• 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.

• Journal of the Korean Society of School Health
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• v.2 no.1
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• pp.58-90
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• 1989

This study was attempted to contribute to the development of school health by providing the basic data about the distribution basis and distribution aspect of teachers holding additional school health that are in charge of school health business in parimary schools, middle schools and high schools without any nurse-teacher. This study analyzed literatures about the history, related laws, organization and professional manpower of school health. The emphasis was set on the distribution basis of theachers holding additional school health. The results of this study are as following: 1. The school health of the world dates to the late 18th century in Europe where was free supplying with food for poor children. The school health of Korea orginated from smallpox vaccination which was executed with appearance of modern schools in the late 19th century. 2. The related laws of school health began as a part of Education Law with was constituted in 1949. By the School Health Law constituted in 1967 and the enforcement ordinance of School Health made firm the legal basis of school health. 3. The administrative organs of school health are the Ministry of Education in center and each Board of Education in cities and provinces. For the first time in 1979, the department of school health was established in the organization of the Ministry of Education. And at about the same time of establishment of the department of school health, health section was established in the department of social physical-training in locality. 4. In the manpower of school health which was presented in the related statute of school health, there are the ward chief of education, the superintendent of educational affair, of cities and districts, the mayors, the governors of provinces, the school managers, the principals, the school doctors, the school pharmacists, and the nurse-teachers, including teachers holding additional school health as the practical manpower of school health. 5. In order to get some information on distribution aspect of teachers additional school health, this study made up a questionnaire from August 3 to August 11, 1988. The subjects of this study were 212 leachers who took part in the yearly training for teachers holding additional school health from Kyunggi province, Chungbuk province and Jeonbuk province. The results of the questionnaire are as following: 1. The distribution percentages of teachers holding additional school health according to each Board of Education wich schools are subject to, are as following:70.1% (Kyunggi), 76.5% (Chungbuk), and 81.4% (Jeonbuk). There was a significant difference. The distribution percentages of teachers holding additional school health according to the school levels of 3 provinces are as following: 74.1% (Primary schools), 77.8% (Middle schools), 76.7% (High schools). There were little significant differences. 2. The distribution according to the general characteristics of the subject schools: There were 64.2 percent of primary schools and 35.8 percent of middle schools among 212 schools. 91. 5 percent of schools were located in districts. Public schools formed 55.7% and then national schools were higher in percentage than private schools. 58.5 percent of schools had 1-9 classes, 64.6 percent of schools had 101-500 students, and 90 percents of schools had 1-20 teachers. In considering student sex, the coed school showed the high distribution percentage (Primary schools : 100%, Middle schools: 81.6%). 3. The distribution according to the characteristics of teachers holding additional school health: 93.3 percent of teachers were female, and more than 60 percent of teachers were 20-29 years old. As the age got higher, the percentage became lower. There were little significant differences by marital status. In considering their educational status, 86.8 percent of teachers in primary schools were from teacher's colleges, and 64.5 percent of teachers in middle schools were from education colleges. In considering teaching career, 46.7 percent of teachers had teaching career of less than 2 years. 73.6 percent of teachers had held additional school health for less than one year. More than 80 percent of teachers had participated in the training one time or twice. More than 70 percent of teachers had 1-2 additional jobs except for the school health business. The motivation to hold additional school health is most caused by mandatory order, which accounts for more than 80.0 percent. In considering interesting degree concerning school health, lukewarm answer is the highest of 62.7 percent, followed by affirmative answer of 23.6 percent. In considering their contentment degree respecting additional school health job, "discontent or very discontent"is the highest of 47.6 percent. As a descontent reason of additional school health job, overwork is the highest factor of 37.9 percent. Among addiitional school health job, the most difficult affair is nursing service to be 34.0 percent, followed by health education of 31.6 percent. It testify the need of professional. The source of knowledge about school health has been acquired from masscommunication or private health experience, which account for as much as 56.1 percent. It shows seriousness of lack of professionalism. With regard to neccessity of school health experts, 95.8 percent represents absolute need. With above consideration of study results, I propose as follows : 1. I propose that the authorities concerned unify and improve statute respecting current school health which has not been steadfastly supporting school health business by ambiguity of expression and dualization. 2. I propose that the authorities concerned give the school manager, school staffs and parents of students educational chance with which they can acknowledge the importance of school health and in which they can participate as well as set up alternative policy plan to be albe to vitalize school health committee. 3. I propose that administrative organization practicable to taking totally charge of school health business is established within the Ministry of Education. 4. I propose that the authorities concerned back up and cooperate in an attempt by make school health better and desirable toward development by way of appointing qualitied health teachers on the basis of legally regular teacher staffs.

