Research into the use of information by health care professionals has generally been conducted in countries dominated by the biomedical model. In these contexts, illness is considered to have a scientifically identifiable physical cause, and treatment practices within the formal health care sector are prescribed and managed in accordance with this definition. Yet there are also contexts where other belief systems inform and guide the way that people think about their health. In comparison to the biomedical model, these contexts have contributed very little to our understanding of how health professionals develop their knowledge. This research investigates how primary health care workers (PHCWs) in one such context, Papua New Guinea (PNG), develop their knowledge about the health services they provide. In order to discover and understand the differing views of these PHCWs, 69 semi-structured interviews were conducted in three culturally and geographically diverse regions of PNG. In explaining the diagnostic and treatment practices they use, these participants provided insights into not only how PHCWs engage with information but also how it informs their professional practice. These data were analysed, interpreted and discussed using a framework consisting of four, primary but interconnecting aspects: the context in which information was provided, the interactions with the sources of information, the processes by which information was understood, and the outcomes realized as a result of the information being used. Findings indicated that the majority of participants in this study acknowledged, if not incorporated, information pertaining to biomedicine, Christianity and Indigenous belief systems into their diagnostic and treatment practices. Even when these belief systems clearly contradicted each other, PHCWs did not in general feel the need to make a conscious choice between them. From their comments it would appear that four factors contributed to this ability to incorporate diverse and often conflicting ideas into the way that patients were cared for. First, all of the belief systems were considered legitimate by at least one group of people connected to the community in which the PHCW worked. Second, although varying in degrees of availability and accessibility, members of these groups were able to disseminate information pertaining to the belief system they supported. Third, the PHCW had no particular affiliation with any one of these groups but instead regularly interacted with a range of different people. Lastly, the PHCW worked in situations where health practices were not generally well supervised by their employers and therefore they were relatively free to choose between various diagnostic and treatment practices. The qualitative interpretive approach adopted in this thesis contributes to the field of human information behavior by affirming that conflict is in the eye of the beholder. When a number of belief systems coexist and all are considered legitimate, information about them is freely available, and the recipients actions are neither constrained by their own dogma, nor imposed upon by others, individuals may quite comfortably embrace diverse beliefs. These findings may also contribute to a better understanding of health management practices in developing countries by suggesting that health professionals are not merely personifications of a biomedical model. Instead, the study demonstrates that multiple belief systems can be combined by PHCWs, and that in turn this benefits the formal health care sector through increased treatment options that are both appropriate and effective in such circumstances.

A quantitative, descriptive, explorative design was used to evaluate a decentralised primary health care training programme at a training unit in the Limpopo Province. The study sought to determine to what extent the newly qualified diplomates were able to manage patients appropriately when faced with the realities, such as the shortage of personnel, large numbers of patients, shortage of resources and time constraints in the real situation without the support and guidance from medical practitioners and senior nursing personnel. Data were collected by observing the diplomates as they managed patients with hypertension by making use of checklists. The diplomates were also interviewed by making use of an in interview schedule. The major inferences drawn from this study was that these diplomates were competent in the management of these patients and were satisfied with their abilities and training. / Health Studies / M. A. (Health Studies)

