The thesis deals with an institutional reform of public employment services implemented in the Czech Republic in 2011. By merging social benefits administration with employment services into the newly established Labour Office of the Czech Republic, the right-wing government attempted to reduce the staffing and administrative costs of these services and to improve the governance of local labour offices. Another aim of the reform was to unify the management of employment services. Using the theoretical concept of "policy cycle" and "policy fiasco" the thesis analyses these organisational changes in the functioning of public employment services in the Czech Republic. Data consist of interviews with experts on labour market policy in the Czech Republic and two focus groups with employees of labour offices. The thesis concludes that there appeared several mistakes during implementation of the institutional reform of public employment services in the Czech Republic in 2011 in terms of the policy cycle and it can be referred to as a policy. The reform harmed the reputation and efficiency of employment services.

The aim of this work is to analyze public library services focusing on teenagers. Theoretical part describes definition of a public library and its services and analysis of some services focusig on teenagers offered by Czech and foreign libraries. Practical part is devoted to analysis of history and the current situation of surveyed public libraries (in Tábor, Strakonice, Český Krumlov and Soběslav). There is also a research included in this section - it is questioning libraries which services they offer to teenagers or why they don't offer this services. This work presents analysis of the different sizes of Czech public libraries in services focused on teenagers and also summary of this services offered by Czech and foreign libraries. Keywords Public library Public library services Teenagers Teens Young adult Youth

Philosophiae Doctor - PhD / In order to manage public dental services, information is required about what work is being performed by the staff at the various clinics. Tally sheets have been used in the past to record treatment procedures but this is not an effective method of recording the amount of work done by staff at public dental clinics. But tally sheets are inaccurate, open to abuse, and fail to provide the necessary information for managers. Nor is it of any real value for providing feedback to staff on their performance. This inhibits a core aspect of job satisfaction for the staff, which is feedback. The staff just persevere, continue doing the same thing and feel frustrated. This contributes to poor work performance. Instead of using a tally sheet, 4 digit treatment codes are used for all treatment procedures (as used in the private sector for billing purposes) and additional codes were developed for services such as brushing programmes for which billing codes do not exist. These are recorded for each patient, together with a code for the patient category. A relative value unit (RVU) has been developed for each treatment code that has been weighted according to policy guidelines and the amount of time and effort required to provide the service. This was done for clinical treatment procedures as well as for community-based preventive activities . A computer program has been developed that captures the treatment codes which are saved in a number of databases that are linked to Excel pivot tables. The data can therefore be easily manipulated by the user to obtain the required information in the form of counts of procedures, monetary cost of the same clinical services in the private sector (useful with the proposed advent of National Health Insurance) and also in the form of relative value units. This is available for the current reporting period as well as for previous periods, allowing a detailed analysis of services rendered and staff performance over a period of time to show trends. Use is also made of an Objectives Matrix where the performance of each staff member can be measured according to seven objectives (Key Performance Areas) (five in the case of oral hygienists) to produce an overall Performance Index - which is a score out of ten. This enables performance appraisal to be carried out much easier than by comparing performance based on a number of diverse treatments provided. The data for all the public dental clinics in the Western Cape Province has been analysed for the period 1994 to 2012 using this system, and it has been shown that the system is sensitive enough to highlight problem areas as well as provide a balanced overall view of the service, as measured by a number of variables. The system is "low tech" in that it runs on a "stand alone" personal computer, but it could easily be applied to an integrated, networked information system provided the latter contained the treatment codes, and certain other patient, staff and clinic identifiers. It is therefore suitable for developing countries, such as South Africa, that may later develop a comprehensive Health Information System based on an electronic medical record. The emphasis is not on the information technology, it is focussed on the concepts behind the processing of the data into meaningful information for managing public dental services.

