The purpose of this study was to find a countermeasure to the U.S. import refusals for the Korean healthcare and life sciences industry. To this end, an analysis of trends during the pandemic was conducted using the KITA Border Rejection Database, which includes information on items and types of import refusals. The reason for rejection was also analyzed according to the FDA violation codes. The degree of countermeasure for import refusals was identified by measuring the unit rejection rate (URR). The results of the analysis showed that the major U.S. import refusals for the Korean healthcare and life sciences industry had expanded from contact lenses to COVID-19 diagnostic kits and drugs after the pandemic broke out. The major reasons for import refusals were non-compliance with the Predicate Device and Drugs Act and non-approval by the FDA for products and facilities. On the other hand, the unit rejection rate (URR) of major items in the Korean healthcare and life sciences industry was measured higher than the industry average. The results therefore showed a low level of response to U.S. import refusals. The results of the analysis of reasons for import refusals by item according to FDA violation codes were as follows. First of all, the main violation for contact lenses and COVID-19 diagnostic kits corresponded to misbranding. This was often due to the fact that Korean companies did not provide the relevant notices and information required by the FDA. Many cases also failed to demonstrate a substantial equivalency compared to predicate devices already on the market. On the other hand, applications for new unapproved drugs were not accepted as they had yet to pass relevant regulations that would prove their safety and efficacy. In conclusion, import refusals for the Korean healthcare and life sciences industry were found to be closely related to technical barriers to trade (TBT).
The COVID-19 pandemic has brought about significant social changes through government prevention and control measures, changes in people's risk perceptions, and lifestyle changes. In response, urban inhabitants changed their behaviors significantly, including their preferences for transportation modes and urban spaces in response to government quarantine policies and concerns over the potential risk of infection in urban spaces. These changes may have long-lasting effects on urban spaces beyond the COVID-19 pandemic or they may evolve and develop new forms. Therefore, this study aims to explore the potential for urban spaces to adapt to the present and future pandemics by examining changes in urban residents' preferences in travel modes and urban space use due to the COVID-19 pandemic. This study found that overall preferences for travel modes and urban spaces significantly differ between the pre-pandemic, pandemic, and post-pandemic periods. During the pandemic, preferences for travel modes and urban spaces has decreased, except for privately owned vehicles and green spaces, which are perceived to be safe from transmission, show more favorable than others. Post-pandemic preferences for travel modes and urban spaces are less favorable than pre-pandemic with urban spaces being five times less favorable than transportation. Although green spaces and medical facilities that were positively perceived during the pandemic are expected to return to the pre-pandemic preference level, other factors of urban spaces are facing a new-normal. The findings suggest that the COVID-19 pandemic has had a significant impact on urban residents' preferences for travel modes and urban space use. Understanding these changes is crucial for developing strategies to adapt to present and future pandemics and improve urban resilience.
