Este trabalho tem o propósito de examinar as implicações da estrutura federativa brasileira no processo de regionalização das ações e serviços de saúde do Sistema Único de Saúde (SUS). A ideia nuclear é que, por sua natureza federativa, a regionalização da saúde no Brasil deve realizar-se no contexto das relações intergovernamentais fundadas na configuração institucional do federalismo cooperativo do país e em sua expressão na área da saúde. O método empregado inclui a utilização de material bibliográfico e a incorporação de componentes de investigação empírica. A análise desenvolvida baseia-se numa abordagem diacrônica do federalismo, tomando-o como princípio organizador do Estado que se manifesta em suas diversas dimensões. Desse modo, o fenômeno do federalismo é estudado em função de sua evolução no tempo e, de forma concatenada, partindo de seus aspectos gerais em direção aos específicos que se exprimem no Estado brasileiro e particularmente no âmbito da saúde. O federalismo sanitário brasileiro é abordado a partir de seu ingresso no ordenamento constitucional, identificando dois períodos bem delimitados de formação: a descentralização e a regionalização. Agregam-se elementos empíricos de pesquisa em que a regionalização da saúde é caracterizada a partir de concepções expressas por atores políticos que representam as perspectivas das três esferas de governo. Os condicionantes do processo de regionalização do SUS são então explorados à luz do referencial teórico do federalismo em três dimensões de análise: base normativa, estrutura de financiamento e dinâmica política. Assim, identificam-se pontos facilitadores e entraves para a regionalização e apontam-se possibilidades para a efetivação dessa diretriz organizativa no SUS. Conclui-se que a regionalização da saúde no Brasil está apoiada em arcabouço normativo bem definido, proveniente da assimilação dos princípios do federalismo cooperativo no direito sanitário brasileiro, e que encontra obstáculos derivados do modelo federativo de financiamento e relacionados ao funcionamento das relações intergovernamentais instituídas no SUS. / This study aims to examine the implications of Brazilian federal structure in the regionalization process of healthcare services of the national health system (Sistema Único de Saúde SUS). The core idea is that, by its federal nature, the regional health planning in Brazil must take place in context of intergovernmental relations founded on the institutional configuration of cooperative federalism in the country and on its expression in health. The method includes the use of bibliographic material and incorporation of empirical research components. The analysis is based on a diachronic approach, taking federalism as an organizing principle of State which is manifested in its various dimensions. Therefore, the phenomenon of federalism is studied in terms of its evolution in time and, so concatenated, starting with its general aspects towards specific ones which are expressed in the Brazilian State and particularly in health. The Brazilian health federalism is approached from its entry into the constitutional order, with two clearly defined development periods: decentralization and regionalization. Empirical elements are added from a study in which health regionalization is characterized from ideas expressed by political actors representing the perspectives of three levels of government. The conditioning factors of SUS regional health planning are then explored in light of the federalism theoretical framework taking three dimensions of analysis: normative basis, funding structure and political dynamics. Thus, facilitators and barriers to regional health planning are identified and opportunities for actualizing this organizational guideline in SUS are indicated. It is concluded that health regionalization in Brazil is supported by well-defined regulatory framework, proceeding from assimilation of cooperative federalism principles in Brazilian health law, and that it has obstacles derived from the federal model of financing and related to the operation of intergovernmental relations established in SUS

Master of Philosophy / As Australia’s leading agency for funding health research (expending over $400 million in 2006), the National Health and Medical Research Council (NHMRC) has a major responsibility to improve the evidence base for health policy and practice. There is an urgent need for better evidence to guide policy and programs that improve the health of Indigenous peoples. In 2002, NHMRC endorsed a series of landmark policy changes to acknowledge its ongoing role and responsibilities in Indigenous health research—adopting a strategic Road Map for research, improving Indigenous representation across NHMRC Council and Principal Committees, and committing 5% of its annual budget to Indigenous health research. This thesis examines how these policies evolved, the extent to which they have been implemented, and their impact on agency expenditure in relation to People Support. Additionally, this thesis describes the impact of NHMRC policies in reshaping research practices among Indigenous populations.

