I E A RCIO 2

WORLD HEALTH ORGANIZATION

R E G I O N A L O F F I C E F O R S O L J T H E A S T A S I A

N I N T H A N N U A L R E P O R T

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T H E R E ( ; I O N A L I > I l < I ~ ( ' I ' O R

T O T H t

R E G l O N A L C O M M I T T E E FOR SOUTH EAST ASIA

July 1956 - July I957

SEA/RC10/2

WORLD HEALTH ORGANIZATION

R E G I O N A L O F F I C E F O R S O U T H E A S T A S I A

N I N T H A N N U A L R E P O R T

0 F

T H E R E G I O N A L D I R E C T O R

T O T H E

REGIONAL COMMITTEE FOR SOUTH EAST ASIA

July 1956 - July 1957

TABLE OF CONTmTS

Introduction

PART I - GENERAL STATmT OF ACTIVITIES I N THE REGION

1. Public Health Administration

Strengthening of National Health Services Community Development hkternal and Child Health Nursing Health Mucation of the Public Nutr i t ion Mental Health Social and Oocupational Health Dental Healtb

2. Lhvironmental Sani ta t ion

3. Education and Training

3.1 Direct Assistance to Mucational I n s t i t u t i o n s 3.2 Fellowships

4. Communicable Diseases

4.1 Malaria and Other Insect-Borne Diseases 4.2 Tuberculosis 4.3 Venereal Diseases and Treponematoses 4.4 Other Comunicable Diseases

5. Epidemiology a n d H e a l t h S t a t i s t i c s

5.1 Epidemiology 5.2 Health S t a t i s t i c s

6. Assistance to Research I n s t i t u t e s

7. Public Health Laboratories and Vaccine Production

7.1 Public Health Laboratories 7.2 Vaccines

8. Curative Services

9. Socio-Economic Aspects of WHO'S Programme

10. Atomic & e r a i n Relation to Health

PART I1 - GBJERAL

Regional Cormnittee

Organization and Administration

Organizational Structure Personnel Staff Welfare Acoommodation of Regional Off i c e Legal and Const i tut ional Matters

Procurement of Equipment and Supplies

Reports and Documents

Collaboration with Other Agencies

United Nations Specialiaed Agencies B i l a t e r a l Agencies Non-Governmental Organizations Other Agencies

Public Information

PART 111 - ACTIVITIES UNDERTBKm BY GOVERNMBVl"l' WITH THE HELP OF 'NHO

Afghanis tan

Burma

Ceylon

India

India - Former French Settlements

Indonesia

Maldive Is lands

Nepal

Portuguese Ind ia

Thailand

1. Organizational cha r t

2. Geographical d i s t r i bu t ion of in te rna t iona l s t a f f assigned to South East Asia Region as of 31 July 1957

3, Conferences and meetings ca l led by the United Nations and special ized agencies a t which WHO was represented

4. Conferences and meetings of ~ v e r n m e n t a l , non-governmental and other organizations a t which WHO was represented

5. Table showing d i s t r i b u t i o n of fellowships by subject of study and by country

6 . Training a c t i v i t i e s ca r r i ed out by governments with the ass i s tance of WHO s t a f f

INTRODUC TION

Progress towards an improved public-heal t h se rv ice has continued to be slow but f a i r l y steady. The chief reasons f o r the slow paoe remain, as before, the shortage of trained personnel and of adequate funds. Most countr ies have experienced increasing d i f f i c u l t i e s i n the procurement of the foreign exchange which is needed f o r development programmes, including those f o r public health.

Lack of supervision of public-health programmes is s t i l l apparent a t a l l l eve ls . The dangers a r i s i n g from such a s i t ua t ion a r e real ized by public heal th departments: f o r example, during the year the Indian Central Health Council resolved on the need f o r proper supervision and asked a l l S t a t e Governments to strengthen t h e i r heal th d i r ec to ra t e s i n order to ensure t h a t the funds made avai lable were being f u l l y and e f f ec t ive ly u t i l i z e d . 'dowever, any improvement i n the ex is t ing unsat isfactory s i t ua t ion cannot be expected u n t i l a much l a rge r number of trained personnel and the funds to employ them become available. Health administrations s t i l l need much strengthening a t the country and s t a t e l eve l s , pa r t i cu l a r ly i n the f i e ld6 of ru ra l health, maternal and ch i ld heal th , environmental san i ta t ion and health education.

WHO'S main ro l e , therefore, continues t o b~ t o a s s i s t governments i n t ra in ing programmes not only f o r f i e l d workers but a lso f o r senior public heal th administrators who can supervise the constantly expanding public health se rv ices . In addit ion to t r a in ing counterpart teams and organizing a very l a rge number of regular t r a in ing courses i n d i f f e r en t subjects , WHO s t a f f has ass i s ted t h i s year i n conducting 40 re f resher courses f o r about 700 t ra inees , cons is t ing of medical o f f i ce r s , nurses, technicians, s an i t a r i ans and other auxi l iary workers. A deta i led statement of t r a in ing a o t i v i t i e s car r ied out with ass is tanoe from PPHO staff is given i n Annex 6. Two seminars were held - one a regional seminar f o r nursing leaders (with 31 par t ic ipants ) and the o ther an inter- regional meeting of tuberculosis workers, with 35 par t ic ipants from the South East Asia and Western Pac i f ic Regiona. A t o t a l of 93 fellowships was awarded. In addit ion, under the speoial arrangements made with the Harvad Sohool of Public Health l a s t year, the experiment of t r a in ing nat ional teachers i n a spec ia l ly organized public-health teachers ' course was continued.

Effor ts a t in tegra t ion and uni f ioa t ion of cura t ive and preventive heal th se rv ices a r e being made i n most countr ies , but Progress is slow.

Although c o m i t y development pro jec t s a r e very popular, every country i n the Region is not r i p e f o r such comprehensive a c t i v i t i e s on a nation-wide scale. These pro jec t s have continued to make progress espeoially i n India, although the most subs tan t ia l pa r t of the Indian programme - the development of 300 new primary health centres - is jus t beginning to be tackled. mhile such comprehensive programmes a r e a na tura l and log ica l method of developing soc ia l services , they require much preliminary prepara- t i on and a great deal of readjustment of re la t ionsh ips between the

various minis t r ies and departments. Local resources a r e a lso very l imited i n most countr ies i n the Region, and t h i s makes the implementation of l a rge programmes a grave undertaking. Their in tegra t ion in to the rout ine work of a heal th department is e s sen t i a l , but t h i s i s necessar i ly s l o w , and much caution needs to be exercised i n preventing too heavy a load. on already overburdened departments.

In the Introduction to o ~ . Eighth Annual Report I had. proposed tha t experts should i n future par t ic ipa te l e s s d l r ec t ly i n f i e l d operations and devote more time to a s s i s t i n g health administrations a t the national and s t a t e leve ls . The Regional Committee, while acoepting t h i s view i n pr inciple , was of the opinion t h a t considerable f i e l d par t ic ipa t ion by WHO was s t i l l very necessary i n t h i s region. These views of the Regional Committee have been kept i n mind during the development of current programmes.

During the period under review, 131 projects have been ass i s ted , a s compared with 96 reported f o r the l a s t period (1955-1956). The main f i e l d s of ass is tance were the control of c o ~ i c a b l e diseases , development of ru ra l heal th services , strengthening of national heal th administrations and t r a in ing of a l l categories of heal th workers. Vhile d e t a i l s of these programmes w i l l be found i n the subsequent pa r t s of t h i s Report, I wi l l mention here some of the trends of our programme during the past year.

In tuberculosis control we a re moving away from demonstra- t ion and t ra in ing projects and concentrating on chemotherapy and domiciliary servlce. Malaria control has been ass i s ted to develop much more rapidly, and wherever f ea s ib l e to become oonverted in to an eradicat ion programme. I n leprosy control the emphasis has been on aot ive case-flnding and non-insti tutional treatment. Valuable r e s u l t s a r e expected from the p i l o t projects i n trachoma i n India and Indonesia. Promotion of maternal and ch i ld heal th centres , as such, i a not being encouraged; i n t e e a t i o n o f maternal and ch i ld heal th i n to the general public heal th services is being act ively promoted, and more s t r e s s is l a i d on adequate child care and on t r a in ing i n paediatr ics .

Much preliminary work has been done to a s s i s t Member States i n the preparation of annual heal th reports ; f o r t h i s purpose a valuable "Manual of Inst ruct ions" has been prepared and sen t to governments i n South East Asia.

The promotion of f u l l time public-health departments i n medical schools has been delayed by the i n a b i l i t y to procure su i t ab l e WHO professors.

A s pointed out a t the ninth session of the Regional Committee, there .is r e a l need f o r keeping 'a watch over projects where d i r e c t WHO assis tance has already been terminated. I t is real ized tha t a slackening of e f f o r t takes place i n some cases, although there a r e many examples where work i n i t i a t e d with the help of WHO has been continued and even expanded, such as i n the

venereal -d isease c o n t r o l programme i n Ceylon. A s t h e s t a f f i n the Regional Off ice i s a l ready f u l l y exp lo i t ed , some of these "follow-up" d u t i e s w i l l n e c e s s a r i l y f a l l on t h e Area Representat ives.

Re la t ions wi th o t h e r o rgan iza t ions both b i l a t e r a l and i n t e r n a t i o n a l have continued t o be good. Close c o l l a b o r a t i o n has been maintained wi th TARRs, UNICEF, t h e I n t e r n a t i o n a l Co-operation Administrat ion of the USA, the Colombo Plan, the Rockefe l ler Foundation and the Ford Foundation. Valuable d i scuss ions have been held wi th numerous members of these o rgan iza t ions who have v i s i t e d t h e Region. We have always sought such d i scuss ions i n o rde r t o promote c o l l a b o r a t i o n wi th a l l agencies working i n the f i e l d of h e a l t h i n South Eas t Asia.

A s u sua l , co-operation on the p a r t of n a t i o n a l h e a l t h admin i s t r a t ions has been exce l l en t . The d i f f i c u l t y wi th regard to coun te rpa r t s , however, cont inues , and t h e r e have been ins tances , as i n p a s t yea r s , where t h e l a c k of s u i t a b l e coun te rpa r t s , o r of c o u n t e r p a r t s a l t o g e t h e r , has l imi ted very s t r i c t l y t h e in f luence of XHO e x p e r t s i n t h e f i e l d .

Four c o u n t r i e s held general e l e c t i o n s dur ing t h e year . I n I n d i a t h e re-organizat ion of the s t a t e s r e s u l t e d i n t h e conso l ida t ion of t h e country i n t o 14 major s t a t e s and 6 Union T e r r i t o r i e s . This r eo rgan iza t ion has a l s o a f fec ted t h e work of some of the WHO teams.

On 31 Ju ly 1957 t h e r e were 126 profess ional s t a f f members i n t h e f i e l d . Recruitment remains a problem; i t i s d i f f i c u l t t o f i n d t h e r i g h t number of t h e r i g h t c a l i b r e of exper ts t o f i l l a l l the vacant pos ts , and some very important pos t s i n t h e Regional Off ice and i n t h e f i e l d have remained vacant . The t o t a l f i n a n c i a l r e s p o n s i b i l i t y f o r programmes i n t h e Region, f o r which t h e Organiza t ion is a s igna to ry i n agreements and p lans of opera t ions , amounts t o over 6.5 mi l l ion d o l l a r s i n t h e c u r r e n t y e a r , i n c l u s i v e of "Other FZtra-Budgetary Fbnds".

The Regional Of f i ce has continued to work under very heayy pressure. I n a d d i t i o n t o l a r g e r f i e l d programme, t h e r e a r e growing r e s p o n s i b i l i t i e s with r e s p e c t to co-operating i n programmes of t h e United Nations and o t h e r agencies - i n t e r n a t i o n a l , n a t i o n a l and b i l a t e r a l . IVHO welcomes a l l o p p o r t u n i t i e s t o a s s i s t i n co-ordinat ing h e a l t h work! never the less , t h i s has meant t h a t t h e work-load of t h e Regional Of f i ce has increased and i s s t i l l inc reas ing , and it w i l l soon be necessary t o make c e r t a i n add i t ions t o t h e s t a f f i n g if i t i s expected t o cont inue to provide a s a t i s f a c t o r y l e v e l of se rv ioe to governments, to f i e l d p r o j e c t s , to headquar ters and t o o t h e r organiza t ions .

I very much r e g r e t t o inform t h e Regional Committee of t h e sudden death of D r . Veenbaas, who mas our Area Representa t ive i n Burma. D r . Veenbaas r e t i r e d from the Organizat ion on 4 June 1957. Unfortunately, he d ied suddenly dur ing t h e r e t u r n

journey to h i s home. He had been one of our o ldes t and most valuable colleagues, and I w i s h here to record our high appreoia- t ion of the services he rendered to the Organization.

On behalf of the Regional Office s t a f f I acknowledge with gra t i tude the excel lent co-operation we have received from a l l governments i n t h i s Region and have the honour to present Ninth Annual Report to the Regional Committee.

Regional Direo t o r

PART I

GE8ERAL STATENBVT OF ACTIVITIES I N THE REGION

1 . PUBLIC HEALTH ADMINISTUTION

1.1 Strengthening of National Health Services

During the discussions a t the n in th session of the Regional Committee, s t r e s s was l a i d on the usefulness of placing FHC experts a t S t a t e o r provincial l e v e l s t o a c s i s t i n strengthening the nat ional heal th services. Xhile i t was pointed out t h a t no master blue-print on public health administration would be r e a l i s t i c and tha t each countqy would have to evolve an administrative pat tern to s u i t i t s own conditions, there mas general agreement with the Regional Di rec tor ' s warning tha t i n a l l countr ies the need fo r increased supervision of public heal th programmes was becoming serious. iNH0 has therefore na tura l ly oontinued to emphaoize ass is tance to national heal th se rv ices a t cen t r a l and provincial 1 eve1 s .

I n f i v e out of t he seven countr ies of the Region, t he Area Representatives assigned to the individual gnvernments have continued to o f f e r advisory services with regard t o t he organiza- t ion and improvement of administrative services i n public health.

In Afghanistan, the public heal th adviser who was a s s i s t i n g a t the Central Directorate l eve l l e f t i n September 1956. Since tha t time, however, a number of Regional Advisers have v i s i t e d Kabul t o a s s i s t the Ministry of Health i n the formulation of the heal th aspects of the Government's Five-Year Development Plan. A 'HP short-term consultant a lso went to Afghanistan i n April/May 1956, and consolidated i n one report the advice of the various advisers in the Regional Office. In Burma, the public heal th adviser continued h i s work i n the Central Directorate and f u r t h e r ass i s ted the Government in the preparation of ar annual report as a regular function.

In other subjec ts as well , ass i s tance has been given a t the nat ional o r s t a t e l eve l . Tho trend with regard t o the strengthening of the general s t ruc tu re of maternal and ch i ld heal th i n a number of S t a t e s and countr ies of South East Asia Region, mentioned i n the l a s t report of tho Regional Director , has continued. WRO has, f o r ins tance, supplied a S t a t e maternal and ch i ld heal th o f f i ce r f o r Wsore S t a t e i n India , and a countqv adviser i n maternal and chi ld heal th f o r Thailand.

!?ith respect to nursing, a nursing advisor a t tho d i r ec to ra t e leve l has reoently s ta r ted work i n Ceylon. A plan of operations has a lso been d r a m up f o r Afghanistan f o r the provision of a nursing adviser to serve a t the country l eve l , and a s imilar plan of operations f o r a country nursing' adviser is under preparation f o r Indonesia. In India , nurses a t the S t a t e advisory l eve l have been assigned to \jest Bengal and @more, and others a r e being planned f o r two more s t a t e s .

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The WHO epidemiologist has continued h i s work of a s s i s t i n g the cen t r a l d i r ec to ra t e i n Ceylon; o ther such epidemiologists a r e under recruitment f o r Burma and Indonesia. WHO ass i s tance to Health S t a t i s t i c s Divisions of nat ional d i r e c t o r a t e s has a lso been considerably increased. Health s t a t i s t i c i a n s have continued i n Afghanistan and Burma; i n Ceylon one has recent ly been appointed a t the S t a t e l e v e l to a s s i s t i n s e t t i n g up a permanent s t a t i s t i c a l service , and i t i s expected tha t a. f u r t h e r s t a t i s t i c i a n w i l l shor t ly take up h i s du t i e s i n Thailand.

Also i n Thailand, following a survey made i n 1955-1956, WHO has made a medioal n u t r i t i o n i s t avai lable to the Government to advise and a s s i s t the Nutri t ion Division i n carrying out the programme adopted.

A new type of WHO ass is tance f o r t h i s region is being given i n the preparation of medical and public heal th l e g i s l a t i o n , f o r which a short-tern consultant was assigned to Afghanistan. Requests f o r s imi la r ass is tance have been received from o ther countries.

The foregoing a r e a l l examples of the d i r e c t ass is tance being provided to Contra1 o r S t a t e governments. I t should be kept i n mind, however, t h a t i t i s not easy to def ine exaotly what cons t i t u t e s the strengthening of na t iona l heal th services. It i s obviously not merely the ass is tanoe given t o cen t r a l d i r ec to ra t e s ; actual ly a l a rge pa r t of the o ther pro jec t s undertaken by WAO could come under t h i s category. The large-scale tuberculosis programme being developed i n India ce r t a in ly e n t a i l s a valuable strengthening of the Indian nat ional heal th service , as does the upgrading of the d i s t r i c t cen t res mentioned i n the following sect ion under "community development". Another valuable f i e l d should not be l o s t si&t of 2 the re f resher course. The re f resher course f o r provincial public heal th o f f i c e r s which took place l a s t year i n Afghanistan and which has j u s t recent ly been repeated, has proved a valuable means of cont r ibu t ing to the improvement of provincial and peripheral services.

1.2 Conumnity Development

The concept of community dovelopment cons t i t u t e s a basic element i n the soc ia l philosophy of several of the countr ies i n tho South Eaot Asic Region. Mainly i n Ind ia but a lso i n Afghanistan, Nepal, Indonesia a id Thailand, plans f o r cormunity development of which heal th i s an in t eg ra l par t have been adopted. While a t the moment the health services under those schemes a r e of a l imited nature and do not necessar i ly cover a l l f i e l d s of public heal th , from a long-range point of view, they are the obvious nucleus f o r l a t e r all-embracing, integrated hea l th services i n the ru ra l areas.

Realieing the tremendous impact which theso programmes w i l l neoessarily have on the countr ies concerned, WHO, with the help of UNICEF, i s more and more engaged i n col laborat ion with the govern- ments i n work i n t h i s f i o l d . A t the Regional Office a Regional Adviser i n Community Development w i l l concentrate on a s s i s t i n g i n the development of community projects.

I n Afghanistan and Nepal the Governments have prepared documents s e t t i n g out the organization of ru ra l development programmes, i n which the nat ional hea l th adoin is t ra t ions a r e adequately represented. A s i t s contr ibut ion to the programme i n Afghanistan, W I G i s supporting the development of a p i l o t project i n Shewaki. Originally s e t up as a ru ra l heal th un i t , t h i s project has been the nucleus f o r a much wider programme, which, with the ass i s tance of several in te rna t iona l agencies, including WBO, U N I C E F and UNESCO, is becoming a community development pro jec t covering a l a rge area. This u n i t i s also a t r a in ing cen t re f o r medical students and f o r san i ta r ians .

With the en te r ing in to force of the Second Five-Year Plan, Ind ia has s t a r t ed to emphasize the hea l th aspects of i t s community development propalme. The basic u n i t i n the Indian system is the primary heal th cen t re , covering a population of approximtely 65,000, d i s t r i bu ted among about 100 v i l lages . Nomally t h i s primary oentre w i l l supervise throe sub-centres. Some supervision of the basio u n i t v ; i l l take place from the d i s t r i c t l eve l , a d i s t r i c t normally comprising a population varying from one to two million. A t the l eve l of the d i s t r i c t , hospi ta l and laboratory f a c i l i t i e s w i l l be ava i lab le f o r r e f e r r a l purposes. I t i s the in ten t ion to organize, a s soon as possible, one mod01 d i s t r i c t i n each State . iW0 and UNICEF a re c lose ly following the pr inciples l a i d down i n the Second Five-Year Plan; a master plan of operations has beon worked out with the Govornment, and the drawing up of subsidiary S t a t e plans of operations i s a t the moment i n progress.

A number of r u r a l t ra in ing a reas a r e being developed i n co- operation with the un ivc r s i t l e s and medical schools, f o r giving f i e l d experience to physicians, nurses, midwives and san i ta ry inspectors , who w i l l thus be b e t t e r prepared f o r vork i n community development areas.

In Indonesia, the Government has decided t o launch an extensive v i l l age c o m i t y development project , proposed t o s t a r t i n 16 selected d i s t r i c t s , each with a population of about 100,000. P i lo t projects f o r community development i n Thailand, with special emphasis on the hea l th aspects, have been s t a r t ed i n four areas with ass i s tance from I C A .

1.3 Maternal and Child Health

During the l a s t year there has been a c r y s t a l l i z a t i o n of ideas on the best !-ray to a s s i s t countr ies i n the Region i n t h e i r e f fo r t s to build up services for mothers and children.

I t has come to be real ized tha t i n order t o serve a Community best i n the f i e l d o f maternal and ch i ld heal th , a s i t is t r ad i t i ona l ly understood ( i . 0 . ante-natal, na t a l , post-natal ca re and heal th supervision of i n fan t s and chi ldren, f o r which separate c l i n i c s have h i the r to been es tabl ished) , a community heal th programme i s needed, i n which these vulnerable groups of

society - the mother and ch i ld - a r e given special a t ten t ion . It is now generally accepted tha t where malnutri t ion and infec t ious diseases a r e s t i l l widespread, i t is not pract icable to attempt to meet the needs through services i n which cura t ive and preventive care a r e separated, but t ha t an integrated service i s required. This concept is more and more gaining acceptance i n the countr ies of the Region, as i l l u s t r a t e d on a l a r g e sca l e i n the present c o m i t y development pro jec t s i n India , i n to whioh !VHO/UNICEF- a ss i s ted programmes, especial ly those i n the f i e l d of maternal and ch i ld heal th , a r e increasingly being integrated.

The main a i f f i o u l t y is , and w i l l be f o r some time to come, the scarc i ty of adequately trained personnel. In addi t ion to the need f o r s e t t i n g up more t r a i n i n g schcols, g rea te r emphasis should be placed on in-service, re f resher and or ien ta t ion t r a in ing of a l l categories of personnel. Even i f t h i s improved t r a i n i n g leads to a c e r t a i n amount of delay and an increase i n cos t , it w i l l be j u s t i f i ed i n order to improve the qua l i t y of the se rv ice and also to prevent the introduct ion in to the services of numerous categories of inadequately t ra ined personnel.

The present posi t ion i n ch i ld ca re i n a l l countr ies of the Region is tha t there is a d iv i s ion between cura t ive services , which a re given by doctors i n hosp i t a l s o r out-patient c l i n i c s and a re mostly l imited to towns, and preventive services , which a re mainly the domain of auxi l ia ry personnel, occasionally supervised by medical s t a f f . Even if more medical o f f i c e r s can be made avai lable to work i n maternal and ch i ld health, ch i ld welfare o r rura l heal th c l i n i c s , t h e i r past and present t r a in ing does not prepare them adequately f o r t h i s task.

In the fu ture , i n order t o secure adequate and e f fec t ive services f o r chi ldren, i t w i l l be e s sen t i a l to improve the teaching of paedia t r ics i n the medical schools. I t shoula be c l ea r ly understood tha t paedia t r ics must oover a l l aspects of ch i ld care , both cura t ive and preventive. Obviously i t is not possible to do t h i s so le ly through an administrative decision to make paedia t r ics a major subject i n the medical curr ioulum~ a number of other s teps w i l l need to be taken.

For the s t a f f i n g of the paodiatrlo teaching departments, with a vlew to providing the medlcal student with an in tegrated course i n ch i ld care , a number of spec ia l t r a in ing cen t res w i l l be needed. General post-graduate t r a in ing abroad v r i l l not suff ice , s lnce the paediatr ic problems with which western countr ies a r e confronted a re so d i f f e r e n t from those i n the South East Asia Region.

In order to enable such t r a in ing centres to function, adequate paediatr ic services , run on proper l i n e s and re la ted to l oca l conditions and problems, must a lso be available.

The t r a in ing cen t re w i l l have three functions which cannot be separated: teaching, se rv ic ing and research. A programme has now been completed f o r a cen t re along these l i n e s i n Madras, and i t is expected tha t one o r two s imi la r programmes may be s ta r tod during the next year elsewhere i n India , and another possibly i n one other country of the Region.

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Meanwhile, considerable progress has been made i n the teaching of paedia t r ics i n several medical col leges i n India , spec i f ica l ly i n connection with WXO-UlUCEF-assisted maternal and ch i ld heal th projects .

A t the Indian nat ional medical education conference held i n November 1955 i n Delhi, the establishment of separate departments f o r paediatr ics i n a l l medical col leges and a l sc the extension of t he teaching course t o three months were recommended. WXO has a l so t r i e d to s t imulate addi t ional improvements, some of which have already been implemented. For example :

I n Nagpur, dur ing the year, an independent Department of Paediatr ics was created, and teaching extended t o three months. A chi ld welfare c l i n i c xas s e t up on the medical col lege grounds to serve f o r teaching promotional and preventive ch i ld care , and a separatc c l i n i c foz spas t ic children - the first i n the Region - was a l so established.

I n Nyderabad., two peripheral prsvontive - cura t ive ch i ld heal th centres have been established i n order to demonstrate to the students the uni ty of these two aspects of ch i ld care,

I n Lucknovr, two ch i ld welfare cen t res which had already been established i n the town were adapted f o r use as a supplement t o tho academic courses i n preventive paediatr ics . On the suggestion of i'NC personnel, the teaching of paedia t r ics i n the f i r s t c l i n i c a l year w i l l cons ie t of the growth, development and supervision of the normal chi ld . Only a f t e r tha t w i l l the students bo taught the pathology of childhood.

In Vis&hapatnam, a nat ional professor of paedia t r ics has now been appointed as counterpart to tho iTi'H0 oaediatr ic ian. and a . - ch i ld welfare cli.nic has been created a s pa r t of the se rv ices and teaching of the Paediatr ic Department. Following the advice of Xi0 cbnsul tants , the Medical Faculty has a p o e d to associate the professor of ~ a e d i a t r i c s .:~ith the professor of preventive and soc ia l medicine ii: teaching p re -c l in i ca l student3 the environmental aspeots of community service .

In w, roul;ine services i n tho i n - p a t i e ~ t departments were improved wit11 the ass is tance of the VmO nurses, and a maternal and ch i ld heal th c l i c i o i n tcum has been adapted f o r use i n under- graduate teaching.

1 . N-

Nursinp Mucation

I n South East Asia the major nood i n nursing education continues to be f o r an increase in number and an improvoment i n qua l i ty of both nu-sing and auxi l ia ry nursing personnel.

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During the past few years progress has been made i n improving and standardiaing the cu r r i cu l a f o r the t r a in ing of the various categories. More a t ten t ion i s now being given t o co r r e l a t i ng classroom teaching ~ r i t h the prac t ica l teaching on the wards. Attempts I have been made to include public heal th as pa r t of the t r a in ing of every nurse and midwife, and nursing schools are thus being encouraged to employ public heal th nurses as par t of t h e i r teaching s t a f f . The f a c t t ha t community heal th services a r e s t i l l l imited, both quant i ta t ive ly and qua l i t a t i ve ly , makes i t d i f f i c u l t to f ind su i t ab l e f i e l d experience i n public heal th nursing. I n some instances i t has, however, been possible to upgrade the services i n l imited areas to serve as teaching f i e l d s . WHO has been a s s i s t i n g i n the development of t h i s aspect of nurse and midwife t r a in ing i n a l l the countr ies i n the Region.

On the whole the schools a r e well supplied with classroom equipment except f o r textbooks i n t he l oca l languages. These a r e s t i l l scarce, but gradually the supply i s being increased as governments a r e preparing tex ts , i n some cases with WHO assistance. In most of the WHO-assisted nursing education pro jec t s , l e c t u r e notes a r e being t rans la ted and mimeographed f o r d i s t r i b u t i o n to the students. I n a few instances WHO has been able t o have small t ex t s printed i n the l oca l language.

The need f o r nursing and midwife t u to r s i s gradually being met. Three countr ies i n the Region a r e now t r a in ing t h e i r own tu to r s , and a four th w i l l begin to do so within a month o r two. The College of Nursing i n New Delhi and the School of Nursing, Vellore, a r e being used to some extent as regional t r a i n i n g centres .

Refresher courses, which a re now being held i n a l l the countr ies , while f i r s t used as a means of strengthening the background of nursing and midwifery personnel whose t r a i n i n g had been of l imited qua l i t y , a r e now being recognized as having a permanent place as a means of helping personnel to keep up to date and to show them how i o take more respons ib i l i ty f o r working out t h e i r own problems. During the past year WHO has ass i s ted with re f resher courses f o r ward s i s t e r s , nurse and midwife t u to r s , paediatr ic nurses and heal th v i s i t o r s . The courses f o r ward s i s t e r s and f o r t u to r s have been pa r t i cu l a r ly well received.

I n most countr ies the major l i m i t i n g f a c t o r s i n the expansion of the t r a in ing programmes a r e the lack of hos te l and classroom accommodation and the shortage of funds f o r student st ipends. Until addi t ional accommodation and st ipends a r e provided i t w i l l not be possible to t r a i n the numbers of nurses and midwives who a re needed to implement the plans of governments f o r the development of heal th services.

Nursing Administration

The establishment of a sound administrative machinery f o r the control of nursing services and nursing education is essent ia l f o r the successful development of the heal th services of the countries. Nurses a r e gradually being given opportuni t ies to pa r t i c ipa t e i n the formulation of administrative policy.

A t the Directorate leve l , nat ional nurses a r e working i n four countr ies of the aegion; two countr ies have also had WHO nursing ass is tance a t t ha t l eve l , and plans a r e being made f o r the provision of !THO nurses t o the Directorates of thTee other countr ies l a t e r in 1957. I n India , i n addit ion t o the nat ional nurses working i n the cen t r a l Directorate , s i x of the fourteen S ta t e s have nurses i n the S t a t e Directorates. WHO has a lso assigned nurses to help a t the S t a t e level8 one has finished her assignment i n one S t a t e ) two have recent ly been assigned to S t a t e Directorates , and one more w i l l take up a similar post during the year. In te rna t iona l fellowships a r e being granted f o r study i n nursing administration and f o r advanced study i n nursing education.

The Regional Nursing Seminar which took place i n August 19.56, i n Delhi, provided the f i r s t opportunity f o r nurses i n South East Asia to meet toc:ethar to discuss mutual problems. This type of session can be proved very useful as a means of helping senior nurses t o c l a r i f y t h e i r thinking and t o plan object ively the wr~.s i n which they can function as leaders i n t h e i r profession f o r the improvement of nursing services and nursing education.

During the Seminar, concern was expressed over the f a c t t h a t there vras confusion with regard to the functions of the various categories of nursing and midwifery personnel, pa r t i cu l a r ly auxi l ia ry personnel. As a r e s u l t of t h i s confusion, t ra in ing is not c losely enough r e l a t ed to the d u t i e s to be performed, and, a lso, personnel a r e not being u t i l i z e d t o the bes t advantage. Effect ive u t i l i z a t i o n of s t a f f i s pa r t i cu l a r ly important i n ' countr ies which a re handicapped by a shortage of t ra ined personnel. To follow up on the discussions a t the Seminar, the nat ional nursing associat ions i n some of the countr ies a r e s t i m l a t i n g fu r the r study of t h i s problem. The Trained Nurses Association of India has undertaken to c o l l e c t da t a on the t ra in ing and u t i l i za - t ion of the a u x i l i a r j nurse midwife, and the material thus co l lec ted should be valuable f o r fu tu re s tud ies on the subject to be car r ied out with the a id of 'WO.

The report of the Nursing Seminar i s being given wide d i s t r i bu t ion .

WHO N u r s i n ~ Ac t iv i t i e s

Compared with 52 nurses a year ago, there a r e a t present 47 WHO nurses working i n 31 WHO-assisted projects i n the Region. The decrease noted is a r e f l ec t ion of the changing pa t te rn of WHO assis tance i n nursing.

During the e a r l i e r years of the Organization nurs ing ass is tance was given mainly i n basic nursing and midwifery education and i n maternal and ch i ld health. Now t h a t most of the oountries a r e b e t t e r able to assume f u l l respons ib i l i ty f o r basic nursing education, the trend i n WIiO ass is tance is towards post-graduate t ra ining, especial ly of nursing and midwifery tu to r s , and towards strengthening the administrative and supervisory machinery f o r nursing i n the Health Directorates . I n Afghanistan and Nepal, however, d i r e c t ass i s tance i n basic t r a in ing programmes w i l l continue to be necessary f o r some years.

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A fu r the r change i s taking place i n the pat tern of assistance. I n the past there has been a tendency to develop a separate project f o r each aspect o f WHO'S ass is tance i n a country. Experience has shown tha t when the projects a r e separated i t is d i f f i c u l t f o r I e i t h e r THO or the government to co r r e l a t e e f fec t ive ly the various aspects of the developments i n nursing. To overcome t h i s handicap an ef for t i s now being made to combine within one project as many a s possible of the WHO-assisted nurs ing a c t i v i t i e s planned f o r a country. An examgle of t h i s i s the nursing education project i n Afghanistan, which includes the a c t i v i t i e s which were to have been undertaken by means of four separate projects. I t i s considered t h a t by t h i s method more e f fec t ive ass is tance can be given i n studying the needs f o r nursing serv ice i n the country and i n co- ordinat ing the programmes which a r e being undertaken to meet these needs.

1.5 Health Eaucation of the Public

The shortage of heal th educators f o r posi t ions of leadership i s a ser ious handicap to the development of nat ional heal th education schemes i n almost a l l of the countr ies i n the Region. Trained personnel i s needed to plan, develop and guide a c t i v i t i e s a t nat ional and s t a t e ( o r provincial) l eve ls .

Although in te rna t iona l fellowships f o r post-graduate t r a in ing i n heal th education a re avai lable (from WHO, the Colombo Plan, ICA and o ther agencies), these fellowships alone cannot meet the needs of the countries. WfiO i s a s s i s t i n g with a proposal f o r the All-India I n s t i t u t e of Hygiene and Public Health, Calcutta, to o f f e r a ten-month s e r t i f i c a t e course f o r t r a in ing medical and non-medical persons as heal th education spec i a l i s t s .

During the past year the All-India I n s t i t u t e offered two three-month in-service courses i n which 50 students ( including medical o f f i ce r s , nurses, teachers, san i ta ry inspectors, heal th v i s i t o r s and heal th education personnel) were enrolled. The experience gained i n these two courses has been valuable as a guide i n making preparations f o r the proposed ten-month c e r t i f i c a t e course.

I n the "Research-cum-Aotion" pro jec t s operating i n three d i f f e r e n t par t s of India , with the ass is tance of the Ford Foundation and o ther agencies, a t ten t ion is being focussed on hea l th education with pa r t i cu l a r roference to environmental s an i t a t i on i n ru ra l areas. Different approaches are being appraised with a view t o u t i l i z i n g on a wide bas i s the methods found most e f f ec t ive i n bringing about improved r u r a l san i ta t ion . A 'WO hea l th educator i s a s s i s t i n g the Research-cum-Action project a t Singur.

In 1956, dur ing the two-day technical discussion on "HOW C a n School Health Wucation Programmes Be Mado More Effective i n South East Asia?", held i n connection with the ninth session of the WHO Regional Committee, various aspects of the subject were considered: the t r a in ing of personnel who cont r ibu te t o

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school heal th education; cur r icu la f o r teacher t r a in ing in s t i t u t i ons8 standards f o r san i ta ry f a c i l i t i e s i n schools, and procedures t o b r ing about co-ordination of e f fo r t s f o r school-health education. A t the request of the par t ic ipants , the working document prepared f o r the discussion and the l i s t of twenty recommendations a r i s ing out of i t were assembled i n a booklet e n t i t l e d "School Health Wuoation i n South East Asia", and widely d i s t r ibu ted .

During the past year, t ra in ing i n heal th education has been given to teachers i n several countries. With the ass i s tance of WHO, a two-week school-health seminar f o r classroom teachers and school pr incipals was conducted i n Indonesia, where spec ia l consideration was given to problems of nu t r i t i on , o o m i c a b l e diseases , environmental san i ta t ion , ch i ld development and heal th teaching. I n India a t a conference df the pr incipals of t r a in ing col leges , plans were made to include heal th education as an important par t of the revised degree syllabus. The Government of Ceylon, i n co-operation with USOM, i s a lso s t a r t i n g a project to strengthen heal th education i n schools. I n several countr ies , including Burma, Ceylon and India , committees a r e being formed with representat ives from the Departments of Health, Departments o f Mucation and o ther in te res ted agencies f o r the purpose of 00-ordinating and developing heal th education i n schools. This is a welcome development i n the Region.

In the five-year plan f o r Afghanistan, beginning i n 1956 provision is being made f o r the development of a nat ional scheme f o r heal th education. Bureaux, d iv i s ions o r sub-divisions of hea l th education have now been established i n Health Departments on the nat ional l e v e l i n Burma, Ceylon, India , Indonesia and Thailand.

Much i n t e r e s t has been shown i n the recent ly published Report of the FAO/VJHO Internat ional Seminar on Fduoation i n Health and Nutri t ion held i n Baguio ( ~ h i l i p p i n e s ) i n the f a l l of 1955. Follow-up a c t i v i t i e s with respect to t h i s seminar continue i n several countries. In hrma, ava i lab le nu t r i t i on mater ia ls were evaluated and new ones developed, and a 91-page book on nu t r i t i on and heal th education, which was wr i t ten f o r professional workers, with the col laborat ion of the WHO heal th educator and the FA0 n u t r i t i o n i s t and t h e i r counterparts, was printed with f inanc ia l ass i s tance from WHO.

The Indian Council of Uedical Researoh has recommended the s e t t i n g up of f i e l d un i t s in d i f f e r e n t S ta tes t o make country-wide surveys of the prevalence of protein malnutri t ion i n i n fan t s and chi ldren, and l a t e r to carry out f i e l d t r i a l s with protein-rich foods i n order to implement i t s reoommendations. WHO ass i s ted i n the six-week t r a in ing course given to o f f i ce r s to be a s s imed to these f i e l d un i t s .

I n preparation f o r the technical discussions on heal th education of the public, to be held i n 1957 i n connection with the tenth session of the WHO Rebional Committee f o r South East Asia, Member Governments have summarized the a c t i v i t i e s r e l a t i n g t o hea l th education of the public i n t h e i r respective countries.

SU/RC 10/2 Page 10

The country papers include information on the scope of a c t i v i t i e s ; the immediate and long-range object ives of hea l th education schemes a t d i f f e r en t l eve l s ; the types of work being car r ied ou t ; coneidera- t ion of various economic, soc ia l and c u l t u r a l f ac to r s i n planning and developing it , and the administrative s teps with respect t o personnel, t r a in ing and organization which have been taken to implement heal th educaticn.

During the past year the Regional Office prepared four Technical Circulars on Health Education of the Public f o r national and in te rna t iona l heal th educators working i n the Region, and f o r other personnel i n selected WHO-assisted projects . These c i r cu l a r s highl ight information r e l a t i n g to developments i n countr ies i n the Region.

One of the s c i e n t i f i c sess ions of the inaugural meeting of the Indian Public Health Association, held i n September 1956, was devoted to heal th education of the public. Among the recommenda- t ions a r i s i n g out of the sess ion was t h a t a heal th education sect ion be established f o r the purpose of bringing together a l l those who a re concerned with planning, developing and car ry ing out hea l th education a c t i v i t i e s .

1.6 Nutr i t ion

It i s generally real ized t h a t the n u t r i t i o n a l problem, par t icu la r ly t h a t of protein malnutri t ion, i s one of the most ser ious handicaps t o the achievement of good hea l th i n the Region. I t is a problem t h a t i s c losely r e l a t ed to most of the projects with which WHO is concerned, and ass i s tance i n n u t r i t i o n i s therefore necessar i ly mainly of an i n d i r e c t nature. Such ass is tance is , f o r instance, being given a s pa r t of the work of the WHO heal th educators, and i n connection with pro jec t s of ass i s tance to general ch i ld hea l th , paedia t r ics and medical education, pa r t i cu l a r ly i n the f i e l d of soc i a l and preventive medicine. WHO has a l so been closely associated with FA0 i n prc jec t s l i k e the study of beri- be r i i n Burma, and with UNICEF i n i t s milk feeding programmes.

More d i r e c t ass i s tance to n u t r i t i o n has been given by providing a grant to the Indian Council of Medical Researoh f o r the s tud ies which i t is conducting on protein malnutri t ion and on loca l ly avai lable non-milk protein-rioh foods. Also, WHO ass i s ted In a t r a in ing course given a t the All-India I n s t i t u t e of Hyaene and Public Health, Calcutta, which was pa r t of a longer course given to State heal th o f f i c e r s a t d i f f e r e n t i n s t i t u t i o n s i n India as a f i r s t s t e p toward s e t t i n g up f i e l d u n i t s i n the d i f fe ren t S ta tes to carry out surveys of the prevalence of protein malnutri t ion In in fan ts and children.

During the year , preparations were completed f o r a go i t r e control projeot i n Ind ia with the co-operation of WHO and UNICEF, and a WHO-assisted n u t r i t i o n project was s t a r t ed i n Thailand ( f o r d e t a i l s see Pa r t 111).

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1 7 Mental Health

In the f i e l d of mental heal th , 'NHO i s concentrating i t s e f f o r t s i n South East Asia on helping to develop the All-India I n s t i t u t e of Mental Health i n Bangalore as a regional t r a in ing centre. WHO has continued to a s s i s t t h i s I n s t i t u t e with personnel, and it i s being used by psychiatry and nursing s tudents from several countr ies of the Region.

The WHO-assisted mental heal th project i n Bangkok continued u n t i l March 1957. This project was la rge ly concerned with the establishment of t e s t pat terns su i t ab l e f o r use i n ch i ld guidance c l i n i c s i n Thailand. More d e t a i l s a r e given i n Par t 111.

1.8 Social and Oocupational Health

The Seminar on Indus t r i a l and Occupational Health, which had been planned fox 1957, i s being postponed unt i l the ond of 1958, as i t was not possible f o r t he ILO, which is a l so a s s i s t i n g i n orgahizing t h i s seminar, t o pa r t i c ipa t e before t ha t time.

The Regional Office has been represented a t meetings of the Advisory Committee and Steer ing Committee of the UNESCO Research Centre on the Social Implications of Indus t r ia l iza t ion i n Southern Asia, and has continued to take an i n t e r e s t i n the UNTAA-assisted Rehabi l i ta t ion Centre i n Bombw, which provides t r a i n i n g i n physio- therapy and occupational therapy.

WHO is also co-operating with UNTAA i n preparations f o r the Seminar on Rehabi l i ta t ion to be held i n Solo i n Indonesia i n August 1957.

1.9 Dental Health

The report of the inter-regional dental seminar held i n the Western Pacif ic Region has been reproduced by the Dental Council of India and given wide c i rcu la t ion .

The Dental Health Officer of WHO Headquarters v i s i t ed Ind ia and Ceylon during the year , mainly i n regard to the preparation of a working conference on the epidemiology of periodontal diseases, to be held i n 1957 i n India and to bc followed by f u r t h e r investiga- t ions on t h i s subject with the ass i s tance of WHO.

