Access to affordable high-quality health care solutions is a global challenge, especially in emerging markets where health care systems are the most resource constrained. The socio-economic benefits of investing in health care are considerable, especially in terms of improvement of life quality and economic development. This creates a strong demand for efficient health care delivery models with good health outcomes. In particular, health programs targeting children in their formative years can have a longlasting effect on the children’s and their families’ lives. In India, which has one of the highest burdens of disease in the world, many states lack adequate school health programs. To address this need, the NICE Foundation has developed a school health program that provides free health care to over 200,000 children. The NICE Foundation has experienced a great interest in their school health model and thus aims to expand their operations. This study analyses the characteristics of the school health program in order to identify future opportunities and to provide strategic advice for the expansion of the NICE Foundation School Health Program. / Tillgång till prisvärd och högkvalitativ sjukvård är en global utmaning, i synnerhet i tillväxtländer där sjukvårdssystemen  är mycket  resursbegränsade.  De socio-ekonomiska  fördelarna  av att investera  i sjukvård  är avsevärda,  med förbättrad  livskvalitet  och ekonomisk  utveckling  som följd.  Det  finns  därför  en  stor  efterfrågan  på  effektiva  hälsomodeller  som  renderar  goda hälsoresultat.   Särskilt  hälsoprogram   som  är  inriktade  på  barn  i  deras  formativa  år  har dokumenterats ge långtgående positiva effekter för individerna och samhället. I Indien, som har en  av  de  högsta  nivåerna   av  sjukdomsbörda   i  världen,   saknar  många  av  delstaterna skolhälsoprogram.   För   att   addressera   detta   behov   har   NICE   Foundation   utvecklat   ett skolhälsoprogram   som  i  nuläget  erbjuder  gratis  sjukvård  för  över  200  000  barn.  NICE Foundation  skolhälsomodell  har  fått  mycket  positiv  respons  och  organisationen  ämnar  att expandera  programmet.  Denna  studie  analyserar  NICE  Foundation  skolhälsomodell  för  att identifiera framtida möjligheter samt för att tillhandahålla strategiska råd för expansion.

Thesis (MBA)--University of Stellenbosch, 2009. / ENGLISH ABSTRACT: The aim of the study was to assess the adult patients' perception of the quality of care received, following a visit to a doctor at Mthatha General Hospital Outpatients Department to establish whether it meets the patients' expectations, and to derive recommendations to improve the quality and assure that it is maintained. A cross-sectional survey was used to obtain the relevant data. A structured interview questionnaire was administered to a systemic sample of 204 adult patients attending the General Outpatients clinic at Mthatha General Hospital after a consultation with a doctor. Data was gathered and analyzed on the 204 patients' records using a Statistical package for Social sciences. This study has revealed that most patients are female (59%), aged between 16 and 70 years, with the majority in the 41 to 50 year age group. The majority of patients are unemployed (55.4%), with grade 1-8 level of education, have presence of long-standing illness or disability (54.9%), and are married (53.4%). The patients' perception of the quality of care was positive. The interpersonal aspects of care was judged by patients to be the most important, followed by technical aspects. Socio-demographic influences on perception of care were significant in those patients with long-standing illness or disability in respect of outcome aspects of care. It is recommended that patients' perception of the care provided to them be periodically assessed to ascertain if it meets their needs. / AFRIKAANSE OPSOMMING: Die doel van die studie was om die volwasse pasient se persepsie van die kwaliteit van versorgingsdiens, soos ervaar na 'n besoek aan 'n dokter by die Mthatha Algemene Hospitaal Buitepasiente Afdeling, te bepaal om gevolglik vas te stel of aan die pasient se verwagtinge voldoen is en om aanbevelings hiervan af te lei om kwaliteit te verbeter en te verseker dat dit volgehou word. 'n Deursnee peiling is gebruik om toepaslike data te bekom. 'n Gestruktureerde onderhoud-vraelys is aan 'n sistemiese monster van 204 volwasse pasiente by die algemene buitepasiente kliniek van die Mthatha Algemene Hospitaai gedoen na 'n besoek aan 'n dokter. Data uit die 204 pasienterekords is versamel en analiseer deur middel van 'n statistiese pakket vir die sosiale wetenskappe. Resultate toon dat die meerderheid pasiente vroulik (59%) en tussen 16 en 70 jaar oud is en oorwegend in die 41 tot 50 jaar ouderdomsgroep val. Die meerderheid pasiente is werkloos (55.4%), het 'n graad 1-8 vlak-opvoeding, vertoon met 'n langtermyn siekte toestand of ongeskiktheid (54.9%) en is getroud (53.4%). Die pasiente se persepsie van die kwaliteit van versorging was positief. Interpersoonlike aspekte van versorging is deur pasiente as die belangrikste beskou, gevolg deur tegniese aspekte. Sosiodemografiese invloede op die persepsie van uitkoms-verwante aspekte van versorging was betekenisvol by pasiente met langtermyn siekte toestande of ongeskikthede. Daar word aanbeveel dat pasiente se persepsie aangaande die versorging wat hulle ontvang periodiek beoordeel word om vas te stel of aan hulle behoeftes voldoen word.

