Health Governance in Bangladesh Essay

The main aim of this assignment is to uncover the dynamics of politics in the agenda setting of the health governance of Bangladesh through investigation of the role of deferent actors. In every policy process politics play an important role in idea generation, formulation and implementation. Policy reform in health sector is not different from other policy reforms. In the process of health policy making of any country, different actors try to bring the governance in their favor through playing significant role. This interaction of deferent actors in governance is known as politics of public policy. In the complex political process of health sector reform viability of special agenda, type of changes in policy reform, vision of national politics play an important role. In Bangladesh, health is one of the most important sectors since good health ensure more social and economic production and good quality of life. Beyond debate, priority of the health sector is forefront in the development discourse, even though, ‘health sector’ it is associated with multi sectoral factors and actors. Thus, making implementation of health sector policy requires interplay of actors and factors from different sectors and levels: local, national, regional and international. Health situation in Bangladesh Till today, health situation in Bangladesh is not quite satisfactory. Lack of broad national health policy or policy vacuum, lack of policy priority setting, discontinuity of policy, lack of policy ownership, lack of resource allocation and lack of proper uses of resources due to lack institutional arrangement and elite dominated health sector are the main characteristics of health sector in Bangladesh. These characteristics create hindrance in the process of achievement of national and international goals and ultimately health situation of common people remains vulnerable. Bangladesh, being a country with small land size of 144,000 sq. km, has the burden of a huge population of 140 million. Still, with low per capita income and low literacy. Though Bangladesh has one of the strongest networks for delivering countrywide health services among developing countries, still the quality of services are not up to the mark and the services are neither client focused nor need based. In the following tables we demonstrated the trends of basic health indicators of Bangladesh Indicators1970s (1978-80)1980s (1990)1990s (1996-972000s (2003)2007 Population growth rate2. 72. 101. 741. 54NA Infant mortality rate(per 1000)150116776652 Maternal mortality rate105. 74. 13NA Delivery care by trained2581218 Under 5 mortality rate(per 1000)2991101169465 Table 3. 1: Trends of Basic Health Indicators of Bangladesh Heath governance system The government driven healthcare service has a network in all over the country from the centre to the extreme periphery, having two wings, one concerned with Population and Family Planning and the other concerned with Health in total. The service network has three approaches with primary care at upazilla level; secondary care at district level; and tertiary care at divisional level. To administer administrative activities the country has six administrative divisions and 64 districts and furthermore the districts are divided into upazilas (476 in number) and upazilas into unions (4,770). It is estimated that each of the union consist of 25,000 people in most cases each of the unions are again divided into nine villages. The upazila health complexes (463) acts as the first referral centers for primary health care along with one district levels hospitals at all districts (64) and most of the specialized hospitals resides at tertiary levels, mostly in Dhaka – the capital of Bangladesh. There is a standard setup for health services in an upazilla consisting of one upazilla health complex, one union health & family welfare center (UHFWC) at union level (4062) and community clinics at village levels for every 6000 populations. It is mentionable that the community clinics were established under the Health and Population Sector Program (HPSP) – a donor driven mega program – were not functioning till now and being revitalized in recent periods (from the regime of interim caretaker government to present AL government) Apart from general health services other services i. e. minimal reproductive, maternal, and child health care services get provided by these centers for the local people free of cost. The ratio of physicians and registered nurses to population is 241 and 136 respectively per million people and the number of hospitals available for a million people is 10, while the availability of hospital beds is one for about 4000 people. Non government organizations (NGO) and private sectors also play an important role to provide health services for the country. Numbers of NGOs have targeted projects, program and facilities to provide antenatal care (ANC) and safe delivery care. Besides in urban areas the number of private service delivery centers and private physicians are also on the rise. Thought the private clinics get operated privately, most of the doctors working in public hospitals work there on part time basis. These clinics have high charges and operate on commercial basis and people living in highest quintiles prefers such clinics for good quality service, which sometimes