The practice of pilgrimage during medieval times Essay Example for Free

The practice of pilgrimage during medieval times Essay Examine and Comment on the practice of pilgrimage during medieval times and its significance in the medieval church As pilgrimage in medieval times is a very large topic to explore, I have decided to use Canterbury as my focus. Canterbury was and is still seen as a very important place for pilgrimage and was the main reason why pilgrims from other parts of England, Europe and all over the world have come to venerate St Thomas Becket. I want to examine how pilgrimage at Canterbury developed and evolved from Beckets death in 1170 to the Reformation in the 1500s. What kind of an effect did this have on the Cathedrals revenue; surely the Cathedral saw a large profit? Even though people had been visiting Canterbury for centuries in small groups so that they could respect and honour saints like Augustine, Dunstan and Alphege, however, was it pilgrimage to the shrine of Thomas Becket, the murdered Archbishop, which made most the money for Canterbury?Did pilgrimage to his shrine help to make a very wide impact on pilgrimage in England as it brung the majority of pilgrims to Canterbury Cathedral? During the medieval ages Canterbury Cathedral saw its peak years in terms of the number of visitors and revenue generated as well as its downfalls which I would like to explore along with the common criticisms of pilgrimage. R.Finucane begins his book Miracles and Pilgrims by asking why pilgrims in the early middle ages would be drawn to the mouldering remains of a saint. The answer is most likely to be because they wanted a cure for their illnesses. Finucane describes cripples writhing on the floor of Beckets simple tomb1Thomas Beckets death in 1170 had a massive effect on the number of pilgrims that came to Canterbury. After he died in 1170 news of miracles spread almost immediately, not just in Canterbury but in other places around England. For example two days after the killing a Gloucester girl was cured of a head complaint after praying to the martyr2 A monk called Benedict who was responsible for the relics recorded the first set of miracles. The following year another Canterbury monk, William recorded 483 miracles. Between the two monks the total which was recorded was 703 miracles in the first ten years after the Archbishops death. From these results we can see that William recorded a larger number of miracles than Benedict which shows that the news of miracles at Canterbury had spread widely even between the early years of 1171 and 11723. Sarah Hopper also tells us that it is estimate that almost a third of visitors to the shrine were foreign and it is also interesting to note that his shrinew received more foreign pilgrims than any other. This large number of miracles that occurred would have encouraged more pilgrims to gradually come to worship at the shrine of St Thomas Becket and when pilgrims first started to visit the Cathedral to venerate Thomas Becket their experience would be a very ordered process. When they got there, there would be welcomed by a monk who would act as their guide and lead them on a tour which was very well structured. Monks would lead the pilgrims to the North transept which was the first pilgrimage station where Becket was murdered. From here the pilgrim would see a column removed and an altar in it place to mark the spot, they would see two broken pieces of steel that had shattered Richard le Brets swords. This reminds pilgrims of the horrendous nature of Beckets death. However what was achieved by Beckets martyrdom was a better understanding and appreciation of what Becket suffered for his beliefs. Some pilgrims might also go up the stairs, on their knees if they wished to the high altar where Beckets body was left the night of his murder. Ascending this path towards the shrine would have been very symbolic for the pilgrim. The quality of the shrines location was of a very high quality as it was at the highest end of Canterbury Cathedral. This was because by following this course the pilgrims would be enacting not only the last steps taken by Thomas Becket but they would be also on a spiritual journey themselves. The next station they may visit is the crypt where the atmosphere was very different, more sombre and still. There they would see Beckets tomb raised and there would be two oval holes where pilgrims placed their heads or their hand against the stone coffin. In John Adairs book The Pilgrims Way he notes that a foreign pilgrim once wrote that church seemed to be piled on church, a new temple entered as soon as one ended4. This implies that the Cathedral was slightly overwhelming for many pilgrims going from station to station, all of which having their own significance. When they had seen scenes of Beckets miracles in the stained glass windows this would encourage many to filled their lead ampullae at the Wall of St Thomas. This water which could be brought at Canterbury was said to contain some of the saints blood. When Becket died the monks used cloth to salvage some of the blood from the saint. This water was also given to many churches in England. This would also see the spreading of the message about Beckets divine healing power. Was this water effective in miraculously curing diseases? Adair also mentions John who was a chaplain to the Archdeacon of Salop was bothered by an unlpeasant polypus in his nose. It started to cause paralysis he described the sensation of the water as cold as ice, chasing the disease through his body and almost freezing his brain5 after a large sneeze he came across a cherry stone in his mouth. He was healed and walked home and he would not leave the cherry-stone behind as it was his evidence of a divine intervention On 21st Febraury 1172, Becket was canonised by Pope Alexander III which brought a larger number of pilgrims to Canterbury. By making someone a saint this would increase their popularity and make them better known. The cult of Thomas Becket had now officially began and thus leading to more people wanting to make their pilgrimage to Canterbury.One can only assume that Pope Alexander heard about Thomas Becket through news of him spreading because of pilgrims. Pilgrims also came to Canterbury to seek penance from St Thomas Becket. Penace was a common reason for many pilgrims to go on a pilgrimage. This was the idea that if you commited a sin you would carry out a pilgrimage to beg forgiveness at the shrine of a saint such as Thomas Becket. Chaucer (c1340 -1400) described, when a man has sinned openly, of which sin the fame is openly spoken in the countryCommon penance is that priests enjoin men commonly in certain cases, as for to go, peradventue, naked in pilgrimages or barefoot One example of a pilgrim who walked in a sackcloth among pilgrims and also barefoot was Henry II, who was also the most famous pilgrim who sought forgiveness Furthermore he was also the most famous royal pilgrim who sought redemption at Beckets shrine after his men murdered the Archbishop. He walked barefoot from the West gate of the city to Beckets tomb. He allowed himself here to be scourged. This was not an unknown act amongst pilgrims. It was a frequent practice and seen as a punishment for those who were making a penance at Canterbury. The pilgrims would be beaten with rods by the clergy. Pilgrimage can also be seen as a spiritual journey as Langland describes that You must travel , both men and women, through Humility, until you arrive at Conscience: there Christ may know for certain that you love God above all else6. So, this highlights the religious importance behind doing a penance as well. It was mainly local people who would come to visit Beckets tomb up to 1220 when his bones were translated to the new Trinity Chapel which stood on the site of the old Trinity Chapel. However, why did they choose to move his body there? a Canterbury monk explains that it stands on the site of the old Trinity Chapel, where he celebrated his first mass, where he was wont to prostrate himself with tears and prayers, under whose crypt for so many years he was buried, where God for his merits had performed so many miracles, where poor and rich, kings and princes, had worshipped him, and whence the sound of his praises had gone forth into all lands7. These associations with the Archbishop was why they chose to translate his body to the new Trinity Chapel Festivals