M. Tech. Business Information Systems / Field-based healthcare is the provisioning of healthcare outside a traditional healthcare facility whose location is fixed. Although healthcare is not location and time dependent, the delivery of the service is often constrained to particular location and time. That is, although data accuracy and timely access to medical information is vital, healthcare service providers are not mobile enough to provide the on-demand healthcare service to patients. With restricted mobility, mistakes, unavailability and inaccuracy of information can have life-threatening consequences. To this point, this mini-dissertation argues that Mobile Information Technology (IT) Innovation could leverage field-based healthcare. Thus Mobile IT is considered essential to reducing medical errors, enhancing patient safety and improving quality of healthcare service delivery. Mobile IT can also be leveraged to meet ICT infrastructural challenges of field-based healthcare. That is, to enhance this service delivery, Mobile IT innovation will include the use of mobile devices such as mobile phones, smart phones, pocket computers, wireless networks and other technologies such as Radio Frequency Identification, smart cards, as well as information systems accessed through these technologies. In recent years, cases of Mobile IT application in healthcare service, particularly in South Africa, suggest the use of Mobile IT for disease management, monitoring as well as evaluation of patient care activities. There is a need for an empirical study to highlight the determinant factors that influence Mobile IT innovation for field-based healthcare. In response to this need, this study captured and unraveled the complexity of Mobile IT innovation for field-based healthcare through a case study conducted at a healthcare service provider.

The research explored the new health care service vehicle of South African with special reference to health service providers in Western Cape Department of health for the period 1995-2001. A study was made of the District Health System and the shift of emphasis from tertiary and secondary level of health care to the more cost effective Primary Health Care Service rendered at District level.

The aim of this thesis was to conduct a situational assessment of human resources planning at one local health authority, in order to determine how decentralisation has impacted the effectiveness of human resources planning.

Master of Philosophy / As Australia’s leading agency for funding health research (expending over $400 million in 2006), the National Health and Medical Research Council (NHMRC) has a major responsibility to improve the evidence base for health policy and practice. There is an urgent need for better evidence to guide policy and programs that improve the health of Indigenous peoples. In 2002, NHMRC endorsed a series of landmark policy changes to acknowledge its ongoing role and responsibilities in Indigenous health research—adopting a strategic Road Map for research, improving Indigenous representation across NHMRC Council and Principal Committees, and committing 5% of its annual budget to Indigenous health research. This thesis examines how these policies evolved, the extent to which they have been implemented, and their impact on agency expenditure in relation to People Support. Additionally, this thesis describes the impact of NHMRC policies in reshaping research practices among Indigenous populations.

Thesis (MPhil)--Stellenbosch University, 2002. / ENGLISH ABSTRACT: One of the main objectives of the new South African government who came into power in 1994 was to improve the daily living conditions of its citizens. To what extent did the government succeed in this objective? This is the basic research question informing the present study. In order to keep it within manageable proportions, the study investigated a very specific area of service delivery, namely the delivery of public health services. This was further narrowed down to the Western Cape and more specifically, to the role of public hospitals in the area. The Western Cape promised to be an interesting case, because although the government of national unity was dominated by the ANC, the Western Cape was ruled by a NNP dominated coalition. On the national level, the Province had to follow national policy guidelines, while on the provincial level it had more freedom to formulate and implement its own policies. The study itself consists of two parts. The first concerns policy formulation, the second policy implementation. As far as policy formulation is concerned, a study was made of basic documents articulating the fundamental values, national priorities and main objectives informing government policy. These included the Freedom Charter, the Constitution, and the Reconstruction and Development Program. It was found that these values and priorities were in general well translated into policy options on both the national and provincial level, especially in the various documents aimed at transforming the national health system. The second part of the study investigates the implementation of the broad policy guidelines in the area of public heath in selected public hospitals in the Western Cape. The main method of investigation was the use of structured interviews with representative employees from all different levels. The findings were therefore of a qualitative rather than a quantitative nature. The focal areas selected were personnel management issues, human