Submitted by Rubia Fernanda Toledo de Oliveira null (rubia_rfto@hotmail.com) on 2017-09-17T21:12:17Z No. of bitstreams: 1 DISSERTAÇÃO MESTRADO FINAL.pdf: 12884115 bytes, checksum: 32c6d00d52407caf9fc15e460b7d8e17 (MD5) / Made available in DSpace on 2017-09-19T18:44:23Z (GMT). No. of bitstreams: 1 oliveira_rft_me_guara.pdf: 12884115 bytes, checksum: 32c6d00d52407caf9fc15e460b7d8e17 (MD5) Previous issue date: 2017-08-14 / Approved for entry into archive by Monique Sasaki (sayumi_sasaki@hotmail.com) on 2017-09-19T18:44:23Z (GMT) No. of bitstreams: 1 oliveira_rft_me_guara.pdf: 12884115 bytes, checksum: 32c6d00d52407caf9fc15e460b7d8e17 (MD5) / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / O setor de saúde no Brasil vive uma crise que se traduz por baixa qualidade, ineficiência e iniquidade. Um conjunto de fatores como, problemas ligados à demora no atendimento, insegurança do paciente, erro médico e aos crescentes custos do processo de atenção à saúde, tem constituído um obstáculo importante para que avanços maiores e mais consistentes sejam conseguidos. Uma forma de melhorar esta situação é o setor de saúde examinar seus processos operacionais e prestar cuidados de forma mais eficiente e eficaz. Nesse contexto a aplicação de conceitos, métodos e ferramentas Lean destaca-se como uma alternativa para a reestruturação dos processos de saúde, denominado por Lean Healthcare. Neste sentido a presente dissertação tem como objetivo analisar a aplicação dos conceitos e ferramentas do Lean Healthcare na melhoria do atendimento em uma unidade de Assistência Médica Especializada (AME). Se tratando dos métodos abordados, foi utilizada a técnica de pesquisa-ação, obtendo resultados desejados não apenas na solução dos problemas imediatos, mais também no aprendizado. Como resultado, uma série de melhorias foram sugeridas com base nos mapeamentos, observações in loco e entrevistas, destacando uma potencial diminuição no tempo de permanência do paciente dentro da unidade em até 18% em um dos processos, caso seja implantado. Possíveis dificuldades encontradas para uma implantação do Lean, assim como, seus benefícios e vantagens também foram apresentadas. / The health sector in Brazil is experiencing a crisis that translates into poor quality, inefficiency and inequity. A number of factors, such as delayed care delivery, patient insecurity, medical error, and the rising costs of the health care process, have been a major obstacle to greater and more consistent advances. One way to improve this situation is for the health sector to examine its operational processes and provide care more efficiently and effectively. In this context the application of Lean concepts, methods and tools stands out as an alternative to the restructuring of health processes, called Lean Healthcare. In this sense, the present dissertation aims to analyze the application of the concepts and tools of Lean Healthcare in the improvement of care in a unit of Specialized Medical Care (AME). When dealing with the methods discussed, the research-action technique was used, obtaining desired results not only in the solution of immediate problems, but also in learning. As a result, a number of improvements were suggested based on the mapping, on-site observations and interviews, highlighting a potential decrease in patient stay time within the unit by up to 18% in one of the procedures, if implemented. Possible difficulties encountered for a Lean deployment, as well as its benefits and advantages were also presented.

