• Title/Summary/Keyword: local knowledge

Search Result 1,038, Processing Time 0.031 seconds

Rapid Rural-Urban Migration and the Rural Economy in Korea (한국(韓國)의 급격(急激)한 이촌향도형(離村向都型) 인구이동(人口移動)과 농촌경제(農村經濟))

  • Lee, Bun-song
    • KDI Journal of Economic Policy
    • /
    • v.12 no.3
    • /
    • pp.27-45
    • /
    • 1990
  • Two opposing views prevail regarding the economic impact of rural out-migration on the rural areas of origin. The optimistic neoclassical view argues that rapid rural out-migration is not detrimental to the income and welfare of the rural areas of origin, whereas Lipton (1980) argues the opposite. We developed our own alternative model for rural to urban migration, appropriate for rapidly developing economies such as Korea's. This model, which adopts international trade theories of nontraded goods and Dutch Disease to rural to urban migration issues, argues that rural to urban migration is caused mainly by two factors: first, the unprofitability of farming, and second, the decrease in demand for rural nontraded goods and the increase in demand for urban nontraded goods. The unprofitability of farming is caused by the increase in rural wages, which is induced by increasing urban wages in booming urban manufacturing sectors, and by the fact that the cost increases in farming cannot be shifted to consumers, because farm prices are fixed worldwide and because the income demand elasticity for farm products is very low. The demand for nontraded goods decreases in rural and increases in urban areas because population density and income in urban areas increase sharply, while those in rural areas decrease sharply, due to rapid rural to urban migration. Given that the market structure for nontraded goods-namely, service sectors including educational and health facilities-is mostly in monopolistically competitive, and that the demand for nontraded goods comes only from local sources, the urban service sector enjoys economies of scale, and can thus offer services at cheaper prices and in greater variety, whereas the rural service sector cannot enjoy the advantages offered by scale economies. Our view concerning the economic impact of rural to urban migration on rural areas of origin agrees with Lipton's pessimistic view that rural out-migration is detrimental to the income and welfare of rural areas. However, our reasons for the reduction of rural income are different from those in Lipton's model. Lipton argued that rural income and welfare deteriorate mainly because of a shortage of human capital, younger workers and talent resulting from selective rural out-migration. Instead, we believe that rural income declines, first, because a rapid rural-urban migration creates a further shortage of farm labor supplies and increases rural wages, and thus reduces further the profitability of farming and, second, because a rapid rural-urban migration causes a further decline of the rural service sectors. Empirical tests of our major hypotheses using Korean census data from 1966, 1970, 1975, 1980 and 1985 support our own model much more than the neoclassical or Lipton's models. A kun (county) with a large out-migration had a smaller proportion of younger working aged people in the population, and a smaller proportion of highly educated workers. But the productivity of farm workers, measured in terms of fall crops (rice) purchased by the government per farmer or per hectare of irrigated land, did not decline despite the loss of these youths and of human capital. The kun having had a large out-migration had a larger proportion of the population in the farm sector and a smaller proportion in the service sector. The kun having had a large out-migration also had a lower income measured in terms of the proportion of households receiving welfare payments or the amount of provincial taxes paid per household. The lower incomes of these kuns might explain why the kuns that experienced a large out-migration had difficulty in mechanizing farming. Our policy suggestions based on the tests of the currently prevailing hypotheses are as follows: 1) The main cause of farming difficulties is not a lack of human capital, but the in­crease in production costs due to rural wage increases combined with depressed farm output prices. Therefore, a more effective way of helping farm economies is by increasing farm output prices. However, we are not sure whether an increase in farm output prices is desirable in terms of efficiency. 2) It might be worthwhile to attempt to increase the size of farmland holdings per farm household so that the mechanization of farming can be achieved more easily. 3) A kun with large out-migration suffers a deterioration in income and welfare. Therefore, the government should provide a form of subsidization similar to the adjustment assistance provided for international trade. This assistance should not be related to the level of farm output. Otherwise, there is a possibility that we might encourage farm production which would not be profitable in the absence of subsidies. 4) Government intervention in agricultural research and its dissemination, and large-scale social overhead projects in rural areas, carried out by the Korean government, might be desirable from both efficiency and equity points of view. Government interventions in research are justified because of the problems associated with the appropriation of knowledge, and government actions on large-scale projects are justified because they required collective action.

