Title Of Paper Germany Essays - Geography Of Europe, Europe

Title of Paper : Germany Grade Received on Report : 92% Germany ( Deutschland) Germany is a country in the middle of Europe. At the north there is the North Sea, Denmark, and the Baltic Sea; on the east are Poland and the Czech Republic. On the south are Austria and Switzerland and on the west are France, Luxembourg, Belgium, and the Netherlands. The official name is the Federal Republic of Germany. It has good relationships with its neighbours and other countries. Germany is in the Northern hemisphere and its capital city's are Bonn and Berlin. Population and Climate ( Bevolkerung und klima) Many people live in Germany. In 1993 Germany had an estimated population of 80,767,591. This means that Germany had about 226 people per sq km. Germany has a changing climate, with an average annual temperature of 9? C. In January the temperature changes from -6? to 1? C. This changes depending on the location. The average July temperature range from between 16? and 20? C. The some places in the north of Germany have a warmer climate than the central and southern parts of Germany. The precipitation is hers. In the south, on the Rhine, is an important industrial area on the cities of Mannheim, Ludwigshafen, and Karlsruhe. Chemicals, machinery, and building materials are made. Stuttgart is the centre of a manufacturing areas because motor vehicles, electronic equipment, office machinery, textiles, and visual instruments are created. Products that are made in Munich are aircraft, motor vehicles, clothing, and beer. Many important industrial areas located in the north west of Germany. These are the Hannover-Brunswick area, where steel, chemicals, and motor vehicles are made. Another major manufacturing area is coastal p! ort cities like Hamburg, Bremen, Kiel, and Wilhelmshaven. The products of this area are refined petroleum, processed food, beer, ships, office machinery, and printed materials. Berlin is also a major producer of electronic equipment. About 8000 companies were working in East Germany in 1990.

Health Sector in Ghana and Investment Opportunities Essay Example

Health Sector in Ghana and Investment Opportunities Essay Example Health Sector in Ghana and Investment Opportunities Essay Health Sector in Ghana and Investment Opportunities Essay AFRICAN LEGACY FINANCE LIMITED| ANALYSIS OF GHANA’S HEALTH SECTOR| AVAILABLE INVESTMENT OPPORTUNITIES| | JONAS HLOMADOR| 1/18/2011| This research document covers issues about the development of the health sector, cost/revenue analysis and investment opportunities available | INTRODUCTION The health sector of a nation is a major contributing factor to sustainable development. Issues about health policy, cost of health, health revenue and investment opportunities in the health sector are among the vital issues that are considered by any government that wants to achieve sustainable development. Among the eight international development goals dubbed (Millennium Development Goals) goals 4, 5, 6 talk about health care. These goals talk about reducing child mortality rate, improving maternal health care and combating HIV, Malaria and other diseases. Ghana is no exception. This research document captures the development of the Ghanaian health sector, a cost/revenue analysis, cost of health care, the challenges in the health sector and the investment opportunities available. PURPOSE OF THIS DOCUMENT The purpose of this document is to inform investors and other stakeholders about the * State of the health sector * Performance of the health sector * Investment opportunities available in the sector This document is first of all very informative concerning health issues. It also aims at forecasting the state and performance of the health sector in the next five years and beyond whiles highlighting areas of potentially viable investment opportunities. Further, serves as a good material for â€Å"Situational Analysis† or â€Å"Environmental Scanning† when embarking on health projects. THE HEALTH SECTOR IN GHANA HISTORY In the late 1970s, the Government of Ghana adopted the primary health care strategy as the vehicle for achieving â€Å"Health for all† by the year 2000. However the economic crisis in the early 1980s drastically reduced resources available to the health sector, resulting in deterioration in the population’s health status. Ghana then embarked on a Medium-Term Health Strategy (MTHS) that aimed to achieve â€Å"Health for all†, by improving service quality and efficiency. As the Ministry of Health (2000) states â€Å"Since 1995, health policy has been based on Ghana’s MTHS which sought to promote greater equity in access to health and outcomes. In pursuit of this objective, Ghana’s MTHS aimed at strengthening district health services, promoting community involvement in the delivery of health services, redirecting health resources to the needy or deprived areas. Although it is difficult to discern the factors that have contributed to the improvement in some health indicators, there was no doubt that the health reform had, to some extent, contributed to the improvements. Based on World Bank data, between 1990 and 1998, infant mortality decreased by a total of 16 percent while life expectancy at birth increased by 5 percent in Ghana. The HIV pandemic