My Journey to the IIM !!

bonddonraj said:
i read this line written at the back of a match stick ====== The difference between genius and stupedity is that genius is has its limts========


======== dhuhhhh------- do i know my limits!!!!!!!! still figuring it out:SugarwareZ-299:
Click to expand...

How true, yaar.... stupidity has no ends.... a stupid person can keep on going arguing endlessly, senselessly.... and hence follows what AJ's signature says....

"Never argue with an idiot...... " :pound::pound:
 
=========SNEEKING IN MY PERSONAL DAIRY======
8 DECEMBER 2004
4 AM( NASIK )

DO YOU WHEN THE BURNING FIRE IS MORE DANGEROUS!!! WHEN IT IS TRAVELS ==TRAVELS TO BRING WHOLE FOREST INTO ASHES == ASITTING FIRE IS ONE DAY EITHER DIES ITS OWN DEATH OR IS KILLED BY OTHER PEOPLE === THATS WHY I SAY ===KEEP MOVING===
 
The best negotiators use an array of techniques, including what have been seen as traditionally female attributes - so why do women still find it difficult to ask for a pay rise? For years, there has been a perception that women are worse negotiators than men. Indeed, compared with men women are, on average, paid less and occupy fewer leadership positions. Women have, on average, fewer or worse negotiation opportunities and conditions. Even in some studies in which women and men were given similar opportunities, women still had, on average, worse negotiated outcomes than men. Much circumstantial evidence indicates that women are worse negotiators than men, which creates the impression that to succeed women must emulate the aggressive, male-associated style.
 
Indian radio industry to reach Rs 12,000 cr by 2010:
FICCI-PriceWaterhouse Cooper

Global Radio Industry
After a sluggish growth in radio advertising in 2001, the radio market has been witnessing steady growth in the last 5 years. The radio market on an aggregate basis has grown consistently by 4.4 per cent in the last 2 years. United States has been leading the growth and has demonstrated growth exceeding the growth in the last year.

The global radio industry is projected to increase from $44.6 billion in 2005 to an estimated $58.8 billion in 2010, averaging 5.7 per cent compound annual growth. Slow-growing public radio license fees will hold down increases in EMEA (Europe, Middle East & Africa) and Asia Pacific to 3.3 per cent and 4.2 per cent respectively. Digital broadcasting will play a key role in improving radio advertising but its positive impact will be partially offset by the growing audience fragmentation that will dampen ad rates. Satellite radio is projected to boost spending in the United States and Canada, and provide modest incremental revenue in Asia Pacific.


Radio Market(USD million)
Region 2001 2002 2003 2004 2005
United States
% change
17,862
-7.4 18,901
5.8 19,229
1.7 19,975
3.9 20,982
5.0
EMEA
% change
13,222
1.1 13,569
2.6 14,061
3.6 14,823
5.4 15,341
3.5
Asia Pacific
% change
5,433
0.9 5,488
0.3 5,574
2.3 5,780
3.7 5,933
2.6
Latin America
% change
761
-13.0 734
-3.5 1,072
46.0 1,147
7.0 1,302
13.5
Canada
% change
875
4.5 903
3.2 979
8.4 996
1.7 1,044
4.8
Total
% change
38,153
-3.3 39,555
3.7 40,915
3.4 42,721
4.4 44,602
4.4
Source:PricewaterhouseCoopers Global Entertainment & Media Outlook 2006-2010

Radio industry in India
After the second FM radio policy, India is growing towards 300 radio stations as compared to 21 stations earlier. 91 cities will be covered by the new radio stations, compared to 21 cities earlier. Thus, listeners in over 70 cities, largely in the B.C and D categories, will be listening to private FM radio stations, earlier serviced only by the State broadcaster. Over 40 companies will be operating in the industry as compared to 7 earlier.

Of the total advertising spend in India the radio industry’s share is about 2 per cent. This share is expected to rise substantially over the next ten years, going by the explosive growth in the ad inventory and the wide reach, especially the lower segment markets that the radio industry can now offer.

Based on these factors, coupled with other regulatory corrections such as migration to a revenue-share regime and allowing Foreign Direct Investment (FDI) up to 20 per cent, the sector is emerging for tremendous growth over the coming years.



KEY TRENDS

Consolidation of advertising inventory
The Indian radio industry today comprises a large number of players, making it difficult for advertisers to reach the sellers. Consolidation could enable the radio group owners to package radio stations and sell them to advertisers as a group. The consolidated group would then also have the ability to provide the advertiser a national reach and command a higher price for its inventory.

However, consolidation may not be successful owing to regulatory factors, attempts to consolidate advertising inventory could result in stations garnering an effective premium to otherwise falling advertising rates.


Clearinghouse services
A concept tested in US, the emergence of clearinghouse services that sell unused airtime has provided a modest incremental revenue stream to radio companies. The services act in a similar manner to those that sell unused seats on airlines or unused hotel rooms. In effect, participating radio stations auction unsold inventory to the highest bidder. Advertisers get inventory at a discount and radio stations get additional revenue that otherwise could not be made up. Emergence of such clearinghouse services in India, independent of the Indian radio companies or the Indian advertisers, could work well.

Digital radio
Globally, many countries are moving towards digital radio with standards ranging from digital audio broadcasting (DAB), digital radio mondiale (DRM) and others. Digital radio not only provides near-CD quality audio, radio stations can also transmit information on songs, artists and sales information to woo advertisers.

In India, digital radio will require the radio companies to install digital broadcasting equipment and for the consumers to purchase receivers. As has been witnessed in other sectors like television distribution, where attempts have been made to move towards digitisation, it seems unlikely that the radio industry can move towards digital broadcasting suo moto. As is the case in several countries, regulatory authorities in India will be required to intervene. The regulatory push will be required for not only drawing up the digitisation plan but also effectively monitoring the same and examining the possibilities of providing incentives for all stake holders to adopt the digital standards.


Advertising clutter
Advertising avoidance continues to remain the key challenge for all media companies including radio. In India, radio stations not only have to fight competition from other media but also with other radio companies operating in the same network. Securing command over local advertisers is the key focus area for radio stations as they reach local people. However, the emergence of other local media players such as the out-of-home segment, cable television, local film theatres and local print media, is providing a further challenge to radio.

Some radio stations, especially in America, have attempted to reduce the advertising inventory with the hope that it will be appreciated by the listener, increasing the listenership and enabling them to command a higher advertising rate and reduce the inventory. Though this attempt has succeeded in some cases for limited periods, the challenge remains that all radio stations in the network do not adopt this mode, leaving a gap for the advertiser to tap into. Targeted advertiser-driven programming formats, niche programming such as sports updates, celebrity hosts etc are some of the ways that radio stations globally are combating this challenge.
 
NATIONAL HEALTH POLICY

NATIONAL HEALTH POLICY


Table of Contents
INTRODUCTION
OUR HERITAGE
PROGRAM ACHIEVED
THE EXESTING PICTURE
NEED FOR EVOLVING A HEALTH POLICY
POPULATION STABILISATION
MEDICAL & HEALTH EDUCATION
NEED FOR PROVIDING PRIMARY HEALTH CARE
REORIENTATION OF EXISTING HEALTH PERSONNEL
PRACTIONERS ROLE IN HEALTH CARE
PROBLEMS REQUIRING URGENT ATTENTION
HEALTH EDUCATION
MANAGEMENT INFORMATION SYSTEM
HEALTH INSURANCE
HEALTH LEGISLATION
MEDICAL RESEARCH
INTER SECTORAL COOPERATION
MONITORING AND REVIEW OF PROGRESS NOTE : A NEW HEALTH POLICY DRAFT IS UNDER PREPERATION YOU ARE


Introduction
1. The Constitution of India envisages the establishment of a new social order based on equality, freedom, justice and the dignity of the individual. It aims at the elimination of poverty, ignorance and ill-health and directs the State to regard the raising of the level of nutrition and the standard of living of its people and the improvement of public health as among its primary duties, securing the health and strength of workers, men and women, specially ensuring that children are given opportunities and facilities to develop in a healthy manner.

1.2 Since the inception of the planning process in the country, the successive Five Year Plans have been providing the framework within which the States may develop their health services infrastructure, facilities for medical education, research, etc. Similar guidance has sought to be provided through the discussions and conclusions arrived at in the Joint Conferences of the Central Councils of Health and Family. Welfare and the National Development Council. Besides, Central legislation has been enacted to regulate standards of medical education, prevention of food adulteration, maintenance of standards in the manufacture and sale of certified drugs, etc.

1.3 While the broad approaches contained in the successive Plan documents and discussion in the forums referred to in para 1.2 may have generally served the needs of the situation in the past, it is felt that an integrated, comprehensive approach towards the future development of medical education, research and health services requires to be established to serve the actual health needs and priorities of the country. It is in this context that the need has been felt to evolve a National Health Policy.

