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Legal Issues on the Collection and Utilization of Infectious Disease Data in the Infectious Disease Crisis (감염병 위기 상황에서 감염병 데이터의 수집 및 활용에 관한 법적 쟁점 -미국 감염병 데이터 수집 및 활용 절차를 참조 사례로 하여-)

  • Kim, Jae Sun
    • The Korean Society of Law and Medicine
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    • v.23 no.4
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    • pp.29-74
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    • 2022
  • As social disasters occur under the Disaster Management Act, which can damage the people's "life, body, and property" due to the rapid spread and spread of unexpected COVID-19 infectious diseases in 2020, information collected through inspection and reporting of infectious disease pathogens (Article 11), epidemiological investigation (Article 18), epidemiological investigation for vaccination (Article 29), artificial technology, and prevention policy Decision), (3) It was used as an important basis for decision-making in the context of an infectious disease crisis, such as promoting vaccination and understanding the current status of damage. In addition, medical policy decisions using infectious disease data contribute to quarantine policy decisions, information provision, drug development, and research technology development, and interest in the legal scope and limitations of using infectious disease data has increased worldwide. The use of infectious disease data can be classified for the purpose of spreading and blocking infectious diseases, prevention, management, and treatment of infectious diseases, and the use of information will be more widely made in the context of an infectious disease crisis. In particular, as the serious stage of the Disaster Management Act continues, the processing of personal identification information and sensitive information becomes an important issue. Information on "medical records, vaccination drugs, vaccination, underlying diseases, health rankings, long-term care recognition grades, pregnancy, etc." needs to be interpreted. In the case of "prevention, management, and treatment of infectious diseases", it is difficult to clearly define the concept of medical practicesThe types of actions are judged based on "legislative purposes, academic principles, expertise, and social norms," but the balance of legal interests should be based on the need for data use in quarantine policies and urgent judgment in public health crises. Specifically, the speed and degree of transmission of infectious diseases in a crisis, whether the purpose can be achieved without processing sensitive information, whether it unfairly violates the interests of third parties or information subjects, and the effectiveness of introducing quarantine policies through processing sensitive information can be used as major evaluation factors. On the other hand, the collection, provision, and use of infectious disease data for research purposes will be used through pseudonym processing under the Personal Information Protection Act, consent under the Bioethics Act and deliberation by the Institutional Bioethics Committee, and data provision deliberation committee. Therefore, the use of research purposes is recognized as long as procedural validity is secured as it is reviewed by the pseudonym processing and data review committee, the consent of the information subject, and the institutional bioethics review committee. However, the burden on research managers should be reduced by clarifying the pseudonymization or anonymization procedures, the introduction or consent procedures of the comprehensive consent system and the opt-out system should be clearly prepared, and the procedure for re-identifying or securing security that may arise from technological development should be clearly defined.

The Effect of Retailer-Self Image Congruence on Retailer Equity and Repatronage Intention (자아이미지 일치성이 소매점자산과 고객의 재이용의도에 미치는 영향)

  • Han, Sang-Lin;Hong, Sung-Tai;Lee, Seong-Ho
    • Journal of Distribution Research
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    • v.17 no.2
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    • pp.29-62
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    • 2012
  • As distribution environment is changing rapidly and competition is more intensive in the channel of distribution, the importance of retailer image and retailer equity is increasing as a different competitive advantages. Also, consumers are not functionally oriented and that their behavior is significantly affected by the symbols such as retailer image which identify retailer in the market place. That is, consumers do not choose products or retailers for their material utilities but consume the symbolic meaning of those products or retailers as expressed in their self images. The concept of self-image congruence has been utilized by marketers and researchers as an aid in better understanding how consumers identify themselves with the brands they buy and the retailer they patronize. Although self-image congruity theory has been tested across many