Les nations développées contemporaines sont souvent décrites comme des économies de services. Dans la majorité des pays de l’OCDE (Organisation de Coopération et de Développement Economiques), plus des deux tiers de l’emploi et de la valeur ajoutée sont issus du secteur des services. Les services occupent une place extrêmement importante dans les nations tournées vers l’économie du savoir. Ils sont également un des principaux moteurs de la croissance économique, et participent activement à la compétitivité du secteur industriel (Nordås and Kim, 2013). La figure IV.9 illustre l’importance croissante des services dans l’emploi et la valeur ajoutée de l’économie française entre 1970 et 2007. Les valeurs utilisées sont prises en référence à l’année de base (1970), et renseignent donc sur le taux de croissance de chaque secteur en terme de valeur ajoutée et d’emploi. Le message est clair sans ambiguïté. Les services professionnels (immobilier, location, services aux entreprises et intermédiation financière) contribuent le plus à la croissance de l’économie française. Ces services, aussi appelés “services complémentaires” par Katouzian (1970) car ils complémentent les activités industrielles, ont connu une croissance de leur valeur ajoutée beaucoup plus forte que le secteur industriel et que les autres secteurs de services (grossistes/détaillants, hôtels et restaurants par exemple). En 2007, le secteur des services professionnels comptait pour un tiers de la valeur ajoutée générée en France, soit deux fois plus que le secteur industriel. Du côté de l’emploi, le constat est encore plus frappant. Les services professionnels contribuent encore une fois fortement à la croissance de l’emploi (avec également les secteurs de l’hôtellerie et de la restauration) alors que le secteur industriel n’a cessé de perdre des emplois sur cette période. En 2007, les services professionnels regroupaient 20% de l’emploi, contre 14% pour le secteur industriel. [...] / Today’s developed economies are often described as service economies. More than two thirds of employment and value added is generated by the service sector in OECD countries. Services are increasingly important in today’s knowledge based economies, are a crucial component of economic growth and contribute to the competitiveness of the industrial sector (Nord ås and Kim, 2013). Figure IV.9 plots the evolution of value added and employment in France between 1970 and 2007. It shows that the professional service industries (Real estate/renting/business services and financial intermediation) are the main contributors to the growth of the French economy. These services (also called “complementary services” by Katouzian (1970)), have been growing much faster than the manufacturing sector, and much faster than the other service sectors (wholesale/retail, hotels and restaurant services). These fast growing services accounted for 33% of the total value added in 2007 (twice as much as the manufacturing sector) and 20% of the overall employment (14% for the manufacturing sector). [...]

Objectives: To contribute to knowledge on the reliability and validity of the contingent valuation method (CVM) and explore the role of context-specific CVM question formats in Southeast Nigeria. Other objectives were to determine the factors that will explain actual willingness to pay (WTP) for insecticide-treated nets (ITNs). Methods: There was an extensive review of theoretical, methodological and empirical literature. A novel WTP question format that mimics price-taking behaviour in south- east Nigeria (called the structured haggling technique (SH)) was developed and compared with the bidding game (BG) and binary with follow-up technique (BWFU). The comparisons were for inter-rater and test-retest reliability, content, construct and criterion validity and the study conducted in three villages in Nigeria. Stated WTP was determined using a questionnaire administered to 810 household heads, while actual WTP was evaluated by offering the ITNs for sale to all respondents after one month of the first survey. Findings: There were considerable gaps in the literature regarding the reliability and validity of the CVM. In the empirical study, BG, BWFU and SH elicited reliable and valid estimates of WTP. The SH was the most content valid, while the BG and SH were the most construct-valid for ITNs and re-treatment respectively. The BG and SH were similarly criterion-valid while the BWFU was the least criterion-valid. All question formats were similar for tests of reliability. There were genuine reasons for divergences between the stated and actual WTP and for test and retest. Low-income status and physical accessibility were the major impediments to ITNs acquisition. Conclusion: The CVM could be used to elicit valid and reliable WTP estimates in the study area, but it was not clearly proven that better content-valid question formats would lead to more valid and reliable estimates of WTP. It is necessary to further determine how the validity and reliability of the SH and other WTP question formats could be improved. Finally, future studies should establish the content validity of question formats in settings where they will be used, and use bigger sample sizes, along with allowing less time between the survey and administering the criterion, for comparing stated and actual WTP.

