Since its inception in 1989, the private water sector of England and Wales has been enlisted as a centrepiece in debates concerning the merits of privatisation. Advocates point to increased environmental performance and increased investment. Critics note a significant retraction of the early free market aspirations and increasingly prescriptive regulation. However, market mechanisms and liberalisation are once again being emphasised in policy, reigniting the debate surrounding the commoditisation of water. This thesis engages directly and critically with Karen Bakker's 'Uncooperative Commodity' approach to the 'reregulation' of the industry, arguing its tenants must be adapted to accommodate these recent developments. While Bakker's earlier accounts of the reregulation of the water industry placed a great emphasis on the geography and biophysical properties of water, later work by both her and her contemporaries have developed more refined and socialised models of how water and society interact to produce temporary regularities in the material world. This thesis argues that an appropriate means of developing Bakker's original thesis would be a greater focus on socio-historical context when exploring the materiality of water, and hence the degree to which water may be transformed into a private commodity. Bob Jessop's Strategic Relational Approach (Jessop 2008) is deployed as a means of describing and relating: (1) the degree to which research can identify underlying mechanisms which govern the outcomes of attempts to commoditise water under capitalist modes of production, (2) the role of the state and politics in flanking or supporting the commoditisation of water and (3) the role of existing discursive-institutional structures in introducing path-dependencies and uneven power geometries which in turn effect the outcomes of collective action towards the commoditisation of water. The thesis documents historical developments in English and Welsh resource planning, regulation, and policy from 1945 to 2012 in order to explain the current structure of the industry, its response to water scarcity, and the origins of the current reform programme. It then focuses on the conflicts and tensions between actors in the industry generated by the current reform programme and their role in affecting the degree of success of the programme itself.

Objective: The promotion of self-management support for people with LTCs is a health policy priority across the UK (LTCAS 2008; DoH 2012). Self-management support is designed to change and improve care for people with LTCs, who form an increasing proportion of the population requiring healthcare and treatment. For health organisations models of care, which support self-management, require greater emphasis on person-focused rather than disease-focused manifestations of health and represents a new model of care delivery requiring changes in practice. Current research demonstrates that health policies are increasingly complex, involve multiple organisations and often fail to translate into effective practice (Noyles et al. 2014). The deficit between what works and what happens in practice is referred to as the “implementation deficit” (Pressman and Wildasky 1984) and traditionally it has been difficult to breakaway from the idea that the policy process is best viewed from the top-down (Barett and Fudge 1981). However, there remains a need to understand the processes of implementation, which takes account of the variation, the multiple layers and interactions which takes place between policy-maker and -implementer as policy becomes practice (Hupe 2011). Implementation of self-management is a contemporary focus in UK health policy and this thesis explains what processes are used to implement self-management policy for people with LTCs into everyday practice in one health board. Methods: A case study approach was used to investigate the policy process with data collected using thirty-one semi-structured interviews with policy-makers and regional and local policy-implementers plus eight hours of observation of national and regional policy meetings. To provide context to the implementation process data also included thirteen policy documents. Data analysis used the retrospective application of NPT as a theoretical framework with which to explore the implementation processes. NPT is an emerging theory that is being promoted as a means of understanding implementation, embedding and integration of new ideas in healthcare (McEvoy et al. 2014). The application of NPT focuses on four mechanisms, termed work (May and Finch 2009: 547), which promote incorporation of new ideas in practice. These areas of work are coherence, cognitive participation, collective action and reflexive monitoring (Mair et al. 2012). Findings: The findings suggest that there are a number of important influences operating behind or as part of the policy implementation process. These included the need for a shared understanding, getting stakeholders involved to drive forward policy, work promoting collaboration and participation was the most detailed and important in the process of policy implementation; the course of policy was affected by factors which facilitated or inhibited stakeholders acceptance of self-management; and NPT fosters key analytical insights. Conclusion: Understanding the process of policy implementation in healthcare and how practice changes as a result of policy is subject to a wide range of influences. What emerges are five key recommendations relating to understanding policy implementation. (1) understanding the concept of self-management is important in promoting policy implementation. This understanding benefits from dialogue between policy-makers and -implementers. (2) stakeholder involvement supports implementation particularly the role of clinical leadership and leadership through existing networks but also value in establishing new organisational structures to create a receptive context. (3) develop participation and collaboration through use of the patient voice which helped simplify the policy message and motivate change. (4) other resources help policy implementation and where these are evident then policy is implemented and where they are absent then implementation is not embedded. Lack of evidence was a particular area of constraint. (5) NPT has shown that social context is important, and provides for this. But in addition there is evidence that historical perspectives and previous experience are also important influence on receptivity to implementation. This research contributes to the development of theory and practice in the area of implementation science. The exploration of the policy implementation has revealed the action and work which policy-makers and -implementers are engaged in while implementing policy. It has tested the utility of NPT in a real-life setting using all four mechanisms.

