Cette étude exploratoire a pour but d’identifier les facteurs pouvant influencer l’implantation des adjoints au médecin dans le système de santé québécois, selon les perceptions de médecins omnipraticiens et de médecins spécialistes. La collecte de données pour cette étude qualitative s’est effectuée à l’aide d’entrevues semi-structurées effectuées auprès de 13 omnipraticiens et spécialistes provenant d’hôpitaux de Montréal et de la clinique médicale des Forces canadiennes de St-Jean (Québec). L’étude a démontré que des obstacles perçus, tels que le corporatisme et le manque d’information sur la profession, pourraient interférer avec l’intégration des adjoints au médecin au Québec. Cependant, les participants s’entendent pour dire que ces obstacles ne seraient pas insurmontables et ont, par la même occasion, identifié de nombreux éléments pouvant faciliter cette intégration. Les adjoints au médecin ont des compétences uniques et travaillent déjà dans d’autres provinces canadiennes qui ont un réseau de santé similaire au nôtre. Cette étude permet donc d’approfondir les connaissances à l’égard de cette profession, en plein essor au pays, dans l’éventualité d’une intégration de ce groupe professionnel au Québec. / The intent of this exploratory study is to identify the factors that could influence the implementation of Physician Assistants in Quebec's medical system based on the opinions of General Physicians and Medical Specialists. The data were collected from semi-structured interviews conducted with 13 generalists and specialists from hospitals in the Montréal area and from the military clinic located in the Canadian Forces Base St-Jean (Québec). The study showed that perceived obstacles such as corporatism and the lack of information about the profession could interfere with physician assistant integration. However, participants agreed that these obstacles could be overcome. They have, at the same time, identified many very positive factors in favour of this integration. Physician assistants have unique skills and are already fully integrated in provincial health care systems in other Canadian provinces. This study offers a better understanding and greater awareness of this expanding profession in our country and the progress towards its possible integration in Québec.

The thesis examines health care system in the United Kingdom of Great Britain and Northern Ireland. In the beginning there is characterised the United Kingdom and its present structure of health care system including assessment of individual functions of system's parts. Then there are analysed sources of finance and their development between 1999 and 2009. The thesis continues with analysis of expenditures where is traced their development between 1999 and 2009 including international comparison. Next there are introduced methods of financial resource allocation into segments of health care system. In the last chapter there are pointed pros and cons of British health care system out and chosen certain components for application in Czech Republic.

Essa pesquisa tomou por objeto a explicação de trabalhadores da Secretaria Municipal de Saúde de São Paulo para o aumento da sífilis congênita na região em que trabalham - instâncias administrativas da Coordenadoria de Saúde Norte e da Supervisão Técnica de Saúde Santana-Tucuruvi-Jaçanã-Tremembé. No Brasil, a sífilis congênita, indicador de qualidade da assistência ao pré-natal, tem apresentado nos últimos anos um acentuado crescimento. Em São Paulo, na região Tremembé e Jaçanã, o crescimento se acentuou a partir de 2008, concomitante à adoção pela SMS do modelo de gestão por Organizações Sociais para a maioria das unidades da Atenção Básica. Utilizou-se como marco teórico o Estado, compreendido como instituição inseparável do modo de produção capitalista, que mede a relação de reprodução do capital e as políticas estatais, como instrumentos dessa mediação. O objetivo do estudo foi identificar a explicação de trabalhadores da Secretaria Municipal para o aumento da sífilis congênita a partir da adoção do modelo de gestão por Organizações Sociais, uma vez que a justificativa para a adoção desse modelo foi a promessa de melhor eficiência e eficácia dos serviços. Metodologia. Trata-se de pesquisa qualitativa de caráter descritivo-analítico, que utilizou a técnica de entrevista para obtenção dos dados e o método da análise de conteúdo para a análise dos depoimentos. Os resultados mostraram que os trabalhadores da Administração Direta reconhecem a piora da qualidade na assistência à saúde da região e a associam ao crescimento dos