Project Management Essay Example | Topics and Well Written Essays - 2750 words

Project Management - Essay Example Measurement and accountability; check if the task has been a winner and if it has maintained all through. This is done by holding meetings and interviewing the leaders of their respective projects (Ganon, 2004). With the scope first, identify the project schedule and time management in which the project manager should come up with a realistic plan and its efficient management and define the time frame for completion of the project. Secondly, a real project is identified within the specified budget. Thirdly, procurement should be in place. Fourthly, consider the project quality. Fifthly, the project team should be looked at ensuring the project has the right skills, at the right place and the right duration to ensure there is the smoothness in the whole project time. Sixthly, ensure there is proper and prompt communication among the project players. Finally, identify the uncertainties. What are the possible causes of risks in that project, what is their possibility of occurrence and their severity, and what measures can we take to mitigate them ( Patel, 2008). Gantt charts and Critical paths help apparently spot where resources need to be anticipated and apportion them. The Gantt helps to ensure the project is within the budget constraint, a thing Mrs. Penny never took into consideration making the project to lose hundreds of thousands of dollars. They also assist the team players to be on the same page as there is a visual framework of the work to be done. Chances of confusion and misunderstanding are minimized as all the stakeholders hold the same data. The Gantt chart also helps in undertaking the task relationship among the project team. The table helps in identifying how various works are interrelated towards achieving the objective of the project. If Penny Black could have plotted the activities of the different functions carried

Admissions Essay Essay Example for Free

Admissions Essay Essay There have been several people with prominent impacts on my life, but why focus only on the people who have influenced me? Let us broaden the scope to include all worldly matter. Then I make no hesitation in stating that my canine companion, Toby, has been my greatest influence. Toby, a vivacious miniature schnauzer, is at a well-ripened age of eleven. He is not the same dog he was when he was younger. He sleeps about 18 hours a day and it is impractical to take a nap on the couch with him, because his snoring is loud enough to be fooled with the reverberation of my dad after a long day of golf. However, just before 5 o’clock in the afternoon, only the gray hairs scattering Toby’s black coat give away his old age. It is around this time every day that Toby begins his racket of letting you know that it is getting â€Å"close† to his dinnertime of 6 o’clock. Toby’s daily reminders guide me to take a stand against the common adolescent breakfast fast. They are also a source of accountability in my quest to keep a positive outlook on all things that I encounter in my life. See more: Satirical essay about drugs While Toby may be an ordinary dog, he and I share something that I have never had with another human. Toby and I communicate better than any two humans do. To a third party, it seems as though I am carrying on a conversation with a non-responsive dog therefore essentially speaking back and forth to myself. However, I assure you that Toby responds back in his own way. What makes our communication so superior is Toby’s masterful ability to express himself non-verbally. This allows me to open up to him and not have to worry about him responding with insensitive or uninsightful utterances. I have learned through Toby that when a person goes to another human to talk they would rather that the person speak less and listen more. I have also found my canine companion to be dependable. He is at my feet when I need him on a cold night to do the job my comforter is supposed to do. After having one of â€Å"those† days I can count on him to be there when I walk through the door and not running to the corner. I use this example of dependability and apply it to my daily life by being there for others as  Toby has been there for me. It may, to some, be a bit silly to consider a dog influential, but these people must not have had the privilege of owning one of man’s very own best friends. I like to think that if our world had more children with dogs like my Toby, it would also have more children learning the core values that aid in responsibility and kindness.

South African Public Hospitals Health And Social Care Essay

South African Public Hospitals Health And Social Care Essay The words crisis and health care follow each other in sentences so often in South Africa that most citizens have grown numb to the association. Clinicians, health managers and public health experts have been talking about a crisis in access to health care for more than half a century, and the advent of democracy has not alleviated the situation. South Africas inability to adequately respond to its many crises is also the result of a national healthcare system designed to provide treatment rather than prevention. The over-dependence on hospital-based care in South Africa not only makes the healthcare system expensive and inefficient, but also precludes much-needed investments in primary and preventative care. Health minister Dr Aaron Motsoaledi honestly conceded that the public health system faces very serious challenges'(Philip 2009). In this review I describe the crisis in childcare and its consequences for the health of children, characterise the underlying reasons for the crisis, examine current interventions and explore some medium and longer term solutions. How severe is the crisis? It is not surprising that the publics perception of health services are often determined by stories about the care offered to children presented in the media. For instance, in one week in May 2010, two stories dominated newspaper and media headlines in Gauteng. One was the death of seven newborn infants and the infection of 16 others as a result of a virulent infection (subsequently identified as a norovirus) acquired by the infants at the Charlotte Maxexe Johannesburg Academic Hospital. At Natalspruit Hospital in Ekhuruleni, 10 children similarly succumbed to a nosocomial (hospital acquired) infection (Bodibe 2010). These types of events, with large numbers of children acquiring infections in hospitals are not uncommon, although only a fraction grabs the headlines. Outbreaks occur at regular intervals at hospitals throughout the country. An outbreak of Klebsiella infection was responsible for 110 babies dying at Mahatma Gandhi Hospital in Durban, according to the organisation Voice that threatened a class action case against the Department of Health. The national health department itself has identified infection control as one of six key areas that needed improvement in the public health sector (Department of Health 2010). Poor health care at several Eastern Cape hospitals left more than 140 children dead in one of South Africas poorest districts within the first three months of 2008 (Thom 2008). A task team investigating these deaths in the Ukhahlamba district concluded that they were not the result to any particular disease outbreak or exposure to contaminated water as initially suspected, but rather that the health service available was hopelessly defective. (Report on childhood deaths, Ukhahlamba District, Eastern Cape) The Ukhahlamba task team, comprising of three experienced public sector paediatricians, painted a grim picture of Empilisweni Hospital childrens ward where most of the deaths occurred. Problems