Bangladesh introduced menstrual regulation (early abortion) into its national family planning program in 1979, and for more than 20 years women with unwanted pregnancies have been able to avail themselves of a relatively safe and accessible service. Over the years, however, concern has been expressed about deficiencies in the implementation of the policy, and by the mid-1990s, the menstrual regulation (MR) policy was approaching a critical juncture. The introduction of health sector reforms and the waning of international and domestic support raised questions regarding the sustainability of the policy. This study was conducted to determine the factors that influenced the development of and support for the MR policy in Bangladesh, in order to explore how far those factors might influence future sustainability. The study used an analytic framework based on literature from the policy field to test what factors were important in the policy process in Bangladesh. Qualitative data was gathered from interviews and documents in an inductive approach to determine the development of the MR policy, which was then subjected to a retrospective analysis of the entire life cycle of the MR policy-how it came to be placed on the policy agenda, how and why it was formulated the way it was, and why it was not implemented as well as it could have been. Data gathered from interviews and document reviews were then used in a political mapping exercise undertaken in a prospective analysis for the policy, providing insights in relation to the future sustainability of the MR policy. The research suggested that the analytic framework used was helpful in providing a systematic analysis of contextual conditions, agenda-setting circumstances, and policy characteristics that could explain much of the variability in the policy process. The role of international donors and attitudes toward religion were found to be particularly relevant to explaining the policy process. The study concluded that the MR policy would likely not be sustained in the future unless purposeful action were taken to mobilise additional bureaucratic and political resources in support of the policy.

This thesis is about the Utilisation of Maternal and Child Health Care Services (MCH) in Rural Bangladesh. Investigations have been made to identify the underlying causes of low use of the MCH services provided through the public sector health care facilities, which is a major concern for the government of Bangladesh. This thesis focuses on the factors that are affecting the use of MCH services both from population and provider perspectives. Socio-economic condition of people, their knowledge and attitudes towards the public sector health care services are considered as population factors, while different aspects of quality of public health services, access to the service facilities and provider's behaviour are explored as the providers' factors. Aims: The aim of this research was to provide policy recommendations for improving utilisation of the public health services at the primary health care level by redesigning more accessible, acceptable and quality health care services, especially for rural women and children. Scope: Maternal health services: antenatal care; tetanus vaccination; place of child delivery; and postnatal care are considered in this study. While two major killer diseases: diarrhoea and acute respiratory infections, and immunisation of children under five years of age are included as child health care services. Methods: A combination of qualitative and quantitative methods are used to collect data /information from 360 mothers, 28 formal and informal community leaders, 44 various types of health care providers and 22 public sector facilities in a rural area of Bangladesh. The World Health Organisation (WHO) recommended 30 cluster sampling method was used in sample design. Household survey, in-depth interview, informal and formal discussion, participant observation and document analysis have been carried out to obtain necessary information/data. Data analyses: The quantitative data have been analysed by using STATA and SPSS statistical computer programme, performing descriptive, bivariate and logistic regression analysis. The qualitative information has been analysed in a descriptive way. Results: The results show that the use of government health facilities: THC, FWC and VHCP is generally very low with an exception of the use of VHCP for TT vaccination to women and child immunisation. The use of VHCP is encouraging for the government policy makers and planners. THC is partially meeting the health care need of rural people and mainly serving the interest of people of relatively high socio-economic condition. FWC is the most unused health care facility at the rural areas of Bangladesh. The majority of people (86%) received health care from non - qualified health care providers. Among the socio-economic factors - family education and income were found to be significant both individually and jointly with the variations of use of MCH services. The majority of the sample population does not have knowledge about the MCH service availability and possessed negative attitudes towards the public sector MCH services. These are attributable to the under utilisation problem. Nine gaps have been identified between peoples' `reasonable expectation' and the `existing' MCH service delivery system. Peoples' involvement in the health service organisation at the thana and union level was found almost nil. However their involvement in the operation of VHCP was encouraging. Low (2-3 minutes) consultation time, lack of privacy in treatment, unregulated involvement of public sector provider in private practice, lack of accountability, supervision and improper behaviour of providers deteriorating the quality of services hence decreases the use of public sector facilities. Unavailability of drug was found to be the single most important reason that deters people from using public facilities. Difficulties in access to quality services were found to be a major problem than access to the service facilities. Conclusions: This thesis suggests that giving priority to improving the service qualities of the existing facilities rather than construction/development of additional facilities at PHC level. It also suggests the initiation of behaviour change programmes for public sector health care providers. Secondly an effective mechanism needs to be developed to ensure peoples' involvement in the management and operation of public health care facilities to enhance accountability of public sector provider to the population and reduce the gap between them. Initiatives could be taken to improve the quality of non-qualified health care providers, as they are the main source of health care for the majority of population. Finally, increasing the education level of rural population particularly for women could increase the use of health services.

