Category Archives: Social Studies

The Impact of Economic Globalization on International Trade Trends in Developing Countries at the Beginning of Third Decade

 Said Mohammad Karim

  • Introduction

Currently, the world is experiencing a new scientific revolution in information, communication, transportation and technological knowledge-intensive. This revolution has deepened the globalization of all aspects of economic life of the movement of goods, capital, services and skilled labor. It became the technological revolution and in particular its part informational pivotal role. With The emergence of the phenomenon of globalization, which is the current stage of development of international economic relations, properties, and not put forward a new theory or a new perspective to understand the mechanisms of this development, and is a composite concept basically means examining the nature of the developments that have taken place for the international relations of economic, social, cultural and political dimensions, which makes impact on the trends of this development in the future.In other words, this might consider to be characteristics of the modern capitalist system.This is taking shape at the beginning of the Nineteenth and Twentieth centuries, which prompted researchers to give up the use of the concept of system, which necessarily involves the mechanisms and rules are clear and specific. Interested in studying changes in the relations between the inside limbs, in favor of the concept of globalization, which seems more neutral in the phenomenon of the more obscure and at the same time. However, this neutrality does not hide faith dimension inherent in it and which threatens the countries that rejected extinction and extinction, especially developing countries .premise from which this search extent to which developing countries of economic globalization and trade liberalization and the acceleration of goods and services flows, are developing their current state countries can to engage in the international economic system.

  • Concept of Economic Globalization

The current stage known a group of radical changes in the global economic system, predicted for the beginning of a new economic system characterized by milestones and trends are different from those prevailing before. Hence, the world is controlled by two trends which are linked and that they were separate, namely, globalization and economic liberalization.These two trends already taken place in switching conditions, the formation of economic behavior, and become more attached to influential tracks international national economy, and so became a success and progress to the strength of nations and blocs measured, this is even linked to the extent of participation or involvement paths of these two directions towards globalization, which has become prevalent even more dominant force in the world today, it was not coincidence. The return of the dream that accompanied the individuals since ancient times, to expand the range, mobility and investment, transfer of wealth and profit open broader horizons, as a result is made possible of the change in the international system, and the decline in the concept of a centralized economy or router to be replaced by the concept of a market economy, and its adoption as a tool essential for development. This concept, which stretch in all directions, is seen to the world as a single market, and thus is represents and embodies a vision based for a large segment of the countries that were leading and defending the principles of a free economy, giving the private sector a leading role. This means the predominance of the ideology of the free economy, triumph of the market economy, market mechanisms, and political liberalism. Consequently, globalization of the economy and on the scope of each of the international economy began to spread to all levels of production, financing, technological, marketing and administrative (Kella, 2011).

By taking a comprehensive look at the global situation, it can be said that the world has become more essential than ever before, and that the economical differences have become more acute and severe than they used to be and that the global distribution of income has become less balanced and less fair, though there is a large gap dominant to the world, it is likely to represent a serious threat to the growth achieved and the continuous development in the future.

The advanced industrial countries, which have committed themselves to the principles of free economy and previously defended him and worked on the publication, these countries are driving the global developments and designed a way that suits them.Because at this stage they have methods and the elements, it has a vested interest and potential of circulation, published and approved by the largest possible number of countries. These countries have prepared themselves in advance, who beneficiaries and are supported by an engine with motive to activate economic their income and activate its institutions list by exploiting existing possibilities and opportunities in the world.

However, developing countries that suffer from significant transitional structural and social problems, in most of these countries are still grappling with and affected by the global developments accelerating. All of these forces and trends formed with each other at the current stage the process of transition of the new global economic system. Which must be closer to the analysis of its components as well as determine the characteristics and features to identify the transformations and challenges and issues that began determined in the field of international trade, monetary system, manufacturing transport technology, preservation of the environment and other (Avhild, 2007). At this stage no wonder to show several terms reflect the features of the current stage, and even the future experienced by the transition process towards the establishment of a new global economic system, such as the term globalization or constellation or inclusiveness.

  • Technological Revolution and the New International Division of Work

The troubles of the existence of the technological revolution and information with the increasing freedom of movement of goods international capital may help clearly on the interrelationship and overlap between the parts of the world and confirm the global markets.Drop the barrier of distances between countries, and create a new type of international division of labor, which is the process whereby industrial productivity between more than one country so that the distribution of the components of any final product manufacture in more than one place. Thus it is no longer the main support of strength, as the economic capability is natural resources,  which it has become the main foundation in that to own advantage or competitiveness in the international arena, and which revolve around the cost and price and productivity and quality and is what the depth of the trend towards interdependence.

The emergence of new patterns of division of labor were not known, where the traditional image of the international division of labor is to allocate some of the country’s raw materials and mining and food commodity and specialty other countries in industrial products, and the assumption was that the country is developing a comparative advantage in the first type, while developed countries have a comparative advantage in industrial goods (Diab, 2010).

This division is no longer in line with reality, and the issue here is not just a shift in the comparative advantages of industrial goods to some developing countries, but what caused the technological revolution of the availability of new possibilities for specialization. This is due to the multiplicity of types of single products, for instance there is no one type of cars or radios or television or computer, but rather there are multiple types of needs and what type them in terms of production conditions may be different from what the other needs. Hence the division of labor between the different countries in the same products appears, and it has become fashionable, but mostly for a large number of consumer durables and machinery and equipment, that the same item appears in the list of exports and imports for the same country, this is known as the division of labor within a single industry.It has become fashionable to parcel one product among a number of the country’s production so that specializes every country in part or more, and this is known as the division of labor within a single product intra – firm.This kind has become of specialization of the most important aspects of the division of labor between the industrialized country and with each other, as well as in increasing cases between industrialized and developing the country.

Thus the decisions of production and investment become taken in accordance with considerations of economic rationalization in relation to cost and earning, even there has become an opportunity for many developing countries to penetrate the global market in a lot of products.Where new styles allow international division of labor to those countries gain competitive advantages in a wide circle of goods, and perhaps the experience of the Asian tigers in Southeast Asia, is the best example to that. The revolution in production was the occupation of knowledge of information relative importance of the first in the production process. Moreover, it is reflected in the emergence of new patterns of international division of labor, where the back of the division of labor within a single product intra – firm so that the distribution of the production of the various parts of a single item on the different countries of the world well be appear according to considerations of economic efficiency (Murray, 2013).

The new world economic system, which began to show its characteristics and features as well as is determined with the beginning of the nineties is still in the process of composition and formation conditions and compared to previous arrangements. It is noted that it uses new tools and methods to maximize the goals and objectives in line with the evolutionary stage – the stage of globalization – which reached and global changes that have taken place, and the new mechanisms that have arisen.Therefore, the dynamic characteristic of the new global economic system make sure day after day, as evidenced by the prospects for changing the balance of the existing economic powers on the basis of the future It is evidenced by the presence of more than one order of what will be the new world economic order in the atheist century the third millennium, some suggesting unipolar shape, some raised pyramidal shape, and othersuggesting parallel blocks shape.

  • Changes in the International Trading System at the End of Twentieth Century

The most important characteristic of a shift in the international trading system towards commercial freedom system after 1994 and the beginning of 1995 along with the establishment of the World Trade Organization – has included not only the liberalization of trade in industrial goods, but also included agricultural goods and other industrial goods such as textiles and clothing. This is in addition to the trade in services which is considered a turning point in international economic relations, and the liberalization of trade applied to services the principle of gradual liberalization and includes trade services, banking, insurance, capital market, transport of land maritime and air, contracting, tourism, telecommunications, and services such as professional technical consultancy and professional services offices. This encourages the phenomenon of labor migration or function instead of the labor force migration. In addition to the liberalization of services, it has included a shift in the international trading system, liberation organization, protection of literary, artistic property industrial, as well as liberalization of investment laws having impact on international trade restrictions.

The transformation of the internal orientation of any development strategy of import substitution to production for export is a result of the new trends of globalization and the great opportunities offered by the global market.This shift comes in particularly large number of developing countries. As a result, because the country has managed to developing high growth rates are achieved by the country has pursued a strategy of export-oriented development based on the exploitation of the potential of the global market to the greatest extent possible.

East Asia countries proved with a growing number of developing country success towards this direction. The international market can accommodate both availability which has the will to penetrate and it is important to complete the elements of export-oriented strategy, which works to promote the expansion of exports of products which features produced or can be produced present or future at relatively low cost compared to the rest of the other countries (Windsor, 2009). The export economy is a traditional long-term development process, is to put the pillars of transformation to be able to bring about changes restructuring in the economy, and that lead to the creation of diverse activities and sectors production structure uses the best technological methods, and earn exported products generally the ability to invade the world market. The strength become highly competitive, including corrects the position of developing countries in the patterns of specialization, and the international division of labor.