A WHO consultant i n dental hea l th a lso v i s i t e d Ind ia f o r th ree months mainly to advise on dental education.

A professor of d e n t i s t l y f o r Burma and a short-term consultant f o r Thailand aro under reoruitment.

1WO is giving fellowships i n the , public hea l th aspects of den t i s t ry , f o r which a speoial course i s avai lable a t the Michigan School of Public Health, USA.

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2 ENVIRO~ENTAI, SANITATION

While i t is generally accepted t h a t there i s no more important problem i n Scuth East Asia than the improvement of environmental s an i t a t i cn , so f a r the attempts to meet the needs i n t h i s f i e l d have met with l imited success. One of the reasons i s the shortage of qua l i f ied public heal th engineers and san i ta r ians , which i s becoming more acute with the increasing demand f o r highly qua l i f ied experts to undertake supervisory and advisory a c t i v i t i e s a t country and s t a t e leve ls . This shortage is a l so hampering V'HOfs recruitment e f fo r t s . In the period covered by t h i s report , the f i e l d s t a f f working on environmental s an i t a t i on i n Scuth East Asia has comprised one v i s i t i n g professor i n public health engineering, four public heal th engineers and seven san i ta r ians .

One hopeful sign i n India has been the increased i n t e r e s t shown by the community development au tho r i t i e s i n the promotion of environmental s an i t a t i on i n the schools connected with c o m i t y development projects. With the aim of a s s i s t i n g the Government t o organize spec i f ic programmes i n environmental s an i t a t i on i n ru ra l areas, a project has recent ly been i n i t i a t e d i n the S t a t e of Kerala ( ~ n d i a ) , and i t is hoped t h a t a second w i l l follow short ly i n U t t a r Pradesh.

The i n i t i a t i v e taken by 'NHO i n 1953 i n promoting a n exchange of ideas on environmental s an i t a t i on by encouraging the holding of seminars of public heal th engineers h2.s had good r e s u l t s i n India. Following the f i r s t informal meeting of a group of public heal th engineers i n New Delhi, held i n connection with the regional seminar f o r water works operators organized by WHO and the Govern- ment of India i n 1953, the Ministry of Health of the Government of India adopted the policy of c a l l i n g annual conferences of s t a t e and other public health engineers to discuss various problems i n t h e i r f i e l d s . The f i r s t such conference was convened i n New Delhi i n 1955, shor t ly afte;. the second regional seminar (on sewage disposal) sponsored by WHC had been held i n Ceylon i n August 1955. The second Indian nat ional conference was held i n 1956, a l so i n New Delhi, WHO representat ives pa r t i c ipa t ing i n the discussions. A t such conferences the main problems i n environmental s an i t a t i on confronted by India a r e discussed.

The post-graduate course f o r t r a in ing public heal th engineers, organized in Madras with the help of WHO, is progressing aa t i s f ac to r i l y . I n addit ion t o the regular post-graduate course, a shor t course f o r engineers and another f o r overseers have been s t a r t ed .

In the other countr ies of the Region as well, a c t i v i t i e s have progressed. The work of WHO i n Afghanistan comprises three types of environmental san i ta t ion a c t i v i t i e s , namely, a programme i n ru ra l areas ( i n the Shewaki project a rea) , environmental s an i t a t i on work i n urban areas ( i n the c i t y of ~ a b u l ) and a school f o r san i ta r ians ( a l so a t ~ a b u l ) . I n Burma, the WHO sani ta r ian continues to give ass i s tance i n t r a in ing san i t a t i on

SEA/RCI 0/2 Page 13

workers and i n fu r the r ing a r u r a l environmen tdl san i t a t i on programme i n the area of Aung San !@o. The environmental s an i t a t i on project i n Ceylon is oontinuing, with public heal th education and the t r a in ing of s an i t a t i on workers forming an in t eg ra l pa r t of the programme of the WHO public heal th engineer. I n Indonesia, the recent ly appointed WHO public heal th engineer has begun to a s s i s t i n preliminary work on a ru ra l environmental s an i t a t i on project , and a san i ta r ian with speoial experience i n por t heal th work has been added t o the mRO team to advise the por t and a i r p o r t au thor i t i es .

A s environmental san i ta t ion work develops, the need t o have adequately trained anc i l l a ry s an i t a t i on personnel i s being f e l t more and more; t h i s implies the study of the functions which should be assigned to these workers, and on t h i s w i l l depend the basic qua l i f ica t ions to be required of candidates, the our r icu la they mst fol low and the examinations they mst undergo. The Regional Office is planning to organize a study group i n Ind ia to deal with these questions.

On t h i s question, the lack of textbooks i n t he nat ional language has been a great handicap. A s t a r t t o f i l l t h i s gap has been made i n Afghanistan, where a s an i t a t i on manual i s under preparation with the he lp of the WE0 public heal th engineer. This manual w i l l be i n Persian and w i l l cover t he pr incipal aspects of environmental s an i t a t i on i n r e l a t i on to the needs i n t h a t country. It w i l l a lso include some basic knowledge on parasitology and communicable diseases.

Some years ago a study on the subject of s e t t i n g up inte* nat ional standards f o r drinking water was s t a r t ed by WHO Headquarters on a global basis. Following preliminary inves t iga t ions , meetings of regional and in te rna t iona l groups were ca l led to s t d y t h i s question i n i t s appl icat ion to l o c a l p rac t ice and l eg i s l a t i on . This study has culminated i n the convening of an in te rna t iona l study group which has now recommended standards to be adopted.

3 . EDUCATION AND TRAINING

An important point brought out a t t he nat ional medical education conferences which have been held i n Ind ia ( 1 9 5 5 ) ~ Indonesia (1955-56) and Thailand (1956) has been the general d i s sa t i s f ac t ion with many aspects of the system of medioal education i n cur ren t use. This has given r i s e to a search f o r possible improvements.

The value of holding nat ional medioal education conferences is i n the opportunity they o f f e r to teachers and administrators to discuss openly the views and general philosophy they have acquired through t h e i r p rac t ica l experience with students i n classrooms, l abora tor ies , hosp i ta l wards and out-patient departments, and i n f i e l d practice. This leads to an honest evaluation of t h e i r work and a per iodical overhaul o f subjects such a s premedical entrance procedures, problems of prec l in ioa l t ra in ing , general cu r r i cu l a content, teaching methodology, e tc . , and even sometimes to an evaluation of the f inished product.

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It has long been f e l t t h a t there is a need i n the South East Asia Region f o r a forum f o r the exchange of information on new ideas and developments i n the medical schools. A s a contr ibut ion towards f i l l i n g t h i s need, a b u l l e t i n on medical education has been s t a r t ed by the Regional Offioe, and is being issued period- i ca l ly . To date , four numbers have been brought out. A s t h i s bu l l e t i n i s becoming be t t e r known, more contr ibut ions a r e being received and a wider c i r cu l a t ion is ca l led for .

The Regional Office has a lso d i s t r ibu ted a number of '8HO documents to the medical schools i n the Region, most of which have been invi ted to take advantage of the special discount on the price of a l l WHO publications and subscriptions to per iodicals , which i s described i n Par t 11, Section 4.

In 1957, a team of two senior Canadian medical educationists under the Colombo Plan made surveys of three selected Indian Medical Colleges. Conferences between them and members of the Regional Office s t a f f resul ted i n a useful exchange of information and opinions.

3.1 Direct Acsistance to Muoational I n s t i t u t i o n s

One of the main aims of WHO has continued t o be the provision of su i t ab l e professors i n preventive and soc ia l medicine to various medical schools i n the Region. During the past year , one post i n India , one i n Burma and one i n Afghanistan have been f i l l e d . There a r e s t i l l four posts vacant - three i n Ind ia and one i n Indonesia. Towards the end of 1956, f i v e prospective professors of preventive and soc ia l medicine from India were sen t on WHO fellowships f o r two years to take a spec ia l course organized by the Regional Office with the Harvard School of Public Health. Four more from India, one from Burma and one from Indonesia are now being seleoted to undertake a s imi la r course.

Another important uvaq i n which \!HC has been a s s i s t i n g medical schools has been by a s s i p i n g teachers i n the pre-cl inioal subjects. A number of professors i n physiology, anatoqy, pharma~ology, pharmacy and pharmaceutical chemistly, preventive and soc i a l medicine and, i n the c l i n i c a l f i e l d , paediatr ics , have been provided to Afghanistan, Burma, Ind ia and Indonesia. The teaching of paediatr ics i s mentioned elsewhore i n the report ( s ee sect ion 2.3). A s usual , provision has been made f o r fellowships i n associat ion with these projects f o r the fu r the r t r a in ing of counterparts, who w i l l take over on the departure of the WHO professors. Unfortunately, there a r e not always su i t ab l e persons ava i lab le to take up these fellowships.

I n Thailand WHO has no medical education programme, although i t is giving ass i s tance to the School of Public Health i n Bangkok. Of i n t e r e s t i s the recent announcement t ha t a third medical school is to be es tabl ished, a t Chiengmai, and tha t the Government and the USOM w i l l each cont r ibu te 32.5 mil l ion baht (approx. $155,000) t o t h i s project over s i x years. A nursing school, i n addit ion, w i l l be b u i l t with ass is tance from USOM.

sm/RC 1 0/2 Page 15

3.2 Fellowships

The fellowship programme continues to expand, both i n the numbers of fellows going out from the Region and of those from other WHO Regions coming to South East Asia f o r courses and study tours. The number of fellowships awarded during t h i s period was 93 as compared with 68 i n 1955-1956. Statements showing (1 ) the number of fellowships awarded by country, sources of funds and the breakdown between regional and in te rna t iona l fellowships, and (2) the d i s t r i b u t i o n of fellowships by subject of study and by country a r e given i n the tab les i n Annex 5.

Awards continue to be concentrated on basic hea l th subjects , such a s maternal and. ohi ld heal th and paediatr ics , nurs ing education, hea l th education, san i ta ry engineering, public hea l th administration, t u b e r c u l o s i s . ~ o n t r o l administration, public heal th den t i s t ry , the t r a i n i n g of professors of preventive and soc'ial medicine and t he t r a in ing of f u t u r e professors i n pre-cl inical subjects .

Ten regional fellowships a r e being granted by WHO and 21 by UNICEF f o r study a t the All-India I n s t i t u t e of Wgiene and Atblic Health a t Calcutta, which has acted a s a r e e o n a l t r a i n i n g cen t re i n a number of f i e l d s , ch i e f ly general public heal th , public hea l th nursing, maternal and ch i ld heal th , hea l th education, and occupational health. Fellows have come not only from South East Asia but from countr ies a s f a r away as Japan and Nigeria. Under the UNICEF fellowship programme 10 non-Indian doctors Bnd 11 non- Indian nurse-midwives a r e following the one-year Diploma Course i n Edaternity and Child Welfare and the C e r t i f i c a t e Course i n Public Health Nursing respect ively. These U N I C E F fellowships a r e processed through the norm1 PJRO fellowship procedures. I n addi t ion, a number of UNICEF fellowships have been taken up by Indian students. The award of diplomas to post-graduates holding degrees from o the r medical schools not off i o i a l l y reoo@rized by Calcut ta University s t i l l remains a problem.

Fellowships i n malaria and f i l a r i a s i s cont ro l a l so br ing doctors and entomologists to the Malaria I n s t i t u t e , Ind ia , and i t s f i e l d operation areas. Among o ther regional t r a i n i n g i n s t i t u t i o n s which a r e being developed m . q be mentioned the All-India I n s t i t u t e f o r Mental Health i n Bangalore, which now a f f e r s oourses f o r psychiatry and psychiatr io nursing.

Besides those who have taken up regional fellowships, nine fellows from outs ide the Region - from Austral ia , China, Mauritius, Papua New Guinea, Nigeria and the Phi l ippines - have, i n the period covered, come on study tours of various South East Asian countr ies f o r periods varying i n length from one to fou r weeks.

The s t ead i ly expanding fellowship programme of WHO i s f i l l i n g an important need a t t h i s time, when medical education i n s t i t u t i o n s a r e being b u i l t up i n t he Region.

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D i f f i c u l t i e s sometimes a r i s e i n regard to fellows' capacity to speak and unde;.stand the language of the country of study. Certa in countr ies l i k e t he United S t a t e s of America and the United Kingdom a r e now i n s i s t i n g on independent t e s t s to show an adequate knowledge of t he language.

Certa in governments i n the Reglon a l so impose basic conditions on t h e i r nat ionals who accept fellowships, whether governmental o r from in t e rna t iona l o r foreign agencies. Sure t ies a r e demanded, and pena l t ies may be imposed where the fe l low f a i l s to complete h i s programme o r does not take up government se rv ice f o r a specif ied time a f t e r h i s return. The WHO application form contains a l e t t e r of t ransmi t ta l by which the Government undertakes t h a t t he fellow w i l l no t suffer i n s a l a ry , s t a tu s , o r promotion prospects by reason of h i s lVH0 fellowship, but these statements a r e qua l i f ied by the governments' own conditions - conditions which, pa r t i cu l a r ly where they r e l a t e to f a i l u r e i n a course of s tud ies , may operate t o the detriment of t he fellow, and which, i n some cases, may poasibly make s u i t a b l s candidates re luc tan t to accept fellowships.

After WIiiii, fe l low has returned from hiu :ollowehip abroad and has beon m>loyed i n h i s country of rcaid.;ncs f o r two years, t he Government concerned r epo r t s t o VEIO on the u t i l i z a t i o n of the services of ."bib fellow, An ana lys i s of tho r epo r i s thue r e c e i v d is made i n t h e Regional Office,

Out of repor t s on 135 fellows which have so f a r been received r

127 (94.1%) a re employed i n the subject of t h e i r fellowship studies! have assumed g rea t e r r e s p o n s i b i l i t i e s ; a r e employed i n a new a c t i v i t y ; have imparted the knowledge gained by means of conferenoes and by a r t i c l e s i n medical journals; a r e engaged i n t r a i n i n g a c t i v i t i e s ; have been able t o introduce new methods; have es tabl ished new services; a r e engaged i n some type of research; have maintained some degree of contact with o ther fellows and o f f i c i a l s whom they came to know during t h e i r s tud ie s ;

2 (1 -596) have been on in t e rna t iona l assignments.

I n the period covered by t h i s repor t , the Colombo Plan is grant ing '7 .fellowships to Burma, 27 to Ceylon, 20 t o India , 4 t o Indonesia, 28 t o Nepal (20 f o r undergraduate s tud ie s i n medicine f o r f i v e and a ha l f years i n 1ndia) and 16 to Thailand i n medical and a l l i e d subjects. I C A has given 13 to Afghanistan, 4 t c Ceylon, 8 t o India, 12 to Indonesia, 4 to Nepal and 33 t o Thailand. The Rockefeller Foundation is grant ing 2 fellowships to Burma and 10 to India. Burma ha$ also received 2 followships fmm the B r i t i s h Council; Ceylon has been given 1 under the Smith-Wdt Scholarship Fund, U.S.A.; Ind ia has been awarded 1 by the Nuffield Foundation, Indonesia 2 by FAO, and Thailand 1 by UNTAA.

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4. COKMUNICABLE DISEASES

Diseases l i k e malar ia , t u b e r c u l o s i s , yaws, trachoma, smallpox, cho le ra , plague, l ep rosy and f i l a r i a s i s a r e s t i l l a major public h e a l t h problem and have t o be tackled i n t h e c o u n t r i e s of t h e Region by a mass approach through s p e c i a l oampaigns. I n some of the c o u n t r i e s , however, t h e c o n t r o l measures f o r c e r t a i n d i s e a s e s l i k e yaws, typhus, plague and smallpox can be and a r e be ing i n t e g r a t e d i n t o t h e genera l h e a l t h services. Thoro s t i l l remains a heavy load of p reven t ib lo d i s c a s o s duo t o i n s a n i t a t i o n , such d i s e a s o s a s cho le ra , on to r io , tho dysontor ios , d ia r rhooas (ospoo ia l ly i n c h i l d r e n ) and worm infestations, f o r which no l a rge - sca le programmos of environmental s a n i t a t i o n have y o t boon launched. Vi'hilo t h e nood f o r such programmos i s r e a l i z e d , tho p r a c t i c a l difficulties a r e still formidable on account of l a c k of i n i t i a l c a p i t a l expondituro, equipment and t r a i n e d s t a f f and. gross ly insuff i c i e n ' t h e a l t h e3ucntion of the publ ic .

4.1 & l a r i a and Othor Insoct-Borne Diseases

Not only docs t h e n a t i o n a l ma la r i a c o n t r o l campaign i n each country of tho Rogion cont inuo t o mako good progress , but t h e r e is a l s o an increased avrarenoss of tho n e c e s s i t y f o r accep t ing malar ia o rad ica t ion a s a coa l t o be achievod i n s t ages . Out of a t o t a l of 285 mil l ion people l i v i n g i n malarious a r e a s i n South Eas t Asia, about 160 mi l l ion a r e now under p ro tec t ion .

The p a t t e r n of TlHO a s s i s t a n c e has , d u r i n g t h e l a s t two y e a r s , sh i f ted to~vards s t r eng then ing n a t i o n a l c e n t r a l malar ia o rgan iza t ions end o f f e r i n g t echn ica l advice i n fo rmula t ing and e v a l u a t i n g n a t i o n a l programmes. I n one country - Indones ia - a d e c e n t r a l i z a t i o n of t h o malar ia s e r v i c e has taken p lace , and WHO'S a s s i s t a n o e has beer. extended t o tho p rov inc ia l l o v o l , with t e c h n i c a l advico i n tho conduct of p rov inc ia l progcammes.

Tho Rogional Committoo a t i t s n i n h soss ion d iscussed a 1 paper submittod by tho Regional D i r e c t o r con ta in ing a review of i t s o a r l i o r rocommondations, s t a t ements of t h o p resen t p o s i t i o n rega rd ing tho opidomiology and c o n t r o l of ma la r i a i n t h e va r ious c o u n t r i e s of tho Rogion and d e t a i l e d sugges t ions f o r a phased programmo of malar ia o rad ica t ion . Tho Rogional Committee mado ce i ' t s in rocommondations2, which, wi th o t h e r dovelopmonts i n malar ia c o n t r o l , a ro b r i o f l y d iscussod bolow.

I n Afghamis t~n, a programme of malar ia o rad ioa t ion i s alroady boing undortakon by tho Govornmont i n c o l l a b o r a t i o n wi th 'THO and U?TICEF. From Septonbor t o Docomber 1956, a WHO

'iG,~.rnep t S U / T ( C ~ / ~ , Corr. 1. and X,!?:. 1:

2jier;olu t i o n S E A / R C ~ / R ~

SEA/RC 10/2 Page 18

malaria advisory team col lected da ta i n the northern and eastern provinces,and spec i f ic recommendations have now been made by the Regional Office f o r the establishment of survei l lance i n these two areas s t a r t i n g i n 1957, f o r the i n t ens i f i ca t ion of s p r w i n g and f o r ce r t a in other re levant measures. The medical o f f i c e r s concerned were given WHO fellowships. About two mil l ion people a r e now under protect ion i n Afghanistan.

I n Burma, t he Government has accepted the malaria eradica- t ion scheme worked out by the Regional Off ice , and has been implementing the recommendations s ince February 1957. During the year , about e ight mil l ion people have been protected. WHO i s supplying personnel and UNICEF i s giving supplies and equipment.

I n Ceylon recommendations were made f o r the re introduct ion of spraying operations i n c e r t a i n areas and f o r an i n t ens i f i ca t ion of the survei l lance procedures. A WE0 malaria advisory team col lected da ta from February through June 1957, and appropriate recommendations w i l l be sen t to the Government. Despite some recrudescence of malaria i n Ceylon when spraying was withdrawn a f t e r more than ten years of e f f i c i e n t malaria cont ro l , the measures now contemplated by the Government maJT reasonably be expected to achieve the goal of eradicat ion and make i t possible t o withdraw spraying a f t e r a few years. The population under protection is about f i v e million.

In India , the or ig ina l proposals made by the Regional Office f o r a programme of eradicat ion have been considerably modified by the Government, i n discussion with I C A and WHO representat ives . Generous provision t o meet the increased cos t of eradicat ion i n so f a r as d o l l a r cos t s a r e concerned i s l i k e l y to be made, a s before, by I C A ; the Government w i l l make an e f f o r t to f ind 75 mill ion rupees from i t s own budget. A t the instance of the Government of India , the Regional Office has ass i s ted i n assessing the progress of the nat ional malaria control programme and has made recommendations f o r the maintenance phase i n areas where control has reached a progressive s tage i n i n t e r rup t ing transmission. During 1956-57 about 125 mill ion persons wore under protection.

The problem of malaria i n Indonesia continues to be a challenge. Indonesia i s the only country i n the Region where t rue physiological res i s tance has been met with i n one vector species (~ . sunda icus ) i n some areas and where the same species i n ce r t a in other areas has manifested an a l t e r a t i o n i n i t s behaviour, making appl icat ion of res idua l insec t ic ides d i f f i c u l t . The change-over to d i e ld r in has had useful r e s u l t s where there is a problem of t rue physiological res i s tance , but present indicat ions a r e t ha t i t may not be of value i n the areas where the vector species has a l t e r ed i t s behaviour. Secondly, there i s an acute shortage of t ra ined medical and para-medical personnel. The Government i s t ry ing to provide para-medical s t a f f a t the leve l of t~control leurs" . Eleven "controlleurs" have already been trained both i n the country and abroad, and th i r t een more, a f t e r t r a in ing loca l ly , a r e now receiving f u r t h e r t r a in ing i n other countr ies of the Region. WHO has increased the scope of its

s U/RC 1 0/2 Page 19

ass is tance, not only by having the sen ior o f f i c e r s take up advisory functions i n the conduct of the provincial programmes but a lso by deputing eight WHO a s s i s t a n t malar iologis ts to supplement the nat ional ccn t ro l leurs and to be placed i n charge of malaria surveys and control a t t he l e v e l of Residencies i n the three provinces of Java. Deta i l s of t h i s plan a re given i n Par t 111. These mcdifica- t ions i n the pat tern of PJHO ass i s tance have been made on the bas i s of discussions between the Regional Office and nat ional and ICA o f f i c i a l s .

I n Nepal, malaria control i n the multi-purpose development pro jec t i n t he Rapti Valley has been undertaken by the Government i n col laborat ion with WHO, which has assigned s t a f f to t h i s project . Here, about 25,000 people have been protected, and the epidemiology of malaria has been studied i n d e t a i l . Training has been an important fea ture of the project . I n addit ion, a na t iona l programme has been developed by the Government with the USOM, and during 1956, about 0.8 mill ion people were under protection. Recently the Regional Of f i ce , a f t e r discussion with the nat ional and USOM o f f i c i a l s , made recommendations f o r a phased ten-year nat ional eradicat ion programme.

I n Thailand, t he good progress towards malaria eradicat ion reported e a r l i e r has continued. More than ten mil l ion people a r e now under protection. Vigilance measures have been fu r the r strengthened by the appointment of a two-member team to v i s i t each v i l l a g e once a year to discover fever cases, take blood s l i des , determine malaria diagnosis microscopically, and undertake treatment of the cases of malaria. This w i l l provide fu r the r information regarding the number of cases i n areas where withdrawal of spraying has been effected o r i s contemplated. It may be necessary t o i n t ens i fy survei l lance procedures i n the l i g h t of the da t a obtained. The question of s e t t i n g up an appraisal committee, cons is t ing of a nat ional , an I C A and a WHO malariologist , to review the programme, i s under consideration.

Other malaria a c t i v i t i e s i n the Region have included a conference of the malar iologis ts of Thailand and Burma, which was held i n August 1956 i n Thailand, the f i r s t meeting of the Anti- Malaria Co-ordination Board ( i n which Vietnam, Laos, Cambodia, Thailand and Burma mere represented) i n Saigon i n November, and an inter-country meeting a t Imphal ( ~ n d i a ) i n January 1951. 'FIB0 was represented a t a l l of these meetings, a r i s i n g out of which recommendations have been made f o r col laborat ion between adjacent countr ies t o f a c i l i t a t e malaria cont ro l i n border areas.

Since the Malaria Eradication Special Accoy t created by WBD has not y e t received subs tan t ia l contr ibut ions , the programme and budget estimates included under t h i s Account and presented to

2 the Regional Committee a t i t s ninth sess ion cannot be considered.

his was the subject of a spec ia l resolut ion of the Tenth '7orld i k a l t h Assembly, iVU?0.32.

'~ocument S E A / R C ~ / ~ Add. 1

Until such time a s t h i s fund can be used, s teps a r e being taken to meet as many of the requirements as possible from the Regular and Technical Assistance budgets and from UNICEF a l loca t ions , to supplement the much l a r g e r nat ional a l loca t ions f o r the purpose. I n India , Indonesia and Nepal, i n the meantime, a l a r g e amount of funds f o r malaria eradicat ion a re being provided by ICk.

4.2 Tuberculosis

The year under review has been an important one i n respect of anti- tuberculosis work. The completion of the first phase of the Indian National Tuberculosis Survey, to whioh reference was made i n l a s t yea r t s repor t , made i t possible f o r t en t a t ive findings to be published. This survey i s being undertaken on a sampling bas i s and includes c i t i e s , small towns and v i l l ages i n t he north, ea s t and south of India. The morbidity is said t o vary from seven to t h i r t y per 1,000 population i n the d i f f e r en t areas , and the r a t e of bacter iologioal ly pos i t ive cases from one to eleven per 1,000.

I t i s of pa r t i cu l a r i n t e r e s t t h a t there seems to be no marked var ia t ion a s regards the prevalence of the disease i n r e l a t i on to the s i z e of the population u n i t , i .e., v i l l age , town, c i t y , e tc . The morbidity r a t e shows a continuous increase with age, e.g., the prevalence i n the age-group of 35 and over i s considerably higher than i n the age-group of 5 to 34. WHO w i l l a s s i s t the fu tu re work of the survey by lending to the Government of Ind ia two spec ia l ly designed t ransportable photofluorographic un i te to reach population groups h i ther to inaccessible to the mobile uni ts .

VGIO has a lso ass i s ted Ceylon i n carrying out a tuberculosis prevalence survey on a random sampling basis. The f i e l d work of the survey was completed i n the very shor t time of f i v e months, and a gra t i fy ing f ea tu re was the high response r a t e - about 96% i n the population u n i t s examined. Some of the preliminary f indings of the Indian survey were duplicated i n Ceylon, e.g., the continuous and s ign i f i can t increase of tuberculosis morbidity with age. The estimated r a t e f o r healed pathology i s 5.5 and f o r unhealed 10 per 1,000 population.

In January 1957, two important tuberculosis conferences were held i n New Delhi. Ono, organized by the In te rna t iona l Union against Tuberculosis,was attended by dist inguished workers from countr ies a l l over the world. Representatives from WHO Headquarters and the Regional Off ice par t ic ipated i n the discussions. The other conference was of 'YHO medical o f f i c e r s of tuberculosis p ro jec t s and t h e i r nat ional counterparts from three WHO regions. There were about 40 par t ic ipants . This was a follow-up o f t h e 1952 WHO conference a t Alexandria, which resu l ted i n a s e r i e s of Headquarters documents recommending technical po l ic ies regarding such matters as standard diagnostic procedures i n underdeveloped countr ies , case documentation and c l i n i c organization.

SEA/RC i 0/2 Page 21

With the a v a i l a b i l i t y to the tuberculosis worker, s ince 1952, of an increasing number of a n t i b i o t i c s and drugs, the s t ra tegy of a t tack on t h i s disease is inevi tably changing. The battleground i s moving from the sanatorium to the p a t i e n t ' s home, making i t no longer e s sen t i a l to provide beds on a l a rge sca le , and through methodological advances i n prevalence surveys i t is now possible to ensure the establishment of population t a rge t s which w i l l give a mass a t tack on tuberculosis the maximum impact. I t is therefore not surpr i s ing t h a t i n both the conferences mentioned above the emphasis was mainly on how to evaluate the incidence of tuberculosis i n underdeveloped countr ies , on problems of ambulatory chemotherapy, and on diagnostic and bio1oy;ical problems posed by the emergence of isoniazid-res is tant tubercule b a c i l l i .

The discussions a t the 'AT30 conference were a l l the more s ign i f i can t i n t h a t the Indian Government is a t the moment developing a plan f o r a country-wide tuberculosis campaign, which includes a request f o r large-scale ass i s tance by WHO and UNICEF. After the conference, WHO Headquarters and the Regional Office were ab le to a s s i s t the Government of Ind ia i n the f u r t h e r d e v e l o p ment of t h i s plan. The general s t ra tegy w i l l be la rge ly determined by the r e s u l t s o f the nat ional survey, and the t a c t i c s , i n par t , by the methods employed i n the mass BCG campaign. The s a l i e n t points a r e along the l i n e s recommended by the Regional Committee a t i t s eighth session,following i t s technical discussion on tuberculosis. The plan envisages a cen t r a l t r a in ing and research i n s t i t u t i o n , s t a t e administrative and t r a in ing cen t res and tuberculosis services a t a d i s t r i c t l e v e l , and the campaign is to be mainly based on domicil iary chemotherapy. The Indian developments w i l l very l i k e l y be followed by simil.ar ones i n other countries.

The tuberculosis chemotherapy pro jec t a t Madras, mentioned i n l a s t yea r ' s annual report , w i l l be of increasing importance, not only f o r the Indian campaign but a lso f o r s imi la r campaigns i n the Region. From a s c i e n t i f i c point of viow, i t i s hoped to obtain answers to some of the problems of domicil iary chemotherapy. From the public heal th administration point of view, tho main questions a re , f i r s t , whether domiciliary chemotherapy is a f e a s i b l e procedure a t a l l i n India , and if so, whether i t is possible to control tuberculosis i n the home by means of a s ing le , cheap, s e l f - administered drug, o r whether recourse must be had to mixed regimes, which might include more cos t ly substances, some of which a re not wholly su i t ab l e f o r self-administration.

Pending the comprehensive r e s u l t s of the t r i a l s i n progress a t Madras, p i l o t schemes f o r using the isoniazid supplied by UNICEF i n domicil iary chemotherapy are i n progress i n Afghanistan, Burma, Ind ia and Thailand.

BCG mass campaigns have continued during the year i n several countr ies of the Region; i n Burma, the Government i s put t ing i n t o e f f ec t a consolidation programme based on the gradually developing network o f r u r a l and urban hea l th centres . The Government of Ceylon also has a programme of BCG consolidation under consideration.

SEA/RC I 0/2 Page 22

4.3 Venereal Diseases and Treponematoses

National workers formerly t ra ined with the ass i s tance of WHO have continued venereal-disease control work i n Afghanistan and Burma. I n Ceylon, a very ac t ive control programme, s t a r t ed some years ago i n col laborat ion viith WHO, has been developed. Plans a r e now under consideration f o r an expansion of the ante- na t a l blood-testing se rv ice throughout the i s land , making use of the ex i s t i ng maternal and ch i ld heal th centres , to be undertaken i n col laborat ion with WHO and UNICEF. The Government has a lso prepared a scheme f o r the eradicat ion of yaws from the few s t i l l ex i s t i ng endemic pockets of the d i sease , for which in te rna t iona l ass is tance i s boing negotiated.

The venereal-disease control work i n the various Indian S ta tes t h a t were o r ig ina l ly ass i s ted vrith UNICEF serologic equipment has been car r ied on by nat ional teams who were t ra ined some time ago a t the WIiO-assisted cen t re a t Simla. There has been no large-scale expansion of viork: The Government of India , however, has included i n i t s Second Five-Year Plan a scheme f o r the control of venereal and other a l l i e d treponemal diseases , the cos t o f 'ihich w i l l be approximately Rs.5.9 mil l ion to the Central Government. This scheme has a lso been included i n the S t a t e Plans, with a provision of approximately Rc.8.4 mill ion. It envisages a s h i f t i n emphasis, within the framework of the ex i s t i ng public heal th s t ruc tu re , f rom the individual cura t ive aspeot t o an integrated programme of venereal-disease control which v i i l l combine both cu ra t ive and preventive aspects. I t i s propoged t o es tab l i sh-dur ing the Plan period 75 properly equipped and s ta f fed venereal-disease c l i n i c s i n associat ion with d i s t r i c t hosp i ta l s , and 8 venereal-disease c l i n i c s a t s t a t e headquarters, preferably attached to teaching hospi ta l s . Yav~s-control a c t i v i t i e s i n Madbya Pradesh, Andhra, Hyderabad and Orissa S t a t e s a r e going forward.. UNICEF' ass is tance to the programme continues.

The yaws-control programme i n Indonesia i s being sa t i s fac- t o r i l y run by the na t iona l workers. A t a "-am symposium held i n July 1956 i n Laviang, East Java, i t vvas recommended t h a t the mass campaien previously planned to continue up to 1965 should be compieted by 1961, and tha t the consolidation of t he mass oampaigm should be effected by 1965. Between 1950, when the programme was s t a r t e d , and the end of 1956, a population of 23.3 mil l ion was examined, a d 3.7 mil l ion yaws cases were detected and t rea ted ; during the same period, out of 31.34 mil l ion people examined i n resurveys, 1.56 mill ion cases iaere t reated.

A WHO venereologist continues t o a s s i s t with the yaws control programme i n Thailand, vuhich, desp i te c e r t a i n handicaps, i s also maintaining sa t i s f ac to ry progress. UNICEF' i s furnishing supplies. Since July 1956 the population coverage has shown an upward trend. From the beginning of the campaign i n Ma,y 1950 till the end of January 1957, over 12 mil l ion people have been examined, and of t h i s number, about 1 .I2 mill ion have been t reated i n provincial tvepon€matosis control c l i n i c s and treatment control areas.

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4.4 Other Communicable Diseases

( 1 ) F i l a r i a s i s

Studies on f i l a r i a s i s a r e i n progress i n Indonesia, Thailand, Ceylon and India.

I n India , 20 f i l a r i a s i s control u n i t s have been functioning during 1956-57 as p a r t of the nat ional f i l a r i a s i s control programme, which i s protect ing about s i x mil l ion people. A combination of hetraeone theram and in sec t i c ide spraying three -times a year i s used i n r u r a l areas; hetrazone therapy and anti- larval measures reinforced by one round of spraying a t the height o f the mosquito season a r e used i n urban areas. I n addit ion, eighteen u n i t s a r e engaged i n a f i l a r i a s i s survey i n the r e s t of the country. So f a r , about 15 mill ion people have been surveyed. I n the e n t i r e area thus surveyed a f i l a r i a l endemioity varying from about 2.5% to 40% has been found.

( 2 ) Leprosy

The expansion of the leprosy cont ro l programme i n Burma i s now under discussion with the Government and UNICEF. I n addit ion to the present provision f o r extending treatment f a c i l i t i e s by the appointment of leprosy inspectors i n each d i s t r i c t , the programme now under discussion would include intensive case-finding and more adequate r u r a l f a c i l i t i e s f o r treatment, to be ca r r i ed out i n f i v e p i l o t a reas i n the country on the same pa t te rn as the Thailand leprosy control project .

The projeot i n Ceylon was terminated towards the end of June 1957. An evaluation of the work car r ied out w i l l be found i n Par t 111.

Further discussions on the Indian leprosy cont ro l programme have taken place vvith UNICEF, and although no f i n a l plan f o r in te rna t iona l ass i s tance sa t i s f ac to ry t o a l l concerned has as y e t emerged, s teps a r e being taken to evolve a su i t ab l e plan.

A WHO l ep ro log i s t was assigned to Indonesia i n October 1956. On the bas i s of preliminary da ta co l lec ted i n the two proposed p i l o t areas , work has s t a r t ed with ass i s tance from WHO and UNICEF.

I n Thailand, the p i l o t project i n Khon Kaen has proved popular and successful. Based upon t h i s project , a plan has been formulated f o r a nat ional leprosy cont ro l programme, intended to serve, during the next few years , the north-eastern provinces of the country, i n which nearly 50% of the leprosy cases a r e located. This plan providos f o r ass i s tance from WHO s t a f f and supplies from UNICEF. The WHO s t a f f at tached to the project has a lso given advioe on the formulation of a r ehab i l i t a t i on project . Various types of treatment schedules a r e being used i n the Khon Kaen pro jec t , and de ta i led plans have been prepared f o r comparison of the r e s u l t s obtained. Special a t t en t ion has been given to the t r a i n i n g of nat ional para-medical personnel.

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\HO has ass i s ted i n plague i n India and Indonesia.

On the completion of the assignment of the WHO e p i d e m i o l o ~ s t i n April 1956, the nat ional team i n India has continued the work. The res idual e f f e c t of insec t ic ides has been studied, and i t has been noticed t h a t the plague vector could eas i ly be control led by the appl icat ion of i n sec t i c ides l i k e DDT, d i e ld r in , a l a r i n , e tc . Of the d i f f e r en t methods of applying insec t ic ides , "patch-dusting" has been found to be the most e f f ec t ive and economical. The team's f indings a lso point to d i e l d r i n a s being more e f f ec t ive than o ther insect ic ides .

The survey i s to be continued i n Saharanpur and the north- western d i s t r i c t s of Ut ta r Pradesh, especial ly i n the foo t -h i l l s of Siwalik; with a view t o de tec t ing plague f o c i i n a reas where no human plague o r r a t mortal i ty has been reported f o r a number of years.

An inveet igat ion of the epidemiology of plague i n the affected areas i n Indonesia has been s t a r t e d with ass i s tance from a WHO consultant. It is hoped to draw up a l o n e t e r m plague control pro grame . (4) Bi lharz ias i s

Following the v i s i t of a member of the Headquarters s t a f f to Ind ia a t the end of 1955, a programme of research on b i lha rz i a s i s has been drawn up. Research on the recept iv i ty of t he intermediate sna i l hosts to the Indian s t r a i n s of schistosomes and the in fec t ion of Indian s n a i l s by foreign p a r a s i t i c s t r a i n s has been recommended by the Sub-Committee on Bi lharz ias i s of the Indian Council of Medical Research.

(5) Smallpox

Smallpox is s t i l l one of the major acute c o m i c a b l e diseases i n South East Asia, and as such i s an important public heal th problem. No one questions the value of a successful vaccination system i n cont ro l l ing smallpox. The f i e l d investiga- t ion in to the causes of the continuance of the disease proposed by the Regional Committee a t i t s eighth session1 w i l l therefore concern i t s e l f l a rge ly with the organizational and administrative aspects of s e t t i n g up an e f f i c i e n t machinery f o r control . It w i l l have to deal with the f e a s i b i l i t y , from both an organizational and economic point of view, of programmes suggested f o r country- wide application.

A few Sta tes i n Ind ia a r e w i l l i n g t o take pa r t i n the proposed invest igat ion. As soon as preliminary enquir ies have been completed, a short-term consul tant w i l l be assigned to v i s i t several pa r t s of Ind ia and Burma.

Countries i n the Region have been informed of the r e s u l t s of the WHO-sponsored f i e l d and laboratory s tud ies on freeze-dried smallpox vaccine, and de ta i led l i t e r a t u r e on t h i s subject has been dis t r ibuted. Assistance i n the form of consultant-servioes to help goveinments i n t he production, where f ea s ib l e , of su i t ab l e f reeze-dr ied vaccine is under discussion.

( 6 ) Trachoma

Trachoma i s a major public hea l th problem among the ru ra l populations i n most of the countr ies i n South East Asia. The epidemiological study of the f ac to r s favouring transmission o f the d i sease and the study of the minimum e f f ec t ive course of an t ib io t i c treatment being car r ied on i n connection with the trachoma p i l o t project i n India a r e making sa t i s f ac to ry progress. A s imi l a r programme has been s t a r t ed i n ~ndonesia . I n the l i g h t of the experienoe gained i n these p i l o t projects , i t w i l l be possible to develop an effect ive, p rac t icab le and eoonomically f ea s ib l e programme of mass control .

Special a t t en t ion i s being paid t o the t r a i n i n g of personnel i n the c l i n i c a l , laboratory and epidemiological aspects of the disease,with f i e l d demonstrations i n t he v i l l ages .

The WHO trachomatologist, apar t from giving ac t ive and constant supervision to the f i e l d operations, i s a l so studying the differences i n t he epidemiological and c l i n i c a l aspects of trachoma i n d i f f e r en t pa r t s of India. This study should be of ass i s tance i n preparing plans f o r s e t t i n g up nat ional control schemes.

During April 1957, the f i r s t phase of the trachoma p i l o t project i n Indonesia was evaluated by a short-term consultant. The technical d e t a i l s f o r oarrying out the second phase of the p i l o t project have s ince beon worked out with the Government.

( 7 ) Virus Diseases

The v i rus ; ~ o u p of diseases i s a t t r a c t i n g increasing a t t en t ion i n the Region. Thailand, Ind ia and Indonesia have shown pa r t i cu l a r i n t e r e s t i n the problem of p o l i o w e l i t i s . I n December 1956, tho Director of the Regional P o l i o w e l i t i s Centre i n Singapore paid a shor t v i s i t t o Thailand to conduct a survey of the extent of p o l i o w e l i t i s infect ion i n Thailand and to inves t iga te the p o s s i b i l i t y of i s o l a t i n g and typing polio viruses loca l ly . Until t h i s can be organized i n Thailand, the f a c i l i t i e s of the cen t re i n Singapore were placed a t the disposal of the Government. A s a - r e s u l t of t h i s v i s i t , the Government of Thailand-.' requested tvio six-month fellowships to enable a doctor and a technician t o study laboratory techniques a t the Singapore Centre.

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The WBO-sponsored Regional Pol ioqye l i t i s Centre i n Bombaq has car r ied out work on i so l a t ion , t i t r a t i o n and iden t i f i ca t ion of s t r a i n s of i n t e s t i n a l vi ruses i n t i s s u e cu l ture , preparation of type-specific an t i s e ra i n monkeys and rabbi t s , and a study of neu t r a l i z ing antibody content i n sera. The Centre a l so undertook a study of the incidence of minor i l l n e s s e s i n the ch i ld population of a selected area i n which po l ioqye l i t i s has been endemic and also a study of the incidence of i n t e s t i n a l vi ruses i n t he ch i ld population of the same area.

The WHO epidemiologist i n Ceylon has stimulated the study of c e r t a i n v i rus diseases i n t ha t country. A number of s e r a were sen t to the Virus Laboratory i n Poona and a l so to the National I n s t i t u t e of Health i n Bethesda, Maryland (USA). A s a r e s u l t of these s tudies , the incidence of dengue f eve r i n Ceylon has been established.

(8) Gas t ro- in tes t ina l Diseases

Largely a s a r e s u l t of the inadequate environmental san i ta t ion mentioned elsewhere i n t h i s report , the gastro- intes t inal group of diseases continues to be responsible f o r high mortal i ty and morbidity i n the Region.

An e f f o r t to evaluate the r e s u l t s t h a t uqy be expected from improved environmental san i ta t ion i s being undertaken i n Ceylon, where pre-operational and post-operational heal th surveys a r e being car r ied out.

While f o r years some rab ies control has been a f ea tu re of most of the heal th programmes of the countr ies of the Region, increased recognition needs to be given to other zoonoses. I n Ceylon, a veter inary public heal th o f f i c e r has been appointed as s t a f f o f f i c e r on the Health Directorate , to maintain l i a i s o n between the veter inary and medical services.

With respect to rabies , the Government of Ceylon i s also planning to s e t up a nation-wide cont ro l programme i n the near future . The present measures a r e therefore being s tudied, and new proposals a r e under consideration. Enquiries have a l so been received from numerous workers about the a v a i l a b i l i t y of hyperimmune serum f o r the treatment of rabies.

