Suchergebnisse

Raportissa tarkastellaan sotilaallisen t&k-panostuksen ja kilpailukyvyn välisiä yhteyksiä. Aineistona käytetään brittiläisen International Institute for Strategic Studies -laitoksen (IISS) "The Military Balance" -raportin tietoja länsimaiden sotilaallisen t&kpanostuksen kehityksestä. Julkisen vallan sotilaallisia t&k-panostuksia verrataan maiden julkisiin siviilipuolen t&k-menoihin, sotilaallisiin hankintamenoihin, sekä suhteessa maiden BKT:hen ja puolustusbudjetteihin. Raportissa on mukana myös tiivis katsaus sotilaallisen t&k-panostuksen ja tuottavuuden välistä yhteyttä kuvaavista kansainvälisistä tutkimuksista. Raportin tulosten mukaan sotilaallisella t&k-panostuksella ja kilpailukyvyllä ei ole suoraa yhteyttä. ; This study discusses the relationship between military R&D and competitiveness. The study is based mainly on a British International Institute for Strategic Studies -institutes publication "The Military Balance", and furthermore its information about the development of Western countrye´s military R&D-stakes for the years 1994 -2001. Government military R&D is compared for government R&D, defence expenditure and also to the countries gross domestic product and defence budgets. The study also includes tight review about the previous international studies, which are focused to study the relationship between military R&D and productiveness. The study concludes, that there are no direct connection between military R&D and competitiveness.

Konstantinos Katsoudas, "A Dictatorship that is not a Dictatorship". Spanish Nationalists and the 4th of August The Spanish Civil War convulsed the international public opinion and prompted most foreign governments to take measures or even intervene in the conflict. Greek entanglement either in the form of smuggling war materiel or the participation of Greek volunteers in the International Brigades has already been investigated. However, little is known about a second dimension of this internationalization of the war: the peculiar forms that the antagonism between the two belligerent camps in foreign countries took. This paper, based mainly on Spanish archival sources, discusses some aspects of the activity developed in Greece by Franco's nationalists and the way Francoist diplomats and emissaries perceived the nature of an apparently similar regime, such as the dictatorship led by general Metaxas. The main objectives of the Francoist foreign policy were to avoid any escalation of the Spanish civil war into a world conflict, to secure international assistance for the right-wing forces and to undermine the legitimacy of the legal Republican government. In Greece, an informal diplomatic civil war broke out since Francoists occupied the Spanish Legation in Athens and Republicans took over the Consulate in Thessaloniki. The Francoists combined public and undercover activity: they worked hard to achieve an official recognition of their Estado Nuevo, while at the same time created rings of espionage and channels of anticommunist propaganda. The reason of their partial breakthroughs was that, contrary to their Republican enemies, the Nationalists enjoyed support by a significant part of the Greek political world, which was ideologically identified with their struggle. Francoist anti-communism had some interesting implications for Greek politics. An important issue was the Francoist effort to reveal a supposed Moscow-based conspiracy against Spain and Greece, both considered as hotbeds of revolution in the Mediterranean, in order to justify both Franco's extermination campaign and Metaxas' coup. Although this effort was based on fraudulent documents, forged by an anti-Bolshevik international organization, it became the cornerstone of Francoist and Metaxist propaganda. General Metaxas was the only European dictator to invoke the Spanish Civil War as a raison d'etre of his regime and often warned against the repetition of Spanish-like drama on Greek soil. Nevertheless he did not approve of Franco's methods and preferred Dr. Salazar's Portugal as an institutional model closer to his vision. For Spanish nationalist observers this was a sign of weakness. They interpreted events in Greece through the disfiguring mirror of their own historic experience: thus, although they never called in question Metaxas' authoritarian motives, the 4th of August regime was considered too mild and soft compared to Francoism (whose combativeness and fanaticism, as they suggested, the Greek General should have imitated); it reminded them the dictatorship founded in Spain by General Primo de Rivera in 1920s, whose inadequacy paved the way for the advent of the Republic and the emergence of sociopolitical radicalism. Incidents of the following years, as Greece moved towards a civil confrontation, seemed to strengthen their views. ; Konstantinos Katsoudas, "A Dictatorship that is not a Dictatorship". Spanish Nationalists and the 4th of AugustThe Spanish Civil War convulsed the international public opinion and prompted most foreign governments to