SEA~RCI112

WORLD HEALTH ORGANIZATION

REGIONAL OFFICE FOR SOUTH EAST ASIA

TENTH ANNUAL REPORT OF THE REGIONAL DIRECTOR TO THE REGIONAL COMMITTEE FOR SOUTH EAST ASIA AUGUST 1957 - JULY 1958 TABLE OF CONTENTS

Introduction

PART I - GENERAL STAT-T OF ACTIVITIES IN TEIE REGION

Publio Health Administration Strengthening of National Health Servioes Community Development Maternal and Child Health Nursing Health Eduoation of the Publio Nutrition Mental Health Sooial and Oooupational Health Dental Health Environmental Sanitation Eduoation and Training Mreot Assietanoe to Eduoational Institutions Fellowships Communicable Diseases Malaria and Other Insect-Borne Diseases Tubemulosis Venereal Diseases and Treponematoses Other Communicable Diseases Epidemiology Health Statistics Assistanoe to Research Publio Health Laboratories and Vaooine Produotion Publio Health Laboratories Vaooine Produotion Curative Servioes Sooio-Eoonomio Aspeots of WHO'S Programme Atomic Energy in Relation to Health

PART 11 - GENERAL Regional Committee Organization and Administration Organizational Structure Personnel Staff (Relfare Aooommodation of the Regional Office Legal and Constitutional Matters Implementation of Projects by Governments Proourement of Equipment and Suppliea Reports and Documents Collaboration with Other Agencies 43 United Nations 43 Specialieed Agencies 44 BiJateral Agencies 45 Non-Governmental Organi~ations 45 Other Agencies 45 Public Information 46

PART I11 - ACTIVITIES UNDERTAKEN BY GOVERNMENTS WITH THE HELP OF WEIO

Afghanis tan 49 Burma 62 . Ceylon 71 India 77 India - Former French Settlements 108 Indonesia 109 Maldive Islands 119 Nepal 120 Portuguese India 122 Thailand 123 .

Inter-Cow try 131 '

ANNEXES

1. Organizational chart

2. Geographical distribution of international ataff assigned to South East Asia Region as of jl July ;'. 1958 . .

3. Conferences and.me.etings oalled by the United, . . . . Nations and specialized agencies at which WHO was represented 4. Conferenoes and meetings of governmental, non- governmental and other organizations at which WHO wae represented . ..

5. Tables showing fellowships. awarded by WO by . .; : ,:. source of funds, type of fellowship, and distri- .. ., ' bution by subjeot of study and by 0o~ntqY ' ' .. . . , . . 6. Training aotivities oarried oyt by governments, , . ). with the assistanoe'of WHO ataff.'fto be issued .. separately) SEA/RC~~/~ INTRODUCTION

This year has seen a slight setback in the steady expansion of public health services, which has been a feature of the past ten years in South East Asia. This setback has been part of a general though slight reduction in the expansion of socio-economic develop ment in at least five countrfes in the Region. Perhaps it is just as well to have a slight reduction in the tempo of these aotivities, as they were beginning to develop a little too rapidly and were not having sufficient time to take deep enough roots. Nationkl resources, which were already slender, were being spread so widely and so rapid- ly that numerous programmes could ill afford to stand the strain of subsequent development. Such a temporery halt is, therefore, useful if it is.exploited for consolidation of existing programmes and for better planning of future activities. That this halt is temporary I have no doubt. The forward march to material progress is too well established to be shaken off by anytbing short of a major world tragedy. People all over South-East Asia now realize the benefits of modern public health services well enough to insist on having for themselves a bigger and better share of them. This is certainly true of the population of rural areas, which forms the bulk of the popula- tion of the Region and which has had, hitherto, the somewhat un- deserved reputation of being resistant to scientific medicine. This so-called "resistancev has in fact been our own inability to adjust modern medicine to the needs of the villagers of South East Asia. There are, admittedly, still many maladjustments to rectify, but the road is now clear and future scientific progress ensured.

In addition to the setback mentioned above, the usual head- aohes of public health programmes have remained unaltered. Departments of health have continued to be harrassed by ministries of finance, aa usual. Shortages of trained and even semi-trained personnel have re- mained as mute as ever, and training programmes are still neither well plenned nor well executed. Counterparts for WHO field staff remeln as elusive as before. Investment in brick and mortar still takes precedence over investment in human beings. It is indeed a major misfortune of public health services in this region that build- ings for hospitals, laboratories, health centres and training insti- tutes eat up such large funds that far too little is loft for hiring adequate personnel to do the job for which these buildings are intended. Administrative delays, better known as red tape, still remain a formidable barrier. The willingness to accept responsibility, among junior workers, and the unwillingness to share responsibility, among senior workers, are &ti14 too evident. A number of old projects, where technical assistance has terminated, still continue to show signs of deterioration, not so much from any lack of ability or desire for progress but from gradual disappearance of locel facilities and resources which had been made available during the period of WHO assistance.

I quote from a recent report of a WHO expert on laboratoriesc

"In practically no instance has the original standard been maintained or improved, mainly because of lack of staff and materials (to be provided by governments). Break- down and delay in the repair of equipment are a common feature of a nunber of laboratories. I wish to put on record my disappointment with the majority of the labor& baries visited to-date". It must not be inferred from the preceding remarks that all is not well with public health programmes in South East Asia. This is far from the truth. In fact, very considerable progress has been made in spite of all these handicaps, which, after all, are insepar- able from such a rapid process of growth. When looked at in re- trospect, the developma'nte during the past ten years have indeed been remarkable, as will be seen from a document which I am presenting to the Regipnal Committee separately under the title "Ten-Year Review r WHO'S Activities in the South East Asia Region."

I give below some of the highlights of the programme. Dur- ing the period under review 136 projects have been assisted. On 31 July 1958 there wore 116 professional staff members in the field. A number of posts were not filled8 recruitment for certain categories still continues to be difficult. The total flnanclal responsibility for programmes in the Region in which the Organization is partioipqb ing amounted to over seven million dollars in the current year, inclusive of "Other Extra Budgetary Fundsu.

The main fields of assistance remain, as before, the control of communicable diseases, the promotion of rural health services and the training of all categories of health personnel.

The state of environmental sanitation throughout the Region continues to remain highly unsatisfactory, partly from lack of fund8 and partly from lack of driving force to improve existing conditions. A more detailed assessment of the sanitation situation appears in a separate document, SEA/RCII/I~, to which I draw the Committee's special attention.

Among the programmes for the control of communicable diseases the most dramatic is the ambitious programme for malaria eradioation, details of which appear elsewhere. There has been no major advance in tuberculosis control, ainoe the largest single programme, which is for 'India, still awaits approval by the Government, and the chemo- therapy research project in Madras has not yet put forward its report. Projects in leprosy control have made good progress, which has been remarkable in the case of Thailand. Yaws control has not yet made the expected progress towards eradication, and the programme in Thailand has, in fact, needed some further strengthening. we still have no adequate answer to the problem of filariasis, especially in r'wal areas. The two pilot projects in trachoma in India and Indo- nesia, have shown good rekults, but the proposed expansion of the programme, especially in India, has not yet obtained government approval.

In rural health tho most notable feature has been the very successful regional conference on that subject which was held in October 1957 in New Delhi. The recommendations of this conference will undoubtedly form an important milestone in the development of rural health servlces in this region. Individual rural health pro- c jects h~vomade considerable progress in India through the community development programme; ten subsidiary etate plans of operations have I been drawn up during the year, and basic criteria completed for rural training areas and demonstration districts. Schemes for the expansion of rural health serviceb in Indonesia and Thailand have been under consideration. The rural health project in Chaurassia, Afghanistan, is now well staffed and well equippbd. In maternal and child health activities we have continued the emphasis on improving standards of paediatrics both by providing medical and nursing aediatric teachers and by holding a paediatric teaching conference (n June 1958). A report of this conference appears separately. The integration of maternal and health services into general public health services continues. An attempt to promote some urban health centres for demonstration purpose8 has not yet been successful.

Training activities have as usual been the main feature of WBO assistance in this region. Projects for assistance to medical schools and nurses'training institutions have been successfully conti- nued. The school for sanitarians in Kabul and the school for health assistants in Kathmandu have both made very good progress and have become a permanent feature of the national health services in Afghan- istan anb Nepal. A detailed enumeration of the extensive training activities which have been assisted during the year appears in Awex 6, to be issued separately.

Efforts have continued for the improvement of the collection of statistics on mortality and morbidity, the training of expert medical workers and the development of locally suitable statistioal techniques. Preliminary work has been done to start assistance to hospitals in the improvement of their records and statistics. In nutrition a number of studies have been carried out in Ceylon, Indo- nesia and Burma, and it is hoped that, with the addition of an adviser in nutrition to the Regional Office, more specific programmes of assistance can be developed in this very important field. As regards mental health, our efforts have been concentrated on the training of essential workers, particularly through assistance to the All-India Institute of Mental Iiealth, Bangalore. Training in radiation protec- tion has been arranged so that each country in the Region may have at least one or two persons sufficiently trained in protection measures (hospital physics and health physics). Details of all the above-mentioned activities will be found in Parts I and I11 of tho Report.

Although the control of ever-increasing populations, parti- cularly through the reduction of birth rates, is a matter in which the brganization does not take an active part, this is not to say that program1.38 for "family planning" are not making progress in this region. However, major activity in this field is almost entirely restricted to India, where such programmes are being pursued more vigorously than before and are becoming somewhat better organized.

Relations with other organizations, both bilateral md inter- national, have continued to be close and cordial, especially with the Technical Assistance Resident Representatives, UNZCFP, the Interna- tional cooperation Administration of the United States, and the Colombo Plan,as well as the Rockefeller and Ford Foundations. A very substan- tial portion of the work in this region has been carried out in joint collaboration with UNICEF, as in past years, and I wish to record my appreciation of that orgenization's strong support to our programmes for daria eradication, for the development of maternal and child health services and for rural health services, as well as in a variety of training programmes. It is with deep eorrow that I record the death of m'. S.F. Chellappah from Ceylon, retired Deputy Director of this Office. Dr. Chellappah, after successfully completing an assignment in Burma, was on his way to yet another aseignment in Afghanistan when he passed away in New Dslhi on 18 October 1957, from a heart ailment. Dr. Chellappahfs work in helping to organize the office in its early stages as well as the great contribution he made to the health services in his own country will long be remembered. To his collea$ues in the Regional OPfice, and to me especially, his death was a great personal loss.

On behalf of the Regional Office staff, I acknowledge with much gratitude the whole-hearted co-oporation that we have received from all govsrnrnents in tho Region, and have the honour to present my Tenth Annual Report to the Regional Committee.

S b(~'fi~C, Regional Mrector PART I

. GFXJEdL STATEMENT OF ACTIVITIES IN TEE REGION

1. PUBLIC HEALTH ADMINISTRATION

1.1 Strenutheninn of National Health Services

In 1957-1958 stress has been further lald on projects designed to strengthen health administrations, and emphasis has been placod on the necessity for a regular appraisal of the work done. !be value of advisory services at the administrative level is now widely recognized.

WBO Area Representatives in five countries and the public health advisers in Afghanistan and Nepal are working in close association with national directorates. Also, the policy of integrating WHO-assietance wtth plans for national development has been continued. A public health officer and nursing and other advisory staff were assigned as a team to work in connection with public health services in national community developnent areas in several Indian otates. WHO staff in Afghanistan and Burma advised on the co-ordination of international assistance with the health requirements of national development plans. The WHO adviser Ln Nepal aeeisted the Government in the public health aspects of its administration.

Integration of maternal and child health services into the general public health and curative services was oontinued. The trend toward a demand f6r integrated health services in Afghanistan, parti- cularly outside Kabul, increased notably. filly integrated maternal snd child health school hoalth contros aro oporawng in Burma in Rangoon and Mandalay. In Ceylon a WOpaediatrician with other staff took part in training programmes at the national training centre at Kalutara. A maternal and child health officer assisted the Thai Government at the directorate level in the further development of maternal and child health services, Nursing advieere at directorate level were assigned to Ceylon, Indonesia, Thailand and certain Indian otates.

Apart from public hoalth cnginoors and sanitarian- ongagod in projocts, in Burma a public health engineer was provided to the Ministry of Health to advise on environmental sanitation services generally. nRo short-term consultants were assigned to Ceylon to advise the Government on revision of legisiation relating to public health, and a public health engineer assisted the Ministry of Health In Indonesia in dealing with rural sanitation progrsmmes. SEA/RC~I/Z Page 2

As assistance to medical education and training is of primary importance in strengthening national health service, medical schools in several countries were ~llippli~dwith teaching staff and equipment.

Rnphasis is now being concentrated on strengthening national administrations rather than on separate projects designed for the control or eradication of communicable diseases. None the less, the latter typee of project remain essential; it is satisfactory to note that they are now largely being carried out by national staff. Most significant is the change in orientation from malaria control to malaria eradication.

In the field of epidemiology a WHO epidemiologist has assisted the health directorate staff in Ceylon to make a study of disease patterns. WHO statisticians have assieted the health directorate in six countries of the Region in improving the means of collecting and processing statistical data and in the establishment of health statis- tics services.

Burma was assisted at the national level in the production of its annual health reports, and the manual of instructions for the preparation of such reports described in last year's Annual Report was completed and distributed to the governments in the Region.

1.2 Community Develoument

1. In India -

1 Community development on the lines demonstrated in India amounts to an organized and planned effort of the community aimed at raising the national standard of living in all its aspects. As such it is a tremendous and revolutionary movement. In effect, its function is to condense the normal transition period of a traditional to a modern economy from a century to little more than a decade. This process involves the organization of all phycjical, economic and social forces in order to transform the old social structure, and also the changing of the attitudes of the people, so as to make them feel they have an essentially personal share in the development. At the root of all community development are self-help and the co-operative principle.

Although, as described above, several oountries of the Region are developing major rural health activities, it is notably in India that rural health services have been made an integral part of thp community development projects.

The assistance of WHO and UNICEF to community development health services in terms of India's Second Five Ycar Plan has considerably in- e creased. Health services are being integrated into the community develop- ment "blocks" from the very beginning, and the importance of their place is being more and more recognized. SEA/RC~~/~ Page 3

Substantial progress has been made in the past year. Though a long-term target, the integration of health and medical services is being gradually attained. In some states this integration has occurred only at the top, and in others two separato services continue, but in all states the services are integratsd at the periphery and, for demonstration purposes on the district level.

Tke basic unit for rendering integrated preventive and curative service is the primary health centre. It is expected that these centres will be assisted by referral hospitals and public health laboratories, each serving a group of primary health centres. Guidance and assistance are being given to some extent from district and higher levels. The staffing of the primary health centres suffered in the beginning from an acute shortage of trained personnel nurses and mid- wives), most training sohools having started extensive training only recently. From mid-1958 on, the flow of qualified personnel will be regular and on an inczeased scale.

Most of the hospitals and laboratories to be cpgraded so as to become referral hospitals and public health laboratories have been visited by WHO staff, and the information on their services which is available has been analyssd eth respect to their conformity to recommended WHO criteria. Whilst UNICEF equipment and supplies to primary health centres are recommended for release as soon as individual primary health centres qualify, equipment for referral hospitals and public health laboratories will be released later. s. Almost all participating districts have at least one medical a officer of health with a diploma in public health. For four special demonstration districts plans have been prepared for organizing the health services according to WHO criteria, and a similar pattern will be followed for other demonstration districts.

In view of the importance of establishing specific rural train- ing areas in order to ensure the sound dovelopment of rural health servioes, high priority has been attached to the promotion of such areas under tho guidance of, and in association with, the Departments of Preventive and Social Medicine of Medical Colleges in India. In four Indian otates tentative plans have already been developed for rural training areas, where training will. bs given to all categories of health workors. Working conditions will be similar to those which graduates will encounter later when posted to primary health centres. In addition, in some states,two to three months' residential training is already being given to all prc-registration medical graduates. Further, all categories of existing personnel at primary health centroe are to be given, in turn, residential orientation training as well as periodical refresher couroos.

Public health is gradually being incorporated into the training of health service workers generally, and preventive and social medicine into the curricula of medical undergraduates. Rnphasis can now be shifted to providing all students with adequate basic training, in- clusive of experience in rural training areas. In some states, e.g., Bombay, almost all primary health centre personnel have been given intunsiv. oriontation in public hoalth, but this is not 30 in many othors.

WHO oriteria for the establishment of demonstration districts, rural training areas and referral hospitals have been submitted to the governments of the Region to serve generally as guidolinos for dovelop- ing specific plans.

For ydurs,up to the end of 1957,~Ogave assistance to community development activities in India through various maternal and child health/nursing education projects. From the beginning of 1958, however, t all these projects were redefined as public health programmes for the * respective states. By June 1958, subsidiary plans of operation for all the states (except Jammu and Kashmir and hsam) had been signed by WHO, UNICEF and the appropriate government representativen. In addi- tion, bilateral plans of oporation for providing direct WHO assistance to community development programmes had been prepared and sent to the Government of India for signature. WHO commitments for 1958 in terms of these plans ares provision of ten public health officers, twenty- one public health nurses and two sanitarians.

Quidance for countries initiating health services in terms of community development projects is contained in the report of a study team appointed by the Planning Commission of the Government of India, which has recently reviewed the possibilities of decentralizing the existing community development machinery in the country. Chiof among tho lessons learnt is that the block advisorx committees should be replaced P by block develo~mentcommittees with local executive powers; these committees are to be named "Panchayat Samitiv. Each such committee should be composed of twenty dologatos indirectly clected from the village panchayat units, with some members co-opted if necessary, to ensure adequacy of representation- Among the functions of the Panchayat Samiti are the promotion of drinking water supply, public health and sanitation and medical relief. As regards the relation- ship between the Panchayat Samiti and tho hoalth department, it is recommended, first, that all officers should be drawn from the corres- ponding state oadres and their services lent to the Panchayat Samitis; second, that technical control should rest with the appropriate govern- ment departments, leaving only administrative and operational control to the community development body, and third, that except where the Panchayat Samiti is not in a position to function in any particular matter, the state govement should not directly undertake any functions in the block.

2. In Other Countries of the ReRion

In association with the dovelopment scheme planned for Afghanistan, ' tho pilot project at Gulzar (Chau~assiaand ~hewaki)near Kabul is now provided with a well-planned rural health and training unit; already a public health officer, a public health nurse and a sanitarian provided by WHO are assisting with this programme. It is expected that the experience gained from developing this unit on comprehensive service and training lines will afford valuable guidance for the promotion of rural health services in the country generally.

Burma's first cornunity development project - the Payagyi project - which was initiated in 1954, is operating a health programme which offers both curative and preventive services to the population of approximately 37,000 residing in the development area. Apart from the base hospital in Payagyi itself, there are in the area two rural health centres, eight maternal and child health centres and a mobilc dispensary.

In Ceylon the principles of community development are largely applied by agencies dcaling mith cconomic dovolopment of rural aroas, there is no representative of the Department of Health Services on the National Planning Counci1,which is concerned in these matters. IIowever, the Health Department does participate in the work of some oonunitteoe of the Council and gives technical advice on health matters at villsgc level.

Both Indonesian and Railand community develpment plans are in their initial stapes, but consideration is being given to the promotion of major rural health programmes of a general character, and WHO assistance for preliminsry planning purposes is being considered*

As regards Nepal, major development plans have yet to be formulated but WHO-assisted projects are training both health assistants and nurses for future work under rural health auepioos.

3 Conferences and S~minars

One of tho most important meetings organieod by WHO in the Region was the Rural Health conference, hold in New Delhi in October 1957, for Member States in the Region. This conforonce is descri'bed in dotail in Part 111. Its report has been published and has attraotod widespread attention among thosc interested in developing rural health services.

In following one of tho recommendations made in tho report,the Rogional Offioo is now establishing a service for collecting materials and publications relating to new devolopmonts in rural health activities, (see Part 11, 2hsptzr 4) and is offering as.;iztulcc in planning nnd conducting seminars on rural health at the national level.

Finally, WHO was represented at the Asia and Far East Seminar on 'Praining for Community Development and Social Work, sponsored by the United Nations and hdld in Lahoro (~akistan)from 9 to 20 December 1957. The major subjects considered in the Community Develop- ment Section of the Seminar werec (1 ) the content of training for SEA/RC~~/~ Page 6

various categories of workers in community development; (a) methods used in training; (3) production, testing and distribution of train- ing materials; (4) contribution of different disciplines to the basic content of training; (5) evaluation of training programmes; and (6 ) major problems connec ted with training for community development.

1.3 Maternal and Child Health

In accordance with our basic philosophy that mothers and children arc best served through community health sorvices rather than by special contres, there have been no separate maternal and child health projects in this Region since tho beginning of 1958, when the oxisting programmes were redefined. Ch the sonrice level, all effort8 are being concentratod on the further development of sound practices within the rapidly expanding community health centres in the various countries. The main emphasis has been on refresher and orientation training of all categories of personnel - doctors, nurses and midwives.

Howover, it is recognized that refresher and orientation ooursos are of only limited valuo as long as the basic training is deficient. Although training in obstetrics is on a reasonably high level for both medical and nursing students, training in child hoalth is still vory unsatisfactory. Real progress can be oxpectod only when the general practitionors and acillary personnol are proporly trained for the main task of all health services - promotion of positivo - health, prevention and early treatment of disease. Since most of thosc objectives are more easily and more effectively achieved through con- L centration on growing human beings, promotion of better child care training in the basic undergraduate curricula is ono of the important activities of WHO in South East Asia.

In Afghanistan tho !VHO visiting professor of paediatrics assigned to the Medical School of Kabul has stimulated sound development of the Raediatric Department. The Govoment has considerably increased the staff and has appointed two professors of paediatrics.

In Burma this yoar the phmical fncilitics of th~pnodiatric teaching unit of tha Rangoon Medical College have improved to a degree which makes it possible to plan for further devolopments. The Govern- ment has been advised to increase tho medical and nursing staff, and VHO is now selocting a visiting profossor of paediatrics.

Ceylon is the first country in the Region to start on a spocial- iaed consuliativo sorvico for childron in rural aroas. A WE0 paediatric team, after having gained oxporience in a pilot projeot in Kalutara, is now assisting in developing a numbor of Paediatric Departments in provincial hospitals to provide consultative and advisory services in the field. SEA/RC~~/~ Page 7

In India, whero until recently there had been only one professor of paediatrics (a second was addod last year), such professors hav~now been appointed in Madras, Visakhapatnam, Byderabad, Bombay and Delk3.; there is an associate professor of paodiatrics in Amritsar, and indepond- ent heads of children's dopartments have been designated as readers pr 1 in Patna, Indore and Nagpur. WHO has been asked to help in the upgrading of the Paediatric Department in Trivandrum.

The period of teaching is oxpanding rapidly from the time occ.1- pied by a dozed lecture sessions, which was the extent of the course given in most Indian modical colleges a fow years ago, to three mont'is, and promotional and preventive aspects are becoming increasingly prdzi- , ncnt in the toaching of undergraduates. - !Tho pxtoblem of securing safe maternity care of the population of Indla has many facets. One, very important, is to make those indi- genous midwives who underwent training in aseptic methods of childbirth acceptable to the population. Another is to sncourage young village girls to take up the profession of auxiliary nurae-midwives.

In order to win thc 00-operation and understanding of the 7ubli0 in these undertakings, the Government of India, with the participstion of the Regional Office, produced a film entitled1 "It Happenod in Our Villaget'. me original version is in English, and oomentaries me being produced in thirteen Indian languages. It is estimated that this film will be seen by three to four million people in rural area8 of India, and, if approved for urban audiences, by many more. - hss spectacular but steady development in this regard bas alsv taken place in Indonesia and mailand.

fn Junc 1958, a group of eighteen t~a~h~rsof paediatrics from six oountries of the Region mot in Bangkok under WHO sponsorship to discuss paediatrio education. This group made far-reaohing recommenda- tions, which it is hoped to prosont in a %parato document to thb Roglonal Committee.

No effective measures to deal with the most vulnerable age group - the toddler - have so far beon developed.

In the field of school health there was limited development. In Afghanistan the first organizod school-hoalth servioo was initiated in Kabul during the year. So far one doctor and threc trained assiet- ants have boon appointed. In Burma, school health in Rangoon and Mendalay is,to a major degree, integrated in the general maternal and child health sorvicos. In Ceylon, groups of apothecaries are undergoing

F special coursos on school health and arc boing posted to rural areas. Thero were no major developments with rospo0t to school hcalth in India, . where, howover, in some of the medical ool2sges9 paediatric departments are beginning to assumo limited responfs!tbility for sohool health services. In Indonesia, a WH~/lJN~~~~-asaistodpilot project in school health in onc urban and one rural aroa has now entered its second year.

Efforts continue to be made to discourage the common tendency towards setting up separate school-health services, and instead to include this activity as one of the major functions of any hoalth contre or unit. Routine medical inspections aro being discouraged in favour of a more thoroughexaminationof selectod groups.

In Thailand, there has boon some oxpansion of activities, but ideas of optimal service have not yet crystallized in spite of the experience gained in the large-scale pilot school-health project in Chachorngsao.

1.4 Nursing

mere has been increasod emphasis on WHO assistance in nursing at the administrativo level, partly through new projects and partly through redefinition and expansion of continuing ones. Cno country adviser in nursing has been assigncd to Ceylon to assist in streng- thening nursing administration in the Health Directorate, and another is helping Indonesia to sot up a Division of Nursing. A similar adviser in nursing education is to be assignod to Burma, where WHO had previously assisted in the establishment of a Division of Nursing. me nursing education projects in Afghanistan and mailand have been redefined and expanded so as to provide for advice and assistance on all matters relating to nursing education on a country-wj.de basis. A new project in India makes provision for assigning nurso ldvisors to some of the states. This trond indicatos an increasing awaroness of the place of international nurses in hclping to formulate policies relating to nursing. National nurses aro gradually being given greator administrative responsibilities by thoir governments.

In order to increase the quality and quantity of nursing pcr- sonncl, many more qualified tutors are noeded for nursing schools, and matrons and ward sisters need additional trdning in suporvision and administration. Some progress is boing made in mooting these needs, particularly with regard ts tutors: four countries in the 3~gion arc now training their own tutoro, and two of India's tutor-train' ing programmes are boingused as regional training centrda. Three centres in India conduct courses for ward sisters. No centres in the Region are yet equipped to train nurse ad$n$nistrators, but this deficiency is being overcome partly through fellowships and partly by means of refresher courses. WHO has assisted with refresher courses for matrons, ward sisters, nurse and midwife tutors, paediatric nurses and health visitors. The increasing supply of qualified tutors is making it possible to improve the quality of training. Curricula are being revised and standardized, and more attention is being given to correlating class- room teaching with practical teaching on tho wards. Attempts aro being made to include public hoalth as part of the training of evory nurse and midwife; for this purpose n number of schools are now employing public health nurses as part of the teaching staff. R?IO is giving direct assistance in the development of this aspect of training and also in providing an orientation in public health for selected groups of graduate nurses. Four countries are conducting post-graduate courses in public health nursing, but the shortago of adequately trained nurses for preventive hoalth services is still serious.

On the wholo, schools are reasonably wcll supplied with teaching - equipment except for textbooks in the local language. Both PC40 and tho local authorities are gradually incroasing the supply of reference material in an effort to moot tho problem. In most countries the major limiting factors in tho expansion of the training programmos are tho shortage of hostel and classroom accommodation and limited funds for stipends. Unless funds are.provided immediately for these purposes, thb govornmentsf plans for the development of thoir health services, which call for largo number of trained nurses and midwives, will havc to be curtailed.

Tho trend towards giving moro WHO assistance in nursing on the adrninistrativo level and loss in respect of individual nuraing schools is a logical one becaueo of the incroasing supply of qualified national tutors who are able to carry out their functions with intermittent international assistance. The present need is for asaistanco to the national nurses who are being appointed to positions in which they have to participate in formulating major policias on nursing matters. Compared with the pattern of a few yoars ago, when most projocts were provided with toms of throe or four nursc-tutors to assist individual schools, a number of WHO'S current projccts provide only one or two intornational nurses who act as senior advisors. In 1955 thoro were 59 nurses assigned to 34 projects, whercas in the current year thore have been only 38 nurses in 26 projects. Although there are now thus fewer posts to be filled by WHO nursos than three years ago, recruit- ment continues to be difficult becauso of tho need for increased numbers of nurses who arc capable of advising at the country or state level.

1.5 Hoalth Education of the Public

Hoalth education of tho public has been strengthened in countries within the Rogion through: (1) national seminars and training courses; (2) the oxtension of health education to statos (provinces or districts) and to fiold training areas, and its emphasis on spacial aspeots such as teacher preparation, and (3) tho technical discussions on health edu- cation of the public which wore hold during tho last session of tho Regional Committee. SEA/RC~~/~ Page 10

To assist with various developments in thc Rogion, provision was made in 1958 for nine hoalth eduoation projects, throo of which provide for country advisers (in Afghnaistan, Burma and Indonesia), two for advisors at stato lovol (in Bombay and Uttar ~radcsh),ono for a visiting professor of hoalth oducation (at tho All-India Instituto of Hygiene and Public Health), ono for assisting in fiold training and with the Research-cum-Action programme (at ~ingur),one for assist- ance with eduoation relating to nutrition (at the Nutrition Rosearch Institute, coonoor), and ono for assistanco with hoalth oducation in the training of toachers (in ~olhi).

National Seminars and Trainina Coursos

In Ceylon, as part of the national hoalth oducation programme, d an intensive thrcomonth courso was given undor tho direction of tho Sub-Division of Health Zducation of tho Diroctorato of Health Services. Fourteen trainoos, seloctod from a group of public hoalth inspectors, were enrolled. On completion of the courso, it is oxpected that th~ trainees will be postod in the field divisions and with specialized health campaigns to carry out health education aotivitios. This is tho second courso of this typo to bo offered in Coylon.

The first national hoalth oducation seminar in Indonosia, in which 72 persons participated, was organized in July 1957 and diroctod by tho Sub-Division of Realth Education with thc assistanco of tho Division of Education (~inistr~of ~oalth), ICA and WHO. Among tho subjocts considered woro the place of health education in public health - (0.g. nursing,saniktion, malaria control),health oducation contont in training programmes, and tho use and evaluation of teaching materials and mothods. A complete report of tho procoedings of the seminar was published in the Indonosian languago for distribution.

At the All-India Instituto of Hygiono and Public Hoalth, Calcutta, two three-month post-graduate hoalth education courses woro offered dur- ing the aoadcmio ynar 1957-58. One of them was in hoalth oducation administration, Tho Health Education Soction of tho Institute and thc field training activitios being carried out at Chotla and Singur continuod to dovelop. A tcnmonth post-graduate cortlficato coursc for proparing hoalth oducation specialists is still under consideration. When this courso is offered, it will bc tho first to provido training for hoalth education specialists in South East Asia. WHO staff assistod in these developments at the Instituto.

In almost all tho countries of the Region, numerous training activities in hoalth education for many categories of workors continuo to be carried out. In addition, during tho year nine persons returnod . after a year of post-graduato study in health education,on followships provided by WHO, ICA or tho Colombo Plan, whereas twelve persoqs . proceeded abroad for post-gmduate studios in health oducation during 1957-58. SEA/RC~ 1/2 Page 11

Extension of Health Education

In tho countries in which technical units in health eduoation have been established within the Ministries of Health, assistance is being extended to district and local groups. In Thailand, progress has been made in developing four rogional demonstration centres in which health education plays a major role. In India, state bureaux of health education are boing strengthened or established, starting with two statesy WHO has assisted tho State of Bombay. Yith the assistance of the Ford Foundation, ICA and other agenoies, throo Research-cum-Aotion projects located in training areas for hoalth workers in the community dovelopment projects are in operation. 'They are largely concorned with finding approaches and methods of education which will be effective in bringing about improvod environmental sanitation. WHO is assisting with the health education phases of one of these projects,looated in tho Singur area. A national project in health eduoation is boing dovelopod in the Ministry of Education in Ceylon vith tho oo-oporation of ICA.

In India, plane havo been finalized for a WHO-assisted project in the Delhi area to develop health eduoation in teachor-training institutians with the co-operation of tho Ministry of Bealth and the Idinistry of Education. Following the recommendations of the Indian delegation to tho Joint FAO/WHO Seminar on Nutrition Education and Health Educaticn,hald in Baguio (~hilip~inos)in 1955, a committee made up of representatives from the Indian Ministries of Education, Agriculture and Health is now roviewing the existing curricula in teacher-training institutions and in primary and secondary sohools with a view to integrating health and nutrition into the curricula. The booklet entitled "A Study Guide on Tbachor Preparation for Health Educationt1, prepared jointly by WHO and UNESCO in 1957, has been distributed widely in the Region.

'Ilechnioal Discussions

As a rosult of a livoly two-day discussion,during the last session of the Regional Committee, on "How Can Health Education of the Public Be More Effectively Develop0d in South East Asia?", thirty-two oonclusions and reoommendations were drawn up, which may servo as guiding principles in tho development of health education in the Region. The recommendations relate to the following8 factors to be considerod when planning programmesj the functions of a tochnioal section of health eduoation at different lovels; the organization and budgot for sducational work; personnol needed and the training of various workers for health education responsibilities; principles underlying tho selootion and use of methods and materials; kinds of looal demonstrations noedod today; how to achiove co-ordinated efforts of official and voluntary agencies, and an appraisal of methods and materials. Before tho discussions the participants had proparod compre- hensive statements of health eduoation wtthin thair countries, md this information was incorporated in a working papor, which, along with tho reoomnendations, hao now boen published in a booklet, for which requests oontinue to be received from countries of tho Region. Suit- able ways of following up these recommendations are now under considera- tion.

1.6 Nutrition

Be increased efforts in nutrition at Headquarters and the closer co-ordination of the work of WHO, FA0 and UNICEF in this field have been reflocted at the regional level, whero fllLIO's main offorts are being directed toward finding solutions for improving nutrition at the village and family lovol. Low standards of living and lack of trained personnol at all levels arc serious barriers to rapid devel opmen t . In a joint effort to study all possible aspects of the total nutrition problem of a single country, two short-term consultants - one provided by WHO and the other by FA0 - visited Ceylon in the last quarter of 1957. As a rosult of thoir findings, a very useful report was produced, copies of which aro boing distributed to the countries of the Region.

!Re WHO-assisted nutrition projoct in Burma was comploted at the end of 1957.

In India, with a grant of $10,000 from WE0 Headquarters, plans have boen comploted for a rosoarch project on the public health sspocts of anaemia,mainly among pregnant women and thoir children and among school-girls. A number of technical probloms rolating to a UNICEF- assisted goitre control project VIQT~ solved, and full dovelopmont of the project can now be expected.' a T#o short-term coneultants were assignod to Indonesia in 1957. \. Ono of them paid special attontion to tho possible effeots of protoin malnutrition and vitamin A deficiency on tho oyesj tho other made n study of tho Tnstituto Of Nutrition and tho national nutrition programme. A report, including rocommendations for strengChoning the Institute of Nutrition in Djakarta, has been issued.

me WHC-assisted nutrition project in Thailand, under which special attention is boing paid to problems related to goitre control and beribori, was continued. sEA/~c11/2 Page 13

1.7 Montal Hoalth

mere is an acute shortago of psychiatrists, psychiatric nurses and ancillary workers in South East Asia. WRO has therefore continued to assist in developing tho All-India Institute of Mental Hoalth at Bangalore as a rogional training centro, whero candidates from differont parts of India and other countries in the Rogion arc taking courscs in psychiatric medicine, psychiatric nursing and psychology. These courses, especially the course in mental health nursing, which is the only on0 being given in South East Asia, should attract many more students from the Region.

- 1.8 Social and Qccu~ational- Health A consultant in social and occupational health was assi~edto the Regional Cffico for three monthg for preparatory work in oonneotion with the Regional Conference on Industrial and Occupational Health, to be held in Calcutta from 24 November to 6 Deoembor 1958. This conference will be jointly sponsored by WHO and ILO.

