Apesar de ser uma das doenças infecciosas mais antigas, a tuberculose (TB) permanece como um dos principais agravos à saúde a ser enfrentado em âmbito global. Diante da complexidade do tratamento da TB, a Organização Mundial da Saúde (OMS) recomendou a implantação da estratégia DOTS (Directly Observed Treatment short-course), após declarar a doença como uma ameaça global. O tratamento diretamente observado (TDO) constitui-se em um elemento-chave desta estratégia e visa fortalecer a adesão do paciente ao tratamento. Este trabalho possui como base conceitual a \"Transferência de Política\", que revela a importância da análise das políticas públicas nos diferentes contextos. O objetivo deste estudo foi compreender a transferência da política do TDO da TB em um município do interior paulista. Trata-se de uma pesquisa descritiva de abordagem qualitativa. Foram realizadas entrevistas semi-estruturadas com 11 profissionais de saúde envolvidos com a prática do TDO, com o intuito de compreender como ocorre a operacionalização do TDO no município. A coleta de dados foi realizada entre abril e maio de 2018. As entrevistas gravadas foram transcritas e os dados organizados através do software Atlas.ti versão 7.0, e analisados por meio do referencial teórico da Análise de Discurso, de matriz francesa. A partir da análise do material empírico, emergiram três blocos discursivos: 1. O acontecer do TDO no cotidiano dos serviços de saúde; 2. Potencialidades da política: a percepção dos atores locais sobre o TDO e 3. O TDO e o doente acometido por TB segundo os discursos dos profissionais de saúde. Os resultados revelaram que a transferência do TDO para a esfera municipal apresentou aspectos ainda poucos negociados, no entanto o município dispõe de espaços de flexibilização que possibilitam adaptações locais para o êxito desta política, visando à centralidade do cuidado no doente. Neste contexto, a potencial indicação do TDO para todos os doentes merece ser repensada, compreendendo ser necessário avaliar o contexto de cada doente para as possibilidades de abandono do tratamento. O compartilhamento de responsabilidades das ações de controle da TB entre instâncias governamentais distintas revelam a necessidade de uma comunicação efetiva para o fortalecimento do trabalho em rede. Os profissionais apontaram aspectos positivos da estratégia como o controle da doença, o favorecimento da adesão e a redução dos casos de resistência às drogas. A falta de autonomia do doente para escolher a modalidade terapêutica mais adequada, as implicações que o TDO exerce sobre a vida do doente, e as dificuldades relacionadas aos SS foram apontadas como desafios que necessitam ser transpostos para o fortalecimento das ações de controle da doença no contexto analisado. Conclui-se que a transferência do TDO no município permite negociações visando favorecer as adaptações necessárias ao contexto local. Além disso, faz-se necessário fortalecer o empoderamento e a autonomia do doente a partir de projetos terapêuticos que contemplem a centralidade do cuidado no doente, como alternativa para superar os desafios impostos pela doença / Despite being one of the oldest infectious diseases, tuberculosis (TB) remains one of the major health problems to be globally tackled. Facing the complexity of TB treatment, the World Health Organization (WHO) has recommended the implementation of DOTS (Directly Observed Treatment short-course) strategy, after declaring the disease as a global threat. Directly observed treatment (DOT) is a key element of this strategy and aims to strengthen patient\'s treatmentadherence. This work has as conceptual basis the \"Transfer of Policy\", which reveals the importance of the public policies analysis in different contexts. The objective of this study was to understand the DOT transfer of TB policy in a city in São Paulo state. This is a qualitative descriptive research. Semi- structured interviews were conducted with 11 health professionals involved in the practice of TDO, in order to understand how TDO operationalization occurs in this city. The data was collected between April and May 2018. The recorded interviews were transcribed, and the data was organized through the software Atlas.ti 7.0, and analyzed through the theoretical reference of Discourse Analysis, of French matrix. From the analysis of the empirical material, three discursive blocks emerged: 1. The occurrence