Suchergebnisse

Het systematisch literatuuroverzicht (systematic review) heeft de laatste jaren enorm aan impact gewonnen in het evidence-based discours en wordt beschouwd als een belangrijke informatiebron ter ondersteuning van besliskunde op praktijk en politiek niveau. Een systematisch literatuuroverzicht brengt resultaten van diverse individuele studies samen om betrouwbare antwoorden te genereren op welbepaalde vragen en wordt gepromoot door internationale non-profitorganisaties, zoals de Cochrane Collaboration en de Campbell Collaboration.
Auteurs van systematische literatuuroverzichten (reviewers) streven een systematische identificatie, evaluatie en synthese na van alle relevante studies rond een bepaald onderwerp, gebaseerd op een expliciete en voorgedefinieerde methodologie. Hierbij wordt uitgegaan van een te beantwoorden vraag, een welgedefinieerde zoekstrategie, in- en exclusiecriteria voor studies, een kwaliteitsbeoordeling van de geselecteerde studies, en de extractie van resultaten uit die individuele studies, wat resulteert in een synthese. Momenteel is de vraag naar de evaluatie van de effectiviteit van medische, therapeutische, educatieve, sociale of criminologische interventies dominant in deze literatuuroverzichten. Hiervoor worden de resultaten uit studies – bij voorkeur gerandomiseerde, gecontroleerde experimenten – samengebracht door middel van een meta-analyse, een statistische techniek waarmee een gepoold resultaat verkregen wordt dat zich uitspreekt in het voor- of nadeel van een bepaalde interventie. Er is echter een groeiende belangstelling voor en erkenning van de waarde van inzichten uit kwalitatief onderzoek. Die inzichten kunnen immers helpen om de resultaten uit syntheses van kwantitatief onderzoek beter te situeren, om de vraagstelling mee te informeren en om een aantal vragen te beantwoorden die moeilijk door kwantitatief onderzoek kunnen worden beantwoord. Voorbeelden van dergelijke vragen zijn: Hoe moeten we interventies implementeren in een bepaalde context? Hoe kan een interventie verbeterd worden? Sluit de interventie aan bij de subjectieve noden van de doelgroep? Hoe wordt de interventie ervaren door diegenen die ze moeten uitvoeren of ondergaan? Die interesse heeft ertoe geleid dat meerdere onderzoekers zich zijn gaan buigen over de vraag hoe die kwalitatief georiënteerde inzichten op een methodologisch verantwoorde manier kunnen worden samengevat. Uiteraard hoeven syntheses van kwalitatief onderzoek niet aan te sluiten bij een systematisch literatuuroverzicht. Er zijn ook voorbeelden van syntheses die op zichzelf staan, zonder enige link met een bestaand literatuuroverzicht. De laatste jaren werd er enorm geïnvesteerd in het ontwikkelen van methoden voor het uitvoeren van syntheses van kwalitatief onderzoek (Dixon-Woods, Agarwal, Jones, Young & Sutton, 2005; Barnett-Page & Thomas, 2009). Twee van die methoden brachten een ondersteunend softwarepakket op de markt, EPPI-reviewer en QARI. EPPI-reviewer (Evidence for Policy and Practice Information and Coordinating Centre review software) werd ontwikkeld ter ondersteuning van thematische syntheses (Thomas & Harden, 2008), QARI (Qualitative Assessment and Review Instrument) werd ontwikkeld in de context van meta-aggregatie (Joanna Briggs Institute, 2007). Meta-aggregatie werd reeds toegepast in talloze literatuuroverzichten geproduceerd door het Joanna Briggs Institute, meestal als onderdeel van een mixed-methods-review. QARI is een onderdeel van het Joanna Briggs
SUMARI softwarepakket (System for the unified management, assessment and review of information). SUMARI biedt software aan voor het uitwerken van literatuuroverzichten met betrekking tot vraagstellingen naar de effectiviteit, kosten en baten van interventies (syntheses van kwantitatief onderzoek) alsook naar de haalbaarheid, gepastheid en betekenis van interventies of fenomenen (syntheses van kwalitatief onderzoek). QARI kan enkel gebruikt worden voor het beantwoorden van kwalitatieve onderzoeksvragen. Ik illustreer het softwarepakket QARI aan de hand van een meta-aggregatie rond barrières ten aanzien van de implementatie van evidence-based praktijkvoering in België (Hannes, 2008).

Tutkimuksessa selvitetään, missä määrin työpaikkojen työsuojeluvalvontaa toteutetaan alueellisesti eri tavalla eli toteutuuko valvonta työpaikoilla yhtenäisesti eri puolilla Suomea. Tutkimuksen ennakko-oletuksena on, että merkittävä syy työsuojeluvalvonnan alueelliseen erilaisuuteen on valvonnan organisointi viiden itsenäisen aluehallintoviraston työsuojelun vastuualueen tehtäväksi. Työsuojeluhallintoa ja työsuojeluvalvonnan toteutumisen yhtenäisyyttä työpaikoilla ei ole tutkittu tieteellisesti 2000-luvulla. Tämä tutkimus arvioi työsuojeluhallinnon rakennetta ja valvonnan toteutumista sekä hallinnon että työpaikkojen näkökulmasta. Tutkimus antaa sekä tieteellisesti perusteltuja teoreettisia että hallinnon asiakkaiden näkökulmia työsuojeluhallinnossa käynnissä olevaan valvonnan yhtenäistämiskehitykseen. Tutkimuksen teoreettisena viitekehyksenä on hallinnon evaluaatiotutkimus, joka tarkoittaa hallinnon toimivuuden arviointia käyttäjä- ja asiakasnäkökulmasta. Työsuojeluhallinto toteuttaa työpaikoille kohdistuvaa työsuojeluvalvontaa työsuojelutarkastuksina, jolloin hallinnon asiakkaita ovat työpaikat ja niiden työnantajat ja työntekijät. Pääasiallisena tutkimusaineistona ovat valvontatietojärjestelmä Veran raportit ja niistä tehdyt 27 valvonnan alueellista vertailua sekä henkilöhaastattelut, jotka kohdistuvat 52:een työsuojeluhallinnon, työmarkkinajärjestöjen ja työpaikkojen työsuojeluhenkilöön. Tutkimuksessa on kolme päälukua: työsuojeluhallituksen aika 1973-1993, itsenäisten alueellisten työsuojeluviranomaisten aika vuodesta 1993 lähtien sisältäen työmarkkinajärjestöjen roolin työsuojeluvalvonnassa ja valvonnan alueellinen vertailu. Tutkimusmatkani kohti yhtenäistä työpaikkojen työsuojeluvalvontaa alkoi työsuojeluhallituksesta, joka perustettiin vuonna 1973 osana hyvinvointivaltion rakentamista ja valtiojohtoista suunnitteluoptimismia. Valtiollinen työsuojelu koottiin yhden ministeriön alaisuuteen. Työsuojeluhallituksen aikana oli keskusjohtoinen, ainakin osittain yhtenäinen työsuojeluvalvonta, mutta keskusviraston toiminta ei onnistunut, koska työnantajat vastustivat sitä koko ajan pitäen sen toimintaa konspiratiivisena, vehkeilevänä. Työsuojeluhallitus lakkautettiin vuonna 1993 osana keskusvirastojärjestelmän purkamista 1990-luvun alun taloudellisen laman seurauksena. Valtion harjoittamaa sääntelyä purettiin hallinnon kaikilla sektoreilla, ja hallintoa madallettiin lähemmäksi asiakasta. Valtion merkitystä vähennettiin koko yhteiskunnassa ja hyvinvointivaltiosta tehtiin kilpailuvaltio, jolloin markkinaliberalismi ja New Public Management voimistuivat. Työsuojeluhallituksen lakkautuksessa tehtiin ehkä muutakin politiikkaa; pirstaloimalla valvovaa hallintoa heikennettiin samalla työpaikoille kohdistuvaa keskitettyä valvonnan voimaa. Itsenäisten alueellisten työsuojeluviranomaisten aikana vuodesta 1993 lähtien entisten työsuojelupiirien ja nykyisten aluehallintoviraston työsuojelun vastuualueiden toiminnallinen itsenäisyys korostui. Hallinnon toiminnassa näkyy, ettei työsuojeluvalvonnalla ole yhteistä keskusjohtoa. Sosiaali- ja terveysministeriön työ- ja tasa-arvo-osasto, jonka alaisuuteen työsuojelu keskushallinnossa