The Regional Office, by moans of a grant, provided for one parti- cipant from India to attend tho Seminar on Rehabilitation hold in Solo (~ndonesia)in August-September 1957 - a seminar organized by tho Govern- ment of Indonesia ad the Unitod Nations in co-oporation with ILO, WHO, the International Society for the Welfaro of Cripplos and tho World Veterans Federation.

A short-term consultant in physical medicine and rehabilitation was assigned to Bombay to advise on the question of providing WHO assistance to tho Rehabilitation Contre in that city.

WHO is continuing to be roprosontod at mooting8 of the Advisory Committoe of the UNESCO Rosoarch Contro (~alcutta)on Social Implica- tions of Industrialization ir. Southern Asia, and a Headquarters consul- tant visitod the Region in connectdon with a pilot case study of four cities (including Calcutta and ~an~kok)with respect to the economic, social and health aspects of urbanization (800 Pnrt 11, Chapter 5).

1.9 Dental Hoalth

A ttworkshoptt on the epidemiology of perjodontal hisoases was held in Bombay from 22 July to 2 August 1957 ayd was followed by a field survey. WHO and the Unitod States Public Health 3ervico each provided a short-ten consultarit to assist in the preparation and - implementation of this programme, in which fofty dontists from India participated. Data collected during the survsy are now being analysod.

1 !The workshop was valuable in stimulating interest in periodontal diseases. 'Ihe Dental Health Officer at WRO Headquarters visited India and Thailand in October,and a WHO consultant in dental health went to Thai- land for thrco months from Novombor 1957 to survoy the dental health activitios and to advise tho Government on the organization of dontal education and dontal health sorvioos.

2. ENVIRONMENTAL SANITATION

In teres t in environmontal sanitation ac tivi ties is gradually gaining ground in the Region, and spocific WHO-assisted projocts havc now been established in Afghanistan, Buns, Coylon, India and Indonesia. .I he serious handicap widely encountored has been tho diversity of govorn- mental authorities dealing with the subject and the absenco of any ad hoo -4 organization which could canalize and 00-ordinate all such activities. A fusion of the services involved and of tho programmes soems particularly desirable, now tht training programmes in various countries are making available an over increasing numbor of qualifiod sanitary enginoors and sanitarians.

In Afghanistan, assistanco to urban sanitation in the City of Kabul was interrupted by the departure of the WHO sanitary enginoor in Deoembe~ 1957, but will bo resumed shortly, whon a sanitarian will be assigned to the project. Tho oxtension and dovolopment of the work in environmental sanitation in Afghanistan arc to rocoivo additional holp from WHO; a sanitary engineor and two additional sanitarians aro now being recruited. A manual on fundamental aspects of environmental sani- tation prepared by the WHO sanitary engineer in Afghanistan was trans- lated into Persian? the English vorsion is boing circulated to all WHO sanitary engineers in the Region for commonts and suggestions before being finally revised.

In Burma, a sanitary cnginoor and a sanitarian aro assisting in tho development of tho sanitation progrsnrme in tho demonstration area of Aung San Myo. In Ceylon, a sanitarian is initiating improvo- monts in tho training of sanitary inspectors, and at tho same time, with tho help of a WHO sanitary engineer, an environmental sanitation programme is being carried out in rural areas. A draft sanitary code prepared by a ,WHO consultant for Ceylon has been rovised by the Regional Office and WHO Headquarters, and is now ready to be submitted to the Government.

As for the work in India, as s contribution to reducing tha shortage of qualified personnel, WHO'S assistance to tho post-graduate course for sanitary engineers in Edrrdras has been continued, and the extension of suoh help to a similar institution is planned. Parallel training activities in tho form of refreshor and reoriontation courses for sanitary inspectors are being started in association with the demonstration districts and rural training areas which are to be established in connection with community development health services in the different states of India. Plans to promote environmental sanitation facilities for Indian schools in connection with these community development health service projects, however, have yet to show tangible results. 'he WBO professor at Madras Univorsity has rocently visitod some of the Indian states to holp advance this programme.

With a view to demonstrating ways by which stato govcrnmonts in India may organize special programmes of environmental sanitation for rural areas, a new project has been startod in Uttar Pradesh on lines similar to programmes already operating in Afghanistan, Burma, Ceylon and Indonesia. In all these programmes progress to date has been compa- ratively slow, mostly on account of tho paucity of numbers of qualified national personnel and the limitation of funds available for practical improvements. -. A definite step has been achieved in promoting public health engineering activities in India by the establishment of a Central Public Health Engineering Research Institute. This is the first unit of its kind in the Region and is expected to undertake research for tho promo- tion of sanitary programmes.

The WHO-assisted environmental sanitation programme in Indonesia is likely to be shifted shortly to an area where developments in rural health in general are to be promoted. It is bolievod that this associa- tion will serve to stimulate work in the environmental sanitation field. A draft manual on the arrangements for drinking water supplies for ports has been prepared by the mnitarian engagod in port-health work. !?his mhual, when revised, may serve as a first measure towards the preparation of a comprehensive manual on port sanitation.

Special efforts are being made in Indonesia to develop the odu- cation and training of ancillary workers in environmental sanitation. A new sanitarian is to bc rocruitod by WHO expressly for this purpose.

Regarding improvements for standards of drinking water, a list of institutions which could undertake some resoarch work on this subject in this region,as part of the international programme being directed from Headquarters, has been proparcd for use in Goncva.

3. EDUCATION AM) TRAINING

Governments tend to continue the policy of adding to the number of medical colleges and of increasing the numbers of student8 with little planning for a sufficiency of well trainod teaching staff. At . the Thai National Medical Education Conference held in 1956 it was wisely said that five full years aro required to preparo, at the parent . school, future teachers for a now daughtor school. The noed for oxpan- sion of medical education in the South East Asia Region should be studied in the light of tho even greater noed for trained and experienced teach- ing staff. sEA/~~11/2 Page 16

'Be lack of trained teachers, espocially in non-clinical subjects, is perhaps the first serious handicap to medical education. In India, with over forty medical schools, there is a deficiency of five to six hundred properly qualified teachers; in othor countries also, whore rapid expansion is going on, the lack is proportional. For the time boing training abroad seems to be necessary for teaching pre-clinical subjects.

It is generally agreed that tho content of modern medical science is now such that no medical student can be expected to cover and absorb all of it and that therefore undergraduate teaching should be directed toward providing a sound knowledgo of basic principles and of methods of approach in problems of health and sickness. There aro, however, as yet very few signs in the undorgraduato curriculum of any radical change in the nature or quantity of subjects being taught. That the medical colleges of the Re ion do not differ in this rogard from their Y sister colleges elsewhore 7with certain notable exceptions) is no matter for complacency. We still suffer from an examination system which is out of dato and which continues to frustrato tho valiant offorts of far-seeing teachors to rationalizo tho planning of medical oducation in order to provide both for national needs and for what n student reasonably can be expected to learn and understand.

There is also a growing discontent with pro-medical oducation in colloges and socondary schools. Tho complaint is that for future medioal students too much timo is givcn to tho study of physics and chemistry, that those subjects arc not taught so that the students can comprehend tho basio principles and that much of tho time devoted to them could more usefully bo givcn to othor pro-medical subjects such as olementary statistics, sociology and the liberal arts, not excluding the language of instruction in the medical collogo. It is obvious that, whoroas a post-graduate student may nood no more thnn guidance as to what he has to learn, an undorgraduato, -tt lr,?st in his early yeare,noeds to be taught how to learn basic principlos which load to an understanding of the dotailod factual data of modical practice. He ncods guidance towards the mothodology and thc faculty of learning for himself, instead of being "spoon fod" with answers to possible examination questions.

This year WHO has given assistance in the teaching of prevent- ive and social medicine by providing visiting professors to the Faculty of Medicine at Kabul, to the Rangoon Medical Collego and to one medical college in India. After completing his assi~mont,the professor in Burma made a short tour of five medical centreg in India for consulta- tions and locturos in social modicino. nroc prospoctivo hoads of dopartmonts of prevontivo and social modicino from India md ono from Indonesia were sent to taka up ono-and-a-half to two-yoar special courses in America. Tho head of the Dopartmant of Public Hoalth at the Faculty of Medicine, Ourabaya, was given a short fellowship to visit four selected contros in India. In othor fields, assistance has boon givon by providing visit- ing professors to Afghanistan in internal modicino and paediatrics Kabul Modical Faculty); to Burma in physiology and provontivo modicino IRangoon Medical College); to India in phmacology (central Drug Research Institute, LUO~QIOW);to Indonesia in anatomy and physiology (~edanMedical Faculty), and in pharmacology (~ursbayaModical Faculty). Fellowships for tho training of count orparts also arc available, but few counterparts have boon able to makc us0 of thom.

A three-wook modical oducation study tour was arranged in Novem- ber 1957 for six profossors and senior teachers of pathology from ha, Indonesia and Thailand. Tho group visitod solectod medical colleg~~and research institutions in India and participated in tho Annual Conference of tho Indian Council of Medical R(.cc.rrch at Lucknow. This tour was the fir3t of a sorios of study tours on diffcrcnt non-clinical subjocts. 'Phe sccond courso in public hoalth for di-t~ictmodical officers, ;;as hold in R~ngoonundor national auspices.

A matter of special importance is the fact that a medical courso for women has beon initiatod at the Mastoorat Hospital in Afghanistan, and is no* in the second ycar. Of tho first group of 18 ontrants to the premedical par, 14 commoncod medical studios this year. !!helve havo been admitted to the second class for pro-mcdical work. After gradua- tion, these women doctors will conotf-k'ta a valuable addition to the present inadequate number of modical personnel in Afghanistan. The entranco of malo students has beon incrcasod to 80, and thero are novr 63 students in the secondyear comparqd with a former average of 30 to 40. At the end of 1957 thirty-four students graduatod, thoreby raising tho total number of doctors in Afghanistan to 270. A number of persons who formerly qualified as assistant doctors aro returning to the Faculty to booome fully qualified. In regard to toaching, tho substance of lecturos is bing mimeographed and translated in the national language and distributed in advance. It is hopod that this will open tho way to moro discussion and us0 of tho library and will contribute to doing away with tho traditional practice of meroly taking down lectures and memorizing.

3.2 Fcllowshivs

me fellowship programme continucd to expand, with a record numbor of 117 awards during tho year ns compared with 93 in 1956-57. Statements showing (1) tho number of fellowships awarded by country, source of funds and breakdown botwaon regional and intornational fellowships, and (2) tho distribution of fellowships by subject of study and by country arc givon in tho tables in Annex 5.

An increasing nmbor of followships was awarded in respoot of medical education, particularly in non-clinical subjocts. Other awards have beon mostly related to projects with emphasis on basic public health subjects, rotably environmental sanitation, health edu- cation and nursing education. Rccont dovolopmonts in the field of malaria eradication arc rcfloctod in tho nunbur of avfards given. sEA/Rc~~/~ Page 18

In selecting countries for fellowship training, increasing use has boen made of tho faoilities availablo within the Region it- . solf. Forty-nine fellowships wore granted for training in regional centres, notably at tho All-India Institute of Hygiene and Public Health, Calcutta, and the Malaria Institute of India, Delhi.

Of' centres which have contributed significantly to our train- ing programme within the Region, special mention may be made of the WHO-assisted leprosy control project in Khon Kaen Provinco in Thai- land, the malaria organizations of Ceylon and Thailand, the Central Roeearch Instituto , Kasauli (1ndia ), the School of Propi cal Medicine, Calcutta, the All-India Institute of Mental Health, Bangalore and the Pasteur Institute, Coonoor (~ndia). A group followship was awarded to fourteen recently qualified Nepalese hoalth assistants for field training at the Najafgarh Training Contro, Delhi, for ono month.

?be problem of recognition of basic modical dogroos conforrod by modical oolloges not officially recognized by Calcutta University still remains, and tho dolay in implomenting tho dosirod chango from the DMCW course to a DPH courso, with a major in M.C.W., is proving a hindranoe to the uso of fellowships in this field.

In addition to rogional fellowships, twelve fellows from other countries (china, Egypt, Iran, Israol, Koroa, the Philippines and Wost Now ~uinea)havo visited tho Region on study toure for periods varying from on0 to six wooks. Placcmcnts were arrangod for sevon follows from outside the ~ogion(from China, Egypt, Iraq, Pakistan and North ~orneo)to undergo regular coursos of study in South East Asia.

Difficulties still arise through delays in the selection of candidates and in the receipt of tho relovant doouments, which often require revision. Further difficultios have arisen when somo govern- ments have failed to ensure the paymont of salaries of the fellows while abroad; this has causod soridus distress and in OnQ case necessitated tho return of a follow before ho could complete his studies.

Certain oentros in wostorn countries arc tightening up on thoir entrance roquiroments for placing follows in study coursos, particularly wlth rospect to language ability.

In January, tho WHO staff of the Hoadquartors Fellowships Section held a conferonce in Geneva with rcgional fellowship officers. At this conferonco fellowship polioios and regulations wore discussod and rovised in tho light of tho cxporionoe gained in tho six roglons. From tho roport of tho Conforenco, a spocial document on tho appraisal of the WHO followship programno was propared and submittod to the %nth World Health Assombly, whioh drew tho attention of Membor Statos to tho need for further improvomants in planning roquosts, soleoting follows and properly employing and utilizing them, and asked the Direotor- General to convey to the Member States concerned th: appraisal results of individual fellows.*

An analysis of the post-fellowship reports received so far in respect of 250 fellows shows that 241 (86.4%) are employed in the subject of their fellowship studies; 131 (52.4%) have assumed greater responsibilities; 61 (24.4$) are employed in a new activity; 146 (58.46) have imparted the knowledge they have gained by taking part in conferenoes or by writing articles for medical journals; 204 (81.6%) are employed in training activities; 151 (60.4%) have been able to introduce new methods; 95 (38%) have established new services; 68 (27.2%) have been engaged in some type of research; 24 (9.6%) have maintained some degree of contact with other fellows and offioials whom they came to lanow during their studies; and 3 (1.5%) have been engaged on international assignments.

Fellowships from other sources

Under the UNICEF fellowship programme, five non-Indian doctors and eleven non-Indian nurses were placed at the All-India Institute of Hygiene and Public Health, Calcutta.

According to available information, the Colombo Plan granted 5 fellowships to Burma, 18 to Ceylon, 3 to hdia, 4 to Indonesia, 10 to Nepal and 23 to Thailand in medical and allied subjects. The International Co-opere tion Administration of the U. 3. A. awarded 4 fellowships to Afghanistan, 4 to Ceylon, 1 to India, 59 to Indonesia, 9 to Nepal and 36 to Thailand. In addition, India has received 4 fellowships from the Rockefeller Foundation, 5 from the Government of France and 3 from the Government of Sweden.

s20ntrol of communicable diseases continues to be one of the major public health problems. Malaria, tuberculosis, yaws, trachoma, filariasis and leprosy are of such high prevalence in the Region that they are still being dealt with by spocial mass campaigns. In the case of malaria and of yaws, the aim is now towards eradication; for that reason it is important that all countriee should co-operate to this end.

%ere are certain preventable diseases which, because of high infectivity and mortality, are of international importance, and which, - though largely controlled olsewhero in the world, still remain as serious problems in South East Asia. The following are the notified , figures from countries in tho Region for 1957: SEA/RCLI/~ Page 20

Country Cholera Planue Small~ox bhus

Afghanistan Cases ni1 nil 239 35 Deaths nil nil 1 4

Burma Cases 11 221(5) 2,738(44) nil Deaths 5 1@(4) 759 (10) nil

Ceylon Cases nil nil 21 nil Deaths nil nil 8 nil

India Cases 56,241 47 78,896 nil Deaths 23,080 16 23,121 nil

Indonesia Cases nil 15 1,516 nil Deaths nil 5 270 ni 1

Portuguese Cases nil nil 2 nil India Deaths nil ni1 - nil

Thailand Cases nil nil 3 nil Doaths nil nil nil nil

Because control of cholera is made difficult largely by lack of sani- tation and safe water supplies, there can be no speedy solution to this problem; control of other diseases, however, requires only an efficient administrative maohinery for propor population coverage, and complete control should be within easy reach of available resources.

When considering cholera, it is necessary to remembor other intestinal diseases which do not attract the same attention but which collectively have a high mortality, especially in ohildhood. These are the dysenteries - diarrh~eas~extensiveworm infestation and enteric diacaacs - the control of which ie dapondent on hnprovement~ in environ- mental sanitation and health eduostion.

The following paragraphs summarize WHO'S work on individual communicable diseases throughout the yoar in South East Asia.

4.1 Malaria and Other Insect-Borne Diseasea

(1) Malaria Eradication

The change of strategy from "malaria control" to "malaria eradication" has been adopted by all the countries of the Region.

Eradication roquiros most careful planning. Specific plans for each country, toga ther with the budgetary commitments under the Malaria Eradication Special Account (MESA), sro included in the documentat'on to be presented to the eleventh session of the Regional Committee. f

1 32i/:?~11/3, Annex 2. Proposed ~rogr&moand Budgot ;intimnti,s for 1960 The progress made in each country to dato is briefly indicated below ((7.$2?113 '.-?I1 bo found und r th, i-dlvidual camtri s 1.t ?art 111)s

Af~hanistanrA malaria eradication progrme is in progress. A detailed plan for operations in 1958, which provides for increased VlHC-assistance from MFSA, has been concluded between the Government, UNICEF and WHO. Whereas now in 1958 no part of the country is ready for withdrawal of spraying, the surveillance procedures in progress in the northern and eastern provinces indicate from which areas in these provinces spraying can be withdrawn in 1959. -Burmat Burma, in collaboration with WHO and UNICXF, adopted a plan for malaria eradication beginning in February 1957. Progress is satisfactory in so far as the spraying procedures and population protected are concerned. The Government has realized the need for further improving the efficiency of appraisal.

Under the MESA programme, increased assistance by way of per- sonnel and of partial payment of salaries to national personnel is under negotiation with the Government.

Ceylon: The eradication programme being carried out by the Government in Ceylon continued to make satisfactory progress. A detailed plan of operations is under preparation. -India: An outstanding event during the year was the implementa- tion of a national malaria eradication programme by the Government of India with effect from April 1958. A plan of operations signed by the Government in May 1958 provides for substantial assistance from WHO by way of personnel, supplies and equipment. The ICA contribution to this programme is on a very generous scale (88.7 million for the operations in 1958). WHO'S assistance from ACESA includes (1) a supply of one and a half million dollarsf worth of DDPj (2) the assignment of two WHO advisory teams, each with a malariologist, an entomologist and two technicians; (3) patial payment of salaries to national personnel employed in inter-state assessment and advisory organizations; (4) payment of stipends -id travol costs to natioh%l trsinccs and to unit medical officers attending the annual national conference, and (5) pro- vision of some fellowships.

The approval of the Government of India has been obtained for the establishment of one of the two proposed experimental surveillance study teams under MESA in India. A separate plan for this pm ject is under preparation. ---Indonesia8 Since the beginning of 1958 the two malaria control projects in operation in Indonesia have been amalgamated into a single project. While WHO'S assistance to this combined project is being oontinued, a detailed plan for malaria eradication on a countrywide basis is in the process of preparation by the participatjng organisa- tions, namely the Government, ICA and WHO. SEA/RC~~/~ Page 22

An important conference of representatives of the Government, ICA and WHO was held in Djakarta in December 1957 to discuss the programme on a 00-operative and 00-ordinated basis. By about August, further detailed discussions are planned for the finalization of a draft plan.

&&I The malaria control programme in the Rapti Valley conti- nued to make good progress. As a result of detailed discussions held in Kathmandu between the representatives of the Regional Office, ICA and the Government, a plan of operations has been drafted and is now await- ing the Government's concurrence. In this plan it is proposed to under- take malaria eradication in the middle pzrt of the country as a pre- paratory phase, after completing a pre-eradication survey and the training of national personnel. Froa 1961 it is proposed to expand the programme to oover the whole country in the light of the experience gained during the preparatory phase.

Thailand: Malaria eradication activities are being continued by the Government with aosistance from ICA.

(2) Other Activities

An inter-regional malaria symposium sponsored by WHO was held in Bangkok in December 1957 and was attended by representatives of the Western Paoific, Eastern Mediterranean and South East ~siaRegions. The symposium covered many useful subjects relating to malaria eradica- tion.

The second meeting of the Anti-Malaria Co-ordination Board, consisting of representatives from Thailand, Vietnam, Laos, Cambodia, Burma and Malaya, was held in Bangkok in December 1957, when border malaria problems of the participating countries were fully reviewed and recommendations made.

The Government of Indonesia deputed two national malariologists to take part in the Fifth Inter-Territorial Malaria Conference, held at Labuan between 26 and 28 November 1957, and a attondsd by the Regional Malaria Adviser. The Sixth Inter-Territorial Malaria Conference took place in Sibu (N. ~orneo)in June 1958, and was attended by the senior WHO officer in Djakarta and the WHO malario- logist in Semarang, along with two WHO assistant malariologists from Kalimantan and national and ICA malariolcgists.

An Inter-Regional Seminar on Resistance of Insects to Insecti- cides sponsored by WHO was held in New Delhi from 27 February to 7 March 1958, for 61 research workers from 14 ccuntries in the Eastern Mediterranean, South East Asia and Western Pacific Regions. 1WO provided three short-term consultants for this seminar. The subjects discussed included genetics, biochemistry and the biological aspects SEA/RC~~/~ Page 23 of insect resistance to insecticides, standard test methods and kits, and various aspects of laboratory study of insect population, with special reference to behaviouristic pattern. The present status of research on this . problem was reviewed. The report on this seminar was widely distributed.

The past year has been one of preparation for the effective employment in tuberculosis control of the techniques made possible by chemotherapy. Whilst we are still lelrning about the full potentialities of the anti-tuberculosis drugs, it has already been possible in one country of the Region (1ndi.a) for WHO to assist in drawing up a national plan for a wide exploitation of those potential- ities. The principal feature of the plan is the development of a national training centre to train large numbers of personnel for work at central and state levels, and to undertake research into realistic methods of control for rural and urban areas through field units. In all the countries of tho Region, basic diagnostic and domiciliary services are being strengthened to permit of the develop- ment of plans of this kind.

The tuberculosis control and training projects in Kabul and Mandalay terminated at the end of 1957. In the case of Mandalay, a counterpart team was trained to take over the centre, and a reason- ably good domiciliary oervice, operating on the basis of chemotherapy, was set up, but, apart from the training of a counterpart team, little other training was carried out because trainees in the various cate- gories were not made available by the Government. At Kabul, a good diagnostic service was established, and a team of doctors capable of taking over tho centre was trained; the domiciliary service, however, was slow in developing because it was not possible to find enough suitable persons for training as home visitors. Neither of these two projects has therefore come up to expectations.

Particularly with reference to the bacteriological diagnosis of tuberculosis, the work that is being done in control and training centres ,developed during the past year throughout the Region with WE0 and UNICEF assistance, continues to receive advice and guidance from the Organization. Some of these contres rcquire strengthening with further WHO asslstanco. It is felt that they can make an effeotive contribution to the more modern development of tuberculosis control and can prove to be worth-while investments.

The integration of BCG vaccination campaigns into the general national health services continues; tho process is slow in most countries and in some has not yet been started. SEA/RC~~/~ Page 24

lhe %berculosis Chemotherapy Project at Madras has progressed in scope and pace towards the point whero answers to some of the questions on chemotherapy, which are so urgently awaited, will shortly be available. In the bacteriological laboratory connected with this project, there has been evolved a modification of the existing Case test for the presence of iecniazid in body fluids, which will enable the self-administration of isoniazid to be checke8. in domiciliary chemotherapy, at present the test requires skilled laboratory technique. Details of this modification are being published.

4.3 Venereal Diseases and Tro~onornatoses

Except for one country in the Region, it remains doubtful whether venereal-disease control services have made much headway in spit0 of considerable effort and expenditure. Services providing for the proper tracing and treahent of cases, contacts and sources~of infection are most expensive, and few countrios can afford them. !&a most offioient ,approach to the problem when resources are limited is not yet clear, Perhaps the wisest course is to concentrate tho major effort on maternal and child hettlth units. International assistance for the training of personnel and ~rovisionof supplios and equipment have continued, but the timo has come for reaesessmont of these acti- vities, and for this purpose consultants are to be provided for Burma and Ceylon in 1958.

Iho yaws control programmos in India (in the Sttttos of Msdhya Pradesh, Andhra, Orissa and ~omba~)are being carried out by national teams, and in December 1957 a conference was arranged at Luclcnow by the Central Ministry of Health to discuss the position. In Ceylon and Indonesia yaws control programmes are also being conducted satia- factorily by national workors with, in the latter country, UNICEF's assistance. In Ihailand, whero WHO and UNICEF are continuing their help, a redeployment of the toms in areas of priority is expected to result in greater concentration of effort and suporvision. In an ondeavour to improve the present personnel situation, tho Thai Government intends to establish a school for health workers with an annual intake of fifty studente. Attempts at integration of the yaws campaign into the general rural hoalth services havc proved untimely.

In many areas in these countrios the incidence of active disoase has been reducod to such a degree that the timo has come to undertake serological surveys to ascertain when tho specialized teams can be withdrawn. In Thailand WHO is to provide additional expert staff for such an epidomiolcglcal assessment. , 4.4 Other Communicable Diseases

In some countries of the Region, filarial infoction, chiofly W.banorofti and W,malayi, presents a sorious public health problem. Its solution to a large extent depends on improved environmental sani- tation, but practical difficulties - for example, control of vectors such as Culox fatime - are formidable on account of lack of funds for tho heavy capital expenditure necessary and also because of grossly insufficient health education of tho public.

Studies on filariasis control methods have continued in Ceylon and India, and WHO is arranging a study tour this year for medical officers engaged in control services.

Modern chemo thorapy with diamino-diphonyl sulf one (DDS ) and, lately, with diphonyl thiourea (DPT) has made it possible to undertake mass case-finding and treatment campaigns and to bring effective treatment to leprosy patients in their homos. The infectivity of tho lepromatous paticnt is diminishod so speedily by treatment that it is no lonpr necessary to rogard isolation of infective patients as an essential port of control moasuros. The countries in this region, where there is a high provalence of the disease, oannot afford to meet tho high cost of isolating and troating all infectious patients in loprosaria. Domiciliary chemotherapy prwidos a comparatively chonp and far moro effective approach to the problom.

WHO and UNICEF havc assisted such mass case-finding and trest- ment oampaigns in large pilot areas in Burma, Indonosia and Thailand. !he leprosy control campaign in Burma is now boing continued by national workers, and an expansion of activitios is taking plaoe in 1958 on tho basis of a now plan of operations rocontly agroed to between the Govern- ment, UNICEF and WHO. In Indonesia and Thailand PMO has continued to provide the services of loprologists, and in both projects the campaigns are boing oxtendod. In Thailand tho Govornmnnt is establishing a school for training all oategorios of leprosy viorkors and is proposing to set up a centro with facilities for surgom and physiotherapy.

The incidence of reported human plaguo has, during the year, been low. The widespread usc of rosidual insecticides undoubtedly is having 8 considorablc influcnco on this incidonco. Howevor, it wou'd be unwise to ansumo that plaguo no longer constitutes a public health hazard. The work carried out in tho WHO-assistud epidemiological investigations in India and Indonesii has revoaled a reservoir of plague in wild rodonts, wrtain epeqies of which have boon idontificd as resistant to the effscbs of plagua infection; such reservoirs of infoction may at any SEA/RC~~/~ Page 26

time lead to an epizootic and to a human epidemic, especially if the insect vectors become resistant to insccticidcs. WHO'S consultants havo advisod that wherever epiaootic infection is discovered in India and Indonosia, action should bo directcd towards fiold rodents and their burrows, in a concentrated offort to destroy tho resistant species and thoir vector parasites; action of this sort should always supplement the ordinary control measures taken against rats md fleas in areas whcro human plague has occurred.

(4) Small~ox (see also Section 8.2)

mere has bcen no improvomont in tho control of smallpox in South East Asia. The recommendation put forward by tho Regional Committoe at its eighth session for an appropriato field invcstiga- tion into tho causes of the continuation of this disease1 still remains unfulfilled.

In June 1958, the Eleventh World Honlth Asscmbly also noted with concern the persistonce of a high prcvalencc of smallpox in somo regions of the world and the permanent threat of sproading into oth~r countries that it constitutcd. It recommended to governments "that during 1959-60 the population be vaccinated in countries in vrhich the principal endemic foci of smallpox exist", "that during 196162 additional vaccination of the population should bo carried out in foci whero tho disaase persists, and that subsequently revaccinations bo given to the oxtent it bocomos necessary in accordance with the expori- ence acquired in each countryt1.2

In January 1958, tho Regional Office issued a questionnaire to all Member Governments requesting information on forty points regarding the organization and methods of thcir vaccination aervicos. Tkis was to prepare the way for a further invostigation, in the hope that a. comparative analysis of the information thus roceivod might pin-point the causes of epidemicity. It may bo that smallpox control is primarily an administrative problom, and the replies to tho quostionnairc may help to confirm or to deny this. Unfortunately, up to July 1958, completo mplies from only one country adpartial replies from another had boon ruceivod. It is hoped that this delay does not rcfLect a lack of intcrost in the problem. WHO hopes to cngago an export to undertake a pilot invostigation into tho subjoct in a solectod aroa of a chosen country.

(5) Cholork (see also Section 8.2)

Tho severe opidernics of this disesso during 1958 havo sorvod to remind us how littlo is known about tho epidemiology of cholera.

1~~~/~~8/~.16- Handbook of Resolutions and Decisions of the Regional Committee, p. I1

2~xcerptfrom Besolution TEA11.54 of tho Xevcnth World Health Assembly During the period 1 January to end June 1958, cholera was reported from three countrios in South East Asia - India, East Pakistan and Thail.md. The figuros notified werec

-India East Pakistan* Thailand -Tbtnl

Deaths

The first caso of cholera in Thnil-md occurred on 22 May, and the above figuros wore subsequently notified up to 28 Juno.

There is good rcason to believe that tho provision of safe wator supplies in particular and improved environmental sanitation in general will control the infection, but this process of education and tho devolopmont of a higher standard of sanitation may take an- other twenty years. In scvoral contros in India, resoarch continues on (1) the problom of the source of infection and its maintonanco between epidemics, and (2) a means of assessing tho value of cholera vaccine and of assaying its potency. YmO, bccausc of its interna- tional oommitments under the Sanitary Rogulations, is especially concerned with and interested in finding a mlution to these problems.

As investigations on the epidemiology of trachoma continue, tho diseaso is showing itself to be a far more widespread and scrious problem than had been sunpooted. In the WH0/UN1~~~-assistodpilot projects in India and Indonesia, studies on epidemiology and troat- ment have made oxcellant progress; the raports on the first two years of work in both countrios will shortly be available, and the recommendations arising from these roports should ourve as n guide to future oxpansion of national trachoma control campaigns.

A short-term consultant visitod Afghanistnn during tho par. According to his findings, trachoma is a serious problem only in tho Kandahar and Kerat Provincoa.

(7) Virus Diseasos

In this region, increasing 3ttcntion is deservedly being paid to the virus group of diseases, to which much epidemiological work and resoarch arc being dovotcd, ospocially in India.

Of groat public health importiinoo is the ncod for a full investigation of tho diarrhoeas of infancy and childhood, and no such investigation c3n be complcto without help from (I virus laboratory.

*Belongs to Fastern l>!editerranean Region of RHO. Ti30 is assisting in the development of virus laboratories by providing training facilities. Numerous fellowships have'been awarded to doctors and teohnicians, and an inter~egionaltraining course in virus laboratory techniques is scheduled to take place lator in 1958. Tho rOgional Poliomyelitis and Influenza Contros in Bombay and Coonoor are maintaining roscarch programnos and continue to serve their essential role as reforence laboratories. Much interest has been aroused by the rosearch on the Kyasanur Forest Disoase, in rospect of whioh tho work of tho Virus Researoh Centre at Poona deserves the highos t credit.

(8) Zoonosos

It has been possible to assist in several investigations of the zoonoses by supplying standard antigons and by facilitating tho exchange of biological specimens. In Coylon, WHO assistod the Munioi- pal Veterinary Doparbent, Colombo, in an investigation to trace tho rcaervoir of Q fever infoction in goats and in a tuberculin survcy of milch cows found on private premisos. In India, tho Voterinmy Research Institute at Muktoswar has givon valuable holp to WHO in obtaining sera from local poniea for investigation at tho Coonoor Influenza Centro, as part of worl6wide studios on the epidemiology of the reoont influenza pandemic.

5. EPIDEMIOLOGY

In a region that is full of major connnunioable disease it is unfortunate that departments of health do not have appropriate epidemio- logical units under the supervision of qualified and experienced epidemiologists. Epidomic disosses continue to tako a heavy toll of life nnd health,year after year, without any serious epidemio- logical investigation being made. Departments of health deal with individual opid~micaona fire-fighting basis only. This io true with regard to smallpox, plague and cholera, as also other communicable gastro-intestinal diseases including the enteric diseaaes, dysenteries, children's diarrh0.a~and wholesale worm infestations.

It is agreed that nn epidemiological unit is an indispensable section of the preventive services of every health directorate, but the present shortage of trained epidemiologists has delayed the implementation of epidemiological studios in most countries of the Region.

It is the policy of the Organization to assist governments, whenever possible, with tho recruitment of international epidemio- logists, md also to award fellowships for the training of national counterparts. In Ceylon, the Organization has continued its assistance by providing an intornationnl opidoniologist. In close collabora- tion with tho laboratory ?niZ with ctstir:ticc and pu73lio h ~lt,hdcpart- ments, the new epidomiologicnl unit has succeeded in organizing better diagnostic, notification and recording services of the principal endemo-epidemic diseases in the country. A twelve-month fellowship was awarded to a national medical officer for post-graduate train- ing in epidemiology in the United States of America.

Arrangements have been made for the recruitment of a further epidemiologist, who will, in tho near future, assist the Oovernment of Indonesia in tho establishment of an opidemiologicnl unit.

Zfforts to give similar assistance to the Government of Burma have not yet been sucoessful.

6. HEAL'TH STATISTICS

Interest in the improvement of vital and health statistics has continued to grow, but there has been difficulty in meeting the demand for suitably qualified medical statisticians. This awakening interest has been most mzrked in the field of hospital records and statistics. From tho standpoint of national planning, in-patient records assume a greator importance than in many western countries; although derived from a highly selectcd population, they constitute the most important source of accurate information on morbidity and causes of death.

Technically, the year was largely one of development and consolidation of mothods previously initiated, but in Ceylon a start was made in a new field. Hero there has been a long-felt need for simpler and more useful forms for records and reports in local health services. Designing a good statistical document is an arduous and longthy task. Consequently, it is a plcasure to record the production of a well-dosigned form for routine reporting.

An important technical advance in this Region would be a separate tabulation of c?un~sofdonth by type of ccrtifior. An illustrated folder on the subject with n covering letter was issued to Member Governments. The concept of having such a tabulation is gaining some acceptance, and one country is far on the way to im- plementing this rocommendation on a nation-wide scale.

WHO'S zssistanco to Afghanistan has terminntod, and the final report of tho hoalth statistician is undor consideration. A project in Thailand was started in August 1957.

Partly owing to lack of routine morbidity data, health surveys are a topic of much interest in the Region. Field. work in the Rama- nagaram Survey has boen comploted,and a comprehensive preliminary SEA/RC~~/~ Page 30 report published. The results should be of much methodological interest, especially as mistakes mado and difficulties met havo been systematically recorded for eventual publication. Rural hoalth surveys in Indonesia have also made a useful contribution to the methodology of tho subject. Work is in progress in the Regional Office on the quostions concorning environmental conditions which usually form part of a morbidity survey.

WHO statisticians in the field were able to givo assistance to countries supplying material for tho First World Health Report. lbo Annual Hoalth Reports for Burma and the statistical raport prepared by project staff in Indonesia wero noteworthy.

