• 제목/요약/키워드: Continuation effect

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한국가족계획사업(韓國家族計劃事業)의 문제점(問題點) (Problems in the Korean National Family Planning Program)

  • 홍종관
    • Clinical and Experimental Reproductive Medicine
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    • 제2권2호
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    • pp.27-36
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    • 1975
  • The success of the family planning program in Korea is reflected in the decrease in the growth rate from 3.0% in 1962 to 2.0% in 1971, and in the decrease in the fertility rate from 43/1,000 in 1960 to 29/1,000 in 1970. However, it would be erroneous to attribute these reductions entirely to the family planning program. Other socio-economic factors, such as the increasing age at marriage and the increasing use of induced abortions, definitely had an impact on the lowered growth and fertility rate. Despite the relative success of the program to data in meeting its goals, there is no room for complacency. Meeting the goal of a further reduction in the population growth rate to 1.3% by 1981 is a much more difficult task than any one faced in the past. Not only must fertility be lowered further, but the size of the target population itself will expand tremendously in the late seventies; due to the post-war baby boom of the 1950's reaching reproductive ages. Furthermore, it is doubtful that the age at marriage will continue to rise as in the past or that the incidence of induced abortion will continue to increase. Consequently, future reductions in fertility will be more dependent on the performance of the national family planning program, with less assistance from these non-program factors. This paper will describe various approaches to help to the solution of these current problems. 1. PRACTICE RATE IN FAMILY PLANNING In 1973, the attitude (approval) and knowledge rates were quite high; 94% and 98% respectively. But a large gap exists between that and the actual practice rate, which is only 3695. Two factors must be considered in attempting to close the KAP-gap. The first is to change social norms, which still favor a larger family, increasing the practice rate cannot be done very quickly. The second point to consider is that the family planning program has not yet reached all the eligible women. A 1973 study determineded that a large portion, 3096 in fact, of all eligible women do not want more children, but are not practicing family planning. Thus, future efforts to help close the KAP-gap must focus attention and services on this important large group of potential acceptors. 2. CONTINUATION RATES Dissatisfaction with the loop and pill has resulted in high discontinuation rates. For example, a 1973 survey revealed that within the first six months initial loop acceptance. nearly 50% were dropouts, and that within the first four months of inital pill acceptance. nearly 50% were dropouts. These discontinuation rates have risen over the past few years. The high rate of discontinuance obviously decreases the contraceptive effectiveness. and has resulted in many unwanted births which is directly related to the increase of induced abortions. In the future, the family planning program must emphasize the improved quality of initial and follow-up services. rather than more quantity, in order to insure higher continuation rates and thus more effective contraceptive protection. 3. INDUCED ABORTION As noted earlier. the use of induced abortions has been increase yearly. For example, in 1960, the average number of abortions was 0.6 abortions per women in the 15-44 age range. By 1970. that had increased to 2 abortions per women. In 1966. 13% of all women between 15-44 had experienced at least one abortion. By 1971, that figure jumped to 28%. In 1973 alone, the total number of abortions was 400,000. Besides the ever incre.sing number of induced abortions, another change has that those who use abortions have shifted since 1965 to include- not. only the middle class, but also rural and low-income women. In the future. in response to the demand for abortion services among rural and low-income w~men, the government must provide and support abortion services for these women as a part of the national family planning program. 4. TARGET SYSTIi:M Since 1962, the nationwide target system has been used to set a target for each method, and the target number of acceptors is then apportioned out to various sub-areas according to the number of eligible couples in each area. Because these targets are set without consideration for demographic factors, particular tastes, prejudices, and previous patterns of acceptance in the area, a high discontinuation rate for all methods and a high wastage rate for the oral pill and condom results. In the future. to alleviate these problems of the methodbased target system. an alternative. such as the weighted-credit system, should be adopted on a nation wide basis. In this system. each contraceptive method is. assigned a specific number of points based upon the couple-years of protection (CYP) provided by the method. and no specific targets for each method are given. 5. INCREASE OF STERILIZA.TION TARGET Two special projects. the hospital-based family planning program and the armed forces program, has greatly contributed to the increasing acceptance in female and male sterilization respectively. From January-September 1974, 28,773 sterilizations were performed. During the same time in 1975, 46,894 were performed; a 63% increase. If this trend continues, by the end of 1975. approximately 70,000 sterilizations will have been performed. Sterilization is a much better method than both the loop and pill, in terms of more effective contraceptive protection and the almost zero dropout rate. In the future, the. family planning program should continue to stress the special programs which make more sterilizations possible. In particular, it should seek to add the laparoscope techniques to facilitate female sterilization acceptance rates. 6. INCREASE NUMBER OF PRIVATE ACCEPTORS Among the current family planning users, approximately 1/3 are in the private sector and thus do not- require government subsidy. The number of private acceptors increases with increasing urbanization and economic growth. To speed this process, the government initiated the special hospital based family planning program which is utilized mostly by the private sector. However, in the future, to further hasten the increase of private acceptors, the government should encourage doctors in private practice to provide family planning services, and provide the contraceptive supplies. This way, those do utilize the private medical system will also be able to receive family planning services and pay for it. Another means of increasing the number of private acceptors, IS to greatly expand the commercial outlets for pills and condoms beyond the existing service points of drugstores, hospitals, and health centers. 7. IE&C PROGRAM The current preferred family size is nearly twice as high as needed to achieve a stable poplation. Also, a strong boy preference hinders a small family size as nearly all couples fuel they must have at least one or more sons. The IE&C program must, in the future, strive to emphasize the values of the small family and equality of the sexes. A second problem for the IE&C program to work. with in the: future is the large group of people who approves family planning, want no more children, but do not practice. The IE&C program must work to motivate these people to accept family planning And finally, for those who already practice, an IE&C program in the future must stress continuation of use. The IE&C campaign, to insure highest effectiveness, should be based on a detailed factor analysis of contraceptive discontinuance. In conclusion, Korea faces a serious unfavorable sociodemographic situation- in the future unless the population growth rate can be curtailed. And in the future, the decrease in fertility will depend solely on the family planning program, as the effect of other socio-economic factors has already been maximumally felt. A second serious factor to consider is the increasing number of eligible women due to the 1950's baby boom. Thus, to meet these challenges, the program target must be increased and the program must improve the effectiveness of its current activities and develop new programs.

