**1. Introduction**

The research on machining is mostly concerned with the machining of objects made of mono-material and special alloys. On the other hand, research on the machining of objects made of multiple materials cannot be ignored, mainly because of the rising concerns for sustainability. The explanation is given below.

In general, sustainability means fulfilling the present generation's needs without compromising the ability to fulfill the future generations' needs [1]. In more specific terms, sustainability means ensuring material efficiency, energy efficiency, and component efficiency, preferably simultaneously, for all products that inhabit the artificial world [2]. Here, material efficiency is with respect to the usages of materials and takes into account the issues regarding energy consumption and resource depletion while producing the primary materials; it also considers issues like the cost and weight reduction of a product [2–5]. Energy efficiency takes into account the energy consumption during the manufacturing activities (e.g., machining and assembly) of a product [2,5]. Component efficiency takes into account the degree of fulfillment of the intended functionality, quality, and reliability requirements of the components used in a product [2]. The interplay of these efficiencies is presented in detail in [2], where it is concluded that material efficiency is more effective than the other two efficiencies in enhancing the sustainability of a product. For example, a multi-material object is better than its monometallic counterpart (e.g., an object made of aluminum–titanium is better than its monometallic counterpart made of Titanium only, in terms of cost, weight, and CO2 footprint) [2]. Increasing

the material efficiency might affect the energy and component efficiencies, which is not desirable. Therefore, optimization is needed to obtain the best that a multi-material object can offer.

Nevertheless, the usages of multi-material products are expected to increase in the years to come due to the fact mentioned above (i.e., enhancing the sustainability of a product from the viewpoint of material efficiency). Nowadays, both physical joining processes (e.g., friction welding) [6–9] and additive manufacturing processes (e.g., selective laser sintering) [10–13] are used to manufacture objects made of dissimilar metals. The advent of such manufacturing processes will also accelerate the usages of multi-material products since these processes help manufacture different parts made of different types of dissimilar metals. It is worth mentioning that additive manufacturing processes that add materials layer by layer based on the solid model of an object have been found suitable for manufacturing very complex and highly customized objects using multiple materials [10–13]. As such, additive manufacturing processes (selective laser sintering) can easily fabricate an object made of multiple materials, which is often difficult to achieve by conventional manufacturing processes (e.g., machining, casting, forming, and welding).

The above explanation refers to the fact that more and more objects made of multiple materials will inhabit our surroundings in the years to come. However, a multi-material object manufactured either by additive manufacturing or by other manufacturing processes (e.g., friction welding) must be machined so that it achieves the required dimensional accuracy and surface finish. This necessitates machining knowledge regarding multi-material objects. In the literature, a relatively limited number of studies are found regarding the machining of objects made of dissimilar materials. In particular, the studies reported in [14–21] are noted. These studies show that the machining of a multi-material object entails some unique properties. For example, a monometallic workpiece can be machined from any sides, whereas while machining a workpiece made of two different materials, the machining direction must be optimized (e.g., machining from the softer material side to the harder material side or vice versa) [20]. The surface roughness quantification process of an object made of two different metals needs some unconventional parameters (e.g., entropy, possibility distribution, and the like) [19,21]. The main issue of such uniqueness is the existence of the joint area or heat-affected zone, where the material compositions and properties (particularly hardness) exhibit a great deal of variability compared to the constituent materials. The authors in [6–9,22] have described this issue elaborately. Depending on whether a cutting tool passes the joint area from the softer material side to the harder material side, or vice versa, the machining characteristics might differ. As a result, the machining forces (cutting force, feed force, and so on) might exhibit a different kind of character when the cutting tool passes the joint area either from the softer material side to the harder material side or vice versa. Since machining forces provide valuable insights into machining phenomena [23], it is worth investigating the nature of the machining forces that arise when a cutting tool passes the joint area from both sides of a bimetallic specimen. From this contemplation, this article reports the characteristics of machining forces that occur when turning three sets of dissimilar metallic specimens made of aluminum–titanium, aluminum–cast iron, and stainless steel–mild steel. Accordingly, the remainder of this article is organized as follows. Section 2 describes the bimetallic specimens, experimental setup, and data acquisition technique. Section 3 presents the characteristics of the machining forces underlying the stainless steel–mild steel in terms of time series data and uncertainty. Section 4 presents the characteristics of the machining forces underlying the aluminum–titanium in terms of time series data and uncertainty. Section 5 presents the characteristics of the machining forces underlying the aluminum–cast iron in terms of time series data and uncertainty. Section 6 discusses the implication of the results. Section 7 provides the concluding remarks of this study.