Our heritage
2. India has a rich, centuries-old heritage of medical and health sciences. The philosophy of Ayurveda and the surgical skills enunciated by Charaka and Shusharuta bear testimony to our ancient tradition in the scientific health care of our people. The approach of our ancient medical systems was of a holistic nature, which took into account all aspects of human health and disease. Over the centuries, with the intrusion of foreign influences and mingling of cultures, various systems of medicine evolved and have continued to be practised widely. However, the allopathic system of medicine has, in a relatively short period of time, made a major impact on the entire approach to health care and pattern of development of the health services infrastructure in the country.

Progress achieved
3. During the last three decades and more, since the attainment of Independence, considerable progress has been achieved in the promotion of the health status of our people. Smallpox has been eliminated; plague is no longer a problem; mortality from cholera and related diseases has decreased and malaria brought under control to a considerable extent. The mortality rate per thousand of population has been reduced from 27.4 to 14.8 and the life expectancy at birth has increased from 32.7 to over 52. A fairly extensive network of dispensaries, hospitals and institutions providing specialised curative care has developed and a large stock of medical and health personnel, of various levels, has become available. Significant indigenous capacity has been established for the production of drugs and pharmaceuticals, vaccines, sera, hospital equipments, etc.

The existing picture
4. In spite of such impressive progress, the demographic and health picture of the country still constitutes a cause for serious and urgent concern. The high rate of population growth continues to have an adverse effect on the health of our people and the quality of their lives. The mortality rates for women and children are still dis- tressingly high; almost one third of the total deaths occur among children below the age of 5 years; infant mortality is around 129 per thousand live births. Efforts at raising the nutritional levels of our people have still to bear fruit and the extent and severity of malnutrition continues to be exceptionally high. Communicable and non- communicable diseases have still to be brought under effective control and eradicated. Blindness, Leprosy and T.B. continue to have a high incidence. Only 31% of the rural population has access to potable water supply and 0.5% enjoys basic sanitation.

4.1. High incidence of diarrhoeal diseases and other preventive and infectious diseases, specially amongst infants and children, lack of safe drinking water and poor environmental sanitation, poverty and ignorance are among the major contributory causes of the high incidence of disease and mortality.

4.2. The existing situation has been largely engendered by the almost wholesale adoption of health manpower development policies and the establishment of curative centres based on the Western models, which are inappropriate and irrelevant to the real needs of our people and the socio-economic conditions obtaining in the country. The hospital-based disease, and cure-oriented approach towards the establishment of medical services has provided benefits to the upper crusts, of society, specially those residing in the urban areas. The proliferation of this approach has been at the cost of providing comprehensive primary health care services to the entire population, whether residing in the urban or the rural areas. Furthermore, the continued high emphasis on the curative approach has led to the neglect of the preventive, promotive, public health and rehabilitative aspects of health care. The existing approach, instead of improving awareness and building up self-reliance, has tended to enhance dependency and weaken the community's capacity to cope with its problems. The prevailing policies in regard to the education and training of medical and health personnel, at various levels, has resulted in the development of a cultural gap between the people and the personnel providing care. The various health programmes have, by and large, failed to involve individuals and families in establishing a self-reliant community. Also, over the years, the planning process has become largely oblivious of the fact that the ultimate goal of achieving a satisfactory health status for all our people cannot be secured without involving the community in the identification of their health needs and priorities as well as in the implementation and management of the various health and related programmes.

Need for evolving a health policy--- the revised 20-Point Programme
5. India is committed to attaining the goal of "Health for All by the Year 2000 A.D." through the universal provision of comprehensive primary health care services. The attainment of this goal requires a thorough overhaul of the existing approaches to the education and training of medical and health personnel and the reorganisation of the health services infrastructure. Furthermore, considering the large variety of inputs into health, it is necessary to secure the complete integration of all plans for health and human development with the overall national socio-economic development process, specially in the more closely health related sectors, e.g. drugs and pharmaceu- ticals, agriculture and food production, rural development, education and social welfare, housing, water supply and sanitation, prevention of food adulteration, main- tenance of prescribed standards in the manufacture and sale of drugs and the conservation of the environment. In sum, the contours of the National Health Policy have to be evolved within a fully integrated planning framework which seeks to provide universal, comprehensive primary health care services, relevant to the actual needs and priorities of the community at a cost which the people can afford, ensuring that the planning and implementation of the various health programmes is through the organised involvement and participation of the community, adequately utilising the services being rendered by private voluntary organisations active in the Health sector.

5.1. It is also necessary to ensure that the pattern of development of the health services infrastructure in the future fully takes into account the revised 20-Point Programme. The said Programme attributes very high priority to the promotion of family planning as a people's programme, on a voluntary basis; substantial augmenta- tion and provision of primary health care facilities on a universal basis; control of Leprosy, T.B. and Blindness; acceleration of welfare programmes for women and children; nutrition programmes for pregnant women, nursing mothers and children, especially in the tribal, hill and backward areas. The Programme also places high emphasis on the supply of drinking water to all problem villages, improvements in the housing and environments of the weaker sections of society; increased production of essential food items; integrated rural developments; spread of universal elementary education; expansion of the public distribution system, etc.

Population stabilisation
6. Irrespective of the changes, no matter how fundamental, that may be brought about in the over-all approach to health care and the restructuring of the health services, not much headway is likely to be achieved in improving the health status of the people unless success is achieved in securing the small family norm, through voluntary efforts, and moving towards the goal of population stabilisation. In view of the vital importance of securing the balanced growth of the population, it is neces- sary to enunciate, separately, a National Population Policy.

Medical and Health Education
7. It is also necessary to appreciate that the effective delivery of health care services would depend very largely on the nature of education, training and appro- priate orientation towards community health of all categories of medical and health personnel and their capacity to function as an integrated team, each of its members performing given tasks within a coordinated action programme. It is, therefore, of crucial importance that the entire basis and approach towards medical and health education, at all levels, is reviewed in terms of national needs and priorities and the curricular and training programmes restructured to produce personnel of various grades of skill and competence, who are professionally equipped and socially moti- vated to effectively deal with day-to-day problems, within the existing constraints.

Towards this end, it is necessary to formulate, separately, a National Medical and Health Education Policy which (i) sets out the changes required to be brought about in the curricular contents and training programme of medical and health personnel, at various levels of functioning; (ii) takes into account the need for establishing the extremely essential inter-relations between functionaries of various grades; (iii) provides guidelines for the production of health personnel on the basis of realistically assessed manpower requirements; (iv) seeks to resolve the existing sharp regional imbalances in their availability; and (v) ensures that personnel at all levels are socially motivated towards the rendering of community health services.

Need for providing primary health care with special emphasis on the preventive, promotive and rehabilitative aspects
8. Presently, despite the constraint of resources, there is disproportionate emphasis on the establishment of curative centres---dispensaries, hospitals, institutions for specialist treatment---the large majority of which are located in the urban areas of the country. The vast majority of those seeking medical relief have to travel long distance to the nearest curative centre, seeking relief for ailments which could have been readily and effectively handled at the community level. Also, for want of a well established referral system, those seeking curative care have the tendency to to visit various specialist centres, thus further contributing to congestions, duplication of efforts and consequential waste of resources. To put an end to the existing all-round unsatisfactory situation, it is urgently necessary to restructure the health services within the following broad approach:

(1) To provide, within a phased, time-bound programme a well dispersed network of comprehensive primary health care services, integrally linked with the extension and health education approach which takes into account the fact that a large majority of health functions can be effectively handled and resolved by the people themselves, with the organised support of volunteers, auxilliaries, para-medics and adequately trained multi-purpose workers of various grades of skill and competence, of both sexes. There are a large number of private, voluntary organisations active in the health field, all over the country. Their services and support would require to be utilised and intermeshed with the governmental efforts, in an integrated manner.

(2) To be effective, the establishment of the primary health care approach would involve large scale transter of knowledge, simple skill and techno- logies to Health Volunteers, selected by the communities and enjoying their confidence. The functioning of the front line workers, selected by the community would require to be related to definitive action plans for the translation of medical and health knowledge into practical action, involv- ing the use of simple and inexpensive interventions which can be readily implemented by persons who have undergone short periods of training. The quality of training of these health guides/workers would be of crucial importance to the success of this approach.

The success of the decentralised primary health care system would depend vitally on the organised building up of individual self-reliance and effective community participation; on the provision of organised, back-up support of the secondary and tertiory levels of the health care services, providing adequate logistical and technical assistance.

