Native American Tribe As The Kickapoo - 1726 Words

Kickapoo Location The Native American tribe known as the Kickapoo would have been more important to Illinois’ history if they would have stayed longer. The Kickapoo had originally lived in Illinois. They were later moved away from the states that they lived in which were Illinois and Indiana. They moved to Missouri after leaving their homelands (â€Å"Indians†). Some of the other Kickapoo chose to move southward, and the reason they moved is because they wanted to get away from the americans and explorers (â€Å"Native†). The Kickapoo that moved to Missouri were later forced into reservations in Kansas and Oklahoma (â€Å"Indians†). Some chose to just keep movings south rather than deal with the americans. The tribe had eventually moved all the way down into Texas and Mexico. This was as far as the Kickapoo moved south, but some of the Kickapoo chose to move back to other places in the United States. The others just remained in Mexico and Texas (â€Å"Nativeâ € ). The Kickapoo were native to Illinois, but that didn’t stop them from becoming one of the most traveling Native American tribes in the United States. Allies and Enemies The Kickapoo however have less to talk about when it comes to enemies and allies. The Kickapoo did not all move away or get forced into reservations. They had been ally in two major rebellions. The Kickapoo rebelled with Pontiac and Tecumseh. The Pontiac rebellion came first, and in this one they were fighting against the colonists. This groupShow MoreRelatedNative American Tribe As The Kickapoo1726 Words   |  7 PagesKickapoo Location The Native American tribe known as the Kickapoo would have been more important to Illinois’ history if they would have stayed longer. The Kickapoo had originally lived in Illinois. They were later moved away from the states that they lived in which were Illinois and Indiana. They moved to Missouri after leaving their homelands (â€Å"Indians†). Some of the other Kickapoo chose to move southward, and the reason they moved is because they wanted to get away from the americans andRead MoreNative American Graves Protection And Repatriation Act Essay1631 Words   |  7 Pagesa history that began with the settlement of European-Americans during the 19th Century as there is little roadside advertising stating the contrary. Kansas, for centuries, was a land where many Native American tribes that lived, fought, and died. Subsequently, the city of Wichita is a good example of this. It is known as a large city of Kansas and not known as the name of a Native American tribe. T he fact of the matter is that the Wichita tribe aided in the establishment of a trading post that ledRead MoreHistory of Lacrosse Essay891 Words   |  4 PagesLacrosse is the oldest team sport in North America, having been played by Native American tribes long before any European had even set foot on the continent. A century after European missionaries discovered the game played by Native Americans, they began to play it themselves, starting in the 18th century. From there, it evolved and grew in popularity from a very savage game that resembled war, into what it is today, a recreational sport played widely in America and other countries. As U.S. LacrosseRead More history of lacrosse Essay examples886 Words   |  4 Pages Lacrosse is the oldest team sport in North America, having been played by Native American tribes long before any European had even set foot on the continent. A century after European missionaries discovered the game played by Native Americans, they began to pla y it themselves, starting in the 18th century. From there, it evolved and grew in popularity from a very savage game that resembled war, into what it is today, a recreational sport played widely in America and other countries. As U.S. LacrosseRead MoreSugar Creek : Life On The Illinois Iowa Prairie, By John Mack Faragher1918 Words   |  8 Pagesenvironment, society, culture, and economy in Sugar Creek throughout the nineteenth century and the changes, development, improvements with it. There are four common themes throughout the monograph: First, the kicking out of the Kickapoo and other Indians in place of Anglo-Americans. Second, the relationship and changes between men and women’s roles throughout the nineteenth century. Third, the community life and the sensibility of bringing the town together. Finally, the transition of agriculture andRead MoreThe Museum s Main Purpose Essay1221 Words   |  5 Pageseducate the public about American Indians, but also to â€Å"decons truct stereotypes† and give tribal members something along the lines of a safe place where they are welcome to embrace their ethnicity. One factor that showcases the information I previously stated is the fact that tribal members have free admission into the museum. Another way the museum salutes the ethnicity of American Indians is by commemorating Native individuals alive today. Names of famous Native Americans are displayed along withRead MoreEssay about United States Expansionism: 1790s- 1860s1176 Words   |  5 Pages The major American aspiration during the 1790s through the 1860s was westward expansion. Americans looked to the western lands as an opportunity for large amounts of free land, for growth of industry, and manifest destiny. This hunger for more wealth and property, led Americans conquer lands that were rightfully someone elses. Manifest destiny and westward expansion brought many problematic issues to the Unites States verses the Indians that took the Americans to the Civil War. The first issueRead MoreThe Mitchell Museum Of The American Indian Essay1514 Words   |  7 PagesThe Mitchell Museum of the American Indian is located at 3001 Central Street in Evanston, Illinois. The museum’s main purpose is not only to educate the public about American Indians, but also to â€Å"deconstruct stereotypes† and give tribal members something along the lines of a safe place where they are welcome to embrace their ethnicity. One factor that showcases the information I previously stated is the fact that tribal members have free admission into the museum. Another way the museum salutesRead MoreManifest Destiny, The Haitian Revolution, Louisiana Purchase, And The Removal Of Native American1227 Words   |  5 Pagesnorth there seem to be an â€Å"end of slavery. Due to the north â€Å"ending slavery† white American were now competing not only with African Americans but as well the massive immigrants that were coming to America. Manifest destiny could have not occurred in the best time were average Americans wanted to own farms and land. Thus, manifest destiny, the Haitian revolution, the Louisiana Purchase, the removal of Native American shares common themes of expansion of slavery, territory and white superiority leadingRead MoreThe American Civil War Was A Death Filled Four Years1243 Words   |  5 PagesThe American Civil War was a death filled four years. Many people died fighting for what they believed. The north, who won the war, got what they wanted; the south was able to keep their property with nearly no consequences for their actions. But one group of people who fought for both sides got nothing for their blood left on the battle field. Both the Union army and the Confederate army promised the Native Americans who fought for them many things such as land, freedom, and rights but did either

“a Contemporary View on Health Care System in Bangladesh.” Free Essays

string(70) " Muslim rule for over five and a half centuries from 1201 to 1757 AD\." CHAPTER – 1 Introduction 1. 0 origin and background of the report The report ‘‘A Contemporary view on Health Care System in Bangladesh’’ is the outcome of Internship Program which is a precondition for acquiring MBA Degree. Only curriculum activities are not enough for handling the real business environment, so it is necessary to get the better knowledge about the real scenario. We will write a custom essay sample on â€Å"a Contemporary View on Health Care System in Bangladesh.† or any similar topic only for you Order Now The report is a requirement of the internship program for my MBA Degree. Conduction of Internship/ Dissertation started on 20th December 2009 and ended on 12th February 2010. My internship supervisor at International Islamic University Chittagong, Dhaka Campus, Mr. R M Nasrullah Zaidi assigned me the topic of my report. The reason behind choosing this topic is getting a clear picture of the health sector of Bangladesh. Working on this topic gives me an opportunity to understand the Problem and prospect of health care system in Bangladesh. In today’s world of globalization Thiland is seeking to encourage â€Å"health tourist† to its country under the banner of ‘Thailand: Centre of Excellent Health Care of Asia’, India is building an e-health industry and Singapore is building hospitals abroad. When scenarios are like that where the health sector of Bangladesh ? Here we try to get a idea about what is the real scenario of various related issues like access to health-relate knowledge and technology, the provision of new hospital and aliened health institution and the availability of health professionals. 1. 1 objectives of the report The objective of my study divided into two segments: 1. 1. 1 Primary Objective The primary objective of this report is to meet the requirements of the course, OCP 5900, Internship. 1. 1. 2 Secondary Objective The secondary objectives are: * To confer a clear picture of National health senario. * To know about list and capacity of existing Hospital clinic * To know about manpower supply capacity and requirement * To know about Morbidity and its rate * To know about Available alternative or traditional medical care system. * To know about health education of mass people * To know about government structure- health system * To know about demographic structure of population * To know about role of different institution in respect of Health Care 1. methodology I have planned to perform the task in four stages: Step 1 Planning of the work Step 2 Data collection Step 3 Analysis and interpretation of data Step 4 Drawing conclusions and recommendations The first stage is the most important stage. I have allocated enormous time for this stage. I am emphasizing on thorough and detailed planning. Planning includes detailed methodology and scheduling of the remaining three stages. I am also emphasizi ng on documenting detailed planning which would serve as a guideline and performance measure for the whole report. The second stage is the data collection stage. I have planned to collect data in three main phases. * Collect data from internet, different books and medical journals. * Conduct interviews with selected representatives from different level of health professionals. This phase actually concentrates on clarification and elaboration of data collected from the first phase. * Conduct interviews and communicate with health providers who are in the front line. This phase actually concentrates on accumulating data for the overall scenario. The third stage is the analysis and interpretation of data. In this stage I would use some statistical and graphical analysis tools to interpret the relationship among different variables and factors. The fourth stage is the stage for drawing conclusions and prescribing recommendations. In this stage the results from the previous stage would be used to draw conclusions about different aspects of concerned matters within the organization and prescribe some recommendation for future improvement. The project is base on both primary and secondary information. Primary Source: * Informal discussion with employees of UHL. Observation while working in different desks * Interview with health care providers. Secondary Sources: * Official Web Site of UHL * Annual Reports of Ministry of Health * Various Manuals and Brochures of DG Health * Different publications of WHO. 1. 3 scope This report solely deals with the health related information of Bangladesh. Here we try to accumulate information from various topics that have role with the health system of a country. The project is based on both primary and secondary information. Health system is a very vast area to work; thousands of issues are related here. Here we make some major segment to discuss like national health status, health care delivery system, facility based health service, leading public health problems and health education. 