Indonesia has one of the highest rates of maternal mortality in Southeast Asia. Community participation has been known to reduce maternal mortality in some areas in Indonesia. However, in Aceh Province, the prevalence remains higher than the general Indonesian maternal mortality rate. The aim of this research was to gain an understanding of pregnancy and childbirth experiences from multiple perspectives, in relation to the use of maternal health services in Aceh, Indonesia. The conceptual framework was based on the importance of community engagement in improving maternal health. A qualitative study design with a grounded theory approach was utilised. This approach was chosen in order to gain an understanding of the social processes and ways in which experiences of pregnancy and childbirth are related to maternal death incidents. The process inherent in the method enabled the emergence of important theoretical concepts. A theoretical sampling strategy was employed. The data collection used multiple methods that involved a series of in-depth interviews, observations and focus group discussions with women, family members, a village leader and health professionals. The sample size was determined by data saturation (19 women, 15 family members, 7 health professionals, 3 kaders, 4 student midwives and 1 village leader participated). Ethical approval was gained and the research setting was in the two villages of Aceh Besar District, Aceh Province, Indonesia. Data were coded and analysed by following a constant comparison process. The emergent core category, entitled “maternal death: the elephant in the room” explains the views of the community about maternal death incidents in the research setting. The research findings highlighted that despite the maternal mortality rate still being high in the region, maternal death was not focused upon, as a problem within the community. The research findings revealed that maternal mortality was a hidden problem within the community, and was related to inadequate maternity practices in the village. The core category “maternal death: the elephant in the room” was found to consist of four interrelated categories. The categories of the value of midwifery in the community, desicion-making of maternity care, social control of the childbearing and distancing of maternal deaths; explain maternity practices in the community. Understanding of social processes related to maternal health can assist in informing strategies to improve the quality of maternal healthcare in Aceh Indonesia.

Thesis (M.P.H.M. (Primary Health Care Management))-- mahidol University, 2005.

Thesis (M.P.H.M. (Primary Health Care Management))--Mahidol University, 2006.

The community-based public health coalition has proliferated in public health practice since the 1970‘s as a favored means of achieving community participation in public health promotion. There is concern, however, that many contemporary coalitions are not particularly inclusive, and that population health indicators fail to demonstrate significant improvement in health outcomes resultant from coalition practice. This dissertation research was designed to critically examine participation and dissemination of coalition-derived ideas through ethnographic study of five community-based participatory public health coalitions in the United States. The research answers calls from public health scholars to improve upon the coalition theory base and to contribute a useful theory of dissemination of public health interventions. At the same time, the research contributes to anthropological calls for better understanding of mechanisms that discourage the participation of all stakeholders. The research uses a theoretical model – Habermas‘ Theory of Communicative Action – that sees participation and dissemination as linked phenomena. The research was designed to contribute to an existing theory of coalition function, Butterfoss and Kegler‘s Community Coalition Action Theory. Qualitative evidence of communicative action was gathered through participant observation of coalition meetings and semistructured interviews with a purposive sample of members of each study coalition. Data were compared across coalitions and across respondent categories to determine variation in diversity of coalition participation and forms of coalition-derived communicative action; as well as indicators associated with motivation for coalition participation, barriers to participation, and dissemination of ideas both in coalition meetings and to broader discourse communities outside the coalition. The results of this applied research include the creation of a typology of diversity of coalition participation, improved understanding of differences in motivation for coalition participation between members in- and outside of the social services sector, the identification of collateral idea exchange as a key coalition outcome, and means of overcoming barriers to participation and dissemination. In addition to representing contributions to theory within anthropology and public health, these results have been shared with leaders of each of the study coalitions.