This study investigates the current preservation and management of four records and documentary heritage in Korea that is in the UNESCO's Memory of the World Register. The study analyzes their problems and corresponding solutions in digitizing those world records heritages. This study also reviews additional four documentary books in Korea that are in the wish list to add to UNESCO's Memory of the World Register. This study is organized as the following: Chapter 2 examines the value and meanings of world records and documentary heritage in Korea. The registry requirements and procedures of UNESCO's Memory of the World Register are examined. The currently registered records of Korea include Hunmin-Chongum, the Annals of the Choson Dynasty, the Diaries of the Royal Secretariat (Seungjeongwon Ilgi), and Buljo- Jikji-Simche-Yojeol (vol. II). These records heritage's worth and significance are carefully analyzed. For example, Hunmin-Chongum("訓民正音") is consisted of unique and systematic letters. Letters were delicately explained with examples in its original manual at the time of letter's creation, which is an unparalleled case in the world documentary history. The Annals of the Choson Dynasty("朝鮮王朝實錄") are the most comprehensive historic documents that contain the longest period of time in history. Their truthfulness and reliability in describing history give credits to the annals. The Royal Secretariat Diary (called Seungjeongwon-Ilgi("承政院日記")) is the most voluminous primary resources in history, superior to the Annals of Choson Dynasty and Twenty Five Histories in China. Jikji("直指") is the oldest existing book published by movable metal print sets in the world. It evidences the beginning of metal printing in the world printing history and is worthy of being as world heritage. The review of the four registered records confirms that they are valuable world documentary heritage that transfers culture of mankind to next generations and should be preserved carefully and safely without deterioration or loss. Chapter 3 investigates the current status of preservation and management of three repositories that store the four registered records in Korea. The repositories include Kyujanggak Archives in Seoul National University, Pusan Records and Information Center of National Records and Archives Service, and Gansong Art Museum. The quality of their preservation and management are excellent in all of three institutions by the following aspects: 1) detailed security measures are close to perfection 2) archiving practices are very careful by using a special stack room in steady temperature and humidity and depositing it in stack or archival box made of paulownia tree and 3) fire prevention, lighting, and fumigation are thoroughly prepared. Chapter 4 summarizes the status quo of digitization projects of records heritage in Korea. The most important issue related to digitization and database construction on Korean records heritage is likely to set up the standardization of digitization processes and facilities. It is urgently necessary to develop comprehensive standard systems for digitization. Two institutions are closely interested in these tasks: 1) the National Records and Archives Service experienced in developing government records management systems; and 2) the Cultural Heritage Administration interested in digitization of Korean old documents. In collaboration of these two institutions, a new standard system will be designed for digitizing records heritage on Korean Studies. Chapter 5 deals with additional Korean records heritage in the wish list for UNESCO's Memory of the World Register, including: 1) Wooden Printing Blocks(經板) of Koryo-Taejangkyong(高麗大藏經) in Haein Temple(海印寺); 2) Dongui-Bogam("東醫寶鑑") 3) Samguk-Yusa("三國遺事") and 4) Mugujeonggwangdaedaranigyeong. Their world value and importance are examined as followings. Wooden Printing Blocks of Koryo-Taejangkyong in Haein Temple is the worldly oldest wooden printing block of cannon of Buddhism that still exist and was created over 750 years ago. It needs a special conservation treatment to disinfect germs residing in surface and inside of wooden plates. Otherwise, it may be damaged seriously. For its effective conservation and preservation, we hope that UNESCO and Government will schedule special care and budget and join the list of Memory of the Word Register. Dongui-Bogam is the most comprehensive and well-written medical book in the Korean history, summarizing all medical books in Korea and China from the Ancient Times through the early 17th century and concentrating on Korean herb medicine and prescriptions. It is proved as the best clinical guidebook in the 17th century for doctors and practitioners to easily use. The book was also published in China and Japan in the 18th century and greatly influenced the development of practical clinic and medical research in Asia at that time. This is why Dongui Bogam is in the wish list to register to the Memory of the World. Samguk-Yusa is evaluated as one of the most comprehensive history books and treasure sources in Korea, which illustrates foundations of Korean people and covers histories and cultures of ancient Korean peninsula and nearby countries. The book contains the oldest fixed form verse, called Hyang-Ka(鄕歌), and became the origin of Korean literature. In particular, the section of Gi-ee(紀異篇) describes the historical processes of dynasty transition from the first dynasty Gochosun(古朝鮮) to Goguryeo(高句麗) and illustrates the identity of Korean people from its historical origin. This book is worthy of adding to the Memory of the World Register. Mugujeonggwangdaedaranigyeong is the oldest book printed by wooden type plates, and it is estimated to print in between 706 and 751. It contains several reasons and evidence to be worthy of adding to the list of the Memory of the World. It is the greatest documentary heritage that represents the first wooden printing book that still exists in the world as well as illustrates the history of wooden printing in Korea.