take measures or even intervene in the conflict. Greek entanglement either in the form of smuggling war materiel or the participation of Greek volunteers in the International Brigades has already been investigated. However, little is known about a second dimension of this internationalization of the war: the peculiar forms that the antagonism between the two belligerent camps in foreign countries took. This paper, based mainly on Spanish archival sources, discusses some aspects of the activity developed in Greece by Franco's nationalists and the way Francoist diplomats and emissaries perceived the nature of an apparently similar regime, such as the dictatorship led by general Metaxas. The main objectives of the Francoist foreign policy were to avoid any escalation of the Spanish civil war into a world conflict, to secure international assistance for the right-wing forces and to undermine the legitimacy of the legal Republican government. In Greece, an informal diplomatic civil war broke out since Francoists occupied the Spanish Legation in Athens and Republicans took over the Consulate in Thessaloniki. The Francoists combined public and undercover activity: they worked hard to achieve an official recognition of their Estado Nuevo, while at the same time created rings of espionage and channels of anticommunist propaganda. The reason of their partial breakthroughs was that, contrary to their Republican enemies, the Nationalists enjoyed support by a significant part of the Greek political world, which was ideologically identified with their struggle. Francoist anti-communism had some interesting implications for Greek politics. An important issue was the Francoist effort to reveal a supposed Moscow-based conspiracy against Spain and Greece, both considered as hotbeds of revolution in the Mediterranean, in order to justify both Franco's extermination campaign and Metaxas' coup. Although this effort was based on fraudulent documents, forged by an anti-Bolshevik international organization, it became the cornerstone of Francoist and Metaxist propaganda. General Metaxas was the only European dictator to invoke the Spanish Civil War as a raison d'etre of his regime and often warned against the repetition of Spanish-like drama on Greek soil. Nevertheless he did not approve of Franco's methods and preferred Dr. Salazar's Portugal as an institutional model closer to his vision. For Spanish nationalist observers this was a sign of weakness. They interpreted events in Greece through the disfiguring mirror of their own historic experience: thus, although they never called in question Metaxas' authoritarian motives, the 4th of August regime was considered too mild and soft compared to Francoism (whose combativeness and fanaticism, as they suggested, the Greek General should have imitated); it reminded them the dictatorship founded in Spain by General Primo de Rivera in 1920s, whose inadequacy paved the way for the advent of the Republic and the emergence of sociopolitical radicalism. Incidents of the following years, as Greece moved towards a civil confrontation, seemed to strengthen their views.

Δεν παρατίθεται περίληψη στα ελληνικά. ; Anna Mahera, Émigration et développement économique dans la Grèce d'après guerre. L'approche du problème par le milieu politique de Centre-gauche Dans les premières années de l'après guerre, en Grèce se pose de nouveau le problème du mode de développement économique. En effet, la perspective de l'arrivée massive des capitaux américains en combinaison avec la disponibilité d'une main-d'oeuvre autochtone créent des conditions favorables à un projet d'industrialisation. C'est au sein des milieux politiques grecques qu'un tel projet est élaboré, alors que les instances internationales —comme le Food and Agriculture Organisation des Nations Unies— signalent les graves difficultés à surmonter. Progressivement, dans le climat de la guerre froide des années 1950, la quasi-totalité des forces politiques grecques ont abandonné l'idée d'un développement industriel, admettant la position subalterne occupée par le pays dans la division internationale du travail. Celui-ci doit se contenter au rôle de fournisseur de main-d'oeuvre vers les pays européens, en particulier vers l'Allemagne, en phase de reconstruction économique, à travers Γ émigration du travail qui prend une grande ampleur dans les années 1950 et 1960. Tout au plus, la Grèce peut-elle envisager le développement du secteur des services. Contrairement aux autres forces politiques, le Centre-gauche a parcouru ce chemin avec une décennie de retard, en raison de la présence en son sein d'une réflexion économique affirmée, émanant d'économistes de haut niveau, orientés vers l'économie de la planification, et peut-être aussi à cause de l'éloignement de ce milieu du jeu politique immédiat. Le rangement du Centre-gauche à la politique officielle d'émigration intereuropéenne a marqué la fin d'une période de fermentation sur le projet d'industrialisation de la Grèce dont l'origine remonte à l'entre-deux-guerres.