casos de sífilis congênita. Atribuem à piora, tanto da qualidade da atenção quanto do quadro epidemiológico, explicações identificadas com o âmbito institucional e com o âmbito individual. No âmbito institucional, destaca-se a priorização das metas quantitativas e o encerramento contratual das Organizações Sociais gerando insegurança e insatisfação do trabalhador, além de relatos sobre a qualidade da assistência antes da adoção desse modelo de gestão. Já no âmbito individual, aponta-se a 9 mulher no centro do crescimento da sífilis congênita e o homem e o jovem no centro do crescimento da sífilis congênita. Explicação para o crescimento da sífilis congênita recaiu também nas características da própria doença e na redução do Estado. Discute-se que essas explicações para o aumento da sífilis congênita, tanto no âmbito institucional, sem o questionamento do modelo de gestão por Organizações Sociais adotado para o município, como na perspectiva dos indivíduos, particularmente nas suas precárias condições de vida, parecem identificadas com o posicionamento desses trabalhadores que indica que a realidade epidemiológica da doença na região é um fenômeno inevitável e imutável. Considera-se por fim que as explicações dos sujeitos estão coerentes com os argumentos do Plano Diretor de Reforma Administrativa do Estado mostrando que as estratégias de convencimento social utilizadas para implantação do modelo privatizante da gestão alcançou os espaços que foram objeto de politização durante a reforma sanitária. / The object of this research is the explanation of the workers of the Health Department of São Paulo city for the congenital syphilis increase in the area they work administrative instance of the Northern Health Coordination and of the Santana-Tucuruvi-Jaçanã-Tremembé Health Technical Supervision. In Brasil the congenital syphilis is an indicator of prenatal care assistance quality that has been sharply increasing in the last years. In the area of Tremembé and Jaçanã in São Paulo, the sharp increase has been occurring since 2008 concomitant with the adoption of the Health Social Organization administrative model by the Health Department for the majority of the Primary Health Care units. Considering our theoretical framework we advocate that the State is an inseparable institution from the capitalist mode of production that mediates the relation between the capital reproduction and the state policies, which are instruments of this mediation. The objective of the study was to identify the explanation of the Health Department workers for the congenital syphilis increase activated by the Health Social Organization administrative model adoption. The justification of the adoption of this model was the promise of efficiency and efficacy enhancement of the health care services. Methodology: This is a descriptive-analytical qualitative research that used interviews to collect data. The content analysis method was used for the testimonials analysis. The results show that the workers recognized the decrease of the health assistance quality in the area and associated that to the growth of the congenital syphilis cases. Considering the assistance quality and the epidemiology scenario, the subjects attributed explanations identified as belonging to the institutional sphere and to the individual sphere. In the institutional sphere, there is prioritization of quantitative goals, end of Health Social Organization contract generating workers insecurity and dissatisfaction, and reports about the quality of the assistance before the Health Social Organization administrative model. In the individual sphere, women in the center of the congenital syphilis growth, and men and youth in the center of the congenital 11 syphilis growth are highlighted. The characteristics of the congenital syphilis and the State reduction are also taken as explanations for the disease growth. We discuss that these explanations for the increase of congenital syphilis seem to be consistent with the workers positioning, which regards to the inevitability and immutability of the epidemiological scenario, both in the institutional sphere and the individual perspective. They do not question the Health Social Organization administrative model adopted by the city nor the precarious life condition of the individuals. We consider that the subjects explanations are coherent with the State Administrative Reform Plan argument, showing that the social convincing strategies to implant the private administration model have reached the spaces that were object of politicization during the sanitary reform.