[pt] Esta tese investiga a contribuição do design para a inovação social dos serviços públicos de atenção primária à saúde. Para tanto, a tese foi organizada em três etapas (1) pesquisa em dados secundários sobre os campos do saber do design, dos serviços e do design de serviços; (2) observação participante em um projeto de pesquisa da Lancaster University, chamado Design in Practice, no qual foi possível identificar as abordagens utilizadas pelos designers de serviços voltados à criação de novos serviços de saúde para o Sistema de Saúde Público Inglês (NHS); (3) pesquisa-ação para avaliar o potencial do método, pela criação de um novo serviço de atenção à saúde, no contexto brasileiro, voltado aos portadores de diabetes tipo II. Esta foi conduzida na Unidade Básica de Saúde (UBS) Vila Gaúcha, na cidade de Porto Alegre, a partir da aplicação da abordagem projetual centrada na experiência dos usuários. Nessa etapa, foi possível fazer uma intervenção de design de serviços, criar um novo serviço de atenção de saúde aos portadores de diabetes tipo II e avaliar os resultados alcançados pelo novo serviço. Os resultados encontrados sugerem que a competência em design pode contribuir de diferentes maneiras para criação de serviços de atenção básica à saúde, a saber: (1) pela interpretação do valor e do significado do serviço para os diferentes atores envolvidos no seu uso; (2) pela tradução desse conhecimento em uma linguagem visual compreensível a todos, possibilitando a (co)criação de uma solução; (3) pela configuração do conceito do serviço, contribuindo para a construção de um argumento persuasivo sobre como as pessoas devem agir em uma determinada situação; (4) pela inclusão das pessoas, cujo comportamento precisa ser afetado, no processo de (co)criação desse argumento, favorecendo o surgimento de uma inovação social. Por fim, a tese apresenta uma proposta de método design de serviços para aqueles que têm por foco uma inovação social. / [en] This thesis investigates the design discipline contribution on primary care health services social innovation. To this end, the thesis has been divided in three stages: (1) desk research about design, service and service design disciplines; (2) participant observational research in Design in Practice research project at Lancaster University, where it was possible to identify the service designers approaches to create new services for British National Health System (NHS); (3) an action research to evaluate the potential of service design method by creating a new primary care health service for patients with type II diabetes, in the Brazilian context. This design project was conducted at Vila Gaucha Basic Health Unit, at Porto Alegre city, by using experience based design approach. At this stage, it was possible to make a service design intervention; to create a new primary care health service for patients with diabetes type II and to evaluate the results reached by this new service. The results shows that the design competence could contribute in different ways for the creation of new primary care health services: (1) by interpreting service value and meaning for different actors involved in its use; and (2) by translating this knowledge into a visual language understandable to all, allowing the co-creation of solution; (3) by configurating services concepts, it building a persuasive argument about how people should act in a certain situation; and (4) by including these people, whose behaviour needs to be affected, in the argument co-creation process, design makes more favourable the emergence of a social innovation. As a result of this investigation, this thesis proposes a method for designing services that focus on social innovation.

Thesis (MPA (Public Management and Planning))--University of Stellenbosch, 2010. / ENGLISH ABSTRACT: The Department of Health estimates that 80 percent of South Africans consult traditional healers before consulting modern medicine. The aim of this study is to investigate the extent of the use of traditional medicine in local communities in the Limpopo Province, and add value to a draft policy that was introduced by the Minister of Health. (South Africa, Department of Health 2007a) Traditional healers are regarded as an important national health resource. They share the same cultural beliefs and values as their patients. They are respected in their communities. In South Africa, traditional healers have no formal recognition as health care professionals. Despite the advantages of modern medicine, there is a dramatic evolution in traditional medicine developing and developed countries. In recognition of the value that traditional medicine has added to people’s health needs, government organisations have realised the gap and needed to embark on public participation to bring to light the solution, by implementing a relevant policy (Matomela 2004). According to research done by Pefile (2005), positive outcomes that resulted from the use of traditional medicine include a more holistic treatment, a wider choice of health care that suits people’s needs, and scientific advancement, this paves a way forward for a policy to be put into place for the legal recognition of traditional medicine. New legislations have been brought about in regulating traditional medicine and practitioners. This paper provides a synopsis of government initiatives to close the gap and address the concerns of integrating traditional and modern medicine. The thesis addresses the challenges involved in incorporating the two disciplines for the best possible impact of local communities in accessing their rights as vested in the constitution. The study is a qualitative study where relevant practicing traditional healers, users, Western doctors, nurses, managers and government policy makers were interviewed regarding