He Reflective Commentary (Dissertation) Essay Example | Topics and Well Written Essays - 1000 words

He Reflective Commentary (Dissertation) - Essay Example 24). In addition were the visits to various eco-tourist destinations which are rather fragile in nature. Thus, the subject gave a lot of knowledge about the various theoretical and practical aspects of sustainable tourism development. Admittedly, I had never considered sustainable tourism as a concept that deserves appreciation. For me, it was more like the claims of the die-hard environmentalists, which are impractical in nature. So, I liked to consider sustainable tourism as a mere concept in its initial stage, which one in the tourism industry should bear in mind. This was so because from my personal experience, I had found that sustainable tourism is a word that was used by tour operators to attract the eco-friendly tourists and to reduce the investment in infrastructure; and the element of sustainability was seen only in green pamphlets and brochures. Thus, for me, sustainable tourism was rather a shallow concept that does not deserve much attention. So, when I started studying Sustainable Tourism, I wanted to see what the subject really meant in the current tourism world and how effective it could be in practical tourism. However, as a part of the studies, I got a chance to know about the impact of tourism on environment. In addition, I learnt about the fragile nature of the places which usually become tourist destinations. ... y various agencies around the world to promote sustainable tourism and the way they reduce the environmental impact of tourism, I understood the fact that sustainable tourism has grown much deeper and stronger than I anticipated. Also, I made the realisation that the future of tourism is almost totally reliant on the amount of sustainability it manages to introduce. Also, the subject gave me valuable insights about the role of various stakeholders; ranging from tourists, governments, tour operators and local population in sustainable tourism. Another important revelation for me was the importance of reflection in the subject I study. As I undertook the task of reflective writing, I learnt how useful, and in fact necessary, it is to learn through reflection in a subject like tourism management. According to Dewey (1933, p. 45), reflection is the practice of thinking for an extended period by linking the later experiences to the earlier ones. It helps one to understand what new things are added, what is lost, what remains the same, and what are interrelated. Thus, reflection in sustainable tourism development helps one look into the concept from the perspectives of all stakeholders. In addition, it helps one to understand if the various methods of sustainable tourism are useful or not. Another benefit of the study was that it helped me realise the areas where legal and governmental supports are lacking. As the subject revealed, it becomes necessary for governments to introduce better and stronger legal frameworks which support sustainable tourism by placing legal barriers on various activities of mass tourism. In fact, the subject acted as an eye opener by making me understand the fact that only sustainable tourism can ensure the survival of such sensitive and highly

Female Genital Mutilation in Egypt Essay Example for Free

Female Genital Mutilation in Egypt Essay Female Genital Mutilation (FGM) is a socio-religious practice that is very prevalent in Africa, Asia and the Middle East. It entails the partial or total removal of the female external genitalia for cultural or any other non-therapeutic purpose. As of 1999, at least 130 million girls and women were believed to have undergone FGM. In the same year, it was estimated that about 2 million girls are at risk of being subjected to some form of the procedure every year (WHO 3). FGM is criticized mainly for its detrimental effects on a woman’s physical and psychological health. Girls and women who had been subjected to FGM may die of hemorrhage, shock, urinary tract infections or tetanus (WHO 21). They may likewise experience psychological disorders such as severe depression, anxiety and psychosomatic illnesses (Markle, Fisher and Smego 79). Advocates of FGM, however, claim that Islam requires the practice in order to preserve a woman’s chastity (WHO 6). The actual origins of FGM are very obscure – ethnologists and historians have come up with different theories regarding the existence of the practice. While FGM is commonly associated with Islam, historical evidence shows that the former has predated the latter by at least 1,200 years. The procedure was believed to have been first discussed by the Greek historian Herodotus (484 – 425 BC) (Bullough and Bullough 205). According to his writings, the Ethiopians, the Hittites and the Phoenicians during the 5th century BC were already practicing FGM (UNFPA n. pag. ). The early Romans, the Egyptians and the Arabs likewise performed FGM – there are historical accounts of Egyptian mummies exhibited signs of having undergone the procedure (UNFPA n. pag. ). For the ancient Egyptians, FGM was regarded as a sign of distinction among the aristocracy (Momoh 5). In Western Europe and the United States, FGM was known as clitoridectomy. Until the 1950s, doctors in these regions used clitoridectomy to treat â€Å"ailments† in women such as hysteria, mental disorders, nymphomania, masturbation and lesbianism (UNFPA n. pag. ). FGM is usually done on girls between 8 to 10 years old. Reproductive health experts, however, point out that the procedure is already being carried out on younger girls – there have been cases wherein infant girls were subjected to FGM just a few days after their birth (WHO 147). FGM is classified into four general types: a. Type I – Excision of the prepuce, with or without excision of part or the entire clitoris. b. Type II – Excision of the clitoris with partial or total excision of the labia minora. c. Type III – Excision of part or the entire external genitalia and the stitching or narrowing of the vaginal opening (infibulation) (Momoh 6). d. Type IV – Pricking, piercing or incising of the clitoris and or the labia; scraping of tissue surrounding the vaginal orifice; cutting of the vagina and or the introduction of corrosive substances or herbs into the vagina to induce bleeding or to tighten the opening (UNFPA n. pag. ). FGM is usually performed by traditional midwifes or village barbers. They use unsterilized instruments such as razor blades, knives, broken glass, scissors or sharpened stones. Furthermore, they conduct procedures without anesthetic in unhygienic settings (WHO, 148). A new phenomenon, however, has emerged in the recent years – the â€Å"medicalization† of FGM. Despite laws banning the practice of FGM, hospitals in Egypt, Kenya and Sudan now clandestinely perform the procedure. Under the pretext of an illness, female teenagers in these countries are circumcised in the hospital either early in the morning or late at night. The procedure is done during these hours in order to evade detection