Health Financing in India

Institute for Financial Management and Research Centre for Insurance and Risk Management Delivering Micro Health Insurance Through the National Rural Health Mission A Strategy Paper Rupalee Ruchismita, Imtiaz Ahmed and Suyash Rai August 2007 Rupalee Ruchismita (rupalee. [email  protected] ac. in) and Imtiaz Ahmed ([email  protected] ac. in) are with the Centre for Insurance and Risk Management at IFMR, Chennai (http://ifmr. ac. in/cirm). Suyash Rai is with the ICICI Centre for Child Health and Nutrition, Pune. The views expressed in this note are entirely those of the authors and do not in any way re? ct the views of the Institutions with which they are associated. . Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission Contents 1 Introduction 2 Health Financing in India 3 Key issues in Health Financing 4 Exploring Risk Transfer and Pooling Strategies 5 Proposal for a National Apex Body 6 Conclusion 7 Annexures 7. 1 ANNEXURE I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. 2 ANNEXURE II . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7. 3 Objectives, Activities, and Services . . . . . . . . . . . . . . . . . . . . . . . 1 1 3 4 8 13 14 14 19 22 0 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission 1 Introduction The Indian health scenario is fairly complex and challenging with successful reductions in fertility and mortality offset by a signi? cant and growing communicable as well noncommunicable disease burden1 , persistently high levels of child undernutrition2 , increasing polarisation in the health status of the rich and the poor3 and inadequate primary health care coexisting with burgeoning medical tourism! This situation is further complicated by the presence and practice of multiple systems of medicine and medical practitioners (several of whom are not formally certi? ed and recognised) and very limited regulation. In such a context, this paper highlights the challenges in ? nancing health in India and examines the role of health insurance in addressing these. It proposes an operational framework for developing sustainable health insurance models under the National Rural Health Mission, responding to the contextual needs of different states. 2 Health Financing in India The total spending on the health sector in India is not low. According to the National Health Accounts 2001-02, the total health expenditure in India for the year was Rs. 1,057,341 million, which accounted for 4. 6 percent of the Gross Domestic Product (GDP). The concern lies in the fact that households are the major ? nancing sources, accounting for 72 percent of the total health expenditure incurred in India. State Governments contribute 12. 6 percent of the total health expenditure, Central Government 6. 4 percent and the public and private ? rms 5. 3 percent. External support from bilateral and multilateral agencies accounts for 2. percent of health expenditure in India, a majority coming in as grant to the Central Government. So, only about 20% of the overall funding comes from India accounts for only 16. 5% of the global population, it contributes to approximately a ? fth of the world’s share of diseases: a third of the diarrheal diseases, tuberculosis, respiratory and other infections, parasitic infestations and perinatal conditi ons; a quarter of maternal conditions; a ? fth of nutritional de? ciencies, diabetes, cardiovascular diseases, and the second largest number of HIV/AIDS cases in the world. Report of the National Commission on Macreconomics and Health. 2005. New Delhi: Ministry of Health and family Welfare. ) 2 National Family Health Survey III, 2005-06. Mumbai: International Institute of Population Sciences. 3 The poorest 20 percent of Indians have more than twice the rates of mortality, malnutrition, and fertility of the richest 20 percent. (Peters DH et al. Better Health Systems for India’s Poor. 2002. New Delhi: World Bank. 1 Although 1 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission he government, which is one of the lowest in the world. This is a signi? cant problem in a country where the government has mandated itself to provide comprehensive quality health care to all. The problem of household expenditure for health care is compounde d by the fact that 98 percent of this is â€Å"out-of-pocket†, which is fundamentally regressive and burdens the poor more. Also, the absence of proper pooling and collective purchasing mechanisms for the households’ money further worsens the situation because of the resulting inef? ciencies. Most of the household expenditure on health goes to the fee-levying and largely unregulated private providers. The share of household consumption expenditure devoted to health care has also been increasing over time, especially in rural areas where it now accounts for nearly 7 per cent of the household budget4 . This situation is not surprising since public and private expenditure on health are closely linked. Given that government spending on health stands at less than 1 per cent of the GDP, which is very low by international standards, the need for private out-ofpocket expenditure increases. Seventy percent of the total ? nancial resources ? ow to health care providers in the for pro? t private sector. Only 23 percent are spent on public providers. In an environment of minimal regulation, this provides signi? cant opportunity for the exploitation of health care seekers. In addition, there are signi? cant inter-state differences in health ? nancing. Among the major states, Himachal Pradesh ranks highest in terms of per capita public spending on health (Rs. 493 per year) and also has the highest public expenditure as percentage of total expenditure (37. 8%). On both these parameters, Uttar Pradesh is the lowest ranking state, with a per capita public spending on health of Rs. 84 per year, and only 7. 5% of the total health expenditure is public expenditure. All India per capita expenditure on health is Rs. 997 (207 from public and 790 from private)5 . There are also indications of declining state government spending in crucial areas. Overall health spending declined over the decade 1993-94 to 2002-03 in 3 states, and declined between 1998-99 and 2002-03 in 6 4 Government Health Expenditure in India: A Benchmark Study. 2006. New Delhi: Economic Research Foundation. All India public expenditure including expenditure by the Ministry of Health and Family Welfare, Central Ministries and local bodies, while private expenditure includes health expenditure by NGOs, ? rms and households. 2 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission states6 . There are also sharp and generally growing rural- urban disparities in spending in most states. 3 Key issues in Health Financing Drawing from the above analysis and other related literature, the following emerge as the key issues in reforming health ? ancing in India. Increasing government spending on public and more speci? cally, primary health care As discussed earlier, the government spending on public health in India, constituting about 4% of its total expenditure and less than 1% of the GDP, is very low. In per capita terms, the government spends only USD 4 annually on public health. According to the World Health Report (2000), only twelve other countries spend less than India on public health, most of them in Africa. For most other nations, government spending on health is more than 10 percent of the total government expenditure. The Commission on Macroeconomics and Health has estimated that public spending in low income countries should be within the range of $30-$45 per capita to ensure achievement of public health goals. In India, most of the government spending is on medical colleges, into tertiary centres, and very little trickles down to the primary and secondary levels. There is therefore a strong case for increasing government spending across the board, with a much higher focus on primary care services. This will reduce the need for spending by the poor and also improve the overall health status. The options for increasing public ? ancing of health include reallocation of the government budget (possibly by re-routing other direct and indirect subsidies) and earmarked taxes (such as the taxes levied for ? nancing the Sarva Shiksha Abhiyan). Addressing the supply and demand-side factors that prevent the poor from bene? ting from the health sector In general the poor bene? t much less from the health sec tor than the rich do largely because of their inability to seek timely and adequate health care. The poorest quintile of Indians are 2. 6 times more likely than the richest to forgo medical treatment when ill7 . Government Health Expenditure in India: A Benchmark Study. 2006. New Delhi: Economic Research Foundation. 7 Peters, D. et al. Better Health Systems for IndiaSs Poor: Findings, Analysis, and Options. 2002. Washington 3 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission However, whatever care they do access, the poor are found to rely signi? cantly on the public system for preventive and inpatient care including 93 percent of immunizations, 74 percent of antenatal care, 66 percent of inpatient bed days, and 63 percent of delivery related inpatient bed days. Improvements in the public system through increased and more effective spending would therefore bene? t the poor signi? cantly. Increasing the effectiveness of public health spending would require attention to supply side factors such as facility location, availability of staff, medicines, equipment and quality of care as well as demand-side factors such as indirect costs (travel, wage loss), non formal charges, awareness levels, perception of quality and uncertainty about payment. Mitigating risks due to out-of-pocket expenditure, particularly catastrophic expenditure for the oor At least 24 per cent of all Indians fall below the poverty line because they are hospitalised8 . It is estimated that out-of-pocket spending on hospital care might have raised the proportion of the population in poverty by 2 per cent. Risk-pooling and collective purchasing mechanisms could increase the ef? ciency and equity with which the households’ money is collected, managed and used, so that the households’ burden is reduced. 4 Exploring Risk Transfer and Pooling Strategies Exploring Risk Transfer and Pooling Strategies in the context of the NRHM In attempting to understand the potential of risk pooling or risk transfer mechanisms such as insurance (which immediately addresses the cost which a household spends on hospitalization) in achieving public health goals within the overall NRHM mandate, the following issues become relevant: 1. The potential value addition that insurance could provide 2. The various models of health insurance for the poor 3. Implementation of the insurance programme in the context of the NRHM D. C. : The World Bank. 8 Ibid 4 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission 1. Health Insurance leads to: †¢ Risk pooling for in patient care (hospitalization): As discussed, one of the major causes of poor households slipping into the poverty cycle is out of pocket expenditure incurred for hospitalization. In such a scenario, insurance, which allows for risk pooling, helps in making available additional source of ? nancing for the household thereby reducing overall vulnerability and smoothening expenditure shocks for larger unpredictable catastrophic health events. Increased utilisation of health services: It is expected that the introduction of health insurance will lead to greater utilisation of health care services. Across the world it has been found that the overall use of curative services for adults and children was up to ? ve times higher for members of health insurance programmes than non-members9,10 . †¢ Standardization and cost effective q uality health care: Insurance as a mechanism attempts to standardize protocols, procedures and bring down cost through rate negotiations. This ensures the availability of cheaper healthcare, controlling fraud and possibility of rent seeking behaviour which is high in the case of the poor who have comparatively lesser knowledge about their health status or possible treatment required. Further due to Health Insurance, the out of pocket expenditures per episode of illness are signi? cantly lower for members as compared with those for non-members11 . Under the NRHM it is hoped that a national level expert committee will play a pivotal role in standardizing treatment protocol and rates. Presently such an activity has been undertaken by World Health Organisation (WHO), India-Of? e, in collaboration with Armed Forces Medical College (AFMC). †¢ Cover for access barriers (loss of wage, transportation cost) and new and emerging diseases: It has been seen that since most of the micro insurance models evolved from community institutions and NGOs, they packaged critical P. , and F. Diop. Synopsis of Results on the Community â €“ Based Health Insurance (CBHI) on Financial Accessibility to Healthcare in Rwanda. HNP Discussion Paper. 2001. Washington, D. C: World Bank. 10 Preker, A. S, Carrin, G. SHealth Financing for Poor People – Resource Mobilisation and Risk Sharing. T 2004. ? ? Washington D. C. : World Bank. 11 Preker, A. S and G Carrin. Health Financing for Poor People – Resource Mobilisation and Risk Sharing. 2004. Washington D. C. : World Bank. 9 Schneider 5 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission access barriers as part of their insurance cover. Also, insurance as a concept works on the principle of risk pooling and cross subsidization for low frequency events. The cost of healthcare for life style diseases like diabetes or critical illnesses and HIV/AIDS, is very high. Community Insurance models delivered at a large aggregation can cover for these rare events and ensure that the poor do not fall back into poverty in the process for paying for this high cost event. This has been tried in some schemes like the Arogya Raksha Yojna (ARY)12 . †¢ Development of stronger referral linkages: Insurance as a mechanism to be sustainable requires developing strong upward as well as downward referral mechanisms. Strong referrals ensure non escalation of cases, thus ensuring ‘right care at the right time’, reducing possibilities of collusion and fraud. †¢ Ef? ciency in the health system in terms of: – Allocative ef? iency in addressing the most risky event a household faces i. e. hospitalisation and by diverting the surplus premium to strengthen the health infrastructure and incentivise manpower. – Value for money: Presently the expenditure on health by the poor includes leakages such as transport costs, spurious drugs, unlice nsed medical practitioners who offer health care of sub optimal quality. 2. Various Models of Health Insurance for the Poor Models of micro health insurance may be categorized into the following: †¢ Social Health insurance: Such insurance models are found in about 8 countries across the world. The overall model works with a differential premium payment mechanism where the economically secure pays a relatively higher premium than what their risk pro? le dictates and the poor pay a comparatively lower premium commensurate with their income. This leads to cross subsidization across the rich and poor category. In India it is mostly seen in the formal sector in the form of ESIS and the CGHS scheme. 12 With Narayana Hrudayalaya, Biocon and ICICI Lombard in Anekal Taluka of Bangalore district of Karnataka. 