#### **2. Machining Experiments and Data Acquisition**

This section describes the bimetallic specimens, experimental setup, and data acquisition technique used while turning the bimetallic specimens.

Three different sets of bimetallic specimens were fabricated using friction welding [6,7]. The description of the welding conditions can be found in [2]. Table 1 lists the materials used to prepare the specimens. The tensile strength, percent elongation, and hardness of each material are also listed in Table 1.

**Table 1.** Materials used for fabricating the dissimilar metallic specimens.

The first set of specimens, defined as SU–SC, was prepared by joining two different materials, namely, stainless steel (JIS: SUS304) and mild steel (JIS: S15CK). The chemical composition (wt%) of the stainless steel was as follows: 0.052 C, 0.416 Si, 1.529 Mn, 0.0319 P, 0.0186 S, 8.057 Ni, 18.293 Cr, 0.185 Mo, 0.483 Cu, and 70.9345 Fe. The chemical composition (wt%) of the mild steel was as follows: 0.15 C, 0.20 Si, 0.40 Mn, 0.19 P, 0.022 S, 0.03 Ni, 0.14 Cr, 0.02 Cu, and 98.848 Fe. The tensile strength (i.e., ultimate strength), elongation, and hardness of the stainless steel were 663 MPa, 55%, and 182 HV, respectively. The tensile strength (i.e., ultimate strength), elongation, and hardness of the Mild Steel were 439 MPa, 38%, and 132 HV, respectively. The second set of specimens, defined as Al–Ti, was prepared by joining two different materials, namely, aluminum (JIS: A1070) and commercial pure (CP) titanium. The chemical composition (wt%) of the aluminum (JIS: A1070) were as follows: 0.03 Si, 0.10 Fe, 0.01 Cu, 0.02 Mg, 0.01 V, 0.01 Ti, others ≤ 0.03 others, and 99.82 Al. The chemical composition (wt%) of the CP titanium was as follows: 0.0011 H, 0.089 O, 0.006 N, 0.038 Fe, 0.005 C, and 99.8609 Ti. The tensile strength (i.e., ultimate strength), elongation, and hardness of the aluminum (JIS: A1070) were 120 MPa, 27%, and 41 HV, respectively. The tensile strength (i.e., ultimate strength), elongation, and hardness of the CP titanium were 401 MPa, 35%, and 146 HV, respectively. The other set of specimens, defined as Al–CI, was prepared by joining two different materials, namely, aluminum (JIS: A5052) and ductile cast iron. The chemical composition (wt%) of the aluminum (JIS: A5052) was as follows: 0.09 Si, 0.16 Fe, 0.02 Cu, 0.03 Mn, 2.6 Mg, 0.25 Cr, 0.01 Zn, ≤0.15 others, and 96.69 Al. The chemical composition (wt%) of the ductile cast iron was as follows: 3.76 C, 2.91 Si, 0.49 P, 0.011 S, 0.029 Mg, and 92.8 Fe. The tensile strength (i.e., ultimate strength), elongation, and hardness of the aluminum (JIS: A5052) were 265 MPa, 17.4%, and 86 HV, respectively. The tensile strength (i.e., ultimate strength), elongation, and hardness of the ductile cast iron were 442 MPa, 18.7%, 79.2 HRB, respectively.