of TDO in the daily life of health services; 2. Policy Potentialities: the local actors\' perception of the TDO and 3. The TDO and the patient affected by TB according to the health professionals\'speeches. The results revealed that the TDO transfer to the municipal sphere presented aspects still few negotiated, however the city has flexible spaces that allow local adaptations for the success of this policy, aiming the patient centrality in care. In this context, the potential indication of TDO for all patients deserves to be rethought, understanding that it is necessary to evaluate the context of each patient for the possibilities of treatment abandonment. The sharing of responsibilities for TB control actions among distinct government bodies reveals the need for effective communication to strengthen networking. The professionals pointed out positive aspects of the strategy as the disease control, the adhesion favoring and the reduction of drug resistance cases. The patient\'s lack of autonomy to choose the most appropriate therapeutic modality, the implications that TDO exerts on the patient\'s life, and the difficulties related to SS were identified as challenges that need to be transposed to strengthen disease control actions in the analyze context. It is concluded that the TDO transfer in the city allows negotiations favoring the necessary adaptations to the local context. In addition, it is necessary to strengthen the patient\'s empowerment and autonomy from therapeutic projects that contemplate the patient centrality in care, as an alternative to overcome the challenges imposed by the disease

The Motor Group of the European Council was commissioned in the autumn of 1997 to prepare a proposal for a new European Bus and Coach Directive. In the beginning, most of the Member States did not have the accessibility requirements as their main concern; still a smaller network with actors from the National delegations from Britain, Germany and Sweden would influence the other National delegations in the Council group to finally agree to retain the requirement of accessibility of the Directive. Within the EU decision process, the European Disability movement acted as a strong player during the whole negotiation process using the proposal to a new Bus and Coach Directive as a tool to influence key actors to go towards a Directive with a strong approach for accessibility. Policy Transfer and Policy Transfer Network are used as analytical tools to understand and structure the transfer of the question of accessibility during the negotiation process. Actors understanding how the bureaucratic process works within the EU decision system have a chance to contributing for the changes in the directions they wishes for within a range of policy areas. The principal aim of the Directive was to guarantee the safety of passengers and to provide technical prescription in particular to wheelchair users. In the end it turned out to be one of the most successful achievements for the European Disability movement in history.

Fenomenet med nationella riskbedömningar är relativt nytt i Europa. Myndigheten för samhällsskydd och beredskap överlämnade den allra första nationella riskbedömningen till regeringen år 2013. Syftet i uppsatsen är att undersöka om man genom ett policy transfer-perspektiv på nationella riskbedömningar kan se några indikatorer som hindrar policy transfer inom riskområdet. En första, översiktlig undersökning görs genom att jämföra de risker man lyfter fram i sju europeiska nationella riskbedömningar för att se om man kan tyda något mönster. Uppsatsen tog avstamp ur antagandet att geografisk närhet och liknande interna förutsättningar kunde tänkas innebära att man även har en liknande syn på risker som länder i ens närområde. Storbritannien var ett av de första länderna att utveckla nationella riskbedömningar. En jämförande fallstudie görs mellan Sverige och Norge som fokuserar på helt olika risker, och för att kunna undersöka faktorer till detta ur ett policy-transfer perspektiv så analyseras om länderna har tagit lärdom och om det finns tecken på policy transfer inom riskområdet från Storbritannien. Resultatet visar att länderna använder sig av olika bedömningsprocesser, och kombinationen av teorin om policy transfer och lärande förklarar att det skett en policy transfer på olika nivåer, dock inte i avseendet vilka risker man har fokuserat på.