The profits from trade liberalization are not distributed evenly on the winners, both in industrialized nations or the developing countries. Hence, a according to the highest estimates is expected to be out collectively by more than 17 percent of the estimated increase in global income developing countries.The industrialized countries will get $ 100 million of the total expected in the world’s income as a result of partial liberalization of trade and of $ 119 billion which increases the share of the industrialized nations of the expected increase of up to 84 percent, and get developing countries to 10.3 percent. Despite those results, the importers of foodstuffs will be one of the most affected by trade liberalization, since the liberalization of trade in agricultural products, especially rice and oil, grain and wheat and uninstall support them by industrialized nations resulting in a rise in prices. On the other hand, it can be said that the distribution of gains attributable to developed countries obsessed by the global triad: the United States, Japan, and the European Union (Salih, 2006).

  • Nature of International Trade and Situation of Developing Countries at the Beginning of the Third Decade

Exchanges between developed and developing countries still in a large part subject to the international division of labor that prevailed after World War II. Accordingly, take it in the form of raw materials in exchange for industrial goods. Raw materials and for historical reasons  is an important part of the trade as well as developed countries providing the bulk of the trade of industrial goods in the world of the total exports of these countries towards the outside while the developing countries do not believe only a small percentage of the trade of raw materials in the world although it is part of the largest oil exports.Despite the fact that developing countries are the main source of raw but there are no raw materials in the industrialized countries and also exchange industrialized countries among them an initial goods. And some of these raw materials needed by countries of the South, and in general, a quarter of the value of exports of industrial countries to developing countries is equivalent to the value of all exports in the form of raw materials coming from these countries to the industrialized nations.International trade rolling is now a market of industrial goods. It can be conclude from this that the developed countries dominate the exports of all industrial goods and an important part of the raw materials we will review the exports of some of these products. However, this growth achieves significant differences between the various developing regions in addition to the contraction of world production growth.There are other factors behind the chill international trade such as the events that took place in the Middle East region, the changes in Eastern Europe, and declining terms of trade for developing countries rates (Salih, 2006).

On the other hand, the nineties identify the fast growth rate of international trade, and this is due in part to the rapid spread and flourishing trade in components of high-tech electronic goods. In spite of ongoing international trade, it grows faster than the speed of growth of total production. This is due mainly to the poor economic performance of developed countries. As regardless of an increase in global production, the rate of growth in developed countries has fallen as a result of the slowdown in production, which represents more than two-thirds of world production, and this is because of multiple factors, including the increase of public debt in most industrialized countries. Secondly, the growing pressure on European currencies as a result of deflationary monetary policies and their impact on exchange rates and interest rates. Finally, imbalances in the budgets of industrialized countries and that happened from the possibility of using fiscal policy as a catalyst for growth.

The beginning of the third decade has decrease in global production and international trade has reached lower global production rate levels since the eighties of the twentieth century, perhaps these reductions offered by global production and international trade through during this period returned mainly to the effects of the events of September 11, 2001, in the United States and that has touched most sectors in all regions with the exception of some Asian countries.

International trade continues to be a main driver behind the growth of the international economy, international trade and the growth rate is still in twice the growth rate of world output. The larger developing economies like China and India have seen continuous growth export activities. There are quite a number of developing countries made profits from the significant improvement in the terms of trade over the past few years, and due in large incision to the incident recovery in oil prices and some other commodity. On the other hand there are a number of oil-importing countries and exporting agricultural crops have been damaged from the terms of trade prevailing and suffered a loss, and in the light of high oil prices exceeded the proportion of the rise in prices exports of those countries as a result of the deterioration of commodity exports to those countries or for the two reasons together. Generally, the price of primary commodities has reached the top level and it is expected that many non-oil commodity prices are falling from the (United Nations report, 2005).

There is no doubt that the global economic changes that have evolved in the new world economic order will affect the developing countries, and that the global trinity economic and what raised from new issues in all areas reflect a new strategy aimed at pre-emptying the strategies most development self-reliant, such as those pursued by Japan and which star by the emergence of economic power to defy the developed countries such as Europe and America. This new strategy of developing countries pays adoptive development in the context of dependency of developed countries based on trade and foreign direct investment. That is why the developing countries adapt to what results this new trading system of the new patterns of international division of labor and toward greater economic interdependence.

 On the other hand, the investment and new issues on social paragraphs as measures of operating procedures, child labor … etc., are likely to act as an obstacle to humanitarian restructuring process. Under the trade agreement on the protection of intellectual property rights system is protecting the rights of the franchise strict and very accurate. Which may generate technological monopolies impede the transfer of technology on a global scale and that this will slow down the resettlement of industries operations. Moreover, the expectation of trade sanctions against countries that disturb the standards of work and child labor will give a significant adverse consequences for the transformation of the economies of low-wage and access to comparative advantages in the global market, and thus the new rules in the game of international trade and investment are likely to affect the recycling comparative advantage through cross-national companies and foreign direct investment process.

It is clear from all of the above, that the developing countries stand at a crossroads, choices are limited, either rejection. Therefore, isolation from the most important part and the most capable of the countries of the world, any part of the product of the progress of scientific and technological development, acceptance and as a result adapt to the international economic system that believes countries of the South that is uneven and unfair. For both options have to pay the price and the cost of each will be incurred (Zakey, 2000).

There are many who are interested in development affairs in the countries of the South incite rejection and call for an alternative think it is more useful to developing countries and their peoples, and is to increase the level of coordination and cooperation between these countries and clustering, if possible, to cope with the new realities in the global economy in order to modify or influence at least for the benefit of the South, and in spite of the theory of gravity for this option. However, the potential application of the facts to face many difficulties and obstacles, including economic limited capacity of the countries of the South in their current state, although it is under the South title meant a large group of countries a population of over 80% of the world’s population but they do not contribute to global income by more than about 20% and more than one billion people live below the poverty line as their share in making scientific development and technological progress modest negligible on a global level.

In addition to the low level of the will of the decision-making circles in these countries to develop the level of cooperation and coordination among them, in one hand to cope with the global economic system, on the other hand to cope with the global economic system. For developing countries to deal more rational and more open to the new economic variables, and working on extensive and comprehensive review of the development of its policies in preparation for the re-formulated in line and the new changes, and the development of economic mechanisms, including work contributes to better exploit the potential available and possible resources (Amin, 1997).

To conclude based from the above point, the new world economic order still needs to be repaired in its mechanisms and the functioning of its institutions, and reconsider the rules, whether in the field of trade, investment or other even it has the consent of the countries and the peoples of the developing world and the developed alike. It also notes that the new global trading system caused a sensation about his future, especially after widespread protest movements against globalization and its mechanisms.

  • Conclusions


  1. Developing countries in general face significant challenges may direct to gains, since if overcome, and could direct to losses if these countries unable to cope the changes.
  2. Reduce significantly the level of protection for the agricultural sector over the next few years, as it is also a most important sector in the economies of most developing countries that have a negative impact and unexpected results.
  3. These countries can draw its policy improvement and the development of their economies, especially with regard to the national production, which it is devoid of protection or low level of protection. There is no valid one answer for each of developing countries, and dealing with the issue of this importance vary from state to state depending on their circumstances and their potential.
  4. The abolition or reduction of subsidies for some products well weakens the competitiveness of developing countries in global markets.
  5. Progressive liberalization of services trade will lead to heightened competition in the global services market, and because of the weakness and fragility of the services sector in developing countries, especially the financial services activity of banks, insurance companies, Projections indicate that this sector may be affected negatively as a result of editing.
  6. The unit controls the commercial multi-density expansion parties and restricted the use of some selective economic policy that had a role in the success of the exports of developing countries tools, is no longer possible in light of the increasing liberalization in the international capital markets.The globalization of production of transnational corporations imposes legislation and laws on companies in relation to the objectives of the industrial policy of the host country. here it is emerge a conflict with the important role that practiced by governments in most developing countries, and especially industrial policies to accelerate structural transformation and strategic in the economy by supporting certain sectors identified as strategic to own comparative advantage kinetic potential task and receive so government support.


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The Role of Private Wing set up in Public Hospitals in Reducing Medical Professionals’ Turnover


Belayneh Bogale zewdie 


The objective of this article is to assess the role of private wings in public hospitals to tackle medical professionals’ turnover in selected public hospitals. Retention of qualified health staff has become a major problem in Ethiopia. Medical professionals left the public sector mainly due to attractive remuneration elsewhere. To solve this problem the Ethiopian government launched private wings within public hospitals in 2008. In this study a descriptive design with mixed approach was applied. Data was collected through questionnaire, key informant interviews, and document review. Purposive sampling was also utilized to target respondents. Data was collected from 5 hospitals and 192 health professionals. The finding revealed that Medical professionals’ level of awareness on different aspects of private wing was not satisfactory; however most of them became happy to know about the chances of earning extra income at home. On average, 50% of the doctors’ and 40% of other health professionals’ total monthly income were earned from private wings. Accordingly, professionals expressed their intention to continue working in their facilities at least for the next 3 years. Hospitals’ human resource documents also reveal a slight but a steady decline in turnover. The study found out that the initiation of private wings in public hospitals contributed to motivation and retention of health professionals. Major benefits to private wing staff include rise in sense of hospitals ownership, skill use and better income.