Nuch i n t r e s t has been shown i n the recent WHO publioations on meat hygiene' and on veterinary public health2, f o r which numerous requests have been received.

'THO HOIonograph Ser ies IJo. 33

2WH0 Technical Report Ser ies No. 111

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5. EPIDENIOLOGY AND HEALTH STATISTICS

For the hea l th administrator to be able to plan h i s heal th s t ra tegy on a r e a l i s t i c bas i s , i t i s necessary t h a t he should be i n possession of r e l i a b l e information on the amount of morbidity and mortali ty caused by the various diseases and such o ther f ac to r s as the mode of spread of these diseases and t h e i r behaviour i n d i f f e r e n t se t t ings . This information, however, i s not avai lable i n respect of most of the diseases prevalent i n South East Asia. There is in su f f i c i en t houvledge of the disease pat tern i n most of the countr ies of the Region. The almost t o t a l l ack of personnel adequately trained i n epidemiology explains the absence of epidemiological se rv ices i n these countr ies .

With a vie-$$ to a s s i s t i n g the Governments of Ceylon, Burma and Indonesia to e s t ab l i sh proper epidemiological services i n t h e i r countr ies , WHO has planned to provide qua l i f ied epidemiologists. Because of d i f f i c u l t i e s i n recruitment, however, only the project i n Ceylon has materialized so f a r .

The s e t t i n g up of an epidemiological se rv ice i s intimately re la ted to the need f o r improvements i n the f i e l d of heal th and v i t a l s t a t i s t i c s .

5.2 Health S t a t i s t i c s

During the repor t ing year, two new f i e l d pro jec t s i n v i t a l and hea l th s t a t i s t i c s have been added t o the four already i n operation, so t h a t ass is tance i s being given to s i x out of seven countries.

Although adequate heal th s t a t i s t i c s f o r the Region depend on a number of extraneous f ac to r s , such as , f o r example, the r a t i o of doctors to population, never thless , technical improvements oould accomplish much vrithin the l imi ta t ions of ex i s t i ng resources. Technical advance i s slow chie f ly because of the lack of heal th s t a t i s t i c i a n s a t the highest professional l eve l , su f f i c i en t ly experienced to adapt standard procedv-res t o Asian conditions and to organize e f fec t ive ly a l l the prac t ica l d e t a i l s of t h e i r implement- at ion. I n some coulltries of the Region, good promess i s being made i n c r ea t ing a t l e a s t a nucleus of well-qualified heal th s t a t i s t i c i a n s by means of an apprenticeship period with a 'NHO s t a t i s t i c i a n , supplemented by f u r t h e r overseas t ra in ing . As i n t h i s Region good hea l th s t a t i s t i c s a r e not being maintained, countr ies cannot speedily develop t h e i r own t o p l e v e l personnel without outside ass is tance, s ince the essen t ia l p rac t i ca l apprenticeship i s not to be had.

S t a t i s t i c a l t r a in ing a t intermediate and elementary leve ls i s equally needed. The t r a in ing courses f o r s t a t i s t i c a l a s s i s t an t s i n Indonesia have continued and have been much appreciated. A s imi la r programme a t Nagpur, I n d i a , i s awaiting f inanc ia l sanction.

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Training courses of t h i s type a re popular, but there i s a danger t ha t they may outrun the e f fec t ive demand. I n a period of three to s i x months, personnel can be trained to be s k i l f u l executants, but they w i l l not be able to design new documents o r i n i t i a t e new procedures. Unless b e t t e r methods a r e being introduced a t the same time, the t r a in ing m8,y be to some extent wasted. It is equally t rue tha t improved methods require t ra ined a s s i s t a n t s , but advances i n both d i r ec t ions should keep i n step.

The type of s t a t i s t i c a l a s s i s t a n t which is .perhaps most needed i s the t ra ined medical coder. Whenever statements of any kind about disease o r cause of death a r e handled, s k i l l e d coding i s required. The work usually devolves on doctors o r untrained c le rks , with poor r e s u l t s i n e i t h e r case. A l l 'JEO project s t a t i s t i c i a n s a r e t r a in ing nat ional coding s t a f f , but much more needs to be done.

A l l medical a d paramedical personnel need education i n the value of good report ing, and here $he f i r s t point of a t tack i s to teach a l l medical students and prac t i s ing doctors how to complete the Internat ional Medical Ce r t i f i ca t e . It is g ra t i fy ing t o note t ha t , i n addit ion to what is being done by WHO s t a t i s t i c i a n s , WHO professors and t h e i r counterparts, t h i s subject has been introduced in to the medical curriculum a t the B.J. Medical College i n Poona. There i s no reason why i t should not be taught i n every medical school i n the Region. Students a r e ea s i ly in te res ted i n something which is i n l i n e with t h e i r c l i n i c a l preoccupations, and the few simple ru l e s a r e explained i n a VYHO brochure. I f needed, a s e t of exercises can be obtained from the Regional Office.

Since i t wi l l take many years to t r a i n na t iona l s t a f f capable of implementing rapid technical advances, WHO f i e l d s t a t i s t i c i a n s must do more than give advice; they must themselves work out new methods, thus giving t h e i r nat ional counterparts the bes t possible apprenticeship.

Among the h igh l igh ts of technical progress dur ing the year has been the development of a new v i t a l s t a t i s t i c s system i n Burma. Agreement has been reached on a l l d e t a i l s within t he Ministry of Health, but some aspects of col laborat ion with other N in i s t r i e s remain to be worked out. I t i s hoped t h a t the f i r s t s tage of the new system w i l l be i n operation before the \HO expert leaves. Again i n the f i e l d of v i t a l s t a t i s t i c s may be mentioned the s e t of n o t i f i - cat ion forms f o r b i r t h s , s t i l l b i r t h s , and deaths, i n use on an experimental bas i s i n Nagpur. These have been printed i n a g l i s h and Hindi and a r e intended to introduce the idea of an individual s t a t i s t i c a l repor t f o r each v i t a l event i n a form s u i t a b l e f o r central ized processing.

Preliminary. documents f o r the regional seminar to be held i n 1958 have been c i rcu la ted to the Regional Committee, and i t i s hoped to e l i c i t the i n t e r e s t and co-operation of a l l delegates.

lmprovements i n hosp i ta l and dispensary s t a t i s t i c s a r e being introduced i n Nagpur and i n Afghanistan. The family heal th survey now i n progress a t Ramanagaram i s primarily a methodological study, and from i t m c h has already been l e a r n t which w i l l r e s u l t i n improved

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techniques f o r fu tu re surveys. Rural heal th surveys a r e being ca r r i ed out i n Indonesia on somewhat s imi la r l i n e s . The branch of heal th s t a t i s t i c s i n which ass i s tance has most of ten been sought has been t h a t of loca l hea l th reporting, pa r t i cu l a r ly f o r maternity and ch i ld heal th services. A Regional Office technical c i r c u l a r has been issued out l in ing the general p r inc ip les under- l y ing good maternal and ch i ld heal th records and reports . The laborious and d i f f i c u l t task of implementing these pr inc ip les i n the f i e l d has been undertaken as a f i r s t p r io r i t y i n the Ceylon project , and w i l l a lso be an object ive i n Thailand and Bomba~r. There i s every prospect of subs tan t ia l advance i n t h i s f i e l d before long.

The programc of ass is tance to Member S ta tes i n the prepara- t ion of t h e i r Annual Health Reports has been mentioned elsewhere. The Regional Offico was for tunate i n securing the services of the Chief of the S t a t i s t i c a l Studies Section, WHO, Geneva, vrho, with the ass is tance of various members of the Regional Office s t a f f , prepared a Manual of Inst ruct ions . Par t I of t h i s Manual has been mimeographed and d is t r ibu ted . With the completion of Par t 11, and with revislone based on experience i n i t s use, the Manual promises to be an invaluable reference work f o r the Region.

6. ASSISTAJCE TO RESEARCH INSTITUTES

Again t h i s year , research i n s t i t u t e s have been ass i s ted by means of grants f o r speclal p ro jec t s and through the t ra in ing i n research methods being given by IN30 v i s i t i n g professors who are assigned to educational i n s t i t u t e s ( s e e sect ion 3 . I ) . WHO has a lso given more d i r e c t ass i s tance i n the form of ce r t a in p i l o t projects , described i n Par t 111 of t h i s report , as , f o r example, the plague pro jec t i n India, which was terminated during the year , the plague project i n Indonesia, a t present i n operation, and the trachoma p i l o t projects a lso being car r ied out i n those two countries. One of the l a r g e s t research projects being conducted with major WHO ass i s tance is the Madras project i n the control of tuberculosis by domiciliary chemotherapy.

Stimulation of research by the dissemination of s c i e n t i f i c documents and material has a lso been proceeding. I n the scheme mentioned i n l a s t year ' s annual repor t f o r fo s t e r ing the exchange of repor t s of various research i n s t i t u t e s , the Regional Office, with the co-operation of the Medical Research I n s t i t u t e i n Colombo, obtained o r duplicated a number of copies of r ep r in t s of various papers by members of t h i s I n s t i t u t e and d i s t r i bu ted thcm to over f i f t y medical schools and research bodies i n the Region. A s the response t o t h i s plan i s good, i t is planned to continue i t on a systematic basis.

Tho Indian Council of Medical Research i s inves t iga t ing the p o s s i b i l i t i e s of undertaking- a project f o r the co-ordination of research, to be ass i s ted by WHO.

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Headquarters, i n exercis ing i t s respons ib i l i ty of co- ordinat ing research on a global bas i s , has es tabl ished a network of research cen t res i n a var ie ty of subjects. The following cen t res i n t h i s Region a re a f f i l i a t e d with WHO as pa r t of t h i s network: nat ional salmonella and s h i g e l l a cen t res i n Bangkok and Colombo; inf luenza centres i n Bombay and Coonoor ( I n d i a ) ; centres f o r biological standards i n Bombay, Kasauli, Calcutta, Coonoor, Guindy ( ~ a d r a s ) , Lucknow and Mukteswar (1ndia) and i n Bandung, Djakarta, Colombo and two i n Bangkok3 a bruce l los i s cen t re i n Mukteswar ( ~ n d i a ) and a yellow-f ever vaccine-testing cen t re i n Bombay.

7 . PUBLIC H U T H LABORATORIES AND VACCINE PRODUCTION

7 .I Public Health Laboratories

One of the great needs i n most of the count r ies of the Region is f o r an improvement of diagnostic f a c i l i t i e s . Without adequate laboratory f a c i l i t i e s , much of the hard work of the heal th personnel is hampered, and the control of a number of communicable diseases made impossible.

I n Afghanistan, the WHO laboratory a s s i s t a n t assigned to the Central Public Health Laboratory continued the t r a in ing of laboratory ass i s tan ts . I n Burma the WHO microbiologist a s s i s t ed the Government i n the strengthening of laboratory services by t r a i n i n g laboratory technicians and by helping to i n t eg ra t e special ized labora tor ies i n to public heal th labora tor ies .

In Ceylon, where there i s a dear th of adequately trained laboratory technicians, s teps a r e being taken t o a s s i s t the Government i n t h i s respect. Here the public hea l th laboratory f a c i l i t i e s a r e concentrated i n Colombo; the Medical Research I n s t i t u t e functions mainly as the cen t r a l se rv ice laboratory, and there is only one bac te r io log is t a t the I n s t i t u t e to deal with the l a rge volume of work; the specimens a r r iv ing a t the I n s t i t u t e a r e processed la rge ly by teohnicians. It is hoped tha t i n the very near fu ture labora tor ies a t Galle, Kandy and Jaffna w i l l be manned by f u l l y qua l i f ied bacterio- l og i s t s . A v i ro log i s t w i l l a lso shor t ly be ava i lab le a f t e r h i s re turn from a WHO fellowship i n Austral ia .

In India , the Second Five-Year Plan makes provj.eion f o r cen t r a l government subsidies to schemes f o r developing the public heal th laboratory services. In te rna t iona l assistance i n es tab l i sh ing such services is under consideration by the Government, WHO and UNICEF.

7.2 Vaccines

Most of the countr ies i n the rlegion a r e now producing the various types of vaccines and s e r a i n common use. To a s s i s t governments i n maintaining standards, arrangements were

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made several years ago through the good o f f i c e s of t h e Government of Ind ia f o r the t e s t i n g of these b io logica ls a t the Central Research I n s t i t u t e , Kasauli. The exoel lent f a c i l i t i e s have not been made use of to an appreciable extent.

I n Afghanistan a 'KliO bac te r io log is t continued to a s s i s t the Government i n the production of vaccines. Burma and Indonesia a r e proposing to upgrade the production of b io log ica l preparations and to s e t up s tandardizat ion methods with the help of a WHO consultant.

8. CURATIVE SERVICES

In the eighth annual report , a t the request of the Regional Committee i n 1955, a first e f f o r t was made to group together WHO'S a c t i v i t i e s i n selected cura t ive f i e l d s . However, i t i s d i f f i c u l t to draw a l i n e between ass i s tance i n prevention and ass i s tance i n cure.

k c h of 'JHO ass i s tance w i l l be leading to b e t t e r cura t ive sorvices only a f t e r some time - when i n e t i t u t i o n s have been upgraded and medical education has been improved. Of more d i r e c t inf luence a re the planned v i s i t s of limo consul tants t o selected medical schools i n India , and especial ly the award of a number of fellovrships i n such subjec ts as drug invest igat ion, hosp i ta l planning and hospi ta l s t a t i s t i c s . A short-term consul tant i n medioal care w i l l s ho r t l y be provided to Ceylon.

I n projeots f o r the cont ro l of oommunicable diseases , most of which include many d i r e c t cura t ive a c t i v i t i e s , increased a t t en t ion has been paid to trachoma and leprosy. With modern chemotherapy, the treatment aspects of 'm0-assisted tuberculosis p ro jec t s a r e receiving more a t t en t ion ; Ind ia ' s tuberculosis plan, with which 'IVHO and UNICEF arc a s s i s t i n g , i s , of course, concerned with treatment as tell as prevention. Maternal and ch i ld heal th projeots a r e a lso s t r e s s i n g the cu ra t ive s ide of ch i ld care.

A short-term consul tant has recent ly been provided to the Cancer I n s t i t u t e i n Ceylon. Radiation treatment v r i l l benef i t from planned pro jec t s f o r hosp i ta l physics, a s will t h e ex anding a c t i v i t i e s i n the peaceful uses of atomic e n e r a ( i so topes 7 .

Deta i l s of p ro jec t s re la ted to cura t ive as well a s preventive services mw be found i n Pa r t 111.

9. SOCIO-SONOKC ASPSTS OF WHO'S PROGUWE

I n a monograph published by the THO on "The Cost of Sick- ness and the Pr ice of IIealth" by the l a t e D r . C.E.A. Winslow, i t i s s t a t ed tha t "a public hea l th programme adapted t o the individual needs of each area o f f e r s the most economical method of breaking the chains of d i sease and poverty and i n i t i a t i n g an upward cycle of soo ia l evolution".

sm/RC 10/2 Page 32

The South East Asia Region i s for tuna te i n the f a c t t ha t i n a number of the countr ies na t iona l development plans have been worked out based on analysis of the t o t a l s i t ua t ion . Thus Ind ia i s already working on i t s Second Five-Year Plan; Burma is i n the process of rev is ing i t s Four-Year Plan; Afghanistan and Nepal have recent ly worked out Five-Year Plans, and Ceylon has a Six-Year Plan.

The ass i s tance being given by WHO is , by means of discussions and del ibera t ions with the nat ional hea l th au tho r i t i e s , being closely geared to these governmental plans, and therefore should form an important contr ibut ion to the socio-economic development of the countr ies concerned. This i s as t r u e f o r the regular a s f o r the WHO Technical Assistance programme, where i t i s spec i f i ca l ly s t a t ed tha t the ass i s tance should contribute to economic development.

A good instance of work of socio-economic s ign i f icance i s the community development Programmes disaussed elsewhere i n t h i s repor t ( sec t ion 2.2). These Community development pro jec t s a r e the processes by which the e f f o r t s of the people themselves a r e united with those of governmental au tho r i t i e s to improve the economic, soc ia l and c u l t u r a l conditions of communities. These programmes a re receiving more and more a t t en t ion from internat ional organizations, and WHO is co l labora t ing with governments i n t h i s f i e l d .

10. ATOKCC ENEBGY I N RELATION TO KEBLTH

WHO'S programme with regard to the peaceful uses of atomic energy can be summarized as follows. The Organization w i l l be prepared (1) to provide t ra in ing ; (2 ) t o c o l l e c t and d i s t r i b u t e information on the medical problem of atomic energy and the medical uses of radio-isotopes; (3 ) to study the hea l th problems involved i n disposal of r a d i o - a t i v e waste; (4) to work with o the r in te rna t iona l agencies f o r the d i s t r i b u t i o n of rad ia t ion standards, recommended codes of pract ice , and recommended pharmaceutical spec i f ica t ions f o r the preparatibn of radio-isotopes f o r medical use; and (5) to s t imulate and co-ordinate research on the hea l th aspects of radiat ion. The t r a i n i n g programme w i l l c a t e r f o r three d i s t r i c t categories of ~ o r k e r s : s p e c i a l i s t s (normally e i t h e r physicians o r "health physicis ts") f o r protection work i n atomic energy labora tor ies ; public-health administratore and san i ta ry engineers who a r e pa r t i cu l a r ly in te res ted i n such questions as the disposal of radio-active waste and the s i t i n g of reactors , and medical users of radio-isotopes. WHO Headquarters i s co-operating c lose ly with a number of important in te rna t iona l bodies i n t h i s respect.

In South East Asia a regional course i n hea l th physics and a course i n hosp i ta l physics with emphasis on rad ia t ion treatment and fellowships f o r the study of isotopes have been envisaged.

The i n t e r e s t of governments i n the Region i n these subjects is increasing, e.g., i n India plans a r e now taking shape f o r a new cent re t o be s e t up near the Indian Cancer Research Centre i n Bombay, to deal with the medical and biological sapeuta af btamic antar=, and alao-aith-haapttal phynice.

SEA/RC 10/2 Page 33

PART I1

1. REGIONAL COMMITTEE

The ninth session of the Regional Committee was held a t the Regional Office i n New Delhi from 24 to 29 September 1956. Represent- a t i v e s of a l l the Nember S t a t e s except France attended.

The Committee discussed the Eighth Annual Report of t he Regional Director , a number of important points emerging from the discussion. After making a de ta i led scrut iny of the programme and budget estimates, the Committee approved the regular programme and budget f o r 1958 with some amendments and endorsed the Technical Assistance Programme. Two days of the session were devoted t o the technical disoussicns on "How Can School Health Mucation Be W e More Wfec t ive i n South-East Asia?", and recommendations were made on such questions a s the personnel to be used i n heal th education programmes i n schools, t r a i n i n g f a c i l i t i e s , improvement i n the san i ta ry environment of the schools, and the co-operation of government departments and voluntary agencies.

The Regional Director ' s t en t a t ive proposals f o r a phased programme to e rad ica te malaria i n the Region v?ere approved i n pr inc ip le , and he was requested to negot ia te with individual governments on these proposals.

The Regional Committee considered tha t the present pa t te rn of regional izat ion was working to the complete s a t i s f a c t i o n of the governments of the Region and should be continued without any change.

With regard to the matter of permanent acoommodation f o r the Regional Office, i t was s t a t ed by the representat ive of India t h a t the question of c o n s t r u c t ~ n g a new building was under ac t ive consideration by the Government. I n the meantime the Regional Office would remain undisturbed i n i t s present location.

I n the f i e l d of public information, the Regional Direotort.8 proposals f o r the i s sue of a t en th anniversary booklet on heal th progress i n South-East Asia, the establishment of a "WHO Feature Service", and the encouragement of the production of shor t films on loca l hea l th problems were accepted by the Committee.

2. ORGANIZATION AND ADMINISTRATION

2.1 Orfianizational Structure

The following changes i n the pat tern of t he Regional Office took place during the year:

A post of Regional Adviser i n Medical Mucation was re- established i n January 1951 and f i l l e d by a short-term consultant.

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The post of Accountant i n the Finance, Budget and Aooounts Unit was suppressed e f fec t ive 1 February 1957 and i n i t s place a new post of Administrative Assis tant was created i n the Office of Health Services.

The t i t l e "Regional Adviselr in Ih*rsl Health", was changed to t h a t of Regional Adviser i n Public Health (Community Development) and tha t of t he Regional Adviser on Venereal Diseases and Treponematoses to Regional Adviser i n Couumnioable Diseases.

The Reports and Documents Unit was t ransferred from the Office of Administration and Finance to the Off ice of Health Services.

2.2 Personnel

The following tab le shows the number of professional and general se rv ice category posts established and ac tua l ly f i l l e d during the period under review:

Established m a t s Posts ac tua l ly f i l l e d f o r 1957 on 31 July 1321.

(1) RepCional Office S.taff

Professional

Regional Off i c e Regional Advisers Area Representatives

General Servioe

Regional Off i c e

Cler ica l Custodial

Area Representatives

Cler ica l 5 Custodial 3

(2) Projeot S ta f f

Professional 198 Professional s t a f f on

leave without pay* - General Services 2 Auxiliary s ta f f 3

I n t he year under review there was a s t i l l grea te r increase i n the volume of work. On 31 July 1957 the number of professional staff members was 159 including 9 short-term consultants.

* including s t a f f on spec ia l leave with insurance coverage.

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A l i s t of the ~ r o f e s s i o n a l s t a f f attached to the Begional Office i s given i n Arinex 1 , "Organizational Chart", and the geographical d i s t r i bu t ion of prof essional s t a f f as on 31 July 1957 i n Annex 2.

I t v s i l l be noticcd tha t , as i n the past , the majority of the s t a f f members r eomi t ed a re from the countr ies af t he Br i t i sh Commonwealth. 3orrever, during the year fu r the r countr ies mere represented on tho s t a f f by the addit ion of Bolivia, I ran and the Philippinos.

In rogard to recruitment f o r the Regional Office, the post of Public Health Administrator "A", which beoame vacant on the t ransfer of the incumbent to UNS'VA, was f i l l e d towards the end of the year by the t r m s f e r of s project s t a f f member. Public Health Administrator "B" was t ransferred to t he post of Director, Office of Hcalth Services, i n an ac t ing capacity. The post of Public Hoalth Administrc~tor "B" thus l c f t vacant was f i l l e d by the t r ans fe r of Public Hoalth Administrator "A", and f o r the l a t t e r post a replaoe- nent i s expected to take up h i s (duties i n August.

Tho post of Regional Adviser i n Communicable Diseases continues to remain un f i l l ed , but a candidate has now been selected, who, i t i s hoped, .:rill be avai lable to take up h i s du t i e s shortly. The new post of Regional Advise-r i n Public Health ( ~ o i m u n i t ~

was f i l l e d i n March 1957. The post of Public Health Cffioer ( T A was f i l l e d by the t r ans fe r of the Regional Adviser i n Deve'Opmen ti bia-tarnal and Child Health, who .,7as replaced by the :!htelnal and Child Health Offioer, vhose post romains vacant.

The new post of Administrative Assistant i n the Office of Health Services was f i l l e d by the t ransfer of a s t a f f member previously viorkin~ i n the &stern Mediterranean Regional Office.

A t tho ond of July 1957 thero nero 126 ViHO pro jec t personnel i n the f i e l t ( including 9 oonsultants) assigned to countr ies i n the Region.

A s i n t he pas t , there were d i f f i c u l t i e s i n r ec ru i t i ng qua l i f ied candidates f o r f i c l d posi t ions i n c e r t a i n specialized f i e l d s such a s public heal th , environmental s an i t a t i on , medical education, epidemiology, heal th education and s t a t i s t i c s . The f i n a l i z i n g of recruitment f o r some of tho posts has a lso been s l o ~ ? , mainly becauso of delays i n securing from governments t h e i r clearance of candidates and si,.gatures to the plans of operations.

The poss ib i l i t y of employing r e t i r e d government o f f i c i a l s from the countr ies of the Bcgion 7rms fu r the r explored, and a number were recrui ted. W f o r t s i n t h i s d i rec t ion were hampered, however, by the f a c t t h a t few su i t ab l c experts a r e avai lable i n tho Region f o r some of the same specialized f i e l d s as those mentioned above, as well as f o r maternal and ch i ld health.

A pathologist and an ophthalmologjst nero made avai lable to Ceylon under the scheme of recruitment of doctors from neighbouring countries.

SEA/RC 1 0/2 Page 36

Some new pro jec t s t a f f members assigned to Ind ia were able t o pa r t i c ipa t e i n the Seminars arranged by the Foreign Technicians Orientation Centre of the University of Delhi to he lp them to adjust to t h e i r new environment.

2.3 Staff '({elfare

A s tho r e s u l t of a United Nations review, a revised system of s a l a r i e s , allowances and benefi.ts v!ns approved by WHO and i s being put i n to e f fec t .

The sa la ry sca l e applicable to General Service s t a f f i n Rangoon was reviewed during the year. A review of the New Delhi sa la ry sca l e i s now i n progress, s ince there have been changes i n the conditions ~f employment i n the loca l area brought about par t ly by a sharp r i s e i n the general c o s t of l i v ing , r en t a l increases and ser ious housing d i f f i c u l t i e s .

The "SEARC NEWS & VIE1/Su has continued to be published during the year. Many s t a f f members have taken a keen i n t e r e s t i n t h i s publication.

The S ta f f Association and i t s Ekeoutive Committee have been very active. They a re paying pa r t i cu l a r a t t en t ion t h i s year to the improvement of the services of the canteen, the sponsorship of language c lasses and the organization of l ec tu re s , discussion groups and f i lm shows; they a re inves t iga t ing p o s s i b i l i t i e s of bringing f i e l d s t a f f in to c lo se r re la t ionsh ip with the s t a f f of the Regional Offioe, and are making de ta i led s tud ies of the housing conditions of s t a f f members and the sa la ry sca les and opportunit ies f o r career se rv ice f o r the general services category s t a f f .

2.4 Accommodation of Regional Office

A t the nineteenth session of the WHO Executive Board held i n Geneva i n January 1957, the question of accommodation f o r a l l the Regional Offices of the Organ i~~a t ion was discussed; reference w a s made a t t h a t time to the unse t t led posit ion of the Regional Office f o r South East Asia, and a resolut ion ( ~ 1 9 . ~ 2 6 ) was passed, requesting the Direotor-General to pursue with the appropriate au thor i t i es of the Government of India , the matter of providing accommodation f o r the Regional Office a t an ear ly date.

In ear ly May 1957, the Regional Director received a l e t t e r from the Government of India s t a t i n g tha t :

(1) the Government of Ind ia would make permanent accommodation ava i lab le a t a "concessional" r e n t , and tha t

( 2 ) pending arrangements f o r su i tab ly adapting an ex i s t i ng building, i t was hoped t h a t i t would be possible to allow the Regional Offioe to continue to remain i n Pa t i a l a House.

Further negutiations a r e continuing.

SEA/RCI 0/2 Page 37

2.5 Legal and Const i tut ional Matters

The posi t ion with regard to making new basic agreements, with Afghanistan, Burma, Ceylon, Indonesia and Thailand i n accordance with the provisions i n the WHO Manual, remains the same a s reported i n the eighth annual report . During the period under review, 36 supplementary agreements ( including 10 exchanges of l e t t e r s ) were signed.

There i s nothing f u r t h e r to report i n respect of accessions to the Convention on Pr ivi leges and Immunities of the Specialized Agencies.

3. PROCURmT OF EQUIPNETT AND SUPPLIW

Procurement aotion was taken i n t h i s year f o r supplies and equipment valued a t $310,000 and comprising 2,823 items, under Regular and Technical Assistance funds. The supply l ists submitted to UNICEF with WHO'S technioal approval consisted of 2,136 items, amounting to $135,000.

Shipments of hosp i ta l equipment were received from the U.S.S.R., f o r Afghanistan, Ceylon and India , under rouble contribu- t ion. The value of the supplies so f a r received i n these countr ies comes t o approximately $180,000.

4. RePORTS AND DOCUMENTS

Public health workers, administrators, medical schools, research i n s t i t u t e s i n South &st Asia - a l l a r e i n urgent need of more technical information, more books and per iodicals , the l a t e s t repor t s of in te rna t iona l experts of every conceivable spec ia l ty and the most recent WHO documents.

The Regional Office has, with the help of i t s Advisers and Area Representatives, compiled l is ts of addresses f o r each subject of public heal th importance f o r the d i s t r i bu t ion of material i n every country of the Region. On the bas i s of these lists, which a r e constantly being reviewed and revised, an attempt is made, whenever documents o r publications of i n t e r e s t a r e issued, to see t h a t they reach a t l e a s t the key workers i n the f i e l d , whether nat ional o r in te rna t iona l . In cases where new publications cannot be given a wide f r e e d i s t r i bu t ion , reviews a r e prepared and issued so t h a t as many i n s t i t u t i o n s and public hea l th workers a s possible may a t l e a s t be aware of what i s available.

Another method which has been adopted i n an attempt to he lp meet t he needs f o r technioal information a s well a s increase the s a l e s of WHO publications has been the scheme f o r grant ing t o selected i n s t i t u t i o n s , medical schools, medical associat ions , l i b r a r i e s , etc., i n c e r t a i n countr ies of t he Region concessional r a t e s (50% discount) f o r the purchase of WBO publications, and

sEA/RC 1 0/2 Page 38

special r a t e s f o r subscr ipt ions to periodicals. This plan was put i n to e f f e c t a t the beginning of 1957. A l a r g e number of orders f o r and enquir ies about WHO publications have been received i n response t o t h i s scheme, and a more extensive coverage has ce r t a in ly been achieved.

I n addit ion, WHO is having to answer a constant ly increasing number of spec ia l requests f o r technical material on a var ie ty of subjects. The material requested includes Headquarters and Regional Office documents, f i n a l repor t s of f i e l d s t a f f , Regional Off ice reports, e tc . Documents which have been given pa r t i cu l a r ly wide d i s t r i bu t ion during the l a s t year ares ( 1 ) the Regional Director 's Annual Report; ( 2 ) the new Bul le t in on Medical Education, which i s being per iodical ly issued; ( 3 ) t he brochure on School Health Education i n South East Asia, and (4) the report of the Regional Seminar on Nursing. The Regional Office is also now compiling and i ssu ing hea l th and medical information i n the form of "technical c i r cu l a r s " on various subjects. These and other publications and documents recent ly d i s t r i bu ted have been well received, and i t ha8 sometimes been necessary to mimeograph hundreds of copies to meet the requests. I t is thought t ha t some time i n the fu tu re i t may become necessary to adopt a policy of p r in t ing c e r t a i n publ icat ions and of s e l l i n g them a t a nominal price, to meet l a rge orders from i n s t i t u t i o n s and requests from individuals.

Work on the scheme f o r fo s t e r ing an exohange of repor t s among research i n s t i t u t e s and research de artments of medical schools i n the Region has been continued 7 see sec t ion 5, Par t I).

There i s a l so a need f o r ensuring adequate d i s t r i b u t i o n of RHO material to f i e l d s t a f f and t h e i r nat ional counterparts. Ef for t s a r e being made to improve t h i s d i s t r ibu t ion .

Closely a l l i e d to the work on d i s t r i b u t i o n of documents a r e the preparation of these documents and the compiling and e d i t i n g of reports. The revised in s t ruc t ions on the preparation of f i e l d reports have now been i n e f f e c t over a year and have given good r e su l t s . A s a new pa r t of theso ins t ruc t ions , a general ou t l i ne f o r f i n a l repor t s of f i e l d s t a f f was drawn up and c i rcu la ted to a l l p ro jec t s a s p a r t of the new policy and procedures handbook. A very l a rge number of such f i n a l reports have been edited and brought out, under the "SEA" documents s e r i e s , and, when appropriate and useful , have also been f a i r l y widely d i s t r i bu ted a f t e r being cleared with the governments concerned.

Another advance during the year was the compilation of a handbook of the resolut ions which have been approved during the various sess ions of the Regional Committee,for ready reference. Other work which is being s t a r t e d is the compilation of a s t y l e manual f o r the use of Regional Off ice s t a f f , and the t r a in ing of ce r t a in members of the s e c r e t a r i a l s t a f f i n prsc'is writ ing.

The serv ices of the Regional Office Library have been considerably improved. The Library News has been f u r t h e r enlarged by the addi t ion of one sect ion on WHO publ icat ions and another on repr in t s . The number of books contained i n t he Library has been

SEA/RC 10/2 Page 39

s u b s t a n t i a l l y inc reased i n c e r t a i n s p e c i a l f i e l d s . The books have been rearranged so t h a t they may be morg e a s i l y access ib le , and completed volumes of YJBO pub l i ca t ions , a s ~ v e l l a s of some o u t s i d e journals , have been bound.

Becauso i t was found t h a t p e r i o d i c a l s from outs ido the Region wers t ak ing a very long timo t o reach tho Regional Office, sometimes a s much a s sovera l months. an arrangement was made with Hoadauarters -~ ~~~~~ - ~ ~ - . - - f o r two wooklios, t h e Lancet and tho Journal of tho America1 Nodical Associat ion, t o bo roceivod i n Gonova and s e n t by pouch. This arrangomont, vrhich has boon i n e f f e c t s inco tho boginning of tho yoar,-has rbsu l tod i n a sav ing of f o u r t o s i x v~ooks i n tho rooeption of thoso two woeklios.

5. COLLABORATION IUTH OTHER AGENCIES

5.1 United Nations

Good r e l a t i o n s h i p s wi th t h e Unitod Nations and o t h e r spoc ia l i zed agencies havo continued. The Regional Off ice and especially t h e 'VHO Area Reprosontat ivos havo maintained c l o s e c o n t a c t s wi th t h e Resident Ropresontat ives of t h e Technical Ass is tanco Board, with whom tho cc-ordinat ion of work on t h e prepara t ion and submisoion of country roquosts f o r hoa l th p r o j e c t s f inanced from Tochnical Ass is tance funds han continued.

The United Nations Tochnical Assistanco Administrat ion (UNTAA) i n South East Asia i s working i n somo f i e l d s a l l i e d to h e a l t h , o.g., DDT and p e n i c i l l i n p l a n t s , r e h a b i l i t a t i o n , and roccn t ly , i n I n d i a , c o m i t y dovolopmont, and t h e Unitod Nations Sooia l 'Welfare Divis ion i s no-:r establishing branch o f f i c o s i n s e v e r a l c o u n t r i e s , wi th the aim of expanding i t s a c t i v i t i o s i n s o c i a l welfare.

Almost h a l f of ',7HOls programmo i n South Eas t Asia i s boing c a r r i e d on j o i n t l y wi th UNICEF, wi th which vmrking r e l a t i o n s h i p s have continued t o be oxcollont . This c l o s o pa r tnorsh ip wi th UNICEF i n many p r o j e c t s has boon n o t only maintained b u t extended t o o thor s u b j e c t s , n a m l y , r u r a l h o a l t h and c o m i t y wolfarc d e v e l o p ment. A s i n tho p a s t , f o r some a d d i t i o n a l pro j o c t s as w e l l as those l i s t o d i n P a r t 111, f o r which UNICEF has boon providing supplies, such a s milk, emorgoncy medical r o l i o f , otc. , tho Regional Of f i ce of VnIO i s g iv ing advisory ass i s t anco .

WHO was ropresented a t a number of meetings of SAFE hold d u r i n g t h e yoar ( f o r d o t o i l e d l i s t s of t h e meotings i n t h e Region t o which \FRO s e n t r o p r o s e n t a t i v e s , soa Annexes 3 an& 4).

5.2 Specia l ized Agonoies

Co-oporation has continued wi th FAO, p a r t i c u l a r l y i n t h e f i e l d of n u t r i t i o n , milk and milk-products, a n d , t h i s yea r , i n tho c e l e b r a t i o n of World Hoalth Day ( t h e therno of vrhich was "Food and ~ o a l t h " ) . J o i n t a s s i s t a n c o was given t o tho n u t r i t i o n

SEA/RC I 0/2 Page 40

project i n Burma and to a new pro jec t s t a r t ed i n Thailand. WHO was represented a t FAO's th i rd conference f o r Asia and the Far East held i n Bandung.

UNESCO - The ninth session of the UNESCO General Conference was held

i n New Delhi i n November 1956; WHO was represented a t many of i t s meetings and a t those of i t s various commissions. WBO has a special i n t e r e s t i n the cen t re s e t up by UNESCO i n Calcutta to study the e f f ec t s of i ndus t r i a l i za t ion on both ru ra l and urban population.

ILO

Close r e l a t i ons have been maintained with ILO, with which joint preparations are being made f o r the Seminar on Indus t r i a l and Occupational Health, to be held i n 1958.

PIBO is col laborat ing with a number of agencies i n the United Nations family i n such programmes a s the r u r a l development project i n Shewaki (Afghanistan).

5.3 B i l a t e r a l Agencies

Colombo Plan

Relationships with the Colombo Plan au tho r i t i e s have continued to be good. The Director of the Colombo Plan Bureau f o r Technical Co-operation, i n Colombo,visited the Regional Office during August 1956 and discussed the poss ib i l i t y of increased co-operation with the United Nations special ized agencies. Experts from the Colombo Plan continued to make up some of the personnel working i n WHO-assisted projects , and some suppl ies and equipment wore a lso provided.

United S ta tes Internat ional Co-omration Administration ( I c A ~

Good col laborat ion with ICh has continued. I C A i s giving aid of various kinds to almost a l l the countr ies i n the Region; t h i s includes some very subs tan t ia l ass is tance to public heal th and, par t icu la r ly , malaria control, and about a hundred fellowships a year. Every e f f o r t is beink made to minimize overlapping by m t u a l consul ta t ions a t both Regional Office and country levels .

Other B i l a t e r a l Agencies

Some assis tance i n the f i e l d of health, under b i l a t e r a l agreements, i s a lso being given by the Union of Soviet Soc ia l i s t Republics and by Norway.

SEB/RC 1 0/2 Page 41

5.4 Non-Governmental Organizations

A t present there a r e 43 in te rna t iona l non-governmental organizations i n o f f i c i a l re la t ionsh ip with WHO, a number of which have branches o r a f f i l i a t e d agencies ac t ive i n the Region, with .;:hich '!TXO's working reLations have been s l i gh t . Ef for t s aye now being made to es tab l i sh c loser contacts with agencies such as the nat ional associat ions i n such f i e l d s as nursing, tuberculosis , soc ia l work, ch i ld welfare and heal th education, as well as organizations l i k e nat ional Red Cross soc ie t ies , with which WHO has mch i n common.

5.5 Other Agencies

There has been c lose co-operation with the Rockefeller and Ford Foundations. Association with the Rockefeller Foundation has been mostly i n the f i e l d of medical education. The Ford Foundation, with which WIIO is co l labora t ing i n Singur (1ndia) and i n general, has been very ac t ive i n India and i s supporting various kinds of t ra in ing , including t h a t i n public hea l th , community development and r u r a l hea l th extension. YE40 par t ic ipa ted i n a meeting of soc ia l s c i e n t i s t s from d i f f e r en t pa r t s of India arranged during September 1956 by the Ford Foundation, a t which the main theme f o r discussion was the react ions of v i l l age people to environmental s an i t a t i on problems and t h e i r concepts of the etiology of disease.

WHO representat ives took part i n a number of meetings during the year. Among them were the f i r s t annual meeting of the Indian Public Health Association, the second Conference of Indian Public Health Engineers, a meeting of the Anti-Malaria Co-ordination Board, various meetings of the Sc i en t i f i c Advisory Board and the Advisory Committee of the Indian Counoil of Medical Research meetings of the committees of the Indian Standards I n s t i t u t i o n [ a t which spec i f ica t ions of insec t ic ides were considered), the Indian Council of Social Work, the Indian Central Council of Health, the Fourteenth In te rna t iona l Tuberculosis Conference held i n New Delhi, the 44th Session of the Indian Science Congress Association, the 18th A l l - Ind ia Opthalmological Conference, and the inter-country Malaria Co-ordination Meeting ( see Annex 4).

6. PUBLIC INFORMATION

Public support f o r the work of the Organization continued to be s t rong i n the Region during the past year. There is a growing appreciation, among professional as well as l ay groups, of WO's r o l e as 00-ordinating agency and ca t a ly s t . The Organization's actual and poten t ia l value t o the Member Governments o f the Region i s more and more c l ea r ly understood, even by people not associated with public heal th work. On the o ther hand, the severe l imi t a t i ons t ha t 'NHO faces i n t ry ing to f u l f i l the hopes placed i n i t a re by no means f u l l y appreciated.

SU/RC 10/2 Page 42

The trend, noted i n l a s t year ' s report , has continued to be towards r e l a t i v e l y heavy emphasis upon those types of public- information work which aim a t strengthening popular support f o r heal th programmes of the Nember Governments themselves. This trend was especially evident throughout the Region i n the observance of World Health Day. Everywhere, people seemed to r e a l i z e t h i s year t ha t the r e a l meaning of the celebrat ion la^ not i n the mere f a c t of WHO'S (and FAO's) sponsorship of the occasion but ra ther i n the theme, "Food and Health", i t s e l f and i t s pa r t i cu l a r s ignif icance f o r the countr ies of South East Asia. The support forthcoming from the Member Governments was, as usual, exoellent. But the most s t r i k i n g f ea tu re of the 1957 observance of World Health Day i n the Region was the en thus ias t ic par t ic ipa t ion of a very l a r g e number of non-governmental and voluntary organizations ( including Red Cross soc i e t i e s , soc ia l welfare agencies, various youth groups, e tc . ) a t the community and v i l l age leve l . Arrangements involving r e l a t i ve ly l a rge numbers of people i n both the planning and the carrying-out of World Hoalth Day procramrnes were widespread i n several countries. The t o t a l number of people reached i n the yea r ' s observance by loca l arrangements, which showed great imaginativeness and var ic ty , appears to have been much l a rge r than ever before. These developments emphasize the po ten t ia l usefulness of World Health Day as a s t a r t i n g point f o r continuing community- wide a c t i v i t i e s i n heal th education.

Another example of the increasing emphasis on the achieve- ments of the Member Governments was the decision to f i l m c e r t a i n aspects of the t r a in ing and use of heal th a s s i s t a n t s i n one of the countr ies of the Region. This f i lming was done as a p a r t of the production of a l a rge r documentary scheduled f o r world-wide re lease next year i n connection with the Organization's t en th anniversary. Based on actual f i e l d reports and interviews with dozens of nat ional heal th workere, the theme of the "human in t e re s t " s to ry vrhich f i n a l l y emerged as the South East Asia sequence of t h i s f i lm was the i n i t i a t i v e and devotion to duty d i s p l q e d by a youthf'ul heal th a s s i s t a n t wvrking i n a remote v i l l age when h i s area was faced with the th rea t of a ser ious epidemic.

Further e f f o r t s have been made during the year to systematize the distribu1;ion of information materials eo as to reach a maximum number of persons i n "key" groups and, a t the same time, avoid wasteful expenditure on mailing them to those of l e s s e r s t r a t e g i c importance. For example, a highly-selective pa t te rn has been devised f o r the i s sue of c e r t a i n types of press re leases only to special categories of newspapers and per iodicals , the se lec t ion depending i n each case upon the known i n t e r e s t s o r po l ic ies of the edi tors . Certain informational publications a r e now dis t r ibuted, almost without exception,in response to spec i f ic requests only, which a re systematically stimulated on the basis of a carefu l advance assessment of probable i n t e r e s t . A t the same time,similar methods have been used to build up c lose r working re la t ionsh ips , f o r public- information purposes, with medical associat ions and col leges of medicine, nursing associat ions , c iv i c bodies of various kinds, soc ia l welfare agencies and youth organizations. This policy has seemed to be successful.