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사회복지기관 개인기부자들의 기부효용감이 기부지속의도에 미치는 영향 -기관신뢰감과 자기수용감의 매개효과와 경제수준의 조절효과를 중심으로- (A Study on the Effect of Donors' Utility on Their Intention for Donation Continuity Focusing on Private Contribution to Social Welfare Organizations)

  • 이원준
    • 한국사회복지학
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    • 제66권1호
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    • pp.333-361
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    • 2014
  • 본 연구는 대구시와 경북지역 사회복지기관 후원자들을 대상으로 이들의 기부효용감이 기부지속의도에 미치는 직접효과와, 기관신뢰도와 자기수용감의 매개효과, 그리고 경제수준이 미치는 조절효과를 검증하였다. 분석방법으로 구조방정식 모형을 토대로 변수간의 인과관계를 분석하였고, 인과관계에 대한 '경제수준'에 따른 비교를 위한 다집단 분석, 계수차이검증에 근거한 구조동일성 모형검증, 다중매개검증, 잠재평균분석을 실시하였다. 통계 패키지는 SPSS 18, Amos 19, Mplus 6을 사용하였다. 분석결과 밝혀진 주요내용은 다음과 같다. (1) '정서적 효용감'과 '가시적 효용감'은 각각 '기관신뢰도', '자기수용' 그리고 '기부지속의도'에 모두 정적 직접효과를 미쳤다. (2) '기관신뢰도'는 기부지속의도에 정적 직접효과와, '정서적 효용감' 및 '가시적 효용감'이 '기부지속의도'에 미치는 영향, 그리고 '자기수용감'에 미치는 영향을 각각 유의하게 매개하였다. (3) '자기수용감'은 '기부지속의도'에 직접적인 영향을 미치지 않았다. (4) '기관신뢰도'가 '기부지속의도'에 미치는 정적 효과는 경제형편이 저조한 경우에는 유의하지 않아, '경제수준'의 조절효과가 실증적으로 확인되었다. 기부행위를 통해 경험한 정서적, 가시적 효용감은 기부 지속의도를 높일 뿐만 아니라, 기부자들이 자기 수용감 증진에도 매우 긍정적인 기여한다는 사실이 실증적으로 규명되었다. 따라서 기부자들을 자원제공자로만 보던 시각에서 기부행위를 통한 수혜자(beneficiary)로까지 시각을 확대하였고, 연구결과를 토대로 사회복지적 함의를 논의하였다.

