The Big Day Essays (1254 words) - Startup Cult,

The Big Day annon I truly detested the sound of that morning timer, that puncturing, aggravating continued blaring. Following a second or two I gradually began understanding that it was not simply one more day, it was the day. I felt the development in the bed as she went after the clock and at that point the blaring quit permitting me to slip back towards serenity once more. Love you, I murmured. Reason me, you were stating? she said wryly. You heard me, I said somewhat stronger yet doing whatever it takes not to strain my drained voice. I didn't state I didn't screwing hear you, I asked you what you said. Rehash it, stronger. What's more, have a go at opening your eyes this time. After a snapshot of examining the circumstance I constrained myself to make an exertion and sat up, taking a gander at her. Everything about her was delightful indeed, even in the first part of the day. The way that wavy practically dark hair simply contacted her shoulders. The easygoing posture she held sitting on the edge of the bed in that well used Lakers T-shirt. I grasped her hand and pulled her a little closer appreciating her underhanded grin. She needed to state something however she hung tight for me to talk first. I kissed her hand over and again and investigating her dim earthy colored eyes I said gradually overenunciating each word: I...love...you. Her grin got more extensive as she answered. You better. Don't you dare drop on me now. She set down alongside me and kissed me delicately folding her arms over me. I slid my hands inside her T-shirt running them here and there her back and I stated: We truly don't possess energy for this. In no way, shape or form. What about the shower? What's more, the shower it was, taking substantially a lot of the time we didn't have. I stood shaving when she asked from the room: Denny's or Jack in the case? Which one is the most sentimental? Breakfast in bed! Alright, you got me. What about Big Bob's in Burbank? You call Big Bob's sentimental? We're not having intercourse there, we're eating. It's a drive, I'm ravenous. I wanna eat now. I took a gander at my appearance in the mirror, experiencing one of those smaller than expected emergencies thinking about whether it was truly me remaining there. Was that truly what I resembled, what my identity was? That was my face, my body, and I would spend an amazing remainder limited to it. Despite the fact that I was very acquainted with my own picture, he appeared to be similar to an outsider. Well? she stated, and I out of nowhere snapped once again into the present. Er, is Jack in the case pass through fine? Great. Great, I thought. Is it true that we were flawless together, she and I? Did we have to be impeccable together? Was every other person? Once in a while she felt like a stranger as well. I thought about what that implied, what it suggested. Perhaps it was since we were not intended to be, possibly it was all off-base and I was simply tricking myself. Might it be able to be that I was moronic to try and imagine that the two of us were a smart thought in any case? I had never pondered that previously. Not in that manner. Not as of not long ago. You got any more stuff to pack? I heard her state it however I didn't consider what she was stating. I was scrutinizing the way that she was in any event, conversing with me. Perhaps she was saying it to another person. Hello, what are you doing out there? Is it true that you are tuning in to me? I was unable to think about a clever response since I had not contemplated what she was stating regardless. In any case, in my psyche I realized that I needed to produce an answer, since it was the second time she was inquiring me...something. Out of commitment I naturally replied: Better believe it, sure. Does that mean you're tuning in to me or that you are very brave stuff you wanna pack, before we leave? I went in to the room and saw her remaining there going to zoom up the bag and she was as enchanting as could be. She was absolutely no more bizarre what's more, nor was I. Having cleared that in my brain I felt calm and I grinned while simply watching her. She had clearly paid heed to my Or maybe weird conduct and gave me a curious and to some degree amazed look. Is it true that you are OK, nectar? I grinned much more extensive. Never better, sweetcheeks. Never better. As she pulled out the carport from the carport she stated: You realize I think I altered my perspective. About what? How about we go to Big Bob's. Fine by me. From that point we can simply swing out on Glendale Freeway. I was nearly surprised when she

Personal Financial Plan Free Essays

Individual Financial Plan Part 5 Sheri Mulder Personal Finance Age 30 Establish great credit and keep away from over the top obligation Invest forcefully for retirement Buy a first home and construct value Make a will and wellbeing mandates Age 30-45 Create a domain plan. Purchase sufficient life and handicap protection. Continue contributing however much as could reasonably be expected. We will compose a custom paper test on Individual Financial Plan or then again any comparable theme just for you Request Now Put something aside for children’s school. Age 45-65 Leverage top acquiring a long time to fabricate money related security. Move retirement reserve funds as vital. Survey domain designs normally as resources develop and to reflect changing life conditions. Age 65 and past Fittingly rebalance resources for oversee hazard. Make a move to limit bequest burdens and encourage riches move to relatives. Ensure medical coverage is sufficient. What was utilized to help set up the individual money related arrangement was a site that had a case of a monetary arrangement considering life-stage changes. The model was useful on the grounds that it demonstrated various ages of an individual’s life and what ought to be finished during those stages. The model was useful to utilize on the grounds that the model is fundamentally the same as the circumstance and way of life changes that are turning into an issue. The budgetary assets that would be utilized to help settle on money related choices is get a credit from the bank for a home loan. Taking out a bank credit would possibly be utilized if there was a lot of cash required and there was insufficient set aside to utilize. It is imperative to have a savings to count on if there should be an occurrence of crises so an individual doesn't need to utilize monetary assets to get that person out a crisis circumstance. Transient Goals Finishing school Increasing bank account Purchasing another vehicle Reducing high premium obligation Buy disaster protection Make plans for retirement Middle of the road Term Goals Paying off costly obligation Creating a rainy day account to cover a year of costs Buying another vehicle Taking exceptional excursion Long-Term Goals Own a home liberated from contract installments Own a summer home in the mountains some place remote Accumulate enough assets to not need to work, yet perhaps something low maintenance on the off chance that I get exhausted My own hazard resistance is traditionalist at this present snapshot of life. Despite the fact that my time skyline has numerous years to contribute, at this moment the benefit level isn't sufficiently high to have particularly left to contribute. My hazard olerance is additionally preservationist due to absence of experience and information on contributing. Later on when there is a higher resource level, there could be a chance of employing an expert to help with a venture. My time skyline impacts my budgetary arrangement due to how long that there is left before retirement. The quantit y of years that an individual has before retirement is imperative to decide how to put away and set aside cash. When of graduation, there ought to be near forty years to take on hazardous ventures. There will likewise be forty years to stack a portfolio with bonds and money. Income Statement Cash from net wages |43220 | |Cash paid for: | |Income charges and findings |-8164 | |Mortgage |-7617 | |Food |-9600 | |Car costs |-7000 | |Clothing |-1800 | |Cell telephone |-1560 | |Internet and satellite TV |-1272 | Balance Sheet |Assets Liabilities | |Car $6,183|Student Loan $10,000 | |Savings $600 | |Total $6,783|Total $10,000 | |Net Worth ($3,217) | Personal Monthly Budget |Projected Monthly Income |$1,667. 28 | |Actual Monthly Income |$2,684. 00 | Housing |Housing |Projected Cost |Actual |Difference | |Mortgage |$934. 72 |$934. 2 |0 | |Phone |$130. 00 |$159. 00 |-29 | |Electric |$212. 00 |$212. 00 |0 | |Cable |$84. 00 |$84. 00 |0 | Start sparing, continue sparing, and adhere to your objec tives Contribute to your employer’s retirement investment funds plan Learn about your employer’s benefits plan Don’t contact your retirement reserve funds Ask your boss to begin an arrangement Put cash into an Individual Retirement Account Find out about your Social Security benefits Time estimation of cash impacts this piece of the arrangement in light of the fact that the more drawn out cash is spared, the more it will be worth when an individual resigns. At the point when you set aside or put away cash, it will be worth more since it will pick up enthusiasm by contributing it. The previous an individual puts away or sets aside cash, the more extended that the measure of cash has the opportunity to pick up premium and increment in esteem. Works Cited https://ww3. janus. com/Janus/Retail/StaticPage? jsp=jsp/Common/JanusReportHTML. jspassetname=JanusReportThroughYears â€â€â€â€â€â€â€â€ | The most effective method to refer to Personal Financial Plan, Papers

How To Read a Whole Book Every Week Critical Linking, April 19, 2017

How To Read a Whole Book Every Week Critical Linking, April 19, 2017 Todays  Critical Linking is sponsored by Bang by Barry Lyga. Most people keep their reading on their nightstand. If you read at night, you probably only get through a few pages before you get sleepy. Instead, I recommend reading in the morning. Even if you’re not an early riser, use the time you spend checking Instagram in bed to read a couple chapters. (I promise not much has happened since you opened the app at midnight.) Make coffee and ease your way into the day. A few useful tips for those trying to fit in a whole book every week. Here’s a reading challenge: Pick up a book you’re pretty sure you won’t like â€" the style is wrong, the taste not your own, the author bio unappealing. You might even take it one step further. Pick up a book you think you will hate, of a genre you’ve dismissed since high school, written by an author you’re inclined to avoid. Now read it to the last bitter page. Sound like hell? You’re off to a good start. A defense of reading books you know youll hate. Human beings are storytellers. We document  who we are, where we have been, and where we are going in words and pictures. Civilizations survive through the stories they leave behind. If someone threatens our books, we will fight to defend them. A plea for keeping the NEA and public libraries fully funded. Sign up to Today In Books to receive  daily news and miscellany from the world of books. Thank you for signing up! Keep an eye on your inbox.

Australian Societal Consequences That Affect The...

