Character study on Inspecter Calls by J.B Priestly :: essays research papers

Toward THE END OF MOST PLAY, SOME CHARACTERS HAVE CHANGED AND SOME HAVE NOT. Talk about TWO CHARCTERS: ONE WHO CHANGES, AND ONE WHO DOESN’T IN THE PLAY CALLED â€Å"AN INSPECTOR CALLS† †BY J.B. Holy The play ‘An Inspector Calls† by J.B Priestly, is determined to an April evening in 1912. The play concerns the Birling family and Gerald Croft unobtrusively celebrating over Gerald and (Mr. Birling’s little girl) Sheila Birling’s commitment, when an Inspector shows up surprisingly in the midst of their family festivity to enquire about a self destruction of a youthful pregnant young lady called, Eva Smith. Through addressing, the auditor reveals that they all have an inclusion to the youthful girl’s demise. In the play, a few characters are changed by the Inspector’s appearance and news. A few be that as it may, continue as before. One character who continues as before is Mrs Birling. In Act One, we are given a general impression of her; a respectful lady however one who knows her capacity of power (being the spouse of a wealthy specialist and the administrator of Brumley Women’s Charitable Society). In Act Two, Mrs. Birling presents herself in an amenable and good way to the overseer (very not at all like the character that she advances into) however he thinks that its difficult to get data out of Mrs. Birling, this can be appeared with the these statements (taken from soon after the Inspector has indicated Mrs. Birling a photo of Eva); (Controller) â€Å"You perceive her?† (Mrs Birling) â€Å"No. For what reason ought to I?† Later in the play, reality comes out that Mrs Birling had met the young lady in the photograph. Sheila bolstered the Inspector when Mrs Birling wouldn’t give out any data about Eva and attempted to convince her mom to talk however Mrs Birling accepting her as being discourteous and disrespectful and demonstrated that she doesn’t like being repudiated. At the point when Mrs Birling tells the Inspector about Eva going to her council for help, she indicated no regret for the little youngster. She took Eva as being rude when Eva said that her name was ‘Mrs Birling’ and was preferential against her case. Hence, she utilized her capacity and authority (just like the director) to impact the others on the board to desert her case. Mrs Birling attempted to dissuade the Inspector about her decisions of Eva and with an unmistakable inner voice; she said she was, â€Å" . . . entirely supported in exhorting my board of trustees not to permit her case for help.

History Essay Example | Topics and Well Written Essays - 750 words - 1

History - Essay Example 1). The term 'Dark Death' can allude to either the pneumonic plague or the bubonic plague. â€Å"The pneumonic plague is the deadlier of the two infections killing its casualties is a few days† (Spielvogel, 2003, p. 275). It was most grounded in the bigger urban areas in view of the thick populaces that lived there and the less clean conditions that could be kept up in these urban territories. â€Å"The plague would visit a territory, keep going for about a year, murder around 33% of the populace, and proceed onward. †¦ Most history specialists accept that somewhere in the range of 1347 and 1351, at any rate 33% of Europe’s all out human populace (20 to 30 million individuals) died† (Piccolo, 2004). Passings alone were by all account not the only result of the Plague, however. The manner in which the congregation dealt with the emergency and the huge number of passings that occurred influenced the monetary, social and political scene of this huge area of the world. The principal flare-up of the plague was most grounded in the less fortunate segments of the city in light of the fact that these individuals were bound to live in unsanitary conditions and had constrained methods by which to ensure their wellbeing. Present day science can affirm the Plague was spread by the rodent bug who took the sickness from the rodent and spread it to the human populace, so territories that were invaded with rodents were among the first to show side effects (Gottfried, 1983). ... Scared churchmen shut up their places of worship and fled to the nation as did numerous individuals in the mainstream world (Luftus et al, 1999). As a result of their insufficiency in the emergency, the congregation lost a lot of its power and initiative and the individuals started to address whether it ought to ever have held that position. Numerous individuals expected God was furious with them and significantly more contrite and unforgiving strict practices were created to pacify God’s rage through penance. Financial conditions changed significantly as contenders from different nations entered the market through the improvement of the societies. The organizations changed financial conditions for singular residents and presented another methods by which urban communities and towns may be run. â€Å"The impacts of relapse on provincial economy were extensive. Work was rare and compensation rose quickly. In England and in Castile and somewhere else enactment was endeavored to fix compensation, however without success† (Nohl, 1926, p. 20). Laborers, particularly workers who were at long last making a fair compensation, revolted savagely to proposed pay decreases and however the purpose was sound, its influences were deplorable. While the Plague was crushing the populace, the confidence in the One Religion and changing the monetary base of whole countries, the Catholic Church was occupied with a full scale war on itself. Pope Clement V declined to move to Rome when he was selected in 1305 and moved the papacy to Avignon as far as anyone knows in light of common distress in Rome, however more probable so he would be nearer to the French government he served (Menache, 2002). By 1378, this had become an issue. In the wake of battling against a profoundly dubious and

More Nonfiction On LGBTQ History And Culture

More Nonfiction On LGBTQ History And Culture LGBT History Month isnt until October but Pride, celebrated each June in commemoration of 1969s Stonewall Riots, is an equally good time to read up on the history of LGBTQ life in the United States. Scholars  have recently turned their attention to recovering the stories of gay, lesbian, bisexual, and queer people that were hidden in plain sight disguised by euphemism, buried in family stories, or simply waiting for someone to bother looking. The four books on this list will, I hope, provide an entry point to this rich body of literature. If youre looking for even more books  on LGBTQ history and culture, check out our past post on Book Riot or the Lambda Literarys list of non-fiction books nominated for the Lammys. Theres also an incredible  #OrlandoSyllabus growing  on Twitter (and in a public  Google doc). That document, managed by Jamie Berrout, Venus Selenite, Oliver Bendorf, and Lydia Willoughby, centers the history and experiences of QTPOC.  All the books here are on the #OrlandoSyllabus but that document includes many, many more suggestions (as this goes to press, its 79 pages and still growing). Performing Queer Latinidad: Dance, Sexuality, Politics  by  Ramon H. Rivera-Servera, a scholar of performance studies at Northwestern University, explores the ways that performance, especially dance, created  a public culture of gay, lesbian, and queer Latinx identity. Rivera-Servera explains that dance and performance is explicitly  political even while it is celebratory and joyous. He studies the ways that sexual and gender identity intersect with class and ethnic identities inside dance clubs. More than perhaps any other book,  Performing Queer Latinidad  speaks directly to the reasons that the attack on Pulses Latin Night has extra levels of meaning.  This is  also a fairly accessible book that folks new to performance studies, LGBTQ history, or Latinx studies will find approachable. Plus, it  won (or was nominated for) a ton of awards from folks working in dance studies, anthropology, and LGBTQ studies. Perhaps most notably, it won  the 2013 Lambda Award in LGBTQ studies. What Color Is Your Hoodie? Essays on Black Gay Identity  by Jarrett Neal This collection of thirteen essays covers topics like classism and racism within the gay community, how black gay men are presented in pornography, and the authors own search for his identity. More personal and lyrical than an academic history text,  What Color is Your Hoodie is a good introduction to important questions about sexuality, race, and personal identity in the early 21st century. The Straight State: Sexuality and Citizenship in Twentieth-Century America  by Princeton University professor  Margot Canaday, chronicles the ways that the United States government both created and responded to the development of a homosexual-heterosexual binary in the early 20th century. This book is a great place to learn about how homosexuality became a state of being rather than a set of sexual acts. It also explains the ways that Americas bureaucracy failed  LGBTQ people. Pick this book up if youre interested in the intersection of immigration and sexuality, the military, or family policy.  Canaday explicitly ties the past to the present, states clearly the injustice of contemporary policies, and advocates for action. Stand by Me: The Forgotten History of Gay Liberation  by Jim Downs, an historian at Connecticut College, provides an excellent overview of gay rights in the 1970s. Downs story begins just after the Stonewall Riot and ends before the worst of the AIDS epidemic hits.  He argues that the 1970s were about creating community and building movement infrastructure, not just dancing, sex, and street protests. Downs work pushes back against a history of GLBTQ life that centers HIV/AIDS. By focusing on the development of religious organizations , newspapers, theaters, and bookstores that both built and served a growing LGBTQ community, Downs adds nuance to the narrative of gay rights in the decades from Stonewall to marriage equality. Please share your favorite books  on LGBTQ history in the comments or to the #OrlandoSyllabus!

