Wokld Health Organization Regional Office for South-East Asia

WOKLD HEALTH ORGANIZATION REGIONAL OFFICE FOR SOUTH-EAST ASIA

TWENTY-THIRD ANNUAL REPORT OF THE REGIONAL DIRECTOR TO THE REGIONAL COMMITTEE FOR SOUTH-EAST ASI.4

1 AUGUST 1970 - 30 JUNE 1971 CORRIGENDA

Please make the following changes in document SEA/RC24/2:

In the third line from the top, reword the sentence "It is gratifying ....'I to read as follows: "It is gratifying to report that several large projects are being promoted with assistance from the UNDP Special Fund. These are: education and training of health manpower in Burma; public water supply, drainage and sewerage for the south-west coastal area in Ceylon; water pollution and drug laboratory techniques and biological standardization in India; occupational health and industrial hygiene in Indonesia; BruceZZa vaccine production in Mongolia, and water supply and sewerage in Greater Kathmandu and Bhaktapur in Nepal".

Under 1.1.2, Organization of Basic Health Services, in the third paragraph deZete the last sentence.

Under 1.3, Nursing, reword the second paragraph to read as follows: "Among the studies mentioned in last year's report was the activity study of public health workers in Thailand; this study was completed, and the report is being processed in the Regional Office. The report of another study in Thailand of the activities of nursing personnel employed in hospitals was issued and has been translated into Thai by the Government. Its findings were used to bring about changes in nursing and midwifery curricula. Also, plans are under way for a study to develop a methodology for reviewing the work of the indigenous midwife in Thailand".

In the second full paragraph, third line, read "assistant" for I9 assistance".

In the table on this page, in the column relating to cholera deaths in Thailand in 1969, insert "40".

In the first footnote under the table on this page, insert ,Ipercentage of the" before "Average".

In the second line from the top, read "field" for "control". In the ninth line, read "batches" for "bottles".

In the third line from the top, reword the sentence starting with "A WHO team.. . .", to read as follows: "A WHO team visited Khon Kaen and held discussions with the national authorities on the various aspects of developing ahealth sciences centre at Khon Kaen University". 49 In the table on this page, against the total number of fellowships in 1970, read "537" for "539" and, in the grand total, read "1629" for "1631".

50 In the eighth paragraph, against 1970, read "537" for "539".

122 In project India 0244, under "Work done during the year", in the first line, insert "to the All-India Institute of Hygiene and Public Health, Calcutta", between "assigned" and "to".

In project Nepal 0029, under "Co-operating Agencies", add "UNICEF".

In project SEAR0 0178, under "Assistance provided by WHO during the year", read "eighteen thirteen-week fellowships.. .." for "seventeen thirteen-month fellowships.. .. " 1 6 P~~lt:.h, Vicr-F~r!~~lc~tnl I!!+II.I, who ina~~guratedrhr ~wc~try-rllirdnuion # nhb W1(0 Reqit:nil Cnnnmltfm in? %outh-E%l 3 held in Hew klhi in 5r:premb~rIWO. In ramamhlimi ,dth Or L.l!uvo.d WilO'c P.uk

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TABLE OF CONTENTS

Introduction vii

PART I - GENERAL REVIEW OF ACTIVITIES

Public Health Administration Planning and Strengthening of Health Services National Health Planning Organization of Basic Health Services Operational Studies and Health Manpower Family Health Nursing Environmental Health Health Education Nutrition Mental Health Dental Health Occupational Health and Rehabilitation Radiation Health Cancer Cardiovascular Diseases Quality Control of Pharmaceutical and Biological Products Medical Stores Management Hazards to Man from Pesticides

Communicable Diseases Malaria Tuberculosis Epidemiological Surveillance and Quarantine - Quarantinable Diseases Smallpox Cholera Plague Typhus and Other Rickettsia1 Diseases Bacterial Diseases Leprosy Venereal Diseases and Treponematoses Diphtheria, Pertussis and Tetanus Virus Diseases Trachoma Poliomyelitis DengueIHaemorrhagic Fever and Other Arboviruses Influenza and Other Respiratory Viruses Viral Hepatitis SEA/RC24/2 Page iv

2.6 Parasitic Diseases 2.6.1 Filariasis 2.7 Veterinary Public Health 2.7.1 Rabies 2.8 Immunology

3. Health Laboratory Services

4. Vaccine Production

5. Health Statistics

6. Education and Training 6.1 Medical Education 6.2 Paediatric and Obstetric Education 6.3 Teaching of Human Reproduction, Family Planning and Population Dynamics 6.4 Fellowships

7. Technical Information and Reference Services

PART I1 - ORGANIZATIONAL AND ADMINISTRATIVE MATTERS

1. The Regional Committee

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

3. Procurement of Supplies and Equipment

Collaboration with Other Agencies United Nations United Nations Development Programme (UNDP) United Nations Children's Fund (UNICEF) United Nations Fund for Population Activities (UNFPA) World Food Programme (WFP) Economic Commission for Asia and the Far East (ECAFE) International Atomic Energy Agency (IAEA) SEA/RC24/2 Page v

Office of the United Nations High Commissioner for Refugees (UNHCR) Specialized Agencies United Nations Food and Agriculture Organization (FAO) International Labour Organisation (ILO) United Nations Educational, Scientific and Cultural Organization (UNESCO) World Bank (IBRD) Non-governmental Organizations in Official Relation with WHO Inter-governmental and Bilateral Agencies National and Other Agencies

5. Public Information 71

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

Project List 77

Burma Ceylon India Indonesia Maldives Mongolia Nepal Thailand Inter-country Inter-regional (Projects Within the Region) Inter-regional (Projects Outside the Region with Participants from the South-East Asia Region)

ANNEXES

1. Organizational Chart

1A. Proposed Organizational Structure

2. Geographical Distribution of International Staff Assigned to the South-East Asia Region SEA/RC24/2 Page vi

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

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

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

Research Activities in the South-East Asia Region Supported by WHO Grants

Fellowship Tables

List of Technical Reports Issued by the Regional Office

GRAPHS

Population at Malaria Risk in the Areas Under Various Phases of the Malaria Eradication Programme in the South-East Asia Region (1962-1971)

Fellowships Awarded by WHO, by Subject of Study and Country of Origin of the Fellow, South-East Asia Region

Fellowships Awarded by WHO in the Last Five Years (1966-1970), South-East Asia Region SEA/KC24/2 Page vii

INTRODUCTION

A number of significant events and achievements have marked the period under revieu. Among these, I should like to mention first of all the official visits of the Director-General of the World Health Organization, Dr Marcolino G. Candau, to Burma, Ceylon and India, where he had the opportunity of seeing some of the more important projects that are receiving WHO assistance and of having discussions in depth with the highest authorities of these countries. Dr Candau also paid a visit to the Regional OfJ'ice and addressed the staff, and this was a great encouragement to us all.

Another important event was the meeting organized in Bangkok in October 1970 to discuss national health planning. This was attended by very senior officials of the goverwnents of the Region, including administrators, and the opportunity was taken to discuss also what steps might be taken to promote in Asia a health charter for development. In view of the considerable experience gained in the Region of the Americas in connection with the Charter of Punta del Este and the health aspects of the Act of Bogotci, we were fortunate in having with us in Bangkok, through the courtesy of Dr Abraham Horwitz, Director of the Pan American Sanitary Bureau, WHO Regional Office for the Americas, one of his senior officers, Dr Hector Coll, who gave us the benefit of his broad experience and of his enthusiasm. There was a very positive response to the idea of promoting a health charter for Asia, and I was given the mandate of approaching the Director of WHO'S Western Pacific Regional Office and of exploring dith him what might be the best frame for such a charter. The meeting felt that an association oJ the South-East Asian and Western Pacific Regions might represent the most desirable grouping. I was also asked to start collecting essential bas~linedata on health and development in the Region so that measurable aims and precise targets couZd be defined before the next meeting is called. This work is nm going on.

I should like to mention also the considerable achievements of the progrmes for the control and eradication of smallpox and malaria. Detailed figures are given in the body of this report, and it will be seen that the total nwnber of reported cases of smallpox from 1 August 1970 to 30 June 1971 represents a decrease of 37% when compared to the number reported in the preceding year. Burma, Ceylon, hlaldi.ues, MongoZi~ and Thailand have remained free of smallpox, ard in Indonesia a total of 1 525 cases were reported in the first six months of 1971, only 66 of which were reported from the whole of Java. It is worth recalling that, in 1967, before the start of the progrme, 85 per cent o.f Indonesia's population was Living in smallpox-endemic areas. This figure is nm 10 per cent.

In malaria, progress has been very satisfactory, and significant percentages of the population are now living in areas under consolidaci~;n or maintenance (Burma SO%, india 75%, Iliepal 78% and Thailiind 74%). In SEA/RC24/2 Page viii

Ceylon, an encouraging decrease in the slide positivity rate has been reported, and the control of the epidemic is in sight. A comprehensive plan for malaria control has been developed for Maldives, and a new plan has been prepared with the Government of Burma. It is gratifying to note that our Member Governments have adopted the more flexible new global strategy for malaria eradication and control.

I should like to refer to the important expansion of our progrannne in environmental health. While in the past the main emphasis has been on cornunity water supply, we are now embarking on other environmental health fields, and particularly environmental pollution. This has become a matter of very great concern to our Member Governments, and most of them are encountering severe financial problems in view of the fact that the funds that are available rarely permit the passage from the pre-investment to the investment phase. Drainage and sewerage, particularly in the larger cities, and pollution of the atmosphere from growing industrializa- tion and heavier traffic represent major problems for the health authorities.

Several governments have manifested a keen interest in problems of health manpower and of delivery of health care. Studies have been started in Thailand and in Ceylon, while the project in Rohtak (Haryana State), India, received further assistance from WHO Headquarters and Regional Office staff. It is becoming evident that governments are concerned about the rising cost of health services, particularly hospital services, and that more attention is being given to the quality of delivery and to its coverage.

Pursuant to the wish expressed by the Regional Cornittee last year, the first steps have been taken to recruit an economist who will be available to co-operate with governments in their planning and evaluation of programmes. Tuo senior consultant-economists, one from the School of Public Health, University of Michigan, and the other from the School of Hygiene, University of Toronto, studied the problem in some depth and made useful recononendations on the scope of this post and on the role which such an economist might play in the Regional Office.

I mentioned last year the creation of a programme support and co- ordination unit in the Regional Office. This is now headed by an Assistant Director of Health Services, and the unit will include a planning officer, a project management officer and a programme analyst. The project SEAR0 01 48, "Strengthening and Development of Health Services", is placed under the direct supervision of this unit, and an operations research specialist and the economist mentioned above have been added to the staff of the project.

The first concern of this unit has been to organize a better monitoring system of progrme delivery which allows the Regional Director, at any time during the year,to pinpoint areas where greater effort may be SEA/HCZ4/Z Page ix necessary and where action must be taken to expedite the execution of a project. The next step will be to achieve better detailed planning of the implementation of approved projects, using modern management techniques and tools. This approach has already been adopted with benefit for large inter-regional projects such as the Research Unit on the Genetic Control of Culicine Mosquitoes in Delhi. Attention is also being paid to improving the retrieval of information so as to better the evaluation process. The unit has also assisted in the planning and conduct of the health manpower studies mentioned earlier.

Another urea which is rzeceiving even more uttention than before is education and training. In the organizationai pattern adopted since 1968 in the Regional Office there has been no single senior technical staff member responsible for the overaZl co-ordination of education and training activities. Training cannot be isolated from services, and it is just as important to have the views of the consumer as those of the teacher. In other words, training must be related to health manpouer needs, and the training of the different members of the health team must be co-ordinated. I have decided, therefore, to establish a task force on education and training in the Regional Office, to be headed by a senior staff member who will not onZy be responsible for the overall education and training progrme of the Region but also be placed in charge of the Regional Office Library and of the new documentation centre that is being established with assistance from the United Nations Fund for Population Activities IUNFPAI. He will also have a supervisory responsibiZity over feZZowships.

Funds made availabZe by the UNFPA have made it possible to elaborate a considerable number of projects related to areas of family health. An increasing number of group educational activities has been planned. It has become apparent that the detailed planning of such meetings must take place earlier and the venue and the exact dates decided upon long before the operating year starts. This means that the recruitment of short-term consultants also has to be started earlier, and considerable progress has been made in ascertaining our recruitment needs two years ahead. In famiZy health particularly, the demand for technical talent is becoming enormous, and the numbers of able people still remain few.

Comnicable diseases remain, of course, the Region's largest problem. Although the malaria situation is not alarming, one cavz f~reseein severat countries a manpower crisis at the same time as the interest of the financing bodies flags. Governments should give some attention to this problem if they are not to find +hemselves suddenly deprived of essential technical talent. Another danger area appears to be poor planning and logistics in the procurement of essential insecticides, even when funds are available; in places where the first cycle of spraying has been delayed, the possibilities of an epidemic are reat.

Cholera has spread westuards very rapidly, reaching a number of countries in the Eastern Mediterranean, African and European Regions. In SEA/RC24/2 Page r

South-East Asia, the fact that cholera has been reported from many more areas than hitherto would indicate an improvement in surveillance and in diagnostic capacity. The fear of choZera in relation to tourism and trade appears to be waning. Health laboratory services continue to develop with both international and bilateral assistance. Attention is being given to the organization of peripheral health laboratory services and to the integration of specialized units into the general health laboratory service. The staff of the RegionaZ Office have taken an active part in inter-agency co-ordination meetings held at various levels in both DeZhi and Geneva in an attempt to cope more efficient% with the problems caused by the inflm of refugees from East Pakistan. The supply units of the Organization have been relating their efforts to those of other agencies, and emergency supplies have been flown out at very short notice. A Regional Office staff member took part in the first mission of the United Nations High Commissioner for Refugees (UNHCR) which visited some of the cqsin India, and assisted in drming up a list of priority health needs. The Regional Office was host to the Fourth Meeting of Directors or Representatives of Schools of Public Health, which was held in March. Participants came fMm countries of the African, Eastern Mediterranean, South-East Asian and Western Pacific Regions of WHO, and the meeting was also attended by the Regional Directors for the Eastern Mediterranean and for the Western Pacific. Unfortunately, illness prevented the Regional Director for Africa from attending; he was represented, however, by one of his Assistant Directors. Reports given by the representatives of the schools showed that not only had technical progress been made in traditional fields b~tteaching nm also embraced new areas such as health planning, the management and evaluation of health services and the epidemiology of non-comnicable diseases. Accepting the recommendations of an interim committee which had worked for some time, the schools of pubZic heaZth of the four WHO Regions formally established a new association, the Association of Schools of Public HeaZth in the African, Eastern Mediterranean, South- East Asian and Western Pacific Regions of the World Health Organization. Officers of the Association were elected, and action was taken toward6 forming a preparatory committee that would investigate the feasibility of forming a World Federation of Associations of Schools of Public Health. Thhe United Nations Development Programne (UNDP) held its Third GZobaZ Meeting of Resident Representatives in February in New DeZhi. The opportunity was taken to have discussions with the resident representatives from all the countries of the Region, and close working relationships continue to obtain between the representatives of WHO and those of SEA/RC24/2 Page xi

the UNDP. The concept of country programing has been the subject of much discussion, and the implementation of this concept is now starting in some countries. It is gratifying to report that several large projects are being promoted with assistance from the UNDP Special Fund. These are: education and training of health manpower in Burma; water pollution, and drug laboratory techniques and biological standardization in India; occupational health and industrial hygiene in Indonesia, ad Brucella vaccine production in Mongolia. It is particularly satisfactory to note that the UNDP is beginning to take an active interest in the education and training of health manpower, and interest is also being shown by the World Bank, as can be judged from some of its recent reports.

Co-operation with the World Bank is becoming closer and more frequent. WHO staff members have participated in some of the Bank's sectoral missions, and the staff of the Bank have visited the Regional Office several times to discuss projects of mutual interest in the fields of enviromental and family health. Another interesting development has been the establishment at our Headquarters of a panel of engineering experts from the World Bank who wiZ2 be avaiZabZe to participate in the several review meetings of Special Fund projects. In this way, we hope that recruitment of competent,experienced sanitary engineers for this purpose will no longer be such an acute problem.

It is hoped also that our regional financing institution, the Asian Development Bank, will feel it useful to promote similar co- operative relationships. In this connection I should like to report that white on a visit to Manila I made it a point to call upon the President and to have discussions with officers of the Bank.

