annual report of the regional director

SOUTH- EAST ASIA REGION

W O R L D HEALTH O R G A N I Z A T I O N REGIONAL OFFICE FOR SOUTH-EAST ASIA

TWENTY-FIRST ANNUAL REPORT

OF

THE REGIONAL DIREC'I'OR

TO THE

REGIONAL COMMITTEE FOR SOUTH-EAST ASIA

1 AUGUST 1968 - 1 AUGUST 1969

CORRIGENDA AND ADDENDA

Pkasc make the following changes in document SEA/RC22/2 :

Page

I I In the second line of the first paragraph, after "relapsing fever", add "and typhus"

Under "1.3.1 Smallpox". In the l a d llne of the second paragraph, for '.endemic". read"epidemic".

13 In the fourth full paragraph, fourth line, delete "and" between "cholerae" and "El Tor".

19 In the second line of the second par~ipraph, for "serological", read "lahoratory"

In the sixth line of the same paragraph, between the words "where" and .'arhoviruses", delete -Group B" and substitute "Groups A and B".

20 Under "Viral Hepatitis", in the fifth line of the first paragraph. modvy the phrase starting with "except when ....." to read as follows : ,'except when they occur in epidemic proportions and when the transmission is proved".

After the three paragraphs under "(4) V~ral Hepatitis", odd the following as item ( 5 ) 1

Influenza and Olher Respiratory Viruses

,'In I I ' ~ 1968 and at the beginning of the year 1969 large outbreaks ofinfluenza(Hong Kong type A. 2 /68 virus) occurred in two waves. India (Madras, Madurai. New Delhi and other big cities) reported the epidemic with tens and even hundreds of thousands of cases. Generally, the epidemic was of a mild type with a low fatalitv rate.

'*The Pasteur Institute in Coonoor made 71 virus isolations of the A.2 Hong Kong strain. Virus isolation5 were alao made from the materials sent from Burma (one isolation) and Ceylon (two isolations) of the same type. The disease appeared in other countries of the Region as well".

30 In the third full paracraph, last line. <.hong-e the number of the annex to "8".

49 In Graph 5, oppmite this p;ige, a d ~ l the following note :

"The periods mentioned in t h ~ s graph do not relate to calendar years hut to the reporting years. i. e., 1968 rcprcsents the period Augoh~ 1968 to August' 1969, etc. (566 blso ~abie'l;Arlnex.lO)".

69 Under "2.2 Organizational Structure", in the second paragraph, ninth line, insert, before "and", '~~dministraGon and Finance Officer". Also, reword the last senteni; 61' the paragiaph,.in eracket;,

. . , ,

L

to read : '.The post of Chief, Office of ~dniidistratibn and Finance, was filled by the promotion of the Administration and Finance Officer, whose post was, in turn, filled by that of the Budget and Finance Officer. This lart post wa< also therefore left vacant".

70 In the table, under "Staff r f the Regional Office", in the column "Posts actually filled", insert -7'' against "WHO Representatives". ., \

128 In the fourth full paragraph, second line, for the figures "92" and "102", read "93" and "103", ' respectively.

148 In the second footnote on this page, in the last line, for "July 1965", read "July 1967". '

175 Under "Indonesia 0086". in the last line on the page, for "provinc'al", read <'regency",

176 In the first line at the top of the 1 age, for "regency", read"district".

181 In the seventh paragraph, fourth line. for "four-year course", read "two-ycar course".

, .

191 In the sixth paragraph, second line, rhanxe "orientation courses ..... were held" to "an ortentation course .... was held".

In the seventh pardgraph, delete the last elght words of the second x n t ~ n c e , so that the \enfence reads "Th~s IS an autonomoua b o ~ y".

i , .

235 In the third paragraph. seventh line, delere "India". Reword the last \enlence of this paragraph as follows : "The microbiologist, who took up a three-month assigilment in June, was also visiting most bf the above-mentipned countries and India to advise on the quality control of biological

products".

245 Under **Inter-reglanai 0475", in thelast line of the first paragraph after " Wurk don? d~dring the t~c>or'b

for "October-November 1969", read "October-November 1968".

251 , I D the 0rgdnij.atiqngl Chart, right-hand column, under the title "Administration and tinanre . Officer", for' 'Lvacalt", read "Mr P. G. T. Dunderdale". , : I ., . , . ,

.. I ; , . , . ' , > , , . .

1

2q, , ihc . left-hand,, Col'umi, of ' , the: ppl:: under "Research". (klerc the item :'Reseakch ijl' I : , , , + I ,: . , , , immunogloh~lins".

SEA/RC22/2 Page iii

TABLE OF CONTENTS

Jntroduction

PART I - GENERAL REVIEW OF ACTIVITIES

Communicable Diseases Malaria Tubrculosis Quarantinable Diseases and International Quarantine Smallpox Cholera Plague Typhus and other Rickettsial Diseases Other Endemo-epidemic Diseases Bacterial Diseases Virus Diseases Parasitic Diseases Veterinary Public Health Immunology

2. Epidemiology

3. Health Laboratory Services

4. Vaccine Production

5. Health Statistics

Public Iiealth Administration Planning and Strengthening of health Services Maternal and Child Health Nursing Environmental Health Health Education Nutrition Mental Health Dental Xealth Occupational Health and Rehabilitation Radiation and Isotopes Cancer Pharmacology and Quality Control of Drugs Other Subjects

Education and Training Nkdical Education

vii

SEA/RC22/2 Page iv

7.2 Fellowships

8. Reports, Technical Publications. Documents and Reference Services

PART II - ORGANIZATIONAL AND ADNiINJSTRATIVE NiATTERS

1. The Regional Committee 67

Administration General Organizational Structure Personnel Staff Training Staff Welfare Finance, Budget and Accounts The Regional Office Building

3. Procurement of Supplies and Equipment 7 3 . .

Collaboration with Other Agencies United Nations United Nations Development Programme (UNDP) Economic Commission for Asia and the Far East (ECAFE) United Nations Children's Fund (UNICEF) International Atomic Energy Agency (IAEA) United Nations Institute for Training and Research (UMTAR) World Food Programme (IVFP) Specialized Agencies Food and Agriculture Organization (FAO) United Nations Educational, Scientific and Cultural

Organization (UNESCO) International Labour Organisation (ILO) World Bank Non-Governmental Organbations in Relation with WHO Inter-governmental and Bilateral Agencies Colombo Plan USAID Others National and Other Agencies

5. Public Information 79

PART 111 - ACTMTIES UNDERTAKEN BY GOVERNMENTS WITH THE HELP OF WHO

Project List

S E A / R C ~ Z / ~ Page v

Afghanistan Burma Ceylon India Indonesia Maldives Niongolia Nepal Thailand Inter-country Inter-regional (projects within the Region) Inter-regional (projects outside the Region with

participants from the South-East Asia Region)

ANNEXES

Organizational Chart

Geographical Distribution of International Staff Assigned to the South-East Asia Region

Meetings and Courses Organized by WHO and Held in the South-East Asia Region

Conferences and Meetings in the South-East Asia Region Called by the United Nations and its Related Specialized Agencies at which WHO was Represented

Conferences and Meetings of Governmental, Non- governmental and Other Organizations Held in the South-East Asia Region at which WHO was Represented 259

Research Activities in the South-East Asia Region Supported by WHO Grants made during the Period August 1968 - August 1969 263

Papers Published, Being Published o r Under Preparation - Tuberculosis Research Projects 266

List of Vital and Health Statistics Reports Issued by Governments and Received by the Regional Office 271

List of Technical Reports Issued by the Regional Office

SEq/RC22/2 Page vi

lo. Fellowship Tables

11. Training of National Staff - Activities Carried Out by Governments With the Assistance of WHO

GRAPHS

1. Expenditure on Projects by Broad Subject Groups, 1968

2. Expenditure on Communicable-Disease Projects, by Main Subject Groups, 1967 and 1968

3. Population at Malaria Risk in the Areas under Various Phases of NTar ia Eradication Programmes: 1960-1969

4. Fellowships Awarded by WHO, by Subject of Study and Country of Origin of the Fellow (1 August 1968 to 31 July 1969)

5. Fellowships Awarded by WHO (1962-1968).

SEA/RC22/2 Page vii

JNTR ODUC TION

Prom observations and studies made during these first eighteen months of my office a s Regional Director, it has become clear to me that in South-East Asia there are some major problems which persist and seem to be increasing, despite the best efforts of health departments to combat them. Among these problems, the total burden of communicable diseases, the special problems of the care of mother and child, water shortage and pollution, malnutrition, the complications resulting from our growing cities, and, in some parts of the Region, the explosive popula.tion growth and the overall shortage of trained manpower and education facilities - these remain very much in the forefront and are inextricably linked with the basic need for adequate coverage by the general health services.

In the face of these challenges, 1968 will be remembered a s the year that ushered in the third decade of WHO'S work in South-East Asia, which started with a strengthened resolve on the part of the Organization to assist further in the development of national health planning as part of the overall socio-economic plans of the countries in the Region. Within this framework, the regional priorities continue to be the promotion of medical education and training of all categories of health personnel to meet the needs of the developing integrated basic health services, provision of community water supplies, pursuance of the goals of malaria and smallpox eradication a s part of the global WHO programme and assistance to national tuberculosis control programmes a s part of the general health services.

One of the most hopeful signs has been the effort on the part of governments to plan on a longer-term basis, with emphasis on mobilization of resources. Since the twentieth session of the Regional Committee (which, it will be recalled, was held in 1967 in Ulan Bator, a t the kind invitation of the Mongolian Government), when the necessity for health planning found articulate expression, it is evident that the ministries of health of our countries have been acquiring expertise in planning and economics in order to ensure that the claims of health receive adequate recognition in plans not only for the social well-being of the community but also for greater economic development.

U s e d on the resppnse of governments to the recommendations on health planning made by the technical discussions group at the last session of the Regional Committee, WHO has helped to establish a special inter-country project embracing the various activities connected with planning. A most useful group meeting on health planning, which was very well attended by senior medical and non-medical health administrators from eight of our minislries of health, was held in the Regional Office early this year. The first regional course on the subject will be started in November 1969 at the Asian Institute for Economic Development and Planning, Bangkok, and it is proposed to have similar courses every year in association with other institutions in the Region, until a nucleus of health planners becomes available in all countries of the Region.

SEA/RC22/2 Page viii

It has been WHO'S experience, in the last twenty years, that the lack of strong national health administrations has often hampered the promotion of new health programmes a s well a s the effective implementation of those already in operation. This is primarily a reflection of the fact that few fundamental changes have yet been made to permit this development in the overall admjnistrative systems of governments. In this technological age the administrative structure of the pre-development e r a still remains largely unchanged. More needs to be done to define better the relationship between the public administrator and the technical specialist, in order to promote team effort,leading, in particular, to joint planning and prompt implementation of plans. Some health institutes have started to train suitable senior doctors in managerial and programming techniques. The mhistry of health in one counlzy has already initiated a study of some of the administrative aspects a€ its work. This is a field demanding attention.

It is necessary not only to produce sdficient manpower but a t the same time to ensure their proper utilization, both by health administrations and by the general public whom they are to serve. Also, while it remalns most essential to intensify tr-g programmes, it has become increasingly apparent that skilLs must be utilized to the maximum to ensure the most economic provision of services. It is gratifying that there seems to be an increasing awareness of the need to undertake operational studies of such services and to develop teamwork whereby each member of the service unit performs clearly defined functions and accepts responsibility for his performance. Operational studies of health services have been launched by several governments in South-East Asia.

The consequences of a sustained high fertility rate in many countries and of inadequate medical facilities have continued to militate against the improvement of the health of mothers and children. Accordingly, several governments have adopted or intensified family planning programmes a s part of the general health services, a s essential to the improvement of the heaIth and welfare of the community and the family. In response to this need and having regard to the potential value of the involvement of WHO staff in these activities, the Regional Office has arranged for orientation courses to be given to relevant WHO staff and, a s from 1970, will be able to provide assistance, when requested, in training programmes on the health aspects of family planning.

Training activities continued to receive high priority, the efforts of governments being reinforced by WHO assistance to national training programmes and by the award of fellowships. There has been an increasing demand for the type of training which permits students to acquire practical experience in the field. During the year under review, a very large number of inter-country and national courses were held in the Region, deaiing with topics ranging from health planning, health statistics, medical education, paediatrics and obstetrics, environmental health and general epidemiology to specific communicable diseases

SEA/R@22/2 Page ix

of major importance such a s malaria, cholera, plague, smallpox and tuberculosis. In the many national courses held, there were more than 3 000 participants from the various countries of the Region in 1968 (see Annex 11). In addition, for the period under review, the Organization awarded 307 fellowships for study abroad, including participation in inter-regional meetings and courses. WHO Headquarters also continued to award grants and provide facilities for the exchange of research workers.

Although all of this reflects the high priority now being given to training programmes, there is an urgent need to make a critical analysis of the problems of training professional and auxiliary health personnel and to estimate carefully future requirements in trained .manpower, in order to prepare long-term plans. In this connection, the Regional Office expects to follow up on the observations arising from a study undertalcen during the year in pursuance of the World Health Assembly's resolution on the training o€ natimal health personnel (WHA21.20). Details of this study are given later in the report.

I am very pleased to be able to record that governments and teaching institutions throughout the Region not only are recognizing the need for a reform of medical education a s it has been accepted in the past, but are taking action to change the aims, methodology and content of courses in the c ~ r i c u l u m in order to adjust the teaching to the various health needs of countries. Emphasis is being placed on community medicine and the preventive and social aspects of health care. Recently developed scientific concepts of teaching and learning methodology are being applied to medical education. Working groups on educational questions have been active, and the work of modernizing examinations has continued.

During the year, a new approach was adopted by bringing in a team of four educators specialized in medical pedagogy to conduct a training course for professors in medical colleges from two countries of.the Region. Several inter- disciplinary teams also have been assigned to medical colleges to help develop a community approach, particularly in the specialties of obstetrics, paediatrics, preventive medicine and health education. Such activities are gathering momentum and should lead to the continued improvement of undergraduate teaching.

I feel that we have now reached a stage where this form of approach should lead to the setting up of advanced or special medical education units in selected medical schools or departments, to which medical educators could come for refresher training. This might be more productive than assistance given by individual consultants in specific disciplines.

The trend toward making greater use of WHO'S Revolving Fund for the provision of teaching and laboratory equipment for medical education and training has cmtinued, as evidenced by the fact that, a s compared with two years ago, WHO complied with about three times the number of requests from countries of this region, (26 requests - $240 COO in the period mid-1968-mid-1962, nnd 10 requests - $80 000 in 1966-1967).

SEA/RC22/2 Page x

The increase in coverage now being attempted by the health services requires a greater awareness on the part of the community of their own role in assisting with the solution of their health problems - an awareness which can be brought about by health education. We are painfully realizing more and more that merely providing health services does not necessarily ensure that they will be utilized. Health education has now become an accepted function of all health workers a s a part of their normal duties, and i t is known that health services are best delivered through a team approach. In this connection, a guide for training all cadres of health workers in health education techaiques was developed a t a workshop held in the Regional Office in October 1968. The problem is now lack of adequate facilities for training enough health educators, and particularly enough teachers in health education, within the Reglon. WHO continues to advise that ministries of health encourage their health education units to collaborate with the appropriate sections of the ministries of education in order to strengthen health education through schools.

The nursing profession in the countries of the Region has still to achieve i ts rightful position. For this reason, an inter-country workshop on nursing legislation and licensing for practice, held in March 1969, was of partictllar moment. N u r s e s a re increasingly being involved in the preparation of plans for tiie development of nursing services and nursing education as a part of national health planning. Greater specializatim in medical care has highlighted the need for nurses to be prepared to functim more effectively a s members of the health team prwiding specialized services.

Progress is slow, but noticeable, in the major efforts of countries to bring about improvements in their environmental conditions, wit!i emphasis on water supply and waste disposal. There has been a cmsiderable increase in WHO'S activities related to UNDP (Special Fund) projects, UNICEF-assisted rural water supply and sanitation projects, and the t r a h h g and educatim of sanitary engineers and sanitarians. Studies of the problems of water pollution and industrial wastes are continuing. Environmental health planning on a national basis has begun to receive considerable attention, and long-term programmes of assistance are being negotiated in association with governmental and international agencies interested in the socio-economic aspects of environmental health.

In the field of research, a s a part of the establishment by Headquarters, this year, of WHO international reference centres in such subjects as community water supplies (The Hague), waste disposal (Zurich) and air pollution (London), WHO has set up a regional reference centre in respect of a i r pollution (Central Public Wealth Engineering Research Institute, Nagpur, India), Three institaticns in this region have also been formally invfkd to participate in this programme as collaborating institutions in community water supplies.

Recent progress in agriculture has led to improved food production, giving hope for a stable food situation in the future. Egwever, there still remains the need to strengthen the work of the nutrition divisions in health departments and to pursue efforts to give medical and health personnel training in nutrition. ?'he upgrading, in January 1969, of the WHO-supported diploma course in nutritioqwhich was started last year a t the Nutrition Research Laboratories, Hyderabad (India),to an M.Sc. degree course was a real step forward. In this connection, I am happy to place on record, on behalf of WHO, appreciation for the valuable collaboration in the fields of public health and nutrition education and research that has always been forthcoming from the Nutrition Research Laboratories, which will be holding their Golden Jubilee celebrations in September 1969. The changing of food habits and removal of taboos are extremely slow processes, and thus there has been natural disappoint- ment that the applied nutrition programmes in operation in several countries have not shown greater results. An assessment of the applied nutrition programme which is to be carried out in India in the secmd half of 1969 may give some pointers a s to the desirable direction of future efforts in nutrition educatim.

The very extensive use of pesticides in agriculture, which has made it possible to step up food production, has also enhanced the possible risk that these chemicals may came injurious effects on the health of mnan. This problem was reviewed by a consultant in one country, and is to be further studied in other countries by WHO in close co-ordination with other agencies.

Notwithstanding the emphasis which WHO places on national health planning, education and training, environmental health, etc , and the constant pressures on departments of health to start a variety of health programmes, we a re conscious that, in the face of such a heavy load of communicable diseases in this regicn, there can be no let-up in our efforts a t cantrol and eradication 6f these diseases. Experience has pointed to three directions in whioh communicable- disease control can be most effective : consistent pursuit of the aiin of integfatim of control programmes into the basic health services; strengthening the epidemiological, laboratory and statistical services as rapidly a s possible, and mare systematic organizatton and implementation of immunization programmes. Some progress is being achieved in buildhg up trained personnel for work in epidemiology, a s part of the WHGassisted international and national courses in this field; however, there are still not enough epidemiologists for the services, which are further handicapped by the under-utilization of laboratories. WE10 is also hampered in its efforts to recruit epidemiologists by the world shortage in this specialty. I believe, however, that in many countries of the Region there is increasing potential for training epidemiologists, microbiologists and statisticians, and our assistance in this regard will be continued and strengthened a s far as possible.

Mention may be made of the attention being given to the role of epidemiological units in the countries of the Region and to the principles governing immunization programmes. These subjects will be discussed at the forthcoming sess im of the Regional Committee.

A s a follow-up of the Regional Committee 's resolution on the importance of developing epidemiological surveillance programmes (SEAbC21/R3), preparatory work has been done through the issue of technical documents, through assistance in training activities and the conduct of field epidemiological investigations, and by the provision of laboratory diagnostic supplies. Pa.rticular attentim was given to dengue/haemorrhagic fever, poliomyelitis, cholera and p-e, and to diphtheria, pertussis and tetanus. Much remaim to be done in definiug the methodology of epidemiologica1 surveillance of the major diseases and in facilitating the exchange of the available knowledge through seminars, training courses, etc. The Organization hopes to be able to assist in these activities to a greater extent in the coming year.

The progress of m-ia eradication programmes during the year can be termed as slow but steady. After the reversions in the programme phssfng in some countries during 1968, which were described in last year's report, it is mtjfyhlg to note that the remedial measures introduced have prevented further set-backs. Causes cd the slow pace of progress were again traceable, for the most part, in administrative and operational failures. If we are to achieve the desired dbjeotive of malaria eradication, it is essential to attain the highest operational standards in all the programmes.

Following the resolutim of the Twentieth World Health Assembly providing for the re-examination of the global strategy of malaria eradication, WHO study teams have visited several countries, including Ceylon, India and Thalland in this region. The report of the Director-General to the'Twenty-second World Health Assembly on this matter deserves careful study.

With regard to amallpox eradication programmes, there has been considerable progress in terms uf vaccination coverage and in local productim of freeze-dried vaccine in some countries. Wealmesses in most of these programmes are due to deficiency in supervision, surveFUance and containment measures. The programmes are still being entrusted almost exclusively to full-time vaccinators, with little or no involvement of the staff of the general health services, whether they are working in hospitals or in health centres. More thought needs to be given to this aspect and to the possible advantages of arranging for more frequent assessments of the programmes by independent teams.

In the year under review, shave sought assisSssce in relatim to cancer, primarily in the establishment of epidemiological studies. In Jndia, at Kancheepuram, plans have been made for a longitudinal study of the incidence of two types of cancers, namely oropharyngsal and cervical, to be carried out over a period of five years in the first instance.

SEA/RC22/2 Page xiii

Increased attention is being given to the strengthening of radiological services, with emphasis on prevention of radiation hazards in radiological departments. This requires the further expansion of the training of hospital physicists and radiographers.

There has been great interest in the Region in the training of technicians in the repair and maintenance of various types of hospital and laboratory equipment, and the Regional Office has responded to requests for assistance in this field by organizing traidng courses in two countries and by planning courses in three others.

The fact that a resolution was passed at the twenty-first session of the Regional Committee concerning the quality control of drugs is a measure of the importance attached to this question by our govenunenta. Considerable activity has taken place in this field during the past year, with the holding of a successful inter-country seminar in Bombay and a study of all aspects of the problem carried out by two WHO consultants in seven countries of the Region. The recommenda- tions which they have made'emphasize the need to strengthen legislation in this field and to train pharmacists d a suitable standard in order to prepare them to enter the drug quality control services.

During 1968-69, WHO assisted 235 projects in the Region. These consisted of 187 country projects, 40 inter-country projects and eight inter- regional projects, including four research programmes sponsored by Headquarters in which the Regional Office participated. The broad health fields covered by the projects were malaria eradication (U), tuberculosis control, including production of freeze-dried BCG vaccine (lo), leprosy (9), smallpox, including production of freeze-dried vaccine (9), other communicable diseases 06), health laboratory services, including the production of other vaccines (13), health statistics 01) , public health administration and rural health services (20), maternal and child health (lo), nursing (21), mental health (4), dental health (3), radiation 03), environmental health and water supply (21). health education (8), nutrition (3), direct assistance to medical 'institutions 06), quality control of drugs (3), and miscellaneous activities (34). A brief description of each individual project to which assistance was given during the period under review is given in Part III of this report.

I have endeavoured, in the foregoing paragraphs, to highlight some of the problems in the development of health services in our countries, In studying the situation during the course of the year, I considered that certain changes needed to be made in the organization of the Regional Office if we were to keep in step with present trends. Accordingly, I have recently orientated our administration of technical programmes towards a country approach, in line with the World Health Assembly resolution on long-term planning in the field of health (WIIX21.49), in order to enable us to meet the needs and problems of each country more effectively.

SEA/KCZZ/Z Page xiv

Our efforts in this direction also'need to be reinforced by placing more emphasis on co-ordination and evaluation. Thus, during the year, greater attention was paid to co-ordination, both within a ~ ~ d outside the Regional Office, with the United Nations and other agencies assisting in the development of health services in the Region. Numerous meetings have been held, particularly with the UNDP representatives in all countries and with UNICEF, both a t country and a t regional level, In this connection, a welcome decision was made by UNICEF to hold its meetings to review proposals for assistance before submission to the 1970 UNICEF Executive Bbard in the respective UNICEF regional offices, that is, in Bangkok and New Delhi, We are maintaining coc~lnuous and close liaison with other agencies through contact with their regional representatives and by advising on the health aspects of their development projects. I wish to thank all our colleagues in the United Nations family, particularly those in UNICEF, UNDP, ECAFE, FAO, UNESCO, ILO and IAEA, for yet another year of close under- standing and joint endeavour.

This is an age of development, and all resources - national, bilateral and international - must be fully utilized. Further and continuing study of the requirements will therefore be carried out in this office so that we may be better prepared to assist more realistically with co-ordinatiori and with the planning, implementation and evaluation of our joint programmes.

Toward the end of the period d e r review, a t the Twenty-second World Health Assembly (July 1969), the Government of Afghanistanrequested inclusion of that country in the Eastern Mediterranean Region of WHO. This trinsfer was approved by the Assembly.

It is with the deepest regret that I record the sad demise of Dr Helweg- Iarsen, Regional Adviser in Health Statisycs, who died suddenly in May this year. after fourteen years of senrice with WHO in South-East Asia, ten of which were spent in the Regional Office,

Throughout the year we have received valuable co-operation from the governments of the Region and rrom our colleagues in the national health services. On behalf of the Regional Office staff, I acknowledge with gratitude their help and understanding. Needless to say, full support on the part of our governments is of paramount importance if the Regional Office is to be of the greatest service to them.

v.T.~i. Gunaratne,F.R.C.P., D.P.H. Regional Director

GRAPH 1-EXPENDITURE ON PROJECTS. BY BROAD SUBJECT GROUPS, 1968 SOUTH-EAST ASIA REGION

Subject group

~ ~-

Communicable-disease projects

Other projects

All projects

Expenditure. 1968 ~- ~p

Amount (US El I Per cent - ~ - ~ l

2 893 023 4029

4 268 355 I 59.71

7 181 378 I 100.00

GRAPH 2-EXPENDITURE ON COMMUNICABLE-DISEASE PROJECTS BY MAIN SUBJECT GROUPS. 1967 and 1968

SOUTH-EAST ASIA REGlO N

Code Subject

- -- ~- -

M A L Malaria

T B Tuberculosis

SPX Smal lpox

LEP Leprosy

EE Endemo-epidemic diseases, including viral and venereal diseases

A l l communcab ie dseases

1967

Amount (US ')

1 020 151

Per csnt

42 09

11 9 2

24.76

5.28

15.95

100.00

P A R T I

" v & N % R A L ir R E V I E W O F A C T I V I T I Z S

SEA/ RC22/2 Page 3

. ,

1. COMMUNICABLE DISEASES I I

In the last few years there have been warnings of the continued changes, within the Region, in the epidemiological pattern of some communicable diseases of both national and international importance, During the year it was necessary to maintain a constant watch on plague in four countries, on the epidemiological pattern of paralytic poliomyelitis in the larger urban areas, and on the fast replacement of classical cholera by the E_1 TA. variety. (The findings in Calcutta and elsewhere that cholera g Tor carriers a re playing an important role in transmission within households deserve attention. The prevalence of sypW.9 and gonorrhoea continue to be on the increase hi urban areas. Morbidity and mortality from diphtheria, pertussis, tetanus and typhoid fever remain unnecessarily high; +The nature of the epidemiology of dengue/haemorrhagic fever has been a cause for concern. The Regional Committee, at its last session, adopted a resolution requesting that WHO provide assistance, including advisory services, training facilities and necessary supplies, to national and regional epidemiological surveillance programmes. The Committee also passed resolutions calling for more attention to diarrhoea1 diseases and to plague.

These developments have strongly emphasized once again the urgency of strengthening epidemiological services and setting up epidemiological surveillance programmes. A surveillance programme demands a continuous study of the distribution and spread of the major infections and the collection and analysis of reliable data to help the health administrator forecast potential out- breaks in time and make decisions on effective control measures. (Attention is drawn to Section 1.3, which follows, on the recent recommendations concerning the revision of the international Sanitary Regulations).

The establishment of epidemiological services a s part of directorates of health is gaining some momentum. This is being achieved partly through the increasing number of trained national epidemiologists who are becoming availL able a s a result of fellowships provided by WHG and WHO-assisted international and national courses in epidemiology. The basic principles and practices in epidemiological surveillance and communicable-disease control a re also being demonstrated in inter-regional, regional and national courses on the control of specific diseases, like cholera, plague, smallpox, malaria and tuberculosis.

A notable feature of the year has been the increasing number of independent assessments of some of the national malaria and smallpox eradication programmes and of national tuberculosis and leprosy control activities.

In addition, multi-subject serological survcys are, with the assistance of WHO refeience laboratories, being used to determine the prevalence and distribution df important infections a s well a s in the plannlng and execution of mccination ~jrogrammes.

Notw'ithstanding these efforts, epidemiological and communlcable- disease control services will remain weak until they a re based on more efficient support by laboratory and statistical services. It is also necessary for countries to promote and establish better career prospects for health personnel in these

SEAIRC2212 Page 4

basic disciplines of public health. It i s a regrettable fact that, though a great deal of the ill hcalth in the Region is preventable, immunization programmes, even in those a r m s in which general health services offer reasonable coverage, havc not been promoted sufficiently or successfully maintained. Immunization of newborns and the young age-groups needs more attention, particularly in many of the larger urban centres enjoying a relatively goal network of health services.

There has been renewed interest in the zoonoses and in veterinary public health in general, and assistance has been provided to some Member countries in reviewing various aspects of their veterinary public health services, including training.

The workshops on immunology held during the year (see aoction 1.4.5) were most successful in stimulating research on the immunology of some d the communicable diseases.

1.1 Malaria

The period under review marked the beginning of a "fresh look" a t the global strategy of malaria eradication. Special study teams were assigned by WHO Headquarters to a number of countries which had met with varying degrees of success in their eradication programmes. In the South-East Asia Region, one such team visited Thailand and another went to Ceylon and India to study and review the adequacy of their vigilance orpnizations in the maintenance phase of malaria eradication.

The general progress of the programmes in the countries of this reglon was fairly satisfactory. Although there were indications of growing concern about the slow pace of somc of these programmes, nevertheless continued eE. . forb were made to safeguard past achievements and to prevent setbacks in the future,

The overall status of malaria eradication in the Region was a s follows (July 1969 estimates):

Total population of the Region 746. 9 million

Population at risk (in originally rnalarious areas) 710.6 million

Population protected: G61.5 million

(a) Attack phase (b) Consolidation phase (c) Maintenance phase

189.6 million 181.9 million 290.0 million

Population under the preparatory phase 9.4 million

Population still unprotected 48.7 million

POPULATION A T MALARIA RISK IN THE AREAS UNDER VARIOUS PHASES OF MALARIA ERADICATION PROGRAMMES

IN THE SOUTH-EAST ASIA REGION (1960-1969)

Population (in millions)

Year

19W

1961

1962

1963

1964

1965

1966

1967

1968

1969

Population at Malaria Risk (In Millions)

Not covered (including

preparatory phase)

91.6

61.4

53.6

55.9

43.7

40 8

38.6

40.9

48 5

49.1

Attack phase

423.4

501.3

381 .I

289.0

212.1

1500

130.8

111.8

197.5

189.6

Consolidation phase

4.2

6.6

162.0

267.1

276.0

281 6

228.6

221 0

198.8

181.9

Maintenance phase

1.4

1.4

1.5

1.5

94.6

171.3

249.1

294.5

253.4

290.0

Total at risk

529.6

570.7

598.2

613.5

626.4

843.7

647.1

668.2

698.2

710.6

Graph l ~ h o w s the changlflg wesd status sf malaria eradication in the countries of South-East Asia during the decade 1960-1969 and the considerable increase in thtr coverage of populatian'in the maintenance and consolidation phases from 5.6 million in 1960 to 41L9 m u o n in 1969, in spite of the reversion of the progTarnme to the I1attaclr" phase in certain areas which was necessary during 1968. Population figures in the maintenance and consolidation phases in 1967, 1968 m d 1969 were 515.5 million, 452.2 million and 471.9 million respectively. llle remedial m d e s in "reverted" areas checked further setbacks, and in 1969, some areas were advanced to the later stages of malaria eradication, though progress in this direction was not as impressive as in earlier years. There was no increase in the number of areas with technical problems, but there were administrative and operational difficulties, such as unfilled staff vacancies, delay in releasing funds, inadequate covcrage of spraying and surveillance operations, etc., which remained largely unsolved.

To summarize the progress of work in individual countries, first, in Afghanistan, a review of the programme was undertaken hi order to draw up a more realistic phasing. A draft plan of operation, which was prepared and is under study, does not envisage'that any area in the country will enter the maintenance phase before 1975. The persistence of transmissicm in Kunduz contihued and was the object of a special study by WHO and the national author- ities.

A WHO short-term consultant is expected to visit Burma in September 1969 to assist in drawiqg up a long-term plan for anti-malaria operations. At the request of the Government, arrangements have been made to assign a WHO laboratory technician to help,with the organization of laboratory services and to train national microscopists.

In Ceylon, emergency and long-term plans of operation to combat the epidemic of 1967/1968 were formulated by a special WHO team. Although progress in the implementation of the emergency plan was somewhat behind schedule, adequate numbers of walking and mobile spraying teams have now been established, and as a result of discussions with the Government, the implementation of the emergency plan is receiving priority. By the end of the first quarter of 1969, spraying @rations had covered 47 out of the 98 health areas, affording protection to some 4.65 million people.

Further adjustments and rephasing of the Indian programme Were under- taken in the Light of the epidemiological situation in the different States. ThE routine annual appraisal d the programme for shiitlng areas into more advanced phases was carried out; for this purpose, assessment teams paid visits to the States of Andhra Pradesh, Assam, Jammu and Wshmir, Maharashtra, Mysore, Orissa and Ut ta r Pradesh, and to the Union Territories of Delhi and Goa. The special working committee of the National Malaria Eradication Programme continued to hold reegular meetings, at which, among other subjects, the criteria

' for restoring the programme to consolidation or maintenance in units M which it had been reverted to an earlier phase were discussed and formulated.

An Mependent assessment d the status of the Monesian programme, which was carried out by a WHO t a m in January-February 1969, has provided a basis for determining the future cow&? of development of the program-ne. Meanwhile, a policy of integrating the mahria eradioabian service into the s m r a l health services has been adopted by the Government and is under implementation.

Spraying operations and case-detection activities against malaria continu~d in Maldives and covered the Male and Faddifolu Atolls.

As part of the programme in Nepal, which continued to make progress, an independent assessment was jointly undertaken in April 1969 by the Govenunent, USAID and WHO, and, a s a result, areas with a total population of 620 000 in the Central and Eastern Zones were approved for entry into the consolidation phase.

In Thailand also, the programme progressed, with areas containing a population of 2 444 580 being advanced into the consolidation phase; out of these, areas with a population of 817 200 were certified a s fit to pass into that phase, based on the findings of an independent assessment made in late 1968. Another assessment undertaken by the national authorities with joint assistance from WHO and USAID,' to make an overall review of progress, was completed by the end of March 1969.

Preparations were under way for a 'Y3emtnar on Applied Epidemiology in relation to Malaria Eradication Programmes", to be held in Ceylon, and for a "Seminar on Methods of Integration of the Malaria Eradication Programmes into the General Health Services", to take place in New Delhi, both in the latter part of the year.

Two inter-country border 00-ordiuation meetings, the Burma-India- Pakistan Malaria Co-ordination Conference,and the Indo-Nepal Border Malaria Meeting - were also scheduled for late 1969. The Regional Office was represented a t the Lower Mekong Malaria Co-ordination Meeting held in Vientiaue (Iaos) from 16 to 19 June. (ThaLland is a member of the Lower Mekong Committee.)

Under the WHO Headquarters research programme, grants for research work on malaria were made to several institutes (see Annex 6).

1.2 Tuberculosis

Efforts were continued to assist the countries of the Region in stabilizing their tuberculosis programmes by including these programmes as an integrd part of national health plans and by having the control services delivered through the general health services. Such integration is a prerequisite for obtaining the required coverage of the population on a permanent basfs, since, i n most of the countries, tuberculosis is as prevalent in the rural areas a s in urban communities.

The concept d integration has become possible only by evolving a methodology for the control of the disease by simple and practicable but not too time-consuming measures. The main objective now is to interrupt the chain of transmission, first through BCG vaccination, and second by bacteriological

SEA/RCZ~/~ Page 7

identification of infectious sources and their elmination through chemotherapy. To attain this aim, programme-orientated traiding i s gven to all categories of ~ M f f , organized as far as possible on a team basis, The Regional Mice has contiaued to participate in and encourage such training, particularly through the training facilities existing in India,

An important step towards strehgthening the control programmes in the countries of the Region was the formation, during the year, of a "Regional Tuberculosis Evaluation and Training Team", which,to start with, has been based at the National Tuberculosis Institute in Bangalore (India), - an Snstitute which, with its varied activities and facilit'ies for epidemiological and operational research and training, provides suitable ground for the team's future work in assessing national programmes. The plan is that, after each independent assessment of a tuberculosis control programme in a country, the team will immediately present its findings to the responsible authorities in a workshop,which will be organized to permit workers in allied fields (such a s maternal and child health, paediatrics and health administration) to review,together with the team,the objectives and techniques of modern tuberculosis control as an integral part of the general health services. .

The practical experience gained through such programme evaluatim in workshops should also provide an excellent basis for the formal Waining which the regimal team is expected to undertake on an inter-country basis. Although, this year, four senibr $W members - one each from Burma, Ceylon, Mongolia and Thailand - participated in the Seventh International Training Course on the Epidemiology and Control of Tuberculosis, held in Prague and a t the National Tuberculosis Institute, Bangalore (India), iliere was a continued neea for training more orgmizers and planners for naticnal tuberculosis programmes.

Staff working in such programmes have been given orientation and training in most of the countries of thc Region, At Uw National 'i'uberculosis institute, Bangalore, the nineteenth regular training course was held during the first quarter of 1969, with 89 participants, bringing up to 189 the number of complete district tuberculosis teams trained for the Indian programme. In Burma and Ceylon, training programmes required for the expansion of the national cbntrol programmes to new divisions and provinces were also successfully carried out.

Orientation in the modern concept and techniques of tuberculosis control was provided at confc?renccs, scrninars and workshops. Represcntatives from h a , Nepal and Thailand participated in the Sixth Enstern Regional Tuberculosis Conference, convened in Kuala Lumpur in November I968 under the auspices of the International Union Against Tuberculosis, Xn India, the Ei&th Pill-hdia BCG Conference, followed by the Twenty-fourth National Conference on,Tqberculosis and Chest Diseases, was held in Trivandrum in January 1969; on that occasion a seminar was also organized for directors of state tuberculosis c o n t r ~ l centres to discuss the further development of theseinstitutions as trainin and demonstration centres. Also, a s an annual feature, a seminar is held a t the % ational Tuberculosis Jnstitute, l3angalore, for senior public health administrators, lecturers in tuberculosis and senior tuberculbsis control officers. An important event in

Indonesia was a week-long workshop, organized in January 1969 in Tjiloto and attended by officials of the Ministry of Health, those of provincial health directorates and senior tuberculosis cmtrol officers. with the oarticioation of WHO and the ~nte&tional Union Against ~uberculosis. ~ i n a l G , in Gghanistan, a seminar on tuberculosis control was organized by the Jnternational Children's Centre, Paris, with the assistance of WHO, UNICEF and the International Union Against Tuberculosis, and held in Kabul in April.

A further method of focussing attention on the concept and the "mechanics" of comprehensive and integrated programmes as applicable to the South-East Asia Region was the prcdwtim of health educational material on this subject, which was distributed to projects for training and orientaticm purposes.

Notable progress was made in individual countries. In Afghanistan, it was agreed to establish a separate tuberculosis unit in the Ministry of Public Health to guide the programme a s well a s to organize formal training for medical and paramedical personnel. After the successful implementation of the BCG campaign in Kabul, systematic BCG vaccination programmes for pre-school and school children were extended to other provinces. Taldng into consideration the reoommendations made a t the tuberculosis seminar in Kabul, mentioned above, and the diaovssions wlth nati-1 authorities which followed, a comprehensive draft plan of action for 1969-1910 was finallzed.

In Burma, from 1 January 1969, direct BCG vaccination for all children up to 14 years of age was introduced a s a routine measure. The Government also approved a five-year phased plan with emphasis on case detection by sputum+mear examination.

The programme in Ceylon, following the comprehensive evaluation and successful holementation of anti-tuberculosis activities in the North-Western ~ r m i n c e , was extended to the Central and North-Central Provinces.

In India, the expansion of the national tuberculosis programme appeared to have slowed down, with only ten new district tuberculosis programmes established during the year. As mentioned above, the total number of trafned teams reached 189, and 174 districts were covered by the programme. The need for strengthening the supervisory and assessment mechanism was, however, apparent. Also, the BCG vaccination programme was handicapped by transport daicult ies and because the local production of thermostable freeze-dried BCG vaccine has not yet passed from the experimental to the commercial stages of development. Great efforts were made to help to expand the work of the BCG Vaccine Production Iaboratory in Gubdy (Madras).

In Indonesia, following the recommendations of the Tjiloto workshop, the programme was directed toward coverage of all the susceptible population with BCG vaccination, possibly with the co-operation of different bilateral agencies. This workshop clarified the objective af inkrruptim of transmission of the disease, a s a basically different approach from that of individual care for patients suffering from chest diseases, including non-infectious tuberculosis.

MALARIA EEAAlCATlQN

P . . . fhc elnbal ~ ~ r ~ z r e v of malaria' mdkarlon i 3 beinv reNl~mlncn ., ... - in view ol the anrveo W I I I C ~ nc +Rarrr in dikefin? C O I I I I ~ ~ ~ S .

I h e pirturer ckow ( I ) fprqi~qj npcrntienl In Mhldlver, (1 ) r ra i r t i ~~g 06q?mymen VI Argllaniaan. (31 dIsttihtltf6nr)t JI.II@

rl I n India. and (4) rakinfl OF blnnd m e a n in Dylon.

T

TU6IERCULC)SlS CUN I KWL

Control of tuberculosis continues t o receive high priority. In these pictures (I) a member of a BCG vaccination team in Bangalore. India, marks a house after a visit: (2) a health worker i n Thailand prepares sputum samples for micro- scopy; (3) self-administration o fad rug by a patient i n Burma (where. as i n some other countries of the Region, domicil iary chemotherapy is being widely accepted) and (4) i n Afghanistan a child receives BCG vaccination.

SEA/RC22/2 Page 9

In Maldives, BCG immunization of all children from 1 to 14 years of age i s being; undertaken in some of the atolls by the health staff conducting tlie anti-malaria campaign. . :

. . . . . . . .

The BCG vaccination programme in Mongolia completed its initial phase, covering practically all of the susceptible population of the cou~try. A maintenance programme has been lawiched,by which newborns are routinely covered in maternity homes and .revaccination is . provided . for children from 12 to 15 years of age before they leave:school. :

In Nepal, a new draft plan of operation was prepared for tuberculosis control as part of the health services. Plans were made to provide a medical officer to the WH@assisted project.

Regular WHO assistance came to an end in Thailand after nine years. Though the BCG vaccination programme has been completely integrated into the prwincial health services, identification of infectious sources through sputum- smear examination at health centres is at present undertaken in only 52 centres in 40 different provinces. Efforts are being made to achieve extension of this aspect of tuberculosis control through the health services available.

The Tuberculosis Field Research Unit in MadanapaUe (India), which has been assisted by a WHO Headquarters research grant, continued its studies. The work being done a t the Tuberculosis Chemotherapy Centre, Madras, and a t the National Tuberculosis Institute, Bangalore (where the Headquarters-assisted feasibility study for a tuberculosis prevention trial also continued), is described in Part JJI of this report, under projects India 0053 and India 0103. Lists of papers emanating from this Yesearch, which were published or were under preparation, are given in Annex 7.

1.3 Quarantinable Diseases and International w- antine

The table on pa@ 10 gives the figures in respect of the quarantinablc diseases - smallpox, cholera, plague, and typhus and other rickettsioces - for the years 1966, 1967 and 1968, a s reported to the World Health Organization.

It will be noted that the number of reported cases of smallpox has increased in Afghanistan, Indonesia and Nepal, This increase may be partly due to improvements in reporling, The reporting of cholera is still unsatisfactory, a s will be explained in a later chapter. As for plague, most of the reported cases in Burma, Indcnesia md Nepal occurred in the early part of 1968, i,e., before the period under review.

A significant event during the year was the fifteenth meeting of the WHO Committee on International Quarantine, which took place in March 1969, The Committee reaffirmed its previous recommendation to the effect that the International Sanitary Regulations as a whole should be revised. After reviewing the comments received from Member States, the Committee recommended that the revised Regulations be entitled "International Health Regulations" and that its own name be changed to "Committee on International Surveillance of Communicable Diseasesu.

Quarantinable Diseases Notified bv Countries of the South-East Asia Redon, 1966. 1967 and 1968

(Sources: 'JEO Health Statistics Report Vol. 21, Nos. 4 and 10, 1968; Vol. 22, No. 4, 1969; VJHO Weekly Epidemiological Record, Nos. 24 and 25, 1969)

. . Data not available - Nil * Provisional r Revised data

ET El Tor R Other rickettsia3 diseases a Imported cage b Total number of cases reported under smallpox

surveillance

t

I Country

Afghanistan

Burma

Ceylon

1 India

Indonesia

Nepal

Thailand

Smallpox 1 Cholera Year

1966 1967 1968

1966 1967 1968

1966 1967 1968

1966 1967 1968

1966 1967 1968

1966 1967 1968 1966 1967 1968

Plague 'ryphus and Other (

Cases

77: 211b 739

6 -

181b

- la -

32 616b 77 974b 31 439

55 283b 13 47Sb 17 311

164b b

96b 249

- - -

Diseases Deaths

- .- -

..,

... ... zR

...

... ...

...

.-.

...

...

.a. ...

... ... ...

Cases

- - -

411 9 - - - -

13 027 12 180 18 145*

2 0 4 ~ ~ 7 07 135

2 5

34 401 148 408

Deaths

- 9

33

- -

37

- - -

6 482 13 054 5 128*

1 403 1 049 1 5 8 8

96 23

+ . . - - -

I Rickettsial Deaths

- - -

45 - - - - -

2 788 2 608 2 916*

36 142 30

- 1

17 21 7

24

Cases ' - - -

48 217 86

- - -

11 - - - -

94

- -

13 - - -

Deaths / Cases

- - - 7 7 3

- - - 8 - - - -

38

- -

12 - - -

- 1 5

... --.

... R

10lR

2 8 ~ 13

... ...

..-

. -. ..,

...

..- ...

... ,.. ... ...

SEA/RC22/2 Page 11

The Committee also recommended that, as part of the global epidemio- logical surveillance programme, outbreaks of louse-borne relapsing fever, influenza and paralytic poliomyelitis should be promptly reported to the Organization by telegram by the health administrations of the countries in which cases occur; its recommendations with respect to malaria were that it should become notifiable in all maintenance phase areas and that, for periodical publication by WHO, each health administration should collect information on (a) areas in the maintenance phase of malaria eradication programmes; (b) cases importedfrom abroad into countries in the maintenance phase; (c) areas with chloroquine-iwsistant strains of parasites, and (d) international ports and airports free from malaria. These recommendations were to be considered by the Twenty-second World Health Assembly.*

1.3.1 Smallpox

Smallpox continued to be a major, thoqh preventable, public health problem in several countries in the Region. In'1968, a total of 49 919 cases of smallpax was reported from five countries, viz., Afghanistan, Burma, India, Ihdone8ia and Nepal. Mia and Indonesia accounted for 97.7% of the reported cases. Ceylon, Maldives, Mongolia and Thailand remained free from smallpox in 1968.

The reduction of 48 per cent in the total number of cases reported from the various countries in the Region resulted from a considerable decrease in the tbtal number of cases reported from India. This was probably due also to increased vaccination activities and partly to 1967 having been an endemic year.

With regard to the incidence af smallpox in the various countries, outbreaks were reported from 21 out of the 28 provinces of Afghanistan. In a border prwince of Burma, after the importation of a case from a neighbouring country, an outbreak occurred but was successfully contained. Smallpox was reported from all the States of India, with a high incidence in Andhra Pradesh, Bihar, Maharashtra and Orissa, and a very low incidence in,Kerala, Madras and Fvnjab. Cases in Indonesia were mainly restricted to Java and Sumatra; the highest incidence was recorded in West and Central Java. In Nepal, the Kathmandu' Valley remained free from smallpox. Most of the outbreaks occurred in the Terai. Case reporting and notification as well a s adequate outbreak containment received greater attention and showed some improvement.

In furtherance of World Health Assembly resolutions WHA19. I6 and WHA21.21, assistance was provided in the f o W t i o n of plans of operation for smallpox eradication programmes and their implementation. Aid from WHO, UNICEF and bilateral sources was in the form of: (a) advisory and assessment services a s required; (b) provision of freeze-dried vaccine and other supplies and equipment; (c) organization of and assistance in the conduct of seminars apd training courses for national and international staff on methods of operation, assessment, surveillance and outbreak containment; (d) the award of fellowships for training and grants for research in the fields d epidemiology and immuno- logy, and (e) support to local production of freeze-dried smallpox vaccine.

*At the time this report was being finalized, it was learnt that the World Health Assembly had adopted the revised International Wealth Regulations (resolul3on WHAZ2.46).

s~A/RC22/2 Page 12

A plan of operation for smallpoor eradication in Afghanistan was prepared and signed by the Gwernment and WHO. According to this revised plan, the country will be divided into four zones, each having a separate staff for vziccination, assess- ment and outbreak containment, with a central directorate in Kabul to p r d & wemll direction to co-ordinate project activities. WHO assists this project with staff, supplies and equipment and cash subsidies to meet the cost of travel and

r diem for staff. Assistance was also given in the coduct of a training course ' supervisors. In July 1969, a joint CwernmentmO team carried out a n assessment of the progress achieved so far and made recommendations for the future. In 1968, a total of 1627 000 vaccinations was recorded.

In Burma, the second round of vaccination will be completed in 1969, and plans are under way to make an assessment of the programme, which should help In drawing up guidelines for the future.

Following on the assessment of the ~nd'ian national smallpox eradicaffm programme in 1967, a revised programme, involving assistance by WHO, has been ' developed, and a draft plan of operation was under consideration by the government. Skrdies on the epidemiology and immunology of smallpox were continued by the -- research unit of the Indian Council uf Medical Research, based in the infectious- Disease Hospital, Madras, and were assisted by a further grant from WHO Headquarters. In 1968, a total of 79 682 000 vaccinations was performed, of which 21 343 000 were primary vaccinations.

The eradication programme ip Indonesia was started on 1 July 1968 in Java and Bali, and will be extended to the rest a€ the country. Prellmiaary data showed that in 1968, 12 2ll 000 vaccfnaticns were performed. An assessment of the programme was carried out in June 1969.

The smallpox eradication programme in Nepal wa,s extended to two more zones; at present it is in operation in six out of the fourteen zones in the country, and extension to two more z'ones is foreseen during 1969. In 1968, 1 450 000 vaccinatiom were recorded.

1.3.2 Cholera

In several countries of the Region cholera persisted, with various lev~ls of endemicity. However, reporting according to the recornmeladations of the WHO Expert Committee on Cholera and the Committee on International Qua.rantlne is not d o r m l y practised everywhere: in some areas, it is confined to those cases which are confirmed bacteriologically and thus does not necessarily cover cases of overt disease. Somebes even the isolaticn of the El Tor biotype is not considered as evidence of cholera, for purposes of reporting.

With the continuing shortcomings in epidemiological and laboratory services at the intermediate and peripheral levels, cholera control is often initfabed after tho anset rather than in anticipation of an outbreak and is confined to cholera management, with inadequate reduction of case fatality, either through shortage of rehydration '

equipment or because of unsatisfactory application uf up-to-date methods of therapy.

WHO assistance during the year consisted af (a) the assignment of the Regional Enteric Infections Team to conduct short training courses for health personnel in Afghanistan, Burma, India and Indocesia, in order to bring about standardization in the diagnosis, reporting and treahnent' af dholera; @) on-the-spot

THE FIGHT AGAINST SMALLPOX

In spite of the efforts made to control smallpox, the incidence of this disease is still high. Smallpox vaccination drives continue in various countries-for example, in (I) Burma, (2) India, (3) Afghanistan, (4) Indonesia. and (5) Nepal.

THE PROBLEM OF LEPROSY

Because o f i ts size, the leprosy problem continues to be a major challenge i n some countries of the Region. Shown hpre are (I) a sensitivity test on a Burmese child during a leprosy survey in a vi l lare near Mandalay; ( 2 ) rehabilitation training of a leprosy patient i n Indoneria: (3) a patient i n India reporting for treatment. and (4) a leprosy survey among children in Thailand.

SEA/RC22/2 Page 13

reviews of possible aetiological causes of the many acute gastro-enteritis outbreaks occurring seasonally in the various countries, including assistance towards the strengthening of epidcmiological and laboratory aspects a s part of WHO-assisted country projects or the work of the regiwal team, and (c) promotion of critical reviews of the principles of cholera epidemiology and management . a s taught in the medical colleges of those countries where the disease is endemic; this has been done through visits of the team, by holding seminars and also by the distribution . .

of relevant literature and technical circulars.

It is expected that the seminars already held in 1968-1969 and others to be organized in 1970 in the various countries of the Region will further contribute to the imprwed organization of cholera management. From 1970, it is proposed to lay emphasis on epidemiological surveillance procedures through available channels of the health services, particularly in urban concentrations.

The Inter-regional Training Course on Cholera was again organized as a travelling seminar and this year was held early in 1969, visits being paid to Caloutta, Hongkong and the Philippines. The nine participants from South-East Aaia came from India (three), Indonesia (three) and Nepal (three).

With WHO assistance, long-term epidemiological studies were carried out in Bangkok and Calcutta during both the cholera season and the inter-epidemic period.

Small outbrealcs of bacteriologically confirmed cases were reported from Burma (in very low number) in 1969. As for 1968, an epidemic of acute gastro- enteritis in Nepal included some cases found to be cholera. In Indonesia, V-o cholerae and E l Tor persisted, causing isolated outbreaks in parts of the country. In India, cholera occurred at a higher level than the previous year, with a consider- able increase in the size of the seasonal outbreaks in Madras and Rajasthan. In Thailand also, in 1968 the number of cases was significantly greater than in 1967, and an epidemic was reported in May 1969.

WHO continued to assist the Cholera Research Centre in Calcutta (a prt of the Indian Council of Medical Research), which is now codcentrating on the immunological aspects of both overt cholera and sub-clinical infection. (Earlier studies have revealed the presence in the community of infected individuals without w e r t disease). WHO'S support to the Central Drug Research Institute a t Luclmow (hdia) in its research on the genetic aspects of the V M o complex, aiming at the development of an immunogenic, streptomycin-dependent vibrio, was also cmtlnued. The WHO International Reference Centre for Vibrio Phage-Typing in Caloutta suckerled in developing improved methods for the epidemiological tracing of infections.

1.3.3 Plague

Apart from the persistent endemic focus in Burma, there were no plague outbreaks reported from the countries of the Region during the period under review ( te . , from August 1968 up to the present). The outbreaks reported last year in two villages of Western Nepal and in the Bojolali District in Central Java ( h i e ) were brought under cbntrol. A few cases of ra t falls were reported in South India and were investignted.

SEA/RCZZ/Z Page 14

In the Bojolali District of Central Java, surveillance has been established, and WHO ms been requested to assist in defininq the area of enzootic pLag;lis and to advise on strengthening the barriers between field and domestic rodents.

A WHO consultant assisted the Government of B m a in epidemiological investigations into the endemic focus of plague, in establishm a field laboratory for continued investigations and in training staff in the conduct of surveys of pIague in man, rodents and vectors. These investigations contributed to the strengthening of plague surveillance in the country.

Following the discussions at the last session of the Regional Committee aed its resolution on the subject (SEA/RC~~/RU), a training course in the epidemiology and control of plague; followed by a seminar on plague surveillance, was organized in Mandalay (Burma). Both the seminar and the course helped to stimulate the interest of medical officers in charge of plague control in the participating countries as well a s to lay down guidelines for plague surveillance a t national and regional levels. The meetings also provided an opporhity for theoretical deliberations to be supported by practical &monstrations in the fieId.

It is expected that the accepted criteria for the diagnosis, control and field investigations of plague wiU bring about uniformity of s w ~ e i k c e activities in the countries concerned; thus contrii;uting to the improvement of plague surveillance in general.

In pursuance of the resolution on plague adopted by the Regional Committee at its last session, a s mentioned above, the Iiaffldne Institute, Bombay, is being proposed for designation a s the Regional Referelice Centre for Plague, to be responsible for (a) the classification of Yersiniac (previously known as Pastemlla), (b) the production and distribution of diagnostic biologicals (antigens and antisera) among the Countries of the Region and (c) the training of personnel in laboratory techniques.

1.3.4 TVphus and other Rickettsia1 Diseases

No outbreaks were reported during the year, but spox-dic cases occurred in hghanistan and Ceylon. In Afghanistan, a surveillance programme for louse- borne typhus was started, with the aim of improving the diagnosis, reporting and control of the disease.

Laboratory investigations carried out in India have shown the ~jresence of murine typhus (91%-of the reported cases occurring from July to December), scrub typhus and tick-borne typhus in one State (Haryana) and Q fevei. h the central regions of the country (Madhya Pradesb). It ha; been observed that cases of typhus are frequently confused with those of typhojd fever, owing to lack of laboratory faciliUes for differentiation between the trvo diseases. Special attention to this aspect is rlceded, particularly in relation to the hternational Sanitary Regulations, so that typhus (the rickettsioses) w i l l be better reported in national surveFUance programmes. . .

SEA/RCZ2/2 Page 15

1.4 Other Endemo-epidemic Diseases

1.4.1 Bacterial Diseases

Coverage of leprosy by control activities in the Region varied from one country to another,

In Afghanistan, the existence of a leprosy problem in parts of Bamiyan Province was confirmed, and recommendations were made for control activities to be started by the regular rural health services. It was decided that in only one district would specially trained paramedical workers be required to supplement the regular health services.

In Burma, the high degree of coverage in hyperendemic areas through clinical Bxamination was further strengthened by the introduction of k c t e r i o b g i ~ a l diagnosis for detecting infectious cases. Attention was given to the dlfficult but important aspect of release from control of patients who had completed their course of treatment.

At the request of the Government of Ceylon, a WHO consultant was assig&d to follow up an earlier assessment of the extent of the leprosy problem in the country and his preliminary findings confirmed that, at least in some parts of Ceylon, leprosy was a greater problem than had been estimated. The consultant also assisted by giving some training to medical and paramedical staff as an initial step towards the intensification of control services.

In India, coverage did not attain more than 25% of the estimated total patient load. During the period under review, the Government authorized a centrally-sponsored scheme to orginize leprosy control, in addition to other disease-control programmes; consequently, further expansion of leprosy control activities is expected, particularly in. hyperendemic areas.

The Aska/Pogiri project in Orissa and Andhra Pradesh, assisted by WHO and the Danish "Save the Children Fund', in co-operation with UNICEF, has developed into a very successful control programme. After six years of work in Pogiri, cases released from control after completion of treatment now outnumber the new cases detected, with a consequent reduction of the total case load. The classification of cases in this project is now being carried out in accordance with the overall WHO policies, Negotiations a re under way with the Government of India for expanding the project into a regional training and demonstration centre.

leprosy control activities in Indonesia were reviewed by a WHO consultant, who found that supervision at the various levels required strengthening in order to ensure adequate case-finding and regularity of treatment.

The leprosy control project in Thailand continued to be successful in reducing the actual patient-load considerably. An independent assessment of the programme, in order to appraise the achievements in the reduction of endemicity, is under consideration.

SEA/RC22/2 Page 16

Assessment of leprosy control programmes is an urgent need, particularly in the countries of the Region where they have been operating for the last ten years or so. With WHO assistance, the hdian Council of Medical Research convened a meeting to review this subject and to formulate parameters for assessment. In addition to WHO medical officers assigned to the leprosy control programme in India, WHO 1eproloe;ists from other countries of the Region attended the meeting, which thus afforded the additional opportunity to make a joint review of the leprosy control programme throughout the Region, individual country projects and the feasibility of integating'leprosy control into the basic health services in originally hypo-endemic areas.

In March this year, a WHO-sponsored inter-country "Seminar on Leprosy Control" was held in Kathmandu. At this seminar, in which there were 16 participants, the various epidemiological and o r ~ a t i o n a l aspects of the subject were reviewed (for details, see SEAR0 0138 in Part Dl). Preparatims were started for another seminar in the Region, to be held early in 1970, to focus attention on the assessment and integraticn of leprosy control activities.

Leprosy research in M i a , on the organism in tissue culture a s well a s the role of chemoprophylaxis, ccntinued to receive WHO assistance. Following the WHO-sponsored inter-country workshops on immunology held in New Delhi in October-November 1968, a seminar for leprologista and immunologists was organized to review the immunoloay of leprosy, Ieprosy is a subject cd great interest for research in immunology, and work has started on measurlng the thymus+pendent immune respmse in leprosy patients.

The WHO Headquarters-assisted research project cn the preventive value of BCG in leprosy, which is being carried out in close co-operation with the Gwernment of Burma, continued as a long-term study in the Mandalay area.

(2) Venereal Diseases

During the year, attention was given to the strengthening cd? the laboratory facilities available for venereal-disease control. A consultant reviewed these aspects of the work of the anti-venereal-disease campaign in Ceylon, as well as those of the national venereal-disease reference laboratories in Madras and Bangkok, particularly with respect to fluorescent antibody techniques.

WHO arranged for FTA antigen to be supplied to the national venereal- disease' reference laboratory in Indonesia. Several national reference laboratories availed themselves of the prdiciency-testing procedures available with the WHO International Venereal-Disease Reference Laboratory in Atlanta OIW.

In view of reports af a persistently high level of hfection of syphilis and gonorrhoea in some countries of the Regicn, partioularly in urban areas, governments are being urged to malre a ocnoerted effort to review the health educational aspects of this complex problem a s they specifically relate to each country.

SEA/RC22/2 Page 17

The report of the WIiO consultant who had assessed the final stage6 of the yaws control programme in Indonesia in mid-1968 was reviewed with the authorities. In view of the successful outcome of the campaign, greater utilization of the yaws workers on a multi-purpose basis a t the peripheral level of the health services will now be possible.

(4) Diarrhoea1 and Enteric Diseases

As a follow-up of a resolution of the Regional Committee (SEA/RCZI/R4), the Regional Office initiated a study of the requirements for the development of rehydratian centres in the maternal and child health services. For this purpose, the WHO consultant assigned under the inter-country nutrition rehabilitation project, who started his work in July, was also undertaking a study of the existing facilities for the care of dehydrated children in Afghanistan, Burma, Ceylon, Indonesia, Nepal and Thailand, with a view to establishing in one or more of these country's number of nutrition rehabilitation and rehydration centres (see section 6.6, Nutrition),

The Regional Enteric Infections Team (formerly hown as the Cholera Control Team), in the course of its assistance to governments, has not limited its activities to cholera but has also reviewed the clinical and laboratory differentiation to be made in a study of cases of vibrio-negative acute gastro- enteritis. During the year it assisted the Governtpent of Maldives in controlling a major outbreak of diarrhoea1 disease (4% case-fatality rate in children).

The controlled field trial with oral typhoid vaccine, conducted by the Indian Council of Medical Research and the National Institute of Communicable mseases, Delhi, with assistance from WHO, is continufng.

(5) Diphtheria, Pertussis and Tetanus

In Mongolia, the initial phase of the mass diphtheria-pertussis-ktmw immunization programme was completed, and coverage of the susceptible young children on a permanent basis through the maternal and child health services, ,particularly in areas with a large population concentration, was initiated.

In Burma, the syst'emaUc immunization programme Bgainst diphtheria, pertussis and tetanus continued. This programme is being carried out in Rangoon.

Assistance from WHO and UNICEF in the production of DPT vaccine in various countries af the Region is reviewed in Chapter 4. It is repettable that, mostly because of administrative difficulties, the locally-produced vaccine, which has successfully passed WHO standard requirements, is not yet being fully utilized by the health services of some countries in the Region.

SOA/RC22/2 Page 18

1.4.2 Virus Diseases

(1) Trachoma

During the year, trachoma control activities in Burma, India and Thailand were reviewed by a WHO consultant. In Burma and Thailand, the operations were found to have been considerably expazided in the Weas where trachoma represents a major public health problem (i. e. in the central provinces in Burma and the north-eastern provinces of Thailand). In India, the treatment of trachoma is being undertaken a s part of the basic health services.

Trachoma control activities were also carried out in Afghanistan through the public health services in those provinces in which the disease is endemic, with assistance from UNICEF in the supply of drugs. The same integrated approach a s in Ihdia has been adopted by the public health services.

Experience gained during recent years shows that, in addition to the efforts of the health services, the co-operation of the people in self-treatment is a factor of utmost importance. Greater attehtian needs to be paid to health education, a s well a s to making antibiotic eye ointment easily and readily available in areas where the disease is endemic.

No sharp increase in cases of paralytic poliomyelitis was reported from the countries of the Region. Poliomyelitis, however, continues to be a public health problem in Ceylon and in the Bangkok and Thonburi areas af Thailand. In Ccylon, immunization activities were pursued, particularly in the areas showing high incidence.

In Thailand, the Government organized a mass immunization programme to protect children up to four years of age with three doses cif oral polio vaccine. The campaign started in Bangkok in January 1969, and there are plans to extend it to Thonburi a s from December 1969. As a follow-up, steps have been taken to ensure that newborns will k immunized by thc general health services in the years following the campaign.

The results of this programme a s regards incidence will be evaluated, and those with respect to sero-conversion will also be used a s a direct assessment, to be carried out coacqrently and at the end of the campaign, to ascertiin the degree of success. qqse latter studies are hos t important, a s prcvious trials in tropical areas have shown that sero-conversion against type 1 poliovirus was relatively low (ahout 63%) a s compared to that against types 2 and 3 (about 95%). This finding calls for strict attention in future immunization programmes against poliomyelitis, if and when started in other areas. A careful watch is being kept on any change in poliomyelitis incidence.

With WHO assistance, a multi-subject sero1og;ical survey was started in Burma, covering a sample of the population in Rangoon in order to establish base-be antibody profiles againat various diseases (including poliomyelitis ). Thc further extension of this survey, simultaneously with the development of epidemiological services a t thc divisicnal levels, has been planned. The report on a similar survey completed in Afghanistan last year was under review.

SEA/RC22/2 Page 19

(3) Haemorrhagic Fever and Other Arbovirus Diseases

In November 1968, the Chief of the Epideiniological Surveillance Unit from WHO Headquarters, accompanied by a WHO Headquarters consultant and one of the Regional Advisers in Communicable Diseases from the Regional Office, visited Burma, Ceylon, India and Thailand to review dengue/haemorrhagic fever surveillance activities and to advise on the further strengthening of surveillance programmes. §teady progress was noted in these activities, in which the principal hospitals, health services and laboratories were co-operating.

The guidelines contained in the technical circulars issued by WHO on clinical and serological definitions of the syndrome and the introduction of standard reporting forms should result in further collaborative investigations on a regional basis. These studies should cover the distribution and spread of denguelhaemorrhagic fever in those countries of the Region where AEdes a e m t i breed, where Group B arboviruses a re known to be prevalent and where dengue/ haemorrhagic fever is suspected.

The development of dengue/haemorrhagic fever surveillance programmes continued to make progress in Burma, Ceylon, India, Indonesia and Thailand.

The total of 6 03-6 cases of hemorrhagic fever reported in Thailand for 1968 was ahnost a three-fold increase over the previous year's incidence (2 0601. However, this increase was acconpanied by a lower case-fatality rate (66 deaths as compared with 59 in 1967). Haemorrhagic fever has so far been showing an upward trend with two-year periodicity; if this cycle continues, another remission should occur in Thailand during 1969.

In Bunna, where, during the period under review, surveillanb has been carried out in co-operation with the Central Epidemiological Unit and the Children's Hospital, a sample of sera was collected and examined at the Virus Research Centre, Poona (India), where it was found that dengue viruses had been circulating among the population. Paired sera for diagnostic purposes were also sent to the Virus Research Institute, Bangkok. Steps a re being taken to develop diagnostic facilities in Rangoon.

In Ceylon, co-operation among the Epidemiological Department in the Directorate of Health Services, hospitals and the newly established virological laboratory is progressively promoting dengue/haemorrhagic fever surveillance.

A start wols made in connection with a dengue/haemorrhagic fever surveillance programme, including an AE&s aerwt i survey, to be carried out in Indonesia by the Directorate General of Communicable Diseases, in collabora- tion with the Department of Microbiolbgy, Eriangga Medical School, Surabaya, and the Bio Farma Institute, Bandung.

In India, the Virus Research Centre, Poona, the medical colleges in Madras and Vellore, the National Institute of Communicable Diseases in Delhi and the Virology Department of the School of Tropical Medicine in Calcutta have

SEA/RC22/2 Page 20

been conducting collaborative investigations on the dengue/haemorrhagic fever complex. The Indian Council of Medical Research is planning a collaborative programme with these institutions, to co-ordinate the activities under one haemorrhagic fever surveillance programme for the whole country.

(4) Viral Hevatitis

This disease continues to be reported as endemic in the majority of the countries of the Region, where it occurs either in small outbreaks or sporadically. In the absence of a specific diagnostic test and with the rather elaborate liver- functioning tests required to confirm the diagnosis, it is likely that many cases go unreported, except when they occur in epidemic proportions or in overt clinical form.

In Mongolia, where the reporting is well organized, the disease poses a major health problem, for the control of which no solution is yet available, apart from adequate treatment to reduce complications and sequelae.

The National Institute of Communidable Diseases in Delhi continues to study the prevalence of viral hepatitis as reported by forty teaching hospitals from all over India. The Institute also carries out epidemiological investigations of epidemics.

1.4.3 Parasitic Diseases

(1) Filariasis

In Ceylon, surveys were continued to determine the extent of filariasis outside the known endemic belt in the south-western part of the island. A pilot trial was also conducted, combining mass treatment with vector control, and resulted, as expected, in considerably reducing the number of infective persons. Long-term follow-up will be needed in order to demonstrate the level of mosquito density which must be reached if transmission is to remain effectively interrupted after such reduction of infectivity in humans with Bancroftian filariasis.

In Rangoon, the WHO Headquarters-assisted research unit for the control of mosquito vectors of filariasis continued its evaluation of fenthion and other insecticides as larvicides against Culex w. fatieana It also started an epidemiological evaluation of the low-cost larval control measures which have been applied in restricted areas of Rangoon for the last few years.

WI-IO Headquarters is negotiating a large-scale research project in India on the feasibility of controlling Culex fatims and N e s aeevwti on an operational scale by genetic manipulation. The agreement for this project, between the Government of India, the United States Public Health Service and WHO, has been signed, and implementation is planned to be guided through the application of the Programme Evaluation and Retrieval Technique (PERT).

SEA/RC22/2 Page 21

In Afghanistan, the Public Health Institute delineated further foci of cutaneous leishmaniasis in Kabul, in which nearly 900 cases were detected. DDT spraying, a s an anti-Phlebotomus measure, and an epidemiological surveillance programme a r e under way.

1.4.4 Veterinarv Public Health

The South-East Asia Region probably has the highest ratio of domestic cattle to human population of any area in the world. Zoonotic diseases a re thus undoubtedly of the utmost importance; yet few studies have been made in the Region on the inter-relationship of diseases in man and in animals. The establishment of veterinary public health units in the public health services would appear to be of prime importance in those countries where such a unit does not exist.

In the period under review, a WHO consultant visited several veterinary institutions and schools of public health in India to explore the possibilities of developing post-graduate training in veterinary public health. His recommenda- tions were followed up with a view to negotiating a possible agreement among Calcutta University, the All-India Institute of Hygiene and Public Iiealth in Calcutta and the Indian Veterinary Research Institute, Izatnagar, for a two-year post-graduate course, to be given jointly. Such an arrangement, if it materializes, should also influence the -king of veterinary public health subjects as part of the curriculum of the Diploma Course in Public Iiealth at the All-India Institute.

There is also a great need to provide training for health and veterinary officials involved in food hygiene, particularly meat and milk hygiene a s well a s aspects related to the contamination of food by insecticides and pesticides.

0 Brucellosis

In Mongolia, another trial of Brucella Rev. 1 vaccine in cattle was carried out, and the results a re being compiled. A small study was made in an attempt to elucidate the possible role of kumiss (fermented mare's milk) in the trans- mission of Brucella organisms, and it w a s established that these organisms do not survive long enough for kumiss to be considered a s a source of transmission of the infection.

Preliminary agreement was reached on the need to produce Brucella vacoine locally in Mongolia and on the requisite facilities for such production.

(2) Rabies

Rabies remains a zoonosis of major public health importance in the Region The number of cases of dog-bite requiring propbylactic treatment among the human population continues to be considerable, a s can be clearly seen from the

SEA/RC22/2 Page 22

reports of the Governments of Burma, Ceylon, India, Indonesia and Thailand, who participated in the ninth world r.abies survey. Ceylon alone reported 270 human deaths from rabies in 1967, but the highest risk is still in Inaia.

An analysis of data pertaining to p r s o n s treaded by the Pasteur Institute, Coonoor (India), and its field centres* showed that during the pericd 1946-1967, no fewer than 17 848 persons bitten by proven or presumably infective animals were immunized. In a group of 800 persons who were bitten by proven infective animals and who received a complete course of immunization, only 59 (7.38%) developed rabies, while another equally exposed group which had not received any treatment had a case fatality rate of 55.9%. The same analysis shaved that out of 7 474 animals involved in rabies transmission, 84.43% were dogs, 12.74% jackals, 0.91% foxes and 1.92% other animals.

Burma, Ceylon, Indonesia and Thailand also reported that rabid dogs played the major role in transmission, that of other animals being negligible.

These findings indicate onre again the importance of the vaccination 'of domestic dops and elimination of strays. There is no doubt that an effective rabies control proearnme, wherever feasible, will eventually cost only a fraction of the present recurrent expenditure on vaccine production, immunization, treatment and hospitalization, apart from bringing about a considerable reduction in loss of life.

Anti-rabies vaccine, mostly of the Semple type, is being produced in, considerable quantity in Burma, Ceylon, India, Indonesia ahd Thailand. India and Indonesia also produce anti-rabies serum.

WHO has assisted Ceylon in increasing and improving the production of rabies vaccine and h the introduction of fluorescent antibody techniques for the diagnosis of rabies. An important event during the year was the WHO-assisted inter-country seminar on tnese technlqucs which was orgamzed in Coonoor (India). (For details, see Chapter 3).

Currently one of the fastest dovelo& brtanchees of the biological s c i w k s , immunology covers a wide range, from toleranue for transplants to measurement of infection. The Regional Office has been active in stimulating the training of immunologists and also the application of up-to-date immunol@&al techniques to the control of communicable diseases.

In this respect, the main feature of the year was the holding of two workshops on the "Cellular and Molecular Basis of the Immune Response", organized in October/November 1968, in close co-operation with the ~ e ~ a r t m e n t of Biochemistry of the All-India Institute of Medical Sciences, New Delhi. In

*Annual Beport of the Director, 1967, and Scientific Report, 1968, Pasteur Institute of Southern India, Coonoor.

SEA/RC22/2 Page 23

these workshops, each of which lasted three weeks, emphasis was placed on practical laboratory training, The tcxhing was on a vcry high level, and the response enthusiastic. As a result,iri the fow countries which sent participants, there has already been some initiative in s tar tkg immunological studies on lepromatous leprosy an ' cholera (for det.Gls, ice. SEAR0 0166 in Part Ill).

The two workshops have undotb&dly prrmotsd not only interest in research but closer collaboration with the variow jnst'tntions in the Region in immunology in general.

WHO has awarded a number of fe!!owships for courses to be held in Singapore (1969), I a u s a ~ ~ n e (Switzerhd) (1969) end Israel (197:).

2. EPIDEMIOLOGY

In order to meet the needs d the countries of the Region, training in epidemiology continued to be emphasized in WHO'S regional programme of assistance.

The annual combined hague/Delhi training course sponsored by WHO ended in March a t the National Institute 'of Communicable Disease, Delhi. The participants included four from the Region (one each from Afghanistan and Indonesia and two from India).

The fourth three-month national training course in epidemiology to be given a t the National Institute 6f Communicable Diseases, Dclhi. started in November 1968 and was completed in February I::>. Bcsidcs pxrticipants fro;n India, two WHO fellows (one each from Afghanistan and Nepal) attended the course, which was assisted by a WHO consultant.

WHO also helped to organize several shorter training courses and seminars in the epidemiology and control of specific communicable diseases. These were held in several different countries. Tie subjects dealt with were: cholera (in Afghanistan, Burma, India and Indonesia), p l a ~ e (Burma) and leprosy (Nepal). In Mongolia, a training course in epidemiolo@cal methods was held for health officers, with the assistance of WHO s A d assigxd to projects in the country.

Considerable efforts have been devoc& to the organization of a "Seminar on the Role of Epidemiolom in Community hledicine", w%.ch is to be heldlater in 1969 for faculty members of md ica l colleges in India. Preparations are also under way for assistance to Indonesia in a ' J:-zr,;lxr or, Statistfcs and Epiderniokw'', to be offered to senior provi?cial officers responsible for epidemiological and communicable-disease control services, also toward the end of 1969.

In Afghanistan, the Public h'ealth Institute in Kabul has, with WHO assistance, focussed its attention on the epidemiological aspects of diseases such as diphtheria, cholera, enteric in fec5as and cutaneous leishmaniasis, as well a s on setting up an epidemiolodcal surveUance programme for the major communicable diseases.

A WHO consultant was assigned to Bunna to help with the further development of epidemiological servlcea, The central epidemiological unit is being reinforced, and disease control units are e;raduaUy being upgraded into divisional epidemiological unite. At the eame time, with assistance from a WHO microbiologist, the laboratory services necessary to support the epidemiological surveillance programme are being strengthened.

The Epidemiological Unit established in Ceylon with WHO assistance continued its constructive work on the appraisal of health problems posed by communicable diseases. This unit is also regularly issuing a most useful epidemiological bulletin.

In India, the development of epidemiological services was considerably enhanced by the provision of gastro-enteritis cells at the State level - in the first instance, in cholera-endemic States. Though the primary purpose of these units is the control of cholera, they should, in due course, in the intervals between the epidemic pericds of cholera, make an important contribution to the assessment of the importance of other communicable diseases.

Assistance to the epidemiological services in Indonesia was resumed in 1969, at the request of the Government. A statistician was assigned in May 1969, and an epidemiologist was under recruitment.

In Mongolia, the strengthening of epidemiological services continued, with further epidemiological surveys on brucellosis, diphtheria and pertussis, and with greater emphasis on trainine; activities. WHO fellowships in epidemiology are helping to increase competence in this field.

A WHO consultant visited Nepal In March 1969 to advise on the objectives and the plan of work of the epldemiolo@cal unit within the Directorate of Health Services.

In Thailand, where the nucleus of an epidemiological unit has been functioning for some time within the Division of Communicable Diseases, plans are being made to establish a central unit in the Directorate General of Health, with the long-term objective of providing epidemiolodcal expertise to the intermediate level of the health services.

All the above-mentioned activities tee* to the increasing interest of governments in expanding their epidemiological services and in undertaking e idemiological surveillance in close co-operation with Laboratory and stati- fi s cal services.

In accordance with a reresolution adopted by the Regimal Committee at its last session (SEA/RC21/R3), the Regicaal Office prepared a worldng paper on "The Role of Epidemioloflcal Units in the Health Services", which was being distributed to Member Governments in the Region, and plans were made to issue a further technical document on this s~bject~incorporating the comments received. A set of documents issued by WHO in respect of epidemiological surveillance of various cornmudcable dLseases was also distributed.

SEA/12C22/2 Page 25

3. KEALTK L;ABORATGRY SERVICES

Despite the emghasis on the csntrol of communicable diseases, the framcwork of the laboratory scrviccs continues, in general, to be iveak. There a rc many causes: (a) those intrinsic to the laboratories, namely, inadequacies of builchgs and of human and material resources, and @) insufficient utilization of laboratory facilities by the health services. It i s also true that, because of the inability of laboratory services to keep pace with the rapidly evolving laboratory technolow, they have been unable to diversify their procedures to satisfy the growing needs of the health services for more exact laboratory data (on, for example, epidemiology and dis6ase intelligence).

To assist in the planning of national laboratory services, WHO, in 1968, assigned a consultant to visit Burma, Indonesia and Thailand, and WHO sta€f membera are working in Afzhanistan, Mmgolia and Nepal. Lang-term plans of action involving the participation of WHO and UNICEF have been drawn up in rcspect of Afgbantstan and Monesia.

As a follow-up of the teclinicitl discussions on the development of national health laboratory services, held during the nineteenth session of the Regional Committee, a regional survey i s being undertaken with WHO assistance, The in- fennation thus collected will be used in the preparation cf a conference of Laboratory administrators; to be held in the Region in 1970.

In most of the countries, increasiw attention is being focussed on the training of laboratory technicians. The approach is three-fold: (a) formal courses &ed a t developins skills in basic medical laboratory sciences; @) "in-sel-vice"

t~ promote technical knowledge of a range of specific duties,, and (c) seminars or t s a b b g c w e e s to impart special skills in particular methods. With the assistance of WHO, eovernrnents have started to take steps to improve formal instruction in medical laboratory technolow, to update trainbe procedures and teaching aids, tu provide more practical training and to revise the syllabi in use. -WHO has assigned technical instructors for the organization and adrninistratim of such courses.

To enable the countries of the Region to keep abreast of the advances in medical laboratory sciences, WHO is conductig a series of inter-country courses on health laboratory techniques with the aim of giving training in modern laboratory technolow to technical officers attached to public health laboratories. The first in this series, a seminar on llImmuno-fluorescent Microscopy in Rabies Diaenosis", was held in Coonoor (India) in April for participants from seven countries. In this seminar, intensive training was given in the laboratory management of rabies with particular reference to immuno-fluorescent microscopy (for details, see SEAR0 0176 in Par t 113.

Highlights in the development of national health laboratory services in the various countries werc as follows :

In Afghanistan, the first group of laboratory assistants completed their course in April. A laboratory to accommodate 20 trainees has been commissioned for the practical classes. The Government has assieped priority to the establishment of health services in areas scheduled to enter the consolidation phase

SEA/RC22/2 Page 26

of the maIaria eradication propamme, The targets for 1969 are : (a) setting up seven new peripheral laboratories, aad @) upgrading four provincial laboratories. Provision hae also been made for two training courses fo- provincial laboratory technloiane,

In Burma, the National Health IaboPatory is being re-organized wlth assistance fkom WHO.

WHO'S direct support of health laboratories in Ceylon, which had been given for several years, was terminated early in 1969. During the period of the project, bacteriological laboratories were established in a number of district hospitals, and the laboratories of the Institute of Hygiene at Kalutara were o r w e d . Epidemiological services were strengthelaed by the establishment of facilities for the aero-diagnosis d the arbovtruses, and improvements were made in the praluctim of rabies vaccine and in rabies diagnosis by the fluorescent antibody technique.

Jn India, the firstDegree Course (B.Sc. Tech.) in Medical Jaboratory ?lechnology, conducted at the Institute af Post-graduat~ Medical Education and Research, Chandiearh, was due to be completed in August 1969. In Trivandrum, the Certificate Course for LaboratoryTecMcians progressed satisfsetorily, and a proposal for a three-year course leading to a B.So. Teoh. degree was submitted to the University Board for approval. Eight district laboratories received assistance from UNICEF.

In Indonesia, in accordance with the fkre-year plan of action, ten prwincial and thirty peripheral laboratories will be established in 1969. Plans arc under way for setting up a medical research institute ancl a central public health laboratory, WHO to prcrvide technical assistance in microbiology and UNICEF to procure supplies and equipment.

The Central Bacterio1og;ical laboratory in Ulan Bator, with its f ~ur newly established departments, caters to the needs of different medical institutions in Mongolia. A chief specialist, assisted by a laboratory advisory committee, administers the laboratory services; WHO is assisting the Government wlth the organization of this laboratory.

In Nepal, with the establishment of an epidemiological unit within the Central Public Health Laboratory, closer association with the department of Communicable Diseases has developed. A formal courae for the training of laboratory technicians has been started with WHO assistance, and supplies, equipment and stipends are to be provided by UNIGEF. ' '

The integration of venereal-disease laboratories into the general health services continues in Thailand; by December 1968, 21 of them had been converted into health laboratories. The MiniaWy of Public Health appointed a health laboratory committee consisting of repreeentatives ofthe Ministry's three Departments to advise the Department of Medical Sciences on problems of integration and management. Plans for the organization and integatioq of a health laboratory scheme were under disca~siop~but no definite decision had bean reached. WHO has assisted the Department of Medical Sciences in strengthening the course for laboratory technicians.

SEA/RC22/2 Page 27

4. VACCINE PRODUCTION

Freeze-dried Smallpox Vaccine

Perceptible progress was made in the local production of vaccine. With a view to improving quality, WHO has encouraged the producing countries to have their vaccine tested by a WHO reference laboratory, and also had distributed a WHO Headquarters document on the subject (SEl68.3) to producing and testing laboratories in the Region.

Direct assistance for stepping up production also continued to be given During the year, a WHO consultant reviewed the situation in Burma, Thailand and Indonesia. Equipment and spare parts have been procured by UNICEF and, in some cases, by WHO. The vaccine is being tested by the manufacturers in Burma, India, Indonesia and Thailand.

Burma produced 1000 000doses of smallpox vaccine in 1968-69; the remodelling of the premises and the construction of a cold room provide scope for further stepping up production In Indonesia, with six sets of centrifuge driers, production in1968 was '7.5 million doses; the aim is to reach the potential capacity of 15 million. Following the remodelling of the premises, the quality of the vaccine has improved. In Thailand, with two sets of driers in operation, production in 1968 was 3 000 000 doses against an installed capacity of 6 000 000 In India, where eight shelf-driers are in operation, production in 1968 was reported to be 50 000 000 doses a s compared with 30 000 000 in 1967 and a n installed capacity estimated a t 60 000 000 doses; the procurement of equipment for the expansion of production capacity to 180 000 000 doses, necessary for the national smallpox eradication programme, is under negotiation with the Government.

Livz Poliomvelitis Vaccine

It is the policy of the Government of India to maintain the production capacity in Coonoor at 500 litres per year. A new neurovirulence testing unit is. under construction at the National Institute of Communicable Diseases, Delhi, and is expected to be in operation in 1970. WHO provided two consultants who assisted in organizing the laboratories and in the formulation of a protocol for testing procedures.

The combined diphtheria/pertussis/tetanus (DPT) vaccine is now being produced by India, Indonesia and Thailand, The D and T components a re also produced by Burma, where the P component is also in the process of being developed, with equipment supplied by UNICEF; it is proposed to assign a WHO consultant to assist in this regard. In India, the target figure of 2 000 000 doses of the triple vaccine was reached in 1967168; however, during 1968, production has outstripped the supply of the vaccine to the health services, resulting in a stock of unutilized vaccine amounting to 2,7 million doses. In Indonesia, 500 litres of D, T, DT and DPT vaccines a re turned out annually. With the reported

SEA/RC22/2 Page 28

commissioning of a continuous culture plant (a "Bilthoven Unit"), the production capacity is likely to be increased further. In Thailand, production is still on an experimental scale. Although a unit for continuous culture is available, it has not been in operation. The production programme is being assisted by WHO and UNICEF.

Brucella Vaccine

The production of Brucella vaccine in Mongolia, with possible assistance from the UNDP(SF), is under discussion. Two WHO consultants are being rccruited to carry out studies relevant to planning and costing, a s well a s to assist in the preparation of a government request to UNDP. The target capacity is estimated at 3.5 million doses of freeze-dried Brucella melitensis, Rev.1 vaccine.

Typhoid Vaccine

Plans were under way to provide further assistance to countries of the Region in regard to the production of this vaccine, particularly thc acetone-dried type.

5. HEALTE STATISTICS

During the year WHO has continued to support countries of the Region in their efforts to develop routine systems for the collection and analysis of statistical data concerning their health situation and the services provided to deal with it. Attention has largely been concentrated on three fields: (a) medical certification of cause of death, (b) hospital service and morbidity statistics, and (c) systems of recording and reporting used by rural health centres, Activities relating to specialized reporting and surveys, particularly in control programmes for &rculosis and leprosy, have also continued. The growing interest in health planning in the Region has been reflected in WHO'S statistical assistance to an operational study of local health services in East Java, and in preparations for a health manpower study in Thailand.

Following a resolution of the Nineteenth World Health Asscmbly (WHA19.44), the Eighth Revision of the International Classification of Diseases (ICD/8) came into effect on 1 January 1968, and its practical introduction into use during the year under review was of major interest to health statistics units in the Region. To assist countries in changing over to the new classification, an inter-regional "Course for Coding Instructorsw was held in the Regional Office in November 1968 for participants from three Regions - from eight countries in South-East Asia, four in the Eastern Mediterranean and three from the Western Pacific (see SEAR0 0167 in Part ID). Courses in medical coding according to ICD/8 will be given at the Model Vital and Health Statistics Unit, Nagpur (India) from 1969. Afghanistan, Ceylon, Mongolia and Nepal a re known to have started using the Eighth Revision for coding hospital discharges, and the Registrar-General's Office in Ceylon has made preparations for coding death reports originating from 1968 in this way. The State of Rajasthan in India is now also coding cause of death statements from hospitals according to ICD/8.

Countries in the Region have continued to supply statistical information to WHO, particularly in the form of data required for the "World Health Statistics Annual'! and the "Fourth Report on the World Health Situation, 1965-1968".

Asian statisticians, including representatives from six countries in the Region, met at an ECAFE-sponsored Seminar on Civil Registration and Vital Statistics, held in Copenhagen in August 1968. This seminar endorsed the principle that properly completed medical certificates of cause of death should be obtained and processed for all deaths attended by physicians. WHO was asked to give attention to difficulties arising in the practical application, in developing countries, of existing definitions relating to '!live birth'! and "maternal death", and it was suggested that the Organization prepare a manual for use in ascertaining and classifying causes of death reported by laymen and paramedical personnel. These recommendations were endorsed by the Ninth Conference of Asian Statisticians, held in Bangkok in June 1969, a t which the WHO Regional Office was represented by two staff members.

In India, the bill for birth and death registration, having been passed by both Houses of Parliam'ent, has now become a law, and the Registrar- General of India has issued the report on the experience and results of the sample registration scheme in rural areas, mentioned in earlier reports.

Efforts to improve cause-of-death statistics continued, particularly in India, where Delhi, Punjab, Rajasthan and West Bengal tabulated annual cause- of-death statistics from hospitals according to WHO recommendations. Andhra m d e s h , Kerala, Maharashtra, Mysore and Tamil Nadu have undertaken and expanded similar programmes.

With WHO assistance, procedures for collecting and processing morbidity and administrative hospital statistics in Indonesia, Mongolia and Thailand were reviewed and improved. The scheme started earlier in Nepal has now been extended to 30 hospitals, Afghanistan and Burma continued to release hospital service statistics. Medical record offices in hospitals in Ceylon, Indonesia and Nepal were strengthened and developed. In Ceylon, a pilot scheme for morbidity statistics based on discharge reports operated successfully in one hospital during 1968 and, in 1969, was being extended to others.

Following on the WHO-sponsored Seminar on Health Centre Records and Reports, held in October 1967, the Government of India organised a national seminar in March 1969 aimed at adapting some of the proposals made at the WHO seminar to coaditins in India. WHO aasistanoe to Afghanistan, Indonesia,

SEA/RC22/2 Page 30

Nepal and Thailand in developing records and reports in health centres has shown satisfactory progress.

To Thailand, WHO provided a senior consultant to review progress in the whole field of vital and health statistics; his recommendations for immediate and long-term development were transmitted to the Government (see also Thailand 0037 iq Part m).

Training courses in vital and health statistics for statistical personnel at intermediate level, as well as orientation courses for health officers, were continued in the Model Vital and HeaIth Statistics Unit, Nagpur, with assistance from WHO. The second diploma course in health statistics conducted by the ~ll-Jndia Institute of Hygiene and Public I-iealth, Calcutta, was concluded in May 1969. The Government of India also continued to support the training of medical record officers in the Christian Ivledical College, Vellore. Other courses for medical record personnel, assisted in varying degrees by WHO, were held in Burma; Ceylon and Nepal.

Vi ta l and health'statistics were published by Afghaaistan, Burma, Ceylon, India and Thailand either as part of their annual health repbrts o r ' separately. Such reports, as well as statistical reports on special s ~ b j e c t a : ~ ' were also issued by some Indian States (see Annex 4).

In '@ailad, results of a surveybf pbpulatioh change.(~964-1967) vieyLi4 released. They .showed a crude birthrate (1964-1965) of 41.8 (against 38.5 and 37.5 registered in 1964 and 1965) and a crude death rate of 10.9 (against 7.9 and 7.3 registered in 1964 and 1965).

Work was undcr way in connection with the 1970 edition of the "summary of Vi ta l and Health Statistics, South-East Asia Region", which is published by the Regional Office at four-yearly intervals. .

Most of the countries in the Region have made preparations for d e c w i a l population censuses, some of which have been planned to be combined with housing censuses. The governments ' plans include procurement of electronic computers or , in Ceylon, India and Thailand, strengthening the capacity of those already installed. Mongolia completed a population census in January 1969. A sampling cell was set up in the office of the Registrar-General of India to develop techniques for application of sampling in the collection and tamation of data in the 1971 census.

SEA/RC22/2 Page 31

6. PUBLIC HEALTH ADMINISTRATION

6.1 Planning and Strendhening of Health Services

National Health Planning

The countries of the Region have now more widely recognized the importance of health planning and the need to determine priorities on a rational basis, with emphasis on equitable allocation of available resources. The trends are: 0) to formulate a national health plan a s part of the overall development plan; (2) to establish health planning units under senior medical officers trained in health planning, supported by personnel with technical skills, such a s statisticians and economists; (3) to train the health personnel required to Inan the health services, and (4) to carry out operational studies not only to strengthen the existing health services but also to serve a s a feed-back to review approved health programmes a s a basis for making adjushents a s and when necessary.

During the year under review, steps were taken to implement some of the conclusions and recommendations arising out of the technical discussion$ on national health planning, which were held during the previous (twenty-first) session of the Regional Committee. Among the activities undertaken was the organization, in March 1969, of the discussion group meeting mentioned in the Introduction to this report, which brought together senior son-medical administrators from ministries of health and directors of health services from most of the countries of the Region. Apart from providing for a very useful exchange of views, this meeting congtituted a step towards introducing the new procedure being adopted by WHO Headquarters (to take effect from 1972) by which the WHO programme will, in the first instance, be elaborated at the country level. The participants were also informed of assistance in health planning that could be made available by WKO.

The first regional course in national heaIth planning to be organized by the Asian Institute for Economic Development and Planning, Bangkok, will start in November 1969, and in Bangkok a technical committee of representatives from the Asian Institute, the National Institute of Health Administration and Education, New Delhi, the United Nations Economic Commission for Latin America, the Pan American Health Organization and the WHO Regional Offices for the Western Pacific and for South-East Asia, met in February to draft a syllabus and determine the teaching staff required. The course is expected to last for fourteen weeks and to have fifteen participants (heads of health planning units) and the syllabus i s in three parts - the first dealing with the processes and principles of development planning a s practised in fields other than health, the second consisting of practical application of a pragmatic method for the

' preparation and implementation of a health plan, and the third outlining the field studies to be carried out.

At the Asian Institute itself, a four-week course in national health planning for medical officers a t the provincial and central levels of the health

' services was orgdnized by the Thai Ministry of Public Health and conducted in the month of May 1969, with the collaboratian of the WHO public health administrator working with the Institute.

SEA/RC22/2 Page 32

During the year, WHO assistance in formulating national health plans a s part of the overall development plans was given to two governments. Similar help to other countries was planned, but there was considerable difficulty in recruiting consultant8 of the right calibre.

In preparation for the technical discussions on the "Training of Paramedical Personnel in Health Centres", to be held in connection with the twenty-second session of the Regional Committee, two WHO consultants, a public health administrator and a public health nurse, visited several countries in the Region to make an on-the-spot study of training programmes.

In pursuance of a resolution of the World Health Assembly (WHA 21.20) and its endorsement by the Regional Committee (SEA/RC21/R5), a circular letter was sent out to requesting idormation on which to base an analysis of the problems faced in the training of national health personnel, and a consultant has been recruited to prepare a report on this subject for considera- tion by the Regional Committee. In addition, assistance was given to various countries in the promotion of in-service training programmes,with the main objective of ensuring the maximum utilization of the personnel available. The efforts of the national governments to strengthen the cadre of their professional personnel were also supported by WHO fellowships.

To a greater degree than in previous years, operational studies were carried out to strengthen the health services by indicating how better use could be made of the available resources and facilities. In Afghanistan, the practicability of using the existing basic health services in the smallpox eradication, malaria eradication and BCG vaccination programmes was studied. In Ceylon, a study was initiated to obtain information on two important aspects - first, the impact of past and present maternal and child health and family planning education, and second, the efficiency of the existing clinical and field services in maternal and child health and family planning. In India, a hospital utilization study was started on a pilot basis in six selected district hospitals, and another study for promoting the notification of communicable diseases by hospitals was also under way. In Indonesia, WHO assisted in preparing a design for the study of the components of the health services a t the intermediate and peripheral levels, and this plan is being followed up by the national health staff.

Organization of Health Services

Some of the important developments during the year were a s follows8

In Afghanistan, the upgrading of the Ghewaki Health Unit as a field practice area for the training of health personnel continued to make good progress. A three-year plan of action for the development of basic health services in three provinces was prepared, and, in order to facilitate its implementation, the budgetary provision for these services was increased from 3 . 5 to 9.5 million afghanis. In consideration of the nursing needs of the basic health services, emphasis was placed on the promotion of the training of auxiliary nurse-midwves. A division of environmental sanitation has been established in the Ministry of Public Health, and the programme for the provision of safe water supplies was continued. The draft master plan of operation for the strengthening of health sen ices in Afghanistan mentioned in the last Annual Report was under discussion with the Government.

SEA/RC22/2 Page 33

In Burma, a WHO consultant in public health administration assisted the Government in formulating a master plan of operation for the strengthening of health services, a s a first step in the preparation of a national health plan. The reorganized health services continued to give improved general health coverage to the rural population.

A WHO public health administrator who was assigned to Ceylon to assist with the training and services provided bythe health unit of the Institute of Hygiene in Kalutara formulated short and long-term plans for upgrading the Institute.

In India, the ten-day workshop on "State Level Planning and Evaluation of Healthand Ekmily which was held in November 1968 at the National Institute of Health Administration and Education, New Delhi, was successful in its objective of identifying the problems facing state planning and evaluation cells, in devising ways of solving these problems, and in suggesting a suitable basic composition for a state health planning and evaluation unit.

