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Role, Change, Job Satisfaction and Obstacles in Carrying out the Role of Public Health Nurses in Health Center (보건소 보건간호사의 역할변화, 역할수행의 장애요인과 만족도)

  • Ahn, Kyeong-Sook;Jung, Moon-Sook
    • Journal of agricultural medicine and community health
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    • v.20 no.1
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    • pp.1-13
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    • 1995
  • Based on the questionnaires sent to 270 nurses of public health centers in kyungnam during the period of March 19 to April 11 in 1992, this study was written for the of finding out the grade of satisfaction, obstacles in carrying out duties concerned with nursing services and the change of nurses role needed according to the change of the local public health administration. The first-ranking tasks carried by nurses of public health center are believed to have been family planning activities before the 1970's, nursing services during the 1970's, mother-child health activities during the 1980's, and nursing services during the period of 1990 to 1992. As far as the priority order of all the family planning activities is concerned, the counseling of the insertion of intrauterine contraceptive device, the use of oral pill or the distribution of condom was placed emphasis on before 1970, and publicity activities of family planning after that time. The first priority order of mother-child health activities has been put on the registration of pregnant women since 1970, with prenatal examination and vaccination ranking next to it. The priority order for activities against tuberculosis was laid on finding out and registration of new T.B. patients every year, with patients' control, and medication or injection ranking next to it. As for the priority order of nursing services, traveling medical examination and treatment ranked the first-stressed activity before 1970, with medication and injection ranking next to it. The first priority order management activity of communicable diseases was put on vaccination before 1970, with medication and injection. ranking next. And consultation and education ranked second to it during 1990 to 1992. As for the health services of the aged, traveling examination and treatment ranked the order, with the assistance of medical examination ranking next to it. As far as troubles and obstacles shown in case of family planning, the rate of residents' lack understanding was 28.8%, that of lacking budget 13.6%, and the imperfection of public health administration system 11.9%. In the case of tuberculosis control, residents' lacking understanding was 32.5%, the deficiency of public health administration system 18.2%, over-duty(shortage of hands) 15.6%, and the insufficiency skill and know-how 13.0%. In the case of nursing services, the deficiency of public health administration system was 18.2%, each over-duty(the shortage of hands) and the shortage of facilities and equipment 15.6% respective, and residents' lacking understanding 13.0%. The rate of dissatisfaction with the chance or possibility of promotion for his or her career or capability was shown to be 49.2%, and 65.9% of the health nurses expressed their complaints of the deficiency of the chance of the promotion to a professional or expert. when the public health nurses were asked in the questionably whether they were satisfied or not with current state of equipment and facilities needed for public health service, 49.6% of them answered in the negative. The grade of the satisfaction with the current individual position was shown to be low as much as the status of his or her position was now. 37.6% of those asked in the research answered to have the readiness to switch jobs for the reasons of dissatisfaction and so on with lacking promotion chance as well as bad working condition. Significant correlation between the grade of job satisfaction and the current status of the po as found to be in this research, which showed that the lower the status of position was, the lower the grade of job satisfaction was. But little correlation between the grade of job satisfaction and his or her schooling and career was found. In order to carry out primary health care successfully, it can be said that more education and publicity activities to make public health nurses and residents see it in a new light are requested. In addition to it, it is suggested that the improvement of promotion system for public health nurses and the enlargement of job province should also be taken in consideration of the high dissatisfaction with and complaints of the chance of promotion and the system of position. In order words, it is important that considerations for system improvement enough to make nursing services pleasant and satisfactory should be taken into.

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A Proposal of a Keyword Extraction System for Detecting Social Issues (사회문제 해결형 기술수요 발굴을 위한 키워드 추출 시스템 제안)