product categories, the theory has not been tested extensively in the retailing. Therefore, this study attempts to investigate the impact of self image congruence between retailer image and self image of consumer on retailer equity such as retailer awareness, retailer association, perceived retailer quality, and retailer loyalty. The purpose of this study is to find out whether retailer-self image congruence can be a new antecedent of retailer equity. In addition, this study tries to examine how four-dimensional retailer equity constructs (retailer awareness, retailer association, perceived retailer quality, and retailer loyalty) affect customers' repatronage intention. For this study, data were gathered by survey and analyzed by structural equation modeling. The sample size in the present study was 254. The reliability of the all seven dimensions was estimated with Cronbach's alpha, composite reliability values and average variance extracted values. We determined whether the measurement model supports the convergent validity and discriminant validity by Exploratory factor analysis and Confirmatory Factor Analysis. For each pair of constructs, the square root of the average variance extracted values exceeded their correlations, thus supporting the discriminant validity of the constructs. Hypotheses were tested using the AMOS 18.0. As expected, the image congruence hypotheses were supported. The greater the degree of congruence between retailer image and self-image, the more favorable were consumers' retailer evaluations. The all two retailer-self image congruence (actual self-image congruence and ideal self-image congruence) affected customer based retailer equity. This result means that retailer-self image congruence is important cue for customers to estimate retailer equity. In other words, consumers are often more likely to prefer products and retail stores that have images similar to their own self-image. Especially, it appeared that effect for the ideal self-image congruence was consistently larger than the actual self-image congruence on the retailer equity. The results mean that consumers prefer or search for stores that have images compatible with consumer's perception of ideal-self. In addition, this study revealed that customers' estimations toward customer based retailer equity affected the repatronage intention. The results showed that all four dimensions (retailer awareness, retailer association, perceived retailer quality, and retailer loyalty) had positive effect on the repatronage intention. That is, management and investment to improve image congruence between retailer and consumers' self make customers' positive evaluation of retailer equity, and then the positive customer based retailer equity can enhance the repatonage intention. And to conclude, retailer's image management is an important part of successful retailer performance management, and the retailer-self image congruence is an important antecedent of retailer equity. Therefore, it is more important to develop and improve retailer's image similar to consumers' image. Given the pressure to provide increased image congruence, it is not surprising that retailers have made significant investments in enhancing the fit between retailer image and self image of consumer. The enhancing such self-image congruence may allow marketers to target customers who may be influenced by image appeals in advertising.

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A Study of the Time-Space and Appreciation for the Performance Culture of Gwanseo Region in Late Joseon Period: Focusing on Analysis of Terminology (조선후기 관서지방의 공연 시공간과 향유에 관한 연구)

  • Song, Hye-jin
    • (The) Research of the performance art and culture
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    • no.22
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    • pp.287-325
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    • 2011
  • This paper studies the time-space and appreciation of the performance culture of Gwanseo region, which is considered to have formed a characteristic culture in late Joseon period. For this purpose, 4 gasa written in hangeul (Korean alphabet), as well as 4 yeonhaeng gasa, 108 articles of Gwanseoakbu were examined. Plus, among the 9 types of yeonhaengrok (Documents of Performance culture) written in Chinese character, those parts which describe the performance traits have been analyzed. Then, 'main list of terminology' has been deduced based on the categorization according to the following points : 1) subjects of performance and appreciation 2) time and period of performance 3) space of performance 4) contents of performance 5) background and motive for performance and 6) method of performance. Through this process, various 'nouns' and 'predicate verbs' in relation to performance culture emerged, which were systemized according to types of performance elements and categories. Major terminology includes predicate verbs and symbolic verbs such as nokuihongsang,' 'baekdaehongjang,' 'jeolsaekgeumga,' 'cheonga,' 'hwaryu,' 'gamuja,' and 'tongsoja,' as well as the terms