1. 4 limitations 1. The major limitation faced in preparing this report is the enormous number of parameters that have relationship to the health care system of a country. 2. Less availability of data at all tiers of service providing especially in the private sector. 3. Less accessibility to data due to shortage of time and proper arrangement and at the same time the authenticity of data not beyond questions. 4. Health sector requires few specified technical knowhow for better understanding. Being a non medical background some time face some problem to understand technical terminology and frequently needed explanation and further study. CHAPTER – 2 Bangladesh: National Health Status 2. 0Location and Geography Bangladesh was emerged as an independent and sovereign country in 1971 following a nine months war of liberation. The country is one of the largest deltas of the world with a total area of 147,570 sq km. Being a low-lying country it stretches latitudinal between 20? 34†² and 26? 38†² north and longitudinally between 88? 01†² and 92? 1†² east. It is mostly surrounded by Indian Territory (West Bengal, Tripura, Assam and Meghalaya), except for a small strip in the southeast by Myanmar. Bay of Bengal lies on the south. The standard time of the country is GMT +6 hrs. 2. 1History Bangladesh has a glorious history and rich heritage. Once it was known as ‘Sonar Bangla’ or the ‘Golden Bengal’. The territory now constituting Bangladesh was under the Muslim rule for over five and a half centuries from 1201 to 1757 AD. You read "â€Å"a Contemporary View on Health Care System in Bangladesh.†" in category "Essay examples" Subsequently, it came under the British rule following the defeat of the sovereign ruler, Nawab Sirajuddaula, at the battle of Plessey on 23 June 1757. The British ruled over the Indian subcontinent including this land for nearly 190 years from 1757 to 1947. During that period, Bangladesh was a part of the British Indian provinces of Bengal and Assam. With the termination of British rule in August 1947, the sub-continent was partitioned into India and Pakistan. Bangladesh was a part of Pakistan and was called ‘East Pakistan’. 2. 2Physiography With about half of its surface below the 10 m contour line, Bangladesh is located at the lowermost reaches of three mighty river systems -the Ganges-Padma river system, Brahmaputra-Jamuna river system and Surma-Meghna river system. Coinciding with the division of the country based on altitude the land can be divided into three major categories of physical units: Tertiary hills, Pleistocene uplands and Recent plains (formed in recent epoch). The heavy monsoon rainfall coupled with the low altitude of major parts of the country makes floods an annual phenomenon in Bangladesh. Quaternary (began about 2 million years ago and extends to the present) sediments, deposited mainly by the Ganges, Brahmaputra (Jamuna) and Meghna rivers and their numerous distributaries, cover about three-quarters of Bangladesh. The physiography and the drainage pattern of the vast alluvial plains in the central, northern and western regions have gone under considerable alterations in recent times. In the context of physiography, Bangladesh may be classified into three distinct regions: (a) floodplains, (b) terraces and (c) hills, each having distinguishing characteristics of its own. The physiography of the country has been divided into 24 sub-regions and 54 units. 2. 3Climate Bangladesh has a tropical monsoon-type climate, with a hot and rainy summer and a dry winter. January is the coolest month with temperatures averaging near 260 C (780 F) and April is the warmest with temperatures from 330 to 360 C (910 to 960 F). The climate is one of the wettest in the world. Most places receive more than 1,525 mm of rain a year, and areas near the hills receive 5,080 mm). Most rains occur during the monsoon (June-September) and little in winter (November-February). Bangladesh has warm temperatures throughout the year, with relatively little variation from month to month. January tends to be the coolest month and May the warmest. In Dhaka, the average January temperature is about 19 °C (about 66 °F), and the average May temperature is about 29 °C (about 84 °F). 2. 4Administration From the administrative point of view, Bangladesh is divided into 6 Divisions, 64 Districts, 6 City Corporations, 308 Municipalities, 482 Upazilas and 4498 Unions. The six administrative division’s are namely, Dhaka, Chittagong, Rajshahi, Khulna, Barisal and Sylhet. The country is governed by the Parliamentary Democracy and it has a unitary National Parliament, nameBangladesh Jatiya Sangsad. There are 40 Ministries and 12 Divisions. The Ministry of Health ; Family Welfare is one of largest ministries in the country. At the national level, the Ministry oHealth ; Family Welfare (MOHFW) is responsible for policy, planning and decision making atmacro level. Under MOHFW, there are four Directorates, viz. , Directorate General of HealthServices, Directorate General of Family Planning, Directorate of Nursing Services and Directorate of Drug Administration. Beside, there are a separate National Nutrition Proje(NNP)and Construction, Maintanance and Management Unit (CMMU). . 5Economy Bangladesh has an agrarian economy, although the share of agriculture to GDP has beendecreasing over the last few years. Yet it dominates the economy accommodating major rural labour force. From marketing point of view, Bangladesh has been following a mixed economy that operates on free market principles. The GDP of Bangladesh is 6. 21% and per capitincome is US$ 599. The principal industries of the country include readymade garments,textiles , chemical fertilizers, pharmaceuticals, tea processing, sugar, leather goods etc. Theprincipal mineral includes Natural gas, Coal, white clay, glass sand etc. 2. 6Communication The transport system of Bangladesh consists of roads, railways, inland waterways, two sea ports, maritime shipping and civil aviation catering for both domestic and international traffic. Presentlythere are about 21,000 km of paved roads; 2,706 route-kilometres of railways (BG-884km and MG -1,822 km); 3,800 km of perennial waterways which increases to 6,000 km durinthe monsoon, 2 seaports (Chittagong and Chalna) and 3 international (Dhaka, Chittagong andSylhet) and 8 domestic airports. . 7Religion and Culture The majority (about 88%) of the people are Muslim. Over 98% of the people speak in Bangla. English, however is widely spoken. Bangladesh is heir to a rich cultural legacy. In two thousand or more years of its chequered history, many illustrious dynasties of kings and Sultans ruled the country and have left their mark in the shape of magnificent cities and monuments. The people of Bangl adesh are very simple and friendly. A beautiful communal harmony among the different religions has ensured a very congenial atmosphere. More than 75% of the population lives in rural areas. Urbanization has, however, been rapid in the last few decades. 2. 8Population and Demography Bangladesh is now Asia’s fifth and world’s eighth populous country with an estimated population of about 146 million. Density of population is around 979 per square kilometer, the highest in the world. Rural population comprises about 76% while urban constitutes about 24%. Adult literacy rate is 54% (2006). Census of 2001 reveals that 43 per cent of the population is below 15 years of age. This young age structure constitutes built-in population momentum. Also urban population is increasing quite fast. Though Bangladesh has made progress in reducing poverty and per capita income has been creeping up, a substantial number of population are poor. Progress made in improving Bangladesh’s Human Development Index (HDI) has placed her among the medium-ranking HDI countries. Strong policy interventions led to continuous reduction in the annual growth rate of population from the level of 2. 33 % in 1981 to 1. 54 in 2001 and further to 1. 48 (2007). The Total Fartility Rate (TFR) also went down from 3. 4 in 1993-94 to 2. 2 (2007). The CPR (any method) increased from 44. 6% in 1993-94 to 58. 1% in 2004, but again fell down to 55. 8% in 2007. Life expectancy at birth has continuously been rising, and is now 65 years (2007) from the level of 58 (1994). Reversing past trends, women now live longer than men. The country, however, is over burdened with about two million new faces every year creating extra pressure on food, shelter, education, health, employment, etc. , and thus making the anticipated economic growth difficult. . 9Health Status Since independence Bangladesh has made significant progress in health outcomes. Infant and Child mortality rates have been markedly reduced. The underfive mortality rate in Bangladesh declined from 151 deaths per thousand live births in 1991 to 65 deaths/1000 live births in 2007 and during the same period infant mortality rate reduced from 94 deaths per 1000 live births to 52. EPI coverage extended its re ach from 54% in 1991 to 87. 2% in 2006. The MMR reduced from 574/100,000 live births in 1991 to 290 in 2007. Deliveries attended by skilled birth attendants increased from only 5% in 1990 to 20% in 2006. The prevalence of malaria dropped from 42 cases /100,000 in 2001 to 34 in 2005. Bangladesh has also achieved significant success in halting and reversing the spread of tuberculosis (TB). Detection of TB by the Directly Observed Treatment Short-course (DOTS) has more than doubled between 2002 and 2007, from 34 to 92%. The successful treatment of tuberculosis has progressed from 84% in 2002 to 91% in 2007. Polio and leprosy are virtually eliminated. HIV prevalence is still very low. Development of countrywide network of health care infrastructure in public sector is remarkable. However, availability of drugs at the health facilities, deployment of adequate health professionals along with maintenance of the health care facilities remain as crucial issues, impacting on optimum utilization of public health facilities 2. 10Nutrition Status There has been considerable progress in reducing malnutrition and micro nutrient deficiencies in Bangladesh. According to BDHS, percentage of U5 underweight (6-59 months) has reduced to 46. (2007) from 67 (1990) and that of U5 stunted (24-59 months) from 54. 6 (1996) to 36. 2 (2007). Percentage of children 1-5 years receiving vitamin-A supplements in last six months has increased from 73. 3 (1999-00) to 88. 3 (2007). The rate of night blindness has reduced to 0. 04 per 1000 people (IPHN, HKI 2006). However, in spite of efforts taken by the government, high rates of malnutrition and micronutrient deficiencies along with gender disc rimination remain common in Bangladesh. 2. 11Urban Health Service The urban areas provide a contrasting picture of availability of different facilities and services for secondary and tertiary level health care, while primary health care facilities and services for the urban population at large and the urban poor in particular are inadequate. Rapid influx of migrants and increased numbers of people living in urban slums in large cities are creating continuous pressure on urban health care service delivery. Since the launching of two urban primary health care projects, the services have been delivered by the city corporations and municipalities through contracted NGOs in the project’s area. Rest of the urban areas and services are being covered by MOHFW’s facilities. Moreover, 35 urban dispensaries under the DGHS are providing outdoor patient services including EPI and MCH to the urban population. 2. 12Organizational Setup of MOHFW The Ministry of Health Family Welfare is one of largest ministries in the country. At the national level, the ministry of Health Family Welfare (MOHFW) is responsible for policy, planning and decision making at macro level. 2. 12. 1Executing Authorities of MOHFW: Under MOHFW, there are four Directorates General or Directorates, e. g. , Directorate General of Health Services, Directorate General of Family Planning, Directorate of Nursing Services and Directorate of Drug Administration. 