UAE Mandatory Health Insurance

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This assignment examines the awareness and experiences of workers regarding the mandatory health insurance policy in the UAE. It involves data collection from secondary sources (news articles, government websites) and primary data through interviews. The analysis focuses on workers' understanding of the policy, their satisfaction with coverage, challenges they face, and opinions on premium affordability. The research aims to provide insights into worker perspectives and potential areas for improvement in the UAE's mandatory health insurance system.

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Running head: RESEARCH PROPOSAL
Exploring the role of TPA and health insurance in the health status of UAE
population
Name of the Student
Name of the University
Author Note

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Executive Summary
United Arab Emirates (UAE) is a federation of seven emirates. The discovery of oil
influenced massive economic growth in UAE. This growth bolstered massive influx of
migrant workers leading to a huge change in the demography. Increase in the
population along with increase in the number of immigrants caused high rate of
disease occurrence in UAE and this in turn lead to the increase in health care costs.
In order to reduce this escalating cost of health care, government of UAE introduced
mandatory health insurance. The rationale of the research is to elucidate the
problems experienced by the people of UAE while availing the benefits of the health
insurance policies. The research will also aim to highlight the possible health benefits
or health threats experienced by the UAE population who are under the health
insurance schemes. In this research work, the researcher will follow the research
philosophy of positivism with a deductive approach. The researcher will select
stratified sampling method The overall research design is descriptive type design.
Qualitative analysis method will be undertaken in order to analyse the answers of the
respondents in the interview.
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Table of Contents
Section 1..................................................................................................................... 3
1.1 Introduction........................................................................................................3
1.2 Rationale........................................................................................................... 4
1.3 Aims and Objectives..........................................................................................6
1.4 Research question.............................................................................................6
1.5 Theoretical framework of the research..............................................................7
Section 2..................................................................................................................8
2.0 Literature Review...............................................................................................8
2.1 Summary and gaps in the research.................................................................14
Section 3................................................................................................................17
3.1 Research Methodology....................................................................................17
3.2 Sampling..........................................................................................................17
3.3 Method of data collection.................................................................................18
3.4 Time Plan of the research................................................................................18
3.4 Research ethics...............................................................................................18
References................................................................................................................19
Appendix 1................................................................................................................ 22
Gantt Chart............................................................................................................22
Appendix 2................................................................................................................ 24
Questionnaire........................................................................................................24
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Section 1
1.1 Introduction
United Arab Emirates (UAE) is a federation of seven emirates (Abu Dhabi,
Ajman, Fujairah, Sharjah, Ras Al Khaimah, Umm Al Quwain and Dubai) and was
established in the year 1971. The discovery of oil influenced massive economic
growth in UAE. This growth bolstered massive influx of migrant workers leading to a
huge change in the demography with a majority being of pre-retirement (Suliman and
Al-Junaibi 2010). This high influx of workers caused high population growth in UAE
(Al-Jenaibi 2017). According to the census data, the population of UAE is highest in
the world with 95% of population are less than 50 years old and male: female ratio is
3:1 (U.A.E National Bureau of Statistics 2012).
Increase in the population along with increase in the number of immigrants
caused high rate of disease occurrence in UAE and this in turn lead to the increase
in health care costs. The cost of the both the amount paid by the insured person and
insurance company has increases significantly in UAE. In order to reduce this
escalating cost of health care, government of UAE introduced mandatory health
insurance (Loney et al. 2013). Under the “Thiqa Program”, the government of Abu
Dhabi provides comprehensive medical coverage for all UAE nationals residing in
Abu Dhabi (The Official Portal of the UAE Government 2017). Under this scheme,
the citizens are assigned with the “Thiqa” card, which grants complete health therapy
access to a huge group of private and public healthcare providers who are registered
under Daman’s network. However, in order to qualify for the “Thiqa Program”, UAE
national under the age bracket of 18 to 75 years are required to pass through

