Wednesday, July 31, 2019

Literature review †Anxiety and Depression in the Workplace Essay

Emotional concerns in the workplace are a considerable loss to employee’s health and welfare. They slow down the performance of employee and so they are harmful to the organisational well-being as well. This literature review would put forward a concise introduction on the two frequently occurring emotional concerns in the workplace: anxiety and depression. Anxiety and depression are a usual and adaptive reaction to the individual who is undergoing such emotional problems in our surroundings. They are a normal part of life, and would take place at any time when there are considerable positive or negative changes in one’s life. In general, it is believed that some of the anxiety and depression are challenging and positive one but some are negative where the individuals feel difficult to handle it. Anxiety and depression would take place in personal life as well as work life. This literature review is mainly focused on how an employee who is suffering from anxiety and depression should behave and at the same time how managers should handle the situations when his/her employee is suffering from anxiety and depression. Analyzations and insinuations of such emotional problems are discussed in this review. Moreover, this literature review is endowed with sensible understanding in support of recognizing and dealing with the anxiety and depression in the workplace. This review also focuses on the role of manager as supporter to the employees by taking necessary initiative steps to decrease the possibilities of anxiety and depression in the workplace. Defining Depression and Anxiety: Defining the term ‘depression’ is very complex because of the involvement of intrinsic uncertainty. According to , ‘ depression can be witnessed as a condition of mood, as a special symptom manifesting itself in many different mental disorders, as a syndrome measured by depression rating scales, and as a clinical diagnosis operationalised in diagnostic classifications’. (Weiten, 2001) and (Barlow, 2005), who are the psychology book writers, highlighted the debilitating effect that depression has on an individual which was agreed by different researchers and scholars. Through his findings, Blair stated that depression is severely debilitating and the most common mental health disorder affecting society. This was further detailed in 2000 by Akiskal that irregular depressive mood experienced as low spirits, dejection, and sadness can be a normal reaction to disappointments, adversities, and losses and should be differentiated from depressive disorders, which represent actual psychological illness and are often accompanied by distinct impairment of psychological, somatic, and social functioning . Bender and Furman agreed with Blair and came to the conclusion in 2003 that depression was found to probably be incurable and had raised to become the world’s number one public health problem. An American judge held that depression is a misleading term for an extremely debilitating illness. (Seligman, et al.,) defined anxiety as â€Å" psychological and physiological state characterized by by somatic, emotional, cognitive, and behavioral components†. Davison stated that â€Å"it is the displeasing feeling of fear and concern† . Depression and Anxiety in the work place: In the present status of the economy, anxiety and depression in the workplace are the rising concerns where the employees are facing more and more situations of work overload, no job safety, no job satisfaction, and lack of self-sufficiency. Depression has significant economic impacts relative to lost productivity within the workplace . Workplace anxiety and depression have been exposed to have unfavorable impacts on employees’ health, well-being, workplace productivity, absenteeism, and workplace performance. Lost productivity involves presenteeism, in which the employee is present in the work setting but productivity is reduced due to health concerns or depressive symptoms, or in terms of absenteeism from work . Anxiety normally occurs when an individual senses that he/she is just going to face some circumstances on which he/she will not have control and ability to manage the situations. Particularly, workplace is the main ground where such situations happen to occur. Changes in the company such as restructurings, amalgamations and change in company policies are quite common incidents which take place in an organisation are some of the source anxiety. Now a day’s most of the organisations are trying to cut off their personnel to the least by putting more pressure on employees and overloading them with more work than their capacity to handle are also one of the main cause of anxiety. In workplace, employees are likely to suffer from anxiety in the following situations; when dealing with austere managers, when there are possibilities of downgrading, being tensed whether they can get their job task completed on time, Panic of getting terminated from their job In any organisations, there are certain existing rules, regulations and company policies which all the employees are enforced to stick on to. At times, these systems of the company can also cause anxiety and depression to an employee when there is some clash of pursuits between acting based on what he/she thinks is right and what the current system of the company states. Moreover, this situation can be pointed up further when the employees have to pact with customers or with the bond with their colleagues. Generally all the employees try to relieve their own anxiety and depression either by adjusting with their work environment or by resigning their job. To overcome such situations, individuals as well as organisations can take some initiative steps to ease the harmful impacts of anxiety and depression, or to prevent it from coming up in the initial stage. Effect of Depression and Anxiety: The course of adjustment to work environment results in employees’ anxiety and depression. Workplace stress is usually caused by employees’ acuity about their position in the organisation and includes the role of variance and role of vagueness. An employee’s perception of his/ her position in the workplace comes up from the job designation, interpersonal bond models, as well as from the emotion of discreteness and relation to others. Workplace depression states several behavior performance and behavioral shortfalls of an individual in the workplace (Lerner, et al., 2004; National Institute of Mental Health, 2011; Wallace, 2011; Wang et al., 2008). An employee who is suffering from anxiety and depression is affected psychologically, physiologically, cognitively. Some of the psychological effects are aggressiveness, evading societal situations, tapered forbearance to hand stress, loosing temper, becoming impatient deprived motor control. Physiologically, employee can suffer from fast heart beating, clammy hands, often headaches, muscle inflexibleness and aches, difficulties in breathing, indigestion, high blood pressure, frequent mood swings, change in eating habits, falling sick regularly and changes in weight. Anxiety would cognitively affect an individual’s capability of focusing, memory power and motor skills. Sometimes, an individual may not recall the names of the person whom he/she know or fails to remember what task he/she wanted to do. Depression and anxiety in the workplace would even effect the organisation in terms of financial loss. It was anticipated that 12 billion dollars was lost by the business and industry from lost output, 12 billion dollars was lost from non-attendance, for direct treatment costs business lost 26.1 billion dollars, and 5.4 billion dollars was lost due to death (Greenberg, et al., 2003; Lerner, et al., 2004). How employees should control their anxiety and depression? There are more possibilities of retaining the talents and experiences of the depressed employee for the organisations, if he/ she takes break for sometime from the work and then return back in a suitable and meaningful role. This would also decrease the possibilities of such occurrence of such situations. Every employee should know how to identify the situations of anxiety and depression and need to make use of personal coping strategies and develop. Employee can use the following methods in coping with their stress ; Meditating – learning Yoga Laughing therapy Spending some time in their hobbies on regular basis Sharing of feelings with their close ones Relaxation techniques – profound breathing, progressive relaxation, listening to relaxation music, massage therapy and hot baths Maintaining balanced diet Depressed employees need enough sleep Avoid consuming caffeine Exercising or joining in dance, swimming classes etc. These techniques will help in muscles relaxing; slowing down the heart beats and reduce emotional problems. This will also help them to concentrate and focus on things and manage anxiety and depression without any difficulty. Role of Organisation as supporters: First of all, the organisation should concentrate on the following question to determine where they are going wrong. i. Is there any circumstance that triggers employees’ anxiety in the workplace? ii. Is there any changes taking place in the organisation frequently? iii. Do the new rules and policies are threatening the employees? iv. Is there any terminations frequently done in the company that trigger the anxiety level of the employees? Successful organisations would assist their employees to defy the bigger demands, reduce their panics and negative levels in the market and the country as a whole. To overcome the emotional problems of the employees, the organisation should start implementing some strategies that can be useful in reducing the effect of depression and anxiety. The approaches are as follows; Company should allow the employer and employees to informal and frank communications so that both can have an opportunity of expressing any apprehensions. Company should have the best policies and procedures in the workplace ensuring the employees’ well-being. Company should send a message stating its support for each employee’s emotional concerns to all the employees. Organisation should aware of the work pressures handled by the employees, percentage of absenteeism and employees’ illness. They should also review their present policies and systems and indentify the positives and negatives of the same so as to change the policies suitable to the organisation. They should implement mental health policy which shows the commitment of the employer of taking care of all the employees who work for the organisation. This will prove that organisation identifies and agrees to the importance of psychological issues of the employees. Companies should make sure that all the employees feel their importance in the organisation and accept them as a part of the organisation. This will also help to reduce the stress level of the employee. They should implement management training and development with regards to anxiety and depression in the workplace. Training should be provided to employees about anxiety and depression. They should learn to identify the symptoms of depression on their own.. This will indeed help the employee’s to know recognise their problem at ease and prevent the circumstances before getting poorer. Manager should also be trained about depression and anxiety so as to be aware about the behavioural changes in the depressed and anxious employees and provide them assistance when need. To decease the situations of depression and anxiety among the employees, quite a lot of researchers have shown that organisations that implement training approaches to the managers tend to avoid practicing the following; Setting unrealistic short task deadlines Giving multifaceted job tasks to the employees without decision making authority Giving repetitive and tedious jobs only to the employee who is capable to doing thing much more than it Deprived management practices where managers are not supportive to the employees and takes unfair decisions. Not giving recognition and not congratulating for good tasks achieved by the employees Organisation should focus on employee engagement; implement programmes like Employee Assistance Programme (EAP), Stress Management Programme. Role of Employers as supporters: Different people are affected by depression and anxiety in different ways. Some people who experience anxiety or depression would manage to handle the situation and would continue with their work. But some people would definitely need a break. In such situations, there should be someone in the organisation to support the employee to return back to the workplace and this is possible only by the employers. Employers are required to realise the basis of such type of psychological problems, prevention of such emotional problems, and the array and efficiency of different treatments related to such problems. Employees can improve their performance of the work with the correct extent of anxiety. But if employee’s level of anxiety goes beyond the right extent, then there are possibilities of interference of anxiety with the employees’ performance of the work and their efficiency level. Employers are required to be familiar with various levels of anxiety or depression to facilitate the employees’ with an atmosphere that brings out their most excellent performances. How to identify anxiety or depression in the workplace? Employers should be conscious of the symptoms of depression and anxiety in the workplace. They should also try to identify the changes in the behavioral aspects of their employees. Some of the symptoms are as follows ; Irreconcilable or decreased productivity, Absenteeism, unpunctuality, or often nonappearance in the job site, Increased mistakes, decreased work excellence, Postponement, failure to reach targets, Extraction from collaboration, teamwork, or unnecessary arguments with colleagues, Over perceptive, over-responsive feelings, Becoming too besieged to work, Showing less interest in the work, Decreased work performance or deliberation procedures, Problems in focusing or recalling work responsibilities, Exhaustion and diminished energy level, Lessened attention, and Impaired educational and professional achievement How employers should deal with depressed or anxious employees? Employers should follow the below steps to deal with depressed or anxious employees. They should try to get some knowledge in regards to anxiety and depression, so as to obtain some ideas on what type of emotional problems the employees are undergoing and in what way they can support them. If the employees hesitate to respond to the questions, the employers should lend a hand to them to bring out their fears by showing care and supporting them. This would help to decrease their level of anxiety. Once the feasible ideas are identified, they should have informal meetings with their employees; listen to their problems and determine how to help them and offer support and encourage to them completely. Employees’ feels that their experiences are sensible. If they feel that they are depressed due to particular work related problems, then the employers should try to listen to their views in a laissez-faire manner and take action aptly. If any employee is acts in a different way, then the employer as well as co-workers should keep in mind that this is an outcome of his/her ill health and understand that it is not their fault. While taking these steps, it is the responsibility of the employers to maintain confidentiality about the health issues of depressed employee from other employees. Employers should inform other staffs in case of any changes in the work allocations without letting down the privacy of depressed employee. This would reduce the possibility of tittle-tattle among the other employees. Employers should be in contact with the employees when they are absent to the work and they can also provide a chance to them to present their views on tasks that are likely to happen in the office, in spite of their absence. They should provide them assistance personally and practically. For example, take them out with other staffs after office hours, encouraging them in their work, advising them eat well, inviting them to have lunch together. Employers should try to make their employees to feel more comfortable in the workplace by inviting them as well in the meetings, work related societal events to support them for speedy recovery from depression and anxiety. All the above steps would help the employee to get rid of their depression and anxiety and concentrate on their work. This will also help the employee to increase their motivation level and self esteem. Moreover, these steps will also help the managers and the organisation to be successful by increase in productivity and company profits. Conclusion: Various finding proves that depression and anxiety has negative impacts on individual, as well as organizations. This impact continues to be raising concern in the economy. Most of the people who are suffering from depression are working without taking any breaks with the anxiety of being terminated. Some try to control their depression by the awareness. Either directly or indirectly, depression has been the reason for many death by high blood pressure, heart attacks etc. Most of the workers are suffering physically and emotionally in the workplace due to harmful workplace atmosphere. From this literature review it is proved that these situations can be managed by individuals or by the management or by the organisation to reduce the psychological illness of the employees. Changes should be done from the hierarchy level and hence it is essential for the managers to identify that they have moral responsibility and authority to protect the physical and mental health of their employees . If the organisations follow the strategies and approaches mentioned in this literature review that and prevent employee from the emotional problems, facilitate required treatment, then the company can increase the net gains in productivity. References 1. Canadian Mental Health Association. (2009). Coping with too much stress. Retrieved 2012, from http://cmhanl.ca/education/publications/cwtms/index.php. 2. Angela, S. (2010). Anxiety and Stress: How Poor Performance and Absenteeism Affect the Workplace. Florida, USA: Dissertation.com. 3. Akiskal, H. S. (2000). Mood disorders: clinical features. In B. J. Sadock, & V. A. Sadock, Comprehensive textbook of psychiatry (7 ed., Vol. 1, pp. 1338–1377). Philadelphia: Lippincott Williams & Wilkins. 4. Barlow, D. H., & Durand, M. V. (2005). Abnormal Psychology: An Integrative Approach. 5. Bender, A. (2009). Depression in the workplace: Recognition and response. Benefits Canada 33 , 41. 6. Bender, K., & Furman, R. (2003). The Social Problem of Depression: A Multi-theoretical Analysis. 30 Journal of Sociology and Social Welfare , 123 . 7. Blair, D. A. (1999). Employees Suffering from Bipolar Disorder or Clinical Depression: Fighting an Uphill Battle for Protection Under Title 1 of the Americans with Disabilities Act. 12 Seton Hall Law Review , 1347. 8. Clark, J. (2002). Stress: A management guide. London: Spiro Press. 9. Cox, A. A., Ness, K. M., & Carlson, R. F. (2010). International perspectives on depression in the workplace. Retrieved 2012, from http://counselingoutfitters.com/vistas/vistas10/Article_04.pdf. 10. Cox, A. N. (2008). Depression in the workplace. Retrieved from VISTAS 2008 Online: http://counselingoutfitters.com/vistas/vistas08/Cox.htm 11. Davison, G. C. (2008). Abnormal Psychology. Toronto: Veronica Visentin. 12. Eyers, K., & Parker, G. (2011). Tackling Depression At Work: A Practical Guide for Employees and Managers. New York: Routledge. 13. Frew, J. (2004). Motivating and leading dysfunctional employees. In J. C. Thomas, & M. Hersen (Eds.), Psychopathology in the workplace: Recognition and adaptation (pp. 293-311). New York: Brunner-Routledge. 14. Greenberg, P. E., Kessler, R. C., Birnbaum, H. G., Leong, S. A., Lowe, S. W., Berglund, P. A., et al. (2003). The economic burden of depression in the United States: How did it change between 1990 and 2000? Journal of Clinical Psychiatry, 64 , 1465-1475. 15. Healey, J. (2006). Anxiety and depression. Thirroul, N.S.W.: Spinney Press. 16. Hayes, J. (2011). Dealing with Anxiety and Depression in the Workplace. Retrieved 2012, from http://www.ibectraining.ie/IBEC/Training/IBECTAD.nsf /vPages/Information_Centr

