Dissertations / Theses: 'Basic Care to Health'

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Snyman, J. S. "Effectiveness of the basic antenatal care package in primary health care clinics." Thesis, Nelson Mandela Metropolitan University, 2007. http://hdl.handle.net/10948/728.

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Pregnancy challenges the health care system in a unique way in that it involves at least two individuals – the woman and the fetus. The death rates of both pregnant women (maternal mortality) and newborns (perinatal mortality) are often used to indicate the quality of care the health system is providing. In terms of maternal and perinatal outcomes South Africa scores poorly compared to other upper-middle income countries (Penn-Kekana & Blaauw, 2002:14). The high stillbirth rate compared to the neonatal death rate reflects poor quality of antenatal care. Maternal and perinatal mortality is recognised as a problem and as a priority for action in the Millennium Development Goals (Thieren & Beusenberg, 2005:11). The Saving Mothers (Pattinson, 2002: 37-135) and Saving Babies (Pattinson, 2004:4-35) reports describe the causes and avoidable factors of these deaths with recommendations on how to improve care. The quality of care during the antenatal period may impact on the health of the pregnant woman and the outcome of the pregnancy, in particular on the still birth rate. In primary health care services there are many factors which may impact on and influence the quality of antenatal care. For example with the implementation of the comprehensive primary health care services package (Department of Health, 2001a:21-35) changes at clinic level resulted in a large number of primary health care professional nurses having to provide antenatal care, who previously may only have worked with one aspect of the primary health care package such as minor ailments or childcare. Because skills of midwifery or antenatal care, had not been practiced by some of these professional nurses, perhaps since completion of basic training, their level of competence has declined, and they have not been exposed to new developments in the field of midwifery. The practice of primary health care nurses is also influenced by the impact of diseases not specifically related to pregnancy like HIV/AIDS and tuberculosis. The principles of quality antenatal care are known (Chalmers et al. 2001:203) but despite the knowledge about these principles the maternal and perinatal mortality remains high. The Basic Antenatal Care quality improvement package is designed to assist clinical management and decision making in antenatal care. The implementation of the BANC package may influence the quality of antenatal care positively, which in turn may impact on the outcome of pregnancy for the mother and her baby. The aim of this study was to evaluate the effectiveness of the Basic antenatal care (BANC) package to improve the quality of antenatal care at primary health care clinics.

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West-Oram, Peter George Negus. "Global health care injustice : an analysis of the demands of the basic right to health care." Thesis, University of Birmingham, 2015. http://etheses.bham.ac.uk//id/eprint/5559/.

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Henry Shue’s model of basic rights and their correlative duties provides an excellent framework for analysing the requirements of global distributive justice, and for theorising about the minimum acceptable standards of human entitlement and wellbeing. Shue bases his model on the claim that certain ‘basic’ rights are of universal instrumental value, and are necessary for the enjoyment of any other rights, and of any ‘decent life’. Shue’s model provides a comprehensive argument about the importance of certain fundamental goods for all human lives, though he does not consider health or health care in any significant detail. Adopting Shue’s model, I argue that access to health care is of sufficient importance to the enjoyment of any other rights that it qualifies as what Shue describes as a ‘basic’ right. I also argue that the basic right to health care is compatible with the basic rights model, and is required by it in order to for it to achieve its goal of enabling right holders to enjoy any decent life. In making this claim I also explore the requirements of the basic right to health care in terms of Shue’s triumvirate of duties and with reference to several key examples.

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Cuesta, C. de la. "Marketing the service : basic social process in health visiting." Thesis, University of Liverpool, 1992. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.316547.

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The present study was undertaken to provide an understanding of the processes underlying health visiting practice. The research strategy selected was grounded theory (Glaser and Strauss 1967, Strauss 1987, Strauss and Corbin 1990). A total of 21 female health visitors from a District Health Authority in the North West of England participated in the study. Data was collected by means of 20 formal interviews and 41 days of participant observation in four different health centres. To recognize the basic social process in any interaction is one of the major aspects of grounded theory. This requires the identification of the "Phenomenon" which motivates the development of a process and the conditions under which it operates. The basic problem or phenomenon in health visiting uncovered in the data was "Securing Life Trajectories". This forms the core of the health visitor's work. The general set of conditions that influence health visiting work was identified as "Working Between Two Worlds". This is used to describe the health visitor's position between the policy agenda and the client's agenda. The process revealed in the data that health visitors use to respond to this overall problem was "Marketing Health Visiting". This refers to the different tactics that they use to introduce the policy agenda into the client's domain. During this process the policy agenda is adjusted to fit the client's circumstances. Three major strategies are identified in this process: 1) Promoting the service, 2) Adjusting delivery and 3) Tailoring the content. This study found that "Marketing Health Visiting" is a gradual process in which the health visitor wins grounds as time passes. As marketing strategies are implemented the conditions influencing the interaction change. Hence it moves from taking place in what is labelled in this study as "Dissociated Context", to a "Convergent Context" and finally to a "Shared Context". The final consequence of implementing marketing strategies is that of constructing "A Common Agenda" with clients. This agenda is basically the personalisation and contextualization of health visiting services. To build this common agenda it is of crucial importance that the client should see and feel the need for the health visiting service as well as the development of trust between the professional and the client. Hence the relationship that is developed between them acts as an enabling factor for reaching mutual collaboration. The discussion of the study focuses on its significance within the actual debate on health visiting about introducing new ways of practice. The health visitor's overall role is examined and the importance of developing relationships with clients is also highlighted.

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Mazetto, Débora. "Assessing the impact the 'Mais Médicos' program on basic health care indicators." reponame:Repositório Institucional do FGV, 2018. http://hdl.handle.net/10438/20284.

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The 'Mais Médicos' Program was launched by the federal government in 2013 with the main objective of reducing the shortage of physicians in regions of socioeconomic vulnerability in Brazil. Since then, the program has been attracting interest in evaluating its effectiveness on the localities adhered. This paper aims to measure the effects generated by the 'Mais Médicos' Program on health indicators of Brazilian municipalities from an econometric approach of policy evaluation. Using a difference-in-differences methodology, the effects on indicators of basic health care, morbidity and mortality were analyzed from the Program data between 2013 and 2015. There are evidences that the 'Mais Médicos' Program has positive effects on the primary healthcare indicators, particularly on appointments, consultations, referrals, examinations, and home visits, and negative effects over some indicators of morbidity. However, the Program does not seem to have been able to reduce mortality in the municipalities.
O Programa Mais Médicos foi lançado pelo governo federal em 2013 e seu objetivo principal é reduzir a escassez de médicos em regiões de vulnerabilidade socioeconômica no Brasil. Desde então, o programa vem atraindo interesse em avaliar sua efetividade sobre as localidades aderidas. Este trabalho se propõe a medir os efeitos gerados pelo Programa Mais Médicos sobre indicadores de saúde dos municípios brasileiros a partir de uma abordagem econométrica de avaliação de políticas. Empregando uma metodologia de diferença em diferenças, foi analisado o efeito sobre indicadores de atendimento básico de saúde, de morbidade e de mortalidade a partir de dados do Programa de 2013 a 2015. Existem evidências de que o programa 'Mais Médicos' tem efeitos positivos sobre os indicadores de atendimento básico de saúde, particularmente em atendimentos, consultas, encaminhamentos, exames e visitas, e efeitos negativos sobre alguns indicadores de morbidade. No entanto, o Programa não parece ter conseguido reduzir a mortalidade nos municípios.

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Paolucci, Francesco. "The design of basic and supplementary health care financing schemes: implications for efficiency and affordability." [S.l.] : Rotterdam : [The Author] ; Erasmus University [Host], 2007. http://hdl.handle.net/1765/10758.

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Friedman, Alexandra. "Evaluation of the World Health Organization’s basic emergency care course and online cases in Uganda." Master's thesis, Faculty of Health Sciences, 2019. https://hdl.handle.net/11427/31832.

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Background Uganda lacks formal emergency care training programs to address its high burden of acute illness and injury. The Ugandan Ministry of Health (MoH) rolled out the World Health Organization’s (WHO) Basic Emergency Care (BEC) course, the first openaccess short course to provide comprehensive basic emergency training for health workers in low-resource settings. The BEC and its new online cases both require further evaluation. Aim and Objectives The study aimed to assess the BEC course and online cases’ impact with the following objectives: 1. Determine participants’ knowledge acquisition and self-efficacy in emergency care. 2. Evaluate BEC participants’ perceptions of the course and online cases. 3. Assess the online cases’ impact on participants’ knowledge and self-efficacy in emergency care. Methods Mixed methods design explored the BEC’s impact. MCQs and Likert scales assessed knowledge and self-efficacy, respectively, among 137 participants pre-BEC, post-BEC and six-months post-BEC using mixed model analysis of variance (ANOVA). FGDs assessed perceptions of the course and online cases post-BEC and six-months postBEC among 74 participants using thematic content analysis. Results Participants gained and maintained significant increases in MCQ averages and Likert scores. The pre-course cases group scored significantly higher on the pre-test MCQ than controls (p=0.004) and found cases most useful pre-BEC. Nurses experienced more significant initial gains and long-term decays in MCQ and self-rated knowledge than doctors (p=0.009, p< 0.05). Providers valued the ABCDE approach and reported improved emergency care management post-BEC. Resource constraints, untrained colleagues and knowledge decay limited the course’s utility. Conclusions Basic emergency care courses for low-resource settings can increase frontline providers’ long-term knowledge and self-efficacy in emergency care. Nurses experience greater initial gains and long-term losses in knowledge than doctors. Online adjuncts can enhance health professional education in LMICs. Future efforts should focus on increasing trainings and determining the need for re-training.

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Simms, Chris. "The reasons for increased childhood mortality in Zambia 1980-90 and their relevance in the 1990s." Thesis, University of Sussex, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.263914.

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Figueiredo, Mariana Dorsa 1977. "Saude mental na atenção básica : um estudo hermeneutico-narrativo sobre o apoio matricial na rede SUS-Campinas (SP)." [s.n.], 2006. http://repositorio.unicamp.br/jspui/handle/REPOSIP/311881.

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Orientador: Rosana Onocko Campos
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Na presente investigação realizamos uma análise sobre a organização das ações de saúde mental na rede básica de saúde de Campinas (SP), a partir da implantação do arranjo de gestão denominado Apoio Matricial. Esse arranjo visa disparar a ampliação da clínica das equipes interdisciplinares de saúde e reorientar a demanda para a saúde mental Desviando a lógica de encaminhamentos indiscriminados para uma lógica da co-responsabilização, ele pretende produzir maior resolutividade à assistência em saúde. Realizamos grupos focais com profissionais de saúde mental, das Equipes de Referência e gestores, e procuramos, sob a ótica da abordagem hermenêutica-crítica, encadear suas principais linhas argumentativas de modo narrativo, a fim de combinar a análise com a construção de sentidos para o material produzido. Após essas construções narrativas, produzimos uma meta-narrativa, conectando os diferentes enredos e vinculando-os ao contexto histórico-social da saúde mental e da saúde coletiva. Pretendemos, com isso, contribuir para que as discussões geradas pelos profissionais possam ser significadas no interior das transformações politicas e assistenciais na área da saúde mental. Palavras-chave: saúde mental, atenção básica à saúde, apoio matricial, gestão.
Abstract: By means of the present study, we analyzed the organization of mental health actions in the basic health network of the city of Campinas (SP), from the implantation of arrangements for the management called Matricial Support. These arrangements aim to advance the enlargement of the clinic of health interdisciplinary teams and reorient the demand for mental health. By deviating the logic of indiscriminate referrals to the logic of co-responsibility, it intends to produce a larger solvability to health assistance. We created focal groups with mental health professionals, from reference teams and managers, and we searched for, under the optics of the hermeneutic-critical approach, an interrelation of their main argumentative lines in a narrative way, with the purpose of combining the analysis with the construction of meanings for the material produced. After these narrative constructions, we produced a narrative goal, linking the different plots and joining them to the social-historical context of mental health and collective health. With that, we intended to contribute so the discussions generated by the professionals may be signified in the interior of political and assistance transformations in the area of mental health. Key-words: mental health, basic health care, matricial support, management.
Mestrado
Saude Coletiva
Mestre em Saude Coletiva

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Dyeli, Nolwando. "An investigation into the implementation of the basic antenatal care programme by midwives in Mdantsane clinics." Thesis, University of Fort Hare, 2011. http://hdl.handle.net/10353/425.

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Basic Antenatal Care (BANC) is a way of training or upgrading the knowledge and skills of all nurses, midwives and doctors involved in antenatal care at the primary health care level so that the minimum care can be provided effectively. This study was conducted to investigate the implementation of the BANC program by midwives in the Mdantsane clinics during February 2009. Methods: A descriptive study design was undertaken targeting midwives providing antenatal care to pregnant women, in 14 clinics of Mdantsane. Data was collected from 25 midwives in the clinics, and from 140 ANC cards of women attending ANC on the day of their visit to the clinic. Results: The majority of midwives providing BANC in Mdantsane clinics were not trained in BANC. There were 10 trained midwives and 15 not yet trained. A total of twenty five midwives were involved in the study. The number of visits according to the BANC schedule was well known by the midwives in the study. The content of the visits was well known for the first visit, but for subsequent visits, the participating midwives could not state exactly what they do on these visits. They perceived BANC as something beneficial for both midwives and pregnant women with 24 of the participating midwives rating BANC as advantageous. In completing an ANC card, the midwives scored between 48 percent and 100 percent. Under examination, they scored between 52 percent and 100 percent. Lastly on interpretation and decision making, they scored between 0 percent and 92 percent. This could have troubling consequences for the health status of the mother and baby. Weaknesses in providing antenatal care identified in the study included participating midwives failing to fill in the last normal menstrual period (LNMP) and the estimated date of delivery (EDD), which was a worrying observation. Plotting of the gestational age at first visit was also not carried out well as only 47 percent of the midwives in the study did this, meaning that there would be a miscalculation of the gestational age thereafter throughout the pregnancies. The body mass index (BMI) was not calculated as the maternal height and weight were not written on the ANC card. This should be completed in order to check the nutritional status of the pregnant woman to help supplement, if malnourished, and educate on diet, if overweight. Only 17 percent of the midwives in the study plotted the foetal presentation. Failure to plot foetal presentation could lead to complications during delivery because women with abnormal presentations could end up delivering in a clinic instead of the hospital.Conclusion: This study showed that even though midwives are implementing BANC among pregnant women, it is not being carried out correctly. Therefore the programme will not be as beneficial as it would be if put into practice correctly. This is highlighted by the lack of knowledge from the untrained midwives regarding the content of care on subsequent visits. Thus there is an urgent need for BANC training to be conducted and monitored at various sites.

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Daugherty, Karen Ruth Ortlip. "Oral health behaviors and beliefs : a basis for oral health care in Africa /." The Ohio State University, 1987. http://rave.ohiolink.edu/etdc/view?acc_num=osu1487331541708332.

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Stratman, Scott A. "Economic analysis of a basic allowance for health care for active duty and retired members of the armed forces." Thesis, Monterey, California: Naval Postgraduate School, 2014. http://hdl.handle.net/10945/44677.

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Approved for public release; distribution is unlimited
In 2014, CBO reported health care expenditures consumed nearly 10 percent of the overall defense budget in 2012, up from 4 percent in 1990. Jansen, of the Congressional Research Service, noted in 2014 that moral hazard is considered one of the drivers of these increased costs; moral hazard results from lower out-of-pocket expenses. Adjustments to the administration of health benefits within DOD may reduce the DHP budget. Implementation of a basic allowance for health care (BAHC) for active duty dependents and retirees to use with a high deductible health plan (HDHP) and health savings account may provide incentives to use more cost-effective levels of care. The price elasticity of demand for health care is used to determine potential savings as the result of increased costs associated with the HDHP. The implementation of a BAHC is also examined from the point of view of the beneficiary to evaluate how they might respond to the changing incentives. This research found that while the plans are likely to invoke behavioral responses among beneficiaries and reduce moral hazard, unless they are widely adopted throughout the DOD they are unlikely to generate substantial cost savings as a percentage of current levels of spending.

