SEA/RC17/2 Page 89 P A R T 111 ACTIVITIES ...

SEA/RC17/2 Page 89

P A R T 111

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

W I T H T H E H E L P O F WHO

SEA/RC17/2 Page 91

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 a r e listed a t the end.

Projects (even though mentioned in last year's report and planned to continue in future years) 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 &ice or Headquarters was the only assistance given, and projects assisted only by grants-in-aid.

In the first column (under "Project No., Source of Funds, Co- operating Agencies") "R" rn eans the Regular budget; "TA" means Technical Assistance funds; "UNSF' the United Nations Special Fund; "UNICEF" the United Nations Children's Fund, t'CWS' the Special Account for Community Water Supply, "MR" the Special Account for Medical Research, and "USAID' the United States Agency for International Development. Names of co- operating agencies, except for UNICEF (see above), whether or not they have contributed funds, a r e given in parentheses.

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 WHO'S assistance.

Projects entitled "Fellowships" a r e those in which fellowships a r e considered a s projects in themselves; other fellowships are shown under the title of the project of which they form a part.

It should also be noted that there a r e 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). Advice of this type continues to be a' growing responsibility of the Regional Office.

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1. AFGHANISTAN

A winter of exceptional severity with very heavy snows made communica- tions to some outlying areas difficult and hampered development work and services. The need for an effective system of vital and health statistics, which will facilitate a more accurate assessment of health needs and will guide planning, has been increasingly recognized. Efforts have been made to accelerate the rate of growth of rural health services, and it has been planned to increase the scope of the rural development programme from three to six project areas a year. Steps have been taken to promote a more integrated rural health service which will be capable of absorbing such mass campaigns a s malaria and smallpox eradication and tuberculosis, leprosy and trachoma control.

A major organizational step has been the division of the country into 29 provinces, whereas previously there were only 13 (seven major provinces and six districts). There will be a provincial medical officer in each province.

A new medical college was opened at Jalalabad in Nangarhar Province. It i s appreciated that a considerable effort is necessary to provide adequate staff and teaching facilities, including a satisfactory teaching hospitaL The Rector of Kabul University and the Dean of the new medical college were assisted to visit India to study recently established medical colleges. It was expected that admission to the Medical Faculty of Kabul University would be increased by about thirty per cent. Co-ordidtion between the Health Ministry and Kabul University has permitted the use of medical institutions under the Health Ministry a s teaching fields for medical students.

With the concurrence of the Ministry of Education, in order to improve the quality of candidates for para-medical training, a decision has been taken by the Medical High Council, chaired by the Minister of Health, that candidates who have passed the sixth grade will be admitted to the Academy of Teacher Training and to a special school connected with the Masturat Hospital (for male and female candidates respectively), where they will receive three yearst schooling with bias on science subjects and subjects related to t h ~ i r future profession. After passing the course they will then be admitted to schools dealing with training in their special professions.

The first year of the programme for training nurse-midwives at Shararah Hospital progressed well. The older established nurse-training programmes also continued to operate. A nursing course to enable senior midwives to qualify a s nurse-midwives promised to produce future leaders in nursing education.

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It has been decided to givc auxiliary-nurse-midwife training at the provincial headquarters. It i s understood that such training has already been started a t Kandahar and also a t Lashkargah, at the latter with the assistance of CARE/Medico.

Many of the initial difficulties hindering the full development of the Public Health Institute are being gradually overcome. The training of sanitarians and the health education activities in the Institute have progressed well. A blood bank was brought into operation, with technical assistance from West Germany.

The Central Health Laboratory was transferred into a new building in the compound of Avicenna Hospital, and continued to do work of high quality.

The smallpox control pilot project in Kabul City was satisfactorily concluded, with a coverage of over eighty per cent. The work was facilitated by donations of freeze-dried vaccine from bilateral sources, promoted by WHO. Plans for a country-wide eradication programme were in train.

A BCG immunization campaign covered most of the school-children in Kabul., The work has been transferred to Kandahar, and plans were made to start a BCG campaign in Shewaki District.

Work was started by the Kabul Municipality on an extensive programme to improve accommodation and sanitation in the older areas of Kabul. The plan envisages complete reconstruction of these areas within twenty-five peara.

PROJECT LIST

P r u l a c t N ? .

Source of Fund;

C o - c p c r a t i n c

A ~ e n c i e s - T i t l e

I,f , :hanistLn 11 - M a l a r ~ a E r a d i c a t i o n

R (nus 1756 - ) UNICEF

A i m of t h e p r o l c c t . Tc eradicate m a l a r i a from t h e e n t i r e c o u n t r y and t o p r e v e n t

t h e r e - e s t a b l i s h m e n t of endemic i ty .

A s s i s t m c e p r o v i d e d by k?iO dur in i : t h e y e a r . ( a ) Thrcc m a l a r i o l o g i s t s , an entomolo-

g i s t , a s a n l t a r i : m , t h r e e l a b o r a t o r y t e c h n i c i a n s and t h r e e s e c r e t a r y - s t e n o g r a m s ;

( b ) one four-month f c l l . > w s h i p t o a t t e n d t h e m a l a r i a t . r a ln ing c o u r s e i n Jamaica , t h r e e four-munth and onc th rce-month f e l l o w s h i p s f o r s t u d y i n N i g e r i a , and t h r e e

th ree-month f e l l o w s h i p s for s t u d y i n I n d i a ; ( c ) s u p p l i e s and equipment and f o u r v e h i c l e s .

( I n a d d i t i o n , a s ix-week i n t e r n a t i o n a l f e l l o w s . d p was awardec! u n d e r t h e scheme f o r i x c h a n g e of Scientific Workers . )

Probable d u r x t i o n of a z s i s t a n c e . U n t i l t h e end ut' 1/67.

Work done d u r i n g t h e y e a r . I n 196q, s p r a y i n g operations a r e p lanned t o c o v e r a

p o p u l a t i c n of a p p r a x i m z t e l y 4.2 m i l l i o n , i n c l u d i n g 581 190 people i n new a r e a s .

S?>ray ing was withdrawn frcm P u l i k u n r i U n i t ; t h i s ilas i n c r e a s e d t h e p c p u l a t i o n under c u n s o l l d a t i c n t o 541 UClO. F o l l o w i n g t h e d i s c o v e r y of a few c a s e s of

m n l a r l a i n t h e Kabssl a:c:l, actic:n h a s hecn t a k c n t o i n t e n s i f y a n t i l a r v a l o p e r a t i o n s and t o d e a l w i t h f i c i by r e s i d u a l s p r a y i n g . Thcrc bras an o u t b r e a k of m a l a r l a i n

S a r o b i a r e a , whcrc thl:r.c i s an segregation of l a b o u r f o r c o n s t r u c t i o n works. S p e c i a l measurcc were t a k c n t o d e a l w i t h t h i s o u t b r e a k .

Entomolcgica l a c ' ; i v i t i e s have been reorgan izer ; . M i n v e s t i g a t i o n i s i n

p r o g r e s s i n Kataghan Province t o a s c e r t a i n i f t h e r e a r e any u n d e t e c t e d v e c t o r s r e s p o n s i b l e fir t h e p e r s i s t a n c e of law-grade t r a n s m i s s i o n i n some a r e a s .

M assessment i:f t h c p r l g r a i m c c c v c r i n g t h e ar ,ens J i roposed f o r withdrawal of s p r a y i n g i n 1965 hcs been undertaken by a Regiona l Assessment Team ( s e e SEAR0 7 ) . Based on t h e f i n d i n g s of t h i s a s s e s s m e n t , a c t i o n i s b e i n g t a k a n t o improve t h e

s u p e r v i s i o n of s u r v e i l l a n c e c p e r a t l o n s .

J f d z n i s t a n 1 3 Medical Educat ior .

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

Alm of t h e p r o j e c t . To b u i l d up d e p a r t m e n t s ~f t h e F a c u l t y of Medicine and t o t r a i n s t a f f .

SEA/~cl7/2 Page 96

As5iStanCe DrOVided by WO dUrinK t h e yea r . ( a ) A p r o f e s s o r of pa tho logy and a p r o f e s s o r of phys io logy; a c o n s u l t a n t f o r t h r e e weeks and a s e c r e t a r y - s t e n o g r a p h e r

f o r s i x months; ( 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 . Until t h e end of 1968.

work done d u r i n e t h e y e a r . The v i s i t i n g p r o f e s s o r of pa tho logy s t a r t e d h i s a s s i gn - ment i n March 1963. He has a s s i s t e d i n o r g a n i z i n g t h e t e a c h i n g of pa tho logy and h i s t > l o g y by p r e p a r i n g l e c t u r e n o t e s i n E n g l i s h , which were t r a n s l a t e d by t h e n a t i o n a l c o u n t e r p a r t i n t o F a r s i , t y s e t t i n g or a t e a c h i n g l a b o r a t o r y and by deve lop ing s e t s of s l i d e r , fo r . s t udy . A pa tho logy d i a e j l o s t i c s e r v i c e was

i n t r o d u c e d at t h e U n i v e r s i t y h o s p i t a l s , f a r whlch an au toma t i c t i s s u e - p r o c e s s i n g machine, p rovided by UNICEF, was a v e r y u s e f u l i t e m . I n t e g r a t i o n of a c t i v i t i e s

w l t h C l i n i c a l depar tments was e s t a b l i s h e d .

The v i s i t i n g p r o f e s s o r of phys io logy jo ined t h e p r o j e c t i n November 1963.

A f t e r making a n assessment of t h e s t a t u s of t h e Department and i t s f u t u r e needs . he a s s i s t e d i n o r g a n i z i n g a s t u d e n t l a b o r a t o r y i n t h e premises r e c e n t l y

evacua t ed by t h e B a c t e r i o l o g i c a l Department . An o r d e r f c r supplementary equipment

was p repa red . Books and p e r i o d i c a l s Were added t o t h e l i b r a r y ; l e c t u r e n o t e s i n E n g l i s h were p r epa red f o r t r a n s l a t i o n i n t o F a r s i by t h e n a t i o n a l c o u n t e r p a r t .

A s s i s t a n c e was a l s o given t o t h e new med ica l c o l l e g e a t J a l a l a b a d by b o t h

t h e v i s i t i n g p r c f e s s o r s .

S e c r e t a r i a l a s s i s t a n c e was provided by WHO, t o h e l p w i t h c l e r i c a l work i n t h e p r o j e c t and t h e t y p i n g of pa tho logy r e c o r d s .

A sho r t - t e rm c o n s u l t a n t v i s i t e d J a l a l a b a d f a r t h r e e weeks w l t h a view t o

reccmmending a programme of development f o r a med i ca l c o l l e g e .

Afuhanis tan 2 0 Vaccine Product ion , Kabul

TA . (Jan. 1955 - Nov. 1960; J u l y - Oct. 1961; Dec. 1962 - ) UNICEF

A i m of t h e ~ r o j e c t . To r e o r g a n i z e , expand and improve f a c i l i t i e s f o r vacc ine p r o d u c t i o n f a r t h e n a t i o n a l h e a l t h programmes; t o t r a i n l o c a l p e r s o n n e l i n t h e

p r o d u c t i o n of b i o l o g i c a l subs t ances .

Ass i s t ance provided by WHO d u r i n g t h e y e a r . A b a c t e r i o l o g i s t .

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 1964.

Work done during: t h e y e a r . Th i s p r o j e c t h a s been a s s i s t e d s i n c e 1955 w i th f u l l -

t ime bacteriologists and c o n s u l t a n t s . S e v e r a l fellowships in b a c t e r i o l o g y and s u p p l i e s and equipment from WO and UNICEF have been p rov ided . The Vaccine

Cent re produces vacc ine s meet ing i n t e r n a t i a n a l s t a n d a r d s .

During t h e y e a r much improvement was e f f e c t e d i n t h e p h y s i c a l f a c i l i t i e s Of

t h e Centre and i n t h e accommodation f o r animal b r e e d i n g . The p r o d u c t i o n of v a c c i n e s

c o n t i n u e d t o be improved. The c o n t r o l c f t h e s e v n c r l n e s by s t e r i l i t y t e s t s , and i n some c a s e s by p o t e n c y t e s t s , was i n t r o d u c e d . L a r g e r q u a n t i t i e s of

b a c t e r i a l v a c c i n e s (TAB and c h o l e r a ) and v i r u s v a c c i n e s ( r a b i e s and smal lpox)

were produced. I n t h e p r o d u c t i o n of TAB v a c c i n e , l o c a l s t r a i n s have been i n t r o d u c e d ; t h e Cent re h a s a l s o s t a r t e d p r e p a r i n g a g g l u t i n a b l e d i a g n o s t i c "0 " s u s p e n s i o n f c r

t h e Widal t e s t .

From 1965 onwards t h e I n s t i t u t e w i l l work c l o s e l y w i t h t h e M i c r o b i o l o g i c a l

Department of t h e P u b l i c H e a l t h I n s t l t u t c , Kabul. wllere, by c h a t t ime . a v a c c i n e

c o n t r o l s e c t i o n w i l l have been e s t a b l i s h e d t o a s s a y i n d e p e n d e n t l y t h e b a t c h e s cf

v a c c i n e Droduced a t t h e I n s t i t u t e .

A f ~ h a n i s t a n 24 H e a l t h Educa t ion

R ( o c t . 1958 - S e p t . 1959~ May 1962 - )

A i m of t h c p r s j e c t . TLI deve lop h e a l t h c d u c a t l o n s e r v i c e i n t h e c c u n t r y ; t G

promote h e a l t h e d u c a t i o n i n t e a c h e r t r a i n i n g ; 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

e d u c a t i o n ; t o e s t a b l i s h and deve lop a h e a l t h e d u c a t i o n s e c t i o n i n t h e I n s t i t u t e of P u b l i c H e a l t h , Kabul .

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 h e a l t h e d u c a t o r ; ( b ) s u p p l i e s and l i t e r a t u r e .


Work done d u r i n g t h e y e a r . Deve lop ing t h e H e a l t h E d u c a t i o n S e c t i o n , i n c l u d i n g a f i e l d l a b o r a t o r y ; a d d i n g a h e a l t h e d u c a t i o n c3mponent t o t r a i n i n g programmes;

p r o v i d i n g a s s i s t a n c e t o v a r i o u s h e a l t h programmes i n p l a n n i n g h e a l t h e d u c a t i o n a c t i v i t i e s , and preparing h e a l t h e d u c a t i o n m a t e r i a l r were t h e main a c t i v i t i e s of

t h e p r o j e c t d u r i n g t h e y e a r .

Teach ing i n h e a l t h e d u c a t i o n was p r o v i d e d t o f i r s t and secund-year s t u d e n t s

i n t h e School f o r S a n i t a r i a n s ; c l a s s e s f o r seccmnd-year s t u d e n t s were h e l d i n l t h e f i e l d l a b o r a t o r y once a week.

Throughout t h e academic y e a r , h e a l t h e d u c a t i d n was i n c l u d e d i n t r a i n i n g

c o u r s e s f o r t r a i n e e s i n C l a s s X I 1 1 and f o r female t r a i n e e s i n C l a s s X I a t t h e T e a c h e r - T r a i n i n g I n s t i t u t e , Kabul. It was a l s o i n c l u d e d i n two s e m i n a r s f o r

t r a i n e e s i n t h e F a c u l t y of E d u c a t i o n and f o r teache1.s a t t e n d i n g t h e th ree-month

mid-win te r i n - s e r v i c e t r a i n i n g c o u r s e . A c t i v i t i e s were c o n t i n u e d w i t h t h e H e a l t h

Committee i n t h e T e a c h e r - T r a i n i n g I n s t i t u t e .

Advice was g i v e n i n connection w i t h t h e develupment of t h e h e a l t h c o n t e n t

of t h e c u r r i c u l u m , u n d c r t h e UNESCO-assisted p r o j e c t on t e a c h e r e d u c a t i o n .

The smal lpox c c n t r o l p r o j e c t was a s s i s t e d by p r o v i d i n g t r a i n i n g i n h e a l t h

e d u c a t i o n t o t h e workers , by p r e p a r i n g h e a l t h education m a t e r i a l s and t h r o u g h

SEA/RCI 712 8

community a c t i v i t i e s i n Kabul. Logar and Jalal .abad.

Work was s t a r t e d on t h e p r e p a r a t i o n of a long- range p l a n f o r t h e development of h e a l t h educa t i on i n t h e coun t ry , c o n s i d e r i n g t h e number of h e a l t h e d u c a t o r s r e q u i r e d , t h e i r placement i n t h e h e a l t h o r g a n i z a t i o n and t h e p rocedu re s f o r t h e i r r e c r u i t m e n t and t r a i n i n g .

Ass i s t ance was g iven i n p l a n n i n g t h e World Hea l t h Day programmerin co- o p e r a t i o n w i t h t h e s t a f f of t h e Tube rcu lo s i s h o s p i t a l . A weekly rad1.i f e a t u r e

h a s been a r r anged by t h e H e a l t h Educa t ion Sec t ion , wi th t h e co -ope ra t i on of o t h e r

h e a l t h workers .

Medical s t u d e n t s undergoing cou r se s i n s o c i a l and p r e v e n t i v e medic ine a t

t h e Medical Co l l ege , Kabul, and male n u r s e t r a i n e e s were a s s i s t e d d u r i n g t h e i r f i e l d expe r i ence a t Shewaki.

The d o c t o r i n charge of t h e H e a l t h Educa t i on S e c t i o n l e f t f o r s t u d y a t t h e

Schuol of P u b l i c Hea l t h , U n i v e r s i t y of Mtnnesota. USA, on a WHO f e l l u w s h i p . Another d o c t o r and a s a n i t a r i a n jo ined t h e S e c t l u n - t h e l a t t e r on h i s r e t u r n

from a USAID f e l l o w s h i p i n B e i r u t f o r s t u d y i n s a n i t a t i o n and h e a l t h educa t i on . Another s a n i t a r i a n t r a i n e d i n t h e School f o r S a n i t a r i a n s , Kabul , was a l s o

a s s i g n e d t o t h e S e c t i o n .

Afghanis tan 26 Rura l Hea l t h

T A ( A p r i l 1956 - ) 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 of r u r a l h e a l t h s e r v i c e s i n which

e f f e c t i v e l y d i r e c t e d and supe rv i s ed c u 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 i n t e -

g r a t e d a t a l l l e v e l s .

Ass i s t ance provided by WHO d u r i n g t h e yea r . ( a ) A p u b l i c h e a l t h o f f i c c 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 nu r se ; ( b ) s u p p l i e s and equipment .


Work done d u r i n g t h e y e a r . The p r o v i s i o n of s lx -month ly t r a v e l p e r m i t s h a s f a c i l i -

t a t e d f i e l d work.

Cons iderab le a t t e n t i o n was g iven t o t h e t r a i n i n g a s p e c t s a f t h e p r o j e c t . A curriculum f o r t r a i n i n g of d a i s was p r e p a r e d , b u t t h e l a c k of a n a t i o n a l

n u r s i n g c o u n t e r p a r t h a s been a handicap t c midwifery t r a i n i n g .

Improvements i n w a t e r supp ly con t i nued t o r e c e i v e c l o s e a t t e n t i o n . A

scheme f o r more s y s t e m a t i c e x e c u t i o n of w a t e r supp ly programmes was p r epa red .

The scheme env i s aged a p l a n n i n g p roce s s , f o l l owed by implementa t ion and subsequent i n t e n s i f i c a t i o n of t h e w o r k .

Thc p r o j s c t h a s succeeded i n p r o d u c i n g s p a r e p a r t s f o r pumps. P r o t o t y p e s of pumps s u i t a b l e f a r t h i s a r e a have a l s a been made l o c a l l y and a r e u n d e r t r i a l .

A t L a r j y n s h a r and N u r i s t q p i p e - d l s t r i b u t i b n sys tems a r e n e a r i n g comple t ion and w i l l s c r v e a p o p u l a t i o n of 3 000 and ? 000 r e s p e c t i v e l y .

The work a t Shewaki i s w e l l e s t a b l i s h e d . Though t h e emphasis h a s been on c u r a t i v e a s p e c t s , i n c r e a s i n g i n t e g r a t i o n w i t h p r e v e n t i v e a s p e c t s h a s been secured t h r c u g h a r i e n t a t l c n t r a i n i n g of h e a l t h s t a f f , v i l l a g e - l e v e l workers and v i l l a g e

l e a d e r s .

T r a i n i n g of h e a l t h p e r s o n n e l c o n t i n u e d s a t i s f a c t u r i l y . A n a t i o n a l counte r -

p a r t t o t h e WH3 n u r s e would h e l p t o c x t e n d t h e t r a i n i n g t o female p e r s o n n e l

o u t s i d e t h e ;I:e.waki Rl 'd : i .

A two-week l n - s e r v i c e t r a i n i n g c c u r s e f c r a l l R u r a l Development Department

s a n i t a r i a n s was p l m e d , a n d t h e t r a i n i n g of v i l l a g e - l e v e l workers g i v e n a more

p r a c t i c a l b i a s . Male n u r s e s of Al iabad H o s p i t a l were, f o r t h e f i r s t t i m e , g i v e n f o u r weeks' o r i c n t a t l c n a t t h e Shcuaki T r a i n i n g Centre,ln p u b l i c h e a l t h in r u r a l

a r e a s .

The WHO p u b l i c h e a l t h o f f i c e r and t h e s e n i o r WHO m a l a r i o l o g i s t in Kabul a s s i s t e d i n o r g a n i z i n g 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 (engaged l n

p a s s i v e s u r v e i l l a n c e ) i n t h e method of t & i n g b l s o d s l i d e s . G i v i n at Shewaki,

t h i s t r a i n i n g !;?is e x t e n t e d L i , s t ,h i r r ~ r a l h e z l t h s t z d f .

A scheme for . i n t e n s i f y i n g t r e a t m e n t of t u b e r c u l o s i s p a t i e n t s i n t h e P P o j e c t

a r e a was worked o u t . The p w j e c t has e s t a b l i s h e d c i s s e c u - o r d i n a t i o n w i t h t h o s e

engaged i n c o n t r o l of communicable diseases, p a r t i c u l a r l y m a l a r i a and t u b e r c u l o s i s . It h a s a l s o c a r r i e d o u t f i e l d a c t i v i t l e s i n c o l l a b o r a t i o n w i t h t h e P u b l i c H e a l t h

I n s t i t u t a .

P r c j e c t s t a f f devoted much t ime t o h e l p combat a l a r g e o u t b r e a k of smal lpox i n Logar I1 a r e a . Arrangements were made f c r t ra in:- v i l l d g e - l ; v c l workers and

f e m a l e s i n v a c c l n a t i u n 3 g a l n s t smal lpox .

Cases of typhus were r e p o r t e d from t h e Yakolong a r e a i n A p r i l 1964, ana c o n t r o l

measures were zdopted . Throa t and n a s a l swabs were c o l l e c t e d i n t h e Shewakl a r e a , where c a s e s of d i p h t h e r i a had been r e p o r t e d .

S i x t e e n h e a l t h c e n t r e s have been e s t a b l i s h e d . It i s aimed t c s e t up ?5 h e a l t h c e n t r e s before t h e comple t ion of thp Scc nd Five-Yertr P lan i n 1966.

Co- o p e r a t i o n w i t h UNICEF and o t h e r Uni ted N a t i o n s a g e n c i e s engaged i n community

development work c o n t i n u e d t o be s a t i s f a c t o r y .

A f ~ h a n i s t a n 28 - School f o r S a n i t a r i a n s . Kabul T A (July 1955 - I

A i m cf t h e p r o j e c t . T? t r a i n s a n i t a r i a n s f o r c o m u r l i t y h e a l t h s e r v i c e s th roughout

t h e c o u n t r y .

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

P1,obable d u r a t i u n of a s s i s t a n c e . U n t l l t h e end rf 1969

Wr,rk done durinp, t h e y c a r . Thr t r a l n i n g programme was c i n t i n u e d i n t h e a c c e p t e d

p a t t c r n , w i t h 21 s t u d e n t s i n t h e s e n i o r c o u r s e 3nd 25 s t u d e n t s i n t h e j u n i u r c o u r s e .

A f i e l d l a b o r a t o r y h a s been deve loped :it Drh S a b z , w i t h f u l l c o - o p e r a t i o n f rcm t h e v i l l a g e r s and t h ~ a u t h o : . l t l e s concerned . It h a s added c u n s i d e r a b l y ti: t h c v a l u e of t h e p r a c t i c a l 3 5 1 ) c c t ~ ruf t r a i n i n g . 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

has b e t n s t r c n z t h m e d by t h e a d d i t i r ~ n !'f s p c c i a l 1 r c t u r . e ~ and d e m o n s t r a t i v n s

on c h e m i s t r y and b a c t e r i o l o g y of w a t e r , sewage and f i jud, g l v e n w i t h t h e a s s i s t a n c e o f t h e M l c r o b i c l o g y S e c t i o n o f t he P u b l i c H e a l t h Institute.

V i s i t s t o t h e townships of 531111b1d, Kand*.ar and G l r l s h k have +.nabled s u p e r v i s i o n and gu idance t u be g i v e n t c s a n i t a r i a n s f o r m e r l y t r a i n e d i n t h e School

and have promoted a p p r e c i a t i o n rmf t h e si!rvices of t h i s c a t i g o r y o f h e a l t h w o r t e r .

A f ~ h a n i s t a n 31 I n s t i t u t e , ~ f P u b l i c H e a l t h , Kabul R ( A p r i l - May 1956; Nov. - Dec . 1958; March - UNICEF May 1961; May 1962; Aug. 1962 - )

A l m of t h e p r o j e c t . Tc. duv~ll 'r? t h c I n s t i t u t e .;f P u b l i c H e a l t h f o r i n v c s t i g a t i o n s . r e s e a r c h and t r a i n i n g cf p u b l i c h e a l t h workers .

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

microbiologist, a l i lbc~l~3t :ory technic i . l z i and a s a n l t a r y eng inee l . ; a c o n s u l t a n t f o r tw: ' io=ks; ( b ) a twel:rr-m,ntll fr:ll?:rsl:lp for s t u d y i n t h e U n i t e d Kingdom; ( c ) SGppl ies and equipment .

Prwbable d u r a t i o n sf a s s i s t a n c e . U n t i l t h e end of 1968.

Work d m e d u r i n g t h c y e a r . The WHO s e n l : , r o f f l c e r nf t h e p r i , j e c t ( p u b l i c h e a l t h

s p e c i a l i s t ) completed h i s ass ignment i n J a n u a r y 1964. H i s r e p c r t h a s been s e n t t o t h e Government.

The WHO m i c r o b i c l o g i s t l e f t i n F e b r u a r y on reass ignment t i t h e Western

P r c i f i c Rc.@i::n, and ;i r t p l ~ c ~ z i n t h a s br.rl, f..uld. In We neantina, t h e Reglona l Advise r i n H e a l t h L a b u r a t o r i c s assis t6:d i n t h e fu r , t t i e r u r g a n i z a t l o n of t h e Microbiological Department and i n s t a r t i n g b n c t e r i u l o g l c a l l n v f s t i g a t i a n s

fr,r d i g h t h s r i a , s a l m c n e l l ? and s h i g e l l a e and f a r w a t c r - t e s t i n g . B a c t e r i o l o g i c a l

e x a m i n a t i a n of w a t c r samples and i n v e s t i g a t i o n s of t h r c ' a t swabs f o r d i p h t h e r i a

were c a r r i e d o u t .

A c o n s u l t a n t was a s s i g ~ ~ d f o r two weeks I n January /Fcbruary t o s t u d y t h e pr~>bli .m I T drug c o n t r o l .

SE."./RC17/2 Page 101

A WH3 l a b o r a t o r y t e c h n i c i a n took up h i s p o s i t i o n i n March 1964. Teaching and t r a i n i n g activities were expanded. M a t e r i a l f o r t h e t e c h n i c i a n s ' c o u r s e , which s t a i , t e d i n March 19611. ~ 3 5 p r s p a r e d , l ~ l d t h ? i ~ c h n i c i a n s n d ~ r t < . c k t h i r ,

a c t i v i t i e s in t h e Microb io logy Department . A su rvey cf Tinea c a p i t i s i n f e c t i o n ,

i n which 147 c a s e s were cxamined, wa:; cumplctcd.

Equipment s u p p l i e d by UNICEF and WHG h a s bcen r e c e i v e d and i n s t a l l e d .

A W J S a n i t a r y e n g i n e e r was n s s i s e d t o t h e I n s t i t u t e i n J u l y 1964. He w i l l a l s o wiil'k w i t h t h c N a t i a n a l Housing and P l m l n g Organiza t iDn, l d v i s e Sn w a t e r s u p p 1 i u s . E t C .

A s t a t i s t i c i a n h a s bcen s e l e c t e d and 1s e x p c c t e d t o be i n p o s i t i o n by October 196U.

A f g h a n i s t a n 33 Tubercu lGs ls Adv1sor.y S e r v i c e s

T A (June - Dec. 1958; June - J u l y 1961; Nov. 1962 - ) UNICEP

A i m of t h e p r o j e c t . T>) expand tuberculosis cont:,cl s c r v i c e s f o r Kabul and i t s e n v i r o n s i n t h e f i r s t i n s t a n c e .

A s s i s t a n c e p r o v i d e d by bIHO during: t h e y e a r . ( a ) A m e d l c a l o f f i c e r ; [ b ) a f o u r -

munth f e l l o w s h i p f l ; r p a r t i c i p a t i o n i n t h e t u b z r c u l u s t s t r n i n i n g c o u r s e i n Rome

(awarded under I n t r r - r e g i o n i l 1 l J . i : ) ; ( c ) s u p p l i e s and equipment .

Pi,obablc d u r a t l - n of 3 s s i s t a n c t . U n t l l t h c and uf 1967.

Work dona d u r i n g t h e y e a r . The BCG vnccinzt ' i r . p r o q a % l i t i n Kabul h a s c i n t i r x x d s u c c e s s f u l l y . Completc coverage of t h e s c h o o l - g o i n g p a p u l a t i c n was ach ieved . It i s p lanned t o g i v e BCO s y s t e m a t i c a l l y t o a l l s c h o o l - m t r a n t s . BCO v a c c i n a t i s n has been ex tended t i ; m i l i t a r y personnel . and f a c t o r y work.:rs, and ti- sume l a r g e r s c h o o l s

o u t s i d e Kabul . Thjs cxpans i?n I:as be<m fac i1 i t : i t r r i 2y t h e t r a i n i q : of p e r s o n n e l

from g e n e r a l h e a l t h s c r v i c e s and s t u d e n t s u f t h e Nurs ing School . A manual on

t e c h n i q u e s of t u b e r c u l i n t e s t i n g and v a c c i n a t i o n w i t h f r e e z e - d r i e d BCO h a s been p r e p a r e d . BCG i s now c a r r i e d o u t i n t h e M a t e r n i t y H3mc and by t h e 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 c i t y . F r e e z e - d r i e d BCG v a c c i n e , t u b e r c u l i n d i l u t i o n and v a c c i n a t i c ~ n k i t s have been s u p p l i . - d by ' W C .

To p r e p a r e f:~,' an cxpani lr ln of t h e case- f ind in ;< and t r e a t m e n t programme

u n d e r t h e Chaman ' I l r b e ~ c u l n s i s Cent1.c :at Kabul, t h c r ' m t i n r p r a c c d u r c s r:f tlrt. work b e i n g c a r r l d c u t t h e r e have bi?cn reviewi:d. The implementa t ion of a t r u l y

ccmmunity-oriented t u b e r c u l o s i s c o n t r o l prugramme throughout t h e c i t y of Kabul,

by making use c.f exist in^ g e n e r a l h e a l t h f a c i l i t i e s and i n s t i t u t i o n s , a n d an e v e n t u a l expans ion of t h s a c t i v i t i e s to t h e r u r a l a r e a o f t h e Sheualci community

dcvelcpment programme, is u n d ~ , r c i .ns ider .a t lon .