The United States is ranked 27th in the world for maternal mortality, yet spends twice as much on maternity care services as countries with better maternal health indicators. Stuck in a technocratic and physician-dominated maternity care system, the U.S. depends on expensive technologies to control birth out of fear of pain and litigation, costing Americans billions of dollars and depriving women of the opportunity to have a transformative birth experience. Through an analysis of the medicalization of birth and the current biomedical model in birth, in conjunction with open-ended interviews with 5 hospital midwives and 3 homebirth midwives, the benefits and challenges of incorporating a midwifery model of care into our maternity services are explored. The midwifery model emphasizes that birth is not pathology and that psychosocial factors play a large role in birth outcomes. Basing their practice on collaboration, education, and support, midwives empower women, avoid unnecessary interventions, and offer a lower cost and higher quality care alternative. The current monopoly of women’s health services by physicians is unsustainable. Incorporating midwives into the maternity care team could provide a sustainable alternative with the caliber of maternity care services that U.S. women and families deserve.

<p><font size="3"> <p>Namibia has recorded an ascending trend of maternal and neonatal mortality rate from 225 &ndash / 449 per 100 000 women from 1992 to 2006, and 38 &ndash / 46 per 1000 live births from 2000 to 2006 respectively. Kavango Region in Namibia is one among the top seven regions with high maternal and infant mortality rate. Most pregnant women in peri-urban areas of Rundu District in the Kavango region, where this study was conducted, attend ante-natal care services but do not use public health facilities for delivery. The health records from the public health facilities in Rundu, especially from Nkarapamwe clinic and Rundu Hospital maternity section, reveal that although the pregnant women comply with the required standard policy of a minimum of three visits per pregnancy or more, over 40% of women who attend public ante-natal care clinics do not deliver in the public health facility. The aim of this study was to explore the perceptions of women regarding obstetric care in public health facilities in Kehemu settlement, a peri-urban area of Rundu town. The objectives of the study were to explore the perceptions of women on accessibility and acceptability of maternity services in public health facilities. An explorative qualitative study design using focus group discussion as a data collection method was conducted with three groups of women. A purposeful sampling procedure was used to select participants. Ethical approval was obtained from the High Degree Committee of University of the Western Cape and permission to use data from local facilities was obtained from the Ministry of Health and Social Services. Participants were recruited on their own free will and they signed an agreement on confidentiality. A data reduction process was used for analysis. The study findings indicate that women wish to use public health facilities for deliveries due to perceived benefits, in particular, safety for the mother and the baby and that those services are<font size="3"> affordable. However a number of reasons hinder women to access services including the attitudes of health care providers, inability to afford transport at night and cultural influences. The study recommends that delivery services at the local clinic be expanded from eight to twenty-four hours / an information campaign on pregnancy and birth complications as well as the benefits of delivering in a public facility be implemented / refresher training for nurses to improve their caring practices during delivery should be considered and that a similar research be conducted with care providers to ascertain ways to improve maternity services in the public health facility in the area. </font></p> </font></p>

