The aim of the study was to investigate motivation, job satisfaction and attitudes of nurses in the public health services of Botswana. The objective was to discover how nurses felt about a wide range of variables in their work environment and ultimately to distil them into what they conceived as the mainstay motivators, job satisfiers and positive attitudes. The non pariel (unrivalled, unique) role of the government in creating both the hardware and the software of national health services was acknowledged and recognised with a particular reference to the primacy it placed on developing the human resources in the form of nurses, in order to realize the goals of administering the public health services efficiently and effectively. It was noted that nurses were the change agents and the axis in promoting quality standards of healthcare but in partnership with the government, which must be seen to be responsive and proactive in discharging its fiduciary responsibilities, in respect of both the content and the context of nurses’ occupational ambience. For the purposes of constructing a database from which both the government and the nurses can draw, the most salient thematic details of the theories of motivation, job satisfaction and attitudes were studied and examined and were used as a scaffolding for the empirical survey of nurses. Nine hundred questionnaires were distributed to both registered and enrolled nurses with a minimum of two years work experience in the public health sector and 702 of these were returned constituting a return rate of 78%. The findings indicated that a majority of nurses enjoyed job satisfaction in certain areas of their work namely autonomy, participating in decision-making, choice of type of nursing, change of wards or departments or work units, interpersonal relationships amongst nurses themselves and between nurses and their supervisors. Nurses also perceived the hospital as an environment in which they could continually learn and they were moreover satisfied with the nursing job or the work itself. The other end of the spectrum revealed an overwhelming majority of 92.2% of nurses who were dissatisfied with the level of pay and 88.5% who were not happy with the fringe benefits including the provision of accommodation. Working conditions were viewed as generally disliked by 67.3% of the nurses. Low pay, workload, lack of viii recognition for outstanding performance and or delayed promotional chances were singled out as being particularly disliked by 67.2%, 64.9%, 42.6% and 44.4% of the nurses respectively. Interviews held with 31 nurses yielded similar results. The research further showed that the most important motivators to nurses were dominated by competitive salary which was mentioned by 80.9% of the respondents, attractive or sufficient working conditions which were stated by 71.2% of the nurses, opportunity for continuous education which was rated by 63.8% of the nursing candidates, reduced workload which was claimed by 59.3% of the nursing cadres, opportunity for the recognition of outstanding performance and opportunity for promotion which were scored by 54.1% and 53.4% of the nurse respectively. Job satisfiers were also represented by competitive salary which received 76.1% of the nurses’ votes. Risk allowance occupied the second position with 69.1% and competitive working conditions were awarded a third ranking by 68.2% of the nurses. Those nurses who derived job satisfaction from the fact of each nursing shift being manned by an adequate number of nurses accounted for 63.1% of the sample. Competitive fringe benefits attracted 60.1% of the nurses. Opportunity to attend workshops and the need for high morale in nursing team-work were chosen as job satisfiers by 53.7% and 49.6% of the nurses respectively. In the section on recommendations the government was exhorted to invoke corrective or remedial measures in view of the detailed exegesis of the satisfactions and dissatisfactions in the nurses’ work environment and the ensuing problematique (doubtful, questionable) of raising the standards of health care in the public health services. Living up to these sanguine expectations should be the cherished longterm vision of the government if it is to meet and quench the soaring aspirations of its modernizing society for quality health care delivery and the escalating needs of the nurses. / Public Administration / D.P.A.