kuuluu, toteuttaa Kansainvälisen työjärjestön ILO:n (International Labour Organization) sopimusten tulkintaa, että työsuojeluhallinto on riippumaton valvontatehtävää suorittaessaan eikä ministeriö siten puutu valvonnan alueellisiin menettelytapoihin. Tutkimus käsittelee myös työsuojeluhallinnon laajaa yhteistyötä työmarkkinajärjestöjen kanssa. Järjestöt osallistuvat kaikkeen päätöksentekoon, jossa käsitellään hallinnon tavoitteita, painopisteitä, valvontaohjeita ja resursseja. Tutkimuksessa arvioidaan edustuksellisen demokratian näkökulmasta korporatiivisen etujärjestövaikutuksen ja hallinnon suhdetta riippumattoman työsuojeluvalvonnan päätöksenteossa ja toimeenpanossa. Tarkastuskertomuksiin perustuva alueellisen valvonnan vertailu osoittaa, että työsuojeluvalvonta on eriytynyt vastuualueittain. Työpaikkojen kunnossaolo määritellään usein eri tavalla, joten tarkastajien valvoma työturvallisuuden minimitaso ei toteudu yhdenmukaisesti koko maassa. Siten velvoitteita korjata tai poistaa työturvallisuusepäkohtia annetaan eri tavalla ja lopputuloksena on se, ettei työnantajia kohdella tasapuolisesti. Tutkimuksen johtopäätöksenä on, että työsuojeluvalvonta on osa kansallista hallintotoimintaa ja laillisuusvalvontaa, ei alueellista tai paikallista hallintoa. Työsuojelu ei eroa toimialoittain maantieteellisesti, koska eri ammattialojen työ on pääpiirteissään samanlaista koko maassa ja niiden työturvallisuus ei juurikaan eroa maantieteellisesti. Tämän vuoksi myös työsuojeluvalvonnan pitäisi olla yhdenmukaista koko maassa. Suomeen pitäisi perustaa Pohjoismaiden mallin mukainen työsuojelun keskusorganisaatio, joka koordinoisi yhtenäistä laillisuusvalvontaa samalla tavalla kuin Poliisihallitus, Syyttäjälaitos ja uusi Tuomioistuinvirasto koordinoivat toimialojensa laillisuusvalvontaa ja toiminnan menettelytapoja. ; This study examines the extent to which workplace occupational safety and health (OSH) enforcing is carried out differently across the Finnish regions, in other words whether workplace enforcing is uniform across Finland. The presupposition of the study is that an important reason for the regional disparity in labour inspection is the decentralized organization of the inspection to by the five independent divisions of occupational health and safety of the regional state administrative agency. The OSH administration and the uniformity of the implementation of OSH in the workplace have not been scientifically studied in the 21st century. This study assesses the structure and implementation of the OSH administration from the perspective of both the administration and the workplace. The study provides a scientifically justified analysis covering both theoretical and customers' perspectives on OSH management and the ongoing integration of health and safety enforcement. The chosen theoretical approach of the study is the administrative evaluation framework, which means assessing the functionality of administration from the user and customer perspective. The Labour Inspectorate carries out workplace safety inspections in the form of occupational safety inspections, whereby the customers of the administration are the workplaces and their employers and employees. The main research material are OSH inspection database Vera reports and personal interviews carried out with 52 persons in the job protection administration, labour organizations and employment OSH personnel. The study consists of three main empirical chapters: the Labour Protection Board, the Central Office 1973-1993, the independent Regional Labour Inspectorate since 1993, including the role of labour organizations in labour inspection and the regional comparison of labour inspection. Shift towards an integrated job labour inspection started with the Labour Protection Board which was established in 1973 as part of the construction of the welfare state during the era of optimism in state-directed planning State labour protection was brought together under one ministry. The Labour Protection Board the system was center-led, at least regarding uniform occupational health and safety enforcing, but the Board's operations were not successful, mainly because the employers were opposed to it throughout its existence. The Labour Protection Board was abolished in 1993 as part of the dismantling of the central office system that followed the economic recession in the early 1990s. State regulation in all sectors of government was decentralized and administration was brought closer to the customers. The role of the state was diminished in society as a whole and the welfare state became a competitive state, with neoliberalism and New Public Management becoming stronger. Other objectives were also part of the decision to abolish the Labour Protection Board; at the same time, the fragmentation of supervisory authorities weakened the efficiency of workplace control. The era of the independent regional labour inspectorates since 1993 underlines the functional independence of the former OSH Inspectorate and the current division of occupational health and safety of the regional state administrative agency. The operation shows that there is no common central management for labour enforcement. The Department for Work and Gender Equality of the Social and Health Ministry, which is responsible for occupational safety in central administration, interprets International Labour Organization (ILO) conventions as meaning that the labour administration is independent in carrying out its supervisory function. Thus, the Ministry does not interfere with regional control procedures. The study also deals with the extensive co-operation between the labour protection administration and the labour market organizations. Trade unions are involved in all decision-making concerning management objectives, priorities, control guidelines and resources. The study examines the influence of corporatist interest groups and the governance of occupational health and safety enforcing decision-making and implementation from the perspective of representative democracy. A comparison of regional control based on inspection reports shows that OSH control of occupational health and safety has varied between the regional divisions. The condition of workplaces is often defined differently, so the minimum level of occupational safety supervised by inspectors is not uniformly applied throughout the country. Thus, obligations to remedy or eliminate occupational safety deficiencies in workplaces are given different treatment and the result is that employees are not treated equally. The conclusion of the study is that health and safety control should be in the competence of national administration and judicial review, not regional or local administration. Occupational safety and health does not differ geographically by industry, as the work of the various occupations is broadly similar throughout the country and there is little geographical variation in occupational safety. For this reason, labour inspection should also be uniform throughout the country. Finland should set up the Nordic model of a more centralized OSH system, which would coordinate an integrated review of legality in the same way as the National Police Board, the Prosecutor's Office and the Court of Justice co- ordinate the law enforcement and operational procedures of their respective sectors.