Important For The Survival Of A Firm Finance Essay - Free Essay Example

Sample details Pages: 11 Words: 3393 Downloads: 4 Date added: 2017/06/26 Category Finance Essay Type Narrative essay Did you like this example? The relationship between liquidity and profitability has been investigated by many researchers (Eljelly, 2004; Zainudin, 2006; Rehman and Nasr, 2007; Bhunia, Khan and Mukhuti, 2011). Some of these researchers claimed the inverse relationship between liquidity and profitability of a firm (Eljelly, 2004 and Rehman and Nasr, 2007) and some researchers argued that positive relationship exist between them (Zainudin, 2006; Bhunia, Khan and Mukhuti, 2011 and Bhunia, 2012). The positive relationship shows that firms which have higher liquidity have a propensity to make better profits (Zainudin, 2006). There are two basic measures of liquidity; current ratio and quick (acid test) ratio. I have used current ratio to calculate liquidity as it is a wide measure of liquidity that gives confidence to short-term creditors that current liabilities will pay off by liquidating current assets (Zainudin, 2006) and mostly used by researchers as a proxy of liquidity (Rehman and Nasr, 2007, Bhunia, Khan and Mukhuti, 2011 and Bhunia, 2012). So the liquidity of a firm would be calculated as under: Don’t waste time! Our writers will create an original "Important For The Survival Of A Firm Finance Essay" essay for you Create order Liquidity= Current Ratio = Current assets/Current liabilities 3.3.2.2 Inventory turnover ratio Inventory turnover ratio pointed out how quickly firm sells its inventory, measured as rate of goods movement into the firm from raw material to finished goods and out of the firm in the form of sales (Stickney Weil, 2002). Variability in inventory turnover ratio is caused by segment-wise-effect and when firms work in sales decline state then bigger changes are due to changes in sales (Kolias, Dimelis Filios, 2010). Usama (2012) argued that minimum inventory turnover in days and cash conversion cycle can create higher profit. Capkun, Hameri Weiss (2009) examined the inventory performance by total inventory and the distinct components of inventory such as raw material, work in process and finished goods. They found that inventory performance is positively correlated with financial performance of the firm and association between the performance of distinct components of inventory and financial performance differ across inventory components. Previous researches show various results regarding inventory turnover ratio as Gaur, Fisher Raman (2004), Boute et al. (2007) and Kolias, Dimelis Filios (2010) claimed that inventory turnover and profitability are negatively correlated while Capkun, Hameri Weiss (2009) and Sahari, Tinggi Kadri (2012) argued that inventory turnover ratio and firm performance are positively correlated. The formula to measure inventory turnover ratio is as under: Inventory turnover ratio= Total sales/inventory 3.3.2.3 Debt-to-equity ratio Debt-to-equity ratio is used to evaluate the risk associated with firms financing structure (Wild, Larson Chiappetta, 2007, p. 689). It shows the proportion of equity and debt which the firm is using to finance its assets. A firm adopts suitable mix of sources of finance such as retained earnings, issuance of ordinary and preference shares and debt to maximize shareholders wealth (Afza Hussain, 2011). Debt financing gives a tax shield to a firm therefore they took high level of debt to gain maximum tax benefits and eventually increase profitability. However, the increase of debt financing increases the possibility of bankruptcy (Myers, 2001). A high leverage or a low equity capital ratio causes to reduce the agency cost related to outside equity and raises firm value (Berger Bonaccorsi di Patti, 2003). The level of investment can be increased through the use of borrowed capital and it increased the return of invested capital but it also increased the risk for the firm and for the owners due to fixed expenses of interest (Eriotis, Frangouli Neokosmides, 2011). Elsas, Flannery Garfinkel (2006) argued that debt financing produces negative long run performance more than equity financing whereas financing with internal funds never produce important share underperformance. Amjed (2011) claimed that debt financing is considered to be cheaper than equity financing due to tax benefit and concluded that long term debt has a negative impact on firms performance and short term debt has a positive impact on firms performance. Eriotis, Frangouli Neokosmides (2011) claimed that debt-to-equity ratio has a negative impact on firms performance. The formula of debt-to equity ratio is provided below: Debt-to-equity ratio= Total debt/Total equity 3.3.2.4 Size ownership Size shows the level of firms operations. Larger firms are stronger to face risky situations and have better means to go through these types of situations. Size also brings stronger bargaining power to the firm over its competitors and suppliers and bigger firms have superior technology (Bhattacharyya Sexena, 2009). ). Gibrat(1931) presented a law that growth rate and size of a firm are independent. His law advocated that during a specific period, the probability of change in size is same for all the firms in the given industry. Small firms are more productive but lower survival probability due to two to four times more level of risk as compare to large firms (Dhawan, 2001). Small firms have high profit rate increase as compare to medium or large firms and when these firms become bigger, their profits rate become higher (Ammar et al., 2003). Past studies have different views regarding size and profitability relationship. Some researchers found that profitability of a firm increases as firm size decreases (Dean, Brown Bamford, 1998; Ammar et al., 2003; Ramasamy, Ong, yeung, 2005; Abu-Tapanjeh 2006 and Punnose, 2008) while other claimed that firm size and level of profitability are positively correlated (Treasy1980, Amirkhalkhali Mukhopadhyay, 1993 and Bhattacharyya Sexena, 2009 ). Many proxies are used for size by many researchers according to the requirements of their study. Mostly total sales, total assets or market capitalization is used as proxy of size. In this study, total sales is used as proxy of firm size. Majumdar (1997) and Bhattacharyya and Sexena (2009) also used total sales to measure firm size. For data symmetry, I used natural log of total sales. So the firm size would be: Size= Log (Total Sales) 3.4 Population Population is the concerned group of individuals, data or items from which sample is taken. The concerned population in this study is the Chemical firms listed on the Karachi stock exchange for the period of 2005-2010. The total number of chemical firms listed on Karachi stock exchange is 36. 3.5 Sample and Sampling technique To find out the determinants of firms profitability, this study took the sample of 20 firms from Textile industry of Pakistan which are listed on Karachi Stock Exchange (KSE) during 2005 to 2010 as it is the oldest and largest stock exchange in Pakistan. The firms were selected for the sample by using simple random sampling technique as this technique assures that each component in the population has an equal probability of being selected in the sample ( Zikmund, 2002, p.384). 3.6 Data sources This study took only firm specific factors which affect firms profitability. So, the data for firms specific factors was calculated from the financial statements of the respective firms and report provided by State Bank of Pakistan namely Financial Statement Analysis of Companies (Non-Financial), listed at Karachi Stock Exchange issue 2005-2010. This research is a longitudinal research because same variables were observed repeatedly for the period of six years from 2005 to 2010. 3.7 Hypothesis This study contains one dependent variable i.e. returns on assets (ROA) and four independent variables such as liquidity, inventory turnover ratio, debt-to-equity ratio and size. So, the testable hypotheses (the alternate hypothesis) are hereafter: H11: There may exist a negative relationship between liquidity and profitability of a firm. Firms with higher level of liquidity may possess lower level of profitability and vice versa. H12: There may exist a positive relationship between inventory turnover ratio and profitability of a firm. Firms with higher inventory turnover ratio may possess higher level of profitability and vice versa. H13: There may exist a negative relationship between debt-to-equity ratio and profitability of a firm. Firms with higher level of debt-to-equity ratio may possess lower level of profitability and vice versa. H14: There may exist a negative relationship between size and profitability of a firm. Firms with larger size may possess lower level of profitability and vice versa. Table 3.1 Explanatory variables with their proxy and expected relationship with the profitability (ROA) Variable Name Proxy for the variable Expected relationship Liquidity Current Ratio (CR) Negative Inventory turnover Inventory turnover ratio (INVT) Positive Debt-to-equity ratio Debt-to-equity ratio (DER) Negative Size Log (Total Sales) (SZ) Negative Chapter 4 Analysis and Discussion This chapter includes the statistical analysis of the sample data and gives details regarding empirical findings of the study. 4.1 Analysis This part would indicate the empirical findings of the study. The first table provides the descriptive statistics which quantitatively describe the main characteristics of the data. The second table contains correlation matrix which shows the association between all the variables. The third table entails the OLS regression estimates with fixed effects and fourth table contains the random effects to establish the relationship between dependent and independent variables. 4.1.1 Descriptive Statistics Descriptive statistics portrays summary of the data which is used in the study to clearly understand the range and characteristics of the data. Table 4.1 represents descriptive statistics for 20 Pakistani Chemical firms for a period of 6 years from 2005 to 2010 and for a 120 firms-year observations. Mean shows the average value of the data and median indicates the middle value of the data. In the table 4.1, mean for the dependent variable i.e. return on assets is 15.927 and median is 13.66. Standard deviation Table 4.1 Descriptive Statistics ROA LQ INVT DER SZ    Mean   15.92700    1.736000    12.59517    1.037250   6.539098    Median    13.66000   1.455000   6.560000    0.945000   6.563317    Maximum   45.13000   5.130000   222.5300    3.490000   7.945245    Minimum -10.98000   0.230000   0.000000   0.190000   5.361393    Std. Dev.   11.32618    0.972208   22.98619   0.671968   0.618107    Skewness   0.566959    1.599074    6.861938   1.111136   0.069343    Kurtosis    2.577047    5.240897   60.02378    4.483081   2.357129    Jarque-Bera   7.323292    76.24882   17200.28    35.69009   2.162585   Probability   0.025690    0.000000   0.000000    0.000000   0.339157    Sum    1911.240    208.3200    1511.420   124.4700   784.6917    Sum Sq. Dev.   15265.60    112.4775    62875.43    53.73339    45.46468    Observations   120   120   120    120   120 signifies the distinctive deviation from the mean. The standard deviation of return on assets is 11.32618. The first main independent variable i.e. liquidity (current ratio) has mean value 1.736; median is 1.455 and standard deviation is 0.972208. The second independent variable which is inventory turnover ratio has mean 12.59517; median is 6.56 and standard deviation is 22.98619. The mean, median and standard deviation of third independent variable i.e. debt to equity ratio are 1.03725, 0.945 and 0.671968 respectively. In the case of firm size (natural logarithm of total sales), which is the last independent variable has mean 6.539098; median is 6.563317 and standard deviation is 0.618107. The data of dependent variable which is return on assets and all the independent variables is positively skewed. The kurtosis is also positive among all the variables. The Jarqua-Bera test is used to check the normality of the data rejects the null hypothesis that all the dependent and independent variables are normally distributed because Jarqua-Bera statistic is very high in most of the variables results and the p value is zero in almost all of the cases. Therefore, the data relating to the variables used in the estimation is not normally distributed because the skewness and kurtosis coefficients are not equal to 0 and 3 respectively. 4.1.2 Correlation Analysis The degree of association between the variables is judged by Pearsons correlation coefficient (r). Table 4.2 presents the correlation analysis of all the variables which are used in the analysis. The basic purpose of correlation analysis is to detect the presence of multicollinearity. Gujrati (2008, p.337) recommends that the problem of multicollinearity exist if the correlation coefficient exceeded 0.80. In correlation matrix, no value is greater than or equal to 0.80. So, there is no high correlation among the variables which are used in the analysis. Returns on assets has significant and positively correlation of 42.57% with liquidity, 39.11% with inventory turnover ratio, 42.48% with firms size and negatively correlated with 27.79% with debt to equity ratio. Table 4.2 Correlation Matrix ROA LQ INVT DER SZ ROA    1.000000   0.425709    0.391140 -0.277932   0.424855 LQ      1.000000 -0.175564 -0.648455   0.002791 INVT       1.000000   0.233890   0.388966 DER       1.000000   0.227785 SZ                1.000000 Inventory turnover is positively associated with debt to equity ratio and firms size with 23.39% and 38.90% respectively. Debt to equity ratio is positively associated with 22.78% with firms size. 4.1.3 Regression Analysis (The Fixed Effects Model) Table 4.3 provides the regression analysis to examine the influence of liquidity (LQ), inventory turnover ratio (INVT), debt to equity ratio (DER) and size of a firm (SZ) on its profitability (ROA). In this model, determinants of firms profitability are estimated with fixed effects. The results of regression analysis shows that this model is good fitted having F-statistic 17.5899 and p- value is 0.000. The adjusted R2 value is 0.762270 which predicts that almost 76% variation in the profitability (ROA) uniquely or jointly due to independent variables. Durbin-Watson stat value is 1.641899, points out that no serial correlation is present in the data as the test value is nearly equal to 2 which is the standard value and it is less than the table value dU= 1.663 under 1% level of significance. Table 4.3 Regression Analysis: The fixed effects model (ROAit= ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²0+ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²1 LQit+ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²2 INVTit+ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²3 DERit+ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²4 SZit+eit) Variable Coefficient Std. Error t-Statistic Prob.  Ãƒâ€šÃ‚   C 5.868965 21.19104 0.276955 0.7824 LQ 4.596135 0.977998 4.699533 0.0000 INVT 0.063956 0.036370 1.758493 0.0819 DER -3.315956 1.584092 -2.093285 0.0390 SZ 0.720754 3.245100 0.222105 0.8247 Effects Specification Cross-section fixed (dummy variables) R-squared 0.808218   Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Mean dependent var 15.92700 Adjusted R-squared 0.762270   Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  S.D. dependent var 11.32618 S.E. of regression 5.522370   Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Akaike info criterion 6.432348 Sum squared resid 2927.671   Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Schwarz criterion 6.989846 Log likelihood -361.9409   Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Hannan-Quinn criter. 6.658750 F-statistic 17.58990   Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Durbin-Watson stat 1.641899 Prob(F-statistic) 0.000000 The relative importance of all independent variables liquidity (LQ), inventory turnover ratio (INVT) debt to equity ratio (DER) and size of a firm (SZ) in the determination of firms profitability (ROA) depends upon the higher coefficient value and t-statistic. Results revealed that liquidity has more influence on the profitability of a firm than other variables. Liquidity, inventory turnover and firms size have positive coefficients of 4.596135, 0.063956 and 0.720754 with t-statistics of 4.649953, 1.758493and 0.222105 respectively while debt to equity ratio has negative coefficient of -3.315956 with t-statistics of -2.093285. Moreover, the variables liquidity, debt to equity ratio and inventory turnover are significant at 1%, 5% and 10% level of significance. 4.1.4 Remarks The aim of this study is to identify the determinants of firms profitability while using the data of Chemical firms in Pakistan which are listed on Karachi Stock Exchange. While analyzing the firm specific factors, liquidity is found to have positive impact on profitability. So, H11 is rejected. Inventory turnover ratio shows the positive impact on profitability according to study findings. So, H12 is accepted in this regard. Moreover, the impact of debt-to-equity ratio is found negative on firms profitability. So, we accept H13. Size of the firm indicated positive impact on firms profitability. So, H14 is rejected with respect to study results. All the variables are found significant determinant of firms profitability except size of the firm which has insignificant result according to the study findings. 4.1.5 Regression Analysis (The Random Effects Model) Table 4.4 entails the regression analysis to examine the influence of liquidity (LQ), inventory turnover ratio (INVT), debt to equity ratio (DER) and size of a firm (SZ) on its profitability (ROA). In this model, determinants of firms profitability are estimated with random effects. In random effects model the intercept shows the mean value or average value of all the intercepts and error term shows the random deviation of single intercept from the mean value. The findings of regression analysis indicates that this model is good fitted having F-statistic 14.92818 and p- value is 0.000. The adjusted R2 value is 0.318882 which predicts that almost 32% variation in the profitability (ROA) randomly due to Table 4.4 Regression Analysis: The random effects model (ROAit= ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²0+ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²1 LQit+ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²2 INVTit+ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²3 DERit+ÃÆ'Ã… ½Ãƒâ€šÃ‚ ²4 SZit+eit) Variable Coefficient Std. Error t-Statistic Prob.  Ãƒâ€šÃ‚   C -22.16595 13.27979 -1.669149 0.0978 LQ 4.447065 0.922300 4.821712 0.0000 INVT 0.097785 0.033657 2.905343 0.0044 DER -3.070943 1.450723 -2.116837 0.0364 SZ 4.943581 2.047117 2.414900 0.0173 Effects Specification S.D.  Ãƒâ€šÃ‚   Rho  Ãƒâ€šÃ‚   Cross-section random 6.345424 0.5690 Idiosyncratic random 5.522370 0.4310 Weighted Statistics R-squared 0.341777   Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Mean dependent var 5.332229 Adjusted R-squared 0.318882   Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  S.D. dependent var 6.785963 S.E. of regression 5.600447   Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Sum squared resid 3606.976 F-statistic 14.92818   Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Durbin-Watson stat 1.382481 Prob(F-statistic) 0.000000 Unweighted Statistics R-squared 0.453175   Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Mean dependent var 15.92700 Sum squared resid 8347.605   Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Ãƒâ€šÃ‚  Durbin-Watson stat 0.597366 independent variables. On the other hand, Durbin-Watson stat value is 1.382481, points out that no serial correlation is present in the data as the test value is less than the table value dU= 1.663 under 1% level of significance. Coefficient value and t-statistic indicates the relative importance of all independent variables liquidity (LQ), inventory turnover ratio (INVT) debt to equity ratio (DER) and size of a firm (SZ) in the determination of firms profitability (ROA). Results revealed that liquidity has more influence on the profitability of a firm than other variables. Liquidity, inventory turnover and firms size have positive coefficients of 4.447065, 0.097785 and 4.943581 with t-statistics of 4.821712, 2.905343 and 2.414900 respectively while debt to equity ratio has negative coefficient of -3.070943with t-statistics of -2.116837. Moreover, the variables liquidity and inventory turnover ratio are significant at 1% and debt-to-equity ratio and size are significant at 5% level of significance. 4.1.6 Remarks The basic purpose of this study is to find out those factors which affect firms profitability. The above model is used to find out the relationship between the dependent and independent variable with the random effects model. The model exhibits that liquidity is significantly positively correlated with profitability. So, H11 is rejected. Inventory turnover ratio shows the significantly positive impact on profitability. So, H12 is accepted in this regard. On the other hand, the impact of debt-to-equity ratio is found to be significantly negatively associated with the firms profitability. So, we accept H13. Size of the firm indicated significantly positive impact on firms profitability. So, H14 is rejected with respect to study results. All the variables are found significant determinant of firms profitability in random effects model. 4.2 Discussion The basic purpose of this study is to identify the determinants of firms profitability while using the data of Chemical firms in Pakistan which are listed on Karachi Stock Exchange. The research findings show that liquidity is significantly positively correlated with profitability which satisfies the findings of (Zainudin, 2006, Bhunia, Khan Mukhuti, 2011 and Bhunia, 2012) but it opposes the results of (Eljelly, 2004 and Rehman and Nasr, 2007). Inventory turnover ratio shows the significantly positive impact on profitability according to study findings which is consistent with the finding of (Sahari, Tinggi Kadri, 2012). On the other hand, the impact of debt-to-equity ratio is found to be significantly negatively associated with the firms profitability which supported the conclusion of (Eriotis, Frangouli Neokosmides, 2011). Size of the firm indicated significantly positive impact on firms profitability according to the findings of (Treacy, 1980; Bhattacharyya Sexena, 2009 and Am irkhalkhali Mukhopadhyay, 1993) and the findings rejected the arguments of (Ramasamy, Ong yeung, 2005, Ammar et al., 2003 and Dean, Brown Bamford, 1998). On the whole, the selected variables are strongly associated with the profitability of the firm. Liquidity is the most important factor to affect profitability. Although size and debt-to equity ratio reveal strong power to affect profitability, but their explanatory power is less than liquidity. On the other hand, inventory turnover ratio has a significant positive relationship with profitability but its explanatory power is less than other independent variables. Chapter 5 Conclusion and Implications This chapter provides conclusion, limitations and of the study further directions for future research. 5.1 Conclusion The primary objective of this study was to find out the factors which determine the profitability of the firm while analyzing the financial data of Chemical industry of Pakistan which are listed on Karachi Stock Exchange for the period of 2005 to 2010. The findings revealed that the selected variables have significant relationship with the profitability and they strongly affect the profitability of the firm. The findings suggested that liquidity has a strong positive impact on profitability. Firms should maintain optimal level of liquidity to meet short term obligations. The results also show that inventory turnover ratio is positively associated with firms profitability. It means that firm gets higher profit by quickly converting its inventory into cash. The findings reject the pecking order theory as debt-to-equity ratio has inverse relationship with profitability as debt-to-equity ratio increases, the firms profitability decreases. It shows that firm should not rely on heavy debt financing. The findings confirm the trade-off theory that firms should focus on trade-off of costs and benefits while selecting how much equity and debt to use as financing sources. Lastly, the findings reject the Gibrats law and claimed that firm size and profitability are positively related. The results indicated that profitability goes up as firms size become larger. 5.2 Limitations of the research This study is carried out in Pakistan which has developing economy so there are many problems with respect to availability of data as many manipulations and misrepresentations are existed in publically available data. Many sources were used for data collection. So, the quality of results of this study depends upon the available data of selected companies. Due to limitations of time and scope of the research required to focus only on limited number of firms. Due to available resources, only internal factors which affect profitability are included in the study. 5.3 Directions for the future research This research was first time conducted in Pakistan to explore the determinants of firms profitability in Karachi Stock Exchange. Further studies should be carried out in Pakistan to explore this phenomenon on different sectors or in other developing economies to evaluate whether the factors have same effect in different economies. Comparative research on this topic could be employed while taking different sectors of the economy. Moreover, external factors could be used to analyze their affect on profitability in developing economy. Different models could be employed for further in-depth analysis.