already known such as gisaeng, iwon, yangbang, akgong, and jeonak, which refer to musicians and dancers. Subjects of performance were divided into performers and listeners, categorized into concert, music, and dance, according to performance form. In the case for music, it was divided into instrumental or vocal, solo or accompanied (byeongju, self-accompaniment). In the case for vocal music, noteworthy was the inclusion of profesional artist's singing (called gwangdae or uchang). The record of 23 names of popular artists from Gwanseo region, with mention of special talents for each person, reflects the degree of activeness and artistic level of the province. Depending on the appreciating patrons, the audience were indicated as the terms including 'yugaek (party guest),' jwasang,' 'on jwaseok,' and 'sonnim (guests).' It seems that appraisal for a certain performance was very much affected by the tastes, views, and disposition of the appreciating patrons. Therefore it is interesting to observe different comparative reviews of concerts of different regions given by literary figures, offering various criticism on identical performance. In terms of performance space, it has been divided into natural or architectural space, doing justice to special performance sites such as a famous pavilion or an on-the-boat performance. Specific terms related to the scale and brightness of stage, as well as stage props and cast, based on descriptions of performance space were found. The performance space, including famous pavilions; Yeongwangjeong, Bubyeokru, Baeksangru, Wolparu, and Uigeomjeong, which are all well-known tourist sites of Gwanseo province, have been often visited by viceroys. governors, and envoys during a tour or trip. This, and the fact that full-scale performances were regularly held here, and that more than 15 different kinds of boats which were used for boat concert are mentioned, all confirm the general popularity of boat concerts at the time. Performance time, categorized by season or time of day (am/pm/night) and analyzed in terms of time of occurrence and duration, there were no special limitation as to when to have a performance. Most morning concerts were held as part of official duties for the envoys, after their meeting session, whereas evening concerts were more lengthy in duration, with a greater number of people in the audience. In the case of boat concert, samples include day-time concert and performances that began during the day and which lasted till later in the evening. Major terminology related to performance time and season includes descriptions of time of day (morning, evening, night) and mention of sunset, twilight, moonlight, stars, candles, and lamps. Such terms which reflect the flow of time contributed in making a concert more lively. Terminology for the contents of performance was mostly words like 'instrumental,' 'pungak,' or 'pungnyu.' Besides, contextual expressions gave hints as to whether there were dance, singing, ensemble, solo, and duets. Words for dance and singing used in Gwanseo province were almost identical to those used for gasa and jeongjae in the capital, Hanyang. However, many sentences reveal that performances of 'hangjangmu' of hongmunyeon, sword dance, and baettaragi were on a top-quality level. Moreover, chants in hanmun Chinese character and folk songs, which are characteristic for this region, show unique features of local musical performance. It is judged that understanding the purpose and background of a performance is important in grasping the foundation and continuity of local culture. Concerts were usually either related to official protocol for 'greeting,' 'sending-off,' 'reports,' and 'patrols' or for private enjoyment. The rituals for Gwanseo province characteristically features river crossing ceremony on the Daedong river, which has been closely documented by many. What is more, the Gwanseo region featured continued coming and goings of Pyeongan envoys and local officers, as well as ambassadors to and fro China, which required an organized and full-scale performance of music and dance. The method of performance varied from a large-scale, official ones, for which female entertainers and a great banquet in addition to musicians were required, to private gatherings that are more intimate. A performance may take the form of 'taking turns' or 'a competition,' reflecting the dynamic nature of the musical culture at the time. This study, which is deduction of terminology in relation to the time-space and appreciation culture of musical performances of Gwanseo region in late Joseon period, should be expanded in the future into research on 'the performance culture unique to Gwanseo region,' in relation to the financial and administrative aspects of the province, as well as everyday lifestyle. Furthermore, it could proceed to a more intensive research by a comparative study with related literary documents and pictorial data, which could serve as the foundation for understanding the use of space and stage, as well as the performance format characteristic to Korean traditional performing arts.