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Karuvelil, John V. "Justice issues in basic health care and the challenge of genetic medicines: A Catholic perspective for the Indian context." Thesis, Boston College, 2010. http://hdl.handle.net/2345/bc-ir:104407.

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Thesis advisor: James F. Keenan
Reviewing the current health care system in India which is grossly inadequate and inefficient, inaccessible and inequitable, this dissertation discusses the relevance of the principles of social justice such as equity, the common good and distributive justice, and the imperatives of social justice such as the option for the poor, subsidiarity, participation and solidarity and argues that a health care system informed and guided by these principles will be more effective, equitable and accessible to people. In addition to examining the numerous challenges faced by the primary health care system in the country, I also examine the many ethical challenges raised by the development of gene therapies in the country and suggest that the same principles of social justice offer guidelines to frame policies regarding the practice of them. This dissertation faces of the very complex health care situation in India. About 40% of people in the country have little or no access to basic health care because of poverty, abysmally low spending on health care by the government, neglect of basic health care facilities, and lack of social security measures like health insurance. However, the government in its effort to boost the country's GDP is making an all-out effort to promote health tourism in the country by investing in super specialty hospitals and in high-end medicines like gene therapy. The government also has been promoting and encouraging private investments in the sector, especially in setting up super-specialty hospitals and in the use of high-end medicines such as gene therapy. In an effort to boost health tourism and to earn greater foreign exchange, the government has drafted its industrial policies for the last three decades, encouraging private, for-profit health care sector. Substantial tax deductions and subsidies are provided to the private sector to allure private investment in the sector. However, in the process, the government has neglected primary health care centers that have been the primary source of health care for the poor and the underprivileged sections of people. In spite of announcing new policies in health care with high promises of programs and initiatives for the poor, women and children, the resource allocation to the sector betrays all promises. The administrative, structural, political and social anomalies, especially corruption at all levels, absenteeism among health care personnel, medical malpractices, a lack of political will, vision and transparency, poor allocation of funds, lack of monitoring and evaluation systems, etc., have crippled the health care system. It is in this context that I argue that the principles of social justice and its imperatives should inform and direct the government in its effort to provide health care in the country. These principles and imperatives should inform and direct not only provisions for basic health care but also the production and use of genetic medicines. A health care system that is based on equity, the common good, distributive justice, subsidiarity, solidarity and participation, that promotes health and meets the health care needs of all in an equitable way, irrespective of the socio-economic disparities that prevails, is the need of the hour in India
Thesis (STD) — Boston College, 2010
Submitted to: Boston College. School of Theology and Ministry
Discipline: Sacred Theology

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Robisnon, Brenda Joyce. "Is there an Association between Non-VA Medical Care Coordination and Utilization of Care?" ScholarWorks, 2016. https://scholarworks.waldenu.edu/dissertations/2376.

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The Non-Veteran Administration Care (NVC) is a program in which the Veterans Health Administration purchases health care when it cannot provide the health services needed for eligible Veterans. The rising cost of this program led to audits by the Office of the Inspector General and other entities. The scholarly problem for this DNP Project was the lack of oversight, accountability, and management, found throughout the audits of NVC, as well as a lack of evaluation of NVC. The purpose of this project was to ascertain if there was a relationship between the Non-VA Care Coordination program (NVCC) and utilization of care. The NVCC was implemented to eliminate the deficiencies cited by audits. Sleep study and chiropractic consults for FY 2013 (pre-NVCC) and FY 2014 (post-NVCC) were examined. Sleep apnea service was available at the local Veteran Administration Medical Center and chiropractic service was not. Utilization of care was determined by emergency room (ER) visits and admissions related to the consult. A logic model was used to conceptualize the project and the longer-term implementation and evaluation of NVCC, and descriptive statistics were used to analyze trends in the chiropractic data (sleep study consults were excluded from the analysis due to the minute number). There were a total of 859 chiropractic consults and 2,184 approved visits analyzed. The results revealed that Veterans who utilized the consults had no ER visits or admissions related to referrals for chiropractic consults. Completed chiropractic consults remained proportionality the same both years. NVCC had no association with the utilization of care. This scholarly project contributes to social change by empowering consumers and providing transparency in the government through audits that facilitate quality improvement and evaluation of the NVCC program.

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Stidworthy, Jennifer Jane. "The implementation of a portfolio assessment system for a rural clinical school in South Africa : what can be learned from the implementation of portfolios as an assessment system in a rural clinical school." Thesis, Stellenbosch : Stellenbosch University, 2013. http://hdl.handle.net/10019.1/80389.

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Thesis (MPhil)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: A portfolio assessment system was designed to meet the needs of a Rural Clinical School education platform, hosting final year MB ChB students for the duration of their final year. A study entitled “What can be learned from the implementation of a portfolio assessment system, to be used in the assessment of clinical reasoning of final MB ChB students placed in a Rural Clinical School in South Africa? “ was conducted. The experience of educators and students during this process was explored. The findings are in keeping with the literature. Van Tartwijk & Driessen 2009, Eley et Al 2002, Lake & Ryan 2004, Burch & Seggie 2008 claim that portfolios drive deep student learning and develop clinical reasoning. Burch & Seggie (2008) offer an assessment tool which has proved feasible within the South African setting on which this portfolio assessment system was modelled. The assessment tool design faced a number of challenges within the RCS setting which were addressed during a review process. The portfolio assessment system is viewed as a work in progress requiring further development. Despite the constraints and challenges, both staff and students unanimously supported the development of patient case studies within the design as a valuable learning tool.
AFRIKAANSE OPSOMMING: ‘n Portefeulje assesserings sisteem is ontwerp om die behoeftes van ‘n UKWANDA Landelike Kliniese Skool opvoedings program wat die gasheer van die MB ChB student tydens hul finale jaar is, na te kom. ‘n Studie genaamd “ Wat kan geleer word uit die implementering van ‘n portefeulje assesserings sisteem, wat gebruik gaan word om die kliniese redenering te bepaal van finale jaar MB ChB student wat geplaas is in ‘n Landelike Klinieke Skool in Suid Afrika? ” is uitgeoefen. Die ervaring van die dosent, so wel as die studente, is ondersoek. Die bevinding is in lyn met die literatuur. Van Tartwijk & Driessen 2009, Eley et Al 2002, Lake & Ryan 2004, Burch & Seggie 2008 beweer dat portfeuljes dryf student tot diep studie en ontwikkel kliniese redenasie. Burch & Seggie (2008) bied ‘n assesserings (hulp)middel aan wat toepaslik en uitvoerbaar is in die SA konteks , waarop die portfeulje assessering sisteem gebaseer is. Die ontwerp van die assesserings (hulp)middel het vele uitdagings binne die RCS opset in die oog gestaar. Dit is aangespreek tydens ‘n proses van hersiening. (Lather, 2006).Die portefeulje assesserings sisteem word gesien as ‘n werk onder hande en vereis verdere ontwikkeling. Ten spyte van die beperkinge en uitdagings het beide die staf en die student onomwonde die ontwikkeling van pasiente gevalle studies, binne die ontwerp, as ‘n waardevolle leermiddel gesien.

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Cantrell, Sarah Ann. "Impact of a Practice Session using Objective Feedback on Basic Life Support Skills 12 Weeks Following Initial BLS Training." The Ohio State University, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=osu1243951595.

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Thorén, Ann-Britt. "How can we optimize bystander basic life support in cardiac arrest /." Göteborg : Institute of Medicine, Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy at Göteborgs University, Sahlgrenska University Hospital, Göteborg, 2007. http://hdl.handle.net/2077/7566.

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Wynaden, Dianne Gaye. "The primary carer's experience of caring for a person with a mental disorder in the Western Australian community: a grounded theory study." Curtin University of Technology, School of Nursing and Midwifery, 2002. http://espace.library.curtin.edu.au:80/R/?func=dbin-jump-full&object_id=15910.

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One in five Australians has a mental disorder and it is estimated that one in four families have a member who has a mental disorder. Since the 1960s there has been an 80 percent decrease in Australian institution-based mental health care. The majority of people who have a mental disorder are now treated in their local community and many of them live with their families. The change in the delivery of mental health care has seen the family emerge as one of the most important supports to their ill family member. While the changes in the delivery of mental health care have been based on human rights concerns, changes in mental health legislature, and economic factors, the multi-dimensional experience of being a primary carer of a person with a mental disorder remains relatively unexplored. The need for empirical evidence on the primary carer's experience is noted in both the scientific literature and from carers themselves and the principal aim of conducting this research was to address the identified need. This qualitative study, using grounded theory methodology, presents the findings of interviews with 27 primary carers and memos documented throughout the study. In addition, existing literature of relevance to the findings of this study is presented. A substantive theory of seeking balance to overcome being consumed is presented in this thesis. Using the grounded theory method the constant comparative analysis of data revealed that the basic social psychological problem shared by all participants was the experience of "being consumed". The problem of being consumed consisted of two stages: "disruption of established lifestyle" and a "sustained threat to self-equilibrium". Six conditions were identified as influencing participants' experience of being consumed.
In order to address the problem of being consumed, participants engaged in a basic social psychological process of "seeking balance". When participants were engaged in this process they moved from a state of being consumed to one whereby they established and consolidated a balanced life perspective that incorporated their caregiving role. The process of seeking balance consisted of three phases: "utilising personal strategies to reduce the problem of being consumed', "restoring self- identity", and "reaching out to make a difference". In addition, data analysis identified the presence of a three phase sub-process entitled "trying to make sense of what was happening". Phases one of the core and sub- processes occurred primarily in the period prior to the time when a psychiatric diagnosis was made on the affected family member. Participants became engaged in the remaining two phases of the core and sub-processes when they became aware that their affected family member had a mental disorder. At the time of being interviewed for this study some participants were not yet engaged in the final phase of the process of seeking balance. Participants' experience of seeking balance was not related to the length of their caregiving experience but rather to their experience of seeking balance and the conditions influencing that process. Four conditions were identified as influencing participants' experience of seeking balance.
This thesis presents the substantive theory of seeking balance to overcome being consumed. While the findings support existing scientific literature, the substantive theory also presents a new insight on caring from the primary carer's perspective. In particular, the findings challenge health professionals to actively pursue strategies to reduce carers' experience of being consumed. The findings of this study have implications for service provision and clinical practice, policy and planning, research, education, the general population, mental health consumers, and carers.

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Falisse, Jean-Benoît. "The community governance of basic social services in fragile states : health facility committees in Burundi and South Kivu, DR Congo." Thesis, University of Oxford, 2016. https://ora.ox.ac.uk/objects/uuid:6e81e494-f01f-4df6-a934-3acd7e2c20f0.

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In many low-income and 'fragile' states, citizens' committees are elected to co-manage basic social services. However, the effects of such committees on service delivery, and the way they are influenced by local contexts, remain understudied. This thesis seeks to fill these gaps by examining the case of the health facility committees in Burundi and South Kivu between 2011 and 2014. It relies on original health facility and committee surveys, household surveys, nested interviews and focus groups, and interviews with key informants. The thesis firstly explores how the committees came about. It then looks at the questions, What makes them get involved in decisions at their health facility? and, How do measures designed to improve committee functioning lead to changes in service delivery, if at all? Mixed-methods work finds that chief nurses largely dominate the health facilities, and the committees appear to be both the product of recent political and administrative changes and a façade of community governance. The work's randomised controlled trial tests the idea that this inefficiency arises from an 'institutional knowledge gap': the committee members and nurses do not know the committee's (official) functioning. An information session has strengthened the committees and led to changes in health facility management in South Kivu, but not in Burundi. This difference seems to come from dissimilar management structures and people's relationships to service providers. The intervention has had no effect on service provision. The remaining chapters report on additional interventions in Burundi, which theory and qualitative research suggest might improve the effects of the knowledge intervention: trust-building between nurses and committee, information about health facility performance, and increased interaction between local leaders and committees. These are either ineffective or have unintended consequences. Overall, the thesis nuances the promises of social accountability mechanisms and stresses the importance of power relationships within basic social services.

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Pacobahyba, Luciana Dias. "Estudo da estratégia saúde da família em Boa Vista, Roraima." Universidade Federal de Roraima, 2013. http://www.bdtd.ufrr.br/tde_busca/arquivo.php?codArquivo=204.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior
O presente estudo objetiva resgatar a história da implantação da Estratégia Saúde da Família ESF em Boa Vista, bem como analisar o funcionamento das unidades hoje existentes. A estratégia Saúde da Família foi implantada no município em 1999 com cinco unidades e em 2001 foi expandido para 47 unidades. A pesquisa foi feita com base em análise documental, entrevistas e questionários com membros das equipes e gestores, além de observação nas unidades pesquisadas. Um dos principais problemas encontrados no processo de implantação da Estratégia foi a falta de diálogo com a população e com os profissionais que deveriam trabalhar diretamente no atendimento dos objetivos do Programa. Na análise do funcionamento das equipes do ESF percebemos um cenário de sucateamento das unidades e equipamentos: equipes incompletas, falta de medicamentos e outros materiais necessários para o trabalho das equipes. A Estratégia de Saúde da Família constitui para Boa Vista a principal porta de entrada para a atenção à saúde da população, de forma que esses problemas têm impacto direto na vida das pessoas.

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20

Moraes, Fernanda Cassioli de [UNESP]. "O médico veterinário capacitando agentes comunitários de saúde para atuação na estratégia saúde da família." Universidade Estadual Paulista (UNESP), 2017. http://hdl.handle.net/11449/150805.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)
Este trabalho propôs capacitar os agentes comunitários de saúde (ACS) quanto aos assuntos relevantes e inerentes à intervenção do médico veterinário na interface saúde humana, saúde animal e saúde ambiental, no contexto “Um mundo, uma Saúde”. Para isso, durante a primeira etapa da pesquisa, foi realizado um diagnóstico de situação por meio do acompanhamento das atividades dos ACS a fim de determinar quais as principais dúvidas e conhecimentos equivocados que oferecem prejuízos nas ações requeridas pela Estratégia Saúde da Família (ESF). Conjuntamente, foi desenvolvido e empregado um questionário aos ACS, a fim de verificar o conhecimento prévio referente a assuntos como zoonoses urbanas, higiene alimentar, cuidados com o meio ambiente e guarda responsável de animais de estimação. Com posse dessas informações, a segunda etapa do trabalho compreendeu a elaboração e aplicação do curso de capacitação aos ACS visando transformá-los em multiplicadores de conhecimento. O mesmo questionário foi aplicado novamente aos ACS e as respostas apresentadas, nesse segundo momento, mostraram uma maior compreensão dos temas abordados no curso, ainda que em níveis menores que o desejado. Isso comprova a necessidade de ações educativas permanentes e ininterruptas para que o entendimento e mudança de comportamento atinjam graus mais satisfatórios. Entretanto, nota-se que, apesar do conteúdo não ter sido totalmente assimilado, os ACS tornaram-se mais curiosos e criteriosos com relação aos fatores de risco desencadeados pela interação pessoa/animal/ambiente em seu território, possibilitando iniciativas mais rápidas diante de problemas que podem comprometer a saúde local. Ao final da intervenção, várias ações educativas estão sendo desenvolvidas pelos ACS na ESF e na comunidade na qual atuam. Uma vez que o conhecimento e o controle de muitas das doenças/agravos são atividades inerentes ao profissional médico veterinário, comprovam-se as colaborações que este profissional pode oferecer como membro da ESF, mais precisamente do Núcleo de Apoio à Saúde da Família (NASF). Suas contribuições devem começar pelo planejamento de ações educativas de forma contínua com os ACS e demais membros da equipe de Atenção Básica, que visem conscientizar a população em relação à promoção da saúde e do bem-estar animal e do ambiente.
This paper proposes to train the community health agents (CHA) on relevant issues inherent to the intervention of Veterinary Doctors in the interface between human health, animal health and environmental health, in the context of "One world, one Health". For this, during the first stage of the research, a situation diagnosis was performed by monitoring the activities of the CHA in order to determine the main doubts and wrong knowledge that offer losses in the actions required by the Family Health Strategy (FHS). A questionnaire was jointly developed and used for the CHA in order to verify previous knowledge regarding subjects such as urban zoonoses, food hygiene, care of the environment and responsible care of pets. With this information in hand, the second stage of the work included the elaboration and application of the training course to the CHAs in order to transform them into knowledge multipliers. The same questionnaire was applied again to the CHA and the answers presented, in that second moment, showed a greater understanding of the topics covered in the course, although at smaller levels than the desired one. This proves the need for permanent and uninterrupted educational actions so that the understanding and behavior change reach more satisfactory degrees. However, it is noted that, although the content was not fully assimilated, the CHA became more curious and judicious about the risk factors triggered by the person / animal / environment interaction in their territory, enabling faster initiatives in the face of problems which may compromise the local health. At the end of the intervention, several educational actions are being developed by the CHAs in the FHS and in the community in which they work. Since the knowledge and control of many of the diseases / injuries are activities inherent to the veterinary professional, the collaborations that this professional can offer as a member of the FHS are proven, more precisely of the Nucleus of Support to the Family Health (NSFH). Their contributions should begin with the planning of educational actions on an ongoing basis with the CHA and other members of the Basic Care team to raise public awareness of health promotion, animal welfare and the environment.