The master plan of operation for the strengthening of health services in Jadonesia was signed by the Government, UNICEF and WHO. Orientation training programmes for medical officers at the regency and sub-district levels and for health staff involved in the development of basic health services were carried out on a planned basis, with assistance from WHO and UNICEF.

In Maldives, the policy of reinforcing the assistance given by the regular WHO staff by the provision of short-term consultants was continued, and consultants assisted in the control of communicable diseases, in the organization of the radiography department of Male Hospital and in a review of the health activities, including the anti-malaria operations. Anti-malaria activities were extended to two more atolls. A new health centre was established, making a total of seven such centres, and a small laboratory for microscopic examination of sputum is now functioning on the premises of the tuberculosis clinic. In the health assistants1 course, eighteen trainees completed their training satisfactorily.

In Mongolia, further fellowships were awarded to health personnel to study the organization of public health services a s well a s hospital administration abroad.

A WHO consultant in public health administration assisted the Government of Nepal in the preparation of a five-year health plan, to serve a s a guide in the development of basic health services in some parts of the country, particularly those which wil l be the first to enter the maintenance phase of malaria eradication. For the first time, an orientation course for medical officers from zonal and district headquarters was conducted, with WHO and UNICEF assistance. The emphasis in the training programme at the School for Auxiliary Health Workers was on field activities and practical training.

In Thailand, a WHO-assisted Seminar on Hospital Administration was held in October-November 1968 and attended by 23 participants (all being medical directors and chiefs of nursing services of hospitals). A team, consisting of a public health administrator, a public health nurse and a sanitary engineer, was assigned,to st* the existing facilities in the urban areas of Bangkok and to advise on further

SEA/R@22/2 Page 34

developments. A WHO public administrator assisted the Ministry of Public Health by advising on the administrative aspects of the health services. Action was also initiated for the provision of two consultants ( a public health administrator and an economipt) to advise on the formulation of a realistic rural health policy and programme for the whole country.

In the fields of hospital administration and hospital design, WHO assistance to the National Institute of Health Administration and Education, New Delhi, by the provision of a hospital administrator,was resumed, and the WHO electro-medical engineer assigned to the All-India Institute of Medical Sciences, New Delhi, also advised various hospitals and other institutions not only on the repair and maintenance of essential equipment but on the design of central services such a s laundry, boiler house and maintenancc departments and sterile supplies. A consultant was provided to Thailaad, a s well, to assist the Government in the field of hospital design and planning.

6.2 Maternal and Child Health

Orpanhation of Services

Apart from some moderate decline in fertility rates in limited are@ of countries with national family planning programmes, the overall conditions in the Region remained adverse to early improvement of the health of mothers and children. This situation dictates a note of urgency in taking action on the recommendations emanating from the earlier technical discussions held during the twentieth (1967) session of the Regional Committee. Guided by these recommendations, WHO assistance was stren-dened, with particular attention to thc integration of maternal and child health services into the national health structure, the upgrading of existing administrative maternal and child health units a t national and state levels, encouragement of comprehensfve advisory and co-ordinating committees, the training of maternal and child health adminis- trators, and appropriate preparation of medical and paramedical personnel to mcet the priority health needs of mothers and children.

In Afghanistan, + major step in the improvement of administration and organization of these services was the designation of the national maternal and child health adviser a s "Director General of Maternal and Child Health and Family Guidance1'. A three-year plan for the development of the services was drafted and has been accepted by the Government. In view of the problems encountered in the expansiofl of materra1 and child health services in the provinces, a WHO consultant was assigned to studythc situation and to advise on measures for improvement.

A consultant was assigned to Ceylon for a period of three months to study the function of the Maternal and Child Health Bureau in the Directorate of Health Services and to advise on measures thought to be essential to the provision of comprehensive health care to mothers and children.

In Indonesia, special attention was given by the Government to the integration of the services into the general health services; this, combined with the high priority which has bccn placed on meeting specific health needs of mothers and children, has resulted in a request to WH3 for the provision of a consultant in this field.

SEA/RCZZ/Z Page 35

In Mongolia, the development of maternal and child. health services and the establishment of referral facilities made satisfactory progress. The Maternal and Child Health Department was strengthened by the assignment of an advisory group of paediatric and obstetric consultants. The district paediatric services in Ulan Bator were integrated into the general health services of the capital, and paediatric services were also initiated in several aimaks. A wide range of training and health education activities was undertaken.

In Nepal, the public health nursing aspect of the maternal and child health services was further strengthened. The avowed purpose of the Government to provide family planning services through maternal and child health centres gave impetus to an accelerated expansion of health service facilities.

Family Planning

In due consideration of demographic trends, an increasing number of Member countries approved family planning programmes a s an essential measure for controlling excessive population growth.

In Afghanistan, family guidance (family planning) activities were on the increase a s a result of the efforts of the Family Guidance Society and assistance being received from bilateral sources and voluntary agencies. Under the auspices of these agencies, several physicians and nurses were sent abroad for training. With the Government's approval, an increasing number of maternal and child health centres and hospitals in Kabul introduced advice on family planning a s a part of their services, and, a s mentioned above, within the governmental framework family planning was placed administratively in the ,Maternal and Child Health Bureau in the Ministry of Public Health.

In Ceylon, the national family planning programme entered its third year of implementation under the administrative direction of the Assistant Director, Maternal and Child Health and Family Planning. Although there w a s marked progress, the programme did not reach projected targets. The assessment of the functioning of the Maternal and Child Health Unit in the Health Directorate by a WHO consultant helped to focus attention on certain weaknesses in the family planning services, closely related to inadequacies in the facilities for the operation of the maternal and child health services.

In M i a , family planning has been assigned high priority in the Fourth Ftve-Year Plan, with a budget of Rs 2500 million. The objective has remained the same, i. e., to reduce the current annual birth rate from 41 to 23 per thousand a s early a s possible. Growing confidence in the programme was shown by the increasing acceptance of the measurcs introduced onthepart of the public.

At the request of the Government, a United Nations team visited India early in 1969 to review the country's family planning programme in relation to the overall development plan. The Regional Office extended full collaboration and such assistance a s was possible.

SEAfRC22/2 Page 36

Following discussions with the Government of India on WHO/UNICEF assistance in the improvement of urban family planning activities a s an integral part of maternal and child health services, a WHO consultant has started a study of the existing situation in order to advise on a phased programme of further international assistance in this field. The Workshop on State-Level Planning and Evaluation of Health and Family Planning, held in Delhi in November 1968, is mentioned in section 6.1.

In view of the considerable advances made by Indian medical colleges in the teaching of human reproduction and the valuable contribution which the Indian experience could make to the global study to be undertaken by WHO in late 1969, the Regional Office is planning to assign a consultant team of four medical educators to India to undertake a special study, from October 1969. Studies of a similar nature may be carried out in other Member countries with national family planning programmes. The Regional Office also collaborated with WHO Headquarters in the preparation of an inter-regional Paining Cour'se on the Methodology of CUnical T r i a b Involving Fertility-Regulating Agents, planned to be undertaken later in 1969 at the Central Family Planning Institute, New Delhi.

In Indonesia, family planning activities were also on the increase. An- quasi-governmental committee, which was established in early 1968, prepared a limited programme for Java, BaIi and Madura, to be integrated into the country's new five-year plan (1969-1973). A special directive on this subject was issued by the President of the Republic (see page 166). The encouragement of voluntary work given by the Government not only attracted the support of international and other agencies but also gave impetus to the activities of the Indonesian Planned Parenthood Association. In October 1968, the National Family Planning Training Institute,for medical, paramedical and allied workers,was established under the auspices of the Association, and a Regional Family Piaming Conference sponsored by the Association and the International Planned Parenthood Federation, among other agencies, was held in Bandung in June 1969, attracting wide national and international participation and serving to focus attention on the close relationship between population growth and national development.

The national hmily planning programme in Nepal was further strengthened by the establishment of a semi-autonomous National Family Planning and Maternal and Child Health Development Board in the Ministry of Health. The Government is also studying ways of building up the health infrastructure and heal.th manpower, with a view to ensuring a balanced development of these activities a s an integral part of maternal and child health services.

In Thailand, activities under the auspices of international and voluntary, a s well a s governmental, agencies continued. A wide range of training programmes for health and allied personnel was in progress, with emphasis on research in the health aspects of human reproduction. The assignment of a WHO consultant to make a study of these activities and advise on the need for WHO assistance for strengthening them was under consideration.

Measures taken for orienting WE10 staff so a s to be better able tn meet the increasing number of requests for assistance in this field are described in Part 11, section 2.4.

Research projects assisted by grants from WHO Headquarters included (a) studies in reproductive endocrinology a t the Central Family Planning Institute, New Delhi, (b) a field study on human reproduction, family health +nd population dynamics, jointly undertsken by the Harvard University Centre for Population Studies and the Ad-hdia Institute af Medical Sciences, (c) immuno- logical and biochemical studies of reproductive functions in the male and clinical field research studies on human fertility-regulating agents, both under- taken in Bombay by the Indian Council of Medical Research, and [d) a trafning programme in the physiology of reproduction for research scientists and physicians, at Delhi University.

Paediatric and Obotctric Education

The three main problems encountered in the joint efforts of governments, WHO and UNICEF to imprwe the teaching of social paediatrics in medical schools have been (a) the reluctance of some universities to recognize child health a s a major independent discipline, (b) the limited time, if any, given by paediakic faculties to the teaching of promotional and preventive child care, and (c) the inadequate use 6f community health services as a device for the development of practical skills.

Recognizing that the competent medical educators already available within countries of the Regicm are not always being fully utilized to overcome these problems, the Regional Office ar?anged to bring together for consultation the technical personnel most concerned. Emphasis was placed on the question of interdependence of the various faculties in the teachhg of comprehensive care and the need for interdepartmental collaboration, and grays representing various interrelated disciplines were invited to act as temporary advigers to the Regional Director to assist in organizing meetings, seminars, etc. The meetings on "Teaching of Social Aspects of Obstetrics" and on "Pwdiatric Education in hdiatl, held a t the Regional Office in September/October 1968 and, also in the Regional Office, the & meeting on paediatric education held in July 1969, which was a follow-up af the October meeting (for details of these meetings, see India 0ll4 in Part III), and the Conference on Paediatric and ObsteMc Education, which took place in Indonesis in March 1969 (see Indonesia 0062), were examples of the application of this approach.

The question of maintaining the momentum, continuity and steady growth a f a programme once initiated in a medical school has been given special attention. Thus, instead of sending a team to a medical school only once for a very short period to advise on desirable changes in curriculum, methodology, etc., i t was decided to assign teams consisting of a senior short- term consultant on repeated assignments and a junior, well-qualified medical educatq on a more extended assignment, to assist projects from the initial stages c& their development and to follow up on progress. WHO assistance to paediatric and obstetric education i~ Afghanistan was being implemented along these Ws. Similar projects were being considered for Ceylon, India and Indonesia.

In order to emphasize the importance of the environmental, social and preventive aspects in the teaching of personal health care of mothers and children and the need for an inter-disciplinary approach in the teaching of paediatrics, obstetrics and preventive and social medicine, the Regional Office arranged two training courses on the organization of maternal and child health field practice programmes in medical colleges for teams of professors in these disciplines. The professors came from Ceylon, India and Indonesia ( for details, see SEARO 0177). Plans were initiated for holding similar courses in the future.

With regard to progress in individual countries, a visiting professor in paediatrics was recruited to work with the WHO consultant(paediatrician) in Afghanistan, and a consultant in obstetrics was assigned in March 1969 to s t d y the obstetric education programme in the medical schools of the country and to advise on measures for improvement.

A consultant in paediatric education was provided to Burma, and another completed his assignment in Ceylon.

In India, where WHO/UNICEF assistance to paediatric and obstetric training and services was further expanded, apart from the faculties for the meetings mentioned above, three WHO consultants in obstetrics took up independent assignments to study the existing training programmes in obstetrics and gynaecology in six medical colleges and to advise on their improvement. In view of the usefulness of the two orientation courses in neonatology for paediatric teachers which had been held in January-February 1968, the consultant who had conducted these courses was reassigned to give two further courses in 1969; under the saine project (India G W ) , a c d t a n t assessed the development of paediatric sutgery in major medical colleges and made recommendations for improvement. A further consultant (health educator) studied tho health education aspects of the training, i. e. , the health education being given in paediatric departments, the content of the teaching in medical schools, utilization of resources, etc. (see SEARO C090).

In Indonesia, the WHO professor of paediatrics completed his work with the Paediatric Department of Bandung Medical Faculty. Two consultants (in paediatrics and obstetrics) were assigned to review the training programmes in obstetrics and gynaecology and paediatrics in the major medical facultics and. during their assignments, also assisted with the Conference on Paediatric and Obstetric Education which has been mentioned earlier. Steps were taken to provide a visiting professor of paediatrics and a visiting professor of obstetrics to assist in the strengthening of paediatric and obstetric education throughout the country.

From September to December, participants in the 1968 London-Bombay course for senior teachers of paediatrics, which is sponsored by UNICEF in collaboration with WHO, spent the last part of the course a t the Paediatric Centre of Grant Medical College, Bombay, for the study of tropical paediatrics. The Regional Office collaborated in the preparation of a revised outline for future coyrses.

SEA/RC22/2 Page 39

Four senior paediatric teachers from Burma, Indonesia and Thailand were awarded WHO fellowships to attend a Seminar on Paediatric Education organized in New Delhi from 3 to 8 February 19G9 by the International Children's Centre, Paris, and the Indian Academy of Paediatrics, in collaboration with UNICEF and WHO. Three WHO consultants assigned to other projects actively participated in this oeminar, several sessions of which were, in addition, attended by the Chief of the Maternal and Child Health Unit from WHO Headquarters and the Regional Adviser in Maternal and Child Health.

Four WHO consultants in obstetrics on assignment to India also participated in an "International Seininar on Maternal Mortality, Family Planning and Reproduction", held in Bombay in March 1969 (see Part 11, Chapter 4).

Social Welfare

The Regional Office continued to give advice on the health aspects of family and child welfare programmes through the health departments of Member countries, and co-operated in the development of social welfare projects assisted by the United Nations Department of Economic and Social Affairs.

As to the developments in social welfare in the various countries, in Afghanistan, limited progress was made in the expansion of day-care centres for pre-school children. In Burma, WHO continued to encourage close collaboration between the expanded social welfare activities and the health services. The co-ordination of training programmes for medical and medic* social students in field practice areas was under further consideration in Ceylon. As for India, the family and child welfare programme assisted by UNICEF and the United Nations Department of Economic and Social Affairs was further expanded, and WHO continued its endeavours to promote close collaboration with health services a t all levels of administration. In Indonesia, advice was given on rchcbilitation and t\c consolidation of a social welfare programme for children and youth assisted by UNICEF, UNESCO and WHO. Activities in the WHO-assisted maternal and child health project in Mongolia included a training course for directors of crCches and kindergartens on the improvement of health standards in these institutions. Finally, in Thailand, the rural pilot project for pre-school children was under review.

The trends in the field of nursing a s outlined in the Twentieth Annual Report continued. Among the morc inarked of these was the need for both short and long-range planning of the nursing component as a c-ordinated but none the less well-defined segment of the national health services.

A s nursing services develop in the countries of the Region, it becomes increasingly evident that understanding and concepts essential to the overall establishment of sound nursing practice and education need discussion and identification by senior medical and nursing administrators responsible for decision-making within the health services. Such basic areas a s legislation

SEA/ RC22/2 Page 4 :

for nurshg practice, rational bystems of nursing personnel* and nursing education, a s well a s other policies and patter28 which provide for the effective control and managenient of the nursmg component of the health services, have received attention.

Plans for this development a s it relates to national planning for health, education and welfare service were initiated in Afghanistan and Nepal. Continuing and expanded WHO assistance to nursing ir. Cles- countries tKiu be.given a s a part of these plans,

The need for the establishment and enforcement of minimum standards in the delivery of nursing care and the conduct of -educational programmes for the training of nwsing personnel resulted in an inter-country Workshop in Nursing Legislation and L'lcensing for Practice, which was held in March an&to which six countries sent participants. Plans were made for a second inter-country workshop, to be held in the last quarter of 1969, and also for a number of country- level courses on the general topic of the control and management of the nursing component of health serteces.

Cost accounting for both nursing services and nursing education, a s well as methods for determining staff needed to deliver nursing care, were topics which were examined briefly and which, it is expected, will receive further attention in the coming year.

Emphasis continued to be placed on providing short courses for qualified nursing personnel. In all, 13 courses, varying in length from two to five weeks and involving 280 national staff, both doctors and nurses, were conducted, the participants coming from Afghanistan, Burma, Ceylon, India, Indonesia, Nepal and Thailand., Among the topics dealt with in these courses were administration of nursing schools, clinical teaching, in-service education and public health nursing. Teachkg and rnference materials were produced on all of these subjects.

The role of the nwse a s a member of the health team a s further demonstrated through the participation of both WHO nurses and national nurses in short courses of an inter-disciplinary nature held in several countries of the Region. The subjects dealt with included management of infectious-disease hospibls, organization of m a t e m 1 and child health fisld practice programmes in medical colleges and training in health education,

Assistance to basic nursing education was again provided to Afghanistan, indonesia, Nepal and Mongolia, and auxiliary nurse training was further

*A rational system of nursing personnel is conceived of a s d-'erdning the types and levels of workers who will deliver nursing services to the public. It gives form to nursing, at the mmc time providing for growth and for the adaptation of the system to thc changmg health needs of society. Ideally, a rational nursing personnel system provides for two or, at the most, three levels of nursing porsonneL

CH and NURSD

The health of the community, especially of mothers and children, depends t o a large extent on the services rendered by nurses and midwives. Pictured here are (I) a young midwife i n a Burmese village home, (2) a graduating class of nurse trainees i n Bir Hospital, Kathmandu, and (3), (4) and (5) nurse/midwives i n action i n Afghanistan, Indonesia and Thailand, respectively.

COMMUNITY WAXER SUPPLY

' 'ir 7 -

- L

' 4 ,

strengthened in the first three of these countries and also in Maldives. The strengthening of post-basic schools of nursing continued in Ceylon, India, Indonesia and Thailand. Fellowships were awarded to prepare national nurse- teachers for faculty positions in both university and certificate post-basic programmes.

In Afghanistan, India, Maldives and Thailand, WHO continued to provide assistance to the strengthening of nursing service administration in hospibls. The long-standing programme for the further preparation of nurses in pediatric nursing was continued in India, and assistance given to the neonatal courses associated with this programme.

The urgent need for better preparatigp of nurses in the specialized clinical areas of nursing found expression in discussions with health authorities in several countries of the Region. As a result, long-range plans were made to conduct, in 1969-1970, short, intensive courses in selected fields of clinical nursing, beginning with a course in orthopedic nursing, to be organized in India in the latter half of 1969.

As regards nursing studies, initial p l a d n g was completed for the study of the activities of nursing personnel in Thailand to be conducted during the second half of 1969 in hospitals under the administrative control of the Department of Medical Services. Also, the hplications of the findings of the WHO-assisted study of the activities of the auxiliary nurse-midwife in three States of India, which was undertaken in 1967, were discussed at a number of meetings among senior health personneL It is expected that these discussions will lead to changes in the content of the tralnin$ of this category of nursing personnel.

6.4 Environmental Health

Based primarily on the concept of promoting and developing water supplies a s a means of improving environmental health conditions in Member countries, the WHO programme in this field continued to make progress. There was increased emphasis on sewerage, water pollution, the disposal of industrial wastes, training and research.

With assistance from the United Nations Development Programme (Special Fund), a considerably expanded programme of water supply and sewerage and drainage schemes was in different stages of planning and implementation in the various countries.

With regard to the project in West Bengal, India, in which assistance is to be provided for the implementation of the master plan for water supply, sewerage and drainage, discussions were held between the UNDP and WHO concerning the documentation prepared by the Calcutta Metropolitan Water and Sanitation Authority on the organizational and management aspects. In July 1969 a consultant took up a short assignment to provide technical advice to the Authority.

SEA/RC22/2 Page 42

In Ceylon, the receipt of final reports in respect of the five high- priority areas in the south-west coastal region of the island marks the successful conclusion of the prelim&;y operations phase of the water scpply, sew-rage and drainage project. Discussions were held With the Government, the World Bank and the firm of consulting engineers on the possibility of the World Bankls financing two water supply schemes, in Galle and towns north of Colombo selected from the high priority areas; the plan of operation for full-scale studies was signed on 27 March 1969, and its implementation has started. The scope of the studies includes (a) the preparation of a comprehensive plan for water supply, sewerage and drainage for the south-west coastal area; @) preparation of detailed engineering designs for the two Water supply schemes mentioned above; (c) organizational and management aspects, and (d) establishment of training facilities. A WHO project manager was assigned to the project in May (for details, see Part UI, Ceylon 0086).

In Nepal, a draft request for Special Fund assistance in the preparation of a master plan, feasibility reports, preliminary engineering and organizational studies for water supply and sewerage in Greater Kathmandu and BhaMapur was prepared, with WHO assistance, and submitted to the United Nations Development Programme k Mai.cil. WHO'S participation in the UNDPIFAO-assisted Trisuli Watershed Development Project continued, the WHO sanitary engineer in the country a s well a s the staff of the inter-contry community water supply project providing advice on the environmental health aspects.

Two consultants were assigned to help the Government of Afghanistan in p r e p a m a request for UNDP(SF) assistance in the development of a master plan and of feasibility, enginering and management studies for water suppues, sewerage and drainage for Greater Kabul. The WHO sanitary engineer provided to the Central Authority for Housing and Town Planning continued to give advice on the sanitary engineering aspects of the Authority's activities.

In Burma, the Government was considering proposals for the involvement of WHO in the preparation of a request to UNDP(SF) for assistance in a community water supply and sewerage project for the cities of Rangoon, Moulmein and Akyab.

The Government of Thailand has asked WHO for assistance in developing UNDP(SF) projects for several aspects of environmental health, including community water supply, waste disposal, water pollution and training. TWO consultants were provided and undertook a review of the master plan for sewerage and drainage for Bangkok, which had been prepared by a consulting engineering finn.

Increased participation by WHO in programmes based on UNICEF assistance was made possible through a new approach, involving development and exploitation of ground water for potable and minor irrigation supplies in m i c u l t and "scarcity" areas of India. In this connection, a master plan of operation prepared through the joint efforts of WHO, UNICEF and FA0 was submitted to the Gsvcrnment for consideration. To be implemented on a long-term basis and for a five-year period in the first instance, the project will seek to provide water supplies for human consumption and for school, community

SEA/!RC22/2 Page 43

and kitchen gardens in an estimated 17 a00 villages. The regular WHO/UNICEF- assisted water supply programme continued to make progress in its parallel approach of providing rural water supplies and assisting in the development of rural health scrvices.

In Afghanistan, further progress was made, particularly in the preparation of plans and designs for twelve new gravity piped water-supply schemes covering a population of 48 600, which were selected by the Government for implementati3n. The Government has now established the rural water supply unit in the Rural Development Department, and this new unit has expedited the training of national personnel for the rural water supply programme. Two hundred hand-pumps havc been fabricated by 3 manufacturing plant in !(abul, and it is planned to instal them during 1969 as part of the rural water supply programme.

In Mongolia, a technical review of the earlier proposals for Water supply schemes in small communities was made by an expert consultant. As a result, a new programme, particularly suited to the climatic conditions obtaining In the country, has been proposed in order to accelerate the implementation of the schemes.

A sanitary engineer is under recruitment for a community water supply and sewerage programme to be carried out in the rural areas of Ceylon with assistance from WHO and UNICEF. Under this programme, twenty rural water supply schemes are to be selected and developed over a three-year period.

It is planned to assign a sanitary engineer to Indonesia to assist the Government in a long-term rural water supply and sanibtion programme.

In Nepal, negotiations are proceeding with the Government and UNICEF for the provision of rural water supply and sanitation facilities on a country-wide basis.

With regard to training and education, in Afghanistan, a sanitary engineer is engaged in strengthening the training of engineers a t the University of Kabul. In Burma, a professor in sanitary engineering is assisting the Institute of Technology and the post-graduate School of Preventive and Tropical Medicine a t Rangoon. Consultants assigned to Ceylon and Thailand (under an inter-country, project) to assist the engineering training institutions in those countries have conducted lectures and discussions on special aspects of environmental health requiring urgent attention. Preliminary steps were being taken in connection with a ground water development course, planned to be implemented at Roorkee University in India. The WHO sanitary engineer working in Nepal is also assisting the Faculty of Engineering in its training programme.

Other training activities for the benefit of professional and sub- professional environmental health personnel have continued in several countries of the Region. The WHO fellowship programme for additional training of environmental health staff was intensified, and 16 fellows were undergoing training in universities outside their countries a t the time of writing.

SEA/RC22/2 Page 44

As a follow-up of WHO'S global scheme for the establishment of inter- national reference ccskcc f c r envirc?~~->rL?! health, thg fo!lcwkg three institutions in the Region were formally invited to participate a s regional reference centres and collaborating institutions:- the Central Public Health Engineering Research Institute, Nagpur, the All-India Institute of Eygiene and Public Health, Calcutta, and the Asian Institute of Technology, Bangkok. The participation of several others, i. e., the P b s i c s and Engineering Research Department of the Union of Burma Applied Research Institute, Rangoon, the Victoria Jubilee Technical Institute, Bombay, and the Institute for Technical Hygiene, Bandung, i n also under negotiation

A further consultant was provided to the Central Public Health Engineering Research Institute, Nagpur, in India, to advise on oxidation ditches. In addition, WHO is assisting the Institute in making preparations for a symposium on this subject, which is planned to take place in October 1969.

In the field of water pollution, a consultant was assigned to Thailand, and similar assistance is proposed for Maharashtra State in India. The situation in Afghanistan, Buri;," 2::: Ccylon w:th regard to water pollution is being assessed in preparation for a seminar which is scheduled to take place in 1970.

With regard to industrial wastes, a consultant assigned to India visited the cities of Nagpur, Calcutta and Bombay to investigate this problem a s well a s that of industrial hygiene. As a result of this assignment, it is expected that the State Government of Maharashtra will seek WHO assistance in preparing a request to UNDP(SF) in connection with a waste disposal and environmental pollu- tion control project. In Ceylon, industrial waste problems of several large industries v&re being studied a s part of the UNDP(SF)-assisted project for water supply, sewerage and surface drainage in that country.

6.5 Health Education

A good example of the importance given to health education in an inter- disciplinary approach was the inclusion of a health educator in the team of consultants (of obstetricians, pediatricians and professors of preventive and social medicine) which conducted two training courses on the organization of maternal and child health field practice areas in medical colleges (see SEAR0 0177 in Part El). It is expected that this activity will result in further strengthening the role of health education in the training of medical students.

Increased attention has been, and is being, given to the educational aspects of seminars, workshops and conferences being organized by the Regional Office, in order to ensure r i i3xh~m learning on the part of the participants. In this connection, a consultant assisted in organizing, in the Regional Qffice Library, a unit of selective materials covering various aspects of planning, conducting and evaluating educational meetings, to facilitate the work of staff both in the Regional Office and in the field in advising national personnel in this regard, and also for use in inter-country educational projects. Based on the materials in this unit, a list was prepared for reference purposes in connection with educational programmes.

SEA/RC22/2 Page 45

A review of the number and placement of trained health educators in the countries of the Region, which was undertaken in the Regional Office, indicated that increasing numbers of health educators were being placed in training institutions or used for training activities, and also that there was a gradually increasing coverage by health education services a t the intermediate level a s an integral part of the general health services.

Fellowships were awarded to three health educators from the Region (one each from India, Nepal and Thailand) for a WHO-sponsore&l'raining Course on Measurement and Evalution Techniques in Health Educationf', which was held in Teheran in November, in order to enable them to bring themselves up to date on new methods and see the work being done in a neighbouring country.

The two post-gradute centres for health education in India (the All- India Institute of Hygiene and Public Health, Calcutta, and the Rural Health and Family Planning Institute, Gandhigram) and the degree-level centre in Thailand (the School of Public Health, Mahidol University) continue to be the only facilities for training health educators within the Region. These centres turn out a number of qualified health educators annually, but a r e not able to meet even the present demand for this category of health worker, and there are considerable numbers of persons holding health education posts who a re not qualified in the subject. Furthermore, the expanding services and programmes, eapeciallythose which depend on the people's action for implementation, will require a correspondingly increased number of health educators. These conditions, together with the present difficulty of obtaining seats for international fellows in educational centres in the more developed countries, make it imperative that emphasis be glven to expanding the facilities for training health educators within the Region, based on each country's requirements, with priority to training the teachers. Another point to be emphasized is that, often, the very institutions giving training courses in which standards for sanitary facilities, pure water supply, etc., a r e being advocated a re themselves without such amenities; it is difficult to see how concepts of sanitation can be effectively imparted under such conditions. In the establishment of sanitary facilities, pr~ori ty should therefore be given to training centres, schools, etc.

Schools are a realistic >leans of approach to the people in that coverage is almost universal, and emphasis has therefore been placed on health education in schools. A consultant was assigned to Nepzl to study and make recommendations in this respect. The joint UNESCO/WHO. document, "Planning Health Education in Schools", was distributed in all countries of the Region by the two organizations concerned, through the education and hzalth ministries. In a t least one country, i. e. , Nepal, it was translated into the national language by UNESCO for the use of educational institutions. In Thailand, the M e y e a r health education curriculum in the School of Public Health has been developed mainly for teacher t r a a c r s and for teachers, a s a means of strengthening health education in schools.

Activities have been continued in most countries for further building up the health education services a s well as Ule functioning of those units already established. In pursuance of this gml, eight fellowships (international a s well a s regional, including some for participation in intercountry meetings) were awarded to personnel in all countries of the Region which have organized health education units.

Health education materials distributed included programme details and the reports of the intercountry workshops held in 1967 and 1968, the guidelines attached to the 1967 report, and a technical circular, "Health liduCati011 in Medical Educntlon" (for details, see Chapter 8).

National health education units and health educators, including WHO consultants, are being involved in an increasingly wide range of activities and programmes. Consultants were assigned during the year to various countries of the Region (Afghanistan, Ceylon, India, Indonesia and Nepal) to advise on health education in projects for the teaching of paediatrics and obstetrics, hospitals and peripheral centres, orientation in public health for district health officers, teacher education, evaluation and research in public health and the educational approach in the planning and implementation of health programmes. In two countries, Afghanistan and Ceylon, assistance was given in the preparation of plans for the development and expansion of the health education services on a phased basis.

Two staff members of the Behavioural Sciences Unit from WHO Headquarters assisted the Central Health Education Bureau in New Delhi in formulating a research programme in the Bureau. During their visit, the Central Health Education Bureau held a two-day conference with 40 participants, including representatives of universities and international and bilateral agencies in India, to review behavioural research in health and extension education.

6.6 Nutrition

The "Indicative World Plan" prepared by FA0 and presented at the Ninth FA0 Conference for Asia and the Far East, held in Bangkok in November 1968, shows the possible development of food production and food availability up to 1985. For some countries in the Region the availability of calories and protein is expected to increase to more than 110 per cent of national average requirements. However, most of the existing nutritional problems are likely to persist for a considerably longer period, and efforts to overcome them must continue.

The planning of realistic nutrition programmes often suffers from the fact that only incomplete epidemiological information is available on most of the nutritional diseases; ~ e v ~ r a l countries have nutrition divisions in their health departments, which are striving to measure the public health importance of malnutrition. During the year progress in We strengthening of these divisions has continued. In Burma, the existing nutrition unit of the Directorate of Health Services was expanded and enabled to take on the functions needed to develop effective nutrition work. In India, nutrition officers of the States met during the year and discussed problems and programmes.

Several projects for the supply of food to vulnerable population groups are being pursued in various countries. India and Thailand a re undertaking the production of protein-rich foods. Early in 1969, a UNDP mission visited India to study the country's potential for producing protein-rich foods. Ceylon is planning the production of a toddlers' food based on vegetable protein, and in the meantime the Government has requested the World Food Programme to

S~A/Rc22/2 Page 47

supply food to the country's child population. World Food Programme food is already being provided to school feeding schemes in Afghanistan (see also below).

Prophylact~c measures agatnst vitamin A deficiency and nutritional anaemias were under considemt~on in India. The plans are for these measures to be carried out on a country-wlde scale through the h ~ a l t h services and the maternal and child health family planning network, and based in part on the results of the research unc;crtaIicn in various insWkiuns in the country with assistance from WHO Headquarters. In Ceylon, a pilot project for the prevention of iron deficiency anaemia in pregnancy is t3 be started, with WHO assistance, later in the year,

Therc was further progress in the control of endemic goitre. A team of WHO consultants which carried out clinical and biochemical studies in Nepal ascertained that low intake of iodine wcs the main aetiological factor; this confirmed the conclusions drawn from the goitre and salt surveys made earlier by the Government and presented to the WHO Seminar on Goitre Control held in 1967. In Burma, the first salt iodation plant started operations. In Ceylon, where endemic goitre is somewhat less severe than in many other countries, the Government has decided on a salt iodation programme and has asked for assistance from WHO and UNICEF.

WHO continued to support the nutrition training courses for medical personnel being given at the Nutrition Research Laboratories, Hyderabad (India). There a r e a t present two annual courses: a certificate course of three months' dunt i& and a nine-month course leading to the degree of Master of Science (Applied Nutrition) of Osmania University.

To strengthen nutrition education through the health services, plans were made to provide a consultant to visit Afghanistan and study the possibility of improving nutrition education through the maternal and child health services. The feasibility of establishing nutrition rehabilitation and rehydration centres on a pilot basis, which would also be used for training purposes, was under study in Afghanistan, Ceylon, Indonesia, Nepal and Thailand, with the assistance of a consultant.

Applied nutrition programmes, with the participation of WHO, UNICEF and FAO, are in operation in India, Indonesia and Thailand. In India, the Central and State Governments and the participating international agencies have agreed on the desirability of carrying out an evaluation of the impact of the programme later in 1969.

A WHO Headquarters consultant and the WHO Liaison Officer with the World Food Programme visited the Regional Office in October 1968 to explore the possibilities of using, in WHO-assisted projects, the food aid made available by the World Food Programme. After spending some time in India, they visited Ceylon, and the Liaison Officer also went to Nepal; in all three countries, discussions were held with the health authorities, WHO staff and World Food Programme officials. These discussions covered, in Ceylon, a special feeding project for re-school children and pregnant and lactating mothers, under which food would be supplied at concessioml rates and the proceeds used for

S E A / R @ ~ ~ / ~ Page 48

strengthening the health services; in India, a scheme for hospital feeding in the metropolitan city of IYelhi and, in Nepal, a proposal to use the aid for communi@ water supply projects.

Assistance to nutrition research under the WI-IO global programme conti- nued to be provided to three different institutions in M i a - the Department of Pathology of the All-India Institute of Medical Sciences, New Delhi, the Christian Medical College, Vellore, and the Indian Council of Medical Research, for a project being undertaken a t the Eiural Health Research Project a t Narangwal, W a b (for details, see Annex 6).

6.7 Mental Health

A psychiatric epidemiologist attached to the WE0 Inter-regional Advisory Team on the Epidemiology of Mental Disorders completed his work in India in October 1968. In the course of this assignment he collaborated with the Agra Field Research Centre of the International Pilot Study on Schizophrenia, which had entered its second phase. He also visited a number of mental hospitals and teaching institutions throughout India, and his obeervations have confirmed that comparatively low priority is still given to mental health care within the general health services', and that the importance of psychiatry in medical education is not fully recognized.

A WHO consultant in psychiatric education who completed his assignment to two medical colleges in India in November came to similar conclusions. The heavy service workload carried by the departments of psychiatry, which, he observed, militated against good teaching of undergraduates, and the absence of a separate examination in psychiatry were leading the students to regard the subject as of minor significance.

A "Workshop on the Classification of Mental Disorders" was organized in April 1969 in New Delhl jointly by the All-India Institute of Medical Sciences and the Indian Psychiatric Association. WHO supplied relevant publications'and was represented at the meetings by a staff member from the Regional Office.

In Ceylon, a senior lecturer has been appointed a s Head of the Department of Psychiatry established last year in the University of Ceylon. WHO has been requested to assist in the development of an undergraduate course in the subject by the assignment of consultants and the award of fellowships.

In Thailand, where the WHO psychiatric nurse has continued her activities, progress was made in the development of this aspect of the post-basic nursing programme; however, scarcity of literature in the Thai language has somewhat hampered the programme.

G. 8 Dental Health

Keeping in mind the resources available in the countries of the Region, WHO has, in its assistance to dental health, continued to give priority to the education and training of personnel. Fellowships have been awarded, and continued assistance to dental colleges in India has been given by WHO consultants.

SEA/RC22/2 Page 49

For the development of public dental health services, emphasis is placed on the importance of utilizing auxiliary personnel working under the supervision of qualified dentists, and, in this way, extending dental services to school-children. UNICEF support is being sought for the latter purpose. Recruitment of a WHO dental sister tutor for a new school for dental auxiliaries in Thailand, and of a dental mechanic a s a tutor for a dental school in Ceylon (which also trains dental technicians and auxiliaries), was undcr my.

Mongolia has requested WHO assistance in the establishment of school dental services, and it was planned to provide a consultant to carry out an assessment of the existing situation and to study prospects for further development.

6.9 Occu~ational Health and Rehabilitation

The theme for World Health Day 1969, "Health, Labour and Productivity", brought to the fore the necessity for the develop- nations not only to strengthen their industrial capacity but also to ensure a llcalthy labour force, which, in t u q entails the provision of adequate health services for the workers. It is considered likely that the needs for improving industrial hygiene and occupational health will be given more and more priority by Member States, and the Regional Office has continued to provide assistance in this field and to maintain close liaison with LO.

The situation with regard to medical rehabilitation services in the Region is that the elements of such services, including staff (physiotherapists, occup- tional therapists and medico-social workers) and workshops for orthopaedic and prosthetic appliances are available in many of the larger hospitals in Member countries. However, the various disciplines a r e often found dissociated from onc another. Particularly in view of the increasing number of industrial, traffic and agricultural accidents, it is thought that the time is fast approaching when much higher priority will have to be given to the fornation of integrated medical rehabilitation services.

At the request of thc Government of Thailand, a programme to develop a pilot rehabilitation service in some Bangkok hospitals was initiated in 1969. This scheme followed a s a natural development from the previously assisted physio- therapy training project in Siriraj Hospital. It is planned to draw together gradually and to strengthen the various elements of medical rehabilitation which already exist and to use the whole a s a training ground for all cadres of health personnel associated with the different disciplines of medical rehabilitation.

In October 1968 a WHO consultant went to Ceylon for four months to advise on thc manufacture of orthopaedic and prosthetic appliances. He visited a number of centres associated with medical rehabilitation and demonstrated new techniques, also giving some assistance to training programmes for technicians and to the reorganization of the workshop which is rjnnufacturing appliances.

SEA/RC22/2 Page 50

The same consultant, assigned to India from March 1969, also for a period of four months, paid visits to Indian workshops manufacturing prosthetic appliances and helped in the development of standards for component parts, as well as giving advice on the training of technicians.

From March 19G9, a WHO physiotherapy tutor was assigned to the new Physiotherapy School in the Shree Sayaji General Hospital, Baroda (India), to assist in the development of a curriculum for the training course and to help with the teaching; she is also advising on the further strengthening of the physiotherapy department and the services provided to the hospital.

The Government of Burma requested the services of a consultant in physical medicine to assess the present position of the rehabilitation services, particularly with regard to the treatment of amputees and the type of injuries associated with accidents in light industry and agriculture. A suitable consultant is being recruited.

From time to time WHO has also given advice on the health and medical services in the ports. A consultant visited Ceylon and Jndonesia in February and March 1969 to advise on the strengthening of port health services with particular reference to sanitary procedures.

6.10 Radiation and I so to~es

It is well recognized that the most common source of ionizing radiation to which man is exposed today is the diagnostic X-ray machine. However, among other sources, X-ray therapy units, isotopes and radio-pharmaceutical products w e all being used in this region to an ever-increasing extent. Thus it is most necessary that competence should be developed in the use of such valuable but potentially dangerous tools and in their proper maintenance and repair. It is towards this end that WHO has been assisting in a variety of projects in South- East Asia.

A joint WNO/IAEA inter-regional "Seminar on Radiation Protection Mmnitoring for Asia and the Far East" was held in b m b a y from 9 to 13 December 1968. Thirteen of the participants were sponsored by WHO, and of these, eleven were from countries in the Region. The Seminar focussed attention on the problems arising in personnel monitoring and monitoring of the working environment, and on the instruments used for these purposes. Only the monitoring of external radiation was considered, and no attemg was made to cover any assessment of quantities of radio-nucleides that might be taken into the body. Attention was particularly paid to instrumentation, the aim being to provide guidance on the selection of the most appropriate instrument to be used in any particular case; calibration and maintenance were also emphasized.

A WHO consultant visited Afghanistan for four weeks in January 1969 to advise on the strengthening of the radiographic services and the training Of

radiographers; here emphasis was also placed on radiation protection (for detalls, pee Part 111, Afghanistan 0067).

In October 1968, a consultant was assigned to Burma, where he undertook an assessment of the orientation training course for radiographers that he had conducted in 1967. Assistance was also given to the radiographic services in a number of hospitals and advice offered on dark-room procedures ahd radiation protection. Ano'her consultant - a physicist - advised the Government of Burma on radiation health and protection, with particular emphasis on radiological services in the hospitals.

The Second Annual Cowsc in iiospital Physics began in September 1968 at the i3habha Atomic Research Ceiztre, Trombay, Bombay. WHO fellows from Indonesia and Thailand are attending this one-ycar course. As in previous years, the Regional Office provided a consullant for two months to assist in the conduct of the course, the syllabus for which received considerable attention; efforts a r e being made to bring it more into line with what i s considered the requirements of hospital physicists,

The Radiation Medicine Centre, Bombay, held its annual short (six-week) course in the medical uses of radioisotopes in November/December 1968. This course is offered to medical practitioners. Its syllabus i s also receiving attention, and a WHO consultant was assigned to assist in this regard.

The School for the Training of Radiographers in Chandigarh (India), to which WHO assistance was continued, progressed satisfactorily into its second year, and the new intake of students started their studies in October 1968. The first g row i s due to take the qualifying (B. Sc.) examination in August 1969.

Ten students completed the First Training Course for Electro- mechanical Repair Technicians at the All-India Institute of Ivledical Sciences, New Delhi, which ended in February 1969. Fifteen new students began the second course in March.

The WHO consultant who had been assigned to Maldives in June 1968 (as mentioned in last year's report) assisted with the establishment of the radiological department in the new hospital a t Male. He also helped in installing a diagnostic X-ray machine and dark-room equipment, and advised on the administration of the department and the ordering of supplies.

In Indonesia, the WIIO-assisted project which has helped to train X-ray engineers in the techniques of repair and maintenance of X-ray equipment underwent a change and broadening of objectives a s from March 1969, and a WHO radiography tutor was assigned to it to assist in strengthening the training of radiographers. It is also intended to provide an electronic engineer.

In Mongolia, two consultants assisted with the installation of two new diagnostic X-ray machines and advised the national staff on maintenance. A t the request of the Government, assistance is also to be provided in the training of X-ray repair technicians.

In Nepal, a WHO consultant carried out a survey of the existing diag- nostic X-ray machines in the country and also gave advice on the strengthening of radiographic services.

SEA/RC22/2 Page 52

The School for Radiological Technology located at Siriraj Hospital, Bangkok, which offers a four-year training course to radiographers, continued successfully without WHO assistance, which had ended in July 1968. A new School k!r Medical Radiography was opened in Ramathibodi Hospital in May 1969. The School, which is supported by WHO, will, in the first instance, train radiopaphers in diagnostic techniques.

6.11 Cancer

Increasing interest i s being shown by the countries of the Region in the epidemiology and incidence of various types of cancer, and WHO assistance is being requested in assessing and advising on the problem.

At the time of a visit of two WHO consultants to Afghanistan in July 1968 to discuss the feasibility of undertaking a survey of the incidence of ompharyngeal tumours (mentioned in last year's report), a site for the survey was chosen in the neighbourhood of an established rural health centre. Two fellowships have since been offered for the training of Afghan dentists in the techniques of undertaking such a survey, which it is expected will be carried our in 1970.

A cancer control pilot project was initiated in March 1969 in Kancheepuram, near Madras (India), with the assistance of both WHO and the Norwegian Government. It is intended to carry out surveys of the incidence of oropharyngeal and cervical carcinomas among a combined rural and urban population nuinkring appraximately 100 000 over the next five years. In o d e r to ascertain the difficulties or problems that might arise in the conduct of such a project, a pre-study is being undertaken in a small random sample of the p~pulation.

A consultant was assigned to R'iongolia in March 1969 for three months to assist in the strengthening of the radiotherapy services a t the Oncological Centre, Ulan &tor.

The Government 3f India has requested the provision of a multi- channel scintillator to assist in the analysis of the proteins in cobra venom. Research is being conducted into the use of certain amino-acids found in such venom a s an anti-cancer agent.

The International Cancer Centre at the C. S. I. Hospital, Neyyoor (South India), which received grants-in-aid from WHO in 1966 and 1967, continued its epidemiological study of the relationship between the occurrence of oropharyngeal tumours and the habit of chewing tobacco with lime and betel nut. The study includes the registration 3f cases and interviews for an estimated twc-year period, by the end of which five per cent of the population over the age of 21 living in Kanyakumari District will have been involved. The grant is also being utilized for the further dcvelopment of the Cancer Registry at the Centre.

SEA/kC22/2 Page 53

6.12 Pharmacolow and Quality Control of Drugs

An important event during thc period under revicw was the inter- country Seminar on the Quality Control of Drugs, which was held in Bombay from 13 to 24 January 1969. This seminar, attended by 15 participants from eight countries of the Region, proved to be particularly popular and successful, with a s many as 70 observers attending the daily sessions (for details, see SEAR0 0154 in Par t m). The pharmaceutical industry shaved great interest, and field visits were paid to several of their manufacturing units during the course of the meetings.

Under an inter-country project, two short-term consultants - a pharmaceutical chemist and a microbiologist - visited a number of countries to advise on legislation and laboratory competence with regard to the quaLity control of pharmaceutical and biological products. Based on their reports, a paper was prepared for the information of the Regional Committee, setting out their recommendations in respect of the countries visited. It is intended to develop a concrete programme of WHO assistance in this field, including, possibly, the establishment of a regional laboratory, a s urged by the'Regtonal Committee during its twenty-first session (resolution SEA/RC21/&6).

The Government of Mia is considering a proposal for launching a UNDP(SF) -assisted project for the further development and strengthening of drug quality control services.

6.13 Other Subjects

.Medical Stores Management

A WHO consultant visited Nepal from February to April 1969 to study the present methods of purchasing, store-keeping, storage and distribution of drugs, medical supplies and equipment by the hfinistry of Health; he also gave advice on some reorganization considered necessary in the management of the medical stores. It is proposed to provide similar assistance to Afghanistan later in the year.

Food Cmtrol

In response to a request received from Thailand, plans were made to provide a consultant to advise the Ministry .of o f l i c Health on the establish- ment of a national food control administration,

Hazards from Pesticides

WHO is also worldng on the problem of the control of pesticides wed in agriculture, which is bringing abwt an urgent need for health legislation.

s~A/RC22/2 Page 54

7. EDUCATDN AND TRAINING*

7.1 Medical Education

In most countries of the Region the expanding health services ' growing demands for personnel are still not being met by the his t ing medical schools. The trend towards establishing new schools and increasing the annual admissions to the old ones is therefore continuing. Ten new medical colleges have been proposed fi the Fourth Five-Year Plan in India. In Thailand, fifth faculty of medicine is being planned for the southern part of the comtry. In Nepal, a Royal Commission has submitted a short-term as well as a long-term plan for the establishment of a medical college.

The training of competent teaching staff and the provision of adequate physical facilities often present serious difficulties in the attempt to increase the numerical output from medical schools. However, how to increase the number of medical graduates is not the only problem: other questions deserving attention might be summariwd as follows:

(I) Is the graduate of a medical school appropriately geared for the task of delivering the kind of health services most urgently needed by the consuming community 7

(2) Is the process of education and training as economical as possible in that the maximum of lmowledge and skills, together with appropriate attitudes, is developed by the trainee in a minimum of time a d with a minimum of expenditure 7

Means for solving these problems have been evolved in recent years in many parts of the world and are continuously being improved. Their practical . implementation, however, is a time-consuming process, which is often slowed down still further by attitudes favouring traditional methods. On the other hand, there are , in this region, increasing numbers of persons who are aware of the problems and who are trying to promote the adjustment of teaching and training programmes to the health situation and apply principles of effectixe teaching and learning.

At the Second Conference of the Burma Medical Research Council in 1968, one of four syndicates dealt with research in medical education, and eight basic documents on this subject were presentecffor discussioh at the sessions.

In Ceylon, working grouph on objective exahnations at both Faculties of Medicine continued their activities, and one of these groups served as a nucleus for the establishment of a working group on medical education, consisting of four committees, i. e. , on (I) aims, (2) course-content, 43) teaching methods, including audio-visual aids, and (4) evaluation techniques. Plans were under consideration to create a department o r unit for the study of medical education, in collaboration with the Department of Education of the University.

*This chapter deals primarily with medical education and with fellowships; WHO'S assistance to the training of nurses, sanitary engineers, auxiliaries, etc. , is shown under the subjects concerned and in relevant annexes.

EDUCATION

Health programmes re- quire the production of m m y categories of health workers, whether (I) den- ta l auxiliaries attending a WHO-assisted school in the Cholburi Training Centre near Bangkok ; (2) health workers for the Indian National Tuber. culorir Contro l Pro- gramme undergoing team training a t the Nat ional Tuberculorir inst i tute i n Bangalore ; (3) radio. graphers receiving train- ing on electro.medical equipment i n D jaka r ta ; (4) students a t Baroda Medical College (India), at which rn experiment involving W H O and teach- ing teams f rom Edinburgh University war completed during the year ; (5) t rain- ees in r hospital physics course at the Bhsbhl Atomic Research Centre i n Trombay (India), o r (6) W H O fellows attcnd- ing courser a t the Nut r i - t ion Research Labora- tories i n Hydcrabad (India).

ESEARCH

Scientists at work at (I) the WHO Headquarters-assisted Research Unit for the Control of Aedes oegypt i i n Bangkok; ( 2 ) the Filariasis Research Unit in Rangoon, also assisted by Headquarters, and (3) the Tuberculosis Chemotherapy Centre in Madras, now i n its fourteenth year. The last picture (4) shows water treatment by the oxidation-pond method a t the WHO/UNDP(SF)-assisted Central Public Health Engineering Research Institute i n Nagpur (India).

SEA/RC22/2 Page 55

Indonesia is planning to assign three of its eleven governmental medical faculties a s "feeder" institutions, to train teachers for all the medical schools in the country, thus applying the frequently recommended principle of strengthening and making use of "centres of excellence".

A revision of the entire system of medical education in Mongolia i s being planned.

In Thailand, a department of medical education has been established in one of the faculties of medicine.

WHO'S Programme

WH@ has assumed an active role in this field. Regional Office and field staff attended all the meetings mentioned above and contributed to the discussions. Plans were under consideration to assist the medical education unit a t the All-India Institute of Medical Sabnces in New Delhi. A "task force" of two con~ultants on evaluation techniques, consisting of a non-medical professor of education and a medical specialist in objective-type examinations, worked with the two Faculties in Ceylon for two months, and the recruitment of a consultant to advise on the establishment of the Medical Education Department was initiated, A similar team has taken up an assignment in Thailand to advise on curriculum revision and development. Consultant teams were being recruited to advise on the expansion of post-graduate medical education in Burma and to assist in the planned refonn of the programmes of the State Medical Institute in Mongolia. Another notable activity was the organization of a study tour to India and the United Kingdom, to enable eight senior teachers from Burma to familiarize themselves with changes and innovations in medical education

Two seminars on the role of pathology in medical education. were held in India, with the participation of pathologists and clinicians not only from India but from Afghanistan, Burma and Ceylon The integral function of pathology in the medical curriculum was specifically emphasized during the proceedings, which were conducted by a WHO consultant and two temporary advisers (see Part III, SEAR0 0133).

A "Seminar on the Undergraduate Teaching of Biochemistry and Clinical Chemistry" was organized in New Delhi jointly with the Indian Academy of Medical Sciences, with participants from Burma, Ceylon, India, Indonesia and Thailand. Again, a WHO consultant and a temporary adviser assisted with the preparation and conduct of the Seminar. Ways and means of improving the teaching of these important subjects and of raising the academic status of biochemistry in those institutions wheke it is not yet fully recognized were among the topics discussed (see India 0221).

At the All-India Institute of Medical Sciences, New Delhi, one such unit, the first in the country, has been created and staffed with an educational psycho- logist and a statistician The Eighth Annual Conference of the Indian Association for the Advancement of Medical Education, held in January 1969, noted an increased interest in this subject among teachers from medical colleges all over the country. The facilities available for post-graduate education for community health work were reviewed at a workshop organized by the National Institute of Health Administration and Education in New Delhi, and guidelines for desirable improve- ments were worked out.

SEA/RC22/2 Page 56

As mentioned in the Introduction to this report, a "Medical Teachers' Training Course" was held in the Regional Office from 7 July to 1 August. This high-level course, which was attended by participants from Ceylon and India, was assisted by four WHO consultants (SEAR0 0096).

Mention must also be made of the various group educatiofial activities pertaining to maternal and child health and described in section 6,2,

Long-term asdistance to medical schools and post-graduate institutions by the assignment of WHO visiting professors was continued in Burma, India and Indonesia, and was resumed in Ceylon. WHO short-term consultants in specific disciplines were assigned for varying periods to Afghanistan, Burma, India, Indonesia and Thailand.

Teams consisting of three WHO consultants worked for two months each a t three medical colleges in India. The three individual WHO consultants in Burma also acted as a team during an overlapping period of their assignments.

Two consultants in obstetrics and paediatrics jointly visited some of the Medical Faculties in Indonesia (for details, see section 6.2).

The Baroda Project

One of the more ambitious projects in medical education, i.e., WHO project India 0183, "Assistance tb Medical Education, Gujarat Stitel', came to a close a t the end of May 1969. Baroda Medical College had been host to WHO visiting professors from the University of Edinburgh Medical School since 1963. During this period of six years, 21 visiting professors stayed for eleven months each and 27 for shorter terms totalling 65 months; in addition, four technicians worked in Earoda for 37 months. Sixteen deparhnents received support:these were: Preventive and Social Medicine, Physiology, Paediatrics, Microbiology, Obstetrics and Gynaecology, Medicine, Surgery, Orthopmdics, Radiology, Psychiatry, Pathology, Clinical Chcmistry , Pharma- cology, Anaesthesiology, Hospital Administration and Medical Records, During the period, 17 WHO fellowships were awarded for study a t Edinburgh Medical School, nine of them for a year or more; the subjects studied were anatomy, physiology, pharmacology, paediatrics, obstetrics and gynaecology, surgery, preventive and social medicine, radiology and medicine. WHO supplied about 900 books for the Library and took out 80 new subscriptions and renewed about 140 subscriptions to medical journals. Laboratory equipment was supplied by WHO, UNICEF, the Colombo Plan and Edinburgh University.

An evaluation report on WHO assistance, now under preparation, shows that, despite the fact that not all the objectives of the project were achieved, the clinical part of the undergraduate curriculum has been integrated and the organization of teaching in smaller groups improved. Also, post- graduate education was developed and there has been improvement in the hospital buildings and in patient care. Other points in the evaluation were that the staff of the College had increased by six professors and 24 lecturers, although four junior lecturers left during the period; the commuuity aspects of preventive medicine, pediatrics and obstetrics and gynaecology had been developed to a considerable extent, and a curative and preventive general practice unit had been established in the teaching hospital.

Medical Libraries

Following on the visit of the Regional Office Librarian to the Faculties of Medicine in Ceylon in May 1968 to advise on improvements of their libraries, WE0 provided equipment and sets of standard textbooks, chiefly in paperback editiohs, to serve as a nucleus for the institution of loan libraries for students.

\%'hen in Ceylon, the Librarian had also hold discussicns with the British Council Lib- for Ceylon, and it was agreed that the Council would provide its two libraries in Colombo and Kandy with copies of those medical books which were not supplied to the medical faculty libraries by WHO. Accordingly, in February 1969, the Council added to its libraries multiple copies of about 100 titles, in addition to the ones already existing. Thus, in co-operation with the British Council, it was possible to make available to medical students in Ceylon a very large number of the texts prescribed by the two Medical Faculties.

In June-July 1969, the Librarian also visited Nepal for three week6 to review facilities for the establishment of a medical library in Kathmandu. His report includes suggestions on the organiz,ation, staffing, equipment, etc., of the Bir Hospital Library and the National Medical Library, which is in the process of development.

7. Z Fellowships

For better planning of WHO fellowships, visits were paid to several carntsies and training institutions in the Region to obtzin &8t-hand lmowbdg? about theirprogrammes, by holding discussions with the afficials and heads of institutions. The opportmity was also taken to interview several former WHO fellows.

During the year, 307 fellowship awards were issued, 277 (90%) of which were new, 19(6%) for a second year of study, and 11(4%) for a third or additional year necessary for the feIlows concerned to complete a specific programme.

Of the 72 fellowships in com&unicable-disease control; 10(14%) were for malaria, 7(9%) for tuberculosis and 4(5%) for leprosy control. The largest numbers were for laboratory training, 17(24%), and vaccine production, 11(15%), and there were also 10(14%) in epidemiology.

Twenty-five fellowships were awarded in the sphere of public health administration, pa.rticukly in such subjects as preventive and social medicine, administration of health services, social security and medical bibliography. Awards were also issued for the training of post-graduate dental teachers, medical record staff and teachers of psychiatry. The tra¶ning of teachers of undergraduate medical education accounted for 18 awards.

Altogether 102 fellowships were awarded to doctors, engineers and nurses f a r one-year post-graduate courses leading to a degree or diploma; 10 were for attendance a t internatiomU courses, 119 for &her types of training or e ~ c i e m e , and 46 for study tours.

SEA/RC22/2 Page 58

Of the tutal number of awards, 80 were for training within the Region.

The following institutians in India afforded training facilities to WHO fellows during the year:

National Tuberculosis Institute, Bangalore; Nutrition Research Laboratories, Hyderabad; National Institute of Health Administration and Education, New Delhi; National Institute of Communicable Diseases, Delhi; Central Health Education Bureau, New Delhi; - All-India Institute of Medical Sciences, New Delhi; School of Tropical Nmdicine and All-India Institute of Hygiene and Public Health, Calcutta; Central Leprosy Teaching and Research Institute, Chingleput; Central Research Institute, Kasauli; Planning, Research and Action Institute, Luchow; Post-graduate Institute of Medical Education and Research, Chandigarh; Pasteur Institute, Cwnoor, and Haffkine Institute, Tata Memorial Institute,

. and Bhabha Atomic Resca r~h Centre, Bombay. * .

Arrangements were made in connection with the Indian part of the following combined courses: epidemiology (Prague-Delhi); epidemiology and control of tuberculosis (Prague-Bangalore) and paediatrics (London-Bombay).

During the year, 94 fellows visited the Region for periods varying from three days to twelve months. These fellows came from the following 28 countries o r territories: Algeria, British Solomon Islands Protectorate, Chile, China, Columbia, Ethiopia, Guinea, Iraq, Israel, Japan, Korea, Kuwait, Lesotho, Malaysia, Mauritius, New Zealand, Papua and New Guinea, Peru, Philippines, Sierra Leone, Singapore, Somalia, United Arab Republic, Venezuela, Viet-Nam and Yugoslavia.

In the accompanying pages, Graph 4 shows the number of fellowships awarded to countries of the South-East Asia Region, by subject of study and country of origin of the fellows, from &August 1968 to 31 July 1969; Graph 5 re~jresents a d s ln numbers, wer a sevenyW.peX/od. The table on page 59 gives fellowships awarded by country gf origin of the feljows, type of course and year of award, and the table on page 60, fellowships a w h e d by man-months.

From only tw~ fellowship awards in 1948 to a total of 318 in 1968, there has been significant increase in the volume of fellowships provided b-countries of the Region; in fact, it will be observed from the follawiag figutes of awards issued during t,he years 1965-1968 that the number of awards has more than doubled during this period: -

1965 - - 1966 - 1967 - 1968

GRAPH 4 - FELLOWSHIPS AWARDED BY WHO, BY SUBJECT OF STUDY AND COUNTRY OF ORIGIN O F THE FELLOW (1 AUGUST 1968 T O 31 JULY 1969)

SOUTH-EAST ASIA REGION

Public Health Administration Other Health Services

sanitation Communicable Diseases

Nuninp a clinical ~ ~ d i ~ i n e

m Maternal and Child Health 0 Basic Medical Sciences and Education

INDIA

MONGOLIA

TOTAL

BURMA CEYLON

INDONESIA -

MALDIVES

THAILAND

GRAPH 5--FELLOWSIUF% AWARDED BY WHO (1962-U)

SOUTH-EAST ASIA REGION

AFGHANISTAN BURMA CEYLON INDIA INDONESIA MALDIVES MONGOLIA NEPAL

Fellowships Awarded bv WHO South-East Asia Region by Countrv of O r i a of the F ~ w , Tvpe of Course and Year of Award, 1962-1968

Type of Course

Awarded for one-year post-graduate courses leading to a degree o r diploma

Awarded for inter- national courses extending up to twelve months

lpor participation in other regular training and. experience

For study tours

Grand Total

Total : 32 !

19 , 24 22 1 32 i

62 I

37 228

3 1 18 44 35 54 1

22 1 111 1 315

33 I 62 1 76 62

105 152 105 595

25 22 2 1 26 33 10

. 65 203

1 3 4 1

Ceylon

8 3 5 1 9

14 8

48

1 1 F 2 4 1 9

24

2

India 9 4 5 2 4

16 6

46

9 4

13 3

15 8

33 85

8 11 25 10 17 25

3 99

11 7 3

17 19

3 15 75

305

I ~v'Wdi\es/ Nbngolla I , Year /Afghmstan Burma

wr/i P m % S cn 9

N N

Indonesia

3 5 3 1 4 4 1

2 1 6 2 7 8

15 - 11 49

3 11 - 3 5

16 11 49

4 - 4 5 2 - 6

2 1

140

- - - - - 1 - 1

- 1 - - - - 1 - - - - 2 1 3

I 6 - - - - - - 2 2

10

Nepal - 2 1 - 2 - >

10

1 - 1 4 4 - 5

15

4 9

10 3

14 9

16 65

1 4 - - - - 5

10

100

.

- - - 1 - 1 1 3 - - 2 2 3 1

14 22

1 6 8 8

13 20 25 8 1 - - - - - - 8 8

114

2

m a i l a n d

6 3 2 5 1 9 3

29

6 5 5

12 5 7

11 5 1

8 6 6 7

15 18 18 77

3 8 9 4 4 4

15 47

204

1963 1964 ' 1965 1966 1967 1968

Total 1962 1963 1964 1965 1966 1967 1968

Total

' 1962 ' 4 1 1963 1964 1965 1966 1967 1968

Total

r 1962 1 1963

1964 1 1965 1966 1 1967

, 1968 Total

1962 7

10 5

17 20 12

, 74 6 3 2 - 1 1 2

15

164

- 2

l j : , 4

6 7 6 I 11

I 3 9 8

33

, 6 3 7 2 4 4

16 42

3

7 8

14 5

50 - - 1 - 2 - 8

11

124

t 9 e 5

37

2 3 2 2 4 1

12 26

4

13 14 29 12 94

1 - 2 .. 5 2 4

14

, 180

Fellowships Awarded by WHO South-East Asia Region bv n%n-Months, 1962-1968

t 1 Year

1962

1963

1964

1965

1966

1967

1968 - Total

Afghanistan

130

41

153

7 3

199

293

276

1 165

India

262

190

366

200

371

432

477

2 298

I

Burma'

79

89

110

145

204

162

234

1023

Ceylon

140

92

156

60

236

267

191

1 142

TYiongolia

12

45

101

72

130

121

368

849

Indca~oh haldivee Thailand

195

112

84

139

152

204

269

1 155

'~epal

38

125

67

27

99

21

149

529

74

120

78

59

133

135

166

765

' Total

930

814

1 118

775

1 575

1 650

2 241

- 9 103

- - 3

- 51

15

111

180

SEq/RC22/2 Page 61

Tables 1 to 5 in Annex I0 give, in respect of each country of the Region, 4) the distribution of the awards by source of funds and type of fellowship, (2) distribution by subject of study and country of origin of the fellows, (3) the number of fellows from the Region going to other regions and vice versa, (4) the number of programmes of study arranged for fellows from the Region, by country of study, and (5) placement of fellows from other regions in countries of this region.

Fellowships in health and mehcal subjects have been awarded to countries of the Region by many other agencies - bilateral, inter-governmental and non-governmental - with which WHO is working in close co-operation. According to avdable information, the Colomho Plan granted 113 such fellow- ships (46 to Burma, 29 to Ceylon, 22 to India and 16 to Thailand); the United States Agency for International Development awarded 47 09 to India, 1 to Indonesia and 27 to Thailand); the Ford Foundation awarded 50 (11 to hdia and 39 to Indonesia); the Ford Foundation 2 (to India); the International Planned Parent- hood Federation 6 (to Thailand); the United States Population Council 7 (2 to India, 1 to Indonesia and 4 to Thailand) and the China Nfedical Board 6 (1 to Indonesia and 5 to Thailand). These are in addition to the fellowships offered by individual gwenunents and by many voluntary agencies, trusts, medical associations, etc.

An analysis of the utilization of former fellows, based on reports received since 1 January 1954 up to the present, is given as part of Annex 10.

Difficulties still persist on account of the receipt of applications which are inadequately completed or fail tb specify clearly the subject in which training is required. Needless to say, such inadequacies inevitably lead to delays, and sometimes to failure in securing placement, since the host institutions naturally give preference to candidates who supply all relevant information in time. Delays In releasing the fellows for studies a t the stipulated time and last-minute cancellation of candidatures of applicants also continue to cause disruption of the arrangements made with receiving institutions.

In general, fellowship awards continue to be a1 invaluable help to Member countries in building up the staff for training institutions, in improving the service programmes and, not least, in stimulating research.

8. REPORTS, TECHMCAL PUBLICATIONS, DOCUMENTS AND REFERENCE SERVICES

A gradual change in the pattern of WHO assistance in this region has had notable repercussions on the reporting, publications, document distribution and reference services of the Regional Office. This has been a trend (first visualized in the Sixteenth Annual Report) away from the assignment of long-term staff for projects such as specializ,ed campaigns against communicable diseases toward stress on the strengthening of basic health services, the organization of various types of educational meetings and the employment of more and more short-term consultants. This pattern of assistance has, in the past year o r two, become fully established.

SEA/RC22/2 Page 62

An important result has been a conspicuous increase in the number of reports being submitted to the Regional Gffice, technically reviaved, edit3d, issued as official o r informal documents and distributed. Also, with all of the training projects and the courses, seminars, etc., now being held, there are accompanying requirements for a substantial volume of documentation and reference services, and the need to provide and distribute more teaching material in greater quantity.

Thus, whereas, in the past, almost all of SEARO's reports, studies, etc. , have been mimeographed and only the occasional one has been issued in printed form, it has now been found necessary to print many more reports and teaching materials. An example was the recent Report of the Inter-country Workshop on the manning, Implementation and Evaluation of Health Education (held in 1967), 2000 copies of which were mimeographed and issued but which was so much in demand that 3000 more copies, along with 7000 copies of the Comprehensive Guidelines for manning, Implementation and Evaluation of Health Education, which were attached, have now been printed. Other reports and allied materials printed or under print during the period under review included a "Study Guide for Auxiliary Nurse-Midwives" (ale0 placed on sale), "Guide to the Study of Activities of Health Personnel in Hospitals", "Study of the Activities of Auxiliary Nurse-Midwives in Haryana, Punjab and Gujarat States, India", and reports on the Inter-country Nursing Conference (held in August-September 1967), the Regional Seminar on Health Statistics (October 1967), the Conference on Psychiatric Education (March 1968), the Meeting on the Teachbg of the Social Aspects of Obstetrics (Seflember 1968), the Meeting on Paediatric Education (October 1968) and the Seminar on Quality Control of Drugs (January 1969).

h addition, 153 reports (107 assignment and final reports, 26 field visit reports of Regional Office s t . and 20 miscellaneous reports) were issued as mimeographed documents. The list of reports issued during the period under review is given as Annex 9 to this report.

Some of the reports which were given especially wide distribution, in addition to those on the meetings mentioned above, were: (a) the Report on the Inter-regional Seminar on Food-borne Diseases and Intoxications and Food Hygiene Practice (held in October 1967); (b) the Report on the Inter-regional Seminar on Water Pollution Control (also held in October 1967); (c) "The Educational Approach in Planning and Implementation of Public Health Programmes" (report on a workshop conducted in Indonesia in August 1968), (d) the Report on an Inter-country Workshop on Training in Health Education (October 1968) and (e) the Report on the Course for Coding Instructors (held in November 1968).

Other work connected with reports included (1) the revision of those parts of the SEAR Handbook that concern reports and dissemination of technical information, apd (2) bringing up to date the lists of the reports issued since the inception of the Regional Office (1949) - a general list arranged according to subject as well as separate lists for reports on each country.

A revised edition of the "WHO Programme Guide" for the South-East Asia Region, originally issued early in 1968, was edited and distributed to Regional m e staff, all projects and other offices of WHO.

SEA/RC22/2 Page 63

Documents and Other Publications

In addition to the regular documentation for the Regional Committee (including the production of bound copies of the report and minutes of the twenty-first session, bound copies of the conclusions and recommendations arising out of the technical discussions and an up-to-date edition of the Handbook of Resolutions and Decisions of the Regional Committee), a Special Anniversary Booklet was brought out as a souvenir of the Twentieth h i v e r s a r y celebrations.

Two technical circulars were issued, one (No. TCIHEJ19) on health education in medical education, and the other (TC/NUR/7 Rev. 1) on the forth- coming establishment of a WHO fellowship centre for nurses at Wellington, New Zealand, in collaboration with the New Zealand Government. Wide distribution was also given to many documents, reprints and publications received from WHO Headquarters o r other sources outside the Regional Office.

Much effort was devoted to reviewing and enlarging the mailing list for distribution of documents on smallpox, and special arrangements were made with Headquarters to ensure that these documents are promptly despatched to field workers in the Region. Also, it was necessary, because of shortage of space, to screen stocks of all documents and publications kept in the Regional Office, to weed out obsolete material and to apply stricter criteria for retention, in order to make room for new and important publications.

Sale - Another means by which the Regional Office seeks to disseminate

technical information is its sales programme, through which it offers WHO and some ReGonal Office publications at low prices in order to bring them to the knowledge of, and within the reach of, workers in the Region.

In 1968, 12 000 copies of different WHO publications were sold on a retail basis, at a value of $7 489 (calculated at the 50% discount rate allowed to non-commercial purchasers). Also, subscriptions worth $G 756 (at the discount rate) were established.

The Regional Office prepared and widely distributed reviews of several WHO publications thought to be of special interest to countries of the Region; it also compiled an annotated list of WHO publications on the subject of radiology and another of publications related to general medical practice. Displays were arranged for eleven conferences, seminars and workshops. As a result, many orders for WHO publications were received.

The 1967 Supplement to the Catalobae of WHO Publications (compiled in the Regional Office) was widely distributed, and when the latest edition of the

SEA/RC22/2 Page 64

Catalogue itself was issued by Headquarters, 1500 copies were sent out, along with a leaflet giving information on the concessional rates offered in the Region.

The publication "WHO: Twenty Years in South-East Asia" has been reprinted and copies have been placed on sale.

The change in the pattern of assistance haa also affected the Library, in that it is now called upon to provide greatly increased reference and biblio- graphy services to many of the meetings being organized. Statistics collected also showed a considerably enhanced use of the library services and a marked increase in the number of requests for references.

To assist in planning, conducting and evaluating educational meetings, a "Materials Unit on Educational Methodology", organized by a WHO consultant, was set up ip the Library (see SEAR 0130 in Part UI). This unit contains books, pamphlets and reference materials.

The collection of current medical and scientific literature continued to grow. During the period under review, 1 240new books and pamphlets and 123 WHO publications were added to the Library, which now also regularly receives 237 current periodicals, 137 on subscription and others free or in exchange for WHO publications. The Library issued1 800publications on loan to Regional Office and field staff and provided about 5 200pages of photocopies.

Selected reference publications were displayed in the Library on the occasion of several meetings held in World Health House, and publications were also lent for use at VJIIC-sponsored meetings.

In view of the growing problems of lack of space in the Regional Office building, retention periods for old periodicals were fixed, and a number removed from the shelves.

A list of duplicate books available in the Library was sent to WHO Representatives' libraries and medical colleges in the Region, and subsequently over 400 publications were provided to various libraries.

Assistance was given to medical libraries in Ceylon in the procurement of cheap textbooks.

In the second half of June, the Regional Office Librariau visited Nepal for three weeks to assist in the organization of a medical library in Kathmandu (see section 7.3 above).

SEA/RC22/2 Page 65

P A R T I1

O R G A N I Z A T I O N A L A N D A D M I N I S T R A T I V E M A T T E R S

SEA/RC22/2 Page 67

1. THE REGIONAL COMMITTEE

The Regional Committee held its twenty-first session in World Health House, New Delhi, from 17 to 23 September 1968. Represenatives of Afghanistan, Burma, Ceylon, India, Indonesia, Mongolia, Nepal and Thailand attended the session. The United Nations, the United Nations Development Programme, UNICEF, FAO, and eleven non-governmental organizations in official relation with WHO were represented, and an observer from the Ford Foundation also attended, The Director-General was represented by an Assistant Director-General.

The Regional Committee set aside the first half day for the celebration of the twentieth anniversary of WHO, an anniversary which coincided with the twentieth anniversary of the Regional Organization for South-East Asia. The commemorative session was inaugurated by His Excellency the late Dr Zakir Husain, President of the Republic of India; other spmkers included Mr S a w a p l Sinha, Minister of Health, Family Planning and Urban Development of the Government of India, Dr Bernard, Assistant Circctor General a t Headquarters, and the Regional Director. A number of messages were received. Copies of the "The World Health Organization - Twenty Years in South-East Asia (1948-1967)", a publication issued by the Regional Office, were presented to participants.

The session itself was declared open by the retiring Chairman, Dr (Mrs) D. Tumendelger (Niongolia). Dr P. K. Duraiswami, Director-Cieneral of Health Services, Government of India, was elected Chairman and Dr P. K. Ratnasingham, Deputy Director of Health Services (PHs) Ceyloii, Vice-Chairman.

During the discussion on the annual report of the Regional Director, the Committee noted the changing trends in WHO'S work in the Region, from the original pattern of prolonged assistance to single-purpose programmes for the control of communicable diseases towards efforts to merge such programmes into strengthened general health services, and to provide ad&e by assigning more short-term experts. The need to Liprove education and training in qW'Jty and quality was recognized, and the increased assistance to group-training activities welcomed.

The Committee noted with concern the regression in some malaria eradication programmes. It expressed satisfaction at the increasing tempo of WHO'S assistance to national smallpox eradication, and recognized that in both malaria and smallpox programmes the development of an adequate health infrastructure was the most important requisite for achieving eradication, It therefore urged governments to give higher priority to the strengthening of their general health services and to the provision of adequate administrative and financial support to programmes for eradication o r control of communicable diseases.

Subjects discussed covered other communicable diseases (including measures for combating preventable diarrhoea1 diseases) and related subjects such a s vaccine production, health laboratory services, statistics, the need for better training in epidemiology and the importance of national and regional surveillance programmes.

SEA/RC22/2 Page 68

On the quality control of pharmaceutical and biological products, the Committee emphasized the necessity for VlHO's continued assistance in establishing regional or national control services.

The technical discussions on "National health planning as part of national economic development plans" aroused much interest. The conclusions and recommendations of these discussions, which this year took the form of a seminar, related mainly to the pre-planning stage of the national health planning process, the relationship of the health plan to the overall socio-economic plan, the necessity of setting up health planning units within ministries of health, the staffing of such units, the methodology of health planning, training programmes for the staff concerned, and manpower studies.

"Training of paramedical personnel in health centres" was selected as the subject for the technical discussions in 1969.

The Committee approved the proposed programme and budget estimates for the Region for 1970 for transmission to the Director-General.

Various resolutions of regional interest adopted by the Health Assembly and Executive Board were noted and discussed. The Committee confirmed its wish to adhere to its practice of meeting in the Regional Office in alternate years and its opinion that, for the sessions held elsewhere, host governments should continue to be asked to pay only the local costs inourred.

The Committee decided that its 1970 session would be held in New Delhi, and accepted the invitation of the Burmese Government to hold the twenty-fourth session, in 1971, in Burma.

2. ADMINISTRATION

2.1 General

During the year, the Regional Director paid official visits to varioug government authorities in Afghanistan, Ceylon, Indonesia, Maldives and several States in India. After attending the Executive Board's session in Geneva, in February 1969, he visited the WHO Regional Office for the Eastern Mediterranean in Alexandria, to familiarize himself with the procedures of that region. In May, on the invitation of the USSR Government, he, together with the Regional Director of the Eastern Mediterranean Regional Office, visited $e Soviet Union to see health work in that country,

The Director of Health Services in the Regional Office reviewed the WHO-assisted programmes in Indonesia. He attended a meeting of UNDP Resident Representatives for Asia and Far East, held in Nmila, at which UNDP Technical Assistance and Special Fund projects were discussed, and was a member of the group from the Regional Office which took part in an orientation course on family planning held in New York and elsewhere (see section 2.4).

The Chief, Office of Administration and Finance, and the Administrative Services Officer visited Nepal in February 1969 in connection with arrangements for the twenty-second session of the Regional Committee.

SEA/RC22/2 Page 69

Following on a resolution (2360) taken by the General Assembly cd the United Nations at its twenty-second session regarding the implementation of the recommendations of the Ad tIoc Committee of Experts to examine the fhmces of the United Nations and the specialized agencies, a ''Joint Inspection Unit" was set up by the United Nations, and members of this unit, individually as well a s jointly, visited the Regional a c e and some countries of this region to review the organizational procadures.

At the request of the Regional Director, the Chief of the Programme Evaluation Unit from Headquarters and a member of the Administrative Management Unit also came to the Regional Office to dtudy various aspects of programme formulation, evaluation and co-ordination. They recommended the establishment of a wPlanninp: Cell" and an 'tInforniatton Retrieval Unit!' in the Regional Office, with a view to increasing WHO% potential for programme evaluation and planning In the Region, and action has been taken to implement these recommendations.

Mr Milton P. Siegel, Assistant Director-General of WHO, accompanied by a member of the Administrative Management Unit from Headquarters, visited the Regional Cffice in April to acquaint the staff with the Organization's plans to develop an integrated manawment information system, in order to provide more accurate, precise and timely hformation to facilitate the decision-maldng processes throughout WHO.

The very large number of seminars and conferences, etc., which were organized during the period under review (see Annex 3) Lncreased the workload on the technical and the administrative units of the Regional Office.

2.2 Orgauizational Structure

As mentioned above, a Planning and Evaluation Unit has been created under the Director of Health Services, and for this purpose one additional professional post and a post for one secretary were approved. A post for a second Adviser on Maternal and Child Health was added. The post uf Regional Sanitary Engineer was redesignated as that of "Regional Adviser on Environmental Health (No.2)".

Out of the six posts shown a s vacant in the last annual report, four - those of the Senior Regional Malaria Adviser, Administrative Services Officer awl WHO Representatives to India and Afghanistan -- were filled. The posts of Sanitary Engineer (Malaria) and Information Officer continued to remain vacant but were expected to be filled very soon. In addition, the following posts fell vacant during the year; RB.gional Adviser on Medid1 Education; Malariologist; Health Statistician; Chief, Office of Administration and Finance; Medical Supplies Officer; Regional Adviser on Health Education; Entomologist (Malaria); Regional Adviser on Environmental Health,'and Regional Adviser on Health Statistics. Of these, the first five were filled(As the post of Chief, Office of Administration and Finance, was filled by the transfer af the Administration and Finance Officer, the latter post was also left vacant.).

An organizational chart is attached a s Annex 1.

SEA/RC22/2 Page 70

2.3 Personnel

Professional staff posted in the Regional Office are listed in the organizational chart mentioned above.

The geographical distribution of professional staff in the Region as on 30 June 1969 is shown in Annex 2. Additional countries represented this year are Austria, Chile, Ecuador and Iraq.

The following table gives the established number of professional and general service category posts and those actually filled as on 30 June, 1969, both in the Regional Office and in the field:

Established ms& Posts actuallv filled

0) Staff of the Regional Office

(a) Professional

Regional Office Regional Advisers WHO ~e~resen ta t ives l

(b) General Services

Clerical Custodial

(2) WHO Representatives ' Offices

Clerical 11 Custodial 10

(3) Proiect Staff

(a) Professional 215 13s2 (b) General Services 16 11

In addition, three professional staff members were 'on leave without pay at the end of June 1969.

'considered as a part of the Regional Office

'Three posts filled by short-term consultants

SEA/RC22/2 Page 71

The salary scales for the general service,category staff in Burma, Ceylon and Indonesia were revised during the year. Effective 1 January 1969, the salaries and post adjustments applicable to all professional staff were also revised.

2.4 Staff Training

Two staff members attended the Fifth Senior Staff Training Course, held at WHO Headquarters from 30 September to 1 November 1968, and threc took part in the sixth course, in May-June 1969.

Also, the increasing number of requests received for assistance in activities related to human reproduction in countries supportbg family planning programmes brought a need for staff training in this specialty. Seven staff members attended two orientation programmes on the health aspects of human reproduction, family planning and population dynamics, also held in Geneva, in October/November 1968 and hlarch 1969, respectively, and three took part in a training course on the co-ordinated approach to health aspects of family planning, organized by W E 0 Headquarters and held in New York in April-May 1969, followed by field trips to observe national family planning programmes in three countries.

Further, for the orientation of field staff on the Organization's policy in this regard and its application to field activities, the Regional Office, in collaboration with WHO I-leadquarters and the Government of India, started to make preparations for a series of orientation courses, to start in November l969.

In June, a staff member from the Programme Evaluation Unit a t WHO Headquarters conducted a short training course for selected general service staff on the proposed project information retrieval system.

2.5 Staff Welfare

The Staff Association continued to be active. As usual, the Association was represented on the Staff Health Insurance Surveillance Committee, Regional Meritorious Increase Committee and the Regional Board of Appeal.

The Regional Office dispensary was re-organized to provide more extensive health services to staff members.

Facilities were made available to the Staff Association for the arrangement of a number of film shows for staff members and their families, and space was found to enable some sports activities such as table tennis, volley ball, etc., to be resumed after office hours,

SEA/RC22/2 Page 72

2.6 Finance, Budget and Accounts

The total obligations incurred on field activities during the last five years, from both the Regular budget and UIqDP(TA ad SF) funds, were as follows:

Assistance from other funds and the obligations incurred were as follows:

Year

1964 1965 1966 1967 1968

The Staff Health Insurance Scheme continued to function satisfactorily for the ninth year. In all, 2 043 claims were settled during 1968, and the amount reimbursed Walled $32 167, as against $31 702 in r e s p c t of 2 231 claims settled in 1967. This increase was mainly due to rising costs of both medicd and dental care.

Source of Funds (expressed in US dollars)

The sale deed and lease agreement on World Health House are under negotiation with the Government of India and a re expected to be finalized; it is also hoped that the title to the ownership of the premises will be transferred to the Organbation shortly.

Regular (including allocation for malaria eradication and smallpox eradi- cation programmes)

2 753 216 3 211 581 3 484 183 4 385 132 5 357 057

i

Source of Funds (expressed in US dollars) Special Account for

UNDP (TA and SF)

1 549 977 1 187 717 1 585 578 1 251 083 1 648 563

1964 1965 1966 1967 1968

Total

4 303 193 4 399 298 5 069 761 5 636 215 7 005 620

Others

- 13 984 76 944 9 415 56 681

Total

308 503 37 572 113 019 105 802 175 758

Eradication

297 426 13 006 11 890 62 387 88 410

Water Supply

11 077 8 786 -

- -

- 1 896 15 000 34 000 30 687

- -

9 185 -

' -

SEA/RC22/2 Page 73

3. PROCUREMENT OF SUPPLIES ANil EQUIPMENT

During the period under review, supplies and equipment worth US5772 034, covering 5 548 items, were procured. These included laboratory equipment and chemicals, hospital and surgical supplies, drugs, vaccines, biologicals, teaching equipment, transport vehicles and, in a few cases, limited supplies of office equipment and stationery. Also, 2 692 medical books and periodicals costing US$37 586 were supplied. Supplies were also procured and handled on behalf of certain research institutions out of the WI-I0 grants to those institutions. A few institutions also availed themselves of the facility extended by WED to procure medical books and literature on a reimburseable basis.

Twenty-eight new requests under the Revolving Fund for the procurement of teaching and laboratory equipment were received, 21 of which were processed; the others were awaiting clearance by governments or advance deposits from the colleges concerned.

Tile numbers of doses of freeze-dried smallpox vaccine danated by Member Governments to the countries of the Region were as f o b s :

Afghanistan : 913 000 doses (from tine USSR)

Burma 75 600 doses (from Switzerland)

Indonesia : 2 550 000 doses (2 000 000 doses from the USSR, 250 000 from New Zealand, 200 000 from China (Taiwan), and 100 000 from Thailand

Nepal : 4 315 000 doses (from the USSR)

In addition to the above, jet smallpox vaccine was supplied - 100 000 doses to Afghanistan and 2 000 000 doses to Indonesia (both donated to WHO from the United States Emergency Reserve). Another 300 000 doses received from WHO Headquarters were sent to Burma.

In response to an urgent request from Malaysia, 250 000 doses of cholera vaccine donated to WHO by the Government of M i a were air-freighted to Kuala Lumpur.

For use in an immunization campaign in Cambodia, 30 000 doses of cholera vaccine, which had been donated by the Government of Ceylon and stored in.New Delhi, were sent to that country.

In order to combat an epidemic of gastro-enteritis in Maldives, steps were taken to send urgently-needed curative and preventive drugs. In addition to the drugs purchased in Colombo by the WHO Representative to Ceylon, 666 bags of normal saline, 50 000 tablets of sulphadimidine, 15C litres of Ringer's lactate solution and 100 litres of chloramphenicol syrup were procured in India and air- freighted to Male.

SEA/RC22/2 Page 74

An epidemic of gastro-enteritis was also reported from Nepal, and 300 000 doses of cholera vaccine from the USSR were immediately suppli~d; also, 8 000 capsules of tetracycline were procured locally from Wlhi and sent to Kathmandu.

4. COLLABORATION WITH OTHER AGENCIES

4.1 United Nations

Co-operation with the United Nations continued to be very close during the year. Attendance a t various inter-agency meetings was conducive to further- ing this collaboration. The twenty-first session of the Regional Committee also helped to bring about closer contacts with the United Nations and its related specialized agencies. Opportunity was taken of a visit to New Delhi of the Under Secretary-General of the United Nations to explore avenues of assistance to country health programmes and, notably, World Bank collaboration in different national water suppIy schemes.

Within the mandate given by the World Health Assembly, co-operation was maintained with the United Nations in the field of family planning. The Regional Office co-operated with the United Nations Family Planning Mission which visited India, and advice was given on the health aspects of this programme as well as those relating to maternal and child welfare.

4.1.1 United Nations Development Programme IUNDP)

Assistance was rendered to UNDP staff during the course of their visits to various WHO-assisted projects.

Continuous consultations with the Resident Representatives of the UNDP by the WHO Representatives in the different countries, a$ well as by WHO Regional Office staff, helped in formulating gov.ermentst requests for new programmes for 1969-1970 to be financed out of UNDP funds. Contacts were also maintained concerning proposed UNDPJSF assistance in the fields d quality control of drugs and repairs to electro-medical equipment in Jndia, water supplies and local production of DDT in several countries of the Region and uf Brucella vaccine in Mongolia.

The Regional Office was represented at the Regional Meetlng of the UNDP Resident Representatives in Asia and the Far East, which was held in Manila in February.

Discussions were held in New Delhi with the UNDP Protein Mission to India.

SEA/RC22/2 Page 75

The visit of the Director, Bureau of P l u g , UNDPHeadquarkrs, to the Regional Office in March led to a useful review of UNDP/WHO collaboration in health programmes under both the TA and SF sectors. Discussions were also held with the Deputy Administrator and Assistant Administrator of the Programme when they passed through New Delhi on their way to Manila to attend the meeting mentioned above.

4.1.2 Economic C o m m i ~ i o n for Asia and the Far East (ECAFE)

WHO participated in several meetings organized by ECAFE, including its 24th Session, held in Singapore in April, and the Fourth Meeting of the Asian Regional Group of the Advisory Committee on the Application of Science and Technology to Development, which took place in Bangkok in August 1968.

Close collaboration was maintained with the Asian Institute for Economic Development and Planning, Bangkok, in the field of health planning. WHO continued to be represented on the teaching faculty of the Institute. A staff member of the Institute assisted with the technical discussions on national health planning held during the twenty-first session of the Regional Committee. The Institute also lent one of its economists for the WHO-sponsored group discussions on national health planning, in March 1969. Preliminary discussions were held with the Institute on the f i r s t course in national health planning scheduled for November 1969.

Contact was maintained with the Asian Development Bank with regard to its potential role in the health field.

4.1.3 United Nations Children's Fund (UNICEF)

Stress is being laid on even closer co-operation with UNICEF in order to attract a still greater percentage of UNICEF partxipation in health programmes. The UNICEF Executive Board meeting held in May highlighted this need, at the same time providing an opportunity for discussions on projects jointly assisted by the two organizations.

Regular contacts were maintained with the UNICEF Regional Offices in New Delhi and Bangkok, as also with individual country offices, on projects jointly assisted by WHO and UNICEF.

The WHO Chief Medical Adviser to UNICEF in New York attended the UNICEF regional meeting held in Bangkok. WHO also participated as an observer in the UNICEF country representatives' met ing held in New Delhi in October 1968.

WHO assisted the International Children's Centre, Paris, in holding a seminar on paediatric education in India. Similar assistance was given to the Centre in organizing a seminar on tuberculosis in Afghanistan. For both meetings, WHO fellowships were awarded to participants from the aountries of this region.

SEA/RC22/2 Page 76

4.1.4 International Atomic Energy Agency (IAEAl

Close liaison has been continued with the IAEA 3egional Office in Bangkok through the WHO Medical Officer attached to the inter-regional project "Assistance to National Radiation Health Programmes" and the WHO Representative to Thailand.

WHO co-sponsored with IAEA an inter-regional "Seminar for Asia and the Far East ofi Radiation Protection Monitoring7', which was held in Bombay in December 1968, The WHO Representatives in Burma, Indonesia arid Thailand gave assistance to the IAEA Travelling Seminar on Food Irradiation, which visited these three countries.

The visit of an IAEA official in connection with the location'of a nuclear power plant in Thailand provided an opportunity for further contacts,

The principal aim of consultation continued to be the avoidance of possible duplication in both organizations' programmes of assistance.

4.1.5 United Nations Institute for Training and Research (UNITAR)

The WHO Representative to Thailand participated in the UNITAR Seminar on Techniques and Procedures of United Nations Technical Assistawe, held in Bangkok in March 1969.

4.1.6 World Food Promamme (WFQ

WHO has co-operated with the World Food Programme in connection with a special feeding project for pre-school children and pregnant and lactating mothers in Ceylon. Technical advice was also given on the healtl- aspects of other different WFP-sponsored programmes. WFP assistance in the fields of water supply, improvement of hospital facilities and malaria eradication programmes in Nepal, India and Ceylon, respectively, was explored during the visit of a WHO Headquarters consultant and the WHO Liaison Officer to the programme in October 1968 (for details, see section 6.6, "Nutrition").

4.2 Specialized Agencies

4.2.1 Food and Agriculture Oripnkzation (FAO)

Applied nutrition programmes in various countries of the Region again provided specific fields of co-operation with FAO.

WHO also gave technical advice on the health aspects of FAO-assisted irrigation projects, inclding advice on environmental sanitation aspects of the FAO-assisted Trisuli Watershed Development Project in Nepal.

SEA/RC22/2 Page 77

4.2.2 Unitdd Nations Educational, Scientific and Cultural ' Or~anization (UNESCO)

Collaboration with UNESCO continued generally and in particular on the project "Experimental World Literacy Programme" in Nepal and the experimental programme in Ceylon for the creation and development of a national network of institutions for the education of out-of-school youth.

WHO took part in the UNESCO-sponsored Conference on the Application of Science and techno log^ to Development in Asia (CASTASIA), held in New Delhi in August 1968.

Advice was given to the UNESCO Representative in Nepal at both the country and Regional Office levels concerning the UNDP literacy project in that country.

4.2.3 International Labour Organization (LO)

During the year, the Regional Adviser of ILO visited the Regional Office, where fruitful discussions were held regarding fields of mutual interest and on avoiding duplication of efforts, especially in the field of occupational health. The World Health Day theme for 1969, "Health Labour and Productivity", chosen by WHO in honour of the Fiftieth Anniversary of E O , provided an occasion for strengthening collaboration.

4.2.4 World Bank

WHO staff in Ceylon and in the Regional Office assisted the Government of Ceylon in negotiations with the World Bank on the Bank's assistance to water supply and sewerage schemes in the south-west coastal areas of Ceylon.

4.3 Non-Governmental Organizations in Relation with WHO

The President of the International Society for Rehabilitation of the Disabled, who paid a visit to New Delhi during the third quarter of 1968, was assisted in his discussions with the Government of India for effecting stronger co-operation and liaison with the International Society. WHO staff also participated in the Sixth Meeting of the Eastern Region of the International Union Against Tuberculosis, held in Kuala Lumpur in November 1968.

As for co-operation with national o r regional affiliates of the international non-governmental organizations, WHO was represented at the Sixth National Conference of the Indian Academy of Paediatrics, held in Lucknow in February 1969, and was actively associated with the holding of a seminar on pediatric education sponsored by the Academy. It was represented at the Third World Conference on General f iactice, sponsored by the Indian Medical Association and held in New Delhi in November 1968. The Regional Office took an active part in the Regional

SEA/RC22 /2 Page 78

Family Planning Conference sponsored by the Indonesian Planned Parenthood Association and the International Planned Parenthood Federation, held in Bandung. It was represented a t the International Seminar on Maternal Mortality, Fpmily Planning and Reproduction, jointly sponsored by the International Federation of Gynaecology and Obstetrics and the Peaeration of Obstetrics and Gynaecological Societies in India (see also section 6.2). Regional Office staff continued to maintain close relations with other organizations such a s the Trained Nurses Association of India, the Indian Association for the Advancement of Medical Education, the Nepal Medical Association, the Mian Medical Association, Hind Kusht Nivaran Sangh (the Indian Leprosy Relief Association), the Indian Public Health Association, the Indian Dental Association, and the Indian Federation of United Nations Associations; various conferences organized by these organizations were attended and assisted by WHO staff. The WHO Wison Officer in Mongolia participated in the thirtieth anniversary celebrations of the Mongolian Red'Cross Society, to which a message of goodwill was sent by the Regional Director.

4.4 Inter-governmental and Bilateral Agencies

4.4.1 Colombo Plan

Close co-operation was, as usual, maintained with the Colombo Plan in connection with the award of fellowships (see section 7.2), and with particular reference to the assistance in radiation protection being given by New Z e a h d to Thailand (see also Thailand 0067 in Par t m).

Co-operation with USAm continued, especially in work on malaria. Preparations in connection with the proposed "International Conference on Community Water Supply", to be held in India in the latter half of 1969 with help from USAID, provided an opportunity for mutual collaboration. Discussions were held with USAIDofficials on assistance to governments in family p 'hning and health education. Co-operation in malaria programmes continued.

4.4.3 Others

Advice and assistance were given to the Government of Ceylon on the use of supplies and equipment provided by the Federal Republic of Germany in connection with the malaria eradication programme.

During the visit of a Japanese investigation team to Nepal in March, the WHO Representative to that country held technical discussions with the team on the nature of assistance to be prwided by Japan in the health field.

Suggestions for possible Swiss co-operation and assistance in the field of health to the countries of the Region were submitted through WHO Headquarters.

The WHO Representative to Indonesia gave advice to CARE in their programme in the fields of school health, family planning, immunization, nutrition education and general hospital care. Collaboration with CARE was also maintained ia Afghanistan in the field of nursing.

SEA/RC22/2 Page 79

4.5 National and Other Azencies

As usual, a very large number of meetings of national g4vernmental and voluntary agencies was attended by various V l X 0 staff members. These included, for example, the annual meetings of the Expert Groups/hdvisory Committees of the Indian Council of Medical Research, held in Nwember-December 1968 in New Delhi.

In the field of leprosy, co-operation was maintained with the Danish stsave the Childrens' Organization, as also with Emmaus Suisse, the Order of Malta and tho Deutches Hllfswerk f u r Aussatzigen. These organizations participated in the WHO-assisted leprosy seminar held in Nepal in March.

An important meeting organized during the year was the Asian Regional Conference of the World Confederation of Organizations of the Teaching Profession, which was held in Indonesia in April 1969 and was attended by the WHO Representative in that country.

5. PUBLIC JNFORMATIDN

The information media th rou~h which the Orgaaization attempts to reach the public have essentially remained the same through the years, namely: press, publicztions, radio and televisicn, films, lecturcn and exhibits. Efforts nn: concentrated on increasing the output to these media and are directed towards stimulating them to producc materfal of their own on matters pertaining to health and the World Health Organization. The Regional Office not only has acted as the disseminator, within the Region, of information received from WHO Headquarters but also has made information on the Region available to Headquarters and, through Headquarters, to the other countries in the world. Towards this end, a number of activities werc undertaken during the year,

Press - The twenty-first session of the Regional Committee in September 1968,

(coinciding with WH3's Twentieth Anniversary), United Nations Day 1968 and World Health Day 1969 prwided excellent opportunities for transmitting valuable information to the press, not only by means of the printed word but also in the form of photographs. The Regional Committee alone accounted for ten out of a total cd about fifty press releases put out during the period under review. World Health Day material on the theme "Health, Iabour and Productivity" was distributed not only in English as received from WHO Headquarters but also in a Hindi translation prepared under the auspices of the Regional Office. The response of the press was gratifying.

Other press releases covered various educational meetings held in the Regional Office in New Delhi and in different countries of the Region. A series of releases on WHO-supported training facilities was issued during 1968&69. Press notes covered appointments of WHO Representatives and otl~er events. Features in Eindi were also issued on a regular matllly basis.