This paper is an analysis of the foreign Aid Policies of two OECD Development Assistance Committee member countries – Finland and Ireland. The analysis reveals that both Finland and Ireland share high principles on their relations with the developing world, although their current policy outlooks appear to differ significantly. Despite Finland's good economic performance and prosperity largely generated by the global demand and market access, the government has so far failed to include the increasing of ODA on its priority agenda. In addition to the declining commitment, the selection criteria for Finnish aid recipients appears to be partially commercially motivated. Ireland on the other hand has a solid record of targeting the poorest of the poor with its development assistance and has recently increased development country focus in national policies. The challenge for Ireland is the effective utilisation of these funds and even more importantly keeping the government's public, international commitment to the 0,7 percent recommendation level despite the possible future slowdown of the economy.

Lambros Flitouris, The Suez Crisis and the Greek-French Relations The Suez crisis in 1956 constitutes an important point in the development of the international relations at the period of the cold war. 1956 is a landmark year for the appointment of the Arabic nationalism as a basic constitutive element of the anti-colonialist wave that convulsed the world. During this period, the relations of Greece with the states involved in the crisis were to a large extent precarious. The anti-imperialists tones of Nasser found impression in the Greek common opinion that was exceptionally irritated from the EOKA's fight in Cyprus. In the present article we examine one particular aspect of the crisis: the relations of Greece with France. The agreements of economic collaboration that was achieved by Markezinis in 1953 signalled a new era in the activation of French capital in Greece. In combination with the big cultural tradition that Prance had in the country but also with the crisis in the relations of Greece with the UK because of the Cypriot question, the French factor in Greece acquired a great importance. However, the French diplomacy followed the policy of London and because of this the relations between Greece and France faced their more important post-war crisis. The Greek common opinion also turned against France, while the French diplomacy lost a great opportunity to strengthen her place in Greece. In the sector of economic relations and cultural exchanges befell a period of algidity with extensions in the Greek internal political life. The crisis of the period 1956-1958 constituted a negative parenthesis in the traditionally good relations between Athens and Paris, while it could be characterized as an adjacent negative result of the anti-colonial struggle and the Cypriot affair. ; Lambros Flitouris, The Suez Crisis and the Greek-French RelationsThe Suez crisis in 1956 constitutes an important point in the development of the international relations at the period of the cold war. 1956 is a landmark year for the appointment of the Arabic nationalism as a basic constitutive element of the anti-colonialist wave that convulsed the world. During this period, the relations of Greece with the states involved in the crisis were to a large extent precarious. The anti-imperialists tones of Nasser found impression in the Greek common opinion that was exceptionally irritated from the EOKA's fight in Cyprus. In the present article we examine one particular aspect of the crisis: the relations of Greece with France. The agreements of economic collaboration that was achieved by Markezinis in 1953 signalled a new era in the activation of French capital in Greece. In combination with the big cultural tradition that Prance had in the country but also with the crisis in the relations of Greece with the UK because of the Cypriot question, the French factor in Greece acquired a great importance. However, the French diplomacy followed the policy of London and because of this the relations between Greece and France faced their more important post-war crisis. The Greek common opinion also turned against France, while the French diplomacy lost a great opportunity to strengthen her place in Greece. In the sector of economic relations and cultural exchanges befell a period of algidity with extensions in the Greek internal political life. The crisis of the period 1956-1958 constituted a negative parenthesis in the traditionally good relations between Athens and Paris, while it could be characterized as an adjacent negative result of the anti-colonial struggle and the Cypriot affair.