is not available in public sectors, as per the wealthiest quintiles perception. Recent politics in policy making Like many other developing country the lifetime of a public policy in Bangladesh depends on the change of political power and health policy is no exception. Visions and directions of all health policies got changed with the change of ruling government. Likewise the NHP 2000 was also interrupted as the government changed. After that two attempts were made to revise the policy till 2008. This instigated disruption in policy implementation rather than bringing any positive change. Many arguments took place in favor of policy reversal by the policyactors but the decision remained absolutely political. The following subsection illustrates the policy vulnerability of NHP 2000 as reflected in its reversal and formulation of NHP 2006 and 2008 and the political dynamics behind it (BHW, 2010). The first and fully operational national health policy was initiated in 1988 during the autocratic regime. In 2000 the democratic government promulgated a national health policy with five goals and objectives, in October 2001 after the Bangladesh Nationalist Party-led coalition government came to power. This new government deviated from NHP 2000 and got engaged in redrafting a new health policy, without rejecting the existing one in its entirety. This NHP 2000 was to some extent rejected when two of its essential components related to structural transformation were made dysfunctional. The issues were i) unification of health and FP wings ii) the issue of community clinic. Key policy actors (both politicians and bureaucrats) had staid uncertainties about the outcome of these two major reforms and believed that these two issues introduction had been politically motivated by Awami League (AL), which finally resulted in non-implementation. The following segments give an outline of how two major reforms proposed by the policy faced rejection. Integration or unification of health and FP wings – the ornerstone of the NHP 2000 – was formally approved earlier through the HPSS and HPSP (1998-2003), did not experience smooth implementation even during the AL arena. This unification was intended to provide health and FP services in a package for improved service efficiency by minimizing duplication and overlapping of service delivery, which did not take place due to bureaucracy. During the era of 2001-2006, reversal of NHP 2000 became the interior of a whirlpool of conflicts, delays, and difference among policy players, including the bureaucrats, politicians, medical professionals and donors. At the early stage of BNP regime, the system of government held substantial power over the execution of NHP 2000. And the final decision on reversing unification was taken by the Health Secretary and the Prime Minister. The new senior level bureaucrats during this period contrasted the amalgamation and community clinics. The bureaucrats believed that incorporation would marginalize the FP section of the health sector, when it was decisive to uphold the responsibilities and sovereignty of the FP workers. The ruling BNP leaders were rigid to renounce the NHP 2000 since it was formulated by the previous AL government. And political leaders played a fundamental part in the policy implications during 2001-2006. It has been observed that the harmonization between the medical professionals and political leaders led to dealings with the bureaucrats and other forces and exercise more power (BHW 2010). The partial refusal of NHP 2000 can be accredited to the customs of confrontational politics and prejudice that permeates every level of the polity, rather than ideological dissimilarity often political parties. There was little ideological difference between the BNP and AL governments, as demonstrated in similar policy proposals of the two respective health policy documents. Interest group & policy issues According to the views presented by the study respondents, numerous problems were highlighted by different levels of organizations and individuals. More than 160 organizations and individuals have submitted written demand to the Program Support Office (PSO), HNPSP, MoHFW more prior to the preparation of the final draft. All of these demands reflected personal or professional interests. The written comments covered about 70 issues and a significant number of NGO participation was seen. All the policy issues were not dominant. Weight of the problems and proper evidence and strategy to highlight the problems play important role to catch attention of the policy makers. Among the policy issues, following were more dominant compared to others. State policy in health governance State actors and non-state actors play their role in the policy process. During the time of agenda setting interest groups try to influence the policy makers to consider their preferable issues. Like other policy process, different actors and factors impacted the generation of ideas in health policy. Till today, health situation of Bangladesh is not satisfactory in term of ‘equity and justice’. In the literature of policy ownership, source of ideas/visions is treated as one of the major indicator to measure the ownership of policy (Osman, 2006). In public policy process ‘agenda setting’ is a stage where owner of ideas/vision and promoter of the ideas adopt different