resource planning, labour relation issues and human resource development issues. The main findings were that the formulation of policy both from basic values to the level of health care policies and from the national to provincial level in general was quite successful. On the other hand, there were serious shortcomings in the implementation of these policies on various levels. The investigation revealed a mixed and often contradictory picture. Although some hospitals made good progress in some respects, there is still a long way before quality health care will be delivered to all patients. A commitment to equity in the health services of the country implies a commitment to correcting the historical gender, class and racial imbalances in the development of human recourses for health care. Of necessity, a compassionate and caring health service will address the issue of corrective action. There is a real need to provide proper planning of those most disadvantaged by apartheid in managerial skills to fill managerial positions in the health sector. It is therefore is necessary to introduce as a matter of urgency new health management programmes, which will promote efficient and effectiveness management at all levels of health care service delivery. Current health managers need to be reoriented from the predominantly bureaucratic, rule-based approach towards a participative approach. The development of managerial capacity in areas such as participative and change management, leadership development, strategic planning, programme management and evaluation, and policy development and implementation is of crucial importance. The study concludes with a series of specific recommendations with regard to affirmative action, managerial and institutional capacity, human resource planning, and training needs for various sectors. / AFRIKAANSE OPSOMMING: Een van die hoofdoelstellings van die nuwe Suid-Afrikaanse regering wat in 1994 aan bewind gekom het, was om die leefomstandinghede van al die land se inwoners te verbeter. Tot watter mate het die regering geslaag in hierdie doelwit? Dit is die basiese navorsingsvraag onderliggend aan hierdie studie. Ten einde die ondersoek binne hanteerbare grense te hou, is op slegs een aspek van dienslewering gekonsenteer, naamlik die lewering van gesondheidsdienste. Hierdie terrein is verder vernou tot die Wes-Kaap en meer spesifiek tot die rol van openbare hospitale. Die Wes-Kaap was interessant omdat hoewel die regering op nasionale vlak deur die ANC beheer is, die Wes-Kaap basies deur die NNP in die periode van ondersoek geregeer is. Die provinsie was verplig om nasionale beleidsriglyne te volg, maar op provinsiale vlak het dit 'n sekere speelruimte geniet om eie beleid te formuleer en te implementeer. Die studie bestaan uit twee dele. Die eerste het te doen met beleidsformulering, die tweede met beleidsimplementering. Wat beleidsformulering betref, is 'n studie gemaak van die basisdokumente wat die kernwaardes, nasionale prioriteite en hoof doelstellings van die regering bevat. Dit het ingesluit die Vryheidmanifes, die Konstitusie en die Heropbou- en Ontwikkelingsprogram. Daar is bevind dat hierdie waardes en prioriteite in die algemeen suksesvol vertaal is in beleidsopsies op beide die nasionale en provinsiale vlak, veral in die dokumente wat gerig was op die transformasie van die nasionale gesondheidsektor. Die tweede deel van die studie het die implementering van die breë beleidsriglyne in die area van openbare gesondheid in geselekteerde publike hospitale in die Wes-Kaap ondersoek. Die hoof-ondersoekmetode was gestruktureerde onderhoude met verteenwoordigende werknemers van alle vlakke. Die bevindinge was gevolglik meer van 'n kwalitatiewe as kwantitatiewe aard. Die fokusareas waarop geskonsentreer is, was personeelbestuur, menslike hulpbronbeplanning, arbeidsverhoudinge en die ontwikkeling van menslike potensiaal. Die hoofbevindinge was dat die formulering van beleid beide van basiese waardes na gesondheidsbeleid en van die nasionale na provinsiale vlak in die algemeen suksesvol was. Aan die ander kant het ernstige gebreke aan die lig gekom sover dit die implementering van beleid op verskillende vlakke betref. Die resultaat was 'n gemengde en dikwels kontrasterende prentjie. Hoewel sommige hospitale goeie vordering gemaak het in sekere opsigte, laat die lewering van gehalte-diens aan alle pasiënte nog veel te wense oor. Die verbintenis to gelykheid in gesondheidsdienste veronderstel 'n verbintenis tot die regstelling van geslags-, klas- en rasse-ongelykhede in die ontwikkeling van menslike hulpbronne in die gesondheidsektor. Dienslewering gebaseer op sorg en empatie is van deurslaggewende belang in hierdie opsig. Daar is 'n groot behoefte aan behoorlike beplanning vir die verbetering van bestuur- en ander vaardighede van agtergestelde groepe. Die implementering van behoorlike bestuursopleidingsprogramme is van die uiterste belang, wat kan bydra tot effektiewe en goeie dienslewering. Die huidige oorwegend burokratiese en reëlsgebonde bestuurstyl behoort in 'n deelnemende benadering omgeskakel te word. Die ontwikkeling van bestuurskapasiteit in gebiede soos deelnemende veranderingsbestuur, leierskapsontwikkeling, strategiese beplanning, programbestuur en -evaluering en beleidsformulering is van die grootse belang. Die ondersoek sluit af met 'n reeks konkrete aanbevelings met betrekking tot regstellende aksie, verbetering van bestuurskapasiteit, menslike hulpbronontwikkeling en die opleidingsbehoeftes van die verskillende afdelings.