This postgraduate thesis investigates legal aspects of human assisted reproduction‘s reimbursement from the Public Health Insurance Fund‘s Budget. Nowadays human assisted reproduction is not covered by the State Budget in Lithuania. That‘s why this thesis presents hypothetical model of reimbursement. The model is substantiated using historical anglysis of the probleme, worldwide practice in biomedicine and health care management. Legal aspects are analysed from the standpoint of intersection in different branches of sciences. The emphasis lays on imperfect legislation and controversies of reproductive health care, it‘s close connections with ethical problemes in human relationships, on human life and traditional family protection as priority in Lithuania‘s Fundamental Law. Legal propositions are linked with Evidence Based Medicine Gudelines (EBMG) and efficient assesment of State Budget resources as a basis of Public Health Insurance.

Submitted by Valdinei Souza (neisouza@hotmail.com) on 2017-06-07T20:40:38Z No. of bitstreams: 1 Angela Cristina Cordeiro - dissertacao.pdf: 1563714 bytes, checksum: 3ea9e96b6a530db7d50d564c70429204 (MD5) / Approved for entry into archive by Urania Araujo (urania@ufba.br) on 2017-06-14T19:35:23Z (GMT) No. of bitstreams: 1 Angela Cristina Cordeiro - dissertacao.pdf: 1563714 bytes, checksum: 3ea9e96b6a530db7d50d564c70429204 (MD5) / Made available in DSpace on 2017-06-14T19:35:24Z (GMT). No. of bitstreams: 1 Angela Cristina Cordeiro - dissertacao.pdf: 1563714 bytes, checksum: 3ea9e96b6a530db7d50d564c70429204 (MD5) / Capes / As Informações em Saúde no Brasil constituem-se um quadro complexo e diversificado da realidade sanitária do território e apoiam as deliberações para a gestão do Sistema Único de Saúde (SUS). Essas informações são geradas em razão dos serviços de atenção à saúde e são os insumos que diariamente alimentam os sistemas de informações do Ministério da Saúde/DATASUS. Os Sistemas de Informações em Saúde (SIS) configuram-se como mecanismos de transferência de informações para a gestão em saúde, no entanto, vários problemas podem ser diagnosticados quanto à utilização desses sistemas: produção de informações de baixa qualidade e subutilizadas, duplicação de sistemas de informações de forma verticalizada e não-integrada, dificuldades quanto à retroalimentação desses sistemas. Percebe-se que as informações que alimentam esses SIS possuem um viés meramente para fins estatísticos e na maioria dos casos, a utilização desses SIS pelos gestores em saúde é feita de forma compulsória. Neste contexto, o objetivo desta pesquisa é verificar se os mecanismos de transferências de informações dos hospitais convergem com as diretrizes da Política Nacional de Informação e Informática em Saúde (PNIIS) e do Plano de Desenvolvimento para a nformação e a Tecnologia da Informação em Saúde (PlaDITIS). Para tanto, são identificadas as fontes e os mecanismos de transferência de informações utilizadas nos organismos de serviços de saúde e, se estas estão em conformidade com estas diretrizes. O arcabouço teórico, metodológico da pesquisa procurou ressaltar a importância da PNIIS e o PlaDITIS para uma gestão integrada, acesso e uso da informação e da tecnologia da informação na definição das políticas de saúde. A pesquisa é exploratória e descritiva com uma abordagem quali-quantitativa. A população para a realização desta pesquisa são 39 hospitais com termo de adesão à Rede de Inovação e Aprendizagem em Gestão Hospitalar. Para o levantamento dos dados utilizou-se como instrumento o questionário e o roteiro semi-estruturado para a entrevista, com a finalidade de alcançar os objetivos propostos. O tratamento dos dados foi realizado por meio da estatística descritiva e análise de conteúdo. Os resultados revelam a necessidade da disseminação das políticas de informação e informática e a necessidade da difusão do uso de mecanismos de transferência de informações entre os organismos prestadores de serviços de atenção à saúde no Brasil. / ABSTRACT - Health information in Brazil constitute a complex and diverse picture of the reality of health and support the deliberations for the management of the unified health system (SUS).This information is generated as a result of health care services and are the inputs that feed the information systems of the Ministry of health/DATASUS. Health Information systems (SIS) configure themselves transfer mechanisms for information management in health, however, several problems can be diagnosed on the use of these systems: production of low-quality information and under-utilized, duplication of information systems of vertical and non-integrated form, difficulties with regard to the feedback of these systems. You understand that the information that feed these SIS have a bias merely for statistical purposes and in most cases, the use of SIS for health managers is compulsory. In this context, the objective of this research is to verify if the information transfer mechanisms of hospitals converge with the guidelines of the national information Policy and health informatics (PNIIS) and the development plan for the information and information technology in health (PlaDITIS). Are identified the sources and information transfer mechanisms used in health services organizations and, where these are in accordance with these guidelines. The methodological research, sought to highlight the importance of PNIIS and PlaDITIS for integrated management, access and use of information and information technology in the definition of health policies. The research is exploratory and descriptive with a quali-quantitative approach. The population for this research are 39 hospitals with term of membership of the learning and innovation network in hospital management. To survey the data used as a tool the questionnaire and semi-structured interview script, in order to achieve the proposed objectives. The treatment of the data was performed by descriptive statistics and content analysis. The results reveal the need for dissemination of information and informatics policies and the need for the dissemination of the use of mechanisms for information transfer between agencies providers of health care in Brazil.