Submitted by Fabricia Fialho Reginato (fabriciar) on 2015-08-28T00:56:54Z No. of bitstreams: 2 RosaneXavier.pdf: 398206 bytes, checksum: c4ba9c2a04074696f1af91408ddf6414 (MD5) RosaneXavier.pdf: 398206 bytes, checksum: c4ba9c2a04074696f1af91408ddf6414 (MD5) / Made available in DSpace on 2015-08-28T00:56:54Z (GMT). No. of bitstreams: 2 RosaneXavier.pdf: 398206 bytes, checksum: c4ba9c2a04074696f1af91408ddf6414 (MD5) RosaneXavier.pdf: 398206 bytes, checksum: c4ba9c2a04074696f1af91408ddf6414 (MD5) Previous issue date: 2012 / Nenhuma / O crescimento do consumo do crack e outras drogas no Brasil e os problemas relacionados ao seu uso é visto atualmente como um grande desafio para a Saúde Pública. Os Centros de Atenção Psicossociais Álcool e Drogas Álcool e Drogas (CAPS AD) são um dos serviços de atenção psicossocial da rede de atenção, no âmbito do Sistema Único de Saúde, especializados no atendimento de usuários de drogas. Para tratar dos desafios na atenção integral de usuários de crack e outras drogas esta dissertação de mestrado, foi dividida em dois artigos. O primeiro artigo, de cunho teórico, através da revisão de literatura e legislação brasileira, discorreu sobre a construção das Políticas Públicas sobre Drogas, implementada pela Secretaria Nacional de Políticas sobre Drogas (SENAD) e da Política de Atenção Integral ao Usuário de Álcool e outras Drogas do Ministério da Saúde (MS). Neste, também foi feito um recorte da pesquisa desenvolvida no segundo artigo onde são apresentados os resultados com relação ao Plano Integrado de Enfrentamento ao Crack e outras Drogas e o programa de Redução de Danos. O segundo artigo empírico teve como objetivo caracterizar as intervenções terapêuticas no tratamento de pacientes usuários de crack e outras drogas, levando em consideração as ações, as dificuldades, as abordagens terapêuticas e os desafios e sugestões para o enfrentamento das drogas, segundo psicólogos que desenvolvem suas atividades neste contexto. Trata-se de um estudo qualitativo, de caráter descritivo, com a participação de oito psicólogos, inseridos nos CAPS AD, nos municípios da região metropolitana de Porto Alegre/RS. Respeitando todos os procedimentos éticos para a realização da pesquisa com seres humanos, para a coleta de dados, utilizou-se entrevistas semiestruturadas, com roteiro previamente estabelecido. Os dados obtidos foram submetidos à técnica de Análise de Conteúdo, segundo Bardin. Dentre os resultados, destaca-se que não há ações específicas para o tratamento do crack nos CAPS AD estudados, os quais buscam a reinserção social dos pacientes, apesar de encontrarem várias dificuldades no tratamento da dependência, nos processos e condições de trabalho e na retaguarda de rede no âmbito do SUS. Os desafios e sugestões apresentados relacionam-se, sobretudo, a melhorias na gestão e ao trabalho de rede. Concluiu-se que os usuários de crack possuem peculiaridades em seu quadro, exigindo o desenvolvimento de um trabalho intersetorial, inclusive para alcançar os usuários em vulnerabilidade social que não chegam aos serviços de saúde, o número insuficiente de CAPS AD para atender a demanda, entre outros. Sugerem-se pesquisas com outros profissionais de saúde das equipes dos CAPS AD, inclusive dos CAPS que atendem usuários de drogas em municípios menores, a eficácia da rede de atenção e a aplicabilidade prática das ações imediatas e estruturantes do Plano de Enfrentamento ao crack e outras drogas. / Consumption growth of crack and other drugs in Brazil and problems related to its use is currently seen as a major challenge for public health. Psychosocial Attention Centers Alcohol and Drugs Alcohol and Drugs (CAPS AD) is one of the psychosocial care services network care under the National Health System, specializing in the care of drug users. To address the challenges in the undivided attention of users of crack and other drugs this dissertation was divided into two articles. The first article, the theoretical / empirical, through literature review and the Brazilian legislation, talked about the construction of Public Policies on Drugs, implemented by the National Drug Policy (SENAD) and Policy of Integral Attention to the User of Alcohol and Other Drugs of the Ministry of Health (MOH). This also was made part of a research developed in the second article where the results are presented in relation to the Comprehensive Plan to Combat Crack and Other Drugs and Harm Reduction program. The second empirical paper aimed to characterize the therapeutic interventions in the treatment of patients using crack and other drugs, taking into account the stock, the difficulties, therapeutic approaches and the challenges and suggestions for dealing drugs, according to psychologists who develop their activities in this context. This is a qualitative study of a descriptive nature, with the participation of eight psychologists, entered in CAPS AD, in the metropolitan region of Porto