Vie WHO medica l o f f i c e r l c f t t h e p r ~ j r c t a t t h t end of' March 1964, on e x p i r y of h e r c o n t r a c t ; ? s u c c . s 5 , r : s i indcr r e c r ~ i t m i r i t .

SEA/flcl'7/2 Page 102

~ f n h a n i s t a n 35 Nursing AdvisOrY Services

T A (June 1957 - )

A i m of the p r o j e c t . To organize and develop nurs ing and midwifery t r a i n i n g programmes and t o co-ordlnate and expand nurs ing education and nurs ing se rv ices of t h e country.

Assistance provided by WHO dur ing t h e year . ( a ) A nurse advisor and t h r e ~ nurse educators ; ( b ) a twelve-month fellowship f o r s tudy i n Lebanon; ( e ) supp l ies and equipment.

Probable durat ion of a ss i s t ance . Unt l l the end of 1969.

Work done dur ing the Year. !4HO a s s i s t a n c e under t h i s p r o j e c t continued t o be provided t o th ree schools of nurs ing i n Kabul: the Mastoorat Hospital School f o r

Remale Nurses, i a three-year programme f o r general nurses ; the Aliabad Hospital School f o r Male Nurses, with a comparable three-year programme; the Shararah Haspita1 School, which has a three-year conrsu f c r nurse-midwives.

A l l the th ree programmes continued t o progress s a t i s f a c t o r i l y .

A s i p i f i c a n t development dur ing the year was the s t a r t of a one-year nurs ing programme f o r f i v e sen io r midwives, who w i l l be q u a l i f i e d even tua l ly t o pursue post-graduate s tud ies i n nurs lng education o r adminis t ra t ion. This w l l l prepare them t o take up s e n i o r p o s i t i o n s i n nurs ing and midwifery.

The s tudents i n the d i f f e r e n t schools continued t o show enthusiasm f o r nurs lng as a ca ree r . It has a l s o been noted t h a t midwives a re now i n t e r e s t e d

i n having an opper tuni ty t o become nurse-midwives.

In-service education by way of r egu la r s t a f f meetings of f a c u l t y members led t o improved nurs ing ca re and made f o r a b e t t e r understanding of t h e programmes. This a l s o resu l t ed i n s t rengthening the e x i s t i n g c u r r i c u l a , b e t t e r teaching

p r a c t i c e s , c l o s e r co-operation and jo in t planning.

The WHO nurses attended severa l meetings a t the M n i s t r y uf Public Health

and the Ministry of Education a t which f u t u r e plans f o r nurs ing education i n

t h e country were discussed; a system of grading nurses f o r comparable s a l a r l e s and the p r i n c i p l e of equal s a l a r y f o r men and women were es tab l i shed . It was a l s o decidsd t o r a i s e the entrance q u a l i f i c a t i o n f o r nurs ing s tudents .

The WHO team leader was reassigned t o another country,and a replacement

was appointed. Vacant posts of two nurse educators were a l s o f i l l e d .

Af nhanistan 44 Trachoma Control* H ( m y - June 1958; Sept . - Oct. 1962; J u l y 1963; April - May 1964; -

A i m of the n r o j e c t . To s tudy the epidemiological aspects o f trachoma i n Herat

Province; t o i n i t i a t e cilntrol a c t i v i t i e s ; t o develop a programme of hea l th

'Previaus t i t l e : Trachoma Ccntrol P i l ~ t Project

A f g h a n i s t a n 201 F e l l o w s h i p s

TA

Medical Radiology: Two twelve-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 Union of S o v i e t S o c i a l i s t R e p u b l i c s .

H e a l t h Educa t ion : 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 of

America.

Food and Water A n a l y s i s : A twelve-month f e l l o w s h i p f o r s t u d y i n I n d i a .

Medical Educa t ion : Two one-month f e l l o w s h i p s f o r . > b s c r v a t i u n s i n I n d i a .

SEA/RC17/2 Page 105

2. BURMA

The health budget for the year 1963-1964 represented just over 6 per cent of the total budget for current expenditure and over 4.5 per cent of the total budget for capital expenditure. The figures compare favourably with the provision made for the previous year.

A Foreign Aid Supervision Committee was established to examine projects proposed for implementation with international or bilateral assistance and to recommend priorities.

The shortage of health staff, particularly doctors, in rural areas codtinues. In order to fill vacancies in civil government and army posts, it was decided to conscript doctors for a minimum of two yeare' service.

Thc Medical College of Mingaladon was opened in 1963. This will relieve the pressure of student overcrowding in Rangoon Medical Faculty and in Mandalay. Orientation training courses for township medical officers and assistant district health officers were continued. Plans were laid for opening a dental college in 1965.

A scheme for the reorganization of laboratory services was developed by the Health Ministry. The former Pasteur Institute has become the National Health Laboratory, destined to be the centre of public health laboratory services for the whole country. The former Harcourt Butler Institute has been converted into the Burma Medical Research Institute, which will co-ordinate medical research programmes. The Burma Pharmaceutical Industry is responsible for the production of all kinds of vaccines and biologicals.

The Paediatric Section of Rangoon General Hospital has been transferred to a separate building and will operate as an independent Children's Hospital; this will be valuable for teaching.

There are now 233 hospitals, 102 dispensaries and 495 health centres in the country. A further 29 new hospitals are under construction, and 100 more health centres arc planned.

An outbreak of cholera El Tor occurred in certain districts in 1963.

The malaria eradication programme was maintained, under national leadership. The leprosy control programme extended its field and continued to operate satisfactorily. Plans for a smallpax eradication programme were advanced. The tuberculosis control campaign was extended towards further case-finding and domiciliary treatment.

SEA/RC17/2 Page 106

The vital registration system introduced in Rangoon in 1961 was gradually extended to other towns. The Vital Statistical Report for Burma, 1962, was published. Progress was made in the development of hospital statistics.

The policy of concentrating midwifery training in a limited number of upgraded schools was maintained. A total of twelve upgraded schools was envisaged.

A School of Medical Technology has been opened, with assistance from the Colombo Plan; training of physiotherapists, radiographers, laboratory technicians and pharmacists will be undertaken.

The Government has ratified the Convention on Narcotic Drugs, thus becoming the seventeenth government to accede to this international agreement drawn up by the United Nations Commission on Narcotic Drugs in 1961.

SEA/RC17/2

Page 107

PROJECT LIST

Project No.

Source of Funds Co-o~era t ing

Agencies - T i t l e

Burma 17 Leprosy Control R (Apri l 1960 - ) UNICEF

A i m of t h e p r o j e c t . To expand and i n t e n s i f y the leprosy con t ro l progrannne t o cover a l l endemic a reas of the country, and t o t r a i n personnel f o r this purpose.

Assistance provided by WHO dur ing t h e year. ( a ) A l e p r o l o g i s t ; ( b ) a twelve- month fellowship f o r s tudy i n India .

Probable durat ion of a ss i s t ance . Unt i l the end of 1968.

Work done dur ing the year. This programme maintained very s a t i s f a c t o r y progress. An assessment was c a r r i e d out during t h e year j o i n t l y by a WHO Leprosy Advisory

Team and the Government. The estimated number of leprosy p a t i e n t s i n the country

i s 200 000. UP t o February 1964, a t o t a l of 121 389 p a t i e n t s were reg i s te red

and 112 875 of these were having regu la r treatment. A notable achievement of the leprosy control programme was the f u r t h e r i n t e n s i f i c a t i o n of school surveys and contact t r a c i n g and the in t roduct ion of house-to-house surveys i n t h e

d i s t r i c t s known t o have a high prevalence of leprosy.

Rurther a t t e n t i o n was given t o the t r a i n i n g of medical o f f i c e r s , leprosy

inspec to rs and a u x i l i a r y workers.

In view of fxtended a c t i v i t i e s , t h e Government has increased i t s personnel t o 21 medical o f f i c e r s , 57 leprosy inspectors and over 420 a u x i l i a r y workers.

UNICEF ass i s t ance was continued.

Burma 22 V i t a l and Health S t a t i s t i c s . Rangoon R (Dec. 1955 - June 1961; Jan. 1962 - )

A i m of the p r o j e c t . To e s t a b l i s h machinery f o r prompt n o t i f i c a t i o n of h e a l t h s t a t i s t i c a l da ta ; t o improve process ing and t r a i n s t a f f i n s t a t i s t i c a l methods.

(The s p e c i f i c aims i n the present phase of t h e p ro jec t are: t o organize an e f f i c i e n t system f o r the 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 ; data e f f i c i e n t l y on a na t iona l scale ,and t o t r a i n medical records and hosp i t a l s t a t i s t i c s personnel.)

Assistance provided by WHO dur ing the year. ( a ) A h e a l t h s t a t i s t i c i a n ;

( b ) supp l ies and equipment and a veh ic le .

SEA/RC17/2 Page 108


Work done during the year. The operat ions of the new medical records system i n

Rangoon Oeneral Hospital were strengthened with the appointment of a medical r r curds o f f i c e r t o the h o s p i t a l . Tabulation of individual discharge repor t s

dur ing the f i r s t s i x months of 1963 was completed.and d iagnos t i c and operation indexes were prepared. Discharge repor t s from Ju ly t o December 1963 were coded and punched; machine-processing of t h e cards proceeded.

A new system of C l i n i c a l record forms ( o b s t e t r i c s and gynaecology) was introduced i n the Dufferin Hospital . Rangoon, i n January 1964.

Also, a monthly adminis t ra t ive r e t u r n (with necessary i n s t r u c t i o n s ) f a r a l l p rov inc ia l hosp i t a l s was introduced i n January 1964. A n in te r im hosp i t a l morbidity repor t , which w i l l be gradual ly replaced by ind iv idua l

discharge repor ts , was a l s o d ra f t ed f o r use i n these h o s p i t a l s .

From the beginning of 1964, the adminis t ra t ive r e s p o n s i b i l i t y f o r v i t a l s t a t i s t i c s was t r a n s f e r r e d t o the Mlnistry of National Planning.

mrma 28 Medical Facul ty , Rangoon* T A (Peb. 1955 - Feb. 1959; Feb. 1961; Sept . 1963; - )

A i m of the p r o j e c t . To s t rengthen se lec ted departments of the Facul ty of Medicine,

Rangoon, and t o improve undergraduate teaching and promote research and post- graduate a c t i v i t i e s .

Assistance provided by WHO dur ing the year . A ten-month fellowship f o r s tudy i n the United Kingdom.


Burma 31 Malaria Eradicat ion

(Feb. 1957 - )

A i m of the p r o j e c t . To e r a d i c a t e malar ia throughout t h e country i n prugress ive

s t ages .

Assistance provided by WHO durinK t h e year . Two four-month fe l lowships t o a t t end

the malar ia t r a i n i n g course i n Jamaica and a three-month fe l lowship f o r s tudy i n Ind ia .

Probable durat ion of a ss i s t ance . Unt i l t h e end of 1967.

Work done dur ina the year. Data on operat ions received from t h e Government show an increase i n the population under consol idat ion phase. The present s t a t u s of the programme has been shown a s 9.488 mi l l ion people under consol idat ion and

*Previ:ius t i t l e : Assistance t o Medical College, Rangoon

s ~ ~ / R C l 7 / 2 Page 109

9.668 mi l l ion under a t t a c k phases. The spraying operat ions i n remote a reas were ca r r i ed out by paid spraymen, while i n others voluntary labourers were used. The Government i s prepar ing a d e t a i l e d , long-term plan of ac t ion .

Burma 44 S t r e n ~ t h e n i n ~ of Health Services (Epidemi010,rfgrr TA (Jan. - Dec. 1961; s u l y 1963 - )

A i m of the p r o j e c t . To s t rengthen the Epidemiological Unit i n t h e Directorate of Health Services; t o s tudy f u r t h e r the p reva i l ing p a t t e r n of communicable d i seases i n the country and provide information f o r sound pub l ic h e a l t h planning and appropr ia te con t ro l measures; a l s o t o develop pub l ic h e a l t h laboratory se rv ices t o support t h e a c t i v i t i e s of t h e Epidemiological Unit.

Assistance provided by WHO durinu the year. A microbiologis t .


Work done dur ing t h e year. I n order t o support t h e Epldemiologlcal Uni t ' s a c t i v i t i e s i n the country, the WHO s t a t i s t i c i a n assigned t o p ro jec t Burma 22

and the microbiologis t a s s i s t e d i n the s t rengthening of the h e a l t h s t a t i s t i c s and microbiology se rv ices . The microbiologis t a l s o helped in the f u r t h e r development of t h e publ ic h e a l t h laboratory se rv ices i n the Rangoon area and l a t e r i n Mandalay.

h r m a 56 Nursing Advisory Services T A (March 1959 - 1

A i m of the p r o j e c t . To upgrade and co-ordinate basic and post-basic education f o r nurses and midwives on a country-wide basis, In order t o e s t a b l i s h s a t i s f a c t o r y standards of nurse and midwife t r a i n i n g and nurs ing and midwifery se rv ices .

Assistance provided by WHO during the year. A nurse educator and a p a e d i a t r i c nurse.


Work done dur ing the year. The programme,designed t o improve e igh t midwifery schools and consol idate i n them the t r a i n i n g formerly given i n some twenty schools i n the country.continued a s planned. The midwifery schuols a t P&oWtu and Pegu have been well establ1shed.with adequate t r a i n i n g f a c i l i t i e s .

Project s t a f f v i s i t e d severa l o the r schools and made recommendations f o r t h e i r upgrading. These recommendations a r e under considerat ion. It i s expected t h a t a l l the e i g h t schools w i l l have been es tab l i shed i n 1964 a n d t h a t f u r t h e r WHO ass i s t ance t o t h i s aspect of the p ro jec t w i l l not be needed. However, i n s u l y 1964,

when the nurse educator completed h e r assignment, a WHO p a e d i a t r i c nurse was added, t o a s s i s t i n upgrading p a c d i a t r i c nursing a t t h e Chi ldren 's Hospi ta l , Rangoon.

S E A / R C ~ ~ / ~ Page 110

Wlm 59' Medical C o l l e ~ e . Mandalay

R (Nov. 1959 - March 1960; Oct. 1960 - April 1961; Jan. 1962 - )

A i m of the Pro jec t . To a s s i s t c e r t a i n departments af the Medical College. Mandalay.

Assistance Provided by WHO dur ine the year. ( a ) A professor of pathology; (bl Supplies and equipment.

Probable durat ion of ass i s t ance . u n t i l the end of 1968.

Work done dur ing t h e Year. The v i s i t i n g p rofessor of pathology assumed h i s d u t i e s i n August 1963. He a s s i s t e d i n improving the teaching of pathology by organizing working r e l a t i o n s wi th t h e hosp i t a l and inc reas ing the n m b e r of post-mortems.

A Journal Club was s t a r t e d , with meetings scheduled a t monthly i n t e r v a l s .

A research p ro jec t on anaemia of pregnancy and on subcutaneous phycomycosis was s t a r t e d .

Plans a re being made t o provide a professor of anatomy t o t h e col lege.

Tuberculosis Control

( Jan . 1964 - ) UNICEF

A i m of the Drolect. To develop community-oriented tubercu los i s con t ro l se rv ices i n the Country, s t a r t i n g with Rangoon and Mandalay, and t o c o l l e c t epidemiological base-line da ta on tubercu los i s f o r f u t u r e planning and assessment.

Assistance provided by WHO dur inu t h e year . ( a ) A medical o f f i c e r and a pub l ic h e a l t h nurse consul tant ; ( b ) a seven-month fellowship f o r p a r t i c i p a t i o n i n the tubercu los i s t r a i n i n g course I n Prague (awarded under In te r - reg iona l 113.1);

( c ) supp l ies and equipment.

Probable durat ion of ass i s t ance . Unt i l the end of 1968

Work done during the year. On the b a s i s of previous information and recommendations,

i t was agreed tha t . a s a shcr t - term object ive , t h e expansion of treatment se rv ices from the Tuberculnsis Centre a t Rangoon t o the whole Of the c i t y ' s population should

be undertaken through a number OF per iphera l treatment (sub-) c e n t r e s , t o develop

a t r u e community-oriented tubercu los i s cun t ro l programme. The capac i ty of the

treatment se rv ice w i l l determine the speed of the case-finding operations, n i t h

p r i o r i t y on t h e in fec t ious case-load. The treatment of p a t i e n t s with i n f e c t i o u s tubercu los i s i s a supervised regimen,cansis t ing of i s o n i a z i d and streptomycin

given on an i n t e r m i t t e n t (twice-weekly) schedule. To a s s i s t i n organizing such treatment on an ambulatory b a s i s through per iphera l (sub-) cen t res , a pub l ic hea l th nurse was assigned. a s short-term consul tant , t o the p ro jec t i n May 1964.

*In f u t u r e t h i s p ro jec t ;ill be merged with a new p r o j e c t , Burma 79

(Medlcal Education)

S E A / R C ~ ~ / ~

Page 111

It has been ar ranged t o provide a sho r t - t e rm c o n s u l t a n t in s t a t i s t i c s t o assist i n t h e c o r r e c t d e s i g n i w and a d m i n i s t r a t i o n of t h e base - l i ne survey,which all

be c a r r i e d out among randcmly s e l e c t e d popu la t ion groups. Ass is tance i n l a b o r a t o r y techniques and mobile mass radiography by means of sho r t - t e rm c o n s u l t a n t s a r e

envisaged.

Burma 67 P a e d i a t r i c Educat ion

Regular ( June 1964 - ) UNICEF

A i m of t he P r o J e c t . To s t rong then the Departments of P a e d i a t r i c s i n t h e t h r e e

medical c o l l e g e s of t h e count ry . t o improve Lhc t e ach ing of paediatrics,particularly i n i t s p reven t ive a s p e c t s , and t o develop p e r i p h e r a l s e r v i c e s a s t r a i n i n g f i e l d s .

Ass is tance vrovided by WHO dur ing t h e Year. A p r o f e s s o r of p a e d i a t r i c 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 he end of 1967.

Work done d u r i n g t h e yea r . A WHO p r o f e s s o r of p a e d i a t r i c s was a s s igned i n

June 1964. He s t a r t e d a p r e l i m i n a r y survey of p a e d i a t r i c s e r v i c e s and educat ion

in t h e count ry .

Burma 76 Survey of Economic and S o c i a l Requlrements

T A of an Gvium-ProducinK Refion I n Burma (March - Apr i l 1964)

A i m of t h e u r o J e c t . To s tudy t h e problem of opium a d d i c t i o n I n t h e KacNn S t a t e s

and t h e medical measures neces sa ry f o r t h e P e h a b i l i t a t i o n and t r ea tmen t of opium

a d d i c t s i n poppy-growing a r e a s .

Ass is tance provided by WHO du r ing t h e Year. A consu l t an t f o r t h r e e weeks.

Work done. I n c o l l a b o r a t i o n wi th a Uhited Nat ions ' c o n s u l t a n t , t h e WHO consu l t an t c a r r i e d out a survey i n t h e poppy-gruwing a r e a s of Burma. His r e p o r t i s under study.

It i s proposed t o provide f u r t h e r consu l t an t s e r v i c e s i n 1965.

~ u r m a 7 7 Burma Pharmaceutical I n s t i t u t e R (Peb. 1964; J u l y 1964 - ) UNICEF

A i m of t h e p r o j e c t . To develop modern methods o f p roduc t ion of vacc ines , anti tOXin

and toxolds. and o t h e r b i o l o g i c a l p roduc t s .

Ass is tance vrovided by WHO durinK the yea r . ( a ) A zhor t - te rm consu l t an t on f r eeze -d r i ed smallpox vacc lne product ion ( a s s i m e d under SEAR0 38) and ano the r

sho r t - t e rm c o n s u l t a n t on DPT vaccine product ion .

s ~ ~ b c 1 7 / 2 Page 112


Work done durinR t h e Year. In February 1964, a short-term consul tant v i s i t e d t h e Burma Pharmaceutical I n s t i t u t e , Rangoon, and found t h a t i t could s u i t a b l y change over from i t s present production of glycer inated lymph t o f reeze-dr ied smallpox vaccine. Equipment w i l l be supplied by UNICEF. Training on WHO fe l lowships f o r a b a c t e r i o l o g i s t and an engineer o f the I n s t i t u t e i s planned t o take place l a t e i n 1964.

I n J u l y 1964, another short-term consul tant was assigned t o B u m , t o s tudy t h e s u i t a b i l i t y of the I n s t i t u t e t o undertake t h e production of diphther ia- pe r tuss i s - t e tanus vaccine.

Burma 201 F e l l o w s h i ~ s TA

Public Health: Two fe l lowships - one of twelve months f o r s tudy i n the United Kingdom, and one of t en months f o r s tudy i n Ind ia .

Preventive and Social Medicine: A ten-month fe l lowship f o r s tudy in t h e United Kingdom, Yugoslavia and I s r a e l .

Medical Laboratory Technoloqy: A twelve-month fe l lowship f o r s tudy i n Ceylon.

F i l a r i a s i s Control: An eight-week fe l lowship f o r s tudy in Ind ia (awarded under p ro jec t Burma 63,wNch i s no longer c u r r e n t ) .

SEA/RC17/2 Page 113

3. CEYLON

Although curative health services have attained a relatively high level, emphasis has continued to be placed on preventive measures. It is recognized that an approach through health education and preventive programmes is necessary to reduce the excessive numbers seeking medical treatment. Preventive health work is based on a health unit system and is effected through the close co-operation of central and local authorities. Systematic communicable- disease control has resulted in the absence of plague, cholera and smallpox and in the near eradication of malaria and yaws. Quarantine measures a t ports of entry help to prevent import of major infectious diseases.

In 1964 a successful course in hospital administration for selected medical officers was conducted, with WHO assistance.

Expansion of maternal and child health care continued, with widespread community acceptance. The increasing amount of work done is reflected in a continuous decline of morbidity and mortality rates in mothers and young children. Recognition of fairly widespread malnutrition has directed the policy of stimulating local focd production, particularly of protective foodstuffs.

The interruption of the transmission of malaria achieved in 1962 was maintained. Strengthening of the tuberculosis control programme included the introduction of BCG vaccination of new-born infants in certain hospitals. Plans were in train to extend this precaution, and x-ray examination of school-teachers and trainee-teachers was introduced. A project involving prophylactic treatment of tuberculin-positive school-children with INH was initiated.

Diarrhoea1 diseases continued to be an urgent public health problem. It was estimated that about one quarter of the deaths of children between the ages of one year and five years and about one fifth of all admissions to hospitals were due to these conditions. As a control measure, efforts were undertaken to expand laboratory facilities.

Filariasis due to W. bancrofti continued to be a serious problem in the south-western coastal region. An early solution is not in sight, and intensification of research is envisaged.

The outbreak of poliomyelitis experienced in the previous year was under control. The initial mass immunization campaign, using oral vaccine, was successful, although the response to the second round was less complete

SEA/RC17/2 Page 114

than to the first round. The continued routine immunization of susceptible age groups needs to be firmly established, and the expansion of rehabilitation facilities requires urgent attention.

A programme designed to undertake mass immunization against rabies of the entire dog population of the Western Province was initiated.

The construction of the building for the Institute of Hygiene, Kalutara, is nearing completion, and the Institute should begin its training and research functions towards the end of 1964. Considerable thought was given to the programme of work and staffing pattern of the Institute.

The Post-basic School of Nursing has been firmly established. Courses for psychiatric nurses, ward sisters and sister tutors have been organized, and the basic nursing syllabus has been revised. An eighth school of nursing has been built at Anuradhapura. The training of nurse-aides was dropped.

Preliminary studies directed towards the expansion and improvement of the water supply systems in Colombo and in some other major cities were started. In view of the high prevalence of dental caries in urban arpas, the feasibility of fluoridation of the Colombo water supply, with WHO/UNICEF aid, is under examination.

PROJECT LIST

Prodect No.

Source of Funds Co-o~era t inq

A ~ e n c i e s T i t l e -

Ceylon 4 Maternal and Child Health

TA (Sept . 1955 - Nov. 1963)

UNICEF

A i m of t h e p r o j e c t . In t h e f i r s t ins tance , t o upgrade t h e Children's Department

of t h e Kalutara Health Unit Hospital; t o i n t e g r a t e t h e preventive and cura t ive aspects of c h i l d care a t the hosp i t a l and i n the f i e l d ; t o improve pub l ic h e a l t h

nurs ing i n t h e Health U n i t and t o t r a i n various categor ies of h e a l t h personnel; when these object ives have been achieved, t o upgrade c h i l d h e a l t h se rv ices i n a

number of p rov inc ia l hosp i t a l s and t o l ink chi ld-care a c t i v i t i e s i n r u r a l a reas with those i n the h c s p i t a l s .

Assistance provided by WHO dur ing the year. A medical o f f i c e r .

Work done. This p ro jec t was s t a r t e d i n September 1955 under the t i t l e "Rural Health Development, Kalutara" and was redesignated "Maternal and Chlld Health, Ceylon" i n March 1961.

WHO provided a p a e d i a t r i c i a n and a publ ic h e a l t h nurse i n 1955. They l e f t a t the end of t h e i r assignments i n 1958 and 1959 respec t ive ly . The paed ia t r i c ian was replaced i n March 1959 by a medical o f f i c e r . During 1960-1962, a p a e d i a t r i c nurse t u t o r was assigned.

From May 1960 t o June 1961, a na t iona l paed ia t r i c ian , appointed i n Kalutara,

ac ted a s counterpart t u the WHO medical o f f i c e r . Although t h e revised plan of operat ions envisaged the appointment of a maternal and c h i l d h e a l t h o f f i c e r a t

h e a l t h d i r e c t o r a t e l e v e l a s the na t iona l opposite number, no pos t ing was e f fec ted .

As an a l t e r n a t e measure, c lose co-operation was es tab l i shed with o the r o f f i c e r s

of the Health Directorate .

During t h e per iod of 'NHO ass i s t ance , a number of p a e d i a t r i c wards i n hosp i t a l s throughout t h e country were opened and severa l p a e d i a t r i c i a n s appointed.

A well-organized r e f e r r a l system between the p a e d i a t r i c h o s p i t a l and domici l iary

se rv ices was es tab l i shed in Kalutara and introduced i n o the r areas ,wi thin the limit s e t by t h e a v a i l a b i l i t y of s t a f f . Special a t t e n t i o n was paid t o n u t r i t i o n

education. Demonstrations of preparat ion of in fan t food were planned and c a r r i e d out i n t h e Kalutara t r a i n i n g centre,and ass i s t ance was given i n t h e preparat ion

of a s e r i e s of l e a f l e t s on feeding and n u t r i t i o n .

Longitudinal s t u d i e s on premature i n f a n t s and pre-school chi ldren and

anaemla i n pregnant women were organized.

S E A / ~ C ~ ~ / Z Page 116

Close co-operation was es tab l i shed with the WHGassisted h e a l t h s t a t i s t i c s p r o j e c t (Ceylon 45) f o r revis ion of maternal and c h i l d h e a l t h and school h e a l t h records , and ass i s t ance was given i n the implementatirm of a new record system and revis ion of Ins t ruc t ions f o r the guidance of t h e pub l ic h e a l t h nurses and midwives.

Evaluation. The p ro jec t was successful i n a s s i s t i n g i n the development of comprehensive maternal and ch i ld h e a l t h se rv ices throughout t h e country.

Ceylon 5.2' Venereal-Disease Control (Fluorescent R Laboratory Technique i n VDT1 UNICEF ( J u l y 1964 - )

A i m of the ProJect . To develop l abora to ry d iagnos t i c f a c i l i t i e s a s p a r t of the National Venereal-Disease Control Programme.

Assistance Provided by hMO dur ing t h e year. ( a ) A short-term consul tant ; ( b ) a supply of vaccine.

Probable dura t ion of a ss i s t ance . Unt i l the end of 1966.

Work done durinp, the year. Following WHO'S recommendations, UNICEF supplied fluorescence microscopy equipment required t o upgrade l abora to ry d i a ~ o s t i c f a c i l i t i e s a t the Venereal-Disease Control Centre i n Colombo. A consul tant was assigned by WHO t o demonstrate the use of immuno-fluorescence technique in t h e f i ia ,g~osis of treponematoses and ganarrhoca; spec la l reagents a l s o were supplied.

Ceylon 42 Medical Education R ( ~ o v . 1963 - )

A i m of t h e p r o j e c t . To organize the var ious departments of the new medical ca l l ege a t Peradeniya and t o a s s i s t wlth the teaching.

Assistance provided by WHO dur ing the year. ( a ) A p ro fessor of physiology f o r f i v e months; ( b ) a twelve-month fellowship f o r s tudy i n the United Kingdom, Denmark and India .

Probable durat ion of a ss i s t ance . U n t i l the end of 1967.

Work done dur inx the year. The v i s i t i n g professor of physiology took up his pos i t ion i n November 1963. His ass i s t ance was divided between Colombo and

Feradeniya, both collr .ges helng under one Faculty. He p a r t i c i p a t e d i n teachine and del ivered spec ia l l e c t u r e s on research methods t o t h e s t a f f . Recommendations f o r the improvement in t h e teaching of physiology were made t o t h e Curriculum Committee of the Facul ty . Research on t h e e f f e c t of pregnancy and l a c t a t i o n in r a t s on oxygen cunsumption and para-aminohippurate uptake of kidney cor tex s l i c e s i n v i t r o was undertaken. --

*WHO'S a s s i s t ance t o p r o j e c t Ceylon 5 .1 , Venereal-Disease Control, terminated i n 1960

sEA/'Rcl7/2

Page 117

Ceylon 5J NursinR Advisory Services

R ( ~ u l y 1960 - )

A i m of the p r o j e c t . To develop a l l aspects of bas ic , post -basic and a u x i l i a r y

nurs ing education, with emphasis on planning, organizat ion and development of

a post-basic school of nursing,and t o develop a nurs ing u n i t within the Depart- ment of Health responsible f o r overa l l adminis t ra t ion of nurs ing education in

the country.

Assistance Drovided by WHO dur ing the year. A nurse adviser , a psych ia t r i c

nurse educator and a pub l ic h e a l t h nurse educator.


Work done during the Year. The p ro jec t continued t o funct ion s a t i s f a c t o r i l y , with thc main emphasis on post-basic nurs ing education within the Post-basic School of Nursing, Colombo, which has es tab l i shed programmes In nurs ing education,

nurs ing adminis t ra t ion, p a e d i a t r i c nursing, and psych ia t r i c nursing.

The WHO nurse adv i se r v i s i t e d various bas ic schools t o advise on optimum u t i l i z a t i o n of the e x i s t i n g equipment and on the use of UNICEF equipment ordered

f o r t h e nurse-aide pr0gramme.whic.h was discontinued a t t h e end of the year. The WHO nurse adv i se r a l s o a s s i s t e d the school f a c u l t y i n reviewing the content

of courses offered a t the Post-basic Schoo1,with a view t o providing a more comprehensive nurs ing programme.

The WHO p s y c h i a t r i c nurse a s s i s t e d i n an in-service education programme f o r nurses i n pos i t ion who had not s tudied psych ia t ry a s p a r t of t h e i r previous

educat ional programmes. He has a l s o helped i n the teaching of t h e post -basic s tudents I n t h e i r spec ia l ty . Psych ia t r i c nurs ing experience was provided t o a l l men s tuden t s i n the bas ic nurs ing course.

Several meetings were held with the o f f i c i a l s i n the Di rec to ra te of Health, a t which f u t u r e plans f o r nurs ing i n Ceylon were discussed and recommendations

made.