then surfaced in the late 90’s and early 2000,s putting more strain on health care. More funds had to be channeled into fighting this deadly disease. HIV awareness became top issue. Money had to be spent to import anti retroviral drugs. A major change occurred in the health services in October 2003. A new health bill was passed. The National Health Insurance Bill was been passed into law by the parliament of Ghana on the 2nd of October. This set up a National Health Insurance Scheme (NHIS), which enabled residents in Ghana to obtain, at least, basic healthcare services without paying money at the point of delivery of the service. This replaced the â€Å"cash and carry† system currently in place. The Bill also provided a policy and regulatory framework in the country for health insurance that would enable the nation to achieve the goal of equitable access to basic healthcare in relation to need rather than socio-economic or socio-cultural status The year 2007 marked the beginning of the third 5 Year Programme of Work based on the health policy developed by the Health Sector since 1995:‘Strengthening Health Systems for effective and efficient delivery of services to households and communities with a focus on improving maternal and child health outcomes’ is the theme of the Ghana Health Service Strategic Framework. This framework which aimed at driving the work of the Service for the next five years was based on the belief that the desired rapid progress cannot be made without a strong functioning health system. SECTOR OVERVIEW The institutions or organizations in the health sector can be put under two categories * Administrative, Control Regulatory Bodies * Service Delivery Organisations Administrative, Control Regulatory Bodies The health sector is managed by two offices, the Ministry of Health and Ghana Health Services (GHS). Ministry of Health is the office responsible for budget allocation and policy definition, while Ghana Health Services, with branch offices at both the regional and district levels, is mainly responsible for the implementation of the budget and policies. The MOH also provides mobile health services, including immunization and family planning, to rural residents. Salaries are distributed by the Controller Accountant General (CAG) directly to the public health personnel through the banking system. Other recurrent expenditures are mostly distributed by the District Health Offices to health facilities. In addition, nongovernment entities are also very active in the health sector. Service Delivery Organisations The Service Delivery Organisations include government hospitals, polyclinics and private hospitals clinics. Ghana also has missionary health facilities, which are mainly hospitals of limited scale and health clinics. The higher-level health providers, in ascending order, are health centers or clinics, district hospitals, regional hospitals, and tertiary hospitals. Ghana also has a network of maternal homes, although they are mainly privately owned. All these organisations are supervised and funded by the administrative, regulatory and control bodies listed above. The vision of the health sector is to create wealth through health and to contribute to the national vision of attaining middle income status by 2015. THE MARKET COST/REVENUE ANALYSIS COST OF HEALTH FINANCING There are many sources of funding for the health sector. They include * Funding by the Government of Ghana through budget allocation to the health sector * Internally Generated Funds Funds from the growth in the National Health Insurance Scheme * Health Funds * Financial Credits * MDA funds Funding by the Government of Ghana While the total allocation to health, in nominal terms, increased by 33. 4% from 2007 to 2008, the proportional Medium Term Expenditure Framework (MTEF) allocation increased only slightly by 2. 1% in the same period which results in a neutral outcome of this indicator. Based on the Budget statement of 2009, the allocation to the health sector as a percentage of the total fiscal space for 2009 was 14. %. In 2010 the allocation to the health sector was †¦Ã¢â‚¬ ¦.. The computation of the budgetary allocation to the health sector as a percentage of the national budget is made difficult by the fragmentation of budgets at both national and sector level. . It is further hampered by the significant level of off-budget funding in the health sector. With that said, allocation to the health sector as a percentage of the national budget from 2006 to 2009 is as follows MTEF ALLOCATION| 2006| 2007| 2008| 2009| MTEF ALLOCATION| 16. 2%| 14. 6%| 14. 9%| 14. 