Poverty, deprivation and exclusion (Saunders, 2011) are factors that have been identified as Australian societal consequences that affect the unemployed today. This essay will gain a greater knowledge of complex social disadvantages that must be recognised. In doing so studies, debates and solutions have the opportunity to gain further insight into how citizens value issues of poverty and disadvantage. While at the same time (Blakemore Warwick-Booth, 2013) understanding how Governments introduce social policies as a means of ‘real world’ problem solving. With the purpose of understanding income management and unemployment. This essay will explain the (Blakemore Warwick-Booth, 2013) intentions, statements, goals and ideas behind†¦show more content†¦To make sure that welfare payments are spent on the essentials of life†. However people such as Paddy Gibson view the BasicCard and income management as (Gibson, 2009) patronising and taking away peoples self- determination. Especially when listening to an infuriating soundtrack about the BasicCard in a monotone voice repeating (Department of Human Services, 2014) â€Å"Do not throw away your BasicCard, Do not tell anyone the PIN for your BasicCard†. The mixed responses of this new policy really questions the effectiveness of it all. Recipients of the BasicCard are unable to purchase; (Katz, et al., 2010) alcohol, home brew kits, home brew concentrates, tobacco products, pornographic material, gambling goods and gift vouchers. However Reports have found that (Branley, 2014) many people are commonly finding ways around regulations. Many are suggesting it has all become a rather expensive failure. News headlines such as (Hermant, 2014) ‘Inexperienced cashiers selling cigarettes to BasicsCard holders’ and ‘BasicsCard users swapping groceries for grog’ do not provide much confidence in the success of the scheme. When the Coalition Government (Mendes, 2012) first introduced compulsory income management in 2007. It was evident that there was going to be an increase of individualistic policies influencing areas such as social disadvantage

My Design Of Sighting A Gun - 2441 Words

I. The purpose for my design is to speed up the process of sighting a gun in, the scope to take into compensate the parabolic launch of a bullet, and to hit to target bulls’ eye. Sighting in a gun requires a long trial and error process that any hunter, marine, or police sniper would agree upon. As a bullet is fired from a rifle it rises a few inches for about one hundred yards or more where it descends below the axis of the barrel. The scope looks like any other scope but will account for the parabolic launch and relocate its self to the correct position for the most accurate shot. Nikon is a company that produces quality scopes and would be a good contestant for the idea. They support their products being â€Å"brighter, clearer, precise, and rugged, but these are just a few of the attributes knowledgeable hunters commonly use to describe Nikon riflescopes. Nikon is determined to bring hunters, shooters, and sportsmen a wide selection of the best hunting optics money ca n buy— while at the same time pushing the envelope to create revolutionary capabilities for the serious hunter† (Nikon). The design would also need an electrical engineer to design the wiring and microchips/sensors, but a mechanical engineer from Power Electrics would also be needed to fit the motor for the positioning of the scope. I would like to arrange a meeting for all of us to discuss and perfect the idea. II. The scope, Buck Slayer by Slade Mills and Nikon, will be about the same size as any otherShow MoreRelatedSecurity Forces51988 Words   |  208 PagesL3ABR3P031 0S1C OBJECTIVE 2b Identify basic facts and terms about threat weapons types and capabilities. Written Measurement (Test #4) T HREAT WEAPONS Terrorists use a variety of firearms to include handguns, rifles, automatic rifles, submachine guns, as well as mortars and rocket launchers. Access to sophisticated firearms is relatively easy for terrorist cells. Sources may include criminal links in the society, other terrorist cells, or indirect and direct sponsors of the terrorist activitiesRead MoreEssay about Phd Comprehensive Exam. in Leadership15004 Words   |  61 PagesEinstein discovered the laws of the universe. The attempt by objectivists to discover the laws human social interactions logically follows. Quantitative Research Techniques â€Å"Research methodology is influenced by the logic of experimental designs derived largely from biological science† (Lee, 1992). For a researcher in the hard sciences to validly study any phenomenon, the researcher must be detached and separate from the phenomenon being studied. Hard scientists believe that if the researcherRead More1000 Word Essay85965 Words   |  344 PagesSemiautomatic Rifle ........................ 130 M18A1 - Antipersonnel (Claymore) Mine .................... 137 M2 - .50 Caliber Machine Gun ........................... 140 M203 - 40 mm Grenade Launcher ......................... 144 M240B - Machine Gun ................................ 147 M249 - Machine Gun ................................. 150 M60 - Machine Gun .................................. 154 Page 1 / 389  © Copyright 1999-2012 ArmyStudyGuide.com Version 5.3 M72 - Light Anti-Tank WeaponRead MoreLogical Reasoning189930 Words   |  760 PagesCollege; and Stephanie Tucker, California State University Sacramento. Thinking and writing about logical reasoning has been enjoyable for me, but special thanks go to my children, Joshua, 8, and Justine, 3, for comic relief during the months of writing. This book is dedicated to them. For the 2012 edition: This book is dedicated to my wife Hellan whose good advice has improved the book in many ways. vi Table of Contents Preface.............................................................Read MoreAuditing Cases22626 Words   |  91 Pageswhich he wrote, While the agreement Enron has with its independent auditors displaces a significant portion of the activities previously performed by internal resources, it is struchired to ensure that Enron management maintains appropriate audit plan design, results assessment, and overall monitoring and oversight responsibilities. Enron has found its â€Å"integrated audit† arrangement to be more efficient and cost-effective than the more traditional roles of separate internal and external auditing functions

The And Its Effect On The World - 1288 Words

The apparently overpowering Roman Empire was guaranteed to collapse soon after the numerous characteristics that made Rome such a prevailing kingdom started to deteriorate away. Rome was the focal point of the biosphere and the thought that such a universal supremacy could decay was disregarded. It was not manufactured in twenty-four hours; therefore, it could not be demolished in twenty-four hours. The spectacular metropolis failed for countless reasons, however there are only a couple key explanations that directed to its diminish. These reasons were the most important part of society, so it explains a lot but it was, Political, economic, religious, and neighboring militaries that were the most important influences that steered to†¦show more content†¦Christianity was spread like wild fire. The Roman rulers sensed that Christianity was so dominant that it could be a potential danger. Around 100 AD. the first discriminations of the Christians transpired. Many of the Romans had previously committed to the belief of Christianity and they rejected to abandon it because it was the supreme key of their life. This steered to many societal complications as well as a weakening in the patriotism that had once existed in the souls of all Romans. The People challenged Roman politics and they became liberated of the government. By the stage that Constantine officially legalized Christianity it was far too late and the Kingdom was too profound in disunity to convalesce. The pronouncement to outlaw Christianity was a dreadful resolution and caused the once integrated empire to disintegrate. During plentiful of the period that Rome existed, the Empire permitted the Germanic communities to live tranquilly inside its areas. For several ages the two assemblies subsisted melodiously until the Huns hard-pressed the communities beyond into Rome. The Germans were treated seriously poor and the Vistagoths rapidly turned in contradiction of the Romans. In an appalling encoun ter the Roman military was overcome and the Vistagoths momentarily apprehended the city of Rome and took it over. Soon after the metropolis was captured the Huns lost an encounter with the Roman/Vistagoth army. The Eastern Empire decided in

In Gary Crew and Phillip Neils... free essay sample

In Gary Crew and Phillip Neilsons text, Edward Britton, the protagonist, Edward, is portrayed to be a strong and brave young adult who had been well educated before he was sent to Point Puer, a prison for boys. Having his own hopes and dreams about his future but also trying not to stand out too much from seven hundred boys, Edward is handsome and has the ability to think and respond quickly to various situations throughout the text. Izod, however, the sub main character of the novel is the opposite of Edward, he is small, bony and is devastated by the murder of his family in which he keeps revenge and dark thoughts on his mind.Izods character shows he has many villainous thoughts throughout the text. He receives great joy from evil, such as hate, revenge and murder. The reason for his hunger for vengeance is because of his devastation from the loss of his family of nine after the Wolfe family had lost everything they owned because of Lieutenant Buckridge. We will write a custom essay sample on In Gary Crew and Phillip Neils or any similar topic specifically for you Do Not WasteYour Time HIRE WRITER Only 13.90 / page Izod was very determined to kill the Lieutenant Buckridge so much that he did not care if he died in the act of murdering but he cannot be happy until its done. In the text, Izod brings the plot forward without being noticed by others too much. The arrival and the beauty of Buckridges daughter, Susan, cannot distract him from his plans. In Edward Britton, a novel by Gary Crew and Philip Neilson (2000), it is stated that Izod is not very interested in Susan or any sort of relationship with her despite her beauty. Izods clever mind assists him with the trial of poisoning one of the Chaplains. This demonstrates that Izod wants to see his victim suffer as much pain as possible by trailing poison on someone else before Buckridge. Izod knows not to attract attention to himself and especially since he has such a cruel and sinful mission to complete.In the beginning of the text, Izod and the rest of the boys attended a Sunday Service at the Church, instead singing the songs from the hymn books, he only pretended by moving his lips. When it was time for kneeling down and praying, the words that raged in his brain would never be considered as a prayer†¦ and if there is no god, and never was, then I call up the Diablos, the Dark One, to use me. In thinking this, this definitely shows the darker parts of Izod and the wicked thought of God. The fact that he wants to kill the Lieutenant Buckridge and his family shows that he is reckless on the loss of others around him. Izod has had no real education before his arrival at Point Puer, he feels stupid in reading and writing. Izods confidence lowers dramatically when he is asked to read to the class. As Mr. Bull whips him hard for stumbling on the words of the book, Izod does not feel the need to kick or to cry. Izods hate for Buckridge keeps him from reacting the same way as other boys might do in a beating. Izods disgusted face triggers Buckridges temper whilst Buckridge is mocking him. Despite Izods lack of education, he finally realises that if he doesnt practice on reading and writing more, soon enough, he will get beaten to death.†¦ it was the line you aint going to get nothin done that hit home. What if he died before he put Buckeridge down? What is he got killed before his revenge was complete? (pg. 87) this shows that he is very determined to kill Buckridge before he dies from a beating.In the text, Edward Britton by Gary Crew and Philip Neilson, Edward and Izod, the two main characters of the novel, show the different roles that they both play throughout the text. Due to Edwards characteristics, he is a brave and handsome young man who shows that his character is completely different from the others at the prison. Izod, however, is seen as a small, unnoticed and evil minded boy who is looking for revenge.

AP Style FAQs Part 1 - The Writers For Hire

AP STYLE FAQS: PART 1 Does â€Å"city-wide† need a hyphen? If you’re writing about a sculpture, should you italicize the title, or put it in quotation marks? The truth is, there’s no right answer. In most cases, style choices like this can vary from client to client. But what do you do when your client has no clear preference? Or when the graphic designer and the proofreader clash on where (and when) to use a hyphen? You refer to The AP Stylebook Online. It’s a great resource for making style choices (and, sometimes, settling disagreements). One note before you read: The AP Stylebook is a guide, not a set of laws. While we often use AP style (it’s sort of the standard and most people are familiar with it), it’s not the only style guide out there. In some cases, you or your client may decide to make your own rule or create an in-house style guide that picks and chooses which AP rules to follow. That’s okay, too. That being said, I thought I’d spend a week or two sharing some of our own in-house AP FAQs – the style, formatting, and punctuation issues that most often send us (and our clients) digging for clear answers. Enjoy! Q: Does the word â€Å"city-wide† need a hyphen? A: Actually, no. According to AP, when you’re using the suffix â€Å"-wide,† you don’t need to use a hyphen. Same goes for â€Å"statewide,† â€Å"nationwide,† and â€Å"worldwide.† Q: Magazine and newspaper titles should always be italicized, right? A: This one surprised me. According to AP, magazine and newspaper titles should be capitalized, but not italicized. Personally, I disagree with this one (and, unless we’ve got a client who says otherwise, we bend this rule in-house – usually with italics). One note on this, though: Whether you follow this rule or not, pay attention to the words â€Å"the† and â€Å"magazine.† These words should ONLY be capitalized if they’re part of the official name. For instance, you’d say The New Yorker (because â€Å"The† is actually part of the publication’s title), but Time magazine (â€Å"magazine† is not part of the name). Q: I’ve seen â€Å"website† written in a zillion different ways: website, Web site, Website, web-site – what does AP say? A: AP prefers â€Å"Web site.† Also â€Å"Web page† and â€Å"the Web.† Honestly, this looks a little silly and old-fashioned to me; if you’ve got a flexible client or in-house style guide, I’d recommend â€Å"website† instead. But there you go. AP often changes or updates its rules, and I’m hoping that this is one entry that gets modernized. Coming up next week: more titles (books and people), acronyms, and more!! Have any questions you’d like us to answer? Let us know and we’ll answer you in an upcoming blog post.