Since 1994 a number of health reforms took place in furthering democracy. These changes included the decentralisation of Primary Health Care Services. This study is a phenomenological research that chronicles the Primary Health Care decentralisation experiences in the Bophirima District of the North-West Province. Using a descriptive phenomenological orientation, the purpose of this study was to describe the experiences of participants associated with decentralisation in the Bophirima District. Also, to illustrate how the participants perceive these experiences in relation to Primary Health Care services. Furthermore, to provide scientific evidence regarding factors related to the decentralisation of PHC services in the Bophirima District. These and other issues remain of paramount importance given the current state of health care in the South Africa. This study took place in the outskirts of the semi-rural area of Bophirima and Central District in the North-West Province. The investigation followed qualitative research design that was descriptive, exploratory, contextual and phenomenological in nature. The sampling procedure involved non-probability purposive, sampling technique with a sample size of five participants. Data was collected by using an unstructured interview technique. The modified Giorgi method of analysis was used for qualitative data analysis. These are contained in Burns and Grove (2001:596) and Polit and Beck (2004:394) are fully explicated in Chapter Four. Guba model (in Babbie & Mouton, 2001:180) was utilised to ensure the trustworthiness of the study. Ethical requirements were considered throughout and these are reflected in chapter four of the thesis.Three forms of decentralisation: deconcentration, delegation and devolution were identified in the findings. The investigation further indicated that the integration of primary health care services was also underway at the time of decentralisation. This integration triggered different psychological and emotional states amongst research participants. Most importantly, the research revealed that the interest of leadership across three spheres of government played a key role in the decentralisation of PHCs and integration of PHCs, while highlighting the importance of community participation in health service delivery (CP). In conclusion, the decentralisation process was generally perceived as empowering although, nationally, leadership needs to be strengthened to support provinces and districts regarding major policy issues such decentralisation. Key recommendations were made and further research was suggested. / Health Studies / D. Litt. et Phil. (Health Studies)

O sistema de saúde vem se transformando pressionado por mudanças sociodemográficas, políticas e econômicas. Essas modificações impõem aos gestores a necessidade de conhecer de maneira particularizada o perfil de demandas da população usuária. Neste contexto, o presente estudo tem por objetivo identificar o padrão e as características de utilização de um serviço de atenção primária à saúde a nível ambulatorial. Como objetivos específicos buscou-se traçar o perfil sociodemográfico dos usuários de unidades de APS, avaliar os motivos das consultas, identificar o tipo de atendimento utilizado e a categoria profissional responsável pelo atendimento, avaliar a relação das consultas com as ações programáticas desenvolvidas nos serviços de saúde e identificar a associação entre a vulnerabilidade da área de moradia e os motivos de consulta. Foi realizado um estudo transversal com dados retrospectivos do Serviço de Saúde Comunitária do Grupo Hospitalar Conceição (SSC-GHC). A fonte primária foi o Boletim de Atendimento(BA), emitido para cada consulta efetuada no período de 1/01/2011 a 31/12/2011. O total de consultas avaliadas foi de 34.014 realizadas em duas unidades da Zona Norte de Porto Alegre por profissionais de nível superior de diferentes categorias profissionais. . A fonte primária do banco de dados foi o BA, emitido para cada atendimento ambulatorial. A análise dos dados foi feita com o programa estatístico SPSS versão 18.0. A análise descritiva respeitou as características e a distribuição das variáveis. As variáveis contínuas e com distribuição normal foram descritas por meio da média e desvio padrão e as variáveis contínuas e sem distribuição normal foram apresentadas como mediana (intervalo interquartil). As variáveis categóricas foram descritas como números absolutos. O número total de consultas efetivadas foi de 34.014, realizadas por 5.033 pessoas com cadastro nas unidades. A participação de moradores de área de risco foi de 31,3%. O número de pessoas consideradas hiperutilizadores - com mais de 6 consultas/ano - foi de 2.216 (44%). Os hiperutilizadores realizaram 78% das consultas. Estavam presentes hiperutilizadores em 53,7% das famílias. Os hiperutilizadores tinham como característica predominante ser mulher (67,8%), pertencer à faixa etária dos 20 aos 49 anos ou de mais de 60 anos. Os problemas relacionados à saúde mental e comportamental têm um percentual mais elevado entre os usuários hiperutilizadores, (6,9% vs 3,5%). O profissional mais procurado foi o médico (59,3%) seguido pelo odontólogo (27,5%). Os motivos de consulta encontrados são semelhantes no grupo de hiperutilizadores e não hiperutilizadores e distribuídos dentro do esperado para as faixas etárias. / The health system has been undergoing transformation due to sociodemographic, political