The hereafter following is abstract of the discourse held by Prof. dr. ir. C. L. Temminck Groll in honour of the jubilee 1899-1989 of the KNOB on September 23th 1989. The KNOB (Royal Antiquarian Society of the Netherlands) exists 90 years. A respectable age after human standards. Although a society depends on human devotion it does not know age limitations. This is an excellent moment to reflect upon our centenary. Then, in 1999, we will have to present an extremely good manifest for the coming millennium! We have been spoiled very much during the past 90 years. Which of the founders would have expected so many people professionally involved at the protection of monuments? Which of them could have estimated the money available to realize restoration activities? Still, despite of all we obtained, we are rightly concerned about our country and especially that part of the world beyond our borders. These concerns are formulated by the National Geographic Society which hereby stated: 'Can we save this fragile earth?' This society aims at the earth herself as well as at human achievements. Co-operation between the protection of nature and the protection of monuments certainly is sensible and could be one of our future actions. How much nature, how much culture is not already 'dead'! Wren's St. Benet in London f.e. seems saved, but surrounded by flowing thoroughfares the church misses every relation with the original urban structure. Thus in fact the monument has not been saved. At Liège, Belgium, 20th century traffic and concrete buildings overran the medieval Place St. Lambert. And what about the European countryside? How much harmonious farmer's land has not been industrialized yet? Old structures disappear everywhere. Instead of the newly made our Society had to study more and more the continuous changes of the already extant. As to our foreign activities, we can distinguish three angles of incidence. First of all: what can we learn from other countries? Our founder mr. dr. J.C. Overvoorde already realized the importance of study of the way monuments are protected in different European countries. ICOMOS at present is the platform to discuss organizational and substantial aspects. Second: stock-taking of Dutch cultural influences to other regions in Europe, which subject used to attract more attention than it does now. At last: Dutch influences beyond European borders. Like our founder in 1910-11 studied Hindu-Buddhistic antiquaries and the monuments of the Dutch East-Indian Company our Foundation Social History of the Dutch Oversea studies these treasures now. One of her working-groups tries to solve Indonesian problems with respect to the protection of monuments and started stocktaking of especially younger architecture and town-planning. Still, a lot remains to be done on this field in the 'West'! Borders fade. But with the introduction of new fields of work we may not forget the old. Not the older monuments, since we are occupied with the young, not the Dutch, being directed at the whole world. After the question of what we study, the question rises how. Our purpose always was protection. Unlike nature culture cannot renew herself: we have to 'maintain'. And then mankind also is a piece of nature with continuous new desires to which the extant has been adapted. 'Maintain' as well as 'adapt to' means: to change. We can let nature change the made - how beautifully weathered the ruins are! - but we can also preserve the weathering - until now. Replacement of weathered material by new in the shape of colour it used to have is another possibility. Also opinions about this sort of alterations are constantly changing. Thus a platform like the KNOB at national level or ICOMOS at international level will always be needed. That's why: an extremely good manifesto in 10 years. One that states that we are occupied with changing instead of static affairs. Alterations must be directed professionally in a careful and modest way. For the real is infinitely more valuable than the copy.

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

Kunnat ovat suuren muutoksen keskellä. Kuntarakenneuudistus sekä sosiaali- ja terveydenhuollon palvelurakenneuudistus tulevat muuttamaan kuntien hallintoa merkittävästi. Kari Hakarin tutkimus tarkastelee yhden suuren kaupungin hallinnonuudistusta uuden julkisen hallinnan teorian näkökulmasta. Uusi julkinen hallinta on kunnallishallinnon uudistamisen kolmas vaihe, joka on kehittynyt perinteisestä julkishallinnosta ja tätä seuranneesta uudesta julkisjohtamisesta. Tutkimuksen tavoitteena on arvioida, onko uudesta julkisesta hallinnasta kuntien hallinnonuudistusten uudeksi suunnaksi. Tutkimuksella tuetaan myös kuntien käytännön kehittämistoimintaa. Tutkimuskohteena on Tampereen kaupungin toteuttama kokonaisvaltainen toimintamallin uudistus. Uudistus muodostuu kolmesta osasta: pormestarijärjestelmästä, tilaaja–tuottaja-mallista sekä asiakaslähtöisestä prosessiajattelusta. Tutkimustulokset osoittavat, että Tampereen muutosprosessi toteuttaa varsin hyvin uuden julkisen hallinnan mukaista ajattelua. Se ei kuitenkaan edusta tätä moderneimmillaan, vaan perustuu vahvasti sekä byrokraattisen organisaation rakenteisiin että uuden julkisjohtamisen mukaiseen markkinoistumisen tavoitteeseen. Näyttää siltä, että Tampereenkin toimintamalli kaipaa päivittämistä, jotta se pystyy vastaamaan paremmin tulevaisuuden haasteisiin. Moderni uuden julkisen hallinnan kokonaisuus kuntien hallinnon kehittämisen näkökulmasta muodostuu 1) avoimesta kumppanuudesta asukkaiden, palvelutuottajien ja muiden sidosryhmien kanssa, 2) paikallisuuden ja yhteisöllisyyden korostamisesta, 3) monimuotoisesta suorasta ja edustuksellisesta demokratiasta, 4) asiakaslähtöisestä palvelujen kehittämisestä, 5) tulosperusteisesta palveluiden hankinnasta sekä 6) monimuotoisesta palvelutuotannosta. Muutos vallankäytössä on yksi uuden julkisen hallinnan ominaispiirre. Kunnan johtaminen edellyttää monimutkaistuvassa yhteiskunnassa uusia välineitä ja toimintatapoja. Tutkimuksen mukaan moderni kunnan johtaminen perustuu onnistuneelle yhdistelmälle pehmeää ja