Literature Review On Stress And Burnout - 1175 Words

Descriptive Literature Review: Stress and Burnout in Mental Health Nursing â€Å"Nurses caring for psychiatric patients who have been referred by law-enforcement for example forensic psychiatric/mental health patients, including patients formerly termed ‘criminally insane’ (Steadman Cocozza, 1978), would inevitably be subject to a greater risk of violence and aggression, and stress and burnout, compared with those working in any other field of nursing† (Mason, 2002 as cited in Dickinson Wright, 2008). It is recognized that mental health nursing is extremely stressful, with the outcome leading to stress and burnout of mental health nurses. An investigation was done by Jones et al (1987) on stress in forensic mental health nurses in a†¦show more content†¦Sherring, S., Knight, D, (2009), Sorgaard, W., Ryan, P., Dawson, I., (2010), Abdi, M. F., Kaviani, H., Khaghanizade, M., Momeni, A, (2007) all used quantitative research method where as in Dickinson Wr ight, (2008) used both quantitative as well as qualitative. The sample sizes in these four articles range from 196-475 participants with a mixture of both qualified and unqualified staff. The study methods used among the four articles were; Maslach Burnout Inventory (MBI), the Mental Health Professional Scale (MHPS), the Psychosocial Work Environment and Stress Questionnaire, the General Health Questionnaire-28, and demographic questionnaires. Dickinson Wright, (2008) and Sherring, S., Knight, D, (2009) had similar findings where there were high levels of emotional exhaustion to the point where participants took sick leaves and considered leaving their jobs. Contrarily, the findings of Sorgaard, W., Ryan, P., Dawson, I., (2010) and Abdi, M. F., Kaviani, H., Khaghanizade, M., Momeni, A, 2007) revealed low levels of emotional exhaustion. Another major topic discovered in the findings of the research studies was workload size. Coffey, M., Coleman, M. (2001) Jenkins, R. and Elliott, P. (2004) used quantitative studies while Edwards, D., Burnard, P., Coyle, D., Fothergill, A. and Hannigan, B. (2000) Taylor, B. and Barling, J. (2004) usedShow MoreRelatedResearch Critique, Part 1: Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction798 Words   |  4 PagesResearch Critique, Part 1: Hospital Nurse Staffing and Patient Mortality, Nurse Burnout, and Job Dissatisfaction Grand Canyon University: NRS-433V 06-04-2016 PROBLEM STATEMENT: The broad research problem leading to this study is the belief that nursing shortage in facilities leads to patient safety issues. The review of available literature on this topic shows strong evidence that lower nurse staffing levels in hospitals are associated with worse patient outcomes. 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Political Changes in Europe Since the Fall of the Soviet Union Free Essays

In April 1986, Mr. Gorbachev began the perestroika, translation â€Å"reconstruction†, which was to end the Cold War that effectively brought down the Iron Curtain. The split between West and East not only partitioned the world into two parts, but also divided the European family for over 40 years. We will write a custom essay sample on Political Changes in Europe Since the Fall of the Soviet Union or any similar topic only for you Order Now With the fall of the Soviet Union came many changes that affected much if not all of Europe. At the end of the Brejnev era , the socialist bloc was severely outdated and far removed from the contemporary world. The economy was in a shambles, independent civil society was largely in exile, and corruption throughout and within the state via the Communist Party had become legendary. In addition, the USSR had to devote an enormous portion of its budget to the military. On the international level, the USSR had lost many allies, because its social model proved to be decreasingly successful in its deceit, and the ill-fated invasion of Afghanistan (1979 – 1989) did not help in any way. It was therefore necessary to undertake urgent measures, especially in countries where satellite totalitarian regimes were challenged and the USSR no longer had the support of local communist parties. The advent of Gorbachev to power marked the beginning of the reconstruction. His first step on his rise to power was the partial liberation of the press, also known as glasnost. The first free newspapers emerged and some major newspapers such as â€Å"Novii Mir (New World),† Argumenti i Fakti â€Å"(Arguments and Facts) or† Moskovskie Novosti (Moscow News) changed editors. Books banned by the Soviet censorship began to appear in stores. Also, films which had been censored until this time were finally appearing on the screen. The policy change was also considerable. Under Gorbachev, 140 dissidents, victims of Stalinist repression, were honored and rehabilitated. From exile in Gorky, Sakharov, who condemned the war in Afghanistan – was released. Several opposition political organizations emerged as a Democratic Union and in 1988 the first anti-communist demonstrations took place. Gorbachev, considering the difficulty and complexity of the political situation at the time, tried at any price to change the political elite in an effort to ensure reconstruction. Policy frameworks† began and brought fresh faces to power. â€Å"Without – parties† (political parties that were not members of the Communist Party) were authorized to occupy important positions in state bodies. In addition, elections were introduced within the party to make elected officials accountable to its voters. Before this time, t he party presented a candidate for the post and members could only nod in approval. Despite all this progress, the USSR was unable to overcome the economic and social crisis that hit the country in the early 80s. The Soviet system was not adaptable by itself and reconstruction was doomed from the start. Gorbachev did not have the political capacity to push the desired reforms through. His strategy, in essence, triggered the collapse of the USSR, which was completely unexpected. Perestroika could not change the structure of the Soviet economy, and thus served as an obstacle to reforms. All means of production were under state control. In addition, factories managers and corrupt officials wanted at all costs to keep the economic system that afforded them considerable privilege, especially in a country where the deficit of consumer products was seen in everyday life. The political system, like the economy, rested on a foundation of lies. Political leaders from cities and regions fabricated domestic and foreign policy statistics, using propaganda, including the newspaper â€Å"Pravda† (Truth). This newspaper was later to become a symbol of Soviet exaggeration of the productivity of the communist state. The Soviet secret services were doing everything to prevent people from having information deemed undesirable; any foreign or independent press was prohibited. In launching his reforms, Gorbachev wanted to reform that which what was not reformable. Perestroika and glasnost had made the system fragile, because the lie was no longer there to blind people. Thus, in 1991 a political system that had seemed indestructible – unbeatable, all but disappeared from the world political map. Perestroika was ultimately the determining factor in the fall of the Iron Curtain. The forces it unleashed, such as freedom of speech (glasnost), by Gorbachev inside his country had devoured the communist parties of Eastern Europe. That was also the case with the fall of the Berlin Wall and subsequent German reunification. The fall of the Berlin Wall was largely provided for by the green light given by Moscow. Without such approval, it would have been very probably a repetition of the â€Å"coup de Prague† of 1968, as the forces of the Warsaw Pact entered the Czechoslovakian capital to put an end to the democratic reforms of Dubcek following the Prague Spring. After the fall of the Berlin Wall on November 9, 1989, the reunification of Germany was inevitable. The non-intervention of Warsaw Pact forces during the fall of the Berlin Wall signaled the outbreak of the revolutions that occurred thereafter. Elsewhere in 1989 in Eastern Europe, democratic movements freed from the tutelage of Moscow out-punched Communism. This is the case in Romania with the fall of Ceausescu, Czechoslovakia and Poland with the resignation of the communist government and the start of negotiations between General Jaruzelski and the representatives of Solidarnosc. The policy of rapprochement between the West promoted by Gorbachev led to the collapse of the Warsaw Pact. Having neither the financial resources nor the political will to save this military alliance, the Soviets proposed in 1988 to repeal the pact against the dissolution of NATO. In December 1988, Gorbachev and Bush declared at a meeting in Malta that the Cold War was over. Immediately after the fall of communism in Europe, former satellites of the Soviet Union chose to join the unified European family and NATO. Chronologically, in the first half of 90 years, almost all the countries of Central and Eastern Europe (CEE) have submitted their applications to join the European Union and NATO. For these countries, membership in these structures is first and foremost a political symbol, to guarantee their freedom and sovereignty. European integration also meant the return of these countries into the European mainstream as equal partners and not merely as â€Å"little brothers†, as was the case with the USSR. Long oppressed by a regime imposed from outside, these countries could finally defend their interests in the democratic framework that the European Union offers. Without perestroika, the world today would not be the same. It is mainly through this process that democratization has been set up in the Central and Eastern Europe and that Europe is no longer divided in two. How to cite Political Changes in Europe Since the Fall of the Soviet Union, Papers