Health System in Egypt

Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO Contents F O R E W O R D †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 5 1 E X E C U T I V E S U M M A R Y †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 7 2 S O C I O E C O N O M I C G E O P O L I T I C A L M A P P I N G †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 11 2. 1 Socio-cultural Factors †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢ € ¦Ã¢â‚¬ ¦ 1 2. 2 Economy †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 11 2. 3 Geography and Climate †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 12 2. 4 Political/ Administrative Structure †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 12 3 H E A L T H S T A T U S A N D D E M O G R A P H I C S †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 14 3. 1 Health Status Indicators †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 4 3. 2 Demography †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 15 4 H E A L T H S Y S T E M O R G A N I Z A T I O N †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 17 4. 1 Brief History of the Health Care System †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 17 4. 2 Public Health Care System †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 17 4. 3 Private Health Care System†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 20 4. 4Overall Health Care System †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 21 5 G O V E R N A N C E /O V E R S I G H T †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 23 5. 1 Process of Policy, Planning and management †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 23 5. 2 Decentralization: Key characteristics of principal types †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 24 5. 3 Health Information Systems†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢ € ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 27 5. 4 Health Systems Research†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 8 5. 5 Accountability Mechanisms †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 28 6 H E A L T H C A R E F I N A N C E A N D E X P E N D I T U R E †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 29 6. 1 Health Expenditure Data and Trends †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 29 6. 2 Tax-based Financing †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚ ¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 32 6. 3 Insurance †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 33 6. 4Out-of-Pocket Payments †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 40 6. 5 External Sources of Finance †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 41 6. 6 Provider Payment Mechanisms †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 41 7 H U M A N R E S O U R C E S †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â ‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 45 7. 1 Human resources availability and creation †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 45 7. 2 Human resources policy and reforms over last 10 years†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 55 8HEALTH SERVICE DELIVERY†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 59 8. 1 Service Delivery Data for Health services †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 59 8. 2 Package of Services for Health Care †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 63 8. 3 Primary Health Care †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 63 8. 4 Non personal Services: Preventive/Promotive Care †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 75 8. 5 Secondary/Tertiary Care †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 7 8. 6 Long-Term Care †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 90 8. 7 Pharmaceuticals †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚ ¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 89 8. 8 Technology †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦.. 100 9 HEALTH SYSTEM REFORMS†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 101 9. 1 Summary of Recent and planned reforms †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 101 10REFERENCES †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 107 11. ANNEXES †¦Ã¢â ‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦. 11. 1 Ministry of Health and Population Organogram†¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦ 1 Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO List of Tables Table 2. 1 Socio-cultural indicators Table 2. 2 Economic Indicators Table 2. 3 Major Imports and Exports Table 3. 1 Indicators of Health status Table 3. 2 Indicators of Health status by Gender and by urban rural 2006Table 3. 3 Top 10 causes of Mortality Table 3. 4 Demographic indicators Table 3. 5 Demographic indicators by Gender and Urban rural Table 6. 1 Health Expenditure Table 6. 2 Sources of finance, by percent Table 6. 3 Health Expenditures by Category Table 6. 3. 1. Health care financing i n Egypt: coverage, eligibility and benefits Table 6. 4 Population coverage by source Table 6. 4. 1 Distribution of HIO beneficiaries by law (1995–2002) Table 6. 4. 2 Comparison between 2002 and 1995 estimates Table 6. 4. 3 Comparative expenditures and subsidies from MOF to hospital services, financial year 2004/2005Table 6. 4. 4 Performance Indicators Table 7. 1 Health care personnel Table 7. 1. 1 Staff registered with syndicates Table 7. 1. 2 Comparison of staff registered and in post in MOHP, December 2005 Table 7. 1. 3 Staff registered and in post in MOHP plus percentage increase in difference over 20 years Table 7. 1. 4 Physicians and nurses by health sector (%) Table 7. 1. 5 Geographical distribution of MOHP physicians and nurses Table 7. 1. 6 Distribution of physicians and nurses by governorate per 100,000 population (2005) Table 7. 2 Human Resource Training Institutions for Health Table 8. 1Service Delivery Data and Trends Table 8. 1. 1 Improvement in hospital based se rvices (1996–2005) Table 8. 1. 2 Distribution of health facilities across Egypt (2006) Table 8. 1. 3 Distribution of health care workers in Egypt (2006) Table 8. 1. 4 Comparison of specialists (2005) Table 8. 1. 5 Comparison of specialists (2005) Table 8. 1. 6 Comparison of MOHP and HIO registered and in post personnel2005 Table 8. 1. 7 Distribution of physicians with private clinics by number of jobs (%) 2 Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO Table 8. 1. 8 Governorates distribution according to phasesTable 8. 1. 9 Basic preventive and promotional public health services Table 8. 2 Inpatient use and performance Table 8. 2. 1 National distribution of inpatient beds by type of facility (2005) Table 8. 2. 2 Change in hospital beds by type of provider (1991, 1997, 2001) Table 8. 2. 3 MOHP strategy (1997, 2001, 2017) Table 8. 2. 4 Distribution of physicians among some service providers (2002) Table 8. 2. 5 Bed distribution by health provider in go vernorates Table 8. 2. 6 Beds/population by governorate and type of provider (2005) Table 8. 2. 7 Private sector providers (2005) Table 8. 2. 8Private sector services (2002) Table 8. 7 expenditure by type of provider and ownership (2005) 3 Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO List of Figures Figure 1 Uses of health resources, by categories of providers Figure 2 Sources of revenues for the health sector, 1995 Figure 3 Distribution of HIO beneficiaries by law (1995–2002) Figure 4 Distribution of physicians and nurses by governorate per 100,000 population (2001) Figure 5 Beds per populations in governorates Figure 6 Growth trends in the pharmaceutical market Figure 7 Expected value of the market size in 2010Figure 8 Trend in drug consumption as expenditure per capita Figure 9 Drug expenditure in private and governmental sector Figure 10 Distribution of drug consumption by therapeutic category (2001–2002) 4 Health Systems Profile- Egypt R egional Health Systems Observatory- EMRO F OREWORD Health systems are undergoing rapid change and the requirements for conforming to the new challenges of changing demographics, disease patterns, emerging and re emerging diseases coupled with rising costs of health care delivery have forced a comprehensive review of health systems and their functioning.As the countries examine their health systems in greater depth to adjust to new demands, the number and complexities of problems identified increases. Some health systems fail to provide the essential services and some are creaking under the strain of inefficient provision of services. A number of issues including governance in health, financing of health care, human resource imbalances, access and quality of health services, along with the impacts of reforms in other areas of the economies significantly affect the ability of health systems to deliver.Decision-makers at all levels need to appraise the variation in health system perfor mance, identify factors that influence it and articulate policies that will achieve better results in a variety of settings. Meaningful, comparable information on health system performance, and on key factors that explain performance variation, can strengthen the scientific foundations of health policy at national, regional and international levels.Comparison of performance across countries and over time can provide important insights into policies that improve performance and those that do not. The WHO regional office for Eastern Mediterranean has taken an initiative to develop a Regional Health Systems Observatory, whose main purpose is to contribute to the improvement of health system performance and outcomes in the countries of the EM region, in terms of better health, fair financing and responsiveness of health systems.This will be achieved through the following closely inter-related functions: (i) Descriptive function that provides for an easily accessible database, that is co nstantly updated; (ii) Analytical function that draws lessons from success and failures and that can assist policy makers in the formulation of strategies; (iii) Prescriptive function that brings forward recommendations to policy makers; (iv) Monitoring function that focuses on aspects that can be improved; and (v) Capacity building function that aims to develop partnerships and share knowledge across the region.One of the principal instruments for achieving the above objective is the development of health system profile of each of the member states. The EMRO Health Systems Profiles are country-based reports that provide a description and analysis of the health system and of reform initiatives in the respective countries. The profiles seek to provide comparative information to support policy-makers and analysts in the development of health systems in EMRO.The profiles can be used to learn about various approaches to the organization, financing and delivery of health services; descri be the process, content, and implementation of health care reform programs; highlight challenges and areas that require more in-depth analysis; and provide a tool for the dissemination of information on health systems and the exchange of experiences of reform strategies between policymakers and analysts in different countries.These profiles have been produced by country public health experts in collaboration with the Division of Health Systems & Services Development, WHO, EMRO