O estudo analisou a sustentabilidade da estratégia DOTS na visão de coordenadores de Programa de Controle Tuberculose (PCT) em sete municípios do interior do estado de São Paulo, prioritários para o controle da Tuberculose (TB). O quadro teórico está sustentado nas dimensões operacional, organizacional e política da gerência e sua articulação no contexto atual das políticas e serviços de saúde. A partir de uma abordagem quantitativa, de estudo epidemiológico descritivo por meio de levantamento de fontes secundárias, foram analisados os indicadores epidemiológicos do PCT: cura, abandono e óbito de casos novos com baciloscopia de escarro positiva, cobertura de Tratamento Supervisionado (DOT/TS) e de detecção de casos. Também optou-se pela abordagem qualitativa, análise de conteúdo-modalidade temática que utilizou como fonte a entrevista semi-estruturada com coordenadores de PCT. A Unidade Temática central foi a sustentabilidade da estratégia DOTS como um desafio para coordenadores de PCT, contendo dois sub-temas: A organização da estratégia DOTS diante da necessidade de captar/otimizar recursos e definir estratégias e A operacionalização das ações de controle da TB: raciocínio estratégico e negociação como ferramentas gerenciais. Os resultados quantitativos mostraram um coeficiente angular positivo para cura, mas a maioria não atingiu a meta de 85%; declínio no percentual de abandono, ainda aquém do esperado. A cobertura de DOT/TS apresentou aumento em todos os municípios, contudo, apenas um atingiu 95%. Nenhum município atingiu a meta de 70% de detecção de casos. Os temas que emergiram neste estudo apontaram nós críticos na captação e manutenção de incentivos financeiros; recursos humanos (RH) insuficientes e despreparados; rotatividade de pessoal; desconhecimento do destino da verba da TB e falta de autonomia para gerenciar os recursos; dificuldades de comunicação e integração com gestores; falta de priorização da doença na agenda política; priorização de agravos com repercussão política e necessidade de parcerias. Sobre a operacionalização do DOTS, o estudo apontou a cooperação de pessoas de fora do serviço como ferramenta gerencial estratégica, quando estimula a coresponsabilização da família e da comunidade como cuidadores ou multiplicadores. A avaliação, pautada em indicadores epidemiológicos, é utilizada prioritariamente para alcançar recursos, ao invés de subsidiar o planejamento. A gerência do PCT parece ser uma gerência burocrática, fundamentada no planejamento normativo. Acredita-se que a efetividade das ações gerenciais para sustentar a estratégia DOTS dependa de atores com conhecimento técnico, habilidades políticas e organizacionais, além de raciocínio estratégico para estimular e envolver todos os atores que lidam com a TB. Habilidades estas que, dificilmente são adquiridas na formação profissional. Conclui-se que os coordenadores trabalham em meio a pressões de cima e de baixo, ocupando dupla posição de transmissão, no plano hierárquico e das relações. Neste sentido, a sustentabilidade da estratégia DOTS representa desafios importantes para estes atores que utilizam poucos instrumentos gerenciais, têm pouca autonomia no processo decisório, lidam com recursos escassos e, muitas vezes, sem preparo para esta função, reforçando a necessidade de investimento na formação e capacitação contínua tanto para estes atores como para aqueles que lidam com a TB / This study analyzed the sustainability of the DOTS (Directly Observed Treatment Strategy). It shows the point of view of the TCP (Tubercolosis Control Program) coordinators of seven priority municipalities in the Sao Paulo State. The theorical framework is based on operational, organizational and political levels of the management and on its articulation in the current context of health policies and services. We carried out an epidemiological-descriptive study, using secondary sources, and through a quantitative approach. The following epidemiological TCP indicators were analyzed: cure, abandonment and death of new cases with positive sputum bacilloscopy, Supervised Treatment (DOTS/ST) and case detection coverage. We also chose to apply a qualitative approach, through a semi-structured interview with TCP Coordinators, and with the application of content analysis in the thematic modality. The main thematic unity is the sustainability of the DOTS strategy as a challenge to the TBP coordinators. It contains two sub-themes: The organization of the DOTS strategy faced with the need for resource captation/optimization and for clearly outlined strategies, and The operationalization of TB control actions: strategic thinking and the negociation as key management skills. Quantititive results show a positive angular coefficient for cure. Nonetheless, the majority did not achieve the 85% goal and the decline in the abandonment rate is still lower than expected. The ST coverage rose in all municipalities. However, only one municipality achieved coverage of 95%. None of the municipalities achieved the goal of 70% case detection rate. The themes analyzed in this study pointed to critical knots in the collection and maintenance of financial incentives; insuficient and unprepared Human Resources (HR); staff turnover; lack of knowledge concerning the destination of the TB funds, as well as lack of autonomy to manage resources; difficulties in the communication and in the integration with other managers; failure in making the disease a priority on the political agenda; priorization of aggravations with political repercussion and the need for partnerships. Concerning the DOTS operationalization, the study pointed to the cooperation of people outside the job as an important strategic management tool. It encourages family and community to take co-responsibility as caretakers and multipliers. The evaluation, which is based on epidemiological indicators, is especially used to achieve resources, instead of subsidizing the planning process. TCP management seems to be exceedingly bureaucratic and based on normative planning. We believe that the effectiveness of management actions to support the DOTS strategy needs characters with technical knowledge, political and organizational skills and strategic thinking. These skilss are important in order to encourage and get involved all those who deal with TB. These skills are hardly achieved in the professional training. We conclude that the coordinators work under pressure from the top and from the bottom of the hierarchy, and occupy a double transmission position: in the hierarchic level and in the relationship level. Thus, the sustainability of the DOTS strategy represents an important challenge for these characters, who use few management tools, have little authonomy in the decisionmaking process, have to work with scarce resources and are usually unprepared for the position they occupy. These findings highlight the need for more investments in continuing education and capacitation not only for coordinators but also for all those who have to deal with TB