Celebrated at Canterbury Festivals celebrated at Canterbury would also attract more pilgrims to Canterbury. People would crowd around the doors outside the Cathedral on the vigils of the Translation and of saints Martyrdom. Here pilgrims may spend the night. Examples of activities that pilgrims would do include prayers, devotions, games and music. However, this would also give the opportunity for many thieves to steal from the pilgrims as they would often wander around the large crowds. Beckets translation led to the annual Canterbury fair on the 7th July which was The Feast of the Translation. Many booths and stalls would be opened making a lot of money from visitors. As the Feast of the Translation was set in the summer and not the winter like The Feast of St Thomas of Canterbury has attracted a larger number of pilgrims from further away. It is said that the first jubilee in 1220 gained a sum of à ¯Ã‚ ¿Ã‚ ½1,142 5s 8. This sum was mainly made up of the offering to the saints shrine and also the site of t he martyrdom There were also other factors which affected the revenue which were of a more social and political nature. For example when the Cathedral hosted the Black Princes funeral in 1376 and the crowning of King George and Queen Isabella in Canterbury Cathedral this saw extremely high amounts in these years. The Customary and revenue at Canterbury It was very important for the shrine to be well guarded every day and night because they had many important tasks to carry out. There was a guide of the custodians duties called the Customary which was written by two monks. There were two guards in the Trinity Chapel one was temporal and the other spiritual. In the summer they would get up at five and it would be six in the winter. They would celebrate a daily Mass in honour of Becket at his shrine and the spiritual guard was responsible for this as well as ringing a bell to gather the pilgrims . These guards also had to ensure that the pilgrims were well looked after because many would be exhausted so they would be offered food and refreshments. Before the Feast of the Translation they had to prepare the shrine for the festivities which were about to take place. The Customary also lists the expenditures from the coins that were offered at the shrine. We assume that because of the many people that visited the shrine the Cathedral generated a great amount of revenue. However, Woodruff calculate that even though there were large some of money received by the Cathedral on both of its own Jubilee years of 1320 and 1370 the cellarers expenditures were extremely large and the accounts show an unfavourable balance9. In other words, this emans that more money had been spent than generated at Canterbury Cathedral at this time. The Corona Beyond the Trinity Chapel at the very eastern end of the Cathedral a special unique chapel was added to protect the Corona or Beckets Crown which was a thin saucer of bone that had been sliced from the Saints skull. This would have also brought more pilgrims because it was a holy relic. Pilgrims would venerate the segment of skull that had been set in a golden likeness of his head encrusted with gold. The Black Death (1349 -51) in the fourteenth century also had its impact on the practice of pilgrimage in Canterbury. The potbreak in 1348-9 led to the shrine of St Thomas Becket benfiting finacialy through generous offerings. Around this time many may have gone to Canterbury in the hope that they would be healed. At this time when the Black Death was at its worse St Thomas saw some very generous offerings as well as St Mary who was in the undercroft However, in the 1400s how did the practice of pilgrimage develop? Offerings from pilgrims would add up to à ¯Ã‚ ¿Ã‚ ½700 at the shrine alone itself. Was the practice of pilgrimage at Canterbury any different at all from its earlier stages ? It wasnt an ordered process anymore. It would be a much noisier atmosphere compared to the early stages of pilgrimage at Canterbury. Many pilgrims would visit Beckets shrine at the apex of steps and altars. For a few coins pilgrims had the opportunity to see the canopy of Beckets shrine raised up and this would reveal gold and silver ornaments and gems and rubies. After the pilgrims had seen the sights at Canterbury and spent a night perhaps at Eastbridge Hospital they would leave the next day with phials of Canterbury water. This was their proof to their neighbours that they had seen he famous tomb of Thomas Becket. However criticisms of pilgrimage to Canterbury soon developed and it is becoming more and more evident that people were lavishly spending their money on souvenirs. William Thorpe was charged with heresy by the Archbishop of Canterbury in 1407 because he expressed his views of how he believed that it was a disservice to God by wasting money and forming rleations with lascivious women in places such as Canterbury as well as Walsingham10 . Did the medieval pilgrims actually abuse pilgrimage or was their behaviour natural because of society at the time. This is certainly the reason as People in medieval times were eager to travel to new places and were probably overwhelmed by the sights and wanted to purchase items as proof that they had seen the famous tomb. However, the more people that came to Canterbury Cathedral the more revenue that was gained Diana Webb notes that in 1370 Simon Sudbury, bishop of London told a group of pilgrims that were on their way to Canterbury for the Jubilee indulgence that they would receive no benefit from it11. The group of pilgrims who had heard this accused the bishop of criticising the merits of Thomas Becket. They prophesised that the bishop would meet an evil end and he was killed by the rebels from Watt Tylers rebellion in 1381.It was also commonly believed that as saints were able to leave their graves so a man didnt have to come in contact with a relic to invoke them or even punished by them. Then when a woman called Aliza heard that a woman had lost their sight after visiting Beckets tomb she burst out laughing, saying, Others whom the Martyr receives in sickness, he sends back healed, you, however, went there well, and now return blind. While dissolved in laughter, Aliza was suddenly blinded, and eventually only partially cured12. Others may citicise motive such as going on pilgrimage for casual sexual experiences and some may use the journey in order to commit adultery. Is there any evidence however that pilgrimage was abused in this manner? Sarah hopper tells us that most of Chaucers pilgrims show to a certain degree their lack of moral values and spiritual discipline. This In 1500 a Venetian described how he saw the shrine the magnificence of the tomb of St Thomas the martyr, Archbishop of Canterbury, is which surpasses all belief13. This was certainly the case until the Reformation where it is written that twenty -six wagons were required to transport all the trasures away from Beckets shrine when Henry VIII destroyed it. After 1538 when Henry VIII destroyed Beckets shrine and his bones there was no longer the amazing shrine for pilgrims to see. However, pilgrimage had again changed before Henry VIII destroyed the shrine . In 1532 there was evidence in a decrease of revenue. In one of the sacristys books a note that the combined offerings at the cathedral added up to à ¯Ã‚ ¿Ã‚ ½ 13 13s 3d and this about thirty times less than received at the shrine when pilgrimage activity at Canterbury was at its highest. After the Reformation, Canterbury saw a significant decrease in pilgrims visiting the Cathedral. In 1538 when Henry VIII destroyed Beckets shrine and his bones there was no longer the amazing shrine for pilgrims to see. Overall, pilgrimage to Canterbury had developed greatly in medieval times from Beckets martyrdom in 1170 to the Reformation in 1538. Early key episodes such as Beckets murder in 1170, his canonization in 1173 and his translation have seen a significant increase in pilgrims coming to Canterbury. The main motive seems to be in order to get healed because it is was news of his miracles spreading further that more people visited the tomb and then the shrine. Its most significant increase as suggested my most scholars such as Dianan Webb, was in 1220 when his bones were translated because of what medieval life was like this would have been a breathtaking and an amazing sight to behold. As time goes on motives may have been more based on seeing and just as an opportunity to travel. There are criticisms that have developed and even though we assume because of the large number of pilgrims that visited Canterbury and even though large sums were offered, it seems that because of large expenditures this did not make the cathedral much of a profit. When Henry VIII destroyed the shrine this meant that there wasnt much for people to see anymore seeing what seemed to be an end to pilgrimage at Canterbury. Overall, I believe it was Thomas Becket who William Langland describes a symbol of resistance to oppression of the Church by the secular power of his day14 which was the main reson that pilgrims ventured to Canterbury. 