1960 1980 2005 2007

Population 24,989,241 37,436,315 47,279,143 49,194,085

Life expectancy

51.5 65.7(M 61.8, F 70.0)

77.9(M 74.8, F 81.5)

78.5(M 75, F 82)

GNI per person ($)

79 1,845 16,291 20,045

No. of family members

5.56 4.62 2.88(20% 1 person,

22.2% 2 persons)

No. of MDs 11,456(1966) 22,564 81,328 88,214(‘06)

No. of RNs 9,851(1966) 40,373 214,900 223,781(‘06)

3

Major Social Issues in 1970-1980

4

Remote areas:

-Poor

-No transportation

-No hospitals, pharmacies

-No health professionals

-No communication & information devices

§National Economic (Social) Development

§Mal-distribution of Resources

§Health Disparities– Rural & Urban

The 4th

National Economic Development Plan (1977-1981)

5

CHP

New Village Movement

PHC,Alma Ata

Basic Philosophy & Goal

Principles

Focus

Service

CHPIn Korea

6

Primary Health Care (1978, Alma Ata)

7

¨ Essential Health Care

¨ Socially Acceptable Methods & Technology

¨ Accessibility

¨ Client / Community Participation

¨ Affordable Cost

¨ Self Reliance / Self Determination

Basic Philosophy of PHC

8

¨ Individual and public right to health

¨ Social justice & equity

¨ Free will & self- determination

: Human uniqueness

9

Primary Health Care: Health for AllPrimary Health Care: Health for All

Basic Philosophy

Human right to Health

Goal

Community Development & Self Reliance

Services

•Health education (Behavior

change & empowerment)

•Nutrition

•Sanitation

•MCH

•Prevention & control endemic ds.

•Treatment of common disease

•Essential Drugs

Focus

•Basic health needs

•Total Population

•Out-reach

•Maximum utilization

of Resources

Principles

•Community Participation

•Intersectorial collaboration

•Accessibility

•Appropriate technology

•Integration with NHCS

Basic Concept of Community Involvement

10

¨ Self-help and mutual aid

¨ Provider-client partnership

¨ Empowerment

¨ Volunteerism

11

CommunityCouncil

CHP CommunityPeople

*Provider does all the process*Announced for advertisement

*Provider does all the process andcommunity helps when they are asked

*Community no influence to decision*Community involved in implement

stage

*Provider does plan, then consult to community before decision

*Community little influence

*Provider and community work together during all the process

* Partners

*Community dose all the process and provider supports

Level of participation

Low

High

Mobilization Public Mobilization

CommunityVolunteer,

Village worker

Assistance

Consult &Referral network

Cooperation

Cooperationwith Committee

Involvement

CommunityCouncil InitiateInitiation

12

Special Law for Remote Area(Dec. 1980)

13

¨ Various methods of health care delivery were

implemented using different health care

professionals

¨ Mandate the deliver of public health care through

CHP

¨ Roles and functions

¨ Locations

Job Descriptions of CHP(Special Law)

14

¨ Common illness treatment

¨ Public health & disease prevention

¨ NCD management

¨ Health education and counseling

¨ MCH & FP: Normal delivery & IUD insertion

¨ Prescribing drugs for common illness

¨ Clinic management & supervision of health worker

¨ Community resource development & organization

¨ Community health planning

Medical Practice of CHP15

¨ Allow CHP medical practice without direct

supervision of MD

¨ Function only in the designated local remote

area

¨ 24 hour service as residence

¨ Temporary status

CHP Training

16

¨ Basic education: RN or Nurse Midwife with clinical

experience

¨ Coursework 24 weeks

¤ Lectures (8 weeks)

¤ Clinical Practice (12 weeks)

¤ Field Internship (4weeks)

¨ Certified by MOH

365

721

1111

1640

2038 20391906

18921891

18991901

1911

200

400

600

800

1000

1200

1400

1600

1800

2000

220019

81

198

2

198

3

198

5

199

0

199

5

20

00

20

01

20

02

20

03

20

04

20

06

Number of CHPost: 1981-2006

17

0

5

8

25

10

9

11

162

131

163

239

240

331

312

219

46

18

DogDo

Health Center

PHCCouncil

VillageHealth Worker

CHP inCHPostSupervision

Support

Participation

Community

Land

Government

Salary

Organize

Construction

19

Health belief/

value (30-50%)

Social system/

Environment

(20-30%)

Health service

(50-70%)

: Health educator/Counselor(Healthy Life Style)

Change agent (Health-supportive

environment)

•Practitioner•Program coordinator/Case manager

20

• Income from clinical service:

Cost Analysis (1992) \ 959/visit

\ 585/service

\ 1,841/pt

(including salary)

• Community: Drug, facilities, administrative cost

& land

• Government: Construct the post, CHP salary21

Qualitative Research on CHP

22

Scientific/ Assessment Community Dx. Skills

(Analytic)

Perceptional/ Conscious ofCHP

(Comprehensive)

In clinic/ Major illness(Disease)

AbandonedChildren & Women

(Wellbeing)

Treatment, Formal Health Education

Community Development Activity & Inter-relationship

23

• Day care for children

• Library

• Establish coop bank

• Construct public bath place

24

Grow Together

¨ SatisfactionHigh: Role & Function

(86-97%)

Low: Salary &

No private life

(23-52%)

¨ Retention

¨ Satisfaction

( 96-98.7% )

¨ Utilization

¨ Development

25

CHP Community

• Age: 1982(%) 1992 (%) 2000(%)

20-29 60 38.9 3.4

30-39 35 36.6 54.4

40 over 5 24.4 42.2

• MarriageSingle 80 32.8 1.4

Married 20 64.9 95.9

(Weekend couple: over 30%)

• Length of WorkUnder 5years 39.7 3.5

0ver 10years 29.0 94.4

26

• 28 years of CHP history

• Remaining under the special law

• Environmental change

through Socio-economic development

• No remote area

but accessibility problem remain

• Nursing development

• Health reform 27

Social Changes in KoreaSocial Changes in Korea

Science & TechnologyScience & Technology

PopulationPopulation

Social ValuesSocial Values

-Rapid Aging

-Low Birth Rate

-IT & Cyber

-Genetics

-Health Industry/ Devices

-Women power

-Welfare oriented

-NGO movement

PoliticalPolitical

Economy Economy

heeCHPHealth Reform-Globalization

2828

-Transportation-e hospital

2.1, ‘83

1.76, ‘84

1.08 , ‘05

Entry to Aging Society

7.2%, ‘00

1.30 , ‘01Population

Improvement Policy 1.58 , ‘96

Aging rate

Total Birth rateEnd Family

Planning 1.58, ‘89

Economic Crisis

29

Nursing Status in Korea (2006)

30

¨ 100years of nursing education

¨ Number of nursing schools: 120

¨ Beginning BS program since 1955

¨ Master’s program (since 1960): 38

¨ Ph.D program (since 1978): 19

¨ No. of M.S holder: 5,018

¨ No. of Ph.D holders: 1,007

¨ 13 area of advanced practice nursing

Number of RNs:

214,900

• Made CHPs remain in work

• Made community cohesiveness

• Made Korean CHP program

world successive

33

• Revitalization of PHC

• Remodeling CHP Role

• Need to train young nurses to learn “True

experience of health” and grow together with the

spirit of PHC preparing for the new phenomena

of health disparity in communities 34

37

The Leader The Leader with a Vision inwith a Vision inGl

obal Society

Global Society

T h

e Leader

The Leader with a Vision inwith a Vision inGl

obal Society

Global Society