Orientador: Karina Lilia Pasquariello Mariano / Banca: Gabriel Cepaluni / Banca: Luciana Togeiro de Almeida / Resumo: O presente trabalho discute a influência do regime de patentes estabelecido internacionalmente, sobre o problema das doenças denominadas "negligenciadas", que recebem esta designação por não despertarem interesse da indústria farmacêutica privada para o desenvolvimento de novos medicamentos, pois vitimam principalmente as populações dos países pobres ou em desenvolvimento localizados na região tropical. Esse regime de patentes também dificulta os objetivos dos programas públicos de produção e distribuição de medicamentos, que visam atender às camadas mais pobres da população, necessitadas destes e sem condições próprias de adquiri-los. Para se ter uma melhor compreensão deste contexto foi analisado, principalmente, o acordo TRIPS (Trade- Related Aspects of Intellectual Property Rights) que regulamenta o atual regime de patentes em nível internacional, considerando a postura da Organização Mundial de Saúde (OMS) e dos governos brasileiros em relação a essa questão. O Brasil foi usado como estudo de caso por se caracterizar como um país em desenvolvimento, localizado na região tropical e reconhecido internacionalmente por resultados positivos em relação ao combate às doenças negligenciadas e pela implementação de iniciativas que visam o maior acesso a medicamentos pela sua população / Abstract: This research discusses the influence of the patent regime in the problem of diseases called "neglected", they receive this designation because the private pharmaceutical industry has a lack of interest of to develop new drugs to them. These diseases victimize people in poor countries or developing countries located in tropical regions. This patent regime also hinders the objectives of public programs for the production and distribution of drugs, which aim to garantee better health conditions to poorest of the population. For a better understanding, we analyzed the TRIPS (Trade-Related Aspects of Intellectual Property Rights) which regulates the current patent regime at the international level, and discussed the behavior of the World Health Organization (WHO) and of Brazilian governments in relation to this issue. Brazil was used as a case study because it is characterized as a developing country, located in tropical region and with positive results internationally recognized in his strategies to combating neglected diseases and in the implementation of initiatives aimed at increase access to medicines for its population / Mestre

Child mental health has been an emerging topic in societal as well as scholar spheres. Mental health is intimately connected with wellbeing and as such their promotion by the World Health Organization(WHO) has allowed for governmental and societal structures to be aware of what is necessary to implement and change in order to achieve better child mental health and wellbeing. Through this thesis, the representations of children and how mental health and well-being are constructed are analysed using Bacchi’s “What’s the problem presented to be” (WPR) method. The aim of this studyis to critically examine how the concepts and representations described above are discursively generated in the annual reports of 2015 and 2016 from the WHO. When analyzing the representations of the child, mental health and wellbeing, two major themes are identified: The vulnerable/agentic child and the best place for a child. The first theme discursively represents children in three forms: Helplessness or victim, passive recipients and agentic.The second theme represents not only children but also their families, the institutions and the institutional staff. Here another three discourses emerge: Connection to the nuclear family discourse,the powerful and harming institutions discourse and the blaming the staff discourse. Regarding the concepts of wellbeing and mental health, the results comprising this thesis suggest that, in the reports,mental health is presented to be a question of who the caregiver is and how resources such as education are distributed. Wellbeing is connected to the presence of the parents with the child avoiding thus institutionalization as well as the children becoming victims of the malpractices of the negligent institutional staff and the possibility of children becoming agents in their own lives. Finally,the seemingly unproblematic aspects of such representations indicate that the arguments about the vulnerable/agentic child and the best place for a child, are not put in context and are about a generalized child that does not fit the specificity of children’s worlds.

A democracia sanitária exige que as normas do direito à saúde sejam derivadas de processos deliberativos que permitam a troca de argumentos que, por sua vez, conduzam à formação da vontade política, sendo que essa vontade deve ser constantemente submetida à confirmação em debates públicos para garantir a responsividade do governo e o controle do exercício do poder político. A partir dessa noção, pretendíamos verificar se, caso fosse aprovado o projeto de Marco para colaboração com os atores não estatais, no seio da reforma da Organização Mundial da Saúde, seriam criadas instituições e processos deliberativos que oportunizassem a participação democrática da sociedade civil internacional. Para tanto, realizamos uma pesquisa qualitativa, e, por meio do método da análise documental, estudamos os documentos básicos e documentos oficiais concernentes à reforma da Organização Mundial da Saúde. A conclusão alcançada foi que, embora o instrumento analisado não promovesse a democracia sanitária em conformidade com o marco teórico adotado no trabalho, ele criaria novas instâncias em que a sociedade civil internacional poderia exercer sua influência. / Health democracy requires that the norms of right to health are derived from deliberative processes that allow the exchange of arguments which, in turn, conduct to the formation of the political will, and this will must be constantly subject to confirmation in public debates to ensure the responsiveness of government and control of the exercise of political power. Based on this notion, we intended to verify whether, if it were approved the draft Framework for engagement with non-state actors, within the reform of the World Health Organization, it would create institutions and decision-making processes that would enable democratic participation of international civil society. To this end, we conducted a qualitative research, and through the method of document analysis, we studied the basic documents and official documents concerning the reform of the World Health Organization. The conclusion reached was that, although the analyzed instrument did not promote health democracy in accordance with the theoretical framework adopted at this work, it would create new instances in which the international civil society could exert their influence.