1 R. Finucane Miracles and Pilgrims- Introduction page 9 2 William Purcell- Pilgrims England Chapter 7 Canterbury and St Thomas p.167 3 Sarah Hopper- To be a Pilgrim The Medieval Pilgrimage Experience Chapter 5 p.60 4 The Pilgrims Way- John Adair page 68 5 The Pilgrims Way- John Adair page 40 6 Piers Plowman- William Langland passus V page 61 7 The Pilgrims Way- John Adair page 68 8 To be a pilgrim- Gods Magic Shrines and Miracles Sarah Hopper p.127 9 European Pilgrimage- Indulgences and Jubilees pg 73 10 To be a Pilgrim chapter Oppositions to Pilgrimage- Sarah Hopper page 162 11 Pilgrims and Pilgrimage Diana Webb- page 72 12 R. Finucane Miracles and Pilgrims- p.34-5 13 Pilgrims England Chapter 7 Canterbury and Thomas William Purcell page183

Satisfaction Rates Among Outpatients of Hospital

Satisfaction Rates Among Outpatients of Hospital Assessment of satisfaction among outpatient department (OPD) patients visiting tertiary level government hospital ABSTRACT Background Selection of an appropriate health care and measurement of its quality is very complex and elusive yet the tools of its measurement have been improving. It is easier to evaluate the patient’s satisfaction towards the service than to evaluate the quality of medical services that they receive. (1) Therefore, a research on patient satisfaction can be an important tool to measure of health system performance and improve the quality of services. (2,3). Satisfaction manifests itself in the distribution, access and utilization of health services. Objective: The main objective of this study is to measure the satisfaction of OPD (Outpatient Department) patients in tertiary care public health facility namely Guru Gobind Singh govt. Hospital, Jamnagar, Gujarat. Materials and Methods: Data were collected from a pre-tested pre-structured questionnaire from 322 patients who gave the verbal consent at the end of their O.P.D visit at tertiary health facility, Guru Gobind Singh Government Hospital, Jamnagar for days from to. The items in the questionnaire referred to particulars of the patients such as age, gender, education, occupation, income, family type etc.; perception of patients towards doctor , paramedical staff, basic amenities and quality of care. The responses were expressed in proportions. The data was tabulated on Microsoft Excel sheet and analyzed using EPI info. Results –Although majority of patients were satisfied with the availability of medicines; availability of information on illness, treatment and prevention; doctor’s patience, compassion and dedication but most of the patients were not satisfied with the behaviour of hospital personnel ;delay in reception of investigation reports ;unhygienic toilets and improper cleanliness of hospital; and lack of availability of drinking water . INTRODUCTION Quality care is the most important dimension of public health and it has emerged as an internationally important aspect in the health care services provision. This quality of care can be measured in terms of structure, process and outcome. Structure refers to the basic infrastructure and facility, process refers to the way the care is delivered and outcome refers to the end result. (4) While measuring health outcome and quality of patient care services, patient’s satisfaction is considered to be important component. Patients’ perceptions about health care systems and his satisfaction seem to have been largely ignored by health care managers in developing countries (12). The outcome of any disease is influenced not only by the appropriate diagnostic and treatment services but also the receipt of satisfactory care from service providers. A satisfied patient is more likely to develop a deeper and longer lasting relationship with their medical provider, leading to improve compliance, continuity of care and ultimately better health outcome. But it is difficult to measure the satisfaction and gauze responsiveness of health systems as not only the clinical but also the non-clinical outcomes of care do influence the patients’ satisfaction ,(5)such as: Quality of clinical services provided, availability of medicine, behavior of doctors and other health staff, cost of services, hospital infrastructure, physical comfort, emotional support, and respect for patient preferences.(6) Mismatch between patient expectation and the service received is related to decreased satisfaction.(7) Therefore, assessing patient perspectives gives them a voice, which can make public health services more responsive to people’s needs and expectations.(8,9) In the recent past, studies on patient satisfaction gained popularity and usefulness as it provides the chance to health care providers and mangers to improve the services in the public health facilities. Patients’ feedback is necessary to identify problems that need to be resolved in improving the health services. Even if they still do not use this information systematically to improve care delivery and services, this type of feedback triggers a real interest that can lead to a change in their culture and in their perception of patients. (10) OPD is the window to any health system and OPD care indicates the quality care of hospital reà ¯Ã‚ ¬Ã¢â‚¬Å¡ected by patient’s perception in terms of satisfaction to the services they are provided.(11)This study was therefore undertaken at OPDs of tertiary level health facility in Jamnagar to measure patient satisfaction. The main objective of this paper is to know the desired level of services as perceived by the patients about various components of out-door patient department (OPD) services. In this study, the OPD is defined as the hospital’s department where patients received diagnoses and/or treatment but did not stay overnight. MATERIALS AND METHODS Study design: Institution based cross-sectional study. Study population: The present study was conducted among the patients attending the outpatient department (OPD) of Guru Gobind Singh government hospital, Jamnagar. Period of study: The period of survey was days from to. Sampling frame: The sampling frame consisted of the outpatient department (OPD) of Guru Gobind Singh government hospital, Jamnagar. . Sample size: fifty percent of the OPD patients. Sampling technique: random sampling technique. The sampling population was interviewed from the most frequented OPDs (Medicine, General surgery, Obstetrics and Gynecology, Paediatrics, Orthopedics, Otorhinolaryngology, Ophthalmology, Skin, Tuberculosis and Chest diseases) according to probability proportion to size based on the past years OPD attendance. Inclusion criteria: A new or referred patient attending the OPD of the respective health care facility who gave verbal consent, Exclusion criteria: Patients working in the health care facility and patients admitted (indoor patients) and follow-up patients attending the OPD of the respective health care facility, who didn’t gave verbal consent or gave incomplete information, were excluded from the study. Selection of patient: The patients attending the OPD of the respective health care facility were selected for the interview by systematic random sampling. Depending upon the previous attendance of the particular department and the time taken to complete the interview, a random number was chosen and every nth patient was selected for the interview. This process was continued till the required sample size was completed. Tools of data collection: Permission to conduct the study was taken from the superintendents of the concerned health care facility. All the patients were interviewed after they had consulted the doctor. Informed verbal consent was taken from all the participating patients before the start of the interview after telling them about the objective of the study and the approximate time that