Δεν παρατίθεται περίληψη στα ελληνικά. ; Juan Suriano, Cultural practices and politics of the argentine anarchism The writer attempts to establish the basic characteristics of the argentine anarchism, analyze its cultural dimensions and show the limits of its strategies. The basic concepts of the anarchism in Argentina were developed during the years 1870-1920, within a constantly changing and cosmopolitan social environment, since it was in that period that the country became part of the international market place. The anarchists' discourse, being flexible and out of rigid structures, based on the principles of class heterodoxy, individualism and universality, as well as on the spontaneous action, achieved to interpret, during the years 1890-1910, not only the demands of the working class, but also the discontent and frustration of the lower classes and oppressed social groups, in general. The anarchists undertook the mission to «illuminate» and educate morally the working class, through the doctrinaire press and a network of a considerable number of circles, clubs and alternative schools, which offered not only economic help but also education and entertainment to the workers and their families. On the other hand, the constant rejection, by the anarchists, of the concepts of citizenship, representation and political participation had a negative effect on the popularity of the movement: because of the new political situation during the 1910s —in 1912 all men obtained the right to vote—, the working class changed its attitude towards the electoral process and got interested in the social measures taken by the radical governments of the period; as a result, the anarchism faced serious difficulties to attract the interest of the lower classes.

Δεν παρατίθεται περίληψη στα ελληνικά. ; Maria Papathanassiou, Illegitimate Children and Foster Children in the Eastern Alps: Research Directions and Perspectives This article deals with the history of illegitimate and foster children (usually also illegitimate) in the region of Eastern Alps (Austria) between the mid-18th and the early 20th centuries. During that period these childrens' number, though not stable, remained considerably high in absolute and relative terms. The paper discerns three basic trends in literature on the subject and comments on their results: a) Studies related to an international historical debate on bastardy in Europe and trying to explain impressive statistical data by pointing to social and economic factors, such as the domination of animal husbandry, the system of inheritance, the family system, labour organization and the so-called «agricultural revolution» in Europe. b) Studies on legislation, on official politics regarding single mothers and illegitimate or foster children, as well as studies on public institutions taking care of illegitimate children and their mothers from the second half of the 18th century on. Austrian law did not provide clearly for illegitimate children until the civil code was enacted in 1811 and only in 1919 a new law came into being regarding illegitimate and foster children together. c) Studies in a «history from below» direction, regarding people and their experiences but clearly not dominating the field in terms of numbers as well as analytical breadth. This essay suggests a more systematic approach in this last direction, particularly by comparing social groups, for example illegitimate children with peasant children, illegitimate children in rural with illegitimate children in urban environments, illegitimate foster children with other foster children in rural Austria, single mothers born and grown up as illegitimate children themselves with single mothers born and grown up as peasant daughters etc.

Athena Syriatou, Duty and Instinct: History in Schools in Post-war Britain 1945-1995 This article deals with the moral role of history in post-war British education, by examining the relationship between the expectations of educationalists and intellectuals from history teaching at schools, and the actual changes which did occur in the classroom on the subject of history as a result of general changes in society and education. It argues that despite the intentions of the educationalists who saw history teaching as a means of promoting ideas which were considered necessary for the moral upbringing of the nation, these ideas very often never reached the classroom or they were considerably altered, demonstrating different ideological dynamics in British society. It initially focuses on the immediate post-war decade when international is educationalists were arguing for the need of history teaching which leads to a world citizenship. The idea of an internationalist approach on history contradicted the conservative, Britocentric, Whiggish history which was finally taught at schools during that period, since there were very few new books published, while civil servants from the Ministry of Education were concerned with the more urgent problems of schools which were affected by enemy action rather than new views on history teaching. The second period which is examined is the decade of mid sixties until mid seventies. Great changes were initiated then, to cover the disparity between the two tier system of education, with the introduction of comprehensive secondary schools, which at the time were considered to contribute to further démocratisation of the welfare state. The spirit of a more tolerant, affluent and democratic society led some educationalists