SEAjRC22/2 Page 80

In following up a visit to India and Ceylon by a staff member from the Division of Public Information in Geneva, a team of journalists from India, the Netherlands, the United Kingdom and the USSR visited Ceylon in May 1969 to report for their newspapers on the water supply project undertaken in co- operation with UNDP.

Newspaper men, radio correspondents and photographers calling on or writing to the Regional Office were supplied with information or aided in obtaining interviews with participants in various meetings organized or assisted by WHO.

Publications

Following the publication of a WHO information folder in Burmese, Hindi and Mongolian, a Thai version was distributed on the occasion of World Health Day 1969.

Co-operation with Headquarters in its publication, tVVJorld Healtht1, has been intensified a s a result of a visit to India by the Chief, Press and Publications, from Headquarters. An article, "Youth in Indiatt, appeared in the July issue of this periodical. The M i a n family planning programme and other regional topics are to be covered in future issues.

Radio and TV

The radio and television coverage of the Regional Committee's session and the Twentieth Anniversary celebration was highly satisfactory. A recording by the Regional Director on the health problems of South-East Asia was broadcast by various stations in the countries of the Region. The "Voice of America", BBC and other networks covered the Regional Committee meetings; they also held interviews with regional participants in various educational meetings. The World Health Day message of the WHO Director-General was broadcast in most countries of the Region, and thc national celebrations this year received ample radio and television time. On many occasions, the press releases issued from this office wcrc included in news broadcasts.

Films and Photographs

A script writer from an independent film production unit in London was assisted in collecting material in India and Thailand for a contemplated film on the theme of World Health Day 1969.

Films listed in the WHO Film Catalogue were circulated on a loan basis among educational institutions, health services and other private organizations. Films and filmstrips were also secured in support of various activities of the Regional Office.

During the reporting period the Public Information Officer visited Burma, Monesia and Thailand, to become better acqwinted with the health situation in these countries and with WHO/field projects, and also to meet members of the press, radio and TV and to intensify contacts with United Nations Information

SEA/RC22/2 Page 81

Centres. To collect material for a new feature series on WHO International Reference Centres in India, to be issued in 1968-69, hc also visited Coonoor and Calcutta. These trips were also useful in enabling a photognphic record to be made of some of the work of WHO; as a result, approximately 250 negatives were added to the photo files of the Regional Office.

k c t u r e s and Exhibits

Talks on WHO were given to groups af visitors to World Health House.

For World Health Day, three-dimensional folding-type exhibits were prepared for display in most countries of the Region. It is hoped that for next year's World Health Day this type d exhibit can be mass-produced for wider distribution.

SEA/RC22/2 Page 83

P A R T I11

A C T I V I T I E S U N D E R T A K E N B Y G O V E R N M E N T S

\F71TH T H E H E L P O F W H O

SEA/RC22/2 Page 85

PROJECT LIST

This part of the report contains a list of the projects for which WHO has given assistance during the whole or part of the period under review, listed by country. A short review of health developments during the year is also given for each country. Inter-country and inter-regional projects are listec! a t the end,

In general, projects for which no active assistance, in the form of field staff, fellowships or supplies, was given during the period covered are not included. Also omitted from the list are projects for which technical advice from the Regional Office or Headquarters was the only assistance given, and projects assisted only by grants-in-aid.

In the first column (under I1Project No., Source of Funds, Co-operating Agenciest1) "Rtl means the Regular budget; UNDP(TA) and UNDP(SF) mean the Technical Assistance Fund and the Special Fund respectively of the United Nations Development Programme; IIUNICEF" the United Nations Children's Fund, and "USAID" the United States Agency for International Development, Names of co-operafig aenc ies , except for UNICEF, whether or not they have contributed funds, are given in parentheses. In the seccmd column, under the title of the project, the starting and, where relemnt,finishing dates are shown within brackets,

The "Aim of the project" states the purpose for which it was undertaken by the government concerned, and is not related to the form or extent of WIIO1s assistance.

Projects entitled llFellowshipslt list those which do not form part cf assistance to a larger project; other fellowships are shown under the projects concerned.

It should also be noted that there are a number of projects not included in the list for which UNICEF is furnishing supplies and WHO technical advice only (with no special personnel being provided).

View of the Hindukush

m-vJF#q?z- y---4F r ... < -

SEtIfiC22 /2 Page 87

1. AFGHANISTAN

Generally, the economic situation remalned static maidy on account of the inability to meet export targets and also because of the necessity to rely, to a considerable extent, on domestic and foreign loans for ,development. However, the expectadon of an increased influx of private investment, a s well a s government aid, particularly to export industries, gave rise to optimism with regard to the future of the economy.

The overall budget for Afghan year 1347 (6 100 million afghanis) (US $81.3 million) showed an increase of more'than 15% over that of the previous year. However, the budget of the Ministry of Public Health rose by only 6%, to 116.4 million (US $1.6 million). There was, however, an additional '(development" bdge t for health purposes which was increased from 13.9 million to 58 million afghanis.

There was a marked effort on the part of the Government to plan future programmes on a realistic' pattern in accordance with the country's ability to absorb aid. This feature, together with financial strhgencies, led to an overall revisibn of the Third Five-Year Development Plan (covering the period up to March 1972), which was tailored to balance between needs and the resources available; this, of course, affected the plans of the Ministry of Public Health.

The amount of bilateral aid remained high, although less so than in previous years and not up to what was expected for the beginning of the third plaMing period; this situation also led to the need to revise the plan,

In view of the low level of literacy, particularly in the rural areas, a significant development was the enactment of a statute making i t compulsory for all children between 7 and 13 years of age to attend school. This was considered to be a prelude to the greater involvement of the women of the country in social welfare activities.

The Government agreed to a three-year plan of action for the strenghening of health services, covering the remaining three years of the third development plan. This plan of action, based on the master plan drawn up last year with the help of WHO and UNICEF, covers three provinces and envisages the bolstering of the provincial health administration so that it may exercise increased supervision over the health centres being established a t the district level. These activities are coinciding with th'e beginning of the consolidation phase of the malaria eradication campaign.

A number of senior appointments were made at the ministry level in order to strengthen the development and supervision of the health network at the periphery. These included a director of the Bureau of Basic Health Services, a senior medical officer to act as liaison officer between the Ministry of Public Health and the Rural Development Department, and an adviser on maternal and child health in the new Bureau of Child Health. A spccial tuberculosis cell was also established to ensure that the national tuberculosis programme would be carried out more purposefully a s part of the general health services.

The Public Health Institute, Kabul, was very active in undertaking essential epidemiological investigations of major communicable diseases, giving guidance for control measures, and organizing numerous training and orientation courses for health personnel.

Notable developments in the period under review were the preparation of a new plan for national community water supply and sanitation and the formulation of a request to UNDP(SF) for a water supply and sewerage scheme for Greater Kabul, including the esbrblinhment of n,respnnsible authority. In the field of maternal and child heaIth services, the assistance given by WHO and UNICEF over a period of years was evaluated, and consideration was given to the feasibility of developing nutritim activities within the maternal and child health services.

It was encouraging to note the increasing sig-118 of evaluation and follow- up of previous WHO-assisted projects in Afghanistan, The desire to analyse the reasons for suocesses or failures of the past aad to take such experience into conaideration when planning for the future was a major step fonvard.

SEA/RCZZ/Z

Page 89

PROJECT LIST

ProJect No.

Source of Funds

Go-ooerat i n s

U e n c i e s T i t l e

~f Rhanistan 0011

R

UNICEF

Malaria Erad ica t ion

(nug. 1756 - )

A i m of t h e p r o j e c t . To e r a d i c a t e malar ia and t o prevent t h e re-es tabl ishment of

endemicity.

Ass is tance provided by WHO durinp, t h e yea r . ( a ) Three m a l a r i o l o g i s t s , an entomologis t ,

t h r e e s a n i t a r i a n s , two l abora to ry t e c h n i c i a n s , a secre tary-s tenographer and a c l e rk -

t y p i s t ; ( b ) s u p p l i e s , equipment and two t r a n s p o r t v e h i c l e s .

Probable d u r a t i o n of a s s i s t a n c e . Un t i l t h e end of 1774.

Work done dur ing t h e yea r . There was no change i n t h e phasing of t h e programme. During t h e y e a r about 3l7$ of t h e population a t malar ia r i s k was i n a r e a s under t h e consol idat ion

phase and t h e remainder i n a r e a s i n t h e a t t a c k phase. Routine malar ia e r a d i c a t i o n

a c t i v i t i e s continued. Ass is tance was g iven i n e s t ima t ing supply requirements f o r the

programme and t e c h n i c a l approval was accorded f o r t h e cont inuat ion of UNICEF'S

commodity a s s i s t a n c e (during 1970. I n October 1968, a gene ra l review of t h e programme

was undertaken i n o r d e r t o draw up d e t a i l e d p lans t o r phasing. A r ev i sed d r a f t plan

of ope ra t ion was prepared and i s under cons ide ra t ion by t h e Government.

During t h e period from August 1768 t o January 1969 , 2 5 ) 565 blood smears were

examined from a reas i n t h e a tcack phase, and 135 659 from those i n t h e conso l ida t ion

phase, r e s p e c t i v e l y . Of t h e s e , 5 830 and 508 r e s p e c t i v e l y turned ou t t o be p o s i t i v e .

P e r s i s t e n t t r ansmiss ion continued i n t h e Kunduz a r e a of t h e Northern Region. This u n i t ,

which is i n t h e a t t a c k phase, accounted f o r 5 258 of t h e 5 830 p o s i t i v e s mentioned

above. The s l i d e p o s i t i v i t y r a t e f o r t h e whole of t h e a t t a c k phase a rea dur ing t h i s

period was 2.38,whereas f o r iiunduz a lone i t was 8 .J$ . Among t h e reasons f o r t h e

p e r s i s t e n t t r ansmiss ion i n Kunduz were changes i n a d r i c u l t u r a l p r a c t l c e , l ead ing t o

a v a i l a b i l i t y of new a rophe l ine breeding Ulaces. Spec ia l epidemiological and

entomological i n v e s t i g a t i o n s revealed t h a t t h e susprc ted vec to r A. Dulcherrimus was

s t i l l s u s c e p t i b l e t o DDT, t h a t A. hyrcanus, not a proved vector,was a l s o p reva len t ,

having an in t e rmed ia te l e v e l of r e s i s t a n c e , and t h a t t h e d e s i r a b l e remedial measures

should include improved spraying coverage, advancement of t h e spray-cycle , a n t i - l a r v a l

measures i n t h e r i c e f i e l d s , c o n t r o l of i r r i g a t i o n p r a c t i c e s , improved l abora to ry

s e r v i c e s and r a d i c a l t rea tment of p o s i t i v e cases . Other a c t i v i t i e s were geographical

reconnaissance i n a r e a s served by newly e s t a b l i s h e d u n i t s , and t h e r e g u l a r spraying

round, c a r r i e d ou t du r ing t h e l a t t e r ha l f of t h e period under review.

SEA/RC?Z/Z

Page 10

With regard t o t r a i n i n g a c t i v i t i e s , a two-month t r a i n i n g course f o r r e c r u i t s

was held f o r 40 s u r v e i l l a n c e a g e n t s , and a similar course f o r 13 microscopis ts . A

t r a i n i n g course f o r a l l c a t e g o r i e s of supe rv i so ry s t a f f was a l s o completed i n t h e

Northern and Centra l -Eas tern Regional Headquar ters , wi th emphasis on geographical

reconnaissance.

Afghanistan 0013 Medical Education

R ( J a n . - Aug. 1952; Sept . 1953 - )

A i m of t h e prodect . To s t r eng then departments of t h e F a c u l t i e s of Medicine of t h e

Unive r s i t i e s of Kabul and Nangarhar, t o develop t each ing p r o g r a m s , and t o

t r a i n s t a f f .

Ass is tance provided by WHO dur ing t h e yea r . ( a ) A consu l t an t i n o b s t e t r i c s ;

( b ) Four twelve-month f e l lowsh ips f o r s tudy i n t h e United S t a t e s of America, a twelve-

month f e l lowsh ip f o r s tudy i n I r a n and a nine-month f e l lowsh ip f o r s t u d i e s i n the VNted

Kingdom and I r a n .

Probable dura t ion of a s s i s t a n c e . U n t i l t h e end of 1973.

Work done durinp: t h e yea r . A consu l t an t i n o b s t e t r i c s was ass igned f o r a period

of t h r e e months from March 1367 t o s tudy t h e o b s t e t r i c educat ion programmes i n t h e

medical schools a t both undergraduate and post-graduate l e v e l s , wi th p a r t i c u l a r regard

t o t h e t each ing of t h e s o c i a l a spec t s of t h i s d i s c i p l i n e and t o a s s a s s i n g t h e country ' s

I'uture needs f o r o b s t e t r i c s p e c i a l i s t s . ice al.so demonstrated modern t each ing and

eva lua t ion methods. H i s r e p o r t Was under s tudy.

A v i s i t i n g p ro fesso r i n p a e d i a t r i c s was expected t o s ta r t an assignment i n

huglist 1969.

Afghanistan 0024 Health Education

R (Oct. 1958 - Sep t . 1959; May 1962 - Nov. 1966;

April-June 1968; ~ u l y 1969 - )

A i m of the p ro jec t . To develop h e a l t h educat ion s e r v i c e s ; t o promote h e a l t h educat ion

i n t e a c h i r - t r a i n i n g es tabl ishments : t o t r a i n h e a l t h s t a f f i n h e a l t h educa t ion , and

t o e s t a b l i s h and develop a h e a l t h educat ion u n i t .

Ass is tance provided b3' WHO dur ing t h e yea r . ( a ) A c o n s u l t a n t ; ( b ) s u p p l i e s and equipment.

Probable d u r a t i o n of a s s i s t a n c e . U n t i l 1970

Work done durinR t h e Year. A consu l t an t took up a three-month assignment i n J u l y i n

o rde r t o a s s i s t i n making plans f o r t h e f u r t h e r developrrent of h e a l t h educat ion

s e r v i c e s and t o fo l low up on t h e a c t i v i t i e s c a r r i e d out and planned dur ing t h e v i s i t

of thu consu l t an t provided i n 1968.

S E A / R C ~ ~ / ~

Page 9 1

A f g h a n i s t a n 0026 R u r a l H e a l t h

UNDP(TA) ( A p r i l 1956 - Dccembor 176111.

UNICEF

A i m of t h e p r o j e c t . To f u r t h e r t h e development ol' r u r a l h e a l t h s e r v i c e s i n t h e whole

c o u n t r y on a un i form p a t t e r n , i n which c ; l r a t i v e and p r e v e n t i v e s e r v i c e s a r e in tegra tur !

a t a l l l e v e l s and e f f e c t i v e l y d i r e c t e a and s ~ l p e r v i s e d ; t o t r a i n p e r s o n n e l .

A s s i s t a n c e p r o v i d e d by WHO d u r i n ~ t h c y e a r . ( a ) ,I p u b l i c h e a l t h o f f i c e r , a s a n i t a r i a n

and a p u b l i c h e a l t h n u r s e ; (b) A fivc-and-a-quartor-month f e l l o w s h i p f o r r t . jd i t .5 11:

New Zealand and I n d i a .

Work done . I n a s s o c i a t i o n w i t h t h e M i n i s t r y of P u b l i c H e a l t h , a t h r e e - y e a r p l a n of

a c t i o n f o r t h e development of b a s i c h e a l t h services i n t h e p r o v i n c ~ s of Baghlan ,

Kapisa and Pakt ia was deve loped . E f f o r t s were c o n t i n u e d t o upgrade t h e Shewaki

H e a l t h Cent re as a f i e l d p r a c t i c e a r e a f o r t h e t m i n i w of h e a l t h p e r s o n n e l and a l s o

f o r t r a i n i n g a d e q u a t e n u m b ~ r s of n u r s i n g p e r s o n n e l r e q u i r e d f o r t h e b a s i c h e a l t h

S e r v i c e s . The n u r s i n g s e r v i c e s p r o v i d e d by t h e Cent re and t h e s u b - c e n t r e s a t t a c h e d

t o i t were upgraded w i t h t h e a s s i s t a n c e of t h e p u b l i c h e a l t h n u r s e . Envi ronmenta l

s a n i t a t i o n a c t i v i t i e s c o n t i n u e d t c nnke s a t i s f a c t o r y p r o g r e s s , p a r t i c u l a r l y w i t h

r e g a r d t o t h e p r o v i s i o n of s a f e w a t e r s u p p l i e s . The l a b o r a t o r y t e c h n i c i a n a t t a c h e d

t o t h e l a b o r a t o r y a t t h e Cent re xorked under' t h e g u i d a n c e o f t h e P u b l i c H e a l t h

I n s t i t u t e , Kab,ll . T h i s l a b o l ~ a t o r y i s b e i n g deve loped as a "woleswali" h e a l t h u n i t

l a b o r a t o r y .

A f g h a n i s t a n 0031.1 I n s t i t u t e of' P u b l i c H e a l t h , Kabul

R ( A p r i l - Kay 1756 ; Nov. - Dec. 1958; March - May 1961;

UNICEF Kay 1 7 6 2 ; Aug. 1962 - )

A i m o f t h e p r o j e c t . To d e v e l o p t h e I n s t i t u t e o f P u b l i c H e a l t h f o r s e r v i c e ,

r e s e a r c h and t h e t r a i n i n g of p u b l i o h e a l t h worker:;.

A s s i s t a n c e p r o v i d e d by WHO d u r i n g t h e y e a r . ( a ) A p u b l i c h e a l t h o f f i c e r , a 3 t a t i s t i c i a n

and a l a b o r a t o r y t e c h n i c i a n ; ( b ) t h r e e f e l l o w s h i p s - two of t w e l v e months and one of

t h r e e months - f o r s t u d y i n I n d i a , two f e l l o w s h i p s - one of s i x weeks and one of two

weeks - f o r s t u d y i n I r a n , a twelve-month f e l l o w s h i p f o r s t u d y i n Czechos lovakia and

I r a n , and a f ive-month f e l l o w s h i p f o r s t u d y i n Y u g o s l a v i a , Denmark and I n d i a ;

( c ) s u p p l i e s and equipment .

P r o b a b l e d u r a t i o n of a s s i s t a n c e . U n t i l t h e cnd o r 1774

* E f f e c t i v e 1 J a n u a r y 1969 , t h i s p r o l e c t was merged w i t h A f g h a n i s t a n 0059,

"Development o f B a s i c H e a l t h Services", indc , r which t h v a c t i v i t i e s w i l l

be c o n t i rxird.

SEA/RC>2/?

Page 9; :

Work done d u r i n g t h e y e a r . The I n s t i t u t e was v e r y a c t i v e i n i n i t i a t i n g

e p i d e m i o l o g i c c ~ l f i r l r l in; .cs t ig; i t iuns. S t a d i ? s w i r s made of ou tbreak ; of' s m a l l p o x ,

typhus and d i p h t h e r i a and w i r c f o l l o w e d by c o n t r o l measures . S e r o l o g i c a l s u r v e y s

of t h u j l r e v a i l i n g d i s e a s e s wcre c o n t i n u e d i n Kabul C i t y , and t h e s c r a examined a t t h ~ .

WHO Serum R e f e r e n c e Bank, Prague .

A c h o l e r a s i i r v e i l l a n c e programme was s u c c e s s f u l l y deve loped a t t h e P u b l i c

H e a l t h Institute, and a p o t e n t i a l c h o l e r a o u t b r e a k n e a r t h e b o r d e r was p r e v e n t e d .

WHO s u p p l l e d two m i l l i o n d o s e s of c h o l e r a v a c c i n e .

I r l A p r j l , t h e r e g i o n a l e n t c r i c i n f e c t i o n s team a s s i s t e d i n t h e conduct of a

t r a i n i n g c o u r s e o n c h o l e r a s u r v e i l l a n c c f o r p r o v i n c i a l m d i c a l o f f i c e r s . The f o u r t h

c d i t i o n o f t h e c h o l e r a s u r v e i l l a n c e document was t r a n s l a t e d i n t o t h e D a r i l anguage

and d i s t r i b u t e d t o medica l o f f i c e r s .

A typhus s u r v e i l l a n c e programme, i n c l u d i n g s t u d i e s of l o u s e r e s i s t a n c e t o

DDT, was c a r r i e d o u t i n Ghazni and Logar P r o v i n c e s .

The c u t a n e o u s l e i s h m a n i a s i s s u r v e i l l a n c e programme was pursued i n 1 9 6 9 , w i t h

an e n t o m o l o g i c a l s t u d y of f o c i o f l e i s h m a n i a s i s d e t e c t e d d u r i n g 1967-1968 and c a s e -

f i n d i n g i n t h e a r e a s covered by D m d u s t i n g d u r i n g t h e 1768 s p r a y i n g programme.

Wi th in t h e framework of t h e m a s t e r p l a n f o r t h e s t r e n g t h e n i n g of h e a l t h

s e r v i c e s , a p l a n of a c t l o n f o r t h e phased develoyment of t h e h e a l t h l a b o r a t o r y

componer~t h a s bcen prupari .d , undcr t h c tcr'ms of which s e v c n ( , e r i p h s r a l 2nd f o u r

I ' r o v i n c i a l l a b o r a t o r i t : ; w i l l r e c e i v e UNICEF a s s i s t a n c e i n 1967-70.

The t r a i n i n g of l a b o r a t o r y t e c h n i c i a n s was improved; t h e S c h o o l o f Medical

L a b o r a t o r y Technology no\: h a s 2 l a b o r a t o r y f o r p r a c t i c a l c l a s s c s . The R u r a l

Development Department h a s a p p r l v e d p l a n s and f m d s f o r t h e c o n s t r u c t i o n of a l a b o r a t c r y

d e m o n s t r a t i o n c e r i t r c i n Shewaki . A s c m i n a r was h e l d f o r t h e t r a i n i n g of l a b o r a t o r y

t e c h n i c i a n s f rom t h e provinces, and a m u a l for ' u s e by p r o v i n c i a l l a b o r a t o r i e s h a s

beer: compiled i n the: Dard l a n g u a g e . The WHO m i c r o b i o l o g i s t t c m p o r a r i l y a s s i g n e d t o t h e

Ip ro j rc t l e f t e a r l y i n August 1 7 6 8 , and e f f o r t s wera u n d e r way t o p r o v i d e a ri:placement.

The Statistical S e c t i o n of t h e I n s t i t u t e compiled and i s s u e d t h e h o s p i t a l

i n - p a t i e n t r e p o r t s f o r Shamsi y e a r s 1346 and l j 4 7 . A d m i n i s t r a t i v e r e p o r t s on s t a f f i n g

and a c t i v i t i e s of h e a l t h c e n t r e s wcre i s s u e d each q u a r t e r . The d a t a on t h e m u l t i -

purpose h e a l t h s u r v e y i n Kabul , c a r r i e d o u t i n 1966-67, were transferred t o punch c a r d s

and t a b u l a t e d .

The S e c t i o n conduc ted a c o u r s e on h e a l t h r e c o r d s and r e p o r t s and t o o k a n a c t i v e

p a r t i n o r i e n t a t i o n c o u r s e s and s e m i n a r s . WHO f e l l o w s h i p s wcre awarded t o s i x s t a f f

members t o undergo t r a i n i n g i n medica l c o d i n g i n I r a n .

The Head of t h e S e c t i o n p a r t i c i p a t e d i n t h e Course f o r Coding I n s t r u c t o r s

(SEAR0 016'7) .

The WHO s t a t j s t i c l a n completed h i s ass ignment i n J u n e

A f p h a n i s t a n 0 0 j 1 . 2 I n s t i t u t e df P u b l i c 8 ~ ~ 1 t h . Kabul

I3 ( T r s i n l n g i n S a n i t a r y En>;ineerlnp;r

UNICE? (,Paly 1766 - Oct. 1767; o c t . 1768 - )

A i r ? of. thi: p r o J c c t . To ru i r i fo rc . . tl:, t i ? a c h l n g c S s a n i t a r y e n g i n e e r i n g s u b j e c t s

i n t h e c i v i l eng inecr i r .& co?trsu ;t t h e d n d e r g r a d u a t e l u v c l .

A ~ s i s t a n c ~ p r o v i d e o by WHO d z r l n g t h e y e a r . h s a n i t a r y e n g i n e e r .

Probable d b r a t i o n of nssis t ; i r ic , . U n t i l t h e end of lY(0 .

Work donc d u r i n g t h e year.. Tra l r i ing a c t j v i t i t s i n s a n i t a r y i n g i n e e r i n g wcre c e n t ? r ? d

o n t h e Col legu of E r a i n e < i r r r ~ g . 'Tn i r ty - fax? seni , : r s t ; l d u n t s completed t h e i r t r a i n l n g

and wcre s u c ~ z s s f i i l jn t h i i ~ f i n a l e x a m i n a t i o n s . The WHO s a n i t a r y e n g i n e e r who t o o k

up h i s d l l t i c s i n October a s s l s t e d i n y l t t i n g i n t o o p e r a t i o n t h e sewage t r e a t m e n t p l a n t

s e r v i n g t h e m i v e r s i t y a r e a , i n s t a l l i n g f low-met r r and c h l o r i n a t i o n u n i t s , and rnkin;

n f c c s s a r y arrsngt-ments f o r wattxr and sewage a m l y s i s a t t h e l a b o r a t c r y .

A f g h a n i s t a n 0033 T u b d r c u l o s i s Advisory S e r v i c e s

WDPITA) (J .JIC - Dec. 1 9 5 8 ; J u n s - J u l y 1 7 6 1 ;

UNICEP Eov. 1962 - Parch 1 9 5 4 ; March 1965 - 0 . : ~ . 1 - )

A i m of t h e p r o j e c t . To i : x p n d t , ~ b ~ r c ~ l o s i s c o n t r o l s ~ ~ r v i c c s i n and around Kabul s n a

I n t h c p r o v i n c e s , w i t h i n thr: framework of t l ~ c dev.:loping b a s i c h e a l t h s e r i i c t , s , axd to

t w i n h e a l t h personnel i n tilt n e c e s s a r y technique-;.

A s s i s t a n c e prov ided by WHO d u r i n g t h e y c a r . A mecilcal o f f i c e r .

P r o b a b l e d u r a t i o n of a s s i s t a n c e . U n t i l t h e end of 1974.

Work done d u r i n g t h e y e a r . I n Kabul , where t h c s c h o o l - c h i l d r e n had bci-n g i v c n BCC

v a c c i n a t j o n i n 1965 , a l l ncw s c h o o l i : n t r ~ m t s (and most sct!ool 1t.auers) havc s i n c t but.n

covrr , ,d i n a n n u a l v a c c i n a t i o n r,ol;n*ls. The v a c c i n a t i o n c o v c r a g r of newborns and i n f a n t s

th rough t h e m a t e r n i t y and c h i l d h e a l t h s c r v i c z s ir. Kabul , however , h a s been l i n i t c d .

h t s i d e Kabul , t h e pr ,e-school and s c h o o l c h i l d r e n of s e v e r a l p r c v i n c i a l towns h2ve beer

covered s y s t e m a t i c a l l y , and v i s i t i n g teams f rom t h e Chaman T u b e r c u l o s i s Cent re have

t r a i n e d g e n e r a l h e a l t h workcr,s i n t h e d l r a c t v a c c i n a t i o n procedur,: and i n t h e tuchnlqsc:r

of r i i r e c t sputum smear, c:isi:-finding and ambula tory treatment of ncwly d e t c c t i d c a s e s .

Under t h e p p r s c n t n ; i t i o n a l h c a l t h p l a n , t u b i ? r c u l c s i s c o n t r o l i s mad,? an i n t e g r a l

p a r t cf t h e b a s i c h c a l t h s e rv i ce s , e s p e c i a l l y i r i the rural a r c a s . The o b j e c t i v e s ,

methods, t e c h n i q u e s anu approaches of c o n t r o l were d i s c u s s e d a t l e n g t h a t a seminar on

t u b e r c u l o s i s c o n t r o l , sr jonscrcd by t h e I n t e r n a t i o n a l C h i l d r e n ' s C e n t r e , P a r i s , v h i c h

was h e l d i n Kabul i n A p r i l 1969. The WHO medica l o f f i c s r a t t a c h c d t o t h e i n t c r - c o u n t r y

? v a l u a t i o n team ("EAR0 0113) a c t i v z l j r participated i n t h e scminal ' and f e l l o w s h i p s wer,.

awarded f o r t h e p a r t i c i p a t i o n of t u b i r c u l o s i s workcrs f rom o t h e r c o u n t r i e s o f t h e

Region. UNICEF and t h e International Union A g a i n s t T u b e r c u l o s i s a l s o prov ided ass i s t? .ncc .

S E A / R C ~ ~ / ~

Page 9'1

I n t h e l i g h t o f t h e conclus ions a r r i v e d a t du r ing t h e seminar , t h e p lan of

ope ra t ion f o r tube rcu los i s c o n t r o l is being r ev i sed and, subsequent ly , a d e t a i l e d p lan

of a c t i o n is t o be developed i n c l o s e c o l l a b o r a t i o n wi th t h e n a t i o n a l a u t h o r i t i e s

concerned. In preparation f o r the new p lan , tile medical o f f i c c r of t h e rueiondl team

lert f o r Afghanistan i n J u l y 176') t o a s s i s t w l th t h e t r a i n l r ~ ~ of supervisory t c a m t o

be posted i i t h e t r r u o provinces i n which thc b a s i c h a a l t h 6crvi3us a r c b ~ n g

s t r e r . g t l ~ r n ~ d ir;.! .ir.ti-rr. l , ,velopir i .

The nrdic:tl i f f i c e r cf t h e p ro jec t completed h i s assignment i n Octcber.; a

reglacement was L;ndcI' r'ccri,tll!cnt.

Afghanistan 0032 Nursing Advisory Se rv ices

UNDP(TA) (June 1957 - )

A i m of t h e prcJ&. To s t r eng then nurs ing admin i s t r a t ion a t n a t i o n a l and l o c a l

l e v e l s , t o dcvelop nurs ing and midwifery educat ion and t o co-ordinate and expand

nurs ing educat ion and t h e nurs ing s c r v i c e s .

Assistance-,~ro_yided by WHO dur ing t h e yea r . ( a ) A nurs ing a d v i s e r and two nurse

educa to r s ; assi .5tanca from t h e publ ic h e a l t h nur se ass igned under p r o j e c t

Afghanistan 0059; ( b ) two ten-month f e l lowsh ips f o r s tudy i n I n d i a and a twelve-month

fe l lowship f o r s tudy i n t h e United S t a t e s of America; ( c ) s u p p l i e s and equipment.

Probable dura t ion of a s s i s t a n c e . U n t i l t h e end of l n 4 . -----

Work done d ~ c i n g the ycar . Continued a s s i s t a n c e has been given t o t h e planning and

dcve1opni:nt uf tho nur s ing component of t h e h e a l t h s e r v i c e s . The WHO nur s ing a d v i s e r ,

through he r n a t i o n a l c o u n t e r p a r t , who i s t h e Chief Nurse, Minis t ry of Publ ic Heal th ,

has advised on a i l is!:ecu- u r m u s i n g s e r v i c e and educat ion. The Board of Nurses

prepared an o u t l i n e f o r t h e c o n s t i t u t i o n of a n a t i o n a l nu r ses ' a s s o c i a t i a n , which i s now under c o n s i d ~ r a t i o n by t h e Minis t ry of Pdblic Health.

The WIiO nurse educators continued t o a s s i s t w i th t h e development of educat ional

programmes f o r a l l ca t egor i e s of nurs ing personnel. There has been c l o s e co-operation

not only wi th t h e n a t i o n a l nurses but wi th nurses of o t h e r i n t e r n a t i o n a l and b i l a t e r a l

o rgan iza t ions . T ra in ing f o r w o r n nurses cont inues a t Mastoorat and Shararah

Hosp i t a l s , and f o r male nurses a t Aliabad H o s p i t a l , t h e t o t a l number of s tuden t s being

98 men and 152 women.

Tra ining of a u x i l i a r y nurses and a u x i l i a r y nurse-midwives has been given

a t one school i n Kabul and i n s i x schools i n t h e provinces , t o a t o t a l of 78 men

and 56 wov.en.

The development of publ ic h e a l t h nurs ing s e r v i c e s under t h e p r o j e c t "Development

of Basic 1 1 ~ ~ 1 t h Sc;.ulces" (Rlghanis tan 0059) i s proceeding g r a d u a l l y , a s s i s t a n c e being

given by t h e WHO publ ic h e a l t h nurses on c l i n i c a l p r a c t i c e a r e a s f o r s tuden t nurses and

a u x i l i a r y n u r z u - ~ i d w i v f s , t h e l a t t e r be ing prepared f o r work i n r u r a l h e a l t h c e n t r e s .

i h r t h e r e f f o r t s w i l l be made t o iclprovs t h e h o s p i t a l nLrslng s e r v i c e s i n

Kabul and t h c provinces and towards t h e dcvclopment of a b a s i c minimum curr icu lum f o r

t h e t h r e e s choo l s of mrsiw. I n t h e Nursing Div i s ion of t h e Min i s t ry of Public

Hea l th , 2 t t m t i o n w i l l bi: pivi,r; t o s'lort 2nd long-range p lanning t h a t w i l l l e a d t o

improved s tani ia rds of nursin; s i ; rvjct , and i ,ducat i sn 2nd u l t i n a t e l y t o t h e i n t r o d u c t i o n

of c o n t r o l s and l c g i s l 3 t i o n f o r i jur.sirZ p m c t i i ' a .

I n March l?o?, 23 heaa r'lrsi:; z t t ended a :short course conducted a t t h e Publ ic

Heal th I n s t i t u t e unde: t ' le j,.-o?'c,:t SX!J:O 0137, "Short Courses f o r Nursing Personnel".

Two male nur.si:s w?rc nw3r.dr.d l'~~llc!!sli:ip5 f c r .I puil l ic h e a l t h n u r s i n g course i n I n d i a

d u r i n g 1 7 6 0 . Two nu:,ses .!ttinaed t : ~ ! in t e r - coun t ry workshop on n u r s i n g l e g i s l a t i o n

and l i c e n s i n g f o r p r z c t i c e , h t : i i i r : llcw Dclhi i n March 1363. ( s e e a l s o p r o J e c t

Afghanis tan 0 0 6 8 ) .

Afghanis tan 0042 ? e n t a l Ii.eaLt&

R (J:in. 1969; - )

A l m of t h e DroJuct . To dcvclor, n i n t a l h c a l t h s r r v k c e s and t o t r a i n n a t i o n a l personnel .

Ass i s t ance provided by WHO dur ing t h e y e a r . A twelve-month f e l l owsh ip f o r s tudy i n

t h e United Kingdom.

Afghanistan 0044 - Trachomn Ccnt ro l

R (idly - .run,? 1958; Sept . - Oct. 1762; J u l y 1369; Apr i l - MLLY 1 7 6 4 ; July 1365 - May 1367; Feb. 1968; Sen t . 1968; - )

A i m of t h e p r o j e c t . To s t , ~ d y t h e epidemiology of trachoma i n Kerat Province and

t o extend t h i s s tudy t o o t h e r a r e a s i n which t h e e x i s t e n c e of trachoma has been

ind i ca t ed by t h e h e a l t h s n r v i c e s ; t o i n i t i a t e c o n t r o l a c t i v i t i e s ; t o develop a

programme of h e a l t h vducat jon i n . ol!u?unicablc eye d. s e a s c s , and t o t r a i n s ta f f .

Ass i s t ance provided &-1.i;ig-~:~.:~:;&t_h!~,~ip~~. A thre i -month f e l l o w s h i p f o r s tudy

i n I n d i a .

Afghanistan 0054 UlDP(TA)

A i m of t h e p r o j e c t . To devcloy a s r : l l l p o r c o n t r o l programme; t o p lan f i e l d

epidemiologica l i n v e s t i g a t i o n s of t h e insjol, p r e v a i l i n g communicable d i s e a s e s o t h e r

t h a n smal lpox, and t o t r a i n personnel i n e p i d e m i o l o ~ and c o m n i c a b l e - d i s e a s e c o n t r o l .

Ass i s t ance ,mcd&be ,!:,'i?-~jUr~;y-t&~~yc~. A medical o f f i c e r and a s s i s t a n c e from

the pub l i c h e a l t h nurse a s s i ~ n r d u n l r r p r o j e c t Wghan i s t an 0064.

SEA/RC72/2

Page 76

Work done. WHO a s s i s t a n c e s t a r t e d i n 1962 u n d e r t h e i n t e r - c o u n t r y s m a l l p o x

e r a d i c a t i o n ;md cpidenl io1,Jgical a d v i s o r y team (ZiAiiO 0 0 3 0 ) . A WHO n ~ c d i c a i a l i ' i c c r

was a s s i g n c d i n J u l y 1 7 6 4 , and e f f o r t s were d i r e c t e d f i r s t towards t h e p r o v i n c e s cC

Kabul , Ghrzni. , Wardak and Zabul , t h e programm* l a t e r b r i n g ex tended t o 1:aplss.

Dadakstian . Samangun , Bnghlan , Tskhar , Wghman , Xunliuz , Chakansur' , Ghor and Hcra t

W o v i n c r s , w i t h emphasis on c o v f r a g c of t h e p r e - s c h o o l and s c h o o l - c h i l d p o p u l a t i o n .

A WHO c o n s u l t a n t (p rov ided u n d e r SEffiO 0136) v i s i t e d t h e c o u n t r y i n ~ o v e m b c r /

December 1766 and a d v i s e d o n a long- te rm p l a n f o r s t a r t i n g a s m a l l p o x e r a d i c a t i o n

progranrte.

Thc p r u d e c t was c l o s l - l y c o - o r d i n a t e d w i t h t h c s m a l l p o x e r a d i c a t i o n p r o j c c t

( A f g h a n i s t a n 00641, w i t h which i t was merged i n J a n u a r y 1 9 5 9 .

A f g h a n i s t a n 0056 P r o v i n c i a l Materna l and Chi ld H e a l t h

UNDP(TA) S e r v i c e s and T r a i n i n g

UNICEF ( A p r i l 1766 - 1

A i m cC t h c p r o j e c t . To develor, m a t e r n a l and c h i l d h f a l t h s e r v i c e s and r e l a t e d

a s p e c t s o f t h e t r a i n i n g yrogrammt f o r h e a l t h p e r s o n n e l i n t h e p r o v i n c e s .

A s s i s t a n c e prov ided by WHO d u r i n ~ t h e y e a r . A m a t e r n a l and c h i l d h e a l t h o f f i c e r ,

a c o n s h ~ l t a n t and a s s i s t a n c e f rom t h e p u b l i c h e a l t h n u r s e p r o v i d e d u n d e r p r o J e c t

A f g h a n i s t a n 0059.

Probable d u r a t i o n of a s s i s t a n c e . U n t r l t h e cnd o f 1769.

Work done d u r i n g t h s yt iar . >"it t h c e n t r a l l r v i l , s major s t e p towards improved

a d m i n i s t r a t i o n and o r g a n i z a t i o n of m a t e r n a l and c h i l d h e a l t h s e r v i c e s was t h e

B e s i g n a t i o n , i n August 1768, of t h e n a t i o n a l Materna l and Chi ld H e a l t h Advise r as thr: Director-General of Materna l and C h i l d H e a l t h and Family Guidance. I n t h e

p r o v i n c e s , an e n c o u r a g i n g f c a t u r e was t i lc s t r o n g s ; r p p o r t l e n t by l o c a l a u t h o r i t i e s

t o t h e dcvclopmcnt of nbatcrnnl and c h i l d h e a l t h s e r v i c e s w i t h i n t h e i r a r e a of

i n f l u e n c e . I n c o n s u l t a t i o n w i t h t h e WHO m a t e r n a l and c h i l d h c a l t h o f f i c e r a p r o p o s a l

f o r a t h r e s - y e a r p l a n f o r t h e dcvclopment o f tti.: :+.ti.rnal -~nd Chi ld Hcii l th Dur::a:i and the

m a t e r n a l snd c h i l d h e a l t h s t r v i c c s i n t h e p r o v i n c e s was d r a f t e d , and h a s been a c c e p t e d

by t h e GovurnmenC. However, f i n a n c i a l s t r i n g e n c y and s h o r t a g c o f f e m a l e p e r s o n n e l ,

. i s p e c i u l l y f-or s e r v i c e i n t i le p r o v i n c e s , a d v e r s e l y a f f e c t e d t h e e a r l y i m p l e m e n t a t i o n

o f t h e o b l u c t i v f s of t h c p r o j e c t .

I n o r d c r t o h e l p meet t h e problems e n c o u n t e r e d , a WHO c o n s u l t a n t w i t h

e x p e r i e n c e i n t h e o r g a n i z a t i o n of f a m i l y p l a n n i n g a c t i v i t i e s a s an i n t e g r a l p a r t

of ina te rna l and c h i l d h e a l t h s e r v i c e s was a s s i g n e d f o r t h r c c months f r o m t h e m i d d l e

of Apr,il 1969 t o a s s i s t t h e Govcrnntent i n a r ?~yryr.ois31 of p a s t a s s i s t a n c e g i v e n by

WHO and UNICEP and t o a d v i s e o n t h e s t r e n g t h e n i n g of t h c Materna l znd Chi ld H e a l t h

' 4 3 r d l l . , , . ! ~ c a h l s t l n , r ~ i ; t of ~ p ~ , i o l ~ : L i , : , i n :.I ; , : t irvt,I .<,!~n;,~lt oi a ph:i:;,ii programme f o r matci.nal ond c h i l d h c a l t h s c r v i c c s o v e r t h e coming y e a r s . The r e p o r t o f t h e

c o n s u l t a n t was u n d e r rev iew i n t h e R e g i o n a l O f f i c u .

S E A / R C ~ Z / Z

Page TI

Ths two WHO p u b l i c h c a l t h n u r s e s a s s i g n e d u n d e r p r o j e c t A f g h a n i s t a n 0059

c o n t i n u e d t o a s s i s t i n t h e devclopnlent of m a t e r n a l and c h i l d h e a l t h s e r v i c e s i n t h e

p r o v i n c e s and i n t h e r t i r a l t l , a i n i n g a r e a a t S h i w a k i , ?.no a l s o i n t h e t r a i n i n g of

h e a l t h pursonriel f o r thcs r : s e r v i c e s .

The WHO m a t e r n a l and c h i l d h c a l t h o f f i c e r a s s i g n e d t o t h e p r o j e c t i n A p r i l 1966

l e f t i n Decembcr 1969 on c o m p l e t i o n of h i s a s s i g n m e n t .

A f ~ h a n i s t a n 0057 Envr ronmcnta l H e a l t h [ w a t s r Supply),

R ( J u n e 1 ~ 6 6 ; Nnv. 1768 - Fzb. 1767; - )

A i m of t h e p r o j e c t . To c a r r y o u t s t u d i e s r e l a t e d t o a w a t e r r e s o u r c e s development

p r o j e c t , b e i n g a s s i s t e d by t h e Uni ted Nat ions Development P r o g r a m ( S p e c i a l F u n d ) ,

p a r t i c u l a r l y i n E l a t i o n t o c c m m n i t y w a t e r s u p p l i e s , and t h e a c t u a l o r p o t e n t i a l

h e a l t h h a z a r d s i n t h e p r o j e c t a r c a .

A s s i s t a n c e prov ided by WHO d u r i n g t h e y e a r . Two : o n s u l t a n t s i n s a n i t a r y e n g i n e e r i n g .

Probable d u r a t i c n of a s s i s t a n c e . U n t l l 1772

Work done d u r i n g t h e y e a r . The two c o n s u l t a n t s , a s s i g n e d f r o m November 1968 t o

F e b r u a r y 1 7 6 9 , a s s i s t e d i n c o l l e c t i n g n e c e s s a r y d a t a and f o r m u l a t i n g a d r a f t r e q u e s t

f o r UNDP(SF) a s s i s t a n c e w i t h a w a t c r s u p p l y , sewcrage and d r a i n a g e scheme f o r Kabul.

The d r a f t p r e p a r e d by t h o c o n s u l t a n t s was ri.vlc.wc,d i n t h e l i g h t of t h e l a t e s t changcs

i n p rocedure f o r s u c h p r o j e c t s , and was s u b m i t t e d t o t h e Government. S t e p s have bcun

t a k e n t o f i n a l i z e t i u s r e q u e s t i n c o n s u l t a t i o n w i t n t h e Government.

A f g h a n i s t a n 0059 Development o f B a s i c H e a l t h S e r v i c e s

R ( A p r i l - May 1 7 6 5 ; March 1766 - )

UNICEF

A i m of t h e r r o j e c t . To e s t a b l i s h b a s i c h e a l t h s e r v i c e s t h r o u g h o u t t h e c o u n t r y based

o n a n i n t c g r a t c d approach w i t h t h e m a l a r i a e r a d i c a t i o n s e r v i c e s f r o m t h e b e g i n n i n g

of t h e c o n s o l i d a t i o n p h a s e , and on t h e c r i t e r i a a?d g u i d e l i n e s l a i d down i n t h e

m a s t e r p l a n of o p e r a t i o n ; t o e n s u r e a d c q u a t e s u p e r v i s i o n and g J i d a n c e t o t h e h e a l t h

p e r s o n n e l i n t h e b a s i c h c a l t h s o r v i c e s t h r o u g h s t r e n g t h e n e d p r o v i n c i a l h e a l t h

a d m i n i s t r a t i o n ; t o f'drther t h e development of t h e h e a l t h a s p e c t s of r u r a l d e v e l o p m ~ n t

p r o j c c t s i n t h e wholc c o u n t r y , a n d Lo t r a i n p e r s o n n e l .

A s s i s t a n c e p r o v i d e d by WHO d u r i n g t h c y e a r . ( a ) a p u b l i c h e a l t h o f f i c e r , two s a u -

t s r l a n s and t u n c ~ i b l i : h c s l t i ~ ?.~,r.s..t; ( b ) Two f e l l o w s h i p s - one f o r t w e l v e months

and one f o r s i x months - f o r s t u d y i n Lebanon; ( c ) s u p p l i e s and equipment .

Probable d u r a t i o n of a s s i s t a n c e . U n t i l t h e end o f 1975.

BEA/RG22/2

Page 78

Work done during t h e year . The master plan of operat ion f o r t h e s t rengthening of

hea l th se rv ices (mentioned i n the l a s t Annual Report) has been accepted by tile

Oovernmnt i n p r inc ip le .

An important f e a t u r e dur ing the year was thc development of a three-year

plan of a c t i o n , based on t h e c r i t e r i a l a i d down i n t h e master p lan , f o r t h e development

of bas ic h e a l t h se rv ices i n t h e t h r e e Provinces of Baghlan, Kapisa and Pakt ia .

Increased budgetary a l l o c a t i o n wos provided. In Baghlan, two h e a l t h cen t rcs and s i x

sub-centres were cons t ruc ted , and i n t h e Andraab h e a l t h c e n t r e a smallpox and BCG

vaccinat ion p r o g r a m was organized a n d c a r r i e d out s a t i s f a c t o r i l y i n ou t ly ing v i l l a g e s

with thi. co-operation of the r u r a l development p ro jec t o f f i c e r . A study f o r the

i n t e g r a t i o n , on a p r i o r i t y b a s i s , cf t h e smallpox and malaria e rad ica t ion and the BCG

vaccinat ion a c t i v i t i e s with t h e Pas ic h e a l t h se rv ices was i n i t i a t e d . The public hcalt i l

nurses a s s i s t e d i n the nurs ing aspects of t h e bas ic h e a l t h se rv ices i n t h i s project

as wel l as i n t h e r u r a l develo~ment p ro jec t s ( see a l s o Afghanistan 0 0 5 6 ) .

Afghanist an 0061 Central Authority f o r Housing and Town

R Planninn , KabuL

UNDP(SF)* an. 1967 - 1

A l m of t h e p ro jec t . To a s s i s t wj th s a n i t a r y engineering aspects-of t h e work of the

Central Authority f o r Housing and Town Planning.

Assistance provided by WHO d u r i m t h e Year. A s a n i t a r y engineer.

Probable durat ion of a ss i s t ance . Unt i l the cnd of 1972.

Work done d u r i n ~ the year . The f i r s t ro .~nd of thc water q u a l i t y con t ro l s u r - e y i n

Kabul was completed, and, based on t h e r e s u l t s , t h e second round was i n i t i a t e d . The

Authority was a c t i v e l y engaged i n conducting su rveys , i n ca r ry ing out design work f o r

i ts p r i o r i t y proJeots and i n explor ing t h e p o s s i b i l i t i e s f o r the l o c a l manufacture 01'

ch lo r ine . A study of a s p e c i a l project Tor s a n i t a t i o n of a wholesale and r e t a i l fond

warehouse and i t s environs was conducted, and p r iva te a s s i s t a n c e T o ~ i t s implementation

was promised. Plans were prepared f o r the cons t ruc t ion of municipal swimming pools

i n order t o avoid t h e use of pol luted r i v e r water f o r bathing purposes. A nine-week

schedule of weekly seminars on s tandards f o r t h e l o c a l design of water supply and

sewerage p ro jec t s was arranged f o r engineers of the Water Supply Department. Assistance

was given t o m b u l Municipali ty i n i t s scheduled l e c t u r e s f o r i t s s a n i t a r i a n s .

Proposals were drawn up f o r t h e c o w t r u c t i o n of a small a b a t t o i r and a meat shop.

*A UNL)P(SP) p r o j e c t , f o r which the United Nations i s t h c Executing Agency.

SEA/RCZZ/Z

Page 99

Afahanis tan 0064 smallpox Eradication

R ( r s r c h 1367 - )

A i m of t h c Pm.'e:t. To dcvelop a n a t i o n a l s m l l p o x e r a d i c a t i o n pmgramme and t o

t r a i n uersonnel .

-rovlded b y a O _ l g L ~ t h e y e a r . ( a ) Two medical officers, a pub l i c h e a l t h

nu r se and a n u r s i n g t e c h n i c l t n ; ( b ) s . ~ g p l i e s and equipment; ( c ) payment of subs idy .

Probable d u r a t i o n o f - . ~ < s ~ . 1 c i . , . I n d c f i n i t ~ .

Work done d u r i w t h e ycz~y. Upon t h e nierger of p r o j e c t Afghanis tan 0054 wi th t h i s

p r o j e c t i n January 1969, a p lan of o p e r a t i o n was s igned by t h e Government and by WHO,

i n accordance wi th which t h e coun t ry has been d iv ided i n t o f o u r zones , each wi th a

zona l o f f i c e and d i r e c t o r a t e , a d a c e n t r a l d i r e c t o r a t e f o r smallpox e r a d i c a t i o ?

provid ing f o r o v e r a l l d i r e c t i o n and co-ordina t ion of t h e programme. Two zona l o f f i c e s

hav i been s e t up i n Kmdahar nnd K,.lnduz. Orea tur a t t e n t i o n was paid t o t h e t r a i n i n g

of s t a f f , and , i n Korch 1969, a WHO-assisted t r a i n i n g cou r se f o r smallpox e r a d i c a t i o n

s u p e r v i s o r s was arg.?nizcd i n Kartdalar. A four-week j o i n t ~ave rnmen t /WH~ assessment of

t h e progranme, t o e v a l u a t e progress a s w e l l a s t o fo rmula t e recommendations f o r

f u r t h e r development of a c t i v i t i e s , was s t a r t e d i n J u l y 1965. During t h e p e r i a d under

review, c a s e - n o t i f i c a t i o n and outbreak-containmsnt measures s t e a d i l y improved; one of

t h e ep idemio log i s t s a t t ached t o t h e i n t e r - c o u n t r y S m l l p o x E r a d i c a t i o n and

Epidemiologica l Advisory Team (SEAR0 0 0 j 0 ) paid s s v t r a l v i s i t s t o t h e p r o j e c t t o

a s s i s t i n p l a n n i r ~ the f u r t h e r ex t ens ion of t h e o r g a n i z a t i o n neces sa ry f o r t h e campaign,

and c l o s e l i a i s o n cont inued t o bu :naintained wi th n a t i o n a l and WHO s t a f f working a t

t h e Publ ic Hea l th I n s t i t u t e , Kabul. On? of t he WHO medical o f f i c e r s l e f t i n June 1969.

ATnhanistan 0066 Community Water Supply and S a n i t a t i o n *

R (NOV. 1966 - )

A i m of t h e p r o j e c t . To develop a n a t i o n a l envi ronmenta l h e a l t h programme through

t h e promotion of a n environmental s a n i t a t i o n u n i t w i t h i n t h e Minis t ry of 2uL:i: Eealtb;

t o assist t h e v a r i o u s governmcnt agencies concerned i n t h e p lanning and imp lcnen ta t ion

of a n a t i o n a l and long-term prograrme of community water supply 2nd waste disposal.

Ass i s t ance provided by WHO d u r i n g t h e y e a r . [ a ) A s a n i t a r y eng inee r ; [ b ) an one-month

f e l l o w s h i p f o r s t ~ d i e : : h L?d:a 2nd ThslWnd: (;) s u p p l i e s a M a@lP~pnent.

Probable d u r z t i o n of a s s i s t a n c e . U n t i l t h e end of 1974.

*Previous t i t l e : "Rural Watur Supplyu

SEA/RC22/2

Page 100

Work done d u r i n g t h e y e a r . The r u r a l ' wa t e r supply u n i t of t h e Rura l Development

Department t ook a l e a d i n g p a r t i n t h e development of t h e r u r l l wa t c r supply orogramme.

'Iko procmmmes f o r t h o c s r r c n t Afghan y e a r were approved and implemented, onc t o

c s t a b l i s t ~ twelve r u r a l water supply schemes and t h e o t h e r t o i n s t a l l 200 l o c a l l y nude

hand-pumps. The performance of t h e i n s t a l l e d hand-pumps was r e g u l a r l y checked; watcr

sys tem f a c i l i t i e s were des igned f o r two new g e n e r a l h o s p i t a l s under c o n s t r u c t i o n i n

Fa izabad and Taloquan, and t h e WHO s a n i t a r y e n g i n e e r v i s i t e d s e v e r a l p rov inces i n

connect ion w i t h t h e c o n s t r u c t i o n of r u r a l wa t e r supp ly schemes.

A p r o g r a m ? c o n s i s t i n g o f t h r e e s t a g e s - p r e l i m i n a r y e n g i n e e r i n g , d e s i g n and

c o n s t r u c t i o n - was developed f o r t h e e s t ab l i shmen t of r u r a l w a t c r supp ly schemes.

Ass i s t ance t o t h e Min i s t ry of Educat ion i n de s ign ing s a n i t a t i o n f a c i l i t i c s f o r s choo l s

i n Kabul and i n t h e provinces was con t inued , i n c o l l a b o r a t i o n wi th UNESCO. The WHO

sanitarf eng inee r and s t a f f working i n p r o j e c t Afghanis tan 0059 a s s i s t e d i n conduct ing

an i n - s e r v i c e t r a i n i n g programme f o r pos t -g r adua t e s a n i t a r i a n s .

Afghanistan 006L School of Radiography

R [ k g . 1968; J a n . - Feb. 1969; - )

A i m of t h e p r o j e c t . To a s s i s t t h e School o f Radiography i n Avicenna H o s p i t a l ,

Kabul, m d t o t r a i n personnel .

Ass i s t ance prcvidud by WHO durinK t h e year. ( a ) A rad iography t u t o r f o r f o u r weeks;

(b) two f e l l o w s h i p s - one f o r twelve months and one f o r twenty- four months - f o r s t u d y

i n I n d i a , and a twelve-month f e l l o w s h j p f o r s t u d y i n Germany; ( c ) s u p p l i e s m d

fquip i len t . Probable d z r a t i o n 01' 2ccl:tancu. U n t i l t h e ,nd cf 1774,

Work done di lr ing t h e yea r . Pending t h e comple t ion of t h e R a d i o l o g i c a l I n s t i t u t e a t Avicenna H o s p i t a l , Kabul, a WHO c o n s u l t a n t was a s s igned f o r approximate ly f o u r weeks

i n January - February 1969, t o a s s i s t i n t h e o r g a n i z a t i o n of r e f r e s h e r c o u r s e s f o r

t r a i n e d r ad iog raphe r s . During t h i s a s s ignmen t , he a s s c s s c d t h e s i t u a t i o n w i t h r ega rd

t o t h e t r a i n i n g of r a d i o g r a p h e r s , bu t on account of t h e i r d i s p e r s i o n ( r a d i o g r a p h e r s

a r e pos t ed t o d i f f e r c n t p a r t s of t h e c o u n t r y ) , i t was n o t p o s s i b l e t o hold r e f r e s h e r

C O l l P S E 5 . Iiowever., t h e assignment was ve ry u s e f u l i n o t h e r r e s p e c t s , p a r t i c u l a r l y i n

t h e d ~ t e c t i o n ni' r a d i a t i o n hazards and t h e assessment of t h e f i e l d t r i a l of a g e n e r a l -

purposc d i a g n o s t i c X-ray u n i t (SEAR0 0145) . The c o n s u l t a n t ' s rccommendatlons were submi t ted t o t h e Oovernment, t o g e t h c r w i t h a p roposa l f o r t h e i r implementa t ion . It

was a l s o planned t o provide v a r i o u s r a d i a t i o n p r o t e c t i o n equipment such a s l e a d mobile

p r o t e c t i v e s c r e e n s , l e a d aprons and l e a d g l o v e s .

SEA/RCZZ/Z

Page 1 0 1

Afghanis tan 0068 N u r s i n ~ Administrntion/Education

R ( I C O * . 1963 - )

A i m o r tmpg . (1) To s d v i s c on and a s s i s t w i t h t h e development o f t h e

a d m i n i s t r a t i o n of n u r s i n g s e r v i c e s and r e l a t e d c l i n i c a l experience f o r s t u d e n t s

i n h o s p i t a l s and o u t - p a t i e n t d e p a r t n i e n t s , ( 2 ) t o 2 a r r y o u t a s u r v e y of s i t e

c o n d i t i o n s a d r e q u i r e m e n t s f o r a s c h o o l o f n u r s i n g , and ( 3 t o p r e p a r e a d e s i g n

and a comple te s e t of d rawines and s c h e d u l e s f o r t h e s c h o o l .

A s s i s t a n c e pl'cvided by W K d i I r i n g t h e y e a r . ( a ) Iko n u r s e a d m i n i s t r a t o r s - c u m -

e d u c a t o r s ; ( b ) s u p p l i c s , equjpjnent and a t r a n s p o r t v c h i c l e .

P r o b a b l e d u r a t i o n of a s s i s t a n c e . U n t i l t h e end uf 1972 .

Work done d u r i n g t h e y e a r . T h i s p r o j e c t p r o v i d e s a s s i s t a n c e i n t h e s t r e n g t h e n i n g

o f n u r s i n g s e r v i c e b d n i n i s t r a t i o n and c l i n i c a l e d u c a t i o n of s t u d e n t n u r s e s i n Avicennn,

M a s t o o r a t , Al iabad 2nd Wazir Akbar Khan H o s p i t a l s , a l l l o c a t e d i n Kabul. A d m i n i s t r a t ~ v e

c h a r t s o u t l i n i n g t h e p o s i t i o n of t h e n u r s i n g u n i t i n t h e o v e r a l l h o s p i t a l

a d m i n i s t r s t i c n and w i t h d e t a i l s of t h e u n i t i t s e l f ' have been p r e p a r e d i n d i s c u s s i o n

w i t h t h o s e n i o r n a t i o n a l d o c t o r s and n u r s e s concerned . C o n s i d e r a b l e work h a s been

dcne o n d e v e l o p i n g t h e f u n c t i o n s sf t h e n u r s i n g u n i t and o n changing a t t i t u d e s

r e l a t e d t o t h c d e l e g a t i o n of a u t h o r i t y t o t h e D i r e c t o r of Nurses and h e r s t a f f . Job

d e s c r i p t i o n s f o r v a r i o u s l e v e l s of n i i r s i n g personno1 i n t h e h o s g i t a l s have been

p r e p a r e d anu sri. i n the p r o c c s s or beiry; t r a n s l a t e d i n t o t h c l o c a l l a n g u a g e . P o l i c i e s

anti p a t t c m s e s s l i n t i a l t o t h imprcvement o f d i r e c t n u r s i n g c a r e t o p a t i e n t s have been

c.volu?r!. Communicatians among t h e s t a f f uf t h c s c h o o l s of n u r s i n g a s s o c i a t e d w i t h

t h e s e h o s p i t a l s have been r c g u l a r l z e d and c o - o p e r a t i v e development of p l a n n i n g and

implementa t ion of c l i n i c a l e x p e r i e n c e f o r s t u d e n t n u r s e s h a s b e e n i n i t i a t e d .

I n - s e r v i c e e d u c a t i o n programmes have r e c e i v e d a t t e n t i o n i n a l l h o s p i t a l s ,

and t h e p o s s i b i l i t y of e s t a b l i s h i n g i n - s e r v i c e e d u c a t i o n i n o r d e r t o p r o v i d e f o r

o r i e n t a t i o n , s k i l l t r a i n i n g and c o n t i n u i n g e d u c a t i o n f o r a r a n g e o f h o s p i t a l employees,

is b e i n g c o n s i d e r r d .

A f g h a n i s t a n 0069 Cancer S t u d i e s [Oropharynuea l C a n c e r 1

R ( J u l y 1963; - j*

A l m o f t h e D r o J e c t . To s t u d y t h e p r u v a l c n c c of oropharynguzd carc inoma and

a s s o c i a t e d ~ t i o l o g i c a l tames.

A s s i s t a n c e p r o v i d e d by WHO d u r i n g t h e y e a r . Two c o n s u l t a n t s .

Probable d u r a t i o n of assist-. U n t i l t h e end of 1973

"Not r e p o r t i d i n l a s t y c 2 r 1 s Anmlal Rcp0r.t .

SEA/RC22/2

Page 102

Work done du r ing t h e y e a r . The WHO c o n s u l t a n t s v i s i t e d Afghanis tan f o r one week i n Ju ly /kugus t 1963 and he ld d i s c u s s i o n s on t h c p o s s i b i l i t y 0 1 cs tzh1is l ; ing an

up idemio l cg i ca l survey of oropharyngcal carcinoma i n t h e coun t ry . The d i s c u s s i o n s

i n d i c a t c d t h e f e a s i b i l i t y of such a su rvey and a l s o t h a t t h e Government would be

i n t e r e s t e d i n such a su rvey . Two a r c a s were s e l e c t e d - one urban and one r u r a l - t h o

l a t t e r a s s o c i a t e d w i t h one of t h o sub -cen t r e s of t h e Shewaki Heal th Cent re .

The o r i g i n a l proposa l was f o r a team of d e n t i s t s from I n d i a t o v i s l t

Afghanis tan f o r f o u r t o s i x months d u r i n g t h e sumrr,cr s ea son and , w i t h t h e assistance

of n a t i o n a l c o u n t e r p a r t s , t o under take t h e survey . Huwever, i t was l a t e r f e l t

t h a t , i n t h e f i r s t i n s t a n c e , f e l l o w s h i p s should bc o f f e r e d t o two Afghan d e n t i s t s t o

work i n I n d i a i n 1963 w i t h t h e team undertaking such su rveys . Arrangements wcre

:iccur,dingly made f o r such t r a i n i n g and t h e Government h a s been i nv i ted t o recommend

two f e l l o w s .

Afghanis tan 0200 F o l l o w s h i ~ s

R

Medical Coding. E igh t six-month f e l l owsh ips f o r s t u d y i n I r a n .

C a r d i o l o w . A three-month f e l l o w s h i p f o r s t u d y i n Ind i a .

Afghanis tan 0201

UM)P(TA)

B a c t e r i o l o r n and V i r o l o a . A ten-month fellowship f o r s t u d y i n t h e Unitdd Kingdom.

Labora tory Techniques. A twelve-month f e l l o w s h i p f o r s t u d y i n Ceylon.

Pa tho loc :~ . A s ix-and-a q u a r t e r month f e l l o w s h i p f o r s t u d y i n t h e United S t a t e s of Americci.

BURM

Shrines forming part of the Shwe Dagon Pagoda in Rangoon

SEA/RC22/2 Page 103

During the year rice production increased, and there was also a marked rise in the production of teakwood. There was slightly more irrigated land under crops in 1967-68 than in the previous year. There was also an increase in capacity for the generation of electric pawer. A number of industrial development schemes were started.

Against this background, the Government has found it possible, in the 1968-69 budget (the financial year is from October to September), to increase further the sums allocatcd to education and health, nearly three quarters of which go to education, to which the Government attaches a very high value. CNt of the total budget of kyats 1 803 941 800 (US$378 820 201), a sum of kyats 105 ll7 230 (US$22 074 177) (5.83 per cent) has been allocated for health.

In accordance with this policy, Burma is now directing its efforts towards providing a full range of post-graduate medical education. To co-ordjnate effort8 in this field, the post of Dean of Post-Graduate Studies was created in 1968, and the establishment of a separate institute is under consideration. WHO'S assistance to the development of both post-graduate and undergraduate teaching continues, and the Ministries of Health and Education have made extensive use of the WHO Revolving Fund in order to obtain training and teaching materials and scientific equipment. Special attention may be drawn to a new approach towards the improvement of educatimal methods whereby a group of eight senior medical educators (including heads of institutes) have recently gone on a WHO study tour of medical schools in other countries to observe modern teaching methodology, at both the undergraduate and post-graduate levels.

The results of this expansion of teaching activity a r e already becoming apparent in the increasing number of doctors available in the country (2 300 in 1968 as compared with 1 600 in 1964). The training of other health workers (which is a commitment under the health rather than education budget) is also proceeding, although the total of 2 600 nurses in mid-19G9 does not compare favourably with the increasing number of doctors.

In the development of health services the Government continues to give attention to building up a solid infrastructure with the intention of bringing the health facilities to the rural a reas where the overwhelming majority of the population lives. At the same time, these activities are' supplemented by specific programmes against the major communicable diseases.

During the year, the second three-year round of smallpox vaccination was completed and the local production of freeze-dried vaccine hew. The Government has decided, an the basis of a successful trial, to give direct BCG vaccination to newborns, pre-school-age children and school-children up to 14 years of age a s a routine. To meet the problem of endemic goitre,the production of iodated salt has been undertaken. The malaria programme has been under way for some years, but preliminary planning undertaken during the year seems likely to lead to a reorganization of the activities.

SEA/FiC22/2 Page 104

Programmes against leprosy, tuberculosis and trachoma, where the main weight of effort is directed towards detection and treatment of cases, continue to make progress. A series of clinical trials was undertaken to clarify some aspects of the trachoma problem, and the results have been studied and reviewed with the help of a WHO consultant.

For these efforts to have their maximum impact, planning and co-ordination are a continuing need, and the Government is now engaged in a study of the overall situation whichit is hoped,will lead to the preparation of a plan for the strengthening of health services mder which future WHO and UNICEF assistance in the health field w i l l operate.

PROJECT LIST

P r o j e c t No.

Source o f Funds

Co-opera t ing

&?enclcs

Burma 0017

R

UNICEF

Leprosy C o n t l ~ o l

[April 1760 - )

A l m of t h c p r o j e c t . To expand and i n t e n s i f y t h e l e p r o s y c o n t r o l p r o g r a m e t o c o v e r

a11 endemic a r e a s of t h e c o u n t r y , and t c t r a i n p e r s o n n e l .

A s s i s t a n c e prov ided by WHO d u r i n g t h e y e a r . ( a ) A l e p r o l o g i s t and a c o n s u l t a n t -

l e p r o l o g i s t ; ( b ) a f i v e - w e e k fcl lowst l i : . f o r s tudi , :s i n t h e United Kingdom and S p a i n ;

( c ) s u p p l i z s and equipment .

P r o b a b l e d u r a t i o n of a s s i s t a n c e . U n t l l t h e end of 1972

Work done d u r i w t h e y e a r . G r e a t e r emphasis was p l a c e d o n t r a i n i n g and r e f r e s h e r

c o u r s e s f o r workers engaged i n t h e l s p r o s y c o n t r o l p r o g r a m e . It is e x p e c t e d t h a t

t h e a d d i t i o n a l t r a i n i n g w i l l c n a b l c them t o cop.: s u c c e s s f u l l y w i t h t h e i r t a s k s

concerned w i t h t h e d i a g n o s i s , fo l low-up and r u l v a s e f r o m c o n t r o l of l e p r o s y c a s e s .

A r e f r e s h e r c o u r s e i 'or l a b o r a t o r y workel's engaged i n t h e l e p r o s y progralim~e

i n Lower Burma was o r g a n i z e d i n Rangoon and a t t e n d e d by 1 9 l a b o r a t o r y a s s i s t a n t s .

A s i m i l a r c o u r s e was h e l d i n Mandalay f o r l a b o r a t o r y workers f r o m Upper Burma. The

WHO l e p r o l o g i s t o r g a n i z e d t h e t r a i n i n g of j u n i o r l e p r o s y workers who, a f t e r r e c e i v i n g

t h e o r e t i c a l and p r a c t i c a l on- thc-spo t t r a i n i n g < n s m e a r - t a k i n g , were g i v e n

UNICEF-supplied s e t s cf' squipment f o r t h i s p u r p o s e .

The WHO l e p r o l o g i s t Gavf l e c t u r e s on l e l l r o s y c o n t r o l t o 1 4 f i n a l - y e a r medical

s t v d e n t s f rom Rangcon U n i v e r s i t y , who had observed c h i l d s u r v e y s i n Marldalay D i s t r i c t .

A t t e n t i o n was p a i d t o s c h o o l s u r v e y s and t h e r e g u l a r e x a m i n a t i o n of c o n t a c t s .

I n a d i s t r i c t i n l o w e r Burma w i t h a low r a t e o f e n d e m i c i t y (Hrawbi D i s t r i c t , Klegd

t o w n s h i p ) t h e i n t e g r a t i o r . of l e p r o s y c o n t r o l : A c t i v i t i e s i n t o t h e g e n e r a l h e z l t h

s c r v i c e s s t a r t c d on a t r i a l b a s i s a i ' t u r s u i t a b l e t r a i n i n g had been g i v e n t o

h e a l t h workr , rs .

The t o t a l number of c a s e s under t r e a t m e r - t was 184 468. Of t h e s e , 171 761 were i n t h e p r o j e c t a r e a and 9 758 o u t s i d e ; 2 949 were i n p r i v a t e i n s t i t u t i o n s . The

t o t a l number o f r e g i s t e r e d c a s e s was 193 017.

The a s s l g m e n t r e p o r t o f t h e . c o n s u l t a n t , who completed h i s ass ignment i n

August 1968. was under r e v i e w .

SEA/RCZZ/Z Page 106

V i t a l and Health St_at_istics, Rawoo; -- (Dee. 1955 - June 1961; Jan. 1962 - )

A i m of the Droject. To develop a system of repor t ing and recording h e a l t h s t a t i s t i c a l

da ta and t o improve processing: t o t r a i n s t a f f i n s t a t i s t i c a l methods.

Assistance provided by WHO during t h e year . Supplies and equipment f o r t a b u l a t i o n

and pub l ica t ion of h o s p i t a l s t a t i s t i c s , including a counter s o r t e r .

Probable dura t ion of a ss i s t ance . Unt i l t h e end of 1970.

I n s t i t u t e of Medicine I, Rangoon

(Peb. 1955 - Peb. 1959; Peb. 1961; Sept. 1963 ; Aug. 1966 - Jan. 1967; Dec. 1967; Ju ly 1968 - )

A i m of t h e Pro jec t . To s t reng then se lec ted departments i n I n s t i t u t e of Medicine I ,

Rangoon; t o improve undergraduate teaching, and t o promote research and post-graduate

s tudy; t o a s s i s t t h e School of Preventive and Tropical Medicine i n developing i t s diploma course.

Assistance provided by WHO dur ing t h e year . ( a ) A professor of epidemiology and a Professor of public h e a l t h admin i s t ra t ion ; (b ) supp l ies and equipment.

Probable dura t ion of a ss i s t ance . Unt i l t h e end of 1974.

Work done durinu t h e year . The WHO professor of epidemiology concentrated h i s

a c t i v i t i e s on t h e post-graduate diploma course a t the School of Preventive and Tropical Medicine ( see a l s o Burma 0075). He made f i e l d t r i p s and paid v i s i t s t o s e v e r a l s p e c i a l

hosp i t a l s and t o t h e Burma Medical Research I n s t i t u t e i n Rangoon, wi th a view t o

studying t h e s t r u c t u r e of t h e h e a l t h s e r v i c e s , t h e s p e c i f i c h e a l t h problems of the

country and t h e p o s s i b i l i t i e s of u t i l i z i n g a v a i l a b l e f a c i l i t i e s f o r f i e l d t r a i n i n g and research purposes. His f ind ings provided a bas i s f o r r ev i s ing t h e epidemiology

sy l l abus i n the diploma course. The WHO professor had discuss ions wi th t h e Head of

the Department of pr~v,,r , t iv, and Soc ia l Medicine, I n s t i t u t e of Medicine, Mandalay,

on t h e undergraduate teaching programme and on possible resea rch p r o j e c t s . He a l s o took over t h e teaching of epidemiology f o r t h e course on prevent ive d e n t i s t r y a t t h e Dental College, I n s t i t u t e of Medicine I.

A p lan f o r inves t iga t ions i n t o the epidemiological and c l i n i c a l f e a t u r e s

of snake-bites i n Burma was drawn up and submitted t o t h e Dean of Post-graduate Studies . The WHO consul tant i n t r o p i c a l medicine (provided under p ro jec t Burma 0 4 9 )

a s s i s t e d i n t h e preparat ion of t h e plan.

Effect ive January 1969, t h e p ro jec t Burma 0075 (School of Preventive and Tro?ical Medicine), was mOrged with t h i s p r o j e c t , which c l o s e l y co l l abora tes wi th t h e o the r Fnedical education p r o j e c t , Burma 0073.

Malar ia E r a d i c a t i o n -- ( F o b . 1957 - )

A i m of t hc p r o , j r c i . To e r ad i caLr ma la r i a f r o n t h e coun t ry i n p r o g r e s s i v e s t a g e s . - -.

ProbaDle du r i l t i an of a s s i s t a n c e . U n t i l t h e end of 1974.

Work done durin;: t h e ye?? . A t t h e r e q u e s t of t h e Government. s t e p s were t a k e n t o -- - -- ~ ~ s i g n z n exper ienced ma la r io jog i s t / consu l t an t t o a s s i s t i n p r e p a r i n g a r e a l i s t i c

p l a n f o r a n t i - m a l a r i a o?e; . t io r . s I n t h e c o u n t r y , and a l a b o r a t o r y t e c h n i c i a n t o h e l p

w i t h t h c o7ganl::atior. of 1nbor.ator.y s e r v i c e s f o r r ~ a l a r i a and t h e t r a i n i n g of n a t i o n a l

m i c r o s c o p i s t s . l?oth t h z s r assiCnments a r e expec ted t o s t a r t l a t e r i n 1967.

Burma 0044.2

UNDP(TA)

S t r eng then ing of Hea l th S c r v i c e s (E?idemiology) ---- ( P e b . - Msy 1960; J a n . 1969 - )

A i m of t h e p r o j e c t . To s t r e n g t h e n t h e Ep idemio log i ca l U n i t i n t h e D i r e c t o r a t e of

Hea l th S e r v i c e s ; t o s t u d y f u r t h c r t h c p r e v a i l i n g p a t t e r n of communicable d i s e a s e s

and t o provide i n fo rmn i lon f o r sourd p u b l i c h e a l t h p lanning and a p p r o p r i a t e c o n t r o l

measures; a l s o t o a s s i s t i n d e v e l o p i w p u b l i c h e a l t h l a b o r a t o r y s e r v i c e s i n suppor t

of t h e Epidemiologica l Un i t .

Ass i s t znce pro~$ici by IlHO d u r i w t h e y e a r . ( a ) A m i c r o b i o l o g i s t and a c o n s u l t a n t .

Probable durat&n of z s s l s t a n c e . U n t i l 1972.

i lork done ~=>~ST t h e y e a r . A WHO c o n s u l t a n t ( e p i d e m i o l o g i s t ) was a s s igned t o t h e

p r o j e c t fron; M3rch t o May 1969, t o a s s i s t i n t h e f . ~ r t h e r s t r e n g t h e n i n g of t h e C e n t r a l

Epidemiologica l U n i t and t h e g r a d u a l development of u n i t s a t d i v i s i o n a l l e v e l , s t a r t i n g

w i t h Rangoon 2nd Ma-illlay. The r e p o r t on a n e a r l i e r assignment (February-May 1968)

was s e n t t o t h e Govcrnmcnt.

A mult?-p:~rposti s e r o l o g i c a l survey t o de t e rmine t h e i m w i t y p r o f i l e of t h e

c h i l d p o p u l a t i o n of t h e C i t y of R:,ngoon was s t a r t e d . It i s expec ted t h a t , w i t h the

developacnt of cpide!: l iological s e r v i c e s i n o t h e r d i v i s i o n s , t h e su rvey w i l l be

g r a d u a l l y extenricd t o o t h e r p a r t s of t h e c o u n t r y .

A WHO m i c r - i b i o l o ~ i s t was a s s i g n e d a t t h e beginning of 1969 t o a s s i s t w i t h

t h e s t r e n g t h e n i r g of t h e C e n t r a l Pub l i c Heal th Labora tory and t h e development of

l a b o r a t o r y f a c i l i t i e s a t t h e d i v i s i o n a l l e v e l , f o l l owing t h e p a t t e r n o f t h e

dcvclopment of i i ~ i d c m i o l o ~ i c a l u n i t s i n t h e coun t ry ( s e e a l s o Burma 0074) .

Burma 0065

UNDP(TA)

UNICEF

TuSe rcu los i s Con t ro l . - - .- - -- ( J a n . 1764 - )

A i m of t h e p a t _ . T c ;evelop community-oriented t u b e r c u l o s i s s e r v i c e s , s t a r t i n g

i n Rangoon and Mar.dalay, a s t r a i n i n g alld p i l o t a r e a s , and t o expand t u b e r c u l o s i s

c o n t r o l t o o the- pa r t ; cf t h c coun t ry .

SEA/RCZZ/Z

Page 108

Assistance provided by WHO dur ing t h e year. ( a ) A medical o f f i c e r and a laboratory t echn ic ian ; ( b ) supp l ies and equipment.

Probable dura t ion of a s s i s t a n c e . Unt i l t h e end of 1972.

Work done dur ing t h e year. Implementation of t h e tubercu los i s programme i n the Eastern Division - t h e next phase i n t h e na t iona l f ive-year plan - has been somewhat

delayed. However, by t h e end of June 1969, t h e Divis ional Tuberculosis Centre a t Taunggyi- s t i l l accommodated p rov i s iona l ly -and s i x r u r a l h e a l t h c e n t r e s had s t a r t e d

work. The required number of medical o f f i c e r s , nurses and o t h e r S t a f f were given

formal t r a i n i n g a t t h e Union Tuberculosis I n s t i t u t e , Rangoon, with per iodic a s s i s t a n c e from a WHO consul tant assigned t o another p ro jec t . Training was a l s o given t o workers

employed i n the programmes i n operat ion In Rangoon and the North-western Division.

BCG team leaders wore a l s o s p e c i a l l y t r a i n e d i n t h e techniques and organizat ion

of d i r e c t BCO vaccinat ion. M t e r c a r e f u l p i l o t s t u d i e s , which proved t h e harmlessness

of t h e d i r e c t vaccinat ion procedure, t h e Cmvernment, as of 1 January 1767, introduced

d i r e c t BCG vaccinat ion as a rou t ine procedure f o r ch i ld ren up t o 14 years of age. A s a

r e s u l t , t h e t o t a l number of BCG vaccinat ions had increased by 62 per cent during t h e

f i rs t quar te r of 1963 a s compared with t h e same period i n 1968, and can be expected t o increase f u r t h e r , e s p e c i a l l y i n view of t h e coverage of newborns, i n f a n t s and pre-

school-age ch i ld ren .

In t h e Rangoon a r e a , 5 683 p a t i e n t s , 62 per cen t of whom were b a c t e r i o l o g i c a l l y confirmed cases of t i tbe rcu los i s , were receiving ambulatory treatment a t t h e end of the

f i r s t quar te r of 1967, e i t h e r a t t h e Union Tuberculosis I n s t i t u t e , Rangoon, o r a t one

of t h e 19 co l l abora t ing hea l th cen t res under t h e Greater Rangoon Health Scheme, where tubercu los i s p a t i e n t s have treatment a v a i l a b l e conveniently c lose t o t h e i r homes.

Because of t h e easy a c c e s s i b i l i t y of t h e I n s t i t u t e , t h e con t r ibu t ion of these h e a l t h

cen t res with regard t o case-f inding has been r a t h e r l i m i t e d , though i t is on t h e increase.

In the North-western Divis ion, where the programme is operated through the

Divis ional Tuberculosis Centre, Mandalay, and 55 co l l abora t ing r u r a l h e a l t h c e n t r e s , a t o t a l of j 783 p a t i e n t s - 81 per cent of whom had t h e i r d iagnosis b a c t e r i o l o g i c a l l y confirmed - were rece iv ing ambulatory treatment.

In t h e Eastern Divis ion, where t h e programme has only recen t ly been implemented, thc re were 272 pa t ien t s on treatment a t t h e end of April 1967; a l l of whom were

b a c t e r i o l o g i c a l l y confirmed cases of tubercu los i s .

Defaul ter r a t e s amongst the cases i n t h e d i f f e r e n t d i v i s i o n a l programmes

var ied between 8 and 12 per cent . The treatment of choice is t h e f u l l y supervised regimen cons i s t ing of s t r e p t o w c i n and i s o n i a z i d , g iven twice weekly. However, i n

areas where the network of hea l th se rv ices has not ye t developed t o provide treatment

f a c i l i t i e s c lose enough t o t h e pa t i en t ' s home, the Ministry of Health has agreed $0 the use of isoniazid- thiacetazone f o r sc l f -admin i s t ra t ion by p a t i e n t s .

k WHO consul tant i n laboratory technclogy, assigned from November 1968 t o

January 1969,made recommendations f o r t h e f u r t h s r improvement of t h e l abora to ry aspects

of d i v i s i o n a l tubercu1osj.s programmes, and a consul tant i n s t a t i s t i c s reviewed t h e

system of records and repor t s being used i n these programmes.

Thi WHO medical o f f i c e r l e f t i n A u g ~ s t 1968 a f t e r having been with the p ro jec t

s i n c e February 1964; h i s replacement took up d u t i e s i n October 1968.

Burma 0061

R

UNICEF

Paediat r ic Education

(Junc 19614 - June 1966 ; Sept . 1966 ; Oct . 1967 ; Oct. 1968; Jaa . 1969; - )

A i m of t h e p r o j e c t . To s t r eng then the departments of paed ia t r i c s i n t h e t h r e e

medical co l l eges of t h e country and t o improve t h e teaching of p a e d i a t r i c s ,

p a r t i c u l a r l y t h e preventlve a s p e c t s , by developing per ipheral se rv ices f o r t r a i n i n g .

Assistance provided by WHO dur ing the year. A twelve-month fe l lowship f o r study

i n t h e United Kingdom and a slx-week t r a v e l fe l lowship f o r s tudy i n B r a z i l , Chi le ,

Colombia and Mexico.

Burma 0074

R UNICEF

Strengthening of Laboratory Services

(May - June 1967; A p r i l 1968 ; June 1968; Aug. - Oct. 1968; - )

A i m of t h e p ro jec t . Tc s t rengthen l abora to ry se rv ices and t o promote t h e i r

development a t t h e s t a t e and d i v i s i o n a l l e v e l s .

Assistance provlded by WHO dur lng t h c year . A consul tant and ass i s t ance f r o n t h e

microbiologis t provided under p ro jec t Burma 0044.2; (b ) t h r e e s i x - m n t h fellowships

f o r s tudy l n I s r a e l , a nine-month fe l lowship f o r s tudy i n the United Kingdom and a

twelve-month fellowship f o r s t u d i e s i n India and the United Kingdom; ( c ) su?pl ies and

equiprant.

Probable dura t ion of a ss i s t ance . Unt i l t h e end of 1972.

Work done during t h e year. A WHO consul tant v i s i t e d t h e p ro jec t from August t o

October 1968 and advised on the reorganizat ion of t h e National Health Laboratory

i n Rangoon. lie a l s o proposed a revised syl labus f o r t h e t r a i n i n g course f o r

laboratory technicians . His a s s l a m e n t repor t has been sen t t o t h e Wvernment.

Since January 1969, t h e WHO microbiologl.st assigned t o p ro jec t Burma 0044.2

has been a s s i s t i n g t h i s p r o j e c t . Diagnostic procedures by means of the f luorescent

antibody technique were strengthened a t the National Health Laboratory i n respect of

d iarrhoea1 d i s e a s e s , cholera and rab ies . Technical approval was given t o UNICEF

f o r t h e procurement of teaching a i d s , l abora to ry equipment and suppl ies f o r t h e

school of technicians a t t h e National Health Laboratory.

SEA/RC22/2

Page 110

Burma 0072

UNDP(TA)

School Of Preventive and. Tropical Medicine

(Oct. 1964; Sept. 1965; Beb. 1967 - Dec. 1968)

A i m of t h e p ro jec t . To a s s i s t t h e School of Preventive and Tropical Medicine i n

developing the diploma course .

Assistance provided by WHO during t h e year . ( a ) A professor of publ ic h e a l t h

admin i s t ra t ion and a s s i s t a n c e from the professor of epidemiology assigned under

p ro jec t Burma 0028, and from t h e consul tant i n t r o p i c a l medicine assigned under

p ro jec t Burm 0077; ( b ) two fe l lowships - one f o r twelve months and one f o r seven-and-

a-half months - f o r study i n t h e United Kingdom; ( c ) supp l ies and equipment.

Work done during t h e year . The second Diploma Course i n Preventive and Tropical

Medicine was concluded i n August 1968; e i g h t s tuden t s passed t h e f i n a l examination.

The t h i r d course s t a r t e d on 15 November. Though t h e a u t h o r i t i e s had be':n consider ing

the increase of t h e number of candidates t o about twenty, only four teen app l ica t ions

were received; eleven candidates appeared i n t h e admission examination, and s i x were

f i n a l l y se lec ted .

The Board of S t u d i e s , a s s i s t e d by the WHO professor of public h e a l t h

adminis t ra t ion and the WHO professor of epidemiology ( t h e l a t t e r provided under

p ro jec t Burma O O Z E ) , reviewed t h e teaching progravme of the course and t h e s y l l a b i

f o r i t s components. S l i g h t changes were made i n t h e a l lo tment of time t o t h e various

sub jec t s i n favour of epidemiology and s t a t i s t i c s ; t h i s gave an opportuni ty t o rev i se

the s y l l a b i and t o l a y more emphasis on t h e s p e c i f i c h e a l t h problems of the country.

J o i n t teaching sess ions on epidemiology, t r o p i c a l medicine and udcrobiology and

medical zoology were organized.

The WHO professor of epidemiology a l s o a s s i s t e d wi th t h ~ cou-srs on

environmental s a n i t a t i o n and microbiology because of t h e shor tage of n a t i o n a l teachers

i n these s u b j e c t s .

The WHO consul tant i n t r o p i c a l medicine, assigned under p ro jec t Burma 0079,

extended h i s activities i n the School and p a r t i c i p a t e d i n the post-graduate teaching

of t h i s sub jec t .

The WHO professor of s a n i t a r y e n g i n c e r i q assigned t o t h e I n s t i t u t e of

Technology, Rangoon,since May 1969 ( p r o j e c t Burma 0089), a l s o a s s i s t e d the School

i n developing t h e course i n environmental s a n i t a t i o n , which forms p a r t of t h c

d i p l o m course.

From January 1769, t h e activities a r e being continued under p ro jec t

Burma 0028.

SEA/RC22/2

Page 111

Burma 0077 R

UNICEP

Burma Pharmacuut;cal IndustrE*

( Y e . 1164; J ~ l y lY64; Aug. 1968; Feb. 1969; - j

A i m of the i r ro jec t . To dcv t lop nlodrrn methods of production and c o n t r o l t e s t i n g

of immuno-biologicals, bacteri2.1 and v i r a l vacc ines , toxoid p repa ra t ions ,

a n t i t o x i n s and o t h e r b i c l a g i c a l products ; a l s o , t o in t roduce modern methods f o r t h e

u t i l i z a t i o n of these vaccines i n im;ua~nizatlon p r o g r a m s .

Ass is tance providcd by WHO durinii t h e yea r . Three t h r e e - m n t h fe l lowships f o r Study

i n I n d i a , a four-month f e l l o v s h i p f ~ r s tudy i n t h e United Kingdom and a six-month

fe l lowshi[ j f o r s t u d i e s i n I t a l y and t h e Netherlands.

Probable d u r a t i o n cf a s s i s t a n c e . U n t i l t h e end of 1970.

Burma 0072 R

Medical Education

(Dcc. 1964 - Feb. 1965 ; March 1966 - Jan . 1967: Dec. 1967 - )

A i m of t h e ~ r o j e c t . To improve undergraduate and post -graduate medical educat ion;

t o t r a i n t each ing s t a f f ; t o develap t h e c u r r i c u l a i n keeping wi th modern Concepts,

and t o i n i t i a t e , encourage and guide r e sea rch .

Ass is tance provided by WHO d u r i w t h e yea r . [ a ) A professor of pharmacology and

f o u r c o n s u l t a n t s ; ( b ) e i g h t two-nonth fe l lowships f o r s t u d i e s i n Ind ia and t h e United

Kingdom, four f e l lowsh ips - t h r e e f o r twelve months and one f o r s i x months - f o r

s tudy i n t h e United Kingdom, two fe l lowsh ips - one f o r twenty-four months and one

f o r twelve months - f o r s tudy i n I r e l and and a twelve-month f e l lowsh ip f o r s t u d i e s i n

Malaysia, S ingapore , t h e United Kingdom, Belgium, t h e Nether lands , Oermany and India;

( c ) Suppl ies and e q u i p m n t .

Probable d u r a t i o n of a s s l s t a n c c . Unt i l t h e end of 1974

Work done d u r i w t h e yea r . The WHO p ro fesso r cf pharmacclogy ass igned t o I n s t i t u t e

of Medicine 11, Mlnqaladon, continued t o p a r t i c i p a t e f u l l y i n t h e undergraduate

teaching p r o g r a m . I n p r a c t i c a l c l a s s e s s t u d e n t s now have t o s u b m i t t h e i r p ro tccc l s

c o l l e c t e d i n ind iv idua l books, f o r assessment purposes, and t h e r e s u l t s a r e valued

f o r marks i n t h e f i n a l examination i n the s u b j e c t . The end of term examinations wzre,

f o r t h e f i r s t t ime, given i n ob jec t ive - type ( m l t i p l e cho ice ) form, and t h e r e s u l t s

analysed s t a t i s t i c a l l y .

I n t h e s t a f f t r a i n i n g programme, r e sea rch p r o j e c t s were s t a r t e d . Col labora t ion

was e s t a b l i s h e d wi th t h e Burma Medical Research I n s t i t u t e i n pha rmco log ica l t r i a l s

of e x t r a c t s from indigenous p lan t s . J o i n t meetings were r e g u l a r l y held wi th t h e

s t a f f of t h e Pharmacological Department of I n s t i t u t e of Medicine I, f o r d i scuss ion

01' p r o b l e m of niutual i n t c r a s t i n t each ing and re sea rch .

*Previous t i t l e : Burma Pharmaceutical I n s t i t u t e .

SEA/RCZ~/Z

Page 112

An 8-mm f i l m , showing t h e technique and conduct of a pharmacological

experiment, was produced f o r use as a v i sLa i t each ing a i d .

I n Novcmber 1968, a WHO consu l t an t i n t r o p i c a l medicine took up a six-month

assignment. He divided h i s t i m between t h e undergraduate course of I n s t i t u t e I and

the diploma course of t h e School of Prevent ive and Tropical Medicine. Budside-teaching

s e s s i o n s , w i th emphasis on h i s to ry - t ak ing and phys ica l examination, were r e g u l a r l y

conducted, and case p resen ta t ions and weekly d i scuss ions i n t h e audi tor ium ware

arrangad. Thc consu l t an t observed examinations i n h i s own and i n r e l a t e d s u b j e c t s

and &laic1 v i s i t s t o t h e I n s t i t u t e of Medicine, Mandalay, when a t t e n d i n g the

in t e r -coun t ry Collrse and Seminar a n Plague Epidemiology and Con t ro l , t o t h e Burma

Medical Research I n s t i t u t e , t h e S t a t i s t i c s Department of t h e Minis t ry of Hes l th ,

t h e Workers' Hospi ta l and var ious o u t - p a t i e n t c l i n i c s . Ho a l s o a t tended st i5sions

on medical t o p i c s a t t h e Burma Research Congress, 1969.

A WHO consu l t an t i n obs te t r ics /gynaecclogy was ass igned f o r two months

dur ing January-March. He s tud ied t h e t each ing programme a t a l l t h r e e I n s t i t u t e s of

Medicine and t h e t r a i n i n g needs o f personnel f o r t h e var ious l e v e l s of h e a l t h

s e r v i c c s , a l s o g i v i n g s p e c i a l a t t e n t i o n t o t h c u t i l i z a t i o n of a n c i l l a r y s e r v i c e s

and t o c o l l a b o r a t i o n wi th r e l a t e d departments. A consu l t an t i n surgery a l s o took

up a three-month assignment t o g e t h e r wi th t h e consu l t an t mentioned above and worked

according t o t h e same plan . Both consu l t an t s p a r t i c i p a t e d i n t each ing ses s ions of

a l l k inds . One de l ive red a gues t l e c t u r e a t t h e School of Prevent ive and Tropical

Medicine and t h c o t h e r was i n v i t e d t o address t h e Burmese Medical Associa t ion on a

s u r g i c a l t o p i c . They a l s o a t tended ses s ions of t h e Burma Research Congress, 1969. The r e p o r t s of a l l t h r e e consu l t an t s were under s tudy .

I n June 1969, a WHO consu l t an t I n paed ia t r , i c educat ion was ass igned f o r s i x

weeks t o make an a p p r a i s a l of developments i n h i s f i e l d s i n c e t h e t e rmina t ion Of

WHO a s s i s t a n c e t o t h e p a e d i a t r i c educat ion p r o j e c t Burma 0067 ( i n June 1966) . and t o

adv i se , a s r e q u i r e d , on t h e p a e d i a t r l c educa t ion programme.

Burma 0080

R

SmallDox Erad ica t ion

( J a n . 1967 - )

A i m of t h e p r o j e c t . To a s s i s t wi th t h e smallpox e r a d i c a t i o n programme and i n t h e

es tabl ishment of a maintenance programme and s u r v e i l l a n c e system.

Ass is tance D r o v i d ~ d by WHO dur ing t h e yea r . Sup[lly of 3'75 600 doses c f f r eeze -d r i ed

smallpox vaccine and t h r e e ped-o- j e t s . (See a l s o SEAR0 0038.2 ) .

Probable d u r a t i o n of a s s i s t a n c e . I n d e f i n i t e

SEA/RCZZ/?

Page 113

Burma 0083

UNDP(TA)

Education i n D e n t i s t r y

(Jan. 1 9 6 7 ; Nov. 1767 - Jan. 1968; Jan . 1969; - )

A l m of the p r o j e c t . To s t r eng then d e n t a l ~ d u c a t ~ o n i n t h e country .

Ass is tance provided by WHO dur ing t h e yea r . Suppl ies and equipment.

Burma 0082

R

Tra ining of Electro-medical Technicians

(March 1967; - )

A i m of t h e Drojcct . To e s t a b l i s h a school f o r t h e t r a i n i n g of t echn ic i ans i n t h e

maintenance and r e p a i r o r X-ray and e lec t ro-medical equipment.

Ass is tance Provided by WHO dur ing t h e y e a r . Two six-month fe l lowships f o r s tudy

I n Ind ia .

Probable d u r a t i o n uC assistance. Untr l the end oC 1771.

Burma 008% R

I n s t i t u t e of T e c h n o l o ~ j , Rangoon

(May 1969 - !

A i m of t h e p r o j e c t . To teach s a n i t a r y engineer ing t o undergraduate c i v i l

engineer ing s t u d e n t s .

Ass is tznce ~ r o v l ~ y ~ ~ , y WHO dur ing t h e yea r . A p ro fesso r af s a n i t a r y engineer ing.

Probabie d u r a t i o n of a s s i s t a n c e . Un t i l t h e end of 197't.

Work donf dur ing t h e y e a r . A WHO v i s i t i n g p r o f i s s o r of s a n i t a r y engineer ing Joined

t h e p r o j e c t i n May; thc p r o f t s s o r of c i v i l engineer ing a t t h e I n s t i t u t e of Technology

has been appointed as h i s coun te rpa r t .

A pr0gram.e o f l e c t u r e s has been s t a r t e d a t t h e I n s t i t u t e , and a s s i s t a n c e i s being g iven i n the development of a new s y l l a b u s t o extend t h e e x i s t i n g course

t o t h e f i f t h and s ix th -yea r students. A survey of t h e a v a i l a b l e l abora to ry ard l i b r a r y f a c i l i t i e s has bcen initiated, and a com;,l.rte l i s t cf r fqui rements w i l l

be prepared.

The v i s i t i n g professor i s a l s o a s s i s t i n g t h c School of Preventive and

Tropical Medicine ( s e e Durma 0075 ) .

SEA/RC22/2

Page 1.14

S t r e w t h e n i n g o r Health Services

(May 1969 - )

A i m o i thii p ro jec t . To s t r e w t h e n t h c h e a l t h s e r v i c e s , p a r t i c u l a r l y t h e r u r a l

h s a l t h s e r v i c e s , i n i t i a l l y by preparing a plan of opera t ion , a s a s t e p towards

f u r t h e r a s s i s t a n c e i n evolving a na t iona l h e a l t h p lan ; t o a s s i s t i n the t r a i n i n g

of h e a l t h personnel f o r bas ic h e a l t h s e r v i c e s .

Assistance provided by WHO dur ing t h e year . A consul tant i n ~ ~ u b l i c hea l th

adminis t ra t ion.

Probable dura t ion of a s s i s t a n c e . Unt i l t h c end of 1972.

Work don2 d u r i m the year . A consul tant asslgned i n &?y ass l s t e t l i n preparing

a master plan of operat ion f o r t h e s t rengthening of h e a l t h s e r v i c e s , Which is under

s tudy. Preliminary s t e p s were taken t o hold a r e f r e s h e r course f o r h e a l t h a s s i s t a n t s

a t tached t o h e a l t h cen t res .

Burow 0200 Fellowships

R

Cl in ica l and Tropical Medicine. A twelve-month fe l lowship f o r study i n the

United Kingdom.

Typhoid Vaccine Production. A two-month fcllowship f o r s t u d i e s i n Yugofilavia and Ind ia .