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“Weqaya” test conducted by Department of Health, Abu Dhabi. This screening is
done in order to identify the cardiovascular risk factors (The Official Portal of the
UAE Government 2017).
Apart from this, in the year 2015, UAE government has also launched new
health insurance program. This program was designed to support the nationals who
are not covered under any government funded health insurance schemes (United
Arab Emirates Healthcare Service 2016). The Dubai Health Authority (DHA) in June
2016 announced that all the residents of Dubai should be covered under the health
insurance that will be tied to renewal and issuance of their UAE residence visa
(United Arab Emirates Healthcare Service 2016).
Moreover, the government of UAE has made it is mandatory norms for the
employers to provide health insurance to their employees along with their
dependents. There are currently two emirates, which mandate the employers to
provide coverage of health insurance to their employees, Dubai and Abu Dhabi (The
National. 2016). Dubai’s Employer Sponsored Health Insurance Scheme for
company employees, faces trouble while regulating scheme under the influence of
the economic downturn. This is because in Dubai it is mandatory for employers to
pay for the medical insurance to all the dependents including the domestic worker.
The scenario is different in Abu Dhabi, which has strictly enforced the employer
sponsored medical insurance scheme (The National. 2016). However, if the
employee has a big family then the onus of the employer only bears up to the fourth
child (The National. 2016).
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1.2 Rationale
Rule of health insurance in UAE are different. In Abu Dhabi there are two
insurance schemes one is Thiqa for Emirates and another one is Abu Dhabi Basic
Plan for expatriates, bestowed by the National Health Insurance Company (Daman).
In Dubai, there is Essential Benefits Plan, which is procured by 12 companies. In
Abu Dhabi, all the employees who are under Abu Dhabi Basic Plan are required to
pay half of the insurance policy in order to get premium service for their dependents
(wife and children). However, they are required to bear the cost of their dependent
parents (The National 2016). According to law of UAE, the maximum amount of
insured coverage in Dubai is Dh150,000 and in Abu Dhabi is Dh250,000. However,
this overage plan may not include emergency or ongoing treatment and also exclude
dental, vaccination eye care costs (The National 2016).
However, in the midst of numerous insurance policies and their different
norms, the people of 7 different emirates lack a clear picture of the insurance plans,
their premium schemes and the extent of coverage. Despite the claims made by the
Health Authority Abu Dhabi (HAAD), the majority of low income workers lack the
clear approach about their health insurance rights (Zaman, 2010). Although they are
happy with the government policy to provide health insurance coverage but they are
confused with the concept of network of coverage that is clinic or hospitals they
should visit (Zaman 2010).
So the rationale of the research is to elucidate the problems experienced by
the people of UAE while availing the benefits of the health insurance policies. The
research will also aim to highlight the possible health benefits or health threats
experienced by the UAE population who are under the health insurance schemes. At
the end the research will try to recommend the potential ways in which this gap
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between the understanding of the health insurance schemes and the role of TPA in
providing the health insurance among the people in UAE can be negated. For this
research, the researcher will only focus over the population of Dubai and Abu Dhabi
as these two have proper structure of the health insurance policies in comparison to
other emirates.
1.3 Aims and Objectives
The main objectives of the research will be
1. Analysing the role of TPA in health and health insurance under the perspectives of
UAE
2. What are health benefits offered by TPA to the population residing in UAE
3. What are possible health threats imposed by TPA on the health of the population
residing in UAE
4. Possible recommendation in relation to health insurance and TPA towards optimal
health care access of UAE population
1.4 Research question
1. Are the employees of UAE are aware of the role of TPA in health insurance?
2. Are the people residing in UAE are able enjoy the health benefits under the
health insurance scheme proposed by the government?
3. What are the health threats or possible complications experienced by the UAE
population in relation to health insurance policies and its associated TPA?

