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Il contributo presenta i risultati di un progetto multi-fase che ha avuto come obiettivo la creazione di un nuovo modello di azione collettiva solidarity-based. Sviluppatosi in tre fasi conseguenti e necessarie, tale progetto mira a fornire indicazioni teoriche, metodologiche ed applicative per interventi di cittadinanza globale capaci di favorire condizioni di giustizia sociale. La prima fase consta di uno studio cross-culturale condotto in Italia, Austria e Stati Uniti volto a rilevare le rappresentazioni sociali dei concetti di obbedienza e disobbedienza in gruppi di giovani-adulti. La discussione dei risultati evidenzia similitudini e differenze cross-culturali tra le rappresentazioni e definisce, per la prima volta in letteratura, attraverso l’utilizzo di mixed methods completamente bottom-up i concetti di obbedienza e disobbedienza. Nella seconda fase è stato creato e validato uno strumento psicometrico in grado di misurare l’atteggiamento relativo alla disobbedienza pro-sociale poiché, nella terza e ultima fase, tale costrutto, insieme alle variabili ragionamento morale e valori di impegno, sono state testate come predittrici del modello EMSICA, modello esplicativo di un’azione collettiva a favore di un out-group in condizioni di svantaggio sociale. La discussione dei risultati indica la rilevanza empirica di tali variabili offrendo interessanti spunti di riflessione per i policy maker. / This dissertation presents the results of a multi-phase project whose goal was the creation of a new model of solidarity-based collective action. Developed in three consequential and necessary phases, this project aims to provide theoretical, methodological and practical guidance for interventions of global citizenship to favor conditions of social justice. The first phase consists of a cross-cultural study conducted in Italy, Austria and the United States aimed at detecting the social representations of the concepts of obedience and disobedience in young adults groups. The discussion of the results highlights the similarities and the differences between cross-cultural representations and defines the concepts of obedience and disobedience for the first time in literature, through the use of completely bottom-up mixed methods. In the second phase has been created and validated a psychometric instrument that can measure the attitude related to pro-social disobedience because, in the third and final stage, this construct, along with the variables moral reasoning and engagement values, have been tested as predictors of the EMSICA model, that explains collective action in favor of a disadvantaged out-group. The discussion of the results indicates the empirical relevance of these variables offering interesting insights for policy makers.

Les systèmes de santé des pays en développement font face à de nombreux enjeux organisationnels pour améliorer l’état de santé de leur population. Au nombre de ces enjeux, il est fréquemment mentionné la présence d’organisations internationales ayant des objectifs et caractéristiques peu convergents et qui interviennent de façon non nécessairement coordonnée. Cette thèse explore la thématique de l’introduction du changement dans ces systèmes de santé en mettant un accent spécifique sur l’enjeu lié à la présence de ces organisations internationales. La méthodologie utilisée est une analyse de concept. Cette approche méthodologique consiste à effectuer des revues critiques de la littérature sur des concepts, à mobiliser de nouvelles approches théoriques pour clarifier ces concepts et à réaliser des études de cas pour leur mise à l’épreuve empirique. En nous appuyant sur la théorie de l’action sociale de Parsons, la théorie de la complexité ainsi que les expériences d’introduction du changement dans différents systèmes de santé, nous avons développé un cadre théorique d’analyse de l’introduction du changement dans les systèmes de santé des pays en développement (1er concept). Ce cadre théorique, qui suggère de concevoir le processus d’introduction du changement comme un système d’action sociale complexe et émergent, a été appliqué à l’analyse de l’introduction d’un système de surveillance épidémiologique en Haïti. Plus précisément, nous avons analysé une étape ainsi que certains aspects du mécanisme sous-jacent au processus d’introduction du changement. Ce faisant, nous avons analysé, dans les deux premiers articles de la thèse, l’étape d’adoption du système de surveillance épidémiologique (2ème concept) ainsi que les déterminants de la collaboration entre les organisations impliquées dans le processus d’introduction du changement (3ème concept). Les résultats de ces analyses nous ont permis d’objectiver de faibles niveaux d’adoption, ainsi qu’une faible articulation des déterminants de la collaboration entre les différentes organisations impliquées dans le processus d’introduction du changement. Partant de ces