• Korean Journal of Environment and Ecology
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• v.37 no.4
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• pp.273-288
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• 2023

Although many studies have been conducted on techniques and effects that can be applied to forest meditation in domestic forest healing meditation research, there has been little research on the space where forest meditation takes place. Nevertheless, a meditation space is not just a place concept but a forest environment element responsible for the healing function of a forest, i.e., a place containing healing factors, and can be an essential clue to the healing mechanism. Therefore, to determine whether a healing forest meditation space is suitable for meditation, this study selected the attribute items of the meditation space using the Delphi expert survey and then surveyed the user satisfaction of the healing forest meditation space using the IPA (Importance Performance Analysis) technique. The survey was conducted from August to November 2022, targeting 315 adults who used the forest meditation space at the National Center for Forest Therapy, the Saneum Healing Forest, and the Jathyanggi Pureunsup Arboretum in Gyeonggi Province. The result of the IPA analysis showed the average satisfaction with the forest meditation space was relatively high at 4.33 points on a 5-point Likert scale (4.33 points for the National Center for Forest Therapy, 4.34 points for the Saneum Healing Forest, and 4.37 points for the Jathyanggi Pureunsup Arboretum), indicating that the three healing forest meditation spaces were suitable for forest meditation. Satisfaction with the "Sounds of nature" was high in all three forests. On the other hand, all three forests showed a relatively low satisfaction with "Quietness," indicating it to be a priority problem to be addressed. Also, an open-ended questionnaire survey showed that the mediation space's natural elements, such as natural sounds, scenery, air, forest spaces, and scents, had a higher positive impact on meditation satisfaction than artificial elements, such as facilities. Therefore, it is essential to secure sound resources such as the sound of water and birds around the meditation space, and it is also necessary to consider ways to create a meditation forest in an independent area to avoid encounters with visitors and allow only participants in the forest healing meditation program to enter to increase satisfaction with forest meditation.

• Journal of Intelligence and Information Systems
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• v.28 no.1
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• pp.287-310
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• 2022

Companies' interest in developing AI-based intelligent new products is increasing. Recently, the main concern of companies is to innovate customer experience and create new values by developing new products through the effective use of Artificial intelligence technology. However, due to the nature of products based on radical technologies such as artificial intelligence, intelligent products differ from existing products and development methods, so it is clear that there is a limitation to applying the existing development methodology as it is. This study proposes a new research method based on KANO-TOPSIS for the successful development of AI-based intelligent new products by using car voice assistants as an example. Using the KANO model, select and evaluate functions that customers think are necessary for new products, and use the TOPSIS method to derives priorities by finding the importance of functions that customers need. For the analysis, major categories such as vehicle condition check and function control elements, driving-related elements, characteristics of voice assistant itself, infotainment elements, and daily life support elements were selected and customer demand attributes were subdivided. As a result of the analysis, high recognition accuracy should be considered as a top priority in the development of car voice assistants. Infotainment elements that provide customized content based on driver's biometric information and usage habits showed lower priorities than expected, while functions related to driver safety such as vehicle condition notification, driving assistance, and security, also showed as the functions that should be developed preferentially. This study is meaningful in that it presented a new product development methodology suitable for the characteristics of AI-based intelligent new products with innovative characteristics through an excellent model combining KANO and TOPSIS.

• Korean Journal of Ecology and Environment
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• v.56 no.3
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• pp.187-195
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• 2023

Almost all of the water from agricultural dams located to the upper of the Yeongsan river is supplied as irrigation water for farmland and thus is not discharged to the main stream of the river. Also, most of the irrigation water does not return to the river after use, adding to the lack of flow in the main stream. As a result, the water quality and aquatic health of the river have become the poorest among the four major rivers in Korea. Therefore, in this study, several strategies for water quality improvement of the river were developed considering pollution reduction and flow rate increase, and their effect analysis was performed using a water quality model. The results of this study showed that the target water quality of the Yeongsan river could be achieved if flow increase strategies (FISs) are intensively pursued in parallel with pollution reduction. The reason is because the water quality of the river has been steadily improved through pollution reduction but this method is now nearing the limit. In addition, rainfall-related FISs such as dam construction and water distribution adjustment may be less effective or lost if a megadrought continues due to climate change and then rainfall does not occur for a long time. Therefore, in the future, if the application conditions for the FISs are similar, the seawater desalination facility, which is independent of rainfall, should be considered as the priority installation target among the FISs. The reason is that seawater desalination facilities can replace the water supply function of dams, which are difficult to newly build in Korea, and can be useful as a climate change adaptation facility by preventing water-related disasters in the event of a long-term megadrought.