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21

Monu, Ruban. "Design and implementation of a basic laboratory information system for resource-limited settings." Thesis, Georgia Institute of Technology, 2010. http://hdl.handle.net/1853/34792.

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Basic Laboratory Information System (BLIS) is a joint initiative of C4G @ Georgia Tech, the Centers for Disease Control and Prevention (CDC) and Ministries of Health in several countries in Africa. The vast majority of health laboratories in Africa, engaged in routinely testing samples drawn from patients (for HIV, malaria etc.), have been using non-standardized paper logs and manual entries for keeping track of patients, test samples and results. Besides the obvious burden of tedious record-keeping, these methods increase the chances of errors due to transcription and mismatches, making it difficult to track patient history or view critical population-wide data. In 2008, PEPFAR (the United States President's Emergency Plan for AIDS Relief) together with the CDC was reauthorized with a $48 billion budget over five years to combat HIV/AIDS, tuberculosis, and malaria. The focus of PEPFAR has shifted from rapid scale-up to the quality and reliability of the clinical health programs and having an effective laboratory management system is one of its goals. C4G BLIS is a robust, customizable and easy-to-use system that keeps track of patients, samples, results, lab workflow and reports. It is meant to be an effective and sustainable enhancement to manual logs and paper-based approaches. The system is designed to work in resource-constrained laboratories with limited IT equipment and across sites with good, intermittent or no internet availability. With varied practices, workflow and terminology being followed across laboratories in various African countries, the system has been developed to enable each laboratory or country to customize and configure the system in a way that suits them best. We describe various aspects of BLIS including its flexible database schema design, configurable reports and language settings, end-user customizability and development model for rapid incorporation of user feedback. Through BLIS, we aim to demonstrate a sustainable ICT solution brought about by the early and constant involvement of the target laboratory staff and technicians, identifying their short- and long-term needs, and ensuring that the system can match these needs. We will present preliminary evaluation results from laboratories in Cameroon, Ghana, Tanzania and Uganda.

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22

Rodrigues, Diana Cris Macedo. "O Lugar do nutricionista nos nÃcleos de apoio Ã saÃde de Fortaleza." Universidade Federal do CearÃ, 2012. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=10760.

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A problemÃtica alimentar e nutricional na contemporaneidade, o perfil epidemiolÃgico e nutricional brasileiro, a assunÃÃo da SeguranÃa Alimentar e Nutricional e do Direito Humano Ã AlimentaÃÃo Adequada como prioridade de Estado e a necessidade do fortalecimento das aÃÃes de atenÃÃo nutricional na ESF, como parte essencial do cuidado integral em saÃde nas RAS, sÃo os principais fundamentos que justificam a inclusÃo da Ãrea estratÃgica de alimentaÃÃo e nutriÃÃo na proposta NASF. A inserÃÃo do nutricionista nesta proposta intenta contribuir para a qualificaÃÃo das aÃÃes neste Ãmbito de atenÃÃo, mediante a realizaÃÃo de um trabalho interdisciplinar, compartilhando prÃticas e saberes com as equipes de SF. O objetivo deste estudo foi compreender percepÃÃes dos nutricionistas atuantes nos NÃcleo de Apoio Ã SaÃde da FamÃlia de Fortaleza acerca de sua inserÃÃo na EstratÃgia SaÃde da FamÃlia. Trata-se de uma investigaÃÃo orientada pela abordagem qualitativa, ancorada em fundamentos epistemolÃgicos da fenomenologia e hermenÃutica. Com o intuito de acessar a produÃÃo subjetiva dos nutricionistas utilizamos a entrevista em profundidade, elegendo, na medida do possÃvel, o procedimento nÃo diretivo. A categorizaÃÃo do material empÃrico nos conduziu a trÃs eixos centrais: 1) InserÃÃo na ESF; 2) PercepÃÃes acerca do contexto; 3) O Nutricionista na ESF. Cada eixo foi desdobrado em diferentes dimensÃes. Os achados revelaram que o NASF configura-se como mais uma oportunidade de emprego surgida, no qual as profissionais tem estruturado seu processo de trabalho assumindo majoritariamente uma prÃtica individualizante e tecnicista, com escassa reflexÃo acerca de sua atuaÃÃo. O SUS e a ESF apresentam-se como serviÃos de saÃde restritos para pobres, revelando o quÃo pouco estÃ disseminada a discussÃo sobre a polÃtica de saÃde entre os trabalhadores que a operacionalizam. Nesse contexto, a realizaÃÃo de atividades em Ãmbito coletivo intentando prevenir doenÃas Ã considerada a principal atribuiÃÃo do NASF. Os achados permitem concluir que o NASF tem organizado seu fazer majoritariamente a partir da assistÃncia direta ao usuÃrio, realizando um trabalho desarticulado da equipe de SF. As interfaces percebidas entre NASF e ESF relacionam-se Ã prevenÃÃo de doenÃas, sendo quase ausente a menÃÃo ao suporte pedagÃgico Ãs equipes de SF. IndustrializaÃÃo, padronizaÃÃo, desterritorializaÃÃo do comer, armadilhas da indÃstria de alimentos na publicidade e incoerÃncias entre modos de vida vendidos pela mÃdia e as condiÃÃes de vida de grande parte dos usuÃrios e a epidemia da obesidade sÃo as principais questÃes alimentares e nutricionais presentes nos territÃrios assistidos pelas profissionais. Nesse cenÃrio, grande parte das profissionais concebe o lugar do nutricionista na prevenÃÃo e tratamento de doenÃas e agravos relacionados Ã alimentaÃÃo, tendo suas aÃÃes destinadas Ã mudanÃa de hÃbitos alimentares por meio de uma educaÃÃo nutricional voltada a trocas alimentares destinadas a racionalizar os recursos disponÃveis em prol do consumo de alimentos mais saudÃveis. Nesse sentido, os achados apontam uma postura alheia das profissionais frente ao ideÃrio do projeto da Reforma SanitÃria brasileira e aos princÃpios das polÃticas de SAN, apontando as distÃncias entre suas atuaÃÃes e as reais necessidades de saÃde da populaÃÃo assistida.
The food and nutritional problems in the contemporary world, the epidemiological and nutritional profile in Brazil, the assumption of the Food and Nutritional Security and the Human Right to Adequate Food as a priority of state and the need of strengthening actions of nutritional care in the Strategy of Family Health (FHS) as an essential part of integral health care in the Networks of Health Care, are the main reasons that justify the inclusion of the strategic area of food and nutrition in the Center for Family Health Support (CFHS) proposal. The insertion of the nutritionist in this proposal intends to contribute to the qualification of the actions in this area of care, by conducting an interdisciplinary work, sharing knowledge and practices with teams from Family Health. The aim of this work was to understand perceptions of nutritionists who work in CFHS in Fortaleza concerning its inclusion in the FHS. It is a research oriented by a qualitative approach, grounded on epistemological foundations of phenomenology and hermeneutics. In order to access the subjective production of nutritionists it was used the in-depth interview, choosing to the possible extent, the nondirective procedure. The categorization of the empirical material led us to three central axes: 1) Insertion at FHS, 2) Perceptions about the context, 3) The Nutritionist at Family Health Strategy. Each axis was split into different dimensions. The findings revealed that the CFHS appears as another job opportunity arose, in which professionals have structured their work process taking a largely individualistic and technical practice with little consideration on their performance. The Unique System of Health and FHS present themselves as health services restricted to poor people, revealing how little the discussion on health policy is widespread among the professionals who operate the services. In this context, carrying out activities in a community attempting to prevent diseases is considered the main task of the CFHS. The findings show that the CFHS has organized its doing mostly from direct assistance to the user, carrying out a work disjointed from the Family Health team. Interfaces perceived between the CFHS and FHS relate to disease prevention, being almost absent the mention to the pedagogical support to the Family Health teams. Industrialization, standardization, dispossession of eating, the traps of the food industry in advertising and inconsistencies between lifestyles sold by the media and the living conditions of most users and the epidemic of obesity are major issues present in food and nutrition territories assisted by professionals. In this scenario, most professionals conceive the place of the nutritionist in the prevention and treatment of diseases and disorders related to food, and his actions are dedicated at changing eating habits through a nutrition education focused on food exchanges aiming to rationalize the resources available in favor of consumption healthier foods. Accordingly, the findings indicate the professionals posture against the ideology of the project of Brazilian Health Reform and the principles of Food and Nutritional Safety policies, pointing out the distances between their actions and the current health needs of the population assisted.

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23

Donovan, Anne, and n/a. "In a nutshell, it's the very basics: remote area nurses' constructions of primary health care." Griffith University. School of Nursing and Midwifery, 1997. http://www4.gu.edu.au:8080/adt-root/public/adt-QGU20050901.104302.

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This study explores the constructions of primary health care held by remote area nurses working in indigenous communities without resident medical practitioners, in the Northern Territory. Primary health care is increasingly permeating health policy in Australia, and nurses in remote areas are responsible for its implementation. The study investigates past and present discussions of the meaning of the concept of primary health care to begin to identify the major forces which have problematically impacted on its evolution and interpretation. It traces the threads which emerge from these forces through the more recent developments of health promotion and new pubflc health to explore the discourses and strategies they have produced, and which overtly and covertly influence the implementation of primary health care. Remote area nurses are individually interviewed and their discussions analysed to explore the constructions of primary health care which they hold. The analysis also explores some of the ways in which these constructions may have come to exist, the evident impact of current discourses, and the absence of effective support in the further development of these constructions. The remote area nurses' discussions display a view of primary health care as the most basic of health services, focussed on personal hygiene and the individual's responsibility in prevention of illness, operated through encounters which offer opportunities for education and basic curative care. While several of the nurses indicate discomfort with the paternalistic nature of such a service, none are aware of ways in which they might resolve their concerns about it. The study briefly explores positive approaches towards the democratization of health care, and examines the support needed by remote area nurses if primary health care is to be effectively implemented by them.

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Torre, Sirlene de Fátima da Silva Dela. "Integralidade no cuidado à saúde da mulher: refletindo sobre a atuação dos profissionais em unidades básicas de saúde do município de Toledo PR." Universidade do Estado do Rio de Janeiro, 2009. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=5569.

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Este estudo tem como objetivo entender como as práticas de saúde das mulheres são desenvolvidas pelos profissionais de saúde, frente ao princípio de integralidade, em unidades básicas de saúde de um município do Estado do Paraná. O estudo teve como suporte teórico a integralidade da atenção, não só como princípio do SUS, mas também como exercício de boas práticas de produção de cuidado que devem estar presentes no atendimento das necessidades de saúde das mulheres, em busca da conquista de uma saúde mais digna e solidária para todos. O Sistema Único de Saúde deve estar orientado e capacitado para a atenção integral à saúde da mulher, numa perspectiva que contempla a promoção da saúde, a proteção e a prevenção às necessidades de saúde da população feminina, o controle de patologias mais prevalentes nesse grupo e a garantia do direito à saúde. Por esta razão, a humanização e a qualidade da atenção implicam promoção, reconhecimento e respeito aos direitos humanos, garantindo a saúde integral e seu bem-estar. A metodologia envolveu uma abordagem qualitativa realizada em duas unidades básicas de saúde do município de Toledo-PR. Utilizou-se como técnica de coleta de dados a observação a 15 atendimentos médicos a mulheres em ginecologia e clínico geral e entrevista com 10 mulheres freqüentadoras de duas unidades de saúde. A análise do material produzido foi organizada em torno de certos aspectos-chave de certas categorias. Identificamos, nos atendimentos observados, que há uma cordialidade desintegral dos profissionais que atendem às mulheres com certa gentileza, mas que ao mesmo tempo são desatentos a certos aspectos fundamentais de um atendimento integral. Deixam a desejar do ponto de vista técnico, comprometendo a integralidade do atendimento, focando sua atenção na queixa principal trazida pela mulher, com atendimentos restritos somente na conversa, ou exame clínico centrado na queixa principal, não explorando aspectos para a prevenção. Tornam, assim, o atendimento seletivo e centralizado, mas cercado por uma cordialidade junto às mulheres, que classificam tal cordialidade como uma sensação de bom atendimento, satisfação ilusória do ponto de vista técnico, em que a atenção clínica não responde a suas necessidades. Estas mulheres não reconhecem esta má prática, relatando uma resolutividade no atendimento diante da resolução da queixa imediata, como o acesso a alguns exames, medicamentos. Identificamos também que algumas mulheres sonham com um atendimento integral, e em alguns atendimentos se percebe a tentativa do profissional de buscar uma atenção que vá além da queixa principal, buscando entender com se dá o modo de andar a vida de certas mulheres. Concluímos que desafios ainda são colocados quando olhamos para a organização dos serviços de saúde na perspectiva da atenção integral. Considera-se fundamental a organização dos serviços de saúde para estarem pautados em cuidados efetivos à saúde da mulher, em busca da produção da integralidade que será traduzida em mais saúde para as mulheres.
This study aims to understand how the practices of women's health are developed by health professionals, compared to the principle of integral basic health units in a city in Paraná State, Brazil. The study was theoretically supported by integral care, not only as a principle of SUS, but also as an exercise in good practices of care that must be present in meeting the health needs of women in search of more dignified health care for everyone. The Unified Health System must be oriented and trained for the integral attention to women's health, a perspective that includes health promotion, protection and prevention to the health needs of women, control of diseases prevalent in this group and ensuring the right to health. For this reason, the humanization and quality of care imply promotion, recognition and respect for human rights, ensuring the overall health and well-being. The methodology involved a qualitative approach performed in two basic health units in the city of Toledo-PR. For data collection, it was used the technique of observation of 15 doctors attending women in gynecology and general practitioner and interviews with 10 women enrolled in two health units. The analysis of the material produced was organized around certain key aspects of certain categories. We identified, in the visits observed, an non-integral warmth of professionals who treat women gently, but at the same time are oblivious to certain key aspects of holistic treatment. They fall short from the technical point of view, compromising integral care, focusing their attention on the chief complaint brought by the woman, with attendance limited only to the conversation, or clinical examination focused on the chief complaint, not exploring ways for prevention. In doing so, they make service selective and centralized, but surrounded by a warmth to women who are classified as cordial as a feeling of good service, illusory satisfaction point of view, in which clinical care does not meet their needs. These women do not recognize this bad practice, reporting a problem-solving in service before the resolution of the complaint immediately, including access to some tests and medication. We also identified some women who dream of a comprehensive care, and in some calls there was the attempt to seek professional attention that goes beyond the chief complaint, seeking to understand how to some women conduct their lives. We conclude that the challenges are still available when we look at the organization of health services in the perspective of integral care. It is essential that the organization of health services be guided by an effective health care of women in search of the production of integral assistance, which will be translated into better health for women.

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Murie, Kathleen F. "Teaching basic Xhosa to non-Xhosa-speaking Health Care Workers : the effects on patient satisfaction, perceived competence to communicate effectively with Xhosa-speaking patients and job satisfaction levels." Master's thesis, University of Cape Town, 2009. http://hdl.handle.net/11427/11114.