Ο μεγάλος αριθμός των ταμείων Κύριας και Επικουρικής Ασφάλισης, η έλλειψη στοιχειώδους οργάνωσης και αρχειοθέτησης των ιατρικών πράξεων, των κλινικών δεδομένων και των συναλλαγών των ασθενών με τα Νοσοκομεία σε σχέση με τους ασφαλιστικούς τους φορείς, η απουσία ενιαίου ιατρικού φακέλου καθώς και η έλλειψη ενιαίας κωδικοποίησης των δράσεων και συναλλαγών που αφορούν την Υγεία ως προς το ασφαλιστικό πρόβλημα, καθιστούν τα ασφαλιστικά Ταμεία στην Ελλάδα ανοχύρωτα μπροστά την έξαρση της απάτης προς αυτά. Το πρόβλημα της εξαπάτησης των Ασφαλιστικών Φορέων αποτελεί θέμα μείζονος οικονομικής σπουδαιότητας στον τομέα της Υγείας, διότι οδηγεί σε οικονομικό μαρασμό τα Ταμεία και καθιστά ελλιπείς τις παροχές τους στους ασφαλισμένους. Από τις πιο βασικές αιτίες που οδηγούν σε εξαπάτηση των ασφαλιστικών φορέων είναι οι διαδικασίες υπερτιμολόγησης ιατρικών πράξεων(upcoding), η ύπαρξη ανεπαρκών ή πλήρως απόντων εγγράφων πιστοποίησης των αναγκαίων ιατρικών πράξεων, κοστολόγηση μη παρασχεθέντων ιατρικών υπηρεσιών, πώληση φαρμάκων από τους δικαιούχους ασφαλισμένους, κατάχρηση φαρμάκων, ακατάλληλη κωδικοποίηση, κ.ά. Ενδεικτικά αναφέρουμε ότι το ποσοστό των διαδικασιών υπερτιμολόγησης ιατρικών πράξεωνpcoding) στις ΗΠΑ κυμαίνεται σε 7-13%.Η τεχνολογία με σύγχρονες λύσεις φαίνεται να μπορ να χειριστεί το πρόβλημα επαρκώς, καθότι σε πολλές ευρωπαϊκές χώρες και στις ΗΠΑ, έχει αρχίσει να αποδίδει καρπούς. Το διαθέσιμο λογισικό εντοπίζει το αίτημα που φέρεται να είναι υπερτιμημένο, αναλύοντας ηλεκτρονικούς φακέλους λογαριασμών νοσοκομείων. Το λογισμικό αναγνωρίζει περιπτώσεις υπερτιμογησης ιατρικών πράξεων(upcoding) συνήθως μετά τη πληρωμή. Μεγάλο μέρος του διαθέσιμου λογισμικού είναι προς πώληση “off-the-shelf”, έτοιμο προς εγκατάσταση και χρήση με τον ελάχιστο επενδυτικό χώρο και χρόνο. Η αποδοτικόττα ενός προϊόντος λογισμικού μετράται ως προς δυοδιαστάσεις εκφραζόμενες ως ποσοστά, αναφερόμενες ως ευαισθησία και συγκεκριμενοποίηση. Η ευαισθησία μετρά το βαθμό στον οποίο το λογισμικό αναγνωρίζει όλες τις περιπτώσεις υπερκοστολόγησης ή άλλων περιπτώσεων απάτης. Η συγκεκριμενοποίηση μετρά την επάρκεια του λογισμικού, δηλαδή το βαθμό στον οποίο το λογισμικό αναγνωρίζει μόνον εκείνες τις περιπτώσεις που υπερτιμολοήθηκαν ή που γενικότερα κατά άλλον τρόπο έφεραν απάτη. Για την αύξηση της ευαισθησίας το λογισμικό πρέπει να συμπεριλάβει περιπτώσεις που δεν έφεραν απάτη (false positives). Για να πετύχει αύξηση της συγκεκριμενοποίησης , το λογισμικό ρισκάρει την απώλεια κάποιων περιπτώσεων που πραγματικά έφεραν απάτη (false negatives).Τα δεδομένα για κάθε εισαγωγή και παραμονή σε νοσοκομείο περιλαμβάνουν κωδικούς διάγνωσης, διαδικασίας, δημογραφικά, στοιχεία εισαγωγής-εξαγωγής ασθενών ,κοστολόγηση ιατρικών πράξεων. Αυτά συνήθως συνιστούν και τα χρησιμοποιούμενα προς επεξεργασία δεδομένα από το εκάστοτε λογισμικό. Απαιτείται μια ενιαία διεθνής βάση δεδομένων με τις καταγραφόμενες περιπτώσεις απάτης, μια διακρατική δυνατότητα μετακίνησης πληροφοριών, εκτενής πληροφόρηση των πολιτών και διαρκής ανατροφοδότηση των αποτελεσμάτων. Εξειδικευμένο προσωπικό με την υπευθυνότητα διεξαγωγής εσωτερικών ελέγχων δεν υφίσταται πάντοτε. Ωστόσο έχει διαπιστωθεί ότι όταν υπάρχουν δυναμικές προ-δράσεις και έλεγχοι τότε τα πράγματα είναι σαφώς καλύτερα στον τομέα της πρόληψης της απάτης. Ως απαραίτητα μέτρα καταστολής και αντιμετώπισης της απάτης θεωρούνται η καθιέρωση κοινών κατευθυντήριων γραμμών και οι δυναμικοί έλεγχοι με κατάλληλο λογισμικό. Βασική προϋπόθεση ωστόσο είναι η απρόσκοπτη και διαρκής συνεργασία όλων των εμπλεκόμενων φορέων( Υπουργεία Υγείας, Απασχόλησης και Δικαιοσύνης), η σύζευξη και με άλλα μέτρα –δράσεις κατά της απάτης, τόσο σε επίπεδο νομοθεσίας όσο σε επίπεδο κουλτούρας ώστε να εισαχθεί και να αξιοποιηθεί στην ελληνική πραγματικότητα η υπάρχουσα καινοτόμος τεχνολογία. Η βασική ιδέα πίσω από το χρησιμοποιούμενο λογισμικό είναι η τεχνολογία εκμάθησης μηχανών. Ο Επαγωγικός Λογικός Προγραμματισμός (ILP), αναπτύσσει λογισμικό βασισμένο σε τεχνικές εξόρυξης γνώσης από τεράστιες βάσεις δεδομένων και σε εκμάθηση μέσω εμπειρίας. Παρόλο που το επίπεδο αυτοματοποίηση είναι ψηλό, η εμπλοκή του ανθρώπινου παράγοντα θεωρείται σημαντική. Η ILP χρησιμοποιεί αλγόριθμους ανάλυσης σχέσεων ανάμεσα στις συναλλαγές και μπορεί να αναπαριστά εικονικά οτιδήποτε θέλει κάποιος ως μαθηματική συνάρτηση. Η γνώση του τρόπου δράσης των ατόμων που διαπράττουν την απάτη δεν μπορεί να είναι πάντα πλήρως διαθέσιμη, λόγω της εναλλασσόμενης φύσης της απάτης ,ωστόσο απαιτείται μια στοιχειώδης γνώση αυτών των «ύποπτων» δράσεων προκειμένου να κωδικοποιηθούν και να χρησιμοποιηθούν γιαεύρεση και καθοδήγηση του είδους των προτύπων που αναζητώνται κάθε φορά από το λογισμικό. / -