6 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission Community Based Health Insurance (CBHI): There are three basic designs of CBHI, depending on who the insurer is. In Type I (or HMO design), the hospital plays the dual role of providing health care and running the insurance programme. In Type II (or Insurer design), the voluntary organisation is the insurer, while purchasing care from independent providers and ? nally in Type I II (or Intermediate design), the voluntary organisation (NGO/CBO) plays the role of an agent, purchasing care from providers and insurance from insurance companies. This seems to be a popular design, especially among the recent CBHIs13 . The merit14 of the last model is the aggregating role and the context speci? city that the NGO/CBO assumes. Since the NGO has systematically addressed information asymmetry, and also shares the community’s trust, these initiatives show better results (as seen in case of Dhramasthala insurance programme). In the case of a national roll out this can be the best model as it will capture the diverse nature of health requirements in the different NRHM states. The provider model or insurer model may not work out as customisation to local condition becomes the main crux of success or failure of the scheme. Further an NGO along with an insurer will be in a better position to retain the large risk of the community as compared to an individual entity like a provider or an NGO alone. It is crucial to ? nd NGOs that have a long term stake and therefore would act as ‘conscientious players’ who will ensure that the insurance programme, generates long term positive impact on the health system of the speci? c geography. 3. Some suggestions for the proposed Health Insurance Programme As discussed earlier, the health system in India is characterised by grave inequities leading to a political economy that makes health care access income and classdependent. This creates the need to explore various types of innovations and changes that could improve this unacceptable situation. Insurance is potentially one such et al. Community-based Health Insurance in India: An Overview. July 10, 2004. Economic and Political Weekly. New Delhi. 14 The Yeshaswani insurance programme (the large health insurance programme in the country) follows this model through the various cooperatives facilitated by the department of cooperatives. Other example is the Dharamasthala insurance programme where the NGO (Dharmastahala trust) is the aggregator and has about 1 million insured under its scheme. 3 Devadasan 7 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission innovation. However, for health insurance to effectively improve the ef? ciency of health spending and ultimately improve health status, it would need to be conceptualised as a part of a larger effort to improve the accessibility and quality of health care s ervices, especially for the poor. In the Indian context, any health insurance programme will have to take into account the plural nature of the health system, especially the presence of a large fee-levying, unregulated and ill understood private sector. It will have to explore synergies and integration with the widespread public health system and its current ? nancing mechanisms. Questions such as who should pay the premiums for the poor and how should incentives be aligned will have to be carefully thought through to ensure the management of problems such as adverse selection, inadequate monitoring and moral hazard, exacerbated because of extreme information asymmetries inherent in health services and goods. Internationally and within India, there is a signi? ant body of literature regarding the impact of different health insurance programmes on the health system. For the Indian context, it would be important to learn from these various experiences, develop a theory about the mechanisms through which insurance can contribute to public health goals, run pilots in different contexts within India to understand feasibility and impact, and determine the ? nal programme based on these learnings. 5 Proposal for a National Apex Body Proposal for a National Apex Body Working as a Coordinating Centre for Micro Health Insurance: It is proposed that a National Apex Body, ideally placed within the Insurance Regulatory and Development Authority (IRDA), be established to monitor and coordinate the implementation of the micro health insurance operations in the country (see ANNEXURE 2). The Apex body should have capacity in the areas of public health and insurance, host national and state-level dialogues on the idea of insurance in the context of health systems, implement pilots in speci? geographies and take forward the learning, and ensure knowledge sharing so that progressively larger regions can be covered under the micro 8 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission insurance scheme. ANNEXURE 2 provides details of potential roles this apex body (tentatively named Micro-insurance Coordinating Centre) could play in taking forward the agenda of usefully employing the strategy of insurance to get closer to the public health goals of the country, focusing on the vulnerable. It is envisaged that this body should play a knowledge-building, technical advisory, policy advisory, facilitative coordination role with a long-term aim of achieving universal health insurance coverage by an optimal combination of social and micro health insurance mechanisms, in a manner that it integrates seamlessly with the overall health system. The proposed apex body should host a process that ‘arrives’ at a framework of implementing health insurance under NRHM. Based on our understanding, the following emerge as important aspects of any national level health insurance programme developed under the NRHM. The health insurance model under the NRHM should explore the Partner-Agent approach which includes both the insurance partner (risk partner) and the agent (NGO). Based on experiences from the pilots, the insurance cover could be a compulsory, cash less health insurance product with a family ? oater with minimum initial deductibles. Depending on the availability and quality of providers, the insured should have the choice to access the nearest (private or public) health care facility and should be allowed to choose between any provider within a given geographical parameter. The client could be issued a biometric ID card which is updated with diagnostic information and refers her/ him to the desired care provider to control overcrowding at the tertiary facility. 1. Product Cover: To begin with, the product should cover basic hospitalisation at the secondary care level (either at the cluster of village, block or district level). It should include the cost of: †¢ Hospitalisation †¢ Diagnostic services †¢ Medicine and consumables †¢ Consultation and nursing charges †¢ Operative charges 9 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission The product should also try to cover for access barriers like transportation cost (with a initial deductible to control frauds and limited to only the cheapest mode of transport available, customized according to the district), loss of wage (in case of the male or female member of the household as de? ned by the state according to the minimum wage guaranteed by the state government. This could be done in tandem with the National Rural Employment Guarantee Scheme (NREGS). In geographies where investment in directed preventive and promotive services can bring down the need for seeking in-patient care, directed primary care primary level care can be provided by the insurance programme. For example, Directed preventive promotive community health education could lead to reduction in the frequency of inpatient care due to vector borne diseases in several geographies15 . Thus based on the speci? location package of additional community health intervention will be developed, which can be paid from the insurance model The insurance programme can work with District Health Societies to offer rehabilitative care and ? nancial help to patients who have recovered but are disabled due to diseases like leprosy or polio. It can also help the People Living with HIV/AIDS (PLHIV) by providing additional services like providing nutritional supplement and other additional services wh ich will supplement the current care being provided by the national programme for control of HIV/AIDS. 2. Health providers: Both private and public facilities at the secondary care level could be empanelled as providers. Private care hospitals could include nursing homes or 20 bedded medical facilities as seen in the Missionary hospitals as well as entrepreneur led inpatient care. For the government hospitals such as the district hospital, the difference in rates could be used for improving infrastructure and incentivising staff. 3. Building information systems: There is a need for a reliable transparent MIS sys15 For Insurance covering hospitalization due to events that can be impacted by Sspeci? S preventive promo? tive health education, it makes economic sense to proactively invest in Community Health Education, which will reduce the probability of hospitalization due to the event. Vector borne diseases show a high degree of sensitivity to such Community Health Education programmes. 10 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission tem to improve the overall ef? ciency of the system. This would reduce paper work, streamline referral linkages and aggregate data helpful for product customization. The community health insurance model could generate a much needed Electronic Health Records (EHR) system. This would imply that as per commonly agreed terms all health related information of an individual (parameters like diagnostic test results (blood pressure, body temperature, pulse rate, ECG), diseases to which he/she is prone; past illnesses etc) is stored onto a system or a database. This database can be accessed by all ensuring anonymity and therefore all insurers, health workers and policy makers can access and interpret the health data to be able to conduct community risk assessment. This will encourage insurers to compete for risk pricing of the community in the said geography and lead to cheaper insurance premiums. The focus of the EHR system would be to ensure – Universality, Consistency, Open Standards, Non-Proprietary, and Acceptability. To institutionalize a reliable EHR system it should be made compulsory that any treatment/diagnosis/medical intervention be updated into the individual’s EHR, such that the EHR is the most authentic source of health information about an individual. The other challenge that needs to be addressed for development of better health insurance products as well as better health care delivery is the challenge of targeting and uniquely identifying the individual. Such identi? cation could be achieved through a biometric identi? cation smart card. The smart card can be used to not only help in identi? cation, but also for storing of? ine health information With an EHR and smart card system, the insured can freely access b oth the public and private health care facilities available in the geography. This helps the insured as well as the medical practitioners and improves diagnosis and response time. The Smart Card can also be used to store health insurance related information of the client. The health provider can thus check the eligibility of the individual in terms of insurance before delivering treatment. The same card can also be used as a payment instrument to capture the payments that need to be made to the health providers. The card can be used to pass 11 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission n incentives to clients as well as the hospital to keep using the card. The biometric card will have terminals (which can upload data of? ine) in the various network hospitals to upgrade data whenever the insured avail care. 4. Formative Research: a Community Needs Assessment (CNA) will need to be done to list down the health needs and the willingness to pay, a mapping of the healthcare facilities in the geography, an unde rstanding about the type of premium and payout that the community are expecting from the insurance scheme and the broad range of social protection measures that they want the insurance to take up. Based on the information provided above the product and the EHR can be developed. Initially, it is advisable to undertake health insurance pilots in different contexts to develop and ? nalise the health insurance programme. 5. Implementation and monitoring: The proposed National Apex body, should monitor and coordinate the implementation of the micro health insurance operations in the country (see Annexure- 2). The following ideas can potentially strengthen the monitoring and implementation of the programme: †¢ The District Health Accounting System and the proposed ombudsman (to be created under NRHM to monitor the District Health Fund Management) will work closely with the NGO and the insurer to ensure the smooth running and monitoring of the programme. †¢ At the backend, the insurance programme with the EHR system will develop a rich data source and act as a Fraud control mechanism. This data will help in identifying disease patterns for the community and could be a critical tool for the NRHM team to de? e ? nancial allocations, target services and make evidence based policy recommendations. (While developing this EHR we should ensure that we are following international standards to be able to be coded properly and stored in a card). In the long run, this apex body should aim at achieving universal health insurance coverage by combination of social and community based health ins urance mechanisms. There is a case for building facilitative institutional arrangements of the ‘right’ stakehold12 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission rs who will pursue this goal. The learning from the challenges and processes involved in implementing Universal Health Insurance Scheme (UHIS) will be very valuable. 6 Conclusion Promoting health and confronting disease requires action across a range of challenges in the health system. These include improvements in the policy making and stewardship role of the government; better access to human resources, drugs, medical equipment, and consumables; and a greater engagement of both public and private provider of services. Insurance has a limited but important role to play in solving some of the health ? nancing challenges. Innovative pilots of partner agent model led micro health insurance could giver useful insights for designing a national level programme, led by an apex body. Such a programme could systematically impact the health system in the country. 13 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission 7 Annexures 7. 1 ANNEXURE I Beyond the pilot, the initial cover will be modi? ed to cover primary and tertiary tier of the health systems in the country. . Primary level: The Insurance will cover: †¢ Diagnostic charges incurred on low and high end diagnostic16 †¢ Medications including expensive medication (like life saving drugs, higher antibiotics etc), injectibles and other consumables not usually available in the primary health centre †¢ Based on the recommendation given in the NRHM document, practitioners of AYUSH and other speci alties can be roped in to act as the Primary Physician †¢ Based on the scale and/or the insurance experience in 1st year, further social security bene? s can be added as follows: †¢ Reimbursement of transportation charges, wage loss, ? nancial compensation for attendant, compensation for disability and subsequent rehabilitation. 