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After the Korean War, Korea rebuilt its destroyed health system with support from WHO, integrating public health education with programs like the Saemaeul Movement and family planning. The government expanded healthcare access through establishing health branches in every town and deploying mobile mass immunization to combat infectious diseases. A policy addressing “doctorless towns” alleviated rural physician shortages by providing scholarships to medical students in exchange for mandatory service in underserved areas. In 2002, Korea launched the National Immunization Registry Information System (IRIS) to systematically track vaccination coverage and timeliness, and in 2009, expanded participation by private clinics through reimbursement incentives. SMS reminder and confirmation services introduced in 2009–2010 improved compliance, creating a robust, data-driven national immunization system.
#health #health data #maternal health #immunization
Immediately after Korea was liberated from Japan and established a government in 1948, the Korean War occurred from 1951 through 1953. As a result, the public health system was not able to meet its demand because the structure of the public health system, along with the broader socioeconomic system, was completely destroyed by the war. From this starting point, South Korea has developed its public health system over the past 60 years, culminating in the modern system of today. The specific reasons for the success of the early immunization program despite an insufficient public health infrastructure are as follows:
First of all, technical support from developed countries including the WHO was applied efficiently. The Saemaeul (“New Community”) Movement (a pan-national campaign for local community development beginning in the 1970s), environmental hygiene projects initiated at the recommendation of WHO advisors, and family planning services including children’s health care were important opportunities to enlighten residents at the village level. These opportunities for public health education became stepping stones toward a comprehensive immunization program as these projects were implemented based on the growth of the national economy.
Secondly, public health branches and health workers were systematically distributed throughout towns. Even though the national socioeconomic condition was terrible several decades ago, strongly driven by a policy named “the solution for a doctorless town,” the Korean government built public health branches in every town, which was a fundamental administrative unit. In addition, health care providers in charge of family planning services, maternal and child health care, and the tuberculosis control program were assigned to control acute and chronic infectious diseases and provide family planning services, which were the most urgent needs. Providing visiting public training and services with a village as a unit, collective education and practice were made available. In other words, the village was the unit in which community-based setting participatory health programs were carried out.
Thirdly, mobile mass immunization was conducted by mobilizing resources on a grand scale. Various infectious diseases such as dysentery, typhoid, cholera, Japanese encephalitis, polio, and measles occurred year after year and the deaths caused by these diseases were difficult to control given the insufficient infrastructure. In particular, people could rarely access the public health clinics due to the shortage of clinics and limited transportation. In these circumstances, having a legal imperative for a mobile mass immunization program, for the distribution of access to physicians, and for the mobilization of health care workers was an important and effective strategy.
Lastly, the government actively implemented the policy of “the solution for a doctorless town” by distributing physicians among towns. To place physicians and nurses in public health institutions, the government provided a scholarship covering tuition fees and additional expenses for students in the health care professions. After graduating, they were expected to work in areas assigned by the government. Afterward, the government continued to try to distribute physicians in each town (the primary unit by law) and also used incentive systems. Physicians had finally been placed in every town by 1983, and infectious diseases were successfully controlled by public health worker education and infectious disease controls in the 1960s and 70s.
The central government set regional immunization goals. Also, in order to tackle the high crude birth rate and the high crude death rate, and because family planning (such as birth control) was advocated by World Health Organization advisers as a major challenge to address, family planning personnel were placed in every town and subcounty. With these family planning services, health education about immunizations and immunization services could also be offered. The benefits of immunizations were also seen in rural areas.
There was another important development. The efforts of international organizations played a major role in raising the general public’s awareness of health issues, improving kitchens and bathrooms, and providing clean wells and otherwise improving overall environmental sanitation. This all helped to reduce the incidences of infectious diseases.
In addition, during the months when infectious diseases spread (e.g., cholera and typhoid in the summer), immunizations were carried out on a large scale at bus terminals, trains, markets, and other places where the general public frequented. When there was an epidemic, this was also a good opportunity to provide immunizations to the general public. Even though there was public interest in immunizations, this strategy was important for providing immunization access to those members of the public who were not proactive in visiting a health care center. Immunizations for infectious respiratory diseases in children were usually given by the family planning staff as they toured the village and simultaneously gave health instruction.