(4) The decentralisation of services would require the establishment of a well worked out referral system to provide adequate expertise at the various levels of the organisational set-up nearest to the community, depending upon the actual needs and problems of the area, and thus ensure against the continuation of the existing rush towards the curative centres in the urban areas. The effective establishment of the referral system would also ensure the optimal utilisation of expertise at the higher levels of the heirarchical structure. This approach would not only lead to the progres- sive improvement of comprehensive health care services at the primary level but also provide for timely attention being available to those in need of urgent specialist care, whether they live in the rural or the urban areas.

(5) To ensure that the approach to health care does not merely constitute a collection of disparate health interventions but consists of an integrated package of services seeking to tackle the entire range of poor health conditions, on a broad front, it is necessary to establish a nation-wide chain of sanitary-cum-epidemiological stations. The location and func- tioning of these stations may be between the primary and secondary levels of the heirarchical structure, depending upon the local situations and other relevant considerations. Each such station would require to have suitably trained staff equipped to identify, plan and provide preventive, promotive and mental health care services. It would be beneficial, depending upon the local situations, to establish such stations at the Primary Health Centres. The district health organisation should have, as an integral part of its set-up, a well organised epidemiological unit to coordinate and superintend the functioning of the field stations. These stations would participate in the integrated action plans to eradicate and control diseases, besides tackling specific local environmental health problems.

In the urban agglomerations, the municipal and local authorities should be equipped to perform similar functions, being supported with adequate resources and expertise, to effectively deal with the local preventable public health problems. The aforesaid approach should be implemented and extended through community participation and contributions, in whatever form possible, to achieve meaningful results within a time-bound programme.

(6) The location of curative centres should be related to the populations they serve, keeping in view the densities of population, distances, topography, transport connections. These centres should function within the recom- mended referral system, the gamut of the general specialities required to deal with the local disease patterns being provided as near to the community as possible, at the secondary level of the hierarchical organi- sation. The concept of domiciliary care and the field-camps approach should be utilised to the fullest extent, to reduce the pressures on these centres, specially in efforts relating to the control and eradication of Blindness, Tuberculosis, Leprosy, etc. To maximise the utilisation of available resources, new and additional curative centres should be established only in exceptional cases, the basic attempt being towards the upgradation of existing facilities, at selected locations, the guiding principle being to provide specialist services as near to the beneficiaries as may be possible, within a well-planned network. Expenditure should be reduced through the fullest possible use of cheap locally available building materials, resort to appropriate architectural designs and engineering concepts and by economical investment in the purchase of machineries and equipments, ensuring against avoidable duplication of such acquisitions. It is also necessary to devise effective mechanisms for the repair, main- tenance and proper upkeep of all bio-medical equipments to secure their maximum utilisation.

(7) With a view to reducing governmental expenditure and fully utilising untapped resources, planned programmes may be devised, related to the local requirements and potentials, to encourage the establishment of practice by private medical professional, increased investment by non- governmental agencies in establishing curative centres and by offering organised logistical, financial and technical support to voluntary agencies active in the health field.

(8) While the major focus of attention in restructuring the existing govern- mental health organisations would relate to establishing comprehensive primary health care and public health services, within an integrated referral system, planned attention would also require to be devoted to the establishment of centres equipped to provide speciality and super-speciality services, through a well dispersed network of centres, to ensure that the present and future requirements of specialist treatment are adequately available within the country. To reduce governmental expenditures involved in the establishment of such centres, planned efforts should be made to encourage private investments in such fields so that the majority of such centres, within the governmental set-up, can provide adequate care and treatment to those entitled to free care, the affluent sectors being looked after by the paying clinics. Care would also require to be taken to ensure the appropriate dispersal of such centres, to remove the existing regional imbalances and to provide services within the reach of all, whether residing in the rural or the urban areas.

(9) Special, well-coordinated programmes should be launched to provide mental health care as well as medical care and the physical and social rehabilitation of those who are mentally retarded, deaf, dumb, blind, physically disabled, infirm and the aged. Also, suitably organised of various disabilities.

(10) In the establishment of the re-organised services, the first priority should be accorded to provide services to those residing in the tribal, hill and back- ward areas as well as to endemic disease affected populations and the vulnerable sections of the society.

(11) In the re-organised health services scheme, efforts should be made to ensure adequate mobility of personnel, at all level of functioning.

(12) In the various approaches, set out in (1) to (11) above, organised efforts would require to be made to fully utilise and assist in the enlargement of the services being provided by private voluntary organisations active in the health field. In this context, planning encouragement and support would also require to be afforded to fresh voluntary efforts, specially those which seek to serve the needs of the rural areas and the urban slums.

Re-orientation of the existing health personnel
9. A dynamic process of changes and innovation is required to be brought about in the entire approach to health manpower development, ensuring the emergence of fully integrated bands of workers functioning within the "Health Team" approach.

Private practice by governmental functionaries

10. It is desirable for the States to take steps to phase out of system of private practice by medical personnel in government service, providing at the same tome for payment of appropriate compensatory no-practising allowance. The States would require to carefully review the existing situation, with special reference to the availability and dispersal of private practitioners, and take timely decisions in regard to this vital issue.

Practitioners of indigenous and other systems of medicine and their role in health care
11. The country has a large stock of health manpower comprising of private practitioners in various systems, for example, Ayurveda, Uncanny, Side, Homeopathy, yoga, Naturopathy, etc. This resource has not so for been adequately utilized. The practitioners of these various systems enjoy high local acceptance and respect and consequently exert considerable influence on health beliefs and practise. It is, therefore, necessary to initiate organised measures to enable each of these various systems of medicine and health care to develop in accordance wit its genius. Simultaneously, planned efforts should be made to dovetail the functioning of the practitioners of these various systems and integrate their service, at the appropriate levels, within specified areas of responsibility and functioning, in the over-all health care delivery system, specially in regard to the preventive, primitive and public health objectives. Well considered steps would also require to be launched to move towards a meaningful phased integration of the indigenous and the modern systems.
 
GIRL FRIEND AND WIFE

G.F and Wife
Dear Tech Support Team:
Last year I upgraded from Girlfriend 5.0 to Wife 1.0.
I soon noticed that the new program began unexpected child-processes that took up a lot of space and valuable resources.
In addition, Wife 1.0 installed itself into all other programs and now monitors all other system activities.
Applications such as BachelorNights 10.3, Cricket 5.0, BeerWithBuddies 7.5, and Outings 3.6 no longer runs, crashing the system whenever selected. I can't seem to keep Wife 1.0 in the background while attempting to run my favorite applications.
I'm thinking about going back to Girlfriend 5.0 , but the 'uninstall ' doesn't work on Wife 1.0.
Please help!

Thanks,
"A Troubled User ":big_grin:

REPLY:

Dear Troubled User:
This is a very common problem that people complain about.
Many people upgrade from Girlfriend 5.0 to Wife 1.0, thinking that it is just a Utilities and Entertainment program.
Wife 1.0 is an OPERATING SYSTEM and is designed by its Creator to run EVERYTHING !!!

It is also impossible to delete Wife 1.0 and to return to Girlfriend 5.0.
It is impossible to uninstall, or purge the program files from the system once installed.
You cannot go back to Girlfriend 5.0 because Wife 1.0 is designed not to allow this. (Look in your Wife 1.0 Manual under Warnings-Alimony- Child Support) ..
I recommend that you keep Wife1.0 and work on improving the environment.
I suggest installing the background application " Yes Dear" to alleviate software augmentation.
The best course of action is to enter the command C:\APOLOGIZE because ultimately you will have to give the APOLOGIZE command before the system will return to normal anyway.
Wife 1.0 is a great program, but it tends to be very high maintenance. Wife 1.0 comes with several support programs, such as Clean 2.5, Sweep 3.0, Cook 1.5 and DoLaundry 4.2. However, be very careful how you use these programs. Improper use will cause the system to launch the program NagNa9.5
Best of luck,
Tech Support :SugarwareZ-254:
 
Goal of yoga and Role of yoga: The goal of yoga, therefore, is to liberate the jéva from his mistaken identification with the material body and the material world and to reconnect him to God (yoga literally means "link"). Yoga involves withdrawing the mind and senses from sense objects and, through unattached action, meditation, philosophical speculation or devotion (depending on which system of yoga one employs), gradually detaching oneself from the mundane world and ultimately realizing the self and his relationship with God.

Types of yoga: Although there is some mention of añöäìga-yoga ("the eightfold path"), the Gétä deals primarily with three important systems of yoga: karma-yoga ("the yoga of action"), jïäna-yoga ("the yoga of knowledge") and bhakti-yoga ("the yoga of devotion").

Karma-yoga: In karma-yoga, one acts in selfless duty to the Supreme, sacrificing the fruits of one's work to God. This purifies the actor and releases him from material entanglement.