strategy to draw the attention of the policy makers. In public policy making ‘ownership’ can be measured with participation of different actors in policy process. In this connection role of the different actors were investigated in this study. According to Jhon Kingdon’s Garbage Can Model, an issue becomes agenda with three confluence â€Å"streams†. Different actors play their role from their own perspective in these steams. In this study it was found that three steams emerged at the same time and opened a window. In problem stream evidence production and dissemination were highly supportive for highlighting the problems of community health issues as policy agenda. In proposal stream national and international policy coherences, international and national good practices and positive attitude of donors were among other factors that supported the community clinic issues as policy proposal. Also, political support of the ruling party (AL) was also positive to highlight the community clinic and community health issues. These problems were highlighted in different documents of governments, NGOs and donors. Moreover, these problems were recognized by bureaucrats, politicians, media people, donors and NGOs. Apart from evidences, ordinary people through experiences and observations also recognized these problems. Thus, all stakeholders had good faith about these evidences. It can be said that three confluence streams emerged and opened a policy window to take a decision for establishing community clinic for solving the community health problems in Bangladesh. In every stream, different actors and factors played vital role to highlight the issue. Evidence is crucial to guide improvements in health systems and develop new initiatives. In this connection state actors and non-sate actors create evidence for highlighting the importance of a policy problem or issues. In this study effort has been made to analyze the system of evidence creation and evidence dissemination. From the systems perspective, it is important to understand how research and knowledge from various sources are produced and synthesized. In addition, effort has also been made to investigate how the research findings were highlighted to strengthen the demand of good health services for community people. These evidences revealed that maternal health situation and services have not reached to the satisfaction level. Situation of child health is still in an alarming condition for attaining national and international goals. Till now population problem is a big challenge for development of Bangladesh but evidence showed that there are human resource gaps in community level to offer proper services to the community people. Cost of health services, absenteeism and distribution of health service providers in the community level were dominant factors which played vital role to highlight the community health situation as a problem. It was found that about 160 organizations and individuals took part in the agenda setting process of the health policy. Among the participants, NGOs presence was significant considering their number. A one may wonder why a significant number of NGOs took part in the agenda setting process. The answer is a large number of NGOs are working in health sectors of Bangladesh whose mission is to highlight the common peoples’ rights and external support for doing policy advocacy. Majority of the participants’ expressed their personal, organizational or professional interest.. Health professionals from government side played significant role while creating evidences. In the absence of wide ranging government sponsored research these professional remained engaged in writing articles in journals and news papers. Due to contracting system of evidence creation, bureaucrats were guided or assisted y a number of consultants and their influences are decreasing nowadays. Apart from the findings of the present study many previous studies showed that during unification of two wings of MoHFW (family planning and health) IMED created evidence to analyze the context. Research findings showed that bureaucrats who were influential during the period of 1996-2001 did not able to exert influence after 2000. It is mentioned that successive health secretaries were either explicitly against or remained passive over the unification process and community clinic program, resulting weak bureaucratic leadership within the ministry. Among the professionals who are involved with party politics, DAB (Doctors Association Bangladesh, aligned with the BNP) and SCP (Shawdhinata Chikitshak Parishad, aligned with the Awami League) played influential roles in agenda setting health issues. In this study it is found that these members who are affiliated with SCP remained vocal from the very beginning of the policy process when Health Advisor of immediate past caretaker government (2008-09) initiated the process of health policy formulation. Historical evidences showed that DAB had great influence in the agenda setting during the draft preparation in 2006. In case of NHP 2010, SCP played an important role in community related agenda setting since they are well connected with the Prime Minister and Health Minister. Medical professionals, particularly physicians, were in favor of the implementation of major reforms under the NHP 2000. Previous researchers found that