  • PDF

Records Management and Archives in Korea : Its Development and Prospects (한국 기록관리행정의 변천과 전망)

  • Nam, Hyo-Chai
    • Journal of Korean Society of Archives and Records Management
    • /
    • v.1 no.1
    • /
    • pp.19-35
    • /
    • 2001
  • After almost one century of discontinuity in the archival tradition of Chosun dynasty, Korea entered the new age of records and archival management by legislating and executing the basic laws (The Records and Archives Management of Public Agencies Ad of 1999). Annals of Chosun dynasty recorded major historical facts of the five hundred years of national affairs. The Annals are major accomplishment in human history and rare in the world. It was possible because the Annals were composed of collected, selected and complied records of primary sources written and compiled by generations of historians, As important public records are needed to be preserved in original forms in modern archives, we had to develop and establish a modern archival system to appraise and select important national records for archival preservation. However, the colonialization of Korea deprived us of the opportunity to do the task, and our fine archival tradition was not succeeded. A centralized archival system began to develop since the establishment of GARS under the Ministry of Government Administration in 1969. GARS built a modem repository in Pusan in 1984 succeeding to the tradition of History Archives of Chosun dynasty. In 1998, GARS moved its headquarter to Taejon Government Complex and acquired state-of-the-art audio visual archives preservation facilities. From 1996, GARS introduced an automated archival management system to remedy the manual registration and management system complementing the preservation microfilming. Digitization of the holdings was the key project to provided the digital images of archives to users. To do this, the GARS purchased new computer/server systems and developed application softwares. Parallel to this direction, GARS drastically renovated its manpower composition toward a high level of professionalization by recruiting more archivists with historical and library science backgrounds. Conservators and computer system operators were also recruited. The new archival laws has been in effect from January 1, 2000. The new laws made following new changes in the field of records and archival administration in Korea. First, the laws regulate the records and archives of all public agencies including the Legislature, the Judiciary, the Administration, the constitutional institutions, Army, Navy, Air Force, and National Intelligence Service. A nation-wide unified records and archives management system became available. Second, public archives and records centers are to be established according to the level of the agency; a central archives at national level, special archives for the National Assembly and the Judiciary, local government archives for metropolitan cities and provinces, records center or special records center for administrative agencies. A records manager will be responsible for the records management of each administrative divisions. Third, the records in the public agencies are registered in the computer system as they are produced. Therefore, the records are traceable and will be searched or retrieved easily through internet or computer network. Fourth, qualified records managers and archivists who are professionally trained in the field of records management and archival science will be assigned mandatorily to guarantee the professional management of records and archives. Fifth, the illegal treatment of public records and archives constitutes a punishable crime. In the future, the public records find archival management will develop along with Korean government's 'Electronic Government Project.' Following changes are in prospect. First, public agencies will digitize paper records, audio-visual records, and publications as well as electronic documents, thus promoting administrative efficiency and productivity. Second, the National Assembly already established its Special Archives. The judiciary and the National Intelligence Service will follow it. More archives will be established at city and provincial levels. Third, the more our society develop into a knowledge-based information society, the more the records management function will become one of the important national government functions. As more universities, academic associations, and civil societies participate in promoting archival awareness and in establishing archival science, and more people realize the importance of the records and archives management up to the level of national public campaign, the records and archival management in Korea will develop significantly distinguishable from present practice.