SEX/RCI 0/2 Page 43

PART I11

This par t of the Report contains a l i s t of the projects f o r which \THC has given ass is tance during the whole o r pa r t of the period under review, l i s t e d by country. Inter-oountry pro jec t s are a v e n a t the end. The " A i m of the project" s t a t e s the purpose f o r which i t was undertaken by the government concerned, and i s not re la ted to the form o r extent of WHO'S ass is tance.

In the f i r s t column (under "Project No., Source of Funds, Co-operating Agenciest') "R" means the regular budget, "TA" means Technical Assistance funds, and "UNICEF" the United Nations Children's Fund. Names of o ther co-operating agencies, whether o r not they have contributed funds, a r e given i n parentheses.

1. A F G H A N I S T A N

P r o j e c t No. Source of Funds T i t l e - Co-operating Agencies

Afghanistan 4* TA

School f o r Male Nurses, Kabul T0ct . 1953 - Nov. 1954; July 1955 - June 1957)

A i m of t h e p r o j e c t . To t r a i n male nurses , i n a three-year course , f o r h o s p i t a l and community h e a l t h s e r v i c e s .

Ass is tance provided by dur ing t h e s e a r . Two nurse t u t o r s .

'Iiork done. In June 1956, with t h e a s s i s t a n c e of one WHO male -- nurse t u t o r , the f i r s t c l a s s was s t a r t e d wi th n ine teen s tuden t s , seventeen of whom s u c c e s s f u l l y completed t h e i r first y e a r o f t r a i n i n g i n May 1957, when a new c l a s ? of t e n w a s a l s o enrol led .

A r e f r e s h e r course was given t o graduate nurses , and a s e r i e s of l e c t u r e s on ward and h o s p i t a l admin i s t r a t ion t o head nurses. A s p a r t of a r e f r e s h e r course f o r t eachers from t h e provinces which was held a t t h e Teachers' College i n Kabul, t h e 'iTfI0 nurse t u t o r gave a s h o r t course of l e c t u r e s on t h e School f o r Male Nurses, a s wel l a s some i n s t r u c t i o n on t h e r ecogn i t ion of c o ~ i c a b l e d i s e a s e s , wi th s p e c i a l r e fe rence t o school ch i ld ren . I n s t r u c t i o n i n anatoqy, p h y s i o l o a and f i r s t a i d was a l s o given t o t h e s t u d e n t s a t t h e School f o r S a n i t a r i a n s .

Although t h e school was s t a r t e d over a y e a r ago, t h e school b u i l d i n g i s s t i l l without water supply and s a n i t a r y f a c i l i t i e s .

A second VfHO nurse t u t o r joined t h e p r o j e c t i n May 1957, b u t t h e second coun te rpa r t has n o t y e t been appointed.

Afghanistan 6 and 39 Pub l i c -Hea l th Administrat ion, Kabul R ?,NOV. 1951 - ) ?A

A i m of t h e pro,iect. To improve public-heal th admin i s t r a t ion and s e r v i c e s ; t o t r a i n medical and para-medical personnel$ t o co-ordinate n a t i o n a l and i n t e r n a t i o n a l l y a s s i s t e d h e a l t h programmes.

Ass is tance provided by WHO dur inf f t h e gea r . A public-heal th adviser u n t i l September 1956, and an a d m i n i s t r a t i v e a s s i s t a n t throughout t h e yea r ; a c o n s u l t a n t f o r f o u r weeks.

*From t h e beginning of J u l y 1957 , t h i s p r o j e c t was amalgamated wi th the Nursing Education P r o j e c t - Afghanistan 35.

sEA/RC I 0/2 Page 45

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 1960 ( ? ) .

Work d u r i n g the yea r . The public h e a l t h a d v i s e r continued t o advise the n a t i o n a l h e a l t h a u t h o r i t i e s on the p lanning and admin i s t r a t ion of h e a l t h programmes u n t i l September 1956, when he l e f t t h e p ro jec t . S teps a r e be ing taken t o f i n d a replacement.

I n connect ion wi th t h e formula t ion of t h e h e a l t h p a r t of a Five-Year Development Plan f o r Afghanistan, a short-term consu l t an t i n publ ic h e a l t h admin i s t r a t ion was ass igned t o assist t h e Government f o r f o u r weeks ( d u r i n ~ : NovemberDeoember 1956). Some of t h e s p e c i a l i s t a d v i s e r s from t h e Regional O f f i c e a l s o a s s i s t e d by d r a f t i n g p a r t s of the Five-Year P lan r e l a t i n g t o t h e i r r e s p e c t i v e f i e l d s . The consu l t an t co-ordinated t h e advice given, i n a s i n g l e r e p o r t .

The a d m i n i s t r a t i v e a s s i s t a n t t o t h e publ ic h e a l t h a d v i s e r continued h i s work, i n c l u d i n g t h e t r a i n i n g of n a t i o n a l staff i n t h e Minis t ry of Publ lc Health i n o f f i c e procedures.

Afghanistan 1 TA

S t r e n ~ t h e n i n g of Health S t a t i s t i c s Organiza t ion , Kabul (Apr i l 1956 - ) -

A i m of the pro, ject . To fo l low up t h e work of t h e WHO-sponsored t r a i n i n g course i n v i t a l and h e a l t h s t a t i s t i c s h e l d i n K a b u l i n 1954; t o reorganize t h e Health S t a t i s t i c s Divis ion of t h e Health D i r e c t o r a t e .

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

Probable d u r a t i o n of a s s i s t a n c e . U n t i l t h e end of 1958.

Work d u r i n g the yea r . 'Nith the absence of m o r t a l i t y d a t a i n Afghanistan, h o s p i t a l and d ispensary s t h t i s t i c s assume p a r t i c u l a r importance, and much of the time of t h e s t a t i s t i c i a n has been spen t i n d e v i s i n g improved r e p o r t i n g methods. Tho e x i s t i n g form f o r monthly r e p o r t s proved imprac t i cab le , and no use had been made of t h e informat ion avai1abl.e. Penaing a r e v i s i o n of t h e form, the p r o j e c t s t a f f t abu la t ed and summarized the r e t u r n s f o r two y e a r s from a l l r e p o r t i n g h o s p i t a l s , ou t -pa t i en t departments and p o l y c l i n i o s , and i n s p i t e of l i m i t a t i o n s and inaccurac ies , a use fu l p i c t u r e was obta ined of t h e ch ie f components i n t h e out- p a t i e n t morbidi ty load . A complete s e t of new s t a t i s t i c a l forms f o r r e p o r t s from h o s p i t a l s and p o l y c l i n i c s has now been prepared and i s under cons ide ra t ion i n t h e Min i s t ry of Health. The i n d i v i d u a l s t a t i s t i c a l r e t u r n f o r in -pa t i en t s 1s a l r eady i n use i n Aliabad Hospi ta l . A s a r e s u l t of t h e i n t e r e s t i n s t a t i s t i c s aroused by the 7lHO professo r of p reven t ive and s o c i a l medicine, an Afghan d o c t o r has been appointed t o t h e poet of medical s t a t i s t i c i a n a t t h a t Hosp i t a l , and is r e c e i v i n g t r a i n i n g i n t h e s t a t i s t i c a l o f f i c e .

SEA/RC I 0/2 Page 46

Report ca rds f o r pregnant women and c h i l d r e n a t t e n d i n g p o l y c l i n i c s have been designed and approved by t h e Min i s t e r of Health. Work has continued on t h e r eo rgan iza t ion and t a b u l a t i o n of admin i s t r a t ive s t a t i s t i c s i n t h e Ministry.

A n a t i o n a l coun te rpa r t has been working wi th t h e VVHO s t a t i s t i c i a n from t h e s t a r t of t h e p r o j e c t , and is expected t o proceed overseas f o r f u r t h e r t r a i n i n g s h o r t l y . Progress has been hampered by t h e shor tage of a n c i l l a r y personnel , i nc lud ing c l e r k s and computers.

The \IiO S t a t i s t i c i a n has a s s i s t e d t h e Government i n t h e p repara t ion of a c o n s t i t u t i o n and m l e s of procedure f o r a National Committee on V i t a l and Heal th S t a t i s t i c s . A l l t h e m i n i s t r i e s concerned have expressed t h e i r i n t e r e s t , and i t is hoped t h a t such a committee w i l l be e s t a b l i s h e d be fo re long.

Afghanistan 2 TA U N I C E F

Tuberculosis Control and Tra in ing Centrs , Kabul (Nov. 1953 - ) -

A i m of t h e p ro jec t . To e s t a b l i s h a model t u b e r c u l o s i s s e r v i c e wi th emphasis on prevention; t o t r a i n n a t i o n a l personnel i n modern methods of d iagnos i s and c o n t r o l , i nc lud ing domic i l i a ry chemotherapy; t o c a r r y o u t epidemiological survey work.

Ass is tance provided by CWO dur ing t h e year . A s e n i o r o f f i c e r , a public-heal th nurse and a l abora to ry technic ian .

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 1957.

Work d u r i n g the yea r . The s e r v i c e s of t h e Centre were developed t o inc lude a c l o s e r c o l l a b o r a t i o n wi th t h e medical p r a c t i t i o n e r s and i n s t i t u t i o n s of Kabul.

I n connection wi th t h e WHO-sponsored r e f r e s h e r course f o r d i s t r i c t medical o f f i c e r s , a course of l e c t u r e s and demonstrations on t u b e r c u l o s i s and i t s prevention was given. Courses were a l s o given t o community l e a d e r s and male s a n i t a r i a n s .

The domici l ia ry chemotherapy work developed slowly owing to personnel and t r a n s p o r t d i f f i c u l t i e s .

The in te r -coun t ry b a c t e r i o l o g i s t reviewed t h e work of t h e l abora to ry dur ing t h e year . The l a b o r a t o r y t echn ic ian completed her assignment a t t h e end of 1956, and a f t e r h e r depar tu re , arrangements were made f o r t h e con t inua t ion of superv i s ion by t h e 'VHO t echn ic ian a t tached t o t h e Public Health Laboratory, Kabul ( ~ f ghanistan 25).

It w a s no t p o s s i b l e t o c a r r y o u t any survey work.

SEA/RC I 0/2 Page 47

Afghanistan 10 Maternal and Child H e ~ l t h i Kabul T A I ~ e c . 1950 - Dec. 1954; Jan. 1955 - Dec. 1956) UNICEF

A i m of the pro,ject. To expand and improve maternal and ch i ld health services and to increase t r a in ing f a c i l i t i e s .

Assistance provided by WHO durinp the year. A maternal and child heal th o f f i c e r and a public-health nurse.

Work done. In 1951 there were established i n Kabul the f i r s t two ante-natal and the f i r s t two well baby c l i n i c s i n the his tory of Afghanistan. By the end of 1956 there were f i v e of each,

The Shararah Maternity Hospital has been reorganized and converted in to a post-graduate teaching in s t i t u t i on . A domiciliary midwifery se rv ice - the f i r s t i n the country - was established, and i t s popularity has become such tha t the Government has found i t necessary to l i m i t the activities f o r the time being, as i t i s not possible t o meet the requirements i n s t a f f and t ransport .

A consul ta t ive ch i ld heal th c l i n i c was establ'ished, and the paediatr ic department completely re-organized.

Eleven nurses graduated from the Mastoorat Hospital and 11 midwives completed t h e i r t r a in ing a t the Shararah Hospital i n 1956. There are now 16 nurses and 18 midwives unaer t ra in ing .

Althougt~ t h i s project has been completed, THO w i l l continue to give nursing ass i s tance to the t r a i n i n g programnies a t the two hospi ta l s and also ass i s tance i n maternal and ch i ld heal th , as pa r t of the new Nursing Education Pro jec t , Afghanistan 35.

Afghanistan 11 Ea la r i a Control ( ~ u g . 1956 - ) T A -..

UNICEF

A i m of the project . To consol idate malaria control campaigns ' (carried out under pro jec t Afghanistan 1 s ince 1949) i n keeping with the new s t r a t e a of eradicat ing malaria; to assess r e s u l t s and plan fu tu re operations.

Assistance provided by lNHO during the year. ( a ) A malaria advisory team, cons is t ing of a malar iologis t , an entomologist and t w o technicians f o r four months from September 1956 and a senior consultant f o r one month from mid-November to guide and review the work of the team; (b ) one six-month in te rna t iona l fellowship and four regional fellovrships - two f o r three months and two f o r two months; ( c ) e s sen t i a l supplies.

Probable duration of ass is tance. Until about 1962.

SEA/RC 1 0/2 Page 48

Work during the gear. I n 1956 protect ion was offered to 1,586,187 persons and S T 9 5 7 to an addi t ional 393,000 persons. Surveillance procedures were i n s t i t u t e d i n the northern and eastern provinoes. Additional malaria inspectors were t ra ined i n the winter of 1956 and employed i n the survei l lance and supervision of spraying operations i n 1957. The recommendations made by 'NHO, on the bas i s of the recommendations of the malaria advisory team and a senior short-term consultant with respect t o in tens i fy ing spraying operations and i n s t i t u t i n g survei l lance procedures i n northern and eastern provinoes have been accepted by the Government. The two medical o f f i c e r s of these provinces were given two-month fellowships i n India. A senior malaria medical o f f i c e r was awarded a six-month in te rna t iona l fellowship to study malaria eradicat ion procedures.

Afghanistan 12 R U N I C E F

Environmental Sani ta t ion, Kabul ' ( D ~ c . 1951 - Nov. 1952; Jan. 1954 - Dec. 1956)

A i m of the pro.ject, To improve environmental s an i t a t i on by san i ta ry surveys, standard san i ta ry i n s t a l l a t i o n s f o r urban and ru ra l communities, design and construct ion of watersupply and san i ta ry i n s t a l l a t i o n s f o r government i n s t i t u t i o n s and public buildings, and l ec tu re s i n s an i t a t i on a t the Faculty of Medicine, Kabul University, and a t o ther t r a in ing i n s t i t u t i o n s f o r hea l th workers.

Assistance provided by WHO during the year. A san i ta ry engineer.

Work done. WHO-assistance was withdrawn i n December 1956, a f t e r the san i ta ry engineer completed h i s assignment.

Some of the important items of work done during the course of t h i s project were8 ( a ) the survey and study of problems connected with the water supply of Kabul and Kandahar C i t i e s , the i n s t a l l a t i o n of public baths, s an i t a t i on of lodging houses, school san i ta t ion and ass i s tance i n the p i l o t project i n environmental s an i t a t i on being car r ied out i n connect ionwith the Shewaki Rural Development P ro j ec to (b) the study and aesign of standard san i ta ry f a c i l i t i e s ; and (c) par t ic ipa t ion i n the t r a i n i n g given a t the Shararah Nidwifery School and the School f o r Lita1.e Nurses, to malaria inspectors , san i ta r ians , student- teachers and v i l l age l eve l workers, and i n the re f resher courses f o r medical o f f i ce r s .

I n assessing the r e s u l t s , i t mzy be sa id t ha t the need and importance of environmental sanitation and the necessi ty f o r having qua l i f ied personnel a r e novr being recognized. Training f a c i l i t i e s f o r hea l th workers i n s an i t a t i on have been developed and s teps taken towards es tab l i sh ing permanent i n s t i t u t i o n s f o r t h i s work. The bas i s f o r a c t i v i t i e s i n r u r a l s an i t a t i on has been l a i d , and a t t en t ion i s being given to the organization of an adequate body which can undertake the work.

A s mentioned by the san i ta ry engineer i n h i s f i n a l report , there i s a need f o r enlarging the f i e l d of work, f o r in tegra t ing environmental s an i t a t i on in to the t o t a l public heal th programme, f o r t r a in ing technical personnel and f o r extending san i ta ry education. Limitations were imposed on the development of a c t i v i t i e s , more especial ly during the e a r l i e r s tages of the project , by lack of qua l i f ied personnel, funds, t ransport and other f a c i l i t i e s .

Afghanistan 13 Assistance to Faculty of Medicine, University R of Kabul (Jan. - Aug. 1952; Sept. 1953 - )

A i m of the project . To develop on sound l i n e s the Departments of Anatow, Physiologr, Preventive Medicine, In te rna l Medicine and ~ a e d i a t r i c s ~ of t h e Faculty of Medicine, &d to t r a i n nat ional counterparts.

Assistance provided by WHO during the year. (a) A professor of anatomy, a professor of physiology, a professor of paedia t r ics and a professor o f preventive and soc ia l medicine; (b) a twelve- month international~fellowship; ( c ) equipment and medical l i t e r a t u r e . -

Probable duration of assiotance. Until the end of 1960 a t l e a s t .

Work during the year. The professor of physiology completed hie a s s i ~ m e n t i n December 1956. From h i s f i n a l report it can be seen t h a t the immediate objectives of t h i s aspect of the project have been accomplished: ( a ) theore t ica l teaching has been complemented by laboratory training8 (b ) each year the number of students i n the c l a s se s has increased5 ( c ) teaching has been co-ordinate&, and other courses a lso benef i ted from the improved teaching of t h i s d i sc ip l ine ; and (d ) a trained nat ional c o u n t e r par t has now replaced the WHO professor. The progress made i n t h i s subject has been qu i t e s a t i s f ac to ry , and the e f f o r t s have been suoessful.

In anatomy, the majority of the second-year students passed the annual examinations held i n December 1956, and the nat ional counterpart w i l l r e turn from h i s fellowship i n September 1957.

I n preventive and soc ia l medicine, WHO'S a ss i s tance s t a r t ed i n December 1956. Training i n t h i s group of subjects w i l l iz!.tially be given to t h i rd , fourth-and f i f t h year students, and a curriculum on modern l i n e s has been accepted by the Medical Faculty. The professor of preventive and soc ia l medicine has taken an ac t ive pa r t i n the second re f resher course f o r medical o f f i ce r s , and on the request of the Government is giving some ins t ruc t ion i n heal th education a t the College of Mullahs, near Kabul.

The work i n paedia t r ics s t a r t ed only i n April 1957.

SEA/RC 10/2 Page 50

Afghanistan 20 TA U N I C E F

Vaccine Production, Kabul an. 1955 - )

A i m of the pro,ject. To reorganize, expand and improve f a c i l i t i e s f o r vaccine production i n order t o provide adequate supplies of vaccine f o r the nat ional heal th programmes; to t r a i n l oca l personnel i n the production of biological substances; to organize a su i t ab l e system of vaccine d i s t r i bu t ion and use.

Assistance provided by WHO d u r i n ~ the year. A laboratory spec i a l i s t .

Probable duration of ass is tance. Until 1959.

Work during the s e a r . Sat isfactory progress was made during the year. The Vaccine I n s t i t u t e buildings were renovated and ce r t a in extensions provided, including an animal house and stabler, f o r sheep and calves. The vaccines produced a t the I n s t i t u t e viere sen t f o r potency and purl ty t e s t i n g to the Central Research I n s t i t u t e , Kasauli ( ~ n d i a ) . The repor t s were sa t i s fac tory . The I n s t i t u t e i s now i n f u l l production and can meet the requirements of the country i n respect of smallpox, cholera, TAB and ant i - rabies vaccines. Production of high t i t r e se ra , along viith dead emulsions and Kahn antigens, i s now being undertaken a t the centre .

The two fellows who were awarded six-month regional fellovrships i n March 1956, have no.;< completed t h e i r t r a in ing a t the Pasteur I n s t i t u t e , Coonoor ( ~ n d i a ) .

Afghanistan 21 Public Health Provincial Br~ans ion and Nursing T A Kducation, Kandahar and Other Provincial- U N I C E F Centres (Jan. 1955 - )

A i m of the pro,ject. To organize and develop and to t r a i n personnel f o r provincial heal th services ( s t a r t i n g i n ~ a n d a h a r ) .

Assistance provided by 'VHO during the year. ( a ) A public health o f f i ce r , a public heal th nurse and a midwifery tu to r ; (b ) supplies.

Probable duration of assistance. Unt i l 1959.

Work during the year. Improvements were car r ied out i n the work of the newly established female and ch i ldren ' s wards.

A plan f o r the improvement of s an i t a t i on i n the town was prepared and accepted by the au thor i t i es .

The t ra in ing of nurse-midwife helpers a lso continued. Six students passed t h e i r f i n a l examination and were taken on the s t a f f of the Female Hospital. Seven students were enrolled fo r

sFA/RC 10/2 Page 51

the second course, which s t a r t ed i n September 1956. A domiciliary midwifery service has been successfully established on a small scale.

A l e c tu re course on personal hygiene and f i r s t - a id was s t a r t ed i n Ma,y 1957 f o r the teachers of the g i r l s ' school.

Afghanistan 22 TA

Wvironmental Sani ta t ion, Kabul Municipality '(NOV. - Dec. 1955; March 1956 - )

A i m of the pro.iect. To develop a s an i t a t i on sect ion i n the Kabul Municipality; to plan and carry out a san i ta t ion programme including <he design, operation and maintenance of s i i t a l y ins ta l la t ionsg to t r a i n san i ta t ion personnel.

Assistance provided by WHO during the year. ( a ) A san i ta ry engineer; (b ) a twelve-month in te rna t iona l fellowship.

Probable duration of assistance. Until the end of 1958.

Work during the year. The BIHO san i ta ry engineer continued h i s e f f o r t s to es tab l i sh and develop a s an i t a t i on sec t ion i n the Kabul Lhnicipal i ty . Different designs and plans f o r san i ta ry works to improve the general san i ta ry conditions of the town were devised.

A p i l o t area i n the City of Kabul has been selected f o r the improvement of s an i t a t i on a f t e r the necessary planning. The san i ta ry survey of t h i s area s t a r t ed during the second quar te r of 1957.

The san i ta ry engineer is also taking pa r t i n the t r a in ing a c t i v i t i e s car r ied on i n the School f o r Sani tar ians , Kabul. A notable achievement was the successful completion of an in-service

J t r a in ing course i n basic san i ta t ion f o r municipal d i r ec to r s of the City of Kabul, which was s t a r t ed during the th i rd quar te r of 1956. A s an i t a t i on manual, i n Fnglish and Persian, based on l ec tu re s given i n the above course, i s under preparation.

A na t iona l counterpar t has been provides, and i t i s expecteh tha t he w i l l soon be awarded a fellovvship f o r fu r the r t ra ining.

Afghanistan 23 R

Refresher Courses f o r Medical Off icers , Kabul 720 May - 10 Aug. 1956; 22 May 1957 - )

A i m of the pro.ject. To provide provincial medical o f f i c e r s with theore t ica l and prac t ioa l t r a in ing i n modern methods of public- heal th practice.

Assistance provided by WHO during the year. ( a ) Assistance from the R e g i ~ n a l Adviser i n Medical Mucation and WHO project s t a f f i n Kabul; (b) s e c r e t a r i a l ass i s tance and teaching equipment; ( c ) half the cos t of t r ave l and maintenance expenses of s i x medical o f f i ce r s from outs ide Kabul.

SEA/RC 1 o/z Page 52

Probable d u r a t i o n of a s s i s t a n c e . To be repeated i n 1958 and 1959.

Worlc done. The f irst course of t h r e e months which was given from c May to August 1956, was descr ibed i n l a s t y e a r ' s r epor t . The f i n a l r e p o r t on t h i s course was d i s t r i b u t e d .

The second three-month course s t a r t e d on 22 May 1957 with s i x p r o v i n c i a l medical o f f i c e r s and t h r e e from t h e h e a l t h s e r v i c e s i n Kabul. For t h i s course a curr iculum on t h e l i n e s o f t h e first course was adopted by t h e ad hoc f a c u l t y comprising n a t i o n a l and WHO p ro fesso r s i n Afghanistan. The course is i n progress a t present .

Afghanistan 2 2 Assistance t o Publlc-Health L a b o r a t o ~ ~ Kabul TA l ~ a y 1956 - ) UNICEF

A i m of t h e pro.ject. To c o n s o l i d a t e t h e work of t h e public-heal th l a b o r a t o r y a t Kabul 3 t o g ive f u r t h e r t r a i n i n g t o l a b o r a t o r y technicians.

Ass i s t ance provided by VIiO d u r i n g t h e yea r . A l a b o r a t o r y technic ian .

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 1959.

Work d u r i n g t h e yea r . A nine-month course f o r l a b o r a t o r y a s s i s t a n t s was completed d u r i n g t h e y e a r , six o u t of t h e seven s t u d e n t s be ing success fu l . A second course f o r l a b o r a t o r y t echn ic i ans , t o l a s t f o r two y e a r s , was s t a r t e d i n February 195Ts viith f o u r t e e n s tuden t s .

The l abora to ry i s f u l f i l l i n g i t s r o l e as a publ ic-heal th l abora to ry . A n t i b i o t i c s e n s i t i v i t y t e s t s were c a r r i e d o u t on a n experimental b a s i s , and i t i s hoped t h a t t h i s work w i l l be f u r t h e r developed a s a r o u t i n e . Photo-e lec t r ic calorimeter methods have been introduced i n the biochemistry and :iaematology departments of t h e l abora to ry . Complete r e o r g a n i z a t i o n o f t h e c u l t u r e media s e c t i o n was undertaken, and a few new c u l t u r e media were in t roduced f o r the f i r s t time.

Afghaniatan 26 Rural I i e d t h Unl t , Chaurass ia (Shewaki 1 T A l ~ ~ r i l 1956 - ) UNICEF

A i m of t h e p r o j e c t . To improve wa te r s u p p l i e s and e x c r e t a a i s p o s a l i n t h e r u r a l a r e a s of Chaurass ia , Shewaki, V o l a y i t i and Nozeis t o d e v i s e s imple, p r a c t i c a l and economical s a n i t a r y works and t e s t t h e i r a p p l i c a b i l i t y on a p i l o t s c a l e ; t o extend similar s a n i t a t i o n programmes t o o t h e r r u r a l a r e a s ; t o t r a i n s a n i t a r i a n s and o t h e r l o c a l s t a f f .

Ass is tance provided by WHO d u r i n g t h e y e a r . ( a ) A s a n i t a r i a n ; 7 b ) one twelve-month i n t e r n a t i o n a l f e l l o w s h i p and one ten-month r eg iona l fe l lowship .

sEA/RC 10/2 Page 53

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 1960.

Work d u r i n g the year . Following t h e f irst survey made d u r i n g t h e first q u a r t e r of 1956, work s t a r t e d i n t h e p i l o t a r e a of Shewaki wi th t h e c o n s t r u c t i o n o f l a t r i n e s and manure cornposting p i t s . The c o n s t r u c t i o n of w e l l s was delayed due t o l a t e a r r i v a l of necessary equipment.

A s f u r t h e r a s s i s t a n c e i n publ ic h e a l t h a c t i v i t i e s , i nc lud ing t h e development of h e a l t h c e n t r e s , was requi red i n t h e programme of c o m n i t y development, i t was decided t o en la rge t h e a r e a t o cover n o t only Shewaki bu t o t h e r r u r a l a r e a s , wi th headquar ters i n Chaurassia , thereby i n c r e a s i n g t h e number of v i l l a g e s t o be covered from t h e i n i t i a l e leven to s i x t y . The s a n i t a r i a n has made a survey of t h i s extended area. UNICEF i s a l s o h e l p i n g i n t h i s new e f f o r t .

The proposals f o r a Five-Year Plan i n &vironmental S a n i t a t i o n f o r Afghanistan, which were prepared by t h e Regional Adviser, and submitted to t h e Government, included p lans f o r work i n the extended a r e a -around Shewaki.

A n a t i o n a l c o u n t e r p a r t was appointed.

The s a n i t a r i a n gave l e c t u r e s t o v i l l a g e l e v e l workers a t V o l a y i t i and t o t h e s t u d e n t s a t t h e School f o r S a n i t a r i a n s , Kabul. He l e f t t h e p r o j e c t d u r i n g the middle o f June 1957, and i t is expected t h a t a replacement w i l l be i n p o s i t i o n by September 1957.

Afghanistan 28 TA

School f o r S a n i t a r i a n s , Kabul ( ~ u l y 1955 - )

A i m of t h e p r o j e c t . To t r a i n s a n i t a r i a n s f o r community h e a l t h s e r v i c e s . Ass i s t ance provided by WHO d u r i n p t h e yea r . ( a ) A s a n i t a r i a n ; '(b) t each ing equipment and supp l i e s .

Probable d u r a t i o n o f a s s i s t a n c e . U n t i l t h e end of 1961.

Work d u r i n g t h e year . The t r a i n i n g of s t u d e n t s a t t h i s School has proceeded s a t i s f a c t o r i l y . From t h e r e s u l t s of a progress examination held i n October 1956 a f t e r s i x months of c l a s s e s , i t would seem t h a t the t r a i n i n g programme has been q u i t e success fu l . Out of 16 s t u d e n t s examined, s ix scored ove r 90% of t h e marks.

The s t u d e n t s have a l s o taken p a r t i n va r ious p r a c t i c a l a c t i v i t i e s - the survey of t h e expanded a r e a of the Rural Development P r o j e c t , t he s a n i t a t i o n a c t i v i t i e s of t h e Kabul Munic ipa l i ty and t h e ma la r i a c o n t r o l work.

A second group (28 s t u d e n t s ) has been en ro l l ed and t h e i r t r a i n i n g begun. The course i s scheduled t o l a s t two and a h a l f yea r s .

The s a n i t a r i a n has a l s o continued h i s l e c t u r e s t o t h e female nur ses a t t h e Idastoorat Hospi ta l .

Afghanistan 22 TA

Assistance to Jalalabad and Kandahar Hospitals 7 ~ o v . 1956 - July 19.57)

P A l m of the project . To modernize the facilities f o r diagnosis, treatment and t r a in ing a t the provincial hosp i ta l s a t Jalalabad and Kandahar.

Assistance provided by WHO d u r i n ~ the s ea r . Diagnostic, surgical and hospi ta l equipment.

Work done. Under t h i s project , '!El0 has agreed to provide (from rouble contr ibut ion) , supplies and equipment to the value of US $75,000, including two motor ca r s and two ambulances f o r the b-~o hospi ta l s a t Kandahar and Jalalabad. Some of t he suppl ies and equipment were delivered during the year , and the r e s t a r e under procurement.

Afghanistan 30 Assistance to X-Ray Department, Faculty of T A Medicine, Kabul (Nov. 1956 - )

A i m of the project . To upgrade f a c i l i t i e s and to improve the standard of teaching i n the X-Ray Department of the Faculty of Medicine; to t r a i n x-ray technicians i n the operation and maintenance of equipment) to improve diagnostic f a c i l i t i e s a t the Aliabad Hospital, arid to give t r a in ing to doctors.

Assistance provided by YirHO d u r i n ~ the year. X-ray equipment and - fi lms.

Probable duration of assistanoe. Until 1959.

Work done. Supplies and equipment comprising x-ray equipment -- and f i lms have been procured and delivered, and an x-ra~r technician i s under recruitment ( rouble contr ibut ion) .

A i m of the project . To develop the t r a in ing of male and female nurses and midwives; to es tab l i sh a t r a i n i n g programme f o r auxi l iary nurse-midwives; to make plans f o r meeting the o v e r a l l nursing needs i n the country.

This project supersedes the pro jec t "School f o r Male Nurses" ( ~ f ~ h a n i s t a n 4) , as well as t ha t par t of the projects "Maternal and Child Health" and "Public Health Provincial Expansion and Nursing Muoation" ( ~ f ~ h a n i s t a n 10 and 21) which provided f o r ass is tance to female nursing and midwifery a c t i v i t i e s i n Kabul.

Assis tance provided by WHO during: t h e yea r . ( a ) Two nurse t u t o r s and a publ ic h e a l t h nur se midwife; ( b ) s u p p l i e s and equipment.

Probable d u r a t i o n of a s s i s t a n c e . U n t i l t h e end of 1961.

Work d u r i n g t h e yea r . The publ ic h e a l t h nur se midwife took up her d u t i e s towards t h e end of June 1957 t o a s s i s t wi th t h e t r a i n i n g of midwives and t h e f u r t h e r development of maternal and c h i l d h e a l t h c e n t r e s i n Kabul. The a c t i v i t i e s of t h e two male nur se t u t o r s , who a r e a t taohed t o t h e "School f o r Male Nurses", a r e repor ted under Afghanistan 4.

Afghanistan 37 Fel lowships TA

Physiology: A twelve-month i n t e r n a t i o n a l fe l lowship .

SEA/RC 1 0 / 2 Page 56

2. B U R M A

Pro ,j ec t No. Source of Funds T i t l e Co-operating Agencies

Burma 10 Riberculosis Covntry Adviser and Lecturer TA (July 1955 - )

A i m of the project . To organize and expand the nat ional tuberculosis service; to give l ec tu re s on tuberculosis to undergraduates and graduates a t the Rangoon Ptedical College: to give fu r the r t r a in ing to counterparts t o carry out both the above functions.

Assistance provided by WHO during the year. ( a ) A tuberculosis adviser and l e c t u r e r ; (b ) R fifteen-month in te rna t iona l fellowship.

Probable duration of assistance. Unt i l the end of 1959.

Work during the gear. Plans have been prepared f o r a tuberculosis prevalence survey and f o r the maintenance phase of the BCG campaign. The l a t t e r plan has been adopted and is be& t r i e d out i n s ev i r a i urban and ru ra l heal th areas.

An attempt to e n l i s t the col laborat ion of general medical p rac t i t ioners i n Rangoon with the tuberculosis control programme met with a poor response.

Courses i n tuberculosis control f o r medical students were continued throughout the year.

The Government's decis ion regarding the carrying out of a tuberculosis survey is awaited.

Burma 11 R

BCG Vaccination ( ~ o v . 1951 - Dec. 1954; June - Aug. 1956)

A i m of the proeject. To review the technical standards of tuberculin t e s t i ng and BCG vaccination by nat ional teams engaged i n the BCG mass campaign.

Assistance provided by WHO. A BCG nurse f o r s i x weeks.

Work done. The BCG nurse v i s i t ed ten teams i n the f i e l d , reviewed techniques of tuberculin t en t ing and vaccination and suggested changes where necessary.

This assignment ended i n August 1956. Her repor t , which contained useful technical and organizational recommendations, was transmitted to the Government i n January 1957.

Burma 18 TA

Tuberculosis Control and Tra in ing Centre, mandala^ ( J u l y 1954 - )

A i m of t h e pro,ject. To e s t a b l i s h a model tube rcu los i s s e r v i c e - with emphasis on prevent ion; t o t r a i n n a t i o n a l uersonnel i n modern methods-of d i agnos i s and c o n t r o l , i n c l u d i n g domic i l i a ry cherno- therapy; t o c a r r y o u t epidemiological survey work.

Ass is tance provided by 'NHO d u r i n g t h e year . ( a ) A medical o f f i c e r , a l a b o r a t o r y t echn ic i an , an x-ray t echn ic i an and a public-heal th nur se ; ( b ) equipment and suppl ies .

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 1958.

Work d u r i n g t h e yea r . During the y e a r t h e p r o j e c t was operated under d i f f i c u l t i e s caused by shor t ages of n a t i o n a l personnel , of c e r t a i n o f f i c e r e q u i s i t e s , b f motor - t i r e s and of s p a r e p a r t s ; Some of these d e f i c i e n c i e s were even tua l ly overcome.

The 'im0 x-ray t echn ic i an completed h i s assignment i n December 1956. He had t r a i n e d s u f f i c i e n t s t a f f t o c a r r y on t h e work of h i s department, bu t no o t h e r t r a i n e e s were made a v a i l a b l e t o him.

It was p o s s i b l e t o expand t h e work of t h e d o m i c i l i a r y s e r v i c e by t h e u s e o f t h r e e m o t o r s c o o t e r s provided by WHO.

I t has n o t been p o s s i b l e t o under take survey work up t o t h e p r e s e n t , but t h e m a t t e r i s under cons ide ra t ion .

Burma 21 St rengthening of Heal th M u c a t i o n Bureau, R Rangoon (Aug. 1955 - Ju ly 1956; Jan. 1957 - ) TA ( f e l lowsh ips )

A i m of t h e p r o j e c t . To s t r eng then t h e Health M u c a t i o n Bureau, Rangoon; t o draw up a h e a l t h educat ion programme f o r t h e Teachers' T ra in ing I n s t i t u t e ! t o t r a i n a l l c a t e g o r i e s of h e a l t h personnel i n h e a l t h educat ion; t o improve h e a l t h educat ion throughout t h e count1y.

Ass i s t ance provided by WHO d u r i n g t h e yea r . ( a ) A h e a l t h educator ; (b ) two three-month r eg iona l fe l lowships .

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 1960.

Work dur ing t h e year . Because of t h e untimely d e a t h of t h e Chief Heal th Education O f f i c e r of t h e Government, t h e new h e a l t h educator provided by IIirHO i n January 1957 worked temporar i ly without a coun te rpa r t . She a s s i s t e d the s t a f f of t h e Bureau wi th o r g a n i z a t i o n a l ma t t e r s , such a s a f i l i n g system and scheme f o r mainta in ing h e a l t h m a t e r i a l s , a card index of t h e books, f i l m s and f i l m s t r i p s , a review of job d e s c r i p t i o n s of t h e s t a f f , a n d a programme of work. A h e a l t h

SEA/RC 1 0/2 Page 58

education newsletter , to be issued regular ly , has been i n i t i a t e d g educational materials have been prepared, and t r a in ing ao t i v i t i e s f o r various categories of personnel conducted, including a ten-day in-service t r a in ing course f o r health education a s s i s t a n t s worklng i n the various d i s t r i c t s and s t a t e s .

I n an evaluation of the repor t submitted i n July 1956 by the previous WHO heal th educator, on completion of her one-year ass ipment , i t was pointed out t ha t although much had been a.ccomplished, the task appeared heavy f o r one adviser, and tha t a t ten t ion might be focussed on three of the main pro jec t objectives! the strengthening of the Health Mucation Bureau, the planning of an overa l l heal th education programme, and t ra ining. Assistance i s now being directed along these l i nes .

Burma 22 Vita l and Health S t a t i s t i c s , Rangoon R 7 ~ e c . 1955 - )

A i m of the project . To es tab l i sh machinery f o r prompt no t i f i ca t ion of accurate s t a t i s t i c a l da t a ; to improve the processing of information and to t r a i n s t a f f i n s t a t i s t i c a l ~ m e t h o d s .

Assistance provided by WHO during the year. A s p e c i a l i s t i n v i t a l s t a t i s t i c s .

Probable duration of ass is tance. Until the end of 1960 ( ? ) .

Work during the year. The s p e c i a l i s t ' s recommendations f o r an improved system of v i t a l r eg i s t r a t i on and s t a t i s t i c s were considered-by the Directorate of Health Services, and complete agreement was reached on a l l points. The recommendations were then submitted to the Inter-departmental Committee on Vi t a l and Health S t a t l s t l c s , where they have been discussed a t several meetings. These discussions are continuing. The far-reaching changes envisaged under the new system necess i ta te lengthy de l ibera t ion to ensure t ha t a l l loca l circumstances a r e taken in to account and tha t the f u l l co-operation of a l l the min is t r ies concerned i s fcrthccrnlng.

The period of se rv ice of the Y E C s p e c i a l i s t has been extended f o r the t h i rd year, and i t is to be hoped t h a t a t l e a s t t he first experimental s tage of the new system w i l l be implemented before h i s departure.

Burma 25 TA

Post-Graduate School of N u r s i n ~ . Ranwon l ~ a n . - Nov. 1955; - )

A i m of the project . To give post-graduate t ra in ing to nursing tu to r s , public-heal t h nurses and midwife tu tors , to meet the requirements of the i n t e p a t e d heal th services .

Assistance provided by WHO during the year. A twelve-month in te rna t iona l fellowship to a s t a f f member of the School.

Probable duration of assistance. Until the end of 1960.

Worl: done. WHO'S ass i s tance to t h i s p ro jec t began i n 1952 (under -- ~ u r m a 6 J , with a course i n public heal th nursing f o r graduate nurse-midwives, which has helped to supply public heal th nurses f o r a maternal and ch i ld heal th project i n the country. The Government trained two fu r the r groups i n public heal th nursing, and i t i s proposed to resume t h i s type of t r a in ing i n the near future .

The public hea l th nurse t u to r provided by WHO l e f t the project i n November 1955. A general nurse-tutor is under recruitment and as soon as she a r r ives , i t is planned to s t a r t a course f o r t r a in ing nurse tutoro. A midwife-tutorst course and a new public-health nursing course w i l l be conducted l a t e r , a f t e r the recruitment of a midwife tu tor .

Burma 26 Nutr i t ion, Ranaoon ( A U ~ . 1954 - ) R

Ford Foundation)

A i m of the project . To reorganize the nu t r i t i on services and car ly out a nu t r i t i on programme; to e s t ab l i sh a n u t r i t i o n laboratory i n Rangoon; to study and improve i n s t i t u t i o n a l d i e t s ; to survey d i e t a ry habi ts and the nu t r i t i ona l s t a t u s of oe r t a in population groups; to es tab l i sh community feeding oentres.

Assistance provided by WHO during the year. A medical n u t r i t i o n i s t and a biochemist.

Probable duration of ass is tance. Unt i l the end of September 1957.

Work during the year. Aot iv i t i es under t h i s projeot continued on tho same l i n e s as i n the previous year and with the same s t a f f , including a home-economist provided by FAO.

The nat ional counterpart to the medical n u t r i t i o n i s t returned from a RXO fellowship and resumed work i n the projeot. A public-health nurse, a lso a returned WHO fellow, s t a r t e d the work of improving hospi ta l d i e t s .

Nutr i t ion and d ie ta ry surveys were car r ied out i n d i f f e r en t pa r t s of Burma and the r e s u l t s analysed. I n a survey on the incidence of be r ibe r i , of 1,500 nursing and pregnant mothers i n Rangoon examinad, the r e s u l t s showed tha t 40% of the primiparae and 50% of the multiparae had ser ious symptoms of ber iber i . Infant mortali ty among ohi ldren born out of these pregnancies was high. There was hardly any difference i n the incidence of ber iber i among middle c l a s s as compared with poorer c l a s s mothers.

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Rice samples and samples of other domestio loca l foods were examined, and i n July a p i l o t feeding programme w a s s t a r t ed , to inves t iga te the e f f e c t of adding f i s h f l o u r to the d i e t of 130 chi ldren i n d a ~ nurser ies . This programme was continued f o r nine months, and the r e s u l t s a r e now being analysed.

The examination of sohoolohildren was completed8 the somatometric da ta of over 30,000 schoolchildren have been analysed.

Lectures on n u t r i t i o n were given to a number of medical o f f i ce r s of health and to medical undergraduates.

The information col lected during the year w i l l be valuable i n planning a nat ional n u t r i t i o n programme under the guidance of a nu t r i t i on i n s t i t u t e i n which well t ra ined s t a f f and laboratory f a c i l i t i e s w i l l be avai lable .

Burma 28 TA

Assistance t o bledical College, Rangoon Uciversity (Feb. 1955 - )

A i m of the project . To upgrade the departments of pharmacology, physiology and preventive medicine i n the Medical College of Rangoon University, a s pa r t of a long-term programme f o r upgrading the Medical Faculty as a whole.

Assistance provided by 'IYHO during the year. ( a ) A professor of p4ysioloar, a professor of preventive medicine and a professor of- pharmicolo a twe1;e-month and a four-month regional fellowship; and supplies.

Probable duration of ass is tance. Until the end of 1960 (?) .