the draft policy on traditional medicine. This was to obtain information on the challenges, gaps and possible solutions regarding the integration of African traditional medicine into the health care system of Southern Africa. Findings show the following: a majority of traditional healers do not agree to scientific trialling and testing on the herbs that they prescribe, and Western doctors feel that traditional healers should only treat patients spiritually unless they have a scientifically tested scope and limitations on their field. The study also found that traditional healers want to be registered and integrated into the health care system, but do not agree to have regulated price fixing. Other conclusions included that the communities seek traditional help for cultural reasons and more benevolent purposes, but are changing their focus towards seeking medical help from clinics where it is provided for them. However, people within the communities are still confused whether to seek traditional or western medicine and therefore seek both. It was found that medications are not readily available in district clinics and hospital waiting times force people into seeking traditional help. Nurses, doctors and caregivers acknowledge that traditional healers are hampering the health care of patients by delaying hospital treatment of patients hence progressing illnesses. However, they also state that traditional healers help people spiritually and mentally. Therefore policy makers have found solutions to educate healers and create regulatory boards to limit and create a scope of practice for traditional healers. Recommendations and solutions for the relevant policy are as follows: It is recommended that traditional health practitioners should only be allowed to practice and train over the age of 21. They must be prohibited from certain procedures, for example: drawing blood, treating cancers, and treating AIDS/HIV. They should only be allowed to practice midwifery if they have had training. They should be prohibited from administering injections and supervised drugs, unless trained at a tertiary level traditional healers can be used as home caregivers, spiritual healers, and traditional advice counselling entities in the communities. Traditional healers must be prevented from referring to themselves as a ‘doctor’ or ‘professor’. This misleads people into believing that they are allopathic doctors. ‘Traditional health practitioners’ must realise that they are holistic healers, and must be addressed as such. A strong recommendation is to rename ‘traditional health practitioners’ as ‘spiritual practitioners’. With regards to regulations, it must be imperative that every practicing traditional health practitioner be registered annually with the relevant board. A good suggestion is for traditional health practitioners (THP) to attend formal training courses, under an experienced herbalist, and it should be documented on paper. A written record of the location of practice, and specialty must also be documented. There must be policies on health and safety, hygiene and sterility that need to be in place. It is suggested that training on patient confidentially must be taught and implemented. A code of conduct and a standard of professional ethics must also be implemented. Health and safety regulations pertaining to the profession and the citizens must be listed. Efforts towards dispelling myths and making people aware, thereby filtering out the positive side of the traditional medicine (e.g. medical benefits with some herbs), and rooting out the ‘quack’ practices (e.g. the use of amulets around a patient’s body to cure diseases) should be practiced. Pertaining to co-operative relationships between modern medical doctors and traditional practitioners, it is recommended that the use of exchange workshops between the two professionals needs to be developed. Also scientific information and technology must be available to traditional healers. A continued professional development (CPD) programme should be a mandatory requirement, as for all other health care professionals. It seems the development of traditional hospitals, in which a scope of practice is defined, can be used as a recovery ward and a spiritual guidance centre. The above recommendations will encourage a healthier, safer and transparent health care system in South Africa, where all disciplines of medicine co-exist in one National Health Care System. / AFRIKAANSE OPSOMMING: Nadat navorsing deur die Departement van Gesondheid gedoen is, is daar gevind dat 80 persent van Suid-Afrikaners tradisionele genesers besoek. Die doel van hierdie navorsing is om ondersoek te doen na die gebruik van tradisionele medisyne deur landelike gemeenskappe in die Limpopo Provinsie, en om ook ‘n bydrae te lewer tot die konsepbeleid wat deur die Minister van Gesondheid bekendgestel is (South Africa, Department of Health 2007a). Tradisionele genesers kan beskou word as ‘n belangrike hulpbron in die nasionale gesondheidsdiens. Hulle deel in kulturele gelowe en waardes van hulle pasiente en word ook gerespekteer in hulle gemeenskappe. Suid-Afrika egter, gee geen erkenning aan tradisionele genesers of die feit dat hulle in die gesondheidsdiens is nie. Ondanks die feit van moderne geneesmiddels, is daar ‘n dramatiese evolusie wat besig is om plaas te vind in die Westerse Wêreld. Die erkenning en waarde van tradisionele medisyne wat bydra tot mense se gesondheidkwaliteit, het daartoe gelei dat Staatsorganisasies begin insien het dat daar ‘n gaping is en dat publieke peilings gedoen word om ‘n oplossing te vind en ‘n beleidsdokument saam te stel wat tradisionele genesers insluit (Matomela 2004). Die ondersoek wat Pefile (2005) gedoen het, het positiewe resultate getoon by die gebruik van tradisionele medisyne wat ‘n holistiese