Introduction of region-based site functions into the traditional market environmental support funding policy development (재래시장 환경개선 지원정책 개발에서의 지역 장소적 기능 도입)

  • Jeong, Dae-Yong;Lee, Se-Ho
    • Proceedings of the Korean DIstribution Association Conference
    • /
    • 2005.05a
    • /
    • pp.383-405
    • /
    • 2005
  • The traditional market is foremost a regionally positioned place, wherein the market directly represents regional and cultural centered traits while it plays an important role in the circulation of facilities through reciprocal, informative and cultural exchanges while sewing to form local communities. The traditional market in Korea is one of representative retail businesses and premodern marketing techniques by family owned business of less than five members such as product management, purchase method, and marketing patterns etc. Since the 1990s, the appearance of new circulation-type businesses and large discount convenience stores escalated the loss of traditional competitiveness, increased the living standard of customers, changed purchasing patterns, and expanded the ubiquity of the Internet. All of these changes in external circulation circumstances have led the traditional markets to lose their place in the economy. The traditional market should revive on a regional site basis through the formation of a community of regional neighbors and through knowledge-sharing that leads to the creation of wealth. For the purpose of creating a wealth in a place, the following components are necessary: 1) a facility suitable for the spatial place of the present, 2)trust built through exchanges within the changing market environment, which would simultaneously satisfy customer's desires, 3) international bench marking on cases such as regionally centered TCM (England), BID (USA), and TMO (Japan) so that the market unit of store placement transfers from a spot policy to a line policy, 4)conversion of communicative conception through a surface policy approach centered around a macro-region perspective. The budget of the traditional market funding policy was operational between 2001 and 2004, serving as a counter move to solve the problem of the old traditional market through government intervention in regional economies to promote national economic strength. This national treasury funding project was centered on environmental improvement, research corps, and business modernization through the expenditure of 3,853 hundred million won (Korean currency). However, the effectiveness of this project has yet to be to proven through investigation. Furthermore, in promoting this funding support project, a lack of professionalism among merchants in the market led to constant limitations in comprehensive striving strategies, reduced capabilities in middle-and long-term plan setup, and created reductions in voluntary merchant agreement solutions. The traditional market should go beyond mere physical place and ordinary products creative site strategies employing the communicative approach must accompany these strategies to make the market a new regional and spatial living place. Thus, regarding recent paradigm changes and the introduction of region-based site functions into the traditional market, acquiring a conversion of direction into the newly developed project is essential to reinvestigate the traditional market composed of cultural and economic meanings, for the purpose of the research. Excavating social policy demands through the comparative analysis of domestic and international cases as well as innovative and expert management leadership development for NPO or NGO civil entrepreneurs through advanced case research on present promotion methods is extremely important. Discovering the seeds of the cultural contents industry cored around regional resource usages, commercializing regionally reknowned products, and constructing complex cultural living places for regional networks are especially important. In order to accelerate these solutions, a comprehensive and systemized approach research operated within a mentor academy system is required, as research will reveal distinctive traits of the traditional market in the aging society.

  • PDF

A Study on Dietary Behavior of Chinese Consumers Segmented by Dietary Lifestyle (중국 현지 소비자들의 식생활 라이프스타일 세분화에 따른 식행동 연구)

  • Oh, Ji Eun;Yoon, Hei-Ryeo
    • Journal of the Korean Society of Food Culture
    • /
    • v.32 no.5
    • /
    • pp.383-393
    • /
    • 2017
  • This study was conducted to analyze the dietary lifestyle of local Chinese consumers and to classify dietary characteristics according to their dietary lifestyle factors and dietary behaviors. This investigation was conducted for 1 month from 1 January 2017 targeting 300 adult males and females living in China using the online survey company surveymonkey. Four factors relating to dietary lifestyle were identified, gourmet factor, healthy factor, convenience factor and economic factor, and these were grouped into 4 clusters according to their dietary lifestyle factor scores. Group 1, the gourmet economy group, showed a high percentage of living alone and a high frequency of eating out, but a relatively low percentage of three regular meals per day. Their dietary lifestyle was sensitive to gourmet factors and economic factors, but less sensitive to health and convenience factors. Group 2, the wide interest group, contained a high percentage of individuals in their 30s, as well as more highly educated individuals and a higher income than other groups. Because their dietary lifestyle scores tended to be higher than those of other groups, they sought a variety of new foods and gourmet meals for enjoyment of dining and life, as well as well-being food materials and foods related to health. Group 3, the health economic group, constituted a family-type consumer group with lower income level than the other groups. Members of this group were seeking health food and natural food in their dietary lifestyle and tended to pursue a high economic profit ratio when purchasing food. Finally, group 4 showed a relatively higher percentage of women over 30 and individuals with a college level or higher education than the other groups. This group was more interested in health and taste than price and convenience, and showed the highest LOHAS orientation among middle aged Chinese women. Moreover, members of this group directly utilized their knowledge regarding nutrition in real life.