Com base em pesquisa realizada no Município de São José dos Campos, São Paulo, Brasil, através de entrevistas e registros em diário de campo, identificou-se e analisou-se os atores sociais locais e sua relação com os temas da participação, dos movimentos sociais e da saúde. Em termos teóricos , classificou-se, a interpretação dos movimentos sociais e da participação em duas direções: uma voltada para a autonomia e, outra para a construção de uma esfera pÚblica. Em termos dos atores sociais analisados, e de suas perspectivas de ação, relacionaram-se diferentes concepções a respeito de saúde. Dois níveis de ação ocupavam o centro da esfera pública: uma ação política, que através do \"movimento\" guardaria um sentido de oposição e de mudança, e uma ação sindical que se basearia na obtenção de salários e melhorias para o grupo de trabalhadores envolvidos. As demandas e expectativas em relação a saúde, ou a um modelo público de saúde, são determinadas por um contexto de discriminação existente entre serviços públicos e privados, sendo estes últimos oferecidos, através de convenios e seguro saúde, aos trabalhadores. As ações de saúde, encontram-se fragmentadas pelos interesses corporativos profissionais, bem como privados e políticos, como de oposição, de crítica generalizada e de procura de obtenção de resultados imediatos. / On the basis of research undertaken in the City of São José dos Campos, São Paulo State, Brazil, and with the use of interview techniques and entries made in a field log, the local social actors involved in the themes health, participation and social movements were identified and analysed. The two following conclusions to the study were drawn. The first, from the theoretical point of view, two tendencies regarding the interpretation of social movements were classified: one towards autonomy and the other towards the reconstruction of the public sphere. The second conclusion, in terms of the social actors analysed and of their actions related to of diversity of meanings attributed to \"health\". two levels of action occupied the center of the stage with regard to the public sphere, on one hand, political action expressing the desire for change and, on the other trade-union action. the demands and aspirations in terms of health should be seen within the context of existing gap between public and private health services, these last offered to the working class by means of contracts between private health services and employers. Health actions were highly fragmented among corporative interests - professional as well as private - and political ones as regards opposition, criticism and results.

Esta tese pretende analisar os processos e mecanismos da participação do controle social na gestão da política de saúde no Município do Rio de Janeiro ao estudar o Conselho Municipal de Saúde do Rio de Janeiro. Os objetivos da pesquisa foram identificar a forma de controle e fiscalização exercida pelo Conselho Municipal de Saúde do Rio de Janeiro na gestão César Maia, averiguar se as decisões importantes da Política de Saúde Municipal passam pelo Conselho Municipal, as principais tensões deste espaço institucionalizado de participação sociopolítica que reproduz as lutas sociais. Realizamos uma pesquisa qualitativa e empírica com enfoque no método dialético, um estudo de caso do Conselho Municipal de Saúde Rio de Janeiro no período de gestão de 2005 a 2008. A tese está estruturada em quatro capítulos. Traz as tensões e os processos sociais da participação do controle social na gestão da saúde, no Município do Rio de Janeiro, no terceiro mandato da gestão César Maia. Foi possível observar o potencial do controle social na cidade do Rio de Janeiro, porém, evidenciam-se vários limites, como a não efetivação da agenda proposta nas diretrizes das conferências municipais, bem como a falta de estratégias ao se elaborar, de forma conjunta, o Plano Municipal de Saúde do Município do Rio de Janeiro e indicativo da de uma assessoria técnica e política por meio do exercício profissional do assistente social nos moldes do projeto políticas públicas da saúde da UERJ. / This dissertation intends to analyze the processes and the mechanisms of the social control participation in the health politics administration of Rio de Janeiro municipality in studies about Rio de Janeiro Healths Municipal Council. The objectives of this study were to identify how the commands way is exercised and controlled by the Rio de Janeiro Healths Municipal Council in Cesar Maia administration, to verify if the important Healths Municipal Politics decisions are analyzed by the Municipal Council, the means stresses in this institution of social and politics place that reproduces social combats. To this study, was realized a qualitative and empirical research with dialectical method focus, a case study by the Rio de Janeiro Healths Municipal Council in the administration by the period 2005 to 2008. The dissertation is structured in four chapters. It brings the stresses and the social processes of the social control participation in the health administration of Rio de Janeiro municipality, in the Cesar Maia third administration command. It was possible to observe the social control powerful in the Rio de Janeiro municipality, but, we can note many limits evidenced as a no fulfillment by the proposal schedule in the directives by the municipal conferences, like as a lack of strategies to prepare, altogether, the Municipal Health Plan of Rio de Janeiro municipality and the indicative of a technical and political assistance by the professional exercise of the social assistance as molded in the healths public politics projected by UERJ.