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1.5 Theoretical framework of the research
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Section 2
2.0 Literature Review
Overview of health system reform in UAE
Health system reform has been implemented in many countries globally to
achieve best health outcome. The Emirate of Abu Dhabi, UAE is also one region that
moved towards the journey of health care reform by introducing the mandatory
insurance coverage scheme for employers. The statutory agency, the Health
Authority-Abu Dhabi (HAAD) is the statutory agency that implements regulations for
health care providers and insurance companies. The Emirati law makes it mandatory
for employers to provide coverage of health insurance to their employees. Currently,
three insurance schemes operates in the country (Paulo, Loney and Lapão 2017).
The Thiqa scheme is for Emirati nationals, the basis cover is for unskilled laborers
and enhanced cover for higher skilled workers. Thiqa cardholders comprise about
40.1% of the market and basic insurance holders consist of 26.5% of the market
(Sharif et al. 2013). The payment scheme for individual members differs based on
different insurance company. The difference in Thiqa cover and basic cover is mostly
seen from difference in expatriate and national population.
Koornneef et al. (2012) has reviewed the health system reform in Abu Dhabi
and gave insight into the main components of the reform. The key driver for reform in
the health care system was the President’s Sheikh Zayed bin Sultan Al Nahyan
vision of improving access to high quality health care for consumers. More than 50%
of the GDP of Abu Dhabi comes from their oil reserves. However, reducing
dependence on oil exports paved way for diversification of the health care system of
the country. With discussion on the three insurance schemes available in the
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Emirate of Abu Dhabia, the study gave idea about the way health insurance has
been distributed among national and expatriate population. The main strength of the
evidence by Koornneef et al. (2012) is that it has pointed out to the gap in achieving
affordable and sustainable health care for payers and providers. Secondly, it
discussed about increase in competition through privatization of many health service
contract, however no data has been provided to prove that competition between
providers changes the provisions for affordability of care. Evidence by Collins et al.
(2015) has showed that health care reforms increase health care coverage and
affordability. Hence, poor health coverage in UAE despite health care reform is an
area of future research.
While evaluating the insurance coverage scheme by looking at the health
system reform in Dubai, Sharif et al. (2013) has revealed that Dubai does not have
compulsory health insurance requirement for expatriate workers compared to those
in Abu Dhabi. The research also pointed to the challenges in UAE health system that
needs attention in the future. The key challenges include responding to socio-
demographic changes in the population and distribution of health insurance across
all emirates. Hence, the manner in which people receive coverage by third parties
may also differ based on different cities of UAE. Research done on people
specifically in one city may help to clarify how third party medical (TPA)
administration plays a role in enhancing coverage.
Overview of the role of TPA in health coverage
The TPAs emerged in the health care field to provide better service to policy
holders and eliminate negative consequences of private health insurance. They are
involved in coordinating between health care consumers and providers and