'fVork during the sear . The professor of physiology continued h i s teaching programme and also the t r a in ing of junior s t a f f i n research techniques. A course i n physiology f o r graduates taking the M.Sc. degree was introduced, and ass is tance was given with the academic examinations a t the Medical College a t Mandalay. In view of the number of students who f a i l e d i n physiology, special a t ten t ion was given to holding t u t o r i a l s and special p rac t ica l c lasses , which led to sa t i s fao tory r e s u l t s a t subsequent examinations. A su i t ab l e counterpart has not y e t been provided.

The professor of preventive medicine completed h i s assign- ment i n April 1957 and was replaced by another WHO professor i n June. The University of Rangoon approved the establishment of a Department of Preventive and Social medicine i n t he Medicd Faculty and a full- t ime Chair from June 1957, sanction being given by the Government f o r one professor, one l e c t u r e r , two demonstrators, one s t a t i s t i c i a n , one public heal th nurse and one upper and one lower d iv i s ion clerk. The WHO professor completed the h g l i s h d r a f t of a textbook on preventive and soc ia l medicine, b u i l t up from the teaching during 1956, a lso taking an ac t ive pa r t i n the refresher courses f o r heal th a s s i s t an t s and i n the f i r s t refresher course f o r medical o f f i ce r s .

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The v i s i t i n g professor of pharmacology completed h i s work in April 1957. H i s a c t i v i t i e s included t u t o r i a l teaching, the development of pharmacological research ( i n which f i e l d some ten papers were produoed during 1956-57) and examination du t i e s a t the Mandalay Uedical College. Regular s t a f f meetings f o r a review of current pharmacological l i t e r a t u r e were inaugurated; the l i b r a r y was improved, and a more systematic use of the l i b r a r y was encouraged. I n view of the adequate s t a f f now avai lable f o r the P h a r m a c o l o ~ Department, there is no need f o r fu r the r WHO ass is tance.

Burma 31 TA UNICEF

Strengthening of Malaria Division l ~ a y 1954 - )

A i m of the project . To strengthen the Malaria Division of the Central Government; to plan the extension of malaria control to the whole country and to t r a i n personnel.

Assistance provided by 'KHO during the year. ( a ) A malariologist as adviser to the Government, a san i ta r ian and an entomologist; ( b ) a throe-month regional fellowship.

Probable duration of ass is tance. Unt i l the end of 1959.

Work during the year. The malaria eradioation programme, covering the e n t i r e country, was s t a r t ed from the beginning of February 1957 by seven regional teams, each with a medical o f f icer . Other s t a f f includes three malaria a s s i s t an t s , an entomological a s s i s t an t , a laboratory technician f o r each region, and f o r each of the 95 u n i t s i n the country an inspector , f i v e supervisors ( a l l through the year) , three foremen employed f o r four months f r o m January through April and 32 spraymen employed f o r th ree months from February through April. Over 8.7 mil l ion persons have been protected during 1957, t h i s t o t a l s l i g h t l y exceeding the t a rge t of 8 million. In some areas the number protected i s s l i g h t l y l e s s than the t a rge t due to conditions of insecuri ty . Appraisal surveys a r e being in tens i f ied .

Burma was represented a t three in te rna t iona l meetings during the year, the f i r s t i n Chiengmai (Thailand and ~ u r m a ) , the second i n Saigon ( tho first meeting of the Anti-Malaria Co-ordination Board cons is t ing of Laos, Vietnam, Cambodia, Thailand and ~ u r m a ) , and the l a s t i n Imphal ( Ind ia and ~urma) .

The Regional malaria adviser v i s i t ed the pro jec t i n February and recommended an in t ens i f i ca t ion of appraisal surveys.

Rural Health Unit. Mandalay l ~ e c . 1955 - )

UNICEF

A i m of the project . To s e t up a r u r a l heal th u n i t i n order to demonstrate a heal th se rv ice combining preventive. cu ra t ive and soc ia l work; to e s t ab l i sh programmes Por t ra ining ' i n r u r a l heal th

SF$/RC 10/2 Page 62

work, including oommunicable-disease control , v i t a l and heal th s t a t i s t i c s , heal th education, maternal and ch i ld heal th , nursing and environmental sani ta t ion! to develop a country-wide programme of ru ra l heal th services .

Assistance provided by WHCl during the year. One ten-month regional fellowship.

Probable duration of ass is tance. Until the end of 1960.

Work done. The f u l l implementation of t h i s project has been delayed.

The three fellowships - one awarded i n December 1955 and the o ther two i n &y 1956 - have been completed, and the fellows have returned to Burma. One more fellowship was awarded i n June 1957.

Personnel w i l l be provided i n 1958.

Burma 34 Strengthening of Environmental Sani ta t ion TA (March 1956 - ) U N I C E P

A i m of the pro.ieot. To e s t ab l i sh i n the Aung San %o area a p i l o t demonstration a rea where ru ra l water supplies and excreta disposal w i l l be improved; to devise simple, p rao t ica l and cheap schemes f o r ru ra l water supply and l a t r i n e constmct icng to provide services and f a c i l i t i e s i n order to extend san i t a t i on to a l l r u r a l areas; to t r a i n s an i t a t i on personnel.

Assistance provided by VWO during the year. A san i ta r ian .

Probable duration of assistance. Until end of $960.

Work during the year. The s i t e of the pro jec t has been sh i f t ed from Mandalay to Aung San w o i n Rangoon. A revised plan of operations has been prepared and signed by WHO and U N I C m ; the Government1 s s ignature i s awaited.

The san i ta r ian a s s i p e d to t h i s p ro jec t has taken part i n the t r a in ing of heal th a s s i s t an t s i n the Aung San w o Health Centre, and has arranged refresher courses and shor t courses f o r heal th a s s i s t an t s and d i s t r i c t hea l th of f icers .

A programme i n ru ra l san i ta t ion has been s t a r t ed i n the area of the Health Centre; a s a n i t a m survey of the area has been undertaken w i t h the help of the t ra inees , and some work i n l a t r i n e construction and well construction has been s t a r t ed . Progress i s slow. Lack of an adequate san i ta ry engineering body, administrative d i f f i c u l t i e s , labour shortage, e tc . a r e among the main reasons f o r the delays.

A helminthic survey oarr ied out i n the v i l l age of Sawbwagygione i n the above area showed high in fe s t a t i on r a t e s .

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Burma 36 R

Public-Health Adminis t ra t ion , Rangoon I l larch - Oct. 1955; Apr i l - Nov. 1956)

A i m of the pro.ject. To expand and co-ordinate h e a l t h s e r v i c e s ; to t r a i n a l l categories of h e a l t h personnel ; t o improve t h e ope ra t ion of the Health D i r e c t o r a t e and co-ordinate i t s vmrk wi th t h a t of o t h e r d i r e c t o r a t e s and m i n i s t r i e s concerned wi th h e a l t h .

Ass i s t ance provided by WHO dur ing t h e yea r . A c o n s u l t a n t i n publ ic-heal th admin i s t r a t ion .

Work d u r i n g t h e yea r . The c o n s u l t a n t was reass igned t o the Health D i r e c t o r a t e i n Sangoon from Apr i l to November 1956 t o h e l p t h e Government i n implementing the recommendations made a f t e r his first assignment from March - October 1955. Fur the r p rogress was made i n a d m i n i s t r a t i v e ma t t e r s3 t h e annual a d m i n i s t r a t i v e r e p o r t f o r 1955 was publ ished; under t h e D i s t r i o t Heal th programme t h e Aung San b&o Heal th Centre was reorganized on sound l i n e s i n t o a Health Uni t and Tra in ing Centre; I n s e i n township was chosen f o r a p l l o t programme i n t h e development of d i s t r i c t h e a l t h u n i t s , and a guide was prepared f o r urban h e a l t h c e n t r e p r a c t i c e .

The need f o r t h e e a r l y implementation of a number of o t h e r recommendations has been s t r e s s e d .

Burma 39 Medical S t o r e s Management, Rangoon R 7 ~ u l y 1956 - )

A i m of t h e pro, ject . To ,study the system of purchasing, s t o r e - keeping and d i s t r i b u t i n g drugs and medical s u p p l i e s ; t o r eo rgan ize t h e c e r t r a l medical s t o r e s ; t o p lan b e t t e r d i s t r i b u t i o n o f medical s u p p l i e s and drugs t o h o s p i t a l s and o t h e r medical i n s t i t u t i o n s .

Ass i s t ance provided by VmO dur ing t h e yea r . ( a ) A s p e c i a l i s t i n medical s t o r e s management; ( b ) some medical l i t e r a t u r e .

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 mid-1958.

Work d u r i n g t h e y e a r . Slow but s teady progress was made i n the d i f f e r e n t a s p e c t s of t h i s p r o j e c t , such as purchasing, s tore- keeping and d i s t r i b u t i o n of drugs and medical supp l i e s . Progress was r a t h e r slow due t o l a c k of staff and of o f f i c e and s t o r a g e space and a huge accumulation of o l d s t o r e s .

Af ter the p repa ra t ion of a pre l iminary r e p o r t on staff and a b u i l d i n g f o r t h e Cent ra l Medical S t o r e s Depot, Rangoon, t h e n a t i o n a l c o u n t e r p a r t t oge the r wi th t h e VIHO specialist succeeded i n b r i n g i n g about a number of improvements." changes were made i n t h e C l e r i c a l Ledger Sec t ion ; proposals f o r new purchase procedures were submit ted , and new o f f i c e space w i l l soon become a v a i l a b l e . There was l i t t l e progress i n avoid ing t h e de lqy ing e f f e c t s of customs procedures.

SEA/RC 10/2 Page 64

A new p r i c e vocabulary has been completed. Although much work remains to be done, t h e progress made so f a r i s f a i r l y promising. There is need, however, f o r we l l t r a i n e d pharmaceutical s t a f f and f o r more s t a f f of s e n i o r s tore-keeper l e v e l .

Burma 42 TA

School of Nursing, Mandalay l ~ a r c h 1955 - Jan. 1957)

A i m of t h e p ro jec t . To improve n u r s i n g and midwifery t r a i n i n g a t t h e General Hosp i t a l , Manadalay, c o r r e l a t i n g t h e o r e t i c a l and p r a c t i c a l teaching and i n c l u d i n g publ ic-heal th nur s ing i n t h e curr iculum.

Ass is tance provided by WE0 d u r i n g t h e year. A midwife t u t o r , a genera l nu r se t u t o r and a publ ic-heal th nur se t u t o r .

Work done. During t h e course of t h e p r o j e c t , a genera l nu r s ing pre l iminary t r a i n i n g school (PTS) was e s t ab l i shed . I t included t h e o r e t i c a l and p r a c t i o a l s tudy i n t h e classroom and demonstrat ion room wi th gradual in t roduo t ion t o w a r d r o u t i n e s and d u t i e s . Publ ic h e a l t h was i n t e g r a t e d i n t o both n u r s i n g and midwife c u r r i c u l a . The midwifery PTS course was r ev i sed t o ensure s a t i s f a c t o r y coverage of a l l s u b j e c t s . Demonstrations and t u t o r i a l s were introduced t o prepare student-midwives f o r domic i l i a ry midwifery experience, and t h e period of domic i l i a ry t r a i n i n g was increased from f o u r t o s ix weeks.

Vi th WHO equipment, f o u r s e c t i o n s - t he genera l i s o l a t i o n u n i t , ma te rn i ty i s o l a t i o n u n i t , s i c k i n f a n t s e c t i o n and premature i n f a n t s e c t i o n - were s e t up wi th in t h e h o s p i t a l wards f o r u s e i n demonstrat ion teaching. A l l t h e wards have been equipped t o meet t h e bas i c requirements of n u r s i n g procedures and t rea tment .

To upgrade t h e work i n the publ ic h e a l t h f i e l d , in-serv ice courses were given i n ante-nata l c a r e , post-natal n u r s i n g c a r e , and h e a l t h educat ion w i t h i n t h e maternal and c h i l d h e a l t h f i e l d , and on t h e use and maintenance of midwifery k i t s .

Burma 44 TA

Communicable-Disease Contro l ( E p i d e m i o l o m ~ R a n ~ c o n (Nov. 1956 - )

A i m of t h e p r o j e c t . To survey t h e epidemiologica l s i t u a t i o n and to e s t a b l i s h an epidemiological u n i t a t t ached t o t h e Heal th D i r e c t o r a t e , t o c a r r y o u t l o n g t e r m planning.

Ass i s t ance provided by WHO dur ing t h e y e a r . Transport vehic le .

Probable d u r a t i o n of a s s i s t a n c e . U n t i l t h e end of 1959.

Tork dono. Owing t o d i f f i c u l t i e s i n o b t a i n i n g the s e r v i c e s of an epidemiologis t , only s u p p l i e s have so f a r been provided to t h i s p r o j e c t . However, a c t i o n is be ing taken t o r e c r u i t an exper t , and i t i s hoped t h a t the programme w i l l s t a r t i n the n e a r f u t u r e .

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Burma 4 5 TA

Strengthening of Laboratory Services 7 an. 1955 - D ~ c . t956 3 - 1

UNICEF

A i m of the project . To s e t up public-health labora tor ies i n Rangoon and hlandalay; to t r a i n technicians f o r the e ight ex is t ing provincial l abora tor ies and f o r o ther labora tor ies to be s e t up; to i n t eg ra t e the provincial laboratory services i n to the programme f o r expanding the d i s t r i c t heal th services .

Assistance provided by WHO during the year. ( a ) A laboratory s p e c i a l i s t (microbiologist) u n t i l December 1956; (b ) a six-month regional fellowship; ( c ) surg ica l instruments.

Probable duration of ass is tance. Unt i l 1959 ( f i r s t phase).

Work during the year. The f i r s t phase of the project came to a c lose i n December 1956. when the 1ri?IO l abo ra tow s p e c i a l i s t a f t e r . - , t r a in ing seven laboratory technicians, completd her assignment.

In her f l n a l report she has recommended tha t the laboratory technicians trained should a t tend a three-month re f resher course a t the Pasteur I n s t i t u t e , Rangoon, a f t e r three years of f i e l d service . She has a lso recommended tha t the t r a in ing of fu ture laboratory a s s i s t a n t s be t ransferred from the Rangoon General Hospital to the Pasteur I n s t i t u t e , Rangoon.

Her report shows f u r t h e r tha t the establishment of c l i n i c a l and bacter iological l abora tor ies cannot be undertaken immediately f o r want of trained medical personnel to take charge of them. An intensive t ra in ing course i n bacteriology should therefore be given f o r a minimum of s i x months a t the Pasteur I n s t i t u t e , Rangoon.

Because of t h i s lack of trained personnel, both medical and auxi l ia ry , four d iv i s iona l l abora tor ies which should have been established have not materialized, with the r e s u l t t ha t the four s e t s of laboratory equipment supplied by 'm0 a t a cos t of $12,000 have not been put to any use so f a r .

To undertake a survey of laboratory services i n the country and to make recommendations f o r strengthening them, '#HO proposes to provide the se rv ices of a short-term consultant f o r four months i n 1957.

h r m a 46 Post-Graduate Courses i n Public Health f o r R D i s t r i c t Medical Off icers . Ran~oon

7 2 2 Oct. 1956 - 15 Jan. 19573 1 June 1957 - ) +.

A i m of the project . To t r a i n d i s t r i c t medical o f f i c e r s i n public heal th pract ice , and to improve preventive services i n d i s t r i c t heal th Eentres. '

.

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Assistance provided by 'E IO during the year. ( a ) Assistance i n teaching given by WHG s t a f f i n Rangoon; (b ) half the cos t of t rave l and maintenance of one provincial medical o f f i c e r a t tending the course.

Probable duration of assistance. To be repeated i n 1958 and 1959.

Work done. This f i r s t three-month ~ b u r s e was s t a r t ed i n the l a s t quar ter of 1956 with eleven par t ic ipants and an ad hoc facu l ty including members of 'NHO s t a f f i n Rangoon. Vfith one exception, the ins t ruc t ion was given to doctors i n Rangoon, and though t h i s t ra in ing w i l l improve t h e i r value to the heal th services , they were not the category (provincial medical o f f i c e r s ) f o r whom the project was planned. The syllabus was comprehensive. Documents r e l a t i n g to the course have been received, but a report and evaluation a re awaited.

In 1957 arrangements have been made by the ~overnkent f o r conducting a course without 'WO's assis tance.

Burma 54 Fellowships R

Maternal and ch i ld heal th: Three regional fellowships - each of three months.

Mental Healthr A two-year regional fellowship.

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3. C E Y L O N

P r o j e c t No. Source of Funds T i t l e - Co-operating Agencies

Ceylon 2 TA UNICEF

Health Muca t ion (March 1952 - A p r i l 1953 ; Sept. 1954 - Deo. 1956)

A i m of t h e p r o j e c t . To c a r r y o u t a comprehensive health-education programme, wi th emphasis on c h i l d h e a l t h , n u t r i t i o n and snviron- mental s a n i t a t i o n ; t o e s t a b l i s h a Div i s ion of Health Education i n t h e Department of Health Services ; t o extend heal th-educat ion s e r v i c e s t o r u r a l and urban a r e a s ; t o t r a i n va r ious c a t e g o r i e s of public-heal th workers, educators , e t c . ; t o e s t a b l i s h a h e a l t h educat ion mater ia ln u n i t and f i l m l i b r a r y .

Ass i s t ance provided by 'WO dur ing t h e y e a r . ( a ) A h e a l t h educator ; l b ) a twelve-month i n t e r n a t i o n a l fe l lowship .

Work done. TITHO provided a h e a l t h educator t o the UNESCO/~@O Fundamental Muca t ion P r o j e c t i n Ceylon from March 1952 t o Apr i l 1953, and i n 1954 was replaced by t h e n a t i o n a l c o u n t e r p a r t , r e t u r n i n g from a twelve-month WHO fe l lowship . I n 1954, an a d v i s e r i n h e a l t h educat ion was appointed t o t h e D i r e o t o r a t e of Health Services f o r two yea r s .

During t h i s time a Sub-Division of Health M u c a t i o n , i n c l u d i n g a M a t e r i a l s Production Uni t , was s e t up i n the D i r e o t o r a t e t o g ive e f f e c t t o a n a t i o n a l scheme f o r h e a l t h educat ion. F i e l d staff ( p u b l i c h e a l t h i n s p e c t o r s w i t h two months of i n t e n s i v e t r a i n i n g i n h e a l t h educat ion) were a t t ached t o t h e 15 d i s t r i c t s under t h e Super in tendents of Health Se rv ices and a l s o wi th t h e major s p e c i a l i z e d campaigns a g a i n s t malar ia , t u b e r c u l o s i s and venerea l d i s e a s e s .

The h e a l t h sducat ion s t a f f work wi th p ro fess iona l and community groups on problems i n environmental s a n i t a t i o n , n u t r i t i o n , school h e a l t h , e to . , and devote much time t o t h e in-serv ice t r a i n i n g of personnel i n h e a l t h departments and i n o t h e r governmental and voluntary agencies.

I n 1956, t h e n a t i o n a l h e a l t h educat ion o f f i c e r was awarded a \iBO f e l lowsh ip f o r post-graduate s tudy ; t h e o t h e r h e a l t h educators , a s w e l l , have been awarded Colombo Plan f e l lowsh ips , and i t i s hoped t h a t i n time a l l s u i t a b l e f i e l d s t a f f have an oppor tuni ty t o s tudy on fe l lor i sh ips from i n t e r n a t i o n a l sources.

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From the f i n a l report submitted by the VTHO heal th educator, i t is seen tha t a g rea t deal has been accomplished i n developing and strengthening heal th education and i n t r a in ing s t a f f to be responsible f o r extending i t to the urban and ru ra l population. Taking in to account the progress made and the i n t e r e s t of the au tho r i t i e s , i t may be expected tha t t h i s work w i l l be e f fec t ive ly car r ied out i n the fu ture . It is suggested, however, t h a t well- planned s tud ies f o r assessing the effect iveness of the work done, research on soc ia l and cu l tu ra l f ac to r s influencing heal th , and periodic analyses of the a t t i t udes of heal th s t a f f and of the public a r e important to fu ture progress.

Ceylon 4 T A UNICEF

Rural Health Development. Kalutara l ~ e p t . 1955 - )

A i m of the pro.ject. To upgrade the Children's Department of the Kalutara Health Unit Hospital! to i n t eg ra t e the preventive and curat ive s ides of ch i ld care a t the hosp i ta l and i n the f i e l d ; to improve public-health nursing and t r a i n various categories of heal th personnel i n the Health Unit.

Assistance provided by l?IHO during the year. ( a ) A paediatr ic ian and a public health nurse; a consultant i n public heal th administration f o r six weeks; ( b ) a thirteen-month in te rna t iona l and a three-month regional fellowship.

Probable duration of ass is tance. . Until the end of 1959.

Work during the gear. The team made a de ta i led survey of a l l ex i s t i ng maternal and ch i ld heal th a c t i v i t i e s i n the country and sugges ted improvements.

The Children's Hospital was upgraded, and the d i e t kitchen and premature u n i t were improved. The attendance a t the well- baby c l i n i c has r i s en considerably.

A mass treatment campaign against worms and a diphther ia survey have been s t a r t ed .

Refresher courses, each of one month's duration, were given to f i v e groups of midwives. Two @-cups of student midwives were given oix months of domiciliary t ra in ing , and 26 midwives a three- month course i n supervision. Supervising midwives a r e being used successfully i n areas where there are no public heal th nurses. One of the midwives of the first s o u p has been appointed to the Health Unit to a s s i s t i n practical teaching of pupil midwives.

The duration of the public heal th nursing course, i n which 15 nurses are enrolled, has been extended from s i x months to nine months.

A nurse has been appointed to supervise the nursing and midwifery service i n the Kalutara area. She has re l ieved the tu to r of many of her r e spons ib i l i t i e s , enabling he r to devote more time to the teaching programme.

SEA/RC I 0/2 Page 69

Ceylon 8 R

Nurses' Training School, Colombo '(0ct. 1951 - Aug. 1956)

A i m of the project . To improve and expand the t r a in ing programme - of the School of Nursing a t the Colombo General Hospital; t o include i n the basic curriculum t r a in ing i n publio heal th and i n paediatr ic nursing and obs te t r ios , i n a f f i l i a t i o n with outside in s t i t u t i ons .

Assistance provided by WHO during the year. A public-health nurse tutor .

Tork done. 'riith the appointment o f a nursing a r t s t u to r i n October 1951, the f i r s t phase of t h i s project concentrated on the development of a course i n nursing a r t s and the teaching of basic and advanced procedures. A procedure committee was s e t up to standardize nursing procedures, thus giving an opportunity f o r those responsible f o r the supervision of the students to disouss problems r e l a t i n g t o procedures. This aspect of the programme was successfully completed and handed over t o the na t iona l t u to r . The W E t u t o r was withdram i n December 1954.

The second phase began with the appointment of a public-heal th nurse t u to r i n September 1954. Necessary adjustments to the curriculum were made so as to include appropriate preventive subjec ts ; prevention and heal th teaching a re now a pa r t of a l l c l i n i c a l teaching. A student hea l th s e rv i ce has been established. The students a r e given t r a in ing and experience i n tuberculo%is nursing a t a e l i s a r a and Colombo; other public heal th services i n Colombo a re also being used f o r student observation and t ra ining.

This project was completed with the termination of t he assignment of the public-health nurse t u t o r i n August 1956. The nat ional t u to r s a r e now carrying on the t r a in ing programme.

Ceylon 15 TA

Nurses' Training School, Krwdy and Galle T5an. 1952 - Dec. 1956)

A i m of the pro,ject. To es tab l i sh schools of nursing a t Kanay and Galle with t r a in ing programmes i n cura t ive and preventive nursing.

Assistance provided by 'Xi0 durinfkt!~e y e n . A nursing a r t s t u to r -- and a public health nurse; (b ) a imelve-month in te rna t iona l fellow- ship.

Work done. During the course of t h i s project , the new school of nursing a t Kandy was firmly established. A curriculum based on the needs of the country was developed; public heal th was included as an in t eg ra l par t of the course, and a promamme of f i e l d experience developed. Nursing procedures were revised and d is t r ibu ted to every ward, as well as to each student. They were l a t e r t rans la ted in to Sinhalese.

SEA/RC I 0/2 Page 70

A useful booklet on experience i n procedures was developed, mainly by the senior nat ional tu tor , with the ass is tance of the WHO t u to r , and was printed loca l ly .

A t the end of the three-year course, the f i r s t group of 26 students graduated from the Kandy School i n 1955 and became State-registered nurses. Seventy-nine students are now on the r o l l s .

An in-service teaching programme was developed f o r a l l hospi ta l nursing personnel, and nat ional counterpart t u to r s were trained. In addit ion, in-service t r a in ing was given to the t u to r s to be assigned to the four new schools of nursing to be opened i n other pa r t s of the country i n the near fu ture .

A t the request of the Government, the senior WHO nurse ass i s ted with the opening of the School a t Galle i n April 1956, with 59 s tudents , and also advised on matters r e l a t i n g to equipment and s t a f f necessary f o r a school to be opened i n Kumegala .

The f i n a l report on the pro jec t has been submitted to the Government .

Ceylon 25 TA UNICEF

Tuberculosis Control and Training Contra, Colombo ( X e l i s a r a l (bby 1953 - ) -

A i m of the ~ ro . i ec t . To survey the extent of the tuberculosis problem; to es tab l i sh a model tuberculosis service; to t r a i n medical and paramedical personnel i n diagnosis and prevention.

Assistance provided by WHO during the year. A medical o f f i c e r an x-ra,y technician, a laboratory technician, a public heal th nurse and a s t a t i s t i c i a n .

Probable duration of assistance. Until 1959.

Work during the year. The f i e l d work of the tuberculosis pre- valence survey was completed ear ly i n the l a s t quar te r of 1956. Concurrently with the survey, a mirbidi ty study -was undertaken.

The public heal th nurse and the laboratory and x-ray technicians completed the c lear ing up of ce r t a in technical d e t a i l s by the end of 1956. The s t a t i s t i c i a n f in i shed the tabulat ion work by mid-1 957.

A repor t of the survey has been sen t to the Government. The r e s u l t s show tha t there was a public response of 96%. The overal l sampling f r ac t ion was 1 ~ 3 7 5 . The estimated r a t e f o r unhealed pathology was 0.97% and f o r healed pathology 0.55%. A high proportion of the cases with unhealed pathology a re i n the older age groups. Of the t o t a l number of estimated cases with unhealed pathology, 81% l i v e under r u r a l conditions, as do 83% of those with healed patholgy. Therefore, i n case-finding the e lder ly ru ra l dwellers should be given p r io r i t y .

SEA/RCIQ/~ Page 71

A l l t h e staff except t h e s t a t i s t i c i a n have now completed t h e i r a s s i s m e n t s .

Ceylon 26 R

Leprosy Control ( ~ u l y 1954 - June 1957)

A i m of t h e p r o j e c t . To modernize t h e leprosy. .control programme VJ improving the work o f t h e p resen t i n s t i t u t i o n s and developing a system of case-f inding , domic i l i a ry t rea tment and c o n t a c t s u r v e i l l a n c e .

Ass i s t ance provided by l!lHO d u r i n ~ t h e y e a r . ( a ) A l e p r o l o g i s t and an occupat ional t h e r a p i s t ! (b ) some e s s e n t i a l supp l i e s .

Work done. During t h e course of t h i s p r o j e c t , t he WHO s t a f f c o n s i s t e d of a l e p r o l o g i s t and an occupat ional t h e r a p i s t , and s u p p l i e s and equipment worth about $5,000 were suppl ied . I n 1956, two medical men went on WHO f e l lowsh ips f o r t h r e e months f o r t r a i n i n g i n l ep rosy , and one of them f o r t en months longer t o q u a l i f y f o r the DPH.

The p r i n c i p l e i tems of work done were (a) surveys ( i n t h i s r e s p e c t , a survey r e s t r i c t e d t o t h e examinations o f c o n t a c t s of r e g i s t e r e d cases and of persons from f o u r o r f i v e neighbouring houses y ie lded t h e b e s t r e s u l t s c o n s i s t e n t with time and money s p e n t and t h e number of new cases r e g i s t e r e d ) , ( b ) b r i n g i n g the n a t i o n a l r e g i s t e r u p t o - d a t e , ( c ) h e a l t h educat ion, ( d ) recommenda- t i o n s f o r t h e improvement of i n s t i t u t i o n a l c a r e , ( e ) domic i l i a ry t rea tment (of 2,145 c a s e s , 1,337 a r e now r e c e i v i n g domic i l i a ry t r ea tmen t ) , (f) t he t r a i n i n g of medical ,;rorkers i n l ep rosy , and ( g ) t h e improvement of l abora to ry f a c i l i t i e s ( t h e c o n s t r u c t i o n of a c e n t r a l l a b o r a t o r y has now been sanct ioned and equipment has been provided). The Government has n o t , however, implemented many of the recommendations made vsith r e s p e c t t o occupat ional t h e r a m .

On t h e whole, i t may be s a i d t h a t most of the o b j e c t i v e s of t h e p r o j e c t have been c a r r i e d out . The r e s t depends l a r g e l y on government i n i t i a t i v e , and s p e c i f i c recommendations have been made f o r t h e continuance of t h e programme.

The occupat ional t h e r a p i s t was withdrawn i n October 1956 and t h e l e p r o l o g i s t i n June 1957.

Ceylon 35 TA UNICEF

Environmental S a n i t a t i o n , Kumnegala T ~ a r c h 1955 -

A i m of the p r o j e c t . To s e t up two p i l o t p r o j e c t s i n rural a r e a s to improve water s u p p l i e s and exc re ta d i s p o s a l and t o t r a i n personnel i n environmental s a n i t a t i o n ; t o develop a h e a l t h educat ion programme t o e l i c i t t h e c o d p e r a t i o n of the people and t o prepare the community i n advance f o r the s a n i t a t i o n programme; t o apply t h e experience so gained i n t h e f u t u r e n a t i o n a l pro gramme.

SEA/RC I 0/2 Page 72

Assistance provided by 'm0 d u r i n ~ the year. A san i ta ry engineer; a short-term consultant f o r two months.

Probable duration of assistance. Until the end of 1961.

Work during the year. I n t h i s project the number of l a t r i n e p i t s l ined and covered with a proper s l ab reached approximately 2,000. The digging of the p i t and the construct ion of the supers t ructure a r e t he respons ib i l i ty of the householder and nearly 700 superstructures have been b u i l t with voluntary labour. Construo- t ion of l a t r i n e s i n public sohcols was a lso s ta r ted .

A number of wells were completed, and others a r e under construction. Water from the f i r s t well was tes ted bacter iological ly a t the Medical Research I n s t i t u t e , Colombo, and was reported to have no l ac tose fermenters and no evidence of faeca l pollution.

A special two-week t r a in ing course i n heal th eduoation was iven to a l l the project s t a f f concerned. Short-term t r a in ing three months) of public heal th inspectors i n environmental

s an i t a t i on has been s t a r t e d with groups of e ight to nine s tudents , and three such groups have already been trained. A san i ta r ian to a s s i s t i n t h i s work has been selected and w i l l be assigned i n September.

The pre-operational heal th survey was completed i n the second pa i r of Korales.

The short-term consultant appointed i n October 1956 to a s s i s t the Government i n the preparation of a Sanitary Code f o r Ceylon has submitted a d r a f t , which i s expected to be f i na l i zed short ly .

The whole project has been reviewed by the Regional Adviser, and h i s suggestions f o r fu tu re action a r e under consideration.

Ceylon 38 Assistance i n Epidemiology to Health TA Directorate (Feb. 1956 - )

A i m of the project . To es tab l i sh an epidemiological u n i t a t the Central Fever Hospital, Colombo; to make epidemiological surveys of the disease pat tern i n Ceylon; to t r a i n undergraduate and post-graduate students and a counterpart .

Assistanoe provided by WE0 during the year. An epidemiologist.

Probable duration of ass is tance. Unt i l 1959.

Work durina the year. The epidemiologist i n i t i a t e d research work on a var ie ty of subjects such as k e r a t i t i s s u p e r f i c i a l i s t ropica, purulent conjunc t iv i t i s , rabies, inf luenza virus , e tc . He also s t a r t e d a project i n Panadura to study the incidence of typhoid and the serological diagnosis of the disease.

SEA/RC I 0/2 Page 73

.. vlhen, du r ing the y e a r , Ceylon had a s e r i o u s epidemic of

smallpox, he a s s i s t e d t h e Covernnient i n t h e i n v e s t i g a t i o n of t h i s outbreak. A number of s e r a were shipped to the Virus Research Centre, Poona, f o r t e s t i n g a g a i n s t a wide range of v i r u s .

A s a r e s u l t of s t u d i e s made i n Ceylon, t h e presence of dengue f e v e r has been e s t a b l i s h e d , and i t i s probable t h a t t h e presence of adeno v i r u s e s may be q u i t e common. The d i s e a s e s caused by such v i r u s e s remain to be i d e n t i f i e d .

A t r a i n i n g programme f o r medical and para-medical personnel involved i n the handl ing of i n f e c t i o u s d i s e a s e s is be ing arranged.

Progress i n e s t a b l i s h i n g an epidemiological u n i t a t t h e Heal th D i r e ~ t o r a t e ~ h o w e v e r , is slow. One of t h e handicaps was t h e l a c k of a n a t i o n a l coun te rpa r t , who has been a v a i l a b l e only s i n c e Ju ly 1957.

Ceylon 39 R

Ass is tance t o Health D i r e c t o r a t e , Colombo - Nursing Adviser ( J u l y 1957 - )

A i m of t h e p r o j e c t . To provide t h e D i r e c t o r a t e of Health Se rv ices with advisory s e r v i c e s i n connect ion wi th n u r s i n g o rgan iza t ion , educat ion , admin i s t r a t ion and l e g i s l a t i o n and wi th t h e development of co-ordinate4 supervisory s e r v i c e s t o ensure uniformly high nur s ing s t andards wi th in t h e n a t i o n a l h e a l t h programme.

Ass i s t ance provided by WHO dur ing t h e year . A n u r s i n g adv i se r .

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 1960.

Work d u r i n g t h e yea r . The nur s ing a d v i s e r assumed h e r d u t i e s only i n Ju ly 1957.

Ceylon 42 TA

Health S t a t i s t i o s ( ~ p r i l 1957 - )

A i m of t h e p r o j e c t . To r e v i s e the system of r ecords and r e p o r t s i n t h e Health Se rv ices ; t o t r a i n n a t i o n a l personnel i n t h e des ign of documents, t h e conduct of surveys and o t h e r s t a t i s t i c a l techniques ; to s e t up a permanent s t a t i s t i c a l s e r v i c e i n t h e Minis t ry of Health.

Ass is tance provided by THO dur ing t h e g e a r . ( a ) A h e a l t h s t a t i s t i c i a n ; ( b ) s u p p l i e s and equipment.

Probable d u r a t i o n of a s s i s t a n c e . U n t i l t h e end of 1960.

Work d u r i n g t h e yea r . The s t a t i s t i c i a n has been i n p o s i t i o n only s i n c e Apr i l 195T9 and has s t a r t e d examining the r ecords and r e p o r t s of t h e Health Department. It i s too e a r l y y e t to at tempt an a p p r a i s a l of the work done.

SEA/RC I 0/2 Page 74

Ceylon 49 R

Cancer I n s t i t u t e , Maharagama ' ( ~ u g . - Sept. 1956)

A i m of the project . To survey the f a c i l i t i e s f o r diagnosis , treatment and ca re of cancer cases; to advise on the development of an appropriate cancer treatment and research programme and on the establishment of a cancer r eg i s t ry a t the Cancer I n s t i t u t e .

Assistance provided by WID. A consul tant f o r two weeks.

Work done. The consul tant , during h i s sho r t assignment, made a study of the work done by the Ceylon Cancer Society and submitted recommendations on the co l l ec t i on of d a t a on cancer, on methods of spreading au tho r i t a t i ve information on i t s prevention and cure and on the organieation of the Cancer I n s t i t u t e and i t s research and treatment programme. H i s r epor t has been sen t to the Government.

It is expected t h a t the consul tant w i l l soon pay a second v i s i t to Ceylon f o r f u r t h e r ass is tanoe i n the development of the Canoer I n s t i t u t e .

Ceylon 50 Fellowshi& R

Pharmacolomr A four-month in te rna t iona l t r ave l fellowship.

Ceylon 51 Fellowships TA

Public hea l th administrat ion: One ten-month and one twelve- month in te rna t iona l fellowship,

4. I N D I A

Pro.iect No, Source of Funds - T i t l e Co-operatinu Agencies

India 2 Maternal and Child Health Department, All-India R &a I n s t i t u t e of TA l ~ u n e 1953 - ) UNICEF

A i m of the project . To develop the Maternal and Child Welfare Section of the All-India I n s t i t u t e of H v ~ e n e and Public Health in to a f u l l Department of Maternal and ch i id-~ iea l th , which w i l l provide t r a in ing f o r students from India and other Asian countries.

Assistance provided br WHO during the year. ( a ) A v i s i t i n g arofessor of Paedia t r ics , an administrative o f f i ce r , a midwife t u t o r , a publio-health nurse and a hea l th educators. (b ) one six- month and one twelve-month in te rna t iona l fellowship. (Cost of personnel during 1956 reinbursed by UNICEF)

Prohuble duration of ass is tance. TJntil the end of 1957.

Work done. A notable achievement i n t h i s project has been the expansion and upgrading of the Maternal and Child Welfare Section.

The Children's Department of t he Chitteranjan Seva Sadan Hospital, which was associated with the I n s t i t u t e , has a lso been upgrded and now forms pa r t of a post-graduate col lege i n o b s t e t r i c s and paediatr ics .

An urban heal th cen t re ( ~ h e t l a ) - the most e laborate i n South East Asia - was established.

The following numbers of students have been t ra ined i n the various courses a t the In s t i t u t e :

Indian Non-Indian - Diploma i n Maternal and Child Welfare 3 1 1

C e r t i f i c a t e i n Maternal and Child Health 23 3 C e r t i f i c a t e i n Public Health Nursing 3 8 12

In addit ion, a C e r t i f i c a t e Course i n Health Education was established i n 1956, from which 19 students have graduated.

The 'XHO nursing personnel h w ass i s ted i n the organization of f i e l d experience, ro ta t ion i n c l i n i c s , par t ic ipa t ion of a l l ca tegor ies of s t a f f and s t a f f education programmes. The nursing

SEA/RC 1 0/2 Page 76

aspects of a l l courses a t the I n s t i t u t e a r e now taught by the nursing s t a f f , and the concept of the s tudent ' s f i t t i n g in to the ex is t ing services and pa r t i c ipa t ing i n them, i s f a r more generally accepted.

Since 1955 the teaching of heal th education has increased considerably, and a proposal to develop a ten-month c e r t i f i c a t e . course i n heal th education f o r t r a in ing medical and non-medical heal th educators a t the I n s t i t u t e is under consideration. The heal th education s t a f f of the I n s t i t u t e has a lso continued to a s s i s t with heal th education i n the Chetla Urban Health Centre and i n the Sin.&r Rural Health Centre.

The v i s i t i n g professor of paediatr ics , the administrative o f f i c e r and the two nurses completed t h e i r assignments during the year, and only the heal th educator remains. This aspect of the programme w i l l continue from 1958 under a separate project number, India 118.

India 19 Nursinq, Calcut ta (June 1952 - SePt* 1956) R

A i m of the project . To upgrade and expand the basic school of nursing a t the Xedical College Hospital, Calcutta, pa r t i cu l a r ly a2 regards ti-aining i n midwifery and public heal th nursing.

Assistance provided by Vni0 during the year. A midwife tu tor .

Work done. This project was s t a r t ed i n 1952 with the assignment of four in te rna t iona l t u t o r s - one each i n general nursing, nursing a r t s , paedia t r ics and midwifery - to the Medical College Hospital, Calcutta.

A l l the courses recorr lcndcd i n the Indian Nursing Council syllabus were included i n the programme developed with WHO'S ass is tance. The continued over-crowding of the hosp i ta l wards and the shortage of graduate s t a f f during the course of t he Project , contributed to d i f f i c u l t i e s i n maintaining sound nurs ing techniques, and resu l ted i n unsat isfactory prac t ica l ins t ruc t ion .

The midwife t u t o r was assigned primarily to strengthen the midwifery programme i n the hospi ta l and to develop f a c i l i t i e s f o r domiciliary midwif cry t ra in ing .

The responsibility f o r the two-week domicil iary course f o r pupil-midwives, s e t up i n conjunction with the S i r Anderson Health School, was taken over on t i re ly by a public heal th nurse appointed by the hospi ta l as a second counterpart to the WHO midwife tu tor . Although de l ive r i e s a r e not as y e t being car r ied out i n the homes, these two weeks of t r a in ing give the student a b e t t e r understanding of the pa t ion t and also a knowledge of the work of o ths r members of the heal th team.

With the withdrawal of the :THO midwife t u to r from the project i n September 1956, the nat ional s t a f f who had received t ra in ing previously under WHO fellowships, assumed respons ib i l i ty f o r the on t i re nursing t r a in ing programme.

India 31 Plague Control. Dehra Dun, Uttar Fradesh R 1 ~ ~ 1 ~ 1952 - Jan. 1957)

( ~ n s t i t u t Pasteur.

A i m of the pro,ject. To carry out research on the epidemiological f ac to r s causing recurrent outbreaks of p l a s o i n Northern India - - - and to plan control measures.

Assistance provided by 'iM0 during the year. ( a ) A medical consultant and a s t a t i s t i c a l a s s i s t a n t ; (b) essen t ia l equipment and supplies.

Work done. This project was s t a r t ed i n 1952 by the Government of India vrith ass is tance from WHO. During the f i r s t two years , fact- f ind ing f i e l d work on the ecology of rodents and t h e i r re la t ion- sh ip to plague outbreaks was undertaken. Intensive f i e l d ~ e s e a r c h was car r ied out during 1954, 1955 and the ear ly par t of 1956, a f i e l d laboratory being established i n the project area , and the I n s t i t u t Pasteur i n Teheran becoming ac t ive ly associated ~ L t h the project . Detailed s tud ies werc made of the species of mild rodents, f l e a paras i tes , c tc .

The WHO consultant v i s i t ed the project area i n 1956 t o review the work of the nat ional team. He suggested t h a t , besides inves t iga t ing a l l plague outbreaks i n the S t a t e of Ut ta r Pradesh, the na t iona l team should continue the survey work i n the Northwestern d i s t r i c t s with a view to de tec t ing plague f o c i i n areas where no human plague o r r a t mortal i ty has been noticed for many years.

A s a r e su l t of the work i t is apparent t ha t DDT-sprwing f o r malaria control , when adequately applied i n a mass campaign, w i l l a l so control the plague vector to some extent. It was also noticed tha t the res idual effeo t of insec t i o ides administered as patch-dusting was super ior to t h a t obtained by spraying.

The personnel was withdrawn by January 1957 , and the f i n a l repor t has been submitted to the Government.

India 38 TA

Nursing, Ludhiana (.June 1954 - June 19565 Jan. 1957 - )

A i m of the pro,ject. To survey the t r a in ing f a c i l i t i e s f o r nurses and midwives in Ludhiana and selected v i l l ages ; to adapt and expand t r a in ing programmes to meet the nursing needs of the community . Assistance provided by WHO during the gear . ( a ) A public heal th nurse educator; ( b ) a twelve-month in te rna t iona l fellowshipi ( c ) e s sen t i a l supplies.