Note that the tensile strength, percent elongation, and hardness of one of the constituent materials are greater than those of the other for each set of specimens. This ensures machining of soft-to-hard material or vice versa at the joint area. Figure 1 shows the pictures of the specimens, one from each set of specimens. The flash generated in the joint area (see Figure 1) was removed by using a turning operation before conducting the machining experiments for obtaining the machining force data. The friction welding conditions used to prepare the bimetallic specimens (Figure 2) are listed in Table 2. As seen in Table 2, for the specimens called SU-SC, the rotating material was S15CK (i.e., mild steel). For the specimens called Al-Ti, the rotating material was A1070 (i.e., aluminum). For the other specimens, the rotating material was A5052 (aluminum). The diameters of rotating material (while performing friction welding) for all specimens were 12 mm. The friction speed, friction pressure, and upset time were 27.5 s−1 (1650 rpm), 30 MPa, and 6 s, respectively, for all specimens. Whereas, the friction times for the specimens namely SU-SC, Al-Ti, and Al-CI were 2 s, 1 s, and 3 s, respectively. The upset pressures for the specimens, namely SU-SC, Al-Ti, and Al-CI were 270 MPa, 90 MPa, and 200 MPa, respectively.

**Figure 2.** Experimental setup.

On the other hand, the cutting conditions for the machining experiments are summarized in Table 3. Carbide inserts (TNMG160404-MF) supplied by SandvikTM were used as cutting tools for the machining experiments. Two cutting speeds (*vc*), 25 m/min and 50 m/min, were used here. The reason for using such cutting velocities is that most job-shop type workshops, where machining is carried out in real-life settings, are often forced to use very low cutting velocities due to resource constraints: see [24] for a detailed description on the choice of cutting speed based on real-life constraints. However, the rotational speed of the chuck was adjusted in every machining run, ensuring the above cutting

velocities. The cutting speeds also ensure no or less tool wear during each machining run. Similar to cutting speed, two values of feed (*f*), 0.1 mm/rev and 0.2 mm/rev, were used, whereas the depth of cut (*ap*) was kept constant (1 mm) for all machining runs. The machining experiments were conducted at three different zones of each specimen: the zones of the constituent materials and the joint area. In Figure 2, one of the constituent materials is denoted as Material A and the other is denoted as Material B. According to Table 1, Material A means stainless steel (JIS: SUS304), aluminum (JIS: A1070), or aluminum (JIS: A5052), for the specimen SU–SC, Al–Ti, or Al–CI, respectively. Similarly, Material B means mild steel (JIS: S15CK), commercial pure (CP) titanium, or ductile cast iron, for the specimen SU–SC, Al–Ti, or Al–CI, respectively.

**Table 2.** Friction welding conditions for fabricating the dissimilar metallic specimens.

**Table 3.** Cutting conditions for machining experiments.

The joint area was machined from both directions—the hard-to-soft material direction and vice versa (i.e., from the Material A to Material B directions, and vice versa)—for each specimen. To do this, the machining force signals for a machining length of about 4 mm were recorded using a strain gage-based data acquisition system, as schematically illustrated in Figure 2. As seen in Figure 2, the system outputs the machining forces from three different channels. One of the channels records the forces in the direction of the cutting speed. The force signals recorded from this channel are called cutting force signals. Another channel records the forces in the direction of the feed. The force signals recorded from this channel are called feed force signals. The other channel records the forces in the direction of the tool post. The force signals recorded from this channel are called thrust force signals. The signals were recorded after every 0.2 ms for the three channels. It is worth mentioning that the cutting and feed force signals were used to calculate the cutting power and thereby to determine the specific cutting energy/pressure. The thrust force signals were not used in the calculations but recorded for the sake of having a complete picture of the machining phenomena.