A Study on Hoslital Nurses' Preferred Duty Shift and Duty Hours (병원 간호사의 선호근무시간대에 관한 연구)

  • Lee, Gyeong-Sik;Jeong, Geum-Hui
    • The Korean Nurse
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    • v.36 no.1
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    • pp.77-96
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    • 1997
  • The duty shifts of hospital nurses not only affect nurses' physical and mental health but also present various personnel management problems which often result in high turnover rates. In this context a study was carried out from October to November 1995 for a period of two months to find out the status of hospital nurses' duty shift patterns, and preferred duty hours and fixed duty shifts. The study population was 867 RNs working in five general hospitals located in Seoul and its vicinity. The questionnaire developed by the writer was used for data collection. The response rate was 85.9 percent or 745 returns. The SAS program was used for data analysis with the computation of frequencies, percentages and Chi square test. The findings of the study are as follows: 1. General characteristics of the study population: 56 percent of respondents was (25 years group and 76.5 percent were "single": the predominant proportion of respondents was junior nursing college graduates(92.2%) and have less than 5 years nursing experience in hospitals(65.5%). For their future working plan in nursing profession, nearly 50% responded as uncertain The reasons given for their career plan was predominantly 'personal growth and development' rather than financial reasons. 2. The interval for rotations of duty stations was found to be mostly irregular(56.4%) while others reported as weekly(16.1%), monthly(12.9%), and fixed terms(4.6%). 3. The main problems related to duty shifts particularly the evening and night duty nurses reported were "not enough time for the family, " "afraid of security problems after the work when returning home late at night." and "lack of leisure time". "problems in physical and physiological adjustment." "problems in family life." "lack of time for interactions with fellow nurses" etc. 4. The forty percent of respondents reported to have '1-2 times' of duty shift rotations while all others reported that '0 time'. '2-3 times'. 'more than 3 times' etc. which suggest the irregularity in duty shift rotations. 5. The majority(62.8%) of study population found to favor the rotating system of duty stations. The reasons for favoring the rotation system were: the opportunity for "learning new things and personal development." "better human relations are possible. "better understanding in various duty stations." "changes in monotonous routine job" etc. The proportion of those disfavor the rotating 'system was 34.7 percent. giving the reasons of"it impedes development of specialization." "poor job performances." "stress factors" etc. Furthermore. respondents made the following comments in relation to the rotation of duty stations: the nurses should be given the opportunity to participate in the. decision making process: personal interest and aptitudes should be considered: regular intervals for the rotations or it should be planned in advance. etc. 6. For the future career plan. the older. married group with longer nursing experiences appeared to think the nursing as their lifetime career more likely than the younger. single group with shorter nursing experiences ($x^2=61.19.{\;}p=.000;{\;}x^2=41.55.{\;}p=.000$). The reason given for their future career plan regardless of length of future service, was predominantly "personal growth and development" rather than financial reasons. For further analysis, the group those with the shorter career plan appeared to claim "financial reasons" for their future career more readily than the group who consider the nursing job as their lifetime career$(x^2$= 11.73, p=.003) did. This finding suggests the need for careful .considerations in personnel management of nursing administration particularly when dealing with the nurses' career development. The majority of respondents preferred the fixed day shift. However, further analysis of those preferred evening shift by age and civil status, "< 25 years group"(15.1%) and "single group"(13.2) were more likely to favor the fixed evening shift than > 25 years(6.4%) and married(4.8%)groups. This differences were statistically significant ($x^2=14.54, {\;}p=.000;{\;}x^2=8.75, {\;}p=.003$). 7. A great majority of respondents(86.9% or n=647) found to prefer the day shifts. When the four different types of duty shifts(Types A. B. C, D) were presented, 55.0 percent of total respondents preferred the A type or the existing one followed by D type(22.7%). B type(12.4%) and C type(8.2%). 8. When the condition of monetary incentives for the evening(20% of salary) and night shifts(40% of. salary) of the existing duty type was presented. again the day shift appeared to be the most preferred one although the rate was slightly lower(66.4% against 86.9%). In the case of evening shift, with the same incentive, the preference rates for evening and night shifts increased from 11.0 to 22.4 percent and from 0.5 to 3.0 percent respectively. When the age variable was controlled. < 25 yrs group showed higher rates(31.6%. 