Pharmaceutical care can be defined as “the care that a given patient requires and receives which assures safe and rational drug usage” (Mikael et al., 1975:567). The supply of medication is an important link in the health care chain, and the supply of chronic medication specifically was reviewed in this study. The World Health Organization (WHO, 2008d) states that chronic disease and related deaths are increasing in low- and middle-income countries, causing 39% and 72% of all deaths in low- and middle-income countries respectively. The main objective of this study was to investigate the difference between chronic medication prescribing patterns and subsequent claiming patterns for community (retail) and mail order (courier) pharmacies in the South African private health care sector. Computerized claims data for the period 1 January 2009 to 31 December 2010 were extracted from the database of a South African pharmaceutical benefit management company. The chronic database consisted of 6 191 147 prescriptions (N = 17 706 524), 14 045 546 items (N = 42 176 768) at a total cost of R2 126 516 154.00 (N = R4 969 436 580.88). A quantitative, retrospective, cross-sectional drug utilisation review was conducted, and data were analysed using the Statistical Analysis System® programme. Various providers of chronic medication were analysed, namely dispensing doctors, dispensing specialists, courier pharmacies and retail pharmacies. Chronic medication represented 34.97% of all medication prescribed. Retail pharmacies dispensed 79% of this chronic medication (n = 2 441 613 items) and courier pharmacies 19% (n = 610 964 items). Courier pharmacies dispensed 1 147 687 prescriptions containing chronic medication and retail pharmacies dispensed 4 900 282. The average cost per prescription for chronic medication at retail pharmacies was R325.43 ± R425.74 (2009) and R335.10 ± R449.84 (2010), and that of courier pharmacies was R398.56 ± R937.61 in 2009 and R436.57 ± R1199.46 in 2010. The top-five chronic medication groups dispensed by both these pharmacy types were selected according to the number of unique patients utilising these medications for at least four consecutive months. The most utilised chronic medication groups were ACE inhibitors (n = 1 611 432), statins (n = 1 449 732), diuretics (n = 962 670), thyroid medication (n = 885 891) and oral antidiabetics (n = 696 631). The average medication possession ratio for retail pharmacies indicated that, on average, statins, diuretics, thyroid medication and oral antidiabetics were undersupplied by retail pharmacies. Courier pharmacies tended to oversupply more often than retail pharmacies, with the cost of oversupplied medication ranging from 9% to 11% of total courier pharmacy medication costs. The average chronic prescription, item and levy cost did not vary significantly between courier and retail pharmacies. This indicates that the relative cost of acquiring chronic medication is similar at retail and courier pharmacy. The medication possession ratios of the top-five chronic medication groups, however, did differ significantly. In order to choose the most appropriate provider, the medical scheme provider needs to consider the over- and undersupply of medication. Oversupply may lead to unnecessary costs whilst undersupply may lead to future noncompliance and associated health problems. The costs associated with undersupply of medication in the South African health care sector need further investigation. / PhD (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014

Pharmaceutical care can be defined as “the care that a given patient requires and receives which assures safe and rational drug usage” (Mikael et al., 1975:567). The supply of medication is an important link in the health care chain, and the supply of chronic medication specifically was reviewed in this study. The World Health Organization (WHO, 2008d) states that chronic disease and related deaths are increasing in low- and middle-income countries, causing 39% and 72% of all deaths in low- and middle-income countries respectively. The main objective of this study was to investigate the difference between chronic medication prescribing patterns and subsequent claiming patterns for community (retail) and mail order (courier) pharmacies in the South African private health care sector. Computerized claims data for the period 1 January 2009 to 31 December 2010 were extracted from the database of a South African pharmaceutical benefit