2. 13Directorate General of health Services (DGHS) The Directorate General of Health Services (DGHS) is entrusted for the implementation of the policy decisions of the Ministry of Health and Family Welfare (MOHFW) as regards health service delivery to all the people under the jurisdiction of the Government of the People’s Republic of Bangladesh. It provides technical guidance to the ministry. DGHS carries out its activities through different directors, line directors, project directors, institution heads, district and upazila health managers and union health staffs. 2. 14Health, Nutrition ; Population Sector Program (HNPSP) The constitution Bangladesh mandates for basic health care services for its people as one of the fundamental responsibilities of the state. Towards this goal, the government has taken different endeavors to extend health facilities to the population. The broader policy document of the Government of Bangladesh that shapes direction of health care is the Poverty Reduction Strategy Paper (PRSP) although the current government has indicated that it will go for Five Year Plan. The Government of Bangladesh is running a program through which the health care services are provided to the people from the grass root to the central level. The program is entitled Health, Nutrition and Population Sector Program for the period of July 2003 through June 2010 (HNPSP 2003-2010). The Ministry of Health and Family Welfare (MOHFW) designed the Program Implementation Plan (PIP) in accordance with the PRSP to implement its sector wide program popularly known as Health, Nutrition and Population Sector Program (HNPSP). The HNPSP covers 38 Operational Plans (OP) to be implemented by 38 Line Directors and 14 Projects/Programs. The Government has recently decided to continue HNPSP until 2011. The details of the program are well documented in the form of Program Implementation Plan (PIP) duly endorsed at the highest policy level of the government, the Executive Committee for National Economic Council (ECNEC). The Implementing Agency of the program is Ministry of Health and Family Welfare (MOHFW) with its attached departments. The financial involvement is estimated to be around Taka 324,503 million which includes contributions for GOB (Government of Bangladesh) and DPs (Development Partners). 2. 15Priority Objectives and Goal One of the important goals of PRSP and HNPSP is attainment of Millennium Development Goals (MDGs). The health sector is specially striving for attainment of health related MDGs. The priority objectives of HNPSP are: (i) reducing MMR; (ii) reducing TFR; (iii) reducing malnutrition; (iv)reducing infant and under-five mortality; (v) reducing the burden of TB and other diseases; and (vi) prevention and control of noncommunicable diseases including injuries. The commitment of the government targets towards reaching the goal of sustainable improvement in health, nutrition and family planning status of the people by the end of the program period. It may be mentioned here that HNPSP deals with health care service delivery of the public sector. Nevertheless, it strives to maintain a strong cooperation and coordination with the efforts of the Private Sector as well so as to ensure the overall well-being of every citizen of the country. Of the 38 OPs, 7 are under MOHFW, 19 under Directorate General of Health Services (DGHS), 9 under Directorate General of Family Planning (DGFP), 1 under Directorate of Nursing Services (DNS), 1 under Directorate of Drug Administration (DDA) and 1 under National Institute of Population Research and Training (NIPORT) and. Of the 14 projects/programs, 1 is under MOHFW, 9 under DGHS, 1 under DGFP, 2 under DNS and 1 under NIPORT. The Health Bulletin 2009 is an attempt of Management Information System (MIS) of DGHS to provide an overview of the current health profiles of Bangladesh. CHAPTER – 3 Health care delivery systems of Bangladesh Distribution of public health care services and facilities follows similar pattern of administrative tiers, viz. national (mostly capital-based in Dhaka), regional (in divisions), district, upazila, union and ward. The country has 7 divisions, 64 districts, 482 upazillas and 4,498 unions. As the Ministry of health and family Welfare deploys health workforce according to the older ward system, which divides each union into 3 wards. Therefore, number of MOHFW wards is 13,494. Primary health care (PHC), which includes family planning services in the urban area (city corporations and municipalities), is provided by Ministry of Local Government; and in rest of the country by Ministry of Health and Family Welfare (MOHFW) provides health care service. Provision of secondary and tertiary care, in both urban divisional directorates with necessary staff. and rural areas, is the sole responsibility of MOHFW. The MOHFW delivers its services through two separate executing authorities, viz. Directorate General of Health Services (DGHS) and Directorate General of Family Planning (DGFP). The names explain their functions. PHC services of both DGHS and DGFP begin at the ward level through a set of community health staffs, at least one in each ward (Table). To supervise these field staffs, there is one assistant health inspector (for DGHS) and one family planning inspector (for DGFP) at union level. There are several hundred non-bed community facilities to provide outpatient services (1466 for DGHS and 3500 for DGFP). Besides DGFP also operates additional 97 maternal and child welfare centers (MCWCs) (union: 23; upazila: 12; district: 62), 471 MCH-FP clinics (upazila: 407; district: 64), 177 NGO clinics (upazila: 68; district: 104; national: 05), 08 model clinics (national: 02; regional: 06) and organizes 30,000 makeshift satellite clinics per month. The public sector hospital care in Bangladesh is mainly provided by DGHS. Primary level hospital care| Secondary level hospital care| Tertiary level hospital care| Begins through Upazila Health Complex (31 to 50 Bed) existing in 418 upazilas. The district hospitals (50 to 375 bed), one each district, provide secondary level hospital care in several specialty areas. | The regional hospital are multidisciplinary tertiary care hospitals (250 to 1700 beds) mostly affiliated with teaching institutes. At the national level, there are postgraduate and specialized hospitals (100 to 600 beds)| 3. 0Divisional level health organization At the divisional level, t here is a divisional Director for Health. S/he is the head of a Divisional Directors supervise the activities of the civil Surgeons. 3. 1District level health organization At the district level, Civil Surgeon is the health manager. S/he has own administrative office supported by various categories of staff. There is either a Sadar Hospital or a General Hospital in each district head quarter. The Hospital provides services under the management of Civil Surgeon with a view to render out-patient, in-patient, emergency, laboratory and imaging services to the people. The in-patient services internal medicine, general surgery, obstetrics and gynecology and other common specialist clinical services. It is the secondary level referral facility of health services of Bangladesh. Currently there are 59 Sadar district hospitals and 2 General hospitals in the country each having 100-250 bed. 3. 2Upazila level health organization Upazila Health Complex (UHC) is another fixed service delivery point next to district level hospital. It provides the first level referral services to the population. In each UHC, there are posts for 9 (nine) doctors including one Upazila Health and Family Planning Officer (UHFPO). UHFPO is the Chief Health Officer of upazila and also Head of the UHC. Other doctors of UHC are Junior Consultants-4, Resident Medical Officer-1, Assistant Surgeons (MO)-2 and Dental Surgeon-1. There are 418 Upazila Health Complexes (UHC) in the country of which 153 are 50bed and rests are 31-bed. UHC provides out-patient, in-patient and emergency services, limited diagnostic and imaging services, emergency obstetric care, contraceptive services and dental care. 3. 3Union level health organization There are four types of static health facilities in the union level. These are Rural Health Centers (RHC, 10-bed hospital), Union Sub-centers (USC), Union Health and Family Welfare Centers (UHFWC) and Community Clinics (CC). There are 22 RHCs, in each of these, there are sanctioned posts of 20 staffs. RHC provides both out-patient and inpatient services. In an USC, there is sanctioned posts for one medical officer, one medical assistant, one pharmacist and one MLSS. Number of USC is 1,362; that for UHFWC is 87. Under HPSP, Government planned for establishing one Community Clinic for every 6000 rural populations. Number of CCs so far built is 11,883. But, these were not made functional. Recently Government has decided to start the CCs again. The total number of CCs will be 18000. The existing UHCs and Union level facilities will also provide services of CCs in the respective communities. So,13,500 additional CCs will be required. The main health workforce in the union level is the domiciliary staff called health assistants. They are placed in each ward, which is the lowest and smallest administrative unit of the health sector. They visit the homes of the local people for providing primary health care services and collection of routine health data. The health assistants routinely organize satellite clinics for immunization services. Besides there are other small to large hospitals and special purpose hospitals spread across the country both in rural as well as in urban areas. Under the DGHS, there are altogether 40 teaching/training institutes and 589 small to large hospitals. In Family Planning sector, there are one national research-cum-training institute, two hospital-based training centers, and 32 other training centers (national: 12; regional: 20). Nearly six hundred health managers under DGHS and a similar number under DGFP, from national to upazila levels, play roles in administering the health and family planning services (1,17). This figure does not include the institute and clinic/hospital heads. CHAPTER – 4 Facility Based Health Services Hospital service is one of the important activities of health sector, which is the most visible health service also. This chapter of the Health Bulletin 2009 will provide an overview of the hospitals and their bed capacity as well as utilization based on the information from January through December of 2008. 4. 