behandeling in ‘n wyer verskeidendheid van medisyne insluit by gebruikers. Ook die wetenskaplike vooruitgang van tradisionele medisyne het daartoe bygedra dat ‘n beleidsdokument in plek gesit word vir die wettige erkenning daarvan. Nuwe wetgewing is in werking gestel om beheer uit te oefen oor tradisionele genesers en tradisionele medisyne. Hierdie dokument verskaf ‘n sinopsis van die Staat se inisiatiewe om die gaping tussen moderne medisyne en tradisionele medisyne aan te spreek en ook om landelike gemeenskappe toe te laat om hulle reg uit te oefen soos wat in die Grondwet vervat is. Die studie is kwalitatief waar relevante praktiserende tradisionele genesers, verbruikers, Westerse dokters, verpleegkundiges, bestuurders en staatsdiensbeleidvormers ondervra is oor ‘n konsep beleidsdokument oor tradisionele medisyne. Dit was gedoen om informasie rakende die uitdaging , gapings en 'n moontlike oplossing te vind vir die integrasie van Afrika se tradisionele medisyne in die gesondheidsorgsisteem van Suidelike Afrika. Belangrike bevindings sluit die volgende in: die meerdeerheid tradisionele genesers stem nie saam dat wetenskaplike toetse gedoen word op kruie wat hulle voorskryf nie; tradisionele genesers will geregisteer en geïntegreer word in die gesondheidsorgsisteem maar stem nie saam oor prysregulering en prysvasstelling nie; Westerse dokters is van mening dat tradisionele genesers net pasiënte geestelik moet kan behandel tensy hulle ‘n wetenskaplik getoetse doel en beperkings in hulle veld het; Westerse dokters glo dat tradisionele genesers dwarsboom die gesondheidsorgsisteem deurdat hulle behandeling vetraag; die gemeenskap soek tradisionele hulp op vir kulturele redes en ander welwillendheidsredes maar gaan soek mediese hulp by klinieke waar dit aan hulle verskaf word; mense van gemeenskappe is verward en raadpleeg beide tradisionele genesers en Westerse dokters vir hulp; sommige medisyne is nie altyd by klinieke beskikbaar nie en mense sien nie kans om in lang rye te wag by hospitale nie en dit noop dat hulle tradisionele medisyne gebruik; verpleegkundiges en gesondheidswerkers erken dat tradisionele genesers mense vertraag om gesondheidsorg en behandeling by hospitale te kry, maar verstaan ook dat tradisionele genesers aan mense geestelike hulp verleen; en besleidskrywers moet oplossings vind om tradisionele genesers op te voed en om komitees te stig wat tradisionele genesers se ruimte van praktisering in toom te hou. Die volgende word as voorstelle tot aanpassing van die genoemde beleidsdokument geïdentifiseer:- Tradisionele genesers mag alleenlik praktiseer en opleiding verskaf na die ouderdom van 21 jaar. Hulle moet verbied word om sekere prosedures, byvoorbeeld die trek van bloed; behandeling van HIV/VIGS; om voor te gee dat hulle mediese praktisyns is; om vroedvroue te wees slegs indien gekwalifiseer daartoe; om inspuitings toe te dien en medisyne uit te reik slegs indien hulle tersiëre opleiding gehad het. Tradisionele genesers se dienste kan gebruik word as gemeenskapsgesondheid hulpwerkers, geestelike genesers, en kan tradisionele advies en begeleiding aan die gemeenskap lewer. Tradisionele genesers moet belet word om die titels “Dokter” en “Professor" te gebruik. Tradisionele genesers moet daarop let dat hulle holistiese genesers is en moet daarvolgens aangespreek word. Hulle moenie pasiënte mislei deur voor te gee dat hulle allopatiese geneeshere is nie. “Tradisionele genesers” moet hernoem word na “geestelike genesers”. Tradisionele genesers moet by ‘n erkende organisasie geregistreer word en moet so-ook jaarliks registrasie hernu. Formele onderrig wat deur ‘n ervare kruiegeneser aangebeid word moet bygewoon en gedokumenteer word. ‘n Geskrewe rekord van die ligging van die praktyk en betrokke spesialisering moet bygehou word. Beleidsvoorskrifte wat verband hou met gesondheid en veiligheid, hygiene en sterilisasie moet in die tradisionele gesondheidgeneserspraktyk geïmplementeer word. Opleiding in pasiëntkonfidensialiteit moet aangeleer en toegepas word. Samewerking en werkswinkels tussen moderne mediese dokters en tradisionele gesondheidgenesers moet geïmplementeer en ontwikkel word. Mediese wetenskapsinligting en tegnologie moet aan tradisionele genesers bekendgemaak word. Voorts moet ‘n voortgesette professionele ontwikkelingsprogram (POP) aan alle gesondheidswerkers voorgeskryf word. Dit blyk wenslik te wees om tradisionele hospitale tot stand te bring waar die bestek van praktyk gedefinieer word. Sulke hospitale kan dien as plekke waar pasiënte aansterk en geestelike onderskraging geniet. ‘n Etiese kode en standaard vir professionele etiek moet geskep word vir tradisionele genesers. Gesondheids- en sekureitsregulasies moet van toepassing wees en geïmplementeer word. Pasiënte moet ingelig word oor die wegdoen van mites en fabels. Daardeur kan die positiewe sy van tradisionele medisyne (byvoorbeeld mediese voordele van kruie), en uitroei van “kwakke” (byvoorbeeld dra van gelukbringers om die lywe), verdryf word. Dit sal die aanmoediging van ‘n gesonder, sekuriteitbewuste en deursigtige gesondheidsorg sisteem bewerkstellig in Suid-Afrika waar alle dissiplines van medisyne saam bestaan in die Nasionale Gesondheidsorgsisteem.