• Journal of the Korean association of regional geographers
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• v.3 no.2
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• pp.163-193
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• 1997

Medical services are a fundamental and essential service in all urban areas. The location and accessibility of medical service facilities and institutions are critical to the diagnosis, control and prevention of illness and disease. The purpose of this paper is to present the results of a study on the location of medical facilities in Kwangju and the utilization of these facilities by the inhabitants. The following information is a summary of the findings: (1) Korea, like many countries, is now witnessing an increase in the age of its population as a result of higher living standards and better medical services. Korea is also experiencing a rapid increase in health care costs. To ensure easy access to medical consultation, diagnosis and treatment by individuals, the hierarchical efficient location of medical facilities, low medical costs, equalized medical services, preventive medical care is important. (2) In Korea, the quality of medical services has improved significantly as evident by the increased number of medical facilities and medical personnel. However, there is still a need for not only quantitative improvements but also for a more equitable distribution of and location of medical services. (3) There are 503 medical facilities in Kwangju each with a need to service 2,556 people. This is below the national average of 1,498 inhabitants per facility. The higher locational quotient and satisfactory population per medical facility showed at the civic center. On the other hand, problem regions such as the traditional residential area in Buk-Gu, Moo-deung mountain area and the outer areas of west Kwangju still maintain rural characteristics. (4) In the study area there are 86 general medicine clinics which provide basic medical services. i. e. one clinic per every 14,949 residents. As a basic service, its higher locational quotient showed in the residential area. The lower population concentration per clinic was found in the civic center and in the former town center, Songjeong-dong. In recently build residential areas and in the civic center, the lack of general medicine clinics is not a serious medical services issue because of the surplus of medical specialists in Korea. People are inclined to seek a consultation with a specialist in specific fields rather than consult a general practitioner. As a result of this phenomenon, there are 81 internal medicine facilities. Of these, 32.1% provide services to people who are not referred by a primary care physician but who self-diagnose then choose a medical facility specializing in what they believe to be their health problem. Areas in the city, called dongs, without any internal facilities make up 50% of the total 101 dongs. (5) There are 78 surgical facilities within the area, and there is little difference at the locational appearance from internal medicine facilities. There are also 71 pediatric health clinics for people under 15 years of age in this area, represents one clinic per 5,063 people. On the quantitative aspect, this is a positive situation. Accessibility is the most important facility choice factor, so it should be evenly located in proportion to demander distribution. However, 61% of 102 dongs have no pediatric clinics because of the uneven location. (6) There are 43 obstetrical and gynecological clinics in Kwangju, and the number of residents being served per clinic is 15,063. These services need to be given regularly so it should increase the numbers. There are 37 ENT clinics in the study area with the lower concentration in Dong-gu (32.4%) making no locational differences by dong. There are 23 dermatology clinics with the largest concentration in Dong-Gu. There are 17 ophthalmic clinics concentrated in the residential area because of the primary function of this type of specialization. (7) The use of general medicine clinics, internal medicine clinics, pediatric clinics, ENT clinics by the inhabitants indicate a trend toward primary or routine medical services. Obstetrics and gynecology clinics are used on a regular basis. In choosing a general medicine clinic, internal medicine clinic, pediatric clinic, and a ENT clinic, accessibility is the key factor while choice of a general hospital, surgery clinic, or an obstetrics and gynecology clinic, thes faith and trust in the medical practitioner is the priority consideration. (8) I considered the efficient use of medical facilities in the aspect of locational and management and suggest the following: First, primary care facilities should be evenly distributed in every area. In Kwangju, the number of medical facilities is the lowest among the six largest cities in Korea. Moreover, they are concentrated in Dong-gu and in newly developed areas. The desired number of medical facilities should be within 30 minutes of each person's home. For regional development there is a need to develop a plan to balance, for example, taxes and funds supporting personnel, equipment and facilities. Secondly, medical services should be co-ordinated to ensure consistent, appropriate, quality services. Primary medical facilities should take charge of out-patient activities, and every effort should be made to standardize and equalize equipment and facility resources and to ensure ongoing development and training in the primary services field. A few specialty medical facilities and general hospitals should establish a priority service for incurable and terminally ill patients. (9) The management scheme for the inhabitants' efficient use of medical service is as follows: The first task is to efficiently manage medical facilities and related services. Higher quality of medical services can be accomplished within the rapidly changing medical environment. A network of social, administrative and medical organizations within an area should be established to promote information gathering and sharing strategies to better assist the community. Statistics and trends on the rate or occurrence of diseases, births, deaths, medical and environment conditions of the poor or estranged people should be maintained and monitored. The second task is to increase resources in the area of disease prevention and health promotion. Currently the focus is on the treatment and care of individuals with illness or disease. A strong emphasis should also be placed on promoting prevention of illness and injury within the community through not only public health offices but also via medical service facilities. Home medical care should be established and medical testing centers should be located as an ordinary service level. Also, reduced medical costs for the physically handicapped, cardiac patients, and mentally ill or handicapped patients should be considered.