Alegre / RS. Respecting all ethical procedures for conducting the research with humans, for data collection, we used semi-structured interviews with previously established routine. The data were subjected to the technique of content analysis according to Bardin. Among the results, it is emphasized that no specific actions for the treatment of AD crack in the CAPS study, which seek to rehabilitate patients, despite various difficulties in finding addiction treatment, processes and working conditions and the rear network within the SUS. Challenges and suggestions made relate mainly to improvements in management and the work network. It was concluded that crack users have peculiarities in their framework, requiring the development of an intersectoral work, even to reach users on social vulnerability that does not come to health services, the insufficient number of CAPS AD to meet the demand, among other. We suggest research with other health teams AD CAPS, including CAPS that serve drug users in smaller municipalities, the effectiveness of the care network and the practical applicability of the immediate actions and structuring of the Plan to Combat crack and other drugs.

By 2020, cancer mortality rates are estimated to increase by 180% in Arab countries, where breast cancer is the most common type of cancer. This thesis explores and evaluates the ‘asabiyya-driven structuration (the cohesive force of the group that gives it strength in facing its struggles for progressive reproduction) of cancer agents, government agents, and the World Health Organization agents for breast cancer prevention and early detection in the Arab region. The layers of the philosophical standing from Ibn Khaldûn’s concept of ‘asabiyya and the theoretical foundation of social systems theory, structuration theory, social network analysis, and social capital theory are peeled in order to explore and evaluate the context, constraints, social networks, autopoiesis, and social capital. Utilizing a qualitative research design, this thesis employs content analysis and in-depth interviews, as well as NVivo as a tool for analysis. Data is collected from 122 publications and knowledgeable informants employed by cancer agencies, ministries of health, and World Health Organization offices in Egypt, Jordan, Morocco, and Oman. The findings are divided into the contextual scope of responsibility and resources, the progressive and hierarchal constraining structure, the optimal and weak social networks, the strong and vulnerable shields of autopoiesis, and the presence and absence of social capital momentum, followed by a discussion on the the struggle for structuration against breast cancer. The findings demonstrate that countries with a national cancer control program witness local strengthening ‘asabiyya and ‘asabiyya-driven structuration, while those without a national cancer control program witness weakening local ‘asabiyya. Ultimately, this thesis proposes strategic recommendations to accelerate the regional ‘asabiyya-driven structuration of breast cancer.

By 2020, cancer mortality rates are estimated to increase by 180% in Arab countries, where breast cancer is the most common type of cancer. This thesis explores and evaluates the ‘asabiyya-driven structuration (the cohesive force of the group that gives it strength in facing its struggles for progressive reproduction) of cancer agents, government agents, and the World Health Organization agents for breast cancer prevention and early detection in the Arab region. The layers of the philosophical standing from Ibn Khaldûn’s concept of ‘asabiyya and the theoretical foundation of social systems theory, structuration theory, social network analysis, and social capital theory are peeled in order to explore and evaluate the context, constraints, social networks, autopoiesis, and social capital. Utilizing a qualitative research design, this thesis employs content analysis and in-depth interviews, as well as NVivo as a tool for analysis. Data is collected from 122 publications and knowledgeable informants employed by cancer agencies, ministries of health, and World Health Organization offices in Egypt, Jordan, Morocco, and Oman. The findings are divided into the contextual scope of responsibility and resources, the progressive and hierarchal constraining structure, the optimal and weak social networks, the strong and vulnerable shields of autopoiesis, and the presence and absence of social capital momentum, followed by a discussion on the the struggle for structuration against breast cancer. The findings demonstrate that countries with a national cancer control program witness local strengthening ‘asabiyya and ‘asabiyya-driven structuration, while those without a national cancer control program witness weakening local ‘asabiyya. Ultimately, this thesis proposes strategic recommendations to accelerate the regional ‘asabiyya-driven structuration of breast cancer.