support of the professionals for the two major elements of the NHP 2000 was reflected in the policy document prepared by the Bangladesh Medical Association (BMA) (BHW, 2010). Donors provide financial supports during evidence creation. While offering financial support, donors imposed some conditions including methodology finalization and indicators setting which ultimately, influenced the process of making evidence based policy. In addition, donors suggested government to include NGOs in this process on the ground of GO-NGO collaboration or public-private partnerships. In the community health related evidence creation USAID, UNICEF and WHO played leading role since 2000. Thus, it can be said that donors had great influence in evidence creations about community health issues. Of course, this is not new in the health sector of Bangladesh. In case of evidence creation for Sector Wide Approach introduction donor community provide guidance and financial supports for evidence creation. When compared to equivalent government operations, NGO services generally run more efficiently and cheaply keeping closer ties with communities. For this reason, donors often favor them as entry points to accessing communities in Bangladesh, especially since the 1980s. In other words, NGOs become powerful and influential, especially because of their external sources of financial support, cooperation, and advocacy. In this regards, NGOs are considered as spokesman of donors. Civil society/NGOs are potential actors to highlight health rights and social welfare goals through mobilization of citizen demand. Through different activities NGOs emphasized on the decentralization as a means of localizing policy-making, bringing decision- making closer to disadvantaged groups, and encouraging local participation. Also NGOs are playing roles of academics and professionals by monitoring and analyzing contextual factors. In this study we found that NGOs remained more or less equivalent in the creation of evidences. Bangladesh health watch was in the leading position to provide evidence for policy making Present Government and Health Strategy: According to the majority portion of respondent, the present government consists with a number of health professionals and they were very much enthusiastic to promote the health facilities issues for ensuring the health rights of community people of Bangladesh. Also as a political party AL has commitment to the people to provide health services for the betterment of common people. Election Manifesto of AL in Election 2008 highlighted the health issues in the following way – â€Å"In order to ensure health facilities to every citizen of the country, the health policy of the erstwhile Awami League government will be reevaluated and adjusted according to the demands of the time. In the light of this policy, 18000 community clinics, established during Awami League rule, will be commissioned. † [Source: Election Manifesto of AL in Election 2008] Conclusion It can be said that proper evidence for highlighting the problem, stakeholders support in the solutions and strong political support highlighted the community health issues as issues to be considered in government actions. In evidence creation and conducting advocacy, NGOs who backed by the donors remained vocal. Top level bureaucrats also played their role with the help of consultants who were generally recommended by the donors. Finally, recognition of ruling political party played an important role in this regard.

A Contemporary Critique on Murasaki Shikibu’s The Tale of Genji Essay

The Heian court and the social structure it provided is a compelling aspect of Japanese history. The 21st century reader is intrigued by such an era and its artistic representations because the general norms, collective conscious, and interpersonal relationships seem to be in clear contrast with the social practices of today. At face value, it appears that Murasaki Shikibu’s discontentment with the aforementioned characteristics of court life manifested itself within the pages of The Tale of Genji. The acclaimed Russian novelist Vladimir Nabokov once stated, â€Å"A masterpiece of fiction is an original world and as such is not likely to fit the world of the reader. † Thus, although Murasaki Shikibu’s work is deeply rooted in exposing the pretense associated with Heian court social rank, marriage practices, and feminine submissiveness, she managed to create a world for Genji which tested the limits of his emotional threshold and, by default, relatable with modern/epic protagonists. Moreover, because the modern audience can at times feel sympathetic toward Genji by relating to his emotional range (i. grief through ecstasy) and psychological abnormalities, The Tale of Genji’s status as a timeless masterpiece is merited. Had Genji been a detached lover with no emotional and psychological depth, Murasaki Shikibu’s work and reputation would not have seen the light of day outside of the court she was heavily critiquing. This essay will compare the qualities depicted in The Tale of Genji with other works that are highly regarded as masterpieces while shedding light on the differences which can be seen as a more direct jab at Heian readership. There is a notion in philosophical theory that is used to show that the ‘robber and the robbed’ share a mutual existence dictated