• Journal of Preventive Medicine and Public Health
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• v.7 no.2
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• pp.349-354
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• 1974

Survey results concerning the general information on health status of 7,050 inhabitants (1,141 households) which have been selected within Keumsan Gun, Chung Choung Nam Do area are as follws: 1. The average family size is $6.18{\pm}2.17$ persons per household. Tertiary sex ratio is 105.5 population composition of Kumsan Gun shown a pyramidal form consisting of 51.6% of the inhabitants under 20 years of age. 2. Rate of illiteracy amounts to 12.1% and only 4.1% of villagers were graduated from high schools, 80% of the inhabitants have some kind of jobs: 46.1% of them are engaged in agriculture, 95.2% of villagers have their own houses, and remaining 4.8% do not have their own. 3. 72% of households made use of health services provided provided by health centre or subcentres during a period of 1 year from April 1, 1973 to March 31, 1974. 26.8% of them visited health centre of sub-centres 2-4 times annually for the following purposes: 1) Vaccination: 35.7% 2) Diagnosis or treatment: 26.7% 3) Family planning: 24.1% 4) Maternal and child health: 10.5% 4. Utilization rate of health facilities is on an average 4.4 times per household and 0.75 times per capita. 5. Birth rate in the area is 1.91% and death rate is 0.75%, indicating the natural increase rate is only 1.16% that is lower than the nationwide rate of 1.8-2.2% in 1970 and 1.5-1.9% in 1973. 6. 37.7% of fertile women (20-40 years old) in the area are still unmarried, Fertility rate is the highest in the age group of 63-40 years old showing a value of 17.1%. 7. The unmarried population in this area amounts to 61.4% : 61.4% in male and 57.6% in female. 8. Number of inhaibtants who practice family planning is 612 persons(22.6%) among the married (2.771). This value consists of 8.3% of married males and 34.8% of married females. Only 16.0% of the people who put family planning in practice undergo permanent contraceptive methods and remaining 84.0% of them do temporary measures. 9. Only 57.7% of the subjects took vaccinations as follows: 1) B.C.G. vaccination: 82.7% 2) D.P.T. vaccination: 76.2% 3) Poliomyelitis vaccination: 67.9% 4) Smallpox vaccination: 62.6% 10. In the utilization of medical facilities in case of sickness drug stores (32.15%) comes first and hospitals or clinics (28.65%), health centre of health sub-centres (17.96%), herb drug stores (7.36%) and herb gerneral practioners (6.31%), etc., in decreasing order. Sickness that people living in this area suffer from are neuralgia, disease digestive troubles, respiratory diseases and skin lesions, etc.

• Journal of Distribution Research
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• v.17 no.4
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• pp.81-101
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• 2012