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There was also an intensive effort by the government to appoint physicians to each town and subcounty. One of the main concerns in the 1960s and 70s after the Korean War ended was relieving areas where there were no doctors stationed. The first policy attempted was commissioning a practitioner in private practice as the community doctor and the director of the community health clinic. The head of the county commissioned certain physicians in private practice to be public doctors during the period from the 1960s to the 80s, including many geographically restricted doctors. [1]
An effort was also made to alleviate the conditions in rural areas where no doctors were present. This was done in two ways. One was a six month specialized residency training program in health institutions in rural areas in 1972. The other was a program in 1976 to give medical licenses to medical students who had failed the state medical examinations if they worked in a rural area where there were no medical personnel for two years.
In addition, in 1961, regulations pertaining to scholarships for health care personnel were enacted (State Council Law, Section 249). Graduate students studying medicine and public health could receive a scholarship if they worked in a specified area for 2-5 years after graduation. In 1976, the Act on Special Cases for Health Care Scholarships was enacted, which also provided scholarships for medical students. After graduation, the students were appointed to a community health center and branch. Later, nursing students were included in this program, and the government was able to recruit nurses in the same way. Similar ordinances were also enacted at the provincial and local levels, and in this manner a medical workforce was secured. In 1980, the Act on Special Measures for Rural Health Care was enacted, and until the present, it has reliably supplied public health doctors, such as physicians, dentists, and oriental medicine doctors, to health care centers and their branch offices. [2] In this manner, a variety of laws and an institutional strategy were developed in order to address the rural areas and areas where no doctors were stationed. As a result, since 1983, no areas have been without doctors. On the basis of these efforts, physicians working in health centers provided preliminary checkups and adequate health counseling for those who were receiving immunizations.
The most important factors in immunization are that a greater than optimum ratio of a total population receive vaccinations, and that they receive vaccinations while maintaining proper immunization intervals for the appropriate age brackets so that every individual can have optimum immunity. In order to determine and maintain precise immunization rates and the timeliness of immunization, every individual’s immunization record should be registered and accessible in real time for use in succeeding immunizations. Computerization is necessary for managing these records. An online system of information exchange where the same records can be shared in real time would be much more efficient. The lack of individual immunization information makes optimal management difficult. This can become an obstacle in the prevention of infectious disease, making us unable to expect to achieve complete immunization. For this reason, as a preparatory step towards the management of target groups and elimination of infectious disease through precise immunization information, the Korea Centers for Disease Control and Prevention has developed a program to computerize and manage all immunization records and has been promoting the National Immunization Registry Information System (IRIS) since 2002. In its beginning stage, IRIS was promoted in all public health centers nationwide, and starting from 2004, it was expanded quantitatively and qualitatively to include private medical institutions.
Despite efforts to develop and spread the registry program in order to promote participation by private medical institutions in IRIS, their participation is still not satisfactory. The main reason why the National Immunization Registry is not up and running is the lack of participation by private medical institutions, which provided about 40% of routine immunizations nationwide until 2009. The government body in charge of this project recognized the necessity of enhancing the quality of immunizations by collecting immunization records through IRIS. In order to motivate private medical institutions to participate in the National Immunization Registry, the government has begun paying the vaccination fees of private hospital and clinic users. 2009 was a seminal year for Korea's national immunization project, with the introduction of the ‘reimbursement system for medical institutions’. An opportunity to address many of the weaknesses that had been observed over the years, this policy was able to solve problems stemming from a low level of participation by private medical institutions such as incomplete immunization records and the inability to measure the exact immunization rate.
The National Immunization Registry is operating in order to carry out six main functions:
Likewise, in South Korea, IRIS systematically collects and manages immunization-related data such as vaccines’ demographic characteristics, inoculation period, and type of vaccinations with the aims of qualitative enhancement of, record keeping for, supervision of, assessment of, and research on immunization services. There are three main strategies for ongoing advancement.