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Includes bibliographical references (leaves 97-102).
To determine if a basic Xhosa course for non-Xhosa-speaking Health Care Workers, working in Primary Health Care Centres in Cape Town improves patient satisfaction for Xhosa-speaking patients, their perceived ability to communicate effectively with Xhosa-speaking patients, and job satisfaction levels.

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Daries, Louella M. "Effect of low-cost housing on household and environmental health of residents in Phumlani Village, City of Cape Town." University of the Western Cape, 2011. http://hdl.handle.net/11394/5363.

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Magister Public Health - MPH
Many poor households in South Africa find themselves living in informal housing and only become proprietors of formal housing via the government subsidy scheme for core low-cost housing, thereby also realizing their constitutional right to housing. The subsidy is however limited and it largely determines materials, and construction methods used. Obtaining a formal low-cost dwelling means that basic services such as electricity, sanitation, water and waste collection, is available to the home owner. Formal low-cost housing settlements are commonly located in poor areas and recipients of the housing subsidy are commonly unemployed or have low-income jobs, and frequently originate from informal settlements where services, albeit limited and often communal, were provided at no cost. This study sought to assess the combined effect of relocating from an informal dwelling to a formal low-cost dwelling and receiving individual house-based basic services of electricity, water, sanitation and waste collection, on environmental- and household health. An ecological study design was used whereby data was collected at "baseline" while households were living in the informal settlement, and again at "2 years relocated" i.e. 2 years after moving in to the formal low-cost dwelling. The study population included all households residing in the Phumlani- and Pelican Park- Zeekoevlei Informal area in the year 2000, who were on the waiting list to receive low-cost core housing units in Phumlani Village and were due to be relocated there. Due to the rapid pace at which construction of new homes occurred not all households could be captured whilst living in the informal settlement, i.e. at "baseline". The actual sample subsequently consisted of 53 households at "baseline", and all, i.e. 124 households at "2 years relocated". Data was collected via a structured interview, whereby one respondent per household was interviewed by a trained fieldworker. Positive health improvements were reported by households in terms of personal and household health. Significant (p<0.05) positive improvements were found for households in formal lowcost housing at "2 years relocated" for exposures to: overcrowded living conditions (PR=1.159, 95%CI=1.153 – 3.328); indoor air pollution due to cooking and heating (PR=2.185, 95%CI=1.655 – 2.885); improper household waste management (PR=7.381, 95%CI=4.313 – 12.633 and inadequate sanitation (PR=0.365, 95%CI=0.255 – 0.523). The incidence of childhood diarrhoea episodes decreased significantly (PR=5.588, 95%CI=1.284 – 24.315) at "2 years relocated". Water access, availability and use also increased significantly (PR=0.212, 95%CI=0.125 – 0.358) 2 years after relocation. Factors that did not improve include levels of employment for which households were found to be worse off, with 16% of households having no person employed at "2 years relocated" as opposed to only 2% at ‘baseline”. Other factors remaining unchanged included incidences of respiratory, skin and eye infections amongst children ≤ 6 years old. Although exposure levels to indoor air pollution decreased for some households, this remained present for others as electricity in combination with bio-mass fuels are still being used for heating and cooking. Environmental health conditions for a variety of factors remained unchanged and there was a reversion back to living conditions and habits of the informal settlement. Littering, dumping of waste within the neighbourhood and a high pest presence, remained unchanged. Subsidised formal housing and associated basic services does have a positive impact on health. However, the amount of free basic services, specifically electricity, provided, in lieu of household energy requirements, does not satisfactorily cover all household needs. Factors such as unemployment and low-incomes hamper the household’s ability to maintain the electricity supply as is needed and for this reason alternatives to reliance on electricity should be included in the design and construction of the low-cost house. The manifestation of poor environmental health conditions indicates that provision of low-cost housing by itself is not sufficient to ensure good environmental health. Therefore hygiene promotion should be included as part of the total beneficiary package.

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Higginson, Martin Richard. "Identifying individual patients' socio-economic position : a basis for vertical equity approaches in primary health care." Thesis, Open University, 2010. http://oro.open.ac.uk/54832/.

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This thesis develops an original approach to identify the socio economic position of individual patients at GP practices. In diverse and densely populated inner city areas, there is reason to expect that an individually based measure of socio-economic position of individuals may be a useful tool to support effective use of resources in primary case. An innovative method of classifying individual patients' socio-economic positions when registering at a GP practice was developed for this purpose. It is argued that this method could be used as a basis for a vertical equity approach to healthcare. Logistic regression techniques and measures of sensitivity and specificity are used in an original method designed to identify patients to two socioeconomic benchmarks. Criteria are provided for a framework in which decisions can be made to target patients. The thesis adopts a critical perspective on current thinking around equity in healthcare. Interviews establish that NHS professionals agree that a vertical equity approach would be an effective means to address health inequities. However, they also see significant barriers to adoption of such an approach. A complex and sophisticated set of issues emerge from qualitative comments from patients concerning this research method. The comments demonstrate a deep engagement with the NHS. They include views on the determinants of health and the way in which healthcare is organised that relate directly to equity in healthcare. The findings are contextualised in the light of recent government policy proposals and challenge the direction of that policy as being ineffective in addressing health inequities. They also highlight possible future tensions between NHS professionals and patients.

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Duarte, Ligia Vanessa Silva Cruz. "Gestão do cuidado na atenção primária à saúde no estado de Goiás." Universidade Federal de Goiás, 2016. http://repositorio.bc.ufg.br/tede/handle/tede/6985.

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Fundação de Amparo à Pesquisa do Estado de Goiás - FAPEG
INTRODUCTION: Studies highlight that care management actions would enable improvements in care continuity and integrality, as they would reduce barriers to access to different health services, performing them in a real and appropriate way. In Primary Health Care, it is necessary that chronic conditions be guided by management practices, aiming at integrating care levels, thus facilitating the ordering of flows and counterflows of people, products and information. This fact puts the PHC in a scenario of constant conflicts of responsibilities, to order and reorder health services and to have more synchronized care. OBJECTIVE: To evaluate care management in PHC using the parameters evaluated by PIAQ - PC in Goiás. METHODOLOGY: This is a cross - sectional study that evaluated PIAQ - PC results in Goiás in 2014. Secondary data from PIAQ-PC External Evaluation database from December 2013 to March 2014 were used. RESULTS: The results of this study allow us to state that there is fragility regarding a consistent registry of the territory, use of standardizations for conducts, agenda scheduling, consultations offering, risk classification and definition of well-defined flows of the user in health units system, in Basic Attention in Goiás, making care barriers and harming those who need them. CONCLUSION: The results found may support the managers' reflection on problems identification in coordination, flow and continuity of care and help in planning, programming and evaluation of intervention measures to be adopted by the Secretary of the State of Health of Goiás and the Municipal Health Secretariats, in order to structure Primary Health Care, making it more resolutive and less expensive.
INTRODUÇÃO: Estudos ressaltam que as ações de gestão do cuidado possibilitariam melhorias na continuidade e na integralidade da atenção, na medida em que reduziriam barreiras de acesso aos distintos serviços de saúde, articulando-os em tempo e local oportunos. No âmbito da Atenção Primária à Saúde, faz-se necessário que o cuidado às condições crônicas esteja orientado por práticas de gestão, com vistas a integrar os níveis assistenciais, facilitando assim, o ordenamento de fluxos e contrafluxos de pessoas, produtos e informações. Esse fato coloca a APS em um cenário de constantes conflitos de responsabilidades, para ordenar e reordenar serviços de saúde e garantir cuidados mais sincronizados. OBJETIVO: Avaliar a gestão do cuidado no âmbito da APS utilizando os parâmetros avaliados pelo PMAQ – AB no estado de Goiás. METODOLOGIA: Trata-se de um estudo transversal que avaliou os resultados do PMAQ-AB, em Goiás, em 2014.Foram utilizados dados secundários extraídos do banco de dados da Avaliação Externa do PMAQ-AB, entre dezembro de 2013 e março de 2014. RESULTADOS: Os resultados desse estudo permitem afirmar que existe fragilidade no que se refere a um registro consistente do território, uso de padronizações para condutas, programação da agenda, oferta de consultas, a classificação de risco e a definição de fluxos bem definidos do usuário dentro do sistema nas unidades de saúde, na Atenção Básica do estado de Goiás, gerando barreiras assistenciais e prejudicando aqueles que precisam dos seus serviços. CONCLUSÃO: Os resultados encontrados poderão subsidiar a reflexão dos gestores quanto a identificação de problemas na coordenação, fluxo e continuidade da atenção e auxiliar no planejamento, na programação e na avaliação de medidas de intervenção a serem adotadas pela Secretaria do Estado da Saúde de Goiás e pelas Secretarias Municipais de Saúde, a fim de estruturar a Atenção Primária tornando-a mais resolutiva e menos dispendiosa.

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Siqueira, Luciana Gomes. "Atenção básica: reflexões a partir da prática de trabalhadores de uma unidade básica de saúde." Universidade de São Paulo, 2015. http://www.teses.usp.br/teses/disponiveis/47/47134/tde-07082015-151749/.

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Buscamos neste trabalho, refletir a partir da experiência de profissionais, sobre a relação entre as práticas da Atenção Básica desenvolvidas em uma UBS e as diretrizes políticas do SUS a que elas se referemr. Realizamos uma breve retomada histórica das práticas de atenção em saúde, uma contextualização da Atenção Básica e de sua situação atual no Brasil, de modo a problematizar como esse contexto atravessa a prática diária. A partir da fala dos trabalhadores e de observações realizadas na UBS, identificamos um distanciamento, que nomeamos como lacunas, entre o trabalho que se prescreve a partir de diretrizes políticas e o trabalho efetivamente realizado. Na análise, identificamos contradições referentes a essas diretrizes e programas derivados para a Atenção Básica: poucos recursos e investimentos em um trabalho que demanda estudo de alta complexidade técnica e profundo conhecimento empírico da realidade para lidar com demandas da população. A complexidade desse setor se expressa entre os trabalhadores através de sentimentos ambíguos e contraditórios em relação à própria atuação profissional e à relação estabelecida com os usuários do sistema de saúde. As ressonâncias na subjetividade desses profissionais são diversas e temas como medo, carência e sentimento de impotência ganham destaque frente à dificuldade de compreensão das próprias práticas e das lacunas entre o que se prescreve e o que se implanta e implementa
We´vesought in this work, based on the health professionals´ experiences, to reflect on primary care practices developed in a UBS (Basic Health Unit) located in the state of São Paulo referred to SUS (Unified Heath System) policy guidelines. We conducted a brief historical research on health care practices, a contextualization of primary care and its current situation in Brazil, in order to discuss how that context goes through daily practice. Based on the spoken comments of workers and observations made in UBS, we identified a kind of distance, which we named as gaps between the work that is prescribed by policy guidelines and the work that is actually performed. In the analysis, we identified contradictions regarding these guidelines and related programs for primary care: few resources and investments in a job that requires studies of high technical complexity, as well as deep empirical knowledge of the reality to deal with demands of the population. The complexity of this sector is expressed by workers through ambiguous and contradictory feelings about their own professional performance, as well as in relationships established among them and the users of the health system. Resonances in the subjectivity of these professionals are several and themes, such as fear, lack of affection and a sense of powerlessness, gethighlighted by the difficult understanding of the practices themselves and the gaps between what is prescribed and what is implanted and implemented

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Belinati, Waldmir. "Avaliação crítica do aumento da capacidade operativa dos serviços de saúde ao nível primário, Londrina, 1986-1992." Universidade de São Paulo, 1994. http://www.teses.usp.br/teses/disponiveis/6/6135/tde-29012018-112308/.

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Foi realizado um estudo quase experimental, com processo periódico de medida, entre 1986 e 1992, baseado em variáveis e indicadores referentes à produção de serviços de saúde ambulatoriais e hospitalares, no nível de saúde da população e no financiamento dos serviços. A população de intervenção foi a cidade de Londrina, através de seu sistema de serviços de saúde baseado na assistência primária. As populações de comparação foram as do Estado do Paraná e a do Brasil, que não foram objeto de ações semelhantes em igual período. O estudo teve o objetivo principal de avaliar as relações entre o aumento da capacidade operativa dos serviços de saúde ao nível ambulatorial e a demanda de serviços de saúde ao nível hospitalar. Constatou-se no estudo a redução das freqüências de internação hospitalar da população residente em Londrina, na vigência de uma política de saúde local que priorizou a extensão de cobertura dos serviços de saúde ao nível primário, e obteve como conseqüência o aumento das freqüências absolutas de consultas médicas e de atendimentos básicos; o aumento das razões de consultas médicas por habitante; o aumento das razões de consultas médicas por internação, e a melhora dos indicadores de saúde.
A quasi-experimental study design was carried out from 1986 to 1992, involving repeated measurements on population health variables and indicators related with: outpatient and hospital health services delivery; population health level and health services financing throughout the observational period. The unit under intervention was Londrina City, compared to the state of Parana and the Country - Brazil, which did not undergo analogous health services modifications. The main objective of the study was to evaluate the relationship amongst operational health service increased capacity at the primary level, and the demands for hospital admissions. The study concluded that the general hospital admission frequencies and rates were lowred during the time when the changing local health policy became effective, maintaining a time downward trend with the primary health services extension of coverage. Other health services indexes that showed improving profiles during the same period were: general population health indicators; medical consultations; basic non-medical attendances, and ratio of medicai visits per inhabitants-vear.

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Morais, Ana Patrícia Pereira. "Saúde mental na atenção básica: o desafio da implementação do apoio matricial." Universidade de São Paulo, 2010. http://www.teses.usp.br/teses/disponiveis/6/6135/tde-08112010-113219/.

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A Reforma Psiquiátrica no Brasil reorienta para um novo modelo de atenção à saúde mental, o qual necessita de contínuas estratégias e práticas para atingir seus objetivos. O fechamento de leitos e hospitais psiquiátricos, o surgimento de serviços extra-hospitalares e a criação de equipes mínimas de saúde mental passaram a exigir maior suporte da rede pública de saúde. No município de Fortaleza-CE, a reorganização das ações e serviços de saúde mental tem exigido da Rede Básica o enfrentamento do desafio de atender aos problemas de saúde mental, o que tem sido possível com a implementação do Apoio Matricial. Para avaliar o atendimento à saúde mental na Atenção Básica, o presente estudo utilizou uma abordagem qualitativa, tendo como referência lógico-conceitual a Reforma Psiquiátrica Brasileira, a Política de Saúde Mental do SUS para a Atenção Básica. Foram entrevistados doze profissionais das equipes da Saúde da Família de 4 UBS com apoio matricial implantado. As análises do conteúdo das falas originaram dois eixos teóricos analíticos. A reorganização dos serviços da Atenção Básica com ApM garantindo o acesso e a reorganização das práticas para a continuidade do cuidar. A implementação do ApM tem propulsado novas articulações entre os níveis de atenção e nos serviços tem possibilitado a responsabilidade compartilhada dos casos de saúde mental. O ApM tem oportunizado aos enfermeiros, médicos e ACS reverem o uso de práticas psiquiátricas tradicionais para atender às demandas em saúde mental na UBS. As UBS estudadas apresentam fragilidades operacionais na reorganização dos serviços, no gerenciamento do atendimento da demanda e no uso do potencial humano para o atendimento. A presença do ApM na AB marca avanço na proposta de trabalhar uma saúde mental em rede no município. O processo não está findo. A mobilização, sensibilização e capacitação da AB precisam ser incrementadas constantemente, bem como a organização e a supervisão do ApM nas UBS
Psychiatric Reform in Brazil is being restructured around a new model of mental health care and this requires the adoption of fixed strategies and practices to attain its objectives. Greater support is required from the networks of public health services as a result of the closure of wards in psychiatric hospitals, the rise of extra-hospital facilities and the setting up of minimum mental health teams. In the municipal district of Fortaleza (Ceará), the reorganization of mental health activities and services has required the Basic Network to meet the challenge of addressing mental health problems, and this has been made possible by implementing the Matrix Support system (ApM). This study has employed a qualitative approach to carry out an evaluation of the treatment provided by Primary Care Mental Health and adopted the Reforms in Brazilian Psychiatry and the SUS (Unified Health System) Policies of Primary Care as a logical-conceptual point of reference. Twelve professionals from the Family Health Teams of 04 UBS (Basic Health Units) were interviewed with the aid of the matrix support system. The analysis of the data obtained from their responses led to the formation of two theoretical axes: the reorganization of the Primary Care services together with the ApM which guaranteed right of access and the restructuring of practices that could ensure continuity of health care. The implementation of ApM has helped to coordinate the health services and allowed responsibility to be shared in the treatment of mental health. It has also enabled nurses, doctors and ACS (community health agents) to review the use of traditional psychiatric practices in meeting the requirements of mental health in the UBS. The UBS that have been studied show signs of operational failings in the reorganization of the services, the administration of public demand for treatment and the use of personnel. The presence of primary care in the ApM signals an advance in the working mental health project in the municipal network. However, the process does not end with improving organization since there is a constant need to increase awareness of the problem and the training of personnel in Primary Care, as well as making the running and supervision of ApM in the UBS more efficient

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Moura, Rita de Cássia dos Santos. "O Programa de Agentes Comunitários de Saúde adaptado à cidade do Rio de Janeiro: uma análise das suas concepções." Universidade do Estado do Rio de Janeiro, 2009. http://www.bdtd.uerj.br/tde_busca/arquivo.php?codArquivo=5300.

