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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(1999) Health workforce rationalization workplan for Egypt. Technical Report No. 48. Bethesda, MD: Abt Associates. Gaventa, J. (2006) Finding the Spaces for Change: A Power Analysis, IDS Bulletin, volume 37, Number 6 Giusti, D., Criel, B., De Bethune, X. (1997) Viewpoint: public versus private health care delivery: beyond the slogans, Health Policy Planning, 12(3), pp. 192-198 Government of Andhra Pradesh (2004). The Andhra Pradesh Un-aided Non-Minority Professional Institutions (Regulations of Admissions into Under Graduate Medical and Dental Professional Courses) Rules, Hyderabad, India: Health, Medical and Family Welfare Department Government of India (2002). National Health Policy [Available online at: https://unpan1.un.org/intradoc/groups/public/documents/APCITY/UNPAN009630.pdf], [Accessed on 25th May 2010] Government of India (2005). Taskforce on medical education for National Rural Health Mission [Internet]. New Delhi: Ministry of Health and Family Welfare; 107p. 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An observational multicountry study. Lancet (372):910-16 Kalantri S. (2007) Indian Journal of Medical Ethics, Vol IV No 4 October-December Kaushik M, Mahal A, Jaiswal A. (2006) Quality of physicians and immigration from India a retrospective cohort study. Unpublished. Boston, USA: Harvard School of Public Health. Khadria B. (1999) Migration of knowledge workers: Second generation effects of Indias brain drain. New Delhi: Sage Publications Kingdon, John. (2001) A model of agenda setting with applications, Law Review 331-337. https://www.law.msu.edu/lawrev/2001-2/Panel_4_Kingdon.pdf Kumar S. (2004) Report highlights shortcomings in private medical schools in Delhi. BMJ; 328(7431): 70 IMA Kerala Branch (2010) Stop BRMS for quality medical education. About the BRMS issue Internet]. Kerala (India): Indian Medical Association Kerala State branch; Available from: https://www.stopbrms.com/index.php Mahal A, Mohanan M. (2007) Growth of private medical educa tion in India, Medical Education, forthcoming Mahal A, Mohanan M. (2006) Medical education in India and its implications for access to care and quality. Available from the internet site https://www.egworkshop2007.net/session%20files/Thursday/Background%20Materials/No.%2042%20-%20Mahal%20-%20Medical%20Education%20in%20India.pdf; [Accessed on 24th May 2010] McCord C (2009) The Quality of Emergency Obstetrical Surgery by Assisstant Medical Officers in Tanzanian District Hospitals. African Workforce. Medical Council of India (MCI) (1999). Establishment of Medical College Regulations. Gazette of India; III (4). Medical Council of India (2007) Medical Colleges and hospitals. Colleges teaching MBBS. Medical Council of India, New Delhi [database on the internet] [updated 2007 Sep 11]. Available from: https://www.mciindia.org/apps/search/viewMBBS.asp; [Accessed on 24th May 2010] Mudur G. (2010) India decides to train non-medical rural healthcare providers. BMJ [Internet]. 2010 Feb 9; 340:c817. Available from: https://www.bmj.com/cgi/content/full/340/feb09_3/c817. [Accessed on 25th May 2010] Mullan F. (2007) Non physician clinicains in 47 sub-African countries. Lancet (370):2158-63. National Knowledge Commission (2007). Report of the working group on medical education [Internet]. New Delhi: Government of India;. 69p. Available from: www.knowledgecommission.gov.in/downloads/documents/wg_med.pdf; [Accessed on 25th May 2010] National Sample Survey Organisation (2006). Morbidity, health care and the condition of the aged, NSS 60th round [Internet]. Ministry of Statistics and Programme Implementation, Government of India; 55p. Available from: https://mospi.gov.in/national_data_bank/pdf/NSS%2060th%20Round-507.pdf; [Accessed on 25th May 2010] Nigenda G. (1997) The regional distribution of doctors in Mexico, 1930-1990: a policy assessment. Health Policy; 39: 107-22. Prashant N.S., (2008), Contracting as if public goals matter: An analysis of Public -private Partnership in primary health care in Karnataka, India, Masters Thesis, MPH- HSMP, Institute of Tropical Medicine, Antwerp Press information bureau. Government of India (2007). Press release. Ministry of Health and Family Welfare. Shortage of doctors and nurses. Available from: https://pib.nic.in/release/release.asp?relid=30771; [Accessed on 24th May 2010] R. Bilimagga, P. Rao. (2002) Medicine, Quackery and the Law. Bangalore: Indian Medical Association Ramdas A. (2010) The wrong way for rural doctors. The Hindu [Internet]; Opinion:[about 4 screens]. Available from: https://www.hindu.com/2010/02/27/stories/2010022762151400.htm Rao, Krishna D. et al. (2010) Which Doctor for Rural India? An Assessment of Task Shifting In Primary Health Care. Oral presentation in International Conference on Health Systems Strengthening May 7-10 2010, Chennai, India Stark R, Nair NVK, Omi S. 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Essay The Day I Found Joy - 917 Words

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Importance Of The Common Good Is A Perfect Compass For...