A publ ic h e a l t h nurse educator was added t o t h e WHO team i n April 1964, t o

a s s i s t in upgrading pub l ic h e a l t h and improving p a e d i a t r i c nursing.

Ceylon P i l a r i a s i s Control

TA (Dec. 1959; April - J u l y 1961; Sept. 1961; Aug. - Sept. 1963; - )

Aim of the p ro jec t . To s t rengthen the f i l a r i a s i s con t ro l programme and introduce

new con t ro l methods a s necessary.

Assistance Drovided by WHO during the Year. ( a ) A consul tant f o r two months; (b ) supp l ies and equipment.

SEA/RC17/2 Page 118

Probable durat ion Of ass i s t ance . Unt i l t h e end of 1967

Work done dur ing t h e year. The WHO consul tant a s s i s t e d i n an assessment of the problem of f i l a r i a s i s i n the south-west c o a s t a l b e l t and advised on a plan of act ion f o r f u r t h e r f i l a r i a s i s s tud ies , surveys, drug t r i a l s and con t ro l measures.

It i s planned t o provide an epidemiologist and an entomologist t o a s s i s t t h i s p ro jec t on a long-term bas i s .

ceylon 58 Malaria Eradicat ion R (nus. 1960 - ) (USAID)

A i m of the Pro jec t . To e rad ica te malar ia from t h e e n t i r e country and t o prevent the re-establishment of endemicity.

Assistance provided by WHO during t h e year. Pa r t payment of l o c a l c o s t s f o r in tens i fy ing su rve i l l ance a c t i v i t i e s . i n c l u d i n g the provis ion of spare p a r t s f o r motorcycles provided by WHO e a r l i e r .


Work done dur ing the year . I n s e c t i c i d e spraying has been t o t a l l y discontinued from the e n t i r e i s l a n d s ince May 1964. During NovemberDecember 1963, t h e Regional Assessment Team (SEAR0 7) c a r r i e d out an assessment of t h e programme. The urgent need f o r e s t a b l i s h i n g t o t a l coverage i n su rve i l l ance has been emphasised.

During 1963, Ceylon recorded only 16 p a r a s i t e c a r r i e r s ; of them, t e n were imported from the Maldives; f i v e were re lapses of P.malariae, and one was indigenous. Arrangements f o r screening a r r i v a l s from the Maldive I s l ands were continued.

ceylon 62 Xsdical Rehab i l i t a t ion poliom my el it is^* TA (Apri l 1962 - )

A i m of the p r o j e c t . To provide f a c i l i t i e s f o r t h e management and r e h a b i l i t a t i o n of p a r a l y t i c cases , and t o c a r r y out an immunization programme f o r the con t ro l of the disease .

ASSiStanCt. Jrovided by WHO dur ing the year. ( a ) A physiother.apist and a c rnsu l t an t Ln medical r e h a b i l l t a t i c n ; (b) supp l ies and equipment.

Probable durat ion of assistance. Unt i l the end of 1966.

Work done dur ing t h e year . A WHO phys io the rap i s t took up h e r second assignment with this p r o j e c t i n October 1963 i n Order t o a s s i s t in t h e r e h a b i l i t a t i o n Of po l iopara ly t i c s . She helped the physician i n charge of t h e Department of

*Previous t i t l e : Control of Pol iomyel i t i s Epidemic

~EA/kC17/2 Page 119

Physical Medicine, Children's Hospital , Colombo, f o r four months, t o develop and s t rengthen the r e h a b i l i t a t i o n f a c i l i t i e s i n the hosp i t a l . She a l s o v i s i t e d r e h a b i l i t a t i o n cen t res i n o the r hosp i t a l s and submitted an in te r im repor t .

A WHO consul tant on medical r e h a b i l i t a t i o n a s s i a e d t o Ind ia v i s i t e d Ceylon f o r a week and recommended the expansion of t h e orthopaedic workshop in Colombo.

Ceylon 64 csmmunity Water Supply R ( o c t . 1963 - )

A i m of the p ro jec t . To develop piped water supp l ies i n major t o m s and o the r community a reas .

Assistance ~ r o v i d e d by WHO dur ing the Year. A s a n i t a r y engineer.


Work done d u r i n ~ the year . The WHO s a n i t a r y engineer took up h i s assignment a t the end of October 1963.

A considerable amount of da ta , h igh l igh t ing the necess i ty f o r numerous improvements t o e x i s t i n g i n s t a l l a t i o n s and t h e provis ion of water supply systems, has been co l l ec ted .

The present design c r i t e r i a have been revised with a view t o reducing the c a p i t a l cos t of schemes and the un i t cost of water. With t h i s new approach, water supply systems w i l l come c l o s e r t o f i n a n c i a l se l f -suff ic iency,which i s an e s s e n t i a l p re requ i s i t e f o r considerat ion f o r e l i g i b i l i t y f o r loans from i n t e r n a t i o n a l lending agencies.

Ceylon 66 R

Study on Diarrhoea1 Diseases (Sept . 1963 - )

A i m of the p r o j e c t . To make long-term s t u d i e s of the epidemiology and con t ro l of d iarrhoea1 diseases .

Assistance Provided by WHO dur ing t h e year. ( a ) A b a c t e r i o l o g i s t ; ( b ) suppl ies and equipment.


Work done dur ing the year . A s a follow-up of the WHO Diarrhoeal Diseases Advisory Team's cross-sect ional epidemiological surveys of e n t e r i c d i seases i n the Colombo a rea l a s t year , a programme f o r the cont inuat ion of ~ p i d e m i o l o g l c a l s t u d i e s on i n t e s t i n a l d i seases on a long-term b a s i s was agreed upon. WHO a s s i a e d a b a c t e r i o l o g i s t i n September 1963 t o a s s i s t i n the establishment and f u r t h e r development of bac te r io log ica l d iagnost ic f a c i l i t i e s i n e n t e r i c diseases , both . in the p r i n c i p a l h o s p i t a l s and in the f i e l d , i n the Colombo a rea .

S E A / R C ~ ~ / ~ Page 120

Laboratory f a c i l i t i e s a t Angoda Fever Hospi ta l , Ragma Hospital and t h e Medical Research I n s t i t u t e have been improved. A course on cur ren t laboratory methods of i d e n t i f i c a t i o n of entero-bacter iaceae. wi th p a r t i c u l a r reference t o

Salmonella and S N g e l l a , was held a t Angoda Hospital .

A plan was prepared f o r an a s c a r i a s i s con t ro l p i l o t proJect .

Ceylon 69 Paed ia t r i c Traininp. and Services R ( J u l y - Sept. 1963)

A i m of the Pro jec t . To a s s i s t the Univers i ty of Ceylon t o develop the t r a i n i n g

of medical s tudents i n s o c i a l p a e d i a t r i c s and t o provide f i e l d t r a i n i n g eltperience.

Assistance Drovided by WHO durinp; the year. A consul tant i n p a e d i a t r i c t r a i n i n g and se rv ices .

Work done. A shor t - term consul tant was ass ig ied t o Ceylon i n Ju ly 1963. She made an assessment of cur ren t p a e d i a t r i c courses f o r medical undergraduate and

post-graduate s tudents and s tudied the l o c a l p a t t e r n of promotional and preventive

chi ld-care se rv ices . She a l s o a s s i s t e d i n improving the teaching of s o c i a l p a e d i a t r i c s and i n developing per iphera l p a e d i a t r i c se rv ices f o r t r a i n i n g purposes.

She completed he r work toward the end of September. Her asslgnment repor t

provided a s e t of guiding p r i n c i p l e s f o r the f u r t h e r development of p a e d i a t r i c

education and se rv ices i n Ceylon.

Ceylon 70 Water Fluor idat ion R (Dec. 1963 - Jan. 1964)

A i m of the P r o j e c t . To reduce the incidence of den ta l c a r i e s by f l u o r i d a t i o n of the water supply of the c i t y of Colombo.

Assistance Provided by WHO durinp. the year. A consul tant f o r one month.

Work done. The ex ten t of den ta l c a r i e s i n Colombo was determined,and the s t a t i s t i c a l

information ava i l ab le was analysed. Water treatment works were v i s i t e d . The consul tant completed h i s s tud ies and rrcomended the f l u o r i d a t i o n of Colombo water

supply a s a means vf reducing t h e high incidence of den ta l c a r i e s In the c i t y .

H i s assignment repor t and recommendations have been sent t o t h e Government f o r

canslderat ion.

Ceylon 71 Course i n HosDital Administration and Management (21 Jan. - 4 Apri l 1964)

A i m of the p r o j e c t . To organize a three-month course i n h o s p i t a l adminis t ra t ion

and management f o r s e n i o r h o s p i t a l personnel and t o prepare a syl labus a s the b a s i s f o r holding s i m i l a r courses frGm time t o time.

S E A / % C ~ ~ / ~ Page 121

Assistance provided by WHO durinR the year. A consul tant i n h o s p i t a l administra- t i o n f o r f o u r months.

Work done. The course was held from 21 January t o 4 April 1964,under the d i rec t ion of a WHO consul tant . The Regional Adviser i n Health S t a t i s t i c s a l s o a s s i s t e d in

the course by de l ive r ing a s e r i e s of l e c t u r e s on h o s p i t a l s t a t i s t i c s . The course was a t tended by twelve t r a i n e e s .

Ceylon 74 TA

I n s t i t u t e of W ~ i e n e , Kalutara ( J u l y 1964 - )

A i m of the p r o j e c t . To develop the I n s t i t u t e a s a cen t re f o r t r a i n i n g and o r i e n t a t i o n courses f o r pub l ic hea l th s t a f f ; t o upgrade and i n t e g r a t e t h e se rv ices planned a t the I n s t i t u t e .

Assistance provided by WHO durinu the year. A consul tant f o r two months.


Work done dur ing the year. The consultant was assigned In J u l y 1964. He has s tudied t h e prospects f o r the t r a i n i n g of Publ ic h e a l t h personnel and the provis ion of h e a l t h se rv ices , including l abora to ry se rv ices , i n the Kalutara Health Unit area.

Ceylon 200 Fellowships

Electro-medical Engineering: A four-month fellowship f o r s tudy i n the United Kingdom. Germany and Holland.

En te r i c Diseases: A five-week fellowship f o r p a r t i c i p a t i o n i n the course on enter ic-disease control held i n Teheran (awarded under a Headquarters ' a l la tmcnt) .

Physical Therapg: A twelve-month fe l lowship f o r undergoing t h e Physical lherapy TeachersSTraining Course i n the United Kingdom.

Ceylon 201 Fellowships TA

Epidemiolom and Advanced S t a t i s t i c s : A twelve-month fellowship f o r s tudy i n the United S t a t e s of America (awarded under p r o j e c t Ceylon 45,which i s no longer current ) . Nutrit ion: A twelve-month fe l lowship f o r s tudy in the United S t a t e s of America.

Medical Laboratory Technology: A twelve-month fe l lowship f o r s tudy i n t h e Uhited Kingdom.

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Sani tary E n ~ i n e e r i n g : Two fellowships - one of twelve months f o r s tudy in t h e United S t a t e s of America. and one of s i x months f o r s tudy i n the United S t a t e s

of Amer,ica and the United Kingdom.

Cl in lca l Biochemistry: A ten-month fellowship f o r s tudy i n Denmark (awarded

under Inter- regional 239).

Hwoan aene t i cs : A three-month fe l lowship f a r s tudy i n Denmark (awarded under In te r - reg iona l 137.2).

B i o 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

Amerlca.

Physical Therap~: A twelve-month fe l lowship f o r undergoing the Physical Therapy

Teachers 'Training Course i n the United Kingdom (awarded under In te r - reg iona l 181).

SEA/RC17/2 Page 123

4. INDIA

The Central Council of Health has recommended realistic estimates of the requirements in medical staff, equipment and drugs for the remaining period of the Third Five-Year Plan a s well a s for the Fourth Plan. The Council has also advocated that overcrgwding in hospitals be reduced, that specialists in all the major disciplines be established at district hospital level and that maternal and child health services be reinforced so a s to reach every village. The Nursing Sub-committee of the Central Council has recommended that during the training period student-nurses should be assigned to primary health centres for training in rural public health.

In view of the national emergency, admissions to medical colleges in India have been raised by about thirty per cent. The risk of lowering standards inherent in increasing the intake of students and shortening the period of the course may have been reflected in higher failure rates. The shortage of medical teachers continued to be severe. Means of improving and expanding post-graduate education with the aim of increasing the production of medical teachers were under serious consideration.

The Malaria Institute of India, now converted into a "National Institute of Communicable Diseases", has started research and training in the broad field of epidemiology and control of communicable diseases. A parallel advance was the inauguration of the National Institute of Health Administration and Education, designed a s a staff college for senior health adminstrators and a s a research centre in the field of organization and administration of health services.

Coverage by primary health units established in community develop ment blocks reached nearly 75% of all blocks, but staffing difficulties remained severe. In recognition of the need for improved health coverage in rural areas, particularly in connection with the malaria and smallpox eradication campaigns, the Directorate General of Health Services recommended the establishment of three additional sub-centres, making a total of six sub-centres in each primary health unit. It was also recommended that wider use should be made of multi- purpose health auxiliaries in rural health services, in order to extend the work of the doctors and also to relieve them of avoidable routine work, thus enabling more adequate supervision and leadership of the health unit team.

The urgent need to provide adequate and safe water supplies in both urban and rural areas was further studied by the central and state governments and appropriate recommendations were made. Diseases due to defective environmental

SEA/RC17/2 Page 124

sanitation were bracketed a t the top, with malnutrition and tuberculosis, a s the major public health problems at present and as serious obstacles to economic and social betterment.

The increasingly rapid transition to an industrial economy in Iudia emphasized the need for improved industrial and occupational health services. Recognition of the widespread prevalence of remediable physical disability led to proposals for providing a network of medical rehabilitation centres.

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PROJECT LIST

Project No.

Source of Funds Co- operat ing

Agencies T i t l e -

Ind ia 52 Tuberculosis Chemotherapy Centre. Madras T A (Dee. 1955 - 1 ( m c ) (ICMR)

A i m of the p ro jec t . To undertake control led t r i a l s i n the search f o r 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 .

Assistance Drovided by WHO during the year. ( a ) n o medical o f f i c e r s , a b a c t e r i o l o g i s t , a laboratory technician and two short-term consul tants ; ( b ) a

six-month fellowship f o r s tudy i n the United Kingdom. Africa and Switzerland;

( c ) suppl ies and equipment and a vehicle.


Work done dur ing the year. The Government and thd :~gi-ncies SponsLring the

p ro jec t have held Purbher d i ~ a u s s i o n s on the permanzncy of the ccntre a s a research uni t . A spec ia l coninittee has andertaken the preparat ion of a r epor t , t o be presented t o the Governing Body Of the Indian Council of Medical Research, i n which the need f o r bas ic research of the kind c a r r i e d out a t Madras w i l l be evaluated and f u t u r e l i n e s of research and the re la t ionsh ip of the Madras Centre

t o other Indian i n s t i t u t i o n s i n t h e f i e l d of tubercu los i s def ined. In February

1964, a na t iona l candidate f o r the post of Di rcc to r cf thu C ~ n t r e was se lec ted by a s p e c i a l l y formed committee; he assumed d u t i e s i n Ju ly 1964.

The high standard of the research work undertaken by the Centre have bcen

maintained. After t h e depar ture of the WHO nurse, the f o u r na t iona l publ ic hea l th

nurses continued t o c a r r y out the ever- increasing work a t the c l i n i c most satis- f a c t o r i l y , under the guidance of medical s t a f f a s s i p e d t o this sect ion. New

s tud ies on i n t e r m i t t e n t treatment have considerably increased the workload a t the

Cl in ic , 3s the treatment i n these s tud ies is given twice weekly a t t h c Centre, and, i n consequence, the number of attendances by p x t i e n t s has grown 1arger.while the number of home v i s i t s c a r r l e d out by t h e hea l th v i s i t o r s has remained unchanged.

Regular meetings of t h e publ ie hea l th nurses a n d t h e h e a l t h v i s i t o r s have ensured continuous co-ordination and review of the work. Every de fau l t ing p a t i e n t requires a t l e a s t one home-visit, and more may be necessary, in connection

with the once-weekly regimen. The c lose follow-up of a l l p a t i e n t s which has been maintained by the s t a f f of the Centre has made i t poss ib le t o keep almost the e n t i r e group of p a t i e n t s from the e a r l i e r s tud ies under constant observation f o r

more than f i v e years.

SEA/hCl7/2 Page 126

In view of the heavy workload i n the rad io log ica l sec t ion , which amounted t o 17 213 x-ray exposures and 2 831 tomograms dur ing one year, expansion of accommodation was santioned i n April 1964. After completion of the new bu i ld ing f o r the x-ray sec t ion , new x s a y ~quipmcnt w i l l be provided by WHO.

I n the laboratory, a new biochemical sec t ion has been constructed and has g r e a t l y re l i eved the pressure on the bac te r io log ica l laboratory. The work has included 18 244 spiltm smear examinations, 20 028 c u l t u r e s , 5 020 s c n s i t i v i t y t e s t s , 26 161 u r ine examinations, 811 haematological examinations and 373 microbiological assays of an t i - tubercu los i s drugs. In add i t ion t o the work c a r r i e d out i n connection with the c l i n i c a l t r i a l s undertaken by the Centre, the laboratory has a l s o ca r r i ed out bac te r io log ica l examinations i n connection with a drug res i s t ance survey organized by the Indian Council of Medical Research.

Numerous repor t s and papers have been published by the Centre o r a r e under preparat ion. These a r e l i s t e d i n Annex 6. A paper was read by a n a t i o n a l medical o f f i c e r a t the Nineteenth Tuberculosis and Chest Diseases Workers' Conference held from 5 t o 7 April 1964 in Delhi.

Ind ia 81 L e ~ r o s y Control

Ind ia 81.1 Leprosy Control (National Pro~rammel R (Jan. 1961 - ) IJNICEF

A i m of t h e p r o j e c t . To develop s country-wide programme f o r l ep rosy control .

Assistance provided by WHO dur ing the year. ( a ) A consul tant l e p r o l o g i s t and a l e p r o l o g i s t ; ( b ) supp l ies and equipment.


Work done durinn the year. The WHO consul tant 1epro log i s t . in c lose co-operation with t h e Director of t h e National Leprosy Control Programme,prepared an appra i sa l of the programme with recommendations f o r the f u r t h e r implementation of the p r o j e c t dur ing t h e remainder of the Third Five-Y.ear Plan and dur ing t h e Fourth Five-Year Plan. A second WHO l e p r o l o g i s t was assigned in February 1964. It was agreed t h a t case-finding, con tac t - t r ac ing and treatment bc I n t e n s i f i e d , p a r t i c u l a r l y in the S t a t e s of Madras,Andhra Pradesh and 0rissa.which a r e known t o have the highest prevalence of leprosy. In order t o support t h i s i n t e n s i f i c a t i o n of work, t en cen t res f o r the t r a i n i n g of leprosy a u x i l i a r y workers were sanctioned. UNICEF ass i s t ance was accordingly increased.

The following consolidated da ta from the National Leprosy Control Programme were repor ted towards t h e end of 1963:

S E A / R C ~ ~ / Z Page 127

Number of cen t res 160 371 29 560 Number of cases r e g i s t e r e d 166 571 kli 6 5 3 17 706 228 930 Number cf cases reg i s te red 146 613 45 157 15 206 206 976

f o r treatment

Number of cases under regu la r 103 791 40 566 12 212 156 569 treatment

Total number of cases reg i s te red ( i n s i d e and outs ide p ro jec t

a r e a s ) 380 6011 Total number of cases under treatment ( i n s i d e and outs ide

p r o j e c t a r e a s ) 358 650

India 81.2 R

Leprosy Control. Srikakulam

(Jan. 1962 - )

A i m of t h e Project . To provide technical d i r e c t i o n f o r a leprosy con t ro l p ro jec t organized and maintained by the Danish "Save the chi ldren" Fund, and t o t r a i n leprosy a u x i l i a r y personnel.

Assistance provided by WHO during the year. A l ep ro log i s t .

Probable durat ion of ass is tance. Unt i l the end of 1968.

Work done dur lnp the year. Fie ld a c t i v i t i e s , including school surveys and contact- tracing,proceeded s a t i s f a c t o r i l y , and. these case-finding a c t i v i t i e s were f u r t h e r

increased by s t a r t i n g house-to-house surveys. Training of new groups of a u x i l i a r y womers was continued; t h i s has enabled the t o t a l number of f i e l d u n i t s t o be

increased t o 31.

The t o t a l number of r eg i s te red and t r e a t e d cases up t o April 1964 was 15 283 - an increase of 7 272 i n a period of t en months.

A 3C-bed hosp i t a l was opened a t Srikakulam. This w i l l g r e a t l y f a c i l i t a t e the treatment of r eac t ion cases , advanced and/or in fec ted pe r fo ra t ing u l c e r s and o the r condi t ions n e c e s s i t a t i n g hosp i t a l i za t ion .

Ind ia 84 hv i ronmenta l San i ta t ion . uttar Pradesh

TA (March 1958 - ) UNICEF

A i m of t h e DroJect. To s e t up i n a r u r a l area a p i l o t p r o j e c t f o r improving water suppl ies and excreta d i sposa l ; t o plan and c a r r y out a s a n i t a t i o n programme, including

t h e design, operat ion and maintenance of simple, p r a c t i c a l and cheap s a n i t a r y i n s t a l l a t i o n s ; t o organize a programme of h e a l t h education; t o t r a i n technicians ,

s a n i t a r i a n s and o the r personnel.

sEApc17/2 Page 128

Assistance provided by WHO durinR t h e year. ( a ) A s a n i t a r y engineer and a s a n i t a r i a n ;

( b ) supp l ies and equipment.


Work done dur ina the year. Latr ine-construct ion programmes were extended throughout t h e S t a t e a t an acce le ra ted pace. Cornunity co-operation has improved. In one Of the p i l o t p ro jec t s where t h e programme i s subsidized up t o 75% of the cos t of i n s t a l l a t i o n , progress was even more rapid .

The a c t i v i t i e s of t h i s p ro jec t were f u r t h e r d i r e c t e d towards r u r a l water supply a s planned, and t r a i n i n g and pus t ing of t ~ o m s of workers f o r well-boring a s well a s i n s t a l l a t i o n of hand pumps a re being i n t e n s i f i e d . E f f o r t s were made t o secure the se rv ices of more f i e l d teachers f o r h e a l t h education work in order t o cover more commqnity h e a l t h blocks.

In the r u r a l piped water-supply programme, the tuba-well f;r t h ~ Banki piped water-supply scheme was constructed,and the d i s t r i b u t i o n system was being l a i d .

Ind ia 91 wain in^ in Preventive and Social Medicine TA (Peb. 1956 - Dec. 1957; %rch 1959 - Sept. 1960; UNICEF Aug. 1961; Ju ly 1962 - Jan. 1963; Dec. 1963 - )

A i m of t h e p ro lec t . To develop the departments of prevent ive and s o c i a l medicine i n se lec ted medical colleges, incorpora t ing prevent ive medlcine i n t o the general curr icul tm and organizing courses i n preventive m d s o c i a l medicine f o r u n d e r graduates; t o e s t a b l i s h urban and m r a l pub l ic hea l th p r a c t i c e f i e l d s f o r t r a i n i n g ; t o t r a i n na t iona l countePparts t o take over from the WHO professors .

Assistance Drovided bv WHO durinR t h e Year. A professor of prevent ive and s o c i a l medicine a t Pondicherry Medical College.


Work dane dur ing t h e year. The WHO v i s i t i n g professor took up his p o s i t i o n i n December 1963.

The p ro jec t l a i d emphasis on in tegra t ion . Intdgrated bedside teacbing was organized,and the p o s s i b i l i t y of providing p r a c t i c a l experience in prevent ive and s o c i a l medicine was explored. Classes cvmbiniw the teaching of p a e d i a t r i c s ,

prevcntlvc. medicine and ch i ld psychiat ry were s t a r t e d .

Ind ia 98 Short courses f o r Nursing Personnel* R (July 1957 - 1

Chandiaarh: (7 Oct. - 2 NoV. 1963)

A i m of the project . To plan and conduct shor t courses f o r nurses , incqrporat lng t h e o r e 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 adapted t o l o c a l conditions.

* Previous t i t l e : Refresher Courses f o r Nurses

SEA/RC17/2 Page 129

Assistance Provided by WHO during the year. ( a ) Half the cos t of t r a v e l and mainte-

nance expenses of p a r t i c i p a n t s i n the courses; [ b ) a ss i s t ance from WHO s t a f f .

Probable durat ion of assistance. Unt i l the end of 1968.

Work done dur ina the year. A shor t course of one month, attended by twenty nurs ing

superintendents from a l l over Ind ia , was held i n Chandigarh from 7 October t o 2 November 1963. I n the course,emphasis was placed on t h e r o l e of the nurs ing superintendent in improving nurs ing education. Courses f o r the cur ren t

w i l l be held i n the l a s t quar te r of 1964.

An overa l l evaluat ion of p ro jec t pruposes and methods was undertaken. A s a

r e s u l t . the o r i g i n a l aim of the Project has s h i f t e d from the provis ion of refresher- type courses t o those which w i l l introduce nurses t o new concepts m d p r a c t i c e s which were not a p a r t of t h e i r bas ic education. Plans have been made t o give a t t e n t i a n t o new knowledge and s k i l l s i n the f i e l d s of p a t i e n t ca re , curriculum development. ln - se rv ice education and nurs ing admlnis t ra t ion. As a r e s u l t of t h i s s h i f t i n emphasis. the t i t l e of the p ro jec t has been changed, a s noted above.

Ind ia 92 Nursing Education [Publ ic Health In tenra t ion l : Assistance t o S ta tes*

Emphasis i n t h i s p ro jec t has begun t o s h i f t from a primary concern with in tegra t ion of the publ ic h e a l t h nurs ing p r i n c i p l e s and p r a c t l c a s i n t o the bas ic

curriculum toward the following:

(1) Assistance ill s ~ t t i n g up educational progrimnes f o r nursing personnel. both a u x i l i a r y and profess ional . i n a reas where no nurse education on the

p a t t e r n l a i d down by the Ind ia Nursing COUncil e x i s t s .

2 Assistance t o bas ic h o s p i t a l nurs ing schools and associa ted pub l ic h e a l t h f i e l d s which a re se rv ing a s c l i n i c a l p r a c t i c e a reas f o r s tuden t s from post-basic schools of nursing.

Ind ia 99.2 Nursing Education (Publ ic Health I n t e a r a t i o n ) . Orissa TA ( m y 1958 -

A i m of the Project . To i n t e g r a t e t r a i n i n g i n pub l ic h e a l t h i n t o the bas ic t r a i n i n g of nurses ; t o Provide supervised p r a c t i c a l observation and experience f o r s tudent

nurses i n a se lec ted undergraduate school of nursing.

Assistance Provided by WHO durinR the year. A pub l ic h e a l t h nurse.


*The p ro jec t s t a r t e d i n September 1957 and i s expected t o continue u n t i l the end of 1965. Assistance t o two S t a t e s (Madras and Maharashtra) has been completed.

S E A / % C ~ ~ / Z

Page 130

Work done dur ing the year. The i n t e g r a t i o n of pub l ic h e a l t h p r i n c i p l e s and p r a c t i c e s

i n t o t h e bas ic curriculum of the school a t Cuttack has been f u r t h e r advanced. Rural

and urban pub l ic hea l th experience has becn improved by b e t t e r s e l e c t i o n of l ea rn ing experiences and by more adequate supervision of nurse s tudents i n t h e f i e l d . Health

teaching and o the r preventive h e a l t h p r a c t i c e s have been given emphasis both i n the

cura t ive and publ ic h e a l t h experience of the nurse . Examination methods have received a t t e n t i o n .

Po l i c ies r e l a t e d t o t h e p r a c t i c e of s e l e c t i n g a por t ion of the s tudent body and o f fe r ing only t o t h i s por t ion an in tegra ted educat ional experience have been

reviewed. A s a r e s u l t , a l l nurse s tuden t s a re now offered the same curriculum

and have the same opportuni t ies t o develop knowledge and s k i l l s i n the pub l ic

h e a l t h f i e l d .

It: has remained d i f f i c u l t f o r part-t ime l e c t u r e r s t o complete t h e i r

schedules within the a l l o t e d time. Consequently, both the sequence and i n t e g r a t i o n of l ea rn ing experience were in terrupted.and c l i n i c a l experience was f requen t ly

undertaken many months bcf7rc formal teaching i n the s p e c i a l t y was given.

Development of the p r o j e c t continued t o be hampered by the laok of provis ion

of a separa te budget f o r the school.

Ind ia 99.4 TA

Nursina Education (?ub l ic Health I n t e a r a t i o n ) . Himachal Pradesh ( k g . 1961 - Sept. 1963)

A i m of the ~ r o J e c t . To i n t e g r a t e t r a i n i n g in pub l ic h e a l t h i n t o the bas ic t r a i n i n g of nurses; t o provide supervised p r a c t i c a l observation and experience f o r s tuden t

nurses i n a se lec ted undergraduate school of nursing.

Assistance provided by WHO durinR the year. A pub l ic h e a l t h nurse .

Work done. WHO ass i s t ance t o t h i s p r o j e c t terminated i n September 1963, wi th the

t r a n s f e r of the WHO nurse from Simla t o Chandigarh.

Luring the period of assignment of the WHO nurse , pub l ic h e a l t h nurs ing a s an i n t e g r a l p a r t of t h e general nurs ing curriculum was es tab l i shed a t Snowdon

Hospital . Simla. Each phase of the programme was in operat ion f o r a s u f f i c i e n t length of time f o r t h e n a t i o n a l counterpart and o the rs concerned t o acquire a sound

knowledge of the organizat ion and implementation of the p ro jec t . P rac t i ce f i e l d s , both urban and r u r a l , were developed,and the prevent ive aspects of p a t i e n t ca re

were introduced i n t o the hosp i t a l wards and ou tpa t i en t c l i n i c s . Specia l courses

i n pub l ic heal th , n u t r i t i o n and mental hygiene were developed. The t o t a l curriculum content was s tudied i n order t o introduce prevent ive teaching throughout.

s ~ ~ / R C 1 7 / 2

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Ind ia 99.5 Nursing Education (Publ ic Health I n t e g r a t i o n ) , Cfoa TA (Sept. 1963 - )

A i m of the p ro jec t . To introduce i n Cfoa p a t t e r n s of bas ic nurse/midwife and

a u x i l i a r y nurse/midwife education s i m i l a r t o those l a i d down by the Indian Nursing

Council; t o develop in - se rv ice t r a i n i n g i n a l l teaching h o s p i t a l s ; t o improve p a t t e r n s of nurs ing adminis t ra t ion f o r the nurs ing component of a l l h e a l t h se rv ices .

Assistance provided by WHO during the year. A nurse educator.


Work done dur ing the year. The p ro jec t s t a r t e d i n September 1963, with thc a r r i v a l of the WHO nurse educator i n Panjim.

Nursing needs and resources were s tudied and plans drawn up f o r the i n i t i a t i o n

of one basic h o s p i t a l nurs ing school and t h r e e schools f o r the t r a i n i n g of a u x i l i a r y nursemidwives. Curricula f o r both types of programmes were reviewed.

Recommendations f o r the provis ion of teachlng and hos te l f a c i l i t i e s f o r a l l schools were put forward.

A n evaluat ion of nurs ing se rv ice a t the Medical College Hospital . Panjim, was c a r r i e d out and a repor t prepared. A s a r e s u l t , new schedules based on an e ight-

hour working day and a 48-hour week were put i n t o operation.