identified included: The structure and layout of the physical facility was inappropriate no nurses station or work surfaces, no separation of clean and dirty areas and no play or stimulation facilities, The ward and cubicles were overcrowded and no provision existed for lodger mothers, who paid R30 to sleep on the floor next to their children, There were grossly inadequate services no oxygen and suction points, too few electrical sockets, no basins or showers and too few toilets in the patient ablutions, and an unacceptable ward kitchen, Extremely limited clinical equipment, Staffing deployment and rotation did not promote effective care, with few nurses dedicated to the childrens ward and doctors changing wards every two months, leaving the ward devoid of experienced personnel, There were limited policy documents and no protocols or access to appropriate clinical reference material or guidelines, Clinical practices were ineffective or dangerous, particularly regarding infection control and the preparation and distribution of infant feeds and medicines, Not a single hospital record included details about the prescribing or administration of infant feeds. Fluid management was badly documented. Three of the children appeared to have died from fluid overload due to inappropriate and unregulated fluid administration, The majority of the children were never weighed, their nutritional status was not assessed nor their HIV status established. The task teams audit of 45 of the deaths revealed that most of the deaths occurred within the first 48 hours of admission to hospital and were in infants who were self-referred. The dominant diagnoses were diarrhoeal disease, pneumonia and malnutrition. The task team concluded that These deaths are more likely the result of poor care of a vulnerable impoverished community with high rates of malnutrition among the infants and poor utilisation of the available health services. The pathetic situation described at Empilisweni Hospital is not unique and similar abject conditions can be found at many of the paediatric wards at the 401 hospitals in the country. While objective evidence to support this contention does not exist, paediatric practitioners in many provinces and settings would readily acknowledge the veracity of the claim. The explanation offered by different investigations of adverse events occurring at public hospitals countrywide is remarkably similar. Uniformly, there is a combination of overcrowded wards, understaffing, overwhelming workloads, a breakdown of hygiene and infection control procedures, and management failure with a lack of auditing or monitoring systems to identify and respond to problems at an earlier stage. Increasing child mortality What is not contentious is that South Africa is one of only 12 countries where childhood mortality increased from 1990 to 2006 (Childrens Institute 2010), with a doubling of deaths in children under the age of five years in this period (from approximately 56 to 100 deaths per 1000 live births). The 2010 UNICEF State of the Worlds Children estimates South Africas under 5 death rate to be 67 per 1000 for 2008 (UNICEF 2009). This high rate ranks South Africa 141st out of 193 countries. The national statistic also hides marked interprovincial variations; from about 39 per 1 000 in the Western Cape to 111 per 1 000 in the Free State (McKerrow 2010). A single disease HIV- is largely responsible for the increased mortality. Countries with a similar economic profile (Gross National Income [GNI]) as South Africa such as Brazil and Turkey boast about four-fold lower under 5 mortality rates (U5MR). South Africas high U5MR is even more disconcerting when compared to poorer countries such as Sri Lanka and Vietnam. These two countries U5MRs are roughly five times lower (15 and 14 per 1,000 respectively) despite having a GNI less than one half to a third of South Africas (UNICEF 2009, World Bank 2010). Despite being classified as a high middle income country, South Africa has high levels of infectious diseases such as diarrhoea, pneumonia, HIV, tuberculosis and parasitic infections normally found in poorer countries. Similarly, there has been little success in reducing undernutrition in children a quarter of South Africas children are stunted (short). Further, as a result of increased urbanisation and economic development, the country is also experiencing increasing levels of traumatic injuries and chronic diseases of lifestyle such as obesity, diabetes and cardiovascular disease that are more typical of better resourced countries. These diseases mainly affect adult populations but are increasingly being identified in children. The worsening in child health has occurred despite significant improvement in childrens access to water, sanitation and primary health services. Almost 3000 new clinics have been built or upgraded since 1994, health care is provided for free to children under 5 years and pregnant women (Saloojee 2005), and the child social support grant is reaching 10.5 million children (more than half of all children in the country) (Dlamini 2011). These achievements have been marred by several shortcomings. Many new clinics and the district health systems are not yet adequately functional because of a lack of personnel and finances, poor administration, and expanding demands. Public tertiary health care (academic hospital) services have severely eroded. Characterising the crisis The World Health Organization, in 2000, ranked South Africas health care system as the 57th highest in cost, 73rd in responsiveness, 175th in overall performance, and 182nd by overall level of health (out of 191 member nations included in the study) (World Health Organization 2000). What explains this dismal rating? Despite high national expenditure on health, inequalities in health spending, inefficiencies in the health system and a lack of leadership and accountability contribute to South Africas poor child health outcomes. Hospitals operate within a dysfunctional health system Poor hospital care is but one marker of a dysfunctional health system that comprises blotches of independent services rather than a coherent, co-operative approach to delivering health care. Most primary health care services for children are only offered during office hours, with some clinics restricting new patients access to services by early afternoon a waste of available and expensive human resources. Some clinics lack basic diagnostic tests and medication. Consequently, many hospital emergency rooms are flooded with children with relatively minor ailments because their caregivers choose not to queue for hours at poorly managed local clinics, or prefer accessing health services after returning from work. The referral system in which patients are referred from clinics to district, regional or tertiary hospitals according to how serious their health problems are has disintegrated in many parts of the country. Children who require more specialised care often cannot get it either because they get stuck within a dysfunctional system or because there is no space for them at the next level of care. Transport to secondary and tertiary level hospitals is problematic, resulting in delays or non-arrival, increasing the severity of the disease and treatment costs when the child does arrive. District hospital services are the most dysfunctional (Coovadia 2009), with patients often by-passing this level of care in settings where access to secondary (regional) or tertiary care (specialist) services are available. Despite cut-backs in budgets, tertiary care settings continue to attempt to provide first-class services, which although commendable, may result in over-investigation and treatment, and denial of essential care to children who reside