농촌 주민의 건강을 위한 가정건강요원 훈련에 관한 연구시안

Abstract

[한글]

[영문]

The public health programs of different countries vary considerably according to their social and economic conditions. However, one can judge the effect of a country's program by infant mortality rate (IMR), maternal mortality rate (MMR) and

by the incidence rate of infectious duseases in general.

According to the 1973 census, Korea has an IMR of 50 and a MMR of 7.8. These figures are relatively high. There are many factors responsible for such high rates, among those being:

1. Lack of facilities and personnel for providing efficient medical care services,

2. Lack of general recognition of the importance of preventive care (as for instance health care for pregnant women which affects both IMR and MMR),

3. Short intervals between pregnancies and frequent artificial abortions, which, through maternal exhaustion, affect child rearing and family life, and thus have an impact on national health, and

4. Porblems existing in policy and organizational sturcture at the governmental leval, which contribute to the existing conditions.

The government is beginning to put greater emphasis on MCH care in order to improve on these most important aspects of health care, and plans exist to integrate MCH care and family planning at the grass root level with enhancement of pre- and postnatal care, safe home delivery programs, integrated pre- and postnatal

family planning education and services, well baby care, etc.. Yet, if such a program is to succeed, it must be available to, as well as acceptable to every woman and child in the target population.

The existing health services are not equipped yet to provide the necessary prerogatives for a successful program. It is more and more recognized that in order to extend existing services to grass root level and to insure availability to all,

the well planned implementation of auxiliary health workers is an almost inevitable mecessity. Programs experimenting with such workers in Korea are already becoming of increased significance. At this point, it is most mecessary to develop a concept for such workers that enables the health services to effictively reach the grass roots and equally important, gives feedback on the community's acceptance of and cooperation in the offered programs and services.

This paper presents considerations about such a concept, about selection, and in particular, about training and instructional contents of a curriculum for such village based semiauxiliary health workers, called Family Health Workers (FHM).

The concept, derived from a study of international and national literature as well as from careful observation of local programs and conditions is applicable to Korean village women comparable to mother's class leaders. Theyare to extend the existing main government health programs in MCH, FP, and TB care into their

villages through routine home visits and regular office hours, with health education, case finding, referal and follow-up. They are also to be integrated with the national health services theough supervision and continuous training by the township health workers.

The selection is done according to carefully stipulated criteria, by village chief and local health authorities, and suggests selection of a woman in good community standing, with known history of social interest and activity, 20-45 years of age, married, and with at least primaru school education.

The curriculum takes account of the underlying purpose of extending the main aspects of national health care delivery in MCH, FP and TB services acceptable to every individual in the target area. Subs equently, it focuses on practical and communicational skill in MCH, FP and TB health education, case finding, referal and follow-up. A four week's course, conducted at the myun level, mainly by myun health personnel under guidance of a trained supervisor is suggested. To enhance the community's interest as well as acceptability of program and worker, main emphasis is given to child health.

The plan presented is currently being implemented as part of the Kang Wha community Health Teaching program and worker, main emphasis is given to child health.

The plan presented is currently being implemented as part of the Kang Wha Community Health Teaching program at Yonsei College of Medicine. It is expected that the described worker will function well within the national health care delivery system and will stimulate the communities to recognize the importance of their participation and initiative for the improvement of health conditions of their own people.