Burma 0201

UNDP(TA)

Bac te r io lo iy . A nine-month fe l lowship f o r s tudy i n the United Kingdom.

h l b l i c Health and Preventive k d i c i n e . A twcnty-four month fe l lowship f o r st,udies

i n Canada, t h e United S t a t e s cf America, t h e United Kingdom, the Netherlands,

Yugoslavia and Bulgar ia .

Radiolcey. A four-month fe l lowship f o r stltdy i n Denmark.

CEYLON

O n a beach near Colombo

SEA/RC22/2 Page 115

3. CEYLON

Considerable economic progress has been achieved by Ceylon during recent years, and this has been the subject of favourable comment by the World Bank Mission. Evcn though a formal development plan does not exist, clearly planned strategy to encourage rapid growth in the two most promising sectors of the economy -- domestic agriculture and manufacturing -- has been evident. The foreign exchange entitlement ccrtificate schemes and the elimination of import control for about 15 per cent of Ceylon's imports (primaruy industrial raw materials and some machinery and spare parts) were important steps towards more effective allocation of resources. Export earnings from tea and rubber rose during 1968 by Rs. 101 million and Rs. 48 million to reach Rs. 1 161 million and Rs. 330 million respectively. The increase in tourist traffic was reflected in the b a b c e of payments situation in 1968, which was appreciably greater than in 1967.

The allocation for the development budget was Rs. 850 million, while that for social services was increased to Rs. 119 m u o n . The Ministry of Health budget for 1968/69 was Rs. 2 873 028 (US $682 362) and that for the Department of Health, Rs. 212 562 898 (US 935 724 857).

The population to be provided with these services continues to increase: in 1966, the last year for which figures are available, it rose by 2.4% over the previous year. However, 1966 also saw the lowest birth rate (32.3 per 1 000 population) recorded since 1946.

The Government is continuing to develop its family planning programme, which, first a voluntary scheme, then through the pilot stage and now a national activity, has always been regarded as an integral part of the general public health services of the country. Activities are conducted through a network of family planning centres in the existing medical institutions, which are being expanded to c w e r the whole country.

The Government is fully aware of the dangers of the recent outbreaks of malaria, which last year necessitated reverting to the attack phase most of the areas previously under consolidation or maintenance, and has taken steps not only to meet the present emergency but also to continue the eradication programme on a sound footing in future years. To meet the emergency, the Gavernment has substantially increased its malaria budget in 1968 and 1969. The WHO team which visited Ceylon in 1968 assisted in drawing up emel-gency and long-term plans, and WHO has continued to assist in control measures.

In the field of environmental health, a plan of operation for a pre- investment survey in public water supply, drainage and sewerage for the southwest coastal area was jointly signed by the Government, WHO and the UNDP Special Fund. Related to this project are negotiations with the World Bank for obtaining a loan for two water supply schemes in the first stage.

SEA/R@22/2 Page 116

Towards the end of 1968, there was an outbreak of gastro-enteritis in Jaffna, which mainly affected infants. The incidence of venereal diseases and infectious syphilis was reported to be on the increase in urban areas. WHO assistance took the form of a review of laboratory techniques in the diagnosis of venereal diseases. Legislation was proposed to make poliomyelitis vaccination compulsory as a condition of.schoo1 entry, as 90% of the cases occurred among children under the age of six.

A mass treatment scheme for the control of filaria with hetrazan Was initiated in a selected area, accompanied by intemive larvicidal activities. Ieprosy prevalence is believed to be higher than the present number of registered cases might suggest, and, accordingly, WHO is assisting in the organization of control activities.

Special attention has been paid to the training and service aspects of the work at the Institute of Hygiene in Kalutara.

Great interest has been shown in the successful development of better teaching methods and evaluation in the two medical faculties in Colombo and Peradeniya, and p W are in hand for the establishment of a centre for the study of medical education.

SEA/RC22/2

Page 117

PROJECT LIST

P r o j e c t No.

Source of Funds

Co-opera t in&

Agrnc ics

Ceylon 0005.2

R

T i t l e -

Venerea l -Dlseasc Cont ro l*

( S e p t . 1 9 6 4 ; Sacit. 1 7 6 6 : Oct . - Dvc. 1 9 6 7 ;

J u l y 1 7 6 0 ; Mar. - m y 1367 ; - )

A i m of t h e p r o j e c t . To d e v e l o p l a b o r a t o r y d i a g n o s t i c f a c i l i t i e s f o r t h e n a t i o n a l

v e n e r e a l - d i s e a s e c o n t r o l programme.

A s s i s t a n i c Drovided by WHO d u r i n g t h e y e a r . ( a ) A c c n s u l t a n t ; ( b ) a ten-month

f e l l o w s h i p !'or s t u d y i n Canada.

Probable d u r a t l o n of assistant?. U n t i l 1971.

Wnrk done d u r i n g thii y e a r . F o l l o v i n g on t h c reccmmendat icns o f t h e WHO c o n s u l t a n t

who v i s i t e d Ceylon i n October-Dcccnber 1 9 6 7 . a n o t h e r c o n s u l t a n t was a s s i g n e d t o t h e

p ro . Joc t f rom March t c May 1767 . She a s s i s t e d w i t h a r e v i e w of l a b o r a t o r y

t e c b ~ i q u e s i n s y p h i l i s s e r o l o g y , a s w e l l as i n modern f l u o r e s c e n t d i a g n o s i s and

gonccocca l b a c t e r i o l o g y , and made recommendations f o r t h e improvement of t h e s e

a s p u c t s o f t h e w n ~ k n ti). C e n t r a l Venerea l -Disease L a b o r a t o r y . She a l s o m d e

s u g g e s t i o n s f o r a d d i t i o n a l r e f e r e n c e p r o c e d u r e s w i t h i n t h e c o u n t r y a s and when

t h e c a p a c i t y cf FTA e x a m i n a t i c n s was i n c r e a s e d . Her recommendations were forwarded

t o t h e Government.

L ~ v i ' r s v C o n t r o l

( O c t . - N L ~ . 1 7 6 7 ; Dtc. 1968 - )

Ain o r t h e r r o j z c t . To a s s e s s t h c l e p r o s y problem and t o a d v i s e un t h e f u r t h e r

development o f t h e l e g r c s y c o n t r o l programne.

hss i s ta i -~cc p r o v i t i ~ d by WHO d u r i n g t h e y e a r . [ a ) A c o n s u l t a n t l e p r o l o g i s t ; ( b ) a

t r a n s ~ o r t V ~ i I i C l ~ i .

P robablc d u r s t l o n c f a s s i s t a n c e . U n t i l 1972

f P r c v i c u s t i tl,. : V e n e r e a l - D l s c a s ~ : C o n t r o l (Fluorescent

L a b c r a t c r y Teciniq: ics i n VDT) .

Work done dur ing t h e yea r . A consu l t an t a s s i s t e d wi th t h e development of a leprosy

con t ro l programme, he lp ing t o evclve a p lan of a c t i o n f o r c o n t r o l , i nc lud ing t h e

t r a i n i n g of medical o f f i c e r s and paramedical workors. The number of new cases

detec ted i n Colcmbo subsequently inc reased , wi th t h e in t roduc t ion of b e t t e r

cl iagncstic procedures. The Government is envisaging as s ign ing a d d i t i o n a l n a t i o n a l

;,ersonnel towards t h e end of 1969 t o s t r e n g t h e n t h e c o n t r o l programme on a

long-tarm b a s i s .

WIT0 fe l lowshiys a r e t c be awarded t o sen io r medical s t a f f i n charge of

. : . -n t ro l n c t i v i t l r s a; we l l a:: t o paramedical ;rcrkcrs who w i l l 5upervise and d i r e c t t h e

lup rcsy con t ro l wcrk i n t h e ccun t ry .

ccylon Ow5 Health S t a t r s t l c s

UAJP (TA) (Apr. 1957 - Dec. 1961 ; Sept. 1964 - Dec. 1966; March-

Apr i l 1967; Juni 196-; A U G . - Oot. 1367; Sept . 1968 - )

A i m of t h e Vro,iect. To r e v i s e t h e system r,f records and r e p o r t s i n t h e h e a l t h

s e r v i c e s and t o t r a i n personnu1 i n t h e d c s i m cf documents, process ing of s t a t i s t i c a l

d a t a and c t h e r advanced techniques i n medical ahd h e a l t h s t a t i s t i c s .

Ass is tance provided by WHO dur ing t h e y e a r . ( a ) A medical record o f f i c e r ;

( b ) supp l i e s and e q u i p i e n t .

Prcbablc d u r a t l o n of a s s i s t a n c e . Unt i l t h e end of 1974.

Wcrk done dur ing t h e yea r . With t h e assignment, i n September 1968, of a WHO

medical record o f f i c e r , it was Dossible t o expand t h e a c t i v i t i e s of t h e p r o j e c t

(which had been ccnf ined t o Colorobo South Hosp i t a l ) t o o t h e r h o s p i t a l s on t h e i s l a n d .

In t h i s connect ion, t h e medical record o f f i c e r v i s i t e d some of t h e Colombo Oroup

of H o s p i t a l s , t h e Kandy ffeneral t i c sp i t a l and t h e Galle &nera l Hosp i t a l . She gave

l e c t u r o s on rrcdical records t o s e n i o r t u t o r s of nurs ing as p a r t of an a d m i n i s t r a t i v e

coursc , and a l s o t c 200 t h i r d - y e a r medical s tuden t s . A one-week t r a i n i n g course on

t h e use of t h e I n t e r n a t i o n a l C l a s s i f z c a t i o n of Diseases (Eighth Revis ion) was

arranged by t h e Health S t a t i s t i c s Department of t h e D i r e c t o r a t e of Health S e r v i c e s ;

s i x coders p a r t i c i p a t e d i n t h i s course.

The WliO s t a t i s t i c i a n wcrking with t h e i n t a r - c o n t r y Croject SEAR0 0161

v i s i t e d t h e p r o j e c t i n Apr i l 1769 t o d i s c u s s i ts devulcpment and progress wi th t h e

WHO medical record o f f i c e r and t h e na t iona l o f f i c i a l s concerned. S ~ m e f i l i n g

equipment and paper f o r record f o l d e r s were provided by WHO t c Colombo South Hospi ta l .

Ceylon OOkZ

R UNICEF

Medical AAucation

(June - Aug. 1955; Nov. 1963 - Apri l 1964; Oct. 1964 - Dfc. 1965 ; Sept . 1966; Nov. 1967; s e p t . 1768 - )

A i m of t h e ProScct. To s t r eng then t h e t each lng programmes i n t h e F a c u l t i e s of

Medlclne a t Colombo and Peradeniya.

SEA/RC22/2

Page 119

Ass i s t ance provided by WHO d u r i n p t . : ~ y e a r . ( a ) A prc ' fessor of microbiology and

and t h r e e c o n s u l t s n t s ; ( L ) t w i ; f ~ l l o w s l ~ i p s - c n ~ f o r twelve months znd one f b r s i x

months - f o r s tudy i n t h ~ United Klngdcrn, :i thrce-month f e l l o w s h i p f o r s tudy i n

Denmark, a s ixteen-month f e l l owsh ip So? s tudy i n t h c United Kingdom and t h e United

S t a t e s of Amzric3, a f ive-wrck f e l l o w s h i p f o r s tudy ir. S w i t z e r l a n d , t h e 'Jni ted Kingdom

and t h e Ne the r l ands , and a two-wcuk f e l l o w s h i p f u r s tudy i n Mexico; ( c ) s u p p l i e s and

equipment.

Probable d u r a t i o n c f assistance. I n d c f i n i t e .

Work done d u r i n p t h e y e a r . I n Scptcmber 1968, a WHO p ro fe s so r of microbiology took

up a n assignment a t t h e Facu l ty of Medicine, Peradeniya. He p a r t i c i p a t e d i n t h e

undergraduate course i n h i s d i s c i u l i n e by g iv ing t h e o r z t i c a l and p r a c t i c a l i n s t r u c t i o n .

Amendments and mod i f i ca t ions of t h e s y l l a b i w+re prcposed and d i scus sed wi th t h e

n a t i o n a l c c u n t e r p a r t , and adv ice was g iven t o a pos t -graduate s t u d e n t on h i s r e s e a r c h

work f o r a t h e s i s . The WO p r o f e s s o r a l s o participated i n t h e 3 c t i v i t i c s of t h e

working group on ob,luctivi?-type examinat ions , enJb l ing mul t ip le-choicc papers t o be

used a t end-of - te rm cxJminat ions .

l k c WHO c o n s u l t a n t s on e v a l u a t i o n methods, ass igned from October t c December 1968,

worked w:th t h e F a c u l t i e s a t b o t h Colonbo and Peradeniya ana s t v d i e d t h e e n t i r e sys tem

of a s s e s s i n g t h e pcrformanc, of s t u d e n t s , d i s c u s s i n g d c t s i l s a t t h e f a c u l t y as w e l l a s

depar tmenta l l e v e l . Ry us ing a s t a t i s t l c s l a n a l y s i s of i.xamination r e s u l t s , they

demonstrated t h s wi?aknesscs of th,! e x i s t j n g nethods ?.nd stlowcd ways of ovi!rcoming t h c

d e f i c i e n c i e s and improving t h e o b S e c t l v l t y and r e l i a b i l i t y of examinat ions . Meetings

were h e l d , i n both F a c u l t i e s , w i th t h e working groups s s t up t o s t u d y mul t ip le-choice

examinat ions . The c ~ n s u l t a n c s a l s o a t t ended t h e r c g u l a r meetings of t h e Working Pa r ty

on Medical Educat ion a t Peradeniya . This and o t h c r a c t i v i t i e s , such a s open d i s c u s s i o n s

w i th t h e f a c u l t y and f n m a l l c c t u r c s , enabled t h e n t o c s v e r a s p e c t s of educational

problems beyond t h e s p e c i f i c f i c l d of ev l i lua t ion . Tcwards t h e end of t h e i r assignment,

t W G workshops weru ar ranged - one i n Colonrbo and t h e o t h e r i n P i radcniya - i n which

t h e t o p i c "Experimental and s t a t i s t i c a l s t udy o r exax ina t ions" was d i scus sed and the

p a r t i c i p a n t s wer,e g iven an oppor tun i ty t c work through s i m p l i f i e d s t a t i s t ~ c a l

procedures and t o cons ide r t h e i n t e r p r e t a t i o n of t h e r e c u l t s t hus ob ta ined .

A WHO v i s i t i n g p ro fe s so r of p a e d i a t r i c s was ass igned t o t h e Facu l ty of

Medicine, Colombo,from March t o June. He s t u d i e d t h e undergraduate and pos t -grcduate

t e a c h i n g programmes wi th sj icci31 reference t o c o l l a b o r a t i o n wi th o t h e r departments

such a s o b s t e t r i c s and yr,!ventive and s o c i a l mrd ic ine , and t h e u t i l i z a t i o n of f i e l d

t r a i n i n g f a c i 1 i t i t : s . H i s ] .@port was under s tudy i n t h c i i rg ional Off ice .

Cevlcn 0056

UNDP(TA)

F i l a r i n s i s Cont rc l

(Dec. 1959 ; Apr i l - J u l y 1961 ; S z p t . 1761 ; ~, '~ :,-,,.

r,.;;. - L _ I - L . &A,; JL.3. 17(,; - )

A i l u of t h e i ~ r o j e c t . To stll!y ttrt, pr~obles! c.1' f i l a r i a s i s icont ro l , t c s t r e n g t h e n t h e

c o n t r o l p r o g r a m l ~ and t o i n t r o l ' i c e such new m~thor ls :is n i y be i n d i c a t c o .

~EA/Rc22/2

Page 120

Assis tance provided by WHO dur ing t h e Year. ( a ] An epidemiologis t and an

F n t o m l r g i s t ; ( b ) cn~:!iiics end cquipmcnt 2nd a t r a n s p o r t v i .h ic le .

Probable d u r a t i o n of a s s i s t a n c e . U n t i l t h e end of 1972.

Work done durinc: t h e yea r . Thrcugh f u r t h e r i n v e s t i g a t i o n s t h e WHO team confirmed

t h e extens ion of f i l a r i a s i s beyond t h e South-West c o a s t a l b e l t , though t h i s ex tens ion

was found not t o be i n a continuoas a r e a but r a t h e r i n va r ious f o c i cf popula t ion

c e n t r e s . The r c g u i a r con t ro l a c t i v i t i e s con t inued , applying f e n t h i o n a s a l a r v i c i d e .

As it was ev iden t t h a t many mcre a r e a s wcre being i n f e c t e d , a p i l o t t r i a l was

dcvelopcd i n an a rea wi th a l a r g e v i l l ag r . i n which v e c t o r Lontrol was combined wi th

lass t r ea tmen t . This tri'al was w e l l prepared, and t h e h e a l t h educat ion a spec t s of

t h e mass t rea tment t r i a l were proper ly executed. F u r t h e r s tudy of t h i s approach

and of c o s t cons ide ra t i cns w i l l br. required f o r a s s e s s i n g t h e long-term e f f i c a c y i n r e spec t of r educ t ion of i n f e c t i o n .

Ceylon 0058

R USAUi

Malaria E r a d i c a t i s n

(nut.. 1960 - )

A i m of t h e pro.lact. To e r a d i c a t e ma la r i a and t o prevent t h e re-es tabl ishment of

endemicity.

Ass is tance provided by WHO dur ing t h e y e a r . (a) An ep idemio log i s t , an entomologist

and s i x shor t - t e rm s a n i t a r i a n s ; (b ] f o u r three-and-a-half-nonth f e l lowsh ips f o r s t u d i e s

i n t h e Ph i l ipp ines and I n d i a ; ( c ) s u p p l i e s and equipment and a t r a n s p o r t v e h i c l e ; ( d ) paynant of subsidy.

Pmbablc d u r a t i o n of a s s i s t a n c e . U n t i l t h e end of 1774.

Work done dur ing thi. y e a r . Thc epidemic which s t a r t e d i n l a t e 1967 continued and,

i n cornparison wi th 3 522 confirmed cases of malaria i n 1967, mere than 435 000 cases

were mic roscop ica l lyde tec ted d u r i l y 1768. En~phasis was the re fo re s h i f t e d t o

emergency m,asures.

The plans formulated by t h e s p e c i a l WHO team which v i s i t e d t h e country i n

June 1768 wcre of two k inas - an emrgenoy plan t o h a l t t h e spread of t h e epidemic

and a l o w - t e r n ) one aimed a t u l t ima te e r a d i c a t i o n cf t h e d i s e a s e . The long-tcrm plan

was u n d e r s tuuy by both t h e Government and WHO, wi th a view t o evolving a s u i t a b l e

p lan of ope ra t ion f o r t h e next few yea r s .

I n acccrdance wi th t h e shor t - term p l a n , walking and mobile sp ray teams were

e s t a b l i s h e d t o g ive p r o t e c t i o n t o about f i v e m i l l i o n people. The a c t u a l implementation

was s o n w h a t slcwc? down because o f recrui tment d i f f i c u l t i e s and de lay i n sanc t ion ing

funds. The Rcgional D i r e c t o r , i n h i s v i s i t t o Ceylon i n nugust 1968,discussed t h e

S E A / R C ~ ~ / ~

Page 1 2 1

programme w i t h t h e a u t k ~ c r i t i e s , and t h e p1.an h a s been g i v e n u r g e n t p r i o r i t y . The

nwnber f mobi le and , i a l k i n p s p r a y 'earns had i n c r e a s e d f r c n 73 i n July/August 1968 t r :nor? t h a n hC0 by fi. h!..!;l"y 1 9 6 9 , 3 f f r r d i n q g r c t c * . t l o n t o 4 . 6 5 m i l l i o n p e n p l r i n

47 h c a l t h a r r a s . By March 1 9 6 9 , t h p t h i r d c y c l e of s p r a y i n 3 had been s t a r t e d i n seven

h c a l t h a m a s . Thc s p r a y i n g c p e r a t l o n s were a s s i s t i ~ d by s i x Y H O s a n i t a r i a n s .

Laboratc;ry s e r v i c e s were d e c e n t r a l i z e d , with t h c e s t a b l i s h m e n t of r e g i o n a l

and f i e l d l a b o r a t o r i e s . A s e p a r a t e c r o s s - c h e c k i n g c e n t r e was a l s o e s t a b l i s h e d , w i t h

a s s i s t a n c e frrrni a WHO l a b o r a t c r y s p e c i a l i s t ( s e e SEARO 0094.2) .

An \El0 c n t > r ; ~ o l o g i s t was a s s i g n e d from J u n c t o December 1968 t o h c l y t o s e t

rlr? a p p r o p r l - t c cnt , , r ; iological techniq: i r ;s and investigations. In December, a n o t h e r

e n t o m c l o g i s t waa a s s i g n e d a rd , w i t h t h e r e c r u i t m e n t r;f o v e r s e e r s and e n t o m o l o g i c a l

a s s i s t a n t s , e n t o m c l c g i c a l wcrk was o r g a n i z e d .

Ceylon 0063.2 * Medical R e h s S r l r t a t l a n

R (Nov. 1768 - Peb. 1 9 6 7 ; - 1

A i m of t h c ;:ro:cct. To advis r : cn t l ~ ~ i m n u f a c t l l r i c f c r t h o p a e d i c n p p l i a n c e s .

A s s i s t a n c e prov ided by WHO dur ' ing tilt y e a r . A c c n s u l t a n t ( t e c h n i c i a n i n

o r t h o p a c d i c a p p l i a n c e s ) .

P r o b a b l e d u r a t l o n ?f z s s l s t a n c r . U n t l l t h e end :f 1971.

Work done d u r i n g t h e ycar,. A WHO c o n s u l t a n t was a s s i g n e d t o t h e p r o J e c t f rom Novcrnbcr

1968 t o Fcbruary 1 ' , ' I t r , a j v i s u o n t h e manufac ture of p r o s t h e t i c and o r t h o p a e d i c

a p p l i a r - e s and a l s o t c a s s i s t i n t l -2 t r a i n i n g of t e c h n i c i a n s . His r e p o r t h a s been

s u b m i t t e d t o the Gcvernment.

In resl 'onse t o a r c q u c s t by t h e Government, a f u r t h e r v i s i t by t h e same

c o n s ~ : l t a n t was u n C c r c c n 3 i J e r a t i o n .

Ceylon 0064

R

C c m d n i t y Water Supply

( O c t . 1963 - )

i t in of the ; , r c J c c t . To d c v ~ l o p corrmd:nlty water sup1,ly and sewcragc schemes.

A s s i s t a n c e p r o v ~ l ~ d by WHO I1:ring thc y c a r . fi c o n s 1 , l t a n t .

P rubable 3 u r a t i ? n of a s a i s t a n c : . U n t l l t h c end rf 1972 .

*WHO ass i s t r? i i cz t o tile f irst :!?asr of tilt: ~ ; r o , j c c t ended i t , L)~.cemabrl, 1966

and was r c p o r t z d und~:r p n j v c t n a r f i b ~ r Ccyl:ln O O t j .

S E A / R C Z ~ / ~ Page 122

Work done dur ing the year. The revised plan o f cpera t ion covering WHO/UNICEF a s s i s t a n c e

t o a country-wide piped water Supply and sewerage programme was sen t t c UNICEF f c r review. The consul tant ( s a n i ~ a r y engineer) wno had been a s s i ~ n e r i tt: the p r o j e c t i n

March 1963 l e f t i n Au:,,::st, and a replatoment was undcr recruitment.

A t the request of the Government, s t e p s were a l s o taken t o r e c r u i t a s u i t a b l e

ccnsul tant t o a s s i s t i n exploring t h e p o s s i b i l i t y of manufacturing, l o c a l l y , chemicals

f o r water t reatment .

Strengthening of Laboratory Services

(Aug. 1966 - March 1969)

A i m of t h e p r o j e c t . To s tudy t h e epidemiology and con t ro l of d iarrhoea1 d i seases

and t o develop bac te r io log ica l d iagnos t i c f a c i l i t i e s f o r e n t e r i c d i seases i n t h e

p r inc ipa l hosp i t a l s and i n t h e f i e l d ; a l s o t o s t reng then l abora to ry se rv ices

throughout t h e country.

Assistance provided by WHO dur ing t h e year . ( a ) A v i r c l o g i s t and a b a c t e r i o l o g i s t ;

(b ) supp l ies and equipment.

Work done. During t h e perjod of i t s operat ion from k ~ g u s t 1966 t o m r c h 1969, t h e

p ro jec t a s s i s t e d wi th t h e establishment of two b a c t e r i o l o g i c a l l a b o r a t o r i e s - one i n

the Angoda In fec t ious Diseases Hospital and t h e o t h e r i n Ragam Oeneral Hospi ta l .

In a d d i t i o n , d iagnost ic se rv ices i n microbiology were strengthened i n Hatnapura

General Hospi ta l , Lady Ridgeway Children's Hospi ta l and Colombc Eye Hospi ta l .

The hnc te r lo log l s t a l s o helped i n the organizat ion o r t h e bac te r io log ica l se rv ices

a t t h e I n s t i t u t e of Hygiene i n Kalutara.

In a s s o c i z t i c n u . ; th thc Central Epldeniulc;l.cal Unit and t h e Medical Rsaearch

I n s t i t u t e , Colcmbo, s i g n i f i c a n t progress was made with regard t o t h e following:

( a ) study on diarrhoea1 d i s e a s e s ; ( b ) con t ro l of a s c a r i a s i s by blanket treatment

with piperazin c i t r a t e ; ( c ) l e p t o s p i r c s i s surveys; ( d ) inves t iga t ions i n t o t h e

a e t i o l o g i c a l causes of cases cf pyrsxia of unknown o r i g i n ( i n Ratnapura) ; ( e ) dengue/

haemorrhagic fever s u r v e i l l a n c e ; ( f ) d iagnosis of r ab ies i n animals; ( g ) improvement

of the q u a l i t y anti kotency of r ab ies vaccine, and ( h ) i n v e s t i g a t i o n of outbreaks of

food poisoning.

Three medical o f f i c e r s were t r a ined and 12 t o 15 technicians were given

t r a i n i n g i n general l abora to ry techniques , f luorescence microscopy, enterdbacter iolcgy,

serology i n arbovirus i n f e c t i o n , l e p t o s p i r a c u l t u r e and serology, and t e s t i n g of

r ab ies vaccine.

Ceylon 0072 Health Education

R ( ' lO\. . 1966 - Feb. 1967; Feb. - m y 1969; - )

p i n of tho c r o j c c t . T. . trengthen f u r t h e r the h c a l t h education se rv ices and t h e i r

functionirig.

SEA/RC22/2

Page 123

Assists.-ce provided by WHO d u r i n g t.=. ( a ) A c o n s u l t a n t ; ( b ) supply of - 61edical l i t e r a t ~ r c .

Probable d u r a t i o n of a s s i s t a n c e . U n t i l t h e end of 1971.

Work done d u r i n g t h e yea r . A c o n s u l t a n t , a s s igned from February t o May 1969,

under took a review of t h e development of h e a l t h e d u c a t i o n s e r v i c e s s i n c e t h e previous

a s s i s t a n c e . Based on h i s f i n d i n g s , recommendations were made f o r t h e f u r t h e r

development of t h e s e r v i c e , and t h e i r implementa t ion on a phased b a s i s . I n

p a r t i c u l a r , t h e r~ccommendations covercd t h e ? ~ p g r o d i n g of t h e Hea l th Educat ion Unit

and t h e e s t ab l i shmen t of a nuc leus of h jgh ly q u a l i f i e d h e a l t h educa to r s . The r e p u r t

of t h e c o n s u l t a n t was under s t udy .

Ceylon 0074

UNDPITA)

I n s t i t u t e of Hygiene, Ka lu t a r a

( J u l y - Sep t . 1964; Feb. 1967 - ]

A i m of t h e pro . jec t . To uevelop t h c I n s t i t u t e a s a c e n t r e f o r t r a i n i n g and O r i e n t a t i o n

of pub l i c h e a l t h s t a f f ; t o improve and i n t e g r a t e t h e s e r v i c e s p lanned; t o deve lop

a p rov inc i a l - t ype h e a l t h l a b o r a t o r y a t t h e I n s t i t u t e , and a l s o t o upgrade t h e d i s t r i c t

h o s p i t a l l a b o r a t o r i e s i n t h e a r e a a s s igned t o t h e l a b o r a t o r y .

A s s i s t a n c e provided by WHO d u r i n g t h e yea r . ( a ) A c o n s u l t a n t i n pub l i c h e a l t h

a d m i n i s t r a t i o n and a s s i s t a n c e from t h e b a c t e r i o l o g i s t provided under p r o j e c t

Ceylon 0066.3 ; [ b ) s u p p l i e s and equipment.

Probable dura t iorf l -? ;ss is t iVice . U n t i l t h e end "f 1969 .

Work done d u r i n g t h e y e a r . The h e a l t h l a b o r a t o r y , e s t a b l i s h e d w i t h WHO a s s i s t a n c e ,

cont inued t o s e r v e a s a r e f e r r a l c e n t r e f o r t h e d i s t r i c t l a b o r a t o r i e s , and s t e p s

were t aken t o encourage b e t t e l u t i l i z a t i o n of t h e f a c i l i t i e s a v a i l a b l e .

With t h e a s s i s t a n c e of t h e WHO c o n s u l t a n t ( p u b l i c h e a l t h a d m i n i s t r a t o r ) ,

a rcv iew was made of t h e t r a i n i n g programmes of th . i I n s t i t u t e a s w e l l a s t h e s e r v i c e s

provided by t h e h e a l t h u n i t component. Based on t h i s r ev i ew , s h o r t - and long-term

p l ans f o r s t r e n g t h e n i n g and i np rov in& t h e s e two a s p e c t s of t h e I n s t i t u t e ' s a c t i v i t i e s

were fo rmu la t ed , and t h e s h o r t - t e r m r e c o m n d a t i o n s were implemented.

Maternal and c h i l d h e a l t h : l c t i v i t i e s i n t h e orcas servcd by t h e I n s t i t u t e

wcre strengthened, wi th t h c a c t i v e c o l l a b o r a t i o n o f ' t h o p a e d i a t r i c s , o b s t e t r i c s

and gynaeco log i ca l u n i t s o i ~ tI1c bas, h o s p i t a l a t Ka lu t a r a .

Ceylon 0075 R

UNICEF

Tube rcu los i s Con t ro l

( J a n . 1966 - 1

A i m of t h c p r o j e c t . To o rgan i ze a community-orii,ntld , i n t e g r a t e d t u b e r c u l o s i s c o n t r o l

prograrune on a p i l o t b a s i s i n t h e North-\,iestcrn Province ; t o cont in i le and expand t h e

SEA/RC~Z/Z

Page 124

BCG vaccinat ion programme t o cover t h e whole country , t o secure t h e eventual

i n t e g r a t i o n or' tubercu los i s con t ro l i n t o l r i u g e l l ~ r a l h e a l t h s e r v i c e s .

Assistance provided by WHO dur ing t h e year . A medical o f f l c e r ~ .

Probable dura t ion of a ss i s t ance . Unt i l t h e end 01- 1974.

Work done durina: t h e year. In Ceylon, where tubercu los i s con t ro l is considered t o

be t h e most important h e a l t h programme a f t e r malar ia e r a d i c a t i o n , the Government,

i n t h e l a s t quar te r 1768, issued a d i r e c t i v e t o the e f f e c t t h a t a l l normal newborns

delivered i n government heal t i i and medical i n s t i t u t i o n s should receivc BCO vnccinat1r.n

before being discharged. As a. r e s u l t , i t was possible t o vaccinate 85 per cen t Of the

babies born i n government general h o s p i t a l s durinp: the s i x montks t h a t followed t h e

i s sue of t h e d i r e c t i v e . Furthermore, t o make t h e BCG vaccinat ion programme more

r a t i o n a l , a revised schedule was adopted, according t o which cP.ildren would receive

BCG vaccinat ion only twice , namcly a t b i r t h and a t t e n years of age. Newborns not

r e c c i v i x BCG a t b i r t h would subscqucntly be covered through t h e general hca l th

se rv ices during infancy. For t h i s purposc, t h e publ ic h e a l t h inspectors who c a r r y

out t h e general l m u n i z a t i o n scheme f o r ch i ld ren i n the provinces a r e given t r a i n i l y

i n techniques of d i r e c t BCG vaccinat ion. The school-chi ldren of t e n years of age

who a re missed a r e covered a t t h e time of l eav ing school.

In add i t ion t o the country-wide BCG programme, f u l l y in tegra ted and

comprehensive p rov inc ia l tubercu los i s con t ro l programmcs a re being c a r r i e d o u t ,

i n accordance with a long-term na t iona l p lan which 1s under preparat ion.

A monitoring ansessment of t h e f i r s t provincia l tubcrcu los i s programme,

which was i n i t i a t e d a s a p i l o t project i n 1966 i n the North-western Province, has

now been undertaken, wi th WHO a s s i s t a n c e , 2nd has produced i n t e r e s t i n g findir:s wi th

regard t o t h e ago composition of t h e p a t i e n t s , t h e i r geographical d i s t r i b u t i o n , and

t h e public t r a n s p o r t f a c i l i t i e s a v a i l a b l e t o them. The f ind ings a l s o confirmled t h e

important con t r ibu t ion made by the r u m 1 h e a l t h se rv ices with regard t a the d e t e c t i o n

of cases of infect ious tuberculusis ,o thcrwise having l i t t l e chance of being revealed.

The experience gained i n the p i l o t a r e a is of g r e a t value f o r t h e o the r p rov inc ia l

tubercu los i s programmes t o be developed throughout t h e country , and the many operat ional

and epidemiological aspects of comprehensive p rov inc ia l tubercu los i s programmes have

bcen the sub jec t of d iscuss ions a t s p e c i a l seminars f o r tubcrcu los i s workers. Those

a r e a l s o presented i n d e t a i l i n t r a i n i n g courses f o r t h e var ious ca tegor ies of h e a l t h

workers being posted t o r u r a l h e a l t h c e n t r e s , who a r e expected t o ca r ry ou t some

tubercu los i s con t ro l work as pa r t of t h e i r d a i l y rou t ine .

In add i t ion t o t h e p i l o t programme i n t h e North-western Province, two more

programmes a re now under implementation, one i n t h e Central and one i n t h e North-

c e n t r a l Provinces. In order t o cope with t h e increased need f o r t echn ica l a s s i s t a n c e

i n connection with the dcvulopmcnt of th, na t iona l tubcrcu los i s p r o g r a m , a fu l l - t ime

WHO medical o f f i c e r was assigned t o t h e prodfct i n August 1768.

A WHO f e l l o w s h i p was awardc .~ t o a medical o f f i c e r f o r p a r t i c i p a t i o n i n t h e

E igh th International T r a i n i n g Course i n t h e Epidemiology and Con t ro l of Tube rcu los i s ,

Prague (awarded under p r o j e c t I n t r r - r e g i o n a l 0113.1) .

P r e p a r a t i o n s were under way f o r h o l d i n g a n i n t e r - c o u n t r y seminar on

t u b e r c u l o s i s e a r l y i n 1970.

Ceylon 0082 I n d u s t r i a l Hygiene

R ( A M . 1968: - )

A i m of t h e p r o j c c t . To a s s e s s t h e s i t u a t i o n w i t h r ega rd t o i n d u s t r i a l hyg i ene , t o

a d v i s e on thi. dcvelopnunt of occupz t iona l h e a l t h s e r v i c e s and t o t r a i n s t a f f .

Ass i s t ance provided by WHO during: t h e yea r . Two nine-month f e l l o w s h i p s f o r s t u d y

i n t h e Unlted Kingdom.

Probable d u r a t i o n of a s s i s t a n c e . U n t i l 1970.

Ceylon ~084 R

Bbte rna l and Chi ld H e a l t h S e r v i c e s

(Dec. 1968 - March 1763; - )

A i m of t h e p r o j e c t . To improve t i le a d m i n i s t r a t i o n and reorientation of t h e p r e v e n t i v e

and c u r a t i v e materna l and c h i l d h e a l t h s e r v i c e s , i n c l u d i n g f a m i l y p l ann ing , and t o

conduct a s e r i e s o f cou r se s on materna l and c h i l d h e a l t h f o r n u r s i n g and medical

PerSONlel a t a l l l ,2 \v . l s .

Probable d d r a t i c n of 7.ssis tance. U n t i l thi? end of 1773.

Work done d u r i n g t h e y e a r . A WHO c o n s u l t a n t was a s s igned from December 1968 t o

March 1969 t o s t u d y t h e a d m i n i s t r a t i v e and f u n c t i o n a l p a t t e r n of materna l and c h i l d

h e a l t h services, i n c l u d i n g f a r i l y p l ann ing , a t a l l l e v e l s of t h e h e a l t h a d m i n i s t r a t i o n .

1Se recommended: ( 1 ) s t r e n g t h e n i n g t h e a u t h o r i t y of t h e A s s i s t a n t D i r e c t o r

i n cha rge of materna l and c h i l d h e a l t h and f ami ly p lanning w i t h i n t h e framework of

t h e Min i s t ry of H e a l t h , ( 2 ) t h c appointment of a s e n i o r and q u a l i f i e d a s s i s t a n t

and provismori rf a d d j t i o n a l c l u r i c a l s t a f f , s u p p l i e s and cquipmrnt , ( 3 ) es t ab l i shmen t

of a j o i n t n t a tu rml snrl rhjld h e a l t h and f a n i l y p l a m l n g a d v i s o r y commlttc'. a t t h e

na t i on31 i c v c l , ( 4 ) e a r l y imp lcn~en ta t i on of t h e d e c i s i o n o f t h e Min i s t ry t o appoin t

f i f t e e n r e g i o n a l nator.n21 and c h i l d hdalth/farnl ly p lanning o f f i c e r s t o be a t t a c h e d t o

t h e o f f i c e s o f t h e Supe r in t enden t s cf Heal th S e r v i c e s , and ( 5 ) r e d e f i n i t i o n of t h e func-

L.i.cric o f , :n:i tk.: t r a i n i n g o f , l i d w i v e s , a s r e q ~ i r e l i , i n crr ier t c meet t h e chanfi inr

p a t t c r n of t h e h e a l t h need:: of mothers and c h ~ l d l ' e n .

Thc ronsu1t;r.t i!:,pil2sizcu ti.. imiior~tznct~ 0 1 ~ ] ~ y l ! u ; c ; r , a t t v n t l n n t o :u~:.\:ni:. i n preenancy , low Si r t i i wi,i>:!lt, and t h e r e d u c t i o n L;' ":orb i d i t y and imr , tu l i t j r nmong

~ ~ ~ ~ e - s c k c o l - c i ~ i l d r ( l n .

SEA/HC22/2

Page 126

Ceylon 0086

UNDP(SF)

Publlc Water Supply. Drainage and Sewerane

fr,r t h e South-Woct :c;stal Area

(Aug. 1967 - )

A i m of t h e Droject. To a s s i s t i n pre-investment s t u d i e s f o r h igh p r i o r i t y water

supply and sewerage schemes i n the south-West c o a s t a l a reas .

Assistance Provided by WHO dur ing t h e year. ( a ) A p ro jec t manager and temporary ass i s t ance from one of the s w i t a r y engineers assigned under p roJec t SEAR0 0064;

( b ) supp l ies and equipment and t h r e e t r a n s p o r t veh ic les .

Probable dura t ion of a ss i s t ance . Unt i l 1971.

Work done dur ing t h e year. The preliminary operat ions phase of t h e p ro jec t was

completed, and t h e consul tant engineering f i r m (Messrs Haigh, Zinn and Humphreys)

submitted t h e f i n a l r epor t s . The plan of operat ion f o r the two-year f u l l - s c a l e s tud ies was s igned , and t h e Government approved t h e appointment of t h e same f i r m a s

sub-contract" ... Thi' f i r m ' s s t a f f a r r ived i n Ceylon i n Apri l and, t h e same month,

a WfZO s a n i t a r y engineer w i t h t h e in ter-country community water supply p r o j e c t , was

temporarily assigned t o the p r o j e c t , pending t h e a r r i v a l of t h e WHO p ro jec t mnager .

Tha l a t t e r took up h i s d u t i e s i n May.

With a view t o exploring t h e p o s s i b i l i t y of ob ta in ing a loan from t h e World

Bank, meetings were held with o f f i c i a l s of t h e Rank and of t h e f i r m of consul t ing engineers. In a jo in t m e t i n g between represen ta t ives of t h e World Bank, WHO and

the Government, which was held i n Washington from 20 t o 22 February, t h e Bank suggested f i n a n c i a l c r i t e r i a t o serve a s a b a s i s f o r f u r t h e r s t u d i e s .

Ceylon 0200 Fellowships H

Cardiac Catheter izat ion. A f l f teen-day t r a v e l fe l lowship i n I s r a e l .

Child Dental Health. A nine-month fe l lowship f o r s t u d i e s i n Sweden and Denmark,

F i l a r i a s i s Control. A one-and-a-half month fe l lowship f o r a s tudy t o u r of Ind ia ,

Burm, Thailand and Malaysia.

Medical C o d i x . Six three-month fe l lowships f o r study i n India .

Nutr i t ion. A three-month fe l lowship f o r s tudy i n India.

Training and U t i l i z a t i o n of Auxi l i a r i e s . A t r a v e l f e l l o u s h i p of seven weeks i n YugOSlavia, t h e United Kingdom, t h c USSR, I n d i a , Malaysia and Singapore.

Rural India, where 80% of the population live

S~A/Rc22/2 Page 127

4. INDIA

The Indian economy has shown some encouraging features during the year, particularly in regard to agricultural production, which reached a record level in 1967-68 despite the vagaries of the monsoons, causing either drmght or flood conditions in various States. The prospects for the overall p i n production in 1968-69 were also excellent. This gave some stimulation to the other sectors of the economy, and there was a m a r b d increase U exports of manufactured goods.

The present year, 1969, represents a sighificant period, as the Fourth Five-Year Plan 0969-74) came into force in April. Depending m the qUBnm of foreign aid and mobilization of domestic resources, the final form of the Plan may differ in some respects from the draft. There is still uncertainty, not only as to what infusion in foreign aid will be available but also regarding how much can be expected from domestic resources. In view of this u n c e m t y , the Government's commitments will be determined on' a yearly basis, according to the immediate needs and resources of the economy. The Plan reflects the two major concerns for India's economic and social future -- its ability to become self-sufficient in food and the related question of a reduction in the rate of population growth, which has contirmed to militate against the attainment of adequate food production.

With an estimated gross population increase of thirteen million in 1968, the population by mid-1969 may well have exceeded 520 million. The critical importance of the family planning programme is thus very evident, and the Government, in addition to an overall allocation for the Plan, has provided for the possibility of additional amounts being granted in the annual plans. m e allocation for health and family planning services in the Plan is Ukely to be about 336, but implomention of the programme may be adversely affected by the uncertainties mentioned above. In the 1969-70 budget, a sum of Rs. 9 727.73 lakhs (US $129.7 million) has been allocated for health and family planning, representing around 5 per cent of the total.

The Five-Year Plan' will in general provide greater flexibility to States in fixing their own priorities. Some of the health programmes will be centrally sponsored; these include family plaMtng, applied nutrition and campaigns against communicable diseases.

In a reshuffle of the Central Cabinet in February 1969, the responsi- bilities of the Ministry of H d t h , Family Plnnning and Urban Development were widened to include the important portfolios of works and housing. In ccasequence, there are, in addition to the Cabinet Minister, two Ministers of State, one in charge of family planning and the other of works and housing.

Apart from the education quota, family planning and rural health are given the place of honour in the social services. The expansion of the rural health services continues, a s it is very much appreciated that the specialized programmes for control or eradication of communicable diseases, particularly

SEA/hC22/2 Page 128

the malaria programme, must be integrated into the general health services, and also that the various units d these services must be strengthened so that they may play their part in providing the information and services required for the family planning programme. In its efforts to expand the services to try to reach every village, the Government ha8 had to face another problem, namely that of ensuring sufficient resources in medical manpower &meet the growth of population and also to give a more comprehensive service.

During the year, at the request of the Government d Mia, ad assessment of the family planning programme was made by a Unitcd Nations team. The manner in which WHO and UNICEF may provide more assistance in the urban programme is being explored. The Government's aim is to reduce the present birth rate of 41 to 25 per thousand over the next ten years.

With the multiplication of health centres to a total of more than 5 000, there has been a concomitant increase in the number of staff trained; the conversion of malaria surveillance workers into basic health workers in areas which have entered the maintenance phase of the malaria eradication programme has contributed to this increase.

The Government has continued to difect attention to the strengthening of health administrations at the disti-ict level. The National Institute of Health Administration and Education in New Delhi has prepared', with WHO-UNICEF assistance, a plan for operational research at this level.

The Five-Year Plan envisnges an increase in the sumbcr of medical schools from the existing 92 to 102 by 1974, in efforts to prwicle sufficient doctors so that there may be one medical practitioner t o4 600 persons. Establishment of suitable faculties poses considerable difficulties.

There is still a dearth of well-trained teaching staff for raising the standards of basic nursing training; and for providing nursing administrators, and efforts are being made to build up post-basic nursing schools.

The importance of epidemiological surveillance is being increasingly recognized as an essential part of the Government's health activities, and, as a necessary adjunct, the phased development of health laboratories is receiving; attention. The training of suitable categories of laboratory staff has somewhat advanced during the ye=, notably in the establishment of degree courses for technicians.

SEA/RCZZ/Z Page 129

PRQJECT LIST

Project No.

Source of Funds

Co-operating

AJencies

Ind ia 00a

UNDP(TA1

(BMRC)

( ICMR)

T i t l e

Tuberculosis Chemotherapy Centre, Madras

(Dec. 1955 - )

A i m of t h e p ro lec t . To undertake control led t r i a l s t o f i n d simple, e f f e c t i v e and

inexpensive methods of tubercu los i s con t ro l through domici l iary chemotherapy of

ambulant p a t i e n t s , and t o c a r r y 01:t r e l a t e d research.

Assistance provided by WHO d u r i w the year . ( a ) A l abora to ry t echn ic ian and two

consul tants ; ( b ) suppl ies and equipment, drugs and a resea rch microscope.

Probable dura t ion of a s s i s t a n c e . Unt i l t h e end of 1974.

Wark done d u r i w t h e year . The inanifold research work c a r r i e d out by t h e Centre

i n connection with t h e development of s u i t a b l e and e f f e c t i v e ambulatory treatment

regimens continued s a t i s f a c t o r i l y , though t h e in take of new p a t i e n t s t o the various

s tud ies was slow. It was the re fo re recommended t h a t , as a mat ter of urgency, t h e

a rea of in take be ihcreased by iraking b e t t e r use of t h e many h e a l t h and diagnost ic

c e n t r e s , co rpora t ion d i spensar ies and insurance c l i n i c s i n Madras City i n

arranging f o r a r e f e r r a l s e r v i c e .

The main l i n e of research a t t h e Centre is t o inves t iga te f u r t h e r the

p r inc ip les of i n t e r m i t t e n t tubercu los i s chemotherapy. A very complex s tudy, i n

which t h r e e d i f f e r e n t oncu-weekly regimens were compared with t h e s tandard regimen

of twice-weekly s t r e p t o w c i n plus lsonLazid,was completed, and t h e repor t was

being f i n a l i z e d . The study has shown t h a t t h e once-weekly s t r e p t o w c i n plus

i son iaz id regimens a re s u b s t a n t i a l l y i n f e r i o r and a l s o t h a t i n e add i t ion of a t h i r d

drug, e . g . , pyrazinamid, i s not producing any improvement. However, i f a once-

weekly r o g i m n is preceded by an i n i t i a l in tensive phase dur ing which streptom,oin

and i son iaz id a r e given d a i l y f o r a month, then t h c e f f i c a c y of the regimen is

s u b s t a n t i a l l y enhanced - provided t h a t t h e pa t i en t is not a so-cal led rap id isonlazld

i n a c t i v a t o r . The repor t has ou t l ined the reasons f o r t h e f a i l u r e of t h e th ree once-

weekly regimens and r e a f f i r m d tile high e f fec t iveness of the s tandard twicr-weekly

regimen.

Another study i n progress is designed t o a s c e r t a i n t h e p o s s i b i l i t y of improving t h e atove-mentioned two-phase regimen by t h e add i t ion u f PAS, both i n t h e

i n i t i a l d a i l y and subsequent once-weekly phase, with a view t o overcoming t h e

def ic iency of t h i s regimen i n t h e case of rapid i son iaz id i n a c t i v a t i o n . A preliminary

ana lys i s seems t o ind ica te t h a t PAS may not be ab le t o improve t h e once-weekly

regimens and t h a t f u r t h e r r esea rch , by i n v e s t i g a t i n g more potent an t i - tubercu los i s

drugs a s a t h i r d drug, may be needed.

A new l i n e of inves t iga t ion of t h e p r inc ip les of i n t e r m i t t e n t chemotherapy i s

by s t u d i e s on o r a l i n t e r m i t t e n t regimens. A s tudy with streptoucfcin, PAS ard

i son iaz id is a l ready under way, and another one using t h e potent drug Ethambutol is i n preparat ion. This s tudy is designed a l s o t o introduce a new p r i n c i p l e i n t o

primary chemotherapy i n v e s t i g a t i o n s , namely, t h a t of explor ing i n a s i n g l e s tudy a new drug administered a t f requencies ranging from d a i l y t o once a week; t h i s would i n t h e s h o r t e s t poss ible time provide an answer t o t h e l i k e l y r o l e of a new drug i n t h e chemotherapy of tubercu los i s .

Apart from t h e rou t ine l abora to ry work immediately connected with t h e

con t ro l l ed c l i n i c a l t r i a l s , a number of inves t iga t ions of genuine s c i e n t i f i c importance

have been c a r r i e d out: comparison of d i f f e r e n t sputum swab c u l t u r e methods us ing cetavlon; comparison of experimental chemoprophylaxis i n guinea-pigs wi th d a i l y and

twice-weekly i son iaz id ; d i r e c t s e n s i t i v i t y t e s t s f a r i son iaz id and s t rep toqvc in ;

experimental i n t e r m i t t e n t chemotherapy with pyrazinamide i n mice; comparison of t h e chsmical methods f o r i son iaz id es t imat ion versus t h e microbiological ( v e r t i c a l

d i f fus ion) method and t h e f luor imet r i c method ( f o r very low i son iaz id l e v e l s ) ;

ace ty la t ion of sulphadimidine a s a simple method t o c l a s s i f y p a t i e n t s a s slow o r rapid i n a c t i v a t o r s of i s o n i a z i d ; t h e r o l e of sulphadimidine i n enhancing t h e i son iaz id

serum l e v e l and prolonging t h e i son iaz id coverage i n rapid i n a c t i v a t o r s ; a t e s t f o r

t h e presence of ethionamtde sulphoxide i n u r ine , and i n v e s t i g a t i o n of the s t z b i l i t y and absorbab i l i ty of i son iaz id i n syrup preparat ions . Phase I11 of t h e drug r e s i s t a n c e

survey dea l ing with semi-urban c l i n i c s , sponsored by t h e Indian Council of Medical

Research, was completed.

A l i s t of r epor t s published, wi th t h e publ ishers o r agen t s , is annexed t o

t h i s r epor t . (Annex 7).

The Di rec to r of t h e Centre p a r t i c i p a t e d i n severa l important meetings held

i n India dur ing the period under rcvicw.

As i n past y e a r s , many WHO fe l lows from a l l over t h e world v i s i t e d t h e Centre

f o r o r i e n t a t i o n a s p a r t of var ious t r a i n i n g courses i n t h e f i e l d of tubercu los i s con t ro l .

Two short-term consul tants a s s i s t e d i n January 1969 with t h e d i scuss ions and wr i t ing c f new Fapers. a s well a s wi th t h e d r s l g n of newly proposed s t u d i e s . Their r epor t has been forwarded t o the Ooverment.

SEA/RC~Z/Z Page 131

Ind ia 0071.3

R

Mental Health

(June 1768; Jan. 1969; Feb. 1969; - )

A i m of t h e prodcct. To review t h e grogress made i n t h e t r a i n i n g of psych ia t r i c

nurses and i n epidemiological r esea rch i n psychiat ry .

Assistance prcvided by WHO d u r i w the year. A twelve-month fe l lowship f o r Study

i n t h e United Kingdom and a three-month fe l lowship f o r s t u d i e s i n t h e United Kingdon,

the Netherlands, Denmark and the USSR.

India 0081.1

R UNICEF

Leprosy Control (National Pro~ramme).

(Jan. 1961 - )

A i m of the p r c j e c t . To develop a programme of leprosy con t ro l .

Assistance Drovided by WHO durinR t h e year . ( a ) A l e p r o l o g i s t ; ( b ) SupplieS and

equipment.

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1973.

York done dur ina t h e year . A s p a r t of t h e Fourth Five-Year Plan, c e n t r a l a s s i s t ance

t o t h e S t a t e s is s h i f t i n g from a centra l ly-aided scheme t o a c e n t r a l l y sponsored one,

increasing the scope f o r t h e development of leprosy c o n t r o l a c t i v i t i e s . A s a r e s u l t ,

t h e t r a i n i n g of s t a f f should receive c l o s e r a t t e n t i o n . Leprosy con t ro l u n i t s w i l l be

es tab l i shed under t h e centrally-sponsored scheme, f r e e i n g workers of survey, education

and t r a i n i n g cen t res (SET) t o form con t ro l u n i t s around t h e l eprosy subs id ia ry cen t res .

These workers, when t r a n s f e r r e d , w i l l a l s o requ i re r e t r a i n i n g .

After a review of t h e programme. it has been decided t h a t 45 d i s t r i c t s wi th

hyperendemicity w i l l receive p r i o r i t y dur ing t h e Plan, which a l s o provides f o r t h e

implementation of t h e programme on t h c b a s i s of t h e r e c o m n d a t i o n s of t h c Jungalwalla

Committee, according t o which leprosy con t ro l u n i t s w i l l be es tab l i shed i n a reas with

a prevalence of 1 0 p e r m i l l e o r more and SET cen t res i n a reas wi th a prevalence r a t e

of between 5 and 1 0 per m1lle;the committee had a l s o recomnended t h a t i n a reas with

a prevalence of 1/2 - 1 per mi l l e the con t ro l work should be taken up by t h e

regu la r h e a l t h s e r v i c e s .

In p repara t ion f o r the o v e r a l l implementation of t h i s t h e WHO l e p r o l o g i s t has

a l ready a s s i s t e d with a prel iminary assessment of t h e present coverage, plans f o r the

organizat ion of c o n t r c l u n i t s i n t h e hyperendemic d i s t r i c t s , and a review of t r a i n i n g

f a c i l i t i e s f o r paramedical s t a f f , i n var ious S t a t e s . A second WHO l e p r o l o g i s t jolned

the p ro jec t i n May and has been posted a t Aska, Oanjam D i s t r i o t ( s e e India 0081.2).

The Oovernment, t h e Indian Council of Medical Research and WHO have a l s o

s t a r t e d formulating measurements f c r assessment of leprosy con t ro l programmes.

SEA/RC22/2

Page 132

Assistance t o research i n chemoprophylaxis continued.

The ICMR has been consider ing t h e p o s s i b i l i t y of combining an assessment

of t h e eff icacy of BCO i n t h e prevention of leprosy with t h e present l a rg r - sca le BCO t r i a l i n tubercu los i s .

It i s expected t h a t with t h e launching of t h e Fourth Five-Year Plan t h e coveragc of cases f o r treatment w i l l g radual ly be considerably increased over t h e

present repor ted 650 000. UNICEF a s s i s t s wi th drugs and t r a n s p o r t , a s w e l l a s

s t ipends f o r the t r a i n i n g of leprosy workers.

India 0081.2

R UNICEF

Leprosy Control, Srikakulam (Jan. 1962 - Nov. 1%6; March 1967 - Peb. 1968; Nov. 1968 - Feb. 1969; May 1969 - )

A i m of t h e p r o j e c t . To provide t echn ica l d i r e c t i o n f o r a con t ro l p ro jec t supported by t h e Danish "Save t h e chi ldren" Organization, and t o t r a i n a u x i l i a r y personnel

a t a l l l e v e l s .

Assistance orovlded by WHO durlnR t h e year . ( a ) A l c p r o l o g i s t and a consul tant ;

( b ) supp l ies and equipment.

Probablo d u r a t i ~ n of a ss i s t ance . Unt i l t h e end of 1973.

Wcrk done dur ing the year. The expansion of a c t i v i t i e s i n Ganjam D i s t r i c t (Or i s sa ) continued, and t h e programme now covers a populat ion of 800 000. Actual case-detect ion

has reached, i n a period of about one and a half year6,a t o t a l of 14 000 p a t i e n t s .

Fur ther expansion i s planned t o cover 1 500 000 pcople. Health educat ion, vcluntary

casu-detect ion and t h e r e g u l a r i t y of treatment a r e of a high s tandard.

The dfvelopment of con t ro l i n t h e o lde r p ro jec t a t Pog i r i , which was s t a r t e d

i n 1962, continued t o show highly s a t i s f a c t o r y r e s u l t s . Tho pat ient- load of t h e p ro jec t a rea has been f u r t h e r reduced through r e l e a s e from con t ro l of many more

cases than those newly de tec ted . A s a r e s u l t , a t t h e end of t h e second q u a r t e r of 1969,the t o t a l number of r e g i s t e r e d cases had reached t h e low f i g u r e of around 25 000 a s compared with the peak number of 34 476 cases . The demands of t h e o v e r a l l

na t iona l programme a s wel l as those of the p ro jec t f o r a s s i s t a n c e i n t r a i n i n g

necess i t a ted t h e recruitment of one add i t iona l na t i cna l doc to r ; two a re now employed. The population under con t ro l remains a t about 1 500 000 and t h e e f f i cacy of c o n t r o l

has a l s o resu l t ed i n considerable reduct ion i n t h e lepromatous r a t e s among the new c a s e s , p a r t i c u l a r l y among ch i ld ren . Thus, a f t e r s i x years of c o n t r o l , only r a r e l y

is a lepromatous case found dur ing t h e var ious case-detect ion procedures ( schoo l , contact and p i l o t mass surveys) . .Also, t h e case-detect ion r a t e among school-children

has reached the low Pigurc of 1 per mi l l c a s compared with t h e e a r l i e r r a t e of 10 per

mi l l e noted when t h e p ro jec t was f i r s t completely s t a b i l i z e d .

SE~/Rc22/2

rage 133

During t h e period under revlew, t h e c l a s s i f i c a t i o n cf p a t i e n t s Was brought

i n t o conformxty with t h e o v e r a l l WHO p o l i c l e s and a l s o i n accordance with tho mtiorza1 Oulde t o Leprosy Control. A WIiO consul tant was assigned from October 1968 t o February

1969 t o a s s i s t i n t h i s regard. t i is r epor t has been forwarded t o the Government.

Data from par t of the t o t a l pat ient- load and t h e i r con tac t s were s tored on

computer t a p e , and a preliminary examination of these d a t a has a l ready yie lded

important conclusions on r e g u l a r i t y of treatment wi th regard t o its e f f e c t on cure

a s wel l as t h c dura t ion of contact su rve i l l ance . A long i tud ina l cohort s tudy of

some 17 000 p a t i e n t s and t h e i r contacts w i l l be included i n a long-term study.

Tha notable e f f i cacy of t h e con t ro l programme was achieved within the low

cos t r a t e , e a r l i c r e s t a b l i s h e d , of US$3.50 per pa t i en t o r ~S$0.07 per head of

population under con t ro l .

UNICEE continued t o a s s i s t t h e programme.

India 0099

UNDP( TA

UNICEF

Nurslty Eu.dcaLion (Pub l ic Health I n t e g r a t i o n ) :

Assistance t o S t a t e s

( S e p t . 1957 - Dec. 1967; Aug. 1968)

The p r o j e c t was completed i n December 1967 . I n nugust 1966, a twelve-month f e l l a n -

sh ip was awarded f o r study i n the United S t a t e s of America.

Ind ia 0102

uNDP(TA1

UNICEF

National Tuberculosis Prouramme

(Oct. 1956 - Oct. 1957; Ncv. 1957 - )

A i m of t h e ~ r o j e c t . To develop a na t iona l tubercu los i s con t ro l programme by providing

technical guidance, based on model r u r a l and urban tubercu los i s control programmes,

epidemiological f ind ings and operat ional r esea rch ; t o t r a i n s u f f i c i e n t numbers of

public h e a l t h workers of var ious ca tegor ies f o r t h e tubercu los i s con t ro l cen t res a t

d i s t r i c t and S t a t e l e v e l s , and t o develop adequate methods and procedures f o r

assessment of tho programme.

Assistance provided by WHO d u r i w t h e year. ( a ) Two medical o f f i c e r s , an X-ray t echn ic ian and a consu l t an t ; ( b ) supp l ies and equipment.

Probable dura t ion of a ss i s t ance . Unt i l the end of 1974.

riork done dur ing the year. The expansion of the na t iona l tubercu los i s programme

made slower progress than i n previous years ; from June 1968 up t o the end of June 1969, only s i x now d i s t r i c t tubercu los i s programmes q u a l i f i e d f o r UNICEF a s s i s t a n c e , br inging

t h e t o t a l number of such programmes up t o 174 ( represen t ing 51 per cent of t h e t o t a l of 336 d i s t r i c t s i n I n d i a ) . Of t h e s e , 138 were regu la r ly submitting r e p o r t s on

t h e i r a c t i v i t i e s .

sEA/Rc22/2 Page 134

With regard t o programme implementation wi th in ind iv idua l d i s t r i c t programmes, it was found t h a t , on an average, only about 44 pe r cent of t h e pe r iphera l h e a l t h i n s t i t u t i o n s e x i s t i n g i n such d i s t r i c t s were t ak ing an a c t i v e p a r t i n tubercu los i s

con t ro l .

The need f o r superv i s ion and f o r assessment of tubercu lcs i s programmes a t t h e S t a t e l e v e l was inc reas ing ly f e l t , and the sub jec t was discussed a t t h e 24th Annual Conference on Tuberculosis and Chest Diseases , held a t Trivandrum i n January 1963. A s i n previous years , a WHO consu l t an t was assigned t o t h e p ro jec t t o a s s i s t i n t h e development of manuals f o r S ta f f of S t a t e tubercu los i s con t ro l cen t res . He a l s o helped with programme-oriented t ra inine; and i n developing a methodology f o r

t h e assessment of t r a i n i n g activities.

S t a f f of t h e . e g i o n a l Tuberculosis Office f o r South I n d i a , where 49 out Of

t h e t o t a l of 64 d i s t r i c t s have tubercu los i s programmes, continued t o assess t h e d i s t r i c t performances by making extensive f i e l d v i s i t s and on t h e b a s i s of repor ted a c t i v i t i e s . The newly-established Northern Regional Tuberculosis Off ice i n New Delhi , where a WIT0 X-ray t echn ic ian has been a s s i s t i n g t h e na t iona l s t a f f , s t a r t e d work.

The X-ray t echn ic ian v i s i t e d 22 out of t h e 44 d i s t r i c t tubercu los i s programmes operat ing i n t h e a r e a , as wel l a s nine d i s t r i c t s i n which a d i s t r i c t programme is t o be implemented i n t h e near f u t u r e .

There a re 216 BCG teams sanct ioned, bu t a t l e a s t 1 0 t o 15 per cent of these teams a r e usual ly non-operative f o r var ious reasons; t h e work of 147 of them has a l ready boen in tegra ted I n t o d i s t r i c t tubercu los i s programmes. The work output per

t echn lc lan needs t o be improved s u b s t a n t i a l l y i n vlew of t h e increase i n POpulatiOn; however, t h e coverage achieved compares wel l wi th expec ta t ions , according t o assessment d a t a from t e n S t a t e s and t h r e e union t e r r i t o r i e s .

The pol icy and approach concerning t h e BCQ vaccinat ion progranqe were t h e main top ic a l s o a t t h e Eighth Al l - India BCa Conference, held a t Trivandrum i n January 1969, where recommendations were made f o r improving t h e output of t h e programme. The National Tuberculosis I n s t i t u t e , Rangalore ( N T I ) i s paying p a r t i c u l a r a t t e n t i o n t o t h e t echn ica l and operat ional problems of t h e BCO programme and has i n i t i a t e d new s t u d i e s , e s p e c i a l l y with regard t o the . f e a s i b i l i t y and methods Of

i n t e g r a t i n g t h e programme i n t o t h e general h e a l t h se rv ices . With a view t o f i n a l l y being ab le t o provide t h e m s t a b l e vaccine t o t h e programme throughout t h e country , t h e na t iona l BCO assessment t e a n under t h e I n s t i t u t e is t e s t i n g thca l lPrgy-produc ins potencies of c e r t a i n batches of f reeze-dr ied vaccine produced by the BCC l abora to ry ,

Ouindy (Iradr's 1.

With t h e assignment of a WHO epidemiologist t o t h e I n s t i t u t e i n January, the processing of t h e epidemiological d a t a from four rounds of long i tud ina l s t u d i e s made progress ; a n ana lys i s of t h e prime epidemiological rjmup of b a c t e r i o l o g i c a l l y confirmed cases of z u b r r c u l c ; ~ ~ da. ; ~ . . , j l e t i . d .

In add i t ion t o research a c t i v i t i e s , t h e I n s t i t u t e has been engaged i n maw

t r a i n i n g a c t i v i t i e s . During t h e y e a r , two t r a i n i n g courses were held f o r 189 key

personnel f o r d i s t r i c t tubercu los i s teams(among whom t h e r e were 17 medical o f f i c e r s ,

51 treatment o rgan ize r s , 28 X-ray t echn ic ians , 32 l abora to ry t echn ic ians , 32 s t a t i s t i c a l

a s s i s t a n t s and 29 BCU team l e a d e r s ) . This brought t o 1 900 the t o t a l number of key

s t a f f t r a ined s i n c e t h e incep t ion of t h e courses i n 1961. The courses were a l s o

attended by WHO fe l lows from Somalia and Thailand.

In 1768, f o r t h e t h i r d t ime , a pa r t of the in ter ,nat ional t r a i n i n g course i n

t h e epidemiology and c c n t r c l 01' t u b e r c u l o s i s , conducted annual ly i n Prague, was

held a t the National Tubrrc,ulosis I n s t i t u t e and was attended by nine WHO fe l lows from

Burma, Ceylon, Japan, Ikx ico , Mongolia, Ph i l ipp ines , Singapore, Thailand and Turkey.

As par t of the course , t h e p a r t i c i p a n t s a l s o v i s i t e d t h e Tuberculosis Chemotherapy

Centre , Madras, and t h e l'dberculosis Research Uni t , mdanapal le .

The s t a f f of t h e I n s t i t u t e p a r t i c i p a t e d i n a WICEF-sponcered t r a i n i n g course

f o r sen io r teachers of p a c d i a t r i c s , as wel l as i n t h c t r a i n i n g of medical s tudents

from var ious medical c o l l e g e s , who were given l e c t u r e s on tubercu los i s con t ro l .

I n t h e d i f f e r e n t sec t ions of the NTI, major con t r ibu t ions continue t o be

made t o research r e l a t e d t o t h e na t iona l programme, e s p e c i a l l y wi th regard t o

assessment methodology and epidemiology. A l i s t of papers r e f l e c t i n g t h e work ca r r i ed

o u t , which have been published o r a r e under p repara t ion , 1s given i n Annex 7.

Ind ia 0108 Health Education: Assistance t o States '

India 0108.4

UNDP(TA)

Health Education, Uujarat

(December 1965 - August 1968)

A i m of t h e Drodect. To develop a h e a l t h education bureau in t h e Di rec to ra te of

Health Services of t h e S t a t e on t h e l i n e s l a i d down by t h e Central Health Education

Bureau; t o provide t r a i n i n g i n h e a l t h education f o r h e a l t h workers and t e a c h e r s ,

and t o plan f o r h e a l t h education of the publ ic .

Assistance provided by WHO during the year . A h e a l t h educator.

Work done. This project w h s concerned with :.he f u r t h e r development of

t h e S t a t e Health Education Bureau. In pursuance of t h i s o b j e c t i v e , WHO provided a h e a l t h educator t o t h e Bureau from December 1965 t o August 1968. In add i t ion , t h e

Assis tant Director of Health Services i n charge of the Bureau was awarded a twelve-

month WHO fel lowship f o r study abroad. Other WHO a s s i s t a n c e included a t r anspor t

veh ic le and supp l ies and equipment.

'The p ro jec t s t a r t e d i n March 1358 and is expected t o continue u n t i l t h e end of 1774. E a r l i e r , a s s i s t ance was given t o t h e S t a t e s of Maharashtra, Ut ta r Pradesh, P lha r and Orissa.

S E A / R C Z ~ / ~ Page 136

Af te r completing h i s s tud ies abroad, t h e Di rec to r of t h e Bureau continued t o work c lose ly with t h e WHO h e a l t h educator. A number of add i t iona l s t a f f

members were added and given o r i e n t a t i o n t r a i n i n g i n t h e Bureau and i n i t s f i e l d areas .

During t h e period of WHO a s s i s t a n c e , t h e Bureau provided t r a i n i n g i n h e a l t h

education f o r var ious ca tegor ies of h e a l t h workers, wi th p a r t i c u l a r emphasis on

t r a i n i n g t r a i n e r s . Assistance was given t o t h e s t a f f i n improving teaching methods

and in preparing o r s e l e c t i n g appropr ia te a i d s f o r t r a i n i n g .

The Bureau's F ie ld Study and Demonstration Unit was es tab l i shed i n connection

with a primary h e a l t h c e n t r e , and t h e School Health Education Unit s t a r t e d funct ioning

i n l i a i s o n with t h e S t a t e ' s Education Department.

The Bureau is cont inuing t o c a r r y on i t s a c t i v i t i e s s i n c e t h e terminat ion

of WHO ass i s t ance .

M i a 0110 M r s i n u Advisers t o States '

Nursing Adviser t o Gujarat (Sept . 1963 - Sept. 1968)

A i m of t h e project . To organize and expand nursing education and nurs ing se rv ices

i n t h e S t a t e , and t o co-ordinate supervisory se rv ices so a s t o ensure uniformly

high standards of nurs ing and midwifery i n t h e h e a l t h p r o g r a m s .

Assistance Drovided by WHO d u r i n ~ t h e year . A nurs ing adv i se r .

Work done. The nursing adviser who jained the p ro jec t i n September 1963 ccmpletcd he r work i n September 1968. During the course o f he r a ss ignment the Nursing Unit of t h e Di rec to ra te of Health Services was s t rengthened, and, f o r t h e

f i r s t t ime, t h e nurse a t t h e S t a t e l e v e l was brought i n t o S t a t e planning. A survey

of the nurs ing s i t u a t i o n i n t h e S t a t e was completed, and nurs ing resources i n terms

of s t a f f , including t h e q u a l i f i c a t i o n s necessary f o r a l l c a t e g o r i e s , were analysed.

An est imate was made of t h e needs f o r nursing s t a f f throughout t h e S t a t e and proposals

pe r ta in ing t o nursing were formulatcd f o r inc lus ion i n the Fourth Five-Year Plan.

There was an increase i n t h e number of t u t o r s and sanctioned posts f o r t u t o r s

i n t h e S t a t e . Nurses were deputed f o r preparat ion a s t u t o r s and public hea l th nurses

and f o r s h o r t courses i n paed ia t r i c s , opera t ing t h e a t r e techniques and c e n t r a l s t e r i l c

supply departments. Dlo nurses were deputed f o r one year of preparat ion a s psych ia t r i c

*The p ro jec t s t a r t e d i n December 1957 and is expected t o continue u n t i l t h e end uf 1970. In September 1968, a twelvs-month fe l lowship was awarded f o r s tudy i n t h e United S t a t e s

of Anorica.

SEA/RC22/2

Page 137

nurses . The WHO nurse helped t o organize conferences , r e f r e s h e r courses and s tudy

days f o r var ious ca tegor i e s of nursrng personnel. The new s y l l a b i i s sued by t h e Indian Nursing Council were accepted and implemented.

With t h e inc rease i n t h e number of nurses and a u x i l i a r y nurse-midwives,

e f f o r t s were made t o t r y t o b r i n g b e t t e r nurs ing c a r e t o more people. A s h o s p i t a l s

a r e expanding and new h e a l t h c e n t r e s a r e being opened, t h e r e w i l l be .u. o v e r a l l

shor tage of nu r s ing s t a f f f o r some t ime t o come, bu t progress has been made towards

p r e p a r i w a s u f f i c i e n t number of nurse t u t o r s and publ ic h e a l t h nurses t o s t a f f

t h e expanding nurs ing educat ion programmes. Steps have a l s o been t aken toward improving

t h e working and l i v l n g cond i t ions of nurs ing personnel.

i n summary, t h e Nursing Unit i n t h e Di rec to ra t e of Health S e w i c e s was s t r eng thened , and cons ide rab le progress was made, e s p e c i a l l y i n prepar ing nurse

t u t o r s and publ ic h e a l t h nurses t c s t a f f t h e expanding nur s ing educat ion and

s e r v i c e programmes.

I n d i a 0110.Z

UNDP(TA)

Nursing Adviser t o Bihar

(Oct . 1966 - Dec. 1968)

A i m of t h e p r o j e c t . To organize and cxpand nurs lng educat ion and nur s ing s e r v i c e s

i n t h e S t a t e and t o co-ordinate supe rv i so ry s e r v i c e s s o as t o ensure uniformly

high s tandards cf nu r s ing and midwifery i n t h e h e a l t h programmes.

Ass is tance provided by WHO dur ing t h e year . A nurs ing a d v i s e r .

Work done. WHO ass igned a nurs ing a d v i s e r t o t h e p r o j e c t i n October 1%6 and

she completed he r assignment i n Cecember 1968.

i n t h e absence of a n a t i o n a l c o u n t e r p a r t , t h e WHO nurse worked i n co-opera t ion

wi th t h e Ass i s t an t D i r e c t o r , Health Se rv ices (Family P lann ing) , who handled nurs ing

mat ters du r ing t h e assignment per iod. Although t h e Government of Bihar had not Yet

c rea ted t h c post of a s e n i o r nursc a d ~ i n i s t r a t o r a t t h e S t a t e l e v e l , t h e need f o r

such a pos t was brought t o t h e a t t e n t i o n of t h e appropr i a t e a u t h o r i t i e s . I n t h e l a s t

weeks of t h e p r o j e c t , t h e Oovei~nment agreed t o a proposal f o r t h e c r e a t i o n of

such a pos t .

Information concerning h o s p i t a l s , h e a l t h c e n t r e s and nur s ing personnel was c o l l e c t e d by means of a s:irvcy of nurs ing needs and resources . The records compiled

from t h i s survey a r e now a v a i l a b l e i n t h e Di rec to ra t e of Health Se rv ices .

Some vacant pos ts f o r nursc t u t o r s and admin i s t r a to r s were f i l l e d by

promotions and t r a n s f e r s and, i n one c a s e , by d i r o c t r ec ru i tmen t ; however, a t t h e

end of t h e assignment, 13 posts f n r n3trOnS and 7 5 f o r t u t o r s s t i l l needed t o be

c rea ted and f i l l e d be fo re t h c e x i s t i n g nurs ing schools wnuld meet t h e requirements

of t h e Indian Nursing Council.

SEA/RCZZ/Z

Page 138

The Oovernment agreed t o depute four nurses f o r higher s t u d i e s f o r two years .

This pol icy w i l l he lp t o bu i ld up t h e teaching and admin i s t ra t ive s t a f f . Experienced h e a l t h v i s i t o r s were encouraged t o take t h e shortened course i n general nursing t o

become e l i g i b l e f o r appointment a s public hea l th nurscs .

Three shor t courses were conducted f o r nurses appointed t o t each i n a u x i l i a r y

nurse-midwifery schools. In these programmes 1 4 nurses acquired some knowledge of

t h e p r inc ip les of nurs ing admin i s t ra t ion and teaching methods and were helped t o

develop s k i l l s i n teaching a u x i l i a r y nurse-midwifery s tuden t s .

Tc fill t h e l a r g e numbcr of vacancies i n h o s p i t a l s and h e a l t h c e n t r e s ,

sound planning of t h e nurs ing educat ional programmes and adequate budgetary

Support a r e needed. Service condi t ions must be improved i n o rder t o prevent t h e

d r a i n away of q u a l i f i e d nurses t o o the r S t a t e s and p r iva te i n s t i t u t i o n s .

India 0111

R

Medical Education

(Dec. 1958 - Sept. 1761; Nov. - Dec. 1965 ;

~ u g . 1966 - )

A i m of t h e ~ r o l e c t . To s t reng then s e l e c t e d medical co l l ages .

Assistance Drovided by WHO during t h e year . ( a ) Eleven consu l t an t s (professors i n

var ious d i s c i p l i n e s ) ; ( b ) t h r e e fellowships - one f o r twelve months f o r s tudy i n t h e United Kingdom, one f o r s i x months f o r s tudy i n the United S t a t e s of America and one f o r s i x months f o r s t u d i e s i n t h e USSR.Demrk,the United Kingdom and t h e United S t a t e s

of America; ( c ) supp l ies and equipment.

Probable dura t ion of a ss i s t ance . I n d e f i n i t e .

Work done dur ing t h e year . A WHO consu l tan t i n psychiat ry assessed t h e teaching f a c i l i t i e s a t t h e Medical College, Madurai, and a t t h e Jawaharlal I n s t i t u t e of Post-

graduate Medical Education and Research, Pondicherry, i n t h e second ha l f of 1968.

At Madurai, t h e work of t h e Department of Psychiatry ( a department which has been i n exis tence s i n c e 1957 wi th in t h e p r i n c i p a l teaching hospita1)was reviewed i n r e l a t i o n t o t h e s e r v i c e workload and t h e amount of t h e teaching being given i n t h i s

sub jec t . The need f o r a separa te examination i n psychiat ry was discussed.

A t Pondicherry, a s i m i l a r review of t h e s t a t u s of psychiat ry was undertaken. In both p laces , t h e WHO consul tant p a r t i c i p a t e d i n t h e teaching a c t i v i t i e s , e spec ia l ly

I n demonstrating combined teaching sess ions wi th o t h e r departments. He advised on

e x i s t i n g and proposed resea rch p r o j e c t s and on the development of appropr ia te s y l l a b i

f o r unde~gradua te and post-graduate i n s t r u c t i o n .

During September-November 1968, a team of t h r e e consu l t an t s , represent ing t h e

d i s c i p l i n e s of pathology, medicine and p a e d i a t r i c s , was assigned t o t h e Medical College. Aurangabad. They s tudied the r e l a t i o n s h i p s between these d i s c i p l i n e s and o t h e r r e l a t e d

departments i n respect of teaching and resea rch a s well a s associa ted c l i n i c a l and

laboratory se rv ices . The consul tants p a r t i c i p a t e d i n var ious teaching activities i n

o r d e r t o promote c l o s e r i n t e r - d i s c i p l i n a r y c o r r e l a t i o n t o o r i e n t s tuden t s towards modern concepts of h e a l t h c a r e , and t o demonstrate e f f e c t i v e methods of l e a r n i n g ,

i n s t r u c t i o n and assessment.

A second team of t h r e e c o n s u l t a n t s , represent ing the d i s c i p l i n e s of preventive

and Social medicine, obstetrics/gynaccology and physiology, undertook a s i m i l a r assignment a t M.Q.M. Medical College, Indore, i n October-December, 1968, and a t h i r d team,

COm1sting ofzthree consul tants i n pathology, microbiology and medicine, was assigned

f o r two months-to the Medical College, Nagpur, e a r l y i n 1969, undertaking a c t i v i t i e s s i m i l a r t o those performed by the f i r s t team.

The recommendations of a l l these teams re fe r red t o the undergraduate curriculum

a s a whole, i n which a rev i s ion of t h e time a l l o t t e d t o t h e var ious d i s c i p l i n e s am3

m r e co-ordination and i n t e g r a t i o n among them were found t o be des i rab le . They

recommended t h a t a continuing system of assess ing t h e s tuden t s ' performance should be gradual ly in t roduced, by giving weight, a s a f i r s t s t e p , t o t h e r e s u l t s of term t e s t s

a l ready i n use a s wel l a s those of f i n a l examination i n computing t h e f i n a l marks. m r e frequent c l a s s t e s t s , preferably of t h e ob jec t ive type,should then be npplied

and weighted f o r t h e f i n a l s . The recommendations of t h e teams a r e supplemented by

suggestions r e l a t e d t o the consu l t an t s ' individual s p e c i a l t i e s . In 'January-February, a consul tant i n bacter iology was assigned t o S.M.S. Medical College, J a i p u r .

India 01111 R

UNICEP

Paed ia t r i c and Obs te t r i c Traininn and Services: Assistance t o S t a t e s

(Auk?. 1958 - 1

A i m of t h e oro3ect. To a s s i s t t h e paed ia t r i c and o b s t e t r i c departments of se lec ted

medical co l l eges and non-tcaching and d i s t r i c t h o s p i t a l s .

,QS i s tance Pmvided by WHO d u r i n ~ t h e year. ( a ) Nine consul tants and 29 temporary adv i se r s ; ( b ) t h r e e twelve-month fellowships f o r s t u d i e s i n the United Kingdomland India and a three-month fe l lowship f o r s t u d i e s i n TurkeY,the USSR,poland, Czechoslovakia, t h e

Netherlands, Bwitzerland, Prance, t h e United Kingdom, Canada, t h e United S t a t e s of

America, Mexico, the Ph i l ipp ines , Japan and Hongkong; ( c ) supp l ies and equipment;

( d ) cos t of attendance of p a r t i c i p a n t s .

Probable dura t ion of a ss i s t ance . Unt i l the end of 1973.

Work done dur ing t h e Year. Two important meetings were held. A Meeting on Teaching of Socia l Aspects of Obs te t r i c s i n Medical Colleges i n India was held i n t h e Regional

Office f r o m 25 t o 27 September 1968. The f i f t e e n p a r t i c i p a n t s , who were inv i t ed a s temporary adv i se r s t o t h e Regional Di rec to r , were medical educators i n t h e f i e l d s of o b s t e t r i c s , paed ia t r i c s and preventive and s o c i a l medicine: r epresen ta t ives of t h e

SEA/FlC22/2 Page 140

Medical Council of India and t h e Indian Association f o r t h e Advancement of Medical Education; s e n i o r hea l th admin i s t ra to r s , and represen ta t ives of the Ministry of Health, Family Planning and Urban Development. An o b s t e t r i c i a n was appointed a s WHO

consul tant t o a s s i s t i n the planning and o rgan iza t ion of t h e meeting and t o a c t a s co-ordinator and rapporteur .

The group de l inea ted t h e f i e l d of s o c i a l o b s t e t r i c s and considered how o b s t e t r i c departments could be adapted t o undertake e f f e c t i v e s e r v i c e and research a c t i v i t i e s i n t h i s f i e l d . It a l s o discussed t h e cur ren t s t a t u s of teaching of s o c i a l aspects of o b s t e t r i c s i n India and made a wide range of recommendations f o r improving the e x i s t i n g courses of o b s t e t r i c s t u d i e s and f o r eva lua t ing t h e i r e f fec t iveness . An important outcome of t h i s meeting was t h e proposal t h a t WHO reass ign t h e WKO consu l tan t f o r a

period of th ree months from October 1969 t o a s s i s t major o b s t e t r i c c e n t r e s i n India i n the implementation of t h e recommendations emanating from t h e meeting.

From 23 t o 25 October 1968 a Meeting on Paed ia t r i c Education, held i n t h e Regional Of f ice , brought toge ther medical educators f o r t h e purpose of o u t l i n i n g d e s i r a b l e measures and suggest ing p r a c t i c a l proposals f o r the development of t h i s spec ia l ty ,wi th in t h e e x i s t i n g curriculum, i n r e l a t i o n t o na t iona l needs. The 14

p a r t i c i p a n t s , i n v i t e d a s temporary adv i se r s t o the Regional Di rec to r , included deans and p r inc ipa l s of medical c o l l e g e s , professors of i n t e r n a l medicine and p a e d i a t r i c s , r epresen ta t ives of t h e Medical Council of Ind ia and t h e Indian Association f o r t h e Advancement of Medical Education, s e n i o r h e a l t h admin i s t ra to r s and represen ta t ives of the Ministry of Health, Family Planning and Urban Development. A major r e s u l t of t h i s

meeting was WHO'S subsequent assignment of a . group of medical educators , recommended by t h e Indian Association f o r the Advancement of Medical Education and t h e Indian Academy of P a e d i a t r i c s , t o make a s tudy , wi th in t h e terms of the recommendations of the meeting, of a curriculum i n c h i l d h e a l t h s u i t a b l e f o r undergraduate s tuden t s . A WHO

consul tant was assigned t o a c t a s co-ordinator of t h i s & meeting, held i n Ju ly .

Three consul tants i n o b s t e t r i c s were assigned independently f o r two t o t h r e e months each dur ing the period from November 1968 t o April 1969 t o s tudy t h e e x i s t i n g teaching programmes i n o b s t e t r i c s and gynaecology i n s i x medical co l l eges and t o advise on improvements. Their suggestions and recommendations r e l a t c d t o p rac t i cab le measures f o r i n t e g r a t i n g t h e teaching of s o c i a l aspects of o b s t e t r i c s i n t o t h e e x i s t i n g curriculum and co l l abora t ion with re levan t departments and organizat ions of

appropr inte f l e l d p r a c t l c e areas. Their assignment hzlped t c inc rease t h e

awareness uf t h e importance of teaching of c o c i a l aspects of o b s t e t r i c s , t o i a p l e m n t t h e recommendations e m n a t i n g from t h e meeting on s o c i a l o b s t e t r i c s described e a r l i e r and t o c a r r y out the plnns f o r S'NICEF a s s i s t a n c e under t h e e x i s t i n g agreement.

In view of t h e usefulness of t h e two e a r l i e r o r i e n t a t i o n courses i n neonatology f o r paed ia t r i c teachers (organized i n January and February 1968). the WHO consul tant responsible f o r these courses was reassigned i n January-February 1969 t o p lan and conduct two s i m i l a r courses a t S.G.S. Medical College, Bombay, and a t Safdarjang Hospi ta l , New elh hi. ~ o r t y - t w o s e n i o r paed ia t r i c teachers ( inc lud ing 21 p a r t i c i p a n t s from l o c a l co l l eges ) a t tended t h e courses , which helped t o emphasize t h e important.? of se rv iccs i n neonatology and the necess i ty f o r paying c lose a t t e n t i o n t o t h i s sub jec t i n medical paed ia t r i c courses. An eva lua t ion of t h e Impact of these courses was planned f o r 1970.

S E A / R C ~ Z / Z

Page 141

In January, a WHO consul tant i n paed ia t r i c surgery took up a two-month

assignment t o . a s s e s s thc s t a g e of development of paed ia t r i c surgery, from the point

of view of i t s se rv ice t o the community and i t s place i n medical educat ion, i n a

representative numbcr of nledical col leges and hosp i t a l s i n India . The consu l t an t ,

as a r e s u l t of h i s finding;, concluded t h a t improved teaching of paed ia t r i c surgery

and t h e develo~ment of paed ia t r i c su rg ica l se rv ices were of some urgency. He recommended

a programme f o r the phase.d development of regional p a e d i a t r i c s u r g i c a l u n i t s t o act a s t r a i n i n g cen t res f o r prospective paed ia t r i c surgeons and paed ia t r i c nurses i n

India . The consu l t an t ' s r epor t was under s tudy.

In March, a consul tant i n hea l th educatlon was assigned (under an inter-country

p r o j e c t ) f o r t h r e e months t o s tudy the h e a l t h education aspects of paed ia t r i c departments

i n se lec ted medical co l l eges ( f o r d e t a i l s , see SEAR0 0096) .

India 0114.6

R

UNICEF

Paedi.atri.c and Obs te t r i c T r a i n i w and

Serv ices , Pun.lab - (Nov. 1765 - !

A i m of t h e v ro jec t . To s t rengthen maternal and c h i l d h e a l t h nursing through: ( a ) a post-basic course i n maternal and ch i ld h e a l t h nursing i n the College of Nursing,

I n s t i t u t e of Post-graduate Medical Education and Research, Chandigarh; (b ) suppie-

mentary courses on paed ia t r i c nurs ing and ca re of the neonate, and ( c ) advice on

nursing se rv iccs i n paed ia t r i c and o b s t e t r i c wards and out-pat ient c l i n i c s .

u s i s t a n c e provided by WHO durinR the year. ( a ) Two paed ia t r i c nurse educators ;

( b ) supp l ies and equi w e n t .

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1970.

Work done during the year. A t t h e P . G . I . Hospi ta l , Chandigarh, two supplementary

courses i n paed ia t r i c nursing were conducted, wi th a t o t a l of 4 3 nurses a t tending.

Experience i n day-care cen t res was new t o many of t h e nurses. Home-visiting of

pa t i cn t s discharged from t h e hosp i t a l r e su l t ed i n 100 per cent attendance a t "follow-up"

o r "well babyn c l i n i c s .

Two courses i n neonatal nurs ing were h e l d , and, a t t h e request of s t a f f nurse:

of Nehru Hospi ta l , a t h i r d course was g iven , which was attended by s t a f f nurses and

pupi l midwives.

A l l s tu5sn t s ir. the second c l a s s of oudwives were sucoessful i n t h e i r examina-

t i o n s . A s d o n i c i l i a w experience has not been s a t i s f a c t ? r y , t h e development of new

areas f o r providing such experience is being pianned.

llursing i x r u i:. t l , i rnat~,~.l::t; n:;.'. Inbo'.:? w : i : l s and deli:-cry rooms continued

t o Improvr. ASSiztance was given i n devtloping a manual of' pr.ocedures f o r the maternity

ward. Separate s t a f f werc provided f c r s e p t i c and c lean a r e a s .

S!U/RC22/2 Page 142

The WHO p a e d i a t r i c nurse educator , a s s i s t i n g t h e maternal and c h i l d h e a l t h branch of s tud ies a+ the College of Nursins, Chq?di8arh, was t r ans fe r red t o t k : "post- basic Nursing Education" p r o j e c t ( Ind ia 0136) located i n Bhandigarh, ab the end of December 1968.

Ind ia 0121 R

Indian Council of Medical Research [ S t a t i s t i c s ) IAug. 1962 - Reb. 1963; Dec. 1963 - June 1965; dug. 1966 - J u l y 1967; Sept. 1967 - May 1968; Oct. 1968 - Jan. 1969; - )

A i m of the ~ r o j e c t . To a s s i s t the Indian Council of Medical Research i n s e t t i n g up a s t a t i s t f c a 1 u n i t a t i t s headquarters and i n organizing and co-ordinating medical research.

Assis tance provided by WHO during the year . ( a ) A consu l t an t ; ( b ) a twelve-month fellowship f o r s tudy i n the United S t a t e s of America.

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1974.

Work done during the year. A c o n s ~ l t a n t was provided from October 1968 t o January 1969 t o a s s i s t i n the ~cru t i ! l ; of rescnrch schemes sponsored by the Indian Council of Medical Research i n New Delhi (715 schemes i n 1969),and i n the d i scuss ions of expert groups. I n b i s assignment r e p o r t , which was sen t t o the Government, he has made recoramentia$ions concerning the maintenance of a r e g i s t e r of s t a t i s t i c i a n s working i n the research p r o j e c t s of the Council, the organizat ion of a seminar f o r sen io r b i o s t a t i s t i c i a n s and a post-graduate t r a i n i n g course on t h e a p p l i c a t i o n of s t a t i s t i c s i n medical research f o r junior s t a t i s t i c i a n s .

India 0125 R

UNICEF

Community Development Areas [ Ju ly 1969 - )

A i m of the p r o j e c t . To promote t r a i n i n g programmes f o r a l l ca tegor ies of h e a l t h personnel and t o a s s i s t i n the development of hea l th se rv ices i n a phased manner, i n which cura t ive and prevent ive s e r v i c e s , e f f e c t i v e l y d i r e c t e d and supervised, a r e in tegra ted a t a l l l e v e l s and a b l e t o provide t echn ica l Ruidance t o f i e l d a c t i v i t i e s and prcmote p o s i t i v e hea l th i n the community; i n the f i rs t i n s t a n c e , t o expand t o urban a r e a s , through urban family welfare planning c e n t r e s , the maternal and c h i l d h e a l t h [ inc lud ing family planning) a c t i v i t i e s now i n progress i n r u r a l a r e a s .

Assistance providcd by WHO during the year . A consul tant .

Probable dura t ion of a s s i s t a n c e . Unt i l August 1969.

Work done dur ing the year . A d r a f t p lan f o r the s t rengthening of h e a l t h se rv ices was prepared and was under s tudy by the Government. This plan includes s p e c i f l c a l l y the s t rengthening of basic h c a l t h s e r v i c e s , maternal and c h i l d h e a l t h ( i n c l ~ d i n g family planning) , r e f e r r a l s e r v i c e s , hca l th education and the t r a i n i n g of medical and paramedical personnel.

I n J u l y , a consul tant was assigned t o study t h e c u r r e n t adminis t ra t ion and de l ive ry of maternal and c h i l d health/family planning se rv ices i n urban a reas and t o

SEA/RCZZ/Z

Page 114)

a d v i s e 0.: WHO-UNICEF a s s i s t a n c e i n t ' 2 improvement and e x p a n s i o n of t h e s e s e r v i c c s w i t h i n t h e framework 0;' tizL n a i i o n a l p l a n fcr t h c development of community g e n e r a l h e a l t h s e r v i c e s . Thu c o n s u l t a n t was e x p e c t e d t o complc te h i s work i n August .

I n d i a 0136

R

P o s t - b a s i c Nurs ing E d u c a t i o n :

A s s i s t a n c e t o S t a t e s ( J a n u a r y 1962 - )

A i m of t h e p r o j e c t . To expand p o s t - b a s i c n u r s i n g c d u c a t i o n and t o upgrade p u b l i c

h e a l t h and i n s t i t u t i o n a l n u r s i n g s e r v i c e s .

A s s i s t a n c e p r o v i d c d by WHO d u r i n g t h e y e a r . ( a ) A c o n s u l t a n t and a s s i s t a n c e from

n i n e n u r s e s a s s i g n e d t o v a r i o u s p r c j u c t s i n I n d i a ; ( b ) a twelve-month f e l l o w s h i p f o r

s t u d y i n t h e Uni ted S t a t e s cf America; c o s t of a t t e n d a n c e of p a r t i c i p a n t s .

P r o b a b l e d u r a t i o n of a s s i s t a n c e . U n t i l t h e end of 1973.

Work done d u r i n g t h e y e a r . I n J a n u a r y , a thr,:i-day workshop on c a - o r d i n a t i o n of n u r s i n g e d u c a t i o n and s e r v i c e s was o r z a n i z e d i n t h e R c g i o n a l O f f i c e f o r WHO n u r s e s a s s i g n e d t o

p r o j e c t s i n I n d i a . Thc wcrkshop p r o v i d e d a n o p p o r t u n i t y f a r t h e s e n u r s e s (who were work- i n g i n o r c l o s e l y a s s o c i a t e d w i t h p o s t - b a s i c n u - s i n g e d u c a t i o n ) t o exchange i d e a s on t h e

c o - o r d i n a t i o n of n u r s i n g c d u c 2 t i o n and n u r s l n s s e r v i c e s . Recommendations wcre made which

were considered t o be common t o a l l p r o j e c t s a s s o c i a t e d w i t h p c s t - b a s i c n u r s i n g e d u c a t i o n i n I n d i a .

A WHO c o n s u l t a n t a s s i s t e d i n t h e p l a n n i n g ?nd c o n d u c t of a workshap f o r n u r s e s

a t t h e S t a t e l e v e l , h c l d i n New D e l h i from 5 t o 1 6 May. A t t h i s workshop p a r t i c i p a n t s

f rom e i g h t S t a t e s gave p a r , t i c u l a r a t t e n t i o n t o methods of p l a n n i n g n u r s i n g s c r v i c ~ s and

t h e u t i 1 ; z a t i o n of a u x i l i a r y workers i n t h e s e s e r v i c e s .

I n d i a 0136.2

R

P o s t - b a s i c Nurs ing E d u c a t i o n , G u j a r a t ( J a n . 1963 - Dec. 1966; Dcc. 1967; J a n . 1968 - )

A i m o f t h e p r o j e c t . To expand p o s t - b a s i c n u r s i n g - d u c a t i o n and t o upgrade p u b l i c h e a l t h and i n s t i t u t i o n a l n u r s i n g s c r v i c e s i n t h e S t a t c .

A s s i s t a n c e p r o v i d e d by WHO d u r i n e t h e y e a r . ( a ) A n u r s i e d u c a t o r and a c o n s u l t a n t ; ( b ) a six-month f e l l o w s h i p f o r s t u d y i n t h e Uni ted S t a t e s of America; ( c ) s u p p l i e s and

squlpmi n t . P r o b a b l e d u r a t i o n o f assistance. Ur.til t h e end of 1 9 7 ) .

Work donc d u r i n g t h e y e a r . The C o l l e g e of Nurs ing became a f f i l i a t e d w i t h G u j a r a t U n i v e r s i t y , and e i g h t of t h e t e n s t u d e n t s a d m i t t c d t o t h e p o s t - b s s i c B.Sc. d e g r c c

programme o o n t i n u e d t h e i r s t u d i e s . A second ,:roup s t a r t e d t h e < c u r s e .

A s s i s t l n c o plo\.idcil by a WHO c c . n s u l t a . ~ t i n p;rbl:c hl!,,ltll n u l , s i n ~ , ::ssi!;ncd from

Decembcr 1968 t o May 1969 , r r s u l t e d i n !.h:: f u r t h e r clcvclopment o f t h e p u b l i c h<:al th

n u r s i n g component o r t h e p r o g r a m e . Her r e p o r t wa:; undcr s t u d y .

SEA/RCZZ/Z Page 144

The l i b r a r y , wi th a fu l l - t ime l i b r a r i a n , has been expanded. WHO has

provided books and o t h e r supp l les and equipment t o lmprove t h e educat ional f a c i l i t i e s .

Construction of the h o s t e l bu i ld ing has been s t a r t e d .

The former p r inc ipa l of the Post-basic School, who completed a master 's

degree programme i n nurs ing educat ion on a WHO fe l lowsh ip , was appointed a s Pr inc ipa l

of t h e College of Nursing. The nurse who served a s Acting Pr inc ipa l of the College

has been deputed t o t h e p o s t - c e r t i f i c a t e B.Sc. programme i n Chandigarh.

Zk-o f u r t h e r WHO nurse ediicators - one i n medical-surgical nurs ing and one i n public hea l th nurs ing - were under recrui tment .

Ind ia 0136.2 Post-basic N u r s i w Education, Funjab

R (March 1964 - )

A i m of t h e p r o j e c t . To s e t up a post-basic school of nurs ing a f f i l i a t e d with a

un ivers i ty .

Assistance provided by WHO during t h e Year. ( a ) Three nurse educators ; (b ) supp l ies

and equipment.