based on standardized templates, comprehensive guidelines and a glossary of terms developed to help compile the profiles. A real challenge in the development of these health system profiles has been the wide variation in the availability of data on all aspects of health systems. The profiles are based on the most authentic sources of information available, which have been cited for ease of reference. For maintaining consistency and comparability in the sources of 5Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO information, efforts have been made to use as a first source, the information published and available from a national source such as Ministries of Health, Finance, Labor, Welfare; National Statistics Organizations or reports of national surveys. In case information is not available from these sources then unpublished information from official sources or information published in unofficial sources are used. As a last resort, country-specific information published by international agencies and research papers published in international and local journals are used.Since health systems are dynamic and ever changing, any additional information is welcome, which after proper verification, can be put up on the website of the Regional Observatory as this is an ongoing initiative and these profiles will be updated on regular intervals. The profiles along with summaries, template, guidelines and glossary of terms are available on the EMRO HSO website at www. who. int . healthobservatory It is hoped the member states, international agencies, academia and other stakeholders would use the information available in these profiles and actively participate to make this initiative a success.I would like to acknowledge the efforts undertaken by the Division of Health Systems and Services Development to help countries of the region in better analyzing health system performance and in improving it. Regional Director Eastern Mediterranean Region World Health Organization 6 Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO 1 E XECUTIVE S UMMARY Egypt is going through a demographic and epidemiological transition that is affecting both the size and health status of the population. The population growth rate has fluctuated from a low of 1. 92% a year during 1966–1967, to 2. 5% annually during 1976–1986, later declining to 2% a year during 1980–1993 and 2. 1% annually in 2001. Changes in fertility and mortality rates ha ve been the major source of population growth in Egypt. The population pyramid has a wide base with children aged under 15 representing 37% of the population, reflecting relatively high fertility in recent years. The proportion of children aged under 10 years is smaller than the proportion aged 10–14 years. The rate decreased from 80 in 1988 to 69 in 2000, so the proportion of productive group aged 15–64 years has increased.The average age of the population has risen, with a life expectancy from birth of 65. 5 years for males in 1996 to 69. 2 years in 2006. It is higher for women than for men (69. 2 and 73. 6 years, respectively). Egypt is a lower-middle-income country with a per capita gross national product (GNP) that doubled between the years 1993 and 1999, from US $600 to $1200 (DHS, 2000). The Egyptian economy has witnessed a turnaround in growth performance following a period of economic slow-down that started in 1986.The adoption of the open door policy in 1975 afforded the Egyptian economy a decade of rapid economic growth, supported by large inflows of foreign assistance, workers’ remittances, and oil and tourism revenues. The drop in oil prices in 1986 signaled the end of a decade of economic boost, underscoring the volatility of Egypt’s key revenues sources and the constraints of an inward-oriented growth strategy. With the success of the stabilization program in achieving its objectives, Egypt has been successful in reversing the slow growth rates that characterized the period 1991–1995.Real GDP grew annually at an average of 3. 8% during 1993–1996 and at an average of 6% during 1996–1998. Inflation has been brought down from a peak of 21% in 1992 to 7% in 1996 and 3. 6% by 2000 (UNDP, 2000). While public expenditure on health in terms of budget share appears to be low in Egypt, overall spending at 3. 7% of GDP is also low, when compared to other comparable income countries. The Ministry of Health an d Population (MOHP) budget, as part of the entire Government budget, increased from 2. 2% in 1995/1996 to 3. % in 2000/2001 and the MOHP expenditure per capita increased from LE26. 8 in 1996 to LE56. 7 in 2001. The health financing system in Egypt today manifests significant systemic inefficiencies and inequities that severely limit the effectiveness of the health system as a whole. Any attempts to expand the scope of services or increase the revenues and expenditures on health care without first addressing these systemic bottlenecks in the health financing system will result in further exacerbating the inefficiencies and inequities in the system.The existing system of health financing mechanisms in place today, whether it is through the general revenues Ministry of Finance or the Health Insurance Organization system or through private spending, establishes a regressive pattern of resource mobilization and resource allocation. Inequities are evident across many dimensions, in terms of income levels, gender, geographical distribution (rural and urban, and by governorate levels), and health outcomes. 7 Health Systems Profile- Egypt Regional Health Systems Observatory- EMROThe coverage of the Egyptian population with the National Health Insurance scheme is increasing through the addition of new population groups under the umbrella of social health insurance, for example school children and newborn children. In the year 1980, the coverage was 4% of the total population, and it doubled in 1990. In the year 1995, it reached 36% and increased over the last ten years to 45%. Out of pocket spending has been rising over past decade and currently stands at 62%. HIO does not reach 80% of the private sector workforce.Highest governmental healthcare spend is proportionately in lowest income quintile. The 1952 Constitution pronounced free medical care as a basic right for all Egyptians. The Government has been the sole provider and financier of all primary/preventive and mos t inpatient curative care in Egypt. However, over the past two decades governmental budgetary constraints have resulted in relatively stagnant health expenditures. The structural adjustment program has also reduced the government's resource position vis-a-vis allocation for social services sectors in general, and health services in particular.The Egyptian health system has a pluralistic nature with a wide range of health care providers competing and complementing each other, allowing clients freedom of choice when seeking care according to their needs and ability to pay. However, the Government is committed to providing health care to poor and unprivileged population groups. Parallel to, and related to, its demographic transition, Egypt is currently facing an epidemiological transition that is characterized by:  ¦ Reduced mortality rates among infants and children from diarrhea, immunization-preventable diseases and respiratory infections. Rising prevalence of risk factors such as obesity, smoking and hypertension, responsible for chronic diseases.  ¦ A changing socioeconomic environment leading to different diets, increased industrialization, and increased motor vehicle traffic accidents. The distribution of the burden of diseases has changed from a predominance of infectious and parasitic diseases to a different mortality pattern whereby cardiovascular diseases are currently the leading cause of mortality (45% in 1991, compared to 12% in 1970 and 6. 3% in 2001).Egypt is therefore affected by a dual burden of disease, thus associating the morbidity and mortality patterns of developing countries with those induced by modernization. As a result of the demographic and epidemiological transition, the major health and population challenges are: 1. Population growth 2. Burden of endemic and infectious diseases 3. Maternal, infant and childhood mortality 4. Burden of chronic diseases, renal failure and cancer 5. Injuries and accidents 6. Smoking, other addiction s, and their complications 7. Disabilities and congenital anomalies 8 Health Systems Profile- EgyptRegional Health Systems Observatory- EMRO 8. Human resources (capabilities, skills, knowledge, allocation, salaries and incentives) 9. Infrastructure (buildings, equipment, furniture and maintenance) 10. Basic public services (housing, unplanned areas and slums, potable water, sewage disposal). The health system has significant strengths and weaknesses resulting from its continuing evolution. The performance of the sector with respect to health services, human resources, physical infrastructure, financing, organization and management, and the pharmaceutical sector will be assessed in following eight sections.Ministry of Health and Population has decided on a reform program based on the strengths of the current system, while at the same time rectifying its weaknesses. The Government of Egypt has embarked on a major restructuring of the health sector. This reform was deemed necessary bec ause the MOHP and its main partners had identified fragmentation in the delivery of health services, excessive reliance specialist care and low primary care service quality as the main constraints to achieving universal coverage.The Egyptian Health Sector Reform Program (HSRP) was officially launched in 1997. The World Bank (WB) started its contribution by designing the Master Plan for Montazah Health District in Alexandria Governorate, in May 1998. By the following year, in 1999, United States Agency for International Development (USAID) was the first donor to begin field-level operations, while the European Commission (EC) joined the HSRP in November 1999. The African Development Bank (ADB) initiated its work through designing Master Plans for three health districts in June 2003.The most recent partner at HSRP is the Austrian Government, which directs its participation to improving the district hospitals as part of health district approach. The overall aim of the HSRP is twofold. Firstly to introduce a quality basic package of primary health care services, contribute to the establishment of a decentralized (district) service system and improve the availability and use of health services. Secondly to introduce institutional structural reform based on the concept of splitting purchasing/providing and the regulatory functions of the Ministry of Health and Population.Coverage would be provided by a National Social Insurance System. The ultimate goal of health sector reform initiatives is to improve the health status of the population, including reductions in infant, under-five, maternal mortality rates and population growth rates and the burden of infectious disease. The HSRP has meanwhile initiated a new primary care strategy in accredited facilities, known as Family Health Units (FHU’s). Facilities are being contracted by a purchasing agency -the Family Health Fund (FHF) – to provide services to the population.It is envisaged that the HSRP will g radually extend its scope to the secondary level by establishing â€Å"District Provider Organizations†. The FHF will consequently develop in the direction of a full purchasing agency of services from the public and private sector. The newly introduced Family Health Model (FHM) constitutes one of the cornerstones of the reform program. It brings high quality services to the patient and will integrate most of the vertical programs into the Basic Benefit Package of services.To date the FHM has been introduced in 817 health facilities, which present 18% of the total public primary health care facilities. HSRP has an ambitious five years plan, by the end of year 2010, to cover the entire public primary health care facilities with the Family Health Model. The Egyptian Health Sector Reform Program went through several stages, including the preparatory stage from 1994 to 1996. During this stage, several valuable studies were conducted and used later to develop the â€Å"Strategies for Health Sector Change† study. 