• Title/Summary/Keyword: Financial Constraints

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A Study on the Work of Dental Hygienists by Service Area (치과위생사의 근무지별 업무실태에 관한 조사 연구)

  • Moon, Kyung-Sook;Hwang, Yoon-Sook;Kim, Young-Kyung;Jung, Jae-Yeon
    • Journal of Korean society of Dental Hygiene
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    • v.2 no.1
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    • pp.63-83
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    • 2002
  • The purpose of this study was to serve as a basis for more efficient dental hygienist human resources utilization and for determining some of the right directions for supplementary education for dental hygienists, by examining how they actually worked and what they thought of job-related things. The subjects in this study were 537 dental hygienists who participated in a seminar by the Korea Dental Hygienist Association. After a survey was conducted, the following findings were given: 1. 50.2% of the dental hygienists investigated completed legally required eight-class education. Those who worked in clinics took less supplementary education classes than the others in the other types of dental institutions. The main reason they didn't receive supplementary education was financial burden and uncooperative employers. 73.2% took supplementary education at the association or its branches. The association was most favored by those in clinical sector as a place that provides supplementary education, followed by its branch and university in the order named. And the dental hygienists in public health sector preferred university most, and the next best favored one was the association and its branch in the order named. Those in clinical sector hoped to acquire clinical information on patient management, implant or aesthetics, and the dental hygienists in public health sector wanted to learn about health administration, public oral health operations and oral health education, which were different from what those in clinical sector wanted. 2. Regarding the period of service, 492% had worked for three years or more. This fact suggested that their service term and average age continued to grow. And they thought they would decide the retirement time on their own. 3. The most common yearly income ranged from 12 million won to 16 million won(40.7%). For-those in clinics, yearly income was 14.36 million won, and that of the dental hygienists who had worked for less than 3 years was 12.90 million won. 4. The Korea Dental Hygienist Association was most required to protect the rights and interests of the members and offer new knowledge and technology. 5. The largest group of them were engaged in patient management, and this type of job also was the most favored one for them to do. The greatest number of the dental hygienists in public health sector were in charge of dental treatment. 6. Concerning their turnover rate, 492% had never changed their occupation. Specifically, 70.0% of the respondents who had worked for less than 3 years had have no experience to do that. The time constraints for self-development and conflicts with other workers were the cause of their turnover. Those in dental hospital and general hospital changed their occupation chiefly due to the lack of time for self-development, and for the dental hygienists in clinics, the conflicts with other workers were the main reason. The above-mentioned findings suggested that the way the dental hygienists looked at things was undergoing change. The service area made a difference to their preference for the type of supplementary education and institution in charge of it, as those in public health and clinical sectors had a different opinion. And the dental hygienists in clinical sector had a different opinion as well, according to service area, about salaries, reason of not taking supplementary education, preferred type of supplementary education, cause of turnover, and type of occupation to which they hoped to change employment. To utilize and supply human resources in a more stabilized manner, job description should be more segmented, standardized and classified clearly, and dental hygienists should be motivated to perform their substantial jobs, including oral disease prevention, oral prophylaxis and oral health education. To make it happen, it seems that dentists are required to have a clear understanding of dental hygienist job and to change the way they look at it.

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In Search of "Excess Competition" (과당경쟁(過當競爭)과 정부규제(政府規制))

