• 농촌지도와개발
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• 제7권1호
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• pp.155-166
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• 2000

1994년 가을 한국을 방문하였을 때 놀란 것 온 도시 근교에 숲과 같이 세워진 고층 아파트 단지와 그 수요의 배경이 된 서울, 수원을 비롯한 수도권의 인구 집중이었다. 이러한 인구 집중을 가져온 것은 바로 제2차, 3차 산업의 발달이었다. 그 이후 6년만인 2000년 3월에 다시 농촌과 농촌지도사업의 변화 동향을 살펴보기 위하여 농가 방문, 도 농업기술원 및 시 ${\cdot}$ 군농업 기술센터를 방문하면서 더욱 진전된 아파트군과 도시 근교의 비닐 하우스 단지였으며, 이는 한국이 지속적인 경제 발전을 하고 있다는 한 증거였다. 한국은 1997년에 내습한 통화위기로 IMF의 구제 금융을 받게 되었고, 이로 인하여 한국 경제는 IMF의 관리하에 있었으나 1년만에 회복의 기미를 보이기 시작하였으며, 1999에는 GDP 성장률이 10.7%에 달하였다. 한국 정부는 이 시기에 구조개혁을 단행하여 금융, 기업, 노동, 공공의 각 부분에 개혁을 단행하였다. 특히 정부로서는 정부 조직을 개편하여 지방화, 행정 조직 인원의 삭감, 농업 예산의 축소하는 방향으로 나아갔고 공기업을 민영화하여 농업 단체의 통합, 각종 규제를 철폐하였다. 중앙 정부의 권력이 지방으로 많이 이양되어 시장, 군수 등의 권한이 크게 늘어났다. 농촌지도사업도 IMF 관리하의 정부 조직 개편 및 규제 완화의 대상이 되었다. 지금까지 중앙 정부 소속이었던 농촌지도 사업이 지방화의 영향으로 시 ${\cdot}$ 군으로 이관되었다. 이것에 동반하여 농촌지도소 수의 축소(64%), 지도 직원의 감원(24%), 사업 예산의 감소 등으로 나타났다. 이러한 개편 과정에서 농촌지도사업의 기본적인 방향을 정하는 것은 중앙의 농촌진흥청이 맡고 인사와 기술 개발, 지원은 도농업기술원, 사업운영 책임은 시 ${\cdot}$ 군에서 맡는 체제로 개편되었다. 시 ${\cdot}$ 군 단계의 농촌지도사업은 담당 기구가 농촌지도소에서 농업기술센터로 그 명칭이 변경되었고, 설치권자가 군수로 되었으며, 그 기능에 기술 개발 업무가 더해졌으며, 농촌지도사 및 생활지도사의 수가 크게 감소되었다. 최근에 한국의 농촌 및 농촌지도사업을 관찰한 결과, 이러한 중앙, 도 시 군의 지도 기능 분담이 그렇게 잘 인식되어 있는 것만은 아닌 면도 있는 것으로 보였다. 이러한 구조 개선을 계기로 해서 농촌의 현실을 반영한 실효성 있는 농촌진흥에 기여할 수 있는 농촌지도사업으로 재출발한다는 의의를 살릴 수 있도록 농촌진흥청은 농업기술센터의 동태를 철저하게 살피고 이와 관련한 도농업기술원의 대응을 파악하여 이를 기초로 기능을 발휘하도록 만들어야 할 것이다. 국가에서 이관된 현지의 농촌지도 거점인 농업기술센터에 관하여 농촌지도소가 개칭되어 농업기술센터가 되었고 조직적인 면에서도 기술개발과가 설치되었다. 이는 현지에서의 기술 개발이 가능하게 된 점과 현지에서 원하는 과제를 신속하게 대응하여 도와 국가의 시험연구 과제로 삼을 수 있게 된 것은 시험 연구 사업에서 크게 평가받을 만한 발전이라 할 것이다. 그러나, 농촌지도 직원이 다른 행정 업무도 겸무하여 될 경우 영농 환경을 좋게 하는 직접적인 행정에 관한 업무에서는 겸무하므로서 농가도 편리해지고, 보급지도의 효과도 촉진되는 경우가 있으나 검사, 취체 업무는 반드시 피해야 할 일이다. 동일인이 이것을 담당하게 되면 농가에게 안심감을 잃어버리고 보급 효과는 기대할 수 없게 될 것이다. 한국의 농촌지도사업의 보급 내용은 농업자재의 절약, 첨단농업기술의 개발, 이를 기반으로 수출농업의 촉진과 생산성 향상, 시장에 강한 농업의 구축 등에 힘을 쏟고 있는 것으로 보였다. 그러나 이러한 농업의 추구는 약탈농업을 추구하는 등 지속적 농업이 되지 않을 가능성이 높아지게 된다. 앞으로 지속적인 농업에 관하여 보다 더 많은 관심을 기울여야 할 것이다. 선진농가들은 기술이나 경영 혁신을 위하여 연구 개발을 위한 정보의 수집과 연구회의 필요성을 크게 강조하고 있었다. 그러나 이러한 선진 농가 이외에 소규모의 농업소득이 낮은 농가도 있었다. 이러한 농가에게는 농업경영에 대한 방향 설정과 추진 방법에 대한 적절한 상담 상대가 없는 것으로 보였다. 이러한 농가들에 대한 시의적절한 정보의 전달, 자력으로 기술과 경영 방책을 만들어내는 힘을 길러주는 지도가 필요하다. 이를 위한 방책으로 그룹의 육성과 가입 촉진이 유효할 것이다. 따라서 한국에 있어서 농촌지도 방법은 크게 두 가지 대상을 의식하여 대 선진농가의 경우에 는 상담 기능, 대 소규모 농가의 청우에는 전달 ${\cdot}$ 교육 기능의 발휘에 있을 것이다. 상담 기능은 정보의 제공과 과도하지 않은 방책을 선택 할 수 있도록 지도 조언하는 것이, 전달 ${\cdot}$ 교육 기능은 과제해결 과정을 체득하게 하는 것이다. 이를 위하여 인터넷의 활용 방법, e-메일에 의한 정보교환 시스템화 등의 연구가 진행되고 있다. 인원의 감소나 겸무화의 진행에 따라 이러한 업무의 수행이 쉬운 것은 아니라고 생각되고, 일 대 일의 지도는 어려울 것이나 집단 지도로는 가능한 측면도 있을 것으로 사료된다.

• Journal of Preventive Medicine and Public Health
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• 제7권1호
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• pp.29-94
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• 1974

Today most developed countries provide modern medical care for most of the population. The rural area is the more neglected area in the medical and health field. In public health, the philosophy is that medical care for in maintenance of health is a basic right of man; it should not be discriminated against racial, environmental or financial situations. The deficiency of the medical care system, cultural bias, economic development, and ignorance of the residents about health care brought about the shortage of medical personnel and facilities on the rural areas. Moreover, medical students and physicians have been taught less about rural health care than about urban health care. Medical care, therefore, is insufficient in terms of health care personnel/and facilities in rural areas. Under such a situation, there is growing concern about the health problems among the rural population. The findings presented in this report are useful measures of the major health problems and even more important, as a guide to planning for improved medical care systems. It is hoped that findings from this study will be useful to those responsible for improving the delivery of health service for the rural population. Objectives: -to determine the health status of the residents in the rural areas. -to assess the rural population's needs in terms of health and medical care. -to make recommendations concerning improvement in the delivery of health and medical care for the rural population. Procedures: For the sampling design, the ideal would be to sample according to the proportion of the composition age-groups. As the health problems would be different by group, the