Flernasjonalt sanitetssamarbeid i internasjonale operasjoner: utfordringer - hva så?

Denne oppgaven tar for seg flernasjonalt sanitetssamarbeid i internasjonale operasjoner. Norge har siden andre verdenskrig ofte sendt sanitetsavdelinger som bidrag til operasjoner i utlandet. I de senere år har bidragene i større grad vært i samarbeid med andre nasjoner. Forsvarets sykehussystem bygger på beredskapsordninger, hvor sivilt helsepersonell fra norske sykehus rekrutteres, for å opprettholde drift av det militære sykehuset. Spesialister har vært en mangelvare, og for å kunne ha en kontinuitet har Norge etablert sanitetssamarbeid, hvor andre nasjoner har stilt med funksjoner vi har hatt behov for. Problemstillingen i studien er «Hvilke utfordringer har Norge møtt i flernasjonalt sanitetssamarbeid i internasjonale operasjoner og hvordan ble disse utfordringene løst?» Oppgaven er løst som en kvalitativ studie, med bruk av intervju som primærkilde ved å studere to caser. Den ene casen er et flernasjonalt sanitetssamarbeid med Tyskland, Sverige og Norge i NATO-operasjonen -International Security Assistance Force (ISAF) i 2006. Den andre casen er et sanitetssamarbeid mellom Serbia og Norge i FN-operasjonen United Nations Mission in the Central African Republic and Chad (MINURCAT) i 2009. Begge casene omhandler det norske sykehussystemet Norwegian Deployable Hospital (NDH) og er på flere områder ganske like. Casene er drøftet i forhold til en rekke faktorer som har betydning for flernasjonalt sanitetssamarbeid. Disse faktorene er delt inn i to overordnede rammer. Den første er politiske og organisatoriske rammer og tar for seg faktorene NATO og FNs krav til flernasjonalt sanitetssamarbeid, juridiske avtaler, helselovgivning, nasjonale og politiske agendaer og samlefaktoren nasjonale ordninger og kultur. Den andre overordnede faktoren, militære rammer tar for seg faktorene som gir evne til samarbeid, eller interoperabilitet. Faktorer som kompetanse, trening og øving, materiell, språk og evnen til informasjonsdeling har blitt studert. Funnene tyder på at de største utfordringene er knyttet til den enkelte nasjons nivå på medisinsk kompetanse og prosedyrer, samt evnen til å gi best mulig helsetjeneste. I tillegg er ulikheten knyttet til nasjonale ordninger og forskjellig kultur en utfordring for det flernasjonale sanitetssamarbeidet i internasjonale operasjoner. Studien viser at flernasjonal trening og øving, for å etablere kunnskap om hverandres organisasjonskultur og utdanningsnivå gir best mulig sanitetssamarbeid. I tillegg ser det ut til at det flernasjonale sanitetssamarbeidet blir mest vellykket når nasjonale team er laveste samarbeidsnivå

Prospective register-based study of the impact of immigration on educational inequalities in mortality in Norway

Background: Differences in mortality with regard to socioeconomic status have widened in recent decades in many European countries, including Norway. A rapid upsurge of immigration to Norway has occurred since the 1990s. The article investigates the impact of immigration on educational mortality differences among adults in Norway. Methods: Two linked register-based data sets are analyzed; the first consists of all registered inhabitants aged 20–69 in Norway January 1, 1993 (2.6 millions), and the second of all registered inhabitants aged 20–69 as of January 1, 2008 (2.8 millions). Deaths 1993–1996 and 2008–2011, respectively, immigrant status, and other background information are available in the data. Mortality is examined by Cox regression analyses and by estimations of age-adjusted deaths per 100,000 personyears. Results: Both relative and absolute educational inequality in mortality increased from the 1993–1996 period to 2008–2011, but overall mortality levels went down during these years. Immigrants in general, and almost all the analyzed immigrant subcategories, had lower mortality than the native majority. This was due to comparatively low mortality among lower educated immigrants, while mortality among higher educated immigrants was similar to the mortality level of highly educated natives. Conclusions: The widening of educational inequality in mortality during the 1990s and 2000s in Norway was not due to immigration. Immigration rather contributed to slightly lower overall mortality in the population and a less steep educational gradient in mortality

A framework to assess welfare mix and service provision models in health care and social welfare: case studies of two prominent Italian regions

BACKGROUND: The mechanisms through which the relationships among public institutions, private providers and families affect care and service provision systems are puzzling. How can we understand the mechanisms in these contexts? Which elements should we explore to capture the complexity of care provision? The aim of our study is to provide a framework that can help read and reframe these puzzling care provision mechanisms in a welfare mix context. METHODS: First, we develop a theoretical framework for understanding how service provision occurs in care systems that are characterised by a variety of relationships between multiple actors, using an evidence-based approach that looks at both public and private expenditures and the number of users relative to the level of needs coverage and compared with declared values and political rhetoric. Second, we test this framework in two case studies built on data from two prominent Italian regions, Lombardy and Emilia-Romagna. We argue that service provision models depend on the interplay among six conceptual elements: policy values, governance rules, resources, nature of the providers, service standards and eligibility criteria. RESULTS: Our empirical study shows that beneath the relevant differences in values and political rhetoric between the case studies of the two Italian regions, there is a surprising isomorphism in service standards and the levels of covering the population’s needs. CONCLUSION: The suggested framework appears to be effective and feasible; it fosters interdisciplinary approaches and supports policy-making discussions. This study may contribute to deepening knowledge about public care service provision and institutional arrangements, which can be used to promote more effective reforms and may advance future research. Although the framework was tested on the Italian welfare system, it can be used to assess many different systems

Danish and Norwegian hospital social workers’ cross-institutional work amidst inter-sectoral restructuring of health and social welfare

Starting in the 2000s, Denmark and Norway have under gone extensive restructuring of the ir health - related social benefit programmes , including how they are governed . Several reforms have sought to enhance inter - sectoral collaboration . Aiming at ensuring patients’ faster return to work , policy makers have ins tituted economic incentives to both individual s and the health and welfare organisation s who handle them . Through an institutional logics approach , t his paper explores how h ospital social workers in these countries are experiencing the se changes . The ‘ social ’ part of post - treatment care and rehabilitation receives more attention in the Norwegian institutional set - up than in the Danish , and whilst challenges are experienced in both countries, in group interviews Danish social workers in particular expres s concerns about the implications of the accelerated return - to - work focus . In both countries, they report increasing difficulties in ‘ making their way through ’ the state - municipal bureaucracy . However, by d rawing on the formal health knowledge derived from medical settings and the symbo lic capital it bestows on them, they often manage to negotiate the work - and - welfare services , and t hereby transforming the social context for the patient