The training programme at Nagpu. included threo courses for statistical assistants, attended by 24 stude~ltsfrom oight Indian Statoa. Ekp~riencsshowed that more effort should be made to plan courses to fit actual and prospective needs of states and tho Contra1 Oovernment. To this ond the training programme has been suspended for a fow months. The most urgent need is for training m~dicslcoders, as correct coding and classification of diagnostic statements 2ro ths foundation of good health statistics.

Preparations for the Rcgional Hoalth St-tistics Seminar plannod for October 1958 are undor way.

7. ASSISTANCE TO RESEARCH

WHO'S direct assistance is being conOentrated morc on fiold research than towards helping puro laboratory investigations; the latter sphere has not, howover, been ignored, for it has boon possible to facilitate work in institutions both in India and Ceylon by provid- ing standard biologicals from reforenco laboratories elsewhero and by assisting Member Governments with the interchange of biological specimens. Dissemination of scientific information through tho issue and exchange of documents and reports is also an important part of WHOts rolo in supporting resoarch activities (see Part 11, Chapter 4).

In epidemiological and fiold research, n field study on protein malnutrition has been carriod out in rural nroas of several of the southern states of India by workers of tho Nutrition Research Institute in Coonoor, with the assistance of XHO. This is tho first largo-scale field investigation to be undertaken by the Institute. The report has bo-n submitted and was read at the Annual Congress (1958) of the Indian Association of Paediatricians.

WHO has continued to assist invostigations into tho treatment and control of tuberculosis in Madras and Mndanapallo in India, and has carried out in Indi? md Indononia pilot proj:.c.t:: in traghomn, designed to reveal the answer to - epidemiological and therapeutic control problems. In Indonesia a WHO consultant completed an epidemiological investigation of plague towards the end of 1957; in India plans havo boon ma60 for a resoarch projoct on tho public health aspects of anaemia, to be assisted with a grant from WHO.

The Ramanagaram Family Health Survey in India is part of a WHO global research project on local hoslth needs and health services. Six pilot survoys havo been initiated in different parts of the world to develop methods for collecting information on these subjects by means of a continuous family morbidity survey. no Rogional Offioe has helped this project to maintain research standards by ~dvice, study and recording of all errors and difficulties oncountared. Contin- ued sssistance is proposed with respoct to accurate processing of tho data and adoquato presentation of the technioal aspects of the survey in the final report.

A matter of spocial interest to resoarch was tho WHO-sponsored Inter-Regional Seminar on the Resistance of Insects to Innocticidcs, which was hold in New Dolhi in February-%rch and i~mentioned olse- where in this roport (soo Part I, Chapter 4). Ro-iwch ~orkars from all parts of the world participatod in this seminar.

EX0 is also assisting the Malaria Institute of India by pro- viding consultants in highly specialized fields and awarding fellow- ships to onablo Indian oxperts to visit rosearch contros oversoas.

8. PUELIC HEllLTH LABORATORIES AND VACCINE PRODUCTTON

8.1 Public Health hboratories

WHO continues to aosist public health laboratorios with oxpcrt advice and by helping to provide training facilities for dootors and technicians.

In Afghanistan assistance from WHO and UNICEF has resulted in the ostabliohment of an oxcollont public health laboratory in Kabul. WHO has continuod to provide a laboratory tochnician to teach national laboratory technicians and assistants; ctudonts from tho voCerinary service also arc taking tho training courso. This training centre will provide staff for district laboratories.

In Ceylon a laboratory tcchniciansf training school has been established, for' sihich mi10 ia-pi-ovidi.ng 3 tochnician. SEA/RCI~/~ Page 32

8.2 77accine Production

During the xear two cmcrgencies arose in countries of the Region, when large supplies of cholcra and T.A.B. vnccinoe woro required at short notice. In both situations, production laboratories in India were contacted spoeiily to provide the urgently noodod supplies - and these at almost cost prico. For this, WHO is grateful to the contra1 and state governments. A part of theso vaccines was also provided free of cost by WHOfrom the omcrgmcy fund at the disposal of tho Executive Board, ant another part by WHO on a reimbursement basis.

There arc may methods of proparing dried smallpox vaccine, somo of which have toon in use on a largo scalo for many years, but it is evident that ~impledrying does not ensure a stable vaccine. Many production methods may result in a stable batch of vaccine from time to time, but tbe greatest difficulty has always been to produce stable batches consistently. The method now recommended by WHO has been proved to produce a I1Vaccine PI1, which is consistently stable at 45"C under repeated testing over n. period of years. Governments have taken advantage of WHOts offer to help them to provide a consis- tently stable vaccine. hring the year a short-term consultant in freeze-dried smallpox vaccine has been provided to Thailand, and efforts are now being made to recruit n similar consultant for India and Indonesia.

Many fellowships, both inter-regional and international, have been awarded to countries for the special training of national per- sonnel. In Afghanistan, WHO and UNICEF have continued to assist the Vaccine Institute in Kabul. Consultants have also been provided to Afghanistan and Thailand. In Burma a modern plant for the Burma Pharmaceutical Industries has been completed by the Government with the help of a foreign firm.

9. CURATIVE SERVICES

The Regional Committee haw often discussed the close relation- ship between prevention (with which, of course, WHO is most closely associated) and cure, and has asked that a separate section of the Regional Director's Annual Report be devoted to WHO'S contribution to curative services. Unfortunately, mostly because there is this very close relationship, it is difficult to make a distinotion between assistance given for prevention and that which leads to cure, or to single out specific programmes which are unusually "curative".

One need only draw attention to the many projects in which WHO has been active that are directed toward the control of communi- cable diseases, and which have necessarily included treatment of the sick. An outstanding example is the emphasis now being placed on the control of tuberculosis by domiciliary chemotherapy, notably in tho ~EA/~c11/2 Page 33 research project going on in Madras. Projects undertaken for the control of leprosy, trachoma, treponematoses and venereal diseases in a number of countries are also directly concerned with curative work. Also, in almost all countries of the Begion, assistance in organizing extensive training projccts for nurses and in improving nursing practices 2nd procedures, as well as the work done in paodiatric nursing and midwifary have undoubtedly had repercussions on curative services. One might also mention equipment for the expansion of hospital services and for the strengthening of paediatrics and obstetric departments, which has been given this year to Afghanistan, Ceylon, India and Indonesia.

Other examples of WHO's. work which has positive curative aspects are projects for assistanco to the X-Ray Department of the Medical FaclllCy at the University of Kabul, the assistance in medical stores management in Afghanistan and Burmc~ and WHO'S participation from time to time in th ILCte work on rehabilit-.tion.

WHO has also continued to provide conaidorable assistance to the All-India Instituto of Nental Health in Bangalore - technical assistance concerned with methods of treatment, organization, train- ing - particularly in preparing it for the rolo it has assumed as a regional training centro. From this assistance clinical neurology and psychiatry havo naturally benefited.

Finally, there may be mentioned the great number of projoots designed to improvo medical training, for which WHO is supplying a number of medical schools with professors -professors in such sub- jects as anatomy and internal medicine (as in -Kabul), pharmacology (in Burma, India and ~ndonesie),preventive and social medicine (in Afghanistan, Burma and in Nagpur, 1ndia) and paediatrics (in Visakha- patnam and Hydcrabnd, India). Pis rcsults in the improvement of curative as well as provcntive services. In the project in Visakha- patnm, notably, in tho paediatric department, the co-ordination of preventive and social medicine with paediatrios has been achieved.

In order to have a more complete picture of NHOts programme in its curativc as well as preventive implications, the reader should turn to tho completc list of projccts with which WHO has assisted during the yoar,. which is given in Part 111.

10. SOCIO-ECOPrOMIC ASPECT'S CF WHO1 S PROGRAMME

l'ne socio-economic n~poctsof WHOts programme could be discussed at great length, and tho Regional Committoc has asked that special attention be bmwm to them in the annual roports. However, it is almost impossible to point to individual progrmmoe under this heading, since almost all WHO'S projects have broad social and economic implications. Here again, one should refer to Part 111, for only by looking at the complete list of projects in which WHO has taken a part during the year is it possible to have an idea of the oontribution they rnay make to social and eoonomic advancement. The projects financed by Technical Assistance funds have, of course, been selected with economic as well as health improvements in view.

In general, WHO-assisted projects have boen largely integrated with national development plans. Notably in India, tho oountry-wido community development plan has been accorded a large measure of inter- national assistance in its public health aspects. Assistance in the field of vacoine and sera manufacture, described in Ch-.ptor 8, has not only provided weapons of vital public health value but has also resulted in effecting savings in external expenditure. The programmes of malaria eradication which are now so extensive will have a remarkable effect on national economies.

WBO-assisted projoots in nutrition, especially thoso devaloped in collaboration with FA0 in Ceylon and Thailand, should holp improve the existing nutritional state and also inoroase agricultural productivity. The large mowt of assistanoo given by WBO and UNICEF to maternal and child hoalth work throughout the Region as well as that which WHO is giving to health education and environmental sani- tation will lead inevitably to a change in tho sooial pattern and in better conditions of living.

One may also cite the aesistanoe given by specialists in medical etores management, e.g. in Burma and Wghanistan, who have advised on purchasing policy and on tho utilization of local resources for production of medical requisites to moot national needs. Improve- ments effoctgd in this sphere should eventually have repercussions on the economy of the country concerned.

Eaving regard to the industrial development in many countries in the Region, WHO, in co-operation with ILO, is preparing for the convening of a regional seminar to study problems of industrial and oooupatfonal health. This seminar, which is to be held in Novomber 1958 is discussed elsewhere (soe Soction 1.8).

It is ropeated that theso are mly oxampleft1 the inter-relation of health with social and economic conditions is too wlaoly recognized to need further oommont here. 11. ATOMIC ENERGY IN RELATION TO HEALTH

The work of WHO in atomic energy in relation to health is becoming increasingly important, and numerous meotings of experts, seminars and training courses are being organized. The subject was discussed at great length during the Eleventh World Health Assembly, which adopted a resolution (~~~11.50)~roguesting the Directcr- General, inter alia, to prepare a programme of concrete measures in this field, to tako part in tho preparation of an agreement of co-operation with the Intornntional Atomic Energy Agency on the peacoful uses of atomic onorgy, and to initiate consultations with tho aim of assisting under-developed countries in the use of radio- active isotopes in modicine,as well to undertake various studies on the effects of radiation.

In this region, the medical officor in charge of questions dealing with atomic enorgy and health at WHO Headquarters visited India and Coylon from 5 to 23 August 1957 to discuss the subjoct of radiation protection and possible programmes in tho field of health physics and hospital physics. Later,in ~ovembel/~ecember,a short-tom consultant in hospital physics went to a number of medical centros in India and Ceylon, where he delivered a serios of loctures on current views on radiation protoction as applied to clinical medicino, and also gave advico on rnoasurcs for radiation protoction in hospitals.

Preparations are being mado for a five-week inter-regional training course for health physicists,to be hold in Bombay during the last quartor of 1956.

Two fello.cvships have beon nxvardod for the study of subjocts relating to the medical aspects of radiation and radiation protection, including hospital physics and tho use of radio-isotopes. SEA/RC~~/~ Page 36

PART I1

GENERAL

1. REGIONAL CWITTEE

!Tho tenth session of tho Regional Committee for South Zast Asia was held in Rangoon, Burma, from 16 to 20 September 1951. Ropresentatives of all Members of the Region (except France) were present. Throe United Rations agencios, ono intor-governmental agenoy and fivo non-governmental organizations were also represented. The session was also attended by the Director-General of WHO. Z

In the discussion on the ninth annual report of the Regional Director, noto was taken of tho profless made in some countries in in- tograting curativc and preventive services. Tho Regional Committoo rooommended that WFIO should assist in prescribing and providing adcquato standards of training for auxiliary workers. It draw attention to tho marginal malnutrition common in tho Rogion and to the control of filariasis.

Tne Regional Committeo approvod tho rogular programmo and budget with some amendments, and endorsod the Technical Assistance programme presented,. Tno procedure for developing inter-country programmes was specially studied.

Technical discussions wore held on "How can health education of the public be moro ~ffoctivolydovelopod in South-East Asia?", and tho recommendations and conclusions reached havo sinco boon widely circulated throughout tho Region. For the technical discussions in 1958, the subject "Health aspects of community development progi-ammos" was solectod. Other questions discussed wcrel the training of x-ray tochnioians; . assistance to dental health propammes, the importance of inter-country and interregional meetings on malaria control, and the difficulties oncountored in training indigonous midwives.

Thc Regional Committeo rocommondod to tho %.ecutivc Board that the contract of the present Regional Director, Dr. C. FLani, should bo oxtended for a period of five years from 1 Idarch 1956. The Committoo also took a numbor of administrative decisions on questions referred to it by the Director-General. 1

'SOC Annual Report of tho Director-Genoral, Gff.Roc.Q/ld Hlth &;. 82, Page 25 SEI/RCI 1/2 Page 37

2. ORGANIZATION AND ADMINISTRATION

2.1 Organizational Structure

In order to meet the heavy increase in the work-load from general expansion of activities as well as from the implementation of the new mslaria eradication programme, the DirectorGeneral reoently approved the establishment of an additional number of professional and general service posts, which are now being filled. Apart from this, there has been no major change in the organizational pattern of the Regional Office.

The Medical Supply Unit, *hioh was attached to the Offioe of the Health Services, was transferred to the Office of the Administration and Finance.

2.2 Personnel

The following table shows the number of professional and general eervice category posts established and actually filled during Che period under review. The list below includes staff provided specially to carry out the malaria eradication programme under the Malaria Eradication Speoial Account (MESA).

Established poets Posts actually filled 1. Regional Office Staff for 1958 as on 31 July 1958

Professional Regional Off ice 15 Regional Advisers 19 Area Representatives 5

General Servioe Regional Off ice Clerical Gus todial

Area Representatives Clerics1 5 Custodial 3

2. Project Staff

Professional Regular and TA 190 mu 6 5

Professional Staff on Leave Without Pay - 3 General Services 3 3 Auxiliary Staff 3 3 *This does not include the 24 staff members recruited for XEbESA projeots in the Region who are now in the Regional Office awaiting finalization of their assignments. aLhlKbIl/~ Page 38 . A list of the professional staff attached to the Regional Office is given in Annex 1, "Organizational Chart".

On 31 July 1958 the total number of professional staff members was 150, includrng two short-term consultants. It will be seen from the organizational Chart that except for four posts - those of Public Health Officer, Assistant Personnel Officer, and the two Administrative Assistants - all pmfessional grade posts have been filled. Two Public Health Administrators were recruited (to fill one vacant post and one new post). The post of Regional Adviser in Public Health (community ~evelo~ment)was filled in November 1957.and the Communicable Diseases post in May 1958. The posts of Wlariologist and Entomologist were filled by the transfer of two field project staff members. The post of Area Representative for India became vacant from Brch 1957, when the incumbent proceeded on sick leave; a new Area . Representative was recruited and took up his assignment on 31 July 1958. The post of Area Representative, Indonesia, which became vacant as of 1 January 1958, was filled by the transfer of a staff member from the Eastern Mediterranean Regional Office. Unfortunately, this staff member at the last moment was unable to proceed to Indonesia. However, a candidate has been selected and is expected to be in position by the end of September 1958.

The geographical distribution of the professional staff as on 31 July 1958 is shown in Annex 2. Additional countries represented on the staff this year are Argentina, Chile, Egypt, Haiti and Nexico.

At the end of July 1958 there were 116 WHO project staff members in the field (including two consultants) assigned to the various countries in the Region. In addition, twenty-four project staff members were at the Regional Office awaiting assignment to MESA projects in the Region.

Difficulties are still being experienced in regard to recruit- mnt of professional staff. This situation is explained in detail in section 2.4 below.

The services cf an arl5ltisnal opthalmologist were mde available to the Government of Ceylon under the scheme of assistance to recruit- ment of doctors from neighbouring countries.

2,3 Staff Welfare

Effective 1 January 1958 the employment conditions of staff members assigned to projects were revised on a global basis. The new scheme provides uniform employment conditions for all professional grade staff members, whether assigned to established offices or field pro jeo ts . The salary soales for general service category staff members working in New Delhi were finalized, and the revised scales implemented from 1 March 1958. Reviews of the salaries payable to staff at this level in the other countries in the Region were undertaken from time to time. SEA/RC~1 /? Page 39

During the period covered by the report, one Regional Office professional staff member and two project staff members were given career-service appointments.

As of 1 February 1958 field project staff members have become eligible to participate in the United Nations Joint Staff Pension Fund as either full or associate participantssand the group life insurance policy which has been specially taken out by the Organization on a global basis for field project staff was discontinued.

Arrangements have been made to provide first-aid treatment to the staff of the Regional Office and Area Representatives' Offices with respect to accidents and illnesses occurring in the office.

The "SEAR0 NEWS and VIEWS" continued to be issued, though rather oocasionally.

The Staff Association and its Executive Committee had a very active year. Besides taking an unflagging interest in the welfare of staff members, the Executive Committee, among other things, by oollecting voluntary "loan" contributions from the Regional Offioe staff, set up a Staff Welfare Fund to help cases of distress among staff members. This plan is now being extended to members of the field staff. The Executive Committee also took a keen interest in a Health Insurance Scheme proposed by the Organization to cover staff members as well as their dependents. Their contribution to the plan by way of comments has been useful.

2.4 Accommodation of the Regional Offioe

With reference to Resolution SEA/RCIO/R.~, adopted by the Regional Committee at its tenth sessionswith regard to the permanent establishment of the Regional Office, the proposal to allot Kapurthala House as permnent accommodation for the Regional Office has been withdrawn by the Government of India. The Government has since proposed the allotment of another site, with respect to which negotiations still continue. A separate document on the "Permanent Establishment of the Regional Office for Scuth Eaot Asia" is being presented to the Regional Committee at its eleventh session.

2.5 Legal 2nd Constitutional Matters

New basic agreemants have been concluded with the Governments of the Union of Burm and the Republic of Indonesia in accordance with the provisions of the WHO Manual. Negotiations are in progress for the conclusion of similar.agxeements with the Governments of Afghanistan, Ceylon and Thailand. In the same period, 75 supplementary agreements (including 39 exchanges of letters) were concluded. SFA/RCI 112 Page 40

2.6 Implementation of Projects by Governments

Considerable delays have been experienced in the signing of plans of operations by governments, with. the consequence that available staff have sometimes been lost; still more important is the question of the financial savings which arise through non-implementation of a project as planned. If some solution cannot be found to delays of this nature, it is impossible to implement the planned programme in an orderly fashion. In this respect it should also be noted that itt is tho po'i-;. ,:f lJ:c ?r;;.::ir;ntion not to dlot funds for any project until the plan of operations is signed, or at least until drafts have been agreed. The following eight oases are given as exhles of delays which have occurred in the past year8

Dste plan of operation Date signed by Approximate delay sent to Government. Gcvernmen t

29 April 1957 22 February 1958 1I$ months 4 July 1957 30 Maroh 1958 9 I, 2 July 1957 3 1 January 1958 7 II 16 &y 1957 29 October 1957 15 July 1957 26 December 1957 $ ;; 31 October 1957 17 July 1958 11 24 June 1957 Not yet signed - 30 December 1957 1 July 1958 6 months

Another of the WHO'S continuing problems is that of recruiting technically qualified project staff; it is often with considerable difficulty that the Organization is able to locate the sight type of candidate in some part of the world. As soon as the Regional Office knows that a candidate is available for recruitment, a letter is sent to the government in question, and, only after the letter has been aclmcwledged by that government does the Organization start recruitment. It is at this stage that very long delays often occur, which, again, sometimes result in the services of a candidate being lost to the Organieation and, as mentioned above, in the accumulation of savings which cannot be spent. The following five cases may serve to illustrate this problem: bte letter sent to Date reply received Approximate delay Government

1 December 1957 25 March 1958 3k months 7 .November 19 57 18 January 1958 4 November 1957 16 January 1958 :: 13 December 1957 8 April 1958 3~ " 9 %Y 1957 4 July 1957 2 Letters have been written to governments proposing that, in order to remedy this situation, in cases where the Regional Office does not receive a reply within a specified number of weeks, the Regional Office will assume that the government oonoerned has no objection to the recruitment of the selected candidate and will finalize recruitment. SEA/RCI 1/2 Page 41

A third problem which regularly occurs and one where help and closer co-operation from governments would be useful is in implementing some of the administrative and financial obligations in accordance with the basic agreements. Under these agreements, governments undertake to contribute to the cost of technical advisory assistance by paying for, or directly furnishing, the following facilities and services, inter alia: (a) local personnel services (technical and administrative, -including the necessary local secretarial help); (b) the necessary office space and other premises; (c) equipment and supplies produced within the coimtri. (4) t.rnrr?nrtntior of personnelp supplies and equipmnts for official purposes within the country, including local transport; (e) post-ge ad tc?,?c~nnunicat~onsfor offioial purposes. It is in obtaining essential small items of equipment and office supplies and in seeurii~gadequate local transportation that our project staff have experlencad recurring difficulties in some countries. Problems also arise under the other headings but less frequently.

The above situation is reported in order to seek closer and better co-operation fros governments in the supply of such small services and equipment as are essential to the conduct of the project. It will be realized that when a government is unable to furnish project staff with the mlnimum small items of stationery, sundry supplies, services and transpoztation which they require in order to carry out their day-to-c?ay duties, they often become discouraged in their work and are prevented from mking the type of progress which is desirable.

3. PROCL?iEYE3IT OF EQUIPMENT AND SUPPLIES

Action has been taken to obtain supplies and equipment, including 'some medical literature and journals, costing about $ 21 1,000 for projects under the Regular and Technical Assistance funds.

Some of the mcro important supply lists completed were those far sanitation equipnent for the environmental sanitation projeot, Kerala; a medical launch for the treponematosis programme, Indonesia, and supplies for tuberoulosis projects in Hyderabad and Kabul and for the tuberculcs~scr,dmo-cherapy project, Madras.

Supply lists xiere also compiled and purchase authories*ions sent to Headquarters for procurement of DDT (worth about one and a half million dollars), laboratory supplies, vehicles, medicine chests, eto., under the Malaria Eradication Special Account.

From past experience it was realized that valuable time was being lost in respect of shipments during the process of clearance at the destination. Arrangements were mde to improve the methods of collecting shipping intelligence. This has proved extremely useful in expediting delivery of supplies to the projects.

Early in January 1958, owing to the floods in Ceylon, an urgent request was made by the Government of Ceylon for a supply of vaccine. This matter received urgent attention, and 200,000 c.o. of cholera vaccine were donated with the approval of the Executive Board. Another SEB/RCI 1/2 Page 42

quantity of 400,000 C.C. of cholera vaocine was donated to Thailand in June 1958 to help combat the cholera epidemic in that oountry. In addition, 330,000 C.C. of T.A.B. vaocine were supplied to Ceylon for flood relief, and a small quantity of BOG vaocine and a pulveriser to Afghanistan on a reimbursable basis.

In respect of eight projects for which WHO'S assistance had been completed, action was taken to hand over the supplies and equipment to the governments concerned for further use in the respective projects.

4. REFORTS AND DOCUMENTS

The need for more technical information, books and periodioals continues to be urgent. The measures adopted last year to cope with the growing demand were intensified by bringing out more technical circulars T and by enlarging the free distribution lists. The following documents and publioations have, in recent months, been distributed in bulks (1) Report of the Rural Health Conference (held in New Delhi in October 1957) ; (2) Health Education of the Public in South East Asia (based on the technical discussions held at the tenth session of the Regional Committee); (3) Report of the Seminar on Health Education of the Public and Nutrition (held in Baguio, Philippines, in 1955) ) (4) Report of the Seminar on the Resistance of Insects to Insecticides (held in New Delhi in February/March 1958) 3 (5) Report of the Seminar on Nursing (held in Delhi in August 1956); (6) Technical Circulars; (7) Medical Education Bulletin, and (8) Regional Director's Ninth Annual Report.

Efforts were made to bring WHO publications to the attention of more institutions and individuals by making a wide distribution of catalogues and reviews, and by continuing the scheme of selling publica- tions at concessional rates to selected institutions, medical schools and medioal associations in most countries of the Region. As a result, the sales in the Region have increased considerably, as compared to those in previous years. The Regional Offioe has -handled a very large number of orders, as well as requests for free publications and docu- ments.

As a further step toward improving the sales of WHO publioations, the firm of Orient Longmans, Calcutta, has been appointed principal distributors of WHO publications in the Region. Orient Longmns will appoint its own agents and organize the sales in Afghanistan, Burma, Ceylon, India and Nepal. The previous sales agents continue to function in Indonesia and Thailand.

A significant trend, though not very pronounced, is that indivi- dual professors in medical colleges and specialists in local public health administrations are becoming aware of the existence of WHO publications and have shown a keen in.terest in those relating to their own subjects. Requests for reprints, photocopies and bibliographies of medical and public health publications were received and oomplied with, with the assistance of Headquarters. The Medical Education Bulletin and the Technical Circulars issued by the Regional Office on subjects such as health education, public health administration and nursing were well received. SEA/RCI 7/2 Page 43

The Regional Office has oontinued its scheme to try to help promote the exchange of technical informaticn on medical research. A document entitled "Research News" - a list of medical researoh projeots which are in progress in the countries of South-East Asia - was brought out this year, with the 00-operation of the research institutes in ' several countries, and distributed to the various researoh bodies active in the field of medical research. If this document is found useful, it is hoped to issue it regularly onoe every three months.

I~~-..--.., . .- .. .. of 2, TI-cz-rrnd.aticn of the Rural Health Ccnferenae, organized by WHO in New Delhi in October 1957, the Regional Offioe has started to collect information on rural health from governments. A mechanism has been set up whereby each government is appointing one person in the country to act as liaison officer with the Regional Office and to supply it periodically with whatever information it is found possible to colleot, for eventual distribution to rural health workers and public health administrators throughout the Region.

In the Regional Office the work of compiling and editing reports and documents has increased. A large number of final reports on oomple- ted projects, field visit reports and assignment reports were edited and issued under the "SER" documents series. The Handbook of Resolutions and Decisions of the Regional Committee, first oompiled in 1957, way ale0 brought up to date.

As mentioned in last year's Annual Report, the Regional Offioe is adopting the policy of printing certain publications to make them more readable and more easily obtainable. This year, the Report of the Conference on Rural Health, mentioned above, and 'Wctes for the Praotising Midwife" (compiled by a member of WHO field staff) were prinked, and a thocsand copios of each made available.

The existing reporting instruotions for field staff were reviewed in the light of the experiance gained after about three years, and a revised edition was issued early in April.

More than four hundred books, in addition to a large number of pamphlets, reprints and periodicals, were added to the Regional Office Library. The Library is maintaining bibliographies of about thirty different subjects, to which more are being added from time to time. A complete list of bibliographies on hand was issued as a supple- ment to the Library News of 30 June 1958.

5. COLLABORATION WITH OTHER AGENCIES

5.1 United Naticns

Close collaboration with the United Naticns and the speoialized agencies has been continued. The Regional Office and the Area Representatives have maintained contacts with the Resident Represents-i tives of the Technical Assistance Board in every country of the Region, particularly in connection with the preparation and submission of programme requests for health projeots under Technical Assistance funds. In January 1958 the Chairman of the Technical Assistanae ibard visited the Regional Office and gave a brief outline of the newly-created Special United Nations Fund, through which more money would be made available for special projects of economic development. During his visits later to Nepal, Burma and Thailand, he mot similarly with the WHO Area Representatives and experts working in those countries.

In Delhi regular meetings have been held between representatives of the United Nations and specialized agencies to discuss administrative problems of interest to all the staff of the United Nations' family stationed in India. Similar meetings have also been held in other countries of the Region, WHO being represented by the Area Representatives.

During the year, WHO took part in two important seminars, one sponsored by UNTAA and the other by the United Nations. The first one, T on rehabilitation, was held at Solo (i'ndonesia) in August 1957, and the other, on training for community development and social work,was held at Lahore (~akistan)in December. Collaboration has also been maintained with ECAFE, particularly in regard to the health aspeots of housing.

UNICEF: Close day-to-day co-operation with UNICEF has continued. Joint &~CEFactivities now average two to three million dollars a year. Collaboration in rural health projects has been developing rapidly and now constitutes one of the most important programmes in the Region. The Regional Offico has also continued to give technical advioe on UNICEF supply projects which do not require WHO field personnel.

5.2 Specialized Agencies

FAO: Co-operation with FA0 continues in the field of nutrition. The nutrition projeat in Burma ended in Deoember 1957, but the project in Thailand is still going on. A joint survey to study the nutrition situation in Ceylon was carried out suooessfully in September-Oatober 1957. There has also been close collaboration between FAO, UNICEF and PlLIO in planning practioal nutrition programmes in connection with maternal and child health and community development projects.

UNESCO: WHO was represented at the fourth session of the Advisory Committee- of the UNESCO Research Centre for the study of the social implications of industrialization, in Calcutta. Assistance was given by UNESCO to a WHO consultant who visited India and Thailand in conneotion with WHO'S contribution to tho broad social study of urbanization, which is being carried out by the United Nations.

ILO: WHO was represented at the Fourth Asian Regional Conference of ILO -held in New Delhi in November 1957. The Regional Offiae is collaborating with ILO in making preparations for the regional seminar on industrial and oooupational health to be held in Caloutta in November 1958.

A list of meetings called by the United Nations and specialized agencies at which WHO was represented during the period under review is given in Annex 3. SEA/RCI 1/2 Page 45

5.3 Bilateral Agencies

Colombo Plan: The Regional Office and the Area Representatives in each country have maintained close collaboration with the Cololmbo Plan.

United States International Co-operation Administration (1~~1: Increased activities in malaria eradication have resulted in still closer collaboration between WRO and ICA, particularly in India, Indonesia and Nepal. There ha; also been eood co-operation on the subjects of health education, health statistics, medical education and fellowships in various countries.

Other Bilateral Agencies. Assistance in the field of health to - some countries in the Region has been continued, under bilateral agree* ments, by the Government of the Union of Soviet Socialist Republios and the Government of Norway.

5.4 Non-Oovernmental Organizations

Contacts have been maintained with the local branches or affilia- ted regional associations (where established) of the 40 non-governmental organizations in official relations with WHO, particularly those working in the fields of tuberculosiss nursing, dental health, child welfare, paediatrios, health education, social welfare, and housing and town planning.

The International Red Cross held its Nineteenth Conference in New Delhi in October-November 1957. WHO mas represented at nearly all the meetings of which this oonferenoe was oomposed.

5.5 Other Agencies

Excellent relationships exist with the Rookefeller Foundation, with which there has been a constant interchange of information on both medical eduoation and fellowships. Co-operation with the Ford Foundation has continued irr the fields of health eduoation (in Singur, ~ndia.)and environmental sanitation.

During the year visits were paid to the Regional Office by representatives of various agencies. Among these visitors were the Associate Editor with the Carnegie Endowment for International Peaoe, who was visiting India and Bum in connection with a study of technical assistance programmes, and the Secretary-General of the Medical Inter national Co-operation (W~DICO),a newly-f ormed unofficial body of American philanthropists whose aim is to assist Asian countries in the field of clinical medicine.

A list of the conferences and meetings called by governmental, non-governmental and other organizations at which WHO was represented is given in Annex 4. SEA/RCI 1/2 Page 46

Beoause of the ever-growing demands for information material which have become increasingly difficult to fulfil with the present staff and funds, it was decided during the year to stimulate production of material through public and private sources.

By far the largest venture of this kind was the production of a film %y a Member Government, with some financial assistance from WHO. This film deals with the training of indigenous midwives and auxiliary nurse midwives. In this case the return on the investment was known in advance; it was planned that the film would be produced in thirteen national languages and seen by an:audience of at least three million people. Copies have been brought and will be circulated in the Region.

During the technical discussions held in connection with last year's session of the Regional Committee, favourable comment was amused by a book published primarily for use in sohools - 'Wankind Against the Killerst1, by James B. Hemming. An abridged edition of the original was published in India at a low price. The publishers were approached and encouraged to prcducs editions in the local languages of different countries in the Region, WHO paying the oost of translations. To date, four such language editions have been produced, and it is hoped that more will follow. Each edition published in 1958 carries a printed inscription stating that it has been is3ued to commemorrtte the Tenth Anniversary of WHO,

An information pamphlet entitled "Health is Wealth", originally published in Geneva, has been accepted by a publisher in the Region for issue after it has been revised to include regioml mterial.

Demands for the illustrated newsletter 'World Health" have continued to inorease. Requests from education authorities alone have totalled 2,000 copies during the past year - representing an increase in ciroulation of 50 percent. The manual work of distribution was beyond the capacity of the present staff, and the national authorities took deliveries in bulk and handled the distribution themselves. A similar increase in circulation of other WHO informtion material is hampered by lack of capacity to deal with the distribution.

Previous reports have stressed the insufficiency of exhibit material and of photographs. To help to solve this problem, members of the Public Information Unit have undertaken photographio coverage themselves when visiting projects to collect information material or when assisting a film unit on location. Four projects have been thus covered during the year, and the position as regards photographs - for which there is a wide and insistent demand - has improved. Photographs taken during the making of the film on the training of indigenous midwives and auxiliary nurse-midwives have been made into a picture-book, which has been accepted by a publisher and will probably be produced in various language editions.

A still wider market for pictures has been opened by instituting a 'Imatf1 sarvicc,whioh enables journals which do not possess photo- engraving equipment to reproduoe WHO'S photographs. This has had an enthusiastic reception. Arising from suggestions mde at the Rural Health Conference held in New Delhi last year, a specimen of a proposed Rural Health Digest by means of which highlights of the information collected from rural health workers might be brought to more general notice has been prepared for the consideration of the Regional Committee.

Co-operation with press and radio throughout the Region continues to be excellent, and the*growth of interest in World Health Day goes on st an increasing pace, 4,000 information kits having been distributed this year against 3,000 in 1956-57. PART I11

ACTIVITIES UNDERTAKEN BY GOVERNMENTS WITH TEE HEW OF WHO

This part of the report contains a list of the projects for which WKO has given assistance during the whole or part of the period under review, listed by country. Inter-country pro- jects are given at the end. The "Aim of the project" states the purpose for which it was undertaken by the government conoerned, and is not related to the form or extent of WHO'S assistance.

In the first column (under tlFroject No., Source of hds, Co-operating ~~encies")"R" means the regular budget; "TA" means Bchnical Assistanoe funds; "UNICEF" the United Nations Children's Fund, and "MESAt1 the Malaria Eradication Special Account. Names of other co-operating agencies, whether or not they have contry- buted funds, are given in parentheses.

"Frobable duration of assistance" cannot, of courso, always be accurately stated, particularly in the case of the public-health programmes in India, which were calculated on the basis of a two- year period but in many cases may continue longer.

The sub-heading 'tFellowships" is used for fellowships consid- ered as projects in themselves; other fellowships aro shown under the title of the project of which they form part.

Projects for which technical advice from tho Regional Office or from Headquarters was the only assistance given during the year, and some projects assisted only by grants-in-aid are not included in this list. 1. AFGHANISTAN

Pro.iect No. Source of Funds Co-operating Agenices

Afahanis tan 4* School for Male Nurses. Kabul* TA (oc~.1955 - NOV. 1954; JUIY 1955 - Dee. 1957)

Aim of the project. To train male nurses, in a threeyear course, for hospital and community heaith services.

Assistance provided by WHO during the yew. (a) live nurse tutors; (b ) Supplies and equipment.

Work done. At the School for Male Nurses, the first and the second group of students continued to receive their training as planned, and a third group of six students was enrolled in April. A refresher course was started for nine male graduate nurses at the Aliabad HOS- pital, and a series of lectures on fundamentals of nursing, surgical nursing and anaesthetics was given to the nurses at the school.

At the beginning of 1958 this project was merged with ~fghanistan35.

@ahanis tan 6** Public Health Advisor R ~NOV. 1951 - )

Aim of the project. To improve public health administration and services; to train medical and para-medical personnel, to co- ordinate national and internationally assisted health pro!gammes.