  • Nam, II-chong;Kim, Jong-seok
    • KDI Journal of Economic Policy
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    • v.13 no.4
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    • pp.31-57
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    • 1991
  • Korean firms of all sizes, from virtually every industry, have used and are using the term "excessive competition" to describe the state of their industry and to call for government interventions. Moreover, the Korean government has frequently responded to such calls in various ways favorable to the firms, such as controlling entry, curbing capacity investments, or allowing collusion. Despite such interventions' impact on the overall efficiency on the Korean economy as well as on the wealth distribution among diverse groups of economic agents, the term "excessive competition", the basis for the interventions, has so far escaped rigorous scrutiny. The objective of this paper is to clarify the notion of "excessive competition" and "over-investment" which usually accompanies "excessive competition", and to examine the circumstances under which they might occur. We first survey the cases where the terms are most widely used and proceed to examine those cases to determine if competition is indeed excessive, and if so, what causes "excessive competition". Our main concern deals with the case in which the firms must make investment decisions that involve large sunk costs while facing uncertain demand. In order to analyze this case, we developed a two period model of capacity precommitment and the ensuing competition. In the first period, oligopolistic firms make capacity investments that are irreversible. Demand is uncertain in period 1 and only the distribution is known. Thus, firms must make investment decisions under uncertainty. In the second period, demand is realized, and the firms compete with quantity under realized demand and capacity constraints. In the above setting, we find that there is "no over-investment," en ante, and there is "no excessive competition," ex post. As measured by the information available in period 1, expected return from investment of a firm is non-negative, overall industry capacity does not exceed the socially optimal level, and competition in the second period yields an outcome that gives each operating firm a non-negative second period profit. Thus, neither "excessive competition" nor "over-investment" is possible. This result will generally hold true if there is no externality and if the industry is not a natural monopoly. We also extend this result by examining a model in which the government is an active participant in the game with a well defined preference. Analysis of this model shows that over-investment arises if the government cannot credibly precommit itself to non-intervention when ex post idle capacity occurs, due to socio-political reasons. Firms invest in capacities that exceed socially optimal levels in this case because they correctly expect that the government will find it optimal for itself to intervene once over-investment and ensuing financial problems for the firms occur. Such planned over-investment and ensuing government intervention are the generic problems under the current system. These problems are expected to be repeated in many industries in years to come, causing a significant loss of welfare in the long run. As a remedy to this problem, we recommend a non-intervention policy by the government which creates and utilizes uncertainty. Based upon an argument which is essentially the same as that of Kreps and Wilson in the context of a chain-store game, we show that maintaining a consistent non-intervention policy will deter a planned over-investment by firms in the long run. We believe that the results obtained in this paper has a direct bearing on the public policies relating to many industries including the petrochemical industry that is currently in the center of heated debates.

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The Perception of Gifted Science Teachers Regarding a Individualized Instruction for Scientifically Gifted (영재 개별화 교육에 관한 과학영재 지도교사들의 인식)

  • Kim, Su-yeon;Han, Shin;Jeong, Jinwoo
    • Journal of the Korean Society of Earth Science Education
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    • v.9 no.2
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    • pp.199-216
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    • 2016
  • The purpose of this study is to figure out how much gifted science education teachers in charge of the class realize the necessity of individualized curriculum and program for scientifically gifted, to find out the problems of the gifted science educational institutions from exploring them in depth in the light of the reality in the gifted science educational institutions, and to draw implications about the applicable direction of more aggressive individualized curriculum and program for scientifically gifted. I chose 15 people with the incumbent teachers who have ever taught scientifically gifted and have a degree in the gifted education or science subject education as study participants and had a depth interview with them. According to result of the study, 14 of 15 study participants recognized the necessity of individualized education in science should understand the personal requirements according to the tendency of the gifted students and should be a study led by students themselves. Of the problems in gifted science education, teachers regarded the reduction in the financial support as the biggest problem and the vocation and professionalism of teachers were referred as a very important factor. With constraints of time and space, there were plenty of opinions that can't ignore the influence of educational environment associated with the university entrance examination. There were many opinions that there is excessive expansion of the agencies and the target for gifted students, no standardized measurement tools and programs and the lack of the system for the coherent observation as a teacher. Also, the unified curriculum of gifted science education institutions were pointed out as the problem and the individualized programs which were already under way have a lot of weakness and being offered marginally. Thus, from now on, to apply for individualized education of gifted science, teachers demanded optimized education conditions and consistent policy support, and expressed the opinion that there needs of a possible continuous observation system. Besides, the curriculum and programs matched the needs of the students should be taken priority the most, and there were another answers that fellow learning within the cooperative learning can be an alternative of the individualized. Along with that, there were lots of opinions that the treatment to overcome an inferiority complex according to the individualized should be followed.