0Hospitals by bed capacity There are 585 hospitals ranging from 10 beds to 1,700 beds under DGHS currently. All of these hospitals provide a total of 37,090 beds. The table below gives a detail profile. No. f hospitals by bed capacity and total beds under DGHS Sl. No. | Bed capacity | No. of hospitals in this type | Total beds | 1 | 1700 beds | 1 | 1700 | 2 | 1010 beds | 1 | 1010 | 3 | 900 beds | 1 | 900 | 4 | 800 beds | 1 | 800 | 5 | 600 beds | 5 | 3000 | 6 | 500 beds | 3 | 1500 | 7 | 414 beds | 1 | 414 | 8 | 375 beds | 1 | 375 | 9 | 250 beds | 19 | 4750 | 10 | 200 beds | 2 | 400 | 11 | 150 beds | 3 | 450 | 12 | 100 beds | 53 | 5300 | 13 | 80 be ds | 1 | 80 | 14 | 56 beds | 1 | 56 | 15 | 50 beds | 158 | 7900 | 16 | 31 beds | 271 | 8401 | 17 | 30 beds | 1 | 30 | 8 | 25 beds | 1 | 25 | 19 | 20 beds | 43 | 860 | 20 | 10 beds | 22 | 220 | | Total = | 589 | 3817138171| Type of hospitals Following list gives an overview of the type of hospitals currently in operation under DGHS Type of hospitals | No. of hospitals | Total bed capacity | Postgraduate institute hospital | 7 | 2014 | Dental college hospital | 1 | 20 | Hospital for alternative medicine | 2 | 200 | Medical college hospital | 14 | 8685 | Mental hospital, Pabna | 1 | 500 | Shekh Abu Naser Specialized Hospital | 1 | 250 | Narayanganj 200 bed Hospital | 1 | 200 | Specialized Health center (Asthma ; Burn unit) | 2 | 150 | Sarkari karmochari hospital | 1 | 100 | Chest hospital | 12 | 566 | Infectious disease hospital | 5 | 180 | Leprosy hospital | 3 | 130 | District Level Hospital | 60 | 8100 | 50 bed hospital(Tongi, Saidpur) | 2 | 100 | 100 bed hospital (Narsingdi) | 1 | 100 | 25 bed hospital (Jhenidah) | 1 | 25 | Bangladesh korea moitree hospital | 1 | 20 | Upazila health complex | 421 | 15958 | Health complex (31 bed) | 3 | 93 | 20 bed hospital | 28 | 560 | 10 bed hospital | 22 | 220 | Postgraduate Institute Hospitals all are national level hospitals and are located in Dhaka) Total = 7 | No. of beds | | Total | Revenue | Develop. | Proposed | Beds will Increase | 1. National Institute of Chest Disease and Hospital (NIDCH) | 600 | 600 | 0 | 0 | 0 | 2. National Institute of Cardiovascular Disease (NICVD) | 414 | 250 | 164 | 0 | 0 | 3. National Institute of Traumatology and Rehabilitation (NITOR) | 500 | 500 | 0 | 0 | 0 | 4 National Institute o f Cancer Research and Hospital (NICR;H) | 50 | 50 | 0 | 250 | 200 | 5 National Institute of Ophthalmology (NIO) | 250 | 250 | 0 | 0 | | 6. National Institute of Kidney Disease and Hospital (NIKDU) | 100 | 0 | 100 | 0 | 0 | 7. National Institute of Mental Health (NIMHR) | 100 | 50 | 50 | 0 | | Total = | 2014 | 1700 | 314 | 250 | 200 | Medical College Hospitals of Teaching Hospitals of equivalent level (Regional hospitals and are used as undergraduate and postgraduate teaching hospitals). Division | District | Name of hospital (Total = 17) | No. of beds | | | | Beds | Revenue | Develop. | Proposed | Bed will increase | Barisal | Barisal | Sher-e-Bangla Medical College Hospital | 00 | 600 | 0 | 1000 | 400 | Chittagong | Chittagong | Chittagong Medical College Hospital | 1010 | 1010 | 0 | 0 | 0 | | Comilla | Comilla Medical College Hospital | 250 | 250 | 0 | 500 | 250 | Dhaka | Dhaka | Dhaka Medical College Hospital | 1700 | 1700 | 0 | 2000 | 300 | | | Sir Salimullh Medical College Hospital | 600 | 600 | 0 | 0 | 0 | | | Shahid Suhrawardy Hospital, Dhaka | 375 | 375 | 0 | 0 | 0 | | | Homoeopathic Degree College ; Hospital | 100 | 100 | 0 | 0 | 0 | | | Unani ; Ayurvadic College ; Hospital | 100 | 100 | 0 | 0 | 0 | | | Dental College and Hospital, Dhaka | 20 | 20 | 0 | 200 | 180 | | Faridpur | Faridpur Medical College Hospital | 250 | 250 | 0 | 0 | 0 | | Mymensingh | Mymensingh Medical College Hospital | 800 | 800 | 0 | 1000 | 200 | Khulna | | Khulna Medical College Hospital | 250 | 250 | 0 | 500 | 250 | Rajshahi | Bogra | SZR Medical College Hospital | 500 | 500 | 0 | 0 | 0 | | Dinajpur | Dinajpur Medical College Hospital | 250 | 250 | 0 | 500 | 250 | | Rajshahi | Rajshahi Medical College Hospital | 600 | 600 | 0 | 0 | 0 | | Rangpur | Rangpur Medical College Hospital | 600 | 600 | 0 | 1000 | 400 | Sylhet | Sylhet | MAG Osmani Medical College Hospital | 900 | 900 | 0 | 1000 | 100 | Total = | 8905 | 8905 | 0 | 7700 | 2330 | Specialized Centers under DGHS with bed capacity (Year 2008) Division | District | Name of hospital (Total = 2) | No. of beds | | | | Beds | Revenue | Develop. | Proposed | Bed will in crease | Dhaka | Dhaka | 1. National Asthma Center at NIDCH | 100 | 0 | 100 | 0 | 0 | | | 2. Burn Unit | 50 | 0 | 50 | 200 | 150 | Total = | 150 | 0 | 150 | 200 | 150 | | | 4. 1BSMMU Bangabandhu Sheikh Mujib Medical University (BSMMU) is the premier Postgraduate Medical Institution of the country. It bears the heritage to Institute of Postgraduate Medical Research (IPGMR)which was established in December 1965. In the year 1998 the Government converted IPGMR into a Medical University for expanding the facilities for higher medical education and research in the country. It has an enviable reputation for providing high quality postgraduate education in different specialties. The university has strong link with other professional bodies at home and abroad. The university is expanding rapidly and at present, the university has many departments equipped with modern technology for service, teaching and research. Besides education, the university plays the vital role of promoting research activities in various discipline of medicine. Since its inception, the university has also been delivering general and specialized clinical service as a tertiary level healthcare center. The university provides patient care services on various disciplines like Psychiatry, Physical medicine, Pediatrics, Neonatology, Pediatric neurology, Pediatric surgery, Clinical pathology, Dermatology, Colorectal surgery, Nephrology, Urology, Neurology, Neuro-Surgery, Internal Medicine, Gastroenterology, Hepatology, Ophthalmology, ENT, Obstetrics ; gynecology, Surgery, Hepatobiliary Surgery, dentistry, and blood transfusion services. It provides different treatment services like Intensive Care, Lithotripsy, Pain management and diagnostic services like radiology, endoscopy, CT scan ; MRI and a one-stop laboratory service. BSMMU runs Institute of Nuclear Medicine (INM). INM is a joint project of Bangladesh Atomic Energy Commission and BSMMU. The INM has modern diagnostic and therapeutic facilities including computerized ultrasonography, gamma camera and a well equipped radioimmunoassay (RIA) laboratory. This is considered to be the best center for noninvasive diagnoses. 4. 2Smiling  Sun  Franchise  Program   (SSFP) The Smiling Sun Franchise Program is a project funded by the United States Agency for International Development (USAID). It is intended to complement the wide network of healthcare facilities set up by the Government of Bangladesh resorting to an innovative approach to health care franchising. SSFP is committed to improve the quality of life of all Bangladeshis by providing superior, friendly and affordable health services in a sustainable manner. To achieve relevant health outcomes, SSFP is jointly working with partnering NGOs to convert the existing network into a viable social health system. SSFP objective is to strengthen partnering organization’s quality of care while helping them to enhance their financial sustainability, thus enabling them to continue serving an important segment of the Bangladeshi society, including the poorest of the poor. Currently 29 NGOs are providing health care services to women, children and through 319 static and 8,500 satellite clinics in 61 districts of Bangladesh. 34 clinics of this network are providing Emergency Obstetric Care (EmOC) services. This network will continue to expand the volume and types of quality health care under ESD provided to the able-to-pay customers as well as underserved and poor clients. 4. 3Urban Primary Health Care Project (UPHCP-II): About 35 million people representing almost 25 percent of the population of Bangladesh live in urban areas, a large proportion of whom are slum dwellers. The health knowledge of the urban slum dwellers and their access to essential basic health services are low. Children living in urban slums are deprived of education and health care, and vulnerable to violence, abuse and exploitation. On the other hand, high rate of mortality and morbidity exists among women who remain neglected in terms of meeting their basic health needs and ensuring their rights. The Government of Bangladesh is committed to put in place strategies to address the issues of improving the health status of the urban population. This is to be done through improved access to and utilization of efficient, effective and sustainable Primary Health Care Services. The provision of public health services in urban areas is the responsibility of Local Government Bodies by dint of City Corporation Ordinance of 1983 and Pouroshova Ordinance of 1977. For primary health care services delivery, the public sector works in partnership with NGOs and the local government institutions such as the City Corporations and Pouroshovas. The health service delivery mechanism in urban areas involves diverse roles of the government (MOLGRDC and MOHFW), NGOs and the private sector. CHAPTER – 5 Leading Public Health Problems 5. 0Communicable disease The prevention and control of communicable diseases represent a significant challenge to those providing health-care services in Bangladesh. Sound knowledge on the disease epidemiology is a must for the health service providers in various levels. The Bangladesh population is namely affected by diarrheal diseases, cholera, hepatitis A E, Malaria, Mycobacterial Disease like Tuberculosis and Leprosy, Dengue, Japanese encephalitis, Nipah virus infection, etc. Crowding, poor access to safe water, inadequate hygiene and toilet facilities, and unsafe food preparation and handling practices are associated with transmission. Cholera is endemic Bangladesh, between 800 and 1000 cases are usually being recorded daily at the hospital of the ICCDR, B in Dhaka. Hepatitis A and E levels are usually high in the country. Malaria risk exists throughout the year in Bangladesh. Thirteen out of 64 administrative districts are high malaria endemic areas. 98% of all malaria cases reported are from these districts, which are mainly located in the border areas of India and Myanmar. Tuberculosis still remains as a major public health problem, which ranks Bangladesh fifth among the high-TB burden countries in the world. The present revised National Tuberculosis Programme (NTP) was launched and field implementation of DOTS (Directly Observed Treatment short course) was started in 1993. Kala Azar or Leishmaniasis or is endemic in Bangladesh and has an incidence of 175 per 100,000 per annum. It is caused by a protozoa which is transmitted from the bite of infected sandfly and may present in cutaneous or visceral forms (particularly common in Bangladesh). Filariasis is a mosquito borne parasitic disease causality urogenital organs, breast, etc. with long arm disability. In Bangladesh, it is endemic in 23 districts, mostly the bordering ones. About 20 million people are already infected, most of whom are incapacitated. Leprosy has been a major health problem in Bangladesh for a long time. Bangladesh was considered a high endemic country and was listed among ten countries with high case load (1992). Leprosy situation has changed globally after 1981 when the Multi Drugs Treatment (MDT) were introduced. Hepatitis A virus infection is common in Bangladesh with a prevalence of about 2% to 7%. Prevalence of hepatitis C virus infection is less than 1%. Sporadic outbreak is often seen caused by hepatitis E virus infection; but presence of hepatitis D infection is not exactly known. Polio free status prevailed from 2001 until now (June 2009) except a small window period in 2006 when 18 cases of child polio were seen in boarder areas of Bangladesh. it is assumed that these cases were imported from India. Dengue fever/Dengue hemorrhagic fever (DF/ DHF) is a viral disease transmitted by the Aedes aegypty mosquito. It is on the increase in South East Asia. Bangladesh reported 100, 000 cases in 2005. However case fatality rate (CFR) remained 1% up to 2006. 5. 1Non-communicable disease There have been a number of demographic and lifestyle changes over the past two decades in Bangladesh. Improvement in health care delivery has increased the number in aging population. Similarly, industrialization has enhanced urbanization and change in life pattern. The rise in aging population and urbanization are accompanied by an increase in non-communicable diseases and mental health problems. The lifestyle changes associated with change in dietary pattern, lack of physical exercise and rest and recreation, use of tobacco etc. , are all changing the epidemiology of morbidity and mortality in Bangladesh. Noncommunicable diseases such as cardio vascular disease, diabetes mellitus, cancer, chronic renal disease, mental problems are some of the important emerging non-communicable health problems in country like Bangladesh. Other conditions like injuries especially road traffic injuries, violence against women are on the rise. Data from some of the major health institutions who deals with noncommunicable disease are presented here. The data will give an indirect impression about the disease burden of NCDs in the country. 5. 1. 1Cardiovascular Diseases Cardiovascular diseases are the leading cause of death and disability in most of industrialized countries. They are also increasing in the developing world as well as in our country too. Major Cardiovascular diseases include Coronary Heart Disease, Hypertension, Rheumatic Heart disease etc. Statistics from National Institute of Cardiovascular Disease (NICVD) and National Center for Control of Rheumatic Fever and Heart Diseases indicates that numbers of patients suffering from cardiovascular diseases are rising over the years. 