A presente dissertação é resultado de uma pesquisa de mestrado realizada acerca dos temas controle social e Política de Saúde do Trabalhador e da Trabalhadora na atenção básica. A partir de diversas conceitualizações, este trabalho opta pela definição de que o controle social está a serviço de um Estado democrático de acesso igualitário a direitos e de participação da população no planejamento e acompanhamento de todas as ações deste mesmo Estado. A Política de Saúde do Trabalhador tem origem no período brasileiro de lutas democráticas contrárias ao autoritarismo do governo militar e em consonância com a perspectiva da Saúde Coletiva, que considera o contexto econômico, financeiro e social de organização dos processos de trabalho. Esta pesquisa delineou-se como um estudo de caso de análise situacional, cuja questão norteadora e objetivos foram construídos após realização de pesquisa exploratória em um Conselho Gestor de um Centro de Referência em Saúde do Trabalhador do Rio Grande do Sul. O campo foi escolhido em consonância com as pesquisas previamente realizadas pelo Núcleo de Estudos e Pesquisa em Saúde e Trabalho (NEST) da Universidade Federal do Rio Grande do Sul. O objetivo principal proposto foi identificar como se dá a participação do Conselho Gestor na implementação da Política Nacional de Saúde dos Trabalhadores e das Trabalhadoras junto ao Centro de Referência em Saúde do Trabalhador. As técnicas utilizadas foram realização de grupo focal, com apoio de um roteiro de entrevista semiestruturada, diário de campo e revisão teórica e documental acerca do tema. Para análise dos dados foi utilizado o método de análise de conteúdo. A sistematização das categorias foi realizada a partir dos objetivos. Os resultados encontrados são referentes ao Conselho Gestor ser uma instância sobre a qual os conselheiros tem pouca clareza do seu lugar; os conselheiros entendem que devem estimular e realizar práticas relativas a atenção básica de prevenção e promoção da saúde do trabalhador; a relação estabelecida com os gestores públicos acontece com diversas dificuldades; os próprios conselheiros tem dificuldade de se ver na posição de gestores e por fim, apontam diversas práticas democráticas de gerenciamento que desempenham sem perceber que estão realizando gestão. Nas considerações finais fica evidenciado o mérito da organização coletiva e democrática deste grupo de Conselho Gestor, o qual não tem diretriz nacional específica a seguir, portanto organizando-se desta forma espontaneamente. / The present dissertation is the result from a master’s degree study performed on social control themes and the Health Policy of the male and female Workers in basic care. It is based on diverse conceptualizations; this study opted for the definition that social control is the work of a democratic State for egalitarian access to rights and the participation of the population in the planning and following up on all the actions of that same State. The Worker Health Care Policy originated in the Brazilian period of democratic struggles against the authoritarianism of the military government and in consonance to the perspective of Collective Health Care, which considers the economic, financial, and social context of the organization of labor processes. This research study was delineated as a situational analysis case study, whose guiding theme and objectives were constructed after performing exploratory research on an Administrative Council of a Reference Center in a Worker Health Care Center in the state of Rio Grande do Sul. The field was selected in consonance with the previous research studies performed by the “Núcleo de Estudos e Pesquisa em Saúde e Trabalho” (NEST) (Health and Labor Research and Study Nucleus) of the “Universidade Federal do Rio Grande do Sul” (Federal University of Rio Grande do Sul). The main proposed objective was to identify what the participation of the Administrative Council is like in the implementation of the National Health Policy of Male and Female Workers at the Reference Worker Health Care Center. The techniques used were performed on the focal group, supported by a semi-structured outline, field diary, and theoretical and documental revision on the theme. The content analysis method was used for data assessment. The systematization of the categories was performed based on the objectives. The result findings refer to the Administrative Council as being an entity