9 Health Systems Profile- Egypt Regional Health Systems Observatory- EMROThis was an analytical report on the Egyptian health sector. Designing the health Master Plans stage for the three pilot governorates followed this. Experimenting stage of the Family Health Model took place in one of the primary health care facilities, which took about two years to implement. This was followed by piloting stage of the Model in three governorates followed by another two governorates and included activities such as: Building staff pattern, designing the contents of the Basic Benefits Package and Essential Drug List, and other components of the Family Health Model.The Program has shifted its strategy in March 2003 from health facility oriented approach to the district approach, which was called the District Provider Organization. As of 2005, the HSRP has gradually expanded its operations to ten additional governorates, pushing the total number of involved gov ernorates to 15, which presents more than 50% of the country coverage.The Health Reform Program has three main components; (1) Service component as seen in the Family Health Mode, (2) Mandate role and functions of the Ministry of Health and Population, and (3) Introduction of a sustainable universal health insurance system. It is envisaged that all three goals and objectives can be achieved in an Integrated District Health System model. All the necessary elements are available and the Sector for Technical Support and Projects (STSP) is in developing process for an integrated health system based on a district that is evaluated internally and externally and be replicable.The Integrated District Health System (IDHS) is the district that covers the following criteria; (1) fully implements the District Provider Organization, (2) has financial sustainability, (3) separates providing from financing of health services, (4) implements the content of the district health coverage plan, (5) pro vides basic benefits and secondary care packages through public, private and NGO, (6) and applies quarterly measures for the achievements of HSRP’s five objectives. 10 Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO 2 S OCIO E CONOMIC G EOPOLITICAL M APPING 2. Socio-cultural Factors Table 2-1 Socio-cultural indicators Indicators 1990 1995 2000 2004 – – – – Literacy Total: 48. 8 (92) 57. 7 (98) 67. 4 (02) 69. 4 02) Female Literacy to total literacy: 35. 3 (92) 65. 9 (98) 63. 4 (01) 67. 4 02) Women % of Workforce 29. 2(93) 18. 0(96) 18. 5(01) 21. 8(02) Primary School enrollment 98. 0(92) 98. 5(98) 91. 7(01) 99. 2(02) % Female Primary school pupils 80. 4(92) 84. 5(98) 93. 2 107. 1(02) %Urban Population 44. 0(86) 43. 0(96) 42. 8 57. 6 Human Development Index: Source: NICHP Report, Ministry of Health and Population, 2005. Egypt Human Development Report, 1995, 1999, 2003, 2004. . 2 Economy Key economic trends, policies and reforms Lack of substantial progress on economic reform since the mid 1990s has limited foreign direct investment in Egypt and kept annual GDP growth in the range of 2%-3% in 200103. However, in 2004 Egypt implemented several measures to boost foreign direct investment. In September 2004, Egypt pushed through custom reforms, proposed income and corporate tax reforms, reduced energy subsidies, and privatized several enterprises. The budget deficit rose to an estimated 8% of GDP in 2004 compared to 6. 1% of GDP the previous year, in part as a result of these reforms.Monetary pressures on an overvalued Egyptian pound led the government to float the currency in January 2003, leading to a sharp drop in its value and consequent inflationary pressure. In 2004, the Central Bank implemented measures to improve currency liquidity. Egypt reached record tourism levels, despite the Taba and Nuweiba bombings in September 2004. The development of an export market for natural gas is a bright spot for futu re growth prospects, but improvement in the capital-intensive hydrocarbons sector does little to reduce Egypt's persistent unemploymentTable 2-2 Economic Indicators Indicators 1990 GNI per Capita (Atlas method) current US$ 2000 2004 NA GNI per capita (PPP) Current International Real GDP Growth (%) 1995 1. 9 (91-92) 5 (95-96) 3. 4 (00-01) 4 (03-04) 11 Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO Real GDP per Capita ($) (91- 92) 769 1,285 1,036 9. 2 (91-92) Unemployment % (estimates) 1,143 9. 6 (91-92) 9. 0 (01) 10. 2 (03) Source: Egypt Human Development Report, 2003. Ministry of Foreign Trade, Egypt, Monthly Economic Digest, February 2005. Table 2-3 Major Imports and Exports Major Exports:Crude oil and petroleum products, cotton, textiles, metal products and chemicals. Major Imports Machinery and equipment, foodstuffs, chemicals, wood products and fuels. 2. 3 Geography and Climate Map of Egypt Arab Republic of Egypt is located at the northern Africa, border ing the Mediterranean Sea, between Libya and the Gaza Strip, and the Red Sea north of Sudan, and includes the Asian Sinai Peninsula. Total area is 1,001,450 sq km (land: 995,450 sq km, water: 6,000 sq km). A total of 2,665 km border countries: Gaza Strip 11 km, Israel 266 km, Libya 1,115 km, Sudan 1,273 km.Coastline is 2,450 km. The climate is desert; hot, dry summers with moderate winters. Natural resources; petroleum, natural gas, iron ore, phosphates, manganese, limestone, gypsum, talc, asbestos, lead and zinc. 2. 4 Political/ Administrative Structure The chief of state is the President, head of government is the Prime Minister. Bicameral system consists of the People's Assembly or Majlis al-Sha'b (454 seats; 444 elected by popular vote, 10 appointed by the president; members serve five-year terms) and the 12 Health Systems Profile- Egypt Regional Health Systems Observatory- EMROAdvisory Council or Majlis al-Shura – which functions only in a consultative role (264 seats; 1 76 elected by popular vote, 88 appointed by the president; members serve sixyear terms; mid-term elections for half the members). People's Assembly election is in three phase voting, last held 19 October, 29 October, 8 November 2000 (next to be held October-November 2005); Advisory Council – last held May-June 2004. The Shoura Council was established constitutionally in 1980. The Shoura Council is mainly a â€Å"think-tank† to advise the Government on national policies.A committee of the Shoura Council on Health, Population and Environment examines issues relevant to these areas prior to their discussion in the Shoura Council’s plenary sessions. Although it does not have a direct legislative role, laws impacting significantly on broad government policy are required to be discussed by the Shoura Council before being passed to the People’s Assembly Laws, before going to the plenary sessions of Parliament, are referred for preliminary study to the relevant c ommittees. These specific committees are currently 22 in number; an example is the Committee for Health and Environment.This committee, consisting solely of Members of Parliament, often invites experts to its meetings for the purpose of obtaining a more comprehensive view of topics under study. The committee influences health policy changes planned for the future 13 Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO 3 H EALTH STATUS AND DEMOGRAPHICS 3. 1 Health Status Indicators Table 3. 1 Health Status Indicators 1990-2005 Indicators 1990 1995 2000 2004 2005 65. 3 (92) 66. 9 (98) 67. 1 (01) 70. 1 (02) – – – – – – 63 66 24. 5 22. 4 20. 5 – 3. 9 (97) 33. 8 28. 6 26. 2 174 (92) 96 (98) 84 (01) 68 (02) 3 – – – – – 26 29. 8 28. 7 NA 17. 6 Prevalence of wasting 3. 4 4. 6 Source: NICHP Report, Ministry of Health and Population,2005. 2. 5 NA 3. 9 Life Expectancy at Birth HALE Infant Mor tality Rate Probability of dying before 5th birthday/1000 Maternal Mortality ratio Percent of Normal birth weight babies Prevalence of stunting Egypt Human Development Report,2004 Table 3-2 Indicators of Health Status by Gender and by urban rural 2006 Indicators Urban Rural Male Female Life expectancy at birth – – 69. 2 73. 6 HALE – – – – Infant Mortality Rate 27. 7 15. 3 – – Probability of dying before 5th birthday/1000 3. 9 20. 6 27. 6 24. 7 Maternal Mortality Ratio – – – – Percent of Normal Birth Weight Babies – – – – – – – Prevalence of stunning/wasting Source: NICHP Report, Ministry of Health and Population,2005. WHO Web Site,August 2005 14 Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO Table 3-3 Top 10 causes of Mortality Mortality Y2005 Rank Intra-cerebral hemorrhage 21,473 Essential (primary) hypertension 20,354 Fibrosi s and cirrhosis of liver 18,434 Hepatic failure, not elsewhere classified 11,353 Atherosclerosis 10,800 Arterial embolism and thrombosis 8,233 Elevated blood glucose level ,000 Acute myocardial infarction 6,645 Cerebral infarction 6,334 Others 320,011 Total 431,637 Source: NICHP Report, Ministry of Health and Population, 2005. The Burden of Disease and Injury in Egypt (Mortality and Morbidity). 2004. 3. 2 Demography Demographic patterns and trends Total population of Arab Republic of Egypt is 77,505,756 (July 2005 est. ). The age distribution is 0-14 years presents 33% (male 13,106,043/female 12,483,899), 15-64 years presents 62. 6% (male 24,531,266/female 23,972,216), 65 years and over presents 4. 4% (male 1,457,097/ female 1,955,235) (2005 est. ).Net migration rate is -0. 22 migrant(s)/1,000 population (2005 est. ). Sex ratio: at birth 1. 05 male(s)/female, under 15 years it is 1. 05 male(s)/ female, 15-64 years it is 1. 02 male(s)/female, 65 years and over it is 0. 74 male(s)/fem ale, for the total population it is 1. 02 male(s)/female (2005 est. ) The median age is 23. 68 years, 23. 31 years for males and 24. 05 years for females (2005 est. ). Eastern Hamitic stock (Egyptians and Bedouins) presents 99%, Greek, Nubian, Armenian, other European (primarily Italian and French) presents 1%. Muslim (mostly Sunni) 94%, Coptic Christian and other 6%.Arabic is the official language, English and French are widely understood by educated classes. 57. 7% of the population (age 15 and over) can read and write. Male presents 68. 3% and female presents female: 46. 9% (2003 est. ). 15 Health Systems Profile- Egypt Regional Health Systems Observatory- EMRO Table 3-4 Demographic Indicators Indicators 1990 1995 2000 2004 2005 – 27. 9 1997 27. 9 27. 0 (03) 25. 8 (05) – 6. 4 1997 6. 3 6. 4 (03) 6. 4 (05) 2. 4 (60. 86) 2. 08 (86-96) 2. 3 (96-02) 2. 0 (03) 19. 1 (05) 74. 7 1992 69. 7 1998 69. 9 (01) 69. 9 (02) – – 37. 8 1996 38. 8 (03) 37. 4 – 3. 90 1992

