Les régimes spéciaux de sécurité sociale des fonctionnaires nourrissent la mythologie française. Leur simple évocation fait généralement l’unanimité, que l’on en parle comme d’avantages acquis, de privilèges catégoriels ou de rémanences du passé. Qualifier juridiquement la protection sociale des fonctionnaires de régime spécial de sécurité sociale présente pourtant certains biais. La notion de « régime » implique une relative cohérence d’ensemble. L’intégration dans la « sécurité sociale » induit le respect des mêmes principes et modes de fonctionnement que l’institution. Le qualificatif « spécial » laisse à penser que ledit régime entretient un rapport de spécial à commun avec le régime général. Ces trois items n’en sont pas moins contestables. La protection sociale des fonctionnaires est une construction itérative, étalée sur plus d’un siècle, où prestations et garanties reposent chacune sur une logique qui lui est propre. Un large pan de cette protection sociale consiste en une couverture administrative, endossée directement par les employeurs publics. Le régime général n’est pas le droit commun de la sécurité sociale. Cela étant dit, c’est une autre étude de la sécurité sociale en général et de la protection sociale des fonctionnaires en particulier qui peut débuter. Le tout pour conclure à une crise d’identités : c’est dans son intégration à la sécurité sociale que la protection sociale des fonctionnaires parvient le mieux à exprimer sa singularité ; mais c’est parce que la protection sociale des fonctionnaires tend à être assimilée à la sécurité sociale qu’il convient d’en admettre la relativité. / Special social security schemes for civil servants belong to the French mythology. Their mention is usually embraced by all, which is spoken of as long-acquired habits, categorical privileges or afterimages of the past. Legally qualify social protection of the civil servants of special social security schemes raise questions. The concept of « scheme » implies a relative overall consistency. The integration to the « social security » means to respect the same principles and operating modes as the rest of the institution. The adjective « special » suggests that the scheme has the same relationship to general scheme as special law to ordinary law. These three items are questionable. Social protection of the civil servants is an iterative construction, spread over more than a century, where the benefits and guarantees each based on its proper logic. A large part of this social protection consists of an administrative cover, endorsed by public employers. The general scheme is not the ordinary social security law. That being said, this is another study of social security in general and social protection of the civil servants in particular who can begin. All for finding an identity crisis: with its integration to social security, social protection of the civil servants succeeds in expressing its uniqueness; but it’s because this social protection tends to be equated with social security that relativity may be deduced from it.

Aucun cap clair n’a été fixé par les pouvoirs publics européens s’agissant du droit de la protection sociale complémentaire. La contribution du droit européen en la matière est toutefois majeure. Les opérateurs spécialisés chargés de la gestion des régimes institués ont fait l’objet de nombreux textes, quoique non axés spécifiquement sur le droit de la protection sociale complémentaire et ne tenant pas toujours compte de l’originalité du modèle économique et social de certains d’entre eux. Les intérêts des bénéficiaires des dispositifs établis ont été pris en considération davantage en raison de l’extension du rôle du droit du travail au sein de l’Union européenne que des dispositions adoptées en droit de la protection sociale. Située au croisement de plusieurs domaines du droit, de l’économie et de la politique sociale, la protection sociale complémentaire cherche toujours, dans le concert du droit européen, à faire entendre une voix qui lui soit propre. Il est cependant permis d’espérer qu’un fil conducteur soit un jour plus clairement adopté, plaçant l’entreprise, qui constitue le socle du droit de protection sociale complémentaire, au coeur des réflexions et des réformes. C’est en effet au sein des entreprises, et en Europe, qu’est née la protection sociale complémentaire. Il serait cohérent que, deux siècles plus tard, les pouvoirs publics européens reviennent aux origines de celle-ci pour en déterminer l’avenir. / No clear direction has been set by the European authorities regarding complementary social protection law. However, European law still makes a major contribution on the subject. The specialized operators in charge of administrating complementary schemes have been the subject of numerous laws, but not specifically focused on complementary social protection law and not always taking into account the originality of the economic and social model of some of them. The interests of the beneficiaries were more taken into consideration because of the employment law growing position within the European Union than because of the measures adopted on social protection law. Complementary social protection happens to be right at the crossroads of several areas of law, economics and social policy. It is therefore still trying to have its own voice heard in the concert of European law. However, we can hope that a common connecting thread will be more clearly adopted, which will put the company, as the foundation of complementary social protection law, at the heart of debates and reforms. It isindeed within companies, and in Europe, that complementary social protection was born. It would make sense that, two centuries later, European authorities return to the roots of the latter to set a course for the future.