and arrest. The punishment for performing FGM is relatively stiff – a $625 fine or incarceration for up to a year. But doctors willingly look the other way for the money – medical practitioners in Kenya, for instance, are paid between $37 and $125 for every procedure they perform. Traditional practitioners, in sharp contrast, could charge only as much as $25 (Nzwili n. pag. ). Egypt’s current problem with FGM can be traced back to the International Conference on Population and Development (ICPD) in 1994. The ICPD was held in Cairo – supposedly a turning point in the understanding of health, development and women’s rights in the Islamic world. Critics, however, pointed out that the Cairo Program of Action merely â€Å"forwarded a holistic vision of the connections between sexual ad reproductive health and women’s economic autonomy, social and political equality, access to education and freedom from violence† (Chavkin and Chesler 35). The issues regarding the right of women to control their sexuality and the relevance of this right to achieving health and social justice were inadequately discussed (Chavkin and Chesler 35). Despite this shortcoming, the ICPD managed to transform the issue of FGM from a relatively low-profile subject into matter of national debate. Conservative religious leaders who participated in the conference and their allies in the Egyptian press expressed their approval of FGM by claiming that it is an important part of national and religious identity. Progressive women’s groups, on the other hand, argued that the practice perpetuated the inferior status of women in Egyptian society. In the process, this dispute on FGM showed that the topic of women’s rights is simply a means for Egyptian politicians to attain popularity among the electorate (Chavkin and Chesler 35). Eager to make a good impression on all the foreign delegates of the ICPD, particularly on those from the West, the Egyptian minister of health stated that FGM was already a dying practice in Egypt. But on the very next day, CNN reported about the circumcision of a young girl that took place somewhere in Cairo (Chavkin and Chesler 35). The minister, in an act of political face-saving, declared that the Egyptian government was determined to confront and put an end to the practice. In order to appease Egypt’s conservative sector, meanwhile, he signed an ambivalent decree which allowed only public medical facilities to perform FGM. The law even included provisions which set standard fees and special days when families could book appointments (Chavkin and Chesler 36). The aforementioned aftermath of the ICPD showed the greatest obstacle towards fully implementing anti-FGM policies and programs not just in Egypt but in all other countries that practice FGM – the reconciliation of universal imperatives of human rights with the values of local cultures. The same dilemma also hounded other FGM-related fatalities, particularly the death of four-year-old Egyptian girl Amira Hassan. She died in 1996 due to anesthesia-related complications while undergoing FGM. Instead of pressing charges against the doctor, Ezzat Shehat, Hassan’s parents simply dismissed her demise as â€Å"a will of God† (HURINet n. pag. ). They believed that subjecting their daughter to FGM was their duty as good Muslims (HURINet n. pag. ). Most Egyptians continue to believe in the said relationship between FGM and Islam. A 2005 UNICEF report on the practice revealed that about 97% of women between 15 and 49 years old were subjected to circumcision (Reuters-AlertNet n. pag. ). Despite a 2008 law which renders FGM punishable by three months to two years in prison and a fine of LE 1,000 to LE 5,000, the practice continues to be secretly carried out in Egypt. According to the country’s conservative and religious groups, FGM is necessary to maintain a woman’s chastity (Samaan n. pag. ). Indeed, cultural and religious beliefs are also major factors behind the issue of FGM in Egypt. The practice has already existed long before the advent of Islam. And for a good reason – patriarchy was already in existence even before the emergence of religion. For a patriarchal society to survive, female sexuality must be limited and controlled (Turshen 146). FGM is regarded as one of the most effective means of controlling a woman’s sexuality. The clitoris, the labia minora and the labia majora – the organs removed in FGM – enable a woman to enjoy sexual intercourse. In a patriarchal society, women are not supposed to experience the pleasures of sex. They are supposed to be sexless beings, faithfully serving their respective families and engaging in sex only for the purpose of procreation. Women who do otherwise are considered promiscuous (Turshen 146). It is therefore believed that circumcised women are less likely to be unchaste and commit adultery. In addition, FGM is viewed as a means of emphasizing femininity. When a woman is circumcised, the parts of her body that are metaphorically seen as male, such as the pubic hair and the clitoris, are removed. During ancient times, it was believed that the clitoris â€Å"would grow and protrude like the (penis)† (Turshen 150). Men, on the other hand, undergo circumcision in order to enhance their sexuality. Male circumcision entails the cutting of the foreskin of the penis. A circumcised penis is believed to be more responsive to sexual arousal than an uncircumcised one; thus the ancient belief that circumcision is necessary for virility. Furthermore, a circumcised penis is easier to keep clean. Circumcision eliminates the formation of smegma, a combination of oil, moisture and dead skin cells which serves as a lubricant during sexual intercourse (Turshen 146). Islam does not directly state that all Muslims must be circumcised regardless of gender. However, much of the existing Islamic literature today emphasizes a special link between Islam and FGM (Turshen 151). The most well-known hadith (oral traditions that record the Prophet Muhammad’s speech and actions) about FGM tells of a debate between Muhammad and Um Atiyyah, a woman who used to circumcise female slaves. Muhammad was said to have asked Um Atiyyah if she continued to practice her profession (Denniston, Hodges and Milos 148). She said she did, adding that she would not stop doing so â€Å"unless it is forbidden and you order me to stop doing it† (Denniston, Hodges and Milos 148). He then replied, â€Å"Yes, it is allowed. Come closer so I can teach you: if you cut, do not overdo it (la tanhiki), because it brings more radiance to the face (ashraq) and it is more pleasant (ahza) for the husband† (Denniston, Hodges and Milos 148). Since the first centuries of Islam, however, Muslim scholars have been scrutinizing the authenticity of the hadiths. They believe that majority of the hadiths were â€Å"contradictory and (contained) affirmations that gave a bad impression of the Islamic religion† (Denniston, Hodges and Milos 148). In lieu of the hadiths, Muslim scholars came up with their own explanations behind the association of FGM with Islam. The first theory was that FGM was a means of