The first strategy is to help with the quantitative and qualitative enhancement of immunization rates. The second strategy is to help improve the timeliness of immunization rates through IRIS. In other words, IRIS distinguishes between the vaccinated and non-vaccinated, makes a list of recipients needing vaccinations, and utilizes it to trace and vaccinate them. With IRIS established, the immunization rate increases due to non-vaccinated individuals feeling a psychological burden from not being immunized and the reminder/recall function automatically notifying them about their children's immunization schedule. The third strategy is to provide base data for vaccine effectiveness assessments and immunization policy. In other words, with the linking of the National Immunization Registry Information System (IRIS) and the Infectious Disease Outbreak Monitoring System, we are able to determine the difference in the rates of infectious disease between vaccinated and non-vaccinated groups. This offers crucial information for examining the effect of any given vaccine as well as the necessity of certain policies. Moreover, this can be an important tool for securing the reliability and quality of vaccines by collecting and analyzing adverse reactions in a timely manner.
There are two main ways for private medical institutions to register immunization records in the computer database. The first way is to login to the immunization registry of the web-based Portal System of the KCDC. The second method involves linkage of the Electronic Medical Records System(EMR) used by private medical institutions to the standardized module. After logging in to the Portal System of the KCDC, whenever previously registered immunization information is accessed, records from the medical office are simultaneously registered in the computer database along with it. Since the Portal System of the KCDC can only be used by medical institutions that have been authorized access, institutions must apply for registration online. After the public health center with jurisdiction approves the registry, the institution is authorized to use the system. When this process is done, institutions can use the system by logging in with their ID/password and officially recognized authentication certificate.
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The data collected in the National Immunization Registry consists of three sets: the vaccinee's information, the guardian's information, and immunization history. The vaccinee’s information, content that verifies the vaccinee’s identity, and the administrative district with jurisdiction over the vaccinee, includes the name, personal identification number, zip code, address, home phone number, and cell phone number of the vaccinee. The guardian's information, including name and resident registration number, is temporarily used in order to distinguish among newborns before they have been issued resident registration numbers. Immunization history data is used to verify whether all the core vaccinations were given, if any other shots are needed, and which vaccines caused adverse reactions. This data includes the vaccine name, date of vaccination, body part vaccinated, method of vaccination, dosage, which does in the vaccine series, and vaccine's lot number.
As the participation of private clinics on national immunization system has been established, the rate of registration of personal immunization records by health care providers has increased in the Immunization Registry Information System (IRIS). As a result, most immunization records have been computerized. Thus, where and how collected and computerized data are applied has become an important political issue. Based on these immunization records for children, the KCDC provides Short Message Service (SMS) messages by mobile phone containing immunization information and the next scheduled immunization date.
An immunization confirmation service was established in March 2009. This service applies to immunization cases in medical institutions that participate in the medical expense reimbursement system. For instance, if children aged 0 through 12 have received their core required immunizations including BCG, Hepatitis B, DTaP, Td, IPV, MMR, varicella, Japanese encephalitis, DTaP-IPV, and Tdap, the next day, parents and guardians receive a confirmation of the children's immunization information as follows: "Your child received [vaccine name] at the [clinic name] on [month and date]."
Since December 2010, KCDC has provided a recall SMS for children who have been registered in the immunization registry system and have agreed to receive SMS messages. If the immunization record for children aged 0 through 12 has been updated in the registry system, the next immunization date is automatically calculated and the parent or guardian is informed by SMS as follows: "The next immunization date for [child’s name] is coming up. Please check your child's immunization history at http://nip.cdc.go.kr."
After the Korean War, Korea rebuilt its destroyed health system with support from WHO, integrating public health education with programs like the Saemaeul Movement and family planning. The government expanded healthcare access through establishing health branches in every town and deploying mobile mass immunization to combat infectious diseases. A policy addressing “doctorless towns” alleviated rural physician shortages by providing scholarships to medical students in exchange for mandatory service in underserved areas. In 2002, Korea launched the National Immunization Registry Information System (IRIS) to systematically track vaccination coverage and timeliness, and in 2009, expanded participation by private clinics through reimbursement incentives. SMS reminder and confirmation services introduced in 2009–2010 improved compliance, creating a robust, data-driven national immunization system.
#health #health data #maternal health #immunization
Immediately after Korea was liberated from Japan and established a government in 1948, the Korean War occurred from 1951 through 1953. As a result, the public health system was not able to meet its demand because the structure of the public health system, along with the broader socioeconomic system, was completely destroyed by the war. From this starting point, South Korea has developed its public health system over the past 60 years, culminating in the modern system of today. The specific reasons for the success of the early immunization program despite an insufficient public health infrastructure are as follows:
First of all, technical support from developed countries including the WHO was applied efficiently. The Saemaeul (“New Community”) Movement (a pan-national campaign for local community development beginning in the 1970s), environmental hygiene projects initiated at the recommendation of WHO advisors, and family planning services including children’s health care were important opportunities to enlighten residents at the village level. These opportunities for public health education became stepping stones toward a comprehensive immunization program as these projects were implemented based on the growth of the national economy.