6| The GOG provides free public health services for immunization and certain communicable diseases. It also provides free health services for certain vulnerable groups such as children under 5, people over 70, and pregnant women. Internally Generated Funds The IGF are the fees collected from the patients who use the services and buy drugs provided by the health facilities. Health Funds Donors-pooled Health Funds are one of the many health funds the finance government projects. In addition, donor earmarked funds and donor-managed funds (projects) also contribute to total health expenditures Funds from Health Insurance Scheme The health insurance scheme now entered its 8th year of operation. Though there are challenges it has generally been a successful project. It seems to be serving its purpose both to the government and the citizenry as well. The wider the scope of the scheme more revenue is generated REVENUE By contrast, real health revenues (after adjusting for inflation) increased as reflected off the Financial Statements of health service organisations leveled off in 2006 and 2007 while falling in 2008. There has always been a tradeoff between quality health care and revenue generation especially in the public health sector. The public health sector has many challenges in delivering quality health care. The equipment and infrastructure available cannot support the demand for health care. The utilization of funds from the health insurance scheme in financing the health service sector has not been able to keep up with the increasing demand. Most of the substantial revenue generated from the health sector comes from the private sector where patients can access quality health. Presently the profit levels are very small. However there is potential for growth. Some challenges faced by the health sector are outlined below Challenges * Some health centre’s lack the necessary tools and devices especially for their clinical engineering unit and other vital service units * Non-computerized systems resulting in slow pace of work and health delivery. The recent computerization of most parts of the service industry has not really caught up with the health industry. * Inadequate residential facilities for health staff in certain regions. Inadequate ambulances for effective health service delivery * General lack of standby generators. The management of Millennium Development Account is doing their best to curb the challenge in this area by providing generators to hospitals to improve health service delivery. * Refusal by health professional to accept postings to certain places (e. g. the north) * Ghana’s brain drain of doctors and nurses is substantial a nd does seriously affect the capacity of the country to improve its human resource base in the health sector. Cost of Health Care Private health care is relatively more expensive since the cost of adequate medical equipments and highly trained and dedicated professional staff for delivering quality health care comes at a cost. The challenge in the private health sector is to seek to improve on operational efficiency or minimize operational cost to keep on doing business at an affordable rate. However people have become more health cautious in recent times. The health culture in Ghana is changing very fast. Ghana is by far becoming a middle income country with many of its citizenry having more disposable income. This situation has led to the demand for better health care; and consumers are looking at private health care. Cost of public health care has been fairly affordable with the help of the National Health Insurance Scheme since 2003. However the assistance offered by the insurance scheme is limited to basic health needs. Health care services outside the basic health care bracket are still a subject of concern in the public health area. Players in the public health care sector must however improve on their quality of service by motivating public health workers through the setting up of reward systems and consistent review of salary levels to meet the demand of changing times. INVESTMENT INCENTIVES GUARANTESS Ghana is a safe investment destination. Guarantees against expropriation of private investments under law are buttressed by the Ghanaian Constitution. Some investments guarantees are detailed below 1. Free transferability of capital, profit and dividends. 2. There are import duty exemptions on imported machinery for the health industry. 3. Capital allowances are granted to persons who own depreciable assets and use these assets in the production of income. Depreciable assets are grouped in Classes and the applicable capital allowance rates implemented. E. g. Computers and Data Handling Equipment have a rate of 40% 4. It has been argued that the development of information and communication technology (ICT) provides leapfrogging opportunities for developing countries. Ghana has not been left out in this revolution. According to the Data Development Group of the World Bank, ICT infrastructure in Ghana is progressing better than other low-income countries and above the 1. % average for Sub-Saharan Africa. ICT infrastructure is also very favourable although there is room for improvement. The  Kofi Annan ICT Centre of Excellence, a joint Ghana/India project has been commissioned with a responsibility to produce the human resource capacity needed for the emerging ICT industry in Ghana and the sub-region. The  Multi-Media Centre is also to serve as an incubator where new private companies in the industry can be nurtured and relocated to the Technology Parks Business Centre, which is to be set up at Free Zone enclave at Tema. These notwithstanding, various investments in ICT infrastructure by existing Internet Service Providers and telecommunication companies are helping to improve communication service delivery in the country. Others too are launching systems that aim at enhancing the provision of high-speed access to the internet and multimedia capabilities. Recently, the