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초등학교 고학년생의 기본심폐소생술 교육효과 및 지속성 (Efficiency and continuancy of basic CPR (Cardiopulmonary Resuscitation) education for the higher grade students of elementary schools)

  • 김희정
    • 한국응급구조학회지
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    • 제12권3호
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    • pp.87-98
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    • 2008
  • Purpose : This study was designed to figure out the necessity of continuing basic CPR education for the higher grade students of elementary school. The assessment contents were knowledge, practice ability, precision level of CPR skills and continuation of the educational efficiency. Methods : Twenty two students of 4th and 5th grade of elementary school in K city in Chungcheongnam-do were recruited for this study. The study method was a control group of non-synchronized design. A preliminary study was done on October 27 in 2006. The main study was performed from February 14 to May 11 in 2007. The researcher adopted the method of Kyung-hui, Kang (1998) such as awareness, attitude and knowledge in control group, emergency medical technician test protocol, Anne/SkillReporter$^{(R)}$ in case of the basic CPR knowledge. Four times of measures were done in shortly after practicing CPR, 4 weeks after the education, 8 weeks after the education, and 12 weeks after the education. By using SPSS/PC+ (version 12.0), the researcher analyzed the collected data based on frequency, percentage, repeated measurement, ANOVA (analysis of variance), and sidak (multiple comparison - sidak). Results : 1) The confidence of people in the control group in terms of practicing CPR showed a statistically meaningful difference (t = 10.230, p = .000) before/after CPR education. Therefore, hypothesis No.1-1 was accepted. 2) The educational necessity of people in the control group showed no statistically meaningful difference (t = -1.695, p = 0.105) before/after CPR education. Therefore, hypothesis No.1-2 was rejected. 3) The knowledge points of people in the control group showed a statistically meaningful difference (t = -7.731, p = .000) before/after CPR education. Therefore, hypothesis No.2 was accepted. 4) The confidence of people in the control group in terms of practicing CRP showed no meaningful difference (F = 2.789, p = 0.072) as time passed. Therefore, hypothesis No.3 was rejected. 5) The knowledge of people in the control group showed a meaningful difference (F = 9.090, p = .000) as time passed. Therefore, hypothesis No.4 was accepted. 6) The capability of people in the control group in terms of practicing CPR showed a statistically meaningful difference (F = 42.795, p = .000) as time passed. Therefore, hypothesis No.5 was accepted. 7) The precision level of CPR skill of people in the control group showed a statistically meaningful difference (F = 25.198, p = .000) as time passed. Therefore, hypothesis No.6-1 was accepted. 8) The precision level of chest compression skill of people in the control group showed a statistically meaningful difference (F = 5.188, p = .003). Therefore, hypothesis No.6-2 was accepted. Conclusion : In a nutshell, CPR education for the 4th and 5th graders of elementary schools had an influence on their confidence in practicing CPR and on their knowledge. This study showed that as time passed. the educational effect declined in terms of knowledge point, capability of practicing CPR, and the precision level of CRP skill. The results of the study could be postulated into the fact that re-education within 8 weeks after the first education was essential to retaining the educational effect. Therefore, we need to vitalize the CPR education for elementary school students repeatedly on a regular basis in order to continue the educational effect after they were grown-ups and to make them play their roles as a first aider.