Jeffersonian Republicanism Essays - , Term Papers

Jeffersonian Republicanism After the extreme partisanship of 1800, it was expected by supporters and foes alike that the presidential administration of Thomas Jefferson would pioneer substantial and even radical changes. The federal government was now in the hands of a relentless man and a persistent party that planned to diminish its size and influence. But although he overturned the principal Federalist domestic and foreign policies, Thomas Jefferson generally pursued the course as a chief executive, quoting his inaugural address We are all Republicans, we are all Federalists. With true republicans warming most of the seats of power throughout the branches, except in the Judiciary, he saw the tools of government as less of a potential instrument of oppression and more of a means to achieve republican goals. Jefferson assumed the presidency in the hopes that his election would represent the triumph of the true republican principles of the American Revolution; ......the defeat of those who had reverted in varying degrees to policies derived from monarchism. His first acts were to reduce the size of the government and to cut spending. He believed the strongest government was that which placed the lightest burden on its citizens. Such is meant in his inaugural address by Sometimes it is said that man cannot be trusted with the government of himself. Can he, then, be trusted with the government of others? Or have we found angels in the forms of kings to govern him? Let history answer this question. Although recognized as an intellectual and scholar, Jefferson was also undoubtedly the first president to become the leader of a political party. He skillfully made use of party politics in making assignations to office pursuing his legislative aims by entertaining members of Congress at the White House as a means of keeping himself in touch and them in line. Jefferson used the powers of his presidential office with an authority that Presidents Washington and John Adams would not have been permitted. His political moderation and enthusiasm to compromise land had won over many of the Adams Federalists. At the same time those Republicans who had rallied behind him in hopes of a radical exodus from previous administrations grew increasingly frustrated. Led by the vibrant and unconventional John Randolph, a group of Republicans in the House, who called themselves the Quids, meaning others, objected to what they interpreted as federalism in the administrations policies. Relying on the Vir ginia and Kentucky decisions, they advocated a strict construction of the Constitution and state rights. They became the most troublesome of the presidents opponents. After Republicans won majorities in both the House and the Senate, and the Federalist ticket was defeated for the presidency in 1800, the Federalists in Congress passed the Judiciary Act of 1801. Since appointments to the Federal bench came with a life time guarantee, they projected to extend their control of that branch of government. The Judiciary Act of 1801 created ten new positions on the Federal District Courts and a new category of appellate court, the circuit court of appeals, between the Supreme Court and the district courts. The act also reduced the size of the highest court by one justice. Before leaving office, President John Adams had appointed as many federalists to these new positions as he could. These appointments were known as the midnight appointments. Faced with a decidedly hostile Judicial branch, the Republicans quickly took steps to defy the Federalist moves. In March of 1802, Congress repealed the Judiciary Act of 1801, which eliminated the new judgeships and designated one Supreme Court justice and one district court judge to sit on the traveling appellate courts. Republicans in Congress, with Jeffersons support, then proceeded to impeach two federal justices who had openly attacked the administration from the bench. The first federal justice, John Pickering of New Hampshire, was mentally deranged presenting a constitutional predicament - His incompetence fell short of the requirement for removal (high crimes and misdemeanors). He was nevertheless convicted by the Senate and removed in 1804. Complaining that few died and none resigned, Jefferson removed some Federalists who had been assigned to high offices by George Washington and John Adams. He appointed no Federalists to high office and when there was a vacancy

economy of jamaica essays

economy of jamaica essays The Jamaican economy is an ailing economy and a prime example of an impoverished nation with an inadequate manufacturing infrastructure, limited nation and agricultural assets and declining foreign investments. With a decline in foreign investments Lee Bailey, President of Cruise Shipping Association who was a guest on the television program, A Nation In Crisis on November 2nd, 2000 at 8:30 pm live on T.V. J stated that with no water, no roads no infrastructure why would foreigners want invest? Why would they want to build a home with these conditions? Mark Kerr Jarrett, President of Montego Bay Camber of Commerce, another guest on A Nation In Crisis stated that law and order must be returned to the streets in order to sell the nation to foreign and local investors. He also said people must reinvest to increase the income of the nation. Jamaica has experience a deteriorating economy along with falling living standards for over 15 years as a result of a heavy debt, a devalued currency and societal malaise. The government is still repaying monies they have borrowed from international leading agencies such as the international Monetary Fund (IMF) and the World Bank. Payment of 3.6 billion in foreign debt alone consumes 49% of the total budget. A series of floods and hurricanes that ravaged the country exposed the governments poor emergency relief preparation forcing authorities to solicit extensive loans from abroad. These debt burdens are an amount of money borrowed together with repayments of interest. Listed below are reasons for an ailing economy: d.) Government measures, stop-go policies related to change in government ...

Word Choice Comprise vs. Compose

Word Choice Comprise vs. Compose Word Choice: Comprise vs. Compose At this rate, it won’t be long before even pedants  give up on the difference between â€Å"comprise† and â€Å"compose.† After all, â€Å"comprise† is frequently misused, particularly by people writing â€Å"comprised of† when they mean â€Å"composed of.† But it’s our job as Guardians of Language (it sounds snazzier than â€Å"proofreaders†) to defend against grammatical abuses. So, in this post, we explain  how â€Å"comprise† and â€Å"compose† should be used. Comprise (To Contain or Include) The verb â€Å"comprise† means â€Å"contain† or â€Å"consist of,† so it is used when describing a whole that includes multiple parts or components: The United States comprises fifty states. Here, â€Å"comprises† shows that the United States (as a whole) includes fifty individual states. Typically, when using â€Å"comprise,† the whole should come before the parts in the sentence. Compose (To Make Up or Constitute) While also a verb, â€Å"compose† means â€Å"make up† or â€Å"constitute.† As such, we could invert the example above to say: Together, fifty states compose the United States as a republic. In this sentence, the focus is on how the fifty individual states combine to form the United States as a country. Those stars arent just there to look pretty. [Photo: Jnn13]We also see why â€Å"composed of† is acceptable while â€Å"comprised of† isn’t, since â€Å"compose† focuses on the parts that constitute the whole. We can therefore rewrite the example sentence again as: The United States is composed of fifty states. More generally, â€Å"compose† can also mean â€Å"create an artistic work† (particularly music or a painting), or even â€Å"calm oneself† (where its a variation of â€Å"composure,† meaning tranquility). Comprise or Compose? The problem with â€Å"comprised of† is that â€Å"comprise† is the opposite of â€Å"compose,† not a synonym. In short, they can’t be used interchangeably. One good way to remember this is the following: The whole comprises the parts; the parts compose the whole. Here we see how both terms refer to how something is constituted, but from opposite directions; while â€Å"comprise† describes the components as belonging to a whole, â€Å"compose† describes the whole as constituted by its parts.

Business logistics Essay Example | Topics and Well Written Essays - 2000 words

Business logistics - Essay Example Zara’s contribution to the European fashion market sales account for a staggering two-thirds of Inditex’ total 9002 Million Euro, of which net profit was 1002 Million Euro.   1.1 THE EXISTING PROCESS AND LOGISTICS OF ZARA A team of designers in Zara is charged with the responsibility of spotting emerging trends in response to consumer demands. Valuable feedback from consumers is received from Store Managers also. The information collected by them on design, outlook and demand is transmitted through a wireless network. These inputs are used by the design Management team to develop the latest products for Zara,  (Sull, and  Turconi, 2008). ... The whole process of design and cutting takes about 10 days. After the prototypes are produced, they undergo a decision process wherein the management decides which of them will go into commercial production. This decision is made on the basis of a special algorithm and the conditions and demands in the market. Generally only about 40% of the prototypes become commercial products for customers. They are then returned to the manufacturing centers to enter the production chain, checked for quality control, and packaging,  (Sullivan, 2005). The ready material is moved to the automated distribution centre in  Arteixo, which is the main Distribution Centre with no storage facility. Logistics models assist the management in assessing the number of batches that should be delivered to the stores twice a week through shipments, which makes sure that the stores are not overloaded and are delivered as per their demands. A fleet of trucks reach out to places with overnight distances and char tered cargo flights are used for larger distances. The company squeezed its shipping models and decided to go with air cargo, so that flights can organize outbound consignment of all company products with return journey loaded with raw materials and half-finished products, (Burt, Dawson, and  Larke, 2003). Fig1: Complete Operations chain of Zara Fashions    Fig2: Outline of operations at Zara SECTION 2   This section presents the  advantages  /  disadvantages, SWOT, PEST analysis of Zara and evaluation of current operations and logistics at Zara.   2.1 Strategic Advantages Being different from traditional retails, its does not outsources its  operations  or products

Middle-Range Theory of Chronic Sorrow Essay Example | Topics and Well Written Essays - 750 words