Secondly, public health branches and health workers were systematically distributed throughout towns. Even though the national socioeconomic condition was terrible several decades ago, strongly driven by a policy named “the solution for a doctorless town,” the Korean government built public health branches in every town, which was a fundamental administrative unit. In addition, health care providers in charge of family planning services, maternal and child health care, and the tuberculosis control program were assigned to control acute and chronic infectious diseases and provide family planning services, which were the most urgent needs. Providing visiting public training and services with a village as a unit, collective education and practice were made available. In other words, the village was the unit in which community-based setting participatory health programs were carried out.
Thirdly, mobile mass immunization was conducted by mobilizing resources on a grand scale. Various infectious diseases such as dysentery, typhoid, cholera, Japanese encephalitis, polio, and measles occurred year after year and the deaths caused by these diseases were difficult to control given the insufficient infrastructure. In particular, people could rarely access the public health clinics due to the shortage of clinics and limited transportation. In these circumstances, having a legal imperative for a mobile mass immunization program, for the distribution of access to physicians, and for the mobilization of health care workers was an important and effective strategy.
Lastly, the government actively implemented the policy of “the solution for a doctorless town” by distributing physicians among towns. To place physicians and nurses in public health institutions, the government provided a scholarship covering tuition fees and additional expenses for students in the health care professions. After graduating, they were expected to work in areas assigned by the government. Afterward, the government continued to try to distribute physicians in each town (the primary unit by law) and also used incentive systems. Physicians had finally been placed in every town by 1983, and infectious diseases were successfully controlled by public health worker education and infectious disease controls in the 1960s and 70s.
The central government set regional immunization goals. Also, in order to tackle the high crude birth rate and the high crude death rate, and because family planning (such as birth control) was advocated by World Health Organization advisers as a major challenge to address, family planning personnel were placed in every town and subcounty. With these family planning services, health education about immunizations and immunization services could also be offered. The benefits of immunizations were also seen in rural areas.
There was another important development. The efforts of international organizations played a major role in raising the general public’s awareness of health issues, improving kitchens and bathrooms, and providing clean wells and otherwise improving overall environmental sanitation. This all helped to reduce the incidences of infectious diseases.
In addition, during the months when infectious diseases spread (e.g., cholera and typhoid in the summer), immunizations were carried out on a large scale at bus terminals, trains, markets, and other places where the general public frequented. When there was an epidemic, this was also a good opportunity to provide immunizations to the general public. Even though there was public interest in immunizations, this strategy was important for providing immunization access to those members of the public who were not proactive in visiting a health care center. Immunizations for infectious respiratory diseases in children were usually given by the family planning staff as they toured the village and simultaneously gave health instruction.
There was also an intensive effort by the government to appoint physicians to each town and subcounty. One of the main concerns in the 1960s and 70s after the Korean War ended was relieving areas where there were no doctors stationed. The first policy attempted was commissioning a practitioner in private practice as the community doctor and the director of the community health clinic. The head of the county commissioned certain physicians in private practice to be public doctors during the period from the 1960s to the 80s, including many geographically restricted doctors. [1]
An effort was also made to alleviate the conditions in rural areas where no doctors were present. This was done in two ways. One was a six month specialized residency training program in health institutions in rural areas in 1972. The other was a program in 1976 to give medical licenses to medical students who had failed the state medical examinations if they worked in a rural area where there were no medical personnel for two years.
In addition, in 1961, regulations pertaining to scholarships for health care personnel were enacted (State Council Law, Section 249). Graduate students studying medicine and public health could receive a scholarship if they worked in a specified area for 2-5 years after graduation. In 1976, the Act on Special Cases for Health Care Scholarships was enacted, which also provided scholarships for medical students. After graduation, the students were appointed to a community health center and branch. Later, nursing students were included in this program, and the government was able to recruit nurses in the same way. Similar ordinances were also enacted at the provincial and local levels, and in this manner a medical workforce was secured. In 1980, the Act on Special Measures for Rural Health Care was enacted, and until the present, it has reliably supplied public health doctors, such as physicians, dentists, and oriental medicine doctors, to health care centers and their branch offices. [2] In this manner, a variety of laws and an institutional strategy were developed in order to address the rural areas and areas where no doctors were stationed. As a result, since 1983, no areas have been without doctors. On the basis of these efforts, physicians working in health centers provided preliminary checkups and adequate health counseling for those who were receiving immunizations.