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RESEARCH PROPOSAL
monitoring uses of services and resources (Kennedy and Bartlett 2014). The study
Hamidi and Akinci (2015) mainly focused on evaluating health care payment reforms
in Abu Dhabi. The mandatory health insurance system resulted in the introduction of
many payment reforms in Abu Dhabi. HAAD has been mainly involved in regulating
health care across UAE. Individuals, employers and government are the three main
sources of financing in the city. The author explained that apart from for-profits
insurance companies and brokers, 13 TPAs are also involves in operating health
insurance scheme. Many regional companies like Oman Insurance and Green
Crescent are large payers and small payers outsource administration to TPAs. The
significance of the Hamidi and Akinci (2015) study is that it gave idea about the
impact of these reforms of health care consumers and providers. The positive side of
health reform implementation was that it resulted in rise in demand for medical
service among expatriates. Expatriates workers got the advantage of letting go off
out-of-pocket payments. However, to address the issue of environment sustainability
in the future, there was a need for more research to critically examine the impact of
TPAs in harmonizing payment system and promoting transparency in hospital
financing. This is necessary because Hoo and Lansky (2016) has argued that health
care cost mainly remain unsustainable and applying principles of incentive alignment
may help to fulfill shared goals.
Although there are very few research which has examined the role of TPAs
particularly in UAE, however research evidence has given insight into potential role
of TPAs in health care system of UAE in the future. Alshamsan et al. (2017) aimed to
evaluate percentage of individuals who borrowed for medical reasons and those
people who failed to get adequate funds in Gulf states. This research was
importance in an effort to realize the goals of universal health coverage and
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RESEARCH PROPOSAL
preventing heavy health investment. The research was mainly done in four countries
of Saudi Arabia, Kuwait, UAE and Bahrain. The common characteristics for all this
country were oil and gas as the main source of income, large percentage of
expatriate population and high possibility of increase in demand of health services.
The study findings demonstrated that poor respondents were mainly borrowing
money for medical purpose and the common reason for this was that they could not
get emergency funds. the main significance of this work is that it points out to equity
concerns in health insurance schemes in Abu Dhabi. Hence, this drawbacks points
to the need for health care reforms particularly for pore people in Gulf states. This
research also points out to the future role of TPAs in enhancing consistency in terms
of quality of care. Hoo and Lansky (2016) also supported the fact that utilization of
TPAs by employers is necessary to manage alternative payment designs and handle
challenges in health insurance plans .
Health Insurance and its coverage in UAE
People living in Dubai are now in a better health condition because Dubai
Health Authority (DHA) has made sudden reforms in health care and health
insurance system in Emirates (Jones 2017). This reform enables almost every
travelling or residing to Dubai to enjoy the coverage of the health insurance. This
change has improved health related outcomes across a broad range of patients as
people of Dubai now feel free to visit doctors in case of even minor health related
complications which was previously a fear arising out of sheer financial burden.
However, cancer, the leading cause of death among the Dubai, is not included under
the coverage of the Essential Benefit Plan of Dubai (Jones 2017). However, DHA is
now taking significant efforts to include cancer treatment under the health insurance
plan as per the requirement laid by the mandatory health law. These changes are
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expected to come into enforcement by 2018 (Jones 2017). However, the insurance
companies have given mixed response in regards to the DHA Health Funding
Department decisions. This is because, cancer will lead to the increase in the
reinsurance cost along with an increase in the premium of the Essential Basic
Package under the banner of the Dubai’s mandatory health insurance schemes.
Moreover, the third party administrator (TPA) are also not willing not include cancer
under the health insurance schemes (Asia Insurance Review 2017). According to the
Managing Director of Global Net, Dr. Sanjay Paithankar, earlier only 1/3rd of the total
insured people were aware of the optimal use of the health insurance card. However,
at present more than 80% of the insured group are utilizing health benefits leading to
increase in cost along with reinsurance. Now including cancer in the under the plan
will further lead to a hike in cost (Asia Insurance Review 2017).
UAE Health Insurance and Confusion
UAE has different insurance schemes for different sectors and this creates
confusion among the UAE residents. The research carried out by the Health Monitor
showed that people in UAE are now undertaking more onus in safeguarding the
health future of their family members. This increase in awareness is getting reflected
in the increase in the take up of the critical illness insurance schemes (increase by
16% in 2016). However, this tendency is more prevalent among the female
population in comparison to the make population. However, 40% of the total
respondents participated in the survey carried out by the Health Monitor are
confused with the mandatory insurance assured by the employer and critical illness
insurance (Wealth Monitor 2017). According to the managing director of Friends
Provident International (FPI) of Middle East and Africa, Chris Divito, “It is worrying
that the number of respondents claiming to have critical illness insurance, and