saving women from the degradation that they experienced in the pre-Islamic era. For the Muslims, the pre-Islamic era was the â€Å"Age of Ignorance† – a period of corruption, bloodshed, moral turpitude and social chaos (Akhtar 23). Women in the pre-Islamic era had few rights. The practice of burying infant females in the sand was very rampant. Those who managed to live to adulthood, meanwhile, had no other means of survival except through prostitution (Akhtar 23). It has been mentioned earlier that the organs removed in FGM – the clitoris, the labia minora and the labia majora – enable a woman to enjoy sexual intercourse. By removing these organs, therefore, it was expected that women would no longer take pleasure in sexual intercourse and abandon prostitution in the process. The second theory is that some Islamic societies might have acquired the practice of FGM from other cultures or religions. During Muhammad’s time, the Jews were considered as the elite of Arab society. Consequently, it became inevitable that Islam was influenced by Jewish doctrines and practices such as circumcision (Denniston, Hodges and Milos 148). But this begs the question of how come even Muslim females are circumcised – the Jews circumcise only males. The answer is that Islam might have tailored certain Jewish doctrines and practices to suit its own objectives. One of the objectives of Islam was to uplift the status of women (Akhtar 23). In order to achieve this goal, Islam put its own flavor to the Jewish practice of circumcision. As a result, even Muslim women were required to undergo circumcision. Despite varying explanations regarding the origins and purposes of FGM, one thing is certain – it is not without detrimental physical and psychological effects. The most immediate negative effects of FGM are severe pain and hemorrhage, which, in turn, can result in hypovolaemic shock and death. Other direct effects include abscesses, wound contamination and local infections – obvious results of performing the procedure in unhygienic surroundings using unsterilized tools (WHO 149). FGM also has substantial long-term risks. The practice usually obstructs the drainage of urine, vaginal secretions and menstrual blood. This occurrence, in turn, results in chronic pelvic infections, menstrual dysfunction and menstrual pain. Urinary retention, meanwhile, leads to chronic urinary tract infection and renal damage. When menstrual blood is unable to flow out of the body, abdominal pain and swelling ensue (WHO 149). The abdominal distention that circumcised women experience due to the lack of menstrual flow has been misinterpreted as a pregnancy. As a result, some circumcised but unmarried women have been subjected to honor killings – killed by their male relatives in order to preserve the honor of their clan. FGM also exposes a woman to the risk of contracting HIV. Unsterilized instruments may transmit HIV-infected blood into an HIV-negative patient (WHO 149). Women who underwent FGM may also experience difficulties in sexual intercourse after the procedure. Penetration may either be painful or impossible due to a narrow introitus. Prolonged postcoital bleeding and anorgasmia may likewise take place. In some cases, surgery was necessary to open up the vagina for penetration (WHO 150). FGM may render a woman infertile. Chronic pelvic infections often lead to the obstruction of the fallopian tubes. The latter is one of the most common causes of ectopic pregnancy, which can lead to the death of both the mother and the baby. Narrowing of the introitus, meanwhile, may force a couple to use the anus or the urethra for sexual intercourse. Fluctuating hormones during pregnancy put circumcised women at more risk for genital and urinary tract infections than their uncircumcised counterparts (WHO 150). The most common psychological disorders among circumcised women are depression and anxiety – they have to conform to parental and societal expectations while dealing with pain, complicated recovery and other long-term health effects. Painful sexual intercourse may result in them having immensely traumatic memories of their wedding night. Circumcised women also have to live each day in fear – they constantly view each cyst that grows in them as a possible symptom of cancer or other serious ailment (WHO 152). When the physical pain becomes too much for them to endure, they might resort to suicide. Female genital mutilation is one of the worst forms of violence that can be inflicted on a woman. In an effort to tie her to the home, she is horribly mutilated and made to live in constant pain for the rest of her life. A circumcised woman is also made to live in fear. She is constantly warned by society that to avoid circumcision is to face ostracism and even condemnation. Much still has to be done before FGM will finally be abolished. But the first step remains to be education. Societies must be made aware of the importance of educating girls. Numerous studies have already proven that girls who have attained basic education are healthier and are less likely to die in childbirth than those who did not. When the members of a particular society – both male and female – are healthy, this society becomes productive. Works Cited Akhtar, Shabbir. The Quran and the Secular Mind: A Philosophy of Islam. New York: Routledge, 2007. Bullough, Vern L. , and Bonnie Bullough. Human Sexuality: An Encyclopedia. New York: Taylor and Francis, 1994. Chavkin, Wendy, and Ellen Chesler. Where Human Rights Begin: Health, Sexuality and Women in the New Millennium. Chapel Hill: Rutgers University Press, 2005. Denniston, George C. , Frederick Mansfield Hodges and Marilyn Fayre Milos. Male and Female Circumcision: Medical, Legal and Ethical Considerations in Pediatric Practice. New York: Springer, 1999. â€Å"Egyptians Stand by Female Circumcision. † 10 December 1996. The Human Rights Information Network (HURINet). 27 February 2009 http://www. hartford-hwp. com/archives/32/018. html. â€Å"Egypt Mufti Says Female Circumcision Forbidden. † 24 June 2007. Reuters-AlertNet. 27 February 2009 http://www. alertnet. org/thenews/newsdesk/L24694871. htm. Markle, William H. , Melanie A. Fisher and Raymond A. Smego. Understanding Global Health. New York: McGraw-Hill Professional, 2007. Momoh, Comfort. Female Genital Mutilation. Abingdon: Radcliffe Publishing, 2005. Nzwili, Fredrick. â€Å"In Africa, FGM Checks into Hospitals. † 5 December 2004. Women’s ENews. 27 February 2009 http://www. womensenews. org/article. cfm/dyn/aid/2097/. â€Å"Promoting Gender Equality: Frequently Asked Questions on Female Genital Mutilation/Cutting. † n. d. United Nations Population Fund (UNFPA). 27 February 2009 http://www. unfpa. org/gender/practices2. htm. Samaan, Magdy. â€Å"Shoura Council Passes Child Law, Criminalizes FGM. † 12 May 2008. Daily News Egypt. 27 February 2009 http://www. dailystaregypt. com/article. aspx? ArticleID=13659. Turshen, Meredeth. African Women’s Health. Trenton: Africa Word Press, 2000. World Health Organization (WHO). 1999. Female Genital Mutilation Programmes to Date: What Works and What Doesn’t. Geneva, Switzerland: Department of Women’s Health – Health Systems and Community Health. World Health Organization (WHO). Mental Health Aspects of Womens Reproductive Health: A Global Review of the Literature. Geneva: World Health Organization, 2008.