2. Impacting infrastructure and Manpower: †¢ Depending on the claims experience and the volume, some monies can be utilized to purchase new or replace old goods/equipment at the Primary Health Centre (PHC) and such activity monitored by District Health Mission through district health accounting system and the proposed ombudsman under NRHM. Besides there is a need for 5-10 bedded hospitals to come up at the taluka or clusters of village level in severely resource constrained area for which emerging entrepreneurs like the Vatsalaya hospitals who have already set up such hospitals elsewhere in the country (especially in Karnataka in this case). L ocal doctors looking at running hospitals can set up such hospital and run it on a franchise model. in this realm may lead to cost effective and customised diagnostic solution. in this regard ICICI Knowledge Park is involved in coming out with such customised solution for the rural poor 16 Innovation 14 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission †¢ There is also a need for high end diagnostic chain to come in to the rural space with similar franchise model of commercial diagnostic companies17 . Standardization of all the services will be done by a committee of experts in each state. These services will include outpatient, in-patient, laboratory and surgical interventions. †¢ Manpower: The ANMs/CHWs/ASHA/MPWs can be incentivised to provide their services more ef? ciently and quickly from such fund given to the Panchayat either from the government or from the insurance fund. It is assumed that with the introduction of ICT component (EHR and biometric cards) like smart card, the 40% of time wasted by ANM on documentation will be saved18 . – To incentivise the doctors to work in the PHC: – Posting of quali? ed graduate doctors in PHCs can be made mandatory and also made necessary pre-requisite for eligibility to sit for Post Graduate Medical Entrance Examination. – Top 10 or 20 high performing PHC doctors in the entire state might be allowed to join specialty of their choice in P. G courses directly or some higher percentage of quotas may be assigned to them which will facilitate them to get admission. Transparency and accountability in the whole service delivery can be brought about by making the health manpower within the PHCs and other levels accountable to the PRIs and the Village Health Committee through a rigorous and scienti? c accountability system19 . †¢ Additional Services: De? ned amounts of fund can be made available to the local Panchayat or a certain percentage of premium collected be allowed to remain with them and be spent for these purposes according to their discretion 17 This entity can set up satellite diagnostic centre at the taluka or district level. They can have sample collection unit which collects the pathological samples from the villages and brings it to the satellite centre where it is examined. The report is either passed on to the patient the next day when the sampling collection team goes to the villages or can be sent directly to the referred doctor under the health insurance scheme. 18 This will give her more time to cover more villages, services and bring about ef? ciency in the overall healthcare delivery. It will also reduce paper work and make information easily accessible at each level. 9 Smart card technology will be used to increase transparency and accountability of the health staff bringing about good people governance. In this the gram Panchayat and the Village Health Committee will completely evaluate the work of ANM and other staffs (including the doctor). Their performance will be graded in a scale devised in consultation with the representatives of the PRIs and the District Health Mission and accordingly incentive/disincentive can be given based on the score. This information can be made available online for access to the general public. 5 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission and mutual decision (It can also cover other expenses like loss of wage and destitute supports). †¢ Health Database management system: ICT component in the form of smart card technology (in the form of a biometric card) be introduced which will ensure the capturing of health and insurance data of the population and minimize fraud. †¢ It requires a decoder cum uploading device which will be portable and hand held. This can be used by ANM/Health staff/PRI/Hospitals to upload or read information starting from the primary to tertiary level †¢ Will be able to transmit images and radiographic reports (X-ray and ultrasound, CT scan) apart from other routine test results. This can be done of? ine (Because in villages, the power supply is erratic or absent and the internet connectivity is lacking) and can be the precursor of telemedicine20 . 3. Tertiary level: It will cover all high cost, sophisticated care which may not be available at the secondary level. The diseases that can be covered are as follows: †¢ Cancer †¢ Myocardial infarction †¢ Major organ transplant †¢ Paralysis †¢ Multiple sclerosis †¢ Bypass surgery †¢ Kidney failure †¢ Stroke †¢ Heart valve replacement 20 With internet connectivity through satellite (which are now provided free of cost by ISRO to interested NGOs and CBOs) which will mean that the patient will not have to travel to district level or tertiary level care and can walk in to such tele-consulting centre within the village where his diagnostic reports are accessed by punching in the unique I. D number of the patient on the smart card. The specialist sitting at the district level can then assess the prognosis of the case and decide whether the patient needs to travel or else advices the local doctor on what is the line of treatment for the patient which then can be carried out locally. This will save a lot of money (on traveling and loss of wages), time and resources which the patient would have spent otherwise. 16 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission 4. Impacting infrastructure, Manpower and Services: †¢ It is envisaged that the government medical college hospitals, other government health institutions, central or regional health institution operating in the state can act as the tertiary care provider. †¢ Insurance can start paying for upgrading these infrastructures and incentivising the medical work force in a similar way as was explained under primary level care. Besides private healthcare who will start the franchise model or other wise interested (and agreeable to the negotiated rate for the insured) will act as the tertiary care providers21 . The government should play a central and leading role in developing a strong referral linkage in the state. †¢ As most high level tertiary care hospital are charitable trust hospital and get substantial subsidies and exemption from the government in return for providing subsidized services for the poor (but in reality a very few actually provide such services) it should be made mandatory and compulsory for these hospitals to treat the insured poor. 5. Health Database Management: †¢ There will be a Central Data Warehouse which will develop from the EHR integrate all the information collected from the primary level upwards, making it accessible to each level and hence acting as a central store house of information. †¢ Additionally it will have personnel(s) who will analyse such data. Such analysis will be invaluable for monitoring, evaluation and mid-course correction. This will help in achieving the following: – Help revise insurance premium – Incentivise and monitor providers 21 The bene? will be two fold – it will provide quality care to the poor (through a TPA and the District Health Mission and Rogi Kalyan Samiti which will empanel hospital) which will ensure compliance to a particular standard of care) and will also help reduce crowding in the government hospital. At the tertiary level, a working arrangement should be made with national level government hospital (like AIIMS,CMC etc), regional ins titutes, post graduate medical institutes (JIPMER) and large private/corporate hospital (Apollo, Wockhardt, Fortis etc) so that patient requiring advanced critical care can be referred to them. 7 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission – Control fraud The developing of referral linkages is very much possible with insurance playing a central role and ICT in the form of smart card technology will ensure equity, ef? ciency and quality in healthcare delivery at each level. The coupling of the whole machinery with tele-medicine will bring about synergy and help the poor in terms of saving money on traveling and also loss of wages. It has to be always borne in mind by all the stakeholders that all component of health care i. . preventive, promotive, curative and rehabilitative care as emphasized under National Rural Health Mission as well as the coming of all stakeholders to work together will ensure harmonious and ef? cie nt delivery of quality healthcare with insurance playing a vital role. None of the components or stakeholders can be undermined as each will ensure that we will be able to see demonstrable impact in the health indicators of the community in days to come. 18 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission 7. 2 ANNEXURE II Setting up of a national coordinating and development entity: One of the key issues recognised by many is that increased coordination as well as sharing of knowledge and resources among the various actors in the sector would greatly stimulate success of NRHM as well as micro insurance development. This is especially true of health micro insurance for which few (if any) truly successful and sustainable programs have been observed to date. Hence it is felt that there has to be an apex body in the form of a coordinating centre which will initiate, regulate and monitor these activities. Following is a matrix which delineates the various stakeholder who will be represented in such a supra structure. 19 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission Stakeholders Stakeholder Needs Coordinating Centre’s Criteria for Success 1. Bene? ciaries * Simpli? ed claims procedures with minimal bureaucracy * Solutions that result in fast claims payment 1. 1 BPL families * Timely payments of * Service satisfaction from bene? ciaries * Solutions leading to affordable insurance products with quality servicing promised bene? s * Systematic increase in product coverage to ensure reduction of access barriers * Access to health services and health risk protection services 2 Microinsurers, Insurers, reinsurers * Access to technical assistance, actuarial studies, EHR records and the Centralized Data Warehouse reports, exposure to international innovations * Long term sustainability of microinsurance programs servicing the poor * E ffective, broad-based microinsurance delivery channels * Microinsurance pro? ts commensurate to investment risk * Competent pool of microhealth experts insurance technical Service packages developed and patronized * Service satisfaction from micro-insurers * Insurers aggressively competing to offer superior products and services to MICC client governments * Investment and ? nancial support from insurers 20 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission Stakeholders Stakeholder Needs Coordinating Centre’s Criteria for Success 3 NGOs, MFIs, trade unions, employer grassroots organizations, organizations, * Strong partnerships with hospitals, diagnostic players, NRHM team, AYUSH, ASHA workers and insurers Satisfaction with the coordinating agency’s ability represents all stakeholders’ interest and re? ected by strong involvement and support and investment through time in the centres work corporate sector, co-opera tive sector, etc. * Successful delivery of risk protection services to their memberships and clientele 4 Insurance Regulatory Development Authority * Robust, vibrant health microinsurance industry * Insurance regulations followed * Robust and vibrant network of micro-insurer clientele * Mandate and support from the IRDA * Achievements towards supportive and enabling policy 5 Health Providers * Timely payment from insurers * Reliable stream of BPL clients utilizing their services * Reasonable pro? tability * Positive ratings from health providers * Service satisfaction of BPL clients * Minimal problems with * Fast claims turnaround Solutions that result in: fraud and overcharging, etc. 6 TPAs Innovative and effective collection, distribution, and servicing channel 21 Sharing best practices Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission Stakeholders Stakeholder Needs Coordinating Centre’s Criteria for Success 7 State Governments * BPL population covered Support and mandates from governments * Ef? cient utilisation of resources and resources leveraged through a resource center * Moving closer to the goals stated under NRHM 8 Government of India * Access to comprehensive and quality health care for all * Improvement in national statistics on accessibility of health care services 8. 1 Ministry of Health and Family Welfare 8. Department of Insurance, Ministry of Finance * In synergy with existing programmes and structures * Proper utilization of departmental funds * National statistics on health insurance penetration * Increase in the number of legalized community health insurance programmes * Moving towards universal coverage * Regularising illegal community health insurance programmes Other major stakeholders that will have to be consulted are the likes of Indian Medical Association (IMA), Institute of Public H ealth (IPH), Federation of Obstetric and Gynecological Societies of India (FOGSI) and Institute of Health Management Research (IHMR). . 3 Objectives, Activities, and Services The stakeholders and clients of the Microinsurance Coordinating Centre envision a network of professionally-managed micro-insurers and accredited service providers offering 22 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission affordable, comprehensive, quality risk protection to the majority of poor people in India. Similarly, the Mission Statement may read as follows: The Microinsurance Coordinating Centre aspires to facilitate delivery of innovative health ? ancing and health insurance solutions in the country and improve the health indicators. It also aims to improve the capacity of insurance providers to provide risk protection services on a sustainable basis. The Centre is committed to building a vibrant health ? nancing and risk pooling sector through coll ective advocacy and through concentration, leveraging, and focusing on resources and knowledge towards developing innovative technologies. More speci? cally, activities and services of the MCC may include the following: †¢ To diagnose the feasibility and requirements of proposed micro-insurance projects in speci? districts of the identi? ed NRHM states; †¢ To develop and offer comprehensive, feasible, customized technical solutions complete with onsite guidance and implementation assistance; †¢ To facilitate strengthening the technical and cost effective management capacities of the NRHM team at the district level; †¢ To analyze and document the leading and best practices in the health microinsurance industry; †¢ To provide a forum for regular exchange and dissemination of ideas, innovations, lessons learned, achievements, and international best ractices; †¢ To develop and support EHR central data warehousing and tools; †¢ To develop health microin surance performance standards and prudential indicators, and the supporting technologies and tools that will enable micro-insurers to meet these standards; †¢ To provide a rating service of NRHM districts with micro health insurance pilots micro-insurers with respect to the standards and indicators; 23 Ruchismita, Ahmed, Rai: Delivering Micro Health Insurance through the National Rural Health Mission To facilitate and strengthen collaboration and partnerships among the various microinsurance providers and Health Ecosystem partners †¢ To establish linkages between insurers and resource institutions such as funding agencies, ? nancial institutions, and research institutions; †¢ To accredit a network of providers delivering affordable, quality health care through use of clinical protocols and negotiated tariff schedules; †¢ To provide and manage a data repository and also a national helpline for query redressal. To conduct industry experience studies and share resul ts for use in pricing and management purposes; †¢ To represent the health microinsurance sector to the Government of India and lobby for favorable and enabling policy; †¢ To identify and facilitate networking and business opportunities among the various stakeholders; and †¢ To elevate the insurance consciousness through awareness campaigns and education. Some of the activities such as product design are already being carried out by insurance companies. However, since microinsurance differs greatly from commercial insurance it requires unique design, marketing, and distribution strategies and skills. The MICC, with its personnel focused and specializing in micro insurance and health (health economists), with access to current data, and with concentration of knowledge about the industry would be positioned to facilitate superior solutions in these areas. 24