Submitted by Isac Macêdo (isac@ioc.fiocruz.br) on 2013-09-22T19:29:05Z No. of bitstreams: 1 MP 2008 - Lucia Maria Pereira de Oliveira.pdf: 3934700 bytes, checksum: a9cb1d03ea59b424193a37a792775cba (MD5) / Made available in DSpace on 2013-09-22T19:29:05Z (GMT). No. of bitstreams: 1 MP 2008 - Lucia Maria Pereira de Oliveira.pdf: 3934700 bytes, checksum: a9cb1d03ea59b424193a37a792775cba (MD5) / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil. / A carência de cultura científica, e de espaços educacionais apropriados para incrementá-la, parecem contribuir à morbimortalidade do câncer uterino pelo vírus do papiloma humano (HPV) em mulheres de baixo grau de escolaridade. Com base na abordagem da pesquisa qualitativa de cunho etnográfico, nosso trabalho procurou demonstrar que, devido à interação das mulheres entre si e delas com a equipe de saúde, as clientes parecem conviver melhor com seus conflitos biopsicossociais. Observamos que a efetividade dos tratamentos está também relacionada à escuta interessada das clientes com papilomavirose, estando sujeitas a agravos em conseqüência de práticas curativas e automatizadas, cotidianamente exercidas por profissionais do sistema público de saúde. Assim sendo, realizamos com base em Freire, o desenvolvimento de um processo socioeducativo que suscitou, como produto, a criação de uma sala de espera interativa no Setor de Ginecologia de um hospital universitário. O principal objetivo foi converter um espaço de espera em uma sala com a preocupação não só de acolhimento, com também de um constante processo de construção compartilhada de saberes. Ao mesmo tempo, práticas ligadas à promoção da saúde e à prevenção do câncer são desenvolvidas, conforme reivindica a atual Política Nacional de Humanização da Saúde. / The lack of scientific culture, and educational activities appropriate to increase it, seem to contribute to morbidity and mortality of cervical cancer by human papillomavirus (HPV) in women of low educational level. Based on the approach of qualitative ethnographic research, our study sought to demonstrate that, due to the interaction of women among themselves and with their health care team, clients seem to live better with their conflicts biopsicossociais. We found that the effectiveness of treatment is also related to hearing from interested customers with papilomavirose, and subject to damages as a result of healing practices, automated daily performed by professional public health system. Therefore, we based on Freire, the development of a process which led childcare as a product, creating a waiting room in the interactive industry of Gynecology of a university hospital. The main objective was to convert a room waiting in a room with a concern not only the host, with also a constant process of shared construction of knowledge. At the same time, practices related to health promotion and cancer prevention are developed, as claims the current National Policy of Humanization of Health.

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 thesis is focused on health care funding in Czech Republic. Comparative analysis confront current Czech health care system with effective one used in Netherlands. First part explains importance of health care activities in welfare state as a public interest priority that influence national economy. Second part presents positive and negative aspects of each type of health care system used abroad. Summary of all these fund sources, type of compensations and health care providers characteristics shapes a hypotetical effective system that can be implemented into a practice of universal health insurance system with detailed considaration of historical, political, legal and social aspects of Czech Republic. According to all these analysis I aim to recommend healt care system improvements that would enhance health care quality.

Problems of mental health care in the Czech republic have been defined in the early nineties. Yet after nineteen years of progress in this area, these problems are still major topics in mental health care policy documents. Main purpose of diploma paper is therefore to analyse mental health care problems and at the same time also might-be solutions. Mental health care problems definitions as conceptualized in mental helth care policy documents are found to be plausible. Though the amount of supportive data is sufficent, there are differences in decisiveness of some arguments. Available solutions are brought up and described in various manners in order to show their own logic, rules and after all their usability. Final conclusions consider the roles and responsiblities of various policy actors.