5 Tips to Compose an Effective Deductive Essay

5 Tips to Compose an Effective Deductive Essay 5 Tips to Compose an Effective Deductive Essay Many students get terrified when learning that they are to perform a deductive essay. Different thoughts come across their minds. They get anxious about such complex terms as deductive reasoning, deductive thinking, and similar definitions. In fact, there is nothing complicated about deductive reasoning process. The main point is to write enough data on the studied topic to clarify your main idea. While writing a deductive essay, you should base your strategy on a specific concept. You are expected to introduce a set of topic-related clues, premises and/or circumstances. These guidelines should develop a situation and come up with a clear and logical assumption. In other words, your major objective is to provide a solution giving specified information in enough amounts. A writer is supposed to make a thorough research of the assigned or chosen topic. Weighing all advantages and disadvantages, it’s needed to draw a reasonable conclusion. Accordingly, the data you’re going to use in this specific piece of writing is utterly important. It must be relevant and convincing. Setting Tone First, you should take into account the tone of your writing. It must be factual and objective. This is a compulsory obligation. Introduce facts and try to be objective. Be honest in your judgments and avoid the subjective point of view. Choosing Your Topic The selection of a topic is of great importance. You ought to be careful. First of all, you should avoid topics that can evoke an overly emotional response. Writing on such themes, you will hardly manage to remain objective. Secondly, your topic is supposed to be relevant and interesting to your readers. Therefore, pick up a non-emotional and significant topic. For instance, you may choose: Online Education. Pros and cons. Democracy vs. Communism. Cultural differences and similarities in your country. Writing Premise The initial part of this essay type is the premise. This technique is very effective because it makes your topic more attractive. An author uses it to craft the conclusion. You may use several premises. Giving some hints on what will be discussed in your research, will ignite the interest in potential readers. Mind that your introduction should clearly explain your main purpose and the problem you are going to disclose. Provide the background of the issue. Study your main question and background carefully. This essay type is based on the facts. Introducing the Evidence The evidence is undeniably vital for such academic paper as a deductive essay. After you write the thesis statement, you should develop your main argument supporting it with examples and proven facts. Supporting paragraphs contain detailed explanations of your main purpose. Each paragraph should have a sub-topic to guide the readers throughout the entire work. The evidence given in all paragraphs must be relevant and official. Therefore, verify all the data you use to state your claims. Don’t forget that you cannot be subjective. You ought to exclude any personal experiences of your own or others. Concluding The conclusion is the defining chapter of your research. It draws the logical line for the premise, evidence, and the final words. It should be brief and straight to the point. It gives readers the balance. You are to restate your opinion. Mind that it should not be obligatorily the dead point. Your conclusion may look forward the future and express the idea for further researches that you wish to undertake. Neither should it be obligatorily positive. It’s not compulsory to write in a positive tone. The objective judgments may reveal negative outcomes of the researched issue. Some Important Details You should never forget definite features of deductive essays; no matter what topic is assigned. First, you have no right to lessen focus. Your research should have a sharp focus on what you explain. If you fail this demand, your readers will lose your point, and your work will be written in vain. Secondly, it is supposed to be clear. Clarity means a lot. Otherwise, your readers won’t understand what you mean. You’ll need plainly structured paragraphs with the organized thoughts. Every section should be logically connected with the previous one. Provide strong support and an effective conclusion. If you need professional assistance from academic experts, visit our service and order a custom deductive essay online, on any topic you need.

Buddy Holly Research Paper Example | Topics and Well Written Essays - 1250 words

Buddy Holly - Research Paper Example It was his family who encouraged his early musical gifts, and he was able to learn playing the fiddle and the piano from a tender age, even as his older siblings taught him how to play the guitar. The family had a business in tiles, while the parents were tailors, but they all let Buddy Holly develop his musical gifts in small and big ways, providng much moral support. Then after secondary school, he formed a band, out of which he further developed his talents, until that fateful event in 1955 when he fronted for Elvis Presley who was touring through their town, and was shortly after signed to a recodring contract by an agent who saw him perform. His early work with the Crickets in 1956 and 1957 paved the way for a career as a solo artist, in 1958, but that career would prove shortlived, as he was killed in a plane crash just a year after. His most famous songs, as reflected in their landing in the Top 40, would come from his work with the Crickets before 1958, notably ‘That Wi ll Be the Day’ recorded in 1957. In all, seven songs from the Cricket era landed in the American Top 40 from that time that Holly spent as the lead of the Crickets. Without that fateful plnba crash shortening the brilliant career of Holly, he would have been in his seventies by now, and would have left as big an imprint as the other greats of rock and roll who have come after him, and who have all cited his work as instrumental in shaping the course of their own music and of rock and roll in general. 1 2 3 4 5 6 7 Maria Elena Santiago holds the intellectual property rights to the work of Buddy Holly and all artifacts associated with the estate, and this is due to the fact that Santiago had become Holly’s wife in 1958. It was on their first date that Holly proposed marriage, and though the widow would suffer a miscarriage, the consummation of their marriage occurred just a few

Defining Beauty Essay Example | Topics and Well Written Essays - 1500 words

Defining Beauty - Essay Example While beauty might have once been truly ‘in the eye of the beholder’, today’s society has beauty defined for it by the overwhelming challenges of the mass media. These messages of the media are so consistent they overwhelm any natural sense of beauty, which is important to our sense of identity and social value. Throughout the history of mankind, humans have projected who and what they are, including their relative social position, through their outward appearance. Study after study has demonstrated people dress a certain way and strive to acquire specific items as a means of signifying that they belong to a particular desirable subset of individuals who also embody their individual ideals (Gilman, 1999). Regardless of whether one has always been a part of this subset or not, it is presumed that an outer appearance in keeping with this group will automatically purchase the coveted membership. In the past few centuries, however, the standard definition for female beauty has had detrimental effects on the feminine identity. â€Å"Women view their bodies as ‘objects of work’ requiring attention and upkeep in order to operate well and promote the desired effect† (Gillen, 2001). ... â€Å"Research in the UK suggests that the wealthier we are, the more likely we are to dislike our body. Experts think there’s more pressure on the wealthy to achieve the thin 'ideal' because they have the money to do so and are more exposed to media images† (Rebecca, 2006). Because the wealthy are expected to be able to achieve this ideal, those who are not so wealthy often struggle to attain the beauty ideal as a means of signifying that they belong within the ranks of the wealthy. Within the past few years, televisions have been inundated with so-called ‘make-over’ shows in which the focus is precisely for the media to inform the public regarding what is considered beautiful or desirable. These shows promise an improved exterior facade to participants’ bodies, fashion sense, faces, homes, lifestyles, etc. that will bring the individual into closer similarity to the ideal image and thus make it possible for them to achieve a higher level of happine ss. This ‘ideal’ image is usually envisioned as someone in their mid-20s, slender almost to the point of skeletal, with specific body measurements at the bust and hips and a specific ‘good-looking’ charm that usually includes blonde hair and a friendly demeanor. This limited view of the ideal obviously eliminates anyone who might have been born with larger bones or other ‘defects’ that resist the reshaping of the plastic surgeon’s scalpel from being accepted into the socially acceptable. Makeovers on TV illustrate the unacceptable qualities of the average individual and emphasize the importance of bringing the individual image more in line with a perceived social ideal that is communicated through the same media channel. It is thus perceived that the only way for individuals to find