outside their immediate catchment areas (because the hospital is full). Changing health environment Some of the increasing stress faced by the public hospitals may be attributed to the changing health environment in which they operate. Two factors are most responsible for the change: rapid urbanisation and the AIDS epidemic. Urban, township hospitals are particularly affected by the burden of increased patient loads, and barely coping with the demand. Although a national strategic plan for HIV/AIDS exists, the ability to implement the plan is constrained by the enormous demands on human and fiscal resources demanded for its implementation. The budget allocated to HIV/AIDS has increased from R4.3 billion in 2008 to an estimated R11.4 billion in 2010 (13% of the total health budget) (Mukotsanjera 2009). New initiatives aimed at strengthening the HIV/AIDS response, include a national HIV counselling and testing campaign and the decentralization of antiretroviral treatment from hospitals to clinics with nurses now providing the drugs. About a third of children at most South African hospitals are HIV infected. HIV-positive children are hospitalised more frequently than HIV-negative children (17% compared to 4.7% hospitalised in the 12 months prior to the study) (Shisana 2010). Children with AIDS tend to be sicker and often require longer admissions despite suffering from the same spectrum of illnesses as ordinary children. Greater numbers of patients, higher disease acuity levels and complications, and slower recovery rates all impact on limited resources. High mortality rates take an emotional toll on doctors and nurses. Hospital paediatrics, which has always been a popular and rewarding choice for newly qualified doctors because of modern medicines ability to quickly restore desperately ill children to health has now become much more about chronic care delivery because of the high number of HIV infected children in the wards, many of whom are re-admitted regularly because of recurrent infections. In recent years, young doctors have been dissuaded from selecting primary care disciplines, such as paediatrics, and have moved instead to pursuing specialities where contact with patients is limited, such as radiology, for fear of acquiring HIV from work-related accidents such as needle-stick injuries. The availability of highly active antiretroviral therapy to increasing number of children nationally, thou gh still limited to fewer than half of all eligible children, has the potential to return paediatrics to its previous status as a rewarding and fulfilling specialty. Inequity Inequities and inequalities abound in South African health care spending generally, and specifically regarding childrens health. Of the R192 billion spent on health care in 2008/09, 58% was spent in the private sector (Day 2010). Although this sector only provides care to an estimated 15% of children, two-thirds of the countrys paediatricians service their needs (Colleges of Medicine of South Africa 2009). Furthermore, of the R90 billion provincial public health sector budget, about 14% is spent on central (tertiary) hospital services (Day 2010), which primarily benefits children residing in urban settings and wealthier provinces such as the Western Cape and Gauteng. Similarly, marked inequities exist in the number of health professionals available to children in different provinces with, for example, one paediatrician servicing approximately 8,600 children in the Western Cape, but 200,000 children in Limpopo (Colleges of Medicine of South Africa 2009). This differential exists among most categories of health professionals. The current health system claims to provide universal coverage to children. Yet, from a resourcing, service delivery and quality perspective, the availability and level of service is inequitable with many patients and communities experiencing substantial difficulty in accessing the public health system. Rural and black communities remain most disadvantaged. Apartheid age differentials continue in present day health care. Thus, for instance, while the formerly whites only Charlotte Maxexe Johannesburg Academic Hospital now mainly serves a black urban population, its resources including ward facilities, staff-patient ratios and overall budget still show a clear positive bias when compared to the resources available to the Chris Hani Baragwanath Hospital located in Soweto (a former black hospital) (von Holdt 2007). Nationally, the most stressed hospitals are those with the lowest resources per bed. The least stressed hospitals continue to be those with previous reputations as high-quality institutions (mostly previously whites only hospitals) that provide them with a kind of social capital (von Holdt 2007). Management capacity crisis The battle for the control of hospitals South Africa has embraced the concept of health services delivered within a three-tiered national health system framework national, provincial and district. Provinces are charged with the responsibility of providing secondary or tertiary hospital services, with district services having responsibility for district hospitals and clinics. Existing legislature allows hospital chief executive officers (CEOs) considerable powers in the running of their own hospitals. However, there is a dysfunctional relationship between hospitals and provincial head offices, which often assume authoritarian and bureaucratic control over strategic, operational and detailed processes at hospitals but are unable to deliver on these. There is a blurred and ambiguous locus of power and decision-making authority between hospitals and head offices (von Holdt 2007). Hospital managers are disempowered, cannot take full accountability for their institutions and are mostly unable to decide on matters such as staff numbers and appointments, drawing up their own budgets or playing any role in the procurement of goods and services. The structural relationship between province and institution is a disincentive for managerial innovation, giving rise to a hospital management culture in which administration of rules and regulations is more important than managing people and operations or solving problems, and where incompetence is easily tolerated. Hospital managers lack of control undermines management accountability and promotes subservience to the central authority. The role of provincial health departments should really be about controlling policy regarding training, job grading and accountability. Silos of management Most South African hospitals have essentially the same management structure where authority is fragmented into separate and parallel silos. Thus, doctors are managed within a silo of clinicians, nurses within a nursing silo, and support staff by a mesh of separate silos for cleaners, porters, clerks, etc. The senior managers in the institutions have wide spheres of responsibility but with little authority to make decisions or implement them (von Holdt 2007). As an example, a clinical department such as paediatrics is headed by a senior or principal paediatric specialist who has no control over the nurses in the paediatric department. In the wards, nursing managers are responsible for effective ward functioning, but have little control over ward support staff such as cleaners or clerks. A senior clinical executive (superintendent) has responsibility for the paediatric (and other) departments, but can exercise little substantial authority over it because power lies within each of the silos (doctors, nurses, support workers). As a result, the clinical executive has to attempt to negotiate with all parties. Doctors and nurses do not determine budgets, or monitor and control costs. In essence, those responsible for using resources have