kovaa valtaa. Tutkimuksen mukaan uusi julkinen hallinta voi kehittyä kuntien hallinnonuudistusten perustaksi. Tätä tukee se, että uudessa julkisessa hallinnassa kehittämisperiaatteet muodostavat loogisen kokonaisuuden, jota voidaan käytännössä toteuttaa monin välinein erilaisissa tilanteissa. Lisäksi on olemassa ilmeinen tarve yhteiselle visiolle, jotta välttämättä edessä oleva kuntien hallinnonuudistus pystytään toteuttamaan. Uudet, isot reformit tarvitsevat aina mallin, johon muutos voidaan perustaa. Uuden julkisen hallinnan kehittymistä tukee myös se, että hallinnon kehittämisen käytännön toteutukset sekä kansainvälisesti että Suomessa toteuttavat jo monella tavoin uuden julkisen hallinnan mukaisia hallinnonuudistuksen kehityssuuntia. Tutkimus tuo uutta tietoa uuden julkisen hallinnan käytännön toteutuksesta suuressa suomalaisessa kaupungissa. Se näyttää myös suuntaa kuntien kehittämistyölle yhdistäen käytäntöä ja teoriaa ja tuo näin tietoa sekä käytännön kuntien kehittämistehtävissä toimiville että tutkijoille. Tampereen toimintamallin päivittämiselle se tarjoaa päämäärän, jota kohti edetä. ; The subject of this dissertation is the new public governance from the perspective of the local government management reforms. The research question is: how is the new public governance reflected in local government reforms? The research ques-tion will be examined from the perspectives of theory, practice and power relations. The empirical object of the study is the management reform of the City of Tampere, Finland. The reform includes three parts: the mayoral system, the purchaser-provider model and the customer-oriented process organization. The study also aims at the development of municipal operations, and presents new public governance as a comprehensive "theory of practice", which combines theory and practice and allows municipalities to find perspectives, tools and a theoretical framework for their management reforms. The study consists of four separate published sub-studies and this summary. The first sub-study deals with the theory of new public governance within the framework of the management reform of the City of Tampere. The second and third sub-studies are concerned with a variety of practical implementations of new public governance in the City of Tampere management reform. The fourth sub-project addresses power relations. In this summary the results are presented from the perspective of a management model, networked service development and the change in the exercise of power. Questionnaires were the empirical basis of the first two sub-studies, the third examined written documents and used interviews with experts and fourth sub-study relied on theme interviews with directors. New public governance (NPG) represents the third wave of the management re-forms evolving from a traditional public administration, and that following the new public management. An essential feature of the new public governance is that it does not completely reject earlier administrative reforms, but rather complements them with new solutions. NPG is based on the view that the public administration is no longer able alone to control society, but the success of governance is based on the partnership with the private and third sectors as well as with the citizens. Within the framework of new public governance one can, at least to some extent, identify three distinct trends. The differences between the trends are mainly in emphasis placed on various matters. Discussion of the new public governance started in network governance. Next, the new public governance was discussed from the perspective of democratic decision-making and public participation. The third emphasis seems to be on the new public governance as a development of customer-focused services and co-production. The results show that the process of change of the City of Tampere can be imple-mented quite well within the new public governance paradigm. At the beginning of the process the new public management was a decided basis of the reform. In the phases of preparation and implementation constraints and international experiences of weaknesses were perceived in the new public management model. On the basis of this, the management model has been developed further so that issues of new public governance such as local democracy, participation, networks and transparency of government have become stronger. The management model of Tampere does not, however, represent the new public governance in its modern form. The Tampere model is built on a basis of democracy and regulation of traditional public administration as well as the quasi-markets of the new public management. The modern new public governance reform seems to be moving especially towards a customer-oriented service development. According to this study the change in the use of power seems to be one of the characteristics of society's growing complexity and new public governance. There is a need for new instruments for leadership and in the exercise of power in an in-creasingly complex society. The modern municipal leadership is based on a suc-cessful combination of soft and hard power. The growth of new public governance as the next paradigm of management re-forms can be justified from three different perspectives. First, the new public gov-ernance is a logical entity. It brings together coherent principles of management reform, which can be implemented in practice by a variety of techniques in different situations. Second, there is an obvious need for a common vision for local gov-ernment reforms. New, large-scale reforms always need a new paradigm in which a change can be set up. There is a need for a common vision for the municipalities and their functions in order to implement local government reform. The new public governance could be the entirety that can show the way for the necessary man-agement reform of municipalities in Finland. Third, the practical implementations of management reforms both internationally and in Finland are already realizing the trends of management reform of new public governance in a number of ways.