The most important factors in immunization are that a greater than optimum ratio of a total population receive vaccinations, and that they receive vaccinations while maintaining proper immunization intervals for the appropriate age brackets so that every individual can have optimum immunity. In order to determine and maintain precise immunization rates and the timeliness of immunization, every individual’s immunization record should be registered and accessible in real time for use in succeeding immunizations. Computerization is necessary for managing these records. An online system of information exchange where the same records can be shared in real time would be much more efficient. The lack of individual immunization information makes optimal management difficult. This can become an obstacle in the prevention of infectious disease, making us unable to expect to achieve complete immunization. For this reason, as a preparatory step towards the management of target groups and elimination of infectious disease through precise immunization information, the Korea Centers for Disease Control and Prevention has developed a program to computerize and manage all immunization records and has been promoting the National Immunization Registry Information System (IRIS) since 2002. In its beginning stage, IRIS was promoted in all public health centers nationwide, and starting from 2004, it was expanded quantitatively and qualitatively to include private medical institutions.
Despite efforts to develop and spread the registry program in order to promote participation by private medical institutions in IRIS, their participation is still not satisfactory. The main reason why the National Immunization Registry is not up and running is the lack of participation by private medical institutions, which provided about 40% of routine immunizations nationwide until 2009. The government body in charge of this project recognized the necessity of enhancing the quality of immunizations by collecting immunization records through IRIS. In order to motivate private medical institutions to participate in the National Immunization Registry, the government has begun paying the vaccination fees of private hospital and clinic users. 2009 was a seminal year for Korea's national immunization project, with the introduction of the ‘reimbursement system for medical institutions’. An opportunity to address many of the weaknesses that had been observed over the years, this policy was able to solve problems stemming from a low level of participation by private medical institutions such as incomplete immunization records and the inability to measure the exact immunization rate.
The National Immunization Registry is operating in order to carry out six main functions:
Likewise, in South Korea, IRIS systematically collects and manages immunization-related data such as vaccines’ demographic characteristics, inoculation period, and type of vaccinations with the aims of qualitative enhancement of, record keeping for, supervision of, assessment of, and research on immunization services. There are three main strategies for ongoing advancement.
The first strategy is to help with the quantitative and qualitative enhancement of immunization rates. The second strategy is to help improve the timeliness of immunization rates through IRIS. In other words, IRIS distinguishes between the vaccinated and non-vaccinated, makes a list of recipients needing vaccinations, and utilizes it to trace and vaccinate them. With IRIS established, the immunization rate increases due to non-vaccinated individuals feeling a psychological burden from not being immunized and the reminder/recall function automatically notifying them about their children's immunization schedule. The third strategy is to provide base data for vaccine effectiveness assessments and immunization policy. In other words, with the linking of the National Immunization Registry Information System (IRIS) and the Infectious Disease Outbreak Monitoring System, we are able to determine the difference in the rates of infectious disease between vaccinated and non-vaccinated groups. This offers crucial information for examining the effect of any given vaccine as well as the necessity of certain policies. Moreover, this can be an important tool for securing the reliability and quality of vaccines by collecting and analyzing adverse reactions in a timely manner.
There are two main ways for private medical institutions to register immunization records in the computer database. The first way is to login to the immunization registry of the web-based Portal System of the KCDC. The second method involves linkage of the Electronic Medical Records System(EMR) used by private medical institutions to the standardized module. After logging in to the Portal System of the KCDC, whenever previously registered immunization information is accessed, records from the medical office are simultaneously registered in the computer database along with it. Since the Portal System of the KCDC can only be used by medical institutions that have been authorized access, institutions must apply for registration online. After the public health center with jurisdiction approves the registry, the institution is authorized to use the system. When this process is done, institutions can use the system by logging in with their ID/password and officially recognized authentication certificate.