A study of the Medical System in the Early Chosun-Dynasty (조선시대(朝鮮時代) 전기(前期)의 의료제도(醫療制度)에 대한 연구(硏究))

  • Han, Dae-Hee;Kang, Hyo-Shin
    • Journal of Korean Medical classics
    • /
    • v.9
    • /
    • pp.555-652
    • /
    • 1996
  • Up to the present the scholastic achievements in the history of the medical system have been rather scare despite its importance in the Korean History. Hence, this dissertation attempts to examine the significance of the institute in the Korean History, covering the period from the ancient times through the early Chosun-Dynasty. In the ancient times, the medical practice relied primarily upon human instincts and experiences at the same time, shaman's incantations were widely believed to cure diseases, the workings of evil spirits supposedly. For the period from the Old Chosun through Samhan(巫堂), Chinese refugees brought a long medical knowledge and skills of the continent. New Chinese medicine, traditional practices and incantations were generally used at this time. Medicine and the medical system were arranged by the period of the Three Countries(三國時代). No definite record concerning Koguryo remains now. As for Paekje, however, history shows that they set up the system under the Chinese influence, assigning medical posts such as Euibaksa(medical doctor), Chaeyaksa(pharmacist), and Jukeumsa(medicine man) within Yakbu(department of medicine). Scientifically advanced, they sent experts to Japan, giving a tremendous influence on the development of the science on ancient Japan. After the unification of the three countries, Shilla had their own system after the model of Dang(唐). This system of the Unified Shilla was continued down to Koryo and became the backbone of the future ones. In the ancient time religion and medicine were closely related. The curative function of the shaman was absolute. Buddhism played a notable part in medical practice, too, producing numerous medical monks. The medical system of Koryo followed the model of Dang with some borrowings from Song(宋). Sangyakkuk(尙藥局) was to deal exclusively with the diseases of the monarch whereas Taeeuigam(太醫監) was the central office to handle the national medical administration and the qualification test and education for doctors. In addition, Dongsodaebiwon(東西大悲院), Jewibo(濟危寶), and Hyeminkuk(惠民局) were public hospitals for the people, and a few aristocrats practiced medicine privately. In 987, the 6th year of Songjong(成宗), local medical operations were installed for curing the sick and educating medical students. Later Hyonjong(顯宗), established Yakjom(clinics, 藥店) throughout the country and officials were sent there to see patients. Foreign experts, mainly from Song, were invited frequently to deliver their advanced technology, and contributed to the great progress of the science in Korea. Medical officials were equipped with better land and salary than others, enjoying appropriate social respect. Koryo exchanged doctors, medicine and books mainly with Song, but also had substantial interrelations with Yuan(元), Ming(明), Kitan(契丹), Yojin(女眞), and Japan. Among them, however, Song was most influential to the development of medicine in Koryo. During Koryo Dynasty Buddhism, the national religion at the time, exercised bigger effect on medicine than in any other period. By conducting national ceremonies and public rituals to cure diseases, Taoism also affected the way people regarded illness. Curative shamanism was still in practice as well. These religious practices, however, were now engaged only when medication was already in use or when medicine could not held not help any more. The advanced medical system of Koryo were handed down to Chosun and served the basis for further progress. Hence, then played well the role to connect the ancient medicine and the modern one. The early Chosun followed and systemized the scientific and technical achievement in medicine during the Koryo Dynasty, and furthermore, founded the basis of the future developments. Especially the 70 years approximately from the reign of Sejong(世宗) to that of Songjong(成宗) withnessed a termendous progress in the field with the reestablishment of the medical system. The functions of the three medical institute Naeeuiwon(內醫院), Joneuigam(典醫監), Hyeminkuk(惠民局) were expanded. The second, particualy, not only systemized all the medical practices of the whole nation, but also grew and distributed domestic medicaments which had been continually developed since the late Koryo period. In addition, Hyeminso(惠民局, Hwarinwon(活人院)) and Jesaenwon(濟生院)(later merged to the first) played certain parts in the curing illness. Despite the active medical education in the capital and the country, the results were not substantial, for the aristocracy avoided the profession due to the social prejudice against technicians including medical docotors. During the early Chosun-Dynasty, the science was divided into Chimgueui (acupuncturist), Naryogeui(specialist in scrofula) and Chijongeui (specialist in boil). For the textbooks, those for the qualification exam were used, including several written by the natives. With the introduction on Neoconfucianism(性理學) which reinforced sexual segregation, female doctors appeared for the female patients who refused to be seen by male doctors. This system first appeared in 1406, the sixth year of Taejong(太宗), but finally set up during the reign of Sejong. As slaves to the offices, the lowest class, female doctors drew no respect. However, this is still significant in the aspect of women's participation in society. They were precedents of midwives. Medical officials were selected through the civil exam and a special test. Those who passed exams were given temporary jobs and took permanent posts later. At that time the test score, the work experience and the performance record of the prospective doctor were all taken into consideration, for it was a specialized office. Most doctors were given posts that changed every six months, and therefore had fewer chances for a goverment office than the aristocracy. At the beginning the social status of those in medicine was not that low, but with the prejudice gradully rising among the aristocracy, it became generally agreed to belong to the upper-middle technician class. Dealing with life, however, they received social respect and courtesy from the public. Sometimes they collected wealth with their skills. They kept improving techniques and finally came to take an important share in modernization process during the late Chosun-Dynasty.