Female Mill Workers in England and Japan

Ariana Delgado History, B Mr. Carmer March 24, 2013 Comparing Workers in England and Japan The Industrial Revolution was the greatest transforming event in human history. Big factors in the revolution were the human figures. Such as exhausted laborers pouring molten steel or the eight year old child working with a bottling machine. But the main focus will be the women and young girls in the textile industry of England and Japan. Most spinning and weaving for the textile industry were done in homes and small shops but a big change in human history was when process of spinning and weaving were moved to factories and done by machine.Because women and young girls have such nimble fingers they were perfect for operating the machines since they required special skills. In England the textile revolution began around 1760 and a series of inventions changed the way cloth was made in England. Many of the inventions were replacing hand weaving and spinning and moved to the factories. As textile manufactures went from the home to the factory, so did thousands of English women. In Japan the revolution began in 1868 when a teen-age emperor, Mutsuhito took over a new power in Japanese government.The goal was to make Japan an equal to western nations. To accomplish this, they began to invest in coal mines, textile mills, shipyards and many others. Technology for the investments already existed it was more of a question of seeking out advice. This is when European experts were invited to Japan to advise the Japanese on how to establish industry. In conclusion, European and Japanese female mill workers were very similar and critical to the rise in power. Some examples of differences between female mill workers are wage, age and working conditions. Female Mill Workers in England and Japan Female mill workers in England and Japan: How similar were their experiences? Nikita Thompson B period 10/6/11 If a person who thinks they have it tough with their job takes a look at the fact that a young Japanese or British girl worked longer hours, got paid less, and put up with horrendous working conditions, that person might reconsider their statement. Despite the fact that Japan and England had many similarities with female mill workers, they still had a few differences. Young children and women worked in big dangerous factories known as mills, spent more hours then the average working person today, making thread or fixing machines.So how were their experiences different? Female Japanese workers had to work more, got paid less, and accepted the role that their society gave them. Compared to English women mill workers, Japanese women worked more. English female workers only worked about 74 hours a week and Japanese female workers worked 91 hours a week (Document 5). This was bec ause the Japanese workers worked longer each day, had fewer holidays, and worked on weekends (Document 5). English female workers had more breaks, worked shorter hours each day, and did not work on weekends. This is a big difference between female English and Japanese mill workers.Even though in both England and Japan women got paid less than men, Japanese women got paid even less than English women. This is why they had so many workers (document 4). Since Japan paid the female mill workers less, they would be able to hire more workers and increase their production rate. Why would they want to pay women less? They paid women less because the women needed money and they would accept any amount given to them (Document 8). Japan and England had different ways they treated women and because of that the Japanese women accepted almost everything they went through in the mills.In Japan the women were treated a little less fairly. Japanese women were more willing to accept their role in the work force because they couldn’t do much about it (Document 11). This is the reason that female Japanese mill workers got low pay and worked more hours. In their society the men were respected more and got paid twice the amount the female Japanese woman got paid (Document 8). Having few if any rights, Japanese women would be forced to accept the role that society put on them and couldn’t put up a fight against the unfair and unlivable conditions put on them.But like the female mill workers in Japan, female mill workers in England were treated terribly as well. For example, one of the few men in the mill would beat the little children if they didn’t do their work right (Document 10). Though a beating is terrible, it has been recorded that some female Japanese mill workers committed suicide (Document 11). It’s because female Japanese mill workers worked longer hours, got paid less than British female workers, and had less freedom in society that we can con clude to the simple fact even though British and Japanese female mill workers had similarities, the Japanese female mill worker had it worse.