However, for the sake of analysis, the raw signals require sampling. Figure 3 schematically illustrates the sampling technique. The description is as follows. The time series of the force signals

consists of the signals produced when the cutting tool approaches the cutting zone, when the cutting tool is removing materials, and when the cutting tool moves away from the cutting zone. Therefore, the raw signals, as shown in Figure 3a, require sampling. To do the sampling, a sampling span, i.e., a time interval, was chosen in such a way that the signals in the sampling span consist of cutting/feed/thrust force signals only when the cutting tool removes the materials either in the constituent material zone (i.e., in the zone of Material A and Material B) or in the joint area (i.e., the segment where Material A and B are physically connected). The case shown in Figure 3 corresponds to the sampling of the machining force signals in the joint area. The force signals after sampling were reset to a time equal to zero. Thus, the following relationships hold between the raw and sampled signals.

**Figure 3.** Force data after sampling.

Let *FRX*(*t*), *t* = 0, Δ, ... , *T*1, *T*1 + Δ, ... , *T*2, ... be the raw signals of *X*, ∀*X* ∈ {C, F, T}. Here, C, F, and T mean cutting, feed, and thrust force signals, respectively. The interval [*T*1, *T*2] is the sampling span. The symbol Δ is the sampling interval of the raw signals *FRX*(*t*). As mentioned before, here Δ = 0.2 ms. The segment of signals *FRX*(*t* = *T*1), ... , *FRX*(*t* = *T*2) is used to get the sampled signals. However, the time interval in the sampled signal can be increased for the sake of analysis. Let *FSX*(*τ*) be the sampled signals. Thus, *FSX*(*τ* = 0) = *FRX*(*t* = *T*1), *FSX*(*τ* = *λ*Δ) = *FRX*(*t* = *T*1 + *λ*Δ), ... , *FSX*(*τ* = *nλ*Δ) = *FRX*(*t* = *T*2). This means that the sampled signal consists of *n* + 1 data points, and the data points are collected using a time interval *λ*Δ. If *λ* = 5, and Δ = 0.2 ms, then *λ*Δ = 1 ms, i.e., the time interval of the sampled signal is 1 ms. Therefore, *FSX*(*τ*) means cutting, feed, or thrust force signals at a time interval of 1 ms where *X* = C, F, or T, respectively. This convention is used throughout this article. The pictures of the specimens taken after machining are shown in Appendix A.


**5. Content of the chapter**

### **5.1 The assessment of the capabilities of staff members who can manage the quality assurance office**

The assessment of the staff members who can manage the QA office depends on the culture and the goals or objectives of the organization. Being appointed as AQ manager is very important because this is attached to greater responsibility and accountability regarding the reputation of the organization.

Therefore, the person should have experience in clinical practice and quality assurance and be passionate about working with all stakeholders both internal and external. Furthermore, the manager should embrace Ubuntu's philosophy to work with all stakeholders with Ubuntu as a global concept derived from a South African Zulu word, promoting love, caring, sharing, respect, kindness, compassion, and cooperation. It encourages equal interaction without feeling less human.

Managers are crucial in maintaining control and strategic decisions in the quality assurance department. They ensure that the department operates at high standards, complies with corporate rules, and meets quality requirements. Their primary tasks include client satisfaction, collaboration with subsidiary companies, and maintaining project quality standards [19].

Quality assurance manager ensures successful implementation in:

*The Importance of Quality Assurance in Rural Public Healthcare Facilities DOI: http://dx.doi.org/10.5772/intechopen.113992*

### **5.2 Healthcare needs, resources, and assessment approaches for quality maintenance**

Despite the importance of quality, managers must be active in patient care delivery. Managers must prioritize numerous quality aspects, take into account the demands of providers and patients, and manage resources given to them by the government, commercial entities, and the community. It is critical to address resource distribution, fee schedules, personnel patterns, and management procedures.

Quality, as a multidimensional notion, is especially useful for managers who prioritize access, effectiveness, technical competence, and efficiency. The QA, on the other hand, involves monitoring healthcare professionals' provision of patient care using cost-effective resources and motivating nurses to deliver excellence. It involves nurses taking accountability for their care and ensuring services are regulated by professional members.

