• 한국치위생학회지
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• 제6권4호
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• pp.437-453
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• 2006

To analyze dental hygienists and other manpower at dental care service institutions where a dental coordinator was working among about 200 dental care service institutions in Seoul, Gyeonggi Province, and Incheon as of June 2005 for contents of training for dental coordinators, opinions of qualification of dental coordinators, present and future services provided by dental coordinators, and awareness of dental coordinators and to provide basic data about future services, roles, and cultivation of dental coordinators, a survey was conducted and 216 copies returned were analyzed, obtaining the following results. 1. 83.8 percent needed an educational program for dental coordinators as an educational content; 41.7% had awareness of the educational content; and 83.8 percent insisted that over the intermediate level of curricula should be taken. Dental coordinator cultivation institutions identified included the institution under the control of the Korean Dental Hygienists Association and the education center for the department of dental hygiene; 76.9% insisted that an appropriate qualifying examination should be necessary. They suggested the central government department and the local government as a certification institution; 39.4% insisted that financial support for the education should be provided by financing education alone. Only 28.7% experienced dental coordinator education and 73.1% hoped to serve as a dental coordinator. They were found to expect a rise in payment(64.4%) and in the title(46.8%) after completion of the educational program. 2. 66.2% saw a dental hygienist as the most appropriate for a dental coordinator; clinical career (39.4%) and practical capacity(29.2%) were suggested as requirements for a dental coordinator; and a period of over three years(47.2%) was suggested for appropriate dental career. 3. Dental coordinators' present services included 'reservation management' for customer management, 'staff service training' for organization management, 'understanding of customer reception attitudes and actions' for self-management, 'hospital information management' for hospital marketing, 'acceptance' for hospital affairs management, and 'hospital environment management' for hospital facilities management; their future services included 'acquisition of ability to use a foreign language' for self-management, followed by 'staff service training' for organization management, 'training and counseling' for customer management, 'acquisition of counseling capacity' for self-management, 'complaining customer reception' for customer management, and 'marketing strategy implementation' for hospital marketing. 4. After comparing dental hygienists and other manpower in terms of dental coordinators' future services, dental hygienists showed interest in 'acquisition of ability to use a foreign language,' 'staff service training,' 'complaining customer reception,' and 'acquisition of counseling capacity' while other manpower showed interest in 'acquisition of ability to use a foreign language,' 'document data management,' 'acquisition of basic service manner,' 'acquisition of counseling capacity,' 'manpower management,' 'establishment and evaluation of a marketing strategy,' and 'education and counseling.' 5. As for awareness of dental coordinators, they were thought of as helpful in improving image of a dental clinic; it was found that continuous training should be necessary to develop dental coordinators' capacity; dental coordinators' services should be important and contribute to patients' qualitative satisfaction.

• 환경영향평가
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• 제30권6호
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• pp.339-354
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• 2021

본연구는 재생에너지 중 육상풍력발전사업 및 육상태양광발전사업의 환경현황 및 환경적 가용입지를 분석하여 신재생에너지 보급이 자연환경의 보존과 상호 공존할 수 있는 추진 방향성을 제시하였다. 2019년 6월까지 협의가 이루어진 환경평가 자료를 바탕으로 신재생에너지 중 가장 활발하게 보급되고 있는 육상풍력 및 육상태양광에 대한 규모, 위치 및 특성을 분석하였다. 재생에너지사업 입지와 관련된 주요 제약사항 및 환경평가 단계에서 요구되는 고려사항들을 도출하고 지역별 가용 면적 분포를 분석하고 이에 근거하여 잠재용량을 추정하였다. 환경영향평가 대상 육상풍력발전사업 총 80건을 분석한 결과, 80개 중 63개(79%) 사업이 산지에 입지하고 있는 것으로 파악되었다. 환경평가가 이루어진 육상태양광발전사업은 총 7,363건에 이르고 있다. 환경적 규제요소를 모두 고려한 육상풍력에 대한 환경적 가용 면적은 2,440km²이며, 육상태양광의 경우 비우량농지 등을 대상으로 산정된 환경적 가용 입지면적은 2,877km²로 산출되었다. 이러한 환경적 가용입지의 지역적 분포 및 특성은 해당 지자체가 지역에서 재생에너지개발사업을 추진하는 데 있어 가장 기본적으로 파악하고 있어야 하는 현황 자료가 될 수 있다. 현재까지 계획된 발전사업의 규모 및 향후 예상되는 증가와 환경평가를 통해 나타나는 환경가치 보전 및 사회·경제적 수용성을 고려한다고 하더라도 현시점에서 재생에너지 발전사업을 위한 가용한 입지용량이 부족하지는 않을 것으로 나타났다. 본 연구에서 도출되는 에너지원별 환경적 가용입지 자료와 같은 정량적이고 과학적인 결과를 토대로 지역별 자연환경 및 입지여건 등의 특성을 고려하여 재생에너지원별 보급 목표량(비율 및 잠재량)의 적정성을 검토할 필요가 있다. 태양광 및 풍력의 경우 해당 지역의 지형적, 환경적 특성을 고려하여 가장 잘 맞는 유형의 에너지원을 선택하는 것이 필요하다.

• 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.