Jïäna-yoga: In jïäna-yoga, one gradually cultivates spiritual knowledge by philosophical induction, exercising the intellect to differentiate between matter and spirit. Bhagavad-gétä introduces these yoga systems not exactly as self-sufficient paths.

Bhakti-yoga : But in this progressive "yoga ladder," the highest rung being bhakti-yoga. The paths of karma-yoga, jïäna-yoga and dhyäna-yoga are prescribed as the various preliminary aspects of a single way to approach God: bhakti, selfless devotional love
 
douglas mcgregor - theory x y
Douglas McGregor's XY Theory, managing an X Theory boss, and William Ouchi's Theory Z
Douglas McGregor, an American social psychologist, proposed his famous X-Y theory in his 1960 book 'The Human Side Of Enterprise'. Theory x and theory y are still referred to commonly in the field of management and motivation, and whilst more recent studies have questioned the rigidity of the model, Mcgregor's X-Y Theory remains a valid basic principle from which to develop positive management style and techniques. McGregor's XY Theory remains central to organizational development, and to improving organizational culture.

McGregor's X-Y theory is a salutary and simple reminder of the natural rules for managing people, which under the pressure of day-to-day business are all too easily forgotten.

McGregor maintained that there are two fundamental approaches to managing people. Many managers tend towards theory x, and generally get poor results. Enlightened managers use theory y, which produces better performance and results, and allows people to grow and develop.

theory x ('authoritarian management' style)
The average person dislikes work and will avoid it he/she can.
Therefore most people must be forced with the threat of punishment to work towards organisational objectives.
The average person prefers to be directed; to avoid responsibility; is relatively unambitious, and wants security above all else.
theory y ('participative management' style)
Effort in work is as natural as work and play.
People will apply self-control and self-direction in the pursuit of organisational objectives, without external control or the threat of punishment.
Commitment to objectives is a function of rewards associated with their achievement.
People usually accept and often seek responsibility.
The capacity to use a high degree of imagination, ingenuity and creativity in solving organisational problems is widely, not narrowly, distributed in the population.
In industry the intellectual potential of the average person is only partly utilised.



characteristics of the x theory manager
What are the characteristics of a Theory X manager? Typically some, most or all of these:

results-driven and deadline-driven, to the exclusion of everything else
intolerant
issues deadlines and ultimatums
distant and detached
aloof and arrogant
elitist
short temper
shouts
issues instructions, directions, edicts
issues threats to make people follow instructions
demands, never asks
does not participate
does not team-build
unconcerned about staff welfare, or morale
proud, sometimes to the point of self-destruction
one-way communicator
poor listener
fundamentally insecure and possibly neurotic
anti-social
vengeful and recriminatory
does not thank or praise
withholds rewards, and suppresses pay and remunerations levels
scrutinises expenditure to the point of false economy
seeks culprits for failures or shortfalls
seeks to apportion blame instead of focusing on learning from the experience and preventing recurrence
does not invite or welcome suggestions
takes criticism badly and likely to retaliate if from below or peer group
poor at proper delegating - but believes they delegate well
thinks giving orders is delegating
holds on to responsibility but shifts accountability to subordinates
relatively unconcerned with investing in anything to gain future improvements
unhappy
how you can manage upwards your X theory boss:
Working for an X theory boss isn't easy - some extreme X theory managers make extremely unpleasant managers, but there are ways of managing these people upwards. Avoiding confrontation (unless you are genuinely being bullied, which is a different matter) and delivering results are the key tactics.

Theory X managers (or indeed theory Y managers displaying theory X behaviour) are primarily results oriented - so orientate your your own discussions and dealings with them around results - ie what you can deliver and when.
Theory X managers are facts and figures oriented - so cut out the incidentals, be able to measure and substantiate anything you say and do for them, especially reporting on results and activities.
Theory X managers generally don't understand or have an interest in the human issues, so don't try to appeal to their sense of humanity or morality. Set your own objectives to meet their organisational aims and agree these with the managers; be seen to be self-starting, self-motivating, self-disciplined and well-organised - the more the X theory manager sees you are managing yourself and producing results, the less they'll feel the need to do it for you.
Always deliver your commitments and promises. If you are given an unrealistic task and/or deadline state the reasons why it's not realistic, but be very sure of your ground, don't be negative; be constructive as to how the overall aim can be achieved in a way that you know you can deliver.
Stand up for yourself, but constructively - avoid confrontation. Never threaten or go over their heads if you are dissatisfied or you'll be in big trouble afterwards and life will be a lot more difficult.
If an X theory boss tells you how to do things in ways that are not comfortable or right for you, then don't questioning the process, simply confirm the end-result that is required, and check that it's okay to 'streamline the process' or 'get things done more efficiently' if the chance arises - they'll normally agree to this, which effectively gives you control over the 'how', provided you deliver the 'what' and 'when'.
And this is really the essence of managing upwards X theory managers - focus and get agreement on the results and deadlines - if you consistently deliver, you'll increasingly be given more leeway on how you go about the tasks, which amounts to more freedom. Be aware also that many X theory managers are forced to be X theory by the short-term demands of the organisation and their own superiors - an X theory manager is usually someone with their own problems, so try not to give them any more.
 
maslow's hierarchy of needs
Abraham Maslow's Hierarchy of Needs motivational model
Abraham Maslow developed the Hierarchy of Needs model in 1940-50's USA, and the Hierarchy of Needs theory remains valid today for understanding human motivation, management training, and personal development. Indeed, Maslow's ideas surrounding the Hierarchy of Needs concerning the responsibility of employers to provide a workplace environment that encourages and enables employees to fulfil their own unique potential (self-actualization) are today more relevant than ever. Abraham Maslow's book Motivation and Personality, published in 1954 (second edition 1970) introduced the Hierarchy of Needs, and Maslow extended his ideas in other work, notably his later book Toward A Psychology Of Being, a significant and relevant commentary, which has been revised in recent times by Richard Lowry, who is in his own right a leading academic in the field of motivational psychology.

Abraham Maslow was born in New York in 1908 and died in 1970, although various publications appear in Maslow's name in later years. Maslow's PhD in psychology in 1934 at the University of Wisconsin formed the basis of his motivational research, initially studying rhesus monkeys. Maslow later moved to New York's Brooklyn College. Maslow's original five-stage Hierarchy of Needs model is clearly and directly attributable to Maslow; later versions with added motivational stages are not so clearly attributable. Maslow's Hierarchy of Needs has been extended through interpretation of Maslow's work by other people, and these augmented models and diagrams are shown as the adapted seven and eight-stage Hierarchy of Needs models below. There is some uncertainty as to how and when these additional three stages (six, seventh and eighth - 'Cognitive', 'Aesthetic', and 'Transcendence') came to be added, and by whom, to the Hierarchy of Needs model, and many people consider Maslow's 'original' five-stage Hierarchy Of Needs model to be the definitive (and perfectly adequate) concept.

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(N.B. The word Actualization/Actualisation can be spelt either way. Z is preferred in American English. S is preferred in UK English. Both forms are used in this page to enable keyword searching for either spelling via search engines.)




maslow's hierarchy of needs
Each of us is motivated by needs. Our most basic needs are inborn, having evolved over tens of thousands of years. Abraham Maslow's Hierarchy of Needs helps to explain how these needs motivate us all.

Maslow's Hierarchy of Needs states that we must satisfy each need in turn, starting with the first, which deals with the most obvious needs for survival itself.

Only when the lower order needs of physical and emotional well-being are satisfied are we concerned with the higher order needs of influence and personal development.

Conversely, if the things that satisfy our lower order needs are swept away, we are no longer concerned about the maintenance of our higher order needs.

Maslow's original Hierarchy of Needs model was developed between 1943-1954, and first widely published in Motivation and Personality in 1954. At this time the Hierarchy of Needs model comprised five needs. This original version remains for most people the definitive Hierarchy of Needs.




maslow's hierarchy of needs - free pdf diagram and free msword diagram
1. Biological and Physiological needs - air, food, drink, shelter, warmth, sex, sleep, etc.

2. Safety needs - protection from elements, security, order, law, limits, stability, etc.

3. Belongingness and Love needs - work group, family, affection, relationships, etc.

4. Esteem needs - self-esteem, achievement, mastery, independence, status, dominance, prestige, managerial responsibility, etc.