by which the counselors perform their role unclearly; the counselors understand that they must foment and perform practices related to basic preventive care and promote the health of workers; the relationship established with the public administrators takes place facing diverse hindrances; the respective councilors find it difficult to place themselves in the position of administrators and ultimately that point out diverse democratic practices of management achieving results without realizing that they are administrating. In the final considerations the merit of the collective and democratic organization became evident of this group of the Administrative Council, which does not have a specific national guideline to follow; therefore it is organized in this spontaneous format.

A presente dissertação é resultado de uma pesquisa de mestrado realizada acerca dos temas controle social e Política de Saúde do Trabalhador e da Trabalhadora na atenção básica. A partir de diversas conceitualizações, este trabalho opta pela definição de que o controle social está a serviço de um Estado democrático de acesso igualitário a direitos e de participação da população no planejamento e acompanhamento de todas as ações deste mesmo Estado. A Política de Saúde do Trabalhador tem origem no período brasileiro de lutas democráticas contrárias ao autoritarismo do governo militar e em consonância com a perspectiva da Saúde Coletiva, que considera o contexto econômico, financeiro e social de organização dos processos de trabalho. Esta pesquisa delineou-se como um estudo de caso de análise situacional, cuja questão norteadora e objetivos foram construídos após realização de pesquisa exploratória em um Conselho Gestor de um Centro de Referência em Saúde do Trabalhador do Rio Grande do Sul. O campo foi escolhido em consonância com as pesquisas previamente realizadas pelo Núcleo de Estudos e Pesquisa em Saúde e Trabalho (NEST) da Universidade Federal do Rio Grande do Sul. O objetivo principal proposto foi identificar como se dá a participação do Conselho Gestor na implementação da Política Nacional de Saúde dos Trabalhadores e das Trabalhadoras junto ao Centro de Referência em Saúde do Trabalhador. As técnicas utilizadas foram realização de grupo focal, com apoio de um roteiro de entrevista semiestruturada, diário de campo e revisão teórica e documental acerca do tema. Para análise dos dados foi utilizado o método de análise de conteúdo. A sistematização das categorias foi realizada a partir dos objetivos. Os resultados encontrados são referentes ao Conselho Gestor ser uma instância sobre a qual os conselheiros tem pouca clareza do seu lugar; os conselheiros entendem que devem estimular e realizar práticas relativas a atenção básica de prevenção e promoção da saúde do trabalhador; a relação estabelecida com os gestores públicos acontece com diversas dificuldades; os próprios conselheiros tem dificuldade de se ver na posição de gestores e por fim, apontam diversas práticas democráticas de gerenciamento que desempenham sem perceber que estão realizando gestão. Nas considerações finais fica evidenciado o mérito da organização coletiva e democrática deste grupo de Conselho Gestor, o qual não tem diretriz nacional específica a seguir, portanto organizando-se desta forma espontaneamente. / The present dissertation is the result from a master’s degree study performed on social control themes and the Health Policy of the male and female Workers in basic care. It is based on diverse conceptualizations; this study opted for the definition that social control is the work of a democratic State for egalitarian access to rights and the participation of the population in the planning and following up on all the actions of that same State. The Worker Health Care Policy originated in the Brazilian period of democratic struggles against the authoritarianism of the military government and in consonance to the perspective of Collective Health Care, which considers the economic, financial, and social context of the organization of labor processes. This research study was delineated as a situational analysis case study, whose guiding theme and objectives were constructed after performing exploratory research on an Administrative Council of a Reference Center in a Worker Health Care Center in the state of Rio Grande do Sul. The field was selected in consonance with the previous research studies performed by the “Núcleo de