management company. The chronic database consisted of 6 191 147 prescriptions (N = 17 706 524), 14 045 546 items (N = 42 176 768) at a total cost of R2 126 516 154.00 (N = R4 969 436 580.88). A quantitative, retrospective, cross-sectional drug utilisation review was conducted, and data were analysed using the Statistical Analysis System® programme. Various providers of chronic medication were analysed, namely dispensing doctors, dispensing specialists, courier pharmacies and retail pharmacies. Chronic medication represented 34.97% of all medication prescribed. Retail pharmacies dispensed 79% of this chronic medication (n = 2 441 613 items) and courier pharmacies 19% (n = 610 964 items). Courier pharmacies dispensed 1 147 687 prescriptions containing chronic medication and retail pharmacies dispensed 4 900 282. The average cost per prescription for chronic medication at retail pharmacies was R325.43 ± R425.74 (2009) and R335.10 ± R449.84 (2010), and that of courier pharmacies was R398.56 ± R937.61 in 2009 and R436.57 ± R1199.46 in 2010. The top-five chronic medication groups dispensed by both these pharmacy types were selected according to the number of unique patients utilising these medications for at least four consecutive months. The most utilised chronic medication groups were ACE inhibitors (n = 1 611 432), statins (n = 1 449 732), diuretics (n = 962 670), thyroid medication (n = 885 891) and oral antidiabetics (n = 696 631). The average medication possession ratio for retail pharmacies indicated that, on average, statins, diuretics, thyroid medication and oral antidiabetics were undersupplied by retail pharmacies. Courier pharmacies tended to oversupply more often than retail pharmacies, with the cost of oversupplied medication ranging from 9% to 11% of total courier pharmacy medication costs. The average chronic prescription, item and levy cost did not vary significantly between courier and retail pharmacies. This indicates that the relative cost of acquiring chronic medication is similar at retail and courier pharmacy. The medication possession ratios of the top-five chronic medication groups, however, did differ significantly. In order to choose the most appropriate provider, the medical scheme provider needs to consider the over- and undersupply of medication. Oversupply may lead to unnecessary costs whilst undersupply may lead to future noncompliance and associated health problems. The costs associated with undersupply of medication in the South African health care sector need further investigation. / PhD (Pharmacy Practice), North-West University, Potchefstroom Campus, 2014

Cette étude exploratoire a pour but d’identifier les facteurs pouvant influencer l’implantation des adjoints au médecin dans le système de santé québécois, selon les perceptions de médecins omnipraticiens et de médecins spécialistes. La collecte de données pour cette étude qualitative s’est effectuée à l’aide d’entrevues semi-structurées effectuées auprès de 13 omnipraticiens et spécialistes provenant d’hôpitaux de Montréal et de la clinique médicale des Forces canadiennes de St-Jean (Québec). L’étude a démontré que des obstacles perçus, tels que le corporatisme et le manque d’information sur la profession, pourraient interférer avec l’intégration des adjoints au médecin au Québec. Cependant, les participants s’entendent pour dire que ces obstacles ne seraient pas insurmontables et ont, par la même occasion, identifié de nombreux éléments pouvant faciliter cette intégration. Les adjoints au médecin ont des compétences uniques et travaillent déjà dans d’autres provinces canadiennes qui ont un réseau de santé similaire au nôtre. Cette étude permet donc d’approfondir les connaissances à l’égard de cette profession, en plein essor au pays, dans l’éventualité d’une intégration de ce groupe professionnel au Québec. / The intent of this exploratory study is to identify the factors that could influence the implementation of Physician Assistants in Quebec's medical system based on the opinions of General Physicians and Medical Specialists. The data were collected from semi-structured interviews conducted with 13 generalists and specialists from hospitals in the Montréal area and from the military clinic located in the Canadian Forces Base St-Jean (Québec). The study showed that perceived obstacles such as corporatism and the lack of information about the profession could interfere with physician assistant integration. However, participants agreed that these obstacles could be overcome. They have, at the same time, identified many very positive factors in favour of this integration. Physician assistants have unique skills and are already fully integrated in provincial health care systems in other Canadian provinces. This study offers a better understanding and greater awareness of this expanding profession in our country and the progress towards its possible integration in Québec.

