Résumé exécutif Introduction. La prise en charge (PEC) des malades de tuberculose a été confiée à des institutions spécialisées et réduite aux seuls aspects biomédicaux du problème. En associant une revue de littérature sur les dimensions du problème posé par la tuberculose et un état des lieux sur la prise de charge de la tuberculose, les besoins non couverts par les centres de diagnostic et de traitement (CDTs) ont été identifiés dans trois districts sanitaires (DS) ruraux du Burkina Faso. Le recueil des évidences sur les interventions à même de corriger ces insuffisances (dans la littérature), associé à l’expérience des acteurs sur le terrain ont conduit à la mise en place d’un dispositif de soins. Ce dispositif intègre i) la décentralisation de la prise en charge des malades des CDTs vers les centres de santé de 1er échelon (CS), ii) l’organisation d’un soutien psychosocial au profit des malades en traitement et iii) la mise en contribution de personnes ressources pour offrir un soutien socioéconomique aux malades. Le présent travail s’intéresse à la conception et le test du dispositif au cours d’une phase pilote. La question générale de recherche était de savoir si un tel dispositif pouvait améliorer significativement non seulement les résultats biomédicaux, mais aussi le confort physique, psychologique et matériel des malades pendant leur traitement. Trois hypothèses, faisant référence aux interventions clé du dispositif de soins, ont guidé l’investigation de cette question : i) Une décentralisation du diagnostic, de l’administration des médicaments et du suivi du traitement de la tuberculose, des CDT vers les CS va contribuer à réduire pour les malades la distance à parcourir et accroitre de ce fait le taux de dépistage. ii) Un soutien psychosocial va renforcer l’estime de soi des patients tuberculeux et réduire la stigmatisation ressentie par eux. Elle contribuera à améliorer le confort psychologique des malades ainsi que les résultats de traitement. iii) Un soutien socioéconomique bien coordonné va résoudre les besoins de base des patients tuberculeux (transport, nourriture, habillement, etc.). Il va contribuer à améliorer les conditions de vie des malades ainsi que les résultats de traitement. Le contenu du présent document comprend cinq parties. La première propose une introduction, la démarche générale et le contexte où le test du dispositif a été mis en place. La seconde présente les dimensions du problème posé par la tuberculose, un état des lieux sur l’offre actuelle de soins et les interventions potentiellement efficaces pour combler les besoins non couverts. La troisième partie décrit comment le dispositif de soin a été conçu et modélisé. La quatrième partie décrit le processus d’implantation et le fonctionnement du dispositif. Enfin, la dernière partie propose une discussion générale et quelques leçons apprises. Première partie : Introduction, contexte et approche méthodologique générale. Dans un chapitre introductif, nous mettons en exergue les défis que représente la promotion de la santé, le centre d’intérêt de la thèse, l’énoncé de la question de recherche et le cheminement méthodologique. Le cheminement utilisé est emprunté au modèle proposé par Campbell et Loeb pour la mise en œuvre et l’évaluation des interventions complexes. Il comporte quatre phases : i) la phase de modélisation, ii) la phase pilote, iii) la phase d’expérimentation définitive et iv) la phase d’implantation à long terme. La conception-modélisation et le test du dispositif de soins au cours d’une phase pilote ont fait l’objet du présent travail. Le second chapitre présente le site de l’expérience. Six districts sanitaires ruraux sont répartis en un site d’intervention (3 districts couvrant un total de 8 453 km2 avec une population de 726 651 habitants en 2005) et en un site contrôle (3 autres districts couvrant un total de 9636 km2 avec une population de 719946). Les 2 sites partagent les mêmes réalités concernant l’organisation des soins en deux échelons (centres de santé de 1er échelon et hôpitaux de référence), la couverture en infrastructures (avec un rayon moyen de couverture par CS d’environ 6 kilomètres), l’organisation de la prise en charge de la tuberculose et les résultats du contrôle de cette maladie. La fréquentation des services de soins curatifs est considérée faible dans les 2 sites, comme dans les autres DS ruraux du pays. Elle se justifierait par les barrières financières, les pesanteurs socioculturelles, les perceptions négatives des populations vis à vis des services de santé et l’absence de système performant pour la prise en charge des urgences et des indigents. Dans le troisième chapitre, un cadre général d’analyse de l’implantation du dispositif et de l’évaluation de son efficacité est proposé. Des précisions sont données à propos des centres d’intérêt, du but final de l’expérience et des méthodes utilisées pour vérifier les hypothèses de recherche. Une étude du processus d’implantation sert à analyser les interactions entre les acteurs et à identifier les obstacles rencontrés de même que les insuffisances du dispositif. Une étude quasi expérimentale sert à évaluer l’efficacité du dispositif. Deuxième partie : Phase théorique. Dans le quatrième chapitre, les insuffisances de l’offre de soins par les CDTs sont décrites et une revue de littérature sur les dimensions du problème posé par la tuberculose est présentée. Les 3 interventions susceptibles de couvrir les lacunes de l’offre actuelle de soins sont alors identifiées. Troisième partie : Phase de modélisation du dispositif de soins. Dans un cinquième chapitre, le processus de modélisation du dispositif est décrit. Une simulation du fonctionnement du dispositif permet de prévoir les effets directs et indirects. Les outils de documentation et d’évaluation du dispositif sont présentés. Quatrième partie : Développement de la phase pilote. Cette