As escolas médicas brasileiras encontram-se diante do desafio de mudar para formar protissional crítico, capaz de aprender a aprender, de trabalhar em equipe, de levar em conta a realidade social para prestar atenção humana e de qualidade. As mudanças necessárias são profundas porque implicam a transformação de concepções, práticas e de relações de poder, tanto nos espaços internos das universidades, como em suas relações com a sociedade, especialmente como os serviços de saúde e com a população. O objetivo deste estudo foi analisar algumas das principais causas das sucessivas histórias de resultados desfavoráveis nas tentativas de mudar a educação médica; analisar como essas questões e problemas cruciais vêm sendo tratados em dois processos de mudança na educação médica atualmente considerados promissores, quais sejam as transformações curriculares de Marília e de Londrina; e construir um conjunto de idéias, propostas e instrumentos que contribuam para a produção de mudanças efetivas na educação médica no Brasil. A metodologia adotada foi a de estudo de caso informado pelo referencial crítico-dialético. Foi feita uma análise política dos processos, assumindo o poder como categoria analítica central. Nos dois casos estudados estão em curso mudanças profundas no âmbito da organização institucional, das concepções e das práticas, bem como das relações entre professores, estudantes, profissionais dos serviços e população. Há avanços significativos, mas também problemas e conflitos, níveis diferentes de acumulação de poder técnico e político, sendo necessário um período de consolidação. / Brazilian medical schools have to face the challenge of changing so as to graduate professionals capable of critical and self conducted learning, of working in teams, of taking social reality into account in the clinical practice and of delivering health attention of good quality. Deep changes will be necessary as conceptions, practices and of relations of power inside and outside the university have to be addressed. This study meant to analyze the main causes of the previous unsuccessful experiences of changes in medical education in Brazil; to analyze how the identified critical questions are being dealt in two changing processes that are taking place in Marília and Londrina and build a set of ideals, proposals and tools that can be useful for changing medical education in Brazil. The adopted methodology was a case study orientated through the critical-dialectic reference. A political analysis was made, taking power as the central analytical category. Both of the studied cases reveal deep changes in the fields of institutional organization, conceptions and practices and relations between faculties, students, health professionals and people. Both groups present relevant results, but also problems and conflicts and different leveis of technical and political power accumulation, what makes necessary a consolidation phase to take place.

Esta dissertação explora as interfaces e possíveis articulações entre os conceitos de Comunicação, Promoção da Saúde e Espaço Social Alimentar. Por meio de revisão bibliográfica, traça-se a história do conceito da Promoção da Saúde no mundo e no Brasil. Em seguida, debate-se o papel do profissional de Comunicação como possível agente de mobilização social, destacando-se a Comunicação Pública como conceito essencial para o desenvolvimento da cidadania. Pautando-se no pensamento da Escola de Montreal, aborda-se a Comunicação Organizacional e suas interfaces com a Comunicação Pública. Propõe-se os modelos comunicacionais de Haswani e de Jaramillo López, como alicerce teórico para ações de Comunicação Interna. A análise da Política Nacional de Promoção da Saúde (PNPS) e da Política Nacional de Alimentação e Nutrição (PNAN) expõe a importância de práticas alimentares adequadas e saudáveis para a promoção da saúde. Elas são contextualizadas, em relação ao estudo exploratório realizado com os funcionários da Escola de Comunicações e Artes da Universidade de São Paulo (ECA-USP), sobre suas práticas alimentares. A metodologia de Jean Pierre Poulain, da Sociologia da Alimentação, pauta o estudo exploratório. A pesquisa pretende ser o primeiro passo para a estruturação de um banco de dados sistematizado sobre fatores condicionantes e determinantes da saúde dos funcionários desta instituição. Este banco proverá dados essenciais para a elaboração e implementação de políticas e ações que visem a Promoção da Saúde na Escola no futuro. / This dissertation explores the commonalities and possible interactions between the concepts of Communication, Health Promotion and Food Social Space. The literature review retraces the historic evolution of Health Promotion as a concept worldwide and regionally in Brazil. It then correlates that field with the current state of Public Communication research in Brazil, defending the notion that Communication professionals have a role to play as health promoters. Based on the theories of the School of Montreal, this paper connects Organizational Communication and Public Communication concepts, with the goal of establishing a path for action that corroborates the defended thesis of the role of the Communication professional in Health Promotion. Lopez and Haswani\'s Public Communication models are used as the theoretical basis for action. The analysis of two public policies (on \"Health Promotion\" and \"Food and nutrition\") lays the ground for the empirical study developed with the employees of ECA-USP. Jean-Pierre Poulain\'s Sociology of Food methodology is adopted in the study of the food practices of the aforementioned public. This dissertation seeks to be a first step in structuring a database with information that can guide future organizational action and programs aimed towards the promotion of employees\' health.