Government signed an agreement with Microsoft Corporation under which the largest ICT Company in the world would provide resources to improve ICT education in Ghana. Vodafone Ghana recently launched the fastest internet cafe in Africa with over 40 megabytes per second. The Vodafone internet cafe and retail store, with its WiFi area can seat up to 100 customers in air conditioned comfort plus the outdoor seating area. Top of the line graphic card and multimedia kits are also installed for those that love online gaming. The new Vodafone Internet Cafes Retail stores are located in Cantonments, Accra North, Accra Central, Accra Mall, Tema, Kumasi, Koforidua, Ho, Tamale and Takoradi . The effect of all these has been the modest growth in ICT activities in Ghana. A host of foreign companies has been attracted to Ghana. Some of these are Affiliated Computer Services, Data Management International Inc. , Rising Data Solutions, Global Response, Busy Internet, AQ Solutions and Supra Telecom. Indications are that a lot more are in the pipeline. GHANA’S COMPETITIVE ADVANTAGE * Availability of Skilled Professionals Doctors, nurses, lab technicians and other workers are highly skilled professionals with many years of experience who are very good at their job. There are policies that govern the work of health professional to ensure that the life a patients are safe guarded against in experienced new junior doctors in special service areas. Improved Academic and training Institutions The University of Ghana Medical School, The Kwame Nkrumah University of Science and Technology, The Korle-Bu Teaching Hospital and The Komfo Anokye Teaching Hospitals are well known institutions that are noted for churning out quality doctors, lab technicians and other health professionals. There are many nursing training institutions the supply the health sector with quality nurses and paramedics * Peace and Stability in Ghana Ghana has a very stable political climate. * Developed Legal and Regulatory Environment Ghana has a relatively developed legal and regulatory environment compared with neighboring countries. * Macro Economic Policies The macroeconomic policies of the government are designed to accelerate the progress of growth and transformation of the economy under competitive conditions * Excellent Work Force As previously said, the work force includes highly skilled and experienced professionals who are very good at what they do. There are also systems that help to improve the efficiency of this work force * Availability of fund sources There are many sources of funding in the health sector as stated above. They incude health funds, funds from government budgetary allocation, internally generated funds, MDA funds, financial credits and funds from the national health insurance scheme. * Availability of land There is adequate land availability to put up more health service facilities and centers. * Foreign Ownership Foreigners are allowed to own substantive equity share s in hospitals and clinics countrywide. * High Safety Standards Investing in Ghana is very safe due to the highly stable political environment for nearly 30 years. INVESTMENT OPPORTUNITIES ICT infrastructure and Computerization in the health sector The recent ICT integration in most service sector industries is yet to take a full swing in the health sector. Investment opportunities are there for investors who want to supply health centers with software and hardware needs that will speed up work and improve the quality of delivery. As stated earlier, such investors will benefit from tax incentives and investment guarantees the government has provided. The initial capital for a comprehensive ICT enablement of private hospital project ranges from GH? 10,000. 00 to GH? 40,000. 0 depending on the scale of work and the equipments, resources and materials used (computers and other network gear, level of technical knowhow of IT contractors and other environmental factors such as computer literacy level of hospital staff among others). Establishment of Competitive Private Hospitals Clinics The work load on the government hospital units are too much for public health service wo rkers. Investors with adequate capital can invest in private hospital ventures that are well managed and work at achieving high operational efficiency while incurring low operational cost. The capital requirement for an ideal ultra modern hospital or clinic will range from US$8 million to US$15 million depending on such factors as size of clinic/hospital, diversity of delivery services, number of equipments to be stocked etc. With adequate corporate finance advise investors can obtain returns in adequate amounts and with these cash flows occurring within adequate time frames whiles minimizing risk of the whole investment to acceptable levels. Establishment of Specialized Clinics Recently, acupressure and acupuncture clinics are taking a significant stage in health care delivery. They offer curative and palliative treatment to their target groups who are mainly the aged in society and the affluent. The Spa service companies are also there for people who can afford a little luxury. There are a few of such spa services companies already in the system. They are making significant profit (e. g. Allure Ghana Spa Services). The Capital requirements for such projects are very varied depending on the scale/size or the project. It ranges between US$10,000. 