China beer market competetor analysis

China beer market competetor analysis CHINA BEER MARKET COMPETETOR ANALYSIS Quick Over view: Aire Breweries plc. Is UK based beer marketing company that been selling premium beers. The company is enjoying fairly good market share. The beer market has become saturated due to intensive competition and in-line pricing strategies. The Aire Breweries plc. as a part of logical extension decided to enter Chinese market, where beer market is largest in the world next to USA. The Strategic Triangle- 3Cs: The strategic triangle proposed by Kenichi Ohmae states that any company success in long run pivots around 3factors: Corporation, Customers Competition. In construction of Business strategy above factors must be examined thoroughly to arrive at marketing plan. The Corporation: Aira Brewries is beer selling company selling beer brands like Hostenbech- European style lager beer, San Bernanardo Cameolet- British style dark bitter beer, Ark royal British style dark bitter beer, pot of gold- Irish style dark stout beer with premium price. The brands are promoted through super markets, fashionable markets, Up market city centre bars. The copany has high cost structure and has efficiency as its strength. The Customer: The proposed target market China is undoubtedly a large consumer market in the world and beer in particular. The vast spread of consumers with varied languages make MNCs experience the difficulty of convincing Chinese consumers. The competitors: In china due to liberalisation policy many MNCs are trying to make a mark in China market. The competition in china Beer markets is very intensive. China market expects to come up with cost effective products where local sellers have an edge over MNCs. San Miguel is one of top three selling brands in china and largest selling brand in china. Sabmiller is the world second largest selling has 47 breweries and operating in 13 provinces of China. Bud Light beer has bottom line structure. Various players include CBR Brewing company inc. china Food beverage company, China resource enterprise ltd., Fomento Economico Mexicano SA de CV, Scottish new castle, Fujian Yanjing Huiquan Brewing group Kirin Brewery Company Ltd., etc. Quick glance at China Economy: China has recorded 11.9% GDP growth rate accounts for $ US 3565 billion (USD 1 = RMB7) is a clear indication that Chinese have got fair standards of living and spending power of consumer has been remarkable Economic Indicators 2007 2006 GDP (RMB trillion) 24.7 21.1 Per capita GDP (RMB) 2,200 16.084 Per capita disposable income of urban households 13,786 11,759 Per capita Net income for rural households 4,140 3,587 Table: 1 Source: National Bureau of Statistics Market Opportunities threats in China: Due to vast population China will offers great opportunities for potential marketers, provided the market is analyzed and a feasible program is developed. The barriers usually for any MNCs are inadequate market data, inappropriate entry strategy. Poor access to supply chain, vast spread of geographical market, cultural differences etc. It is advocated to distinguish the gap between the developed and less developed markets. Uniform marketing strategy is not suitable in view of large market. The beer market is not similar every where; it is more of localized driven by local tastes and preferences. It could be defined as pool of regional markets. Domestic players will play dominant role and take maximum market share. But their presence is limited to maximum of 2% of national market. Majority of market share i.e. 45% is controlled by 4 players. Beer Market Scenario in China: The high spending level of consumers in China has lead to growth of Beer market in manifolds and ignited by Foreign Direct investment. China has now became largest national beer market in the world crossing USA. There were 4 companies in china and has grown to 60 by 2007. McKinsey Global institute has thrown light on newly emerging segment in the recent past- Urban Middle class who has been earning RMB 100000 ($12000) a year became a hot button to every beer marketer. Table 2 Year Million Liters Annual Growth (%) 2007 32035,83 10.04 2008 33459.42 4.44 2009 34 904.69 4.32 2010 36,371.42 4.20 2011 37.860.59 4.09 Source: http://www.globalbusinessinsights.com/content/rbaa0012m.pdf Growth of China Population Trends: It is a known fact that china is most populated country with 1321 millions as per 31 December 2007 comprise of 51% male 49 percent female. The population size makes china a land of opportunities driven by advanced technology usage while producing. Understanding Chinese Market Risk Element: Small Medium enterprise like Aire breweries may need to mobilize recourses to tap the potential of Chinese beer market. In this regard they have to analyse their strengths weaknesses. Most of MNCs fail because of the poor distribution system and failure to identify a piggy back partner. More over the law in china has been very stringent. Unless the marketer study the cultural aspects thoroughly it may lead to chaotic situation. Cultural aspects of China Market: Chinese consumers are very patriotic and do practice their culture meticulously. Due to strong socialistic approach they support local products. Foreign players may suffer from non-acceptance of their offering due to invisible influences of culture which cannot be demonstrated. Law at China: The china legal system is very complicated and frustrating to MNCs. The familiarity to china culture will facilitate the understanding of law. It is always better to have a local partner to promote the business and as a part of political risk (i.e. confiscation of assets or blockage of funds) handling mechanism Geographical Segmentation: It is wise to adapt Regio-centric approach or Multi Domestic approach to reach vast china market. Here subsidiary in each province of china has to devise their plan to suit the need Preferences of that region. This approach demand to have varied marketing mix with coordinated efforts of other territories. Demographic Profile of Consumers: China population (1341 millions male female ratio 51:49) has been multi-religious ranging from Buddhism, Taoism, Catholics, Protestantism, and Islam, interestingly deal business according to their religions and Socio-cultural values. Since ages Chinese companies have been transferring ancestral values to present generation which establish relationships refer to term â€Å"guan xi†. Relations drive the businesses to offer extent of product mix. Distribution of Population income wise: Table 3 Population (million) Gross National Income (Billion) Low Income 2512 10.20 Middle Income 2667 49.22 High Income 955 49.22 Source: US census Bureau, World Bank group, McKinsey analysis Marketing Mix: Product: China has been largest beer market but with different tastes across the nation. 500 ml and 750 ml are most preferred quantities served in bottles cans. The per capita consumption 18 ltrs has not been impressive when compared with USA (84 ltrs) UK (74 ltrs) per capita consumption. Aire Breweries need to develop localized tastes along with their premium brands. The test marketing will help company to know the preferences. Price: The beer in china market is sold at pretty cheap. 750 ml beer costs 25 cents. Locally made MNC brands Carlsberg and Pabst blue are also sold at fairly cheaper rates. Aire breweries plc., has to adapt bottom line pricing or inline pricing to get acces in the market Promotion: As many languages are used across china, mandarin is widely used language, it is a difficult task to develop a theme while advertising. Few MNCs failed to translate the essence of ad copy lead to waste. It may be advocated to be cautious to understand cultural dimensions while developing ad copy to rural folks Place (Distribution): The mechanism of distribution of beer products in China takes place via Distributors appointed by Manufacturers in turn retailer super markets. Distributor is focal point from which whole-salers supply the goods. Each distributor holds rights to sell one brands. Wholesalers will buy different brands from different distributors and dispense. Foreign players suffer from effective reach. Joint venture structure of distribution will help to overcome problems. Piggyback model of distribution will strengthen Distributor- retailer model. Multi channel mode of distribution will serve the purpose. Marketing Planning: International marketer need to deal with at least two level of uncontrollable uncertainties. The success of marketing program depends on optimal adjustment to business climate in which you are operating. After analyzing opportunities and select the province of china next step is to define the target market. Chinese are got enough disposable income and have been accepting beer as food beverage. Target market will give a direction to develop marketing mix and total number of potential consumers approximately. Aire Breweries should have good local partner to implement marketing strategy and extend support to reach target market. The price and promotion campaign need to be devised according to local practices. Entry Strategy: Once the market profiling is done, it is always good to enter in to the Chinese market through a joint venture. For many years, the Aire Valley Breweries plc, a UK company focused its marketing effort on premium-priced products. As beer market is growing at good rate, it is high time to get in to China market with constructive marketing strategy. A Joint-venture with local partner will offer ease in operations procurement of recourses, recruitment and handling beaurocratic issues. The local partner knowledge on competition, language, culture and business systems can influence the government policy. Conclusion: China is very potential because of vast population but high levels of risk has been demonstrated.Aire breweries may take assistance of local marketing research organisation to seek first hand information for political socio-cultural aspects. References: Kenichi Ohmae, (1990), The Next global stage available at http: //en.wikipedia.org/wiki/3c%27s_model Jeffrey Hays (2008) wine beer in China available at http://www.factsanddetails.com/china.php?itemid=142catid News Report (Dec 2006) Beer market in china http://www.globalbusinessinsights.com/content/rbaa0012m.pdf National Bureau of statistics of China, available at http://www.chinaknowledge.com/market/book- Starmas international Business consultants (2009) China trends available at http://www.starmass.com/china_review/economy/_overview/china_macroeconomic.htm China Knowledge Bureau report, (2008) available at http://www.chinaknowledge.com/market/book-china consumer.aspx?subchap=1content=3 Chinese Beer Industry Report, (October 2007) Koncept Analytics Publishers, UK available at http://www.reportbuyer.com.food_drink/alcoholic_drinks/beer/chinese_beer_industry Beer Market in china (2008), A Market analysis of Aroq Ltd. Published at UK available at http://www.justdrinks.com/store/product.aspx?id=68150 Jeffrey Hays (2008) wine beer in China available at http://www.factsanddetails.com/china.php?itemid=142catid 10. Richard Benson-Armer, Joshua Leibowitz, And Deepak Ramachandran (1999) Global Beer: Whats On Tap? available at https://www.mckinseyquarterly.com/ghost.aspx?ID=/Global_beer_Whats_on_Tap_321 News Report, (December 2006 ) Beer market in China http://www.globalbusinessinsights.com/content/rbaa0012m.pdf Don Lee, (29, April 2009), China relaxes business regulations, Los Angeles Times, available at http://articles.latimes.com/2009/apr/29/business/fi-chinaregs29 Charles W. L Hill, 2005, 5th Ed, International Business, Tata McGraw-Hill, New Delhi, India p- 166 Philip R Cateora, John L Graham (2008) 3ed, International Marketing, Tata McGraw-Hill, New Delhi, India p26 InfoPacific Development Inc. (2009), Kompass, China http://www.chinatoday.com/general/a.htm Prof. Jiangang (Jim) Dai Prof. Chen Zhou (March 2008), Beer Distribution In China, Georgia Institute of Technology, available at http://www.scl.gatech.edu/research/china/beerreport2008.pdf China Business Intelligence analysis available at http://chinabizintel.com/industry-updates/several-major-problems-in-chinas-beer-market.html

Characterization In A Classic Novel Essay -- essays research papers

Characterization in a Classic Novel   Ã‚  Ã‚  Ã‚  Ã‚  Mary Shelly’s Frankenstein is the story of a scientist, Victor Frankenstein, and his quest to create life from death. Frankenstein’s experiment goes dreadfully wrong and he is forced to flee from the monster he created. Throughout this novel, Frankenstein is characterized by his extreme intelligence, skepticism and withdrawn behavior, and remorse.   Ã‚  Ã‚  Ã‚  Ã‚  In the beginning of this novel, it is clearly stated that Victor has a love for knowledge. â€Å"It was the secrets of heaven and earth that I desired to learn; and whether it was the outward nature and the mysterious soul of man that occupies me, still my inquiries were directed to the metaphysical, or in its highest sense, that physical secrets of the world,† (37). Victor is educated but self-taught in his favorite subjects. He begins reading books dealing only with science and describes himself as, â€Å"always having been imbued with a fervent longing to penetrate the secrets of nature,† (39). When Victor is old enough, he attends college in Ingolstadt. At Ingolstadt, Victor becomes interested in chemistry and the human body. Frankenstein decides to create a human being in hopes that he will be able to restore life to the dead.   Ã‚  Ã‚  Ã‚  Ã‚  It is apparent that Victor dislikes groups of people. During his childhood, he has one friend who remains close to him throughout his life. Instead of talking to his friend or family when...

