Background This thesis explores processes involved in stakeholders’ attempts to secure sustainability of three short-term funded community health initiatives known as healthy living centres (HLCs). The overall aim was to identify and examine development of sustainability strategies in Scottish HLC organisations. In contrast to retrospective accounts examining influences on extent of sustainability little is known about how this concept is considered by organisations approaching the end of funding. Organisational development theorising has focused on organisational change, with no attention given to sustainability processes in short-term funded organisations. Building on a concurrent longitudinal evaluation of a larger sample of HLCs, the temporal nature of this PhD study offered scope to explore development of, influences on and changes to stakeholders’ sustainability strategies over time. Methods The study used a qualitative evaluation methodology. A case study approach framed the HLCs, permitting comparison between sites. An ethnographic approach using observations and in-depth interviews was employed. Interviews were undertaken with stakeholders (comprising managers, staff, partners and board members) from each HLC. Managers were interviewed on several occasions. Latterly, interviews were undertaken with respondents holding policy, practice and funding posts. A thematic analysis, informed by grounded theory, was carried out. This used a constant comparative methodology to understand the data against the backdrop of the PhD study aims and wider literature. Findings Findings examine stakeholders’ accounts of the impact of a range of issues on HLC sustainability strategies. These are located in the context of health and community sector restructuring. Especially challenging were: efforts to secure local partners and further lottery funding; consideration of new funding criteria and models of service delivery; and limitations in demonstrating effectiveness. Addressing such challenges, managers’ strategic positioning signified attempts to influence HLCs’ fit within local health structures. Stakeholders’ accounts highlighted attempts to secure continuation of HLCs’ original identity; ensuring continued accessibility of Centres to local communities; and, seeking continuation of developmental methods of work. External respondents’ perspectives illuminated how policy-driven changes restricted system-wide attention to HLC sustainability. Latterly, Government-provided funding offered a short-term fix, enabling continuation of attempts to secure sustainability. Conclusions and implications This study offers new perspectives on the temporal exploration of sustainability of shortterm funded health initiatives. Analysis of stakeholders’ accounts over time provides insight into the effects of restructuring and ways in which system-wide flux impacted on influences known to enhance the likelihood of sustainability. Recommendations address programme design and wider responsibilities of health system actors in positioning and considering a future for such organisations after short-term funding ends.

This qualitative study focuses on the intersection of Organizational Studies and Public Health. Through the use of cross-sector work, the Public Health field coordinates work across multiple organizations to diagnose and prevent health issues. Interviewing several administrators from organizations who partake in the Healthy Ontario Initiative allowed me to examine how organizations of different types and sectors interact and connect around this project. This study will predominantly focus on the challenges they face, how they overcome them, and how they are evaluated. Highlighting the intersection of Public Health and Organizational Studies and the way a current Public Health initiative organizes and delivers services may impact the way in which the field evolves in the future.