Cette thèse étudie théoriquement et empiriquement les interrelations entre la santé de la population, la dégradation de l'environnement et le développement économique, ses conséquences pour les pays en développement, et fournit certaines réponses en termes de politique économique. Elle est subdivisée en deux parties. La première partie s’intéresse à la relation entre l’environnement, la santé, et les inégalités. Elle analyse dans un premier temps l’hypothèse selon laquelle la dégradation de l'environnement pourrait être considérée comme un canal supplémentaire par lequel les inégalités de revenu affectent les taux de mortalité infantile et juvénile (chapitre 2). Nos travaux théoriques et empiriques montrent que les inégalités de revenu affectent négativement la qualité de l'air et de l'eau, et cela à son tour dégrade la santé de la population. Par conséquent, la dégradation de l'environnement peut être considérée comme un canal non négligeable à travers lequel les inégalités de revenu influence l’état de santé. Il est ensuite démontré que les émissions de dioxyde de soufre (SO2) et celles des micro-Particules (PM10) sont en partie responsables des grandes disparités dans la mortalité infantile et juvénile au sein des pays pauvres (chapitre 3) .En outre, nos résultats soutiennent l’idée selon laquelle les institutions démocratiques jouent un rôle de protection sociale en atténuant cet effet pour les classes de revenu les plus pauvres et ainsi réduisent les inégalités de santé provoquées par la pollution. La deuxième partie évalue le lien entre la santé, l'environnement et la croissance économique. Le Chapitre 4 évalue l'effet de la santé (charge globale de la maladie, maladies transmissibles et paludisme) sur la croissance économique. Ce chapitre montre que les indicateurs de santé, lorsqu'ils sont correctement mesurés par l'écart entre l'état de santé actuel et une situation de santé idéal où toute la population vit à un âge avancé, indemne de maladie et d'invalidité, et lorsqu’ils sont convenablement instrumentés, ont un impact négatif significatif sur la performance économique. Les conséquences de ces interactions sur la convergence économique des pays pauvres vers leur état régulier, sont théoriquement et empiriquement analysées dans le dernier chapitre. Il en ressort que la dégradation de l'environnement réduit la capacité des pays pauvres d'atteindre leur état régulier, renforçant ainsi notre argument théorique selon lequel l’amélioration de la qualité de l'environnement joue un rôle considérable dans le processus de convergence économique. En outre, la dégradation de la qualité de l'air et de l'eau affecte négativement la performance économique, et l'état de santé demeure un canal important par lequel la dégradation de l'environnement agit sur la croissance économique même si elle n'est pas le seul. L’hypothèse de la courbe environnementale de Kuznets (EKC) est également vérifiée. / This dissertation investigates theoretically and empirically the interrelationships among population’s health,environmental degradation and economic development, its consequences for developing countries, and someeffective policy responses. The first part explores the association between health, environment, and inequalities. Itfirstly analyzes whether environmental degradation could be considered as an additional channel through whichincome inequality affects infant and child mortality (chapter 2). Theoretical and empirical investigations show thatincome inequality affects negatively air and water quality, and this in turn worsens population’s health. Therefore,environmental degradation is an important channel through which income inequality affects population health. Then,it is shown that sulphur dioxide emission (SO2) and particulate matter (PM10) are in part responsible for the largedisparities in infant and child mortalities between and within developing countries (chapter 3). In addition, we foundthat democratic institutions play the role of social protection by mitigating this effect for the poorest income classesand reducing the health inequality it provokes. The second part is devoted to the link among health, environment,and economic growth. The effect of health (global burden of disease, communicable disease, and malaria) oneconomic growth is assessed in Chapter 4. This chapter shows that health indicators, when correctly measured by thegap between current health status and an ideal health situation where the entire population lives to an advanced age,free of disease and disability, and when accurately instrumented have significant impact on economic performance.The consequences of these interrelationships on the convergence of poor countries towards their steady state aretheoretically and empirically investigated in the last Chapter (chapter 5). It is found that environment degradationreduces the ability of poor countries to reach their own steady state, reinforcing our argument according to whichenvironment quality improvement plays a considerable role in economic convergence process. Moreover, thedegradation of air and water quality affects negatively economic performance, and health status remains an importantchannel through which environment degradation affects economic growth even if it is not alone. The EnvironmentalKuznets Curve (EKC) hypothesis is also verified.