by past events. Their meeting, the robbery, is the climax of their distinct lifelong plots. The idea that humans are simply ‘victims of circumstance’ applies directly to Genji as can be seen through his decisions and amorous plight. Through the first few chapters of Murasaki Shikibu’s tale, the audience can infer on the surface that the plot revolves around the development of the protagonist’s Oedipus complex. Upon meeting young Murasaki whose resemblance to Fujitsubo was ‘astonishing’, the author specifies Genji’s yearning for Fujitsubo as the reason he was brought to tears (Murasaki 71). Although inquiries of Genji’s psychological state are not without merit, the bond between Murasaki’s work and Sophocles’ Oedipus the King delves much deeper. The growth and development of Genji’s character and traits do a bit more than clarify his current actions: should one have started reading at the â€Å"Lavender† chapter, it provides an insight to a past riddled with complexity. Through Genji’s dialogues and decisions regarding dilemmas of the heart the readership is given a man who, involved with the particular situations Genji had experienced, would most likely act in a similar fashion to Genji. Every act through Oedipus the King paints a picture for the reader of the power that emotional disposition has over Oedipus and his quests, which is not at all unlike Genji himself. After hearing about the crimes he was to commit, how can a reader not feel sympathetic towards his pursuit for independence from the oracle? In similar fashion to this masterpiece, Murasaki utilized the tool of plot reappearance across characters and time settings to give readership the sense that Genji was predisposed to repeat past deeds. After the death of Genji’s mother, the emperor (Genji’s father), was in mourning and grief and seeking to fill the void left over. After coming across the remarkable beauty of Fujitsubo and in an effort to bring her in, the emperor stated that he would â€Å"treat the girl as one of his daughters† and adding that given Genji’s resemblance to her, she â€Å"could pass for his mother† (Murasaki 22). As previously mentioned, this father-like quality resurfaced in Genji’s admiration for Murasaki. However, a distinct difference is that Genji’s paternal instinct is more or less a fabrication resulting from the impediment, put in place by Murasaki’s nurse, of his unyielding desire to make her his future lover: â€Å"It is you who do not understand. I see how young she is, and I have nothing of the sort in mind. I must again ask you to be witness to the depth and purity of my feelings†¦How can she bear to live in such a lonely place? (Murasaki 95). At this point, one can see the psychological abnormalities developed in Genji which were not corrected by his upbringing; in fact, witnessing his father’s adamant love for this exact model of beauty might have amplified the effect on his behavior. When Oedipus proclaimed the total expulsion of the murderer who was still unknown (practically accepting Jocasta, his mother, as his wife), the knowledge of the f oreseeable future which the readership possessed allowed one to feel the helplessness which Oedipus embodied. Much to the same effect, is the reader supposed to feel that Genji does not have the ability escape fate? One can infer that Murasaki’s response to this is a resounding â€Å"No†. Although the similarities between the two works are many, the major difference lies in two factors: Oedipus’ fate was sealed, and, prior to his emotional endeavor regarding the oracle’s prophecy, he was an exemplary combination of leadership and intelligence which suited a king well. Even though Murasaki gave Genji an emotional depth, she left out the qualities of critical thought and consideration for others. Doing so, Murasaki left Genji at the mercy of his circumstances without his fate being set in stone, and, thus continuing the chauvinistic characteristic of male aristocrats of the time. Through her literary prowess, Murasaki subtly but effectively proclaimed that high rank/position did not equate to intellectual superiority nor did it predetermine that all aristocrats in those positions were fit to rule as can be witnessed by Genji’s preoccupation with his love affairs and not the further betterment of court reputation or intellect. Another ubiquitously renowned masterpiece with similar sexual deviance from its protagonist is Homer’s The Odyssey. Odysseus’ journey to return home to his wife is juxtaposed with temptation by utmost beauty which ultimately leads him to succumb to the latter. In academic circles, the reunion with his wife is seen as one of the most romantic scenes in literary history; yet, there seems to be a lack of uproar regarding his adventures with Calypso and Circe. On the other hand (with critical awareness of the social norms of the time), Genji is met with great disdain by the general audience. In comparison to The Tale of Genji, the similarity lies with the degree of sympathy the protagonists evoke more so than the actual plot: although both characters had multiple extramarital affairs, does Odysseus’ long term physical displacement conjure up a greater forgiveness from the readership s oppose to Genji’s emotional dissatisfaction with his current state of affairs? The fact that Murasaki’s work, more specifically her protagonist Genji, is able to