Control of tuberculosis has often been managed as a simple issue, the belief being that activities to care for people affected by tuberculosis can be uniformly standardised and centred on the diagnosis and treatment of tuberculosis. The DOTS strategy has been the most concrete illustration of this approach. It is undeniable that this has been successful in re-organising unstructured and very inefficient national TB control programmes. Today, many countries’ programmes are better organised and have reached case detection and cure rates close to the targets set by WHO (i.e., 70% of cases effectively detected and 85% of detected cases cured). There are mounting arguments to enlarge the scope of activities to care for people affected by TB beyond the classical standardised strategies for diagnostic and treatment of tuberculosis. Indeed, it has become widely accepted that to increase further coverage of diagnosis and treatment of TB, it is necessary to address the economic and psychosocial problems of the people affected by tuberculosis, particularly for those having the least access to and worse quality of care. This will be possible only if, additionally to the current approaches, customised care can be developed after analysis to capture the complexity of care and interventions that take the specificity of local systems in their context into consideration. In chapter 1-2, we illustrate this through the review of the recent customisation of Directly Observed Treatment (DOT) as its naturally evolve in various contexts world-wide. Developing an analysis that captures complex issues in PATB care means having a proper understanding of the interactions between parts of the local care systems to people affected by TB and identifications of the important patterns of these interactions. That is possible only if information different than the usual quantitative indicators is generated. We illustrate this in the part 2. We took the case of Nicaragua’s TB control programme, which is renowned for its performance in America. In that context, we illustrated the limits of a classical approach to TB control programme evaluation (chapter 2-3) and gave four examples of care process analysis that illustrated the economic and psychosocial problems of people affected by tuberculosis (PATB) (chapter 2-4 to 2-7). Developing customised system-sensitive interventions to improve the care process means recognising that the interventions cannot be isolated from the organisational context and social dynamics during changes. Thinking must therefore move beyond the design of universal, standardised tool kits. We illustrate specifically in the part 3 the importance of combined local, national and international processes in improving the care process for people affected by TB in Nicaragua: lessons from successful and unsuccessful local and customised processes of implementing interventions in four local health systems (chapter 3-4) can be an opportunity for a health system research unit in a public health school to build a strategic process of care improvement at national level (through scaling up and through the building of a conducive environment) (chapter 3-5). As a conclusion of this work, we propose in part 4 a three-level reflection through discussion of patterns emerging from the analysis done in the previous chapters: (1) patterns of care and (2) of organisation of health care system are presented in the form of an analytical framework; (3) patterns of regulation and management to improve care for PATB are presented together with a strategy to work on it.

Nas últimas décadas inúmeras experiências alternativas na área de organização de serviços de saúde tem se desenvolvido no Brasil e países Latino Americanos. O autor considerando as atuais modificações do Sistema de Saúde no Brasil, a partir da criação do Sistema Único de Saúde, estuda a experiência realizada no município de Cotia, existente há mais de 20 anos, tendo como objetivo central analisar seu processo de implementação e os resultados obtidos, dentro da ótica de um Sistema Local de Saúde. O estudo de caso é desenvolvido em dois eixos básicos, um de contextualização da experiência, reconstituindo as diferentes políticas nas esferas federal, estadual e municipal e ainda suas bases conceituais, e outro a partir da experiência em si, recuperando os processos através dos aspectos institucionais, organizacionais, padrões de financiamento e modelo assistencial, avaliando ainda seus resultados e impactos na saúde da comunidade. As conclusões a partir do estudo de caso ressaltam alguns aspectos centrais. Em relação ao desenvolvimento institucional a particularidade da experiência de Cotia, é ter como instituição hegemônica uma entidade privada de caráter filantrópico, a Associação Hospital de Cotia. Essa Associação, desenvolve uma estrutura de participação local, mas predominantemente é orientada a partir de lideranças técnicas fora do município e ligada à Universidade (Faculdade de Saúde Pública). Sua organização contempla como base doutrinária a integração das ações preventivas e curativas e a conformação de uma direção única para o sistema, hospital e rede básica de saúde. Outro aspecto refere-se a formação de recursos humanos incorporada e desenvolvida desde o inicio da experiência. Em relação