sample was divided into 10 different age-groups. If the sample were allocated by proportion of composition of each age group, some age groups would be too small to estimate the health problem. The sample size of each age-group population was 100 people/age-groups. Personal interviews were conducted by specially trained medical students. The interviews dealt at length with current health status, medical care problems, utilization of medical services, medical cost paid for medical care and attitudes toward health. In addition, more information was gained from the public health field, including environmental sanitation, maternal and child health, family planning, tuberculosis control, and dental health. The sample Sample size was one fourth of total population: 1,438 The aged 10-14 years showed the largest number of 254 and the aged under one year was the smallest number of 81. Participation in examination Examination sessions usually were held in the morning every Tuesday, Wenesday, and Thursday for 3 hours at each session at the Namchun Health station. In general, the rate of participation in medical examination was low especially in ages between 10-19 years old. The highest rate of participation among are groups was the under one year age-group by 100 percent. The lowest use rate as low as 3% of those in the age-groups 10-19 years who are attending junior and senior high school in Taegu city so the time was not convenient for them to recieve examinations. Among the over 20 years old group, the rate of participation of female was higher than that of males. The results are as follows: A. Publie health problems Population: The number of pre-school age group who required child health was 724, among them infants numbered 96. Number of eligible women aged 15-44 years was 1,279, and women with husband who need maternal health numbered 700. The age-group of 65 years or older was 201 needed more health care and 65 of them had disabilities. (Table 2). Environmental sanitation: Seventy-nine percent of the residents relied upon well water as a primary source of dringking water. Ninety-three percent of the drinking water supply was rated as unfited quality for drinking. More than 90% of latrines were unhygienic, in structure design and sanitation (Table 15). Maternal and child health: Maternal health Average number of pregnancies of eligible women was 4 times. There was almost no pre- and post-natal care. Pregnancy wastage Still births was 33 per 1,000 live births. Spontaneous abortion was 156 per 1,000 live births. Induced abortion was 137 per 1,000 live births. Delivery condition More than 90 percent of deliveries were conducted at home. Attendants at last delivery were laymen by 76% and delivery without attendants was 14%. The rate of non-sterilized scissors as an instrument used to cut the umbilical cord was as high as 54% and of sickles was 14%. The rate of difficult delivery counted for 3%. Maternal death rate estimates about 35 per 10,000 live births. Child health Consultation rate for child health was almost non existant. In general, vaccination rate of children was low; vaccination rates for children aged 0-5 years with BCG and small pox were 34 and 28 percent respectively. The rate of vaccination with DPT and Polio were 23 and 25% respectively but the rate of the complete three injections were as low as 5 and 3% respectively. The number of dead children was 280 per 1,000 living children. Infants death rate was 45 per 1,000 live births (Table 16), Family planning: Approval rate of married women for family planning was as high as 86%. The rate of experiences of contraception in the past was 51%. The current rate of contraception was 37%. Willingness to use contraception in the future was as high as 86% (Table 17). Tuberculosis control: Number of registration patients at the health center currently was 25. The number indicates one eighth of estimate number of tuberculosis in the area. Number of discharged cases in the past accounted for 79 which showed 50% of active cases when discharged time. Rate of complete treatment among reasons of discharge in the past as low as 28%. There needs to be a follow up observation of the discharged cases (Table 18). Dental problems: More than 50% of the total population have at least one or more dental problems. (Table 19) B. Medical care problems Incidence rate: 1. In one month Incidence rate of medical care problems during one month was 19.6 percent. Among these health problems which required rest at home were 11.8 percent. The estimated number of patients in the total