By 2020, cancer mortality rates are estimated to increase by 180% in Arab countries, where breast cancer is the most common type of cancer. This thesis explores and evaluates the ‘asabiyya-driven structuration (the cohesive force of the group that gives it strength in facing its struggles for progressive reproduction) of cancer agents, government agents, and the World Health Organization agents for breast cancer prevention and early detection in the Arab region. The layers of the philosophical standing from Ibn Khaldûn’s concept of ‘asabiyya and the theoretical foundation of social systems theory, structuration theory, social network analysis, and social capital theory are peeled in order to explore and evaluate the context, constraints, social networks, autopoiesis, and social capital. Utilizing a qualitative research design, this thesis employs content analysis and in-depth interviews, as well as NVivo as a tool for analysis. Data is collected from 122 publications and knowledgeable informants employed by cancer agencies, ministries of health, and World Health Organization offices in Egypt, Jordan, Morocco, and Oman. The findings are divided into the contextual scope of responsibility and resources, the progressive and hierarchal constraining structure, the optimal and weak social networks, the strong and vulnerable shields of autopoiesis, and the presence and absence of social capital momentum, followed by a discussion on the the struggle for structuration against breast cancer. The findings demonstrate that countries with a national cancer control program witness local strengthening ‘asabiyya and ‘asabiyya-driven structuration, while those without a national cancer control program witness weakening local ‘asabiyya. Ultimately, this thesis proposes strategic recommendations to accelerate the regional ‘asabiyya-driven structuration of breast cancer.

The aim of the study was to investigate motivation, job satisfaction and attitudes of nurses in the public health services of Botswana. The objective was to discover how nurses felt about a wide range of variables in their work environment and ultimately to distil them into what they conceived as the mainstay motivators, job satisfiers and positive attitudes. The non pariel (unrivalled, unique) role of the government in creating both the hardware and the software of national health services was acknowledged and recognised with a particular reference to the primacy it placed on developing the human resources in the form of nurses, in order to realize the goals of administering the public health services efficiently and effectively. It was noted that nurses were the change agents and the axis in promoting quality standards of healthcare but in partnership with the government, which must be seen to be responsive and proactive in discharging its fiduciary responsibilities, in respect of both the content and the context of nurses’ occupational ambience. For the purposes of constructing a database from which both the government and the nurses can draw, the most salient thematic details of the theories of motivation, job satisfaction and attitudes were studied and examined and were used as a scaffolding for the empirical survey of nurses. Nine hundred questionnaires were distributed to both registered and enrolled nurses with a minimum of two years work experience in the public health sector and 702 of these were returned constituting a return rate of 78%. The findings indicated that a majority of nurses enjoyed job satisfaction in certain areas of their work namely autonomy, participating in decision-making, choice of type of nursing, change of wards or departments or work units, interpersonal relationships amongst nurses themselves and between nurses and their supervisors. Nurses also perceived the hospital