The Labour Intensive Public Work (LIPW) programme under the Ghana Social Opportunity Project (GSOP), is a social protection programme initiated by the Government of Ghana, to offer jobs and income earning opportunities to some targeted rural residents, especially the youth, through the application of labour intensive technology in the construction of community infrastructure that has the potential of generating secondary employment. This is a mixed method study sought to provide an account on the Ghanian version of LIPW programmes. The study assessed and identified the challenges facing the programme implementation from beneficiary and implementers’ perspective in order to set the platform for an interactive feedback between project implementers and community members for the smooth implementation of future LIPW programmes. The study also assessed the impact of the programme on poverty and migration among the youth in Ghana. In identifying the challenges facing the programme from implementers’ perspective, 15 key project implementers were interviewed. An interview guide and a questionnaire were also developed to collect data from 500 beneficiaries of the programme to know their challenges. In assessing the impact of the programme on migration among the youth, questionnaires were administered to 239 households in beneficiary communities and 189 households from non-beneficiary communities of the LIPW programme. Finally, data was collected from 90 youth who benefited from the programme and 90 youth who did not benefit from the programme to compare and determine the extent to which the programme has contributed in reducing poverty among the youth. The study revealed that the key challenge facing the programme implementation from the implementers’ perspective is capacity problem involving, inadequacy of staff to implement the programme at the district level, frequent breakdown of vehicles for monitoring, and delays in the release of funds for commencement of project. Beneficiaries of the programme also indicated that they were not satisfied with the amount of money they were receiving as wage for their labour. They were also unhappy with the delays in payment of their wages and the period of engagement in the programme. The study found out that the LIPW programme under the GSOP has not contributed in reducing migration among the youth. However, the programme has contributed to reducing poverty among the youth. The study therefore recommends that capacity gap analysis conducted before project initiation should include adequacy of staff and logistics to cater for any deficiency. It is strongly recommended that beneficiaries of the programme should be consulted in setting the wage rate to avoid resentment provoking misunderstanding between beneficiaries and project implementers. The study further recommended that the government should scale up the programme to cover more communities in order to reduce poverty among the youth in Ghana. Finally, the study proposed a new model for LIPW for the youth known as ‘LIPW +3Cs’. This model incorporates three Cs, that is ‘C’ompetence’, ‘C’onnections’ and ‘C’haracter’ into LIPW programmes. ‘LIPW +3Cs’ will not only train youth to secure jobs after the programme (Competence) but will assist them to establish a network among themselves and other supporting institutions (Connections). Issues of character which encompases a sense of right and wrong will also be inculcated in the youth to assist them to function effectively in the society (Character). / Adult Basic Education (ABET) / D. Phil. (Adult Education and Youth Development)

Cette thèse montre que l’ecclésiologie de l’Église-Famille de Dieu peut se construire en articulation avec la question de la protection sociale des prêtres, et que corrélativement la problématique de la protection sociale des ministres sacrés peut se penser par rapport à la théologie de l’Église-Famille de Dieu. Le repérage des failles dans les pratiques ecclésiales de protection sociale des prêtres en cours en Côte d’Ivoire et leur divergence avec les textes du magistère de l’Église m’amènent à considérer un principe : l’organisation d’une protection sociale des prêtres vise à libérer ces derniers des inquiétudes pour l’avenir, qui peuvent nuire à leur ministère et à leur disponibilité dans le temps présent. De plus, lorsqu’elles sont resituées dans le contexte théologique et pastoral de la nouvelle évangélisation, et qu’elles sont mises en dialogue entre elles, la problématique ecclésiologique de l’Église-Famille et celle de la protection sociale des prêtres évoquent l’enjeu majeur de l’engagement social des chrétiens. Si la réception d’une théologie de l’engagement contribue à l’émergence d’un engagement chrétien authentique, l’ecclésiologie entrepreneuriale propose l’entrepreneuriat pastoral comme une autre façon d’entreprendre en Église-Famille pour réussir le pari de la protection sociale des prêtres, conformément