Com base em pesquisa realizada no Município de São José dos Campos, São Paulo, Brasil, através de entrevistas e registros em diário de campo, identificou-se e analisou-se os atores sociais locais e sua relação com os temas da participação, dos movimentos sociais e da saúde. Em termos teóricos , classificou-se, a interpretação dos movimentos sociais e da participação em duas direções: uma voltada para a autonomia e, outra para a construção de uma esfera pÚblica. Em termos dos atores sociais analisados, e de suas perspectivas de ação, relacionaram-se diferentes concepções a respeito de saúde. Dois níveis de ação ocupavam o centro da esfera pública: uma ação política, que através do \"movimento\" guardaria um sentido de oposição e de mudança, e uma ação sindical que se basearia na obtenção de salários e melhorias para o grupo de trabalhadores envolvidos. As demandas e expectativas em relação a saúde, ou a um modelo público de saúde, são determinadas por um contexto de discriminação existente entre serviços públicos e privados, sendo estes últimos oferecidos, através de convenios e seguro saúde, aos trabalhadores. As ações de saúde, encontram-se fragmentadas pelos interesses corporativos profissionais, bem como privados e políticos, como de oposição, de crítica generalizada e de procura de obtenção de resultados imediatos. / On the basis of research undertaken in the City of São José dos Campos, São Paulo State, Brazil, and with the use of interview techniques and entries made in a field log, the local social actors involved in the themes health, participation and social movements were identified and analysed. The two following conclusions to the study were drawn. The first, from the theoretical point of view, two tendencies regarding the interpretation of social movements were classified: one towards autonomy and the other towards the reconstruction of the public sphere. The second conclusion, in terms of the social actors analysed and of their actions related to of diversity of meanings attributed to \"health\". two levels of action occupied the center of the stage with regard to the public sphere, on one hand, political action expressing the desire for change and, on the other trade-union action. the demands and aspirations in terms of health should be seen within the context of existing gap between public and private health services, these last offered to the working class by means of contracts between private health services and employers. Health actions were highly fragmented among corporative interests - professional as well as private - and political ones as regards opposition, criticism and results.

Este trabalho trata da relação entre os atores que participaram no Conselho Estadual de Saúde do Rio Grande do Sul (CES/RS), no período 1999 a 2002. A partir da leitura de Atas das Reuniões Plenárias do CES/RS foram selecionados alguns conflitos e articulações em torno dos quais os conselheiros manifestaram posicionamentos acerca do funcionamento e do desempenho do Conselho. Através da formação da pauta e da atuação dos Conselhos Regionais, usuários e trabalhadores, em aliança com o gestor estadual, influenciaram a decisão no CES/RS e criaram meios para aumentar o controle sobre a distribuição dos recursos financeiros repassados a municípios e hospitais. Eles atuaram na intensificação do controle sobre o repasse de verbas, ao mesmo tempo que confrontavam interesses dos gestores municipais e dos prestadores privados de serviços. / The present study aims to analyze the dynamic of the relationship between the actors who participate in institutionalized spaces in the health area. The case studied focuses on the Health Council of the Rio Grande do Sul state (CES) during the years 1999 until 2002. Starting from the reading of the minutes of these meetings, there were chosen some conflicts and articulations that some advisers demonstrated their point of view about the function and performance of the CES. Through the formation of the agenda and the performance of the Regional Councils, users and health workers, in an alliance with the state manager, influenced the decision making process of this Council. These representatives have been influencing the workings of the State Health Council in a decisive way and also increasing the control of the distribution and transferring the resources to cities and hospitals of the Health Unique System (SUS). At the same time, those actors confronted the interests of the managers and of the people who do private services for the Health Unique System (SUS).