no influence on their budgetary allocation, while those responsible for the budget assume no responsibility for the services that the budget supports. Most clinical heads have no idea what their budgets are and costs are not disaggregated within the institution to individual units or wards. Thus, what should be managed as an integrated operational unit (for example, a ward or clinical department) operates instead in a fragmented fashion with little clear accountability. In this circumstance all parties are disempowered, and relationships oscillate between diplomacy, persuasion, negotiation, angry confrontation, complaint and withdrawal. In the process few problems are definitively resolved, with negative consequences for patient care. Where institutional stress is high, the fragmented silo structures generate the fault lines along which conflict and managerial failure manifest (von Holdt 2007). Financial crisis Insufficient expenditure on health, hospitals and child health Between 1998 and 2006, South African annual public per capita health expenditure remained virtually constant in real terms (i.e. accounting for inflation), although spending in the public sector increased by 16.7% annually between 2006 and 2009 (National Treasury 2009). Nevertheless, the small increases in expenditure have not kept pace with population growth, or the greatly increased burden of disease (Cullinan 2009). In 2009 the country spent 8.9% of the gross national product (GDP) on health (Day 2010), and easily met the World Health Organisations (WHO) informal recommendation that so-called developing countries spend at least 5% of their GDP on health (World Health Organization 2003). However only 3.7% of GDP was spent in the public sector, with 5.2% of GDP expended in the private sector (Day 2010). In per capita terms R9605 was spent per private medical scheme beneficiary in 2009, while the public sector spent R2206 per uninsured person (Day 2010). Although the health of mothers and children has been a priority in government policy since 1994, including in the latest 10 Point Plan for Health (Department of Health 2010), it has not translated into movements in fiscal and resource allocation. Children comprise nearly 40% of the population (Statistics South Africa 2009), but it is unlikely that a similar proportion of the health budget is spent on child health. No reliable data exist, as government departmental budgets do not specifically delineate expenditure on children, easily allowing this constituency to be short-changed or ignored. Poor fiscal discipline A lack of accountability extends throughout the health service, and includes the lack of fiscal discipline. Provincial departments of health collectively overspent their budgets by more than R7.5bn in 2009/10 (Engelbrecht 2010). Provincial departments frequently fail to budget adequately, resulting in the freezing of posts and the restriction of basic service provision (e.g. routine child immunisation services were seriously disrupted in the Free State province in 2009 [Kok D 2009]). Every year, budgetary indiscipline results in critical shortages of drugs, food supplies and equipment in many provinces, particularly during the last financial quarter from January to March, and during April when new budgetary allocations are being released. Stock-outs of pharmaceutical agents, medical supplies such as disinfectants or gloves or radiological material, and food or infant formula, may annoy staff but may have devastating consequences for patients, including death. Most of these stock-outs are the result of suppliers terminating contracts because of failure of payment of accounts. In Gauteng, medical suppliers are currently owed more than half a billion rand by the Auckland Park Medical Supplies Depot, the central unit from which medicines are distributed to provincial hospitals and clinics. The largest amounts owed by the depot are to two pharmaceutical companies (some R130 million) (Bateman 2011). A recent embarrassing occurrence is the return of R813 million to Treasury at the end of the past financial year by the health department because of unspent funds (Bateman 2011). Most of the money was budgeted to revive collapsed and unfinished infrastructure at hospitals. This function belongs to the Department of Public Works, and hospitals have little influence on the functioning of this separate department a further example of fragmented services. Treasury has nevertheless allocated funds for the revival or construction of five academic hospitals by 2015, mainly through public private partnerships. These are Chris Hani Baragwanath in Soweto, Dr George Mukhari in Pretoria, King Edward VIII in Durban and Nelson Mandela in Mthatha, as well as a new tertiary hospital for Limpopo. Provincial health departments are beginning to show modest success in rooting out fraud and corruption, but their efforts have revealed widespread swindling costing taxpayers billions of rands, much of it deeply systemic (Bateman 2011). The bulk of endemic corruption involves dishonest service providers with links to key health department officials, looting via ghost and multiple payments loaded onto payment systems. In the Eastern Cape an external audit of anomalies in four health department supplier databases revealed R35 million in duplicate or multiple payments in 2010 (Bateman 2011). Some 107 suppliers had the same bank account number, 4 496 had the same physical address and 165 suppliers shared the same telephone number. Less sophisticated fraud involved the bribing of district ambulance service directors to transport private patients. Theft of equipment, medication and food is pervasive, aggravating existing bottlenecks in supply chain management. Almost R120 000 worth of infant formula destined for malnourished babies or infants of HIV-positive mothers was stolen in the Eastern Cape in 2010 for which three foreign national businessmen and four health department officials were arrested. Eight nurses at Mthathas Nelson Mandela Academic Hospital were arrested for allegedly stealing R200 000 worth of medicines (Bateman 2011). In KwaZulu-Natal, a report to the finance portfolio committee revealed 24 high priority cases involving irregularities, supply chain and human resource mismanagement, overtime fraud, corruption, nepotism, misconduct and negligence, amounting to nearly R1 billion. Among others, the former health MEC, Peggy Nkonyeni faced charges of irregular tender awards amounting to several million rands (Bateman 2011). Ten health department officials in Mpumalanga, including its chief financial officer, appeared before a disciplinary tribunal on charges of corruption. Three separate probes uncovered massive fraud and corruption in the department, including irregularities with tender procedures and the buying of unnecessary hospital equipment. Perversely, Sibongile Manana, the health MEC, was removed from her post by the provincial Premier, and given the Sports, Recreation, Arts and Culture portfolio. The Premier justified this decision by claiming that the reshuffle of his executive council was to rectify instances of mismanagement and wrongdoing uncovered by a series of forensic audits (Bateman 2011). Human resources crisis Staff shortages Staff shortages are a critical problem in most public hospitals, and are the result of underfunding as well as a national shortage of professional skills. Almost 43 % of health posts in the public sector countrywide are vacant, and more concerning appear to be increasing (up from 33% in 2009 and 27% in 2005) (Lloyd 2010). Some institutions are running with less than half the staff they need, with more than two-thirds of professional nurse posts and over 80% of medical practitioner posts in Limpopo unfilled (Lloyd 2010). Shortages