Thesis (MPhil)--Stellenbosch University, 2010. / ENGLISH ABSTRACT: The purpose of this study was to identify possible viable future healthcare models for South Africa, using the techniques and methodologies advocated in the field of future studies by futurists and erudite academics such as Ackoff, Drucker, De Jouvenel, Slaughter, Dostal and Roux. This topic necessitated a problem-orientated approach to future studies based on the complexities inherent thereto. A great deal of emphasis was therefore placed on the tools of rational analysis, which are supported by unregarded worldview assumptions about the ability of humans to regulate and control the world and therefore the framing of new laws, rules and regulations. The forward view was generated by using the appropriate methodologies such as environmental scanning and the analysis of trends and outcomes. Enrichment to the foresight work, beyond the respective models, was furthermore achieved by acknowledging the cultural and social-political arena wherein the current healthcare models in South Africa operate. The focused scan of salient and credible material and publications was extended to include research into healthcare outcomes achieved in countries with comparable economic and demographic profiles to South Africa. Supplementary research was also conducted into comprehensive aspects such as ethics and health economics in conjunction with recognised international healthcare models. The drivers of quality healthcare at primary and secondary healthcare levels and therefore also representing the constraining factors in the South African milieu being available healthcare practitioners, training, physical infrastructure, technology, access to facilities and the affordability of healthcare were explored to ensure the viability of the futures healthcare models contemplated. The identification of probable futures was accomplished by means of scenario development which focussed on the critical uncertainties of healthcare funding models and nationalisation as opposed to free market models competing for available resources in a semi-regulated environment. Thereafter Delphi techniques were used to acquire consensus from specialists currently working in the field of public and private healthcare along with stakeholders such as leaders of enterprise, healthcare funders and regulators as regards the identification of preferred future healthcare models that will meet, in a sustainable manner, the constitutional right to basic healthcare and enhance the quality of life and life expectancy of all South Africans. The relevance and credibility of the consensus opinions of the selected experts who participated in the research was again tested against the futures discourse publicised in the press to ensure that personal, cultural and organisational factors were not disregarded in the process. The study concluded on the fact that additional research and debate are required to ensure that the societal, organisational and individual aspects of the system wherein healthcare operates are comprehensively addressed by all relevant stakeholders in a manner that void of the neuroses caused by anxiety when thinking of the future. / AFRIKAANSE OPSOMMING: Die doel van die studie was om moontlike volhoubare toekomstige gesondheidsorgmodelle vir Suid-Afrika te identifiseer deur gebruik te maak van tegnieke en metodologieë soos voorgehou deur deskundiges en hoogs belese akademici in die veld van toekomstudies, soos Ackoff, Drucker, De Jouvenel, Dostal en Roux. Die studie het, as gevolg van die kompleksiteit daarvan, ´n probleem-gerigte benadering tot toekomstudies verlang. Gevolglik is baie klem geplaas op rasionele analise-tegnieke, wat ondersteun word deur wêreldsiening-aannames aangaande die mens se vermoeë om die wêreld te reguleer en te beheer deur middel van nuwe wetgewing, reëls en regulasies. Die toekomsgerigte siening is gegenereer deur die gebruik van toepaslike metodologieë, soos byvoorbeeld omgewingskandering en die analise van tendense en uitkomste. Die toekomsgerigte werk is aangevul deur erkenning te gee aan die kulturele en sosio-politiese milieu waarbinne die huidige gesondheidsorgmodelle in Suid Afrika funksioneer. Die gefokusde skandering van kredietwaardige bronne en publikasies is uitgebrei ten einde navorsing oor gesondheidsorguitkomste, soos behaal in lande met vergelykbare ekonomiese en demografiese profiele, soos Suid Afrika, in te sluit. Aanvullende navorsing is verder onderneem en was gerig op omvattende aspekte soos etiek en gesondheidsekonomie, tesame met erkende internasionale gesordheidsorgmodelle. Die kernbepalers van kwaliteit-gesondheidsorg op primêre en sekondêre gesondheidsorgvlak, wat dus ook die beperkende faktore in die Suid-Afrikaanse milieu verteenwoordig, naamlik beskikbaarheid van mediese praktisyns, opleiding, fisiese infrastruktuur, tegnologie, toegang tot fasiliteite en die bekostigbaarheid van gesondheidsorg, is ondersoek ten einde die volhoubaarheid van die toekomsgesondheidsmodelle te verseker. Die identifiserings van waarskynlike toekomste is bereik deur scenario-ontwikkeling wat gefokus het op die kritiese onsekerhede van gesondheidsorgbefondsing en nationalisering, teenoor ´n vryemarkstelsel wat meeding om beskikbare hulpbronne in ´n deels-gereguleerde omgewing. Daarna is Delphi-metodieke gebruik om konsensus te verkry onder kenners wat tans in die veld van openbare en privaat gesondheidsorg werksaam is, asook belanghebbendes soos leiers in besighede, gesondheidsorgbefondsers en reguleerders, ten opsigte van voorkeur-toekomsgesondheidsorgmodelle wat op ´n volhoubare wyse die grondwetlike regte tot basiese gesondheidsorg en die verbetering van die kwaliteit van lewe en lewensverwagting van alle Suid-Afrikaners sal bevorder. Die toepaslikheid en geloofwaardigheid van die konsensusmenings van die gekose kenners wat deelgeneem het aan die navorsing is weer getoets teen toekomsgesprekke soos gepubliseer in die media ten einde te verseker dat persoonlike, kulturele en organisatoriese faktore nie in die proses misken is nie. Die studie het tot die slotsom gekom dat verdere navorsing en debat nodig is ten einde te verseker dat die sosiale, organisatoriese en individuele aspekte van die stelsel waarbinne gesondheidsorg funksioneer omvattend aangespreek word deur alle belanghebbendes, en op ´n wyse wat enige neurose wat tot angstigheid oor toekomsdenke kan lei, die hok slaan.