Assistance ~rovidedby WHO durinff the year. (a) A public health advisor and an administrative assistant; Tb) Transport vehicle.

Probable duration of assistanco. Until the end of 1961.

*:Jon a part of Af~hanistan35 **This includos former project Afghanistan 39 '1 Page 50

Work done durica the year. A new public health adviser (replace- ment) was appointed in February 1958. Up to then, advice to the national authorities on planning and administration was given by regional advisers during frequent visits and by a short-tern esaig~ ment of the Area Representative normally assigned to Ceylon. Conti- nuity was largely maintained by the administrative assistant,who carried out the administrativo functions of the office throughout. He also conducted classes in office methods for compounders and laboratory assistants.

:Asoos8mcnt of progress achieved in public hualth under the Fivo-Year Development Plan has boen initiated.

Af~hatrietan2 Strengthening of Health Statistics TA Or~anieation.Kabul (~~ril1956 - May 1958) Aim of the project. To follow up the work of the WHO-sponeored training course in vital and health statistics hold in Kabul in 1954, to roorganiae the Health Statistics Division of the Health Directorate.

Assistance provided by WHO during the year. (a) A health statis- tician; (b) A twelve-month international fellowship; (c) Supplies and equipment.

Work done. WHO'S assistance to the project formally terminated in May 1958,when the statistician was transferred to the Eastern Mediterranean Regional Office. His counterpart, now away on fellowship, will later take charge of tho project.

During the course of the project, good progress was made in implementing the new system of records and reports for hospitals, polyclinics and out-patient departments. All the new forms have been printed and introduced. 'Il-10 hospital in-patient record oard has been in use for about a year in Aliabad and Mastoorat Hospitals, and about 4,000 statistical reports of discharges and deaths have been recoived and coded in tho Vital Statistics Division. In April 1958 a death notification form for hospital use, embodying the International Medical Certificate of Cause of Death, was intro- duced in all Afghan hospitals. The value of this innovation is primarily oducatiohal.

A list of all Afghan doctors,containing information regarding age, qualifications, training, present position, etc., has been prepared.

Statistical advico was given to a number of institutions, and the WHO sanitary engineer was assisted in the planning and conduct of a sanitary survey in Kabul City. SEA/RC~~/~ Page 51

Training opportunities have been limited by the unavoidable scarcity of educated personnel. The Director of the Division is now on an cverseks fellowship, Both he and tho Deputy Director have received apprenticeship training, and should be able to carry on the work of the project successfully.

The WHO statistician assisted in the preparation of the constitution and rules of procedure for a National Committee for Vital and Health Statistics, the establishment of which has receivod the sanction of tho King.

Afghanistan 2 lbberculosis Control and Waininn Centre, TA~- -Kabul (NOV. 1953 - Nov. 1957) UNICEF

Aim of the project. To establish a model tuberculosis service particularly for preventive work; to train staff ih modern methods of diagnosis and control, including domiciliary chemo- therapy; to carry out epidemiological survey work.

Assistance providgd by WHO during the year. (a) A madical off- icer, a public health nurse and a laboratory technician; (b) Supplies and equipment.

Work done. '?his project started in November 1953. By July 1954 the TUberculosis Centre was opened for routine work.. WAO's assistance to the project terminated in November 1957.

In a little over three years of operation, the following are some of the achievements:

(a) The setting up of a dia~osticservice,' employing tuberculin testing, photofluorography and laboratory work, including culturo of the tubercle bacillus.

(b) The training of sixteen doctors, two x-ray technicians, twelve x-ray assistants, two laboratory technicians, five laboratory assistants and twenty-one nurses and home visitors.

(c) 'be establishment of a domiciliary service. Only a very limited service could be set up, but it was well planned. It is boing operated correctly and has possibilities of expansion.

UNICEF supplied isoniazid, as well as bicycles for the domiciliary service, and also the equipment (including containers and record cards) needod for sending batches of sputum to a laboratory in Europe for spocial examination, including typing of the organism. Transport problems and frequent movemont of families made it difficult to bring large numbers of poople under this service. sEA/Rc11/2 Page 52

Malaria Fkadication* (AM.- 1956 - ) UNICEF MESA

Aim of the oroject. To consolidate the malaria control campaign (carried out under project Afghanistan 1 since 1949); to gear the campaign to eradication in stages and to achieve malaria eradica- tion throughout the country.

Assistance provided by WHO durina the year. (a) A malariologist for two months; (b) A short-term consultantship to the President, Malaria Institute of Kabul, to attend the mird Malaria Conference for South Eastern Europe at Bucharest in June 1958; (c) Supplies and equipment.

Probable duration of assistance. Until 1962.

Work done durin~the year. The eradication programme maintained satisfactory progress. A malariologist was assigned to the project from mid-August to mid-October 1957 to help the Government to insti- tute surveillance procedures, which showed that in a total population of 283,494 in Kataghan and Mishriqui provinces, under surveillance from August to December 1957, there were 8,553 cases of fever, of which 955 were found to be due to malaria. It was evident that no part of this area was ready for the withdrawal of spraying in 1958. Surveillance procedures in progress in these provinces will indicate from which areas spraying can be withdrawn in 1959.

The total population exposed to malaria risk in areas already surveyed and protected in 1957 operations was 1.9 million, as against 1.6 million protected in 1956. During 1957, 65,000 people in Kandahar town were protected by anti-larval control following the 1956 epidemic, in addition to the 300,000 in Kabul town and 20,000 in Pul-i-Khumri who have boen similarly proteated for tho last few yoars.

The Regional Malaria Adviser visited Afghanistan in July 1957. A dotailed plan of operations for 1958, which provides for increased WHO-assistance by way of personnel, equipment and supplies to be financed under the MESA schcmo, has been concluded between the Oovsrn- ment, UNICEF and WEIO. 'i%o malariologists and two technicians are being assigned to the project, and supplies, including two transport vehicles, laboratory equipment and medicine chests, are under procuromon t.

*Previous title; "Malaria Control" Af~hanistan13 Assistance to Faculty of Medicine,University of R -Kabul an. - Aug. 1952, Sept. 1953 - )

Aim of the pro,ject. To develop on sound lines the Departments of Anatomy, Physiology, Preventive Medicine, Internal Medicine and Paediatrics of the Faculty of Medicine and to train national counterparts to the visiting professors.

Assistance providod by WHO during the year. (a) A professor of anatomy, a professor of paediatrics, a professor of preventive and social medicine and a professor of internal medicine; (b) %O twolvcmonth international followships; (c)Transport vohi0l~,other equipment and medical literature.

Probablo duration of assistance. Until the end of 1960 at least.

Work dono durin~the year. lhe professor of anatomy completed his assignment in December 1957. According to his final report, tho immediate objectives of this aspect of the project have been successfully accomplished1 (a) A department of anatomy has been firmly established,with dissecting rooms and museum, and lectures have been supplemented by essential practical work; (b) A high standard of examination has been achieved,and the majority of students havo passed on their first attempt; (c) Three assistants have received training and experience, the most senior (the counter- part) has returned from a fellowship abroad and is in chnrge of teeoh- ing. Text books have been provided.

In preventive and social medicine, teaching now takes place during the three final years, and the hours have been increased. Supplies furnished include a bus for field work by students and museum equipment. The WHO professor took an active part in the second and third refresher courses for medicill officers (Afghan- istan 23).

The professor of paediatrics established a separate out- patients clinic for teaching purposes on the premises of the Paedistric Department, with the help of a nurse attached for a limited period to the department; ward routines havo improved. Two of tho nztional paediatricians have been appointed as professors.

A professor of internal medicine was provided from September to December 1957, when ill health prevented him from continuing his services. A successor is being recruited. Afghanistan 20 Vaccine Production, Kabul TA an. 1955 - ) UNICEF

Aim of tho project. To reorganize, expand and improve facilities for vaccine production in order to provide adequate supplics of vaccine for the national health programmes; to train local personnel in the production of biological substances; to organize a suitable system for the distribution and use of vaccines.

Assistance nrovided by WHO during the soar. (a) A laboratory specialist; a consultant for one month; [b) Some essential supplies.

Probable duration of assistance. Until 1963.

Work done durine the year. The laboratory specialist continued to advise the national staff of the Kabul Vaccine Institute. The laboratories are producing smallpox, cholera, T.A.B. and rabies vaccines, for which tho Institute has been able to meet all the demands of the national health sorvicos. These vacoines we regularly tested for potency and purity by the Central Rosearoh Institute, Kasauli (~ndia).

A short-term consultant visited Kabul in the autumn of 1957 to evaluate the achievements of the project,and has made recommenda- tions inter alia for the further expansion of accommodation for smallpox-vaccine production.

The Director of the Institute and another national doctor, who had been working at the Institute since its inooption, have been transferred to other duties, and a new counterpart has been appointed for the WHO specialist.

Afnhanistan 21 Publio Bealth Provincial Zmansion and Nursinq TA Education, Kandahar and other Provincial Centres UNICEF 7~an.1955 - Dec. 1957)

Aim of the oro.joct. To organiae and develop provincial health services (starting in ~andahar),inoluding tho training of personnel.

Assistance provided by WHO during the year. A public health nurse and a midwife tutor.

Work done. A WHO public health officer worked with the projec t for slightly over a year, his activities being concentrated on Kandahar city and including a survey of hcalth conditions, the starting of a health centre and the training of seven auxiliary sanitarians in a fourmonth course. His counterpart was available only on a part-time basis. The public health activities did not extend beyond a modest beginning in Kandahaz city. The nursing aspects of the project were very successful. Assistance was given with a venereal disease and skin clinic, daily clinics for infants, weekly clinics for older children, ante-natal clinics and domiciliary obstetrical services. The female hospital was expanded and bettcr equipped with the help of UNICEF. Antenatal care and child welfare grew to be woll accepted and understood. This also applied to the domiciliary midwifery service: home visiting, however, did not greatly develop. The gynaocolog~calward in the hospital was often over-crowded, but acceptance of the maternity ward was slow. The children's ward admitted only 37 children in the three-year period.

As for the other more general training activities, close contact was maintained with the girls1 school and through this with the women of Kandahar. Seven nursemidwife helpers were trained in one year and six in the subsequent year - the first female health personnol to be trained in Kandahar and essential . for the development of the aforementioned services. On the whole it can bc statcd that in a period of three years health care for mothers and children developod from practically nothing to a much approciated service. No oounterparts were available to the nursing personnel.

kther evaluation of these services should be made later.

Af~hanistan22 Environmental Sanitation. Kabul Municioalit~ TA (Nov. - Dec. 1955; March 1956 -)

Aim of the period. To develop a sanitation section in the Kabul Municipality; to plan and carry out a sanitation programme in- cluding the design, operation and maintenance of sanitary installa- tions; to train sanitation personnel.

Assistance ~rovidedbr WHO during the rear. (a) A sanitary engineer; (b) A twslvcmonth international fellowship.

Probable duration of assistance. Until the end of 1961.

Work done durin~the year. The sanitary engineer continued his activities in tho Sanitation Section of the Kabul Municipality up to December 1957 and left the project at the end of his contract. The pilot area in the City of Kabul selected for the improvement of sanitation has boon surveyed,and data collected are being used for the development of this area.

The sanitation manual (in Persian and English) started last year has been completed and is now under rovision. SEA/RC~~/~ Page 56

A sanitarian is being recruited to help in continuing some of the work already started in the City of Kabul.

The national counterpart of the sanitary engineer is now study- ing in thc USA on a WHO fellowship, and on his return will take over the responsibilities of the Sanitation Section.

Afnhanistan 21 Refresher Courses for Medical Officers R (second courser 22 May - 11 Sopt. 1957) (Third coursoc 1 May 1958 - )

Aim of the project. To provide provincial medical officers with theoretical and practical training in modern methods of public- health practice.

Assistance provided by WHO during: the year. For the second course, forty per cent of the cost of travel and of maintenance expenses of six medical officers from outside Kabul; assistance from WHO projoct staff in Kabul, sscrotarial help, and teaching equipmon t . For the third course, thirty per cent of the cost of travel and of maintenance of threo medical officers from outside Kabul; assistance from WHO project staff, secretarial help, teaching equipment and text' books. Probable duration of assistance. Similar courses aro planned for 1959 and 1960.

Work done during the year. The first course, which took place from 20 May to 10 August 1956, was dsscribod in the last hnual Report.

Tho second course, held from 22 May to 11 September 1957, was attended by nino medioal officers - threo from Kabul and six from the provinces. More attention was paid to field experience and group discussions in the curriculum of this course.

The third courso was startod on 1 May 1958 and has not yet finished. Scvon medical officers %re attonding the course.

These courses resemble a condensed DPH course and are of considerable value to the participants, to whom they are an introduction to formal public hoalth training.

Afghanistan 25 Assistanco to Public-Health Laboratory, Kabul TA (May 1956 - ) UNICEF

Aim of the projoct. To consolidate the work of tho public- health laboratory at Kabul; to give further training to lnboratory technicians. Assistance provided by WE0 during the year. (a) A laboratory technician; (b) One thirteenlnonth international fellowship and two six-month rogional folldvrships; (c) Supplies and equipment.

Probable duration of assistance. Until mid-1960.

Work done during tho year. The laboratory technician who had beon working on the project since 1956 left Kabul in April 1958; a suoceesor is under reruitment. Until that time, technical advice and assistance were continuod, and tho training courses for both laboratory assistants (a three-year course) and laboratory technicians(a tvroiyoar cours~)~rogressedsatisfactorily; there are now 14 assistants and 18 technicians under training. In addition to equipment previously supplied, ten more mioro- scopes wero provided by THO during the year. Several new tech- niques have boen introducod,and the laboratory now prepares its own Kahn antigen and diagnostic anti-aera for typhoid, para- typhoid and shigella.

Afahanistan 26 Rural Hcalth md Trninin~Unit. Gulzar* TA 7~pril1956 - ) UNICEF

Aim of the pro.iect. To establish a rural health training unit; to develop further the existing environmental sanitation programme; to promote health education activities.

Assistance provided bg WHO during the gear. A sanitarian, a public health nurse and a public health officer.

Probable duration of assistance. Until the end of 1961.

Work done during the sear. The sanitarian continued trials on the drilling of wells. Severe weather conditions obstructed the progrcsa of construction during the wintcr months, but survey activities and anti-typhus dusting operations were carried on. Lectures and talks were given to student nurses, village level workers and teachers by the sanitarian and the public health nurse. The public health nursc helped with tho organization of the clinics and started a home visiting programme. The Covcrnmont posted an additional full-time doctor to the project, and the WHO public health officer arrived in June.

Afghanis tan 28 School for Sanitarians. Kabul TA (July 1955 - )

Aim of the -pro,iect. lb train sanitarians for community health services.

* Formerly "Rural Health Unit, Chaurassia". SEA/RC~~/~ Page 58

Assistance provided by WHO during tho year. (a) A sanitarian; 7b) Supplies and equipment.

Probable duration of assistance. Until the end of 1961.

Work done during the .war. ?he training courses at the School are progressing satisfactorily. Students in the first course passed their final examination with satisfactory results and have now been assigned to different areas for a sixtnonth period of in- service training. 'Innose in tho second course aro continuing their training. The third course started in 1958 with an admission of 12 students.

A second sanitarian is under recruitment to help in handling the increased activities of the School, especially the field training.

Afuhanistan 23 Assistanoe to Jalalabad and Kandahar Hosuitals TA 7~0~.1956 - July 1958)

Aim of the pro.ioct. To modernize the facilities far diagnosis, treatment and training at the provincial hospitals of Jalalabd and Kandahar.

Assis tanco providod b.y WHO (~oubleTontribution 1. Supplies and equipmont, including two transport vehioles and two ambulances for the two hospitals at Jalalabad and Kandahar.

Bfnhanistan 30 Assistance to X-Ray De~arhent.Faculty of TA Medicine, Kabul (NOV. 1956 r )

Aim of the project. To upgrade facilities and to improve the standard of teaching in the X-Ray Department of the Faculty of Medicine) to train x-ray technicians in the operation and mainten- ance of equipment: to improve diagnostic facilities at tho Aliabad Hospital, and to give training to doctors.

Assistance ~ro~id~dby WHO (~oubloContributionl. X-ray equipment and films.

Probable duration of assistance. Until the ond of 1963.

Work done during tho year. All the x-ray oquipmont procured by WHO has boon suppliod and doliverod in Kabul. Great difficulty is being rxpcrionced in recruiting an x-ray ongineer and/or a radiographer to assemble and use this equipmat,which was obtained from the USSR. Afghanistan 33 Wberculosis Country Adviser TA (~une- July 19581 - ) Aim of the project. To review the work of tho 'I\uberculosis Control and Training Centre, Kabu1,and to make recommendations for its further development and expansion.

Asdistance provided by WHO durine the year. A short-term consul tan t.

Pr~babloduration of assistance. Until tho end of.1960.

Work done during the year. The short-term consultant was assigned for one month early in June 1958, As part of the evaluation of the work of tho Rtberculosis Centre, he conducted a survey of school-children and teachers in Kabul. About 4,000 primary school children were Mantoux-tested, and non-reactors wero vaccinated. The consultant completed his assignment at tho beginning of July 1958, and is expected to visit Afghanistan again in 0ctoberJ November 1958. Further assistance is planned in 1959 and 1960.

Afghanistan 2 Nursing Education (~unc1957 - ) TA

Aim of the prodect. 'Po dovelop the training of male and femalo nurses and midwiveq to establish a training programme for auxiliary nurso-midwivcisi to plan for meeting the countryls neede in nursing services.

Assistance providod by WHO during the ponr. (a) Two nurse tutors transferred from "Afghani~t~w411)and a public-health nurse-midwife; b) Supplios and equipment.

Probable duration of assistance. Until thb end of 1962.

Work done during the year. Nino sonior students at the Shararah Hospital School of Midwifery completed their training, and fifteen junior students arc continuing theirs. A successful rotation programme, which includes three polyclinic sessions per week, was developed for senior students. A staff education programme was started for midwives.

Classes and demonstrations in the public health nursing aspects of midwifery were given to the medical officers participating in the third refresher courso being held in Kabul.

A senior WHO nurse is being recruitod for assignment to the Mastoorat Hospital School of Nursing. In the meantime, a prelim- inary survey of hospital conditions was started by the WBO public health nurse in preparation for establishing a course for training auxiliary nursornidwives. SEA/RC~~/~ Page 60

- F'rom the beginning of 1958, project Afghanistan.4, School for Male Nurses, was amalgamated with this project. The work accom- plished at the School for Male Nurses is, for the purposes of the present report, described under Afghanistan 4.

Of the throe national counterparts required, only one has been provided so far. This lack of counterparts is hampering tho progross of the school.

Afghanistan 36 Fellowships R Nursing8 ?hro twolve-month fellowship for study in Lebanon.

Public Health &~ineering: A twelvenonth fellowship for study in th: USA.

Laboratory Techniauer An eight-month fellowship for study in India.

Vaccine Productionn Three fellowships - one for nine months and two for six months each for study in India.

Afghanistan 38 Nursin~- Domiciliary and Hospital TA by1958 -

&m of the ~roject. To supply equipment for the expansion of hos- pital services.

Assistance provided by WHO (~opblo cobtribution). Only one ship- ment,made up of two sewing machinos and hospital linen,has been shippod. The balancc of suppli~sand cpuipmdnt is, howov~r,oxpocted to be shipped shortly.

Probable duration of assistance. Until tho 1231; quartcr of 1958.

Medical ,Stores Management 7~0~.- Dec.1957)

Aim of the uro.iect. To improve the organization, system of storage and distribution methods of tho Central Medical Depot of the Min- istry of Public Health.

Assistance ~rovidedby WHO durin~tho year. A consultant for six weeks.

Work done. During the short period of his assignment, the consult- ant examined the system of storage, purchase and distribution of medical supplies and suggestod improvements in recording, stock- taking, ordering, purchasing and issuing. He has recommended the establishment of a manufacturing laboratory to produce a number of drugs which now have to bo imported.

Recomondations have also been mado to socure a greater degree of control over narcotics and othor habit-forming drugs.

Local manufacture of certain pharmaceutical requisites includ- ing alcohol has been advisod, and suggestions wrc mado for the train' ing of pharmacists.

The report of the consultant has been sent to the Government.

Afnhanistan 44 Trachoma Control TA (May - June 1958)

Aim of tho pro.ioct. To survey the problem of trachoma in Afghanistan.

Assistance urovidod by WHO during the year. A consultant for one month.

Work done. This short-term consultant (trachomatologist) visited Afghanistan in ~ay/~une1958. His report and recommendations have been received and are undor study. SEA/RC~~/~ Page 62

2. BURMA

Project No. Souroe of Funds Title Co-operating Agencies

Burma 10 Tuberculosis Country Adviser TB 7-

Aim of the project. To organize and expand the national tuberculo- r sis service; to give lectures on tuberculosis to undergraduates and graduates at the Rangoon Medical College; to give further training to oounterparts so that they may carry out both the above functions.

Assiatance provided by WHO during the year. A ~olv~nonthintor- national' fo'llokship. .. 1, .,

Probable duration of assistance. Until the end of 1960.

Work done. The adviser left Burma at the end of June 1957 on termina- tion of his contract. It in hopodtto raplacorhim in 1959.

During the two years of his assignment, he gave lectures and practical demonstrations in tuberculosis diagnosis and control to undergraduate and post-graduate students in Rangoon. In collabora- tion with the Assistant Director of Health Services (tuberculosis), he drew up plene for a national tuberculosis prevalence survey, for a BCG consolidation programme and for domiciliary chemotherapy schemes in association with the Rangoon and Mandalay Tuberculosis Centres. Assistance was also given to the Director of the Rangoon Tuberculosis Centre in reviewing the technical prooedures in use and in improving them where necessary.

Burma 18 Tuberculosis Control and Training Centre TA Mandala2 (July 7954 - Deo. 1957) Aim of the project. To establish a model tuberculosis service with emphasis on prevention; to train national personnel in modern methods of diagnosis and control, including domiciliary chemotherapy; to carry out epidemiological survey work.

Assistance provided by WHO during the year. (a) A medical officer, a laboratory technician and a public health nurse) (b) Supplies and equipment.

Work done. There was no organized tuberculosis service in Mandday or anywhere in Upper Burma before this project was started. There was also no statistically valid information regarding the prevalence of infectious tuberculosis in the area, but there was some indicar tion that the disease was widely diffused. WHO provided a team of four experts, equipment and supplies for setting up diagnostic and domiciliary follow-up services, as well astwo fellowships. The Government provided the necessary buildings and a team of counter- part personnel.

The following are some of the achievements of the projects

(1) An effective diagnostic and control unit on modern lines has been set up to serve the Mandalay area.

2 A national team has been trained in the standardized diagnostic techniques md tho domicilizry fbllowup and drug tro&- ment scheme recommended by WHO, together with the recommended codes for x-ray and laboratory findings and the recording and reporting system. It seems, however, that, after the departure of the WHO team, although the diagnostic section continued to work well, the same was not true of the domiciliary service. The cars are out of repair and the staff is not using the motor scooters.

(3) Training was carried out in the nursing section,for nurses, student nurses, lady home visitors,etc. It did not prove possible, however, for the Government to assign tralnees for the laboratory and x-ray sections.

(4) Attention has been given to education af tho publia in public health maasuros for the control of tuberculosis by the staff of the centre and by means of the press, posters, cinema slides and the domiciliary service.

Although it was not possible to undertake epidemiological survey work on a statistically planned rando~samplingbasis, certain investigations which were carried out in Mandalay and in the Shan States indicated the likelihood that infective tuberculo- sis was present in the areas covered.

Burma 21 Strengthening of Health Education Bureau, R nangcon (Aug. I955 - July 1756; Jan. 1957 - ) Aim of the project. To strongthcn thc Health Zducation Burc,?u,Rangoon, to ds- slop- tho hoalth cducstion programmu in tho Tcaeherst Training Institute; to train all categories of health personnel in health education; to improve health education throughout the country.

Assistance provided by WHO during the year. (a) A health educa- tor; (b) Two ten-month international fellowships; (c) Supplies and equipmen t . Probable duration of assistance. Until mid-1960.

Work done during the year. The health educator worked with the staff of the Bureau in preparing "Suggested Guide Lines for Strengthening the Bureau of ~ealthEdGcation and Programme of Work for 1957-58". Attention was given to the functions of the Bureau, programme planning, recruitment and training, production, appraisal and use of visual aids, office management, field reports, etc. One of the six working groups in the National Rural Health Conferenoe held in Rangoon in August 1957 considered the subject of health education, its place in strengthening the services of the rural health unit and types of activities to be carried out4

As part of a short course in public health, a series of ten sessions on principles and methods of health education was given to a group of twenty medical officers, In-service training of the Rure~ustaff and of other health workers was continued.

The issue of a Newsletter was started by the Health Education Bureau for the purpose of promoting communication between the Health Directorate and health education personnel in the districts.

Burma 22 Vital and Health Statistics, Rangoon R t~ec.1955 - ) Bim of.the project. To establish machinery for prompt notifioation of accurate statistical data; to improve the processing of the information and to train staff in statistical methods.

Assistance provided by WHO during the year. (a) A specialist in vital statistics; (b) A twelve-month international fellowship;. (c) Supplies adequipment.

Probable duration of assistanoe. Until the end of 1960.

Work done during the year. The plan for a new vital statistics system for Burma has now been approved by all the Government DeDart- mints concerned. The final report, presenting the plan in full- detail, has been prepared and awaits Cabinet approval. Implementa- tion of the new system throughout Burma, or even in the whole of the present registration area, will be a difficult task and will prob- ably take a long time, but it is hoped to implement the new methods in the coming year in Rangoon City and the Insein rural area. The country will then have a good working model which can be extended to other areas as circumstanoes permit. In the meantime efforts have been made to improve the reporting of vital events under the existing system.

The project staff has continued to prepare vital statistics tables up to and including 1957. Revised and more complete tables were prepared for the Demographic Year Book, and vital statistics information was supplied to a number of agencies and individuals. The staff also rendered considerable assistance to the WHO special- ist in the preparation of the Annual Health Reports of Burma for 1955 and 7956.

A health statistics section has been organized, and has undertaken the processing of monthly returns from hospitals and dispensaries. Efforts are being made to obtain more regular re- orting, but not much progress can be made without additional staff P both professional and clerioal) and international assistance. The Civil Surgeons' Conference in January 1958 provided the WHO specialist with a valuable opportunity to arouse interest in better vital and health statistics. Training of the national staff in the work of the vital statistics section is being continued. One of the aseistmt sta- tisticians is on fellowship in England.

Burma 25 post-Graduate School of Nursing, Ran~oon TA '(Jan. - Nov.. 7955~Aug. 1956 - July 19571

Aim of the project. To give post-graduate training to nursing tutors, public-health nurses and midwife tutors in order to meet the requirements of the integrated health services.

Assistance provided by WE0 during the year. A nurse educator.

Probable duration of assistance, Until the end of 1960.

Work done during the year, The nurse educator took up her assign- ment in A-t 1957. She visited various hospitals and clinics in Rangoon and schools of nursing and health centres in Mandalay, Maymyo and Sagaing in connection with the preliminary planning of a course for training nurse tutors. The syllabus was drawn up,md the first group of eleven students was enrolled in June 1958. Financial stlringencyhas been responsible for the delay in opening the course.

Assistance was given to the Rangoon General Hospitd's School of Nursing in preparing a tentative plan for a schedule of "blocktt class rotations, and preliminary steps for its implementa- tion are being studiec;.

Burma 26 ~utritihn,Rangoon (~ug.1954 - Dee* 1957) R { "0' Ford Foundation)

Aim of the project. To reorganize the nutrition services and carry out a nutrition programme8 to establish a nutrition labora- tory in Rangoon; to stidyand improve institutional diets; to survey dietary habits and the nutritional status of certain papule- tion groups; to establish comity feeding centres.

Assistance provided by WHO during the year. A medical nutritioniet and a biochemist.

Vork done. Before the project started in August 1954, there was no organized nutrition service to cope with the nutrition problems of the country. There were no pmsonnel trained in nutrition, no nutrition institute ,nd laboratory. A national programme for nutri- tion was lackingsand hardly any dataworeavailable on which to base such a programme. uua/ ll~ll/, Page 66

WHO provided a medical nutritionist and a biochemist, to- gether with some equipment and supplies mainly for the nutrition laboratory; FA0 provided a home economist, and the Pord Foundation also assisted the laboratory with val~ableequipment.

The following are some of the achievements of the project1

A Nutrition Section consisting of Medical, Biochemical and Home Economi~sDepartments was developed in the Directorate of Health Services, and thus formed the nucleus of a Nutrition Insti- tute. Good co-operation was established between thin section and other sections of the health services. A nutrition laboratory was established 86 part of the nutrition section and is now adequately staffed and equipped to do routine and recearch work in connection * with food analysis and clinical aspects of nutrition.

A number of dietary and nutritional surveys were made in eleven different distriotsg somatometric data were collected from school-ohil&x3n. National counterparts and other national staff were trained in survey techniques, and advioe on balanced diets was given, to be introduced in the districts concerned.

Special investigations were made into the incidence of beri- beri among expectant and nursing mothers of different economic groups.

Assistance was given in training undergraduate medical students and with the refresher training of 150 staff members of health centres and rural health units.

The home economist provided by FA0 assisted in developing a test kitchen, which axperimented on the preparation and introduc- tion of fish flour as a supplementary food.

So far it has not been posaible to create a national nutri- tion councilj only one counterpart of the WHO medical nutritionist has been trained, and the clinical aspects of nutrition have received only limited attention. Co-operation with clinical Staff, especially of the medical faculty, and with members of tho medical profession in general needs strengthening.

As a result of this project, the firat step towards a national nutrition service has been taken. The nutrition labora- tory has been firmly established, but many other aspects of tha project need well-plared continuous ~ctionif the results achieved are not to be lost.

Burma 28 Aseistanoe to Medical Colleae, Rannoon T l~ob.1955 - Aim of the project. To upgrade the Departments of Pharmacology, Physiolom-- and Preventive Medicine in the Medical College of ~&goonITniversity, as part of a longterm programme for upgrad- ing the Medical Faculty as a whole. Assistance provided by WHO during the year. (a) A professor of of preventive and social medicine; regional fellowship.

Probable duration of assistande. Until the end of 1960.

. Work done during the,year. The professor of physiology continued . with his undergr,aduate te&ching programme, tho training of junior staff in research methods, and his assistance to the new course in physiology for LSc. candidates. The professor assisted in academic examinetione at the branch Medical College at Mandalay. No suitable counterpart has yet been provided, but two assistants who have returned from study abroad are assuming more responsibility in teaching duties. The senior physiology class now has 470 students.

The new professor of preventive and social medicine started his work in June 1957. He confined his teaching to social medicine; the hygiene and public health course was continued by 6n expe- rienced national colleague. A series of 25 lectures in social medicine based on stems from an annual report of the Ministry of Health was mimeographed and distributed. A counterpart, who was grovi- dud in January 1957, has since left the Faculty. The WHO professor gave a course of lectures and assisted in professional examinations at the branch college at Mandalay. Both at Rangoon and Xandalay only some 4Wo of the candidates passed their tests. No etaff %or this depwtment other than the counterpart has yet been provided. The WHO professor completed his assignment in April.

The Government has decided that the study of English at university level will no longer be compulsory after 1960 and that all teaching (including medicine) at the universities in Burma is to be in the national language after 1962. Special cormittees have been formed to complete the translction of medical textbodks into Burmese. The Mandalay College has been upgraded to nn inde- pendent university,but it is likely that the Mandalay Medical College will retain its close association with its parent college in Rangoon. The teaching ~t both colleges is seriously handicapped by the lack of full-time staff.

Burma 30 Development of Environmental Sanitation T A Division, Ministry bf Health (March 1956 - ) Aim of the project. To develop and strengthen the Division of Environments1 Sanitation in the Ministry of Health; to plan a country-wide programme in environmectal sanitation; to develop a demonstration and training centre in the Bung San My0 area.

Assistance provided by WHO during the year. A ssnit~ryengineer'

Probable duration of assistance. Until the end of 1960.

Work done during the year. The sanitarian ettached to the allied project Burma 34 was working on this project as well until the arrival of the sanitary engineer in August 1957. Since then, SEA/RC~~/Z Page 68

Special efforts have been made to develop and strengthen the Environmental Sanitation Division of the Ministry of Health. A plan for its expansion, organization and staffing has been pre- pared and submitted to the Government. To overcome the diffi- aultj,os in recruiting technical personnel, different sohemes have been proposed for attrwting candidates.

Special attention has also been given to the Aung San Myo areel, where a pilot project is under way for the improvement and expansion of its demonotration and training work.

Burma 31 Malaria Erbdication* T A '(Nay 1954 - 1 UNICEF

dim of the project. To strengthen the ~albikDivision of the Centrhl Government; t~ trbin personnel, Alid to plan, implement and achieve malcia eradioati~nthroughout the country.

dssistanoe provided by WHO during the year. (a) A malariologist, an entomologist and two saniteriansc (b) An zdvisory teem ooneist- ing of a malariologiat, an entomologist and two technicians from August to December 1957; (c) Six regional fellowships - one for four months, two for two and a half month3 and tbbo far two. months oaoh - and one international fellowship for twelve months. Probable duration of assistance. Until 1960.

Work done during the year. The eradication programme instituted by the Government in February 1957 with ~o/UNICEFeasistanoe maintained good progress; 9.23 million peoae were proteoted in 1958. Entomological studies on the &aka coast revealed that A.sundaicus exhibited higher tolerance to Dm, and thia inssc- ticide was thus replaced in 1958 by dieldrin.

The WHO Advisory Team on Malaria Eradication No.3, assigned to the country, visited Lashio and Mandalay areas in order to examine how far transmission had been interrupted in the Lashio area and to collect mdrlariornetric data in the Mandalay area. The findings of the tern have been submitted to the Government.

Malariometric surveys,'routine calleotion of data, trein- ing of personnel and insecticide spraying are being continued. Requirements in insecticides, sprayers, etc., for the programme are being met by UNICEF.

It is proposed to provide increased assistanoe in the way of persohnel and partial payment of the salaries of the national malaria staff under the MESA soheme. This plan is under negotiar tion with the Government.

The Regional Malaria Adviser visited Burma in September 1957 and again in JIaroh 1958.

*Previous titles "Strengthening of Malaria Division, ?angoon". Burma 32 Rural Health Unit, Mandalay TA '(~ec. 1955 - Dee. 1957) UNICEF

Aim of the project. To set up a rural health unit in order to demonstrate a health service combining prevmtive, curative and social work; to establish programmes for trsining.in rural health.

Assistance provided by WHO during the year. A ten-month regional fellowship.

Work done. So far only fellowships have been awarded under this projeot. No further asaistanco is expected.

Burma 34 Strengthening of Environmental Sanitation Td 11956;) UNICEF

Aim of the project. To establish in the Aung San Myo area a pilot demonstration area where rural water supplies and excreta disposal will be improved; to devise simple, practical and cheap schemes for rural water supply and latrine construction; to provide services and facilities for extending sanitation to all rural areas; to train sanitation personnel.

Assistance provided by WBO during the year. A sanitarian.

Probable duration of assistance. Until the end of 1960.

Work done during the year. With the combined efforts of the sani- tarian and of the sanitary engineer attached to Burma 30, the work in this projoct has begun to show some progress. In connection with latrine construction, the work in health education of the public was intensified,and better results have been achieved. The construction of tube wells is oontinuing although there was eome interruption due to technical difficulties. Improvements have also been cjffeoted in the use and control of labour, but shortage of personnel and occasional diversion of the existing staff from the main programme are still being encountered.

A survey of latrine construction carried out in the village of Pawkan showed that 63$ of the householders had sanitary latrines and 1% had made some progress towards installing such units.

Training activities for health personnel were undertaken with the assistance of WHO staff.

The sanitarian workod also on a temporary assignment in Nepal for about two months.