• Magazine of the Korean Society of Agricultural Engineers
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• v.16 no.2
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• pp.3361-3394
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• 1974

The purpose of this thesis is to disclose some characteristics of water consumption in relation to the quantities of dry matters through the growing period for two statured varieties of paddy rice which are a tall statured variety and a short one, including the water consumption during seedling period, and to find out the various coefficients of evapotranspiration that are applicable for the water use of an expected yield of the two varieties. PAL-TAL, a tall statured variety, and TONG-lL, a short statured variety were chosen for this investigation. Experiments were performed in two consecutive periods, a seedling period and a paddy field period, In the investigation of seedling period, rectangular galvanized iron evapotranspirometers (91cm${\times}$85cm${\times}$65cm) were set up in a way of two levels (PAL-TAL and TONG-lL varieties) with two replications. A standard fertilization method was applied to all plots. In the experiment of paddy field period, evapotanspiration and evaporation were measured separately. For PAL-TAL variety, the evapotranspiration measurements of 43 plots of rectangular galvanized iron evapotranspirometer (91cm${\times}$85cm${\times}$65cm) and the evaporation measurements of 25 plots of rectangular galvanized iron evaporimeter (91cm${\times}$85cm${\times}$15cm) have been taken for seven years (1966 through 1972), and for TONG-IL variety, the evapotranspiration measurements of 19 plots and the evaporation measurements of 12 plots have been collected for two years (1971 through 1972) with five different fertilization levels. The results obtained from this investigation are summarized as follows: 1. Seedling period 1) The pan evaporation and evapotranspiration during seedling period were proved to have a highly significant correlation to solar radiation, sun shine hours and relative humidity. But they had no significant correlation to average temperature, wind velocity and atmospheric pressure, and were appeared to be negatively correlative to average temperature and wind velocity, and positively correlative to the atmospheric pressure, in a certain period. There was the highest significant correlation between the evapotranspiration and the pan evaporation, beyond all other meteorological factors considered. 2) The evapotranpiration and its coefficient for PAL-TAL variety were 194.5mm and 0.94∼1.21(1.05 in average) respectively, while those for TONG-lL variety were 182.8mm and 0.90∼1.10(0.99 in average) respectively. This indicates that the evapotranspiration for TONG-IL variety was 6.2% less than that for PAL-TAL variety during a seedling period. 3) The evapotranspiration ratio (the ratio of the evapotranspiration to the weight of dry matters) during the seedling period was 599 in average for PAL-TAL variety and 643 for TONG-IL variety. Therefore the ratio for TONG-IL was larger by 44 than that for PAL-TAL variety. 4) The K-values of Blaney and Criddle formula for PAL-TAL variety were 0.78∼1.06 (0.92 in average) and for TONG-lL variety 0.75∼0.97 (0.86 in average). 5) The evapotranspiration coefficient and the K-value of B1aney and Criddle formular for both PAL-TAL and TONG-lL varieties showed a tendency to be increasing, but the evapotranspiration ratio decreasing, with the increase in the weight of dry matters. 