Middle-Range Theory of Chronic Sorrow - Essay Example This is the theory in a nutshell and the article expands and repeats it throughout, using certain keywords: Antecedents, Loss Situations, Disparity, Trigger Events, Affected Individuals, Family Caregivers, Bereaved Individuals, Management Methods, (Internal and External). Most of what is written is easily understood and contains a great deal of common sense. The repetitive nature and volume of information may actually only serve to confuse that understanding. Taking each keyword and explaining it simply makes the article more accessible and easily absorbed. Antecedents: These are basically the events leading up to chronic sorrow developing. They have similarities with loss situations, disparity and triggers, all seem to be intertwined resulting once again in confusing repetitions. A good explanation of these by Lindgren et al ., (1993) and Teel, (1991) is as follows: Loss Situations: Only three are emphasized, these being, ongoing or chronic loss, (described as 'ongoing') such as chronic illness or having a physically or mentally disabled child; loss suffered by caregivers as they watch loved ones suffer and deteriorate, and also their own loss of a normal life; finally, loss through bereavement, (described as 'circumscribed), death of a a loved one and the change of roles the sufferer may encounter as a result of this loss. Disparity: The Disparity: The person's current reality is different from what they would like it to be. A gap between the 'actual' and the 'desired' state exists, and as the loss may be experienced periodically, so too is the grief. The gap cannot close and so the grief keeps returning. Trigger Events: Closely linked to disparity, these are situations that bring the realization of the loss into focus and depend on whether the loss is chronic for an individual, or as a caregiver, or due to bereavement. A chronic illness which causes deterioration may bring on the sorrow for that person. Parents seeing a disabled child failing to reach 'normal' milestones will suffer, as will a bereaved person on the anniversary, birthday etc. of the lost loved one. Affected Individuals: As has already been stated, these are sufferers of chronic loss conditions, caregivers and bereaved individuals. The article is repeating the model, key factors and concepts, when it has already identified the people and conditions which bring about chronic sorrow. Management Methods - Effective Internal and External: Once again, the common sense of these is almost lost by the huge amount of words used in the article. However, the information on coping 3. mechanisms is well presented, giving the reader easy access to vital tools for identifying ways to help and support, as well as understanding of the condition and the needs of individual sufferers. Internal Management Methods: These include a