5. 1. 2Rheumatic heart disease (RHD) Rheumatic heart disease (RHD) is a consequence of rheumatic fever and is the commonest heart ailment among the pediatric age-group and young adults of Bangladesh. In our country context, poverty, overcrowding, lack of nutrition and lack of health education concentrates the problem more. Statistics from the National Center for Control of Rheumatic Fever and Heart Diseases shows the increasing trend of rheumatic heart disease. 5. 1. 3Diabetes Diabetes is a major public health problem for not only developed countries but also developing countries like us. The prevalence and the morbidity-mortality data due to diabetes are grossly under estimated all over the world. And the economic burden of the disease is also increasing. Without emphasis on prevention it will not be possible for Bangladesh to combat the disease epidemic. We are yet to develop large scale structured program on primary prevention of diabetes or secondary prevention of diabetes complication. Next to public sector, Diabetic Association of Bangladesh (BADAS) is playing a major role in treatment of diabetes in Bangladesh. Data from BIRDEM and affiliated associations under BADAS shows that diabetic patients are ever increasing. 5. 1. 4Cancer Cancer is emerging as a public health concern worldwide. Though cancer occurs predominantly in elderly people of developed countries, developing country like Bangladesh is also having increased number of malignancies annually. As the health system is improving, mortality rate is gradually declining with the consequence of increased people in the elderly group. Rapid urbanization, environmental pollution, and change in lifestyle along with change in food habit are influencing the rise in number of cancer incidences of our country. The National Institute of Cancer Research and Hospital (NICRH) is the leading institute for cancer related hospital services and programs. Some of the Cancer related data provided by NICRH are included in the current health bulletin. 5. 1. 5Renal Disease Various type of renal disease is occurring in our country that includes not only acute but also chronic renal failure. Lack of optimum personal hygiene, inadequate health education and improper lifestyle influences the incidences of renal disease. Chronic renal failure not only increases disease burden but also creates huge economic burden. National Institute of Kidney Disease and Urology has taken a central role in treating the renal disease. Data from NIKDU shows that annual incidences of patients suffering from different type of renal diseases are constantly increasing. 5. 1. 6Mental Health Many people in our country suffer from mental illness and some of them are predicted to have serious and disabling mental disorders, and some to have psychosomatic disorders. Though epidemiological studies are not available, small scale studies suggest that prevalence of mental disorders is on increase in our country. National institute of Mental Health (NIMH) is one of the key institutes in treatment of mental disorders. To focus some light on the mental health related illness, this bulletin has included some of the patient related statistics of NIMH. 5. 2Occupational diseases The main occupational diseases include pneumoconiosis, poisoning, and physical injury. Because of poor working conditions and the lack of effective protection, the prevalence of occupational diseases has been rising rapidly in recent years. Nearly 20 million workers still work in harmful environments, which are present in at thousands of enterprises throughout the country. 5. 3Unhealthy life-style Smoking has been steadily increasing in recent years, especially in the young. Among middle school students, 34% of boys and 4% of girls smoke. alcohol consumption has also increased since the 1980s, as has alcohol dependence, with the age of the onset becoming younger. 5. 4Population aging A large population over 60 years old has emerged in many big cities and economically developed rural areas. In 2000, the total number of people over 60 was 10% of the country’s population. Nearly 30% of the aged are in poor health. Hypertension, coronary heart disease, chronic bronchitis, stroke, cancer, diabetes mellitus, and benign prostatic hypertrophy pose serious threats to the elderly, which at present make up 8% of the total population. 5. 2Top 10 death causes by age group The causes of death s for 27,789 cases were grouped according to age. In age group, distribution of the cause of deaths was made to find the top 10 causes of deaths. It is found that birth asphyxia (44. 9%) and complications of pre-term low birth weight (23. 8%) are the two top causes of deaths in the newborns aged 0-to 7-days; septicemia (25. %) and pneumonia rank first and second position in top 10 causes of deaths respectively in 7-to 28days’ age group. Causes of deaths like complications of pre-term low birth weight (12. 5%) and birth asphyxia (11. 3%) descend to third and fourth position in this age group. Pneumonia is at the top of the causes of death in 1 month-to 1 year’s (42. 4%) and 1-to 4-years’ (28. 1%) age group respectively. Among the 5-to 14-years’ age group, encephalitis (11. 1%) tops the causes of deaths list followed by pneumonia (8. 4%). Among the 15-to 49years’ age group, respiratory failure (12. 3%) and pesticide poisoning (8. 0%)rank first and second position in the list of causes of deaths. Acute myocardial infarction (14. 5%) tops the causes of deaths in the age group of 50to 59-years, indicating the rise in prevalence of cardiac problems in elderly population of Bangladesh. Similarly, another non communicable disease the cerebrovascular disease (17. 4%) is at the top of the causes of deaths in the 60+ years’ age group. CHAPTER – 6 Health Education,HRM ; Promotion Program 6. 0Background Health promotion aims for improvement in health, preventing specific disease rather than treating illness alone. The major principles that underpin health promotion ideology are that health is essential for achieving a socially and economically productive life. Successful implementation of health promotion strategies needs political and social actions to modify public policy. Without the policy support for creating enabling environment it will be difficult to change behavior only through health education and promotion. 6. 1Initiatives There are significant health promotion initiatives around the Globe. The Government of Bangladesh has initiated several health promotion policies such as Millennium Development Goals which include several health promoting objectives i. e. poverty reduction, water supply and sustaining the environment, reduction of maternal ; infant mortality rate, improvement of health status and reduce disease burden. The Government of Bangladesh has ratified global framework convention of tobacco control adopted by World Health Organization. Bangladesh has been working on all these agenda with special emphasis to health promotion in a multi sectored approach. 6. 2Country Profile Health education as health promotion initiative has started in Bangladesh in 1958 under the Directorate General of Health Services. It is considered as precondition for successful implementation of health care. The network of health promotion is extended up to the grass root level. The key strategic components of health education and promotion in Bangladesh are: ? Community Health Education ? School Health Education ? Industrial Health Education ? Hospital Health Education Environmental Health Education ? Education for prevention and control of communicable and non-communicable disease. ? Health Education for improvement of maternal and child health. ? Health Education for Diet and Physical activity. ? Education for impro vement of nutritional status of the people. 6. 3Methods and Media for Health Promotion in Bangladesh ? Interpersonal communication and counseling. ? Group discussion and peer group education by the health care providers. ? Projection of documentary films, Videos on health issues in the community. ? Distribution and display of IEC materials on priority health issues. ? Social mobilization and advocacy at different levels. Use of Electronic and Print media to disseminate health messages. ? Dissemination of health messages through Audio-visual equipments in the hospitals and clinics. ? Health education and promotion campaign on different health problems. ? Health Education in the mosques and other religious institutions. 6. 4National Priority Ministry of Health and Family Welfare has given priority on Health Education and Promotion program in the country. Health Promotion has been incorporated as an essential component in the Health, Nutrition and population sector program of the Gover nment of Bangladesh with financial allocation of Taka 900 million for the period 2003-2010. This has been guided by health policy and aim to be contributed towards poverty alleviation, gender equity, violence against women, acid prevention, environment protection, disease prevention and control of drug abuse, maternal child health nutrition. The Country has been strengthening health promotion program at macro and micro level based on actual health needs of the community. 6. 5Vision 2015 ? Improve knowledge, attitude and practices of the people towards prevention and control of communicable and non-communicable diseases. ? Strengthen multisectoral approach and stakeholders participation in the development of health promotion. ? Improve knowledge and skills of health service providers in communication. ? Establish community Support System in every village for health promotion program. Incorporate health promotion in all the ongoing health program. ? Strengthen Bureau of health Education and its network up to the sub-district levels. ? Share knowledge and experiences with regi onal countries to implement health promotion in a better way. ? Improve knowledge and skills of Health Education professionals through training, study tour in abroad. ? Conduct operational research and impact evaluation. ? Establish health promotion network within the region. 6. 6Grounding of Health Professionals The Directorate General of Health Services is the key government organization, which is responsible for delivering health care to the people all over Bangladesh. In order to deliver the service over one lakh health care personnel and staffs are manned by DGHS throughout Bangladesh. The manpower deployment and redeployment process is very dynamic and at every point of time the picture is changing. Retirement, placement, transfer of manpower is constantly occurring and it influences the process of distribution of human resources. Besides this, depending upon the personnel category, transfer and posting may take place at different level viz. , MOHFW, DGHS and offices of the Divisional Directors of Health and Civil Surgeons office. So limitations arise at any given point of time when we try to pick up accurate picture of human resource distribution. 6. 6. 01Alternative Medical Care Forty five Medical Officers (15 Unani, 15 Ayurvedic and 15 Homoeopathic) on Alternative Medicine have been appointed in the selected district level hospitals under the work plan of HPNSP, so that the patients of these districts have the option to receive the types of treatment according to their own choice. To assist the medical officers 64 support personnel (compounder) have been appointed. To develop awareness on medicinal plants, 467 herbal gardens. 6. 6. 02Human Resource Development As the population of the country is increasing, the country will need large number of physicians, nurses, medical technologists and other paramedical workforces to cope up with the growing need. Along with the national development, the country is experiencing a positive growth in the development of human resources for health. Both the public and private sectors are expanding their respective capacities of developing skilled health personnel that include physicians, nurses, medical technologists and other staffs like pharmacists. Bangladesh health personnel are also working in the different parts of the world and there is a growing need of Bangladeshi personnel globally. In the subsequent part of this chapter, information on capacity of teaching/training institutes for development of human resources for health will be outlined. 