<p><font size="3"> <p>Namibia has recorded an ascending trend of maternal and neonatal mortality rate from 225 &ndash / 449 per 100 000 women from 1992 to 2006, and 38 &ndash / 46 per 1000 live births from 2000 to 2006 respectively. Kavango Region in Namibia is one among the top seven regions with high maternal and infant mortality rate. Most pregnant women in peri-urban areas of Rundu District in the Kavango region, where this study was conducted, attend ante-natal care services but do not use public health facilities for delivery. The health records from the public health facilities in Rundu, especially from Nkarapamwe clinic and Rundu Hospital maternity section, reveal that although the pregnant women comply with the required standard policy of a minimum of three visits per pregnancy or more, over 40% of women who attend public ante-natal care clinics do not deliver in the public health facility. The aim of this study was to explore the perceptions of women regarding obstetric care in public health facilities in Kehemu settlement, a peri-urban area of Rundu town. The objectives of the study were to explore the perceptions of women on accessibility and acceptability of maternity services in public health facilities. An explorative qualitative study design using focus group discussion as a data collection method was conducted with three groups of women. A purposeful sampling procedure was used to select participants. Ethical approval was obtained from the High Degree Committee of University of the Western Cape and permission to use data from local facilities was obtained from the Ministry of Health and Social Services. Participants were recruited on their own free will and they signed an agreement on confidentiality. A data reduction process was used for analysis. The study findings indicate that women wish to use public health facilities for deliveries due to perceived benefits, in particular, safety for the mother and the baby and that those services are<font size="3"> affordable. However a number of reasons hinder women to access services including the attitudes of health care providers, inability to afford transport at night and cultural influences. The study recommends that delivery services at the local clinic be expanded from eight to twenty-four hours / an information campaign on pregnancy and birth complications as well as the benefits of delivering in a public facility be implemented / refresher training for nurses to improve their caring practices during delivery should be considered and that a similar research be conducted with care providers to ascertain ways to improve maternity services in the public health facility in the area. </font></p> </font></p>

Magister Public Health - MPH / Namibia has recorded an ascending trend of maternal and neonatal mortality rate from 225 – 449 per 100 000 women from 1992 to 2006, and 38 – 46 per 1000 live births from 2000 to 2006 respectively. Kavango Region in Namibia is one among the top seven regions with high maternal and infant mortality rate. Most pregnant women in peri-urban areas of Rundu District in the Kavango region, where this study was conducted, attend ante-natal care services but do not use public health facilities for delivery. The health records from the public health facilities in Rundu, especially from Nkarapamwe clinic and Rundu Hospital maternity section, reveal that although the pregnant women comply with the required standard policy of a minimum of three visits per pregnancy or more, over 40% of women who attend public ante-natal care clinics do not deliver in the public health facility.The aim of this study was to explore the perceptions of women regarding obstetric care in public health facilities in Kehemu settlement, a peri-urban area of Rundu town. The objectives of the study were to explore the perceptions of women on accessibility and acceptability of maternity services in public health facilities.An explorative qualitative study design using focus group discussion as a data collection method was conducted with three groups of women. A purposeful sampling procedure was used to select participants. Ethical approval was obtained from the High Degree Committee of University of the Western Cape and permission to use data from local facilities was obtained from the Ministry of Health and Social Services. Participants were recruited on their own free will and they signed an agreement on confidentiality. A data reduction process was used for analysis.The study findings indicate that women wish to use public health facilities for deliveries due to perceived benefits, in particular, safety for the mother and the baby and that those services are affordable. However a number of reasons hinder women to access services including the attitudes of health care providers, inability to afford transport at night and cultural influences.The study recommends that delivery services at the local clinic be expanded from eight to twenty-four hours; an information campaign on pregnancy and birth complications as well as the benefits of delivering in a public facility be implemented; refresher training for nurses to improve their caring practices during delivery should be considered and that a similar research be conducted with care providers to ascertain ways to improve maternity services in the public health facility in the area.

Thesis deals with the definition of quality health care, quality management approaches, quality measurement and strategies that help us to achieve a better level of quality. Another part of this work defines indicator of quality, properties, the development phase and what it is used. The aim of this work is to define a set of national indicators of quality health care in the Czech Republic.