The international evidence base for healthcare commissioning

The international evidence base for healthcare commissioning According to the Department of Health (2006) healthcare commissioning is more than just procurement of services. Effective commissioning is about care that adds maximum value for patients in a system that promotes fairness, inclusion and respect from all the sections of the society. The following essay focuses on the international evidence base for healthcare commissioning, explaining the healthcare commissioning of Finland, Sweden, Europe, New Zealand, Arizona and United States and the challenges for healthcare commissioning within the context of economic recession and the ways in which these challenges might be addressed. The fundamental aims of healthcare commissioning includes service improvement, decreasing costs wherever feasible, better patient outcomes, and NHS priorities should be taken into account for all commissioning activities (InPharm, 2010). The cycle of commissioning is fragmented into 3 segments: Strategic planning (the beginning of the cycle), procuring services and monitoring and evaluation. Various NHS tools for supporting the PCTs are available like Better Care Better Value indicators, NHS indicators etc. By restructuring the patient pathway at the first time, we improve clinical quality, decrease expensive readmissions, better staff and patient satisfaction and in turn generate savings which can be used for various services (Peskett, 2009). After the NHS reforms in England, the PCT were considered as the main commissioners of healthcare (Peskett, 2009).. In addition to the NHS providers and NHS Foundation Trusts (FTs), the independent and third sectors were also considered as the main healthcare commissioners. The Operating Framework (Department of Health, 2007a) of 2008/2009 focused mainly on world class commissioning which defines the commissioners skills and competencies for commissioning healthcare successfully from a variety of providers. According to Ham (2009) market like mechanisms has been applied to the health reforms in England. In the emerging market it will be of critical importance for the commissioners of care to manage equivalent with the providers. The government has laid down plans for establishing world class commissioning but evidence shows that commissioning is not done consistently in any of the systems. World class commissioning if developed might not be successful because of lack of potential in absence of other modifications in the making of reforms like payment modes and autonomous providers. An alternative to this would be to develop competing integrated systems. World class commissioning (WCC) is metamorphosing the means through which services are commissioned, resulting in improved health consequences and reducing health inequalities adding life to years and years to life (NHS: Department of Health, 2009). The Department of Health along with the NHS launched WCC in December 2007 which aims to d evelop World class commissioners of NHS-funded services. The NHS in England had designed a 10 year program of reform to handle long standing weaknesses in performance which they are halfway through (Ham, 2008). The commissioners of care play a critical role in negotiating similar terms with providers and use the resources efficiently for improving the health and performance of health services. In the early 1990s commissioning was a weak link in the internal market and it is risky if the history is repeated again. Many countries worldwide have drawn attention towards healthcare commissioning for bringing reforms. The traditional systems which have integrated financing and planning of healthcare (eg the UK, New Zealand and Sweden) have experienced the detachment of commissioning from provision since the early 1990s. The roles of insurers and providers have been strengthened due to traditional partition like Germany, Netherlands and US. Experience of commissioning in Europe: (Ham, 2008) It was found that commissioning in Europe had substantial diversity in context to organization that do purchasing. The type of organization like the central or regional government, municipalities that can act as purchaser, market concentrations and the way of interaction differs from country to country. Variations are also observed in their funding sources and jurisdictions. The function of the purchasers was merely carried out in the challenging surrounding despite of the tangled European health policy debates because of the market based reforms. Figureas and colleagues stressed that a fundamental lesson from European experience is that a broad systems approach for purchasing and various components are required by policy makers. Experience of commissioning in Finland: The Healthcare Commissioning system in Finland is micro level, non-competitive and within the local government (Benson, 2011). For an average of 11,000 populations there are about 448 municipal councils which are responsible for purchasing. Each of these 448 councils is valid for a period of 4 years and an executive board is appointed which leads to democratic linkage between the citizens and health commissioners. The councils are authorized to commission secondary or tertiary services of their choice themselves or by merging with other councils. Experience of commissioning in Sweden: The Swedish healthcare system comprises of 3 levels of government: the central government, county councils and municipalities (The Commonwealth Fund, 2010). The local government is responsible for the ways in which services are delivered considering the local conditions and precedence whereas the central government accounts for the overall goals and regulations of the healthcare system. Thus at local level the delivery system varies because of this decentralization. The central and local taxation is held responsible for public funding of healthcare services. The financing of prescription drug subsidies is provided by the central government. It also provides funding by grants apportioned using a risk adjusted capitation pattern to county councils and municipalities. Financing of primary and mental healthcare and specialist services is provided by the 21 county councils whereas home care and services and nursing home care services are provided by the 289 municipalities. The private sector covers about 5% of the population and it provides easy access to care for patients. The 21 county councils are responsible for the organization of primary care services. For residents within a devoted geographical area, the primary care is provided by the health centers. But there have been significant changes in the model and now the residents can choose their provider and physician. A new law holding an alternative for the population and primary care privatization has