6. 6. 03Postgraduate medical degree There are 33 institutes in Bangladesh which offer postgraduate specialist degrees in medical fields. Of these institutes, 22 are in public sector, 5 are non-profit organizations (these institutes receive financial grants from government to run the institutes or their affiliated hospitals), one is operated by Bangladesh Armed Forces and others are in private and NGO sector. Of the public sector institutes, 19 are under Directorate General of Health Services (DGHS) and one is autonomous medical university. Of the 19 institutes under DGHS, 9 are postgraduate institutes offering onlypostgraduate medical degrees. Others are medical or dental colleges and offer both undergraduate and postgraduate medical degrees. List of postgraduate medical institutes (total number: 11) under DGHS 1. Institute of Child and Mother Health (ICMH), Matuail, Dhaka 2. Institute of Nuclear Medicine and Hospital 3. National Institute of Cancer Research and Hospital (NICRH), Mohakhali, Dhaka 4. National Institute of Cardiovascular Diseases (NICVD), Sher-E-Bangla Nagar, 5. National Institute of Diseases of the Chest and Hospital (NIDCH 6. National Institute of Kidney Diseases and Urology (NIKDU) 7. National Institute of Mental Health and Research (NIMHR), Sher-E-Bangla Nagar 8. National Institute of Ophthalmology (NIO), Sher-E-Bangla Nagar 9. National Institute of Preventive and Social Medicine (NIPSOM), Mohakhali, 10. National Institute of Traumatology, Orthopedic and Rehabilitation (NITOR) 11. Center for Medical Education List of medical colleges under DGHS, which in addition to providing postgraduate medical degrees (total number: 10) 1. Chittagong Medical College, Chittagong 2. Dhaka Dental College, Dhaka 3. Dhaka Medical College, Dhaka 4. MAG Osmani Medical College, Sylhet 5. Mymensingh Medical College, Mymensingh 6. Rajshahi Medical College , Rajshahi 7. Rangpur Medical College , Rangpur 8. Sher-e-Bangla Medical College, Barisal 9. Sir Salimullah Medical College , Dhaka 10. SZR Medical College, Bogra Medical University under MOHFW (total number: 1) 1. Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbagh, Dhaka Postgraduate Institute under Bangladesh Armed Forces (total number: 1) 1. Armed Forces Medical Institute List of non-profit institutes which offer postgraduate medical degrees (these institutes receive government grants for running their institute or affiliated hospital; total number: 4) 1. Bangladesh College of Physicians and Surgeons (BCPS), Mohakhali, Dhaka 2. Bangladesh Institute of Child Health, Sher-e-Bangla Nagar, Dhaka 3. Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), Shahbagh, Dhaka 4. National Heart Foundation Hospital and Research Institute, Mirpur, Dhaka List of other institutes in private and NGO sector which offer postgraduate medical degrees (total number: 9) 1. Chattagram Maa and Shishu and General Hospital, Chittagong 2. Institute of Child Health and Shishu Hospital, Shishu Sasthya Foundation, 3. Lions Eye Institute and Hospital, Lions Bhaban, Agragaon, Dhaka 4. MAI Institute of Ophthalmology and Islamia Hospital, Sher-e-Bangla Nagar, 5. Institute of Health Sciences (Under USTC), Foy’s Lake, Chittagong 6. Institute of community Opthalmology, Chittagong 7. James P Grant School of Public Health, BRAC University, Mohakhali, Dhaka 8. State University of Bangladesh, Dhanmondi R/A, Dhaka 9. Gono Bisshobidhyaloya (People’s University) 6. 6. 04Undergraduate medical degree There are 59 medical colleges and 14 dental colleges in the country to offer bachelor’s degree in medicine (MBBS) and dentistry (BDS). Of the 59 medical colleges, 17 are under the MOHFW, one under Bangladesh Armed Forces and 41 are in the private sector. Of the 14 dental colleges, 3 are under MOHFW and 11 are in the private sector. The medical colleges currently have capacity of annual admission 5,549 students for MBBS course. These include 2,494 seats in medical colleges under MOHFW, 100 seats in Armed Forces Medical College and 3,055 seats in private medical colleges. Out of these seats in medical colleges under MOHFW, 40 seats are reserved for children of freedom fighters, 20 for tribal students and 84 for foreign students. 6. 6. 05Nursing education There are 13 nursing colleges and 69 nursing institutes in the country for production of nursing workforce. The nursing colleges offer BSc nursing degree, and the nursing institutes offer diploma in nursing. Of the 13 nursing colleges, 5 are under MOHFW and 7 under private sector and one is manned by Bangladesh Armed Forces Of the 69 nursing institutes, 46 are under MOHFW, 1 under Bangladesh Armed Forces and 22 under private sector. Under the MOHFW, 6 nursing institutes are attached with medical college hospitals, 11 with general hospitals and 17 with district hospitals. The nursing institute under the Bangladesh Armed Forces is attached with the Armed Forces Medical Institute, Dhaka. Besides, 2 institutes produce specialized nurses. These are National Heart Foundation, Mirpur, Dhaka (20 seats; intensive care unit, coronary care unit, cardiac nursing) and Bangladesh Health Professionals Institute, Savar, Dhaka (20 seats; rehabilitation nursing). 6. 6. 06Production of medical assistants Medical assistants are the assistants to the doctors working at the upazila health complexes or union sub-centers. Bangladesh has a shortage of graduate medical doctors. In this context, the medical assistants serve as the doctors. Currently there are 7 medical assistant training schools in the country which together have seat capacity of 650 students. Medical assistant’s course requires a student to complete a 3 years’ course to obtain a medical diploma. 6. 6. 07Production of medical technologists Medical technologists are technicians who perform the laboratory tests, take x-ray images, provide physiotherapy or radiotherapy, help making artificial dentures, etc. To produce medical technologists there are currently both graduate and diploma courses in the country. Sixteen institutes conduct BSc medical technology courses in laboratory medicine, physiotherapy, occupational therapy and dentistry. Total seat capacity is 1065. Of the 16 institutes, 3 are under MOHFW and the rests are in private sector. To produce diploma medical technologists, the DGHS has 3 institutes of health technology (IHT) in the government sector. They altogether have 1010 seats. There are 47 private IHTs which have total seat capacities of 5696. These IHTs offer 3 years diploma in medical technology in 7 disciplines, viz. laboratory, radiography, physiotherapy, dental technology, radiotherapy and pharmacy. Currently 50 institutes both in government and private sector have total seat capacity of 6706. Two institutes (Gonobisshobidhyaloya, Savar and BHPI, Savar: total 25 seats) have started MSc course in medical technology in discipline of physiotherapy. Top of Form | | | Number of seats in the different postgraduate medical courses provided under institutes and colleges Institute | Name of course with number of seats | | MS| MD| M. Phil| Diploma| MPH| Other| Total| 1. BSMMU | 140| 150| 70| 106| -| MTM-10| 476| 2. Centre for Medical Education (CME) | -| -| -| -| -| MMED-15| 15| 3. Dhaka Medical College | 70| 110| 86| 82| 06| -| 354| 4. Chittagong Medical College | 37| 48| 29| 48| 03| -| 165| 5. Mymensingh Medical College | 22| 40| 33| 59| -| -| 154| 6. Rajshahi Medical College | 10| 19| 25| 41| 05| -| 100| 7. MAG Osmani Medical College | 20| 12| 28| 40| -| -| 100| 8. Sher-E-Bangla Medical College | 04| -| 08| 22| -| -| 34| 9. Rangpur Medical College | 08| 08| 08| 22| -| -| 46| 10. Sir Salimullah Medical College | 21| 36| 18| 40| 05| -| 120| 11. BIRDEM | 10| 22| 15| 14| -| -| 61| 12. NICVD | 20| 20| -| 14| -| -| 54| 13. NIDCH | 06| 15| -| 20| -| -| 41| 14. Institute of Child Health and Shishu Hospital | -| -| -| 06| -| -| 06| 15. National Institute of Child Health | 10| 15| -| 15| -| -| 40| 16. National Institute of Cancer Research and Hospital | 06| 12| -| -| -| -| 18| 17. NIPSOM, Dhaka | -| -| 07| -| 166| -| 173| 18. National Heart Foundation | 05| 05| -| -| -| -| 10| 19. Institute of Nuclear Medicine and Hospital | -| -| -| 10| -| -| 10| 20. Institute of Child Mother Health (ICMH) | 10| 10| -| 30| -| -| 50| 21. National Instit How to cite â€Å"a Contemporary View on Health Care System in Bangladesh.†, Essay examples

Persuasive Essay Topics Essay Example

Persuasive Essay Topics Paper Topics for a Persuasive Essay What is a persuasive essay? Tips on writing a good persuasive essay More tips on persuasive essay writing How to structure a persuasive essay? Persuasive topics list Do you know that feeling which appears after a month of a strong quarrel, when you suddenly come up with such a great argument but understand that now is needless at all? Of course, you do. This artful â€Å"after quarreling† arguments drive us crazy and torture for a few days after that. How to choose the best persuasive essay topics? What about improvement? How to gather yourself, stay concentrated and tell the reasons clearly and with right ranking? What is a persuasive essay? A persuasive essay is a good answer to those two questions. This essay  is a type of writing that attempts to convince the reader or opponent that your argument or claim is correct. The main objective of the persuasive speech is to make the students master the art of persuasion.  Persuasive  essays  are a bit like  argument essays, but they tend to be a little kinder and gentler. Argument essays require that you discuss and attack an alternate view, while persuasive essays are more like attempts to convince the reader that you have a believable argument. Tips on writing a good persuasive essay We will write a custom essay sample on Persuasive Essay Topics specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Persuasive Essay Topics specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Persuasive Essay Topics specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Let’s read some rules! The goal of a persuasive essay is to convince readers! Memorize it. Use the next three tools while writing persuasive essay topics. Their names are Ethos, Pathos, and Logos: Ethos, or  Authoritative Appeal: It is a backup of what you say with facts from reliable sources. Your audience can believe everything you tell them after that. 2. Pathos, or Emotional Appeal: Speak to the audience as human beings, allowing them to view an issue from a variety of perspectives. 3. Logos, or Logical Appeal: Prove that your argument is true and makes sense to the audience. More tips on persuasive essay writing Except for those three tools, we have some pieces of advice to you as well: Select your point of view. It means that you have to come up with a clear purpose and aim. Which side of the problem are you going to talk about? Will you give any solutions to solve it? Investigate your audience. You have to comprehend if they will agree or disagree with you in advance. Search a lot your topic. You can’t look superficially while writing. A persuasive essay must provide specific and convincing evidence. Going beyond your knowledge and experience is necessary. If you need to visit the library or interview people who are experts on your topic, do it. Encourage your arguments. Use hard facts.  