Quality assurance aims to create an environment that produces consistent, reliable, and high-level products, detects challenges, and corrects problems that may affect quality. It is a proactive process that prevents quality failures by setting core standards and ensuring compliance. Procedure and policy manuals, healthcare standards, and the South African Nursing Council's scope of practice guide healthcare staff in providing quality patient care. However, the strategies were put in place with limited positive results. Patient satisfaction is not met. There are a lot of complaints in most rural public healthcare facilities that lead to various litigations. The study by Madaka [20] reveals that despite numerous quality improvement initiatives, South Africa's healthcare facilities have not achieved high-quality service delivery, posing a challenge for the government to ensure long-lasting improvement. Below are the challenges faced by relatives, patients, and quality assurance managers handling complaints.

#### **5.3 Challenges faced by relatives, patients, and quality assurance managers handling complaints**

The two components of quality management are quality assurance and quality control, with QA activities encompassing the full quality system and QC being a subset of QA activities [21]. The evaluation of healthcare quality is becoming

more and more important in developing nations, with outcomes serving as a major indicator. Some African nations are creating national quality programs and policies, such as South Africa's National Policy on quality in Healthcare and Zambia's National Quality Assurance program [22, 23]. Ghana is putting into practice a national health quality program, and it is anticipated that quality assurance systems will become essential to the regular provision of health services. Through the implementation of quality assurance systems, Nigeria's health sector reform seeks to increase access to high-quality healthcare. All reform plans and programs must include quality improvement measures according to the Federal Ministry of Health. To establish a quality culture in healthcare systems, health professionals must participate in the quality program and be aware of the required behaviors. An example was the study conducted by Romdhane et al. [24], which showed three key problems in Africa's healthcare system:

More than two-thirds of the perceived problems are attributed to these obstacles, which focus on leadership and governance, the healthcare workforce, the provision of health services, and financing [5]. Furthermore Broadhurst et al. [22], revealed that inadequate training facilities, brain drain, and adverse governmental policies are overt problems. Another significant issue is inadequate funding with low budgetary allocation and poverty being the two main financial obstacles that African healthcare systems must overcome. The approaches for restoring Ubuntu in healthcare facilities are described below.

### **5.4 Restoring Ubuntu in healthcare facilities**

Ubuntu relates to humanity. It is a worldwide concept derived from a South African Zulu word. The concept is based on a saying in Zulu, which states that "umuntu ngomuntu Ngabantu" which means I am because you are Um and Lau [25]. In this chapter, "Ubuntu" refers to embracing love, caring, sharing, respect, kindness, compassion, and cooperation in promoting quality assurance. It is very difficult to ensure that QA is maintained in rural health facilities without embracing the Ubuntu philosophy. Therefore, incorporating Ubuntu in daily activities by health workers is very important.

Caring in nursing and Ubuntu have many parallels because both emphasize caring and other caring ideals, such as respect and dignity. The notion that "a person is a person through other people," which is a direct translation of practically all African languages, is at the center of Ubuntu moral theory, and is known in Tshivenda as "Muthu ndi Muthu Nga Munwe." Ubuntu ethics encourage people to share their belongings for the benefit of all and to care for all people.

The study conducted by Maphumulo and Bhengu [18] mentions Ubuntu as what is ethically decent for individuals and communities, and it is assessed by dignity, respect, and contentment to promote the well-being of others, all of which are frequently shared fairness ideas. Hence, the following Ubuntu principles need to be of value. Ubuntu principles can help clinicians gain a deeper understanding of patients

#### *The Importance of Quality Assurance in Rural Public Healthcare Facilities DOI: http://dx.doi.org/10.5772/intechopen.113992*

and others in their daily lives. These include humaneness, empathy, compromise, learning, change, renewal, restorative justice, love, spirituality, and hope. By incorporating these concepts, clinicians can develop relationships with patients, and harnessing their energy to be the healers, they are meant to be. By embracing these principles, clinicians can create a more compassionate healthcare system.