and economic changes. These alterations impose to managers the need to individually know the demand profile of the user population. In this context, the present study aims to identify the use pattern and characteristics in primary health care service at ambulatorial level. As for specific objectives, this research intended to develop the sociodemographic profile of Primary Health Care (PHC) units users, evaluate the reasons for consultations, identify the type of service utilized and the professional category responsible for providing the service, assess the relationship between consultations and the programmatic actions performed by health services as well as to identify the association between the vulnerability of the housing area and the reasons for consultation. A cross-sectional study was conducted with retrospective data from the Community Health Service of the Conceição Hospital Group (SSC-GHC). The primary source was the outpatients' charts issued for each consultation in the period between 1/1/2011 and 12/31/2011. The study comprised a total of 34,014 consultations performed in two units of the North Region of Porto Alegre by professionals with tertiary education from different occupational categories. The main objective of this study was to identify use pattern and characteristics of primary health care services at ambulatorial level. The specific objectives were to develop the sociodemographic profile of PHC units users, evaluate the reasons for consultations, identify the type of service utilized and the professional category responsible for providing the service, assess the relationship between consultations and the programmatic actions performed by health care services as well as to identify the association between the vulnerability of the housing area and the reasons for consultation. The primary source of the database was the chart issued for each outpatient’s ambulatory care. The data analysis was realized with the SPSS statistics software version 18.0. The descriptive analysis considered the characteristics and distribution of variables. The continuous variables with normal distribution were described through averages and standard deviation whilst the continuous variables without normal distribution were presented as median (interquartile range). Categorical variables were described as absolute numbers. The total number of consultations was 34,014 referring to 5,033 people registered in the units. The participation of risk area residents was 31.3%. The number of people considered frequent users - with more than 6 consultations per year - amounted to 2,216 (44%). The frequent users accounted for 78% of the consultations. They were present in 53.7% of households. Frequent users were predominantly women (67.8%), belonging to the age group ranging from 20 to 49 years old or over 60. Mental and behavioral health related issues have a higher percentage among frequent users (6.9% vs. 3.5%). The most requested professional was the physician (59.3%) followed by the odontologist (27.5%). The reasons for consultation found are similar in both frequent and non-frequent users and distributed within the expected for the age groups.

Justificativa: As Internações por Condições Sensíveis à Atenção Básica são um conjunto de problemas de saúde, para os quais o acesso aos serviços de AB e ações efetivas poderiam reduzir a ocorrência destas internações, tornando-as um indicador de resultado para avaliação da qualidade e do acesso nesse nível de atenção. Assim, analisou-se o indicador de ICSAB, buscando fatores associados à sua ocorrência, a fim de avaliar a sua capacidade de verificar a resolutividade da atenção básica. Métodos: Realizou-se uma análise exploratória descritiva do ICSAB nas sete macrorregiões de saúde e 30 regiões de saúde do Rio Grande do Sul, com base na Cobertura de Saúde da Família, seguida de uma revisão da produção indexada sobre ICSAB, com o objetivo de verificar quais fatores estão correlacionados com o desfecho ICSAB. Por fim desenvolveu-se um estudo ecológico com medidas agregadas, testando o grau de correlação linear entre as variáveis selecionadas a partir da revisão, utilizando o coeficiente de correlação de Spearman Resultados: Foram encontrados na literatura diversos fatores correlacionados à ocorrência de ICSAB, tanto no âmbito da disponibilidade de serviços de saúde, como na perspectiva socioeconômica. Em relação a realidade do RS, encontrou-se correlação de ICSAB com quantidade de leitos (p=0.002), Proporção de pessoas com planos de saúde (p=0,001), IDH (p=0.004) e analfabetismo (p=0.001) e população menor de quatro anos (p=0,001). Considerações: O indicador ICSAB cumpre seu objetivo de tornar comparável de forma sintética a situação da Atenção Básica nas diversas possibilidades de recortes territoriais. Contudo, as variáveis que interferem nesse desfecho são diversas, operando de maneiras diferentes em cada contexto e necessitando de maior aprofundamento. Enquanto subsídio para políticas e ações de qualificação da Atenção Básica, a mudança