Household ability to pay (ATP) for health care services has become a critical policy issue in developing countries because of changes to health system financing and delivery that are likely to impose higher illness cost burdens on poor households. The research presented in this thesis was driven by widespread concern about ATP among different policy actors, and by the fact that conceptual and empirical understanding of the issue remains poorly developed. The thesis uses a conceptual framework for assessing ATP that is, at its core, concerned with the implications that illness costs and related coping strategies have for household livelihoods. The main research objectives were to measure the household costs of illness, examine the types of asset (e. g. financial, social) that are mobilised to cover illness costs, and to evaluate the impact of these illness cost burdens and coping strategies on household livelihoods in the medium term. In so doing, the thesis aimed to identify factors which make households robust or vulnerable to illness costs which development agencies might support. Research was conducted in two low-income communities in Colombo, Sri Lanka. A survey of 423 households was carried out to obtain a profile of illness, treatment actions and illness costs in the two communities, and to identify case study households. The main part, of the research was to follow 16 case study households for eight months, which enabled in-depth investigation of treatment seeking behaviour, expenditure patterns, asset strategies and their impact on household livelihoods. The main findings of the research were ' that free public provision of health services protected poor households from high treatment -costs. In particular, public tertiary hospitals protected households against potentially catastrophic treatment costs associated with inpatient care. This enabled households to access treatment without adopting risky coping strategies. However, aspects of the health system failed to protect households from illness costs, and in a context of low and insecure incomes, illness costs did not have to be high to exceed daily budgets and undermine ability to meet basic food needs. Consequently, households often required additional resources to meet illness costs, and people's financial and social resources were shown to be important factors influencing ability to manage illness costs. However, the research also found that income-poor households had weak social resource endowments which forced them into riskier borrowing or asset strategies. Policy actions to support household assets are examined.

This thesis analyses the state's capacity to pursue health reform. It argues that the feasibility of health reforms, as well as their final content, are in great part determined by their political context, and the political strategies reformers resort to when pursuing their policy agenda. The analysis is framed in the political context in which a reform initiative evolves, the political dynamics of and around the health reform process, and the characteristics and strategies of the teams in charge of leading policy change (change teams). The research aims to contribute to existing knowledge in the health policy field by furthering the analysis and explanation of the political feasibility of health reforms. A two case study comparative analysis is used based on primary and secondary sources and in-country interviewing. Colombia and Mexico, challenged by the need to attain universal coverage, and faced with large inefficiencies, set about to transform their health systems in the 1990's. While Colombia was successful in passing legislation and initiating implementation, Mexico made a series of similar attempts, but its reform was brought to a near halt. The analysis of these contrasting outcomes given the similar choice of political strategies in comparable political contexts, allows for a greater understanding of the factors at play. Key findings demonstrate the relevance of the political context in determining the potential of interested actors within and outside the state, to influence health reforms. The study also reveals the remarkable resemblance between the political strategies used by health reform teams, and those used by economic adjustment teams in the 1980's. While these strategies enabled the latter to introduce major policy change, they helped health reform teams only partially. As a result, health reformers were successful in enabling the creation of new private health financing and provider organisations, but the transformation of the old public health service institutions remains a challenge.