Programmes of on-the-job t r a i n i n g were introduced i n severa l hosp i t a l s in an e f f o r t t o improve p a t i e n t care and prepare t r a ined s t a f f f o r the increased respon-

s i b i l i t y of s tudent educatiun.

Ind ia 101

R National Trachoma Control Programme (Feb. - May 1956; o c t . 1956 - )

UNICEF

(1Ci-R)

A i m of the p ro jec t . To reduce t ransmiss ion of i n f e c t i o n , morbidity and d i sab l ing condi t ions i n the community t o such a l e v e l t h a t trachoma and secondary b a c t e r i a l in fec t ions w i l l cease t o be a pub l ic h e a l t h problem i n t h e a reas under opcratlon; t o continue t o give t r a i n i n g i n control measures t o ophthalmologists, general

physicians and f i e l d personnel; t o pursue the programme of h e a l t h education a t a l l l e v e l s ; t o f u r t h e r the implementation of the po l i cy of in tegra t ion of

communicable eye-disease con t ro l i n t o the general h e a l t h se rv ices .

Assistance provided by WHO dur ing the year. ( a ) A t rachomatologis t ; ( b ) supp l ies

and equipment.


SEA/Rc17/2 Page 132

Work done dur ing the year. A l a rge -sca le trachoma con t ro l p r o g r m e was launched

with 15 f i e l d units i n Punjab and 25 f i e l d u n i t s i n Rajasthan. A r u r a l population of about 1.6 mi l l ion was under treatment i n these S ta tes . The Government of Ut ta r Pradesh has sanctioned t h e i n i t i a t i o n of t h e progranrme i n the S t a t e - the a t t a c k phase per iod t o s t a r t from August 1964, with six f i e l d u n i t s . Small-scale treatment programmes were i n i t i a t e d i n Gujarat (by four government and two voluntary organiza- t i o n u n i t s ) . Bihar, Jammv and Kashmir and Madhya Pradesh (by one u n i t in each S t a t e ) .

The Government has decided t o continue and f u r t h e r extend t h e programme in the S t a t e s of Funjab, Rajasthan, Cujarat and Ut ta r Pradesh.

Ind ia 102 National Tuberculosis Programme TA (Oct. 1956 - Oct. 1957; Nov. 1957 - ) UNICEF

A i m of the p r o j e c t . To develop a n a t i o n a l tubercu los i s control programme by providing t echn ica l guidance and ass i s t ance based on model r u r a l and urban con t ro l programmes, epidemiological f ind ings and operat ional research; t o t r a i n a r e q u i s i t e number of pub l ic h e a l t h workers of var ious ca tegor ies t o be employed i n tubercu los i s control c e n t r e s a t d i s t r i c t and s t a t e l eve l ; t o develop adequate methods and procedures f o r assessment of the country-wide programe.

Assistance Provided by i4UO during the year. ( a ) Three medical o f f i c e r s , a soc io log i s t , a s t a t i s t i c i a n , an x-ray engineer, a l abora to ry technician and a pub l ic h e a l t h nurse; ( b ) a six-month fellowship f o r s tudy i n the United S t a t e s of America, and a five-month fellowship f o r p a r t i c i p a t i o n in t h e tubercu los i s t r a i n i n g course i n Prague (awarded under Inter- regional 113.1); ( c ) supp l ies and equipment.


Work done dur ing the year. The development and implementation of the na t iona l tubercu los i s programme have received inc reas ing a t t e n t i o n by the Government. This i s r e f l e c t e d i n the preparat ion f o r the next Five-Year Plan from April 1966. The Central Council of Health has recommended that the S t a t e s e s t a b l i s h one tubercu los i s cen t re i n each d i s t r i c t . Information on appropr ia te t r a i n i n g of key s t a f f a t the National Tuberculosis I n s t i t u t e and of o the r add i t iona l personnel by t h e respec t ive S t a t e tubercu los i s cen t res , and on s t a f f i n g p a t t e r n s and r e q u i s i t e budgets necessary f o r a country-wide tubercu los i s con t ro l scheme a t d i s t r i c t l e v e l , has been given by t h e Central Government t o adminis t ra t ive medical o f f i c e r s of the S t a t e s and Union T e r r i t o r i e s a t a conference and b y a c i r c u l a r Letter.0.n addendum t o t h e plan of operat ions i s beins negot ia ted with the Government, t o cover the needs f O P the remaining period of the cur ren t Five-Year Plan.

Twenty-eight medical o f f i c e r s , 28 x-ray technicians , 21 l abora to ry technicians , 23 h e a l t h v i s i t o r s , 20 BCG team leaders and 12 s t a t i s t i c a l a s s i s t a n t s were t r a ined during t h e f i f t h and s i x t h t r a i n i n g courses a t the National Tuberculosis I n s t i t u t e . They a re intended t o work a s key d i s t r i c t personnel. Twenty-five more teams have entered t r a i n i n g i n the seventh course. This w i l l b r ing the t o t a l number of key s t a f f t r a ined a t the I n s t i t u t e up t o about 350 persons.

SE@Cl7/2 Page 133

Moreover, 28 sen io r medical tubercu los i s workers, delegated from 1 6 S ta tes . p a r t i c i p a t e d i n the Second Tuberculosis Control Seminar held a t t h e I n s t i t u t e i n May 1964; t a l k s and l e c t u r e s a t t h i s seminar l a i d s p e c i a l emphasis on organizat ion a s a key f a c t o r i n developing adequate con t ro l programmes.

To meet the request f o r a speedy development of the na t iona l tubercu los i s programme, UNICEF has agreed, in add i t ion t o providing newly es tab l i shed d i s t r i c t tubercu los i s cen t res with standard x-ray and l abora to ry equipment, expendables and a t r anspor t veh ic le , t o make up def ic ienc ies of equipment i n tubercu los i s cen t res previously s e t up and equipped by the Government, provided t h a t they comply with t h e condi t ions s e t out i n the o f f i c i a l recommendation f o r n d i s t r i c t tubercu los i s programme.

The diverse a c t i v i t i e s under the respec t ive sec t ions of the National m b e r c u l o s i s I n s t i t u t e a r e p a r t l y r e f l e c t e d i n the l i s t of pub l ica t ions from the I n s t i t u t e (see Annex 7 ) . Model u ~ b a n and d i s t r i c t p r o g r m e s , r u n i n c lose co- operation with the I n s t i t u t e , have been used a s t r a i n i n g and demonstration areas. Epidemlologlcnl inves t lga t ions , operat ional research and t es t - runs have been c a r r i e d out t o evaluate and e luc ida te problems i n cmnec t ion with t r u l y community- or iented, economical case-f inding and treatment sch,mcs on a country-wide bas i s .

The WHO soc io log i s t completed h i s assianment a t the end of September 1963. and the WHO X-ray engineer and WHOlaboratory technician l e f t the p r o j e c t a t t h e end of December 1963. However. f i v e WHO s t a f f members continued se rv ice i n t h e p ro jec t .

Ind ia 108 Health Education: Assistance t o S t a t e s C

Ind ia 108.5 Health Education, Orissa TA ( J u l y 1964 - )

A i m of the p ro jec t . To develop tho Health Education Bureau i n t h e Health M r e c t o r a t e on the l i n e s of modern education methods, including a f i e l d s tudy and demonstration centre : t o provide t r a i n i n g i n h e a l t h education t o h e a l t h workers and teachers , and t o plan f o r hea l th education of the general public.

Assistance Drovided by WHO durinR the year. ( a ) W e h e a l t h educator; ( b ) h e a l t h education l i t e r a t u r e and a vehicle .

Probable durat ion of ass is tance. ? C ~ G years.

Work done dur ing the year. Zhe h e a l t h educator joined the p r o j e c t towards the end of July 1964 and began a s tudy of the present s l t u a t i o n , i n preparat ion f o r the development of the S t a t e Health Education Bureau along the l i n e s of t h e plan of t h e Central Health Educat im Bureau.

he pro jec t s t a r t e d i n March 1958 and is expected t o continue u n t i l the end of 1968. Assistance t o t h r e e S t a t e s (Maharashtra, U t t a r Pradesh and Bihar ) has been complcted and i s bcing planned f o r one more ( a u j a r a t ) .

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India 110 Nursing Advisers t o S ta tes*

Ind ia 110.2 Nursing Adviser t o Punjab T A ( A U ~ U S ~ 1961 - )

A i m of t h e p ro jec t . To organize and expand nurs ing education and nurs ing se rv ices i n the S t a t e and t o co-ordinate supervisory se rv ices so a s t o ensure uniformly

high s tandards of nurs ing and midwifery i n t h e h e a l t h programmes.

Assistance ~ r o v i d e d by WHO durlnR t h e Year. A nurse adviser .


Work done durinu the Year. The Ass i s t an t Director ,Heal th Services [Nursing), who i s the na t iona l counterpar t t o t h e WHO Nursing Adviser ( s t a t i o n e d i n Chandigarh), has

been away dur ing t h e y f a r on a WHO fellowship.

Routine advisory and supervisory v i s i t s have continued t o be paid t o hosp i t a l s ,

nurs ing schools and publ ic h e a l t h cen t res throughout the S t a t e . Advice and a s s i s t a n c e were given t o lmprovo both nursing se rv ice and nurs ing education.

Proposals regarding budget allotment f o r nurs ing schools and se rv ice r u l e s f o r

nurses and the nurs ing cadre were put forward.

Assistance was given t o committees plannlng f o r the development of the nurs ing

component of hea l th se rv lces dur ing the next Fivc-Ycar Plan period.

The MO nurs ing adv i se r p a r t i c i p a t e d i n committees concerned with the ddevelop- mcnt of p lans f o r the i n i t i a t i o n of a post -basic degree course f o r nurses a t the

Punjab University.

Ind ia 110.4 Nursing Adviser t u Orissa T A (oc t . 1962 - )

A i m of t h e p ro jec t . To organize and expand nurs ing education and nurs ing se rv ices i n the S t a t e , and t o co-ordinate supervisory se rv ices so a s t o ensure u n l f o m l y

high standards of nurs ing and mldwifefy i n the h e a l t h programmes.

Assistance provided by WHO dur ing the year. A nurse adviser .

Probable durat ion of a ss l s t ance . Unt i l t h e end of 1966.

Work done dur ing t h e year. Consolidation and development of the Nursing Unit i n t h e Di rec to ra te of Health Services i n Bhubaneswar continued. Routines f o r advisory and supervisory v i s i t s t o i n s t i t u t i o n s employing nurs ing personnel throughout the S t a t e

were es tab l i shed . Proposals r e l a t e d t o b e t t e r u t i l i z a t i o n and f u r t h e r education of

*The p ro jec t s t a r t e d i n December 1957 and i s expected t o continue until the end of 1968. Assistance t o two s t a t e s (Madhya Pradcsh and Madras) has been completed.

S+C17/2 Page 135

'both graduate nurses and health visitors were put forward. Recruitment patterns

and policies were studied and recommendations made for encouraging girls from Orissa State to take up nursing. Attention was given to living and 14orking conditions for both graduate and student nurses.

The post for a senior nurse at Directorate level has not yet been established, and the WHO nursing adviser continued to work with the Superintendent of Medical Aid to Women and hildren in relaticn to nursing Staff and services, and with the Additional Director of Education and Planning in relation to all levels of nursing education.

India 110.5 Nursing Adviser to Oujarat T A (Sept. 1963 - )

Aim of the project. To organize and expand nursing education and nursing services in the State, and to ca-ordinate supervisory services so as to ensure uniformly high standards of nursing and midwifery in the health programmes.

Assistance provided by WHO during the year. A nurse adviser.

Probable duration of assistance. Until the end of 1966.

Work done during the year. MI10 assistance to this project started in September 1963, with the arrival of the WHO nursing adviser in Ahmedabad. A study of nursing needs and resources was made. The study began in October, when hospitals, nursing schools and auxiliary nurse/midwifery programmes in Ahmedabad were visited. Up to the end of March 1964 a total of thirty hospitals and twenty primary health centres throughout the State had been studied. Plans for the development of the nursing component of health services, based on the findings of the study, have been placed before the Director of Health Services.

India 114 Paediatric Education: Assistance to States*

India 114.1 R

Paediatric Education, Kerala (Aug. 1958 - Aug. 1959: March - Sept. 1962:

Aim of the project. To expand, upgrade and reorient the teaching of paediatrics in Trivandrum Medical College.

Assistance provided by WHO during the year. A paediatric nurse tutor and periodic visits to the project by the WHO professor of paediatrics assigned to Mysorc State.

Probable duration of assistance. Until the middle of 1965.

Work done during the year. Assistance was given to improve paediatric patient care and nurse education. Better ward staffing and supervision have been introduced. Development of good practice fields in social paediatrics has been slow, but improvement has been achieved in both urban and rural peripheral centres.

*Previous title: Paediatrio Education and~services: Assistance to States.

Assistance to thc: projxt is expected to continue until the end of 1966.

SEA/RC17/2

Page 136

IInrd teaching has been improved and expanded. The flow of s tudents through tho pncd in t r i c wards has been s t a b i l i z e d . Health teaching has been given p r i o r i t y i n pa t i en t care and student education.

In-service c lassas have been organized f o r graduate nurs ing s t a f f and ward

a s s i s t a n t s .

The development of an expanded and more e f f e c t i v e s e r i e s of p a e d i a t r i c l e c t u r e s has not been f u l l y achieved. The appointment of a fu l l - t ime p a e d i a t r i c nurs ing t u t o r t o the s t a f f of the bas ic nurs ing school should improve t h i s

aspect of the teaching.

In June 1964 a two-month re f resher course i n p a e d i a t r i c nurs ing was organized i n mivandrum f o r graduate nurses from t h e S ta te who were working i n . p a e d i a t r i c u n i t s .

The WHO nurse t u t o r l e f t the p r o j e c t a t the end of July .

Ind ia 114.2 Paed ia t r i c Education. Ut ta r Pradesh

R [May 1961 - March 1964)

UNICEF

A i m of the p ro jec t . To expand, upgrade and r e o r i e n t the teaching of p a e d i a t r i c s i n the medical co l l eges of the S ta te .

Assistance provided by WHO during the year. A professor of p a e d i a t r i c s and a p a e d i a t r i c nurse t u t o r a t S a r o j i n i Naidu Medical College, Agra, and a consul tant p a e d i a t r i c i a n a t Kanpur Medical College f o r two months.

Work done. WHO/UNICEF ass i s t ance t o the p ro jec t s t a r t e d i n May 1961 and was

ccmpleted i n March 1964. WHO provided a v i s i t i n g p rofessor of p a e d i a t r i c s from

May 1961 t o May 1962 and another from October 1962 t o Apri l 1964. A WHO p a e d i a t r i c nurse t u t o r was assigned t o t h e p r o j e c t from'october 1961 t o December 1963. Both

were located a t Agra Medical College. The na t iona l p ro fessor of p a e d i a t r i c s and a senlor s t a f f nurse were counterpar ts t o the WHO t e r n members.

Paed ia t r i c se rv ices i n t h e Department and the out-pat ient c l i n i c were f u r t h e r developed,and th ree pe r iphera l p a e d i a t r i c cen t res es tab l i shed . Reorienta t ion of undergraduate and DCH courses of s t u d i e s towards s o c i a l p a e d i a t r i c s was e f fec ted .

Co-ordination with the Departments of Obs te t r i c s and Preventive and Soc ia l Kedicine i n the f i e l d of t r a i n i n g was accepted and f a i r l y well-developed. The s t a f f of the Paed ia t r i c Department was strengthened, but the bu i ld ing of t h e new Children's

Hospital su f fe red delays. In the f i e l d of p a e d i a t r i c nurs ing, improved nurs ing

techniques were introduced, b e t t e r house-keeping p r a c t i c e s encouraged and planned

regu la r r o t a t i o n of both graduate and s tudent s t a f f implemented. C l i n l c a l ins t ruc t ion , with emphasis on h e a l t h teaching and involvement of mothers i n p a t i e n t

care , was s t a r t o d . Two regu la r a l l - I n d i a p a e d i a t r i c nurs ing r e f r e s h e r courses

provided supplementary t r a i n i n g i n p a e d i a t r i c nurs ing f o r th i r ty-seven nurses.

The p ro jec t was f a i r l y successful i n developing improved p a e d i a t r i c se rv ices

and i n in t roducing s o c i a l p a e d i a t r i c s as an i n t e g r a l p a r t of the p a e d i a t r i c courses

o f s t u d i e s .

SEA/Rcl7/2 Page 137

A sho r t - t e rm 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 from Janua ry t o March 1964. Working i n Kanpur, he made a n assessment of c u r r e n t cou r se s f o r medica l under-

g r adua t e and pos t -g r adua t e s t u d e n t s and s t u d i e d t h e l o c a l p a t t e r n of p romot iona l

and p r e v e n t i v e c h i l d h e a l t h s e r v i c e s . He x l s o a s s i s t e d i n improving t h e t e a c h i n g of s o c i a l p a e d i a t r i c s and deve lop ing p e r i p h e r a l p a e d l a t r i c s e r v i c e s f o r t e a c h i n g

purposes . H i s r e p o r t i n c l u d e d a recommendation f o r t h e f u r t h e r upgrad ing and expans ion of p a e d i a t r i c educa t i on and s e r v i c e s of t h e medica l c o l l e g e a t Kanpur.

I n d i a 114.2 P a e d i a t r i c Educa t ion . Mysore R (Oct. 1961 - ?lay 1364 )

UNICEF

A i m of t h e p r o j e c t . To expand, upgrade and r e o r i e n t t h e t e a c h i n g of p a e d i a t r i c s i n t h e medica l c o l l e g e s of t h e S t a t e ; t o e s t a b l i s h a p a e d i a t r i c u n i t i n a d i s t r i c t hosp i t a1 , and t o deve lop a n u c l e u s of an a d v i s o r y and c o n s u l t a t i v e p a e d i a t r i c

s e r v i c e f o r r e f e r r a l h o s p i t a l s and pr imary h e a l t h c e n t r e s i n t h e d i s t r i c t .

As s i s t ance provided by WHO durinp; t h e yea r . ( a ) A p r o f e s s o r of p a e d i a t r i c s and a p a e d i a t r i c n u r s e t u t o r ; ( b ) s u p p l i e s and equipment .

Work done. WHO a s s i s t a n c e s t a r t e d i n D c t ~ b c r 1961 and was cnmpletcd in May 1964.

I n e a c h of t h e p a e d i a t r i c depar tments of t h e f o u r medica l c o l l e g e s of t h e

S t a t e , t h e p r o f e s s o r of p a e d i a t r i c s a c t e d a s t h e n a t i o n a l c o u n t e r p a r t t u t h e tlH0

v i s i t i n g p r o f e s s o r . A n a t i o n a l n u r s e c o u n t e r p a r t nas i n p o s i t i o n a t t h e a r r i v a l

of t h e WHO nursu t u t o r .

During t h e p e r i o d of a s s i s t a n c e , t a r g e t s l a i d down i n t h e p l an of o p e r a t i o n s were f u l l y met. A l l b u i l d i n g p l a n s o r e x t e n s i o n s were completed. The medica l staff of a s s o c i a t e d p a e d i a t r i c depar tments was s t r e n g t h e n e d by a d d i t i o n a l appoin tment

of 7 q u a l i f i e d p a e d i a t r i c i a n s , 11 medica l o f f i c e r s w i th DCH and 1 3 house p h y s i c i a n s .

There was n o s i g n i f i c a n t i n c r e a s e i n n u r s i n g s t a f f i n any of t h e 11Gspital depar tments and u n i t s i nc luded i n t h e p r o j e c t .

A comprehensive p a e d i a t r l c cou r se f o r medica l unde rg radua t e s was i n t r o d u c e d i n t h e medica l c u r r . i c u l ~ v . Mcdem t e a c h i n g methods of c o - o r d i n a t i n g and i n t c g r a t i n g t e a c h i n g of p a e d i a t r i c s w i th o t h e r course6 of r e l a t e d s u b j e c t m a t t e r were

demons t ra ted . Cons iderab le succe s s was ach ieved i n t h e develupment of p e r i p h e r a l p a e d i a t r i c c l i n i c s f o r t e a c h i n g purposes . A t t e n t i o n was g iven t c t h e development

of r e s e a r c h a s an i n t e g r a l p a r t of t e a c h i n g a c t i v i t i e s . P a e d i a t r i c s e r v i c e s i n t h e p i l o t d i s t r i c t were developed s a t i s f a c t o r i l y and c o n s u l t a t i v e s c r v i c e s i n t roduced

a t s u b - d i s t r i c t l e v e l .

The n e c e s s i t y f o r improvement of p a e d i a t r i e t r a i n i n g i n t h e b a s i c n u r s i n g

cu r r i cu lum was r ecogn i zed , b u t t h e l i m i t e d o p p o r t u n i t i e s d i d n o t j u s t i f y concent ra - t i o n on t h i s a s p e c t . Three a l l - I n d i a r e f r e s h e r cou r se s i n p a e d i a t r i c n u r s i n g ,

conducted in Bangalore d u r i n g t h e p r o j e c t p e r i o d , have Provided an o p p o r t u n i t y f o r r e - o r i e n t a t i o n of a number of n u r s e s .

S ~ ~ / R c 1 7 / 2

Page 138

Evaluation. The p ro jec t was successful i n br inging up the standard of the teaching i n

departments of paed ia t r i c s and s t imula t ing the develupment of modern teaching

methods i n a l l e x i s t i n g medical col leges; spec i f i ca l ly ,cons ide rab le success was achieved i n the establishment of pe r iphera l p a e d i a t r i c c l i n i c s f o r teaching purposes.

Ind ia 114.4 Paed ia t r i c Education, Maharashtra

R (oc t . 1963 - ) UNICEF

A i m of the Droject. To expand, upgrade and r e o r i e n t the teaching of p a e d i a t r i c s

i n t h e medical col leges of the S ta te .

Assistance provided by WHO during the year. A p ro fessor of paed ia t r i c s .

Probable durat ion of a s s i s t ance . Unt i l the end of 1965.

Work done dur ing the year. The p r o j e c t i s based i n Bcmbay.

Considerable a t t e n t i o n was paid t o the development af a sound po l icy i n the l ea rn ing and p r a c t i c e s of comprehensive ch i ld heal th . An encouraging f e a t u r e was the expansion of the p r o j e c t t o the 175-bed B.J. Wadia Hospital f o r Children and the

in t roduct ion of comprehensive immunization programmes i n the f i e l d - t r a i n i n g areas.

UNICEF s t ipends were awarded t o seven MD s tudents . A co-ordinated post- graduate programme, providing f o r ro ta t ion between the p a e d i a t r i c departments of

the th ree medical colleges,was drawn up.

The WHO professor undertook teaching of medical undergraduate and post-

graduate s tudents through informal discuss ions , seminars and case-demonstrations i n wards and out-pat ient c l i n i c s . He a l s o gave l e c t u r e s t o l o c a l p ro fess iona l

s o c i e t i e s and p a r t i c i p a t e d i n p a n ~ l discuss ions , cnnfcrenccs and v i s i t s t o p a e d i a t r i c departments of ~ t h e r medical co l l eges i n t h e S t a t e .

The major problems continued t o b e heavy w;rlclcads,inadcquatc b a r r i e r nurs ing

i n general wards, l imi ted capaci ty of t h e c e n t r a l p a e d i a t r i c l abora to ry and shortage of textbooks.

Ind ia 114.2 Paed ia t r i c Education. Madhya Pradesh

R (Dec. 1963 - Jan. 1964)

UNICEF

A i m of the DroJect. To develop a biochemicnl sec t ion i n thc e x i s t i n g 1aboratc.ry

of the P;ii~d~.atr:i.c D c ~ n r t a e n t of the M.G.M. Medical College, Indore.

Assistance provided b y WHO during the year. A consul tant i n b i o c h e m i s t r y f o r two

months.

Work dme. The WHO consul tant was assigned t o the Paed ia t r l c Department of M.G.M.

Medical College, Indore,from December 1963 t o January 1964. E f f o r t s t c f i l l the post of a biochemist i n the Department were unsuccessful, but a paed ia t r i c ian on the s t a f f was seconded t o a c t a s a na t iona l counterpart .

The consul tant made an assessment of e x i s t i n g biochemical laboratory f a c i l i t i e s

i n the Medical Collrgc f o r the purpose of e s t a b l i s h i n g a complementary service in the Paed ia t r i c Department. She a s s i s t e d i n in t roducing rout ine biochemical

Procedures i n the side-room laboratory a t tached t o the Department and i n developing a separate biochemical laboratory f o r post-graduate s tudents i n paed ia t r i c s . The p ro jec t achieved some success i n in t roducing rout ine biochemistry methods and developing a nucleus Of a working un i t from whlch expanded biochemistry se rv ices

can emanate, subject t o the appointment of appropr ia te s t a f f and provision of

supplementary equipment.

m d i a 121 Indian Council of Medical Research R (Aug. 1962 - Feb. 1963; Dec. 1963 - )

A i m of t h e p ro jec 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 i c a l u n i t a t i t s headquarters, and i n organizing and co-ordinating medical research a c t i v i t i e s .

Assistance Drovided by WHO during the year. ( a ) A s t a t i s t i c i a n ; ( b ) suppl ies and

equipment.

Probable durat ion of assistance. Unt i l t h e entl of 1967.

Work done during the year. A W O s t a t i s t i c i a n was assigned t o the p r o j e c t i n December 1963. Recruitment of a na t iona l counterpart was i n t r a i n .

The s t a t i s t i c i a n attended the annual conference of t h e Indian Council of

Medical Research,held i n Visakhapatnam, and the meetings of i t s S c i e n t i f i c Advisory Board i n Delhl.

He prepared the hea l th s t a t i s t i c s p a r t of a t r a i n i n g course i n epidemiology organized by the National I n s t i t u t e of Cammunicable Disease, Delhi, and a l s o del ivered l e c t u r e s a t the course.

India 136 Post-basic Nurslnp, Education: Assistance t o S ta tes*

The aim of t h i s p ro jec t has been expanded during the year t o place emphasis

on the development of post -basic nurs ing education within the un ivers i ty . Pro-

grarrrmes leading t o a bachelor ' s degree, whlch Includes advanced preparat ion i n a nurs ing spec ia l ty , have been encouraged. Author i t ies responsible f o r operation of i s o l a t e d advanced nurs ing cuurses have been urged t o plan f o r the development

Previous t i t l c r Post-graduafe Training of Nurses.

"hc pro jec t s t a r t e d i n January 1962 and 1s expected t o continue u n t i l the end

of 1970- R s s i s t a n c s . t o one S t a t e (Ut ta r Pradesh) ha3 beco oomglcted.

~ E A / k ~ l 7 / 2 Page 140

of a post-basic school of nurs ing and the gradual a ssoc ia t ion of the school with a un ivers i ty . A phased programme o u t l i n i n g t h i s type of development has been prepared by the Regona l Office, and ass i s t ance has been given in every S t a t e where the p r o j e c t i s i n operation s o a s t o develop th lnk ing and planning which w i l l eventual ly lead t o a post -basic degree programme. This s h i f t i n emphasis i s r e f l e c t e d i n the change in the t i t l e of t h e p r o j e c t a s shown above.

Ind ia 136.2 R

Post-basic Nursing Education. Quja ra t (Jan. 1963 - I

Aim of the p ro jec t . To expand post-basic nurs ing education and upgrade pub l ic h e a l t h and i n s t i t u t i o n a l nurs ing se rv ices i n the S t a t e .

Assistance Drovided by WHO dur lnn t h e Year. A nurse educator.


Work done during the year. Expansion and development of the course f o r pub l ic hea l th nurses , wbiob i s being g v e n i n Ahmedabad Medical College,continued. Methods f o r s e l e c t i n g both s tudents and l e a r n i n g experiences were improved. Physical f a c i l i t i e s were added, and teaching equipment and reference mate r ia l s were expanded.

Preliminary discuss ions d i r e c t e d towards l ay ing a foundation f o r t h e development of the course tuwnrds a post-basic school and u n i v e r s i t y a f f i l i a t i o n were held. - Sost-basic Nursina Education. -lab

R (March 1964 - )

A i m of t h e p ro jec t . To develop a u n i v e r s i t y - a f f i l i a t e d post-basic school of nurs ing i n the S ta te .

Assistance provided by WHO during the year . lCro nurse educators.


Work done dur ing t h e year. Work has progressed r a p i d l y toward the development of a post -basic degree programme f o r nurses . A Board of Nursing Studies has been es tab l i shed under the Facul ty of Medicine of the Univers i ty of Punjab. The syl labus and regulat ions f o r the two-year post -basic degree progranrme, which w i l l o f f e r a s p e c i a l i z a t i o n i n teaching and adminis t ra t ion, have been prepared. Faculty, teaching and h o s t e l f a c i l i t i e s have been a l loca ted i n t h e Post-graduate I n s t i t u t e of Medical Sciences, Chandigarh. It i s planned t o hold c l i n i c a l teaching i n t h e h o s p i t a l s and h e a l t h cen t res i n and adjacent t o Chandigarh. The f i r s t c l a s s of s tuden t s was enro l l ed in Ju ly 1964.

~EA/Rcl7/2 Page 141

Ind ia 136.4 R

Post-basic Nursing Education. Mysore (Feb. 1964 - )

A i m of the Droject. To expand post-basic nurs ing education and upgrade publ ic h e a l t h and i n s t i t u t i o n a l nurs ing se rv ices i n t h e Sta te .

Assistance Drovided by WHO durinR the sea r . A nurse educator.


Work done during the year. Direct WHO a i d t o the p r o j e c t began with the appointment of a nurse educator.wh0 a r r ived i n Bangalore i n e a r l y Pebruary 1964.

Assistance was given i n upgrading the current post -basic courses f o r ward s i s t e r s and t u t o r s .

Preliminary discuss ions have been s t a r t e d with t h e object of l ay ing the founda t im f o r the expansion and developraent of the educat ional programme toward a post-basic school with, eventual , u n i v e r s i t y associa t ion.

Ind ia 136. i Post-basic N u r s i n ~ Edueation. Madras R (June 1964 - )

Aim of the Drodect. To e s t a b l i s h a u n i v e r s i t y - a f f i l i a t e d post-basic school of nurs ing i n the S ta te .

Assistanoe Drovided b y WHO dur ing t h e year. A nurse educator.


Work done dur ing the sear . The WHO nurse educator took up d u t i e s i n Madras i n June 1964. Exploratory discuss ions on the development of the cur ren t post-basic courses i n t o a u n i v e r s i t y - a f f i l i a t e d school have been s t a r t e d .

Ind ia 145 Public Health Programme. Bihar R (Jan. 1958 - Feb. 1964) UNICEF

Aim of the Pro jec t . To t r a i n personnel and t o expand the h e a l t h se rv ices i n canmunity development areas .

Assistance Drovided by WHO d u r i n ~ t h e year. A pub l ic h e a l t h o f f i c e r and a pub l ic hea l th nurse .

Jork done. This p ro jec t was developed from an e a r l i e r p r o j e c t . Maternal and Child Health/Nursing, Bihar ( I n d i a 56) . a s s i s t e d by WHO with UNICEF support from 1954.

sEn/Rc17/2

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In January 1962 WHO assigned t o this continuing p r o j e c t a pub l ic h e a l t h

o f f i c e r and a pub l ic h e a l t h nurse. both based a t Patna (Bihar) . The counterpart t o the WHO publ ic h e a l t h o f f i c e r was the Assis tant Di rec to r of Health Services (Planning). Tho WHO publ ic h e a l t h nurse had no counterpart but worked i n c lose

co-operation with the Assis tant Di rec to r of Health Services (MCH) and o the r na t iona l s t a f f .