desse indicador só ocorrerá quando esse dado servir como dispositivo inicial para entender processos complexos e locais, que ocorrerão através de processos de educação permanente. / Background: Hospitalizations for Sensitive Conditions to Primary Health Care (HSCPHC) are a group of health problems, for which access to Primary Health Care services and effective actions could reduce the occurrence of these hospitalizations, making them an outcome indicator for quality and access to this level of attention. Thus, the HSCPHC indicator was analyzed, looking for factors associated with its occurrence, in order to evaluate its capacity to verify the resolution of basic care. Methods: A descriptive exploratory analysis of the HSCPHC was carried out in the seven macro-regions of health and 30 health regions of Rio Grande do Sul, based on the Family Health Coverage, followed by a review of the indexed production on HSCBC, with the objective of verify which factors are correlated with the HSCPHC outcome. Finally, an ecological study with aggregate measures was developed, testing the degree of linear correlation between the variables selected from the review using Spearman's correlation coefficient Results: A number of factors correlated with the occurrence of HSCPHC were found in the literature, both in terms of the availability of health services and in the socioeconomic perspective. In relation to Rio Grande do Sul reality, we found a correlation of HSCBC with number of hospital beds (p = 0.002), Proportion of people with health plans (p = 0.001), HDI (p = 0.004) and illiteracy (p = 0.001) and population younger than four years (p = 0.001). Considerations: The HSCPHC indicator fulfills its objective of making the situation of Primary Health Care in the various possibilities of territorial cuts comparable in a synthetic way. However, the variables that interfere in this outcome are diverse, operating differently in each context and requiring further study. As a subsidy for policies and actions to qualify Primary Health Care, the change in this indicator will only occur when this data serves as an initial device to understand complex and local processes that will occur through processes of permanent education.

O sistema de saúde vem se transformando pressionado por mudanças sociodemográficas, políticas e econômicas. Essas modificações impõem aos gestores a necessidade de conhecer de maneira particularizada o perfil de demandas da população usuária. Neste contexto, o presente estudo tem por objetivo identificar o padrão e as características de utilização de um serviço de atenção primária à saúde a nível ambulatorial. Como objetivos específicos buscou-se traçar o perfil sociodemográfico dos usuários de unidades de APS, avaliar os motivos das consultas, identificar o tipo de atendimento utilizado e a categoria profissional responsável pelo atendimento, avaliar a relação das consultas com as ações programáticas desenvolvidas nos serviços de saúde e identificar a associação entre a vulnerabilidade da área de moradia e os motivos de consulta. Foi realizado um estudo transversal com dados retrospectivos do Serviço de Saúde Comunitária do Grupo Hospitalar Conceição (SSC-GHC). A fonte primária foi o Boletim de Atendimento(BA), emitido para cada consulta efetuada no período de 1/01/2011 a 31/12/2011. O total de consultas avaliadas foi de 34.014 realizadas em duas unidades da Zona Norte de Porto Alegre por profissionais de nível superior de diferentes categorias profissionais. . A fonte primária do banco de dados foi o BA, emitido para cada atendimento ambulatorial. A análise dos dados foi feita com o programa estatístico SPSS versão 18.0. A análise descritiva respeitou as características e a distribuição das variáveis. As variáveis contínuas e com distribuição normal foram descritas por meio da média e desvio padrão e as variáveis contínuas e sem distribuição normal foram apresentadas como mediana (intervalo interquartil). As variáveis categóricas foram descritas como números absolutos. O número total de consultas efetivadas foi de 34.014, realizadas por 5.033 pessoas com cadastro nas unidades. A participação de moradores de área de risco foi de 31,3%. O número de pessoas consideradas hiperutilizadores - com mais de 6 consultas/ano - foi de 2.216 (44%). Os hiperutilizadores realizaram 78% das consultas. Estavam presentes hiperutilizadores em 53,7% das famílias. Os hiperutilizadores tinham como característica predominante ser mulher (67,8%), pertencer à faixa etária dos 20 aos 49 anos ou de mais de 60 anos. Os problemas relacionados à saúde mental e comportamental têm um percentual mais elevado entre os usuários hiperutilizadores, (6,9% vs 3,5%). O profissional mais procurado foi o médico (59,3%) seguido pelo odontólogo (27,5%). Os motivos de consulta encontrados são semelhantes no grupo de hiperutilizadores e não hiperutilizadores e distribuídos dentro do esperado para as faixas etárias. / The health system has been undergoing transformation due to sociodemographic, political and economic