Medical Brain Drain in Developing Countries

Medical Brain Drain in Developing Countries CHAPTER ONE BACKGROUND The loss of human capital from developing countries to developed countries is not a new phenomenon. It is commonly refer to as brain drain which broadly represents the migration of highly skilled professionals from one country or part of a country to another in search of a better prospect (Sako, 2002). The loss of highly skilled professional attributed to brain drain has been of interest internationally for over four decades (Giannoccolo, 2004). Concern over the international migration of health workers first came to limelight at the Edinburgh Commonwealth Medical Conference in 1965. This situation prompted the World Health Organisation (WHO) in 1970 to examine the global process and flows of doctors and nurses (Mejia, 1978). The report however made little impacts on migration of health workers which has continually been on the increase over the years (Levy, 2003, Pang et al. 2002) The concept of the medical brain drain, that is the migration of doctors and other health professionals from developing economies to developed countries has been the subject of interest and research across a variety of fields including labour economics, human resource studies and human geography (Diallo, 2004, Buchan, 2004 and Stilwell et al., 2004) The migration of medical personnel has been identified by WHO as the most critical problem facing the delivery of health service in developing countries (WHO, 2007), besides the emigration of doctors in particular to other countries have received a more considerable attention (Beecham, 2002) The extent to which health professionals migrate to developed countries has continue to be on the increase in recent years and this has been attributed to an apparent response to demand from the developed countries where medical professional are in short supply to cater for demands due to demographic changes, aging population, growing income, feminisation of workforce amongst others (Pond and McPake, 2006). Foreign-trained medical and nursing workforces are estimated to account for more than a quarter of health professionals of the Australia, Canada, the US, and the UK (OECD, 2002).The quest for highly skilled professionals has been on the increase in many developed countries. According to statistic report from the Global Atlas of Workforce cited in Pond and McPake, (2006), the United Kingdom (UK) was ranked among the least staffed of high income countries with 166 doctors and 497 nurses per 100,000 populations the second lowest doctors density and the fourth nurses lowest density among the Organisation for Economic Cooperation and Development (OECD) countries. Moreover, as at the year 2000, the UK health system currently require about 10,000 physicians and 20,000 more nurses to meet the demand of the NHS plan (Department of Health, 2000). Between the year 1999 and 2004 when the targets was achieved earlier than expected, a new target was set to increase the number of nurses by 35000 ( 10%) and physicians by 15000 (25%) between 2001 and 2008. In order to achieve the new target, several methods were adopted to recruit doctors and nurses from other country to fill the shortage within the NHS. However, the approach created a surge in the international recruitment of health worker (Department of Health, 2004). Conversely, the poor economy condition in the developing countries coupled with poor remunerations, lack of infrastructural facilities, and low morale, emigrating to developed countries by doctors is seen as an opportunity for a better prospect. Furthermore, the continuous rise in disease prevalence, emigration, productivity losses, and shortage of doctors in Sub-Saharan Africa, has resulted in health resource crisis (Aluwihare, 2005). Insufficiency in human capacity for health care delivery in developing countries have been identified as a significant factor that is responsible for the inability to achieve the target set by WHO for the treatment of 3 million HIV infected people by year 2005. (This initiative was tagged 3by5) (WHO, 2005). This has also been identified as a major constraint limiting the progress of Millennium Development Goals (MDGs) Initiatives (IOM, 2005). In response to the migration of health professionals to developed countries and the undermine effect to the economy, social and health status of exporting countries, the Commonwealth Ministers of Health agreed to uphold and keep the Commonwealth values of cooperation, sharing and supporting one another, thus a consensus approach to deal with the problem of international recruitment of health workers was adopted. The Code of Practice for the International Recruitment of Health Workers is intended to provide a framework to governments within which international recruitment should be carried out (Commonwealth Code of Practise, 2003). Similarly, Department of Health (2004), presented a revised policy on code of practise for international recruitment of health care professionals this demonstrated the concerned of the UK government in protecting the health care system of developing countries. The revised code of practise for recruitment addresses role of private employer and agencies in the international recruitment of health professionals from developing countries (Eastwood et al., 2005). Nevertheless, developing countries have made some effort in preventing the emigration of physician to developed countries. In spite of this, addressing factors that encourage emigration, such as large disparity in remunerations, standards of living, opportunities for career development amongst host other benefits are usually difficult to come by. At the 1998 UN Conference on Trade and Development, WHO study indicated that 56% of doctors from developing countries migrate to developed nations, while only 11% migrate in the opposite direction; the imbalance is even greater for nurses. (Chanda, 2002). As a result, further effort is being deployed by developing countries to search for means to manage the migration of the health workforce to developed countries (Hussey, 2007). Despite measures, it may be difficult to totally prevent health professionals from migrating. As the large scale of medical brain drain from developing countries is now having a negative impact on the development process of the health system of those countries, it is however imperative for stakeholders to develop a consequential means to curtail the continual movements of health professionals. Nigeria Health Services Historical Background Nigeria, the most populous black nation in the world with a total population of 140 million people (2006 census). As a country with mono-cultural economy, the major source of foreign earnings is from crude oil. The poor level of resources allocated to the health care sector is one of the main factors responsible for the deplorable health condition in the country (Campbell, 2007). The public health service in Nigeria started in 1946 with a 10-year colonial administration plan; the development came about when treatment was required for soldiers of the West African Frontier Force and the colonial administration staff. In 1975 attempt was made to adopt primary health care under the Basic Health Service Scheme (BHSS). The BHSS aimed to improve the accessibility to heath care in terms location, affordability, increase access to disease prevention and distribution of services, and provision of adaptable health services based on local need and socially acceptable method of technology (Hodges 2001). The Current Health Care System in Nigeria Over the last two decades, the health care system in Nigerias has deteriorated a fact ascribed to the countrys poor governance and leadership which was more pronounced during the military era. This was reflected in budget allocations and the fiscal requirements of the Structural Adjustment Programmes. The deficient of reliable data makes it difficult to provide a detailed assessment of the degree of financial commitment to the health sector (Ali-Akpjiak and Pyke, 2003). According to World Bank source, Nigeria public spending per capita for the health sector is less than $5 USD and is as low as $2 USD in some parts of the country. This is far below the $34 USD recommended by WHO for developing countries within the Macroeconomics Commission Report. Nevertheless the Federal Government recurrent budget on health showed an increasing trend from 1996 to 1998, a decline in 1999 and started to rise again in 2000, available evidence shows that most of the recurrent expenditure is spent on personnel. The Federal Government recurrent expenditure on health as a share of the total Federal Government recurrent expenditure which stood at 2.55% in 1996, 2.96% in 1997, and 2.99% in 1998, declined to 1.95% in 1999 and 2.5% rose in 2000. Beyond budgetary allocations, there is a wide gap in the available between the budgetary figures and the actual amount of funds released from the treasury for health activities (WHO 2009a). The decline in the Nigeria health sector was accompanied by collapse of institutional capacities, poor remuneration and lack of conducive environment, dilapidated equipment and infrastructure have over the years, job dissatisfaction and low motivation, have led to increase migration of health professionals to seek employment in overseas countries. In a bid to curtail the impasse, Nigeria has subscribed to the Commonwealth Code of Practice for the International Recruitment of Health Workers for which a framework of responsibilities is presently being developed (WHO 2009b). Demographic and Health Indicators The demographic data in Nigeria are not very reliable. Data gathered from various exercises such as census, vital registrations and surveys are often inconsistence and sometimes contradictory. Nonetheless, there is evidence that the key indicators have either remained constant or worsened (WHO 2005). Life expectancy declined from 52.6 years for male and 58.8 years for female in 1991 to 45 years and 46 years for both Male and Female respectively in 2004. The infant mortality rate (IMR) in 2004 is 103 per 1000 live births when compared to 87.2 per 1000 live births in 1999. Fifty percent of deaths under 5 years of age have been attributed to malnutrition. The maternal mortality rate (MMR) of 800 per 100,000 births is the second highest in the world after India. This has been attributed partly to shortage of skilled medical personnel. For instance only 41.9 % of primary health facilities is provides antenatal and delivery services. Moreover 57.3% of such health facilities operate without a doctor, midwives or senior community extension worker. The Nigeria health system is one of the worst in sub-Saharan African with a disability life adjusted expectancy of 38.3 years and ranked 187 in the world (WHO 2005) Health Workforce in Nigeria Among the several challenges facing the health system in Nigeria is the lack of competent health care professionals. This has been attributed to inadequate infrastructures and poor remunerations packages, making a sizeable numbers of doctors, nurses and other medical professionals vulnerable to be lured away to developed countries in search of a fulfilling and lucrative employments (Stilwell and Awofeso, 2004, Raufu, A., 2002) There are 52, 408 Nigerian Doctors registered with the Nigeria Medical Council as at December 2007, There are 128,918 nurses and 90,489 midwives on the register, although only a fraction of these pay the required practicing licensing fee. There are 13,199 pharmacists, 840 radiographers, 1,473 physiotherapists, 12,703 medical laboratory scientists, and 19,268 Community Health Officers. All these health workers are required to pay annual practicing licensing fees; however the lists have not been pruned for those have migrated out to foreign countries, deaths, retirements or those that have left the profession for another career entirely. Health workers are poorly distributed and most are in favour of urban areas, southern, tertiary health care services delivery, and curative care. For some cadres of health workers such as doctors and nurses, more than 50% have their place of work in the South Western part of the country with vast majority residing in the commercial city of Lagos (Labiran et. al, 2008). Medical Brain Drain in Nigeria Among the countries in sub-Saharan African, Nigeria is a major export of health professionals. An estimated number of 20, 000 health professionals emigrate from Africa annually. A trend that poses threat to sustainable health care delivery in Nigeria. Statistical data on Nigerian doctors who are legally migrating overseas are scarce and unreliable, this is largely due to the fact that most wealthy nations like Australia currently makes it very difficult for overseas trained doctors to practise in their country primarily on the basis of medical skills. However, hundreds of doctors trained in Nigeria continue to emigrate to developed countries annually (Stilwell and Awofeso, 2004). Better remunerations and medical facilities among other factors are cited as one of the major reason for flight of Nigerian doctors (Raufu, 2002) and also there are limited incentives and encouragement for overseas based Nigerian doctors that is willing to relocate back to the country (Stilwell et al., 2004) . Purpose of the study In sub-Saharan African, there is has been a significant rise in disease burden, loss of productivity and the emigration of medical doctors to developed counties have resulted in the in dearth of the most required health resource (Aluwihare, 2005). Most studies on medical brain drain have examined the subject from the perspective of recipient developed countries and little attention has been paid to the donor developing countries. Thus, scarcity of data from developing country makes it difficult to fully describe the impact of migration on countries of origin (Hagopian et al., 2004). Most studies on doctors migration from Sub-Saharan African have tended to focus on numbers, without exploring the underlying reason for migration, assessing the potential negative impact of migration on the health care systems, or considering means to alleviate the problem. In actual fact, information regarding the extent of migration is usually obtained through data from countries of destination (Stilwel l et al 2003). The migration of medical doctors from Nigeria and other countries in sub-Saharan African generates three areas of major concern. The first is a loss of the basic health services available to the citizen. for instance, Ghana, faced with a ratio of nine doctors to every 100 000 patients and no more than 22 paediatrician are licensed to practise in country and no more than 10 specialists of any kind practising in the remote area. Similarly, Nigeria lack adequate doctors to care for the sick especially patients residing in the rural communities The second effect doctor migration from Nigeria is that it prevent the health sectors the ability to organize and expand. Public health institutions heavily depend on doctors to lead, develop and promote them as they work to advance health care delivery. As obtained in US, doctors are well positioned to serve their organisation by actively involved in managing resources and articulating priorities. It is therefore speculated that as the numbers of available medical doctors in developing countries reduces. The third challenges are that doctors migration depletes a significant element of the middle class in developing countries. As in the developed countries, medical doctors in African comprise of an important segment of the social and economic make up of the middle class. They are generally accorded a lot of respect in the society, as being above corruption, they advocate for improvement in quality of education of public schools and they play a vital role in political (Hagopian et al., 2005). In Nigeria, over 70.2% of the population lives on $1 per day (WHO, 2006) Research aim and objectives The aim of this study is to analyse the causes of medical brain drain from developing countries, benefits and burdens associated with brain drain based largely on the views of Nigerian doctors practising in UK. The objectives are: To identify the factors that influence the decision of medical doctors to migrate to developed countries migration To identify the impacts of migration on healthcare in developing countries CHAPTER TWO LITERATURE REVIEW Concept of Brian Drain Brain drain has been defined by many analysts in different ways. It is not surprising the social phenomenon has been examined and analysed from different perspective, based on their general orientation and or awareness of the subject. Brain drain will be conceived in this study as the loss of medical professionals or significant number of human capital within the health care system to other sector of the economy or country. Migration of skilled professionals differs from one country to another and from time to time it is however misleading to generalise the possible impacts of migration in developing countries. Moreover, it can be argued that various studies have attempted to measure the phenomenon from different perspective. Single analytic measurement cannot be used to justify all migration although migration of highly skilled professionals from developing countries has been attributed to various factors which political, social and economical factors account for a significant reasons behind the phenomenon (AUN report, 2002). The migration of highly skilled workers can justify the use of the term brain drain however the expression should be used cautiously. Replacing drain by a more common and value expression such as migration may generate alternate meaning. The difference in the word may be heightened by saying while all brain drains constitute brain migration notwithstanding, brain migration may not necessarily refer to brain drain. Brain drain denote the de-facto transfer of resources spent on impacting education and developing both technical and professional skills of the drained brain in question by the parent (donor) country to the (recipient) country of transfer. The developed countries thus save financial resources on education and professional training and invariably obtain the service of professionals such as doctors, nurses, engineers, scientists who earn more than their colleague in developing countries with a better comfortable living environment (Glaser and Habers, 1978). Several efforts have been made to define the concept of brain drain, most especially by international organisation. According to United Nations Educational, Scientific and Cultural Organisation (UNESCO report, 1969), the brain drain could be defined as an abnormal form of scientific exchange between countries, characterized by a one- way flow in favour of the most highly developed countries. Approximately four decades later, the definition of brain drain has undergone no significant change with a lot of highly skilled workers still leaving the shores of developing countries in pursuit of greener pastures in the developed nations. Medical doctors, engineers and scientists usually tend to predominate or account for a larger proportion among the migrants. Their higher the level of skills or professional qualification, make them more susceptible to migration. Gillis, et al. (1987) suggested two main reasons why brain drain is detestable to most developing countries. The first is that the calibres of people that migrate represent one of the scarce human resources in these developing countries and secondly the amount of resources, financial cost and time involve in educating these group of people is expensive and heavily subsidise by the government. Such migration to foreign country therefore becomes expensive and costly to the donor countries. In most cases the developing countries completely loose these highly skill professionals to the developed countries (Edokat, 2000). This phenomenon has generated a lot of arguments that have been advanced for or against brain drain; however this is not a concern for this study. All that can be concluded is that migration of highly skilled workers from developing countries to develop countries creates a vacuum in the former countries (Edokat, 2000). Types of brain drain Primary external brain drain occurs when trained professional or skilled human resources emigrate from their country of origin to work in developed countries such as America, Europe and Australia. Secondary external brain drain occurs when a trained professional or skilled human resources leave their country or any other less developed country to work in a another developing country such as Botswana, South Africa, Zimbabwe and Namibia. Internal brain drain occurs when a trained professional or skilled or skilled human resources seek for employment in a field not related to his to his/her expertise or when such individual migrate from the