as an environment in which they could continually learn and they were moreover satisfied with the nursing job or the work itself. The other end of the spectrum revealed an overwhelming majority of 92.2% of nurses who were dissatisfied with the level of pay and 88.5% who were not happy with the fringe benefits including the provision of accommodation. Working conditions were viewed as generally disliked by 67.3% of the nurses. Low pay, workload, lack of viii recognition for outstanding performance and or delayed promotional chances were singled out as being particularly disliked by 67.2%, 64.9%, 42.6% and 44.4% of the nurses respectively. Interviews held with 31 nurses yielded similar results. The research further showed that the most important motivators to nurses were dominated by competitive salary which was mentioned by 80.9% of the respondents, attractive or sufficient working conditions which were stated by 71.2% of the nurses, opportunity for continuous education which was rated by 63.8% of the nursing candidates, reduced workload which was claimed by 59.3% of the nursing cadres, opportunity for the recognition of outstanding performance and opportunity for promotion which were scored by 54.1% and 53.4% of the nurse respectively. Job satisfiers were also represented by competitive salary which received 76.1% of the nurses’ votes. Risk allowance occupied the second position with 69.1% and competitive working conditions were awarded a third ranking by 68.2% of the nurses. Those nurses who derived job satisfaction from the fact of each nursing shift being manned by an adequate number of nurses accounted for 63.1% of the sample. Competitive fringe benefits attracted 60.1% of the nurses. Opportunity to attend workshops and the need for high morale in nursing team-work were chosen as job satisfiers by 53.7% and 49.6% of the nurses respectively. In the section on recommendations the government was exhorted to invoke corrective or remedial measures in view of the detailed exegesis of the satisfactions and dissatisfactions in the nurses’ work environment and the ensuing problematique (doubtful, questionable) of raising the standards of health care in the public health services. Living up to these sanguine expectations should be the cherished longterm vision of the government if it is to meet and quench the soaring aspirations of its modernizing society for quality health care delivery and the escalating needs of the nurses. / Public Administration and Management / D.P.A.

FundaÃÃo Cearense de Apoio ao Desenvolvimento Cientifico e TecnolÃgico / A coordenaÃÃo dos cuidados pela atenÃÃo primÃria à saÃde (APS) ocupa uma posiÃÃo de destaque na agenda das polÃticas de saÃde de vÃrios paÃses. à uma alternativa possÃvel para o problema da segmentaÃÃo em sistemas de saÃde, que gera iniquidade e ineficiÃncia, desarticulaÃÃo da rede assistencial e prejuÃzo no acesso aos nÃveis de atenÃÃo mais complexos. O objetivo geral do estudo foi comparar a induÃÃo centralizada da coordenaÃÃo dos cuidados pela APS em dois sistemas de saÃde universais. Estudo de abordagem quanti-qualitativa, à classificado como exploratÃrio-descritivo, valendo-se de dados documentais e orÃamentÃrios e da realizaÃÃo de nove entrevistas semiestruturadas com sujeitos-chave correspondentes ao National Health Service (NHS), do Reino Unido, e ao Sistema Ãnico de SaÃde (SUS), do Brasil. Foi utilizada anÃlise de conteÃdo temÃtica, estatÃstica descritiva e anÃlise comparativa. A pesquisa obedeceu à ResoluÃÃo 196/96 do Conselho Nacional de SaÃde e obteve parecer favorÃvel (nÃmero 198.092). A pesquisa identificou que o fortalecimento da APS à a base inicial para viabilizar a coordenaÃÃo dos cuidados no Brasil. O MinistÃrio da SaÃde do Brasil vem desenvolvendo polÃticas nacionais que impactam indiretamente