Suchergebnisse

"Encounters, breaks and bonds: a study of the mother work in the Supermammat peer group This study explores a peer group for mothers, which is presented by the pseudonym Supermammat. The group is a third sector agent, which has served mothers and their children almost three decades. In the Supermammat group mothers get opportunity for carrying out functional programme, taking their children to organized childcare, sharing peer support and receiving professional aid. In addition to weekly meetings, outings, camps and other recreational activities are organized in the group. The aim of the operation is to support motherhood.
The objective of the study is to describe practices of supporting mothers in the operation of the Supermammat group. The objective is approached by treating group's history, current operation and principles directing it together with workers and their job towards supporting mothers participating in the operation of the Supermammat group. However, the study par excellence gives voice to people for whom the group has established. It's most central aim is to tell what kind of meaning the operation of the group has for mothers. This is ethnographically executed case study, which starting point is to explore restricted research subject by utilizing different perspectives and datas. The core data consists of interviews of mothers participated in the operation of the Supermammat group (N=23) and fieldnotes gathered during participant observation. In addition, interviews of persons worked on the group (N=11) are included in the data. The data gathered is supplemented by the documents from the operation of the group.
Research findings indicate that the operation of the group has turned more professional and functionally more various in the course of time. The operation consists of many elements, reaches dozens of mothers annually and requires contribution of several agents. Participating in the operation gets it's meaning as encounters, breaks and bonds. The group gives an opportunity for encounters forming both peer support and professional aid. At the same time, it constructs a chance of withdrawing from everyday life by producing breaks to mother's routines. In addition, participating in the operation of the Supermammat group gives space for constructing an affinity, various relationships and connections fastened on the group. " - "Kohtaamisia, katkoksia ja sidoksia: tutkimus Supermammojen vertaisryhmän äitityöstä Tämä tutkimus tarkastelee äitien vertaisryhmää, joka esiintyy peitenimellä Supermammat. Kyseessä on kolmannen sektorin toimija, joka on palvellut äitejä lapsineen lähestulkoon kolmen vuosikymmenen ajan. Supermammojen ryhmässä äidit saavat mahdollisuuden toiminnallisen ohjelman toteutukseen, järjestettyyn lastenhoitoon, vertaistuen jakamiseen ja ammatillisen avun vastaanottamiseen. Ryhmä kokoontuu viikoittain, jonka lisäksi järjestetään retkiä, leirejä ja muuta virkistystoimintaa. Toiminnan tavoitteeksi on asetettu äitiyden tukeminen.
Tutkimuksen tavoitteena on kuvata käytäntöjä, joilla Supermammojen toiminnassa tuetaan siihen osallistuvia äitejä. Tavoitteeseen vastataan tarkastelemalla ryhmän historiaa, tämänhetkistä toimintaa ja sitä ohjaavia periaatteita sekä työntekijöitä ja tehtäviä, joita he toteuttavat Supermammojen toimintaan osallistuvien äitien tukemiseksi. Ennen kaikkea tutkimus kuitenkin antaa äänen ihmisille, joita varten Supermammojen ryhmä on perustettu. Sen keskeisin päämäärä on kertoa, millainen merkitys ryhmän toiminnalla on siihen osallistuneille äideille.
Kyseessä on etnografisesti toteutettu tapaustutkimus, jonka lähtökohtana on rajatun tutkimuskohteen tarkastelu erilaisia näkökulmia ja aineistoja hyödyntäen. Keskeisin osa aineistoa ovat Supermammojen toimintaan osallistuneiden äitien haastattelut (N=23) ja osallistuvan havainnoinnin perusteella kirjatut kenttämuistiinpanot. Aineistoon kuuluu myös ryhmässä työskennelleiden henkilöiden haastatteluja (N=11) ja Supermammojen toiminnasta tuotettuja dokumentteja.
Tutkimustulokset osoittavat, että Supermammojen toiminta on ajan kuluessa muuttunut paitsi professionaalisemmaksi myös toiminnallisesti moninaisemmaksi. Toiminta koostuu monista elementeistä, tavoittaa vuosittain kymmeniä äitejä ja vaatii toteutuakseen useiden toimijoiden työpanosta. Siihen osallistuminen saa merkityksensä kohtaamisina, katkoksina ja sidoksina. Ryhmä antaa mahdollisuuden kohtaamisille, joissa rakentuu sekä vertaistukea että ammatillista auttamista. Samalla se luo tilaisuuden arkielämästä irtaantumiselle tuottamalla katkoksia äidin arkeen. Lisäksi Supermammojen toimintaan osallistuminen antaa tilaa yhteenkuuluvuuden tunteen, moninaisten ihmissuhteiden ja ryhmään kiinnittyvien yhteyksien rakentumiselle. "

