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가족계획과 모자보건 통합을 위한 조산원의 투입효과 분석 -서산지역의 개입연구 평가보고-
방숙,한성현,이정자,안문영,이인숙,김은실,김종호,Bang, Sook,Han, Seung-Hyun,Lee, Chung-Ja,Ahn, Moon-Young,Lee, In-Sook,Kim, Eun-Shil,Kim, Chong-Ho 대한예방의학회 1987 예방의학회지 Vol.20 No.1
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 o
새마을 교육(敎育)과 농촌환경(農材環境) 및 보건위생(保健衛生)
방숙,Bang, Sook 대한예방의학회 1982 예방의학회지 Vol.15 No.1
The Saemaul Undong has brought great improvements tothe life-style environment of rural communities, but it has not been able to focuson a health program. In order to improve rural health, develop human resources, and utilise the nation's manpower, the Saemaul Undong should focus on a community health project. Mobilizing the manpower for such a project can be done by providing opportunities for youth and young adults, especially village women, to betrained as primary health caretakers. This project can be achieved through the joint support of the Ministry of Horne Affairs, the Ministry of health and Social Affairs, and other Ministries. It will take decision and courage by government officials to implement such a grand plan, but it is a very crucial task to promote primary health care throughout the whole nation. This calls for top leader's concern & will to adovocate and support a 'Saemaul Movement for health', giving health asfirst priority to the Saemaul Undong as afresh political drive of the fifth Republic of Korea Government.
방숙(Sook Bang),조유향(Yoo Hyang Cho) 한국노년학회 1993 한국노년학 Vol.13 No.2
본 논문은 노인의료문제가 점점 심각한 사회문제로까지 부상하고 있는 현시점에서 노인보건의료문제를 살펴보았을 때 많은 문제점을 파악할 수 있어 이러한 문제점을 해결하고, 앞으로 다가올 고령화사회에 대처하기 위한 대책방안의 강구를 제시해 보고자 하였다. 연구방법으로는 그동안 우리나라의 노인보건의료를 위해 실시된 제반 정책을 기존문헌과 연구보고서를 검토하는 한편 노인을 위해 앞으로 요청되는 정책대안을 제시하고 그 우선순위를 결정하기 위해 delbecq방법을 이용한 결과, 그 우선순위는 다음과 같다. 노인을 위한 보건의료정책의 발전적 대안으로는 첫째 노인보건법(가칭)의 제정, 둘째 지역사회 노인 보건사업의 확대실시, 셋째 가정간호체계의 확립 및 전개, 넷째 노인의료비 부담의 경감, 다섯째 노인보건의료시설의 확충, 여섯째 노인보건/의료재활 서비스 전담인력의 양성, 배치 등이었으며, 이와 같은 6가지의 대안이 빠른 시일안에 정착되어 나아가기를 바라마지 않는다. One of the consequences of lowering fertility in Korea is the aging problem and the proportion of population over sixty-five is expected to increase from the current level of 5.0% in 1990 to 6.8% in 2000 and 13.1% in 2021. Towards the 21st century, therefore, there is a need of developing more preventive and productive health policies and programs for the aging population in Korea. Currently, however, the Korean welfare law for elderly is only limited to provision of health examination services for the poor sixty-five and older. This paper first describes the demographic and socio-economic change in Korea since 1960 and the current health status of the aged population in terms of disability, morbidity and mortality based on the available data. Then, it made a literature review to examine the policies and programs practiced or planned by the government and also those recommended by the scholars in the field of health and medical care for the elderly(age 65 and over). Among the list of policies and programs based on the literature review study, Priorities were studied by using the Delbecq method and the following five areas were identified as priority areas to be implemented for the aging population towards the 21st century in Korea. Those five areas were; ⅰ) strengthening health promotion starting at the age of 40 years old, ⅱ) better development of health and medical care services at institution, family, and community, ⅲ) reducing the burden of self-payment of medical cost of the elderly in the national medical insurance system, ⅳ) increasing the qualified health and medical manpower for the care of the elderly, and ⅴ) enactment of a special health law for the elderly. This paper further discusses the five issues in adopting such health policies and programs. Those issues were; a) responsibility of family and /or society for the care elderly (who is primary responsible for the care?), b) economic aspects of health care(who bears cost ?), c) service target(selective or universal?), d) cultural aspects of care of the elderly( e, g, perception towards the aged, the concept of normalization), and e) sectionalism and integration issues in developing service delivery system for elderly. This paper emphasized the need for continuing efforts to arrive at a national consensus on the above issues in formulating those five priority areas of health policies and programs as preventive and productive measures for the care of aging population towards the 21st century.