  • Jeong, Dami;Kim, Jaeseok;Kim, Gi-Nam;Heo, Jong-Uk;On, Byung-Won;Kang, Mijung
    • Journal of Intelligence and Information Systems
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    • v.19 no.3
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    • pp.1-23
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    • 2013
  • To discover significant social issues such as unemployment, economy crisis, social welfare etc. that are urgent issues to be solved in a modern society, in the existing approach, researchers usually collect opinions from professional experts and scholars through either online or offline surveys. However, such a method does not seem to be effective from time to time. As usual, due to the problem of expense, a large number of survey replies are seldom gathered. In some cases, it is also hard to find out professional persons dealing with specific social issues. Thus, the sample set is often small and may have some bias. Furthermore, regarding a social issue, several experts may make totally different conclusions because each expert has his subjective point of view and different background. In this case, it is considerably hard to figure out what current social issues are and which social issues are really important. To surmount the shortcomings of the current approach, in this paper, we develop a prototype system that semi-automatically detects social issue keywords representing social issues and problems from about 1.3 million news articles issued by about 10 major domestic presses in Korea from June 2009 until July 2012. Our proposed system consists of (1) collecting and extracting texts from the collected news articles, (2) identifying only news articles related to social issues, (3) analyzing the lexical items of Korean sentences, (4) finding a set of topics regarding social keywords over time based on probabilistic topic modeling, (5) matching relevant paragraphs to a given topic, and (6) visualizing social keywords for easy understanding. In particular, we propose a novel matching algorithm relying on generative models. The goal of our proposed matching algorithm is to best match paragraphs to each topic. Technically, using a topic model such as Latent Dirichlet Allocation (LDA), we can obtain a set of topics, each of which has relevant terms and their probability values. In our problem, given a set of text documents (e.g., news articles), LDA shows a set of topic clusters, and then each topic cluster is labeled by human annotators, where each topic label stands for a social keyword. For example, suppose there is a topic (e.g., Topic1 = {(unemployment, 0.4), (layoff, 0.3), (business, 0.3)}) and then a human annotator labels "Unemployment Problem" on Topic1. In this example, it is non-trivial to understand what happened to the unemployment problem in our society. In other words, taking a look at only social keywords, we have no idea of the detailed events occurring in our society. To tackle this matter, we develop the matching algorithm that computes the probability value of a paragraph given a topic, relying on (i) topic terms and (ii) their probability values. For instance, given a set of text documents, we segment each text document to paragraphs. In the meantime, using LDA, we can extract a set of topics from the text documents. Based on our matching process, each paragraph is assigned to a topic, indicating that the paragraph best matches the topic. Finally, each topic has several best matched paragraphs. Furthermore, assuming there are a topic (e.g., Unemployment Problem) and the best matched paragraph (e.g., Up to 300 workers lost their jobs in XXX company at Seoul). In this case, we can grasp the detailed information of the social keyword such as "300 workers", "unemployment", "XXX company", and "Seoul". In addition, our system visualizes social keywords over time. Therefore, through our matching process and keyword visualization, most researchers will be able to detect social issues easily and quickly. Through this prototype system, we have detected various social issues appearing in our society and also showed effectiveness of our proposed methods according to our experimental results. Note that you can also use our proof-of-concept system in http://dslab.snu.ac.kr/demo.html.

The Policy of Win-Win Growth between Large and Small Enterprises : A South Korean Model (한국형 동반성장 정책의 방향과 과제)