Probable dura t ion of a ss i s t ance . Unt i l the end of 1973

Work done durinu t h e Year. The S t a t e of Punjab has recognized the B.Sc. Nursing

( P o s t - c e r t i f i c a t e ) degree with e f f e c t from 1 December 1964. Such recogni t ion i s

necessary before t h i s can be recognized by t h e Indian Nursing Council.

Review of the cxr icu l i in t and plans f o r i t s r ev i s ion were proceeding. It was found t h a t awarding a diploma a t t h e end of t h e f i r s t y e a r , a s o r i g i n a l l y planned,

would not be necessary, a s a l l s tuden t s opted t o complete t h e two-year programme. Consequently, i t was considered advisable f o r thc course of s t u d i e s t o be i d e n t i c a l

f o r both es tab l i shed branches (maternal and c h i l d h e a l t h and administration-cum-

teaching) i n t h e f i r s t year and t o be spec ia l i zed only i n t h e second year .

A na t iona l nurse educator was appointed t o a s s i s t on t h e maternal and c h i l d

h e a l t h s i d e . The WHO paed ia t r i c n u r R educator with p m j e c t India 0114, "Paediat r ic and Obste t r ic Training and Services" , was reassigned t o t h i s p ro jec t a t t h e end

of December. The WHO s e n i o r nurse educator , who had been with t h e p ro jec t f o r f i v e y e a r s , l s f t i n September, Two WHO nurse educators were under recrui tment .

The physical f a c i l i t i e s , including t h e l i b r a r y of t h e c o l l e g e , have been improved.

SEA/RCZZ/Z Page 145

I n d i a 0136.4

R

Pos t -bas ic Nursing Educat ion , W s o r e

(Fcb. 1764 - Dec. 1965 ; Aug. 1968 - )

A i m of t h e p r o j e c t . To expand pos t -ba s i c n u r s i n g educa t i on and t o upgrade pub l i c

h e a l t h and i n s t i t u t i o n a l n u r s i n g s e r v i c e s i n t h e S t a t e .

Ass i s t ance Drovided by WHO d u r i n g t h e yea r . A twelve-month f e l l o w s h i p f o r s t u d y

i n t h e United S t a t e s of America.

I n d i a 0136.2 Pos t -bas i c Nursing Educat ion , Madras

R (sum 1964 - )

him of t h e oro , jec t . To s e t up a pos t -ba s i c s choo l of n u r s i n g a f f i l i a t e d w i th a u n i v e r s i t y .

A s s i s t a n c e provided by WHO durinR t h e y e a r . ( a ) Two nu r se e d u c a t o r s ; ( b ) s u p p l i e s

and equipment.

Probable d u r a t i o n of' a s s i s t a n c e . U n t i l t h e end of 1973

Work done d u r i n g t h e y e a r . The Col lege of Nursing made p r o g r e s s , a l t hough s e v e r e l y

handicapped by l a c k of n u r s i n g f a c u l t y . The c l i n i c a l and n o n - c l i n i c a l p r o f e s s o r s

o f Madras Medical College showed an i n c r e a s i n g i n t e r e s t i n t e a c h i n g n u r s i n g s t u d e n t s .

I. second g m u p of s t u d e n t s was admi t t ed .

The c l i n i c a l n , i r s i n g a s p e c t s of t h e med ica l - su rg i ca l n u r s i n g branch o f

s t u d i e s were f u r t h e r developed and s t r eng thened .

A pa r t - t ime l e c t u r o r i n p u b l i c h e a l t h n u r s i n g from t h e College of Nursing,

C h r i s t i a n Medical C o l l f g e , V c l l o r e , a s s i s t e d w i t h t h e p u b l i c h e a l t h n u r s i n g c o u r s e ,

and some c l i n i c a l i:xperience was provided i n Vel loru . There is an u rgen t need f o r

n a t i o n a l and WHO nu r se educa to r s i n t h i s c l i n i c a l s p e c i a l t y . A WHO pub l i c h e a l t h

nurse educa to r was undcr r c c r u i t m c n t .

Teaching eq,Jipment and l i b r a r y books were provided i n l a r g e r q u a n t i t i e s .

I n d i a 0153

R

USAID

Malar ia E r a d i c a t i o n

( A L ~ . 1758 - 1

Aim of t h e p r o j e c t . Tn e r a d i c a t e m a l a r i a and t o prevent t h e r e - e s t ab l i shmen t of

endemic i t y .

Ass i s t ance ~ r o v i d e d by WHO d u r i w t h e y e a r . ( a ) F ive e p i d e m i o l o g i s t s ; ( b ) t h r e e

m a l a r i o l o ~ i s t s ( f o r abo:lt a month each ) : ( c ) f i v e three-week f e l l o w s h i p s f o r a s t u d y

t o u r o r Turkey, Romania and Tha i l and ; ( d ) s u p p l i e s and equipment and a t r a n s p o r t

sEA/Rc22/2

Page 146

v e h i c l c ; ( e ) p a r t i a l payment of s a l a r i e s t o na t iona l s t a f f , and t r a v e l expenses

of na t iona l s t a f f a t t end ing conferences, seminars and t r a i n i n g courses.

Probable dura t ion of a ss i s t ance . Unt i l t h e end of 1974.

Work done dur inn t h e year . The WHO epidemiologists a s s i m e d t o tho various Regional

Co-ordinating Organizations i n M i a continued t o a s s i s t t h e programme by v i s i t i n g

t h e S t a t e s under the j u r i s d i c t i o n of t h e respec t ive organizat ion.

The programme was f u r t h e r adjusted and re-phased i n r e l a t i o n t o t h e

epidemiological s i t u a t i o n prevailing i n the d i f f e r e n t S t a t e s . The Specia l Working

Committee of the National m l a r i a Eradicat ion Programme continued t o hold both

regu la r and emergency meetings, a t which, among o t h e r t h i n g s , t h e c r i t e r i a f o r r e s t o r i n g rever ted u n i t s t o t h e i r o r i g i n a l phases were discussed. A phasing plan, g iv ing t h e recommended p a t t e r n of work depending on t h e prevalence of malar ia cases , was worked out f o r such u n i t s .

The rou t ine annual appra i sa l f o r s h i f t i n g a reas t o t h e conso l ida t ion and

maintenance phases was c a r r i e d out by th ree independent teams i n January-February 1969.

WHO a s s i s t e d by providing t h r e e malariologists/epidemiologists. Out of 1.334 u n i t s projected f o r e n t r y i n t o t h e consol idat ion phase.0.764 wcre approved, and, out of

8.18 u n i t a reas projected f o r en te r ing the maintenance phase, 5.11 were approved.

With t h i s , the phasing f o r 1967-70 w i l l be: t o t a l number of u n i t s - 395.250; maintenance phase - 217.046 units; consol idat ion phase - 68.74 u n i t s ; a t t a c k phase - 107.46U u n i t s .

The budget f o r 1968-70 was approved. I n order t o remedy t h e s i t u a t i o n a r i s i n g from shor tage of funds i n support ing v ig i l ance a c t i v i t i e s i n t h e S t a t e s , the Central Government decided t o subs id ize t h e expenditure incurred by S t a t e s on

these a c t i v i t i e s . Ear ly reques t s f o r i n s e c t i c i d s s were made and t h e supp l ies

required f o r t h e f i r s t cycle i n 1769 were received and d i s t r i b u t e d dur ing t h e l a s t q u a r t e r of 1968. Those f o r t h e second cycle of 1767 were a l s o expected t o a r r i v e on time.

I n t h e Palghar u n i t a rea of Mharashtra,where vec to r r e s i s t a n c e t o DDT was repor ted , malathion was sprayed on a t r i a l b a s i s and has been recommended f o r use

i n areas where t h e vec to r has acquired r e s i s t a n c e t o DDT and BHC. Such a reas a r e

a t present l imi ted t o small f o c i i n Maharashtra, wi th a t o t a l population of Qbout

one mil l ion people. A s malathion is more expensive than DDT, f u r t h e r f i e l d

experiments were under way t o determine whether some kind of s e l e c t i v e spraying could be adopted, which would reduce the c o s t and a t t h e same t i m e achieve

e f f e c t i v e vec to r con t ro l .

Extensive s u s c e p t i b i l i t y t e s t s on A. c u l i c i f a c i e s were c a r r i e d out i n the

S t a t e s of Madhya Pradesh, Ut ta r Pradesh, Rajas than, Gujarat and Maharashtra, and

out of a t o t a l of 200 l o c a l i t i e s t e s t e d i n these S t a t e s , 98 showed r e s i s t a n c e , 89 intermediate r e s i s t a n c e and 1 3 s u s c e p t i b i l i t y , t c DDT.

S~A/Rc22/2

Page 147

India 0111

R UNICEF

Production of DPT Vaccine, Kasauli (Jan. - March 1761 ; Sept . 1961 ; March 1965 ; Dec. 1966; Aug. 1967; Oct. 1968; Nov. 1968; - )

A l m of the p r o j e c t . To develop thc production of immunizing agents aga ins t d i p h t h e r i a , p e r t u s s i s and t e tanus .

Assistance Drovided by WHO during the year . Three six-month fe l lowships - one f o r

s t u d i e s i n the USSR,Yugoslavia and Demark,One f o r s tudy i n I r a n and Hungary, and one f o r s tudy i n Hilngary.

Probable dura t ion of a s s i s t a n c e . Unt i l t h e end of 1970.

Ind ia 0174 R

UNICEF

Production of Freeze-dried S m a l l ~ o x Vaccine (Sept. - Oct. 1964; June 1965 - March 1966; Feb. 1967 - )

A i m of t h e p ro jec t . To increasc t h e production of f reeze-dr ied smallpox Vaccine.

Assistance ~ r o v i d e d by WHO d u r i w t h e year . Supplies and equipment.

Work done durinu t h e year . WHO has a s s i s t e d with t h e production of f reeze-dr led

smallpox vaccine s i n c e the s t a r t of t h e four production c e n t r e s i n India . I n i t i a l l y planned t o t u r n out e lgh ty mi l l ion doses , t h e p rogra rm has been f u r t h e r expanded t o produce one hundred and e igh ty mi l l ion doses , i n order t o meet t h e requirements of the

na t iona l smallpox e rad ica t ion programme. Al together , e igh t s h e l f - d r i e r s a re i n

operat ion. Assistance i s being continued under project Ind ia 0233, "Smallpox Eradicat ion" .

India 0176 R

Central Public Health Engineering Research I n s t i t u t e , Nagpur

(Feb. 1761 - )

A i m of t h e Drodect. To develop the I n s t i t u t e a s a major cen t re f o r research on environmental s a n i t a t i o n problems; t o co-ordinate resea rch programmes and t o t r a i n

research workers.

Assistance Drovided by WO during the year . ( a ) A consul tant i n oxidat ion d i t ches and sewage t reatment : ( b ) a six-month fe l lowship f o r s t u d i e s I n the United S ta tes oP America, Canada and Europe.

Probable dura t ion of a ss i s t ance . Unt i l the end of 1974.

Work done dur ing t h e year . In January, the f i n a l r epor t of t h e UNDP(SF)-assisted P P O J C C ~ was submitted t o t h e Government by the Resldent Representative of t h e

Progranune i n New Delhi.

SEA/RCZZ/Z Page 148

A WHO consul tant was assigned to t h e I n s t i t u t e i n March t o adv i se and a s s i s t with regard t o the s p e c i f i c programe f o r the treatment of sewage and l i q u i d i n d u s t r i a l wastes through oxidat ion ponds and d i t ches . Steps were taken a l s o t o provide a s s i s t a n c e t o o the r a spec t s of t h e research programme.

India 0178 R

Production and Control of Po l io Vaccine* ( J a n . 1963; Oct. 1966; Oct. 1967; Jan. - Feb. 1969; May - June 1969; - )

A i m of the p r o j e c t . To produce a t t enua ted l i v e po l iomyel i t i s v i r u s vaccine and t o e s t a b l i s h f a c i l i t l e s f o r independent t e s t i n g .

Assistance provided by WHO dur ing the year . ( a ) Two consu l tan t s ; ( b ) supp l ies and equipment.

Probable durat ion of a s s i s t a n c e . Unt i l the end of 1969.

Work done during the year . A WHO consu l t an t , provided dur ing ~ a n u a r y - ~ e b r u a r y 1969, reviewed the s t a t u s of the production of l i v e po l io vaccine i n Coonoor and made suggestions f o r s t reamlining productibn. His views and observat ions were discussed with the a u t h o r i t i e s concerned, and hls repor t was being processed. Another consu l t an t , provided i n May-June, v i s i t e d the National I n s t i t u t e of Communicable Diseases . Delhi , and the Haffkine I n s t i t u t e , Bombay, where he reviewed the e x i s t i n g f a c i l i t i e s f o r v i r o l o g i c a l t e s t i n g of po l io vacc ine , and submitted proposals f o r suppl ies and equipment a s well a s on neurovirulence t e s t i n g . His repor t was also under s tudy.

India 0180 R

Health Education i n Schools+ ( ~ u l y 1964 - ~ u l y 1967; Sept. 1968; - )

A i m of the p r o j e c t . To develop heaI th education i n basic t eacher - t ra in ing courses , t o be extended t o t eacher - t ra in ing i n s t i t u t i o n s throughout the country.

Assistance provided by WHO during the year . lVo fe l lowships - one f o r twelve months and one f o r e ighteen months - f o r s tudy i n the United S t a t e s of America

'Previous t i t l e : Production of Pol io Vaccine.

+An evaluat ion of t h i s p r o j e c t , t o which WHO assigned a h e a l t h educator from J u l y 1964 t o Ju ly 1965, was given i n the l a s t Annual Report.

S E A / R C ~ Z / ~

Page 149

Ind ia 0182

UNDP(TA)

StrengtheninK of Health Services (Epidemiolo~y)

(Marcti 1963 - )

A i m of t h e p r o j e c t . To e s t a b l i s h o r improve hca l th i n t e l l i g e n c e u n i t s i n S t a t e

hea l th d i r e c t o r a t e s ; t o t r a i n s t a f f i n epidemiology, h e a l t h s t a t i s t i c s , microbiology

and communicable-disease c o n t r o l , and t o develop t h e National I n s t i t u t e of

Communicable Diseases ( N I C D ) . Delhi.

Assistance ~ r o v i d e d by WHO dur ing t h e year . ( a ) A v i r o l o g i s t and t h r e e consu l t an t s ;

( b ) a nine-month fellowship f o r s tud ies i n Czechoslovakia and I n d i a ; ( c ) suppl ies and

equipment; ( d ) a grant- in-aid t o t h e National I n s t i t u t e of Communicable Diseases,

Delhi (under p ro jec t India 0259).

Probable dura t ion of a ss i s t ance . Unt i l the end of 1974.

Work done dur ing t h e year. WHO a s s i s t e d the National I n s t i t u t e of Communicable

Diseases i n severa l d i f f e r e n t ways. F i r s t , a consul tant was provided t o help with

t h e National Seminar on Zoonoses, held i n October and organized by t h e NICD i n c lose

co-operation with the Indian Veterinary Research I n s t i t u t e , I za tnagar , and the Indian

Council of Agr icu l tu ra l Research. The Seminar achieved considerable success i n

h igh l igh t ing t h e problems of zoonoses and f o s t e r i n g t h e epidemiological approach i n

t h e s o l u t i o n of ve te r ina ry public hea l th problems. A comprehensive repor t i n two par t s - one c o n s i s t i n g of a summary of the proceedings and recommendations and t h e o the r

containing the papers presented - was issued by t h e NICD.

Assistance was again given with t h e year ly three-month na t iona l course i n

epidemiology, which took place a t t h e I n s t i t u t e from November 1968 t o February 1969.

The course is benef i t ing from t h e new t rend a t t h e NICD t o implement modern teaching

methods a s f a r a s poss ible wi th t h e resource personnel ava i l ab le . A suMnary of t h e

consu l t an t ' s recommendations was communicated t o t h e Oovernment and h i s r epor t was

under review i n t h e Regional Off ice .

Furthermore, s ince Deccnber 1968, a WHO medical o f f i c e r ( v i r o l o g i s t ) has

been a s s i s t i n g the NICD i n t h e development of an entero-virus l abora to ry . This

v i r o l o g i c a l l abora to ry , f o r which personnel , space and equipment have been a l l o c a t e d ,

is co-operating wi th , but is d i f f e r e n t from, t h e s e c t i o n ca r ry ing out neurovirulence-

t e s t i n g of pol io vaccine, which is a l s o being developed and f o r whioh WHO has provided

a s s i s t a n c e thrcugh consu l t an t s and fe l lowships .

F i n a l l y , a consul tant (epidemiologis t ) was provided t o he lp With the Delhl Par t of the WHO-sponsered nine-month combined (Prague - Dclhi) t r a i n i n g course i n epidemiology,

held a t t h e I n s t i t u t e . This year only nine of t h e o r i g i n a l l y planned t e n p a r t i c i p a n t s

a t tended t h e Delhi p a r t of t h i s course , which took place from 17 February t o 17 May.

Considerable improvements have been made i n t h e teaching methods and i n the f i e l d

v i s i t s t o various teaching i n s t i t u t i o n s .

9EA/RC22/2

Page 150

India 018.3-

UNDP(TA)

Medical Education, a u j a r a t S t a t e (Dec. 1962 - May 1969)

A i m of t h e ~ r o J e c t . To develop medical education and medical r esea rch i n Baroda Medical College.

Assistance provided by WHO dur ing t h e year . ( a ) Five v i s i t i n g p rofessors , a l abora to ry t echn ic ian , t h r e e professors a s temporary adv i se r s and two a s consu l t an t s ;

a s s i s t ance from t h e professor provided under Ind ia 0182; ( b ) f i v e fe l lowships - two

f o r twelve months, one f o r three-and-a-half months, one f o r s i x months and one f o r

t h r e e months - f o r s tudy i n t h e United Kingdom, a three-month fe l lowship f o r s t u d i e s

i n t h e United Kingdom, Germany and Denmark, a twelve-month fe l lowship f o r s t u d i e s i n

t h e United Kingdom and Sweden, and a twelve-month fe l lowship f o r s tudy i n Ceylon;

( c ) supp l ies and equipment.

Work done. This p r o j e c t , whioh was s t a r t e d a s a n cxperim~ent over s i x ycars .ago,

when WHO e n l i s t e d the co-operation of the University of Edinburgh.to a s s i s t the

Medical co l l ege i n Baroda (QnJara t s t a t e ) , drev t o a n end i n May 1969.

From 1963 onwards, each year a group of s i x teachers from Edinburgh was

ass igned, normally f o r one academic year a t a t i m e , t o work i n Baroda, g iv ing he lp

t o various departments in r o t a t i o n , a s needed and agreed by t h e medical co l l ege a u t h o r i t i e s . Also, WHO has financed t h e v i s i t of s e n i o r shor t - term consu l tan t s and

has awarded fe l lowships t o enable Baroda teachers t o s tudy i n Edinburgh. WHO has

a l s o provided equipment and medical l i t e r a t u r e (books and journals f o r t h e l i b r a r y ) .

From t h c time t h e p ro jec t s t a r t e d i n 1963, 21 v i s i t i n g p rofessors , 27 professors a s

consul tants ,and f i v e t echn ic ians were provided. The p ro jec t has cos t t h e Regional

Office a n average of $106 000 a year .

Durlng t h e period under revlew, WHO provided two v i s l t i n g professors i n m'diclnc (one of them f o r th rec months) ,two i n preventive and s o c i a l medicine, and

professors i n o b s t e t r i c s and gynaecology, biochcmistry. microbiology and c h i l d h e a l t h , a s we l l a s a l abora to ry technician. A consul tant m neurology completed a two-and-a-

half month assignment, and one on h o s p i t a l admin i s t ra t ion assigned f o r t h r e e months a l s o spent a pa r t of h i s time a t Baroda Medical College but t h e major por t ion wi th t h e

Di rec to ra te of Health and Medical Services of Quja ra t S t a t e . The p r o j e c t was a l s o

v i s i t e d by t h e Executive Dean, Faculty of Medicine, Edinburgh.

A meeting with t h e WHO s t a f f assigned t o the p ro jec t was held i n t h e

Regional Off ice i n December, t o review WHO a s s i s t a n c e t o t h e p ro jec t s i n c e i t s

incept ion. C r i t e r i a wei'e worked out f o r an eva lua t ion of the p ro jec t on t h e terminat ion of WHO a s s i s t a n c e , and cons ide ra t ion was given t o t h e quest ion of continued

WHO a s s i s t a n c e on a reduced s c a l e .

A d r a f t f i n a l r epor t on t h e e n t i r e p ro jec t has now been prepared by t h e

members of t h e l a s t team,in co l l abora t ion with t h e i r counterpar ts and t h e na t iona l a u t h o r i t i e s . The d r a f t is under review, but a comparison of t h e condi t ions encountered

a t t h e beginning of t h e p ro jec t and thosc noted a t the end i n terms of s t a f f i n g ,

teaching programmes and developments i n departments may be given i n b r i e f .

S E A / R C Z Z / ~

Page 151

It is d i f f i c u l t t o de termine which of t h e changes t h a t have t aken p l ace

i n Baroda Medlcal College and t h e S.S.O. Hosp i t a l i n t h e s ix -yea r per iod a r e due

t o t h e i n f l u e n c e of t h e p r o j e c t and which might w e l l have occurred wi thout t h l s

a s s i s t a n c e . Por example, r e g u l a t i o n s have been promulgated by t h e Ind ian Medical

Counci l , which have l e d t o t h e f o r m a l i z a t i o n and l a t e r implementat ion of improvements

i n s t a f f i n g , accommodation and equipment. However, t h e r e have been deve lopMnts

which a r e undoubtely a t l e a s t p a r t l y t h e r e s u l t of t h e combined e f f o r t s of t h e S t a t e

hve rnmen t and WHO.

I n t h e Medical College i t s e l f , t h e r e have no t been marly phys i ca l changes.

Some space f o r l a b o r a t o r i e s ha6 been r e e l l o c a t e d . I n t h e H o s p i t a l , a new p a e d i a t r i c

b u i l d i n g is i n f u l l u s e ; a new s u r g i c a l b lock , not y e t f u l l y equipped, i s p a r t l y i n

use on two f l o o r s , and a new n u r s e s ' home has been completed and i s occupied , p a r t l y

by t h e r e s i d e n t medical s t a f f . The o r g a n i z a t i o n of t h e l i b r a r y remained u n s a t i s f a c t o r y

There has been a s t a f f i n c r e a s e of s i x p ro fe s so r s and a s s o c i a t e p ro fe s so r s and

24 l e c t u r e r s . I n 1963, t h e r e were 73 academic s t a f f members, i n c l u d i n g 20 jun io r

l e c t u r e r s (who cannot be cons idered a s exper ienced t e a c h e r s ) . The s t a f f - s t u d e n t

r a t i o , exc lud ing jun io r l e c t u r e r s , was l:5 i n 1963 ( f o r 120 admissions and 411 e n r o l l e d

s t u d e n t s ) and 1:6 i n 1969 ( f o r 120 admissions and 773 e n r o l l e d s t u d e n t s ) . This i s a

f avourab le r a t i o . Thc development of r e s e a r c h a t Baroda has been s a t i s f a c t o r y i n some

depa r tmen t s , no t ab ly pharmacology, b u t s t i l l l a g s behind i n o t h e r s .

The e f f e c t of t h e p r o j e c t on s t u d e n t s is d i f f i c u l t t o a s s e s s , bu t t h e

consensus i s t h a t Baroda s t u d e n t s i n 1969 a sk ques t ions more f r e e l y and d i s c u s s t h e i r

work w i t h t h e i r t e a c h e r s more r e a d i l y t h a n d i d t h e i r p r edeces so r s i n 1965. The

pas s - r a t e i n t h e f i n a l examinations has not changed. Almost a l l depar tments have

i m p r x e d o v e r t h e per iod i n terms of i nc reased s t a f f , more equipment and books, and

i n some c a s e s accommodation. There has a l s o been a r e o r g a n i z a t i o n of t h e t each ing .

An i n t e g r a t e d cu r r i cu lum has been i n o p e r a t i o n s i n c e November 1965, and sma l l group

t each ing now t a k e s P l ace . The Departments of Prevent ive and S o c i a l Medicine,

O b s t e t r i c s and Oynaecology and P a e d l a t r i c s have s t r e s s e d t h e c o m n i t y a s p e c t s of

t h e i r disciplines b o t h i n t e a c h i n g and i n s e r v i c e a c t i v i t i e s . Most departments

tuw b e n e f i t e d from t h e a s s i s t a n c e g iven .

P r e - c l i n i c a l b iochemis t ry has been s e p a r a t e d Prom phys io logy, and t h e r e is now combined t e a c h i n g of physiology and c l i n i c a l medicine. ' C l i n i c a l chemis t ry has

become a s e p a r a t e department under a n a s s o c i a t e p r o f e s s o r , and some r a t i o n a l i z a t i o n

of l a b o r a t o r y s e r v i c e s has t a k e n p l ace . S i m i l a r l y , microbiology h a s been s e p a r a t e d

from pathology. A second f u l l - t i m e u n i t has been addcd t o t h e Department of

Medicine and a Hnematology Department s e t up. I n t h e Department of Surgery a f u l l -

time p r o f c s s o r and a l e c t u r e r i n p l a s t i c su rge ry have been appoin ted . In o b s t e t r i c s ,

weekly v i s i t s t o f i v e primary h e a l t h c e n t r e s a r c pa id by t h e s t a f f t o c a r r y out a n t e -

n a t a l c l i n i c s and g i v e advice . The Department of P a e d i a t r i c s has t a k e n r e s p o n s i b i l i t y

f o r t h e newborn, and t h e Primary Hea l th Centre a t Padra and ano the r c e n t r e a r e

v i s i t e d weekly by t h e s t a f f . A r c h y d r a t i o n u n i t has been s e t up. The Cura t ive and

Prevent ive General P r a c t i c e Unit i n S.S.G. H o s p i t a l , e s t a b l i s h e d i n 1965, b r ings

t o g e t h e r t h e s t a f f of t h o Department of Prevr2ntive and S o c i a l Medicine w i th t h a t of t h e

Department of Medicine i n t e a c h i n g s t u d e n t s and post-examination t r a i n e e s . Thc

former Department has cons ide rab ly developed t h e t e a c h i n g i n epidemiology be ing g iven

t o s t u d e n t s a t t h e Primary Heal th Centre and i n t h e p a t i e n t s ' own homes.

SEA/Rc22/2

Page 152

A Nedical Records Department has been organized and has developed i n t o a very e f f i c i e n t u n i t , now being used f o r t r a i n i n g a t a l o o a l l e v e l ; if augmented, it nlght be considered as a t r a i n i n g c e n t r e f o r S t a t e o r na t iona l personnel. \

The conclusion is t h a t , i n genera l , t h e ob jec t ives of t h e p m j e c t a s s e t out i n t h e plan of opera t ion , wi th t h e exception of those concerning research, may be considered t o have been achieved.

W i a 0185.2/3 S t r e w t h e n i n n of Health Serv ices , R Funjab and Harvana UNICEF (Jan. 1967 - )

A i m of t h e p ro jec t . To s t reng then n a t i o n a l h e a l t h se rv ices a t S t a t e , d i s t r i c t and l o c a l l e v e l s , wi th emphasis on t r a i n i n g progranmres f o r h e a l t h s t a f f , supervis ion of a u x i l i a r y s t a f f by appropr ia te profess ional s t a f f and opera t iona l s t u d i e s .

Assistance provided by WHO durinc: t h c year . A public h e a l t h o f f i c e r and a public h e a l t h nurse .

Probable d u r a t i o n of a ss i s t ance . Unt i l 1974.

-. Orien ta t ion courses f o r medical o f f i c e r s o r primary h e a l t h cen t res were continued i n Funjab and s t a r t e d i n Haryana S t a t e . The sy l l abus has been cons tan t ly reviewed and t h e l e a r n i n g experience improved. Training courses f o r bas ic h e a l t h workers and l abora to ry t echn ic ians were a l s o continued.

Steady progress was made i n s t rengthening t h e s e r v i c e s a t Karnal Hospi ta l , which is being developed i n t o a r e f e r r a l hosp i t a l . In p a r t i c u l a r , improvements were made i n the l abora to ry diagnosis of p a t i e n t s , i s o l a t i o n of cases of communicable d i seases and development of ou t -pa t i en t c l i n i c s .

Because of an increase i n t h e incidenoe of malar ia , spraying operat ions were undertaken by t h e bas ic h e a l t h se rv ices and both a c t i v e and passive s u r v e i l l a n c e a c t i v i t i e s strengthened. ?%is has r e s u l t e d i n improvements i n malar ia case-finding. The Directorates o f Health of both Funjab and naryana a r e planning t o place g r e a t e r emphasis on eradicat ion.

The coverage of smallpox vaccinat ion has improved, but a r ecen t r a c i a l s c a r Survey has shown t h a t primary vaccinat ion of c h i l d r e n under one year of age is not y e t s a t i s f a c t o r y , p a r t i c u l a r l y i n t h e urban areas .

A p i l o t s tudy of t h e f e a s i b i l i t y of n o t i f i c a t i o n of communicable d i seases has been i n i t i a t e d i n both S t a t e s . Also, preparat ions f o r h o s p i t a l u t i l i z a t i o n s t u d i e s have reached a n advanced s tage .

SEA/RCZZ/~

Page 153

India 0181

R

Training of Radiographers

(March 1967 - )

A i m of t h e project . To t r a i n radiographers.

Assistance provided by WHO dur ing the year . A radiography t u t o r .

Probable d u r a t i o n of a ss i s t ance . Unt i l the end of 1972.

Work done d u r i w the year . The l e c t u r e programme f o r the f i r s t - y e a r s tuden t s a t

t h e I n s t i t u t e of Post-graduate Medical Education and Research, Chandigarh, ended on

22 July 1968, and terminal examinations i n f i v e s u b j e c t s were given. A 1 1 s tudents

were successful and entered the second year of t h e i r t r a i n i n g .

Of t h e e leven candidates who appeared f o r interviews f o r t h e next i n t a k e ,

s i x were accepted f o r t r a i n i n g course.

A new l e c t u r e yrograme was prepared f o r both f i r s t - and arcond-pear s t u d e n t s ,

and systematic i n s t r u c t i o n according t o t h i s t ime-table commenced i n mid-Octcber 1968.

The second-year s tuden t s completed t h e i r general physics and radiographic

photography s y l l a b i and s t a r t e d the course i n r a d i a t i o n physics. Their i n s t r u c t i o n i n

radiotherapy techniques was resumed i n January 1969, and they a l s o s t a r t e d a s s i s t i n g

i n t h e treatment of p a t i e n t s wi th a newly opened Cobalt-60 un i t i n t h e Department of

Radiotherapy.

The l e c t u r e and i n - s r r v i c c t r a i n i n g f o r both f i r s t and second-year s tuden t s

continued according t o plan i n t h e Department of Radiodiagnosis and i n t h e Department

of Radiotherapy; a l l f i r s t - y e a r s tuden t s were issued wi th r a d i a t i o n monitoring f i l m

badges. An assessment of t h e r a d i a t i o n dosage being received by the s tudents

revealed s a t i s f a c t o r y r e s u l t s , and no ovcrdoso occurred.

Lectures i n the two a u x i l i a r y sub jec t s "Hospital p r a c t i c e and ca re of pa t i en t s" ,

and "Basic ~ n g l i s h " s t a r t e d on 23 and 29 October 1768 r e s p e c t i v e l y , and a r e attended

j o i n t l y by s tudents of both years .

The p ro jec t received t h e textbooks which had been ordered e a r l i e r by WHO, as a l s o

anatomical wal l -char ts , which wcre used f o r dcmonstration purposes.

The f i r s t f i n a l examinations a re due t o be held i n August 1969.

India 0188

R

S t r e w t h e n i n g of Laboratory Services

(Peb. 1965 - )

A i m of the p ro jec t . To s t rengthen henl th labor ' l tory sexvices and t o improve the

t r a i n i n g of l abora to ry technicians .

SEA/ACZZ/~ Page 154

Assistance Drovided by WHO d u r i n r the year. ( a ) TWO l abora to ry technicians (one s t a t ioned i n Trivandrum and one i n Chandigarh); ( b ) supp l ies and equipment.

Probable d u n t i o n of a ss i s t ance . Unt i l the end of 1972.

klQrk done dur ing the year. In Trivandrum, the s t a f f panel of the School of Medical Laboratory Technology no.$ c o n s i s t s of three f u l l - t i m e and two par t - t lme t u t o r s from t h e Medical College s t a f f . Twenty-four s tudents were s a t i s f a c t o r i l y following t h e one-year c e r t i f i c a t e course which s t a r t e d i n September 1968. The sy l l abus f o r t h i s course was revised and approved by the a u t h o r i t i e s . A proposal f o r a three-year degree course (L3.Sc.Tech.j was submitted to the Univers i ty Senate f o r f i n a l approval. The construct ion of a new school was in progress , and bas ic l abora to ry equipment and supp l ies were received. The construct ion of a publ ic h e a l t h l abora to ry a t Cal icut made good progress .

In Chandigarh, the course of i n s t r u c t i o n was being administered t o two forms - f i rs t year and second year of the B.Sc.Tech. degree course. The teaching of t h e English language was increased from 60 t o 80 hours pe r year. m e f i r s t B.Sc. Tech. examination f o r the f i n a l s was scheduled f o r August 1969. The appointment of a fu l l - t ime t u t o r was s t i l l awaised.

India 0190 Training i n Health Education ( s e p t . 1968; - )

A i m of the Droject . To e s t a b l i s h th ree post-graduate h e a l t h education t r a i n i n g cen t res and to prepare a curriculum f o r a h e a l t h education course t o be organized in

the f i rs t ins tance a t the Al l - India I n s t i t u t e of Hygiene and Public Health, Calcutta.

m b a b l e durat ion of a ss i s t ance . Unt i l the end of 1974.

Assistance Drovided by WHO dur ing the year. A n eighteen-month fe l lowship f o r s tudy i n t h e uni ted S t a t e s of America.

India 0192 R

Radiation Medicine Centre. Bombay - (Jan. - Feb. 1963; March 1967 - )

Aim of the up_oDDnrti. Ta s t rengthen the Radiation Medicine Centre, Bombay.

Assistance provided by WHO dur ing the year. [ a ) A consul tant ; ( b ) f i v e fe l lowships - four f o r twelve months and one f o r e ighteen months - f o r s tudy in the United S t a t e s of America; ( c ) supp l ies and equipment.

Probable durat ion of a ss i s t ance . Unt i l t h e end of 1972.

Work done during the year. A WHO consul tant in thyroid metabolism was a s s i m e d to t h i s p r o j e c t f o r two months (February and March 1969). H i s r epor t was under study.

In accoruance with the recommendations of the consul tant a s s i m e d to t h e

p r o j e c t n December l 9 6 7 ~ ~ a n u a r y 1 9 6 2 , a c t i o n was under way to r e c r u i t an organic

chemist to a s s i b t the Centre i n the development of new rad ic -ac t ive isotopes and

phamaceu t ica l products. Placement was arranged f o r a n a t i o n a l s t a f f member t o take up some t r a i n i n g abroad before the assignment i n preparat ion f o r the a r r i v a l of the organic chemist mentloncd above.

Textbooks were provided.

India 0194 R

UNICEF

Medical Rehabi l i ta t ion

(Nov. 1963 - Feb.1964; Apri l - June 1967;

Feb. - June 1969; - )

A i m Of the Pro jec t . To expand medical r e h a b i l i t a t i o n se rv ices ; to e s t a b l i s h regional

cen t res i n some l a r g e c i t i e s and u n i t s i n some medical co l l eges , and t o improve the f a c i l i t i e s a t the All-India I n s t i t u t e of Physical Medicine and Rehab i l i t a t ion , Bombay.

Assistance Provided by WHO dur ing the year. A consul tant ( t echn ic ian in orthopaedic

app l iances ) ,

Probable durat ion of a ss i s t ance . U h t i l the end of 1971.

Work done durinR the year. A WHO consul tant (orthopaedic appl iances t echn ic ian) was assigned to the p ro jec t from end-February t o end-June 1969. He v i s i t e d va r ious cen t res i n India to assess the s i t u a t i o n i n the departments and workshops connected with the manufacture cf orthopaedic, p r o s t h e t i c and o r t h o t i c appliances. H i s

assignment repor t was being processed.

India 0199 School f o r Training of Technicians UNDP(TA) ( s e e . 1767 - ) UNICEF

A i m of the [ i roject . To t r a i n t echn ic ians f o r the i n s t a l l a t i o n , maintenance and r e p a i r of X-ray apparatus and o the r e lect ro-medical equipment.

Assistance provided by WHO during the year. ( a ) An electro-mechanical engineer; ( b ) suppl ies and equipment.

Probable dur3t ion of a ss i s t ance . Unt i l the end of 1972.

Work done during the Year. The f i r s t course f o r the t r a i n i n g of electro-mechanical

h o s p i t a l t echn ic ians from Delhi h o s p i t a l s , which was s t a r t e d on 1 July 1968 a t the All-India I n s t i t u t e of Medical Sciences, New Delhi, was o r i g i n a l l y scheduled t o run f o r s i x months but had t o be extended by two f u r t h e r months a s the e l e c t r i c a l and

mechanical p a r t o f the p r a c t i c a l t r a i n i n g f e l l behind pending t h e r e c e i p t of some

hand too l s . The course thus ended i n February 1969. The t en p a r t i c i p a n t s were presented h i t h c e r t l f l c a t e s of attendance by the I n s t i t u t e .

SEA/RCZZ/Z Page 156

The second course began i n March, wi th 15 new s t u d e n t s , who came from several

Indian S t a t e s a s wel l as from Delhi.

UNICEF p a y s s t l p e n d s t o the s tudents .

India 0200

R Fellowships

Qidemiology and Health S t a t i s t i c s . A twelve-month fe l lowship f o r s tudy i n the United S t a t e s of America.

Health S t a t i s t i c s . A twelve-month fe l lowship f o r study i n the United S t a t e s of America.

Soc ia l Secur i ty . A two-month fe l lowship f o r t r a v e l i n Mexico, t h e United S t a t e s of

America, Canada. Denmark and Sweden.

Teaching of S t a t i s t i c s . A one-week fellowship f o r study i n the Netherlands.

India 0201

UNDPI TA) Pellowships

Cardlolo&. A six-month fellowship f o r s t u d i e s i n the United S t a t e s of America, the United Kingdom and Europe.

Obs te t r i c s and aynaecologx, A twelve-month fe l lowship f o r s t u d i e s i n the United Kingdom, Switzer land, Yugoslavia and Nigerla . Orthopaedic Surgery. A twelve-month fe l lowship f o r study i n the United Kingdom.

Virological Techniques. A six-month fe l lowship f o r s tud ies i n t h e United S t a t e s of

America, France and Yugoslavia.

India 0208

DNDPI TA)

Improvement of Dental Education ( J u l y - Dec. 1966; Sept . 1967 - )

A i m of the p r o j e c t . To improve and s t rengthen den ta l education and research i n a

se lected den ta l co l l ege .

Assistance provided by WHO dur ing the year . ( a ) hyo professors of d e n t i s t r y ; ( b ) a six-month fe l lowship f o r study i n the United Kingdom'and a three-month fe l lowship f o r study i n the United S t a t e s of America: ( c ) supp l ies and equipment, including a micro-

p ro jec to r .

Probable durat ion of a s s i s t a n c e . Unt i l the end of 1974.

Work done during the year. The WHO consul tant on o r a l surgery and orthodontia who

a s s i s t e d the Government Dental Col lege, Bangalore, from May, completed h i s assignment

i n September 1968. Dur ing t h i s p e r i o d , he v i s i t e d Mangalore t o i n a u g u r a t e t h e s c i e n t i ~ i c s e s s i o n of t h e d e n t a l co..;erence o rgan i zed by t h e Sou th Canara D i s t r i c t

and Manipal b ranches oi' t h e I n d i a n D e n t a l Association, and a l s o d e l i v e r e d same

l e c t u r e s and c a r r i e d o u t c h a i r - s i d e demons t r a t i ons . He v i s i t e d t h e d e n t a l c o l l e g e a t t a c h e d t o Na i r H o s p i t a l , Bombay, t h e D e n t a l Wing a f Madras Medical C o l l e g e , t h e

D e n t a l Co l l ege i n Hyderabad and t h e A l l - I n d i a I n s t i t u t e of Medica l S c i e n c e s , New D e l h i ,

t o d e l i v e r l e c t u r e s and t o c a r r y o u t demons t r a t i ons .

In Feb rua ry 1969 , a c c n s u l t a n t i n p r o s t h e t i c s took up a n ass ignment a t t h e Government Den t a l C o l l e g e , B3ngalore . t o h e l p t he c o - o r d i n a t o r of Block 5 i n t h e

development of t h e i n t e g r a t e d t e a c h i n e programme and t o t a k e p a r t i n t h e a c t u a l t e a c h i n g i n c l i n i c s and l a b o r a t o r i e s . A r e s e a r c h p r o j e c t was proposed and implemented.

The c o n s u l t a n t a l s o v i s i t e d t h e d e n t a l c o l l e g e s a t Trivandrum and Manipal .

A c o n s u l t a n t i n p e r i o d o n t i c s , a l s o t o be a s s i g n e d t o Bangalore , was under r e c r u i t m e n t .

I n d i a 0209 R

Comm.uni_tv_ W'tter Supply

(March - May 1964; Oct. - Dec. 1965;

Feb. 1968; March 1969: - )

A i m of t h e p r o j e c t . Second phase: To s t u d y t h e f e a s i b i l i t y and t h e f i n a n c i a l and manage r i a l a s p e c t s LI" wate r supp ly and d r a i n a g e schemes.

A s s l s t a n c c provided by WHO d u r i n g t h e y e a r . A six-month f e l l o w s h i p f o r s t u d i e s i n t h e

United S t a t e s of America, t h e United Kingdom and t h e F e d e r a l Republic of Germany.

I n d i a 0210

UNDP(TA) Pub l i c Hea l t h Eng inee r i ng Educa t i on

(Oct . - L c . 1967; March - A p r i l 1963; Nuv. 1968; - )

A i m o f t h e p r o j e c t . To a s s i s t w i t h t h e e d u c a t i o n and t r a i n i n g of s a n i t a r y e n g i n e e r s and t h e dev,?lopmcnt a f advanced c o u r s c s i n d e s i g n f o r community w a t e r supp ly programmes.

A s s i s t a n c e provided by WHO d u r i n g t h e y e a r . S u p p l i e s and equipment .

I n d i a 0212 Nursing Admin i s t r a t i on*

I n d i a 0212 .1 Nurs ing A d m i n i s t r a t i o n , Chandigarh ( J a n . 1968 - )

A i m o f t h c p r o j e c t . Tc deve lop sound n u r s i n g a d m i n i s t r a t i o n i n t e a c h i n g h o s p i t a l s and t o promote i n - s e r v i c e t r a i n i n e and c l - o r d i n a t i o n of n u r s i n g s e r v i c e s .

*The p r c d c c t s t a r t d i n Jdnuary 1 9 ~ a 3nd i s cxpectej . t c con t i nue u n t i l t h e end of 1972.

Assistance provided by WHO dur ing the year. ( a ) A nurse adminis t ra tor ; ( b ) supp l ies and equipment.

Probable dura t ion of a ss i s t ance . Unt i l the end of 1972.

Work done d u r i n z the year. To c o r r e l a t e theory with p r a c t i c e , and t o s t rengthen c l i n i c a l supervis ion and teaching, bhe curriculum of t h e Nehru Hospital School of Nursing was revised. Regular conferences wi th s i s t e r t u t o r s and ward s i s t e r s were es tab l i shed .

The B.Sc. s tudcn t s from the College of Nursing, a s p a r t of t h e i r p r a c t i c e teaching, conducted an in - se rv ice education programme f o r a small group of s t a f f nurses . This pro,wame, based on microbiology and a s e p t i c technique, was wel l rcceived. A committee made up of B.Sc, s tuden t s , s t a f f members of t h e Hospital and t u t o r s in the School of Nursing developed some nurs ing procedures f o r adaptat ion f o r use i n both Hospital and School.

E f f o r t s were made to s t rengthen nurs ing adminis t ra t ion a t va r ious l e v e l s - in t h e Hospital , departments and wards. P o l i c i e s a f f e c t i n g nurs ing were reviewed and changes made, where possible and des i rab le : In an e f f o r t t o improve s tandards of nurs ing se rv ice .

The main d i f f i c u l t y in nurs ing admin i s t ra t ion i s the l ack ,a t a l l l e v e l s , of well q u a l i f i e d nurs ing personnel wi th experience in adminis t ra t ion. There is a l s o a shortage of s t a f f nurses , and coverage on the wards by q u a l i f i e d s t a f f ( s t a f f nurses ) on a 24-hour b a s i s i s n o t poss ib le in the present circumstances.

A l i b r a r y was s e t up in the h o s p i t a l , and was supplied with books by WHO. Nurses a r e gradual ly becoming more i n t e r e s t e d in reading; consequently t h e r e has been an increase i n the demand f o r l i t e r a t u r e .

The WHO nurse admin i s t ra to r completed he r r egu la r assieflrrent a t the end Of

December 1968 and re turned t o the p r o j e c t in February 1969 a s a short-term c o n - > ~ l t a n t . A long-term replacement was under recruitment.

India 0212.2

R

Nursing Administration, Gujarat

( J u l y 1968 - A i m of the p ro jec t . To develop sound nurs ing adminis t ra t ion in teaching h o s p i t a l s and to promote in - se rv ice t r a i n i n g and co-ordinat ion of nurs lng se rv ices .

Assistance provided by WHO dur ing t h e year. ( a ) A nurse admin i s t ra to r ; ( b ) SURDlieS and equipment.

Probable durat ion of a ss i s t ance . Unt i l the end of 1972.

Work done dur ing the year. In some departments of both t h e Civ i l Hospi ta l in Ahmedabad and the S.S.O. Hospital , Baroda, committees of medical and nurs ing s t a f f were es tab l i shed to i d e n t i f y problems and devise methods of providing b e t t e r p a t i e n t care. Specia l cmphasis was given to t h e prevent isn and con t ro l of in fec t ion within t h e hosp i t a l s . In-service Educational programmes were developed f o r nurses and d i f f e r e n t p a t t e r n s f o r ward management followed in some departments.

In the c i v i l Hospital , p lans were proceeding f o r the establishment of a u n i t f o r c l i n i c a l teaching and improved p a t i e n t care in which some aspec t s of progress ive p a t i e n t care w i l l be incorporated.

Tutors in the h o s p i t a l schools of nurs ing were given some a s s i s t a n c e in curriculum construct ion and i n the c l i n i c a l supervis ion and teaching of s tudents .

Tfiis p r o j e c t i s c l o s e l y co-ordinated with p r o j e c t Ind ia 0136.2 "Post-basic Nursing Education, GU j a ra t " .

Ind ia 0214 Viroloaical TFchnique:. R (Sept. 1968; - )

Aim of t h e Droject. m e s t a b l i s h f a c i l i t i e s ( 1 ) f o r t h e diagnosis and epidemiological s t u d i e s of v i r a l d i seases , ( 2 ) f o r the production of v i r a l vaccines, including a t t enua ted l i v e po l iomyel i t i s vaccine, and ( 3 ) f o r independent t e s t i n g .

Assistance provided by WHO during t h e year. A twelve-month fe l lowship f o r s t u d i e s in t h e Ukited Kingdom and DciUUark.

Pmbable durat ion of ass is tance. Unt i l the efid of 1971.

India 0218 National m s t l t u t e of Health R Administration and Education (NIXAE), UNICEF New Delhi

(Sept. 1965 - May 1967; March 1968; Dec. 1968 - 1

Aim of t h e p ro jec t . To a s s i s t i n the teaching of h o s p i t a l and h e a l t h adminis t ra t ion and t o promote planning of comprehensive h e a l t h se rv ices in d i s t r i c t s .

Assistance provided by WHD during the year. A s p e c i a l i s t i n h o s p i t a l adminis t ra t ion.

Pmbable dura t ion of a ss i s t anco . U h t i l the end of 1974.

Work done dur ing the year. WHO provided a fe l lowship(under p r o j e c t SEAR0 0200) t o enable a candidate from Ceylon t o p a r t i c i p a t e i n the s t a f f col lege course held a t the I n s t i t u t e ' f r o m 19 August to 19 October 1968.

me plan of opera t ion for WHO a s s i s t a n c e t o t h i s i n s t i t u t e ws f i n a l l z e d and a h o s p i t a l admin i s t ra to r took up h i s d u t i e s a t NIHAE in December. It was a l s o proposed t o ass ign a pub l ic h e a l t h o f f i c e r and a consul tant i n s t a t i s t i c s .

A ten-day Workshop on S t a t e Level Planning and Evaluation of Health and Family Planning, a t tended by c h i e f s of S t a t e Health Planning and Evaluation Ce l l s and sen io r non-medical admin i s t ra to r s from S t a t e h e a l t h departments, was held a t t h e I n s t i t u t e , f m m 20 November. The Workshop provided an opportuni ty t o take stock of Ind ia ' s resources , needs and problems in the f i e l d of hea l th planning and to devise ways and means, through t r a i n i n g and otherwise, of s t rengthening the h e a l t h planning and evaluat ion agenoies in the S ta tes .

SEA/RCZZ/~ Page 160

A s a follow-up of the Workshop, f u r t h e r t r a i n i n g programmes in depth w i l l be developed f o r t h e var ious d i s c i p l i n e s involved i n h e a l t h planning.

fils0 a t t h e m s t i t u t e , from 24 t o 27 February, a Workshop on Post-(fmduatc Education f o r community Health Work was held in which t h e r e were 33 p a r t i c i p a n t s , hal f of whom were from d i f f e r e n t agencies of t h e Central Uovemment and t h e o t h e r ha l f from e i g h t S t a t e s . me workshop was divided i n t o plenary sess ions and th ree working groups dea l ing with o r i e n t a t i o n and s t a f f col lege courses and with diploma l e v e l and doc to ra l l e v e l education.

The proposed resea rch p r o j e c t i n d i s t r i c t h e a l t h admin i s t ra t ion , which was

s tudied by a team of th rce s t a f f members from WM) Headquarters in March 1968 was agreed t o by the S t a t e Qovernment of Haryana and i s now under considerat ion by t h e Government.

Seminars and Workshops on Medical Education (Dec. 1965 - May 1966; Jan. 1967 - )

Ain of t h e p ra jec t . m a s s i s t with seminars in spec ia l i zed f i e l d s organized by t h e Indian Academy of Medical Sciences, in order to s t rengthon medical teaching in the country.

Assistance Provided by dur ing t h e year. ( a ) A consul tant and a temporary adv i se r , and ass i s t ance from the Regional Adviser i n Medical Education; ( b ) a e c r e t a r l a l a s s i s t ance ; ( c ) cos t of attendance of p a r t i c i p a n t s .

Probable durat ion of ass is tance. m t i l the end of 1974.

Work done dur ing the year. A WHO consul tant and 3. temporary adv i se r helped t o prepare and conduct a one-week Seminar on t h e Teaching of Biochemistry and C l i n i c a l ChemiStFY, j o i n t l y arranged by t h e Indian Academy of Medical Sciences and WID. The seminar,which was held i n NEW Delhi from 20 t o 24 January, was at tended by 34 teachers of these sub jec t s from Ind ia and eleven from Bunna, Ceylon, Indonesia and Thailand.

The discuss ions brought to l i g h t the considerable v a r i n t i o n a s among t h e countr ies represented - and even within the same country - regarding t h e amount of importance a s s i p e d to bioohemistry in the undergraduate medical course. It was agreed t h a t advances in modem medicine required t h e f u t u r e physician t o have a sound understanding of t h e sub jec t , s ince i t promoted the d e s i r a b l e development of a s c i e n t i f i c a t t i t u d e towards problems of h e a l t h care. P a r t i c i p a n t s drew up a number of reoommendations f o r r a i s i n g the s t a t u s c f bioohemistry in t h e academic s t r u c t u r e and i n the teaching programmes. It was a l s o r e c o g i z e d t h a t q u a l i f i e d non-medical biochemists could equa l ly contribute t o the teaching of the sub jec t in medical education courses and t h a t they should enjoy the same r i g h t s a s t h e i r medical ly q u a l i f i e d colleagues.

Preparat ions were s t a r t e d f o r a one-week seminar on t h e teaching of epidemiology, t o be he ld in November 1969.

India 0222 Drug Laboratcry Tfchniques and

R Biological Standardizat ion (Juno 1967; Oct. - Dec. 1967; Aug. 1968; - )

A i m of the p ro jec t . To a s s i s t i n q u a l i t y con t ro l of drugs and t r a i n i n g of personnel.

Assistance Provided by WHO dur ing the Year. A twelve-month fe l lowship f o r s tudy i n Yugoslavia.

India 0228 Rcgis t ry of Pathology

R (Nov. 1966 - EL1rch 1967; Aprl l 1969)

A i m of t h e p ro jec t . To a s s i s t the Indian Regis t ry of Pathology in organizing a pe r iphera l

cent* a t Grant Medical College, Bombay.

Assistance provided by WHO dur ing thc year. ( a ) A tuelve-month fe l lowship f o r s tudy in t h e United S t a t e s o f America; ( b ) supp l ies , equipment and a photomicro camera.

India 0232

R Course in Hospital Physics

(oc t . 1967 - )

A i m of the prc ject . To t r a i n h o s p i t a l phys ic i s t s .

Assistance provided by WHO durinu the year. ( a ) A consu l t an t ; ( b ) half t h e cos t of attendance of p a r t i c i p a n t s .

Probable durat ion of a ss i s t ance . U n t i l the end of 1974.

\fork done dur ing the year. m e second course i n h o s p i t a l physics s t a r t e d on 1 6 September 1968 a t the Di rec to ra te of Radiation Protect ion, Bhabha Atomic Reszarch Centre, Bombay. Bet ides the 20 candidates from Ind ia , t h e r e uerc twa p a r t i c i p a n t s froxi Indoncsld and one from Thailand, a t t end ing the course on WHO fe l lowships ,as well a s th ree from Indonesia sponsored by the Colombo Plan. A WHO consul tant a s s i s t e d with

the course f o r two months (February and March 1969) by glving l e c t u r e s and p r a c t i c a l

demonstrations.

Thc sy l l abus f o r the course received a t t e n t i o n , and recommendations regarding modif icat ions were suggested,

Ind ia 0231

R Smallpox Eradicat ion ( o c t . 1967 - )

Aim of the p ro jec t . To develop the smallpox e rad ica t ion programme, including the maintenance phase and per iod ic assessments, and t o a s s i s t in the production of f reeze- d r i ed smallpox vaccine to meet n a t i o n a l needs.

SEA/RCZZ/Z Page 162

Pmbable durat ion of a ss i s t ance . Indef in i t e .

Work done durinR the year. Assistance to. t h i s P ro jec t was given under SEARO 0030.

India 0234 UNDP( TA)

Medical Education (Al l - India Xnst i tu ta - -~

of Medical Sciences. New D e l h i l

(May 1968; J u l y 1968; Sept. 1968; - ]

A i m of the p ro jec t . To prepare a cadre of n a t i o n a l medical educators i n var ious d i s c i p l i n e s .

Assistance Dmvided by WHO durin,? the year. A ten-and-a-half-month fe l lowship f o r s tudy in the United S t a t e s of America and a twelve-month fe l lowship f a r s t u d i e s i n the United S t a t e s of America and the United Kingdom.

Ind ia 0238 Cancer Control P i l o t Project , Madras

( Ju ly 1968 - )

Aim of the p r o j e c t . To s t a r t a cancer c m t r o l p r o j e c t and to s e t up a nucleus of t r a i n i n g cen t res .

Assistance Drovided by WHO dur inn the year. A consul tant {pro jec t d i r e c t o r ) and a temporary adv i se r ; ( b ) supp l ies and equipment.

Pmbable durat ion of a ss i s t ance . Unt i l the end of 1973.

Work done dur ing t h e year. mi5 p m j e c t i s being a s s i s t e d by both WHO and the Norwegian (lovemment (NORAD). An amount of one mi l l ion kroner ($140 000) was given by Norway towards the cos t of the new cancer c l i n i c and equipment.

The WHO consul tant ( p r o j e c t d i r e c t o r ) took up an a s s i m c n t - i n September 1968 and l e f t a t the end of Apri l 1969.

A pre-study c o n s i s t i n g of a survey of a small sec t ion of the female population, covering approximately 2 000 homes i n the Kancheepuram area.was begun i n March 1969, to e luc ida te the d i f f i c u l t i e s l i k e l y to be met dur ing the major survey and the methods of so lv ing them. It was t o cover research i n t o the methodology of contact ing people, and of being welcomed i n t o t h e i r homes a s well a s on t h e i r f e l t needs regarding the d i sease and attendance a t screening c l i n i c s , e t c . To h e l p with t h i s study, a temporary adv i se r ( s o c i o l o g i s t ) was assigned f o r a week (March - Apr i l ) t o advise on t h e means of achieving maximum co-operation fmm the populat ion and a l s o on the methods of h e a l t h education t o be used.

The foundation-stone of the new Annadurai Memorial Cancer I n s t i t u t e a t Kancheepuram was l a i d on 21 March. This bu i ld ing i s t h e f o c a l point of the p r o j e c t , a t whioh the examinations f o r cancer a r e undertaken. The maJor survey of the whole population f o r both c e r v i c a l and oropharyngeal cancers w i l l s t a r t a s soon a s the bu i ld ing i s ready.

sEA/Rc22/2 Page 163

India 0240 R

UNDP( SF I

Calcut ta Metropolitan Water and S a n i t a t i o n Authority

(Peb. - Apri l 1968; Ju ly 1969 - 1

A i m of t h e p r o J e c t . To a s s i s t the Calcut ta Metropolitan Water and S a n i t a t i o n Authority i n various aspects of the implementation of the master p l a n f o r water supply, seweraec

and drainage, and a l s o i n t h e management and operat ion of t h e water supply, sewerage

and drainage systems.

Assis tance provided by WHO during the year . A consul tant (provided under SEAR0 0064).

Probable dura t ion of a s s i s t a n c e . Unt i l t h e end of 1971.

Work done during the year . An inspec to r from t h e UNDP Inspect ion Unit v i s i t e d the p ro jec t i n September. The plan of operat ion f o r the t h i r d phase of the p r o j e c t i s s t i l l wi th the Governmsnt and i s being followed up c l o s e l y . Negotiations were i n i t i a t e d

wi th UNDP(SF) f o r thc recruitment of two exper t consul tants t o review the t echn ica l

documentation prepared by t h e Authority on ' the management, o rgan iza t iona l and admin i s t ra t ive aspec t s . I n J u l y , a consul tant was assigned f o r one month t o provide t echn ica l advice t o the Authority.

India 0241

UNDP(TA)

Nursing Administration and Education

( J a n . 1969)

A i m of t h e p r o j e c t . To provide an opportunity f o r a S t a t e nursing superintendent t o s tudy the admin i s t ra t ion of nursing se rv ices a t the na t iona l l e v e l and t o receive

formal educat ion i n admin i s t ra t ion .

Assistance provided by WHO during the year . A twelve-month fellowship f o r s t u d i e s i n the United S t a t e s of America, Canada and the United Kingdom.

M i a 0252 R

Physiotherapy School, Baroda

(May 1968; March 1969 - )

A i m of the p r o j e c t . To s t reng then the Physiot;herapy School i n Baroda.

Assistance provided by WHO during the year . A physiotherapy t u t o r .

Probable dura t ion of a ss i s t ancu . Unt i l the end of 1971.

Work done during t h e year . A WHO consul tant (physiotherapy t u t o r ) took up an elcven-month assignment i n March 1969 t o a s s i s t i n the development of a three-year

degree l e v e l sy l l abus f o r the t r a i n i n g of phys io the rap i s t s . She i s a l s o t a H n g p a r t i n the t r a i n i n g programme and advis ing on t h e s t rengthening of the physiotherapy department and s e r v i c e s .

SEA/~c22/2 Page 164

India 0260 R

I n d u s t r i a l Waste Pmblems (Oct. Nov. 1968; . )

A i m of the Projcct . To formulate mcasurfs t o avoid po l lu t ion from l n d u s t r i a l wastcs and advise on appropr ia te l e g i s l a t i o n .

Assistance provided by WXO dur ing the year. A consultant.

Probable durat ion of a ss i s t ance . Unt i l thc end of 1970.

Work done dur ing the year, The consu l t an t , a s s i m e d f o r one month in October-November, v i s i t e d i n d u s t r i a l i n s t i t u t i o n s in s e v e r a l S t a t e s of Ind ia t o c o l l e c t data on l n d u s t r i a l wastes and t o assess the extent of water p o l l u t i o n and t h e e x i s t i n g l abora to ry f a c i l i t i e s . X i s a s s i g m e n t repor t was under study.

m e Regional Advisers in Wvironmental Health went t o Bombay in January t o discuss the consu l t an t ' s f ind ings and recommendations with the '3uthori:ios and t o cxplorc thc p o s s i b i l i t y of developing a WDP(SP)-assisted p r o j e c t on the problems of the d i sposa l of wastes i n the Greater Bombay a rea . The proposed request t o the UNDP(SF) w i l l a l s o be based on the f ind ings of the two consul tants to bc provided to the S t a t e of Maharashtr3. under p ro jec t India 0226, 'lwater Pol lut ion Control, Mahamshtra".

INDONESIA

The Tangkuban Prahu (Overturned Prow) Volcano near Bandung, Java

5. INDONESIA

In Djakarta, important political, financial and economic decisions were taken during the year. The Cabinet was replaced by a "Development Cabinet", in which several senior economists have been included.

In the process of economic stabilization, not only was inflation brought under control but the exchange rate uf the rupiah to the US dollar was subsequently reduced and stabilized. In the current year's budget (extonding over a fifben-month period from January 1968 to March 1969) of 96 billion rupiahs (US $253 333 333) a sum of Rps. 3 401 421 258 (59 070 457) haa been allocated for health, representing 3.58 per cent of the total amount. The fiscal year, hitherto coinciding with the calendar year, was changed: it now extends from 1 April to 31 March.

A five-year development plan was formulated and launched as from 1 April 1969. Of the 304 billion rupiahs budgwted for 1969/'70, 100 billlon were earmarked for development projects.

The main emphaais of the national development plan is on ap;riculkrre, with the aim of achieving seIt4cienoy in food production by 1973 and increasing foreign exchange earnings,

During the year under review, there was no significant change in the atruc* of the health services.

The health sector of the five-year plan covers p r o p m m e s in (i) the control of communicable diseases, (ii) the bullding up of the infpastructare of the health organization in line with the master plan of operation for the strengthening of health services, (iii) health education, (iv) family planning, (v) health promotion, (vi) training of health personnel, (vii) applled research and surveys and (viii) evaluation.

A master plan of operation for the strengthening of the health semioes was signed by the Government, UNICEF and WHO, and a protocol was drawn up for the study of the various components of health services a t the regency and sub-district levels.

Training activities in various health fields in the form of workshops, seminars, etc., constituted one of the principal features of the year.

A start was made in implemenbg a scheme for eonduotiw a wide range of short courses for various levela and types of nursing personnel, and plans for the study of nursing education and for the preparation of a basic '

minimum oufiiculum for the training of nurse midwives were also under way.

The epidemiological unit'has been revived, and an active epidemiological surveillance programme initiated. A long;-tenn plan for the strengthening of '

laboratory services was prepared and a national health research institute set up. A co-ordination committee was established in the Ministry of Health to ensure effective implementation of al l health programmes.

SEA/RC22/2 Page 166

Family Phmhg was formally accepted by the Government as a part of the health serviccs and proclaimed by the President as an essential national prcpamme to be implemented by the people themselvee, with the assistance, support and protection of the Wernment. A Nafional Family Planning Institute and a National Family Plauning Advisory Board have been established to supplement the present activities of the Moneeian Planned Parenthoad

The Regional Family Planning Conference in Eandung in June 1969, co-sponsored by the International Planned Parenthood Federation gnd the Monesian Planned Parepth6od Aseociation, 'focuesed attention on th8 relation- ship between national development and population p;rowth.

The upgrading of matarnal and child health services arad thair inkgation with the general health services received attention.

A draft bill seeking to lay down uni~orm'standarda in a l l governmental and private medical schbols was under cohsideration.

The smallpox eradication programme launched in Java and Bali was well under wax with plans for extendion to other islands. Though there were problems in malaria eradication actwities', it is expected that a phased promamme wiJ.l be in operation in the near future. .An outbreak of plague in one district in Central Java was brought under control. The problem of health hazards from pesticides, related to the increase in Eoad prcduction, received special attention.

In August 1968, a workshop on the educational approach in planning and implementation of pi~blic health programmes was conducted by the Division of Health Education in collaboration with WHO. Also, a national workshop oh tuberculosis was held in Tjilotc in Jawary 1969; its recommendations on protecting the you% susceptible population with BCG vaccination were being followed up.

WHO assistance to the development of health programmes in West Irian did not reach the implementation stage'bcahse of the lack of accomnlcdation for personnel, which neceasitatsd the postponement of recruitment of sW.

PROJECT LIST

Pro jec t No.

Source of Punds Co-operating

Agencies

Indonesia 0001 Yaws Control R (May 1950 - Nov. 1956; J u l y - Sept . 1968; -)

UNICEP

A i m of the p r o j e c t . To revlew and assess the yaws con t ro l programme.

Assis tance provided by WHO during t h e year . A consul tant .

Probable dura t ion of a ss i s t ance . Unt i l 1970.

Work done dur ing t h e year. The WHO consul tant who took up a n assignment i n J u l y 1968 t o c a r r y ou t a n assessment c f the ex ten t rf the remaining yaws prrblern i n Indonesia, completed h i s work a t t h e end of August. According t o h i s r e p o r t , which k s been reviewed with the Government, t h e programme achieved remarkable success , and the yaws con t ro l fie.ld s t a f f i n c e r t a i n a r e a s can now be u t i l i z e d f o r o the r pub l ic h e a l t h a c t i v i t i e s i n t h e i r own a rea of opera t ion , whi le , a t t h e same time, ensuring the continuous yaws surve i l l ance whloh i s requiretl.

Indonesia 0009 R UNICEF

Leprcsy Control ( ~ u l y - ~ e p t . ' l 9 5 5 ; Sept . 1956 - Dec. 1967; Reb. - May 1969; - 1

A i m of the p r o j e c t . To develop a leprosy e o n t s o l programme, wi th in the framework of the general hea l th s e r v i c e s , i n a l l the endemic a r e a s of the Country, and to t r a i n personnel.

Assis tance provided by WHO dur ing the year. A consul tant .

Work done dur ing the year. From February t o May 1969, a WHO consul tant a s s i s t e d wi th a revlew of leprosy and i t s c o n t r o l s i n c e t h e completion of the assignment of the WHO l e p r o l r g i s t i n December 1967. His r e p o r t was being processed, and a summary of h i s raconGnendationS was forwarded t e the Qnrrerment.

Indonesia 0032 R

Malaria Eradicat ion (May 1955 - 1

A i m of the p ro jec t . To e rad loa t f malaria i n s tages .

Assistance provided by YHO during the year . ( a ) A ma la r io log i s t and a t r a n s l a t o r -

t y p i s t ; a s s i s t a n c e from a tcam cons i s t ing of two consu l t an t s and an entomolo:ist

provided under p r o j e c t SEARO 0123: ( b ) suppl ies and equipment; ( c ) subsidies f o r meetings, conferences and t r a i n i n g courses f o r n a t i o n a l s t a f f .

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1974.

Work done dur ing the year. The WHO sen ior malor io log i s t assigned t o t h e programme

i n June 1968 made a rapid assessment of th- s i t u a t i o n i n Java and Ba l l and found t h a t

the incidence of malaria had increased i n tho a r c a s previously i n the consol idat ion phase. Furthermorc, on account of i n t e r r u p t i o n of systematic f i e l d a c t i v i t i e s during

the previous few years , the epidemiological s i t u a t i o n had d e t e r i o r a t e d and no s t r i c t

i d e n t i t y of a r e a s i n tht. consol idat ion and a t t a c k phascs was possible.

I n January-February 1969, a n independent assessment of the malar ia s i t u a t i o n was made by a WHO team ( s e e a l s o SEARO 0123). Meanwhile, a t a conference of p rov inc ia l

c h i e f s of h e a l t h Services and p rov inc ia l d i r e c t o r s of the Malaria Eradicat ion Programme,

held i n September, a p o l i c y of i n t e g r a t i n g the programme with the general h e a l t h

se rv ices was adopted. In accordallcc wi th t h i s scheme, the programme a t various l e v e l s w i l l become a p a r t of the commuhicabla-disease con t ro l set-up. The c h i e f s of p rov inc ia l and regency h c a l t h se rv ices will be i n charge of admin i s t ra t ion , whereas

the c e n t r a l a u t h o r i t i e s w i l l be responsible f o r o v e r a l l guidance, supervis ion and

eva lua t ion , a s we l l a s f o r the procurement of supp l ies and equipment. During the Year,

t h i s po l i cy of i n t e g r a t i o n was under implementation and was repor ted a s being near ly

completed i n Centra l Java and Bal i by March 1969. The malar ia e rad ica t ion p rogram2

was incorporated i n t o the hca l th s e c t o r of Indonesia ' s B i r s t Five-Year Development

Plan (REPELITA) . As a r e s u l t of the i n t e g r a t i o n of the malar ia programme wi th the general h e a l t h

s o r v i c e s , the prospects of u t i l i z i n g p rov inc ia l and l o c a l funds f o r malaria e rad ica t ion a c t i v i t i e s became br igh tc r .

A conference of p rov inc ia l h e a l t h c h i e f s of the ou te r i s l a n d s , held i n January 1969, devoted two days t o a d i scuss ion -f malaria problems i n t h e 19 provinces t h a t

comprise these i s l ands .

Case-detection was c a r r i e d out on a l imi ted s c a l e , and a v a i l a b l e data f o r July-December 1968 ind ica ted 7 D?2posit ives out of 1 4 1 8 495 blood smears.

Indonesia 0036

U N D P ~ T A ) UNICEF

Paed ia t r i c and Obste t r ic Education and ~ e r v i c e s *

(Oct. 1956 - Dec. 195'7; May 1967 - June 1969; - )

A i m of the p r o j e c t . To expand and impreve p a e d i a t r i c and o b s t e t r i c se rv ices and tho

teaching of medical and nurse s tuden t s i n maternal and c h i l d h e a l t h i n a nunber of

medical schools.

- -~ - - --

*Previous t i t l e : ~ a e d i a t r l c Training and Services

SEA/RCZZ/Z Page 169

Assistance provided by WHO d u r i n ~ the year. ( a ) A paed ia t r i c ian and a p a e d i a t r i c nurse; ( b ) suppl ies , equipment and a t r anspor t v e h i c l e .

Probable durat ion of a ss i s t ance . Unt i l the end of 1973.

Wo* done dur ing the year. The p r o j e c t made steaiiy progress . Closer co l l abora t ion was e f f e c t e d among re levant p r e - c l i n i c a l and c l i n i c a l departments. I n t e r - d i s c i p l i n a r y seminars and case demonstrati0r.s were arranged or. a r egu la r bas i s . The WIfO professor

in P a e d i a t r l c s concentrated on s t rengthening the teaching of s o c i a l p a e d i a t r i c s and

the organizat ion of urban and r u r a l f i e l d t r a i n i n g a reas . Some delay was encountered i n the redevelopncnt of the r u r a l t r a i n i n g centre a t Badjongloa, on account of shortage of s t a f f and equipment. The WHO professor l e f t i n June 1969 a t the conclusion of h i s a s s i g m e n t .

In preparat ion f o r the expansion of the p m j e c t to o t h e r medical schools i n the country and with a view t o bmadening the ob jec t ives t o include a l s o t h e teaching of

o b s t e t r i c s , two consul tants - one i n p a e d i a t r i c s and one i n c b s t e t r i c s - were assigned

to make a s tudy of the teaching of these d i s c i p l i n e s i n medical schools throughout Indonesia. The consul tants a l s o a s s i s t e d i n the conduct of a WHO-sponsored Conference on Paed ia t r i c and O b s t e t r i c Education, held i n Djakarta fmm 24 t o 26 March ( f o r

p a r t i c u l a r s see mdonesia 0062). The WHO nurse l e f t i n October 1968.

Indonesia 0041

UNDP(TA)

A l m of the Droject. To upgrade and expand t r a i n i n g programmes f o r nurses and midwives.

Assistance Pmvided by WHO durinK the year. ( a ) A nurse educator; ( b ) supp l ies and equipment and a t r anspor t veh ic le .

Work done. WHO a s s i s t a n c e t o t h i s p r o j e c t began i n October 1957, with the a r r i v a l of a WHO nurse adviser . The i n i t i a l ob jec t ives were t o advise and a s s i s t

i n the s t rengthening, expansion and co-ordination of programmes f o r the t r a i n i n g of a l l

ca tegor ies of nurs ing and nurse/mldwifery personnel; the development of nurs ing organizat ion, adminis t ra t ion and l e g i s l a t i o n , and the development of nurs ing se rv ices wi thin the n a t i o n a l h e a l t h programme.

By 1965, the main a c t i v i t i e s of the p r o j e c t could be focussed d i r e c t l y on the f i r s t of t h e above ob jec t ives ; a s s i s t ance i n a c h i e v i n g t h e o t h e r two was no longer requested. m e p r o j e c t was considered a s completed i n November 1968, when the l a s t

of the WHO nurses was withdrawn. I n a l l , a t o t a l of four nurses have p a r t i c i p a t e d i n the prpgramme, pmvid ing 112 exper t man-months of service . In add i t ion , under the p ro jec t . WHO provided f i v e f f l lowsh ips - th ree f o r twelve months each and two f o r

18 months each - a t r anspor t vehicle and o t h e r supp l ies and equipment.

*Since 1 January 1969 the a c t i v i t i e s of t h i s p r o j e c t a r e being continued under Indonesia 0074.

SEA/RCZZ/Z Page 170

It i s d i f f i c u l t t o a s s e s s the impact of the p r o j e c t a s , i n k d o n e s i a , a unifnrm system of n u r s i n ~ personnel has not yet been developed; and the o v e r a l l con t ro l and management of the nurs ing componcnt of h e a l t h se rv ices a r c a l s o divided among s e v e r a l medical u n i t s a t both the n a t i o n a l and p rov inc ia l l eve l s . E a r l i e r attempts t o establish a nurs ing d iv i s ion within thc Ministry of Health were successful i n so f a r a s t h i s u n i t was created and a chief nurse appointed. However, the func t ions a l l o c a t e d t o the Division have no t allowed i t so f a r t o develop major p o l i c i e s o r p a t t e r n s f o r the management o r con t ro l of nurs ing se rv ices and nurs ing education. I n t e r e s t i n t h e need f o r sound nurs ing legislation was s t imulatcd; the passage of in ter im measures o r the rev i s ion of e x i s t i n g laws w i l l no doubt be considered i n due course.

In the f i e l d of nurs ing education, the p r o j e c t was morc successful . Improvements were made i n the c u r r i c u l a f o r t r a i n i n g nurses and midwives. Post-basic and bas ic degree programmes f o r nurses were s t a r t e d i n Bandung and Djakarta, l a y i n g the foundation f o r l eadersh ip in severa l f i e l d s of nursing.

I n t e r e s t and understanding r e l a t i n g t o the need f o r s tandardiz ing types and l e v c l s of nurs ing personnel and f o r TrQviding required minimum c u r r i c u l a f o r a l l l e v e l s of woMere withln a well-defined nurs ing personnel system were developed. A s a r e s u l t , s t eps were taken to c lose some marginal t r a i n i n g programmes and to e f f e c t a reduction

i n the numbers of ca tegor ies .

A WHO nurso helped with shor t courses f o r nurses and midwives, and made f i e l d v i s i t s t o t r a i n i n g cen t res i n many p a r t s of t h e country. UNICEF provided a s s i s t a n c e i n the form of teaching and ward equipment t o schools which were ab le t o meet the es tab l i shed c r i t c r i a .

Indonesia 0050 R UNICEF

Tuberculosis Control ( J U ~ Y 1961 - )

A i m of thc p ro jec t . To i n t e g r a t e d i r e c t BCD vaccinat ion i n t o the widespread network of maternal and c h i l d h e a l t h c l i n i c s and regency p o l y c l i n i c s ; t o t r a i n s t a f f i n techniques of d i r e c t BCa vaccinat ion, and t o sxpand and i n t c g r a t e tubercu los i s case- f ind ing by microscopic sputum examination and ambulatory treatment of cases.

Assistance Provided by WHO dur ing t h e year. A six-month fe l lowship f o r s tud ies i n Denmark and Japan.

Probable dura t ion of a ss i s t ance . Unt i l the end of 1972.

Indonesia 0060 R

UNICEF

Laboratory Services

(June 1967; - June - Aue. 1968; - )

A i m of the Pro,lect. To s t rengthen h e a l t h l abora to ry se rv ices .

Probable dura t ion of a ss i s t ance . Until thc end of 1774.

Work don& d u r i n ~ the year. P o l l o i i i n ~ on t ,?i recommendations made by the iiHO

consul tant who r~s:!sted the p r o j e c t fmm Juni? t o August 1960, a f ivc-year p lan o f

ac t ion was d r a m up i n consu l t a t ion with the Govarnment. Negot ia t ions wcre a l s o under wriy with UIJICEF f o r t h e provis ion of tquipment and supp l i c s f o r the r e h a b i l i - t a t i o n of t e n p r o v i n c i a l and 30 f l c l d l a b o r r t o r i i s dur ing 1969-70.

Traininn i n San i t a ry EnPzneering (Seb. - March 196e; Sept. 1968; May 1969; - )

A i m of the p r o j e c t . Ta a s s l s t in education, t r a i r l ing and resea rch i n environmental s a n i t a t i o n and i n r e sea rch on the publ ic h e a l t h a spec t s of housing.

Assistance Provided bv WHO dur inn the year. Three twelve-month fe l lowsh ips f o r s tudy in the United S t a t e s of America.

Probable eu ra t ion of a s s i s t ance . m t i i 1974.

Work donc durinR the year, The ass imment of twci consu l t an t s t o the I n s t i t u t e of Technology. Bandung, was under conr ldc r s t ion .

Indonesia 0062 R

Medical Education [May 1964 - )

A i m of the n r o j e c t . rn a s s i s t s e l e c t e d departments of va r ious f a c u l t i e s of medicine.

Assistance provided by WHD d u r i n ~ the year. ( a ) Two p ro fessors - onc of pharmacolog:. and one of h i s to logy and embryology - and two consu l t an t s - one i n p a e d i a t r i c s and

one i n o b s t e t r i c s - a s s i s t a n c e from the Regional Adviser i n Maternal and Child Health and a secre tary-s tenographer from the Regional Of f i ce ; ( b ) two fe l lowships - one f o r

twelve months and one f o r s i x months - f a r study i n Singapore, an eichteen-month fellowship f o r study i n the Netherlands and 3 th l r tc in-month f ~ l l o w s h i p f c r s t u d i e s i n the United Xingdcm, India and Burma; ( c ) supp l i e s and equipment; ( d ) c a s t of 22

p a r t i c i p a n t s i n t h e c n n f ~ r e n c e on p a e d i a t r i c educat icn ( s e e below).

Probable dura t ion of a s s i s t ance . u n t i l t he end of 1974.

Work done dur ing the year. The WHO p ro fessor of pharmacology continued h i s a c t i v i t i ~ s a t thc F a c u l t i e s of Medicinu i n both Jogjakar ta and Scmarang. The s t a f f t r a i n i n g a c t i v i t i e s were continued within the Dcpartmcnt and a s an in tcr-depar tmental exercise . The WHO p ro feszor a l s o v i s i t c d the Departncnt of Phnmaeolo!g of the Univers i ty of Indonesia i n Djakar ta , t h e S t a t e Institute of Drug :ontrol and the Medical Research I n s t i t u t e of the Indonesia? Navy. He discussed resea rch and o thor a c t i v i t i e s with the n a t i o n a l s t a f f and conduotcd a seminar un non-specif ic r e s i s t a n c e induced by drugs.

The W H O p m f e s s o r of histology and e m S r y o l 0 ~ continued h i s a c t i v i t i e s a t Gadjah Kada Univers i ty , Jogjahnrta. In add i t ion t o h i s r o u t i n e a c t i v i t i e s i n the Department, he advised t h e cu r r i cu lun committee of t h e Medical Facul ty on p lans t~ introduce a course i n ~ e n e t i c s i n the undergraduate curriculum, and was a l s o assoc ia ted with a s tudy of the r e s u l t s of the scmoster examinations he ld s ince 1963, which was being c a r r i e d o u t with a view t o ma kin^ recommendations on the examination system t o the curriculum comnittcc.

S E A / R C ~ ~ / ~ Page 172

In January, two consul tants ( i n p a e d i a t r i c s and o b s t e t r i c s r e s p e c t i v e l y ) were ass ig led f o r 3 pcriod o f th ree months earh t o review the t r a i n i n g pmgrarmes i n o b s t e t r i c s and Bynaecology and p a e d i a t r i c s a t the major medical f a c u l t i e s and t o advise on the improvement of the p n e d i a t r i c and o b s t e t r i c courses e s p e c i a l l y with regard t o the s o c i a l aspects . Towards the end of t h e i r assignments, a three-day U ~ o n f e r e n c e on Paed ia t r i c and Obs te t r i c ducati ion" was organized i n Djakarta. The 22 p a r t i c i p a n t s , who were i n v i t e d a s temporary adv i se r s to the Regional Director , included ned ica l educators i n the f i e l d of o b s t e t r i c s and p a e d i a t r i c s and s e n i o r h e a l t h admin i s t ra to r s an8 represen ta t ives of the Education and Health Min i s t r i e s . They examined p r e c t i c a b l e measures f o r improving the teaching r f o b s t e t r i c s and p a e d i a t r i c s i n the medical curriculum i n Indonesia, and how departments of o b s t e t r i c s and p a e d i a t r i c s bo adapted t o undertake e f f e c t i v e se rv ice , teaching and research a c t i v i t i e s i n t h i s f i e l d . Based on the recommendations of the conference, considerat ion was given to f u r t h e r a s s i s t a n c e i n o phased development programme f o r t h e s t rengthening of p a e d i a t r i c and o b s t e t r i c education throughout Indonesia. The assignment r e p o r t s Of both the consu l t an t s were under study.

mdoncsin 0069 R

Strengtheninn of t h e Training of Rad iogra~hers* (March 1966 - )

A i m of the p ro jec t . To e s t a b l i s h a school f o r the t r a i n i n g of t echn ic ians in the maintenance and r e p a i r of X-ray and o t h e r e lec tm-medica l equipment.

Assistance Provided by WXO dur ing the year. ( a ) A s p e c i a l i s t i n e lectm-medical techniques/a radiographer t u t o r ; (b ) a ten-and-a-half-month fe l lowship f o r s tudy i n the United S t a t e s of America, the Netherlands and Genany and a twelve-month fc l lowshlp f o r s tudy i n India ; ( c ) s u p p l l ~ ' ~ and equipment and a t r a n s p o r t vehicle .

Probable durat ion of a ss i s t ance . Unt i l the end of 1974.

Work done dur ing the year. I n t h i s school, which was e s t a b l i s h e d i n t h e General Hospital i n Djakarta i n March 1966, t h e o r e t i c a l and p r a c t i c a l t r a i n i n g of nine f i r s t - year, twelve second-year and s l x th i rd -year s tuden t s i n e lectm-medical techniques continued.

The WHO s t a f f member (X-ray engineer) whb had been working with t h i s p r o j e c t s ince the b e g M n g , c o m p l e t e d h i s assierment and l e f t a t the end of Pebruary 1969.

As ass i s t ance i n the t r a i n i n g of X-ray r e p a i r t echn ic ians has now been given f o r three years and i n view of n a t i o n a l competence to continue such t r a i n i n g , the emphasis wi l1 ,a t theGovernmentls request , now be on the t r a i n i n g of radiographers and e l e c t r o n i c technicians. Thus t h e WHO X-ray engineer was succeeded by an X-ray t e c h n o l o ~ i s t ( r a d i o g r a p h e r t u t o r ) , who a r r i v e d i n Elarch, and a WHO e l e c t r o n i c engineer was under recruitment t o a s s i s t with the t r a i n i n g of e l e c t r o n i c technicians who, a f t e r t r a i n i n g , w i l l be assigned to h o s p i t a l s to undertake the maintenance and r e p a i r of o lectm-medical equipment.

*Previous t i t l e : School f o r the Training of Technicians i n Electro-medical Techniques.

National C0rnm.mit.Y Water Supply and -- T a i l t ~ t z (March 1969; Junc - J u l y 1969; -

~ ~ ~ t . ~ i - . ~ _ ~ _ o . ~ & ~ ~ , TO plan a cov:nunity m t e r supaly, sewerage and storm-water drainage sys ten, l inter po l lu t io r . con t ro l and general s a n i t s t i o n a c t i v l t l e s .

Assls thnse provide-d-b'l~~~7nc: the xE=r. ( a ) A s a n i t a r y engineer ; (b) two one-month ---- f e l l o ~ ~ s h l p s f o r stu?l.es i r i I n j l 2 azci 5:'3allnnd.

Prohxble dur?.l;lo? of ~ ~ s s l r t a n c e . . m t i l the end of 1974.

Wori: done dur lnx t _ h e y @ ~ . A GMO consul tant i n s a n i t a r y engineer ing was assigned t o the p r o j s c t f o r -ne nanti. I n Jlc~c-;uly t o a s s e s s the s i t u a t i o n with regard t o environmental h e a l t h i n the c o m t r j r and t o c o l l e c t necessary da ta f o r the p repara t ion of a p lan of operat ion f o r the p r o j e c t .

I n d o ' 1 e s i a - 0 ~ c E:ursinp: E d u v t i o n and Services* R (June 1967; Aug, 1967; Jan. 1969 - )

A i m of the uro , fcct . Ta s t rengthen nurs ing admin i s t r a t ion a t n a t i o n a l and l o c a l l e v e l s -- and t o advise and a s s i s t in the development of nurs ing and midwifery s e r v i c e s and education.

Assistnnce provided by W E d u r i n ~ t h e year. Two nurse consu l t an t s .

Probable durat ion of a s s i s t a n c e . ~ n t i l the end of 1976.

Work done durin;? the year . Two consu l t an t s i n nurs ing education were provided i n 1969. ---- One of them a s s i s t e d with the development of p lans , r e fe rence m a t e r i a l s , t each ing mate r i a l s , e t c . f o r the conduct 4 a wide range of s h o r t courses f o r a l l l e v e l s and types of nurs ing personnel. The second worked with n a t i o n a l s t a f f i n drawing up p lans f o r a s tudy of nurs ing education which, i t i s hoped, w i l l r e s u l t i n the p repara t ion of a bas ic m i n i m c ~ r r r i c u l m f o r t h e education of t h e nurse/fnidwife and w i l l f u r t h e r c l a r i f y t h e n?ir;ing personnel system t o be followed i n Indonesia. .

Indonesia C O ~ ----- R

I:osoital S t a t i s t i c 2 ---- ----- ( ~ o v . 1 9 6 8 ; May 1969; - 1

A i m of the DmJect . T organize an e f f i c i e n t system f o r t h e maintenance and f l o w

of records i n se lec ted h o s p i t a l s ; to c o l l e c t , process and p r e s e n t h o s p i t a l s t a t i s t i c s , anrl t o t r a i n medical rc.cord and h o s p i t a l s t a t i s t i c s personnel.

Assistance provided by WHO dur ing the yea r . ( a ) Three three-week fe l lowships f o r s tud ies -- i n Burma, Thailand and Malaysia; ( b ) supp l i e s and equipment.

Probable dura t ioe of a s s i s t ance . U h t l l the end of 1972.

- 'Fsom January 1969, the a c t i v i t i e s of t h e p r o j e c t Indonesia 0041 a r e being continued under t h i s pr : : jec t .

SEA/Rc22/2

Page 174

Work done dur inz the year. The WHO s t a t i s t i c i a n a t tached t o t h e in te r -coun t ry p r o j e c t , SEARO 0072, v i s r t e d Indonesia f o r one month i n July/August 1968 t o exambe i n s r e a t e r d e t a i l the prospects f l r the immediate deve1,opment of medical record. se rv ices wL$h a v l r w Lr, t h e i r r v ~ n t w l c o - c r d i n a t i ~ n witr. a nailan-wide hospital. s t a t i s t i c s system; a ri?port on h i s v i s i t was sent t c the Government.

Equipment f o r use i n the medical record u n i t of t h e Central Hospi ta l , Djakarta, was provided by WHO. .

A medical record o f f i c e r u a s under recruitment.

Health Education (Aug. - Sept. 1968; - )

A l m of the Pro jec t . To s t rengthen the teaching of h e a l t h education i n the School of Public Health (Djakarta Medical Facu l ty ) , t o b u i l d up the h e a l t h education se rv ices and to a s s i s t n a t i o n a l workshops i n t h e follow-up of the in te r -coun t ry p r o j e c t SEAR3 0130 (Develapmcnt of Health Education).

Assistance provided by WHO dur ing the year. ( a ) A consul tant ; a sec re ta ry - stenographer from the Regional Off ice; ( b ) supp l ies and equipment; ( c ) cos t of attendance of p a r t i c i p a n t s .

Probable durat ion of a ss i s t ance . Unt i l 1972.

Work done dur ing the year. A "Workshop on the Educational Approach in the planning and Implementation of public Health ~rogrammes" was conducted a t Tjimatjan from 19 t o 31 August 1968. The 27 p a r t i c i p a n t s were l eaders i n h e a l t h education and h e a l t h programmes a t both the n a t i o n a l and p rov inc ia l l eve l s . In add i t ion , the re were s e v e r a l observers. The workshop was a s s i s t e d by a WHO consul tant . The p a r t i c i p a n t s made many suggestions f o r improving h e a l t h education i n t h e i r country and planned ways of implementing the suggestions.

lhe repor t of the workshop ( i n both Engl ish and Indonesian) was widely d i s t r i b u t e d .

Indonesia 0081 S m a l l ~ o x Eradicat ion R (Dec.1967 - )

A i m of the p r o j e c t . lb develop 3 n a t i o n a l smallpox e r a d i c a t i a n programme and t o s t rengthen basic h e a l t h s e r v i c e s by t r a i n i n g appropr ia te cadres of vaccinators and o t h e r hea l th workers necessary f o r a success fu l programme.

Assistance provided by WHO dur ing the year. (a ] A medical o f f i c e r and a consul tant i n jet-gun vaccinat ion technique; ( b ) two six-week fe l lowships f o r s t u d i e s i n India and Thailand; ( c ) suppl ies and equipment, f reeze-dr ied smallpox vaccine, motorcycles and b icyc les and four t r a n s p o r t veh ic les ; ( d ) payment of subsidy t o meet cos t of attendance of na t iona l s t a f f a t meetings, seminars, e t c .

Probable dura t ion of a s s i s t a n c e . I n d e f i n i t e .

Work done d u r i n g t h e y e a r . A f t e r c o m p l e t i n ~ the p r e p a r a t o r y phase , t h e Government embarked upon a smallpox e r a d i c a t i o n programme f o r ' J a v a and B a l l on 1 J u l y 1968.

Improvements were registered i n t h e p roduc t ion of f r e e z e - d r i e d smallpox vacc ine a s

w e l l as i n t h e s t o r a g e and d i s t r i b u t i o n of vacc ine . S u i t a b l e o r e a n i z a t i o n f o r a r o u t i n e v a c c i n a t i o n programme i s being b u i l t up. S p e c i a l a t t e n t i o n was pa id t o r e p o r t i n g and n o t i i i c a t i o n of smallpox c a s e s and t o adequate containment measures.

I n January 1969, a seminar was conducted f o r t h e d i r e c t o r s of p r o v i n c i a l h e a l t h s e r v i c e s and the medical o f f i c e r s i n charge o f ccmmunicable-disease c o n t r o l from t h e

provinces o u t s i d e Java and B a l l , i n o r d e r t o d l s c u s s t h e p l a n of a c t i o n f c r t h e

ex t ens ion of t he programme t o t he whole of Indones ia . A t r a i n i n g cou r se a l s o was conducted f a r s u p e r v i s o r s of t h e smallpox progranne i n Java and B a l l , w i th p a r t i c u l a r

emphasis on assessment t echn iques and su rve i l l an?s /ou tb reak containment.

I n 1968, smallpox was r e p o r t e d on ly frmm Java and Sumatra, w i th smal l f o c i i n ff i l imantan and Sulawesi . I n June 1969, a j o i n t Gcvernment/WHO assessment was c a r r i e d o u t i n o r d e r t o a s s e s s t he p rog res s made and t o t 'ormulate recommendations f o r t h e

f u t u r e . One of t he memb~rs of t he team a l s o reviewed the t e s t i n g procedures of smallpox

vacc ine a t Bio Farma I n s t i t u t e , Bandung, and r e p o r t e d t h a t t hey were s a t i s f a c t o r y .

Indones ia 0083

UNDP( TA Vaccine and Sera Product ion (Dec. 1968: Jan. 1969; - )

A i m of t h e p r c j e c t . To improve methods of p roduc t ion of vacc ines , a n t i t o x i n and

toxo ids . Ass i s t ance provided by WHO du r ing the yea r . A four-month f e l l o w s h i p f o r s tudy i n t he

United Kingdom and a six-month f e l l owsh ip f o r s t u d i e s i n I n d i a and t h e Nether lands .

( A four-month f e l l o w s h i p f o r s t u d i e s i n Hungary and the Nether lands was awarded under p r o J e c t Indones ia 0040.)

Indones ia 0086

R

UNICEF

S t r eng then ing of Na t iona l Hea l th S e r v i c e s (Feb. - March 1969: May 1969: - )

A i m of t h e p r o j e c t . To s t r e n g t h e n i n t e g r a t e d h e a l t h s e r v i c e s a t a l l l e v e l s , i n a phased manner, as p a r t of t h e socio-economic p l a n of t h e count ry : t o s t a n d a r d i z e and i n t e n s i f y t he t r a i n i n g progralrmes f o r a l l h e a l t h s t a f f : t o s tudy the p r e s e n t

components and f u n c t i o n s of t he h e a l t h s e r v i c e s a t a l l a d m l n i s t r a t i v e l e v e l s .

Ass i s t ance provided by WHO d u r i n g the y e a r . Two c o n s u l t a n t s

Probable d u r a t i o n of ' a s s i s t a n c e . u n t i l t h e end of 1974.

Work done du r ing t h e y e a r . The master p l a n of ode ra t ions f o r s t r eng then ing the h e a l t h

s e r v i c e s was s igned by t h e Government, UNICEF and WHO i n January 1969.

With t he a s s i s t a n c e of tho c o n s u l t a n t s ( a p u b l i c h e a l t h a d m i n i s t r a t o r e x p e r i m c e d i n n a t i o n a l h e a l t h p l ann ing and a WHO s t a t i s t i c i a n ) , a desi&n f o r t h e s tudy of the p r e s e n t components of t h e h ,?a l th s e r v i c e s a t Kabupaten ( p r o v i n c i a l ) and Ketajmatan

SEA/RCZ2/2 Page 176

(regency) l e v e l s was prepared. This desipp was adopted and s t e p s were taken to r e c r u i t a shor t term consul tant experienced In the adminis t ra t ion of h e a l t h se rv ices to analyse t h e f ind lngs of t h e s tudy and to help t o improve thc adminis t ra t ive and managerial a spec t s , including job desc r ip t ions of h e a l t h s t a f f . Or ien ta t ion courses f o r medical o f f i c e r s a s well a s h e a l t h s t a f f of bas ic h e a l t h se rv ices ware conducted, with UNICEF and WHO ass i s t ance . The t r a i n i n g of t u t o r s working i n t r a i n i n g cen t res f a r h e a l t h personnel and in the a t t ached f i e l d p r a c t i c e a reas was s t a r t e d .

Towards the end of July, a WHO consul tant took up a two-month n s s i m e n t to n s s i s t the (Mvernmcnt i n prepar ing a progranmc f o r t h e t r a i n i n g of t r a i n e r s ( t u t o r s ) involved i n the t r a i n i n g of h e a l t h personnel.

Indonesia 0090 Hazards t o Man from Pes t i c ides R (Feb. - March 1969)

A i m of the Pro jec t . To review the hazards t o man from p e s t i c i d e s in use i n agr icu l tu re .

Assistance ~ r o v i d e d by WHO dur inu the Year. A consul tant .

Workdone, The consul tant Feviewed t h e use of p e s t b i d e s . It appeared tha t there were regu la r i n c i d e n t s of i n t o x i c a t i o n through contamination of food with p e s t i c i d e s , and t h a t many of them were causcd by inadequate a r r a n p m e n t s f o r the t ranspor t and handl ing of p e s t i c i d e s , of which l a r g e q u a n t i t i e s a re needed f o r a g r i c u l t u r a l purposes.

The repor t of the consul tant was sen t t o the Giovemment, and h i s recommendations a re under review. The consul tant a l so formurlated proposals f o r a long-term study of t h e e f f e c t of DDT on malaria.

It has recognized t h a t the re was an urgent need f o r h e a l t h l e g i s l a t i o n in

r e l a t i o n t o the handl ing of pes t i c ides .

mdonesia 0091 Strengtheninn nf E p i d c m i o l o ~ i c a l Services R (June 1969 - )

A i m of the p ro jec t . To a s s i s t the Oovernment wi th the development of an epidemiological u n i t a t the c e n t r a l a s well a s in termediate l e v e l and t o t r a i n n a t i o n a l s t a f f in the epidemiologicnl approach towards a n a l y s i s of pub l ic h e a l t h problems.

Assistance provided by m durina the year. A s t a t i s t l c i a n .

rrobable durat ion of a ss i s t ance . m t i l 197Q.

Work done during the year. The f i r s t few months of t h e assippment of the s t a t i s t i c l a n were devoted mainly t o o r i e n t a t i o n and development of s t a t i s t i c a l f a c i l i t i e s , including supp l ies and equipment. She has helped with the preparat ions f o r a n a t i o n a l seminar on epidemiological su rve i l l ance , t o be held i n OctoberjNovember 1969, which w i l l a l s o be a s s i s t e d by a WHO consul tant epidemiologist .

Indones i a 0200

H

Fe l l owsh ips

~ u b l i c Hcal th Adminis t ra t ion . A twclve-month fellowship f o r s t u d y i n Belgium.

S o c i a l P a e d i a t r i c s . A three-month f e l l o w s h i p f a r s t u d i e s in t h e Uhited Kingdom, t h e Netherlands, Yu.goslavia and Singapore .

I ndones i a 0201

UNDP(TA) Fe l l owsh ips

Epidemioloily. A nine-month f e l l o w s h i p f o r s t u d i e s i n Czechoslovakia and I n d i a .