of support workers such as cleaners and porters exacerbate the problem, since nurses and doctors end up performing unskilled but essential functions. Shortages of nurses in particular are generating a healthcare crisis in South African public hospitals (von Holdt 2007). Nurses have a wide scope of practice, and bear the brunt of increased patient-loads, staff shortages and management failures. Ironically, a number of nursing colleges were closed down in the late 1990s as part of governments cost-cutting measures while government made it very difficult for foreign doctors to practice in the country. The situation is now being addressed with recognition of the need for both more nurses and doctors to be trained. However, the constricted resources available limit a speedy or meaningful response and considerable investment in new facilities and trainers is required over the next decade to address the current deficit. Throughout the country, doctors and nurses constantly make decisions about which patients to save and which to withhold treatment from based on available staff and physical resources, rather than medical criteria. Because of the pressure on beds, children are sometimes denied admission to hospitals, not referred appropriately or discharged prematurely, thus facing the danger of deterioration, relapse or death. Conditions of service Understaffing and vacant professional posts and are the result of a number of factors, and vary in different locations. They include failure to establish new posts despite the increased demand for services, frozen posts because of insufficient funding being available and lack of suitably qualified staff. This lack may be because of pull or push factors. Pull factors attract staff away from the public service and include emigration and movement to the more lucrative private sector. Push factors such as poor salaries, the inability of hospitals to satisfy the simple creature comforts of staff, particularly in rural or township settings, and a blatant disrespect by hospital administrators of the professional status of staff induce staff to leave the public service. The high death rate of health workers from AIDS has further exacerbated the skills crisis. The Occupational Specific Dispensation was a measure introduced to specifically address the poor salaries paid to nurses and doctors. Although the intervention has been successful in retaining some staff in public sector hospitals and even enticing private sector nurses and doctors back, this financial incentive was insufficient to prevent national strikes by both doctors in 2009 and the entire health sector in 2010. Much of the dissent and unhappiness related to conditions of service, rather than the declared dispute about the size of the annual increase of the pay package. The long and bruising six-week strike was a sad indictment of the poor levels of professionalism of health workers, with wards full of newborn and young infants in many hospitals being abandoned instantly and completely with no interim plans for their feeding or care. This necessitated emergency evacuations or alternative arrangements by practitioners who were willing to place their little patients needs above th ose of the strike action, and by concerned members of the public. Undoubtedly, many hundreds of childrens lives were lost during this industrial action but the details of these deaths and any consequent punitive action has been conveniently ignored in an attempt to placate further strike action by the responsible parties. Aberrant staff behaviour Absenteeism among health workers is rife, even at well run institutions such Durbans Addington Hospital (Cullinan 2006). This is mostly due to stress, but nurses moonlighting in private hospitals to supplement their state salaries is also a factor. At hospitals where management was weak, such as Cecilia Makiwane Hospital in East London or Prince Mshiyeni in Durban, nurses also turned up late, left early, and often neglected patient care such as regular monitoring of vital signs (Cullinan 2006). Hospital managers ability to take disciplinary action is severely limited by the centralised nature of provincial health bureaucracies. In many provinces, the provincial head of health is the only person able to dismiss staff. Hospitalised children are the most vulnerable, since they cannot demand services or advocate for their own needs. Thus missed feeds, failure to receive prescribed medication timeously or missed doses, inattention to monitoring vital signs and delays in responding to sudden clinical deterioration are daily occurrences in childrens wards countrywide. Service delivery crisis Inadequate patient care There is a crisis of caring at hospital throughout the country. Evidence of poor service delivery at hospitals is disputed, ignored, and mostly tolerated by readily accepting the excuse of low staff morale, staff or resource shortages and no money (Saloojee 2010). The caring ethos that characterises the health profession has eroded to the degree that most patients are grateful for any acts of kindness directed to them. Many patients can recount how their most basic needs, such

Ambient Music And The Impulse Towards Deconstruction :: essays research papers

Out of Light – cometh Darkness, dark ambient music and the impulse towards deconstruction  © 2000 Daniel du Prie 1. â€Å"These recordings may be seen as a notation of our deadminded society, but not as a reaction against it, we will all become ambient dead heads, if not...† (Archon Satani, In Shelter, liner note, 1994) If not, then ellipsis. The conditional clause of fact, followed by an open-ended ellipsis, where not only the conjunction between a conditional present and an effected future (then...), but the whole of future time itself is omitted – is a good way to immerse oneself in a description towards a functional definition of a difficult form of a â€Å"popular† underground music (I write popular because it is, in critical terms, usually excluded from the domain of â€Å"high† culture, or â€Å"serious† music, being more aligned with other popular underground genres, eg, industrial, death metal), that would seem to defy the very notion of popularity a priori: I write of so-called ‘dark ambient’ music. 2. Your attention is drawn to a notation of the future as ellipsis, as a potent form of signifying a coming-into-being that is never-yet, and may well never be, as a danger: The future can only be anticipated in the form of an absolute danger. It is that which breaks absolutely with the constituted normality and only be proclaimed, presented, as a sort of monstrosity (Derrida, 1974: 3). This ellipsis of the future, signifying danger (becoming, in Archon Satani’s space, dead headed), also dislodges the comfort of the present, and of presence; of the representing object, and its relation to the object represented, of the sign versus its referent. Hence the need for a notation, obtuse of signifying directives, not yet as a denotation and decoding, full of revealed meaning, of a certain type of society; but only of the function of recording qua art in reality, over and against symbolised reality, and even without any metaphysical reality. Archon Satani refuse permission for their recordings (not yet historicised as music, nor art) to be seen and hence, to be read as a reaction qua art against society: â€Å"we will all become ambient dead heads...†   Ã‚  Ã‚  Ã‚  Ã‚   3. In refusing music, and art, and reaction as historically revealed, politics are also seen to be refused. The future is one where the listener-subject will become as dead as the given inanimacy of the environment that surrounds her. Fundamentally psychoanalytic desires – those hinged upon death and sex may be in nuance in such a statement.