public sector to private sector or to another sector within a particular country. While this may pose a problem for a country, it is however not a loss of human resource to the country or the continent. Brain Drain Theories These theories are based on general migration approaches. In brain drain discussion, these approaches have been referred to briefly or summarized. Occasionally specific remarks will be made to provide more clarity regarding the theories. It is however important to state that nearly the theoretical outlook consists of specific mix of different theories or based on the nature of the dominating factors. On the other hand, the scientific approach in which the theories were founded. Another approach in the use of division based on the level Micro, Meso or Macro. These groups cover greater number of theoretical approaches (Oderth, 2002). This level has been defined as: Micro level the decision making of individual is affected by his or her motives, circumstances and access to information. Meso level an aspect of social ties that affects migration such as the effect of network of friends and relatives on migration Macro level opportunities and constraints available at societal level which include political, socio-cultural and economical factors There is no Grand theory linked with research on brain drain although attempts have been made to integrate the subject with economic and social theory, spatial analysis and social science (Kangasniemi et. al., 2004). The study of brain drain and other behaviour by demographers was able to draw insights from other disciplines such as statistics, history, economy, medicine and anthropology (Oderth 2001). A common example is the push and pull model of labour mobility. The model states that individual migration decision is a combination of family, economic, social and political factors. Categories of factors identified to be affecting migration include: 1) Factors at the point of origin, 2) Factors at point of destination, 3) Intervening obstacles and 4) personal circumstances. The push and pull model has been widely used by scholars in studies. Economic factors of employment and material benefits are regarded to have the strongest influence on migration decision (Oderth 2002) Despite the frequent use of the push and pull model approach in migration literature, the approach has been seen as too mechanical and rational choice based and with less consideration for intervening obstacles or institutional and structural constraints (Massey et al, 1993). Most migration tends to be unidirectional from poor to rich nations. The rate of emigration also differs vary considerately between countries and regions on similar economic level and the poorest or the less educated people hardly ever move. A major challenge for the migration is lack of insights in the interconnectedness of all the processes (Kangasniemi et. al., 2004) Another model is the migration system approach it involves formation of a link that encourages migration between a sender and receivers which are strengthened over a period of time. Such links include economic, political and cultural interaction often based on historical activities. Once a link has been created between the migrant places subsequent migration is facilitated through the links. The migration system approach emphasis that social network of the migration provides the intending migrants with information and assistance to ease migration. An important feature of such system is that immigration to a country is directed to specific regions. Such migration is partly dependent on specific areas (Gillis, et al. (1987)). The scope of medical brain drain The World Health Report (2006) estimated that an approximately 817,992 (138%) health workers would be required In Africa to achieve the coverage of basic health interventions. The rate at which doctors and other health professional migrate differs from country to country. Nevertheless, the pattern of migration shares certain similarities. The severe shortage of doctors particularly in rural health facilities has critical negative effects on accessibility and equitable distribution of health care in sub-Saharan African (Ovberedjo, 2007). Studying a specific group of employments from a pool of migration statistics revealed a substantial net loss of human capital among certain key profession in sub-Saharan African. An obvious and highly skilled professional to emerge from such analysis are medical doctors (SOPEMI, 2008). This particular phenomenon can be described as Medical Brain Drain. However, to what extent doctors migrated from sub Saharan African to developed countries? This section will review the scope of migration among doctors in sub Saharan African. Medical brain drain is important and deserves consideration because it is obvious that any decrease in the labour supply among doctors in any country is bound to generate a significant negative impact on the health system of that particular country. In year 2000, statistical data revealed an average of 18.2% of employed doctors working in OECD countries were foreigners. The United States has the largest number of doctors (about 200,000) born and trained in foreign countries followed by the United Kingdom which account for almost 50,000 and France about 34,000. Health worker in India and Philippine formed a greater percentage of the immigrant health workforce OECD countries. In addition, doctors from India account for 56,000 of foreign born doctors practising in OECD countries while nurses of Philippine origin account for about 110, 000. These represent about 15% each of the total (SOPEMI, 2008). The French and the Portuguese African speaking countries contribute some of the highest emigration rate to OECD countries for medical doctors some of other African countries such as Guinea Bissau, Sao Tome and Principe, Senegal, Carpe Verde, Congo, Benin and Togo rank between 17th and 23rd places with emigration rate of 40%, while the English speaking countries in African such as Malawi, Kenya and Ghana have lower emigration rate ranked 25th, 28th and 38th respectively. South African and Nigeria were the only two countries in sub-Saharan African among the top 25 countries with foreign doctors and nurses practising in the OECD countries. This was due to the fact that most African countries have smaller population of workforce (SOPEMI, 2007). Statistical data from the American Medical Association (AMA) Physician Master file shows that 5, 334 non-federal trained doctors trained in Africa medical schools were licensed to practise medicine in the United States in 2002. Nigeria account for 2,158, while South Africa 1,943 doctors. Another 478 doctors are from Ghana medical schools. Other countries contributing to the list in sub-Saharan African include Ethiopia 257 physician, Uganda 153 doctors, and Kenya 93 doctors. The total number of 5,334 represents 6% of the total number African doctors (Hagopian et al. 2004). After United States, the United Kingdom and Canada are the most common destinations in developed countries for African Physicians, with a total of 3,451 and 2, 151 African trained doctors are recorded to be practising in United Kingdom and Canada respectively. Moreover figures in the UK include only doctors who arrived after 1992 thus the number may probably be higher, other destinations for African-trained doctors include Australia, New Zealand and the Gulf States (Hagopian et al. 2003) Migration of doctors also occurs between countries within African continent. For instance, countries such as South Africa, Senegal and Botswana export doctors to developed countries and likewise import doctors from other African countries to cater for shortfall in medical personnel (EQUINET, 2003). Causes of Brain Drain The factors guiding individual choice of migration is in essence personal and thus susceptible to the prevailing personal circumstances. Nonetheless, the economic and social context of such decision deserves an important consideration. Moreover, the disparity between the economic and social development status of different sectors within a particular country and of different countries within African has countries has broaden over the year (Stilwell, 2004). Brain drain of doctors and other highly skilled professional from Africa has been blame on unfulfilled dream at country of origin caused by strife, corruption and misuse that mark Africas post-colonial history (Bridgewater, 2003 cited in Mbanefoh, 2007). Also according to Dovlo (2003), causes can be linked using six gradients which include job satisfaction, salary, career opportunity, governance, social security and benefit, protection and risk. Furthermore the dualistic nature of the world economy has been found to be a major contributing factor to brain drain, as highly skilled medical professionals particularly doctors try to escape the endemic poverty by migrating to wealthy, developed and technologically advanced countries of the world (Mbanefoh, 2007). Factors guiding individual decision to emigrate are a result of the interplay of economic, cultural, social, political and legal forces. Others factors encouraging cross-border migration are usually considered under two main categories: Push factors (Supply) and Pull factors (Demand) (Kline, 2003). Over time the pattern of migration is facilitated through networks that provide prospective migrants with information about job opportunities in countries of destination as well as offer various support to help adjustment after migration (Matin, 2003). Push factors (Supply) these are conditions that make a doctor to be dissatisfied with work and professional careers in their country of origin. The factors may be evident both in the developed and developing countries facilitating the migration of health care professionals from one country to another which is perceive to offer better opportunities in some way. However, these factors are more prominent in developing countries, and they greatly influence the decision of doctors to emigrate in these countries. Pull factors (Demand) these are conditions in countries of destination that motivate workers to migrate. In the same manner as push factors, pull factors can also influence the migration of doctors from one developed country to another developed country. However, the pull factors has a more pronounced influence on individuals in developing countries for instance, there is surge in migration of nurses to Canada after the review of cost of Medical Brain Drain in Developing Countries Medical Brain Drain in Developing Countries CHAPTER ONE BACKGROUND The loss of human capital from developing countries to developed countries is not a new phenomenon. It is commonly refer to as brain drain which broadly represents the migration of highly skilled professionals from one country or part of a country to another in search of a better prospect (Sako, 2002). The loss of highly skilled professional attributed to brain drain has been of interest internationally for over four decades (Giannoccolo, 2004). Concern over the international migration of health workers first came to limelight at the Edinburgh Commonwealth Medical Conference in 1965. This situation prompted the World Health Organisation (WHO) in 1970 to examine the global process and flows of doctors and nurses (Mejia, 1978). The report however made little impacts on migration of health workers which has continually been on the increase over the years (Levy, 2003, Pang et al. 2002) The concept of the medical brain drain, that is the migration of doctors and other health professionals from developing economies to developed countries has been the subject of interest and research across a variety of fields including labour economics, human resource studies and human geography (Diallo, 2004, Buchan, 2004 and Stilwell et al., 2004) The migration of medical personnel has been identified by WHO as the most critical problem facing the delivery of health service in developing countries (WHO, 2007), besides the emigration of doctors in particular to other countries have received a more considerable attention (Beecham, 2002) The extent to which health professionals migrate to developed countries has continue to be on the increase in recent years and this has been attributed to an apparent response to demand from the developed countries where medical professional are in short supply to cater for demands due to demographic changes, aging population, growing income, feminisation of workforce amongst others (Pond and McPake, 2006). Foreign-trained medical and nursing workforces are estimated to account for more than a quarter of health professionals of the Australia, Canada, the US, and the UK (OECD, 2002).The quest for highly skilled professionals has been on the increase in many developed countries. According to statistic report from the Global Atlas of Workforce cited in Pond and McPake, (2006), the United Kingdom (UK) was ranked among the least staffed of high income countries with 166 doctors and 497 nurses per 100,000 populations the second lowest doctors density and the fourth nurses lowest density among the Organisation for Economic Cooperation and Development (OECD) countries. Moreover, as at the year 2000, the UK health system currently require about 10,000 physicians and 20,000 more nurses to meet the demand of the NHS plan (Department of Health, 2000). Between the year 1999 and 2004 when the targets was achieved earlier than expected, a new target was set to increase the number of nurses by 35000 ( 10%) and physicians by 15000 (25%) between 2001 and 2008. In order to achieve the new target, several methods were adopted to recruit doctors and nurses from other country to fill the shortage within the NHS. However, the approach created a surge in the international recruitment of health worker (Department of Health, 2004). Conversely, the poor economy condition in the developing countries coupled with poor remunerations, lack of infrastructural facilities, and low morale, emigrating to developed countries by doctors is seen as an opportunity for a better prospect. Furthermore, the continuous rise in disease prevalence, emigration, productivity losses, and shortage of doctors in Sub-Saharan Africa, has resulted in health resource crisis (Aluwihare, 2005). Insufficiency in human capacity for health care delivery in developing countries have been identified as a significant factor that is responsible for the inability to achieve the target set by WHO for the treatment of 3 million HIV infected people by year 2005. (This initiative was tagged 3by5) (WHO, 2005). This has also been identified as a major constraint limiting the progress of Millennium Development Goals (MDGs) Initiatives (IOM, 2005). In response to the migration of health professionals to developed countries and the undermine effect to the economy, social and health status of exporting countries, the Commonwealth Ministers of Health agreed to uphold and keep the Commonwealth values of cooperation, sharing and supporting one another, thus a consensus approach to deal with the problem of international recruitment of health workers was adopted. The Code of Practice for the International Recruitment of Health Workers is intended to provide a framework to governments within which international recruitment should be carried out (Commonwealth Code of Practise, 2003). Similarly, Department of Health (2004), presented a revised policy on code of practise for international recruitment of health care professionals this demonstrated the concerned of the UK government in protecting the health care system of developing countries. The revised code of practise for recruitment addresses role of private employer and agencies in the international recruitment of health professionals from developing countries (Eastwood et al., 2005). Nevertheless, developing countries have made some effort in preventing the emigration of physician to developed countries. In spite of this, addressing factors that encourage emigration, such as large disparity in remunerations, standards of living, opportunities for career development amongst host other benefits are usually difficult to come by. At the 1998 UN Conference on Trade and Development, WHO study indicated that 56% of doctors from developing countries migrate to developed nations, while only 11% migrate in the opposite direction; the imbalance is even greater for nurses. (Chanda, 2002). As a result, further effort is being deployed by developing countries to search for means to manage the migration of the health workforce to developed countries (Hussey, 2007). Despite measures, it may be difficult to totally prevent health professionals from migrating. As the large scale of medical brain drain from developing countries is now having a negative impact on the development process of the health system of those countries, it is however imperative for stakeholders to develop a consequential means to curtail the continual movements of health professionals. Nigeria Health Services Historical Background Nigeria, the most populous black nation in the world with a total population of 140 million people (2006 census). As a country with mono-cultural economy, the major source of foreign earnings is from crude oil. The poor level of resources allocated to the health care sector is one of the main factors responsible for the deplorable health condition in the country (Campbell, 2007). The public health service in Nigeria started in 1946 with a 10-year colonial administration plan; the development came about when treatment was required for soldiers of the West African Frontier Force and the colonial administration staff. In 1975 attempt was made to adopt primary health care under the Basic Health Service Scheme (BHSS). The BHSS aimed to improve the accessibility to heath care in terms location, affordability, increase access to disease prevention and distribution of services, and provision of adaptable health services based on local need and socially acceptable method of technology (Hodges 2001). The Current Health Care System in Nigeria Over the last two decades, the health care system in Nigerias has deteriorated a fact ascribed to the countrys poor governance and leadership which was more pronounced during the military era. This was reflected in budget allocations and the fiscal requirements of the Structural Adjustment Programmes. The deficient of reliable data makes it difficult to provide a detailed assessment of the degree of financial commitment to the health sector (Ali-Akpjiak and Pyke, 2003). According to World Bank source, Nigeria public spending per capita for the health sector is less than $5 USD and is as low as $2 USD in some parts of the country. This is far below the $34 USD recommended by WHO for developing countries within the Macroeconomics Commission Report. Nevertheless the Federal Government recurrent budget on health showed an increasing trend from 1996 to 1998, a decline in 1999 and started to rise again in 2000, available evidence shows that most of the recurrent expenditure is spent on personnel. The Federal Government recurrent expenditure on health as a share of the total Federal Government recurrent expenditure which stood at 2.55% in 1996, 2.96% in 1997, and 2.99% in 1998, declined to 1.95% in 1999 and 2.5% rose in 2000. Beyond budgetary allocations, there is a wide gap in the available between the budgetary figures and the actual amount of funds released from the treasury for health activities (WHO 2009a). The decline in the Nigeria health sector was accompanied by collapse of institutional capacities, poor remuneration and lack of conducive environment, dilapidated equipment and infrastructure have over the years, job dissatisfaction and low motivation, have led to increase migration of health professionals to seek employment in overseas countries. In a bid to curtail the impasse, Nigeria has subscribed to the Commonwealth Code of Practice for the International Recruitment of Health Workers for which a framework of responsibilities is presently being developed (WHO 2009b). Demographic and Health Indicators The demographic data in Nigeria are not very reliable. Data gathered from various exercises such as census, vital registrations and surveys are often inconsistence and sometimes contradictory. Nonetheless, there is evidence that the key indicators have either remained constant or worsened (WHO 2005). Life expectancy declined from 52.6 years for male and 58.8 years for female in 1991 to 45 years and 46 years for both Male and Female respectively in 2004. The infant mortality rate (IMR) in 2004 is 103 per 1000 live births when compared to 87.2 per 1000 live births in 1999. Fifty percent of deaths under 5 years of age have been attributed to malnutrition. The maternal mortality rate (MMR) of 800 per 100,000 births is the second highest in the world after India. This has been attributed partly to shortage of skilled medical personnel. For instance