SEA/RC 1 0/2 Page 78

Probable duration o f a s s l s tmoe . Until the end of 1957.

Work during the year. The WHO public heal th nurse, who joined i n June 1954, l e f t the project i n June 1956, and was replaced only i n January 1957. During the inter im period, the work established was continued by the nat ional publiq heal th nurse.

The WE0 public hea l th nurse, i n con junction with the national hea l th v i s i t o r from the heal th school, made preliminary v i s i t s to the v i l l ages and-some o f the houses i n Ludhiana i n order to fami l ia r ize herself with t he a c t i v i t i e s already developed. She also ass i s ted i n carrying out a school inspection i n a g i r l s ' school, where a vis ion t e s t was done f o r the f i r s t time. Some time was spent i n the out-patients ' department of the Chr i s t ian Medical College Hospital to assess the poss ib i l i t y of es tab l i sh ing f o l l o w u p service.

It i s planned to organize a sub-centre and also a programme f o r t r a in ing da i s a t Jamalpur v i l l age . School heal th se rv ices a r e being developed a t the Ewing Chris t ian School, where medical and nursing students w i l l be given p rac t i ca l ins t ruc t ion .

India 40 Nursing, Bombay (sep t . 1953 - Dec. 1956) R

A i m of the pro.ject. To extend tho nurs ing t r a in ing programme i n the J.J. Group of Hospitals; to develop i n these hosp i ta l s nursing techniques and procedures su i ted to l oca l conditions; to c o r r e l a t e theore t ica l teaching vrith teaching i n the wards, and to include public heal th nursing i n the curriculum.

Assistance provided by WHO during the year. ( a ) A nurse educator, a public heal th nurse t u to r and a midwife tu tor ; (b ) some medical l i t e r a t u r e .

Work done. The pro jec t was s t a r t ed i n September 1953 with the provision of three in te rna t iona l t u t o r s to a s s i s t i n upgrading and expanding the t r a in ing of nurses and midwives a t the J.J. Eospital , Bombay. A four th t u to r was added i n mid-1954.

Considerable progress was made i n most phases of the programme, and by 1955 the nat ional t u t o r s had taken over most of the classroom teaching. The currioulum was revised to include a l l courses recommended by the Indian Nursing Council; ward '

'

procedures were drawn up, and a s t a f f education programme was established. A ward-teaching programme was developed i n s i x representat ive wards and was car r ied on by the na t iona l c l i n i c a l tu tor . A midwifery nursing service and domiciliary nursing service were introduced. F'urther, a public heal th nurs ing serv ice was s t a r t ed within the hospi ta l compound, where student nurses received experience i n t h i s branch of nursing.

sFA/RC 1 0/2 Page 79

By December 1956, a l l t h e i n t e r n a t i o n a l t u t o r s had been withdrawn, and the n a t i o n a l s t a f f had taken over t h e e n t i r e r e s p o n s i b i l i t y of con t inu ing the work begun wi th WHO a s s i s t a n c e .

The r e p o r t on t h i s p r o j e c t has been submit ted t o the Government.

I n d i a 42 T A

Tuberculosis Control and Tra in ing Centre, Nagpur (Nov. 1955 - )

A i m of t h e p r o j e c t . To e s t a b l i s h a model t u b e r c u l o s i s s e r v i c e s with emphasi : on prevent ion; to t r a i n n a t i o n a l personnel i n modern methods of d i agnos i s and c o n t r o l , i n c l u d i n g domic i l i a ry chemotherapy$ t o c a r r y ou t epidemiologic&l survey work.

Ass is tance provided by YrMO d u r i n g the yea r . ( a ) A medical o f f i c e r , a l a b o r a t o r y t echn ic i an , an x-ray t echn ic i an and a publio-heal th nurse ; ( b ) a twelve-month i n t e r n a t i o n a l f e l lowsh ip ; ( c ) r a d i o l o g i c a l and l abora to ry equipment and supp l i e 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 the end of 1959.

Work d u r i n g t h e yea r . Some s u p p l i e s f o r t h i s p r o j e c t were s e n t i n 1955 and 1956, and the medical o f f i c e r a r r i v e d i n October 1956. Af te r he had spent some time i n pre l iminary p repa ra t ions , t h e WBO team moved i n t o p o s i t i o n i n January 1957. I t has n o t been p o s s i b l e up t o now f o r the Centre t o ope ra te f u l l y because of d e l w s i n the d e l i v e r y of r a d i o l o g i c a l equipment (ordered i n 1956 bu t t h e ou t s t and ing i tems of which have been d e l i v e r e d only r e c e n t l y ) and i n the i s s u e of the S t a t e Government's s a n c t i o n f o r c a r r y i n g o u t c e r t a i n a d d i t i o n s to the X-Ray Department bui ld ing . Never the less , t he t r a i n i n g of l abora to ry s t a f f and home v i s i t o r s is now being proceeded with.

I n d i a 43 TA

Rtbe rcu los i s Control and Tra in ing Centre, Hyderabad (Dec. 1956 - )

A i m of t h e p r o j e c t . ( a ) To t r a i n n a t i o n a l personnel i n d i a g n o s i s and c o n t r o l , with emphasis on prevention and i n c l u d i n g methods of domic i l i a ry c o n t r o l , t he personnel so t r a i n e d t o s t a f f t he d i s t r i c t c e n t r e s i n t h e S t a t e ; ( b ) t o a s s i s t n a t i o n a l personnel t o put i n t o p r a c t i c e s p e c i a l mass techniques of d i a g n o s i s and oon t ro l evolved by t h e p i l o t mobile u n i t s e s t ab l i shed under t h e Indian n a t i o n a l tube rcu los i s o o n t r o l plan.

Ass is tance provided by THO d u r i n g t h e yea r . ( a ) Laboratory equipment; ( b ) two i n t e r n a t i o n a l f e l lowsh ips - one of twelve months and one of f o u r months.

SEA/RC 1 0/2 Page 80

Probable duration of assistance. Until 1960.

Vork done. A plan of operations has been prepared and sen t to the Government of Ind ia f o r approval. The equipment received has been stored by the Government pending the s e t t i n g up of centre .

India 49 R UNICW

Maternal and Child ~ e a l t h / ~ u r s i n Hyderabad ( h m h 1954 - March 1r57)

(Colombo Plan)

A i m of the pro.iect. To develop the maternal and ch i ld heal th services of the S ta te , with special a t t en t ion to the t r a in ing of nursing personnel.

Assistance provided by WHO d u r i n ~ the year. Three midwife t u to r s and a public heal th nurse (two nursing a r t s i n s t ruc to r s wore provided under the Colombo Plan).

Work done. Most of the work of t h i s p ro jec t has been on the t r a in ing of nursing personnel, which has developed very sa t i s f ac to r i l y . The t r a in ing of indigenous da is and improvement of nursing pract ices and procedures i n paediatr ic departments, especial ly t ha t of the Niloufer Hospital f o r Women and Children, received considerable a t tent ion. On the assumption tha t f o r oome time most of the de l ive r i e s i n the r u r a l areas w i l l be conducted by da i s , the WHO domiciliary midwifery tu to r devoted a consid- erable amount of time to t h i s subject . The r e s u l t appears to be sa t i s fac tory .

Ph i l e a very good urban t r a in ing f i e l d was developed by the public heal th nurse, the ru ra l t r a in ing cen t re did not benef i t? there being a l oca l reluctance to make any changes.

The t r a in ing of auxi l ia ry nurse-midwives by the medium of Ehglish did not prove to be a success. It was also found tha t , i n order to be able to function properly a f t e r graduation, the candidates a r e bes t t ra ined i n hosp i ta l s nearer t h e i r homes, i n the d i s t r i c t s where they w i l l eventually be appointed.

The heal th school and maternal and chi ld heal th cen t res i n both c i t y and S ta t e were upgraded. The Niloufer Hospital has developed in to one of the foremost i n s t i t u t i o n s i n India.

A l l the in te rna t iona l personnel were withdrawn by Edarch 1957, and the a c t i v i t i e s a r e being car r ied out by the nat ional s t a f f .

SU/RC 10/2 Page 81

India 53 and 102 Tuberculosis Chemotherapy Centre, Edadras R (Deo. 1955 - ) TA

( ~ r i t i s h Medical Research Council and Indian Council of Medical ~ e s e a r c h )

A i m of the pro jec t . ( a ) To determine what proportion of i n fec t ive cases l i v i n g on crowded urban areas can be rendered non-infective by treatment with drugs su i t ab l e f o r self-administration a t home 8 (b) to determine how long these pa t ien ts can be kept ncn- i n f e c t i v e j ( c ) to compare the r e s u l t s of drug treatment i n domiciliary pa t ien ts with those of treatment i n hosp i ta l pa t ien ts ; (d) l a t e r to study the community e f f eo t s of wide-spread chemo- therapy on ambulant pa t ien ts ; ( e ) to provide f a c i l i t i e s f o r t r a in ing i n research techniques.

Assistance provided by WO during zhe year. (a ) A senior medical o f f i c e r , an a s s i s t a n t aedical o f f i ce r , a bac te r io log is t , an administrative o f f i c e r , a laboratory technician, an x-ray technician, and two public-health nurses; a consul tant f o r three weeks; (b ) two in te rna t iona l fellowships - one f o r twelve months and one f o r four months; ( c ) laboratory and x-ray equipmant, suppl ies and t ransport vehicles.

Probable duration of assistance. Until 1961.

Work durlng the year. Three groups of pa t ien ts a r e now being t reated P

( a ) those admitted i n the ear ly s tages whils t procedures and methods were being evolved;

(b ) those receiving treatment by one of several regimes which have been al located a t random ( these pa t ien ts f a l l i n t o two groups - those receiving treatment a t home and those cared f o r i n a sanatorium);

( c ) tuberculosis contacts of pa t i en t s under category (b ) ( t hese a r e studied with reference to the locat ion of the index case).

A t the end of June 195Ts 158 pat ien ts under (b) were being covered i n the study of the PAS and i scn iaz id regimes which was s t a r t ed i n September 1956. Contacts of these pa t ien ts ( c ) were a lso under study. I n t h i s f i r s t phase, 83 pa t ien ts have been studied f o r three months and 36 f o r s i x months. The second phase, which includes a study of the use of isoniazid alone i n therapy, w i l l be s t a r t ed shortly.

Some d i f f i c u l t i e s were caused by delays i n completing s t r u c t u r a l a l t e r a t i o n s to the c l i n i c and i n construct ing the animal house. It has not y e t been possible to f i l l a l l the counterpart posts.

sEA/RC 1 012 Page 82

Two meetings of the Project Committee (on which the Covern- ment and other sponsors of the project a r e represented) were held during the year, one i n Februaqy and. the other i n July.

India 52 TA U N I C E F

Maternal and Child ~ e a l t h / ~ u r s i n & , west Benw-1 (Nov. 1954 - JEXI . 1955;

A i m of the project . To strengthen the public heal th services i n the S t a t e and to assist with the t r a in ing of nursing and midwifery personnel.

Assistance provided by WHO during the year. A public heal th nurse.

Probable duration of ass is tance. Until 1961.

Work during the gear . A s a r e s u l t of discussions with the Central and S ta t e Governments i t was decided to rev ise the plan of operations. A public heal th nurse was appointed i n June 1957.

India 56 R UNICEF

Maternal and Child ~ e a l t h / N u r s i n ~ . Bihar '(NOV. 1954 - )

- - (colombo Plan)

A i m of the pro.iect. To develop the maternal and ch i ld heal th services of the S t a t e ; t o t r a i n nursing personnel.

Assistance provided by YVHO during the gear. A maternal and ch i ld hea l th o f f i ce r , two public-health nurses and three midwife tu tors . (two nursing a r t s i n s t ruc to r s were provided under the Colombo Plan) . Probable duration of ass is tance. Until the end of 1961.

Work during the year. Ten new maternal and ch i ld hea l th centres were opened during the year. One ch i ld welfare c l i n i c i s now used i n Patna f o r t r a in ing of undergraduate medical s tudents i n promotional and preventive aspects of ch i ld care.

Most of the a c t i v i t i e s were i n the f i e l d of nursing t ra ining. The domicil iary midwifery teaching f i e l d i n Patna has been expanded, and the various nursing schools i n the S t a t e have made considerable progress. Examinations were held a t the Nursing

SEB/RC~ 0/2 Page 83

School, Patna, during October 1956. Of 29 f i r s t year students, 13 were successful. Thirty new nursing students commenced preliminary t r a in ing ear ly i n November 1956.

The f i r s t group of e ight auxi l iary nurse-midwives in the S t a t e passed the f i n a l midwifery examination held i n Ga,ya.

Seventeen student lady health v i s i t o r s completed t h e i r nine-months' t r a in ing in Ranchi.

With the ass is tance of the rXH0 nurses, a s t e r i l i z a t i o n and treatment room was s e t up i n the Paediatr ic Department of Patna Medical College. A committee made up of t u to r s and ward s i s t e r s (nat ional and in te rna t iona l ) , under the chairmanship of t he Matron, has s e t up standard nursing procedures i n the Medical College Hospital.

The public heal th nurse and the midwife t u to r working i n Gwa completed t h e i r a c t i v i t i e s . The auxi l ia ry nurse midwifery oourse, including the domiciliary aspects of t ra ining, has been well es tabl ished, and the nat ional nurses have assumed full responsibi l i ty . The public heal th nurse has been t ransferred to the Medical College Hospital , Darbhanga, to s e t up a programme f o r the in tegra t ion of public heal th in to the basic nursing curriculum. The midwife t u to r completed her assignment i n April.

India 5 1 B UNICEF

Maternal and Ut ta r Pradesh

A i m of the project . To develop the maternal and ch i ld heal th services of the S t a t e ; t o t r a i n nursing personnels to es tabl ish a paedia t r ic t ra in ing hospi ta l a t t he Medical College, Lucknow.

Assistance provided by WHO during the year. A paediatr ic ian, two public. heal th nurses and a paediatr ic nurse.

Probable duration of ass is tance. Until the end of 1961.

Work during the year. The paediatr ic hosp i ta l has been improved and teaching of undergraduates developed fur ther .

Two ch i ld welfare cen t res were used f o r t ra in ing u n d e r graduate medical students i n promotional and preventive ch i ld care.

The senior public health nurse attached to t h i s project was assigned to the Maternal and Child Health Division i n the Directorate of Health Services i n J a n u a ~ y 1955, to advise and a s s i s t i n the development of midwifery t ra in ing and services i n the State . The second public-health nurse has been a s s i s t i n g with the Health Vis i to rs ' School i n Lucknow. The curriculum was

SEA/RC I 0/2 Page 84

expanded and improved, pa r t i cu l a r emphasis being plaoed on prac t ica l t ra ining. Two addi t ional hea l th v i s i t o r s ' schools were opened, but, because of the shortage of tu tors , there has been l i t t l e progress. Both nurses were withdrawn towards the end of 1956 on completion of t h e i r assignments.

The paediatr ic nurse has begun to give l ec tu re s to the s i s t e r s and s t a f f nurses. The student nurses a r e taught mainly by prac t ica l ward demonstration. Ins t ruc t ion and prac t ice i n the basic care of i n fan t s i s being given to the mothers i n the wards, and steady pmgress has been made towards improving ward hygiene,

India 62 Maternal and Child ~ e a l t h / ~ u r s i n g , Kerala R (Feb. 1955 - ) UNICEF

(Colombo Plan)

A i m of the pro.ieot. To develop the maternal and ch i ld heal th services of the S t a t e ; to t r a i n nursing personnel; to e s t ab l i sh a ru ra l heal th teaching cen t re f o r the Medical College, Trivandrum.

Assistanoe provided by WHO during the year. A maternal and ch i ld heal th o f f i ce r , s : .Lil.lc-l!e~lth nurse and a midwife t u to r ( a second pu;l&-llnn:.i;!~ rj?.lr;e was provided under the Colombo Pl::n).

Probable duration of assistance. Unt i l the end of 1961.

Work during the gear. The urban and r u r a l maternal and chi ld heal th services were expanded and strengthened.

The midwife t u to r s who were undergoing short-time t r a in ing com~le ted t h e i r course and were posted to midwifery t r a in ing schools - three as senior t u to r s and four a s a s s i s t an t s . A re f resher course f o r f i f t y midwives a t the S.A.T. Hospital , Trivandrum, and a t the Medical College Health Unit was alno completed.

A UNICEF-assisted re f resher course f o r midwife t u to r s was held a t the S.A.T. Hospital i n June; i t was attended by f i f t e e n tutors .

A r e g i s t e r of public heal th nurses, heal th v i s i t o r s and midwives working i n the Public Health Department of the S t a t e has been prepared.

India 63 R

POST-Graduate Co.lrse f o r blidvnfe %tors , College of Ilursing, New Delhi (Feb. 1956 - )

A i m of the project . To develop a post-graduate course f o r midwife tu tors .

SEA/RC I 0/2 Page 85

Assis tance provided by WHO d u r i n g t h e yea r . ( a ) A midwife t u t o r ; ( b ) equipment and medical l i t e r a t u r e .

Probable dura t ion o f a s s i s t a n c e . U n t i l t h e end of 1958.

Work dur ing the gea r . P r a c t i c a l exper ience was arranged i n t h e Girdhar i La1 Hospi ta l where, f o r pe r iods of f o u r weeks i n r o t a t i o n , t h e s t u d e n t s a t tended t h e a n t e and post-natal examina- t i o n rooms, the labour ward and t h e post-partum ward. A l e c t u r e programme was c a r r i e d o u t by v i s i t i n g d o c t o r s , t h e s t a f f of t h e College and the midwife t u t o r . Spec ia l i n s t r u c t i o n on methods of demonstrat ion and t h e u s e of t h e blackboard was a l s o given. P r a c t i c e i n publ ic speaking took a prominent p l ace i n t h e weekly -programme.

The s t u d e n t s completed t h e i r p r a c t i c a l and t each ing exper ience with s i x weeks i n t h e V i c t o r i a Zenana Hospi ta l ( f o r domic i l i a ry p r a c t i c e , ward exper ience and c l a s s e s ) and another s i x weeks do ing domic i l i a ry midwifery. The l a s t two months of the course were spen t on s tudy and review.

I n d i a 71 R

Assi3:anc.e t o t h e All-India I n s t i t u t e of Kental Health, Bangalore (March 1955 - )

A i m o f the p r o j e c t . To e s t a b l i s h at the All-India I n s t i t u t e of Mental Health, Bangaloren ( a ) a post-graduate t r a i n i n g programme i n psych ia t ry and p s y c h i a t r i c nu r s ing , and (b) a programme of r e sea rch i n psych ia t ry , neurolo@y and neuro-surgery; t o t r a i n n a t i o n a l c o u n t e r p a r t s t o t ake over from t h e WHO personnel .

Ass is tance provided by 'NHO during; t h e yea r . Two p s y c h i a t r i c nu r ses , a p ro fesso r of psych ia t ry f o r t h r e e months and a neuro log i s t-elec t rophys io log 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 he end of 1959.

Work d u r i n g t h e y e a r . Many changes have been e f f e c t e d i n t h e course of t h e y e a r , e.g. t he opening of a new academic wing i n t h e I n s t i t u t e and of a f o u r t h pav i l ion of the h o s p i t a l ; t h e c e n t r a l i z a t i o n and reo rgan iza t ion of t h e I n s u l i n Coma Treatment Unit ; t h e r eo rgan iza t ion of the o u t p a t i e n t s department; f u r t h e r improvement of the n u r s i n g c a r e o f t h e p a t i e n t s ; improved f a c i l i t i e s f o r occupational and r e c r e a t i o n therapy; and t h e modif ica t ion of working schedules f o r n u r s e s and ward a t t e n a a n t s , l e a d i n g to b e t t e r i n t e g r a t i o n of t h e work i n the h o s p i t a l and t h e I n s t i t u t e .

The courses f o r t h e Diploma i n Psychological Medicine and t h e Diploma i n Medical Psychology were cont inued, wi th 23 and 18 s t u d e n t s r e s p e c t i v e l y . A t the end of December 1956, 13 out of 1 j oandidates , who were undergoing t h e f i r s t p s y c h i a t r i c

SEA/RC 1 0/2 Page 86

nursing course, s a t i s f a c t o r i l y passed the f i n a l examination, and i n Warch 1957 a new course was s t a r t e d with 78 students. These courses have contributed much to increased recognition of the importance of psychiatric nursing.

The WHO psychiatric nurses also continued to a s s i s t i n the l e c t u r e programme of a number of o ther hosp i ta l s i n Ifpore State.

A t the end of June 1957, a neurologis t -e lect rophysiologis t replaced the one who l e f t i n June 1956, and recruitment of a neurologist to a s s i s t i n the development of a Department of Neurology i s proceeding. A professor of psychiatry was assigned to the I n s t i t u t e as a short-term consul tant f o r three months (~ecember 1956 - February 1957). According to h i s report , the I n s t i t u t e w i l l soon be able to provide not only good c l i n i c a l work and ins t ruc t ion to students, but a l so research a c t i v i t i e s through which the students can learn the elements of a s c i e n t i f i c approach .

Progress made on t h i s project has brought the I n s t i t u t e nearer to i t s ta rge t of becoming a f i r s t c l a s s nat ional and regional t ra in ing i n s t i t u t e f o r mental health.

India 73 Domiciliary Nursing and Midwifery, Lad., T A Hardinge Medical College Hospital, Newy~elhi

(July 1956 - ) A i m of the pro,ject. To provide, i n associat ion with the Lady Hardinge Medical College Hospital , t r a i n i n g i n domicil iary nursing and midwifery services.

Assistance provided by WHO durinfl the year. A domiciliary midwife tutor.

Probable duration of assistance. Unt i l the end of 1959.

Work during the gear. Soon a f t e r a r r iv lng and a f t e r v i s i t i n g various special health centres and nurs ing schools, the midwife t u to r proposed c e r t a i n preliminary a c t i v i t i e s as e s sen t i a l f o r achieving the object ives in domiciliary nursing and midviifely. A committee was formed to study the technical aspects of implementing the project and made recommendations, which were agreed to by the Government of India. A s a r e su l t , two staff midwives were assigned to the domiciliary department, and two nurse-midwife students and two heal th v i s i t o r students s t a r t e d t h e i r domiciliaxy t ra ining. A follom-up service f o r pa t ien ts discharged from the maternity wards was s t a r t e d , and an area chosen to be used f o r the home del ivery service.

Work was s t a r t ed on the preparation of a handbook i n domiciliary midwifery, and a l e c t u r e programe i n basic midwifeq was i n i t i a t e d .

SEA/RC I 0/2 Page 87

India 7 6 TA

Maternal and Child ~ e a l t h l ~ u r s i n g Eaucaticn, w s o r e (Oct. 1956 - )

UNICEF

A i m of the project . To improve the preventive and cura t ive services . par t icu la r ly maternal and ch i ld heal th services , of primary *d secondary- heal th un i t s throughout the S t a t e ; . t o proviae t r a in ing i n maternal and chi ld heal th i n the c i t i e s of Bangalore and Dqysore; to es'tablish three d i s t r i c t diagnostic labora tor ies ; to t r a i n a l l categories of heal th personnel f o r work i n ru ra l areas a t the heal th t r a i n i n g cen t re a t Ramanagaram; to expand heal th education programmes and t r a in ing programmes f o r doctors, midwives, nurses and heal th inspectors.

Assistance provided by THO during the year. ( a ) A maternal and ch i ld heal th o f f i c e r and a public heal th nurse8 (b ) a twelve- month in te rna t iona l fellowship.

Probable duration of assistance. Until the end of 1961.

Work during the year. A deta i led survey of the maternal and ch i ld heal th services i n the S t a t e was made with a view to e f f ec t ing improvements. A ru ra l hea l th t r a in ing u n i t f o r medical students was es tabl ished, and a research p m j e c t i n the treatment of worms with papaya products has been in i t i a t ed .

The WHO publio-health nurse, who joined the pro jec t i n November 1956, car r ied c u t a survey of the t r a in ing of the nursing personnel i n the State , and v i s i t ed a number of d i s t r i c t s . A comprehensive report on the r e s u l t s of t h i s survey and her recommendations f o r strengthening the t r a in ing programmes is under preparation and w i l l soon be submitted to the Government.

Assistance was given by the public-health nurse i n the re-organization of the Nursing School a t the Victor ia Hospital , Bangalore. ,She also undertook the drawing up of a syl labus f o r the t r a in ing of a u x i l i a q nurse-midwives.

India 7 7 TA

Public-Health Fngineering, University of Madras (Aug. 1955 - )

A i m of the project . To es tab l i sh a Department of Public-Health Engineering a t the University of Madras and t o organize post- graduate courses and f i e l d t r a in ing i n public-health engineering a t the University; to t r a i n a nat ional counterpart to take over from the WHO professor.

Assistance provided by WHO during the year. ( a ) A professor of public-health engineering! (b ) a twelve-month in te rna t iona l fellowship; ( c ) one t ransport vehicle and laboratory equipment.

Probable duration of assistance. Until the end of 1958.

SEA/RC I 0/2 Page 88

Work during the year. The v i s i t i n g professor i s continuing h i s work on post-graduate courses i n the College of Engineering.

The second post-graduate course, with nine students, was s t a r t ed during 1956, and the academic pa r t was completed i n April 1957. The nat ional s t a f f f o r the course has been increased, but there are s t i l l three vacancies.

Three-month courses f o r engineers and engineering subordinates have also been organized, one s t a r t i n g i n Febmary and another planned f o r July. For these courses, an addi t ional professor and three l ec tu re r s have been provided.

Plans f o r plants to demonstrate water pur i f ica t ion and sewage treatment have been prepared, and i t i s expected tha t construction w i l l s t a r t short ly . A public heal th engineering laboratory is under construction, and the necessary equipment has been ordered3 several items have already arrived.

India 78 R UNICEF

Maternal and Child ~ e a l t h / ~ u r s i n g , Nagpur ? ~ a y 7955 - )

A i m of the project . To develop integrated ru ra l hea l th servioes, pa r t i cu l a r ly maternal and ch i ld heal th services ; to improve the teaching of paedia t r ics a t the Nagpur Medical College; to es tab l i sh a ru ra l heal th teaching u n i t f o r the College.

Assistance provided by WHO durinn the year. A maternal and ch i ld heal th o f f i c e r , a public heal th nurse and a domiciliary midwifery tutor.

Probable duration of assistance. Unt i l the end of 1961.

Work during the year. The maternal and ch i ld heal th o f f i c e r completed h i s assignment i n Janualy 1957.

The Paediatr ic Section of the Medical College was developed in to an independent Department. The ourriculum i n the teaching of paediatr ics was revised,and now includes promotional and preventive ch i ld care. A separate c l i n i c f o r spas t ic chi ldren ( t h e f i r s t i n India) was established, and a premature u n i t developed.

A t the Health V i s i t o r s ' School, the r e s u l t s of the improvements introduced into the s tudents t p rac t ica l t ra in ing can now be seen. The attendance of expectant mothers has improved considerably s ince the introduction of an Appointments Book. A l l mothers a r e given d e f i n i t e appointments f o r the ante- na ta l c l i n i c , and a l l "defaulters" a r e followed up a t home by the students. A s imi la r improvement i s seen i n the attendance a t the Child Welfare Cl inic . These a c t i v i t i e s were handed over to the na t iona l nurses on the withdrawal of the WHC public hea l th nurse i n May 1957.

SEA/RCIO/~ Page 89

Domiciliary midwifery t r a in ing has been well established a t the Mayo Hospital. Attempts to develop a s imi la r se rv ice i n connection with the Medical College Hospital have not been so successful. Small maternal and ch i ld hea l th cen t res have been s e t up i n the Out-patients' Departments of these hosp i ta l s , providing good prac t ica l experience f o r the nurse and midwife students. Some assis tance has been given i n upgrading in s t i t u - t i ona l midwifery t r a in ing i n the hosp i ta l s i n Nagpur.

India 7 9 TA U N I C E F

Maternal and Child ~ e a l t h h u r s i n g , Bombay (Aug. 1955 - )

A i m of the project . To develop integrated rura l heal th services , pa r t i cu l a r ly maternal and ch i ld heal th services; to improve the teaching of paedia t r ics a t the Poona Medical College; t o e s t ab l i sh a rura l heal th t r a in ing u n i t f o r the College.

Assistance provided by WHO during the year. ( a ) A maternal and ch i ld heal th o f f i ce r and three public-health nurse educators; (b) two twelve-month in te rna t iona l fellowships.

Probable durat ion of assistance. Unt i l the end of 1959.

Work during the s ea r . The t o t a l number of primary heal th u n i t s es tabl ished under t h i s project is 78. I n addit ion, 50 maternal and chi ld health centres were opened.

The S i ru r Training Unit was f u r t h e r developed, and. the fallowing numbers of personnel received public heal th or ientat ion:

C a t e ~ o m Duration of Course Number of Trainees

Medical o f f i ce r s s i x weeks Nurse-midwives

89 three months

Midwives 189

one month 121 Sanitary inspec to r s three weeks 99

I n addit ion, f a c i l i t i e s avai lable a t the Poona Municipal Corporation and the Medical College are now used f o r b e t t e r o r ien ta t ion i n various aspects of o b s t e t r i c s and paediatr ics .

I t i s evident t h a t the qua l i ty of the nurses completing the or ien ta t ion programme i s improving. They st111 need guidance, however, i n es tab l i sh ing and developing serv ices i n t h e i r r u r a l primary heal th uni ts .

Reorganization of the du t i e s of the public heal th nurses on the s t a f f has made i t possible to have more e f f eo t ive supervision of t ra inees and s t a f f i n the sub-centres of t h e heal th un i t . One of the WHD publio health nurses t ransferred fmm S i r u r i n February 1957, has developed a comprehensive t r a in ing programme associated with t he Sassoon Hospital and the maternal and ch i ld hea l th centres i n Pocna.

SE(I/RC 1 0/2 Page 90

A s the basic t r a i n i n g of the nurse-midwives deputed f o r o r ien ta t ion has not been adequate, pa r t i cu l a r ly i n paedia t r ics and midwifery, a s i x weeks1 re f resher course f o r a l l such s tudents has been established i n Poona.

India 82 Short-Term Refresher Courses f o r Nurses R Hyderabad: 3 Sept. - 3 Nov. 1956;

!ew Delhi? 6 Nov. 1956 - 5 Jan. 1957) . .

A i m of the prc,iec t . To plan and conduct two short-term refresher courses f o r ward s i s t e r s , incorporating theoreticral and prao t ica l ins t ruc t ion adapted to l o c a l conditions.

Assistance provided by %I0 and work done. Two courses were provided under t h i s project .

The f i r s t , held i n Hyderabad frcm 3 September to 3 November 1956, was attended by eighteen ward s i s t e r s from various pa r t s of the country, and was d i rec ted by the WHC nursing personnel of the Maternal and Child ~ e a l t h h u r s i n g Pro Jec t , Hyderabad ( ~ n d i a 49).

In the second course, which was held from 6 November 1956 to 5 January 1957 a t the Lady Hardinge Xedical College Hqspital, New Delhi, i n conjunction w i t h the Domiciliary Nursing and Midwifery Project (1ndia 75), nineteen nurses frcm d i f f e r e n t s t a t e s i n India par t ic ipated.

Both courses consis ted of l ec tu re s , p rac t ica l ward assign- ments, v i s i t s to i n s t i t u t i o n s and group discussions. Emphasis was placed on the need f o r b e t t e r ward administration and supervision.

The value of short-term re f resher courses is now widely recognized, with the r e s u l t that employing agencies a r e readi ly arrangihg leave to enable selected personnel to a t tend such courses, i n s p i t e of shortage of s t a f f and heavy serv ice demands. It is through t h i s type of a c t i v i t y t ha t great encouragement is given to the t u to r s and ward s i s t e r s who a re responsible f o r the development of nursing i n the countr ies of t he Region.

Ind ia 81 TA UNICEF

llaternbl snd Child Ileal t h h b l i c - ~ e a l t h train in^. Saurashtra (March 1956 - )

A i m of the pro,jec t. To extend public-health se rv ices i n rural areas, par t icu la r ly maternal and ch i ld hea l th services , by means of primary and secondarj health unite! to improve and increase the se rv ices given by maternal and ch i ld heal th cen t res i n urban areas; to improve the standard of t r a in ing of nurses, midwives, auxi l ia ry nurse-midmves and dais .

SEA/RC I 0 /2 Page 91

Assistance provided by WHO during the year. A maternal and ch i ld health o f f i c e r and a public-health nurse.

Probable duration of assistance. Until April 1958.

Work during the year. Twenty-nine primary centres , with a t l e a s t three sub-centres each, have been established, mostly with the ac t ive ass is tance of the people. A new chi ldren ' s hosp i ta l was b u i l t i n Rajkot and now functions f u l l y , and chi ldren 's departments i n Bhavnagar, Jamnagar and Junagadh have been upgraded .

Several d i s t r i c t s were v i s i t ed and advice and guidance given on the organization of the work of the nursing personnel i n the heal th un i t s . Two intensive or ien ta t ion courses were given i n Sorath and i n Junagadh to f i f t e e n auxi l ia ry nurse- midwives p r io r to t h e i r posting to primary health un i t s .

The "Vest Hospital i n Rajkot has moved to i t s new quarters. The WHO public heal th nurse was c losely associated with i t s re-establishment, pa r t i cu l a r ly with regard to t he nursing school.

Two nat ional nurs ing tu tors have joined the pro jec t - one i n Bhavnagar and one i n Jamnagar. Three trained nurses have been sen t to Indore f o r a combined ward administration and nurse t u to r s ' course.

The f i r s t group of 60 & a i s t ra ined under t he pro jec t have completed a six-month course; 35 a re now under t r a in ing i n e ight primary heal th centres .

India 90 T A

Vital and Health S t a t i s t i c s , Namur '(h~arch 1956 - )

A i m of the pro,ject. To es tab l i sh a demonstration and t r a in ing u n i t i n an urban area, to serve as a model heal th s t a t i s t i c a l service; to t r a in l oca l personnel i n heal th s t a t i s t i c s .

Assistance provided by WHO during the year. ( a ) A hea l th s t a t i s t i c i a n ; (b) supplies and equipment.

Probable duration of ass is tance. Until the end of 1959.

Work during the gear. This project has been beset by a number of administrative d i f f i c u l t i e s from the s t a r t , owing to the na t iona l respons ib i l i ty being vested i n three d i f f e r e n t bodies, viz. the Nagpur Corporation, the S t a t e Government and the Central Government. The progress achieved i n s p i t e of these d i f f i c u l t i e s has been very encouraging. A nat ional counterpart has been trained now f o r nearly a year. A number of l ec tures , both theore t ica l and p rac t i ca l , have been given to the medical prcfes- sicn. Some of the more important s tud ie s car r ied out include: i) a sample study of deaths i n Nagpur i n 1955 and i n 1956; ii) a repor t on the diagnostic re turns from hospi ta l s and

SEA/RC 10/2 Page 92

dispensar ies in Nagpur i n 1955; ( i i i ) a study of the or ig ina l reports on cause of death received from chowkidars a t burning ghats; and ( i v ) a preliminary report on the r e s u l t s of introducing a s t a t i s t i c a l report card i n Nagpur dispensar ies f o r the f i r s t quar te r of 1957. Perhaps the most s i g n i f i c a n t achievement has been the introduction, on an experimental basis , of forms f o r the no t i f i ca t ion of b i r t h s , ' dea ths , and foe t a l deaths. The i n i t i a l r e s u l t s have been very promising. The no t i f i ca t ion of death form f o r use i n hosp i ta l s incorporates the In te rna t iona l Form of Medical C e r t i f i c a t e of Cause of Death, and i t i s hoped tha t the Nagpur experiment may lead to a wider use of the in te rna t iona l form when circumstances permit. The forms have been printed i n both English and Hindi. Another major a c t i v i t y of the project has been preparations f o r a t r a in ing oourse f o r s t a t f s t i o a l a s s i s t an t s drawn from a l l over the country. The syllabus has been drawn up and the Central Government is se l ec t ing the candidates. I t is expected tha t the oourse w i l l s t a r t as soon as s u f f i c i e n t candidates a r e forthooming.

India 91 Professors i n Preventive and Social Medicine TA ' ( ~ e b . 1956 - )

A i m of the project . To develop the Departments of Preventive and Social Medicine i n four selected medical oolleges, i n t eg ra t ing preventive medicine in to the general curriculum and developing courses of i n s t m c t i o n i n preventive and soc ia l medicine f o r undergraduates; to e s t ab l i sh cen t res f o r p rac t ica l t ra in ing ; to give special t r a in ing to selected students to prepare them f o r teaohing and research; to t r a i n nat ional counterparts t o take over from the WHO professors.

Assistance provided by \THO during the year. ( a ) Two professors i n preventive and soc ia l medicine - one f o r the Assam Medical College and one f o r the Nagpur Medical College; (b) Five two-year in te rna t iona l fellowships and a t rave l fellowship f o r four and half month.

Probable duration of ass is tance. Until the end of 1959.

Work d u r i n ~ the gear. The v i s i t i n g professor of preventive and soc ia l medicine a t the Assam Medical College, Dibrugarh, completed h i s assignment i n M ~ J 1957. A cha i r and a s ta f f f o r a f u l l department have been sanctioned, and a counterpart has been appointed. A ru ra l f i e l d prac t ice area i s i n operation. There is good co-operation between the Department of Preventive and Social Medicine and the loca l heal th service . The WHO professor 's f i n a l repor t i s being forwarded to the Government.

The v i s i t i n g professor of preventive and soc ia l medicine a t the Medical College, Nagpur commenced h i s du t i e s i n December 1956. A counterpart has been provided, and the fu ture head of the department i s studying a t Earnard, USA, under

a WHO fellowship ( s e e below). A teaching syllabus covering a four-year period, s t a r t i n g i n July 1957, has been accepted. Two public heal th research projects are i n operation, i n col laborat ion with t he Departments of Medicine and Biochemistry. The IYHO professor i s a lso making a survey of the teaching of preventive and soc ia l medicine a t the three Bombay medical schools, and w i l l d iscuss the planning of t h i s teaching with the relevant au thor i t i es .

This project i s s t i l l hampered by the laok o f su i t ab l e v i s i t i n g professors. I t i s not proving possible to f i l l three posts which have been vacant f o r a long time.

A s pa r t of t h i s project , f i v e candidates a r e under t ra in ing on WHO fellowships i n the special two-year course a t the Harvard School of h tb l i c Health, t o f i t them to become heads of depart- ments of preventive and soc ia l medicine.

India 92 UNICEF

Public Health Nursing Edu_cation, Andhra -E -r=I--JI

A i m of the project . To improve the ex i s t i ng public-health se rv ices , pa r t i cu l a r ly maternal md child heal th services , i n r u r a l areas; to expand them throughout the S ta te and co-ordinate them with c o m i t y development projects and national extension schemes ; to improve and increase t r a in ing f a c i l i t i e s f o r a l l categories of heal th personnel.

Assistance provided by 'JVHO during the year. (cos t reimbursed by UNICEF) A paediatr ic ian, a paediatr ic nurse, a public-health nurse and a midwifery tu tor .

.

Probable duration of assistance. Until the end of 1959.

Viork during the year. The Children's Hospital has been upgraded, and a separate out-patients ' c l i n i c f o r chi ldren has been established. A ch i ld welfare c l i n i c has a lso been developed for t r a in ing undergraduate medical students. The curriculum of paediatr ic teaching has been revised.

The nursing personnel joined the project a t the end o f March. The paediatr ic nurse, together with the nat ional nursing personnel, has reorganized the nursing procedures i n the paediatr ic wards a t the King George arid the Victor ia Hospitals.

A re f resher course f o r midwives of the municipal centres was successfully completed. Training i n domiciliary midwifery f o r a l l categories of midwives w i l l be i n i t i a t e d a s soon as the U N I C E F equipment a r r ives .

Lectures providing m introduction t o public health were given both to the nurse students i n the Preliminary Training School and to those i n t h e i r t h i rd year of training.

Assistance is being given i n the reorganization o f the maternal and chi ld heal th centre a t Chengalaraopet.

India 93_ UNICEF

Rural ~ e a l t h h u r s i n g Education, Assam (Oct. 1956 - )

A i m of the project . To develop integrated ru ra l heal th services , par t icu la r ly maternal and child heal th services; to e s t ab l i sh a rura l health u n i t f o r t r a in ing various categories of heal th personnel, such as s an i t a r i ans axd nurses.

Assistance provided by WHO during the year. ( cos t reimbursed by UNICEF) Two public-health nurses.

Probable duration o f assistance. Until the end of 1959.

Work d u r i n ~ the year. The two nurses assumed t h e i r du t i e s a t the Medical College Hospital, Dibrugarh, i n October 1956, and immediately explored p o s s i b i l i t i e s of i n t eg ra t ing public health t ra in ing in to the nursing curriculum and of es tab l i sh ing domiciliary services , including those f o r ante-natal , post- na ta l and chi ld care.

The f i r s t heal th cen t re has now been opened i n the hospi ta l compound, an area containing about 175 houses. A programme f o r home v i s i t i n g has been s ta r ted .

Regular l ec tu re s to student nurses have begun, and l ec tu re s i n domiciliary midwirery a r e being given once a week. Prac t ica l experience w i l l shor t ly be provided a t the hea l th centre.

Temporary buildings have been s e t u p a t the Chabua Rural Health Unit, where some s t a f f a r e already i n position. The student-sanitarians a r e undergoing t ra in ing , and it is expected tha t the f i r s t group of nurse midwives f o r o r ien ta t ion i n p b l i c health nursing w i l l be i n the f i e l d by September 1957.

India 9& Health Mucation, S i n m r TA XDec. 1956 - )

(Ford ~ounda t ion )

A i m of the pro,iect. To a s s i s t with f i e l d programmes i n health education procedures f o r public heal th and other personnel a t the Singur Health Cehtre and a t the All-India I n s t i t u t e of Hygiene and Public Health, Calcutta.

Assistance provided by WHO during the year. ( a ) A hea l th educator; (b ) four twelve-month in te rna t iona l fellowships.

Probable duration of assistance. Until the end of 1958.

Work during the year. The WHC heal th educator assumed h i s du t i e s i n December 1956. Two nat ional heal th education s t a f f members, the f i r s t to be assigned to the Singur area , a r e working with him, and plans are being made f o r i n i t i a t i n g prac t ica l heal th education a c t i v i t i e s i n t he v i l l ages in the area.

SEA/RC 10/2 Page 95

Many students, who d i f f e r considerably i n age, experience, background, educational l eve l and length of s tay, come to the Singur Centre f o r t ra ining. Teaching a c t i v i t i e s are arranged f o r d i f f e r e n t groups, such as health workers ( i n the Re- o r ien ta t ion Training Course) who a r e working i n the Community Development Projects , students enrolled i n the DPH, and other courses a t the All-India I n s t i t u t e of Eygiene and Public Health, Calcut ta , students i n the three-month in-service course i n heal th education a t the I n s t i t u t e , students from the South Calcut ta G i r l s College, publio heal th inspectors from the extension t ra in ing cen t re f o r v i l l age l eve l workers, and students from the Calcutta School of Tropical Medicine.

The heal th education a c t i v i t i e s i n the Singur Health Centre and of the research-cunrac t ion pro jec t i n environmental sanita- t ion ( a s s i s t ed by the Ford ~ounda t ion ) a r e being co-ordinated. I n the research-cum-action project emphasis w i l l be placed on problems of san i ta t ion r e l a t i n g to l a t r i n e s - acceptance, s u i t a b i l i t y of design, use and maintenance. Singur i s one of the three research-cum-action areas i n India.