Campaign Speech Essay Sample

To my darling instructors. fellow pupils. campaigners. the module and staffs. and to our invitee. a pleasant twenty-four hours to all! First and first. I’d like to take this chance to thank you for being here. for your clip. for leting me to portion my thoughts. and for holding this election. without your presence this election wouldn’t be of great success. Actually. I’m out or words right now. as I stare at you guys because I’m imposingly mesmerized by how gorgeous and fine-looking my audience are that I could barely retrieve what I was supposed to state. As I stand here in forepart of you. I know most of us know my intent of talking in such a large crowd. I’m here to present myself among those who don’t cognize me. By the manner I am ( insert name ) . I’m on my ( twelvemonth ) of analyzing ( class ) . I’d like to run in the place of going your following pupil president. For the past old ages. I’ve been a dedicated pupil with a passionate bosom to function others. As a pupil. I know the demands of my fellow pupils and that most of us wants to see betterment in this school. If a given a opportunity to go your president. I will do certain that what most of us wants would be implemented. One of my platforms is to implement a systematic registration procedure. This is ever the job we pupils encounter during registration and so holding a systemized process and stairss could do us avoid fuss and questions. Another is the changeless updates of proclamations and posting calendar of activities through Bulletin Boards and other ways so that bulk will cognize the approaching activities. I have tonss of thoughts for the improvement of the bulk. I may non province them one by one ‘cause that may tire you and besides I don’t want to do this address any longer. One thing’s for certain that I will make my really best to go to to your demands and wants. I will non assure anything for a promise is merely a word of award. but I will certainly be committed and that is far greater than a promise. Now that you have heard my platform. the determination is yours. to vote or non to vote. Be certain. ballot sagely.

Clostridium Botulinum Research Paper Example | Topics and Well Written Essays - 750 words

Clostridium Botulinum - Research Paper Example Furthermore, these spores may at times get into the human gastrointestinal system and can be able to withstand the hostile environment. Once the spores reach the colon, some germinate to produce the bacteria, but in cases of adults, often cannot withstand competition from the normal microflora. However, in infants, due to lack or few existing microflora, these organisms often take advantage of multiplying and causing infections through production of botulinum toxin. In relation to botulinum toxin, there exist several types: Toxin A, B, C, D, E, F, and G. There are only types A, B, E and rarely F, which mostly cause the flaccid paralysis symptom in humans. The other types often cause disease in animals. Botulinum toxin often results to a condition called botulism. Botulism This is a paralytic illness that results due to the botulinum toxin. Botulinum toxin is a neurotoxin. People often get the toxin in their bodies via ingestion of contaminated foods already having botulinum toxin, th rough the bacteria infecting a wound and producing the toxin, and through consuming spores that produce the bacteria that finally produces the toxin to cause the condition (Smith 34). From the three modes of in which botulinum toxin could get into the human body system, one could identify three types of botulism namely; food borne botulism, wound botulism and infant botulism. Botulism is a fatal condition and all times considered medical emergencies. Botulism neurotoxins often prevent neurotransmitters in the nervous system from functioning properly. In fact, they usually inhibit the functioning of the motor control. A patient often exhibits paralysis stating from top to bottom, beginning from the eyes, face as it moves down the neck, chest, upper limbs and lower limbs (Shneider, Chang & Goodrich). Botulism often produces symptoms 12 to 72 hours on ingestion of contaminated food. Symptoms of botulism generally appear 12 to 72 hours after eating contaminated food.   Infant botulism This type of botulism accounts for the most number of cases reported of botulism. It often affects children due to having few or lacking microflora in their colon (Hauschild 40). In homes, improperly canned foodstuffs often the spores of the bacteria, which upon ingestion by infants, result to overgrowth of the bacteria in the colon leading in production of botulinum toxin. Symptoms In infant botulism, symptoms exhibited include poor appetite, lethargy, constipation, drooling, weak cry, poor feeding, paralysis and drooling eyelids. The general symptoms which botulism poisoning produce entail fatigue, nausea, vomiting, double vision, dizziness, dry skin, dry throat, dry mouth, difficulty swallowing, slurred speech, body aches, muscle weakness, and paralysis (Canadian Food Inspection Agency). Treatment Treatment can be instituted in the early period before the toxin takes toll of the nervous system completely. An antitoxin is often administered in such cases (Emmeluth & Alcamo 67). T he antitoxin functions by blocking the circulating botulinum toxin In the blood thereby limiting its action. This form of treatment only prevents the worsening of the patient’s condition. Patients from such incidences often take several weeks to recover completely from the effect. Prevention In relation to the three types of botulism and the mode through which the toxin gets to enter the human body, preventive measures can be

Different Generations of X-ray CT Essay Example | Topics and Well Written Essays - 250 words

Different Generations of X-ray CT - Essay Example 1st Generation: Parallel projections Had a single X-ray source and detector cell to collect data for just a single slice. It produced pencil beam and worked via the translation and rotation process. 2nd Generation: multiple detectors They had several detectors and the X-ray source emitted radiations in a wide angle. They would obtain multiple scans multiple projections in a single scan. 3rd: Generation: Fan Beam It had a large array of detectors and would scan in about two seconds. The detector and tube array would rotate around the patient. 4th Generation: A rotating X-ray tube and stationary detector ring It reduced complexity by reducing motions. Eliminated the translation and rotation motion, had a large fan beam, and had about 4,800 detectors. 5th Generation: Electron Beam CT It was characterized by a large ring that circled the patient. They would produce electron beams of high energy and capable of scanning in milliseconds. It would produce 17 CT slices every second.

Computer networking and management Essay Example | Topics and Well Written Essays - 5000 words

Computer networking and management - Essay Example It is also possible for network managers to restrict or otherwise bock the service for specific types of traffic or threats. (Herman 2006) These tools can be as simple as blocking certain domains from access using open dns or as sophisticated as virus and spyware protection software products. (Korzeniowsk 1998) However there can sometimes be too much control and blocking useful resources can result from over zealous network traffic mangers. Blocking VoIP is just one such threat that may be considered. Blocking peer-to-peer traffic is also another example of the general problem of this threatened innovation. This can also fall into the commercialization of networking. Often many telecommunications executives have threatened to charge extra fees for valuable services simply because they can by blocking the service otherwise. â€Å"As soon as a new application increases the value of network resources†¦ or disproportionately draws upon those resources†¦BSPs [Binary Space Partitioning] may have the economic incentive to surcharge or degrade those services.† (Herman 2006) BSPs can therefore extort fees from users in direct proportion to thier perceived value of the new advancement. Conversely they can also block bandwidth-intensive mechanisms instead of upgrading their networks. â€Å"This systematically favours the technological status quo, reducing the competition for new online innovations and therefore reducing social welfare.† (Herman 2006) Many users have seen this on their existing network where upgrades and updates are avoided rather than spending extra money on new equipment to increase memory and bandwidth. As more and more management tools become available there has been a need for management of the management tools. An excellent example of this is Microsoft’s Small Business Server (SBS) toolbox of management software. Using the windows SBS console the network manager can add view, and edit users quickly and

Advantages of Distributed Operating Systems Assignment

Advantages of Distributed Operating Systems - Assignment Example For instance, the design of distributed systems is such that a malicious program can easily be replicated across a large number of machines, and this can result in major damage (Moffett, 2004). To this extent, although distributed operating systems might attempt to enhance high reliability through fault tolerance, it is however clear that fault tolerance is hard to achieve. Secondly, the distributed operating systems are designed with the aim of enhancing performance. Evidence however shows that this is particularly a challenging concept since as these systems attempt to enhance performance; they actually end up conflicting with other properties, especially the reliability and security of the system. For example, in Amoeba distributed operating system, there are many applications that are replicated, an example being the databases (Tanenbaum, et al, 1990). These replications help this operating system to support fault tolerance, there enhancing its performance and reliability. However, it should be noted that as the software and hardware components are increased to enhance fault tolerance, this may end up negatively affecting the security and overall performance of the system. Third, there is evidence to show that indeed distributed operating systems helps to enhance communication. In many of these systems, communication is mainly through messages. This allows for communication in distributed operating system easy and efficient. In many cases, the communication needs in distributed operating systems are of the request/response type (Mullender, 1988). This allows for message passing to be embedded in protocols for the remote operations. In this case, a process sends a request to another process and the request is carried out and the response returned to the initial process. Through such a mechanism, the communication process in a distributed

Sunk Costs and Organizational Decision Making Research Paper

Sunk Costs and Organizational Decision Making - Research Paper Example The $100,000 the company expends to buy the license is a sunk cost. Thus, sunk cost is one that when once it has been incurred, it could not be transformed or changed by a present decision. Thus, the company cannot rectify what was done by going back into the past and undo the decision made in the past. Further, it cannot be refunded or recovered as the government will neither permit the same to be resold or to will buy back the same. (Arnold, 2008, p184). Clark and Wrigley (1995) recognise three varieties of sunk costs which can efficiently produce a lesser or greater magnitude of such locational inaction. In the first type of sunk cost, for instance, for training costs of inward investors , whenever there is a requirement of significant skills to be harnessed , but on the assumption that lion’s share of such inward remittance based on low-skilled jobs and in such cases , sunk costs are particularly so significant. According to Peck (1996), the second type of sunk cost may be the cost of leasing or acquiring local property and land. Poignantly, a considerable quantum of such setup sunk costs may be met by subsidy from either central or state governments or shared by both by way of regional developments of grants and the leveling and provision of premises and sites. As per Gold (1981), there is a technical sense where the economies of scale is associated with the physical capacity which is notionally regarded as set-up sunk costs but none can be important in assessing industries and firms to specific places and the best illustration, here would be the location of chemical industries and petrochemical industries. Lastly, Clark and Wrigley recognise â€Å"exit† sunk costs, which become perceptible when a factory winds up its operations or a business exit from industry or a market. The best example here is the cost associated with pension provisions and severance pay. (Phelps, 2002, p 61-62). 2) Statement of the Problem- â€Å"Sunk cost† is a term borrowed from accounting and economics, referring to those costs that have been incurred and are therefore no longer relevant to future decision-making (Hirschey, 2009; Taylor, 2010). However, despite it irrelevance in terms of monetary reckoning, the psychological effect of â€Å"sunk cost† on the human decision making process remains evident. The effect of sunk costs on decision making in general has been a topic of interest in diverse areas such as human development (Kelly, 2004; Arkes, 1999) and education (Rover, et al., 2009). In business likewise, they figure unintentionally in managerial decision making. 3) Significance of the problem- Without realizing it, investors and managers are prone to the â€Å"sunk cost effect.† The disproportionate consideration of sunk costs constitutes a trap to decision making; positions are sometimes taken or products pushed too long in the hope that they may still turn profitable, because the investor or manager refuses to ad mit that it was a bad investment to the point of abandoning it (A to Z of Management Concepts & Models, 2005). In the interest of avoiding mistakes in decision making that will eventually affect firm profitability, studies should continue on