population is 1,206. The health problems reported most frequently in interviews during one month are: GI trouble, respiratory disease, neuralgia, skin disease, and communicable disease-in that order, The rate of health problems by age groups was highest in the 1-4 age group and in the 60 years or over age group, the lowest rate was the 10-14 year age group. In general, 0-29 year age group except the 1-4 year age group was low incidence rate. After 30 years old the rate of health problems increases gradually with aging. Eighty-three percent of health problems that occured during one month were solved by primary medical care procedures. Seventeen percent of health problems needed secondary care. Days rested at home because of illness during one month were 0.7 days per interviewee and 8days per patient and it accounts for 2,161 days for the total productive population in the area. (Table 20) 2. In a year The incidence rate of medical care problems during a year was 74.8%, among them health problems which required rest at home was 37 percent. Estimated number of patients in the total population during a year was 4,600. The health problems that occured most frequently among the interviewees during a year were: Cold (30%), GI trouble (18), respiratory disease (11), anemia (10), diarrhea (10), neuralgia (10), parasite disease (9), ENT (7), skin (7), headache (7), trauma (4), communicable disease (3), and circulatory disease (3) -in that order. The rate of health problems by age groups was highest in the infants group, thereafter the rate decreased gradually until the age 15-19 year age group which showed the lowest, and then the rate increased gradually with aging. Eighty-seven percent of health problems during a year were solved by primary medical care. Thirteen percent of them needed secondary medical care procedures. Days rested at home because of illness during a year were 16 days per interviewee and 44 days per patient and it accounted for 57,335 days lost among productive age group in the area (Table 21). Among those given medical examination, the conditions observed most frequently were respiratory disease, GI trouble, parasite disease, neuralgia, skin disease, trauma, tuberculosis, anemia, chronic obstructive lung disease, eye disorders-in that order (Table 22). The main health problems required secondary medical care are as fellows: (previous page). Utilization of medical care (treatment) The rate of treatment by various medical facilities for all health problems during one month was 73 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 52% while the rate of those who have health problems which did not required rest was 61 percent (Table 23). The rate of receiving of medical care for all health problems during a year was 67 percent. The rate of receiving of medical care of those who have health problems which required rest at home was 82 percent while the rate of those who have health problems which did not required rest was as low as 53 percent (Table 24). Types of medical facilitied used were as follows: Hospital and clinics: 32-35% Herb clinics: 9-10% Drugstore: 53-58% Hospitalization Rate of hospitalization was 1.7% and the estimate number of hospitalizations among the total population during a year will be 107 persons (Table 25). Medical cost: Average medical cost per person during one month and a year were 171 and 2,800 won respectively. Average medical cost per patient during one month and a year were 1,109 and 3,740 won respectively. Average cost per household during a year was 15,800 won (Table 26, 27). Solution measures for health and medical care problems in rural area: A. Health problems which could be solved by paramedical workers such as nurses, midwives and aid nurses etc. are as follows: 1. Improvement of environmental sanitation 2. MCH except medical care problems 3. Family planning except surgical intervention 4. Tuberculosis control except diagnosis and prescription 5. Dental care except operational intervention 6. Health education for residents for improvement of utilization of medical facilities and early diagnosis etc. B. Medical care problems 1. Eighty-five percent of health problems could be solved by primary care procedures by general practitioners. 2. Fifteen percent of health problems need secondary medical procedures by a specialist. C. Medical cost Concidering the economic situation in rural area the amount of 2,062 won per residents during a year will be burdensome, so financial assistance is needed gorvernment to solve health and medical care problems for rural people.