Changing Aspects and Factors of Shaman's Play in Donghaeanbyeolsingut (동해안별신굿 굿놀이의 변화양상과 요인)

  • Kim, Shin-Hyo
    • (The) Research of the performance art and culture
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    • no.38
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    • pp.33-69
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    • 2019
  • In this article, I would like to pay attention to the changesofShaman's play as a part of examining the process of changeofDonghaeanbyeolsingut. Currently, Shaman's play can be seeninBaekseok2-ri, Byeonggok-myeon, Yeongdeok-gun, Gugye-ri, Namjeong-myeon and Yeongdeok-gun. Among them, ShamanRitual of Baekseok2-ri is short in cycle and easy to see change. InShaman Ritual of Baekseok2-ri, various Shaman's plays suchasJungdodukjabi(중도둑잡이), Wonnimnori(원님놀이), Talgut(탈굿), Mallori(말놀이), Hotalgut(호탈굿) and Georigut(거리굿) areperformed. Shaman's play carried out in Donghaeanbyeolsingut changesevery time it is carried out. Depending on the degree of change, itcan be classified into passive change and positive change. Whilepassive changes are improvisational, aggressive changes areintentional. Shaman's plays are jungdodukjabi, Mallori, Hotalgut, which are the improvisational changes, and the intentional changesare Wonnimnori, Talgut, Georigut. The biggest change in Shaman's play is the disappearance of the Shaman Ritual. The Shaman Ritual is suspended due to lackofpeople, financial difficulties, religious conflicts or rational accidents. Secondly, the period of separation is shortened or shortened. Thiscauses Shaman's play to be dropped or shrunk to change. InShaman Ritual, changes in Shaman's play are variable andcreative. The change due to the intervention of the spectatorsismainly improvisation. On the other hand, the change bythepreliminary plan of the acquaintance is intentional, and the changeis large. The changing factors of Shaman's play are influenced bythedemands of the times and the recognition of the tradition group. Changes in the traditional environment can be attributed to lackofhuman resources, individualism, changes in the workingenvironment and time constraints. At the same time, givingautonomy to traffickers is a major reason for Shaman's playtochange.

Comparison of Attitudes toward Children among Mothers of Young Children and Maternal Grandmothers: With Specific Focus on Ideal Number of Children, Gender Preference, Expectation Old Age Security and Positive and Negative Values of Children (유아 어머니와 외할머니 세대의 자녀관련 인식 비교: 이상적 자녀 수, 자녀의 성별에 대한 선호도, 노후부양에 대한 기대, 긍정적 자녀가치와 부정적 자녀가치를 중심으로)

  • Young-Shin Park ;Uichol Kim ;Mi-Sook Kim
    • Korean Journal of Culture and Social Issue
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    • v.18 no.1
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    • pp.127-152
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    • 2012
  • The research investigates the attitudes toward children among mothers young children and maternal grandmothers, focusing specifically on the ideal number of children, gender preference, old age security and positive and negative values of children. A total of 442 respondents, consisting of 221 young mothers (average age of 35) and 221 maternal grandmothers (average age of 63) completed a questionnaire developed by Kim, Park and Kwon (2005). The reliability of the scales ranged from Cronbach α of .78 to .91. The results are as follows. First, as for the ideal number of children, young mothers reported that they would prefer two children, while grandmothers reported that they would prefer four children. As for the ideal number of male child, young mothers reported that they would prefer that they would prefer one son, while grandmothers reported two sons. Second, as for the gender of the child, young mothers did not show a gender preference, while grandmothers stated that at least one child should be a son, especially if it is the only child. Third, grandmothers had higher expectation of old age security in their male child than young mothers but two groups did not show any difference for the female child. Fourth, as for positive values of children, young mothers were more likely to emphasize personal aspects (i.e., psychological pleasure and happiness) and family cohesiveness, while grandmothers were more likely to emphasize social aspects (i.e., continuing the family line and old age security. As for negative values of children, young mothers were more likely to emphasize personal aspects (i.e., parental role and responsibility), while grandmothers were more likely to emphasize social aspects (i.e., family conflict and relationship). Fifth, as for factors that influenced the number of children that they decided to have, young mothers were more likely to report negative values of children (i.e., financial constraints), while grandmothers were more likely to emphasize positive values of children (i.e., continuing the family line).