Marxismin mukaan kapitalistisen yhteiskunnan jäsenet jakaantuvat kolmeen luokkaan: porvaristoon, keskiluokkaan ja työväenluokkaan. Jotkut marxismin tukijat jakavat keskiluokan talonpojistoon ja muuhun keskiluokkaan. Talonpojisto on vähenevä luokka. Koska marxismin luokkateorian mukaan poliittiset puolueet vaalivat yhteiskuntaluokien intressejä, tutkin pitääkö tämä väite paikkansa. Ensin selvitin marxilaisen teorian luokista ja niiden intresseistä eli eduista, joiden puolustamiseski luokat järjestäytyvät poliittisiksi puolueiksi. Ne laativat itselleen yhteiskuntapoliittiset ohjelmansa, joita ne pyrkivät politiikansa avulla toteuttamaan. Tutkimusaineistona käytän Suomen eduskunnassa tutkimusvuosina edustettina olelleiden puolueiden tavoite- ja yleisohjelmia, joista selvitän sisällön analyysiä käyttäen niiden sisällön ja julkilausutut tavoitteet. Erityisesti pyrin selvittämään orientoituvatko puolueet ohjelmissaan tiettyjen luokkien etujen puolustajiksi vai missä määrin ne esiintyvät yhteiskunnan yleisten etujen vaalijoina. Tutkimus tapahtuu toisaalta puolueiden eduskuntoimintaa selvittämällä. Tällöin pyrin saamaan selville sen toimivatko puolueet periaate- ja tavoiteohjelmiensa mukaisesti laatiessaan lakialoitteita eduskunnassa. Kolmantena tutkimuskohteena on hallituksen esitysten sisällön eritteleminen intressiorientaation pojalta. Kysymys kuuluu palvelevatko hallituksen esitykset yleistä vai luokkien erityisetuja. Tutkimuksessa selvisi, että puolueet niin ohjelmalausumissaan kuin eduskuntatoiminnassaan vaalivat sekä yleistä etu, josta käytän nimitystä luokkien yhteisetu, että luokkien erityisetuja. Eniten puolueet vaalivat yhteisetua. Erityiseduista puolueet vaalivat kukin tiettyä luokkaetua enemmän kuin toista. Tämän perusteella puolueet jakaantuvat ensijaisesti porvariston, keskiluokan ja työväenluokanetuja vaaliviksi. Hallituksen esityksissä luokkaorientaatio on heikompaa kuin kansanedustajien lakialoitteissa. Tutkimustuloksistani selviää myös se, että vaikka puolueet ovat viime vuosikymmeninä ottaneet vaaliakseen aikaisempaa enemmän kaikkien luokkien intressejä ja niiden yleispuolueominaisuudet ovat lisääntyneet, tietty luokkaorientaatio on säilynyt. ; Classes continually alter and influence party strategies and also the behaviour of voters. The members of classes form economic, professional and political organisations. Every class aims to exert the greatest influence upon the state with the help of its political party. This study researches the class basis of political competition, the effect of class interests on the policies of nine Finnish parties in their political programmes and initiative work in the Parliament. The investigation is based on historical materialism and its class structure theory developed by Karl Marx, Friedrich Engels and other Marxists. The aim of study is to estimate how appropriate the class schema of historical materialism is for analysing the political partisanships and ideological conflicts in advanced industrial society. The statements and aims of political party programmes are put into practice in Parliament. This research analyses how parties represent their aims in their political programmes and what their parliamentarians do in Parliament. Is a party the representative of one class or does it equally promote the interests of many classes? Is it a class party or a generally oriented party? As in historical materialism, the programmes and legislative initiatives have been classified into five groups. The first group contains general class interest, oriented towards the common good. The next four groups comprise bills with a specific class interest orientation: bourgeoisie, the middle class, farmers and workers. The parties investigated are The National Coalition Party /The Conservative Party, The Swedish People`s Party, The Finnish Centre Party, The Finnish Social Democratic Party, The Left Alliance, The Liberals, The True Finns, The Christian Democratic Party and The Greens. The changes in politics and in party relationships over thirty years are investigated by comparing the parliamentary actions of parties from the 1960´s to the 1990´s. The study concerns the legislative initiatives of the years 1965, 1972, 1988 and 1999. The data on the programmes were collected from the two political programmes of nine parties from the years 1950 2003. The programmes of political parties are the public flag of the party as Engels expressed it, although their programmes have lost some of their class orientation. In the programmes of all nine political parties the contents aiming at the common good are the first, most important aim, the percentages being 76 98 %. Differences in the programmes of the political parties can still be found. The political parties emphasise their interests and aims in their own ways. The Conservative Party, The Swedish People´s Party and The Liberals have the next important interest in the bourgeoisie. The Swedish People´s Party, The Finnish Centre Party and The True Finns emphasise the middle class and the farmers. The Finnish Social Democratic Party, The Left Alliance and The Greens take care of working class. The main task of Parliament is to enact legislation. Bills can be submitted to Parliament by the Government or as private members bills. In this process the class interests notably emerge in private members bills of plenary sessions. The main Finnish political parties took into consideration the interests of all classes. All nine parties have made in the largest extent common good legislative initiatives. For all nine parties, the most prevalent type of legislative initiatives was those for the common good (84 -67 %). At the same time they tended to favour special class interests. The least specific class parties were The Christian Democratic Party, The Green Party and The Swedish People´s Party. Among special class interests all the parties oriented more to middle class interests in Parliament than in their declared objectives (18.8 7.0 %). The Liberals, The Conservative Party, The Social Democratic Party, The Left Alliance and The True Finns had the strongest middle class orientation. The Conservative Party were the most bourgeois party (10.2%). The strongest working class interest was found in The Left Alliance, The Social Democratic Party and The Green Party (18.8 13.1 %). The Finnish Centre Party and The Social Democratic party, The Left Alliance and The True Finns were closest to working class interests. Are there class oriented differences in the contents of the legislative initiatives and political programmes of the nine political parties? The contents were classified into eleven groups: administration, civil rights, nature conservation, economics, occupation structure, social policy, public health, education, culture, labour market and international affairs. All nine parties have the same three most important contents of legislative initiatives. These were finance/economics, social policy and administration systems. And all nine parties were more interested in financial and economic aims than their political manifestos suggest. The fourth important content for The Conservative Party, The Swedish People`s Party, The Liberals and The Christian Democratic Party was education. Employment was the fourth aim of The Finnish Centre Party and The True Finns. The Labour Market was also important to The Finnish Social Democratic Party, The Left Alliance and The Greens. Nature conservation was important to The Greens, too. The contents of government bills are more oriented towards the common good than are the private members bills. The conclusion is that the main Finnish political parties took the interests of all classes into consideration. At the same time they reveal preferences for special class interests. This emerges in political manifestos and legislative initiatives and government proposals. The Finnish political parties are not purely general parties devoid of class background. Finance and economics was the basis upon which the people arranged their lives and formed political opinions. The class structure of historical materialism is suitable to demonstrate political partisanship in Finland during the second half of the twentieth century. Social changes affect both the class structures and the political aims of parties and give rise to social and ideological conflicts in advanced industrial societies. The consensus policy is one appearance of civilized class struggle.