5. Self-Actualization needs - realising personal potential, self-fulfillment, seeking personal growth and peak experiences.
 
what hierarchy of needs model is most valid?
Abraham Maslow created the original five level Hierarchy of Needs model, and for many this remains entirely adequate for its purpose. The seven and eight level 'hierarchy of needs' models are later adaptations by others. Arguably, the original five-level model includes the later additional sixth, seventh and eighth ('Cognitive', 'Aesthetic', and 'Transcendence') levels within the original 'Self-Actualization' level 5, since each one of the 'new' motivators concerns an area of self-development and self-fulfilment that is rooted in self-actualization 'growth', and is distinctly different to any of the previous 1-4 level 'deficiency' motivators. For many people, self-actualizing commonly involves each and every one of the newly added drivers. As such, the original five-level Hierarchy of Needs model remains a definitive classical representation of human motivation; and the later adaptations perhaps serve best to illustrate aspects of self-actualization.




Maslow said that needs must be satisfied in the given order. Aims and drive always shift to next higher order needs. Levels 1 to 4 are deficiency motivators; level 5, and by implication 6 to 8, are growth motivators and relatively rarely found. The thwarting of needs is usually a cause of stress, and is particularly so at level 4.

Examples in use:

You can't motivate someone to achieve their sales target (level 4) when they're having problems with their marriage (level 3).

You can't expect someone to work as a team member (level 3) when they're having their house re-possessed (level 2).




Maslow's Self-Actualizing characteristics
keen sense of reality - aware of real situations - objective judgement, rather than subjective
see problems in terms of challenges and situations requiring solutions, rather than see problems as personal complaints or excuses
need for privacy and comfortable being alone
reliant on own experiences and judgement - independent - not reliant on culture and environment to form opinions and views
not susceptible to social pressures - non-conformist
democratic, fair and non-discriminating - embracing and enjoying all cultures, races and individual styles
socially compassionate - possessing humanity
accepting others as they are and not trying to change people
comfortable with oneself - despite any unconventional tendencies
a few close intimate friends rather than many surface relationships
sense of humour directed at oneself or the human condition, rather than at the expense of others
spontaneous and natural - true to oneself, rather than being how others want
excited and interested in everything, even ordinary things
creative, inventive and original
seek peak experiences that leave a lasting impression (see the Hellespont Swim case study)


Maslow's Hierarchy of Needs in advertising
To help with training of Maslow's theory look for Maslow's Hierarchy of Needs motivators in advertising. This is a great basis for Maslow and motivation training exercises:

Biological and Physiological needs - wife/child-abuse help-lines, social security benefits, Samaritans, roadside recovery.
Safety needs - home security products (alarms, etc), house an contents insurance, life assurance, schools.
Belongingness and Love needs - dating and match-making services, chat-lines, clubs and membership societies, Macdonalds, 'family' themes like the old style Oxo stock cube ads.
Esteem needs - cosmetics, fast cars, home improvements, furniture, fashion clothes, drinks, lifestyle products and services.
Self-Actualization needs - Open University, and that's about it; little else in mainstream media because only 2% of population are self-actualizers, so they don't constitute a very big part of the mainstream market.
You can view and download free Maslow's Hierarchy of Needs diagrams, and two free Hierarchy of Needs self-tests, based on the original Maslow's five-stage model and later adapted eight-stage model, ideal for training, presentations and project work, at the businessballs free online resources section.

interpreting behaviour according to Maslow's Hierarchy of Needs
Maslow's Hierarchy of Needs is an excellent model for understanding human motivation, but it is a broad concept. If you are puzzled as to how to relate given behaviour to the Hierarchy it could be that your definition of the behaviour needs refining. For example, 'where does 'doing things for fun' fit into the model? The answer is that it can't until you define 'doing things for fun' more accurately.

You'd need to define more precisely each given situation where a person is 'doing things for fun' in order to analyse motivation according to Maslow's Hierarchy, since the 'fun' activity motive can potentially be part any of the five original Maslow needs.

Understanding whether striving to achieve a particular need or aim is 'fun' can provide a helpful basis for identifying a Maslow driver within a given behaviour, and thereby to assess where a particular behaviour fits into the model:

Biological - health, fitness, energising mind and body, etc.
Safety - order and structure needs met for example by some heavily organised, structural activity
Belongingness - team sport, club 'family' and relationships
Esteem - competition, achievement, recognition
Self-Actualization drivers - challenge, new experiences, love of art, nature, etc.
However in order to relate a particular 'doing it for fun' behaviour the Hierarchy of Needs we need to consider what makes it 'fun' (ie rewarding) for the person. If a behaviour is 'for fun', then consider what makes it 'fun' for the person - is the 'fun' rooted in 'belongingness', or is it from 'recognition', ie., 'esteem'. Or is the fun at a deeper level, from the sense of self-fulfilment, ie 'self-actualization'.

Apply this approach to any behaviour that doesn't immediately fit the model, and it will help you to see where it does fit.

Maslow's Hierarchy of Needs will be a blunt instrument if used as such. The way you use the Hierarchy of Needs determines the subtlety and sophistication of the model.

For example: the common broad-brush interpretation of Maslow's famous theory suggests that that once a need is satisfied the person moves onto the next, and to an extent this is entirely correct. However an overly rigid application of this interpretation will produce a rigid analysis, and people and motivation are more complex. So while it is broadly true that people move up (or down) the hierarchy, depending what's happening to them in their lives, it is also true that most people's motivational 'set' at any time comprises elements of all of the motivational drivers. For example, self-actualizers (level 5 - original model) are mainly focused on self-actualizing but are still motivated to eat (level 1) and socialise (level 3). Similarly, homeless folk whose main focus is feeding themselves (level 1) and finding shelter for the night (level 2) can also be, albeit to a lesser extent, still concerned with social relationships (level 3), how their friends perceive them (level 4), and even the meaning of life (level 5 - original model).

Like any simple model, Maslow's theory not a fully responsive system - it's a guide which requires some interpretation and thought, given which, it remains extremely useful and applicable for understanding, explaining and handling many human behaviour situations.



maslow's hierarchy of needs and helping others
There are certainly some behaviours that are quite tricky to relate to Maslow's Hierarchy of Needs.

For example:

Normally, we would consider that selflessly helping others, as a form of personal growth motivation, would be found as part of self-actualisation, or perhaps even 'transcendence' (if you subscribe to the extended hierarchy).

So how can we explain the examples of people who seem to be far short of self-actualising, and yet are still able to help others in a meaningful and unselfish sense?

Interestingly this concept seems to be used increasingly as an effective way to help people deal with depression, low self-esteem, poor life circumstances, etc., and it almost turns the essential Maslow model on its head: that is, by helping others, a person helps themselves to improve and develop too.

The principle has also been applied quite recently to developing disaffected school-children, whom, as part of their own development, have been encouraged and enabled to 'teach' other younger children (which can arguably be interpreted as their acting at a self-actualising level - selflessly helping others). The disaffected children, theoretically striving to belong and be accepted (level 3 - belongingness) were actually remarkably good at helping other children, despite their own negative feelings and issues.

Under certain circumstances, a person striving to satisfy their needs at level 3 - belongingness, seems able to self-actualise - level 5 (and perhaps beyond, into 'transcendence') by selflessly helping others, and at the same time begins to satisfy their own needs for belongingness and self-esteem.

Such examples demonstrate the need for careful interpretation and application of the Maslow model. The Hierarchy of Needs is not a catch-all, but it does remain a wonderfully useful framework for analysing and trying to understand the subtleties - as well as the broader aspects - of human behaviour and growth.




self-actualisation, employees and organisations
Maslow's work and ideas extend far beyond the Hierarchy of Needs.

Maslow's concept of self-actualisation relates directly to the present day challenges and opportunities for employers and organisations - to provide real meaning, purpose and true personal development for their employees. For life - not just for work.

Maslow saw these issues fifty years ago: the fact that employees have a basic human need and a right to strive for self-actualisation, just as much as the corporate directors and owners do.

Increasingly, the successful organisations and employers will be those who genuinely care about, understand, encourage and enable their people's personal growth towards self-actualisation - way beyond traditional work-related training and development, and of course way beyond old-style X-Theory management autocracy, which still forms the basis of much organised employment today.

The best modern employers and organisations are beginning to learn at last: that sustainable success is built on a serious and compassionate commitment to helping people identify, pursue and reach their own personal unique potential.

Whn people grow as people, they automatically become more effective and valuable as employees.

In fact virtually all personal growth, whether in a hobby, a special talent or interest, or a new experience, produces new skills, attributes, behaviours and wisdom that is directly transferable to any sort of job role.