  • Lee, Jang-Woo
    • Korean small business review
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    • v.33 no.4
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    • pp.77-93
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    • 2011
  • Since 2000, the employment rate of small and medium enterprises (SMEs) has dwindled while the creation of new jobs and the emergence of healthy SMEs have been stagnant. The fundamental reason for these symptoms is that the economic structure is disadvantageous to SMEs. In particular, the greater gap between SMEs and large enterprises has resulted in polarization, and the resulting imbalance has become the largest obstacle to improving SMEs' competitiveness. For example, the total productivity has continued to drop, and the average productivity of SMEs is now merely 30% of that of large enterprises, and the average wage of SMEs' employees is only 53% of that of large enterprises. Along with polarization, rapid industrialization has also caused anti-enterprise consensus, the collapse of the middle class, hostility towards establishments, and other aftereffects. The general consensus is that unless these problems are solved, South Korea will not become an advanced country. Especially, South Korea is now facing issues that need urgent measures, such as the decline of its economic growth, the worsening distribution of profits, and the increased external volatility. Recognizing such negative trends, the MB administration proposed a win-win growth policy and recently introduced a new national value called "ecosystemic development." As the terms in such policy agenda are similar, however, the conceptual differences among such terms must first be fully understood. Therefore, in this study, the concepts of win-win growth policy and ecosystemic development, and the need for them, were surveyed, and their differences from and similarities with other policy concepts like win-win cooperation and symbiotic development were examined. Based on the results of the survey and examination, the study introduced a South Korean model of win-win growth, targeting the promotion of a sound balance between large enterprises and SMEs and an innovative ecosystem, and finally, proposing future policy tasks. Win-win growth is not an academic term but a policy term. Thus, it is less advisable to give a theoretical definition of it than to understand its concept based on its objective and method as a policy. The core of the MB administration's win-win growth policy is the creation of a partnership between key economic subjects such as large enterprises and SMEs based on each subject's differentiated capacity, and such economic subjects' joint promotion of growth opportunities. Its objective is to contribute to the establishment of an advanced capitalistic system by securing the sustainability of the South Korean economy. Such win-win growth policy includes three core concepts. The first concept, ecosystem, is that win-win growth should be understood from the viewpoint of an industrial ecosystem and should be pursued by overcoming the issues of specific enterprises. An enterprise is not an independent entity but a social entity, meaning it exists in relationship with the society (Drucker, 2011). The second concept, balance, points to the fact that an effort should be made to establish a systemic and social infrastructure for a healthy balance in the industry. The social system and infrastructure should be established in such a way as to create a balance between short- term needs and long-term sustainability, between freedom and responsibility, and between profitability and social obligations. Finally, the third concept is the behavioral change of economic entities. The win-win growth policy is not merely about simple transactional relationships or determining reasonable prices but more about the need for a behavior change on the part of economic entities, without which the objectives of the policy cannot be achieved. Various advanced countries have developed different win-win growth models based on their respective cultures and economic-development stages. Japan, whose culture is characterized by a relatively high level of group-centered trust, has developed a productivity improvement model based on such culture, whereas the U.S., which has a highly developed system of market capitalism, has developed a system that instigates or promotes market-oriented technological innovation. Unlike Japan or the U.S., Europe, a late starter, has not fully developed a trust-based culture or market capitalism and thus often uses a policy-led model based on which the government leads the improvement of productivity and promotes technological innovation. By modeling successful cases from these advanced countries, South Korea can establish its unique win-win growth system. For this, it needs to determine the method and tasks that suit its circumstances by examining the prerequisites for its success as well as the strengths and weaknesses of each advanced country. This paper proposes a South Korean model of win-win growth, whose objective is to upgrade the country's low-trust-level-based industrial structure, in which large enterprises and SMEs depend only on independent survival strategies, to a high-trust-level-based social ecosystem, in which large enterprises and SMEs develop a cooperative relationship as partners. Based on this objective, the model proposes the establishment of a sound balance of systems and infrastructure between large enterprises and SMEs, and to form a crenovative social ecosystem. The South Korean model of win-win growth consists of three axes: utilization of the South Koreans' potential, which creates community-oriented energy; fusion-style improvement of various control and self-regulated systems for establishing a high-trust-level-oriented social infrastructure; and behavioral change on the part of enterprises in terms of putting an end to their unfair business activities and promoting future-oriented cooperative relationships. This system will establish a dynamic industrial ecosystem that will generate creative energy and will thus contribute to the realization of a sustainable economy in the 21st century. The South Korean model of win-win growth should pursue community-based self-regulation, which promotes the power of efficiency and competition that is fundamentally being pursued by capitalism while at the same time seeking the value of society and community. Already existing in Korea's traditional roots, such objectives have become the bases of the Shinbaram culture, characterized by the South Koreans' spontaneity, creativity, and optimism. In the process of a community's gradual improvement of its rules and procedures, the trust among the community members increases, and the "social capital" that guarantees the successful control of shared resources can be established (Ostrom, 2010). This basic ideal can help reduce the gap between large enterprises and SMEs, alleviating the South Koreans' victim mentality in the face of competition and the open-door policy, and creating crenovative corporate competitiveness. The win-win growth policy emerged for the purpose of addressing the polarization and imbalance structure resulting from the evolution of 21st-century capitalism. It simultaneously pursues efficiency and fairness on one hand and economic and community values on the other, and aims to foster efficient interaction between the market and the government. This policy, however, is also evolving. The win-win growth policy can be considered an extension of the win-win cooperation that the past 'Participatory Government' promoted at the enterprise management level to the level of systems and culture. Also, the ecosystemic development agendum that has recently emerged is a further extension that has been presented as a national ideal of "a new development model that promotes the co-advancement of environmental conservation, growth, economic development, social integration, and national and individual development."