The work of the p r o j e c t was concentrated on t h e establishment of o r i e n t a t i o n

t r a i n i n g courses f o r medical o f f i c e r s i n charge 'of primary h e a l t h cen t res ; the development of r u r a l cen t res t o be used f o r t r a i n i n g ; a ss i s t ance t o primary h e a l t h cen t res , r e f e r r a l h o s p i t a l s and l abora to r ies , and ass i s t ance i n the nurs ing aspects of t h e programme.

Orientation t r a i n i n g f o r Primary h e a l t h cen t re doctors a t the Public Health I n s t i t u t e , Patna, with r u r a l f i e l d experience a t Rajgir F i e l d T r a i n i n g Centre.

began i n November 1962. By November 1963, 34 medical o f f i c e r s had undergone o r ien ta t ion t r a i n i n g i n four groups. Each course l a s t e d f o r four weeks.

The WHO nurse a s s i s t e d schools of nurs ing i n planning the i n t e g r a t i o n of pub l ic hea l th i n t o the bas ic curriculum and a l s o i n the organization of t r a i n i n g programmes f o r a u x i l i a r y nurse-midwives.

Evaluation. The p r o j e c t developed an o r i e n t a t i o n t r a i n i n g programme f o r medical o f f i c e r s , a r u r a l t r a i n i n g cen t re and cur r i cu la f o r nurs ing personne1,and aided

i n the upgrading of h e a l t h cen t res and r e f e r r a l hosp i t a l s .

Ind ia 141 R UNICEF

Public Health ProKramme. Kcrala (June 1960 - )

A i m of the DroJect. To t r a i n personnel and t o expand the h e a l t h se rv ices i n community d t v ~ l o p m t n t areas .

Assistance Drovided b y WHO durinn the year. A Publ ic hea l th nurse.


Work done dur ing t h e year. I n October 1963, the duty s t a t i o n of the WHO publ ic

hea l th nurse was t r ans fe r red from Trivandrum t o the Indo-Norwegian Health Centre a t Neendakara. A t t h i s h e a l t h centre a p r a c t i c e f i e l d i n pub l ic h e a l t h nurs ing

f o r a l l ca tegor ies of nurs ing personnel has been es tabl ished. Home v i s i t i n g has

been well developed. Maternal and c h i l d h c a l t h c l i n i c s a t the Centre a r e being

u t i l i z e d , and s tuden t s have opportuni t ies t o follow the mothers and ch i ld ren from

the materni ty and p a e d i a t r i c wards of the Centre i n t o t h e i r houses i n the community. Health teaching i s being glven p r i o r i t y .

Public-health nurs ing s tuden t s , bas ic nurse/midwife s tudents and aux i l i a ry nurse/midwives a r e rece iv ing t r a i n i n g a t the Centre.

srn/Rc17/2 Page 143

D i f f i c u l t i e s have been encountered i n assur ing a s teady flow of a s ing le category of s tuden t s through t h c whole of t h e p r a c t i c e f i e l d .

Ind ia 150.2 PuUlic Health Pro~mmme. Naharashtra* T A (Apri l 1963 - ) UNICEF

A i m of the p r o j e c t . To develop a r u r a l envirGnmenta1 s a n i t a t i o n programme and t o improve t h e t r a i n i n g of environmental s a n i t a t i o n s t a f f .

Assistance Drovided by WO durina t h e Year. A s a n l t a r l a n .


Work done durinR the Year. The twelve-month t r a i n i n g course f o r s a n i t a r y inspectors a t t h e Public Health I n s t i t u t e . Hagpur, was conducted,with t h e a c t i v e p a r t i c i p a t i o n of the WHO s a n i t a r i a n and h i s nation31 counterpart . There were approximately 1 000

app l ican t s f a r seventy-five places .

An or ien ta t ion t r a i n i n g course of f i v e weeks' durat ion f o r medical o f f i c e r s of primary h e a l t h cen t res was held i n January 1964. The s a n l t a r l a n and na t iona l c o u n t e r P a r t a s s i s t e d with l e c t u r e s and p r a c t i c a l f i e l d demonstrations i n general san i t a t ion .

Assistance was a l s o provided t o r u r a l water supply and l a t r i n e construct ion programmes i n se lec ted National Extension Service blocks of the Public Health Units of S i r u r , Saoner, and Palghaf.

Ind ia 151 Malaria Eradicat ion R (AM. 1958 - (USAID)

A i m of t h e p ro jec t . To e rad ica te malar ia from the whole country and t o prevent the re-establishment of endemicity.

Assistance Drovided by HHO durlna t h e Year. ( a ) Three entomologFsts and two laboratory technicians ( f o r p a r t of t h e year ) ; ( b ) a two-month i n t e r n a t i o n a l t r a v e l fellowship; ( c ) suppl ies and equipment.


Work done dur ina the year. This programme continued t o maintain i t s s teady progress. The annual assessment f o r d e t e r m i a n g the a reas f o r withdrawal of spraying was c a r r i e d out during the f i r s t q u a r t e r of 1964 by nine teams and a panel of consul tants from the Government, USAID and WHO. A s a r e s u l t of t h i s assessment, an add i t iona l 60 units entered t h e consol idat ion phase e a r l y i n 1964. The programme has now 1C4 u n i t s i n the a t t a c k phase and 288 units i n t h e consol idat ion phase, of which 8 0 a r e i n the process of e n t e r i n g the maintenance phase. Some reorganizat ion of the u n i t s s t i l l

*The f i r s t phase of t h i s programme was completed December

SJ.h C17/2 Page 144

i n t h e a t t a c k phase has been undertaken.with a view t o concentra t ing e f f o r t s on sparse ly populated h i l l f o r e s t a reas . The transmission of malar ia i n some urban a reas , where A.steohens1 i s the vector , has a l s o been c f f e c t i v e l y tackled by i n t e n s i f y i n g a n t i - l a r v a l measures and surve i l l ance operations.

Elaborate arrangements have been made f o r t h e maintenance phase: these include expansion of bas ic h e a l t h s e r v i c e s t o provide t o t a l v ig i l ance cover; provis ion of f a c i l i t i e s f o r rout ine mioroscopic diagnosis of f e v e r cases a t h e a l t h cen t res , d i s t r i c t l abora to r ies , etc. ; development of epidemiological se rv ices . and t r a i n i n g and reorien- t a t i o n of var ious ca tegor ies of h e a l t h personnel i n accordance with the requirements of t h e i r d u t i e s .

India 1% Curriculum Guide f o r Nursing and Elidwifery Training R (Jan. 1963 - j

A i m af t h e Droject. To rev i se the cur ren t ly required mir.imum s y l l a b i f o r general nurs ing and midwifery; t o prapare a curriculum guide t o the revised sy l l ab i .

Assistance Drovided by WHO dur ing the year. A s p e c i a l i s t i n nurse t r a i n i n g .

Probable durat ion of a ss i s t ance . . Vnti l March 1966.

Wor!i done dur ing t h e year. The WHO nurse returned from study-cum-home leave i n November 1963, s i n c e when t h e f i r s t two s tages of the p r o j e c t have been completed.

The f i r s t s tage consis ted of the collection of mater ia l from a l l over Ind ia I n order t o obtain a general p i c t u r e of the present s i t u a t i o n in nurs ing, bas ic nurs ing education and the h e a l t h problems and h e a l t h se rv ices of t h e country. This was completed i n March 1964.

The second s t a g e c o n s i s t s of t h e rev i s ion of the present Indian Nursing Council sy l l abus f o r general nurs ing and midwifery, and t h e regu la t ions f o r recogni t ion of ~ c h o o l s of nursing. This i s under considerat ion by the Co-ordinating Committee.

In ca r ry ing out these a c t i v i t i e s , the p r o j e c t operated through 19 sub-committees which were appointed by t h e S t a t e Nursing Councils,with represen ta t ives from a l l S t a t e s , Mission Boards and t h e Army Nursing Services , and through s p e c i a l sub- committees i n Delhi with which t h e WHO nurse worked more c losely . A l l a c t i v i t i e s have been co-ordinated by a s p e c i a l c o m i t t e e of eleven, appointed by t h e Indian Nursing Council. This c o m i t t e e has held meetings every s i x months.

Preparation of the guide has been s t a r t e d .

Ind ia 170 Survey of Water S U D D ~ Y Resources of Q r e a t e r Calcut ta R (Oct. - Nov. 1959; Sept. - Nov. 1961; Reb. 1963 - ) UNSF

A i m of the p r o j e c t . To improve t h e water supply and drainage of Greater Calcutta.

SEA/RCl7/2

Page 145

Assistance Provided by WHO dur ing the year. A r e s iden t s a n i t a r y engineer and a s a n i t a r y englneer (planning) .

Probable durat ion of a ss i s t ance . U n t i l t h e end of 1966.

Work done dur ing the year. Wo& on c o l l e c t i o n and f i n a l compilation of bas ic techni-

c a l d a t a f o r the preparat ion af the Master Plan on watcr supplies,sewerage and drainage f o r Greater Calcut ta has proceeded.

m e p ro jec t has been v i s i t e d twice by represen ta t ives of the World Bank ( I D A ) t o discuss the prospects o f f i n a n c i a l a s s i s t ance f o r in te r im water supply schemes

and f u t u r e water supply and sewerage schemes. WHO has p a r t i c i p a t e d i n these discuss ions .

Deep ground-water exploret ion with s u i t a b l e d r i l l i n g r i g equipment has been

s t a r t e d i n the southcrn par'ts of Q r c l t e r Calcutta.

A d r a f t b i l l t o c rea te the Calcut ta Metropolitan Watcr and San i ta t ion Authority

has been prepared and submitted t o the Legis la ture .

The Government of Ind ia has requested the extension of the se rv ices of the

Consulting Engineer, i n order t o ca r ry out deep ground-water source s tud ies a s well a s

t o cover a g r e a t e r area i n metropolitan Calcut ta and t o e f f e c t the reg lona l i za t lon af sewerage and drainage schemes.

Ind ia 176 Central Public Health Enaineerinn Research I n s t i t u t e , R Nanuur UNSF (Feb. 1961 - )

Aim of the v ro jec t . To develop t h e I n s t i t u t e a s a major resea rch centre f u r environ- nen ta l s a n i t a t i o n problems, t o co-ordinate research programmes and t o t r a l n research

workers.

Assistance provided by WHO during thc year. Short-term consul tants i n ins tnuncntat ion, pub l ic h e a l t h engineering education, water po l lu t ion con t ro l and sewage t reatment , and s a n i t a r y engineering research.


Work done durfnn the year. Scientific equipment prgvidcd b y the Uhited Nations Special Fund t o thc Central Public Hcalth Engineering Research 1ns t i tu te .on the

advice of WH0,was del ivered a s planned.

A consul tant on instrumentation was assigned and assisted in t h e preparat ion of

a f i n a l l i s t of equipment and mater ia ls . Another consultan! advised on long-term

appl ied research programmes i n a number of f i e l d s .

SEA/?4~17/2 Page I46

A symposium on pub l ic h e a l t h e n a n e e r i n g education was held a t the L l s t i t u t e i n October 1963 with ass l s t ance from WHO i n the form, of a professor of publ ic h e a l t h engineering. This consul tant a l s o v i s i t e d severa l educat ional i n s t i t u t i o n s and repor tee on post-graduate Publ ic h e a l t h engineer ing education i n India .

Research on development of l o c a l mate r ia l s and cost -saving methods on systems of water and sewage treatment were among t h e important a c t i v i t i e s d e r t a k e n by the I n s t i t u t e .

A consul tant on water po l lu t ion and sewage treatment completed a three-month assignment.during which he a s s i s t e d i n the establishment of r c a s m a b l e s t a n d a d s f o r streams and f o r e f f l u e n t d ischarge. He a l s o advised on the performance of water- p o l l u t i o n surveys and on i n d u s t r i a l waste treatment.

Ind ia 180 Health Education i n Schools R ( J u l y 1964 - )

A i m Of t h e p ro jec t . To develop h e a l t h education i n the bas ic teacher- t ra ining courses and i n t h c t eacher - t ra in ing i n s t i t u t i o n s i n the country.

Assistance provided by WHO durlnR t h e Year. A h e a l t h educator.

Probable durat ion of a s s l s t ance . Unt i l the end of 1966.

Work done durinR t h e year. The h e a l t h educator was asslgned t o the p r o j e c t towards t h e end of Ju ly 1964. She i s making a s tudy of h e a l t h education i n the current bas ic t eacher - t ra in ing courses.

Ind ia 182 S t r e n ~ t h e n i n ~ of Health Services ( E ~ i d e m i o l o ~ y ~ TA (March 1963 - )

A l m of t h e p r o l e c t . To e s t a b l i s h o r improvo h e a l t h i n t e l l i g e n c e u n i t s in s t a t e h e a l t h 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 con t ro l ; t o develop f u r t h e r t h e National I n s t i t u t e of Communicable Diseases. Delhi.

Assistance provided by W O d u r i n ~ the year. ( a ) Five consul tants ; ( b ) two fellowships - one of twelvc months and one of s i x months.for s tudy i n the United S t a t e s of America, t h ~ e ten-month fe l lowships f o r s tudy i n Europe,and one three-month fe l lowship f o r s tudy i n Denmark and the United Kingdom; ( c ) suppl ies and equipment.


Work done d u r i n ~ t h e year. I n t h e p a s t th ree years, ton fellowships. i n epidemiology were awarded by WHO t o se ldcted medical graduates with D.P.H., who on t h e i r re turn from training.would be responsible f u r e s t a b l i s h i n g an epidemiological u n i t a t s t a t e l eve l . In the l a t t e r p a r t of 1963, a WHO consul tant v i s i t e d thc h e a l t h d i r e c t o r a t e s

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of those S t a t e s t o which t h e fe l lows had returned a f t e r t r a i n i n g , i n order t o fol low

up the progress made by them i n s e t t i n g up epidemiclogical u n i t s . He a l s o advised on the p r i o r i t y of cpidemiolagicnl s tud ies and the urgent need t o develop support ing microbiological and s t a t i s t i c a l se rv ices .

A second consul tant a l s o v i s i t e d the in f -c t i cus -d l seases h o s p i t a l s i n f i v e p r i n c i p a l c i t i e s of Ind ia and advised on t h e i r upgrading and on the r o l e they should p lay i n epidemiologicai i n t e l l i g e n c e and as teaching centres .

Three consul tants a s s i s t e d the National I n s t i t u t e of Communicable Diseases, Delhi,

i n developing f a c i l i t i e s f u r and i n the teaching of epidemiology, microbiology and

s t a t i s t i c s , in t h e f i r s t five-month t r a i n i n 8 course in Epidemiolom s t a r t e d a t t h e I n s t i t u t e i n Ju ly 1964. T1.ro fellowships wcre awarded t o s t a f f mcmbcrs cf the I n s t i t u t e f o r advanced t r a i n i n g i n serology and i n i n s e c t physiology. Supplies and equipment were provided f o r t h e new f t tcrcbiological Ikpnrtment.

India 183 Medical Education, a u j a r a t S ta te TA (Dec. 1962 - )

A i m of the DrGdect. To develop medical education and medical research i n Baroda Medical College.

Assistance Drovided by WHO during the year. ( a ) A team of s i x v i s i t i n g professors from Edinburgh University (up t o May 1964). and another team of f i v e v i s i t i n g professors

(from Ju ly 1964) from the same un ivers i ty ; t h r e i short-term consul tants ; ( b ) suppl ies m d equipment.


Work done dur ing the ycar. The WHO team of s i x v i s i t i n g professors took p a r t i n seminars

on "The Objective of the Project" , "cross In fec t ion" , "Diarrhoea1 Diseases" and

"Medical Education". They held consul ta t ions with t h e i r n3t ional colleagues an0 prepared 3 repor t on thr nedic:l college cxnd h u s p i t a l s , with recommendations f o r improvtme.ls

of f a c i l i t i e s and s t a f f i n each department under ass i s t ance , a s well a s f o r the hospi ta ls

in general.

The v i s i t i n g professor of preventive and s o c i a l medicine was designated a s sen io r

WHO o f f i c e r . He co-ordinated t h e work of the members of t h e team. He a l s o p a r t i c i p a t e d in the l e c t u r e s t o s tudents and introduced prevent ive aspects i n combined c l i n i c a l

l ec tu res . Hr i l s o gave l e c t l r c s on the hazards of nuc lea r r a d i a t i o n t o man.

I n l d d i t i l n t.i i n s t r u c t i n g undcrgraduatcs and undertaking post-graduate c l i n i c a l

teaching and t u t o r i a l s , the WHO professor of p a e d i a t r i c s a s s i s t e d i n the improvement

of the f a c i l i t i e s i n the c h i l d r e n ' s wards.

The WHO p r o f e s s c ~ of bacter iology, i n co l l abora t ion with h i s na t iona l c o u n t e r p a r t , was able tc, e s t a b l i s h a r e l i a b l e d iagnos t i c bac te r io log ica l service . He

reviewed the se ro log ica l methods i n use and made suggestions f o r t h e i r improvement.

SEA/UCl'I/Z Page 148

A l abora to ry technician, provided on a short-term bas i s , was able t o t r a i n the laboratory s t a f f and organize l abora to ry work. Several research p r o j e c t s were undertaken.

The v i s i t i n g professor of o b s t e t r i c s and ggnaecology, though handicapped by having no s u i t a b l e counterpar t , contr ibuted t o t h e improvement of t h e teaching of the subject and the organizat ion of c l i n i c a l work.

The v i s i t i n g professor of medicine p a r t i c i p a t e d i n t h e teaching of under- graduates and post-graduates. He introduced an in tegra ted l e c t u r e course on t h e cardiovascular system f o r post-graduate s tudents . A s p e c i a l course on n u t r i t i o n a l anaemias was organized.

A the rapeu t ic conunittee made a s tudy of the a v a i l a b i l i t y and use of intravenous f l u i d s i n S.S.G. Hospital .

The v i s i t i n g Professor of physiology besides t ak ing p a r t i n t h e normal teaching, helped t u s e t up a neurophyslological laboratory, p a r t i c i p a t e d i n c l i n i c a l teaching on neurological p a t i e n t s , put up an electrornyographic apparatus and made photographic arrangements.

A professor of bacter iology and a biochemist were a s s i m e d f o r a shor t time. They made recommendations on the d e s i r a b i l i t y of e s t a b l i s h i n g independent departments of microbiology and biochemistry.

Recommendations f o r f u r t h e r development of the col lege included proposals f o r enhanced s t a f f i n g of the h o s p i t a l and col lege, appointment of fu l l - t ime s t a f f t o be i n charge of the c l i n i c a l departments, improvement of t h e phys ica l f a c i l i t i e s of the h o s p i t a l s , reorganizat ion of h o s p i t a l adminis t ra t ion.and in t roduc t ion of a s u i t a b l e h o s p i t a l records system.

Members of t h e WHO team, i n d i v i d u a l l y o r i n small groups, v i s i t c d t h e o the r medical col leges i n Gujarat and o the r cen t res of medical education i n India . They have contr ibuted by l e c t u r e s , d iscuss ions and seminars t o medical education i n general. They a l s o participated i n the conference on medical education convened by the Indian Association f o r t h e Advancement of Medical Education i n Febwary 1964 in

Madras.

A second team o f v i s i t i n g p r o f e s s o r s ( i n i n t e r n a l medicine, c l i n i c a l biochemistry. psychological medicine, surgery, hosP i t3 l admin i s t ra t ion) s t a r t e d work in Baroda Medical College i n Ju ly 1964.

Ind ia 185 S t r e n a t h e n i n ~ of D i s t r i c t Health Administration R ( J a n . 1964 - ) UNICEF

A i m of the Droject. To s tudy and develop the organizat ion of d i s t r i c t h e a l t h se rv ices so a s t o provide the maximum e f f e c t i v e se rv ice t o the pub l ic , having regard t o the hea l th personnel ava i l ab le .

S E A / R C ~ ~ / ~

Page 149

Assistance Drovided by WHO dur ing the year. A pub l ic hea l th o f f i c e r , a publ ic h e a l t h

nurse and a s a n i t a r i a n .


Work done d u r i n s the year. In keeping with the es tab l i shed system of d i s t r i c t adminis t ra t ion, the p ro jec t i s a s s i s t i n g t o e s t a b l i s h adminis t ra t ive p a t t e r n s which

w i l l provide adequate technical guidance and supervis ion t o d i s t r i c t h e a l t h personnel

and w i l l develop a more e f f e c t i v e us i of hcn l th s t n f f a t f i e l d l e v s l .

The p ro jec t has been i n operation i n Jamnagar M s t r l c t of Gujarat S t a t e s ince January 1964. The WHO team cons i s t s of a publ ic h e a l t h o f f i c e r , a publ ic h e a l t h

nurse and a s a n i t a r i a n . Counterparts have been appointed by the S t a t e Government. The team has examined t h e e x i s t i n g h e a l t h condi t ions wi th a view t o prepar ing a programme of a c t i v i t i e s based on the f indings . The Government of Gujarat has

sanctioned a d i s t r i c t tubercu los i s programme, and the required s t a f f a r e being

rec ru i t ed .

Ind ia 186 Assistance t o Schools of Den t i s t ry

R ( o c t . 1963 - ;uly 1964)

Aim of t h e p ro jec t . To demonstrate modem techniques and improved methods of teaching, and t o organize research and t m i n i n g , i n the f i e l d of den ta l hea l th .

Assistance provided by WHO during the year. A professor of d e n t i s t r y .

Work done. The WHO v i s i t i n g professor of d e n t i s t r y Ltrrived i n e a r l y October 1963. After a t t end ing the meeting of i n v e s t i g a t o r s of epidemiology and pathology of oropharyllgeal tumours held in New Delhi from 8 t o 15 Octobcr, he undertook teaching

and o the r d u t i e s connected with h i s assignment a t the following den ta l colleges:

(1) Dental College and Hospital , Luchow, ( 2 ) Government Dental College, Bombay,

( 3 ) Nair Hospital Dental College, Bombay, ( 4 ) Dental College, Bangalore, and (5 ) Dental College, Trivandrwn.

He introduced modem methods of teaching d e n t i s t r y , s t a r t e d research p r o j e c t s and provided an ou t l ine syl labus f o r teaching s tuden t s i n a systematic manner. His repor t has been sen t t o the Government.

India 189 Urban Health Develo~ment

R (Nov. - Dec. 1963)

A i m of the Droject. . To organize and develop urban h e a l t h se rv ices and t r a i n personnel

f o r work i n urban communities.

Assistance Drovidfd by WHO durinR the year. A consul tant i n urban h e a l t h development.

s ~ c 1 7 , L 2 Page 150

Work done. Assistance was requested in a study of the health problems due to rapid urbanization and industrialization in Bangalore City. A WHO consultant was assigned in November to examine the urban health problems in all their aspects and make recommendations. He completed his work in December 1963. His recommendations are under consideration.

India 194 R

Medical Rehabilitation (Nov. 1963 - Peb. 1964; - )

UNICEF

A i m of the project. To expand medical rehabilitation services throughout India and the facilities available at the All-India Institute of Physlcal Medicine and Rehabilitation, Bombay; to set up a Central Institute of Orthopaedics in Delhi as a training and research aentre; to develop 8 to 14 other departments in selected cities which already have well developed orthopaedic departments, and to establish a large plant in Delhi for the manufacture of standard prosthetic components.

Assistance provided by WHO during the year. Two short-term consultants.


Work done during the year. Two short-term consultants were assigned by WHO in November 1963. They visited various major hospitals/institutions concerned with medical rehabilitation and held discussions with local authorities in several of the principal towns, viz.. Bombay, Paona. Madras, Vellore, Bangalore, Calcutta, Chandigarh. Kanpur and Lucknow.

One of the consultants completed his work in January, and the other in ~ebruary.1964. In their report they have recommended a programme for the gradual development of a country-wide rehabilitation service for the physically handicapped. The report has been forwarded to the Qovernment.

It is proposed to provide the services of a technician in orthopaedic appliances in 1965.

India 195 R

Course in Radiological Physics, Bombay

(April 1962)

Aim of the project. To strengthen the training of radiological physicists.

Assistance provided by WHO during the year. A consultant for one month and payment of 5@ of the stipends to fourteen participants in the course.

Probable duration of assistance. Until 1966.

Work done during the year. The first one-year course in radiological physics was conducted by the Atomic Energy Establishment, Bombay, with assistance from a WHO consultant on radiation protection, who was working with project SEARO 42. The course was

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completed a i t h i e n 1 cf : ' l rch 1963. F o r t h e second c o u r s e , which s t a r t e d i n

May 1 9 6 3 , Wi:O p r o v i d c d a n o t h e r c o n s u l t a n f o r one month. He gave a s e r i e s of s p e c i a l l e c t u r e s and a l s o madc sorle u s e f u l s u g g e s t i o n s f o r m o d i f i c a t i o n of t h e

cur r icu lum.

S i m i l a r c o u r s e s w i l l be g i v e n i n 1965 and 1966.

I n d i a 196 i l l n ~ a n . s e P o i s o n i n e

R (NVV. - D C C . 1 9 6 3 )

A i m of t h e p-. To promote s a f e t y mechanisms and p r o c e d u r e s a g a i n s t manganese and ferro-manganese p o i s o n i n g .

A s s i s t a n c e prov ided by Xi0 dllr-i_"g t h e y e a r . A c o n s u l t a n t f o r t h r e e weeks.

Work done . A 1?10 co:::lllt.r.nt was a s s i g n e d t o t h i s P r o j e c t a t t h e end of November

1963. PC.. ' r i - r t e d thr ferro-manganese m'ncs and p l a n t s i n Plysore and O r i s s a and

h e l d d i s c . uns w;,il gover ;D.~nta l and conm?rc ia l a u t h o r i t i e s concerned i n Banga lore .

Madras and O r l r s a S t a t e s . He a l s o v i s i t e d t h e A l l - I n d i a I n s t i t u t e a f Hygiene and P u b l i c H e a l t h , C a l c u t t ? . On h i s v i s i t t o O r i s s a h e was accompanied by t h e p r o f e s s o r

of p h y s i o l o g i a a l and L!:2a;trihl n y g i s n e a t t h e I n s t i t u t e .

H e l a t e r addressed t h e I n d i a n Academy of Medical S c i e n c e s , New D e l h i , on " E x p l o r i n g th., D .n:crGus Trades".

lie c o n p l c t e d his ass ignment i n December. H i s r . o p a r t , s ' ~ n t t c v t h i S~.vernmsnt ,

c u t l i n e s nath.ods rs:r t l i r i p r c v d n t l u n ;f n?n&rtne;e p c i s o n i n e by d u s t and fumes.

I n d i a 197 I n 3 u s t r i a l and Occupa: a n a l H e a l t h --.-- R ( n g r l l 1764 - )

A i m o f t h e p - o j i . .t. To s t u d y t h e m,?dical f a c i l i t i e s a v a i l a b l e i n t h e v a r i o u s - -. . - - .. . - i n d u s t r i a l undt-rt;'<inns and i n s t i t u t i o n s i n I n d i a ; t o s t u d y t h e p o t e n t i a l i t i e s f o r f u r t h e r strengthening and ,i . :-: . l?plng th': t r a i n i n g f a c i l i t i e s i n i n d u s t r i a l and

o c c u p a t i o n a l h e a l t h ; t o p r e p a r e g u i d i l i n c s f o r Promot ion of o c c u p a t i o n a l h e a l t h in

i n d u s t r y .

A s s i s t a n c e p r o v i d e d by 1 2 1 0 u r i n i : t h e y e a r . A c o n s u l t a n t f o r six months.

P r o b a b l e d u r a t l o n of a s s i s t a n c ~ . U n t i l November 1964.

Work done d u r i n g t h e y e a r . The WHO c o n s u l t a n t a r r i v e d i n A p r i l 1964. He v i s i t e d --- Ahmedabad, Bonbay, Cochin, Coimbatore and Banga lore , t o s t u d y t h e medica l f a c i l i t i e s a v a i l a b l e and p r o t l ? m s of i n i u s t r l a l and o c c u p a t i o n a l h e a l t h h a z a r d s a t t h e i n d u s t r i a l u n d e r t a W n p s and t r l i n l n p i n s t i t u t i o n s .

A c t i o n i s b e i n 6 t a k e n t o a s s i g n a n i n d u s t r i a l t o x i c o l o g i c a l e n g i n e e r f o r t h r e e months from August 1964.

SEA/RC17/2 Page 152

Ind ia 198 R

Plague Control (Jan. - Apri l 1964)

A i m of t h e project . To i n v e s t i g a t e and determine t h e f a c t o r s responsible f o r t h e pers is tenoe of f o c i of plague in South I n d i a and advise on s u i t a b l e c o n t r o l ~ n a a s u r e s .

Assis tance provided by WHO during t h e year. ( a ) A consul tant f o r four months; ( b ) sup- p l i e s and equipmcnt. ( A v i h i c l e was made ava i l ab le from pro jec t Ind ia 153).

Work done. The consul tant ca r r i ed out a d e t a i l e d s tudy of rodents , wild and domestic. and of t h e i r e c t o p a r a s i t e s , i n order t o determine t h e i r r o l e i n t h e p e r s i s t e n t t r a n s - mission of plague i n the a f fec ted zones of Hysore, Madras and dndhra Pradesh S ta tes . The presence of s y l v a t i c plague was successful ly demonstrated by P. p e s t i s i s o l a t i o n s from th ree species of wild rodents and t h e w f l e a s . A s tudy of t h e epidemiology of outbreaks of human plague was continued.

Co-ordination of the necessary inves t iga t ions and con t ro l measures was undertaken by a team from the National I n s t i t u t e of Communicable Diseases. Delhi, i n co l l abora t ion with t h e anti-plague se rv ices of the th ree S t a t e s concerned.

Ind ia 200 Pellowships R

Production of Po l io Vaccine: A twelve-month fe l lowship f o r study i n t h e United S t a t e s of America and Canada.

Nursing Administration: A twelvejnonth fellowship f o r s tudy i n New Zealand.

Health Education: A two-month t r a v e l fe l lowship in t h e United S t a t e s of America and Europe.

Physical Therapy: A twelve-month fe l lowship f o r undergoing the Physical Therapy Teachers 'Training Course i n the United Kingdom.

g idemio logy of Po l iomyel i t i s and Production of Po l io Vaccine: A twenty-inonth fe l lowship f o r s tudy i n the United S t a t e s of Pimerica ard Canada.

Neuro-virulancc Test ing: A three-month fe l lowship f o r study i n the United S t a t e s of America.

Ind ia 201 Fellowstiips T A

Sani tary Engineering: A six-month t r a v e l fe l lowship i n the United S t a t e s of America and Europe.

Paed ia t r i c s : A four-month fe l lowship f o r study i n t h e United S t a t e s of America.

sm/Rc17/2 Page 153

m: A twelve-month fellowship far study in the United Kingdom. Quarantine Administration and Yellow Fever Control: Two ten-week international travel fellowships in Africa and Europe.

Clinical Biochemistry: Two ten-week fellowships for study in Denmark (awarded under Inter-regional 239).

Industrial Hygiene: Two eight-month fellowships for study in Yugoslavia (awarded under Inter-regional 180).

Basic Sciences for Surgeons: Two three-month fellowships for study in Denmark [awarded under Inter-regional 243).

India 209

CWS Community Water Supply (March 1964 , )

Aim of the project. To assist in the organization and conduct of a Seminar, and to assess and advise on the feasibility and presentation of definitive schemes of water supply and associated drainagc,in relation to the conditions and requirements of World Bank loans.

Assistance provided by WHO during the year. (a) ma consultant on financing and two consultants on engineering: (b) some supplies.