The best modern employers recognise this and as such offer development support to their staff in any direction whatsoever that the person seeks to grow and become more fulfilled.
 
frederick herzberg motivational theory
Frederick Herzberg's motivation and hygiene factors
Frederick Herzberg (1923-2000), clinical psychologist and pioneer of 'job enrichment', is regarded as one of the great original thinkers in management and motivational theory. Frederick I Herzberg was born in Massachusetts on April 18, 1923. His undergraduate work was at the City College of New York, followed by graduate degrees at the University of Pittsburg. Herzberg was later Professor of Management at Case Western Reserve University, where he established the Department of Industrial Mental Health. He moved to the University of Utah's College of Business in 1972, where he was also Professor of Management. He died at Salt Lake City, January 18, 2000.

Frederick Herzberg's book 'The Motivation to Work', written with research colleagues Bernard Mausner and Barbara Snyderman in 1959, first established his theories about motivation in the workplace. Herzberg's survey work, originally on 200 Pittsburgh engineers and accountants remains a fundamentally important reference in motivational study.

Herzberg expanded his motivation-hygiene theory in his subsequent books: Work and the Nature of Man (1966); The Managerial Choice (1982); and Herzberg on Motivation (1983).

Significantly, Herzberg commented in 1984, 25 years after his theory was first published:

"The original study has produced more replications than any other research in the history of industrial and organizational psychology." (source: Institute for Scientific Information)

The absence of any serious challenge to Herzberg's theory continues effectively to validate it.

Herzberg was the first to show that satisfaction and dissatisfaction at work nearly always arose from different factors, and were not simply opposing reactions to the same factors, as had always previously been (and still now by the unenlightened) believed.

See the Herzberg hygiene factors and motivators graph diagram, and the Herzberg diagram rocket and launch pad analogy diagram, (both require Acrobat free reader).

He showed that certain factors truly motivate ('motivators'), whereas others tended to lead to dissatisfaction ('hygiene factors').

According to Herzberg, Man has two sets of needs; one as an animal to avoid pain, and two as a human being to grow psychologically.

He illustrated this also through Biblical example: Adam after his expulsion from Eden having the need for food, warmth, shelter, safety, etc., - the 'hygiene' needs; and Abraham, capable and achieving great things through self-development - the 'motivational' needs.

Certain parallels can clearly be seen with Maslow.

Herzberg's ideas relate strongly to modern ethical management and social responsibility.

Many decades ago Herzberg, like Maslow, understood well and attempted to teach the ethical management principles that many leaders today, typically in businesses and organisations that lack humanity, still struggle to grasp. In this respect Herzberg's concepts are just as relevant now as when he first suggested them, except that the implications of responsibility, fairness, justice and compassion in business are now global.

Although Herzberg is most noted for his famous 'hygiene' and motivational factors theory, he was essentially concerned with people's well-being at work. Underpinning his theories and academic teachings, he was basically attempting to bring more humanity and caring into the workplace. He and others like him, did not develop their theories to be used as 'motivational tools' purely to improve organisational performance. They sought instead primarily to explain how to manage people properly, for the good of all people at work.

Herzberg's research proved that people will strive to achieve 'hygiene' needs because they they are unhappy without them, but once satisfied the effect soon wears off - satisfaction is temporary. Then as now, poorly managed organisations fail to understand that people are not 'motivated' by addressing 'hygiene' needs. People are only truly motivated by enabling them to reach for and satisfy the factors that Herzberg identified as real motivators, such as personal growth, development, etc., which represent a far deeper level of meaning and fulfilment.

Examples of Herzberg's 'hygiene' needs (or maintenance factors) in the workplace are:

policy
relationship with supervisor
work conditions
salary
company car
status
security
relationship with subordinates
personal life
Herzberg's research identified that true motivators were other completely different factors, notably:

achievement
recognition
work itself
responsibility
advancement
personal growth



to what extent is money a motivator?
This question commonly arises when considering Herzberg's research and theories, so it's appropriate to include it here.

People commonly argue that money is a primary motivator.

For most people money is not a motivator - despite what they might think and say.

For all people there are bigger more sustaining motivators than money.

Surveys and research studies repeatedly show that other factors motivate more than money. Examples appear in the newspapers and in other information resources every week.

For instance, a survey by Development Dimensions International published in the UK Times newspaper in 2004 interviewed 1,000 staff from companies employing more than 500 workers, and found many to be bored, lacking commitment and looking for a new job. Pay actually came fifth in the reasons people gave for leaving their jobs.

The main reasons were lack of stimulus jobs and no opportunity for advancement - classic Herzberg motivators - 43% left for better promotion chances, 28% for more challenging work; 23% for a more exciting place to work; and 21% and more varied work.

Lots of other evidence is found in life, wherever you care to look.

Consider what happens when people win big lottery prize winners.

While many of course give up their 'daily grind' jobs, some do not. They wisely recognise that their work is part of their purpose and life-balance.

Others who give up their jobs do so to buy or start and run their own businesses. They are pursuing their dream to achieve something special for them, whatever that might be. And whatever it means to them, the motivation is not to make money, otherwise why don't they just keep hold of what they've got? Why risk it on a project that will involve lots of effort and personal commitment? Of course the reason they invest in a new business venture is that pursuing this sort of plan is where the real motivators are found - achievement, responsibility, personal growth, etc - not money.

The people who are always the most unhappy are those who focus on spending their money. The lottery prize-winners who give up work and pursue material and lifestyle pleasures soon find that life becomes empty and meaningless. Money, and spending it, are not enough to sustain the human spirit. We exist for more.

Money is certainly important, and a personal driver, if you lack enough for a decent civilised existence, or you are striving for a house or a holiday, but beyond this, money is not for the vast majority of people a sustainable motivator in itself.
 
adams' equity theory
j stacey adams - equity theory on job motivation
John Stacey Adams, workplace and behavioural psychologist, put forward his Equity Theory on job motivation in 1963. There are similarities with Charles Handy's extension and interpretation of previous simpler theories of Maslow, Herzberg and other pioneers of workplace psychology, in that the theory acknowledges that subtle and variable factors affect each individual's assessment and perception of their relationship with their work, and thereby their employer. Awareness and cognizance feature more strongly than in earlier models, as does the influence of colleagues and friends, etc, in forming cognizance, and in this particular model, 'a sense of what is fair and reasonable'.
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adams' equity theory
We each seek a fair balance between what we put into our job and what we get out of it. Adams calls these inputs and outputs. We form perceptions of what constitutes a fair balance or trade of inputs and outputs by comparing our own situation with other 'referents' (reference points or examples) in the market place. We are also influenced by colleagues, friends, partners in establishing these benchmarks and our own responses to them in relation to our own ratio of inputs to outputs.

Inputs are typically: effort, loyalty, hard work, commitment, skill, ability, adaptability, flexibility, tolerance, determination, heart and soul, enthusiasm, trust in our boss and superiors, support of colleagues and subordinates, personal sacrifice, etc. People need to feel that there is a fair balance between inputs and outputs. Outputs are typically all financial rewards - pay, salary, expenses, perks, benefits, pension arrangements, bonus and commission - plus intangibles - recognition, reputation, praise and thanks, interest, responsibility, stimulus, travel, training, development, sense of achievement and advancement, promotion, etc.

If we feel are that inputs are fairly and adequately rewarded by outputs (the fairness benchmark being subjectively perceived from market norms and other comparables references) then we are happy in our work and motivated to continue inputting at the same level.

If we feel that our inputs out-weigh the outputs then we become demotivated in relation to our job and employer. People respond to this feeling in different ways: generally the extent of demotivation is proportional to the perceived disparity between inputs and expected outputs. Some people reduce effort and application and become inwardly disgruntled, or outwardly difficult, recalcitrant or even disruptive. Other people seek to improve the outputs by making claims or demands for more reward, or seeking an alternative job.
 