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indicating that it is provided by their employer, has increased in the last year. I am
concerned they may be confusing their mandatory health insurance with critical
illness insurance, which is not something typically provided by an employer as part of
a benefits package. These are two completely different types of insurance and these
people may not be as well protected as they might think”(Wealth Monitor 2017).
Thus the people of UAE is failing to understand the basic difference between health
insurance and critical illness insurance. Health insurance is designed only to cover
the medical insurance and the amount payable is dependent on the cost of the
actual medical treatment. Long-term recuperation, home-care service and therapy
are not included under the health insurance schemes (Wealth Monitor 2017). Critical
illness insurance schemes can be used in a variety of way by the policyholders
depending on their circumstances. Chirs Divito is of the opinion that the people must
consider critically illness insurance as an important addition to their mandatory health
insurance is they have an extended family who is totally dependent on them. On the
other hand, the health insurance will take care of the cost of medical bills in short
term but may not replace the earning that may get endangered in terms of critical
illness (Wealth Monitor 2017).
The same discrepancy in understanding is being reflected in terms of the
mandatory health insurance policy. In Abu Dhabi, the low wageworkers do not have
a clear idea about their health insurance rights. They are not familiar with the
hospitals or clinics, which are under the coverage of the health insurance policies
(Zaman 2010). According to the reports published in the Gulf News, one Indian
construction worker has found complaining that none of the hospitals that he visited
accepted his insurance card and hence he was compelled to avail the health care
facility in his own expense. The excerpts of his statement, “I did not know where to
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go, and was forced to pay one-third of my monthly salary when I sustained a neck
injury and needed treatment. I also asked my family back home to send me the
prescribed medicines” (Zaman 2010). However, when the spokes person from the
company was interrogated, he said that the workers could have approached the
respective supervisors in the head offices in order to fetched relevant information
(Zaman 2010).
2.1 Summary and gaps in the research
The mandatory health insurance for expatriate employees was the main
component of the health care reform in the UAE, however the issue that has been
found in the research by Koornneef et al. (2012) is the uneven distribution and
utilization of health care despite insurance of three health insurance plans. This gap
in information gives direction to fulfill the research objective. It also gives direction
towards investigating the reasons for lower utilization of the health insurance
schemes. The study also gave little insight regarding the affordability of health care.
Hence, conducting research on the role of TPA in health insurance coverage in UAE
is necessary as it can give insight into the reasons for poor utilization of the scheme.
Collecting data directly from expatriate workers in UAE can give idea regarding what
impact does mandatory health insurance system has had on the health care
provisions of the country and how TPA support theme in claiming health insurance
benefits.
Hamidi and Akinci (2015) discussed about health care payment reforms in
Abu Dhabi. It gave idea about the impact of reform on health care providers,
however specific role and contribution of TPAs in health insurance has not been
covered in past research. Due to this limitation, the current research proposal is
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important. Literature review has given idea about challenges in health care reform in
UAE context and role of different funding sources in coverage. As small parties
mainly outsource their administration from TPAs, hence it would be interesting to
evaluate the strength and weakness of TPAs in addressing health insurance issue in
UAE.
The review of literature also provides an insight regarding how the government is
trying to cover all the diseases under the mandatory health care schemes. The
report published in Asia Insurance Review stated that the TPA in UAE is opposing
the proposal of including the cancer coverage under the mandatory health insurance
scheme. The reason cited by Jone (2017) is probable hike in the overall cost of the
reinsurance. However, the review of literature did not highlight how the insured
person is reacting to such policies undertaken by the government or what are their
opinions in regards to the TPA's unwillingness to support cancer patient under the
health scheme. This potential gap in the research opens the gate towards the
analysis of the mindset of UAE population upon the proposal of including the health
coverage of the cancer patient.
The review of literature also highlighted that the there lies certain confusion
among the low-wage workers among the optimal utilization of the health insurance
schemes (Wealth Monitor 2017). However, the review of literate did not provides any
specific insight regarding how or why this confusion is arising among the low-wage
workers. There are also lack of insight in how the TPA is helping these people to
overcome this confusion or whether they are bothered to this problem. Thus this gap
in the research has open the avenue for new research direction that will anlyse that
whether this group of people who are facing difficulty in understanding the optimal