Tuesday, July 30, 2019

Philosophy Term Paper: Abortion

Philosophy Term Paper Sometimes problems of mental disability and illness arise within a fetus during human development. Questions arise whether or not those fetuses should live or not (abortion). I believe that they do have a right to live. No one can play God and decided whether or not a being should live. We cannot judge whether or not a person is going to be mentally ill or not. We do not know the full potential of that person and we cannot predict whether or not he will always stay mentally challenged. How do we know that person will not get better? How do we know that he really is mentally disabled? We have no right to take a life because we THINK that we may be are helping that individual by not bringing him into a life of hardship and complication. This can be compared to â€Å"ending the misery† of an old person because we think he is pain. This is absurd and wrong. I believe that the double effect principle is not in accordance to the catholic natural law. The catholic natural law states that evil may not be done that good come of it. This means that you can never have something good come out from something evil. Hence, if the double effect states that it is ok to take the life of the baby to save the life of the mother, we are saying it is ok to kill the baby to save the mother; even though killing a person is unjustifiable. This goes against the natural law because the natural law says there is no good from something evil. So, if killing a person is evil there is nothing good that could come out of it. This is why the two ideas are not accordance. In fact, they are completely contradictory- one justifies the abortion and the other doesn’t. 3) I do agree with the both of his principles because he assumes the zygote and whatever comes after it a form of human life and will potentially becomes a person. Devine describes humanity as stages. The way kids turn into adolescent, adolescent into adult, adult into elder. This can also imply that there is development before infancy from zygote to fetus. This is a link in the stages of humanity that philosophers mention of. Also, people do not realize how the infant is the same person in and out the mother’s tomb. The mother gives a name to the fetus and talks about him/her. She treats the fetus as if it was outside the womb, becoming attached to the baby. Looking at these to principles we can see why Devine talks about abortion as murder. We see the zygote being a link in the chain of humanity and the way it is perceived as an infant before delivery. Unless there is a reason for the abortion (mother’s health), abortion should be considered murder. ) 5) Warren states that the first two are enough to prove that a fetus is not a person, justifying the abortion. She expands her claim not only to infants but also to, â€Å"a man or woman whose consciousness has been permanently obliterated but who remains alive is a human being which is no longer a person; defective human beings with no appreciable mental capacity, are not and presumably never will be people; and a fetus is a human being whic h is not yet a person, and which therefore cannot coherently be said to have moral rights. So, not only does she deduce the fact that fetuses are not a person, but also the mentally challenged and ill. Warren also keeps in mind that the attributes that are relevant in determining whether or not moral rights are no different from those which are relevant. Hence, if there is signs of brain activity and resemblance this is not enough to prove the fetus as a person, justifying abortion. 6) To prove his point, he talks about how human cells are present but they lack the structure of a human organism. True human life is only recognizable to about three weeks and primitive brain function does not begin until about the eighth week. He also mentions how twins are not formed until the fourteenth day after conception. Since it takes two weeks to form twins, how can there be a soul in the beginning of conception and then divide into twins; you cannot divide the soul in half for each twin. For this reason I do not believe that the soul is put into the human zygote after conception. When after conception I do not know.

Monday, July 29, 2019

My recommendations to the board Research Paper Example | Topics and Well Written Essays - 1500 words

My recommendations to the board - Research Paper Example Table of Contents 1. Introduction 4 2. About Coca-Cola Company 4 3. Issue in question 7 4. Recommendations 8 4.1 Career development 8 4.2 Workplace safety 8 4.3 Corporate reputation and organizational culture 8 4.4 Compensation benefits 9 4.5 Mentoring and Termination 9 5. Recommendations for implementation plan 10 6. Conclusions 10 References Appendices I. Equal Opportunities Policy 14 II. Sexual Harassment Policy 15 III. Drug Testing Policy 16 IV. Loan Policy 17 V. Termination Policy 18 1. Introduction: An evaluation of company policies based on changing performance trends will help in identifying existing gaps and taking appropriate actions. An attempt towards this direction will be made to identify existing gaps in organizational policies of the beverage-manufacturing giant, Coca-Cola in the North America region. Based on findings, recommendations to include or modify existing policies will be made keeping in mind obligatory aspects related to regulations and ethics. 2. About Coc a-Cola Company: Coca-Cola, a world-leading manufacturer of about 500 varieties of beverages being sold in more than 200 countries and employing over a million people, was an invention of an American about 125 years ago (Pendergrast, 2000), and PepsiCo that arrived much later has been its archrival competitor since many years. With its expansive growth, Coca-Cola is one of the largest multinational companies in the world, and has thus eventually shifted towards a global philosophy of business management. Coca-Cola has always focused on establishing itself locally and serving its local people; and hence, their management philosophy has been to â€Å"think globally and act locally,† (Anfuso, 1994). Considering the current position of Coca-Cola, management has to put in efforts not only to sustain its competitive position but also protect its reputation by adopting the right strategies, as well as modifying some of the existing strategies. Coca-cola operates its various divisions in six groups namely, north America, the EU, the Pacific Region, the East Europe/Middle East, Africa and Latin America. The corporate HRM at Coca-Cola facilitates the connection between human resources of these regional groups through propagation of common HRM philosophy within the company, and through leadership to manage the business internationally (Ashwathappa & Dash, 2013). From a policy perspective, Coca-cola focuses on translating all its organizational policies into practices and procedures that abide by the national laws and are aligned to local culture. Coca-Cola’s HRM philosophy is translated into different strategies in different regions that suit the necessary regulations, culture, and business requirements. For instance, in North America, Coca-Cola employs skilled personnel irrespective of their ethnic background, which not only helps their business but also abides by the federal laws of employment by following diversity in recruitment and recruiting on the bas is of performance, skills and qualifications (Workplace Rights Policy, n.d). A brief hypothetical account of demographics at Coca-Cola is represented in Table 1 below: Coca-Cola employs a comprehensive HR policy that addresses various HR needs that would be required for it to sustain its co

