Introduction The human immunodeficiency virus (HIV) epidemic has led to the upsurge of tuberculosis (TB) infection globally, but most especially in areas with high HIV prevalence. In the past, there was lack of a coordinated global and national response between TB and HIV programmes to curb the devastating impacts of both infections. However, the ProTEST Initiative piloted in sub-Saharan Africa in 1997 demonstrated that TB and HIV programmes could collaborate successfully in delivering joint services. This prompted the development of the WHO interim policy on collaborative TB/HIV activities in 2004, aimed at reducing the burden of TB and HIV in populations affected by both infections. This thesis explores how collaborative activities between TB and HIV programmes have been established in Cameroon and implemented in the Northwest Region. It also highlights the achievements and constraints in delivering joint services to TB patients co-infected with HIV. Methods The study was conducted in the Northwest Region, one of the 10 regions of Cameroon with the highest HIV prevalence. The study uses health system research combining qualitative and quantitative methods to explore the research objectives. Qualitative methods were used to capture the perspectives of: i) the service providers; key informants from the central, regional and district levels concerned with the collaboration process and in delivering HIV services to TB patients, and ii) TB patients regarding HIV testing as an entry point to HIV services. Quantitative methods were used to ascertain TB patients’ access to HIV services provided for by the collaboration. Results The study demonstrated that although there were varying levels of collaboration between TB and HIV programmes from the central to operational level in the health system, delivering joint services was feasible. Furthermore, despite the challenges TB patients faced in testing for HIV, overall implementing TB/HIV collaborative activities increased TB patients’ acceptability and accessibility to HIV services. These were facilitated by the improved collaboration at the operational level, and enhanced service provider-patient alliance which was instrumental in building patients’ trust in the health system. Collaboration also led to cross-training and teamwork between staffs from both programmes, and improved networking between service providers and other actors involved in TB and HIV care. Nevertheless, there were health system constraints including inadequate leadership and management, shortage of human and infrastructural resources, frequent interruptions in the supply of essential drugs and laboratory materials Conclusion TB/HIV collaborative activities have improved service delivery and TB patients’ access to HIV services. Nonetheless, appropriate stewardship which guarantees joint planning, monitoring and evaluation of essential activities, and accountability at all levels in the health system is invaluable. Besides, the identified health system constraints which could adversely influence effective joint service delivery and a sustainable collaboration deserve due appraisal. / Introduction L’épidémie du virus de l’immunodéficience humaine (VIH) a conduit à une augmentation globale  de la tuberculose(TB), particulièrement dans les régions à forte prévalence du VIH. Il y’avait par le passé un manque de coordination tant sur le plan mondial que national, des programmes de lutte contre la TB et le VIH pour freiner les effets dévastateurs liés à la co-infection des deux pathogènes. Cependant, l’initiative pilote “ProTEST”  conduite en 1997 en Afrique sub-saharienne  a démontré que les programmes de lutte contre le VIH et la TB pouvaient collaborer avec succès en combinant leurs services. Cette étude pilote a inévitablement incité a un changement de politique du bureau intérimaire a l’Organisation Mondiale de la Santé (OMS), de lutte contre le VIH/TB  à mettre sur pieds en 2004 des objectifs pour la réduction de l’impact du VIH/TB parmi les populations atteintes des deux infections. Cette thèse explore comment la collaboration entre les activités des programmes  de lutte VIH/TB a été établie au Cameroun, et comment son application se fait  dans la région du nord ouest. Il est également mis en exergue et les réalisations les difficultés que rencontrent les services combinés lors de la dispensation des soins aux malades de TB avec une coïnfection au VIH. Méthodes L’étude a été faite dans la région du nord ouest, une des 10 régions du Cameroun, avec le taux de prévalence au VIH le plus élevé. L’étude utilise le système de recherche en santé combinant des méthodes qualitatives et quantitatives pour explorer les objectifs de la recherche. Les méthodes qualitatives ont été utilisées pour enregistrer les données suivantes: i) centre offrant les services combinés; les personnes en charge au niveau central, régional, et des districts, qui sont responsables de l’intégration au processus et qui d’autre part veillent a ce que les malades de TB bénéficient des services du VIH ; et ii) les malades de TB qui considèrent le dépistage du VIH  comme porte d’entrée dans les services VIH. Des méthodes quantitatives ont été utilisées  pour confirmer  l’accès des malades de TB aux soins de services VIH offerts par la collaboration. Résultats L’étude a démontré que bien qu’il y ait  plusieurs niveaux de collaborations entre les programmes de VIH et TB depuis le sommet jusqu’ à la base du  système de santé, la provision de services combinés  est faisable. Malgré les difficultés rencontrées par les malades de TB pour avoir accès au dépistage du VIH, l’application en somme de la collaboration des activités entre les programmes de VIH et de TB a augmenté l’acceptation et l’accessibilité des malades de TB aux services de VIH. Ceci fut facilité par l’amélioration de la coopération au niveau des opérations des deux programmes permettant ainsi  la facilitation de l’établissement d’une alliance entre le personnel de soin et le patient, alliance qui fut primordiale dans l’élaboration du rapport de confiance que le malade doit avoir à l’endroit du system de santé. La collaboration a également conduit  à un travail d’équipe et une formation croisée entre les équipes des deux programmes, il a été également établi une amélioration du réseau d’échange entre les personnels de soins et toutes personnes actives dans le secteur du VIH et TB.    