to propose the expulsion of history from schools and its replacement with other humanities such as sociology and behavioural studies. However, history did remain at schools during that period and in many ways it incorporated the new ideas, creating the so called 'new history' with the efforts of the progressive, non traditionalist, and often leftist historians. Problems of implementation of the new history' appeared during the following years as a result of the difference of academic standards at schools which at this period comprehensive education could not eliminate. The final period which is examined is the decade of mid eighties until mid nineties when the New Right ideology was dominant in the political scene, while a National Curriculum for all schools was deemed necessary. Educational planners of the Conservative Party argued that history should teach again traditional values, which were, according to them, intrinsic to the British nation. However, the National Curriculum for History which was drafted by educationalists coming various convictions,(nevertheless appointed by the Conservative government), was closer to the beliefs of the new history' creators, rather than the beliefs and national values that the Conservatives initially wanted to promote. ; Athena Syriatou, Duty and Instinct: History in Schools in Post-war Britain 1945-1995 This article deals with the moral role of history in post-war British education, by examining the relationship between the expectations of educationalists and intellectuals from history teaching at schools, and the actual changes which did occur in the classroom on the subject of history as a result of general changes in society and education. It argues that despite the intentions of the educationalists who saw history teaching as a means of promoting ideas which were considered necessary for the moral upbringing of the nation, these ideas very often never reached the classroom or they were considerably altered, demonstrating different ideological dynamics in British society. It initially focuses on the immediate post-war decade when international is educationalists were arguing for the need of history teaching which leads to a world citizenship. The idea of an internationalist approach on history contradicted the conservative, Britocentric, Whiggish history which was finally taught at schools during that period, since there were very few new books published, while civil servants from the Ministry of Education were concerned with the more urgent problems of schools which were affected by enemy action rather than new views on history teaching. The second period which is examined is the decade of mid sixties until mid seventies. Great changes were initiated then, to cover the disparity between the two tier system of education, with the introduction of comprehensive secondary schools, which at the time were considered to contribute to further démocratisation of the welfare state. The spirit of a more tolerant, affluent and democratic society led some educationalists to propose the expulsion of history from schools and its replacement with other humanities such as sociology and behavioural studies. However, history did remain at schools during that period and in many ways it incorporated the new ideas, creating the so called 'new history' with the efforts of the progressive, non traditionalist, and often leftist historians. Problems of implementation of the new history' appeared during the following years as a result of the difference of academic standards at schools which at this period comprehensive education could not eliminate. The final period which is examined is the decade of mid eighties until mid nineties when the New Right ideology was dominant in the political scene, while a National Curriculum for all schools was deemed necessary. Educational planners of the Conservative Party argued that history should teach again traditional values, which were, according to them, intrinsic to the British nation. However, the National Curriculum for History which was drafted by educationalists coming various convictions,(nevertheless appointed by the Conservative government), was closer to the beliefs of the new history' creators, rather than the beliefs and national values that the Conservatives initially wanted to promote.

VTT Symposium 191 ; Energian ja ympäristön leikkauskohdassa on viime vuosina tapahtunut suuria mullistuksia. Energiamarkkinat ovat vapautuneet ja osana kestävään kehitykseen pyrkimystä ekologinen ajattelu on saanut jalansijaa myös perinteisessä markkinataloudessa, tyyppiesimerkkinä vihreän sähkön käsite ja kierrätys. Ympäristöproblematiikassa on siirrytty megasarjaan, esimerkiksi ilmastokysymyksessä eletään suurten päätösten aikaa. Energia- ja ympäristöteknologian myynnissä myyjältä vaaditaan yhä enemmän osaamista. Tuotteiden käytön pitkäaikaiset ympäristöominaisuudet vaikuttavat ratkaisevasti kaupan syntyyn. Perinteisen kovan teknologian rinnalle tarvitaan uutta innovatiivista pehmoteknologiaa. SIHTI-ohjelma on paneutunut näihin kysymyksiin niin sanotuilla strategisilla selvityksillään. Ympäristönsuojelun ohjaukseen tarvittavaa tietoutta on luotu lukuisissa ympäristövaikutusten arvottamiseen liittyvissä hankkeissa sekä talouden ja ympäristönsuojelun optimia hakevissa selvityksissä. Yritystasolla tehtävää ympäristölaskentaa varten on luotu uusia työkaluja ja menetelmiä ja päästöpörssien monulotteisia vaiktuksia on analysoitu. Poliittisen päätöksenteon tueksi on kehitetty kasvihuonekaasujen