aos aspectos financeiros do sistema, durante todo período de sua existência a receita operacional tem forte dependência aos orgãos públicos, gerando deficits operacionais cobertos por doações e convênios com instituições internacionais. Em relação ao investimento, essa mesma dependência é observada. Os custos unitários de procedimentos obtidos pelo sistema podem ser considerados baixos, tendo em vista os aspectos qualitativos da prestação de serviço pelo mesmo. Quanto ao modelo assistencial, a experiência de Cotia obedeceu a critérios de racionalização de recursos adotando uma regionalização local, uma hierarquização da rede de serviços e uma articulação intra e intersetorial, desenvolvendo programas, respeitando a integralidade das ações de saúde, criando um sistema de referência e contra-referência efetivo tendo como base na sua priorização a realidade epidemiológico social da comunidade. O componente da participação comunitária do modelo, gerou experiências completas de gerência conjunta de unidades sanitárias e um grau de participação foi considerado satisfatório dada a realidade socio cultural do município. Quanto a área de recursos humanos a experiência desenvolve linhas de formação de recursos humanos de amplo espetro desde o nivel elementar até o nivel universitário, criando um sistema de formação de médicos gerais comunitários adaptados a realidade local. Quanto a dinâmica dos serviços e seus resultados, o sistema atingiu altos graus de cobertura nas populações de maior risco; interferindo de maneira efetiva na melhoria de alguns indicadores de saúde do município principalmente na área Materno-Infantil e de controle das doenças transmissíveis. O autor também vê no atual quradro de organização do Sistema Único, a partir da experiência estudada, a possibilidade de extensão do modelo tendo como base na área hospitalar as Santas Casas. Ainda recomenda o reestudo das formas de financiamento, para o desenvolvimento dos Sistemas Locais, e a criação de uma unidade de gerência neste nivel de intervenção sobre a realidade local. / Some alternative experiences concerning the organization of health services have been developed in Brazil and in other latin americam countries, these late decades. Regarding aspects of the Brazilian Health System imposed through our Constitution, the author studies the experience developed in the Cotia county since twenty years, always having as its main objeetive, the analysis of its implementation process and the achievement obtained within the concept of a Local Health System. The case study is developed focusing two basic points: one, referring the experience already attained by the federal, state and municipal health services, as far as its institutional organization; its financial and health model and final results attained, always dealing with the community health as a whole. The conclusions after the case study point out to some important aspects: dealing with the institutional development of the Cotia Project, it is emphasized a philantropic entity, the Cotia Hospital Association, which has a strong local participation as far its structure is concerned, but also, it is predominantly technical oriented from outside sources of the county, as the school of Public Health of the University of São Paulo. Its organization is based on the philosophy dealing with the integration of preventive and curative health activities, directed towards our existing health system, as far as hospital and health centers services are concerned. Another aspect deals with the development of new human recources, a subject which started at the beginning of the experience. Related to the financial aspects of the project, its operational funds since the starting of its activities, it depends on governmental funds and donations from philantropy as well as from agreements between the \"Associação\" and international institutions. The same situation goes on as far as money investment is concerned. Costs out of services offered are not too high, since its quality is always considered excellent. As far as the model of the Cotia experience, it was always directed towards the rationalization of its owm recources, the local regionalization and hierarchilization of health services, its intra and intersectorial articulation, always developing programs concerning the integration of acceptable health actions. This philosophy creates a two-way referencial system based on priorities and the social epidemiological reality of the community, given place to new experiences dealing with the community participation on he administration of the project. This is a very satisfactory achievement, considering the socio cultural reality of the Cotia county. Also, as far as the preparation of new human resources, the project has been. developing courses from the elementary up to the university levels of education, so creating an educational system for the training of the general practitioner, adapted to our local reality. As far as the dynamics of the services and final results, the project has been covering the population standing for high health risk, a fact that effectively attains the betterment of some of the indewes of the Cotia county, mainly concerning to maternal and infant care areas and also to the control of infectioms diseases.