The Global Fund to Fight HIV/AIDS, Malaria and TB and U.S President’s Emergency Fund for AIDS Relief (PEPFAR) are global health initiatives (GHIs) that were established in the early 2000s with the mandates to increase global capacity to address HIV and AIDS rapidly. When the two GHIs were created, Namibia was one of the highest recipients of funding from both GHIs. A significant portion of their support to the country went to the Ministry of Health, which was the principal provider of treatment services in the country. Critics have argued, however, that the rise of financial support from the Global Fund and PEPFAR was associated with the creation of new administrative structures and procedures at the country level. This approach raises important questions about the degree to which Namibian health policymakers were able to exercise autonomy in the presence of GHI support. The aim of this thesis is to analyse the implications for institutional capacity and autonomy at the rise and fall of funding from the Global Fund and PEPFAR to the Ministry of Health concerning financial flows; human resources recruitment; and civil society engagement. With a focus on the changing relationship between the Ministry of Health and the two initiatives, the thesis examines the implications for country ownership and health systems capacity in the context of decreasing financial support from the Global Fund and PEPFAR. The field studies for this research was undertaken in 2011- 2012, when the two GHIs had indicated their intentions to scale-down the financial support made available to Namibia. This thesis uses multiple sources of data to qualitatively analyse the influences of Global Fund and PEPFAR support to Namibia from when the two initiatives were first established in 2002 and 2004, respectively, to 2012. A principal source of data was 43 semi-structured interviews conducted in Namibia during a placement with the Directorate of Special Programs in the Ministry of Health in early 2012. For financial flows, both the Global Fund and PEPFAR channelled and managed their funding through funder-specific structures and procedures that were developed and operated in parallel to existing Ministry of Health operations. Both for financial flows and human resources, initial structures and processes created difficulties for the Ministry of Health’s long-term objectives for HIV and AIDS. For civil society engagement, the thesis examined the Ministry of Health’s relationship with the Global Fund. At the rise of funding, the Global Fund required the establishment of a new multi-sector coordination structure for HIV and AIDS. This new structure operated at the same time as the existing national coordination structure and was perceived as having undermined the Ministry of Health’s role as the primary steward of Namibia's response. The Global Fund was also criticised for initially funding civil society organisations without making provisions for sustaining their capacity in the event of funding decline. The findings presented in this thesis indicate that at the rise of financing, the Ministry of Health’s engagement with the two HIV and AIDS GHIs initiatives was governed by the objectives of the two initiatives, rather than the long-term health systems goals of the Namibian Government. Their relationships with Namibia had an adverse impact on the Ministry of Health’s autonomy in making decisions on the national response to HIV and AIDS. The initial operations of the GHIs also had negative implications for Namibia's ability to sustain the health systems capacity they had helped to increase.

Försvarsmakten är en av Sveriges största myndigheter och har i uppgift att verka som landets försvar. Studien genomfördes genom ett samarbete med Försvarsmakten i Halmstad med syftet att belysa på vilket sätt Försvarsmakten i Halmstad arbetar för att främja de anställdas fysiska aktivitet för att de skall uppnå grundnivån enligt Försvarsmaktens Fysiska Standard. Syftet var även att studera de anställdas träningsvanor samt vilka faktorer som de upplever kan påverka deras benägenhet till att träna på arbetstid ur ett hälsoteoretisktperspektiv. Enkäten skickades ut till 325 anställda på Försvarsmakten i Halmstad, samt genomfördes tre intervjuer med tre anställda vilka arbetar med fysisk aktivitet. Resultatet från enkäten visade att den främsta anledningen till att de flesta som inte tränade på arbetstid inte gjorde det var på grund av hög arbetsbelastning och tidsbrist. Resultatet från intervjuerna visade att stor oro förelåg inför hösten 2018 då bemanningen ökar eftersom de redan har trångt med utrymmen och inte kommer räcka till för att främja och stötta alla som kommer att behöva det. Konklusion för studien kan dras som sådana att Försvarsmakten arbetar aktivt för att främja fysisk aktivitet, däremot bör det arbetas mer för att öka ett tillåtande och öppet klimat, där dialog uppmanas. Det föreslås att FM bör se över sin nuvarande hälsokultur och vidare genom hälsofrämjande arbete komplettera dess nuvarande arbete samt värna om de kulturer som faktisk kan främja fysisk aktivitet. / The Swedish Armed Forces is one of Sweden’s largest authorities and has the task of acting as the country’s defense. The study was conducted through a cooperation with the Swedish Armed Forces in Halmstad with the aim of illustrating the way in which the Swedish Armed Forces in Halmstad work to promote the physical activity of the employees in order to achieve the basic requirements according to the Swedish Armed Forces Physical Standard. The aim was also to study the employee’s training habits and which factors they perceive could influence their tendency to train during working hours via a health theoretical perspective. The survey was sent out to 325 employees at the Swedish Armed Forces in Halmstad, three interviews were conducted with three employees which work with physical activity. The result from the survey showed that the main reason why most employees don’t train during working hours were because of high workload and time constraints. The result from the interviews showed that great concern exist fore the fall of 2018 when more employees will come with already narrow spaces and they won’t be enough to promote and support everyone who will need it. In conclusion the study can prove that the Swedish Armed Forces in Halmstad work actively to promote physical activity, although they should work to increase a more accepting and open climate, were dialogues are encouraged. It is suggested that the Swedish Armed Forces in Halmstad should look over their current health culture and further through health promotion complement the work that exists now, but also nurture the actual cultures that promote physical activity.