kehitystä kuvaavia indikaattoreita ja analysoitu vaihtoehtoisten päästörajoitustekniikoiden kustannuksia ja tehokkuutta. SIHTI-ohjelmassa savukaasujen puhdistustekniikka-alueelle on syntynyt oma vahva tutkimuskokonaisuutensa, jonka ympärille on kehittynyt kansainvälisestikin arvostettuja tutkimusryhmiä. Pienhiukkasten tärkeimpiä päästölähteitä on kartoitettu, koostumuksia ja kokojakaumia mitattu ja erilaisia keinoja vaikuttaa pesureitten ja sähkösuodattimien erotustehokkuuteen tutkittu. Tutkimusryppääseen on kuulunut sekä teoreettisia mallinnuslaskelmia, laboratoriomitan laiteteknistä kehitystyötä että täyden mitan koetoimintaa. Osoituksena onnistuneesta panostuksesta on, että tutkimustuloksia on jo voitu hyödyntää kaupallisesti ja täyden mittakaavan laitetoimituksia ulkomaille on jo toteutettu. Uusia innovatiivisia teknisiä ratkaisuja ympäristöpäästöjen mittaamisella on myös kehitetty. Metsäteollisuuden ympäristövaikutusten hallinnan parantamiseksi on ohjelman puitteissa perusteellisesti mitattu ja mallinnettu haitallisten aineiden kulkeutumista eri virroissa ja prosessiyksiköissä sekä tutkittu ja kehitetty uusia säästävän teknologian ratkaisuja mm. sellutehtaan vesikiertojen sulkemiselle, viherlipeäsakan ja tuhkan hyödyntämiselle sekä siistauslietteen ja jätepaperin poltosta syntyvän tuhkan kierrättämiselle. Turvetuotannon valumavesien sekä pöly- ja melupäästöjen paremmalle hallinnalle on kehitetty uusia menetelmiä ja ohjeita, joita on jo otettu käyttöön. Vaihtoehtoisia ratkaisuja käytettyjen turvetuotantoalueiden jälkikäytölle on niin ikään tutkittu. Poikkitieteellisen lähestymistavan takia SIHTI-ohjelma on pyrkinyt tiedottamaan tutkimustuloksistaan mahdollisimman laajasti. Ohjelman vuosiseminaari ja sen yhteydessä pidettävät istunnot energiantuotannon päästöjen ympäristövaikutuksista, pienhiukkasten erottamisesta ja kiinteiden jätteiden hyötykäytöstä suovat oivallisen tilaisuuden niin esitelmänpitäjille kuin kuulijoillekin antaa oman panoksensa meitä kaikkia hyvin läheisesti askarruttavaan kysymykseen, mikä on oikea tie ja etenemistapa kestävään energiantuotantoon. ; Great revolutions have taken place in the intersection of energy and environment in recent years. The energy market has been liberated, and in part of sustainable development, an ecological pattern of thought has gained a footing in traditional market economy, typical examples being green electricity and recycling. As regards environmental problems, we have moved towards a mega-league; for example, we are living an era of great resolutions on environmental issues. More diversified knowhow is required from the sellers of energy and environmental technology. Long-term environmental impacts of the use of products are of decisive significance in business transactions. New innovative soft-line technology is required in addition to conventional hard technology. The Finnish National SIHTI Programme has attended to these issues via so-called strategic surveys. Knowledge required for the control of environmental protection was created in a number of projects on evaluation of environmental impacts and in assessments searching an optimum for economy and environmental protection. New tools and methods were developed for environmental accounting in enterprises, and diversified impacts of emission exchange were analysed. Indicators describing the development of greenhouse gases were developed and costs and efficiency of alternative technologies for limiting emissions were analysed to support political decision-making. In the SIHTI Programme, a strong research integrity was formed in the field of flue gas cleaning technology, and research groups with a high international esteem were also formed. Most significant emission sources of particulates were surveyed, their composition and particle size distributions were measured, and different tools of improving the separation capacity of scrubbers and electrical precipitators were studied. This research integrity included both theoretical modelling calculations, laboratory-scale equipment-technical development and full-scale testing. An indicator of successful focusing is that research results have already been utilised commercially, and industrial-scale equipment commissions have been executed. New innovative technical solutions for measuring emissions to the environment have also been developed. To improve the control of environmental impacts of the pulp and paper industry, the transportation of detrimental substances in different flows and process units were measured and modelled, and new solutions of non-waste technology were developed for closed water cycles in pulp mills, for the use of green liquor sludge and ash and for the recovery of ash from the combustion of deinking sludge and waste paper. In peat production, new methods and instructions were developed and introduced for the control of drainage waters and for dust emissions and noise problems. After-use alternatives for exhausted peat production fields were also studied. Due to the interdisciplinary approach, the SIHTI Programme has disseminated information about research results as widely as possible. The Annual Seminars of the Programme, and sessions on environmental impacts of emissions from energy production, separation of particulates, and utilisation of solid wastes have offered excellent opportunities to the lecturers and to the audience to bring their own contribution to the issue occupying our mind: what would be the right way of approaching sustainable energy production.