Eben Lowy Dr. Robin Datta Introduction to Political Science March 16th 2015 In a most-just society, equality is the best way to set our course. Although tradition and freedom are both laudable goals, equality allows us to do the most good for the most people. The idea of the Common Good is a perfect compass for equality. That being said, when navigating by ideal, we must first focus on the reality that we strive for. Or, as Minogue puts it, â€Å"Ideals are important in politics, but in the end realities must determine where we go, and how fast we travel† (74). Equality is the search for a balance between all citizens. Even since the Greeks, freedom has been contrasted and defined by equality. Minogue says of the Greek system of freedoms, â€Å"a life lived among equals, subject only to law, and ruling and being ruled in turn.† (17) This idea, that by making all men equal allows greater freedoms to evolve, is central to the idea of our most-just society. Our goal of equality is simple: to make each citizen equal to one another in respect to their rights and responsibilities. We seek to make true the promise of the Declaration of Independence, which said â€Å"We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness† (US 1776). The surety of these rights is our central goal and the driving force between our push for equality. TheShow MoreRelatedSimilarities Between Communism And Communism1266 Words   |  6 Pagesgovernments vary in their placement on the political spectrum. Two of these political theories which hail from the opposite reaches of the political compass are communism and fascism. Throughout history governments implementing these political theories have clashed and considered each other enemies. 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Grinding Machines free essay sample

GRINDING MACHINES Grinding is the process of removing metal by the application of abrasives which are bonded to form a rotating wheel. When the moving abrasive particles contact the workpiece, they act as tiny cutting tools, each particle cutting a tiny chip from the workpiece. It is a common error to believe that grinding abrasive wheels remove material by a rubbing action; actually, the process is as much a cutting action as drilling, milling, and lathe turning. The grinding machine supports and rotates the grinding abrasive wheel and often supports and positions the workpiece in proper relation to the wheel. The grinding machine is used for roughing and finishing flat, cylindrical, and conical surfaces; finishing internal cylinders or bores; forming and sharpening cutting tools; snagging or removing rough projections from castings and stampings; and cleaning, polishing, and buffing surfaces. Once strictly a finishing machine, modem production grinding machines are used for complete roughing and finishing of certain classes of work. SAFETY PRECAUTION GRINDING MACHINE SAFETY Grinding machines are used daily in a machine shop. To avoid injuries follow the safety precautions listed below. Wear goggles for all grinding machine operations. Check grinding wheels for cracks (Ring Test Figure 5-11) before mounting. Never operate grinding wheels at speeds in excess of the recommended speed. Never adjust the workpiece or work mounting devices when the machine is operating Do not exceed recommended depth of cut for the grinding wheel or machine. Remove workpiece from grinding wheel before turning machine off. Use proper wheel guards on all grinding machines. On bench grinders, adjust tool rest 1/16 to 1/8 inch from the wheel. TYPES OF GRINDING MACHINE From the simplest grinding machine to the most complex, rinding machines can be classified as utility grinding machines, cylindrical grinding machines. and surface grinding machines. The average machinist will be concerned mostly with floor-mounted and bench-mounted utility grinding machines, bufting machines. and reciprocating surface grinding machines. UTILITY GRINDING MACHINES The utility grinding machine is intended for offh and grinding where the workpiece is supported in the hand and brought to bear against the rotating grinding abrasive wheel. The accuracy of this type of grinding machine depends on the operator’s dexterity. kill, and knowledge of the machine’s capabilities and the nature of the work. The utility grinding machine consists of a horizontally mounted motor with a grinding abrasive wheel attached to each end of the motor shaft. The electric-motor-driven machine is simple and common. It may be bench-mounted or floor-mounted. Generally, the condition and design of the shaft bearings as well as the motor rating determine the wheel size capacity of the machine. Suitable wheel guards and tool rests are provided for safety and ease of operation. Grinding machines come in various sizes and shapes as listed below. Floor Mounted Utility Grinding Machine The typical floor-mounted utility grinding machine stands waist-high and is secured to the floor by bolts. The floormounted utility grinding machine shown in Figure 5-1 