Information Use

The design of Information flow and security Is a major concern In any enterprise. Without consistent and proper flow then statistical or decisional errors may occur. Therefore, the design of the information stream is a chief concern of the Information technologist. It is also important to safeguard the data from inappropriate viewing. To that end, it is important to map out the pattern. This example uses a doctor- patient visit in a medical clinic of the twenty-first century.The first bit of the whole comes at the front desk confirming the patient identity and insurance Information. This must be with human Interaction and scanning equipment. Staff verify the ID cards and scan Insurance cards Into the record. There is a lot of personal information just in this step alone. This information proceeds to the triage nurse who takes the vital signs. Then the data and the patient proceed to the provider for the actual visit. Currently, there are already three people who can compromise the in formation and its security.Incorrect data entry and wrong patient are the most common information errors. The remediation for these Is double-checking the information at the point of entry or using more automated means such as vital signs sensors connected to the data system. The security is physical in nature. The identification must be assured in the first place, and the insurance records accurate and safeguarded. Remember, the patient's complaints or diagnosis shall be utterly confidential. If the insurance data is incorrect or not collected, billing will be incorrect and delayed.This is inconvenient and costly. If the vitals are not correct, it wastes time retaking them. The data must be present and accurate prior to seeing the clinician. The doctor has the responsibility to enter complete Information Into the patient's medical record accurately. This will include deliverables to the pharmacy, laboratory, radiology, the insurer, and others. Each of these risks a potential for in put error increasing time usage and the ultimate cost. The provider enters diagnosis codes in as an alphanumeric decimal fashion.One incorrect character will cause the insurance company not to pay for the visit, the medicine or the procedure. Storage of the data Is for billing, statistics and historical record. The database Is not onsite for the smaller clinics, necessitating network link to a server. The flow of the Information Is simplistic. It moves from the clinic information, to the server storage with five or six data entry points in the clinic. The data input is the most important aspect. Would it be reasonable for the patient to pay for prescriptions when an input error caused insurance not to cover it?Of course, this is wrong, but it happens all the time. What would happen If entry of the procedure code were for an uninsured technique? If his happened repetitively, the patients would stop using the practice. The security mentioned above is a physical issue during the patien t visit. However, patient privacy and data security is the penultimate concern in the medical profession. This applies to the billing and insurance data and the diagnosis. Consider this: a hacker changes the mentioned coding. Alternatively, the hacker changes the amount due to the practice.Finally, the hacker determines the patient Is chronically taking narcotics; this makes the patient a target for theft. These are all examples of crimes In recent the tools used. The medical profession has a unique security framework. Most medical offices have an independent system for the medical and billing data; as opposed to their communications system (if they even have one). The notion of not having internet in the office is foreign to most, but it does improve the security of records. Therefore, the transmission phase of the figures to the server is the weak link in the chain.Virtual Private Networks (VPN, Tunneling) ensure secure transmission if partnered with encryption. The information ar rives securely at the data farm where physical and virtual protection is by the best possible applications and structures. It is accessible only by the firm who stored it and via VPN. Stored data security is easy when there is not an internet connection. However, data transfer is over a VPN, which utilizes the internet, subjects the data to interception. It also means the server is susceptible to intrusion. Therefore, the server farm maintains high security for the files.A fence and gate with security checkpoints and guards round the building. Additionally, the server room has cipher-key locks and security doors. Remember, physical security is as important and virtual security. Therefore, the servers have exceptional mallard protection. There are both physical and virtual firewalls and monitoring software. These form a fortress of protection for the medical data. The final piece of fortification is a honey pot. This attracts the hackers and makes them believe they have found the rea l servers. This is a good defensive strategy for the medical data.The data flows from the patient through the clinic staff and into the server under heavy guard. Specified personnel retrieve data for billing, auditing and statistical analysis. The entered data is double-checked and passes down the chain of care in the clinic and eventually transmitted to and stored in the server farm. Trained professionals, computer structure and applications keep the data from misuse during this process. Though this scheme is bulky and expensive, it effectively ensures data accuracy and integrity from source to archive.