partie se compose de 4 chapitres qui sont: la présentation des interventions, des résultats intermédiaires, des interactions entre ces interventions et le système de santé. L’évaluation des effets observés termine cette partie. Le sixième chapitre présente la manière dont le dispositif a été mis en place et son fonctionnement. En partant d’une démarche standardisée, obtenue après une concertation entre les différents acteurs (professionnels de santé et personnes issues du milieu de vie des malades), trois interventions ont été implantées dans les districts d’intervention. Il s’agit de la décentralisation du diagnostic et du traitement de la tuberculose dans 24 CS (8 / district), la mise en place de sessions de groupes de parole dans chaque CDT au profit des malades et la mise en place d’un comité de soutien dont les membres sont issus de l’environnement socioculturel des malades. Le septième chapitre présente les résultats intermédiaires de chaque intervention. Le huitième chapitre an alyse les interactions entre les interventions et le système de santé en place, sous forme des adaptations opérées sur le dispositif et sous forme des changements constatés dans l’organisation des soins. -Au titre des adaptations, les sessions de groupes de paroles ont été organisées dans les CDTs plutôt que dans les CS. La coordination du dispositif a été assurée par les responsables CDTs au lieu des ECDs dans deux des trois DS d’intervention. Les procédures de gestion des fonds alloués aux comités de soutien ont été allégées suites aux problèmes rencontrés. -Sur le plan managérial, le premier changement a été l’adjonction au paquet minimum d’activité (PMA) des CS, de la collecte des crachats chez les suspects et de l’administration du traitement aux malades confirmés. Les CDTs ont continué à confirmer le diagnostic (à travers l’examen microscopique systématique des crachats provenant des CS) et à contrôler la qualité du suivi des malades (à travers les supervisions dans les CS). Le second changement a été la responsabilisation des CDTs pour l’organisation des sessions de groupes de paroles avec les malades en traitement. Le troisième changement a été le soutien matériel, financier et social proposé aux malades par les comités de soutien. -Sur le plan stratégique, les pouvoirs des équipes cadres de district (ECDs) sont restés stables. Ils étaient de type bureaucratique et liés à la planification mécanique des activités, à l’allocation des ressources et à la coordination des activités. Le pouvoir d’action des malades tuberculeux s’est renforcé au cours des sessions d’accompagnement psychosocial, avec la mise en place d’associations de malades tuberculeux à Boussé et Ziniaré. Malgré les difficultés et les conflits, une dynamique de groupe s’est mise en place progressivement au niveau de chaque comité de soutien. Le neuvième chapitre présente les résultats de l’étude quasi expérimentale pour l’évaluation de l’efficacité du dispositif après 2 années de fonctionnement (2006 et 2007). On note un accroissement significatif du taux de détection des tuberculeux dans les 3 DS d’intervention, comparaison faite avec les 3 DS contrôles. Dans la cohorte des malades de 2006 et 2007, la comparaison des proportions d’échec au traitement, de malades ayant suspendu le traitement et de décès, n’a pas montré de différence significative entre les deux sites. Le dispositif a eu un impact positif sur le niveau d’estime de soi et celui du stigma ressenti, surtout des malades en traitement ayant un faible statut économique. Le dispositif semble n’avoir pas eu un effet sur la fréquentation des 24 CS d’intervention. Cinquième partie : Discussion générale et conclusion. Le dixième chapitre propose une discussion du processus d’expérimentation du dispositif de soins. Elle présente d’abord les limites et les contraintes de l’étude. Le dispositif a permis d’améliorer l’accessibilité géographique de l’offre de soins et d’enrichir son contenu, en y apportant quelques stratégies de résolution des problèmes psychosociaux rencontrés par les malades. Cependant il a eu un faible impact sur la continuité des soins quoiqu’ils aient été mieux intégrés au niveau des CS qu’au niveau des CDTs. La suite de la discussion révèle que la modélisation du dispositif est restée imparfaite, n’ayant pas pris en compte l’ensemble des facteurs pouvant potentiellement influencer les résultats attendus. Cependant, même si la prise en compte de tous ces facteurs au cours de cette phase avait été l’approche la plus probante, sa faisabilité dans le temps imparti n’était pas assurée, au regard de la complexité du dispositif qui en aurait découlé. Les conditions d’optimisation du dispositif de soins sont proposées. Elles concernent la correction des insuffisances majeures caractérisées par i) l’absence d’un circuit de l’information approprié entre les intervenants et ii) la faible intégration des composantes du dispositif conséquence directe des lacunes dans la coordination des soins. Pour optimiser ce dispositif, la coordination des soins devrait être confiée aux équipes de soins des CS. Ce chapitre se termine par la proposition d’un modèle révisé du dispositif. Le onzième et dernier chapitre, propose un retour aux hypothèses de recherche et quelques leçons à retenir. La formulation des hypothèses de recherche a facilité la mise en place des interventions, mais il a été difficile d’isoler l’effet de chaque composante du dispositif sur les résultats obtenus. Compte tenue de l’imprévisibilité et de l’incertitude qui caractérise la logique systémique, les simulations de la phase de conceptualisation-modélisation se sont révélées insuffisantes au point de rendre nécessaire la révision du modèle de départ. Cette expérience pilote peut soutenir le changement positif dans le système d’offre de soins. Elle a montré l’importance du rôle du CS de 1er échelon, pour que le dispositif soit efficace. Responding