During the year a permanent WHO Liaison Office with ECAFE was established in Bangkok under the inter-regional budget. The Liaison Officer has been very active, and as a result it has been possible to have much closer contacts with the various divisions of ECAFE, particularly the one concerning population. The Liaison Officer also has the responsibility of maintaining close contact with the office of the Ezecutive Agent of the Co-ordination Committee for the Development of the Lower Mekong River Basin. At the request of this Committee, a WHO sanitary engineer was assigned to work with the Executive Agent and to advise on the health problems that it was feared might result from man's interference with the natural flow of the Mekong River. In particular, great care was taken to avoid the recurrence of epidemics of maZaria among construction workers.

Our co-operative relationships with the offices of UNICEF have remained excellent, but the Committee will regret to note that YNICEF's assistance to health programmes is decreasing.

It is my intention to promote very much more actively a regional progrme in cancer control. A pilot project in this field, assisted SEA/RC24/2 Page xii jointly by our Headquarters' Cancer Unit and by the Regional Office, is currently operating in southern India. It is hoped that the experience from this project will be of use to cancer control progrmes in other countries. Member Governments are also taking a growing interest in cardiovascular diseases, including, of course, the very important subject of rheumatic fever, in which so much can be accomplished by a preventive progranme among the younger age-groups. In order to provide the technical competence necessary to promote progrmes in these fields, a post for a regional specialist in chronic and degenerative diseases is being established.

The post of regional adviser on tuberculosis has been abolished because the need for technical advice in tuberculosis has decreased, since there are many specialists in this field in the Region. The Regional TubeeruLosis Training and Evaluation Team remains available in any case, and the services of consultants are also being provided when requested.

The development and strengthening of occupationaZ health services continued to receive attention. WHO co-operated with the Government of Indonesia in the preparation of a draft request to the UNDP Special Fund for assistance in establishing an industrial hygiene laboratory and in training health personnel required for service in sconomically productive areas. In November, WHO organized a symposium in Ahmedabad, India, on academic education and training in occupational health and hygiene. Occupational health has been included as a separate item on the agenda of the Regional Cononittee's session and will no doubt be discussed in detail.

In all, 32 group dducational activities were organized in the Region during the year. The subjects included national health planning, maternal and child health, family planning and human reproduction, rehydration therapy, nursing, water pollution, school health education, the teaching of psychiatry, organiaation of mental health services, occupational health and hygiene, quality control of drugs, smallpox, health laboratory services, health statistics and medical r ducat ion.

During the yeax under review WHO has given assistance to 255 projects in the Region, of which 41 were inter-country projects and 205 country projects. The total also includes 9 inter-regional projects sponsored by Headquarters in which the Regional Office Fas participated. The broad health fieZds covered by the projects were public health administration and basic health services (171, maternal and child health (271, nursing (211, environmental health and water supply (22/, health education (91, nutrition (7), mental health (41, dental health (51, radiation health 112), quality control of drugs (6), malaria (111, tuberculosis (101, smallpox (8/, leprosy , other cononunicable diseases (17/, health taboratory services and production of vaccines (161, hzalth statistics (71, direct assistance to medical institutions (131 and other activities (361. Brief descriptions of all these projects are given in Part III of this report.

A comparison betmeen the numbers of fellowships awarded during the periods covered by the last report and this year's report shows SEA/RC24/2 Page xiii an increase in the total as well as in the percentages in some fields. The increase2 are in public health administration +49%; enviromentaZ heaZth +71%; nursing +39%; maternal and child health +lIO% (this has been possible because of the availability of UNFPA funds), and clinical medicine +104%. In all, 474 fellowships have been awarded during the year under review as compared with 349 during the previous year.

In this short introduction I have ngt attempted to summarize the body of my report, which, I trust, will be studied and discussed in depth by the Regional Cornittee. The WorZd HeaZth Organization is the only body in the United Nations system to have regional committees to guide and counsel the regional directors, and, as is well known, the Director-General, the Executive Board and the World Health Assembly attach very great importance to the cornents of these committees.

I am in the fortunate position of having been abZe to visit the countries of the Region more than once, and it is my impression that the close continuing co-opera tion between the hea Zth authorities and the WUO representatives is giving a new coherence and meaning to our joint efforts and to international health work.

It is encouraging and reassuring that, in this Region, governments are participating more and more actively in the work of the Organization. The Regional Office is receiving from Member countries a number of suggestions and new ideas that have helped me to formulate th progrme. My stuff and I are indeed most gratefuZ for their generous support and unfailing understanding.

V.T.H. Gunaratne, F.R.C. P., D. P. H. Regional Director PART I

GENERAL REVIEW OF ACTIVITIES SEA/RC24/2 Page 3

1. PUBLIC HEALTH ADMINISTRATION

1.1 Planning and Strengthening of Health Services

The governments of South-East Asia are continuing to give priority to the expansion and strengthening of basic health services and to the integration of specialized programmes into these services. In most of the countries, due attention is given to national health planning, and, in several, studies of health manpower are in progress or are under preparation. During the year, WHO has assisted with these activities at both national and regional levels.

1.1.1 National Health Planning

Assistance to national health planning during the year took the form mainly of organizing an important discussion group meeting and the second regional training course.

A discussion group meeting on national health planning was held in Bangkok from 12 to 14 October 1970. At this meeting, to which senior officials of health and related ministries from the countries in the Region were invited, the discussions centred on possible approaches to obtaining further financial support for the improvement of health and on the development of health planning units by Member Governments. Great interest was expressed in drawing up a social charter, with specific goals and targets in the field of health, for the countries of the South- East Asia and Western Pacific Regions. The meeting decided that as a first step WHO should co-ordinate the collection of baseline data and should subsequently prepare projections on the basis of this information. It was also proposed that a meeting of Ministers of Health should be convened later to examine the data and decide on further action.

The Second Regional Course in National Health Planning started in New Delhi on 4 January and ended in Bangkok on 4 April. It was organized, as was the first course (held from November 1969 to February 1970), in collaboration with the Asian Institute for Economic Development and Planning, Bangkok, and the National Institute of Health Administration and Education, New Delhi. It was attended by eighteen participants from the countries of the Region and followed a revised syllabus, based on experience gained in the first course. (For more details, see SEAR0 0178 in Part 111.)

At the national level, in Burma a country course in development and health planning was held in Rangoon from 5 to 26 November 1970. This course was assisted by the WHO public health administrator and the WHO economist assigned to the Asian Institute, in addition to two WHO temporary advisers. SEA/RC24/2 Page 4

Finally, an orientation training course was organized at the Asian Institute in the autumn of 1970 for two economists from Indonesia who had attended a course in health planning at the Royal Tropical Institute, Amsterdam. Plans are under way to hold a country-level course in national health planning in Indonesia during August 1971.

1.1.2 Organization of Basic Health Services

Strengthening of basic health services as the focal point for the further improvement of health care for the community - in coverage as well as quality of care - continues to receive emphasis. There was, in the various countries, consolidation of the steady progress in the administration of health services. The highly important and successful specialized programmes were examined and explored in order to bring about closer co-ordination and co-operation with the general health services, with the aim of achieving final integration.

In Burma, the integrated health services administration took over the responsibility for all the health services which were formerly under various ministries, boards and corporations, and this change resulted in the emergence of a single unified health service in the country. Projects to study the effectiveness of mass disease-control campaigns through an integrated approach continued in Magwe and Mandalay. The Demonstration Health Unit in Hlegu, near Rangoon, made satisfactory progress, organizing practical field training for all categories of health workers; it participated in the field training of medical students and conducted studies in public health, administration and epidemiology.

In Nepal, the strengthening of the health administration at the zonal level continued; the total number of health posts is now 139, of which 26 were opened during the first six months of 1971. Narayani Zone was being developed as a pilot demonstration area. At the central level, an integration section was established at the Directorate of Health Services in order to achieve improved and closer co-operation among various technical divisions as a prelude to eventual integration. During April-May 1971, a course on health administration for senior health workers was organized at Rampur, with the aim of orientating these workers to the existing health problems and programmes as part of the country's general plan for socio-economic development.

In Thailand, too, integration is making headway, the leprosy control programme in some parts of the country having already been made a part of the general health services. The three-member WHO team which, in July-September 1970, studied and evaluated the health services in Pitsanuloke Province (mentioned in the last Annual Report), assisted the Thai Government in formulating supporting schemes for the evolution of an effective rural health service, in the light of experience gained in Pitsanuloke. Plans were made for a group of top-level planners and health administrators to undertake a study tour in order to explore the SEA/RC24/2 Page 5 feasibility and practicability of introducing a new type of medical auxiliary in Thailand. The group, on return from this tour, will advise on whether a category of this type should be developed in Thailand.

In India, following the preparation of a master plan of operation in line with the objectives of the Fourth Five-Year Plan, the Government continued to expand and reinforce the basic health services. Two WHO staff members stationed in Chandigarh advised the Directorates of Health in Haryana and Punjab States on the development of basic health services. Particular attention was paid to the collection of data at State level to form the basis for the provision of health services, the training of different categories of health workers, improvement in the functions of the district health organization, and co-ordination between municipal and basic health administrations.

At the request of the Government of Indonesia, a WHO consultant made a thorough review of the country's health services system and advised on its future development. With the assistance of long-term WHO staff the Government is also endeavouring to strengthen the health services. Priority was given to the development of the field training area at Bekasi, which became operational early in 1971. In order to strengthen this area, two training courses were given, in addition to an orientation course for provincial medical officers. On the advice of the WO consultant mentioned above, the Government has started on a partial reorganization of the Ministry of Health, readjusting the functions of the different bureaux and adding new ones. A health manpower census, an inventory of health training institutions, and an enquiry into the staffing and facilities in autonomous regions were undertaken. At the end of the reporting period, plans were under way to consolidate the data collected and to develop a phased programme of reporting on 1.o-alth resources.

In the Maldives, there are now 13 health centres, scattered over the different atolls. The staff of the hospital in Male was augmented during the year by the addition of a physician and an ophthalmic surgeon. A programme for the training of auxiliary nurse-midwives in Male was agreed on and was planned to be implemented later in 1971. The health administration continued to pay special attention to the various disease- control programmes - particularly those for leprosy, tuberculosis and filariasis. Mass direct BCG vaccination of children under 15 was completed in all the atolls. The completion of malariometric surveys in December 1970 has paved the way for a malaria control project.

Medical care

Under a regional project a consultant made a preliminary draft of a guide to the functional programming of hospital facilities, after visiting some countries in the Region. Preparations were made for a seminar on this subject, to take place in October-November 1971 in New Delhi. SEA/RC24/2 Page 6

"Hospital Referral Services" was the subject of the technical discussions held during the twenty-third session of the Regional Committee. The discussion group focussed their attention on the prerequisites for setting up high-quality services, and one of their conclusions was that a well-organized medical care referral system was essential, not only for the efficiency of the overall health structure but also for the economical use of the available staff and facilities.

1.1.3 Operational Studies and Health Manpower

As for operational studies and research, a study of health manpower was under way in Ceylon. Consolidating various resources, the Ceylonese study embraces all other activities of a similar nature and allied subjects. Six areas of operation have been delineated: these are demography, health needs and demands, health care institutions, health manpower, the education process, and health systems. Undertaken with the co-operation of WHO Headquarters and the Regional Office, the initial stage of this phased study was started in February 1971. The Director of the Division of Organization of Health Services from WHO Headquarters visited Ceylon in March 1971 to review the plans for the study.

In Indonesia, the development of a health resources reporting system was initiated, and a health manpower study, at a later date, was envisaged as a follow-up of this system. Assistance was provided in organizing and conducting a national workshop on health management.

In the health manpower studies in Thailand, conducted by the Government with WHO assistance, a considerable amount of useful data was collected. A consultant visited Thailand early in 1971 to scrutinize the data assembled and made recommendations for the future development of the project. He suggested the establishment of a health manpower study group with a full-time director, the division of the study into five major areas, and the early participation of statisticians and systems analysts.

The research project in district health administration in India (Rohtak District), undertaken by the National Institute of Health Administration and Education and assisted by WHO, continued; the initial stages of Phase I - interviews of public health centre staff and work analyses of the centres - were completed, and other aspects of the administrative studies were being pursued in 1971. In Chandigarh, the WHO Headquarters-assisted hospital utilization study continued to be carried on by the health officials of Punjab and Haryana States. In addition to elucidating information useful for future planning of hospital organization, the study has helped to consolidate the routine hospital statistics systems of the two States. ~EAlRC2412 Page 7

An inter-regional Course on Health and Manpower Planning, organized by WHO Headquarters, was held at the National Institute of Health Administration and Education, New Delhi, in October-November 1970 (see Inter-regional 0439 in Part 111).

The inter-country team, "Strengthening and Development of Health Services" (project SEARO 0148), set up in 1970 and based in the Regional Office, provided advice and assistance to the various operational studies. The team has worked in close association with the Programme Information Retrieval Sub-unit.

1.2 Family Health (The educational aspects. including- training- in methods of regulating human reproduction,etc., as well as paediatric and obstetric education, appear in Chapter 6)

The importance given by governments to the improvement of family health and the continued availability of financial assistance for health programmes incorporating family planning activities through the United Nations Fund for Population Activities (UNFPA), remained a major stimu- lant to the accelerated development of the family health programmes in the Region. Several UNFPA projects, formulated jointly by the Regional Office and governments interested in the health aspects of family planning, were endorsed by the Regional Committee at its twenty-third session. In their implementation emphasis was placed on close co- ordination of the activities with those of the already existing WHO projects.

The inter-country team on family health, consisting of a medical officer, a health educator, a statistician and a nurse, which came into being early during the year, assisted with training courses and other group educational activities. Details are given under SEARO 0192 in Part I11 of this report.

Some delay was encountered in the establishment of the Regional Documentation Centre on Human Reproduction, Family Planning and Popda- tion Dynamics owing to difficulty in recruitinga senior librarian for this centre. However, books and equipment for the centre were procured.

Activities undertaken in the various countries were as follows:

In Burma, WHO assistance included the assignment of a consultant who studied and advised on strengthening the organization and management of maternal and child health services.

In Ceylon, at the request of the Government, a joint United Nations/UNESCO/WHO mission, early in 1971, made a comprehensive review of the national family planning programme in the overall context of socio-economic development, advising on its continuance and improvement SEA/RC24/2 Page 8 and identifying areas in which external aid would be required. The report of this mission was, at the time of writing, under review by the Government.

In India, initial steps were taken to develop a project on integrating maternal and child health (including family planning) services into the general health services: (1) As a follow-up of the meeting on comprehensive maternal and child healthlfamily planning services in urban medical and health institutions in India (which had been held in June 1970), a "Workshop on the Integration of Maternal and Child Health and Family Planning Programmes in Rural Areas" was held in the Regional Office in May 1971, with twenty participants representing central and State health departments; (2) Subsequently, in June, ten senior health officials (the majority of whom had participated in the workshop mentioned above), invited as temporary advisers to the Regional Director, prepared a draft plan of operation for the project, with the assistance of the WHO consultant who had helped in conducting the workshop, and (3) Towards the end of the period under review, a second workshop, with the aim of enabling senior research workers and public health administrators to exchange views and propose areas for operational studies which might be developed in support of the project, was going on, also in the Regional office.

In Indonesia, activities of a wide range aimed at providing a sound base for the development of the national family planning programme were in progress. A workshop on the cowrdination of national and international resources available for this purpose was held from 6 to 8 August, to inform potential donor countries about the national family planning programme and to activate and involve them in its development. A further workshop to review the national plan for strengthening family planning in the health services, attended by senior health officials and representatives of other ministries concerned with the programme, was organized in October 1970.

Also, WHO assigned three consultants to Indonesia - one who, in August-September 1970, assisted in the preparation of a plan of action for an integrated maternal and child health and family planning project; another (September-October 1970) who studied existing facilities for establishing laboratory services for cytology as a part of family planning and whose findings led to efforts to ensure a realistic development of cytology facilities, and a third (May-June) who made a general review of WHOIUNFPA-assisted projects under the Ministry of Health and advised on desirable measures of improvement. A further consultant was under recruitment to study and advise on priorities for WHO involvement in operational studies related to the delivery of the family planning programme through the health services. In June 1971, two consultant librarians were assigned for three months - one to study and advise on the improvement of library facilities in health offices and teaching institutions, and the other to study and advise on the establishment of a textbook-lending system for medical students (see also Chapter 6). Moreover, in response to the SEA/RC24/2 Page 9

Government's request, plans were made to provide an additional medical officer under the project "Strengthening of National Health Services" to assist in the overall organization of maternal and child health and family planning activities.