Health care concerns everybody. Man{\crq}s right to health care is one of the fundamental human rights. There is no ideal health care system as yet, and states reform their health care systems and the ways of their funding. The reform of the health care system has been conducted in this country for a long time. No minister, however, has introduced more substantial changes and interferences in the present system than the Health Minister MUDr. Tomáš Julínek. This reform is known to citizens especially because of the introduction of fees for health treatment. However, the reform reaches farther. Further steps of the reform propose changes in the public health insurance, providing health care and in education, science and research. The transformation of the health care system of the Czech Republic has not completely resolved and finished a number of matters. Finishing these matters is braked by disputes in the political representation. This thesis is focused on finding out the understanding and attitudes of physicians towards the present reform of the health care system. To collect data, I used the questionnaire method. Its data were collected between January and March 2009. The return rate of questionnaires reached 84 per cent. The set of respondents consisted of physicians from the Vysočina Region in the districts of Havlíčkův Brod and Jihlava. The objective of my thesis was to find out the attitudes of physicians towards the present reform of the health care system. The objective of my thesis was fulfilled. I verified the following hypotheses by my research: Hypothesis 1: Opinions of self-employed physicians are different from those in employment relationship. Hypothesis 2: Differences in physicians{\crq} opinions are also dependent on their specialisations. Both hypotheses were confirmed in most aspects. I suppose that my research has brought new information concerning the opinions of physicians of the Czech health care system and of the changes going on in it. A number of things changed while this diploma thesis was being written, and the reform of the health care system did not proceed in the way it had been planned. I think that despite this the research results are useful and may be used as a basis for further research in this field, and thus enlarge information concerning this subject.

Thesis / The objective of this study is to assess the nature of women’s empowerment promoted by the Sudanese Women General Union (SWGU) in Sudan as a strategy for simultaneously addressing both poverty alleviation and women's empowerment using microcredit as a tool in the fight against poverty and women's empowerment at the household level during the period 1999-2005. The SWGU directed its development efforts towards promoting the women's cause officially and unofficially through the whole spectrum of governmental institutions and non-governmental organizations. Therefore, the government support these initiatives of women development processes and assisted in establishing the SWGU in 1990 as a strategic planning and coordination mechanism for poverty alleviation through the lead of the Ministry of Welfare and Social Development and with the cooperation from other ministries, government and non-government organisations at national, state and grassroots levels. The problem of the research reveals that majority of women in Sudan live with low or no income; economically they are dependent on their husbands' income; burdened with their household activities and responsibilities to feed; educate and take care of many children, encounter a core problem which is lack of access to credit and financial services to economically, socially and politically empower themselves and improve their status. The study reviewed the relevant literature, the context of women's poverty in Sudan, Sudan poverty strategies and policies, SWGU's role in strategic planning, coordination and implementation of the microcredit programmes. The achievements of the study on the socioeconomic empowerment of women at the household levels, the constraints and the recommendations were summarised. The researcher carried out this study during the period 2005-2009, to add to the body of the empirical literature of women studies in particular to the SWGU's microcredit projects best ii practices and lessons learned. In addition the study could help in conducting further womenstudies in Sudan and other developing counties. / Development Studies / D.Litt. et Phil. (Development Studies)

