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Contribution à l'ingénierie des systèmes de production de soins dans les pays en voie de développement : vers un système sans murs en Haïti

Abstract : The tools used in the transformations of the production systems of goods and services in the industrial world to respond to market pressures around the 1970's have been applied since the past two decades in the health system in order to organizing more effectively and more efficiently healthcare for the populations. Facing an increase care demands; an aging population and a lack of qualified human resources in this field, health facilities managers are confronted with constraints that prevent them from responding adequately to the patient's expectations. The implementation of a Home Health care structure appears to be a fair alternative to traditional hospitalization. That helps to treat the patient in his/her environment/home, to reduce psychological pressure, to manage rationally the beds in the hospitals, and to avoid the risk of nosocomial infections, at the end to cut down on health care costs. However, the situation appears more critical in the developing countries where for many services, the current techniques in application to plan and to organize care deliveries are those used in the late nineteenth century in industrialized countries. The maternity ward is most affected by this lack of resources. In Haiti, 75% of births are home deliveries without any qualified medical assistance. The maternal mortality rate is 670 per 100,000.00, the highest in the American continent. In the other side, the infant mortality rate is 80 ? live births. While in the other countries located in the Caribbean as well as Haiti, such as the Dominican Republic, Cuba and Jamaica, there are respectively per 100,000.00 live births, maternal mortality rates of 150, 45 and 170; and infant mortality rates per 1,000.00 births alive, amounted to 27, 6 and 16. We need emergency responses to reduce the risk of death in the motherhood process. The goal of our work is to propose an alternative to the traditional maternity ward in order to prevent and to reduce maternal and infant deaths in the country. Indeed, a partial modeling of Haitian hospital system is carried out into two steps. At first, we address the problem of resources staffing based on engineering of conception. To quantify in optimal way the human resources that will be part of the "maternity home care assistance" team, we have applied the methodology ASCI (Analysis, Specification, Design, Implementation), originally designed at LIMOS laboratory at the University of Clermont Ferrand II by Michel Gourgand and Patrick Kellert Gourgand in the early 90s. With this methodology, we have developed a model of knowledge (with Petri nets) which allowed us to formalize the different knowledge of the system; some models of actions (using simulation with ARENA software) to assess the performance of the system; and a model of results that has provided indicators to intervene and to improve the system if necessary. And to optimize the results found, we have coupled our simulation with an optimization tool "OptQuest for ARENA". Second, the distributed control has enabled us to proceed to the coordination of planning for periodic assistance of the maternity home care. To achieve this goal, we have borrowed a tool of problem formulation applied in industrial engineering which is "MLCLSP (Multi-Level Capacitated Lot Sizing Problem). We have developed a mixed linear optimization algorithm that allows us to obtain optimal results for the planning of medical visits to pregnant women who had previously register to the platform for maternity home care assistance. The optimization of the algebraic model of decision is realized in the MIP solver (Mixted-Integer Programing) - CPLEX, implemented in GAMS (General Algebraic Modeling System)
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Norly Germain. Contribution à l'ingénierie des systèmes de production de soins dans les pays en voie de développement : vers un système sans murs en Haïti. Sociologie. Université de Lorraine, 2012. Français. ⟨NNT : 2012LORR0327⟩. ⟨tel-01749406⟩



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