Burma 39 Medical Stores Management, Rangoon R '(JU~Y 1956 - July 1958) Aim of the project. To study the system of purchase, store- keeping and distribution of drugs and medical supplies; to SEA/RC~~/~ Page 70

reorgsnize the central medicaL stores; to plan better distribution of medical supplies and drugs,to ho~pitalsand other medical institutions.

Assistance provided by WHO during the yew. A specialist in medical stores management. . . Work done, After two years, the WHO specialist left the project in at the end of his contract. During his assignment the different aspects of purchasing, storage, store-keeping and distri- bution of drugs and medical suppliesworothoroughly examined, and some improvements effectedr Changes were made in the Clerical Leeer Section, and a new price vooabulary was prepared. New purchase procedures xrrs ecggestod. _ Prog~~ash%o bden .nsatisfac%or~in two . vital aspects, namely, in regard to assessment of needs (fore- casting of future supplies) and distribution of supplies after thoy havc bean delivered by the MedicU Stores Depot. Improve- ment of both these aspects requires closer contact between the Central Medical Stores Department and the hospitals in the country.

An interesting feature of the project was the co-operation and co-ordination achieved with the newly establisaed Burma Phnrma- ceutical Industry.

From the experience gained it would seem that a preliminary visit by a short-term consultant to study the need for and the objectives of long-term projects such as this might, in future, be useful.

Burma 54 Fellowships R Nursing1 One twelve-month fellowship for study in New Zaland.

Histologyr One six-month fellowship for study in India.

Health-Assistants Trainings Three fellowships, each of three months, for study in India.

Leprosy control; One travel fellowship for one month for study in Thailand.

Burma 55 Fellowships TA X-ray Techniquest Three fellowships, eaoh of twelve months, for study in India.

Nutritions One fellowship for twenty-one months for study in India.

Nursing%Two fellowships, each of twelve months, one for-stady l%n Now Zo&d md one for study in Australia. SEA/RCII/~ Page 71

3. CEYLON

Project No. Souroe of Funds Title Co-operating Agencies -

Ceylon 4 Rural Health Development, Kalutara TA T~ept.1955 - ) UNICEF

Aim of the project. To upgrade the Children's Department of the Kalutara Health Unit Hospital! to integrate the preventive and curative sides of ohild care at the hospital and in the field; to improve public-health nursing in the Health Unit and train various categoriee of health personnel.

Assistance provided by WHO during the year. A paediatrician and a public health nurse.

Probable duration of assistance. Until the end of 1960.

Work done during the year. A new Children's Department was built with adequate isolation facilities and a separate milk kitchen. The national and WHO staff are attenaing the well baby clinic regularly.

Visits were paid by the pediatrician and public health nurse to five provincial hospitals where separate children's departments exist. Work has been initiated in these units for their upgrading and re-orientation on the Kalutara pattern.

Ceylon 18 Nutrition (~ept.- Nov, 1957) TA (FAG)

Aim of the ~rodect. To study the medioal aspects of the nutrition situation in the country and to review and evaluate the nutrition programme.

Assistance provided by WAO during the year. A consultant for three months.

Work done. The ooneultant worked in conjunction with a short-term consultant provided by FAO. Together they studied many aspeots of the nutrition situation in Ceylon and prepared a joint report, which has been submitted to the Government. Ceylon 25 Tuberculosis Control and Training Centre, TA Colombo (Welisara) (May 1953 - Aug. 1957 ; UNICEF Nov. 1957 - Jan. 1958; - ) Aim of the project. To survey the extent of the tuberculosis problem; to establish a model tuberculosis service; to train medical and paramedical personnel in diagnosis and prevention.

Assistance-- provided by WHO during the year. A statistioion and a short-term consultant.

Probable duration of assistance. Until the end of 1960.

Work done during the year. A short-term consultant (tuberculosis specialist) was in Ceylon from 2 November 1957 to 15 January 1958 to advise the Government in the further planning and development of a country-wide tuberculosis programme in accordance with modern methods for controlling the disease, and to review the progress made in the development of the projeot since the termina- tion of his last assignment (at the end of 1955).

According to his final report, the recommendations made during his earlier visit largely have been acted upon, and there has been oonsiderable progress in reorienting the polioy of the tuberculosis service from curative to preventive lines.

Within the next two years the present clinio-building programme should be complete. Further progress towards effective tuberculosis control will then depend on the evolution of a reliable and simplified technique of domiciliary chemotherapy.

The statistician left the projeot in August 1957 on the expiry of his contract. Another statistician is under recruit- ment to complete the work on the study of tuberculosis morbidity and the reoords of the BCG campaign.

Ceylon 35 Environmental Sanitation, Kurunegala TA 'tMarch 1955 - ) UNICEF

Aim of the projeot. To set up two pilot projects in rural areas for the purposes of improving water supplies and exoreta disposal and of training personnel in environmental sanitation; to develop a health education programme in order to elicit the co-operation of the people and prepare the community for the sanitation pro- gramme; to apply the experience so gained in the future national programme.

Assistance provided by WHO durina the year. A slmitary ~ngineor tind a c~itarian. Probable duration of assistance. Until the end of 1960. SEA/RC~~/~ Page 73

Work done during the gear. In spite of some temporary setbacks in the construction programme due to lack of funds, to emergency situations arising from widespread floods and to other causes, the work has been going ahead. Additional latrines and wells have been constructed, and the health education campaign is being continued.

Construction of latrines and sanitary wells in Tisawa Korale has been almost completed. A pre-operational sanitary survey is now being conducted in the third pair of korales. In the meantime, in one of these korales a special survey is being carried out to determine the attitude of the people towards disease, mortality and sanitation before starting a $health educa- tion programme. This survey will be repeated after the completion of the activities planned for that area in order to assess the results achived.

Three field-training courses for officers in charge of health units were conducted, as was also a five-day training course for health education overseers of the project.

The sanitarian arrived in Ceylon in November 1957 and, after a short period spent in the Kurunegala project for orienta- tion purposes, took up his duties in Kalutara in January 1958. He is principally involved in helping in the teaching of health inspectors and in promoting their education and training.

Ceylon 38 1 Assistance in Epidemiology to Health TA Directorate (Feb. 1956 - ) Aim of the project. To establish an epidemiological unit at the Directorate of Health Services, Colombo; to make epidemiolog-ical surveys of the disease pattern in Ceylon; to train undergradate and post-graduate students and a counterpart.

Assistance provided by WHO during the year. (a) An epidemio- logist; (b) A twelve-month international fellowship.

Probable duration of assistance. Until the occond quarter of 1960.

Fork done during the year. The epidemiologist who had been wcrk- ing with the project from February 1956 finished hie assignment in December 1957; his successor assumed his duties in April 1958.

&ch work has been done to stimulate interest in the accurate diagnosis and reporting of infectious disease and to improve methods of tracing sources and contacts of infection. Several surveys in connection with epidemic and endemic diseases were undertaken, and training programmes for medical officers on epidemiology and infectious diseases were begun.

An opidemiological unit has been established in the Wrantine Department adjoining thj Secretariat, and the e~idemio- logical laboratory has been set up in the bledical Research Institute. Ceylon 39 Assistanoe to Health Direotorate R 'I~ursingAdviser) (July 1957 - ) Aim of the project. To provide the Directorate of Health Services with advisory services in oonneotion with nursing organization, eduoation, administration and legislation and with the development of 00-ordinated supervisory services,iin order to ensure uniformly high nursing standards within the national health programme.

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

Probable duration of assistance. Until the end of 1960.

Work done during the gear. After her arrival in July 1957, the nursing adviser went on an observation tour of the four existing schools of nursing and also of the two hospitals which are planning to open new schools in the near future. She is making a study of nursing service administration and nursing education in Ceylon, with a view to bringing about needed improvements. In order to obtain accurate and comprehensive information on the basio nursing education in the country and material for future planning, a questionnaire was prepared and oirculated to all the nursing schools in the country. Data from the replies roueived are now being mompiled.

Ceylon 44 Expansion of Hospital Services TA l~eo.1956 - July 1958) Aim of the project. To provide essential equipment and supplies required for the programme for extending hospital servioes.

Assistance provided by WHO (Rouble Contribution). Supplies and equipment to meet the requirements of the Government for the expansion of hospital services envisaged under the next six-year plan.

Ceylon 41 Health Statistics (~pril1957 - ) TA

Aim of the project. To revise the system of records and reports in the health services; to train personnel in the design of documents, the conduct of surveys and other statistical techniques; to set up a penranent statistical service in the Ministry of Health. Assistance provided. by WHO durink the year. (a) A health stptiz- tician; (b) 2ssen.Lial equipment. Probable duration of assistance. Until the end of 1960.

Work done during the year. In pursuance of the main object of the projeot-the reorganization of records and reports -the statis- tician and his national counterpart travelled extensively through- out Ceylon and held discussions with medioal and paramedical personnel. A systematic study of all forms is in progress with a SEA/RC~~/~ Page 75

view to eliminating some unnecessary or obsolete forms and improving others. A memorandum was prepared on the charts and diagrams customarily maintained in the offices of Medical Officers of Health and agreement reached on their revision.

In co-operation with the obstetricians on the Committee of the Maternity and Child 'ifelfare Services, an improved statistical report form has been designed for the routine investigation of all maternal deaths. A preliminary draft of the Maternal Death Report has been mimeographed and is being given a trial in selected hospitals.

At the request of the Director of Health Services, the project staff spent some time in reorganizing the collection and presentation of material for the annual Administrative Report.

The statistician oollaborated with the Registrar-General and his staff with a view to improving mortality statistics. Studies were made of lay statements of oause of death and the functions of Medical Registrars. Advice was given on extending the use of the form of International Medical Certificate and on upgrading the coding of causes of death. I

An analysis was made of dental examinations of school- ohildren at the Dental Training School, Maharagama, and assist- ance given in the preparations for the proposed island-wide dental survey, inoluding advioe on documentation and sample design, and analysis of the pilot survey. Statistical super vision of the Xurunegala Health Assessment Survey continues.

The statistician gave lectures to fourth-year medical students on the design of medical records for statistical purposes and their analysis. He also delivered another lecture on international medical certificatmto students for the Diploma in Tropical Medicine and Hygiene.

He and his national counterpart have taken an active part in the work of the technical sub-committees of the National Committee on Vital and :ieslth Statistics, including preparations for the forthcoming Regional nealth Statistics Seminar.

Ceylon 46 Public Health Legislation (Feb. - April 1958) TA

Aim of the pro.ject. To consider the problem of preparing ccn- solidated legislation; to formulate proposals for amendments or additions to existing enactments; to consider the administrative organization required for a long-term review of health legislation.

Assistance provided by WHO during the year. A medical consult- ant and a legal draftsman for about two months. SEA/RC~~/~ Page 76

Work done. A broad survey was made of the organization of the health services in Ceylon and their operation in the field. Existing hoalth legislation was studied,together with its actual application in practice. A report has been submitted to the Government, togethor with a draft act with notes on clauses and tables.

Ceylon 50 Fellowships R

Leprosy (~aboratory~echniqueelc One three-month fellowship for study in India.

Ceylon 51 Fellowships TA

Psychiatric Nursing: Two fellowships,each of twelve mcnths,for study in India.

Nursingr One twelve-month fellowship for study in the United States of America. 4. INDIA

Project No. Source of mde -Title Co-operating Agencies

India 2 Maternal and Child Health Department, All-India T A Institute of Hygiene and Public Health, Caloutts UNICEF > dim of the projeot. To develop the Maternal and Child Welfare Section of the All-India Institute of Hygiene Bnd Public Health into a full'Department of M~ternaland Child Health, which will provide training for students from India and other Asian countries,

Assistance provided by WHO during the yea. A health educator (see India 118) . Work done, The maternal and child health aspects of this project were completed in early 1957, and an account of the work done was described in detail in last year's Annual Report. Of the team originally assigned to the project, the health educator only re- mained during the period under review. The work done during the year is reported under project India 118, to which the health educator was transferred in January 1958.

India 31 Plague Control, Dehra Dun, Uttm Predesh R '(Ju~~1952 - Jsn. 1957; April 1957; Nov, 7957) (~nstitutePasteur, Teheran)

Aim of the project. To carry out research on the epidemiological fa-tdrs causing recwrent outbreaks of plague in Northern India and to plan control measures.

Assistance provided by WEIO during the year. A short-term consult- mt*

Work done. The work done from the beginning of WHO'S assistance to the project in 1952 was described in detail in the last Annual Repc?t.

In April and ag~inin November 1957 the project was visited by a short-term consultant, who reviewed the work of the national team. He suggested that,, besides investigating all plague out- breaks in Uttar Prsdesh, the national team should continue survey work in the Northwestern districts with a view to deteoting plague foc: in areas where no human plague or rat mortality has been no?ioed for many years. SEA/RCI 1/2 I Page 78

The final report on the project, which includes a recommenda- tion for action to eradicate the reservoir of infection in field rodents, has been submitted to the Government.

India 38 Nursing, Ludhiana (~une1954 - June 1956; TA Jan. - Dec. 1957) Aim of the project. To survey the training facilities for nurses and midwives in Ludhiana and selected villsnes:-, to adaut end ex- pand training programmes to meet the nursing needs of the oommunity.

Assiatente provided by WHO during the year. A publio-health nurse educator 4

Work done. During th+ operation of the project oonsiderable improvement in the nursing training programme was brought about, and Teoommendations were made for further expahsion. The syllabus of the Indian Nursing Council was adopted by the School of Nursing at the Christian Medical Collegog the educational requirements for admission were raised to full m~triculation~the Preliminary Train- ing School period was extended from two to three months, and "public health" was introduced by claesroom teaching and field practice. Ward teaching for half a day each week was included in the Preli- inary Training School period.

Public health field practice in villages was introduced for student nurses in their second and third yew of training, d experience in domiciliazy midwifery was arranged for fourth-year students.

A procedure committee was formed, and a procedure book intro- duoedj techniques .t@ughf in the classroom were brought into line with those used on the wards.

Help was given in organizing a domiciliary midwifery service, which enabled all students - medical, nursing, health visitor and auxiliary nurse-midwife - to gain experience in domiciliary mid- wifery and the nursing of parturient women.

Assistance was given in developing services in three village health centres, but frequent changes of staff prevented satisfao- tory development of this programme.

The WHO nurse completed her assignment in December ,1957, and a capable and enthusiastic national publio health nurse took over the public health aspects of the training programme.

Tuberculosis Control and Training Centro, Nagpur (Nov. 1955 - ) Aim of the project. To establish a model tuberculosis service particularly to do preventive work; to train personnel in modern methods of diagnosis and control, including domiciliary ohemo- therapy; to carry out epidemiological surveys. sEA/~c11/2 Page 79

8.(a) A medicd officer, a laboratory technician, an x-ray technician and a public health nurse3 (b) A twelve-month international fellowship; (c) Transport vehicle, supplies and equipment.

Probable duration of assistance. Up to the end of 1959.

Worlt done during the ye-. It is regrettable that although the W30 team has bcen in position from January 1957 it has taken six months to reach a point where full operation of the Centre can be de- veloped. This long delay has been due to tho shortage of national staff and to the time taken to carry out simple structural altera- tions end installation of essential services in the buildings of the Centre. There were also s depletion of the WHO staff due to illness, which necessitated the finding of repl~cements, and some delay in delivering and installing x-roy equipment.

In the meantime it has been possible to train n number of home visitors and some 1~borat0~ystaff.

India 43 Tuberculoai~Control -d Trdning TA Centre, Hyderabed (Dec. 1956 - ) Aim of the project. (a) To trein doctors, home visitors and techni- cians in diagnosis md control of tuberculosis for the district centres in the Strte, the methods of control being based on domicil- iary chemotherapy and home hygiene; (b) to assist national personnel in xiopting these methods of control to the conditions obtaining in the project area and in evolving new ones which may be especially suitable to these conditions.

( a) A medical officer, ). ). a public health nurse and a laboratory technician; (b) Transport vehicle, supplies and equipment.

Probable duration of assistance. Until the end of March 1960.

Work done during the year. The medical officer and the public health nurse took up their assignments at the end of March 1358; they were joined a little later by the laboratory technician. A full team of national counterparts and satisfactory temporary prep ises have been provided by the State Government. WHO'S advice on the planning of a permanent centre has been sought by the State Government.

Six sub-centres already in operation provide a good frame- work for a domiciliary service, and the training of home-visitors is going ahead. A laboratory is being set up,and temporary radio- logical arrangements have been made pending the arrival of the proper x-ray equipment',which is being provided by the Government. SEB/RC11/ I Page 80

India 53 and 102 Tuberculosis Chemotherapy Centre, Mwlras R {~eo.1955 - ) TA ' , (British Medics1 ...... Re.search Council and Indian Council of Medical ~esearch)

Aim of the project. (a) To determine what proportion of infective cases living in crowded urban areas can be rendered non-infective by treatment with drizgs suitable for self-administration at homes b to determim how long these patients can be kept non-infective; 13.t'o compare the results of drug treatment of domiciliary patients with those of treatment of hospital patients; (d) later to study the effects in the community of wide-spre'ad chemotherapy on ambulant patients; (e) to provide facilities for training in research, . techniques. P

Assist&ce provided ky WHO durine; the year. (a) A senior medical officer, an assistant medical officer, a bacteriolodst, a labora- tory technician, an x-ray technician,'two public heslth.nurses and an administrative officer. and an administrative ossi~tantj(b)-~ trfelve-mbnth ihternational fellomship; (c) Supplies and equipment.

Probable duration' of assistance. For ihree to five more years.

Work dons during the year. The initial study started in September 1956 to compare the resuits of the same drug treatment ct home end in hospital, has been continued. After a year of treatment those with quiescent disease are being studied in the second year with respect to the incidence of relapse and the value of more prolonged chemo- therapy in preventing it. Lnformation has been oollected regeMing the diet and socio-economic status of these patients.

A further comparative study of different regimes of domiciliary chemotherapy was started in October 1957; by the end of May 1958, out of an estimated total intake of 360 patibnts, 184 had been admitted to this study. .

Household contacts of all patients have been followed closely to detect any differences in the infection and morbidity rates between contacts of home and hospital patients in the first study, and contacts of patients on different &rug Psgimss in the second. Contacts having, or developing, tuberoulosis are being treated, and thsir'bacteriology is being carefully investigated.

The domiciliary health visiting and social welfare services have expanded; 426 families were under observation at the end of May 1958. Clinic attendances have reached over 3,QOO par month.

By Nay 1958 routine diagnostic work in the laboratory had increased to a level of 2,476 smear, 1,542 culture and 425 drug sensitivity examinations per month. Original research includes studies of isoniazid metabolism, identification and estimation of isoniaeid in urine and in vitro identification tests for tubercle bacilli. Guinea-pig virulencs tests have been started to investi- gate isoniazid resistant organisms and to compare sensitive pre- treatment strains of Indian bacilli with strains from other coun:ries, SEA/RO~~/~ Page 81

The national laboratory staff and a visiting baoteriologist and laboratory technician, have reoeived training in speoialized teohniques. Training courses have also been held for health visitors, publio health nurses and radiographers.

Maternal and Child ~ealth/~ursin, We~tBen~al*(Nov. 1954 - Jan* 1f553 June '- Deo. 1957)

Aim of the projeot, To strengthen the public health services in the Stat0 and to assist with the training of nursing end midwifery personnel.

Aesistanoe provided by WHO during the year. A public heblth nurse.

Work done. The public health nurse completed and presented to the State Government detailed proposals for the integration of public health into the basic nurse training course at the Medioel Colloge Hospitrl, Calcutta. In order to improve the available public health practice field for student nurses, a maternal and child health advisory centre with a follow-up home-visiting servloe was oshblished and developed nithin the ourtilagr_of the hospital. Some in-servbe training was oonduoted for the semior nursing staff of thi~and the Dufferin Hospital, but prossure of the servfae needs at both these hospitals proeluded suetained mrk except for sporadic periods.

India 56** Maternal end Child ~ealth/Nursin~,Bib+ R XNov. 1954 - Deo. 19571 UNICEF (Colombo plan)

dim of the psojeot. To develop the maternal and child health services of the State; to train nursing personnel.

Assistanoe provided by WHO during the year. A maternal and ohild health officer, two public health nurses, one midwife tutor (one nursing arts instmotor was provided under the Colombo plan).

Work done. bet of tho activities were oohaentrated on the training of ~WS~UBpersonnel. The entire nursing curriculum of the Patna nursing school was reviewed and re-sdjuatedi public health was eventually integrated into the nuraing curriculum. In the training of midwives, domiciliary midwifery was introduced, and it is now an integral pat of the currioulum. RBfresher courses for midwives were organized, ad it was observed that, following this, fewer obstetrical oases were admitted to the hospitals as emergencies.

* In January 1958 this project was redefined as a Publio Health Programme for West Bengal under a separate project number (oee India 144). *+ In January 1958 this project was redefined as a Publio Bedth Programme for Bihar under s separate project number (see India 145). ~E4/~~11/2 Page 82

The midwife school in Gaya was converted into a school for auxiliary nurse-midwives, and three additional schools for awdl- iary nurse-midwives were opened.

The Dharbanga Medical College School of Nursing was extended

and upgraded,- - ...... -...... - . Two mate&& and child health: centres-in.. Patna, one in chi and one in Dharbanga, were upgraded. A nm centre was established in Bethiah, where two rural health centres for the training of health visitors were slso set up, Since 19.54, sixty maternal and Child he'dth centres have been established, making .s total'of ninety-three such centres in the State. Not all centres arethow- ever,fully staffed. The WHO maternal end child health officer ... visited sixty-nine of th~esecentres and offered advice ad.... suggest- ions for their improvement.

Twenty-eight teaching centres have been establiabed,with a target of training one thousand dais...... Assistance'to health schools was not included %n the plan of operations, bui the international personnel have contributed to the upgrading of two schools in Patna and Ranchi......

India 57 Maternal and Child ~ealth/~ursin&, R Uttar Pradosh (Feb. 1955 - ) UNICEF , ...... --...... Bim of the project. *o,develop the maternal and child health services of the Xate; to train nursing personnel; to establish a paediatric training hospital at the Medical College, Lucknow.

Assistance provided by WHO during the year. A paediatrician end a paediat-ic .nupee.

Probable duration qf assistance. Until the end of 1958.

Work done during the pear, The only asaiatance provided durihg the year was to the Children's Hospital, Lucknow.

Preventive as-psts of child care were introduced intbthe curriculum cfmedic'&l students and student.nurses, aswell a8 into the daily routine'of the hospital. Ward routiws.have impmved considersbly. A foundation was laid.for a separateindependent Paediatric Department......

It'did not prove wssible to i%ka ove,eg $ape., prts 0P the children' e.'hospital building, which are at, pre8en.t in the custody of the Department of Medicine. Nor was it possible for the.. paediatricians to utilize the various ttwgioslV.beds installed in the rooms of thePaediatri0 Department but at pnesent in the hanib of other specialists. . . -. SEB/RC~~/~ Page 83

India 62 Maternal and Child ~ealth/~ursing,Kerala R tFeb. 1955 - March 1958) UNICEF

Aim of the project. To develop the maternal and child health services of the fiate; to train nursing personnel; to establish a rural health teaching oentre for the Medical College, Trivandrum.

Assistance provided by WHO during the year. A publio health nurse and a midwife tutor. An additional publio health nurse (health educator) was provided by the Colombo Plan.

Work done. In Trivandrum a model midwifery school has been devel- oped at the S.A.T. Hospital. Four additional midwifery schools, for which the tutors were trained locally by the midwifery tutor, were also established in the State.

The Schools of Nursing at Trivandrwn and Ernakulum were up .graded. A Health Visitors Sohool was establiahed in Trivandrum, end training of auxiliary nurse-midwives was initiated in seven district hospitals.

A Medical College Rural Health Unit was established in Trivandrum to serve undergraduate medical students as a treining field in preventive and social medicine.

Four primary health centres in the State have been upgraded for the training and orientation of various types of health personnel.

All the international personnel who had been serving on this project have completed their assignments, and the project has now been redefined as a public health programme for Kerala State under projeot number "India 147". Work on the new project will commence when the staff to be provided by WHO has been recruited.

India 63 Post-Graduate Course for Midwife Tutors, R College of Nursing, New Delhi (Feb. 1956 - Ma!! 1958) Aim of the project. To develcp a post-graduate course for train- ing midwife tutors.

Assistance provided by WHO during the year. (a) A pidwife tutor; ) Some essential supplies and equipment.

Work done. During the second year of this .project, a seoond course of training for midwife tutors was conducted by the WHO tutor and her counterpart. Eight out of ten students suocess- fully completed the final examinations and were awarded diplomas by the College of Nursing, New Delhi. sEA/~Gll/2 Page 84

This second course followed the recommendations of the Indian Nursing Council.for co-ordinating the three post-certifioate courses of the College of Nursing given to students studying nurs- ing administration, general nurse tutoring and midwifery tutoring. While some lectures were taken in common, all practical work and practice teaching were geared to midwifery. Stress was laid on actual practice in midwifery in clinical work and in classroom . teaching.

The experience gained during the course of this project has proved the need for post-certificate teaching courses for midwifery tutors,whioh shoutd include further practice of both institutional and domiciliary midwifery.

The midwife tutor completed her assignment in Hay 1956. In her report she has made certain recommendations regarding the length, content and the p~acticefields for future training courses. A post-graduate course for midwife tutors, based on the pattern and recommendations made in the report, will be incorporated in the regular teaching activities of the College of Nursing.

India 71 Assistance to the All-India Institute of R Mental Health, Ban~alore(March 1955 - ) Aim of the project. To establish at the All-India Institute of Mental Health, Bangalorer (a) a pcst-graduate training programme in psychiatry and psychiatric nursing, and (b) a programme of research in psychiatry, neurology and neuro-surgery; to train national counterparts to take over from them0 perponnel.

Assistance provided by WHO during the year. (a) A neuro-psychia- trist, a neurologist and two psychiatric nurses; (b) Essential supplies.

Probable duration of assistann. Until tbc? cnci of ?960, at least.

Work done during the yea:. Emphasis was placed on systematic teach- ing with courses of lectures in neuroanatomy, neurophysiology and neurology,and demonstrations in neuroLogy, psychiatry and electro- enoephalography. A programme of research items was initiated, mainly with a view to increasing student insight into scientific methods of approach.

A national counterpart for the neuro-psychiatrist was appointed. Reorganization of the neurology department was under taken, and a new out-patient de?artment for neurclogicd cqses Was opened. Equipment for a department of neuro-radiology was obtain- ed and installed. The neuro-pr:'chiaCrlst undertook direct aupez- vision of the insulin coma unlt and training in this form Of treatment. He introduced the use of electro-convulsion therapy with muscle relaxants and ane.esthesia. The neurologist arrived in February 1958. He took part in the clinical teaohing of neurology and electroencephalography, and organized classes in neuroanatomy. A national neuro-surgeon was appointed in March 1958 The pass rate for parts I and I11 of the examination was commendably high. In January 1958, twelve doctors entered for the D.P.M. course and ten students for the 3.X.F. course.

The psychiatric nurses reorganized the medical stores, distri- bution of linen and laundry arrangements. A dick ward was establi- shed, which proved invaluable for in-service training of nurses. The project was left without nursing counterparts in April, but the appointment of two was being arranged.

Out of 19 candidates for the examination for the Certificate in Psychiatric Nursing, 15 passed, 3 with distinction.

Tnanty nursing students from India and-? f?onCeylon entered - training at the beginning of 1952. -...I tr-.nts vcrd nclected from ovor 60 applications.

The Mysore State Government has sa?ctioned a monthly allowance - of Rs. 20/- to all nurses working in the State who are holders of the Certificate in Psychiatric Nursing.

India 73 Domiciliary Nursing and Midwifery, Lady T Hardinge Medical Ccllege Bospital, New Delhi \July 1956 - Dec. 1957) Aim of the project. To provide, in association wit4 the Lady Hardinne Medical Collene Hospital,. training- in domicilimy nursing end midwifery services;

Assistance provided by WHO during the year.. (a) A domiciliary mid- wife tutor, (b) A twelve-month international fellowship.

Work done. During the course of the project an adrcinistrative and working unit was established within the hospital, and regular ante- natal clinics were held. Midwives were given an opportunity to exercise the full range of their responsibilities, including health teaching and case finding. New methods of procedure, channels of communication and ways of keeping records were determined, and the scope and responsibilities of both the midwife and the interns of the hospital were defined. Three hospital nurses, fifteen student nurse-midwives and fifteen health visitor students spent some time participating in the activities of the unit. The midwifery tutor took an active part in the classroom and clinical teaching pro- gramme for student midwives. Notes for the practising midwife, which formed the basis for discussion and teaching within the unit, have been compiled and are being printed by the Organization.

The follow-up home nursing service which was started during the first year of the project was continued and expanded to include the teaching of ante-natal and infant care in the homes.

A home delivery service was developed, in which 64 women Were delivered by the midwifery staff and student midwives. Towwds the end of the project it was evident that the patients receiving SEB/RC~~/Z Page 86

domicilicry nursing and midwifery care were most appreciative of this service and were beginning to rely' upon it hore.arid more. Difficulties were encountered when medical a~sik%ancbwas +&ired in emergencies, and this limited the expansion' of the progrhe.

The midwifery tutor left the project in December 1957. Her final report has been presented to the Government.

Maternal and Child ~ealth/~ursin w* Education, Mysore*(Oct. 1956 - D:c. 1957) UNICEF

Aim of the project. To improve the preventive and curative ser- vices, particularly the maternal and child health services, of primary and secondary health un'its throughout the State; to provide training in maternal and child health in the cities of Bangalore and Mysore; to establish three district diagnostic laboratories; to train all categories of health personnel for work in rural areas at the health training centre at Ramanagaram; to expand health education programmes and training programmes for doctors, midwives, nurses and health inspectors.

Assistance provided by WHO during the year, (a) A maternal and child health officex and a public health nurse; (b) A twelve-month international fellowship.

Work done. The public health nurse completed a survey- on training facilities of all categories of nursing personnel and submitted a report with her recommendations. She drew up the syllabus for the auxiliary-nurse-midwives and asslsted the nurse tutor at the Victoria Hospital, Bangalore, in the implementation of the suggee- ted teaching procedures. A refresher course for 20 midwives of the Bangalore Corporation was organized. Memoranda on the integra- tion of public health into basic nursing and dais tfaining and the introduction of a Nurses Act for Mysore State were prepaped and submitted to the State Government.

The maternal and child health officer completed a survey of the maternal and child health services inthe State. The administra- tion of the Vani Vilas Hospitai for Children in Bangalorewas reorganized, and the' staff upgraded. ' . . A maternal and child health field study was arranged for thirty students of the Mysore Medical College. Maternal and child health seminars for probationers and symposia on maternal and child health for visiting medical students have become a regular feature of the activities of the project.

* In January 1958, this projeot was redefined as a public health programme for Mysore State under a separate project number (see India 148) . SEA/RC~~/~ Page 87

India 77 Public-Health Engineering, Universitx 7 of Madras (Aug. 1955 - ) Aim of the project. To eotablish a Department of Public-Health Engineering at the University of Madras and to organize post- graduate courses and field training in public-health engineering at the University; to train a national counterpart to take over from the WHO professor.

Assistance provided by WHO during the year. (a) A professor of public health engineering1 (b) A twelve-month international fellow- ship.

Probable duration of assistance. Until the end of 1961.

Work done during the year. The third post-graduate course in pub- lic health engineering was started in July 1957 with 15 students. The students of the second course completed their research theses in December, thus fulfilling all the requirements preliminary to their qualification. In addition, a three-month course for engineers and engineering subordinates has also been conducted.

Two teaching posts have not yet been filled by the Government. The counterpart of the visiting professor is undergoing advanced training in the USA on a 1#HO fellowship nnd is olpooted to resume his duties in September 1958.

The construction of the new lecture and drawing halls, as also of the laboratory, is almost complete. Construction of a water treatment demonstration plant was started in November 1957, but work on the sewage treatment demonstration plant has not yet been started.

The Government of Madras has decided to give a higher salary grade to graduates in public health engineering as Qornpared to holders of only the B.E. degree. This, along with the decision of the Central Government to award stipends for the post-graduate course, is expected to stimulate greater interest in the course.

India 78 Maternal and Child ~ealth/Nursing, Nagpur R t~ay1955 - Nov. 1957) UNICEF

Aim of the project. To develop integrated rural health services, particularly maternal and child health services! to improve the teaohing of paediatrics at the Nagpur.Eedica1 College; to estab- lish a rural health teaching unit for the College.

Assistanoe provided by WHO during the year. A domiciliary tutor.

Work done. The work under this project was conoentrated on the city of Nagpur. The programme consisted of two partsr (I) child health services and teaching,and (2) nursing education. SEA/RC~~/Z Page. 88

An extensive reorganization of the wards, aiming at safer care of the children and better general service, was carried out. Six new isolation rooms were procured, and following this a rarer occurrence of cross-infebtions was observed. The general hygiene was revised; UNICEF equipment was brought into use, and new forms of temperature charts and bed records, as well as modern methods of medical investigation and treatment, were introduce&. me staff was considerably expanded.

A new Premature Unit was establishsd and connected, with the Paediatric Department. Results are already evident in the consid- erably decreased mortality in the premature category.

The Out-Patient Department was enlarged and moved to new premises, and the services were improved.

A training centre for spastic children was establishod.

BCO vaccination was introduced and is carried out by doctors from Paediatric Department. It is offered to every new-born child in the hospital, 92.9% of the new-born thus being vaccinated.

New-born children are now regularly checked up, and regular supervision of children in the other departments of the hospital is carried out once a week by doctors from the Paediatric Depart- ment.

A comprehensive threemonth course in paediatrics for under- graduates of the fourth year, a onemonth course in paediatrios for undergraduates of the fifth year, a fivewok COU3?8e on children's care and on the basic knowledge of children's diseaeos for nurses (to be repeated every year) and the teaching of auxiliary nurse-midwives and student midwives have been organized and carried out.

Some research work, notably on dirth-weight and morbidity in children, was done, and more is planned.

At the hospital, a new maternal and child health centre has been established for teaching purposes, and smallpox vaccination introduced as a routine.

'Ihe nursing education part of the programme has been less successful, perhaps p&rtly because of the'absencn of a nursing adviser at state level. !he Mayo Hospital took some advantage of the assistance offered by WHO nurses.

India 79* Maternal and Child ~ealth/~ursinu,Bombap TA (AU~.1955 - Dec. 1957) UNICEF Aim of the ~rcject. To develop integrated meal health services, partihlarly maternal and child health services; to improve the

*In January 1958 the project was redefined as a public health pro- amme for Bombay State under a separate project number see India 150). SEA/RC~~/Z Page 89

teaching of paediatrics at the Poona Medical College; to establish a rural health training unit for the College.

, Assietance provided by WHO during the year. (a) Three public health nurse educators; (b) A twelve-month international fellowship.

Work done. A post of an Assistant Director for Maternal ad Child Health has been established a0 part of the government commitments under the plan of operations. A total of 78 primary health centres and 50 maternal end child health centres were established by the end of 1957.

The rural public-health orientation programmes at Poons and Sirur (42 miles from ~oona)were continued as planned. The Public Health Training Unit at Sirur, wee extended and upgraded. Faoil- ities for further training of the various categories of health personnel were established in Poona ih connection with the Medical College.

Environmental Sanitation, Uttar Pradesh I~arch1958 - ) Aim of the project. To set up a pilot project in a rural area for improvin~water supplies and excreta disposal: to plan and Carry Out a sanitation pr~gramme, inoluding the design, operation and- maintenance of simple, practical and cheap sanitary installations~ to Organise a programme of health ed;uoation; to train technicians, ssnitarians and other personnel.

Assistance provided by WBO during the year. (a) A sanitary engineer and .k sanitarian; (b) A transport vehiole. 'Probable duration of assistance. Until the end of 1961.

Work done during the year. Before taking up hie duties, in March %58, the sanitarian spent some time in the Environmental Sanita- tion Project, Kerala (India 95) in order to get first-hand experience with regard to local conditions.