On the other hand, QA integrated with Ubuntu is a crucial aspect of quality management, ensuring the fulfillment of quality requirements for both management and external stakeholders. It involves systematic activities within the quality system to demonstrate confidence in a healthcare service. For instance, [19] found that Ubuntu can affect how nurses provide care. It involves nurses taking accountability for their care and ensuring services are regulated by professional members. Furthermore, QA involves monitoring healthcare professionals' provision of patient care using cost-effective resources and motivating nurses to deliver excellence showing Ubuntu throughout the caring practices.

Quality assurance aims to create an environment that produces consistent, reliable, and high levels of quality patient care, detects challenges, and corrects problems that may affect quality. It is a proactive process that prevents quality failures by setting standards and ensuring compliance providing quality patient care using autonomy in whatever decision is taken.

#### **5.5 Barriers to maintaining quality care in healthcare facilities**

Financial obstacles to healthcare services with high rates of out-of-pocket spending are further issues with the continent's healthcare system that are common [20]. These issues are caused by an ineffective national health insurance system and insufficient service integration. According to some research, nurses working in rural locations frequently deal with few resources, erratic staffing schedules, and unpredictably high patient census and acuity levels [5, 8].

*Inadequate resources*: A particular level of output is unachievable with inadequate infrastructure, tools, funding for ongoing costs, and employees.

*Personnel issue*: The standard of treatment is impacted by a lack of properly trained, skilled, and motivated staff members.

Patients and staff who are unreasonable: Illness, anxiety, delayed response to therapy, unreasonable, and uncooperative behavior, which, in turn, impacts the quality of care.

*Poor maintenance*: To be used effectively, buildings and equipment need to be properly maintained.

*Lack of an informed public*: In order to increase the quality of nursing care, it is important for individuals to become informed and assert their legal and ethical obligations to receive high-quality care.

*Lack of accreditation regulations*: Hospitals are not adequately inspected to make sure that the minimum requirements are met: Investigate significant instances of neglect and punish the negligent health providers.

*Lack of incident review procedures*: Several occurrences that may occur, while a patient is hospitalized and have an impact on their care and eventual recovery, include wrong medicine, burns caused by substandard practices, or equipment.

*Delayed attendance by doctor or nurse*: A patient dies in a hallway without a doctor or nurse present.

*Not enough effective healthcare information systems*: An effective management information system is crucial for evaluating the quality of care.

*Patient satisfaction surveys not conducted*: surveys that will be conducted by social workers, hospital management students, and consultant groups using questionnaires, interviews, etc.

*Lack of nursing care records*: Nurses should consistently record the care they provide using the nursing process or a problem-oriented record system.

*Lack of oversight*: Absence of supervision, ignorance of the philosophy of nursing care, absence of a policy and administrative manual, absence of a process manual, inadequate quality and quantity of professionals, and subpar education and training.

*Poor management*: Lack of evaluation methods, ineffective departmental and cross-departmental collaboration, absence of formal job descriptions, and job specifications.

*Inadequate programs for nurse education*: Lack of continuous education and inservice training opportunities.

#### **5.6 The effects of poor healthcare services**

Poor healthcare services are increasing illness burdens and health costs globally, hindering progress in all income levels [12]. Besides, the study conducted by Mosadeghrad [26] showed that poor healthcare services failure endangers patients' health and safety. Therefore, QA is crucial to measure quality patient care and put quality control in place to mitigate deviations. For example, inadequate resource distribution, particularly inadequate medication supply, increases the risk of malaria, tuberculosis, and HIV/AIDS, which leads to more complications in patients.

The main causes of poor healthcare, which may be prolonged waiting times for treatment and surgery, negative outcomes, poor cleanliness, inadequate infection control procedures, limited resources, and poor record-keeping if well addressed can ensure quality care. In addition, inadequate training of staff members leads to inadequate knowledge and a lack of competency. As a result, it is critical to explain the interventions for the purpose of raising the standard of quality of patient care, see below.