au vœu des Pères du Concile repris dans le Code de droit canonique de 1983. / This thesis demonstrates that the ecclesiology of the Church-God’s family can be built in relation to the issue of the social welfare for the priests, and linked to that, the issue of the social welfare for the sacred ministers can be thought about with regard to the theology of the Church as Family of God. The finding of weaknesses in the ecclesial practices of the social welfare for the priests which exists in Côte d’Ivoire and their difference with the Church magisterium texts makes me consider a principle: the organization of a social welfare for priests aims at making them free from worries in the future, which can harm (endanger) their ministry and their availability in the present time. In addition, when they are restored in the pastoral and theological context of the new evangelization, and if they are in connection, the ecclesiological issue of the Church-Family and that of the social welfare for the priests evoke the major stake of the Christians’ social commitment. If the reception of a theology of commitment contributes to an emergence of an authentic Christian commitment, the entrepreneurial ecclesiology suggests the pastoral entrepreneurship as another way to undertake in Church-Family to make a success of the bet of the social welfare for the priests in accordance with the wish of the Council Fathers taken back in the Code of Canon law of 1983.

Power, and how it is exercised within social relations is pivotal in explaining policy change. Hence, this dissertation explores policy change in Kenya by examining the transfer and subsequent adoption of social protection policies in the form of cash transfer schemes. Instead of the current analytical frameworks drawing from political settlements, political institutions, and ideational approaches in explaining policy uptake, the research studies policy making from a policy transfer and power nexus. The study examines power relations among multiple actors in the national context to explain the adoption of social protection policies. Hence this dissertation articulates power dynamics and asymmetries inherent in policy-making involving national and transnational actors as underpinning policy transfer processes. The thesis is premised on the following interrelated arguments; firstly, I show how transnational actors created and manipulated interests and incentives based on their resource base in three significant ways: controlling the policy agenda, constraining the agency of other actors and influencing the preferences of actors in the policy space. The interaction of interests and resources – financial, and ideas and knowledge – converged to bring about policy change. Secondly, I focus on the role of ideas and knowledge within policy space to show how the creation of a discursive hegemony and a structure of knowledge, social construction and policy narratives played a significant role in shaping learning and influencing national actors. Thirdly, I argue that transnational actors used structural mechanisms based on financing and coerced government to adopt social protection policies through a catalysing mechanism and imposition of conditionalities. The study depicts how transnational actors conditioned and manipulated national context and institutions to align with the idea of cash transfers. This thesis employs a qualitative approach to study policy transfer and subsequent adoption of two cases of transfer schemes in Kenya, the Cash Transfer for Orphans and Vulnerable Children (CT-OVC) and the Hunger Safety Net Programme (HSNP). / Sociology / D. Phil. (Sociology)

La réalisation des politiques de protection sociale en Afrique soulève des questions complexes, notamment leur raison d’être et le choix des contenus (Merrien, 2013). L’originalité de cette thèse tient au fait qu’elle soit la première du genre à analyser l’élaboration des politiques de protection sociale au Burkina Faso autre que celles dans le domaine de la santé. À travers une analyse de la politique nationale de protection sociale et programme pilote de protection sociale en santé des personnes démunies, la thèse répond aux questions suivantes : pourquoi et comment la protection sociale est devenue une priorité gouvernementale et quels sont les facteurs qui ont influencé la mise en forme de ces deux politiques publiques et la mise en œuvre du programme de solidarité ? À partir de cadres d’analyse issue de diverses perspectives disciplinaires (science politique, sociologie, anthropologie), la réalisation des politiques publiques de protection sociale est considérée comme le fruit de l’interaction d’une multitude d’acteurs et de leurs intérêts divers : organisations internationales, coopération bilatérale, structure étatique, associations et ONG locales. La méthodologie est essentiellement qualitative. L’entrevue semi-dirigée approfondie, l’analyse documentaire et