Key Words: Private Wing set up, Turnover, Medical Professional, Health care reform and Public hospitals


The African continent is facing a health crisis occasioned by very low funding of health services and deterioration of health service infrastructure (Dovlo, 2003). The loss of health workers has significant economic as well as replacement consequences which include high cost and time taken to recruit, select and train new staff. Ethiopia is among many other countries that have been affected by a turnover and brain drain of health workers. Many studies show that the shortage of health workers in Ethiopia has been at a crisis point. According to FMoH (2008), health professionals migrate either from rural to urban areas, from government to private institutions, or to foreign countries in a very alarming rate for various reasons.


After 1991 the Ethiopian government undertook a robust reform in deferent sectors. One of the reforms was health sector reform. After thorough study and assessment of the health situation, the FMoH of Ethiopia developed a health care financing strategy in 1998 that was endorsed by the Council of Ministers and became a very important policy document for introduction of health financing reforms. The government recognized that health cannot be financed only by government and underscored the importance of promoting cost sharing in provision of health services (FMoH, 1998).

In line with the health care financing strategy and based on the approved legal frameworks, a wide range of health care financing reforms have been implemented since 2006.
The initial phase of the implementation was very narrow in few selected regions and health institutions. However, later the health care financing reforms have been expanded to nearly all parts of the country. The reform consists of eight components; revising user fees charged at government health facilities, retaining the collected fees at the facility and using that revenue to improve quality, rationalizing and systematizing rules for fee waivers, increasing hospital managerial autonomy, opening private wings in public hospitals, and outsourcing nonclinical health services. These reforms are being implemented in all regions of Ethiopia (USAID, 2012:3).

Establishment of private wings in public hospitals is one aspect of the Ethiopian government’s health sector financial reform program which was launched in 2008. In the last four years or so, certain Ethiopian public hospitals have created private wards that function within their physical and organizational boundaries. According to FMoH (2010) the establishment of public hospital private wings has the potential to generate additional income and can increase the ownership of the hospital services by health professionals. The establishments provide services to those who can afford to pay more for those services. The set up is meant to improve the quality and timeliness of services. It also helps reduce the turnover of skilled manpower through additional compensation, and to motivate staff members to provide more and better service.

Hence the article will focus on the assessment and analysis of the role of private wings in reducing medical professionals’ turnover with particular reference to government owned hospitals under Addis Ababa Regional Health Bureau.


Although Ethiopia has one of the highest numbers of health workers in sub-Saharan Africa, its large population leaves it with a very low health worker to population ratio. The Ministry of Health reported a total of 66,314 health workers are in service, including 30,950 health extension workers. The national health worker ratio per 1000 population is 0.84. This result is far less than the standard set by the World Health Organization of 2.3 per 1000 population (FMoH, 2010 cited in AHWO, 2010). Even out of the total health work force (in terms of skill mix), Doctors and Midwives form a significantly smaller share. Despite the government’s effort to tackle this problem, the shortage and high turnover of health workers has become a severe setback. The county is one of 57 countries considered to have a health workforce crisis (UNDP, 2010).

Retention of highly qualified health staff has become a major problem in Ethiopia. Between 1987 and 2006, 73.2% of Ethiopian medical doctors left the public sector mainly due to attractive remuneration in overseas countries, local NGO’s and private sectors. Unless the proper remedial measure is taken, the problem will even get worse in the coming years (Birhan, 2008). The 2005 bulletin of the WHO reports that there are more Ethiopia doctors working outside Ethiopia than in the country itself.

In developing countries where medical professionals’ turnover is rampant different intervention mechanisms to tackle the problem are emerging. Similarly, the Ethiopian government introduced Health Care Finance Reform including private wing establishment in public hospitals as one component. Setting up of private wings in government health institutions where the professionals could work at during their leisure time and earn additional income is mainly aimed at cutting back turnover due to low payments.

Despite all its benefits, prior researches and international experience suggests that this type of ward has much potential for promoting inequity within hospitals. The three key problems are the failure to generate sufficient revenue to sustain hospital-wide quality improvements, the likelihood of resource allocations within the hospital becoming biased towards the private wards and failure to meet their predetermined objective of reducing turnover (Birn et al., 2000; Suwandono et. al, 2001).

In Ethiopia as these private wing establishments were created and started delivering services, it became clear that not much was being done to evaluate them and to understand their governance arrangements and the impact on medical professional’s turnover. Even the limited available data is not rich enough to provide reliable information on the issue.  Therefore, whether public hospitals has gained benefit of retaining medical professionals as a result of setting up private wings and the role the establishments practically play is a critical knowledge gap that needs to be addressed. Thus, this study therefore sought to investigate the role of private wings in public hospitals in reducing medical professionals’ turnover.


The overall objective of this study is to assess and scrutinize the role played by private wings in public hospitals to tackle the problem of medical professionals’ turnover in five selected public hospitals in Addis Ababa. More specifically:


  • To assess the extent of private wings’ contribution to motivate medical staff, and to improve their income;
  • To describe the contribution and achievements of the private wings in retaining medical professionals;
  • To find out the attitude and awareness of medical professionals on private wings;
  • To describe the challenges/constraints of private wings in reducing medical professionals’ turnover.


Research Design

 It is generally accepted that the selection and application of a research design is dictated by the problem at hand. Accordingly, to carry out this research and achieve the objectives, a mixed research approach (both qualitative and quantitative) is used. The mixed research approach is very efficient in answering research questions compared to the quantitative and qualitative approach when used in isolation (Creswell, 2003). Therefore, by using a mixed approach it is able to capitalize the strength of quantitative and qualitative approach and remove any biases that exist in any single research approach.

Besides, the research applied descriptive type of research design using the survey method. Descriptive research includes surveys and fact-finding enquiries of different kinds. The major purpose of descriptive research is description of the state of affairs as it exists at present (Creswell, 2003). Since little is known and researched about the roles and contributions of private wings in medical professionals’ turnover, the researcher has no control or effect on the variables of the study. The study was rather intended only to describe the roles and contributions of the wards.

Data Sources and Instruments

In this study, both primary and secondary data sources were utilized to address the research objectives. The techniques used to elicit primary data were questioners, key informant in-depth interviews and review of organizational documents. The design of the questionnaire and interview questions was guided by the objectives of the study and the literature research. The secondary data was more or less collected from published documents, books, and journal articles. Other magazines, internet sources including access to electronic scientific articles such as Google’s scholar search facilities, as well as hard copies or reports and other studies were also utilized in the process of data gathering.

Sampling and Sampling Procedures

The study was conducted on those government owned hospitals under Addis Ababa health bureau that have private wings. These hospitals are five in number namely Yekatit 12, Dagmawi Minilik, Gandhi Memorial, Ras Desta Damtew, and Zewuditu Memorial.

The population of this study was all health professionals in the five hospitals with diploma and above academic qualification in their field of work. According to AAHB (2014), there are 1,281 health professionals in the five hospitals that have diploma and above qualification. Since the study population of this study was homogeneous (all were government employed medical professionals) 15% (192) medical professionals were purposively selected as a sample to fill the questionnaires.

Proportional techniques of study subject allocation to the five hospitals were also applied. Accordingly, selection of intended study subjects from the five governmental hospitals under Addis Ababa health bureau was made using the following formula:

                                                 Where nx – sample size in x hospital

                                                             n – Estimated final sample size

                                                             Nx – Total number of medical professionals in x hospital

                                                             N – Total medical professionals in all hospitals

Table 1: Proportional sampling procedure of the study subjects

Hospitals No of medical Professionals Proportional allocation samples
Gandhi Memorial 207 32
Ras desta Damtew 177 27
Dagmawi Minilik 298 45
Yekatit 12 306 46
Zewditu 276 42
Total 1281 192

Source: calculated by the researcher based on the HR summary from the health bureau: 2014

The questionnaire was distributed to cover different categories of health professionals as it was given to doctors (all types), nurses and midwife, pharmacists, health officers, laboratory technologists, and radiologists. On the other hand key informant in-depth interview was also conducted with medical services directorate director of AAHB, hospital directors and personnel department heads of each hospitals.

 Method of Data Analysis

In this thesis both qualitative and quantitative data analysis techniques were employed. Data collected by using questionnaires was organized, coded and then analyzed. Specifically, simple statistical analysis like percentage, frequency, tabulation and graph were used in order to analyze the data easily. Microsoft excel was also applied for producing charts and to simplify the calculation. On the other hand, information gained through key informant interviews was described qualitatively.


Assessment on Motivation and Income Improvement

The data revealed that the establishment of private wings has contribution to motivate and improve the income of medical professionals; however there is still a considerable level of intent to quit among medical professionals. Close to 40 percent of the study participants showed their interest to continue working in their hospitals at list for the coming three years. This may justify the rise in commitment after the introduction of private wings. However there is still high intent to quit, close to 30 percent of the study subjects were actively searching for alternative jobs. Seeking better job oversea, narrow opportunity for further education, poor leadership and communication, poor pay and benefit, inadequate facility and supplies, and seeking better job in private sector and NGOs are reasons for the intent to quit.