will be involved in the completion of the interview. The prescribing doctor was largely kept unaware of the procedure, except in unavoidable circumstances, to avoid the bias in their behaviour with the patient. A pre-tested pre-structured questionnaire was used to record information taking the key elements of socio-demographic characteristics and perception of the patients regarding quality of services available at the outpatient health care facility. Analysis Data was tabulated on Microsoft Excel sheet and analyzed using the software Epi Info version 6. OBSERVATIONS AND RESULTS:- Table 1-socio-demographic profile of the patients:- Among all the subjects interviewed during the data collection, 322 were included in the statistical analysis and the remaining were not included, because of incomplete information. A majority (56.21%) of the responders were male. The mean ages of the responders were years .About 40% of the responders were illiterate. About half (56%) belonged to a joint family. Nearly half of the study subjects belonged to the lower socioeconomic status category as per the Kuppuswamy classification. TABLE 2-PATIENTS’ PERCEPTION OF THE QUALITY OF SERVICES AVAILABLE (n =322) The results regarding each question are shown in Table 2. Most of the respondents were satisfied with the availability of medicines, also they were able to get the medicines easily. Most of the respondents agreed that complete information was provided to them on the illness, treatment, and the methods to avoid illness. Almost half (48%) of the patients were not satisfied with the politeness of the hospital personnel. More than half (61%) of the patients stated that hospital personnel were not helpful. 59 % patients said that the doctor did not give them adequate time while 60% of the patients said that the doctor has given enough time to listen completely to their complains. 57% of the patients were satisfied that the doctor has checked carefully and was readily answering their questions. Almost 50% of the patients were told that the doctor gave them adequate time and didn’t rushed. 42% patients couldn’t easily locate the place of investigation. 55% of the patients didn’t receive their reports in time. 57% of the patients were not satisfied with the cleanliness of the hospital. 69% of the patients were not satisfied with the toilet conditions. 59% of the patients stated that drinking water wasn’t available in the hospital. TABLE – 3: QUALITY OF CARE Overall 66.45% respondents termed the hospital services as satisfactory, 62.11% were satisfied with the treatment given, but 52.48% stated that the services provided were not worth the money spent, and 40.99% replied that they would not like to visit the facility again in future. [Table 3]. DISCUSSION In our current study, patients were satisfied with the ease of availability of the required medicines while in a study done by Sivalenka (13) medicine supply was an area of concern. Most of patients were satisfied with the information provided to them about illness, its treatment and prevention. Patients were not very satisfied with the behaviour of the hospital personnel .lack of monitoring of staff, due to very high patient load, could be the reason for this. It was observed during the study that the ultimate satisfaction of the patient is their rapport with the doctor. A patient forgets the pain he faces to reach the doctor if the doctor sees him with patience and compassion. In our study, most of the patients were satisfied with the behaviour of the doctor, which was similar to the result of study by Kumar et al (14). More than half of the patients were not satisfied due to the delay in reporting time of the investigations thereby increasing their waiting time which is similar to other studies (17-18). Some of the responder cited inability to locate the departments as a constraint. Lack of proper sign boards leads to difficulty in locating the departments. A good number of patients were not satisfied with the cleanliness of the hospital. Also most of them were not satisfied with the condition of the toilets. As compared with private sector, government hospitals lack in general cleanliness and hygienic toilets, thereby leading to severe patient aversion and dissatisfaction, which needs to be improved .similar findings have been observed in some other studies (13-16) As observed in our study, Overall level of satisfaction of patients towards government tertiary care health facility is low, although patients appeared to be satisfied with the doctors, which seems to be a strong reason of their still existing faith in the tertiary care government hospital. Thus we need to improve the rest of the factors so as to keep up to the expectations of the patients ,thereby try to fulfill the basic need of patient- which is readily available ,easily accessible, and satisfactory health services for all. CONCLUSIONS Efforts should be made to reduce the patient load at the tertiary level facilities so that doctors and other staff can give more attention and time to the patients. The findings of the present study can be utilized to improve the services at public health facilities of the state resulting in the more satisfaction of patients availing such public health facilities. REFERENCES (1)Study on Patient Satisfaction in the Government Allopathic Health Facilities of Lucknow District, India, Ranjeeta Kumari et al Indian Journal of Community Medicine / Vol 34 / Issue 1 / January 2009 (2) White B. Measuring patient satisfaction: how to do it and why to bother. Family Practice management [serial online] January 1999; [9 screens]. Available from: http://www.aafp.org/ fpm/990100fm/40.html. (3) How satisfied are your patients? Family Practice Management April 1998; [2 screen]. Available from: http://www.aafp.org/ fpm/980400fm/fpstats.html (4) Measuring patient satisfaction: A Cross sectional study to improve quality of care at a tertiary care hospital. – by Andrabi Syed Arshad et.al. Healthline ISSN2229-337X Volume 3 Issue 1 January-June 2012 (5) Agrawal D. Health sector reforms: Relevance in India. Indian J Community Med 2006;31:220-2. (6) Jenkinson C, Coulter A, Bruster S, Richards N, Chandola T. Patients’ experiences and satisfaction with health care: Results of a questionnaire study of specific aspects of care. Qual Saf Health Care 2002;11:335-9. (7)McKinley RK, Roberts C. Patient satisfaction with out of hours primary medical care. Qual Health Care 2001;10:23-8. (8)World Health Organization. The World Health Report 2000-Health Systems: Improving Performance. Geneva: WHO, 2000. (9) Rao KD, Peters DH, Bandeen-Roche K. Towards patient-centered health services in India- a scale to measure patient perceptions of quality. Int J Qual Health Care 2006;18:414-21. (10) 6. Boyer L, Francois P, Doutre E, Weil G, Labarere J. Perception and use of the results of patient satisfaction surveys by care providers in a French teaching hospital. Int J Qual Health Care 2006;18:359-64. (11) Assessment of Client’s Perception in Terms of Satisfaction and Service Utilization in the Central Government Health Scheme Dispensary at Kolkata, D Haldar, AP Sarkar, S Bisoi1, P Mondal2Indian Journal of Community Medicine, Vol. 33, Issue 2, April 2008 (12) Measuring Patient Satisfaction: A Case Study to Improve Quality of Care at Public Health Facilities. Prahlad Rai Sodani. Indian Journal of Community Medicine / Vol 35 / Issue 1 / January 2010 (13) Sivalenka S. Patient satisfaction surveys in public hospitals in India. Available from: http://www.rand.org. [Last accessed on 2011 Feb 16] (14) Kumari R, Idris MZ, Bhushan V, Khanna A, Agarwal M, Singh SK. Study on patient satisfaction in the government allopathic health facilities of Lucknow district, India. Indian J Comm Med 2009;34:35à ¢Ã¢â€š ¬Ã¢â‚¬Ëœ42 (15) Peerasak L, Surasak B, Pattanawadi U. Patient satisfaction on health service at the family medicine learning centers. Chiang Mai Med Bull 2004;43:67à ¢Ã¢â€š ¬Ã¢â‚¬Ëœ76. (16) Bhattacharya A, Prema Menon P, Vipin Koushal V, Rao KL. Study of patient satisfaction hospital in a tertiary referral hospital. J Acad Hosp Adm 2003;15:29à ¢Ã¢â€š ¬Ã¢â‚¬Ëœ31 (17) Measuring patient satisfaction a case study to improve quality of care at public health facilities / Ind jcom. Med Vol 35 issi 1 jan 2010, 52-56. Prahlad Rai Sudani et.al. (18)Patient satisfaction with out of hours primary medical care. Quality in health care,2001;10:23-28 R K McKinley, C Roberts.

