RESEARC H Open AccessIraqi health system in kurdistan region: medicalprofessionals’ perspectives on challenges andpriorities for improvementNazar P Shabila1*, Namir G Al-Tawil1, Rebaz Tahir2, Falah H Shwani2, Abubakir M Saleh1, Tariq S Al-Hadithi1AbstractBackground: The views of medical professionals on efficiency of health system and needs for any changes arevery critical and constitute a cornerstone for any health system improvement. This is particularly relevant to IraqiKurdistan case as the events of the last few decades have significantly devastated the national Iraqi health systemwhile the necessity for adopting a new health care system is increasingly recognized since 2004. This study aims toexamine the regional health system in Iraqi Kurdistan from medical professionals’ perspectives and try to define itsproblems and priorities for improvement.Methods: A survey questionnaire was developed and administered to a convenience sample of 250 medicalprofessionals in Erbil governorate. The questionnaire included four items; rating of the quality of services andavailability of resources in the health institutions, view on different aspects of the health system, the perceivedpriority needs for health system improvement and gender and professional characteristics of the respondents.Results: The response rate to the survey was 83.6%. A high proportion of respondents rated the different aspectsof services and resources in the health institutions as weak or very weak including the availability of the requiredquantity and quality of medicines (68.7%), the availability of sufficient medical equipment and investigation tools(68.7%), and the quality of offered services (65.3%). Around 72% of respondents had a rather negative view on theoverall health system. The weak role of medical research, the weak role of professional associations in controllingthe system and the inefficient health education were identified as important problems in the current health system(87.9%, 87.1% and 84.9%, respectively). The priority needs of health system improvement included adoption ofsocial insurance for medical care of the poor (82%), enhancing the role of family medicine (77.2%), adopting healthinsurance system (76.1%) and periodic scientific evaluation of physicians and other health staff (69.8%).Conclusion: Medical professionals were generally unsatisfied with the different aspects of the health system inIraqi Kurdistan region. A number of problems and different priority needs for health system improvement havebeen recognized that require to be studied in more details.BackgroundThe major objective of a country’s health system is toassure the health of the general public through offeringgood quality and prompt services according to theneeds of the population [1]. The health system needs togo through a process of continuous changes andimprovement in order to be able to cope with differentchanges in the health and population environments andto appropriately respond to different challenges andneeds [2].The history of formal health care system in Iraq beganin early 1920s, but the Iraqi Ministry of Health (MoH)was established in 1952 and its organizational structurewas formalized in 1959. This organizational structurehas changed little since its establishment [3,4]. Thehealth care Theoretical Perspectives on Deviance Theoretical Perspectives on Deviance Bởi: OpenStaxCollege Functionalists believe that deviance plays an important role in society and can be used to challenge people’s views Protesters, such as these PETA members, often use this method to draw attention to their cause (Photo courtesy of David Shankbone/flickr) Why does deviance occur? How does it affect a society? Since the early days of sociology, scholars have developed theories attempting to explain what deviance and crime mean to society These theories can be grouped according to the three major sociological paradigms: functionalism, symbolic interactionism, and conflict theory Functionalism Sociologists who follow the functionalist approach are concerned with how the different elements of a society contribute to the whole They view deviance as a key component of a functioning society Strain theory, social disorganization theory, and cultural deviance theory represent three functionalist perspectives on deviance in society Émile Durkheim: The Essential Nature of Deviance Émile Durkheim believed that deviance is a necessary part of a successful society One way deviance is functional, he argued, is that it challenges people’s present views (1893) For instance, when black students across the United States participated in “sitins” during the civil rights movement, they challenged society’s notions of segregation Moreover, Durkheim noted, when deviance is punished, it reaffirms currently held 1/14 Theoretical Perspectives on Deviance social norms, which also contributes to society (1893) Seeing a student given detention for skipping class reminds other high schoolers that playing hooky isn’t allowed and that they, too, could get detention Robert Merton: Strain Theory Sociologist Robert Merton agreed that deviance is an inherent part of a functioning society, but he expanded on Durkheim’s ideas by developing strain theory, which notes that access to socially acceptable goals plays a part in determining whether a person