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An Empirical Study on the Determinants of Supply Chain Management Systems Success from Vendor's Perspective (참여자관점에서 공급사슬관리 시스템의 성공에 영향을 미치는 요인에 관한 실증연구)

  • Kang, Sung-Bae;Moon, Tae-Soo;Chung, Yoon
    • Asia pacific journal of information systems
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    • v.20 no.3
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    • pp.139-166
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    • 2010
  • The supply chain management (SCM) systems have emerged as strong managerial tools for manufacturing firms in enhancing competitive strength. Despite of large investments in the SCM systems, many companies are not fully realizing the promised benefits from the systems. A review of literature on adoption, implementation and success factor of IOS (inter-organization systems), EDI (electronic data interchange) systems, shows that this issue has been examined from multiple theoretic perspectives. And many researchers have attempted to identify the factors which influence the success of system implementation. However, the existing studies have two drawbacks in revealing the determinants of systems implementation success. First, previous researches raise questions as to the appropriateness of research subjects selected. Most SCM systems are operating in the form of private industrial networks, where the participants of the systems consist of two distinct groups: focus companies and vendors. The focus companies are the primary actors in developing and operating the systems, while vendors are passive participants which are connected to the system in order to supply raw materials and parts to the focus companies. Under the circumstance, there are three ways in selecting the research subjects; focus companies only, vendors only, or two parties grouped together. It is hard to find researches that use the focus companies exclusively as the subjects probably due to the insufficient sample size for statistic analysis. Most researches have been conducted using the data collected from both groups. We argue that the SCM success factors cannot be correctly indentified in this case. The focus companies and the vendors are in different positions in many areas regarding the system implementation: firm size, managerial resources, bargaining power, organizational maturity, and etc. There are no obvious reasons to believe that the success factors of the two groups are identical. Grouping the two groups also raises questions on measuring the system success. The benefits from utilizing the systems may not be commonly distributed to the two groups. One group's benefits might be realized at the expenses of the other group considering the situation where vendors participating in SCM systems are under continuous pressures from the focus companies with respect to prices, quality, and delivery time. Therefore, by combining the system outcomes of both groups we cannot measure the system benefits obtained by each group correctly. Second, the measures of system success adopted in the previous researches have shortcoming in measuring the SCM success. User satisfaction, system utilization, and user attitudes toward the systems are most commonly used success measures in the existing studies. These measures have been developed as proxy variables in the studies of decision support systems (DSS) where the contribution of the systems to the organization performance is very difficult to measure. Unlike the DSS, the SCM systems have more specific goals, such as cost saving, inventory reduction, quality improvement, rapid time, and higher customer service. We maintain that more specific measures can be developed instead of proxy variables in order to measure the system benefits correctly. The purpose of this study is to find the determinants of SCM systems success in the perspective of vendor companies. In developing the research model, we have focused on selecting the success factors appropriate for the vendors through reviewing past researches and on developing more accurate success measures. The variables can be classified into following: technological, organizational, and environmental factors on the basis of TOE (Technology-Organization-Environment) framework. The model consists of three independent variables (competition intensity, top management support, and information system maturity), one mediating variable (collaboration), one moderating variable (government support), and a dependent variable (system success). The systems success measures have been developed to reflect the operational benefits of the SCM systems; improvement in planning and analysis capabilities, faster throughput, cost reduction, task integration, and improved product and customer service. The model has been validated using the survey data collected from 122 vendors participating in the SCM systems in Korea. To test for mediation, one should estimate the hierarchical regression analysis on the collaboration. And moderating effect analysis should estimate the moderated multiple regression, examines the effect of the government support. The result shows that information system maturity and top management support are the most important determinants of SCM system success. Supply chain technologies that standardize data formats and enhance information sharing may be adopted by supply chain leader organization because of the influence of focal company in the private industrial networks in order to streamline transactions and improve inter-organization communication. Specially, the need to develop and sustain an information system maturity will provide the focus and purpose to successfully overcome information system obstacles and resistance to innovation diffusion within the supply chain network organization. The support of top management will help focus efforts toward the realization of inter-organizational benefits and lend credibility to functional managers responsible for its implementation. The active involvement, vision, and direction of high level executives provide the impetus needed to sustain the implementation of SCM. The quality of collaboration relationships also is positively related to outcome variable. Collaboration variable is found to have a mediation effect between on influencing factors and implementation success. Higher levels of inter-organizational collaboration behaviors such as shared planning and flexibility in coordinating activities were found to be strongly linked to the vendors trust in the supply chain network. Government support moderates the effect of the IS maturity, competitive intensity, top management support on collaboration and implementation success of SCM. In general, the vendor companies face substantially greater risks in SCM implementation than the larger companies do because of severe constraints on financial and human resources and limited education on SCM systems. Besides resources, Vendors generally lack computer experience and do not have sufficient internal SCM expertise. For these reasons, government supports may establish requirements for firms doing business with the government or provide incentives to adopt, implementation SCM or practices. Government support provides significant improvements in implementation success of SCM when IS maturity, competitive intensity, top management support and collaboration are low. The environmental characteristic of competition intensity has no direct effect on vendor perspective of SCM system success. But, vendors facing above average competition intensity will have a greater need for changing technology. This suggests that companies trying to implement SCM systems should set up compatible supply chain networks and a high-quality collaboration relationship for implementation and performance.