Nas últimas décadas inúmeras experiências alternativas na área de organização de serviços de saúde tem se desenvolvido no Brasil e países Latino Americanos. O autor considerando as atuais modificações do Sistema de Saúde no Brasil, a partir da criação do Sistema Único de Saúde, estuda a experiência realizada no município de Cotia, existente há mais de 20 anos, tendo como objetivo central analisar seu processo de implementação e os resultados obtidos, dentro da ótica de um Sistema Local de Saúde. O estudo de caso é desenvolvido em dois eixos básicos, um de contextualização da experiência, reconstituindo as diferentes políticas nas esferas federal, estadual e municipal e ainda suas bases conceituais, e outro a partir da experiência em si, recuperando os processos através dos aspectos institucionais, organizacionais, padrões de financiamento e modelo assistencial, avaliando ainda seus resultados e impactos na saúde da comunidade. As conclusões a partir do estudo de caso ressaltam alguns aspectos centrais. Em relação ao desenvolvimento institucional a particularidade da experiência de Cotia, é ter como instituição hegemônica uma entidade privada de caráter filantrópico, a Associação Hospital de Cotia. Essa Associação, desenvolve uma estrutura de participação local, mas predominantemente é orientada a partir de lideranças técnicas fora do município e ligada à Universidade (Faculdade de Saúde Pública). Sua organização contempla como base doutrinária a integração das ações preventivas e curativas e a conformação de uma direção única para o sistema, hospital e rede básica de saúde. Outro aspecto refere-se a formação de recursos humanos incorporada e desenvolvida desde o inicio da experiência. Em relação aos aspectos financeiros do sistema, durante todo período de sua existência a receita operacional tem forte dependência aos orgãos públicos, gerando deficits operacionais cobertos por doações e convênios com instituições internacionais. Em relação ao investimento, essa mesma dependência é observada. Os custos unitários de procedimentos obtidos pelo sistema podem ser considerados baixos, tendo em vista os aspectos qualitativos da prestação de serviço pelo mesmo. Quanto ao modelo assistencial, a experiência de Cotia obedeceu a critérios de racionalização de recursos adotando uma regionalização local, uma hierarquização da rede de serviços e uma articulação intra e intersetorial, desenvolvendo programas, respeitando a integralidade das ações de saúde, criando um sistema de referência e contra-referência efetivo tendo como base na sua priorização a realidade epidemiológico social da comunidade. O componente da participação comunitária do modelo, gerou experiências completas de gerência conjunta de unidades sanitárias e um grau de participação foi considerado satisfatório dada a realidade socio cultural do município. Quanto a área de recursos humanos a experiência desenvolve linhas de formação de recursos humanos de amplo espetro desde o nivel elementar até o nivel universitário, criando um sistema de formação de médicos gerais comunitários adaptados a realidade local. Quanto a dinâmica dos serviços e seus resultados, o sistema atingiu altos graus de cobertura nas populações de maior risco; interferindo de maneira efetiva na melhoria de alguns indicadores de saúde do município principalmente na área Materno-Infantil e de controle das doenças transmissíveis. O autor também vê no atual quradro de organização do Sistema Único, a partir da experiência estudada, a possibilidade de extensão do modelo tendo como base na área hospitalar as Santas Casas. Ainda recomenda o reestudo das formas de financiamento, para o desenvolvimento dos Sistemas Locais, e a criação de uma unidade de gerência neste nivel de intervenção sobre a realidade local. / Some alternative experiences concerning the organization of health services have been developed in Brazil and in other latin americam countries, these late decades. Regarding aspects of the Brazilian Health System imposed through our Constitution, the author studies the experience developed in the Cotia county since twenty years, always having as its main objeetive, the analysis of its implementation process and the achievement obtained within the concept of a Local Health System. The case study is developed focusing two basic points: one, referring the experience already attained by the federal, state and municipal health services, as far as its institutional organization; its financial and health model and final results attained, always dealing with the community health as a whole. The conclusions after the case study point out to some important aspects: dealing with the institutional development of the Cotia Project, it is emphasized a philantropic entity, the Cotia Hospital Association, which has a strong local participation as far its structure is concerned, but also, it is predominantly technical oriented from outside sources of the county, as the school of Public Health of the University of São Paulo. Its organization is based on the philosophy dealing with the integration of preventive and curative health activities, directed towards our existing health system, as far as hospital and health centers services are concerned. Another aspect deals with the development of new human recources, a subject which started at the beginning of the experience. Related to the financial aspects of the project, its operational funds since the starting of its activities, it depends on governmental funds and donations from philantropy as well as from agreements between the \"Associação\" and international institutions. The same situation goes on as far as money investment is concerned. Costs out of services offered are not too high, since its quality is always considered excellent. As far as the model of the Cotia experience, it was always directed towards the rationalization of its owm recources, the local regionalization and hierarchilization of health services, its intra and intersectorial articulation, always developing programs concerning the integration of acceptable health actions. This philosophy creates a two-way referencial system based on priorities and the social epidemiological reality of the community, given place to new experiences dealing with the community participation on he administration of the project. This is a very satisfactory achievement, considering the socio cultural reality of the Cotia county. Also, as far as the preparation of new human resources, the project has been. developing courses from the elementary up to the university levels of education, so creating an educational system for the training of the general practitioner, adapted to our local reality. As far as the dynamics of the services and final results, the project has been covering the population standing for high health risk, a fact that effectively attains the betterment of some of the indewes of the Cotia county, mainly concerning to maternal and infant care areas and also to the control of infectioms diseases.

