No description available.

Thesis (Ph. D.)--University of Washington, 2005. / Vita. Includes bibliographical references (leaves 259-265).

In 1981/82 there was renewed interest in the concept of a regionalized form of health service delivery in British Columbia. A discussion paper which outlined a proposal for regionalizing those services funded directly by the Ministry of Health was circulated to the senior managers in the Ministry in August of that year. In this paper it was suggested that regionalization would encourage the integration and co-ordination of health services at a regional level, thereby increasing the efficiency and effectiveness of the health delivery system. This study considers strategies for planning health service delivery at this regional level, with the model of regionalization outlined in the 1981 proposal used as a basis for discussion. Every effort has been made to develop an approach to planning that is feasible, given the context within which health policy decisions are made in British Columbia in 1982. To do this the changing trends in health care management in B.C. have been considered, and relevant planning and organization theory reviewed. Evaluations of regional planning systems in three other jurisdictions are also described. The potential difficulties a Regional Manager might face in developing an integrated approach to regional planning are identified, and strategies to deal with these possible conflicts outlined. It would seem from this analysis that the degree to which authority is decentralized to the region is central to any decision about planning at the regional level. A model based on normative centralization, and operational decentralization is suggested, with needs assessments, and prioritization of needs taking place at the region. Support for integrated regional health planning by both the government and the provider groups seems to be necessary if good regional plans are to be developed, and if implementation of the plans and policies that evolve from the process are to be successful. It is suggested that introducing the structures and processes for planning at the regional level should involve two stages. During the first, the administrative functions for direct services would be decentralized, and a general review of health services and health care in the region undertaken. The development of a regional identity and liaison among the many subgroups operating in the region would be an important aspect of this first stage. The second stage, which would be implemented after one year, would see the development of a Regional Advisory Council and multidisciplinary, multiagency, Service Development Committees formed along service or functional lines. More authority would be transferred to the Regional Manager during this time in the areas of hospital budget review, and physician manpower planning. This is the most important stage as it has the potential to make the health care system more efficient and effective. In this model support is built into the structure for planning and there are regional wide coordinating and integrating mechanisms. / Medicine, Faculty of / Population and Public Health (SPPH), School of / Graduate

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 6 uppsatser.

No description available.

Blindness is one of the most debilitating health disorders and avoidable blindness is a major international health problem. The World Health Organization has estimated that globally, there are 45 million persons who are blind - a figure that is expected to increase to approximately 76 million by the year 2020. Approximately 80% of blindness is avoidable and can be prevented or cured with appropriate service delivery efforts. Research suggests that the combined annual global GDP loss from blindness in 2000 was more than $40 billion. Yet blindness has received relatively little attention in worldwide efforts to promote health and it is not at present a high health priority in many countries. Consequently, unless there are alternative and more efficient and extended endeavours to address this situation and model an approach that will provide a long-term solution, avoidable blindness will continue. In recent years, eye care service delivery organisations have assumed a greater level of responsibility for addressing the problem of avoidable blindness. A number of successful approaches have been designed and implemented to expand the delivery of eye care services. The approaches have focused on the development of organisational capacity and on sustainability, and they have effectuated a reduction in avoidable blindness in particular target populations. However, despite their importance, contemporary eye care service delivery models have largely been neglected in the literature and few formal organisational approaches to eye care have been developed and documented. There are few definitive independent studies available that outline the bases of these approaches and no explicit and standardised methodologies that can assist service delivery organisations to replicate the approaches. Objective and comprehensive research is accordingly required to promote current and new approaches to eye care and to develop ways of facilitating their adoption. The thesis attempts to address this problem by developing a theory–based, case study–supported practical methodology to identify, support the progression of, and measure the strategic and operational objectives of eye care service delivery organisations. The research seeks to identify the issues relevant to the management of eye care service delivery organisations and subsequently evaluate whether they can be incorporated into a distinct and explicit management framework. It seeks to present the value of the process and the possibility that it can be accomplished elsewhere and in dissimilar organisations. By developing a widely applicable management framework, the research's primary contribution is that it extends eye care organisational management theory to assist in the facilitation of blindness reduction. A conceptual management framework is developed in the thesis which unifies contemporary eye care organisational approaches with the Balanced Scorecard management framework. The framework was devised for and evaluated by undertaking two case studies – one in India and one in South Africa. The significance of developing such a framework is demonstrated at various points throughout the thesis. The research process reveals the potential applicability of the framework – the Strategic Management Framework (SMF). The research concludes that the SMF is able to support and enhance organisational development, performance management, and scenario analyses in eye care service delivery organisations operating in developing countries. Although the framework developed in the thesis is specific to eye care organisations it is flexible enough to be transferable to other healthcare organisations in developed countries. The final conclusion of the thesis is that, while the SMF is not in itself a solution to the problem of avoidable blindness, it is an appropriate and practical management tool which will improve existing, and assist in the establishment of new, eye care service delivery organisations. In this context, the research makes a number of significant and original contributions to prevention of blindness literature and theory. / Thesis (Ph.D.)--School of History and Politics, 2004.