changes. These alterations impose to managers the need to individually know the demand profile of the user population. In this context, the present study aims to identify the use pattern and characteristics in primary health care service at ambulatorial level. As for specific objectives, this research intended to develop the sociodemographic profile of Primary Health Care (PHC) units users, evaluate the reasons for consultations, identify the type of service utilized and the professional category responsible for providing the service, assess the relationship between consultations and the programmatic actions performed by health services as well as to identify the association between the vulnerability of the housing area and the reasons for consultation. A cross-sectional study was conducted with retrospective data from the Community Health Service of the Conceição Hospital Group (SSC-GHC). The primary source was the outpatients' charts issued for each consultation in the period between 1/1/2011 and 12/31/2011. The study comprised a total of 34,014 consultations performed in two units of the North Region of Porto Alegre by professionals with tertiary education from different occupational categories. The main objective of this study was to identify use pattern and characteristics of primary health care services at ambulatorial level. The specific objectives were to develop the sociodemographic profile of PHC units users, evaluate the reasons for consultations, identify the type of service utilized and the professional category responsible for providing the service, assess the relationship between consultations and the programmatic actions performed by health care services as well as to identify the association between the vulnerability of the housing area and the reasons for consultation. The primary source of the database was the chart issued for each outpatient’s ambulatory care. The data analysis was realized with the SPSS statistics software version 18.0. The descriptive analysis considered the characteristics and distribution of variables. The continuous variables with normal distribution were described through averages and standard deviation whilst the continuous variables without normal distribution were presented as median (interquartile range). Categorical variables were described as absolute numbers. The total number of consultations was 34,014 referring to 5,033 people registered in the units. The participation of risk area residents was 31.3%. The number of people considered frequent users - with more than 6 consultations per year - amounted to 2,216 (44%). The frequent users accounted for 78% of the consultations. They were present in 53.7% of households. Frequent users were predominantly women (67.8%), belonging to the age group ranging from 20 to 49 years old or over 60. Mental and behavioral health related issues have a higher percentage among frequent users (6.9% vs. 3.5%). The most requested professional was the physician (59.3%) followed by the odontologist (27.5%). The reasons for consultation found are similar in both frequent and non-frequent users and distributed within the expected for the age groups.

Justificativa: As Internações por Condições Sensíveis à Atenção Básica são um conjunto de problemas de saúde, para os quais o acesso aos serviços de AB e ações efetivas poderiam reduzir a ocorrência destas internações, tornando-as um indicador de resultado para avaliação da qualidade e do acesso nesse nível de atenção. Assim, analisou-se o indicador de ICSAB, buscando fatores associados à sua ocorrência, a fim de avaliar a sua capacidade de verificar a resolutividade da atenção básica. Métodos: Realizou-se uma análise exploratória descritiva do ICSAB nas sete macrorregiões de saúde e 30 regiões de saúde do Rio Grande do Sul, com base na Cobertura de Saúde da Família, seguida de uma revisão da produção indexada sobre ICSAB, com o objetivo de verificar quais fatores estão correlacionados com o desfecho ICSAB. Por fim desenvolveu-se um estudo ecológico com medidas agregadas, testando o grau de correlação linear entre as variáveis selecionadas a partir da revisão, utilizando o coeficiente de correlação de Spearman Resultados: Foram encontrados na literatura diversos fatores correlacionados à ocorrência de ICSAB, tanto no âmbito da disponibilidade de serviços de saúde, como na perspectiva socioeconômica. Em relação a realidade do RS, encontrou-se correlação de ICSAB com quantidade de leitos (p=0.002), Proporção de pessoas com planos de saúde (p=0,001), IDH (p=0.004) e analfabetismo (p=0.001) e população menor de quatro anos (p=0,001). Considerações: O indicador ICSAB cumpre seu objetivo de tornar comparável de forma sintética a situação da Atenção Básica nas diversas possibilidades de recortes territoriais. Contudo, as variáveis que interferem nesse desfecho são diversas, operando de maneiras diferentes em cada contexto e necessitando de maior aprofundamento. Enquanto subsídio para políticas e ações de qualificação da Atenção Básica, a mudança desse