The level of private wings’ contribution to make employees stay in the public sector was rated “to some extent” by most respondents. Besides, after the establishment of private wings medical professionals’ commitment and moral show some extent of improvement. The above statements infer that the extent of private wings contribution to make employees stay in the public sector is small and is not at the expected level. In addition regardless of the rise in income still considerable number of respondents claims no change in level of motivation and morale. Therefore, the hospitals must utilize non financial motivators at the same time so as to boost up the level of motivation and moral to the expected level.

Further, the study found that reliance on private wings as sustainable source of income has not yet deepened and professionals’ livelihood improvement after the introduction of the scheme is insignificant. Respondents expect little rise in income followed by those who expect no income rise from the future expansion and development of private wards. The level of livelihood improvement after the launching of private service was also rated insignificant/little; therefore it is difficult to say the establishment of private wings in public hospitals brought momentous improvement in the livelihood of health professionals.

Medical professionals are delighted with their chance of earning extra income from private wings. However, they criticize private wing set ups for not providing the entire necessary benefit package for the staff (see the table below).

Table 2: Level of medical professionals’ satisfaction with pay/benefits
















1 I am frustrated by the payment in the private wing      16










2 I feel satisfied with my chances for earning extra income     35









3 There are benefits we do not have which we should have    24






   24 (13.1%)  183


Source: Owen Survey: 2014

Note: (5) = strongly agree, (4) = agree, (3) = neutral, (2) =disagree, (1) =strongly disagree

 In this regard the survey result indicated on an average 50% of the medical doctors (all types) and 40% of other professionals’ total monthly income is earned from private wings. This is a good rise in monthly income due to the establishment and operation of private wings.

Nonetheless, the finding illustrates the existence of equity related complain in the distribution of private wings profit which may contribute to resignation of professionals who feel that they are not sharing equally. (See the graph below). Moreover, the study also found that private wings payment is not as lucrative as other part time option.

Enhancement in Retention and Reduction in Turnover

In the study the contributions and achievement of private wings in retaining medical professionals was also assessed. One third of the health professionals had quit offsite dual practice because of the part time job created in private wings. Therefore, the success of private wings in avoiding off site dual practice (some call it public private overlap) is considerable. In addition all most all respondents who are still engaged in offsite dual practice would give up given private services strengthened and sustained. This implies if properly managed and strengthened public hospital private wings have a potential of reducing unregulated and illegal dual practice.

With regard to medical professionals’ public-private hospitals preference, the result shows “some extent” of preferences of private hospitals over the public ones. However in comparison with prior research (Tigist, 2006) made in the same study area, medical professionals in the public sector had “great extent” of preference of the private sector over the public. Though other variables may contribute for the difference in the extent of preference (“great” and “some”), perhaps motivation resulted from private wings may also contribute which may in part be viewed as a success in this regard.

Moreover, despite the fact that the highest number of respondents (43%) responded that private wings did not significantly reduced turnover so far, decline in turnover after the initiation of private services was noted from the calculation of turnover rates over. Hospitals under the Addis Ababa Health Bureau experience a slow but steady decline in medical professionals’ turnover rate since the establishment of private wings in 2008. (See the graph below)

This decline in medical professionals’ turnover may also be due to other interior and exterior variables, but since private wings were lunched as intervention mechanism to reduce turnover its success in this regard is observable.

On the other hand, close to half of medical professionals who participated in this thesis were considering job oversea even after initiation of private services. Hence, the contribution of private wings to curb outmigration is very insignificant. A focus on monetary compensation as a tool to prevent medical professionals from migrating abroad would mean their total income would have to be raised impossibly high. Therefore, instead of considering private wings as sole instruments, some of the other push factors of outmigration may need to be focused on.

 Attitude and Awareness

With regard to the attitude and awareness of medical staff on different aspects of private wings, the general impression and experience of the medical professionals in private wings is rated positive/favorable and the time they spent in private wings is productive. The establishment of private

wings also created a chance to use maximum skill for medical professionals and sense of hospitals ownership also shows improvement.

The awareness survey reveals that most professionals (87 percent) are conscious of the objective of private wings, but the remaining 13 percent has little awareness of that. This shows some health workers are blindly involved in private service without clearly understanding the objectives. It also shows poor communication and awareness creation activates from the management side. Likewise, there is good level of awareness on the rights and responsibilities of medical professionals involved in private service and on types of services provided in private wards. However, the level of awareness regarding rights and responsibilities of patients and financial aspects (revenue and expenditure, and pricing policy of private wings) is limited. This ambiguity and knowledge gap on the rights and responsibilities of patients and financial aspects of the wards may create conflict and uncertainty which may generate intent to quit.

In the study, most health workers (more than 70 percent) are comfortable with the schedules of private wings (see the chart below). However, since all medical professionals (particularly nurses) are not involved in private wards at the same time, most of them feel underutilized and fail to get a permanent additional income.

 The study also reveals respondents are neither satisfied nor dissatisfied by their workload. Despite the fact that training or special orientation is critical before the implementation of a reform agenda, trainings or at least special orientation program designed particularly for private wing services are not given to the great majority of the professionals. Therefore, the hospitals should organize and provide special trainings for staff discharging private wing tasks.

  Constraints/Challenges of Private Wings in Reducing Turnover

The major constraints/challenges faced by private wings in an effort of reducing medical professionals’ turnover are as follows. First, the income tax issue has slowed down the success of the private wings. The incentive to provide services in the private wings is lessened since the staff member has to report the extra income and pay taxes. The tax issue needs to be resolved with the regional tax bureau, or there may need to be a national policy. A related issue rose by the study subject, particularly nurses, was the need for some system to reward staff based on performance and the equity on pay related complain. Secondly, little knowledge about the existence and operations of private wings among service seekers (patients) is another constraint. Medical service seekers low level of knowledge about private wings as alternative option may create a mismatch between service provider and clients. Thirdly, medical professionals also complain the irregularity of private wings pay due to poor management as a problem. Another constraint is related to the capacity of private wings which make the benefits neither consistent nor all inclusive. Fifthly and finally, hospital managers also expressed their fear of over stretching the already scarce resources in public hospitals due to the establishment of private wing. Therefore unless these problems are solved it may back slide the already attained promising achievements.

Overall, the establishment and operation of public hospital private wings has brought about considerable rise in motivation and in income of medical professionals. The scheme also improved the staffs’ sense of hospitals ownership; created chance of earning extra income, the actual turnover rate was also declined. Nonetheless, professionals’ level of awareness on some aspects of private wings is poor and various challenges/constraints are faced in the process of the wards operation.



On the basis of the findings and conclusions reached, the following recommendations are forwarded in order to improve the contribution of private wings in reducing health workers turnover.


  • The medical professionals who discharge private wing tasks should have at least basic awareness on different aspects of private wings before taking the responsibilities. To this end relevant and continuous awareness creation and informative seminars has paramount importance to minimize the information gap of staff in private wards. Moreover, there has to be a mechanism to check out whether the provided training has improved the trainees’ attitude and knowledge as well as their performance. Hence, the hospitals should organize and provide informative trainings and seminars as soon as possible.
  • The development of private wings in hospitals for health workers to earn additional income outside of regular hours may already be a step in the right direction. However, reliance on private wings and financial incentives as a sole motivator and retention mechanism is very erroneous. Therefore, hospital management bodies should create good working environment and encourage employees through the application of different incentive mechanisms both financially and non- financially with the support of the government and other stakeholders. Policies and interventions may also want to focus on nonmonetary compensation, which was found to affect health worker motivation worldwide. Policies that provide quality and needs-based compensation in the form of access to further training, career development opportunities, and professional guidance can help in motivating health workers to better perform and motivation.
  • The health bureau and hospitals under it should promote and advertize private wing set ups in public hospitals and provide information for service seekers. Moreover, service seekers should be aware of a broad mix services provided in private wards, the pricing policy and the benefit they enjoy relative to other private options.
    • There are gray areas about private wings among medical professionals and service seekers. Some of these are due to information gap and different perceptions on the effect the private wing will have on the normal health facility services. Hence, the researcher recommends that an in-depth evaluative study on the various methods presently utilized in the various regions as well as in the AAHB facilities be conducted. And the best methods of operating private wings should be presented for all regions to consider. Some national guidelines may also need to be established to allow some consistency across the country.

Collaborations and partnerships form the backbone for most of the cost intensive projects. Public Private partnership projects if implemented and monitored carefully yields mutually beneficial results. Partnership can be monetary, skill based or resource based. Collaboration/ partnership can be within government departments, within private organisation or a mix of two. A case of taking land for using it as a financing tool is also possible as highlighted in thesis infrastructure financing through land which is a project undertaken by government agency.


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NON PERFORMING ASSETS AND ITS MANAGEMENT (A comparative study between public and private sector)



Bhanu Uday Somisetti

Dr. P. Raja Babu

                                                      K.Venkateswara Kumar                                                                     


Today banking has to play very prominent and crucial role in developing countries like India. In the Indian financial system banks acts as a financial intermediary or institution serves different services to accelerate the economic growth of the country. To improve the financial health of the banks various norms have been introduced at regular intervals. It is quite clear that generally the good health of a bank is reflected in better return on assets. The Non- Performing assets not only reduce the profitability of the banks by writing of the principal amount, as well as the amount of interest on advances and it is also a threat to the stability of the bank. This article mainly focuses on the causes and how a bank manages Non-Performing Assets (NPAs) under the guidelines of RBI.