  • PDF

An Exploratory study on the demand for training programs to improve Real Estate Agents job performance -Focused on Cheonan, Chungnam- (부동산중개인의 직무능력 향상을 위한 교육프로그램 욕구에 관한 탐색적 연구 -충청남도 천안지역을 중심으로-)

  • Lee, Jae-Beom
    • Journal of the Korea Academia-Industrial cooperation Society
    • /
    • v.12 no.9
    • /
    • pp.3856-3868
    • /
    • 2011
  • Until recently, research trend in real estate has been focused on real estate market and the market analysis. But the studies on real estate training program development for real estate agents to improve their job performance are relatively short in numbers. Thus, this study shows empirical analysis of the needs for the training programs for real estate agents in Cheonan to improve their job performance. The results are as follows. First, in the survey of asking what educational contents they need in order to improve real estate agents' job performance, most of the respondents show their needs for the analysis of house's value, legal knowledge, real estate management, accounting, real estate marketing, and understanding of the real estate policy. This is because they are well aware that the best way of responding to the changing clients' needs comes from training programs. Secondly, asked about real estate marketing strategies, most of respondents showed their awareness of new strategies to meet the needs of clients. This is because new forms of marketing strategies including internet ads are needed in the field as the paradigm including Information Technology changes. Thirdly, asked about the need for real estate-related training programs, 92% of the respondents answered they need real estate education programs run by the continuing education centers of the universities. In addition, the survey showed their needs for retraining programs that utilize the resources in the local universities. Other than this, to have effective and efficient training programs, they demanded running a training system by utilizing the human resources of the universities under the name of the department of 'Real Estate Contract' for real estate agents' job performance. Fourthly, the survey revealed real estate management(44.2%) and real estate marketing(42.3%) is the most chosen contents they want to take in the regular course for improving real estate agents' job performance. This shows their will to understand clients' needs through the mind of real estate management and real estate marketing. The survey showed they prefer the training programs as an irregular course to those in the regular one. Despite the above results, this study chose subjects only in Cheanan and thus it needs to research more diverse areas. The needs of programs to improve real estate agents job performance should be analyzed empirically targeting the real estate agents not just in Cheonan but also cities like Pyeongchon, Ilsan and Bundang in which real estate business is booming, as well as undergraduate and graduate students whose major is real estate studies. These studies will be able to provide information to help develop the customized training programs by evaluating elements that real estate agents need in order to meet clients satisfaction and improve their job performance. Many variables of the program development learned through these studies can be incorporated in the curriculum of the real estate studies and used very practically as information for the development of the real estate studies in this fast changing era.