Jusqu’à un passé récent, l'eau était considérée comme abondante et inépuisable, et une mobilisation accrue était la réponse donnée à l’augmentation des besoins liés à l’augmentation de l’activité anthropique. Néanmoins, avec l’apparition des conflits d’usage, l’idéologie techniciste a été remise en cause et a laissé place à des modèles plus intégrés de gestion. La GIRE et la mise en place d’organisation de bassin sont donc devenus des impératifs de la bonne gouvernance du secteur de l’eau, largement promus par les « entrepreneurs internationaux de politique ». Le Maroc, en 1995, a mis en place une réforme globale du secteur de l’eau basée sur ces deux principes, et qui a abouti à la création d’agence de bassin. Deux décennies après, l’articulation du cadre juridique et institutionnel du secteur parait inefficiente. Les contraintes liées à des dépendances au sentier et à l’environnement institutionnel ont en effet, largement façonné les Agences créant un fossé important entre le « Modèle Agence de bassin » et sa traduction marocaine. L’analyse de l’action de l’Agence dans le bassin fermé du Tensift révèle que le pouvoir de celle-ci est dilué en faveur des autres secteurs qui maintiennent leurs prérogatives historiques sur la ressource. Il est de plus retenu au niveau central, par le ministère de tutelle. Devant les enjeux économiques et politiques qui s’opèrent au niveau du bassin, et qui limitent sont champs d’action, l’Agence est contrainte à un laisser-aller, qui est en soit une forme de gestion de la demande qui laisse opérer une 'sélection naturelle' porteuse d'inégalités et de risques sociaux ainsi que de dégradations environnementales accrues. / Until recently, water was considered abundant and inexhaustible, and increased mobilization was the answer given to the increased needs related to the increase in human activity. Nevertheless, with the emergence of use conflicts, the technicist ideology has been called into question and has given way to more integrated models of management. IWRM and the establishment of basin organization have therefore become imperatives of good governance of the water sector, widely promoted by "international policy entrepreneurs". Morocco undertook a comprehensive reform of the water sector in 1995, based on these two principles, which led to the creation of a basin agency.Two decades later, the articulation of the legal and institutional framework of the sector seems inefficient. The constraints related to path dependencies and the institutional environment have, in fact, largely shaped the Agencies creating an important gap between the "Basin Agency Model" and its Moroccan translation. The analysis of the Agency's action in the Tensift Basin reveals that its power is being diluted in favor of other sectors that maintain their historic prerogatives over the resource. It is moreover retained at the central level, by the ministry of supervision. Facing the economic and political stakes that operate at the basin level, and which limit its fields of action, the Agency is forced to ‘laisser- aller’ attitude, which is in itself a form of demand management that allows to operate a 'natural selection' carries inequalities and social risks as well as increased environmental degradation

Este estudo teve como objetivo analisar a transferência da política do Tratamento Diretamente Observado (TDO) da tuberculose, em sua fase de manutenção e expansão, nas unidades de Atenção Primária à Saúde em municípios prioritários para o controle da tuberculose no estado do Amazonas. Trata-se de um estudo de métodos mistos, do tipo convergente, com a combinação das vertentes quantitativa e qualitativa, realizado em cinco municípios: Itacoatiara, Manacapuru, Parintins, Tabatinga e Tefé. Na etapa quantitativa participaram 138 profissionais de saúde e na etapa qualitativa sete enfermeiros e quatro Agentes Comunitários de Saúde. O estudo quantitativo foi caracterizado como um estudo tipo inquérito epidemiológico, sendo aplicado o instrumento \"Avaliação da Transferência de Políticas - Inovação, Informação e Conhecimento em Tuberculose - ATP-IINFOC-TB\" agrupado em sete domínios de análise. Para a etapa qualitativa foi utilizado um roteiro para entrevista, previamente testado, composto por questões semiestruturadas relacionados às informações gerais do TDO. A coleta dos dados foi realizada no período de janeiro a abril de 2016. A análise dos dados quantitativos foi realizada por meio de técnicas de estatística descritiva e multivariada, utilizando o software Statistica 12, da Statsoft.Inc e programa R versão 3.2.3. Para a organização dos dados qualitativos utilizou-se o software Atlas.ti 7.0., e a análise dos dados foi realizada por meio do referencial teórico metodológico da Análise de Discurso, em três etapas: Passagem da superfície linguística para o objeto discursivo; Passagem do objeto discursivo para o processo discursivo; Delineamento da formação discursiva e sua relação com a ideologia. Os resultados apontaram que, dos sete domínios avaliados, cinco (ações da gestão, ações da equipe de saúde, recursos para o desenvolvimento do TDO, prática do TDO e percepção sobre estratégias para melhorar o TDO) apresentaram diferença estatística significante para média, apresentando os menores valores na avaliação dos profissionais de saúde. Na análise exploratória dos domínios com menores valores e mediante as sequências discursivas analisadas identificou-se uma infraestrutura deficitária; escassez de recursos humanos; necessidade