Submitted by Mario Mesquita (mbarroso@fiocruz.br) on 2014-11-05T17:32:40Z No. of bitstreams: 1 Ana_Claudia_Mello_EPSJV_Mestrado_2012.pdf: 6388953 bytes, checksum: bea0df0196a6c04c8013562c7b67c45b (MD5) / Approved for entry into archive by Mario Mesquita (mbarroso@fiocruz.br) on 2014-11-05T19:02:46Z (GMT) No. of bitstreams: 1 Ana_Claudia_Mello_EPSJV_Mestrado_2012.pdf: 6388953 bytes, checksum: bea0df0196a6c04c8013562c7b67c45b (MD5) / Made available in DSpace on 2014-11-05T19:02:46Z (GMT). No. of bitstreams: 1 Ana_Claudia_Mello_EPSJV_Mestrado_2012.pdf: 6388953 bytes, checksum: bea0df0196a6c04c8013562c7b67c45b (MD5) Previous issue date: 2012 / Fundação Oswaldo Cruz. Escola Politécnica de Saúde Joaquim Venâncio. Programa de Pós-Graduação em Educação Profissional em Saúde. / Aborda a diferença nos discursos e nos fatos, tomando como recorte a política de recursos humanos viabilizada na prática pela Secretaria Estadual de Saúde do Rio de Janeiro, através da manutenção dos “temporários permanentes” com o argumento de sanar os problemas dos hospitais do Rio de Janeiro, para implantar a Fundação Estatal de Direito Privado e posteriormente as Organizações Sociais na gestão dos serviços estaduais de saúde, como estratégia que visa abolir o instituto da estabilidade no serviço público e adaptá-lo à lógica mercantil privada da flexibilização da mão de obra. Utiliza como método revisão bibliográfica da produção teórica e da análise de documentos publicados concernentes à saúde do estado do Rio de Janeiro, editais dos processos seletivos, legislações, notícias e entrevistas divulgadas pela mídia, experiência pessoal das formas fragmentadas e precárias de contratação, particularmente o contrato por tempo determinado, as fundações estatais e as organizações sociais como projetos para extinção do vínculo estatutário. Desenvolve uma reflexão sobre a complexificação das relações entre Estado e sociedade, com base em Gramsci e Nicos Poulantzas, contemplando as novas configurações do capitalismo neste novo contexto histórico. Discute o controle social, na forma de Conselhos e Conferências de Saúde como instâncias de participação social do SUS, por um lado, a conquista de uma instância de participação popular reconhecida, por outro, a formalização de uma única instância representativa da sociedade como lugar de discussão e proposição das políticas de saúde o que burocratiza e limita as ações da sociedade civil nas suas formas de luta, expressão, participação e controle sociais. / Discussion about the gap between speeches and facts, based on the human resources policy currently applied by Rio de Janeiro State Department of Health, marked by the continued use of temporary workforce. Under the allegation of solving Rio de Janeiro hospitals troubles, in fact, this practice just prepares to establish Private State Health Foundation to be gradually substituted by Social Organizations to manage all Rio de Janeiro State health services. It is an strategy that aims to abolish permanent public workforce, in accordance with the private-market logic of more flexible public employment terms. The methodology used is based on bibliographic review of theoretical studies along with analysis of published documents related to Rio de Janeiro State Health practices, public selection processes for recruitment documents, laws, news and interviews published on media, personal experience on precarious and temporary contracts of employment, mainly fixed terms agreements, and, moreover, Station Foundation and Social Organization projects that intend to extinguish public permanent employment relationships. Presents a reflection on the complexity of the relationships between State an society, based on Gramsci and Nicos Poulantzas, that contemplate the news capitalism configurations in our present historical context. Discusses the social control mechanisms in the form of Health Counsels and Conferences, as social participation instrument in Brazilian Health Unified System (SUS): on one hand, the achievement of a recognized social participation forum, on the other hand, the formalization of an unique social participation forum to discuss and propose health policies, that tends to bureaucratize and limit civil society in their different forms of struggling, expressing, participating and preserving social control.