Havaianas Advertisement Essay

This article is stating that these sandals fit all personalities and characters; no one is too cool for these sandals. In order to persuade the audience they obviously use attractive models to gain the reader’s attention. They then go on to dress the models in the clothing the words are describing. All in all they made a pretty cool looking ad that will definitely grab the attention of their audience, Cosmopolitan readers. The ad keeps one looking around the page so that the reader will see at the bottom where the name of the company and what they are selling is located. Havaianas is not necessarily implying that one benefits in any particular way by wearing their sandals, they are just trying to iterate that these sandals are or can be worn be anyone. Superhero’s, movie stars, and even tango enthusiasts would wear these at times, so they must have the style and comfort for all occasions. Havaianas might not make u better person, but it appears from the models that they are in a good mood and comfortable in there surrounding even though the house is getting destroyed. At first glance I thought the article was trying to make it seem one would be more popular for wearing Havaians, but then I realized they are trying to sell people on the products versatility, how it is a sandal for all occasions. After studying and trying to find the different meanings of the article I conclude that the implied claims are supported efficiently by the content of the ad. The words â€Å"and/or† are placed in the article twice; this helps the reader distinguish the proper meaning of the article and not assume that these are the people you can become by wearing them.

Is consociational democracy democratic? Essay

Today, democracy is both a pervasive presence and a valued symbol in European politics1. Theorists of the concept generally agree on the fundamental principles of democracy but have tended to differ radically in their conception of popular rule and democratic practices2. Consequently, it was somewhat inevitable that democracy as an ideal emerged in different forms across the diverse societies prevalent in Western Europe. Arend Lipjphart’s seminal work on ‘consociational democracies’3 contributed to democratic theory – concerned primarily with political stability of democratic regimes in plural societies4. The democratic viability of Lipjphart’s theory has recently been called into question however5. What then is ‘democracy’? Establishing the benchmarks of the concept at the outset will allow us to evaluate the extent to which ‘consociational democracy’ can be seen as ‘democratic’. An assessment of the key themes of Lipjphart’s theory – that of ‘grand coalitions’, ‘segmental autonomy’, ‘proportionality’ and ‘minority veto’ respectively – will set the structure to the following discussion. Drawing examples from the Belgian and Swiss ‘consociational’ regimes will provide illustrations of the emerging argument that consociational democracy is undemocratic6. Abraham Lincoln famously described the concept of ‘democracy’ as ‘government of the people, by the people, for the people’7. Lincoln’s prominent phrase encapsulates three fundamental principles, which, roughly translated, mean that we as citizens govern through political parties representing our interests; exercise our choice through franchise to elect those in control; and have the right to hold persons in power accountable for their actions. Moreover, the fourth striking characteristic noted by academics is that democracy represents political stability8. For Lipjphart, â€Å"consociational democracy means government by elite cartel designed to turn a democracy with a fragmented political culture into a stable democracy†9. ‘Grand coalitions’ would be used to prevent cultural diversity from being transformed into â€Å"explosive cultural segmentation†10. Politics, by its very nature, feeds on conflicts arising from social heterogeneity11 and the stability of divided societies often depends on whether the elites of rival subcultures are willing and able to reject confrontation in favour of compromise12. A grand coalition enables political leaders of all the segments of the plural society to jointly govern the country13. Nobel prize winning economist Sir Arthur Lewis endorses the system by arguing that all who are affected by a decision should have the chance to participate in making that decision, because â€Å"to exclude losing groups from participation clearly violates the primary meaning of democracy†14. In this sense, by embracing the notion of grand coalition, consociationalism can be said to be ‘democratic’15. There is, however, evidence to suggest that in practice the principle of ‘grand coalition’ does not adhere closely to the benchmarks of democracy. The Belgian governmental arena has overall remained fairly closed to non-pillar parties, which seems to contradict the very essence of grand coalition government16. In Switzerland, even though the major parties are represented on roughly proportional grounds in the Federal Council, the representatives are not always those nominated by the party17. Does this lie comfortably with the initial conception of democracy as government ‘of the people’? What of accountability? Since the Federal Council makes its decisions in a collegial manner, no party can hold its representative government directly responsible18. The Swiss consociational system cannot therefore be said to be truly accountable to the electorate – contrary to one of the fundamental principles of democracy19. Moreover, the Swiss referendum system has often highlighted flaws inherent in a ‘grand coalition’. Although the outcome of a policy decision is one of ‘amicable agreement’ among the elite, it might be opposed by 49% of the electorate at referendum20. Papadopoulos argues that the major problem stems from the fact that, since some decisions are taken at the end of the process by popular vote, it effectively excludes any further appeal or bargaining21. Can the ‘grand coalition’ system truly coincide with the democratic principle of representativeness if binding collective decisions may be taken on very small popular majorities?22 Furthermore, since accommodating strategies are not always effective, they are more easily gridlocked23 and potentially unstable24. Consequently, it seems that elite accommodation does not fulfil its proposed stabilising function and thus does not conform to the ultimate proposition of democratic stability. In all democracies power is necessarily divided to some extents between the central and non-central governments in order to avoid a concentration of power25. The ‘consociational’ school, inspired by the writings of Tocqueville, sees decentralisation of power as the essence of democratic government26. The principle of ‘segmental autonomy’ seeks to ensure that decision-making authority is, as much as possible, delegated to the separate subdivisions of society whereas issues of common