To provide better health care services to the rural population, the government has made the Community Health Practitioner(CHP) a regular government official from April 1, 1992. This study was carried out to study the impact of officialization of CHP on the activities and management system of Primary Health Post(PHP). Fifty PHPs were selected by two stage sampling, cluster and simple random, from 595 PHPs in Kyungnam and Kyungpook provinces. Data were collected by a personal interview with CHPs and review of records and reports kept in the PHPs. The study was done for the periods of January 1-March 31, 1992 (before officialization) and January 1-March 31, 1993 (after officialization). Ninety-six percent of the CHPs wanted to become a regular government official in the hope of better job security and higher salary. The proportion of CHPs who were proud of their iob was increased from 24% to 46% after officialization. Those CHPs who felt insecure for their job decreased from 30% to 10%. Monthly salary was increased by 34% from 802,600 Won to 1,076,000 Won and 90% of the CHPs were satisfied with their salary, also more CHPs responded that they have autonomy in their work planning, implementation of plan, management of the post, and evaluation of their activity. There were no appreciable changes in such CHPs' activities as assessment of local health resources, drawing map for the catchment area, utilization of community organization, grasping the current population structure in the catchment area, keeping the family health records, individual and group health education, and school health service. However, the number of home visits was increased from 13.6 times on the average per month per CHP to 27.5 times. More mothers and children were referred to other medical facilities for the immunization and family planning services. Average number of patients of hypertension, cancer, and diabetes in three months period was decreased from 12.7 to 11.6, from 1.5 to 1.2, and 4.3 to 3.4, respectively. Records for the patient care, drug management, and equipment were well kept but not for other records. The level of record keeping was not changed after officialization. The proportion of PHPs which had support from the health center was increased for drug supply from 14.0% to 30.0%, for consumable commodities from 22.0% to 52.0%, for maintenance of PHP from 54.0% to 68.0%, for supply of health education materials from 34.0% to 44.0%, and supply of equipment from 54.0% to 58.0%. Total monthly revenue of a PHP was increased by about 50,000 Won; increased by 22,000 Won in patient care and 34,700 Won in the government subsidy but decreased in the membership due and donation. However, there was no remarkable changes in the expenditure. The proportion of PHPs which had received official notes from the health center for the purpose of guidance and supervision of the CHPs was increased from 20% to 38% during three months period and the average number of telephone call for supervision from the health center per PHP was increased from 1.8 to 2.1 times(p<0.01). However, the proportion of PHPs that had supervisory visit and conference was reduced from 79% to 62%, and from 88% to 74%, respectively. The proportion of CHPs who maintained a cooperative relationship with Myun Health Workers was reduced from 42% to 36%, that with the director of health center from 46% to 24%, that with the chief of public health administration section from 56% to 36%, and that with the chairman of PHP management council from 62% to 38%. Most of the CHPs (92% before and 82% after officialization) stated that the PHP management council is not helpful for the PHP. CHPs who considered the PHP management council unnecessary increased from 4% to 16%(p<0.05). Suggestions made by the CHPs for the improvement of CHP program included emphasis on health education, assurance of autonomy for PHP management, increase of the kind of drugs that can be dispensed by CHPs, and appointment of an experienced CHP in the health center as the supervisor of CHPs. The results of this study revealed that the role and function of CHPs as reflected in their activities have not been changed after officialization. However, satisfaction in job security and salary was improved as well as the autonomy. Support of health center to the PHP was improved but more official notes were sent to the PHPs which required the CHPs more paper works. Number of telephone calls for supervision was increased but there was little administrative and technical guidance for the CHP activities.
When the marcher visited Korea in fall 1994, he was shocked to see high rise apartment buildings around the capitol region including Seoul and Suwon, resulting from rising demand of housing because of urban migration followed by second and third industrial development. After 6 years in March 2000, the researcher witnessed more apartment buildings and vinyl house complexes, one of the evidences of continued economic progress in Korea. Korea had to receive the rescue finance from International Monetary Fund (IMF) because of financial crisis in 1997. However, the sign of recovery was seen in a year, and the growth rate of Gross Domestic Products (GDP) in 1999 recorded as high as 10.7 percent. During this period, the Korean government has been working on restructuring of banks, enterprises, labour and public sectors. The major directions of government were; localization, reducing administrative manpower, limiting agricultural budgets, privatization of public enterprises, integration of agricultural organization, and easing of various regulations. Thus, the power of central government shifted to local government resulting in a power increase for city mayors and county chiefs. Agricultural extension services was one of targets of government restructuring, transferred to local governments from central government. At the same time, the number of extension offices was reduced by 64 percent, extension personnel reduced by 24 percent, and extension budgets reduced. During the process of restructuring, the basic direction of extension services was set by central Rural Development Administration Personnel management, technology development and supports were transferred to provincial Rural Development Administrations, and operational responsibilities transferred to city/county governments. Agricultural extension services at the local levels changed the name to Agricultural Technology Extension Center, established under jurisdiction of city mayor or county chief. The function of technology development works were added, at the same time reducing the number of educators for agriculture and rural life. As a result of observations of rural areas and agricultural extension services at various levels, functional responsibilities of extension were not well recognized throughout the central, provincial, and local levels. Central agricultural extension services should be more concerned about effective rural development by monitoring provincial and local level extension activities more throughly. At county level extension services, it may be desirable to add a research function to reflect local agricultural technological needs. Sometimes, adding administrative tasks for extension educators may be helpful far farmers. However, tasks such as inspection and investigation should be avoided, since it may hinder the effectiveness of extension educational activities. It appeared that major contents of the agricultural extension service in Korea were focused on saving agricultural materials, developing new agricultural technology, enhancing agricultural export, increasing production and establishing market oriented farming. However these kinds of efforts may lead to non-sustainable agriculture. It would be better to put more emphasis on sustainable agriculture in the future. Agricultural extension methods in Korea may be better classified into two approaches or functions; consultation function for advanced farmers and technology transfer or educational function for small farmers. Advanced farmers were more interested in technology and management information, while small farmers were more concerned about information for farm management directions and timely diffusion of agricultural technology information. Agricultural extension service should put more emphasis on small farmer groups and active participation of farmers in these groups. Providing information and moderate advice in selecting alternatives should be the major activities for consultation for advanced farmers, while problem solving processes may be the major educational function for small farmers. Systems such as internet and e-mail should be utilized for functions of information exchange. These activities may not be an easy task for decreased numbers of extension educators along with increased administrative tasks. It may be difficult to practice a one-to-one approach However group guidance may improve the task to a certain degree.