Sunday, July 28, 2019

Management Appreciation Essay Example | Topics and Well Written Essays - 1000 words

Management Appreciation - Essay Example The individual and team workers making up the functional departments get instructions from the supervisors heading a given task. The supervisors obtain detailed instructions from the department manager concerning the actions to be taken. A Matrix Structure PRESIDENT MANUFACTURING MARKETING PROCUREMENT FINANCE PRODUCT A PRODUCT B PRODUCT C One of a limited public company is Radient Pharmaceuticals Corporation, pharmaceuticals, and Biotechnology Company in the United States. This company operates with a matrix organizational structure. Matrix structure is the commonly used because of its advantages over other structures as argued by Baltes (2004 p.142). This structure works well for those companies operating in a dynamic business environment, like drugs and technological organization. Within Radient Corporation has categorized its personnel into both functional and product departments. A president, who is also the organization’s chief executive officer, heads the company. The ne xt rank of its management structure comprises of functional categories. These include the manufacturing department, finance department, human resource, procurement, research, development, and the marketing department. The next category comprises of product departments. This category is in the same rank with the functional departments. ... The different departments will coordinate their processes together in an effort to accomplish any goal. Within the team, each individual is assigned a distinctive role together with the expected results. Each team ought to complete their task within the given timeframe, after which the team leader will present the report to the relevant department manager. Based on this style of functioning, it is clear that Radient Corporation practices the task culture. The style of operation conforms to the Handy’s task culture, which defines it as a team-based result oriented culture. Matrix structure ensures effective integration of all the human resources of any given institution. It allows all the personnel to share ideas, hence improving performance and service delivery within a company. In matrix structure, the chain of command and lines of communication allows information to flow in a formal manner. This facilitates efficient sharing of information throughout the company. In addition , the task-teams result oriented culture facilitates motivation among the workers. Within a task team, each worker is assigned a role to play. The individual is expected to perform as per the set standards. This culture increases the aspect of accountability, hence increasing motivation and attitude among employees. Giunipero et al (2008) asserts that, business performance associated with Radient Corporation can be attributed to its management structure and work culture. The culture and the structure enhance a flexible working environment, hence improving the process of research and development within the company. One of the major factors that might affect Radient involves restrictions from authorities. This may affect the smooth management of the company, hence

Saturday, July 27, 2019

Innovation Management and its Critical Success Factors Research Paper

Innovation Management and its Critical Success Factors - Research Paper Example    Across the world, competition is intensified due to increasing globalisation. Hence, businesses today are facing numerous challenges besides issues of cost or quality of their products and services. Gaining customer loyalty and satisfying their expectations are at the forefront in business operations; hence companies have to products and services that are considered as valuable. By becoming innovative organizations, it is possible for companies to compete in this dynamic and changing business environment. Evidence from research reveals that innovation is one of the paths to maintaining increasingly progressive organisational performance. It is also the key element â€Å"for sustaining competitiveness and ensuring an organization’s future potential† (Wong & Chin, 2007, p.1290). The critical role played by organizational innovation management in organizational performance and progress, makes it necessary for organizations to manage and sustain organizational innovati on well. The inadequate involvement of several companies in innovation management is because of inconclusive and inconsistent research on the subject. This results in organizations failing to capture comprehensive concepts of innovation, and are unable to translate these into practical organizational innovation procedures (Wong & Chin, 2007). Research conducted by Wong and Chin (2007) investigated organizational innovation management as one of the critical means to sustain competitiveness in the long term.  ... Hence, businesses today are facing numerous challenges besides issues of cost or quality of their products and services. Gaining customer loyalty and satisfying their expectations are at the forefront in business operations; hence companies have to products and services that are considered as valuable. By becoming innovative organisations, it is possible for companies to compete in this dynamic and changing business environment. Evidence from research reveals that innovation is one of the paths to maintaining increasingly progressive organisational performance. It is also the key element â€Å"for sustaining competitiveness and ensuring an organization’s future potential† (Wong & Chin, 2007, p.1290). The critical role played by organisational innovation management in organisational performance and progress, makes it necessary for organisations to manage and sustain organisational innovation well. The inadequate involvement of several companies in innovation management i s because of inconclusive and inconsistent research on the subject. This results in organisations failing to capture comprehensive concepts of innovation, and are unable to translate these into practical organisational innovation procedures (Wong & Chin, 2007). Research conducted by Wong and Chin (2007) investigated organisational innovation management as one of the critical means to sustain competitiveness in the long term. The purpose of the study was to develop and validate an organisation-wide innovation management framework. An extensive literature review helped to develop core values and concepts of an organisational innovation management system. Wong and Chin (2007) identified organisational

Friday, July 26, 2019

International aviation law Coursework Example | Topics and Well Written Essays - 2250 words

International aviation law - Coursework Example Aeronautics Act enacted in June 1938 created the Civil Aeronautics Authority (with mandate over the economic and passenger matters), the Air Safety Board (has power to investigate accidents) and the Administrator of Civil Aviation (concerned with the infrastructure construction and airway system maintenance. 1 The Civil Aeronautics Authority was reorganized and renamed Civil Aeronautics Board (CAB), and absorbed the functions of the Air Safety Board which was abolished. CAB enforced a rigid system that restricts growth and mergers. Thus, the Airline Deregulation Act was enacted in 1978 that would allow â€Å"maximum reliance on competitive market forces†. 2 The Act stripped the CAB regulatory powers in 1984 but government regulation of the industry is still performed through the Federal Aviation Administration. The precursor to the Chicago Convention is the 1919 Paris Convention, otherwise known as the Convention Relating to the Regulation of Aerial Navigation. 3 This Convention, signed by the United States, Great Britain, France, Italy, Brazil, Czechoslovakia, Poland and other countries, allowed innocent passage of aircraft in other territories during peace time, required the registration of aircrafts in a state and grants aircrafts a nationality, and prohibited explosives and firearms inside the aircraft. 4 The Convention established the International Commission for Air Navigation to settle international disputes. 5 The signatories and other countries (which were not signatories) revised their local laws according to the provisions of the 1919 Convention. 6 The first to enact a law was England with the passage of the Air Navigation Act 1920 that declares â€Å"full and absolute sovereignty and rightful jurisdiction of his Majesty †¦ over the air.† 7 The United States adopted the same notion of sovereignty to the air above its territory in the Federal Aviation Act of 1958. 8 Under the Federal Aviation Act of 1958, all rule-making power was vested upon the Federal

Thursday, July 25, 2019

Engineering and construction Essay Example | Topics and Well Written Essays - 3000 words

Engineering and construction - Essay Example ............................................ 30 Task 1 Laminar flow Laminar flow is a type of flow where fluids generally move at low velocity. The layers of the fluid slide by one another. There is no lateral mixing of the fluid and no formation of eddies, cross current or any swirls. Particles of the fluid move in straight line in orderly manner parallel to the boundary walls which can be seen in straight sections of pipes. It generally occurs at a Reynolds number below critical value of 2040. Turbulent flow Turbulent flow is a type of flow that occurs in large velocities characterized with the formation of eddies, swirls and other disturbances in the flow pattern. There is irregularity of flow pattern, fluctuating nature of flow, and diffusivity of particles due to rapid lateral mixing. There is a rapid change in pressure and velocity happening with respect to the space and time. The drag due to boundary layer skin friction is increasing and the overall drag often reduces due to t he changing of structure and location of boundary layers. It generally occurs at a Reynolds number greater than 2040. Uniform Flow Uniform flow occurs when the terminal velocity of the flow is reached. This phenomenon arises when the loss of potential energy in flow is equal to the work done against the channel surface friction. If flow properties are the same at every location along the channel, the flow is uniform. dy/dx = 0. The energy line, water surface and channel bottom becomes all parallel thereby creating uniform flow. So= Sf . In a uniform flow, the velocity can be expressed only as a function of time. According to Eulerian, it is described as   Non-Uniform Flow Non-uniform flow is a type of flow for fluids where the velocity and other hydrodynamic parameters at a particular instant of time is not the same at all points. Change in parameter occur both in points where flow is in the same direction and perpendicular to the direction. The perpendicular non-uniformity is enc ountered near solid boundaries where the fluid passes through. This can be explained by the no-slip condition which occurs when the viscosity tries to reduce the relative velocity of fluid to zero. Steady Flow A steady flow is a type of flow where the hydrodynamic properties of fluid do not change at particular location and time. However, this flow is restricted with space but not with time. There is a required frame of reference. For example, in a laminar flow within a sphere, the flow is kept stationary and steady with respect to the shape of the object. Using the Eulerian approach, a steady flow is described as, and Unsteady Flow An unsteady flow is a type of flow where the hydrodynamic parameters and fluid properties at a particular point changes with respect to time. Turbulent flow is generally unsteady in nature. Reynolds Number Reynolds number denoted by Re is a dimensionless number. It represents a critical quantity to determine the type of flow of fluids, whether it is lami nar or turbulent. It is a ratio of the inertial forces to the viscous forces of fluid. Laminar flow occurs at low Reynolds number while turbulent flow occurs at high Reynolds number. [4] where: = The mean velocity of the object relative to the fluid. The unit is m/s L = Characteristic linear dimension. The unit is m ? = Dynamic viscosity of the fluid. The unit is kg/(m ·s) ? = Kinematic viscosity. The unit is (m?/s) = The density of the fluid. The unit is kg/m? Bernoulli's Theorem Bernoulli's theorem states than in a flow which has no viscosity or inviscid flow, there