Political science and tobacco policy--Theories of policy change--The global policy context--European countries and the EU--The UK: a case study--The United States--Other advanced industrial countries--Tobacco control policymaking in developing regions--The WHO Framework Convention on Tobacco Control (FCTC) / https://dc.etsu.edu/etsu_books/1104/thumbnail.jpg

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published_or_final_version / Public Administration / Master / Master of Public Administration

The service industry has been growing fast as national economies grew therefore becoming a major contributor to national gross domestic products (GDP). This growth in the services sector has led to questions around the issue of service quality. The aim of this study was to identify the determinants of service, assess the level of service quality in commercial real estate leasing and identify possible quality improvement measures. In carrying out the study, the service quality model developed by Parasuraman, Zeithaml and Berry (1988:14), SERVQUAL, was used. The study was based on the leasing services of the broking department of one of the leading commercial real estate companies operating in Durban. The study was restricted to the Durban market. A non-probabilistic sample of 120 customers was drawn from a list of lease transactions concluded in the last one year. From this sample, 84 questionnaires were successfully completed either by way of a face to face interview or by telephone, showing a response rate of 70 percent. Data was collected using a questionnaire based on the SERVQUAL model and adjusted by the researcher in order to be relevant to the commercial real estate industry. The questionnaire comprised two sections each with 22 questions divided into the five determinants of service quality, which are service tangibles, reliability, responsiveness, assurance and empathy. The first section of 22 questions was on customer expectations of service while the second section of 22 questions was on customer perceptions of service quality received and factor rating at the end. Factor analysis of survey response data was used to analyze the data and draw conclusions. The study findings are that commercial real estate service quality determinants match those in other industries except for rank and order. In general, service quality was found to be below customer expectations and commercial real estate firms need to work on ways to improve it. The study is limited to the specific settings of customers of property brokers in the Durban commercial real estate market. It is uncertain as to whether the findings can be generalized to other areas. / Thesis (MBA)-University of KwaZulu-Natal, Westville, 2010.