na coordenaÃÃo dos cuidados - PolÃtica Nacional de AtenÃÃo BÃsica, NÃcleos de Apoio à SaÃde da FamÃlia e Programa Nacional de Melhoria do Acesso e da Qualidade da AtenÃÃo BÃsica. A polÃtica de Redes de AtenÃÃo à SaÃde revelou-se fator limitante ao papel coordenador da APS. As Tecnologias de InformaÃÃo e ComunicaÃÃo surgiram com menos Ãnfase no Ãmbito federal. O incremento estrutural no TelessaÃde Brasil Redes e os Cadernos de AtenÃÃo BÃsica sobressaÃram por sua capacidade de induzir mudanÃas organizacionais nos serviÃos. O NHS estruturou a coordenaÃÃo dos cuidados pela APS a partir do contrato dos general practitioners e busca empoderÃ-los para gerir 60% do orÃamento do sistema. A pesquisa concluiu que o modelo de Estado federativo brasileiro dificulta a coordenaÃÃo dos cuidados pela APS, em comparaÃÃo ao Estado unitÃrio inglÃs. A municipalizaÃÃo e descentralizaÃÃo tornaram complexo o processo de coordenaÃÃo dos cuidados, cabendo ao MinistÃrio da SaÃde o papel de induzir, de forma vertical, e aos municÃpios, operar o sistema em cada ponto de atenÃÃo de forma horizontal, situaÃÃo que nÃo ficou bem alinhada e configurou um modelo oblÃquo, gerando uma contradiÃÃo no desenho federativo brasileiro e dificultando a coordenaÃÃo dos cuidados. / The coordination of care for the primary health care (PHC) occupies a prominent position on the agenda of the health policies of various countries. It is a possible alternative to the problem of segmentation of health systems, which generates inequity and inefficiency, disarticulation of the care network and impaired access to more complex levels of care. The general objective of this study was to compare the centralized induction of coordination of care by PHC in two universal health systems. This study has a quantitative and qualitative approach and it is classified as exploratory and descriptive, by using documental and budgetary data and performing nine semistructured interviews with key subjects corresponding to National Health Service (NHS), from the United Kingdom, and the Unified Health System (SUS) in Brazil. The thematic content analysis, descriptive statistics and e comparative analysis were used. The research followed the Resolution 196/96 of the National Health Council and obtained its assent under number 198 092. The research identified that the strengthening of PHC is the initial basis to facilitate the coordination of care in Brazil. The Ministry of Health of Brazil has been developing national policies which impact indirectly on coordination of care - National Policy for Primary Care, Centers of Support for Family Health and the National Program for Improving Access and Quality of Primary Care. The Politics of Health Care Networks proved to be limiting factor for coordinating role of the PHC. The Information and Communication Technologies have emerged with less emphasis on the federal level. The structural increase in BrazilÂs Telehealth Networks and Protocols Notebooks of Primary Care, stood by their ability to induce changes in the organizational processes of the services. The NHS structured care coordination by PHC from the contract of general practitioners and seeks to empower them to manage 60% of the budget system. The research concluded that the brazilian federal State model complicates the coordination of care by PHC, compared to the english unitary State. The municipalization and decentralization made the process of coordination of care more complex, leaving to the Ministry of Health the role of inducing vertically and, to the municipalities, operate the system at each point of care in a horizontal manner, a situation which was not well aligned and configured an oblique model, generating a contradiction in the brazilian federal design and bringing difficulties to the coordination of care.