Über die letzten zwölf Jahre sind globale Indikatoren für Demokratie- und Freiheitsrechte kontinuierlich gesunken. Demokratie ist eine wichtige Triebkraft für wirtschaftliche Entwicklung, daher folgen aus diesem Vertrauensverlust auch Sorgen über die Zukunft des ökonomischen Wohlstandes. Diese Dissertation besteht aus drei Essays und untersucht mögliche Reformen für effektivere politische Gestaltungsmöglichkeiten in demokratischen Systemen: Dezentralisierung und Privatisierung. Das erste Essay überprüft, ob durch Dezentralisierung der öffentlichen Arbeitsvermittlung mehr Arbeitslose in freie Stellen vermittelt werden können. Dafür untersuche ich die Kommunalisierung deutscher Jobcenter im Jahr 2012. Dabei stelle ich fest, dass sich durch Dezentralisierung die Neuanstellung von Arbeitslosen um rund 10% verringern. Es zeigt sich, dass dezentralisierte Arbeitsvermittlungen vermehrt öffentlich geförderte Arbeitsbeschaffungsmaßnahmen nutzen. Das zweite Essay beschäftigt sich mit finanzpolitischen Wechselwirkungen zwischen Gemeinden in Kolumbien, wo die Verantwortlichkeit für einen großen Teil des Staatsbudgets an die kommunale Regierungsebene übertragen wurde. Es ergeben sich starke räumliche Autokorrelationen im lokalen Ausgabeverhalten. Allerdings zeigt sich durch einen Instrumentalvariablenansatz, dass es keine kausalen fiskalischen Interaktionseffekte zwischen den Gemeinden gibt. Das dritte Essay analysiert, ob Regierungen ökonomischen Effizienzüberlegungen folgen, wenn sie entscheiden, welche staatlichen Firmen für eine Privatisierung ausgewählt werden. Basierend auf der Massenprivatisierung in Folge des Falls der Berliner Mauer untersuche ich Firmendaten, welche mehr als 6.000 Privatisierungs- und Liquidationsentscheidungen umfassen. Die Ergebnisse legen nahe, dass Privatisierungsentscheidungen weniger politisch, sondern stärker ökonomisch orientiert sind, als dies durch bisherige Studien bekannt ist. / Global indicators of democracy and civil liberties have continually decreased over the past twelve years. Scholars have identified weak public policy-making as an origin for low levels of trust in democratic governance. In three essays, this dissertation studies two reform options to improve policy-making, namely decentralization and privatization. The first essay examines whether the decentralization of public employment services (PES) increases job placements among the unemployed. Using a difference-in-differences design, I exploit unique within-country variation in decentralization provided by the partial devolution of German job centers in 2012. I find that de-centralization reduces job placements by approximately 10% while expanding the use of inefficient public job creation schemes. Essay two explores fiscal interactions in Colombia, a developing country which shifted the responsibility for a large share of public spending from the central to local governments. I find evidence of strong spatial autocorrelation of local public spending. However, an instrumental variable approach reveals that there are no significant causal fiscal interaction effects between municipalities. The third essay studies whether governments incorporate economic efficiency considerations when choosing which firms they select for privatization. Analyzing mass privatizations following the Fall of the Berlin Wall in Germany, I employ previously unavailable firm data on more than 6,000 privatization and liquidation decisions. The analysis suggests that privatization decisions are less politicized and more efficiency-oriented than found in previous studies.

A atividade turística em determinadas regiões brasileiras intensifica fluxos populacionais sazonais e gera impactos socioambientais, dentre eles agravos em saúde sexual e reprodutiva dos moradores das comunidades anfitriãs, o que exige respostas programáticas dos sistemas locais de saúde. Uma das estratégias de prevenção e promoção da saúde sexual que tem sido valorizada no debate sobre o tema constitui na maior incorporação de ações de prevenção ao Programa Saúde da Família (PSF), de acordo com suas diretrizes que prevêem a integração entre ações de prevenção, tratamento e reabilitação, de acordo com a realidade epidemiológica e sociocultural. Os objetivos do estudo foram: (1) descrever a vulnerabilidade social e programática às DST/HIV, gravidez não planejada e ao mercado sexual, entre jovens residentes em comunidades anfitriãs de turismo do litoral sul fluminense; (2) compreender de que modo os profissionais da rede básica/Programa Saúde da Família, da mesma localidade, reconhecem os impactos do contexto do turismo sobre a saúde do segmento jovem caiçara e quais as ações de prevenção que desenvolvem. O estudo de desenho qualitativo utilizou a observação etnográfica e entrevistas semi-estruturadas em profundidade realizadas com dois grupos de informantes: 12 jovens e 11 profissionais de saúde (dez da rede básica/PSF e um gestor da Coordenação Estadual de DST/Aids-RJ). RESULTADOS: O gênero, a cor/etnia, a geração, a nacionalidade e o status social mostraram-se fundamentais para a compreensão do cenário sexual e sociocultural, bem como das interações afetivo-sexuais entre jovens moradores locais e turistas. O cenário sexual amplia a vulnerabilidade dos (as) jovens às DST/HIV, à gravidez não-planejada e ao mercado sexual. A disponibilidade para as interações afetivo-sexuais entre jovens das comunidades e visitantes é marcada pelos estereótipos como turista, gringo (a), caiçara e nativo (a) e pelo intercâmbio de bens materiais e simbólicos que distinguem pessoas de fora e pessoas daqui. Os profissionais do PSF, por sua vez, reconhecem a vulnerabilidade específica da juventude; atribuem-na à pobreza, à escolaridade, à vida familiar, à promiscuidade e às características tradicionalmente atribuídas à fase da adolescência. A gravidez na adolescência e a multiplicidade de parceiros, significadas como promiscuidade