Magister Public Health - MPH / Disparity in health service delivery between Ghana’s urban and rural areas has been noted to have contributed significantly to the huge gap that exists in health status between the rural and urban areas in the country. Consequently, since the Alma Ata Conference in 1979, Ghana has had a policy of making community-based services available to all, through community-based care and has adopted the Community-based Health Planning and Services (CHPS) Initiative as a national health reforms strategy to mobilize volunteerism, resources and cultural institutions for supporting community-based primary health care. The successful implementation of the CHPS initiative rests heavily on the participation and involvement of the communities.

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The purpose of this study is to trace the growth and development of the health service program of the North Texas State Teachers College from 1918-1941 through Campus Chat files, the Minute Book of the Board of Regents of the Teachers College, college records, hospital records, and personal interviews with staff members of North Texas State Teachers college who have been affiliated with the program since its beginning in 1918.

Background Based on the Global Trends report from the United Nations High Commissioner for Refugee, in high-income countries, there are 2.7 refuges per 1,000 national population, girls and women account for nearly 50 percent of this refuge population. In these high-income countries, compared with the general population refuge women have higher prevalence of mental illness. To our knowledge this is the first systematic review that addresses access to mental health services for refugee women in high-income countries. Thus, this review was conducted to examine the barriers to and facilitators of access to mental health services for refugee women in high-income countries for refugee resettlement. Methods MEDLINE, EMBASE, PsycINFO, and CINAHL databases were searched for research articles with qualitative component (including mixed-method or multi-method with qualitative component), in order to examine barriers and facilitators related to accessing mental health services. Relevant studies were collected on March 14, 2020 and were extracted and critically appraised by multiple authors. A narrative synthesis was conducted with the included studies to gather key synthesis evidence. Results Of the four databases searched, 1258 studies were identified with 12 meeting the inclusion criteria. The major barriers identified were language barriers, stigmatization, and the need for culturally sensitive practices to encourage accessing mental health care within a religious and cultural context. There were several studies that indicated how gender roles and biological factors played a role in challenges to accessing mental health services. The major facilitators identified were service availability and awareness in resettlement countries, social support and the resilience of refugee women to ease access of mental health services. Conclusion This review revealed socio-economic factors contributed to barriers and facilitators to accessing mental health among women refugees and asylum seekers. Addressing those social determinants of health can reduce barriers and enhance facilitators of access to mental health care for vulnerable populations like refugee women. Although there is a difference in health access policy among the top resettlement courtiers, the review found that there are no significant differences in accessing mental health for refugee and asylum seeker women among leading resettlement countries. The review findings suggest the need for further research on this topic given the potential significance of the findings on refugee and asylum seeker women mental health.

Home physiotherapy is a valid service option for the patient who was recently discharged from hospital after sustaining a stroke, as it enhances functional independence in friendly and familiar surroundings, as opposed to an outpatient clinic (Bader 2008). The aim of this study was to investigate the system responses to the planning and implementation of a home physiotherapy service as an innovation within the Maltese Public Health Service, uncovering barriers or constraints that influenced the introduction and development of state-run home physiotherapy in Malta. Method A qualitative approach was used for this research. A case study design was selected because it possessed contextual, descriptive and heuristic characteristics. Study participants planned and implemented the service using the available resources. Policy makers, physiotherapists, stroke patients and caregivers contributed to the study through their responses to, and experiences of, this service innovation. It was both an exploration and an opportunity to learn about service innovation from a Maltese perspective. A group of stakeholders were interviewed during the planning stage (Phase 1) of the home physiotherapy service. The main purpose of these interviews was to inform the design of the service. Another group of participants was interviewed in the active service stage (Phase 2) - at the beginning and at the end. The purpose here was to gather data from their direct experiences with home physiotherapy. Documents relevant to home rehabilitation were accessed and analysed hermeneutically. These included newspaper media, as it was considered a sensitive instrument to understand social context (Catalán Matamoros 2007; Davis 1990). Findings and discussion Data analysis identified categories of findings such as ¿barriers to the implementation of a new service¿, ¿attitudes to home physiotherapy¿ and ¿fragmented rehabilitation service¿. The category components were discussed and linked to the hermeneutical analysis of documents, offering a deeper understanding of the categories within the local context, and revealing a reinforcement of establishment-based health care. Conclusion The findings of this study provided an insight into the constraints that would appear if home physiotherapy, indeed home rehabilitation, were introduced by the Maltese Public Health Service. This research had an impact on the state physiotherapy services. Recommendations to help mitigate the constraints in an overarching manner were offered at the end of the thesis. To the international reader with experience in organised home physiotherapy, this study gives a glimpse into how issues that would seem trivial and obvious at first glance become significant challenges¿.challenges that the uninitiated would need to overcome.

The public sector, particularly healthcare organisations are under ever increasing pressure to do more with less. This coupled with the need to keep up to the constant technological changes and ever increasing abundance of information has led to many public sector organisations adopting Business Intelligence (BI) in order to leverage business value and improve decision-making. However, many organisations such as the National Health Service (NHS) continue to fail in their Information Technology (IT) related initiatives. While the rise of BI and its growing influence in organisations has attracted much academic attention, this has largely been from architectural, design and technological perspectives, whilst little is known about how BI is used by various organisational actors to reach decisions, nor much is understood regarding its resulting impact on organisational power dynamics. Thus, there remains an under researched area of discussion in the literature from the perspective of BI users. While studies report how BI can impact organisational effectiveness, facilitate data driven decision making and supposedly overcome intuitive decision making, the extent to which BI impacts and alters power dynamics between organisational actors across the organisation has received little attention. Accordingly, this research adopts a qualitative case study approach to explore power resulting from BI use within a large NHS trust by conducting 30 semi-structured interviews consisting of operational managers and BI analysts. Through taking a human-centric approach, this research uncovers how BI is altering power dynamics between organisational actors, whereby BI analysts are becoming increasingly influential as a result of their analytical skills. It was found that operational managers are becoming more reliant upon data analysts, resulting in the analysts having more and more influence. However, this research finds it is only when the analysts supplement their technical skill-set with their institutional knowledge, that they have the ability to influence and enact power within the organisational settings. The research also offers insights into the contestations and conflicts which arise from the use of BI, between operational managers and analysts as well as between in-house analysts, based in the operation setting and the centralised analysts, operating across the entire trust. Accordingly, this research empirically validates a BI Power Enactment Framework and proposes the BI Power Matrix, which may assist policy makers in identifying determining key factors which are contributory to the success or failure of technological initiatives.

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