Norman Conquest of England Research Paper Example | Topics and Well Written Essays - 2750 words

Norman Conquest of England - Research Paper Example Cnut had become the King of England in 1016 thereby returning Emma to her previous position. Emma’s Children however remained in Normandy where they awaited their return to England. They made several unsuccessful attempts to enter the nation with one attempt leading to the death of one of them, Alfred, in 1036. The last remaining son of Aethelred was recalled to England by his half brother Harthacnut, son of Cnut and Emma. However, Harthacnut died within a year and Edward took the throne becoming King of all England. Edward took Edith, daughter of the prominent Earl Godwin, as his wife bringing her family into a more dominant position. Earl Godwin had risen to power during King Cnut’s reign mainly due to his extensive wealth and his marriage to the King’s sister in law. The Earl had so much wealth that he became the most powerful earl of England. King Edward took several Norman advisers into his court and eventually named one of them, Bishop Robert, the Archbisho p of Canterbury against the wishes of his citizens who wanted one of Godwin’s kinsmen to take the position. Due to this act, Earl Godwin and his sons, Tostig and Harold, went into exile due to their fierce opposition of the King’s choices. The King faced a strong Godwinian alliance and due to this, he banished his wife from the court into a nunnery. Earl Godwin eventually returned to England and together with Flemish support, he was able to convince the King to get rid of the Norman influence and to take back his wife. King Edward and his wife were unable to bear children and thus he had no heir. He was thus required to find a successor in which the King made promises to several candidates including Edward, grandson of King Aethelred. The grandson... The paper tells that the Norman Invasion and the Battle of Hastings were very important events in English history. The Norman invasion brought with it many changes that acted as a turning point of English politics and Culture. King William attempts to maintain control on England forced several changes to the country that shaped the way it operated for a very long time. William attained control over the country by systematically confiscating land belonging to English landowners and giving it to his supporters or keeping it to himself. He confiscated all land and used his armies to ensure that all Englishmen were aware that he had complete dominion over all the lands. Williams also forced English women to marry Normans in order to control inheritance of land. The Norman invasion also led to English emigration. Many people fled the country due to the war and oppression and took refuge in neighboring countries such as Scotland and Ireland. This outflow of people led to the spread of Engl ish customs to other parts of Europe. The Invasion also led to the mixing of Norman and English cultures in Europe. Old English was displaced by the introduction of Anglo-Norman, a dialect of French. French words and names began being used in the country and soon were part of the English language. English grammatical structures were also heavily influences by the Norman influences leading to the development of a new dialect that eventually led to Middle English which eventually formed the modern language.

Psychosocial Risks at Work Essay Example | Topics and Well Written Essays - 250 words

Psychosocial Risks at Work - Essay Example Whereas one's interpersonal relations influence the success of the strategies to minimize stress in the workplace, these strategies have a significant impact on approaches to reduce depression and related health-issues of the employees. In their study on psychosocial risks at work, Michael Ertel, et al. maintains that "psychosocial risks such as work-related stress, violence, bullying and harassment have become major concerns for occupational safety and health." (Ertel, et.al., 169) Therefore, it is essential to comprehend that there is a close cause-and-effect relation between occupational health and psychosocial factors. "Psychosocial factors refer to all organizational factors and interpersonal relationships in the workplace that may affect the health of the workers." (Vzina, et.al) As a result of the emerging need for reducing psychosocial risks, modern companies adopt several psychosocial risk intervention strategies to deal with psychosocial factors. It is indubitable that the stressful nature of a work situation, workload, interpersonal relationships, career prospects, and organizational climate highly affect an employee's health-related issues, including depression.