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토양(土壤)의 물리성(物理性)과 유기물(有機物) (Soil Physical Properties and Organic Matter)

  • 임정남
    • 한국토양비료학회지
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    • 제11권3호
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    • pp.145-160
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    • 1979
  • 유기물(有機物) 시용(施用)의 토양물리성(土壤物理性) 개선(改善) 효과(效果)와 이에 따른 토양생산력(土壤生産力)과의 관계(關係)를 지금까지 이루어진 국내외(國內外) 연구결과(硏究結果)를 가지고 고찰(考察)해 보았으며, 우리나라 경작지(耕作地) 토양(土壤)의 유기물함량(有機物含量)과 토양물리성(土壤物理性)의 문제점(問題点)을 개략적(槪略的)으로 알아 보고 토양별(土壤別)로 유기물(有機物) 시용(施用)의 물리성(物理性) 개선(改善) 효과(效果)를 비교(比較) 검토(檢討)해 보았다. 유기물(有機物) 시용(施用)은 식질토(埴質土)의 투수(透水), 통기성(通氣性)을 개선(改善)하고 사질토(砂質土)의 보수력(保水力)을 증진(增進)하는 효과(效果)가 크며 토양(土壤)의 내침식성(耐浸蝕性) 및 내압밀성(耐壓密性)을 증대(增大)시키므로서 토양생산력(土壤生産力) 증진(增進), 토양보전(土壤保全), 농기계작업(農機械作業)에 매우 유익(有益)한 효과(效果)를 가져 올 수 있다. 우리나라 경작지(耕作地)에서의 유기물(有機物)의 물리성(物理性) 개선효과(改善效果)는 일반적(一般的)으로 논보다는 밭에서 훨씬 크고 토양(土壤) 유형별(類型別)로는 답(畓)에서는 미숙답(未熟畓) 보통답(普通畓)에서 크고, 전(田)에서는 사질전(砂質田) 중점출(重粘出)에서 높을 것으로 생각된다. 따라서 유기물(有機物) 시용효과(施用效果)를 극대화(極大化)한다는 면(面)에서 보면 논보다는 밭, 숙전(熟田)보다는 신개간지(新開墾地)에 더 많은 유기물(有機物)이 시용(施用)되어야 할 것이다. 토양물리성(土壤物理性) 개선면(改善面)에서 볼때 최적(最適) 토양유기물함량(土壤有機物含量)은 3.0-3.5%정도(程度)로 정(定)할 수 있으며 우리나라 경작지(耕作地)의 유기물함량(有機物含量)은 매우 낮은 수준(水準)이기 때문에 보다 많은 유기물(有機物)을 계속(繼續) 시용(施用)하여 토양유기물(土壤有機物) 함량(含量)을 증가(增加)시켜 주는데 많은 노력(努力)을 경주(傾注)해야 할 것이다.

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SF영화 <스타트랙> 시리즈와 시간여행의 모티프 (SF Movie Star Trek Series and the Motif of Time Travel)

  • 노시훈
    • 대중서사연구
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    • 제25권1호
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    • pp.165-191
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    • 2019
  • 본고의 목적은 SF영화 <스타트랙> 시리즈에 나타난 시간여행의 모티프가 서사적 측면과 비서사적 측면에서 하고 있는 기능에 대해 고찰함으로써 SF서사에서 이 모티프가 계속 반복되는 이유를 밝히는 데 있다. <스타트랙 IV: 시간 초월의 항해>(1986)는 실제로 사용되는 항법인 슬링샷으로 태양 주위를 돌파하여 그럴듯하게 시간여행을 하는 것과 당시에는 없던 투명 알루미늄의 제작 공식을 알려줘 역사에 변화를 가져오는 예정 역설을 불러오는 것을 통해 이야기에 대한 관객의 흥미를 끌고자 한다. 또한 이 영화는 혹등고래를 중심 서사에 포함시켜 고래 보호운동이라는 당대의 현실적 문제에 부응함으로써 생태주의라는 이데올로기를 환기시키는 기능을 한다. <스타트랙 VIII: 퍼스트 콘택트>(1996)는 빛보다 빠른 속도로의 비행을 가능하게 해주는 가상의 장치로 스타트랙을 대표하는 기술인 워프 드라이브를 시간여행을 통해 그 탄생 시점에서 다룸으로써 서사에 흥미를 더하고자 한다. 그리고 영화는 핵전쟁이 가져올 수 있는 인류의 멸망을 경고하여 평화적 노력을 계속할 것을 역설하고, 외계와의 조우로 행성연방의 창설을 예고하여 현실 세계에서의 국가 간 협력의 중요성을 강조함으로써 평화주의와 이상주의의 시각을 드러낸다. <스타트랙: 더 비기닝>(2009)은 블랙홀에 의한 과거로의 시간 여행과 그로 인해 생성된 평행우주라는 시간여행 서사 요소를 통해 흥미를 높이는데, 특히 후자는 그동안 전개된 이야기를 그대로 유지하면서 자유롭게 새로운 시간선의 이야기를 창조하도록 해주는 리부트 기능을 한다. 더불어 이 영화는 스팍(과 연방함대)과 네로의 대립, 벌컨 행성과 로물루스 행성의 파괴, 인간과 벌컨족의 협력을 통해 1996년 영화에서 보여주었던 평화주의와 이상주의를 반복한다. 결국 세 편의 <스타트랙> 영화에서 시간여행은 서사적 측면에서 이야기에 대한 관객의 흥미를 최대한으로 끌어올리고 서사를 자유롭게 전개하게 해주는 기능을 함과 동시에 비서사적 측면에서 현재의 문제에 대해 논평하고 이상적인 해결 방안을 제시하는 기능을 한다고 할 수 있다. 본고의 의의는 위와 같은 시간여행의 기능으로 볼 때 SF서사에서 시간여행의 모티프가 앞으로도 계속해서 반복되면서 진화할 것이라는 예상을 가능하게 한 데 있다.