constats, nous avons pu mettre en évidence, dans le troisième article, une phase de « chaos » dans le fonctionnement du système de santé d’Haïti. Cette phase de « chaos », qui pourrait expliquer les difficultés liées à l’introduction du changement dans les systèmes de santé des pays en développement en général et plus particulièrement en Haïti, était caractérisée par la présence d’un ordre sous-jacent au désordre apparent dans le fonctionnement de certaines composantes du système de santé d’Haïti, l’existence d’une instabilité, d’une imprédictibilité ainsi que d’une invariance structurelle aux différents niveaux de gouvernance. Par ailleurs, cette recherche a également permis de démontrer que les caractéristiques du « chaos » sont entretenues par la présence de trois groupes de systèmes d’action sociale bien articulés et bien cohérents à tous les échelons de la pyramide sanitaire en Haïti. Il s’agissait des systèmes d’action liés aux agences de coopération bilatérale, ceux liés aux initiatives ou fondations internationales de lutte contre le sida et finalement ceux associés aux organisations onusiennes. Ces systèmes d’action sociale sont en outre associés à d’autres systèmes d’action plus complexes qui sont situés à l’extérieur du système de santé d’Haïti. Au regard de ces résultats, nous avons proposé une nouvelle approche permettant de mieux appréhender l’introduction du changement dans les systèmes de santé des pays en développement et qui s’inscrit dans une logique permettant de favoriser une plus grande variété et une plus grande diversification. Cette variété et cette diversification étant soutenue par la création et la mise en place de plusieurs interconnections entre tous les systèmes d’action en présence dans les systèmes de santé qu’ils soient d’appartenance nationale, internationale ou qu’ils agissent au niveau central, départemental ou local. La finalité de ce processus étant l’émergence de propriétés systémiques issues non seulement des propriétés des groupes de systèmes d’action individuels qui interviennent dans la constitution du système émergent, mais aussi d’autres propriétés résultant de leur mise en commun. / In an attempt to improve the health status of their population, health care systems in developing countries face several organizational issues. These issues include the presence of international organizations with different goals and characteristics, as well as little convergence and poor coordination. While focussing on this specific issue, the objective of this dissertation is to deeply explore the issues related to the process of introducing change in health care systems of developing countries. The research method for this study is a concept analysis that requires a literature review, the use of new theories to clarify these concepts as well as the use of case studies to empirically validate these concepts. Using Parsons’s social action theory and the complexity theory, a new theory of change (1st concept) was developed and applied to the process of introduction of an epidemiological surveillance system in Haiti. More specifically, in the first two articles, we have analysed the process of adopting the epidemiological surveillance system (2nd concept) and the determinants of collaboration among the different organizations involved in the change process (3rd concept). The results from these two articles enabled us to highlights the low level of adoption as well as the weak articulation of the determinants of collaborations between the various organizations involved in the change process. From these analyses, we were able to highlights the dynamics of chaos operating in Haiti’s health care system in the third article. This chaos stage which could enable us to show the difficulties associated with the introduction of change in health systems in developing countries in general, and Haiti in particular, was characterized by a hidden order underlying an apparent disorder in the operation of certain components of the Haitian’s health system, the existence of instability, unpredictability as well as structural invariance at various levels of governance. Moreover, this research also enabled us to show that these characteristics are maintained by the presence of three well articulated and coherent social action systems at all levels of the health pyramid. They are those related to bilateral cooperation agencies, those related to international foundations and global initiatives fighting against AIDS, and finally those associated with the United Nations Organizations. These social action systems are also associated with other more complex systems outside the Haiti’s health system. On the basis of these results, we proposed a new approach to understand the process of introducing change in health care systems of developing countries that would fit into the logic that supports the setting up a larger interconnections and diversification among various organizations involved.