The purpose of this study was to examine the extent to which human resources capacity of the Ministry of Health and Social Services (MoHSS), Namibia, influences health care services delivery to the Namibian population. A qualitative research model using exploratory and descriptive study designs was adopted. Data were collected through semi-structured interviews with 46 health workers from two referral hospitals and two directorates in Windhoek District. The study found that there is severe staff shortage in the MoHSS, which has resulted in high workload and poor health care. Health worker migration, new services and programmes, emerging diseases, and population growth were reported to have contributed to staff shortage and high workload in the MoHSS. Study findings suggested a need to create more posts to accommodate emerging needs, and to introduce an effective retention strategy to attract and retain health professionals with scarce skills, and those working under difficult conditions. / Public Administration & Management / M. Tech. (Public Management)

Introdução: A adoção e a implementação de medidas de prevenção de quedas de paciente no ambiente hospitalar são indissociáveis dos atributos qualidade e segurança nos serviços de saúde, pressupondo uma abordagem sistêmica, na qual o êxito depende do compromisso e da responsabilidade da organização, dos profissionais, dos pacientes e de seus acompanhantes. Objetivos: Compreender a vivência dos pacientes acometidos pelo evento queda e dos enfermeiros acerca do processo de implementação de medidas preventivas e do monitoramento do evento queda de paciente em um hospital privado do Município de São Paulo. Caminho Metodológico: Estudo qualitativo, exploratório, descritivo na modalidade estudo de caso. O cenário foi o Hospital Alemão Oswaldo Cruz. Os participantes corresponderam a dez pacientes e 11 enfermeiras. A coleta de dados foi realizada no período entre maio de 2014 e março de 2015, empregando-se a entrevista semiestruturada gravada para os pacientes acometidos pelo evento queda, que foi transformada em narrativas, e as do grupo focal, para as enfermeiras. As narrativas oriundas das entrevistas e o material produzido nas três sessões do grupo focal foram submetidos à análise de conteúdo de Bardin, emergindo duas categorias e três subcategorias. Achados: As categorias foram: a singularidade do evento queda: da expressão do fato à manifestação de sentimentos; o olhar do paciente e familiar para os recursos institucionais: elementos da estrutura, processo e resultado; a vulnerabilidade e os determinantes no evento queda; a implementação de medidas para a prevenção de queda à luz da tríade Donabediana e o modo de ser: reflexões atitudinais acerca da interface enfermeiro-paciente. Para a análise interpretativa dos achados foram adotados os referenciais de qualidade em saúde, segurança do paciente e de autoeficácia, preconizado por Bandura. Considerações Finais: Esta investigação propiciou compreender a percepção dos pacientes e enfermeiros frente ao evento queda, interpretar e revisitar os processos assistenciais e gerenciais na prevenção e monitoramento das quedas. Por conseguinte, permitiu elaborar propostas, visando a aprimorar os componentes de estrutura, processo e resultado para dirimir as quedas, bem como reconstruir o material instrucional e aprimorar os protocolos e planos de ação, com vistas a qualificar o cuidado na Instituição. / Introduction: The spiritual aspect is very important and is becoming increasingly necessary in the practice of health care. S Introduction: The adoption and the implementation of measures to prevent patients fall in hospital are inseparable from quality and safety dimensions in health care services, assuming a systemic approach in which success depends on the commitment and on the responsibility of the organization, of the professionals, of patients and their escorts. Objectives: Understand the experience of patients affected by fall events and nurses about the process of implementation of preventive measures and the monitoring of the event of fall at a private hospital in the city of São Paulo. Methodology: Qualitative, exploratory, descriptive study, a case study. The scenario was Hospital Alemão Oswaldo Cruz. Participants corresponded to ten patients and 11 nurses. Data collection was made from May 2014 to March 2015, by applying semi structured interview recorded to patients affected by fall event, which was converted into narratives, and the focus group for the nurses. The narratives from the interviews and the material produced in the three sessions of the focus group were submitted to Bardin content analysis, emerging two categories and three subcategories. Findings: The categories were, the singularity of fall event: from the fact itself to the manifestation of feeling; the perception of the patient and family regarding the institutional resources: elements of structure, process and outcome; the vulnerability and major factors in the fall event; the implementation of measures to prevent fall according to the Donabedian triad and the way of being: attitudinal reflections on the nurse-patient interaction. For an interpretative analysis of findings, guidelines of health care quality, patient safety and self-efficacy as called for Bandura were adopted. Final comments: this research made possible the understanding of patients and nurses perception regarding the event of fall, the interpretation and revisit of health care and management processes in the prevention and monitoring of falls. Consequently, it allowed the creation of proposals in order to better the components of structure, process and result to reduce falls and also to rebuild the instructional material and improve the protocols and plans of education with the aim of qualifying care in the institution.