Finally, WHO arranged, with the assistance primarily of its inter- country family health team, two two-month training courses on the health aspects of human reproduction for selected medical officers engaged in the management of the family planning programme and for persons giving training in family planning. These were held from January to March and from May to July 1971, and the programmes included visits to selected training centres in Bangkok and in India. Proposals for activities in 1971 and 1972 and projections for the remaining part of the country's third five-year plan were drawn up and sent to the Government.

In Mongolia, where the WHO/UNICEF-assisted maternal and child health services project made further progress, the Government gave particular attention to the improvement of the health care of mothers and children through progressive integration of maternal and child health services into the general health services, establishment of effective referral systems, improvement of paediatric and obstetric institutions and units and introduction of effective ambulatory treatment of diarrhoea1 diseases and of other health problems of children. Many educational activities were undertaken.

In Nepal, the national family planning and maternal and child health activities received WHO assistance through the existing nursing education and public health administration projects and in the form of fellowships. Plans were made to hold a national seminar on the integration of maternal and child health and family planning services in October 1971, with WHO assistance.

In Thailand, the main activity was the preparation of a five-year plan (1972-1976) for the national family planning project. A WHO Head- quarters team consisting of a senior obstetrician and a public health administrator visited Bangkok in February 1971 to make a general appraisal of the family planning situation in the country, to study the Third Five- Year Plan in this connection and to indicate the areas in which WHO might be of assistance. In March, discussions on the family planning programme were held when the Regional Director and the Director of the Division of Family Health from WHO Headquarters visited Bangkok. Plans were made to convene a national seminar on the integration of maternal and child health and family planning services in August 1971.

Other aspects of family health which received attention were school health and social welfare. In February 1971, a seminar on school health was held in Rangoon, with twenty participants, who were senior health officials concerned with school health programmes in Burma, Ceylon, India, Indonesia and Thailand (for details, see SEAR0 0184 in Part 111). SEA/RC24/2 Page 10

The Regional Office continued to give technical assistance on the health aspects of social welfare programmes in Burma, Ceylon, India, Indonesia and Thailand being assisted by the United Nations Department of Economic and Social Affairs (WESA) and UNICEF, and to encourage close collaboration between the health departments and other concerned with the educational, nutritional and social welfare aspects of family and child welfare programmes.

As for research in family health, a WHO mission visited India and ThaiLand in November 1970 to explore the possibility of setting up a regional research team for the evaluation of fertility-regulating agents. Plans were in progress to establish such a team at the Chulalongkorn Medical Faculty, Bangkok, and possibly another at the All-India Institute of Medical Sciences, New Delhi, subject to availability of funds.

Further, as part of the inter-regional "Feasibility Project for Expanded Research and Development and Research Training in the Field of Human Reproduction", two Headquarters consultants and the Chief of the Human Reproduction Unit from Geneva visited a number of selected research institutions in India and Thailand early in 1971.

WHO Headquarters gave financial support to research projects in human reproduction, family planning and population dynamics being undertaken by several institutions in the Region (see Annex 6).

1.3 Nursing

The strengthening of nursing and midwifery as well-defined components of the national health services continued to receive major attention.

Among the studies mentioned in last year's report was the activity study of public health workers in Thailand; this study was completed, and the report was issued and has also been translated into Thai by the Government. The findings of another study in Thailand - the 1969-1970 study of the activities of nursing personnel employed in hospitals - were used to bring about changes in nursing and midwifery curricula. Also, plans were under way for a study to develop a methodology for reviewing the work of the nurse-midwife in Thailand.

In all the countries WHO continued its assistance to the strengthening of educational programmes for nursing and midwifery personnel. Nurses who are qualified as clinical specialists are urgently needed, and to meet this demand, assistance was given through the fellowship programme, the conduct of short courses in the clinical specialties of orthopaedic and neurological patient care, and the continuing post-basic courses in clinical specialties (maternal and child health and medical-surgical nursing, psychiatric nursing and post-basic nursing education). Initial plans were made to conduct six short courses in different countries in 1972 - one each in SEA/RC24/2 Page 11 orthopaedic, psychiatric, eye, ear, nose and throat and neurological nursing and two in paediatric patient care. In India, a draft plan of operation for a project on nursing in clinical specialties, which is also to start in 1972, was prepared and submitted to the Government. In Mongolia emphasis was placed on supplemental courses for local nurses, which covered a wide variety of subjects, including medical-surgical and paediatric nursing.

At the WHO-sponsored Training Centre for Nurses in Wellington, New Zealand, which started functioning in January 1970, the first course ended in December and the second course began in January 1971, with ten nurses (see also SEW 0194 in Part ILX).

The awareness of the value of regular review and revision of curricula as required to meet changing health needs led to the extension of the assistance nurse-midwife programme in Nepal from an eighteen-month to a two-year course. In Ceylon, the addition of obstetrical nursing to the general nursing curriculm and the provision that every nurse should have an opportunity to study midwifery after completing the general programme constituted another realistic approach to changing needs.

WHO nurses have been increasingly involved in family planning and family health progrmes. The Regional Office collaborated in the preparation of a "Guide for the Integration of Family Planning in the Auxiliary Nurse-Midwife Syllabus", which was published by the Government of India. In Indonesia, early in 1971, a short course was conducted for teachers of nursing and midwifery in order to help them to develop content in family planning and population dynamics in curricula for preparing nurse-midwives.

Throughout the Region, it is recognized that senior nurses at national and provincial levels should be involved to a greater extent in decision-making in the planning for health services. The need for identification of effective systems for the delivery of nursingjmidwifery services as a part of the overall health services as well as for evolving sound systems for the education of nursingjmidwifery personnel continued to be a concern of both the governments in the Region and WHO. There remains an unfortunate tendency, however, in some countries to increase the numbers of levels and categories of health personnel on an ad hoe basis, without considering the effect on the overall personnel system. A further cause of concern has been the under-utilization of nurse-midwives and their use in spheres for which they have not been trained. Also, there is an urgent need for rational decisions regarding the desirable ratio of professional to auxiliary personnel.

1.4 Environmental Health

The environmental health programmes assisted by WHO have covered community water supply, waste disposal and training of personnel. SEA/RC24/2 Page 12

An important activity was the Regional Seminar on Water Pollution Control, which was held in Bangkok in November 1970, with participants from Ceylon, India, Indonesia, Nepal and Thailand (for details, see SEAR0 0132 in Part 111).

The rural community water supply programmes assisted jointly by WHO and UNICEF in several countries proceeded as planned. Such programmes were under way in Ceylon, India, Indonesia, Nepal and Thailand, and were planned for the Maldives and Mongolia. Preliminary data were collected for the implementation of a water supply and excreta disposal project in Male. In India, a village water supply programme, which is an expansion of the rural water supply scheme started in 1963, was being carried out in several States, with increased technical and financial support from the two agencies. In Thailand, where the national community water supply programme is progressing satisfactorily, there was steady expansion,and further assistance was given in the exploration and development of ground- water.

The UNDP(SF) project for the preparation of a regional master plan for water supply and sewerage in Ceylon was expected to be completed in July 1971. A panel of consultants made an evaluation of the progress of the project on two separate occasions. A similar project was started in Nepal in January 1971.

At the time of writing, the Government of India was reviewing a background document which had been prepared by a WHO Headquarters staff member in 1969 to serve as a basis for a government request for UNDP(SF) assistance in water pollution investigations and control in Maharashtra State.

WHO'S programme of assistance has also included advice on drafting legislation for air pollution control in India and on the development of a more effective refuse disposal system in Nepal.

Training has continued to be an important component of assistance to environmental health projects. A professor of sanitary engineering has been teaching at the Rangoon Institute of Technology in Burma and another at the Institute of Technology in Bandung, Indonesia. Advice on the development of training courses was also given to Thailand. In India, as a part of WHO'S collaboration with the Central Public Health Engineering Research Institute, Nagpur, in a research and training programme undertaken by the Institute, assistance was provided in conducting a course on preventive maintenance of water distribution systems,which started in Bombay in April 1971.

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1.5 Health Education

Governments are now giving higher priority to health education than before, and are eager to meet pressing needs such as assessing, reorganizing and strengthening health education services at all levels of the health administration and in different national health programmes. These needs have been taken into account in formulating long-range plans for further development in each country. The training of health educators and of other professional workers, integration of health education into the national educational systems and the conduct of research in health behaviour have formed a part of this effort.

Health education is a vital and integral component of the family health programmes, which include maternal and child health, family planning, human reproduction and population dynamics. Ceylon, India, Indonesia and Thailand have shown themselves to be keen to ensure, with the assistance of WHO, that the educational aspects of their respective programmes are scientifically planned and implemented, with provision for built-in appraisal. Plans were in an advanced stage in connection with health behavioural studies,the assessment and strengthening of health education services, and training of health and other technical personnel in health education in Ceylon and Indonesia, and action was initiated for planning similar activities in Thailand. The school-health education project in India, which has been in progress for some years, has been modified and enlarged to emphasize population education in line with the national population policy and the family planning programe. In preparation for an inter-country workshop on the production, utilization and evaluation of health education media in family health, scheduled to be held in October 1971, governments have been requested to set up study groups to make a critical review of their media programnes.

In order to assist in the further development of school-health education in the Region, an inter-country workshop on this subject was held in Bangkok in November. Twenty-eight senior officials from Burma, Ceylon, India, Indonesia, Nepal and Thailand, representing both health and education ministries, participated in the workshop (for details, see SEX30 0130 in Part 111). As a follow-up, national and local workshops have been planned in several countries.

For over a decade, India has made significant advances in several fields of health education and has demonstrated in the different States its ability to attain programme goals through organized efforts. A large number of health educators needed for these programmes have been trained at the All-India Institute of Hygiene and Public Health, Calcutta, and the Institute of Rural Health and Family Planning, Gandhigram (Madurai). In addition, the Central Health Education Bureau is now in the process of developing a graduate programme in collaboration vith Delhi University,the third institution to provide graduate training in health education in India. The Central Bureau and some State bureaux of health education are SEA/RC24/2 Page 14

now proposing, with WHO assistance, to undertake a critical review of their major functions to determine the direction of further development. In addition, with the help of a WHO Headquarters grant, the National Institute of Health Administration and Education in New Delhi is carrying out a study of several aspects of health education in hospitals. A similar grant to the Central Health Education Bureau for the study of some aspects of community health education has been sanctioned.

Major changes in the organization of health education services are taking place in Ceylon. The present Health Education Division is being raised to the level of a Bureau, within which it is proposed to establish several units for training, research, hospital health education and field supervision, to be staffed by appropriately trained personnel; the curricula for the training of such staff at the Institute of Hygiene, Kalutara, have been revised, with the major emphasis on health education. There has also been an intensification of the programme in the provinces, with attention also to the relevant aspects of specialized disease-control campaigns. Of particular importance are the special projects undertaken in each of the fifteen "superintendent of health" areas in order to demonstrate the potential impact of health education on health programmes.

Progress continues to be made in Burma, despite limited resources. There is a shortage of fully trained staff to plan, conduct and evaluate health education services effectively, and health personnel at all levels need preparation to carry out their educational responsibilities. Even those health educators who are available at the national and provincial levels require additional training in different aspects of the subject. There is also a shortage of qualified health education specialists in the different medical and health training institutions. The Government has already taken steps to meet these needs.

Conditions similar to those existing in Burma also obtain in Indonesia. A WHO-assisted workshop brought out clearly the critical need to assign a minimum number of well qualified health educators at national and provincial levels in order to improve the quality and quantity of the health education work carried out by different categories of field personnel, by both long-term and short-term training and by participation in planning, conducting and evaluating the educational aspects of service. A five-year plan for the development of health education manpower and services has been drawn up, with assistance from WHO and US AID.

In Nepal, health education is an integral part of the national health plan, which provides for health education services at national, provincial and other levels as well as for increased assistance to the specialized health programmes. Towards the end of 1970, WHO assigned a consultant to review the implementation of recommendations made by earlier WHO consultants, and to assist in planning, conducting and evaluating a one-week national workshop for participants from the fields of health and education. This workshop was a follow-up activity of the inter-country workshop held in Bangkok. SEA/RC24/2 Page 15

Thailand has been active in the health education field for a number of years, and has given priority to this subject in health programmes, especially those concerning maternal and child health and family planning. As mentioned earlier in this chapter, Bangkok was the venue of the WHO-sponsored inter-country workshop on health education in schools, in the conduct of which the Government actively assisted. The Government has followed up by sponsoring a course for primary school- teachers, conducted by the Education Department, which has also set up a committee to take further action.

1.6 Nutrition

Assistance continued to the two training courses in nutrition being given at the National Institute of Nutrition, Hyderabad (India) - the nine-month degree course and the three-month certificate course (for details, see SEAR0 0097 in Part 111).

Early in 1971, assistance was provided to Burma by the Regional Adviser on Nutrition in the further development of the Nutrition Unit of the Directorate of Health and in the establishment of a pilot nutrition rehabilitation centre in Rangoon. A consultant was under recruitment to undertake a study of the growth, development and physical fitness of children and youth.

In Ceylon, the pilot project for the prevention of nutritional anaemia, which was assisted by a WHO temporary adviser during the period from December 1969 to January 1970, reached the final stages of its first exploratory phase. A consultant is to be assigned later in 1971.

Efforts continued to assist the goitre programme in Burma and to help in planning a programme in Nepal. Also, in Indonesia a consultant visited the province of West Irian, where goitre is endemic in the still largely undeveloped highlands, in order to carry out a feasibility study for starting a control programme.

Internationally-assisted applied nutrition programmes are continuing in India, Indonesia and Thailand. Efforts were made to recruit a public health officer for the Indian programne and a consultant for Indonesia, where a base-line survey is being planned. Frequent discussions were held with UNICEF on these programmes and other nutrition projects as well as on projects for the production of protein concentrates and protein-rich foods. Also, requests for projects under the World Food Programme from countries in the Region were scrutinized in respect of the health aspects.

A consultant was assigned to Thailand early in 1971 to make preliminary arrangements for the Regional Symposium on Vesical Calculus, scheduled to be held in 1972. SEA/RC24/2 Page 16

The Regional Adviser on Nutrition attended the First Asian Congress of Nutrition, held in Hyderabad (India) in January-February 1971 (see also Chapter 4 in Part 11).

Under WHO'S global programme of research, assistance was given to the All-India Institute of Medical Sciences, New Delhi, and the Christian Medical College Hospital, Vellore, for studies on nutritional anaemias, and to the Indian Council of Medical Research for studies on the interaction of malnutrition and infection, which the Council has undertaken, in collaboration with Johns Hopkins University, at Narangwal, Punjab. A study of the prevention of iron-deficiency anaemia through fortification of fish sauce is under way in Thailand with WHO assistance.

1.7 Mental Health

Two WHO-sponsored seminars on the subject of mental health were held during the year. The first, an inter-country seminar on the teaching of psychiatry, took place in New Delhi in September 1970, as a follow-up of a previous meeting on the same topic which was held in Agra in 1968. The participants, who came from Burma, Ceylon, India, Indonesia and Thailand, reported encouraging progress in their respective countries in the development of psychiatry as an academic discipline during the two-year intervening period. The second seminar, which discussed the organization and future needs of mental health services, was also held in New Delhi, all the participants being from India. The WHO consultants were from the academic, administrative and field research areas, and suggestions were made for meeting local needs in mental health services in terms of training and organization. Details of these meetings are given in Part 111.

A staff member from WHO Headquarters, who took part in the Seminar on the Teaching of Psychiatry, also visited Ceylon to acquaint himself with the organization of mental health services and with the teaching programmes at the two faculties of medicine. He discussed future developments with the authorities concerned and gave advice on the study of psychiatric epidemiology being carried out at the University of Ceylon with WHO assistance.

Two WHO consultants - one in psychiatry and one in clinical psychology - who were assigned to the Department of Psychiatry at the Faculty of Medicine, University of Ceylon, Colombo, during October- December 1970,,have made recornendations aimed at the strengthening of both undergraduate teaching and mental health services.