interest are decided jointly. In contrast with majority rule, it may be characterised as â€Å"minority rule over the minority itself in matters that are their exclusive concern†27. This follows from Jan-Erik Lane’s proposition that all societal groups will respect the rules of democracy if they have autonomy over their own affairs28. Federalism is the best-known method of giving segmental autonomy to different groups in society. Segmental autonomy may also be provided on a non-territorial basis which is of particular relevance to plural societies where distinct sub-societies are not geographically concentrated. Such non-territorial autonomy characterised the Belgian system prior to its transformation into a federal state in 1993. Switzerland is also a federal state in which power is divided between the central government and a number of cantonal governments. Both systems, according to Tocqueville’s analysis, are conducive to democracy. It is evident that one of the subsidiary characteristics of segmental autonomy in the form of federalism is that the smaller component units are overrepresented in the federal chamber – their share of legislative seats exceeds their share of the population29. The maximum extension of this principle seems to be equality of representation regardless of the component units’ population. Such parity is evident in Switzerland where two representatives stand for each canton. Can an overrepresentation of minorities be truly democratic if it disregards the will of the majority? Moreover, the form segmental autonomy takes in the Netherlands is that pillar organisations in areas such as education, health care and housing are recognised and financed by the government. Each organisation has considerable influence in the running of their policy sector, but the increasing intervention of the state in imposing standards means that â€Å"the organisations that are autonomous in name are, in practice, quasi-governmental agencies†30. Thus, it can be argued that the pillars are to an extent no longer democratically representative of the societies they act for. What of democratic stability? In the Swiss context, highly decentralised federalism has been accused of being a hindrance of effective government31 and Belgium’s new system of federal consociationalism is bipolar, which is not always a good condition for its smooth operation32. â€Å"There can be no doubt that the adoption of a system of elected administrative officers plays a most vital part in the process of democracy†33. The notion of ‘proportionality’ serves as the basic standard of political representation34. The rule of proportionality, said to be so central to the ‘politics of accommodation’, attempts to ensure that all parties have access to state resources35. Indeed, it seems that if partisan conflict is multi-dimensional, a two-party system must be regarded as an â€Å"electoral straight jacket that can hardly be considered to be democratically superior to a multi-party system reflecting all of the major issue alternatives†36. Moreover, in two-party systems the party gaining an overall majority will tend to be overrepresented in parliament, whereas votes translate into seats proportionally through the adoption of proportional representation37. The Swiss consociational system, takes representation a step further through referenda, whereby the public effectively have a veto on state policy38. Thus, with regard to representation, it would seem that consociational democracy acquires the higher democratic ground. On the other hand, even if we concede that ‘proportionality’ is more ‘representative’, it is implicit that a defining characteristic of consociational democracy is the absence of competition since the campaigning is directed at the mobilization of the sub-cultural constituency, not at competition with other parties. Competition between parties is, however, a defining feature of democracy39, stemming from the notion of freedom and choice. Can non-competition be equated with absence of choice and thus be seen as undemocratic? Conversely, certain academics have argued that in its pure form the system of proportional representation â€Å"generally backfires and may turn out to be the kiss of death†40. Indeed, party volatilities may have significant consequences for the political process in consociational democracies41. The Swiss party system is highly fragmented42, and the increasing fractionalisation of the party system in Belgium has led to high volatility elections and instability43. Does this adhere to the democratic notion of stability? Moreover, in the Swiss context it may be argued that referendums are basically majoritarian in their effects, because they are usually decided by simple popular majorities. Indeed, it has been suggested that, due to the inability to discuss matters emerging in referenda, they are bound to be more dangerous than representative assemblies to minority rights44. Additionally, statistics show that the level of participation in Swiss referenda has been low – often below 50 per cent of those eligible to vote45. In the light of some assertions that ‘too many referenda kill democracy’46, can this aspect of proportionality in Swiss politics be described as democratic? The ‘grand coalition’ system of government serves to give each societal segment a share of power at the central level. There is no provide a guarantee, however, that the policy will not be outvoted by a majority when its primary objectives are contested47. The purpose of a ‘minority veto’48 in consociational democracies is to provide such a guarantee. The ‘minority veto’ tool provides a strong system of checks and balances and reinforces the notion of separation of powers at the heart of government. Indeed, academics have noted that Belgium’s federal state is â€Å"replete with checks and balances†49, and the notion of separation of powers in both Belgium and Switzerland manifests itself through a bicameral legislature with equal legislative powers. Consequently, it may be argued that the ‘minority veto’ sustains the democratic principle of holding the government to account. Does ‘mutual veto’ work in practice? One of the ‘rules of the consociational game’ was ‘the government’s right to govern’ with the corollary that the parties should not interfere thus allowing the government to â€Å"rise above inter-subcultural strife†. To a considerable degree, this â€Å"aloofness from party politics has given way to a politicisation of the cabinet by the governing parties†50, making the minority veto principle largely redundant. However, when it does have an effect, the reciprocal control of power inherent in mutual veto often results in mutual obstruction and blocked decision-making. Swiss constitutional amendments, for example, must be approved by a majority of the cantons – which effectively gives the smallest cantons, with less than 20 per cent of the population, a potential veto51. It is implicit in Switzerland that good solutions are often