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Este trabalho trata de um estudo sobre uma experiência de adaptação do modelo Programa de Agentes Comunitários de Saúde, executado pela Coordenação de Saúde da Comunidade, da Secretaria Municipal de Saúde do Rio de Janeiro, no período de 2002 a 2005, que se coloca com certa divergência ao projeto político do Ministério da Saúde. Propõe-se a apresentar o contexto em que surge essa proposta e identificar e analisar as concepções da sua formulação. Poucos foram os documentos oficiais disponíveis para este estudo, transformando as entrevistas na técnica primordial para a realização do mesmo. Verificamos que havia um vazio de formulação de uma política de mudança da atenção básica para a cidade e, dessa forma, a oportunidade para formulações técnicas de modelos experimentais se colocou. Nesse cenário, surge a proposta da implantação de equipes de PACS, como uma tentativa de dar resposta aos obstáculos colocados à expansão da ESF, sendo aproveitado para ser adaptado de forma a aumentar a oferta de ações da atenção básica, nas áreas consideradas estratégicas pela NOAS 01/01.
This work is about a study on an adaptation experience of the model Programa de Agentes Comunitários de Saúde (Health Community Agents Program), conducted by the Community Health Coordination, at Rio de Janeiro Municipal Health Secretary, from 2002 to 2005, that is presented with a certain anachronism to the political project of the Health Ministry. It proposes to present the context in which this proposition arises, and to identify and analyze the concepts of its formulation. Few were the official documents available for this study, what made the interviews the primordial technique able to carry out the study. We observed that there was avoid in the formulation of the policy of change from the basic health care for the city and, therefore, the opportunity for technical formulations of experimental models were opened. In this scenario arises the proposal of implantation of the PACS groups, as an attempt to refute the obstacles posed to the expansion of the ESF, used to be adapted so as to increase the offer of actions of the basic health care, in areas considered strategic by the NOAS 01/01.

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Lopes, Cláudia de Souza. "Saúde do trabalhador na atenção básica : desafios e possibilidades de uma experiência municipal." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2013. http://hdl.handle.net/10183/95383.

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Esta dissertação se constitui em um estudo de caráter exploratório e explicativo sobre a Saúde do Trabalhador (ST) no âmbito da Atenção Básica (AB) ancorada em uma abordagem qualitativa que busca identificar a configuração das ações em ST na rede de AB no município de Porto Alegre/RS; com vistas a dar visibilidade às estratégias de intervenção e as dificuldades vivenciadas pelas equipes de saúde na inserção destas práticas na direção da promoção, proteção e recuperação dos trabalhadores. São sujeitos desta pesquisa 12 (doze) profissionais de saúde que no ano de 2012 trabalharam em serviços da rede de AB. No processo de coleta de dados utilizou-se a técnica de entrevista do tipo semiestruturada com aplicação de formulário composto de questões abertas. As informações foram submetidas à análise de conteúdo com base em Bardin (2004), identificando-se núcleos temáticos, de acordo com a síntese das categorias: saúde do trabalhador e atenção básica e das subcategorias temáticas: ações em saúde do trabalhador, modelo de atenção em saúde do trabalhador, facilidades e dificuldades vivenciadas em saúde do trabalhador, mediadas pelos aportes teóricos-metodológicos que dão suporte para a discussão e as proposições tecidas. Os resultados desta pesquisa apontam para: a) o não reconhecimento de uma ação específica do campo da ST; b) ausência de um sistema efetivo para o referenciamento do usuário/trabalhador para os serviços de saúde; c) problemas e falhas com a emissão de notificações de acidentes e/ou agravos relacionados ao trabalho; d) falta de preparação dos profissionais de saúde da rede de AB para o exercício de suas atividades em ST, decorrente da falta de investimento e de educação permanente e; d) falta de reconhecimento dos serviços de saúde do CEREST enquanto suporte técnico e científico em ST, reduzindo suas ações apenas para a atenção em saúde. Imediatamente destaca-se que apesar dos avanços significativos tanto no campo conceitual quanto na ampliação de recursos legais na saúde do trabalhador, o cuidado a ST na AB de Porto Alegre/RS, carece ainda de ações interdisciplinares e transversais, de um efetivo quadro de recursos humanos qualificado e de um sistema de informação capaz de efetivar as ações em ST com base em problemas originados das reais condições de trabalho do usuário/trabalhador. Nesse sentido, surge neste estudo como proposição de intervenção junto à rede de AB em Porto Alegre/RS o investimento na qualificação profissional e no matriciamento em ST.
This dissertation presents an exploratory study as an explanation about Occupational Health (hereby ST) in the scope of Basic Occupational Health Services (hereby AB) using a qualitative approach to identify ways of how ST actions are set as part of AB health network at Porto Alegre/RS; in order to provide visibility to the intervention strategies performed by health care teams as well as the difficulties faced by the health care teams as part of the occupational health promotion, protection and recovery. The data collection involved a semi structured interview, applying an open questions questionnarie on 12 professionals that worked for AB network in 2012. The collected information was processed through content analysis based on Bardin (2004), identifying themes based on two categories: occupational health and basic occupational health under subcategories: occupational health actions, basic occupational health model, easiness and difficulties faced on occupational health, which are mediated by theory and methodology to support this study discussions and propositions. The results of this research points to: a) the non recognition of specific actions on the ST área; b) the absence of an effective system for referencing user / worker to health services ; c) problems and issues to file notifications of accidents and / or injuries related to work; d) lack of training to professionals from the AB network to carry out their activities in ST, which is a result from the lack of investment on continuing education and; e) the lack of recognition from the CEREST health services as technical and scientific support in ST, reducing their actions as just the health care. It is important to note that despite significant advances on both conceptual level as well as the expansion of legal resources in occupational health, it still lacks the following conditions: interdisciplinary and cross-cutting actions to care ST under AB context on Porto Alegre / RS; an effective and qualified human resources pipeline and an information system able to accomplish the actions in ST based on issues originated by the actual working conditions of the user / employee. In this sense, the investment in vocational training and in matrix arises from this study as an intervention proposition by the AB network in Porto Alegre / RS.

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Piccinini, Carlos Augusto. ""A saúde bate a sua porta" : estratégias de cuidado dos agentes comunitários de saúde na atenção básica." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2012. http://hdl.handle.net/10183/70044.

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O presente escrito objetiva a analisar a singularidade da ação dos Agentes Comunitários de Saúde em sua circulação pelo território. Considerou-se que os encontros entre agentes e território extrapolam as prescrições e expectativas das políticas de saúde. Problematizou-se a produção de uma imagem idealizada dos agentes, no qual são vistos como a “mola propulsora” das transformações esperadas à Atenção Básica. Analisando a complexidade das demandas presentes em seu cotidiano de trabalho, destacou-se a multiplicidade de estratégias de cuidado produzidas pelos agentes comunitários. A singularidade de cada território, das equipes de saúde, da gestão, entre outras inúmeras variabilidades, pressionam os agentes e os demais trabalhadores das equipes da Estratégia Saúde da Família a encarar uma “realidade” bastante distinta do que se supõe. Destacou-se, portanto, a importância de se produzir uma posição crítica e reflexiva, colocando em questão os limites e possibilidades dessa prática. Logo, o objetivo é produzir uma cartografia do trabalho dos agentes, dando visibilidade ao modo como realizam seu trabalho em ato no território, a fim de potencializar as estratégias de cuidado ali existentes. Tomaram-se como analisadores a questão da resolutividade, a gestão das informações e a relação território-vínculo.
This writing aims to analyze the singularity of the action of the Community Health Agents (Agentes Comunitários de Saúde – ACS) in their movement through the territory. It was considered that the meetings between agents and territory go beyond the prescriptions and expectations of health policies. The production of an idealized image of the agents was problematized, image in which they are seen as the "propelling spring" of transformations expected to Basic Care. Analyzing the complexity of the demands in their daily work, it was emphasized the multiplicity of care strategies produced by community agents. The singularity of each territory, of health staff, of health management, among many other variabilities, push agents and other employees of the staffs of the Family Health Strategy to face a "reality" very different of that which is supposed. It was emphasized, therefore, the importance of producing a critical and reflective position, questioning the limits and possibilities of this practice. Therefore, the aim is to produce a cartography of the agents work, giving visibility to the way they do their work in act on the territory, in order to potentiate the care strategies existent there. The issue of resolvability, information management and relationship bond-territory were taken as analyzers.

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Campelo, Gaussianne de Oliveira. "A residÃncia multiprofissional em saÃde da famÃlia: revelando sentidos dos profissionais egressos." Universidade Federal do CearÃ, 2015. http://www.teses.ufc.br/tde_busca/arquivo.php?codArquivo=16129.

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FundaÃÃo de Amparo Ã Pesquisa do Estado do CearÃ
CoordenaÃÃo de AperfeÃoamento de Pessoal de NÃvel Superior
EstÃ assegurado na ConstituiÃÃo Federal o papel do SUS como ordenador da formaÃÃo de trabalhadores da saÃde, o que fez surgir uma crescente preocupaÃÃo com o ensino na saÃde, pois deve ser pautado nos princÃpios do SUS. Dessa forma, o MinistÃrio da SaÃde, em parceria com o MinistÃrio da EducaÃÃo, tem investido em diversos programas que visam Ã reorientaÃÃo da formaÃÃo e as ResidÃncias Multiprofissionais em SaÃde, constituindo um avanÃo no ensino na saÃde. Dentre essas, as ResidÃncias Multiprofissionais em SaÃde da FamÃlia tem o desafio de preparar profissionais para atuarem na AtenÃÃo PrimÃria Ã SaÃde. Por isso, o objetivo geral desta pesquisa foi: analisar o sentido das prÃticas do profissional egresso do programa de ResidÃncia Multiprofissional em SaÃde da FamÃlia e Comunidade da Universidade Estadual do PiauÃ (RMSFC/UESPI); apresentando como objetivos especÃficos: conhecer a trajetÃria acadÃmica e profissional deste egresso; investigar a utilizaÃÃo prÃtica dos conceitos apreendidos durante a ResidÃncia; identificar o sentido das aÃÃes desenvolvidas por este egresso no seu ambiente de trabalho, bem como suas contribuiÃÃes para a reorientaÃÃo das prÃticas em saÃde. Para tal, adotou-se a metodologia qualitativa, de carÃter exploratÃrio e descritivo, fundamentado no referencial teÃrico-metodolÃgico das âprÃticas discursivas e produÃÃo de sentidosâ, desenvolvido por Spink e colaboradores. Foram entrevistados quinze profissionais egressos das primeiras turmas da RMSFC/UESPI. Os participantes, todos do gÃnero feminino, apresentaram mÃdia de idade de 29,9 anos e mÃdia de 6,3 anos de conclusÃo do curso superior. As respostas foram organizadas em Mapas e, a partir das lembranÃas da RMSFC/UESPI, se construÃram as Ãrvores de associaÃÃo. Deste material, emergiram trÃs categorias de anÃlise: o sentido das prÃticas, o sentido da novidade e o sentido dos afetos; e trÃs subcategorias: integralidade como inovaÃÃo no cuidado; movimentos produzidos pelo trabalho em equipe multiprofissional; e, aprendendo com a comunidade â a integraÃÃo ensino-serviÃo-comunidade. Verificou-se a integralidade como eixo norteador da nova prÃxis profissional dos egressos, indicando que a RMSFC/UESPI ampliou o olhar dos profissionais, trazendo os variados sentidos que esse termo possui. O trabalho em equipe e a integraÃÃo com a comunidade foram pontos muito lembrados pelos egressos, carregados de sentimentos positivos, apontando para que mais Ãnfase seja dada a essas ferramentas pedagÃgicas, consideradas âpadrÃo-ouroâ para a formaÃÃo de profissionais da saÃde, visando o comprometimento com o acolhimento e a resolutividade das demandas de saÃde da populaÃÃo. Ao se constatar que os egressos estÃo espalhados pela Rede de AtenÃÃo Ã SaÃde, observou-se as tentativas em adaptar o conteÃdo teÃrico-prÃtico apreendido durante a ResidÃncia Ãs novas condiÃÃes de trabalho. Como um âdivisor de Ãguasâ, a RMSFC/UESPI despertou sentimentos, mexeu com os sentidos e gerou um terreno fÃrtil para que aconteÃa a invenÃÃo de novas formas de cuidado, amparadas pela integralidade da assistÃncia, pelo respeito Ã autonomia dos sujeitos e pelo vÃnculo interpessoal.
The Federal Constitution ensures SUS (Unified Health System) as the regulator in the education of health professionals, which gave rise to ever-increasing attention to training in the area, for it must be in accordance with the principles established by the system. So, the Ministry of Health, in a partnership with the Ministry of Education, has invested in many programs aiming at the redirection of education, where Multidisciplinary Residency poses as a major improvement. Among these, Multidisciplinary Residency in the Family Health Program is challenged to prepare professionals to act in Basic Health Care. Thus, this research seeks to analyze practices of professionals coming from the Multidisciplinary Residency in Family and Community Health Program of the State University of PiauÃ (RMSFC/UESPI), presenting the following specific objectives: to know their academic and professional background; to investigate the practical use of the concepts learnt during Residency; to identify the aim of actions developed by these professionals in the workplace, as well as their contributions for redirecting health care practices. For such, this study adopted an exploratory-descriptive qualitative methodology, which is based on the methodological references of the âdiscursive practices and the production of meaningâ, designed by Spink and collaborators. The study interviewed fifteen professionals egressed from the first groups of RMSFC/UESPI. The participants, all of which were females, aged on average 29.9 years old and had finished college on average 6.3 years before. The data were organized on Maps and the trees of association were built from the recollections of RMSFC/UESPI. This material brought to light the categories of analysis: the sense of practices, the sense of novelty and the sense of affection; and three subcategories: integrality as innovation in health care; movement caused by multiprofessional team work and learning with the community â the education-service-community integration. Integrality is seen as the main guideline to their new professional practices, indicating RMSFC/UESPI has enhanced professionalsâ perception, bringing up all the meanings that the word carries. Factors like team work and integration with the community were constantly recalled by the professionals and were frequently followed by positive feelings, indicating that more emphasis must be given to these pedagogical tools, which are considered âgold standardâ for the formation of health care professionals, aiming at the commitment with care and resoluteness of the peopleâs demands for health. When the study found that the egressed professionals were scattered all over the Health Care Network, it observed the attempts to adapt theoretical and practical content learnt during Residency to the new work conditions. Like a milestone, RMSFC/UESPI stirred feelings and paved the way for the advent of new ways of care, backed by integrality in assistance, respect to individualsâ autonomy and by interpersonal relationships.