00 to US$20,000. 00 for a typical start up. With a thorough situational analysis and business plan, investors can invest in such ventures and make significant gains Importation of Pharmaceutical Drugs Though the health insurance covers the purchase of some drugs, the pharmaceutical industry makes billions every year selling drugs that are not covered by the NHIS. Building Of Nursing Training Centers Private nursing training schools are also very good investment areas. More than ever before there is an increase in the shortage of nurses across the world, and this trend is expected to even become worse. Ghana needs more nurses for her health services. Every country needs nurses. Almost every country is scrambling to find and keep them. The International Council of Nurses notes a shortage that spans the world. As of 2009, U. S. medical facilities were in need of an additional 100,000 nurses. By 2012, there could be up to 1. 1 million unfilled nursing positions in the United States. Australia, the UK, and the US receive the largest number of migrant nurses to fill the employment gap in the health sector. Australia received 11,757 nurses from other countries between 1995 and 2000. The U. S. Immigration and Naturalization Service (INS) records show that more than 10,000 foreign nurses were given H-1A visas to enter the United States within the same time frame. Saudi Arabia also depends on the international nurse supply with 40 nations represented in its nurse workforce. In only four years, the U. K. admitted 26,286 foreign nurses from 1998 to 2002. Netherlands needed to fill 7,000 nursing positions in the year 2002, England needed to fill 22,000 positions in the year 2000, and Canada will needed about 10,000 nursing graduates at the beginning of this year 2011. Meanwhile tens of thousands of Ghanaians especially the youth seek non existing employment opportunities as many students application for admissions are turn down year after year by nursing training institutions. Ghana stands to gain tremendously if stake holders in education, health, Employment and Social welfare and society can deploy a program to train more nurses for the countrys healthcare facilities and for export to other countries where there are increasing shortages of nurses such as UK, Austria, Norway, Japan, Australia, Netherlands, and Saudi Arabia. A nurse in Ghana earns between $3,600 and $4,800 annually after tax but with rising transport and food costs, many are forced to take on a second job in private health and then to work back-to-back shifts working between 15 and 18 hours a day. As of 2002, salaries for registered nurses in the United States were around $48,090, with the top 10% earning more than $69,670. Salaries for Licensed Vocational Nurses (LVNs) were around $31,440 with the top 10% earning more than $44,040. The working period for both RN and LVN is 6 hours and a nurse who works at two jobs earns a double of these salaries. International recruitment and nurse migration are increasingly being seen as solutions to nursing shortages. Historically, nurse migration has been mostly opportunistic or based on individual motivation and contacts. During the past decade, however, active large scale planned international recruitment has occurred with developed countries recruiting nurses from both other developed countries and developing countries. In addition, developing countries are recruiting from each other, even within the same geographic region according to the International Council of Nurses. Currently there are 10 public nursing training colleges accredited by the National Accreditation Board in Ghana. These are Government sponsored institutions and trained nurses from these institutions would be required to serve the country for 5 years before they can have the release of certificate for them to work abroad. This is because in theory a nurse wishing to work abroad would have to produce a certificate as proof of qualification and so until any fine has been paid, the Health Ministry can withhold the certificate. There are good business prospects for Private Nursing Training Outfits that can develop recruitment programs for their trained nurses to work abroad while such nurses pay a percentage of their earning to the institutions once they are gainfully employed outside. Foreign or local investors with huge capital who are ready for long term investments can look into Private Nursing Training Projects. Importation of Hospital machinery The import duty exempt and the high demand for hospital machinery make investments in such ventures very lucrative and profitable. Government Partners to improve quality of service in the public sector The sources of funding to the public sector is in adequate to support the needed pace of growth. Investors with substantial capital can partner with government to undertake developmental projects in the public health sector that aims at improving the quality of service. CONCLUSION The health sector is a vital part of a nation’s development. Adequate and feasible policies which will help improve the sector attract investor interest and eventually ensure a steady and significant development of the sector.