As a follow-up of previous visits, a consultant in psychiatry and a medical educator were assigned to the College of Medical Sciences, Banaras Hindu University (India). Also in India, another consultant . visited medical colleges at Chandigarh, New Delhi, Jaipur, Udaipur, Ahmedabad, Baroda, Bangalore, Madurai, Madras and Mangalore, to assess SEA/RC24/2 Page 17

the present status of, and facilities for, the training of undergraduates and post-graduates in psychiatry.

1.8 Dental Health

Direct assistance to the training of professional and auxiliary dental personnel was given in Ceylon and Indonesia; in the latter country a WHO consultant also assisted in drawing up a long-term plan for the development and expansion of the existing dental colleges and schools. Plans are being made to provide consultants to Burma, India, Indonesia, Mongolia and Thailand.

1.9 Occupational Health and Rehabilitation

Between September 1970 and January 1971, a consultant in industrial hygiene and occupational health assisted the Government of Indonesia in further strengthening the occupational health services and in preparing a request to the United Nations Development Programme for the development of a Special Fund project in this field. Some of his recommendations were that: (1) the ILO conventions and codes on occupational health safety should be followed until legislation concerning occupational health is strengthened with assistance from ILO; (2) an industrial hygiene laboratory equipped with simple basic equipment should be established, and (3) health officers, sanitarians and nurses, particularly those stationed in economically productive areas, should be trained in occupational health.

In India, WBO assisted in organizing a "Symposium on Academic Education and Training in Occupational Health and Hygiene", which was held in Ahmedabad in November 1970 in conjunction with the inauguration of the National Institute of Occupational Health. The 22 participants included proEessors of various disciplines from different medical colleges in India (for details, see India 0197 in Part 111).

WHO continued to provide assistance in the training of physiotherapists. The School of Physiotherapy at Baroda (India) was upgraded and the syllabus revised. In Thailand, the WE0 physiotherapy tutor continued his assistance to the training programmes at the School of Physiotherapy in Bangkok.

In the field of medical rehabilitation, a WHO prosthetic tutor was assigned to India in September 1970 to help with the training of prosthe- ticians and with research on the development of standard components for orthopaedic appliances. A school for prosthetic and orthotic technicians was started in New Delhi in June 1971 and was preceded by a training course for tutors.

In March/April 1971, a WHO consultant visited various institutions concerned with medical rehabilitation in Burma, Ceylon, Indonesia and Thailand and held discussions with the authorities of these institutions. SEAfRC24f2 Page 18

1.10 Radiation Health

WHO assistance in the training of radiographers in the countries of the Region continued satisfactorily.

In Burma, the first training course for technicians and artisans in the repair and maintenance of hospital equipment was held, and a second course was started. A WHO electro-mechanical engineer assisted with various aspects of the training programme.

The WHO radiography tutors assigned to the School of Radiographers in Chandigarh (India) and the School of Radiographers and Electro-medical Technician in Djakarta helped with the training programmes of these institutions. At the latter school, the second refresher training course in radiography for the staff employed in departments throughout Indonesia was completed, and the participants were awarded certificates.

At the ~choolfor Hospital Electro-mechanical Repair Technicians, All-India Institute of Medical Sciences, New Delhi, the fifth course, which had started in mid-July 1970, ended in January 1971.

A WHO consultant was assigned to the Radiation Medicine Centre in Bombay in NovemberfDecember 1970 to advise on radio-immunoassay. He has recommended the provision of an up-to-date automatic well counter for the promotion of in vitr~oassays at the Centre.

In Thailand, at the School of Medical Radiography in Bangkok, examinations for both first and second-year students were held in February 1971. All the second-year students qualified in the examination and have obtained employment in the government medical service.

Under an inter-regional project, "Assistance to National Radiation Programmes", a WHO Headquarters staff member visited various radiation health projects in Burma, Ceylon, India, Indonesia, Nepal and Thailand and held discussions on (i) radiation protection measures, (ii) the improvement of diagnostic and therapeutic radiology, particularly with regard to medical physics tasks, and (iii) diverse other radiation health problems.

In November 1970, the Chief of the Radiation Health Unit at Head- quarters visited the Radiation Medicine Centre in Bombay and the Radiation Protection Services in Bangkok and held discussions on problems associated with the training programmes.

1.11 Cancer

A study of the morbidity pattern of neoplasms in the countries of the Region shows certain geographical features. Oropharyngeal, cervical and oesophageal cancers are found with increasing frequency in hospitals. SEA/RC24/2 Page 19

Epidemiological surveys and organization of services for early detection and treatment, and health education for prevention, are facets of cancer control programmes that are being developed in this region. On the basis of available hospital morbidity data,neoplasms registering higher frequency are identified, and assistance is provided for pilot control projects and development of national oncological services.

The pilot project for the early detection of cervical and oropharyngeal cancer in Kancheepuram, India, conducted with assistance from the Norwegian Government and WHO, has completed its pre-survey studies, and the data collected are being analysed. The physical facilities for the location of the training centre are nearing completion. The WHO programme director has arrived in Kancheepuram and is organizing the field study. Various staff members of the project have been awarded WHO fellowships for study abroad. A consultant in statistics is expected to join the team in October 1971. Facilities are being provided for the treatment of cancer patients detected during the survey.

In Mongolia, WHO assistance continues to be provided as regards the organization of the oncological services. A WHO consultant advised on the organization of these services and another on chemotherapy. Fellowships were provided for the training of national personnel in radiotherapy and surgery Cancers of the oesophagus and the stomach form 35.2% and, of the cervix, 26.6% of a total of 2 291 cancer patients seen at the Oncological Dispensary in Ulan Bator during the period 1962-1967. The epidemiology of cancer of the oesophagus and stomach needs investigation.

1.12 Cardiovascular Diseases

The epidemiology of cardiovascular diseases in the Region indicates a high incidence of rheumatic fever with cardiac involvement and a rising trend in morbidity and mortality due to ischaemic heart disease and hypertension. Programmes are planned to stimulate national studies in prevention, the organization of services, training of medical and paramedical personnel and community-based education for the prevention of cardiovascular diseases.

In Mongolia, the cardiovascular-disease project is being assisted by a short-term consultant in paediatric cardiology. Another consultant is being provided to advise on methodology and research on the etiology and pathogenesis of essential hypertension.

Data on the incidence of cardiovascular diseases in the countries of the Region are being collected in order to establish priorities in planning control projects and to provide facilities for the training of personnel, organization of the services and education of the public. SEA/RC24/2 Page 20

1.13 Quality Control of Pharmaceutical and Biological Products

An important event which took place during the year under review was a WHO-sponsored Seminar on the Quality Control of Drugs at Inspector Level, which was held in Bangkok from 25 January to 6 February 1971, with fifteen participants from five countries. This was the second regional seminar on quality control of drugs to have been convened by WHO in South-East Asia, the first having taken place in Bombay in January 1969 (for details, see SEAR0 0154 in Part 111).

Three consultants were provided - one to Ceylon and two to India. In Ceylon, during January-April 1971, a pharmacist undertook a review of the training of pharmacists, the need for such training and the curricula at present in use, and reconrmended measures for improving the training of pharmacy technicians, establishing a two-year diploma course for senior pharmacists and eventually considering the introduction of a degree-level course.

A WHO pharmaceutical chemist assisted the Government of India in preparing a request for the development of a UNDP/Special Fund project for the quality control of drugs, and held preliminary discussions with the UNDP Resident Representative in New Delhi and government officials. An expert in biological preparations visited various laboratories in the country and also collaborated with the other consultant.

1.14 Medical Stores Management

In response to a request from the Government of India, a consultant is being provided to advise on the modernization and development of the ~overnment's pharmaceutical factories attached to the Medical Stores Depots in Bombay and Madras.

At a suggestion from the Government of Nepal, the appointment of a WHO pharmaceutical chemist (mentioned in the last report) to assist in implementing the recommendations of the WHO consultant in medical stores management who visited the country in 1969, was deferred until the end of 1971.

1.15 Hazards to Man from Pesticides

The WHO consultant who was assigned to Indonesia during July- August 1970 (briefly mentioned in last year's report) to carry out an assessment of the problems surrounding the importation, storage and handling of pesticides, with particular reference to their use in agriculture and public health projects, has recommended measures to prevent or minimize hazards to man arising from the use of pesticides. SEA/RCZ(r/Z Page 21

2. COMMUNICABLE DISEASES

The new global strategy of malaria eradication, mentioned in last year's report, has been implemented by Member countries, and formal strategy reviews, on lines indicated by WHO, have been carried out in India and Nepal. In addition, Ceylon, Indonesia and Thailand have made internal assessments.

The Regional Office has continued to assist Member countries in strengthening their epidemiological services and in improving epidemiological surveillance of communicable diseases. There has been much improvement in the surveillance of three diseases, viz., smallpox, cholera and plague. The number of reported cases of smallpox has decreased in India, Indonesia and Nepal, while no cases have been reported from Burma, Ceylon, the Maldives or Thailand. Cholera has continued to be prevalent in India and Indonesia particularly, and to a lesser extent in Burma and Nepal. Plague has been reported from Burma and Indonesia, but only sporadically and in small foci.

The Regional Epidemiological Surveillance Team has been promoting the surveillance of diphtheria, pertussis, tetanus and poliomyelitis, in addition to those diseases covered by the International Health Regulations. Most of the countries in the Region have been visited and are being encouraged to set up immunization programmes, at least in urban areas. The part to be played by health laboratories and health statistics in such surveillance has been repeatedly stressed, since, without reliable data, health planning cannot be realistic.

The consultant on port health assigned to Indonesia from February to September 1970 has, in his report, recommended (i) the organization of in-service training, (ii) closer co-ordination between the Quarantine Unit and other units of the Health Department, and (iii) elementary health education for port and airport workers.

The Regional Tuberculosis Training and Evaluation Team has been assisting the national tuberculosis programme in Ceylon.

The 1970 International Training Course in Epidemiology held in Czechoslovakia and India was completed, and diplomas were awarded. The participants came from Afghanistan, Burma, Colombia, Czechoslovakia, India, Iran, Japan, Mexico, Mongolia and Sudan.

Recornendations made by the Fourth WHO Expert Committee on Leprosy1 may have implications for national programmes, particularly the recommendation that regular treatment of lepromatous leprosy should be extended from five to ten years and, in some cases, even for life.

'WZ~ HZth Org. 2'echn. Rep. Ser., 1970, No.459 SEA/RC24/2 Page 22

Veterinary public health continues to be accorded a high priority in WHO assistance.

2.1 Malaria

There has been a growing realization among Member countries of the need to step up their efforts towards eventual malaria eradication even if this has meant interim changes of plans. WHO assistance has already been, or is in the process of being, provided where necessary. More posts for WHO personnel have been requested by Burma, Ceylon, Indonesia and the Maldives.

The controversy over the universal banning of DDT has seemed to lead to the view that its use should definitely be continued in countries with pressing malaria problems. The requirements for this insecticide for the six WHO regions in 1971 total 48 936.6 metric tons, of which the South-East Asia Region alone needs 21 831.3 tons (44.621, almost double the amount required by any other region. WHO is promoting the continued production of DDT in the required quantities by manufacturers.

As already mentioned, the new global strategy for anti-malaria measures has been implemented in one form or another by all the countries concerned. Plans of operation based on local circumstances have been drawn up by Burma, Ceylon, Indonesia, the Maldives and Thailand. The recognition of problems and development of a methodology to deal with them will undoubtedly help to meet many difficult situations. However, at this stage it is necessary to point out that some countries have not requested, through international supply agencies, sufficient or timely supplies of DDT, even though funds are available. In fact, since the beginning of the 1971 transmission season, the first cycle of DDT spraying has been delayed to such an extent that the possibilities of an epidemic in these countries are high.

The overall status of malaria eradication in the Region is as follows (June 1971 estimates): Millions

Population in areas where eradication is claimed (maintenance phase) 306.9

Population in areas under malaria eradication:

consolidation phase attack phase preparatory phase

Population in areas where eradication has not yet started 41.3 Population in areas where malaria has never been indigenous 29.7 GRAPH 1-POPULATION AT MALARIA RISK IN THE AREAS UNDER VARIOUS PHASES OF THE MALARIA ERADICATION PROGRAMME IN THE SOUTH-EAST ASIA REGION (1962.1971) SEA/RC24/2 Page 23

In view of the revised strategy, the figure of 253 million persons shown as living in attack phase areas is 13.7 million more than that of last year. Of these, a population of 161.7 million is in the true attack phase according to malaria eradication terminology. The remaining 91.3 million include 3 million persons living in areas under extensive anti-mosquito measures, mostly larviciding, and 88.3 million in places where malaria drugs are distributed and focal spraying has been undertaken.

The progress made throughout the Region during the period under review is summarized in the paragraphs which follow.

In Burma, a plan of operation has been completed and discussed by the Government and WHO. Malaria microscopists have been trained, with the help of a WHO laboratory technician, and a change in staining techniques has been introduced in the central laboratory. Further WHO assistance is envisaged through the assignment of the laboratory specialist in cross-checking attached to an inter-country project. Supplies and vehicles have been provided during the year, and further WHO staff will be assigned at the request of the Government and in accordance with the plan of operation. It is hoped that the Malaria Institute will be able to move into a suitable building as soon as possible.

In Ceylon, a plan of operation based on realistic needs has been completed. The number of positive slides has been decreasing since July 1970, and there are indications that the P.vivarc component of the epidemic will continue to fall. A close watch has been maintained and precautions have been taken in areas with P. faZciparwn malaria. The training of various categories of staff is now in full swing at the Malaria Eradication Training Centre, which has moved into new buildings. The centre has the full-time services of a WHO sanitary engineer, and it is planned to assign a WHO malariologist and a para- sitologist. In the meantime, all the other WHO malaria staff contribute to the training programme in addition to carrying out field duties.

The decentralization of laboratories for blood examination has resulted in an almost complete elimination of a backlog of blood slides.

The programme in India is suffering from lack of DDT in many areas, and there have been both gains and losses during the year. A large strategy review team, consisting of one national team leader and ten WHO/US AID staff members, completed a review of the programme. The main recommendations of the team are under consideration by the Government.

As a result of the annual independent assessment of the programme, which was carried out in January 1971, a population of 1 768 355 was advanced from attack to the consolidation phase, and 2 119 251 from consolidation to the maintenance phase. SEA/RC24/2 Page 24

In Indonesia, plans of action for a control programme have been prepared for Java and Bali as well as the other islands of Sumatra, Kalimantan, Nusatenggara, Sulawesi and Maluku, adding a further 4.0 million persons to the total number already receiving some form of anti-malaria protection. There have been considerable difficulties in recruiting WHO staff. However, it was possible to assign three malariologists and two entomologists, and a sanitary engineer is under recruitment. Supplies for the anti-malaria programme in West Irian were processed and despatched.

A request from the Maldives for assistance in the anti-malaria campaign has been translated into action. A plan of operation covering the entire country for an initial period of four years awaits signature. WHO provides technical advice and also acts as a supply agency. Six atolls have been sprayed so far. The effectiveness of future operations will depend largely on the availability of transport.

The programme in Nepal continues satisfactorily, but in order for it to be successful, the pace at which the basic health services are being strengthened should be greatly accelerated. A strategy review team consisting of national, WHO and US AID personnel prepared a report on future strategy, which is under study by the Government. The annual assessment of the programme was carried out in February 1971, and a population of 307 125 advanced from attack to consolidation.

The WHO-supported studies on the specific role played by A.baZaba- censis in malaria transmission continued in Thailand. The WHO team has been strengthened by the addition of a laboratory technician.

For various reasons, it was not possible to hold the usual border anti-malaria meetings (one of which is the Burma-India-Pakistan Co- ordination Conference) to discuss the malaria problem in border areas. However, the Sixth Indo-Nepal Border Anti-malaria Co-ordination Meeting was held in Kathmandu in March 1971.

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

2.2 Tuberculosis

Evaluation of tuberculosis control programmes continued to receive attention.

In Burma, preparations were made for an assessment of the project, and a pre-assessment survey has been carried out by the Regional Tuber- culosis Training and Evaluation Team in collaboration with the national authorities responsible for the project. SE~/Rc24/2 Page 25

In Ceylon, the rural part of the baseline survey was completed, and the findings are being processed at the Data Processing Division of the Department of Census and Statistics in Colombo. In addition, a detailed analysis of all bacteriologically confirmed cases was undertaken and cross-checked with the National Tuberculosis Register.