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Onyeador, Victor Nkemdilim. "Health and healing in the Igbo society : basis and challenges for an inculturated pastoral care of the sick /." Frankfurt, M. : Lang, 2007. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=016424795&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.

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ARAÚJO, Danielle Dayse. "Utilização de plantas medicinais e fitoterapia na estratégia saúde da família no município de Recife: impacto de ações implementadas sobre a prescrição e recomendação." Universidade Federal de Pernambuco, 2014. https://repositorio.ufpe.br/handle/123456789/18299.

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CAPES
A inserção das plantas medicinais nos sistemas de saúde tem sido recomendação da OMS em função da sua ampla utilização pela população, mesmo com acesso aos serviços de saúde. No Brasil, a criação da Política Nacional de Práticas Integrativas e Complementares e da Política Nacional de Plantas Medicinais e Fitoterápicos veio a legitimar o uso de plantas medicinais no SUS, especialmente na atenção básica. No Recife, embora implantada antes das políticas nacionais, a fitoterapia teve nos últimos anos a implementação de novos serviços e a criação, em 2012, de uma política municipal respaldando a prática. Considerando o acima exposto, o objetivo do estudo foi avaliar o impacto na prescrição e recomendação da fitoterapia e plantas medicinais pela Estratégia Saúde da Família após a inserção de medicamentos fitoterápicos na rede SUS-Recife e a criação da Política Municipal de Práticas Integrativas e Complementares. Foi realizado um estudo descritivo de corte seccional e atributos de painel repetido entre Novembro e Dezembro de 2013 com médicos, enfermeiros e dentistas das Unidades de Saúde da Família do Distrito Sanitário IV do Recife. Os dados obtidos constituíram o painel atual, que foram comparados aos dados de uma pesquisa realizada em 2011 (primeiro painel), previamente a disponibilização dos fitoterápicos na rede e a criação da Política Municipal, a qual abordou diversas práticas integrativas e complementares, incluindo a fitoterapia e plantas medicinais. Para análise estatística foi utilizado o teste de Qui-quadrado através do programa SPSS versão 13.0. Foram verificados entre os dois painéis, aumentos significativos relacionados ao uso pessoal da fitoterapia pelos profissionais, bem como o uso da fitoterapia e de preparações de plantas medicinais para suas famílias. Entretanto, a prescrição e a recomendação das práticas não elevaram-se significativamente. Avaliando o painel atual foi verificado que 70,0% dos profissionais não tem formação na área, embora 92,4% a deseje. Ainda verificou-se associação estatística entre a formação dos profissionais e a recomendação das práticas avaliadas, o que não foi observado para a variável prescrição. A implementação da fitoterapia e plantas medicinais no SUS-Recife mostrou-se conhecida por 66,7% dos sujeitos, com apenas 2,6% referindo não desejá-las. O conhecimento de legislação municipal foi relatado apenas por 12,3% dos profissionais e a disponibilidade de fitoterápicos na rede municipal por 45,2% dos participantes. Com os dados obtidos, foi possível concluir que apesar da evolução na implementação da fitoterapia e plantas medicinais no Recife, são necessárias ações para sua consolidação no sistema municipal de saúde, especialmente no que se refere à comunicação e divulgação dos serviços aos profissionais bem como a realização de capacitação e educação permanente na área, de forma a garantir o acesso do usuário a tais práticas.
The insertion of medicinal plants in healthcare system have been recommended by WHO due to its wide use by the population, even with access to health services. In Brazil, the creation of the National Policy on Integrative and Complementary Practices and National Policy on Medicinal Plants and Phytotherapy came to legitimize the use of medicinal plants in the National Health System, especially in primary care. In Recife, while implanted ahead of national policies, phytotherapy had in recent years being implemented with new services and with the creation, in 2012, of a municipal policy endorsing the practice. Considering the above, the objective of the study was evaluate the impact on prescription and recommendation of herbal and medicinal plants by the family health strategy after insertion of herbal medicines in SUS-Recife network and the creation of Municipal Policy on Integrative and Complementary Practices. A descriptive cross sectional study and repeated panel study attributes were performed between November and December 2013 with doctors, nurses and dentists from IV District Units Family Health Recife. The data obtained constituted the current panel, which were compared to data from a survey conducted in 2011 (first panel) that addressed several complementary and integrative practices, including herbal and medicinal plants. Statistical analysis included the chi-square using SPSS version 13.0 was used. Between the two panels were observed significant increases related to personal use of phytoterapy by professionals as well as the use of phytoterapy and herbal preparations for their families. However, the prescription and recommendation practices did not increase significantly. Assessing the current panel was found that 70.0% of professionals do not have training in the area although 92.4% want to. Also there was a statistical association between the training of professionals and the recommendation of the practices evaluated, which was not observed for the prescription. The implementation of herbal and medicinal plants in the SUS-Recife proved known of 66.7% of the subjects, with only 2.6% stating not desiring them. Knowledge of municipal legislation was reported by only 12.3% of professionals and availability of herbal medicines in public schools by 45.2% of participants. With the data obtained, was possible to conclude that despite the progress in the implementation of herbal and medicinal plants in Recife, actions are required to be consolidated in the municipal health system, especially with regard to communication and dissemination services for professionals and the conducting of qualification and ongoing education in the area, to ensure user access to such practices.

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Mutta, Doris N. "Economic basis for sustaining traditional bio-innovation in developing countries : the case of health care in Madagascar and Kenya." Thesis, University of Strathclyde, 2004. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.288623.

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Guadagnin, Eduardo. "O território como elemento constituinte do processo de trabalho das Equipes de Saúde da Família: relevância e desafios." Universidade de São Paulo, 2013. http://www.teses.usp.br/teses/disponiveis/6/6135/tde-28022014-142055/.

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Objetivos - Compreender como as equipes de Saúde da Família consideram o território em seu processo de trabalho. Identificar e analisar as concepções de território dos profissionais das equipes de saúde da família. Analisar as potencialidades e limitações presentes nas concepções de território dos profissionais das equipes de saúde da família na perspectiva do cuidado integral à saúde na atenção básica. Procedimentos metodológicos - Pesquisa com abordagem qualitativa. Realizada analise documental e 22 entrevistas com profissionais de duas unidades de saúde da família do município de Jacareí - SP. Resultados - Os profissionais entrevistados apresentaram diferentes concepções sobre o território que atuam. Alguns profissionais associaram o território às características geopolíticas do mesmo, considerando apenas o território solo. Outros profissionais correlacionaram tais características com o modo de vida da população, considerando a ocupação e as dinâmicas existentes no mesmo, trabalhando com a lógica do território singularizado. Diversos profissionais trouxeram uma compreensão do território a partir dos determinantes e condicionantes do processo saúde-doença. Estas concepções trouxeram influencias do modelo de Programas de Saúde, do modelo das Vigilâncias em Saúde e do Modelo em Defesa da Vida. As diferentes concepções influenciaram de forma diversa nos processos de trabalho das equipes. As concepções relacionadas ao modelo dos Programas de Saúde favoreceram a inclusão de usuários com um conjunto de patologias pré-estabelecidas. As concepções baseadas no modelo das Vigilâncias em Saúde possibilitaram uma maior compreensão dos determinantes e condicionantes do processo saúde-doença. As concepções baseadas no modelo em Defesa da Vida se mostraram mais eficazes para a compreensão e consideração das necessidades de saúde dos usuários no processo de trabalho das equipes. Houve diferenças na organização dos processos de trabalho, na organização do cuidado e na forma de gestão das duas unidades estudadas. As equipes estudadas consideram parcialmente o território na organização do processo de trabalho, porém é necessária a ampliação do olhar sobre as vulnerabilidades existentes no processo saúde-doença, favorecendo uma clínica ampliada, mediante de arranjos institucionais pautados no vínculo, acolhimento e responsabilização da equipe com o cuidado integral em saúde, a partir das necessidades de saúde dos usuários
Objectives - Understand how teams of the Family Health consider the territory in their work process. Identify and analyze the concepts of territory of professional teams of family health. Analyze the strengths and limitations present in the territory conceptions of professional of teams of the Family Health in the perspective of comprehensive health care in primary care. Methodological Procedures - Research with a qualitative approach. Held documental analysis and conducted 22 interviews with two units of family health in the city of Jacareí-SP. Results - The professionals interviewed had different conceptions about territory they serve. Some professionals associated territory geopolitical features of it, considering only the ground territory. Other professionals such characteristics correlated with the mode of life, considering the occupation and the existing dynamic in it, working with the logic singled territory. Several professionals have brought an understanding of the territory from the determinants and constraints of the health-disease process. These conceptions brought influences the model of Health Programs, the model of Surveillance in Healthcare and Model in Defense of Life. Different attitudes influenced differently in the work processes of teams. The concepts related to the model of Health Programs favored the inclusion of users with a set of pre-established conditions. The concepts based on the model of Surveillance in Health allowed a greater understanding of the determinants and determinants of health-disease process. Conceptions based on the model in Defense of Life proved more effective for understanding and consideration of the health needs of the users in the team work process. There were differences in the organization of work processes in the organization of care and management in the form of the two units studied. The teams studied consider the territory part in the organization of the work process, but look at the expansion of existing vulnerabilities in the health- disease process is required, favoring an expanded, guided by the institutional arrangements in the bond, hosting and accountability of staff with clinical the comprehensive health care from the health needs of the users

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Vasconcelos, Erico Marcos de. "\"Comportamento dos cirurgiões-dentistas das Unidades Básicas de Saúde do município de São Paulo quanto à prevenção e ao diagnóstico precoce do câncer bucal\"." Universidade de São Paulo, 2006. http://www.teses.usp.br/teses/disponiveis/23/23139/tde-30102006-155849/.

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Este estudo teve como objetivo conhecer as ações que os cirurgiões-dentistas das unidades básicas de saúde do município de São Paulo têm desenvolvido quanto à prevenção e ao diagnóstico precoce do câncer bucal, além de suas percepções para a realização de tais ações, a fim de analisar o comportamento destes profissionais a cerca das questões relativas a esta morbidade. A maioria dos diagnósticos de câncer bucal é feita em estágios avançados em São Paulo, cidade que possui as maiores taxas de incidência nacionais, semelhantes a de outras regiões do mundo. O cirurgião-dentista exerce um papel fundamental e estratégico no combate aos fatores ligados ao aparecimento desse agravo. Foram enviados, em março de 2005, 885 questionários aos cirurgiões-dentistas das 286 unidades básicas de saúde de São Paulo, via Correio. Foi feito um banco de dados utilizando o software de informática Epi Info versão 6.04b. Participaram da pesquisa 282 profissionais, (taxa de resposta de 32%), em sua maioria do sexo feminino, com mais de 20 anos de graduação, com perfil generalista e que possui outros vínculos empregatícios. Além do baixo grau de conhecimento constatado quanto aos fatores de risco ligados à etiologia e às condições bucais em relação a possível evolução para um câncer bucal, a maioria dos participantes expôs limitações relevantes quanto às práticas relativas ao apoio à cessação do hábito do tabagismo e etilismo e às aptidões para executarem citologia esfoliativa e biópsia. Verifica-se a necessidade de se propor políticas públicas de enfrentamento do câncer bucal em São Paulo, que considere o aprimoramento dos cirurgiões-dentistas das unidades básicas de saúde em relação a esse problema e a melhor estruturação desses locais para a pronta realização dos exames complementares para fins diagnósticos.
The purpose of this study was to know the actions that dentists from basic health units of the city of São Paulo have been developing for the prevention and early diagnosis of oral cancer, besides their perceptions for the accomplishment of such actions, in order to analyze the behavior of these professionals about these subjects in relation to this morbidity. Most of the diagnosis of oral cancer is made in advanced stages in São Paulo that possesses the largest national incidence taxes, similar to other areas of the world. The primary health care dental professional plays a fundamental and strategic role against the linked factors related to the greater appearance of this malignant neoplasm. Eight hundred and eighty-five dentists from 286 basic health units of the city of São Paulo were surveyed in march 2005. It was made a database using the computer software Epi Info, version 6.04b. Two hundred and eighty-two professionals have answered the questionnaires (a response rate of 32% was obtained) and their majority composed by female general dental practitioners, with more than 20 years of graduation and that have other kinds of employment. Besides the low degree of knowledge verified for the risk factors linked to the etiology and the oral conditions in relation to a possible evolution for an oral cancer, most of the participants exposed relevant limitations as for the relative practices to support tobacco and alcohol cessation as for the accomplishment of esfoliative cytology and biopsy. It is verified the need of proposing public policies to face the problem of oral cancer in São Paulo, which considers not only the technical improvement of the primary health care dental practitioners but also the best structuring of those places for the ready accomplishment of the complemental exams to leading final diagnosis.

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Souza, Ana Lúcia Ferreira de. "Análise situacional dos Núcleos de Apoio à Saúde da Família no estado de Goiás." Universidade Federal de Goiás, 2017. http://repositorio.bc.ufg.br/tede/handle/tede/8300.

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Introduction: The Family Health Support Center is an innovative strategy that aims to support, expand and improve health practices and management through a range of professionals from different areas of knowledge who will work side by side along with the Family Health Teams, in view of the significance of this level of attention within the system and the lack of professionals in the daily lives of the teams. Objective: To characterize and describe the work developed by the Family Health Support Centers in the State of Goiás through the National Program for Improving Access and Quality of Primary Care, cycle II. Methodology: a cross-sectional descriptive study, which evaluated the results of National Program for Improving Access and Quality of Primary Care in Goiás. Secondary data were extracted from external evaluation database between November 2013 and February 2014. Participation in the study was 60 Family Health Support Center of the state of Goiás and 550 Family Health Teams that are supported by them. Results: the most mentioned professionals in the composition were physical educator, physiotherapist, veterinarian and nutritionist. Only 45% of the have clinics for exclusive use in health units. As for the work process, the planning and programming of the actions are carried out monthly by the majority (86.2%). The activities that stood out most were Health Education, Community Activities, Home Care and Therapeutic Groups. The frequency of meetings and activities between Family Health Support Center and Family Health Teams is quite variable and a small part does not work with defined periodicity. The average time for support to be taken care of was 7 days for 78% of ESF. Conclusion: the work done by the Family Health Support Center in the state of Goiás strengthens the Primary Health Care since the referrals to the specialized demand have been reduced and the health indicators have improved. However, there is still a lot to do to refine the work, and for that, one of the key factors is to increase the proximity and synchronism of the Family Health Support Center with the Family Health Teams, establishing partnership and really working together.
Introdução: o Núcleo de Apoio à Saúde da Família (NASF) é uma estratégia inovadora da Atenção Primária, que tem por finalidade apoiar, ampliar e aperfeiçoar as práticas e a gestão de saúde, através de uma gama de profissionais de distintas áreas do conhecimento que irão atuar lado a lado com as Equipes de Saúde da Família (ESF), tendo em vista a significância desse nível de atenção dentro do sistema e a carência de profissionais no cotidiano das equipes trata-se de um estudo de grande relevância para a saúde coletiva. Objetivo: caracterizar e descrever o trabalho desenvolvido pelos NASF no Estado de Goiás por meio do Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica, PMAQ-AB ciclo II. Metodologia: estudo descritivo de corte transversal, que avaliou os resultados do PMAQ-AB, em Goiás. Foram utilizados dados secundários, extraídos do banco de dados da avaliação externa do PMAQ-AB entre novembro de 2013 a fevereiro de 2014. Participaram da pesquisa 60 NASF do estado de Goiás e 550 ESF que são apoiadas por eles. Resultados: os profissionais mais referidos na composição dos NASF foram educador físico, fisioterapeuta, médico veterinário e nutricionista. Apenas 45% dos Núcleos possuem consultórios de uso exclusivo nas unidades de saúde. Quanto ao processo de trabalho, o planejamento e programação das ações são realizados mensalmente pela maioria dos NASF (86,2%). As atividades que mais se destacaram foram Educação em Saúde, Atividades Comunitárias, Atendimento Domiciliar e Grupos Terapêuticos. A periodicidade de encontros e atividades entre Núcleos e Equipes apoiadas é bastante variável e uma pequena parte não trabalha com periodicidade definida. O tempo médio de demora para o apoio ser atendido foi de 7 dias para 78% das equipes de ESF. Conclusão: o trabalho realizado pelos NASF no estado de Goiás fortifica a Atenção Primária à Saúde tendo em vista que os encaminhamentos para a demanda especializada foram reduzidos e os indicadores de saúde apresentaram melhora. Porém, ainda, há muito que percorrer para refinar o trabalho dos Núcleos, e para isso, um dos fatores primordiais é aumentar a proximidade e o sincronismo dos NASF com as equipes de ESF, estabelecendo parceria e atuando realmente em conjunto.