e dificuldade de adaptação do TDO à realidade local; necessidade de potencializar o processo de discussão entre a equipe; dificuldades que permeiam o processo de tratamento da pessoa com TB; a falta de treinamentos e a necessidade do uso de estratégias de sensibilização para melhorar a prática do TDO. Conclui-se que, para avançar na transferência da política do TDO, os municípios necessitam investir em infraestrutura adequada; disponibilização de materiais educativos; recursos humanos suficientes e qualificados e estratégias que atendam aos indivíduos na sua singularidade, como orientações individuais, acolhimento, uso de figuras, roda de conversa e projetos terapêuticos singulares, considerando as características de cada população e os determinantes sociais de saúde / This study aimed to analyze the transfer of the policy of Directly Observed Treatment (DOT) for tuberculosis, in its phase of maintenance and expansion in the Primary Healthcare Units in priority municipalities for tuberculosis control in the state of Amazonas. This was a mixed methods, convergent study, with a combination of quantitative and qualitative aspects, carried out in five municipalities: Itacoatiara, Manacapuru, Parintins, Tabatinga and Tefé. A total of 138 health professionals participated in the quantitative stage and seven nurses and four community health agents in the qualitative stage. The quantitative study was characterized as a epidemiological, inquiry study, with the application of the instrument \"Policy Transfer Evaluation - Innovation, Information and Knowledge in Tuberculosis - ATP-IINFOC-TB\" covering seven analysis domains. For the qualitative step, a pre-tested script, consisting of semi-structured questions related to general information about DOT, was used for the interviews. Data collection was carried out from January to April 2016. The analysis of the quantitative data was performed through descriptive and multivariate statistical techniques, using the Statistica 12 software, Statsoft. Inc, and R version 3.2.3 program. For the organization of the qualitative data the Atlas.ti 7.0 software was used, and data analysis was performed using the methodological theoretical framework of Discourse Analysis in three stages: Passage from the linguistic surface to the discursive object; Passage from the discursive object to the discursive process; Design of the discursive formation and its relation with the ideology. The results showed that, of the seven domains assessed, five (management actions, health team actions, resources for the development of DOT, practice of DOT and perception of strategies to improve DOT) presented statistically significant differences for the mean, presenting the lowest values in the assessment of the health professionals. In the exploratory analysis of the domains with lower values and through the discursive sequences analyzed, the following factors were identified: a deficient infrastructure; shortage of human resources; need and difficulty to adapt DOT to the local reality; need to enhance the process of discussion among the team; difficulties that permeate the treatment process of the person with TB; lack of training; and need to use awareness strategies to improve the practice of DOT. It was conclude that, to advance in the transfer of the DOT policy, the municipalities need to invest in adequate infrastructure; provision of educational materials; sufficient and qualified human resources; and strategies that contemplate individuals in their uniqueness. such as individual guidance, acceptance, use of figures, wheel of conversation and individual therapeutic projects, considering the characteristics of each population and the social determinants of health

Abstract Does Geography Matter? A Study of the Bologna Process from a Policy Transfer Perspective. Essay in Political Science (D-level) at Karlstad’s University by Beatrice Högå, Spring 2007 Tutor: Susan Marton The purpose of this essay is to generally see how theories of policy transfer can help us to better understand the process through which the Bologna Process is being spread throughout Europe, and to specially see if geographic placement, i.e. in the heart of Europe, plays a role in how well and how fast the Bologna Process is implemented. To be able to answer the purpose, I have used Evans and Davies theoretical model on policy transfer network to describe the Bologna Process. Furthermore, Sweden and France are the countries being examined when they differ on the independent variable. From there, I have applied an analytical tool, namely process tracing, to examine whether there are differences in the two countries’ work with the implementation of the Bologna Process. I have designed six specific research questions: Have France performed more extensive work than Sweden when it comes to implement the two-cycle system? Have France performed this work earlier? Have France performed more extensive work than Sweden when it comes to recognize awards and periods of study? Have France performed this work earlier? Have France performed more extensive work than Sweden when it comes to quality assurance? Have France performed this work earlier? After applying the analytical tool to be able to answers these research questions, the answer to the general question Does geographic placement, i.e. in the heart of Europe, play a role in how well and how fast the Bologna Process is implemented? is negative. In this case, there are no unambiguous results to support that idea.