Natural vs Synthetic Fiber Reinforced Polymer

Natural vs Synthetic Fiber Reinforced Polymer Concrete technology as a branch discipline of technology requires increase in the degree of specialization and consolidation of the fiber material in the cement matrix form composite materials. It requires knowledge of the concepts related to the interaction between the fiber and adhesive cement, mortar or matrix concrete that influence the production and nature of the product. The scientists and engineers have been actively exploring to find the materials that will be used as replacement of conventional materials that can provide a feature best new design and innovation to enhance the material. The development of fiber technology is in the line with the development of knowledge of the material. Following the high demand and innovation in applying fiber, the fiber technology has produced various kinds of fibers potential for commercialization. Participation fiber reinforcement in concrete, mortar and cement adhesive work to improve the engineering properties of many based materials such as fracture resistance, bending strength and resistance to fatigue, impact, thermal shock or chipping. Consolidation of materials in the form of cement mortar or concrete has become an attraction as a building material because it is inexpensive, has the resilience and has a compressive strength and stiffness sufficient for restructuring. However, the disadvantages are located on fragile nature, tensile strength and impact of the weak as well as receptive to moisture movement. Hence, reinforced by fibers that have enhanced capabilities offer a suitable alternative, practical and economical to overcome the lack of features of conventional concrete or mortar. Elements of a fiber is a continuous filament in the form of an express term sheet or spreadsheet form. Fibers can generally be categorized into three types : synthetic fibers, natural fibers and mineral fibers. Synthetic fibers are man-made fibers. It is based chemicals such as petrochemicals and synthetic fibers derived mostly from nylon, polyster, aerylic polymer and polyacrylonitrile fibers used to make fiberglass. There is also a bundle of fibers that make the polymer chain is as strong as aramid and chain bond length as dyneema. While natural fiber derived from natural sources, from plants and animals. Plant fibers are cellulose and lignin-based stacks such as cotton, jute, coir, oil palm bunches, flax and so on. It can be obtained from seeds (cotton, kapok), leaf (pineapple, banana), leather plant (jute, kenaf, rattan, hemp), fruit (coconut, palm) and straw (rice, wheat, barley, grass). Next, animal fibers derived from protein particles like silk and wool. For mineral fibers, it derived from the earths crust and it happens naturally. It is based on asbestos fibers (chrysotile, amosite, crocidolite, tremolite, actinolite, anthophyllite), ceramic fibers (glass wool, quartz, aluminum oxide, silicon carbide) and fiber-metal (steel, aluminum). However, both of natural and synthetic fiber reinforced concrete have their own challenges and weakness. Nothing is being done without deficiencies. Synthetic fiber however has more challenges than natural fiber because of its production. Future development of natural and synthetic fiber reinforced polymer concrete will make us want to investigate more about them. OBJECTIVES To know about polymer concrete and why fiber being reinforced in it. To describe the characteristics of natural and synthetic fiber reinforced polymer concrete. To describe the challenges in environment while using both composite materials in construction. To describe the future development in both composite materials. LITERATURE REVIEW POLYMER CONCRETE AND ITS CHARACTERISTICS Polymer concrete is a composite material in which the binder consists entirely of a synthetic organic polymer. It is variously known as synthetic resin concrete, simply resin concrete or plastic resin concrete. Because the use of a polymer instead of Portland cement represents a substantial increase in cost, polymers should be used only in applications in which the higher cost can be justified by superior properties, low labor cost or low energy requirements during processing and handling. It is therefore important that architects and engineers have some knowledge of the capabilities and limitations of polymer concrete materials in order to select the most appropriate and economic product for a specific application. Polymer concrete consists of a mineral filler such as an aggregate and a polymer binder which may be a thermoplastic, but more frequently, it is a thermosetting polymer. When sand is used as a filler, the composite is referred to as a polymer mortar. Other fillers include chalk, gravel, limestone, crushed stone, condensed silica fume (silica flour, silica dust), quartz, clay, granite, expanded glass, and metallic fillers. Generally, any dry, non-absorbent, solid material can be used as a filler. To produce polymer concrete, a monomer or a pre-polymer which mean a product resulting from the partial polymerization of a monomer, a hardener (cross-linking agent) and a catalyst are mixed with the filler. Other ingredients added to the mix include plasticizers and fire retardants. Sometimes, silane coupling agents are used to increase the bond strength between the polymer matrix and the filler. To achieve the full potential of polymer concrete products for certain applications, various fiber reinforcements are used. These include glass fiber, glass fiber-based mats, fabrics and metal fiber. Setting times and times for development of maximum strength can be readily varied from a few minutes to several hours by adjusting the temperature and the catalyst system. The amount of polymer binder used is generally small and is usually determined by the size of the filler. Normally the polymer content will range from 5 to 15 percent of the total weight, but if the filler is fine, up to 30 p ercent may be required. Polymer concrete composites have generally good resistance to attack by chemicals and other corrosive agents, good resistance to abrasion, have very low water sorption properties and good marked freeze-thaw stability. Also, the greater strength of polymer concrete in comparison to that of Portland cement concrete permits the use of up to 50 percent less material. This puts polymer concrete on a competitive basis with cement concrete in certain special applications. The chemical resistance and physical properties are generally determined by the nature of the polymer binder to a greater extent than by the type and the amount of filler. In turn, the properties of the matrix polymer are highly dependent on time and the temperature to which it is exposed. The viscoelastic properties of the polymer binder give rise to high creep values. This is a factor in the restricted use of polymer concrete in structural applications. Its deformation response is highly variable depending on formulation ; the elastic moduli may range from 20 to about 50 GPa, the tensile failure strain being usually 1 percent. Shrinkage strains vary with the polymer used. For example, high for polyester and low for epoxy-based binder. It must be taken into account in an application. A wide variety of monomers and pre-polymers are used to produce polymer concrete. The polymers most frequently used are based on four types of monomers or pre-polymer systems : methyl methacrylate (MMA), polyester pre-polymer-styrene, epoxide pre-polymer hardener (cross-linking monomer) and furfuryl alcohol. Table 1 : General Characteristics And Applications of Polymer Concrete Products Poly (methylmethacrylate) General Characteristics Low tendency to absorb water. As a result, high freeze-thaw resistance ; low rate of shrinkage during and after setting. Outdoor durability and good chemical resistance. Typical Applications Used in the manufacture of faà §ade plates, stair units and sanitary products for curbstones. Polyester General Characteristics Good adhesion to other materials, relatively strong, good chemical and freeze-thaw resistance but have high-setting and post-setting. Typical Applications Because of lower cost, widely used in panels for public and commercial pipes, buildings, floor tiles, stairs, various precast and cast-in applications in construction works. Epoxy General Characteristics Strong adhesion to most building materials, low shrinkage, good creep and fatigue resistance, superior chemical resistance and low water sorption. Typical Applications Epoxy polymer products are relatively costly. They are mainly used in special applications including use in mortar for industrial flooring, skid-resistant overlays in highways, epoxy plaster for exterior walls and resurfacing of deteriorated structures. Furan-based polymer General Characteristics Composite materials with high resistance to chemicals which most acidic or basic aqueous media, strong resistance to polar organic liquids such as ketones, aromatic hydrocarbons and chlorinated compounds. Typical Applications Furan polymer mortars and grouts are used for brick such as carbon brick and red shale brick, floors and linings that are resistant to chemicals, elevated temperatures and thermal shocks. Source : Blaga, A. and Beaudoin, J.J., (1985). Polymer Concrete. Canadian Building Digest published November 1985. THE CHARACTERISTICS OF FIBER AND TOUGHNESS CONCEPT Characteristics of fiber in use to hardened concrete : Fibers should be significantly stiffer than the matrix which has a higher modulus of elasticity than the matrix. Fiber content by volume must be adequate. There must be a good fiber-matrix bond. Fiber length must be sufficient. Fibers must have a high aspect ratio. Means that they must be long relative to their diameter. Toughness is defined as the area under a load-deflection (or stress-strain) curve. Adding fibers to concrete greatly increases the toughness of the material. That is, fiber-reinforced concrete is able to sustain load at deflections or strains much greater than those at which cracking first appears in the matrix. NATURAL FIBER REINFORCED POLYMER CONCRETE AND ITS CHARACTERISTICS Potential use of natural fiber reinforced concrete in the application of natural fibers