Made available in DSpace on 2009-11-18T18:50:27Z (GMT). No. of bitstreams: 1 TESE MC - volume I.pdf: 909223 bytes, checksum: cc5990de43a280b0ad4d88104dd1513a (MD5) Previous issue date: 2004 / In the recent years Corporate Social Action (CSA) has become more and more relevant to corporate context. The aim is to benefit both poor communities and the donnor companies, as it meets the needs of their salient stakeholders. Nevertheless, there still exists considerable scepticism concerning CSA. In order to become a solid management practice, it is critcal to evidence the attained results. Up to now, the focus has been on process evaluation, that is, on the policies companies are adopting. Literature revision has shown a great need of studies related to results identification in this field. Therefore, using stakeholders` framework (according to Wood, 1991; Donaldson and Preston, 1995; Hopkins, 1997; Hamil, 1999), we have developped a methodology to evaluate CSA results, based on public and private effectiveness criteria. As we applied it to assess Xerox social action in Brazil we were able to identify the attainment degree of expected results related to the benefitted community (Mangueira) and also to some Xerox salient stakeholders (employees and clients). / Nos últimos anos, a ação social das empresas (ASE) vem cada vez mais ganhando relevância no contexto corporativo. A expectativa é de que essa ação possa beneficiar tanto as comunidades carentes como a própria empresa, na medida em que atenda aos interesses dos seus stakeholders relevantes. No entanto, ainda existe considerável ceticismo quanto à ASE. Para que ela se torne uma prática de gestão sólida, torna-se fundamental evidenciar os resultados alcançados. Até o momento, o foco das avaliações tem sido no processo, ou seja, nas medidas que as empresas vêm tomando. Por outro lado, a revisão da literatura apontou a grande carência de estudos no que diz respeito à identificação de resultados nessa área. Assim, utilizando o enfoque dos stakeholders (Wood, 1991; Donaldson e Preston, 1995; Hopkins, 1997; Hamil, 1999), desenvolvemos uma metodologia para avaliar os resultados da ASE com base nos critérios da eficácia pública e da eficácia privada. Quando a aplicamos para avaliar a ação social da Xerox no Brasil, pudemos identificar o grau de alcance dos resultados esperados para a comunidade atendida (Mangueira) e para alguns dos seus stakeholders relevantes (funcionários e clientes).

Text in German / The present dissertation considers the historical and theological foundations of radical evangelicalism and puts it in the context of theologies which influenced it and are similar to it. It will be demonstrated that the evangelicals are enriched by radical evangelicalism - an evangelical basic concept with elements of anabaptism, the social gospel, liberation theology and the ecumencial theologies. Thus it will be demonstrated that radical theology is genuinely evangelical, yet is capable of overcoming the one sidedness of western evangelical theology. Special attention is given to the contributions of radicals from North America as well as from Latin America since they are of considerable importance to radical evangelicalism. The aim of the dissertation is to present radical evangelicalism, to critically evaluate it, and to make it profitable to the European evangelical scene. The first section names the sources from which radical theology flowed. The second section reviews the historical development of radical evangelicalism. It will be demonstrated that, in the thirty years of its existence, radical evangelicalism has become a significant factor within the worldwide evangelical movement. The third section presents the fundamental characteristics of radical theology within a selection of themes. It demonstrates that the radicals have confronted the evangelical movement with a transforming theory of mission, which shows itself to be relevant for today's pressing problems. The fourth section describes the social action of radical evangelicalism and demonstrates that the energetic theology of the radicals is in fact based on a compelling spirituality. The fifth section records the results of the investigation and presents conclusions for praxis and further theological study. / Die voriiegende Dissertation erfasst die geschichtlichen und theologischen Grundlinien des radikalen Evangelikalismus und stellt ihn in den Kontext ahnlicher und ihn beeinflussender Theologien. Es wird aufgezeigt, dass der radikale Evangelikalismus eine evangelikale Grundkonzeption mit Elementen des Anabaptismus, des Social Gospel, der Befreiungstheologie und der Theologien im Umfeld des Okumenischen Rates der Kirchen bereichert Dabei wird deutlich, dass die radikale Theologie genuin