No description available.

Community workers supporting adults with intellectual disability get a lot of positive impact from their work. However, staff are also required to deal with challenges such as aggressive behaviours which can be associated with burnout. This thesis used a cross-sectional mixed methods design consisting of survey data analysis and qualitative interviews. The study aims were to examine staff report of emotional difficulties related to working with aggressive behaviours and use of available workplace resources. Staff frequently reported experiencing emotional difficulties; however use of workplace resources was low. Findings fit within existing models of general health service utilization with workplace resource use affected by: preventing and coping, severity threshold, enabling factors and cost versus benefit appraisal. Some unique factors included o-worker relationships, finding relief, lacking or inflexible rules and organizational focus on the service recipients. Multi-faceted interventions are likely to be the most successful in improving staff and related organizational outcomes.

Community workers supporting adults with intellectual disability get a lot of positive impact from their work. However, staff are also required to deal with challenges such as aggressive behaviours which can be associated with burnout. This thesis used a cross-sectional mixed methods design consisting of survey data analysis and qualitative interviews. The study aims were to examine staff report of emotional difficulties related to working with aggressive behaviours and use of available workplace resources. Staff frequently reported experiencing emotional difficulties; however use of workplace resources was low. Findings fit within existing models of general health service utilization with workplace resource use affected by: preventing and coping, severity threshold, enabling factors and cost versus benefit appraisal. Some unique factors included o-worker relationships, finding relief, lacking or inflexible rules and organizational focus on the service recipients. Multi-faceted interventions are likely to be the most successful in improving staff and related organizational outcomes.

No description available.

No description available.

No description available.

No description available.

Municipal health commissions have been key elements in the reform of the Brazilian health system over the past thirteen years. The reform made publicly financed health care, in principle, universally accessible, while the system became better integrated as well as decentralised. Municipal health commissions have become a widespread institutional feature of the health system. They have gradually increased their planning and supervisory roles over health services located within their territorial jurisdiction. The participatory schemes of municipal health commissions can achieve better results in areas where they have the support of strong social and trade union movements. This is the case in the southern region of Brazil and, in particular, in Porto Alegre. This study analyses the ways in which users were involved in the municipal health commission of Porto Alegre, between 1985 and 1991, verifying which institutional-political factors have most influenced their involvement. The study develops a "methodology" for the assessment of user participation in statutory fora. The attendance lists and minutes of meetings, interviews with regular participants in the forum, and other sources of information, were used to build up indicators of user involvement and of the factors that could influence the participatory process. Two main sets of variables are identified. The first set of indicators is concerned with the ways in which users participated in the commission. Two indicator-variables were created to assess this participation: the attendance of users at weekly plenary meetings of the commission (the decision-making division of the forum) and the types of involvement of user representatives in the decision-making process. The second set of indicator-variables refers to institutional- political factors that could have most influenced the participation of users. Among these are; (a) major policy changes in the institutional framework of the Brazilian health system, (b) changes in the organisation of urban social movements in Porto Alegre (since trade unions had not regularly participated in the work of the commission), (c) changes in the relationship between public health professionals and leaders of urban social movements, (d) the types of interest which municipal, state and federal health authorities had in promoting the participation of user representatives in the decision-making process, and, finally, (e) the types of issues discussed in the majority of plenary meetings. Relationships were then established between both sets of variables to verify which factors most influence this involvement. The study concludes that, between 1985 and 1991, variations in the attendance of users at plenary meetings, as well as variations in the type of involvement user representatives had in the decision-making process of the forum, were strongly associated with important changes: (1) in the institutional framework of the Brazilian health system, (2) in the organisation of urban social movements in Porto Alegre and (3) in the relationship between public health professionals and leaders of urban social movements. The position of municipal health authorities on user participation has also influenced user involvement in the commission. The other factors, however, had apparently determined only short term changes in user involvement. The study also highlights the role of Brazilian health system reformers as promoters or stimulators of these changes. This policy community had a central role in attracting urban social movement activists to become involved in these formalised fora. They can be regarded as policy formulators as well as an active part of an alliance established between them and urban social movement activists. In the case of Porto Alegre, it is possible to affirm that social organisations, particularly those representing shantytown populations, sustained consistent involvement of their representatives in the overt political spaces of the local and municipal health commissions. These commissions had limited power over health services in the city, mostly due to delays in placing these services under municipality control. However, the case examined indicates the gradual formation of an alternative type of political relationship in the health sector in Porto Alegre, in which the interests of the urban shantytown residents are represented formally and publicly. In this sense, the consolidation of participatory fora can assist in the democratisation of Brazilian institutions, giving voice to social sectors traditionally excluded from the political system. Through their involvement in the commission, these representatives were also increasing the responsiveness of publicly financed health services to the needs of users who, individually, lacked the political power to sustain their demands.

This study explores the policy options for health insurance in Thailand, considering the present structure of the country and taking account of international experiences. The development of health insurance in Thailand is analysed from the supply side i.e. health services. The problem of inefficiency and inequity in the health care system has led to the search for better alternatives for organizing and financing. This coincides with the overall growth in the country's socio-economic situation and the policy of health insurance laid down in the Sixth Five Year Health Development Plan (1987-1991). These factors provide positive conditions for establishing health insurance in Thailand. The demand for health insurance from employers who are likely to join the scheme is investigated. A survey of 200 private establishments in Thailand was conducted. This investigation provides essential national baseline data for the organization of health insurance, particularly on the health care fringe benefits provided by employers, and the methods of paying health care providers. Methods of organizing health insurance are formulated from international experience. The historical development of voluntary health insurance and its modified forms, as well as that of compulsory health insurance, are examined. The arguments for and against each form of health insurance are analysed. The study also highlights salient issues of health care reforms which attract the world's attention. International experience has shown that methods of paying providers is a major issue in providing viable health insurance. The study comprehensively analyses the advantages and disadvantages of each method of paying the doctor and the hospital under health insurance systems. Finally, it explores the policy options for the future development of national health insurance in Thailand.

This thesis relates informatics to the problems of health and medicine experienced in less developed countries. It evaluates the potential of health informatics and investigates the issues that constrain successful implementations. This serves as a basis for establishing a generic description of viable computer applications in the developing world. The thesis contains two case studies from sub-Saharan Africa. The first, undertaken in The Gambia, is based on a computer-assisted data collection system used in a longitudinal child health survey. The second, undertaken in Kenya, relates to a medical decision-aid system used in an out-patient clinic of a district hospital. In each case, an outline is given of the background to the application domain, and an analysis is made of some comparable prior systems that have been developed and evaluated. The two case studies provide interesting investigatory comparisons since both systems are used by health personnel with little computer experience, and exploit some state-of-the-art technologies despite the identified constraints that exist in developing countries. The context, system design, methods, and results of each case are described. A generalised evaluation approach is proposed and is used to summarise the case study findings. The evaluation framework employed includes components related to functional and human perspectives as well as the anticipated benefits to the health care system. The thesis concludes by suggesting some guidelines for the design and evaluation of future health information systems.