l’entrevue informelle ont été utilisées pour collecter les données. Les résultats sont structurés en cinq articles scientifiques. La décision de formuler ces deux politiques était principalement motivée par la recherche d’une cohésion sociale pour maintenir la paix et l’ordre social (article 1 et 4). Le processus de la formulation n’a pas permis de conduire une réflexion sur le problème à résoudre, d’identifier les besoins spécifiques des bénéficiaires, d’évaluer la capacité des solutions pour choisir celles appropriées. Les logiques des acteurs nationaux étaient de maintenir leurs acquis financiers et de mobiliser des ressources supplémentaires. Les acteurs internationaux ont été guidés par la logique de promotion d’instrument de protection sociale en adéquation avec leurs valeurs, leurs idées, leurs missions, et ce pour la mise en œuvre de leur mandat institutionnel. Cela a donné lieu au constat empirique de « non-design » ou de non-formulation (article 2 et 4), a révélé l’influence des idées et des intérêts des acteurs dans le choix des solutions, mais a aussi montré qu’une volonté politique est importante pour que les choix puissent répondre aux besoins des populations pauvres et vulnérables. Par ailleurs, les connaissances issues de la recherche scientifique ont été très peu utilisées pour éclairer les choix comparativement aux connaissances issues de la littérature grise (article 3). Les gains politiques, c’est-à-dire la perception des conséquences sociales et politiques associées à une recommandation fondée sur des connaissances scientifiques, influencent la prise en compte de cette dernière. L’analyse de la mise en œuvre montre que des lacunes de formulation influencent l’efficacité d’une politique. Aussi, la mise en œuvre offre des circonstances opportunes d’adaptation et de reformulation pour intégrer les spécificités du contexte et les besoins des bénéficiaires en vue d’améliorer l’efficacité (article5). / The development of social protection policies in Africa raises complex issues, including its rationale and choice of content (Merrien, 2013). This thesis is the first of its kind to analyze the development of social protection policies in Burkina Faso other than those in the field of health. Through an analysis of the National Social Protection Policy and pilot program of Social Protection in the Health of the Poor, this thesis answers the following questions: why and how social protection has become a government priority; and what factors have influenced the shaping of these two public policies and the implementation of the solidarity program? Based on analytical frameworks from various disciplinary perspectives (political science, sociology, anthropology), the process of developing public social protection policies is the result of the interaction of a multitude of actors and their diverse interests: international organizations, bilateral cooperation, state structure, associations, and local NGOs. The methodology is essentially qualitative. This thesis collects data thorough semi-structured interviews, literature review, and informal interviews. The results are structured in five scientific articles. The desire for social cohesion to maintain peace and social order motivated the decision to formulate these two policies (Articles 1 and 4). The formulation process did not lead to a reflection on the problem to be solved, to identify the specific needs of the beneficiaries, to evaluate the capacity of the solutions to choose the appropriate ones. The motive of the national actors was to maintain their financial assets and to mobilize additional resources. International actors have been guided by the logic of promoting a social protection instrument in line with their values, their ideas, and their missions, for the implementation of their institutional mandate. This implementation gave rise to the empirical observation of "non-design" or non-formulation (Article 2 and 4), revealed the influence of the ideas and interests of the actors in the choice of solutions, but also showed that it is important for choices to meet the needs of the poor and vulnerable. In addition, knowledge derived from research data was used very little compared to knowledge from gray literature (Article 3). Political gains, that is, the perception of social and political consequences associated with a recommendation based on scientific knowledge, influence the latter's consideration. The iv analysis of the implementation of the solidarity program shows that formulation gaps influence the effectiveness of a policy. Thus, the implementation offers opportune circumstances for adaptations and reformulations to integrate the specificities of the context and the needs of the beneficiaries with an aim of improving efficiency (Article 5). However, these opportunities have not been utilized by program implementers, helping to keep those who are impoverished excluded from health services.