Epidemiology and S t a t i s t i c s . A nlne-month f e l l c w s h i p f o r s t u d y i n t h e Uhited Kingdom.

The harbour of Male

.;a

SEA/RC22/2 Page 179

The Maldive Islands became the "Republic of Maldives" on 11 November 1968. The 1968 estimated population is about 105000, spread over 20 atolls (group of islands). It may be expected to increase a t the rate of 2.2 per cent per year.

As yet, it has not been possible to establish a health directorate as such in the Republic. However, medical officers are being trained with this end in view. In the interim period, WHO staff, reinforced by WHO short-term consultants in specific fields a s and when required, a r e filling this gap.

The hospital in Male, with about 45 beds, is being reorganized, WHO having assisted with the nursing aspects and in the establishment of the X-ray department.

Expansion of health services to the other islands is taking place in a phased manner, and'seven health centres have been established, with health aseistants in charge. Increased attention is also being given to the training of health assistants in adequate numbers to man the expanded health services.

In the field of communicable diseases, periodic outbreaks of acute gastro-enteritis have occurred; in 1968 there was an epidemic, which was subsequently brought under control. Anti-malaria activities, which had been confined to Male Atoll, made good progress and were extended to two further atolls. The BCG immunization campaign, which had also been restricted to Male, was integrated with the anti-malaria programme and extended to two more atolls. As in the past, regular blood-filming for microfilaria has been carried out but in a more systematic manner, the positive cases being given adequate treatment.

Health education activities have received greater attention,and weekly radio p r o p m m e s on health education were a regular feature.

The possibility of UNICEF assistance to Maldives was being explored.

Towards the end of the period under review, WHO began a special study of the health services provided in Maldives to assess the anti-malaria activities so far carried out,with a view to recommending measures for the future expansion of the health programmes.

SEA/RC22/2 Page 180 ..

PROZ3CT LIST

Project No. .,

Source of Funds Co-o~era t ing

Amncies T i t l e - Maldives 0002 Public Heal th Administration

R (act. 1959 - ) '

A i m of the p ro jec t . m develop comprehensive bas ic h e a l t h s e r v i c e s and to t r a i n personnel, including h e a l t h a u x i l i a r i e s ; to c a r r y out, an t i -mala r ia work on the i s l a n d of Male; t o s t rengthen t h e se rv ices provided by the h o s p i t a l at Male.. ,,: , .:

Assistance Provided by WHO dur ing the year. ( a ) A pub l ic h e a l t h o f f i c e r , a s a n i t a r i a n , a l abora to ry technicinn and a pub l ic h e a l t h nurse; f o u r consu l t an t s in var ious f i e l d s ;

( b ) suppl ies and equipment, drugs and DDT.

Probable durat ion of a ss i s t ance . u n t i l 1974.

Work done dur ing the year. . Anti-malaria a c t i v i t i e s were extended t o cover two more

a t o l l s , and a new h e a l t h cen t re 'was established.. Systematic n i g h t blood-filming f o r m i c r o r i l a r i a was continued, and p o s i t i v e cases were t r e a t e d by h e a l t h a s s i s t a n t s with the guidance of the WliO medical office;. n ibe rcu los i s c o n t r o l work was strengthened by the establishment nf a laboratory f o r micmscopic examinat+on of sputum. Eighteen t r a i n e e s completed the h e a l t h a s s i s t a n t s ' course. T h e , t r a i n i n g of nurse-aides n s wel l a s of indigenous midwives was continued. A radiography department.;as

organized a t Nale h o s p i t a l with t h e a s s i s t a n c e of WI%), and the s t a f f were t r a ined . Steps were taken to combat an epidemic outbreak of diarrhoea which occurred dur ing the l a t t e r Tar t of 1960, and t h e Regional I n f e c t i c u s Diseases Team v i s i t e d t h e

i s l a n d s t o advise on containment measures.

In June,' a consul tant Ln pub l ic h e a l t h admin i s t ra t ion was a s s i e e d t o review the s i t u a t i o n with regard t o the organigat ion of h e a l t h se rv ices in t h e i s l a n d s and to advise on f u r t h e r WHO ass i s t anoe .

Maldives 0200 P e l l o w s h i ~ s - X

Malaria Eradicat ion. A two-month fe'llowship f o r s tudy in India.

Maldives 0201 UNDP(TA)

B l s i c Nursing. A twelve-month fe l lowship f o r s tudy in India .

Und~rgraduate Medical S tud ies . A seventy-two-month fe l lowship f o r s tudy i n India .

MONGOLI, - p '

Daily life in an aimak

SEA/RC22/2 Page 181

7. MONGOLIA

With the Fourth Plan (1966-1970) now entering its final phase, prelimi- nary preparations are afoot to draw up the outlines for the Fifth Five-Year Plan (1971-1975) for Mongolia.

According to the estimates of the Central Statistical Board, the country had, at the close of 1967, a population of 1.2 million, with birth and death rates of 42 and 9, respectively, per 1 000.

The allocation for health in the budget for 1968 was 176 600 000 tughriks (US $44 150 000); this allocation, as in the past two years, constituted ten per cent of the total budget of the country. The per c a ~ i t a expenditure on health was x&Mained at tughriks 156 (US $39).

The policy of the dovernment is basically oriented to the health needs of the great majority of the population who live in remote areas away from aimak headquarters towns. The following comparisons between 1967 and 1968 give an indication of the progress made by the country in the field of health: Number of doctors per 10 000 population, 15.3 in 1967; 16.5 in 1968. Number of paramedical staff per 10 000 population, 57.3 in 1967; 61.2 in 1968. Number of hospital beds per 10 000 population, 90.1 in 1967; 96.5 in 1968. (The target for 1970 is 98 per 10 000.) Tn 1968, 205 doctors graduated from the Medical Institute and 318 feldshers from the Technicum. At the end of the year, there were more than 3 000 nurses, constituting one sixth of the total medical and health personnel in the country.

The Government has taken steps to reorganize the Medical Institute, to extend the period of study to six years and to work out a new curriculum; WHO assistance has been requested. A new building for the Institute is under construc- tion and is expected to be ready in 1970.

The main emphasis continued to be on education and training, full advantage being taken of VJHO fellowships and the numerous training activities organized within the country.

New fields of WHO assistance, to which the Government is giving increasing attention, are health statistics, cancer, epidemiology and radio- therapy. With regard to nursing, a survey of the existing situation was made, and a four-year course of study for the nursing technicum was prepared.

In the investigations into the epidemiology of prevalent diseases and their control, increasing emphasis is being laid on the strengthening of epidemiological, laboratory and statistical services.

Measures for the protection of the child population against tetanus, diphtheria and pertussis were provided through systematic country-wide immunization.

SEA/RC22/2 Page 182

The mass BCG vaccinatim programme drew to a ssucessfid close at the end of 1968 and covered all eligible age-groups. A maintenance programme for the regular coverage of all newborns, school entrants and school leavcrs was started in 1969. Another important event was the holding of a national conference on plberculo6is in September 1968 to review the progress of tuberculosis control work.

BrucelIa vaccine trials were continued. The Government attaches very high priority to production of the vaccine in the country, in order to control brucellosis both in animals and ammg the human population at the greatest risk. WHO is to assist the Government in prep- a request for UNDP(SF) assistance in the production of thie vaccine.

In the field of maternal and child health, the attendance of expectant mothers and infants at the maternal and child health centres was encouraging. Plane. for the further strengthening of m a t e d and child health services in 1969 were formulated, and implementation is proceeding. Advice was glven to the Gwenunent on the feas2bLUty of a rheumatic fever prevention programme as part of the m a t e d and child health services.

Efforts have continued to explore the poesibilily d mtUng up in aimak tawne a sound water supply system suited to tbe climattm qonditions of the c-.

PROJECT LIST

Project No. Source Of Punds Co-operating

Agencies

Ebngolia 0001 Strengtliening of Health Scrvices (Epidemioloml R (July 1963 - I

Aim of t h e p ro jec t . To undertake epideniological surveys of Prevai l ing communicable d i seases i n order t o plan p r a c t i c a l controlmeasures ; t o advise a l l branches of the medical and hea l th se rv ices on the u s e of opidemiologlcal methods, and to t r a i n personnel.

Assistance provided by WHO dur ing t h e year. ( a ) A team cons i s t ing of an epldemio- l o g i s t , a microbiologis t and a ve te r ina ry publ ic h e a l t h o f f i c e r ; ( b ) two fellowships - one f o r twelve months and one f a r e i g h t months - f o r s t u d i e s i n Czechoslovakia, the USSR and Bulgaria; ( c ) suppl ies , equipment and vaccines.

Probable dura t ion of a ss i s t ance . Unt i l the end of 1972.

Work done dur ing the year . The achievements o f t h e mass campaign f o r t h e Dm i m u n i z a t i o n of ch i ld ren were f u r t h e r consolidated by extending up t o 1 5 years the age l i m i t of the group t o be immunized with DT and following up e a r l i e r d e f a u l t e r s i t ; t h e younger age-group a s wel l a s ch i ld ren who had not completed t h e i r dosage. Following t h e mass campaign t h e implementation of a r e g u l a r immunization programme f o r ch i ld ren was pursued by the general h e a l t h se rv ices .

Serological surveys i n man and c a t t l e continued, with t h e co-operation of the WHO Serum Reference Bank, Prague.

The WHO epidemiological team a s s i s t e d with the study and control of outbreaks of a number of ind iv idua l d i seases , e.g., d iph ther ia , i n f e c t i o u s h e p a t i t i s and influenza. T r a i n i ~ was given t o respons ib le medical and paramedical s t a f f I n t h e a reas of these outbreaks.

The ve te r ina ry publ ic h e a l t h s t a f f a f the p ro jec t conducted a n add i t iona l vaccine t r i a l i n c a t t l e , evaluat ing the two vaccines, Rev.1 and B.19, i n the p ro tec t ive value of i n f e c t i o n of Br. me l i t ens i s i n h e i f e r s . The extreme c l imat ic condi t ions p reva i l ing i n Mongolia a f fec ted tne execution of the t r i a l , which was expected t o be completed by t h e end o f July . The r e s u l t s may thus not be d e f i n i t i v e .

Durine a v i s i t t o the country i n August 1968, t h e Chief of the Veter inary Publ ic Health Unit from WHO Headquarters reviewed t h e p o s s i b i l i t y of i n i t i a t i n g the l o c a l production of Brucel la vaccine on a large-scale . Subscquently, the ve te r ina ry public hea l th o f f i c e r of the p ro jec t held f u r t h e r consul ta t ions abroad on requirements f o r t h i s production. A request f o r poss ible UNDP (Specia l Fund) ass i s t ance i s being considered and WHO consul tants w i l l be provided t o h e l p i n preparing such a request .

s E A / R C 2 2 / 2 Page 184

Considcrable emphasis was placed o n g i v i n t t r a i n i n g i n epidemiology t o medical s t a f f a t var ious l e v e l s o f the h e a l t h se rv ices , and p a r t i c u l a r l y on toaching thcm t o apply epidemiolopical mcthods i n assessLng the country's d l sease problems. I n t h i s conncction, t h c WHO team a s s i s t e d with a t r a i n i n g course f o r aimak h e a l t h o f f i c e r s i n December and, i n c lose co-operation w i t l ~ the S t a t e Medical I n s t i t u t e and through t h e I n s t i t u t e of Hygiene, Epidemiology and >Ucrobiology, conducted a course on epidemiological methods f o r medical o f f i c e r s of Ulan Bator and i t s surrounding areas .

The WWO microbiolof i is t completed h i s assienment i n August 1968 and a laboratory s c i e n t i s t was being r e c r u i t e d ; the microbiologis t ' s func t ions a re planned t o be covered by t h c microbiologis t to be assigned to Mangolia 0002.

b n g o l i a 0002 Public Health Laboratory Services UNDP(T.4) (Way - Aug. 1964; net. 1964; Aug. 1965; Oct. 1966 . UNICEF Sept. 1968; Jan. 1969; May 1969; - )

Aim of t h e p ro jec t . To s t reng then h e a l t h laboratory se rv ices and t o tr 'ain personnel i n medical l abora to ry technolo6y.

Assistance provided by WHO d u r i w t h e year. ( a ) A microbiologis t ; ( b ) two six-month fe l lowships - onc f o r study i n Poland arid one f o r s t u d i e s i n Yugoslavia and the USSR; ( c ) supp l ies and equipment.

Probable dura t ion of a ss i s t ance . Unt i l the end of 1974.

Work done during the year. The microbiologis t completed a two-year a s s l g m e n t i n September. H i s r e p o r t was being processed f o r submission t o t h e Government.

A s recommended, t h e l abora to ry se rv ices i n Ulan Bator have been reorganized; four departments have been es tab l i shed within t h e Centra l Bac te r io log ica l Laboratory; b a c t e r i o l o g i c a l se rv ices to h o s p i t a l s and c l i n i c s i n Ulan Bator have been pooled, and an advisory councl l f o r t h e l abora to ry s c r v l c e s has been s e t up. WHO fe l lowships were awarded t o medical o f f i c e r s and teclinicians f o r t r a i n i n g i n bas ic l abora to ry procedures.

Mongolia 0002 Tuberculosis Control UM)P(TA) (Dec. 1963 - Jan. 1964; Aug. 1965 - 1

Aim of the projcct . To study the epidemiology of tubercu los i s and t o organize a na t iona l tubercu los i s control programme.

Assistance provided by WHO during the year. ( a ) A medical o f f i c e r and a ~ C ~ / p u b l i c h e a l t h nurse; ( b ) a six-month fe l lowship f o r study i n Czechoslovakia and an e i g h t - month fe l lowship f o r study i n t h e USSR.

Probable dura t ion of a ss i s t ance . Unt i l the end of 1974.

S E A / F ~ C Z ~ / Z Page 185

Work done during the year . With t h e successful completion of t h e mass BCG vaccina- t i o n programme i n t h e country towards t h e end of 1968, a beginning was made t o ca r ry out the main tena~ce programme, through which newborns, school e n t r a n t s and school l eavers w i l l bc refiularly covered by t h e general h e a l t h services .

A na t iona l BCD assessment team reviewed the vaccinat ion of newborns i n a inak materni ty homes and evaluated the s i z e of post-vaccination l e s i o n s (one t o two years a f t e r vacc ina t ion) i n a number of se lec ted somons.

I n f u r t h e r support of the BCG programme, two-week r e f r e s h e r courses were arranged, through which, success ively , groups o f vaccinators from Ulan Bator and

from the a lnaks rcceiverl the necessary re - t ra in ing .

The second tl l iacetazone s ide -e f fec t inves t iga t ion , covering a t o t a l of 140 Pa t i en t s , revealed t o x i c s ide -e f fec t s i n only 23. A preliminary repor t has been prepared.

With the establishment of t h e tuberc le cu l tu re l abora to ry a s an i n t e g r a l pa r t of the Public h e a l t h laboratory, t h e con t ro l programme has been f u r t h e r s t r e n ~ t h e n e d .

I n order to b r ing t h e recording and repor t ing procedure i n t o l i n e with t h e accepted WU0 recommendation, a c e n t r a l tubercu los i s r e g i s t e r has been maintained s ince January 1969.

I n Pb.y 1969 the Minister of Public Health issued a pol icy d i r e c t i v e on tubercu los i s control , through which d i r e c t BCO vaccination, sputum case-f inding among symptomatic p a t i e n t s and ambulatory t reatment a r e now recognized a s t h e key components of a country-wide, in tegra ted tubercu los i s con t ro l programme. This d i r e c t i v e was addressed t o the oh ie f s of a l l aimak h e a l t h se rv ices a s well a s t o army and ra i lway h e a l t h se rv ices , i n order t o ensure uniformity and t o f a c i l i t a t e f u l l i n t e g r a t i o n a t a l l l e v e l s , under t h e t echn ica l d i r e c t i o n and supervis ion of t h e Republ ic ' s Tuberculosis Control Off icer .

A na t iona l conference on tubercu los i s was he ld i n Ulan Bator from 18 t o 24 September 1968, a l s o a t tended by healtr . workers from s e v e r a l o the r countr ies . The WHO medical o f f i c e r took par t i n t h e conference.

The WHO medical o f f i c e r a l s o p a r t i c i p a t e d i n the t r a i n i n g of ep iden io log i s t s from Ulan Bator and t h e aimaks, giving l e c t u r e s on the epidemiology and control of tuberculosis .

Mongolia 0004 Maternal and Child Health Services UNDP(TA) (June - Sept. 1965; Nov. 1966; Ju ly 1967 - ) m1cm

A i m of t h e p ro jcc t . To develop maternal and chi ld h e a l t h se rv ices and t o e s t a b l i s h r e f e r r a l f a c i l i t i e s .

Assistance provided by WHO during t h e year. ( a ) A maternal and chi ld h e a l t h o f f i c e r ; ( b ) a four-month fe l lowship f o r study i n the USSR; ( c ) supp l ies and equipment.

SEA/RCZZ/~ Page 186

Probable dura t ion of a ss i s t ance . U n t i l the end o f 1972.

Work done dur ing tho year . The Maternal and Child Health Department o f t h e Ministry of Public Health was f u r t h e r strengthened by the ~ . s t ab l i shment of an advisory group of consul tants i n . p a e d i a t r i c s and o b s t e t r i c s . Tie i n t e g r a t i o n of t h e d i s t r i c t paed ia t r i c sc rv ices lrlto t h e general h e a l t h s e r v i c e s was effected i n Ulan Bator and i n i t i a t e d i n severa l aimaks. I n s t i t u t i o n a l and ambulatory hea l th sc rv ices f o r mothers and ch i ld ren were markedly improved both i n Ulan Bator and a t aimak headquarters by the in t roduc t ion of more e f f e c t i v e the rapeu t ic procedures. P a r t i c u l a r a t t e n t i o n was glven t o thc organizat ion of rehydrat ion se rv ices f o r ch i ld ren i n Ulan Bator and t o ensuring a regu la r supply of rehydrat ion f l u i d s . The WHO maternal and chi ld h e a l t h o f f i c e r a s s i s t e d i n t h e formulation of r u l e s on t h e content and standards of s p e c i a l i s t t r a i n i n g In o b s t e t r i c s and paed ia t r i c s , which were subsequently adopted and implemented by t h e Univers i ty . A wide rance of t r a i n i n g a c t i v i t i e s was under- taken, including o r i e n t a t i o n and r e f r e s h e r coursos f o r paed ia t r l c ians , o b s t e t r i c i a n s and nurses a t var ious l e v e l s , Headquarters S ta f f v i s i t i n g aimaks took the opportuni ty t o organize group discuss ions , seminars and case demonstrations f o r l o c a l s t a f f on sub jec t s r e l a t e d to maternal and c h i l d h e a l t h organizat ion and services , arid a l s o the involvement of a l l i e d serv:ces, e s p e c i a l l y erkchcs and kindergar tens . Radio and t e l e v i s i o n proyramnes considerably enhanced the value of h e a l t h education a c t i v i t i e s undertaken throu* t h e regu la r services.

Environmental Health (Community Water Supply)

(June 1966 - ~ a y 1968; Sept. 1968; - ]

A i m of the project . To develop water supp l ics and excre ta d i sposa l systems i n provincia l towns and r u r a l areas .

Assistance provided by WHO dur ing the year. A s p e c i a l i s t i n water supply systems f o r cold c l imates , and a s s i s t a n c e from a s a n i t a r y engineering consul tant provided under t h e in ter-country p ro jec t SEAR0 0064.

Probable dura t ion of a ss i s t ance . Unt i l the end of' 1972.

Work done during tile year. The consul tant provided i n Ju ly 1968 compluted h i s assignment i n December. An exper t consul tant was engaged t o make a c r i t i c a l review of the project proposals prepared by t h e WHO s a n i t a r y engineer assigned from June 1966 t o May 1968. The r e p o r t of the exper t was under review, and s t e p s were being taken t o r e c r u i t a s u i t a b l e consul tant t o a s s i s t i n the implementation of the project proposals.

Mongolia 000Z Health S t a t i s t i c s R (Aug. - Sept. 1967, Sept. 1968; Jan. 1969 - J

A i m of t h e project . To develop hea l th s t a t i s t i c s se rv ices and t o t r a i n personnel i n hea l th s t a t i s t i c s procedures.

Assistance provided by WHO dur ing t h e year . ( a ) A consu l t an t ; ( b ) a twelve-month Zellowshlp f o r s t u d i e s i n Czechoslovakia and the USSR and a six-month fe l lowship f o r s t u a i c s i n Czcchnslovakia, t h u USSR and Bulgaria: ( c ) supp l ios , equipment and a t r anspor t vehicle .

SEA/RCZZ/~

Page 167

Probable dura t ion of a ss i s t ance . Unt i l 197!t.

Work done d u r i n ~ t h ~ year . The WHO s t a t i s t i c i a n who joined t h e p ro jec t i n January 1969 reviewed the e x i s t i n g h o s p i t a l s t a t i s t i c s system and worked out p r a c t i c a l

procedures f o r t h i processing of h o s p i t a l in -pa t i en t s t a t i s t i c s and f o r the maintenance of 2 system of medical records.

Courses i n hea l th s t a t i s t i c s were givcn t o personnel Of the F i r s t Ci ty Hospi ta l and t o aimak hea l th inspectors .

Mongolia 0008 R

Nursing Services and Education (Dec. 1966; June 1968 - )

Aim of t h e proJect. To develop a bas ic school of nursing; t o s t rengthen e x i s t i n g t r a i n i n g programties f o r nursing personnel, and t o improve nurs ing se rv ices .

Assistance provided by WHO during the year. ( a ) A nurse educator; ( b ) a t h i r t y - s l x - month fe l lowship f o r study i n Poland.

Probable d u r a t i o n of a ss i s t ance . Unt i l the end of 1974.

Work done during the year . The WHO nurse educator who has been w o r k i y with the p ro jec t s ince June 1968 a s s i s t e d i n a survey of 5.1e po l i c ies , pa t t e rns and i n s t i t u t i o n s f o r t h e t r a i n i n g o f nursing personnel. Based on t h e f ind ings of t h i s survey, s t u d i e s zild plans f o r t h e f u r t h e r improvement of h e a l t h se rv ices , proposals were put for!iard f o r t h e co-ordinated development of nursing eduoation. S y l l a b i and c u r r i c u l a were prepared f o r ( a ) f u r t h e r t r a i n i w i n nursing f o r f e ldshers ; ( b ) 3. four- year course f o r t n e t r a i n i n g of nurses i n t h e technicurn, and ( c ) fur t l ler t r a i n i n g f o r nurses workin; i n materni ty h o s p i t a l s .

Plans were prepared f o r the opening of nurse t r a i n i n g schools which w i l l o f f e r the four-year curriculum, a s soon a s t eachers and educat ional f a c i l i t i e s become ava i l ab le .

Mongolia 0010 R

Cardlovasoular Diseases (May - June 1967; Ju ly 1969; - )

A i m of t h e p ro jec t . To study the e p i d c m i o l o ~ of cardiovascular condi t ions and t o advise on f u r t h e r act ion.

Assistance provided by WHO during the year. A slx-month fe l lowship f o r s tud ies i n t h e USSR, Czechoslovakia and Bulgaria.

Probable dura t ion of a ss i s t ance . Unt i l t h e end of 1973.

Mongolia 0011 Cancer - R (Mny 1968; March 1969 -

A i m of t h e project . To study and advise on i h e epidemiology and r a d i o t h e r a p j of cancer.

Assistance provided by WHO during the year. ( a ) A consul tant ; ( b ) a six-month fe l lowship f o r study i n the USSR.

Probable dura t ion of a ss i s t ance . Unt i l the end of 1971.

Work done during t h e year. The repor t of the WHO consul tant who v i s i t e d Mongolia i n May 1958 t o review the epidemiology of t h e p reva i l ing cancers i n the country was submitted t o t h e Governnent.

I n March, a consul tant i n radiotl lerapy was assigned t o the Oncolo~y Centre i n Ulan Bator l o r a period of four t o s i x months t o a s s i s t i n s t rengthening tho radiotherapy Services.

Mongolia 0012 Strengthening of Radiological Services

R (Xov. 1968 - Feb. 1969; - )

Aim of t h e project . To undertake t h e r e p a i r and maintenance of d i f f e r e n t r a d i o l o g i c a l u n i t s i n t h e country, and t o t r a i n p e r s o p e l i n t h i s f i e l d .

Assistance provided by UKO during the year. Two consul tants .

Probable dura t ion of a ss i s t ance . Unt i l the end of 1374.

Work done during t h e year . I n November, two consul tants were assigned t o a s s i s t i n i n s t a l l i n g two X-ray u n i t s supplied by UNICEF t o the Centra l Children's Hospi ta l and the F i r s t Maternity Home i n Ulan Bator. They completed t h e i r work i n February 1969, and t h e i r recommendations were submitted t o t h e Government. The rccommenda- t i o n s included the assignment of a f u r t h e r consul tant t o undertake dosimetr ic surveys i n X-ray departments.

Action was being taken t o provide a WHO t u t o r i n r a d i o l o g i c a l s e r v i c e s t o a s s i s t i n the t r a i n i n g of X-ray r e p a i r technicians .

Mongolia 0200 Fellowships

R

Biological Assay and Production. A threednontn fe l l?wship f o r s t u d i e s i n t h e USSR, Czechoslovakia and Hungary.

Communicable Diseases. A six-month fe l lowship f o r s tud ies in Yugaslavia+ Czechos loWia and the USSR.

Cardiology i n Children. A twelve-month fe l lowship f o r s t u d i e s i n Bulgaria and the USSR.

Community Water Supply and Sani ta t ion. A six-month fe l lowship f o r s t u d i c s in Yugoslavia and Finland.

S E A / R C Z Z ~

Page 149

Dermato1oF;L. '2 six-month fe l lowship f o r s t u d i e s i n the USSR and Poland.

Electrophysiolocj . A ninc-month fellowstlip f o r s t u d i e s i n the USSR, Poland and

Czechoslovakia.

Experimental Surgery. A one-month fe l lowship f o r s tud ies i n Yugoslavia uld Czechoslovakia.

Health Mucat ion. h four-month fe l lowskip t o r study i n t h e USSR.

In fec t ious Hepa t i t i s . An eleven-month f e l l o w s l ~ l p f o r s t u d i e s i n tire USSR and

CzechoslovakLa and a slx-month fe l lowship f o r s tud ies i n the USSR and Bulgaria.

Hystopathologp .\ six-month fe l lowship f o r s t u d i e s i n Hungary and the USSR.

Obs te t r i c s and Gynaecology. Two slx-month fe l lowships - one f o r study i n t h e USSR and the o the r i n the USSR, Poland and Bulgaria.

Paed ia t r i c s . Two s i x m o n t h fe l lowships - one f o r s t u d i e s i n Czechoslovakia, Bulgar ia and the USSR and t h e o the r i n the USSR and Bulgaria -. and a twe lve~nonth fellowship f o r s t u d i e s i n the USSR, Bulgaria and Yugoslavia,

Pathology. A s ixmonth fe l lowship f o r s t u d i e s i n Poland and the USSR.

Patho-physiology. A six-month fe l lowship f o r s t u d i e s i n the USSR and Bulgaria.

Pharmaceutical Industry . A s i x m o n t h fe l lowship f o r s t u d i e s i n t h e USSR and Czechoslovakia.

Physiology and Mrdical Genetics. A ten-month fe l lowship f o r s t u d i e s i n the USSR, Czechoslovakia and Germany.

Physiotherapy. A six-nonth fe l lowship f o r s t u d i e s i n t h e USSR, Yugoslavia and Czechoslovakia.

Publ ic Heal th Administration. Eleven fe l lowships - four f o r two months f o r s tud ies

i n Romania, Poland and the USSR, t h r e e f o r one month f o r s tudy i n the USSR, one f o r six months f c r s tudy i n the USSR, one f o r two months f o r s t u d i e s i n t h e USSR, Hungary and Bulgaria, one f o r th ree months f o r s t u d i e s i n the USSR, Czechoslovakia and Bulgaria, and one f o r nlne months f o r s tudy i n t h e USSR.

stoma to log^. A nine-month fe l lowship f o r s t u d i e s i n the USSR, Bulgaria and

Czechoslovakia.

. Two s i x a o n t h fe l lowships f o r s t u d i e s i n t h e USSR, Bulgaria and Romania.

Therapeutics. A six-month fe l lowship f o r s tudy i n the USSR.

Tuberculosis S t a t i s t i c s . A n inemonth fe l lowship f o r s t u d i e s i n Czechoslovakia, Hungary, Poland and the USSR.

NEPA -" .., _ " _ l__.. . , rQ*?D""

Terraced rice fields in Kathmandu Valley

SEA/kC22/2 Page 191

8. NEPAL

Nepal continued to enjoy economic stability during the year, with an estimated 9% increase in agr;lcultural production. A number of projects for road development were in progress.

The period under review coincided, almost exactly, with the fourth year of the Third Five-Year Plan. For 1968-69, the budget was increased to 667 million rupees (US $65 909 090), including a foreign aid element of 40 per cent. Thirty-three million rupees (US $3 260 870) were allocated for health, with a significant increase in funds for smallpox eradication (from 34'7 thousand to 1.1 million), and for maternal and chUd health and family pl-g (from 501 t h o d to 2.1 million). In addition, a sum of 2. '7 'million rupees was allocated for the construction of hospitals and health centres.

An outline for the Fourth Five-Year Health Development Plan 0969-73) was prepared with the assistance of a WHO consultant. The plan envisages the development of a health infrastructure strong enough to support the communicable- disease control and eradication programmes, giving priority to those areas which will f irst enter the maintenance phase of malaria eradication and following the pattern of zonal and district health services.

In the Directorate of Health an epidemiological unit was established in collaboration with the Central Public Health Laboratory. This unit, when rJly developed, will be responsible for studying the prevailing communicable diseases, in association with the health statistics and laboratory services.

There are plans for further development of public health nursing in Kathmandu Valley. At the School of Nursing in Kathmandu, it is now possible to be selective in the recruitment of train'ees, a s the number of applicants for training exceeds the number of vacancies. A third auxjlkuy nurse-midwifery school has been opened at Nepalganj, and another is being established in Kathmandu.

This year, with the assistance d WHO and UNICEF, for the first h e , orientation courses' in public health were held for medical officers from the zones and districts.

During-the year a Maternal and Child Health and Family Planning Board was esbblished. This is an autonomous body under the chairmanship of the Minlster of Health.

Malaria eradication has continued to function efficiently, and an asseesment made by a joint WHO/USAID team in April 1969'recommended areas to be transferred from the attack to the consolidation phase. Expansion of the smallpox eradication programme has continued, and isolated outbreaks of amallpox in the Narayani and Iumbini zones were speedily cmtmlled.

In the wake of a WHO-sponsored seminar on leprosy, held in Kathmandu in March, a national advisory committee was constituted to clevelop leprosy control on modern lines and to advise on legislative changes.

SEA/hC22/2 Page 192

In March-April, with assistance from a WHO team, investigations were carried out in goitre-endemic areas, in preparation for launching a national programme for the use of iodated salt, as recommended earlier.

In the field of environmental health, the progrsmme for improving and augmenting rural water supplies has continued,and a revised request for UNDP assistance for a water supply .and sewerage programme for Greater Kathmandu and Bhaktaqur was prepared.

PmJZCT LIST

P r o j e c t No. Source of Funds C o - o ~ e r a t i n g

Agencies

M a l a r i a Z r a d i c n t i o n

( r u n s lir54 - )

A i m o f th;i p r o j e c t . To e r a d i c a t e m a l a r i a i n s t a g e s .

A s s i s t a n c e p r o v i d e d by WHO d u r i n g t h e year . ( a ) A m a l a r i o l o g i s t , an e p i d e m i o l o g i s t , an e n t o m o l o g i s t , a s a n i t a r y e n g i n e e r , t h r e e s a n i t a r i a n s , a l a b o r a t o r y t e c h n i c i a n , an a d m i n i s t r a t i v e a s s i s t a n t , a t r a n s p o r t a s s i s t a n t and a c l e r k - s t e n o g r a p h e r ; ( b ) s e r v i c e s

of a n a s s e s s m e n t team c o n c i s t l n g ef trjo m a l a r i o l o g i s t s and a l a b o r a t o r y t e c h n i c i a n

( p r o v i d e d u n d e r t h e i n t c r - c o u n t r y p r o j e c t SEA?% 0 0 0 7 ) ; ( c ) s u p p l i e s and equipment and two t r a n s p o r t v e h i c l e ? .

P r o b a b l e d u r a t i o n of a s s i s t a n c e . U n t i l t h e end of 1974.

Work done d u r i n g t h e year . me programme p r o g r e s s e d f u r t h e r d u r i n g t h e y e a r , w i t h a r e a s i n t h e C e n t r a l and E a s t e r n Zones w i t h a t o t a l p o p u l a t i o n of 620 000 a d v a n c i n g

i n t o t h e c o n s o l i d a t i o n phase. This r e p h a s i n g was based on t h e r e s u l t s of a n i n d e p e n d e n t

a s s e s s m e n t c a r r i e d o u t i n A p r i l 1969 b y t h e Nepal M a l a r i r E r a d i c a t i o n O r g a n i z a t i o n w i t h

a s s i s t a n c e from WHO and 'JSAID; YO a s s i s t a n c e c o n s i s t e d o f two malariolo&ists/epidemio- l o g i s t s and a l a b o r a t o r y t e c h n i c i a n , and t h i S ~ n i o ~ . F ~ g i o n s l M?lr.ri? Adviscr. scl ived c n

t h e p a n c l o f c o n s u l t a n t s .

Rout ine f i e l d a c t i v i t i d s c o n t i n u e d , and t h e g o n e r a l e p i d e m i o l o g i c a l s i t u a t i o n was s a t i s f a c t o r y . D u r i n g t h e second c y c l e o f s p r a y i n g i n 1968, d i f f i c u l t i e s were e n c o u n t e r e d on a c c o u n t o f t h e h i e t u r n - o v e r of s t a f f caused by wea ther c o n d i t i o n s and t h e

c o i n c i d e n c e o f paddy c u l t i v a t i o n . Mop-up and mobi le s p r a y teams were o r g a n i z e d t o s p r a y t.he houses missed and t h o s e t h a t had come up a f t e r t h e comple t ion of spray ing .

The November c y c l e , which was aimed a t g i v i n g p r o t e c t i o n t o 1 .4 m i l l i o n p e o p l e in

t h e hyperendemic a r e a s of t h e f o u r zones was s t a r t e d and completed m s c h e d u l e . Data a r e b e i n g c o l l e c t e d . In C e n t r a l Zone A , 1 627 v i l l a g e s w i t h a p o p u l a t i o n of 262 529 2nd i n C e n t r a l Zone B, 988 v i l l a g e s w i t h 208 832 people were covered . D i s t r i b u t i o n of

s u p p l i e s and r n a t u r i r ? l s , i n c l u d i n 3 DDT, f o r t h e f i r s t and second c y c l c of s p r a y i n g i n 1969,was p m g r c s s i n g s a t i s f a c t o r i l y .

Surveillance a c t i v i t i e s c o n t i n u e d w i t h f o r t n i g h t l y rounds in hyperendemic

l o c a l i t i e s and montk,ly rounds in hypo-cndemic o m s . Dur ing t h e p c r i o d A u w s t - December 1968 , f o r ,which r o s u l t s were a v a i l a b l e , 1 201 p o s i t i v e c a s e s wsre d e t e c t e d

from a t t a c k - p h a s u a r m s : - C e n t r a l Zone A - 004 c a s e s , C e n t r a l Zone B - 47 c s s c s , E a s t Zono - 250 c a s e s . Dur ing the same p e r i o d , 36 p a s i t i v c s were r e p o r t e d from a r e a s i n t h e c o n s o l i d a t i o n phase:- C a n t r n l Zone A - 1 6 cases, C e n t r a l Zone B - 1 3 c a s e s and E a s t Zoni. - 7 c a s c s . From a r e a s i n t h o 'West ZOnc where c a s e - d o t e c t l o n was u n d e r way, 171 p o s i t i v e s

were r e p o r t e d d u r i n z Au~wst-Novcmbcr 1966. E n t o m o l o g i c a l a c t i v i t i e s of a r o u t i n s n a t u r e were c a r r i e d o u t .

Health education and t r a i n i n g a c t i v i t i e s a l s o continued a s usual. Specia l seminars were held t o glvc t r a i n i n g to d i f f e r e n t catogorics of s t a f f and t o r;vioW the previous year ' s f i e l d a c t i v i t i e s .

NeDal 0002 UNDP(TA) UNICEF

Nursinn Education and Services (Nov. 1954 - )

A i m of t h e Droject. To e s t a b l i s h a Division of Nursing in t h e Di rec to ra te of Health Services t o co-ordinate nurs ing a c t i v l t i c s i n the country; t o s e t up a bas ic nurs ing school t o prcpare q u a l i f i e d nurse-midwlve; f o r h e a l t h s e m i c e s ; t o organize courses Tor a s s i s t a n t nurse-midwives; to Upgrade n u r s i n e s e r v i c e s in B i r Hospi ta l ; t o improve the c l i n i c a l f a c i l i t i e s f o r s tudent nurses , and t o develop pub l ic h e a l t h nurs ing se rv ices which w i l l provide sound teaching f i e l d s f o r nurse and a s s i s t a n t nurse-midwife s tudents .

Assistance provided bv WHO durinR the year. ( a ) A nurs ing adv i se r and a nurse educator; temporary a s s i s t a n c e from two nurse educators a t tached t o o t h e r p r o j e c t s ; (b ) Two fe l lowships - one f o r t en months and one Tor twelve months - f o r s tudy i n India ; ( c ) suppl ies and equipment.

Probable durat ion of a ss i s t ance . Unt i l the end 0.f 1974.

Work done dur inx t h e year. A c t i v i t i e s connected with e s t a b l i s h i n g a nurs ing sec t ion in the Minis t ry of Health were continued. A proposal t o e s t a b l i s h a n a t i o n a l nurs ing Service and a phased plan f o r t h e development of n u r s i n g were drawn up and a r e under consideration. ?he r e s p o n s i b i l i t i e s t o be a t tached t o 13 pos t s f o r nurs ing s t a f f and t h e func t ions of the incumbents were drawn up.

Nineteen s tuden t s were enro l l ed i n the School of Nursing; four teen w i l l complete the course in 1969. The t o t a l number of s tuden t s i n t h e school i s 62. Tne course in

ward management was re-organized and a guide developed f o r the p r a c t i c a l app l ica t ion of theory i n the h o s p i t a l wards.

In November,l8 a s s i s t a n t nurse-midwives q u a l i f i e d and another 18 w i l l complete the course i n 1969. Al together there a r e 51 s tuden t s i n t h e two schools. One new school f o r a s s i s t a n t nurse-midwives i s to be opened i n 1969.

A WHO nurs ing consul tant c a r r i e d out a survey in preparat ion f o r drawing up a phased programme f o r the development of pub l ic h e a l t h nurs ing i n Kathmandu Valley.

m o re f resher courses f o r a s s i s t a n t nurse-midwives were conducted i n November. Five shor t courses w i l l be organized dur ing 1969 - two for. nurses ?.nd t h n i c f o ~ assistant

nurse-nldwivis - a s w i l l a s 2 workshop f o r nurses .

Nurses deputed f o r f u l l and short-term courses dur in& the period were: one t o New Zealand (nurs ing educat ion) , four t o India (pub l ic h e a l t h n u r s i n g ) , two f o r a WHO- a s s i s t e d shor t course i n Ceylon, two f o r a WHO-assisted workshop .in Delhi, and two f o r a shor t family planning course i n USA sponsored by USAID.

sFA/%c22/2

Page 195

Nepal 0002

UNDP(TA)

Strengtheninn of Health Services

( > m o 1355 - Jnri. 1962; Dec. 1962 - r'cc. 1368; Jan. I?<'); - UNICEF

A i m of the p ro jec t . Ta develop e f f e c t i v e l y d i r e c t e d and supervised hea l th se rv ices in

which cura t ive and prevent ive s e r v i c e s a r e i n t e g r a t e d a t a l l l e v e l s , and which nre ab le

t o pmvide adequate t echn ica l guidance t o f i e l d a c t i v i t i e s and s t a f f and a l s o in the

t r a i n i n g of h e a l t h s t a f f required t o man the bas ic h e a l t h services.

Assistance provided by WHO dur ing the year. [ a ) A pub l i c h e a l t h o f f i c e r ; ( b ) th ree twelve-month fe l lowships f o r study i n Ind ia ; ( c ) :upplies and equipment.

Probable durat ion of a s s i s t ance . i m t i l t he end of 1969.

Work done dur ina the year. Following a survey c a r r i e d out i n Narayani Zone, t h i s area was s e l e c t e d as the p i l o t a rea f o r t h e phased development of a system of comprehensive h e a l t h s e r v i c e s i n the whole community. A s a t i s f a c t o r y method of p m j e c t i n g seFviCeu was designed, and the func t ions and d u t i e s nf h e a l t h personnel were defined. The

organ iza t ion of zonal h e a l t h s e r v i c e s w i l l be based on h e a l t h o f f i c e s and hospitals a t

the zonal and d i s t r i c t l e v e l s , supplemented by h e a l t h p o s t s , designed t o serve COnImUni-

t i e s of ?PProxinl t ly 1 5 000 popula t ion and s t a f f e d by a u x i l i a r y personnel.

The e x i s t i n g curriculum and sy l l abus a t the School f o r Auxi l iary Health Workers

provide the s tudents with n s a t i s f a c t o r y foundation, inc lud ing f i e l d v i s i t s t o Pi-ovidc o r i e n t a t i o n i n the f i r s t year and p r a c t i c a l t r a i n i n g ( inc lud ing experience with spec ia l i zed programmes and a t h o s p i t a l s , h e a l t h c e n t r e s and h e a l t h pos t s ) i n the second

year. Short courses f o r compounders, l e a d h g t o promotion t o multi-purpose a u x i l i a r y

h e a l t h workers, a r e a l s o being held , and p lans f o r the conversion of malar ia s t a f f

i n t o multi-purpose wo&ers have reached an advanced stage.

Two two-week o r i e n t a t i c n courses i n community h e a l t h f o r zonal and d i s t r i c t

h e a l t h o f f i c e r s were held dur ing May 1969.

The WHO medical o f f i c e r with the p r o j e c t l e f t in December 1 9 6 ~ on completion of h i s assignment; a replacement. was undcr recruitment. Temporary a s s i s t a n c e bras provldr:d

by a n epidenlologisl: :ind A incalth educator assigned t o o the r p r o j c e t s .

Nepal 0008 Maternal and ch i ld Heal th Services*

R (Dec. 1963 - J a n . 1968; J u l ) 1968: May 1969 - )

UNICEF

ALn of the p r o j e c t . To develep maternal and ch i ld health.inc3uding family Planning s e r v i c e s , t o e s t a b l i s h r e f e r r a l facilities and t o conduct r e f r e s h e r and ~ r i e n t a t i a n courses f o r nurses and medical personnel a t a l l l eve l s .

Assistance provided by WHO dur ing the year. ( a ) A publ ic h e a l t h nurse; ( b ) n twelve-

month fe l lowship f o r s tudy i n the United S t a t z s of America; ( c ) supp l i e s and equipncnt . Probable durat ion of azs i s t ancc . U n t i l t he end of 1973.

. . *Previous t i t l e : I n t e g r a t i o n of Maternal and Child Iiealth Services .

Work done durin!? the year. A WHO publ ic h e a l t h nurse educator joined the p r o j e c t In May. She &ill advise and a s s i s t with t h e development of a u x i l i a r y nurse-midwifery schools. P a r t i c u l a r emphasis w i l l bu placed on publ ic h e a l t h nurs ing in a l l cu r r i cu la .

Nepal O O O ~

R UNICEF

Smallpox Eradicat ion and Control of o t h e r Communicable Diseases (Peb. 1962 - Dec. 1965; Aug. 1966 - )

A i m of the p ro jec t . To a s s i s t the n a t i o n a l smallpox e rad ica t ion programme and t o develop the communicable-disease con t ro l u n i t in tho Di rec to ra te of Health Services.

Assistance provided by WHO durinfi the year, ( a ) A publ ic h e a l t h o f f i c e r ; ( b ) suppl ies , equipment, f reeze-dr ied Smallpox vaccine and two t r a n s p o r t vehicles : ( c ) payment of subsidy, p a r t i c u l a r l y t o meet c o s t of temporary vaccinators .

Probable durat ion of a ss i s t ance . Indef in i t e .

Work done dur ing the yLeay. The pro&ramme maintained progress on es tab l i shed l i n e s . With extension t o two new zones, viz. Lumbini and Janakpur, in the l a s t q u a r t e r of

1968, the p r o j e c t i s now in operat ion in s i x zones. The s torage and d i s t r i b u t i o n of vaccine have been s u i t a b l y organized, and surve i l l ance and outbreak containment a c t i v i t i e s were f u r t h e r developed. With t h e employment of temporary vacc ina to rs , a h igh vaccinat ion coverage was r e 8 i s t t r c d during t h e winter months. An assessment of the

p ro jec t i s planned f o r l a t e 1969.

NeDal 0010 R UNICEF

Health Uborabory Services

(May 1967 - )

A i m of the p r o j e c t . To develop h e a l t h l abora to ry se rv ices in o r d e r t o improve dia@Jlostic s e r v i c e s and t o support an,epidemiological u n i t .

A ~ s i s t a n c e provided by WHO dur ina the year. ( a ) A microbiologist; ( b ) a twelve-month fe l lowship f o r study i n the ,Uhited Kingdom; ( c ) supp l ies and equipment.

Probable durat ion of a ss i s t ance . Uht i l the end of 1972.

Work done dur ing the year. The d i a g J I o s t i i ~ s c r v i c e s in d i f f e r e n t departments of the Central Public Health Laboratory a re being consolidated. A formal t r a i n i n g course f o r l abora to ry technicians has been s t a r t e d . In-service t r a i n i n g of t echn ic ians a t tached t o t h e h o s p i t a l s and t h c teaching of a u x i l i a r y h e a l t h wor)rers continued.

Nepal 0012 L e p m s ~ Control R (March 1967; FCC. 1968; - ]

A i m of tha P r o j e c t . 'I0 develop con t ro l se rv ices f o r l ep rosy in Kathmqndu Valley and t o t r a i n hea l th personnel.

Assistance providcd bv WHO during the.yeor. A two-and-a-half-month fe l lowship f o r s tudy i n India.

NeDal 0014 R

UNICEF

Community Water SuPDly ( m e 1964 - June 1967; March - May 1968; - Scpt. 1968 - )

Aim of the p ro jec t . To plan md co-ordinate the development of community water suppl ies .

Assistance pmvided by WHO dur ing the year. ( a ) R s a n i t a r y engineer and a consul tant ; ( b ) a one-month fe l lowship f o r s tudy i n Ind ia and Thailand; ( c ) suppl ies , equipment and a t r anspor t vehicle .

Probablc durat ion of oss ia tnncc. U n t i l t h e end of 19'10.

Work done dur ing the year. lbe WHO s a n i t a r y engineer, who re joined the p ro jec t in

September, r egu la r ly - i i s i t e d the W H ~ / u ~ I c ~ F - a s s i s t e d r u r a l water supply schemes i n d i f f e r e n t a reas of the country to review progress and t o provide on-the-spot teckmical advice wherever necessary. The r u r a l water supply scheme f o r t h e t h r e e v i l l a g e s of

Chapagoan, Thecho and Sonaguthi was revised, and a d e t a i l e d l i s t of mate r ia l drawn up. A s i t e f o r a UNICEF-assisted workshop was se lec ted , and constructLon s t a r t e d .

June, e W H O consul tant a s s i s t e d i n processing t h t Government's request t o UNDP(SF) f o r a ss i s t ance with t h e provis ion of water supply and sewerage f o r ( t reater Kathmandu and Bhaktapur ( see a l s o Nepal 0025).

Medical Education ( J u l y 1968; - 1

A i m of t h e p r o j e c t . R, prepare f o r the establishment of a medical school.

Assistance provided by WXO dur ing the year. A fnur-month fe l lowship f o r s tudy in

India.

Pmbablc durat ion of a ss i s t ance . U h t i l the end of 1974.

Nepal 0016 R

UNICEF

Tuberculosis Control (March 1965 - )

Aim of the ~ m j e c t . To develop a tubercu los i s con t ro l pmgmmme a s p a r t of the expanding bas ic h e a l t h se rv ices , s t a r t i n g with Kathmandu Valley, and t o give the r e q u i s i t e t r a i n i n g to hea l th personnel. .

Assistance Dmvided by WO during the year. ( a ) A ~c ( t /pub l ic h e a l t h nurse and a s s i s t a n c e fmrn the s t a t i s t i c i a n provided under an inter-country p m j e c t ; ( b ) suppl ies and equipment.

Probable durat ion of a ss i s t ance . U r , t i l t h e end of 1974

Work done dur ing the year. In December 1968/January 1969, a WHO s t a t i s t i c i a n working with P S in te r -coun t ry p m j e c t undertook a reviuw of thc recording nnJ roport '1g system a t the Tuberculosis Centrc i n Kathmandu. A t the Centre, cmphasis was given t o the appropr ia te recording of sputum case-f inding and of b a c t e r i o l o g i c a l l y confirmed cases of tubercu los i s , t h e i r r egu la r t reatment , i n cohorts , and tile recording of r e q u i s i t e follow-up and defau l t e r - t r ac ing a c t i v i t i e s .

Assistance was a l s o provided i n completing the annual BCG repor t f o r 1968. The repor t shows t h a t the BCG vaccinat ion programme in Kethmandu Valley, excluding the BCG work c a r r i e d out a t the Katmandu N b u r c u l o s i s Centrc, covcrcd 7 283 newborns and in f3n t s , 13 941 pre-school-age chi ldren, 30 185 school-children 2nd 994 persons of an older age.

During the f i r s t hal f of 1969, 5 477 newborns 2nd i n f a n t s , 7 878 pro-school-age ch i ld ren , 16 973 school-children and 456 persons in t h e o l d e r age-group were covered by BCG vaccinat ion, br inging the cumulative t o t a l of vaccinat ions performed since the incept ion of t h e programme in June 1965 t o 180 4711.

Steps wcrc taken t3w;rci I wull-phased expansion of the BCO, programme t o o the r densely populated a reas of the country ou t s ide Kathmandu Valley. However, implementation

of such an expansion w i l l be poss ib le only when the necessary f a c i l i t i e s a re made ava i l ab le t o n a t i o n a l s t a f f a s s i m e d to train,implement and supervise the programme, Since BCG vaccinat ion has , on a small sca le , a l ready been undertaken in var ious places by non-~ovemmental h o s p i t a l s and voluntary organizat ions , it i s envisaged t h a t any co-operating i n s t i t u t i o n may be considered f o r p a r t i c i p a t i o n in the fu tu re programme, f o r which a plan of a c t i o n was under preparat ion.

E f f o r t s were continued t o t r a i n more general h e a l t h se rv ice s t a f f in the d i r e c t BCG vaccinat ion procedure a s well a s techniques f o r t i l e ~ rgnr : i z ; t i cn i f s p u t : ~

case-f inding and ambulatory treatment of newly de tec ted cases. This i s t h e most important p r e r e q u i s i t e i f the developing ani! expand in^ gcncral h e a l t h se rv ices a r c to undertake tubercu los i s con t ro l work a s a rout ine . It i s expected t h a t the Tuberculosis Centre i n Kathmandu, in close co-operation w i t h t h e h c a l t h l abora to ry sa rv ices , w i l l

p l ay a n important ro le , especially in providing the necessary t r a i n i n g f o r the var ious ca tegor ies of s t a f f .

The absence of a WED medical o f f i c e r and f requent changes in and absences among t h e n a t i o n a l s t a f f somewhat hampered a c t i v i t i e s dur ing the year. A WHO medical o f f i c e r was under recruitment.

Health Education (May - Aug. 1967; Sept. 1'168; Nov. 1968 - Feb. 1969; - )

A i m of the p m j e c t . To plan h e a l t h education in t h e bas ic hca l th . sc rv ices and spec ia l i zed p r o j e c t s and to s t rengthen h e a l t h education in schools and i n teacher t r a in ing .

Assistance provided by WHO during the year. ( a ) A consul tant ; ( b ) an eleven-month fe l lowship f o r s t u d i c s in India and I r a n and a three-month fe l lowship f o r s tud ies

in Ind ia , I ran. WAR and Pakistan; ( c ) supp l ies and equipment.

Probable durat ion of a ss i s t ance . Unt i l the end of 1974.

Work done dur ing the year. During November 1968 - February 1969, a WHO consul tant

made a re vier^ of h e a l t h education i n schools and t e a c h e r t r a i n i n g i n s t i t u t i o n s . In h e r r epor t , which has been sent to the Government, she has made susgest ions and

recommendations f o r the f u r t h e r s t rengthening of h e a l t h education with regard to

s y l l a b i , textbooks, teacher t r a i n i n g programmes and co-ordination. During the a s s i p e n t , she a l s o advised on thu r o l e of the Health Education Section of the

Di rec to ra te of Health Services.

Public ~ e a l t ' h Administration (Sept. - Nov. 1968; - )

Aim of the p ro jec t . To s t rengthen tha developlnent of in tegra ted h e a l t h se rv ices

in conformity wi th the Gavernment's plan f o r a pmgress ive development of se rv ices p r imar i ly i n a reas expected to e n t c r the maintenance phase of malar ia e rad ica t ion .

Assistanoe provided by W1%) during the year. ( a ) A consul tant ; ( b ) a two-week fe l lowship f o r s tudy in Japan; ( c ) supp l ies and equipment.

Probable durat ion of a ss i s t ance . Lhtil the end of 1974.

Work done dur ing t h e year. During September-November 1968, a WHO consul tant i n publ ic h e a l t h adminis t ra t ion a s s i s t e d the Gavarnment of Nepal i n t h e preparat ion of a f ive-year h e a l t h plan. He recommended a bas ic h e a l t h i n f r a s t r u c t u r e a t the zonal and d i s t r i c t

l e v e l s , where the s e r v i c r s w i l l bu pmvided by a u x i l i a r i e s and supervised by zonal

o r d i s t r i c t doctors. This i n f r a s t r u c t u r e w i l l be b u i l t up i n a phased manner, p r i o r i t y being given to those a reas i n which the malaria e rad ica t ion programme e i t h e r

has rcached the consol idat ion phase o r i s well advanced, and t o a reas u n d e r p i n g

rap id s o c i a l and economic development. In h i s r e p o r t , which has baen sen t to the Government, the consul tant has recommended ' that dur ing the f ive -year per iod a t t e n t i o n

should be concentrated on four teen d i s t r i c t s with a t o t a l population of 2 1/2 mil l ion.

The necessary t r a i n i n g of s t a f f has been analysed and annual p lans f o r bu i ld ing requirements have been worited out.

Nepal 0024

R Gaitro Control

(May 1968; Mar. - April 1969; - )

A i m of the p ro jec t . 'm conduct a survey i n se lec ted a r e a s and to e s t a b l i s h basel ine data f o r the con t ro l of g o i t r e through a s a l t ioda t ion programme.

Assistance pmvided by WHO dur ing the year. ( a ) Three temporary adv i se r s ; ( b ) suppl ies

and equipment.

Probable durat ion of a ss i s t ance . Lhtil 1971.

Wcrk done during the ycnr. A t c m sf thrcc- t~ rnpora ry n d v i s ~ r s - tu;, p ~ t ~ . @ l c i ; ; s t s and cne hicchelrist - c a r r i e d out biochemical inves t iga t ions in the g a i t r e endemic regions of Nepal. The team confirmed t h a t endemic g o i t r e in Nepal was due t o iodine de f ic iency and could be con t ro l l ed by a s u i t a b l e programme of iodine supplementation.

Nepal 002:: water Supwly and Sewerage f o r Specia l Account ~ r e a t e r Kathmandu and Bhaktapur f o r community ( J u l y 1969 - 1 Water Supply

A i m of t h e p ro jec t . To improve water supply and sewerege i n Greater Kathmandu and Bhaktapur.

Assistance provided by W I i D durinR t h e yeaP. Tnree consul tants (one pmvided under Nepal 0014)

Probable durat ion of a ss i s t ance . U n t i l 1171.

WOM done during the year. A team of t h r e e WHO consul tants - two s a n i t a r y engineers and a hydrogeologist - was pmvided in July. In co l l abora t ion with a s t a f f member from UNDP Headquarters, New York, they a s s i s t e d the Government i n t h e reformulation of i t s 1968 request to UNDP f o r a s s i s t a n c e i n a water supply and sewerage scheme f o r Greater Kathmandu and Bhaktapur. m e rev i sed request has been o f f i c i a l l y forwarded t o UNDP.

Newal 0200 R

Nursing Education. A twelve-month fe l lowship f o r s tudy in New Zealand.

Public Health Nursing. A ten-month fe l lowship f o r study in India .

Public Health Nursing I m b e r c u l o s i s ~ . A ten-month fe l lowship f o r s tudy in India.

Floating market in Bangkok

SEA/RC22/2 Page 201

9. THAILAND

h e of the major developments during the year was the promulgation of the new Constitution.

Thkland's economic development during the last decade has been '

impressive. The First National Six-Year Plan (1961-66) achieved a growth rate of 7.5% per annum. The Second Plan (1967-72) was more ambitious, and it was estimated that during this plan the rate of growth in the gross domestic product would average 8.5% per year. However, poor agricultural yields, due to unfavourable weather and the severe drought in 1967, slowed down the production during the first two years. The actual increase in 1967 was 796, and for 1968 an estimated 6%.

The health budget for 1968-69, which showed an increase of 10% over that of the previous year, constituted 2.73% of the national budget. The amount allocated was bahts 654 410 000 (US $31 416 707).

The rate of population growth in Thailand was 3.2% - one of the highest rates in the world - and the total population exceeded 34 million. Although there is no formal policy on population contrgl, the Government supported the development snd strengthening of family health programmes through maternal and child health services,

The main problem faced by the health authorities was not only how to expand rural health services but also how to ensure the full and effective utilization of the facilities already available. Further studies on (a) the distribution of health staff and facilities in rural areas in relation to need, (b) the present utilization of such staff and the services they render to the community, and (c) the improvement and further development of the working relationship between provincial hospitals and health centres,were envisaged.

A notable advance was made in the strengthening and reorganization of some administrative aspects of the Ministry of Public Health. A planning unit is to be formed in the Under-Secretary I s Office, and planning and budpiing for the three divisions of the Ministry are to be co-ordinated. Three senior public health administrators proceeded abroad in 1968 to study planning methodology, and an orientation course in health planning was organized primarily for provincial health officers.

An important event in the field of medical care was the opening of Ramathibodi Medical College and Hospital. The Hospital has an initial capacity of 280 beds, and is to reach a total bed strength of 700 in four years' time.

The Thailand Country Report on a Health Survey of the Lower Mekong Basin (conducted by WHO), which was circulated widely during the year, emphasized the need for an expansion of the medical care and health services and for greater attention to be paid to environmental sanitation and water supplies in the development of north-eastern Thailand. A similar survey is to be carried out for the southern part of the country.

SEA/RC22/2 page 202

The progress of the malaria programme was fairly satisfactory, the general trend being to safeguard past achievements and prevent any setbacks.

The control of other communicable diseases continued to receive priority, and there was noticeable progress in work on BCG vaccination and on trachoma control. The most highly endemic areas of leprosy in the country, i.e., in the North-East Region, now have a sound leprosy control service, and the feasibility of expanding control activities to the less endemic areas was being studied.

A three-man committee examined the functions and staffing of all the health laboratories in the country and recommended that those under the various departments of the Ministry of Public Health should be placed under the adminis- trative control of the Department of Medical Sciences. Steps were taken toward the unification of existing laboratory facilities into a national laboratory service.

Measures were taken to strengthen the veterinary public health organization in the Ministry of Public Health and also at the regional leve1,by the appointment of senior veterinary officers.

The Division of Sanitary Engineering actively pursued the community water supply programme. Twenty-one systems were completed, and designs a d contract documents for twenty more were prepared.

Notable progress was achieved in the Applied Nutrition hogramme, and child-feeding centres were established in many villages.

Attention was directed towards the establishment of graduate trabing courses in the newly created Department of Nursing Education in Chulalongkorn University. Psychiatric aspects of the nursing programme were also developed.

SEA/RC22/2 Page 203

PROJECT LIST

Project No. Sourcc? of Funds Co-operating

ARen c ie s

Thailand 0002.2 S t r e n ~ t h e n i n y of Health Services* UNDP(TA) (Jan. 1764 - Dm. 1968; Feb. 1969 ; - )

UN1CF.F

A i m of the p r o j e c t . To pmmote the i n t e g r a t i o n of spec ia l i zed communicable-disease c o n t r o l programmes i n t o the general h e a l t h se rv ices and t h e f u r t h e r development and organizat ion of r u r a l h e a l t h services .

Assistance orovided by WN) during the year. ( a ) A Pub l ic h e a l t h o f f i c e r and a publ ic h e a l t h nurse , and a s s i s t a n c e from the l abora to ry t echn ic ian provided under p m j e c t

Thailand 0042; ( b ) a twelve-month fe l lowship f o r study in Aus t ra l i a and a nine-month fellOWShip f o r s tudy in the United Kingdom.

Probable dura t ion of a ss i s t ance . Unt i l the end of 1973.

Work done dur ing t h e year. m e f i r s t phase of WR3 ass i s t ance t o this p m j e c t was completed with the withdrawal of t h e WHO medical o f f i c e r and l abora to ry t echn ic ian i n September and t h e pub l ic h e a l t h nurse in December 1968 ' ( t h e pub l ic h e a l t h nurse was t r ans fe r red t o p r o j e c t Thailand 0089, " ~ u r s i n g Education and Services") .

The programme, which included a d e t a i l e d s tudy of h e a l t h se rv ices , including job a n a l y s i s of personnel, in Pitsanuloke Province, has been valuable i n designing a s u i t a b l e p a t t e r n of h e a l t h un i t s . drawing up job desc r ip t ions and f o m u l a t l n g t r a i n i n g programmes.

In Pitsanuloke, h e a l t h u n i t s have been developed i n a l l d i s t r i c t s with the exception of one. The number of h e a l t h and medical c e n t r e s has been increased from 33 t o 55 and the s t a f f from 35 to 113. The organizat ion and adminis t ra t ion of h e a l t h s e r v i c e s have been improved by reorganizat ion. It was found necessa ry t o provide in-service o r i e n t a t i o n t r a i n i n g , which has proved e f f e c t i v e in improving both the q u a l i t y and t h e q u a n t i t y of care.

Public h e a l t h nurs ing supervis ion and in - se rv ice education f o r the nurs ing and midwifery s t a f f in both Urban and r u r a l a reas of Pitsanuloke Province conticued t o receive a t t e n t i o n . The development of a pub l ic h e a l t h p r a c t i c e f i e l d f o r s tudents of the Pitsanuloke School of Nursing was s t a r t e d ; e i g h t s t a f f members from the m l c l p a l i t y , t h e Provincia l Health Of f ice and t h e School of Nursing a t tended t h e in - se rv ice programme f o r the i n t e g r a t i o n of hea l th se rv ices and preparat ion of the f i e l d t r a i n i n g a rea f o r the s tudent nurse-nidwives.

*Previous t i t l e : Strengthening of Health Services ( I n t e g r a t i o n of Specia l ized b o g r m e s ) .

SEA/RC22/2 Page 204

The rev i s ion of h e a l t h records was completed, and agreement was reached on the

use of these forms in a l l d i s t r i c t h e a l t h se rv ices in the Province. A modifled repor t ing system and a system of r e g i s t e r s worc introduced.

7510 WHO consu l t an t s - one i n pub l ic h e a l t h adminis t ra t ion and the o t h e r i n h e a l t h economics - were under recruitment t o evaluate what has t m e n p l a c e so f a r and t o assess the f e a s i b i l i t y of u t i l i z i n g t h e experience of Pitsanuloke a s a b a s i s f o r

t h e development of nation-wide r u r a l h e a l t h services.

Mental f lealth Education and Services (June 1963: Dec. 1963 - Feb. 1964; Jan. 1965 - )

A i m of the Droject. To s t rengthen t h e b a s i c nurs ing curriculum i n respec t of psych ia t r i c nurs ing; t o develop a post -basic programme i n p s y c h i a t r i c nurs ing; t o impmve the mental h e a l t h services .

Assistance Drovided by WHO dur ing the year. ~n adv i se r i n p s y c h i a t r i c nurs ing.

Probable durat ion of a ss i s t ance . Unt i l the end of 1970.

Work done d u r i n ~ t h e year. P r i o r i t y was given t o t h e post-basic degree programme to meet i t s goal of prepar ing i n s t r u c t o r s and f u t u r e nurse l eaders in p s y c h i a t r i c nursing. In add i t ion to t h e t h e o r e t i c a l course being o f fe red , p a r t i c u l a r a t t e n t i o n was pa id t o o r i e n t a t i o n t o the c l i n i c a l f i e l d . The e i g h t s tudents of the f i r s t c l a s s who chose p s y c h i a t r i c nurs ing a s t h e i r major i n t e r e s t received t h e i r B.Ed.(N) degrees in June. Six s tuden t s i n p s y c h i a t r i c nurs inz who were enro l l ed i n the second c l a s s completed the f i r s t year of ' t h e i r programme in March.

An in-service education programme has been under way in Somdet Chao Phldya Psychiat r ic Hospi ta l , t o improve c l i n i c a l i n s t r u c t i o n in group a c t i v i t i e s f o r t h e i n s t r u c t o r s involved i n the teaching of both bas ic and post-basic nurs ing s tudents . It i s planned t o s t a r t s i m i l a r programmes f o r t h e head nurses who supervise s tudents .

Problems a r i s i n g from the emigration from Thailand of a l a r g e number of q u a l i f i e d nurses who have been working i n p s y c h i a t r i c nurs ing have adverse ly affected the e n t i r e educat ional programme a s we l l a s p a t i e n t care .

Thailand 0021 UNDP(TA)

Nursing Advisory Servioes (Apri l 1954 - Dec. 1957; Jan. 1958 - Dec. 1968)s

A i m of the Droject. To a s s i s t the Division of Nursing in the Ministry of Public Health in co-ordinat ing nurs ing a c t i v i t i e s and nurs ing education; t o develop bas ic nurs ing education, and to e s t a b l i s h a col lege of n u r s i n g which, in the first instance, w i l l o f f e r a post-basic d e p e e .

*Effective 1 January 1969, the a c t i v i t i e s of t h i s p r o j e c t a r e being continued under p ro jec t Thailand 0089.

SEA/RC~Z/Z Page 205

Assistance provided by WHO during: the year. ( a ) A nurs ing adv i se r and a s s i s t a n c r from the nurse educator provided under ?hailand 0089; (b ) a twelve-month fe l lowship

f o r s tudy in India.

Workdone. This p ro jcc t w3a s t s r t ~ d i n Apl .11 1954 t o i n i t i a t c t h c development of post -basic (post -graduate) education f o r nurses . Towards this object ive , a c e r t i f i c a t e ccurse f o r pub l ic h e a l t h nurses was s t a r t e d t h a t ve ry f i r s t year within the School of Public Health, Banejrok, and the School of Nursing and Midwifery

I n s t r u c t o r s was es tab l i shed under the a a d i n i s t r a t i o n of the Division of Nursing, Minis t ry of Public Health. (Shor t ly af terwards , the School was t r a n s f e r r e d to the Department of Medical Services in the same f4lnistry.) These two programmes have been supported and strengthened over the years and have provided Thailand with most of her q u a l i f i e d nurse teachers and pllblic hea l th nurses .

A s the p r o j e c t developed, t h e ob jec t ives were broadened t o include ass i s t ance

in: (1 ) improving nurs ing se rv ices , p a r t i c u l a r l y in i n s t i t u t i o n s used f o r teaching; ( 2 ) expanding and upgrading the undergraduate education of nurses , and ( 9 ) e s t a h l i s h - i n g a d iv i s ion of nurs ing i n the Minis t ry of Public Health t o co-ordinate nurs ing a c t i v i t i e s and nurs ing education within t h e country.

During the time in which the p r o j e c t has been i n operat ion, i t has played a major r o l e in both nurs ing s e r v i c e s and nurs ing education within Thailand. It has been

ins t rumental in a s s i s t i n g the development of post -basic , bas ic and a u x i l i a r y nurs ing education, upgrading nurs ing se rv ices - p a ? t i c u l a r l y i n teaching hosp i t a l s i n Bangkok and the provinces - i n t r o d u c i n ~ pub l ic h e a l t h nurs ing, ment i l h c a l t h and psych ia t r i c nurs ing i n t o tho bas ic nurs ing curriculum, and developing b a s i c minimwn cur r i cu la f o r both nurs ing and midwifcry education.

Short courses have been given, and in-service education programmes s t a r t e d with t h e ' a s s i s t a n c e of p r o j e c t s t a f f . Supervisory v i s i t s t o p rov inc ia l h o s p i t a l s and t r a i n i n g schools by s t a f f of the responsible u n i t s in the Ministry of Public Health have been i n i t i a t e d .

In t h e l a t e r years of the p r o j e c t , p a r t i c u l a r attention was paid t o developing the func t ions of the Division of Nursing i n the Ministry of Public Health, a s a co-ordlnating body f o r a l l n u r s i n s thmughout Thailand. I n t c r e s t was st imulated in

legislation t o con t ro l the p r a c t i c e of nurs ing and the education of nurs ing personnel, in the establishment of a r a t i o n a l system of nurs ing personnel and in shor t and lOng-tCrm planning f o r the nurs ing component of the h e a l t h services . Zhe value of advisory se rv ices from the Division of Nursing has been demonstrated, and th ink ing has been o r ien ted to the po in t where sound p a t t e r n s f o r the management and con t ro l of the nurs ing component of h e a l t h se rv ices a r c in the process of being developed.

Wn W I D nurses a s s i m e d t o the p r o j e c t a t d i f fe ren t per iods have provided a t o t a l of 271 man-months of exper t se rv ices . (Among these nurses were th ree s h o r t - t c m consu l tan t s ) . In a l l , t en fe l lowships were awarded - th ree f o r twelve months each, f o u r f o r twenty f o u r months each, two f o r s i x months each and one f o r seven days only. WHO a l s o procured a t r anspor t vehicle f o r the p r o j e c t , and provided o t h e r ~ u p p l i e S .

including nurs ing l i t e r a t u r c .

SEA/RCZZ/Z

Page 206

Ir. a p r o j e c t which dea l s i n a l a r g e measure wi th the growth of concepts and understanding e s s e n t i a l t o the sound t e c h n i c a l and economlc dcvelopment of a u n i t of h e a l t h se rv ices , i t i s d i f f i c u l t t o make an evaluat ion i n terms of r e s u l t s t h a t can be measured aga ins t any f ixed sca le now ava i l ab le . A q u a l i t a t i v e evaluat ion of t h i s p r o j e c t s u f f e r s from t h i s l i m i t a t i o n , but the re can be l i t t l e quest ion of the impact of t h e p r o j e c t i n terms of p o s i t i v e r e s u l t s r e l a t e d t o the development of a t t i t u d e s and concepts e s s e n t i a l t o t h e growth of e f f e c t i v e programmes in both nurs ing se rv ices and nurs in& education.

m a i l a n d 0030 R UNICEF

Leprosy Control (Oct. 1955 - )

A i m of the p ro jec t . To expand and i n t e n s i f y the leprosy con t ro l programme t o cover a l l endemic a reas ; t o t r a i n personnel.

Assistance provided by WHO dur ing the year. ( a ) A l e p r o l o g i s t and a l e p m s y con t ro l o f f i c e r ; (b) a twelve-month fe l lowship f o r study i n the United Kingdom; ( 0 ) suppl ies and equipment.

Probable durat ion of a ss i s t ance . Unt i l t h e end of 1972.

Work done during the year. During the year under review, f o u r new provinces were included i n t o the opera t iona l a rea , i.e., Nakomsawan, Suphanburi, mad and Chantaburi, wi th a t o t a l population of 1 5 5 0 000.

An a n a l y s i s of the r e s u l t s achieveQ so f a r showed t h a t t h e crude prevalence of hown cases i n s i d e the p r o j e c t a reas was 2.8 p e r thousand of the p ~ p ~ l a t i ~ n . Compared with t h e f i g u r e f o r 1963, which was 6.9 p e r m i l l e , t h e prevalence r a t e appears t o have come down by 59% i n f i v e years.

During the year , 3 994 new p a t i e n t s came under t reatment , 623 of whom were chi ldren, Over the same per iod, 1 994 oases were re leased from con t ro l and 2 564 came out of con t ro l . Regular i ty of treatment i n 27 provinces was 75% and above, while i n o the rs ( e i g h t provlhces) it was lower. Eighty p e r cent of the lepromatous p a t i e n t s were examined bac te r io log ica l ly , and ou t of these 795 were repor ted a s negative.

Annual meetings of n a t i o n a l leprosy con t ro l o f f i c e r s were he ld i n c e n t r a l , n o r t h and nor th-east Thsfland, a t which the programme a c t i v i t i e s and achievements were reviewed. The s p e c i f i c t a r g e t s f ixed f o r 1969 were: ( i) t o lmprove surve i l l ance and recogni t ion of e a r l y l e s i o n s , p a r t i c u l a r l y in chi ldren, (ii) t o follow up re leased and out-of-control lepmmatous cases; ( i l l ) Per iodic check up of DDS in take by p a t i e n t s under t reatment , and ( i v ) progress ive i n t e g r a t i o n of the leprosy con t ro l a c t i v i t i e s i n t o t h e general h e a l t h se rv ices .

SEA/RC22/2 page 207

m a i l a n d 0032 V i t a l and Health S t a t i s t i c s R (Aug. 1957 - culy 1959; Oct.1959 -

Apr i l 1960; Nov. 1968 - Jan. 1969; - )

Ain of the p ro jec t . To develop the Health S t a t i s t i c s Section of the Division of Vi ta l S t a t i s t i c s and t o t r a i n personnel in modem s t a t i s t i c a l techniques.

Assistance provided by WHO dur ing the year. ( a ) A consul tant : ( b ) a twelve-month fe l lowship f o r s tudy in the United Kingdom.

Probable durat ion of a ss i s t ance , Unt i l the end of 1973.

Work done dur lnn the year. A consul tant was provided from November 1968 t o January 1969 t o review and make recommendations on t h e funct ions and organizat ion of t h e e t a t i s t i c a l systems of t h e Ministry of Public Health. He has drawn up a three-year t ime-table f o r implementing the improvements which he has suggested. H i s r epor t has been sen t to the Government.

Thailand 0042 UNDP(TA) UNICEF

lUberculosis Control

( a c t . 1958 - May 1959; Dec. 1959 - Dec. 1968; - )

Aim of the Droject. To develop an in tegra ted n a t i o n a l tubercu los i s con t ro l programme based on t h e experiencc gained in urban and r u r a l p i l o t p r o j e c t s and t o t r a i n hea l th personnel in WHO-recommended tubercu los i s con t ro l techniques.

Assistance pmvided by WHO d u r i n ~ t h e Year. ( a ) A medical o f f i c e r and a l abora to ry technician; ( b ) a six-week fe l lowship f o r s tud ies i n Denmark, Norway, the ~ c t h e r l a n d s and Czechoslovakia.

Probable durat ion of a ss i s t ance . Unt i l the end 01 1972.

Work done dur ing the year. fn the BCQ vaccinat ion programme, which has been i n t e g r a t e d with the general h e a l t h se rv ices s ince March 1967, i t has been poss ib le , s ince the adoption of the d i r e c t vaccinat ion procedure, t o give about 1.8 mi l l ion vaccinat ions Per year - almost four times the number given in previous years . It i s expected t h a t t h e cumulative t o t a l cf BCQ vaccinat ions given s ince the s t a r t of t h e new programme w i l l c ross the f i v e mi l l ion mark in 1969. However, t h e l a r g e s t p a r t of the vaccinat ions has been zlven t o school-children, and t h e percentage i n t h e pre-school-age groups, including newborns, needs t o be improved s u b s t a n t i a l l y in order t o make the Programme more e f f i c i c n t and t o cope with the n a t u r a l inc rease i n t h e population.

A nation-widc BCQ week, observfd i n October 1968, had a s t imula t ing e f f e c t on t h e BCG a c t i v i t i e s in Bangkok a s wel l a s in the provinces.

In t he intc?&rated rwral tubi-rculosis pro&rammc, operating i n 54 hea l th cen t res throughout the country, a cumulative t o t a l of 2 933 smear-posit ive cases of tubercu los i s have so f a r been detected. The y i e l d among symptomatic p a t i e n t s examined a t these cen t res has becn in the o rder of 11.7 p e r cen t , g iving a monthly average of about 3.2 cazes pe r centre. In view of the considerable number of h e a l t h c e n t r e s in the country which could p a r t i c i p a t e in the sputum-smear case-f indink f o r i n f e c t i o u s tubercu los i s , the re a re g rea t p c s s i b i l i t i c s f o r f u r t h e r development.

SEA/RCZZ/Z Page 208

Compared with t h i s , the y i e l d a t spec ia l i zed tubercu los i s cen t res a t the regional

and sub-regional l e v e l , where considerable s t a f f and equipment a-- employed, has been r a t h e r low. During the f i r s t seven months of 1968, f o r example, more than 200 000 persons wero examined by X-ray a t these cen t res o r by t h e mobile u n i t s opera t ing under thcm, and 16 011 were diafposed ar, suspect f o r tubercu los i s , but only 4 269(represent ine a y i e l d of only two per cent) could be conf imed bac te r io log iga l ly .

On an average, the re a r e about j 000 t o 6 000 p a t i e n t s r e g i s t e r e d a t the var ious cen t res f o r treatment of tubercu los i s , and 70-75 per cent of them a re l a o m t o c o l l e c t t h e i r drugs regu la r ly every month.

~n 1968, f o r the f i r s t time, a p a r t i c i p a n t from Thailand, who was awarded a WHO fe l lowship, a t tended t h e I n t e r n a t i o n a l Training Course in the Epidemiology and Contml of Tuberculosis, he ld annual ly i n Prague; another i s a t t m d i n g i n 1969. Also, a tubercu los i s o f f i c e r t ak ing p a r t i n a tubercu los i s t r a i n i n g course i n lbkyo has been awarded a WIOS fe l lowship t o enable him to v i s i t var ious tubercu los i s con t ro l ProETammes i n the Western Pac i f i c Region.

The WO labora to ry technician at tachcd to the p ro jec t l e f t i n September 1968, and the medical o f f i c e r completed h i s a s s i w e n t a t the end of 1968. In h i s assignment repor t , which i s under study, he has made a number of use fu l recommendations f o r the f u t u r e development of tubercu los i s con t ro l i n Thailand.

Fur the r a ss i s t ance t o t h e p r o j e c t w i l l continue through the assignment of shor t - t e m consul tants from time t o time according to the needs of the programme.

Tnailnnd 0051 R

Hospi ta l Administration

(Oct. - Nov. 1968; Feb. 1969; - )

A i m of the p r o j e c t . m improve Uhe adminis t ra t ion in h o s p i t a l s , p a r t i c u l a r l ~ teaching hosp i t a l s .

Assistance umvided by WHO durinK the year. ( a ) A consul tant f o r one month and s e c r e t a r i a l a s s i s t a n c e [provided under p r o j e c t SEAR0 0104); ( b ) subsis tence allowances f o r 23 p a r t i c i p a n t s , including cos t of t r a v e l f o r th0;c from ou t s ide Ban&ok; ( c ) 3 three-month fe l lowshlp f o r s tudy in the United Kingdom.

Work done dur ing t h e year. A successful Seminar on Hospit31 Administration was organized a t S i r i r a j Hospi ta l , Bangkok, from 24 October t o 6 November 1968. The 23 p a r t i c i p a n t s includcd medical d i r e c t o r s of h o s p i t a l s and c h i e f s of nurs ing se rv ices . In addition, s i x observers were present . A Wo consul tant , with the help of n a t i o n a l s t a f f cngaged i n h o s p i t a l admin i s t ra t ion a t S i r i r a j Hospi ta l , a s s i s t e d in organizing and conducting the maetings.

The Seminar evoked g rea t i n t e r e s t in t h e subject among the p a r t i c i p a n t s and helped t o focus a t t e n t i o n on the need f o r s t rengthening the adminis t ra t ive aspec t s of hosp i t a l s and ensur ing b e t t e r se rv ices t o t h e p a t i e n t s seeking treatment. At tent ion was d i rec ted t o g iv ing adequate t r a i n i n g t o h o s p i t a l d i r e c t o r s and to cnsur ing co l l abora t ion between - LL.. .-- ~. . - . -~ . .~-.. .. ~ . ~-

S E A / R C Z ~ / Z

Page 209

Thailand 0057 R

Facul ty Of TroDiCal Medicine (Aug. - Sept. 1959; June - Aug. 1961; June 1962; June - July 1963; Jan. - May 1964; June - Dec. 1964; Jan. 1967; Aug. 1967; Ju ly 1966; June 1969 - )

A i m of the p ro jec t . To s t rengthen the Post-graduate School of Tmpica l Medicine of Mahidol m i v e r s i t y , Ban@.ok.*

Assistance provided by WHO dur ing t h e year. Two consul tants .

Probable dura t ion of a ss i s t ance . Unt i l the end of 1974.

Work done dur ina t h e year. In June, a consul tant In paras i to logy took up a three-month

a s s i w e n t a t the Faculty. He observed and p a r t i c i p a t e d in the teaching of helminthology, protozoology, medical entomology and t r o p i c a l medicine and advised on d e s i r a b l e changes i n course content and pedagogical methods, with a view t o l ay ing more emphasis on l o c a l h e a l t h problems, avoiding unnecessary r e p e t i t i o n and b e t t e r i n t e g r a t i n g science with c l i n i c a l teaching.

A WHC consul tant (on a v i s i t t o iha i l and) advised on s t u d i e s on the i n t e r a c t i o n of c i r c u l a t i n g antibody with mononuclear c e l l s i n the des t ruc t ion of amoeba.

A consul tant on t h e biochemical a spec t s of n u t r i t i o n in the t r a i n i n g and research programmes of t h e Facul ty was under recruitment.

m a i l a n d 0062 R

Medical Education (Sept. 1960 - June 1964; Oct. 1968; - )

Aim of the p ro jec t . To develop t h e Departments of Preventive and Social Medicine in the F a c u l t i e s of the m i v e r s i t y of Medical Sciences a t Chulalongkorn and S i r i r a j i n Bangkok.

Assistance provided by WHO dur ing the year. A twelve-month fe l lowship f o r s tudy in the Vnited Kingdom.

Thailand 0065 R (USAID)

Malaria Eradicat ion (Jan. 1962 - )

Aim of the p r o j e c t . To e r a d i c a t e malar ia from the e n t i r e country.

*Formerly the University of Mcdical S^ iences .

SEA/RC22/2 Page 210

Assistance provided by WHO dur ing the year. ( a ) A ma la r io log i s t , an epidemiologist , nn entomologist , a s a n l t a r y cncineer , f i v e s a n i t a r i a n s and a t r a n s l a t o r - t y p i s t ; th rec mala r io log i s t s ( f o r about a month each) ; ( b ) a team c o n s i s t i n g of a mala r io log i s t and an entomologist ~~~~~~~~d undcl. SEAR0 0007); ( c ) supp l ies , equipment and two t ranspor t vehicles ; ( d ) payment of subsidy.

Probable durat ion of a ss i s t ance . Unt i l the end of 1974.

Work done durini: the year. The programme in Thailand was subjected t o severa l assessments dur in3 the period under review. In July-August 1968, a s p a r t of a review of the global s t r a t e g y of malar ia e rad ica t ion , a WHO Headquarters team undertook an assessment of the p ro jec t with regard t o i t s soclo-economic aspec t s [ see a l s o I n t e r - regional 0585). Another assessment, t o consider t h e s h i f t i n g of a reas In to the consol idat ion phase, was c a r r i e d out by f i v e teams i n November. A panel of consul tants , basing t h e i r c r i t e r i a on WID s tandards , appmved the withdrawal of spraying operat ions from an area with a population of 817 198 ou t of a t o t a l population of 5 821 338 recommended by the Govrrment . However, t h e Government a l s o decided to withdrew spraying from add i t iona l a reas with a population of 1 627 332. A t h i r d assessment team made an o v e r a l l review of t h e s t a t u s of the programme between December 1968 and March 1969.

The second round of spraying f o r 1968, l imi ted t o a reas of high t ransmiss ion, was c a r r i e d out and completed between September and December in the d i f f e r e n t regions. The l a r g e turn-over of spraymen and squad c h i e f s i n s e v e r a l a reas put the operat ions behind schedule. On account of a shortage of funds and of DDT, the su r faces t o be sprayed were reduced. A t h i r d cycle of spraying i n Zone 7 of Region I s t a r t e d i n November and l a s t e l f r r f r u r munths.

Survei l lance a c t i v i t i e s continued i n a l l the regions. During t h e period July- December 1968, 1 522 426 blood smears were examined, g iv ing 57 754 p o s i t i v e cases in the a t t a c k phase; dur ing the same per iod, the fi,wres f o r r r n s r l l d a t i - n phase a reas were 855 396 blood smears examined and 8 026 p o s i t i v e s . The population in a t t a c k and consol idat ion phase a reas was, r e spec t ive ly , 18.5 mi l l ion and 14.7 mi l l ion .

Specia l s t u d i e s were undertaken t o determine the r o l e of farm hu t s a s a major cause of p e r s i s t i n g transmission. A three-member committee in Packchong Zone studied methods of evaluat ion a f t e r spraying operat ions i n Canton Musi.

Training and h e a l t h education a c t i v i t i e s continued throughout the year. Seminars were organized by the Health Education and Training Division of the National Malaria Eradicat ion Programme.

Routine entomological i n v e s t i g a t i o n s continued. Specia l s t u d i e s in r e l a t i o n t o a malar ia outbreak i n a sapphire mining area i n Nong Dawn in kegion v and in se lec ted a reas of Vi l lages 2 and 7 of Canton Num Mm in Zone 3 of Region I1 were c a r r i e d out. A s tudy was a l s o made of the l a s t i n g e f f e c t of DDT on the wal ls and roofs of the houses of a h i l l t r i b e in Meo v i l l a g e in Chiengmai.

SEA/RC22/2

Page 211

Tha i land 0067

R

R a d i a t i o n P r o l e c t i o n S e r v i c e s ( A p r i l - May 1 3 6 3 ; Feb. - Msrch 1965; Nov. - Drc. 1J05; D-L. 1966 - Feb. 1967; Nov. 1967:

Dec . 1 o 6 j - P r b . 1368; Fab. - May 1369; J u l y 1969; - )

A i m of t h e p r o j e c t . To e s t a b l i s h a D i v i s i o n of R a d i a t i o n H e a l t h P r o t e c t i o n i n t h e

M i n i s t r y of P u b l i c H e a l t h ; t o d e v e l o p r a d i a t i o n p r o t e c t i o n measures and t c o r g a n i z e a r a d i a t i o n p r o t e c t i o n c o u r s e .

A s s i s t a n c e p r o v i d e d t y WHO d u r i n g t h e y e a r . ( a ) Thrce c o n s u l t a n t s ; ( b ) t h r e e f e l l o w s h i p s - tvc f o r s i x wccks and one f o r t w e l v e months - f o r s t u d y i n I n d i a ;

( c ) s u p p l i e s and equipment .

P r o b a b l e d u r a t i o n of a s s i s t a n c e . U n t i l t h e end of 1971.

Work done d u r i n g t h e y e a r . This p r o j e c t , f o r which GIHO h a s been p r o v i d i n g s h o r t - t e r m

c o n s u l t a n t s from t ime t o t i m e , was a l s o a s s i s t e d by t h e Government of New Zcaland

under t h e Colombo P l a n . Under a t r i p a r t i t e a g r e e m e n t , New Zealand h a s p rov ided a p p r o p r i a t e t r a i n i n , % f a r T h a i s t a r f , and h a s a l s o dona ted r a d i a t i o n measurir.2 equipment .

A WHO c o n s u l t a n t was a s s i g n c d Car t h r e e months from 1 F e b r u a r y 1969 t o a s s i s t ttie R a d i a t i o n P r o t e c t i o n S e r v i c e w i t h t h e establishment o f p e r s o n n e l f i l m badge m o n i t o r i n g

u n i t . H l s r e p o r t was b e i n g p r o c e s s e d f o r submissior . t o t h e Government. Another

C o n s u l t a n t was a s s i g n e d f a r one weck i n A p r i l 1969 , t o e v a l u a t e and a s s e s s t h c p r o g r e s s made by t h e S e r v i c e tcwards s e l f - s u f f i c i e n c y , and t c , make recommendations f c r f u r t h e r development . H i s r e p o r t v a s undcr s t u d y i n t h e Rcn:icnai Offick:. The p r o j e c t was a l s o v i s i t e d by a t h i r d c o n s u l t a n t who, i n J u l y , f o l l o w e j up on h i s own e a r l i e r ass ignment

d u r i n g Dccembcr 1967 - F e b r u a r y 19119.

Tha i land 0069

R

Urban P u b l i c H e a l t h A d m i n i s t r a t i o n

( J u l y 1969 - )

A l m of t h o p r o j e c t . Tn d c v e l o p comprehensive urban h e a l t h s e r v i c e s and t o t r a i n

p e r s o n n e l f o r work i n ul,ban communities concentrating on t h e pr ,ov is ion of a compruhcnsive

m a t e r n a l and c h i l d h e a l t h s e r v i c e bascd on t h c e f n c r a l h e a l t h services.

A s s i s t a n c e p r o v i d e d by WHO d u r i n g t h e y e a r . Two c o n s u l t a n t s .

Work done d u r i n g t h c y e a r . I n J u l y 1969 , a tcam c o n s i s t i n g of a p u b l i c h t a l t h admin is -

t r a t o r and a p u b l i c h e a l t h n u r s e s t a r t e d a s t u d y of "he f a c i l i t i e s f o r m a t e r n a l and c h i l d h e a l t h s c r v i c ~ s a v a l l a b l f i n t h c m u n i c i p a l arczis nf Bangkok and Thonblirl i n o r d e r

t o a d v i s o con f u r t h e r dcvclapmcnt .

Tha i land 0070

R V ~ c t o r - B o r n e D i s e a s e C o n t r o l (Haemorrhagic F e v e r )

(Suno 1963; J u n c 1964: March - May 1965; June 196;; Drc . 1568 ; - )

A i m of t h e p r o j e c t . Tn s t u d y t h e cp idc ,mio lay ica l p a t t e r n of t r a n s m i s s i o n o f haemorrhagic

f e v e r and dcvolop a metho*clai:y f a r p r < . v e n t i o n and c c n t r o i of o u t b r e a k s of the d i s u a s e .

SEA/RCZZ/Z Page 212

Ass i s t ancfpmvided by WHO d u r i n ~ the year. A twelve-month fz l lowship f o r s tudy i n thc United S t a t e s of America.

Thailand 0071 UNDP(TA)

School f o r Medical Radiography, Banaok* m an. 1965 - )

Aim of the p r o j e c t , m t r a i n radiog:lphers.

Assistance provided bxWHO durinR the year. A rorliography t u t o r .

Probable durat ion of a s s i s t a n c f . Unt i l t h e end of 1973.

Woric done during-the gear. Under t h i s p m j e c t , in which WHO helped t o e s t a b l i s h a "School f o r Radiolo&ical ~echnology", which, up t o 1968, was s i t u a t e d in S i r i r a j Hospi ta l , Ban@.ok, a sy l l abus was being followed which covered a four-year per iod and included two years of b a s i c szience and two years of r ad io log ica l technology, Elaven t e ~ h n ~ l ~ g i s t s have graduated fmm t h i s school. However, in view of the shortage of t r a ined radio&raphers i n Thailand, i t was f e l t t h a t l a r g e r numbers of t h i s cadrc of workers should be produced and t h a t a shor te r , two-year sy l l abus should be evolved. A new school f o r the t r a i n i n g of radiographers was the re fo re opened in the Department of Radiology a t Ramathibod1 Hospi ta l , Ban&ok, and the f irst two-year t r a i n i n g oourse, p r imar i ly i n d iagnos t i c radiography.was s t a r t e d i n mid-1969 with an i n i t i a l i n t a k e of twelve s tudents from var ious p a r t s of Thailand. ?he school in S i r i r a j Hospi ta l a l s o continues under the tu to r sh ip and d i r e c t i o n of n a t i o n a l s t a f f .

The curr iculun f o r the t r a i n i n g of radiographers, which was prepared by t h e School 's t r a i n i n g committee, includes a sy l l abus f o r a second-year course i n radiotherapy and nuc lea r medicine, although, f o r the time being, only the d i a ~ o s t i c course will be gigen. The t r a i n i n g committee, while adding t h e radiotherapy curriculum t o the second-year d i a m o s t i c course, suggested a reduction i n t h e number Of l e c t u r e s and the aniount of p r a c t i c a l work in radiographic techniques.

The WHO t u t o r radiographer v i s i t e d the r a d i o l o g i c a l i n s t a l l a t i o n s in severa l h o s p i t a l s i n B3n&ok and es tab l i shed contact wi th t h e Radiation Protect ion Service.

Six i,.'adua:p X-ray t echno log i s t s fmm the School of Radiological Technology a t S i r i r a j Hospi ta l were appointed t o t h e s t a f f of Ramathibodi Hospi ta l - f o u r t o t h e d i a e ~ l o s t i c sec t ion and two t o t h e therapy sec t ion ; in November 1968, two of them pmceedcd t o Ncw Zealand on Colombo Plan fe l lowships f o r f u r t h e r t r a i n i n g , and a t h i r d w i l l go t o thc United Kingdom on a WHO fe l lowship.

Thailand 007.3 IUNDP ( TP.)

Physical Therapy Training (Dec. 1965 - Sept. 1968)

UNICEF

A i m of the pmws$t. m develop the t r a i n i n g of phys io the rap i s t s f o r the expansion of orthopaedic and r c n a h i l i t a t i o n se rv ices .

*Previous t l t l c : Schos: :cr 3ad io log lca l Technology. Bangkok.

SEA/RC22/2

Page 213

A- the year. A physiotherapy t u t o r .

Work done. ii Schrc l ::f Physiotherapy was start ird i n S i r i r a j Hosp i ta l , Bangkok in May 1965. A WHO physiothurapy t u t o r Joined the p r o j e c t in December of t h a t year and a s s i s t e d in drawing up a curriculum f o r the B.Sc. (Physiotherapy) course. The

f i r s t group of 1 7 s tuden t s entered the Schrol in May 1965, of whom s l x graduated i n March 1968. Enrolment was slow t o begin with, but a s the p r o j e c t gathered momentum

and the profess ion of physiotherapy became more popu la r , th i s s i t u a t i o n improved.

National s t a f f who have been t r a i n e d abroad cn WHO fc l l awsh ips , havc, a s from the beginning of 1969, taken over teaching d u t i ~ s i n the School.

The a c t i v i t i e s of t h c p r o j e c t , which ended in September 1968, a re belng contir~uod under an expanded p ro jec t "Medical Rehah i l i t a t inn (Thailand 0093). t o which the WHO

t u t o r was r e a s s i m e d i n October 1968.

'Ihailand 0075

Regular

S t r e n a t h e n i n ~ of Laboratory Services

(Apr i l - May 1968; Mar. 1969; - )

Aim of the Pro jec t . Ta s t rengthen the venereal-disease d i a @ s s t i c l a b o r a t o r i e s on a phased b a s i s so t h a t t h s y may funct ion a s pub l ic h e a l t h l abora to r ies .

Assistance Pmvided by dur ing the year. An eighteen-month fe l lowship f o r s tudy i n the United Kingdom.

Probable durat ion of a ss i s t ance . Until t h e end nf 1972.

Kork donc during the y e a r . Thc ass i ,Tnont repor t of the consul tant a s s i p e d i n April-May 1968 was forwarded t o the Government. Ihe course f o r the school of

pechnicians has been revised and a syl labus drawn up.

Discussions were he ld on t h e f u t u r e organizat ion of t h e p rov inc ia l h e a l t h

l a b o r a t o r i e s ( inc lud ing the upgrading of the venereal-disease l a b o r a t o r y ) , and a fe l lowship programme w 3 s evolved f o r the t r a i n i n g of t u t o r t echn ic ians f o r the School

of Technicians, Department of Medical Sciences, Bangkok.

mal land 0081 Water Pol lut ion

R (Dec. 1966 - Jan. 1967; oc t . 1967; Sept. 1968; Oct. 1968; Jan. 1969;

May 1969; - )

A i m of the project , To provide t e c h n i a l advice nn organizational and o t h e r problems r e l a t e d t o the prevention and con t ro l of water pol lut ion.

Assistance Provided by WHO durinR the year. ' ( a ) A consul tant ; ( b ) a six-month

fe l lowship f o r study in the United Kingdom, the Federal Republic of Germany, t h e

Netherlands and Switzerland, a four-month fe l lowship f o r s tudy in the United O g d o m and a three-week t r a v e l fe l lowship f o r s tudy in Ind la , the Federal Republic of Germany, the Netherlands and the lmitcd Kingdom; ( c ) suppl ies , equipment and a low-temperature r e f r i g e r a t o r .

SEA/RC22/2 Page 214

Probable durat ion o~a_ass~st~n-c.e. Unt i l 1970.

Work done dur ing the year. In May, a consul tant was a s s i s c d f o r one month to a s s i s t f u r t h e r in the invee t iga t ion of the problem of water po l lu t ibn and t o give advice an resea rch and o t h e r s t u d i e s required t o dctennine the most p r a c t i c a l and economical methods of undertaking a water p o l l u t i o n con t ro l programme. H i s f ind ings and f'ecommendations werc under review.

lha i l and 0081 Sewerage and Drainam Plans. Baneok R (Nov. - Dec. 1968; - )

A i m of the p ro jec t . To study and review the master plan f o r e s t a b l i s h i n g a s ing le a u t h o r i t y f o r the water, sewerage, drainage and f lood p ro tec t ion systems f o r Bangltok, and t o make s u i t a b l e recommendations.

Assistance Drovided by WHO during t h e Year. Two consul tants .

Wo* done dur ing t h e year, Two consu l t an t s were provided in November-Dscember 1968 t o a s s i s t in a'comprehensive s tudy and review of t h e master p lan f o r sewerage, drainage and f lood p ro tec t ion systems f o r Bangkok, prepared by a f i n n of consul t ing engineers , and t o advise on t h e f e a s i b i l i t y of e s t a b l i s h i n g a s ing le a u t h o r i t y f o r the planning, management, adminis t ra t ion and operat ion of the water supply system a s wel l a s of t h e sewerage, drainage and f lood p ro tec t ion system. Tne consu l t an t s ' repor t was sent t o the Government.