to the medical and psychosocial needs of tuberculosis patients in Burkina Faso - what strategies to adopt? Executive summary Introduction. Care for tuberculosis (TB) patients has for a long time been the responsibility of specialised institutions (sanatorium, diagnosis and treatment centre…) and reduced to only the biomedical aspects of the problem. Today the comfort and quality of life, during and after medical treatment are viewed as a legitimate concern for the tuberculosis patient. It is therefore, indispensable to adopt a method capable of improving the diagnosis and treatment of tuberculosis, taking into consideration the physical, mental and social states of the patient. A new health care system that integrates strategies capable of significantly improving, testing and treatment of tuberculosis and tackling the psychosocial problems of the patient, has been implemented in the rural context of Burkina Faso. This research work provides information on the model of care tested during a pilot phase. The research question sought to find out if such a care system could significantly, improve not only biomedical results, but also the well being of TB patients during the treatment. The investigation of the research question was guided by three hypotheses that border on the key interventions of the model of care, as follows: i) Decentralising the diagnosis, the drugs’ delivery from the diagnosis and treatment centres (DTCs), to first line health centres (FLHCs), must contribute to reducing the distance that patients cover and increase the TB detection rate. ii) Structured psychological support must improve the self confidence of patients and reduce the feeling of stigmatisation thereby, contributing to improving the well being during treatment; iii) Structured socio economic support for tuberculosis patients (transportation, food, clothing, love from neighbours, etc) must contribute to improving the well being of the TB patients and the treatment outcomes. The content of the document has been divided into five sections. The first section is the introduction, general approach and the context where the care system has been tested. The second one presents shortcomings of the TB care system in place. The third discusses the effectiveness of some interventions to improve TB care. The fourth one describes the design-modelling of the new care delivery system. The fifth one details the implementation of the care system. The fifth section looks at a general discussion of the experimental approach and some lessons learnt. Section One: Introduction, context and general approach to the trial. The weaknesses of the biomedical approach being used currently in the medical treatment strategies of TB patients are highlighted. Areas not covered by proposed DTCs in Burkina Faso are generally psychological and socio-economic. The site where the new care system was tested in the form of a quasi experimental study is presented. It is six rural health districts divided into two groups: the implementation site (3 districts covering a total of 8 453 km2 with a population of 726651 inhabitants in 2005) and a control site (3 other districts covering a total of 9636 km2 with a population of 719946 inhabitants). The number of people seeking curative care is considered very low in the two sites, just as it is in the other rural health districts in the country. This could be explained by financial barriers, socio cultural burdens, negative perceptions of the people, vis-à-vis health services and lack of efficient system for emergency treatments, and treatment for the poor. In the two sites, the organisation of health care for tuberculosis patients is based on the application of the norms and procedures enacted at the central level and on the standardisation of tasks. The same weaknesses are observed in the organisation of TB care and a low detection rate. The populations on the 2 sites base their beliefs on tuberculosis and these beliefs influence their individual and/or collective health seeking behaviours. A general methodological approach has been proposed to assess the efficacy of the new care system, at inducing positive and durable changes in health care quality and access, for TB patients. This is the model called the «continuum of accumulating evidences» proposed by Campbell and Loeb, which includes four phases: i) the modelling phase; ii) the pilot phase; iii) the final experimental phase and iv) the long-term implantation phase. The two first phase of testing the new care system are documented into the present study. Section Two: Seeking evidences of the effectiveness of the care system. Using literature reviews, the experiences aiming at tackling the problem of TB in the holistic manner have been analysed. The results of that analysis associated with the experiences of the field actor facilitated the identifying of the new care system’ key components. The theoretical care system is composed of three key components: i) decentralising the diagnosis and treatment of TB from DTCs to FLHC, geographically nearer to the people; ii) a psychosocial support to the patient during treatment and iii) socio economic support obtained with the involvement of the civil society. Section Three: Phase one: Designing and modelling of the care system. The integration of the 3 interventions is planned. It comprises a description of stakeholders, their tasks, relationships between them, and a simulation of the functions of the care system. A presentation of the expected effects on the control of the disease, on the patients and on the curative performances of HC, on the one hand, and data collection tools, on the other hand, ends this modelling phase. Section Four: Phase two: Pilot Phase. The implementation of the key interventions of the care system is described. The three interventions have been implanted in the standardised manner, in the intervention