Two consultants visited the Tuberculosis Chemotherapy Centre in Madras (India) in order to assist with the analysis and interpretation of the results of studies nearing completion, design new studies and also plan a review of microbiological and biochemical components of chemothera- peutic trials. The National Tuberculosis Institute in Bangalore continued to train key personnel for district tuberculosis programmes, and to arrange courses for district public health nurses. The participants in the joint JapanIWHO tuberculosis course received training at the Institute, as did those in the international (Czechoslovakia-India) course on the epidemiology of tuberculosis.

A WHO consultant is assisting the Government of Indonesia in strengthening the tuberculosis control activities and in planning for their future development.

On the basis of the information obtained from various countries (Burma, Ceylon and India) related to the activity of non-specific mycobacteria, WHO may need to review the position and strategy of tuberculosis control.

2.3 Epidemiological Surveillance and Quarantine - Quarantinable Diseases

The International Health Regulations, revising the earlier "Inter- national Sanitary Regulations", came into force on 1 January 1971. It should be noted that the new regulations, mainly based on the national and international surveillance rather than on strict quarantine measures, are aimed at ensuring the maximum security against the international spread of disease with a "minimum interference with world traffic". During 1970, all Member Governments of WHO were given the opportunity to submit comments on and reservations to these regulations, and these reservations were reviewed by the Committee on International Surveil- lance of Comunicable Diseases, which met in Geneva from 30 November to 4 December 1970.

Of this region, two countries, India and Indonesia, submitted reservations; those of the Government of India related to yellow fever and were accepted by the World Health Assembly for a period of three years, whereas Indonesia explained that its reservations should be interpreted only as comments aimed at clarifying related matters. Burma, which had not been bound by the earlier International Sanitary Regula- tions, has not submitted any reservations to the new regulations, which therefore apply to that country as well. SEA/RC24/2 Page 26

In view of the increasing importance of epidemiological surveillance of comunicable diseases, the Regulations are also intended to strengthen the use of epidemiological principles, as applied internationally, to detect, reduce or eliminate sources of infection, improve sanitation in and around ports and airports, prevent the dissemination of vectors and, in general, encourage epidemiological activities at the national level so that there is little risk of outside infection establishing itself. The table on the next page gives the figures in respect of quarantinable diseases - smallpox, cholera, plague and yellow fever - for the years 1968, 1969 and 1970 as reported to the World Health Organization. It is observed that during the year 1970, India reported the lowest incidence of smallpox in its history; Burma had no cases, and those in the other countries reporting smallpox (Indonesia and Nepal) showed a considerable reduction.

Cholera would seem to have increased in Burma, Indonesia and Nepal; no cases were reported by Ceylon or Thailand, and the figures from India were incomplete.

As for plague, a few cases were reported in Burma and Indonesia only. The highly efficient surveillance activities, which are reflected in a low number of cases and case fatality rates, have continued in all the enzootic and bordering areas.

The Regional Epidemiological Surveillance Team (project SEAR0 0193) has prepared documents on poliomyelitis, diphtheria, tetanus and pertussis for distribution to epidemiologists in South-East Asia. They have contained information about the incidence of these diseases in the countries of the Region, possible methods of surveillance and methods of laboratory diagnosis. It is hoped that governments will inform the Regional Office of other studies that may have been carried out within their countries but which are not mentioned in these documents. The members of the team visited a number of countries in the Region and held discussions with the officials concerned with regard to the surveillance of communicable diseases. They also assisted with, and took part in, several cholera training courses (see also chapter 2.3.2, "Cholera").

2.3.1 Smallpox

Smallpox eradication activities continued successfully. Burma, Ceylon, the Maldives, Mongolia and Thailand remained free from smallpox during the period 1 August 1970 to 30 June 1971. During this period, the smallpox incidence in India was 12 004,in Indonesia 3 336 and in Nepal 97.

The total of 15 437 cases reported for this period (1 August 1970 - 30 June 1971) represents a decline of 37 per cent when compared with the incidence of 24 723 for the same period in 1969-1970. DISEASES NOTIFIED UNDER THE INTERNATIONAL HEALTH REGULATIONS BY COWRIES OF THE SOVTH-EAST ASIA REGION, 1968, 1969 AND 1970

(Sources: World Health Statistics Report, Vo1.23, Nos. 4-5, Weekly Epidemiological Record, 45, No.51, and 46, No.14, 1971, and supplementary information as reported to WHO ~ead~harters)

Smallpox Cholera P 1: ;ue Country Year cases Deaths Cases Deaths Cases Deaths I Burma 1968 181 1 37 - I - 86 1 1969 69 11 30 1970 1 - 808 49 - I Ceylon 1968 - - - - 1969 - i - - - - 1970 - 1 - - - - India 1968 30 295 7 266 4 472 - 1969 19 120 1 4 154 19 280 - 1970 9 991 1 1749 - Indonesia 1968 17 350 / 1 586 135 30 9 1 1969 17 972 714 659 230 - 1970 10 081 1, 1 269 6 140 1 217 11 Nepal 1968 249 1 . . . 34 17 13 1969 163 19 226 1 6 - 1970 78 1 11 29 3 ... - I Thailand 1968 I 402 , 24 - - I - ' - 961 1 I I 1969 - , - -1- - ' 1970 - 1 - - *~ncompleteyear - Nil . . . Data not available S~A/Rc24/2 Page 28

The plan of operation for the Indian programne was signed in September 1970, since when the expansion of the programme has been accelerated. WHO epidemiologists are now in position in highly endemic areas in northern India, and WHO consultants are conducting assessments in States presenting special problems. The knowledge of the situation thus obtained has led to a more precise direction of eradication measures.

Emphasis has been placed on the implementation of effective reporting, surveillance and containment activities. Special stress was laid on the co-ordination of these activities at district, State and national levels.

In Indonesia, Central Java has now joined East Java and Bali in attaining a smallpox-free status. West Java, which is also expected to become free of smallpox in the near future, reported only 366 cases as compared with 8 805 for the period from 1 August 1969 to 30 June 1970.

The addition of three WHO consultants to the programme greatly strengthened the eradication activities in Sumatra and Sulawesi.

In Nepal, anti-smallpox activities were extended to two more zones, and are now in operation in 10 out of the country's 14 zones. Efforts were continued to improve reporting and surveillance, especially in those zones bordering on Indian territory.

In Burma, a joint Government/WHO team assessed the programe and formulated guidelines for future strategy.

Assistance to the smallpox eradication programmes in the Region continued in the form of support to local production of freeze-dried vaccine and supply of vaccine to those countries not producing it locally. WHO has organized and assisted in the conduct of seminars and training courses for national staff, awarded fellowships for training, and given grants for research. The Organization continued to provide supplies and equipment where necessary.

A significant event during the year was the inter-regional Seminar on Surveillance and Assessment in Smallpox Eradication, which was held in New Delhi in November-December 1970. This seminar has led to a gratifying improvement in the exchange between countries of epidemiological information vital to the maintenance of effective smallpox surveillance services.

2.3.2 Cholera

During the year 1970, cholera El Tor spread westwards, reaching many countries in Africa and Europe. This spread was expected, but it was remarkable that the disease invaded such large areas in such a relatively short time. SEA/RC24/2 Page 29

In South-East Asia, cholera continued to be reported from Burma, India, Indonesia and Nepal. Ceylon, the Maldives and Mongolia were not affected. Thailand has reported no cases.

TWO features characterized the cholera problem in South-East Asia during the year: first, the disease began to be diagnosed in, and reported from, many more areas than hitherto, indicating that governments have intensified their efforts in the dissemination of knowledge about cholera and organization of control measures. Secondly, the fear of reporting cholera cases as being an obstacle to the progress of trade and tourism seemed to be waning.

Training activities at the country level continued to be assisted by the Regional Epidemiological Surveillance Team. In India, the team helped with further training courses and seminars (held at Tirunelveli [Tamil ~adu]and Bombay). A cholera seminar for senior health officers and lecturers of medical colleges involved in cholera control and teaching was organized in Bhopal (Madhya Pradesh). An assessment was made of the impact of the cholera courses previously held in Andhra Pradesh.

With the help of a WHO consultant, assistance in the surveillance of gastro-enteritis was given to Nepal, and a course on the laboratory aspects of cholera control was held in Burma, again with assistance from WHO .

WHO sponsored the participation of officials in charge of cholera control activities in the South-East Asia Region in an important inter- regional seminar on cholera control held in Manila in October 1970. The seminar, which was also attended by the Regional Director and one of the Regional Advisers on Communicable Diseases, discussed several aspects of cholsra control, particularly inter-country co-operation in the surveillance of the disease.

Early in the year under review an outbreak of cholera was reported from Indonesia, and two WHO consultants were immediately assigned to assist the Government in combating the epidemic. Supplies were airlifted to Indonesia.

In May and June an epidemic of cholera and other infective diarr- hoeas occurred in some of the camps for East Pakistan refugees, notably in West Bengal, with 29 041 cases and 4 156 deaths reported (a fatality rate of 14.3%). At the end of June, the epidemic was subsiding. In response to a request from the Government of India WHO provided some urgently needed supplies (see Chapter 3 in Part 11).

Assistance continued to be provided to research on cholera (see Annex 6). SEA/RC24/2 Page 30

2.3.3 Plague

The enzootic foci of plague were dormant. No outbreak of human plague was reported during the year, but sporadic cases have occurred from time to time, indicating that circulation of Y. pestcs is still taking place and that efficient and constant surveillance activities should be carried out.

Two WHO consultants visited Rangoon late in 1970 and reviewed the plague surveillance activities in Burma. They made preparations for WHO assistance in epidemiological investigations to be started towards the end of 1971. These field activities will culminate in a training course in plague surveillance, to be held in the plague endemic area; participants will be national medical officers from countries in which endemic foci either exist or are suspected to exist.

Preparations were made for a research project in the epidemiology of plague, with the aim of studying primarily the factors contributing to the persistence of plague foci in tropical countries. The investigations will be carried out in Indonesia in the well known foci in Bojolali District.

The disease is well under control but still receives high priority in the surveillance programmes of all the countries of the Region, as well as in all training activities for medical staff.

2.3.4 Typhus and Other Rickettsia1 Diseases

Although these diseases were included in some of the national surveillance programmes, they did not receive a high priority during the year. There has been no organized activity for their control or surveillance in any of the countries of the Region; only occasional interest has been shown in Burma, India and Thailand. It is expected that in Central Burma a field investigation in scrub typhus will soon be included in the national surveillance programne.

2.4 Bacterial Diseases

2.4.1 Leprosy

The leprosy control programmes in Burma and Thailand have reached the stage of integration into the basic health services. In Thailand, integration is progressing gradually, and difficulties in achieving satisfactory coverage of the population are being studied.

In Burma, the project has succeeded in detecting, registering and treating the great majority of the total. number of expected cases. An overall assessment of the project is planned for next year, with the aim of drawing up an integration programme. SEA/RC24/2 Page 31

In Ceylon, school surveys are being intensified in areas with high prevalence rates. The control progranrme is making good progress, particularly in regard to case-detection.

WHO assistance to the national leprosy control programme in India is being reduced at the Government's request; the only medical officer with the project will leave after December 1971. Future WHO assistance will take the form of fellowships. A longitudinal study of data relating to the programme was conducted, with WHO assistance, and the results were being processed in the Regional Office.

It was planned to assign a consultant to the Maldives to assist in assessing the present position regarding leprosy.

2.4.2 Venereal Diseases and Treponematoses

It has been observed in all countries that venereal diseases are on the increase, particularly among the younger age-groups. In pursuance of a resolution adopted by the Regional Committee at its twenty-first session, a Regional Symposium on Venereal Diseases is scheduled for December 1971, and will review the venereal-disease problem in all the countries in the Region and give suggestions for future action.

Consultants are being recruited to assist Burma and Thailand in strengthening their national venereal-disease control programmes.

One of the Regional Advisers on Communicable Diseases visited Indonesia early in 1971 and initiated an assessment of the yaws problem in that country.

In proficiency testing, the co-operation of the laboratories in Ceylon, India and Thailand with the laboratory of the National Comnuni- cable Diseases Center, Atlanta (USA), continued, resulting in the improvement of the MRL technique. It is expected that some more laboratories (e.g., in Burma and Indonesia) will also join the programme in order to contribute further to the improvement, standardization and reliability of laboratory tests.

2.4.3 Diphtheria, Pertussis and Tetanus

The reporting of these three diseases in this region is still poor. The various health administrations are taking control measures, depending on the local conditions and the availability of resources.

Systematic immunization of children continued throughout Mongolia through the maternal and child health services, with a very high degree of coverage (about 90%) of the eligible children. Simultaneously, investigations of the reported cases of diphtheria and their contacts have been routinely carried out by the epidemiological services, at both aimak sEA/RC24/2 Page 32 and central levels, and necessary prophylactic measures with the vaccine or serum, as necessary, were taken. The methodology of epidemiological surveillance and the follow-up action were developed satisfactorily and have resulted in a gross reduction of diphtheria, in comparison with the situation existing before the WHO-assisted mass immunization was undertaken in Mongolia in 1966-1967. Pertussis also showed a significant reduction, by about 50%, but not as much as in the case of diphtheria. As for tetanus, it is difficult to judge, as the number of immunized people in the total population is still low. It is expected that, with the increase in the size of the iwunized population, a reduction in the number of tetanus cases and their shift to the right (to older population groups) will take place. This will make it possible for effective assessment of the volume of immunization against tetanus.

In countries other than Mongolia, the DPT immunization campaigns are usually confined to the capital and other large cities.

In Burma, DPT immunization continued in Rangoon, with varying degrees of success. A quick on-the-spot investigation showed that when the coverage of the pre-school children in the areas reached 60%, cases of diphtheria became rare.

2.5 Virus Diseases

2.5.1 Trachoma

A WHO consultant visited the trachoma control programme in Burma and Thailand to evaluate progress as well as the result of clinical trials with one and two rounds of treatment.

The programme in Burma has made good progress. A high cure rate in active trachoma - the highest possible under prevailing conditions - has been achieved with two courses of treatment. The programme enjoyed the full support of the general health services and the co-operation of the community.

In Thailand, the programme is expected to be integrated into the basic health services in the near future. Initially, the population around health centres will be covered and cases detected and treated, with eventual extension of the activities to meet the needs of the total population in endemic areas.

UNICEF continued to provide supplies to the existing projects in Burma, India and Thailand.

2.5.2 Poliomyelitis

There were no large outbreaks of poliomyelitis in the countries of the Region during the year under review. However, about 1 000 cases SEA/RC24/2 Page 33 were observed in New Delhi during the first half of 1971. It is noted that the number of cases of paralytic polio reported yearly increases constantly in the big cities, and preventive and control measures should be taken very soon. With the decrease of infant mortality in the capitals and other big cities (below 80 o/oo), the incidence of polio increases - a correlation observed in nearly all developing countries.

Susceptible population groups have been identified in some cities through serological surveys. The results will provide a baseline for planning imunization programmes. The immunization progrme carried out on the basis of the survey undertaken in Bangkok in 1969 led to a remarkable reduction of poliomyelitis cases, so that the disease has become an uncommon occurrence. The maintenance of this situation will depend on continued immunization of new generations.

Health administrators in the various countries are faced with the problem of the extent of immunization coverage, i.e., whether to use the vaccine, on a systematic basis, with routine immunization of newborns, or only to control outbreaks. The economic and logistic factors are being studied at present.

2.5.3 Dengue/Haemorrhagic Fever and Other Arboviruses

Denguelhaemorrhagic fever was reported from Rangoon (Burma) at the end of May 1970. The outbreak subsided by the last quarter of the year, by which time more than 1 500 cases had been reported. The dengue virus type I11 was isolated by the Burmese Medical Research Institute.

The pattern of the outbreak was typical of those reported earlier in other countries, i.e., it started during the hot season, continued during the monsoon and stopped at the end of the monsoon; most of the patients were children under seven years of age. A number of samples of paired sera were sent to Bangkok for examination, and most of them were diagnoses as either dengue or chikungunya or both.

Some observations made during the outbreak are important for future epidemiological surveillance of the disease. It was noted that there were typical clinical cases of dengue/haemorrhagic fever, with completely nega- tive serological findings (about 30%) and also that the disease recurred after a few months in some children. In future activities, therefore, attention should be paid to clarifying the etiology and improving the differential diagnosis. Plans have been made in Burma to deal with future outbreaks.