Esta tese pretende analisar os processos e mecanismos da participação do controle social na gestão da política de saúde no Município do Rio de Janeiro ao estudar o Conselho Municipal de Saúde do Rio de Janeiro. Os objetivos da pesquisa foram identificar a forma de controle e fiscalização exercida pelo Conselho Municipal de Saúde do Rio de Janeiro na gestão César Maia, averiguar se as decisões importantes da Política de Saúde Municipal passam pelo Conselho Municipal, as principais tensões deste espaço institucionalizado de participação sociopolítica que reproduz as lutas sociais. Realizamos uma pesquisa qualitativa e empírica com enfoque no método dialético, um estudo de caso do Conselho Municipal de Saúde Rio de Janeiro no período de gestão de 2005 a 2008. A tese está estruturada em quatro capítulos. Traz as tensões e os processos sociais da participação do controle social na gestão da saúde, no Município do Rio de Janeiro, no terceiro mandato da gestão César Maia. Foi possível observar o potencial do controle social na cidade do Rio de Janeiro, porém, evidenciam-se vários limites, como a não efetivação da agenda proposta nas diretrizes das conferências municipais, bem como a falta de estratégias ao se elaborar, de forma conjunta, o Plano Municipal de Saúde do Município do Rio de Janeiro e indicativo da de uma assessoria técnica e política por meio do exercício profissional do assistente social nos moldes do projeto políticas públicas da saúde da UERJ. / This dissertation intends to analyze the processes and the mechanisms of the social control participation in the health politics administration of Rio de Janeiro municipality in studies about Rio de Janeiro Healths Municipal Council. The objectives of this study were to identify how the commands way is exercised and controlled by the Rio de Janeiro Healths Municipal Council in Cesar Maia administration, to verify if the important Healths Municipal Politics decisions are analyzed by the Municipal Council, the means stresses in this institution of social and politics place that reproduces social combats. To this study, was realized a qualitative and empirical research with dialectical method focus, a case study by the Rio de Janeiro Healths Municipal Council in the administration by the period 2005 to 2008. The dissertation is structured in four chapters. It brings the stresses and the social processes of the social control participation in the health administration of Rio de Janeiro municipality, in the Cesar Maia third administration command. It was possible to observe the social control powerful in the Rio de Janeiro municipality, but, we can note many limits evidenced as a no fulfillment by the proposal schedule in the directives by the municipal conferences, like as a lack of strategies to prepare, altogether, the Municipal Health Plan of Rio de Janeiro municipality and the indicative of a technical and political assistance by the professional exercise of the social assistance as molded in the healths public politics projected by UERJ.

Este trabalho trata da relação entre os atores que participaram no Conselho Estadual de Saúde do Rio Grande do Sul (CES/RS), no período 1999 a 2002. A partir da leitura de Atas das Reuniões Plenárias do CES/RS foram selecionados alguns conflitos e articulações em torno dos quais os conselheiros manifestaram posicionamentos acerca do funcionamento e do desempenho do Conselho. Através da formação da pauta e da atuação dos Conselhos Regionais, usuários e trabalhadores, em aliança com o gestor estadual, influenciaram a decisão no CES/RS e criaram meios para aumentar o controle sobre a distribuição dos recursos financeiros repassados a municípios e hospitais. Eles atuaram na intensificação do controle sobre o repasse de verbas, ao mesmo tempo que confrontavam interesses dos gestores municipais e dos prestadores privados de serviços. / The present study aims to analyze the dynamic of the relationship between the actors who participate in institutionalized spaces in the health area. The case studied focuses on the Health Council of the Rio Grande do Sul state (CES) during the years 1999 until 2002. Starting from the reading of the minutes of these meetings, there were chosen some conflicts and articulations that some advisers demonstrated their point of view about the function and performance of the CES. Through the formation of the agenda and the performance of the Regional Councils, users and health workers, in an alliance with the state manager, influenced the decision making process of this Council. These representatives have been influencing the workings of the State Health Council in a decisive way and also increasing the control of the distribution and transferring the resources to cities and hospitals of the Health Unique System (SUS). At the same time, those actors confronted the interests of the managers and of the people who do private services for the Health Unique System (SUS).