A Study on Industries's Leading at the Stock Market in Korea - Gradual Diffusion of Information and Cross-Asset Return Predictability- (산업의 주식시장 선행성에 관한 실증분석 - 자산간 수익률 예측 가능성 -)

  • Kim Jong-Kwon
    • Proceedings of the Safety Management and Science Conference
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    • 2004.11a
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    • pp.355-380
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    • 2004
  • I test the hypothesis that the gradual diffusion of information across asset markets leads to cross-asset return predictability in Korea. Using thirty-six industry portfolios and the broad market index as our test assets, I establish several key results. First, a number of industries such as semiconductor, electronics, metal, and petroleum lead the stock market by up to one month. In contrast, the market, which is widely followed, only leads a few industries. Importantly, an industry's ability to lead the market is correlated with its propensity to forecast various indicators of economic activity such as industrial production growth. Consistent with our hypothesis, these findings indicate that the market reacts with a delay to information in industry returns about its fundamentals because information diffuses only gradually across asset markets. Traditional theories of asset pricing assume that investors have unlimited information-processing capacity. However, this assumption does not hold for many traders, even the most sophisticated ones. Many economists recognize that investors are better characterized as being only boundedly rational(see Shiller(2000), Sims(2201)). Even from casual observation, few traders can pay attention to all sources of information much less understand their impact on the prices of assets that they trade. Indeed, a large literature in psychology documents the extent to which even attention is a precious cognitive resource(see, eg., Kahneman(1973), Nisbett and Ross(1980), Fiske and Taylor(1991)). A number of papers have explored the implications of limited information- processing capacity for asset prices. I will review this literature in Section II. For instance, Merton(1987) develops a static model of multiple stocks in which investors only have information about a limited number of stocks and only trade those that they have information about. Related models of limited market participation include brennan(1975) and Allen and Gale(1994). As a result, stocks that are less recognized by investors have a smaller investor base(neglected stocks) and trade at a greater discount because of limited risk sharing. More recently, Hong and Stein(1999) develop a dynamic model of a single asset in which information gradually diffuses across the investment public and investors are unable to perform the rational expectations trick of extracting information from prices. Hong and Stein(1999). My hypothesis is that the gradual diffusion of information across asset markets leads to cross-asset return predictability. This hypothesis relies on two key assumptions. The first is that valuable information that originates in one asset reaches investors in other markets only with a lag, i.e. news travels slowly across markets. The second assumption is that because of limited information-processing capacity, many (though not necessarily all) investors may not pay attention or be able to extract the information from the asset prices of markets that they do not participate in. These two assumptions taken together leads to cross-asset return predictability. My hypothesis would appear to be a very plausible one for a few reasons. To begin with, as pointed out by Merton(1987) and the subsequent literature on segmented markets and limited market participation, few investors trade all assets. Put another way, limited participation is a pervasive feature of financial markets. Indeed, even among equity money managers, there is specialization along industries such as sector or market timing funds. Some reasons for this limited market participation include tax, regulatory or liquidity constraints. More plausibly, investors have to specialize because they have their hands full trying to understand the markets that they do participate in

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A Study on Knowledge Entity Extraction Method for Individual Stocks Based on Neural Tensor Network (뉴럴 텐서 네트워크 기반 주식 개별종목 지식개체명 추출 방법에 관한 연구)

