Power sharing regimes in resource management, including co-governance and co-management schemes, are now common across New Zealand. These schemes bring together iwi and the Crown to facilitate various environmental objectives. These arrangements often utilise the tenants of tikanga Māori, in particular the concept of kaitiakitanga, and are generally provided for outside of the Resource Management Act 1991. This thesis shows how two iwi, Ngāi Tahu of the South Island, and Ngāi Tūhoe of Te Urewera in the central North Island, are utilising such schemes to promote the interests of their people. It explains that Ngāi Tahu have built up co-governance in a patchwork manner, utilising the provisions of their settlement to build three distinct co-management arrangements in Canterbury. The thesis shows that Ngāi Tahu have yet to gain full co-governance capacity, but may well have a future role at the table in regional Canterbury governance from 2016 onwards. In comparison, Ngāi Tūhoe have been granted a different kind of governance arrangement that arguably goes beyond co-governance. This governance arrangement is based off the fact that legal personality has been granted to Te Urewera, and will allow Ngāi Tūhoe to promote the interests of their people in a unique way. The thesis will show that the face of co-governance is changing, and the future face of such arrangements may well give iwi more control. However, that there are pitfalls associated with such resource management power sharing schemes that must be taken into account when planning for future arrangements.

Orientador: Gastão Wagner de Souza Campos / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas / Made available in DSpace on 2018-08-13T03:50:50Z (GMT). No. of bitstreams: 1 Cunha_GustavoTenorio_D.pdf: 3083996 bytes, checksum: 7394ebdd8397352bfd69c1fc23977597 (MD5) Previous issue date: 2009 / Resumo: A prática gerencial hegemônica costuma privilegiar a padronização de condutas e a fragmentação do trabalho, em lugar do apoio aos profissionais de saúde no desafio de fazer uma clínica ampliada, que reconheça a singularidade dos sujeitos e grupos. Esta prática gerencial reforça um tipo de clínica que costuma ter dificuldade para lidar com pessoas reais, uma vez que enxerga na complexidade do adoecimento e do sofrimento, apenas os aspectos diagnósticos e recortes disciplinares, com graves conseqüências para a qualidade da atenção. É necessário, portanto, que os profissionais desenvolvam tanto alguma crítica a este tipo de conhecimento universalizante (e ao hábito quase inconsciente de tomar a "parte" pelo "todo") quanto alguma capacidade de lidar com a subjetividade inerente ao trabalho em saúde (do usuário, dos grupos e dos próprios profissionais). Michaël Balint, em meados do século passado, foi pioneiro em apontar que o aprendizado clínico não se reduzia aos seus aspectos cognitivos, propondo a criação dos GRUPOS BALINT para o apoio através da discussão supervisionada de casos clínicos. O presente trabalho aborda alguns dos principais desafios da atenção básica e apresenta a elaboração e experimentação de um instrumento de apoio à gestão da clínica e formação dos profissionais: os Grupos BALINT-PAIDÉIA, que procura adaptar os grupos BALINT para a realidade atual do SUS em síntese com o Método Paidéia para a co-gestão de coletivos. Inicialmente, apresentam-se instrumentos conceituais relevantes - Método Paidéia, Grupos Balint, Equipe de Referência e Apoio Matricial, Projeto Terapêutico Singular (PTS) e Clínica Ampliada - juntamente com uma breve contextualização da Atenção Básica no SUS. Em seguida, apresenta-se a formulação da proposta de GRUPOS BALINT PAIDÉIA (GBP) como instrumento complementar de apoio e formação em serviço, privilegiando a clínica ampliada e a co-gestão. Apresenta-se, então, o relato da experimentação prática de um GBP com 18 profissionais médicos e enfermeiros da rede básica na cidade de Campinas, elaborada a partir do diário de campo, metodologia utilizada no acompanhamento do grupo. Na seqüência, são apresentados alguns possíveis aprendizados teóricos a partir desta experiência: (1) sobre a importância e as implicações da coordenação de casos clínicos; (2) sobre o tema da Clínica Ampliada e sua relação com os conceitos de Flash e Intuição, com o Método Clínico Centrado na Pessoa (MCCP), com algumas das contribuições de Nahman Armony ; (3) sobre a medicalização e os paradigmas de saúde; (4) sobre a influência das religiões nas práticas de saúde; e (5) sobre os desafios no processo de formação dos profissionais de saúde / Abstract: The hegemonic management practice usually focuses on the hegemonic standards of conduct and fragmentation of work, instead of supporting health professionals in the challenge to make an extended clinic, which recognizes the singularity of individuals and groups. The hegemonic practice reinforces one type of clinic that frequently shows difficulties in dealing with real people, since it withdraws from the complexity of illness and suffering, only the diagnostic aspects and disciplinary particularities, carrying serious consequences for the quality of health care as result. Hence it is necessary that professionals develop critical positions related to such universalizing knowledge (and to the almost unconscious habit of taking the "part" as the "whole") specially referring to some capacity to deal with the subjectivity which is inherent in working in health care (related to the user, to the groups and to the professionals themselves. Michael Balint, in the middle of last century, was the pioneer in pointing out that clinical learning is not reduced to its cognitive aspects. He proposed the creation of BALINT GROUPS as support by means of monitored discussion of clinical cases. This thesis addresses some of the major challenges of primary care and presents the development and experimentation of a support instrument to clinical management and training for health professionals: Groups BALINT-PAIDEIA, aiming to adapt the groups BALINT to the current reality in the Brazilian National Health System (SUS) and working with Paideia, a Method for collective co-management of groups. Initially, this work presents relevant conceptual tools - Method Paideia, Balint Groups, Reference and Support Team Matrix, Singular Therapeutic Project (TSP) and Extended Clinic - along with a brief contextualization of Primary Care in SUS. Then it presents the formulation of the proposed BALINT GROUPS PAID (GBP) as a complementary instrument to support and in-service training, focusing on clinical and expanded comanagement. It is then reported the hand-on practice experimentation of a GBP including 18 professional doctors and nurses of the core network in the city of Campinas, prepared from daily field notes, methodology which is used in monitoring the group. In sequence is presented some possible theoretical learning from this experience: (1) on the importance and implications for coordination of clinical cases, (2) on the issue of Extended Clinical its relationship along with the concepts of Flash and Intuition, along with to The Patient- Centred Clinical Method and finally with some contributions from Nahman Armony, (3) on the paradigms and the medicalization of health, (4) on the influence of religion in health care practices, and (5) on the challenges in the training of health professionals / Doutorado / Saude Coletiva / Doutor em Saude Coletiva

改革開放為中國大陸創造了令人驚艷的經濟成長，卻也帶來區域不平衡的嚴重問題。近年來，中國大陸區塊化的發展受到各界關注，包括珠三角、長三角、環渤海區等。而長期以來受到忽略的福建省，終於在海西區的規劃中得到了來自中共中央的政策支持。福建擁有對台先行先試，探索兩岸進行區域合作試點的權力，在海西區的架構下，平潭綜合實驗區被中共中央寄與厚望，以「五個共同」積極與台灣進行各種創新合作，其中，最為人所注目的即是「共同治理」。本文認為，從目前中共中央給予平潭的各項政策利多及兩岸在此議題上的角力來看，兩岸「共同治理」，仍有許多問題亟待克服。