evangelikal ist, die Einseitigkeiten der westlichen evangelikalen Theologie aber zu uberwinden vermag. Besondere Aufmerksamkeit ist den Beitragen radikaler Nord- und Lateinamerikaner gewidmet, da diese den radikalen Evangelikalismus wesentlich gepragt haben. Ziel ist es, den radikalen Evangelikalismus darzustellen, kritisch zu wiirdigen und fur die europaische evangelikale Szene fruchtbar zu machen. Der erste Teil nennt die Quellen, aus denen sich die radikale Theologie speist. Der zweite Teil zeichnet den geschichtlichen Werdegang des radikalen Evangelikalismus nach. Es wird nachgewiesen, dass der radikale Evangelikalismus in den dreissig Jahren seines Bestehens zu einem bestimmenden Faktor in der weltweiten evangelikalen Bewegung geworden ist. Der dritte Teil stellt die Grundzuge der radikalen Theologie mittels ausgewahlter Themen dar. Er zeigt auf, dass die Radikalen die evangelikale Bewegung mit einer transformatorischen Missionstheorie konfrontiert haben, die relevant fur die drangenden Probleme der Gegenwart ist. Der vierte Teil stellt die soziale Aktion des radikalen Evangelikalismus dar und zeigt auf, dass die energische Theologie der Radikalen im Grande genommen zur Tat driingende Spirituality ist. Der funfte Teil halt die Ergebnisse der Untersuchung fest und zieht Folgerungen fur die Praxis und das weitere theologische Arbeiten. / Christian Spirituality, Church History and Missiology / M.Th. (Missiology)

This study sought to explore gender issues affecting management promotions in Malawi's health care services, utilising both qualitative and quantitative techniques in data collection and analysis. Promotion patterns were compared and contrasted for male and female managers. The study was based on the assumptions that • both men and women were aware of experiences that affected their promotion opportunities • promotion patterns showed fewer variations than did cultural, social and gender factors • male prejudices were maintained which oppressed women's promotions • increased decision-making power lowered stress about professional growth and development The findings supported the first two assumptions, but not the last two. The findings suggested that males and females encountered similar experiences concerning managerial promotions in Malawi's health care services. Factors that enhanced management successes for both males and females included management orientation and mentorship. Unclear promotion policies and procedures hindered management promotions. Information derived from this research could enable policy-makers to establish an environment that increases supportive networks and interactions between male and female managers in Malawi. Furthermore, to ensure equal opportunities in the health care services management, monitoring strategies by Malawi's Ministry of Gender, the Department of Human Resources Management and Development, and the Ministry of Health and Population need to be established and implemented. / Health Studies / D.Litt. et Phil. (Health Studies)

Social work / M.A. (Social Work)

This study sought to explore gender issues affecting management promotions in Malawi's health care services, utilising both qualitative and quantitative techniques in data collection and analysis. Promotion patterns were compared and contrasted for male and female managers. The study was based on the assumptions that • both men and women were aware of experiences that affected their promotion opportunities • promotion patterns showed fewer variations than did cultural, social and gender factors • male prejudices were maintained which oppressed women's promotions • increased decision-making power lowered stress about professional growth and development The findings supported the first two assumptions, but not the last two. The findings suggested that males and females encountered similar experiences concerning managerial promotions in Malawi's health care services. Factors that enhanced management successes for both males and females included management orientation and mentorship. Unclear promotion policies and procedures hindered management promotions. Information derived from this research could enable policy-makers to establish an environment that increases supportive networks and interactions between male and female managers in Malawi. Furthermore, to ensure equal opportunities in the health care services management, monitoring strategies by Malawi's Ministry of Gender, the Department of Human Resources Management and Development, and the Ministry of Health and Population need to be established and implemented. / Health Studies / D.Litt. et Phil. (Advanced Nursing Sciences)