2. Paddy field period 1) Correlation between the pan evaporation and the meteorological factors and that between the evapotranspiration and the meteorological factors during paddy field period were almost same as that in case of the seedling period (Ref. to table IV-4 and table IV-5). 2) The plant height, in the same level of the weight of dry matters, for PAL-TAL variety was much larger than that for TONG-IL variety, and also the number of tillers per hill for PAL-TAL variety showed a trend to be larger than that for TONG-IL variety from about 40 days after transplanting. 3) Although there was a tendency that peak of leaf-area-index for TONG-IL variety was a little retarded than that for PAL-TAL variety, it appeared about 60∼80 days after transplanting. The peaks of the evapotranspiration coefficient and the weight of dry matters at each growth stage were overlapped at about the same time and especially in the later stage of growth, the leaf-area-index, the evapotranspiration coefficient and the weight of dry matters for TONG-IL variety showed a tendency to be larger then those for PAL-TAL variety. 4) The evaporation coefficient at each growth stage for TONG-IL and PAL-TALvarieties was decreased and increased with the increase and decrease in the leaf-area-index, and the evaporation coefficient of TONG-IL variety had a little larger value than that of PAL-TAL variety. 5) Meteorological factors (especially pan evaporation) had a considerable influence to the evapotranspiration, the evaporation and the transpiration. Under the same meteorological conditions, the evapotranspiration (ET) showed a increasing logarithmic function of the weight of dry matters (x), while the evaporation (EV) a decreasing logarithmic function of the weight of dry matters; 800kg/10a x 2000kg/10a, ET=al+bl logl0x (bl>0) EV=a2+b2 log10x (a2>0 b2<0) At the base of the weight of total dry matters, the evapotranspiration and the evaporation for TONG-IL variety were larger as much as 0.3∼2.5% and 7.5∼8.3% respectively than those of PAL-TAL variety, while the transpiration for PAL-TAL variety was larger as much as 1.9∼2.4% than that for TONG-IL variety on the contrary. At the base of the weight of rough rices the evapotranspiration and the transpiration for TONG-IL variety were less as much as 3.5% and 8.l∼16.9% respectively than those for PAL-TAL variety and the evaporation for TONG-IL was much larger by 11.6∼14.8% than that for PAL-TAL variety. 6) The evapotranspiration coefficient, the evaporation coefficient and the transpiration coefficient and the transpiration coefficient were affected by the weight of dry matters much more than by the meteorological conditions. The evapotranspiratioa coefficient (ETC) and the evaporation coefficient (EVC) can be related to the weight of dry matters (x) by the following equations: 800kg/10a x 2000kg/10a, ETC=a3+b3 logl0x (b3>0) EVC=a4+b4 log10x (a4>0, b4>0) At the base of the weights of dry matters, 800kg/10a∼2000kg/10a, the evapotranspiration coefficients for TONG-IL variety were 0.968∼1.474 and those for PAL-TAL variety, 0.939∼1.470, the evaporation coefficients for TONG-IL variety were 0.504∼0.331 and those for PAL-TAL variety, 0.469∼0.308, and the transpiration coefficients for TONG-IL variety were 0.464∼1.143 and those for PAL-TAL variety, 0.470∼1.162. 