Sales Marketing Plan Essay Example for Free

Sales Marketing Plan Essay Marketing is one of the most important aspects of a business. According to Peter Drucker â€Å"There will always, one can assume, be need for some selling. But the aim of marketing is to make selling superfluous. The aim of marketing is to know and understand the customers so well that the product or service fits him and sells itself. Ideally, marketing should result in a customer who is ready to buy. All that should be needed then is to make the product or service available. † (Peter Drucker, Marketing Management, Philip Kotler). In this report, we have planned to market the service ‘Hair care’ by opening an Hair Salon in Silver spring, USA. We have analyzed different marketing strategies and designed a marketing plan for the same. SLP 01 1. NAME, LOCATION amp; NATURE NAME: â€Å"Looks† Location: Silver spring, Montgomery County, Maryland, USA Nature: ‘LOOKS’ will be one stop solution that will allow the entire family to have their hair needs satisfied in one convenient location. It will serve men, women, and children and it will accept appointments as well as walk-ins. ‘LOOKS’ will also sell premium hair care products. It will focus on serving the entire family in one quick, convenient visit. It will excel due to its attention on their clients, so as to build a long term relationship. Through unheralded customer attention, ‘LOOKS’ will slowly but surely gain market share as it services the entire family, creating long-term relationships. Being on one of the best location of Silver Spring, it will attract a lot of traffic. 2. SELF-ANALYSIS The US salon market accounts for approximately 60 billion dollars. Looking stylish, trendy and beautiful is one of the major concerns of the people in US today and providing this, forms the strength of â€Å"Looks†. As the mission of â€Å"Looks† aligns with this need of the market and as it has comparatively higher competency in the world of fashion it is a strong player. 3. CUSTOMER ANALYSIS The population of Silver Spring is 78,488, with a growth of 2. 5%. The population of Silver Spring consists of 48% males and 52% females. The immediate geographic target of LOOKS is Silver Spring and its neighboring communities of total 250,000 of population. Approximately 12 miles geographic radius is in need of the offered services. The total targeted population 100,000. Baby boomers, Gen-Xers and baby boomlet and the young generation are the groups that are targeted by ‘LOOKS’. 4. ANALYSIS OF  PRIMARY COMPETITORS The location chosen offers very less competition or no competition. Though there are two major competitors which LOOKS has to compete with. Ebony Barbers Unisex ;amp; Fenton Barber Shop are the two major competitors of LOOKS. As Silver Spring is one of the biggest hub for business it may likely to be hurt by emerging competition. LOOKS will have to face Monopolistic competition, as its competitor is able to differentiate their offerings. 5. MARKET RESEARCH The demographic segregation of Silver Spring is displayed in the graph displayed below: Age Group| %| Under 18 yrs| 23%| 18 – 24 yrs| 9. 3%| 25 – 44 yrs| 37%| 45 – 64 yrs| 21. 2%| Above 65 yrs| 9. 6%| Silver Spring is a ‘Salad Bowl’ society with ethnic group maintaining their ethnic differences, neighborhoods and culture. The Silver Spring population comprises of different racial people which are 46. 61%  white, 28. 07%  African American, 0. 44% Native American, 8.22% Asian, 0. 06% Pacific Islander, 11. 55% from  other races and 5. 04% from two or more races 22. 22% people of the total population are of Hispanic or Latino race. ‘Looks’ will concentrate on the needs and wants of all races as each group has a specific want that need to be satisfied. The Household pattern in Silver Spring is ‘diverse’ as maximum people in Silver Spring are adult live together, single parent family and single live out. 6. MARKETING ENVIRONMENT a. Political and legal factors This environment comprises of laws, government agencies and pressure groups. Business Legislation protects companies from unfair competition, customers from unfair business practices, and interest of the society. Consumer Protection is one of the most important aspect that had to be followed by the business legislation in Silver Spring, maintaining the product quality and disclosing the facts about the product is very important. Anti-competitive agreements among competitors are restrained in Silver Spring. Agreements such as price fixing and customer and market allocation agreements are prohibited in Silver Spring. Economic factors Economic environment helps in determining the strength and size of the market. LOOKS need to analyze the economic environment as the available purchasing power in an economy depends on current income, prices, savings, debt and credit availability in the economy. So its important to analyze the major trends in income and consumer spending patterns. Income Distribution The total number of household in Silver Spring is 30,374. Average household income of the area is $51,653 and the average income of the family is $60,631. The per capita income of Silver Spring is $26,357. 9. 3%(7300 people) of the population are below poverty line. The cost of living in Silver Spring is 40. 12% higher than the US average and the unemployment rate is 5. 10%. The recent job growth trend is negative. c. Social factors Silver Spring people are looking for services and products that provide them ‘Self realization’. Customers have become more value driven in choosing their products or services. Silver Spring organizes several ethnic festivals, musical and entertainment events. One of the most famous film festival i.e. Silver docs Documentary film festival is held every year in the month of June. Silver Spring also organizes Silver Spring Jazz festival which is one of the biggest musical festival which attracts more than 20,000 people. This festival is held on the second Saturday in the month of September. It also hosts American Film Institute Silver Theatre and culture, which showcases American as well as different foreign movies. Silver Spring is one of the major area of Montgomery County, the revitalization of Silver Spring has beckoned diversity of people wide variety of ideas. Thus, Silver Spring had a wide variety of culture. SLP02 7. COMPETITIVE ADVANTAGE ANALYSIS SWOT Analysis : Strengths : * Location, centrally located * Well-trained employees with excellent styling, hair care skills * Customer focused business practice * Wide range of services * Low cost * A powerful strategy supported by competitively valuable skills and experience in key areas * A strong financial condition; ample financial resources to grow the business * Product innovation skills * Wide geographic coverage Weakness : LOOKS will cater to a diverse variety of people of different culture and races i. e. whites, African American, Native Americans, Asians and people of other communities and culture. The Social class which LOOKS will target will be Middle class, upper middle class, Lower upper and upper uppers. Psychographic Segmentation: ‘Lifestyle’ and ‘Style statement’ are one of the priorities of people of Silver Spring. LOOKS will target the audience who are straights, swingers and long hairs having different personality traits. LOOKS will personify the personality of its target audience, by giving a style to their living. 9. SERVICE DESCRIPTION Silver Spring organises lots of cultural festivals, film festivals, and musical events. So LOOKS will cater the need of style needed by the target audience during these occasions. LOOKS will provide a quality service so as to keep the customers satisfied. With the trained and specialized staff it will also be able to speedy service to the client. As people look for quality, convenience and speed. LOOKS will focus in making hard core loyals, through its customer service, quality and style. 10. BUSINESS MISSION LOOKS is committed to provide the best services to its customers, it will provide its customers best professional services in the field of Hair care and styling. With the changing environment, the company will acquire new trends and will upgrade its services to provide best services to its customers. 11. GENERAL OBJECTIVES or GOALS Financial: 1. To reach the breakeven point within two years of the business operations 2. Growth of 10% profits from the base year. Nonfinancial: 1. Expand the operations of business by including new hair care programs within five years. 2. To become one of the best hair care salon in Silver Spring 3. Attracting the customers from the areas near silver Spring 4. Providing best services all round the year. 5. Provide professional services in affordable price. SLP03 12. DISTRIBUTION, LOCATION ;amp; TIMING The primary base of any beauty hair salon is to provide basic hair cut and other hair styling. LOOKS will be one stop solution for all the hair care needs. LOOKS provides hair styling for the entire family. The services of LOOKS will include Haircuts, Formal Styling of hairs, Casual hair styles, coloring, highlighting, perms, deep conditioning treatment, hair care treatment, hair spas, relaxers, massage, hair extension. Service is offered on a walk in basis or by appointment. LOOKS will emphasize a customer-centric service where the customers needs are always the priority. Highlighting is one of the essential services that is demanded by the customers in silver Spring. Coifed hair is one of the famous dress code that is followed by many women at their workplace. Customers not only just look for getting their hairs highlighted, but also prefer the services as cut with waving and smoothing. The main focus of customers in today’s time is quality of service that is provided at the hair salon, they aspire quality services as work place appearance code is one the important aspects of people in Silver Spring. Colouring and highlighting of hairs helps is transforming or changing the look and appearance of the person. Hair straightening and smoothening is also one of the major services that is demanded by the customers. LOOKS will also follow the new trends of hair styling just as blowout styling. LOOKS will also provide therapies and spa treatment which will help in recovering the damage hairs, hair loss and thinning hair treatments. 13. VARIATIONS IN TARGET MARKET LOOKS will tailor its services so that it caters the needs and wants of local customer group as well as immediate neighbours of Silver Spring. People in Silver Spring are of different races and culture so the customers will have diffused preferences, the consumer preferences will be diverse. LOOKS will operate in Silver Spring and its surroundings and will cater all the local variations. It is a suburban area. With the connectivity with two major cities, Washington D. C and Biltmore, it will also target the people residing near Silver Spring. SLP04 14. INFORMATION NEEDS Information on segmentation and competition are essential. Marketing Segmentation is an effort which helps in increasing company’s precision marketing. LOOKS will practice Segment Marketing as it will help in creating large potential market, as LOOKS will provide its services at low cost, it will be able to attract customers and the low costing can help gaining higher margins in future as LOOKS will cater a large market. The main aim of LOOKS will be to create and retain customers, keeping in mind the tastes and preferences of the customers. LOOKS can also create a few fine toned services and can price them accordingly for a high class segment. 15. PERSONAL SELLING LOOKS will adopt Full Market coverage strategy, it will serve all customer groups with all the products they might need. The services and marketing will be designed in such a way that it will appeal the broadest number of buyers. It will aim to endow its services with a superior image in people’s mind. It will try and win price sensitive market by keeping low cost to the services provided. 16. TRAINING * Gap between management perception and service quality specification: This gap occurs when management correctly perceives the requirement of the client but it is not able to provide that service because of the specified performance chart. There are several guideline that a company has to follow. LOOKS will use the products of latest technology so as to serve its clients with the services and style needed. Gap between service quality specification and service delivery: This gap occurs when the personnel is not trained properly and is incapable to meet the standards. LOOKS will focus on training its stylists from few of the top styling professionals, so that LOOKS is able to deliver the specified service required by the client. * Gap between perceived service and expected service: This gap occurs when the customers misperceives the services that is to be provided by the company. LOOKS will minimize the gap between the perceived service and the expected service. It will cater to the expected needs of the clients of LOOKS. LOOKS will give importance to reliability, responsiveness, assurance, and empathy so as provide the determined service quality. 17. INCENTIVES * Gap between customer expectation and management perception: This gap occurs when the management is not able to perceive correctly the requirement and wants of the customer. LOOKS will consult the clients to know their expected needs and wants. The stylists will be trained in the way, that they work in accordance with the expectation of the clients so as to reduce the gap between customer satisfaction and management perception. Gap between service delivery and external communications: This gap occurs when customer satisfaction are affected by statements made by company personnel. LOOKS will focus on meeting the requirement of the clients, the clients who are decisive about the style or the service needed by them will be consulted by our consulting professional who will specially focus on understanding the requirement of the client. 18. EVALUATION OF SELLING PERFORMANCE LOOKS is a customer centred organization. LOOKS has to differentiate its services from its competitors to emerge as the best Beauty Hair Salon in Silver Spring. LOOKS will provide high Performance Quality to its customers. It will provide its customers the style and services as per their specifications. LOOKS will focus on customer satisfaction; the services that will be provided by LOOKS will enable the customer to feel good. LOOKS will provide the adequate and demanded quality to its customers by consulting the customers, the stylist will provide the services as needed by the customer. LOOKS will earn a strong competitive advantage through Personnel Differentiation. LOOKS will train the employees by the best stylists to cater to its customers. The physical space of LOOKS will be another powerful image generator. 19. COMMUNICATION OBJECTIVES LOOKS will help women in balancing their lifestyle, taking care of their hairs. It will be a treat for women who have time. It will be one of the places where men and women can get pampered by the hair treatment, spas and other hair styling and hair care services. LOOKS position itself as â€Å"one-size-that -fits-all†, and â€Å"A mirror to your Image† 20. COMMUNICATIONS STRATEGY The main objective of LOOKS is to build trust in women, once LOOKS is able to gain the trust then they tend to be loyal. Objectives of LOOKS: * Visual excitement environment * Fashion authority * Above average quality and value for money * Customer dedication * Providing unrevealed value to our customers in the quality of services provided by LOOKS * A commitment to putting customer first at all times. LOOKS will focus on building awareness, attracting traffic or eyeballs, turning first-time buyers into loyal repeat customers as it is the Holy Grail of marketing strategies. It will provide new innovative colors as well as style to their clients. As the customers in this industry have diffused preferences, the preferences of the clients will be considered and worked accordingly. The salon will focus on satisfying both Employees as well as customers because if the employees are happy they will keep the customers happy. A Fun to work environment will be adopted to add a spark in the working environment. 21. MEDIA LOOKS will follow the cheapest mode of advertising . i. e word of mouth as it will focus on customer satisfaction. Other modes of promotion will also be followed like advertising through banners and hoardings. LOOKS will position itself as ‘Mirror to your image’. * Newspaper : One page advertisement will be displayed in the leading news papers of Silver spring as Silver spring Gazette, and Mondotimes. It will help in targeting a greater audience as it covers large geographic area. * Front store Display: As these displays are visible by the pass by, it will help in attracting customers. * Banners: these displays will also help it attracting huge customer base. * Radio :Radio is also one of the most effective mode of promotion, In Silver spring there are huge number of radio stations that operate. It will also help in attracting huge customers as radio also targets huge geographical area. AM station like WACA, (1540 AM), W7OP (1500 AM), FM stations like WWDC (101. 1 FM), WCSP (90. 1 FM) * Pamphlets: To increase more awareness, printed pamphlets can be distributed near schools, shopping places, amusement parks. * Specialty advertising: In this LOOKS will advertise by few useful, low cost items bearing the company’s name and address, on few of the items advertising message will also be displayed. This will include ball pens, calendars, memo pads. Maintaining ongoing contact is essential for building relationships. It is the extension of engaging and focuses on keeping a customer. The objective is to increase the customer base, and retaining customers and engaging them on an ongoing basis results in increased product service opportunities and provides the opportunity to learn more about the customer, and forge closer relationships. 23. SALES PROMOTIONS LOOKS has to build effective communication strategy so as to capture maximum market. LOOKS has to work to develop an insight in people. LOOKS will be positioned in the mind of people as â€Å"one stop solution for hair care and styling†, one-size-that -fits-all†, and â€Å"A mirror to your Image†. LOOKS has to follow â€Å"learn-feel-do† model for determining its communication objective as the target audience has high involvement with a service provided to have differentiation. 24. ADVERTISING AND PROMOTIONS EFFECTIVENESS Competition and Buying patterns of people of Silver Spring LOOKS competitors include: 1. Traditional Barbers: 2. Franchised Quick Salons 3. Independent Salons Ebony Barbers Unisex ;amp; Fenton Barber Shop are the main competitors of LOOKS. The buying patterns of men and women are quite different. Men are more sensitive towards pricing and convenience. Women are concerned and conscious with their styles and trends that are being followed. Monitoring needs to be carried out effectively, and that the feedback gained is useful and appropriate, it is also imperative that feedback is considered in any future decision-making SLP05 25. OVERALL COSTS The average price that we will charge for the styling of hairs will be approximately $100. The fixed cost will be approximately $100,000 per year including the equipments and the variable cost will be approximately $25 which will mainly include the electricity expenses, employee cost and other miscellaneous cost. Calculating the break even point: BEP = [FC ? (P – UVC)] BEPQuantity = [$100,000 ? ($100 – $25)] = 1333 customers BEPRevenue = 1333 customers ? $100 = $133300 The above figures are tentative and subject to change with the market conditions and demand. LOOKS will follow super value strategy, it will provide high quality of service in low price, so as to attract maximum customers. LOOKS initial focus is to attract maximum customers. It will follow Market penetration pricing, this will allow LOOKS to win the largest market share. New and quality product range of the hair care products will also be kept at the salon as many people prefer these for home use as well and it will turn out to be one of the channels for sale for high premium brand products. 27. TEMPORARY PRICE PROMOTIONS A new style of services will be provide to the client, all their requirements will be considered so as to provide them with the best result, the salon will give a total new look to the client keeping in mind the texture and the nature of his hair using best products and giving best services. The salon will follow distinctive strategy for positioning. The price will be on a lower end, as main motive of LOOKS is to give customers the value for the product and their satisfaction, as Customer value and customer satisfaction are very important for any company or a brand to sustain in the market and capture the market share. LOOKS will be focusing on price-quality effect . i. e. providing high degree of quality product. 28. PROFITS LOOKS will also keep premium  hair care products  for sale as they are one of the important revenue generator, they help in providing 5% to 40% of revenue. These professional quality supplies will include shampoos, conditioners, hair colors, reconstructions, brushes, combs, and other styling aids. 29. LEARNING Attract The critical first step of the customer experience is to attract customers to LOOKS. After attracting, it then need to engage customers to obtain their interest and participation. Engage The key factors at this stage are Convenience combined with interesting and innovative services. Learn Building up a knowledge database on each customer – is an important aspect that needs to be done at LOOKS as it can create value for the customer and help build the brand-customer relationship. Relate By leveraging the multidimensional data gathered from ongoing interactions with individual customers, LOOKS can create value by providing a personalized experience. Customization and good Customer Care help to erect switching barriers and encourages customers to return and repeat the cycle. LOOKS has to focus on generating high customer loyalty by delivering high customer value by designing superior value proposition backed by superior value delivery system. LOOKS success depends on the way it creates and deliver the value which is superior than its competitors, which is develops following capabilities : * Understanding customer value * Creating customer value * Delivering customer value * Capturing customer value * Sustaining customer value LOOKS will focus in making their customers their ‘True Friends’ i. e. it will bbuilding relationships with the right customers Conclusion: The marketing strategy will seek to first create customer awareness regarding the services offered, then develop the customer base, and finally work toward building customer loyalty and referrals. The message that LOOKS will seek to communicate is that the entire family can be served quickly, professionally, with superior customer service at reasonable rates. The message will be communicated through various methods. The first is in-store and storefront displays. This will be a convenient method to attract people that walk past LOOKSs store front. The other method of communication is advertisements in two local newspapers.