Dental Health (Jan. 1967; Nov. 1967 - Apri l 1968; Apr i l 1969; - )

Aim of the p r o j e c t . To improve and s t rengthen den ta l education of both profesnional and a u x i l i a r y s t a f f a s well a s d e n t a l se rv ices .

Assistance Drovided by WIK) dur inn the year. ( a ) A thirty-six-month fe l lowship f o r s tudy i n the ZBlited S t a t e s of America; ( b ) suppl ies and equipment.

Thailand 0087 Administrative Aspects of Health Services R (Sept. - Dcc. 1968; - )

Aim of the p r o j e c t . To formulate and develop a programme f o r t h e reargapizat ion of the i n t e r n a l adminis t ra t ive ' s t r u c t u r e of the Ministry of Fublic Health wi th emphasis on personnel and f i n a n c i a l management, f i l i n g , record-keeping and archives , programme planning and evaluat ion.

Assistance provided by WHO dur ing t h e year. A consul tant .

Probable durat ion of a ss i s t ance . U h t i l the end of 1973.

Work dcne during the year . A WHO consul tant (pub l ic admin i s t ra tc r ) v i s i t e d Thailand d u r i n g September-December 1168 t o review and evaluate the c x i s t i n g machinery w i t h regard t c some

of thc a d m i n i s t r a t i v e a s p e c t s c f t h i wcrk of the Ministry of Public Health. During h i s assigrment he was, of course, unable t o study a l l the admin i s t ra t ive aspec t s in dcpth. In e s t a b l i s h i n g p r i o r i t i e s , he f i r s t i d e n t i f i e d key problems in adminis t ra t ion, the

so lu t ion t o which l a y within t h e d i s c r e t i o n of the Ministry of Public Health. Studies were made and proposals presented in the fol lowing a reas of adminis t ra t ion: ( 1 ) a mechanism f o r programme planning; ( 2 ) budget fo rnu la t ion and co-ordination; ( 3 ) recording

and f i l i n g systems i n sc lec tcd d iv i s ions ; ( 4 ) se lec ted aspects of the personnel system, and ( 5 ) organieat ion f o r cvaluat ion. Detailed recommendations were made in thesc f i v e f i e l d s and, with regard to some of them, the O o v c m e n t has bccn ab le t o take immediate ac t ion , e.g., co-ordination of the budgets of: the d i f f e r e n t Departments thraugh t h e Off ice .of the Under-Secretary.

Amongst the consul tant 'e general concluslons were the following: a new post of Deputy Under-Secretary f o r Administration should be es tab l i shed t o f a c i l i t a t e co- ordinat ion of the adminis t ra t ive func t ions of the Departments of the Ministry; t h a t a National h e a l t h planning and cvaluat ion bureau should be s e t up, with sec t ions f o r Programme Planning, budget development and evaluat ion and t h a t a c e n t r a l r e g i s t e r of

a l l personnel i n the Ministry should be maintained a s one of the funct ions of a new personnel d i v i s i o n . H i s r epor t was sen t t o the Oovernment.

lha i l and 0089 ~ u r s i n p Education and Servioes R (Jan. 1968 - 1

Aim of the p ro jec t . To a s s i s t the Division of Nursing in t h e Minis t ry of Public Health to s tudy nurs ing needs and resources and to s t reng then nurs ing se rv ice and education a s ind ica ted ; t o a s s i s t i n the development of un ivers i ty - l eve l courses f o r nurses and p a r t i c u l a r l y the post-basic degree programme a t the Department of Nursing, Chulalon&orn University; to a s s i s t i n t h e org;anizatien and conauct of s t u d i e s r e l a t e d t o nurs ing se rv ice and education.

Assis tance provided by WW durinR t h e year. ( a ) A nurs ing adv i se r , two nurse educators, a pub l ic h e a l t h nurse , and ass i s t ance fmm the adv i se r i n p s y c h i a t r i c nurs ing assigned under Thailand 0017.2; ( b ) two three-month fe l lowships f o r study in the United Kingdom and a twenty-four-month fe l lowship f o r s tudy in the m i t c d S t a t e s of America; ( c ) suppl ies , equipment and a t ranspor t vehicle .

Probable durat ion of a ss i s t ance . Unt i l the end of 1974.

Work done durinu the year. With the reass imment of the WHO nurse adv i se r and the !4HO publ ic h e a l t h nurse (from p r o j e c t s Thailand 0021 and 0002 rcspec t ive ly ) on 1 January

1969, and the c lose co-operation of the WHO psych ia t r i c nurse adv i se r a s s i e e d under m a i l a n d 0017.2, i t has Seen poss ib le t o c r e a t e t h e nuoleus of a team t o co-ordinate a l l a spec t s of the WHO a s s i s t ance t o nurs ing programmes in Thailand.

In the pcs t -bas ic dcgree programme of the Department of Nursing Education, Facul ty of Education, Chulalon&om Univers i ty , which i s prepar ing nurse teachers , some minor changes have been made in the curr&culum in o r d e r t o provide f o r a sounder educat ional programme i n the major c l i n i c a l a r e a s of nurs ing, and the f a c u l t y a re

SEA/RC22/2

Page 216

examining the need f o r a f u r t h e r revis ion of the curriculum in the l i g h t of the pas t yea r ' s cxpcriencc, In ipnera l , p o s s ~ b l l ' t l c s f o r s t rengthenin3 thc c l i r i c a l nurs ing component and reducina t h e educat ional theory a r e being explorcd.

The excess ively heavy teaching load f o r the a v a i l a b l e s t a f f has been re l i eved somewhat by the appointment, in January 1969, of two add i t iona l nurse i n s t r u c t o r s f o r t h e c l i n i c a l areas . Fur ther f a c u l t y appointments w i l l be made a s soon a s qualified

personnel can be rec ru i t ed .

Because of t h e increased nwnber of post:basic s tudents in medical-surgical nurs ing, two more wards of chulalongkom Hospi ta l (making a t o t a l of f o u r ) have been s f l e c t e d f o r t h e i r p rac t i ce . Thc YHO nurse educator i n t h i s area has had constnnt and c lose contact with t h e mcdical and nurs ing s t a f f of these wards.

The WHO nursc educators a s s i s t e d wi th the WHO organized courses on h o s p i t a l adminis t ra t ion and management of in fec t ious -d i sease h o s p i t a l s , held in Bangkok dur ing the year.

The ob jec t ives and plan of work of the WHO pub l ic h e a l t h nurse f o r the year include a s s i s t a n c e t o t h e t r a i n i n g programmes and supervisory a c t i v i t i e s of pub l ic h e a l t h nurs ing and midwifery personnel in the var ious d i v i s i o n s of the Department of Health, Ministry of Public Health. Evaluation of the t r a i n i n g programmes f o r nurses and midwives r:lven by the School Health Division has begun through questlon- n a i r e s t o 311 personnel who p a r t i c i p a t e d in them, t o be followed by observat ion of a se lec ted number of them t o a s s e s s t h e i r work. The pub l ic h e a l t h nurse , e a r l i e r when working with pn? j ec t Thailand 0002, had a s s i s t e d the Maternal and Child Health Division of the Health Department i n r e v i s i n g t h e bas ic currlculwn f o r midwifery schools and i n a r e f r e s h e r course f o r midwives. She continued t o a t t end courses f o r nurses and midwives givcn by the Division f o r o r i e n t a t i o n and assessment of t h e i r

needs; follow-up of p a r t i c i p a n t s of theso courses was planned. Suggestions f o r the continued developnent of the pmeramme i n Pitsanuloke Province were outlined b y the WHO publ ic h e a l t h nurse .

lPle WHC nurse adv i se r continued t o work with thc Division of Nursing, Mlnistry of Public Health, thc func t ions of which have been f u r t h e r strengthened. She conducted workshops on "cor re la t ion of classroom teaching and c l i n i c a l p rac t i ce" in th ree of the Prov inc ia l h o s p i t a l schools of nurs ing (Korat, Chantaburi and Songkhla) f o r t h e i n s t r u c t o r s m d head nurses of those schools and hosp i t a l s .

Thailand 0090 UNDP( TA) UNICEF

National Commllnitv Watcr Supply

an. 1969 - )

A i m of the p ro jec t . lk plan, organize and adminis ter a n a t i o n a l environmental h e a l t h programme and, more s p e c i t i c a l l y , t o provide t e c h n i c a l advice and guidance f o r the expansion of the n a t i o n a l community water supply and o t h e r environmental h e a l t h programmes.

Assistance Provided by WHO during the year. A s a n i t a r y engineer.

Probable durat ion of a s s i s t ance . Ur.til t he end of 1774.

Work done dur ing the year. In August 1968, the Governmant s i p e d the plan of operat ion f o r t h i s project. Within the n a t i o n a l community water supply programme, d e s i p s ,

s p e c i f i c a t i o n s and con t rac t documents f o r abaut 100 community water supply p r o j e c t s were completed. C r i t e r i a were formulated a s a guide in the s e l e c t i o n of communities.

E f f o r t s were continued t o incorporate i n the design and cons t ruc t ion of UNICEF-assisted

p r o j e c t s s tandards aiming a t g r e a t e r t e c h n i c a l e f f i c i e n c y and lower cos t .

m e WHO s a n i t a r y engineer r e g u l a r l y v i s i t e d the water supply schemes in d i f f e r e n t a reas of the country t o a s s e s s progress and t o provide t echn ica l advice. F i e l d k i t s

and ten t r a n s p o r t v e h i c l e s pmcured by UNICEF were d i s t r i b u t e d . Other supp l i e s and

equipment ordered by UNICEF had begun t o a r r i v e .

In view of t h e p ress ing need f o r a r ap id expansion of t h e n a t i o n a l community water supply p m g r m n c , p o s s i b i l i t i e s were being explored f o r a UNDP(SF) p r o j e c t in t h i s f i e l d . The WHO s a n i t a r y engineer i s a l s o providing a s s i s t a n c e t o the Lower Mekong Basin Project (Thailand 0 1 0 j ) .

Aim of the p r o j e c t . To s tudy human resources in the h e a l t h s e c t o r (pub l i c and p r i v a t e )

and t o f o r e c a s t the s i t u a t i o n wi th regard t o demand and supply of p ro fess iona l ,

t e c h n i c a l and a u x i l i a r y personnel.

Assistance provided by WHO during the year. A consul tant .

Probabii durat ion of a s s i s t ance . sntil 1970.

Work dane dur ing the year. In the l a s t week of July 1969, a Y(HO consul tant was a s s i q e d t o the p r o j e c t f o r a shor t per iod t o a s s i s t the ELinistry of EUblic Health in prepar ing a d r a f t protocol i n connection with a study of hwnan resources In t he hea l th

sec to r .

Medical Rehabilltat5.cn

(Oct. 1968 - )

A i m of thc proJect . To 3 s s i s t in the s t r i . n g t h e n l n ~ ofor thopaedic and r e h a b i l i t a t i o n

se rv ices and t o continue physiotherapy t r a i n i n z p r o g a m e s .

Assistance provided by :fHC during the year. A physiotherapy t u t o r .

Pmbablc durat ion of a s s i s t ance . U n t i l t he znd of 1971.

SEA/RC22/2 Page 210

Work don:-during t h e year. With t h e r e a s s i p n e n t t o t h i s p r o j e c t , on 1 October 1968, of the WIiO physiotherapy t u t o r who had been working with p r o j e c t Thailand 0073, "Physical l'herapy Training,, the t u t o r and h i s n a t i o n a l coun ts rpar t , a s a f i r s t s t e p towards widening the scope of t h e e a r l i e r a c t i v i t i e s i n o r d e r t o cover medical r e h a b i l i t a t i o n i r ~ general, be@ 2 survey of the e x i s t i n g physiotherapy s e r v i c e s and the s t a f f pos i t ion in the country. m e WHO physiotherapy t u t o r a l s o advised on the reorganizat ion of the Physiotherapy Department in S l r i r a j Hospi ta l , Bangkok; a hew method of documentation of t h e p a t i e n t s was under t r i a l .

Thailand 0092 R

Public Health Education (Dec. 1968 - Jan. 1969; - )

Aim of the p r o j e c t . To s tudy ai7d advise on the development of var ious courses of s tudy in the School af Public Health.

Assistance Provided by WHO dur lna t h e year. A consul tant .

Work done&; tile yesr. A WHO consul tant in pub l ic h e a l t h adminis t ra t ion was assigned f o r four. weeks In December 1 9 6 8 - ~ m u a r y 1969. He s tudied t h e s t r u c t u r e and train in^ programmes of the Facu l ty of Public Health and had discuss ions wi th t h e Dean, the teaching s t a f f from the Facu l ty proper , from o t h e r f a c u l t i e s of Mahido1 Univers i ty and wlth government o f f i c i a l s .

Based on h i s obsenmtions , t h e consul tant has made s e v e r a l recornendations with regard t o t h e organizat ion and teaching programmes of the Facu l ty and has , among o t h e r po in t s , emphasized t h e n e c e s s i t y f o r s t d n g t h e n i n g f i e l d t r a i n i n g . A summary of his f inding* was sent t o t h e Gavernnent.

Fellowships

Health Education, A twelve-month fe l lowship f o r s tudy in t h e United S t a t e s of America.

Maternal and Child Health. Two fe l lowships - nne f o r f i v e weeks f o r s t u d i e s i n the - United S t a t e s of America, Euerto Rico and Mexico, and t h e o t h e r f o r a week in Pakistan.

Preventive and Soc ia l Medicine. A seven-month fe l lowsh ip f o r s tudy in t h e United Kingdom.

Tuberculosis Control. Pour three-month fe l lowships f o r s tudy in India .

m a i l a n d 0201 Fel lowsNps UNDP(TA)

NeurcphysisloRy. A twelve-month fe l lowship f o r s tudy in the Ilnited Kingdom.

Production of DPT Vaccine. A six-month fellowship f o r s tudy i n t h e United Kingdom.

Standardizat ion of B io log ica l Products. A two-month fe l lowship f o r s tudy in I s r a e l .

sm/kc22/2 Page 219

PROJECT LIST

Project No. Source of Funds Co-operating

Agencies

S U O 0001 Regional Assessment Team on R W l a r i a Eradicat ion

(hy 1959 - Dec. 1961; Nov. 1963 - I

A i m 01 t h e p ro jec t . To make an independent a p p r a i s a l of the s t a t u s of malar ia e r a d i c a t i o n and of any s p e c i a l aspects of the programme i n countr ies o f t h e Region.

Assistance provided by WHO dur ing t h e year. ( a ) Three mala r io log i s t s , a n entomologist and a l abora to ry technician ( f o r assessment); ( b ) supp l ies and equipment.

Probable d u r a t i s n uf a ss i s t ance . Unt i l the end of 1974.

Work done during the year. An assessment of the malar ia e rad ica t ion programme i n Thailand was s t a r t e d i n December 1968 and completed i n March 1969. The f ind ings of t h e team (which cansls ted of a WHO maia r io log i s t and a WHO entomologist) were discussed with t h e au t l io r i t i e s on 24 March. A summary of the team's f indings

war sen t t o the Qoverll7itnt.

Simultaneously with t h e assessment of t h e t echn ica l a spec t s of the programme, t h e Government s e t up a working group t o evaluate t h e admin i s t ra t ive aspects. This group was made up of r epresen ta t ives from the National Research Council, t h e National Economic Development Board, t h e Department of Technical and Economic Co- operat ion and t h e ' ~ u d g e t Bureau.

I n Apri l 1769, 3n assessment of thc proerame i n Nepal was ca r r i ed out by a WHO team cons i s t ing of two mala r io log i s t s and a l abora to ry t echn ic ian (see a l s o Part I,

s e c t i o n 1.1, " k l a r i a " I .

s m o 0030 UNDP (TA )

Smallpox Eradicat ion and Epidemiological Advisory Team (act. 1962 - )

A i m of t h e p ro jec t . To a s s i s t t h e countr ies of Cne Reeion i n smallpox e r a d i c a t i a n and i n the development of epidemiological serv1ct.s.

Assistance provided by WHO during t h e year. ( a ) Two epidemiologis ts and a c le rk - s t emgraphcr ; ( b l supply of b i fu rca ted needles to Afghanistan, India , Indonesia and Nepal.

Probable dura t lon of a ss i s t ance . Unt i l thc end of 197&.

S E A / R C ~ ~ / ~ Page 220

Work done dur ing the year. Durlng the per iod under review, the epidemiologis ts continued to render a s s i s t a n c e to the govemments of smallpox-endemic countr ies i n the Region i n the preparat ion of s u i t a b l e plans o f operat ion and necessary plans of ac t ion , anri i n ca r ry ing ou t assesstnents of thc smallpox s i t u a t i o n m d immunity s t a t u s of the population. Zhey a l s o a s s i s t e d in the organizat ion and conduct of seminars, t r a i n i n g courses and meetings on smallpox.

In India , a s s i s t a n c e was ziven with the preparat ion of a d r a f t p lan of operat ion f o r the smallpox e rad ica t ion pmgramme, based on the f ind ings of the jo in t mvernment of India/LIHO assessment i n 1967. One of the epidemiologis ts of the team attended a meeting organized by the (lovernment in November 1960 to d i scuss the main modif icat ions i n pmgramme s t ra tegy . He a l s o took p a r t in discuss ions on augment- i n g the pmduct ion of f reeze-dr ied smallpox vaccine ( s e e p r o j e c t SEAm 0038.2 below).

With the gradual switch-over t o the use o f the b i fu rca ted needle in severa l coun t r i es of the Region, WHO has arranged f o r suppl ies of these needles t o Afghanistan, Ind ia , Indonesia and liepal.

Production of Freeze-dried SmallDox Vaocine (Nov. - Dec. 1967; Nov. - Dec. 1968; - )

A i m of the p ro jec t . To a s s i s t with t h e pmduct ion of f reeze-dr ied smallpox vaccine.

Assistance Drovided by WHO durinE the year. ( a ] A consul tant f o r four weeks; (b l suppl ies and equipment.

Probable durat ion of a ss i s t ance . U n t i l tho end of 1974.

Work done dur ing the year. In November-December 1969, a consul tant assessed the s t a t u s of f reeze-dr ied vaccine production i n Burma, Indonesia and Thailand. Based on h i s recommendations, iinprovements have been in tmduced in t h e phys ica l f a c i l i t i e s f o r the producing cen t res in Rangoon and Bandung. Technical approval was given f o r the procurement of spare p a r t s and a d d i t i o n a l d r i e r s by UEIICEP. His r e p o r t s have been sen t t o the govemments concerned,

Radiation Protect ion (Sept. - Dec. 1968; A p r i l 1969; - ) *

A i m of the o m ject . To t r a i n personnel concerned with the operat ion of X-ray apparatus in improved measures f o r guarding a g a i n s t the harmful e f f e c t s of i o n i z i n g rad ia t ion .

AssisLance provided by WHO dur ing t h e year. ( a ) Two consu l tan t s ; ( b ) supply of a t r n n s i s t o r i z e d sealer / t imer/high vol tage u n i t t o Burma.

Probable durat ion of assit i tance. U n t i l the end of 1974.

Work done dur ing the year. A WHO consul tant was a s s i p e d to Burma f o r one month in

Septembcr-October t o evaluate t h e t r a i n l n g course wi th which he had a s s i s t e d (under the tubercu los i s con t ro l p r o j e c t ) in 1967, and t o advise on the f e a s i b i l i t y of cont inuing such courses in o t h e r p a r t s of the oountry. A summary of h i s r epor t ,

+WHO a s s i s t a n c e to the f i r s t phase of the p ro jec t ended in November 1963 and was repor ted under p r o j e c t number S A R O 0042.

SBA/ac22/2 Page 221

which contained use fu l recommendations, was submitted t o t h e Government. H i s f ind ings indicated t h e n e c e s s i t y f o r ensuring t h a t the textbooks and j curna l s required f o r t h e t r a i n i n g of radiographers (X-ray t echn ic ians ) , were a v a i l a b l e a t the General Hospital , Mandalay, and a t the Paramedical I n n t i t u t e , Rangoon, and t h a t lead screens, l ead aprons, and gloves were added t o t h e p ro tec t ive equipment i n t h e Nyaung-oo Township l iosp i t a l and ICyavkse D i s t r i c t Hospi ta l . Provis ion of these supp l ies was urder consideration. He a l s o v i s i t e d Indonesia i n November-December 1968. A

sununary of h i s recommendations was sen t t o the Government.

Under the same p r o j e c t , a consul tant was assigned t o Nepal f o r two weeks i n Apri l t o undertake a survey of the e x i s t i n g X-ray u n i t s i n the country. A summary of h i s recommendations has been submitted t o the Government.

Health S t a t i s t i c s Training Centre (Jan. 1968 - )

Aim of t h e project . To a s s i s t t h e countr ies of the Region i n the t r a i n i n g of v i t a l and h e a l t h s t a t i s b i c s personnel a t the primary and intermediary l e v e l s and i n introducing

e f f i c i e n t v i t a l and h e a l t h s t a t i s t i c s procedures i n a r u r a l d i s t r i c t ; t o advise on v i t a l and h e a l t h s t a t i s t i c s , P a r t i c u l a r l y on t h e c l a s s i f i c a t i o n of d i seases and causes of death.

Assistance provided by WHO dur ing t h e year. ( a ) A s t a t i s t i c i a n ; (b) supp l ies and equipment.

Probable dura t ion of a ss i s t ance . Unt i l t h e end of 1969.

Work done d u r i ~ the year. Based i n t h e Regional Office, t h e WHO s t a t i s t i c i a n took par t i n t h e Course f o r Coding I n s t r u c t o r s (SEAR0 0167).. She a l s o gave ass i s t ance with regard t o t h e s t a t i s t i c a l a spec t s of l ep rosy and tubercu los i s p ro jec t s (ceylon 0075, India 00e1 and Nepal 0016 ) .

Supplics and equipment were provided t c s t rengthen t h e teaching a c t i v i t i e s of t h e h d e l V i t a l and Health S t a t i s t i c s Unit, Nappur ( I n d i a ) .

SBARO -0 Reorganization of Rural I iealth Records R and Reports

(Jan. 1961 - )

Aim of t h e p ro jec t . To organize a system of r u r a l h e a l t h se rv ice records and repor t s i n se lec ted cen t res and t o t r a i n personnel i n t h e collection, processing and p resen ta t ion of v i t a l and h e a l t h s t a t i s t i c s a t t h e r u r a l h e a l t h cen t re l eve l .

Assistance provlded by WHO dur ing t h e year. ( a ) A s t a t i s t i c i a n ; ( b ) supply of PrYntlng paper t o India .

Probable dura t ion of a ss i s t ance . Unt i l t h e end of 1974.

sm/kmzR Page 222

Work done during the year. In Afghanistan, t he system of recording and repor t ing of r u r a l hea l th services was reviewed and modifications i n the recording of gcneral out-pat:ent and maternal and chi ld hea l th se rv ices were proposed. A new system of no t i f i c a t i on of communicable diseases and of report ing on the a c t i v i t i e s of hea l th oentres was introduced, i n co-operation with the WHO projects Afghanistan 0026 and Afghanistan 0031. In Gujarat S ta te ( I nd i a ) , where the project continued i ts assis tance, forms were supplied f u r a State-wide one-year t r i a l .

I n Indonesia, the ex i s t i ng system of r u r a l hea l th records and r epo r t s i n East Java was reviewed and proposals f o r simplifying the procedures were discussed with the na t iona l s t a f f ; ass is tance was a l so given with t h e design of a survey of hea l th services .

The operation uf the new recording and report ing system,introduced i n Thailand a f t e r successful preliminary t r i a l s i n Pitsanuloke Province, was reviewed, and s t ep s were taken t o introduce it i n adjoining provinces.

Development of Community Water Supply P r o m m e (Apri l 1965 - )

A i m of the project . To provide governments of the Region with consultant services f o r t he development of t h e i r urban and r u r a l community water supply projects .

Assistance provided by WHO during the year. Three san i ta ry engineers, th ree san i ta ry engineering consultants and a clerk-stenornapher.

Probable cluraticn of ass is tance. Until the end of 1974.

Work done during t he year. One of the san i ta ry engineers with t he project continued t o give technical advice i n the execution and development of the YIHO/UNICEW-assisted r u r a l water supplx schemes i n severa l S ta tes i n India i n t he cour6e.of regular v i s i t s , He went t o Nepal i n March 1969 t o co l lec t da t a f o r t he preparation of a plan of operat ion f o r a r u r a l water supply programme i n t h a t country and t o advise on environmental s an i t a t i on aspects of the UM)P(SF)~AO..assisted T r i s u l i Watershed Development Project .

Tne other san i ta ry engineer attended the 12th Indian Standards Convention held a t Bhubaneswar ( Ind i a ) i n December, and t he Seminar on Indus t r i a l Waste Treatment and Defluoridation of Water Supply, which took place in Hyderabad ( Ind ia ) i n January, presenting papers on water po l lu t ion control a t both meetings. He a s s i s t ed i n reviewing d r a f t request f o r UNDP(SF) ass i s tance f o r Afghanistan and Nepal, a s well a s other re levant technical documents on the current UNDP(SF)-assisted pro jec t s i n t he Region, and prepared work plan diagrams f o r these programmes. I n Apr i l , he was ter'porarlly assigned t o the UNDP(SF) projeot Ceylon 0086 pending the a r r i v a l of the WHO project manager i n mid-May. One of the consul tants a l s o a s s i s t ed with d r a f t requests and documents and i n November 1968 was reassigned t o APghanlstan 0057,

The t h i rd sani tary, engineer assigned under the project continued h i s ass i s tance t o the programme i n Thailand and, e f fec t ive 1 January 1969, was reassigned t o project Thailand 0090. The consultant provided t o Mongolia i n July completed h i s ass igment i n December. I n Ju ly , a consultant provided under t h i s project took up du t ies with the Calcutta Metropolitan Water and Sani ta t ion Authority (see India 0240).

sEA/Rc22/2

Page 223

~ o s p i t a l S t a t i s t i c s (Jan, 1963 - Dec. 1968 )

Aim of t h e project . To h e l p governments of t h e Region to organize an e f f l c l e n t system f o r t h e maintenance and flow of records i n se lec ted hosp i t a l s ; t o c o l l e c t , process and present h o s p i t a l s t a t i s t i c a l d a t a e f f i c i e n t l y on a na t iona l sca le , and t o t r a i n medical record and h o s p i t a l s t a t i s t i c s personnel.

Assistance provided by WHO dur ing t h e year. A s t a t i s t i c i a n and a medical record o f f i c e r .

Work done dur ing ' the year. The WHO s t a t i s t i c i a n a s s i s t e d with t h e Course f o r Codlng Ins t ruc to r s , held i n the Regional Office I n November 1968 (SEARO 01671, and with the s t rengthening of t h e medical record department a t S r i Saya j i Hospi ta l , mods (I*ia).

The medical record o f f i c e r , dur ing h e r assignment t o t h i s p ro jec t between Ju ly and September 1968, was s t a t ioned i n t h e Regional Office, where she completed t h e f i r s t d r a f t of a manual f o r t r a i n i n g medical record s t a f f working i n hosp l t a l s .

SEARO 0094.2.' R

External Cross-Checking of Blood Fi lms (Sept. 1968 - )

A i n of t h e p ro jec t . To develop and s t reng then f a c i l i t i e s i n t h e coun t r i es of t h e Region f o r independent cross-checking of blood f i lms from malar ia e r a d i c a t i o n programmes.

Assis tance provided by WHO dur ing t h e year. ( a ) A l abora to ry s p e c i a l i s t ; [ b ) supp l ies and equipment.

Probable d u r a t i o n of a ss i s t ance . U n t i l t h e end of 1974.

Work done dur ing t h e year . I n September 1968, WHO a s s i s t a n c e t o t h i s p ro jec t , which had been completed i n 1966, was revived with t h e assignment of a WHO l abora to ry s p e c i a l i s t t o Ceylon t o a s s i s t t h e Government i n reorganizing t h e l abora to ry se rv ices of t h e Anti-malaria Campaign and i n e s t a b l i s h i n g independent cross- checking centres .

Decen t ra l i za t ion of l abora to ry se rv ices was undertaken i n order t o reduce t h e back-log of work and the delay involved i n r e c e i p t of s l i d e s and n o t i f i c a t i o n of Pos i t ive cases. Reeional and f i e l d l a b o r a t o r i e s were es tab l i shed and t h e r e were, a s of Apri l 1967, one c e n t r a l , four, r eg iona l and two f i e l d l abora to r ies .

A separa te bu i ld ing was acquired f o r e s t a b l i s h i n g t h e corss-checking centre , ' which had o r i g i n a l l y been loca ted i n t h e c e n t r a l laboratory. The s t a f f of the

cen t re conbisted cf 20 microscopis ts and one medical l abora to ry technician, and it was ProposeSto increase t h e number of microscopis ts t o 24.

+ Effect ive 1 January 1969, t h e a c t i v i t i e s of t h i s p ro jec t a r e being continued under SEARO 0161 (Hospi ta l S t a t i s t i c s and Medical Records)

tt WHO a s s i s t a n c e t o t h e e a r l i e r phase of t h e p ro jec t ended i n December 1966 and was reportell under SEARO 0094.

S E A ~ C ~ Z / Z

Page 224

A medica lo f f i ce r who had completed a t r a i n i n g course a t t h e WHO W l a r i a Eradicat ion Training Centre, Manila, was placed i n charge of the l abora to ry services . Since t h e l abora to ry could no t cope with t h e number of blood smears

being submitted, it was decided t o c o l l e c t blood smears i n t h e f i e l d from suspected and c l i n i c a l cases only.

Medical Education (Wrch 1969 - )

Am of t h e p ro jec t . To review t h e teaching programmes of medical col leges , develop cur r i cu la and introduce modern methods of teaching and evaluation.

Assistance provided by WHO dur ing the year. ( a ) Six consu l tan t s and a s s i s t a n c e from a s t a f f member from WHO Headquarters; ( b ) cos t of attendance of p a r t i c i p a n t s i n t h e medical teacher t r a i n i n g course ( see below].

Probable dura t ion of a ss i t ance . Unt i l t h e end of 1974.

Work done d ~ r i z i g t h e year. Ear ly i n March, a consul tant i n h e a l t h education provided under t h i s p ro jec t took up a three-month aseigtunent i n I n d a to a s s i s t i n implementine t h e objectives of t h e paed ia t r i c and o b s t e t r i c t r a F r d n g and Services p ro jec t ( ~ n d i a 0114). She s tudied t h e s i t u a t i o n i n t h e p a e d i a t r i c departments of se lec ted medical col leges and assoc ia ted h o s p i t a l s with regard t o t h e h e a l t h education of p a t i e n t s and t h e i r famil ies , t h e teaching of t h i s d i s c i p l i n e t o medical s tudents , and t h e u t i l i z a t i o n of t h e a v a i l a b l e resources , e s p e c i a l l y manpower, f o r h e a l t h education purposes. Her conclusions and recommendations were being s tudied.

Ear ly jn Ju ly 1969, a four-week Medical Teachers ' Training Course was s t a r t e d i n t h e Regional Office, a t tended by 21 teachers from 15 medical co l l eges and poet- graduate i n s t i t u t e s i n Ind ia and two from t h e two medical f a c u l t i e s i n Ceylon. A

f a c u l t y of four WHO cdnsul tants - t h r e e of them eclucationists with s p e c i a l experience i n problems of medical educat ion and one medical educator q u a l i f i e d i n education was assigned t o organize and conduct t h e course. The f a c u l t y was a s s i s t e d by a s t a f f member from WHO Headquarters. The programme of t h e course was designed i n col labora- t i o n with thc pa r t i c ipan t s , emphasis bein& placed on those t o p i c s i n which they were ch ie f ly in te res ted . Study groups were formed and were a s s i s t e d i n t h e i r work by t h e f a c u l t y a s resource persons. Time was s e t a s ide f o r assigned reading ( a s p e c i a l reference l i b r a r y had been assembled f o r t h i s purpose) and f o r work on an i n d i v i d u a l l y se lec ted project under t h e guidance of a f a c u l t y member. The impact of t h e course was assessed continuously a8 it progressed,and t h i s assessment, together with feed-back from the p a r t i c i p a n t s , was used f o r modif icat ions i n t h e programme.

Also i n July , a consul tant i n pathology took up a three-month assignment i n Indonesia. The consul tant had undertaken a s imi la r assignment i n Indonesia i n 1968, but had unavoidably t o terminate i t beforc covering t h e e n t i r e propamme. Working with those medical f a c u l t i e s not v i s i t e d dur ing t h e e a r l i e r assignment, he reviewed t h e teaching, se rv ice and resea rch programmes i n h i s d i s c i p l i n e with a view t o advis ing on and demonstrating t h e c e n t r a l r o l e of pa tho low and the most e f f e c t i v e way of i n t e g r a t i n g it i n t o t h e c l i n i c a l t e a c h i w , a s wal l a s how t o u t i l i z e f u l l y , and t o der ive t h e maximum b e n e f i t from, the s e r v i c e s offered by l a b o r a t o r i e s a t tached t o pathology departments.

t WHO a s s i s t a n c e t c t h e e a r l i e r phase of t h e p r o j e c t ended i n March 1967 and was repor ted under SEAR0 0096.

s ~ ~ / A c 2 2 / 2 Page 225

Nut r i t ion Tra in ing (Dec. 1963 - )

UNICEF

A i m of t h e p r o j e c t . To a s s i s t i n t r a i n i n g i n n u t r i t i o n and t o support t h e Nut r i t ion ~ e s e a r c h Laborator ies , Hyderabad ( I n d i a ) , i n ca r ry ing out t h e i r programme.

Assistance provided by WHO during the year. ( a ) A grant- in-aid t o the Laborator ies ; ( b ) seven three-month fe l lowships f o r candidates from Afghanistan ( I ) , Ceylon ( 2 ) (one of which was awarded under Ceylon 0200), Nepal ( 1 ) and Thailand ( 3 ) , f o r p a r t i c i p a t i o n i n the c e r t i f i c a t e course i n n u t r i t i o n ( f o r t h i s course , a fellowship f o r a candidate from t h e Ph i l ipp ines was a l s o provided by the Regional Office f o r the Western P a c i f i c , and UNICEF pa id s t ipends t o the s i x candidates from I n d i a ) : three nine-month fe l lowships f o r a candidate each from Afghanistan, Ceylon and Nepal t o follow the degree course; th ree two-week fe l lowships f o r candidates from Indonesia ( 1 ) and Thailand ( 2 ) t o a t t end a t r a i n i n g course i n research on n u t r i t i o n a l anaemia, held i n Kuala Lumpur; ( c ) two guest l e c t u r e r s .

Probable dura t ion of a ss i s t ance . Unt i l the end of 1974.

Work done dur ing the year. The s i x t h c e r t i f i c a t e course , which began a t the Nut r i t ion Research Laborator ics , Hyderabad ( I n d i a ) i n December 1968, ended i n February 1969, a t tended by four teen p a r t i c i p a n t s from s i x countr ies . The f i rs t degree course i n n u t r i t i o n (which had s t a r t e d a s a diploma course i n June 1968 and was upgraded i n January 1969) a l s o drew t o a c lose i n February. Six candidates - f i v e from India and one from Indoncsia - at tended the course. The second degree caurse began i n June 1969 with f i v e p a r t i c i p a n t s from four coun t r i es of tho Region, i n add i t ion t o s i x from India .

The c e r t i f i c a t e course covers a wide range c f top ics considered e s s e n t i a l f o r acqu i r ing a bas ic lolowledgc i n n u t r i t i o n , d i e t e t i c s a s we l l a s r e l a t e d f i e l d s such a s a g r i c u l t u r e and t h e economic a s p e c t s of food product ion, t h e use of s t a t i s t i c a l methods, education, e t c .

The degree course i n appl ied n u t r i t i o n i s meant f o r candidates who have a bas ic degree I n medicine o r sc ience and who teach biochemistry, physiology, a n a t o ~ y . pathology o r bacter iology i n a medical col lege o r publ ic h e a l t h i n s t i t u t e .

Two guest l f c t u r c r s were provided by WHO t o a s s i s t i n t h e two courses. One of them a l s o evaluated the two courses and found that the i n s t r u c t i o n imparted was of a high order .

The Regional Adviser i n Nut r i t ion v i s i t e d the Laborator ies e a r l y i n January 1969 and addressed the s tudents of the two courses on n u t r i t i o n problems and programmes i n the Region.

SEAhC22/2 Page 226

SEARO 0099.3 A

Epidemiology of Virus Diseases (Aug. - oc t . 1967; Jan. 1969; - )

A i m of t h e p ro jec t . To a s s i s t i n t h e development of regional epidemiological su rve i l l anceof haemorrhagic fever and i n s t u d i e s on e f f e d t l v e methods of con t ro l a t na t iona l and i n t e r n a t i o n a l l e v e l s .

Assistance provided by WHO during the year . Suppl ies and equipment f o r Burma.

Asian I n s t i t u t e f o r Economfc Development and Planning, Bangkok an. 1964 - )

ECAFE UNICEF

A i m of t h e p ro jec t . To s t rengthen t h e f a c u l t y of t h e Asian I n s t i t u t e f o r Economic Development and Planning, e s tab l i shed by ECAFE a s executing agency f o r VNDP(SF), wi th the help of s e v e r a l United Nations agenc ies , including UNICEF, and t o a s s i s t wi th the t r a i n i n g i n h e a l t h aspec t s of Planning and publ ic h e a l t h adminis t ra t ion.

Assis tance provided by Mi0 dur ing the year. ( a ) A publ ic h e a l t h adminis t ra tor ; ( b ) supp l ies and equipment.

Probable dura t ion of a s s i s t a n c e . u n t i l the end of 1974.

Work done dur ing the year. WXO public h e a l t h admin i s t ra to r , bes ides carrying on with h i s normal teaching programme i n h e a l t h s u b j e c t s , gave a s s i s t a n c e t o one of the s p e c i a l course6 i n human resources development and s o c i a l planning condlsted a t thc I n s t i t u t e . Included i n t h i s particular educat ional a c t i v i t y were twelve seminars, wi th case-s tudies and exorc i ses on f a c t o r s i n hea l th planning.

A t a workshop on S t a t e - l e v e l Planning and Evaluat ion, organized by the National I n s t i t u t e of Health Administration and Education (NIHAE) and held i n New Delhi i n November 1968,thc pub110 h e a l t h adminisbrator read 3 paper on " ~ e a l t h and Economics"

The Asian I n s t i t u t e ' s annual general course began i n February.

The publ ic h e a l t h admin i s t ra to r was appointed t o draw up the curriculum f o r the f i r s t three-month coursc i n n a t i o n a l h e a l t h plannlng f o r sen io r o f f i c i a l s of m i n i s t r i e s o r h e a l t h , scheduled t o begin a t t h e I n s t i t u t e i n November 1969.

E f f o r t s continued t o r e c r u i t a n economist to a s s i s t the WHO publ ic h e a l t h admin i s t ra to r i n s t rengthening the t r a i n i n g programme.

SEARO 0103 R

Hospi ta l Designs ( ~ c t . - Dec. 1966; Aug. - Dcc, 1967; Dec. 1968 - Jan. 1969; - 1

A i m of t h e p r o j e c t . To a s s i s t i n t h e preparat ion of h o s p i t a l designs.

sEA/Rc22/2

Page 227

Assistanco provided by WHO during t h e year . A consul tant f o r th ree weeks.

Pr,otable durat ion of a ss i s t ance . Unt i l 1970.

Work done dur ing thc ycar. A consul tant was assigned t o Thailand i n December 1968 - January 1969 t o advise and a s s i s t the Qovernment f u r t h e r i n respec t of the various aspec t s of h o s p i t a l a r c h i t e c t u r e , p a r t i c u l a r l y funct ional a r c h i t e c t u r a l planning and design of f a c i l i t i e s , taking i n t o account the l o c a l condi t ions and a v a i l a b i l i t y of cons t ruc t ion mate r ia l s . His repor t was under study.

SEARO 0104 A

Hospi ta l Administration (Aug. 1968 - )

A i m of t h e p r o j e c t . To promote t r a i n i n g i n h o s p i t a l adminis t ra t ion through t r a i n i n g courses and workshops.

p r . [ a ) A consu l tan t f o r two months and a secretary-stenographer from the Regional Off ice; ( b ) two three-month fellowships fo r candidates from Afghanistan ( 1 ) and Nepal ( 1 ) . f o r study i n t h e United Kingdom, and th ree two-week fe l lowships f o r candidates from Indonesia t o s tudy i n Thailand and Malaysia: ( c ) c o s t of attendance of twenty p a r t i c i p a n t s .

Probable dura t ion of a ss i s t ance . Unt i l the end of 1574.

Work done during the ycar . A course i n h o s p i t a l adminis t ra t ion was conducted a t the

c e n t r a l Hoapi ta l , Bandung (Indonesia) , from 16 September t o 18 October 1968. rt was at tended by 20 p a r t i c i p a n t s - one from Ceylon, 1 5 from Indonesia and two each from Nepal and Thailand. A WHO consul tant a s s i s t e d i n organizing and conducting thc course , f o r which t h e Regional Officc provided s e c r e t a r i a l a s s i s t ance .

SEARO 0113 R

Regional Tuberculosis Training and Evaluation Team (Dec. 1967 - )

A i m of t h e p r o j e c t . To provide t r a i n i n g i n tubercu los i s con t ro l : t o a s s i s t i n opera t iona l r esea rch r e l a t e d t o the assessment and evaluat ion of in tegra ted tubercu los i s c o n t r o l programmes i n the Region; t o give p r a c t i c a l a s s i s t a n c e t o na t iona l tuberculosis programmes a s required.

Assis tance provided by WHO during the year . ( a ) A medical o f f i c e r and a s t a t i s t i c i a n ; ( b ) supp l ies and equipment.

Probable durat ion of a s s i s t a n c e . Unt i l the end of 1974.

Work done dur ing thc year . The medical o f f i c e r of the team, who a l s o a c t s a s the team l e a d e r , took up h i s d u t i e s i n December 1968 and t h e second member, a s t a t i s t i c i a n , joined i n January 1969. E f f o r t s were being made t o r e c r u i t a publ ic h e a l t h nurse and a 2aboratory technician.

sEA/ac22/2 Page 228

Tine team is expected to assist the countries of the Region with regard to training, particularly the organizational and administrative aspects, as well as with the asscssmcnt and evaluation of integrated tuberculosis control programmes. It is initially concentrating its attention on the development of an appropriate methodology. For this purpose, and also because the National Tuberculosis Institute at Bngalore has already devoted attention to operational research in similar approaches to programme evaluation and assessment, the team has been based in Eangalore for tho time being where there is close co-operation with the Institute.

In March 1969, the statistician in the team took up a five-week assignment in Burma where he carried out an evaluation of the systen of records and reports used in divisional tuberculosis control programmes.

In April, the medical officer took part in the tuberculosis seminar held in Kabul (see Afghanistan 0033). During this visit, he.assisted in the preparation of a comprehensive plan of action for tuberculosis control.

: "'? the c r f l i c a l officer returned to Afghanistan in order to assist in conducting the necessary theoretical and in-service treining of managerial teams (provincial supervisory teams) for three provinces in which the rural health services are being strengthened and developed further.

In addition to its work on the development of assessment methodology, the team is preparing for aseminar on tuberculosis control which it is scheduled to organize in Ceylon at the beginning of 1970.

Malaria Advisory Services (Jan. - Feb. 1969; - j

Aim of the project. To assist the governments of the Region in any special assessments or studies of malaria eradication programmes.

Assistance provided by WHO during the year. A team consisting of a consultant malariologist, a consultant public health administrator and an entomologist.

Probable duration of assistance. Till the end of 1969.

Work done during the year. In January-February 1969, an independent assessment of the malaria programme in Indonesia was carried out by the WHO team. The report of the team was under study.

During a visit in March, the Senior Regional Malaria Adviser held discussions with the government on the findings of the assessment team.

Plague Epidemiologp (May 1968 - )

Aim of the project. To assist governments of the Region in assessing factors responsible for the persistence of plague and in studying any new potential plague foci; also to provide emergency assistance during outbreaks of the disease.

'Previous title: Studies on Plague.

SEA~CZZ/~!

Page 229

Assistance provided by WHO during the year. (a) Two consultants; assistance from the Chief of the Bacterial Diseases Unit at WHO Headquarters, one of the Regional Advisers in Communicable Diseases and two secretary-stenographers from the Regional Office; (b) cost of attendance of twenty participants; (c) three three-month fellowships for candidates from Nepal - two for study in India and one for study in Iran.

Probable duration of assistance. Until 1970.

Work done during the ?car. In November 1968, a WHO consultant was assigned to Burma to assist in establishine a special plague unit for research on the epidemiological aspects of the foci of endemic plague in Middle Burma (Myingyan). The studies revealed the persistence of P.pestis among domestic and field rodents, causing sporadic cases of plague in the human population.

During the assignment, the consultant, together with the rther WHO consultant, assisted in the conduct of a training course and a seminar held in Mandalay from 6 to 17 January 1569. The training course, on plaguc epidemiology and control, was for 15 medical officers from B u m , India, Indonesia, Nepal and Thailand, and consisted of theoretical training supplemented by practical demonstrations given by the special plague w i t located in Myingyan. It was followed by a three-day seminar on plague surveillance for senior medical officers responsible for this work in their countries and the seminar laid down guidelines for plague surveillance at the national and regional levels.

Infcctious-Disease Hospitals (oct. 1967 - )

Aim of the project. To assist governments of the Region in improving infectious- disease hospitals so that they may provide adcquate facilities for the diagnosis, treatment and teaching of infectious diseases.

Assistance provided by WHO during thc year. (a) Thrce consultants and four temporary advisors: assistance from one of the Regional Advisers in Communicable Diseases and two secretary-steno~raphers from the Regional Office; (b) cost of attendance of 31 participants.

Probable duration of assistance. Until the.end of 1974.

Work done during the ycar. A second trainine course on the managemant of infectious- disease hospitalsCwas organized in Nonthaburi (Bangkok) from 18 to 30 November 1968, with assistance from WHO, as shown above. Thirty-onc participants (2 from Afghanistan, 2 from Burma, 2 from Caylon, 11- from India, 6 from Indonesia and 15 from Thailand) attended the training course, which made an extensive review of methods and procedures for upgrading infectious-disease hospitals, particularly the need for controlling cross- infec tion.

Before the course started, two of the consultants (the epidemiologist/clinician and the nurse) undertook a follow-up of the previous training course by visiting the

*The first was held in Bombay in 1967.

S E A ~ C Z Z / ?

Page 230

infect ious-disease h o s p i t a l s i n De lh i , Kanpur, Bombay, Hyderabad,Madras and Uthmandu. The revlew ind ica ted t h a t improvements had been achieved following the e a r l i e r course.

Afte r t h e conclusion of the course , the same consul tants v i s i t e d the infect ious-disease h o s p i t a l s i n Djakar ta , Rangoon and Kathmandu f o r a n on-the-spot review of improvements considered possible f o r implementation i n t h e immediate f u t u r e . Their conclusions were t h a t f u t u r e WHO a s s i s t a n c e i n improving the management of infect ious-disease h o s p i t a l s should be concentrated on se lec ted h o s p i t a l s i n order t o f o s t e r "areas of excellence" where f u r t h e r t r a i n i n g of h o s p i t a l s t a f f could be undertaken.

The t h i r d WHO consul tant ( b a c t e r i o l o g i s t ) , i n h i s r e p o r t , h ighl ighted t h e need f o r a concerted e f f o r t i n the con t ro l of h o s p i t a l i n f e c t i o n i n the general teaohing h o s p i t a l s , and proposed a plan of a c t i o n i n t h i s regard.

The ind iv idua l r epor t s of the consu l t an t s , a s we l l a s the repor t on the course , were sen t t o the governments, and some of them were widely d i s t r i b u t e d .

Development of Health Education (June 1967 - )

A i m of the p ro jec t . To arrange workshops and o the r educat ional group meetings f o r na t iona l l eaders i n h e a l t h admin i s t ra t ion and h e a l t h education and f o r o the r key personnel , f o r the study of sub jec t s such as : ( 1 ) t h e t r a i n i n g i n h e a l t h education given t o var ious kinds of h e a l t h workers; (2 ) h e a l t h education i n t h e c u r r i c u l a f o r medical s tuden t s ; ( 3 ) school h e a l t h e d u c a t i ~ and teacher t r a i n i n g , and ( 4 ) methods of curriculum development: a l s o t o conduct a study of f i e l d t r a i n i n g p r a c t i c e s .

Assistance provided by WHO dur ing the year. ( a ) A h e a l t h educator and a consul tant ; f o r thc workshop '(see below),two consul tants and a s s i s t a n c e from Regional Office and

thrce f i e l d s t a f f members; ( b ) cos t of attendance of 2 7 p a r t i c i p a n t s ; ( c ) supp l ies

and equipment.

Probable dura t ion of a s s i s t a n c e . Unt i l t h e end of 1974.

Work done dur ing the year . An in te r -coun t ry Workshop on Training i n Health Education was held i n t h e Regional Off ice from 14 t o 26 October. The workshop, which was i n t e r - d i s c i p l i n a r y i n charac te r , was a t tended by 27 p a r t i c i p a n t s - two from Afghanistan. two from Burma, th ree from Ceylon, seven from I n d i a , four from Indonesia, two from Mongolia, th ree from Nepal and four frem Thailand. I n the workshop, teamwork was demonstrated, and t h e r e was maximum participation by a l l uho a t tended i t , each p a r t i c i p a n t being given opportuni t ies t o serve i n a number of l eadersh ip r o l e s . The repor t on the Workshop has been widely c i r c u l a t e d , and a l a r g e number of requests f o r the documents prepared f o r the meetings were roceived and f i l l e d .

Under t h i s p r o j e c t , a WHO consul tant took up an assignment from November 1968 t o February 1969 t o a s s i s t i n s e t t i n g up a "Mater ia ls u n i t f o r Educational Methodology" i n the Regional Officc Library. This u n i t i s intended f o r the use of Regional Office and f i e l d s t a f f i n planning and conducting educat ional meetings such a s workshops, seminars and conferences. The oonsul tant a l s o prepared a n annotated l i s t of the mate r ia l s a v a i l a b l e i n the u n i t .

A h e a l t h educator was assigned t o the p r o j e c t i n May a rd has been giving a s s i s t a n c e t o s e v e r a l projectrr .

s ~ ~ / k c 2 2 / 2 Page 231

Strengthening of Medical Education (Apr i l - Aug. 1967; Sept. - Nov. 1967; Dcc. 1957 - Feb. 1968; Dts. 1968 - Frb. 1969; - )

Aim. To s t rengthen se lec ted departments of medical co l l eges and t o in t roduce modern teaching methods.

Assis tance provided by WHO dur ing the year . ( a ) A consul tant and two temporary a d v i s e r s ; f o r the seminars ( see below) a s s i s t a n c e from the Regional Adviser i n Medical Education and a secretary-stenographer from the Regional Off ice; ( b ) c o s t of attendance of 58 p a r t i c i p a n t s .

Work done dur ing the year. During December 1968-February 1969, a WHO consul tant i n pathology v i s i t e d nine medical co l l eges i n seven S t a t e s and Union T e r r i t o r i e s of India t o review, together with the na t iona l s t a f f , teaching, se rv ice and research i n t h i s s u b j e c t , i n order t o i d e n t i f y a reas i n which improvements seemed poss ib le and to suggest ways of achieving g r e a t e r e f fec t iveness . A noteworthy observation made by t h e consul tant was t h a t , with a few except ions , t h e r e was a r e l a t i v e s c a r c i t y of au tops les i n the medical co l l eges v i s i t e d . There was a l s o a re luc tance on the p a r t of the c l i n i c i a n s t o t a l k t o the r e l a t i v e s of the deceased i n order t o convince them of the s c i e n t i f i c importance of a post-mortem and ob ta in t h e i r concurrence t o i t .

During t h i s assignment, the consul tant a l s o a s s i s t e d i n organizing and conducting two seminars on the r o l e of pathology i n medical educat ion, held i n Mysorc (20-23 January) and New Delhi (3-5 February). Twcnty-two teachers of pathology and c l i n i c a l d i s c i p l i n e s from India and s i x from Ceylon a t tended the seminar held i n Mysore, and, f o r the one i n New D e l h i , the re were 30 p a r t i c i p a n t s (24 f r a n India and th ree each from Afghanistan and Burma). Two WHO temporary adv i se r s (one f o r each of the seminars) a s s i s t e d the consul tant i n conducting t h e meetings, and the Regional Off ice provided s e c r e t a r i a l a s s i s t a n c e . The obJect ives were no t only t o discuss and demonstrate the var ious methods appl ied i n the teaching of pathology, but a l s o t o promote i t s i n t e g r a t i o n with c l i n i c a l d i s c i p l i n e s and b e t t e r u t i l i z a t i o n of the se rv ices rendered by pathology departments.

The consu l t an t a l s o a t tended the annual meeting of the Indian Association of Pa tho log i s t s i n Bombay and presented a paper.

Leprosy Training Course (17-22 March 1969)

A i m of the p r o j e c t . To Conduct a leprosy t r a i n l n g course wi th emphasis on epidemiology and con t ro l .

Assistance provided by WHO dur ing the year. ( a ) A consul tant and a temporary adv i se r and a s s i s t a n c e from one of t h e Regional Advisers i n Communicable Diseases; ( b ) cos t of attendance of 16 p a r t i c i p a n t s .

S E A I R C Z Z ~ Page 232

Work done. An in te r -coun t ry Seminar on Trprasy Control wa?, held i n Kathmand', from 17 t o 22 March. ~t was a t t ended by four teen p a r t i c i p a n t s from Nepal ( t e n of whom were observers) and one each from Afghanistan and Ceylon, with a s s i s t a n c e from WHO

a s noted above.

A t t h i s seminar, d e t a i l e d discuss ions were held on var ious aspec t s of the epidemiology and con t ro l of leprosy under d i f f e r e n t and var ied condi t ions of prevalence.

The repor t on t h i s seminar was being processed.

SEAR0 0139 R UNICEF

Short Courses f o r Nursing Personnel ( Jan . 1967 - )

A i m of the p r o j e c t . To a s s i s t programmes f o r t r a i n i n g nurses i n the organizat ion, conduct and evaluat ion of shor t courses f o r nurs ing personnel and acquaint ing them with new concepts and s k i l l s ; t o prepare teaching and re fe rence m a t e r i a l s use fu l t o the e f f e c t i v e conduct of these courses; t o i d e n t i f y and develop s t u d i e s on nurs ing se rv ice and education.

Assistance provided by WHO dur ing the year . ( a ) Four nurse educators and a s s i s t a n c e from th ree nurses a t t ached t o o the r p r o j e c t s ; ( b ) a clerk-stenographer; ( 0 ) supp l ies a M equipment.

~ r o b a b l A u r a t I o n of a s s i s t a n o e . Unt i l t h e end of 1974.

Work done dur ing the year . During the period under review, t e n oourses were conducted under t h i s p r o j e c t i n s i x coun t r i es of t h e Region - two i n Afghanistan, one i n Burma, one i n Ceylon, f o u r i n I n d i a , one i n Nepal and one i n Thailand The top ics included c l i n i c a l teaching, admin i s t ra t ion of schools of nurs ing , h o s p i t a l house-keeping, planning f o r p a t i e n t c a r e , nurs ing l e g i s l a t i o n and l i c e n s i n g f o r p r a c t i c e , and supervis ion i n publ ic h e a l t h nurs ing. Four were in ter-country courses and s i x were na t iona l . O f the na t iona l courses , f i v e received a s s i s t a n c e from UNICEF. One of the courses l a s t e d two weeks, one three weeks, one f i v e wreks and the remaining seven four weeks each. A t o t a l of 200 p a r t i c i p a n t s a t t ended , from: Afghanistan (46). Burma (151, Ceylon (19) . Ind ia ( 4 1 ) . Indonesia ( 6 ) . Nepal (38) and Thailand (35) .

Also. under t h i s p r o j e c t , a workshop on nurs ing l e g i s l a t i o n and l i cens ing f o r p r a c t i c e was held i n the Regional Office i n March. Along with the nurses , f o u r non- nurse r e g i s t r a r s of nurs tne counci ls and one doctor having r e s p o n s i b i l i t y f o r hoal th l e g i s l a t i o n i n h i s country took p a r t in t h i s two-week workshop. I n t e r e s t was aroused i n nurs ing l e g i s l a t i o n and r e g i s t r a t i o n examinations, and recommendations were made t o help coun t r i es i n the preparat ion of nurse p r a c t i c e a c t s and with the r e v i s i o n of l e g i s l a t i o n a l ready enac Led.

I n vlew of the i n t e r e s t evinced by the p a r t i c i p a n t s i n the course on h o s p i t a l house-keeping which had been held i n 1968, a second course was conducted i n J u l y 1969 ( i n Trivandrum , Ind ia ) .

SEA/RCZZ/Z

Page 233

E f f o r t s have been made t r e v a l m t c t h c e f f e c t i v e n e s s of t h e s e n u r s i n g c o u r s e s .

Follow-up v i s i t s were p a i d t o n u r s e s who a t t e n d e d t h e pr~ogr'ammes and a s chedu l e f o r i n t e r v i e w s h a s been developed. Thcre a r e mzny problems r e l a t e d t c t h e devilopment of

e f f e c t i v e t o o l s f a r e v a l u a t i o n , and methods a v a i l a b l e t o d a t e do n o t a l l o w f o r a n

e f f e c t i v e a s se s smen t of t h e programne.

The v i s i t s by one of t h e WHO n u r s e s - t h e c o - o r d i n a t o r of t h e p r l j e c t - t o some of t h e c o u n t r i e s of t h e Region t o d l s c u s s f u t u r e c o u r s e s and t h e i r p l a c e i n t h e o v e r a l l n u r s i n : ~ c d u c a t i o n s y s t c n h a s he lped t o emphasize t h e need f o r b e t t e r p l ann ing

of e d u c a t i o n a l programmes i n r e l a t i o n t o t h e h e a l t h and n u r s i n g needs of t h e c o u n t r i e s

concerned .

SEARO 0140 R

R a d i a t i o n H e a l t h (Dec , 1967; Nov. - Dec. 1968; - 1

A i m of t he p r o j e c t . To a s s i s t i n p r o v i d i n g p r o t e c t i o n a g a i n s t i o n i z i n g r a d i a t i o n .

A s s i s t a n c e provided by WHO d u r i n g t h e yea r . A c o n s u l t a n t f o r two weeks.

Work done d u r i n g t h e y e a r . A WHO c o n s u l t a n t v i s i t e d Burma f o r app rox ima te ly t e n days i n November-December 1968 t o a d v i s e on p r o t e c t i o n a g a i n s t r a d i a t i o n h a z a r d s . I n h i s

r e p o r t , he recommended, among o t h e r t h i n g s , ass ignment of a team of t h r e e r a d i a t i o n

s a f e t y e x p e r t s , f u l l y equipped w i t h t h e n e c e s s a r y i n s t r u m e n t s , i n o r d e r t o conduct d e t a i l e d p r o t e c t i o n su rveys of t h e v a r i o u s r a d i a t i o n i n s t a l l a t i o n s I n t h e l a r g e

h o s p i t a l s i n Burma and i n a number of o t h e r s m a l l e r X-ray i n s t a l l a t i o n s i n t h e coun t ry .

The r e p o r t of t h e c o n s u l t a n t was submi t t ed t o t h e Government.

SEARO 0143

R Pha rmaceu t i c a l and Medica l S t o r e s Management

(March - June 1969; - )

A i m of t h e p r o j e c t . To p rov ide a d v i c e and a s s i s t a n c e t o governments of t h e Region i n connec t i on w i t h medica l s t o r e s s e r v i c e s : t o o rgan i ze academic t r a i n i n g c o u r s e s

i n t h i s f i e l d and t o h e l p t r a i n pe r sonne l .

A s s i s t a n c e p rov ided by WHO d u r i n g t h e y e a r . A c o n s u l t a n t .

Work done d u r i n g t h e yea r . A WHO c o n s u l t a n t was a s s i g n e d t o Nepal f o r t h r e e months

from mid-March t o a d v i s e and a s s i s t t h e medica l s t o r e s s e r v i c e s and t o h e l p t r a i n

pe r sonne l . A summary of h i s recommendations h a s been forwarded t o t h e Government.

sBnpc22/? Page 234

p g l o n a l Enteric Infections Team* (sept. 1966 - )

Aim of the Project. To a s s i s t governments in epidemiological investigations and control of outbreaks of enter10 infections including cholera,and wlth short t raining and demOnStration courses in the subject.

Assistance Provided by WHO d u r i n ~ the year. ( a ) A bacteriologlst and an epidemiologist/ cl inician (consultant); (b) a clerk-stenographer; ( c J supplies and equipment.

Probable duration of assistance. U n t i l the end of 1974.

Worlc done durinp; the year. During the period under review, the team assisted the Governments of Maldives and Nepal wlth the investigation and control of outbreaks of acute cases of gastro-enteritis. It also v i s i t ed Afghanittan, B u m and mdcnesia f o r VaryLng periods to help to review the choler8 si tuation in these countries and to conduct short orientation courses f o r medical s taf f of the health services on the diamosis, treatment and surveillance of cholera. In mrma, the team assisted wlth bacteriological investigation of acute gastro-enteri t is and also held orientation courses fo r health r f f ioe r s in the management of cholera. Similar assistance was provided to Afgkanistan. Assistance was provided wlth training courses i n India.

m e team paid a second v i s i t t o Burlna i n crder to a s s i s t with the-s.trengtben- ing of b a o t e r i o l o g l c a l - ~ . e p i d e m l o l ~ i o a l 1nvestigatians.of cases of acute gastro- e n t e r i t i s i n Rangoon.

Action was in i t i a t ed f o r holding a training course on cholera control i n Djakarta in December 1969, a s part of t h i s project.

Quali ty Control of Drum (oct. - Nov. 1968; Jan. 1969 - )

A i m of the project. To a s s i s t countries cf the Region in establishing o r strengthening t h e i r quali ty control servioes and laboratory competence, and to organize seminars on the quali ty control of drugs.

Assistance Provided by Wig) during the year. ( a ) Ihree consultants. For the seminar (see below) seven temporary advisers, the Chief of the Pharmaceuticals Unit a t WHO Headquarters, and assistance from the Reglonal Public Health Officer, an interpreter and two secretary-stencflaphers from the Regional Office; (b) cost of attendance of 15 participants.

Probable duration of assistance. u n t i l the end of 1975.

*Previous t i t l e : Regional Cholera Control !ream.

Work done dur ing the year. Dnder t h i s p r o j e c t , i n October-November, a WH) consul tant v i s i t e d New Delhi and Bombay t o make prel iminary arrangements f o r the seminar on q u a l i t y con t ro l of drugs ( see below).

The in te r -coun t ry Seminar on the Qual i ty Control of Drugs was held in Bombay from 1 3 t o 24 January and was a t tended by 15 p a r t i c i p a n t s from e i g h t coun t r i es of t h e Region. The temporary adv i se r s and s c i e n t i s t s from t h e pharmaoeutical indus t ry presented a t o t a l of 34 papers. In add i t ion t o the p a r t i c i p a n t s , t h e Seminar was a t tended by a s many a s 70 observers d a i l y . A repor t on t h e Seminar was under p r i n t .

Two WHO consu l tan t s - a pharmaceutical chemist and a micmbio log i s t - v i s i t e d var ious coun t r i es in the Region and undertook an assessment of the e x i s t i n g l e g i s l a t i o n and l abora to ry competence with regard t o t h e q u a l i t y con t ro l of drugs, and advised upon means and methods f o r the s t reng then ing of these services . The pharmaceutical chemist took up his six-month assignment e a r l y in January and, a f t e r a t t end ing p a r t of t h e seminar on q u a l i t y con t ro l mentioned above, v i s i t e d Afghanistan, B u m , Ceylon, India , Indonesia,Nepal and Thai land. During h i s v i s i t t o Burma, he a l s o a s s i s t e d t h e Qovemment in the p repara t ion of l e g i s l a t i o n f o r t h e q u a l i t y con t ro l of drugs and advised on bu i ld ing andequipgdng a c e n t r a l drugs laboratory. His r e p o r t s were being processed f o r submission t o t h e Clovernments concerned. The microbiologis t , who took up a three-month assignment in June, was a l s o v i s i t i n g t h e above-mentloned coun t r i es t o advise on t h e q u a l i t y c o n t r o l of b io log ica l products.

SEdHJ 0160 Nursing Studies R (June 1969 - )

AFm of t h e p ro jec t . To a s s i s t in t h e development and conduct o f s t u d i e s r e l a t e d to nurs ing s e r v i c e and education and in the use of t h e f ind ings of these s tud ies ; t o p a r t i c i p a t e in t h e s t u d i e s which r e l a t e t o n u r s i n g and/or t o provide consul tant se rv ices t o a u t h o r i t i e s wlshing t o develop s t u d i e s with a nurs ing component.

Assistance Drovided by WHO during the year. A consul tant .

Pmbable durat ion of a ss l s t ance . m t i l the end of 1974,

Work done d u T l n ~ the year. Towards the end of June, a WHO ~OnsUl tan t took up an assignment in Thailand t o a s s i s t in long-range planning f o r t h e conduct of a s tudy of t h e a c t i v i t i e s of nurs ing personnel a s s i m e d t o h o s p i t a l s under the Department of Medical se rv ices . c o l l e c t i o n of information f o r the study, which w i l l take a t l e a s t one year t o complete, has gone on throughout t h e per iod under review. Zhe o u t l i n e of t h e s tudy design was under preparat ion.

Hospi ta l S t a t i s t i c s and Medical Records (Jan. 1969 - )

Aim of t h e p ro jec t . To a s s i s t governments of t h e Region: ( I ) t o organize an e f f i c i e n t system f o r t h e maintenance and flow of records i n se lec ted h o s p i t a l s , (11) t o c o l l e c t , process and p resen t h o s p i t a l s t a t i s t i c a l data e f f i c i e n t l y on a r a t i o n a l sca le and (111) t o t r a i n medical records and h o s p i t a l s t a t i s t i c s personnel.

sEA/Rc22/2

Page 236

Assistance Provided by WHO d u r i n ~ the year. ( a ) A s t a t i s t i c i a n and a medical record o f f i c e r ; (b) supr lg cf pa?-r t o Ceylon f o r t h e n repara t ion of record f o l d e r s .

Probable durat ion of a ss i s t ance . u n t i l t h e end of 1974.

Work done dur ina t h e year. The p ro joc t came i n t o being Ln January 1969 a s a r e s u l t of the merging of p r o j e c t s SEAR0 0061 and SEAW 0072.

The WM) s t a t i s t i c i a n provided ad & a s s i s t a n c e t o t h e National I n s t i t u t e of Health Administration and Education, India. In February, he v i s i t c d Thailand f o r discuss ions on t h e t r a i n i n g of medical record o f f i c e r s and development of admin i s t ra t ive h o s p i t a l s t a t i s t i c s . He a l s o p a r t i c i p a t e d , i n Ban&ok, in the ECAFE-sponsored Workshop on S t a t i s t i c s of Children and Youth, a s well a s in the discuss ions n t t h e Asian I n s t i t u t e f o r Economic Development and Planning on t h e curriculwn f o r the f i r s t t r a i n i n g course in h e a l t h planning, to be held in November 1969.

In Apri l , a WHO medical record o f f i c e r was a s s i m e d t o Nepal f o r s i x months t o reorganize the medical record dspartment of B i r Hospi ta l in i t s new premises.

In Ceylon, some a s s i s t a n c e 1s being given t o t h i s p r o j e c t by t h e W H D medical record o f f i c e r a t tached t o t h e h e a l t h s t a t i s t i c s p r o j e c t (Ceylon 0045).

WorkshoDs on C e l l u l a r and Molecular Basis of the Iuimune Response. New Delhi (14 Oct. - 23 Nov. 1968 )

Aim of the Pro jec t . To t r a i n biochemists and immunologists in t h e bas ic techniques of modem molecular immunology a s well a s t o c r e a t e an atmosphere conducive t o advanced resea rch i n immunology in t h e Region, wi th p a r t i c u l a r emphasis on communicable diseases .

Assistance provided by Wm dur ina t h e year. ( a ) Four consul tants , t h r e e temporary adv i se r s and ass i s t ance from the Chief of the Iuimunology Unit , WHO Headquarters, and one of the Regional Advisers in Communicable Diseases; ( b ) subsis tence allowances f o r 'M p a r t i c i p a n t s , including cos t of t r a v e l f o r those from ou t s ide Delhi; ( c ) secretarial ass i s t ance ; (d ) suppl ies and equipment.

Work done. With t h e co-operation of s e n i o r s c i e n t i s t s in immunology from t h e United Kingdom and t h e U.S.A. two workshops on imunology - one on t h e molecular b a s i s and the o t h e r on t h e c e l l u l a r b a s i s of t h e immune response - were organized a t the A l l - India I n s t i t u t c of Medical Sciences. New Delhi. Tne workshop on t h e molecular b a s i s was a t tended by 20 p a r t i o i p a n t s from the Region [ I 9 from Ind ia and 1 from Thailand), and t h a t on t h e c e l l u l a r b a s i s was a t tcnded by 19 (1 from Ceylon, 17 f r o m Ind ia and 1 from Thailand) a s Well a s one parbioipant from the Western-Pacifiic-Re&m (Singapore) .

The c o n s u l t a n t - s c i e n t i s t s cons t i tu ted an i n s p i r i n g f a c u l t y , r e s u l t i n g in continuous aild in tens ive p a r t f c i p a t i o n by a l l those present . A l a r g e p a r t of the a c t u a l working time was devoted to p r a c t i c a l s , dur ing which a t l e a s t 13 t e s t s were performed by the pa r t i c ipan t s .

sEAhc22/2

Page 237

m e workshop r e s u l t e d in the es tabl ishment of r egu la r contact between s c i e n t i s t s within the Region doing t h e i r o m research in Fmmunology. A s a p a r t of t h e wo&shop, two seminars on communicable d i seases - one on cholera and one on l eprosy - were arranged, which achieved t h e i r goa1.m t h a t severa l of the s c i e n t i s t - p a r t i c i p a n t s who had no t been involved in communicable d i seases e a r l i e r , agreed t o c a r r y out Fmmunological r esea rch in these two diaeases. A s a r e s u l t , a t l e a s t two resea rch p r o j e c t s in these sub jec t s were s t a r t e d .

The workshops were followed up by an arrangement t o i s sue a ha l f -year ly news le t t e r f o r and by the p a r t i c i p a n t s . The f i r s t i s s u e in t h i s s e r l e s a p p o a r e d i n May.

Arrangements have been made f o r follow-up v i s i t s by consu l t an t s a s wel l a s f o r a review of t h e a c t i v i t i e s i n va r ious i n s t i t u t i o n s in o r d e r t o reach t h e goal of s e t t i n g up an eventual reference and t r a i n i n g cen t re in immunology.

SEAR0 0162 Course f o r Coding I n s t r u c t o r s . New Delhi R (11 - 20 November 1968)

A i m of t h e ~ r o d e c t . To provide o r i e n t a t i o n on the use of the Eighth Revision of t h e I n t e r n a t i o n a l C l a s s i f i c a t i o n of Diseases.

Assistance DrOvided by IWO during the year. (a) Two consu l tan t s and a s t a t i s t i c i a n from t h e Health S t a t i s t i c s Division, MRl Headquarters, and a s s i s t a n c e from Regional Office and f i e l d s t a f f ; ( b ) c o s t of attendance. of 27 p a r t i c i p a n t s .

Work done. Ihe course was held i n the Regional Of f ice from 11 t o 20 November 1968. m e r e were 20 p a r t i c i p a n t s from e i g h t coun t r i es of the Region (Afghanistan, BurDa, coylon, India , Indonesia, Mongolia, Nepal and Thailand). In addi t ion, f o u r p a r t i c i p a n t s from t h e Eastern Mediterranean Region and t h r e e from t h e Western Pac i f i c a t tended the course. The IWO s t a f f members involved ac ted a s "resourcc persons" under t h e t echn ica l d i r e c t i o n of the Regional Adviser in Health S t a t i s t i c s . The course provided o r i e n t a t i o n and t r a i n i n g in t h e use of t h e Eighth Revision of the I n t e r n a t i o n a l c l a s s i f i c a t i o n of Diseases, which came i n t o e f f e c t on 1 January 1968, and on t h e coding of diagnoses and causes of death.

SEARO 0168 Training in Veterinary Public Health R (Aug. - Sept. 1968; m r c h - June 1969; - )

Aim of t h e o r o l e a t . To a s s i s t in t h e t r a i n i n g of v e t e r i n a r y pub l ic h e a l t h o f f i c e r s .

.. .. Assistance Drovided by WI~O during t h e Year. DO consu l t a i~ t s .

Probable durat ion of a ss i s t ance . Unt i l t h e end of 1971.

Work done d u r i n ~ t h e year. In August 1968, a WHO consul tant v i s i t e d t r a i n i n g i n s t i t U t i 0 n s i n both medical and v e t e r i n a r y f i e l d s In m d i a and reviewed t h e possible establishment of a two-year post-graduate course in v e t e r i n a r y pub l ic hea l th , t o be organized j o l n t l y by the Indian Veter inary Research I n s t i t u t e . Izatnagar , and the Al l - India I n s t i t u t e of Hygiene and Public Health, Calcut ta . His recommendations

SEA/RC22/;!

Page 238

were followed up, and an i n i t i a l agreement t o give t h i s t r a i n i n g was reached

with t h e University of Calcut ta . Fellowships have been offered f o r s e n i o r s t a f f

members t o be t r a ined abroad t o serve i n t h e new u n i t of veterinary publ ic h e a l t h

t o be es tab l i shed a t t h e Al l - India a s t i t u t e . Fur ther a s s i s t a n c e w l l l bc given on t h e comgletion of these fellowships so a s t o support the development of a c t u a l

t r a i n i n g i n ve te r ina ry public hea l th .

During March-June 1969, another WHO consul tant a s s i s t e d the Government of

India i n t h i s f i e l d , with p a r t i c u l a r reference t o t h e development of an animal-

d i sease i n t e l l i g e n c e s e r v i c e . The consu l t an t ' s r e c o m n d a t i o n s were under review.

The same consul tant a l s o reviewed the s t a t u s of ve te r ina ry public hea l th

t r a i n i n g i n t h i s sub jec t i n Indoncsia and Thailand: h i s recornendations were

l a t e r discussed with the respec t ive governments. The review c l e a r l y brought out

t h e need f o r f u r t h e r e f f o r t s towards t h e e s t a b l i s h m n t of regional t r a i n i n g

f a c i l i t i e s i n ve te r ina ry public hea l th .

Por t Health

( ~ e b . - A p r i l 1969)

pim of the ~ r o d e c t . To s t reng then por t h e a l t h s e r v i c e s .

Assistance Drovidad by WHO dur ing the Year. A consul tant .

Work done. Under t h i s p r o j e c t . a WHO c o w u l t a n t v i s i t e d Ceylon-and Indonesia dur ing t h e period from February t o A p r i l , to a s s i s t the governments

concerned with s t rengthening and reorganizing t h e i r por t h e a l t h s e r v i c e s . His re -

commendations have been discussed with t h e governments, and h i s r e p o r t s were

being processed.

Rehab i l i t a t ion of Handicapged Children

(Oct. 1968 - J a n . 1969; - )

pim of the w o l e c t . To s tudy t h e a v a i l a b l e r e h a b i l i t a t i o n f a c i l i t i e s f o r

handicapped ch i ld ren and t o advise on measures f o r improvement.

Assistance provided by WHO durinR the year . A consu l t an t .

Work done dur ing t h e year . During October-December 1968, a WHO consul tant s tudied

t h e p reva i l ing s i t u a t i o n i n regard t o hand icappedch i ld ren i n Afghanistan, Burma,

I n d i a , Indonesia and Thailand.

Based on h i s f i n d i n g s , and i n keeping with t h e p r i o r i t y needs and resources

of t h e coun t r i es v i s i t e d , he proposed p r a c t i c a l measures f o r improving t h e h e a l t h

care programmes f o r handicapped ch i ld ren and ou t l ined f i e l d s i n need of f u r t h e r

s t u d i e s . His r e p o r t was s e n t t o the governments concerned, and-ass i s t ance i n

implementing t h e major r e c o m n d a t i o n s was under considerat ion.

Seminar on F l u o r e s c e n t Antibody

Technique i n t h e D i a g n o s i s of R a b i e s ( 2 1 - 28 A p r i l 1969; - )

A i m of t h e p r o j e c t . To d e m o n s t r a t e t h e f l u o r e s c e n t a n t i b o d y t e c h n i q u e i n t h e

d i a g n o s i s of r a b i e s .

A s s i s t a n c e p r o v i d e d by W O d u r i n g t h e y e a r . ( a ) A c o n s u l t a n t a n d two temporary

a d v i s e r s ; ( b ) a s s i s t a n c e from t h e R e g i o n a l Advise r on H e a l t h L a b o r a t o r y S e r v i c e s and t h r e e s t a f f members a s s i g n e d t o f i e l d p r o j e c t s ; ( c ) c o s t o f a t t e n d a n c e of 1 3

p a r t i c i p a n t s ; ( d ) s e c r e t a r i a l a s s i s t a n c e ; ( e ) s u p p l i e s and equipment and a

f l u o r c s c e n c c microscope .

P r o b a b l e d u r a t i o n of a s s i s t a n c e . U n t i l t h e end of 1974.

Work done d u r i n g t h r y e a r . The Seminar was h e l d a t t h e F a s t e u r I n s t i t u t e i n Coonoor ( S o u t h I n d i a ) from 2 1 t o 2 8 A p r i l and was a t t e n d e d by 1 3 p a r t i c i p a n t s ( t w o from

A f g h a n i s t a n , one from Burma, two from Ceylon , two from I n d i a , two from I n d o n e s i a ,

two from Nepal and two from T h a i l a n d ) . I n a d d i t i o n t o d e m o n s t r a t i o n s of immuno-

fluorescent nr ic roscopy , t h c p a r t l c i p a n z s wcre giv:>n o r i c n t a t i o n i n o t h e r l a b o r a t o r y

p r o c e d u r e s i n t h e d i a g n o s i s of r a b i o s . P a r t i c u l a r s of t h e t e c h n i q u e w i l l be g i v e n

wide c i r c u l a t i o n .

The seminar l e d t o a r r a n g e m e n t s f o r c l o s e r c o - o p e r a t i o n between workers

i n t h e Region and t h e I n t e r n a t i o n a l R a b i e s R e f e r e n c e C e n t r e i n Coonoor.

T r a i n i n g Courses on t h e O r g a n i z a t i o n of M a t e r n a l and C h i l d H e a l t h F i e l d P r a c t i c e

Programmes i n Medica l C o l l e g e s ( J a n . - Mar. 1969)

A i m of t h c p r o j e c t . To f o r m u l a t e p l a n s f o r strengthening t h e r c l a t i o n s h i p among

d e p a r t m e n t s o f s o c i a l and p r e v e n t i v e m e d i c i n e , o b s t e t r i c s and gynaecology , a n d p a e d i a t r i - s and i l s o for. d c v e l o p i n c a j o i n t comprehensive m a t e r n a l and c h i l d h e a l t h

f i e l d t r a i n i n g programme w i t h i n t h e framework of e x i s t i n g c u r r i c u l a .

A s s i s t a n c e p r o v i d e d by WHO d u r i n g t h e y e a r . ( a ) A f a c u l t y c o n s i s t i n g of s i x WHO c o n s u l t a n t s ( two of whom were on tcmporary l o a n from o t h c r p r o j e c t s ) and s e v e n

temporary a d v i s c r s ; ( b ) s e c r e t a r i a l a s s i s t a n c e : ( c ) c o s t of a t t e n d a n c e of p a r t i c i p a n t s .

Work done . The f i r s t of t w ~ c o u r s e s was h e l d a t C h r i s t i a n Medica l C o l l e g e , V e l l o r e

( I n d i a ) f rom 1.1 t o 28 F e b r u a r y 1 9 6 9 , and t h e sccond t o o k p l a c e a t t h e A l l - I n d i a I n s t i t u t e of M r d i r a l S c i e n c e s , New D e i h i , from 11 t o 22 March. Thc p a r t i c i p a n t s were

professors and s e n i o r t e a c h e r s of p r e v e n t i v e and s o c i a l medicine, o b s t e t r i c s and

p a e d i a t r i c s from 1 4 m e d i c a l colle&'es i n I n d i a , one i n Ceylon and one i n I n d o n e s i a . The c s u r s c k i l d i n V c l l o r a was a t t i ended by 20 p a r t i c i p a n t s ( 1 8 from I n d i a and two

from C e y l o n ) * and t h a t i n New D e l h i by 2 1 (18 from I n d i a and t h r e e from I n d o n e s i a ) . The pr , ;g: ,am.~ c n n t < . n t -f t h i ::cur;.::, 2 s ir:c,:rmini.d 'ly th,: r b j c c t i v c s , was concerned w i t h bo th t h e 3 r y a n d p r a c t i c a l a p p l i c a t i o n oi' comprehenslve c a r e f o r mothers and

c h i l d r ~ c n .

sm/Rc22/2 Page 240

Each course was planned and car r ied out as a workshop, i n l i n e with t he pr incipal object ive of preparing prac t ica l plans f o r j o in t provis ian of f i e l d t ra in ing f o r each col lege from which the par t i c ipan ts came.

Subsequent evaluat ion by par t i c ipan ts and f acu l t y indicated t h a t the workshops had been useful and had met t he object ives s e t by affording key members of the departments opportuni t ies : (a) t o explore together the concept of comprehensive hea l th care f o r mothers and ch i ld ren ; (b) t o consider the r e spons ib i l i t i e s and functions of the doctor i n providing t h i s c a r e ; ( c ) t o evaluate t h e i r own medical school cur r icu la ; (d ) t o determine what changes a r e required t o improve the doctor 's a b i l i t y t o meet h i s r e spons ib i l i t i e s and f u l f i l h i s funct ions; ( e ) t o l e a rn i n what ways each of the spec i a l t i e s considered it Was contr ibut ing t o t h i s goa l , and ( f ) t o develop j o in t l y , i n each of t he f i e l d p rac t ice s e t t i n g s , concrete plans f o r teaching comprehensive carc of mothers and chi ldren.

National Health Planning (March 1969; - )

A i m of the pro jec t . To promote the development of na t iona l hea l th s e m i c e s i n the countr ies of the Region by (1) formulating and evaluat ing nat ional hea l t h plans; ( 2 ) t r a i n ing nat ional hea l th personnel; ( 3 ) organizing meetings and study groups and 4 conducting operat ional and manpower s tud ies .

Assistance provided by WHO durinx t he year . ( a ) Three temporary advise rs ; ass i s tance Pram Regional Office and f i e l d s t a f f ; ( b ) co s t of attendance of par t i c ipan ts i n two mee t i qp .

Probable durat ion of ass i s tance . Until 1972.

york done durinx t he year. In February, a technical committee met a t t h e Asian I n s t i t u t e f o r Economic Development am3 Planning, Bangkok, t o prepare a syl labus f o r the f i r s t course i n na t iona l hea l th planning, t o be organized a t the I n s t i t u t e i n November 1969. The committee a l s o determined t he f acu l t y a s well a s the durat ion of the course and t he number of par t i c ipan ts . A WHO temporary adviser a s well as a regional o f f i c e and a f i e l d stsir member per t io ipa ted i n t h i s meeting.

Between 26 and 28 March, a discussion group meeting was convened i n the Regional Off ice , attended by 34 par t i c ipan ts (20 from M i a and two from each of the other countr ies of the Region with the exception of igldives),who were a l l sen ior o f f i c i a l s of d i r ec to r a t e s of hea l th services o r non-mdical adminis t ra tors from min is t r i es of heal th . 14ro WHO temporary advisers a s s i s t ed with the conduct of t he meeting, i n which severa l s t a f f members took pa r t . The m i n object ive of the meeting was t o give a br ie f orientation on na t iona l hea l th planning as par t of development planning and t o acquaint the par t i c ipan ts of possible WX0 ass i s tance i n t h i s f i e l d .

SEA/RCZZ/Z Page 241

SEAR0 0179 Nut r i t iona l Rehab i l i t a t ion and Rehydration Centres R (July 1967 -

A i m of the prodect. To assess the f e a s i b i l i t y of i n s t i t u t i n g s p e c i a l cen t res

f o r n u t r i t i o n a l r e h a b i l i t a t i o n and rchydrat ion of c h i l d r e n ; t o study the a v a i l a b i l i t y of h e a l t h f a c i l i t i e s f o r undernourished and dehydrated ch i ld ren ,

and t o advise cn d e s i r a b l e measures of improvement, i n co-operation with major

paed ia t r i c departments o r h o s p i t a l s .

Assistancf Drovidcd by WHO dur ing the year . A consul tant

Probable dura t ion of a s s i s t a n c e . Unt i l the end of 1969.

Work done dur ing t h e year . Ear ly i n J u l y , a WHO consul tant took up a three-month assignment, dur ing which he 1s t o v i s i t Afghanistan, Burma, Ceylon, Indonesia,

Nepal and Thailand, t o assess t h e f e a s i b i l i t y of e s t a b l i s h i n g n u t r i t i o n a l

r e h a b i l i t a t i o n and rehydrat ion ccn t rcs a s p a r t of the general h e a l t h services.

By the end of J u l y , he had completed h i s s tud lus i n Afghanistan and Nepal.

SEAR0 02 00 P e l l o w s h i ~ s R

Hospital Administration. A two-month fe l lowship f o r a m d i c a l o f f i c e r from Ceylon f o r p a r t i c i p a t i o n i n the R i f t h S ta f f College course , held a t t h e National I n s t i t u t e

of Health Administration and Education, New Delhi ( see Ind ia 0218).

~l%~/RC22/2 Page 242

11. INTER-REGIONAL (PRWECTS WITHIN THE REGION)' . . .. . . - . . . . . . . . . .. . . . . . .~

Project No. Source of Funds Co-operating

Agencies T i t l e - Inter-regional 0190 Leprosy/Bc~ T r i a l Team. Burma

R (Apr i l 1964 - )

A i m of the p ro j ec t . To car ry out a t r i a l of BCG vaocination i n the prevention of leprosy.

Assistancc provided by WHO during the year . A l epro log is t , a s t a t i s t i c i a n , a leprosy cont ro l o f f i c e r and a s c i e n t i s t .

Probable durat ion of ass iotance . Unti l 1971.

Work done during t he year . mis long-term study i n Mandalay proceeded s a t i s f a c t o r i l y . The t o t a l population included i n the t r i a l was 78 012 (36 483 up t o 15 years of agc and 41 529 i n the age-group above 15 y e a r s ) ; out of these 72 136 were examined. Cases detected i n the t r i a l area were: lepromatous 319, tuberculoid 1 728 and borderline 45. The t o t a l number of chi ldren reached 13 793 i n the BCO group and 13 786 i n the cont ro l group.

The re-exandnation of chi ldren, pa t i en t s and household contacts was continued, and new population i n the v i l l age s was reg is te red and examined. Children under one year of age were a l s o included i n the t r i a l .

Inter-regional W28 Seminars and Training Courses on R Cholera Control

(10 May - 8 June 1965; 14 March - 4 Apri l 1966; 19 May - 6 June 1969; - )

A i m of the pro jec t . To give advanced t ra in ing t o medically qua l i f i ed workers who are a c tua l l y dealing with cholera con t ro l work.

Assistance provided by WHO during the year . ( a ) A consultant and ass i s tance from two

Staff members from WHO Headquarters; (b) cost of attendance of pa r t i c i pan t s .

Work Qone during the year . An Inter-regiorml Training Course on Cholera Control was held a t the School of Tropical Medicine, Calcut ta , from 19 t o 3 1 May and i n

'This l i s t Includes meetings and scninars hclii wi thin thc Region f o r which the m?in rcsPonsib1llty was t ha t .f WHO Hcadqwrtcrs. However, ass i s tance i n t h e i r organization hzs Often been givcn by the Regional Off ice , which a l s o has sometime8 financed i t s own par t i c ipa t ion . Meetings of t h i s nature f o r which the Regional Office has the main respons ib i l i ty a r e l i s t e d i n Sect ion 10.

SEA/RC22/2 Page 243

n a n i l a and Hongkone from 1 t o 6 June 1969. The course was a t tended by 1 5 p a r t i c i - pan t s f r c m t h e Eastern Mediterranean, Western Pac i f i c and S o u t h - ~ a s t Asia Regions ( 2 each from I n d i a , Indonesia and Nepal).

In te r - reg iona l 0271 Research Unit f o r the Control of Mosquito Vectors of F i l a r i a s i s , Rangoon (Nov. 1962 - )

A i m of t h e p ro jec t . To c a r r y out research and f i e l d t r i a l s on t h e con t ro l of mosquitoes, p a r t i c u l a r l y the vectors of f i l a r i a s i s , using organo-phosphorus and o the r new i n s e c t i - c i d e s , b io log ica l con t ro l procedures and o the r techniques not a t p resen t employed.

Assis tance provided by WHO d u r i n ~ the year . A medical o f f i c e r (epidemiologis t ) and t h r e e entomologists.

Probable dura t ion of a ss i s t ance . Unt i l the end of 1969.

Work done during t h e year. The Chief of the Vector Biology and Control Unit from WHO Headquarters, accompanied by a WHO consul tant and one o f the Regional Advisers i n Communicable Diseases , v i s i t e d the p r o j e c t and had d e t a i l e d d i scuss ions on t h e programme with the p ro jec t s t a f f and Burmese Government Of f ic ia l s .

Epidemiological inves t iga t ions aimed a t a s sess ing the transmission of f i l a r i a s i s and i ts i n t e r r u p t i o n by vector con t ro l measures were continued,

Laboratory experiments on a t t r a c t i o n , sk in pene t ra t ion , blood inges t ion and mating of C.p.fatigans were conducted.

In te r - reg iona l 0276 Cholera Control Team WP( TA) (March 1964 - )

A i m of t .e p r o j e c t . To a s s i s t i n ep:demiological s t u d i e s and i n measures f o r the con t ro l of cholera and to proncte na t iona l programmes f o r the study and c o n t r o l of t h i s d isease .

Assistance provided by WHO during the year. A b a c t e r i o l o g i s t , a s a n i t a r y engineer and s c v ~ n c o n s ~ ~ l t i l n t s .

Work done dur ing the year. The team a t the Cholera Research Centre, Calcueta, completed i t s s tud ies on the epidemiology of cholera and confirmed, through longi- tud ina l follow-up of f a m i l i e s , the wide spread of i n f e c t i o n i n con tac t s of cholera cases . The s t u d i e s i n 1969 were concentrated mostly on the immune responses i n cholera cases a s well a s i n sub-c l in ica l in fec t ions and negat ive contacts . For t h i s purpose, severa l consul tants : issisted f o r shor t per iods dur ing the cholera season.

The epidemiologist on t h e team, who took up h i s d u t i e s i n March 1968, spent some time i n Thailand, reviewing the s tud ies on cholera epidemiology i n and around BangXok. He completed h i s assignment i n September 1968 and was reassigned t o t h e p r o j e c t i n March 1969. During the 1969 assignment the epidemiologist again a s s i s t e d the s t u d i e s i n Thailand.

During the g e a r , another consul tant went t o Bangkok t o a s s i s t with cholera c a r r i e r s t u d i e s .

SEA/Rc22/2 Page 244

The s aa i t a ry engineer completed h i s assignment i n January 1969.

Inter-regional 0306 Research U n i t f o r the Control of Special Account f o r Aedes a e m t i . Bangkok Medical Research (Apr i l 1966 - )

A i m of the p ro j ec t . To car ry out research and f i e l d t r i a l s , o n the cont ro l of ABdes aegypt i .

Assistance provided by WHO during the year . A medical o f f i c e r , an entomologist and a consul tant .

Work done during the year . I n the research on the bionomics and ecology of the vector , considerable work was done t o es t imate the densi ty of the vector a r a i t s b i t i ng hab i t s , and t o study aspects of vector con t ro l . The r e s u l t s of the experi- ments have shown tha t the l a rv i c ide Abate, when used i n water containers , i s h i sh ly e f f ec t i ve . The t r i a l s with ultra-low-volume spraying a l s o e f fec ted a ConsidePable reduct ion in the number of adu l t mosquitoes i n sprayed a reas .

A WHO consultant v i s i t e d the pro jec t t o review the work of the un i t and made recommendations on v i ro log ica l and epidemiological s tud ies . He observed t h a t the epidemiological evaluat ion of the e f f e c t of con t ro l measures i n the transmission of denguehaemorrhagic fever would be d i f f i c u l t a s such an evaluat ion would requi re a much more extensive and comprehensive mosquito cont ro l programme covering l a rge r areas than i s a t present being undertaken.

The team leader completed h i s assignment and was t rans fe r red t o another region.

Inter-regional 0308 Advisory Team on the Epidemiology of R Mental Disorders

(March 1968 - )

A i m of the pro jec t . To a s s i s t research pro jec t s on the epidemiology of mental disorders i n var ious countr ies .

Assistance provided by WHO during the year . A psychiatric epidemiologist .

Probablc durat ion of ass i s tance . Unti l 1970

Work done during the year . The WHO psychia t r ic epidemiologist , who, a s a p a r t of t h i s team, a s s i s t ed the Agra Pield Research Centre of the In te rna t iona l P i l o t Study on Schizophrenia, completed N s work i n October. During t h i s assignInent, h e a l s o v i s i t e d a number of mental hea l th hosp i t a l s and teaching i n s t i t u t i o n s throughout Ind ia . H?.S nbserrat ions cnnfirmcd t h a t comparatively low p r i o r i t y was being assigned t o mental hea l th care within the genera l hea l t h se rv ices , and t h a t the lmportance of psychiatry i n medical education was not ye t f u l l y recognized.

SEA/RCZ2/2

Page 245

~ n t e r - r e g i o n a l 0388 second 1n':er-regional Training Course on

R Methods and Techniques f o r P a r a s i t i c - Disease Surveys, Bangkok

( 5 May - 14 June 1969)

A i m of the p r o j e c t . To enable medical o f f i c e r s i n charge .of p a r a s i t i c d i sease

con t ro l programmes and other responsible o f f i c e r s t o adapt modern epidemiological

survey techniques t 0 l o c a l cond i t ions .

Assistance provided by WHO during the yoar . ( a ) Two consul tants ; ( b ) c o s t of

attendance of p a r t i c i p a n t s .

Work done. This six-week course was held a t the Schonl of Tropical, Medicine i n Bangkok f o r s ix teen p a r t i c i p a n t s from s i x regions. It was a t tended by s i x p a r t i c i p a n t s from Sauth-East Asia: one from Burma, one from Ceylon, and two each from Indonesia and Thailand. I n add i t ion t o the consu l t an t s , 1'7 temporary adv i se r s a s s i s t e d with the course f o r varying per iods .

In te r - reg iona l 0475 Assistance t o National Radiat ion

R Heal th Programmes

(Scpt . 1968 - )

A i m of t h e p r o j e c t . To a s s i s t governments i n planning and implementing r a d i a t i o n

h e a l t h programmes and i n t r a i n i n g na t iona l personnel .

Assistance providrrl by ',!iiO during t h e year . A medical o f f i c e r

Probable dura t ion of a ss i s t ance . Unt i l 1970

Work done during the year . A WHO medical o f f i c e r , assigned j o i n t l y t o the

Regional Off ices f o r South-East Asia and t h e Western P a c i f i c , took up h i s d u t i e s

i n August 1968. He v i s i t e d Bombay and Pudukottai i n Ind ia , and a l s o Burma. Thailand,

Indonesia and Ceylon, during October-November 1969, and submitted r e p o r t s .

He l e f t f o r Manila i n December t o take up a s imi la r assignment i n the

Western Pac i f i c RegLon.

In tc r - reg iona l 0585 Advisory Groups on Malaria Erad ica t ion MESA S t r a t e u

( ~ u n e 1968 - )

A i m of the p r o j e c t . To i d e n t i f y and a s s e s s , i n se lec ted malaria e r a d i c a t i o n

programmes a t various s t agcs of pl.oeress, the socio-economic, admin i s t ra t ive and

t e c h n i c a l f a c t o r s , both favourable and unfavourablc, r e l a t e d t o t h e i r p lan t ing and implementation; t o s tudy and review the adcquacy of the v ig i l ance organizat ion

i n the maintenance phase of malaria e rad ica t ion .

SEA/RCZ~/Z Page 246

Assistance provided by WIIO during the year. See below

Probable duration of ass i s tance . Until the end of 1969.

Work done during the year. The pro jec t was i n operation f o r two d i f f e r en t and independent purposes.

F i r s t , a s pa r t of a review of the global s t ra tegy of malaria e rad ica t ion , a rrocic-economic assessment of the programme i n Thailand was undertaken during July- August 1968 by a team consis t ing of an economist (team l e ~ d e r ) , a public heal th planner, a malarfologis t and a s t a t i s t i c i a n . The team, t o which a s t a t i s t i c a l a s s i s t a n t and a secretary-stenographer were assigned from the Regional Office, prepared a repcr t on i t s f indings f o r submission be WHO Headquarters, PS om ET. nine repcr t s from s imi la r prcgrammes i n varioi;s regions, Pcr use i n preparing m t e r i a l f o r t he Twenty-second World Health Assembly.

Early i n 1969, under the same p ro j ec t , a rnalari0logiSt and n p u b l i c h e a l t h adminis t ra tor from WXO Headquarters v i s i t e d the malaria programmes i n Ceylon and India i n order t o study &r,d review the adequacy of the vigi lance organization i n the maintenance phase of malaria eradicat ion.

sEAfic22/r Page 247

Project No. and Source of Funds

Inter-regional 0120.2

UNDP ( TA )

Inter-regional 0221 Regular

Inter-regional 0285 UNDP( TA)

Inter-regional 0398

Regular

INTER-REGIOWLL (PROJECTS OUTSIDE THE REGION WITH PARTICIPANTS FROM THE SOWH-EAST ASIA REGION)

T i t l e - Number of

Par t i c ipan ts

~ i g h t h Course on the Epidemiology and Control 3 ( 1 from Ceylon,

of Tuberculosis, 1 from Indonesia and

Prague (17 Apri l - 17 Ju ly 1969) and 1 from Thailand)

India (18 Ju ly - 17 August 1969)

Nineteenth Anaesthesiology Course, Copenhagen 3 (1 from M i a , (13 January - 12 December 1969) 1 from Indonesia and

1 from Thailand)

S ix th Refresher Course i n Anaesthesiology, 1 from Thailand

Copenhagen ( 1 - 21 June 1969)

Fourth Training Course i n Human Genetics f o r 2 ( 1 from Ceylon and

Teaching i n Medical Schools. Copenhagen 1 from M o n e s i a !