Probable Puration of assistance. Until the end of 1966.

Work done during the year. The WHO consultants and staff of the Regional Office assisted in the organization of the Government of India's Seminar on Water and Sewerage Works Financing and Management,held in Delhi from 24 to 30 April 1964. WHO staff participated in the deliberations of the Seminar and assisted in the preparation of the final report.

Immediately after the Seminar, the engineering and financial consultants visited typical water and sewerage schemes in the States of Mysore, Madras and Maharashtra and held discussions with responsible officials on proposed schemes and related problems. Their reports have been sent to the (ioverment.

It is planned that thesc preliminary visits will be followed by further visits at a time to be decided in the light of developments. Other areas will also be visited fcr the same purpose.

SEA/RC17/2 Page 155

Despite a number of economic measures taken by the Government, the inflationary.trend continued during the year. This has reacted unfavourably on health services, which have had difficulty in meeting the increased costs occasioned by rising prices. The national malaria eradication campaign has been hampered by shortage of funds. Many hospitals and health centres have operated to less than full capacity, owing to insufficient funds for staff and maintenance services. However, there has been a truly impressive axpansion of medical education. There are now fourteen medical faculties, of which only two (Djakarta and Surabaja) have been established long enough to have produced medical graduates. The shortage of teachers, equipment and textbooks is acute, and this problem has not yet been solved. The University of California and the China Medical Board have given substantial help to the Medical Faculties of Djakarta and Surabaja. Plans for WHO and UNICEF assistance to medical education in Jogjabrta and Bandung have been completed.

The rapid growth of population, particularly in Java, has emphasized the urgent need for increasing food production and providing safe water supplies. There is serious rat infestation in rural areas. In addition to their potential menace in the spread of disease, rats have been responsible for very grave wastage of food. Rodent-control measures were undertaken by the Department of Agriculture.

The Central Epidemiological Unit in the Ministry of Health maintained its present somewhat limited investigatory and training functions. The Unit has assisted actively in the control of outbreaks of communicable diseases. The system of reporting communicable diseases was continued, though reporting is still far from complete. The work of the Unit has stressed the necessity for further development of health laboratory services. Epidemiological sections have been set up in five provinces, and expansion to other provinces is envisaged as staff is trained

There were further outbreaks of cholera El Tor, assuming epidemic proportion during the rainy season. Cases of smallpox continued to occur: the disease appeared to have become endemic in West Java. Plans to increase the production of freeze-dried smallpox vaccine, with the assistance of WHO and UNICEF, were being developed

The success of the malaria eradication campaign in Java suggests that tuberculosis is the next serious public health problem. It has been estimated that nearly 5% of the population in Central Java have active, progressive

SEA/RC17/2 Page 156

tuberculosis. The national BCG campaign has been intensified The tuberculosis control programme in Jogjakarta has made good progress, and the activities have been extended to MaLang, Surabaja and Makasear.

The first steps were taken for the extension of the leprosy control programme from J a m and Bali to some of the outer islands. It has been decided that leprosy control should be an integral part of the general health services.

PROJECT LIST

Prodect No.

Source of Funds Co-operating Agencies

Indonesia 2 Leprosy Control R ( J u l y - Sept. 1955; Sept. 1956 - ) UNICEF

A i m of the P r o j e c t . To develop a leprosy contrgl programme withln the framework af the general hca l th se rv ices i n a l l endemic a reas of t h e country.

Assistance provided by WHO during the year. ( a ) A l e p r o l o g i s t ; ( b ) supp l ies and equipment.

Probable ourat ion of a ss i s t ance . Unt i l the end of 1967.

Work done d u r i n ~ t h e year. The na t iona l leprosy con t ro l programme has continued t o receive the support of the Government, s p e c i a l emphasis being given t o an in tegra ted method and approach t o leprosy control and t o t h e t r a i n i n g of spec ia l i zed s t a f f a s well a s of general h e a l t h se rv ices personnel.

In view of the r e s u l t s obtained i n Java and Ba l i , p lans were made f o r f u r t h e r consol idat ion within Java and Bal l and f o r the expansion of the Programme i n t h e ou te r i s l a n d s , p a r t i c u l a r l y in Sumatra and Kalimantan.

The s i t u a t i o n a s repor ted a t t h e end of 1963 can be summarized a s follows:

Province

Djakarta Raya West Java Central Java East Java Bal i North Sumatra South Sumatra South Sulawesi Jogjakar ta

P o ~ u l a t i o n examined i n g h j -

Total of new cases i n 1962

Cumulative t o t a l of cases r e n i s t e r e d up t o t h e end of 1962

Total 703 033 2 273 36 978

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Indonesia 22 Strennthenina of Health Services ( E p i d e m i o l o m ~ T A (Dec. 1958 - March 1964)

A i m of t h e p r o j e c t . To s e t up an epidemiological u n i t i n the Ministry of Health and i n the pl,ovlnces i n order t u determine the p r e u a i l i n g d i sease p a t t e r n and plan con t ro l measures; t o advise a l l branches of t h e medical se rv ices on t h e use of epidemiological methods.

Assistance Drovided by WHO dur ing the year. ( a ) An epidemiologist; (b ) a twelve- month fellowship f o r study i n the United S t a t e s of America; ( c ) suppl ies and equipment.

Work done. The Epidemiological Unit i n the Ministry of Health continued i t s advisory a c t i v i t i e s and inves t iga t ion of the p r e v a i l i n g d i seases and t h e i r con t ro l . It promoted and helped t o e s t a b l i s h epidemiological sec t ions i n t h e Departments of Bealth of the Provinces of Java and Ba l l .

During t h e year. s p e c i a l inves t iga t ions were c a r r i e d out on t h e epidemiology of cholera E l Tor, smallpox, d iph ther ia , p e r t u s s i s and t e tanus .

The Epidemiological Unit organized and a s s i s t e d i n var ious t r a i n i n g courses i n epidemiology f o r newly graduated doctors a s well a s f o r e x i s t i n g h e a l t h personnel.

After a period of over f i v e years of d i r e c t a s s i s t a n c e t o t h e Epidemiological Unit, WHO a i d t o t h e p ro jec t t e m i n a t e d a t the end of March 1964.

Evaluation. The p r i n c i p a l aim of this p r o j e c t , namely t o s t rengthen epidemiological se rv ices i n the Ministry of Health, can be considered t o be well on i t s way t o achievement.

Indonesia 32 Malaria Eradicat ion R (May 1955 - 1 TA UNICEF (USAID)

A i m of the p ro jec t . To e r a d i c a t e malar ia throughout the country i n progress ive s t ages .

Assistance provided by WHO dur ing the year. ( a ) Nine mala r io log i s t s , three entomo-

l o g i s t s , one a s s i s t a n t mala r io log i s t , four s a n i t a r i a n s , an admin i s t ra t ive Off icer , th ree clerk-stenographers and one t r a r i s l a to r - typ i s t ; ( b ) a four-month fe l lowship fo r

attendance a t t h e malar ia t r a i n i n g czurse i n Jamaica, a three-month fellowship f o r s tudy i n Ind ia and two fe l lowships of three-and-a-half months each f o r s tudy i n t h e Phi l ippines and India; ( c ) supp l ies and equipment.


SEA^ cz 7/z Page 159

Work done durinp: the year. Spraying operat ions and case-detection a c t i v i t i e s were continued i n Java, Bal l and South Sumatra. During 1963 the spraying operat ions had t o be suspended temporarily f o r adminis t ra t ive reasons. E f f o r t s continued t o be made t o improve supervision of operat ions , including the maintenance of vehicles .

I n s e c t i c i d e res i s t ance of the vectors A.sundaicus and A.aconitus in some p a r t s of Java and demographic f a c t o r s following the volcanic erupt ion of M t . Qunung and the i n t e r - i s l a n d movement of population have presented some problems. There has been some increase i n malar ia cases i n Bal l , Madura and !Fulungagung Zone.

An i n t e r n a l assessment of the programme was undertaken during the f i r s t q u a r t e r of 1964, and,followlng t h i s , spraying was withdrawn from some zones i n Java.coverfng approximately 15.4 mi l l ion people. Arrangements have been made t o i n t e n s i f y su rve i l l ance a c t i v i t i e s i n these a reas .

In South Kalimantan, malariometric surveys were c a r r i e d out along the &?reto River. Tnc bui ld ing of o f f i ces and s t a f f quar te r s f o r malar ia e rad ica t ion headquar te r s i n BanJarbasu i s progressing.

In t h e Province of West I r l a n , pre-eradicat ion a c t i v i t i e s were continued. Spraying operations covered a population of 182 000 i n 1964. A na t iona l technical , l i rector has joined the programme. Six zones have been es tab l i shed with 23 sec to r s . A p lan of operat ions i s being f i n a l i s e d .

Indonesia 40 Vaccine and Sera Production TA (Apri l 1959; June 1960; Feb. - March 1963; UNICEF Sept. - Dec. 1963; - )

A i m of the orodect. To improve methods of production of vaccines, a n t i t o x i n and tOxoids.

Assistance provided by WO durinp: the year. A three-month fe l lowship f o r s tudy in t h e United S t a t e s of America.

Probable durat lon of a ss i s t ance . Unt i l t h e end of 1966.

Work done dur ing t h e year. A s a follow-up of the recommendations f o r the es tab l i sh - ment of a production u n i t f o r d iph ther ia , p e r t u s s i s and t e tanus vaccines, made by a shor t - term consul tant who v i s i t e d the Bi., Farma I n s t i t u t e . Pandung, i n 1963, WHO'S t echn lca l approval was given t o UNICEF f o r ass i s t ance with add i t iona l equipment needed. Fur ther follow-up of the p ro jec t Is envisaged i n t h e next two years.

Indonesia 41 Nursing Advisory Services T A (Oct. 1957 - J u l y 1959; Nov. 1960 - )

A i m of t h e p r o j e c t . To develop a Division of Nursing i n t h e Kin i s t ry of Health which w i l l co-ordinate i n s t i t u t i o n a l and pub l ic h e a l t h nurs ing se rv ices and upgrade and expand t r a i n i n g programmes f o r nurses and midwives.

Assistance provided by WO durinn the year. A nurse adviser .

Probable dura t ion of a ss i s t ance . Uht i l the end of 1968.

Work done dur lnn the m a r . The WHO nurse adv i se r l e f t the p r o j e c t on study-cum- home leave i n J u l y 1963,and h e r replacement a r r ived i n November 1963.

The need t o def ine the funct ions of the Division of Nursing i n t h e Mlnistry of Health a s well a s the d u t i e s and r e s p o n s i b i l i t i e s of i t s ,personnel was emphasized,and a s s i s t a n c e t o t h i s , end was given.

The WHO nurse p a r t i c i p a t e d i n a committee t o make recommendations f o r the development of a uniform curriculum which might be used i n a l l bas ic nurs ing schools throughout the country. A review of t h e s t r u c t u r e and funct ions of the Post-basic School f o r Nurses and Mldnives has been undert&en.nith a view t o recommending more e f f e c t i v e functioning.

In order t o s tudy t h e overa l l nurs ing needs of t h e country and t o determine t h e funct ions of the Division of Nurs ing, i t has been planned t h a t the WHO nurse adv i se r will make f i e l d v i s i t s t o a reas which have no t been v i s i t e d by a nurse s p e c i a l i s t s o f a r . This w i l l a l s o provide an opportuni ty t o give on-the- Spot a s s i s t a n c e t o some of t h e schools and i n s t i t u t i o n s which have requested such help.

Indonesia 50 Tuberculosis Control R [ ~ u l y 1961 - ) UNI CEP

A i m of t h e Pro jec t . To proceed wlth the na t iona l tubercu los i s progranrme; t o t r a i n na t iona l s t a f f i n r a t i o n a l case-f inding and ambulatory treatment techniques and methods; t o e s t a b l i s h a c e n t r a l tubercu los i s epidemiological unit which w i l l d i r e c t the control operat ions throughout the country.

Assistance Drovided by WHO during the year. ( a ) A medical o f f i c e r , a pub l ic h e a l t h nurse, a l abora to ry technician, an x-ray t echn ic ian and a s t a t i s t i c i a n ; [b ) suppl ies and equipment and a t r anspor t vehicle .


Work done dur inn t h e year. A re-examination of p a t i e n t s who had been under t r e a t - ment f o r one year and an add i t iona l 2% sample of persons Known t o have had normal lungs a t i n i t i a l examination were undertaken. This was concluded a t t h e end of 1963, thus completing the urban p i l o t p r o j e c t in Jogjakar ta . Mass con t ro l se rv ices , in which a l l persons over 9 years of age a r e covered by x-ray examination without prel iminary tuberculin tes t ing,have been i n s t i t u t e d . A l l cases de tec ted have been put on treatment with INH alone. More than 1 0 000 examinations were c a r r i e d out i n January 1964, and 'operat ions have exceeded t h e t a r g e t , n i t h a coverage of

sEA/Rc17/2 Page 1 6 1

over 8%. The estimated Prevalence of cases of tubercu los i s considered t o be i n need of treatment has remained on the same l e v e l a s dur ing t h e p i l o t p ro jec t operat ions , namely 4.075.

The follow-up r e s u l t s of the p i l o t s tudy population showed t h a t more than 90 p e r cent of t h e i n f e c t i o u s cases had become i n a c t i v e dur ing t h e one year of treatment with IETH only. However, the rad io log ica l "healing r a t e " appeared t o be lower than 3%. and cases with extensive and/or c a v i t a r y l e s i o n s showed the lowest heal ing r a t e .

In Surabaya, a mass case-finding and treatment programme has been s t a r t e d , applylng the methods and procedures es tab l i shed i n the Jogjakar ta p r o j e c t .

A p i l o t p ro jec t i s being s t a r t e d a t Malang (East Java) t o a s c e r t a i n t h e most s u i t a b l e method f o r a tubercu los i s con t ro l programme i n r u r a l a reas of Java. Di f fe ren t approaches t o the organizat ion of mass treatment through e x i s t i n g h e a l t h se rv ices vlll be evaluated under t h i s study, and mass oase-finding i n keeping with the capaci ty of the treatment se rv ice w i l l be i n s t i t u t e d .

Indonesia 2 Strengthening of Health Services R (Sept . 1959 - UNICEF

A i m of the p r o j e c t . To develop a comprehensive h e a l t h se rv ice providing adequate h e a l t h coverage, I n both q u a l i t y acd quant i ty .

Assistance provided by WHO durinK the year. A publ ic h e a l t h nurse and a s a n i t a r i a n .


Work done during t h e year. A WHO nurse and a s a n i t a r i a n a s s i s t e d i n t h e organiza- t i o n and conduct of t r a i n i n g courses a t Bekasi. They were a l s o ab le t o provide ass i s t ance i n the work of hea l th se rv ices within the surrounding area of the p ro jec t .

The s a n i t a r i a n advised m.and..asalsted in.the.lplprovement of UrJICEF-aided. water supply programmes t o r hcmes and orphanages.

Transfer of t h e loca t ion of the p r o j e c t i s under study.

Indonesia 62 Medical Education R (May 1964 - 1

A i m of the p ro jec t . To a s s i s t se lec ted departments of t h e Facul ty of lkd ic ine i n the country.

SEA/~c17/2 Page 162

AssiStance Provided by WHO d u r i n ~ the year. A professor of p h y s i s l o ~ .


Work done durinK the year. A v i s i t i n g professor of physiology was assigned t o the Medical Faculty, Qadjah Mada S t a t e Univers i ty , Jog jakar ta , in May 1964. Since then he has made a s tudy of t h e l o c a l problems and needs of the bas ic medical sc iences i n Indonesia.

Indonesia 64 School of Phys io the ra~y . Solo R (March 1963 - )

A i m of the DroJect. To improve, expand and upgrade the e x i s t i n g t r a i n i n g of phys io the rap i s t s a s well a s t o develop physical medicine and r e h a b i l i t a t i o n se rv ices in the country.

Assistance provided by 1M0 dur ina the year . A physiotherapy t u t o r .

Probable durat ion of a ss i s t ance . u n t i l t h e end of 1966.

Work done durinpl the w a r . Twenty s tuden t s , who had begun t h e i r course with a revised syl labus i n September 1963. and 21 s tuden t s en te r ing t h e i r t h i r d year s t a r t e d work i n Djakarta h o s p i t a l s f o r p r a c t i c a l experience. The 'dHO t u t o r a s s i s t e d i n t h e t r a i n i n g of "physiotherapy-aides" a t t h e Crippled Children's Centre, Solo; 26 of these aide8 were rec ru i t ed i n October f o r a me-year course, although t h i s t r a i n i n g does no t f o m a p a r t of t h e Oovernment's t r a i n i n g scheme f o r phys io the rap i s t s . Altogether, 67 s tuden t s a r e i n different s t a g e s of t r a i n i n g . A f u r t h e r group of 12 s tuden t s completed t h e examination and.9 of them were successful ; t h e th ree unsuccessful ones remained i n Djakarta u n t i l re- examination i n April 1964,when they vere a l s o successful.

Indonesia 200 Fellowships

Health Education: A twelve-month fellowship f o r s tudy i n the United S t a t e s of America.

E n t e r i c Diseases: A five-week fe l lowship f o r participation i n the course on en te r i c -d i sease con t ro l , held t n Teheran (awarded under n Headquarters' a l lo tment) .

Indonesia 201 Fellowshie;? T A

Anatomy: A twelve-month fellowship f o r s tudy i n Belgium and Sweden.

PhySiolo&: A twelve-month fe l lowship f o r study i n the United S t a t e s of America.

Publ ic Health: Two twelve-month fe l lowships f o r study in the United S t a t e s of America.

SEA/RC17/2 Page 163

6. MALDNE ISLANDS

Training of national health auxiliaries and provision of preventive and curative services in Male were continued. An auxiliary nurse training programme was started. One qualified national nurse, trained on a WHO fellowship, returned to Male and provided a welcome reinforcement to the health services.

Difficulties of communication have continued to dictate that the development of health services should be concentrated in Male, though occasional visits to other islands have been undertaken,mainly in connection with the treatment of leprosy and control of epidemics. The government hospital ship has rendered possible some extension of health services outside Male.

The possibility of initiating malaria control was studied.

Maldivian medical students and nurses continued training on fellawships from WHO and bilateral sources.

SEA/RC17/2 Page 164

PROJECT LIST

Prolect No. Source of Funds Co- oDerating Auencies, T i t l e -

Maldive Is lands 2 Public Health Administration R (act. 1959 - 1

A i m of t h e Droject . To organize h e a l t h se rv ices and f a c i l i t i e s and t r a i n h e a l t h personnel.

Assistance Provided by WHO durinu the year. ( a ) A pub l ic h e a l t h o f f i c e r and a pub l ic h e a l t h nurse educator: ( b ) supp l ies and equipment.

Probable durat ion of a ss i s t ance . Until the end of 1970.

Work done dur ina the year. The t r a i n i n g of h e a l t h a s s i s t a n t s continued; out of t h e f i f t e e n s tudents who s a t f o r t h e f i n a l examination i n August 1963, four teen were successful . A f u r t h e r course has been planned.

Nurse-aide t r a i n i n g was i n i t i a t e d , w i t h t en s tuden t s i n January 1964.

The hea l th cen t re a t Male was re-es tabl ished and a new cen t re opened i n Naifaru. Two h e a l t h a s s i s t a n t s were posted t o Guraidu h e a l t h cen t re . Other h e a l t h a s s i s t a n t s were occupied i n home-visiting programmes i n Male.

Treatment of l ep rosy and tubercu los i s p a t i e n t s has been u n d e r t a e n . An outbreak cf measles occurred dur ing July-September 1963, and t h i s i n t e r r u p t e d the smallpox vaccination programme. The h e a l t h a s s i s t a n t s a t Male have a s s i s t e d i n immunization with DPT, smallpox vaccinat ion and rou t ine treatment of leprosy m d tubercu los i s p a t i e n t s .

A preliminary study of t h e malar ia s i t u a t i o n was made by a WHO malaria epidemiologist i n April 1964.

Health education work was i n t e n s i f i e d through rad io and personal contacts .

SEA/RCI7/2 Page 165

7. MONGOLIA

The Director-General and the Regional Director visited Mongolia during July 1964.

The WHO programme of assistance has developed satisfactorily. A fuller understanding of the health needs of the country and of the possibilities of WHO co-operation was obtained in detailed discussions with the Chief Surgeon of the Ministry of Health during his visit to the Regional Office. An Assistant Director of Health Services from the Regional Office, accompanied by the Director of the Division of Communicable Diseases a t WHO Headquarters, visited the country in April to study the operation of WHO-assisted projects and to discuss with the Government further patterns of programme development. Five WHO fellowships were awarded for training in various fields.

Despite the widespread development of arable farming, principally wheat-growing, and some industrialization, animal husbandry is of paramount importance in the national economy. A human population of about one million possesses twenty to thirty million sheep, goats, cattle, horses and camels. Poultry and rabbits are increasingly reared a s valuable animal crops. This large animal husbandry is responsible for the importance of the zoonoses a s a public health problem, and the -THO epidemiological team is assigned to assist in the study and control of these diseases.

Tuberculosis is a serious health problem. A WHO short-term consultant visited the country, and further assistance in strengthening control and immunization programmes is planned.

SEA/RC17/2 Page 166

PROJECT LIST

Project No. Source of Funds Co- operat inq ngencies

Mongolia 1

R

T i t l e -

StrenRtheninn of Health Services ( E p i d e m i o l o ~ y ~ (July 1963 - 1

A i m of the P ~ o j e c t . To undertake epidemiological surveys of t h e p r e v a i l i n g communicable d i seases i n order t o plan p r a c t i c a l con t ro l measures; t o advise a l l branches of the medical and h e a l t h se rv ices on the use o r epidemiological methods.

Assistance Provided by WHO dur ing the year. ( a ) ~n epidemiologist , a b a c t e r i o l o g i s t and a ve te r ina ry Pub l ic h e a l t h o f f i c e r ; ( b ) two fe l lowshtps - one of twelve months and one if s i x months - f o r s tudy i n Czechoslovakia; ( c ) supp l ies and equipment. including two vehicles and a f u l l y equipped mobile laboratory van.

Probable durat ion of a ss i s t ance . . U n t i l the end of 1967.

Work done durinu the Year. P o members of t h e WHO epidemiological team a r r i v e d in Mongolia i n August 1963,and t h e t h l r d member joined them i n October. A f u l l complement of n a t i o n a l counterpar ts has been appointed.

After a per iod of preparatory and organizat ional work on bas ic t r a i n i n g i n the methodology of f i e l d epidemiology and i n e s t a b l i s h 8 contact with

Pr inc ipa l i n s t i t u t i c n s and l abora to r ies , the team,early i n 1964,s tar ted f i e l d epidemiologlcal inves t iga t ions of b r u c e l l o s i s i n man and domestic mimals - c a t t l e , sheep, goats , horses and camels. Studies of t h e n a t u r e and ex ten t of b ruce l los i s w i l l be continued i n a reas of d i f f e r e n t geographical and eco log ica l condi t ions . in the c e n t r a l , nor thern, eas te rn and southern aimaks (provinces) . In add i t ion , the team s t a r t e d c o l l e c t i n g da ta f o r planning brucella-vaccine f i e l d t r i a l s i n man and animals , to be s t a r t e d e a r l y i n 1965.

In co l l abora t lon with a WHO reference laboratory, the team s t a r t e d immunological surveys of d i seases o the r than b ruce l los i s , p r i n c i p a l l y p o l i o - mYelit ls , inf luenza v i r u s e s , the arboviruses and r i c k e t t s i o s e s .

Mmgolia 2 Public Health Laboratory Services TA ( m y 1964 - )

A i m of the DrOject. To develop h e a l t h l abora to ry s e r v i c e s and t r a i n personnel in h e a l t h laboratory procedures and p r a c t i c e s .

Assistance Drovided dur ing the year. ( a ) A short-term consul tant ; ( b ) a nine- month fellowship f o r s tudy i n Japan and a twelve-month fe l lowship f o r s tudy i n Bulgaria, Romania and Yugoslavia.

SEn/RC17/2 Page 167


Work done dur ing t h e year. A consul tant was assigned f o r about three months in Kay 1964,to assess the e x i s t i n g laboratory f a c i l i t i e s (micrcb1ological.and prophy?actic and d i a p r o s t i c products) and advise on upgrading.

Equipment was supplied t o the Central Hygiene and Epidemiological S ta t ion . Ulan Bator, f o r bac te r io log ica l and se ro log ica l work connected with the work of the epidemiological team (Mongolia 1 ) .

Mongolia 2 Tuberculosis Control T A (Dec. 1963 - Jan. 1964; - )

A i m of the ~ r o j e c t . To s tudy the epidemiology of tubercu los i s f o r f u r t h e r development of a control programme.

Assistance provided by WHO durinu the year . ( a ) A consul tant f o r two months; (b) supp l ies and equipment.


Work done dur ing the year. A consul tant was a s s i m e d from 7 December 1963 t o 23 January 1964,to e s s i s t i n a s tudy of t h e tubercu los i s problem i n the country and t o recommend measures f o r tubercu los i s con t ro l . In l i n e with h i s recommenda- t i o n s , i t is planned t o provide a medical a f f i c e r , a pub l ic h e a l t h h c a nurse and a s t a t i s t i c i a n t o a s s i s t i n f u r t h e r development of a control programme.

Cardiac S u r g e r p A s i x - m a t h fellowship f o r s tudy in Ind ia .

D e m t o l o g y and Venereologx: A six-month fellowship f o r s tudy i n Poland and Czechoslov&ia.

SEA/RC1?/2 Page 169

8. NEPAL

The budget for health services was maintained at about 6% of an increased total national budget.

A most important development was a decision to introduce free and compulsory primary education throughout the country within a period of ten years. A National Guidance Council, designed to promote social harmony and to forward community effort in development, was established. A plan for the reorganization of the Directorate of Health Services, including the creation of an increased number of divisions, was being formed.

Three bills of health designed to imprwe the control of communicable diseases and to create a Medical Council were enacted early in 1964. Development of a comprehensive health service based on the administrative division of the country into zones and districts was under planning.

WHO assigned a short-term consultant to advise on the preliminary requisites for the establishment of a medical college. The training programme in the School of Nursing made good progress, though there was some difficulty In obtaining enough suitable entrants: a number of educated girls prefer to accept fellowships from bilateral sources for basic nursing education abroad.

The requirements for accreditation of professional schools of nursing were apprwed by the Nepal Nursing Council.

The first-year course at the Auxiliary Health Workers' Training School was completed in January. It has now been decided to restrict training in the second-year course to the category of clinical assistants.

With the renovation of the medical block, the Bir Hospital has reached a capacity of 230 beds. Work started on the construction of a new surgical block. After its completion, it is intended that the existing surgical block should be adapted as a nurses' training school and hostel. Construction of three new zonal hospitals, each with 25 beds, was started.

Based on the Maternity Hospital at Kathmandu, a maternal and child health service, including domiciliary midwifery and home visiting, has been started.

Plans were in train for the construction of a new health laboratory in the compound of tbc Bir Hospital.

SEA/RCl7/2 Page 170

Malaria remains a major health problem. Surveillance is complicated by the formidable problems of communication,which confront all rural health services in Nepal.

The magnitude of the tuberculosis problem has not been assessed, but it is certainly great. Plans have been made for a joint control programme for tuberculosis, leprosy and other communicable diseases, initially in Kathmandu Valley, with subsequent extension to other areas. Outbreaks of smallpox both in Kathmandu Valley and in other parts of the country have occurred frequently.

An important development was the first meeting of the National Committee on Vital Statistics. Certification of births and deaths was introduced on an experimental basis in certain areas outside Kathmandu.

A successful, government-sponsored conference on tuberculosis was held in Kathmandu in December 1963.

The first number of the Journal of the Nepal Medical Association made a welcome appearance in January 1964.

SEA/RC17/2 Page 171

PROJECT LIST

Project No. Source of Funds Co-onorating ~ i ~ z e n c i e s - T i t l e

Malaria Eradicat ion (Juno 1954 - )

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 throughout t h e country i n progress ive s tages .

Assistance provided by WHO dur ing the Year. ( a ) Three mala r io log i s t s , an entomologist, a s a n i t a r y engineer, th ree s a n i t a r i a n s , a l abora to ry technician, an adminis t ra t ive o f f i c e r , an adminis t ra t ive a s s i s t a n t , a supp l ies a s s i s t a n t , and th ree sccretary-stenographers; ( b ) four t r a v e l fe l lowships - one of two months i n Ind ia , Ceylon and Indonesia, and th ree of 26 days in Ind ia and Ceylon; ( c ) supp l ies and equipment.


Work done dur ina the year. The progranrme has made s u b s t a n t i a l progress. The t r a i n i n g of su rve i l l ance personnel was continued. In thc Central Zone, su rve i l l ance a c t i v i t i e s now cover t h e whole of Sector B and p a r t of Sector A. The second cycle of DDT spraying i n the a reas of perennial transmission s t a r t e d in November 1963 and was completed in January 1964. Specia l a t t e n t i o n was paid t o the preparat ion of maps and numbering of houses. I n t h e East Zone, geographical reconnaissance has been completed,and spraying operat ians have been planned t o cover t h e e n t i r e a rea south of Mahabharat Range of mountains. The headquarters f o r t h e West Zone has been es tab l i shed in Nepalganj,and a rapid reconnaissance of the a rea f o r c o l l e c t i n g prel iminary l o g i s t i c da ta has been undertaken. A long-tern p lan of operat ions f o r malarln e rad ica t ion i s under preparat ion.

Nursing Education TA (Nov. 1954 - )

A i m of t h e pro.iect. To e s t a b l i s h a nurse t r a i n i n g school i n Nepal i n order t o prepare q u a l i f i e d nurse-midwives f o r the country's h e a l t h services.

Assistance provided by YHO dur ing t h e year. ( a ) A nurse educator; ( b ) a twelve- month fellowship f o r s tudy in Indla; ( c ) suppl ies and equipment.


York done dur ina t h e year. The p r o j e c t continued t o progress s a t i s f a c t o r i l y . S i ~ i f i c a n t changes t o inprove t h e t h e o r e t i c a l aspects of t h e p r o g r a m

SEA/Rcl7/2 Page 172

have been made i n t h e curriculum. This should be r e f l e c t e d i n a b e t t e r q u a l i t y of nurs ing service . Other teaching a c t i v i t i e s and c l i n i c a l experience f o r s tudent nurses continued a s planned.

E f f o r t s were made t o get t h e llurring Council organized. The W O nurse educator a s s i s t e d with the preparat ion and completion of mate r ia l f o r the accredi ta- t i o n Of schools of nurs ing i n the country.

A post of Nursing Superintendent, with gazetted rank, has been es tab l i shed , and the s t a f f of t h e School of Nursing were given permanent p o s i t i o n s r e t r o a c t i v e l y from 1961. Thls s t a b i l i z a t i o n of nurs ing s t a f f is expected t o provide f o r more e f f e c t i v e operat ion of t h e prooject.

Another na t iona l nurse t u t o r re turned from h e r fe l lowship s tudy t o jo in the s t a f f , making a t o t a l of f o u r q u a l i f i e d t u t o r s within t h e School. Another candidate proceeded on a WHO fellowship t o undertake s tud ies which w i l l q u a l i f y he r a s a nurse t u t o r .

Training of Health Assis tants , Kathmandu (June 1955 - Jan. 1962; Dec. 1962 - ]

A i m of t h e ~ r o j e c t . To e s t a b l i s h a school f o r h e a l t h a s s i s t a n t s f o r se rv ice i n r u r a l a reas and t c p l an f o r t h e i r e f f e c t i v e use i n the r u r a l h e a l t h se rv ices .