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RESEARCH PROPOSAL
use of the health insurance are aware of the help procured from the TPA in this
regards or what are their understandings in the ground of role of TPA in health
insurance policies.
The review of literature summarizes important elements of health care
reforms in UAE and the role of mandatory health insurance scheme for improving
access to health services for both national and expatriate population. However,
research literature also pointed out to certain limitations in health insurance coverage
such as poor utilization of services, issues related to affordability of services and lack
of emergency medical funds for poorer people. Although specific role of TPA in
health insurance for UAE context has not covered in research literature, however
TPAs are likely to play an important role in regulating the health insurance industry in
UAE.
The report by Nair (2018) explains that TPAs need to raise their game to
comply with new requirements of health regulators. They have to play intermediary
role in processing health insurance claims. The report also recommended that TPAs
needs to become regional players rather than local operator of insurance. Before this
requirement can be realized by TPAs, efficiency in their work can be enhanced by
evaluating the strength and weakness of their current role in health insurance
coverage. This research proposal topic and data coming out from research can give
useful insight regarding the current role of TPA in health coverage and the changes
needed in future to comply with new requirements in health insurance coverage
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Section 3
3.1 Research Methodology
In this research work, the researcher will follow the research philosophy of
positivism with a deductive approach. This will help to formulate the research
hypothesis with the help of the theoretical framework. The researcher will select
stratified sampling method (Saunders, Lewis and Thornhill 2015). This will help to
select the focus group upon which the interview will be done. The overall research
design is descriptive type design. Qualitative analysis method will be undertaken in
order to analyse the answers of the respondents in the interview (Saunders, Lewis
and Thornhill 2015).
3.2 Sampling
For this research, the research will choose random stratified sampling
technique. The criteria that will be taken into consideration while selecting the
respondents for the interview are
1. Participants must be low-wage or medium wage workers
2. Participants must reside in Abu Dhabi or Dubai (permanent resident of UAE)
3. The participants must have a minimum qualification up to 10th standard
4. All the participants are adult and above the age of 18
5. Participants must be enrolled under the mandatory health care policy of Dubai or
Abu Dhabi
6. Participants must have minimum 1 year of work experience in Dubai or Abu Dhabi
On the basis of the above mentioned criteria 30 participants will be selected
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3.3 Method of data collection
The data will be collected on the basis of 10 open ended questionnaire that
will be disseminated among the 30 respondents of the interview. (Questionnaire in
Appendix 2)
3.4 Time Plan of the research
Provided in Appendix 1
3.4 Research ethics
It is duty of the researcher to abide by the Data Protection Act of 1998 while
conducting the research (Saunders, Lewis and Thornhill 2015). The researcher will
try to avoid biasness in the process of data collection and qualitative analysis of the
data. Moreover, the research will also take informed yet signed consent from each of
the participants before the initiating the interview process. The consent form will also
ensure that the research will maintain the confidentiality of each of the participants
via not disclosing their identity (Saunders, Lewis and Thornhill 2015). The research
question will be framed such a way that it avoids any personal questions. Moreover,
no participants will be forced to participate in the interview and will be allowed to
leave at any point of the interview process as per their will. The researcher will also
ensure that the data collected for this research will not be used for other research
work in order to maintain the confidentiality of the research (Saunders, Lewis and
Thornhill 2015).

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Available at: http://gulfnews.com/news/uae/health/workers-confused-about-health-
insurance-rights-1.653565 [Accessed 30 Jan. 2018].

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22
RESEARCH PROPOSAL
Appendix 1
Gantt Chart
Main activities/ stages Week 1 Week
2
Week
3
Week
4
Week
5
Week
6
Week
7
Selection of the Topic
Data collection from
secondary sources (from
journals, news articles
and government
websites)

Creating layout of the
research process

Review of literature
Formation of the plan of
the research

Selection of the
Appropriate Research
Techniques that are
logical, understanding and
reliable

Primary data collection
from interview

Analysis & Interpretation of
Data Collection both from
the review of the literature
and interview (qualitative
analysis)
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23
RESEARCH PROPOSAL
Research findings
Conclusion of the research
and possible
recommendation

Formation of Rough Draft
Submission of Final Work
1 out of 24
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