Surveillance of dengue/haemorrhagic fever continued in Thailand.

In other countries of the Region surveillance proceeded along the lines of the previously established methodology, as set forth in technical circulars issued earlier by the Regional Office. No significant outbreaks were reported in India, Indonesia or Ceylon. SEA/RC24/2 Page 34

2.5.4 Influenza and Other Respiratory Viruses

No significant outbreak of influenza was reported fro@ any of the countries of the Region. However, at the Pasteur Institute, Coonoor (South India), the A 2/Hong Kong/68 strain was isolated from seven patients, indicating that this strain had been in circulation up to November 1970, although it did not cause any large outbreak. The influenza 'B' virus was isolated in more instances than in previous years, when the A 2/Hong Kong168 strain had been prevalent.

The influenza centre in Bangkok continued its work on influenza surveillance with virus isolation and serology, mostly from the material drawn from patients referred by hospitals. No epidemic was observed in Thailand during the year under review.

The Government of Mongolia was planning to start a measles vaccination campaign in Ulan Bator City and subsequently to extend it to the entire country. In preparation for this campaign, there are also plans for a field control trial with measles vaccine to assess the reactogeni- city of the vaccine and the feasibility of implementing the programme; in this trial, some children between eight months and three years of age who have never had measles will be enlisted (the exact size of the group studied to depend on the number of such [susceptible] children detected by interviews of parents and statistical evidence available).

Similar trials have earlier been carried out in other countries of the Region (e.g.. in Thailand in 1968 and in Madras [~ndia]in 1970).

2.5.5 Viral Hepatitis

This disease continued to be endemic in all countries, occurring mostly sporadically or in small outbreaks. No large outbreak was reported.

A noteworthy event, which raised hopes of attaining a better insight into the epidemiology of viral hepatitis, was the discovery of the so- called "Australia" antigen. It is expected that by the use of this antigen the diagnosis of cases, as well as the screening of population groups for susceptibility, will be facilitated. However, the matter is still under scientific scrutiny; it is hoped that the results will be known soon.

2.6 Parasitic Diseases

2.6.1 Filariasis

Filariasis control activities continued in Burma, Ceylon and India. The focus of attention in Burma was on vector control in Rangoon, where a project was started in 1970. The procedure follows the vector control methodology evolved by the earlier WHO Headquarters-assisted Filariasis Research Unit (IR 0271), which was based in Rangoon, in which the systematic application of fenthion as a larvicide on the breeding places of SEA/RC24/2 Page 35

&la2 p.fatigans resulted in reducing their density by 98%, at which level transmission of filariasis will be difficult. The programme aimed at covering the whole of the city with vector control activities, case- finding and treatment, including the treatment of microfilaria carriers.

In India, surveillance of distribution and vector density continued in ten States (Andhra Pradesh, Assam, Gujarat, Kerala, Madhya Pradesh, Maharashtra, Mysore, Orissa, Uttar Pradesh and West Bengal) , the infectivity index of the vector also being regularly checked at the same time.

In Ceylon, a proposal to incorporate filariasis control within the framework of a vector control project is under study.

2.7 Veterinary Public Health

The two-year Master's Degree Course in Veterinary Public Health, which was started at the All-India Institute of Hygiene and Public Health, Calcutta, in July 1970, continued. A WHO consultant, assigned for a period of three months, has assisted in the teaching since May 1971.

It is now intended that the inter-country project on training in veterinary public health (SEAR0 0168) should concentrate on assisting the countries of the Region with the development of their respective veterinary public health services.

2.7.1 Rabies

Rabies continued to be a problem of major public health importance in all countries of the Region. In Burma and India, efforts were continued to improve the quality of vaccines intended for both human and animal use, and have been followed by systematic analyses of their effectiveness. In an assessment made in 1970 by the Pasteur Institute of Coonoor (South India), it was found that 7.33% of the persons bitten by proved infective animals developed rabies in spite of having received a complete course of treatment with the vaccine. On the other hand, persons of the same category who refused any treatment showed a case fatality rate of 56.62%. Since rabies, once clinically developed, is still incurable (case fatality loo%), one can conclude from the above figures that humans are not highly susceptible to rabies and also that the vaccine needs further improvement.

As in previous years, dogs are the main vectors of the disease, accounting for about 85% of the total number of animals involved in rabies transmission.

The Eleventh (1969) World Survey of Rabies, carried out by WHO Headquarters, was completed, and the findings were issued as a document (WHO/Rabies/71.175). From South-East Asia, India, Indonesia and Thailand participated in the survey. Coonoor and Kasauli (India) together reported 153 299 vaccinated persons injured by various rabid or suspect animals. SEA/RC24/2 Page 36

The amount of vaccine produced during the year in the two institutions was also impressive - 974 910 doses and 5 664 476 doses of animal and human rabies vaccine respectively. The institutes in Bandung (Indonesia) and Thailand produced 100 000 and 600 000 doses of human vaccine respectively. These figures clearly indicate the magnitude of the problem of rabies and rabies control.

For quick diagnosis, where facilities and trained staff were available (Burma, Ceylon, India, Indonesia and Thailand), the fluorescent antibody technique (FAT) was introduced.

It is evident that increased attention to rabies control is being given in the countries of the Region, but much remains to be done, particularly as regards the reduction of rabies transmissions among and from animals.

2.8 Immunology

In order to explore possibilities for the establishment of immunological competence within the Region, a WHO consultant spent some weeks at the National Institute of Communicable Diseases, Delhi, in the latter half of 1970. In addition, a consultant and the Chief of the Immunology Unit at WHO Headquarters visited a number of countries to discuss the establishment of a Reference Centre for Immunology. This matter is being actively pursued by both the Regional Office and WHO Headquarters.

3. HEALTH LABORATORY SERVICES

Further progress has been made in the organization of health laboratory services.

In Burma, the reorganization of health laboratory services envisages the functioning of a graded four-tier hospital-based scheme to provide an integrated service. Three divisional and eleven district laboratories are being upgraded during 1970-71 with UNICEF assistance. In India, ten more district laboratories have benefited from UNICEF assistance; two regional laboratories, for which criteria have been elaborated, are also being considered for such assistance in 1971.

The Central Public Health Laboratory in Djakarta, Indonesia, was under construction and was expected to be ready by June 1971. An example of multilateral aid, the Central Laboratory is being equipped by the Government of Switzerland, with WHO providing technical assistance and awarding a fellowship to the director of the laboratory for training in the USA. Outside Djakarta, nine provincial and 30 kabupatan (regency) laboratories are being upgraded, with equipment from UNICEF; WBO is intensifying its assistance to the training of laboratory personnel. In Mongolia, a Laboratory Council has been established, and a new chief of SEA/RC24/2 Page 37 laboratory services has been designated. The immediate function of the Council will be to promote, at the aimak level, the integration of the specialized laboratories into a unified laboratory service that will cater to medical and health needs. In Nepal, the students in the first class (consisting of eleven laboratory assistants) completing the WHO/ UNICEF-assisted training course have been posted in the hospital laboratories in and outside Kathmandu. In Thailand, six more venereal-disease laboratories were upgraded during the year, bringing the total number of provincial health laboratories to 47.

In Burma, Indonesia, Mongolia and Nepal, WHO teams are being called upon more and more to assist with general laboratory organization. They are also consulted on more specific microbiological problems arising in other areas in the field of medical and health services and in the surveillance of comunicable diseases. This development is significant since it presupposes that those responsible for the health services at the central level have begun to realize the importance of the role of a reliable laboratory organization. It is now necessary for those at the intermediate and peripheral levels to be aware of this fact and for health officers and those assigned to disease-control programmes at all levels to work in close co-ordination with the health laboratory services.

Technically, in WHO-assisted field projects the main emphasis is laid on training programmes as the first step in upgrading laboratory services. Basic courses in medical laboratory technology are conducted in all the countries; the degree courses for technicians in India and Thailand have progressed satisfactorily. In India, with the establishment, late in 1970, of a post-graduate course in Chandigarh, career prospects for technicians have improved, as specialization in laboratory sciences has now become easier.

As a follow-up of the technical discussions on health laboratory services held during the nineteenth session of the Regional Committee, a meeting of technical and administrative staff working in health laboratory services was called in the Regional Office in November 1970. Participants from Ceylon, India, Indonesia, Mongolia, Nepal and Thailand attended this meeting, which underscored the prerequisites for a balanced development of laboratory services and emphasized the need for co-ordination with medical colleges (for details, see SEAR0 0159 in Part 111).

With regard to the promotion of reference services, WHO assistance continued to be provided to the different national laboratories. Staphy- lococcus phages were provided to the Central Bacteriology Laboratory, Mongolia, and a set of salmonella phages and propagating strains as well as typing sera to the National Health Laboratory, Rangoon. The National Salmonella Centre at Kasauli, India, received help in confirming and typing salmonella strains received from Burma. With WHO assistance, cholera strains from Burma were confirmed, typed and phage-typed at the Cholera Research Centre in Calcutta. Diagnostic sera for grouping and SEA/RC24/2 Page 38 typing streptococci were procured for the Department of Bacteriology at Lady Hardinge Medical College, New Delhi, where a consultant from the WHO International Streptococcus Reference Centre, Prague, studied the feasibility of developing a reference laboratory for streptococci.

Type sera and strains of polio and other enteroviruses as well as cell lines were procured for the newly established Virology Laboratory at the National Institute of Communicable Diseases, Delhi. Plague isolates from Burma were confirmed and typed at the Institut Pasteur, Paris.

In order to comply with emergency requests for bacteriological media and diagnostic sera used conventionally in the laboratory investigation of diarrhoea1 diseases and cholera, arrangements were made to establish a small stock of such material in the Regional Office.

There is a rapidly growing demand for mice, resulting from more extensive instruction in virology in the countries of the Region. Moreover, other small laboratory animals are needed in connection with the quality control of biologicals and drugs. For this purpose, the Regional Office has encouraged the establishment of reference libraries on laboratory animals and has provided each country with an index to laboratory animals and a set of reference books. Burma and Ceylon were also supplied with mice to help strengthen their respective colonies, and a consultant advised Burma and Thailand in the management of laboratory animals. A further consultant is to be assigned to Thailand later in 1971 to assess the need for a central breeding farm.

4. VACCINE PRODUCTION

In order to secure the timely programming of regional action in the event of any major outbreaks of infectious diseases, the Regional Office undertook a survey of the status of the vaccines produced by the various countries. Information was also sought on their assay regarding potency and stability. Answers to completed questionnaires sent out were received from Ceylon, Indonesia and Thailand, and the table on the opposite page illustrates the status of the cholera, rabies and smallpox vaccines in these three countries. In Thailand, there is scope for maintaining a larger build-up of cholera and rabies vaccines, which are used regularly by the health services. In Indonesia, stepping up the present stock of the locally produced smallpox vaccine to tide over an eventual breakdown in the plant is indicated. Ceylon and Indonesia maintain adequate stocks of rabies vaccine for their current use. (At the time of preparing this report, information had also been received from Burma and India and was being analysed.)

Action was taken to collect baseline information on the status of development of the quality control of biologicals. A questionnaire specially designed for this purpose by WHO Headquarters and a copy of an Status of Cholera, Smallpox and Rabies Vaccines in South-East Asia: Ceylon, Indonesia and Thailand

Stock carried over from 1970* Vaccine Assay Country Cholera Smallpox Rabies Requirement Frequency Potency Test Sterility Toxicity (litres) (lo6 doses) (litres) Stability 1 Ceylon WHO e.b. - + + + 24 I (42%) 1 1.3 (LV) WHO e.b. t 30' + + (175%) 180(GBV) WHO e.b. t t + + 1 (15%)

Indonesia 340 e.b. I (34%) 1 BP 0.13 (FD) WHO e.b. 1 (0.5%) 25 (MBV) NIH e.b. (12.5%)

Thailand ' 516.45 WHO a.r. + t t + (4%) 1.15(FD) WHO e.b. + + t + (32.7%) 92.2 WHO e.b. + t + + (5.2%)

% - Average of the last three years' annual production B.P. - British Pharmacopoeia GBV - Goat brain vaccine NIH - National Institute of Health,USA MBV - Monkey brain vaccine WHO* - World Health Organization w m FD - Freeze-dried - As on 1 January 1971 c%ID -.!2 LV - Liquid vaccine + - Test is performed wom e.b. - Every batch - - Test is not done \D f-N a.r. - At random Blank - No information received --.N SEA/RC24/2 Page 40 offprint of Technical Report Series No. 444 (a report of the WHO Expert Committee on Biological Standardization) were being distributed to countries in the Region.

There is often confusion in interpreting the results of the boiling test for the assay of the potency of freeze-dried smallpox vaccine. In order to avoid controversies which might arise from a wrong interpretation of the results of this test, an information circular summarizing the significance of the results and discussing the advantages and limitations of the test was sent to manufacturers and control laboratories in South- East Asia.

In India, technical capability in the manufacture of glass ampoules for freeze-dried smallpox vaccine has been established: ampoules for the vaccine and the diluent are being produced according to the standard specifications recommended by the Indian Standards Institution.

At the Central Veterinary Laboratory, Kathmandu, a new laboratory for the production of rabies vaccine is being built, with FA0 assistance.

The status of production of the various vaccines is as follows:

Freeze-Dried Smallpox Vaccine

The overall production in South-East Asia amounted to 69.3 million doses in 1970: in India, 35 million; in Indonesia, 27.2 million, and in Thailand, 7.1 million. These figures are lower than the 1969 figures by 3.9 million, and the fall is due to a reduction in the output in India, where production in 1970 was 10 million doses less than during the previous year. This fall was, however, partly offset by the increase In the production in Indonesia and Thailand. The vaccine produced is of good quality and is being tested regularly for potency and stability. The practice of submitting samples to international reference centres is being maintained.

Diphtheria/Pertussis/Tetanus Vaccine

The production of DPT (diphtheria/pertussis/tetanus) vaccine in 1970 in India, Indonesia and Thailand totalled 4 435 394 doses, an increase of 2.14 million doses over the 1969 figure. This increase is accounted for by the doubling of the production at centres in India and Thailand, i.e., by the Central Research Institute, Kasauli (4 million doses) and the Government Pharmaceutical Organization, Bangkok (195 394 doses).

Brucella Vaccine (Veterinary)

In February 1971 the Government of Mongolia submitted to the United Nations Development Programme a request (mentioned in the last Annual Report) for assistance with a project for the production and use of BruceZZa vaccine. WHO, as the executing agency, will be responsible SEA/RC24/2 Page 41 for the production of the vaccine, and FA0 will provide expert assistance in the control aspects of the project.

Rabies Vaccine

The production in Ceylon, Indonesia and Thailand totalled 3 282 litres - Ceylon 1 200, Indonesia 260 and Thailand 1 822 - showing little increase over the 1969 figure (3 120 litres). The vaccine is animal brain emulsion inactivated with phenol. In Coonoor, India, beta propiolactone is being used. In Burma, experimental trials were run with two bottles of beta propiolactone plus inactivated freeze-dried vaccine.

Freeze-Dried BCG Vaccine

Altogether, 36.14 million doses were produced: India 30 million doses of liquid BCG and 5 million doses of the freeze-dried variety, and Thailand 1.14 million doses of liquid BCG. In Indonesia, successful runs of freeze-dried BCG vaccine are being maintained, the batches being tested in Copenhagen.

5. HEALTH STATISTICS

The continuing and growing interest in national health planning on the part of governments in the Region creates new demands for information as well as a wider interest in the present body of available data and in the use of statistical skills both to supplement and to make use of it. Against this background it becomes important to develop techniques for the ad hoe collection of information immediately required for the identification and solution of current problems, without prejudicing the necessarily slower development of routine statistical systems. At the same time, in many countries an increased comnitment to family planning programmes delivered through and as part of the general health services places additional demands on data capture systems at all levels, i.e.. from the field health worker, who has to keep records of new items of information and submit additional reports, to the health statistician, who is required to tabulate and analyse the resultant figures.

In all these fields, WHO assistance has been sought and given during the year. A central theme in health planning has been to introduce the statistician as a full-fledged member of a multi-disciplinary team. To this end a statistical consultant was provided to the second Regional Course on National Health Planning; besides conducting some sessions on specifically statistical topics, he was present throughout the course and, by assisting in the development of the total curriculum, integrated much of the statistical teaching into more general seminars.