Estudos e Pesquisa em Saúde e Trabalho” (NEST) (Health and Labor Research and Study Nucleus) of the “Universidade Federal do Rio Grande do Sul” (Federal University of Rio Grande do Sul). The main proposed objective was to identify what the participation of the Administrative Council is like in the implementation of the National Health Policy of Male and Female Workers at the Reference Worker Health Care Center. The techniques used were performed on the focal group, supported by a semi-structured outline, field diary, and theoretical and documental revision on the theme. The content analysis method was used for data assessment. The systematization of the categories was performed based on the objectives. The result findings refer to the Administrative Council as being an entity by which the counselors perform their role unclearly; the counselors understand that they must foment and perform practices related to basic preventive care and promote the health of workers; the relationship established with the public administrators takes place facing diverse hindrances; the respective councilors find it difficult to place themselves in the position of administrators and ultimately that point out diverse democratic practices of management achieving results without realizing that they are administrating. In the final considerations the merit of the collective and democratic organization became evident of this group of the Administrative Council, which does not have a specific national guideline to follow; therefore it is organized in this spontaneous format.

Este estudo objetivou analisar a viabilidade de implantação de sistemas de custeio na Rede Hospitalar Federal no Rio de Janeiro, investigando a existência de sistemas de custeio implantados, e, em caso positivo, quais os métodos de custeio utilizados, o perfil das unidades e dos gestores, bem como suas experiências em utilização de sistemas de custeio e suas percepções sobre a questão da implantação de sistemas desta natureza nas unidades analisadas. Para tanto, realizou-se um estudo exploratório, qualitativo. Empregou-se como instrumento de um questionário estruturado, contendo perguntas fechadas e abertas, que foi aplicado aos diretores gerais, coordenadores assistenciais e aos coordenadores administrativos - bem como com alguns responsáveis por áreas financeiras e áreas afins, dos 6 hospitais que compõem a Rede Hospitalar Federal do Rio de Janeiro, no período compreendido entre novembro de 2009 e março de 2010. As respostas ao questionário foram tabuladas e analisadas com o aplicativo estatístico EXCEL versão 7.0 da Microsoft. O estudo revelou que a Rede Hospitalar Federal do Rio de Janeiro não utiliza quaisquer formas de apuração de custos e que os gestores consideram o momento como propicio a implantação de sistemas de custeio nestas unidades. Algumas questões importantes foram apontadas, como a não utilização de quaisquer sistemas de custeio e a existência de um ambiente favorável ao inicio de trabalhos de implantação de sistemas de custeio nas unidades / This study aimed to examine the feasibility of deployment of costing systems in the Federal Network of Hospitals in Rio de Janeiro, investigating the existence of costing systems deployed, and if so, which of the costing methods used, the profile of the units and their managers as well as their experiences in the use of costing systems and their perceptions on the issue of deployment of the systems in production services. To this end, we carried out an exploratory, qualitative. Was employed as an instrument of a structured questionnaire containing closed and open questions, which was applied to general managers, care coordinators and administrative coordinators - as well as some areas responsible for financial and related fields, the six hospitals comprising the Network Hospital Federal do Rio de Janeiro during the period between November 2009 and March 2010. The questionnaire responses were tabulated and analyzed with the statistical application of Microsoft EXCEL version 7.0. The study revealed that the Federal Network of Hospitals in Rio de Janeiro does not use any form of cost settlement and that the managers consider the propitious moment as the deployment of costing systems in these units. Some important issues have been identified as not using any cost systems and the existence of a favorable environment for the early deployment jobs costing systems in the units