indicador só ocorrerá quando esse dado servir como dispositivo inicial para entender processos complexos e locais, que ocorrerão através de processos de educação permanente. / Background: Hospitalizations for Sensitive Conditions to Primary Health Care (HSCPHC) are a group of health problems, for which access to Primary Health Care services and effective actions could reduce the occurrence of these hospitalizations, making them an outcome indicator for quality and access to this level of attention. Thus, the HSCPHC indicator was analyzed, looking for factors associated with its occurrence, in order to evaluate its capacity to verify the resolution of basic care. Methods: A descriptive exploratory analysis of the HSCPHC was carried out in the seven macro-regions of health and 30 health regions of Rio Grande do Sul, based on the Family Health Coverage, followed by a review of the indexed production on HSCBC, with the objective of verify which factors are correlated with the HSCPHC outcome. Finally, an ecological study with aggregate measures was developed, testing the degree of linear correlation between the variables selected from the review using Spearman's correlation coefficient Results: A number of factors correlated with the occurrence of HSCPHC were found in the literature, both in terms of the availability of health services and in the socioeconomic perspective. In relation to Rio Grande do Sul reality, we found a correlation of HSCBC with number of hospital beds (p = 0.002), Proportion of people with health plans (p = 0.001), HDI (p = 0.004) and illiteracy (p = 0.001) and population younger than four years (p = 0.001). Considerations: The HSCPHC indicator fulfills its objective of making the situation of Primary Health Care in the various possibilities of territorial cuts comparable in a synthetic way. However, the variables that interfere in this outcome are diverse, operating differently in each context and requiring further study. As a subsidy for policies and actions to qualify Primary Health Care, the change in this indicator will only occur when this data serves as an initial device to understand complex and local processes that will occur through processes of permanent education.

O sistema de saúde vem se transformando pressionado por mudanças sociodemográficas, políticas e econômicas. Essas modificações impõem aos gestores a necessidade de conhecer de maneira particularizada o perfil de demandas da população usuária. Neste contexto, o presente estudo tem por objetivo identificar o padrão e as características de utilização de um serviço de atenção primária à saúde a nível ambulatorial. Como objetivos específicos buscou-se traçar o perfil sociodemográfico dos usuários de unidades de APS, avaliar os motivos das consultas, identificar o tipo de atendimento utilizado e a categoria profissional responsável pelo atendimento, avaliar a relação das consultas com as ações programáticas desenvolvidas nos serviços de saúde e identificar a associação entre a vulnerabilidade da área de moradia e os motivos de consulta. Foi realizado um estudo transversal com dados retrospectivos do Serviço de Saúde Comunitária do Grupo Hospitalar Conceição (SSC-GHC). A fonte primária foi o Boletim de Atendimento(BA), emitido para cada consulta efetuada no período de 1/01/2011 a 31/12/2011. O total de consultas avaliadas foi de 34.014 realizadas em duas unidades da Zona Norte de Porto Alegre por profissionais de nível superior de diferentes categorias profissionais. . A fonte primária do banco de dados foi o BA, emitido para cada atendimento ambulatorial. A análise dos dados foi feita com o programa estatístico SPSS versão 18.0. A análise descritiva respeitou as características e a distribuição das variáveis. As variáveis contínuas e com distribuição normal foram descritas por meio da média e desvio padrão e as variáveis contínuas e sem distribuição normal foram apresentadas como mediana (intervalo interquartil). As variáveis categóricas foram descritas como números absolutos. O número total de consultas efetivadas foi de 34.014, realizadas por 5.033 pessoas com cadastro nas unidades. A participação de moradores de área de risco foi de 31,3%. O número de pessoas consideradas hiperutilizadores - com mais de 6 consultas/ano - foi de 2.216 (44%). Os hiperutilizadores realizaram 78% das consultas. Estavam presentes hiperutilizadores em 53,7% das famílias. Os hiperutilizadores tinham como característica predominante ser mulher (67,8%), pertencer à faixa etária dos 20 aos 49 anos ou de mais de 60 anos. Os problemas relacionados à saúde mental e comportamental têm um percentual mais elevado entre os usuários hiperutilizadores, (6,9% vs 3,5%). O profissional mais procurado foi o médico (59,3%) seguido pelo odontólogo (27,5%). Os motivos de consulta encontrados são semelhantes no grupo de hiperutilizadores e não hiperutilizadores e distribuídos dentro do esperado para as faixas etárias. / The health system has been undergoing transformation due to sociodemographic, political and economic