In Ceylon, a WHO statistician worked with the WHO consultant in health planning and reviewed available data systems. Subsequently, a SEA/RC24/2 Page 42 start has been made in developing a group of related studies involving WHO assistance and leading towards more detailed health manpower planning, the statistical aspects of which have been assisted by the statistician attached to the inter-country project for the strengthening and development of health services.

Thailand, too, has embarked on a series of connected studies aimed at a comprehensive review of the current supply of, and future demand for, health manpower; a consultant assisted during the year in reviewing these proposals and in making recommendations regarding the conduct of the studies.

General interest in health statistics was further illustrated by the inclusion for the first time of a discussion on this topic in the deliberations of the tenth session of the Conference of Asian Statisti- cians, held in Kuala Lumpur in December 1970. For this meeting, two background papers were prepared in the Regional Office, one on current needs in health statistics with special reference to health manpower, and the other on the role of health surveys in a national health statistics system.

The output of data produced officially by countries of the Region may be seen in the 1970 edition of the "Summary of Vital and Health Statistics, South-East Asia Region", which was issued by the Regional Office at the beginning of the period under review.

During the year, various activities were directed towards assisting the development of the basic health statistics systems which give rise to these data. In India, in Gujarat State, a one-year trial of a system of rural health records and reports, designed earlier with assistance from a WHO inter-country project, was under way. In Mongolia, a consultant assisted in the further development of the activities of the health statistics unit according to broad outlines already laid down. In Nepal, a statistical consultant is preparing guidelines for a basic system of records and reports to be used by health institutions in the country. A consultant visited Thailand to review existing methods of collecting health statistics, with a view to finding out how far they were meeting the needs of the Ministry of Public Health for planning and evaluation, and to making recommendations leading to closer co-ordination of effort.

The development of hospital statistics was assisted by an inter- country team, which so far has visited Burma, Indonesia and Thailand. From the beginning of 1972 it is proposed to combine this project with the one on rural health records so as to provide assistance to the whole field of strengthening the recording and reporting organization of health statistical services.

Two major activities in the sphere of education took place during the year. In India, a consultant visited the Model Vital and Health Statistics Training Centre in Nagpur, as well as selected State statistical units During an offlcial visit to the Region in November 1970, the Director-General of WHO. Dr M.G. Candau, visited several important public health institutions. Here he is seen at the WHO Headquarters-assisted Research Unit for the Genetic Control of Culicine Mosquitoes in New Delhi. Participants from rour wnu neglons (nrrlca. South-East Asia. East nd Western Pacific) attended the Fourth Meeting of Directors or Representati lblic Health. which took place in the Regional Office in March 1971. SEA/RC24/2 Page 43 employing students trained at the Centre, and made detailed proposals for revising the curriculum of the course for intermediate-grade statisticians, in a form that should prove useful to similar training institutions elsewhere. Meanwhile, proposals for the establishment of a second training centre in India were under discussion. Further WHO assistance is envisaged for implementing these plans.

The second activity was in Indonesia, where a consultant visited selected medical schools to review the teaching of biostatistics to medical undergraduates; he also helped in organizing a seminar on the methodology of teaching health statistics in undergraduate medical education, at which a minimum standard curriculum for this subject was developed.

The Indian Council of Medical Research has now expanded its statistical section into a Division of Statistics and Communication. A WHO consultant reviewed the present use of the computer by the Council and advised on future policy with regard to the development of computer science and facilities.

New connnitments in the health aspects of human reproduction, family planning and population dynamics led to considerable advisory work, much of it involving liaison with other international bodies. A statistician joined the inter-country team on family health early in 1971.

6. EDUCATION AND TRAINING

6.1 Medical Education

During the year, a total of 42 short-term consultants assisted in implementing programmes in medical education in the various countries. (This figure does not include those assigned in connection with the educational aspects of maternal and child health or UNFPA projects.)

Follow-up visits to seven medical colleges in India and to one each in Ceylon and Indonesia were made by consultants in teams of two or three or as individuals, in order to assess the changes made since their last visit. Short-term consultants were assigned to two medical colleges in India which had not previously been included in the programme. Long- term assistance by four WHO medical educators was continued in Burma and Indonesia.

A major activity was the holding of the Fourth Meeting of Directors or Representatives of Schools of Public Health, which took place in the Regional Office in March 1971, with participants from countries of the African, Eastern Mediterranean, South-East Asian and Western Pacific Regions of WHO (for details, see SEAR0 0185 in Part 111). Other important meetings included (i) the Seminar on Problems of Health Care and Medical Education in the Tropics (Colombo, August-September 1970); (ii) the SEA/RC24/2 Page 44

Second Medical Teachers' Training Course (Peradeniya, Ceylon, November- December 1970), and (iii) the Seminar on Rheumatic Heart Diseases, Epidemiology, Prophylaxis and Clinical Management (New Delhi, February 1971). A total of 13 consultants served on the faculties for these meetings.

Two consultants visited Burma to study medical education in the three Institutes of Medicine in order to explore the possibility of seek- ing assistance from the UNDP (Special Fund) for a long-range plan for the development of health manpower. The reports were studied; a staff member from WHO Headquarters visited Burma and helped in preparing a draft request based on the findings.

In Ceylon, a WHO consultant assisted with preliminary preparations for a study on the role and functions of doctors, to provide a rational basis for revision of medical curricula. The same consultant had recommended carrying out this study during a previous assignment early in 1970. He worked in close co-operation with staff members from WHO Head- quarters and an inter-country project in order to integrate the study in the overall plan for a comprehensive manpower study (see section 1.1.3).

Of great interest to WHO were the recommendations of a Conference on Medical Education, convened by the Government of India in July 1970 to discuss the Report of a Committee on Medical Education set up in 1969. The meeting drew up proposals for overcoming evident deficiencies in the preparation of doctors for their work, such as the still heavy clinical bias and the compartmentalization of the curriculum. One of the Regional Advisers on Medical Education attended the conference.

In Indonesia, the Consortium of Medical Sciences, established by the Government in early 1970, completed its fact-finding visits to all medical schools. The Government has designated a number of departments in various medical faculties as "feeder" departments, where junior teaching staff from other faculties will be trained. Minimum requirements with regard to the curriculum, staffing and facilities for a medical school have also been laid down and will serve as a basis for the further planning and development of government medical schools as well as for according recognition to private institutions.

In Nepal, plans to establish a medical college were revived. The long-standing Medical College Committee submitted to the Government a 11 sl~ort-term" plan and a "long-term" plan, recommending implementation of the former scheme in 1973. Discussions were held with the Government and other authorities on the various aspects of international assistance which would be required.

Two new medical schools in Thailand are being planned, one in the south (Songkhla) and one in the north-east (Khon Kaen). WHO participated in a UNESCO project preparatory mission to Thailand to advise on the SEA/RC24/2 Page 45

Government's request to the World Bank for assistance in strengthening the existing Faculty of Sciences at Songkhla University in order to enable that faculty to provide pre-medical education. A WHO team held discussions with the national authorities on the various aspects of developing a health sciences centre at this university.

As a first follow-up of the Medical Teachers' Training Course held in Ceylon in the fourth quarter of 1970, a set of 23 books on educational principles and problems was distributed to all those medical colleges in Burma, Ceylon, Indonesia and Thailand which had sent participants.

In collaboration with WHO Headquarters, a scheme was developed whereby material for clinico-pathological conferences will be distributed to interested medical schools in South-East Asia. The material is provided monthly free of charge by the Massachusetts General Hospital in Boston.

Collaboration with WHO Headquarters covered several aspects of medical education. The occasions of visits by Headquarters staff members were utilized to discuss matters of mutual interest. These included Head- quarters' assistance and advice on the promotion of modern teaching methods by the use of teaching aids, "a comprehensive and co-ordinated long-range training programme for teachers of medical and allied health sciences" and two global studies launched by Headquarters on education in public health and on continuing medical education. The Regional Office also participated in a Headquarters-organized Travelling Seminar on the Organization of Refresher Courses for Medical Staff, held in the USSR in October 1970.

6.2 Paediatric and Obstetric Education

As in the past, assistance to paediatric and obstetric education in medical schools was directed towards strengthening the teaching of the social, cultural and psychological aspects of child health and obstetrics, promotion of inter-disciplinary co-ordination and integration of teaching, the establishment of field practice areas for students, and acquisition of practical knowledge and skills in handling the most common health problems of mothers and children within the framework of the family and the community as a whole.

A consultant in paediatrics was assigned to Burma in April 1971 to assist with the first diploma course in child health at Institute of Medicine I, Rangoon, and in strengthening the undergraduate paediatric course of studies at the Institute of Medicine, Mandalay. A similar consultant was to be provided to Ceylon to advise on the further development of the diploma course in child health at the Medical College,Colombo.

The Government of India agreed to select two medical colleges for a trial of the undergraduate paediatric curriculum prepared by the WHO- sponsored Ad Hoc Committee on Medical Education. SEA/RC24/2 Page 46

Towards the end of the period under review, a consultant was recruited to study the progress in post-graduate paediatric education which India had made subsequent to the study undertaken in 1966-1967, and to recomnend measures for further improvement.

Plans were being made to provide WHO assistance in strengthening departments of paediatrics and obstetrics and preventive and social medicine of medical colleges in India under a unified and combined project.

The report of the consultant who, in July 1970, made an assessment of the benefits derived by participants from South-East Asia from their attendance at the WHO/UNICEF "London-Bombay Course" for senior teachers of child health in earlier years, was sent to the institutions involved and to UNICEF. The scope of this course has been enlarged to include another area, and it is now called the "United Kingdom/Kampala/India Course". During September-November 1970, a WHO consultant assisted in the preparation and conduct of a field study designed for the ten participants in the Indian part of the 1970 course.

Two consultants were recruited to study and advise on the teaching of paediatrics and obstetrics and gynaecology in the context of human reproduction, family planning and population dynamics in four medical colleges in India selected for assistance in 1971.

In Indonesia, two medical educators - one in paediatrics and one in obstetrics - were assisting selected departments with the strengthening of the teaching of these specialties, particularly in the context of human reproduction, family planning and population dynamics.

The first course on "Rehydration Therapy Centres" was held in Surabaja (Indonesia) in April 1971, with the participation of 27 senior paediatric teachers from medical faculties in Indonesia.

A consultant advised the Faculty of Medicine at Siriraj Hospital, Bangkok, on the further development of an endocrine laboratory in the Department of Obstetrics and Gynaecology.

A regional symposium on the role of the paediatrician in a family planning programme is also planned to take place in Madras (India) in December 1971.

6.3 Teaching of Human Reproduction, Family Planning and Population Dynamics

In countries with national family planning programmes and WHO/ UNFPA-assisted projects for the teaching of human reproduction, family planning and population dynamics, high priority vas given to strengthening all departments, both pre-clinical and clinical, concerned with the teaching of these subjects, in order to develop a balanced, integrated SEA/RC24/2 Page 47

course of studies and LO ensure an effective integration of community- oriented experience in the total curriculum.

In March, the Consortium of Medical Sciences in Indonesia, mentioned earlier, organized a workshop on the teaching of human reproduction, family planning and population dynamics with assistance from WHO.

Earlier in February, the four WHO consultants who participated in the workshop advised on the teaching of these subjects in medical schools in Indonesia in preparation for drawing up a plan of operation for a project in this connection.

Under an inter-regional project, a team of three consultants visited various medical centres in Thailand to study and advise on the development of a national project for the teaching of human reproduction, family planning and population dynamics.

A wide range of regional activities, consisting of courses and seminars, was undertaken. A major event of the year was the 14eeting of Deans and Principals on the Teaching of Human Reproduction in Medical Schools, which was held ill the Regional Office in December 1970. Four consultants - on curriculum development, child health, obstetrics and gynaecology and human biology - made preparations for and conducted the proceedings of the meeting, which discussed a wide range of topics related to the course content, faculty development, teaching methods and pattern of co-operation between the teaching institutions and the health administrations.

Of significant impact were two seminars on "Recent Developments in the Basic, Clinical and Public Health Aspects of Human Reproduction", held in Thailand (Bangkok) and India (Bangalore) in October 1970 in collaboration with WHO Headquarters. The participants were leading members of medical faculties, clinicians and public health administrators.

The Regional Office also assisted WHO Headquarters in the organization of a two-month training course in human reproduction for senior teachers of obstetrics and gynaecology in medical colleges in India, which was held at the National Institute of Family Planning, New Delhi, during August-September 1970, and plans were in progress to organize a further such course for teams of senior medical educators from selected medical schools in the Region, to be held at the same institute in September 1971.

6.4 Fellowships

During the year, 504 fellowships were awarded, 474 (94%) of which were new, 21 (4%) for a second year of study and 9 (2%) for a third or additional year necessary for the fellow concerned to complete specific progranrmes . Fellowships Awarded by the WHO South-East Asia Region, by Subject of Study and Country of Origin of the Fellow

(1 August 1970 to 30 June 1971)

I I I Subject / Burma , Ceylon I India Indonesia I Maldives I Mongolia / ~epal1 Thailand I Total I I I I 1 i i 1. Public health I i i - administration / 111 9 1 13 13 10 4 14 64 I 2. Sanitation 3 5 I 9' 11 - 1 2 5 36 1 3. Nursing I - 3 ' 18 2 1 3 6 10 43 4. Maternal and 1 child health 1 5. Other health 1 I services 9 6. Comunicab le diseases and laboratory services

7. Clinical medicine

sciences and education GRAPH 2-Fellowships awarded by WHO, By Subject of Study and Country of Origin ot the Fellow (1 August 1970 to 30 June 19711, South East Asia Region.

Public Health Administration Other Health Services Sanitation a:: Communicable Diseases EL Laboratory Services tf Nursing a ~li~i~~l~~di~i~~ Maternal and Child Health ~asicMedical ~cisncerand Education

TOTAL

BURMA CEYLON

INDIA INDONESIA MALDIVES

MONGOLIA NEPAL THAILAND GRAPH 3-Fellowships Awarded by WHO in the Last Five Years (1966-1970), South East Asia Region

BURMA CEYLON INDONESIA MALDIVES MONGOLIA NEPAL THAILAND Annual Distribution of Fellowships by Country and by Type of Fellowships, 1966 to 1970 (calendar year), for Study Within and Outside the South-East Asia Region SEA]RC24/2 Page 50

Of 131 fellowships in communicable-disease control. 31 (24%) were for malaria, 17 (13%) for tuberculosis, 44 (34%) for laboratory services, 10 (8%) for leprosy, 7 (5%) for epidemiology. and 22 (17X)for filariasis. international quarantine, port health, smallpox, trachoma control, tropical public health, veterinary public health, medical entomology and thyroid hormones.

Sixty-four fellowships were awarded in the sphere of public health administration, particularly in such subjects as national health planning, medical care administration and hospital administration.

Of the total number of awards for the period covered by this report, 85 (18%) were for training within the Region.

In all, 148 fellowships were awarded to doctors, engineers and nurses for one-year post-graduate courses leading to a degree or diploma; in addition, 68 were given for attendance at international courses, 207 for other types of training or experience, and 51 for study tours.

Arrangements were made in connection with the Indian part of the follaring combined courses: epidemiology (Prague-Delhi); epidemiology and control of tuberculosis (Prague-Bangalore); paediatrics, and several courses organized by the Malaria Eradication Training Centre, Manila.

During the year, 91 fellws from outside South-East Asia visited the Region for periods varying from 15 days to 44 months. These fellows came from the follwing countries or territories: Afghanistan, Colombia, Czechoslovakia, Fiji, Ghana, Iran, Iraq, Japan, Jordan, Kenya. Korea. Laos, Lesotho, Malaysia, Mexico, Papua and New Guinea, the Philippines, Singapore, Sudan, the United Arab Republic, the United Kingdom and the United States of America.

Graph 2 and the accompanying table on page 48 show the number of fellowships by subject of study and country of origin of the fellow, from 1 August 1970 to 30 June 1971; Graph 3 and the table on page 49 show the number of awards over a five-year period.

It may be seen from the following figures that there has been a very significant increase in the nuder of awards issued annually during the last five years: -1966 -1967 -1968 -1969 -1970 200 212 296 384 5 39

Tables 1 to 4 in Annex 7 give, in respect of each country of the Region: (1) the distribution of the awards by sources of funds and type of fellowship; (2) distribution by subject of study and country of origin of the fellw; (3) the number of fellows from the Region going to other regions and vice versa, and (4) utilization of former WHO fellows. SEA/RC24/2 Page 51

In order to overcome language difficulties, tuition in the language of study has, in exceptional cases in which this has been recommended by the testing agency, been subsidized by WHO.