Political economy to address physicians - Free Essay Example

Sample details Pages: 31 Words: 9334 Downloads: 2 Date added: 2017/06/26 Category Health Essay Type Analytical essay Did you like this example? Political economy to address physicians deficiency A policy analysis of three-year medicine course in the state of Chhattisgarh, India 1. Introduction- Human resources are central to all public health systems and a considerable share (42% of government share on health expenditure worldwide WHO report 2006) of resources allocated to public health goes towards them (Public health workforce: challenges and policy issues; Robert Beaglehole and Mario R Dal Poz). Health workers in adequate numbers, in the proper places, and properly trained, motivated and supported are the backbone of an effective, equitable, and efficient public health care system (Rao, K. Don’t waste time! Our writers will create an original "Political economy to address physicians" essay for you Create order D. et al). Determining and achieving the right mix of health personnel is a major challenge for most healthcare organisations and health systems with two thirds of health workers are in public sector and one third of them are in private sector. The challenge of shortage in health care organisations is true for health service providers and health management and support workers respectively (The World Health Report 2000. Health Systems: improving performance). 1.1 Public health workforce in India- Indias health workforce is mixed and diverse in nature with presence of different cadres of health workers offering health services in different Indian systems of medicine. As per the revised national occupation of classification (NOC) 2004, the health service providers constitute allopathic physicians to practitioners of Indian system of medicine (Ayurveda, Yoga, Unani, Sidha and Homoeopathy- collectively known as AYUSH) and paramedical workers from nurses to midwife and a range of oth er supportive staff (Directorate general of employment and training, Ministry of labour, Government of India). There is informal sector of health care providers called registered medical practitioners or quacks which are major workforce in rural and urban slum areas. As per the study of Rao. K 2009, about 25% of health care providers belonged to this informal sector. In pre independence era two classes of allopathic doctors were present in the health work force: medical doctors who underwent a five-and-a-half year course and Licentiate medical practitioners (LMPs) with three to four year course. About two third of the rural practitioners were LMPs (Priya R 2005, Gautham M, 2009). The unease of medical doctors and their resistance towards LMPs forced the government to abandon the LMP course in the years following independence. Considering the WHO definition of health professionals (physicians, nurses and midwives) there were 2,168,223 health workers in India in 2005, meaning a density of approximately 20 health workers per 10,000 population. The estimated shortage of health workers is considered around 20% (WHO standard of 25 per/10,000) (WHO, 2007, GOI, 2005) in India. Presently, the doctor population ratio is 1 per 1,598 persons or 62.5 per 100,000 population with wide inter-state variations such as 1 doctor per 471 persons in Delhi, 1 doctor per 714 persons in Punjab and 1 doctor per 26,000 persons in Chhattisgarh (Health workforce in India, WHO 2007; Human resource for health in India, Policy Note #2, Datta, K.K., Public health workforce in India: career pathways for public health personnel, 2009). As per the World Health Report (2006), the density of health workers is directly proportional to the outcome of health especially in vulnerable groups like maternal and child. Several national level policy, plan and review documents outlined insufficient numbers of doctors in government health care service provision throughout the country, both general m edical officers and specialists, and the issue has been a matter of government concern for some time (7th five year plan, planning commission, 1985-89, Govt. of India; Bajaj Report, 1987; National Health Plan, 2002). It has again become the subject matter of discussion with significant government efforts to scale-up health care delivery through the National Rural Health Mission (NRHM). The Government of India has increased its financial allocation to health through the NRHM and the new Indian Public Health Standard (IPHS) norms for health facilities that, to be achieved, will require many more doctors to enter public health service (Indian Public Health Standards). In the given context, a new state Chhattisgarh was created in India, in November 2000, on the basis of high tribal population (32%). Burdened with the poor health infrastructure and human resources from the parent state and based on contextual influence of deficiency of allopathic physicians in rural public health ser vices, the ruling Congress party state government tried to address the multitude of health care delivery issues by creating a new cadre of health workers through the three-year course, now called Rural Medical Assistants (RMAs). This study will address the policy issue of human resources in health in the given context with an analysis of different actors, content and processes involved in managing the problem and its consequences (both positive and negative) in the health care delivery system. I also intend to analyse the perspective of skill mix, integrated workforce planning, human resources and service planning, evidence- informed interventions for human resource development terms of employment and working conditions in health sector reforms. I will make use of local data, literature and personal experiences, interviews and observations. The Walt and Gilson (1994) health policy analysis framework, the Kingsdon model of agenda setting and J. Gaventa (2006) power cube to des cribe the power relationships with regards to participation and analysis of power and process of policy making for better health outcomes will be used from the literature modified for the local context. The lessons learnt during the study course will be used to analyze the policy process. 2. Context 2.1 Indian context Demographic profile-The republic of India is a country in South Asia. It is the 7th largest country in the world with 2.1-2.3% of worlds land area and 2nd most populous country in the world after China with 1.16 billion population (United nations statistic division 2007). It is pluralistic, multilingual with 1652 different languages and dialects (census of India, 1961, language in India) multiple political parties both at national and regional level. It is constituted of 28 states and 8 union territories. India is the biggest democracy in the world with democratically elected governments at national and sub-national up to village level. Socio-economic and health status-After being colonized by United Kingdom for more than 200 years and getting independence in 1947, India has grown remarkably becoming 12th largest economy (1235.975 billions, 2941 USD per capita) and 4th largest in purchasing power (International monetary fund, World Economic Data base, 2009) in the world. The gr owth has reflected in health and social sector also as poverty was reduced from 51.3% in 1977-78 to 27.5% in 2004-05 as per criteria of Planning Commission of India. The life expectancy at birth has also doubled from 37 in 1951 to 65 years in 2000. Infant Mortality Rate has declined from 146 in 1951 to 54 per 1000 live births in 2005 (National Health Policy 2002, National rural health mission, health profile). However there is disparity in health and socio-economic welfare in different regions and caste groups in India. As per the constitution of India, 4 castes have been recognised; general, scheduled castes, scheduled tribes and backward classes with the current estimates of 25%, 7%, 16% and 52% respectively (census of India 2001). However, these achievements are not sufficient to satisfy the health needs of the people. The nation still lags behind in health outcomes more than many other developing countries. Although it accounts for 17% of the global population, it contributes one fifth of the worlds share of diseases, a third of the diarrheal diseases, tuberculosis, respiratory and other infections; a fifth of nutritional deficiencies, diabetes, cardiovascular diseases, and the third largest number of HIV/AIDS cases in the world (Report of the National Commission on Macroeconomics and Health, 2005). Role of the states in health care provision in India- Constitution of India through its article 21-no person shall be deprived of life and 47-Primary duty of state is to raise level of nutrition and standard of living of its people and improvement of public health delegates the responsibility to states to protect, ensure and maintain the health rights of its people. Health system in India- The health system in India is a mix of different systems of medicine which are parts of two groups of health care service providers. These are public and private health care sector. Private health care sector is the dominant health care provider both in rural and urb an areas (WHO India country office 2007). It means that the financing of health service is mainly private through out of pocket at the point of delivery of services. Public health system in India- The public health system has two distinct health care delivery infrastructure; rural and urban. The Indian rural public health care delivery system is a 4 tier system from sub centre (SHC), primary health centre (PHC), community health centre (CHC) to district hospital level based on the population criteria under jurisdiction. The sub centre should cater 3-5000 population and manned by health workers male female whereas Primary health centre should cater 20-30, 00 population and staffed by 15 different health staff including 2 medical doctors, community health centre should envisage 80-120,000 population with 25 staff including 4 specialist medical doctors with finally a district hospital catering the entire district population (Indian public health standards, Bhore committee) There has been a significant increase in public health infrastructure. There was one Primary Health Centre (PHC) for 75,000 population in 1981, whereas, on an average 31,652 population are covered under a PHC as of 2001 almost reaching the target of a Primary Health Centre for 30.000 population (Bulletin on Rural Health Statistics in India, 2009). The average population coverage of community health centre is 173641 (Bulletin on Rural Health Statistics in India, 2009). Rural health infrastructure vis-ÃÆ'Â  -vis coverage area distances from the village- The average area of SHC is 21.35 sq km, PHC is 132.93 sq km and CHC is 729.2 sq km. With regards to average radial distance from SHC, PHC CHC is 2.61 km, 6.5 km 15.23 kms respectively (Bulletin on Rural Health Statistics in India, 2009). With regards to population coverage the average population covered by SHC, PHC CHC is 5084, 31,652 and 173,641 respectively. The following diagram illustrates the rural health care system in India Urban health system includes a district hospital and network of health centres through the local governmental bodies called municipal corporations in big cities and towns. In big cities and towns there are civil hospitals, Urban family welfare centres (UFWC), health posts and post partum centres. UFWC and Post partum centres are the nodal point for provision of reproductive and child health family welfare services. Apart from these, there are dispensaries and hospital for employees in formal sector through the Employees state insurance scheme (ESIS) and Central government health scheme (CGHS) Private health sector- The private sector includes both for-profit and not-for-profit health care providers. The informal sector is also prevalent in the country in the form of faith healers, traditional birth attendants and other unqualified medical practitioners. There are also private pharmacies which also do dispensing of medicines without any formal prescription of physicians. In al l, there are health care institutions ranging from general practitioners and one bedded clinics to big nursing homes and corporate hospitals dispersed according to their motive of maximising the profits. Status of physicians in India With available data there were 920,000 registered doctors in India in 1991, including all the systems of medicine out of which 365,000 were from the allopathic stream and rest from other Indian systems of medicine. Out of total allopathic doctors 75% were working in private sector. The recent figures of medical council of India 2007, state that there are 683,682 allopathic doctors registered in different state medical council and practising. With 72% of Indias population being rural the total number of doctors working in rural public health sector i.e PHC CHC are only 23,858, which corresponds to only 3.7% or 1 doctor per 3,112,820 population in rural public health sector. In another words 60% of physicians are in urban areas and 70% in private sec tor of health (WHO India 2007). There are large numbers of medical practitioners in the informal sector as well, they are often the first point of contact, mainly in rural and urban slum areas. As per the study of Rao K (2009), 25% of allopathic practitioners belong to this informal sector out of which 42% are in rural and 15% are in urban areas. Another study by Banerjee A in Rajasthan state in 2003, reports that 41% of private medical practitioners had no accredited medical degree. Census estimates adjusted for qualification, which are based on the self reported occupation in National Sample Survey Organization (NSSO) shows that there are 3.8 physicians per 10,000 population than 6 per 10,000; nurses are 2.4 per 10,000 population than 5.8 per 10,000 population; Midwives are less than 1 per 10,000 population than 2.5 per 10,000 population and overall density of health workers is 8 per 10,000 population than 20 per 10,000 population estimated by census of India 2001. Consid ering the rural-urban distribution of health workers in India (2005), there were large mal-distributions between rural and urban areas in the country with-in the states and there are intra state and intra district variations. The density of physicians in rural area is 3.3 per 10,000 population with regard to urban presence of 13. 3 per 10,000 population, four times higher than rural areas. With regard to other health professionals like nurses midwife, it is 4.1 per 10,000 population in rural area to 15.9 per 10,000 population in urban area and overall density of health workers in rural area is 10.8 per 10,000 population than 42.1 per 10,000 in urban area. Health Financing- Being the 12th largest economy in the world, India spends 4% of total expenditure on health as proportion of gross domestic product with almost three times increase in per capita government expenditure on health (PPP $) from 12 to 33 in 1995 to year 2008 respectively. But still out-of-pocket expenditure as pro portion of private expenditure on health remains almost constant between 91.5 to 89.5 % from 1995 to 2008, one of the highest in the world (WHO, updated national health accounts 2008). Health Policy Trend- The health policy in India dates back to 1920s when British rulers established research into the highly prevalent disease leishmaniasis (then commonly called as British Government disease) in Bengal state (Dutta 2005) and this communicable disease control oriented approach continued even after independence with introduction of many health programmes and action plans for the control and eradication of major communicable diseases after Bhore committees recommendations. Still the National Health Policy (NHP) in India was not framed until 1983 and since then India has built up a vast network of health infrastructure and initiated several national health programmes impacting the health sector: adoption of the National Health Policy in 1983, 73rd and 74th Constitutional Amendments in 1992, National Health Policy (NHP) in 2002, introduction of Universal Health Insurance schemes for the poor in 2003, and inclusion of health in the National Common Minimum Programme (NCMP) of the UPA (United Progressive Alliance) Government in 2004. Under this programme, health care is one of the main focus areas, where it is decided to scale up the government expenditure in the health from the prevailing 0.9 % of GDP to 3% of GDP over the five years (2007-2012), concentrating on primary health care. The National Rural Health Mission (NRHM) was envisioned for improving the health service delivery in an integrated manner and has been operationalized since April, 2005 throughout the country. Special attention is on 18 states of the country including the state of Chhattisgarh. The NRHM proposes strategies and sub strategies to improve the health status of people. The main strategy is to up grade 100% PHCs for 24 hours referral service, with the provision of two medical officers (one male and one female) on a need based criteria. 3.0 Analytical frameworks used Gill Walt Lucy Gilson (1994) have proposed a policy analysis triangle systematically about the interrelationships among policy content, process, context and actors, in policy development. The triangle can be elaborated more on three dimensional axis with regards to relationships. For better analysis, the framework of Walt G. and Gilson, L. (1994) is used in a modified form analysing interrelationship among context, policy content and actors and their impact on the process which has also been used in European Commission supported project of Health Policy-Making in Vietnam, India and China (HEPVIC 2005). Kingdons (2001) model of agenda setting helps to understand how certain issues get onto government policy agenda and suggests that policy is made through three independent process; the problem stream, the politics stream and the policy stream. The constellation of factors coming together creates an opportunity of an issue to be on the agenda. Gaventa (1996) analyses power t hrough the model of power cube: the levels, spaces and forms of power. The Gaventa power cube framework can be used to assess the possibilities of transformative action in various political spaces. 