4.8%) than those of > 25 yrs group(15.5%. 1.3%) respectively preferring the evening and night shifts(p=.000). The civil status also seemed to operate on the preferences of the duty shifts as the single group showed lower rate(69.0%) for day duty against 83. 6% of the married group. and higher rates for evening and night duties(27.2%. 15.1%) respectively against those of the married group(3.8%. 1.8%) while a higher proportion of the married group(83. 6%) preferred the day duties than the single group(69.0%). These differences were found to be statistically all significant(p=.001). 9. The findings on preferences of three different types of fixed duty hours namely, B, C. and D(with additional monetary incentives) are as follows in order of preference: B type(12hrs a day, 3days a wk): day shift(64.1%), evening shift(26.1%). night shift(6.5%) C type(12hrs a day. 4days a wk) : evening shift(49.2%). day shift(32.8%), night shift(11.5%) D type(10hrs a day. 4days a wk): showed the similar trend as B type. The findings of higher preferences on the evening and night duties when the incentives are given. as shown above, suggest the need for the introductions of different patterns of duty hours and incentive measures in order to overcome the difficulties in rostering the nursing duties. However, the interpretation of the above data, particularly the C type, needs cautions as the total number of respondents is very small(n=61). It requires further in-depth study. In conclusion. it seemed to suggest that the patterns of nurses duty hours and shifts in the most hospitals in the country have neither been tried for different duty types nor been flexible. The stereotype rostering system of three shifts and insensitiveness for personal life aspect of nurses seemed to be prevailing. This study seems to support that irregular and frequent rotations of duty shifts may be contributing factors for most nurses' maladjustment problems in physical and mental health. personal and family life which eventually may result in high turnover rates. In order to overcome the increasing problems in personnel management of hospital nurses particularly in rostering of evening and night duty shifts, which may related to eventual high turnover rates, the findings of this study strongly suggest the need for an introduction of new rostering systems including fixed duties and appropriate incentive measures for evenings and nights which the most nurses want to avoid, In considering the nursing care of inpatients is the round-the clock business. the practice of the nursing duty shift system is inevitable. In this context, based on the findings of this study. the following are recommended: 1. The further in-depth studies on duty shifts and hours need to be undertaken for the development of appropriate and effective rostering systems for hospital nurses. 2. An introduction of appropriate incentive measures for evening and night duty shifts along with organizational considerations such as the trials for preferred duty time bands, duty hours, and fixed duty shifts should be considered if good quality of care for the patients be maintained for the round the clock. This may require an initiation of systematic research and development activities in the field of hospital nursing administration as a part of permanent system in the hospital. 3. Planned and regular intervals, orientation and training, and professional and personal growth should be considered for the rotation of different duty stations or units. 4. In considering the higher degree of preferences in the duty type of "10hours a day, 4days a week" shown in this study, it would be worthwhile to undertake the R&D type studies in large hospital settings.

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The First North Korean Painting in the Collection of the National Museum of Korea: Myogilsang on Diamond Mountain by Seon-u Yeong (국립중앙박물관 소장 산률(山律) 선우영(鮮于英) 필(筆) <금강산 묘길상도>)

  • Yi, Song-mi
    • MISULJARYO - National Museum of Korea Art Journal
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    • v.97
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    • pp.87-104
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    • 2020
  • Myogilsang on Diamond Mountain, signed and dated (2000) by Seon-u Yeong (1946-2009), is the first work by a North Korean artist to enter the collection of the National Museum of Korea (fig. 1a). The donor acquired the painting directly from the artist in Pyeongyang in 2006. In consequence, there are no issues with the painting's authenticity.This painting is the largest among all existing Korean paintings, whether contemporary or from the Joseon Dynasty, to depict this iconography (see chart 1. A Chronological List of Korean Myogilsang Paintings.) It is ink and color on paper, measures 130.2 × 56.2 centimeters, and is in a hanging scroll format. Since this essay is intended as a brief introduction of the painting and not in-depth research into it, I will simply examine the following four areas: 1. Seon-u Yeong's background; 2. The location and the traditional appellation of the rock-cut image known as Myogilsang; 3. The iconography of the image; and 4) A comparative analysis of Seon-u Yeong's painting in light of other paintings on the same theme. Finally, I will present two more of his works to broaden the understanding of Seon-u Yeong as a painter. 