( 2 September - 23 November 1968)

Inter-regional Malaria Conference, Beirut 2 from Afghanistan (5 - 11 December 1%8)

Inter-regional Ga in ing Course on Cholera, 9 ( 3 from M i a ,

Ind ia , Hong Kong and Phi l ippines , 3 from Indonesia and (19 May - 6 June 1969) 3 from Nepal)

Second Inter-regional Course f o r Cl in ica l 3 (1 from India and Ins t ruc tors i n Physical Therapy, Copenhagen 2 from Indonesia ) ( 1 September - 30 Bovember..l%8) . Third Advanced Training Course i n the 2 ( 1 fron: India and Diagnosis, Treatment and Prevention of 1 from Mongolia) Major Cardiovascular Diseases, Copenhagen (1 November 1968 - 28 June 1969)

F i f t h course i n Child Dental Health, 2 (1 from India and Copenhagen 1 from Indonesia) (1 March - 3 1 May 1969)

In te r - reg iona l Training Course i n Biologi- 1 from Indonesia c a l Standardization, Zagreb

(30 September - 26 October 1968)

~EAhc22f2 Page 248

Project No. and Source of Funds

Number of Part icipants

Inter-regional 0468 Inter-regional Course on Mothods of Epidemio- Regular logica l Surveillance, Prague and Primstone

(V - 27 August 1968)

Inter-regional 0471 Training Course on Occupational Health i n Regular Agriculture, Dundee

(1 October - 8 November 1968)

Inter-regional 0473 Advanced Course i n Maternal an i Child Health, Regular Warsaw

(12 September - 25 October 1968)

Inter-regional 0476 Inter-regional Seminar on Teaching Methoda Regular and Teaching Aids, Aaa ra

( 9 - 14 September 1968)

Inter-regional 0488 Travelling Seinlnar on the Disinfection of W P ( TA ) Drlnking Water, USSR

( 2 - 24 September 1968)

Inter-regional W96 Inter-regional Travelling Seminar on the UMDP(TA) Organization of Refresher Courses fo r

Medioal S t a f f , USSR ( 8 - 31 October 1968)

NON-INTER-REQIONAL ACTIVITIES WITH PARTICIPATION OF CANDIDATES FRClil THE REQION

Training Course on Measurement and Evaluation Techniques in Health Edwation. Teheran ( 4 - 30 November 1968)

Rfl0/81/l Seinlner on Agricultural and Public Health WHOhAO/IAEA Aspects of Environmental Contamination by

Radioactive Materials, Vienna (24 - 28 March 1969)

!i&%& Laboratory Training Course i n Nutr i t ional US-Japan Co-operative Anaemia Research, U l a Iumpur Medical Soience (24 March - 6 April 1969) Programme

2 (1 from Ceylon and 1 from India)

j (1 from Ceylon,

1 from Indonesia and 1 from Thailand)

2 ( 1 from Indla and 1 from Nepal)

8 (1 from Afghanistan, 2 from Ceylon, 1 from M i a , 2 from Indonesia and 2 from Thailand)

4 (1 from Afghanistan 2 from Ceylon and 8 from India)

5 (1 from Afghanistan, 1 from Ceylon, 1 from Mongolia and 2 from Thailand)

3 ( 1 from India, 1 from Nepal and

1 from Thailand)

2 (1 from M i a and 1 from Indonesia)

5 (1 from Afghanistan, 1 from Ceylon.

1 from M o n c s i a and 2 from Tnalland)

SEA/RC22/2 Page 249

A N N E X E S

ORGANIZATIONAL CHART ( 1 ku,-ust 1969)

r OFFICE OF THE REGIONAL DIRECTOR

R e ~ i o n a l D i r e c t o r i--

I

S D i r e c t o r , Heal th Services

I ASSISTANT DIRECTORS, HEALTH SERVICES

Dr S .P. Ramakrishnan 1 D r Mahendra Prasad

Dr K.S. Sea l

D r Marsaid

-AL ADVISZRS -

Malar ia Erad ica t ion - Dr F .R.S. K e l l e t t

M a l a r i o l o g i s t s - D r V.S. Orlov - D r Y.S. K i m - Dy G .L. Adan

Entomologist (Mall S a n i t a r y Engiheer (Mal) - Vacant) Tuberculosis

- Ivacantl - D r t .L . Hi tze Communicable Diseases - D r B. I g n j a t o v i c Communicable Diseases - D r J.L. de V r i e s Community Heal th Serv ices - (Vacant) Community Heal th Serv ices - D r Q.H. K i l l e n Public ~ e a i t h O f f i c e r - D r R.H. Strudwick Health Laboratory Serv ices - D r G.S. Tau11 Bealth S t a t i s t i c s - (Vacant) Health S t a t i s t i c i a n -Miss V.C. Nguyen Nursing - Miss D.C. Hall l u r s i n g - Miss R. Dean kea l th Education - (Vacant) t a t e r n a l and Child Health - D r A.M. Gade t a t e r n a l and Child Health - (Vacant) Zu t r i t ion - D r W . K e l l e r $ n v i r o m e n t a l Heal th - M r G. Et ienne lnvironmental Heal th - (Vacant) l e d i c a l Education - D r E.G. Kapal l e d i c a l Education - D r A.R. M i l l s ~ e l l o w s h l p s O f f i c e r - D r R . Manrique

WHO .-;S

Afghanistan - D r P.P.M. Clement

Burma - D r C . Guttuso

Ceylcn - D r N.M. Van d e r Hoff

l n d i a - DP F . Loven Indonesia - D r A . Malaterre

Mongolia - D r R . HanaW

Nepal - Dr c .G .I. Gordon

Thailand - D r G . J . S t o t t

Reports Of f ice r

Miss M . Wheldon

I INPORMATION RETRIEVAL UNIT I

I FIELD PROJECTS I * l i a i s o n Off ice r

M r K. Frucht Information Of f ice r

(vacan t )

I OFFICE OF ADMINISTRATION AND FINANCE Chief . Off ice of Admin. and Finance

i I M r R.S. Well 1 Adminis t ra t ion and Finance Of f ice r

(Vacant)

Personnel Off icer

I I FINANCE, BLTGET AND ACCOUNTS WIT [ Budget and Finance Of f ice r

M r P.G.T. Dunderdale Finance Off icer - M r J.M. Chaula

MEDICAL SUF'PWES UNIT

Medical Supp l ies Off icer M r N. Cobbold

SEA/RC22/2 Page 252

Annex 2

GEWRAPHICAL DISTRIBUTION OF INTERNATIONAL STAFF ASSIGNED

TO THE SOUTH-EAST ASIA REGION (AS ON 30 JUNE 1969)

Country

Afghanistan

Argentina

Austra l ia

Austr ia

Belgium Bol ivia B r a z i l

Bulgar ia Burma

Canada

Ceylon Chile

Colombia

Czechoslovakia Denmark

Ecuador

France

Germany, Federal Republic of (ireece

Guatemala

H a i t i

I r e land

I t a l y Jamaica

Japan

Korea, Republic of Lebanon Malta

Mexico

Nepal

Netherlands

New Zealand Norway

Pakis tan

Phi l ippines

Paland

Sweden

Regional Off ice

including WRS

- - - - - - - - - 1 1 - - - - - 4 - - - - 1

- - - 1

- - - - 1

- - 2

- - - - 1

-

Advisers - - - - - - - - - - 1 1 - - - 1 - - 3 - - 1

1

1 - 1 - - - 1 - - 1 1 1

- - - 1 - - [ c o n t i n u ~ d

P i c l d

s t a f f

2

1

4 1

1

2

1 1

1

8 5 1

1

9 1

1

1

4 1

1 - 7 6 1

3 - 2

1 1 2 - - 2

2

1

1

1

Tota l

2

1

4 1

1 2

1

1

1

1 0

7 I

1

9 2

1

5 7 1 1

1

9

7 1

4 1 2

1 2 2

1

1

J 5 1

1 1

l 2 I I

7 2

on next page) I

SEA/RC22/2

Page 253 Annex 2

Switzerland M o n ofSoviet Social ist

Republics United Arab Republic Dnited Kingdom of meat Britain

and Northern Ireland United States of America Vte t -Nam Yugoslavia

country

I I I I

Regional Office including WRs

I I I I

Total

Advisers

18

Field staff

- -- Total

23 135 I @

SEA/IICZZ/Z Page 254

Annex 3

MEETINGS AND COURSES OROANIZED BY WHO AND

HEID I N THE SOUTH-EAST ASIA REGION*

(1 AUGUST 1968 - 1 AUGUST 1969)

19-31 August 1968 Workshop on the Educational Approach t o t h e Tjimat Jan

Planning and Implementation of Public Health

Programmes ( Indonesia 0078)

20 August - Course i n thc Epidemiology and Control of Bangalore

20 September 1968 Tuberculosis , ( I R 0113 ) ( I n d i a n Chapter of

t h e Praguebangalore Course)

16 September - Course i n Hospital Administration Bandung 18 October 1968 ( SEAR0 0104 ) ( Indones ia )

25-27 September 1968 Meeting on Teaching Of Soc ia l Aspects of New Delhi Obste t r ics ( I n d i a 0114)

14-26 October 1968 Inter-country Workshop on Training i n

Heal th Education (SEARO 0130)

New Delhi

14 October - Workshops on t h e C e l l u l a r and Molecular New Delhi

23 November 1968 Basis of the Immune Response (SEAR0 0166)

23-25 October 1968 Meeting on Paed ia t r i c Education ( I n d i a 0114) New Delhi

24 October - Seminar on Hospi ta l Administration

6 November 1968 (Thailand 0051 )

Bangkok

11-20 November 1968 Course f o r Coding I n s t r u c t o r s ( I C D , Eighth New De l h i Revision) (SEARO 0167 )

18-30 November 1968 Training Course on the Management of Bangkok

Intect ious-Disease Hosp i ta l s ( SEARO 0128 )

9-13 December 1968 In te r - reg iona l Seminar on Radiat ion Bombay Pro tec t ion and Monitoring ( i n co-sponsorship wi th t h e I n t e r n a t i o n a l Atomic Energy Agency)

6-14 January 1969 Training Course on the Epidemiology and Control Mandalay

of Plague (SEAR0 0125 i (Burma I

*Excluding courses v.nder p ro jec t SEARO 0139, which a re included i n Annex 11, and

na t iona l courses o r meetlngs i n which WHO a s s i s t a n c e was r e s t r i c t e d t o t h e Pt'OViSiOn

of consu l t an t s .

S E A / R C Z ~ / ~

Page 255 Annex 3

15-24 January 1969 Seminar on the Q u a l i t y Control of Drugs

(SEARO 0154)

Bombay

15-17 January 1969 Regional Seminar on Plague Survei l lanee

( SEARO 0125 )

Mandalay

(Burma

18 January - 12 March 1969

Combined Training Course i n Epidemiology

( p r a g u e b e l h i ) ( I n d i a 0182 )

Delhi

20-23 January 1969 Seminar on t h e Role of Pathology i n Medical Education (SEARO 0133)

Mysore

( I n d i a )

20-24 January 1969 Seminar on t h e Teaching of Biochemistry

and C l i n i c a l Chemistry ( I n d i a 0221)

New Delhi

20-31 January 1969 Or ien ta t ion Course i n Neonatology

( I n d i a 0114)

Bombay

3-5 February 1969 Seminar on the Role of Pathology i n

Medical Education (SEARO 0133)

New Delhi

17-20 February 1969 Or ien ta t ion Course i n Neonatology

( I n d i a 0114)

New Delhl

17-28 February 1969 Training Course on Organization of

Maternal and Child Health Fie ld

Prac t i ce Programmes i n Medical Colleges

(SEARO 0177)

Vellore

( I n d i a

11-22 March 1969 Training Course on Organization of

Maternal and Child Health Fie ld Prac t i ce

Programmes i n Medical Colleges

i SEARO 0177)

New Delhi and

Narangwal

( I n d i a )

17-22 March 1969

17-28 March 1969

Seminar on Leprosy Control (SEARO 0138) Kathmandu

New' Dclhi Workshop on Nursing Leg i s la t ion and

Licensing f o r Prac t i ce (SEARO 0139)

24-26 March 1969 Conferenoe on Paed ia t r i c and Obste t r ic

Education ( Indonesia 0062)

Djakarta

26.26 March 1969 Discussion Group Meeting o n National

Health Planning (SEARO 0178)

New Delhi

sEA/RC22/i! Page 256 Annex 3

21-28 Apri l 1969

5-16 May 1969

5 May - 14 June 1969

7-9 J u l y 1969

7 J u l y - 1 August 1969

21 J u l y - 2 0 August 1969

Seminar on Fluorescent Antibody Techniques i n t h e Diagnosis of Rabies (SEAR0 0176)

Workshop of S t a t e Nursing Superintendents

( I n d i a 0136 J

Second In te r - reg iona l Training Course on Methods and Techniques f o r Paras l t ic-Disease Surveys ( I n t e r - H ~ g i o n a l 0388)

P i f t h In te r - reg iona l Training Course on Control of Cholera ( In te r - reg iona l 0228)

Pollow-up of Meeting on "paed la t r i c Education "held i n October 1968 - Preliminary Pre-study Meeting ( I n d i a 0114)

Medical Teachers ' Training Course (SEAR0 0096)

Course i n Epidemiology and Control of Tuberculosis (IR 0113) ( I n d i a n Chapter of the Prague/Bangalore Course )

Coonoor

( I n d i a

New Delhi

Bangkok

New Delhi

New Delhi

Bangalore

SEA/RCZZ/

Page 257 Annex 4

CONBERENCES AND MEETINGS I N THE SOUTH-EAST ASIA REGION

CALIED BY THE UNITED NATIONS AND ITS REIATED SPECIALIZED

AGENCIES AT WHICH WHO WAS REPRESENTED

(1 AUGUST 1968 - 1 AUGUST 1969)

5-7 August ECAFE: Fourth Meeting of t h e Asian Regional Group of t h e Advisory Committee on t h e

Appl icat ion of Science and Technology t o

Development

9-20 August UNESCO: Conference on t h e Appl icat ion of Science and Technology t o Development i n

Asia (CASTASIA)

27 ~ v g u s t - United Nations : Seminar on Elimination of

9 September A l l Forms of Rac ia l Discr iminat ion:

New Delhi

New Delhi

1-2 November FAO: Second. Conference of Representatives of National Freedom from Hunger Campaign Committees i n Asia and t P e Far East Bangkok

4-15 November FAO: Ninth Regional Conference f o r Asia and the Far East Bangkok

18-25 November ECAFE: Regional Conference on Water Resources Development (Eighth Sess ion) Bangkok

20-27 November ECAFE: Workshop on National Personnel Systems Bangkok

1-8 December I n t e r n a t i o n a l Geographical Union: Twenty-first

I n t e r n a t i o n a l Geographical Congress New Delhi

4 December Unlted Nat:ons I?evelcpment Programme: I n t e r -

Agency Meeting on Programme Co-ordination New Delhi

23 December UNICEF: Inter-Agency Working Group on Nut r i t ion i n Ind ia

4-10 February

6 February

27 February

10-28 March

7-16 May

15-16 May

2-15 June

24 June - 1 July

United Nations: Meeting of the United Nations

and Its Specia l ized Agencies

ECAPE: Workshop on S t a t i s t i c s of Children and

Youth Through Sample Surveys

united Nations, Meeting of the Heads of United

Nations Agencies i n Ind ia

United Nations Development Programme: Meeting Of

t h e Heads of Unlted Nations Agencies i n Ind ia wi th

the J o i n t Inspect ion U n i t

EcAR~/United Nations I n s t i t u t e f o r Training

and Research: Seminar on Techniques and t h e Procedures of United Nations Technical Assis tance

f o r Asia and Far East

ECAFE: F i f t h Sess ion of the Cormnittee f o r

Development Planning

ECAFE: Tcnth Regional Inter-Agency Meotlng on Rural and Community Development i n Asia

ECAFE: Conferenoe of Asian S t a t i s t i c i a n s ,

Ninth Sess ion

ECAFE: Scmlnar on Experience of Major

Administrative Reforms f o r Development

New Delhi

Bangkok

New Delhi

New Delhi

Bangkok

Bangkok

Bangkok

Bangkok

SEA/RCZi 2

Page 25[ Annex 5'.

.ii

CONFERENCES AND MEETINGS CF GOVERNMENTAL, NON-GOVERNMENTAL

A N D OTHER ORGANIZATIONS HELD I N THE SOUM-EAST ASIA REGION AT W H I C H WHO WAS REPRESENTEDI

(1 AUGUST 1968 - 1 AUGUST 1969)

1 August Trained Nurses Association of India : Open

Forum of the Diamond J u b i l e e CommLttec

20 August Qovernment of Ind ia : Meeting of Deputy Medical Superintendents and Off ice r s

i n Charge of l abora to r ies of Hospi ta ls

i n Delhi

New Delhi

New Delhi

2 2 August (iovernment of India : Meeting t o Review the Strengthening of the Venereal-Disease

Training and Demonstration Centre a t

Safdarjang Hospi ta l New Delhi

11-15 September Indian Council of Medical Research: Seminar on Review of Research Work i n India on the

I n t r a - u t e r i n e Contraceptive Device New Delhi

2 9 September - Science and Technology Soc ie ty , Kanpur: 2 October Symposium on the Bionormcs and Control of ffinpur

Rodents ( I n d i a )

14-17 October Government of Ind ia : F i f t e e n t h Meeting of the Bombay Centra l Council of Health ( I n d i a

17-20 October National I n s t i t u t e of Sciences of Ind ia :

Symposium on His tory of Science i n Ind ia New Delhi

4-9 November Trained Nurses Association of Ind ia : 33rd Ahmedabad

Annual Conference ( I n d i a )

11 November - Indian Council of Medical Research: Annual

6 December Meetings of Qroups Establ ished by the

S c i e n t i f i c Advisory Board New Delhi

*This l i s t does not include meetings j o i n t l y sponsored by WHO o r meetings held i n connection with WHO-assisted p r o j e c t a c t i v i t & e s .

SEA/RC22/2 Page 260 Annex 5

23-28 February Hindu Kusht Nivaran Sangh: X I A l l Ind ia

Annual Leprosy Workers' Conference New Delhi

3-5 March Government of Ind ia : Second Workshop f o r S t a t e Nut r i t ion Of f ice r s

Trivandrum

( I n d i a

3-8 March I n t e r n a t i o n a l Federation of Gynaecology

and Obs te t r i c s and Federat ion of Obs te t r i c s

and Gynaecology Soc ie t i e s i n Ind ia : I n t e r n a t i o n a l

Seminar on Maternal Mor ta l i ty , Family Planning Bombay

and Biology of Reproduction ( I n d i a

4-7 March

9 March

12-14 March

5-6 A p r i l

18 Apr i l

22 Apr i l

20-26 Apr i l

21-26 A p r i l

25 Apr i l

Government of Ind ia (Cen t ra l Bureau of Health

I n t e l l i g e n c e ): Seminar on Heal th Centre Records

and Reports

Indian Medical Association: Annual Meeting

of the Ali,Qrh BrWOh

National Buildings Organization: Symposium on

Role of Housing i n National Economy

A l l I nd ia I n s t i t u t e of Medical Sciences:

Workshop on C l a s s i f i c a t i o n of Psych ia t r i c

Disorders

Tubarculcsis Association of Indla :

T h i r t i e t h Annual General Meeting of t h e Tuberculosis Association of Ind ia

Indian Council of Medical Research: Survei l lance of Dengue Haemorrhagic Fever

World Confederation of Organizations of the

Teaching Profession: Asian Regional Conference

I n t e r n a t i o n a l Children's Centrf , Par i s : Seminar on t h e Fight Against Tuberculosis

College of Nursing, New Delhi: Synposlum on Changing Trends towards Higher Education

I n Nursing

New Delhi

Allgarh

( I n d l a )

New Delhi

New Delhi

New De l h i

New Delhi

Djakarta

Kabul

New Delhi

1st w e e k h y Government of Ilulia: Workshop on Family

Planning f o r Public Health Nursing

I n s t r u c t o r s

SEA/RC22/2 Page 261 Annex 5

24-28 November

25-26 November

Indian Medical .Association: Third World Conference on Qeneral P rac t i ce New Delhi

National Committee f o r Oandhi Centenary: Seminar on Manual Scavenging i n Ind ia New DeLhi

30 November - 5 December

Government of India : S i x t h Al l - India Family Planning Conference

Chandigarh ( India )

7-9 December Kasturba Hospi ta l f o r In fec t ious Diseases,

Bombay: Natlonal Conference of In fec t ious Diseases Bombay

* 3-6 January Tuberculosis Associa t ion of Ind ia : 24th Natiollal

Conference of Tuberculosis and Chcst Diseases Workers

Trlvandrum

( I n d i a I

4-6 January Indian Association f o r the Advancement of Medical Education: Eighth Annual Conference

6-7 January Government of Andhra Pradesh: All-India Seminar on I n d u s t r i a l Waste Treatment and Defluor idat ion

Hyderabad

( I n d i a )

14 January

3.8 February

USAID: Seminar on the Production of B a c t e r i a l Prote ins New Delhi

I n t e r n a t i o n a l Children's Centre. P a r i s , and Indian Academy of Paed ia t r i c s : Seminar on Paed ia t r i c Education New Delhi

8-10 February Indian Public Heal th Associa t ion: Th i r t een th Annual Conference

Madras ( I n d i a )

8-11 February Nepal Medical Association: Annual Conference Birganj

(Nepal I

12-15 February Indian Academy of Paed ia t r i c s : V I Natlonal Conference

Lucknow

( India )

22 February Government of Ind ia : Meeting of S t a t e Leprosy Medical Off icers

SEA/RCZZ/Z Page 262 Annex 5

19-20 May

26-28 May

1-7 June

Government of IMia: Two-day Conference of Beh?vioural Scientists New Delhi

Oovernment of Thailand: Third Advisory Council Chiengmi Meeting of tho Biotrop Centre, Chlengmai

Indoneeion PlaMed Parenthood Assooiation: Regional Conference of International Planned Parenthood Association Bandung

SEA/RC22/2

Page 2 6 3 Annex 6

RESEARCH ACTIVITIES I N THE SOUTH-EAST ASIA REGION

SUPPORTED BY WHO GRANTS MADE DURINO THE PERIOD

(1 AUGUST 1968 - 1 AUGUST 1969)*

Research I I n s t i t u t i o n

I Communicable Diseases

Research on the ecology, biology and con t ro l of Communicable Diseases (Control ) ~ i v i s i o n

ABdes aegypti Ministry of Public Health. Bangkok. I- Studies on t h e cytogenet ics of o r i e n t a l vectors

of malaria

Department of Zoology, Central College

Univers i ty of Bangalore, Bangalore

Arbovirus s t u d i e s

Str.dies of cholera vaccines on antmnl nodr ls

Vlbrio phage-typing

Virus Research Centre. Poona ( I n d i a )

(WHO Virus Collaborating Laboratory)

Xaffkinc I n s t i t u t e , P a r e l , Bombay

Studies on c a r r i e r s an3 immunology of cholera

Study of gene t i cs and v a r i a t i o n s of V . cholerae

Epidemiological s t u d i e s on cholera

Cholera Research Centre, Indian Council

of Medical Research, Calcut ta

Centra l Drug Research I n s t i t u t e ,

Lucknow ( I n d i a )

Cholera Research Centre, Indian Council

of Medical Research,(WHO I n t e r n a t i o n a l

Reference Centre f o r vib-ios) ,Calcutta

Communicable Diseases (Control)Divis ion,

Minis t ry of Public Health, Bangkok

] Studies of smallpox epidemiology and neonatal I Infel t ious-Disease Hospi ta l , Madras 1

Studics on t h e d i s t r i b u t i o n of r e s p i r a t o r y and

e n t e r i c v i ruses and arboviruses

Perumahaan Negara "Bio Farma"

Bandung

I and t r i a l New Delhi I

vaccinat ion

F e a s i b i l i t y s tudy of tubercu los i s prevention

Tuberculosis research - chemotherapy

Indian Council of Medical Research,

Inngi tudinal inves t ign t lons i n tubercu los i s epidemiology and community con t ro l n t a s w ( z

Tuberculosis Chemotherapy Centre,

Madras I I Indian Council of Medical Research,

Nc ! 3clhl I *Research a c t i v i t i e s supported by previous g r a n t s , even though they might have been continue

during thc period under review, a r c not included 111 t h i s l i s t . 4

SEA/RC22/2 Page 264 Annex 6

- Research

Anti-leprosy drugs

Chemoprophylaxls of leprosy

Cul t iva t ion of M . leprae

Studiea of inf luenza v i r u s vaccine

Studies i n Immunochemistry

Research i n immunoelobulins

Inves t i@t ions on simian malaria i n Ceylon

Study on t h e e f f i cacy of o r a l pol ionryel i t i s

v i rus vaccines i n t r o p i c a l o o n d l t i o ~

Controlled f i e l d t r i a l o r o r a l typhoid vaccine

Human Reproduction

Epidemiological study of human reproduct ion i n r u r a l India

Fle ld s t u d i e s on human reproduction, family

h e a l t h and populat ion dynamics i n M i a

Service and admin i s t ra t ive resea rch on h e a l t h

aspects of family p l a ~ i n g i n r u r a l Ind ia

Biomedical research on problem assoc ia ted wi th

the use of modern con t racep t ives i n Ind ia

I n s t i t u t i o n

Centra l Leprosy Teaching and Research I n s t i t u t e , Chingleput ( India

Cen t ra l Leprosy Teaching and Research I n s t i t u t e , Chingleput ( I n d i a )

Indian Cancer Research I n s t i t u t e , Bombay

Pasteur I n s t i t u t e of Southern I n d i a , coonoor

A l l I nd ia I n s t i t u t e of Medical Sciences , New Delhi

A l l India I n s t i t u t e of Medical Sciences , New Delhi

Department of Paras i to logy, Faculty

o f Medicine, University of Ceylon. P ~ r a d e n l y a

C h r i s t i a n Medical College and Hospi ta l ,

Vellore ( I n d i a )

Indian Council of Medical Research,

New Delhi

The Johns Hopkins Rural Health Research

Pro Jec t , Narangwal ( I n d i a )

Harvard Univers i ty Centre i n Population

S tud ies , Cambridge, Massachusetts

Rural Heal th Research ProJect . Narangwal, Ludhiana ( I n d i a )

Centra l Family Planning I n s t i t u t e ,

New D e l N

1

SEA/RC22/2 Page 265 Annex 6

Resrrrch

Nut r i t ion

Studies on i n t e r a c t i o n of malnu t r i t ion and i n f e c t i o n

Prevalence s tud ies on anaemia arri the rapeu t ic t r i a l s

Studles on n u t r i t i o n a l megaloblastic anaemias

Other Subjects

Studies on snake ant ivenina

Comparative research on s p e c i f i c mental d i so rders

Physical pe r fo rmnce capaci ty of high a l t i t u d e populations i n Nepal

I n s t i t u t i o n

Rural Health Research Pro jec t , Narangnal Teaching Health Centre, Chr i s t i an Medical College, Ludhiana, M i a n Council of Medical Research

A l l India I n s t i t u t e of Medical Sciences, New Delhi

C h r i s t i a n Medical College and Hosp i ta l , Vellore ( I n d i a )

Queen Saovabha Memorial I n s t i t u t e , Bangkok

Mental Hospi ta l , Agra [ I n d i a )

I n t e r n a t i o n a l Council of S c l e n t i f l c Unions, Rome, I t a l y

2

SEA/RC22/2

Page 266 Annex 7

PAPERS PUBLISHED, BEING PUBLISHED OR UNDER PREPARATION

TUBERCULOSIS RESEARCH PRCJECTS

(1 JULY 1968 - 1 AUGUST 1969)

1. Tuberculosis Chemotherapy Centre, Madras

A . Paper Published

No. T i t l e

1. I

Toxici ty of pyrazinamide

administered once weekly i n

high dosage

I

4 .

(1) Bindings i n urban c l i n i c s

among p a t i e n t s giving no

h i s t o r y of previous chemotherapy

2 .

3 .

A simple qualitative t e s t f o r d e t e r i o r a t i o n of cycloser ine

5. and

6 .

Concentration of pyrazinamide a t t a i n e d i n serum wi th d i f f e r e n t

doses of drug

Dete r io ra t ion of cycloser ine

i n t h e t rop ios

Prevalence of drug r e s i s t a n c e i n p a t i e n t s wi th pulmonary

tuberculosis present ing f o r the

f i r s t time w i t h symptoms a t

ches t c l i n i c s i n Ind la

Author

C .V. Ramakrishnan,

B. Janardhamm,

D .V. Krishnamoorthy , H. s t o t t , s . Subbammal and

S .P . Tripathy

K.V. Nageswara Rao,

L. EiduS , C . Evans, S . Fallasam,

S . Radhakrishna,

P . R . Somasundaram,

H . s t o t t , S. Subbammal and

S.P. Tripnthy

Reference

WHO B u l l f t l n (1968)

2, 775-779

s. Subbammal. D.V. Krishnamurthy.

S .P. Tr lpathy and

P . Venkataraman

WHO B u l l e t i n (1968)

Ip, 781-789

WHO B u l l e t i n (1968)

2, 771-774

K.V. Nagcswara Rao, S. Itailasam and

N.G.K. Nair

WHO B u l l e t i n (1968)

2, 842-844

Indian Council ~f -

Mtdicnl Research

Indian Journa l of Medical

Research 11968) :. , 1617-1630

SEA/RC22/2 Page 267 Annex 7

No.

7.

1.

2.

T i t l e

( 2 ) Findings i n urban c l i n i c s among p a t i e n t s g iv ing no h i s t o r y of previous chemotherapy

A note on the r e l a p s e r a t e over

a 4-year period i n p a t l e n t s wi th quiescent pulmonary tubercu los i s following treatment with reserve regimens

Author

-do-

S . Velu and S. Sambamoorthy

1 Reference

Indian Journal of Medical Research (1969)

21, 823-835

Tubercle, Land., (1968) - 49, 410-412

Preparat ion

WHO B u l l e t i n

Tubercle, Lond . .

4

8. Papers Being

A 5-year study of p a t i e n t s wi th pulmonary tuberculosis t r e a t e d a t home i n a con t ro l l ed comparison of i son iaz id plus PAS

with t h r e e regimens of i son iaz id alone

A four-year follow-up of p a t i e n t s wi th quiescent pulmonary tubercu los i s a t the end of a year of chemotherapy with twice-weekly i son iaz id p lus streptomycin or d a i l y i s o n l a z i d plus PAS

Published o r under

C . Evans, S . Devadatta , Wallace Pox, P . R . J . Qangadharam, N.K. Menon, C .V. Ramakrishnan, S . Sivasubramanian, P.R. Somasundaram, H . S t o t t and S . Velu

C .V. Ramakrishnan, S . Devadatta, C . Evans, Waliace Box,

N K. Menon, 0. Nazareth, S . Radhakrishna , S . Sambamoorthy. H . s t o t t , S.P. Tr ipathy and S . Velu

SEA/RCZ 2/2 Page 268 Annex 7

Response t o treatment wi th i s o n i a z i d plus PAS of tuberculous p a t i e n t s with primary i son iaz id

res i s t ance

S.P. T r i p a t w , N.K. Nenon, D.A. Mltchison, A .S .L. Narayana, P.R. Somasundaram, H . S t o t t and 5 . Velu

Reference NO. - ...~ 1 T i t l e

4.

Author

A sputum swab c u l t u r e method f o r tuberc le b a c i l l i using centrimide B.P. compared wi th two o ther i .R . J . Gangadharam swab methods anrl t h e concentra t io c u l t u r e method

5 .

Attack r a t e of tubercu los i s i n

a 5-year period among c lose family con tac t s of tuberculous p a t i e n t s under domiciliary

treatment wi th i son iaz id p lus PAS o r i son iaz id alone

Sulplladimidine a e e t y l a t i o n t e s t f o r c l a s s i f i c a t i o n of p a t i e n t s a s slow or rap id i n a c t i v a t o r s of i son iaz id

6 .

K.V.N. Rao. D.A. Mitchlson. N .G .K . Nair, K. P r a m and S.P. Tr ipathy

A oontrol led comparison of a twice-weekly and three once-weekly regimens i n the treatment O f

pulmonary tubercu los i s

Tubercle, London

Tubercle, London

11. National Tuberculosis I n s t i t u t e , Bangalore

A . Papers Published

1. G . V . J . Bai ly e t a l . --

P o t e n t i a l y i e l d of pulmonary tubercu los i s cases by d i r e c t microscopy of sputum cases i n a d i s t r i c t of South Ind ia

WHO B u l l e t i n (1967) 11. 892 I

SEA/~c22/2 Page 269 Annex 7

No.

2 . Proceedings of 23rd Nation; Conference on Tuberculosis and Chest ~ l s e a s e s . I74

Title

Simultaneous smallpox and I Kul Bhushan BCG vaccinaticn e t a l . I--

. Proceedings of XMth InteF. na t iona l tuberculosis Conference, 53

Direct BCO vaccination - simultn- neous BCO and smallpox vaccinat io

Proceedings of XIXth In t e r . n a t i o ~ l tuberculosis Conference, 148

--

I I B. Papers with Publishers

Author

Assessment of diagnosis of pul- rnonary tuberculosis by d i r e c t microscopy of sputum i n a d i s t r i c tuberculosis programme

Reference

Inter-reader and intra-reader va r i a t i on i n d i r e c t microscopy and t h e i r influence on s e n s i t i - v i t y and s p e c i f i c i t y

Some implications of the observed socio-epidemiological character- i s t i c ~ of cut-pat iznts a t tending a c i t y tuberculosis con t ro l centre

BCO vaccination: i t s present s t a t u s

National tuberculosis programme i n India

G.V.J. Baily

V.B. Naidu

I WHO Bu l l e t l n

Proceedings of the 24th National Confererne on Tuberculosis and Chest Diseases

Mysore S t a t e Tuberculosis Seal Sale Brochure

C . Papers under Preparation

SEA/RCZZ/Z

Page 2 7 1 Annex 8

LIST OF VITAL AND WEALTH STATISTICS REPORTS ISSUED BY GOVERNMENTS AND RECEIVED BY THE REGIONAL OFFICE (1 AUGUST 1968 - 1 AUOUST 1969)

-

Country

Afghanistan

Burma

Ceylon

India

Name of Report

Hospi ta l in -pa t i en t r epor t f o r Shams1 Year

1346

Hospi ta l in -pa t i en t r e p o r t f c r Shamsi

Year 1347

Administrative q u a r t e r l y r e p o r t s

Report t o t h e people by the Unlon of Burma

Revolutionary Council on t h e Revolutionary

Government 's Budget Estimates f o r 1968-1969

Administration Report f o r 1965-66

Report o f t h e R e g i s t r a r Oeneral on V i t a l

S t a t i s t i c s f o r 1963

Report of the Reg is t ra r Oeneral on V i t a l

S t a t i s t i c s f o r 1964

Directory of paramedical i n s t i t u t i o n s

i n I n d i a , 1966

Annual Report of t h e Di rec to ra te General

of Health Services . 1963

Sample r e g i s t r a t i o n - repor t on r u r a l

a r e a s , 1965-67

C i v i l hospitals and d i spensar ies : annual

admin i s t ra t ion r e p o r t f o r 1966, Gujarat

Health S t n t i s t i c s of Punjab, 1968

Causes of deaths medically c e r t i f i e d i n

major h o s p i t a l s i n Punjab, 1967

Deaths i n h o s p i t a l s due t o in fea t lve and

p a r a s i t i c d i s e a s e s , Punjab, 1968

Issued by

Mlnls t ry of Public Health,

Kabul

- do -

- do -

Direc to ra te of Health

Serv ices , Colombo

Off ice of the Reg is t ra r General

Office of the Reg is t ra r

General

Di rec to ra te Oeneral of

Health Services

Centra l Bureau of Health

I n t e l l i g e n c e

Office of t h e Regis t rar

General of Ind ia

Dl rec to r of NedicS.1 Health

Services , Oujarat

Di rec to r of Nedical Health Services . Punjab

Di rec to ra te of Health Services

- do -

SEA/RC22/2 Pac;e 272 Annex 8

Country

India

( c o n t ' d )

Indonesia

Thailand

Name of Report

Medical and h e a l t h s t a t i s t i c s : progress

s i n c e 1951, Rajasthan

Report on t h e h e a l t h condi t ions i n Madras

S t a t e f o r t h e year 1962 ( inc lud ing the

r e p o r t s of the Government Analyst and t h e

Chief Water Analyst f o r 1962-63 )

Administration Report f o r t h e Year

1966-67

v i t a l s t a t i s t i c s B u l l e t i n f o r 1966. Kerala

Deaths among in -pa t i en t s of teaching and

d i s t r i c t h o s p i t a l s by cause ( A U s t ) , age

and sex , Mysore ,1968

Annual r epor t s on c i v i l h o s p i t a l s and

d i spensar ies i n Ut ta r Pradesh f o r t h e

years 1957, 1958, 1959, 1960 and 1961

Survey s o s i a l ekonomi nasional tahap kedua [Nopember 1964-Pebruari 1965): s i f a t

demografi penduduk, Indonesia

Survey s o s i a l ekonomi nas iona l tahap kedua

( Nopember 1 9 6 4 - ~ e b r u a r i 1965 ) : kelahiran/

kematian penduduk dan lcasuburan i b u , Indonesia

public h e a l t h s t a t i s t i c s , 1966

Report on t h e survey of populat ion change,

1964-1967

F ina l r epor t on t h e survey of populat ion,

2 1 March - 22 Apr i l 1966

- Issued by

Di rec to ra te of Medical and

Heal th Services , Rajasthan

Deportment of Public Health,

Madras

Department of Health Services ,

Kerala

- do -

Direc to r of Health Serv ices ,

Mysore

Di rec to ra te of Medical and

Heal th Services . Uttar Pradesh

Bi ro Pusat S t a t i s t i k , Djakarta

- do -

Divis ion of v i t a l S t a t i s t i c s ,

Minis t ry of Public Health,

Thailand

National S t a t i s t i c a l Off ice ,

Bangkok

National S t a t i s t i c a l Office,

Bangkok

LIST OF TECHNICAL REPORTS ISSUED BY THE REOIONAL OFFICE

(16 JULY 1968 - 1 AUOUST 1969)

Document No.

Assignment repor t on cancer problem i n the Mongolian People 's Republic

(Mongolia 0011). 2-29 May 1968

I Cardiovascular Diseases

I T i t l e

D r V. Demln

Assignment repor t on the need f o r a

survey on o r a l precencerous condi t ions

i n Afghanistan (Afghanistan 00691,

J u l y - August 1968

Assignment repor t on coronary care i n t h r e e countr ies of South-East Asia

(coronary ca re uni ts ' ) (SEARO 0162),

8-27 Apri l 1968

Author

Dr F a l l S. Mehta and D r Jens J . Pindborg

Assignment repor t dn coronary c a r e i n

Burma (SEARO 0162). 8-13 Apr i l 1968

Assignment repor t on coronary ca re i n

Indonesiz (SEARO 0162). 23-27 Apr i l 1968

SEA/CVD/~ ~ d d .3 Assignment repor t on coronary ca re i n - do - Thailand ( SEARO 0162 ) , 13-23 Apri l 1968 I Assignment repor t on coronary ca re i n

India and Ceylon ( SEARO 0162 ) , March 1968

D r A . Tyb jaerg Hansen

Report on a v i s i t t o Kathmandu, Nepal,

5-12 f:ugust 1965 D r E. Nakano

Report on 3 v i s i t t o Thailand t o a s s i s t

wi th t h e cholera c a r r i e r s t u d i c s ' ( 1 R 0276).

Mrs Cec i l i a 2 . Gomez

17 February - 17 Apri l 1969 !

aEA/Rc22& t,

Page 274 h e x 9

I I Communicable Diseases I

aocument No.

SBA/cD/l6 Add. 1 Report on follow-up of t he Regional

Training Course on the Management of Infectious-Disease Hospitals held i n - Bombay, 27 November - 9 December 1967 (SEARO 0128). October - November 1968

T i t l e

Assignment r epo r t on smallpox e rad ica t ion

and cont ro l of o ther communicable diseases (Nepal 0009) . September 1566 - November 1967

- Author

-- -

Assignment repor t on infect ious-disease

hosp i t a l s , Djakarta ( Indones ia ) ,

(SEARO 0128). 1-6 December 1968

Assignment r epo r t on management of

communicable diseases. Rangoon ( SEARO 0128 1, 7-12 December 1568

Report; on the Regional Training Course on the Management of Infectious-Disease

Hospitals, held i n Bangkok, from 18 t o

30 November 1968 (SEARO 0128)

Assignment repor t on por t hea l th

Inaonesia (SEAR0 0169). 21 March - 7 Apri l 1969

Dr W .M. Jamieson and

Miss J . P . Pernie

D r Satnam Singh

D r W.M. Jamieson and

Miss J .P . Fernle

D r W . M . Jamlcson,

Professor S .D . Rubbo

and MISS J . P. Fernie

s ~ l b ~ b 5

Mr William Hewitt SEAbrugs/l

Dental Health

Assignment report on improvement of

dental education, Government Dental College, Bangalore, ( Ind ia 0208),

May - September 1968

Assignment r epo r t on qua l i t y con t ro l

of drugs, Nepal (SEARO 0154),

23-51 January 1969

D r J . Eschler

SE@CZZ/~

Page 275 Annex 9

SEAhnv .San/61 and Corr .l

SEAhnv .San/63, Corr .l and Corr .2

T i t l e

Environmental Health

Assignment repor t on a s s i s t a n c e t o water

supply and sewerage f o r Greater Kathmandu

and Bhaktapur (Nepal 0025), 25 March - 9 June 1968

Assignment r e p o r t on training i n

s a n i t a r y engineering ( Indonesia 0061 1, 1 February - 6 March 1968

Report on a Conference on the Training

and U t i l i z a t i o n of Auxi l iary Sanitation

Personne1,held i n the WHO Regional Office. f o r South-East Asia, New Delhi , from

10 t o 15 June 1968 ( SEAR0 0165 )

Professor N . Majumdar

Assignment repor t on t h e School of Public Health, Bangkok, ( a s s i s t a n c e t o the

San i ta ry Engineering Department af the

Faculty of Public Heal th) (Thnlland 0038). 29 December 1967 - 26 March 1968

Assignment repor t on publ ic water supply, drainage and sewerage f o r south-west

c o a s t a l areas, Ceylon (Ceylon 00861,

August 1967 - February 1968

Assignment report: on community water

supply (Ceylon 0064). March - August 1968

M r M . A . Por te r

Regional Office

Professor En i l T . Chanlett

Mr M.T.Skodje and

M r V.C.P. Thirugna- nendran

M r M .T . Skod je and

Mr J.D.E. Perera

SEAhnv . s a d 6 6

sEA/Env . s a d 6 6 Add .l

Assignment repor t on pre-investment s tud ies of h igh p r i o r i t y water supply

am3 sewerage schemes i n south-west

c o a s t a l a reas of Ceylon (management

a s p e c t s ) (Ceylon 0086), May - Ju ly 1968

Assignment r e p o r t on pre-inves tment s tud ies of high p r i o r i t y water supply

and sewerage schemes i n south-west

c o a s t a l a reas of Ceylon (lunagement

aspects I (Ceylon 0086 ) - Addendum:

a l t e r n a t i v e suggestion f o r execution

Mr N . J . Pugh l

Regional Office

of funct ions of the Centra l Water ~ u t h o r i t y I --

SEA/RCZZ/Z Page 276 Annex 9

Document No.

~EAhnv .San/K7

I ~ ~ A h n v . S a n h 9 and

T i t l e Author

Assignment report on community water supply (Ceylon 0064). October 1965 - February 1968

I I

Mr M . A . Porter

Assignment report on sewerage and drainage plans, Bangkok (Thailand 0083 ) , November - December 1968

D r E .A. Berry and D r H . Rohde

Assignment report on water supply and excreta disposal i n Male, Maldives (Maldives 0005)

D r P.H.A. Martin Kaye

Report on a v i s i t t o Ceylon, 17-24 March 1969

M r S.Q. Serdahely

Assignment report on public heal th engineering education (Victoria Jubilee Technical I n s t i t u t e , Bombay) ( India mlo ) , March - April lgb8

Professor W . Stumm

Assignment report on public heal th engineering eduoation (Victoria Jubilec Technical I n s t i t u t e , Bombay)

I pest icides (Indonesia 0090), February - March 1969 I

Professor Em11 T .

Chanlett

( India C e l O ) , 13 October - 22 December

1967

Assignment report on hazards t o man from D r John E. Davies

I Field v i s i t report on environmental heal th projects i n Afghanistan,

A s s i g w n t report on pre-investment s tudies

of high p r i o r i t y water supply and sewerage schemes i n south-west coastal areas of

Ceylon ( f i n a m i a l aspccts) (Ceylon 0086 1 , 26 May - 26 Ju ly 1968

M r C.L. Cosandy

S E A / R C ~ Z / ~

Page 277 Annex 9

Docwnent No. t-- I SEAhpidE2 and

Corr .l

S E A h p i d E j , Corr . l and Corr.2

T i t l e

Epideml ology

Assignment r e p o r t on s t r e w t h c n i n g of h e a l t h se rv ices (epidemiology) ( I n d i a 0182). January - Apr i l 1968

Assignment repor t a n s t rengthening of h e a l t h se rv ices (epidemiology ) (Burma OW4), 1 8 Rebruary - 25 May 1968

Rssignment r e p o r t on s t rengthening of hea l th se rv ices ( e p i d e d o l o g y ) (Mongolia 0001). September 1964 - June 1968

issignment r e p o r t on s t rengthening of l e a l t h se rv ices (epidemiology) [Tnailand 0059), December 1966 - July 1967

.- - . .

? le ld v i s i t r epor t on U m i a s i s i n :eylon, 11 - 22 November 1968

i e a l t h Education

l s s i g m n t repor t on h e a l t h education Afganistan 00241, Apri l - June 1968

Iea l th education programe d e t a i l s leve loped and used i n Workshop on t h e tethodology of Planning, Implementation knd Evaluation of Hcalth Education, leld i n New Delhi from 7 t o 16 November 156

'he educat ional approach i n planning and mplementation of pub l ic h e a l t h programmes 'eport on a workshop conducted by t h e ) i v i s i o n of Health Education, Bureau of :ducation and Treining , Minis t ry of Heal th

epub l ic of Indonesia,and t h e WHO Regional Iffice f o r South-East Asia , T j i m t j a n Indones ia ) , 19-31 August 1968

Author

D r Jura J Cervenka

D r J . Pecenka

D r M . Rusinko

D r 2 . Bencic

D r S .P. Ramkrishnan

D r S.K. Simonds

Regional Office

W H . J . Weddle

S E A / R C Z ~ / ~ Page 278 Annex 9

I Document No. I T i t l e I Author

SEA/%IE/J~ and Corr . l

s u h m k 8 Add.1 and Corr .l

sEA/~IIM/JO and Corr.1

S E A ~ I M / J ~ , Corr .I and Corr .2

1 Assignment r e p o r t on h e a l t h eduontion,

Gujarat ( I n d i a 0108.4). December 1965 - August 1968

Report of a n in te r -coun t ry Workshop on Training i n Health Education,held i n Pew Delhi from 14 t o 26 October 1968 (SEARO O U O )

Assignment r e p o r t on h e a l t h educat ion i n Nepal (Nepal 0019), 20 November 1%8 - 20 February 1969

Assignment repor t on a un i t of mate r ia l s on educat ional methodology (workshops,

seminars, e t c . ) (SEARO 0130). 25 November 1968 - 3 March 1969

Heal th Iaboratory Methods

Assignment repor t on Public Health I n s t i t u t e , Kabul (Afghanistan 0031). May - August 1968

Assignment repor t on the vaccine c e n t r e , Public Health Insf i t u t e , Kabul, June- 1968

See SEAhB/90

Assignment repor t on s t rengthening of l abora to ry se rv ices (Burma 00741, 13 August - 4 October 1968

Assignment repor t on strengthening of l abora to ry s e r v l c e s (Tnailnnd 0075 ) , A p r i l -. May 1968

Report on a v i s i t t o Indonesia. 14-29 October 1968

Assignment r e p o r t on s t rengthening of l abora to ry se rv ices (Ceylon 0066 and Ceylon 0074). February 1967 - January 1969

Miss M.F. Pa t t e r son

Regional Office

Miss Maisie Boomardt

MISS Vivian V.

Drenckhahn

D r Soemiatno

D r a. Lofstrom

Dr G.S. l'd.wil

D r Soemlatno

Document No. 1 T i t l c Author I Assignrntnt r c p n r t on l z b o r a t o r y services,

I n d o n e s i a [ I n d o n c s i s 0 0 6 0 ) , June - ~ u g u s t 1968

D r G. Lofs t rom

Leprosy

Assignment r e p c r t o n s t r e n g t h e n i n g of

i lu: i l th s e r v i c e s ( i n t e ~ r a t i r ~ n of s p e c i a l i z e d

progranlmus) ( T h a i l a n d 0002 .2) and

t u k r r c u l o s i s c o n t r o l ( T h a i l a n d Ow?),

J a n u a r y 1161 - Jun? 1968

Assignment r e p o r t on l e p r o s y c o n t r o l i n

C,:ylon (Ceylon 00261, 3 1 O c t c b c r - 2'; Novcmbur 176y

Dr L u i s Arnau,

D r V i r a J S u l i t u l a

D r S u p a t r a Suvanamalik

Repor t o n a v i s i t t o r e v i e w l e u r o s y

c o n t r o l s e r v i c e s , A f g h a n i s t a n ,

3-10 November 1968

ss;;gnnlcnt r c p o r t on l c p r o s y c o n t r o l

( c 1 ; l s s i f i c a t i o n 01' c n s e s o f l e p r o s y i n

p o g i r l / k s k a ) ( I n d i a 0 0 8 1 . 2 ) ,

Nnverrber 1368 - F e b r u a r y 1969

Assignmcnt r e p o r t on l e p r o s y c o n t r o l

( T h a i l a n d 0 0 1 0 ) , March 1 9 6 1 - Scpterrber 1967

P. iport 01, a v i s ; t t o t h e l e p r o s y

s . > b s i d i a r y c e n t r c , Hiramzndalurn,

S r i k a k u l a m d i s t r i c t (Andnra P r a d r s h ) ,

(Indil 0 0 8 1 . 1 ) , 7 , Ja rnary 1969

Dr F.M. Nouss i tou

Dr K.S. S e a l

D r C.de 0. S i l v a

Mr R. Mason

Dr J.A. Cap

Dr F.M. Nouss i tou

Assignment r e p o r t on l e p r o s y c o n t r o l I Dr J . Wal te r

( I n d c n e s i s 0 0 0 3 ) , Novcn~ber 1963 -

S~AhC22/2 '.

Page 280

Annex 9

Malaria -- I

Report on a v i s i t t o Kunduz Unit, Northern Region (Nat ional Malaria Eradicat ion Programme, Afghanistan)

(Afghanistan 0011), 27 October - 10 November 1968

Document No.

Assignment repor t on malaria e rad ica t ion

(Thailand 0065 ) , October 1965 - February 1968

- T i t l e

Assignment report on operat ional aspects

of malaria erad1cat ion.prugrame

(Ceylon O@8), October 1968 - February

1969

I

I Maternal and Child Health

s ~ ~ f i c ~ h o SINhed .Educ/llO ( Printed )

S E A ~ C H A ~ SEAhed .Edu0hO9

(Pr in ted 1

Report of the Meeting on Teaching of

Social Aspects of Obstetrics, held i n New Delhi from 25 t o 27 September 1968

Report of the Meeting on Pacdiatr ic

Education ( Ind i a ) , held i n New Delhi fr,om 23 t o 25 October 1968

Report of Ad Committee meeting

on paed ia t r ic cdUCatl0n held i n

New Delhi from 7 t o 9 July 1969 ( Ind ia 0114)

Maternal and Child Health and Family

Planning

Aesigment repor t on development of maternal and ch i ld hea l th services i n

r e l a t i o n t o family planning ( I M l a 0250).

22 June - 19 Ju ly 1968

Author

D r D.A. Muir

D r A.B. Po l t r in ie r f

Mr R.A. Fi tz john

Regional Office

- do -

RegfoM1 Office

Dr a. Arbona and D r Howard C. Taylor

SEA/RCZZ/Z

Page 281

Annex 9

Document No.

SEAhed .Educ/lO3 Add .I

SEA/%& .Educ/lOf, Add. I

~ E A h e d .Educ/l09

SEAhed .Educ/llO

SEADed .Educ/ll l

SEAhed .Educ/113'

SEA/hent/l7

[ P r i n t e d )

Medical Education

Assignment repor t on medical educat ion, Department of Pharmacology, Facul ty of

Medicine and S i r i r a j Hospi ta l , Bangkok

(Thailarrl ) ( SEARO 0133 ) , September - October 1967

Assignment r e p o r t on medical c o l l e g e ,

Trivandrum ( teach ing cf paed ia t r i c s and

c h l l d h e a l t h ) ( I n d i a 0111). October - November 1967

Assignment repor t on Medical College, Trivandrum ( i n t e r n a l medicine ) ( I n d i a 0111). October - December 1967

Report on a v i s i t t o the l i b r a r i e s

of t h c Medlcal Facul ty , Colombo and

t h e Medical Faculty. Peradeniya

(Ceylon 0047), 20 May - 1 June 1968

See S E A ~ C H A ~

See S E A ~ C R ~ O

Assignment repor t on medical education

(Sawai Man Sin@ Medical College. Ja ipur ) ( I n d i a 0111). 10 January - 8 February 1969

Assignment r e p o r t on medical education,

Quja ra t S t a t e ( I n d i a 0183 1, 22 December

1968 - 28 January 1969

Report on the Regional Seminar on the Plac of Psychiatry i n Medical Education. Agra ( I n d i a ) , 12-18 March 1969

Report on a Seminar on the,Teachlng of

Preventive and S o c i a l Medicine, held i n

Ceylon from 30 November t o 7 December 1566

(SEARO 0110)

D r Jan Venulet

D r J .P. S t a n t i e l d

D r Er ik Hauptmann

S.C. D h i r

D r P . Collard

D r R . Cruickshank

Regional Office

Dr J . Pemberton,

Dr F.J. Mil le r , D r J . Qal lagher arrl

Mrs A . R . Moore

S E A / R C ~ ~ [ ~

Page 282

Annex 9

Document No. I----

sEAfiwsA4.5 (Not available fo r d is t r ibut ion)

T i t l e I Author

See s E A ~ c H ~ ~

Mental Health

See ~ ~ / h e d . ~ d u c / l l 3

Assignment report on medical education (preventive anl soc i a l medicine), Oujarat State (Baroda Medical College) ( M i a 0183 20 November - 19 December 1968

Professor S.L. Morrison

,

Assignment report on mental heal th,

Rangoon (Burma 0037). April 1965 - April 1968

Miss Leith Nance

Assignment report on nursing advisers t o S t a t e s , QuJarat (India 0110). September 1963 - September 1968

Information on a supplementary course i n paediatr ic nursing,held a t the I n s t i t u t e of Post-graduate Medical Education and Research, Chandigarh ( India) (India 0114.6). 5 February - 4 May 1968

'

Miss C. Walsh

Information on a short course on neo- na ta l nursing,held i n Chandigarh a t the Nehru Hospital, I n s t i t u t e of Post- graduate Medical Education and Rescarch

(India 0114 .6 1. 6-31 May 1968

Information on a short course on in-servic Mr A . R . Bubb education,held a t the I n s t i t u t e of Public Healtii, Kabul (Afghanistan) (SEARO 0139). 24 June - 22 July 1968 1

Miss J .E.F. Hutcheson

Information on the Workshop i n In-service Education,held a t the Nakorn Rajsima Hospital, Nakorn Rajsima, m r a t (Thailand) (SEARO Oljg), 10-21 June 1968

Miss E. Qi l l e sp ie

SEA/RC~Z/Z

Page 283 Annex 9

Document No.

SEAhursb53 and Corr .l

T i t l e

Information on t h e Worksnop i n In-Service

Education,held a t t h e Southern School of

Nursing, Songkhla (Thai land) (SEARO 0139),

15-26 ~ u l y 1968

Infornat ion on a shor t coursc on

c l i n i c a l teaching,held a t the Rangoon

General Hospi ta l , Rangoon (Burma (SEARO O U g ) , 2-27 September 1968

Information on a shor t course i n c e n t r a l

s t e r i l e supply,held a t t h e Post-Basic

School of Nursing, Vic to r ia Hospi ta l , Bangalore (SEARO 0139), 24 June - 19 J u l y

1968

Informatlon on a s h o r t course i n c l i n i c a l

teaching and i t s evaluat ion,held a t t h e

College of Nursing, Charuligarh ( I n d i a )

(SEARO O139), 11 November - 6 December

1968

Information on a shor t coursc on c l i n i c a l te2chillg and eva lua t ion f o r nursing

tu to r s ,hc ld a t the P o s t - c e r t i f i c a t e

School of Nursing, Kanpur ( I n d i a )

(SEARO 0139). 25 November - 20 December

1968

Information on a s h o r t course i n neonatal nursing, held a t Nehru Hospi ta l , I n s t i t u t e

of Post-graduate Medical Education and

Research, Chandigarh ( I n d i a 0114), 16 December 1968 - 11 January 1969

mformation on a supplementary course i n

paodiat r ic nursing ,held a t Nehru Hospi ta l ,

I n s t i t u t e of Post-graduate Medical 3ducation and Research, Chandigarh

( I n d i a 0114). 16 September - 14 Decembfr 1968

Author

Mlss E. O l l l e s p i e

Mr A . R . Bubo

Mlss I.M. Lovedee

Mr A . R . Bubl;

Miss 3 .E.F. Hutcheson

~EA/flc22/2 Page 284 Annex 9

Document No.

~ ~ A h u r s P 6 5 ( P r i n t e d )

Assignment r e p o r t on nurs ing advisory Miss G.M. Spear p r o j e c t , Bihar ( I n d i a 0110), Ootober 1966 December 1968

T i t l e Author

Assignment r e p o r t on nursing adminls t ra- Kiss K. P e i s e l t i o n ( I n d i a 02121, January - December 1968 I

I -

1 i

Report on t h e Workshop on Co-ordination of Nursing Education alld Servlces ,held i n World Health House, New Delhl , from 7 t o 9 January 1969 ( I r d i a 0136)

Plan f o r a pub l ic h e a l t h nurs ing programme,

Nepal; r epor t on a v i s i t (Nepal 0002),

19 August - 27 September 1968

Regional Office

Miss I . M . lnvedee

Assignment repor t on nurs ing education

(Indonesia 0&1), W c h 1966 - Novimber 1968

NLiss R . Ask

Asslgment r e p o r t on s t rengthening of h e a l t h se rv ices (nurs ing component on ly ) I 2 ( P a l j a b d i d H a v a n a ) ,

March 1967 - J a n u a v 1969

us8 J .E. Roberts

Guide t o t h e s tudy of a c t i v i t i e s of h e a l t h personnel i n h o s p i t a l ( I n d i a 0223 )

~ i s s B.M. Darbyshire I I

Assignment repor t on nursing advisory

se rv ices , Afghanistan (Afghanistan 0035), January 1966 - January 1969

I OrganL~~bLo. i of Medical Sare I

Miss A.M. Pae

Information on a s h o r t course f o r head nurses,held a t t h e Public Heal th I n s t i t u t e , Kabul (Afghanistan)

(SEAR0 01399, 3-27 March 1969

Mr A .R. BUbb

Assignment repor t on the Seminar on

h o s p i t a l admln i s t ra t ion (Thailand 0051), 8 October - 6 November 1968

D r P.N. O'DonneIl

SEA/RC22/2 Page 285

Annex 9

Document No.

iEA/Pn~/63 and Corr.1

EA/PHA/64

T i t l e

Assignment repor t on an inter-country

course on h o s p i t a l adminis t ra t ion.held 11

Bandung (Indonesia I (SEAR0 01041, 24 August - 18 October 1968

Physiotherapy

Assignment repor t on Physiotherapy School

Baroda ( I n d i a 02571, 1-28 May 1968

F ina l r epor t on the School of Physio- therapy, Solo ( Indonesia ) ( Indonesia 0065

February 1963 - December 1965 (followed

by v i s i t s i n June 1966: M a r c h - ~ p r i l 1967; and arch-~pril 1968)

Report on t h e Regionai Scminar on Plague Survei l lance,held a t thu I n s t i t u t e of

Medicine, Mandalay (Burma), from 15 t o 17 January 1969 (fol lowing the t r a i n i n g

course on Plague Epidemiology and Contr01,held i n Mandalay from 6 t o

14 January 1969) (SEARO 0125 1

P ro jec t Review

Report on a v i s i t t o Ceylon. 11-22

November 1968

Public Health Administration

Assignment repor t on s t rengthening of hoa l th se rv ices (Thailand OOW), February

1966 - Ju ly 1968

National h e a l t h planning: conclusions and recommendations a r i s i n g out of t h e

t e c h n i c a l d i scuss ions held a t t h e twenty-

f i r s t s e s s i o n of the WHO Regional

Committee f o r South-East Asia, New Delhi. 17-23 September 1968

Author

D r D . Verdugo Binim e l i s

M r A . H . Hopker

- do -

Regional Office

D r S .P . Ramakrishnan

D r (iuillermo Guevara E

Regional Office

SEA/~c22/2 Page 286 h e x 9

~ocument NO. I ~ i t l e I

sEA/PHAb5 and Corr.1

s ~ I I h a d h 6 (Not ava i l ab le f o r d i s t r i b u t i o n )

A s s i g m n t repor t on pub l ic h e a l t h admin i s t ra t ion (Nepal 0021). 30 August - 30 November 1968

Report on a v i s i t t o Burma, 13 January - 5 February 1969

Assignment repor t on admin i s t ra t ive aspec t s of h e a l t h s e r v i c e s (Thailand 0087) 12 September - 4 December 1968

Design of a s tudy on operat ion of h e a l t h se rv ices i n East Java, r epor t on s t reng- thening of na t iona l h e a l t h se rv ices (Indonesia 0086) and re-organizat ion of r u r a l h e a l t h records and repor t s (SEARO OqO) , March 1959

Report on a v i s i t t o Ceylon. 29 June - 5 Ju ly 1969

Radiation I Assignment repor t on School f o r Radio- l o g i c a l Technology (Thailand COTl), January 1965 - June 1968

Assignrent r ~ p o r t cn public h e a l t h admit&ration (X-ray techniques ) (Maldives 0005 ) , Nay - November 1968

Assignment r e p o r t on course i n h o s p i t a l physics ( ~ n d i a 0232). 14 May - 16 June 196

Assignment repor t on r a d i a t i o n h e a l t h , Burma (SEARO 01401, 22 November - 5 December 1968

Rehab i l i t a t ion

Assignment r e p o r t on r e h a b i l i t a t i o n of handicapped c h i l d r e n (SEARO 0174). October - December 1968

- Author 1

D r Henry Richords I D r S .P . Ramakrishnan I Mr Alfred J . Davidson

Dr David A . Tcjada de Rivero and

D r Esmat I. Hammoud

D r P. Rajasingham I

M r D.A. J c s i a h

S E A / R C ~ ~ / ~

Page 287

Annex 9

I Document No.

SEAhehabh (Afghanistan)

SEAhehabh

(Burma )

I ~ E A h e h a b h

( I n d i a )

SEAhehabh

( Indones ia )

SEAhehabh

(Thailand 1

I

SEA/Smallpox/24 Rev .l

I SEA/Smallpox/25, Corr .l and Corr.2

I

~ ~ A / S m a l l p o x / 2 7 and

Corr .l

T i t l e

Assignment repor t on r e h a b i l i t a t i o n of handicapped ch i ld ren (SEAR0 0174).

October - December 1968

Assignment r e p o r t on t h e development of

orthopaedic and p r o s t h e t i c appliance services and a n assessment of medical

and vocat ional r e h a b i l i t a t i o n se rv ices

(Ceylon 0063), November 1968 - Feburary

1969

Smallpox

Report on a v i s i t t o the smallpox

e r a d i c a t i o n . programme, Indonesia,

3-23 June 1968

Assigmcnt r e p o r t on smallpox erndicatiol) ,

Indonesia ( Indonesia 0081)

Report on a v i s i t t o t h e smallpox eradicn- t i o n programme. Afghanistan, 10-17

November 1968

Assignment repor t on smallpbx e r a d i c a t i o n

( Indonesia 0081), J u l y 1968 - January

1969

Report on a v i s i t t o t h e smallpox eradica-

t i o n programme, Indonesia, 10 January - 2 February 1969

Author

- do-

- do -

- do -

- do -

Mr J . A . E . Cleave

Dr J . Keja

Mr L.W. Wade

Dr J.KeJa

D r M.F. Polak

Dr J . Keja

SEA/Rc22/2 Page 288

Annex 9

Document No. 6

s ~ ~ / \ r a o c i n e l ~ 9 and

Corr .l

siu/Vaccine/JO

Tuberculosis I

T i t l e Author

Assignment repor t on freeze-dr ied BCQ vaccine production ( Ind ia 022 j ) . 28 May - 23 June 1968

Miss Bunch-Christens

A s s i g m n t report on the National Tuberculosis Programe. India

( Ind ia 0103 ) , Ju ly 1963 - January 1968

Tuberculosis con t ro l i n Indonesia, 1952 - 1965, repor t on WHO pro jec t s : SEARO OW3 and Indonesia W50

D r D. sav ic

Regional Office

Assignment report on tubercu lcs i s con t rc l (Ceylon 0075). 6 Ju ly - 12 August 1968

D r Q.V.J. Bai ly and Mrs H. Patterson

Assigntnent repor t on t he Tuberculosis Chemotherapy Centre. Madras ( Ind ia 0053). 12 February - 1 March 1%9

Vaocines

D r Wallace Fox ard D r D.A. Mitchison

Assignment r epo r t on National Tuberculosis Programme ( Ind ia 0103), Apr i l 1966 - Pebruary 1967; September 1967 - February 1968; September 1968 - January 1969

Assignment repor t on freeze-dr ied smallpox vaccine production, Bunna (SEARO 0038), 8-12 November 1968

D r K. Toman

Assignment repor t on freeze-dried smallpox vaccine production, Thailand

(SEAR0 0038 1, 14-15 November 1968

Assignment repor t on freeze-dr ied smallpox vaccine production, Indonesia (SEARO 0038). 19-28 November 1968

Assignment repor t on the production of D r L.R. Boulger

pol io vaccine ( Ind ia 0178), 1-29 May 1969

SEA/RCZZ/Z

Page 289

Annex 7

I Document No.

~EApJm/12 Rev .l

sEAhD~/l3 and Corr . l

sEA/~DT/~@

T i t l e

Assignment repor t on production of p o l i o

vaccine ( ~ n d i a 01781, January - February

1969

Venereal Diseases and Treponematoses

Assignment repor t on yaws c o n t r o l , Indonesia (Indonesia 0001). 18 June - 30 August 156%

Assignment r e p o r t on venereal-disease

c o n t r o l (Thailand w 8 2 ) , February - nugust 1967

Report on a v i s i t t o the Centra l Venereal Disease Laboratory (Div l s lon of Venereal Disease and Treponematoses Control,

Bangrak Hospi ta l , Bangkok) (Thailand 0082 17-26 May 1969

Vil;~illWiry Public Health

Assi&.nnient r epor t on t r a i n i n g i n veter inal

pub l ic h e a l t h ( ~ n d l a ) (SEARO 0168), August - September 1968

V i t a l and Health S t a t i s t i c s

Report on a v i s i t t o t h e Di rec to ra te of Health Services and t h e Bureau of Economic

and S t a t i s t i c s , Mysore (Bangalorc) , 20-24 May 1568

Report on a v i s i t t o V i t a l and h e a l t h

s t a t i s t i c s p r o j e c t , Rangoon (Burma 0022 1, 24 Apr i l - 15 june 1968

Report on a v i s i t t o Nepal - rcorgan iza t i c

of r u r a l h e a l t h records and r e p o r t s

(SEAR0 0050), 11-22 December 1767

Author

D r V.A. Iashltevich

D r C . J . Hackett

D r B.H.R. H i l l

Miss G.W. S tout

Professor C .W . Schwabs

Miss V.C . Ngwen

SEA/RC22/2

Page 290

Annex 9

SEA/VHS/99 Add .I

-- .- . -. . .

Assignment repor t on development of

hosp i t a l medical records (hosp i t a l

s t a t i s t i c s ) (SEAR0 0072), April 1966 - pay 1768

Document No. T i t l e

Assignment repor t on a s s i s t a n c e t o t h e

Indian Council of Medical Research

(India 0121), October 1967 - May 1968

Author

Assignment r e p o r t on a s s i s t a n c e t o t h e

Indian Council of Medical Research

( I n d i a 0121) , October - Deccmber 1968

-

Report on a coursc f o r coding i n s t r u c t o r s

( I n t e r n a t i o n a l C l a s s i f i c a t i o n of

Diseases , Eighth Revision) held i n

New Delhi ( I n d i a ) , 11-20 November 1968

Punctions and organizat ions of t h e

S t a t i s t i c s Systems of the Ministry of

Public Health, Thailand, Assignment repor t

on v i t a l and hea l th s t a t i s t i c s

(Thailand 0037). November 1968 - January 1969

S E A / V H S / ~ O ~

Reorganization of r u r a l hea l th records and

r e p o r t s (SEARO 0050): r epor t on v i s i t s t o

Thailand, 14 January - 4 February 1968

and 27 August - 17 September 1968

Reorganization of r u r a l h e a l t h records

and repor t s (SEARO 0050): r epor t on a

v i s i t t o Afghanistan, 4-18 August 1968

Development of h o s p i t a l medical record

departments, r epor t on a v i s i t t o

Indonesia (Indonesia 0075). 8 Ju ly - 4 nugust 1968

See SEA/pHA/68

Mrs M. Withus

Mr J Radkovsky and

D r A . D . Taskar

Mr J . Radkovslty

Regional Off i c e

Dl- E . I. Hammoud I D r For res t E. Lindcr

D r E . I. Hammoud

SEA/RC22/2

Page 291

Annex 9

Document No.

SEA/RC22/2 Paee 292 Annex 10

Table 1. Fellcwships Auardcd by thc WHO Scuth-East Asia Rcgicn, by Source of Punds and Country of m i g i n of the Fellow

(1 August 1968 t o 1 AUgUSt 1969)'

l ~ h e f igures do not include the extensions of previous years' fellowships, and are broken up

in to two par t s : for the periods 1 August t o 31 December 1968 and 1 January t o 31 July 1969.

Table 2 . Fellowships Awarded by t h e WHO South-Esst Asia Rcaion

by Subject of Study and Country of Origin of t h e Fell:wl

( I Awust 1968 - 1 Awust 1969)

SEA/RC22/2 Page 294 Amex 10

Table 2 (continued)

7

(trow NO.

5.

6.

Subject

Other Health Services

Mental health Health education Industr ial hygiene Nutrition Health s t a t i s t i o s

( imluding medical codins)

Dental health Physiotherapy Control of pharmaceu-

t i c a l and biological preparations

Ocoupational dermatology

Total

~ u n i c a b l e Diseases and Laboratory

Malaria Venereal diseases and

treponematoses Tuberculosis Epidemiology Tropical medicine Fl lar iaa is control Leprosy control Epidemiology of plague Vector-borne diseases Trachoma control Iabcratory Virology Vaccine production

m t a l

- - C m C1 111

m r( m m 2

d d d d

1

1 - 1

9 - -

- -

12

- - - 1 1 - - - - - 3 - - 5

- - -

- 1 -

- - 1

- - - - 1 - 1 - - 3 4 - 4

13

- - 2

3

6 1 -

- -

12

4

1 - - - 1 - - - - - - -

6

3 3 - -

3 2 -

3

-

14

5

- - 1 - - - - - - 4 2

1 5

13

- - - 1

6 - -

-

-

7

- - 1 1 - 1

1

1 - - - -

10

- - - -

- - -

- - -

1

- - - - - - - . - - - ..

1

- 1 - -

2

1 1

2

1

8

- - 1

5 - - - - - - 3 - -

- 2 - 1 5

- - -

- - 3

- - - 2 - - 1 1 - - 2 - -

9 6 9 7 2

- 1 -

- 2 -

1

- 9

- - 5 - - - 1

1 - 1 - 1

4 8 2

11

26

7 1

6

1

66

10

1

7 10

2 2

4 2

1

3 17 2

11

Table 2 (continued)

SEA/RC22/2

Pace 2 9 5 Annex 10

SEA/RC22/2 Page 296 Annex 10

Table 3. Fel lonships Awarded by t h e WHO South-East Asia Region For Study In Other Regicns and v ice ve rsa

(1 August 1968 . 1 August 1969)

Prom South-East

Asia Region to:

TO SOUth-EBS t Asia Region fran:

African Region

1

1 0

Region of t h e

Americas

48

5

European Region

131

2

Eas te rn

Mediterranean Region

24

11

Western

Pac i f i c Region

21

6 7

Tota l

225

95

Table 4 . Programmes of S t u d y Arranged f o r WHO F e l l o w s from -

t h e WHO South-Eas t A s i a R e g i m , by Count ry of O r i g i n

and R e c e i v i n g Count ry ( 1 August 1968 - 1 August 1969)

S e r i a l

No.

1. 2 .

3 . 4 .

5 . 6 . " I. 8. 9 .

10. 11.

1 2 .

13.

1 4 .

15. 1 6 .

1 7 . 18. 19. 20 .

2 1 . 2 2 .

23 . 24 .

25 . 26 .

27 . 28 .

29 . 30 .

R e c e i v i n g C o u n t r i e s

A u s t r a l i a Belgium B r a z i l B u l g a r i a

Burma Canada

C h i l e Colombia Czechos lovakia Denmark

F i n l a n d

F r a n c e Germany, F e d e r a l

Republ ic o f

Hong Kong

Hungary I n d i a I r a n

I r e l a n d I s r a e l

~ t a l y

J a p a n Lebanon

Malays ia Mexico

N e t h e r l a n d s New Zealand

N i g e r i a

Noway P a k i s t a n P h i l i p p i n e s

a r( ti 0 M

X

- - -

1 4 - - - -

17 - 1 -

- - 4 - - - - - - - - - - - - - 1 -

C m 4 m i c

W 4

- - - - - - - - 1 1 - - - - -

12 12 - - - - 2 - - - - - - - -

5 ti

U

- - - - 1

1 - - - 2 - -

- - -

1 6 - - 1 - - - 2

1

1 - - - - 4

4 s 3 m

- 1

1

1 - 1

1

1 - - - -

1 - -

1 6 - 1

3 1 - - 1

1

3 - - - - -

.-4 m a 0 Z

- - - - - - - 1 - - - - - -

12

3 - - - 1 - - - - 1 - - - -

C o u n t r y

co i

2 - H

- - - - - 5 - - 2

6 - 2

2

1 2

4

1 - - - 1 - - 2

3 - 1 - - 1

.n C m ti 4

€.

1 - - - - - - - - 1 - -

1 - -

12 - - 1 - - - 2 1

2 - - 1

1 -

--- A

3 m Y 0

2 H

1 2

1

15 5 7 1

1

22

11

1

2

5 1

7 8 4

17 1

5 1 3 2

1 3

5 1 4

1

1

1

3

5

of

m ;I

s IJ C

H X

- 1 - - 4 - - - 1

1 -

1 - 1

1 0 1 - - - 1 - 8 - 5 - - - 1 -

O r i g i n

m a > s -4 d

- - - - - - - - - - - -

- - - 2 - - - - - - - - - - - - - -

SEA/RC22/2 Page 298 Annex 10

Table 4 (continued)

-

S e r i a l N O .

31. 32. 33. 3 4 35. 36. 37. 38. 39. 40. 4 . 42.

43. 44.

Receiving Countries

Poland Puerto Rico Romania Singapore spa in Sweden Switzerland Thailand Turkey UAR mc USA USSR Yugoslavia

Total

- - Country

2 C1 "7 4

m d

of

u ) rl LO U

3 1

H C

- - 3 - - -

12 - - 1;

4 - 1

59

$. 4

- - - - - - - 1 - - 3 4 - 1

57

Origin

a, > rl 0 4

2

- - - - - - - - - - - - - -

2

a ' U

- - - 1

1 - - - - -

15 1 - 2

53

rd 4 4 0 M

X 2

11 - 6 - - - - - - - - -

41 6

101

- - - 1 - 1

1 1 - - 7 1 1 1

43

C H

1 - 4 - - 2

2

4 6 -

2 3

27 3 4

109

_I "4

C - .

12 1

10

5 1

3 3

19 6 1

66 44 45 35

469

4

Z

- - - - - - - 1 - 1

2 2 - -

24

w r: 3

t i ? % E4

- 1 - - - - - - - -

12

5 - -

41

SEA/RC22/2

Page 299 \ Annex 10

Table 5 . Fellowships Avardfd by Other Re,qicns of WHO f o r Study i n

thc Soilth-East Asia Roxion, by Country of Origin uf the Fellow and R2ceivinfi Ccuntrp (1 August 1968 to 1 Aumst 1969)

S e r i a l

No.

1.

2.

3 . 4.

5. 6 . 7. 8. 9.

10.

11.

12.

1 14.

15. 16. 17. 18. 19. 20.

21.

22.

23.

4

25. 26.

27.

~ountryf l 'e r r i tory

of Origin

Algeria

B r i t i s h Solomon I s lands

Pro tec to ra te

Chile

China

Colombia

Ethiopia

Ouinea

I r a q

I s r a e l

Japan

Korea

Kuwait

Lesotho

Malaysia

Maurit ius

New Zealand

Papua and New Ouinea

Peru

Phi l ippines

Saudi Arabia

S i e r r a Leone

Singapore

Somalia

United Arab Republic Venezuela

Viet-~drn

Yugoslavia

To ta l

2 C)

; m

e

-

- - - - - 1

- - - - - - 3 - - - - 3 - - - - - 1

- -

8

g p m

-

- - - - - - - - - - - - - - - 2 - - -

- - - - - -

2

.-4

o

-

- - - - - 1

- - - - - - - - - 1 - - - - - - - - - -

2

Receiving

e d

H

1

1 2

1

1

6 1

1 1

3 - 1

2

13

3 2

6 1

24

1

1

1 1

1

- 1

1

77

rl m U) C)

0 -3

c 3 ; ? B -

- - - - - - - - - - - - - - - - - - - - 1 - - - - -

1

Country

Y)

rl a

-

- - - - - - - - - - - - - - - - - - - - - - - - -

-

TJ rl

g , rl

-

- - - - - - - - - - - - - - - - - - - - - - - - - -

-

- 2 2 3 %

-

- - - - - - - - - - - - - - - 1 - - - - - - - - - -

1

2 - 3 -

r

-

- - - 4 - - - - 1 2 - - 4 - - 4 - 3 - - - - - - 3 -

2 1

--

m

h

1

1 2

1

5 6 3 1

1 4 2

1 2

20

3 2

14

1

30 1

1 2

1 1

1 4

1

112 I

S E A / R C ~ ~ / ~

Page 300 Annex 10

Table 6. U t i l i z a t i o n of Former WHO Fellows, South-East Asia Region lAna lys i s of 1182 r e p o r t s received s ince 1 January 1954).

U t i l i z a t i o n

U t i l i z a t i o n r e p o r t s received

Employed i n t h e subject of t h e i r fe l lowships

Asswned g r e a t e r r e s p o n s i b i l i t i e s i n t h e i r former f i e l d s of a c t i v i t y

Began new a c t i v i t i e s i n h e p i n g with t h e i r fellowship s tud ies

Introduced new methods

Establ ished new se rv ices

Imparted the knowledge gained t o o the rs by means of conferences and by a r t i c l e s i n medical journals

Engaged i n t r a i n i n g a c t i v i t i e s

Engaged i n research

Maintained some degree of contact with o the r fellows and o f f i c i a l s whom they came t o know during t h e i r s t u d i e s

Had been on i n t e r n a t i o n a l assignments

c m 4 m rl

Ci 4

121

112

75

55

76

39

67

91

7

11

j

1 2 , m ' U

144

136

75

63

87

45

86

117

30

15

5

139

136

82

46

94

44

83

118

31

24

1

r l

U C H

447

379

242

187

274

271

287

340

168

128

132

Number

rl * m a

Q C H

90

86

56

45

66

43

67

80

34

9

1

of

s

Z rl

rl 0

2

5

3

2

3

3

3

2

3

1

-

-

Fellows

m rl i 0

LO C

r

14

13

9

9

12

5

1-

13

10

5

1

rl

rn Q

71

69

36

32

35

25

41

41

7

2

-

rj C m d I-(

g $ S

203

1 2 1

8 0

131

89

131

182

55

34

2

.

r Y I)

1234

1861120

698

520

778

564

778

985

343

228

145

-- - Total

m NI m *

2 5

e, 0 -.

-

91.0

57.0

42.0

63.0

46.0

63.0

80.0

28.0

18.0

12.0

T9nIii'ING Or' X:.TIONAL STAFF - ACTIVITIES CI.RJiI%D OGT BY GOVERNMENTS WITH THE ASSISTANCE OF WHO

( 1 JULY 1968 - 1 AUGUST 1%9)*

Total

of t r a l Subject

Malaria

g 2 E 2 % < X It

w n W O N

W V N

i >

'The f i g u r e s i n t h i s t a b l e have been obtained from WHO f i e l d s t a f f i n r e s p e c t of t h e i r t r a i n i n g a c t i v i t i e s .

Because of poss ib le omissions i n o r d u p l i c a t i o n of r e p o r t i n g , they cannot be regarded a s being completely

accura te . Regular academic courses i n medical and nurs ing co l l eges and t r a i n i n g a c t i v i t i e s uhlch form t h e

main ob jec t of WHO-assisted p r o j e c t s , e . ~ . . " N u t r i t i c n Tra in ing (SEAR0 0097). h2vc not bccn included. An e;:ceptien h a s , however , k;en made i n r e s p e c t of t h e in te r -ccun t ry p r o j c c t "Short Courses f o r Nursing Personnel"

(SEUHO 0139).

Type of course o r t r a i n i n g

Basic t r a i n i n g course i n

malar ia e r a d i c a t i o n

techniques

Basic t r a i n i n g course i n

malar ia e r a d i c a t i o n

techniques

Refresher course i n

microscopy

- do -

Refresher course i n malar ia

e r a d i c a t i o n techniques

Duration and l o c a t i o n

AFGHANISTAN

3 months

Malaria I n s t i t u t e ,

Kabul

- do -

2 weeks

Kabul

4 weeks

Kabul

6 1 / 2 months a t

Kunduz , Pul-i-Khumri.

Fnanabad. Khajhaghar,

M z i a r - i - s h a ~ i f

Categories t r a i n e d

J m i - r i n d s e n i o r

malar ia inspec to rs

Student s a n i t a r i a n s

Microscopis ts

- do -

Supervisors and

junior inspec to rs

NO. Of

courses

1

1

1

1

7

TotalNo. of trainees

9

48

15 100

20

17 29 17 2

15

31

-

8

Duration and location

1 week mbul

1 week Public Health Ins t i tu t e . Kabul

2 weeks Public Health I n s t i t u t e , Kabul

3 months Vaccine I n s t i t u t e , Kabul

1 week Smallpox Zonal Offlce. Kandahar

3 weeks public Health ~ n s t i t u t e , Kabul

3 weeks Public Health Ins t i tu t e ,

Kabul

i Categories trained

U n i t off icers

Medical of f icers

Sanitarians and vaccinators

Vaccinators

sanitarians Senior vaccinators Sanitarians Trainee vaccinators

Medical officers

Provincial medical of f icers

Type of course or trainlng

Seminar on malaria eradication

Seminar on tuberculosis control

Refresher training (Techniques and methods of smallpox eradication)

Basic training course i n smallpox eradication

Training course for supervisors

Seminar on bas10 health services

Orientation course

NO. of courses

1

1

1

1

1

1

1

I Subject

Malaria (cont 'd

Tuberculosis

Smallpox

Public Health

Subject

Publ ic Heal th

(con t 'd )

N u r s i w and

Nidwifery

Cholera

Iaboratory

Techniques

Type of course o r t r a i n i n g , Duration and l o c a t i o n I I

Refresher course i n ward

admin i s t ra t ion

Basic s e m i ~ r on records

and repor t ing

Short course ( i n s e r v i c e 1 i n publ ic h e a l t h nurs ing

1 week

Public Health I n s t i t u t e ,

Kabul

4 weeks

Publ ic Health I n s t i t u t e ,

Kabul

4 weeks

Publ ic Heal th I n s i t u t e ,

Kabul

Basic t r a i n i n g course 8 months

i n nurs ih- Paruan Hosp i ta l

Basic t r a i n i n g i n

midwif e ry

Seminar on cho le ra c o n t r o l

Refreshar course i n

l abora to ry technology

6 months

Herat and Sharara ,

Kabul

1 week

Public Heal th I n s t i t u t e ,

m b u l

1 month

Public Health I n s t i t u t e ,

Kabul

C3tegories t r a i n e d

S a n i t a r i a n s ,

nurses and c l e r k s

Graduate nurses and

nurse-midwives

Auxi l iary nurse-midwives

Doctors

' Labcratcrg A s s i s t a n t s

and Technicians

No. of j T o t a l N o .

courses /of t r a i n e e s

Subject

ursing

eprosy

l a l a r i a

Pyge of course or training

Refresher course i n c l in ica l teaching

Refresher training i n laboratory work

Refresher t r a i n i w i n

leprosy control

Basic t r a l n l w i n malaria

eradication

Basic training i n microscopy

Duration and location

i weeks langoon

! weeks leprosy Clinic, leneral Hospital,

bwoon

! weeks Leprosy Hospital,

mndalay

1 month kprosy Clinic.

[teneral Hospital,

Rangoon

1 week

Colombo

3 months Colombo

Categories trained

enior s t a f f nurses

aboratory a s s i s t an t s

lediczl of f icers ard ,cprcsy i.?spi.ctors

iedical officer

Ucroscopists

rota1 No. P t rainees

Type of course or t r a i n ing

Reorientat ion course i n community or iented TB cont ro l programme

Reo r i en t a t im i n micro- scopy and laboratory

se rv ice

Or ien ta t ion i n laboratory techniques

Orientat ion course i n tubercu los i s con t ro l

(He l l t h Education and Defaulter Action)

Orientat ion course i n

tubercu los i s con t ro l (Reports and Records)

Refresher course i n adminis t r a t i o n of schools of

nursing

Post-basic course i n publ ic hea l th nursing (academic courses hnd sewJnars, admin is t ra t i cn and f i c l d t r a i n i n g )

Duration and loca t ion

1 week Kurunegala

1 week Kurunegala

2 weeks

Kurunegala

2 weeks

Kurunegala

1 month, Kandy

9 months I n s t i t u t e of Hygiene. Kalutara

Categories t ra ined

Medical o f f i c e r

Medical laboratory technicians

Public hea l th inspec tors

Assis tant s t a t i s t i c i a n c le rks

Pr inc ip les and sen ior t u t o r s

Graduate nurses

No. Of courses

Cotal No. ! t r a i n e e s

Subject

Nursing ( cont 'd )

Maternal and

Child Health

Health S t a t i s t i c s

Tuberculosis

I I

rype of course or t r a i n ing ) Duration and loca t ion

Basic course i n publ ic hea l t h and midwifery

Post-basic course,

seminars. demonstrations and f i e l d t r a i n i n g

Orientat ion t o t he 8 t h revis ior . cf Ir . tcrnationa1 C la s s i f i c a t i on of .Diseases

Basic course f o r medical

record c l e rk s

Training course i n laboratory diagnosis

methods

Training i n laboratory

technology

6 months I n s t i t u t e of Wgiene, Kalutara

2 weeks

I n s t i t u t e of Hygiene, Kalutara

1 Meek Colombo South Hospi ta l ,

Colombo

3 weeks Colombo South Hospi ta l ,

Colombo

3 weeks TB Chemotherapy Centre,

Madras

1 week

TB ChemDtherapy Centre, Madras

Categories t ra ined

Crainee publ ic hea l t h nidwives

I s s i s t an t medical o f f i c e r s

Coding c l e r k s

Hospital c le rks

Medical o f f i c e r

Technicians of voluntarj- hea l th se rv ices

No. o r courses

-

Total No. ,f t r a inees

SubJect

Nursing

Malaria

Smallpox

Duration and locat ion

3 weeks

Tslvandrum

2 weeks College of Nursing

New Delhl

2 weeks Iady Health Vis i tors

School, Pntna

IrnON-ESIA

1 week CDC Training Centre

T j l l o t o

2 weeks CDC Trzining Centre

T j i l 0 t0

2 weeks

Type of course or locat ion

Refresher course i n hospi ta l keeping

Workshop of s t a t e nursing

superintendents

Course fo r preparing personnel fo r teaching and

administrative responsibi- l i t i e s i n ANN Schools

Orientation course i n malaria eradicat ion

(academic)

Refresher course I n malaria

eradicat ion

Training course f o r supervisors

Categories t rained

Nursing superintendents,

matrons, senior tu tors medical superintendents

Qraduate nurses

Nurse tu tors

Medical o f f l ce r s and heal th c t n t r o l l e r s

Entomolo~lsts

Health inspectors

No. Of Courses

1

1

1

5

1

2

Total NO

of t rainees

22

20

10

13 3

11

20

-.

Subject C- Smallpox

(cont 'd

Public hea l th

Tuberculosis

Neonatology

Paedia t r ics

Pype of course or t r a i n ing

Pralning course i n

smallpox e rad ica t ion

Seminar on smallpox

e rad ica t ion

Refresher t r a i n i n g i n

midwifery

Refresher and p r a c t i c a l

t r a i n ing i n tubercul in

t e s t s reading, BCO

vaccinat ion and assessment

Refresher t r a i n ing i n

paed i a t r i c nursing i n

neonatal units

Refresher course

Duration and loca t ion Categories t ra ined NO. of

courses

2 weeks

CDC Training Centre

T j i l o t o and Djakarta

1 week

T j i l o t a

3 months

Male

2 weeks

Ulan Bator

3 weeks Ulan Bntor

2 months

Children 's Cl inic

Ulan Eator

(edical o f f i c e r s and

supervisors

Medical o f f i c e r s

Midwives

BCG vaccinators ,

fe ldshers and

nurses

Nurses

Chiefs of almaks,

paed ia t r ic ians

!otal No

t r a i nee s

Subject

Paediatr ics ( cont 'd )

Obstetr ics

gynaecology

Cancer

i

* w w 3 ; g n 2.. x _ g P W N C O N >

Type of course or t ra in ing

Refresher course i n

paedia t r ic nursing

mien ta t ion course i n paediatr ics

Demonstration and f i e l d t ra in ing i n massage. g y ~ l a s t i c and upgrading res is tance of chi ldren

OTlentatlon course

Refresher t ra in ing course i n radiotherapy

fiefresher t ra in ing course i n radiotherapy, 6GniMr

and demonstration

Duration and locat ion

3 weeks

Central Children's

POlYClfni~, Ulan Bator

2 weeks Children's Hospital, Choibhlsan

1 week

Creche Model No.: 43, . Bator

4 month; Children's Hospital,

Choibalian

4 montl j

Republican Ontological

Dispensary, Ulan Bator

4 month;

Rcpublisan Cmcologieal

Dispensary, Ulan Bator

No. of courses

3

1

1

1

1

1

I Categories traitled

Paediatr lc d l s t r i c t nurses

Paediatr icians

Nurses from

creches

Obstetricians

Oncology doctors

Laboratory technicidns

Total No. of t ra inees

56

10

22

25

13

7

-

Suoject

Public hea l t h

and epideniologj-

Nursing

Type of course or t r a i n ing

Refresher course

- do -

Training course f o r counter-

pa r t s t a f f i n epidemiologi-

c a l , microbiological and

bruce l los i s an t igen

production

Training course

(academic )

- do -

Duration and loca t ion

J months

S t a t e I n s t i t u t e of

Epidemiological Microbio-

logy and Hygiene, Ulan

Bator

2 weeks

S t a t e I n s t i t u t e of

Epidemiological Microbio-

logy and Hygiene,

Ulan Bat or

30 h r s

I n s t i t u t e of Epid.

Microbiology and Iiygine,

Ulan Bator

3 weeks

School of Nursing,

Ulan Bat or

4 weeks

School of Nursing.

U l a n Bator

Categories t ra ined

Physicians and

epidemiologists

Veterinarians and l a b .

a s ~ i s t a n t s

Nurses ( t r a i n e e s )

- do -

NO. Of

courses

1

1

2

1

1

* Total No.

of t r a i nee s

14

15

11

8

12

Subject

Health j t a t i r t i c s

Malaria

Type of course or t r a i n ing

Orientat ion course

Training course

- do - (coding ICD)

Basic and f i e l d t r a i n ing

Refresher course

(academic )

Basic t r a i n ing i n recording system

Duration and l oca t i on

2 months

F i r s t City Hospi ta l . Ulan Bator

2 weeks Min. of Pub. Health, Ulan Bator

1 week P i r s t City Hospi ta l , Ulan Bator

NEPAL

4 months Kathmandu

5 months

Kathmandu

2 months

Kathmandu

2 weeks Central Zone "B"

Categories t ra ined

Physicians, medical s t a t i s t i c i a n s , aimak

inspec tors of hea l t h se rv ices

Physicians and hosp i t a l medical s t a f f

Superintendents and microscopists

Microscopists

Microscopists and supervisor recorders

Supervisor recorders

No. of

courses Total No. f t r a i nee s

-

30

26

10

10

14

29

35

> a m s w m 2 2 < xuF? W W N W N N

h

Subject

Refresher seminar 1 week

Kathmandu

Type of course or t r a i n i n g Duration and l o c a t i o n

Malaria I Refresher t r a i n i n g i n

( c o n t d . ) recording system 1 week

Cen t ra l Zone "B"

Refresher t r a i n i n g i n

spraying and s u r v e i l l a n c e

Basic Training i n

spraying and s u r v e i l l a n c e

25 days

West Zone

2 weeks

Centra l Zone

3 weeks

East Zone

1 0 days

Cen t ra l Zone "A"

12 days

Centra l Zone "B"

1 week

Centra l Zone "B"

Categor ies t r a i n e d

- do -

Supervisor recorders

2 weeks

Cen t ra l Zone "B"

Jun io r and sen io r r a l a r i a

inspec to rs

J u n i o r and s e n l o r mala r l r

inspec to rs and superv i sor

recorders

Senior malar ia inspec to rs

Senior and junior malar ia

inspec to rs

Malzria inspec to rs

Senior and junior malar ia

inspec to rs

No. Of

courses

1

1

1

2

1

1

1

1

4

Tota l No.

of t r a i n e e s -

20

47

34

54

14

32

19

8

41

* a c? 3 c . m 3 2 - ; 2

w n + . + m r u m

3

Subject

Malaria ( con t ' d )

Public heal th

Type of course o r t ra in ing

Basic course (academic)

Basic t ra in ing (academic and f i e l d )

Orientation course i n malaria eradicat ion

Seminar on spraying and surveillance

Refresher seminar

Basic f i e l d t ra in ing i n

entomology

Basic t ra in ing i n

maintenance and

Operation

Workshop ( or ienta t ion

course)

Duration and locat ion

2 weeks Kathmandu

1 week Kathmandu

1 week NMEO Headquarters

Kathmandu

9 days Central Zone "B"

12 days

Kathmandu

1 month Central Zone 'A"

1 week

NEB Katmndu

2 weeks Kathmandu

Categories t rained

Senior and junlor malaria impectors

Malaria inspectors and superintendents

Auxiliary heal th workers

Senior and junior malaria

inspectors and supervisor recorders

Senior and junior. superin- tendents and senior mlcro- scopis t s

Field a s s i s t an t s (entomological )

Driver mechanics and t r ac to r operators

D i s t r i c t and zonal senior medical of f ioers

NO, o r courses

Total No. ,f t rainees

P W W s o n t ( m * g m >

i,, 0 r r _ V C I - N >

j Subject

Nursing and midwifery

Iaboratory techniques

I

Type of course o r t r a i n i n g

Training course (academic and f i e l d )

Workshop i n ANM curriculum and regu la t ions

Refresher course i n teaching and superv i s ion a t ward l e v i l

Refresher course

P r a c t i c a l t r a i n i n g course i n leprosy microscopy

Pre - se rv ice t r a i n i n g course f o r junior h e a l t h

workers

Pre-service t r a i n i n g i n microscopy

Duration and l o c a t i o n

2 weeks

K a t h n d u

1 week

Blra tnagar

4 weeks K?thmandu

4 weeks Bira tnagar

3 months Central Heal th Laboratoq Kathmandu

1 1 / 2 years

Cholburi , Khonkaen

Phrabuddabat

2 months Malaria h a i n l n g Centre

Categories t r a i n e d

Ass i s tnn t supervisors

vacc ina to rs and v i l l a g e l e v c l workers

Tu tors , sen io r pub l ic h e a l t h nurse and h o s p i t a l s t a f f

Nurses

Auxi l iary nurse-midwives

Nicroscopis ts

Secondary school

graduates

No. of

courses

1

1

1

3

1

3

2

T o t a l No. ,f t r a i n e e s

46

10

20

28

2

54

55

1 Subject

Leprosy

c o n t r o l

( cont 'd )

Type of course o r t r a i n i n g

Refresher course

Basic t r a i n i n g (academic)

Or ien ta t ion course i n

leprosy i n t e g r a t i o n

Refresher t r a i n i n g

Refresher course

Duration and l o c a t i o n Categor ies t r a i n e d

1 week

Plrapradacng

5 months

Phrapredaeng

1 week

IamPane

11 days

School of Nursing,

Korat

2 week;

School of Nursing,

Chantaburi

2 weeks

School of Nursing,

S o n g b l a

2 weeks

Snan Prung Hospi ta l , Chlangmal

1 No. of

Iunior s a n i t a r i a n s

Zuxi l iary leprosy

#orkers

3 a n i t a r i a w and midwives

Nurses ,head nurses

supervisors and

I n s t r u c t o r s

Graduate nurses

courses

1

1

1

1

1

1

1

( Tota l N O .

' t r a i n e e s -

12

2 2

10

36

20

2 0

3 0

Duration of l c c a t i o n

3 weeks

Pi tsanuloke

1 month

Asian I n s t i t u t e f o r

Economic Development and

Planning and Elinistry of

Public Heal th , Bangkok

Categories t r a i n e d

Head nurses and s e n i o r

s t a f f nurses

Prov inc ia l nad ica l o f f i c e r s

h o s p i t a l d i r e c t o r s ,

s a n i t a r y engineers and

nurses

1 Subject

Psych ia t r i c

nurs ing

(con t 'd )

Heal th

planning

b

m e of c surse o r t r a i n i n g

Refreshzr course

(planning f c r p a t i e n t c a r e )

Training course i n h e ~ l t h

and development planning

No. of courses

1

1

Total No. of t r a i n e e s

--

24

30