são as problemáticas mais reconhecidas. Valorizam a prevenção e realizam ações educativas de base comunitária. Como obstáculos à qualidade da prevenção entre os jovens, o estudo identificou: 1) a compreensão pouco aprofundada do cenário sexual, das relações de gênero e das diferenças de status social enquanto aspectos relevantes ao planejamento das ações de promoção da saúde sexual e reprodutiva entre jovens caiçaras; 2) as abordagens utilizam prioritariamente o recurso das palestras que enfatizam aspectos biomédicos e a orientação como base em valores pessoais; 3) há dificuldades operacionais para disponibilizar insumos e planejar ações de prevenção no âmbito da rede básica/PSF; 4) a interlocução é incipiente entre Atenção Básica/PSF (municipal) e Programa Estadual de DST/Aids-RJ. CONCLUSÃO: A intensificação da economia associada ao turismo nas comunidades anfitriãs amplia a vulnerabilidade social ao sexo desprotegido e ao mercado sexual, atribuindo um caráter singular à desigualdade de gênero, cor/etnia e status social. Essas dimensões, invisíveis aos olhos dos profissionais do PSF, juntamente com o modelo de prevenção tradicional (palestras e orientações) ampliam a vulnerabilidade programática dos jovens às DST/Aids, gravidez não planejada e mercado sexual. Haja vista o repertório de atitudes e práticas dos profissionais ter se mostrado insuficiente para o manejo das tecnologias psicossociais que integram a dimensão sociocultural da sexualidade, recomenda-se fortemente o investimento na formação adequada dos profissionais do PSF para sofisticar suas ações de prevenção. / The touristic activity in certain Brazilian regions intensifies seasonal population flows and it generates socioenvironmental impacts, among which problems to the sexual and reproductive health of the host communities inhabitants. This demands scheduled responses by the local health systems. One of the strategies of prevention and promotion of sexual health is the accretion of more prevention actions into the Programa Saúde da Família PSF [Family Health Program]. This strategy has grown in the discussions on this theme. According to its guidelines, which foresee the integration between prevention actions, treatment and rehabilitation, and also according to the epidemiologic and sociocultural reality. The objectives of the study were: (1) describe the social and programmatic vulnerability to the STDs and AIDS, unplanned pregnancies and to the sexual market, among young residents of the host communities for tourism on the southern coast of the Rio de Janeiro state in Brazil; (2) understand how the professionals of the primary health care/PSF of those same places, recognize the impacts of the tourism context on the health of the Caiçara youth segment and what are the prevention actions that they develop. The qualitative design study used the ethnographic observation and semi structured in-depth interviews applied to two groups of informants: 12 of the youth of the host community and 11 health professionals ten from the primary health care/PSF and one member of the State Coordination of STDs and AIDS of the State of Rio de Janeiro. RESULTS: Gender, ethnic, the generation, the nationality and the social states were proven to be fundamental to understand the sexual and sociocultural scenery, as well as the sexual-affective interactions among tourists and young local residents. These social markers enhance the vulnerability of the youth to STDs and AIDS, unplanned pregnancies and to the sexual market. The availability to the sexualaffective interactions among youth of the host communities and the tourists is marked by the stereotypes like tourist, gringo(a) [commonly used slang in Brazil for foreigners], caiçara and native and by the interchange of material and symbolic goods which separate people from abroad and people from here. On the other hand, the PSF professionals recognize the specific vulnerability of youth and link it to poverty, to schooling, to the family life, to promiscuity and to the characteristics usually linked to the adolescent phase. Adolescent pregnancy and the presence of multiple sexual partners, known as promiscuity are the better known problems. They value prevention and promote educational actions for the community. This study has identified some obstacles to the quality of the prevention among the youth of the host community as follows: (1) the little comprehension of the sexual scenery and of the gender and social class relations as relevant aspects to the planning of the sexual and 11 reproductive health promotion actions among the Caiçara youth; (2) the approaches use mainly the resource of lectures which emphasize biomedical aspects and orientation as a base for personal values; (3) there are operational difficulties to supply medicine needs and to plan prevention actions on the scope of the primary health care/PSF; treatment and rehabilitation actions are preferred; (4) the communication between the primary health care/PSF (municipal administration) and the State Program for STDs and AIDS of the State of Rio de Janeiro. CONCLUSION: The enhancement of the economy associated with the tourism on the host communities expands the social vulnerability to unprotected sex and to the sexual market, giving an unique character to the gender, ethnicity and social class differences. These dimensions, invisible to the eyes of the PSF professionals, along with the traditional prevention model of lectures and orientation, enlarge the programmatic vulnerability of the youth to the STDs and AIDS, to unplanned pregnancies and to the sexual market. Even though the assortment of attitudes and actions of the professionals has proven to be insufficient to manage psychosocial technologies which are part of the sociocultural dimension of sexuality, it is strongly recommended to invest on the proper education of the PSF professionals to expand their prevention actions.

