Final evaluation of the Korea health demonstration project

Final evaluation covers a period ending 10/80 and is based on site visits and interviews with project officers and USAID/K and Korean Government officials. The Korean Health Development Institute (KHDI), the implementing agency, successfully established township-level public health units (PHU"s) which were found to be clean; adequately equipped, staffed, and supplied; and possessed a satisfactory referral system. Community health practitioners performed creditably (despite being underpaid and overworked) and apparently helped PHU"s meet project targets in maternal/child care, family planning, and immunization services. The major weakness of PHU"s - tuberculosis control - resulted mainly from inadequate health education and lack of patient cooperation and interest. Community health centers (CHC"s), the county-level health care dispensaries and supervisory centers, enjoy good facilities, management, and supply. CHC problems included a satisfactory to poor referral system and staff dissatisfaction due to low pay, heavy workload, and borrowing of staff by other government agencies. Village health aides were found to be competent and dedicated but expressed a need for more specialized training. Overall, the KHDI program enjoyed high acceptabililty and incurred lower costs than previous programs; however, it also stressed curative over preventive care like its predecessors. It is recommended that the KHDI intensify anti-tuberculosis efforts, re-examine the role of non-physician practitioners, emphasize preventive medicine, and take steps to reduce attrition among health personnel. For the long-term, it is recommended that the Korean Government replicate the KHDI program nationwide and that KHDI provide technical assistance in implementing a national health care system, develop new demonstration projects, and conduct health care research and policy analysis and planning. Recommendations to improve training and program evaluation are also provided.