districts. It has lead to the decentralisation of the diagnosis and treatment of tuberculosis in 24 FLHC (8 districts), to the creation of parole groups in each DTC, for the benefit of TB patients, and the creation of a support committee whose members live under the same socio-cultural environments as the patients. The role of the latter is to offer socioeconomic support to TB patients. The district executive teams (DET) could not carry out the coordination of the car system as planned. Procedures for managing funds allocated to support committees were reduced, due to problems encountered. The FLHCs collected sputum samples from suspected sick people and provided TB treatment to those confirmed as being sick. The DTCs still confirmed the diagnosis (through microscopic analysis of sputum samples from FLHCs) and ensured supervision in the FLHCs. In addition, DTCs managed the parole group sessions with TB patients. TB patients benefited of material, financial and social support from the support committee. There have been an improvement in the work into DTCs and an enhanced feeling of responsibility of care providers, vis-à-vis their patients. The strength of the TB patients improved with the formation of TB patients’ clubs at Boussé and at Ziniaré. After two years of operating the care system (2006 and 2007), the results have been relatively satisfactory at the biometrical level with a significant increase in the TB detection rate in the intervention site. Comparison of rates of unsuccessful treatments, deaths and patients suspending their treatments between 2006 -2007, between the intervention and the control sites, did not show any significant difference. The care system has had a positive impact on the level of self confidence and the stigma felt, especially on TB patients with low economic status. Section Five: General Discussion and Conclusion. First of all, the limits and difficulties encountered during the experimental stage are presented. The limits are in connection with lack of precision of some measuring indicators, some techniques of data collection and the level of changes detection. The difficulties are associated with logistics produced by the health administration system in place, the relative short period of time allocated and the use of relay persons who are not the best for obtaining the sound results. The mechanism has come to improve the geographical accessibility to health care and enriched the content of health care, bringing in its wake some strategies to resolve psychosocial problems encountered by patients. However, there has been little impact on the continuity of health care in the form of organisation, even though health care integration has improved more in FLHCs, than in the district hospital. During the discussions, it came to light that designing the care system has still not been perfect, because it did not take into consideration all factors capable of influencing the expected results. Conditions for optimising the health care system are correcting the major short falls, characterised by i) lack of appropriate information channel among the actors and ii) the low level of integration of its components. To optimise this care system, health care coordination must be assigned to the health care teams in FLHCs. Meetings of the health delivery services (DTCs and FLHCs), members of the support committee and members of TB associations must be formalised. These meetings would permit the detailed analysis of the concerns of each patient and jointly contribute to finding the expected solution. This type of meeting would contribute to solving the needs of patients from all angles at the same time.

This study examines the effect on school achievement of a policy such as hostels, aimed at giving children from a poor socioeconomic background an opportunity to receive education. Data is collected from two different schools in a district in Andhra Pradesh, India, in which both hostel students and day-scholar students, having a similar background, are studying. Exam scores for three different subjects are used as dependent variables in the analysis. The results indicate that private hostels do have a positive effect on achievement in all subjects, thereby contributing to reducing the large gap in school achievement between different socioeconomic groups

El primer objetivo de esta tesis es la identificación y análisis de aspectos clave para la gobernanza de los servicios de agua rural en países que adolecen de bajos niveles de cobertura, altos índices de pobreza, se encuentran en procesos de descentralización, reciben un importante apoyo de donantes internacionales. Esta situación es común para muchos países de África Sub-sahariana. Por ello, se eligió Tanzania como objeto de estudio. El segundo objetivo de esta tesis ha sido el ensayo de nuevas herramientas y mecanismos institucionales para la mejora de la eficiencia, equidad y sostenibilidad en la provisión de agua en las zonas rurales, con especial énfasis en el nivel de gobierno descentralizado. Para ello, se desarrollaron experiencias piloto así como procesos de investigación-acción. En el capítulo 1 se estudia el papel desempeñado por los diferentes actores internacionales en la financiación del sector del agua en los países en desarrollo durante la década 1995-2004. En el capítulo 2 se analizan los indicadores existentes para el seguimiento del sector del agua a nivel internacional, específicamente los utilizados para valorar el cumplimiento de los Objetivos del Milenio, así como el Índice de Pobreza Hídrica (Water Poverty Index). Se detallan algunos limitantes en cuanto al alcance y metodología de cálculo de estos indicadores, y se proponen las características básicas que los indicadores deben tener para apoyar la toma de decisiones a nivel gubernamental. En el capítulo 3 se presenta una metodología para el desarrollo de indicadores