicamentos do Componente Básico da Assistência Farmacêutica no município de Aracaju. Tratase de um estudo observacional descritivo, de cunho exploratório, do tipo Estudo de Caso, avaliando o período compreendido entre os anos de 2008 e 2012. Iniciase o trabalho com um breve resgate da história da Assistência Farmacêutica no Brasil, seus mecanismos de financiamento e o processo de descentralização da saúde. Procede-se à análise das entrevistas semi-estruturadas realizadas junto ao gestor Municipal de Assistência Farmacêutica, dos Relatórios Anuais de Gestão do município, dos relatórios elaborados pela coordenação Municipal de Assistência Farmacêutica e dos depósitos realizados na conta do Fundo Municipal de Saúde destinada ao Componente Básico da Assistência Farmacêutica e discutem-se os resultados encontrados. Após avaliação dos resultados, verificou-se que, para o período da pesquisa, existiu suficiência de recursos para atender toda a demanda municipal por medicamentos desse componente, entretanto, pôde-se perceber que, houve descontinuidade no abastecimento e, consequentemente, no acesso a esses medicamentos. Concluise assim, que não existiu relação entre suficiência financeira e garantia de acesso a medicamentos do Componente Básico da Assistência Farmacêutica no município de Aracaju durante o período da pesquisa.

The issue of national health care has actively plagued the 20th century political spectrum in both the U.S. and the United Kingdom. It has been an issue of astounding resilience and vexation, alluding almost all simple-quick answers while consuming an ever increasing amount of public resources. There have been three principal time periods when both the United States and Great Britain have actively addressed universal coverage: the 1910s; the 194Os; and the 1990s. This dissertation extends John Kingdon's theory on policy agenda formation by examining the aforementioned debates. The conclusions that come from this study are four fold. (1) Contemporaneous interactions can occur between nations. (2) Century-long longitudinal development of a single policy area is possible and is illustrated. (3) Kingdon's policy streams approach can be utilized to conduct a comparative analysis of the policy agenda formation process. (4) Kingdon's conceptual model is more accurate at depicting the policy agenda formation process of the British parliamentary system than it is for the divided government structure of the U.S. / Ph. D.