Kansalaisosallistuminen YVA-menettelyssä Ympäristövaikutusten arviointimenettelyn (YVA) yksi keskeinen tavoite on lisätä kansalaisten tiedonsaantia ja osallistumista ympäristövaikutuksiltaan merkittävissä hankkeissa. YVA-menettelyllä pyritään tuomaan kansalaisten näkemykset, huolet ja toiveet mukaan suunnitteluun ja päätöksentekoon mahdollisimman varhaisessa vaiheessa. YVA edustaa väitöstutkimuksessa modernia vuorovaikutteista ympäristöpolitiikan ohjauskeinoa ja osallistumisen välinettä. Väitöstyön ensimmäisenä tutkimustehtävänä oli luoda YVAan osallistumisen analyysille teoreettinen viitekehys: millaista demokratia- ja suunnitteluideaa YVA voi edustaa ja millainen politiikkaverkosto YVA on kansalaisosallistumisen kannalta. Toisena tutkimustehtävänä analysoitiin YVAan osallistumisen historiallista kehittymistä ja muutoksia Suomessa. Kolmantena tutkimustehtävänä tarkasteltiin osallistumisen käytännön toteutusta sekä arvioitiin osallistumisen vaikuttavuutta. Lisäksi analysoitiin vaikuttavuuden mahdollisia esteitä, miten läpinäkyviä ja avoimia YVA-menettelyt ovat ja miten hyväksyttävänä osallistumisvälineenä YVAa pidetään. Osallistumisen kannalta olennainen seikka on YVAn institutionaalisuus: se on julkishallinnon luoma väline, jonka lisäksi toimenharjoittajalla on keskeinen YVA-menettelyn käytännön toteuttajan rooli. Tämä luo osallistumisen kannalta rakenteita, joissa korostuu toimijoiden väliset epäsymmetriset valta-asemat. YVA-menettelystä tulee helposti kaikille osapuolille vallan käytön ja politiikan tekemisen väline ja niin osallistumisen järjestämistä kuin itse osallistumista ohjaavat toimijoiden poliittiset intressit ja tavoitteet. YVA on parhaimmillaan eri osapuolten välinen avoin keskusteluareena, joka lisää suunnittelun ja päätöksenteon läpinäkyvyyttä, mutta YVA on myös poliittisen kamppailun areena. Suomen YVA-lainsäädännössä osallistumisella on aina ollut tärkeä rooli. Suomalaisessa YVA-järjestelmässä on korostettu kansalaisten osallistumismahdollisuuksia. Ajan saatossa myös kriittisyys laajaa osallistumisoikeutta ja useita osallistumismahdollisuuksia kohtaan on lieventynyt. Haaste on kuitenkin siinä, että osallistumisen toteutus määritellään laissa väljästi, eikä lainsäädäntö takaa laadukasta osallistumista tai varsinkaan sen vaikuttavuutta. Toinen havaittu haaste on YVAn ja osallistumisen suhde päätöksentekoon. YVAn ulkopuoliset päätöksentekojärjestelmät ja edustuksellisen vallankäytön rakenteet eivät ole muuttuneet, ja siksi YVAn vaikuttavuus voi jäädä vähäiseksi. Vaikka YVA edustaisikin osallistuvaa demokratiaa ja toteuttaisi vuorovaikutteista ja moniäänistä suunnittelua, voi osallistumisen merkitys vesittyä ja kansalaisten osallistumisaktiivisuus hiipua. Ilmiöön liittyy myös tarpeetonta kriittisyyttä. Osallistumisen vaikuttavuus ei ole kertaluonteista, vaan se on usein välillistä ja ajoittuu prosessin eri vaiheisiin. Osallistumisen merkitystä ja vaikutuksia ei aina tunnisteta. YVAsta ei ole muodostunut Suomessa laajojen joukkojen osallistumisvälinettä. Ennemminkin YVAan osallistuvat tyypillisesti harvat kansalaisaktiivit, jotka hyödyntävät YVAn lisäksi lukuisia muitakin osallistumisen ja vaikuttamisen keinoja. Osallistujien määrän sijaan huomio tulee kuitenkin kiinnittää sisältöön ja suunnittelun moniäänisyyteen. Olennainen kysymys on se, millaisen roolin kansalaiset ja maallikkoasiantuntijuus voivat saada perinteisesti asiantuntijavetoisessa suunnittelukulttuurissa. ; Public participation in environmental impact assessment Environmental impact assessment (EIA) is a policy instrument based in law and used to prevent harmful environmental impacts, increase public information access, and improve public participation opportunities. EIA is an open process for discussion and participation of different actors: it increases the transparency and broadens the information base of environmental policy planning and decision making. One aim of EIA is to incorporate citizens views and opinions, concerns and desires into planning at an early stage. EIA is a process of identifying and evaluating potential impacts from proposed activities. It is also an interactive and communicative policy instrument and should facilitate direct participation. EIA is an example in the development process of direct participation in Finland during 1990 s. In this study EIA is approached as a participation instrument. Public participation is the perspective from which the EIA-process is analysed. The aim of the research is to examine participation in EIA both a theoretical and empirical way, and to interpret and explain the operation logic and efficacy of participation. There are three main research tasks in the study. The first task is to create a theoretical framework for analysis of public participation in EIA. For this purpose, the theoretical and methodological triangulation is made in the study. There are four main parts in the triangulation. Firstly, the elements of participative and deliberative democracy and communicative planning theories are combined. This theoretical discussion shows what kind of democracy and planning EIA can represents. Secondly, network analysis and evaluation are integrated in the methodological triangulation. The concepts of policy networks and intervention theory are used in theoretical and methodological manner. The outcomes of theoretical and methodological triangulation are criteria of deliberative EIA and four policy network models of EIA as an instrument of public participation: 1) EIA as a negotiation process; 2) EIA as a technical process of information collection, 3) EIA as an information instrument; and 4) EIA as tool for controlling of participation. While the theoretical part of the thesis has its own analytical objectives, these policy network models are utilized with evaluation criteria in the empirical part of the study. The second research task is to analyse the historical development of participation in Finnish EIA legislation. The focus of this part is on the long lasting political process and arguments behind the enacting of Finnish EIA Act in 1980 s and 1990 s. The most important amendments of EIA legislation and the international and national reasons behind them are also considered. According to results of this part of thesis, the role of participation has been central to the Finnish EIA system. Even if the EIA Act was implemented in Finland relatively late in 1994, the legislative foundation for public participation has always been strong. Though the implementation of participation is defined in a flexible way, Finnish EIA legislation supports public participation and in principle creates possibilities for deliberative democracy. The third research task is to evaluate public participation in two case studies. This part includes following questions: 1) what kind of objectives do different actors seek from participation; 2) how does participation impact EIA and what are the obstacles of effective participation; and 3) how transparent and acceptable is the EIA process? The two cases used, the EIA of a road project and the final disposal of nuclear waste, show how much the aims, the implementation and the effectiveness of public participation can not only vary between different projects, but also during the planning process in one certain project. Notably, in the nuclear waste case, the nature of top-down instrument of EIA was clearly observed, while the developer of the project assumed a dominant role. The three elements of policy network (actors, arenas and agenda) were defined by the developer. Even if participation was carried out with great visibility, professional implementation and sufficient resources, the impact of public participation and lay people expertise was not so essential, while the economic and political interests of the project and the role of experts were in central role. In this case study EIA represents the policy network model of controlling of participation: the role of governance was more important than deliberative participation. In the road case the planning situation was more open. There did not seem to be the same need to define and control participation and the agenda of the EIA. The contribution of citizens was used in planning in a more effective manner. The EIA assumed a more traditional role ­ as an information distribution tool, and as a place for open discussion and effective participation. The case studies suggest that the legislative base can not alone guarantee the effectiveness of public participation. Most important factor is the attitude of main actors. Each EIA process is unique and general theories of participation in EIA are difficult to create. In practice, the EIA is more or less an institutional process of power division between different actors, and the developer has the central role. EIA is an open arena that allows political disagreements to form and emerge into the open. However, EIA can also be used to promote political interests. EIA and participation can be harnessed by the proponent, but EIA can also feed the so called NIMBY (Not In My Back Yard) phenomenon. It is also possible, that policy instruments like EIA create a new elite ­ active lay experts. Theoretical ideas of deliberative democracy or communicative planning are challenging to implement in practice. At the same time it is important to estimate the criteria and expectations concerning participation. One can see, that EIA has lot of deliberative potential, but the main challenges are in the relationship between EIA and decision making, and in the structures of political power and decision making outside of EIA.

