• 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.

• KOREAN JOURNAL OF CROP SCIENCE
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• v.11
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• pp.81-97
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• 1972

Experiments and investigations were done basically and practically for the purpose of labor saving in paddy rice cultivation especially on Homizil i.e. hoeing and herbicide, 1969. 8 concrete tanks were established on the open base of Keon Kuk University for comparison of percolation, dissolved oxygen and yield test of rice in the paddy plot of tank. The dimension of the bottom of each tank is square meter. Each of the 4 of the 8 tanks is 21cm in height and each of the remaining 4 tanks is 36cm. Each tank has a system that comprises 2 sets of tubes, each of which has 20 holes of 5mm in diameter scattered every side and is covered with nylon cloth taking water in the tank. One set consists of 4 P.V.C tubes. The first set is situated 8cm below the top of the tank and the second set is located at bottom layer inside the tank. The 4 tubes of each set are combined together and led to the glass tube which protects from inside to outside. And this inside-outside glass tube is connected to the small rubber tube. Also a glass tube is set 4cm below the top of the tank. Paddy loam was filled on sand in each of the tanks in the soil depth of either 15cm or 30cm. The depth of sand was 5cm in the soil depth of 15cm and 10cm in the soil depth of 30cm. (Fig. 1, 2 and 3). The paddy rice was grown in the tank. The percolation of water, the dissolved oxygen and the yield of rice were observed in the tank. And the dissolved oxygen was detected by Winkler method. A sandy paddy field of heavy percolation was selected at the field of the National Agricultural Material Inspection Center in Seoul. It was divided into 9 plots. These plots were given 3 treatments: (A) not hoeing, (B) hoeing one time and (C) hoeing two times. These treatments were replicated 3 times along the latin square design. The paddy rice was grown and sprayed with Stam F-34 in the all plots for the purpose of killing weeds before hoeing. The two types of paddy of field i.e. one for normal percolation and the other for ill drainage were selected at Iri Crop Experiment Station, Jeonla-Bukdo. Each field was divided into 24 plots for 8 treatments. They are: (A) not hoeing; (B) hoeing one time; (C) hoeing two times; (D) not hoeing but treating with herbicide, Pamcon; (E) hoeing one time and weeding two times also treating with herbicide, Pamcon; (F) hoeing two times and weeding one time a], o treating with herbicide, Pamcon; (G) hoeing two times and weeding two times also treating with herbicide, Pamcon, ; (H) usual manner. The labor hours and expenses needed for weeding in the paddy by hoeing were investigated in a farmer at Suwon and the price of herbicide and the yield of rice were taken out at Iri, Jeonla-Bukdo. The results obtained from the above experiments and investigations are as follows: 1. The relationship between percolation and dissolved oxygen shows that a very small amount of oxygen is detected in the soil water under 2cm below surface of earth in the paddy even when percolation is over 4.0cm per 24 hours (Tab. 1). 2. The relationship between percolation and yield of rice shows that the yield of rice increases in the percolation of 0cm and 1.5cm per 24 hours and decreases in the percolation of 2.5cm and 3.4cm in the plot of the 15cm ploughing depth and increases in the percolation of 1.4cm and 3.0cm and decreases in the percolation of 0cm and 4.0cm in the plot of 30cm ploughing depth (Tab. 1 and Fig. 5). 3. The yield of paddy weeded with Stam F-34 in the sandy field of heavy percolation in Seoul was 3.02 tons in the plot of not hoeing, 2.99 tons in hoeing one time and 3.05 tons in hoeing two times per hectare (Tab. 5). 4.1). 4. 1) The yield of rice per 10 ares in the field of normal percolation at Iri was 338kg in not hoeing, 379kg in hoeing one time, 383kg in hoeing two times, 413kg in spraying herbicide, Pamcon, and not hoeing, 433kg in spraying herbicide, Pamcon, and hoeing one time and weeding two times, 399kg in spraying herbicide, Pamcon, and hoeing two times and weeding one time, 420kg in spraying herbicide, Pamcon, and hoeing two times and weeding two times and 418kg in usual manner (Tab. 6-1). 2) The yield of rice per 10 ares in the field of ill drainage at Iri was 323kg in not hoeing, 363kg in hoeing one time, 342kg in hoeing two times, 388kg in spraying herbicide, Pamcon, and not hoeing, 425kg in spraying herbicide, Pamcon, and hoeing one time and weeding two times, 427kg in spraying herbicide, Pamcon, and hoeing two times and weeding one time, 449kg in spraying herbicide, Pamcon, and hoeing two times and weeding two times and 412kg in usual manner (Tab. 6-2). 5. 1) The labor hours for weeding by hoeing was 37.1 hours but 53.5 hours if hours for meal, smoking and so on are included, and the expenses including labor cost needed for weeding by hoeing in the paddy rice was 2, 346 Won per 10 ares at Suwon (Tab. 7). 2) The labor hours for weeding by spraying herbicide with hand sprayer in the paddy rice was about 5 hours per 10 ares at Suwon and the expenses for weeding by spraying herbicide in the paddy rice was 750 Won but 1130 Won if the loss by decrement of rice in the paddy field of ill drainage per 10 ares is calculated in estimation at Iri (Tab. 8). From these observations and investigations it is known that using of some kinds of herbicides Saves labor and expenses of weeding, almost without giving damages to the rice itself, in the field of normal or heavy percolation comparing usual manner of hoeing.

