주민참여로 마을의 건강을: 1970-80년대 마을건강원 활동과 보건의료에서의 주민참여 논쟁

This paper aims to historically re-evaluate the issues surrounding resident participation in health care and its legacy by examining the community participation in health care. In the 1970s and 1980s, community participation was one of crucial trends and a controversial topic in the international health as well as the international aid. Throughout the 1970s, local participation was regarded as one of essential elements for the access to basic healthcare and primary health care in developing countries. Community health projects which aimed to apply primary health care were implemented in rural areas and some urban areas in the 1970s and 1980s. Village Health Workers(VHWs) were a symbolic example of community participation in these projects. They consisted of local women and led health activities with simple skills in their villages. They served as a bridge between the project team and the residents. Health professionals expected them to be health leaders for “self-help” in health of their communities. In the mid-1980s, however, as the number of health facilities and professional health care workers increased, the activities of VHSs were decreased. The mixed understanding of the responsibilities and roles of VHSs among the health professionals affected the skeptical view on the achievement and effects of community participation in health care. In the mid-1980s, as the government officially organized the VHWs, the dilemma surrounding community participation intensified. When the community health projects were ended, most of the VHW organizations were also disbanded. After the projects, the spirit of community participation was only inherited by some healthcare movement organizations, such as medical cooperatives.