has long attracted the attention of researchers. Various researches has been conducted in many countries for a variety of mechanical properties, physical performance and durability of materials reinforced by natural fibers. Natural fibers are categorized as organic waste from plants such as fiber coconut, sisal, bagasse, jute, wood dust and so on. Natural fiber reinforced concrete is essentially a special concrete where it contains fibers with a small diameter, independently and randomly distributed in the cement matrix. Uniform distribution in the cement matrix, contributing to an increase in the tensile and resistance to cracking, impact and improved the ductility values à ¢Ã¢â€š ¬Ã¢â‚¬ ¹Ãƒ ¢Ã¢â€š ¬Ã¢â‚¬ ¹for the good aspects of energy absorption. Although many types of fibers were used as reinforce material in concrete, the use of natural fibers had long been in existence and there is a lot of evidence of the usage of these fibers in the history of civilization. Nature has given human the fiber reinforced material in the form of wood, bamboo and other plants. The use of straw in mud bricks and horse hair in the mortar has the potential of natural fibers. Only in the late 1960s and early 1970s, research began to study the potential use of various types of natural fibers as reinforcement material in the slab concrete and cement-based composite materials. Natural fiber reinforced cement or concrete products that use fibers such as coir, sisal, sugar bagasse, bamboo and so on have been produced and tested in more than 40 countries. For economic reasons in developing countries where natural fibers is so much available, it is demanding for construction industry players to enhance the usefulness of these resources in an effective and economical as to introduce composite materials for residential use and others. Basic needs use of natural fibers as reinforcement material in concrete matrix is à ¢Ã¢â€š ¬Ã¢â‚¬ ¹Ãƒ ¢Ã¢â€š ¬Ã¢â‚¬ ¹tensile strength and high elastic modulus, the bond between the matrix and fiber, good chemical composition, stable geometry and good durability. SYNTHETIC FIBER REINFORCED POLYMER CONCRETE AND ITS CHARACTERISTICS Synthetic fibers are man-made fibers resulting from research and development in the petrochemical and textile industries. There are two different physical fiber forms: monofilament fibers, and fibers produced from fibrillated tape. Currently there are two different synthetic fiber volumes used in application, namely low-volume percentage (0.1 to 0.3% by volume) and high-volume percentage (0.4 to 0.8% by volume). Most synthetic fiber applications are at the 0.1% by volume level. At this level, the strength of the concrete is considered unaffected and crack control characteristics are sought. Fiber types that have been tried in concrete matrices include : acrylic, aramid, carbon, nylon, polyester, polyethylene and polypropylene. The characteristics is depend on the types of synthetics used to reinforced with polymer concrete. Different fiber has different properties. Adding carbon fiber decreased the unit weight of polymer concrete. Carbon fiber provides much higher compressive strength, flexure strength and ductility of polymer concrete. PVC and polypropylene fibers did not significantly influence the compressive strength and gave the lowest pulse velocities and modulus. NATURAL VS SYNTHETIC FIBER REINFORCED POLYMER CONCRETE : CHALLENGES The challenges of polymer concrete are the monomers of polymer can be volatile, combustible and toxic. Initiators, which are used as catalysts, are combustible and harmful to human skin. The promoters and accelerators are also dangerous. Natural fibers are emerging as lightweight, low cost, and more environmentally rather than synthetic fibers in composites. This is because : natural fiber production has lower environmental impacts compared to synthetic fiber production. natural fiber composites have higher fiber content for equivalent performance, reducing more polluting base polymer content. the light-weight natural fiber composites improve fuel efficiency and reduce emissions in the use phase of the component, especially in auto applications. end of life incineration of natural fibers results in recovered energy and carbon credits. A compound reinforced with natural fibers is not only low density, low-cost, and abrasion resistant, it also offers an absence of toxicity and better dimensional stability. Polyester raw material releases high amounts of carbon dioxide. This rapidly increases global warming, which is why polyester and other synthetic fabrics are widely discouraged. The other reason is that some synthetic fabrics come from non-renewable resources such as oil. Eventually rise of these synthetic fibers usage have been causing environmental problems such as dumping and recycling. In addition, glass fiber can cause acute irritation of the skin, eyes, and respiratory tract. Mainly concerns have been raised for long term disease such as cancer and lung scarring. Moreover, when released, glass fiber does not decompose and hence again it results in environmental pollutions, as well as, threaten animal life and nature along. Therefore, one of the solutions is using natural fibers instead of synthetic fibers in developing composites materials as they are renewable. Also the consumption of renewable resources would provide positive image for sustainability of green environment. Natural fibers are less harmful to the environment and the society because they are derived from plants and animals which are more eco-friendly. Products which manufactured from natural fabric eventually dissolves into the earth. Plant and animal based fabrics are a part of the evolutionary process of life. They return to the earth to return once more to life. Synthetic fibers are more harmful to the environment because they are enhanced with chemicals. Polyester and nylon fabrics are made from a substance which creates nitrous oxide. Materials that are labeled petrochemical, flame retardants, nylon, acetate and non-wrinkle are all chemically treated. Chemicals which used for the manufacture of synthetic fabrics is harmful and can enter into the water supply and cause health problems. Also workers who are continuously exposed to dangerous chemicals are at risk for developing auto-immune diseases and disease of the lung. Products made from petrochemicals take years to break down, creating a constant need for landfills. Synthetic products that are disposed into the ocean are a threat to marine life. The threat to aquatic animals will eventually precipitate a food shortage. Although, synthetic fibers may offer softer fabrics and more durable materials, the long term effect on the environment far outweigh any advantages. The high cost of petrol along with global awareness of how natural fibers improve overall quality of life will help motivate manufacturers to find more innovative ways to utilize natural fibers. NATURAL VS SYNTHETIC FIBER REINFORCED POLYMER CONCRETE : FUTURE DEVELOPMENT Synthetic : Although not investigated extensively, the use of two or more fiber types in the same concrete mix is considered promising. The decision to mix two fibers may be based on the properties that they may individually provide or simply based on economics. Considerable improvement in the load deflection response was observed mixing steel with polypropylene fibers. In a more recent study, steel micro-fibers (25 microns in diameter and 3 mm long) and carbon micro-fibers (18 microns in diameter and 6 mm long) both in mono- and hybrid- forms were investigated. In the mono-form, steel fiber provided better strengthening than the carbon fiber and carbon fiber provided better toughening than the steel fiber. Interestingly, in the hybrid form (in combination), they both retained their individual capacities to strengthen and toughen. It appears possible, therefore, that by properly controlling fiber properties and combining them in appropriate proportions, one can actually tailor-make h ybrid fiber composites for specifically designed applications. Natural : Environmental awareness and depletion of the petroleum resources are among vital factors that motivate a number of researchers to explore the potential of reusing natural fiber as an alternative composite material in industries such as packaging, automotive and building constructions. However, their applications are still limited due to several factors like moisture absorption, poor wettability and large scattering in mechanical properties. Among the main challenges on natural fibers reinforced matrices composite is their inclination to entangle and form fibers agglomerates during processing due to fiber-fiber interaction. So, the research on natural fiber is being done by mercerization treatment on mechanical properties enhancement of natural fiber reinforced composite or so-called bio composite. It specifically discussed on mercerization parameters, and natural fiber reinforced composite mechanical properties enhancement. It was found that the most parameters used in merc erization treatment were alkali concentration, fiber soaking temperature and fiber soaking duration. Although similar types of reinforced fiber are used, it could give different values in its final composite mechanical properties due to different parameter setting during a mercerization treatment process. Therefore, there is a significant need to conduct further work focusing on main effect and interaction effect of mercerization parameters setting toward enhancement of natural fiber reinforce composite mechanical properties. CONCLUSION In conclusion, natural fiber reinforced polymer concrete has more environmentally characteristics than the synthetic one. But, in the context of advantages, synthetic fiber reinforced polymer concrete has more than natural. Both of them have their own advantages and disadvantages. Because of several characteristics of natural fibers such as moisture absorption, poor wettability and large scattering in mechanical properties, thus it makes reinforcement with polymer concrete a bit less advantageous. Future works will be needed to improve the properties of both natural and synthetic fiber reinforced polymer concrete included with environment impacts.