Pro gradu ­tutkielma koostuu seuraavista osista: Rouvinen, Kaisa. Lisääntymisterveydenhuollon haasteet ja naisten hyvinvointi vähiten kehittyneissä maissa. Tampereen yliopisto. Terveystieteen laitos. Kirjallisuuskatsaus. Osasuoritus Pro gradu ­tutkielmaan. 26 s. 2003 Rouvinen, Kaisa. Quality of care in reproductive health services at health posts in Nepal. International EuroQuan Conference on Quality and Nursing Practice. Proceedings. Norsk sykepleieforbund. 1997; 224-231. Rouvinen, Kaisa. Quality of care in reproductive health services at five government health posts in Siraha District, Eastern Nepal. A dissertation submitted to the University of Liverpool (School of Tropical Medicine) in partial fulfilment of the degree of Master in Community Health. 95 pages. 1996 ; 1. JOHDANTO 6 2. LISÄÄNTYMISTERVEYS KEHITYKSEN INDIKAATTORINA 7 3. NAISEN ELÄMÄN TÄRKEÄT JA KRIITTISET VAIHEET 10 3.1. RASKAUS JA SYNNYTYS - TURVALLISEN ÄITIYDEN TAVOITE 10 3.2. PERHESUUNNITTELU JA ABORTTI 15 3.3. HIV JA MUUT SUKUPUOLITAUDIT 17 3.4. LAPSETTOMUUS JA LAPSEN SUKUPUOLI 19 3.5. SUKUPUOLIELINTEN TRADITIONAALINEN SILPOMINEN 20 3.6. KÖYHYYDEN, TRADITIOIDEN JA OLOSUHTEIDEN MERKITYS 22 4. HAASTEET JA MAHDOLLISUUDET 23 LÄHTEET 26 QUALITY OF CARE IN REPRODUCTIVE HEALTH SERVICES AT FIVE GOVERNMENT HEALTH POSTS IN SIRAHA DISTRICT, EASTERN NEPAL ACKNOWLEDGEMENTS 1 TABLE OF CONTENTS III LIST OF TABLES VI LIST OF FIGURES VII LIST OF ABBREVATIONS AND ACRONYMS VIII GLOSSARY IX EXECUTIVE SUMMARY X CHAPTER 1. INTRODUCTION 1 1.1. THE CLIENT AND THE CONCERN 1 1.1.1. Save the Children US in Nepal 1 1.1.2. Save the Children Siraha project 1 1.1.3. Problem statement 2 1.2. THE STUDY 2 1.2.1. Study question 2 1.2.2. Aim and objectives of the study 2 1.2.1. Action plan and accomplishment of the study 3 1.3. STUDY LOCATION 4 1.3.1. Nepal 4 1.3.2. Siraha District 4 CHAPTER 2. LITERATURE REVIEW 6 2.1. GLOBAL VIEWS OF WOMEN'S HEALTH 6 2.2. PRIMARY HEALTH CARE IN NEPAL 8 2.2.1. Safe Motherhood and Family Planning 8 2.3. QUALITY IN HEALTH CARE 10 2.3.1. What is quality? 10 2.3.2. Approaches to assessment of quality in health care 10 2.4. SELECTED ISSUES IN QUALITY OF HEALTH CARE 14 2.4.1. The structure of the health care and its relevance in quality assessment 14 2.4.2. Health care providers' job motivation and its impact on quality of health care 15 2.4.3. User satisfaction 16 2.5. CONCLUSION 17 CHAPTER 3. METHODOLOGY 19 3.1. EVALUATION OF HEALTH POST FACILITIES AND SERVICE ARRANGEMENTS 20 3.1.1. Study location 20 3.1.2. Selection of health posts 20 3.1.3. Issues and variables used to explore the objective 20 3.1.4. Tools and strategies of data collection 20 3.2. EXPLORING HEALTH CARE PROVIDERS' PERCEPTIONS ABOUT THE QUALITY OF CARE 21 3.2.1. Study population 21 3.2.2. Selection of informants 21 3.2.3. Issues and variables used to explore the objective 21 3.2.4. Tools and