The sanitary engineer assumed his duties in May 1958. Prepar- tory work has already started, and a work mite for the project has been selected at Chinhat, near Lucknow.

Health Education i~inistryof Health'in' , co-operation with Ministry of ducati ion) tho. 1957 - ) Aim of the project. T; develop training activities ad experi- mental currioula relating to health education in one or more teacher training institutions in Delhi.

~esistanceprovided by WHO durbg the ybu. A twelve-month international fellowship. sEA/Fic11/2 Page 90

probable duration of assistance. Until theend'of: 1960. ' ,

Work done during the year. A health educator has been selected for assignment to this project, and is expected to arrive shortly.

Maternal and Child ~ealth/~ublic-~ealth Training, Saurashtra (March 1956 - Feb. 1958)

Aim of the project. To extend public-health 'services in rural areas, particularly maternal and child health services, by means of primary and secondary health units; to improve and increase the services given by maternal and child health centres in urban areas5 to improve the standard of training of nprses, midwives, auxiliary nurse-midwives and dais.

Assistance provided by WHO during the year. (a) A maternal and child health officer and a public health nurse; (b) A ten-month international.. fellowship. Work done. This project may be viewed as the beginning of a re- orientation from exclusive concentration on maternal and child health to a broader concept of integrated health-services with emphasis on rural areas. This is expressed in the unique develop ment of primacy health centres and subcentres, which, is by far the most successful in India.

When the plan of operations was drawn up, here were only six primary health centres. Twelve more were established in 1956 and six more by the end of 1957, bringfng the total to twenty-four.

In the beginning it was thought that it might not be possible to establish more then two sub-centres for a primary health centre, but ~.ctuallythree subcentres for each cf the primary health centres (in some areas even more) were established.

By the end of 1957, a total of 120 auk-centres had been set up. Each sub-centre is staffed by one qualified midwife and one trained dai.

It was possible to establish only one of the five secondary health centres probably because of the change in policy of the Central Government, which did not allocate funds for the establishment of secondary centres during the period of the Second Five-Year Plari. The four maternity hospitals - in Rajkot, Bharmagar, Junagadh and Jamnegar - with a total capacity af fewer than 200 beds, were expanded to provide 100 beds in each hospital.

Before the project started there was one paediatric unit of 20 beds in Bhavnegar. This was converted into a separate hospital with 40 beds; a new children's hospital was built in Rajkot and a 2C-bed paediatric department establbhed in Junagadh. The two SEA/RC~~/~ Page 91

nursing schools in Saurashtra had a total capacity of 100 students; this number was increased to 120. Three schools for auxiliary nurse-midwives with thirty students each were also established.

In 1957 a health visitors1 school with 50 students was opened in Rajkot.

India 90 Vital end Health Statistics, Nagpur T A X~arch1956 - )

Aim of the project. To establish in an urban area a demonstration and training unit, which will serve as a model health statistical service; to train personnel in health statistics.

Assistance provided by WHO during the year. (a) A health statis* ician; (b) Supplies and equipment.

Probable duration of assistance. Until the end of 1960.

Work done during the year. The statistician left the project early in December 1957 on the expiry of hi's contract. His final report has been submiited to the GovLrnment. A replacement has been selected and is expected to be in posltion by the em3 of August 1958. In the meantime, the project has been ~~ithou~regular international assistance, but the WHO statistician in Ceylon was assigned for two weeks' duty, and the Regional Adviser has visited the project several times to assist the staff.

A national counterpart has been appointed,and the Senior Statistician of the Bombay State Government has acted as temporary state counterpart,but a permanent state counterpart is awaited.

'Beginning from 22 July 1957, three eight-week training courses for statistical assistants have been given, attended by 24 students from eight states and from Delhi. The response of the students was excellent, and there is good reason to think that those trained will be able to perform their duties more efficiently as a result. With the agreement of the Government, the training programme has been suspended for a few months to enable the needs of the states to be ascertained more accurately end specialized types of courses planned to fit them.

The new notification'forms introduced by the project are now in use for the reporting of all vital events in Nagpur. Good co- operation has been obtained from hospitals and institutions (particularly from the Nagpur Medical ColIege ~ospitel)in the completion of the Internation~lMedical Certificate, but, as is to be expected, tho doctors noed more help to enable them to complete the forms correctly. The load of work involved in the training courses has delayed the orderly and rapid processing of the new forms, including the dispensary reports, It is hoped to remedy this in the next few months, so as to get the full value out of the new materials for demonstration and training pnposes, and to provide an adequate intelligence service for the Nagpur Corporation. SEB/~c11/2 Page 92

India 97 Professors of Preventive wd Social Medicine TA T~eb.1956 - Aim of the project. To develop the Departments of Preventive and Social Medicine in four selected medical colleges, integrating preventive medioine into the general curriculum and developing courses of instruction in preventive and social medicine for undelc graduates; to establish centres for practical training; to give special training to seleoted students to prepare them for teffihing and research; to train national counterparts to take over from the WHO professors.

Assistance provided by WHO during the year. (a) A professor of preventive and social medicine for the Nsgpur Medioal College up to December 1957; (b) Four two-year international fellowships.

Probable duration of assistance. Until the end of 1960.

Work done during the yoar. The visiting professor of preventive and soci;l medicine completed his assignment at the Nagpur Medical College in December 1957. His final report shows that this aspect of the prcject was very successful. The Department was soundly established and staffed; a curriculum of preventive and social medicine spread over four years of the medical course was accepted and ic operating; field practice work was developed; thoee field research projects were undertaken by the Department in ccllabora- tion with other departments; a public health museum was developed, and experience was given to a suitable counterpart. The WHO professor mde visits to two other medical colleges in Bombay Stcte for consultaticns and discussions. The future head of the Department of Preventive and Social Medicine at Negpur is at present on a two-year WHO fellowship at the Harvard School of Public Health and will return to his post in September 1958.

The project as a whole has been hampered by the lack of suit- able visiting professors, and recruitment is in hand for filling four vacant posts. As part of this project seven fellows are undergoing training at present at Harvard to fill future posts as hede of departments of preventive and social medicine in India.

India 92* Public ~ealth/~ursingEducation, Andhra* R TNov. 1956 - Dec. 1957) UNICEF

Aim of the prcject. To improve the existing public-health serv- ices, particularly maternal and child health services, in rural areas$ to expand them throughout the State and co-ordinate them with community development projects and national extension echernes; to improve and increase training facilities for all categories of health personnel.

* In January 1958 this project was redefined as a public health programme for Bndhra Pradesh under a aeparate project number (see India 151). The paediatric aspect was continued as a separate entity under another project number, India 143. sEA/~011/2 Page 93

Assistance provided by WHO during the year, A paediatrician, a paediatric nurse, a public health nurse, a public health nurse- midwife,end a midwife tutor. A public henlth officer joined the tern early in November.

Work done. Four municipal maternal and child health centres in Visakhapa$nam are being used for the training of nursing personnel end undergraduate medical students. Midwifery students stay in these centres for fixed periods and gain good experience in domiciliary midwifery.

Undergraduate teaching in paedistrice has been organized on the following basis*

(I) In the preclinical period, basic concepts of child henlth and .dsvelopment are taught, along with ~natomyand physiology.

(2) Third-year students are posted to both in- ad out-patient paediatric departments a whole morning once a week over a two-and-&-half month. . period.

(3) Final-year students are posted for a full monthls clerkship in paediatric wards. During this period, they receive twelve didactic lectures.

Paediatrio nursing is now taught in each of the three years of the nursing course.

The nursing team ~ssistedin expanding nurse and midwifery training programmes and in upgrading public health services to provide an improved public health prectice field. The curriculum of the general nuree training school at Visakhapatnam has been revised so as to integrate theoretical end practical teaching of public health end the social aspects of disease into the basic nurse training. Improvements h~vebeen mde in the environmental conditions of the living quarters of nurses end of health visitors, and in the physical examinations given to nurses.

Public health activities and teaching have been expanded at the Simchalum Rural Health Unit.

India 93* Rural ~ealth/~ursin~Education, Assam* R TOct. 1956 - Deo. 1957) UNICEF

Aim of the project. To develop integrated rurd health services, Particularly maternal end child health services; to establish 8 rural health unit for training various categoribs of health perS0nnel such as senitarians end nurses.

Aesistance provided by WHO.during the year. (a) Two public health nurses and a sanitarian, 1%) A twelve-month international fellow- ship.

*In January 1958 this project was redefined as a blic health programme for Assem under a separate project number P"see India 1~). . .. . Work done. .During the first .stage,of this project_ &l.:the activ- 'ities were concentrated on th6 building up.of the Ptiblic Health Training Centre inchabua, attached to the Dibhgeh Medical College. The local staff was augmented, and domiciliary nursing and midwifery services were developed.

The ViBO nurses also helped in establishing the first well- 6aby clinic in Dibrugarh;

India 94 Health Education, Singur TA ID'w. 1956 - ) (Ford Foundation)

Aim of the project. To develop field programmes in health educa- tion procedures for wblic health and other personnel at the Singur Health Centre and at the All-India Institute of Hygiene and Public Health,- Calcutta.

Assistance provided by WEIO during the Bar. (a) A health educator; (b) A twelve-month. interna.tional f~llcwship;(c) Supplies and equipment. Probable duration of assistance, Until the end of 1958. - Work done during the year. Intensive in-service training of the staff was continbed throughout the year. Progpees has been made in developing field training; Principles of heaith education are applied in the approach, methods and procedures of obtaining the oo-operation - of people. Teachlng'was oarried out for many groups of students represent- ing varlou's' 6atkgories of public health workerstdiffering greatly

..in , background",' expekience, training and length Of stay at Singur. Throughout tiie year, some teaching was done at the All-India Insti- tute of Hygiene and Public.Recilth. ': '''..' In th'e Research-cueAction project, intensive health education activities relating to sanitation have been started in two selected villages; in he, the emphasis will be on mass media as a point of departure,and in the other,on community arganizaticn in studylng common problems and ways to solve them.

India 95 Environmental Sanihation, Kerala TA TNov. 1956 - )

Aipl of 'the project. To set up ;: pilot project ,in_.arural area for imp2oving water eupplies and excrete, disposs;l; to'p1.m end carry out a sanitation programme, including the design, :-operation and maintenance of simple, practicar &nd cheap sanitary installations; to organize a programme of health education; to train technicians, Sanitarians 'and 'other personnel...... Assistance provided by WHO during the year. (a) A sanitary engineer and a sanitarian; (b) A twelve-month international fellowship$ ( C) Supplies and equipment. - Probable duration of assistgnce. Until the end of 1960.

Work done during the year. This project has made substantial promeas. Activities in health education, latrine construction &d-water supplies have been continuouslydeveloped.

In a pre-operational sanitation survey, it was found that only 3.7% of the total number of houses had latrines and 62.93% of the householders had wells, which are mostly unprotected. In the latrine conetruction progremme, a total of about 3,660 slabs have been sold, and 1,886 latrines are now in use. This represents a coverage of 13% of the houses existing in the area. The rate of latrines put in use is now about 10 Bnd that of the slabs cast has reached about 23 per day.

The Trivandrum Corporation has decided to adopt the type of latrine used in the project area to cover the needs of the un- sewered part of the city, and steps have been taken to implement this decision. Also, the Government has recommended the adoption throughout the State of the wrrter seal latrine slab being used In the project.

For water supplies, the construction of deep tube wells, filter point wells and dug wells has been undertaken, but short- ages of technical personnel end other adainistrative difficultiee have not permitted a full development of this activity.

School sanitation activities have also been started, but the limitation of funds h~srestricted the work.

Health education of the public is being promoted but needs to be further intensified in order to obtain the co-operation of all the people concerned, inoluding those who have yet to come round to the idea of having shnitary latrines.

Besides giving lectures on environmental sanitation subject8 to different health worke~sand at public meetings, the project staff has organized training activities for public health personnel.

The project has attracted the interest of many officials and organizations, and many visits have been paid to the siCe.

India 98 Refresher Courses for Nurses, Patne @d R la Delhi I0 July - I4 Syt. i957; 18 Nov. - 14 Dee. 1957; - Aim of the project. To plan and conduct short-term refresher courses for nurses, in corpora tin^- theorehical and practioal in8tluC- tlon adapted to local conditions..

Aeeistance provided by !THO during the yeas. (a) &siatsnce from WHO hureing staff at Patna and New Delhi; (b) Half the cost of travel end-maintenance expenses of 20 ward sisters and 30 nursiq superintendents and matrons. Pmbable duration of assis$ance. To be repeated in 1958, 1959 and 1960.

Work done. The first refresher course was held at Patna from 75014 September 1957 for twenty ward sisters from various parts of India. The WHO nursing personnel of the Maternal and Child ~ealth/~ursingProject , Bihar, (India 56) assisted in conducting the course,

The second course was held at the College of Nursing, New Delhi from I8 November to 14 December 1957 and attended by thirty nursing superintendents and matrons from different parts of India. WHO personnel assigned to projects India 63 and India 73 assisted in conducting the course, and the Colombo Plan nurse working with the project India 56 gave overall guidance.

India 99 Nursing Education (Public Health Integration) TB I~ept,1957 - ) Aim of the project. To integrate training in public health into the basic training of nurses; to provide supervised practical observation and experience for student nurses in three selected undergraduate schools of nursing,

Assistance provlded,by WHO during the year. Three public health nurses; (b) Transport vehicle and supplies and equipment.

Probable duration of assistance. . Until the end of 1962.

Work done during the yeas. One of the three public health nurses provided by WHO under this project took up her assignment st the School of Nursing of the Government General Hospital, Madras, towaris the end of September 1957. The other two nurses, one for the Medical College Hospital School of Nursing, Nagpur,and the other for the Medical College Hospital School of Nursing, Cuttack (~rissa),joined the project in April and May 1938 rc~spootivoly.

At Madras the curriculum of nursing was revised with respect to subjects basic to public health nursing, and plans for further improvements were reviewed. Clinical instruction in the ward was given more emphasis, and the WHO nurse spent some time in the hospital for clinical teaching. Staff education was started in two hospitals in Madras City with the object of clarifying %he purpose of integrating public health into the undergraduate train- ing. The WE0 nurse ass$sted in a state-wide refresher course for staff nurses. An advisory committee organised by the matrons ad senior tutors of the Madras City BospitaJs is now studying the curriculum and exploring the possibilities of extending public health nursing integration to the fourth-year midwifery training.

The other two nurses at Cuttack and Nogpur are studying the training programmes and methods used at the schools and are sur- veying the public health services with 8 view to developing practice fields for student nurses. India 101 Trachoma Pilot Project R X~eb.- M5v- 1956;-. Oct. 1956 - ) UNICEF (1ndi.w Council .. of Medical ~esearch)

Aim of the project. (a) To make a survey of trachoma in parts of Utter Pradesh:r (br., to establish s pilot -project - to study8 (I) the incidence md pattern of trachoma &d the factors favouring trans- mission, ( 2) the minimum effective course of antibiotic treatment and the rate of relapse and reinfection, and (3) the effect of repeated treatment on the epidemiology of associated conjunctivitis and on the clinical picture of trachoma3 (0) to develop a mass control programme.

Assistance provided by WHO during the year. A traohomstologist and a short-term statistical consultant.

Probable duration of assistance. Until and of Maroh 1960.

Work done dminp: the year. In an.opFdomidogSce1 sup~cywvoring 29 villages in the Aligarh District of Uttar Pradeah, 15,157 people in 4,105 households-were examined by doolcto-door visits3 88.5% were found to have clinical signs of traohoma and 22.6% to have active trachoma. As a result of this survey it has been possible to define the epidemiologioal pattern.

A pilot mass treatment campaign wee carried out on 2,443 people in 20 villages, using aureomycin 1% ointment by lood application twice daily on three successive days, repeated seven times at two-weekly intervals for a period of three months. 4. school treatment programme was carried out in 37 rural end 5 urban schools by local application of aureomycin 1% ointleent twice daily for 60 days.

The preliminary snalysis of the results attained in the pilot treatment programme during its first year indicates that there is no appreciable difference in response to treatment bc- twoon tho intermittent and continuous methods. Further trials are needed md are being undertaken in Sitapur District, where 2,400 cases with aativa trachoma have been recorded during the examina- tion of 12,000 people; of these, 1,401 cases were submitted to trea%ment with achromycln 1% oil, 1,002 oases serving as control 08SWB.

National Tuberculosis Progcamme* {Oct. 1956 - Oct. 1957; Nov. 1957 - ) Aim of the project. To establish a national tub~r0ul08iScentre for ~Wea~?hand training and also for planning end directing * This project was originally planned as a nTuberculosis Control ana Training Programme" for one of the Indian states, but later redefined as a national programme for the whole of India. control programmes in all the states, to include BCG vaccination and the opening of tuberculosis oiinics in districts.

Assistance provided by WHO during the year. Two short-term consultants assigned by Headquarters.

Probable duration of assistance. For We,.. . to.. fivo . _ .-mora . years. . -. .. . -:.. .,. .. .-.., , . Work done during the yeas. The fellowship awarded in 1956 was completed in October 1957.

The consultants arrived in November arA assisted the Tuber culosis Adviser to the Govsrnment af. India in drawing up detailed plans for the establishment of the National Tuberculosis Cefitre. These were incorporated in a comprehensive draft plan of operations, which was submitted to the Government in January 1958 for consider- ation. The plan envisages the.swtabl$.Shment, in addi$innk to tuberculosis centres at state and district leve1,of B':national training centre with a co-orclinating unit and field arms, for training supervisory personnel, doctors; home visitors.iund techni- cians, and conourrently carrying on .field studibs'of various types of tuberculosis- controi, which could %e:.u+ed in urban. weas and in connection with *a1 health centres. "~hi~s.plan is still. .. . being studied by the Governqent. . .

India 104 ~sgiistanceto Selected Paediatric and TA 'bbstetric Departments (Aug. 1957 - T..?.. 40EQ1

. ~ Aim of the project. To improve and upgrkde the standard of service 'in different,,paediatric an& Rbstitric departmerits 0f;oiedical . ., schools and hospitals iq India. - Assistance provided by WO (~ouble~ontributionl, Supplies and equipmeqt required for upgrading paediatric and obstetric depart- ments in various medical schools and hospitals in India.

India 108 Health Education, States of Bombay TA Uttsr Pradosb and Bihar (~arah195; - ) Aim of the project, To ,d,ev;eiop tpe health educatidh bureau in the Directorate of Public Eealth and a pilot demonstration and field training area? to teach health education to public health 'personnel and others. .. . . Assistance';p~6of&e~.~b?:~0during the year. (a) A health educator; lb) Transport vehicle, &.zpplies and bquipment.

Probable duration of gssistance. Until tle end of 1960.

Work done during the year. The heal".h educator has arranged let- ture-discussions on methods and techniques of healtlwducation for sanitary inspectors studying at the Vaccination and Public Health Institute, Nepur. He is participating in a village health project of the Department of Preventive Medicine. At the Soenar Health Centre, there are weekly seminars in which members of the s-aff, the headmasters of two local schools, and the professor of social and preventive medicine (tTsgpur Medical college) all take part. Health education problems reported by the staff me discussed at these meetings and suitable solutions suggested. Assistance in the field of health education is also being given to a sanitation projecf of the-Coenar Healhh Centre and do the Tuberculosis Gantrol- 2nd Traiding Centre at Kagpur. I. This project will be extended to two other states.

India 110 Nursin Advisers to States T A T-G3-E*, - ) Aim of the project. To develop end expand nursing education and nursing services in three seiected States; and to cc-ordinate supervisory services in order to ensure uniformly high standards of nursing and midwifery within the health programmes of the States.

Assistance provided by WHO during the :rear. (a) Two twelve-month' international fellowahi?~;(b) A t~rutsportvehicle.

Probable duration of assistance. Until the end of 1960.

Work done during the year. .Only fellowships and equipment were provided this year: the nursing advisers are under recruitment.

India 112 Rehnbilitation Centre, Bombax T A TaF~uno~9 58) UNICEF UNTAA

Aim of the project. To develop a centre for the etudy of physical medicine and medical rehabilitation, providing services and train- ing facilities. .

Assistance provided by WHO during the year. A consultant for six weeks.

WoFk done. The consultant acquainted himself with the actual work- ing of the Rehabilitation Centre and its plans for the future, and held consultations with all parties involved. His report in- cludes recommendation? for contiaucd WHO assistance, subject to certain conditions,

Anatomy~ One twelve-month fellowship for.study in the United Kingdom.

Pharmacolog~sOne twelve-month fellowship for study in the United Kingdom. Biochemistrp One twelve-tnonth fellowship for study in the United Kingdom.

Dental Health: Two six-month fellowships for study in the United States of America.

Malaria Eradication: Three fellowships of three and a half months each .for study in the United States of America and other countries,

Medical Entomoloey: One five-month fellowship for study in the United States of America.

Hospital Physics: One twelve-month fellowship for study in Europe.

India 116 Fellowships TA Paediatricsr Two fellowships - one of twelve months and one of six months - for study in the United States of America. Medical Isotopes: One twelve-month fellowship for study in the United Kingdom.

WaterSupply and Sanitations One twelve-month fellowship for study in the United States of America.

India 117 Malaria Institute of India, Delhi TA TNov. 1957)

Aim of the project. To establish a regular exohange of scientific information between other scientific institutions and the Malaria Institute of India, and to provide for the exchange of soientifio personnel.

Assistance provided by WBO during the year. .A consultant for one month.

Work done. A consultant was provided to the Malaria Institute of India to advise on the genetical aspects of the resistance to insecticides of insects of public health importance. Researoh * activities in malaria control and eradication in which the Insti- tute was already engaged further benefited by this assignment. The recommendations of the consultant are under implementation.

India 118" Health Education - All-India Institute T A of Hygiene and Public Health, Calcutta '(June 1955 - ] Aim of the project. To develop, at the All India Institutg of Rygiene and Public Health, the Health Education Section, which will provide training in health education to students enrolled at the Institute.

-~~~~~ ~ Continuation of the health education aspect of project India 2. * . . 9EA/Rc11/2 Page 101

Assistance provided by WHO during the year. A professor of health education.

Probable duration of assistance. Until the end of 1959.

Work done during the year. Further progress has been made in the development of the Health Education Section of the Institute. by the integration of health education into the various ~ourses~be~~ offered at the Institute. Two three-month (certificate) courses were offered during the year - one in health education for eigh-n students, and the other in health education administration for three. Altogether, since 1956, four short courses in health education for a total of 71 students have been offered by the Institute.

Considerable progress has been made in developing the health education aspects of field training at the Singur and Chetla Health Centre areas for students of the Institute.

A ten-month post-gr.r-duate certificate course in health edu- cation is under consideration, When the Institute starts this course, it will be the only institution in South East Asia that trains specialists in health education.

India 134 Assistance to Vpgradel 3epsrtnent of R Paediatricq, :.!.adras Kedical College UNICEF TYOV.,457 - ) Aim of the project. To expand, upgrade and re-orient the teaching of paediatrics at the 14adras Mec'ical College.

Assistance provided by WHO during the year. A paediatricien. Probable duration of assistance,-. Until the end of 1960. Work done during the year. The paediatrician has mede a thorough survey of the condl'cions in the . - and out-patient depertments. Three medical officers and six nurse9 have been appointed to staff the peripheral child health centres. As a result of slow building activities, there,has been no expansion of services so far, except for the establishment of post-graduate training in paediatrics. Undergraduate medical students are receiving training in supervision of well-babies and children.

India 140 Tuberculosig National Training Courses R First course; 25 Nov. - 6 Deo. 1957; endcoursei 9-20 Dee. 1957)

Aim of the project. To hold two orientation courses,for tuber culosis doctors and specialists in public health and for directors of health services in charge of tuberoulosis in the states, on the new national tuberculosis control plan and the special techniques which are to be employed in it. Assistance provided by WHO during the year, (a) Lectures by WHO field personnel; ib) Half the cost of travel and maintenance of forty participants for six weeks.

Work done. Two orientation courses, each of six weeks' duration, were held at the tuberculosis centres at Delhi, Calcutta and Madanapalle. The couraes covered the Indim national tuberculosis control plan and tho special techniques to be employed. Twenty participants from different states in India, consisting of the following categories, participated in each courses

(a) Assistmt directors of health services in charge of tuberculosis in the states;

(b) Officers selected or likely to be selected to fill such posts;

(c) Doctors likely to be put in charge of the new district centres (for whom this cource served as preliminary training).

WHO personnel, including the Regional Tuberculosis Adviser, were amongst those who gave lec.lures in these courses.

India 141 Ce.ntrd Drug Research Institute, Lucknow R \~ay- Aug. 1957) . Aim of the project. To provide specialized assistance to the Central Drug Research Institute, Lucknow, in planning and carrying out research in pharmacology, especially with respect to indigenous drugs.

Assistance provided by WHO during the year. (a) A consultant in pharmacology for three months; (b) Supply of drugs.

Work dune. The consultant (a lrofessor of pharmacology) started his work by holding discussions with the heads of various sectiona of the Central Dpug Research Institute on certain research projects being conducted there. This short assignment was of considerable value to the Instituter a new technique was introduced and some interesting research stimulated. Among the several problems dedt with, one concerning a study on the intraduodenal administration of crude extracts of indigenous drugs was completed, and another, dealing with synthetic anti-tuberculosis and anti-leprosy drugs, was initiated. A suggested procedure for using dogs and chickens instead of tests for screening anti-helminthio drugs was tried with good results. sEA/Rc11/2 Page 103

India 143" Paediatric Programme, Visakhapatn& R '(NOV.1956 - June 1958) UNICEF

Aim of the project. To upgrade the development of paediatrics of the K.G. Medical College and the teaching of paediatrios at the Visakhapatnam Medical College. -Assistance provided by WHO during the year. A paediatrician. Work done. The Paediatric Department of Visakhapatnam, which be- fore the beginning of %he project was one of the smallest and least developed in India, is now very near the top. Preventive and curative services snd teachin& have been well integrated, and a post-graduate course for a diploma in child health has been established. Ward routines have improved. In oo-operation with the Obstetrics Department the car- of new-borns has bew very considerably improved. Thc hed of the Department has been appoin- ted full professor, thus becoming the second professor of a paediatrics in the whole of India.

Some of the personnel shown und.er the project India 92 also assisted with tllis programme.. -.

WHO'S assistance to this project terminated in June 1958, when the paediatrician completed his assignment.

India 144 Public Health Programme, West Bengal TA TJ~.1958 - UNICEF

Aim of the project. To further the development of health services in community development areae, including training of personnel; to develop other related rural health services, with the object of integrating such services into the total community development programme under the Second Five-Year Plan.

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

Probable duration of assistance. Until the end of 1961, at least.

Work done during the year. The teaching programme for nurses at the Medical College Hospital was reoxganized, and more clinical teaching was introduced. Local maternal and child health services were developed further to serve as a practice field for students.

A course in public health oriantation for trained nurse- midwives who will serve in community development primary health centres has been organized in the Rural Health Centre, Singur. This course will serve as a demonstration programme. Surveys have been undertaken to extend the teaching field to meet the * Continuation of the pae4iatric aspect of the previous Public Jiealth and Nursing Dducation pro jeot ( India-92). sEA/~c11/2 Page 104

constantly increasing needs of the student body receiving training at Singur, and training centres other th& the one at Singur are expected to be developed.

India 145 Public Health Programme, Bihar R I~an.1958 - ) UNICEF , (c'olom?~Plan)

Aim of the project. To further the development of health services in community development areas, inoluding the training of personnel3 to develop other related rural health services, with the object of integrating such services into the total community development programme under the Second Five Year Plan.

Assistance provided by WE0 during the year. A public health officer, a p~blichealth nurse, a midwjfe tutor and a nursing arts instmotor (provided by Colombo plan).

Probable duration of assistance. Until the end of 1961, at least.

Work done during the year. Progress was made in the Patna Nurse Training School with a staff education programme, which elicited an increasingly good response from staff members, a revision of nursing procedures, acceptance of the principles of having a contra1 supply room, the establishment of such a room, and regular meetings of tutorial staff to co-ordinate the teaching. The duties of various categories of staff were defined and policies regarding service conditions discussed and presented to the Covern- ment. Working conditions and study time for students were improved, Some guidance and supervision were given to the Infection Diseases Hospital..

The integration of public health into the basic nurse train- ing programme proceeded in the Darbhanga Medical College Hospital, where supervision of the personal health of student nurses has improved, in spite of limited facilities. Greater interest in nurse training and student activities is being shown by the student nurses themselves and by the medical staff of the Hospital.

The domiciliary midwifery service is expanding, particularly in relation to ante-natal work, and student midwives are benefit- ing from domiciliary ezperience. A public health orientation course for nurse-midwives has been organized. Training of dais continues to be given by health visitor students under superPision, and assistance is also being given with the teaching of health assistants. ~EA/~c11/2 Page 105

India 148 Public Health Programme, Mysore TA-.. T~an.1958 ) UNICEF -

Aim of the project. To further the development of health services in community development areas, including training of personnel; to develop other related rural health services, with the object of integrating such services into the total cornunity development programme under the Second Five-Year Plan.

Assistance provided by WHO durina the year. A medical. officer and a public health nurse.

Probable duration of assistance. Until the end of 1961, at least.

Work done durina the year. The medical officer assisted the Government in selecting primary health centres, referral hospitals and laboratories to be upgraded and assisted by UNICEF.

The following proposals have been accepted in principle by the Government for implementation in the near futures

Establishment of a maternal and child health bureau; transfer of school health services to this bureau; introduction of a Nurses' Act for the State; creation of four new nursemidwife training Schools, a post of a nursing adviser on state level, and a new oadre for nurse tutors; and award of 75 extra stlpends for nurse a tuden ts.

The first group of nine auxiliary nursenidwives have complet- ed their training and have been posted to primary health centres. Out of the twelve UNICEF-assisted refresher courses scheduled to be given to rural midwives in groups of twenty, four such courses have taken place. Thirty midwivos from Bangalore Corporation have undergone these courses.

A twelve-day field study on "The Bealth of the School-Age Child" was organized in a community development block for 45 medical students from Mysore Medical College.

The QlHO medical officer left the project in May on transfer to the Regional Office. A replacement is under recruitment.

India 142 Public Health Promamme. Madhya Pradesh R (!day 1958 - ) UNICEF

Aim of the project. To further the development of health services in community development areas, including training of personnel; to develop other related rural health services, with the object of integrating such services into the total community development programme under the Second Five-Year Plan.

Assistance provided by WOdurina the year. A public health nurse. SU/RC~~/~ Page 106

Probable duration of assistance. Until the end of 1961, at least.

Work done during the year. Discussions ere taking place with the

staff of the J.J. Hospital, Gwalior, and a survey is being- made of local public health services with a view to organiging a public health orientation course for nurse-midwives who will serve in rural health centres. A pubiic health officer, a sanitarian and a second public-health nurse are under recruitment.

Publis Health Pro -anme Boa %P lxiir-7- .T--- UNICEF

Aim of the project. To further the development of heclth services in community development areas, including training of personnel; to develop other related rural health services, with the object of integrating such services into the total community development programme under the SECO~~Five-Year Tlan, Assistanoe povided-. by WHO during the year. One public health officer and three pcblic healtb nurses.

Probable duration of assistance. Until the end of 1961? at least.

Work done during the year. Assistance was given to the Sassoon Hospital, Poona and to the local maternal and child health serv- ices in conducting the firnt half of the public health orientation course for qualified nu-se-midwives prepering to work in rural health centres, The second half of the course, which is being given at Sirur, received full-lime guidance from one of the WHO nurses up to July 1958. National counterparts are now redy to undertake both a~pectsof this programme, and it is proposed to assess the value of the training programme by follow-up visits to trainees now in service.

The gublic heal1,h office-: joined the project during the last week of May 1958.

India 151 Puh?lc Iieal th Programme, Andhra Pradesh R i3y7753-Z"J UNICEF

Aim of the project. To furtk.er the development of health services in community devel.opment mess, including training of personnel$ to develop other relzt.;d r-uza.1 henlthservices, with the object of integrating such service? into the tots1 community development under the Second Five-Yea? Plan,

Assistance provided by WIiO durin? the year. A public health offi- cer, a public health nurse, a public health nurse-midwife, a midwife tutor and a paediatric nurse.

Probable du-stjon of assistance. Until 1961, at least. ~EA/~c11/2 Page 107

Work done during the year. The public health officer assisted the State Governpent in the implementation of schemes to improve the health services in community development areas. Targets have been attaineo in respect of the establishment of a pumber of priw ary health cantres. The Hyderabad Demonstration District is being developed as are also two rural training areas. Plans for two additional ma1 training areas are being considered.

The State Government accepted the suggestion of the Central Health CoupCil to appoint a specific medical officer in the State Qealth Directorate to be in charge of all the health aspects of the community development programme.

The nursing service of the paediatric Department has been upgraded, and the WHO paediatric nurse completed her assignment in March 1958. Staff education has been inaugurated in the mi$- wifery unit, and a revised programme drum up for midwifery training. Assistance with classroom teaching and practical work has been given to the Havamahal Health School. The public health and domiciliary midwifery services have been improved with a view to providing a more adequate practice field for student nurses, midwives and health visitors.

Tours have been undertaken to assist with the training schools for auxiliary nurse-midwives. Widespread and intensive training for dais has been conducted, and refresher courses have been held for tutors, paediatric nurses, senior nurses and health visitors engaged in the training of dais.

Difficulties are still being encountered because of changes of qualified staff, the established pattern of rotation of duties and pressure of the service needs of the training institutions, but new patterns of nurse training are beginning to emerge.

The WHO public hedth officer left the project during the first week of May 1958.

India 1.~~ Public Health Programme, Assam R l~an.1358 - ) UNICEF

Aim of the project. To further the development of health services in community development areas, including training of personnel; to develop other related rural health services, with the object of integrating such services into the total community development programme under the Second Five-Year Plan.

Assistance provided by WHO during the year. (a) A public health officer, two public health nurses and a eanitarian~(b) Some essential supplies. Probable duration of assistance. Until the end cf 1961 -, at least. ~EA/~c11/2 Page 108

Work done during the year. The public health officer msisted the 'State Government in preparing a plan for a mal training ma at Chabus and for a district demonstration projeo0.

The training programmes already under way at Dibrugarh and Chabua have been. progressing satisfactorily, the WHO team assist- ing with the theoretical and practical teaching.

The nurses continued to guide and assist with the programme for the integration of public health into the curriculum for basic nurse training at the Assam Medical College Hospital. The public health orientation courses for nurse-midwives were oontinued at the Chebua Rural Training Centre. The domiciliary midwifery service, which has made some progress, offers an improved practice field for these students, but this programme urgently needs further expansion.

An ante-natal clinic and a nursery have been planned for the new maternity wing of the Medical College Hospital.

A second nine-moEth course for sanitarians was started in February with 28 students. The sanitarisn continued to give lectures to the students at Chabua as also practical demonstra- tions of the construction of sample incinerators. A sanitary survey of a village pas started,- and the sanitation plannad.

5. I N D I A - FORMER FRENCH SETTLEMENTS

Nothing to report. SIU/~c11/2 Page 109

6. INDONESIA

Pro'eot No *;unds -Titlr, Co-operating Agencies

Malaria Contirol Qemonstrbition, Tjilatjap and Semarang* (Aug. 1951 - Deo. 1957) Aim of the projeot. To demonstrate melaria oontt.01 (in three phsses - survey, control operations! resurvey) 5 to set up a re- searoh and demonstration centre; to train medical dffioers, entomologists and auxiliary personnel.

Assistance provided by WHO during the yeex. A malariologist, five assietant malariologists and a public heath engineer.

Work done. During the year, spraying operations were oontinued in the four residencies of the province of Mid-Java; up to the end of f957,2.4 million people bad been protected.

A WHO short-term consultant from Headquarters visited Indonesia during the last quarter of 1957 to make a study of the problem of resistance. He submitted a report on the vscious fac- tors connected with the resistanoe of A.aunddous in Java! the development of resistance in A.subpiotus to dieldrin in certain pets of Weet Jeva was also reported.