conforms or deviates From birth, we’re encouraged to achieve the “American Dream” of financial success A woman who attends business school, receives her MBA, and goes on to make a million-dollar income as CEO of a company is said to be a success However, not everyone in our society stands on equal footing A person may have the socially acceptable goal of financial success but lack a socially acceptable way to reach that goal According to Merton’s theory, an entrepreneur who can’t afford to launch his own company may be tempted to embezzle from his employer for start-up funds Merton defined five ways that people respond to this gap between having a socially accepted goal but no socially accepted way to pursue it Conformity: Those who conform choose not to deviate They pursue their goals to the extent that they can through socially accepted means Innovation: Those who innovate pursue goals they cannot reach through legitimate means by instead using criminal or deviant means Ritualism: People who ritualize lower their goals until they can reach them through socially acceptable ways These members of society focus on conformity rather than attaining a distant dream Retreatism: Others retreat and reject society’s goals and means Some beggars and street people have withdrawn from society’s goal of financial success Rebellion: A handful of people rebel, replacing a society’s goals and means with their own Terrorists or freedom fighters look to overthrow a society’s goals through socially unacceptable means Social Disorganization Theory Developed by researchers at the University of Chicago in the 1920s and 1930s, social disorganization theory asserts that crime is most likely to occur in communities with weak social ties and the absence of social control An individual who grows up in a poor neighborhood with high rates of drug use, violence, teenage delinquency, and deprived parenting is more likely to become a criminal than an individual from a wealthy neighborhood with a good school system and families who are involved positively in the community 2/14 Theoretical Perspectives on Deviance Proponents of social disorganization theory believe that individuals who grow up in impoverished areas are more likely to participate in deviant or criminal behaviors (Photo courtesy of Apollo 1758/Wikimedia Commons) Social disorganization theory points to broad social factors as the cause of deviance A person isn’t born a criminal, but becomes one over time, often based on factors in his or her social environment Research into social disorganization theory can greatly influence public policy For instance, studies have found that children from disadvantaged communities who attend preschool programs that teach basic social skills are significantly less likely to engage in criminal activity Clifford Shaw and Henry McKay: Cultural Deviance Theory Cultural deviance theory suggests that conformity to the prevailing cultural norms of ... LOCAL PERSPECTIVES ON THE ENVIRONMENTAL AND SOCIAL IMPACTS OF SHRIMP FARMING IN TAM GIANG LAGOON, VIETNAM. TUONG PHI LAI A Thesis Submitted in Partial Fulfillment of the Requirement for the Degree of Master of Science (Management of Natural Resources and Sustainable Agriculture) Submitted to: Norwegian University of Life Sciences Department of International Environment and Development Studies June, 2005 ii The Department of International Environment and Development Studies, Noragric, is the international gateway for the Norwegian University of Life Sciences (UMB). Eight departments, associated research institutions and the Norwegian College of Veterinary Medicine in Oslo. Established in 1986, Noragric’s contribution to international development lies in the interface between research, education (Bachelor, Master and PhD programmes) and assignments. The Noragric Master theses are the final theses submitted by students in order to fulfil the requirements under the Noragric Master programme “Management of Natural Resources and Sustainable Agriculture” (MNRSA), “Development Studies” and other Master programmes. The findings in this thesis do not necessarily reflect the views of Noragric. Extracts from this publication may only be reproduced after prior consultation with the author and on condition that the source is indicated. For rights of reproduction or translation contact Noragric. © Tuong Phi Lai, June 2005 E-mail: tuongphilai@yahoo.com Noragric Department of International Environment and Development Studies P.O. Box 5003 N-1432 Ås Norway Tel.: +47 64 96 52 00 Fax: +47 64 96 52 01 Internet: http://www.umb.no/noragric Formatted: French (France) Formatted: English (U.S.) iii DECLARATION I, Tuong Phi Lai, do hereby declare to the Senate of the Norwegian University of Life Sciences, that this dissertation is entirely the product of my own original research work, unless where it is acknowledged, and that it has not been submitted to any other University or academic institution for award of any degree. ------------------------- ------------------ While the core principles of governance are the same throughout the world, the Asian model places particular emphasis on trust and relationships. This paper discusses the key differences between the western and Asian approaches to help business leaders explore the best aspects of both. Global perspectives on governance: lessons from east and west Conclusions 1. The corporate governance model that’s familiar in Asia, Africa and most developing nations places strong emphasis on trust and relationships. This can be beneficial for stakeholders: the typical pattern of ownership in businesses means that there can be a longer-term view of an organisation’s success compared with that in a western company. But the system is potentially vulnerable to corruption and cronyism. It can also be difficult to implement basic control procedures. 