Introdução: A adoção e a implementação de medidas de prevenção de quedas de paciente no ambiente hospitalar são indissociáveis dos atributos qualidade e segurança nos serviços de saúde, pressupondo uma abordagem sistêmica, na qual o êxito depende do compromisso e da responsabilidade da organização, dos profissionais, dos pacientes e de seus acompanhantes. Objetivos: Compreender a vivência dos pacientes acometidos pelo evento queda e dos enfermeiros acerca do processo de implementação de medidas preventivas e do monitoramento do evento queda de paciente em um hospital privado do Município de São Paulo. Caminho Metodológico: Estudo qualitativo, exploratório, descritivo na modalidade estudo de caso. O cenário foi o Hospital Alemão Oswaldo Cruz. Os participantes corresponderam a dez pacientes e 11 enfermeiras. A coleta de dados foi realizada no período entre maio de 2014 e março de 2015, empregando-se a entrevista semiestruturada gravada para os pacientes acometidos pelo evento queda, que foi transformada em narrativas, e as do grupo focal, para as enfermeiras. As narrativas oriundas das entrevistas e o material produzido nas três sessões do grupo focal foram submetidos à análise de conteúdo de Bardin, emergindo duas categorias e três subcategorias. Achados: As categorias foram: a singularidade do evento queda: da expressão do fato à manifestação de sentimentos; o olhar do paciente e familiar para os recursos institucionais: elementos da estrutura, processo e resultado; a vulnerabilidade e os determinantes no evento queda; a implementação de medidas para a prevenção de queda à luz da tríade Donabediana e o modo de ser: reflexões atitudinais acerca da interface enfermeiro-paciente. Para a análise interpretativa dos achados foram adotados os referenciais de qualidade em saúde, segurança do paciente e de autoeficácia, preconizado por Bandura. Considerações Finais: Esta investigação propiciou compreender a percepção dos pacientes e enfermeiros frente ao evento queda, interpretar e revisitar os processos assistenciais e gerenciais na prevenção e monitoramento das quedas. Por conseguinte, permitiu elaborar propostas, visando a aprimorar os componentes de estrutura, processo e resultado para dirimir as quedas, bem como reconstruir o material instrucional e aprimorar os protocolos e planos de ação, com vistas a qualificar o cuidado na Instituição. / Introduction: The spiritual aspect is very important and is becoming increasingly necessary in the practice of health care. S Introduction: The adoption and the implementation of measures to prevent patients fall in hospital are inseparable from quality and safety dimensions in health care services, assuming a systemic approach in which success depends on the commitment and on the responsibility of the organization, of the professionals, of patients and their escorts. Objectives: Understand the experience of patients affected by fall events and nurses about the process of implementation of preventive measures and the monitoring of the event of fall at a private hospital in the city of São Paulo. Methodology: Qualitative, exploratory, descriptive study, a case study. The scenario was Hospital Alemão Oswaldo Cruz. Participants corresponded to ten patients and 11 nurses. Data collection was made from May 2014 to March 2015, by applying semi structured interview recorded to patients affected by fall event, which was converted into narratives, and the focus group for the nurses. The narratives from the interviews and the material produced in the three sessions of the focus group were submitted to Bardin content analysis, emerging two categories and three subcategories. Findings: The categories were, the singularity of fall event: from the fact itself to the manifestation of feeling; the perception of the patient and family regarding the institutional resources: elements of structure, process and outcome; the vulnerability and major factors in the fall event; the implementation of measures to prevent fall according to the Donabedian triad and the way of being: attitudinal reflections on the nurse-patient interaction. For an interpretative analysis of findings, guidelines of health care quality, patient safety and self-efficacy as called for Bandura were adopted. Final comments: this research made possible the understanding of patients and nurses perception regarding the event of fall, the interpretation and revisit of health care and management processes in the prevention and monitoring of falls. Consequently, it allowed the creation of proposals in order to better the components of structure, process and result to reduce falls and also to rebuild the instructional material and improve the protocols and plans of education with the aim of qualifying care in the institution.