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

In the current digital media environment, legacy newspapers and their readers are often regarded as obsolete. For media executives and many journalists, the future of news is exclusively digital. Given the economic uncertainties facing the industry, news producers' eyes are focused on audience metrics and their capacity to shed light on readers' preferences.

This book sets out to analyse news reading from the perspective of the audience. Employing interviews as well as the so called obsläs method, it examines how readers of two Finnish regional newspapers, Hämeen Sanomat and Karjalainen, navigate in three distinct architectures of the newspaper: printed, digital replica and online news application. The assumption underlying the analysis is that each of these user interfaces favour somewhat differing reading protocols and routines.

The empirical analysis responds to the big question pondered by editors and publishers: Where are the readers? It appears that most of the participants of the study tended to move from one architecture to another depending on their contextual and situational needs. In this comparison, the strengths of a printed newspaper seemed evident for many, while the balance between the pros and cons of the digital environment was more mixed.

In addition to reporting the findings of the empirical audience study, this book evaluates the future of newspapers in the context of economic statistics and media policies. While the newspaper business in Finland struggles with increasing costs and volatility of income, it may well rely on the robust newspaper reading culture among the Finnish reading public.

Demokratia ja tehokkuus muodostavat kunnallishallinnon keskeisimmän arvopohjan. Näiden välillä vallitsee tietynlainen jännite. Kauko Heurun väitöskirjassa tutkitaan oikeushistoriallisessa valossa kunnanvaltuuston asemaa tämän jännitteen sisällä. Siinä selvitetään kunnanvaltuuston vallan syntyhistoria sekä sen kehittyminen yhteiskunnallisen muutoksen osana. Kunnallishallinnossa on perinteisesti korostettu demokraattisia arvoja. 1990 -luvulla tässä tapahtui ratkaiseva muutos. Tällöin tehokkuusvaatimukset voimistuivat, ja niihin myös vastattiin. Maamme kunnallishallinto siirtyi erilaisten kokeilujen ja hallinnonuudistusten kautta uudenlaiseen kunnallishallintoon, jonka johtavana aatteena on tulosjohtamisen idea. Mitä pitemmälle tulosjohtamista on kunnallishallinnossa toteutettu, sitä enemmän valtuusto on menettänyt asemaansa kunnan päätösvallan käyttäjänä. Valtuuston valtaa on siirretty täytäntöönpanijoille tietoisesti, mutta sitä on siirtynyt myös salaisesti. Jokainen pelkän tavoitteen asettava valtuuston päätös, jota ei sidota keinovalikoimaan, siirtää valtuuston valtaa. Samoin tekee määrärahapäätös, jota ei sidota yhteen määrätarkoitukseen. Yleistymässä oleva käsitys valtuuston aseman heikkenemisestä saa tutkimuksellista vahvistusta. Kauko Heuru selvittelee yli 400 -sivuisessa väitöskirjassaan laajasti tämän kehityksen syitä. Tällöin hän osoittaa kunnallishallinnon kiinteän yhteyden yhtäältä valtioon ja toisaalta ajan yleisiin virtauksiin. Hän näkee, että 1980 -luvulla alkanut kunnallishallinnon uudistaminen ei ollut ilmiönä itsenäinen, vaan se liittyi kiinteästi uusliberalismin nousuun ja valtionhallinnon uudistamiseen. Kunnallishallinnon vahvistamisen nimissä tehdyt lainsäädännölliset uudistukset kuten normien purku, vapaakuntakokeilu ja kuntien valtionosuusjärjestelmän uudistaminen olivat tarkoitukseltaan ensisijassaq valtionhallinnon uudistamista. Valtion edustajat eivät kuitenkaan ajaneet kuntia muuttamaan hallintoaan, vaan tämän tehtävän hoitivat kuntien keskusjärjestöt. Ne aloittivat jo 1970 -luvulla määrätietoisen koulutus- ja muun ohjaustoiminnan mangeristisen kunnallishallinnon aikaansaamiseksi. Kaiken perustana oli uusliberalismi sekä amerikkalainen liiketaloustieteellinen tutkimus ja sen osakseen saama huomio OECD-maiden julkisessa hallinnossa. Kauko Heuru pohtii myös valtuuston aseman vahvistamista. Hän tulee siihen tulokseen, että nykyajan tehokkuuden ihannointi antaa vain vähän mahdollisuuksia siihen. Näistä merkittävämpänä on vallan ja vastuun jaon normatiivinen täsmentäminen. Tämä merkitsee nykyistä selkeämmän poliittisen johtajuuden luomista suomalaiseenkin kunnallishallintoon. Tutkija, jolla itsellään on pitkä kaupunginjohtajan virkaura, puoltaa pormestarityyppistä johtamisjärjestelmää. Tämän hän tekee nimenomaan valtuuston vallan kannalta. ; The study was designed to investigate the origins of the competency to use municipal decision-making power and its development in the light of the central development of municipal law, including causal relationships and