KEYWORDS: Non-Performing Assets, Financial Institutions, Profitability, Banking Sector, Economic Growth, Reserve Bank of India (RBI).


All assets do not perform uniformly. In some cases, assets perform very well and the recovery of principal and interest happen on time while in other cases there may be delays in recovery or no recovery at all because of one reason or the other. Similarly, an asset may exhibit good quality performance at one point of time and poor performance at some other point of time. NPAs refer to loans which are at risk of default. Reserve Bank of India (RBI) defines “An asset, including a leased asset, becomes non­-performing when it ceases to generate income for the bank. Banks have to classify their assets as performing and non-performing in accordance with RBI’s guidelines. Under these guidelines an asset is classified as non-performing:

  • If any amount of interest or principal installments remains overdue for more than 90 days in respect of term loans.
  • In respect of overdraft or cash-credit an asset is classified as non-performing if the account remains out of order for a period of 90 days and
  • In respect of bills purchased and discounted account, if the bill remains overdue for a period of more than 90 days.

According to the RBI guidelines banks must classify their assets on an on-going basis into the following four categories:

  • Standard assets: Standard asset service their interest and principal installments on time, although they occasionally default up to a period of 90 days. Standard assets are also called performing assets. They yield regular interest to the banks and return the due principal on time and thereby help the banks earn profit and recycle the repaid part of the loans for further lending. The other three categories (sub-standard assets, doubtful assets and loss assets) are NPAs and are discussed below.
  • Sub-standard assets: Sub-standard assets are those assets which have remained NPAs (i.e., if any amount of interest or principal installments remains overdue for more than 90 days) for a period up to 12 months.
  • Doubtful assets: An asset becomes doubtful if it remains a sub-standard asset for a period of 12 months and recovery of bank dues is of doubtful.
  • Loss assets: Loss assets comprise assets where a loss has been identified by the bank or the RBI. These are generally considered uncollectible. Their realizable value is so low that their continuance as bankable assets is not warranted.

‘If banks do not classify an asset as NPAs, they naturally have more money to earn interest income on their advances. If a large portion of NPAs goes unreported, the bank could reach a situation where it has advanced more money than it has available – a technical bankruptcy’. By giving this leverage ultimately RBI is delaying the inevitable, at some point of time the NPA bubble will burst.


There are two key ratios for measuring bank asset quality.

  • Gross Non-Performing Assets (GNPAs): Gross NPAs is the sum of all loan assets that are classified as NPAs as per RBI guidelines. Gross NPA Ratio is the ratio of gross NPA to gross advances (loans) of the bank.
  • Net Non-Performing Assets (NPA) ratio:  Net NPAs are calculated by deducting provisions from gross NPAs. The net NPA to advances (loans) ratio is used as a measure of the overall quality of the bank’s loan book.

Net non-performing assets = Gross NPAs – Provisions

NPA ratio = Net non-performing assets / Advance


Banks with high level of NPAs have lesser funds to give loans and advances, i.e. lesser funds their interest income has to be reduced. Another negative impact of high NPAs:

  1. High level of provisioning (banks are required to keep aside a portion of their operating profit as provisions, higher NPAs will increase the amount of provision thereby impacting the profitability)

Provisioning Norms:

  1. For substandard loans, a general provisioning of 15% on the total outstanding amount is made if the loan is secured, for unsecured loans the total provisioning that needs to be done is 25% of the outstanding balance;
  2. For doubtful assets, provisioning of 100% on the total outstanding amount is made if the loan is unsecured, for secured loans the total provisioning is in the range of 25% to 100 % of the outstanding balance depending upon the period for which the asset has remained doubtful;
  3. Loss assets should be completely written off. If loss assets are permitted to remain on the books for any reason, 100 % of the outstanding amount should be provisioned.
<li>The burden of maintaining the capital adequacy ratio;</li>
<li>Increased pressure on Net Interest Margin (NIM);</li>
<li>Reduce competitive position;</li>
<li>Continuous draining of profits;</li>
<li>Negative impact of goodwill with the bank;</li>
<li>Restricted cash flow by the bank due to the provision of a fund created against the NPA.</li>

The main objectives of the study are given below:

  • To study the concept of Non-Performing Assets in the banking sector
  • To analyze the performance of banks under the concept of NPAs
  • To understand how a bank manages its NPAs and
  • To study various channels to recover the NPAs

  2. Chandan Chatterjee, Jeet Mukherjee and Dr.Ratan Das, (2012) ‘Management of non-performing assets – a current scenario’ in their study they evident that the NPAs have a negative influence on the achievement of capital adequacy level, funds mobilization and deployment policy, banking system credibility, productivity and overall economy. And they also compare the performance of public, private and foreign banks and they present that the public sector banks are facing more problems with NPAs rather than others.
  3. Amit Kumar Nag, (2015) ‘Appraisal of non-performing assets in the banking sector: An Indian perspective’ the author of this article done a comparative study by taking ten private, public and foreign banks. This article reveals the performance of various banks and he suggested some measures to overcome NPAs difficulty.
  4. Rajeshwari Parmar, (2014) ‘Non-Performing Assets (NPAs): A Comparative Analysis of SBI and ICICI in this study the author takes a comparative study between SBI & ICICI banks and construct a relation between Net profit and Net NPAs. The author found that there is a positive relation. In case of SBI means that as profits increase NPA also increase because of mismanagement on the side of the bank and the other side of the coin ICICI bank got a negative relation which indicates that amount of NPA decreases and Profits will increase more by the amount not becoming NPA. So, they conclude that when compare to SBI (PSB), ICICI (Private bank) manages NPAs efficiently.
  5. Sonia Narula and Monica single, (2014) ‘Empirical Study on Non-Performing Assets of Bank’ in this article the authors conduct a study on private bank i.e., Punjab National Bank (PNB). It is concluded that when PNB Gross and Net NPA compared with total advances we get the result that there is mismanagement on the side of PNB. While analyzing the impact of NPA level on PNB we derived the conclusion that there is a positive relation between Net Profits and NPAs of PNB. It simply means that as profits increases NPA also increases. It is because of the mismanagement on the side of the bank.


Table: 01 shows Gross, Net advances and net NPAs of Public and Private Sector banks during the period of 2003-14. It is found that gross, net advances and Net NPAs of public and private sector banks were raised more ten times during the period of 2003-14 whereas the ratio between Net NPAs and Net advances, Total assets have been increasing between 2010 and 2014 for public sector banks whereas private sector banks have been decreasing. It is clearly indicated that when increasing loans and advances as a result Net NPAs also increases.


 (Amount in Billion)


While comparing public and private sector banks with NPAs, public sector banks are back to regulate NPAs and there is a need for proper management of NPAs because to increase the profitability and productivity. Last month, Finance Minister Arun Jaitley had said that though NPAs in the banking sector was a cause of concern, there was no ground to “panic”. Due to NPAs is the challenging for the banking sector and its impact on the economy slowed down. He had said the NPA was mainly in sectors like highways, steel, and textiles.

            Central Bank of India has topped the list of public sector banks with maximum bad loans, including restructured assets as a percentage of total advances. According to the data provided by the RBI to the Finance Ministry, Central Bank of India’s 21.5 per cent assets are either bad or have been restructured to save them turning non-performing assets (NPAs). The other banks, which have significant amounts of gross NPAs and restructured loans include United Bank of India (19.04 per cent), Punjab & Sind Bank (18.25 per cent) and Punjab National Bank by 17.85 per cent as on December 2014. Indian Overseas Bank, State Bank of Patiala, Allahabad Bank and Oriental Bank of Commerce all have bad and restructured loans in excess of 15 per cent. The rising bad loans have become a major concern for the Reserve Bank as well as the government. Most of the restructured loans are from the corporate sector. The top 30 defaulters are sitting on bad loans of Rs 95,122 crore, which is more than one-third of the gross non-performing assets of PSU banks at Rs 2, 60,531 crore as on December 2014.



  1. Debt Restructuring

Once a borrower faces difficulty in repaying loans or paying interest, the bank should initially address the problem by trying to verify whether the financed company is viable in the long run. If the company project is viable, then rehabilitation is possible by restructuring the credit facilities. In a restructuring exercise, the bank can change the repayment or interest payment schedule to improve the chances of recovery or even make some sacrifices in terms of waiving interest etc.

The RBI has separate guidelines for restructuring loans. A fully secured standard/sub-standard/ doubtful loan can be restructured by rescheduling of principal repayments and/or the interest element. The amount of sacrifice, if any, in the element of interest, is either written off or provision is made to the extent of the sacrifice involved. The sub-standard accounts/doubtful accounts which have been subjected to restructuring, whether in respect of a principal installment or interest amount are eligible to be upgraded to the standard category only after a specified period.

To create an institutional mechanism for the restructuring of corporate debt the RBI has devised a Corporate Debt Restructuring (CDR) system. The objective of this framework is to ensure a timely and transparent mechanism for the restructuring of corporate debts of viable entities facing problems.