Background: Enhancing the performance of front-line health workers serving vulnerable populations is crucial for redressing inequities. Traditional approaches have focused on introducing technical solutions, such as guidelines and incentives, to modify performance outcomes. Recognition of the complex social nature of health system function draws attention to the intangible software elements that shape performance, including the values, ideas, interests, and norms that guide human behavior and interactions. Insight into the operation of software elements can provide a base for people-focused solutions to support health workers and enable them to confront constraints in low resource settings. This study examines the social environment of the practice of front-line auxiliary nurses (AN) in rural Guatemala, in order to understand the role of health system software elements in enabling their performance and to gain insight into how organizational support can be strengthened through locally-relevant actions. Methods: A mixed methods approach provided a multi-level view of the AN practice environment, situated in the regional health system of the rural department of Alta Verapaz. Interviews with ANs and observations of practice were conducted to understand the values orienting them and how these shaped their relationships with patients and communities. A theory-driven case study of AN supervision was conducted in selected health posts to understand the values orienting supervisors in their role and examine how these shaped their relationships with ANs. The participatory method of concept mapping was used to examine the views of health workers, district and regional managers on actions to strengthen organizational support for the performance of ANs. Results: The values of nursing vocation and community connectedness were prominent in ANs’ interpretations of their work. In relationships, nursing principles oriented them to be attentive to understanding patient needs, and a shared ethnic identity and personal experience of local needs served as a base for engaging with local leaders in community work. The dominant orientation of supervisors in their role was managerial control, and it provided limited support. It contributed to standard-centered relationships with ANs focused on fulfillment of ministry criteria. Supervision oriented by a holistic understanding of ANs’ needs and the goal of improving patient care was more successful in enabling AN motivation. This relationship was characterized as people-centered, based in a shared interpretation of the value of work with patients and the responsive support provided to ANs’ problems. “Organizational climate of support across levels”, where working relationships are characterized by respectful treatment, attention to psycho-social well-being and responsiveness to needs, was identified by health-system actors as a top priority for improving performance. Conclusions: To enable performance, there needs to be a balance between attention to standards and attention to the human dimensions of health worker practice. The dominant approach to supervision did not recognize or build on AN values. Supervision and management should be oriented by a more holistic view of the ANs’ work and their needs, in order to promote a people-centered approach to working relationships. Locally relevant action to strengthen district and regional management’s support for AN performance should focus on operationalizing performance goals that go beyond standards to encompass care that responds to patient and community needs.

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Thesis (MPhil)--Stellenbosch University, 2004. / ENGLISH ABSTRACT: Competition in the long-term insurance industry is intense and is increasing. This market is highly sophisticated and competitive and has developed substantially over the last few years with increasing integration into the world economy. Many companies have come to a crossroad as far as expansion of their market share is concerned. They have to operate in this highly competitive market and are under increasing pressure from legislation. New customers are in a short supply and competition is fierce. These facts are forcing companies to look at alternative ways of increasing their market share, especially through projects that try to maximise the value of existing clients. This paper looks intrinsically at information quality and how it coincides with customer relationship management projects for it to be effective and to give companies a competitive advantage. Through qualitative exploratory methods I was able to get a clear picture of how one of South Africa's biggest insurance companies tries to increase its market share in such a saturated market using information about their customers to gain competitive advantage. I first develop a thorough theoretical background on the terrain of information quality and how it relates to customer information management, which in turn has a great impact and forms the foundation of customer relationship management. Then, I explain how the company sees customer relationship management and how customer information management and information quality playa role in this view. Finally, I look at practical examples of quality information management at work within a framework of customer relationship management. / AFRIKAANSE OPSOMMING: Kompetisie in die langtermyn versekerings-bedryf is intens. Die mark is hoogs gesofistikeerd en kompeterend en het substansieel ontwikkel in die afgelope paar jaar met 'n verhoogde integrasie in die wêreld-mark. Vele maatskappye bevind hulself tans by 'n kruispad- met betrekking tot die uitbreiding van hulle aandeel in die mark. Besigheid moet gedoen word in 'n baie kompeterende mark en dan is daar ook die ewig toenemende druk wat toegepas word met betrekking tot wetlikheid en konformiteit. Dit, tesame met die feit dat kliënte al hoe minder raak, dwing maatskappye om na alternatiewe maniere te kyk om verdienstes op te stoot, en spesifiek deur projekte wat probeer om die waarde van bestaande kliënte te verhoog. Die werkstuk kyk spesifiek na informasie-kwaliteit en hoe dit verband hou met kliënte verhoudingsbestuur projekte om dit effektief te maak. Daar word ook gekyk na hoe dit die maatskappy 'n kompeterende voordeel gee. Deur kwalitatiewe ondersoekende metodes kon ek 'n helder beeld kry van hoe een van Suid Afrika se versekerings-maatskappye probeer om verdienstes te verhoog in so 'n versadigde mark deur gebruik te maak van informasie oor hulle kliente om 'n kompeterende voordeel te verkry. Eerstens ontwikkel ek 'n deeglike teoretiese agtergrond oor die gebied van informasie kwaliteit, en hoe dit verband hou met kliënte informasie-bestuur, wat op sy beurt weer 'n groot impak het en die grondslag vorm van kliënte verhoudingsbestuur. Tweedens verduidelik ek hoe die maatskappy kliënte verhoudingsbestuur sien en hoe kliënte informasie bestuur en informasie-kwaliteit 'n rol speel in die siening. Laastens kyk ek na praktiese voorbeelde van kwaliteit informasie-bestuur en die impak wat dit het op kliënte verhoudingsbestuur.