been implemented from January 2010. The various modes for payment of private primary care providers are taxation, topped up with fee-for-service and targeted payments. The residents can now directly go to the hospitals or the private specialists. Experience of commissioning in New Zealand: There was a separation of purchaser and provider roles in New Zealands healthcare system from 1993 to 2000 (Ham, 2008). From a recent study both the positive and negative side of purchasing and contracting in New Zealand were highlighted. The drawback was that it was difficult to co-relate providers performance and negotiate contracts because of insufficient data on cost, volume and quality. An antagonistic environment was appreciated because of legalistic approach to contracting. It was difficult to sustain long term contracts or conjunctive relationships because the competition law concerns were not even whereas on the positive side because of purchasing the purchasers and providers focused more on costs and volumes of services and specified the categories and levels of services supplied. According to the providers written contracts would encourage them to focus on improvement of quality of care. Ashton and colleagues have summarized the New Zealand healthcare as: contracting has amended the providers direction on costs and volumes, increased the clarity of services and greater emphasis on methods for improving quality. New Zealands healthcare faces the challenge whether the profit of contracting maintained with simultaneously declining the transaction costs. Experience of commissioning in United States: In United States, indemnity insurance was used for financing and delivery of healthcare (Ham, 2008). Patients selected their providers and the providers charged the insurers by paying fees for services. Hence the patient had a flexible choice and the providers prevailed. Because of increase in healthcare managed care approach was developed in the US in the 1980s and 1990s which was based on the funding authority playing a significant role as commissioners. Evidence suggests that managed care temporarily curbed the increasing healthcare costs in the US. But managed care led to fee-for-service providers. In spite of the evidence, a reinvention movement known as consumer directed healthcare movement took place in the health insurance industry. Experience of commissioning in Arizona: The healthcare commissioning system in Arizona (USA) known as Arizona Healthcare Cost Containment System (AHCCCS) was launched in 1982 (Benson, 2011). Arizona had two tier arrangements: AHCCCS covers about million Medicare and Medicaid from a number of purchasers. The purchasers are liable to commission health services operationally for 35,000 to 200,000 people known as members or lives and they purchase services from various providers. In order to sustain the contract or win, the AHCCCS has to produce detailed bids every 5 years and not all the health plans covered under AHCCCS are for profit organizations. The Department of Healths (2007d) recently published documents suggests that the world class commissioners will (Peskett, 2009): Run the NHS locally Function along with the community partners Both patient and public involvement will be there Merge with clinicians Organize and assess knowledge and needs respectively Accelerate the market Enhance innovation and improvement Draw upon some sound financial investment Supervise the local health system One of the ways of addressing one end of the spectrum is PBC which challenges the PCTs for having the proper governance arrangements and bringing awareness about absolute clarity between responsibilities and boundaries. CHALLENGES FOR HEALTHCARE COMMISSIONING: According to Le Grand (1999), commissioning problems were due to very weak incentives and very strong constraints (NHS CONFEDERATION, 2010). History says that commissioning had failed in the internal market in the 1990s and hence there is risk if repeated again (Ham 2008). Weak commissioning is because of the tendency to focus less on PCTs and PBC and giving importance to national, specialized and joint commissioning. Healthcare commissioning has become weak because of the following reasons: In publicly financed systems purchasing of health services is quite difficult Inability to control the referrals and activity of GPs in general Insufficient power against the number of providers, especially the Foundation Trusts (FTs) for shaping the market Curtailment of clinical engagement and base for decisions related to healthcare commissioning Lack of ability to comprehend an issue and perform in analysis of requirement and demand, managing budget, risk taking etc. There is hardly any evidence which suggests that commissioning has made a symbolic or strategic impact in secondary care services (Smith, et al., 2004). Healthcare commissioning is perplexed and postulating and requires both technical as well as managerial skills (Peskett, 2009). Ham (2008), quoting Mays and Hands (2000) defines Healthcare commissioning as complicated, unclear, not exhibiting information symmetry between buyer and seller, lengthy training mandatory and is based on long term relationships between patients and professionals. Often there is misunderstanding among the commissioners and providers, clinicians and managers, and sometimes between the primary and secondary care commissioners which builds up stress, hence a prominent degree of competence and communication skill is mandatory. The challenges for healthcare commissioning were revealed by the UKs Department of Health Independent Sector Program, particularly for assessment of governance arrangements and identification of high standards of healthcare providers (Peskett, 2009). A successful care pathway commissioning requires an acquaintance and proficiency of the clinical intakes, turnouts and consequences as well as organizational skills for process management and patient journey. Pertinent inter and intra-organizational governance arrangements should be verified. Evidence suggests that healthcare commissioners will need not only time but also stability and persistence of management and organization, if a sustainable progress is required for betterment of local services (Smith, et al., 2005). The recently developed primary care commissioning organizations focuses internally in their initial stages and in future with the secondary care and other providers. The factors which facilitate effective commissioning may also pose to be the greatest challenge. One of these includes for engaging the GPs a set of incentives is created, for patient with long term conditions new forms of seamless services being developed and eventually making an absolute effect on the broader healthcare system, which was difficult for the primary care commissioning to achieve. From a survey conducted recently a conclusion was drawn that about 50% of GPs did not show interest in commissioning budget (Smith, et al., 2005). The GPs would thus have power and would play the role of managers but the power was not distributed equally among the