With an increasing rate of urbanisation in East Africa, and with the highest prevalence rate of undernourished population than any region in the developing world, the issue of food access insecurity in urban areas has received considerable attention. While there are noticeable differences between big, medium- and small-sized towns, the variation in the household’s response to food access insecurity across urban hierarchies remains largely unexplored. This study aimed to investigate the social, economic and demographic factors in coping with food access insecurity among households in urban slum areas of Ethiopia. The study used both secondary and primary data sources. The national surveys of household consumption and expenditure survey and welfare monitoring surveys of 2004/5, 2010/11, and 2015/16 was used to analyse the food security situation in Ethiopia across time and urban hierarchies. Primary data of 500 households and three focus group discussions were conducted from slum areas of Addis Ababa, Hawassa, and Sheki representing a big city, medium- and small-sized town, respectively. The household survey data were subjected to descriptive statistical analysis and a standard regression model to investigate the relationship between factors such as household structure and composition, economic resources, social protection programmes and projects, and urban-rural linkages with coping with food access insecurity across urban hierarchies. A global model and three site-specific regression models were constructed. Descriptive results from both the primary and the secondary data sources have revealed that the proportion of the households affected by food shortage varies across the urban hierarchy that food insecurity was highest in the small-sized town as compared with the medium-sized town and the big city. The quality of food consumed was consistently low among female-headed households regardless of their socio-economic characteristics when compared with male-headed households. The result of the regression analysis for the global model has shown that economic resources (asset and source of income) predict nearly half of the variability in coping with food access insecurity. Household structure and composition such as gender and education of the head of the household, family structure (nuclear/extended), and the ratio of young children in the household predict a quarter of the variability in coping. Social protection programs and services predict one-tenth; the remaining variability in coping is explained by the combined effect of all the factors involved. The significance of these factors in predicting coping with food access insecurity, however, varies across the urban hierarchies. The contribution of economic factors in predicting coping is the highest at the big city (Addis Ababa); household structure and composition took the leading role in predicting coping at the small-sized town (Sheki); the significant factors in predicting coping at the mediumsized town (Hawassa) was the combined effect of all the factors involved. Household characteristics such as female headship, a higher ratio of young children, low education of the household head, lack of access to the financial loan, asset and income poverty, and weak linkages with kin structure at rural areas increase vulnerability to food insecurity and put households under stress to cope with food access insecurity. The study results show that the traditional urban-rural dichotomy may not suffice to portray the degree of food insecurity, as well as the mechanisms how food insecure households strive to cope with food access insecurity, which varies across the continuum of urban hierarchies. Those who wish to support food insecurity challenges need to be sensitive to the variability of factors in coping with food access insecurity across urban hierarchies. During policy, design and program implementation policymakers and international partners need to consider that the needs and coping mechanisms of urban households vary across urban hierarchies besides the other social, economic and demographic variables. / Development Studies / Ph. D. (Development Studies)

Ce travail ambitionne de comprendre comment ont évolué les dispositifs qui permettent en france aux personnes de nationalité étrangère d'accéder à la prévention et aux soins en ville et à l'hôpital. nous nous demanderons comment et pourquoi sur une période longue un etat permet ou au contraire empêche l'accès d'une population majoritairement plus pauvre que la population générale, les étrangers, à un bien supérieur, la santé.l'objectif est de rendre compte du mouvement apparemment paradoxal que l'on observe depuis près d'une trentaine d'années : d'une part, des politiques migratoires de plus en plus restrictives et répressives, de l'autre, la santé devenue 'un des derniers refuges du droit' (didier fassin) pour les étrangers. cette période a été marquée par des évolutions législatives majeures, qui scanderont notre travail, notamment la mise en place de l'aide médicale d'etat et du droit au séjour pour soins en 1999. nous nous intéresserons aux acteurs étatiques, et en premier lieu, au