Indonesia 2 TB =2*- Jan. 1955; July 1957, - ) Ajm of the pro,iv+. Second phases To study the nutrition problems with a view tq developing a national nutrition progreme.

Assistance provided by WHO during the year. Two consultants (a medical nutritionist and a speoialist in eye diseases) for about a month. Probable duration of assistanoe. Until the end of 1961.

Work done during the year. The two consultents provided in July 1957 studied nutrition problems, with special referenoe to protein malnutrition and its possible effeots on diaeasee of the eye. The report which they submitted contains reoommendations for a national nutrition programme, including the strengthening of the Nutrition Institute. Recruitment is now under way for a medioal nutritionist.

* At the beginning of 1958,this project was analgated with the malaria eradication programme Indonesia 32. ** Previous titles1!T.nstitute of Nutrition, Djakarta". SEA/RC~~/~ Page 110

Indonesia 9 Leprosy Control R T~uly- Septa 1955; Sept. 1956 - ) UNICEF

Aim of the project, Second phases To plan and carry out a long- term leprosy control programme.

Assistance provided by WHO during the year. A leprologist,

Probable duration of assistance. Until the end of 1960.

Work done during the year. The work started in September 1956 in the pif&O arraas of Bekasi and Blora has been continued. Two methods of treatment are in use - DDS tablets by mouth and DDS in oil sus- pension by injection. Child contacts are being given prophylactic trettment. U to the end of 1957, 74,612 persons had been examined and 302 (0.4$f patients placed under treatment. There were also 101 suspicious cases and 913 contaots under observation. Case- finding has been done through a system of screening the entire population.

In 1958, two new areas, Kampong Melaju end Mengentifwere added to the project. In the latter area an expociment is under way using yaws control workers for leprosy case-finding.

Indonesia 12 - April 1956; T A (Institut Pasteur, ~eheran)

Aim of the project. To survey the plague situation; to carry out a programme of research to determine the conditions responsible for the persistence of plague; to develop a long-term control programme.

Assistance provided by WHO durin~the year. A plague consultant.

Work done. The consultant completed his assignment in October -ng carpied out research into the conditions supporting the maintenance of plague in the country. He was able to identify the wild rodent cmriers of infection, and his findings have help ed to define the epidemiological picture of plague in Indonesia. His recommendations for future work are under study. .

Indonesia 13 Assistance to Faculty of Medicine, Gsdjeh R Marla University (Sept. 1953 - ) I

'Aim Of the project. To develop the Departments of Pharmecy end Paediatrice on sound lines; to train national counterparts to take over from the professors provided by WHO.

Assistance provided by WHO during the year. (a) An eighteen-month international fellowship; (b) Laboratory equipment. SEA/RC~~/~ Page 111

Probable duration of assistance. Until the end of 1960.

Work done. It has not yet been possible to appoint a suitable successor to continue the work of the visiting professor of phar- macy and pharmaceutical chemistry who left the project in February 1957. Recruitment action is proceeding.

Indonesia I5 Post-Graduate School of Nursing, Bandung R XJan. 1954 - Sept. 1957) ( ICA) Aim of the project. To organize post-graduate courses in tka teaching of midwifery and in public-health nursing at the Post-Greduate School of Nursing, Randung, and at the Rantjabadak City Hospital.

Assistance provided by WHO during the year. A public health nurse tutor end c midwife tutor.

Work done. During the course of this project, training courses for public health nurses and midwife teachers were firmly established. The curricula were revised and developed in aocordance with the needs of tho country. There was close co-operation between the teachers in the planning of classroom teaohi~lg,in which relevant lectures were combined. This resulted in the different groups taking their turn at teaching, demonstrating, role-playing and conducting group discussions for the benefit of the others. Much valuable basic health knuwledge wns thereby learned.

An outline for a curriculum for basic and post-basic nursing schools was developed, in which a course in the fundamentals of public health nursing was included,and the students were encouraged to devote more time to the preventive aspects of nursing ccre. A course in teaching methods was also given to students of the public health nursing and midwife tutor ooursos. In-aervice train- ing programmes were organized for the graduate staff in the hoe- pitals in Bandung.

A sub-centre of the Andir Training Centre was developed for practical field experience for public-health nurse students. This experience included services in maternal and child health centres, home visiting, school health, the teaching of first aid .snd home nursing, tuberculosis, sanitation and statistics.

Assistance was also given in the establishment of a train- ing centre at Anstanaanjar, Bandung, for use by the school for assistant midwives. At the request of the sisterin-cherge, the centre was assisted in practice teaching in the classroom and in the maternity shelter, clinics and domiciliary field. This centre is now available also to the students of the Midwife Tutors' Course for practice teaching.

A school health service was started in Bandung under a graduate of the public health nursing course. Be is organizing the service for about 16,OOC students from 18 public schools. sFA/~c11/2 Page 112

Thirty public health nurses have graduated since 1954. Forty-three midwife teachers have dso graducted, ~ndall are em ployed in teaching posts.

Since the withdrawal of WHO personnel, the national staff has taken over the responsibility for continuing all the activ- ities of the school.

Indonesia 20 Environmental Sanitation, Djakarta T A XJune 1956 - Aim of the project. To prepare a co-ordinated plan for environ- mental sanitation, particularly in rural areas: to devise and construct simple,~practicaland economical sanitary facilities; to organise a programme of health education on the nature and causes of diseases resulting from faulty environment; to train sanitation personnel.

Assistance provided by WHO during the year. (a) A sanitary engineer, a sanitarian and a port-health sanitarian; (b) A twelve- month international fellowship; (c) Supplies and equipment.

Probable duration of Until the end of 1960.

Work done during the year. Following preliminary work, Pas- Mingu was selected as the area for this pilot project. A reconne;issance survey to find water supply Gources was undertaken,and a sanita- tion survey for pat of the area has been completed. Activities have started in the construction of wells end of water seal latrines, but progress has been clow, and difficulties have been experienced in securing the necessary funds and the personnel.

WHO personnel. took part in the preparation of a syllabus for training sanitary inspectors and are also helping to train kontrolir kesehatan (sanitary inspectors) and pendidikan tenaga (rural sani- tarians),

A course for training penilihara kesehatan palabuha (port health inspectors) has been started. In-service training of the staff of the ports of Nedan and Mekasar has also been undertaken.

A draft of querantine rules and regulations &~da draft on the port health aspocts of water supply have been prepared. Sugges tions for the improvement of sanitary conditions in different airports and of port conditions in general have been given.

The problem of providing a full-time counterpert for the sanitary engineer has not yet been solved.

With the object of developing a rural health demonstration area the Government has suggested shifting this project to Bekasi, where a major programme has been planned. The matter is under the consideration of the Regional Office, SEA/RC~~/~ Page 113

Indonesia 25 Vital and Health Statistics TA w Aim of the project. To expand the statistical organization in the Ministry of Health and train key members of the statistical staff; to develop a long-range statistical programme with a sound system of reporting ~otifiablediseases, hospital services, and general vital and health statistics; to develop an upto-date service of vital snd heslth statistics for planning and evaluating health progremmes.

Assistance provided by WHO during the year. (a) A health statist- icieni (b) A twelve-month international fellowship; (c) Supplies and equipment . Probable duration of assistance. Until the end of 1960.

Work done during the year. The arrival of a punchin machine has enabled the processing of medical death certificates f0mn)received from hospitals to be speeded up; tabulations for 1956 will be completed soon. Work on the improvement of the completeness and accuracy of vital registration has continued. A memorandum presenting proposale for the improvement of population and vital registration was prepareatby the Division of Vital and Health Statistics for the National Planning Board and presented, together with a paper on present problems, some Regional Office publications and some other n)atorial,on statistics, at a Conference of Health Inspectors and Institute Directors held in February 1958. Considerable interest was shown in the problems discussed.

The statistician and the project staff prepared a very comprehensive statistical paper for the First World Health Report. This will materially assist the Ministry of Health in the prep- tion of its Annual Health Rcports for the years 1953-1956 and 1957

The planning and conduct of health surveys have continued to be a feature of the project. Preliminary reports on the heslth surveys in the Rekasi, Senen and Andir areas, and on the Djakarta population survey, have been mimeographed. A plan for an environ- mental sanitation survey in Pasar Minggu, Djakarta City, has bean prepared. As a part of the plan, a suxvey of helminthic infesta- tion of school children has been carried out.

A course of lectures and practical work in public health statistics has been given in the newly-opened school for sanitary I inspectors.

Statistical advice has been given to a number of organize tions, in particular those concerned with trachoma, malaria ad nutrition, and the Departments of Social and Preventive Medicine at Djakarta and Jogjskarta. SEIL/RC~~/~ Page 114

Indonesia 21 Strengthening of Health Services - TA -Bealkh Education (Fob. 1957 - ) Aim of the project, To develop and expand the hetilth educatioe programme, including increased training in i~ealtheducation for all categories of health workers; to develop and increase the use of health education materials, including sydio-visual eida,

Assistence provided by WHO during the year. (a) A health educator! Tb) A transport vshicle.

ProbabJe duration of assistance. Until 1962.

Work done during the year. A good deal of attention was paid to- the in-service training of staff of the Health Education Sub- Division, teaching health education to malaria workers, students of the Port Sanitarians School and others. Assistance was also given in the development of a field training area in Djakarta for students of the Akademi Kontrolir Kesehatan (~choolfor Sanitary ~nspectors). A report on "Health Education in Indonesia", with recommender tions, submitted by the short-term consultant on completion of her assignment at the end of July 1957, has been made available to the Covenunent . A ten-day health education seminar was otganized (see Indonesia 53).

Indonesia 31 Trachoma Control (Nov. - Dec. 1954; TA 1956; April 1957 - ) UNICEF

Aim of the project. To study in a rural population the incidence and pattern of trachoma and the underlying factors favouring transmission of infection; to ascertain the minimum effective course of antibiotic treatment of the Indonesian type of trachoma and the rate of relapse or reinfection during the follol~upperiod; to set up a mass control programme based on the experience gained in the pilot project.

Assistance provide'd by WHO during the year. (a) A trachomatologistj Tb) Tabulating cards.

Probable duration of assistance. Until the end of 1960.

Work done during t4e year. The trachomatcl~gistassigned to this project started work in April 1957. The pilot project has two main partsc in the Semarang area surveys only have been conducted; in six other regions of the country studies have been made on the trestment of trachoma in school-children.

From May 1957 to April 1958 repeated surveys were carried out every month in two villages with a total of t,408 inhabitants. SEA/RC~~/~ Page 115

Monthly fly counts and meteorological data were also recorded. A general systematic survey which coverod nine villages included ckinical md laboratory investigations, a socio-economic and dietary survey and a clinical nutpitional survey.

School treatment studies covered (I) children from n group of schools in which treatment was carried out dth achromycin oily suspension, (2) those from another group where treatment was given by aureomycin ointment, and (3) a control group in which neither treatment nor health education was given. In the trested schools the children were divided into two groups, .*h~.ving continyous treatment, i.e. local application of pntibiotics twice daily during a period of three months, and 5% having interrupted treatment, i.e. twice daily for three successive days repeated seven times at two-weekly intervals during a period of three months.

The cumulative data obtained from the wo.rk up to April 1958 havo boon prooesscd.and cramined statistinally, an2 ths findings are now under study,

Indonesia 32 Malaria Erdication* T A XM~Y1955 - (ICA)

Ait.To improve and intensify the national malaria Programme, which is under the direction of the Malaria Section of the Ministry of flealth; to extend the facilities of the MaJaria Institute, Djakarta.

Assistance provided by WHO during the year. ( a) Two malariologiats, eight assistant malariolcgist s and an entomologist; (b) TWO regional five-month fellowships; (c) Thermometers and filing cabinets.

Probable duration of assistance. Until the end of 1962.

Work done during the yea. The 1957 spraying operations showed that in West Java 5.4 million people were protected as against a target of 4.8 million. In Central Java, insecticide spraying was continued, and special investigations were undertaken on the susceptibility of mophelines to DDT ad dieldrin. In East Java, the 1957 spraying oampaign gave protection to a population of 2.9 million, nearly 0.5 million of whom were in DDT areasand the rest in the dieldrin &re&. The eight assistent malariologists who assist the provincial inspectors of health have been located at strategic centres. Training activities at Lembwa 2Calaria (Malaria ~nstitute), Djakarta, refresher courses and lectures have been continued. A training centre for West Java has been established. * Previous title: "Strengthening of Malaria Section, Ministry of Health". SEA/RC~~/~ Page 116

A detailed plan of operations for the eradication of malaria is under preparation, in consultation with the Government and ICA representatives; ICA has deputed a consultant for the purpose. The Regional Malaria Adviser visited Indonesia in December 1957 and again in July 1958 to collaborate with ICA and national officials in drafting the broad principles of the agreement for Preparing national malaria eradication plan.

Assistance to Medan Medical School XSept. 1956 - ) dim of the project. To upgrade the Departments of Anatomy, Physiol- ogy and Pharmacology at the Medan Medical Sohool and to develop ourricula in these subjects; to improve the pre-clinical treining programme; to train national counterparts.

&gsistance providgd by WHO during the year. (a) A professor of hatomy and a professor of physiology; (b) Supplies and equipment.

Probbble duration-of assistance, Until the end of 1960, at least.

Work done during the year. The two professors continued their- courses of instructionr The construction of new btiildings for pre-clinical departments is proceeding slowlyc No counterparts have become available, but use is being made of student aaeist- ants. There is a continued improvement in attendance at lectures, and increased interest in the subjects is being shorn. Laok of laboratory facilities and unavoidable delays in the delivery of supplies have hindered the development of practic'd work, especial- ly in physiology. Textbooks supplied by' WHO for loan to students have been very helpful, as have also the special classes for tutoring students who have failed.

Recruitment of a professor of pharmacology awaits the pro- vision of accommodation, a laboratory and equipment.

Paediatric Nursing, GBdjah Mads University, Jogjakarta (Oct. 1956 - Jan. 1958)

Aim of the project. To improve the nursing care of children by better training of students in pandiatrios and paadiatrio:.nwsing at the Gadjah Yada University Hospital.

Assistance provided.by WHO during the ye&. A paediatric nurse tutor.

Work done. During the assignment of the paediatric nurse, ward procedures were drawn up and put into effect,and reasonably satia- factory techniques were established in the Milk Room, for preparing feedings, and in the Isolation Unit. A clinic for weekly conmltations was established, but it was not possible to develop a comprehensive system for the follow-up of patient* after discharge. The graduate nursing staff in the paediatrio unit sEB/BC~~/~ Page 117

...... responded with enthusiasm :to the in-service training, but the student teaching was not so good due to the 'factthfit the operation of the school was unsatisfactory. There were no classrooms except for those shared with the medical sohool, no demmstration room

for teaching nursing techniques. , Students were-'kssigned to the wards without regard to their backgrqdor knowledge.

On the whole it may be said that WHO'S sssistance to this project has resulted in improved nursing procedures and in a bette~knowledge of paedlatrlc nurslng on the part of the graduate nursing staff.

Indonesia 36 Strengthening of Maternel and Child TA Health Services (Oct'. 1956 - Dec. 1957) UNICEF

Aim o: the project. To evaluate the maternal and child health services and training facilitXes in the country and to plan their extension.

A.esistance provided by WHO during the year. Two international fellowships - one for twelve months and one for five months. Work done. So far only fellowships have been awarded under this project, and the recruitment of a maternal and child health officer has been postponed at the request of the Govement. h co~~ulta~t my be prwrided in 1959. -Indonesia 41 I& Nursin Adviser Aim of the project. To assist in strengthening, expanding an& co- ordipating programmes for training all categories of nursing and midwifery personnel, and in establishing a Division of Nureing.

Ascistance provided by WHO during the year. A nursing adviser. -.Probable duration of assistance. Until the end of 1961. -Vork done during the year. The nursing adviser took up her assign- merit in October 1957. She gave some assistance to the Post-Graduate School of Nursing, Bandung, in its teaching programme, and paid visits to Djskarta, Krawang, Surabaja, Semarang, Blura and Tjiandur, to assist in collecting information on the needs of the training schools and to help the Government in its survey of the anuiliary nursing services in Indonesia. The questionnaire form already prepared for this survey was reviewed, and necessary changes and additions were made.

Indonesia 45 Assistance to Faculty of Medicine, R Surabaya (Pharmacology) (Sept. 1957 - ) Aim of the project. To upgrade tho Department of Pharmacology at the University of Surabaya and to improve- teaching- and training- facilities. SEA/RC~~/~ Page 118

Assistance provided by WHO during the year. (a) A professor of pharmacology; (b) Laboratory equipment and supplies.

Probable duration of assistance. Until the end of 1961.

Work done during the year. The professor of pharmacology has established his department, which has been provided with adequate space for holding classes,~laboratoryand oifice. A suitable counterpart and two assistants have also been provided. Regular teaching in pharmacology is proceeding. The counterpart is being prepared for fellowship studies abroad commencing in September 1953.

A survey of common drugs in use in Indonesia has been made, and a research project in the drug treatment of leprosy is in hand. The breeding of laboratory animals has commenced.

Indonesio 46 Drug Investigation (~asistanceto Institute TA of Pharmacology)*

Indonesia 48 Fellowships R Health Educations Two twelve-month fellowships for study in the United States of America and Lebanon respectively.

Nursing* Two twelve-month fellowships for study in Australia.

Preventive and Social Medicines One travel fellowship for one month in India.

Jndonesia 49 Fellowships TA

Preventive and Social Medicines One eighteen-month fellowship for study in the Unite@ States of America.

Assistance to hiblic Health Laboratories and Hospitals (Dec. 1957 - ) Aim of the project. To provide modern equipment and supplies for the purposes of upgradin, Lhe Central VLtblic Health Laboratory and five other provincial laboratories and of improving the exist- ing facilities for training laboratory technical staff. Assistance provided by TTHO (~ouble ~ontribution). Laboratory and pharmaceutical equipment.

Probable duration of assistance. Until the end of 1958.

* A separate consultant was not provided for this project, as was intended. The sersioes of the professor of pharmacology assigned to Indonesia 45 were used to assist with this programme, and the two fellowships awarded were completed in May 1957. No firther assistance is contemplated. SEA/~c11/2 Page 119

Indonesia 53 National Health Education Trainin R Course, Bandung (14 - 24 July 19%) (1Ck)

Aim of the project. To provide further orientation in health education to selected health workers from the various provinces and to persons responsible for teaching health eduoation in the schools and training centres operated by the Ninistry of Public Heslth.

Assistance provided by WBO during the year. (a) Half the cost of travel and maintenance of 36 participants who came from outside Bandungs (b) Assistance from the health educator assigned to project Indonesia 27 and also from the short-term consultant previously attached to that programme.

Work done. This first national health education training oourse was organieed and directed by the Health Education Sub-Division in co-operation with the Division of Education, ICA and WHO. It was attended by approximately 72 participants and observers from fifteen provincial areas and from the training schools operating under the Ministry of Public Health. The course was planned to demonstrate good education methods, including teaching by demonstra- tion, group discussions, role-playing and lectures. Housing and Study rooms were provided in tho basic medical training school in B andung.

7. MALDIVE ISLANDS

Meldive Ialands 3 Fellowships R

Medical Education8 One five-year fellowship for medical education in a medioal college in India. ~FA/~c11/2 Page 120

Project No. Source of Funds -Title Co-operating Agencies

-x* -x* (June 195.4 - )

Aim of the project. To study the malaria situation and determine suitable control techniques, to carry out indoor spraying with DDT in areas not covored by ICA; to train personnel in malaria prevention.

Assistance provided by WE0 during the Year. (a) A malariologist, an ontomologist and three auxiliary workers; (b) A twelve-month international fellowship and three regional fellowships - two for three months each and one for six weeks; (c) Supplies and equip- ment.

Frobable duration of assistance. Until 1962.

Work done during the year. In the Rapti Valley, the malaria control programme being carried out by the Government in collabora- tion with WHO maintained satisfactory progress. Insecticide spray- ing, malariometric surveys and entomological activities were continued. A. minimus continued to be absent from sprayed struc- tures. Post-spray malariometric studies indicated that there was no transmission in sprayed villages.

Tne entomologist left tho project in >:ovember 1957, and a replacement is cxpccted to arrive shortly.

Tho Regional Malaria Advisor visited Nepal in March and again in 'hy, when detailed discussions with the Government and ICA autho- rities were held in connection with the proposed malaria eradioa- tion programmo under the MESA schemo. A draft plan of operations and a detailed first plan of action have been devoloped and are awaiting the Government's approval.

Training of Nurses. Kathmandu (NOV. 1954 - )

Aim of the ~roject. To train nursos for institutional, domici- liary and public-he8lth work.

*The title of this project is to be changed to "Malaria Eradioation". SEA/RC~~/~ Page - 121

Assistance provided by WHO durin~the year. (a) Three nurse tutors; (b) Supplies and equipment.

Probable duration of assistance. Until the end of 1961.

Work done during the year. A more suitable building has now been provided for the School. First and second-year students appeared for the end-of-term examination in May 1958. Tnirteen students ,!rho h-ta completed the preliminary course have started their practical experience in the Bir Hospital.

'Two medical wards in the Male Hospita1,in addition to the female wards,were taken over as teaching wards,and one of the tutors spends her full time there with the students. In rotation, groups of four health assistant trainees are being assigned to the male wards for four hours daily for practical training under the staff of the Nursing School.

The third national counterpart tutor has been appointed. The appointment of a second driver, a head clerk and a second cook has also facilitated the day-to-day work.

One of the WHO rurses resigned in December 1957. She will be replaced by another,who will be concerned particularly with clinical teaching on the wards.

Training of. Health Assistants. Kathmandu (~une1955 - )

Aim of the orc,iect. ?b establish a school for health assistants in Kathmandu to give theoretical and practical training; to plan a programmo of rural health services which will make the best use of the health assistants.

Assistance provided by WHO during the year. (a) A medical offioer (public health specialist) and a ssnitar$an; (b) A ten-month inter- national fellowship and fourteen regional fellowships for one month each; (c) Supplies and equipment.

Probable duration of assistance. Until the end of 1960.

Work done during the gear. This project continues to develop satis- factorily. The WHO medical officer (replacement) assumed his duties in January 1958,and two additional doctors md a sanitarian have been selected by the Government as counterparts. From the first group of seventeen students, fousteen completed their two-year course success- fully and were awarded WHO fellowshipfor one month for further train- ing at the Re-orientation Centre, Najafgarh e el hi ).

In the first-year class all nineteen students qualified to take up more advanced studies on the basis of the seoond-year syllabus. 'Twenty new students were selected out of 54 applicants for the new first-year class ,which began in February 1958. sFA/~c11/2 Page 122

Students belonging to the first group to graduate are now taking post-graduate practical training in a WHO malaria-control project and at a ~ovcrnmcnt/IC~-dovelopodhoalth centre in the Terai area of the country.

Nepal 4 Assis tance to Central Health Directorate TA '(~ugust1957 - )

Aim of the ~ro.ioct. To organizo tho work of the Central Health Directorato and to dovelop short-tom and long-term health plans to meet tho country's basic public-hoalth and medical problems.

Assistance provided by WHO during the year. (a) A public health advisor abd'an administrative assistant1 (b) A transport vehicle.

Probable duration of assistance. Until tho end of 1960.

Work done during the year. ??ho public health ahisor arrived in Nepal at the and of August 1957. Hc ostablishod cordial relations with tho officials of tho Government and has maintained close liaison with officors of the United Nations, bilateral and non-governmental agencies. Ha participated in the discussions on reorganization of the hoalth administration and gave his advice on proposals to constituto autonomous boards to direct the Bir group of hospitals and alliod scrvicos and the maternal and child hoalth centre, Kathmandu. A system for amalgamating the Secretariat of the Ministry of Health and the Health Directorate has been workod out, and assistance was given in drafting a number of enactments.

Tho adviser assisted in the projoct for the training of nurses (Nepal 2) and also assumed chargo of the projoct for tho training of hoalth assistants (~o~al3) for some time until a medical officor was recruited for that project. bau. Fellowships R

'_I- Basic Modioiner A t-to-year fellowship for study in India.

9. PORTUGUESE INDIA

Portuwose India 5 Followships R Environmental Sanitation: Ono twelve-month fellowship for sfudy in the United States of America.

Biochemistrp One six-month fellowship for study in the United States of America and Switzerland. sEA/~~11/2 Page 123

10. THAILAND

Project No. Source of hds -Title Co-onerating A~encios

Thailand 2 Treponematosis (~a~e):mtml(%laDay 1950 - ) TA UNICEF

Aim of the projoot. To carry out systematic control of yaws throughout tho country; to roduce tho reservoir of infection to a level at which the disease can bc controlled by rural health authorities; to train local poroonnel; to incorporate yaws control in the permanent public-health services.

Assistance provided by WHO durin~the ycar. A yaws specialist.

Probable durzticn of assistance. Until thc end of 1962.

Work dona durin~the year. By tho ond of March 1958 the country- wide coverage of the campaign had roached 44 provinces; 14,655,698 porsons had boon examinod and 1,227,914 pationts treatod. The work is progressing satiofactorily, and a special effort has been mado during the yoar to raiso tho moralo of the field toms, to improvo reporting methods and to strongthcn supervision and control. Preliminary cxperimcnts are under way for partial in- tegration of the yaws control service into the goneral rural health sorvicos, whorc these exist. The first inter-country yaws conferenco for Cambodia and Thailand was held in February 1958.

A now agreement on the future dovclopmont of the yaws control programme has bczn negotiated by the Government, UNICEF and WHO. lhis is designed further to strengthen thc project; it provides, inter alia, for the creation of a training school for health workers to bc used later in the control campaign. WHO is to provide a sooond medical officer, a statistician and an assistant statistician to help in tho assessment of the epidemiological status by maans of plannod clinical and scrological surveys.

Thailand 21 Nursing Education* TA (~~ril1954 - Doc. 1957, Jan. 1958 - )

Aim of the nrojcct. lb cc-ordinate, oxpand and upgrado the undergraduate and post-gradustc nursing cducation programmee in accord,mcc with tho ncods of tho country,and to improve nurehg services, particularly in those institutions which are used for teaching.

*In January 1958, tho prcvious title f'Post-Graduato School of Nursing, Bangkok" was ohangod to tho morc comprohensivc title of "Nursing Education". sEA/~c11/2 Page 124

Assistance providod by WHO during: the sear. (a) A nurse educator and a public hoalth nurse tutor; (b) Supplios and equipment.

Probable duration of assistance. Until the end of 1961.

Work done durina tho year. Considorable progress was made in providing practical oxporienco for tho student toachors in the wards at tho Wcmonts Hospital. Sincc thoro were difficulties in taking the secona-ysar public health nursing students to Cholburi for rural fiold experience, a eubstitutc rural training area was dovolopod at Minbury noar Bangkok. Assistance was givon to the committoo appointed by tho Governmont in Octobor 1957 to ccnsidcr tho establishment of liconsing oxaminationa,standards for accreditation, and a minimum curriculum for all nursing schools in tho country.

Rocommondations made by tho WHO nurso tutor in September 1957 for reorganizing tho nursing administration at tho Wcmonts Hospital, Bangkok, and tho currioulum of the School of Nursing wore accoptod by tho Oovornmont, and the curriculum Tias rovisod.

In January 1958 tho School of Nursing and Midviifery Instructors was transforrod from tho Divinion of Nursing to tho Department of Medical Sorvicos. Tho final term of tho school yoar was comploted, and twenty-one graduates received thoir diplomas. Tho methods usod for field exporionce during tho two provious years wero oxtonsively revised. A now evaluation outline for studont teachers and a toachorsi outline for nursing care studies wore prepared and put into use oxporimentally.

Tho provincial hospitals at %k, Lampang, Payao and Chaingrai and the hospitals and nursing schools at Pitsanuloko and Chiengmai wcro visitod in order (1) to study tho conditions in provincial nursing schools and hospitals in connection with tho rovision of curricula in tho basic nursing schools opc-ratod by tho Depart- ment of Modical Scrvic,~, (2) to sez tho work being dono by graduates of the Post-Graduate School of Nursing, and (3) to detormino which of tho provincial hospitals might be made suitable for providing additional clinical oxporienca for basic nu- ing otudsnts from tho Womomonts Hospital.

The WHO public health nurso tutor was withdrawn in Doccmbor 1957 on complotion of hor assignment.

Thailand 24 Rural Health Promammo (nursing Su~orvision) R (nlay 1954 - ) (ICA)

Aim of tho pro.ioct. To dovclop tho nursing and midwifery aspects of rural hoalth scrvicosy to provide adequate guidan~oand supcr- vision of nursing and midvifery services. SEA/RCU/Z Page 125

Assistanco orovided by WHO durinn the year. A public health nurse- midwife.

Probablo duration of as$ista.nce. UnOil the ond of 1958

Work dono durina tho yoar. Assistance was givcn in drawing up an organization plan for tho new Division of Public Hoalth Nursing in the Department of Hoalth S~rvicesand in drafting proposals for tho functions and staff roquiroments for the Division. A study io bcing mado of tho reports submitted by the field supcrvisors.

A short-term courso was arrangod for four nursos from tho Health Department and one from tho Rod Cross Hoalth Centro. Assistance was given to an oricntati~ncourso for a group of university-trained sanitarians who wcrc recruited to work in the trepcnomatosis programmo at Rsjburi.

Tho 'KHO nuroo attcndcd th~meeting of thc 'Vorking Committee on Public Health Nursing and asoistcd with revisions of the job descriptions of the midwife, nurse-midwife and public h~althnurso in Thailand. Tho content of tho refresher coursos for midwives was rcvisod, and a new curriculum for training student mi5wivcs has boon draftcd.

A special committec complotcd plsns for n country-widc schemo for training moh-tam-yaos (indigenous midwives). A one-weok course for sup~rvisorsfrom nine provinces was arrangod in Chiengmai to prcpnro thorn for such tcaching. Forms for the reporting system of thc moh-tam-yacs' training schomo were revised and put into effect on an exporimcntal basis.

Thailand 26 R (UNZSCO)

Aim of tho project. To ipt:.~=;!:i: nublic Guj;lth.&mz~-kim into the fundamental education programmei

Assistance arovided by WHO durin~tho year. A public health nurso with oxporicnco in health education.

Work done. The Fundamental Zducation Training Centre in Ubol was established to give two-year courses for training fundamental education officers. For three years WHO assisted in developing the health aspccts of the programme.

A course of 40 lectures dealing with various aspects of community health was included in tho general programme for all first-year students. A special training programme was developed sEA/Rc~ 1/2 Page 126

for first-year students -signed to the Health Section. The importance of teaching the villagers by demonstration rather than by lectures was emphasized, and group discussions were held on the layman1s ability to solve his own health problems in every- day life.

Second-year students were assigned in groups to seleoted villages for field training, where they worked very closely with the district health staff and assisted in maternal and child care, environmental sanitation, school health services, control of ccmmunicable diseases and other aspects of rural health pro- grammes, with special emphasis on health education. During their stay in the villages, the students, together with the villagers, built latrines, improved wells, collected stool specimens to be sent to the Intestinal Parasite Control Clinic, improved the sanitary arrangements in primary schools, built covered disposal pits for sewage water, set up exhibitions at village fairs and arranged classes in home nursing, first aid and baby care for young women.

In two village centres the students assisted in carrying out a health survey in order to get more accurate data on morbid- ity. Family health charts were introduced for follow-up records, particularly in connection with the control of communicable diseases.

WIIOls assistance was withdrawn at the end of 1957, when the public health nurse completed her assignment.

The health aspects of the training programme are being carried on by the national staff.

Thailand 30 Le ros Control* R t*- UNICEF

Aim of the project. To organize a pilot project in Khon Kaen Province for demonstrating- modern methods of leprosy._control, with emphasis on case-finding, domiciliary treatment and surveillance of contacts; to train personnel; to extend the control programme to other parts of the country.

Assistance provided by WHO during the year. (a) A leprologist; b) Two regional fellowships - one for three months and one for four months.

Probable duration of assistance. Until the end of 1960.

Work done during the year. The pilot project in the Khon Kaen province began in 1955 and has now reached the stage of oonsolida- tion. The first survey was completad by the end of 1956, and a resurvey carried out in 1957. There are now 6,168 registered patients out of a population of 600,000 in Khon Kaen province#

*Previous titles "Leprosy Control, Khon Kaen Province" SEA/RC~~/~ Page 127

54$ me infective. Treatment has been carried out by oral dapsone at static clinics and with injections of DDS suspension in oil by mobile teams. Domiciliary follow-up has ensured a high average of regularity in treatment.

During the year, theoretical and practical training was given to twenty additional health workers,who have now been assigned to the three new provinces to which the control project has been extended.

Thailand 31 Schools of Nursing, or at and Pitsanuloke TA 'I~uly1955 - March 1958) Ajm of the p,roject. To plan and carry out nursing education pro- urammes; to improve nursina services to meet local needs: to correlqte theoretical teaching and teaching in hospital wards, and to give training in public-health nursing, at the schools of nursing in Korat and Pitsanuloke.

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

Work done. Originally WHO'S assistance was provided only to establish a new School of Nursing at the Provincial Hospital in Korat, and the first nurse educator took up her assignment in July 1955; the second joined in May 1956. At the request of the Government, assistance v.as extended early in 1956 to the School of Nursing at Pitsanuloke as well.

In furtherance of the aims of the project, a curriculum based on the one already in use at the Women's Hospital, Bangkok, was developed at the Korat Nursing School. A night-duty system was introduced for some groups of students, a 24-hour nursing service thus being established. A new obstetric block was opened, and a central supply servlce set up. The teaching material at tho school was rearranged to suit looal conditions, and a re- fresher course was given to graduate nurses, following which weekly talks werc errengcd. A procedure book giving uniform nuts ing procedures was drawn up for use on every ward. Two instruc- tors were trained in the methods of teaching midwifery and the preparation of teaching material.

In Pitsanuloka, preventive nursing was integrated into the student-nurses' training, and the theoretical teaching of public health nursing was established on a. sound basis. One of the national counterparts was trained to be used as nurse instructor in public health nursing. A course of lectures on public health nursing was developed for senior students. A limited clinical field for public health nursing was established; and a home visiting programme set up. Procedures were prepared and trans- lated for use by the national staff. A system of reporting and record-keeping was formulated. Senior students were also given some experience in school health nursing.

Lecture notes in both schools were translated into Thai. SEA/RC~~/~ Page 128

For the two-year period, the new School of Nmsing in Korat was successfully established, and the School of Nursing in Pitsanuloke was upgraded. The major handicap, especially in Korat, has been the shortage of trained ;tutors and of graduate staff.

Thailand 32 Vajira School of Nursing, Bangkok T A '(AU~.1957 - ) Aim of the project. To upgrade the education programme of the School of Nursing and the nursing services at the Vajira Hospital.

Assistance provided by WHO during the year. (a) A nurse educator) b) Two twelve-month international fellowships4(c) Equipment.

Probeble duration of assistance. Until the end of 1959.

Work done during the year. The nurse educator took up her assign- ment in January 1958. As part of her orientation, she visited various hospitals, institutions, schools of nursing and health centres in and outside Bangkok. She spat a few days with the public health instructors observing domiciliary work in the hos- pital area.

Work on improving midwifery techniques in the wards of the Vajira Hospital and home visits to post-natal mothers and babies discharged from the hospital were started. Twenty-eight graduate nurses have been appointed to the hospital staff, and their duties have been defined.

Twenty-sik student.8 were admitted to the School in Xay 1958.

Maternal and Child Heal.thc Strengthening of aentral Health Organisation (June 1956 - &Y 1958) UNICEF

Aim of the project. To evaluate the standard of maternal and child health and soh001 health and the facilities for training maternal and child health personnel; to develop techniques and prooeduree for maternal md child health work integrated into urban and rural health services.

Assistance provided by WEO. h matornal and child health offiocr.