doctors. It has been suggested that an important incentive within fund holding and total purchasing would lead to changes and might improve the services as well, if there were profits during the practice process. In order to engage all the GPs into budget commissioning more strident incentives would be required. If a new NHS market is developed then it will offer sharper incentives so that the GPs and nurses can become practice based commissioners. Hence services could be purchased from new providers of primary care and diagnostics by a commissioning budget. For the non NHS providers, there arises a possibility that the primary care should demand increasingly for budget commissioning and thus become equivalent to the NHS GP s and nurses. (Peskett, 2009) Separation of managerial and clinical goals led to failure with no clinical leadership. Negative targets had detrimental consequences and if the financial flow encouraged efficiency and not effectiveness it leads to failure of service. A culture of collaboration would be helpful rather than competition with command and control ethos. The managers and the organization should be responsible enough to provide commercial expertise, infrastructure and information and the clinicians should provide specialist and knowledge related to healthcare. Weak and ineffective engagement of clinicians of primary and secondary care would lead to crucial Primary Care Trust Commissioning. Commissioning fails if there is lack of resources, capacity and capability and an ability to sustain long duration relationship. Commissioning organizations also require robust governance system in business transactions for ensuring no conflicts of interests. Lack of time, personnel, resources and diffic ult long term relationship were the challenges that Healthcare commissioning had faced (Checkaland, et al., 2009). The four major challenges faced by healthcare commissioning are (Boyd, 2010): Ameliorating the health of the patients Assuring a high quality standard of care in healthcare arena Supervising costs and savings. It includes preventing and managing falls, assessment of risk and saving tax payers money. Managing the transition to clinical commissioning (Boyd, 2010)The key responsibilities of healthcare commissioning includes buying high quality services throughout the care pathway in order to meet the needs of common people and making decisions for not purchasing services. The detailed information regarding organizations engaged in pathway, from primary care to tertiary care is available to the commissioning team and their aim is to fit together all the parts of care pathway to provide a holistic care. Foundations for effective commissioning are as follows: improving outcomes, patient empowerment, evidence based practice, community mobilization and sustainability (Royal College of General Practitioners, n.d.). If these foundations are not taken into consideration carefully then it might lead to difficulty in commissioning health services. Payment by Results (PBR) plays a massive role for achieving efficiency gains in commissioning decisions (InPharm, 2010). A key challenge to an efficacious healthcare commissioning is that there is an absence of general/global, apparent/definite commissioning procedure for the NHS. Several factors are taken into consideration for establishing a business case and introducing it to the decision makers for authorization. These factors includes financing the services, route of commissioning whether the prevailed services be improved or put a tender, assessment of both the NHS and patient needs and views of patient. According to Baird, et al. (2010) one of the various challenges that the healthcare commissioning had was the size and performance in commissioning organizations, both in the NHS as well as internationally. It was concluded that small commissioning organizations would struggle more if they took the responsibility of commissioning the entire spectrum of healthcare and there was negligible relationship between performance and size of commissioners. The providers would also face a number of challenges (NHS CONFEDERATION, 2010). These include: Handling the PCTSs during their transition phase Making commitments for the next 2-3 years about services and financial plans Understanding the new GP consortia and their managers Making arrangements for contract with multiple consortia behaving individually and in networks Ascertaining that the PCTs vital statutory activities are being taken into account even during a major organizational transition. The challenges of Healthcare commissioning might be addressed by focusing more on clinical leadership (NHS CONFEDERATION, 2010). For the local needs and services, the consortia will develop a real, risk adjusted, capital budget. The consortia will be held responsible for economic risk, service execution and health outcomes. Amongst the local system, the consortia will have an outstanding position. Therefore it should be capable of attracting a powerful management and have clout. Gray (2001) says that these challenges are difficult to address because it is not possible to decrease hospital care expenses and divert it into budgets of primary care drugs. Accessibility to diagnostic service costs might be prohibited which is subjected internally within the provider unit and not to external contracts. Savings within the hospital can be redirected to hospital care by professionals in any other service. Conclusion: Healthcare commissioning personifies the improvement in quality of healthcare and it is responsible for publicizing the national healthcare standards, assessing the organizations performance and comparing it with other organizations, solving the problems when it is not possible to resolve it locally and looking into severe service failure. According to Sobanja (2009) commissioning is defined as the act of committing resources, particularly but not limited to the health and social care sectors, with the aim of improving health, reducing inequalities, and enhancing patient experience. Many countries throughout the world are now concentrating on healthcare commissioning. Experience and evidence available from Europe, United States and New Zealand suggests that commissioning is not done systematically in any of the systems. There have been innovations in all the systems but again there are illustrations of barriers and limitations of effective commissioning. Commissioning tends to be dif ficult may be due to the nature of healthcare and the expectation of the healthcare commissioners to have a high level of technical and managerial skills. Payment system, incentive, market organization and regulation influence the impact of commissioners. The concluding point to stress is that there is only one element called commissioning in the health reforms and its impact will be affected by how different elements are carried forward. Hence it can be concluded that even if world class commissioning is enhanced it may not reach the standards and fall short of its potential due to lack of variations in system design.