  1. Other recovery options

If rehabilitation of debt through restructuring is not possible, banks themselves make efforts to recover. For example, banks set up special asset recovery branches which concentrate on recovery of bad debts. Private and foreign banks often have a collection unit structured along various product lines and geographical locations, to manage bad loans. Very often, banks engage external recovery agents to collect past due debt, who make phone calls to the customers or make visits to them. For making debt recovery, banks lay down their policy and procedure in conformity with the RBI directives on the recovery of debt. The past due debt collection policy of banks generally emphasizes on the following at the time of recovery:

  • Respect to customers
  • An Appropriate letter authorizing agents to collect
  • Due notice to customers
  • Confidentiality of customers’ dues
  • Use of simple language in communication and maintenance of records of communication

In difficult cases, banks have the option of taking recourse to file cases in courts, Lok Adalats, Debt Recovery Tribunals (DRTs), One Time Settlement (OTS) schemes, etc. DRTs have been established under the Recovery of Debts due to Banks and Financial Institutions Act, 1993 for expeditious adjudication and recovery of debts that are owed to banks and financial institutions. Accounts with loan amount of Rs. 10 lakhs and above are eligible for being referred to DRTs. OTS schemes and Lok Adalats are especially useful to NPAs in smaller loans in different segments such as small and marginal farmers, small loan borrowers and SME entrepreneurs. If a bank is unable to recover the amounts due within a reasonable period, the bank may write off the loan. However, even in these cases, efforts should continue to make recoveries.

  • SARFAESI Act, 2002

Banks utilize the Securitization and Reconstruction of Financial Assets and Enforcement of

Security Interest Act, 2002 (SARFAESI) as an effective tool for NPA recovery. It is possible where non-performing assets are backed by securities charged to the Bank by way of hypothecation or mortgage or assignment. Upon loan default, banks can seize the securities (except agricultural land) without intervention of the court. The SARFAESI Act, 2002 gives powers of “seize and desist” to banks. Banks can give a notice in writing to the defaulting borrower requiring it to discharge its liabilities within 60 days. If the borrower fails to comply with the notice, the Bank may take recourse to one or more of the following measures:

  • Take possession of the security for the loan
  • Sale or lease or assign the right over the security
  • Manage the same or appoint any person to manage the same

The SARFAESI Act also provides for the establishment of asset reconstruction companies regulated by the RBI to acquire assets from banks and financial institutions. The Act provides for sale of financial assets by banks and financial institutions to asset reconstruction companies (ARCs). The RBI has issued guidelines to banks on the process to be followed for sales of financial assets to ARCs.

  1. Through website

            The present era is the internet era, RBI provide website like  to sell the mortgaged assets banks and ARCs can conduct an auction through this website in an effective manner.


            In the above study it can be concluded with some proper recommendations to manage NPAs with an efficient and effective manner. Some of the recommendations can be provided by dividing before advancing and after advancing explained as follows:

  • Before advancing
  • The bank should find the proper reasons prior to provide loans and should verify the purpose of loan required by the borrower.
  • The bank should verify the financial strength of the borrower whether he can repay or not.
  • The bank should go for credit analysis, i.e.. Credit execution and administration, Credit appraisals with the help of CIBIL (Credit Information Bureau India Limited). They should concentrate on short term funds rather than long term because chance to repay will high and working capital will be adequate.
  • Diversification of funds is needed means by investing total in one area you can reduce the risk through diversification to various sources.
  • Banks are under the control of RBI nowadays the regulatory authority is easing the norms on PSBs there is chance of easing the more norms to reduce NPAs.
  • Banks should go their policies and procedures strictly.
  • They should go with proper collateral security.
  • After advances:
  • Need to keep an eye on borrower whether he is paying proper payments are not.
  • If proper repayment is not there banks should critically examine and analyze the reasons behind time overrun.
  • Creation of separate department for recovery of loans with a proper officer.
  • Some studies reveal that bank officials are hesitant to sell bad loans because they fear this might be perceived as an admittance of failure to recover the loan. To sell bad loans to ARCs (Asset Reconstruction Companies) leads some recoveries.
  • There is a need to strengthen and fasten the recovery of loans by banks.
  • Bank officials should frequently visit the unit and should verify the physical position of assets and how it manages because if one unit/branch fails affects the total productivity of the entire bank.
  • Banks should go with various recovery strategies and recovery options to manage NPAs in an effective and efficient manner.
  • They should have proper monitor and manage to control NPAs.


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  2. Chatterjee, 1. C., mukherjee, j., & das, d. (2012). Management of non performing assets – current scenario. International journal of social sciences and interdisciplinary research. 1 issue 11, ISSN 2277 3630
  3. Sonia Narula, m. S. (2014). Empirical study of non performing assets of bank. International journal of advanced research in computer science and management science, Vol 2, issue 1, ISSN: 2321-7782.
  4. Nag, a. K. (2015). Appraisal of non performing asset in banking sector: an Indian perspective. Indian journal of accounting Vol. XIVII, ISSN-0972-1479.
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The slum is not only a manifestation of mismanaged urban planning in the countries of the South. The existence of slums worldwide is also a sign that the slum is a crucial element of contemporary urbanisation. This article will attempt to define this phenomenon and understand its causes. Adequate policy responses are then suggested. Without finding appropriate solutions to the housing problems of a majority of urban dwellers, public and private decision makers will not be able to meet the challenges of sustainable development.

The primary causes of slum development are urbanisation, migration of the population from rural to urban areas, lack of proper affordable residences in the urban areas, unhygienic living conditions of the people in these slums. The slums are mostly built in low lying areas next to water bodies and drainages. These also pose as a health hazard for its occupants. The lack of sanitation facilities like proper toilets and bathrooms leads to unhealthy habits like open defecation, washing of clothes in the polluted river water, breathing in the stale, unclean air.

The secondary factors like education facilities, basic government services like policing, security etc are non-prevalent in the slum areas. As the slums are an illegal settlement on government land, the people have no life security and may be asked to evacuate at any time. Even the houses they live in are small compact and tightly packed. The settlement is very rudimentary and haphazard without any proper planning. These being situated in low lying areas are the first to be affected during natural disasters like floods and rains. The government has taken several measures to uplift the pitiful living conditions of the slum dwellers.

The report also contains case studies, both Indian and foreign, for further explanation on the life in squatter settlements. The case study in India is based on Dharavi, Asia’s biggest slum. The financial capital of India known as Mumbai is home to estimated 6.5 million slum people.

Nearly half of Mumbai’s Population lives in small shacks surrounded by open sewers. Nearly 55% of Mumbai’s population lives in Slum areas. Despite of Government efforts to build new houses and other basic infrastructure, most of the people living in slum areas do not have electricity, water supply and cooking gas.

The second case study is on Sao Paulo, in Brazil. A home to one of the biggest slums in the world called Favelas. Slums world‐ over share some common characteristics including a higher incidence of violent crime due to lack of attention from local law enforcement, a higher incidence of disease due to poor sanitation and access to healthcare facilities, the dominance of the informal economy and political bosses, and a higher incidence of child labour, prostitution, and substance abuse. Clearly, the culture of a nation or region plays a large role in determining the degree to which these factors shape the slum. The development of slums appears to be an entirely organic phenomenon which occurs when poorer countries that have under‐developed

urban management, governance structures and poor infrastructure undergo rapid industrialisation and urbanisation and fail to minimise the disparity of prosperity between the urban and rural population.


One of India’s biggest challenges today is coping with the wave of urbanization unleashed by economic liberalization. An estimated 160 million people have moved to the cities in the last two decades, and another 230 million are projected to move there within the next 20 years.

Unfortunately, as any visitor to India can see for themselves, its major metros and tier‐II cities are clearly finding it difficult to cope with the inflow of people. It is no surprise that India’s famously poor infrastructure is critically over‐strained. In response, the ill‐equipped urban systems and the informal housing that are the slums have expanded exponentially in the last few decades without proper access to basic services such as sanitation, healthcare, education, and law and order. While they are often teeming with entrepreneurial activity, they are nevertheless an inefficient use of the city’s human resources and land. In order to truly unleash the productive potential of this dynamic urban population, India will need to build scalable urban systems capable of housing, caring for, employing and integrating large and increasing numbers of new inhabitants. India is not alone in this challenge of course; Mexico, Brazil and Africa have some of the largest slums in the world. It is unclear that there are simple solutions to the problem of slums given their extraordinary organic growth rates– 70% of the world’s population is expected to live in urban centers by 2050 – and solving slums requires a rethink of the design of cities and their borders as well as of the role of rural areas. The challenge is incorporating all of these factors and still being able to provide safe and sounds residences to the abundant inflow of people, with proper planning and without the compromise on the use of the resources of the state.

In this article we will be running through the problems faced by the government due to slum and squatter settlements. The appalling living conditions of these illegal settlements, the health problems caused, the issues faced by the people living there and ways of rectifying this situation in the best possible manner.