Assistance Drovided by WHO dur ing the year. ( a ) A publ ic h e a l t h o f f i c e r and a s a n i t a r i a n ; ( b ) a twelve-month fellowship f o r s tudy in Ind ia ; ( c ) suppl ies and equipment.


Work done dur ing the r e a r . With the decis ion of t h e Government not t o t r a i n s a n i t a r i a n s separately. i n t h e second year of the course, the number of categor ies of hea l th a u x i l i a r i e s being t r a i n e d has been reduced t o one. There has a l s o been a reduction i n the number of s tuden t s from the o r i g i n a l 66 t o 30.

The t r a i n i n g of h e a l t h a s s i s t a n t s was suspended from 24 November t o 7 December 1963,and t h e s tuden t s wortred with t h e smallpox p l l o t p r o j c c t in combating a smallpox epidemic i n the Thimi a rea . They ca r r i ed out vaccinat ions i n Thimi and i n t h e f i e l d p r a c t i c e a reas of Bhurunkhel and Pode Tole. The WHO s a n i t a r i a n a l s o spent much time with the smallpox p r o j e c t .

Considerable improvements were e f fec ted i n t h e t r a i n i n g given t o h e a l t h a s s i s t a n t s . The course now includes l e c t u r e s i n elementary chemistry a s an a i d t o understanding physiology. F i e l d work includes working wlth fami l i e s i n allot . ted houses t h r e e t imes a week f o r two hours a day, t r a i n i n g i n elelnentary nursing f o r a week i n the Bi r Hospita1,and pub l ic h e a l t h f i e l d p r a c t i c e in the a reas se lec ted f o r t h i s purpose a t Bhurunkhel and Pode Tole. Improvements t o s a n i t a t i o n i n these f i e l d t r a i n i n g a reas were discussed with the ha i rman of Kathmandu Municipality.

S E A / % C ~ ~ / ~

Page 173

The Government plans t o reorganize h e a l t h se rv ices . This wlll include considerat ion of the t r a i n i n g of pub l ic h e a l t h s t a f f required. WHO, through i t s s ta f f i n Nepal and in the Regional Office, has a s s i s t e d the Government i n

prel iminary reviews of the problems involved.

&&g-g Maternal and Chlld Health R (Dec. 1963 - ) UNICEF

A l m of the DroJect. To develop maternal and c h i l d h e a l t h se rv ices and 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 Drovided by WHO dur ing the year. A maternal and c h i l d hea l th o f f i c e r .

Probable durat ion of a ss i s t ance . Uht i l the end of 1967.

Work done dur ing t h e year. Assistance t o the p r o j e c t s t a r t e d i n December 1963 with t h e a r r i v a l of t h e WHO maternal and c h i l d h e a l t h o f f i c e r . A Maternal and Child Health Section i n the Di rec to ra te of Health was c r e a t e d , v i t h a na t iona l counterpart i n oharge.Three maternal and c h i l d h e a l t h cen t res and one c h i l d hea l th centre were es tab l i shed i n and around Kathmandu. m r t h e r development of Shr i W s h m i Devi Paropakar Maternity Hospital , Kathmandu, and the development of domic i l i a ry midwifery se rv ices i n the v i c i n i t y of the h o s p i t a l were s t a r t e d .

SmallDox Control P i l o t Project (Feb. 1962 - )

A i m of t h e Drodect. To i n i t i a t e a smallpox con t ro l p i l o t pro . tect . in Kathmandu Valley i n the f i r s t ins tance and subsequently t o expand t h e p r o g r k gradual ly , a s and when the s i t u a t i o n permits.

Assistance ~ r o v i d e d by WHO dur ing the year. ( a ) A smallpox con t ro l o f f i c e r ; ( b ) supp l ies and equlpment.


Work done dur ing t h e year. The vaccinat ion a c t i v i t i e s of the p r o j e c t were i n t e n s i f i e d within the Kathmandu Valley.aiming a t obta ining b e t t e r response and coverage i f the pwuln t lon . A fcw outbreaks of smallpox which occurred i n the

Valley were success fu l ly con t ro l l ed , and, in add i t ion ,use fu l preventive work was c a r r i e d out a t s t r a t e g i c check po in t s dur ing the in f lux of pi lgr ims t o the Valley. Freeze-dried smallpox vaccine was supplied.

Prom t h e s t a r t of the p r o j e c t (February 1962) t o 9 February 1964, a t o t a l of 187 249 vaccinat ions (33 277 primary and 153 972 re-vaccinat ions) was ca r r i ed out.

SEA/RC17/2 Page 171(

Nepal 14 Community Water Supply R (June 196u - )

A i m of the p ro jec t . To plan and co-ordinate the development of a c t i v i t i e s i n t h e f i e l d of community water suppl ies .

Assistance Provided by WHO dur ing t h e year. ( a ) A s a n i t a r y engineer; ( b ) supp l ies and equipment and a vehicle .


Work done dur inu the year. The WHO s a n i t a r y engineer a r r i v e d i n Nepal a t the end of June 1964. m r i n g the period covered by t h i s r epor t , h l s a c t i v i t i e s have been those of o r i en ta t ion and acqu i r ing knowledge of e x i s t i n g conditions.

Public Health: A ten-month fellowship f o r s tudy i n Ind ia .

V i t a l and Health S t a t i s t i c s : TuQ ten-week fe l lowships f o r s tudy i n India .

Laboratory Techno1o.q: A twelve-month fellowship f o r s tudy in Ceylon.

NeDal 201 Fellowships R

Food Analysis: A twelve-month fe l lowship f o r s tudy i n I n d i a ;

SEA/RC17/2 Page 175

9. THAILAND

The creation of the Ministry of National Development was a significant feature of government reconstruction. The Department of Technical and Economic co-operatin is an important unit of the Ministry. The Department deals with the utilization of international assistance from all sources.

The increase in the gross national income was estimated a s being maintained a t 5.3%, apd the natural increase of population of the order of 3%.

Free primary education was started, and a large expansion of the teachertraining programme undertaken.

Improvements in the Bangkok water supply system made available an additional 160 000 cubic metres (4 220 000 gallons) of safe water daily.

Some progress was made towards the integration of specialized communicable-disease control programmes into the general health services. The need for more doctors and nurses to work in rural areas is still acute. There also remains the need for increased training of para-medical staff for medical rehabilitation and of radiographers.

An outbreak of cholera El Tor occurred during the latter part of 1963. A mass vaccination campaign was started just before the onset of the outbreak and is believed to have limited its course. Provsd cases of malaria (P. falci- parumf infections resistant to anti-malaria drugs were cawing concern. Fortunately, treatment with quinine was still effective. WHO assisted in a study of this problem.

The incidence of haemorrhagic fever was again high in 1963, a departure from the previous epidemiological pattern,in which the incidence in alternate years has been relatively low, and the fatality rate of the disease was serious. WHO provided two consultants to assist in a study of the problem and to advise on a pilot Aedes a e m t i control project.

The national tuberculosis control programme was continued in the semi- rural area of Chiengmai. A mass case-finding and treatment campaign was initiated in Bangkok. A successful diphtheria immunization campaign was undertaken,

Some encouraging results were achieved in the pilot project of applied nutrition in Ubol. A decision was taken to expand the project to include 42 villages.

SEA/RC17/2 Page 176

Better co-ordination of nursing administration and nursing services has been achieved by reorganization of the nursing unit in the Ministry of Public Health. Separate divisions of nursing in the Department of Health and the Department of Medical Services have been discontinued. The Chief Nurse, Division of Nursing, Ministry of Public Health, has overall respo~ib i l i ty for all nursing affairs.

The Government of Thailand is the host to the United Nations Special Fund project "Asian Institute for Economic Development and Planning". The

' Institute has completed its first six months of operation.

The UNICEF Executive Board held its January 1964 meeting in Bangkok. This was the first time that the UNICEF Board had met in an Asian country.

Agencies

PROJECT LIST

T i t l e - Thailand 2 Strengthening of Health Services (Yaws Control

T A a-Integration)l u N I C ~ (May 1950 - )

A i m of the p ro jec t . To i n t e g r a t e communicable-disease con t ro l programmes i n t o the t h e general h e a l t h se rv ices and f u r t h e r develop and organize r u r a l services .

Assistance provided by WHO dur ing the year. A yaws adv i se r , a pub l ic h e a l t h o f f i c e r , a pub l ic h e a l t h nurse and a l abora to ry technician; a consul tant on venereal d i seases f o r two months.

Probable dura t ion of a ss i s t ance . Unt i l t h e end of 1966.

Work done dur ing the year. WHO has a s s i s t e d t h i s p ro jec t f o r a period of t h i r t e e n years . Yaws, previously a Serious pub l ic h e a l t h problem, has now been reduced t o an i n s i g n i f i c a n t l e v e l , and yaws surve i l l ance has now been in tegra ted Lnto the permanent publ ic hea l th se rv ices of 45 provinces i n which the d i sease had been endemic. The p ro jec t a l so helped promote t h e f u r t h e r development of the r u r a l h e a l t h services . The ob jec t ives of t h i s aspect of the p ro jec t can be sa id t o have been achieved. The WHO yaws adviser completed h i s work i n December 1963. H i s r epor t has been forwarded t o t h e Government.

The WHO l abora to ry t echn ic ian helped i n the f u r t h e r upgrading of laboratory d iagnos t i c f a c i l i t i e s .

Othur ass is tanoe t o t h i s p ro jec t has been d i r e c t e d towards the improvement of r u r a l h e a l t h s e r v i c e s and the consol idat ion and maintenance of comunicable- d i sease control a c t i v i t i e s .

A NiO publ ic hea l th o f f i c e r was assigned t o the p ro jec t i n August 1963. He and the government l i a i s o n o f f i c e r s tudied a c t i v i t i e s in r u r a l h e a l t h se rv ices . Visits were made by c a r , horse , t r a i n and bicycle . Information was provided t o t k prov inc ia l h e a l t h o f f i c e r regarding the work of t h e personnel. and suggestions were made f o r improvement of services . Studies have l a i d the foundation f o r developing a d e f i n i t i v e plan of ac t ion .

Assistance was glven in dea l ing with an outbreak of cholera.

Discussions on t h e development of the p ro jec t were held with the national a u t h o r i t i e s .

-- *Previous t i t l e : Yaws Control

s~..4/Rc17/2 Page 178

Liaison was maintained with the WliO-assisted programmes in trachoma,leprosy control and upgrading of laboratory facilities.

A WHO nurse has been engaged to join in August 1964.

A WHO consultant in venereal diseases assisted in a study of the nature and extent of venereal diseases in Thailand and advised on practical control measures.

Thailand 17 Mental Health Services* R (March 1955 - Feb. 1957; Nov. 1958 - Feb. 1959;

June 1963; Dec. 1963 - Feb. 1964; - )

~ i m or the project. To strengthen training programmes for psychiatric nurslng services and to improve mental health services.

Assistance provided by WHO during the year. A consultant in psychiatry for three months.


Work done during the year. The WHO consultant arrived in Thailand in December 1963 and completed his work in February 1964. He has recommended a staged progrwe for developing the mental health services to cover the whole country, introducing further material in psychiatry into thc undergraduate.medica1 curriculum,und-t~aking post-graduates in psychiatry. His report has been forwarded to the Government.

Thailand 21 TA

Nursing Advisory Services (April 1954 - Dec. 1957; Jan. 1958 - )

Aim of the project. To establish a Division of Nursing in the Ministry of Public Health which will co-ordinate nursing activities and nursing education within the country.

Assistance provided by WHO during the year. A nurse adviser(replacfng a nurse educator),a nurse educator and a short-term consultant.


Work done during the year. A WHO nurse educator was replaced by a WHO nurse adviser in Bebruary 1964.

A Division of Nursing has been established in the Ministry of Public Health, and a chief nurse and several deputies are now in position. Co-ordination and strengthening of nursing service and nursing education programmes have been undertaken. The WHO nurse adviser participated in discussions with national authorities in this development.

'Previous title: Mental Health

The second WdO nurse educator continued to assist with clinical inf.tnc- tion and supervision of students in the school of nursing at the Women's Hospital in Bangkok. There has been notable progress in that the students are now better able to correlate theory with practice. Improvement has also been noted Ln patient-nurse relationship.

A short-term consultant was provided to assist in the evaluation of field experience at the Post-basic School of Public Health Nursing to strengthen this phase of the programme.

It was planned to hold a workshop of chief nurses from provincial hospitals to discuss their problems and difficulties and to formulate recommendations for solving them. A proposal to establish a Board of Nurse Examiners was under consideration by the Government; such a board will be a valuable means of securing uniform standards of nursing education and qualification.

Thailand 30' -- R

Leprosy Control I.-.. 1955 - )

UNICEF

Aim of the project. To expand and intensify the leprosy control programme to cover all endemic areas of the country,and to train personnel.

Assistance provided by WHO during the year. (a) A senior consultant leprologist, two leprologists and two leprosy control officers; (b) a twelve-month fellowship forstudy in the United Ktngdom; (c) supplies and equipment.


Work done during the year. Pollowing tht joint assessment of the leprosy control programme by the WHO Leprosy Advisory Team and the Government in 1962, a WHO consultant leprologist was assigned in 1963. The latter, in conjunction with the Director of the national leprosy control programme, assisted in the organization of further consolidation of the leprosy control campaign, particularly in the Northern and North-Eastern Provinces,!monn to have the highest prevalences. A plan of action to cover the activities of all the 18 WHO-assisted project areas over the next few years was drawn up. In addition, control activities are in operation in ccight other provinces, plus Bangkok, Thonburi and Prapradaeng . areas, under government direction and supervision.

In the North Eastern Provinces, further resurveys and ~provements in the treatment prograinme were made,by intensification of contact-tracing and other case-finding activities, by opening further sub-centres and additional selected treatment services, paying special attention to irregular patients, and by - enlisting greater participation on the part of village headmen. Several training programmes were also organized.

.. . - *Projects previously reported under two separate numbers, Thailand 30.1 (Leprosy Control - North-Eastern Provinces) and Thailand 30.2 (Leprosy Control - Northern Provinces), have now been amalgamated.

SE~/%c17/2 Page 180

I n the Northern Provinces, spec ia l a t t e n t i o n was paid t o the supervis ion of S t a t i c and mobile work i n the Provinces of Udon, Nongkai. Sakon Nakhon, Nakhon Panom and Lampang. The number of p a t i e n t s on t h e p rov inc ia l r e g i s t e r and on treatment a t t h e end of March 1964 was: Udon (2362); Nongkai (320); Sakon Nakhon (1218 ); NaWlon Panom (570); Lampang (825); Chiengrai (1201); Nan (320); Roi-Et (9067); Kalasin (4036) .

Thailand 42 T A

National Tuberculosis Programme - P i l o t P ro jec t (Oct. 1958 - May 1959; Dec. 1959 - )

A i m of t h e p ro jec t . To establish i p l l v t p ro jec t i n an urban and a r u r a l a rea , s o a6 t o demonstrate t h e organizat ion of case-f inding and treatment se rv lces f o r tubercu los i s and to provide a t r a i n i n g f i e l d f o r na t iona l personnel: t o e s t a b l i s h and develop an epidemiological centre f o r the c o l l e c t i o n and e l u c i d a t i o n of information on the problem of tubercu los i s in the country.

Assistance provided by WHO dur ing the year . ( a ) A medical o f f i c e r , a s t a t i s t i c i a n . n publ ic hoa l tk nurse, a l abora to ry tecbnici?n and an x-ray t echn ic iu l ; ( b ) two four. month fe l lowships f o r study i n India ; ( c ) supp l ies and equipment,


Work done during t h e year. The p i l o t a rea p r o j e c t i n hiengmai town and i n twenty randomly se lec ted v i l l a g e s throughout the Province of Chiengmai was completed. Routine mass operat ions have been s t a r t e d i n t h e city,aimed a t Luvcring the estimated t o t a l population of 71 526,and i n t h e r u r a l a reas of t h e rovince. I n Chiengmai town, 14 958 persons were examined dur ing thc p i l o t p roJec t phase: 7.2 per cent showed shadows suggestive of tuberculosis ,and 1.1 per cent had in fec t lous d i s e a s e , e i t h e r confirmed by laboratory examination o r evidenced by the presence of c a v i t i e s . I n the se lec ted v i l l a g e s of the Province, 18 058 persons were examined; the prevalence of lung pathology suggestive of tuber. cu los i s was found t o be only 5.5 per cen t , and only 0.6 pe r cent were found with i n f e c t i o u s disease . Figures var ied according t o ease of access t o the t o m . Males were general ly more a f fec ted than females i n a l l age groups. The mean age of a c t l v e d i sease was about 45 years i n Chiengmai town, and more than 50 years i n t h e v i l l ages . The prevalence of tubercu los i s under the age of 14 year6,excluding h i l a r enlargement, was l e s s than 1 p e r cent i n a l l a r e a s , compared with a prevalence of a c t i v e d i sease i n a l l a reas a s high a s 10 pe r cent i n t h e s i x t h decade of l i f e .

Three d i f f e r e n t approaches t o the organizat ion of case-finding and treatment of the detected cases were evaluated. The most i n t e r e s t i n g approach,from a pub l ic hea l th and p r a c t i c a l organizat ional point uf view, was the "community approach" seeking persons who complained of broncho-pulmonary symptom. After an interview, these "symptomatic" p a t i e n t s were r e f e r r e d t o the p rov inc ia l headquar ters f o r x-ray and laboratory examination. After completion of such examination on a l l symptomatic patients, t h e t o t a l populat ion (97% coverage) of the 30 v i l l a g e s se lec ted f o r t h i s study was examined by x - rays and bac te r io log ica l ly . It t ransp i red t h a t 50%

SEA/RC~?/Z Page 181

of the total case-load and almost 505 of the patients with infectious tuberculosis were discovered by the "community approach". Females gave better response to this approach. It was found that the existing general health services were not very suitable for treatment organization. The use of village headmen as peripheral drug distributors,uith the support of mobile treatment teams visiting the villages monthly and seeing cases in their homes,gave fairly good results. h e results of treatment after one year are under compilation.

In Bangkok, mass case-finding and treatment operations commenced in January 1964. Five mobile 70 nun x-ray units were used,with the aim of covering a population of about 1.7 million of the capital within a period of 4-5 years. The programme proceeded smoothly,and targets were aohieved or exceeded. About 2 000 nev patients were brought under treatment every five weeks as a result of this operation. A mass comparative study on the acceptability of isoniazid/ thiacetazone and two forms of PAS with INH has been undertaken on 2 000 cases. No evidence of major toxlclty oP thiacetazone has been f?und.

Treatment teams have not fully kept up with the pace of case-finding,owing to shortage of suitable personnel. The provision of sufficient junior medical officers, competent personnel for supervision, servicing and maintenance of the many x-ray units in operation,and laboratory technicians with adequate knowledge of the needs of public health work in rural areas poses training problems which demand solution. In an effort to meet the need, specially designed orientation courses and symptomatic in-service training have been introduced.

The statistical unit of the project has, in addition to its routine vork of planning and assessment of the project work, given much time to the construction of an epidemetrlc/econometric model of tuberculosis uhich is now under trial as to its ability to yield realistic forecasts.

In close collaboration with the Tuberculosis Control Divisi0n.a statistical/ epidemiological centre for tuberculosis is under development in Bangkok. A national statistical officer is undergoing training by participating in a special course of general and applied statistics.

Hass BCG vaccination operations have been carried out in Thailand for more than ten years. A more detailed, though preliminary, assessment was undertaken with the help of the national BCG assessment technicians. The results of :his assessment disclosed that the use of liquid vaccine had serious limitations and, moreover, that the population coverage was far below expectations and actual needs. Requisite steps were taken.to remedy these shortcomings. It is planned to carry out a further assessment in 1965, wlth the assistance of the WHO Inter- country BCO Assessment Team, on a more comprehensive and country-wide scale.

Expansion of tuberculosis control in the north-east of the country by opening a tuberculosis centre at Khon Xaen and with a mass programme on lines similar to those devised for Chiengmai was started.

SEAPC17b Page 182

I n May 1964, a new medical o f f i c e r too& over a s sen io r WHO o f f i c e r on

the depar ture of t h e previous t c m leader . The WHO pub l ic h e a l t h nurse l e f t t h e p r o j e c t i n ~ 1 1 1964.

Thailand 43 R

Trachoma Control ( Ju ly - Aug. 1959; April 1961; Oct. 1961 -

UNICEF April 1962; June 1962 - )

Aim of t h e p ro jec t . To introduce a trachoma con t ro l programme and i n t e g r a t e it i n t o the pub l ic h e a l t h se rv ices i n those a reas where trachoma i s known t o be endemic.

Asslstance provided by WO dur ing t h e year. ( a ) A trachomatologiat; ( b ] a ten- month fe l lowship f o r study in t h e United Kingdom; ( c ) supp l ies and equipment.

Probable dura t ion of ass is tanoe. Unt i l e a r l y 1966.

Work done dur lng the year. Pur the r s t u d i e s on t h e epidemiology of trachoma and at tempts a t i n t e g r a t i o n of trachoma control a c t i v i t y in f i f t y v i l l a g e s around seven e x i s t i n g h e a l t h cen t res were continued. Greater p a r t i c i p a t i o n of h e a l t h personnel and of v i l l a g e r s was es tabl lshed. Self-treatment was encouraged, and t h e purchase of a n t i b i o t i c olntment from v i l l a g e shops a t a subsidized r a t e was made possible . ' h e experiment of havlng t eachers give treatment t o school- ch i ld ren was successful .

Pur ther prevalence surveys were c a r r i e d ou t i n t h e Por thern ud Oorth- Eas te rn provinces.

Training and h e a l t h education a c t i v i t i e s were c a r r i e d out.

Thailand 57 Facul ty of Tropical Medicine and Wdemic R Diseases

(Aug. - Sept. 1959: June - Aw. 1961: June 1962: .

June - J u l y 1963; Jan. 1964 - 1

A i m of the p ro jec t . To e s t a b l i s h a Post-graduate School of Tropical Medicine and Endemic Diseaaes i n t h e Univers i ty of Medlcal Sciences, Bangkok.

AsslStancc provided by !rXO during the year. ( a ) A consul tant i n pa ras i to logy f o r t h r e e months; ( b ] a four-month fellOw8hip f o r study i n India ; ( c ) suppl lPs and-cqulpnent.

Probable dura t ion of a ss i s t ance . Unt i l t h e end of 1966.

Work done dur ing t h e year. A WHO consul tant was assigned in June 1964 f o r a per iod . of th ree months,to advise On research a c t i v i t i e s i n pa ras i to logy and t o a s s i s t i n the t ea rh ing of the subject . Be h w *ti&& N a work.

Equipment and reference books have been supplied.

S~~/aC17/2 Page 183

Thailand 58 Departments of Paediatrics R (May 1962 - July 1964) UNICEP

Aim of the project. To improve the child health services of the maternal and child health centres in Bangkok through technical guidance of the paediatricians, and to provide a teaching field in promotional and preventive aspects of child care for the undergraduate medical students of the two medical schools (Qlulalongkorn and Siriraj).

Assistance provided by W0 during the year. A professor of paediatrics.

Work done. The WHO vLsiting professor was assigned to the project from May 1962 to July 1964. The professors of paediatrics at the Siriraj and Chulalongkorn Medical schools acted as national counterparts. The curriculum in paediatrics for medical students was revised, and social paediatrics and field experience were added to the teaching. Close co-operation between the Departments of paediatrics, obstetrics and preventive and nocial Medicine was secured. Consider- able impetus was given to Fzsearch in the field of social paediatrios. The WHO Professor helped the Health Department of the Bangkok Corporation in the develop. ment of maternal and child health services assisted by UNICEF. An effective service for referring newborns to maternal and child health centres was established in four selected Obstetric Departments. The introduction of a registration system ensured the use of the most appropriately located centres and improved attendance.

The health staff of the Corporation was strengthened by the appointment of medical officers with experience in paediatrics and obstetrics.

The WHO professor lectured and also assisted in clinical sessions in the paediatric departments. In-service refresher courses were arranged for the Corporation's medical officers and nursing and midwifery staff.

At the Close of the project, a National Advisory Committee on Maternal and Child Health was created.

Evaluation. The project was successful in introducing social paediatrics into the paediatric course of studies, and stimulated the development of modern teaching methods,in close collaboration with related departments. A peripheral paediatric clinic for teaching purposes was established. Considerable success was aahieved in establishing close co-operation between medical schools and the Health Depart- ment of Bangkok Corporation.

Thailand 60 R

School of Pharmacy, Bangkok (Nov. 1962 - )

Aim of the project. To train qualified pharmacists and post-graduate students to prepare them for teaching in schools of pharmacy; to carry out pharmaceutical research; to build up a cadre of qualified pharmacists to staff pharmaceutical departments.

SEA/RC17/2 Page 184

Assistance provided by WHO during the year. A professor of pharmacy.


Work done during the year. The WHO professor visited various places, from time to time, to study the situation in the field of pharmacy and to Advise on developments. He also shared instruction in various courses and advised on the development of laboratory and library facilities. The library has been improved by supplying books urgently required for reference purposes.

The WHO professor completed the first year's presentation of the courses in drug evaluation and professional c~mmunications and participated in the final examination for thc courses. Of the 79 students who took the course, only five were unsuccessful.

Thailand 62 R

Medical Education (Sept. 1960 - June 1964)

Aim of the project. To develop the Departments of Preventive and Social Wediclne in the Faculties of the University of Medical Sciences at Chulalongkorn and Siriraj in Bangkok.

Assistance provided during the year. (a) A professor of preventive and social medicine; (b) two one-month travel fellowshipa in India and Taiwan.

Work done. At the Thai National Conference on Medical Education, held in Bang- Saen (Thailand) from 25 to 30 November 1956, it was recommended that a section of preventive and social medicine should be established in the departments of medicine of each of the medical schools in Thailand and that it should be given departmental status as soon as qualified staff becake available. It was also recommended that the teaching programme should run throughout the four years of the medical curriculum.

In order to assist with the development of this discipline, WHO assigned a visiting professor of preventive and social medicine from 1 September 1960 to 9 June 1964. By that time,the teaching programme had been developed to extend over all the four years of the medical curriculum. Urban training centres, with a "family study and advice servicet',were developed around each of the medical schools in Bangkok. Other associated activities included: a family advisory service to urban populations in the neighbourhood of the teaching hospitals; seminars on the results of the surveys madr by students on the immunization status of communities and children, and surveys carried out on (1) blood pressure levels in adults over 40 years of age, (2) tendencies towards developing hyperpiesla (essential hypertension), (3) problems resulting from personal habits related to consumption of foods containing a high percentage of saturated fats. cholesterol and the use of alcohol and tobacoo, (4 ) the proportion of family income used on food and the percentage of families not spending enough for adequate food, (5) the incidence of hflminthic bowel infestations and haemoglobin content of the blood, and (6) the use of the well-baby clinic by the population.

sEA/kc17/2 Page 185

Two national counterparts to the visiting professor went abroad on WHO fellowships for advanced studies; the heads of the sections were awarded short- term travel fellowships for orientation visits to India and Formosa to acquaint themselves with the present trends in the teaching of preventive and social medicine. Preventive and social medicine is now fully established as a discipline: the recent decision of the Council of the University of Medical Sciences, Thailand, to establish independent departments for this subjrct in ooah of the medical sohoois is very encouraging and should result in further improvements in staff positions. Further fellowship assistance will be provided to younger members of the teaching staff tb enable them to obtain training abroad and thus to strengthen the departments.

The purpose of the project has been achieved.

Thailand 63 Nutrition R (AW. 1963 - UNICEF FA0

Aim of'the project. To strengthen the Nutrition Department of the Ministry of Public Health and to develop laboratory, clinical and field nutrition work, including an expanded nutrition programme.

Assistance provided by !4iO during the year. A medical nutritionist, assigned in October 1963; supplies and equipment.


Work done during the year. Assistance was provided in the reorgazaeim of the Nutrition Department at tho central level and in the planning and operation of school nutrition programmes. A study of the health aspects of an applied nutrition programme in the pilot area of Ubol was started. This included the organization of laboratory services for studirs on anaemia as related to parasitic infections. especially hookworm, in mothers and children. Prophylactic treatment for anaemia was introduced in maternal and child health centres.

Thailand 65 R

Malaria Eradication an. 1962 - )

Aim of the project. To eradicate malaria from the entire country.

Assistance provided by WHO during the year. (a) An entomologist and a malariologist (epidemiologist); (b) four one-month travel fellowships in India and Ceylon, one four-month fellowship to attend the malaria training course in Jamaica and two three-month fellowships for study in Nigeria. (In addition, a six-week international fellowship was awarded under the scheme for Exchange of Scientific Wonlrcts.)

SEA/~C~ 7/2 Page 186

Probable duration of assistance. Until the end af 1969.

Work done during the year. According to the detailed plan of action prepared for this programme for 1964,the spraying operations are planned to cover 18.5 million

people; 2.25 million previously under spraying entered the consolidation phase. A population of 4.3 million has been placed under surveillance without spraying, as this area, as judged from available data, has only a low incidence of malaria. If,after twelve months of surveillance there is evidence of local transmission, these areas can be included in the attack phase. The 196U operations have eventually been adjusted to the available supplies. A concerted effort has been made to inprove the training of personnel. Instances of resistance of P.falciparum to chloroquine have been reported from Thailand. This is being carefully studied.

Thailand 68 R

Narcotic Drugs Control (Peb. - March 1964)

Aim of the project. To establish a suitable program of ri!habilitation,5noIud~ post-discharge follow-up and placement of rehabilitated addicts; to organize an appropriate medical anti-addiction programme.

Assistance provided by WHO during the year. A consultant for five weeks.

Work done. The WHO consultant visited various hospitals and institutions where treatment and ruhabilitation of d r u ~ addicts arL being undcrtakcn. Hts report 1s under study.

Thailand 69 Urban Public Health Administration R (Oct. - Dec. 1963)

Aim of the project. To assist the Bangkok lhlnicipal Corporation in assessing the health needs of the city and to recommend a plan of phased development of comprehensive and integrated basic health services for the city.

Assistance provided by W O during the year. A consultant in public health administration for three months.

Work done. A WHO consultant was assigned from October to December 1963. He made

a study of health administration and services in the twin cities of Bangkok and Thonburi,to assess general coverage and standards in terms of current legislation, funds and staff.

Based upon his findings and taking into account the prevailing economic and social conditions, means were suggested by wflich short-term and long-range measures

3

might be applied to bring the standards of public health administration and services in the metropolis up to a level consistent with its growing international importance. Particular attention was paid to the delegation of more definite

S E A / % C ~ ~ / Z Page 187

and e f fec tua l l e g a l and f i n a n c i a l powers t o t h e municipal corporat ion, , ca re fu l

s e l e c t i o n and appointment of qualified techn ica l s t a f f , reorganizat ion of e x i s t i n g hea l th se rv ices and progressive planning f o r expansion a s opportunity o f f e r s .

Thailand 70 R

Vector-Borne Disease Control (Haemorrhagic Fever1 (June 1963 - )

A i m of t h e project . To study the epidemiological f a c t o r s responsible f o r pe r s i s - tence of haemorrhagic f e v e r , p r i n c i p a l l y t h e bionomics of the responsible vectors , i n order t o take e f f e c t i v e con t ro l measures.

Assistance provided by WHO during t h e year. A consul tant f o r two weeks.


Work done dur ing t h e Year. Haemorrhagic fever contlnucs t o present a pub l ic h e a l t h problem i n Bangkok and o the r urban areas. A Mi0 consul tant made a s tudy of the epidemiological s i t u a t i o n and advised on the s e t t i n g up of a p i l o t scheme f o r the control of Aedes aegypt i , which is incriminated a s the vec to r , i n a se lec ted d i s t r i c t of Bangkok. The Government subsequently, i n April 1964, s t a r t e d a p i l o t con t ro l p ro jec t i n the v i l l a g e of Hwai Kwang, on the o u t s k i r t s of Dlndaeng, a suburb of Bangkok.