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Isaac Setton Feb 17 2014 11HX Mr. Weisenberg Reconstruction Essay After the war there were many plans which were similar but different in a way. The plans were Lincolns plan, Wade Davis Bill, Andrew Johnson's Plan, and Radical Republicans Plan. Even before the war ended, President Lincoln started to think about reconstruction because he already thought about how the war would end. He wanted to build a strong Republic in the South. To end the war, he made a proclamation of amnesty and reconstruction for those areas of the Confederacy were ere was ran by Union armies. What Lincoln did was when ten percent of the population would sign a loyalty oath, he would reinstate that state into the union. In order to get this ten percent he wanted the knowledgeable blacks to vote. Voters the were able to elect delegates to give changed state constitutions and create new state governments. All southerners except for high line Confederate army officers and government officials were granted full amnesty. Lincoln guaranteed southerners that he would protect their private property which excl...

Benefits of Breastfeeding Essay

It’s amazing how all creation have been endowed with built-in capabilities to procreate and sustain its progenies. It is said that â€Å"there are 4,000 species of mammals† and each kind produces a distinctive sort of milk for their young (Ruth Lawrence, M. D. , professor of pediatrics and obstetrics, in Williams, accessed in the Internet last February 27, 2007, http://www. fda. gov/Fdac/features/895_brstfeed. html ). Given that, the natural food for an infant is its mother’s milk. Human milk is custom-built for human babies and enough to meet all the dietary needs of a suckling babe. It is an established fact that years of research on the efficacy of breast milk making it perfectly suitable to provide nourishment to infants and basically protect them from illness. In comparison to bottle-fed babies, the former have decreased rates of admissions or hospitalizations, infections related to the ear, rashes and allergies, diarrhea, and a host of other medical concerns (Williams, accessed in the Internet last February 27, 2007,http://www. fda. gov/Fdac/features/895_brstfeed. html) . This paper examines and proposes the manifold benefits of breastfeeding both for the infant and its mother, its historicity, and society’s role in its practice as well the risks when mother is exposed to questionable lifestyle or substance use-whether legal or illegal. II. Review of Related Literature Despite its popularity and very common occurrence in various parts of the globe, breastfeeding is a subject frequently being researched. In a compendium on this matter, Cadwell and others brought together information on the incidence, and other studies to present a realistic picture of the importance and condition of the breastfeeding in America (Calandro & Marcus in Cadwell et al article, 2003). Historically, this maternal activity is unquestionably a norm or an everyday occurrence of early Americans. According to Cadwell and other writers however, this is no longer the situation. Breastfeeding moms are fast becoming an â€Å"endangered species† so to speak. This team among others, are convinced that a resurgence of the breast feeding practice is most needful, and education’s place in promoting breastfeeding. In addition to the many positive effects of breastfeeding, recent study published by the La Leche League International focuses on the OSA (Obstructive Sleep Apnea) occurrence (Palmer, 1999). Findings revealed that breastfeeding and the longer a baby is breastfed lowers the incidence of this disorder. III. Historicity and Occurrence of Breastfeeding Culture and society shape people’s values to a large extent. They shape attitude early on those developmental stages. Family, teachers and friends greatly have their effects on other people’s beliefs about what are those ways that are acceptable and are not (Canahuati et al, 1999. http://www. waba. org. my/wbw/wbw99/foldereng99. htm). Many in the research field say that ninety-nine (99%) percent of human history has been known to have breast milk as the primary or sole food until two years of age. There is common knowledge also that this practice of infant nursing even continues for more than those two years (______ in Small, last accessed in the Internet, February 27, 2007). However, culture and society slowly evolved until the norm became non-existent almost. Today, in first world countries mainly, the women now choose the option to nurse or breastfeed – the ready solution to feeding a baby has become to bottle-feed them. And this beside the avalanche of information that reach mothers, many women still choose to introduce formula which all agree as an artificial substitute (Matusiak, 2005). This was actually introduced around the 1860s in the U. S. and in Europe with advertisements persuading women to purchase what might well be the scientific discovery of the day at the same time convincing its customers they are paying for the most perfect substitute for mother’s milk (Matusiak, 2005). It is true that culture is most influential when the choice to breastfeed is taken or not. To date, there are various intricacies where culture and the choice to breastfeed are involved. Matusiak in his study on A Cultural Perspective of the Feeding Habits said that â€Å"In all cultures there exist a number of factors and beliefs not directly related to breastfeeding that nevertheless affect women’s decisions on how to feed their children† (Matusiak, 2005). They include feeding habits – when to feed and when not to feed – and also the duration (one year or less for instance) of nursing the child. This even includes the feeding position – the cultural differences that influence the mother to decide what she has been taught to do. This goes to mean that mothers hand over to their children what they usually practice. In addition, it undeniably true also that whenever one mother decides to breastfeed, society almost always dictate to a large degree this decision made by women. In Pakistani society for example, male children are more preferred at than the female children. So much so that when a mother gave birth to twins, the male child was breastfed while the infant daughter was given the formula (Matusiak, 2005). Again to quote Matusiak â€Å"The cultural aspects of what roles the male and female play complicates the issue. As seen, societies that favor a male over a female, as in some developing countries, tend to have the male breastfed, while the female gets the artificial breast-milk. While more developed countries are struggling with the emergence of a strong, self-willed female population† (Matusiak, 2005).