4.0 Problem Analysis 4.1 Contextual background to the problem analysis- The state reorganisation commission was setup in 1954 to look into the need of creating new states and a new state (the 26th in India) Chhattisgarh was crafted out of a large state Madhya Pradesh in central part of India on 01 November 2000 by Madhya Pradesh Reorganisation commission in 2000. It is geographically the 9th largest state, covering 135,194 square km, it is 17th in rank by population size of 20.1 million (2001 Census). The population is dispersed with a density which is half that of the national average i.e.154 for the state as against 312 per sq km for the country (Census of India 2001, Chhattisgarh vision document 2010) with 40% of the land areas is classified as forest lands. Of the 18 districts of the state, 12 are classified as remote, tribal and extremist-affected areas. Socio-economic and health status- As per the census 2001, 89% population of the state is underprivileged with one third of states population t ribal, the highest among the large states, 12% of scheduled castes and 45% of other back ward classes. The 61st round of National sample survey organisation of ministry of statistics and programme implementation has estimated (based on uniform recall period of 30 days), Chhattisgarh to be the 3rd most poor state in the country with 40.9% population below poverty. With regard to key health indicators; infant mortality rate and maternal mortality rate are 70 per 1000 live births and 397 per 100,000 live births respectively, much lower than the national figure of 39 per 1,000 live births and 330 per 100,000 live births (State health profile, National rural health mission). Despite winning the 4th J.R.D Tata award for population and reproductive health programmes in 2008, the state is facing challenges in multitude of health like deficiency of human resources in rural health services, malnutrition, communicable diseases like leprosy- highest prevalent in the country with prevalence of 2 .4 per 10,000 population, tuberculosis and chloroquine resistant falciparum malaria, only 18.1% institutional deliveries, only 59.3% children fully immunised and other aspects of health care delivery. Health financing in Chhattisgarh- Chhattisgarh spends 3.4 % of public expenditure as share of state expenditure which is 0.7% of public expenditure as share of Gross state domestic product. Like other states it receives grant in aid from the federal government and other financial supports for the national health programmes. Rural health infrastructure training capacity- The rural health infrastructure in the state is on the same pattern elsewhere in the country i.e. Subcentre, Primary Health Centre, Community Health Centre District Hospital. But the population coverage of all the tier of health service is poor than the country average. This can be explained better in the following table 1. 4.2 Elements of issue as a health policy political problem In this context a Congress-led political party took over the governance at the time of creation of state (in November 2000) with upcoming general state assembly (in Indian context a state senate is called as an assembly rather than parliament which is at federal level) elections in 2003. The biggest challenge the state government had faced in the health sector was the challenge of human resources in health. Table 4 explains the existing human resource at different levels at the time of state formation (2002-03) and in 2006-07. The distribution of health professionals across the regions of the country is an important determinant for physical access of health care in the community (Nigenda G., 1997; Wibulpolprasert S., 2003). Chhattisgarh being no exception and a new state experienced the deficiency of human resource in health as well as mal-distribution as most of the human resource in health remained with the parent state of Madhya Pradesh with poor infrastructure in public sect or of health specially the rural areas. It still is facing the same problem even after the 10 years of coming into existence. With regards to tackling the shortage of health professionals (doctors, nurses and midwives) the existing capacity to produce trained health professionals at the time of creation of state was very limited. This can be understood by table 5 mentioning the existing capacity to produce trained human resource in health and at the time of creation. Present Status One medical college with capacity of 100 students per year One private (for profit) college of nursing admitting 30 students per year in undergraduate nursing course 2nd medical college opened in August 2002, got recognition in 2006 with 50 intake capacity 3rd medical college opened in July 2007 with 50 intake capacity (yet to be recognised by MCI) Government college of nursing with 33 intake capacity (2005) Two nursing colleges-post graduate nursing course Ten nursing colleges-undergraduate course Four nursing colleges-diploma in nursing With the constraints of limited resources and allocation of resources, the particular interest of government was to address the challenge with respect to physicians. 4.3 Policy options within the contextual setting- Two options were mainly considered by the ruling government; open new medical colleges and scaling up of intake of existing medical college. The other option which was a brain child of Chief Minister himself, to explore the possibility of starting a new cadre course on the pattern of LMP which was practiced in states of Assam West Bengal but abolished after the recommendations of Bhore committee in 1946. The ruling congress party government considered developing a new three- year course to train medical professionals or three-year doctors as it was then popularly known to serve in rural areas with four reasons Candidates from rural areas are more likely to serve back in rural areas and thus can address the issue of physicians deficiency at rural health services; Less opportunities for them to get engaged in private practice in urban areas and thus can retain them at rural health service; This new cadre can replace the unqualified medical practitioners in informal sector; All this is possible within the three years life span of the political government 4.4 Policy development Identification of actors with regard to level of power and their position- There were many actors which affected policy process through direct and indirect influence pertaining to their powers, interests, ideologies, personal experience and skills. These actors were Politicians both at central, state and local level Bureaucrats in Ministry of Health Medical Council of India Indian Medical Association Judiciary Private sector in health Beneficiaries or service users Media Others In the formulation of the policy of starting a three-year course for medicine there were three key actors; State Government, Medical Council of India and Indian Medical Association (a professional body of doctors). In other sense these three actors represented the three different level of powers in the Gaventa cube; the Central Ministry of Health represented by the MCI as an autonomous body which gives its recommendations to the ministry of health for issuing the official notifications, the state government representing the power at state level and Indian Medical Association representing the power at district level. Stakeholder analysis with regards to their power and interests shows that state government was so powerful that it managed only few key stakeholders and engaged them in the dialogue through communication, advocacy, meetings etc. rest of the stakeholders were either informed or monitored for their opposition or protests. Except the state government all the key acto rs were in opposition for this course. Analysis of interrelationship of places, forms and level of power- Not being a coalition government, (coalition governments are quite common in Indian political scene due to lack of clear mandate) there was no barrier to take major reforms but the time period to remain in the power as a government in the state was limited to only three years to make any sort of impact in the form of visible result. 4.5 Analysis of policy process Immediately, after taking the leadership by the Congress party in November 2000, there was a formation of a three members committee constituting the professors of medical college to look into the various options to address deficiency of doctors in the state, certainly with a hidden mandate to give the option which is applicable and gives results within the span period of three years, before next political elections (interview with Dr Aadile, Director of Medical Education, MoH, Chhattisgarh). To the expectation, committee suggested the option of starting a three-year medicine course on the pattern of standard medicine course of four and half years for physicians, but reduced version of it. Government took quick decision in proposing option to Medical Council of India with-out consulting any further with different key stakeholders like professional bodies, research institutes etc or looking into the legal and ethical issues or any kind of alliance building. The power of the governmen t expressed in the visible form with out creating any space for the participation be it invited, closed or claimed at least in the matter of deciding on the formulation of new policy. The medical council of India was prompt in responding and immediately refused the proposal of the course simultaneously with another refusal of a proposal to open a medical college from a private sector in one of the districts on the ground of norms and standards not conforming to the set standards and lack of infrastructure and logistics respectively (MCI annual report 2001, 2007). Claiming and using the power of the State Government as per the Concurrent list of Constitution of India with regard to responsibilities of a State in protecting and promoting public health, and for respecting, protecting and fulfilling rights of its citizen (National human rights commission, Public health and human rights, report and recommendations 2001), Government of Chhattisgarh went ahead with the proposal of starting the new course.. After expected refusal from the MCI, the State Government was still committed to initiate the course and high level officials in the Ministry and experts were invited within the department of law, health and general administration to come to a strategy for implementation. The agreement was to create an autonomous medical board through a legislation which implements three-year course. In this case MCI would not have to approve the course. Within no time the special session of the State legislative assembly was convened and the CCM act was passed on 2nd March 2001 with the name of the course termed Diploma in modern medicine and surgery. The administrative process was hastened to officially start the CCM and proposal was sent to ministry of finance for the approval. Ministry of finance, a powerful stakeholder and in opposition by its position objected to financial liability for the government. The consensus was sought again to contract out the implementation to th e private (for-profit) sector and appointing the civil servants as the members of the CCM as an additional charge to avoid any financial commitment. The approval of ministry of finance on 29th March 2001 cleared the way for the creation and functioning of CCM. Being a hot issue and political priority in the circle of Ministry, the administrative clearance was smooth and after the approval of the cabinet meeting, the final approval by the Governor of Chhattisgarh on 16th May 2001 cleared the entire path for the implementation process. Policy implementation process Creation of CCM and its role The CCM comprised the Director of Health Services as President, the Dean of the Medical College in the State capital as Vice-President and a District Chief Medical Officer to be as Registrar. With such limited initial capital and human resources in CCM, the new body was a limited institution but authenticated with enormous powers. The powers given to this autonomous body were more than the medical council of India (MCI), another autonomous body established under the MCI act of 1956 enacted by parliament of India, which is responsible for accreditation, registration, regulation ethical conduct of different medical courses and institutions in the country (MCI act 1956). The powers given to CCM included- To initiate the process of contracting out identify the private sector for starting the new institutes for the three-year course To formalise the syllabus and initiate the admissions process To have power to change the syllabus of the course To look into financing of the course like tuition fees etc. for the three-year course To be responsible for undertaking the examinations process; and To be the registration body for graduates from the three-year course. Privatisation of medical education- There was no objection from the ministry of finance because of clear understanding about non public funded entities for three-year course. Private funded institutes with public interest were a big step which can be understood by the figure9. Standard Operating Procedure The expression of interest was floated with a condition to open the institute in rural area close to district hospital for clinical trainings. The minimal operating procedures yet to be finalised and finalisation of the last two years of course curriculum, three participants were selected out of 15 bidders to open the institutes. The members of CCM being civil servants with additional charge as member had limited experience in determining the minimum standards of infrastructure and course development. The initial mandate was to start only three institutes with intake capacity of 100 students per year for each one of them but on the contrary, another three institutes were opened in the later part of 2002 with intake capacity of 150 as against 100. The staff and infrastructure for all the three institutes seemed to be in-sufficient as understood in interviews with key stakeholders. The staffs were senior physicians in district hospitals and visiting faculties from medical college. Some of the district health officers also came for teaching with no previous experience of medical teaching. Selection criteria for the selection of students once again was influenced by the fact that it was a private funded course and the seats were distributed in three categories; i) Free merit seats- 50% (75 seats), ii) Payment merit seats- 33% (53 seats), iii) Non resident seats (NRI)- 15% (22 seats). The criteria of selection was to interview the applicants based on the cut off points of 75% in the higher secondary school leaving examination with biology one of the compulsory subjects. The first advertisement saw a good response with over 9000 applications within 20 deadline days and applicants were allotted the institute as per preference of choice and against vacant seat. For the admission of third batch even the interview did not take place and admissions were given directly in the institute. One reason was the low interest of the students due to two critical events; one was the legal issue of course name and content and second was the administrative resistance to continue with this course. Overall, 2200 students were selected in all the six institutes for three consecutive years but only 1391 completed the course as rest of the students dropped out due to uncertainty of the future of the course explained in table 5 Course fee, curriculum teaching faculty Each candidate paid USD 1,000 (INR 45,000) as a yearly course fee excluding the seats for Management NRI quota, which were sold many folds of the standard fee structure. The course curriculum was designed and approved by eminent medical experts and professors and approved by a committee but to arrange for faculty remained a problem due to un-availability, hiring remuneration issues. The teaching was arranged through experienced district hospital officers and visiting medical college faculty from State capital. Table 6 explains the curriculum of the course. Critical events and future pathway- Over the course of time three critical events changed the entire pathway for the policy of starting three-year course. These critical events are- (i) Public interest litigation (PIL) by Indian medical association in high court in May 2001 (ii) Strikes and agitation by the students in 2003, 2004 2006 (iii) A new political ruling party formed the government in November 2003. Legal issues and their influence on the course The professional body of doctors, IMA, sought judiciary support in high court objecting the name of the course, its duration and content against the standards of allopathic doctors. Government acted swiftly in anticipation of legal influence on the course and changed the name of the course to Diploma in alternative medicine to remove the two words surgery and medicine from the title of the course. Also, there was inclusion of other subjects like acupressure, magneto-therapy, physiotherapy, bio-chemic medicine etc into course content to justify for the name of alternative medicine. There were many issues which were still unresolved, which made government to act in defensive way to avoid legal barriers. These issues were- Transparency in admission process Finalisation of the course content Accreditation of graduating students by diploma or certificate Hiring of teaching faculty and their remuneration Institutional provisions related to standards Provision of stipend during internship Future carrier pathway Administrative ignorance for the course and subsequent events Despite the strong political interest and use of its powers there was still lack of alliance building within the ministry. Another important step taken by the government was to relieve the secretary health, who is an administrative head of the ministry of health, from the task of three-year course. Instead, the task was delegated to a senior professor of public health department in the medical college who was given a political post of officer on special duty (OSD). The role of the OSD was to act as a link between president of CCM and secretary health. But on the contrary OSD was asked to report directly to chief minister than to secretary health