POLITICS BY PROVINCE: Goal-oriented rational action or value-oriented rational action in closed debate on the Wadden region and public consultation on the ecological infrastructure General This thesis is a study of political conduct, and of provincial politics in particular. It is based on three research projects. The first two research projects are empirical studies that examine, respectively, the functioning of the discussion platform for government bodies relating to the Wadden Islands area and the relationship between the regional press and provincial political organs. Each of these two projects is based on a defined problem, a theoretical framework, methodology and conclusions. Although both case studies deal with provincial politics, they are completely separate from each other. The third case study is theoretical. It seeks to clarify the rationalization theories of Max Weber and Karl Mannheim, and place the concepts of goaloriented rational action and value-oriented rational action in their theoretical context. This theoretical chapter produces a number of research questions that can be used as a 'rationality grid' to be applied to the two empirical case studies in order to determine what form of action, goal-rational or value-rational, characterizes provincial politics. Chapter One describes the background to the studies and gives a short introduction to the research themes. This chapter also presents a view of contemporary provincial politics and discusses the scientific position from which this thesis has been written, emphasizing the unique role of the sociological vision. How does the government manage the Wadden Sea? The first section examines the way in which the government manages the Wadden Sea. The study is based on an evaluation study of the functioning of the Coördinatiecollege Waddengebied (CCW) in the period 1987 to 1994. The CCW (a platform for administrative consultation between the government, the Wadden provinces and the Wadden municipalities) was set up in 1980 for the purpose of "ensuring coherent administration and an coordinated policy by the government, provinces and municipalities with regard to the Wadden region." The study is based on a bottleneck analysis; in other words, by identifying problems, concrete solutions can be proposed. The evaluation study employed a combination of two popular lines of research in organizational sociology literature – the 'whole-system approach' and the 'parties approach'. In the whole-system approach, shared values or a feeling of solidarity are what unites the organization. In the parties approach, the organization is seen as a coalition of parties with different interests and aims. The parties work together for their own benefit, or because negative sanctions force them to do so. Both approaches are integrated in the 'parties-withina-system' perspective, which focuses on the relationships between the parties and the organization as a whole. This integral approach was used to evaluate the functioning of the CCW because the CCW places great emphasis on shared values and responsibilities, which are the core elements of the whole-system approach. At the same time, however, the CCW is composed of different parties which all have their own tasks, powers and interests – the core elements of the parties approach. This perspective has been tailored to the evaluation of the CCW using the following criteria: shared values, support base, differing interests, power structure, sense of purpose, and success/failure factors. The study is based on qualitative interviews with participants in the CCW platforms, telephone interviews with councillors and members of the States General, dossier analyses and reconstructions from minutes from the CCW consultations on the following cases: enlarging the scope of the Nature Conservation Act; delegation of powers with regard to inspection and control; co-ordination of international activities, problems relating to 'traditional brown shipping'; the review of the Waddenzee II Key Planning Decision, and gas extraction in the Wadden Sea. This treatment of the original research report emphasizes a systematic description of conduct within the context of the administrative co-ordination of the Wadden region, which is usually of a closed nature. The main problem areas are the following:  a lack of shared values due to the fact that the purpose of the Wadden consultation platform is given a different interpretation depending on the interests in question;  by way of preparation for the Wadden consultations, a process of harmonization takes place within the various authorities, thereby creating an administrative support base. However, this process of preliminary consultation and feedback reveals the other side of the bureaucratic coin – this circuit is, administratively and politically speaking, strongly inward-looking;  there are no substantial conflicts of interest between the layers of government. However, mutual suspicion exists with regard to the extent to which other parties are committed to the Wadden policy. Each party suspects that the other parties will ultimately allow economic interests to prevail;  with regard to the delegation of authority, the balance of power between the government and the provinces is seen as unacceptable. The continuous lack of consensus, whether manifest or otherwise, is a barrier to discussion on a equal footing;  there are various problems relating to the sense of purpose, including the role of the Chairman and the lack of a clear definition/delegation of tasks. This analysis shows that the problems are not related to the structure of the Wadden consultative platform but rather to its culture, and more specifically to the participants' perceptions of the role and responsibilities of the platform. In addition, there appears to be a distinct lack of leadership. The main conclusions are as follows:  harmonization within the various Wadden authorities (government, provinces and municipalities) hampers harmonization between the Wadden authorities;  the representatives from the three layers of government do not present the role and purpose of the consultative platform in a consistent and uniform way;  the CCW is hampered in its work by an ongoing debate about how powers are delegated between the layers of government. Because the analysis of success and failure factors revealed that clearly defined relationships between the government authorities are essential for successful consultation, possible solutions aim to create that clarity. Recommendations have been laid down, for example, relating to the role of the Chairman, drawing up the agenda, and clearly defining the tasks of the various bodies. Although, as far back as 1995, the CCW largely acknowledged the problem areas and supported the proposals for improvement, none of the recommendations will actually be implemented before 2001. Politics and the press on the ecological infrastructure in Friesland and Drenthe Section 2 describes a study of the relationship between the regional press and northern provincial politics. The basis for the study is the political decision-making regarding the establishment of the ecological infrastructure in the provinces of Friesland and Drenthe in the period 1989 to 1996. The conclusion of a survey of the relationship between the printed press and parliamentary democracy is that the main function of the press is to provide information, criticism and comment. The role of information-provider is examined on the basis of the following:  actual report of a meeting of the Provincial Councils;  a news report giving information about matters relating to the ecological infrastructure in both provinces;  a background article describing the context, history and/or different interpretations of matters relating to the ecological infrastructure. The role of critic is examined on the basis of the following:  editorial comment;  a column in which one of the editors gives his opinion under his own name;  opinions of third parties, in which a third party, who is not an editor, is given the opportunity to express an opinion. Using four recent examples, it is then argued that the central question relating to the relationship between politics and the press is one of management – who controls political communication or, put another way, is the relationship determined by 'party logic' or by 'media logic'? The study will compare decision-making on the ecological infrastructure (as this was perceived in decision-making meetings of the provincial councils) with reporting by the regional press in both provinces. The decision-making process of the provincial councils was reconstructed for this purpose. The result is not only an analytical reconstruction of the decision-making surrounding the ecological infrastructure in Friesland and Drenthe, but also a chronicle of provincial political customs and morals. A