Purpose: This study evaluated the manpower planning of dental technicians. Methods: Methods : Survey was conducted regarding subject's general characteristics, characteristics of dental technician's occupational view and working conditions, and reason to enter into branches of the public health enter. The survey sample consisted of 323 dental technicians (221 male/ 102 female). Survey was conducted for one month from August 1 to September 1 in 2010. Following results were obtained. Results: 1. Regarding general characteristics of the subjects, there was a slight male predilection with 68.4%. Subjects in their 40s occupied the highest proportion of 32.2%. Majority of subjects worked in the big cities (71.5%). Favored working places were dental laboratory (57.6%) and dental hospital or dental clinic (19.5%). Although no position is available in the public sector such as public health center or health care civil servant, 9.3% preferred working in the public health center. Public sector is more favored than 2-year technical colleges or dental supply and equipment companies. In respect to education, 57% of the subjects graduated college. 67.8% were married. Subjects who specialize in the porcelain or all-ceramic were 57.9%. With regard to current position, head of the dental laboratory was most common. 2. Following occupation characteristics were found. Economic reason took the highest proportion when deciding their occupation (39.9%) followed by gaining social experience (36.5%). Majority of the subjects (76.5%) wanted to work as dental technicians until their retirement. 71.5% pursuit to become a manager of the dental laboratory. 76.1% agreed on opening a dental technician position in the public health center. Regarding an authority to lead developing the dental technician position in the public sector, majority of the subject chose ministry of health and welfare (35.6%) and Korean dental technologist association (34.7%). Employment (average, 30%) and turnover rate (average, 36.5%) of dental technology college graduates ranged from 40% to 60%. Most important factors for the employment were practical experience (41.2%) and competency (34.4%). With regard to job satisfaction, so-so as 46.7% and satisfactory was 42.7% 3. In respect to the reason for opening a position in the public health center, 'It is needed to continue denture rogram for elderly patients' obtained the highest score (4.14 point). 'Institutional devices are required to open a position for dental technicians as a public healthcare provider' received high score (4.11 point). 4. Concerning the working conditions, 'professional knowledge is required' received the highest score (4.23) followed by 'too short maternity and parental leave' (4.21). 5. Relationship between general characteristics of the subjects and favor of working in the public health center was investigated. Significant differences were found according to the current and favored working area, favored occupation, education level, marital status, and specialty. Working in the public health center was favored by following subjects: working in mid- or small-sized cities (4.16 point, p<0.05); PhD degree-holder (4.59 point, p<0.01). 6. Among general characteristics of the subjects, significant difference of working conditions was found in the following factors: gender; working areas; favored working areas; favored working positions, and education level. Majority of subjects favored working in big cities and currently work in big cities although satisfaction was comparatively low (3.75 score). 7. Future plan to work in public health center was evaluated according to occupational characteristics. Subject's intention to work in the public healthcare center was significantly affected by opening of dental technician position, leading authority, average turnover rate, and factors affecting employment. Working in the public health care center was favored by the following subjects: Dental technicians who actively supported opening of the dental technician position (4.34 point, p<0.001); subjects who thought the Korean dental technologist association is responsible for the opening of positions in the public sector (4.26 point, p<0.001); and subjects who thought that attitude and character are important for the employment (p<0.001). 8. Concerning difference of working conditions according to the occupational characteristics, significant difference was demonstrated by factors such as a reason to choose to be a dental technician, work plan, pursuing position, responsible authority, average employment rate, and job satisfaction. High standard of working conditions was required in subjects who selected to be a dental technician for the leisure time after work (s.05 point, p<0.01), who planted to work until their marriage (4.25 point, p<0.001), and who pursuit to be a manager (3.98, p<0.05). 9. In respect to influence of general characteristics on the advancement to public health centers, the coefficient of determination (R2) was 0.068 and age affected the working condition with significant difference according to the pvalue. 10. Regarding influence of general characteristics on the advancement to public health centers, the coefficient of determination (R2) was 0.335 and work plan, opening of dental technician position in the public sector, and responsible authority had significant influence over the subject's intention to work in the public health center according to the p-value. 11. With regard to the influence of general characteristics on the advancement to public health centers, the coefficient of determination (R2) was 0.091 and reason to choose to be a dental technician, work plan, and responsible authority significantly affected subject's working conditions. Conclusion: Korean society is becoming a super-aged society according to several statistics. As aged population is rapidly increasing, national health insurance plans to cover denture for senior citizen over 75 years old from 2012. Therefore, dental technicians are urgently needed in the public health centers all over the nation. Many subjects in this study planed to work until their retirement and recognized dental technician's expertise. Ministry of health and welfare and Korean dental technologist association should co-operate each other to prepare foundation and institutional devices for dental technicians to advance into the public health center. This will improve oral health of the population. This study showed urgency of medical facilities and services which meets increasing number of aged population and welfare of the population.