only 41.9 % of primary health facilities is provides antenatal and delivery services. Moreover 57.3% of such health facilities operate without a doctor, midwives or senior community extension worker. The Nigeria health system is one of the worst in sub-Saharan African with a disability life adjusted expectancy of 38.3 years and ranked 187 in the world (WHO 2005) Health Workforce in Nigeria Among the several challenges facing the health system in Nigeria is the lack of competent health care professionals. This has been attributed to inadequate infrastructures and poor remunerations packages, making a sizeable numbers of doctors, nurses and other medical professionals vulnerable to be lured away to developed countries in search of a fulfilling and lucrative employments (Stilwell and Awofeso, 2004, Raufu, A., 2002) There are 52, 408 Nigerian Doctors registered with the Nigeria Medical Council as at December 2007, There are 128,918 nurses and 90,489 midwives on the register, although only a fraction of these pay the required practicing licensing fee. There are 13,199 pharmacists, 840 radiographers, 1,473 physiotherapists, 12,703 medical laboratory scientists, and 19,268 Community Health Officers. All these health workers are required to pay annual practicing licensing fees; however the lists have not been pruned for those have migrated out to foreign countries, deaths, retirements or those that have left the profession for another career entirely. Health workers are poorly distributed and most are in favour of urban areas, southern, tertiary health care services delivery, and curative care. For some cadres of health workers such as doctors and nurses, more than 50% have their place of work in the South Western part of the country with vast majority residing in the commercial city of Lagos (Labiran et. al, 2008). Medical Brain Drain in Nigeria Among the countries in sub-Saharan African, Nigeria is a major export of health professionals. An estimated number of 20, 000 health professionals emigrate from Africa annually. A trend that poses threat to sustainable health care delivery in Nigeria. Statistical data on Nigerian doctors who are legally migrating overseas are scarce and unreliable, this is largely due to the fact that most wealthy nations like Australia currently makes it very difficult for overseas trained doctors to practise in their country primarily on the basis of medical skills. However, hundreds of doctors trained in Nigeria continue to emigrate to developed countries annually (Stilwell and Awofeso, 2004). Better remunerations and medical facilities among other factors are cited as one of the major reason for flight of Nigerian doctors (Raufu, 2002) and also there are limited incentives and encouragement for overseas based Nigerian doctors that is willing to relocate back to the country (Stilwell et al., 2004) . Purpose of the study In sub-Saharan African, there is has been a significant rise in disease burden, loss of productivity and the emigration of medical doctors to developed counties have resulted in the in dearth of the most required health resource (Aluwihare, 2005). Most studies on medical brain drain have examined the subject from the perspective of recipient developed countries and little attention has been paid to the donor developing countries. Thus, scarcity of data from developing country makes it difficult to fully describe the impact of migration on countries of origin (Hagopian et al., 2004). Most studies on doctors migration from Sub-Saharan African have tended to focus on numbers, without exploring the underlying reason for migration, assessing the potential negative impact of migration on the health care systems, or considering means to alleviate the problem. In actual fact, information regarding the extent of migration is usually obtained through data from countries of destination (Stilwel l et al 2003). The migration of medical doctors from Nigeria and other countries in sub-Saharan African generates three areas of major concern. The first is a loss of the basic health services available to the citizen. for instance, Ghana, faced with a ratio of nine doctors to every 100 000 patients and no more than 22 paediatrician are licensed to practise in country and no more than 10 specialists of any kind practising in the remote area. Similarly, Nigeria lack adequate doctors to care for the sick especially patients residing in the rural communities The second effect doctor migration from Nigeria is that it prevent the health sectors the ability to organize and expand. Public health institutions heavily depend on doctors to lead, develop and promote them as they work to advance health care delivery. As obtained in US, doctors are well positioned to serve their organisation by actively involved in managing resources and articulating priorities. It is therefore speculated that as the numbers of available medical doctors in developing countries reduces. The third challenges are that doctors migration depletes a significant element of the middle class in developing countries. As in the developed countries, medical doctors in African comprise of an important segment of the social and economic make up of the middle class. They are generally accorded a lot of respect in the society, as being above corruption, they advocate for improvement in quality of education of public schools and they play a vital role in political (Hagopian et al., 2005). In Nigeria, over 70.2% of the population lives on $1 per day (WHO, 2006) Research aim and objectives The aim of this study is to analyse the causes of medical brain drain from developing countries, benefits and burdens associated with brain drain based largely on the views of Nigerian doctors practising in UK. The objectives are: To identify the factors that influence the decision of medical doctors to migrate to developed countries migration To identify the impacts of migration on healthcare in developing countries CHAPTER TWO LITERATURE REVIEW Concept of Brian Drain Brain drain has been defined by many analysts in different ways. It is not surprising the social phenomenon has been examined and analysed from different perspective, based on their general orientation and or awareness of the subject. Brain drain will be conceived in this study as the loss of medical professionals or significant number of human capital within the health care system to other sector of the economy or country. Migration of skilled professionals differs from one country to another and from time to time it is however misleading to generalise the possible impacts of migration in developing countries. Moreover, it can be argued that various studies have attempted to measure the phenomenon from different perspective. Single analytic measurement cannot be used to justify all migration although migration of highly skilled professionals from developing countries has been attributed to various factors which political, social and economical factors account for a significant reasons behind the phenomenon (AUN report, 2002). The migration of highly skilled workers can justify the use of the term brain drain however the expression should be used cautiously. Replacing drain by a more common and value expression such as migration may generate alternate meaning. The difference in the word may be heightened by saying while all brain drains constitute brain migration notwithstanding, brain migration may not necessarily refer to brain drain. Brain drain denote the de-facto transfer of resources spent on impacting education and developing both technical and professional skills of the drained brain in question by the parent (donor) country to the (recipient) country of transfer. The developed countries thus save financial resources on education and professional training and invariably obtain the service of professionals such as doctors, nurses, engineers, scientists who earn more than their colleague in developing countries with a better comfortable living environment (Glaser and Habers, 1978). Several efforts have been made to define the concept of brain drain, most especially by international organisation. According to United Nations Educational, Scientific and Cultural Organisation (UNESCO report, 1969), the brain drain could be defined as an abnormal form of scientific exchange between countries, characterized by a one- way flow in favour of the most highly developed countries. Approximately four decades later, the definition of brain drain has undergone no significant change with a lot of highly skilled workers still leaving the shores of developing countries in pursuit of greener pastures in the developed nations. Medical doctors, engineers and scientists usually tend to predominate or account for a larger proportion among the migrants. Their higher the level of skills or professional qualification, make them more susceptible to migration. Gillis, et al. (1987) suggested two main reasons why brain drain is detestable to most developing countries. The first is that the calibres of people that migrate represent one of the scarce human resources in these developing countries and secondly the amount of resources, financial cost and time involve in educating these group of people is expensive and heavily subsidise by the government. Such migration to foreign country therefore becomes expensive and costly to the donor countries. In most cases the developing countries completely loose these highly skill professionals to the developed countries (Edokat, 2000). This phenomenon has generated a lot of arguments that have been advanced for or against brain drain; however this is not a concern for this study. All that can be concluded is that migration of highly skilled workers from developing countries to develop countries creates a vacuum in the former countries (Edokat, 2000). Types of brain drain Primary external brain drain occurs when trained professional or skilled human resources emigrate from their country of origin to work in developed countries such as America, Europe and Australia. Secondary external brain drain occurs when a trained professional or skilled human resources leave their country or any other less developed country to work in a another developing country such as Botswana, South Africa, Zimbabwe and Namibia. Internal brain drain occurs when a trained professional or skilled or skilled human resources seek for employment in a field not related to his to his/her expertise or when such individual migrate from the public sector to private sector or to another sector within a particular country. While this may pose a problem for a country, it is however not a loss of human resource to the country or the continent. Brain Drain Theories These theories are based on general migration approaches. In brain drain discussion, these approaches have been referred to briefly or summarized. Occasionally specific remarks will be made to provide more clarity regarding the theories. It is however important to state that nearly the theoretical outlook consists of specific mix of different theories or based on the nature of the dominating factors. On the other hand, the scientific approach in which the theories were founded. Another approach in the use of division based on the level Micro, Meso or Macro. These groups cover greater number of theoretical approaches (Oderth, 2002). This level has been defined as: Micro level the decision making of individual is affected by his or her motives, circumstances and access to information. Meso level an aspect of social ties that affects migration such as the effect of network of friends and relatives on migration Macro level opportunities and constraints available at societal level which include political, socio-cultural and economical factors There is no Grand theory linked with research on brain drain although attempts have been made to integrate the subject with economic and social theory, spatial analysis and social science (Kangasniemi et. al., 2004). The study of brain drain and other behaviour by demographers was able to draw insights from other disciplines such as statistics, history, economy, medicine and anthropology (Oderth 2001). A common example is the push and pull model of labour mobility. The model states that individual migration decision is a combination of family, economic, social and political factors. Categories of factors identified to be affecting migration include: 1) Factors at the point of origin, 2) Factors at point of destination, 3) Intervening obstacles and 4) personal circumstances. The push and pull model has been widely used by scholars in studies. Economic factors of employment and material benefits are regarded to have the strongest influence on migration decision (Oderth 2002) Despite the frequent use of the push and pull model approach in migration literature, the approach has been seen as too mechanical and rational choice based and with less consideration for intervening obstacles or institutional and structural constraints (Massey et al, 1993). Most migration tends to be unidirectional from poor to rich nations. The rate of emigration also differs vary considerately between countries and regions on similar economic level and the poorest or the less educated people hardly ever move. A major challenge for the migration is lack of insights in the interconnectedness of all the processes (Kangasniemi et. al., 2004) Another model is the migration system approach it involves formation of a link that encourages migration between a sender and receivers which are strengthened over a period of time. Such links include economic, political and cultural interaction often based on historical activities. Once a link has been created between the migrant places subsequent migration is facilitated through the links. The migration system approach emphasis that social network of the migration provides the intending migrants with information and assistance to ease migration. An important feature of such system is that immigration to a country is directed to specific regions. Such migration is partly dependent on specific areas (Gillis, et al. (1987)). The scope of medical brain drain The World Health Report (2006) estimated that an approximately 817,992 (138%) health workers would be required In Africa to achieve the coverage of basic health interventions. The rate at which doctors and other health professional migrate differs from country to country. Nevertheless, the pattern of migration shares certain similarities. The severe shortage of doctors particularly in rural health facilities has critical negative effects on accessibility and equitable distribution of health care in sub-Saharan African (Ovberedjo, 2007). Studying a specific group of employments from a pool of migration statistics revealed a substantial net loss of human capital among certain key profession in sub-Saharan African. An obvious and highly skilled professional to emerge from such analysis are medical doctors (SOPEMI, 2008). This particular phenomenon can be described as Medical Brain Drain. However, to what extent doctors migrated from sub Saharan African to developed countries? This section will review the scope of migration among doctors in sub Saharan African. Medical brain drain is important and deserves consideration because it is obvious that any decrease in the labour supply among doctors in any country is bound to generate a significant negative impact on the health system of that particular country. In year 2000, statistical data revealed an average of 18.2% of employed doctors working in OECD countries were foreigners. The United States has the largest number of doctors (about 200,000) born and trained in foreign countries followed by the United Kingdom which account for almost 50,000 and France about 34,000. Health worker in India and Philippine formed a greater percentage of the immigrant health workforce OECD countries. In addition, doctors from India account for 56,000 of foreign born doctors practising in OECD countries while nurses of Philippine origin account for about 110, 000. These represent about 15% each of the total (SOPEMI, 2008). The French and the Portuguese African speaking countries contribute some of the highest emigration rate to OECD countries for medical doctors some of other African countries such as Guinea Bissau, Sao Tome and Principe, Senegal, Carpe Verde, Congo, Benin and Togo rank between 17th and 23rd places with emigration rate of 40%, while the English speaking countries in African such as Malawi, Kenya and Ghana have lower emigration rate ranked 25th, 28th and 38th respectively. South African and Nigeria were the only two countries in sub-Saharan African among the top 25 countries with foreign doctors and nurses practising in the OECD countries. This was due to the fact that most African countries have smaller population of workforce (SOPEMI, 2007). Statistical data from the American Medical Association (AMA) Physician Master file shows that 5, 334 non-federal trained doctors trained in Africa medical schools were licensed to practise medicine in the United States in 2002. Nigeria account for 2,158, while South Africa 1,943 doctors. Another 478 doctors are from Ghana medical schools. Other countries contributing to the list in sub-Saharan African include Ethiopia 257 physician, Uganda 153 doctors, and Kenya 93 doctors. The total number of 5,334 represents 6% of the total number African doctors (Hagopian et al. 2004). After United States, the United Kingdom and Canada are the most common destinations in developed countries for African Physicians, with a total of 3,451 and 2, 151 African trained doctors are recorded to be practising in United Kingdom and Canada respectively. Moreover figures in the UK include only doctors who arrived after 1992 thus the number may probably be higher, other destinations for African-trained doctors include Australia, New Zealand and the Gulf States (Hagopian et al. 2003) Migration of doctors also occurs between countries within African continent. For instance, countries such as South Africa, Senegal and Botswana export doctors to developed countries and likewise import doctors from other African countries to cater for shortfall in medical personnel (EQUINET, 2003). Causes of Brain Drain The factors guiding individual choice of migration is in essence personal and thus susceptible to the prevailing personal circumstances. Nonetheless, the economic and social context of such decision deserves an important consideration. Moreover, the disparity between the economic and social development status of different sectors within a particular country and of different countries within African has countries has broaden over the year (Stilwell, 2004). Brain drain of doctors and other highly skilled professional from Africa has been blame on unfulfilled dream at country of origin caused by strife, corruption and misuse that mark Africas post-colonial history (Bridgewater, 2003 cited in Mbanefoh, 2007). Also according to Dovlo (2003), causes can be linked using six gradients which include job satisfaction, salary, career opportunity, governance, social security and benefit, protection and risk. Furthermore the dualistic nature of the world economy has been found to be a major contributing factor to brain drain, as highly skilled medical professionals particularly doctors try to escape the endemic poverty by migrating to wealthy, developed and technologically advanced countries of the world (Mbanefoh, 2007). Factors guiding individual decision to emigrate are a result of the interplay of economic, cultural, social, political and legal forces. Others factors encouraging cross-border migration are usually considered under two main categories: Push factors (Supply) and Pull factors (Demand) (Kline, 2003). Over time the pattern of migration is facilitated through networks that provide prospective migrants with information about job opportunities in countries of destination as well as offer various support to help adjustment after migration (Matin, 2003). Push factors (Supply) these are conditions that make a doctor to be dissatisfied with work and professional careers in their country of origin. The factors may be evident both in the developed and developing countries facilitating the migration of health care professionals from one country to another which is perceive to offer better opportunities in some way. However, these factors are more prominent in developing countries, and they greatly influence the decision of doctors to emigrate in these countries. Pull factors (Demand) these are conditions in countries of destination that motivate workers to migrate. In the same manner as push factors, pull factors can also influence the migration of doctors from one developed country to another developed country. However, the pull factors has a more pronounced influence on individuals in developing countries for instance, there is surge in migration of nurses to Canada after the review of cost of