1. Seon-u Yeong: According to the donor, who met Seon-u at his workshop in the Cheollima Jejakso (Flying Horse Workshop) three years before the artist's death, he was an individual of few words but displayed a firm commitment to art. His preference for subjects such as Korean landscapes rather than motifs of socialist realism such as revolutionary leaders is demonstrated by the fact that, relative to his North Korean contemporaries, he seems to have produced more paintings of the former. In recent years, Seon-u Yeong has been well publicized in Korea through three special exhibitions (2012 through 2019). He graduated from Pyeongyang College of Fine Arts in 1969 and joined the Central Fine Arts Production Workshop focusing on oil painting. In 1973 he entered the Joseon Painting Production Workshop and began creating traditional Korean paintings in ink and color. His paintings are characterized by intense colors and fine details. The fact that his mother was an accomplished embroidery specialist may have influenced on Seon-u's choice to use intense colors in his paintings. By 1992, he had become a painter representing the Democratic People's Republic of Korea with several titles such as Artist of Merit, People's Artist, and more. About 60 of his paintings have been designated as National Treasures of the DPRK. 2. The Myogilsang rock-cut image is located in the Manpok-dong Valley in the inner Geumgangsan Mountain area. It is a high-relief image about 15 meters tall cut into a niche under 40 meters of a rock cliff. It is the largest of all the rock-cut images of the Goryeo period. This image is often known as "Mahayeon Myogilsang," Mahayeon (Mahayana) being the name of a small temple deep in the Manpokdong Valley (See fig. 3a & 3b). On the right side of the image, there is an intaglio inscription of three Chinese characters by the famous scholar-official and calligrapher Yun Sa-guk (1728-1709) reading "妙吉祥"myogilsang (fig. 4a, 4b). 3. The iconography: "Myogilsang" is another name for the Bhodhisattva Mañjuśrī. The Chinese pronunciation of Myogilsang is "miaojixiang," which is similar in pronunciation to Mañjuśrī. Therefore, we can suggest a 妙吉祥 ↔ Mañjuśrī formula for the translation and transliteration of the term. Even though the image was given a traditional name, the mudra presented by the two hands in the image calls for a closer examination. They show the making of a circle by joining the thumb with the ring finger (fig. 6). If the left land pointed downward, this mudra would conventionally be considered "lower class: lower life," one of the nine mudras of the Amitabha. However, in this image the left hand is placed across its abdomen at an almost 90-degree angle to the right hand (fig. 6). This can be interpreted as a combination of the "fear not" and the "preaching" mudras (see note 10, D. Saunders). I was also advised by the noted Buddhist art specialist Professor Kim Jeong-heui (of Won'gwang University) to presume that this is the "preaching" mudra. Therefore, I have tentatively concluded that this Myogilsang is an image of the Shakyamuni offering the preaching mudra. There is no such combination of hand gestures in any other Goryeo-period images. The closest I could identify is the Beopjusa Rock-cut Buddha (fig. 7) from around the same time. 4. Comparative analysis: As seen in , except for the two contemporary paintings, all others on this chart are in ink or ink and light color. Also, none of them included the fact that the image is under a 40-meter cliff. In addition, the Joseon-period paintings all depicted the rock-cut image as if it were a human figure, using soft brushstrokes and rounded forms. None of these paintings accurately rendered the mudra from the image as did Seon-u. Only his painting depicts the natural setting of the image under the cliff along with a realistic rendering of the image. However, by painting the tall cliff in dark green and by eliminating elements on either side of the rock-cut image, the artist was able to create an almost surreal atmosphere surrounding the image. Herein lies the uniqueness of Seon-u Yeong's version. The left side of Seon-u's 2007 work Mount Geumgang (fig. 8) lives up to his reputation as a painter who depicts forms (rocks in this case) in minute detail, but in the right half of the composition it also shows his skill at presenting a sense of space. In contrast, Wave (fig. 9), a work completed one year before his death, displays his faithfulness to the traditions of ink painting. Even based on only three paintings by Seon-u Yeong, it seems possible to assess his versatility in both traditional ink and color mediums.

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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