You can gather these from your research, observations, or personal experiences. But be careful! In order to avoid  plagiarism, you must cite your sources. You should always use verifiable statistics. Being able to back up your argument with data is important. How to structure a persuasive essay? The introduction in your persuasive essay should grab the readers attention and provide background information about your subject. It should end with a clear statement of your thesis. The body should consist of all the arguments that support your thesis. Each paragraph should focus on one particular theme. Use the last sentence of each body paragraph for the transition to the next paragraph.In order to establish flow in your essay, you want there to be a natural transition from the end of one paragraph to the beginning of the next. The conclusion should restate the main argument and supporting point. If its something your reader wont easily forget, your essay will have a more lasting impression. Don’t just restate the thesis; think about how you will leave your reader. What questions may be raised? What actions could reader take after reading the essay? Best 50 persuasive topics Finally, the top 50 persuasive essay topics to choose from while writing a persuasive essay. Exams don’t show real students’ abilities. Sugary water: like Pepsi, Coca-Cola has to be forbidden from selling in schools’ canteens. Should the government allow the fast food in schools? Different classes or even schools have to exist in each city or town. Parents must be in prison instead of their children who commit any crime. Only parents are responsible for their children diet. Parents must check if their kids have any drugs or alcohol each week. Has the government rights to kill terrorists if they don’t have evidence to avow? Animals are for the living, not for testing medicine. Is it illegal to talk on a hands-free device while driving? Alternative energy is cheap enough to replace the fossil fuels. Police have to kill dogs if they have bitten someone. Is it ok for teachers to have mobiles on the lessons? Churches have to pay taxes as any other governmental agency. Do teachers need to wear the uniform as pupils? Children have to be allowed to drink starting 18 years old. Does the government have rights to control Internet content? Are children who commit an adult crime be trialed like an adult? Prisoners who are now free have to have rights for voting. Are such hard sports like: box, karate, all-in wrestling legal or the government has to control it? Sex orientation is visible starting from childhood. Is death penalty a crime? The humans are the main causes of a climate change. Mercy killing should be legal. Adults must be allowed to carry stun guns. If a person hasn’t got citizenship of a country but committed a crime, it should be convicted according to the rules of the last country. Is there an equal representation of genders in politics? Usage of telephones make children difficult to concentrate People should be more attentive to what they post on the Internet. Cyber-attacks are a vital intelligence tool for all countries. Recycling rubbish is more important now than it was a few decades ago. Is it important to represent girls as like boys in sports competitions according to modern growing up feminism? Domestic terrorism is not the one while a woman or man didn’t complain to the police. Fast food restaurants shouldn’t write the number of calories on boards. The government should cancel the taxes. If the defendant is not guilty because of insanity, psychiatrists should testify it in court. Prospective parents should be required to take parenting classes. Getting married in high school have to be forbidden. Prisons should use music and art to calm prisoners. Educated people must be involved in volunteerism forcibly. There is no such thing as good and evil. Sexual preferences determine human behavior? Selfishness is in big demand in today’s society. Intelligence is a thing which runs in the blood. Genetics determines human behavior. It is harder to be bad that to be good. God is alive. There is very much evil in the world that we should at least believe in God. Education at universities is not important in modern technological society. Wealth and success are things with which you have to be born. By the way, don’t forget to check your essay or precis before giving back to the teacher. That is an obvious rule to avoid misunderstandings. Now, you understand everything about persuasive essays and believe we helped you choose the best persuasive essay topics.

Communication across cultures Essay Example

Communication across cultures Essay Example Communication across cultures Paper Communication across cultures Paper The article presents an approach towards the critical interpretation of nonverbal cues from different language with respect to global communication whose importance has increased in the modern world especially due to globalization of international trade. Has been on the. In the introductory paragraph of the article, communication is explained as merely the exchange information that may take broad shape depending on people culture, first knowledge and level of education. Communication is also a way of passing our attitudes, emotions and desires using either spoken or non-spoken language. According to the article, sometimes due to language barriers that exist in passing our emotions and desires, sometime it becomes very crucial to understand the different ways we can improve communication on a global scale especially in this current era where business has been globalized and therefore transactions being made by people from diverse cultural background. Ideally, global communication is the ability to access information and transfer information across cultures throughout the world through listening, speaking and acting. Global communication is specifically very important in the business field due to the manner in which business tractions are carried out in the modern world. It is most important in areas where language barriers and cultural specification critically influence efficiency and quality of communication (Ainsworth, 2013). Communication in business remain a key factor toward s success of any business thus establishing global communication call for effectively understanding both verbal and non- verbal communication alongside interpreting languages into different mode that can be understood by people from diverse culture. The importance and the significance role of global communication was given a lot of weight after the Second World War with technological advancement and increased importance international relations. Global communication has increased its importance more specifically to evolutionary of global trade aided by technological advancements. Global communication is may take two forms with respect to corporate communication (Ainsworth, 2013). For instance, internal communication within a business will involve passage of information from within a business organization for example senior management to subordinate workers. International for of global communication in loves remittance and acquisition of information from international sources that are usually international. Article summary The article presents an illustration of the use of both verbal and non-verbal communication to aid communication global communication in international trade. In most instances, communication barriers arise due to cultural and language differences. In this event verbal and non-verbal cues offers a solution that facilities passage of information between business persons to ensure the transactions are effectively executed. For instance, in the event of language barrier as result of having different languages that each party cannot understanding, non- verbal cues are present ads vital item that offers a communication mean though crude to link the buyers and the seller in the international market (Ainsworth, 2013). In the event of misunderstanding between buyers and the seller, verbal cues offers a good channel through which the information not clearly understood is reinforced. This is most effective where both parties in a transaction are able to verbally communicate. Sometime s in case of language barriers the verbal cues offers a platform for eliminating any doubt and miscommunication by enabling the parties seek the assistance of a language translator. This ensures that message from each party in clear understood despite the challenges encountered in the communication process. According to Ainsworth (2013), every culture is very different and operates under different sets of rules which some of its members take for granted while others accord the required concern unto them. In the article, verbal and non-verbal communication strategies are established as the main drivers for reliable communication. Essentially, the articles tries to figure out the impacts of having a working communication systems across cultures as well as bringing into light the key elements of intercultural communication especially in business fields. Most importantly, according to Ainsworth, it is apparent that most of the worldwide business organizations recognize the impacts and the importance of intercultural communication as well as the significance of verbal and non-verbal communication cues. In fact, it is evident that globalization has played a major role in integrating the impacts of intercultural connections across the globe. Through critical understanding of the generalization in communication, verbal and non-verbal techniques have made the business field accomplish their desired goals and objectives by interlinking individuals and organizations from diverse spheres. However, the efficiency in international communication is profoundly influenced by cultural differences. The major challenge in communication and especially in business terms is that even when the communicating parties approach each other in good will, it is always perceived that miscommunication will likely cut short the endeavor especially in the event of cultural differences between them. More importantly, miscommunication, which is a result of poor use of verbal and non-verbal skills may lead to conflicts or augment the conflict, which may be present even before the meeting of the involved parties. The article goes further to explain the truth about different communication variables such as; time, space and responsibility as well as the personal fate in regards to verbal and non-verbal communication approaches. Critically, the article shows how communication in business practices is affected by global cultural concerns, ethnicity, personal communication techniques; that is the verbal and the non-verbal strategies. Inherently, according to the author of the article, non-verbal communication is the communication that makes sense in the absence of the words. Discussion When comparing this article with the other four read articles, I found there were several similarities as well as differences that were vivid after a critical analysis of the five. Terragni (2010), embarked on the idea that business communication depended fully on the effective application of the verbal and the non-verbal communication approaches. In the second article, the author majored on the idea that gender, ethnicity and cross-cultural differences were key to the effective business communication and that the three have profound impacts on the success of business communication set up, both locally and internationally (Longoria, 2006). In the third article, it was evident that the author recognized that business communication depends much on the efficient and realistic incorporation of individuals from diverse backgrounds as solution to the bigger differences that occur during international business communication processes (Lustig, Koester Zhuang, 2006). In the fourth article, I was able to find out that Martin Nakayama, (2007), wanted to show the world that the best way to communicate both verbally and non-verbally is by understanding that people from diverse cultures have different ways of communicating. In conclusion, all the articles offer a basic understanding of how individuals in communication should be flexible and open to change while in different environments. References Ainsworth, J. (2013). Business Languages for Intercultural and International Business Communication: A Canadian Case Study. Business Communication Quarterly, 76(1), 28- 50. Doi: 10.1177/1080569912471186 Longoria, R. (2006). Communication across cultures. interactions, 13(2), 28. Lustig, M. W., Koester, J., Zhuang, E. (2006). Intercultural competence: Interpersonal communication across cultures. Pearson/A and B. Martin, J. N., Nakayama, T. K. (2007). Intercultural communication in contexts. Terragni, G. (2010). Communication across cultures. arq: architectural research quarterly, 14, 193.