The way weaponry has been portrayed. Essay Example for Free

The way weaponry has been portrayed. Essay Theme: The way weaponry has been portrayed. Throughout literature poets have used various literary devices in order to convey their message to the audience. Wilfred Owen has cleverly personified weaponry in the context of war and has woven it in his poems. This in turn accentuates the message he is trying to convey the paradox of War. The use of this tool is most prominent in three of his poems, The Last Laugh, Arms and The Boy and Anthem for Doomed Youth. In these poems he depicts weapons as sinister, flesh-hungry savages whose only purpose is to kill. In Anthem for Doomed Youth Wilfred Owen writes and elegiac sonnet moaning the loss of innocent life. Like his other poems to one too is steeped in irony. War he wants to point out is not fanfare and glory. It is dirt and muck and pain and struggle which ultimately end in death. His view of war is greatly influenced by his own experiences. Disenchanted, brutalised and lied to by his own nation he like so many others felt betrayed. They were taught that war was glorious and soldiers were proud and valiant, the truth of it was that war was none of these and soldiers were being herded like cattle to tthose deaths. He goes on to personify weapons in the Last Laugh as mocking the soldiers that they ruthlessly killed using words such as â€Å"guffawed and chirped† In the poem Arms and the Boy, Owen changes the portrayal of the weapon and showcases it as a toy that is being handed out to a child â€Å"Let the boy try along this bayonet-blade†. Along with the description of the weapon Owen also juxtaposes the loss of innocence that prevailed during the time of war. In the poem Sonnet On Seeing a Piece of Our Heavy Artillery brought into Action Owen portrays weapons as an object that has to be paid respect to, this is shown by the words ‘thou, thee’. He furthermore goes on to personify the guns by saying that he slowly lifted ‘thou long black arm’ and also describes the destruction that they eventually cause. The four poems have a lot of literary devices packed into them such as sound imagery, metaphors and personification which compliment his description of the weapons. World War 1 was the war that changed history. The use of mechanised weapons on an unsuspecting enemy proved to be the biggest challenge. Earlier war was seen as something glorious and even  chivalrous. World War 1 overturned that view, the senseless bloodshed, the ruthless use of weapons made this war anything but glorious. Owen was one such soldier who first hand experienced the horrors of war and unlike poets before him conveyed the reality of war. He and a few others were instrumental in ripping the faà §ade of the honour and glory that war claims to be. His poems are raw, undisguised versions of the harsh reality of what was occurring in the t renches of the Western Front. Wilfred Owen uses a significant amount of literary devices to convey how weapons play a large role in warfare. His poem the Last Laugh begins with an expletive, ‘Oh! Jesus Christ! I’m hit’ the title itself is rich in irony as the poem goes on to depict how the weapons that are personified ‘chuckle’ and ‘guffaw’ at the soldier’s death. Lines like ‘the bullets chirped, machine guns chuckled†¦and the Big Gun guffawed’ reveal the dark humour that underlies the poem. The use of onomatopoeia adds to the chilling darkness of the imagery, â€Å"tut tut and the way the splinter spat and tittered’ are evidence of this. His use of alliteration enhances the poetic tempo. The ‘lofty Shrapnel’ is personified as it ‘gestures leisurely’ at the dying man calling him fool. Weapons are further personified as grim, hostile entities. The Bayonets have ‘long teeth’ and grinned as ravels of shells ‘hoot and groan and gas hisses’. The use of capital letters to classify the weapons furthe r draws attention to their significance, in this case as purveyors of destruction. In Arms and the Boy, Owen depicts how innocence is destroyed by war. The title itself seems like an oxymoron because children are usually not associated with weapons. The poem begins with a calm suggestion of letting the boy try the bayonet blade and see how ‘cold the steel is’ The bayonet itself is personified as a creature with a predatory nature, ‘it’s keen with hunger of blood’ its appetite is further described as ‘famishing for flesh’ this use of alliteration of fricative sounds embellishes the rapacious nature of the weapon, it is described as being ‘blue with all malice, like a madman’s flash’ this simile conveys the cruelty and evil that is associated with this weapon. By using explosive sounds and the use of adjectives such as cold increase the sinister effect of the weapon. The second stanza similarly begins with a tender gesture asking the young boy to ‘stroke these blind blunt bullet leads’ the use of consonance  adds to making the bullets seem less deadly than they are words such as ‘ long to nuzzle’ portray warmth but ironically the euphuism , ‘in the hearts of lads’ stands for the death of young children. Cartridges are described as having fine zinc teeth, their sharpness is compared to ‘the sharpness of grief and death’ in saying ‘give him’ these weapons of destruction the poet is juxtaposing innocence with experience and death. Owen does so in a manner that seems innocuous asking the boy to play with these objects of death and destruction. The third stanza ‘his teeth seemed for laughing round an apple’ conveys the idea of childish innocence. The young boy does not have fangs nor ‘claws behind his fingers supple’. Furthermore Owen writes ‘God will grow no talons at his heels or ‘antlers through the thickness of his curls’. This conveys that God had not meant for man to be like a beast. Man needs to arm himself with weapons to don the mantle of a predator. In showing the young boy through the ‘thickness of his curls’ further implies how angelic and innocent he is. Owen is bereaved that he will one day pick up the weapons of destruction and will thus be robbed of his innocence. Owen uses many literary devices such as personification to depict the weapons he says the cartridges ‘have fine zinc teeth’ and the bayonet is described as being ‘keen with hunger of blood’. The poet alludes to Virgil’s epic the Aeneid ‘of arms and the man I sing’. The poem itself uses half rhyme and alliteration ‘famishing for flesh’, ‘blind blunt bullet leads’ to convey the tone of the poem which is largely sinister. In his poem ‘Anthem for doomed youth’ Owen takes the theme of how weapons destroy one step further. Here to the imagery is stark and the poem begins with sound imagery, ‘what passing bells for these who die as cattle?’ The reference to cattle further shows the diminished emotion that war instils in humans. Soldiers are equated to cattle and the death knells are merely in passing. Written as a Petrarchan sonnet with a ABA rhyme scheme Anthem for doomed youth vividly demolishes the myth of soldiers being valiant of glorious in battle. Here too weapons are personified guns are shown as having ‘monstrous anger’ and ‘the stuttering ripples rapid rattle’ The use of alliteration further enhances the sound imagery as the reader is transported back in time. Word s such as ‘stuttering and patter’ convey a sense of grief and hesitation. There is no one to grieve for those who have  died, ‘no mockeries now for them†¦nor any voice of morning save the choirs’ and these choirs are that of the ‘shrill demented, wailing shells’ by using words such as wailing and mourning Owen is trying to depict the harsh reality that the soldiers had to face. There is neither fanfare nor celebration ‘and bugles call for them from sad shires’ the soldiers are portrayed as the forgotten, remembered only in the ‘pallor of girl’s brows’ And in the ‘tenderness of patient minds’. Owen juxtaposes very interestingly the two themes of religion with war. The imagery of candles and flowers are harshly juxtaposed against that of death and pain. His use of mild innocuous language contrasts sharply with the violence of the action depicted. The two stanzas are starkly different as the first vividly describes the horror of war and the second the hope of the families left behi nd waiting for fathers, brothers, sons to return. The disillusionment and bitterness is illumined in this poem. The tone is contrite and bitter and a sense of irony pervades the poem. Written as a eulogy the heading conveys the theme perfectly, it is truly an Anthem for the youth who are doomed to die in a war that made no sense. In the Sonnet that Owen wrote he describes the weapons initially as an object those posses’ majestic qualities. He praises the gun by calling it â€Å"Great† which shows his respect for this artillery. He furthermore shows the Gun ‘towering towards heaven’ which shows that the gun is about to attack God himself, portraying the amount of power that it posses. He personifies the gun and lifted its ‘long black arm’. He also describes the canon as a weapon that protects its soldiers as well as kills. Throughout this poem he admires the weapons but the last two lines reveal his true perception of artillery. Harsh words such as ‘cut thee from our soul’ shows the level of resentment that he has against weapons as he also asks God to ‘curse thee’. The title itself is absurd as a Sonnet is a poem that is addressed to a lover however he uses it differently and uses it to both praise the weapons as well as criticise them. All of Wilfred Owens poems are bound by the sense of irony. His poems resound with pathos. He truly conveys the pity of war and doesn’t seek to elevate it as poets in the past did. His poems are stark snippets of reality as were experienced by young soldiers in trenches. The horror, the infestation the overpowering stench of war is all beautifully conveyed through his poetry. His poetry does not want to gloss  over reality it is reality.