Work done. The materm. and child health' offioer, first appointed in.Junc, 1956, conoontmtad on =king an aasessmont. cf tho present maternal and child health services in urban and rural areas. He conducted a large number of investigations and compar ative studies, and advised the Government on the various aspects of maternal and child health activities. His assignment was com- pleted in Yay 1958, and his final report is under consideration in the Regional Office. Thailand 36 Nutrition TA (Nov. 1955 - Jan. 19561 Jan. 1957 - ) ( FAO) Aim of the project. To survey the nutritional situation; to investigate the problems of endemic goitre and beriberi.

Assistance proviaed by WHO during the year. A medical nutritionist.

Probable duration of assistance, Until 1960.

Work done during the year. The medical nutritionist concentrated his attention on the problems of goitre and beriberi. In collabo- ration with the national biochemist, he developed a method for determining thiamine content in human milk. No medical counter part has been made available so far.

Although considerable work has been done, progress towards the formulation and implementation of a national nut'rition programme has been slow. ,..

Thailand 37 Vital and Health Statistics R 7Aug. 1957 - 1 Aim of the project. To strengthen the Division of Vital Statist- ics by developing health statistics and improving the system of reports from rural services.

dssistvlce provided by mC iuring the year. (a) A heslth statie- tioian;( b) Supplies and equipnent.

Probable duration of assistance. Until mid-1960.

Work done during the year. As an interim measure, pending complete centralization of reports of vital events, the statistician designed n punch card for processing provincial returns. Revised estimates of birth and dcith rates for the last tvtenty years have been computed and tabulated, based on returns from 38 provinoes with more complete reporting, and from Bangkok and Thonburi municipalities.

A nem monthly report from health centres, which will great- ly reduce the number of forms to be completed-at--each stage and permit an administrative appraisal of the work done, has been introduced. The statistician also collaborated with the Nursing Adviser in the introduction of new forms for reporting the work of moh-tam-yaes.

Plans are being prepared for the tabulation and crose- classification of causes of death by type of certifier. Thailand has taken the advanccd step of introducing everywhere cause-of- death coding acoording to the "Detailed List", but the necessity of having to work in two languages wlll make accurate coding difficult to achieve. A start has been made in eliminating the SEA/RC11/2 Page 130

more obvious sources of orror and in training the staff of the Vital Statistics Division in correct coding procedures.

In November 1957 a newly graduated physician was appointsd as the WHO statistician's counterpart in the health statistics section.

Thailand 44 Hospital- Statistics TA vov. 1957 - 1 Aim of the project.' To improve the collection of statistical data from hospitals by means of training programmes for medical records officers and statistical clerks in hospitals.

Assistance provided by WHO during the year. A twelve-month inter- national fellowship.

Probable duration of assistance. Until tho end of 1961

Work done during tho year. The candidate selected for training left for the United States of America in June 1958 to take an M.P.H. course at Columbia University, with specialieation in hospital statistics. It is planned to provide a ~tatistioianin 1959.

Thailand 42 Dental Hoalth R ~NOV, 1957 - Jan. 1958) Aim of the project. To organize dental health services and to expand training facilities.

Assistance provided by WHO during the year. (a) A consultant for - three months; (b) A twelve-month intot-national fellowship. Work done. The consultant studied the pooition of dental eduoa- tion and dental services in Thailand. Be also made a survey of the prevalence of dental caries and of periodontal diseases. In his report he has recommended the improvement of undergraduate and post-graduate training and the training of dental auxiliary personnel, and has stressed the need for dental health education. ?=- Fellowships Health Education: Ono twelve-month fellowship for study in the United States of America and one travel fellowship for one month and a half in the United Kingdom.

Malaria Eradication; Two two-month travel fellowshipa in Taiwan, India, Coylon and Burma.

Thailand 47 Fellowships TA Production of Biologicalsr One twelve-month fellowship for study in the United States of America. sEA/Rc~~/z Page 131

11. INTER - COUNTRY

Pro ect No. &Funds Title Fo-operating Agencies -

SEAR0 2 Assistance to Tuberculosis Laboratories * 7 XAug. 1955 - ) Aim of the project. To assist countries of the Region (Afghen- istan, Burma. Ceylon. India. Indonesia and ~hdlsnd)in develo~ina- - laboratory work in connection with the expansion of. their tuber- culosis services.

Assistance provided by WHO during the year. A baoteriologist.

Probable duration of assistance. Until the end of 1960.

Work done during tho year. The present bscteriologiat (replace- ment) assumed his dutiesin November 1957. During the first three months he took part in planning the Indian ~etionalTuber culosis Control Progranune and visited the tuberculosis chemotherapy project, Madras, the Nagpur Tuberculosis Project, BangalLbro and Hydorhbad.

Two pilot research projects on simplified culture methods and the keeping qualities of egg media were initiated in the lab- oratory of the New Delhi Tuberculosis Centre.

The work of the laboratories sttachad to present and former WBO-assisted tuberculosis projects in Afghanistan, India, Burma and Thailand was reviewed during the course of visits in January, February and April 1958. Routine disgnoatic procedures were checked, newer techniques demonstrated and lectures given on these and related topics. In practically no instence has the original stmdard been maintained or improved, mainly becnuse of lack of staff and materiels (to be provided by the governments). Break- down and delay in the repair of equipment are a common feature of a number of leboratories. In the course of his visits to Kabul, Patna, Calcutta, Rangoon and Mandalay, the bacteriologist also advised on the work and organization of public health laboratories, training of laboratory technicians, etc.

During May 1958, be paid a ahort visit to Hongkong on behalf of the Western Pacific Regional Office to advise on tuberoulosia and public-health laboratory services.

* The assistance given under this project is shown, for budget purposes, under the individual tuberculosis projects of the various countries. sEA/~c11/2 Page 132

--Conference on Industrial and Occupational --heel~h, ~alcui'zaT!~'eb. - April 1958; - )

Aim of the project. To bring together for mutual discussion persons actively associated with occupationel and industrial health activities,representing ministries of health, ministries of labour, industrial medical officers and employers' and employees' organizations, with the primary objective of enabling tho countrieq in t'le Regicn to plan more &equate and well. co-ordinated iridustrial ar.d oocupational health services at an early stye. Assistance provided by WHO during- the year. A consultant for three months. -

Work done durinehe yea;,, This conference scheduled to take --* is rlace az the All--1ndia Institute of Hygiene and Public Health, Calcutta, from 24 Ndvebber to 6 ~ecember1958. It is expected to produce a numje;. of specific recommendations for the stimulation, organi$ation and co-ordination of en industrial and occupational health pi.ogza~me. Technical and c5miniatrative arrangement8 for the conference h6,ve riow been comoleted.

In the e.rrly part of the'gecr, tiiG consultcnt visited India, Burmz, Ceylon and Thailand, making cor..ca&ts with 5ndustrial health workers and government officials,to acquaint htmself with the devnlcpment of industrial health in the Region and to collect data for the prepsrotion of working papers for the conference. ?

Prep-.raticn of Annual Public Health Reports \1~323cn:, Oct. 19578 - ) . -.. Aim of the project. To assiQt the he~lthdepartments of certain countries in the Hegien- in preparing their annual public health reports.

-".Assistance provided by WHO.-. duriy the yea.x. (a) A consultant in public health 'adrninietrcticnn c Sup?iles md equipment. -Probable dur2,tion of assistance. Until the end of 1:'1- Work done durin~t'le year,' The consultant assisted the Health De~~artmentof the isvern~sntof Rnrms in the preparation of its annual health repcrts for 1955 cnd 1956, This work was interrupt- ed by his sudden and tragic death in October 1956. Tno manuscripts were revised in the Rogional Office and returned to the Director of Health Services.

A consultant end statistical assistar.t are now under re- cruitment to assist the ?Kinistry of Health in Afghanistan in the preparation of its annual health reports. SEA/R~~/Z Page 133

Rural Health Conference, New Delhi m'0ct. 1957)

Aim of the project..- To discuss the problems of organizing health services in rural areas,

Assistance provjded by WHO durin~the year. (a) A consultant in public-health adcinistration for six months, to make afiennements for the Conference and prepme Wrking papers; (t) Cost of-travel and maintenance expanses of twenty-nine participants from Afghanistan, Eurrm, Ceylon, India, Indonesia, Nepal and Thailand.

Work done. Thin Conference was conducted by means of the presenta- tion and discussio:~of workin.: papers, formal lectures, group discussions and field visits, Thre was an exchange of techniasl information on the $$ate of deve!.oprnent of the rural health services represented,nnd particulzr attention was paid to the planning, orgwizing ts:: aimini~trs-tionof theoe services, including their finw.~ingand s;.enfing. the size of the health units, selection oi crnt-es, ser-r'ces to be provided, supervision of thestsff xeqljirud, f.rs.ic?'n: rf personnel, evaluation, integra- tion of special. h?.lfh e-ti-itietl i.nd comntty participation.

The Conference gave particulrrly satisfactory results from the point of view of pz~ctical,apcroach to the rural health pro& lems. in South East Asia. Its report aas printed and has been widely distributed.

-Re~qna:. Teaching Conference on Child Eealth, --Tj TA Lr iL - 5 Jane I?%)

Aim of the prbdac:,-,-., -- To discuss the present set-up of maternal and child health sc+,,.;ities in ilff:.rant countries of the Region.and make recornmendatisns for future de-relopme'nts.

Assistance providodb.y ??I0 dvrj.;:r the ye=. Cost of travel and -. --- --.- .-- -4-. .--'A- maintenance extms:?r, of six-:::cr sarticipmts from Afghanistan, Burma, Ceylon, IraLa &nJ, i!-d~necj-a,

Work dons, Eight:m teachc~sof paediatrics from different countries of tie Regicn (inc..udin,: two from halla and), met at Bangkok between 2-5 Juqo 'i358 ',o diocuss the present setup of maternal wd child health pi.-tix-i'ics i;l their respective coun- tries and to make reoom~ndationsfor futcre developments.

Among the recommend~tionsmsdo were the following;

(1) There s110uld be 9 sep~~~teDepartment of Paediatrics in every medical school cnder the charge of a full prof cssor of paodiatr' cs.

(2) At least 303 hours should be devoted to paediatrics in the a?derg:adunte ccrriculum, and at least one month dczing the pre-registration year. sEA/~c11/2 Page 134

(3) Promotional and preventive aspects of child care should be given greater emphasis in the teaching.

The report on the Conference is under preparation.

.Medical Education Study Tour tfirst tours Ncv. - Dec. 1957; - ) dlm of the project. To arrange study tours to enable small groups of professors and senior teachers in selected non-clinical sub jects to visit certain medical colleges and research institutions in India, on a programme of discussions in their specialty.

Assistance provided by WHO during the year. (a) A short-term consultant (senior prcfeseor of pathology from 1ndia); (b) Travel costs and subsistence allowances for six visiting profesaora of pathology.

Probable duration of assistance. Until tho ond of 1960.

Work done. A three-week tcur programme was arranged from 21 Novem- %er for six senior visiting professors of pathology from South East Asian oountrios other than India. Under the guidance of a senior Indian professor of pathology, the group visited Calcutta, Bombax, Madras, Coonoor, Agra and Lucknow. They also attended the Eigth Annual Conference of the Indian Association of Pathologists and initial sessions of the Annual Conference of the Indian Council of Medical Research at Lucknow. The visiting professors derived considerable benefit from the discussicns, demonstrations and professional contacts in the course of this tcur. Full cc- operation was received from the Government of India and from the institutions visited.

The success of the tour was largely due to the presence of an experienced and well-known representative of the host country as guide.

It is proposed to arrange similar tours in respect of other non-clinical subjects in 1958 and 1959.

SEBRO 32 Conference on Auxiliary Nursing, Delhi R l~arch1958 - Aim of the project. To provide an opportunity for national and international personnel who have had experience in auxiliary training to meet together to exchange ideas and to examine the problems of training and use of auxiliary workers) to establish some guiding principles and to stimulate enrichment of literature in this field.

Assistance provided by WHO during the year. Twa short-term consultants. Work done during the year. The Conference will be held in Delhi from 3-15 November 1958. Two consultants - a nrrrso ,and,a sociEil scientist - hnvcs boen accigned to makornrran ants for th~Conhr- ence. They spent six weeks in Bhopal (IndiaFhere they carried out a brief study on auxiliaries in order to obtain background material.

Questionnaires have been drawn up and sent to governments for use in preparing background material for the Conference. The Governments of Afghanistan, Burma, Ceylon, India, Indonesia and Thailand have declared their interest in taking part, and the participants have been selected.

Hospital Physics Dov. - Dec. 1957) Aim of the project. To supply hospital staff, research workers and public-health administrators with information on radiation protection in hospitals.

Assistanoe provided by WHO during the year. A consultant for six weeks.

Work done. The consultant arrived in India in the last week of 8ovember. He visited medical centres in India elhi hi, Lucknow, Madras, Bombay and Calcutta) and in Ceylon. At eaoh place visited, he gave a number of lectures, mainly on radiation protec- tion in hospitals. Ile discussed hospital phyeios in general with hospital staff and advised on radiation protection measures in the radiological units. His report is awaited. sW.RO 38 Production of Freeze-Dried Smallpox Vaccine R l~an.1958; - ) Aim of the project. To advise Member Governments in the Region on the rnoduotion of a thermostable dried smallpox vaccine.

Assistanoe provided by WO during the year. A consultant for one month.

Probable duration of assistance. Until the end of 1958.

Work done during the yew. The short-term consultant visited Thailand in January 1958 to assess local facilities for the D~o~uC- tion of smallpox vicoine. He has submitted his recommendations on the steps to be taken for the local production of freeze-dried smallpox "Vaccine Pfl.

bother short-term consultant for assignment to India and Indonesia is under recruitment. Oraanizational Chart '31 July 1958

Mfioe of the Regional Mreotor Regional Mreotor Regional Committee Dr. C. %mi ~ublio~nformation Publio Information Offioer I Mr. G. Boshell r Offioe of Health Servioes Mreotor, Office of Health Services Chief, Offioe of Administration and Finance Dr. A. Barkhuus Ms. A.G.B. Sutherland Regional Publio Health Administrators e Administrative Assistant - (vacant) Prn - Dr. L.G. Eddey PB2 - Dr. R.3. Bland pH3 - Dr. H. Riobards Administrative Assistant - Miss V. Peters Fellowship Unit 53. B.D. Hopkirk 1 ~r.J.M. vine Assistant Personnel Officer - (vaaant) Regional Advisers UeIedical Eduoation - Dr. J.M. Vine &lalaria - Dr.D.K.Viswanathan Jhlariologist - Dr. F.A.Ronnefeldt Reports Offioer Entomologist - ( C.Y. Chow - selected) Tuberoulosis - Dr. E.J.T.McWeeney Communioable - Dr. A. Zaka Disaaaes tlaternal and - Dr. P. Robinson Child Health ECE Officer - Dr. A.M. Gade Publio Health(Conr - Dr. A. Vuletio mity Development Area Representatives Health Statistios - Dr. E. Charles Burma - Dr. T.C. Puri Nursing - Miss E.S. Graham Ceylon - Dr. R.L. Tuli Nursing Off ioer - Miss F. Lillywhite India - Dr. J.F. Castillo Health Eduoa'tion - Miss V.V.DrenokEah Zndonesia (Dr. 3. Deew - Ehvironmental . - G. Ponghis selected) Sanitation Thailand - Dr. L.W. Fitzmurice. Publio Health - Dr. G. Mettrop Publio Health Advisers Off ioer Afghanistan - Dr. J.B. Petrie Public Bealth - (vaoant) Dr. Offioer Nepal - D.P. Rath Ad2 inistrstive Assistant - (vacant) J I I Field Projects 1 SEA/~c11/2 Annex 2

OeograpMcd Distribution of International Staff Assigned to South Ewt Aeia Region as of 31 July 1950 SWRCI112 Annex 3

Conferences and Meetings called hy the United Nations and Specialized &oncies at which WHO Was Represented

(1 August 1957 to 31 July 1958)

United Netions: Seminar on Civic Bangkok Responsibilities and Increased Participation of Asian Women in Puhlio Life

26 August - 7 September UNTAAI Seminar on Rehabilitation Solo (~ndoneaia)

13 - 26 November ILOc Fourth Asian Regional New Delhi Conference 9 - 20 December United Nations: Asia and Far East Lahore Seminar on Training for Community (~akistan) Development and Social Work

20 - 21 January UNESCO: Fourth Session of Advisory Calcutta Committee of UNESCO Research Centre on Social Implications of Industrialization in Southern Asia

(~ote:WHO had also planned to be represented at the United Nations Conference Inaugurating the Demogra- hic Teaching and Training Centre in Chemhur, India P 5-10 November 1957). Unfortunately the WHO represen- tative fell ill at the last moment. Conferences end Meetings of Governmental, Non-Governmental and Other Orpanizations at which WHO Was Repreeented

...... -...... , . .. . . --(1 August 1957-~~31.~.uly.1958):'. m 26 - 30 August Third Tuberculosis Congress Malang (~ndonesia) 24 October - Nineteenth International Red Cross New Delki 7 November Conference 16 - 17 November Indian Conference of Soci~lWork, Delhi New Delhi Branchr Third Annual Conference

18 November - Pacific Science Associationr Ninth Bangkok 9 December Pacific Science Congress 9 - 18 December Indian Council of Medical Researchr Lucknow Conference of Advisory Committees of the Scientific Advisory Board 13 - 16 December Sixth All-India Leprosy Workers Gorakhpur Conf erence 22 - 24 December Bombay State Maternal and Child Health Rajkot Conference 28 - 30 December Indian Public Health association^ Calcutta Second Annual Conference

2 - 8 January Indian Science Congresst Fortpfifth Madras Session 5 - 7 January Government of Indiar Sixth Meeting of Bangalore tho Central Council of Health 19 - 23 January Association of Paediatricians of Indiar Trivandrum Annual Conference 29 - 31 January Fourteenth Indian Tuberculosis Workers Maclras Conference 6 - 8 February Indian Paelliatric Societyr Ninth Annual Visakhapatnam Meeting 13 - 15 February Conference of the All-India Ophthal- Indore mological Society 15 - 24 February Asian-African Conference of Women Colombo 76 Februsry All-India Institute of Hygieno and Public Calcutta Healthr Twenty-fifth Anniversary Meeting 27 - 28 February Conference of State BCG Officers Aurangabad 26 - 30 May First Asian Regional Paediatric Congress Singapore SEA/RC II /2 Annex 5

. .. Fellowships Awarded by WHO

(1 nugust 1957 to 31 JU~Y1958) ! , .

Table I . . Source of Funds and Type of Fellowship

. . - . Source of Funda Total International Regional Country Regular TA

Afghanistan 7 5 12 7 5

Burma 9 15 24 7 17 Ceylon 1 4 5 2 3

India II 20 3 1 31 - Indoneeia 5 6 11 8 3 Maldive - - I alands I I I

Nepal 5 15 2 0 1 19 Portuguese - - India 2 2 2

Thailand 7* 4 II 10 1

48 69 1!7 68 49

* Of these, two awards were made under the Malaria Eradication Special Account (~sA) SEA/RC II /2 Annex 5 Page 2 Table I1 Distribution by Subject of Study and by Country

s 0 0 m Subject

& Health Organiaation and Services Public Health Administration - I - 1- -1 - - 3 Maternal and Child Health - - -21 - - - - 3 Health Education -2 - 2 2 -- - 2 8 Nutrition - I ------I Nursing 23 143 - -- 2 15 Environmental Sanitation 2- -31 - - 1-7 Mental Health and Psychiatric ------2 Nursing 2 - - Vital and Health Statistics - 1 ------I Hospital Statistios ------1 1 Communicable Diseases Malaria -6 - 3 2 -3 - 216 Tuberculosis - - - 2- - - - - 2 Epidemiology - - 1------1 Leprosy - 1- - - - - .. I 2 Leprosy (Lab. techniques) - - I - - - d - I 2 ~aoteriolo~~/~linioalPathology I ------1 Production of Biologicals ------I I General Laboratory Techniques 5 ------5 Medical Entomology - 1 - I - -1 - 3 X-ray Techniques -3 ------3 Clinical Medical Sciences and Education Preventive and Social Medicine - - - 4 2-- - - 6 Radioisotopes - - - I - - - - - I Anatomy I - - I - - - - - 2 Clinical Pathology - I ------'I Pharmacology - - -1- - - - - I Histology - I ------I Biochemistry - - - 1 - - - 1 - 2 Dental ~ducation/~ublicHealth - 2- - - - 13 Dentistry - - Paediatrics I - -2- - - - - 3 Hospital Physics - - - 1 - - - - - I Basic Medicine - - - - - 11 - - 2 Eealth Assistants' Training -3 - - - - 14 - - 17

Total 12 24 5 31 I1 I 20 211 117 I& I& 'pp.g&~!,!*

Graduato nurses. Rofrrshrr n.ollrrn.

Aealth superviaor students.

oaursr - 31 trainees Psndidikan tanagn (rursl sanitarians). tr~inirtpn; pqrt nf the regulvr aourse (3 ~esrs). Pengamt kseehatan ~n~ix~~rn~t~tnlsnsi tntian theozetioal nnd field Continuous (malaria inspaotors). tnlininp as pvrt nf the regulnr aourse (2 ears) 1 ooar~?- 22 trainees Bale nureeo. Trninir~alti port li~nlthsonitntion (2 years? ' Continooun 2 cournrr - 2 trainees Xontrolir end n nale nurse. 1nor1~Jo0 trntrlt!~~in port liealth work. 7-4 months harovroalogi snd ?%%% 519 trainees Medioal students. llornill un,lrrgr,lmtc course in pharauloologr. Continuous 6 coure?s - 10 sti~dknts Student assietants. Thooratir?l unl arperimsntsl trainins in anatomy. Continuous 1 aourno - 70 atudenta Nedioal students. llornnl whriergmilusie course in anatonpi. C~ntinuo~s

mm. . ~ 1 aortroe - 3 ntudenta Student assistante. heo ore tin-I n11.1 c.xperimenta1 training-in Cotitihll~~~ *h?isiolo~,~. 1 courn - ?a students Nedi0~1etudents. Norrml r,iil"rep (3 y~nrs). can ti nu^ Eduaation 2 ooorees - 37 treinees Health asaistsnt trainees. Instructionn m genonl ounttiv~nnd Cantinmu Pre~enti78vork (7 yebr~).

f aoums - 13 trsinees Third grsda eanitnrians. Intronuollon into snno aompai~naotivitioa, 5 weeks inoludir,a olitlirnl nnoootn. tranemisoion nnrl -... 1 oorlrse - 8 trsinees Nedical officers. Revies of piaa or,rlirol work in various sub- 10 dny~ headquarters, e~garimsntalintegration, evaluation of work, reporting, supemleion. 1 oo~trao- 58 trniness Selsated ntudents and fourth General training for health aorkers engaged 1 year grsde sanitarians. on yewo cnmpaip mllj. 4 oolrr-ro - 59 trainems Pravinoial health affioers, Theorrtiml nn< prnotionl training in leprosy 1-1 weeks 1ebPratorY teohnioians, senior oantrol, inborntr,ry work, eto. sanitarians and other euxillely ~t~ff. -NursFlg I aourse - 11 trainees Graduate nurses. Inoerrion rminini: in superviaion of tmining 1 anok of innignnolln hlirlrivaa. 1 oaurae - 5 tminees Graduate nurses. Innervioe tninil8~in nursing euperviaion. 6 months 1 ocslrss - 21 trninaes Graduate nurses. Post-gmluota ai~Iertutors oaurae. I year 1 ccllrsr - 34 trninees Gradwte nu2988. Paet-gn~lllste trailling (2 yeorb). Cantinuaus 2 enhooln - 333 trniness Student nurses. Gnnaral ,>urnin8 ronrso, including midwifery Continuous nnd public lienlti~nursing (4 yenre).

Trnining in the honlth ospeoto ao part of tho Continuous fundnmentnl ~aot.1 iivn oourno (2 yesre). &.terra1 and Child Ben1 th Gcouraes - I3 trainees motors, publio health nwesa Inser~iortrvinirlg, evnlustion of mternb.1 and 2-4 weks snd midwives. ohilg he3lth ~crrioe,hsolth survey of young ohildron.

Pnotionl hioohemioal vork. 4 months u-. ,-.- . Annex 6 ' Pago 3

Catsgaq of Tralnoes TyDeuf Training

w-First aim and &&$ens 1 month 75 tlai~res Student teaohere. Tclohnr trni,>iliR. aealtth Visiting -57 tratnees Student health irieitors. H~*Jth ..ipitnrql training course (28 years). Psedit~trioNurslnd -415 t~~inees Ornduate nurses. Rnfri.4tsr oo%~rir . 1 month 150 trainesa Student nurses. Oonerrl mrrns trnining oourae (3 yoare). Con tinuode IIenlth vinitv,r- training oourse years). Cantinuout ,,3 15, , tmlnnaa...... - student health visitors. (a ---Heal kh Eduos @ 5 onomes - 79 trainee. Stste Direatore of Wberoulasis, Illncr'rior tnlni!lg in heelth eduostion.

nnntora.~ aaaistnnt surcaona and -.. . -, ~--~~~ - health sduostion students. 10 month* I ocurea - 96 tralneee Keslth edunstion students. mplon~ranurn- 1,s publia health. 6 oc"rae8 - 159 trainees Dootors, sanitary inspeators, neori-utaticn in ~ublioheelth and pre-sarvioe 1-8 weeks lady hsalth vinitors, nwses. trRilliinR. 10 drys I oourne - 14 trsineea Health eduoetion staff and Leotur-s and RTOU~di00UDSionB on prinoiplos -.. . - - .. - . of hnrl tli rduoation. bternal and Child Bealth 6 oliursee - 197 trainees ICE students, house phyaioions, teoturnn, nrmirlnrn snd praotioal mark on ohild 2 reeks - medioal students, heslth henltl<. 7 months visitors and nuras trsineee. 1 rmrae - 45 treiness nediae.1 etudente. FialcI srnvs) of sillsges in reepsat of the 12 days healtl, of thn aohool-ega ohildran. 1 ouurae - 12 ~tudente mH students. Out.-pntient and ward leoturss on peodistrioo. 1 yenI 2 couraea - I03 atudsnta Medias1 students. OUt-pe tient .~ndward lsoturee an podistrio*. 1-43 mont Environmental snitation 7 coursea - 12 trainees Realth ineoeotore. 1-3 month leoturea an* field aork. I course - 15 trsineea B.50, and publio health Post-graduate ctodies in pnblio health Cantinuou engineering students. engineerin8 (I5 to 18 monthe). I aourae - 28 trainees Student health ine~eotor. Looturca, demot~etrationend field work in 9 month8 environmental osnitation, ee part of the

re.-"lRT 0"UTBB.- ~ " ~ Ban !el Hsslth I OOUTB~- 10 tminees Post-gredtmte dootors. Trninin,q for diploma in payohologiaal mediolne Continuou (2 yr;irs). .2 aouraes - 40 students Poat-oertifioste geneml Tminini: for riiplorul in peyahalogical motioins Continuou! ~UPSCB. (7 rr~.rs). 1 oourse - 20 trainees bm:iliary nuree midwivaa. TOacliinp of elementaq pqyohie.tria nursing. 1 year 2 :oursee - 35 trainees Midrivea. Trsirli~win elementaq psyohology and hums" I month . Pr~vcntiv.3end Social rela tians. -?hi*: Staff cnd atudente of mediosl Leotnmn on praveniive and ~ooiblmadlolhe. Lectures I oolleges

K&ll 2 noureea - 24 treineee Yantri etudente. Pr~oticalnrM theoretiaal inetruationa in I-Q yeors nolnrin oontrnl and durvsy. 4 cnurass - 39 trainees Mediosl offioers. PzOoti~?Iand fheoretioal inatruotiona in j malarin control and eradioation. 4 oouraea - 23 trainees Yolarie teohnioiane and ~hs~~ito00ll~~tion ~nb diaeeotion, wraeite 2 weeks ' inseot collsotors. ldio tif ira tim. I ooures - 150 trainees Hediaal students. Thooratianl ?nd praotioal inetruatiana in 4 months medioa 1 nnlnrrr~lom..~. ooursee - 5 trainspe Djumjateks and nurse* Field Lminfnr in leprosy oantral 4-6 week4 Aexlth Statiatioa ( 1 oorwee - 47 trainees Student sanitary inepeotors. Leoterns ,and pmoticsl rork. 88 hours : I oourse Dootora ond medioal students. Loaturon on nt~rvelteahniquas. - -Health Muoation 1 course - 10 trainees Staff of Health Eduontion Inser':loe rmlning through disaueeion. Division. 2 oooraee - 70 trainsea hlsria workers. ~ortsani- Rofrenhac oorrreen. tarians and asiiatant midwives. i onaraea - 01 trainee. Dureea, midviivea and health Leotllmn nnd <

AJ'GUNISTkN

mberauloaie 1 aourse - 16 trainees botora end nuraea. Leotures and demonstrations. Lsaturea only Clinioal Patholo& 3 OQUrae0 - 33 trainees Laboratory teohnioians, ihborii- Theoretioal and practioal training in oliniaal Continuous tory aaaistants md medjoal pathology and laborstory teahnipusa off ioers Publio Bealth Administration 3rd aowae - 7 traineee Hrifr~shercourse in publio health. Off i~eAdminietra tion and Library Xethods I oourse - 6 traineea Dwwnatration in offioe adminiatration and 1 year library methods. Health Statistias 1 aourse - 35 trainees ifadios1 students. *'our ie~twesan publio health statiatioa. Lsc turaa only )luraing 31 trainees Stlldant nursea (msle). Qenaral nuraing course (3 years). Canainuous o~adwtenureee (male). Rcfrsshsr oourae (part time). 1 year

Student midwives. ldldwifery trainin oourse (28 months). Cantinuoue 32 traineee Graduate midwives. Asfresher oaures ?part tima). 6 owntha Nursing and Yldwife 2 oourese - 12 trazees Student kasistant nws+i#,ld'!~ivad. Elementary nursing and midwifery aourso. Con timlous ~aediatrioa 2 oourses - 35 trainees &dioiil students snd post- Lsatures and olinioal demonstrations, 2-8 months gnrdwo trainees* pra.gotioa1 training in the Rsnta Environmental Ssnitatim 1 nouse - 40 trsinees Sanitarian students. Environmental sanitation, thsoretiool and Continuous fiold training as part of the regular oourae. 1 oourss - 6 traineee Village level workers. Oriontation in -1 sanitation. 5 months Psraonal and Community Bsalth I 1oourse - 16 trainees .Law students and aivii earvioe Theorstioal training in personal and offioera. oomity health. Preventive and Sooial Uedioine -1 oourae - 160 treinses Yledioal students. Undurgraduate oourse in eooiel and preventive Con tinuaus medioine.

-llalaria 3 ooursea - 70 traineee Malaria snd entomolo~ioirl Lootu~os,i'r~onstrhtiolls ;PO pxaotioaltraining 2-4 months assistants, mslaria inupaoturb in maloriologg, entomology, onsgulto oontrol, and laboratory toohnialans. huumtology, paraeitolom and laboratory toobnisusa. l'ubemuloais 3 oourssa - 26 trrrineea Dootors, nursea and ottzdefits. Lectures and praotioal demonatmtion on TB 8-12 monthe oontral; home asiting and domioiliary treatment of TB* inservioa trnining. Vital an& Health Stetistias 2 aouraea - 45 trainees Dootors, sisters and olvff 1,eotures end pmotioal work 00 vital and Cantinuoke nurses. honltb atatietios. Nursing 1 oourse - 11 trainees Oraduote nurses. Pust-&mdmte sister tutora' oourae. 1 yanr Phvsiolo d-372 trainees Mediaol and soienoe atlrdsnta. Uudergraduate ooursea in physiology and Contiztwu~ urisntetian for &So. etudents. F'revantive and Sooial Uedioine 1.- -180 tr~ineea Uadioal students Undo~grsdustemedioal oourse. 0ontinu~uai .~- ~- ' Note* The figures in this table have been obthlllad fruii; WHO field staff in reapeot of their training aotivitleo. 1 Beaause of passible omissione in or dupllolition of ruporting, the figures oannot ba regarded as oomplstoly soourate. They do, however, represent a ruliable reoord of training aotivitiea during the year.

...... ~ , ...... * Annex 5 Page 2

nfsotiaus Diseases -ontrol 4 oournos - 87 tzsinoes Physicians and mediozl affioers 'P~a.ining ill diagnosis, notifiaotion and 3 days each of hsalth. aon tral nf infeotious diseaeea. month

Graduate nurses. Relr~~horaourses in toaohlng and publia 2-3 month6 h-1 th nrrr line supervision. wfsy 2 courtlea - 49 trainees Student midwives. hi? li.r,,n l :,nd ahild hr:<h onpeote of mid- 5 months .7j re,ry 9t.,,T8<>. wnaL and Child

17 ooucses - Medical officers, publio health Rtrr~sheroourses, inscrviae training, 2 weeks - 217 trainees inspectors, apothecaries, srrpnrvisor. training in maternal and child 6 months teaohers and voluntary workers. h*~lLh,h-alth cduontion, puhlio health ~>,a1tygj.one. eronmentsl Sanitation 3 oourees - 22 traineoe Officers in ohnrge of Heolth R~f'~'.~her'IOUPRO and training in ehviron- 2 woks Off iae~. I,\-nt:.I i~ni,t~tion.

Asoistant Director, assistant Cc,!ot.io:. 111 r-lation to insect resiatanoe. entamoldgist, research sssistnnt, sonior laboratory assistont and other workers in the insaoticidos laboratory. Tubera~Llonis I oaome - 1 trainee Itediool off ion?. Tn::i,r?ioe (.raining in tuberoulosis ..... " - L34y health visitaaa. 1.9~t!trcma rind prootiool wo~kin different 2 weeks rlr~partmantb related to tuberoulosis oontrol.

2 oaucsea - Medioal~~ ~~ students and new Sgr,~illnrson :ubereulosia oontrol and viait to - 125 trainees grnduates (MBBS). tnl~~ratrlcriiacentres. 2 collc4es - 5 trainees X-ray technician trainees. l~%-taresoad demonstrations on r-mv 1 month t'"hlliq'~"s. Public health midaives,tubsr 'Trpinina in tuberoulosis home visiting and 3 weeks - aulosis health visitors and ,,,:,r4 41,ty . 8 months medioal students. Communioable Eve ---Dineusss 1 oqurne - 26 trainees !fediool affiaere, with past- Ci'n4lw.r m oummunic3bln eyc diseases, including graduate qualifiostions in clinics m? field ilamonstratione. ophthnlmology. --Vital and Health --S?atistioa 3 collroes - 21 trainees Statisticians, statistical I-~turos, seminsrs and prsatical work related olarks, sanitary inspeotors. i.' -rit?l 2nd health stntistics.

Student nurseb and atudont R;vj.c mrrn inp couree (Integration of publio Continuous nurse-midwives. Ir~vitli irsro the hpsio ourriculum). Auxiliary nursa-midwives. Ilri ivn tstinr, to pub1 io health nurning snrvioea. 3 months Graduate nurse-midwives. 0~irlltit tior to publia health nursing servioes. 46 months Graduate gublia honlth nurnes Ln-..~r"so. Lmining. 1 month and health visitors. 5 courses - 89 trainees Ward sisters, sister tutorn R-ir~ah-rrwrses in nu*ging administration. 1 month Kidwi1:re~ and matrons. 220 trainees Graduate nurses. IIic!,:iifury aorlrse (domiciliary aepeots). 6 months 64 t rnineea Student health visitors. lii,l?ifer~ ooursc (domioilinrx aspects ~ ~ - Continuous 2.L >PO,,). Graduate nurse-midwives. Di !ylor,:i c,rl~l.nc for midwif e tutors. 1 year - - Bidwives and nurse-midwivoo. Rcfrcnhrr cnuroo in domioilinry midwifery. 1 month 216 tmineee anoh course Domiciliary Care 50 traineos Medionl undergradun tes. 'I'r:,ininp in home visiting for domioiliary 3 months C~TBan3 honlth tsnehing of postnatal patients (part time).