5 Ways to Handle a Racist Family Member

5 Ways to Handle a Racist Family Member It’s no secret that family gatherings can cause stress and lead to conflict, especially if some family members have racial views that youre staunchly against. What’s the best way to proceed when a loved one seems not only small-minded but outright racist? Don’t suffer in silence through one family gathering after another. You can take several steps to stop the Archie Bunker of the family in his tracks. These strategies include setting boundaries and calling attention to the racist behavior. Be Direct Confrontations are never easy. That said, if you don’t want to listen to your parents or siblings rattle off racial stereotypes every Thanksgiving, the direct approach is necessary. How will your family members understand that you find their behavior offensive unless you tell them? The moment your sister makes a racial joke or uses a racial stereotype, tell her that you’d appreciate it if she didn’t make such jokes or racial generalizations in front of you. If you believe that calling out your relative in front of others will make her more defensive, ask to speak to her privately and then make your feelings known. If your family member uses a racial slur in front of you, request that she doesn’t use such epithets in your presence. Do so in a calm, firm voice. Make your request short and then move on. Don’t attack your family member’s character. Just let her know that her comments make you uncomfortable. Get Help What if this family member intimidates you if he’s an elder or an in-law and you aren’t comfortable calling attention to the behavior you find inappropriate? Find a relative you feel more comfortable with and request that he accompany you as you confront the family member you believe is offensive. Tell the insensitive family member that you love and appreciate him but find his views on race hurtful. Alternatively, if your grandfather has made remarks you consider racially insensitive, you might want to ask your parent to speak with him about his behavior. If your father-in-law is the party in question, ask your spouse to confront him about his language and attitudes concerning race. If no one else in your family will serve as an ally, consider taking a less direct approach to confronting your relative. Write a brief letter or email informing him that you find his comments hurtful and asking him to refrain from such remarks in the future. Don’t Argue Whatever you do, don’t get into a debate with your relative. Agree to disagree with this family member about race rather than listening to her argument about why her racial stereotypes are valid and you’re too politically correct. Stick to the following script: â€Å"I find your comments hurtful. Please don’t make these remarks in front of me again.† Arguing with the relative will likely be a waste of time. The family member will be on the defensive and you will be on the offensive. Meanwhile, you will have convinced her of little or nothing about racial sensitivity. Focus on your feelings about the relative’s comments rather than on the validity of her beliefs. Set Consequences Depending on your situation, you might have to set guidelines with your relative. Say, for example, that you have children. Do you want your children to hear the comments by your family member? If not, let your relatives know that if they make bigoted remarks in your children’s presence you will leave the family gathering at once. If your relatives routinely make such comments, let them know that you will skip family gatherings with them altogether. This is an especially important move if you’re in an interracial relationship or have multiracial children who will feel targeted by your family members’ comments. Try Outside Influences You probably wont open your relatives’ eyes about race by arguing with them about the issue, but you can take steps to influence them that they might go along with. Organize a family trip to a museum with a social justice focus. Have a movie night at your house and screen films addressing issues of racial inequity or showing minority groups in a positive light. Start a family book club and select anti-racist literature.

To what extent can improvements in productive flow and product quality Essay - 4

To what extent can improvements in productive flow and product quality lead to an increase in sales and profit - Essay Example product flow and quality, and determine how their association can be harnessed to promote sales as well as profits. Business organisations exist with a goal of maintaining continuous improvement and productivity; a goal that can only be achieved if high sales and profits are maintained. Enhanced sales and profits provide adequate opportunities and resources to the manufacturers that they apply for innovation and growth. Enhanced innovation enables manufacturers to provide superior and lean quality products that attract customers. Most companies strive to leverage operational improvements into strategies that transform the company (Williams, Haslam and Williams, 1992). Production flow defines the concept of mass production. It is the idea of producing large quantities that are manufactured through application of high standardised methods. Production flow is applied by many companies because it promotes the production process; it is easier and quicker. The introduction bit of the proce ss is cumbersome and difficult although it becomes easier once the production flow attains momentum. Owing to its emphasis on production of large quantities of commodities, production flow relies on the machinery for most of its roles. This implies that surmountable resources require to be allocated in the purchase, training and maintenance for the strategy to be efficient. Machines involved in this process should be selected and handled carefully to ensure that they are not vulnerable to wear and tear. This may lead to loss in terms of maintenance and replacement costs (Womack, Jones and Roos, 1990). According to Oulton (1987), mass production has its merits as well as demerits. Installation of the machinery required for production requires abundant financial resources. However, once the machinery has been installed, organisations save considerable financial resources, especially the money required in hiring and maintenance of human labour (Gilchrist, 1971). The work output is norm ally high. The accuracy levels are also high provided the machines are maintained in a superb working form. Machines are also capable of abiding to the set deadlines with no requirement for extensions. Abiding to the performance deadline is enhanced by the presence of assembly lines that allows continuous and consistent flow of manufactured products. This enhances output as well as the quality of the products produced in the long term, leading to increased sales and profits. Investing in production flow process benefits the manufacturer due to improved sales, leading to the increase in profits. Quality can be defined as the ability of a product or service to fulfil the client needs or expectations. Therefore, it can be measured depending on the level that the quality of a product satisfies the expectations of a consumer. High quality products have superior features that satisfy the consumer needs while the features of low quality products do not correspond to the needs of the consum er. For instance, the features that determine the quality of mechanical products include appearance, safety and reliability. Product quality improvement should consider the customer’s needs and expectations, extent of fulfilment of both national and international regulations and the competitiveness of the product (Williams, Haslam and Williams, 1993). Improving the product quality will not only satisfy the consumer needs; more customers will be attracted leading to increa To what extent can improvements in productive flow and product quality Essay - 1 To what extent can improvements in productive flow and product quality lead to an increase in sales and profit - Essay Example Additionally, there is product price, product quality, customer preference, and economic stability of a market. Product quality and productive flow are also factors that affect sales and profit. They have various ways through which they affect sales and profit (Shaharudin, Mansor, Hassan, Omar & Harun, 2011, p. 8163; Shetty & Buehler, 1991, p. 8). The extent, through which product quality and productive flow can increase sales and profit, can only be shown through explaining the effect of these two factors on sales and profit. How improving these factors can lead to increased sales and profit, will clearly be produced in the explanations given about their effects. The essay is, therefore, divided into two main sections: The effects of product quality on sales and profit, and the effect of productive flow on sales and profit. These will show the relationship between product quality and productive flow to sales and profit hence; help in understanding how improving the two factors can l ead to increased sales and profit. Effect of Product Quality on Sales and Profit The main element that brings value to a customer in the market offering is the product. A product is more than a tangible object. It includes performance quality, service features, brand name, design and packaging. The quality of a product is very important since it affects the product performance and so is connected to customer satisfaction and value (Shaharudin, Mansor, Hassan, Omar & Harun, 2011, p. 8164). Consumers of today seek high quality products. The only problem is different perceptions held by customers about quality. Any company interested in selling its products should conduct thorough market research, depending on the type of product they have, to determine what their consumers perceive as high quality. Consumers in the United States, for example, rank quality based on reliability of a product, durability, easy maintenance, ease of use, brand name and the price. This is specifically on mot or cycle products (Shaharudin, Mansor, Hassan, Omar & Harun, 2011, p. 8164). Improving the quality of a product, therefore, increases the sales of a product. Sales depend on customer satisfaction and value, and product quality is one way of satisfying the customer and offering something of value depending on the customer. The extent to which product quality affects sales is great. This is because, for goods to be sold, customers have to want, need or prefer them. Preference is most common where there are a variety of products with different features, prices, brand names, quality and so on. Product quality is a determining factor in preference for a product, so affects sales. Customer satisfaction and value is vast. There are different customers with different tastes, needs, and economic capability. All these determine the preference hence the intent to purchase a product (Shaharudin, Mansor, Hassan, Omar & Harun, 2011, p. 8164). Product quality is the totality of a product or servic e characteristics that give the product or service the ability to satisfy given needs. If a product fulfils a customer’s expectations, the customer becomes satisfied and begins to build loyalty. Loyalty is developed through trust and positive relationship with the customer. Customer loyalty retains customers and contributes to the number of sales made in a given period of time. This clearly indicates one of the various ways through which product qua

Marketing Strategy at Tesco plc Essay Example | Topics and Well Written Essays - 1750 words

Marketing Strategy at Tesco plc - Essay Example Superior service quality leads to favourable behavioural intentions, customer retention, a constant revenue stream, increased spending, willingness to pay price premiums, and word-of-mouth advertising and customer capture. Verbalising good intentions is merely the first step in creating a positive attitude of satisfaction, but the second more important one is delivering on the good intentions. Kotler (1977) emphasised that a market-orientated business must focus not only on selling but on customer satisfaction but failed to emphasise the disconnection between the two. Zemke and Schaaf (1990, 53) argue that the really useful, specific, directly applicable information comes from talking to customers, constantly and often at length, to determine what the company is doing that makes them happy or not. Cronin and Taylor (1994) focus on performance measures of service quality rather than customer expectations. Piercy's (2002) customer relationship sliding scale (Fig. ... , specific, directly applicable information comes from talking to customers, constantly and often at length, to determine what the company is doing that makes them happy or not. Cronin and Taylor (1994) focus on performance measures of service quality rather than customer expectations. Customer Focus Piercy's (2002) customer relationship sliding scale (Fig. 7.1, p.344) is more complicated than the matrix used by Reinartz and Kumar (2000) to determine which types of customers are worth keeping and for whom the company must spend marketing resources to achieve retention. Its justification came from research that "it can cost five times more to get a new customer than to keep an existing one" (Weinstein et al., 1999, p. 119), following Reicheld (1994) who asserted that a 5 percent increase in loyalty can lead to a 25 to 85% increase in profitability. Pine (1993) talked of mass customisation and one-to-one marketing, echoing Hamel and Prahalad (1989) who warned of convergence of producers and customers with the Internet, which empower customers to become active co-creators of products, services, and value. Businesses have to show greater sensitivity to customer wants. Market Choices The simplified market choice diagram (Piercy, 2002, Fig. 8.1, p. 410) builds on the complex market analysis models proposed by academics such as the product-customer matrix (Piercy, 2002, Fig. 8.2, p. 412). These models build on studies made by management science academics as Freeman (1984) who proposed that the company must satisfy all of its stakeholders, quite an impossible task even for the best managers. Bartlett and Ghoshal (1994) argued for strategic choice, related to the purpose for the existence of the business. Hamel and Prahalad (1989, 75) suggested that businesses define