This p r o j e c t is conncctcd with thc in ter-country p ro jec t S E A R 0 99 (Haemorrhagic Fever Control ).

Thailand 200 Fellowships R

F i l a r i a s i s Control: An eight-week fe l lowship f o r study i n India .

Sani tary Engineerink: A t r a v e l fe l lowship f o r twenty days i n France, Oennany and I s r a e l .

Venereal-Disease Control: A t r a v e l fe l lowship f o r f i f t e e n days i n Europe.

Thailand 201 Fellowships T A

Radiation and IsOtopeS: A twelve-month fellowship f o r study i n the United Kingdom.

Anaesthesiology: Two twelve-month fe l lowships f o r study i n Denmark (awarded under EURO 52).

Nutr i t ion: A ten-week fellowship f o r study i n India.

Human Genetics: A three-month fe l lowship f o r study i n Denmark (awarded under

In te r - reg iona l 137.2)

Physical Therapy: A twelve-month fe l lowship f o r undergoing the Physical Therapy

Teachers' Tralnlng Coursc in the Unitcd Kingdon (awarded under I n t c r s e g i o n a l 1811.

S E A ~ C I 7/2 Page 189

10. INTER-COUNTRY

PROJECT LIST

Project No. Source of Rmds CO- operat ing Agencies - n t l e

BCO Assessment Team

Bca Assessment Team. Indonesia ( m y 1963 - )

TJNI CEF

A i m of the ~ r o j e c t . To s t rengthen BCO vaccinat ion programmes and t o introduce f reeze-dr ied BCO vaccine.

Assistance Provided by WHO during t h e Year. ( a ) A medical o f f i c e r , a s t a t i s t i c i a n and a BCG nurse; (b) supp l ies and equipment.


Work done during the year. The team succeeded in int roducing the use of f reeze- d r i ed vaccine i n a l l BCO teams i n Java and Madura by t h e end of January 1964. Technicians were advised on vaccinat ion techniques and the use of non-leaking syringes,which permit more accurate dosages. F i e l d v i s i t s were made t o vaccinat ion teams. t o a s s i s t them i n planning the work,vith t h e object of inc reas ing t h e output t o a mor& s a t i s f a c t o r y l eve l . It was suggested t h a t t h e teams could increase t h e i r performance by forming small sub-teams consis t ing-of two technicians , thus obtaining a wider population coverage.

Reorganization on these l i n e s was a l s o s t r e s s e d a t a meeting i n Surabaja convened by the Inspector of Health f o r East Java, i n February 1964. Tuberculosis and chest s p e c i a l i s t s and medical o f f i c e r s r esp&sib le f o r the BCO programme i n seven Regencies have agreed t o these recommendations. It has a l s o been agreed t h a t vaccinat ion programmes should concentrate on the school-going population, s ince approach t o organized population groups would c e r t a i n l y increase the output of t h e programme.

Administrative d i f f i c u l t i e s have hindered t h e uorlt of some BCO teams, p a r t i c u l a r l y i n East Java. E f f o r t s a re being made t o r e a c t i v a t e operations; UIgICEP has been asked t o replace >bsolcte vehicles .

Ihe WHO nurse helped t o t r a i n t h e two na t iona l nurses dest ined t o work with t h e planned permanent n a t i o n a l BCG assessment team. The WHO team cmt inued an epidemiological s tudy by carrying out tubercu l in t e s t i n g i n sample groups i n accordance with t h e protocol devised f o r BCO assessment work.

SEA/~c17/2 Page 190

The team i s expected t o complete i t s ass i s t ance t o the assessment in

Indonesia a t t h e end of 1964.

s&g-J Regional Assessment Team on Malaria Eradicat ion R (May 1959 - Dec. 1961; Nov. 1963 - )

A i m of the p r o j e c t . To make an independent appra i sa l of the s t a t u s of malar ia e rad ica t ion o r of any spec ia l a spec t s of t h c programme in count r i es of the Region.

Assistance provided by WHO dur ing t h e year. ( a ) A ma la r io log i s t , an entomologist and a laboratory technician; ( b ) suppl ies and equipment.


Work done dur ing t h e year , m e team c a r r i e d out an assessment of the Ceylon programme i n November-December 1969 and of t h e Afghanistan programme i n April- June 1964. The l abora to ry technician of t h e team a s s i s t e d t h e Regional Centre f o r External Cross -Checking of Blood Films dur ing per iods when ' the re was no assessment work.

SEAR0 30 Smallpox Eradicat ion TA (0ct . 1962 - )

A i m of the p r o j e c t . To a s s i s t the coun t r i es of the Reglon i n ca r ry ing out t h e contro1,and u l t ima te ly the eradicat ion. of smallpox.

A s s i s t a c e provided by WHO dur ing the sea r . ( a ) A medical o f f i c e r working in Afghanistan; ( b ) supp l ies and equipment and two vehicles .


Work done dur ing the year . The medical o f f i c e r a s s i s t e d in the planning and implementation of the smallpox control p i l o t p r o j e c t i n Afghanistan. La te r i n the year, he was t r a n s f e r r e d t o New Delhi t o a s s i s t i n plannlngiand ca r ry ing cut o the r campai&ns i n the Region.

From Ju ly 1964 t h e Afghanistan p ro jec t w i l l continue a s a separa te P r o j e c t , with the ass i s t ance of another medical o f f i c e r (see Afghanistan 54) .

SEAR0 38 Production of Freeze-dried Smalluox Vaccine R (Jan. 1958; 0ct.-Nov. 1958; Feb. 1961; Nov.-Dec. 1961; UNICEF Nov.-Dec. 1962; Feb.-March 1964; - )

A i m of t h e proJect. To a s s i s t t h e countr ies of the Region with the production Of

f reeze-dr ied smallpox vaccine.

SEA/RCl7/2

Page 191

Assistance ~ r o v i d e d by WO during t h e Year. ( a ) A consul tant f o r f i v e weeks; ( b ) four six-week fe l lowships t o candidates fmm h d i a f o r s tudy in the uni ted Kingdom.


Work done dur ing t h e Year. The f i r s t batches of f reeze-dr ied smallpox vaccine produced i n Ind ia a t the S t a t e Vaccine I n s t i t u t e , Patwadangar, and King I n s t i t u t e . Ouindy, and those produced a t the Bio Parma I n s t i t u t e , Bandung, Indonesia, met i n t e m a t l o n a l requirements. Production i n Thailand i s proceeding s a t i s f a c t o r i l y .

A WHO consul tant took up h i s a s s i p m e n t i n Bebruary and v i s i t e d Bum, m d i a and Indonesia.

A s f o r India , he recomended t h a t two add i t iona l i n s t i t u t e s , a t Hyderabad and Belgaum, be a s s i s t e d in orner t o r a i s e t h e number of production cen t res t o four . He advised on new productlon techniques, with shelf -drying machines and automatic ampoule-fi l l ing and sea l ing , which w i l l make it poss ib le t o increase production t a r g e t s up t o a t o t a l of 100 t o 120 mi l l ion doses a year. UNICEF vill

a s s i s t with the equipment required.

The consul tant v i s i t e d t h e Bio Fama I n s t i t u t e i n Indonesia and advised on an add i t iona l freeze-drying p l a n t which w i l l make i t poss ib le t o increase t h e p o t e n t i a l output t o 25 o r 30 mi l l ion doses annually.

The consul tant recomended t h a t the Burma Pharmaceutical I n s t i t u t e , Rangoon. was s u i t a b l e f o r the production of f reeze-dr ied smallpox vaccine, provided t h a t some of the s t a f f could be t r a ined i n cur ren t methods of production and s p e c i a l equipment obtained. A p o t e n t i a l output of seven mi l l ion doses a year is envisaged. WHO and UNICEF will a s s i s t .

WHO has agreed t o arrange f o r the t e s t i n g of the f i r s t few batches of vaccine produced in the above-mentioned WHO-assisted vaccine production cen t res i n the Region a t no cos t t o the governments concerned.

SEAR0 42 Radiation Protect ion R (Dec. 1959 - March 1960; Feb. - Nov. 1963; - )

A i m of the e r o j e c t . To advise the ,-ovemments of the Region on r a d i a t i o n p ro tec t ion i n a l l i ts aspects .

Assistance Drovided by WHO dur ing the year. A consul tant .

Probable durat ion of a ss i s t ance . M t i l t h e end of 1966.

Work done durinK the year. During the year under review, t h e WHO consul tant paid v i s i t s t o the S t a t e s of Ut ta r Pradesh. Andhra Pradesh, Madras (Vel lore only). Mysore and Kerala. He completed h i s assieplment i n November. His repor t s emphasize

SEA/RC17/2 Page 192

the importance of t h e na t iona l h e a l t h a u t h o r i t y ' s acoepting r e s p o n s i b i l i t y f o r safe- guarding t h e publ ic aga ins t t h e harmful e f f e c t s of i o n i z i n g rad ia t ion , the s t a f f i n g of major rad io log ica l i n s t i t u t i o n s with rad io log ica l p h y s i c i s t s and the need f o r improved medical undergraduate teaching i n radia t ion.

E a r l i e r , the consul tant had v i s i t e d t h e Departments of Radiology a t var ious hosp i t a l s and tubercu los i s cen t res i n Ceylon, t h e Cancer I n s t i t u t e a t Etaharagama, the Univers i ty of Ceylon, t h e School of Radiography in Colombo and the Electro- medical Division of the Ccylon Department of Health, t 3 d i scuss r a d i a t i o n prc%e&lOn, radiotherapy and the in t roduc t ion of f u r t h e r mate r la l on rad ia t ion p ro tec t ion i n t o the undergraduate medical curriculum.

The repor t s of t h e consul tant have been sent t o t h e governments concerned.

SEAR0 50 Reoruanization of Rural Health Records and Reports R an. 1961 - 1

A i m of the p r o j e c 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 a t se lec ted cen t res and t o t r a i n Personnel i n the c o l l e c t i o n , Processing and p resen ta t ion of v i t a l and hea l th 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 e v e l .

Assistance provided by WHO during t h e year. ( a ) A s t a t i s t i c i a n ; (b ) supp l ies and equipment. (A vehicle was made ava i l ab le from p r o j e c t Ind ia 99.4).


Work done dur ing t h e year. The p ro jec t continued t o be located in rlujarat ( I n d i a ) . It took s p e c i a l i n t e r e s t i n reorganizing the maternal and c h i l d h e a l t h records and repor t s i n r u r a l h e a l t h cen t res .

An ante-nata l record and two d e l i v e r y records (domici l iary and i n s t i t u t i o n a l ) were draf ted. Work r e l a t e d t o maternal and c h i l d h e a l t h was defined.

Tabulation of out-pat ient morbidity (1962) in one d i s t r i c t i n Oujarat S ta te was completed.

Advice was given t o a s tudy on d e f a u l t i n submtssion of b i r t h and death re tu rns in rural areas i n the S t a t e .

SEAR0 61 Hosuital Records train in^ Course R ( 9 June 1964 - )

A i m of the p r o j e c t . To a s s i s t i n the t r a i n i n g of Personnel of d i f f e r e n t grades t o work i n h o s p i t a l records and s t a t i s t i c s departments.

Assistance Provided by WHO dur ing t h e Year. ( a ) Six nine-month fe l lowships t o enable candidates from Afghanistan, Burma, Indonesia, Nepal and Thailand t o a t t end the course; ( b ) supp l ies and equipment.

SEA/RC17/2 Page 193


Work done dur ina t h e year. The t r a i n i n g course f o r medical records o f f i c e r s s t a r t e d i n Bangkok on 9 June 1964. There were t en p a r t i c i p a n t s ( 2 from Afghanistan, 1 each from Burma. Indonesia and Nepal and 5 from Thailand). Rmong Thai candidates only the one who came from Chiengmai was awarded a WHO fellowship; the o the r f ,>ur were res iden t s of Bangkok.

The course i s planned f o r nine months and includes l e c t u r e s , l abora to ry exerc i ses and supervised p r a c t i c a l work on medical records sc ience, a s well as medical terminology, hosp i t a l s t a t i s t i c s and bas ic medical sc iences such a s microbiology, anatomy, physiology and paras i to logy.

The course i s conducted by the s t a f f of the Hospital S t a t i s t i c s Project (SEARO 7Z) ,ass l s t ed by guest l e c t u r e r s from S i r i r a j College of Medicine.

SEAR0 72 H U s ~ i t a l S t a t i s t i c s T A (Jan. 1963 - )

Aim of the p r o j e c t . To help governments of the Region t o organize an e f f i c i e n t system f o r the maintenance and flow of records i n se lec ted h o s p 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 s data e f f i c i e n t l y on a n a t i o n a l sca le ; t o t r a i n medical records and hosp i t a l s t a t i s t i c s personnel.

Assistance provided by WHO dur ina the year. ( a ) A s t a t i s t i c i a n , two medical records Off icers and a t y p i s t ; ( b ) supp l ies and equipment.


Work done durine: the year . A second WHO medical reccrds o f f i c e r was assigned t o this pro jec t from May 1964.

Prom January 1964, the hospital s t a t i s t t c s systemdcveloped by the p ro jec t was extended t o a l l the 88 general hosp i t a l s under the Department of Medical Services, c m t a i n l n g about 11 400 beds. I n add i t ion , i t a l s o covered the S i r i r a j Hospital , Pol ice Hospital , Bangkok Chris t ian Hospital and Chulalongkorn Hospital .

Annual r epor t s were completed f o r the year 1963 f a r the Women's and Children's Hospital , the S i r i r a j Hospital and the 33 ,-enera1 hosp i t a l s which had completed one f u l l year of r epor t ing a t the end of 1963.

A s p e c i a l s tudy was undertaken on the length of s t a y i n general hosp i t a l s a s a funct ion of sex, age and s t a t u s a t discharge.

The p r o j e c t s t a f f prepared t h e cui-riculum and conducted the t r z i n i n g course f o r medical reccrds o f f i c e r s (SEARO 61) ( see above).

SEA/RC17/2 Page 194

SEAR0 75 Medical Education Study Tour (Deans and P r i n c i ~ a l s T A of Medical C o l l e ~ e s l

(26 Jan. - 23 Feb. 1964)

A i m of t h e p ro jec t . To enable a group of deans and p r i n c i p a l s from medical i n s t i t u t i o n s i n var ious coun t r i es of the Region t o s tudy the organizat ion and adminis t ra t ion of medical education.

Assistance Drovided by WHO durinc: t h e year. ( a ) A consul tant f o r s i x weeks; ( b ) t r a v e l cos t s and subsis tence allowances f o r a l l p a r t i c i p a n t s .

Work done. The t o u r was held from 26 January t o 23 February 1964.. Pa r t i c ipan t s included one from Afghanistan, th ree from Ind ia , twu from Indonesia and two from Thailand. The group v i s i t e d Delhi, Madras, Vellore and BangJcok; in al1 ,nlne medical col leges were v i s i t e d .

The team a l s o p a r t i c i p a t e d i n the Annual Conference of t h e Indian Associa- t i o n f o r the Advancement of Medical Education, held i n Madras i n February 1964.

A v i s i t was paid t o the Instruments and Ct.errlcn1 Company, Ambalo, t o study the manufacturing of physiological instruments. The group a l s o discussed the p o s s i b i l i t i e s of t r a i n i n g t echn ic ians f o r instrument r e p a i r shops of medical col leges .

SEARO 76 R

Studies on F i l a r i a s i s (NOV. 1962 - )

A i m of the Droject. To c a r r y out f u r t h e r research on f i l a r i a s i s in order t o evolve more e f f e c t i v e methods of con t ro l .

Assistance Drovided by WHO dur ina the year. A consul tant epidemiologist and a S t a t i s t i c a l a s s i s t a n t ( f o r th ree months),provided under the Regional Office budget a s SupBlementary t o t h e p r o j e c t which i s being conducted by WHO Headquarters and funded from t h e Specia l Account f o r Medical Research.


Work done dur ing t h e year. A s s t a t e d i n l a s t y e a r ' s annual r epor t , the Regional

Office i s c l o s e l y associa ted with t h i s p r o j e c t , e s t a b l i s h e d in Rangoon in November 1962 a s p a r t of the wo global r esea rch programe.

During t h e year under review t h e epidemiologist s tud ied ava i l ab le d a t a On the epidemiology of f l l a r i a s i s i n . t h e Rangoon a rea and suggested a protocol f o r f u r t h e r s t u d i e s .

The Headquarters' team,consis t ing of an epidemiologis t , an entomologist . a p a r a s i t o l c g i s t and o the r consu l t an t s , continued i ts s t u d i e s cn mosquitc vectors of f i l a r i a s i s , p a r t i c u l a r l y on t h e i r ecology, biunomlcs, genet ics , v e c t o r i a l capaci ty , i n s e c t i c i d e s u s c e p t i b i l i t y and cross-res is tance t o d i f f e r e n t compounds.

SEAR0 94 External Cross-Checking of Blood Films R (June 1963 - )

A i m of the p ro jec t . To provide f a c i l i t i e s f o r ex te rna l cross-checking of blood f i lms from malaria e rad ica t ion programmes i n the South-East Asia Region.

Assistance provided by WHO dur ing the year. ( a ) A l abora to ry technician;

( b ) a grant t o t h e Government of Ind ia t o meet t h e cos t of employment of na t iona l

s t a f f and contingencies.


Work done dur ing the year. This centre , e s tab l i shed i n Kasauli i n June 1969,-

received blood films from Afghanistan, Burma, Ceylon and Indonesia f o r checking. Altogether, 20 791 s l i d e s were examined in the centre up t o the end of April 1964.

The major i ty of the s l i d e s received were from Ceylon.

SEAR0 95 Maternal and Child Health Assessment Team R [Dec. 1963 - March 1964; - )

A i m of the o r o j e c t . To s tudy the adminis t ra t ion and organizat ion of maternal and c h i l d h e a l t h se rv ices i n countr ies of the Region with a view t o advis ing on f u r t h e r i n t e r n a t i o n a l a ss i s t ance .

Assistance ~ r o v i d e d by WHO during the year. A maternal and ch i ld h e a l t h consultant f o r three months and a pub l ic hea l th nurse f o r s i x weeks.

Probable durat ion of a ss i s t ance . Unt i l 1966.

Work done dur ing the year. The maternal and ch i ld h e a l t h consul tant was assigned t o Thailand from December 1963 t o March 1964. The pub l ic h e a l t h nurse joined him

in February. Two s e n i o r o f f i c e r s i n the Department uf Health were assigned t o co-operate u i t h the maternal and c h i l d hea l th consul tant . :he WHO n u r s ~ worked c lose ly with the Chief Nurse i n t h t Nursing D i v l s i ~ , n of the Ministry of Hcalth.

The s tudy included v i s i t s t o 82 r u r a l cen t res . A systematic approach t o the c o l l e c t i o n of re levant mater ia l was obtained by the use of quest ionnaires . Specia l

a t t e n t i o n was paid t o standard h e a l t h promotion aspects of se rv ices , work-load, range of a c t l v l t i e s , adminis t ra t ion and supervis ion, record keeping, support ing

services ,and t r a i n i n g and preparat ion of h e a l t h personnel in maternal and c h i l d

h e a l t h a t a l l l e v e l s . The f indings of the p r o j e c t confirmed the soundness of

cur ren t i n t e r n a t i o n a l a s s i s t a n c e , l e n t support t o the po l i cy of the Department of Health i n expanding h e a l t h cen t res i n r u r a l a reas of Thailand with s p e c i a l

reference t o maternal and ch i ld hea l th , and emphasised t h a t the re should be a commensurate inc rease i n t r a i n i n g f a c i l i t i e s f o r workers i n a l l f i e l d s of Services

concerned u i t h r u r a l heal th .

s E A / R c ~ ~ / z Page 196

Similar assessments w i l l be made i n Indonesia i n 1964 and i n o the r coun t r i es of the Region In 1966.

SEAR0 97 Nut r i t ion Training R (Dec. 1963 - 1

Aim of the ~ r o j e c t . To a s s i s t in t r a i n i n g i n appl ied n u t r i t i o n and,by means of a g ran t , t o support t h e Nut r i t ion Research Laboratories, Hyderabad ( I n d i a ) , i n carrying out the programme.

Assistance provided by WHO durinp: the year. A grant-in-aid t o the Nut r i t lon Research Laboratories, Hyderabad. and f o u r three-month fe l lowships f o r candidates from Afghanistan, Eurma, Ceylon and Indonesia t o a t t end the t r a i n i n g course on n u t r i t i o n .


Work done dur ing t h e year. The f i rs t three-month course in n u t r i t i o n f o r medical graduates and S t a t e Nut r l t ion o f f i c e r s was held a t t h e Nut r i t lon Research Laboratories, Hyderabad, between December 1963 and February 1964. It was attended by s i x t e e n candidates - twelve from Ind ia and four from 0 ther . coun t r l es of t h e Region. The course consls ted of ( a ) l e c t u r e s and seminars. (b ) p r a c t i c a l f i e l d work and v i s i t s t o appl ied n u t r i t i o n p r o j e c t s and c l i n i c a l work I n h o s p i t a l s and (c 1 l i b r a r y work.

Preparations a r e being made f o r conducting t h e second course i n 1964/1965 f o r teachers of preventive and s o c i a l medicine, teachers of p a e d i a t r i c s , pub l ic h e a l t h o f f i c e r s and maternal and c h i l d h e a l t h o f f i c e r s oharaad with a m n i s t r a t l y e r e s p o n s i b i l i t y f o r o r supervis ion of n u t r i t i o n programmes. Assistance was given in t h e preparat ion of a s u i t a b l e programme f o r the course, including a revised syl labus , with g r e a t e r emphasis on t h e epidemiological, h e a l t h education, teach- i n g and admin i s t ra t ive aspects .

SEAR0 29 liaemorrhaaic -Fever Control R (Jan. 1964 - 1

A i m of the p ro jec t . To stress t h e urgency f o r global epidemiological su rve i l l ance of haemorrhagic fever and f o r s tud ies on e f f e c t i v e methods of con t ro l a t na t iona l and In te rna t iona l l eve l s .

Assistance provided by WO during t h e year. A consul tant f o r two weeks.


Work done dur ina t h e Year, m e consul tant repor ted on the present epidemiological s i t u a t i o n of haemorrhaglc f e v e r and dengue-like d i sease i n Thailand, Burma (Rangoon a r e a ) and Ind ia (Ca lcu t t a a r e a ) .

In Thai lmd, the d i sease has been present i n n mzjor epidemic form s ince 1958, and i t has now spread t o o the r urban a reas . (See p r o j e c t Thailand 70) .

I n Burma, t h e epidemic of a dengue-like disease , which occurred in the Rangoon a rea from J u l y t o September 1963, was e i t h e r c l a s s i c a l dengue o r chikungunya, more probably the l a t t e r .

In Ind ia , haemorrhagic fever appeared f o r t h e f i r s t time i n epidemic form i n t h e Calcut ta a r e a , i n the second half of 1963. The consul tant submitted recommendations f o r a c l o s e r epidemiological su rve i l l ance and f o r s t r i c t e r Aedes a e m t i control measures i n the Region and a l s o i n t e r n a t i o n a l l y . '

Asian I n s t i t u t e of Economic DeveloDment and Planning (Jan. 1964 - I

UNSF E CAFE UNICEF

A i m of the DroJect. To t r a i n personnel of Member and Associate tiember countr ies of the ECAPE region i n planning and economic development; t o undertake resea rch and advisory se rv ices .

Assistance Provided by WHO durlng the year. A publ ic hea l th admin i s t ra to r ( consu l t an t ) .

Probablb durat ion of a ss i s t ance . Unt i l the end Of 1969.

Work done dur ing the year. The 1ns t i tu te .under the aeg i s of ECAPE a s Executing Agency f o r UNSP,was inaugurated i n January 1964. It i s accommodated in the bu i ld ing which formerly housed the Facul ty of Commerce and Accountancy of the Univers i ty of ChulalongJcorn and i s within the University campus. I n add i t ion t o t h e M r e c t o r , n ine i n t e r n a t i o n a l s t a f f were i n p o s i t i o n . Three add i t iona l s t a f f members were subsequently posted and th ree short-term members were appointed. Th i r ty fe l lows ( 2 from Afghanistan, 1 from Ceylon, 4 from India , 3 from Indonesia, 2 from Nepal, J from Thailand, 2 from China (Taiwan). 1 from I ran , 1 from Laos, 2 from Malaysia, 3 from Pakistan, 2 from the Phi l ippines , 3 from Korea, 1 from Viet-Nan) s t a r t e d s tud ies from e a r l y February. The course was designed t o provide an i n i t i a l r e f r e s h e r o r i e n t a t i o n period of f o u r weeks, followed by a period af f i v e months covering "planning f o r econamlc growth and s o c i a l planning and development", and a f i n a l th ree months devoted t o e l e c t i v e subjects .

Teaching by means of seminars was l a r g e l y adopted. Health top ics , including h e a l t h in s o c i a l and economic development planning, the r o l e of h e a l t h promotion i n a developing economy, p l a n n i n g s t r a t e g y f o r the h e a l t h s e c t o r , h e a l t h considerat ions i n a g r i c u l t u r a l and i n d u s t r i a l development,and h e a l t h d e s i p s f o r the development of r u r a l and urban a reas , covered some twenty-flve p e r cent of the time a l loca ted f o r t h e seminar.

SE~/Ac17/2 Page 198

Under the chairmanship of the Director of the I n s t i t u t e , weekly s t a f f meetings were held t o discuss po l i cy 2nQ a d m W s t r a t i v e m ? t t a and t echn ica l p r o b l h s .

Specia l Course on Advanced Malaria Eaidemiolo . New Delhi i .".im of the-vrodect. ( 1 ) To provide t r a i n i n g i n advanced malar ia epidemiology t o s e n i o r na t iona l medical o f f i c e r s responsible f o r the planning and execution of epidemiologlcal evaluat ion of the malaria e rad ica t ion programmes i n t h e i r countries; ( 2 ) t o provide bas ic cxperience tc-enzble the p a r t i c i p a n t s t o conduct s i m l l a r courses i n their ' respectiv.? countr ies .

Assistance urovided by WHO during t h e vear. ( a ) Payment of t r a v e l c o s t s and s u b s i ~ t e n c e allowance t o p a r t i c i p a n t s and allowance t o temporary adv i se r s of the facu l ty ; ( b ) books and reading mate r ia l f o r the p a r t i c i p a n t s .

Work done. This Course was conducted with the co l l abora t ion of the National I n s t i t u t e of Communicable Diseases, Delhi,and t h e National Malaria Eradicat ion P r o g r m e , India .

Nine p a r t i c i p a n t s (from Ceylon, India , Nepal, Thailand, Pakistan and I r a n ) attended the course. The course consis ted of l e c t u r e s and group discuss ions f o r nine days,followed by f i e l d v i s i t s with i n s t r u c t o r s f o r t en days. The

sub jec t s covered included bas ic epidemiology, s p e c i f i c malar ia epidemiology, use of s t a t i s t i c a l methodology, epidemiological requirements of t h e maintenance phase i n an in tegra ted h e a l t h se rv ice , t r a i n i n g of s t a f f i n epidemiology, h e a l t h education, e t c .

The course, bes ides providing i n s t r u c t i o n s on the academic aspects of t h e epidemiology of malaria, a l s o served t o focus a t t e n t i o n on the epidemiological problems of t h e countr ies from which the p a r t i c i p a n t s were drawn. A l l the p a r t i - o ipants took an a c t i v e p a r t i n the discuss ions . The f i e l d v i s i t s were planned in such a way t h a t the success of sound epidemiological organizat ion a s wel l a s

4.

the f a i l u r e s of de fec t ive epidemiological planning could be shown. The partic1patIts expressed t h e i r d e s i r e t o hold s i m i l a r courses i n t h e i r respect ive countr ies .

Similar courses w i l l be conducted i n 1965 and 1966.

11. INTER-REOIONAL

PROJECT LIST Project No. Source of Funds Co- operat ing Agencies

I n t e r - r e a o n a l 1% I n t e r n a t i o n a l Training Course on Laboratory and F i e l d

R Methods i n Hwnan Population Genetics, Bombap (18 Nov. - 14 Dec. 1963)

A l m of the p r o j e c t . To make ava i l ab le current developments and methods in the f i e l d of human genet ics t o workers who a r e i n a p o s i t i o n t o use them i n teaching, in rou t ine h e a l t h work and in research.

Assistance provided by WHO dur ing the year. A f a c u l t y cons i s t ing of f o u r fu l l - t ime i n s t r u c t o r s and f o u r s p e c i a l l y se lec ted l e c t u r e r s .

Work done. With t h e co-operation of the Government of India , a WHO-sponsored i n t e r n a t i o n a l t r a i n i n g course on laboratory and f i e l d methods i n human population genet ics was held i n Bombay from 18 November t o 14 December 1963. There were 17 p a r t i c i p a n t s - 6 from Ind ia , 4 from Indonesia, 2 from Thailand. 1 each from I r a n and Pakistan, and 3 nominated by the Councll f o r In te rna t iona l Organizations of Medical Sciences (CIOELS) (2 from Ind ia and 1 from Pakis tan) . The course consis ted of t h e o r e 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 and a l s o f i e l d s tud ies .

In te r - rep lona l 190 Leprosy/BCG Tr ia l . Burma MR (Apri l 1964 - )

A i m of the project . To c a r r y out a t r i a l of BCG vaccination i n the prevention of leprosy.

Assistance Provided by WHO during the year. A team cons i s t ing of a medical Officer ( l e p r o l o g i s t ) and a laboratory technician.


Work done dur ing t h e year. A WHO team cons i s t ing of a l e p r o l o g i s t and a l abora to ry technician was assigned t o mrma i n April 1964 t o s t a r t a long-term s tudy 41 the epidemiology of l ep rosy and,in pa r t i cu1ar . a t r i a l of BCQ vaccination i n the preven- t i o n of leprosy. A protocol Tor these s tud ies and a plan of operat ions were Prepared and agreed t o by the aovemment of Burma.

I n t e r - r e a o n a l 218 Meetinn of Inves t ina to r s on t h e Evidemiolom and Pathology of Oropharyngeal Turnours. New DelN (8-15 oct. 1963)

-. To disouss the pathological and epidemiological aspects of oropharyngeal tumours.

SUhm7/2 Page 200

Assistance provided by WHO during the year. Assistance by two s t a f f members from UHO Headquarters and a consultant.

Wo* done. The above meeting took place i n t h e WHO bu i ld ing in New Delhi from 8 t o 15 October 1963. It was a t tended by 6 p a r t i c i p a n t s and 3 observers from Ind ia , 1 each from Ceylon, t h e Unlon of South Africa and t h e USSR, and 1 represen ta t ive of the I n t e r n a t i o n a l Uhion aga ins t Cancer. In add i t ion t o t h e two s t a f f members from WHO Headquarters and a consul tant , t h e UHO v i s i t i n g professor of d e n t i s t r y assigned t o a p r o j e c t i n Ind ia and a UHO medical o f f i c e r engaged in an epidemiological s tudy on oropharyngeal tumours in I n d i a took p a r t in t h e meeting.

Reoommendations were made a s t o the design of a study t o be. ca r r i ed out t o i n v e s t i g a t e these cancers, in view of t h e i r r e l a t i v e l y high frequency in severa l coun t r i es of t h e Region and a poss ib le r e l a t i o n s h i p t o smoking and chevtng hab i t s .

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