Made available in DSpace on 2016-12-23T14:36:50Z (GMT). No. of bitstreams: 1 Rutineia Jacob de Melo.pdf: 1468876 bytes, checksum: c4ee5dfa9069e4a9ea549e4bbf85ccf5 (MD5) Previous issue date: 2009-06-22 / The aim of this work is to analyze the ideological and political format of the Ministry of Health (MS) discourse about Primary Health Care (APS) and Basic Health Care (AB), with a view to unveiling the context in which such discourse emerges. The analysis focuses on the following questions: why is it that the MS assumes that AB is synonymous with APS, which rationales underlies this assumption and what were the implications of this point of view for the adoption of the Family Health Strategy (ESF), during the 1993-2007 period. Following the analysis, a documental research was carried out. Reference for this analysis was the wider context of the Brasilian health policies. Within such context an attempt has been made to grasp the concrete meaning of APS, considering their insertion in the Unified Health System (SUS), as well as their abstract dimension, in terms of the ideological definition perceived in the documents produced by the World Health Organization (OMS), Panamerican Health Organization (OPAS) and by the MS. The data have revealed that what is prevalent in Brazil is a reductionist interpretation of APS, focused on a basic basket of services recommended by the World Bank (BM) to the peripherical countries; APS can be looked at from multiple viewpoints and lends itself to different interpretations, all of them intersected by political, ideological and theoretical issues as well as by different sanitary practices. Yet that discourse does not cover the whole scope of practices derived from the guidelines proposed in the Alma-Ata Declaration. It further points out that discourse is emphatically states the principles upheld by SUS, including the concept of an all-inclusive APS, it prioritizes a marketing perspective of health. Besides demonstrating that the discussion is restricted to the AB scope, held to be synonymous with APS, with the purpose of hiding its reductionist nature. As the political and economic aspects of the question are not considered, is left out of the discussion, thus denying the responsibilities inherent to the State and therefore reducing its social role. There is evidence that the health services are fragmentary and that the implementation of EFS is affected by problems such as the underfunding of the health sector together with the precarious conditions of the work relationships. It also hides rationales such as shared social responsibility for the services rendered and for the administration of the public sector, in the interest of cost reduction, while it overemphasizes the family and the ACS work and the election of basic services as an absolute priority. The MS seems to adopt the assumption that a new terminology will automatically change practices, with no consideration for structural aspects such as low quality services, social inequality and unfair income distribution, factors which, together, make for the permanence of all the iniquities inflicted on the population. As no effort is made to face the more general economic and social determinations of the health-disease possesses, the problems detected require actions not only within the health care system itself. Summing up, in spite of the positive discourse of MS and the innovations proposed, no significant changes have been noticed to emerge in the health system, which has in fact remained medic-centered model. / Objetivou analisar as dimensões ideológica e política que formatam os discursos do Ministério da Saúde (MS) sobre a Atenção Primária à Saúde (APS) e a Atenção Básica à Saúde (AB), visando desvendar qual o contexto no qual esses discursos se inserem, porque o MS defende a AB como sinônima de APS, que racionalidades são engendradas e que implicações os mesmos têm sobre a implantação da Estratégia de Saúde da Família (ESF), no período temporal de 1993 a 2007. Foi realizada pesquisa documental procedida de análise do conteúdo. No contexto das políticas de saúde brasileira a análise buscou captar tanto o significado concreto da APS, outorgado por sua inserção no Sistema Único de Saúde (SUS), bem como sua dimensão abstrata, ou seja, a definição ideológica percebida nos documentos da Organização Mundial de Saúde (OMS), Organização Pan-Americana de Saúde (OPAS) e do MS. Como resultados, verificou-se que no Brasil prevalece uma interpretação reducionista da APS, focada na cesta básica de serviços preconizada pelo Banco Mundial (BM) aos países periféricos; que a APS possui múltiplos olhares e diferentes interpretações, perpassadas por questões políticas, ideológicas, teóricas e práticas sanitárias distintas, sem que o discurso alcance a ampla aplicação da orientação proposta na Declaração de Alma-Ata; que, mesmo reafirmando uma APS abrangente, presente nos princípios do SUS, a perspectiva mercadológica da saúde é priorizada, evidenciando que a discussão limita-se ao âmbito da AB, defendida como sinônima de APS, com a intenção de ocultar o caráter reducionista que a está revestindo, sem considerar os aspectos políticos e econômicos, logo, não discutindo a crescente desresponsabilização do Estado e a conseqüente refuncionalização de seu papel no âmbito social. Isso implica em questões como o subfinanciamento do setor saúde, a redução de custos e a precarização das relações de trabalho, que, dentre outros, atravessam a implantação da ESF e demonstram a fragmentação dos serviços de saúde. Os discursos ocultam ainda algumas racionalidades, dentre as quais a co-responsabilização social pelos serviços e pela gestão pública, a ênfase na família e no trabalho dos Agentes Comunitários de Saúde (ACS) e a prioridade em ações básicas. Considerou-se, por fim, que o MS assume a postura de que ao mudar a terminologia de APS para AB, as práticas de saúde automaticamente mudariam, desconsiderando assim aspectos estruturais como a baixa qualidade do atendimento, a desigualdade social e a má distribuição de renda que convergem para que as iniqüidades em saúde permaneçam, pois não se enfrentam as determinações econômicas e sociais mais gerais dos processos saúde-doença, o que demandaria ações não apenas no sistema de atenção à saúde. Em suma, apesar das mudanças propostas e dos aspectos positivos e inovadores que revestem os discursos do MS, não ocorreram mudanças significativas no sistema de saúde, prevalecendo até o momento o modelo médico-centrado.