List of Abbreviations



ANM : Auxiliary Nurse Midwife

BEE : Block Extension Educator

BMS : Basic Minimum Services

CBR : Crude Birth Rate

CHC : Community Health Centre

CNNA : Community Needs Assessment Approach

DHE : Diploma in Health Education

FWTRC : Family Welfare Training and Research Centre

GIRHFWT : Gandhigram Institute of Rural Health and Family Welfare Trust

HA (F)/LHV : Health Assistant (Female)/Lady Health Visitor

HA (M) : Health Assistant (Male)

HFWTC : Health And Family Welfare Training Centre

HW(F) : Health Worker (Female)

ICDS : Integrated Child Development Schemes

IMR : Infant Mortality Rate

ISM & H : Indian System of Medicine and Homeopathy

IUD : Intrauterine Device

MCH : Maternal and Child Health

MNP : Minimum Needs Programme

MO : Medical Officer

MPW (F) : Multi Purpose Worker (Female)

MPW (M)/HW (M) : Multi Purpose Worker (Male)/Health Worker (Male)

MTP : Medical Termination of Pregnancy

NHP : National Health Policy

PHC : Primary Health Centre

PMGY : Pradhan Mantri Gramodaya Yojana

PRI : Panchayati Raj Institution

QPR : Quarterly Performance Report

RCH : Reproductive and Child Health

RFWC : Rural Family Welfare Centre

RHTC : Rural Health Training Centre

RTI : Reproductive Tract Infection

SC : Sub Centre

STD : Sexually Transmitted Disease

TDA : Trained Birth Attendants

TFA : Target Free Approach

VHG : Village Health Guide

WHO : World Health Organisation
 
List of Abbreviations



ANM : Auxiliary Nurse Midwife

BEE : Block Extension Educator

BMS : Basic Minimum Services

CBR : Crude Birth Rate

CHC : Community Health Centre

CNNA : Community Needs Assessment Approach

DHE : Diploma in Health Education

FWTRC : Family Welfare Training and Research Centre

GIRHFWT : Gandhigram Institute of Rural Health and Family Welfare Trust

HA (F)/LHV : Health Assistant (Female)/Lady Health Visitor

HA (M) : Health Assistant (Male)

HFWTC : Health And Family Welfare Training Centre

HW(F) : Health Worker (Female)

ICDS : Integrated Child Development Schemes

IMR : Infant Mortality Rate

ISM & H : Indian System of Medicine and Homeopathy

IUD : Intrauterine Device

MCH : Maternal and Child Health

MNP : Minimum Needs Programme

MO : Medical Officer

MPW (F) : Multi Purpose Worker (Female)

MPW (M)/HW (M) : Multi Purpose Worker (Male)/Health Worker (Male)

MTP : Medical Termination of Pregnancy

NHP : National Health Policy

PHC : Primary Health Centre

PMGY : Pradhan Mantri Gramodaya Yojana

PRI : Panchayati Raj Institution

QPR : Quarterly Performance Report

RCH : Reproductive and Child Health

RFWC : Rural Family Welfare Centre

RHTC : Rural Health Training Centre

RTI : Reproductive Tract Infection

SC : Sub Centre

STD : Sexually Transmitted Disease

TDA : Trained Birth Attendants

TFA : Target Free Approach

VHG : Village Health Guide

WHO : World Health Organisation
 
THINGS YOU NEVER KNEW YOUR CELLPHONE COULD DO...

There are a few things that can be done in times of grave emergencies.

Your mobile phone can actually be a life saver or an emergency tool for

survival. Check out the things that you can do with it:



1. The Emergency Number worldwide for **Mobile** is 112.*



If you find yourself out of coverage area of your mobile network and there is an

emergency, dial 112 and the mobile will search any existing network to

establish the emergency number for you, and interestingly this number 112

can be dialed even if the keypad is locked. **Try it out. **



2. Subject: Have you locked your keys in the car? Does you car have remote keys?

This may come in handy someday. Good reason to own a cell phone:

If you lock your keys in the car and the spare keys are at home, call

someone at home on their cell phone from your cell phone.

Hold your cell phone about a foot from your car door and have the person

at your home press the unlock button, holding it near the mobile phone on

their end. Your car will unlock. Saves someone from having to drive your

keys to you. Distance is no object. You could be hundreds of miles away,

and if you can reach someone who has the other "remote" for your car, you

can unlock the doors (or the trunk).

Editor's Note: *It works fine! We tried it out and it unlocked our car over a cell phone!"*



3. Subject: Hidden Battery power

Imagine your cell battery is very low, you are expecting an important call

and you don't have a charger. Nokia instrument comes with a reserve battery.



To activate, press the keys *3370# Your cell will restart with

this reserve and the instrument will show a 50% increase in battery.



This reserve will get charged when you charge your cell next time.


4. How to disable a STOLEN mobile phone?

To check your Mobile phone's serial number, key in the following digits on

your phone: * # 0 6 #

A 15 digit code will appear on the screen. This number is unique to your

handset. Write it down and keep it somewhere safe. When your phone get

stolen, you can phone your service provider and give them this code. They

will then be able to block your handset so even if the thief changes the

SIM card, your phone will be totally useless.

You probably won't get your phone back, but at least you know that whoever

stole it can't use/sell it either.

If everybody does this, there would be no point in people stealing mobile phones.
 
One in 48 women in India is at risk of dying during childbirth. The Maternal Mortality Ratio (MMR) in India is a high 407 per 100,000 live births, according to the National Health Policy 2002. Other sources put the MMR at a higher 540 (NHFS and UNICEF data, 2000). Reducing the Maternal Mortality Ratio (MMR) by three-quarters by 2015 is a Millennium Development Goal (MDG) for all countries including India. Achieving this means reducing the MMR to 100 by 2015. Part of the problem is this measurement – MMR data is just not there and if it is, it varies widely depending on what method was used to get it.

Studies show MMR among scheduled tribes (652) and scheduled castes (584) is higher than in women of other castes (516, according to one study). It is higher among illiterate women (574) than those having completed middle school (484). The key determinant seems to be access to healthcare. Less-developed villages had a significantly higher MMR (646) than moderately or well-developed villages (501 and 488 deaths, respectively).

"It is very sad that the numbers are so high even 57 years after independence," avers Dr H Sudarshan who is Vigilance Director (Health) of the anti-corruption body Karnataka Lokayukta. "Not only are the numbers from the Sample Registration System (SRS) high, they are also incomplete. We do not know how many mothers actually died during childbirth and why. Underreporting is rampant and people hide MMR numbers in fear of repercussions. We need state-wise and within states, district-wise data," says Sudarshan who was also Chairman of the Karnataka Health Task Force which made wide-ranging recommendations based on a 2-3 year detailed study conducted in the state. Regardless, the UN MMR numbers for India (540) are several times higher than those for other developing countries like China (56), Brazil (260), Thailand (44), Mexico (83) or even Sri Lanka (92).

Medical reasons

So what exactly leads to such a high MMR? The main reasons for maternal deaths related to pregnancy are anaemia, post-partum bleeding and septic abortions with anaemia being the most rampant. "Antenatal care is most important," declares Sudarshan, "and that is just not being done. This kind of care checks for high risk pregnancies."

Public health advocate Dr Mira Shiva agrees, "Hypertension and the toxemias of pregnancy can only be detected with antenatal care. There is a total neglect of a mother's health in India. [The situation] is disgusting because a big chunk of all this is preventable. The medical establishment is busy with micronutrients but that is not the answer. Giving one iron tablet to a woman during her pregnancy is too late." Shiva is coordinator of the All India Drug Action Network (AIDAN) and one of the founding members of the People’s Health Movement (PHM). Striking out at a more endemic problem, she says, "The real problem is food. It is all about food, the cost of food and the nutrition content therein. These pregnant women have to fetch the water, make fuel, work the buffaloes, etc., all on the measly amount of food they can afford. How can the nutritive intake be enough? It becomes a negative calorie balance. In short, what is needed goes beyond a medical solution."

Studies show MMR among scheduled tribes (652) and scheduled castes (584) is higher than in women of other castes (516, according to one study). It is higher among illiterate women (574) than those having completed middle school (484). The key determinant seems to be access to healthcare. Less-developed villages had a significantly higher MMR (646) than moderately or well-developed villages (501 and 488 deaths, respectively).

"It is very sad that the numbers are so high even 57 years after independence," avers Dr H Sudarshan who is Vigilance Director (Health) of the anti-corruption body Karnataka Lokayukta. "Not only are the numbers from the Sample Registration System (SRS) high, they are also incomplete. We do not know how many mothers actually died during childbirth and why. Underreporting is rampant and people hide MMR numbers in fear of repercussions. We need state-wise and within states, district-wise data," says Sudarshan who was also Chairman of the Karnataka Health Task Force which made wide-ranging recommendations based on a 2-3 year detailed study conducted in the state. Regardless, the UN MMR numbers for India (540) are several times higher than those for other developing countries like China (56), Brazil (260), Thailand (44), Mexico (83) or even Sri Lanka (92).

Medical reasons

So what exactly leads to such a high MMR? The main reasons for maternal deaths related to pregnancy are anaemia, post-partum bleeding and septic abortions with anaemia being the most rampant. "Antenatal care is most important," declares Sudarshan, "and that is just not being done. This kind of care checks for high risk pregnancies."

Public health advocate Dr Mira Shiva agrees, "Hypertension and the toxemias of pregnancy can only be detected with antenatal care. There is a total neglect of a mother's health in India. [The situation] is disgusting because a big chunk of all this is preventable. The medical establishment is busy with micronutrients but that is not the answer. Giving one iron tablet to a woman during her pregnancy is too late." Shiva is coordinator of the All India Drug Action Network (AIDAN) and one of the founding members of the People’s Health Movement (PHM). Striking out at a more endemic problem, she says, "The real problem is food. It is all about food, the cost of food and the nutrition content therein. These pregnant women have to fetch the water, make fuel, work the buffaloes, etc., all on the measly amount of food they can afford. How can the nutritive intake be enough? It becomes a negative calorie balance. In short, what is needed goes beyond a medical solution."