Néanmoins, il a été relevé des défis dans le système de santé telle une insuffisance dans le leadership et la gestion de fréquente interruption dans la chaine de distribution des médicaments essentiels et du matériel de laboratoire. Conclusion La collaboration des activités des programmes VIH/TB a amélioré la qualité des soins et services  avec pour résultante une meilleure accessibilité des malades de TB aux services de VIH. Néanmoins, une conduite appropriée qui garantie une planification mixte, une évaluation et un suivi des activités essentielles, ainsi qu’une gestion fiable a tous les niveaux du système de santé est indispensable. Outre, les difficultés liées au système de santé identifiées par cette étude et qui méritent une évaluation, du fait  qu’elles pourraient affecter négativement l’application effective du but recherché et la collaboration durable entre les deux services.

Made available in DSpace on 2016-08-10T10:32:32Z (GMT). No. of bitstreams: 1 VERA LUCIA DOS SANTOS SILVA.pdf: 796951 bytes, checksum: 82611c16d7b40289d43c9c832b939f8a (MD5) Previous issue date: 2010-10-14 / Perspective of modernity and rationality this work addresses the issue of health and social control, is prepared in three chapters. The first traces of a historical overview of the research conducted in space 2 working researcher who is Northwest Health District. Goiânia was constructed from a conception of a planning and with traits of modernity, but its disorderly expansion has submitted to municipal management various challenges. One relates to the issue of lack of housing, the invasions of public and private areas have effective steadily. The first organized occupations of goiana capital occurred in Garden New hope and in nearby areas, the importance of social movements and the installation of the first residence multiprofessional health family in the capital. The second deals with the relationship between the local councils and the Municipal Council of health by focusing on the creation of local health councils from the 1st Conference of Health from Goiânia, the mapping of conferences and councils created in period searched: 1989-2009. The third chapter deals with the insertion of Social Service in Municipal Department of health and the importance of the work performed by social workers next to social control in the institution, in particular in the continuous training of health advisers. / Numa perspectiva de modernidade e racionalidade o presente trabalho aborda a questão do controle social na saúde e, encontra-se elaborado em três capítulos. O primeiro traça um panorama histórico do espaço da pesquisa realizada no lócus de trabalho da pesquisadora que é Distrito Sanitário Noroeste. Goiânia foi construída a partir de uma concepção de um planejamento com traços de modernidade, porém a sua expansão desordenada tem apresentado à gestão municipal desafios diversos. Um deles relaciona-se à questão da falta de habitação, as invasões de áreas públicas e particulares têm se efetivado de forma constante. As primeiras ocupações organizadas da capital goiana ocorreram no Jardim Nova Esperança e em áreas próximas localizadas na Região Noroeste de Goiânia, a importância dos movimentos sociais e a instalação da primeira residência multiprofissional em saúde da família na capital. O segundo trata da relação entre os conselhos locais e o conselho municipal de saúde ao enfocar a criação dos conselhos locais de saúde a partir da 1ª Conferência de Saúde de Goiânia, o mapeamento das conferências e dos conselhos criados no período pesquisado: 1989 a 2009. O terceiro capítulo trata da inserção do Serviço Social na Secretaria Municipal de Saúde e a importância do trabalho realizado pelas assistentes sociais junto ao controle social

This qualitative study of representative bureaucracy examines the extension and limitations of liberal democratic rights by connecting environmental and social history with policy, individual decision making, gender, race, and class in American history. It documents major cultural shifts in a homogeneous patriarchal organization, constraints, advancement, and the historical agency of women and minorities. "Creating a Multicultural Forest Service" identifies a relationship between natural and human resources and tells a story of expanding and contracting civil liberties that shifted over time from women and people of color to include the differently-abled and LGBT communities. It includes oral history as a key to uncovering individual decision points, relational networks, organizational activism, and human/nature relations to shape meaningful explanations of historical institutional change. With gender and race as primary categories, this inquiry forms a history that is critical to understanding federal bureaucratic efforts to meet workforce diversity goals in natural resource organizations.