“Slums are litmus tests for innate cultural strengths and weaknesses. Those peoples whose cultures can harbor extensive slum life without decomposing will be, relatively speaking, the future’s winners. Those whose cultures cannot will be the future’s victims.” – Robert D. Kaplan, The Coming Anarchy, 1994

A slum is a heavily populated informal urban settlement characterized by substandard housing and squalor. While slums differ in size and other characteristics from country to country, most lack reliable sanitation services, supply of clean water, reliable electricity, timely law enforcement and other basic services. Slum residences very from shanty houses to professionally built dwellings that because of poor quality design or construction have deteriorated into slums.

Slums form and grow in many different parts of the world for many different reasons. Some causes include rapid rural-to-urban migration, economic stagnation and depression, high unemployment, poverty, informal economy, poor planning, politics, natural disasters, and social conflicts.

Most of the people who live in slums are extremely poor, and many are treated as second class citizens by their society. Health problems tend to be very high, as a result of improper sanitation and lack of access to basic health care. Malnutrition is another serious problem in many places, as is crime, which can make them very dangerous for their inhabitants.

Many people view slums as the ultimate symbol of inequality, and in some regions, such areas have formed in some very unexpected locations, sometimes neighboring the homes of the wealthy. Organizations that campaign against them argue that no human being should be forced to live in such poor conditions, and that as a basic act of humanity, cities need to provide livable low cost housing and regulate construction.

Unfortunately, the solution is seldom this simple. The world’s population is rapidly growing, putting immense pressure on available resources, and as developing countries become more developed, this pressure is likely to grow. Although it is somewhat disheartening to think about, gross inequality seems to go hand in hand with growing societies.


Democracy provides free mobility to its people. Part of the freedom of India’s democratic population is the apparent liberty to pursue their dreams anywhere in the country and India’s aspiring population is dynamic and determined to do so. The great slums of India are predominantly created when large numbers of individuals or families move to the urban centres of their dreams, usually in search of better economic prospects. Mumbai has been the number one choice of generations of Indians for decades. These urban centres are not geared to, nor governed in a manner that can accommodate (or reject) such an influx of people. As a result, the incoming migrants find accommodation in unorganised dwellings. India’s slums have received global attention not just from the global NGOs but also in popular culture through movies like Slumdog Millionaire,which portray them as centres of unmitigated squalor and despair. However poor this quality of life may seem from the outside, from a migrant slum‐dweller’s perspective, living there is an entirely rational decision based on three basic factors:

  1. A Higher and More Stable Income. The productive employment opportunity in the urban centre will likely generate a higher and more consistent personal disposable income than in the place of origin – likely a rural, farming centre (e.g. being a chauffeur in Mumbai is a more lucrative and sustainable job proposition than being a labourer at a farm, typically a small plot in an un‐electrified village with erratic water availability.

  1. Social Mobility for the Next Generation. Raising children in an urban environment creates a higher “option value” for the next generation. Typically, cities offers a wider choice of education and employment opportunities, and while no parent wishes their child to grow up in a slum, the chances that the child could rise to a middle class life provides a strong incentive to migrate to one from the countryside. This contrasts to a child growing up in a village dominated by a sub‐scale farm with poor education and employment opportunities, who is unlikely to ever have the same social mobility opportunity.

  1. No Other Option. Unfortunately, slums are the only way to inhabit the city for the vast majority of migrants. With little available low‐cost housing of decent quality near the city centre, a rural migrant would need to go well outside even the suburbs and outskirts of the city to be able to afford real estate. Given the poor transport linkages to the cities, this can create a significant trade‐off for migrant in terms of the occupations that are available and their earnings potential. As a result, most are willing to compromise and make the trade‐off to slum housing in the city to be closer to the place of work.

The coalescing of this process over decades, with successive waves of migrants and no exodus of the previous waves leads to slums growing in scale and scope (see inset on the phases in slum development). Over time, informal economies develop in these slums as they form their own social practices and codes in the absence of any effective oversight from the local government. The larger slums often become a zone for small‐scale industries by illegally diverting public resources (water, electricity) to meet their requirements. These slums also provide bluecollar

labour for construction, manufacturing, and other trades.

Clearly, India’s slums are far from their popular stereotypes as only centres of disease and want. Indeed, an overwhelming number of people in these slums have left their homes in the countryside in the pursuit of opportunities in urban India because of their strong aspirations. Ironically, it is the informal economy which traps many of these slum‐dwellers into the vicious cycle of poverty.

Without real options for their children to secure competitive standards of schooling and with the overwhelming number of slum‐dwellers not trained for the better jobs, social mobility for this class, though inspiring when it occurs, is still limited. Further, continuing urbanisation and slum growth through fresh arrivals from the countryside increases competition for limited resources and, opportunities further reducing both liveability and individual chances for mobility. The very presence of slums ultimately risks creating a different class of urban citizens who only rarely mix with the other ‘classes’ other than as employees. While India’s slums today are full of ambitious hard workers, lack of opportunity can quickly institutionalise poverty and create an unbridgeable gap between poor and rich. Although global technological innovation and India’s growth provides its slum dwellers with access to some of the modern consumables such as motorcycles, televisions, and mobile phones, their ability to shape their own destiny remains limited – and the productive potential of the young migrants eager to work is under‐utilised. However, having established viability and survived attempts to dismantle the slum, India’s largest slums like Dharavi, are now in phase VI, continuous growth through adaptation. This makes them an organic entity that has demonstrated its Darwinian survival status.

Strategies for transforming India’s slums

The history of urbanisation is full of examples of cities which started off by being the hosts (willingly or not) to the economically weaker section of the population who were ultimately graduated from poor living conditions to a combination of affordable housing and basic civic amenities. The solution ultimately lies in better nations, not just better cities, which are scalable and capable of not only absorbing the inflow of people (from within or without), but in fact are economic magnets in attracting the best talent from the country. Five insights provide the basis of the solution.

Firstly, slums are a logical response to urbanisation and the relative lack of opportunity outside of major urban centres in predominantly poor countries. They are facilitated by the right to migrate. So, they are a structural phenomenon.

Secondly, slums become a system of living perpetuated by economics, politics and societal factors. Therefore, it makes sense to see them as a part of the system of a country and also the global system of trade and distribution of wealth.

Thirdly, people accept and adapt to their circumstances without (external) triggers to encourage them to do otherwise. In this sense, slums are adaptive organisms.

Fourthly, slum dwellers can improve the slum to a large extent if mobilised to do so. Therefore, they can also be developed as one would any organisational entity through the application of techniques of change management.

Finally, slum dwellers cannot transform their slum (into a non‐slum) without the support of the environment around them. They lack the critical human and financial resources to make a clean break from their situation. Their transformation requires external impetus and resources. In the absence of this external intervention, they can become disenfranchised rather than citizens in‐waiting and have the potential to develop a culture, set of values and behaviours that can threaten the on‐slum environment they live in.

“People accept and adapt to their circumstances without (external) triggers to encourage them to do otherwise … slums are adaptive organisms”

Therefore, ultimately, a comprehensive and long‐term solution to the problem of India’s slums cannot be about the slums themselves. A viable solution would have to take a holistic view dealing with India’s larger macro challenges and recognise the critical role which cities will have to play if India is to successfully transition into a middle‐income country. Such a solution and would include the following strategies:

  1. Industrial Revolution and Continued Development. While it was the industrial revolution which led to a wave of rapid urbanisation in the West and gave rise to slums,without the industrial revolution, the West would not have been able to afford to develop housing and infrastructure required for its growing populations. The solution to slums is not to reverse industrialisation or to try and contain urbanisation, but indeed to press forward with it more aggressively so that businesses can afford to provide jobs to slum‐dwellers and pay them a proper wage.

  1. Knowledge and Freedom Advantage. India is not fully leveraging its “freedom advantage” (see our previous paper on China which highlights the strong link between a society’s freedom and its development potential) which should in theory allow for people to strive to realise their aspirations. In particular, India needs to create an open knowledge economy where the slum‐dwellers are empowered to solve their own problems and have the access to financing to do so. This requires scaled charities and NGOs that can apply global bestpractices to tackling India’s urban issues and also raise the necessary financing.


  1. Slum Architecture. Lesson from other cities indicate that slums are best solved when housing is horizontal not vertical. In order to assimilate slum‐dwellers into urban life instead of further ostracizing them, India cannot just bulldoze the slums and pile up the people into apartment blocks. A real solution would involve building high‐quality, low‐cost, multi‐storey, diverse formats in the current areas such that these become integrated with the rest of the city (as we see in London or Paris). This needs the best brains in India and the world to come in and design the solutions. The slum is merely the platform for an urban re‐invention.

  1. Sustainable Continuous Dynamic Infrastructure Provisioning. The government needs to create a framework for gradual and continuous upgrading of slum infrastructure through innovative public‐private models and by leveraging the many dynamic charities and NGOs in India. Such a model would see the slum‐dwellers become the driving force of, rather than bystanders to, the improvement of their living conditions by empowering them to identify the solution and then finance and implement it.