systematization of municipal law. The frame of reference consisted of the democratic values and efficiency values of local government. Up to the end of the 1980s local government in Finland can be regarded as a legal-administrative practice. In a closer analysis, we can distinguish three pha-ses: liberalism, rule-of-law and social state. In the beginning of the 1990s the Finnish state administration was refor-med in line with the managerial theory. The idea of management by results played a key role in this development. Local government was remodelled on the same con-cept. From the 1990s on we can speak of managerial local government. The entire legal-administrative period was characterized by the priority of democratic values in local government. While demands for efficiency grew, they we-re mainly responded to by detailed norm setting and direction by the state. The launch of management by results meant that efficiency values took precedence over democratic ones. If municipal decision-making power is understood as competency to form local intent, and if we assume as municipal laws have assumed that the exercise of this power resides in the local council, the introduction of managerial local go-vernment and management by results has not been possible without transferring aut-hority from the local council to the executive organization. The main reason was that local government activities had become increasingly target-oriented. This involved a demand to separate strategic and operational activities. According to the idea of ma-nagement by results, strategic activities cover the setting of general objectives, whe-reas concrete (case-specific) decisions should be made at the operational level. The level of strategic activities is formed by the work of the local council, and the level of operational activities by the work of the executive organization. The local council's (the local government's) decision-making power can be transferred legally to the executive organization within the limits of the law by a by-law. This is called delegation, whereas in the management-by-results system local decision-making power is factually transferred in other forms too. This happens either in a permissible manner or secretly, and the more the more generally the coun-cil has set the objectives and the more systematically strategic and operational acti-vities are separated. The most important tool for transferring the council's power is the municipal budget, even if the law does not recognize it as such. The introduction of the management-by-results system to local govern-ment broke the mechanisms that had protected the council's authority in the legal-administrative practice. Such mechanisms included general budget principles (no-tably the detail principle) and the inner logic of the dual principle of local govern-ment. The detail principle required that the municipal budget be detailed to the extent that none of the council's power could be transferred to the executive or-ganization through this way. For the purpose, the budget was to be divided in ap-propriations up to one designation. The inner logic of the dual principle corresponded to the perceptions of the rule of law and legal positivism about formal rational legal order; implementation was based on subsumptional logic rather than independent consideration. Expedien-cy, which thus was not conveyed from the decision to be implemented, did not reside with the executive organization. During the legal-administrataive local government, the number of muni-cipal officials increased steadily. However, we cannot speak of bureaucracy in the true sense of the word, because municipal offices existed mainly for executive func-tions only. During managerial local government, municipal officials became also executors of the self-government of local residents. Generally, it can be said that the further the idea of management by re-sults is taken in local government, the more the status of the council shifts from a decision maker to a legalizer of municipal activities. Along with the change the conceptual contents of municipal democracy have changed. The decision-making moment is no longer the sole basis of evaluati-on, rather, it is the moment when the consequences are seen. Newer research has anticipated a shift from representational democracy towards direct democracy, but it seems unlikely. Representational democracy still appears to have its chances. This requires increasing attention to the political functi-on of municipalities, including stricter normative definition of municipal authority and responsibility. In the end, the key issue is whether the Finnish local government will have a distinct political leader or not.