A study on the case of education to train an archivist - Focus on archival training courses and the tradition of archival science in Italiy - (기록관리전문가의 양성교육에 관한 사례연구 -이탈리아의 기록관리학 전통과 교육과정을 중심으로-)

  • Kim, Jung-Ha
    • Journal of Korean Society of Archives and Records Management
    • /
    • v.1 no.1
    • /
    • pp.201-230
    • /
    • 2001
  • Conserving the recored cultural inheritance is actually the duty of all of us. Above all, the management and conservation of archives and documents is up to archivists who have technical knowledge about archival science. Archivists have to not only conserve archives and documents but also carry out classifying and appraising them in order to define them as current historic ones. The fundamental education about archival science is made up of history and law. Because Archive is the organisation which manage archives and documents produced by legal and administrative actions. Although there are still arguments about technical knowledge and degree archivists have to acquire, most of them prefer the studies related with history and emphasize legal studies to be the general boundary of archivits' ideology and trust. The training course about conservation of archives is conducted in about 9 National Archives of Torino, Milano, Venezia, Genova, Bologna, Parma, Roma, Napoli, Palermo. The training course in 19th was mostly based on the lectures of Phaleography, Diplomatics. There were not the education about archival science yet. Toward the end of 19th and 20th, people stressed the most basic subject in the training course of National Archive was not Phaleography and Diplomatics but archival science. The goal of archival science is to study the institution and organisation transferring archives and documents to Archive. And also it help archivists not wander about with ignorance of organisational and original procedures and divisions but know exactly theirs works. Like this, the studies on institution and organisation have got in the saddle as a branch of archival science since a few ten years. While archival science didn't evoke sympathy among people and experienced the tedious and difficult path in italy and other countries, Archive was managed by experts of other branches. As a result, there were a lot of faults in Archival Science. Specializing training course for Italian archivists came into being under the backdrop of Social Science Institute of Roma National University in 1925. The archival course of universities accomplished by the studies of history, law and economy. And such as Eugenio Casanova and Giorgio Cencetti were devoted archival science was abled to settle down in national archive. The training course for experts of 'archival science, 'Phaleography and Diplomatics' in National Archive of Bologna(Archivio di Stato di Bologna) is one of courses conducted in 17 National Archives in italy. This course is gratuitous and made up of 8 subjects(Archivistica, Paleografia, Diplomatica, Storia dell' Archivio, Notariato e documenti privati, istituzione medievale, istituzione moderna, istituzione contemporanea) students have to complete for two years. Students can receive the degree through passing twice written exam and once oral test. After department of Culture and education finally puts the marks of students, the chief Nationa Archive of Bologna confer the degree of 'archival science Phaleography and Diplomatics' on students passing the exams. This degree authenticates trainees' qualification which enables him to work at the archive in province, district and administrative capital city and archive of comunity and so on. Italian training course naturally leads archivists to keep in contact with valuable cultural inheritance through training in Archive. And it shows the intention to strengthen the affinity with each documents in the spot of archival management before training archivists. Also this is appraised as one of positive policies to conserve the local cultual inheritante in connection with the original qualitity of national archive with testify the history of each region. Traning course for archivist in Italy shows us the way how we have to prepare and proceed it. First, from producing documents to conserving than forever there has introduced 'original order that is to say a general rule to respect the first order given at the time producing documents'. Management of administrative documents is related consistently with one of historical documents. Second, the traning course for archivist is managing around 17 national archives. because italian national archive lay stress not or rducation of theory bus on train for archivest working in the first time of archival science. Third, diplomatics and phaleography for studies about historical document support archives. Forth, the studies on history id proceeding by cooperation between archivist and historian around archive. How our duties is non continuinf disputer who has to conserve and manage document and archives, but traing experts who having ability, vision and flexible thought, responsibility about archivals.

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
    • /
    • v.20 no.1 s.21
    • /
    • pp.165-203
    • /
    • 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.

  • PDF