#### **5.7 The improvement interventions**

Quality is every health worker's responsibility and accountability. This means that in every healthcare facility, the developed policies and procedures in place should be defined to reinforce compliance to the standard of service. Therefore, remedial actions should be suggested in case of deviations between the performance and the standards for QC. QA strategy integrates organizational approach, management, staff, and quantitative techniques to meet client needs and expectations. It is an orderly managerial improvement strategy aimed at addressing the demands and prospects of all organizations as they attempt to deal with rising change, complexity, and pressure within their organizations. Hence, the following interventions are implemented to improve the quality. Healthcare managers should contact non-returning patients for information and implement generic measures to improve service quality and patient well-being. Furthermore, suggestion boxes for survey questionnaires are used to determine patient satisfaction with services rendered.

Healthcare managers need to understand the importance of service quality dimensions in patient satisfaction and how dissatisfied patients react to service failures in order to intervene further to improve the quality of care. Ref. [27] affirmed that healthcare is dependent on patient-provider collaboration and supportive surroundings. Furthermore, [28] demonstrated that change can result from visionary

#### *The Importance of Quality Assurance in Rural Public Healthcare Facilities DOI: http://dx.doi.org/10.5772/intechopen.113992*

leadership, sound planning, education, training, resource availability, proficient management, and provider collaboration. For example, peer reviews and audits must be completed within the agreed-upon time frame, and sometimes unannounced audits are required to improve the quality of care. Furthermore, the buildings must be evaluated in order to increase the security and safety of both clients and health personnel. To avoid unintended consequences, risk officers and occupational health safety personnel should conduct risk assessments in collaboration with quality and infection control practitioners.

The study conducted by Polizzi et al. [28] showed that quality improvement must be a long-term, ongoing activity aimed at reducing errors and creating a trusting atmosphere for both health workers and patients. The healthcare nursing service manager is not solely responsible for quality assurance. All staff members are responsible for assessing and controlling all accidents or hazards. In addition, stated that QA and improvement program is an ongoing assessment of internal audit and consulting work, aiming to enhance the quality and commitment of auditors. As a result, the purpose of the chapter was to explain the significance of quality assurance in public rural healthcare facilities.


**2. Motivation and objectives of hackers**

The purpose of a hacker is to break the security of computers and networks affecting the confidentiality, integrity, and availability of information/service on systems. Such activities of hackers are considered illegal as they invest their time and know how, to make personal gains and breach the security across networks. Before looking at the taxonomy of computer threats, it is necessary to classify the different types of hackers. Each type of hacker is expected to have their own motivation for their activities. The most common of those are included here:

**Fun:** Fun is the only motivation for the script kiddies and lot of nonserious hackers. For them, the breaking into a secure system is a challenging and adventurous enjoyable game to test their wits and skills.

**Vulnerability testing:** Vulnerability testing is done by administrators to locate vulnerabilities and hence develop protections. The same is also done by hackers to identify vulnerabilities in target systems and to find the exploits for those vulnerabilities. This is almost a pre-phase of an attack.

**Theft:** Theft or stealing of data is when hackers infiltrate on a database of credentials of individuals or organizations.

**Espionage:** Espionage is another type of theft where the hacker tries to get protected information instead of the direct financial gain. The information stolen can be either sold in black market or used by adversaries to gain strategic advantages.

**Spamming:** Spamming is not just about unsolicited emails. This spam can be due to certain particular malware that invade the web browser and devastate with unwanted ads.

**Control:** The hacker uses a Trojan or other means to take remote control over another system. Then the hacker can turn that compromised system into a bot or a zombie computer that they use to power spam or to deploy distributed denial of service attacks.

**Disruption:** Disruption of services or access to information, by taking over websites or social media accounts, is usually an act of competition, protest, or rivalry. This effect will slow down or shut down of the target's Internet activity.