• Magazine of the Korean Society of Agricultural Engineers
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• v.11 no.1
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• pp.1534-1548
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• 1969

This experiment was conducted, making use of the 'NONG-RIM6' arecommended variety of rice for the year of 1968. Main purposes of the experiment are to explore possibilities of; a) ways and means of saving irringation water and, b) overcoming drought at the same time so that an increased yield in rice could be resulted in. Specifically, it was tried to determine the effects of the Rotation irrigation method combined with differentiated thickness of lining upon the growth and yield of rice. Some of the major findings are summarized in the following. 1) The different thicknesses show a significant relationship with the weight of 1,000 grains. In the case of 9cm lined plot, the grain weight is 23.5grams, the heaviest. Next in order is 3cm lined plot, 6cm lined plot, control plot, and wheat straw lined-plot. 2) In rice yield, it is found that there is a considerably moderate significant relationship with both the different thickness of lining and the number of irrigation, as shown in the table. 3) There is little or no difference among different plots in terms of a) physical and chemical properties of soil, b) quality of irrigation water, c) climatic conditions, and rainfalls. 4) It is found that there is a significant relationship between differences in the method of rotation irrigation and the number of ears per hill. The plot irrigated at an interval of 7 days shows 17.4 ears and plot irrigated at an interval of 6 days, 16.3 5) In vinyl-treated plots, it is shown that both yield and component elements are greatest in the case of the plot ith whole of $3cm/m^2$ Next in order are the plot with a hole of $2cm/m^2$ the plot with a hole of $1cm/m^2$ In the case of the plot with no hole it is found that both yield and component elements are decreased as compared to the control plot. 6) The irrigation water reqirement is measured for the actual irrigation days of 72 which are the number subtracted the days of rainfall of 30 from the total irrigation days of 102. It is found that the irrigation water requirement for the uncontrol plot is 1,590mm as compared to 876mm(44.9% saved) for the 9cm-lined plot, 959mm(39.7% saved) for the 6cm-lined plot 1,010mm(36% saved) for the 3cm-lined plot and 1,082mm(32% saved) for the wheat straw lined plot. In the case of the Rotation irrigation method it is found that the water requirement for the plot irrigated at an interval of 8 days is 538mm(65% saved), as compared to 617mm(61.6% saved) for plot irrigated at an interval of 7 day 672mm(57.7% saved) for plot irrigated at an interval of 6day, 746mm(53.0% saved) for the plot irrigated at an interval of 5 days, 890mm 44.0% saved) for the plot irrigated at an interval of 4 days, and 975mm(38.6% saved) for the plot irrigated at an interval of 3 days. 7) The rate of evapotranspiration is found 2.8 around the end of month of July, as compared to 2.6 at the begining of August 3.4 around the end of August and 2.6 at the begining of August 3.4 around the end of August and 2.6 at the begining of September. 8) It is found that the saturation quantity of 30mm per day is decreased to 20mm per day though the use of vinyl covering. 9) The husking rate shows 75 per cent which is considered better.