Essay --

Culture is an integral part of every society. Culture is a learned pattern of behavior or ways by which people live their lives or how society behaves. Some characteristics of the culture of people or a society are their music, food, laws, arts, marriage, festivals among others. Ghana is the first sub-Saharan African nation to gain its independence from the British in 1957. It is located in West Africa and it consists of different ethnic groups with different dialects. One such group is the Ga-Adangbe tribe. The Ga-Adangbe tribe constitutes of the Adangbe and the Ga people of Ghana who form one ethnic group known as the Ga-Adangbe tribe. The Ga-Adangbe people inhabit the Accra Plains. The Adangbe people inhabit the eastern part of Accra while the Ga people inhabit the western part of Accra coastlands. The language of both ethnic groups is from a common proto-Ga-Adangbe ancestral language. There is one notable thing about these ethnic groups in Ghana and it is their culture o f festivals. These festivals range from the naming of a child, puberty rites, marriage and funerals among other things. One of these beautiful festivals that this paper seeks to discuss is puberty rites. The Ashanti tribe who hail from the Ashante Region of Ghana and the Adangbe tribe who hail from Eastern Region of Ghana celebrate this beautiful festival called puberty rites. The Ashanti tribe of Ghana calls this festival or puberty rite â€Å"Bragoro† while the Adangbe people from the Eastern part of Ghana call it â€Å"Dipo.† My focus in this paper is how the Adangbe tribe celebrates the Dipo rite in Ghana. â€Å"No other ritual, in the life of a female Krobo, is of greater importance than – or equal to – the dipo.† Hugo Huber, 1963 The Manya and the Yilo Krob... ...his study will therefore contribute to knowledge in these areas and possibly give ideas for future studies on the subject of the Dip custom. From the foregoing, Dipo is a festival of the Manya and Yilo Krobo tribe to celebrate the puberty of adolescent girls, encourage them to preserve their chastity and to prepare them for marriage. The girls learn lessons on womanhood in preparation leading up to the festival. The Dipo festival has gone through some modification due to some factors such as abuse of human rights. For example, the Krobo people believe that children that are born before their mothers undergo the Dipo rite are cursed. So currently, children under the age of ten years undergo Dipo and not the adolescent girls to afford them to avoid having cursed children, as is their conviction and to avoid exposing their breast to the public during the ceremony.

Freedom of Choice in Steinbecks East of Eden Essay -- John Steinbeck

Our circumstances do not determine our lives. Instead, our lives are determined by our choices. That is not to say that our lives are not impacted by the country in which we were born, the family which we were born to, or the tragedies which touched our lives. We are given a choice of how we respond to those things, and the power of choice means that the lessons and value of our lives is not determined by outside influences, but instead it is determined by our reaction to those influences. In the novel, East of Eden by John Steinbeck theorizes that all individuals have the freedom to make choices in order to triumph over evil. Steinbeck demonstrates this by his use of the word timshel, the word, which translates to â€Å"thou mayest,† is used in the story of Cain and Abel in the Bible. God t... Freedom of Choice in Steinbeck's East of Eden Essay -- John Steinbeck Our circumstances do not determine our lives. Instead, our lives are determined by our choices. That is not to say that our lives are not impacted by the country in which we were born, the family which we were born to, or the tragedies which touched our lives. We are given a choice of how we respond to those things, and the power of choice means that the lessons and value of our lives is not determined by outside influences, but instead it is determined by our reaction to those influences. In the novel, East of Eden by John Steinbeck theorizes that all individuals have the freedom to make choices in order to triumph over evil. Steinbeck demonstrates this by his use of the word timshel, the word, which translates to â€Å"thou mayest,† is used in the story of Cain and Abel in the Bible. God t...

Legal Basis of Implementation of K to 12 Essay

LEGAL BASIS OF IMPLEMENTATION OF K TO 12 1. THE WHY OF OUR BEING HERE TODAY †¦. 2. * THE ENABLED FILIPINO * THE LEGAL BASIS 1987 Constitution – Article XIV, Section 1 – Article XIV, Section 2.1 R.A. 7160 (Local Gov’t Code ) * THE K+12 BASIC EDUCATION REFORM * THE SYNTHESIS 3. The enabled/empowered value-driven, visionary Filipino is the greatest treasure of this nation, a vision shared by every segment of our society, a vision achieved through quality education. 4. Article XIV, Section 1. – The State shall protect and promote the right of all citizens to quality education at all levels and shall take appropriate steps to make such education accessible to all. Article XIV, Section 2 (1). – The State shall establish, maintain and support a complete, adequate and integrated system of education relevant to the needs of the people and the society. 5. WHERE ARE WE AT NOW? Insufficient mastery of basic competencies due to congested curriculum High school graduates (< 18 years) lack basic competencies and maturity 6. Locally, only 6 of every 1,000 Grade 6 elementary students are prepared to enter high school. Only 2 of every 100 4 th year high school graduates are fit for college. 7. Internationally, Filipino youths rank 41st in Science and 42 and in Math among 45 countries. 8. Millions of Overseas Filipino Workers (OFW) especially the professionals and those who intend to study abroad are at a disadvantage. Our graduates are not automatically recognized as professionals abroad. The Washington Accord and the Bologna Accord prescribe 12 yrs of basic education for university admission. 9. The Philippines is the only remaining country in Asia with a 10-year pre-university program Source: Adapted from SEAMEO-INNOTECH Table 3 Comparative Data on the Pre-University Education in Asia Country Basic Education Cycle Total Brunei 12 Cambodia 12 Indonesia 12 Lao PDR 12 Malaysia 12 Myanmar 11 Philippines 10 Singapore 11 Thailand 12 Timor-Leste 12 Vietnam 12 Mongolia recently added grades to make basic education 12 years. 10. Why Add Two Years? Decongest and enhance the basic education curriculum Better quality education for all 11. â€Å"We need to add two years to our basic education. Those who can afford pay up to fourteen years of schooling before university. Thus, their children are getting into the best universities and the best jobs after graduation. I want at least 12 years for our public school children to give them an even chance at succeeding.† – President Benigno S. Aquino III 12. K+12 is not new. The proposal to expand the basic education dates back to 1925. 13. WHAT IS K+12? K+12 mean Kindergarten and the 12 years of elementary and secondary education. Kindergarten refers to the 5-year old cohort that takes a standardized kinder curriculum. 14. K+12 Education Vision Graduates of Enhanced K+12 Basic Education Program will: Acquire mastery of basic competencies. Be more emotionally mature. Be socially aware, pro-active, involved in public and civic affairs. Be adequately prepared for the world of work or entrepreneurship or higher education. Be legally employable with potential for better earnings. Be globally competitive. 15. Studies in the Philippines have shown that an additional year of schooling increases individual earnings by 7.5%. 16. What Will the Society Gain from K+12? K+12 will facilitate an  accelerated economic growth. K+12 will facilitate mutual recognition of Filipino graduates and professionals in other countries. A better educated society provides a sound foundation for long-term socio-economic development. 17. What Will the LGUs Benefit from K+12? EVERY CHILD A PRIDE OF THE LOCALITY Increase employment locally and globally Increase business enterprises More entrepreneurs and investors Improved family income Improved LGU income 18. Studies validate that improvements in the quality of education will increase GDP growth by 2% to 2.2%. 19. How Do We Add the Two Years? Proposed Model: K-6-4-2 Model Senior High School Grades 11 to 12 (16-17 years old) Junior High School Grades 7 to 10 (12-15 years old) Elementary School Grades 1 to 6 (6-11 years old) Kindergarten (5 years old) 20. What is Senior High School? 2 years to consolidate academic skills and competencies and allow in-depth specialization for students depending on the occupation/career track they wish to pursue Skills and competencies relevant to the job market 21. Implementation Plan (proposed) 22. Summary Change is two-fold: curriculum enhancement and transition management. K+12 is a less costly alternative to the present system of education. We have 5 years to address shortages before implementation. 23. * 1987 Constitution Art. XIV, Sec. 1 Art. XIV, Sec.2.1 * R.A. 7160 THE ENABLED FILIPINO: VISION & VALUE DRIVEN * Highly competent; Highly skilled; Emotionally mature; Highly productive K+12 ENHANCED BASIC EDUCATION (K+ 6 + 4 +2) Local Government Units Other Government Agencies THE ENABLED FILIPINO 24. Therefore, this is the perfect time for the K+12 Enhanced Basic Education Reform. It cannot wait any longer. 25. WE COUNT ON YOU!!! Make K+12 your LEGACY!!! 26. Team 4A Dr. Carmelita T. Dulangon Dr. Caredad Labe Dr. Ma. Milagros Velez Dr. Rosalie Pasaol Mr. Bianito Dagatan 27. THANK YOU!!!