To find the personal radiation dose of radiological technologists, a survey was conducted to 623 radiological technologists who had been working at 44 general hospitals in Korea's 16 cities and provinces from 1998 to 2002. A total of 2,624 cases about personal radiological dose that were collected were analyzed by region, year and hospital, the results of which look as follows : 1. The average radiation dose per capita by region and year for the 5 years was 1.61 mSv. By region, Daegu showed the highest amount 4.74 mSv, followed by Gangwon 4.65 mSv and Gyeonggi 2.15 mSv. The lowest amount was recorded in Chungbuk 0.91 mSv, Jeju 0.94 mSv and Busan 0.97 mSv in order. By year, 2000 appeared to be the year showing the highest amount of radiation dose 1.80 mSv, followed by 2002 1.77 mSv, 1999 1.55 mSv, 2001 1.50 mSv and 1998 1.36 mSv. 2. In 1998, Gangwon featured the highest amount of radiological dose per capita 3.28 mSv, followed by Gwangju 2.51 mSv and Daejeon 2.25 mSv, while Jeju 0.86mSv and Chungbuk 0.85 mSv belonged to the area where the radiation dose remained less than 1.0 mSv In 1999, Gangwon also topped the list with 5.67 mSv, followed by Daegu with 4.35 mSv and Gyeonggi with 2.48 mSv. In the same year, the radiation dose was kept below 1.0 mSv. in Ulsan 0.98 mSv, Gyeongbuk 0.95 mSv and Jeju 0.91 mSv. 3. In 2000, Gangwon was again at the top of the list with 5.73 mSv. Ulsan turned out to have less than 1.0 mSv of radiation dose in the years 1998 and 1999 consecutively, whereas the amount increased relatively high to 5.20 mSv. Chungbuk remained below the level of 1.0 mSv with 0.79 mSv. 4. In 2001, Daegu recorded the highest amount of radiation dose among those ever analyzed for 5 years with 9.05 mSv, followed by Gangwon with 4.01 mSv. The area with less than 1.0 mSv included Gyeongbuk 0.99 mSv and Jeonbuk 0.92 mSv. In 2002, Gangwon also led the list with 4.65 mSv while Incheon 0.88 mSv, Jeonbuk 0.96 mSv and Jeju 0.68 mSv belonged to the regions with less than 1.0 mSv of radiation dose. 5. By hospital, KMH in Daegu showed the record high amount of average radiation dose during the period of 5 years 6.82 mSv, followed by GAH 5.88 mSv in Gangwon and CAH 3.66 mSv in Seoul. YSH in Jeonnam 0.36 mSv comes first in the order of the hospitals with least amount of radiation dose, followed by GNH in Gyeongnam 0.39 mSv and DKH in Chungnam 0.51 mSv. There is a limit to the present study in that a focus is laid on the radiological technologists who are working at the 3rd referral hospitals which are regarded to be stable in terms of working conditions while radiological technologists who are working at small-sized hospitals are excluded from the survey. Besides, there are also cases in which hospitals with less than 5 years since establishment are included in the survey and the radiological technologists who have worked for less than 5 years at a hospital are also put to survey. We can't exclude the possibility, either, of assumption that the difference of personal average radiological dose by region, hospital and year might be ascribed to the different working conditions and facilities by medical institutions. It seems therefore desirable to develop standardized instruments to measure working environment objectively and to invent device to compare and analyze them by region and hospital more accurately in the future.