Policy transfer defies the notion of national boundaries in policy making and development. With globalisation processes in the picture, purely state centric policy making models are not the only option. International and domestic policy entrepreneurs have been pivotal in transfer processes. For developing countries, international donor organisations have been instrumental through conditioning assistance to policy reform. Due to the prevailing hierarchical aid regimes, the assumption is that developing countries would implement these policies for the fear of losing the much-needed aid. However, this study argues that the actual implementation of reforms emanating from the global arena is not an automatic process even in the context of coercive transfers, as it is mediated by country specific contextual frameworks. Moreover, even if implemented, the extent to which the transfers attain the promised transformation ends depends on prevailing environmental factors, appropriateness of the reforms, and the implementers' in-depth understanding of the reform instruments. The analysis used the cases of hospital autonomy and district health management decentralisation reforms which are based on the new public management (NPM) paradigm to examine the mechanisms of policy transfer; factors constraining or facilitating the adoption and/or implementation of transferred policies; and the impacts of the policy programmes on service delivery transformation in Malawi. A multilevel framework was used to analyse the dynamics at international, national and application levels. It used a qualitative research strategy. Therefore, data was collected through in-depth interviews, focus group discussions, documents, and observations. The study finds that due to Malawi's heavy aid reliance, international donor organisations attempted to introduce the hospital autonomy and district health management decentralisation reforms on its policy agenda through aid conditioning mechanism which has coercive attributes. In the former, USAID as an international institutional entrepreneur was the driving force through its non-project assistance (NPA) aid regime while in the later case it was the European Commission within the institutional framework of the Lome IV Convention. A comparative analysis of the two reforms revealed that a combination of contextual issues of: mode of transfer, policy content and political-economic context, path dependence, parliament-cabinet configuration, bureaucratic politics, pressure from citizens, institutional compatibility and prerequisites, and social economic forces; determined their adoption and subsequent implementation. While hospital autonomy was rejected by cabinet, and not implemented, despite large amounts of donor resources invested in the transfer processes because of these contextual issues, decentralisation was implemented as the environment was favourable, although it met bureaucratic resistance. However, the study found that when implemented, decentralisation faced several contextual challenges including modest levels of application, reproductions, reversals, cultural factors, and unintended consequences so that it has not achieved the intended transformational results. To this end, the findings provide a better understanding of the dynamics of policy transfer in developing countries and work as a springboard for donor organisations to reorient their approach in aiding policy development in developing countries.

Climate change is one of the most challenging crises in sustainable development agenda. Tackling the problem requires the global transition towards renewable and sustainable energies. The uptake of these new technologies is often supported by policies and technological know-how that is developed by early adopters, and later spread and transferred to other places. Although renewable technology transfer and diffusion have long been studied, the question of how supporting policies flow from one country to another, and how they are adapted to the local contexts are merely investigated. This paper sheds some light on the process, mechanisms, and dynamics of policy transfer, and investigate the influences of national contextual characters on the adoption of policy from other countries, using Thailand's feed-in tariff policy as an example. The study applies an adapted version of ‘Dolowitz and Marsh model (1996, 2000, 2012)’ as the guiding policy transfer framework to analyse the information gathered through literature study and fieldwork, and to present the results and findings. The study discovers that policy transfer is not a straightforward process with a clear transfer timeline and boundary, but rather a dynamic and complex process that involves interactions with many factors, internal and external, and are continuously shaping the process and outcomes of the transfer. Moreover, the case study proves that Dolowitz and Marsh model is a useful and effective framework to understand and depict the process. However, if to treat policy transfer as an independent variable affecting the process outcomes, it would need to combine other frameworks, for instance, Marsh and McConnell Model (2010), to give an in-depth and comprehensive analysis to measure the success of policy transfer and policymaking. / Förnybar energi är en av de viktigaste lösningarna för att ta itu med klimatförändringarna. Utnyttjandet av denna nya teknik stöds alltid av politik, som vanligtvis utvecklas av ett land och överförs till andra länder. Denna avhandling använder ramen för policyöverföring för att analysera hur feed-in tariffpolitik från Europa spred sig och överförs till Thailand. Fallet belyser processen, mekanismerna och dynamiken för att illustrera hur politik som utvecklats av ett land inspirerade andra länder med deras beslutsfattande.