changes. These alterations impose to managers the need to individually know the demand profile of the user population. In this context, the present study aims to identify the use pattern and characteristics in primary health care service at ambulatorial level. As for specific objectives, this research intended to develop the sociodemographic profile of Primary Health Care (PHC) units users, evaluate the reasons for consultations, identify the type of service utilized and the professional category responsible for providing the service, assess the relationship between consultations and the programmatic actions performed by health services as well as to identify the association between the vulnerability of the housing area and the reasons for consultation. A cross-sectional study was conducted with retrospective data from the Community Health Service of the Conceição Hospital Group (SSC-GHC). The primary source was the outpatients' charts issued for each consultation in the period between 1/1/2011 and 12/31/2011. The study comprised a total of 34,014 consultations performed in two units of the North Region of Porto Alegre by professionals with tertiary education from different occupational categories. The main objective of this study was to identify use pattern and characteristics of primary health care services at ambulatorial level. The specific objectives were to develop the sociodemographic profile of PHC units users, evaluate the reasons for consultations, identify the type of service utilized and the professional category responsible for providing the service, assess the relationship between consultations and the programmatic actions performed by health care services as well as to identify the association between the vulnerability of the housing area and the reasons for consultation. The primary source of the database was the chart issued for each outpatient’s ambulatory care. The data analysis was realized with the SPSS statistics software version 18.0. The descriptive analysis considered the characteristics and distribution of variables. The continuous variables with normal distribution were described through averages and standard deviation whilst the continuous variables without normal distribution were presented as median (interquartile range). Categorical variables were described as absolute numbers. The total number of consultations was 34,014 referring to 5,033 people registered in the units. The participation of risk area residents was 31.3%. The number of people considered frequent users - with more than 6 consultations per year - amounted to 2,216 (44%). The frequent users accounted for 78% of the consultations. They were present in 53.7% of households. Frequent users were predominantly women (67.8%), belonging to the age group ranging from 20 to 49 years old or over 60. Mental and behavioral health related issues have a higher percentage among frequent users (6.9% vs. 3.5%). The most requested professional was the physician (59.3%) followed by the odontologist (27.5%). The reasons for consultation found are similar in both frequent and non-frequent users and distributed within the expected for the age groups.

Distinct dimensions of quality vary in importance depending on the context in which quality assurance effort takes place. Working through the process of quality assurance and continuous quality improvement may create an environment for transforming the health services and achieving positive health outcome goals. Substantial improvements have been observed in the coverage and access to health service delivery in Ethiopia. However, the quality of care has been lagging behind. The purpose of this study was to develop guidelines for care to enhance quality health services at Gindabarat District, Oromia Regional State, Ethiopia. The study followed a mixed method approach. The participants were purposively included in the study based on their availability, from a total of 7 government health facilities from the Gindabarat District. Self-administered questionnaires and interviews were used to collect data from samples of 127 health care workers and 29 health facilities managers, respectively. Collected data were analysed using SPSS Version 24 and ATLAS TI 8 respectively. The results revealed barriers towards quality health services delivery which were lack of equipment and supplies (inadequacy of blocks, materials, medical equipment; lack of sustainable supplies of drugs); inadequate human resources (low retention of skilled staff; absence of focal person assigned for quality improvement; shortages of health workers); absence of standard operating procedures (protocols, guidelines and manuals); and dissatisfaction of health care providers with services provided at the District. Based on the results, guidelines were developed to enhance quality health care delivery. The reccommendations were aimed at improvement approaches at all levels of health service delivery. / Health Studies / D.Litt. et Phil. (Health Studies)

MCur / Department of Advanced Nursing Science