The data collected in the National Immunization Registry consists of three sets: the vaccinee's information, the guardian's information, and immunization history. The vaccinee’s information, content that verifies the vaccinee’s identity, and the administrative district with jurisdiction over the vaccinee, includes the name, personal identification number, zip code, address, home phone number, and cell phone number of the vaccinee. The guardian's information, including name and resident registration number, is temporarily used in order to distinguish among newborns before they have been issued resident registration numbers. Immunization history data is used to verify whether all the core vaccinations were given, if any other shots are needed, and which vaccines caused adverse reactions. This data includes the vaccine name, date of vaccination, body part vaccinated, method of vaccination, dosage, which does in the vaccine series, and vaccine's lot number.
As the participation of private clinics on national immunization system has been established, the rate of registration of personal immunization records by health care providers has increased in the Immunization Registry Information System (IRIS). As a result, most immunization records have been computerized. Thus, where and how collected and computerized data are applied has become an important political issue. Based on these immunization records for children, the KCDC provides Short Message Service (SMS) messages by mobile phone containing immunization information and the next scheduled immunization date.
An immunization confirmation service was established in March 2009. This service applies to immunization cases in medical institutions that participate in the medical expense reimbursement system. For instance, if children aged 0 through 12 have received their core required immunizations including BCG, Hepatitis B, DTaP, Td, IPV, MMR, varicella, Japanese encephalitis, DTaP-IPV, and Tdap, the next day, parents and guardians receive a confirmation of the children's immunization information as follows: "Your child received [vaccine name] at the [clinic name] on [month and date]."
Since December 2010, KCDC has provided a recall SMS for children who have been registered in the immunization registry system and have agreed to receive SMS messages. If the immunization record for children aged 0 through 12 has been updated in the registry system, the next immunization date is automatically calculated and the parent or guardian is informed by SMS as follows: "The next immunization date for [child’s name] is coming up. Please check your child's immunization history at http://nip.cdc.go.kr."
Immediately after Korea was liberated from Japan and established a government in 1948, the Korean War occurred from 1951 through 1953. As a result, the public health system was not able to meet its demand because the structure of the public health system, along with the broader socioeconomic system, was completely destroyed by the war. From this starting point, South Korea has developed its public health system over the past 60 years, culminating in the modern system of today. The specific reasons for the success of the early immunization program despite an insufficient public health infrastructure are as follows:
First of all, technical support from developed countries including the WHO was applied efficiently. The Saemaeul (“New Community”) Movement (a pan-national campaign for local community development beginning in the 1970s), environmental hygiene projects initiated at the recommendation of WHO advisors, and family planning services including children’s health care were important opportunities to enlighten residents at the village level. These opportunities for public health education became stepping stones toward a comprehensive immunization program as these projects were implemented based on the growth of the national economy.
Secondly, public health branches and health workers were systematically distributed throughout towns. Even though the national socioeconomic condition was terrible several decades ago, strongly driven by a policy named “the solution for a doctorless town,” the Korean government built public health branches in every town, which was a fundamental administrative unit. In addition, health care providers in charge of family planning services, maternal and child health care, and the tuberculosis control program were assigned to control acute and chronic infectious diseases and provide family planning services, which were the most urgent needs. Providing visiting public training and services with a village as a unit, collective education and practice were made available. In other words, the village was the unit in which community-based setting participatory health programs were carried out.
Thirdly, mobile mass immunization was conducted by mobilizing resources on a grand scale. Various infectious diseases such as dysentery, typhoid, cholera, Japanese encephalitis, polio, and measles occurred year after year and the deaths caused by these diseases were difficult to control given the insufficient infrastructure. In particular, people could rarely access the public health clinics due to the shortage of clinics and limited transportation. In these circumstances, having a legal imperative for a mobile mass immunization program, for the distribution of access to physicians, and for the mobilization of health care workers was an important and effective strategy.
Lastly, the government actively implemented the policy of “the solution for a doctorless town” by distributing physicians among towns. To place physicians and nurses in public health institutions, the government provided a scholarship covering tuition fees and additional expenses for students in the health care professions. After graduating, they were expected to work in areas assigned by the government. Afterward, the government continued to try to distribute physicians in each town (the primary unit by law) and also used incentive systems. Physicians had finally been placed in every town by 1983, and infectious diseases were successfully controlled by public health worker education and infectious disease controls in the 1960s and 70s.