Master of Public Health - MPH / The Health Extension Program (HEP) is an innovative, community based comprehensive primary health care program that Ethiopia introduced in 2003. It gives special emphasis to the provision of preventive and promotive services at community and household level. However, utilization of the HEP packages is low and reasons for this underutilization are not well known. The aim of this study is to assess the availability and utilization of the Health Extension Program Service in Akaki District of Oromia Region, Ethiopia. Quantitative study using a cross-sectional survey design. The study was conducted in Akaki District of Oromia Regional State in Ethiopia with 79,162 inhabitants. Random sampling was used to select 355 households. A structured data collection tool/ questionnaire was employed to collect data from the study participants. Data were analyzed using SPSS for Windows version 19. Descriptive statistics were used to analyze socio demographic characteristics of the study participants and to assess the availability and utilization of each service component. The response rate of the study was 100% with complete data obtained from 335 (94.4%) of the households. The majority (93.1%) of respondents were women. The availability of HEP services as described by the household visit of Health Extension Workers (HEWs) is very high with 86.6% visiting at least monthly and 11.3% visited sometimes. There was a highly significant association between the health extension workers’ visit to households and health extension service utilization during pregnancy (OR=16.913, 95% CI 8.074-35.427 at p<0.001). HIV testing utilization showed a tenfold increase among households who received education. Participation of households in the Model family initiative was another key factor associated with high levels of HEP services utilization. Though HEP services are available for most households, the frequency of household visits by HEWs and the involvement of Households in model family training greatly influenced service utilization. Improving frequency of services availability at household level and consistent health education will greatly improve services utilization.

By 2020, cancer mortality rates are estimated to increase by 180% in Arab countries, where breast cancer is the most common type of cancer. This thesis explores and evaluates the ‘asabiyya-driven structuration (the cohesive force of the group that gives it strength in facing its struggles for progressive reproduction) of cancer agents, government agents, and the World Health Organization agents for breast cancer prevention and early detection in the Arab region. The layers of the philosophical standing from Ibn Khaldûn’s concept of ‘asabiyya and the theoretical foundation of social systems theory, structuration theory, social network analysis, and social capital theory are peeled in order to explore and evaluate the context, constraints, social networks, autopoiesis, and social capital. Utilizing a qualitative research design, this thesis employs content analysis and in-depth interviews, as well as NVivo as a tool for analysis. Data is collected from 122 publications and knowledgeable informants employed by cancer agencies, ministries of health, and World Health Organization offices in Egypt, Jordan, Morocco, and Oman. The findings are divided into the contextual scope of responsibility and resources, the progressive and hierarchal constraining structure, the optimal and weak social networks, the strong and vulnerable shields of autopoiesis, and the presence and absence of social capital momentum, followed by a discussion on the the struggle for structuration against breast cancer. The findings demonstrate that countries with a national cancer control program witness local strengthening ‘asabiyya and ‘asabiyya-driven structuration, while those without a national cancer control program witness weakening local ‘asabiyya. Ultimately, this thesis proposes strategic recommendations to accelerate the regional ‘asabiyya-driven structuration of breast cancer.