• 농촌의학ㆍ지역보건
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• 제43권2호
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• pp.114-124
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• 2018

본 연구는 지역사회보건사업의 한 영역인 보건간호의 근대 역사를 6개 시기로 구분하여 고찰하고 보건간호가 나아갈 방향에 대해 제안하였다. 태동기는 1908년부터 시작되었으며 선교사에 의해 보건간호가 시작되었으나 귀국 조치되면서 위축되었다. 기반형성기는 대한민국정부 수립 후 중앙정부조직과 보건관련 법령을 체계화한 시기로 1956년 보건소법 제정으로 보건소의 법적 근거를 확보하였다. 기반조성기에 정부는 가족계획사업을 정책사업으로 수행하였고 기생충질환예방법, 결핵예방법, 모자보건법 등이 제정되면서 보건소 사업이 증가하였다. 의료법 개정으로 업무분야별 간호사 자격이 인정되어 보건간호분야 간호사가 인정되었으며 조산원이 읍면동에 배치되어 임부의 분만 출산을 돕는 등 보건간호가 활성화되었다. 분야별 정비기에는 보건소 건강증진사업이 새롭게 영입되고 정신보건센터가 전국적으로 설치되면서 국민건강의 분야별 사업이 정비되었다. 또한 지역보건의료계획을 작성하게 되어 지역주민들의 요구를 반영한 사업을 할 수 있게 되었으며 정부는 국민건강증진종합계획을 설정하여 이를 보건의료 사업의 목적으로 삼았다. 보건소 기능확대기에는 건강형평성 확보를 위해 전국 차원의 맞춤형 방문건강관리사업을 실시하였고 도시보건지소와 건강생활지원센터를 설립하여 주민들에게 접근성을 높인 일차보건의료서비스를 제공하였다. 앞으로 보건간호는 우리나라 보건의료전달체계의 특성에 알맞은 보건간호체계의 구상과 설계, 간호 인력에 대한 동기부여, 역할개발과 훈련, 새로운 보건체계와 보건간호서비스에 대한 종합적 평가 등을 통해 발전해 나가야 할 것이다.

• Journal of Preventive Medicine and Public Health
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• 제20권1호
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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.

• 한국지역지리학회지
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• 제16권5호
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• pp.517-536
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• 2010

진주시에는 8개의 요일장이 열리고 있는데, 이 요일장은 시장주기와 입지라는 측면에서 전통적 정기시장인 5일장과 다른 특성을 나타낸다. 진주시에서는 요일장이 월요일에는 <이현 웰가아파트> 입구의 공터에서, 화요일에는 <금산 아파트단지>의 도로변에서, 수요일에는 <주약 한보아파트> 후문의 도로변에서, 목요일에는 <초전 아파트단지>의 도로변과 <망경 한보아파트> 입구의 공터에서, 금요일에는 <평거 들말한보타운> 인근의 도로변에서, 토요일에는 <가좌 주공그린빌아파트> 입구의 도로변과 <가호 아파트단지> 입구의 도로변에서 열리고 있다. 진주시 요일장에 상품을 출시하는 상인은 크게 세 부류로 나눌 수 있다. 첫 번째는 진주시 요일장들을 함께 순회하며 전업 상업 활동을 하는 이동 상인들이다. 두 번째는 자가 생산한 농산물을 요일장에 출시하는 농민 상인들(60대 이상의 여성)이다. 세 번째는 주로 간식류를 판매하는 노점 상인들이다. 진주시 요일장의 형성 원인을 기존의 정기시장에 관한 이론을 동원하여 세 가지 이론으로 설명하는 것이 가능하다. 첫째, 진주시 요일장에 출시하는 상인들은 일정한 지점들을 순회함으로써 수요를 확보할 수 있다. 둘째, 진주시 요일장에 출시하는 상인들은 영업상의 고정지출비용을 줄이면서도 적정 수준 이상의 수요를 확보할 수 있다. 셋째, 일주일에 한 번씩 요일장이 열리는 것은 진주시민의 생활리듬에 맞는다.