2. The prestige of what can be broadly termed the western governance model has diminished in the aftermath of the financial crisis. This model has driven globalisation and has emphasised a combination of legislation and standards as well as transparency, with a focus on developing appropriate structures, processes and frameworks. This is widely understood and helps to create a level playing field. But major financial failures over the past two years, such as that of Lehman Brothers, have shown that there are limits to what can be done to tighten checks and balances. A new emphasis on the behavioural aspects of governance is overdue. 3. Both models have their strengths and it is important to understand the benefits and drawbacks of each. CIMA’s model of boardroom leadership is useful in illustrating the importance of both behavioural and structural issues in achieving good governance. One particular area where both western and Asian models remain unduly weak is in creating a culture that allows people in authority to be challenged constructively. 4. The key indicator of good governance in an organisation is that it’s sustainable in the long-term. There should be confidence that the business model will deliver this, using appropriate risk mitigation, and that performance indicators and incentives will reinforce the desired culture and behaviour. 5. Management information that’s relevant, accurate and up-to-date is a crucial success factor for all organisations worldwide. Professionally qualified management accountants, bound by a code of ethics, have a vital role in providing and demonstrating the long-term strategic value of high-quality management information. Contents Introduction 1 The significance of individual relationships in Asia 2 Benefits of trust 5 Balancing the two models 6 1. Case study: Satyam Computer Services 8 2. Case study: Banyan Tree Holdings 9 3. Case study: Toyota 9 4. Case study: Tata Group 10 References and other relevant CIMA publications 11 About CIMA CIMA, the Chartered Institute of Management Accountants, founded in 1919, is the world’s leading and largest professional body of management accountants, with 172,000 members and students operating in 168 countries, working at the heart of business. CIMA members and students work in industry, commerce and not-for-profit organisations. CIMA works closely with employers and sponsors leading-edge research, constantly updating its qualification, professional experience requirements and continuing professional development to ensure that it remains the employers’ choice when recruiting financially trained business leaders. About the authors Victor Smart is CIMA’s head of profile and communications and Gillian Lees is CIMA’s enterprise governance specialist. Other CIMA contributors include Naomi Smith (London), Larry Zhang (Shanghai) and Damian Yip (Hong Kong). We also thank the [...]... DDT It is just one of the many battlegrounds in humanity’s long fight against malaria 14 PERSPECTIVES ON DISEASES AND DISORDERS CHAPTER 1 Understanding Malaria VIEWPOINT 1 An Overview of Malaria Carol A Turkington and Rebecca J Frey Photo on previous page The female Anopheles gambiae feeds on human blood Mosquitoes use the blood for egg production, but it may also carry the malaria infection.  (Sinclair... fected person and then passes the infection on to the next human it bites It is also possible to spread malaria via contaminated needles or in blood transfusions This is why all blood donors are carefully screened with questionnaires for possible exposure to malaria Complementary Roles Played by Humans and Mosquitoes in the Malaria Infection Cycle Malaria It is possible to contract malaria in non-endemic... analysis PERSPECTIVES ON DISEASES AND DISORDERS 21 Malaria Anyone who becomes ill with chills and fever after being in an area where malaria exists must see a doctor and mention their recent travel to endemic areas A person with the above symptoms who has been in a high-risk area should insist on a blood test for malaria The doctor may believe the symptoms are just the common flu virus Malaria is often... falciparum malaria in Africa, South Africa, India, and southeast Asia are now resistant to chloroquine In Thailand and Cambodia, there are strains of falciparum malaria that have some resistance to almost all known drugs A patient with falciparum malaria needs to be hospitalized and given antimalarial drugs in different com22 PERSPECTIVES ON DISEASES AND DISORDERS Understanding Malaria binations and doses... air conditioned hotels on tourist itineraries in urban or resort areas are at lower risk than backpackers, missionaries, and Peace Corps volunteers Some people in western cities where malaria does not usually exist may acquire the infection from a mosquito carried onto a jet This is