The study was designed to gain necessary basic data, in order to grasp the actual condition on personal hygiene of primary school students and to help school health education and child health education data development of parents of students, the survery was carried out through this reporter's interview for mothers who have primary school pupil in KyungBug area during the period of a month from 14 the April to 30 the April 1994. The results of this study can be summarized as follows. 1. As for general characteristics, the percent of answer mothers with 30~34 years 44.9%, and the percent of answer mothers with 35~39 years was 37.6%, 14.6% of answer mother was 40 years and over. The most house types was apartment house, that is 64.8% and independence house was 18.9%, 13.7% of answer mothers was multivalent house residents. As for level of school career, the percent of high school was 64.2% and the percent of university was 20.5%, 10.1% of answer mothers was finishment of middle school. As for religion a lack of religion was 38.4% and a Buddhist was 36.8%, a christian was 13.4%, 10.4% of answer mothers was a catholic. As for jobs, the percent of office was 33.9%, specialist and expert skiller was 17.3%, self-management was 16.0%, fishing and agrarian villiages was 11.6%, public service personnel and shool personnel was 9.1%. As for the number of sons and daughters, the percent of two was 70.5%, the percent of one was 16.0%, and the percent of male students was 54.1%. As for level of economic life middle level was 59.9%. 2. The percentage of washing hand after school hours was 66.8% and not washing hand after school hours was 33.2%. In washing hand after school hours family of independence house, mothers that have schoolcareer of university, female students, three and over of sons and daughters was high individually (p<0.05). 3. As for paring one's nails, once a ten days was 52.9% once a five days was 22.5% once a fifteen days was 19.0%, once a twenty and over was 5.6%. 4. 54.7% of primary school students of answer mother's take a bath once a few days and 31.6% take a bath once a week, 10.1% take a bath once a tendays. 5. The percentage of changing of underwear once a day was 60.9%, once a few days was 37.1%, once a week was 2.0%, as for changing of underwear, sons and daughters that has mothers with 29 years and downward, one number of sons and daughters, females students was high individually (p<0.01). 6. The percentage of haircut once a 20~30 days was 59.9%, once a 31~40 days was 17.9%, once a 40 days and over was 16.6%. As for the percentage of haircut once a 20~30 days apartment house residents, male students was high (p<0.01). 7. The percentage of experience in taking nutrition was 79.8% and the percentage of experience in taking restorative was 72.3%. As for taking nutrition, apartment house residents, one number of sons and daughters, male students was high individually (p<0.01). As for taking restorative apartment house residents, on number of sons and daughters, male students was high individually (p<0.05). 8. The percentage of habit of unbalanced diet was 44.0%, sons and daughters that have mother with 40 years and over apartment house residents, male students, one number of sons and daughters was high indivdually (p<0.05). 9. As for hygiene condition of sons and daughters, the percentage of good state of health was 65.2%, middle state of health was 3.5% bad state of health was 11.4%. In good state of health sons and daughters that have mothers with 29 years and downward, multivalent house residents, three numbers of sons and daughters, female students, high birth was high individually. 10. As for fattness of sons and daughters, existence was 18.2%. No existence was 81.8%. in existence sons and daughters who have mothers with 40 years and downward, independence house resident, special job and expert skill job, three and over number of sons and daughters, female students, low birth was high individually. 11. As for use aspect of medical facilities of sons and daughters, hospital doctors was 53.1%, drugstore was 42.3%, chinese medicine hospitals or health organization was 4.6%. In usage of drugstore, sons and daughters of mothers with 29 years, 40 years and over was 55.6%, 61.4% individully, inusage of hospital doctors 30~34 years, 34~39 tears was 64.5%, 49.1% individully (p<0.01), apartment house residents, one or two numbers of sons and daughters, male students was high individually. In the percentage of using drugstore, school career of middle school and downward, in occupation, three and over numbers of sons and daughters, low birth was high individually (p<0.05). According to the results mentioned above. An actual condition and a related matters on personal hygiene of primary school students must be used as the basis data of a health education program and a health data of a health education program and a health data related, a teaching materials development and must be helped to the health life education of parents of students and childs.