Developing a Pre-sentence Investigation Report Interview Guide Essay

Developing a Pre-sentence Investigation Report Interview Guide - Essay Example ances of the arrest, the evidence or suspicion that led the officer to book the suspect, the crime of offense he or she is charged with, and the events after the suspect has been booked. The pre-sentence investigation report is usually prepared by the arresting or investigating officer once the defendant/ suspect or offender is at the police precinct. This document is usually presented before a judge in the course of the hearings that may transpire in the event the accused is found guilty of the crimes for which he has been booked. This is a legal requirement. The pre-sentence investigation report is the outcome of an interview between the defendant and the investigating officer and usually includes basic information about the defendant as well as the circumstances of the arrest and the crime of which he is being charged. A typical pre-sentence report would include the following details: The first question allows the defendant to tell his story or his version of the events in a completely open and unbiased manner. This is especially if the arresting officer is not the one who is interviewing the defendant. However the arresting officer’ s version of these events are also as important, if not more, as the defendant usually lies to protect himself and his real intentions. The second question allows the defendant to establish his version of the events and prove them by any evidential means possible. In a minority of cases, the arresting officer may be wrong or make an incorrect arrest depending on the circumstances, just to diffuse social tension or deal with the situation. That is why it is also important sometimes, where possible, to revisit the scene of the crime and try to contact any persons or witnesses who were there at the time the crime was committed or frequent the location or work there in the normal course of events. These witnesses or onlookers can provide invaluable clues as to the events that occurred (cjcj.org website, 2011) Q. 3. Is this your

Wednesday, July 24, 2019

SIMPLIFIED ACQUISITION PROCEDURES Research Paper

SIMPLIFIED ACQUISITION PROCEDURES - Research Paper Example The whole process is often inefficient due to several documentation procedures that are often involved. The slow procurement processes are often disadvantageous to the government departments like the Department of Defense whose operations can be delayed with significance negative impacts on its mission attainment. In relation to this, the government through the congress intervened to develop procurement procedures that could be more efficient and cost-effective for relatively smaller purchases. The program was initiated in the early 1990s and has hard various improvements since then. The US General Accounting Office (GAO) has provided various reports that focus on the effectiveness of the program. This paper focuses on a 2001 report by GAO on the benefits of these new procurement procedures. The report indicated that the benefits of the procedures were not clearly demonstrated even though the executives believed in their effectiveness. Similar results were provided in another 2003 re port by GAO. 2. Simplified Acquisition by the Federal Acquisition Regulation (FAR) The Simplified Acquisition Procedures (SAPs) are procurement procedures authorized by the Federal Acquisition Regulations to speed up the procurement process to the benefit of the two or more parties involved. The SAPs allow for quick procurement procedures through accelerating the evaluation and selection of the contracting officers and removing unnecessary documentation procedures that can slow the procurement process (US GAO, 2001, p.2; GAO, 2003, p.2). The use of these procedures was authorized in 1994 by the Congress and at this time, it only applied for the purchases not more than $100,000. Further adjustments were made on the simplified acquisition procedures in the subsequent periods. In 1996, the Congress allowed an extension of these procurement procedures to the purchases up to $5 million worth of products or services (GAO, 2003, p.3). The program removed some of the procedural requirements involved in procurement when purchasing products worth this value in a bid to improve the operations at the business organizations and the federal agencies. The program was instituted to serve the government and the business industry in a number of ways. Firstly, the program aims at reducing the administrative costs at the federal agencies due to the improved procurement process (Straight, 2004, p.1). Various personnel involved in the usual procurement procedures make the agencies incur some huge operations costs. Secondly, the programs are aimed at improving efficiency and economy in contracting. The initiatives enable small business organizations to have a better access to the government contract since the tedious and costly procedures are not involved (Straight, 2004, p.1). The program ensures that the burden on the contracting agencies is reduced. 3. The conditions for use of simplified acquisition procedures according to the FAR It has been stated that the simplified acquisiti on procedures were extended to the purchase of items no not exceeding $5 million in order to improve the efficiency and economy of the procurement process. It is then inappropriate to apply the procedures in the situations that these desired objectives cannot be met. For instance, it will not be economical to apply the procedures for a procurement exceeding the stated value. Section 13.003 of the Federal Acquisition Regulation stipulates the federal agenc

Tuesday, July 23, 2019

Corrections Essay Example | Topics and Well Written Essays - 250 words - 2

Corrections - Essay Example W., n.d.). With the dreaded conditions stated above and with the fact that crime is being associated with the poor economic background of people, politicians and the general public deem that bending prison policies such as the mandatory sentencing and punishing of technical parole violations rather than extending parole time would be best to not only effectively curb criminal cases despite limited resources but at the same time help these criminals to be able to pay the legal consequences of their acts immediately and at the same time be able to move on with their life without delay which will also help them support their families better and not worsen the problem of budget challenges (Criminal Justice USA, n.d.). This is because of the fact that in most cases, those who have been incarcerated have slashed annual earnings because many employers would refuse to hire them and given the fact that most of those incarcerated are the breadwinners of their family, delaying parole time is not the solu tion for both the criminal and the society. This is something that Justice Anthony Kennedy affirmed, pushing for the review of political outcomes and processes to improve the problem of overcrowding, prison medical and mental health, and most especially, the post incarceration impacts in a criminal’s life and society as a whole. 10 Stats You Should Know About Our Prison System - Criminal Justice USA. (n.d.). CriminalJusticeUSA.com - Criminal Justice Careers, Jobs and Degree Information. Retrieved August 24, 2012, from http://www.criminaljusticeusa.com/blog/2011/10-stats-you-should-know-about-our-prison-system/ Miller, D. W. (n.d.). The Drain of Public Prison Systems and the Role of Privatization, ProQuest Discovery Guides. CSA. Retrieved August 24, 2012, from