This thesis investigates the impact of international organizations on the making of international law by applying insights on how international organizations work—or fail to work—to the process of institutionalized treaty making. Specifically, I probe the relationship between the World Health Organization (“WHO”) and international infectious disease law, focusing in particular on the 2005 International Health Regulations (“2005 IHR”), which was negotiated, adopted, and is now being implemented under WHO’s auspices. The 2005 IHR is the most recent development in international infectious disease law, the history of which extends back to the beginning of international health cooperation in the mid-nineteenth century, before any international health organization was formed. Relying on secondary sources, WHO documents, archival materials, and personal interviews, I chronologically trace the evolution of international infectious disease law across changing institutional settings. I first examine the incremental growth of the older “barrier” approach to infectious disease regulation, initially developed in the absence of any international health organization and then with the aid of one of WHO’s predecessor organizations. I then analyze the decline of the barrier approach and the rise of the new “epidemiological” approach embodied by the 2005 IHR, with the aid of WHO. Based on my empirical analysis, I conclude that WHO has radically changed the process of making international infectious disease law as well as its content. On its own initiative and without member state demand, WHO’s permanent staff experimented with novel practices that subsequently became the basis for the 2005 IHR. WHO’s work reduced the length of formal negotiation needed to arrive at a new agreement and the uncertainty associated with adopting a novel regulatory system. Its influence also raises normative questions about the proper role of international organizations in making international law—questions that require further exploration.

The concept of global governance is nowadays commonly used for studying international relations. The goal of this thesis is to analyze the nature of global governance in health sector, to discover how the main participants involved in international relations react to new challenges that arise, specifically how they react to the case of obesity. Global governance occurs on multiple levels; WHO occurs at the global level whereas individual national states occur at the lower level. This thesis answers the questions to topics such as: how the global health governance's politics are made, whether obesity represents a threat and how various participants that are involved in international relations coordinate their steps towards fighting obesity, on which levels they coordinate their agenda and for whom they are working for when fighting obesity.

Master of Public Health - MPH / Background:Theoutcomeofpregnanciesinmanyinstancesislargelypredicatedon availabilityofSkilledBirthAttendants(SBAs).Despitethisphenomenon,illiteracyand financialdisadvantagehavebeenvariouslycitedastwinfactorspromotingtheinterest andpatronageofTraditionalBirthAttendants(TBAs)bywomenfolk.Itistherefore expected thatwomenhavingtertiarylevelofeducationandpossessing adequate economic resources would naturally prefer to use the SBAs.However,these http://etd.uwc.ac.za/ 9 observationshavenotsignificantlyreflected therealityin thechoiceofmaternal healthcareprovidersinNigeriaandthecityofLagosinparticular.Yet,accessto maternalservicesoftheSBAshasbeenwidelyacceptedasoneoftheleadingwaysof loweringmaternalmortality.Therefore,inordertoimprovethepatronageofSBAsand correspondinglylowermaternaldeathrates,itbecomesimperativetounderstandthe rationalebehindthepreferencefortheTBAs’usebywomenwhoarenotordinarily expectedtodosobyvirtueoftheirhighlevelofeducationandgoodfinancialcapacity. Aim:Theaim ofthisstudywastoexploreandunderstandtheexperiences,perception and beliefsystems influencing well-educated,middle income women and their reasoningfortheuseofTraditionalBirthAttendantsratherthanSkilledBirthAttendants fordeliveryservicesinLagos,Nigeria. Methodology:ThisisaqualitativestudyconductedinAlimoshoLocalGovernmentArea ofLagosinNigeria.Tenwomenwithtertiarylevelofeducationandbelongingtomiddle incomeeconomiccategorieswereenrolledasparticipants.Inaddition,itinvolved3 FocusGroupDiscussionscomprising7TraditionalBirthAttendantspergroup. Results:Behaviouraland attitudinalshortcomings by the SBAs;misconceptions regardingsurgicaldeliverybywomen;bureaucraticdelaysandbottlenecksexperienced attheSBAs’centres;thebeliefbythewomenthatpregnancyisasacredandspiritual eventwhichonlytheTBAshaveabilitytomanage;women’sconfidenceintheTBAsas havingbettercapacitytomanagecertaincoexistingmedicalconditionsinpregnancy; andmisinformationonmanagementmodalitiesforcertainconditionslikeinfertilityand fibroidallcombinetoinfluencepreferenceforutilizationofTBAsbywell-educated, middleincomewomeninthestudyarea.