7) The evapotranspiration ratio, the evaporation ratio (the ratio of the evaporation to the weight of dry matters) and the transpiration ratio were highly affected by the meteorological conditions. And under the same meteorological condition, both the evapotranspiration ratio (ETR) and the evaporation ratio (EVR) showed to be a decreasing logarithmic function of the weight of dry matters (x) as follows: 800kg/10a x 2000kg/10a, ETR=a5+b5 logl0x (a5>0, b5<0) EVR=a6+b6 log10x (a6>0 b6<0) In comparison between TONG-IL and PAL-TAL varieties, at the base of the pan evaporation of 343mm and the weight of dry matters of 800∼2000kg/10a, the evapotranspiration ratios for TONG-IL variety were 413∼247, while those for PAL-TAL variety, 404∼250, the evaporation ratios for TONG-IL variety were 197∼38 while those for PAL-TAL variety, 182∼34, and the transpiration ratios for TONG-IL variety were 216∼209 while those for PAL-TAL variety, 222∼216 (Ref. to table IV-23, table IV-25 and table IV-26) 8) The accumulative values of evapotranspiration intensity and transpiration intensity for both PAL-TAL and TONG-IL varieties were almost constant in every climatic year without the affection of the weight of dry matters. Furthermore the evapotranspiration intensity appeared to have more stable at each growth stage. The peaks of the evapotranspiration intensity and transpiration intensity, for both TONG-IL and PAL-TAL varieties, appeared about 60∼70 days after transplanting, and the peak value of the former was 128.8${\pm}$0.7, for TONG-IL variety while that for PAL-TAL variety, 122.8${\pm}$0.3, and the peak value of the latter was 152.2${\pm}$1.0 for TONG-IL variety while that for PAL-TAL variety, 152.7${\pm}$1.9 (Ref.to table IV-27 and table IV-28) 9) The K-value in Blaney & Criddle formula was changed considerably by the meteorological condition (pan evaporation) and related to be a increasing logarithmic function of the weight of dry matters (x) for both PAL-TAL and TONG-L varieties as follows; 800kg/10a x 2000kg/10a, K=a7+b7 logl0x (b7>0) The K-value for TONG-IL variety was a little larger than that for PAL-TAL variety. 10) The peak values of the evapotranspiration coefficient and k-value at each growth stage for both TONG-IL and PAL-TAL varieties showed up about 60∼70 days after transplanting. The peak values of the former at the base of the weights of total dry matters, 800∼2000kg/10a, were 1.14∼1.82 for TONG-IL variety and 1.12∼1.80, for PAL-TAL variety, and at the base of the weights of rough rices, 400∼1000 kg/10a, were 1.11∼1.79 for TONG-IL variety and 1.17∼1.85 for PAL-TAL variety. The peak values of the latter, at the base of the weights of total dry matters, 800∼2000kg/10a, were 0.83∼1.39 for TONG-IL variety and 0.86∼1.36 for PAL-TAL variety and at the base of the weights of rough rices, 400∼1000kg/10a, 0.85∼1.38 for TONG-IL variety and 0.87∼1.40 for PAL-TAL variety (Ref. to table IV-18 and table IV-32) 11) The reasonable and practicable methods that are applicable for calculating the evapotranspiration of paddy rice in our country are to be followed the following priority a) Using the evapotranspiration coefficients based on an expected yield (Ref. to table IV-13 and table IV-18 or Fig. IV-13). b) Making use of the combination method of seasonal evapotranspiration coefficient and evapotranspiration intensity (Ref. to table IV-13 and table IV-27) c) Adopting the combination method of evapotranspiration ratio and evapotranspiration intensity, under the conditions of paddy field having a higher level of expected yield (Ref. to table IV-23 and table IV-27). d) Applying the k-values calculated by Blaney-Criddle formula. only within the limits of the drought year having the pan evaporation of about 450mm during paddy field period as the design year (Ref. to table IV-32 or Fig. IV-22).