The central government set regional immunization goals. Also, in order to tackle the high crude birth rate and the high crude death rate, and because family planning (such as birth control) was advocated by World Health Organization advisers as a major challenge to address, family planning personnel were placed in every town and subcounty. With these family planning services, health education about immunizations and immunization services could also be offered. The benefits of immunizations were also seen in rural areas.
There was another important development. The efforts of international organizations played a major role in raising the general public’s awareness of health issues, improving kitchens and bathrooms, and providing clean wells and otherwise improving overall environmental sanitation. This all helped to reduce the incidences of infectious diseases.
In addition, during the months when infectious diseases spread (e.g., cholera and typhoid in the summer), immunizations were carried out on a large scale at bus terminals, trains, markets, and other places where the general public frequented. When there was an epidemic, this was also a good opportunity to provide immunizations to the general public. Even though there was public interest in immunizations, this strategy was important for providing immunization access to those members of the public who were not proactive in visiting a health care center. Immunizations for infectious respiratory diseases in children were usually given by the family planning staff as they toured the village and simultaneously gave health instruction.
There was also an intensive effort by the government to appoint physicians to each town and subcounty. One of the main concerns in the 1960s and 70s after the Korean War ended was relieving areas where there were no doctors stationed. The first policy attempted was commissioning a practitioner in private practice as the community doctor and the director of the community health clinic. The head of the county commissioned certain physicians in private practice to be public doctors during the period from the 1960s to the 80s, including many geographically restricted doctors. [1]
An effort was also made to alleviate the conditions in rural areas where no doctors were present. This was done in two ways. One was a six month specialized residency training program in health institutions in rural areas in 1972. The other was a program in 1976 to give medical licenses to medical students who had failed the state medical examinations if they worked in a rural area where there were no medical personnel for two years.
In addition, in 1961, regulations pertaining to scholarships for health care personnel were enacted (State Council Law, Section 249). Graduate students studying medicine and public health could receive a scholarship if they worked in a specified area for 2-5 years after graduation. In 1976, the Act on Special Cases for Health Care Scholarships was enacted, which also provided scholarships for medical students. After graduation, the students were appointed to a community health center and branch. Later, nursing students were included in this program, and the government was able to recruit nurses in the same way. Similar ordinances were also enacted at the provincial and local levels, and in this manner a medical workforce was secured. In 1980, the Act on Special Measures for Rural Health Care was enacted, and until the present, it has reliably supplied public health doctors, such as physicians, dentists, and oriental medicine doctors, to health care centers and their branch offices. [2] In this manner, a variety of laws and an institutional strategy were developed in order to address the rural areas and areas where no doctors were stationed. As a result, since 1983, no areas have been without doctors. On the basis of these efforts, physicians working in health centers provided preliminary checkups and adequate health counseling for those who were receiving immunizations.
The most important factors in immunization are that a greater than optimum ratio of a total population receive vaccinations, and that they receive vaccinations while maintaining proper immunization intervals for the appropriate age brackets so that every individual can have optimum immunity. In order to determine and maintain precise immunization rates and the timeliness of immunization, every individual’s immunization record should be registered and accessible in real time for use in succeeding immunizations. Computerization is necessary for managing these records. An online system of information exchange where the same records can be shared in real time would be much more efficient. The lack of individual immunization information makes optimal management difficult. This can become an obstacle in the prevention of infectious disease, making us unable to expect to achieve complete immunization. For this reason, as a preparatory step towards the management of target groups and elimination of infectious disease through precise immunization information, the Korea Centers for Disease Control and Prevention has developed a program to computerize and manage all immunization records and has been promoting the National Immunization Registry Information System (IRIS) since 2002. In its beginning stage, IRIS was promoted in all public health centers nationwide, and starting from 2004, it was expanded quantitatively and qualitatively to include private medical institutions.
Despite efforts to develop and spread the registry program in order to promote participation by private medical institutions in IRIS, their participation is still not satisfactory. The main reason why the National Immunization Registry is not up and running is the lack of participation by private medical institutions, which provided about 40% of routine immunizations nationwide until 2009. The government body in charge of this project recognized the necessity of enhancing the quality of immunizations by collecting immunization records through IRIS. In order to motivate private medical institutions to participate in the National Immunization Registry, the government has begun paying the vaccination fees of private hospital and clinic users. 2009 was a seminal year for Korea's national immunization project, with the introduction of the ‘reimbursement system for medical institutions’. An opportunity to address many of the weaknesses that had been observed over the years, this policy was able to solve problems stemming from a low level of participation by private medical institutions such as incomplete immunization records and the inability to measure the exact immunization rate.