The Effects of Perceived Quality Factors on the Customer Loyalty: Focused on the Analysis of Difference between PB and NB (지각된 품질요인이 고객충성도에 미치는 영향: PB와 NB간의 차이분석)

  • Ye, Jong-Suk;Jun, So-Yon
    • Journal of Distribution Research
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    • v.15 no.2
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    • pp.1-34
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    • 2010
  • Introduction As consumers' purchase behavior change into a rational and practical direction, the discount store industry came to have keen competition along with rapid external growth. Therefore as a solution, distribution businesses are concentrating on developing PB(Private Brand) which can realize differentiation and profitability at the same time. And as improvement in customer loyalty beyond customer satisfaction is effective in surviving in an environment with keen competition, PB is being used as a strategic tool to improve customer loyalty. To improve loyalty among PB users, it is necessary to develop PB by examining properties of a customer group, first of all, quality level perceived by consumers should be met to obtain customer satisfaction and customer trust and consequently induce customer loyalty. To provide results of systematic analysis on relations between antecedents influenced perceived quality and variables affecting customer loyalty, this study proposed a research model based on causal relations verified in prior researches and set 16 hypotheses about relations among 9 theoretical variables. Data was collected from 400 adult customers residing in Seoul and the Metropolitan area and using large scale discount stores, among them, 375 copies were analyzed using SPSS 15.0 and Amos 7.0. The findings of the present study followed as; We ascertained that the higher company reputation, brand reputation, product experience and brand familiarity, the higher perceived quality. The study also examined the higher perceived quality, the higher customer satisfaction, customer trust and customer loyalty. The findings showed that the higher customer satisfaction and customer trust, the higher customer loyalty. As for moderating effects between PB and NB in terms of influences of perceived quality factors on perceived quality, we can ascertain that PB was higher than NB in the influences of company reputation on perceived quality while NB was higher than PB in the influences of brand reputation and brand familiarity on perceived quality. These results of empirical analysis will be useful for those concerned to do marketing activities based on a clearer understanding of antecedents and consecutive factors influenced perceived quality. At last, discussions about academical and managerial implications in these results, we suggested the limitations of this study and the future research directions. Research Model and Hypotheses Test After analyzing if antecedent variables having influence on perceived quality shows any difference between PB and NB in terms of their influences on them, the relation between variables that have influence on customer loyalty was determined as Figure 1. We established 16 hypotheses to test and hypotheses are as follows; H1-1: Perceived price has a positive effect on perceived quality. H1-2: It is expected that PB and NB would have different influence in terms of perceived price on perceived quality. H2-1: Company reputation has a positive effect on perceived quality. H2-2: It is expected that PB and NB would have different influence in terms of company reputation on perceived quality. H3-1: Brand reputation has a positive effect on perceived quality. H3-2: It is expected that PB and NB would have different influence in terms of brand reputation on perceived quality. H4-1: Product experience has a positive effect on perceived quality. H4-2: It is expected that PB and NB would have different influence in terms of product experience on perceived quality. H5-1: Brand familiarity has a positive effect on perceived quality. H5-2: It is expected that PB and NB would have different influence in terms of brand familiarity on perceived quality. H6: Perceived quality has a positive effect on customer satisfaction. H7: Perceived quality has a positive effect on customer trust. H8: Perceived quality has a positive effect on customer loyalty. H9: Customer satisfaction has a positive effect on customer trust. H10: Customer satisfaction has a positive effect on customer loyalty. H11: Customer trust has a positive effect on customer loyalty. Results from analyzing main effects of research model is shown as