called airport or runway malaria PERSPECTIVES ON DISEASES AND DISORDERS 25 VIEWPOINT 2 Malaria Is One of the Oldest and. .. means of controlling malaria Travelers to high-risk areas should use insect repellant containing DEET for exposed skin Because DEET is toxic in large amounts, children should not use a concen24 PERSPECTIVES ON DISEASES AND DISORDERS Understanding Malaria tration higher than 35% DEET should not be inhaled It should not be rubbed onto the eye area, on any broken or irritated skin, or on children’s hands It... eludes researchers For National Geographic reporter Finkel, writing about malaria had a personal dimension: Finkel himself contracted the illness while traveling in northern Thailand in 2002 SOURCE:  Michael Finkel, “Stopping a Global Killer,” National Geographic, July 2007 Reproduced by permission 26 PERSPECTIVES ON DISEASES AND DISORDERS Understanding Malaria W e live on a malarious planet It may... thousands of Allied forces contracted malaria in the South Pacific and the Allies responded by spraying the region with DDT to combat the high rates of infection among the troops So it was with these successes in mind that WHO began its seemingly monumental task of coordinating a global malaria campaign One of the early target countries was the island nation of Borneo in Indonesia, which had 10 PERSPECTIVES. .. insecticide-treated bed net Prevalence of respiratory symptoms and cases suspicious for tuberculosis among public health clinic patients in Afghanistan, 2005–2006: Perspectives on recognition and referral of tuberculosis cases Yolanda Barbera ´ Lainez 1 , Catherine S. Todd 2 , Ahmadullah Ahmadzai 1 , Shannon C. Doocy 3 and Gilbert Burnham 3 1 International Rescue Committee, Kabul, Afghanistan 2 Division of International Health & Cross-Cultural Medicine, University of California San Diego, La Jolla CA, USA 3 Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore MD, USA Summary objectives To assess diagnosis and management of suspected pulmonary tuberculosis (TB) among patients with respiratory complaints attending Comprehensive Health Centers (CHCs) in Afghanistan. methods Consecutive consenting patients presenting with respiratory complaints at 24 health centres in eight provinces were enrolled between November 2005 and February 2006. Demographics, health histories, clinic provider and study representative exam findings and diagnoses, and diagnostic test results were recorded. Correlates of TB-suggestive symptoms (defined as cough >2 weeks and ⁄ or haemoptysis) were assessed by logistic regression. results There were 1401 participants; 24.6% (n = 345) were children (age 17 or under). The TB-suggestive symptoms of cough >2 weeks and ⁄ or haemoptysis were reported by 407 (31.3%) and 44(3.3%), respectively, with 39 participants reporting both symptoms. Of 413 participants reporting TB-suggestive symptoms, only 178 (43%) were diagnosed as having suspected TB; 22.0% received no clinical diagnosis. Suspected TB was significantly associated with having a household member residing in a refugee camp within the last 2 years (OR = 6.0; 95% CI: 4.1–8.7), seven or more people sleeping in the same room (OR = 1.9; 95% CI: 1.4–2.6) and cooking with a wood fire in the sleeping room (OR = 1.6; 95% CI: 1.2–2.2) in univariate analysis. conclusions Diagnostic sensitivity by the health worker for possible cases of pulmonary TB was low, as 22% of persons with suspected tuberculosis received no diagnosis. Further, some common ⁄ chronic respiratory ailments were under-diagnosed. There is great need for improved practical training and continuing education in pulmonary disease diagnosis for clinical health workers. keywords Afghanistan, tuberculosis, respiratory symptoms, cough, sputum smear accuracy Introduction Globally, respiratory disease accounts for 19% of deaths, many avoidable through risk behaviour reduction and prompt diagnosis and treatment (WHO 2000). Among nine developing countries surveyed, respiratory problems comprised 18% of presenting complaints in primary health clinics (WHO 2004). Most reflect acute respiratory infec- tions, responsible for 25% of infectious disease deaths in developing settings (Scherpbier et al. 1998). Pulmonary tuberculosis (TB) is the leading cause of infectious disease mortality globally, with 80% of cases concentrated in 22 low-income countries (Corbett et al. 2003, World Health Organization 2004). Diagnosis of pulmonary TB is a multi-step process, requiring clinical acumen and diagnostic procedures. Criteria for TB-suggestive cases (productive cough >2 weeks and ⁄ or haemoptysis) may be non-specific and result in diagnostic delay by either providers or patients in initiating appropriate investigations (Ward et al. ... Jury 1996) 8/14 Theoretical Perspectives on Deviance Travis Hirschi: Control Theory Continuing with an examination of large social factors, control theory states that social control is directly... extreme cases, primary deviance can morph into secondary deviance Secondary deviance occurs when a person’s self-concept and behavior begin to change after his or her actions are labeled as deviant... sentencing Why? Because Mississippi is one of 12 states in the United States that bans convicted felons from voting (ProCon 2011) 6/14 Theoretical Perspectives on Deviance To Strickland, who said she