The National Immunization Registry is operating in order to carry out six main functions:
Likewise, in South Korea, IRIS systematically collects and manages immunization-related data such as vaccines’ demographic characteristics, inoculation period, and type of vaccinations with the aims of qualitative enhancement of, record keeping for, supervision of, assessment of, and research on immunization services. There are three main strategies for ongoing advancement.
The first strategy is to help with the quantitative and qualitative enhancement of immunization rates. The second strategy is to help improve the timeliness of immunization rates through IRIS. In other words, IRIS distinguishes between the vaccinated and non-vaccinated, makes a list of recipients needing vaccinations, and utilizes it to trace and vaccinate them. With IRIS established, the immunization rate increases due to non-vaccinated individuals feeling a psychological burden from not being immunized and the reminder/recall function automatically notifying them about their children's immunization schedule. The third strategy is to provide base data for vaccine effectiveness assessments and immunization policy. In other words, with the linking of the National Immunization Registry Information System (IRIS) and the Infectious Disease Outbreak Monitoring System, we are able to determine the difference in the rates of infectious disease between vaccinated and non-vaccinated groups. This offers crucial information for examining the effect of any given vaccine as well as the necessity of certain policies. Moreover, this can be an important tool for securing the reliability and quality of vaccines by collecting and analyzing adverse reactions in a timely manner.
There are two main ways for private medical institutions to register immunization records in the computer database. The first way is to login to the immunization registry of the web-based Portal System of the KCDC. The second method involves linkage of the Electronic Medical Records System(EMR) used by private medical institutions to the standardized module. After logging in to the Portal System of the KCDC, whenever previously registered immunization information is accessed, records from the medical office are simultaneously registered in the computer database along with it. Since the Portal System of the KCDC can only be used by medical institutions that have been authorized access, institutions must apply for registration online. After the public health center with jurisdiction approves the registry, the institution is authorized to use the system. When this process is done, institutions can use the system by logging in with their ID/password and officially recognized authentication certificate.
The data collected in the National Immunization Registry consists of three sets: the vaccinee's information, the guardian's information, and immunization history. The vaccinee’s information, content that verifies the vaccinee’s identity, and the administrative district with jurisdiction over the vaccinee, includes the name, personal identification number, zip code, address, home phone number, and cell phone number of the vaccinee. The guardian's information, including name and resident registration number, is temporarily used in order to distinguish among newborns before they have been issued resident registration numbers. Immunization history data is used to verify whether all the core vaccinations were given, if any other shots are needed, and which vaccines caused adverse reactions. This data includes the vaccine name, date of vaccination, body part vaccinated, method of vaccination, dosage, which does in the vaccine series, and vaccine's lot number.
As the participation of private clinics on national immunization system has been established, the rate of registration of personal immunization records by health care providers has increased in the Immunization Registry Information System (IRIS). As a result, most immunization records have been computerized. Thus, where and how collected and computerized data are applied has become an important political issue. Based on these immunization records for children, the KCDC provides Short Message Service (SMS) messages by mobile phone containing immunization information and the next scheduled immunization date.
An immunization confirmation service was established in March 2009. This service applies to immunization cases in medical institutions that participate in the medical expense reimbursement system. For instance, if children aged 0 through 12 have received their core required immunizations including BCG, Hepatitis B, DTaP, Td, IPV, MMR, varicella, Japanese encephalitis, DTaP-IPV, and Tdap, the next day, parents and guardians receive a confirmation of the children's immunization information as follows: "Your child received [vaccine name] at the [clinic name] on [month and date]."
Since December 2010, KCDC has provided a recall SMS for children who have been registered in the immunization registry system and have agreed to receive SMS messages. If the immunization record for children aged 0 through 12 has been updated in the registry system, the next immunization date is automatically calculated and the parent or guardian is informed by SMS as follows: "The next immunization date for [child’s name] is coming up. Please check your child's immunization history at http://nip.cdc.go.kr."