Yi, Sang-Il; (2002) Responsiveness, equity and decentralisation: The example of community health centres of Seoul, South Korea. Doctoral thesis (Ph.D), UCL (University College London).

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Abstract

The reason that local service provision exists is to provide responsive and equitable service for local people. Korea has experienced local authority head and assembly elections in 1995 and 1991, transferring financial responsibilities to the local authorities, and increasing the local staff. How have these processes affected the system of local government in Korea? This study demonstrates how South Korea's decentralisation affected the responsiveness and equity of Community Health Centres (CHC) in the Seoul Metropolitan City. The research strategy and design for data collection was in four parts. First, the study examined conceptual, theoretical and historical aspects of decentralisation in the context of Korea. Secondly, it analysed empirical data collected from archival records of the district local authorities. Thirdly, it interviewed users with structured questionnaires. Finally, it undertook in-depth qualitative inquiries with local officials and staff. There were 390 interviewees who were users of the CHC users, and 24 officials, nurses and social workers. The field research for the study was mainly carried out in four districts, that is, Kuro, Socho, Tobong and Nowon-gu of Seoul, Korea. Provision of local services are affected by many factors, such as the level and the share of spending, and the operation and management of available resources. As a result of that, local residents of the four districts were aware of the differences in quality of services among the four district CHCs, and expressed different levels of satisfaction. However, the different perceptions about the CHCs, according to their demographic characteristics, affected the degree to which the users were satisfied with their services, especially in relation to the users' levels of education. Correspondingly, elderly people and women with young children were in the most need of such services and made up the majority of the user groups. In comparing the local finance data from 1994 with the data from 1998, it can be seen that in 1994, the locally-raised revenues showed the strongest positive association with regional development spending. However, in 1998, it was the welfare spending that grew rapidly as the locally-raised revenues rose. Moreover, in relation to the findings from the four CHC budgets, it was found that there is positive link between the personnel spending and users' satisfaction. By in-depth interviews, it was also found that the present differences between the four districts regarding the level and access to community health services, were explained better by the extent of co-operation between the authorities and the surrounding civic and social resources of the different localities, rather than by the different resources of the local authorities themselves.

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