India 95 TA

Wvironmental Sani ta t ion, Kerala (Nov. 1956 - )

A i m of the project . TO s e t up a p i l o t p ro jec t i n a ru ra l area f o r improving water supplies and excreta disposal ; to plan and carry out a san i ta t ion programmo, including the design, operation and maintenance of simple, p rac t i ca l and cheap san i ta ry i n s t a l l a t i o n s ; to organize a programme of hea l th education; to t r a i n technicians, s an i t a r i ans and o ther personnel.

Assistance provided by YiHC d u r i n ~ the year. A san i ta ry engineer and a s an i t a r i an ; (b) four in te rna t iona l fellowships - three of . . . - twelve months and one of s i x months.

Probable duration of assistance. Unt i l the end of 1959.

Work durin,? the ?rear. Equipment was provided i n 1956, and a san i ta r ian i n Januii,-y 1957. '?&en the san i ta ry engineer joined the project i n May 1957, the team was complete.

The area of operations selected f o r t h i s p ro jec t cons i s t s of nine v i l l ages , with a population of about 105,000. An Advisory and Co-ordinating Board has been s e t up, i n which, besides the WHO personnel, the in te res ted public heal th services a r e represented. A pre-operational san i ta t ion survey was rnade i n the schools and in 10% of the houses i n the p i l o t area, f o r guidance and subsequent evaluation purposes. The mapping of the p i l o t area is also under way. Preparatory work is going ahead f o r the construction of l a t r i n e s and water supplies. A school san i ta t ion programme has been proposed to

SEA/RC 1 0/2 Page 96

the school au tho r i t i e s , and i t is expected tha t f u r t h e r act ion w i l l be taken short ly . Health education a c t i v i t i e s have been s t a r t ed i n col laborat ion w i t h the Maternal and Child Health and Nursing Project working i n the same area, and the co- operation of other in te res ted heal th agencies working i n the same area has also been requested. A deputy counterpart has been assigned to work full- t ime a t the project .

India 96 UNICEF

Post-Craduare and Refresher Courses i n Maternal and Child Health and Atblic-Health Nursing (June 1955 - March 1956; June 1956 - March 1957; -

A i m of the project . To prepare qua l i f ied personnel f o r leading posi t ions i n maternal and chi ld heal th p r o n a m e s by post-- b a d u a t e t ra ining, and to prepare other-selected personnel by su i t ab l e re f resher t ra in ing .

Assistance provided by WHO d u r i n ~ the year . Par t ic ipa t ion by TNBO personnel working i n Calcutta. (Stipends and t r ave l expenses f o r fellows pa r t i c ipa t ing i n the courses paid by UNICEF.)

Probable duration of assistance. To be repeated i n 1958.

Work d u r i n ~ the year. A ten-month post-graduate course f o r the Diploma i n Maternal and Child Welfare (DMCW) was s t a r t e d i n ~ & e 1956 a t the All-India I n s t i t u t e of Hygiene and Public Health, Caloutta, with nine medical o f f i ce r s who completed the course i n &rch 1957. A s imi la r course was s t a r t e d i n June 1957 with 25 medical o f f icers .

A ten-month Post-Graduate Ce r t i f i ca t e Course i n Public Health Nursing (cPHW) m s held a t the I n s t i t u t e f m m June 1956 to March 1957. Out of 27 nurses enrolled f o r t h i s course, 22 completed the t ra ining. Another course was s t a r t ed i n June 1957, with 30 nurses.

A one-month re f resher course i n midwifery was held a t the College of Nursing, New Delhi, from 3 October to 1 November 1956, i n con junc t ion with the Pos t-Graduate Course f o r Midwife Tutors (1ndia-63), with the par t ic ipa t ion of 20 nurses from d i f f e r en t s t a t e s i n India.

A course i n paediatr ic nursing was held a t the Niloufer Hospital, Hyderabad, from I2 November to 8 December 1956, f o r 20 nurses from d i f f e r e n t s t a t e s India. This course was ass i s ted and directed by the WHO nurses attached to Maternal and Child ~ e a l t h / ~ u r s i n ~ Project , &&erabad ( ~ n d i a 49).

SEA/RC I 0/2 Page 97

India 100 R

Dental Health ( J U ~ ~ - bug. 1956; Dec. 1956 - )

A i m of the project . To survey t ra in ing f a c i l i t i e s i n dental education, with a vlew to fu r the r development.

Assistance provided by WHO during the year. ( a ) A consultant i n dental health f o r about two months; (b) one twelve-month in te rna t iona l fellowship awarded i n December 1956.

Probable-duration o f ass is tance. Until 1959.

Work done. The coroultar!t v i s i t ed several Aental i n s t i t u t i o n s , as described l a s t year. No report has been received.

India 101 Trachoma P i l o t Pro jec t , Ut ta r Pradesh R l ~ e b . - Kqr 1956; Oct. 1956 - )

(1ndian Council of Medical ~ e s e a r c h )

A i m of the project . To make a survey of trachoma i n pa r t s of Ut ta r Pradesh; ( b ) to es tab l i sh a p i l o t project to study (1) the - . incidence a n d p a t t e r n of trachoma &d the f ac to r s favouring. transmission, ( 2 ) the minimum e f f ec t ive course of an t ib io t i c treatment and the r a t e of re lapse and reinfect ion, and ( 3 ) the e f f e c t of repeated treatment on the epidemiological aspect of associated conjunc t iv i t i s and on the c l i n i c a l p ic ture of trachoma! ( c ) to develop a mass control programme.

Assistance provided by WHO during the year. A trachomatologist; '(b) equipment and supplies.

Probable duration of ass is tance. Until the end of 1959.

Work during the s e a r . The trachoma p i l o t project was i n i t i a t e d i n October 1956. Three medical o f f i c e r s and 22 auxi l ia ry persomel were given intensive t r a in ing before the promamme was actual ly s t a r t ed . Field and laboratory invest igat ions are now proceeding s a t i s f a c t o r i l y . By October 1957 the epidemiological s tud ies and the f i r s t assessment of the e f f e c t of an t ib io t i c treatment w i l l have been completed. The 'fMO trachomatologiet i s ac t ive ly pa r t i c ipa t ing i n the a c t i v i t i e s of the project . He is also a s s i s t i n g i n the study of the regional cha rac t e r i s t i c s r e l a t i n g to the epidemiological and c l i n i c a l aspects of trachoma i n d i f f e r en t par t s of the country. He has v i s i t ed Bombay, Rajasthan and Mysore i n this.conneotion and has reported on h i s f indings i n these areas.

SEA/RC I 0/2 Page 98

India 103 TA

Tuberculosis Control and Training Centre, i ~ r e a u n d e s i ~ a t e d ) (Oct. 1956 - )

A i m of the project . ( a ) To t r a i n nat ional personnel i n diagnosis end control , with special emphasis on prevention, including the u t i l i z a t i o n of methods of domiciliary cont ro l , the personnel so trained to man the d i s t r i c t centres i n the S t a t e ; (b ) to put in to prac t ice special mass techniques of diagnosis and control methods evolved by the p i l o t mobile un i t s established under the Indian national tuberculosis control plan.

Assistance provided by WHO during the gear . ( a ) A twelve-month in te rna t iona l fellowship; (b ) laboratory equipment.

Probable duration of ass is tance. Until the end of 1960.

Work during the gear . Intimation has been received from the Government tha t the buildings f o r the Centre a r e l i k e l y to be ready during the Indian f i s c a l year 1957-58. It is possible tha t the funds avai lable f o r personnel may be used to provide some of the WHO s t a f f of the national t ra in ing centre. The laboratory equipment which was provided out of rouble contribu- t ions i s being held i n s t o r e f o r the project .

India 112 Fellowships R

Nursing: A six-month in te rna t iona l t r ave l fellowship.

India 116 Fellowships TA

Leprosy: Two four-month in te rna t iona l t rave l fellowships.

Health Education: Two twelve-month in te rna t iona l fellowships.

N u r s i n ~ : A six-month in te rna t iona l fellowship.

Bac te r io loa : A ten-month in te rna t iona l fellowship.

India 130 Vis i t ing Paediatr ic ian an. - Feb. 1957) R

A i m of the project . To survey and assess the paediatr ic education programme i n India.

Assistance provided by WHO. A paediatr ic ian f o r s i x weeks.

Work d u r i n g the year . This short-term consu l t an t ( p a e d i a t r i c i a n ) v i s i t e d severa l medical co l l eges and maternal and c h i l d h e a l t h c e n t r e s , holding meetings with admin i s t r a t ive medical o f f i c e r s , p a e d i a t r i c i a n s and o t h e r s t a f f members of medical co l l eges . Suggestions were made f o r improvements i n undergraduate and post-graduate teaching i n p a e d i a t r i c s .

H i s r e p o r t i s being submitted t o t h e Government.

I n d i a 141 R

Centra l Drun Research I n s t i t u t e , Lucknow I M ~ Y - July 1957)

A i m of t h e pro,iect. To provide s p e c i a l i z e d a s s i s t a n c e t o the Cen t ra l Drug Research I n s t i t u t e , Lucknow, i n planning and c a r r y i n g o u t r e sea rch i n pharmacoloa , e s p e c i a l l y i n t h e f i e l d of indigenous drugs.

Ass is tance provided by WHO dur ing t h e year . A short-term c o n s u l t a n t i n pharmacology.

Work done. A WHO v i s i t i n g p ro fessor of pharmacology, between ass i rnments , has been provided f o r a s h o r t time t o c o l l a b o r a t e with t h e research s t a f f of t h e Centra l Drug Research I n s t i t u t e , Lucknow, working p a r t i c u l a r l y on t h e pharmacology of indigenous mater ia medica. H i s r e p o r t i s expected a t t h e end of July.

5. I N D I A - FOFXER FBDTCH SETTLEMBTTS

Nothing t o r epor t .

SEA/RC 10/2 Page 100

6. I N D O N E S I A

Pro,jeo t No. Source of Funds - T i t l e Co-operating Agencies

Indonesia 1 Treponematosis Control (May 1950 - ) TA UNICEF

A i m of the project . To es tab l i sh a yaws-control programme covering the whole country; to develop a venereal-disease control scheme, f i r s t i n the Surabaya and Djakarta areas , and l a t e r throughout the country (1950-53); to expand the control a c t i v i t i e s ; to e s t ab l i sh a system designed to meet the looa l conditions with the in ten t ion of continuing such work a f t e r in te rna t iona l ass is tance oeases; to i n t eg ra t e the control of yaws in to the permanent public heal th se rv ices when the mass campaign s tage has been consolidated.

Assistance provided by WHO during the gear . ( a ) A three-month in te rna t iona l fellowship; (b ) some laboratory suppl ies (serum).

Probable duration of ass is tance. Until 1959.

Work during the year. The expanded yaws programme, s ince December 1955, has been run so le ly by the national workers. It i s hoped tha t the mass campaign w i l l be completed by 1961 and tha t consolidation w i l l be effected by 1965. The project laboratory a t Jogjakarta and the Venereal-Disease Research I n s t i t u t e a t Surabaya continue to cont r ibu te towards the conduct of the campaign.

WHO is r ec ru i t i ng an epidemiological a s s i s t a n t to a s s i s t the nat ional d i r ec to r i n ex t rac t ing the epidemiological information gathered during the campaign.

Indonesia 4 T A

Malaria Control Demonstration, T j i l a t j a ~ and Semarang (August 1951 - )

A i m of the pro.ject. To demonstrate malaria control ( i n three phases - survey, control operations, resurvey) ; t o s e t up a research and dkinonstration oentre; to t r a in medical o f f i c e r s , entomologists and auxi l iary personnel.

' Assistance provided by YfHO during the year. A malariologist , an entomologist and a public heal th engineer.

Probable duration of ass is tance. Until the end of 1957.

SFA/RC I 0/2 Page 101

Work during the year. The malaria control campaign i n mid-Java was reorganized i n accordance with the nat ional plan, and protection offered to 1.8 mi l l ionpeople (which may go up to 2.4 mill ion) during the year 1956-57, against a t a rge t of 3.5 mill ion. National s t a f f was t ra ined! s tud ies on the behaviour of vectors were continued, and the malariometric data col lected by nat ional personnel were studied. In May 1957 the entomologist was t ransferred to mo the r project (Burma 31 ) . Five a s s i s t a n t mdlariologists have been appointed by the Government.

Indonesia 2 TA

I n s t i t u t e of Nutr i t ion, D.jakarta t ~ a n . 1952 - Jan. 1955; July 1957 - )

A i m of the project . To organize e f f ec t ive programmes i n nu t r i t i on education and r a i s e the s c i e n t i f i c standard of teaching; to reintroduce school feeding programmes; to make nu t r i t i on surveys; to carry out chemical analyses of Indonesian foodstuffs and of biological material col lected i n order to assess the nu t r i t i ona l standards of the population (1952 - 1955).

To study the problems of protein malnutri t ion a d to a s s i s t the I n s t i t u t e of Nutr i t ion i n developing a nat ional nu t r i t i on programme (1957).

Assistance provided by WHO during the year. A short-term consultant and a s p e c i a l i s t i n n u t r i t i o n f o r one month.

Probable duration of ass is tance. Until 1961.

Work during the year. A short-term consul tant was assigned ear ly i n July, to study problems of protein malnutrition. He was accompanied by another WHO s p e c i a l i s t , who w i l l study i n pa r t i cu l a r the e f f ec t s of protein malnutri t ion and vitamin A deficiency on eye diseases.

Indonesia 88 BCG Vaccination (0c t . 1952 - Dee. 1956) R UNICEF

A i m of the project . To expand a previous BCG p i l o t scheme l p a r t of the or ig ina l plan of operations) in to a nation-wide mass campaign, with f o r t y trained teams to be i n operation by the end of 1956.

Assistance provided by WHO. Two BCG nurses.

Work done. The BCC campaign i n Indonesia was s t a r t ed as a p i l o t p ro jec t i n October 1952. The mass campaign commenced i n November 1953 and s t i l l continues with UNICEF assistance. WHO'S par t ic ipa t ion terminated a t the end of 1956, when the two nurses completed t h e i r assignment.

SEA/RC I 0/2 Page 102

Between November 1953 and December 1956 the WHO team trained 62 mantris and 143 l ay vaccinators, and s i x more mantris and 23 l ay vaccinators'were trained by Indonesian doctors, themselves trained by the team. Egcluding the pro jec t s t a f f , 19 doctors were given f i e l d and theore t ica l t r a in ing and are now working as supervisors. I t i s intended to maintain the f o r t y teams now i n operation throughout 1957. Cumulative f igures to the end of March 1957 were: t e s t s completed - 11,700,000; vaccinations given - 3,185,000.

A consolidation plan envisaging the use a t the regenoy leve l (approximately 1 t o 16 mill ion people) of part-time teams, each cons is t ing of one mantri and one vacc ina tor , i s under consideration. Two p i l o t areas of t h i s kind a re being s e t up.

Indonesia 8B TB UNICEF

Tuberculosis Control and Training, Bandung t ~ e p t . 1952 - July 1957)

A i m of the pro.iect. To survey the extent of the tuberculosis problem; to es tab l i sh a model tuberculosis service; to t r a i n medical and para-medical personnel i n diagnosis and prevention) (b ) to es tab l i sh a domiciliary chemotherapy scheme.

Assistance provided by 'm0 during the s e a r . ( a ) A public health nurse and a laboratory technician; ( b ) some essen t ia l dm@+.

Work done. In 1952, a t the time the pro jec t was s t a r t ed , a high prevalence of tuberculosis, possibly 1 to 2% ac t ive cases, was believed to ex i s t amongst the population i n Bandung. There was a small c l i n i c i n operation, inadequately equipped and s taffed.

I n the period of almost f i v e years of WHO assis tance, a well-planned tuberculosis oentre has been developed where modern diagnostic and control methods can be dononstrated and taught to the various categories of tuberculosis workers, and where a good service , including domiciliary chemotherapy and BCG vaccination, i s ava i lab le f o r the area of operations. A nat ional team of doctors, home v i s i t o r s and technicians has been trained, capable of taking charge of the cen t re and of t r a in ing others. L i t t l e o r no use has so Par been made of the t r a in ing f a c i l i t i e s avai lable , however, and i t has not proved possible to develop e i t h e r survey work o r mobile case-finding and treatment i n connection with the centre .

The laboratory technician l e f t the project a t the end of June and the public h'-.~!.i;li nurso .n the th i rd week of July 1957 on completion of t h e i r assignment.

SEA/RC 1 0/2 Page 103

Indonesia 9 R

Le ros Control ( J U ~ Y - Sept. 1955; -* U N I C E F

A i m of the project . To survey the leprosy s i t ua t ion (1955); t o plan and carry out a long-term control programme (1956 - 59).

Assistance provided by TWO during the year. ( a ) A l epro logis t ; I b ) supplies of drugs.

Probable duration of assistance. Until the end of 1959.

Work during the gear. Preliminazy survey, along with treatment a f t e r the case-finding programme, were undertaken i n the Blora and Bekasi p i l o t areas. Transport and equipment have been provided by UNICEF on loan. There has a lso been advance procure- ment of drugs by UNICEF and addi t ional supplies from WHO.

Indonesia 12 p an. - April 1956; TA

( ~ n s t i t u t Pasteur,

A i m of the project . To survey the plague s i t ua t ion ; to carry out a programme of research to determine the conditions responsible f o r the pers is tence of plague; to develop a l o n e term control programme.

Assistance provided by WHO during the year. ( a ) A plague consul tant ; (b ) equipment and supplies.

Probable duration of ass is tance. Unt i l the end of 1959.

Work during the year. Arising out of the recommendations of the WHO consultant who v i s i t e d the country ear ly i n 1956, act ion was taken to procure the suppl ies and equipment needed f o r the research phase of the pmgramme. The services of a s p e c i a l i s t have been made ava i lab le f o r s i x months from May i957. He i s now engaged i n the study of data on plague co l lec ted during the pas t s i x years, and i s i n i t i a t i n g research and invest igat ion i n order to def ine the conditions supporting the maintenance of plaguep especial ly i n the sub-mountainous regions of Indonesia.

Indonesia 13 R

h s s l s ~ a n c e to Faculty of Kodlclne, G a A . j a h &do L'nivorslty: Jog.jakarta and Semaranh I s o p t . 1953 - )

A i m of the proeject. To develop the Departments of Biochemistry, Pharmacy and Paediatr ics on sound l ines3 to t r a in nat ional counterparts to take over from the professors provided by WHO.

SEA/RC I 0/2 Page 104

Assistance provided by WHO during the year. ( a ) A professor of pharmacy and pharmaceutical chemistry; (b) medical l i t e r a t u r e .

Probable duration of assistance. Unt i l the end of 1956.

Work during the year. The v i s i t i n g professor of paedia t r ics completed h i s work i n July 1956 and the v i s i t i n g professor of pharmacy and pharmaceutical chemistry l e f t the organization i n February 1957. A successor to the professor of pharmacy i s being recrui ted.

During the course of the projeot , the teaching of paedlatr ics has been expanded and upgraded, with the construction o f a special ch i ld ren ' s hospi ta l i n the medical facul ty . I t is hoped tha t t h i s hospi ta l w i l l develop in to a centre f o r post-graduate t r a in ing i n paediatr ics .

A t the f i n a l examinations i n pharmacy held i n August 1956 and i n January 1957 s i x s tudents received t h e i r diplomas. A course i n drug control and analysis over s i x months was conducted by the WHO professor.

Indonesia 15 R

( I C A )

Post-Graduate School of Nursing. Bandung 7 ~ a n . 1954 - )

A i m of the project . To organize post-graduate courses i n the teaching of midwifery and i n public-health nursing a t the Post- Graduate School of Nursing, Bandung, and a t the Rantjabadak City Hospital.

Assistance provided'bg VmO during the year. Two public hea l th nurses and a midvrife tutor .

Probable duration of ass is tance, Until September 1957.

Work d u r i ? ~ t h e $ e a r . The th i rd s e r i e s of academic courses f o r 22 midwife teachers and 10 public heal th nursing

students was s t a r t ed i n September 1956. The nursing students received experience i n teaching heal th education to pa t ien ts a t the Hantjciiiada". Hospital as well as i n teaching home nursing, f i r s t a id and prevention of accidents. They were given prac t ica l experience i n the c l i n i c s and homes, and experience i n group-teaching. Groups of three students a lso ass i s ted with the heal th examination of the s tudents i n one school, and v i s i t ed Djakarta, Jogjakarta, Solo and Surabwa f o r f i e l d observations.

The midwife teachers were given experience i n prac t ice teaching i n the domiciliary f i e l d i n Djakarta and Tjeribon.

The Astana Anjar Maternity Centre i n Bandung has now become avai lable f o r p rac t ice teaching of a s s i s t a n t midwife pupils. Good progress has been made i n the preparation of notes f o r midwife teachers.

SEA/RC 10/2 Page 105

The l a s t term of the course has proved more sa t i s fao tc ry , as the schedule now allows time f o r consolidation, with t he appl icat ion i n prac t lce teaching of the laowledge gained i n the f i r s t pa r t of the course.

One of the public heal th nurses completed her assignment and l e f t a t the end of 1956.

Indonesia 20 TA

Favironmental Sani ta t ion, Djakarta ' ( ~ u n e 1956 - )

A i m of the project . To prepare a co-ordinated plan f o r environmental san i ta t ion , par t iou la r ly i n rura l areas; to devise and construct simple, p rac t ica l md economical san i ta ry f a c i l i t i e s ; to organize a programme of heal th education on the nature and causes of diseases r e su l t i ng from fau l ty environment9 to t r a i n san i ta t ion personnel.

Assistance provided by iVHO during the year. (a) A san i ta ry engineer, a san i ta r ian and a p o r t h e a l t h san i ta r ian ; (b) equipment and supplies.

Probable duration of ass is tance. Until the end of 1961.

Work during the year. The san i ta r ian joined the pro jec t i n June 1956, the sani tary engineer i n December 1956 and the s an i t a r i an i n port heal th i n January 1957. The WHO team is now complete.

I n the beginning, the san i ta r ian helped to t r a i n heal th workers i n Magelang and s t a r t ed some demonstration work i n l a t r i n e construction i n vi l lages . After the a r r i v a l of the san i ta ry engineer, he was posted to Djakarta, and both a r e now working i n c lose collaboration.

Inspection and or ien ta t ion t r i p s were made by the san i ta ry engineer to study the ex i s t i ng conrlitions i n the country, and to s e l e c t a su i t ab l e rura l area f o r s t a r t i n g a p i l o t project .

The question of t r a in ing anc i l la ry heal th personnel i s under review; the TNHO team i s helping to work out a syl labus f o r the t r a in ing programme.

The san i ta r ian i n por t heal th made a study of the ex i s t i ng procedures, equipment, s t a f f , etc. i n por t areas with a veiw to developing a demonstration and teaching u n i t f o r in-service t ra in ing . The proposals which he submitted have been accepted, and in-service t r a in ing of the s t a f f of the Quarantine Department has begun.

A survey of the ex is t ing san i ta ry conditions a t the Kemajoran Airport has been completed, and suggestions f o r improvement have been made.

SEAIRC 10/2 Page 106

Indonesia 2 5 TA

Vita l and Health S t a t i s t i c s l ~ u g . 1955 - )

A i m of the pro,iect. To expand the s t a t i s t i c a l organization i n the Ministry of Health and t r a i n key members of the s t a t i s t i c a l staff; to develop a long-range s t a t i s t i c a l programme with a sound system of report ing f o r n o t i f i a b l e disease, hosp i ta l services , and general v i t a l and heal th s t a t i s t i c s 3 to develop an up to -da t e service of v i t a l and heal th s t a t i s t i c s f o r planning and evaluating heal th programmes.

Assistance provided by WHO during the year. ( a ) A heal th s t a t i s t i c i a n ; (b ) supplies and equipment.

Probable duration of ass is tance. Until the end of 1959.

Work during the year. Another t r a in ing course f o r s t a t i s t i c a l a s s i s t a n t s was held during the yea2, and the s t a t i s t i c i a n has continued to a s s i s t with the teaching of heal th s t a t i s t i c s to medical students i n the University of Djakarta. A revised and improved t r ans l a t i on of t he In te rna t iona l C la s s i f i ca t ion of Diseases has been issued. The s t a t i s t i c i a n trained medical coders and supervised the coding of the In te rna t iona l Medioal Ce r t i f i ca t e s of Cause of Death received from hospi ta ls . A number o f , . v i s i t s have been paid to d i f f e r e n t pa r t s of the country with a view to improving the ccinpleteness and accuracy of v i t a l r eg i s t r a t i on and extending the area of b i r t h and death reg is t ra - t ion ( t r i p l i c a t e forma).

Rural heal th surveys were car r ied out i n several areas, and work has been done on improved schedules and ins t ruc t ions i n "bahasa Indonesia". The processing of t he r e s u l t s i s awaiting the a r r i v a l of a punching machine. The project s t a f f a lso ass i s ted the Public Health and Public Works Departments of the C i t y of Djakarta i n a population SuiTey of the c i t y . The s t a t i s t i c i a n has spent considerable time i n advising the Venereal-Disease Research I n s t i t u t e , the Division of Malaria Control, the I n s t i t u t e of Nutr i t ion and o ther government bodies on t h e i r s t a t i s t i c a l problems. S t a t i s t i c a l material has been col lected f o r the forthcoming WHO regional ru ra l hea l th conference and f o r the Di reo torGenera l ' s F i r s t World Health Report.

Indonesia 2 1 TA

Strengthening of Health Services 1Health MucationL (Feb. 1957 - )

A i m of the project . To develop and expand the heal th education promamme, including increased t ra in ing i n heal th education f o r - - a l l categories of heal th workers; to a s s i s t i n the use and development of heal th education mater ia ls , including audic- visual a ids .

SEA/RC I 012 Page 107

Assistance provided by WHO during the year. ( a ) A consultant i n heal th education f o r s i x mnths , and a heal th educator; (b ) two regional fellowships - one f o r s i x months and one f o r three months.

Probable duration of ass is tance. Until the end of 1960.

Work during the year. A heal th education consultant, recruited f o r a period of s i x months, s t a r t ed work i n l a t e February. To succeed her, a heal th educator was appointed f o r a period of two years s t a r t i n g i n July.

The consultant was assigned to the Sub-Division of Health mucat ion i n the Division of Rural Hygiene and Health Mucaticn of the Ministry of Health. She worked c lose ly with her counter- par t , the Director of Health Mucation, i n assessing the needs before making recommendations on ways of developing hea l th education and strengthening i t nat ional ly .

Library materials have been assembled i n the cen t r a l o r f i ce f o r use i n in-service t r a in ing f o r the s t a f f , and plans have been i n i t i a t e d f o r organizing and conducting a shor t t r a in ing course i n heal th education f o r l eaders from d i f f e r e n t t r a in ing i n s t i t u t i o n s i n the country.

- Indonesia 29 TA

S t r e n g t h e n i n ~ of Health Services ( ~ i d e m i o l c m ) Inbaroh 1956 - Feb. 19575 - )

A i m of the project . To s e t up an epidemiological u n i t to ae f ine the preva i l ing d i sease pa t te rn and to plan control measures; to advise a l l branches of the medical sciences on the use of the epidemiological method.

Assistance provided by WHO durinp the year. 4. four-and-a-half- month regional fellowship.

Probable duration of assistance. For three years a f t e r the assignment of the epidemiologist.

Work during the year. The programme could not s t a r t during the year because of the d i f f i o u l t i e s i n obtaining the se rv ices of a - su i t ab l e epidemiologist. Recruitment act ion is being pursued and the i n i t i a t i o n of the programme wi l l have to wait till the a r r i v a l of the epidemiologist.

Indonesia 31 T A UNICEF

Trachoma Control (Nova - Dee. 19541 Nov. 1955 - June 1956; April 1957 - )

A i m of the pro,ject. To make a study of trachoma and recommenda- t ions f o r control (1954) ; to demonstrate methods of treatment among s c h o o l c h i l d r e n , ~ f ~ r s t i n a selected area and l a t e r i n four o ther areas; a f t e r treatment, to carry out three re-examinations to assess immediate r e s u l t s (1955).

SEA/RC 1 0/2 Page 108

To re-examine a l l schoolchildren i n the project area i n order to assess the long-term r e s u l t s of the treatment; to carry out a mass control programme (1956).

Assistance provided by WBO during the year . A trachomatologist.

Probable duration of ass is tance. Unt i l the end of 1959.

Work during the year. The trachomatologist assigned to t h i s project arrived i n Djakarta i n April 1957. He was aooompanied by the WHO trachomatologist attached to project Ind ia 101. The l a t t e r spent three weeks i n Indonesia and made an evaluation of the f i r s t p i l o t project which waE car r ied out by the Government with supplies from UNICEF. Deta i l s f o r the second p i l o t project were worked out, and the pro jec t was s t a r t ed i n Mw 1957.

A two-week t r a in ing course was conducted f o r 25 par t ic ipants , including medical and para-medical personnel.

Indonesia 32 TA

(ICA)

Strengthening of Malaria Section, Ministry of Health, Djakarta (May 1955 - )

A i m of the pro.iect. To improve and in t ens i fy the na t iona l malaria programme, which is under the d i r ec t ion of the Malaria Section of the Ministry of Health; t o extend the f a c i l i t i e s of the Malaria I n s t i t u t e , Djakarta.

Assistance provided by WHO during the year. ( a ) A malar iologis t and an entornologisti ( b ) a six-month regional fellowship awarded about the end of July 1956.

Probable duration of ass is tance. Until the end of 1959 ( a t l e a s t ) .

Work durina the gear. To give b e t t e r help to the na t iona l plan undertaken with ass i s tance provided by I C A the att tern of WHO ass is tance has been changed- and the k 0 s t a f f give advice to provincial au tho r i t i e s i n the provincial campaign, and the malar iologis t , i n addit ion, co-ordinates the work of WHO s t a f f i n the country in so f a r a s i t bears on the nat ional plan.

WHO s t a f f has a lso ass i s ted i n t r a in ing nat ional personnel. Three a s s i s t a n t malar iologis ts were appointed by the Government i n July.

Indonesia 34 R

Assistance to Uedan Medical School I s e p t . 1956 - )

A i m of the project . To upgrade the Departments of Anatoqy, Physiology and Pharmacology a t the Medan Medical School .and to develop c i r r i c u l a i n t h e s e subjects ; to improve the pre-cl inical t r a in ing programme; to t r a i n nat ional counterparts.

SM/RCI 0/2 Page 109

Assistance provided by WHO during the year. ( a ) A professor of ana tow and a professor of p h y s i o l o a ; (b) suppl ies and equipment.

Probable duration of assistance. Until the end of 1960.

Work during the year. The v i s i t i n g professors of ana tow and p h ~ s i o l o m continued t h e i r teaching and departmental organizing -- dut ies . Some progress was made in-sp i te of d i f f i c u l t i e s of accommodation, lack of laboratory f a c i l i t i e s and delay i n receiving equipment. Teaching i n ailatow was s t a r t ed on seminar and group demonstration l i nes . Attendance a t l ec tu re s is improving, but there i s a lack of d i ssec t ion material . I n physiology some improvement is noticed i n the students ' understanding and i n t e r e s t i n the subject .

Plans f o r the new buildings have made l i t t l e progress because of f inanc ia l r e s t r i c t i ons .

Neither professor y e t has a counterpart , but i t is hoped tha t the e f f o r t s being made to f i l l t h i s gap wil l be suocessful.

Indonesia 35 Faediatr ic Nursing, Cadjah Nada U n i v e r s i t ~ , TA Jogjakar ta (Oct. 1956 - )

A i m of the pro.iect. To improve nurs ing care of chi ldren by b e t t e r t r a in ing of students i n paedia t r ics and paediatr ic nursing i n Gadjah Mada University.

Assistance provided by WHO during the year. ( a ) A paedia t r ic nurse t u t o r ; (b ) supplies and equipment.

Probable duration of ass is tance. Unt i l mid-1958.

Work during the year. The Paediatr ic Ward and the Nursing School were surveyed i n order to assess the teaching and t r a in ing f a c i l i t i e s . Lectures i n paediatr ic nurs ing were given t o medical s tudents and graduate nurses. Nursing care ou t l ines were prepared. Paediatr ic nursing l ec tu re s have been s t a r t e d f o r the four th c l a s s nursing students and f o r outs ide graduates. Prao t i c a l demonstrations and l ec tu re s on the ward have been arranged f o r seven aux i l i a r i e s .

Indonesia 36 T A UNICEF

Strengthening of Maternal and Child Health Services (Oc t. 1956 - )

A i m of the project . To evaluate the maternal and ch i ld heal th services and t ra in ing f a c i l i t i e s i n the country and to plan t h e i r extension,

SEA/RC 1 0/2 Page 110

Assistance provided by WHO durina the gear . Four internat ional fellowships - one f o r twelve months, one f o r e ight months and - two f o r s i x months.

Probabledurat ion of assistance. Until the end of 1959.

Work done. So f a r only fellowships have been awarded i n connection with the project , as i t has not y e t been possible to r e c r u i t a su i t ab l e maternal and ch i ld heal th of f icer .

Indonesia 46 T A

Drug Invest igat ion ( ~ c t . 1956 - ) A i m of the project . To a s s i s t the I n s t i t u t e of Pharmacology to exchange s t a f f and information with other i n s t i t u t i o n s , and to t r a i n s t a f f f o r i ts pharmacological invest igat ion programme.

Assistance provided by WHO d u r i n ~ the year . Two six-month regional fellowships awarded to s t a f f of the I n s t i t u t e f o r study a t the Central Drug Research I n s t i t u t e , Lucknow.

Probable duration of ass is tance. Until the end of 1957.

Work d l ~ r i n g the year. Steps a r e being taken f o r the provision of a short-term consul tant f o r three months towards the end of 1957. The fellows commenced t h e i r t r a in ing i n October 1956 and, a f t e r complet.ing t h e i r s tud ies , returned to Djakarta i n

1957.

Indonesia 48 Fellowships R

Dental hea l th$ A twelve-month in te rna t iona l fellowship.

Radiology and radio-isotopes: A twslve-month in te rna t iona l fellowship.

Production of biologicals : A four-month in te rna t iona l t rave l fellowship.

Indonesia 49 Fellowships TA

Dental health: A twelve-month in te rna t iona l fellowship.

7 . M A L D I V E I S L A N D S

Nothing to report .

SEA/RC i 0/2 Page 1 1 1

8. N E P A L

Fro,ject No. Source of h d s - T i t l e to-operating Agencies

Nepal 1 R

( ICA)

Malaria Control. Rapti Valley l ~ u n e 1954 - )

A i m of the project . To study the malaria s i t ua t ion and determine su i t ab l e oontrol techniques; to carry out indoor spraying with DDT i n areas not covered by the United S ta t e s In te rna t iona l Co- operation Administration (ICA) 8 to t r a i n personnel i n malaria prevention.

Assistance provided by WHO d u r i n ~ the year. ( a ) A malariologist , an entomologist and three auxi l ia ry personnel; (b) one twelve- month and two six-month regional fellowships.

Probable duration of ass is tance. Unt i l the end of 1959.

Work during the year. A de ta i led malariometrio survey has been car r ied out i n the pro jec t area: about 25,000 persons have been protected by DDT spraying with very good r e s u l t s , judging from the absence of malaria-carrying anophelenes f o r about a year a f t e r spraying. A post-spraying appraisal survey is i n progress. After the Regional Malaria Adviser's v i s i t to the projeot i n April 1957, recommendations were made f o r a nat ional malaria eradicat ion programme over a ten-year period.

Nepal 2 TA

Training of Nurses. Kathmandu TNOV. 1954 - )

A i m of the project . To t r a i n nurses and midwives f o r i ne t i t u - t iona l , domiciliary and publio-heal t h work.

Assistance provided by WHO during the year. ( a ) Two nurse t u to r s and a public hea l th nurse; (b ) two regional fellowships - one f o r twelve months and one f o r twenty-four months.

Probable duration of ass is tance. Until t he end of 1961.

Work during the year. Out of the f i f t e e n students who s t a r t ed t h e i r t r a in ing i n June 1956, twelve completed t h e i r f i r s t year of t ra in ing , and a new c l a s s is now under recruitment. !he ourriculum includes l ec tu re s on public heal th nursing, ch ie f ly covering tuberculosis f o r the home-visiting programme, and ch i ld

SEA/RC I 0 /2 Page 112

care f o r ass is tance a t the ch i ld ren ' s c l i n i c to be opened i n the near future . A home-visiting programme f o r pa t ien ts suf fe r ing from tuberculosis was s t a r t e d i n November 1956, but has not proved very sa t i s f ac to ry through laok of f a c i l i t i e s f o r i so l a t i ng the pa t ien ts and f o r soreening and examining the contacts.

A 40-hour l ec tu re programme on nursing procedures and techniques was given to the students a t the School f o r Health Assistants.

There i s a considerable amount of work s t i l l to be done to evolve midwifery and publio heal th f i e l d s f o r t r a in ing purposes. Because o f t ransport d i f f i c u l t i e s and insuf f ic ien t messing allowances (which have, however, recent ly been inoreased) , the students have so f a r been unable to spend more than four hours a day on the wards, thus learn ing only a l imited amount of p rac t i ca l nursing.

Many other administrative and o the r problems which s t i l l e x i s t a r e also hampering progress. For example, the necessary renovations to provide l i v i n g quar ters have not y e t been s t a r t ed , and no furn i ture has been ordered f o r bedrooms f o r the second group of students. The sect ion of the hos te l to be occupied by the new group has no e l e c t r i c i t y o r san i ta ry f a c i l i t i e s , and is badly i n need of repair .

Nepal 3 TA

Training of Health Assis tants , Kathmandu ' ( ~ u n e 1955 - )

A i m of the project . To es tab l i sh a school f o r heal th a s s i s t an t s i n Kathmandu to give theore t ica l and p rac t i ca l t ra in ing ; to plan a programme of G r a l hea l th services which w i l l make the best use of the heal th a s s i s t an t s .

Assistance provided by WHO during the year. ( a ) A medioal o f f ioe r (publ ic heal th s p e c i a l i s t ) and a san i ta r ian ; (b) teaching material.

Probable duration of ass is tance. Unt i l t he end of 1960.

Work during the year. This pro jec t s t a r t e d i n June 1955 with the a r r i v a l of the WHO senior o f f i ce r . He prepared the sound f o r es tabl lshlng the Health Assis tants School, which s t a r t e d to funotlon i n February 1996 with 20 students. In &rch 1956 a W'HO san i ta r ian joined the teaching s t a f f .

Many d i f f i c u l t i e s o r ig ina l ly had to be overcome, and the curriculum i s demanding continuous strenuous e f f o r t on the par t of the students. Therefore, the f a c t t ha t only th ree out of twenty students abandoned the course during the f i r s t year and tha t a l l the remaining seventeen passed the examination f o r entry in to the second year ' s c l a s s gives reason f o r satisfao- t ion.

SEA/RC I 012 Page 113

A new group of 20 s t u d e n t s was e n r o l l e d i n March 1957. Resu l t s so f a r have been s a t i s f a c t o r y .

For the second-year s t u d e n t s twelve days of f i e l d t r a i n i n g were arranged i n a v i l l a g e nea r Kathmandu. The s t u d e n t s a r e a l s o r e c e i v i n g r e g u l a r c l i n i c a l t r a i n i n g i n h o s p i t a l and out- p a t i e n t s ' departments. I t has been d i f f i c u l t t o f i n d s u i t a b l e s a n i t a t i o n s e r v i c e s f o r demonstrat ion purposes.

WHO nurses assigned to a nu r s ing p r o j e c t i n Kathmandu have taken p a r t i n the t r a i n i n g i n n u r s i n g procedures and techniques.

The s e n i o r o f f i c e r l e f t t h e p r o j e c t i n December on t r a n s f e r , WHO provid ing a short-term c o n s u l t a n t a s a temporary replacement. A successor t o t he s e n i o r o f f i c e r w i l l be appointed s h o r t l y . The n a t i o n a l coun te rpa r t re turned from a WHO f e l lowsh ip d u r i n g which he obta ined the Diploma i n Public Heal th from C a l c u t t a Univers i ty .

Taking the i n i t i a l d i f f i c u l t i e s i n t o account, t h i s p r o j e c t , t r a i n i n g a type of h e a l t h worker new t o the country, has made a promising s t a r t .

Wepal 1 Fellowships R

Publ ic h e a l t h admin i s t r a t ion : A twelve-month r eg iona l fe l lowship .

9. P O R T U G U E S E I N D I A

Portuguese I n d i a 2 Fellowships R

Tuberculosis : A nix-month r eg iona l f e l l o w s h i p (awarded ..

i n 1956 a g a i n s t 1955 a l lo tmen t ) .

SEA/RC I 0/2 Page 114

10. T H A I L A N D

Project No. Source of h d s T i t l e - Co-operatine Agencies

Thailand 2 Treponematosis Control ( ~ a y 1950 - ) 'PA UNICEF

A i m of the pro,ject. To car ry out systematic control of yaws throughout the country; to reduce the reservoi r of in fec t ion to a l eve l a t which the disease can be control led by the rura l heal th au tho r i t i e s 5 to t r a i n loca l personnel 8 to incorporate yaws cont ro l i n the permanent public-health services.

Assistance provided by WFD during the year. A venereologist.

Probable duration of assistance. Unt i l the end of 1959.

Work during the year. The progress made i n the mass oampai&n was maintained. Since July 1956 the population coverage has shown an upward trend, and experimental in tegra t ion i s under study .

During the period from July 1956 to June 1957, systematic mass examination of 866,758 persons was made and 55,218 were given treatment. In the resurvey operations 7,299,298 persons were examined and 61,965 t reated. Out of 12,267 persons who attended the c l i n i c s f o r diagnosis, 3,551 were given treatment.

Thailand l i TA UNICEF

Rural Health Unit, C h i e n m i TNOV. 1951 - Dec. 1956)

A i m of the pro.iect. To es tab l i sh a r u r a l heal th se rv ice with emphasis on environmental san i ta t ion , maternal and ch i ld heal th , and t ra in ing of various categories of heal th personnel.

Assistance provided by WHO during the year. A public-health nurse and a san i ta r ian .

Work done. Since the inoeption of the project , twenty maternal and ch i ld heal th cen t res i n the area have been upgraded, and public-health nurses have been appointed to f i v e of them.

SEB/RC 1 0/2 Page 115

A t the time t h a t WHO s t a f f was withdrawn, 50% of the de l ive r i e s i n 'the-area were being conducted by trained midwives.

The following personnel from a l l over Thailand received or ien ta t ion t ra ining:

Category Duration Number of Trainees

Nurse-supervisors

Public heal th nurses

Midwives

Mo h- t am-y aes

3 weeks 43

2-5 weeks 14

6 weeks 199 i r r e g u l a r 555

The f i n a l report on the project has been received and has been submitted to the Government.

Thailand 1 1 R

(UNESCO )

Mental Health, Dhonburi and BanRkok l ~ a r c h 1955 - Feb. 1957)

A i m of the project . To develop the psychological aspects of psychiatry both as a spec ia l ty and a s pa r t of general medical p rac t ice ; to introduce psychology in to public-health courses f o r graduate physicians, medical s tudents and auxi l ia ry workers; to develop modern c l i n i c a l f a c i l i t i e s and pract ices; to t r a i n an understudy to continue the work a f t e r WHO assis tance is withdrawn.

Assistance provided by !EIO during the gear. A psychologist.