  1. Rural ReVisioning and Investment. India cannot solve its slum problem by focusing on the cities alone. Any city which develops the systems to accommodate more people and create economic opportunities will attract a disproportionate number of migrants putting it under further strain unless opportunities in rural areas are sufficiently attractive relative to those in the city. Therefore a comprehensive solution would necessarily have to involve improved infrastructure, schools, employment opportunities and the overall quality of life in India’s small towns and rural centres. India’s countryside has all the potential of a Switzerland (Kashmir and the Himalayas), the Caribbean (the many beaches along its long coast), an African safari (the many wildlife sanctuaries and forests), and a Gulf desert trek (Rajasthan’s deserts and palaces) – however, the

country has barely begun to exploit this potential.



Dharavi slum is located in Mumbai (formally Bombay) in India. India‛s and Mumbai’s biggest slum is known as Dharavi. There are a million people crammed into one square mile in Dharavi. At the edge of Dharavi the newest arrivals come to make their homes on waste land next to water pipes in slum areas. They set up home illegally amongst waste on land that is not suitable for habitation. In the wet monsoon season these people have huge problems living on this low lying marginal land. Many of the people here come from many parts of India as a result of the push and pull factors of migration.


Conditions in the slum


In the slum people have to live with many problems. People have to go to the toilet in the street and there are open sewers. Children play amongst sewage waste and doctors deal with 4,000 cases a day of diphtheria and typhoid. Next to the open sewers are water pipes, which can crack and take in sewage. Dharavi slum is based around this water pipe built on an old rubbish tip. The people have not planned this settlement and have no legal rights to the land. There are also toxic wastes in the slum including hugely dangerous heavy metals. Dharavi is made up of 12 different neighbourhoods and there are no maps or road signs. The further you walk into Dharavi from the edge the more permanent and solid the structures become. People live in very small dwellings (e.g.12X12ft), often with many members of their extended families.

Many architects and planners claim this slum could hold the solution to many of the problems of the world‛s largest cities. Water is a big problem for Mumbai’s population; standpipes come on at 5:30am for 2 hours as water is rationed. These standpipes are shared between many people. Rubbish is everywhere and most areas lack sanitation and excrement and rats are found on the street. 500 people share one public latrine. The famous cloth washing area also has problems, despite its social nature sewage water filters into the water used for washing clothes.

The Positives of Dharavi Slum


There are positives; informal shopping areas exist where it is possible to buy anything you might need. There are also mosques catering for people’s religious needs. There is a pottery area of Dharavi slum which has a community centre. It was established by potters from Gujarat 70 years ago and has grown into a settlement of over 10,000 people. It has a village feel despite its high population density and has a central social square. Family life dominates, and there can be as many as 5 people per room. The houses often have no windows, asbestos roofs (which are dangerous if broken) and no planning to fit fire regulations. Rooms within houses have multiple functions, including living, working and sleeping. Many daily chores are done in social spheres because people live close to one another. This helps to generate a sense of community. The buildings in this part of the slum are all of different heights and colours, adding interest and diversity. This is despite the enormous environmental problems with air and land pollution. 85% of people have a job in the slum and work LOCALLY, and some have even managed to become millionaires.

Recycling and waste in Dharavi


Kevin McCloud found that people seemed genuinely happy in the slum. However, toilets are open holes above a river – hardly hygienic. This could lead to Dengue fever, cholera and hepatitis Dharavi has a recycling zone. It is claimed that Dharavi‛s recycling zone could be the way forward to a sustainable future. Everything is recycled from cosmetics and plastics to computer keyboards. 23% of plastic waste gets recycled in the UK, in Mumbai it is 80%. However, it is humans who work to sift the rubbish in the tips where children and women sift through the rubbish for valuable waste. They have to work under the hot sun in appalling conditions. They earn around a £1 a day for their work. At the edge of the tip the rag dealers sort their haul before selling it on to dealers. The quandary is that people have to work in poor conditions to recycle waste. From the tip it arrives in Dharavi where it is processed. It is sorted into wire, electrical products, and plastics. Plastics in India are continuously recycled. People work in dangerous conditions with toxic substances without protective clothing; this could affect people‛s life expectancy. Even dangerous hospital waste is recycled. One private enterprise makes the metal cages inside suitcases, making 700 pieces per day, paid 3 rupees per piece. There are 15,000 one room factories in Dharavi which there are 300 feeding most of Mumbai. Many of the products from Dharavi end up around the world based upon very cheap labour. Many of the people work in very poor working conditions, and includes children. Indeed, Dharavi is trying to do in 20 years what the west did in 200, develop.



The Favelas are densely packed informal settlements made of wood, cardboard, corrugated iron and other makeshift materials. Later they are replaced by concrete block construction. Often only one wall at a time will be built as a family saves up enough money to buy materials for the next wall. Then concrete tiles replace corrugated iron or other makeshift materials on the roof.

The large-scale improvement in favelas in São Paulo is due to residents’ expectations of remaining where they are. This in turn reflects a change in public policy in the past 20 years, from one of slum removal to one of slum upgrading.

Attempts to tackle the slum housing problem

Over time, a range of attempts have been made to tackle the housing crisis in São Paulo. These include:

  • A federal bank (BNH) which funded urban housing projects and low-interest loans to lower and middle-income home buyers
  • A state-level cooperatives institute (INCOOP) which helped to build housing for state workers such as teachers
  • A state-level development company (CODESPAULO) for housing for low-income families and financing of slum upgrading projects
  • A collaborative private sector/state company scheme (COHAB) to develop housing for limited-income families
  • A municipally managed COHAB for public housing construction, which also funded self-help projects (‘mutiroes’) to upgrade substandard housing.

During the period 1965 to 1982, over 150,000 housing units were built or upgraded, mostly through COHAB. Since the early 1980s, because of cutbacks at federal and state levels, the public housing burden has fallen more heavily on the municipality. Due to its own financial problems the number of housing units built by the municipality each year since the mid-1980s has averaged less than 6,000 a year.

The administration of leftist mayor Luiza Erundina (1989–92) tried to speed up public house building. Here the emphasis was on self-help housing initiatives, known as ‘mutiroes’. The city supplied funding directly to community groups. The latter engaged local families to build new housing or to renovate existing housing. However, the annual house building total only increased to 8,000 during this period.

The new strategy

The election of socialist mayor Marta Suplicy in 2000 marked a change in strategy towards the housing issue:

  • The new administration promised to spend $R3 billion on housing during its term in office.
  • The 1,000 unfinished Cingapura housing units were to be completed.
  • The new strategy would be designed to obtain maximum impact for minimum cost.
  • The concept of the mutiroe (self-help scheme) was resurrected, assisting families in self-construction or upgrading of their own homes.
  • The house unit cost of self-help schemes is between $R11,000 and $R15,000 compared to over $R20,000 for housing units in the Cingapura Project.
  • A flagship scheme to alleviate poverty in favelas is under way in Santo André (Figure 13).

Occupation of buildings by homeless

In July 2003, more than 4,000 homeless people occupied four abandoned high-rise blocks in the centre of São Paulo. Police prevented the occupation of two other buildings. This occupation and others was organised by ‘Movimento Sem Teto do Centro’ (Movement of Roofless in Centre). This organisation is protesting about the poor record of the authorities in tackling the homeless problem. They are also angry about the way street sellers are treated, with the authorities confiscating their goods because they are trading without licenses. For many homeless families and others, street selling is their only source of income.


Brazil has a greater disparity in income levels than most other countries. This impacts on housing and all other aspects of the quality of life. The occupation of buildings by homeless people is an illustration of the social tensions that such a wide income disparity can bring. It can be argued that housing is the biggest problem that São Paulo and Brazil in general has to tackle.


All the strategies described above on their own can transform the slums. However, if implemented together, they could represent a sea change in the way that world’s mass migration and resulting urbanisation is managed. This requires a recognition that the reason why slums in India persist and continue to expand is because of the failure to address fundamental issues of economic opportunity across the country, population growth, urban and rural development and education and skills development. A middle income India will indeed demand world‐class cities and conversely, to reach middle income levels, India needs to create opportunity for the population to be gainfully employed. Given India is already in the midst of a rocky economic cycle at the same time as slums are growing at the edge of every major city, the investment in urban infrastructure can create a highly positive multiplier effect for the economy while addressing a major issue. There is no single point in time or crisis which will tell us that India’s cities have suddenly become “un‐livable”; however if the status quo prevails for the next 20 years, they will get progressively more chaotic and at some stage in the not‐too‐distant future, it will be impossible to harness the economic potential of India’s population without even more radical changes than those outlined above. Addressing this issue is one of the key steps in the regeneration of the India story and will have a highly positive impact on the success of the next government. Indeed, solving the issue is about as difficult as putting a man on the moon, but would have massive collateral benefits for the nation as a whole and would be a true indicator that India is truly ready to play its role on the global stage.

“Solving the issue is about as difficult as putting a man on the moon, but would have massive collateral benefits for the nation as a whole and would be a true indicator that India is truly ready to play its role on the global stage.”


  2. McKinsey, India’s Urban Awakening, 2010
  3. Deccan Herald, “Dharavi SelfCreated Special Economic Zone for the Poor”, 2011
  4. Sussane Wendt(1997), Dissertation for phd, Slum and Squatter settlements in Dhaka
  5. Kevin McCloud, Slumming It