Final Project Scenario Solution Darren Coco HSM Essay

Statement of Opportunity The services provided for high school dropouts will require a knowledgeable staff in different fields to obtain the skills needed to gain employment. Offering education courses and tutoring in basic reading and writing skills, with the goals of getting the students ready to take a GED test or working towards a high school diploma. Impact on Organizational Structure A professional staff that works well with high school children, volunteers who are willing to be patient and work with the professional staff. The need for a human resource department is very important, and will represent the collective capabilities and experiences of its people. Usually with high school dropouts it is based on social background and academic behaviors. The organizational structure needs a positive teacher-student relationship where the students will be encouraged to want to learn and succeed. In this type of case with high school dropouts there may be a need to set up an informal organizational chart, which introduces flexibility into the structure. The kids that will be participating in these programs may be working at a job, and need to set time for education at night or vice versa. Having a flexible schedule can help provide time for all of the students to benefit from. This type of structure can be categorized under the heading of matrix organizations. This struc ture would have the need for more than one supervisor for the employees. Sometimes this type of chain of command can run into problems such as power and authority. However, the benefits may well outweigh the costs if better decisions are made, if they are more widely supported though out the organizations, and if they prevent the alienation that so often accompanies a rigid, bureaucratic structure. Community and Environmental Factors This organization will need to do an assessment to find out the targeted areas of the schools with the highest dropouts occurring recently. Speaking with the school’s superintendent and principals in the area will be able to provide vital information of the student’s history. Strategic planning is always anticipate changing community needs, demographics, economics, location of population centers, and other such variables that is needed for the organization. Government-funded programs by far are the major source of funding for social service programs in federal and state governments. This type of funding tends to be organized around the population groups and problem areas. Dropout high school students will fall under this type of funding. Liederman (1995) points out policy and practice tend to follow social and economic swings and to adapt to changing conditions. Local agency directors who expect to receive funding for services that fall within the child welfare networks can improve their chances for participation if they keep track of proposed programs, legislation, and funding streams initiated at the federal and state levels. By participating in the political process, an agency director, board member, or selected staff members can become integral parts of the decision-making processes and will understand the rationale and the politics of government funding. This knowledge puts an agency director and other participants in a position of strength when the time comes to submit grant or contract proposals to fund agency programs. There is also a possibility that the government agency may grant fund to a family-service agency to strengthen its foster care recruitment, training, and licensing program. The government agency would be awarding the agency a grant to carry out its own programs because these programs benefit the community, and the agency does not have the necessary resources to increase or strengthen the program on its own. (Kettner & Martin, 1987). Human Resources This department consists of selecting, hiring, and retaining the optimum mix of staff. These factors include finding mutual support, leadership, and mentoring. Being able to find the right mix is difficult, but can be done with careful planning and of a clear understanding of what types of people  work best together to achieve high levels of productivity while demonstrating a firm commitment to the organizations mission. A core or hub around which human resources planning revolve is made up of three elements: human resources law, a profile of staff needs, and a job analysis for each position. With these elements at the core, a plan is developed that involves (1) recruitment, (2) selection, (3) orientation, (4) supervision, (5) training and development, (6) performance appraisal, (7) promotion and career development, and , if necessary, (8) termination. Human resources plan is compiled with a clear sense of direction and vision focusing on the qualities and characteristics that are needed to achieve the organization’s mission, goals, and objectives. Human resources will need to find the professionals who will give everything they have learned and more to help dropout kids finish their education. The final decision involves a series of final steps prior to making an offer of employment. These may include any or all of the following: (1) final evaluation of candidates by the selection committee, (2) final check of references, (3) recommendation by the selection committee to the hiring authority, (4) the job offer, and (5) notification of unsuccessful candidates of their status. Human resources have a big responsibility to choose the best candidates to work these children. Let’s hope the each student passes with flying colors, and will succeed in all that life has to offer them.