Submitted by Luciana Ferreira (lucgeral@gmail.com) on 2015-12-08T07:03:52Z No. of bitstreams: 2 Dissertação - Renatha Cândida da Cruz - 2015.pdf: 7162038 bytes, checksum: cf247e6c52c05b38afe2f497f3091a21 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-12-08T07:06:33Z (GMT) No. of bitstreams: 2 Dissertação - Renatha Cândida da Cruz - 2015.pdf: 7162038 bytes, checksum: cf247e6c52c05b38afe2f497f3091a21 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-12-08T07:06:33Z (GMT). No. of bitstreams: 2 Dissertação - Renatha Cândida da Cruz - 2015.pdf: 7162038 bytes, checksum: cf247e6c52c05b38afe2f497f3091a21 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2015-09-18 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / The socioeconomic changes observed in the country in the past decades have been studied and researched in recent years and have given different classifications. The "New Middle Class" is a new therm. According to the studies, with the increase of income of the Brazilian families, many of them got into the middle class, in a range between R$ 291,00 and R$ 1054,00 per capita. Other studies realize that, far beyond the income, the connexion of other factors need to be considered , such as work and education, for example, and so it appears more appropriate to give to the group the name of the "New Working Class". In this sense, this dissertation aimed to understand the socio-spatial dynamics of Goiania's Northwest Region in 2010, to identify whether the defining elements of the "New Middle Class" and the "New Working Class" could be applied to the delimited area. We adopted the methodology bibliographical and statistical on the NorthWest Region and the guiding themes of work, followed by the preparation of charts, tables and maps that supported our considerations and discussions. In this study, we showed that the Northwest Region of Goiânia has, in 2010, a dynamic quite different from its genesis occurred in 1979 with the collective struggle for urban land. To understand this process, we developed a timeline and each step was assigned the name of a neighborhood in the region namely: Esperança (1979-1981), Finsocial (1982-1987), Vitória (1988-2001) and Triunfo ( 2002-2010), besides of the intermediate phase, which we call Tremendão (1979-2010). Based on the analysis, we found that the population of the Northwest Region is a representation of the "New Working Class", justified by the low education, long work hours, although with enormous changes in income and consumption pattern. / As mudanças socioeconômicas observadas no país nas últimas década vêm sendo tema de estudos e pesquisas nos últimos anos e fizeram surgir diferentes nomenclaturas. A nova classe média é uma delas. De acordo com os estudos, com o aumento da renda das famílias brasileiras, muitas delas se ingressaram na classe média, em uma faixa entre R$ 291 e R$ 1.054 per capita. Outros estudos dão conta de que, muito além da renda, a relação de outros fatores necessita ser levada em consideração, como o trabalho e a escolaridade, por exemplo, e assim se mostra mais adequado atribuir ao grupo o nome de nova classe trabalhadora. Nesse sentido, a presente dissertação teve por objetivo entender a dinâmica socioespacial da Região Noroeste de Goiânia no ano de 2010, para identificar se os elementos definidores da nova classe média e da nova classe trabalhadora se aplicavam ao recorte espacial. Adotamos como metodologia o levantamento bibliográfico e estatístico acerca da Região Noroeste e das temáticas norteadoras do trabalho, seguimos com a elaboração de gráficos, tabelas e mapas que subsidiaram nossas considerações e discussões. Nesta pesquisa, evidenciamos que a Região Noroeste de Goiânia apresenta, em 2010, uma dinâmica bastante diferente de sua gênese ocorrida em 1979, com a luta coletiva pelo solo urbano. Para compreender esse processo, elaboramos uma cronologia e a cada etapa foi atribuído o nome de um bairro da região a saber: Esperança (de 1979 a 1981), Finsocial (de 1982 a 1987), Vitória (de 1988 a 2001) e Triunfo (de 2002 a 2010), além da fase intermediária, que chamamos de Tremendão (de 1979 a 2010). Com base nas análises, constatamos que a população da Região Noroeste é uma representação da nova classe trabalhadora, justificada pela baixa escolaridade, as longas jornadas de trabalho, embora com intensas modificações na renda e no padrão de consumo.