북한 초기 고전 각색 가극과 선별의 음악 정치 - 혁명가극 이전 민족 가극을 중심으로 (North Korean folk Operas and Musical Politics of Selection - Focused on National Operas Prior to Revolutionary Operas)

  • 정명문
    • 공연문화연구
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    • 제39호
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    • pp.69-96
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    • 2019
  • 북한은 혁명가극 이전의 가극을 선택적으로 보존했다. 이중 초기 고전 각색 가극은 1950년대 이후 남북한의 가극 장르 변화를 추적하는데 중요 단서를 제공한다. <금강산 팔선녀>, <춘향전>, <콩쥐팥쥐>, <온달>은 비현실적인 상황을 조정하고, 계급 문제를 제기하는 방향으로 각색되었다. 초기 고전 각색 가극에서 부각시킨 인민은 신분 격차와 상관없이 부지런히 일하고 애국심을 갖춘 이였다. 또한 부당한 착취에 대해 조직적인 투쟁을 함께하는 공동 구성원이기도 했다. 이는 노동과 개인 생활의 통일, 낡은 것의 파멸, 그 파멸을 촉진하는 투쟁을 지지하는 창작 독려의 성과였다. 선별 보존된 작품들은 극장에서 집중시킨 감각을 일상에서 유지시키는 일종의 모범 사례이기도 했다. 고전 각색 가극은 신분제도 반대, 국토 찬양, 긍정적인 근로 방향과 같은 국가 강령을 자연스레 관객에게 각인시킬 수 있었다. 하나의 작품이 무대화되면 소재, 주제, 음악, 운영방안 측면에서 평가를 거쳐 생존 여부가 판단되었다. 그 표징은 '김일성'의 관람 여부 및 방향성 제시였다. 김일성 일가의 수정 지시 사항을 받아들여 집단이 재창조하고, 해외 공연을 통해 선전하는 과정은 혁명가극의 극작 및 홍보 방식과 맞닿는다. 이렇게 선별된 가극은 인민, 여성, 문학 차원에서 스토리텔링화 되면서 모델이 되었다. 이렇게 북한 초기 고전 각색 가극은 공적인 교감과 음악정치 구축의 상관성을 보여주는 사례이다.

가족계획과 모자보건 통합을 위한 조산원의 투입효과 분석 -서산지역의 개입연구 평가보고- (An Intervention Study on Integration of Family Planning and Maternal/Infant Care Services in Rural Korea)

