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Korean Journal of Epidemiology 1988;10(2): 174-194.
보건지표로 본 지역사회 보건의료사업의 평가: 음성지역 보건의료사업을 중심으로
한성현, 정경희, 방숙
Evaluation of a community health services based on the basic health indicators
Seung Hyun Han, Kyung Hee Chung, Bang Sook
Abstract
This study attempted to measure the effects of a community health works conducted in Soyi and Wonnam townships in Eumseong County from August 1985 in terms of several health indicators. The community health works are primary consisted of (1) coaching PHC personnel to functionalize their work with emphasis on MCH, (2) organizing & training VHWs to link providers & consumbers, and (3) publishing a monthly village health newsletter. Data was collected through a baseline(or before) survey in July 1985 prior to the start and an after survey two years later. The study area was Soyi & Wonnam townships and the control area was Maingdong township. The survey population were 1,542 eligible women living in 3,787 households residing in the three townships for the baseline survey and 1,440 eligible women in 3,706 households for the after survey. The following is a summary of study results. First, there were no significant social, economic, and demographical differences by area at each survey, and there were no inter-area differences except for the tendency for decreased crude birth rate(from an average of 11.1 to 9.7) and increased mortality rate(from an average of 7.3 to 10.8) in all three areas. The three townships showed slight reduction in their total fertility rate(TFR) in each of Soyi, Wonnam, and Maingdong townships, slumped from 2.5 to 2.2(Soyi) and 2.3 to 2.0(Wonnam), and 3.0 to 2.4(Maingdong), respectively. Second, the family planning(FP) acceptance rate increased from 71% to 77% tubectomy accounting for over 50% in all three areas, and no significant inter-area differences. Third, in regard to the acceptance rate of maternal and child health(MCH) care, the prenatal care rate rose from 66.5% to 80.4% among women with pregnancy experiences over the last two years(before each survey), with Soyi showing a high utilization rate of 85.2% due to such efforts as an operation of the mobile prenatal clinic of the public health physicians(PHP) from the Maternal and Child Health Center(MCHC). The rate of women receiving prenatal care more than 3 times in this township also climbed to 40% from 61%, thus being relatively higher than other townships. In regard to the side of prenatal care, the Project area has a 30% utilization rate of the MCHC which is higher than the control area(6%). Accordingly, a rise in the MCHC utilization rate may be forecasted, should the Project be continued. The home delivery rate was lowered from the 48% of the before survey to the 23% of the after survey, showing a relatively apparent increase in the rate of institutional delivery. About 77% of the births in the Project area were delivered at institutions; 30% did so at the MCHC and about 43% at hospitals and clinics. In the control area, there were about 75% of deliveries at institutions; 24% at MCHC and 46% at hospitals & clinics, indicating no difference from the project area. The basic vaccination rate was over 90% in the project area but remained at 70% in the control township. There was also a tendency for the control area to lag behind in vaccination rates for hepatitis, M.M.R., and Japanese B encephalitis. Fourth, looking at utilization rate of the medical and health care institutions for their illness, there are no mainfested areal and periodical differences, but there were about 20% of people who perceived their disease yet unmet their needs(who feel they have a disease but do not treat it). Also there were an extremely poor utilization rate of the health subcenters(5 to 7%) where a young public health physician is assigned in lieu of Army services for 3 yrs. The results of this study have the following limitations in demonstrating the effects of the project. First, the time of the After survey was not the end of the project and so there was too early to assess the program input effects to be revealed. Second, because of the nature of the project which was not designed experimentally but primary to coach health personnel, there were no pre-determined of health indicators to be evaluated prior to the start, and it was difficult to set an appropriate health indicators to be evaluated. Third, the involvement of the surveyors in morbidity study varied in their training & skills, so that there were validity problems regarding morbidity items in both surveys. Fourth, changes in the social, economic, and cultural conditions and problems caused by health policies and health adminstration of the community could not be controlled. Nevertheless, a preliminary results shows that in the utilization of primary health care, there were significant effects on maternal and child health care works which represent personal health services(preventive aspects), but none whatsoever in the treatment aspects. This shows that programs which induce community participation, such as the organization and training of village health workers(VHW) and the publicaton of ''Village Health News”(newsletter), were fairly influential, but that the implementation of treatment functions did not take place. In other words, the problem points of this project were: First, primary health care institutions are functionally deficient in their ability to carry out their work, esp. primary care(clinical aspects). Second, there was the lack of organized systematic and technical linkages such as connections between public health institutions and private or secondary medical care institutions. Third, there were no particular support systems which could solve geographic and economic accessibility problems. And fourth, there were not sufficient health education program to improve their health & illness behaviour in the community. Consequently, should all such problems not be solved at a political(strategical) level, then(one would think that) it is hard to expect for the effectiveness primary health care works to achieve the goal of “Health for all by 2,000".


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