mounts two 12-inch-diameter by 2-inch-wide grinding abrasive wheels. The two wheel arrangement permits installing a coarse grain wheel for roughing purposes on one end of the shaft and a fine grain wheel for finishing purposes on the other end this saves the time that would be otherwise consumed in changing wheels. Each grinding abrasive wheel is covered by a wheel guard to increase the safety of the machine. Transparent eyeshields. spark arresters. and adjustable tool rests are provided for each grinding wheel. A tool tray and a water pan are mounted on the side of the base or pedestal. The water pan is used for quenching carbon steel cutting took as they are being ground. Using the 12-inch wheel, the machine provides a maximum cutting speed of approximately 5. 500 SFPM. The 2-HP electric motor driving this machine has a maximum speed of 1. 750 RPM. Bench Type Utility Grinding Machine Like the floor mounted utility grinding machine, one coarse grinding wheel and one fine grinding wheel are usually ounted on the machine for convenience of operation. Each wheel is provided with an adjustable table tool rest and an eye shield for protection. On this machine, the motor is equipped with a thermal over-load switch to stop the motor if excessive wheel pressure is applied thus preventing the burning out of the motor. The motor revolve at 3. 450 RPM maximum to provide a maximum cutting speed for the 7 inch grinding wheels of about 6,300 surface feet per minute (SFPM). SURFACE GRINDING MACHINE The surface grinding machine is used for grinding flat surfaces. The workpiece is supported on a rectangular table hich moves back and forth and reciprocates beneath the grinding wheel. Reciprocating surface grinding machines generally have horizontal wheel spindles and mount straight or cylinder-type grinding abrasive wheels. GRINDING WHEEL STANDARD TYPES OF GRINDING WHEELS Grinding wheels come in many different sizes, shapes, and abrasives (Figure 5-7). Some of the various types are listed below. Straight Straight wheels, numbers 1, 5, and 7, are commonly applied to internal, cylindrical, horizontal spindle, surface, tool, and offhand grinding and snagging. The recesses in type numbers. 5 and 7 accommodate mounting flanges. Type number 1 wheels from 0. 006-inch to l/8-inch thick are used for cutting off stock and slotting. Cylinder Cylinder wheels, type number 2, may be arranged for grinding on either the periphery or side of the wheel. Tapered Tapered wheels, type number 4, take tapered safety flanges to keep pieces from flying if the wheel is broken while snagging. Straight Cup The straight cup wheel, type number 6, is used primarily for surface grinding, but can also be used for offhand grinding of flat surfaces. Plain or beveled faces are available. Flaring Cup The flaring cup wheel, type number 11, is commonly used or tool grinding. With a resinoid bond, it is useful for snagging. Its face may be plain or beveled. Dish The chief use of the dish wheel, type number 12, is in tool work. Its thin edge can be inserted into narrow places, and it is convenient for grinding the faces of form-relieved milling cutters and broaches. Saucer The saucer wheel, type number 13, is also known as a saw gummer becaus e it is used for sharpening saws. ABRASIVES Most grinding wheels are made of silicon carbide or aluminum oxide, both of which are artificial (manufactured) abrasives. Silicon carbide is extremely hard but brittle. Aluminum oxide is slightly softer but is tougher than silicon carbide. It dulls more quickly, but it does not fracture easily therefore it is better suited for grinding materials of relatively high tensile strength. ABRASIVE GRAIN SIZE Abrasive grains are selected according to the mesh of a sieve through which they are sorted. For example, grain number 40 indicates that the abrasive grain passes through a sieve having approximately 40 meshes to the linear inch. A grinding wheel is designated coarse, medium, or fine according to the size of the individual abrasive grains making up the wheel. BONDING MATERIAL Bond The abrasive particles in a grinding wheel are held in place by the bonding agent. The percentage of bond in the wheel determines, to a great extent, the â€Å"hardness† or â€Å"grade† of the wheel. The greater the percentage and strength of the bond, the harder the grinding wheel will be. â€Å"Hard† wheels retain the cutting grains longer, while â€Å"soft† wheels release the grains quickly. If a grinding wheel is â€Å"too hard† for the job, it will glaze because the bond prevents dulled abrasive particles from being released so new grains can be exposed for cutting. Besides controlling hardness and holding the abrasive, the bond also provides the proper safety factor at running speed. It holds the wheel together while centrifugal force is trying to tear it apart. The most common bonds used in grinding wheels are vitrified, silicate, shellac, resinoid, and rubber. Vitrified A vast majority of grinding wheels have a vitrified bond. Vitrified bonded wheels are unaffected