or director of health services. This arrangement was made to consider the work overload on secretary and director but negative externalities of this step less and less information sharing and more communication gap between CCM, secretary and OSD. The pending legal issue and mounting pressure from the students forced the OSD to suggest a pro posal of affiliating the institutes to universities and change the name of the course to Diploma in holistic medicine and paramedical course. The idea behind this proposal was to relieve CCM from the responsibilities of conducting examinations in the face of adverse verdict of the high court and accreditation of the course from the State Paramedical Council which will attract less resistance from paramedical bodies having less power, in the face of country wide criticism of the course in the media and elsewhere. This step proved to be wrong as the process of affiliation with universities delayed the examination of all the batches by six months to one and half year and agitation by the students against the paramedical word in the diploma, which means that this course was no longer a medical course as posed at the time of admission and advertisement. Strikes agitation by the student Lack of initial preparation into development of the course and standard operating procedures led the course on a path of confusion and uncertainty among students and their families. The change in the name of the course was enough for the students to express their dissent on future outcome of the course. There were three strikes and demonstrations by the students in January 2003, July 2004 December 2006. The first strike forced the government to drop the word paramedical and re-name the course to Diploma in modern and holistic medicine, the second strike again made the new government to change the name of the course to Practitioner in modern and holistic medicine and the third strike which was the longest and most crucial one forced the government to increase the duration of internship from six months to one year and assure the students for the government job security and recognition of the course by the state medical council. Table 7 explains the delay in course. New government formation by another political party and subsequent policies The Bhartiya Janta Party (BJP), another national political party formed new government in November 2003 after general elections in the state. Understandably the three-year course was no longer a priority. Further admissions for three-year course were stopped in after the third batch as the course had already seen a difficult future outcome with uncertainties. Government decided to have a fresh look at the course with change in leadership both at political administrative level with new health minister, secretary of health and no longer an OSD. Immediately, after taking over government faced 2 strikes by the students and finally announced officially to stop the course on 1st September 2008. However, government had still to find an answer to use this trained human resource in health. Subsequent events and final outcome Article 41 46, of part I of constitution of India, iterates the responsibilities of a state to protect right to education and promote educational rights of all classes with special emphasis on weaker sections of the community. With regards to medical education, state medical council can not contradict against the recommendations of MCI for accreditation, regulation and approval of a new course unless the course is recognised by a state medical council (MCI act 1956, Supreme court decision on civil appeal no 152, 1994). The CCM did not enjoy this status as it was neither a legal body nor registered in the state medical council. Recognition of course under paramedical council also failed due to students strikes. However, still a person can practice medicine if registered under a separate state medical register in a state medical council for a separate course (Section 15(2) b, MCI act 1956). Different options were considered, right from creating a new post (both medical and para-medi cal) to appoint them under already existing vacant para-medical positions. Some options were refused by finance ministry and some did not draw attention of graduates. Provision of a second medical officer at PHC on contractual basis under Indian Public Health Standards (IPHS) and fund availability through the NRHM saw some ray of hope. Considering the existing vacant positions of doctors in PHCs and status quo for foreseeable future, finally, it was a prudent step to post all the graduates to vacant remote PHCs under the new name of Rural medical assistants (RMA). The words medical assistant was welcomed by the graduates and they willingly accepted this arrangement. Remuneration was fixed at USD 180 (INR 8,000) as against USD 340 (INR 15,000) for medical doctors and this was never a financial burden for the state government even in the scenario of ceasing the fund from NRHM in near future, state finance budget taking up this activity. The postings started in 2008 after RMAs finished one year of internship comprising of one month posting in SHC, three months in PHC and four months each in CHC and district hospital. Table 8 explains the postings of RMAs in different districts according to the classification. The provision was made to appoint all the male RMAs to PHCs and females to CHCs considering the different aspects of security, access and other enabling conditions. Job descriptions of RMA In lieu of basic minimum package of service provision as per the national health policy 2002, all the RMAs were given responsibility to provide minimum services thereby improving the service delivery and access of the community to public health services. The important tasks allotted to them are following- Curative services for common diseases and ailments and use of essential generic drugs available at PHC CHC Preventive and promotive health services Referral of cases after primary treatment support Maternal and child health services except the caesarean section and invasive contraceptive procedures Simple surgical procedures like wound suturing and dressing, abscess drainage, applications of splints in fracture cases etc. Assist in implementation of all national state health programmes Attending regular meeting of the supportive staff Any other responsibility assigned by the medical officer in-charge of that health facility or by the state Policy influence at central level India committed to improve the health service delivery and quality health care in alignment of MDG saw new minister of health after the new government took charge in 2008. The new minister also faced the same challenge of having limited workforce in public health sector. In order to address the human resource crisis he visited some countries to have an understanding of it and in the process visited China. He was quite impressed with the arrangement China has made giving more emphasis on task shifting and training cadres in basic minimum package of services. On return minister consulted with the technical body of the ministry and in the process invited high level officials from Chhattisgarh to share the experience of RMAs policy process and implementation. On 6th February 2010 Government of India announced to launch a new course of Bachelor of Rural Medicine and Surgery (BRMS) to fill the gap of physicians in rural health services. It still needs to be passed by the Parliament of In dia, a supreme body to make it as legislation. Policy output Within this context and policy development implementation RMAs have been posted in rural remote PHCs and CHCs. They have started functioning but its still early days to comment on their performance. But, as a matter of fact that coverage of the PHCs CHCs has improved with regards to availability of a person trained in modern medicine. A recent study has been conducted by Public Health Foundation of India and its partners (2009), comparing the performance of RMA with physicians and medicine dispensing ISM practitioners and others (Rao, 2010). 5.0 Discussions- Analysis of RMA policy response by the state of Chhattisgarh has ignited the longstanding issue of idealism of ethical medical practice in rural areas and the reality of absence of physicians in rural areas of India. Reasons for shortage of physicians in rural areas and need for policy options In reply to a question in the Upper House of the parliament, Government of India notified that there is no shortage of physicians in the country with regard to aggregate numbers, estimated to be 683,682 i.e. 6 per 10,000 population, in 2007. Still, only one in 10 physicians works in rural area (Press Information Bureau of India, 2007). Multi-factorial reasons for the rural-urban mal-distribution are related with social determinants, working and living conditions, better income opportunities, higher work satisfaction and lack of continuing medical education in villages (Kalantri S., 2007). Also, every year 40% of medical graduates go for specialisation after which no body opts to serve in rural areas. This may further worsen if trend continues like in Egypt where 62% of physicians are specialists (G. Gaumer, 1999) As per the document of Government of India for its National Health Policy 2002, most of the ISM trained professionals are practising westernized medicine due to poor re gulations and regional bias. Although, this kind of practice is violating the Supreme Courts ruling of 1996 and 1998, prohibiting ISM practitioners from practicing modern medicine but this has been facilitated by the absence of physicians in rural and economically backward areas of the country and also with the training of traditional healers in modern medicine in their teaching institutes (Burman P., 1998; R. Bilimagga, 2002). This kind of access to modern medicine and mushrooming of private pharmacies in India has somehow responded to the demands of the community and hence it has remained a top-down policy approach by the governments and bureaucrats and not bottom-up approach where community gets involved in policy process. Ethical Issues on practice The medical education in India in public sector is highly subsidized against the privately funded institutes where the students have to personally finance their expensive studies. This can be considered an investment which will pay dividend after the completion of studies. With 50% of medical graduates out of total 30,000 yearly passed outs, coming from private medical institutes, its useless to expect them to serve in rural areas with no incentive of any kind (MCI, 2007). The mechanisms are lacking to orient medical graduates to repay their subsidized education as an ethical and moral obligation in the form of ensuring equity and equality of health care services to the society. Lack of family medicine in medical curriculum and less than 3% of seats for Community Medicine as a post graduate degree in the medical institutes are also one of the reasons apart from societal pressure for the medical graduates to go for specialisation. The issue of ethical obligation becomes furthe r complex when there are precedents that more than 56% of medical graduates migrated internationally form one of the premier medical institutes of the country between 1956 and 1980 (Khadria B., 1999; Kaushik M., 2006) Privatisation of Medical education and its effect on the rural health services Chhattisgarh government decided to privatise the RMA course in alignment with the policy trends of federal government. India adopted structural change (as advocated by World Bank) in its policy of medical education thus opening it to private for-profit sector in health with a public health goal of providing trained human resource of physicians to bridge the gap among what is required, what is produced and what is available to serve in the rural areas where more than 60% population of India live. As per 2007 figures of MCI, the number of privately funded and managed medical institutes are 49.8% (134 out of 269) of the total medical institutes in India and still growing at an enormous pace which is almost an increase of 900 percent since 1950 till 2004 (Mahal A 2007). At current rate more than 30,000 physicians are produced every year which is 4.5% of total number of physicians in India, estimated to be 683,682 in 2007 (Press Information Bureau, Government of India 2007). This has al though led to improvement in aggregate numbers of physicians but simultaneously has increased regional inequities and mal-distribution of physicians in rural and urban areas (Mahal A. 2007). Quality of medical education in privately funded institutions Rapid growth of private medical institutions has shown its effect on the quality of education as understood also with the RMA course with in-sufficient staff and infrastructure. Despite laws for infrastructure and quality standards set by MCI, poor implementation of it has led to decline in quality of medical education (MCI regulations act 1999, Government of Andhra Pradesh Medical rules 2004). There are evidences for poor staff infrastructure (including hospital beds) in private medical institutes as well as corruption in the admission process and high fees in different quota seats and in MCI, affecting the quality of medical education (Dutta R.,2002; Deccan Herald News, 2004; Tilak J., 2002; Kumar S., 2004). Understandably, with two fold increase in production of physicians from 12,000 to 24,000 from 1980 to 2004, the un-availability of faculty in medical institutes can be imagined (Mahal A., 2007). Policy options to address the physician deficiency in rural areas To address the problem of availability of physicians at rural public health services, there have been many strategies practiced in the past in India. Each option is having its strengths, weaknesses, opportunities and threats as well as positive and negative externalities. These options are Positive discrimination for rural area candidates in medical education; Subsidized medical education for rural candidates; Compulsory rural services after medical graduation; Open new medical colleges in rural areas; Scale up of intake capacity of existing medical colleges; Contracting-out and Contracting-in; Workforce management; Incentives (financial and non-financial); Non-physician medical practitioners. In the past many approaches like preferences to rural candidates for medical education, compulsory rural practice, opening up of medical colleges in rural areas, penalising physicians for not following the rural service bond etc. have been practiced in India to attract young doctors to the rural health services but many of them could not succeed to attain the desired results (Kalantri S 2007). The Government of India, in 2007, tried to impose mandatory one year rural internship before awarding the medical graduation degree to the students after their course as is practiced in other countries like Singapore and Malaysia where mandatory National Health Service is for three years (K. Ramdoss 2007; Press Information Bureau, Government of India 2007). Incentive approach both financial and non-financial is one of the important strategies tried in many states of India like positive discrimination for specialization for in-service physicians, practiced in Haryana state and higher salary st ructure for physicians to serve in remote rural areas practiced, in the state of Himanchal Pradesh, Uttarakhand and Chhattisgarh (Rao et al 2010). But it involves a human resource in health (HRH) policy and plan at national and sub-national level as also advocated in the WHO guidelines for policies and plans for human resources for health in WHO African region. Compulsory rural services is already in practice elsewhere in the state of Tamilnadu (after medical graduation) and in Maharashtra as a pre-requisite for specialisation after medical graduation. Opening up of medical colleges in rural areas (as in the state of Gujarat) and scaling up of intake of existing medical colleges have also not succeeded to attract physicians to work in rural areas although, MCI announced to open 100 more medical institutes in rural areas in coming years (DNA news, 2009). Public-private partnerships in the form of contracting-out the primary health care to NGOs like in the state of Karnataka (Pr ashant N. S., 2008) or contracting-in doctors from other states has also not worked out due to issues of accountability, co-ordination and regulation. Even direct recruitment of physicians from the technical directorate as happened in the state of Haryana or taking decisions on posting of physicians to remote rural areas centrally like in the state of Uttrakhand has also failed due to nepotism, regulations and control. Failure of all the policy responses is due to inability to consider context, cultural belief and practices and lack of a human resource policy plan at national and state level. Need for non-physician clinicians and evidences elsewhere Each country has developed its own way to address the deficiency of physicians at first line health services. Trained non-physician clinicians have provided curative, preventive and promotive services as a minimum package of activities where there is shortage of physicians. This coping mechanism is seen both in developed and developing countries. This cadre is known by many names like clinical officers, health assistants, nurse practitioners or health post aides (Tamas Fulop MIR, 1987; Mullan F., 2007; Huicho L., 2008). As per the study of Mullan F (2007), non-physician clinicians are present in 25 out of 47 sub-Saharan African countries. In some African countries they are the mainstay of the health care delivery system in absence of physicians and provide curative as well as some surgical services also (Mc Cord C., 2009). Even in Asia, the strategy of bare foot doctors in late 1970s was in practice which was a similar kind of attempt to address the scarcity of physicians. In In dia also similar practice was in vogue in the form of Community Health Workers in 1970s (Haines A., 2007). In India, there is a strong debate on the exclusive cadre for rural health services and many key stakeholders have expressed their views against it (IMA Kerala, 2010; Mudur G., 2010; Ramdas A., 2010) Conclusion Reference Berman, P. 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