difficult to reach because the Federal council â€Å"does not observe the implicit rules of the accommodation game†52. Can a system that disregards the wishes of the majority be truly democratic? Some have even commented that â€Å"to admit the minority veto as a major and normal means of limiting power is to admit a shuddering principle†53. If you reward divisiveness through veto power, you institutionalise those divisions. In this light, Lipjphart’s machinery seems to engender â€Å"consensus-braking than consensus-making†54. Divisiveness and instability can hardly be reconciled with the traditional concept of democracy. Is consociational democracy democratic? Assessing the main themes of Lipjphart’s concept has highlighted â€Å"fundamental weaknesses† in consociational theory55. Even though ‘grand coalitions’ seek to represent all groups in society, the collegial manner of decision-making raises problems of accountability. ‘Segmental autonomy’ may be praised in theory, but it seems that in practice, smaller pillars tend to become institutionalised through heavy regulation at central level, thus negating the democratic essence of the notion. The concept of ‘proportionality’ aims at a fair distribution of power, yet the party volatilities produced as a result can hardly be conducive to democratic stability. Academics of the consociational school argue that ‘minority veto’ resolves the accountability deficit inherent in grand coalition government since it provides a system of checks and balances. On the other hand, critics contest that mutual veto encourages gridlock and frustration at the heart of administrations. The Swiss and Belgian experience has shown that consociational democracies tend to be stable, but are they stable because they are consociational56? At the very least, empirical evidence highlights a ‘democratic deficit’ in consociational theory57. 1 What democracy is and is not, p.70 2 http://www.xrefer.com/entry/343784 3 http://www.keele.ac.uk/depts/spire/Staff/Pages/Luther/researchint.htm 4 Politics and Society in Western Europe, lane + ersson, p.156 5 http://www.xrefer.com/entry/343729 6 Consociationalism has been practiced in Belgium and Switzerland since 1945 and 1943 respectively. Note: It has been argued that the Swiss model does not strictly fit into the consociational mould (Barry, Review article), but for the purpose of this analysis we will discuss Switzerland due to its grouping as one of the four original identified ‘consociational’ societies (Paul Pennings, party elites in divided societies, p.21, also Kenneth D Mc Rae p.520) 7 http://www.xrefer.com/entry/343784 8 ‘On Liberty’, J.S. Mill, Cambridge University Press, 1989 9 Sited in Politics and Society in W Europe, lane + ersson p.157 10 The odd fellow, Switzerland, p.135 11 Politics and society in Western Europe, Neo Taqu. p.2 12 http://www.keele.ac.uk/depts/spire/Staff/Pages/Luther/researchint.htm 13 Arend Lipjphart, Consociation and Federation p.500 14 W. Arthur Lewis, Politics in West Africa (London: George Allen and Unwin, 1965) p.64 15 Since 1959, Switzerland has been governed by a grand coalition of the four major political parties. The Belgian state is also maintained according to Luther’s framework of vertical linkage within the subcultures as well as engagement in overreaching accommodation to bridge the gap between the pillars (From consociation to federation, Belgium, p.104) 16 From consociation to federation, Belgium, p.98. In Belgium, to an increasing extent, the system of consociational accommodation became the ‘system’ of Christian Democrat and socialist cooperation. In 1999, the ‘natural’ centre left coalition has been in power for twelve years 17 Brian Barry, review article, p.482 18 The odd fellow, Switz, p.154 19 Indeed, it has been said that power and strict accountability for its use are the essential constituents of good government. Woodrow Wilson, Congressional Government: A study in American Politics (New York: Meridian Books, 1956) p.186 20 Brian Barry, review article, p.483 21 The odd fellow, Switz, p.138 22 In a multi-party system without a majority party, the coalition’s programme will be a compromise between the individual party platforms – a compromise made by political leaders instead of mandated directly by the voters. (Democracies, p.110) 23 Comparative constitutional engineering, p.71 24 Party Elites in divided societies, paul pennings, p.22 25 Democracies p.169 26 Politics and Society in Western Europe, Ersson + Lane, p.169 27 Lipjphart, consociation and federation, p.500 28 Lipjphart, consociation and federation, p.500 29 Democracies, p.173 30 Party elites in divided societies, Rudy Armstrong, p.124 31 The Swiss Labyrinth, p.25 32 From consoc. To fed. Belgium, p.107 33 European democracy between the wars, p.23 34 Consociation and federation, Lipjphart, p.501 35 Parties, Pillars, Rudy B. Andeweg, p.129 36 Democracies, p.113 37 Democracies, p.151. The two-party ‘leader’s bias’ was strongly illustrated in the UK in 1997, with Labour gaining 65 per cent of British seats on 45 per cent of the vote, while the Conservatives were under-represented in the commons (Dunleavy, Developments in British Politics p.147) 38 Indeed, Switzerland has developed â€Å"the theory and practice of the referendum to a pitch to which no other nation has begun to match† (Butler and Ranney, eds., Referendums:A Comparative Study of Practice and Theory (Washington, D.C.: American Enterprise Institute, 1978) p.5 39 What democracy is and is not p.70 40 Comparative constitutional engineering, p.73. It has been said that the dispersal of power across several minority parties adds profusion to confusion, Ibid. p.71 41 paul pennings, party elites, p.38 42 The odd fellow, p.141 43 From consociation to federation, Belgium, p.93. In ‘Democracy or Anarchy?’ Ferdinand A Hermens warned of the dangers proportional representation posed to the survival of democracy, arguing that the instability created by the latter would invoke the rise of autocratic regimes. (F.A. Hermens, Democracy or Anarchy? Astudy of Proportional Representation (New York: Johnson Reprint Corporation, 1972) p.293) 44 Democracies, p.31 45 The Swiss Labyrinth, p.5 46 The Swiss Labyrinth, p.5 47 Consociation and Federation, Lipjphart, p.501 48 Note: The term ‘minority veto’ will be used interchangeably with ‘mutual veto’ 49 From consociation to federation, Belgium, p.103. The Belgian constitution can only be changed by two-thirds majorities in both chambers of the legislature. This rule is effectively a minority veto where a minority or a combination thereof controls at least a third of the votes in one chamber. 50 Parties, Pillars and the Politics of accommodation, Andweg p.127 51 Democracies, p.190 52 The Swiss Labyrinth, p.27 53 Comparative Constitutional Engineering, p.71 54 Comparative constitutional engineering, p.72 55 http://www.sagepub.co.uk/journals/details/issue/abstract/ab013998.html 56 http://www.xrefer.com/entry/343729 57 Craig and De Burca p.155