No description available.

Trata-se de estudo qualitativo desenvolvido por meio de análise de discurso cujo objetivo foi analisar a discursividade dos gestores em diferentes níveis de gestão sobre transferência da política do tratamento diretamente observado (TDO) no controle da tuberculose. Para isto, esta análise parte do contexto de decisão macropolítico para o contexto micropolítico tendo como cenário local o município de Ribeirão Preto-SP, considerado prioritário para o controle da doença. Foram entrevistados quatro sujeitos-gestores envolvidos com a política do TDO nas instâncias estadual, regional, municipal e no nível intermediário entre a regional e o município, mediante aceite de termo de compromisso. Os dados foram coletados no período de agosto a dezembro de 2013, as entrevistas foram audiogravadas, transcritas, respeitando-a na sua íntegra. O corpus da pesquisa foi composto por recortes, formação discursiva e marcas linguísticas, quais foram selecionados dos discursos dos sujeitos. A análise ocorreu mediante a fundamentação teórico-metodológica da Análise de Discurso (AD) de matriz francesa, que se sustenta sobre três vertentes teóricas: o Materialismo Histórico, a Linguística e a Psicanálise. Este tipo de análise não visa uma análise exaustiva horizontal ou de toda extensão do objeto de pesquisa, por entender que este não se esgota e que um discurso institui-se sempre em relação aos outros. Busca-se apoiar na exaustividade vertical com o intuito de contemplar o objetivo do trabalho e da temática abordada. Os dados foram organizados sob o eixo da temática da transferência de políticas e da temática da TB os quais apontaram para diferentes efeitos de sentido durante a transferência da política do TDO como o silenciamento, apagamento, polifonia, polissemia e contradição durante o processo de transferência desta política nos diferentes níveis de gestão, que passou gradativamente pelo processo de transferência autoritária para a transferência voluntária da maior instancia política para a menor. Destaca-se que no município este processo ocorreu de forma incompleta visto que não houve a superação do paradigma da desconcentração das ações de TB para a Atenção Primária em Saúde (APS) / This qualitative study was conducted using discourse analysis, the objective of which was analyzed the reports of different level managers regarding policy transfer of Directly Observed Treatment (DOT) in the control of tuberculosis. This analysis starts with the context of macro-political decisions in the micro-political context and the local setting was the city of Ribeirão Preto, SP, Brazil, considered a priority in the control of the disease. Four managers involved with the DOT policy at the state, regional, and city levels and another manager in the intermediate level between region and city were interviewed after signing consent forms. Data were collected from August to December 2013. The interviews were recorded, transcribed, respecting it in its entirety. The study\'s corpus was composed of excerpts, discursive formations and linguistics marks, which were selected from the participants\' reports according to the guiding question. Analysis was based on the French theoretical-methodological framework of Discourse Analysis, which in turn is grounded on three theoretical aspects: the Historical Materialism, Linguistics and Psychoanalysis. An exhaustive horizontal analysis, or an analysis that encompasses the entire extent of the research\'s object, is not intended in this type of analysis because the topic is not exhausted and discourses are always instituted in relation to others. The objective is to be supported in vertical exhaustiveness to contemplate the objective of the study and the topic under study. Data were organized under policy transfer\' and tuberculosis\' thematic axis, which indicate different effects of meanings during DOT policy transfer, such as muting, blanking, polyphony, polysemy, and contradictions during this policy transfer process at the different levels of management, which gradually moved from an authoritative transfer to a voluntary transfer, from a higher political instance to a lower one. Nonetheless, this process was not completed in the city because the paradigm decentralizing TB actions from Primary Health Care (PHC) was not overcome