Monday, July 22, 2019

Macbeth Analysis Essay Example for Free

Macbeth Analysis Essay The extract before me is from Macbeth written by William Shakespeare in the year 1606. It is from Act 1 Sc 7. It takes place in a room at Macbeths castle at Inverness. The extract primarily deals with the ploys that Lady Macbeth uses to persuade her husband Macbeth to commit the crime of murdering King Duncan. Two important themes are bought out in this extract, one is about the creation of gender roles and stereotypes and the second one is about appearances often being deceptive. The extract begins with Macbeth telling Lady Macbeth We shall proceed no further in this business. This is obviously referring to something which has happened before in the scene. Macbeth has been contemplating the consequences of this murder. He conceives a very apocalyptic vision of how the angels of heaven are gonna be coming and spreading the news of this murder all across. The angels are gonna be pleading for Duncans virtues and the people are gonna be actually crying and there be like a flood of tears which will drown the Earth. So, he tells Lady Macbeth that he does not wish to do away with his golden reputation, he does not want to lose its gloss and therefore, he does not want to proceed with the bloody business as he calls it. Lady Macbeth is obviously very affected by this and she ends up trying to accuse Macbeth of being unmanly. She uses adjectives like pale, green. She compares him to the poor cat in the adage. She is trying to drive the wedge between him and his doing and his desire to achieve the throne and his lack of action. Now, Lady Macbeth says, what beast was it then that made you break this enterprise to me. This is a reference to Act 1, Sc 5 because in Act 1 Sc 5, Macbeth tells Lady Macbeth about the prophecies that the witches had made and how he is supposed to become the King of Scotland after becoming the Thane of Cawdor. Now, Lady Macbeth is just wedging upon those lines saying that when you dared to commit this to me, that is when you were a man and now if you are actually gonna commit the deed of murder, you are gonna commit the heinous crime of regicide, you will be even more the man. Lady Macbeth reasons out that the time and the place were not appropriate to kill Duncan at that time but now since he has come into our battlements, he is in our castle as our guest, we are supposed to kill him. Lady Macbeth is surprised that Macbeth is losing his resolve at this time. Lady Macbeth goes on to create a very grotesque image that shows that the milk of human kindness is actually not present in her. She says that she has suckled the baby at her breast and she knows how tender it is to love the babe that milks me and she says that if she had ever said that she had committed to anyone that I am going to be killing my child, she would have actually plucked his mouth out of her nipple and dashed his brains out against the wall. This is a very grotesque image produced by Lady Macbeth has produced. This makes it clear to us that Lady Macbeth has been dehumanised, defeminised in all ways. Thus, she has achieved her wish which she asked from the spirits. She is totally unwomanly and does not have any maternal instincts. She is actually a reminder of the character Medea from the play Medea written by Euripedes because Medea had self-decided to kill her own children. Now, we see that the scene has become progressively darker with Lady Macbeth creating images of death and Macbeth ends up contemplating the possible consequences if we should fail. We should see that there are several times when Macbeth and Lady Macbeth talk about each other as being one. They perpetually use we. Macbeth has never said that i am gonna fail at the murder. He says that we should fail. This shows that there is a sense of togetherness and they are partners not only in greatness but also in crime. So, Lady Macbeth immediately retaliates but then at this time there is a shift in tone. It becomes much more pragmatic because she divulges the plan of the murder to Macbeth. There is a metaphor used over here, its about stringed instruments, now just as you take the string and you create the appropriate tension by tying it to the right peg. Similarly, Lady Macbeth expects that Macbeth decides to be headstrong and resolute and decides to screw his courage to the sticking place. If he does so, they will certainly not fail. She goes on to discuss the plan of murder with Macbeth. She says that when Duncan will be asleep and in all probability, he is likely to sleep due to his long journey. The two sentinels outside his room are gonna be intoxicated by Lady Macbeth using wine, drugs. She will make sure that they are so drunk that they will lose thier memory which has been described as the warder of the brain. The receipt of reason will not be there. Reason will actually be distilled out of their brains. They will not be able to understand anything. They will actually behave like swine and sleeping in that manner. Lady Macbeth sees it as golden opportunity to perform the murder. She once again, as I said, talks about them being one. She says what cannot you and I perform upon the unguarded Duncan? when in fact the murder is going to be committed by Macbeth alone. Lady Macbeth is obviously very important partner in his crime. Now, Lady Macbeth further tells him that they are gonna be taking the daggers and staining the officers with the blood. She expects the officers to bear the guilt of our great quell. Now, the use of the word guilt over here is very important and it is also very ironic because it is not like they do not do away with thier guilt ever. In fact, they leave in torment of the very murder. Lady Macbeth in Act 5, Sc 1 in the sleep-walking soliloquy is a woman who has completely lost her senses. She is leaving under intense emotional pressure and she is the one who is not able to sleep anymore. So, it shows that they are actually guilty of the crime. Macbeth himself in Act 2 Sc 2 does not wish to even go back to the scene of the crime again. So, it shows that even though they are gonna be staining the sentinels with blood. In fact, both of them are gonna be living in horror of the deed. Now, Macbeth seems to be quite convinced and he asks Lady Macbeth to bring forward male children only because the undaunted mettle should compose nothing but males. Now, this is very significant because it is about the creation of the gender stereotypes. In the Shakespearean area, it was expected of men to be embodiment of valour, courage and ruthlessness to some extent and woman on the other hand were expected to be more submissive and incapable of coming up with wicked plans. However Lady Macbeth is an exception to this rule because she comes across as one who is so resolute and cold, so devoid of pity that this is something which should be there only in men. Macbeth once again questions his wife and asks her that if they are gonna marking the two sleepy sentinels with blood, would it not see that they have done it. Lady Macbeth says that while they will be hysterically crying and lamenting the death of Duncan, suspicion will never fall upon them. Macbeth finally capitulates to all its wifes persuasions and he seems to have bend up each corporal agent to this terrible feat. This is a very important line in the building up of the tragic hero because Macbeth is gonna be himself responsible for his fate. He has decided to put his heart and soul into committing so heinous a crime and he is indeed gonna be bearing indeed the consequences of it as we see later in the play. The scene ends with a couplete that rhymes which is typical of Shakespeare. It says that Away, and mock the time with fairest show: false face must hide what the false heart doth know. So, it recounts the theme that appearances are often deceptive. This theme has been running throughout the play. It all began with King Duncan in Act 1 Sc 2 when he wished that he would be able to recognise people by simply looking at their faces. It is also present in Act 1 Sc 5 when Lady Macbeth asks her husband to look like the innocent flower but be the serpent under it. This time Macbeth is the one who is actually telling his wife that she is suppose to be having composure, she is suppose to conceal her ulterior motives and her false face must hide the real intentions that she has. In conclusion, i can say that there is a big contrast between the characters of Macbeth and Lady Macbeth. Macbeth is the one who is contemplating the fear of failure. He says that we should fail, what would happen. He is no doubt ambitious but at the same time he also comes across as a rational being.

Sunday, July 21, 2019

Effect of Temperature on Water Properties

Effect of Temperature on Water Properties Life is inseparable from water. This dependence of life on water can be attributed to the unique properties of water, water is directly intimately involved in all details of animal physiology but because it is so common, water is often regarded with indifference as an inert space, filter in living system. The special properties of water are so important to life stem directly from its molecular structure. Therefore it is important that we should begin by understanding its molecular structure. Not only that water is also a driving force of all living organisms, hence the saying â€Å"water is life, conserve it.† MOLECULAR STRUCTURE OF WATER The shape of water and of all organic molecules is necessary to the structure and functional roles they playin living organisms, for example, hormones having specific shapes that allow them to be recognized by the cells in the body. We can stay well only when the antibiotics combine with disease- causing agents like a key fits into a lock, similarly homeostasis is only maintained when enzymes have the proper shape to carry out their particular reactions in cells. The shape of a water molecule and its polarity makes hydrogen bonding possible. Water’s shape also enables it to support life as shown below Water has several functions due to its unique properties that make it vital to living organisms. The following are some of the properties of water which can either be physical or chemical and its significance to living organisms. Water is said to be; UNIVERSAL SOLVENT Water is said to be an excellent universal solvent for polar substances like salts which contains charged particles, as shown below; From the diagram above of a salt molecule it can be seen that water is able to surround a salt molecule, which makes it to be dissolved by a water molecule, hence the reason for water being a universal solvent that is enabling it to dissolve nutrients in other living organisms, also water being a universal solvent means that more substances both organic and inorganic are dissolved in water than in any other solvent. For this reason water is rarely pure, being almost always in solution containing dissolved substances. (Lacksonetal 1995:14) Hence because of water being a universal solvent it plays an important role in living organisms, it is suitable for life in which diffusion and osmosis occur easily, that is it helps in the diffusion of gases to facilitate gaseous exchange in insects as well as in fish which usually uses oxygen that has dissolved in water. Aquatic organisms such as fish, amoeba and so on benefit from water by making use of the dissolved oxygen in water for their respiration. Water also acts as a transport medium as in the blood, lymphatic and excretory systems, such as in the removal of water products in the body such as urine, as well as in the alimentary canal of a living organism and in the xylem to transport mineral salts in plants and in the phloem to transport manufactured food. It is also an important solvent in which most of the bodily solute are dissolved, it also plays an important part in metabolism processes as well as helping organisms to transport nutrients and oxygen throughout the body. The tendency of water to cause amphipathic molecules to form in cells is important in the formation of biological membranes in living cells and may have provided the basis for the first cell-like organisms of living system in the organic-rich shallow seas in which the beginning of life is believed to have undergone its first stages (Eckert and Randi 1978:20) DENSITY AND FREEZING PROPERTIES OF WATER When we consider this property of water having less density when in solid state (ice) than liquid water which has a maximum density at a temperature of 40c we see that ice tends to float on water. When water is cooled to form ice the hydrogen bonds become more rigid but also more open causing water to expand thus increasing in volume. This reason explains why a cans containing water bursts when placed in a freezer for a long period of time. It is generally observed that matter expands upon heating hence the behavior of water to expand when heated is sometimes referred to as â€Å"the abnormal behavior of water.† The ability of ice to float on water prevents the whole body of water (ponds, rivers, lakes and oceans) from freezing solid because it acts as in insulator on the water surface, as a result this property of water protects aquatic organisms and enables them to survive through the winter. HIGH HEAT CAPACITY Heat capacity is the amount of energy required to change the temperature of a substance by 1oc. water is said to have a high heat capacity because water has the ability to retain a good amount of energy with only a little fluctuation in its own temperature. This means that for water to have a change in its temperature it requires a lot of energy. This property of water is important not only to aquatic life but for all living organisms because the temperature of water rises and falls slowly organisms are better able to maintain their normal internal temperature and are protected from rapid temperature changes. COHESIVE AND ADHESIEVE Cohesion refers to the ability of water molecules to cling to other water molecules due to hydrogen bonding. Because of cohesion, water exists as a liquid under ordinary conditions of temperature and pressure. Cohesion in water contributes to the transport of water in plants living because water molecules are strongly attracted to each other, and its surface tension makes it possible for water striders, a common insect to walk on the surface of a pond (Mader 2010:29) Furthermore, high surface tension and cohesion are also important properties of water which makes water molecules to stick together. The high surface tension or cohesion of water molecules is important in cells and many organisms such as insects which rely on surface tension to settle on water. Below is a diagram illustrating the structure of water that makes it cling to other water molecules due to hydrogen bonding. ÃŽ ´+ H H ÃŽ ´+ ÃŽ ´+ H O †¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦Ã¢â‚¬ ¦..†¦. H O 2ÃŽ ´ 2ÃŽ ´ ÃŽ ´+ Hydrogen bond Key: ÃŽ ´+ : slightly positively charged H : Hydrogen atom ÃŽ ´ : slightly negatively charged O : Oxygen atom Taylor etal(1997:37) HIGH HEAT OF VAPORIZATION High heat of vaporization is also another important property of water. Latent heat of vaporization is the measure of the heat energy required to vaporize a liquid- that is the energy needed to overcome the attractive forces between its molecules that they can escape as a gas. The energy transferred to water molecules to allow them to vaporize results in the loss of energy from surrounding that is cooling taking place. As a result this property is made use of in the cooling of the temperature of living organisms through sweating and panting. It can be concluded that the properties of water are vital to all living organisms and it plays important roles by ensuring that living organisms survive. It can be seen that the properties of water outlined in this discussion have a direct link to the survival of living organisms and that without water life on earth as we know would not exist. Therefore water is life conserve it. REFERENCES Berner E. eatal (1987), The global water cycle.  prentice- Hall inc: New Jersey. Eckert and Rand (1978), Animal physiology 2nd edition.  C.B.S publishers: New Delhi. Raven J. (2000), Science of biology.  Cambridge university press: New York Silver Mader .S. (2010), Biology 10th edition  McCraw Hill Companies: New York. Taylor DJ.T. etal (1997), Biological Science 1st and 2nd edition.  Cambridge University press: New York.