ministère de la santé mais également à la sécurité sociale et aux associations qui ont joué un rôle double : elles ont mené un intense travail de plaidoyer pour le maintien et le perfectionnement des dispositifs d'accès aux soins et se sont vues délégués une partie de la dispense de soins auprès des populations étrangères. l'accès aux archives officielles étant limité du fait du caractère très contemporain du sujet, nous nous appuierons sur les fonds détenus par les organismes et les personnes privés ainsi que sur la constitution d'archives orales. s'il s'agit d'un travail d'histoire, nous intégrerons des données ethnographiques recueillies lors d'enquêtes de terrain. / In France, the healthcare costs of undocumented foreign nationals are covered by a specific welfare benefitcalled State Medical Aid (Aide médicale d’État). This benefit was created in 2000, as part of the law onUniversal Medical Insurance (Couverture médicale universelle) which enables French nationals andundocumented foreign nationals to benefit from the state health insurance scheme (Assurance maladie) as longas they are resident in France. This thesis explores the origins of a measure created exclusively for people whosepresence on French territory is judged illegal and the impact of the existence of this particular healthcarecoverage.The approach brings together a history of public policy and an ethnography of care settings and reception centresfor undocumented foreign nationals.Part One retraces the stages involved in opening up access to the state health insurance scheme from the mid-1980s onwards. It focuses on the way in which a distinction progressively emerged between the public healthissue of undocumented people accessing healthcare, and that of poor people accessing healthcare. The role ofhumanitarian associations, notably Doctors without Borders and Doctors of the World, who opened freehealthcare centres in France from 1986 onwards, is underscored, as are their links with movements defending therights of foreigners. These processes are located within a longer history of debates about access to welfare forthe poorest going back to the nineteenth century, and the subordination of social policy to the objectives ofcontrolling migratory flows.Part Two, based on research carried out in a hospital and in a health rights organization, analyses theconsequences of the introduction of immigration administrative categories into the healthcare system as well asthe emergence of a degraded form of social citizenship for people living illegally in France.

Depuis une cinquantaine d’années l’action sociale en faveur des personnes âgées et des personnes handicapées s’est construite par empilements successifs de dispositifs législatifs et réglementaires sans une volonté d’harmonisation et de cohérence.Les services à domicile, sanitaires ou médico-sociaux, créés ces vingt dernières années n’échappent pas à ce mouvement, qu’ils soient en direction des enfants ou des adultes handicapés, ou des personnes âgées.Cette thèse fait l’état de ce qui existe en recherchant comment les bénéficiaires utilisateurs ont accès aux services, par leurs propres moyens financiers, par un financement public ou par le biais de la solidarité nationale. Des propositions de simplification des dispositifs, de mise en cohérence entre eux sont faites pour permettre un plus large accès.La recherche de la protection des bénéficiaires y est présente notamment d’une part, par la qualité du service, dans l’étude des processus de professionnalisation des acteurs à travers leur formation ou l’organisation professionnelle du secteur. D’autre part, la protection des bénéficiaires est également étudiée sous l’angle des dispositifs juridiques existants, pour lesquels il semble nécessaire d’y apporter un renforcement. Enfin, pour développer le soutien aux aidants familiaux, pilier essentiel de la prise en compte de la dépendance des personnes âgées et des personnes handicapées, il faut modifier le droit actuel. / Since fifty years the social action for the elderly and disabled persons has been built by successive stacks of legislation and regulations without desire for harmonization and consistency.Home services created in the last twenty years are no exception to this trend, whether towards children and adults with disabilities and the elderly, health or medico-social.This thesis is the state that exists by searching how recipient users have access to services through their own financial resources, through public funding or through national solidarity. Proposals for simplification of the devices, to ensure consistency between them are made to allow wider access.The search for the protection of beneficiaries is present, especially in the study of processes of professionalization, through training or professional organization of the sector. Proposals are made there. The protection of beneficiaries is also studied in terms of existing legal frameworks, where it seems necessary to make it stronger. Finally to expand the support for family caregivers, an essential pillar of taking into account the dependence of the elderly and disabled persons, we have to change the current law.