invoke an amount of emotional response from contemporary audiences comparable to that of The Odyssey without relying on 20 years of desolation from its main character in itself should merit the reputation it has received. In regards to the previously mentioned question, Murasaki would probably be displeased with Odysseus’ affairs. Although universally accepted justification would never be reached, his unfading love for Penelope goes without question. The major difference between the two protagonists lies in their response to utmost beauty. Facing Calypso, Odysseus admits that she is far more beautiful than his wife who is a mere mortal, but that he â€Å"pines† all his days to see his return to her (Lawall et. al 265). Genji, on the other hand, falls ‘prey to the female’. Murasaki’s commentary on relationships lies in the deliberate absence of discernment in Genji and his state of being out of touch with reality. Moreover, his narrow focus on beauty does not allow him to see the combination of flaws and qualities that all women possess; thus, his longing for the specific mold of beauty he yearns for seen in the beginning of Murasaki’s work holds no merit and thus, true sympathy fails to reach Genji’s amorous quest. This notion is exemplified by Murasaki’s narration describing Fujitsubo’s beauty: â€Å"There was no one else quite like her. In that fact was his undoing: he would be less a prey to longing if he could find in her even a trace of the ordinary† (Murasaki 86). Furthermore, Murasaki leaves no indication that Genji exhausted all possibilities in an attempt to make love work with Aoi (or even Rokujo); this would at least add some credibility to his dissatisfaction with them. Instead, he utilizes their unfavorable idiosyncrasies as further incentive for his extramarital adventures. Murasaki expresses her own dissatisfaction with marriage practices/relationships, in essence, by making the case that male aristocrats at court lack the judgment and intellect (which is supposed to be innate to them given the hierarchal structure of the society at the time) to fully comprehend and appreciate the complexity of women and lack the consideration to take into account that their actions affect not only hemselves. All in all, the clearest insight to Murasaki’s critique of Heian structure, rank, and interpersonal outlook comes directly from Genji and it sounds as if Murasaki implied to state the true intentions of Heian male aristocrats: â€Å"I am weak and indecisive by nature myself, and a woman who is quiet and withdrawn and follows the wishes of a man even to the point of letting herself be used has much the greater appeal. A man can shape and mold her as he wishes, and becomes fonder of her all the while† (Murasaki 62). Lastly, Heian era Japan was not the only male dominated civilization and this type of society has not yet disappeared. The fact that one can use the same critiques Murasaki masterfully made about Heian court to dispute manifestations of chauvinism in certain aspects of society today solidifies The Tale of Genji as a masterpiece which stood the test of time.

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Understanding of virtue - Assignment Example , n.d.) If this is correct, the virtue of a dressmaker is what enables her to sew beautiful dresses, or the virtue of a gardener is what enables him to produce a bountiful harvest, or etc.. In this aspect, virtue is different from person to person, but this does not give us a general description of a virtue. Mackenzie (1985), in her discussions of moral theories, said that Plato has a naturalist approach to evaluative qualities, and to relations which causes complexities. It is Plato’s reasoning that an object has a particular value to different persons at a different time and in a different relation, it is opposite. As digressed By Mackenzie, Plato values of an object vary subjectively, so that to be able to understand it, one must be able to assess and understand it, and that sometimes, these assessments are contradictory, since they are cognitively unreliable. Plato has made a conclusion, as Mackenzie pointed out, that â€Å"over and above sensible things, there exists ent ities that give absolute understanding of values, and these are the Forms which are cognitively reliable, pure instantiations, or absolutes, of value that provide us with the knowledge of what is best†. Plato’s representation is hard to follow, as in when he said that when we use a value term twice, it should have the same meaning, in mind. Plato has a view that for any given term, there should only be one Form that represents it all. (Mackenzie) There should be a universal term, but this thing is not possible because of complexity of meaning. Take the word beautiful or noble for example. This means, as I gathered from Plato’s discourse, a term may have different evaluative meaning like the words useful, fine and pleasant The first discourse In Plato’s dialogue about virtue and the question that lies beneath is whether or not virtue can be taught. His understanding of virtue in the book is that virtue is not a form of knowledge and that it has no clear definition. I cannot simply

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The Airline Industry Essay Example | Topics and Well Written Essays - 1500 words

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