Os serviços de saúde devem ser proporei~ nados de forma continua, em lugares acessiveis e de maneira aceitável pela população. O presente trabalho procurou tr! zer uma contribuição para o estudo da área de influência de oito postos municipais de saúde da região de Santo Amaro no Municlpio de são Paulo. Foram utilizados instrumentos da área de Geografia, que se mostraram eficientes, no sent! do de possibilitar uma visualização da distribuição geográfica do local de residência dos usuários que passaram por consulta médica de pediatria, no decurso de um ano, naque - les postos. O processo manual de localização dos endereços, que foi por nós empregado, apresenta boas condições de apl! cação, para populações de pequena ou média proporções. Para populações de dimensões maiores seria preferlvel a utilização da mesma metodologia, agora através de codificação e processamento, por computador. Assinalamos, ainda, que o trabalho apresentado pode ser identificado como parte in tegrante de um ramo da Geografia Humana, sugerindo-se ain da, para esse setor a denominação de \"Geografia em Saúde Pública\" / Health services should be offered in a continuous manner , in accessible places and in such a way that they be acceptable by the population. This paper is intended to bring forth a contribution towards the study of the area of influence of eight out-patient municipal health service units in the region of Santo Amaro, county of são Paulo Brazil. Instruments belonging to the field of Geography were employed and proved to be efficient as they allowed I a perfect insight regarding home addresses of the users of those units who had gone through paediatric consultations throughout a whole year. The manual procedure for placing such addresses developed by us was very useful as far as populations of minor or medium dimensions were concerned For larger populations it would be better to use the same methodology through coding and computer processing. We would also like to point ou that the present work could be identified as a branch of Human Geography and even suggest it be called \"Public Health Geography \"

Made available in DSpace on 2016-08-10T10:53:40Z (GMT). No. of bitstreams: 1 BERNARDETE GATTO.pdf: 1728558 bytes, checksum: 4a1558a8858f275753f9ef9626a7c582 (MD5) Previous issue date: 2012-03-13 / The health services solid waste (RSSS) have high levels of contamination, not only harmful to human health, but harmful to the environment. For the reduction of problems caused by these kinds of wastes it s important to have an administration and implementation of programs for the management of the health services solid waste (PGRSSS). This program must be implemented and monitored in the institutions that produce solid wastes, with the committed participation of all employees, rescuing ethical values and environmental responsibility. The main purpose of this study was to identify public policy of the management to the treatment of the health services solid waste and the actions to put in practice in the city of Rondonópolis, MT. To reach the purpose, it was developed an exploratory descriptive study, with secondary and primary data. It was found that the healthcare professionals of the city of Rondonopolis, MT does not have access to the PGRSSS printed and neither the knowledge about the actions to be performed in order to make the management of the public policies effective. It was also found that the healthcare professionals are not trained to work properly to have health, safety and environmental protection. During this study was noted that among the steps of PGRSSS, the temporary storage is one of the most precarious problems and has no proper place for storage. Besides that, the collection is been made in a way that does not comply with the relevant legislation, a fact that also occurs in the transport, in which the box trucks, although they are licensed, the RSSS are incorrectly accommodated, violating the rules that require sealed containers. It was concluded that there are absence of implementation of public policy for the management of the RSSS directed to the final disposal of this solid wastes, as well, the control from the public agencies with respect to all the stage of the PGRSSS. These measures would require from the government to perform and execute with more responsibility actions to the protection of the public health and the environment. / Os resíduos sólidos dos serviços de saúde (RSSS) são de alto teor de contaminação, nocivos não apenas a saúde dos seres humanos, mas agressivos ao meio ambiente. A redução dos problemas causados por estes resíduos fecunda-se na gestão e implantação de programas de gerenciamento dos resíduos sólidos dos serviços de saúde (PGRSSS). Este programa deve ser implantado e fiscalizado nas instituições geradoras de RSSS, com a participação comprometida de todos os trabalhadores, resgatando valores éticos e de responsabilidade ambiental. O objetivo geral deste estudo foi identificar as políticas públicas de gestão para o tratamento dos resíduos sólidos de saúde e as ações para sua implementação no Município de Rondonópolis-MT. Para o alcance do objetivo foi desenvolvido um estudo exploratório-descritivo, com dados secundários e primários. Constatou-se que os profissionais da saúde de Rondonópolis-MT não possuem acesso ao PGRSSS impresso e nem conhecimento sobre as ações a serem realizadas de forma a tornar as políticas públicas de gestão eficazes. Foi observado ainda que os trabalhadores da saúde não são treinados para trabalhar de forma a ter saúde e segurança e proteção ambiental. Durante este estudo se observou que dentre as etapas do PGRSSS o armazenamento temporário é o mais precário e não possui local apropriado para acondicionamento, bem como a coleta é feita de forma a não cumprir com as legislações pertinentes, fator este que ocorre também no transporte, em que os caminhões do tipo baú, embora sejam licenciados, os RSSS são acomodados de forma incorreta, não obedecendo às normas que exigem bombonas ou conteiners lacrados. Concluiu-se que a falta da aplicação da política pública de gestão dos RSSS voltada para o descarte final destes resíduos, bem como, a fiscalização dos órgãos públicos com relação a todas as fases do PGRSSS. Essas medidas exigiriam do poder público executar com maior responsabilidade as ações voltadas para a proteção da saúde da população e do meio ambiente.