To provide better health care services to the rural population, the government has made the Community Health Practitioner(CHP) a regular government official from April 1, 1992. This study was carried out to study the impact of officialization of CHP on the activities and management system of Primary Health Post(PHP). Fifty PHPs were selected by two stage sampling, cluster and simple random, from 595 PHPs in Kyungnam and Kyungpook provinces. Data were collected by a personal interview with CHPs and review of records and reports kept in the PHPs. The study was done for the periods of January 1-March 31, 1992 (before officialization) and January 1-March 31, 1993 (after officialization). Ninety-six percent of the CHPs wanted to become a regular government official in the hope of better job security and higher salary. The proportion of CHPs who were proud of their iob was increased from 24% to 46% after officialization. Those CHPs who felt insecure for their job decreased from 30% to 10%. Monthly salary was increased by 34% from 802,600 Won to 1,076,000 Won and 90% of the CHPs were satisfied with their salary, also more CHPs responded that they have autonomy in their work planning, implementation of plan, management of the post, and evaluation of their activity. There were no appreciable changes in such CHPs' activities as assessment of local health resources, drawing map for the catchment area, utilization of community organization, grasping the current population structure in the catchment area, keeping the family health records, individual and group health education, and school health service. However, the number of home visits was increased from 13.6 times on the average per month per CHP to 27.5 times. More mothers and children were referred to other medical facilities for the immunization and family planning services. Average number of patients of hypertension, cancer, and diabetes in three months period was decreased from 12.7 to 11.6, from 1.5 to 1.2, and 4.3 to 3.4, respectively. Records for the patient care, drug management, and equipment were well kept but not for other records. The level of record keeping was not changed after officialization. The proportion of PHPs which had support from the health center was increased for drug supply from 14.0% to 30.0%, for consumable commodities from 22.0% to 52.0%, for maintenance of PHP from 54.0% to 68.0%, for supply of health education materials from 34.0% to 44.0%, and supply of equipment from 54.0% to 58.0%. Total monthly revenue of a PHP was increased by about 50,000 Won; increased by 22,000 Won in patient care and 34,700 Won in the government subsidy but decreased in the membership due and donation. However, there was no remarkable changes in the expenditure. The proportion of PHPs which had received official notes from the health center for the purpose of guidance and supervision of the CHPs was increased from 20% to 38% during three months period and the average number of telephone call for supervision from the health center per PHP was increased from 1.8 to 2.1 times(p<0.01). However, the proportion of PHPs that had supervisory visit and conference was reduced from 79% to 62%, and from 88% to 74%, respectively. The proportion of CHPs who maintained a cooperative relationship with Myun Health Workers was reduced from 42% to 36%, that with the director of health center from 46% to 24%, that with the chief of public health administration section from 56% to 36%, and that with the chairman of PHP management council from 62% to 38%. Most of the CHPs (92% before and 82% after officialization) stated that the PHP management council is not helpful for the PHP. CHPs who considered the PHP management council unnecessary increased from 4% to 16%(p<0.05). Suggestions made by the CHPs for the improvement of CHP program included emphasis on health education, assurance of autonomy for PHP management, increase of the kind of drugs that can be dispensed by CHPs, and appointment of an experienced CHP in the health center as the supervisor of CHPs. The results of this study revealed that the role and function of CHPs as reflected in their activities have not been changed after officialization. However, satisfaction in job security and salary was improved as well as the autonomy. Support of health center to the PHP was improved but more official notes were sent to the PHPs which required the CHPs more paper works. Number of telephone calls for supervision was increased but there was little administrative and technical guidance for the CHP activities.
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,