The aim of the study was to evaluate the level of community participation employed by the City of Tshwane in the implementation of the Indigent Exit Strategy (IES) as a poverty alleviation measure in Olievenhoutbosch. A total of twenty two respondents participated in the research. The first group was ten beneficiaries and the second was ten that was exited from the database. Lastly, two Social Workers coordinating the programme were interviewed as well. The research findings reflect that the IES was not sufficiently rolled out as outlined in the policy and strategy. Capacity building and skills development, assistance to emerging entrepreneurships and other forms of economic development support did not reach out to the broader community as outlined in the IES. The study recommends that: the Indigent Exit Strategy interventions should be made accessible to the registered indigent households so that they can clearly know what is expected of them. / Development Studies / M. A. (Development Studies)

Dans beaucoup de pays, surtout dans des pays avec des ressources limitées, des efforts importants sont investis dans la mise en œuvre des initiatives innovantes à petite échelle, qui connaissent beaucoup de succès au niveau local mais qui subséquemment n’arrivent pas à être soutenues et étendues, et déclinent avec le temps. L’objectif de cette thèse est de comprendre et d’approfondir les enjeux liés aux processus de mise en œuvre, de mise à l’échelle et de pérennisation des initiatives innovantes dans des pays avec des ressources limitées. Ce sujet est important vu les défis majeurs auxquels sont actuellement confrontés les systèmes de santé dans ces pays. Cette thèse analyse la mise en œuvre, la mise à l’échelle et la pérennisation des initiatives innovantes selon la théorie de l’action sociale de Talcott Parsons. Cette théorie stipule que toute action sociale est composée de petites sous-unités de systèmes d’action interreliées et imbriquées les unes avec les autres, interagissant entre elles et avec leur propre environnement. La théorie de l’action sociale permet d’effectuer des analyses portant sur différents phénomènes liés et imbriqués, et situés à différents niveaux systémiques et temporels comme les processus de mise en œuvre, de mise à l’échelle et de pérennisation. Dans le cadre de cette thèse, nous concevons le système d’action sociale du processus de mise à l’échelle comme un système d’action sociale du processus de mise en œuvre à un niveau supérieur dans l’espace, et le système d’action du processus de pérennisation comme un système d’action du processus de mise en œuvre continue dans le temps au même niveau ou à un niveau supérieur. Dans le cadre de la recherche, nous avons étudié ces trois processus dans un contexte de pays avec des ressources limitées, à l’aide d’une étude de cas multiples basée sur une recherche qualitative avec des niveaux d’analyse imbriqués. Quatre initiatives innovantes introduites dans le secteur de la santé tunisien entre 1964 et 2010 ont fait l’objet de l’étude. Il s’agit de : la stratégie mobile pour les services de planification familiale (1964), le projet de réforme de la gestion des hôpitaux universitaires (1991), le programme national de développement des circonscriptions sanitaires (1994), et le projet d’optimisation de la chaîne d'approvisionnement des vaccins (2010). Les données ont été collectées par le biais d’entrevues semi-dirigées, suivies d'une période d'observation de dix jours (et de discussions informelles), et d'un examen des documents officiels pour chaque initiative étudiée. Les données ont été analysées à l'aide d'une analyse de contenu dans le logiciel QDA-Miner (version 4.1.27). Cette recherche empirique nous a permis de mettre en évidence la nature et le niveau d’influence de plusieurs déterminants contextuels qui permettent d’expliquer les différents niveaux de mesure (structurel, processuel et effectif) de mise en œuvre, de mise à l’échelle et de pérennisation proposés par le cadre théorique de l’étude. Les résultats de cette recherche soutiennent la proposition qu’il est possible que les systèmes d’action sociale des processus de mise en œuvre et de mise à l’échelle (quel que soit le niveau) soient principalement influencés par des déterminants structurels (engagement politique, contexte historique et juridique, etc.) et organisationnels (leadership, expertise technique, disponibilité des ressources, collaborations, etc.), tandis que des déterminants individuels (niveau des compétences, engagement, confiance et motivation) et des caractéristiques liées aux initiatives innovantes (pertinence, compatibilité pratique et technique avec le contexte local, simplicité, etc.) soient davantage impliqués dans le système d’action sociale du processus de pérennisation. Ces résultats envoient un signal aux bailleurs de fonds et décideurs qui voudraient réussir la mise en œuvre, la