más completos de acceso al agua, basándose en el Mapeo de Puntos de Agua (Water Point Mapping-WPM). La metodología propuesta, denominada Mapeo Mejorado de Puntos de Agua, incluye la medición de parámetros básicos de calidad del agua y estacionalidad de los servicios. La factibilidad y pertinencia de la adopción de esta metodología a nivel nacional se desarrolló satisfactoriamente a modo de experiencia piloto en dos distritos de Tanzania, con una población rural aproximada de 840.000 personas (capítulo 4). En el capítulo 5 se analiza la sostenibilidad de los servicios de agua rural en relación al tipo de tecnología utilizada para el abastecimiento. El análisis se basa en los datos de 6814 puntos de agua, sobre una población equivalente al 15% de la población rural de Tanzania. El capítulo 6 se analiza el proceso de toma de decisiones, desde el nivel central al nivel comunitario, para la asignación de recursos en el sector del agua rural. Los resultados en los 4 distritos estudiados muestran que menos de la mitad de los proyectos asignados se destinan a zonas con baja cobertura de servicios. Las incoherencias entre el diseño y la implementación de los planes nacionales, y la influencia de los poderes políticos locales son los mayores obstáculos para una equitativa distribución de los recursos. El capítulo 7 detalla el caso de investigación-acción ejecutado a nivel de gobierno local entre 2006 y 2009 con el gobierno del distrito de Same, Tanzania. La mejora de la equidad y la sostenibilidad se fomentaron mediante el desarrollo de herramientas de planificación basadas en el WPM y de mecanismos institucionales para el apoyo a largo plazo a los sistemas de agua rurales. En el capítulo 8 se detallan las conclusiones generales y líneas de investigación futuras. La resolución de los desafíos principales encontrados implican la adopción de paradigmas diferentes: i) la aceptación del agua rural como un servicio responsabilidad del gobierno y no de las comunidades; ii) las actuaciones deben decidirse en función de las necesidades de las comunidades, y no de su capacidad de demanda, iii) el establecimiento de sistemas de información internos que partan desde el nivel local y estén adaptados a las capacidades de actualización disponibles, iv) el desarrollo de mecanismos para la orientación y el seguimiento cercano de los procesos de toma de decisión a nivel local / The first objective of this thesis is the identification and analysis of key issues in the governance of rural water services in countries that suffer from a lack of rural water access, high levels of poverty, are under decentralization processes and receive significant donor support. This is a common situation for many Sub-Saharan countries. To address the relevant aspects, Tanzania was taken as a case study and was analyzed in depth. The second objective was to test tools and propose institutional arrangements at that can improve efficiency, equity and sustainability in the provision of water for the rural areas, with special focus at the local government level. This was made through pilot experiences and an action research case study. In Chapter 1 we analyse the role played by the international actors in the financing of the water sector of developing countries, in the period 1995-2004. In Chapter 2 we study existing indicators for international monitoring, specifically the ones used by the Joint Monitoring Programme for the monitoring of the MDGs, as well as the Water Poverty Index (WPI). Some drawbacks are found the indicators’ scope and methodology, which prevents them from being used as policy drivers at national level. The chapter concludes by proposing the main characteristics that those indicators must entail to be useful for governmental decision making. In Chapter 3, a methodology to define water access indicators, based on GIS-based Water Point Mapping (WPM) is proposed. The methodology, named Enhanced Water Point Mapping (EWPM), includes the measurement of basic parameters of quality of water and seasonality of the service. The feasibility and relevance of adopting this methodology at national level was tested with success in two districts in Tanzania, covering a rural population of approximately 840,000 people, as described in Chapter 4. In chapter 5, we analyze the sustainability of systems over time, and the relation between sustainability and technology; this chapter is based on the study of 6814 water points, covering 15% of the rural population in the country. Chapter 6 analyses the aspects affecting financial resource allocation for rural water in Tanzania at all levels, from central government to village level. Results in four districts studied showed that less than half of allocated projects go to underserved areas. Incoherencies between the design and the implementation of the plans and political influences at local level are highlighted as major obstacles to the effective, equitable allocation of resources. In chapter 7, we describe an action research process that was carried out at local government level, together with Same District Council, between 2006 and 2009. The improvement of equity and sustainability was supported through the development of EWPM based planning tools and new institutional arrangements for the long-term support of community managed water supplies. In Chapter 8 the overall conclusions and future research lines are presented. We propose some new paradigms in the sector: i) rural water supply must be considered as a service, with government and not communities as main duty bearers; ii) the adoption of a needs-based approach to projects planning at community level, instead of the current demand driven, iii) the establishment of bottom-up internal information systems adapted to available updating capacities and iv) the development of mechanisms for the guidance and close monitoring of local government decision-making.