Work done. This two-year project was s t a r t e d i n March 1955 a t the Mental Hospital i n Dhonburi. No department of psychology existed a t the University, and t r a in ing i n soc ia l work had jus t begun. WHC provided a psychologist i n 1955. A team of three nat ional workers had s t a r t ed a ch i ld guidance se rv ice i n the new mental heal th c l i n i c i n 1953. Two o f them proceeded on WHO fellowships within the f i r s t year of operation and were replaced by others , who, although not f u l l y qua l i f ied , did a commendable job. On re turn the fellows w i l l resume t h e i r du t i e s a t the c l i n i c .

The project was completed a t the end of February 1957, when the psychologist l e f t a f t e r two years of service. I t s main accomplishments were the fu r the r development of the Child Guidance Cl inic as pa r t of the Mental Health Cl inic; the preparation of psychological t e s t s su i t ab l e to Thai conditions; the outlining of a programme of f u r t h e r research f o r f u t u r e years , and in-service t r a in lng of the s t a f f of the mental hospi ta l . A six-month post-graduate course i n psychiatry, attended by 24 s tudents , was also conducted.

The experience gained in t h i s p ro jec t w i l l be useful i n carrying out s imi la r programmes i n the Region.

SEA/RC 10/2 Page 116

Thailand 21 TA

Post-Graduate School o f Nursing, Bangkok l ~ p r i l 1954 - )

A i m of the projeot. To es tab l i sh a post-graduate school f o r nurses3 to organize post-graduate t r a in ing i n public-health nursing and nursing education.

Assistance provided by tPM) during the year. A public-health nurse t u to r and a general nurse t u to r .

Probable duration of assistance. Until the end of 1961.

Work during: the year. Twenty-two public health nursing students and 25 nurse t u to r s and midwife t u to r s graduated from the School i n March 1957. One of the graduates from the 1955-56 c l a s s has been loaned to the School of Nursing and Midwifery Ins t ruc tors as a second full- t ime s t a f f member.

An advisory committee has been appointed f o r the School of Nursing and Midwifery Ins t ruc tors with a view to es tab l i sh ing educational po l ic ies f o r the School and a s s i s t i n g i n improving the curriculum. It has been decided to t ransfer the School from the administrative d i rec t ion of the Division of Nursing to t ha t of the Department of Medical Serv ices , s ta r t ing i n 1958.

The employment of the graduates from the School is a pressing problem. Out of 48 nurses graduated so f a r , the Department of Public Health has employed only a few, as i t is continuing to t r a i n i t s own personnel who have previously worked i n heal th centres , paying t h e i r sa la ry f o r the t r a in ing time and promoting them to work as supervisors. The matter has been taken up with the Government.

The WHO general nurse t u to r ass i s ted with an intensive course i n c l i n i c a l teaching given to the head nurses and supervisors of the Women's Hospital. She also ass i s ted with the arrangements and programme f o r the v i s i t of a group of Cambodian nurses to Thailand to observe i n s t i t u t i o n a l and public- heal th nursing.

Thailand 2% R

Rural Health Programme (Nursing: supervision) l ~ a y 1954 - )

A i m of the pro.ject. To develop the nursing and midwifery aspects of ru ra l heal th services; to provide adequate guidance and supervision of nursing and midwifery services .

Assistance provided by WHO during the year. A public heal th nurse-midwife.

Probable duration of assistance. Until the end of 1958.

SEA/RC 10/2 Page 117

Work durlni: the year. Plans were completed f o r a oountry-wlde scheme f o r t ra ln lng moh-tam-yaes by dramng up a syl labus, preparing a manual givlng a shor t course f o r the supervisors to be responsible f o r conductlng the course. Help was glven I n conduotlng the courses a t Korat, Burlram, Chaiyaphum and Lamphlmaart.

The form f o r report ing the da i ly a c t i v i t i e s of nurses and midwives was revised, and a new form was prepared f o r report ing abnormalities of ch i ldb i r th . The WHO nurse acted as an adviser to the sub-committee appointed by the F i r s t National Meeting of the Department of Health to deal with the organization of health centres , and gave a short t a l k on the "Purpose and Supervision i n the Rural Health Centre". Thirteen provinces were v i s i t od i n order to observe and assess the work being done.

Thailand 26 Fundamental mucat ion, Ubol ( ~ e c . 1954 - ) R

(UNESCO)

A i m of the project . To in tegra te hea l th education in to the fundamental education t r a in ing programme.

Assistance provided by 'NHO during the year. A public-health nurse w i t h experience i n health education.

Probable duration of ass is tance. Unt i l the end of 1957.

Work during the year. The f i rs t -year students were given olaes- room l ec tu re s and demonstrations on various subjects i n public health. For prac t ica l experienoe two s tudents were made responsible, i n da i ly ro ta t ion , f o r the san i ta t ion of the campus. In the v i l l age cen t res they were given prac t ice i n hea l th education, environmental san i ta t ion and maternal and ch i ld care , and also health education i n schools. The second-year students received theore t ica l and prac t ica l t r a in ing on subjec ts mostly concerning community health.

A family heal th cha r t was prepared f o r use by the etudents f o r follow-up, pa r t i cu l a r ly i n conneotion with the cont ro l of communicable diseases.

Every e f f o r t was made t o keep the t r a ln ing prac t ica l and to give the students the general and spec i f ic knowledge they w i l l need i n order to deal with the heal th needs of the community when they re turn to work i n t h e i r own areas.

Thailand 30 R UNICEF

Leprosy Control, Khon Kaen Province 10c t . 1955 - )

A i m of the project . To organlee a p i l o t project i n Khon Kaen Province f o r demonstrating modern methods of leprosy control , m t h emphasls on case-finding, domiciliary treatment and survei l lance of contacts ; t o t r a i n personnel; to extend the control programme t o o ther par t s of the country.

SU/RC 1 0/2 Page 1 18

Assistance provided by WE0 during the gear. ( a ) A l epro logis t ; I b ) some medical l i t e r a t u r e .

Probable duration of assistance. A t l e a s t u n t i l the end of 1959.

Work durinn the gear. The p i l o t project i n Khon Kaen province continued to make sa t i s f ac to ry progress.

I n the p i l o t area,with a population of about 600,000,the number of regis tered leprosy pa t ien ts is 4,689 (0.8%). Of these, 32% were found to be lepromatous, 43% tuberculoid and 25% indeterminate; there were s i x border-line cases. Out of the regis tered cases, 2,174 a re under o r a l DDS treatment and 2,515 under i n j ec t ab l e DDS treatment. The number of leprosy cases with react ional phase was only seven.

On h i s v i s i t i n IJovember 1956 the Regional Adviser on Malaria discussed proposals f o r extension of the present p i l o t pro jec t to the north-eas tern provinces, the programme to be spread over a period of s i x years from 1958. A plan covering WHO/UNICEF assis tance initially f o r a period of two years (1958-59) i s being completed. The period w i l l be fu r the r extended i f the leprosy control programme i s accepted by the Government.

A programme f o r occupational therapy f o r pa t i en t s i n the leprosarium a t Khon Kaen, where leprosy pa t ien ts from o ther north-eastern provinoes a r e regis tered and given regular treatment, is also under consideration.

Plans are underway to continue the second-year resurveys on a "spot-check" bas i s i n the southern zone, to carry out comparison t e s t s on methods of treatment, to e s t ab l i sh three provincial emergency s ta t ionary cen t res i n the flooded areas, to r e c r u i t and t r a i n new health workers, and to organize soc ia l and welfare work i n the Ban Noi vi l lage.

A handbook on leprosy control f o r non-medical auxi l ia ry leprosy personnel has been prepared.

Thailand 31 Schools of Nursing, Korat and Pitsanuloke TA ~ J U ~ Y 1955 - )

A i m of the project . To plan and carry out nursing education programmes; to improve nursing services to meet l oca l needs; to co r r e l a t e theore t ica l teaching and teaching i n hosp i ta l wards, and t o give t r a i n i n g i n public-health nursing, a t the schools of nursing i n Korat and Pitsanuloke.

Assistance provided by WHO auring the gear. (a) Two nurse tu tors ; (b) some laboratory equipment.

Probable d u r a t i o n of a s s i s t a n c e . Un t i l t h e end of 1958.

Work d u r i n r t h e g e a r . I n Hora?: t h r e e graduate n u r s e s who had a y e a r ' s s tudy i n t h e USA,mere added t o t h e s t a f f ; one was appointed a s a c o u n t e r p a r t t o one of t h e WHO nurses . P l ans were made t o in t roduce n i g h t duty f o r some croups of s t u d e n t s 30 a s t o e s t a b l i n h s 24-hour n u r s i n g s e r v i c e . This was a major s t e p forward i n the r,ursing c a r e provided by t h e h o s p i t a l . A new o b s t e t r i c block was opened, and t h e number of monthly d e l i v e r i e s sli@;2.iil:r i .ncreased. A c e n t r a l supply s e r v i c e was e s t a b l i s h e d . The b t i rd school y e a r was completed i n March 1957. This threo-cznd-a-hiilf-yesr cour se w i l l con t inue up t o Sopternher.

In P i t sanuloke t h e ;TI0 nurses gave c l a s s e s i n ward a d m i n i s t r a t i o n an? supervised head n u r s e s and graduates . A horne- v i s i t i n g programme ,;:as i n i t i a t e d f o r s t u d e n t s , and procedures were prepared and t r a n s l a t e d f o r u s e by t h e n a t i o n a l s t a f f . Chemistry no te s f o r s t u d e n t nu r ses were completed and t r a n s l a t e d , and the f i r s t s e c t i o n of tho l a b o r a t o r y manual was completed f o r t r a n s l a t i o n . O f t h e 30 s t u d e n t s who graduated i n November, !956, o i g h t havc been posted a t the F i t sanu loke P rov inc ia l I Iospi ta l . The new school y e a r s t a r t e d i n May 1957 with 50 s t u d e n t s .

Thalland 34 Maternal and Chlld ilealthn S t r eng then ing of TA C e n t r a l Heal th Organization (June 1956 - ) UNICEF

A i m of t h e pro, ject . To i ~ v a l u a t e t h e maternal and c h i l d h e a l t h and school h o a l t h s t a n d a r d s , a s a l s o f a c i l i t i e s f o r t ra ' in ing maternal and c h l l d h e a l t h pLrsonne1; t o develop techniques and procedures f o r rr,aternr,l and c h i l d h e a l t h work i n t e g r a t e d i n t o urban and r u r a l h e a l t h s e r v i c e s .

Ass i s t ance provide* by %I0 d u r i n g t h e y e a r . A maternal and c h i l d h e a l t h o f f i c e r .

Probable durs t io l l of a s s i s t a n c e . U n t i l the end of 1959.

Work d u r i n ~ t h e y c c r . The maternal and c h i l d hea l th , o f f i c e r made a d e t a i l e d s tudy of maternal and c h i l d h e a l t h f a c i l i t i e s and p a e d i a t r i c ze rv ic cs.

Evalua t ion s t u d i c s havo been s t a r t e d and a r e be ing continued i n r e s p e c t of t h e Bangkok and C h i e n m a i p r o j e c t s previous ly a s s i s t e d by WHO. The r e s u l t s so f a r a v a i l a b l e appear t o be of g r e a t va lue i n t h e p lanning of f u t u r e s e r v i c e s .

Thailand 36 ! . iutr i t ion -(l<ov. 1955 - Jan. 1956; Jan. 1957 - ) T A

( FA0 )

A i m of t h e p r o j e c t . To survey the n u t r i t i o n a l s i t u a t i o n ; t o i n v e s t i g a t e t h e prevalence of endemic g o i t r e and b e r i b e r i and t o c a r r y o u t a c o n t r o l programn,e.

SEA/RC I 0/2 Page 120

Assistance provided by WJ30 during the year. A medical n u t r i t i o n i s t .

Probable duration of ass is tance. Unt i l the end of 1959.

Work during the year. The medical n u t r i t i o n i s t , on h i s a r r i v a l , reviewed the work done so f a r on n u t r i t i o n i n the country and col lected addi t ional da t a on ber iber i . He has been surveying several provinces with a view to f ind ing the most s u i t a b l e areas f o r s e t t i n g up s a l t iodizing p lan ts f o r the control of endemic goi t re .

Thailand 38 School of Public Health, Bangkok R Dec. 1955 - lraarch 1956; Dec. 1956 -

Larch 1957; - ) A i m of the project . To strengthen the School of Public Health, Bangkok, by advising on various aspeots of public heal th and the teaching of ce r t a in subjects .

Assistance provided by WHO during the gear. A s p e c i a l i s t i n public heal th f o r four nwnths.

Probable duration of ass is tance. Until the end of 1960.

Work during the year. A s p e c i a l i s t i n public heal th was re-assiwed to the project from December 1956 u n t i l the end of Maroh 1957.

The most urgent need of the School i s f o r the development of a p rac t i ca l t r a in ing f i e l d f o r the use of s tudents , mainly of the D.P.H. course. The s p e c i a l i s t ass i s ted i n preparing plans f o r the ear ly establishment of such a f i e l d . H i s report has been submitted to the Government.

Steps a r e being taken to r e c r u i t a short-term consultant i n parasitology.

Thailand 40 TA

Midwifery Training School, Chienmai l ~ a n . 1956 - Deo. 1956)

A i m of the pro.ject. To es tab l i sh a t r a in ing school f o r second- c l a s s midwives i n Chiengmai.

Assistance provided by WHO during the year. A midwife tutor .

Work done. During the course of t h i s project , the curriculum was developed and revised within the l imi t a t i ons l a i d down by the au tho r i t i e s i n Bangkok, and recommendations were made for reducing the excessively high number of lectures . Administrative

sEA/FX 1 0/2 Page 121

and n u r s i n g techniques i n a l l t he departments were improved, and s tandard nur s ing techniques l a i d down. Ward r o u t i n e s were worked o u t and t r a n s l a t e d i n t o Thai. P r a c t i c a l t r a i n i n g i n domic i l i a ry midwifery was secured by u s i n g the maternal and c h i l d h e a l t h c e n t r e s i n the province.

The YLHO midwife t u t o r completed h e r a s s i e m e n t a t t h e end of December 1956.

Thailand 46 R

Fellowships

Mental hea l th : A two-year i n t e r n a t i o n a l fe l lowship .

Virus d i s e a s e s $ Two six-month r eg iona l fe l lowships .

P h y s i o t h e r a ~ : A twelve-month r eg iona l fe l lowship .

Thailand 4 1 Fellowships TA

-: A twelve-month i n t e r n a t i o n a l fe l lowship .

Publ ic h e a l t h admin i s t r a t ion : A twelve-month i n t e r n a t i o n a l fe l lowship .

Hospi ta l admin i s t r a t ion : A f i f teen-month i n t e r n a t i o n a l fe l lowship .

Production of b i o l o g i c a l s : An eleven-month r eg iona l fe l lowship .

Surgery: ?hro six-month i n t e r n a t i o n a l fe l lowships .

Malaria: A six-month r eg iona l fe l lowship .

sm/RC 1 0/2 Page 122

11. I N T E R - C O U N T R Y

Proeject No. Source o f Funds T i t l e - Co-operating Agencies

Ass i s t ance to Tuberculosis Labora to r i e s ~ A U C . 1955 - )

A i m of t h e p r o j e c t . To a s s i s t c o u n t r i e s of the Region ( ~ f ~ h a n i s t a n , Burma, Ceylon, I n d i a , Indones ia and Thailand) i n developing l abora to ry work i n connect ion with t h e expansion o f t h e i r tuberculo- s is s e r v i c e s .

k s s i s t a n c e provided by TI10 d u r i n g t h e y e a r . An inter-country 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 1959.

:Nark done. Durir,;: t h e period of h i s assignment,from August 1955 t o June 1957 , t h e b a c t e r i o l o ~ i s t v i s i t e d t u b e r c u l o s i s l a b o r a t o r i e s establi:;hed with 'VV'HO'O a n s i s t a n c e i n Afghanistan, Ind ia , Burma, Ceylon, Indonesia and Thailand, and reviewed and assessed t h e method; boiri;, fol lowed, t h e equipment used and t h e t e c h n i c a l s t andards maintained i l l thcac l a b o r a t o r i e s . He a100 gave advice on the ori:anization and opera t ion of courses of i n s t r u c t i o n f o r n a t i o n a l l abora to ry t echn ic i ans , and on the planning and o rgan iza t ion of these l a b o r a t o r i e s .

f i t tho r eques t of t h e iniliari Council of Nedical Research, he made a tou r of c e r t a i n &:teas i n I n d i a , i n c o l l a b o r a t i o n wi th a bacteric10,:ist nominate,? b:i t he Government, t o s tudy t h e b a c t e r i o l o y i c a l techniques and procedures bein?; uaod i n the n a t i o n a l tube rcu los i s prevalence aurvey. A j o i n t r e p o r t on the f i n d i n g s of t h i s s tudy has been s e n t t o the Indian Council of Medical Researoh.

I n h i s :;umnini: up of the po::ition with regard t o ViH0- a s s i s t a n c e t o t u b e r c u l o s i s l a b o r a t o r i e s i n the Region, he has s t a t e d t h a t the :~ccomplishmentn of t h e l abora to ry d iagnos t i c servic:es I t he var ious c o u n t r i e s muut be regarded a s reasonably s a t i o f a c t o r y , t ak ing i n t o cons ide ra t ion t h e comparat ively s h o r t time i n which the s e r v i c c s have been function in;^?. I t has n o t been p o s s i b l e i n a l l t he c o u n t r i e s t o t r a i n a s a t i s f a c t o r y number of l a b o r a t o r y personnel up to now, hut t h i s i:; because pos t s f o r such personnel when t r a i n e d krn no t irr.mec1i a t e l y a v a i l a b l e . P lans a re , however, beinp; madt f o r expanded l a h o r a t o q sel 'vice, p a r t i c u l a r l y i n I n d i a , i n connect ion .rr.;th tho t u b e r c u l o s i s c o n t r o l programme under the Second Five-Year Plan , and t r a i n e d personnel w i l l soon be much i n riemand,

SEA/RC 10/2 Page 123

The b a c t e r i o l o g i s t l e f t t h e p r o j e c t a t t h e end of June 1957 on completion of h i s c o n t r a c t . A replacement i s under r e c r u i t - men t .

Regional Seminar f o r Nursing Leaders , De lh i , 6 - 25 A u ~ n t 1956 ( ~ ~ r i 1 . - August 1956)

A i m of t h e p r o j e c t . To g ive nur s ing l e a d e r s i n t h e South East Asia Region an oppor tuni ty o f d i s c u s s i n g experiences, progress and developments i n the va r ious a s p e c t s of nurs ing , inc lud ing n u r s i n g educat ion.

Ass is tance provided by WHO dur ing the yea r . ( a ) A c o n s u l t a n t f o r s i x monthsj (b ) c o s t o f t r a v e l and pe r diem f o r 31 p a r t i c i p a n t s .

Work done. A three-week seminar f o r n u r s i n g l e a d e r s was held i n Delhi i n August 1956, wi th I n d i a as t h e h o s t country. Burma, Ceylon, Ind ia , Indones ia and Thailand were represented . There were 31 p a r t i c i p a n t s , i nc lud ing the c h i e f nu r ses of these c o u n t r i e s and o t h e r nu r ses experienced i n pub l i c h e a l t h nurs ing , n u r s i n g admin i s t r a t ion and nur s ing educat ion , and one represent - a t i v e from t h e Trained Nurses Assoc ia t ion of India .

The Seminar was d iv ided i n t o f o u r d i s c u s s i o n groups, and i n a d d i t i o n held genera l s e s s i o n s a t which v i s i t i n g speakers presented va r ious r e l a t e d s u b j e c t s f o r d i scuss ion , and where group r e p o r t s a l s o were discussed.

The t o p i c s s e l e c t e d by t h e groups f o r d e t a i l e d d i s c u s s i o n were: t h e s e l e c t i o n , p repa ra t ion and f u n c t i o n s of t h e ward s i s t e r , wi th emphasis on in-serv ice educat ion; t h e r o l e of t h e ward s i s t e r i n the development of teamwork i n h o s p i t a l n u r s i n g s e r v i c e s ; t h e c a t e g o r i e s and func t ions of a u x i l i a r y n u r s i n g personnel , a s seen f o r t h e f u t u r e , and t h e i n t e g r a t i o n of public h e a l t h a spec t s i n t o t h e bas i c n u r s i n g curr iculum.

The p a r t i c i p a n t s were a l s o grouped according t o count ry t o d i s c u s s p lans f o r follow-up a f t e r t h e i r r e t u r n home.

The Seminar provided the f i r s t oppor tuni ty f o r nu r ses i n South East Asia t o meet toge the r t o d i s c u s s t h e i r mutual problems. I t demonstrated t o a l l who a t t ended t h a t t h i s type of s e s s i o n can be very u s e f u l a s a means of he lp ing s e n i o r nu r ses t o c l a r i f y t h e i r t h ink ine and t o plan o b j e c t i v e l y t h e ways i n which they can f u n c t i o n a s l e a d e r s i n t h e i r p ro fess ion f o r t h e improvement of nu r s ing s e r v i c e s and nur s ing educat ion. The r e p o r t has r e c e n t l y been widely d i s t r i b u t e d .

SEAR0 13 Tuberculos is Workers' Meeting, New D e l h i a R '(14 - 18 Jan. 1957)

A i m of t h e p r o j e c t . To exohange views and experience concerning d i f f e r e n t approaches t o t u b e r c u l o s i s c o n t r o l , methods and techniques used, d i f f i c u l t i e s encountered and success achieved i n apply ing such approaches, methods and techniques. .

SEA/RCI 012 Page 124

Assistance provided by WHO. Cost of t rave l and maintenance expenses of sixteen par t ic ipants from the South East Asia Region.

Work done. This meeting was held i n Nem Delhi under the chairmanship of the Chief of the Tuberculosis Section a t WHO Headquarters, I t was attende' by WHO tuberculosis f i e l d workers and t h e i r national counterpar t s f rom the South East Asia, Eastern Mediterranean and Western Pacif ic Regions. I n a l l , 35 persons, including the Tuberculosis Advisers o f . t h e South East Asia arid Western Pac i f ic Regional Off ices , par t ic ipa ted , and a l l took pa r t i n the discussions. The number of par t ic ipants from the South East Asia Region was s ixteen. The meeting provided an excellent.opportunity to discuss the philosopby of the approach and the technical methods to be employed i n tuberculosis control programmes.

Preparation of Annual Public Health Reports XMar~h 1957 - )

A i m of the project . To a s s i s t tho heal th departments of ce r t a in countr ies i n the Region i n preparing t h e i r annual public heal th reports .

Assistance provided by 'KHO during the year. A consultant i n public hea l th administration.

Probable duration of assistance. Until nid-1958.

Work durinp the year. The consul tant s t a r t ed h i s work i n Burma i n the th i rd week of March 1957. He held discussions with the Director of Health Services on matters r e l a t i n g to the publica- t ion of tho Annual Report f o r 1955 and the preparation of the Annual Report f o r 1956.

He i s oontinuing the work on the preparation of annual reports which he had s t a r t ed during a previous assignment as public heal th adviser to the Directorate of Health Services.

Rural Health Conference, Ceylon, 1957 (5-7 Dec. 1955; Dec. 1956 - )

A i m of the project . To discuss the problems of organieing health services i n r u r a l areas.

Assistance provided by WHO durina the year. Two short-term consultants.

Work done. After a preparatory meeting, held i n December 1955, a short-term oonsultant was assigned to t h i s p ro jec t f o r two months from the l a s t week of December 1956 to prepare the working papers f o r t h i s conference, t o be held i n October 1957. A fu r the r consultant was appointed i n the l a s t week of July to continue with the arrangements f o r t h i s conferenoe.

Organizational Chart 31 July 1957

O f f i c e of t he Regional Di rec tor 8 s

Regional Committee Regional Direo t o r D r . C . %ni Public Information

Public Information Off icer

, -, I

Office of Bealth Services 3 Direc tor , Off ice of Health Services

D r . A. Barkhuus (act ing) Regional Publlc Health Administrators - D r . R.H. Bland ( se lec ted) - Dr . L.G. Ftldw

I ~ m i n i s t r & t i v e Assistant - ~ i s s V. Pe t e r s I I Fof lo*hip Uni t

Regional Advisers Dr. J.M. V i ~ e

Medical Education - D r . J .&I. Vine Ida1 ar i a - D r . D.K.Viswanathan Reports and Document

Tuberoulosis - D r . E.J.T. McWeeney Unit

Conmhulicable - D r . A . Vuletic Reports Off icer

Diseases ( s e l ec t ed ) Miss M. mheldon

Maternal and - D r . P. Robinson Child Health

M.C.H. Of f i ce r - (vacant) Medical Supply Off icer

Public Health(Com- - D r . M. Naughten I munity Development) I I Health S t a t i s t i c s Nursing Nursing O f f i o e r

Health muca t ion Ehvironmen t a l San i t a t i on

Publio Health Off icer (T.A.)

- D r . E. Charles - M i s s E.S. Graham - Miss F .Li l l h i t e ( s e l e c t e d T - Niss V. Drenckhahn - Mr. G. Ponghis

- D r . G. Mettmp

I . Office of Administration and Finance

Chief, Off ice of Administration and Finance Mr. A.G.B. Sutherland

I ' Personnel Unit

Personnel Off icer

I A . R.D. Hopkirk I t Finance. Budgeget and Accounts Unit 1 {

Budget and Finance Off icer XI-. R.S. Garg

Finance Off icer - M r . J. Bugge ( se lec ted) H Administrative Services Unit

Arlministrative 1 I . J. Unger 1

I Area Representatives

Burma - D r . T.C. Pur i 1 Ceylon - D r . R.L. Tul i Ind ia - D r . MR. Smks Indonesia - Dr. R.W.C. Thambiah Thailand - Dr. L. W. P i tzmaurioe

Publ ic Health Adviser Afghanistan - (vacantJ

I ) ~ i e l d P ro j ec t s 1

SEA/RC 1 0/2 Annex 2

Geographical Dis t r ibut ion of Internat ional Staff Assigned to South East Asia Region as o f 31 July 1957

sEA/RC 10/2 Annex 3

Conferences and Meetings Called by t h e United Nations and Spec ia l i zed Agencies a t which WHO Wae Represented

( 1 August 1956 to 31 J u l y 1957)

m 30 Ju ly - 6 August

8 - 18 August

4 - 20 October

8 - 19 October

31 October - 5 November

5 November - 5 December

29 October - 1 November

9 November

uz 7 - 15 March

18 - 28 March

1 - 2 A p r i l

25 - 26 A p r i l

SAFE: Working P a r t y on Housing Bangkok and Bu i ld ing Mate r i a l

UN/UNESCO : J o i n t Seminar on Bangkok Urbaniza t ion i n t h e SAFE Region

UNESCO : Study Conference on Bangkok Science Teaching

FAO: 3 rd Regional Conference Bandung f o r Asia and t h e Fa r Eas t

UNESCO: 45th Sess ion of t h e Executive Board

New Delhi

UNESCO: 9 t h Sess ion of New Delhi t h e General Conference

UNa Regional Conference o f Colombo Non-Governmental Organiza- t i o n s from Burma, Ceylon, I n d i a , Nepal and Pak i s t an

UNESCO: Spec ia l Meeting of t h e Advisory Committee of t h e Research Cen t re on t h e S o c i a l Impl i ca t ions o f Indus t r i a l i z a - t i o n i n Southern Asia

New Delhi

EGAFE: 9 t h Sess ion of t h e Bangkok Committee on I n d u s t r y and Trade

SAFE: 1 3 t h Sess ion of t h e Bangkok Commission

TAB: Meeting o f t h e TAB Bangkok Represen ta t ives i n t h e Far &st

UNESCO: Meeting of t h e S t e e r i n g C a l c u t t a Committee of t h e UNESCO Research Cen t re on t h e S o c i a l I m p l i c a t i o n s o f I n d u s t r i a l i z a t i o n i n Southern Asia

SEA/RC 1 0/2 Annex 4

Conferences snd K e e t l n ~ o of kvernmer. t s l , ::on-Governmenral and Ocher Organizazions a t which WHC 7 a s Represented

( I August 1956 - 31 July 1957)

m 6 - 9 August Government o f Ind ia r 2nd Conference

o f Pub l i c Health Fngineers New Delhi

C hiengmai ( haila and)

27 - 29 August Governments of Burma and Thailand; Anti-Malaria Co-ordination Conference on t h e Burm-Thailand Border

C a l c u t t a 25 - 29 September Indian Publ ic Health Associa t ion: Inaugural Meeting

22 - 26 October

25 October

Trained Nurses Associa t ion of I n d i a r Annual Conference

C a l c u t t a

Government of Ind ia : Meeting of the Co-ordination Committee of I n t e r n a t i o n a l and B i l a t e r a l Health Agencies

New Delhi

14 - 22 November

15 - 27 November

In ter -Par l iamentary Union: 45th Conference

Bangkok

Indian Council of Medical Research: Meetings of t h e S c i e n t i f i c Advisory ~ o a & and Advisory Committees

Government o f Indiax 5 t h Meeting of the Cen t ra l Council of Health

Rano h i ( ~ i h a r )

J a i p u r

14 - 16 December

28 December - 1 January 1957

Indian Counoil of Soc ia l Work: 9 t h Sess ion

1421. 3 January Government of

Co-ordination and B i l a t e r a l

India8 Meeting of the New Delhi Committee of I n t e r n a t i o n a l Health Agencies

I n t e r n a t i o n a l Union a g a i n s t Tuberculosiss New Delhi 14th I n t e r n a t i o n a l h t b e r c u l o s i s Conference

7 - 11 January

14 - 20 January

15 - 17 January

Indian Science Congress Associa t ions C a l c u t t a 44th Sess ion

Governments of I n d i a and Burma: Imphal Malar ia In te r -Coun t ry Co-ordination ( ~ s s a m ) Meeting

SEA/RC 1 0/2 Annex 4 Page 2

( con td . )

25 January Indian Council of Medical Research8 A 1 i garh Meeting o f t h e Advisory Committee on Trachoma

21 - 23 February All-India Ophthalmological Society2 Bangalore 18th All-India Ophthalmological Conference

24 June - 13 Ju ly Associated Countrywomen of t h e Worldr Colombo 8 t h T r i e n n i a l Conference an& Seminar

SEA/RC 10/2 Annex 5

Fellowships Awarded by WHO

August 1956 - Ju ly 1951

Table I

Source of Funds and Type of Fel lowshie

Country

Afghanistan

Burma

Ceylon

I n d i a

Indonesia

Nepal

Thailand

Tota l

9

12

5

3 4

16

6

11

93

SourceofFunds I n t e r n a t i o n a l

4

2

4

3 4

8

- 7

-

59

Regular

- 4

1

3

3

4

4

19

Regional

5

10

1

- 8

6

4

3 4

TA

9

8

4

3 1

13

2

7 -

7 4

SEA/RC 1 0 / 2 Annex 5 Page 2

Table I1

Distribution by Subjec t o f Study and-b!~ Country

Note: Three f e l lowsh ips a r e under n e g o t i a t i o n f o r - Portuguese Ind ia .

a

.rl

m G s G a d +

il

- 1 - - - 1 - 1 -

1 - 1 - - - - 1

1 - - - - - - - - 1 2

11

a, z5

2 - - - 2

- - -

- - - - - - - -

- - - - - - - - - -

G

S u b j e c t

Health Organiza t ion and Services

Publ ic Health Adminis t ra t ion Maternal and Child Health Health m u c a t i o n N u t r i t i o n Nursing Denta l Health Environmental S a n i t a t i o n Mental Health V i t a l and Health S t a t i s t i c s

Communicable Diseases Services

Malar ia Tuberculos is Laboratory Techniques Venereal Diseases Leprosy Quarantine and P o r t Health Bacter io logy Virology Production of B io log ioa l s

C l i n i c a l , Medical Sciences and Muca t ion

Anaes t h e s i o l o a Radiology and Radio-isotopes Anatow Physiology C l i n i c a l P a t h o l o a Pharmacology Prevent ive and Soc ia l Medicine Medical Wucat ion Pharmacognosy of Indigenous Drugs Hospi ta l Adminis t ra t ion Teaching of Surgery

Tota l

2 - i= m

6 'H 4

1 - - - - - -

5 - - - - - - - -

- - - 1 - - - - - - - 9

o

d

8 ,

2 2 2 - 3 -

2 - - - - 1 -

- 1 - - - - - - 2

- - - - 1 - - - - - -

12

E+

8 6

11 1 8 5 5 2 1

11 5 1 1 3 1 1 1

1 4

1 1 1 1 1 1 6 1 2 1 2

93

d .d

- 1 6 - 4

- 5 - - 1

- 4 - - - 2 - 1 - -

- - 1 - - -

- 6 - 1

- - 34

2 a 8 , 0

- - 1

- -

- - - 1 - - - -

- - - - - 1

- - - - 5

!

id .ri

a,

a E: H

- 1 2 1 1

- 2 2 -

- -

- 3 2

- 1 - 1 - - 1

- 1 - - - - -

- 2 - - -

16

SEA/RC I 0/2 Annex 6

Traininst Ac t iv i t i e s Carried Out by Governments With the Assistance of WHO Staff

(August 1956 - July 1957)

Sub .j ec t Category of Trainees Type of Trainina, Duration

AFGHANI STAN 'hberculosis Medical o f f i c e r s , x-ray

( 4 courses - technicians and 11 t ra inees) san i ta r ians .

Public Health Expansion and N u r s i n ~ Education '(2 courses - 15 t ra inees)

Health S t a t i s t i c s ( 2 courses - 15 t ra inees)

Vaccine Produc- t ion (3 courses - - 46 t ra inees)

Auxiliary s an i t a r i ans and nurse midwives.

Director and Deputy Director of s t a t i s t - i c a l o f f i c e , c l e rks and medical o f f i c e r s from provincial centres .

Sani tar ians ,Vaccinators and laboratory s t a f f .

Nursin Strident nurses + w t r s e -

10 t ra inees) , Laboratory technicians,

laboratory a s s i s t an t s and san i ta r ians .

Office Procedures Direo t o r s of various (2 courses - departments and 26 ' t ra inees) c le rks .

Wvironmen t a l Student-teachers, Sanitation municipal o f f l c l a l s , 73 courses - and v i l l age l eve l - i07 trainees) workers.

Medical Mucation Medical students. ( 5 courses - 203 t ra inees)

Refresher Course Medical o f f i ce r s . f o r Medical Officere ( 2 e s - 18 t ra inees)

Lectures and demonstra- 1-8 weeks t ions , p rac t ica l work i n x-ray department, tuberculosis diagnosis, dark room work, f i e l d t ra ining.

Elementary course i n ( 4 months basic san i ta t ion and ( t o theore t ica l and (1 year prac t ica l nursing md midwifery .

Ins t ruc t ions on medical and administrative s t a t i s t i c s , supervi- sion of o f f i c e work and re f resher course.

Lectures and demonstra- Continuous t ions , general labora- tory procedure on vaccine production.

General nursing course. 3 years

General laboratory i 5 months ieohniques, p rao t ica l s to i n bac t e r i o l o m , 3 years haematology and parasitology.

Lectures and demonstra- 1 month t ions on o f f i c e procedures and l i b r a r y 1 year methods.

l tO Academic and prac t ica l 3 months

t r a in ing in rura l s an i t a t i on , basic

[ t o (23 years

s an i t a t i on and hygiene. Lectures and p ra s t i ca l s 2 years

i n anatomy and preven- t i v e and soc ia l medicine.

Lectures and seminars 3 months each

sEA/RC 10/2 Annex 6 Page 2

Sub.iec t Category of Tralnees Type of Training Duration

BURMA - Malaria ( 6 o o e s -

70 t ra inees) Tuberculosis

( 9 courses - 173 t ra inees)

Vital and Health S t a t i s t i c s (2 courses - 3 6 t ra inees)

, y % r s e s - 45 t ra inees)

129 t ra inees)

Nutri t ion 4 courses -

/58 t ra inees)

Bhvironmen t a1 Sani ta t ion '(3- 182 t ra inees)

902 t ra inees)

Medical o f f i ce r s , malaria inspec to r s and malaria ass i s tan ts .

Medical students, student-nurses and midwives and laboratory technicians.

Graduate doc tors .

Student nurses and midwives.

Lady hea l th v i s i t o r s , heal th a s s i s t an t s and heal th education o f f i ce r s .

Assistant surgeons, heal th a s s i s t & t s , hea l th o f f i c e r s and medical students.

School students, heal th inspec t o r s , heal th a s s i s t an t s .

Medical s tudents , medical o f f i c e r s a n d heal th a s s i s t an t s .

Theory and prac t ica l ( 2 weeks work i n malariology and entomology. [ iOmnths

Lectures on tuberculosis 1-8 weeks and c l i n i c management f i e l d t ra ining, seminars.

Lectures 3 months each

Courses i n general nursing and midwifery.

Eeal t h teaching of 6 to 20 individuals and groups, days introduction to heal th education methods and mater ia ls , re f resher courses.

Theoretical and prao- t i c a l t ra in ing i n nu t r i t i on .

1::""' (1 year

Refresher course, academic and prac t ica l to t ra ining.

t3 (a years

Lectures, f i e l d work and seminars.

1 year

C F I L O N Rural Health Pupil midwives, and Lectures on ch i ld 49 lec tures

(70 t ra inees) student public heal th hygiene. nurses.

(26 t ra inees) Supervisory midwives. Cl in ica l teaching i n 1 month Kalutara Hoapi t a l .

(26 t ra inees) Midwives Refresher course. 6 l ec tu re s Thvironment a1 Health inspec to r s Refresher course. 5 weeks

26 t ra inees)

I N D I A - Tuberoulonis

i ( 3 courses - 1 48 t ra inees)

I I i r

each

Nursing s tudents , Lectures on tuberculosis, 2 weeks student heal th v i s i t s to c l i n i c s and to v i s i t o r s and public labora tor ies , home-

! (1 month

heal th midwives. v i s i t i n g and demonstra- t ions .

SEA/RC 1 0/2 Annex 6 Page 3

Subject

Trachoma - ( i X G s e -

25 t ra inees)

Vita l and Health S t a t i s t i c s 11 course - 25 t ra inees)

Maternal and Child Health - All-India In s t i - t u t e of Hygiene and Public Health, Calcutta (2 courses)

Maternal and Child EIealth/

?='TO courses - 2,920 t ra inees)

Health Wucation ( 9 courses - 699 t ra inees)

Environmental Sanitation. post- padua te Course i n h b l i c Health Ehgineering ( 2 courses - 17 t ra inees) Refresher courses ( 2 courses - 15 t ra inees)

l6eLtal ~ e a l t h ( 3 courses - j9 t ra inees)

Preventive and Social Medicine 3 courses -

H40 tra inees)

Catenom of Trainees Type of Training Duration

Medical o f f i ce r s , Theoretical, p r ac t i ca l 2 weeks inves t iga tors , heal th and c l i n i c a l work i n educators, laboratory the epidemiology of technicians and male trachoma, with pa r t i cu l a r nurses. reference to f i e l d work.

Medical o f f i ce r s . Lectures and exercises Continuous i n heal th s t a t i s t i c s .

Medical o f f i c e r s and Post-graduate courses. 10 months public heal th nurses. each

Medical o f f i ce r s , Refresher courses f o r i 1 month medical students, ward s i s t e r s , midwives, to public heal th nurses, lady heal th v i s i t o r s , 24 years heal th v i s i t o r s , nurse- diploma course i n midwives, ward s i s t e r s midwifery, o r ien ta t ion and s a n i t a ~ y inspectors. i n public heal th f i e l d ,

study of morbidity i n chi ldren.

Medical o f f i ce r s , Re-orientation t r a in ing 3 weeks san i ta ry inspec t o r s , i n public heal th , heal th educators,

[ t o a e r t i f i c a t e courses i n (1 year

soc ia l workers, hea l th education a d teachers and post- l ec tu re s to students of graduate students. DPH, D I H and DTBa courses.

Civ i l ellgineering Academic and p rac t i ca l 1 year students. t ra ining. each

Sanitary engineers and Lectures and p rac t ioa l s 3 months engineering sub- each ordinates

Medical graduates, N.A. Classes in medical 1-2 years s tudents and nurses. psy~hology, psycholog-

i c a l medicine and psychiatr ic nursing.

Medical s tudents and Lectures, p r ac t i ca l s 44 to 12 san i ta ry inspectors. and seminars, f i e l d months

v i s i t s and c l i n i c a l teaching.

SEA/RC 1 0/2 Annex 6 Page 4

INDONESIA Malaria m c o u e s -

346 t ra inees)

Tuberculosis ( 14 courses - 126 t ra inees)

' e r s e s - 7 t ra inees)

Trachoma -se -

46 t ra inees) Vlta l and Health Statistics ( 3 courses - 256 t ra lnees)

N e r s e s - 68 t ra inees)

Paedla t r lc Nursiag: ( 5 courses - 107 t ra inees)

Health mucat ion (2 courses - 70 t ra inees)

E)lvlronmental

f%%- 11 2 t ra lnees)

Medical Mucatlon ( 2 courses - 126 t ra inees)

NEPAL - Nursin d r s e -

15 t ra inees) Medlcal Mucation

( 2 courses - 37 t ra inees)

Cate~ozy of Trainees Type of Tralning Duration - Medioal students,

malaria a s s i s t a n t s , mantri teaohers, and mantri students.

Medical o f f i c e r s , nurses and mantris.

Medical o f f i c e r s and nurses.

Lectures , refresher (1 week courses, f i e l d t ra in ing , t o organization of 1 years entomological u n i t s and f i e l d labora tor ies , supervision and administration of spraying campaign.

Lectures, in-service t r a in ing and laboratory work.

Diagnosis and case- Continuous f ind ing technique.

Ophthalmologists and Lectures and prac t ica l 2 weeks mantris. t ra ining.

Medical undergraduates Lectures, p rac t ica l ( 2 weeks and s t a t i s t i c a l clerks. exercises and in- ( to

se rv ice training. ( 6 months

Nurse tu tors , midwife t u to r s and public health nurses.

Graduate nurses, medical and nursing students.

Medical students and "controlleurs".

School students.

Training i n public 10 months heal th nursing and each midwifery .

Lectures, demonstra- 7 days t ions and c l i n i c a l teaching. /:months

General o r ien ta t ion , 6-10 d q s l ec tu re s , seminars and group discussions.

Academic, p rac t ica l and 2 years f i e l d training.

Medical students. Lectures, demonstrations Continuous and prac t ica l s i n anatoqy and physiology.

Student nurses General nursing, 3 years including midwifery and public health.

Health a s s i s t a n t Ins t ruc t ion i n general .t 2 years t ra inees preventive and cura t ive

work.

SEA/RC 10/2 Annex 6 Page 5

Subject Catemm of Trainees T v p e of Training: Duration

THAILAND

e r s e s - 27 t ra inees)

Nursin W r S e s - 102 t ra inees)

Maternal and ch i ld

f-rses - 4 t ra inees)

Nutri t ion

Health workers Field t r a in ing 3 weeks

6 months

students. Lectures and demons t ra-

l tO Post-graduate nursing Public heal th nursing. 2 gears

t ion. Medical o f f icers , In-service training. One f o r

public heal th nurse 3 weeks and nurse supervisor. and one

f o r 4 weeks

Sanitary inspec to r s P rac t i ca l nu t r i t i ona l 1 year survey.

Health Mucation Students of the Theoretical and 2 years ( 1 course - h a a m e n t a1 Muc a- p rac t ica l t ra in ing i n 120 t ra inees) t ion Pro gramme. ru ra l health, with

emphasis on heal th education.