A franchise system develops competitive products for a franchise store through the system established by the franchise head office. Therefore, it has advantages of expanding the marketing effect since the risk of failure is reduced for a founder and the franchise head office supports the overall sales, advertisement and promotional activities. Also, a franchise store has advantages of fulfilling necessary facilities and tools on advantageous terms, reducing expenses by purchasing in bulk, and getting a supply of products with stable qualities. However, aside from such advantages, franchise head offices are forcing franchise stores to make unnecessary investments in equipments and remodel the interior. Also, franchise business operators are being made to share the cost of marketing and multiple franchise stores are being approved within the same business district, and franchise business operators are suffering damages. Therefore, cases of shutting down a franchise store or not renewing the contract are frequent. From the position of a franchise head office, profits that are generated from franchise fees, interior remodeling fees and supplying facilities and materials will increase as the number of new franchise stores increases. However, franchise stores are faced with difficulties due to excessive competitions between similar types of businesses and the overlapping of business districts that come from increases in the number of stores, and they eventually end up shutting down. Therefore, in order for a franchise business operator and franchise head office to grow and develop continuously, opening new stores is important, but successfully renewing the contract by maintaining a relationship with an existing franchise business operator is desirable. In this aspect, a study that examines the elements that can affect the relationship between a franchise business operator and franchise head office is believed to be important for the development of the franchise industry and creating safe jobs for the public. With an emphasis on the relationship between a franchise head office and franchise store, this study attempted to examine the effect of characteristics of a franchise head office and franchise business operator on the bilateral relationship such as the faith and immersion, and wished to review the effects of such faith and immersion on the satisfaction of a franchise store, including an intention of renewing the contract. In particular, in the current situation of great uncertainties in the market, this study also wished to examine how uncertain market elements will affect the relationship between the characteristics of a franchise head office and franchise business operator, and the faith and immersion. The study revealed that among the characteristics of a franchise head office, the standardization management of a franchise head office hinders a franchise store's faith and immersion in a franchise head office. Also, a franchise head office's support was shown to increase a franchise store's faith and immersion. However, it was revealed that a franchise head office's regulation and incentive policies for a franchise store do not affect a franchise store's faith and immersion. Among characteristics of a franchise business operator, a franchise store's healthy financial status and entrepreneur spirits were shown to enhance the faith and immersion in a franchise head office. However, it was shown that excellent business abilities of a franchise business operator actually reduce the immersion for a franchise head office. Also, the faith and immersion in a franchise head office were shown to enhance the intention of renewing the contract by increasing the satisfaction for a franchise head office. In addition, it was originally believed that the effects of a franchise business operator's characteristics on the faith and immersion in a franchise head office will vary depending on the market uncertainty, but the effect of a franchise business operator's characteristics depending on the recognition of uncertainties was shown to be insignificant. Such findings show that instead of making a franchise store pay for equipment investments and marketing and obtaining profits by force, a franchise head office should actively support a franchise store so that a franchise store's business activities can be conducted well, which will bring profits to a franchise store and ultimately to a franchise head office. This is a more desirable direction for the development of both parties. Implications of such findings are summarized as follows. First, it was shown that a franchise head office's standardization management actually reduces a franchise store's faith and immersion. Therefore, it is believed that instead of conducting standardization managements for regulating and managing franchise stores, measures should be developed so that franchise stores can actually participate voluntarily. For this, a head office should put in efforts to develop and provide standardized manuals, and make sure that a self-review system takes root. Second, a franchise head office's incentives did not have significant effects on the faith and immersion, but the support was shown to be effective. Therefore, it can be seen that instead of taking post-measures for a franchise store, taking pre-measures of actively supporting is more effective in maintaining a franchise store. Third, among characteristics of a franchise head office, it was shown that a franchise store's healthy financial status increased the faith and immersion in a franchise head office. Therefore, when selecting a franchise business operator, instead of thoughtlessly opening up franchise stores for the profit of a head office, it is believed that reviewing a franchise business operator's financial firepower and credit status is necessary. As for academic implications, previous studies examined the relationship by focusing on the characteristics of a franchise head office and franchise store, but this study focused on the characteristics of a franchise business operator. Therefore, this study dealt with the importance of a franchise business operator's competence, and is significant because it revealed the fact that a franchise business operator's excellent commercialization ability can become an element that hinders the immersion in a franchise head office. It was originally believed that a franchise store's characteristics will have different effects on the faith and immersion depending on the market uncertainty, but it was shown that the effect of a franchise store's characteristics depending on the recognition of uncertainties was insignificant, and that is the limitation of this study.