Accountability and Transparency in Public Procurement

Accountability and transparency in public procurement Police chief Hemant Karkare died with bullet proof jacket at Chhatrapati Shivaji Terminus on 26/11/2008 at 22:45 PM while attacking pakistani terrorists. Bullet Proof jacket was such low quality that does not work! From the above example, we can easily understood the Public procurement is how much transparent in our country. Moreover, It was not published in any newspaper that who is/are accountable for that Bullet Proof jacket(s). Nobody was accountable nor anybody got punishment!!! We can make a lot of SWOT analysis upon accountability and transperancy, public procurement vs. ommercial procurement etc. but the question is what’s the thresold limit of compromising. Not only India, most of the countries alongwith international agencies such as UNDP and the World Bank are in the process of harmonizing and perfecting their approaches to the diagnosis of financial accountability. Such as World Bank’s Country Financial A ccountability Assessment (CFAA) (CFAA assess the risk that public funds may be used illegitimately, inefficiently or ineffectively, by comparing the financial management standards and practices of agencies using funds against an international or ‘best practice’ standard. Sustainable Public Procurement is one major way of seeking to achieve the UNDP’s good governance goal of â€Å"realizing development that gives priority to the poor, advances women, sustains the environment and creates needed opportunities for employment and other livelihoods. † The United Nations Convention against Corruption (UNCAC) is the first legally binding international anti-corruption instrument. As of 12 July 2012, the convention had been ratified, accepted, approved or acceded to by 161 countries as well as the European Union.On Dec 20, 2011 the Europian Commission officially announced its proposal for the new procurement directives. Literature review Literally accountability mea ns the state of being accountable, liable, or answerable i. e. responsible, by both its people and its elected bodies, for its choices and actions. Transparency denotes the free access to governmental political and economic activities and decisions. Procurement is everything associated with an incoming invoice. This holds true for goods, services, and works.In public procurement transparency and accountability have been recognised as key conditions for promoting integrity and preventing corruption, balancing with other good governance imperatives, such as an efficient management of public resources, providing guarantees for fair competition etc. In order to ensure overall value for money, the challenge for decision makers is to define an appropriate degree of transparency and accountability to reduce risks to integrity in public procurement while pursuing other aims of public procurement. Who is accountable?Every person who is in a position of power on trust is accountable for the u se of that power. Within the execution of any system, there is a hierarchical structure by which each level is accountable to the next higher level, from desk clerk to the cabinet. For instance, the clerk who failed to maintain up-to-date records, the Officer who failed to supervise the Clerk, the Head of Department who is answerable to Parliament, but failed to get sufficient trained staff etc. and so on. But it is easy to pin down who is accountable. Public Procurement & Transparency The goal of Public procurement are : ) serving the organisation, b) appropriate use of public funding, c) efficient use of public funding, d) accountability, e) value for money etc. But the real picture of public procurement is horrible ! The most common practice is â€Å"Low Bid† or H1 bidder. But the â€Å"low bid† is equated to a poor quality standard have often soured the public perception of the profession, even though the interpretation of some of these decisions may have been repo rted out of context. Even through e-procurement always there is a gap exists. Secondly supplying Low quality by paying bribe to govt. fficials is a very common practice. Generally Political powerholder to government servants are engaged in circumvention of their own laws. Lot of examples are failure of budget estimates of revenues and expenditures, avoidance of credit limits through an accumulation of unpaid bills, transfer of amounts toward the end of the year to deposit accounts to avoid lapse of funds, manipulation of performance data and associated means. Hence economic growth and policy measures may not be formulated. General public may not always know what the government is doing.While some countries review of the estimates by the audit agency, or through an assessment by credit rating agencies but this practice work against financial accountability. There are vital gaps in most public budgets and accounts. In several cases, they do not provide information on tax expenditures, outstanding guarantees, non-financial assets, and liabilities including contingent ones. Public procurement operations are subject to various controls: local controls, accounting controls, controls made by fiscal authorities, as well as external controls and audits.As public procurement has become more decentralised, a key concern is the lack of co-ordination between various controls, which has led to some loopholes and overlaps in controls over the procurement process. Only a few countries have mechanisms to ensure coordination of control. A related difficulty is to maximise the use of information produced by different controls. Demand for Public Procurement Public procurement created by external demands. As we know that these are transparency, integrity & accountability. Transparency refers to openness and equal opportunities for all interested bidders.Integrity refers to avoiding improper, wasteful or corrupt and fraud practices. Accountability refers to the fact that public pro curement authorities are responsible for effective, legal, and ethical way of procurements. Public procurement is affected by distinct internal demands. This is serving multiple political goals. This complicates public procurement, because sometimes it is not clear to identify the influence of political powers on public procurements. The second internal demand is serving a large amount of stakeholders. These various stakeholders may have different objectives.Ultimately Common public suffers. There are other factors also affects on the procurement process. 1) Demands on the process from legal regulations. 2) Public procurement is restricted from engaging into long-term relationships with their suppliers. 3) Absence of a perfect competition in public procurement may affects by various ways. Benefits of accountability Poverty is the biggest challenge facing the globe in the new millennium. Government is less accountable and responsive to citizens. All the citizens do not get equal acce ss to government services.Conversely, improvements in governance are associated with higher per capita income, higher adult literacy, lower infant mortality and reduced poverty. Fiscal transparency is a necessary condition for sound economic governance. Timely publication of a budget document enables the market to evaluate government’s intentions and allows itself a constructive discipline on the government. Transparency increases the political risk of unsustainable policies. A transparent public financial accounting policy makes it possible to determine what the government has done and to compare budgeted and actual financial operations.Further, open procurement policies not only facilitate the achievement of basic macroeconomic policy objectives, but also increase the productivity of public expenditure. One of the underlying objectives of improved transparency and accountability is to reduce the extent of corruption in the management of governmental affairs. Points to ensur ing accountability and transparency in public procurements are : Accurate records: A pre-condition for accountability and control. Internal control: A management instrument for improvement. External audit: Must for SWOT analysis.Challenging procurement decisions: Complaint and recourse mechanisms with ensuring public scrutiny. Hence the steps to be taken are: a) Strengthening parliamentary control in big infrastructure projects. b) Governments to reduce the high costs and the distortion effect of corruption in public procurement. c) Ensuring transparency at all phases of procurement, from demand creation to contract management and payment, through unrestricted access to all documents for the Monitor and for all activities, which brings both policy and technical expertise to the project. ) Providing adequate incentives and sanctions for both the public authority and bidders i. e. equal opportunity; f) Provide the right environment for detecting corruption and protects against it. Bes ides raising awareness about the structure and the application of the public procurement systems, we should follow the International common methodology for benchmarking and assessing public procurement systems. The Capacities of Supporting Transparency and Accountability by our civil society is the strength of novel and innovative progress. PARTHA MUKHERJEE [email  protected] com (1018 words)