archives@tulane.edu / Public health finance is still a relatively young field and, as such, many questions have yet to be asked—and answered. To date, few have examine how specific revenue streams—alone or in combination—shape local health departments’ (LHD) resources and capacity to accomplish their public health missions. Given ongoing policy conversations about financing for public health, it’s important for researchers to rigorously examine the and the potential costs and benefits associated with different revenue sources. Introduction Chapter: The central thesis for the body of work encapsulated by this dissertation is simple: where money comes from matters. This chapter critically examines published evidence and theory linking public health financing mechanisms and their interactions to LHD operations, outputs, and even outcomes. The chapter also introduces situates the specific research questions addressed in this dissertation within a broader conceptual framework. Paper 1: The first paper examines the relationship between revenue diversification and revenue volatility among Washington State LHDs. Using fixed effects linear regression models and revenue data reported during 1998-2014 by all LHDs operating in Washington State, the paper finds little evidence to suggest revenue diversification is significantly associated with revenue volatility. Paper 2: The second paper evaluates whether available revenue sources differentially effected the scope of programs provided by Washington State LHDs between 2000 and 2011. Using two measures of program scope and both linear and non-linear fixed effects panel regression models, the paper finds that only funding received from federal Medicaid was consistently and significantly associated with both measures of program scope. Paper 3: The third paper examines changes in total LHD expenditures in Washington State between 2006 and 2013 following introduction of a new state funding program to support core public health services and infrastructure. Using a pre-post design regression model to evaluate changes in LHD expenditures, the paper finds overall spending among LHDs significantly increased with receipt of the new state funds in the first years of the program. However, those increases were not sustained over the longer term Conclusion Chapter: The final chapter reviews findings from the three papers and discusses their implications for public health policy, practice, finance, and research. / 1 / Abigail Hope Viall

Introduction: The appropriate role of local health departments (LHDs) as a clinical service provider remains a salient issue. This study examines differences in clinical service provision among rural/urban LHDs for early periodic screening, diagnosis, and treatment (EPSDT) and prenatal care services. Methods: Data collected from the 2013 National Association of County and City Health Officials Profile of Local Health Departments Survey was used to conduct a cross-sectional analysis of rural/urban differences in clinical service provision by LHDs. Profile data were linked with the 2013 Area Health Resource File to derive other county-level measures. Data analysis was conducted in 2015. Results: Approximately 35% of LHDs in the analysis provided EPSDT services directly and 26% provided prenatal care. LHDs reporting no others providing these services in the community were four times more likely to report providing EPSDT services directly and six times more likely to provide prenatal care services directly. Rural LHDs were more likely to provide EPSDT (OR=1.46, 95% CI=1.07, 2.00) and prenatal care (OR=2.43, 95% CI=1.70, 3.47) services than urban LHDs. The presence of a Federally Qualified Health Center in the county was associated with reduced clinical service provision by LHDs for EPSDT and prenatal care. Conclusions: Findings suggest that many LHDs in rural communities remain a clinical service provider and a critical component of the healthcare safety net. The unique position of rural LHDs should be considered in national policy discussions around the organization and delivery of public health services, particularly as they relate to clinical services.