mise à l’échelle et la pérennisation des initiatives innovantes dans le domaine de la santé dans un contexte de ressources limitées. Au regard de ces résultats, nous avons proposé une nouvelle approche intégratrice permettant de mieux appréhender l’analyse des processus de mise en œuvre, de mise à l’échelle et de pérennisation des initiatives innovantes dans les systèmes de santé. Cette approche considère les processus de mise en œuvre, de mise à l’échelle et de pérennisation comme étant des systèmes d’action sociale imbriqués et interreliés, qui sont en constante évolution et en interaction avec un environnement commun englobant plusieurs déterminants de succès ou d’échec agissant à différents niveaux (structurel, organisationnel, individuel et intervention). / In many countries, especially in countries with limited resources, significant efforts are invested in the implementation of small-scale innovative initiatives, which are very successful at the local level, but subsequently fail to be expanded and decline over time. The objective of this thesis is to understand and explain the issues related to the implementation, scaling up and sustainability processes of innovative initiatives in countries with limited resources. This topic is important given the major challenges currently facing health systems in these countries. This thesis analyzes the implementation, scaling up and sustainability of innovative initiatives according to Talcott Parsons’ social action theory. This theory states that all social action is composed of small subunits of interrelated and interlocking systems of action interacting with each other and with their own environment. The social action theory allows for analysis of different related and embedded phenomena at different systemic and temporal levels such as implementation, scaling up and sustainability processes. As part of this thesis, we design the social action system of the scaling up process as a social action system of the implementation process at a higher level in space, and the social action system of the sustainability process as a social action system of the continuous implementation process over time at the same level or at a higher level. As part of the research, we investigated these three processes in a country context with limited resources, using a multiple case study based on qualitative research with nested levels of analysis. Four innovative initiatives introduced in the Tunisian health sector between 1964 and 2010 were the subject of the study. These include the Mobile Strategy for Family Planning Services (1964), the Hospital Management Reform Project (1991), the National Health District Development Program (1994), and the Vaccine Supply Chain Optimization Project (2010). Data was collected through semi-structured interviews, followed by a ten-day observation period (and informal discussions) and review of official documents for each initiative. The data was analyzed using a content analysis in the QDA-Miner software (version 4.1.27). This empirical research has allowed us to highlight the nature and the level of influence of the contextual determinants that make it possible to explain the different levels of implementation, scale up and sustainability measures (structural, procedural and effective) proposed by the theoretical framework of the study. The results of this research support the proposition that social action systems of implementation and scaling up processes (at any level) may be primarily influenced by structural determinants (political commitment, historical and legal context, etc.) and organizational (leadership, technical expertise, availability of resources, collaborations, etc.), while individual determinants (level of skills, commitment, trust and motivation) and characteristics related to innovative initiatives ( relevance, practical and technical compatibility with the local context, simplicity, etc.) are more involved in the social action system of the sustainability process. These results send a signal to donors and policymakers who would like to successfully implement, scale up and sustain innovative health initiatives in the context with limited resources. In light of these results, we have proposed a new integrative approach to better understand the analysis of implementation, scaling up and sustainability processes of innovative initiatives in health systems. This approach considers the processes of implementation, scaling up and sustainability as interconnected and interlocking social action systems, in constant evolution and interaction with a common environment encompassing several contextual determinants of success and challenges operating at different levels (structural, organizational, individual and intervention).