by heat or cold and are made in a greater range of hardness than any other bond. They adapt to practically all types of grinding with one notable exception: if the wheel is not thick enough, it does not ithstand side pressure as in the case of thin cutoff wheels. Silicate Silicate bond releases the abrasive grains more readily than vitrified bond. Silicate bonded wheels are well suited for grinding where heat must be kept to a minimum, such as grinding edged cutting tools. It is not suited for heavy-duty grinding. Thin cutoff wheels are sometimes made with a shellac bond because it provides fast cool cutting. Resinoid Resinoid bond is strong and flexible. It is widely used in snagging wheels (for grinding irregularities from rough castings), which operate at 9,500 SFPM. It is also used in utoff wheels. Rubber In rubber-bonded wheels, pure rubber is mixed with sulfur. It is extremely flexible at operating speeds and permits the manufacture of grinding wheels as thin as 0. 006 inch for slitting nibs. Most abrasive cutoff machine wheels have a rubber bond. GRADES OF HARDNESS The grade of a grinding wheel designates the hardness of the bonded material. Listed below are examples of those grades: A soft wheel is one on which the cutting particles break away rapidly while a hard wheel is one on which the bond successfully opposes this breaking away of the abrasive. grain. Most wheels are graded according to hardness by a letter system. Most manufacturers of grinding abrasive wheels use a letter code ranging from A (very soft) to Z (very hard). Vitrified and silicate bonds usually range from very soft to very hard, shellac and resinoid bonds usually range from very soft to hard, and rubber bonds are limited to the medium to hard range. The grade of hardness should be selected as carefully as Figure 5-8 illustrates sections of three grinding abrasive the grain size. A grinding abrasive wheel that is too soft wheels with different spacing of grains. If the grain and bond will wear away too rapidly, the abrasive grain will be materials in each of these are alike in size and hardness, the discarded from the wheel before its useful life is wheel with the wider spacing will be softer than the wheel realized. On the other hand, if the wheel is too hard for with the closer grain spacing. Thus, the actual hardness of the job, the abrasive particles will become dull because the grinding wheel is equally dependent on grade of hardness the bond will not release the abrasive grain, and the and spacing of the grains or structure. wheel’s efficiency will be impaired. STANDARD SHAPES OF GRINDING WHEEL FACES Figure 5-10 illustrates standard shapes of grinding wheel faces. The nature of the work dictates the shape of the face to be used. For instance, shape A is commonly used for straight cylindrical grinding and shape E for grinding threads. SELECTION OF GRINDING WHEELS Conditions under which grinding wheels are used vary considerably, and a wheel that is satisfactory on one machine may be too hard or soft for the same operation on another machine. The following basic factors are considered when selecting grinding wheels, though it should be understood that the rules and conditions listed are flexible and subject to ccasional exceptions. GENERAL GRINDING OPERATIONS GENERAL Efficient grinding depends primarily upon the proper setup of the machine being used. If the machine is not securely mounted, vibration will result, causing the grinder to produce an irregular surface. Improper alignment affects grinding accuracy, and it is good practice to check the security and plumb of t he machine every few months. It is advisable to place a strip of cushioning material under the mounting flanges, along with any necessary aligning shims, to help absorb vibration. When a grinding wheel is functioning properly, the abrasive rains cut very small chips from the workpiece and at the same time a portion of the bond of the wheel is worn away. As long as the bond is being worn away as fast as the abrasive grains of the wheel become dull, the wheel will continue to work well. If the bond is worn away too rapidly, the wheel is too soft and will not last as long as it should. If the cutting grains wear down faster than the bond, the face of the wheel becomes glazed and the wheel will not cut freely. CLASSES OF GRINDING Precision and semiprecision grinding may the following classes: Cylindrical Grinding be divided into Cylindrical grinding denotes the grinding of a cylindrical surface. Usually, â€Å"Cylindrical grinding† refers to external cylindrical grinding and the term â€Å"internal grinding† is used for internal cylindrical grinding. Another form of cylindrical grinding is conical grinding or grinding tapered workpieces. Surface Grinding Surface grinding is the grinding of simple plain surfaces. Tool and Cutter Grinding Tool and cutter grinding is the generally complex operation of forming and resharpening the cutting edges of tool and cutter bits, gages, milling cutters, reamers, and so forth.