In order to cope with an agricultural economic structure and the development of industrial and commercial use land, the government conducted significant amendment to the Statute for Agricultural Development, adjusting the original ¡§farmland owned by farmers¡¨ and ¡§farmland for agricultural use¡¨ to ¡§releasing farmland owned by farmers¡¨ and ¡§farm building on farmland.¡¨ In addition to loosening the qualifications for the acquisition of farmland, the government also allows for the construction of cluster farm buildings or individual farmhouses. The goal of the policy of cluster farm buildings is established upon the foundation of ¡§production, life, and ecology.¡¨ Regarding production, farmland is not allowed to be segmented, which is beneficial to the promotion of agricultural machinery and rewarding in the expansion of the scale of farmland operation. Regarding everyday life, the construction of well-planned public facilities is able to promote living environment and quality. Regarding ecology, the well-planned management of sewage processing can reduce environmental contamination, protecting the environment. Regarding landscape, the building of farmhouses in a cluster is able to make landscape harmonious. Regarding public investment, the concentration of government funds on a certain area is able to enhance the efficiency of public investment. Although the policy of farm building cluster is made with positive intensions, it is unable to compromise with the current situations of rural areas, rendering problems that affect the growth of rural areas. In fact, these problems have arisen because of the inadequacy of laws and regulations related to rural areas. Therefore, this research examines whether the policy of the construction of farm building cluster can accomplish the three major goals of the sustaining development of rural area and solve the problems of the current problems farm building clusters are facing now and possible solutions. The research employs literature review, secondary source analysis, and on-site investigation as methods. Interviews with various personnel related to the construction of farm buildings, such as administrative, reviewers, scholars, contractor, local farmers, and residents in farm building cluster are conducted with the help of the government. Integrating viewpoints and suggestions from the business, government, and academia, it provides references for the government to promote the amendment of laws and policies related to the construction of farm building cluster in the future. This research discovers that the construction of farm building clusters cannot accomplish its three original goals of ¡§protecting the integrity of farmland, avoiding the loss of excellent farmland, and promoting effective use of farmland¡¨, ¡§enhancing public construction to promote rural area¡¦s additive values, farmers¡¦ living quality, and harmony for the community¡¨, and ¡§avoiding farm buildings in clusters that contaminate farmland, protect ecological environment, and promote harmony in the community.¡¨ In the aspect of production, it suggests the government to 1. Limit the distance between farm buildings and farmland; 2. Prohibit using ¡§forests¡¨ and ¡§reserve areas on slopes¡¨ as farmland; 3. Delimit suitable areas for the construction of farm buildings; 4. Assist utilization of farmland to create production values. In the aspect of everyday life, it suggests 1. Delimit the standard of minimum area for the construction public facilities. In the aspect of ecology, it suggests 1. Build green belts between farm buildings and farmlands; 2. Delimit the standard of sewage discharge testing; 3. Provide funds to assist building ¡§green¡¨ farm buildings; 4. Refurbish old rural areas to make their appearance harmonious with farm building clusters. In the aspect of policy, it suggests 1. Established supervising and monitoring management system; 2. Prohibit the acquisition of farmland for the construction of farm buildings for 2 years to avoid farmland speculation; 3. Publicize laws and policies related to the construction of farm building cluster; 4. Simplify the application procedure of cluster construction; 5. Limit the number of the application of building individual farmhouses; 6. Establish service platform to assist farmers to plan and apply for the construction of farm building clusters by providing instant transparent information.

In vier ländlichen Gemeinden Sachsens wurden die Bewohner zu ihrem Umzugsverhalten befragt. Mehr als ein Drittel der befragten Zuzügler stammt aus den Nachbargemeinden oder anderen Ortsteilen der eigenen Gemeinde. Knapp die Hälfte kam aus anderen Teilen Sachsens. Nur 14 Prozent zogen von außerhalb des Freistaats zu. Ausschlaggebend für den Zuzug sind zumeist familiäre oder persönliche Gründe. Dazu gehören die Zuzüge zum Lebenspartner oder den Kindern und Familiengründungen. Auch der Wunsch nach einem eigenen Heim wird häufig genannt. Berufliche Gründe für den Zuzug sind selten. Sie spielen dafür als Wegzugsgrund eine große Rolle. Dörfliche Ortsteile werden insbesondere von jungen Familien gewählt, um sich ihren Wunsch nach Wohneigentum zu erfüllen. Menschen, die die Nähe zu Einkaufsmöglichkeiten, ärztlicher Versorgung oder die ÖPNV-Anbindungen suchen, entscheiden sich häufiger für die Kleinstädte. Gefragt wurde auch nach der Zufriedenheit der Zugezogenen mit ihrem neuen Wohnstandort und nach Verbesserungen und Verschlechterungen der Lebensbedingungen. Die Studie legt so Stärken und Schwächen ländlicher Wohnstandorte offen und gibt Hinweise zur Steigerung der Zuzugsattraktivität von ländlichen Städten und Dörfern.

The main aim of this study is to investigate the poverty situation and outline a strategy for poverty alleviation in the rural area of Mashau. Mashau is one of the villages in the Limpopo province of South Africa and it forms part of the 70% of the country's most poor people who are in the rural areas. Chapter 1 of this study presupposed by way of a central theoretical argument that community based job creation projects that ensure the participation of all stakeholders, community members, government, traditional leaders, non-government and faith-based organizations and business people, can be a useful poverty alleviation strategy in general and also in Mashau. This should be implemented in line with the human centred approach. Each of the four objectives (1.3) comes under scrutiny in Chapters 2-5 respectively. The quest to investigate and assess the poverty situation at Mashau and to come up with a relevant strategy required a broader understanding of the economic and demographic context of the entire Republic of South Africa. That is why Chapter 2 of this study mainly focused on identifying the core variables that are used to measure levels of poverty in South Africa, whilst Chapter 3 focused on current strategic initiatives for poverty alleviation on the part of the government. Chapter 4 paid attention to the scale, manifestations and causes of poverty in Mashau. It became clear that the majority of people in Mashau are unemployed, lack the basics of life and are unable to access services. They depend mainly on government social grants and natural resources (small-scale farming) for subsistence. Although South African policies and frameworks for poverty alleviation are among the best in the world, they have failed the country's people regarding implementation. Mashau village is one of many examples of this neglect. The government has succeeded in building a small number of RDP houses and providing other services at a very low pace. But further than that, the Mashau people cannot experience and enjoy the beauty of South African economic policies and strategies for poverty alleviation. Chapter 5 suggests a relevant strategy for poverty alleviation at Mashau. The strategy proposed affirms the central theoretical argument outlined in Chapter 1. It may be concluded that the suggested strategy can only succeed if the implementation plan or program is put in place together with monitoring and evaluating systems. / Thesis (M. Development and Management)--North-West University, Potchefstroom Campus, 2006.