Quais os impactos de curto prazo ocorridos a partir dos ciclos iniciais de implantação do “Programa Mais Médicos” (PMM) em municípios do Rio Grande do Sul? Essa dissertação versa um sobre subtipo de ensaio comunitário acerca da problemática em questão, com estudo agregado com múltiplos grupos, longitudinal em série temporal retrospectiva, a partir de dados de fontes secundárias, com análise descritiva de propósito exploratório. Trata-se de 10 grupos conformados por agregados de municípios do Rio Grande do Sul, selecionados e estratificados em 5 faixas populacionais, estando pareados pela condição de implantação e não implantação do PMM. Realizou-se análise comparativa e descritiva de um conjunto selecionado de indicadores correlatos aos serviços de Atenção Primária à Saúde (APS). De um modo geral, observou-se o incremento de indicadores de estrutura nos agregados de municípios com implantação do PMM, notadamente nos agregados com faixas de menores populações. Em termos de indicadores de resultados observou-se discreto incremento na produção de serviços nos agregados com implantação do PMM, contudo, não foram identificadas diferenças significativas de internações por causas sensíveis e de outros indicadores de impacto próprios da APS. As hipóteses mais plausíveis para explicar os achados estão referidas ao exíguo tempo decorrido entre a implantação do PMM e a realização do estudo, além da constatação de que nos ciclos iniciais de implantação do programa houve predominância de caráter substitutivo de trabalho profissional médico nos municípios selecionados para o estudo. / What are the short-term impacts occurred in the early cycles implementation of the "More Doctors Program" (PMM) in municipalities of Rio Grande do Sul? This research focuses on one community trial subtype, added to multiple groups, in longitudinal retrospective time series, based on data from secondary sources, with descriptive analysis of exploratory purpose. It is conformed by 10 groups clusters of municipalities of Rio Grande do Sul, selected and stratified into five population groups, being matched by the deployment condition and not implementation of PMM. We carried out comparative and descriptive analysis of a selected set of indicators related to the services of Primary Health Care (PHC). In general, there was the structure of indicators of growth in clusters of municipalities with implementation of PMM, especially in conglomerates with smaller populations tracks. In terms of outcome indicators showed a slight increase in the production of services in conglomerates with implementation of PMM, however, significant differences in hospital admissions were identified by sensitive causes and other APS's own impact indicators. The most plausible hypotheses to explain the findings are referred to the narrow time between the implementation of the PMM and the study, besides the fact that in the early cycles of program implementation was substitute character predominance of medical professional working in selected municipalities to the study.

Quais os impactos de curto prazo ocorridos a partir dos ciclos iniciais de implantação do “Programa Mais Médicos” (PMM) em municípios do Rio Grande do Sul? Essa dissertação versa um sobre subtipo de ensaio comunitário acerca da problemática em questão, com estudo agregado com múltiplos grupos, longitudinal em série temporal retrospectiva, a partir de dados de fontes secundárias, com análise descritiva de propósito exploratório. Trata-se de 10 grupos conformados por agregados de municípios do Rio Grande do Sul, selecionados e estratificados em 5 faixas populacionais, estando pareados pela condição de implantação e não implantação do PMM. Realizou-se análise comparativa e descritiva de um conjunto selecionado de indicadores correlatos aos serviços de Atenção Primária à Saúde (APS). De um modo geral, observou-se o incremento de indicadores de estrutura nos agregados de municípios com implantação do PMM, notadamente nos agregados com faixas de menores populações. Em termos de indicadores de resultados observou-se discreto incremento na produção de serviços nos agregados com implantação do PMM, contudo, não foram identificadas diferenças significativas de internações por causas sensíveis e de outros indicadores de impacto próprios da APS. As hipóteses mais plausíveis para explicar os achados estão referidas ao exíguo tempo decorrido entre a implantação do PMM e a realização do estudo, além da constatação de que nos ciclos iniciais de implantação do programa houve predominância de caráter substitutivo de trabalho profissional médico nos municípios selecionados para o estudo. / What are the short-term impacts occurred in the early cycles implementation of the "More Doctors Program" (PMM) in municipalities of Rio Grande do Sul? This research focuses on one community trial subtype, added to multiple groups, in longitudinal retrospective time series, based on data from secondary sources, with descriptive analysis of exploratory purpose. It is conformed by 10 groups clusters of municipalities of Rio Grande do Sul, selected and stratified into five population groups, being matched by the deployment condition and not implementation of PMM. We carried out comparative and descriptive analysis of a selected set of indicators related to the services of Primary Health Care (PHC). In general, there was the structure of indicators of growth in clusters of municipalities with implementation of PMM, especially in conglomerates with smaller populations tracks. In terms of outcome indicators showed a slight increase in the production of services in conglomerates with implementation of PMM, however, significant differences in hospital admissions were identified by sensitive causes and other APS's own impact indicators. The most plausible hypotheses to explain the findings are referred to the narrow time between the implementation of the PMM and the study, besides the fact that in the early cycles of program implementation was substitute character predominance of medical professional working in selected municipalities to the study.