  • Yang, Yunseok;Lee, Hyun Jun;Oh, Kyong Joo
    • Journal of Intelligence and Information Systems
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    • v.25 no.2
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    • pp.25-38
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    • 2019
  • Selecting high-quality information that meets the interests and needs of users among the overflowing contents is becoming more important as the generation continues. In the flood of information, efforts to reflect the intention of the user in the search result better are being tried, rather than recognizing the information request as a simple string. Also, large IT companies such as Google and Microsoft focus on developing knowledge-based technologies including search engines which provide users with satisfaction and convenience. Especially, the finance is one of the fields expected to have the usefulness and potential of text data analysis because it's constantly generating new information, and the earlier the information is, the more valuable it is. Automatic knowledge extraction can be effective in areas where information flow is vast, such as financial sector, and new information continues to emerge. However, there are several practical difficulties faced by automatic knowledge extraction. First, there are difficulties in making corpus from different fields with same algorithm, and it is difficult to extract good quality triple. Second, it becomes more difficult to produce labeled text data by people if the extent and scope of knowledge increases and patterns are constantly updated. Third, performance evaluation is difficult due to the characteristics of unsupervised learning. Finally, problem definition for automatic knowledge extraction is not easy because of ambiguous conceptual characteristics of knowledge. So, in order to overcome limits described above and improve the semantic performance of stock-related information searching, this study attempts to extract the knowledge entity by using neural tensor network and evaluate the performance of them. Different from other references, the purpose of this study is to extract knowledge entity which is related to individual stock items. Various but relatively simple data processing methods are applied in the presented model to solve the problems of previous researches and to enhance the effectiveness of the model. From these processes, this study has the following three significances. First, A practical and simple automatic knowledge extraction method that can be applied. Second, the possibility of performance evaluation is presented through simple problem definition. Finally, the expressiveness of the knowledge increased by generating input data on a sentence basis without complex morphological analysis. The results of the empirical analysis and objective performance evaluation method are also presented. The empirical study to confirm the usefulness of the presented model, experts' reports about individual 30 stocks which are top 30 items based on frequency of publication from May 30, 2017 to May 21, 2018 are used. the total number of reports are 5,600, and 3,074 reports, which accounts about 55% of the total, is designated as a training set, and other 45% of reports are designated as a testing set. Before constructing the model, all reports of a training set are classified by stocks, and their entities are extracted using named entity recognition tool which is the KKMA. for each stocks, top 100 entities based on appearance frequency are selected, and become vectorized using one-hot encoding. After that, by using neural tensor network, the same number of score functions as stocks are trained. Thus, if a new entity from a testing set appears, we can try to calculate the score by putting it into every single score function, and the stock of the function with the highest score is predicted as the related item with the entity. To evaluate presented models, we confirm prediction power and determining whether the score functions are well constructed by calculating hit ratio for all reports of testing set. As a result of the empirical study, the presented model shows 69.3% hit accuracy for testing set which consists of 2,526 reports. this hit ratio is meaningfully high despite of some constraints for conducting research. Looking at the prediction performance of the model for each stocks, only 3 stocks, which are LG ELECTRONICS, KiaMtr, and Mando, show extremely low performance than average. this result maybe due to the interference effect with other similar items and generation of new knowledge. In this paper, we propose a methodology to find out key entities or their combinations which are necessary to search related information in accordance with the user's investment intention. Graph data is generated by using only the named entity recognition tool and applied to the neural tensor network without learning corpus or word vectors for the field. From the empirical test, we confirm the effectiveness of the presented model as described above. However, there also exist some limits and things to complement. Representatively, the phenomenon that the model performance is especially bad for only some stocks shows the need for further researches. Finally, through the empirical study, we confirmed that the learning method presented in this study can be used for the purpose of matching the new text information semantically with the related stocks.

An Intervention Study on Integration of Family Planning and Maternal/Infant Care Services in Rural Korea (가족계획과 모자보건 통합을 위한 조산원의 투입효과 분석 -서산지역의 개입연구 평가보고-)

  • Bang, Sook;Han, Seung-Hyun;Lee, Chung-Ja;Ahn, Moon-Young;Lee, In-Sook;Kim, Eun-Shil;Kim, Chong-Ho
    • Journal of Preventive Medicine and Public Health
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    • v.20 no.1 s.21
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    • pp.165-203
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    • 1987
  • This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, $85{\sim}90%$ of the services provided by the health workers were other than FP/MCH, mainly for immunizations such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs.31%) and for more combined care (45% vs.23%). C) Organization factors (admistrative integrative issues) 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following ; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub·center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwive's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea); 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through family planning practice. 2) Goal consensus in FP/MCH shouBd be made among the health workers It administrators, especially to emphasize the need of care of 'wanted' child. But there is a long way to go to realize the 'real' integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (in) there should be a health sub·center director who can provide leadership training for managing the integrated program. There is a need for 'organizational support', if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the managment of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Worker, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.

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