The main aim of this study is to investigate the poverty situation and outline a strategy for poverty alleviation in the rural area of Mashau. Mashau is one of the villages in the Limpopo province of South Africa and it forms part of the 70% of the country's most poor people who are in the rural areas. Chapter 1 of this study presupposed by way of a central theoretical argument that community based job creation projects that ensure the participation of all stakeholders, community members, government, traditional leaders, non-government and faith-based organizations and business people, can be a useful poverty alleviation strategy in general and also in Mashau. This should be implemented in line with the human centred approach. Each of the four objectives (1.3) comes under scrutiny in Chapters 2-5 respectively. The quest to investigate and assess the poverty situation at Mashau and to come up with a relevant strategy required a broader understanding of the economic and demographic context of the entire Republic of South Africa. That is why Chapter 2 of this study mainly focused on identifying the core variables that are used to measure levels of poverty in South Africa, whilst Chapter 3 focused on current strategic initiatives for poverty alleviation on the part of the government. Chapter 4 paid attention to the scale, manifestations and causes of poverty in Mashau. It became clear that the majority of people in Mashau are unemployed, lack the basics of life and are unable to access services. They depend mainly on government social grants and natural resources (small-scale farming) for subsistence. Although South African policies and frameworks for poverty alleviation are among the best in the world, they have failed the country's people regarding implementation. Mashau village is one of many examples of this neglect. The government has succeeded in building a small number of RDP houses and providing other services at a very low pace. But further than that, the Mashau people cannot experience and enjoy the beauty of South African economic policies and strategies for poverty alleviation. Chapter 5 suggests a relevant strategy for poverty alleviation at Mashau. The strategy proposed affirms the central theoretical argument outlined in Chapter 1. It may be concluded that the suggested strategy can only succeed if the implementation plan or program is put in place together with monitoring and evaluating systems. / Thesis (M. Development and Management)--North-West University, Potchefstroom Campus, 2006.

Magistrinio darbo tema: „Kaimo vaistinių darbo ypatumai“ Kaimo vietovėse retesnis sveikatos priežiūros įstaigų tinklas, dažnai apsunkina pascientų kreipimąsi pas gydytojus ir skatina domėtis savigyda. Tokiose vietovėse, vaistininkas dažniausiai arčiausias ir lengviausias pasiekiamas sveikatinimo specialistas, galintis suteikti patarimą ir išduoti reikalingą vaistinį preparatą bei suteikti reikalingą konsultaciją Tikslas: Vaistininko konsultacijos kaimo vietovių gyventojams ypatumai. Tyrimo metodas: Stebėjimo tyrimas, atliktas natūraliomis sąlygomis, naudojant standartizuotą stebėjimo formą. Formą sudarė 17 testinių klausimų, suskirstytų į keturis blokus: socialinės ir demografinė informacija, vizito, paciento ir vaistininko elgsenų charakteristikos. Tyrimo imtį sudarė trijų kaimo vietovėje esančių visuomenės vaistinių pacientai. Stebėti 452 vaistinės klientai iš jų 333 moterų (74proc.) ir119 vyrų (26 proc.). Pagal amžių pacientai buvo suskirstyti į tris amžiaus grupes (18-30], (30-60], (60<). Tyrimas buvo vykdomas po dvi darbo dienas, kiekvienoje iš trijų vaistinių, pacientai buvo stebimi visą vaistinės darbo laiką. Pacientai nebuvo informuojami, kad yra stebimi, apie stebėjimą žinojo tik vaistininkas. Rezultatai: Vaistininkas pažinojo 49proc. Vaistinės pacientų. Vienas kitą pažįstantys pacientai su vaistininku buvo labiau linkę bendrauti ne su sveikatos problemomis susijusiomis temomis(p<0,001). Pacientai pažįstantys vaistininką linkę bendrauti išplėstinėmis... [toliau žr. visą tekstą] / Master‘s thesis: “The role of the pharmacist for rural area patient” Community pharmacists have been identified as being well-placed to perform a medicines education and health promotion role. In rural areas pharmacist sometimes is the only easy to access health care health care professional. Good consultation requires communication and counseling skills where the pharmacist is prepared to listen to, and to respond constructively to, patient‘s question and whishes. Objective: Evaluate the pharmacist’s consultation and health advice seeking patient’s behaviors at the rural community pharmacy. Methods: A participant observation method was applied. Study was made during 2009 13th of October- 12th of August at 3 rural community pharmacies. The observation took place during all pharmacy opening hours, twice in every of chosen pharmacies. The observer filled earlier prepared from for every rural community pharmacy patient’s visit. The statistical analysis of the quantitative findings was performed using the data accumulation and analysis software package SPSS version 17.0 for Windows. P-values less than 0.05 were considered to be significant. Results: The pharmacist knew 49proc. pharmacy patients. Patients who know the pharmacist were more likely to communicate with various subjects, not only with health problems related (P <0.001). 73.2 percent of patients, who do not know the pharmacist, more likely to be limited basic conversation. 19.54 percent objectives of the visit on the... [to full text]

Die Bewohner von sechs Dörfern der LEADER-Region »Elbe-Röder-Dreieck« wurden zur Versorgungssituation befragt. Im Ergebnis der geführten Interviews wird die jeweilige Versorgung mit Waren des täglichen Bedarfs, die medizinische Versorgung, das Dienstleistungsangebot und die Erreichbarkeit von Versorgungsangeboten außerhalb des Ortes unterschiedlich bewertet. In fünf Dörfern wird Verbesserungsbedarf bei der medizinischen Versorgung und beim Post- und Bankdienstleistungsangebot gesehen. Hingegen ist eine mobile und stationäre Versorgung mit Waren des täglichen Bedarfs in vier Dörfern, in zwei Dörfern aber nur in Form einer mobilen Versorgung derzeit gegeben. In allen Dörfern werden mobile Dienstleistungen mit Haustürservice wie Lieferdienste, Physiotherapie oder Frisör angeboten. Die Befragung ergab zahlreiche Beispiele wie private, gewerbliche und kommunale Initiativen zur Verbesserung der Versorgungslage beitragen können. In unterversorgten ländlichen Regionen ist jedoch eine kleinräumige Nahversorgungsstrategie nötig, um die Grundversorgung zu sichern.