The private health sector in Pakistan has been expanding rapidly, largely unregulated and partly at the expense of the public sector. While there have been previous attempts at formulating policies for the regulation of this sector, these have not always been based on ground realities, with the result that they never reached the stage of implementation. The objectives of the thesis were: 1) to describe and evaluate the existing regulatory framework governing health care provision in general and private health care provision in particular both at federal & provincial levels; 2) to explore the views and perceptions of key stakeholders regarding existing regulations and the reasons for their effectiveness/non-effectiveness; 3) to identify whether and how regulatory mechanisms can be made to work effectively; and 4) to explore the views of stakeholders regarding the potential for alternative mechanisms for ensuring the quality of formal private medical services, including the role of information dissemination to service users/the public. The methods adopted to achieve the stated objective were mapping of the existing legislations and a stakeholder analysis. The results showed that the existing legislations on regulation of health care provision were scanty, weak and inadequate and required radical re-structuring. The stakeholder analysis demonstrated the conflicting interests of the state and the private providers, the role of the powerful medical community and the views of the service users, who were shown to be the ultimate victims. Avenues for alternative regulatory mechanisms, including one based on information dissemination were explored and their feasibility discussed. It is hoped that the information gained from this study, by reflecting the views of the various actors in this process, will contribute towards the formulation of a policy for regulation of private health care provision in Pakistan, which is realistic, feasible and sustainable.

Community care has been an explicit policy goal in the United Kingdom since the end of the 1940s. The policy had traditionally taken the form of the provision of help and support in non-institutional settings, usually in the individual's own home. The services provided are intended to keep the individual in the community and out of institutions. Statistical data would suggest that there has been a huge expansion in domiciliary welfare provision. However, recent studies of such services suggest that the real gains made have not increased to the same degree as the per capita expansion in-services might suggest. Alongside the observations about the outcomes of the explicit policy goal for community care there has been a growing awareness that policy implementation is not simply a continuation of the process of policy formulation ie implementation starts where policy stops. It has been argued that policy may be a response to pressures and problems experienced on the ground and it is essential, therefore, to look at implementation not solely in terms of putting policy into effect but also in terms of observing what actually happens or gets done and to seek to understand how and why. The development of domiciliary services over the years has relied largely on professional judgments but despite this there has been relatively little research into decision-making related to the provision of the services and the closely related service of residential care. For this reason two case studies were conducted which examined, inter alia, the home help service and residential care decision-making processes. Fieldwork for the study was carried out in the area of the Western Health and Social Services Board during 1982. Data collection involved interviews with the senior staff involved in the management and supervision of the social work assistants responsible for the provision of the home help service, the distribution of self-completion questionnaires to social work assistants in respect of recipients of the home help service and to officers-in-charge of old people's homes in respect of the residents in those homes. In addition information was also collected from the files of people newly admitted to old people's homes. The study raises questions about current Government policy, the rationing of services and the targeting of services to particular groups of the population.

No description available.

The purpose of the research described in this thesis is to develop useful and acceptable methods for assessing the effects and value of off-the-job middle management training in the National Health Service. The Preamble describes the background of this need in the NHS, where a rapid growth of management training courses has not been accompanied by any systematic means of securing evidence on the consequences of the training in individual and organisational work performance. Seeing this situation as one which embraces both the classroom and the workplace, the early chapters offer a conceptual framework for the study of management development, built up from theoretical prespectives on the nature of organisations and their management on the one hand, and the nature of human and managerial learning on the other. These concepts are related specifically to the management of health care organisations. The consequent view of management development emphasises considerations of contingency and choice, and is placed in its historical context in the NHS. The characteristics of evaluation are then examined in terms of a comparison of effects with objectives, and a valuing of that comparison, taking place within a particular local system which needs to be understood. The attempt to do so in fieldwork within the Wessex and Oxford NHS regions between 1974 and 1978 is then described, together with the methodology developed to secure and feed back Information about the working of the system to the interested parties. Lastly, the findings of the research are described and discussed in relation to the hypotheses tested and to a multivariate analysis of the influence of course learning, individual and organisational factors on subsequent work performance. The Sequel outlines the present state and future prospects for this research in further developing and testing evaluation strategies and methods for management training in the NHS. "He" and "his" stand for male and female genders throughout the thesis.