Local Health Departments (LHD) that aim to address the public health needs of growing populations require qualified professionals with management competencies. In Arizona, the majority of public health services are delivered by the county health departments, which are charged with assisting community members and monitoring and improving community health. These activities are funded with federal, state and local money, which varies across counties. This study provides a comprehensive understanding of the local public health system in Arizona, the distribution of public health services across counties and examines the association between health outcomes data and funding patterns for each county. National Association of City and County Health Officials (NACCHO) data from their 2008 survey was used to examine the activities performed at the local level. The majority of the activities in which the LHDs focus fall within the assurance function of public health. Interviews with all Arizona county health department directors (N=15) were conducted. Discussion focused on LHD activities, county and state political/policy climate and partnerships that contribute to LHDs activities. Responses varied significantly across the state due to differences in demographic and financial characteristics of the counties. Many political, socioeconomic and environmental barriers to provision of services were identified as well as the need for developing a stronger public health infrastructure.Finally, associations between several health outcomes and funding, workforce and demographic data of the 15 local health departments in Arizona were examined by conducting correlation analysis and linear regressions. This study found strong positive associations between LHD revenues, LHD expenditures, population size and number of LHD employees and HIV/AIDS incidence, low birth weight births and infant mortality rate. Positive associations were also found between revenues and number of women who received prenatal care and HIV/AIDS mortality rate as well as between number of LHD employees and diabetes mortality rate. This study represents a small step in better understanding the local public health system in Arizona, the distribution of public health services across counties and the political, financial and policy constraints faced by county health department directors.

Inledning: Trots den positiva utvecklingen av folkhälsan i Sverige har skillnaderna i hälsa mellan olika befolkningsgrupper ökat sen 1980-talet. En strategi som kan användas för att minska skillnaderna i hälsa är att arbeta hälsofrämjande på lokal nivå. Syfte: Syftet med studien är att ta reda på hur personalen upplever arbetet med det folkhälsoprojekt som ska genomföras och tanken som finns med att delar av projektet ska kunna implementeras i den ordinarie verksamheten. Metod: Till denna studie har använts en kvalitativ metod där datainsamlingen skett genom intervjuer och analyserats med kvalitativ innehållsanalys. Resultat: Resultaten visar på att personalen överlag var positivt inställd till att arbeta med folkhälsoprojektet och till att försöka få in fungerande delar i ordinarie verksamhet. Personalen ser också till övervägande del positivt på den samverkan som finns. De hinder som finns, både på lång och kort sikt, rör framför allt det organisatoriska. Slutsats: Personalen har en medvetenhet om hälsa och en positiv syn på att arbeta hälsofrämjande. Det finns förutsättningar för folkhälsoprojektet att lyckas om man ser till varje mötesplats egna möjligheter och behov. Samverkan ses som positivt, vilken är en förutsättning för att hälsofrämjande arbete ska lyckas. Förbättrad samverkan kan leda till ännu bättre resultat genom inspiration och en underlättad arbetssituation. Tidsbrist och brist på resurser är det stora hindret för att projektet och en implementering av det ska lyckas. / Introduction: Despite the positive development of the Swedish public health, the difference in health between groups of people has increased since the 1980’s. One strategy that can be used to reduce the disparities in health is local health promotion. Purpose: The aim of the study is to find out how the employees experience working with a health promoting project and the thought that is that parts of the projects could be implemented in the ordinary work. Method: For this study has been used a qualitative approach where data collection occurred through interviews and analyzed using qualitative content analysis. Results: The results show that the employees were mostly in favor of working with public health project and trying to get functioning parts into regular activities. The employees also find existing collaboration as something positive. Organizational issues are the main obstacle, both long term and short term. Conclusion: The employees have got an awareness of health and they have a positive approach to working with health promotion. There is potential for public health project to succeed if we consider each meeting place’s opportunities and needs. Collaboration is seen as positive, which is a prerequisite for health promotion to succeed. Improved collaboration can lead to even better results through inspiration and a facilitated work situation. Lack of time and resources is the main obstacle for the project and the implementation of it to succeed.