Made available in DSpace on 2014-06-11T19:32:52Z (GMT). No. of bitstreams: 0 Previous issue date: 2010-06-07Bitstream added on 2014-06-13T19:03:31Z : No. of bitstreams: 1 alves_lmc_dr_jabo.pdf: 5616819 bytes, checksum: 4a53256d90bbcf403f575125bc5a14c7 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A água é um recurso natural indispensável à vida, é essencial à promoção social, à produção de alimentos e ao desenvolvimento econômico. Com o objetivo de se avaliar a qualidade microbiológica e físico-química de águas subterrâneas e superficiais na microrregião de Itapecuru-Mirim-MA foram colhidas 172 amostras de água, sendo 86 no período chuvoso (março a maio) e 86 amostras no período de estiagem (agosto a outubro). Destas, 39 amostras eram águas consumidas em residências rurais procedentes de poços artesianos, poços rasos, fontes naturais e Rede Publica de Abastecimento, 05 eram de uso doméstico, 08 de lavagem dos tetos das vacas; 02 de uso em laticínios, 01 de uso em matadouro, 01 de fábrica de polpas de frutas, 18 de bebedouros dos animais, 09 águas de uso em piscicultura e 03 de irrigação de hortaliças. Foram analisados parâmetros microbiológicos e físico-químicos e aplicado um questionário fechado contendo perguntas objetivas para se avaliar o nível de conhecimento das pessoas quanto à qualidade da água usada ou consumida e mapeado geograficamente os pontos de colheitas. Os resultados das análises microbiológicas e físico-químicas identificaram 52 (66,66 %) amostras de água de consumo humano em desacordo com os padrões microbiológicos e 23 (29,48%) em desacordo com os parâmetros físico-químicos, nove (90%) amostras de água de uso doméstico não atenderam aos padrões microbiológicos, enquanto seis (60%) não o foram para os padrões físico-químicos, para água de lavagem dos tetos evidenciaramse 13 (81,25%) e 10 (62,50%) amostras, respectivamente, fora dos padrões microbiológicos e físico-químicos vigentes. Não foi constatada contaminação microbiológica nem físico-química para água de uso em laticínio e em fábrica de polpa de frutas. Referente à água de uso em matadouro, uma (50%) amostra não atendeu aos padrões... / Water is a natural resource essential for life, it is essential to social promotion, food production and economic development. In order to evaluate the microbiological and physical chemistry quality of groundwater and surface water in the municipality of Itapecuru-Mirim-MA were collected 172 water samples, including 86 in the rainy season (March-May) and 86 samples in the dry weather period (August- October). From these total, 39 samples were water consumed in rural residences coming from shallow water wells, artesian water wells, natural sources and public water supply, 05 were domestic water, 08 from teat washings of cows; 02 for use in dairy products, 01 from the slaughterhouse, 01 from a factory fruit pulps, 18 from animal drinking fountains, 09 water samples used for pisciculture and 03 from vegetables irrigation. They were all analyzed for the microbiological and physical-chemical parameters. A close questionnaire with objective questions was also applied to evaluate the awareness level of people about the water quality used or consumed and the crops points were geographically mapped. The microbiological and physical-chemical results identified 52 (66,66%) water samples for human consumption in discordance with the microbiological standards and 23 (29,48%) in discord to the physical-chemical parameters, nine (90%) water samples for domestic use did not attend to the microbiological standards, while six (60%) were not for the physical-chemical parameters. The teat washing water results showed that 13 (81,25%) and 10 (62,50%) samples, respectively, were out of the microbiological and physical-chemical actual patterns. It was not detected microbiological contamination of water used in the dairy and in the fruit pulp factory. Referring to the water used in the slaughterhouse, one (50%) sample did not attend to the microbiological patterns, but all samples attended to the physical-chemical...(Complete abstract click electronic access below)