Most of the medical care facilities and manpower are concentrated in Urban, Korea, as in most other countries. Therefore the populations of rayon areas depend on front line health workers for their health and medical care.
There are around 4,000 myon health workers and the population in myon areas is about 40% of the total population. In fact we are facing the problem of how to improve the health 1vorkers´ activities in the most efficient and productive way. The government recommends covering the health workers simple purpose function into multipurpose functions in order to improve the efficiency at their activity of through the health center system.
Previously, the Ministry of Health and-Social Affairs had conducted a study of the multipurpose activities in demonstration area, which was located in Yong in gun, Kyonggi province, with the cooperation of WHO. Also the Ministry of Health and Social Affairs conducted an Operations Research Study to determine the health. care delivery system is operating efficiently and how best to improve the effectiveness and efficiency of the demonstration project.
This study was aimed at obtaining headed Information for appropriations and preparation of further planning for multipurpose activities.
The following are the summary of the findings:
1. Nine Health Workers were observed, 7 of those were nurse aides and 2 of those were midwives, 2 midwives were aged 53 and 60. The educational background of the midwives was i year technical midwifery training with basic middle school education. The other 7 nurse aides were under 30 years old and 4 workers were married. 4 were high school graduates and 4 had experience as health, workers for over 5 years. -
-2. The population and size of the 3 myons were similar to other rural areas in Korea, but population density and distribution in the 3 myons were quite different.
3. Health Sub centers´ facilities and equipment observed were adequate at present. Utilization of Health Sub centers was very low (3-5/day/each Health Subcenter)
4. In distribution of working time by functional category, slack time accounted for 23%, ancillary and supportive activities consumed 22%. It is yet to be determined whether the time distribution was adequate for appropriate health care. , Particularly, in TB control, 13% was spend on technical activities, . if the reason for less-used TB control was based on the need of community people, the multipurpose activities would be efficient. However, the reason has yet to be determined.
5. It was found that among the health sub centers and health workers within the same sub centers, time spent on technical activities and slack time was quite-varied. It was revealed that such result-, were not due to age, basic education or marital status of health workers, but their ability to conduct technical activities, particularly delivery skill for maternal care. Experiences as health workers were very closely related to that ability.
6. Daily slack time of health sub center units and health workers were quite varied during the observation period. Sub center I spent 3.3-40.1% on slack time, Sub center ii spent 1. 5-63. 5%, and Sub center III spent 8.0-45.7%. By health worker, a much wider range was found in daily slack time distribution.
The above finding indicated that working program, cooperation among health workers, coordination of daily working program and allocation of working load were rot well set up or were not functioning.
In addition to that, the health center is required to provide regular supervision to health workers. Therefore, the health centers´ organization and functions must be modified for that purpose, otherwise the unification of Health Workers´ functions cannot be efficiently accomplished.
Improvement in the following points for the health care system at Myon level is deemed necessary on the ground of findings for the multipurpose activities.
It was suggested that single purpose health workers be converted into multipurpose workers carrying out overall health service activities in a designated area. It is too premature, however, to conclude that productivity of multipurpose worker could be increased without modifying the other components of the health center service system. It is evident that changes in the peripheral service components can be expected when other relevant factors of health center system is changed at the same time.
In concretely, firstly, since there exist many factors which influence the scope of activates in Myon area, such as population, geographical characteristics it is necessary to deploy an adequate number of health workers to serve the area, instead of just posting uniform number of health workers to a Myon regardless of the size and geographical characteristics of the Myon. Secondly, as it was noted that midwives were utilizing their allotted time better than any other workers and furthermore, maternal and child health services are needed in rural area, skills and techniques in delivering maternal care should be emphasized for multipurpose health workers. Thirdly, without the improvement in management system for, health care, particularly in supervision, direction and technical advice, we cannot expect the improvement in the productivity of health workers. Lastly, it is necessary to develop the standard on the activities to be performed and standard and method for the evaluation of multipurpose health worker.
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