    , and moderating effects is shown as
    . Results This study is designed with 16 research hypotheses, Results from analyzing their main effects show that 9 of 11 hypotheses were supported and other 2 hypotheses were rejected. On the other hand, results from analyzing their moderating effects show that 3 of 5 hypotheses were supported and other 2 hypotheses were rejected. H1-1: (SPC: Standardized Path Coefficient)=-0.04, t-value=-1.04, p>. 05). H1-2: (${\Delta}\chi^2$=1.10, df=1, p> 0.05). H1-1 and H1-2 are rejected, so it is prove that perceived price is not a significant decision variable having influence on perceived quality and there is no significant variable between PB and NB in terms of influence of perceived price on perceived quality. H2-1: (SPC=0.31, t-value=3.74, p<. 001). H2-2: (${\Delta}\chi^2$=3.93, df=1, p< 0.05). H2-1 and H2-2 are supported, so it is proved that company reputation is a significant decision variable having influence on perceived quality and, in terms of influence of company reputation on perceived quality, PB has relatively stronger influence than NB. H3-1: (SPC=0.26, t-value=5.30, p< .001). H3-2: (${\Delta}\chi^2$=16.81, df=1, p< 0.01). H3-1 and H3-2 are supported, so it is proved that brand reputation is a significant decision variable having influence on perceived quality and, in terms of influence of brand reputation on perceived quality, NB has relatively stronger influence than PB. H4-1: (SPC=0.31, t-value=2.65, p< .05). H4-2: (${\Delta}\chi^2$=1.26, df=1, p> 0.05). H4-1 is supported, but H4-2 is rejected, Therefore, it is proved that product experience is a significant decision variable having influence on perceived quality and, on the other hand, there is no significant different between PB and NB in terms of influence of product experience on product quality. H5-1: (SPC=0.24, t-value=3.00, p<. 05). H5-2: (${\Delta}\chi^2$=5.10, df=1, p< 0.05). H5-1 and H5-2 are supported, so it is proved that brand familiarity is a significant decision variable having influence on perceived quality and, in terms of influence of brand familiarity on perceived quality, NB has relatively stronger influence than PB. H6: (SPC=0.91, t-value=19.06, p< .001). H6 is supported, so a fact that customer satisfaction increases as perceived quality increases is proved. H7: (SPC=0.81, t-value=7.44, p<. 001). H7 is supported, so a fact that customer trust increases as perceived quality increases is proved. H8: (SPC=0.57, t-value=7.87, p< .001). H8 is supported, so a fact that customer loyalty increases as perceived quality increases is proved. H9: (SPC=0.08, t-value=0.76, p> .05). H9 is rejected, so it is proved influence of customer satisfaction on customer trust is not significant. H10: (SPC=0.21, t-value=4.34, p< .001). H10 is supported, so a fact that customer loyalty increases as customer satisfaction increases is proved. H11: (SPC=0.40, t-value=5.68, p< .001). H11 is supported, so a fact that customer loyalty increases as customer trust increases is proved. Implications Although most of existing studies have used function, price, brand, design, service, brand name, store name as antecedent variables for perceived quality, this study used different antecedent variables in order to analyze and distinguish purchase group PB and NB through preliminary research. Therefore, this study may be used as preliminary data for a empirical study that is designed to be helpful for practical jobs. Also, this study is made to be easily applied to any practical job because SEM(Structural Equation Modeling), most strongly explaining the relation between observed variable and latent variable, is used for this study. This study suggests a new strategic point that, in order to increase customer loyalty, customer's perceived quality level should satisfied for inducing customer satisfaction, customer trust, and customer loyalty. Therefore, after finding an effective differentiating factors in perceived quality in order to increase customer loyalty through increasing perceived quality, this factor was made to be applied to PB and NB. Because perceived quality factors which is recognized as being important by consumers is different between PB and NB, this study suggests how to efficiently establish marketing strategy by enhancing a factor. Companies have mostly focused on profitability in terms of analyzing customer loyalty, but this study included positive WOM(word of mouth). Hence, this study suggests that it would be helpful for establishing customer loyalty when consumers have cognitive satisfaction and emotional satisfaction together. Limitations This study used variables perceived price, company reputation, brand reputation, product experience, brand familiarity in order to determine whether each constituent factor has different influence on perceived quality between purchase group PB and NB. These characteristic variables are made up on the basis of the preliminary research, but it is expected that more precise research result would be obtained if additional various variables are included in study. This study selected a practical product that is non-durable, low-priced and bestselling product in a discount store through the preliminary research because it can be easily estimated by consumers. Therefore. generalization of study would be more easily obtained if more various product characteristics is included. Regarding a sample used in this study, it was only based on consumers who purchase products in a large-scale discount store located in Seoul and in the capital area. Accordingly, this sample has some geographical limitation, If a study is expanded by including more areas, more representative research results may be produced. Because this study is only designed to analyze consumers who purchase a product in a large-scale discount store, some difference may be found according to characteristics of each business type. In other words, there is certainly some application limitation, so research result from this study may not be applied to other business types. Future research may have fruitful results if it adjusts a variable to each business type.

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

    • Bang, Sook;Han, Seung-Hyun;Lee, Chung-Ja;Ahn, Moon-Young;Lee, In-Sook;Kim, Eun-Shil;Kim, Chong-Ho
      • Journal of Preventive Medicine and Public Health
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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.

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