Le programme Ville-Santé de l’OMS est une référence sur laquelle les acteurs ayant compétence à agir sur les espaces de vie des populations peuvent s’appuyer pour intervenir stratégiquement, de manière globale, intersectorielle, partenariale et participative en faveur de la santé des populations. Du point de vue de l’aménagement et la gouvernance des territoires, la thèse s’inscrit dans la démarche d’analyse a posteriori de la construction locale de la santé publique. Du point de vue géographique, l’un des aspects les plus intéressants de Ville-Santé est de voir comment les villes adhérentes cherchent à promouvoir des initiatives dans des lieux et configurations spatiales spécifiques et comment ces lieux et ces initiatives localisées contribuent à la santé et au bien-être.En définissant la santé comme « un état de complet bien-être physique, mental, social », l’OMS a contribué à diffuser un modèle des déterminants de la santé qui accorde une importance significative aux facteurs liés aux environnements physiques et sociaux. Le programme Villes-Santé a été lancé en 1986 afin de reconnaître le rôle des acteurs de l’urbain dans la promotion de villes susceptibles de concourir à l’épanouissement et la santé pour Tous. Au-delà de l’analyse des modalités d’adhésion de chacune des villes bretonnes concernées au réseau, la thèse évalue l’élargissement de la prise en compte de la santé dans les priorités locales, en s’intéressant plus particulièrement aux choix en matière de gestion et d'aménagement des espaces urbains / The Healthy Cities Project of World Health Organization is a reference that the actors competent to act on the living spaces of people can use to intervene strategically, globally, intersectoral, participatory and partnership for health populations. From the perspective of management and governance of territories, the thesis is in the process of post hoc analysis of the construction of local public health. From geographical point of view, one of the most interesting aspect of “Healthy Cities” is to see how the member cities seek to promote initiatives in places and specific spatial patterns and how these places and these initiatives contribute to local health and well-being.In defining health as "a state of complete physical, mental, social, well-being”, WHO has helped to disseminate a model of the determinants of health that attaches significant importance to factors related to physical and social environments. The Healthy Cities Program was launched in 1986 to recognize the role of actors in the urban development of cities likely to contribute to the vitality and Health for all. The goals of Healthy Cities were then reinforced, and rivaled or surpassed by the goals of sustainable development. Beyond the analysis of the terms of accession of each of the Breton towns involved in the network, the thesis seeks to assess the expansion of the inclusion of health in local priorities, with particular attention to the choices management and planning

Objetivou-se com o presente trabalho investigar as relações existentes entre dois espaços de \"cura\": o serviço local de saúde e a instituição religiosa, representada pelas várias Igrejas Pentecostais. A investigação, de corte qualitativo, baseou-se em depoimentos colhidos de sujeitos que frequentavam simultaneamente estes dois espaços de \"cura\". Concluiu-se que os dois espaços são usados conjuntamente e percebidos como nitidamente distintos. Através da análise dos depoimentos foi possível estabelecer uma série de categorias distintivas que permitem especificar as particularidades e diferenças entre o espaço racional científico e o espaço religioso, quando se trata de \"cura\". Concluiu-se também que os sistemas oficiais tem muito a aprender dos \"sistemas religiosos\" notadamente no que diz respeito ao caráter \"acolhedor\" destes últimos. / The objective of this work is to investigate the relationships between two \"cure\" spaces: the local health service and the religious institution represented here by several Pentecostal Churches. The qualitative section investigation was bas.ed on statements taken from people who attended the two \"cure\" spaces simultarieously. We concluded that the two spaces are used concurrently and understood as clearly distinct. Through the analysis of the statements it was possible to establish a series of different categories permitting to specify peculiarities and dissimilarities bet\\veen the -rational - scientific and the religious spaces when we refer to cure\". We have also concluded that the official systems have much to leam from \"religious systems\" especially when considering the \"welcoming\" character o f the latter ones.

Objetivou-se com o presente trabalho investigar as relações existentes entre dois espaços de \"cura\": o serviço local de saúde e a instituição religiosa, representada pelas várias Igrejas Pentecostais. A investigação, de corte qualitativo, baseou-se em depoimentos colhidos de sujeitos que frequentavam simultaneamente estes dois espaços de \"cura\". Concluiu-se que os dois espaços são usados conjuntamente e percebidos como nítidamente distintos. Através da análise dos depoimentos foi possível estabelecer uma série de categorias distintivas que permitem especificar as particularidades e diferenças entre o espaço racionalcientífico e o espaço religioso, quando se trata de \"cura\". Concluiu-se também que os sistemas oficiais tem muito a aprender dos \"sistemas religiosos\", notadamente no que diz respeito ao caráter \"acolhedor\" destes últimos. / The objective of this work is to investigate the relationships between two \"cure\" spaces: the local health service and the religious institution represented here by several Pentecostal Churches. The qualitative section investigation was based on statements taken from people who attended the two \"cure\" spaces simultarieously. We concluded that the two spaces are used concurrently and understood as clearly distinct. Through the analysis of the statements it was possible to establish a series of different categories permitting to specifY peculiarities and dissimilarities between the -rational - scientific and the religious spaces when we refer to \"cure\". We have also concluded that the official systems have much to leam from \"religious systems\" especially when considering the \"welcoming\" character of the latter ones.