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Van, Hoi Le. "Health for community dwelling older people : trends, inequalities, needs and care in rural Vietnam." Doctoral thesis, Umeå universitet, Epidemiologi och global hälsa, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-47467.

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Background InVietnam, the proportion of people aged 60 and above has increased rapidly in recent decades. The majority live in rural areas where socioeconomic status is more disadvantaged than in urban areas.Vietnam’s economic status is improving but disparities in income and living conditions are widening between groups and regions. A consistent and emerging danger of communicable diseases and an increase of non-communicable diseases exist concurrently. The emigration of young people and the impact of other socioeconomic changes leave more elderly on their own and with less family support. Introduction of user fees and development of a private sector improve the coverage and quality of health care but increase household health expenditures and inequalities in health care. Life expectancy at birth has increased, but not much is known about changes during old age. There is a lack of evidence, particularly in rural settings, about health-related quality of life (HRQoL) among older people within the context of socioeconomic changes and health-sector reform. Knowledge of long-term elderly care needs in the community and the relevant models are still limited. To provide evidence for developing new policies and models of care, this thesis aimed to assess general health status, health care needs, and perspectives on future health care options for community-dwelling older people. Methods An abridged life table was used to estimate cohort life expectancies at old age from longitudinal data collected by FilaBavi DSS during 1999-2006. This covered 7,668 people aged 60 and above with 43,272 person-years. A 2007 cross-sectional survey was conducted among people aged 60 and over living in 2,240 households that were randomly selected from the FilaBavi DSS. Interviews used a structured questionnaire to assess HRQoL, daily care needs, and willingness to use and to pay for models of care. Participant and household socioeconomic characteristics were extracted from the 2007 DSS re-census. Differences in life expectancy are examined by socioeconomic factors. The EQ-5D index is calculated based on the time trade-off tariff. Distributions of study subjects by study variables are described with 95% confidence intervals. Multivariate analyses are performed to identify socioeconomic determinants of HRQoL, need of support, ADL index, and willingness to use and pay for models of care. In addition, four focus group discussions with the elderly, their household members, and community association representatives were conducted to explore perspectives on the use of services by applying content analysis. Results Life expectancy at age 60 increased by approximately one year from 1999-2002 to 2003-2006, but tended to decrease in the most vulnerable groups. There is a wide gap in life expectancy by poverty status and living arrangement. The sex gap in life expectancy is consistent across all socioeconomic groups and is wider among the more disadvantaged populations. The EQ-5D index at old age is 0.876. Younger age groups, position as household head, working, literacy, and belonging to better wealth quintiles are determinants of higher HRQoL. Ageing has a primary influence on HRQoL that is mainly due to reduction in physical (rather than mental) functions. Being a household head and working at old age are advantageous for attaining better HRQoL in physical rather than psychological terms. Economic conditions affect HRQoL through sensory rather than physical functions. Long-term living conditions are more likely to affect HRQoL than short-term economic conditions. Dependence in instrumental or intellectual activities of daily living (ADLs) is more common than in basic ADLs. People who need complete help are fewer than those who need some help in almost all ADLs. Over two-fifths of people who needed help received enough support in all ADL dimensions. Children and grand-children are confirmed to be the main caregivers. Presence of chronic illness, age groups, sex, educational level, marital status, household membership, working status, household size, living arrangement, residential area, household wealth, and poverty status are determinants of the need for care. Use of mobile teams is the most requested service; the fewest respondents intend to use a nursing centre. Households expect to use services for their elderly to a greater extent than did the elderly themselves. Willingness to use services decreases when potential fees increase. The proportion of respondents who require free services is 2 to 3 times higher than those willing to pay full cost. Households are willing to pay more for day care and nursing centres than are the elderly. The elderly are more willing to pay for mobile teams than are their households. ADL index, age group, sex, literacy, marital status, living arrangement, head of household status, living area, working status, poverty and household wealth are factors related to willingness to use services. Conclusions There is a trend of increasing life expectancy at older ages in ruralVietnam. Inequalities in life expectancy exist between socioeconomic groups. HRQoL at old age is at a high level, but varies substantially according to socioeconomic factors. An unmet need of daily care for older people remains. Family is the main source of support for care. Need for care is in more demand among disadvantaged groups. Development of a social network for community-based long-term elderly care is needed. The network should focus on instrumental and intellectual ADLs rather than basic ADLs. Home-based care is more essential than institutionalized care. Community-based elderly care will be used and partly paid for if it is provided by the government or associations. The determinants of elderly health and care needs should be addressed by appropriate social and health policies with greater targeting of the poorest and most disadvantaged groups. Building capacity for health professionals and informal caregivers, as well as support for the most vulnerable elderly groups, is essential for providing and assessing the services.
Aging and Living Conditions Program
Vietnam-Sweden Collaborative Program in Health, SIDA/Sarec

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Linnér, My, and Jennie Sundbye. "Basala hygienrutiner vid sårbehandling vid ett sjukhus i Tanzania : en observationsstudie." Thesis, Röda Korsets Högskola, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-190.

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Vårdrelaterade infektioner kan leda till sjuklighet och för tidig död och påverkar många människor, inte bara individen själv utan även dennes familj och samhället i stort. Vårdrelaterade infektioner drabbar både patienter och sjukvårdspersonal. Med goda basala hygienrutiner och medvetenhet om hur infektioner sprids kan många fall förebyggas och mycket lidande förhindras. Denna studies syfte var att beskriva basala hygienrutiner vid sårbehandling på en avdelning vid ett sjukhus i norra Tanzania. Studien hade en kvalitativ och en kvantitativ ansats där det kvalitativa datamaterialet har bearbetats med innehållsanalys och det kvantitativa datamaterialet har redovisats med deskriptiv statistik. Innehållsanalysen resulterade i kategorierna Kontaminering av omgivning/material, smutsig rutin och ren rutin. Slutsatsen visade att de basala hygienrutinerna brast vilket kan öka risken för vårdrelaterade infektioner samt att basala hygienrutiner inte tycks vara väl implementerade på avdelningen.
Health care-associated infections can lead to morbidity and premature death and affect many people, not only the individual himself/herself but also his/her family and the society at large. Health care-associated infections affects both patients and healthcare staff. With good basic hygiene and awareness of how infection spread many cases can be prevented and much suffering be avoided. The aim of this study was to describe the basic hygiene routines of wound care at a ward at a hospital in northern Tanzania. The study had a qualitative and a quantitative approach in which the qualitative data material was processed with content analysis and the quantitative data material was presented with descriptive statistics. Content analysis resulted in the categories contamination of the environment/materials, dirty routine and clean routine. The conclusion showed that the basic hygiene routines were rarely performed properly which increased the risk of healthcare associated infections and that basic hygiene routines did not seem to be well implemented on the ward.

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von, Hage Alexandra, and Abena Turkson. "Basala hygienrutiner : faktorer som påverkar följsamheten : en litteraturstudie." Thesis, Röda Korsets Högskola, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:rkh:diva-72.

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Intresset för ämnet vårdhygien väcktes under den verksamhetsförlagda utbildningen då vi uppmärksammade att vårdpersonalen på avdelningarna ofta slarvade med handhygien och andra basala hygienrutiner. Vårdrelaterade infektioner beräknas drabba en av tio patienter. Många av dessa infektioner skulle kunna förebyggas genom följsamhet till basala hygienrutiner. Syftet med denna studie var att belysa faktorer som påverkar vårdpersonals följsamhet gällande basala hygienrutiner. En litteraturstudie genomfördes där tio artiklar med kvalitativ och kvantitativ ansats analyserades. Resultatet delades upp i två huvudkategorier och nio underkategorier. De två huvudkategorierna som skapades var Organisatoriska faktorer och Individuella faktorer. Under Organisatoriska faktorer framkom Tidsbrist och arbetsbelastning, Kunskap, Arbetsklimat och förebilder samt Tillgänglighet på material. Under de Individuella faktorerna framkom Attityd, Typ av klinisk procedur, Teknik, Hudirritation och Yrkesgrupper. Studien bidrar till ökad förståelse för dessa faktorers inverkan på följsamheten till basala hygienrutiner. Resultatet visade att brist på tid, kunskap och material försämrade följsamheten till handhygien. Vidare visade resultatet att en arbetsledning och kollegor som var goda förebilder påverkade vårdpersonalen positivt gällande följsamheten. Vårdpersonal var medvetna om riskerna med dålig handhygien men förminskade problemet och attityden till handhygien försämrades över tiden. Läkare hade generellt sett lägre följsamhet än övrig vårdpersonal. Vid vardagliga moment ansågs handhygienen inte vara lika viktig och vid moment som medförde en högrisk för smitta var följsamheten låg.
Interest in infection control developed during the work-based training when we realized that nursing staff in the departments were often careless with hand hygiene and other basic hygiene routines. Healthcare associated infections are estimated to affect one of ten patients. Many of these could be prevented by observing basic hygiene. The purpose of this study was to elucidate factors that influence healthcare staff´s observance of basic hygiene. This was done through a literature study of ten articles consisting of qualitative and quantitative data. The results were divided into two main categories and nine subcategories. The two main categories were Organizational factors and Individual factors. The Organizational factors that emerged were Lack of time and workload, Knowledge, Working environment and role models and Availability of materials. The Individual factors were Attitude, Type of clinical procedure, Techniques, Skin irritation and Professions. The study contributes to a greater understanding of these factors in the observance of basic hygiene. The results showed that lack of time, knowledge and lack of material had a negative influence on the observance of hand hygiene. Furthermore, the results showed that supervisors and colleagues who were good role models influenced medical staff in a positive way. Healthcare staff were aware of the risks of poor hand hygiene but ignored the problem to some extent and the approach to hand hygiene deteriorated with time. Doctors generally had lower observance than other health care staff. In everyday encounters hand hygiene was not considered as important and at moments with a high risk of infection there was generally low compliance.

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Gutierrez, Adriana Cóser 1976. "A co-produção da politica estadual de atenção basica do Rio de Janeiro." [s.n.], 2008. http://repositorio.unicamp.br/jspui/handle/REPOSIP/309410.

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Orientador: Gastão Wagner de Souza Campos
Dissertação (mestrado) - Universidade Estadual de Campinas, Faculdade de Ciencias Medicas
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Resumo: Este estudo teve como objetivo caracterizar e analisar a co-produção de uma política de atenção básica de saúde no ano de 2007, a partir do cenário de mudanças ainda em curso no modo de gestão da política de saúde do Estado do Rio de Janeiro. Para tal foram utilizados a análise documental e o diário de campo da pesquisadora, que exerce atualmente o cargo de superintendente estadual de atenção básica e gestão do cuidado. Buscou-se descrever a constituição desta política da Secretaria de Estado da Saúde do Rio de Janeiro, bem como analisar as informações obtidas, recorrendo-se ao conceito de filtro proposto por Campos (2000) no Método Paidéia, que se vale dos conceitos de co-gestão e de produção de políticas. A pesquisa aponta para o resgate da função da esfera estadual no fomento à estruturação e à consolidação da atenção básica, ao reconhecer a necessidade de superação do seu atual papel de mediador entre as políticas federais e municipais, permitindo assim que a Secretaria de Estado de Saúde e Defesa Civil do Rio de Janeiro seja protagonista deste processo, considerado o contexto histórico, que sofre o impacto dos inúmeros desafios sanitários instalados. Conclui com a proposição de novos arranjos e de dispositivos internos e externos à Secretaria de Estado de Saúde como estratégia de co-produção da Política Estadual de Atenção Básica de Saúde. Palavras chave: política de saúde, co-produção; atenção básica em saúde, saúde da família
Abstract: The objective of this study is to identify characteristics and to analyse a jointly devised policy on the provision of primary health in 2007, deriving from a scenario of ongoing changes in the management of health policy in the State of Rio de Janeiro. In order to identify these characteristics, record analysis as well as a field diary by the researcher - who works as a Primary Health and Care Management Superintendent of the state- were used. The aim was to describe the components of such policy from the State Health Secretary of Rio de Janeiro whilst analysing this information by way of the filter concept, using the Paideia Method proposed by Campos (2000) which relies on joint management and policy- making concepts. The study focuses on reinstating the function of the state in promoting the organisation and consolidation of primary health, through awareness of the need to improve the state¿s role as a mediator between federal and municipal policies. This would confer prominence to the State Health and Civil Defence Secretary of Rio de Janeiro, by way of a leading role in this process taking into consideration the historic context determined by innumerable challenges posed by health implementations. This reaches a conclusion by way of a proposal to the Secretary of State for Health, for new arrangements to be made together with external and internal devices, as a strategy for a jointly devised State Primary Health Policy. Key words: Health policies, joint- policy making, primary health care, family health provision
Mestrado
Saude Coletiva
Mestre em Saude Coletiva

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McCulloch, Douglas William. "The quality-adjusted life year (QALY) approach as a basis for health care resource allocation : the validity of a QALY measure, and the application of QALYs to clinical practice." Thesis, University of Ulster, 1998. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.264696.

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Dornelas, Rodrigo Faria. "Participação de gestantes em grupos educativos do pré-natal na atenção básica." Universidade Federal de Goiás, 2016. http://repositorio.bc.ufg.br/tede/handle/tede/7155.

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The Ministry of Health (MS) recommends quality and humanized prenatal care based on convenient and educative behavior, in addition to the minimum of six visits for a proper follow-up of the pregnant woman. The education group is an interactive space that prepares the pregnant woman for the pregnancy and puerperal period. It enables the exchange of experience and knowledge among pregnant women and health professionals in order to promote health and humanization. The present study aimed to analyze the participation of pregnant women in pre-natal education groups in basic health care units of the Sanitary District Campinas-Centro of Goiânia-Goiás. This is a cross-sectional, exploratory and descriptive study with a quantitative approach which was carried out between 2014 and 2015, with pregnant women over 18 years of age. The pregnant women were enrolled in the prenatal program of four Basic Health Care Units in Goiânia -Goiás. The pregnant women were interviewed about their participation of the prenatal education group before voluntary acceptance through the Informed Consent Form. We performed a descriptive analysis of the data using absolute (n) and relative (%) frequency measurements. The results were categorized and presented in tables and figures. This study was conducted in a population of 90 pregnant women. The majority of the participants were aged between 18 and 28 years, more than nine years of schooling, living with his partner, income of up to two minimum wages and they did not own a property. They had normal pregnancy in the thi rd trimester with an average of five follow-up visits and had been pregnant previously. The subjects of greatest interest to the pregnant women were "Newborn Care" (77.8%) and "Breastfeeding" (55.6%). Regarding other topics, "Indications and types of childbi rth" was pointed out as the most relevant. The facilitating and hindering factors for the participation in the pregnant group were, respectively: meeting schedule (60% and 34.4%), place (78.9% e 14.4%); pe rsonal availability (53.3% e 46.7%), working schedule (27.8% and 34.4%), study schedule (33.3% and 6.7%), having someone to take care of thei r children (22.2%) and not having someone to take care of thei r children (7.8%), not having children (43.3%) and transportation (14.4%). We concluded that the participation of the pregnant women in the prenatal education groups was different among the healthy units and influenced by availability with "meeting schedule", " place" and "not having children". The results reinforce the role of nurses in the planning and management of the group as an important strategy for health promotion and education for pregnant women and their families.
O Ministério da Saúde (MS) preconiza a atenção pré-natal de qualidade e humanizada a partir da inclusão de condutas acolhedoras e educativas, com número mínimo de seis consultas para o acompanhamento adequado da gestante. O grupo educativo constitui um espaço interativo de preparo da gestante para o período gravídico-puerperal, permite o intercâmbio de experiências e conhecimentos entre as gestantes e profissionais da saúde para que favoreçam a promoção da saúde e humanização. Este estudo objetivou analisar a participação de gestantes em grupos educativos do pré-natal, em unidades de atenção básica de saúde, do Distrito Sanitário Campinas-Centro de Goiânia-Goiás. Trata-se de um estudo transversal, descritivo exploratório com abordagem quantitativa, realizado em 2014 e 2015, com 90 gestantes maiores de 18 anos, usuárias do Sistema Único de Saúde, cadastradas no programa pré -natal de quatro Unidades de Atenção Básica de Saúde de Goiânia-Goiás. As gestantes foram ent revistadas acerca da sua participação do grupo educativo de pré-natal, após aceite voluntário por meio do Termo de Consentimento Livre e Esclarecido. Realizou-se análise descritiva dos dados, com utilização da medida de frequência absoluta (n) e relativa (%). Os resultados foram categorizados e apresentados em forma de tabelas e figuras. A grande maioria das participantes apresentou idade entre 18 a 28 anos, mais de nove anos de estudo, união estável, atividade de trabalho remunerado com renda de até dois salários mínimos, sem imóvel próprio, gestação normal no terceiro trimestre com média de cinco consultas. Os temas de maior interesse das gestantes foram “Cuidados com o recém-nascido” (77,8%) e “Amamentação” (55,6%). Os fatores facilitadores e di ficultadores para a participação no grupo de gestantes foram, respectivamente: horário dos encontros (60% e 34,4%), local (78,9% e 14,4%); disponibilidade pessoal (53,3% e 46,7%), horário de trabalho (27,8% e 34,4%), horário de estudo (33,3% e 6,7%), ter quem cuida dos filhos (22,2%) e não ter (7,8%), não ter filhos (43,3%) e locomover até a unidade de saúde (14,4%). Concluiu -se que a participação das gestantes nos grupos educativos do pré-natal foi diferente entre as UBS e influenciada pela disponibilidade ao “horário do grupo”, “loc al dos encontros” e “Não ter filhos”. Isto reforça o papel do enfermeiro no planejamento e gestão do grupo como importante estratégia de promoção e educação em saúde da gestante e de sua família.