Since securitization processes are agued to be able to create excessive power to actors, there are arguments that claim that securitization is a negative process. By combining aspects of the original securitization theory with Juha Vuoir’s theory of illocutionary force, this thesis makes an attempt at finding what different actors claimed was threatened in their respective securitization of the issue terrorism. The motive behind the actors are also investigated and argued to be made visible through the different speech acts each actor employs when trying to securitize an issue. The thesis concludes that all three securitizing actors use some traditional notions of what is being threatened, namely the state. However, they are all found to use less traditional referent objects in addition to the state. The thesis also concludes that the motives of the different actors are found. These are showcased through the president of the USA trying to create deterrence for attackers of his state and trying to create control on the international arena. The High Representative of the EU, trying to legitimize future acts of more integration in the Union. Finally the World Health Organization’s motive is argued to have been to put the issue on the agenda.

Despite the Alma Ata inspired slogan ‘health for all by 2000’ in the second decade of the twenty first century, the world remains affected and infected with bad health. This situation has generated much debate, and as a result, national and global responses have arguably entered a new era building on the past success and failures of health movements, most notably on the back of the global HIV/AIDS movement. It is acknowledged that the rights instruments that exist relating to the right to health have provided a healthy platform for advocacy and have lead to successes on the ground, but the question is where to go from here. / Thesis (LLM (Human Rights and Democratisation in Africa)) -- University of Pretoria, 2011. / http://www.chr.up.ac.za/ / nf2012 / Centre for Human Rights / LLM

MPH / Department of Public Health / HIV/AIDS is an overwhelming global pandemic that affects the country’s health-care system. In order to reduce HIV/AIDS morbidity and mortality, the World Health Organization has called on countries to provide earlier access to antiretroviral therapy. In order to comply with the World Health Organization’s call, South Africa has developed the National Consolidated Guidelines, which were aimed at increasing access to ART as well as reducing new infections through viral suppression. Although the new guidelines have been implemented, they have not been fully implemented, especially in rural-based Primary Health Care facilities. The researcher observed that women who were pregnant were not tested every three months, as prescribed by the HIV/AIDS guidelines. The aim of this study was to investigate Challenges faced by health professionals regarding the implementation of HIV/AIDS guidelines at PHC facilities of Vhembe District, South Africa. This study adopted a qualitative, explorative, descriptive and contextual approach targeting nurses working at rural-based primary health care facilities at Vhembe District. Face-to face in-depth, Semistructured interviews were conducted, audiotaped and transcribed verbatim. The study used non-probability quota sampling method to identify participants until data saturation was reached with 12 participants. The results revealed that nurses faced some challenges when implementing HIV/AIDS guidelines, including shortages of resources, poor technical support, poor infrastructure, work overload, patients starting ART while there are not ready, shortage of ART, late booking of antenatal care, and mothers’ denial of HIV positive status, HIV positive babies, and poor RPC after birth. Ethical considerations were observed throughout the study. The data collected was analyzed using interpretative phenomenological analysis and all measures to ensure trustworthiness of the study findings were ensured. Some recommendations were made based on the findings of the study / NRF