  • 방숙;한성현;이정자;안문영;이인숙;김은실;김종호
    • Journal of Preventive Medicine and Public Health
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    • 제20권1호
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    • pp.165-203
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    • 1987
  • This project was a service-cum-research effort with a quasi-experimental study design to examine the health benefits of an integrated Family Planning (FP)/Maternal & Child health (MCH) Service approach that provides crucial factors missing in the present on-going programs. The specific objectives were: 1) To test the effectiveness of trained nurse/midwives (MW) assigned as change agents in the Health Sub-Center (HSC) to bring about the changes in the eight FP/MCH indicators, namely; (i)FP/MCH contacts between field workers and their clients (ii) the use of effective FP methods, (iii) the inter-birth interval and/or open interval, (iv) prenatal care by medically qualified personnel, (v) medically supervised deliveries, (vi) the rate of induced abortion, (vii) maternal and infant morbidity, and (viii) preinatal & infant mortality. 2) To measure the integrative linkage (contacts) between MW & HSC workers and between HSC and clients. 3) To examine the organizational or administrative factors influencing integrative linkage between health workers. Study design; The above objectives called for quasi-experimental design setting up a study and control area with and without a midwife. An active intervention program (FP/MCH minimum 'package' program) was conducted for a 2 year period from June 1982-July 1984 in Seosan County and 'before and after' surveys were conducted to measure the change. Service input; This study was undertaken by the Soonchunhyang University in collaboration with WHO. After a baseline survery in 1981, trained nurses/midwives were introduced into two health sub-centers in a rural setting (Seosan county) for a 2 year period from 1982 to 1984. A major service input was the establishment of midwifery services in the existing health delivery system with emphasis on nurse/midwife's role as the link between health workers (nurse aids) and village health workers, and the referral of risk patients to the private physician (OBGY specialist). An evaluation survey was made in August 1984 to assess the effectiveness of this alternative integrated approach in the study areas in comparison with the control area which had normal government services. Method of evaluation; a. In this study, the primary objective was first to examine to what extent the FP/MCH package program brought about changes in the pre-determined eight indicators (outcome and impact measures) and the following relationship was first analyzed; b. Nevertheless, this project did not automatically accept the assumption that if two or more activities were integrated, the results would automatically be better than a non-integrated or categorical program. There is a need to assess the 'integration process' itself within the package program. The process of integration was measured in terms of interactive linkages, or the quantity & quality of contacts between workers & clients and among workers. Intergrative linkages were hypothesized to be influenced by organizational factors at the HSC clinic level including HSC goals, sltrurture, authority, leadership style, resources, and personal characteristics of HSC staff. The extent or degree of integration, as measured by the intensity of integrative linkages, was in turn presumed to influence programme performance. Thus as indicated diagrammatically below, organizational factors constituted the independent variables, integration as the intervening variable and programme performance with respect to family planning and health services as the dependent variable: Concerning organizational factors, however, due to the limited number of HSCs (2 in the study area and 3 in the control area), they were studied by participatory observation of an anthropologist who was independent of the project. In this observation, we examined whether the assumed integration process actually occurred or not. If not, what were the constraints in producing an effective integration process. Summary of Findings; A) Program effects and impact 1. Effects on FP use: During this 2 year action period, FP acceptance increased from 58% in 1981 to 78% in 1984 in both the study and control areas. This increase in both areas was mainly due to the new family planning campaign driven by the Government for the same study period. Therefore, there was no increment of FP acceptance rate due to additional input of MW to the on-going FP program. But in the study area, quality aspects of FP were somewhat improved, having a better continuation rate of IUDs & pills and more use of effective Contraceptive methods in comparison with the control area. 2. Effects of use of MCH services: Between the study and control areas, however, there was a significant difference in maternal and child health care. For example, the coverage of prenatal care was increased from 53% for 1981 birth cohort to 75% for 1984 birth cohort in the study area. In the control area, the same increased from 41% (1981) to 65% (1984). It is noteworthy that almost two thirds of the recent birth cohort received prenatal care even in the control area, indicating that there is a growing demand of MCH care as the size of family norm becomes smaller 3. There has been a substantive increase in delivery care by medical professions in the study area, with an annual increase rate of 10% due to midwives input in the study areas. The project had about two times greater effect on postnatal care (68% vs. 33%) at delivery care(45.2% vs. 26.1%). 