The Great Salt March Essays - Gandhism, Tax Resistance, India

The Great Salt March After proclaiming the Declaration of Independence of India on January 26, 1930, Mahatma Gandhi came to an impasse in his political career focused on freeing India from British rule. A new anti-government campaign was imperative for achieving the secularization of India for its people; it remained unclear, however, to Gandhi what form was most appropriate for this campaign to take (Sheean 152; 156-7). During the period that followed in which he could find no light at the end of the tunnel,; it became apparent to Gandhi that non-violent civil disobedience would form the basis for any ensuing protest (Sheean 152; 156-7). Beginning in February 1930, Gandhi's thoughts swayed towards the British salt tax, one of many economic improprieties used to generate revenue to support British rule, as the focal point of non-violent political protest (Ashe 301). The British monopoly on the salt tax in India dictated that the sale or production of salt by anyone but the British government was a criminal offense punishable by law (Ashe 301). Moreso than in more temperate climates, salt was invaluable to the people of India, many of whom were agricultural laborers and required the mineral for metabolism in an environment of immense heat and humidity where sweating was profuse. Occurring throughout low-lying coastal zones of India, salt was readily accessible to laborers who were instead forced to pay money for a mineral which they could easily collect themselves for free (Jack 235). Moreover, Ghandi's choice met the important criterion of appealing across regional, class, and ethnic boundaries. Everyone needed salt, and the British taxes on it had an impact on all of India. Led by an inner voice during this period of strategical uncertainty, Gandhi used the British Government's monopoly of the salt tax as a catalyst for a major Satyagraha campaign (Copley 46-8). One of Gandhi's principal concepts, satyagraha goes beyond mere passive resistance; by adding the Sanskrit word Agraha (resolution) to Satya (Truth). For him, it was crucial that Satyagrahis found strength in their non-violent methods: Truth (Satya) implies Love, and Firmness (Agraha) engenders and therefore serves as a synonym for force ... that is to say, the Force which is born of Truth and Love or Non-violence.... [If] we are Satyagrahis and offer Satyagraha, beleveing ourselves to be strong ... we grow stronger and stronger everyday. With our increase in strngth, our Stayagraha too becomes more effective, and we would never be casting about for an opportunity to give it up. (Gandhi 87) Choosing the salt tax as an injustice to the people of India was considered an ingenious choice by critic Judith Brown (1977) because every peasant and every aristocrat understood the necessity of salt in everyday life (Copley 46-8). It was also a good choice because it did not alienate Congress moderates while simultaneously being an issue of enough importance to mobilize a mass following (Copley 46-8). In an effort to amend the salt tax without breaking the law, on March 2, 1930 Ghandi wrote to the Viceroy, Lord Irwin: If my letter makes no appeal to your heart, on the eleventh day of this month I shall proceed with such co-workers of the Ashram as I can take, to disregard the provisions of the Salt Laws. I regard this tax to be the most iniquitous of all from the poor man's standpoint. As the Independence movement is essentially for the poorest in the land, the beginning will be made with this evil. On March 12, 1930, Gandhi and approximately 78 male satyagrahis set out, on foot, for the coastal village of Dandi some 240 miles from their starting point in Sabarmati, a journey which was to last 23 days (Jack 237). Virtually every resident of each city along this journey watched the great procession, which was at least two miles in length (Jack 237). On April 6th he picked up a lump of mud and salt (some say just a pinch, some say just a grain) and boiled it in seawater to make the commodity which no Indian could legally produce--salt (Jack 240). Upon arriving at the seashore he spoke to a reporter: God be thanked for what may be termed the happy ending of the first