quantitative and qualitative analysis subsequently shows how the regional press fulfils its role as information provider and critic. The quantitative analysis addresses the question of how often the press fulfils its role as information provider and critic with regard to decision-making on the ecological infrastructure. The qualitative analysis addresses the question of how the press fulfils those roles. It is argued that the quality of the information provided is determined by the degree of objectivity, but that the best measure of quality is a clear standpoint. These conclusions were used to formulate an 'ideal' against which the quality of informative and critical articles can be measured. A factual report is as objective as possible when:  it deals not only with the decision itself, but also with the opinion-forming process;  it gives the opinion not only of the representatives of official bodies, but also of opponents or those outside such bodies;  the reporter does not give his own opinion. A news report or background article is as objective as possible when:  it presents more than one perspective and/or quotes more than one authority on the subject. An editorial or column makes a constructive critical contribution when:  the author adopts a clear standpoint;  the context (history, background or current event) of that standpoint is given;  the author describes how the standpoint was reached, and on which information or authorities it is based. Conclusions about the information function:  in almost half of the cases, the regional newspapers do not report on provincial council meetings relating to the ecological infrastructure. The people who live in the province, but fall outside a given environmental or agricultural target group, will not become informed about the ecological infrastructure by reading their local newspaper. Neither will they become informed about the role of the provincial government in this;  in the reports which do deal with meetings of the provincial councils, there is a lack of balance. Generally speaking, no effort is made in such reports to show the full palette of political colours represented in the provincial council;  there is only relatively wide newspaper coverage on occasions when political emotions are running high. Examples are: Friesland in 1993, when an agreement was reached with the agricultural sector, and Drenthe in 1993, when an amended programme of intent for the soil-protection areas was introduced (the agricultural lobby also played an important role in this). This attention from the press can be explained by incident politics. Political groups hold widely different opinions; they make no effort to hide their differences and journalists are keen to pick up on this. Another possible explanation is that, in these cases, ecological policy is heavily influenced by the farming lobby, which itself is strongly supported by influential political groups;  the news reports are usually brief and present an event from only one perspective, without a journalistic contribution from the author. This leads to the inevitable conclusion that press releases sent to the newspapers have been published without any further interpretation;  the most common simple perspective is that which opposes the ecological infrastructure;  there are very few background articles. Background articles that clarify the situation, and outline the problems confronting provincial politicians, are indispensable with regard to a far-reaching and complex plan such as the development of the ecological infrastructure of the two provinces;  it is notable that most of the background articles are only written from one perspective, with very little informative context. On the basis of these findings, it appears that the way in which the regional press fulfils its role as information provider leaves room for improvement. Scant attention is paid to council decision-making and the quality of reporting also leaves something to be desired. Little can be said about how the press fulfils the role as critic because so few articles appear in this context. The question Who controls political communication? cannot therefore be answered because the press pays too little attention to provincial politics. Goal-oriented or value-oriented rationality: which form of rationality determines political action? Section 3 examines which form of rationality (i.e. goal-oriented or value-oriented rationality) occurs most in the closed discussions between government bodies in the Wadden study, or in public discussions on the ecological infrastructure from the study of the relationship between politics and the press. For this purpose the rationalization theories from the work of Weber and Mannheim were used. Both Weber and Mannheim recognise increasing instrumental and formal rationality (Weber) and functional rationality (Mannheim) in all areas of life, and a decrease in material rationality (Weber) and substantial rationality (Mannheim). Weber and Mannheim identify the rise and influence of a specific form of instrumental rationality, particularly within economic, legal and bureaucratic institutions. Within such institutions, actions are characterized by goal-oriented rationality. This means that the prevalent institutional pattern of norms and values that more or less prescribes how people should act within the institutions (role-related behaviour) places great emphasis on goal-rational behaviour. In order to establish whether this also applies in provincial politics and administration, a study was made of the conception of rationality in the work of Weber and Mannheim. The question of whether goal-oriented or value-oriented rationality is dominant is addressed by a secondary analysis of the material. The secondary analysis takes the form of a 'rationality grid' that is applied to the material from the two empirical studies. The grid has a coarsely meshed structure that can separate out goal-oriented and value-oriented rationality. Following the study of Weber and Mannheim's concepts of rationality, goal-oriemted rational action is defined in this study as action that is geared towards finding the most appropriate means to achieve a goal that is considered as given. When action is successful in terms of the defined goal, we speak of goal-oriented rational action and formal rationality. Success or effectiveness is therefore the measure for goal-rational behaviour. The essence of this concept is expressed in the following questions:  is conduct geared towards resources and procedures within the given of administrative co-ordination or within the structured political (provincial) discussions?  are the goals open to discussion? If action is a logical extension of or derives from a higher value or ideal, we speak of 'valueoriented rational action' and 'material rationality'. The extent to which an action is valueoriented is therefore the measure for value-rationality. In this study, value-oriented rational action is defined as action that is based on the assessment of the desirability of a given goal by means of a party-political value system. The essence of the concept, as used in the present context, is expressed in the following question:  is the action geared towards assessing the desirability of a particular goal, based on a political value system? Conclusions: 1. With regard to discussion between government bodies on the subject of the Wadden region, the hypothesis was that, within the sphere of formalised and regulated administrative co-ordination in the Wadden region, actions are largely determined by goal-oriented rationality. The purpose of the discussion platform is, after all, to co-ordinate and realise goals defined elsewhere. The hypothesis is confirmed – the Wadden discussion platform is characterized by goal-oriented rational action. But this type of action is not related to the ultimate goal of the discussion platform but rather to another goal: the increasing of the influence and governance of the government layer in question. 2. With regard to the decision-making on the ecological infrastructure in Friesland and Drenthe, the hypothesis was that political decision-making debates are characterized by the discussion of values to be lived up to and aims to be realised. It is therefore to be expected that such debates are mainly characterized by value-oriented rationality. However, the findings do not confirm this hypothesis. The discussions of the provincial councils of Drenthe and Friesland are certainly not goal-rational in nature, yet neither can they be described as valuerational. Actions are indeed geared towards assessing the desirability of a particular goal, but that assessment is not based on a political value system. It is not party-political principles that determine political conduct; it would be more true to say that conduct is based on notions of consistency in terms of policy and support.