strategies of data collection 21 3.3. DESCRIBING THE LEVEL OF USERS' SATISFACTION 22 3.3.1. Study population 22 3.3.2. Selection of informants 22 3.3.3. Issues and variables used to explore the objective 22 3.3.4. Tools and strategies of data collection 23 3.4 ADDITIONAL DATA COLLECTION METHODS 24 3.5. PRE-TESTING AND TRANSLATION 24 3.6. DATA HANDLING AND STORAGE 25 3.7. DATA ANALYSIS 25 3.8. QUALITY ASSURANCE AND ENCOUNTERED CONSTRAINTS IN DATA COLLECTION 25 CHAPTER 4. RESULTS 27 4.1. EVALUATION OF HEALTH POST FACILITIES AND SERVICE ARRANGEMENTS 27 4.1.1. Location and accessibility 27 4.1.2. Target population and service statistics 27 4.1.3. Sub-health posts, outreach clinics and staffing 28 4.2.4. Waiting facilities at health posts 28 4.1.5. Rooms for counselling and MCH and FP services 28 4.1.6. Infection prevention 29 4.1.7. Equipment and instruments for use in MCH and FP 29 4.1.8. Availability of contraceptives and essential medicines 29 4.1.9. IEC material and activities 29 4.1.10. Record keeping and reporting 30 4.1.11. Health post management and supervision 30 4.1.12. Conclusion 30 4.2. HEALTH CARE PROVIDERS' PERCEPTION ABOUT THE QUALITY OF CARE 31 4.2.1. Job satisfaction and experience as a health care provider 31 4.2.2. Health workers' perception of what is good quality in health care 32 4.2.3. Health workers' perception about users' expectations 33 4.2.4. Health workers' suggestions for improvement of health care 33 4.2.5. What are the specific reasons for low utilisation of FP and AN services 34 4.2.6. Conclusion 35 4.3. QUALITY OF CARE FROM THE USERS' POINT OF VIEW 35 4.3.1. The sample 35 4.3.2. Perceptions of the quality of care 37 4.3.3. Suggestions for improvement for the quality of care at a health post 40 4.3.4. Conclusion 40 4.4. SUMMARY OF RESULTS 41 CHAPTER 5. DISCUSSION 43 5.1. IMPACTS OF STRUCTURE OF HEALTH CARE ON QUALITY OF THE SERVICE 43 5.1.1. Accessibility 43 5.1.2. Clinical settings and procedures 44 5.1.3. Service arrangements 44 5.2. HEALTH WORKERS' ROLE 47 5.2.1. Users' expectations contradicting providers' perceptions 47 5.2.2. Implications of health workers' perceptions for improvement of quality 48 5.2.3. Job motivation 48 5.2.4. Quality assurance cycle 50 5.3. CONCLUSIONS 50 5.4. COMMENTS ON METHODS USED IN THE STUDY 51 CHAPTER 6. RECOMMENDATIONS 53 REFERENCES 54 APPENDICES APPENDIX 1 PHOTPGRAPHS: WALL PAINTINGS AND TBA TRAINING 58 APPENDIX 2 MAPS OF NEPAL AND SIRAHA DISTRICT 59 APPENDIX 3 INVENTORY FORM FOR HEALTH POST FACILITIES 60 APPENDIX 4. BACKGROUND VARIABLES 70 APPENDIX 5.A STRUCTURED QUESTIONNAIRE FOR USER EXIT INTERVIEW 71 APPENDIX 5.B MAITHALI TRANSLATION OF THE QUESTIONNAIRE 75 APPENDIX 6 EVALUATION OF HEALTH POST FACILITIES AND SERVICE ARRANGEMENTS 79 APPENDIX 7. FINDINGS FROM HEALTH PERSONNEL IN-DEPTH INTERVIEWS 84 APPENDIX 8. USERS' EXPRESSIONS OF THE QUALITY OF CARE. QUOTATIONS. 85