Sudarshan echoes Shiva's sentiment, "We need to move from a medical model to a social model. Nutrition for pregnant mothers is very important and the ICDS Anganwadi scheme has clearly not achieved the hoped results." Where antenatal care is good, the results are good as well. Kerala and Tamilnadu have good antenatal care and correspondingly have two of the lowest MMRs in India. In Assam and Bihar where antenatal care is almost zero, the MMRs are among the highest. India has the lowest percentage of antenatal coverage (60%) among countries like China, Brazil, Mexico, Thailand and Sri Lanka which are all in the high 86-95% range.

While antenatal care is paramount in the prevention of pregnancy-related deaths, septic abortions are more insidious. What is worse, the latter tends to go unreported due to the nature and circumstances surrounding it. In many rural areas couples do not use any spacing methods and women conceive within 7 months of having given birth. Dr Leena Joshi of Family Planning Association of India (FPAI) is familiar with this scenario. Her voice drops with concern when she mentions abortion rates in the remote reaches of Maharashtra. "The abortion rate in these areas is just so high. With it comes hidden mortality from septic abortion deaths. Since the PHCs do not have MTP methods, the abortions are performed by quacks. And even if the PHCs or district hospitals have MTP methods, the people opt for local help." Why? "It saves them money. These are very poor people and transport costs and medical costs can be saved by walking to a local quack." As a result there are a high number of abortion-related deaths which do not get reported under maternal mortality. Dr. Joshi laments that everybody only talks about deaths during the childbirth process. "But since there are so many septic abortion cases it all goes unreported."

The problem of unsafe abortion is something that Shiva worries about as well. "Abortion (MTP) being legal in India, no one is turned away. Second trimester abortion is a big reason for rising MMRs." People come late for the abortions and complications ensue. And apparently these are not only driven by spacing problems. "Contraceptives are used only by women and failure of these is common," says Joshi. Of course, abortion of female fetuses is routine and it goes on until the woman conceives a male child. The whole scenario makes one shudder.

But all this seems to be not even half the story.

Take malaria, for example. Orissa has a high incidence and accounted for 28.6% of detected cases of malaria -- 41% of falciparum -- and 62.8% of all material deaths in India (1998). Malaria and pregnancy form a sinister synergistic pair. Falciparum malaria leads to abortion and still births in the gravid woman and can severely compound anaemia. Coincidentally, Orissa has a high incidence of sickle cell anaemia. The combination is lethal. The haemoglobin in pregnant women could drop to 1gm/dL (healthy levels are between 12-16gms/dL). While drugs are available to treat the malaria, the treatment requires a high degree of awareness and care in administration. For example, the common primaquine and tetracycline are absolute no-nos during any stage of pregnancy. But chloroquine and quinine are allowed. "But mistakes occur and are lethal," says Shiva. Acting fast and carefully is paramount and any deaths due to these infections are primarily due to gross neglect or ignorance. Orissa has one of the highest rates of MMR in India at 738.

Another key reason for deaths during pregnancy is post-partum bleeding or haemorrhage. The need for blood in such cases is imperative and access is less than ideal. Both Sudarshan and Shiva worry about the blood bank policy in India. Heavily driven by the HIV/AIDS lobby, they feel that somewhere the important issue of access to blood has been sacrificed for quality and safety since the policy makers are looking at it all from the AIDS perspective. Says Sudarshan,"The policy says you have to keep the blood in an air-conditioned room. But in Coorg, for example, you don't need it. HIV awareness is good, but blood banks need to be demystified and access and availability improved." Shiva adds, "It is imperative in case of complications during pregnancy to have blood available. But no. NACO only sees blood banks from their perspective and only in an emergency are you allowed to take blood from the banks. It is a major concern." When it comes to donation, Shiva points to an endemic problem. The strange connection between men, caring for women, and giving blood. "If the men have to pay a lot of money and go far to get blood for their wives, they just won't. And men will never give blood. They think a 100 drops of blood equals one drop of semen and thus, giving blood is related to potency. And so many times, when women need blood, it is not available."

Organisational reasons

Early diagnosis of high-risk pregnancies and complications and quick referrals are of paramount importance. But is institutionalising deliveries the answer? By requiring 100% institutional deliveries, the World Bank supported vertical program Reproductive Child Health 1 (RCH1) resulted in the abolishing of the dais (Traditional Birth Attendants), and Sudarshan believes, probably increased MMR. Subsequently, following a public uproar, the program was amended to advocate "training" TBAs into Skilled Birth Attendants. "Institutional support will bring down MMR, yes, but what type of institution is important," says Sudarshan. "The so called Primary Health Care units are so dirty that infection will probably increase because of them." "In Bihar, for example," explains Sudarshan, "80% of the deliveries happen at home. In Karnataka it is 70%." Joshi concurs with this high degree of preference. "In the Bhandara area almost 100% prefer home deliveries. And if there are complications, it means there are inevitable delays in getting more sophisticated care."

In India only 43% of deliveries involve a skilled birth attendant compared to between 86% and 99% in Mexico, China, Sri Lanka, Brazil and Thailand.

Now, if there were a skilled birth attendant (SBA) at the time of each delivery or for antenatal checkups for each pregnancy, he or she can recognize a high-risk pregnancy or a potential complication and refer the mother to a district hospital or closest emergency care unit. The incidence of death from complications would be reduced. Countries like Malaysia have employed this strategy to bring down MMR to less than 100. In India only 43% of deliveries are attended by an SBA compared to between 86% and 99% in Mexico, China, Sri Lanka, Brazil and Thailand.

Sudarshan himself is involved in training tribal girls in the Soliga communities of Karnataka to be auxiliary nurse midwives (ANMs). For a population of 3000, there is a sub-centre and for every 5 or 6 sub-centres, there is a primary health care unit. Sudarshan's team trains the tribal girls in each village so that the few ANMs posted do not have to walk the 20 kms between the 4-5 villages this program covers. Joshi's team in Bhandara also trained 25 local dais or Traditional Birth Attendants (TBAs) to recognize complications and give basic medicines and obstetric care in the villages, one to each village. They also conduct antenatal checkups every month in about 10 villages. But funds for such programs are scant primarily because maternal health is not recognized as a priority issue in India. "The awareness that a pregnant woman should be taken care of is just not there," says Joshi. "If a woman is not delivering, the attitude used to be, let's wait and see, maybe tomorrow morning she will deliver. Now with our training, the dais can recognize complications but the money to shift the patient to a hospital is still not there."

This brings us to the next obstacle. So say the SBA refers to patient to an emergency obstetric care unit (EOC) and let's assume that we have one of those for every few villages. How would the patient reach the EOC? "Transport is a big issue. It is appalling that we do not have EMS (emergency medical services) that is efficient and well staffed," Sudarshan states categorically. He is working on building one for Karnataka with a coordinating body at district level which has jeeps, ambulances, even tractors available for responding to emergency calls. "We have to strengthen the PHC and an EMS is an integral part of that," he says. Bhandara is not so lucky. "Vehicles are available in 50% of the cases. But they are expensive. In the day, people can use buses, but not at nights. There are several rivers in this area and the buses are not allowed to travel over these at night," says Joshi.

Suppose the patient does reach the first referral unit (FRU) with complications that say, require a C-section. Is that a guarantee for a safe delivery? Sadly, no. Few FRUs run 24 hours. Joshi's hospital has 2-3 gynaecologists where the recommended number for the population of that area is 5-6. "All the C-sections and hysterectomies are carried out by these 2-3 gynaecologists. In the PHC in the villages, there is one doctor and 2-3 sisters (nurses), but they are only graduates, not post graduates or MBBS. So they cannot even do a complicated normal delivery, let alone C-sections."
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Even in Karnataka, the FRUs are woefully understaffed and in some cases dangerously mismatched. "In one case," says Sudarshan with an ironic smile, "an orthopedist was posted where an obstetrician was required. With bribes, these so-called doctors can get posted to any area they want regardless of what is actually required there." And then there is the big problem of anaesthetists. At the Taluka level there is an acute shortage of them. Anaesthetists are required during complications and surgeries. When Sudarshan's team proposed that nurse obstetricians and other doctors also get trained in anaesthetics, the proposal was shot down by the medical lobby. Human resource management in the health sector seems to be a big issue. Shiva echoed the sentiment saying, "We need trained people in PHCs. And people with the right training. There is no point sending patients who require C-sections to where there is no anaesthetist or ob-gyn."
 
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