Quais os impactos de curto prazo ocorridos a partir dos ciclos iniciais de implantação do “Programa Mais Médicos” (PMM) em municípios do Rio Grande do Sul? Essa dissertação versa um sobre subtipo de ensaio comunitário acerca da problemática em questão, com estudo agregado com múltiplos grupos, longitudinal em série temporal retrospectiva, a partir de dados de fontes secundárias, com análise descritiva de propósito exploratório. Trata-se de 10 grupos conformados por agregados de municípios do Rio Grande do Sul, selecionados e estratificados em 5 faixas populacionais, estando pareados pela condição de implantação e não implantação do PMM. Realizou-se análise comparativa e descritiva de um conjunto selecionado de indicadores correlatos aos serviços de Atenção Primária à Saúde (APS). De um modo geral, observou-se o incremento de indicadores de estrutura nos agregados de municípios com implantação do PMM, notadamente nos agregados com faixas de menores populações. Em termos de indicadores de resultados observou-se discreto incremento na produção de serviços nos agregados com implantação do PMM, contudo, não foram identificadas diferenças significativas de internações por causas sensíveis e de outros indicadores de impacto próprios da APS. As hipóteses mais plausíveis para explicar os achados estão referidas ao exíguo tempo decorrido entre a implantação do PMM e a realização do estudo, além da constatação de que nos ciclos iniciais de implantação do programa houve predominância de caráter substitutivo de trabalho profissional médico nos municípios selecionados para o estudo. / What are the short-term impacts occurred in the early cycles implementation of the "More Doctors Program" (PMM) in municipalities of Rio Grande do Sul? This research focuses on one community trial subtype, added to multiple groups, in longitudinal retrospective time series, based on data from secondary sources, with descriptive analysis of exploratory purpose. It is conformed by 10 groups clusters of municipalities of Rio Grande do Sul, selected and stratified into five population groups, being matched by the deployment condition and not implementation of PMM. We carried out comparative and descriptive analysis of a selected set of indicators related to the services of Primary Health Care (PHC). In general, there was the structure of indicators of growth in clusters of municipalities with implementation of PMM, especially in conglomerates with smaller populations tracks. In terms of outcome indicators showed a slight increase in the production of services in conglomerates with implementation of PMM, however, significant differences in hospital admissions were identified by sensitive causes and other APS's own impact indicators. The most plausible hypotheses to explain the findings are referred to the narrow time between the implementation of the PMM and the study, besides the fact that in the early cycles of program implementation was substitute character predominance of medical professional working in selected municipalities to the study.

In recent years, the term "Healthy Communities" has become a catch phrase among planners, health promotion workers, social workers and government agencies, and increasing numbers of professionals have taken a role in the development of healthy communities projects. The literature on the healthy communities concept has increased in size and scope. Yet the concept itself is byno means clearly defined. Nor is there a standard method for developing a successful healthy communities project, or a regional collaboration of healthy communities projects. The question remains, when a planner undertakes a role in the development of a healthy communities project, what are the most important factors to consider? This thesis examines the influence of various project inputs on the ability of a regional healthy communities project to achieve its objectives. The thesis uses a case study of the Tri-City Health Promotion Project, a collaborative healthy communities project undertaken in the cities of Castlegar, Trail and Nelson in the West Kootenay region of British Columbia. In this study, documentary analysis and interviews with Tri-City project staff illuminate the importance of several influences on a regional healthy communities project. Some of these are: the approach used by the participants (task- orprocess-orientation), the resources and constraints specific to each community, the context from which the project grew, the personalities of those involved, the ability of the collaborating communities to work together, and the relationship between the community and regional bodies in the project structure. Conclusions: While every healthy communities project will be affected differently by various inputs, in the case of the Tri-City Health Promotion Project, the relationship between the regional and community bodies in the project structure had the greatest influence on the ability of the community Steering Committees to achieve their goals. Planners working on a regional healthy communities project must carefully examine the design of the project, in order to develop a structure which enhances the working relationship between regional and community bodies. This is particularly crucial in the healthy communities context, where decision-making power often resides at the community level, rather than being centralized in the regional body.