• Korean Security Journal
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• no.1
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• pp.371-408
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• 1997

This article is the reserch on actual condition of crime of arson which occurs in Korea and its countermeasures. The the presented problem in this article are that (1) we have generally very low rate concern about the crime of arson contrary to realistic problems of rapid increase of crime of arson (2) as such criminal motives became so diverse as to the economic or criminal purpose unlike characteristic and mental deficiency of old days, and to countermeasure these problems effectively it presentation the necessity of systemantic research. Based on analysis of reality of arson, the tendency of this arson in Korea in the ratio of increase is said to be higher than those in violence crime or general fire rate. and further its rate is far more greater than those of the U.S.A. and Japan. Arson is considered to be a method of using fire as crime and in case of presently residence to be the abject, it is a public offense crime which aqccompany fatality in human life. This is the well It now fact to all of us. And further in order to presentation to the crime of arson, strictness of criminal law (criminal law No, 164 and 169, and fire protection law No. 110 and 111) and classification of arsonist as felony are institutionary reinforced to punish with certainty of possibility, Therefore, as tendency of arson has been increased compared to other nations, it is necessary to supplement strategical policy to bring out overall concerns of the seriousness of risk and damage of arson, which have been resulted from the lack of understanding. In characteristics analysis of crime of arson, (1) It is now reveald that, in the past such crime rate appeared far more within the boundary of town or city areas in the past, presently increased rate of arsons in rural areas are far more than in the town or small city areas, thereby showing characteristics of crime of arson extending nation wide. (2) general timetable of arson shows that night more than day time rate, and reveald that is trait behavior in secrecy.(3) arsonists are usually arrested at site or by victim or report of third person(82,9%).Investigation activities or self surrenders rate only 11.2%. The time span of arrest is normally the same day of arson and at times it takes more than one year to arrest. This reveals its necessity to prepare for long period of time for arrest, (4) age rate of arson is in their thirties mostly as compared to homicide, robbery and adultery, and considerable numbers of arsons are in old age of over fifties. It reveals age rate is increased (5) Over half of the arsonists are below the junior high school (6) the rate of convicts by thier records is based on first offenders primarily and secondly more than 4 time convicts. This apparently shows necessity of effective correctional education policy for their social assimilation together with re-investigation of human education at the primary and secondary education system in thier life. The examples of motivation for arosnits, such as personal animosity, fury, monetary swindle, luscious purpose and other aims of destroying of proof, and other social resistance, violence including ways of threatening, beside the motives of individual defects, are diverse and arsonic suicide and specifically suicidal accompany together keenly manifested. When we take this fact with the criminal theory, it really reveals arsons of crime are increasing and its casualities are serious and a point as a way of suicide is the anomie theory of Durkheim and comensurate with the theory of that of Merton, Specifically in the arson of industrial complex, it is revealed that one with revolutionary motive or revolting motive would do the arsonic act. For the policy of prevention of arsons, professional research work in organizational cooperation for preventive activities is conducted in municipal or city wise functions in the name of Parson Taskforces and beside a variety of research institutes in federal government have been operating effectively to countermeasure in many fields of research. Franch and Sweden beside the U.S. set up a overall operation of fire prevention research funtions and have obtained very successful result. Japan also put their research likewise for countermeasure. In this research as a way of preventive fire policy, first, it is necessary to accomodate the legal preventitive activities for fire prevention in judicial side and as an administrative side, (1) precise statistic management of crime of arson (2) establishment of professional research functions or a corporate (3) improvement of system for cooperative structural team for investigation of fires and menpower organization of professional members. Secondly, social mentality in individual prospect, recognition of fires by arson and youth education of such effect, educational program for development and practical promotion. Thirdly, in view of environmental side, the ways of actual performance by programming with the establishment of cooperative advancement in local social function elements with administrative office, habitants, school facilities and newspapers measures (2) establishment of personal protection where weak menpowers are displayed in special fire prevention measures. These measures are presented for prevention of crime of arson. The control of crime and prevention shall be prepared as a means of self defence by the principle of self responsibility Specifically arsonists usually aims at the comparatively weak control of fire prevention is prevalent and it is therefore necessary to prepare individual facilities with their spontaneous management of fire prevention instead of public municipal funtures of local geverment. As Clifford L. Karchmer asserted instead of concerns about who would commit arson, what portion of area would be the target of the arson. It is effective to minister spontaveously the fire prevention measure in his facility with the consideration of characteristics of arson. On the other hand, it is necessary for the concerned personnel of local goverment and groups to distribute to the local society in timely manner for new information about the fire prevention, thus contribute to effective result of fire prevention result. In consideration of these factors, it is inevitable to never let coincide with the phemonemon of arsons in similar or mimic features as recognized that these could prevail just an epedemic as a strong imitational attitude. In processing of policy to encounter these problems, it is necessary to place priority of city policy to enhancement of overall concerns toward the definitive essense of crime of arson.

• Journal of agricultural medicine and community health
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• v.26 no.1
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• pp.19-35
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• 2001