4. The study area had better reproductive efficiency (wanted pregancies with FP practice & healthy live births survived by one year old) than the control area, especially among women under 30 (14.1% vs. 9.6%). The proportion of women who preferred the 1st trimester for their first prenatal care rose significantly in the study area as compared to the control area (24% vs 13%). B) Effects on Interactive Linkage 1. This project made a contribution in making several useful steps in the direction of service integration, namely; i) The health workers have become familiar with procedures on how to work together with each other (especially with a midwife) in carrying out their work in FP/MCH and, ii) The health workers have gotten a feeling of the usefulness of family health records (statistical integration) in identifying targets in their own work and their usefulness in caring for family health. 2. On the other hand, because of a lack of required organizational factors, complete linkage was not obtained as the project intended. i) In regards to the government health worker's activities in terms of home visiting there was not much difference between the study & control areas though the MW did more home visiting than Government health workers. ii) In assessing the service performance of MW & health workers, the midwives balanced their workload between 40% FP, 40% MCH & 20% other activities (mainly immunization). However, $85{\sim}90%$ of the services provided by the health workers were other than FP/MCH, mainly for immunizations such as the encephalitis campaign. In the control area, a similar pattern was observed. Over 75% of their service was other than FP/MCH. Therefore, the pattern shows the health workers are a long way from becoming multipurpose workers even though the government is pushing in this direction. 3. Villagers were much more likely to visit the health sub-center clinic in the study area than in the control area (58% vs.31%) and for more combined care (45% vs.23%). C) Organization factors (admistrative integrative issues) 1. When MW (new workers with higher qualification) were introduced to HSC, it was noted that there were conflicts between the existing HSC workers (Nurse aids with less qualification than MW) and the MW for the beginning period of the project. The cause of the conflict was studied by an anthropologist and it was pointed out that these functional integration problems stemmed from the structural inadequacies of the health subcenter organization as indicated below; i) There is still no general consensus about the objectives and goals of the project between the project staff and the existing health workers. ii) There is no formal linkage between the responsibility of each member's job in the health sub-center. iii) There is still little chance for midwives to play a catalytic role or to establish communicative networks between workers in order to link various knowledge and skills to provide better FP/MCH services in the health sub-center. 2. Based on the above findings the project recommended to the County Chief (who has power to control the administrative staff and the technical staff in his county) the following ; i) In order to solve the conflicts between the individual roles and functions in performing health care activities, there must be goals agreed upon by both. ii) The health sub·center must function as an autonomous organization to undertake the integration health project. In order to do that, it is necessary to support administrative considerations, and to establish a communication system for supervision and to control of the health sub-centers. iii) The administrative organization, tentatively, must be organized to bind the health worker's midwive's and director's jobs by an organic relationship in order to achieve the integrative system under the leadership of health sub-center director. After submitting this observation report, there has been better understanding from frequent meetings & communication between HW/MW in FP/MCH work as the program developed. Lessons learned from the Seosan Project (on issues of FP/MCH integration in Korea); 1) A majority or about 80% of the couples are now practicing FP. As indicated by the study, there is a growing demand from clients for the health system to provide more MCH services than FP in order to maintain the achieved small size of family through FP practice. It is fortunate to see that the government is now formulating a MCH policy for the year 2,000 and revising MCH laws and regulations to emphasize more MCH care for achieving a small size family through family planning practice. 2) Goal consensus in FP/MCH shouBd be made among the health workers It administrators, especially to emphasize the need of care of 'wanted' child. But there is a long way to go to realize the 'real' integration of FP into MCH in Korea, unless there is a structural integration FP/MCH because a categorical FP is still first priority to reduce the rate of population growth for economic reasons but not yet for health/welfare reasons in practice. 3) There should be more financial allocation: (i) a midwife should be made available to help to promote the MCH program and coordinate services, (in) there should be a health sub·center director who can provide leadership training for managing the integrated program. There is a need for 'organizational support', if the decision of integration is made to obtain benefit from both FP & MCH. In other words, costs should be paid equally to both FP/MCH. The integration slogan itself, without the commitment of paying such costs, is powerless to advocate it. 4) Need of management training for middle level health personnel is more acute as the Government has already constructed 90 MCH centers attached to the County Health Center but without adequate manpower, facilities, and guidelines for integrating the work of both FP and MCH. 5) The local government still considers these MCH centers only as delivery centers to take care only of those visiting maternity cases. The MCH center should be a center for the managment of all pregnancies occurring in the community and the promotion of FP with a systematic and effective linkage of resources available in the county such as i.e. Village Health Worker, Community Health Practitioner, Health Sub-center Physicians & Health workers, Doctors and Midwives in MCH center, OBGY Specialists in clinics & hospitals as practiced by the Seosan project at primary health care level.

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