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Campos, Lucas Vinco de Oliveira. "A estratégia de saúde da família em sua micropolítica: um estudo de caso sobre a Humanização nos processos de trabalho." Universidade de São Paulo, 2011. http://www.teses.usp.br/teses/disponiveis/22/22133/tde-29082011-145703/.

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A temática deste estudo trata do trabalho cotidiano produzido em uma equipe de Estratégia de Saúde da Família (ESF), na perspectiva da humanização, como disposta da Política Nacional de Humanização (PNH). Foi desenvolvido junto a todos os trabalhadores de uma equipe de ESF do município de Ribeirão Preto - São Paulo, com os objetivos de mapear os modos de produção e captura dos movimentos de humanização que se constituem na micropolítica do processo de trabalho desta equipe, interpretar as práticas no trabalho da ESF considerando as dimensões constituídas nos temas fundamentais da PNH e analisar os modos de produção das realidades/subjetividades no contexto da ESF que podem ser incorporativas de humanização. Constituiu-se um estudo de abordagem qualitativa, caracterizado como estudo de caso, utilizando a cartografia como método de pesquisa. Optou-se pela observação participante como instrumento para a coleta de dados. Através das análises dos dados foi possível identificar que os processos de humanização ainda encontram resistências. As possibilidades de mudanças anunciadas pela PNH, no que tange à autonomia, criatividade, responsabilização e trabalho em equipe, encontram-se atravessadas por linhas de força historicamente instituídas, como policiamento, hierarquia verticalizada, fragmentação do processo de trabalho, primazia do saber científico, isolamento, burocratização e desarticulação política, tanto nas relações estabelecidas entre os trabalhadores, quanto entre trabalhadores e usuários. Como consquência de tais atravessamentos, estas relações constituem-se enquanto relações de poder. A partir disso, pode-se perceber, por vezes, a produção de apatia e o sentimento de desvalorização, principalmente entre os trabalhadores de nível médio, e de impotência, entre os de nível superior. No entanto, os temas fundamentais da PNH se produzem em algumas brechas da instituição. Ainda que pontualmente marcados, em espaços não considerados oficiais dentro da equipe, que nas análises foram identificados como estando do lado de fora, em guetos, observaram-se intervenções de alguns trabalhadores em que emergiam principalmente a criatividade e autonomia. Estes momentos apontam que há muita potência para a produção do cuidado humanizado no conhecimento informal, no acúmulo de experiência dos trabalhadores e nos momentos de proximidade com os usuários. Faz-se necessário, portanto, um uso dos espaços institucionais que vise a inclusão, em todo o processo de trabalho cotidiano da equipe, destes movimentos de humanização, para que seja possível, assim, articular autonomia e criatividade com a responsabilização dos seus agentes, e a inserção efetiva no trabalho em equipe.
The subject of this study regards the daily work performed by a team in Family Health Strategy (FHS), in the perspective of humanization, as provided by the Humanization National Policy (HNP). It was carried out by workers of a FHS team from the region of Ribeirão Preto - São Paulo, aiming to map out the ways of producing and capturing the humanization movements that are established in micropolitics of this team\'s work process, to interpret the FHS\' work practices considering the dimensions founded in the HNP fundamental subjects, and to analyze the modes of production of realities/subjectivities in the FHS\' context that may incorporate humanization. A study of qualitative approach was carried out, which was characterized as a case study, using cartography as a research method. Participant observation was used as a tool for data collection. Through the data analyses it was possible to identify that humanization processes still find resistance. The possibilities for change announced by the HNP - those that regard autonomy, creativity, responsibilization, and team work - are crossed by lines of force that are historically instituted, such as monitoring, vertical hierarchy, fragmentation in work process, primacy of scientific knowledge, isolation, bureaucratization, and political disarticulation, both in established relations among workers and among workers and users. As a consequence of such intersections, these relations stand as power relations. Hence, what can sometimes be seen is the feeling of apathy and belittling, especially among high school leveled workers, and that of powerlessness among workers with higher educational level. However, the HNP\'s fundamental topics are produced in some gaps of the institution. Although accurately pointed out, in settings that were considered to be unofficial inside the team, which were identified in the analyses as being outside, in ghettos, some workers\' interventions were observed from which mainly creativity and autonomy came out. Those moments show that there is a lot of power for the production of humanized care within informal knowledge, in the workers\' experience accumulation and in moments of closeness to the users. It is necessary, hence, that institutional settings are used aiming inclusion along all daily team process of these humanization movements, so that it is possible, thus, to articulate autonomy and creativity with their agents\' responsibilization and the effective insertion in team work.

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Pinto, Hêider Aurélio. "Múltiplos olhares sobre e a partir do Programa Nacional de Melhoria do Acesso e Qualidade." reponame:Biblioteca Digital de Teses e Dissertações da UFRGS, 2014. http://hdl.handle.net/10183/108955.

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Esta dissertação analisa o Programa Nacional de Melhoria do Acesso e da Qualidade (PMAQ) em dimensões relacionadas à sua formulação, implementação e avaliação inicial além de estudar elementos centrais da Política Nacional de Atenção Básica (PNAB) induzidas e avaliadas por ele. Buscamos o quadro teórico metodológico no campo de análise de políticas e em estudos da Saúde Coletiva que analisavam políticas de saúde e o processo da reforma sanitária brasileira. Foi realizada análise documental e de dados secundários tais como de pesquisa da ouvidoria ativa acerca do acesso, uso e satisfação de usuários do SUS, do processo de autoavaliação e avaliação externa do PMAQ e da pesquisa realizada pelo Ministério da Saúde com gestores que participaram do primeiro ciclo do PMAQ. Foram desenvolvidos estudos integrados que contaram com a participação de pesquisadores parceiros e gestores e pessoal da gestão envolvido com o programa. No primeiro estudo, o PMAQ foi relacionado com outras ações de um novo contexto da política nacional de saúde e descrito através da análise das fases que o constitui. No segundo estudo, analisou-se o processo de formulação do PMAQ e os diferentes papéis que assume no contexto da PNAB em seus primeiros 3 anos de implantação com foco no desempenho do que foi denominado “apostas estratégicas” do programa. O terceiro estudo, teve como foco a evolução do financiamento federal da Atenção Básica (AB) de 1998 até 2014 destacando o papel que o PMAQ teve na mudança quantitativa e qualitativa do mesmo. No quarto estudo, foi analisada a primeira experiência de pesquisa sistemática e regular de acesso, uso e satisfação dos usuários com os serviços de AB e de urgências com o objetivo de orientar e acompanhar a PNAB. No quinto estudo, foi analisado o que o PMAQ permitiu identificar e avaliar da prática de educação permanente em saúde pelas equipes de atenção básica . No sexto e último estudo, foi analisado o quanto a AB cumpre ou não o papel de principal porta de entrada do sistema, ordenadora das redes de atenção à saúde e coordenadora do cuidado. O PMAQ foi considerado uma política com importante sucesso na adesão de municípios, gestores e equipes, com grande poder de mobilização e com importante avanço na implantação e desenvolvimento de suas apostas estratégicas. O financiamento da AB teve o maior aumento nos últimos quatro anos desde a criação do PAB na década de 90 e grande parte da mudança quantitativa e qualitativa do mesmo se deve ao PMAQ. Contudo, embora o PMAQ tenha apresentado capacidade de avaliar macro e meso processos de organização do processo de trabalho na AB e tenha permitido avançar muito na avaliação da AB em todos os pontos tratados nesta dissertação, muitos elementos importantes ainda lhe escapam e isso exige uma série de aprimoramentos no programa relacionados à participação social, comunicação, uso e crítica de seus resultados, associação com diferentes pesquisas quanti e qualitativas e articulação como de ações e inciativas de base loco-regional.
This dissertation analyses the National Program for the Improovement of Access and Quality (PMAQ) in dimensions related to its formulation, implementation and first evaluation, and also studies core elements of the National Basic Health Care Policy (PNAB) inducted and evaluated by the program. We adopted the theoretical and methodological guidelines of the field of policy analysis and Collective Health that analised health policies and the Brazilian process of sanitary reform. It was made a documentary and a secondary data analysis, such as researches with ombudsman responsible for hearings on access, use and satisfaction of users of the Brazilian public health system(SUS), researches about the process of self evaluation and external evaluation of the PMAQ and the research conducted by the Ministry of Health with managers that took part in the first cycle of the PMAQ. Integrated studies that counted with the participation of partner researchers and managers and managing staff conected to the program were developed. In the first study, the PMAQ was associated to other actions developed in the new context of the national health politics, and it was described through the analysis of fases that constitute it. In the second study, the process of formulation of the PMAQ and the diferent roles that it assumes within the context of the PNAB in its first 3 years of implementation was analysed, focusing on the performance of what was called “strategic bets” of the program. The third, study focused the evolution of the federal financing in Basic Health Care (AB) from 1998 to 2014, highlighting the role that the PMAQ had in the quantitative and qualitative change of this financing. In the fourth study, the first experience of sistematic and regular research of access, use and satisfaction of users regarding services of AB and of urgencies with the goal of guiding and following the PNAB was analyzed. In the fifth study, the informations that the PMAQ allowed to identify and evaluate in the practice of permanente education in health conducted by teams of AB was analysed. In the sixth and last study, the extent to which AB fulfills or not the role of main gateway of the system, organazing the networks of health care and coordinating the care was analyzed. The PMAQ was considered a policy with an important success regarding the accession of cities, managers and teams, with a great power of mobilyzation and with importante advances in the implementation and development of its strategic bets. Since the creation of the PAB in the 90’s, the financing of AB had its bigger increase in the last four years and a great extent of the quantitative and qualitative changes that it has passed is due to PMAQ. Nevertheless, even though PMAQ has shown the capacity to evaluate macro and middle processes of organization of the work process in AB and has permited to advance considerably in the evaluation of AB in all of the subjects discussed in this dissertation, many important elements are still missing and demand many improvements in the program related to social participation, comunication, use and critic of its results, associations with different quanti and qualitative researches and articulations such as actions and initiatives locus-regional.

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Bastos, Jaina Larissa Bastos Costa de. "A atenção básica no município de Niterói: um estudo de caso." Niterói, 2016. https://app.uff.br/riuff/handle/1/4895.

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Faculdade de Medicina de Petrópolis. Faculdade Arthur Sá Earp Neto. Docente
Esta dissertação discute a atenção básica de Niterói, enfocando na transição do Programa Médico de Família (PMF) para Estratégia Saúde da Família (ESF). O PMF foi implantado em 1992 no município de Niterói e possui características próprias, relacionadas ao desenvolvimento desse nível de atenção no âmbito local. A ESF implantada com essa configuração a partir de 2006 tem como um dos seus principais objetivos, estruturar a atenção básica do país. O estudo buscou investigar: o que pensam os atores sociais (profissionais da saúde e da gestão), sobre a transição do PMF para ESF? A análise dos dados se processou com base na leitura e discussão dos relatórios finais das Conferências Municipais de Saúde (CMS); na observação da 7ªCMS e nas entrevistas realizadas. Para análise dos dados foram estabelecidas três categorias: modelo assistencial; participação da população e processo de trabalho, que emergiram com os dados do campo. Os resultados apontaram que o município está em transição, para implementação da ESF. Foram identificadas características do PMF e da ESF. Na categoria modelo assistencial, foram identificadas mudanças: o aumento da população adscrita, da cobertura, aumento da equipe, diminuição das atividades de campo e concomitância de modelos (o hegemônico e o alternativo com o PMF e a ESF). Na categoria participação da população, consta a diminuição desta e a falta de consenso com relação à cogestão. Na categoria processo de trabalho, foram identificadas questões sobre a forma de contratação, ligadas ao modelo de gestão e questões relacionadas às mudanças no processo de trabalho, com a diminuição de visitas domiciliares e o aumento da população atendida. Os dados da pesquisa indicam o cenário complexo que a atenção básica está se desenvolvendo no país. Revela-se particularidades na implementação da ESF que extrapolam uma noção única, visto que cada município tem uma singularidade na sua implantação. Sugerem-se mais estudos, considerando o nível local, a fim de captar as particularidades e o desenvolvimento da atenção básica nos diferentes municípios do país. Assim como, mais estudos sobre o acompanhamento dos modelos alternativos e sua relação com os processos de trabalho. Esta pesquisa pretende contribuir também com a memória da Atenção Básica de Niterói
This thesis discusses the structure of Niterói‘s basic health care, focusing on the transition from the Niterói`s Family Doctor Program (FDP) to the Family Health Strategy (FHS). The FDP was established in 1992 in the city and has its own characteristics, related to its attention level in the local scope. The FHS, which was deployed in this configuration since 2006, has as one of its main the objectives the Basic Health Care structuration in the country. The study aimed to investigate what the social stakeholders (health and management professionals) think about the transition from FDP to FHS. The data analysis takes place through the reading and discussion of the final reports of the Municipal Health Conference (CMS); on the 7ªCMS observation and on interviews with professionals and health managers. There were three categories established for data analysis that emerged with the field data. The results indicated that the city is in transition for FHS implementation. Characteristics have been identified from FDP and FHS. In the assistance model category, changes have been identified: the increase in registered population, the increase of the coverage, increased staff, reduction in field activities and concomitant models (the hegemonic and the alternative with the FDP and the FHS). In the population's participation category, the field data indicate that there has been a decrease in participation and a lack of consensus in relation to the co-management. In the work process category, questions were identified about the hiring process, linked to the management model and issues related to changes in the labor process, with a decrease on home visits and increased population served. The survey data indicate aspects of how this level of care is developing in this country. It revealed particularities on the FHS implementation that goes beyond a single notion, since each municipality has a singularity on the model implementation. It is suggested further studies considering the local level in order to capture the characteristics and the development of basic health care in the different municipalities of the country. As well as more studies on the monitoring of alternative models and its relation to the work processes. This study also aims to contribute to the memory of Niterói`s Basic Health Care

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