This study was conducted to investigate the internal changes and the countermeasure for performance improvement by Separation of Prescribing and Dispensing Practice (SPDP) in Health Center. Data were collected from two sources: Performance report before and after SPDP of 25 Health Centers in Kyongsangbuk-do and 6 Health Centers in Daegu-City and self-administerd questionnaire survey of 221 officials at health center. The results of this study were summarized as follows: Twenty-four health centers(77.4%) of 31 health centers took convenience measures for medical treatment of citizens and convenience measures were getting map of pharmacy, improvement of health center interior, introduction of order communication system in order. After the SPDP in health centers, 19.4% of health centers increased doctors and 25.8% decreased pharmacists. 58.1% of health centers showed that number of medical treatments were decreased. 96.4%, 80.6% 80.6% 96.7% of health centers showed that number of prescriptions, total medical treatment expenses, amounts paid by the insureds and the expenses to purchase drugs, respectively, were decreased. More than fifty percent(54.2%) of health centers responded that the relative importance of health works increased compared to medical treatments after the SPDP, and number of patients decreased compared to those in before the SPDP. And there was a drastic reduction in number of prescriptions, total medical treatment expenses, amounts paid by insureds, the expenses to purchase drugs after the SPDP. Above fifty percent(57.6%) of officers at health center responded that the function of medical treatment should be reduced after the SPDP. Fields requested improvement in health centers were 'development of heath works contents'(62.4%), 'rearrangement of health center personnel'(51.6%), 'priority setting for health works'(48.4%), 'restructuring the organization'(36.2%), 'quality impro­vement for medical services'(32.1%), 'replaning the budgets'(23.1%) in order. And to better the image of health centers, health center officers replied that 'health information management'(60.7%), 'public relations for health center'(15.8%), 'kindness of health center officers'(15.3%) were necessary in order. Health center officers suggested that 'vaccination program', 'health promotion', 'maternal and children health', 'communicable disease management', 'community health planning' were relatively important works, in order, performed by health center after SPDP. In the future, medical services in health centers should be cut down with a momentum of the SPDP so that health centers might reestablish their functions and roles as public health organizations, but quality of medical services must be improved. Also health centers should pay attention to residents for improving health through 'vaccination program', 'health promotion', 'mother-children health', 'acute and chronic communicable disease management', 'community health planning', 'oral health', 'chronic degenerative disease management', etc. And there should be a differentiation of relative importance between health promotion services and medical treatment services by character of areas(metropolitan, city, county).

• Journal of Yeungnam Medical Science
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• v.12 no.2
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• pp.347-365
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• 1995

A survey was conducted to study perception and attitudes of health workers towards health center's activities and organization of health services, from August 15 to September 30, 1994. The study population was 310 health workers engaged in seven urban health centers in Taegu City area. A questionnaire method was used to collect data and response rate was 81.3 percent or 252 respondents. The following are summaries of findings: Profiles of study population: Health workers were predominantly female(62.3%); had college education(60.3%); and held medical and nursing positions(39.6%), technicians(30.6%) and public health/administrative positions(29.8%). Perceptions on health center's resources: Slightly more than a half(51.1%) of respondents expressed that physical facilities of the centers are inadequate; equipments needed are short(39.0%); human resource is inadequate(44.8%); and health budget allocated is insufficient(38.5%) to support the performance of health center's activities. Decentralization and health services: The majority revealed that the decentralization of government system would affect the future activities of health centers(51.9%) which may have to change. However, only one quarter of respondents(25.4%) seemed to view the decentralization positively as they expect that it would help perform health activities more effectively. The majority of the respondents(78.6%) insisted that the function and organization of the urban health centers should be changed. Target workload and job satisfaction: A large proportion (43.3%) of respondents felt that present target setting systems for various health activities are unrealistic in terms of community needs and health center's situation while only 11.1 percent responded it positively; the majority(57.5%) revealed that they need further training in professional fields to perform their job more effectively; more than one third(35.7%) expressed that they enjoy their professional autonomy in their job performance; and a considerable proportion (39.3%) said they are satisfied with their present work. Regarding the personnel management, more worker(47.3%) perceived it negatively than positive(11.5%) as most of workers seemed to think the personnel management practiced at the health centers is not fair or justly done. Health services rendered: Among health services rendered, health workers perceived the following services are most successfully delivered; they are, in order of importance, Tb control, curative services, and maternal and child health care. Such areas as health education, oral health, environmental sanitation, and integrated health services are needed to be strengthening. Regarding the community attitudes towards health workers, 41.3 percent of respondents think they are trusted by the community they serve. New areas of concern identified which must be included in future activities of health centers are, in order of priority, health care of elderly population, home health care, rehabilitation services, and such chronic diseases control programs as diabetes, hypertension, school health and mental health care. In conclusion, the study revealed that health workers seemed to have more negative perceptions and attitudes than positive ones towards organization and management of health services and activities performed by the urban health centers where they are engaged. More specifically, the majority of health workers studied revealed to have the following areas of health center's organization and management inadequate or insufficient to support effective performance of their health activities: Namely, physical facilities and equipments required are inadequate; human and financial resources are insufficient; personnel management is unsatisfactory; setting of service target system is unrealistic in terms of the community needs. However, respondents displayed a number of positive perceptions, particularly to those areas as further training needs and implementation of decentralization of government system which will bring more autonomy of local government as they perceived these change would bring the necessary changes to future activities of the health center. They also displayed positive perceptions in their job autonomy and have job satisfactions.

• 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.