Changes in the programme of study and last-minute cancellation of fellowships still cause problems and are the main source of difficulties in the administration of fellowships.

The Regional Fellowships Officer visited several countries and training institutions in the Region for observations, with a view to achieving better planning of the WHO fellowship programme and obtaining first-hand knowledge about the prograuune as a whole. Discussions were held on possibilities of increasing the number and improving the quality and timing of applications, as well as of bringing about better programme delivery.

7. TECHNICAL INFORMATION AND REFERENCE SERVICES

The period under review was one of reappraisal. Certain reporting procedures which had been followed for many years were reviewed to see whether they were meeting the changing needs resulting from emphasis on country programming. Some procedures were changed or dispensed with; for example, in the interests of reducing the amount of paper work, it was decided to do away with the requirement for routine monthly progress reports from field project staff. The method of transmitting assignwnt reports to governments, as the final act of programme delivery, also underwent some modification. Furthermore, it was decided to discontinue asking governments, as a routine, for clearance of assignment reports by consultants and field staff but to do so only for certain reports, with a consequent effect on the distribution policy. The contents and presentation of the Regional Director's Annual Report were reviewed and somewhat revised. As regards the Regional Office Library, plans were made to amalgamate it with the Regional Documentation Centre on Family Planning, Human Reproduction and Population Dynamics, when established, and to transfer it from the Reports and Documents Unit to form part of the proposed "Education and Training Task Force".

Reports

Altogether, in tlte eleven-month period covered by this report, 182 reports were edited and issued. These consisted of 136 assignment reports, 12 reports of field visits by Regional Office and other staff and 34 reports on seminars, courses, special studies,etc. Among the more important reports, four - those of the Inter-country Workshop on the Control and Management of the Nursing Component of Health Services (held in November 1969), the Third Regional Seminar on Leprosy Control (held in January 1970), the First Regional Seminar on Veterinary Public Health (held in April 1970), and the Symposium on Academic Education and Training in Occupational Health and Hygiene (held in November 1970) - SEA/RC24/2 Page 52 were issued under printed cover. Others, including the report on the Regional Seminar on Community Water Supply (held in March 1970), were widely distributed as mimeographed documents.

The increase in the number of reports received for editing and processing (consequent on the assignment of large numbers of short-term consultants) has become a regular feature. To cope with the additional workload, one of the two additional editorial posts recommended by the Regional Committee at its twenty-second session in 1969 was filled in March 1971.

Documents and Other Publications

The report and minutes of the twenty-third session of the Regional Committee, the report of the technical discussions on "Hospital Referral Services" held during that session, and the revised "Handbook of Resolu- tions and Decisions of the Regional Committee" were, as usual, compiled, edited and issued under printed cover. In addition, the second "Immuno- logy Newsletter" was brought out in June.

Distribution

One of the functions of the Regional Office continues to be the dissemination of technical information to governments as well as to health workers and others interested in matters of health. Some of the more important documents to which wide distribution was given (in addition to the material mentioned above) included (a) the 1970 edition of the "Summary of Vital and Health Statistics, South-East Asia Region" (mentioned in last year's Report); (b) an article entitled "Status of Malaria Eradication during the year 1969" (offprint from the Weekly Epidemiological Record, Vol. 40, 1970, 429-445); (c) Archives of Envisonmental Health, Vol. 19, No. 6, issued by the American Medical Association; (d) MaZaria Eradication News, Nos. 10. 11 and 12, issued by the National Institute of Comunicable Diseases, Delhi; (e) Maternal Nutrition and FdZy l'lanning in the Americas, issued by the Pan American Health Organization; (f) "Principles and Practice of Cholera control" (PubZic LleaZth f'upers No. 40) ; (g) "Report of the WHO Expert Committee on Leprosy" (WHO Techical Report Series No. 459), and (h) a large number of documents received from Headquarters, such as smallpox surveillance reports and reprints on subjects like malaria, tuberculosis, cholera and venereal diseases.

As in previous years, documentation and reference services were provided during meetings organized by WHO; document lists were compiled and requests for documents complied with.

Documents and publications stocked on various floors of the Regional Office building were shifted to the new storeroom built adjacent to the garage, and documents and the relevant files were screened in order to weed out unnecessary material. SEA/RC24/2 Page 53

Sales

The value of sales of WHO publications has continued to increase each year, and 1970 was no exception. However, the amount of increase ($2 OOO), was less than that of the previous year ($3 OOO), probably because of the cumulative effect of the lack of publicity over several years (which it has been found difficult to carry out for various reasons, including staffing problems). As for subscriptions, there was an increase from 472 in 1969 to 524 in 1970.

In all, the sales during 1970 amounted to US $19 111 (subscriptions to $10 598 and retail sales to $8 513)*, and, during the first six months of 1971, to $14 695.

WHO publications were displayed during seventeen meetings, not only many sponsored by the Regional Office (see Annex 3) but others convened by outside agencies, one of the most important of which was the XI Inter- national Congress of Internal Medicine, held in New Delhi in October 1970. In most cases, lists of WHO publications on the relevant subjects were prepared and distributed to participants. The displays resulted in a number of orders and subscriptions.

Library

The detailed survey of the Library mentioned in last year's Annual Report was completed, and the recommendations were being implemented.

With regard to the study of medical school libraries in the countries of the Region, which was carried out by means of a questionnaire in order to obtain information on the facilities available (also mentioned last year), replies were received from 90 out of 114 institutions. A report was prepared outlining the findings, giving an analysis by country and including suggestions for improving the services.

The Library acquired, during the period under review, 1 244 new books and pamphlets and 133 WHO publications. It now receives 384 current periodicals (about 200 on payment and others free or in exchange for WHO publications). In all, 2 111 publications were issued on loan to Regional Office and field staff, and about 2 200 pages of photocopies provided. Library News, listing the new acquisitions and containing articles of interest to WHO, was brought out regularly.

Lists of about 1000 books and over 3 000 issues of periodicals available in the Library were prepared and, on the recommendation of the Library Committee, sent this year to medical institutes in Burma.

*All figures relating to sales are based on the net amount shown in the invoices, in most of which a 50% (40% in respect of subscriptions) discount and, in some cases, an additional 10% trade discount have been allowed. Therefore, the commercial value of the publications sold should be taken to be approximately double the figures given. SEA/RC~~/~ Page 55

PART I1

ORGANIZATIONAL AND

ADMINISTRATIVE MATTERS SEA/RC24/2 Page 57

1. THE REGIONAL COMMITTEE

The twenty-third session of the Regional Committee for South-East Asia was held from 22 to 28 September 1970 in the Regional Office. Representatives from all countries in the Region were present. In addition, representatives of the United Nations and United Nations Development Programme, UNICEF, the Office of the High Commissioner for Refugees, the United Nations Military Observer Group in India and Pakistan, FAO, ILO, UNESCO, as well as of sixteen non-governmental organizations in official relations with WHO and one observer (from the Ford Foundation), were present. The Director-General of WHO was represented by one of the Assistant Directors-General.

In the absence of the outgoing Chairman and Vice-Chairman, the Regional Director opened the session. The Vice-President of India, Mr G.S. Pathak, delivered the inaugural address, and a speech was read on behalf of Mr K.K. Shah, Minister of Health and Family Planning, Works. Housing and Urban Development, Government of India, by the Minister of State for Health. Statements were also made by the representatives of the Directorxeneral and by the Regional Director.

The Regional Committee elected Dr Chitt Hemachudha (Thailand) as Chairman and Dr Thein Tun (Burma) as Vice-Chairman.

In considering the Regional Director's Annual Report, the Committee noted a change in its presentation, which was thought to reflect the growing interest of governments in organizing and strengthening the basic health services, and the new concept of "family health". In the discussion of the report, the importance of health planning was stressed, and attention was drawn to the course organized with the assistance of the Asian Institute for Economic Development and Planning, Bangkok, and the National Institute of Health Administration and Education, New Delhi.

The Committee discussed at some length the problem of communicable diseases, which continued to cause concern, and, in this connection, the importance of health education and of more research in the behavioural sciences. Continued priority was advocated to assistance in training health workers and thereby building up manpower. The need to attract physicians to work in the rural areas and also to absorb single-purpose workers into the basic health structure was stressed.

Among other subjects discussed by the Committee were radiation health, air pollution, quality control of drugs, immunology, cancer control, health statistics, and programme planning of public health activities.

It also considered and adopted resolutions on the subjects of (1) long-term financial indicators, (2) adverse effects of tobacco smoking, and (3) the Organization's Fifth General Programme of Work Covering a Specific Period. SEA/RC24/2 Page 58

The Committee established a sub-cormnittee on programme and budget, consisting of representatives of all Members, to review the proposed programme and budget estimates for 1972, which were subsequently approved for transmission to the Director-General.

In the technical discussions on "Hospital Referral Services", the prerequisites for a good hospital referral service and practical aim of finding ways of implementing a suitable system were considered. The discussions revealed that there must be better utilization of limited resources for a well-organized medical care system, which was essential not only for the efficiency of the overall health structure but also for the economical use of the staff and the facilities available.

"Health Statistics Requirements for National Health Planning" was chosen as the subject for the technical discussions to be held in 1971.

The Regional Comnittee confirmed its earlier decision to hold its twenty-fourth session in Rangoon, Burma, in September 1971, and decided to accept the invitation of the Government of Ceylon to hold its twenty- fifth session in that country in 1972.

2. ADMINISTRATION

2.1 General

Early in the year, the Regional Director paid his first official visit to Mongolia. Other visits during the period under review took him to Burma, Ceylon and Thailand. On visits to Burma and Ceylon, he accompanied the Director-General (see below). In Ceylon, he also attended the inauguration of the WHO-sponsored Seminar on Problems of Health Care in the Tropics. In Thailand, he participated (together with the Director of Health Services) in a three-day meeting on national health planning held in Bangkok, and, on a second visit, in the company of the Director of Health Services and the Director of Family Health from WHO Headquarters, held discussions on the Thai family planning program with the Government and the Resident Representative of the United Nations Development Programme. Burma, Ceylon and Thailand were visited by the Director of Health Services.

In April 1971, the Regional Director delivered the first "Dr Shantilal C. Sheth Endowment Lecture in Medicine" under the auspices of the University of Bombay. In June, he paid a one-day visit to Calcutta, together with the Health Secretary to the Government of India, to acquaint himself with the health situation arising out of the influx of refugees from East Pakistan.

The Regional Director also went to Manila, where he attended an inter-regional seminar on cholera control and held consultations with the Regional Director for the Western Pacific on the proposed health charter for Asian countries. SEA/RC24/2 Page 59

The Regional Office welcomed the Director-General in November 1970, when he paid official visits to India, Burma and Ceylon at the invitation of the respective governments. In addition to paying courtesy calls on high government officials in these countries, he visited a number of important public health institutions. The Regional Director accompanied the Director-General on his tour.

The Regional Xrectors for the Eastern Mediterranean and the Western Pacific also visited the office, on the occasion of the Fourth Meeting of Directors or Representatives of Schools of Public Health (see Part I, Chapter 6, and SEAR0 0185 in Part 111).

Following a visit to the Regional Office paid by the Chief of the Foreign Relations Division of the Mongolian Department of Civil Aviation, an agreement was signed between WHO and the Government of Mongolia for the provision of air tickets on credit to WHO.

In October, two members of the United Nations Joint Inspection Unit visited WHO-assisted projects in Indonesia and Burma respectively and held discussions with the WHO Representatives in Djakarta and Rangoon.

In view of the considerable expansion of the field programme in the Region (the Regional Committee, at its last session, had expressed concern about the capacity of the staff to cope with the work), it was considered necessary to review the supporting services, both in the Regional Office and in the offices of the WHO Representatives. Accordingly, at the request of the Regional Director, two staff members of the Administrative Manage- Dent Unit from Headquarters assisted the Regional Office in conducting two types of surveys, i.e., first, an assessment of the workload distribution to explore possibilities of streamlining the organizational patterns and methods, and, second, a review of the planning, monitoring and deliverv of programmes. This two-month survey was carried out in March-April 1971. Workshops on the subject of management tools for programme planning, monitoring and delivery were also organized for the benefit of Regional Office staff, and a study of microforms was undertaken.

As in the previous year, arrangements were made for a number of h'K0-sponsored meetings, seminars, etc. A list is given in Annex 3.

2.2 Organizational Structure

The structure of the Regional Organization as of 30 June 1971 is shown in Annex I to this report. The proposed organizational structure as from 1 July 1971 is given in Annex I(A).

As at 1 July 1971, there were three professional vacancies in the Regional Office (Budget Officer, Information Officer and Administrative Officer). Action to recruit the Budget Officer was already in progress at 30 June, leaving two posts still to be provided for.

In the technical services category, nine posts were vacant on 1 July, for three of which candidates had been selected. Recruitment SEA/RC24/2 Page 60

is in progress for the posts of specialists in health planning and in public health. The remaining four vacancies, namely, one Assistant Director of Health Services, Programme Management Officer,Administrative Officer and Liaison Officer, had still to be filled.

In April 1971 the new WHO Representative to Mongolia was appointed, and the post of WHO Representative to Nepal, which fell vacant in the course of the year, was filled by the reassignment in May of a staff member from the Regional Office.

2.3 Personnel

Professional staff assigned to the Regional Office and the WHO Representatives are listed in the organizational chart mentioned above. The distribution by nationality of professional staff in the Region as on 30 June 1971 is shown in Annex 2.

The following table shows the number of posts in the professional and general service categories established for the Region and the numbers actually filled as on 30 June:

Established Posts actually Vacant posts filled posts I(1) Regional Office Professional General service l(2) Offices of the Regional Advisers

Professional General service

(3) Offices of the WHO Representatives

Professional General service

(4) Field Progranrme

Professional General service

In addition, three professional staff members were on leave without pay as on 30 June.

The post adjustments for Indonesia (West Irian) and Nepal were revised upwards. A time-to-time survey of the cost of living in New Delhi was conducted.

*Five posts filled by short-term consultants. The Regional Office starts its week with a "Monday Morning Meeting" of technical staff, who report on project activities and discuss other current matters. - --

Meetings constitute an important element of the day's work. Here, the Regional Director and some of his senior staH in discussion with a management expert from WHO Headquarters on methods of improving the work of the office. Featured on this page are a few memoerr or me tecnn~calstaff working in the Regional Office. The Regional Fellowships Officer is consulting his files ......

...... the rplaemiologlsr or tne int ~f the Regional Adv~sers on country Smallpox Eradication Advisor, Envnronme~~ralHealth has discussions with Team studies a report from the field ...... a field staff member ......

I the Regional Adviser on Health Education addresses participants in a WHO-sp I on the Promotion of Public Health Information. SEA/RC24/2 Page 61

The salaries and allowances of general service staff in Djakarta and Kathmandu were also revised.

The Committee on Local Grading, Salaries and Allowances (set up by the United Nations agencies in Delhi) met a few times to review various matters concerning the general service staff in New Delhi.

Action was initiated for the annual review by the Regional Standing Committee and the Beadquarters Standing Comnittee, both established last year (as mentioned in last year's Annual Report), of cases of staff members who reached the top of their grades and served for at least five years in the same grade.

Steps were taken to improve recruitment procedures in order to permit long-range recruitment planning which would lead to faster programme delivery.

2.4 Staff Training

Three WHO Representatives attended the WHO Representatives' Training Course in February, and the Budget and Finance Officer and the Personnel Officer participated in the course for administrators, from 15 June to 1 July, both courses being held in Geneva. The Assistant Director in charge of the Programme Support and Co-ordination Unit and one of the regional nursing advisers were, at the time of writing, avay undergoing training in management.

2.5 Staff Welfare and the Staff Society

The Regional Office Dispensary continued to provide health services to the staff. In view of the considerable increase in the work, it was decided to appoint the dispensary nurse on a full-time basis.

The Staff Society was active. It was represented on the Staff Health Insurance Surveillance Committee, the Regional Meritorious Increase Committee, the Regional Board of Appeal and the Regional Standing Colnmittee mentioned in 2.3 above, as well as at the meeting of the Council of the Federation of International Civil Servants' Associations (FICSA), held in Geneva in Hay. The Society continued to administer a welfare fund and to sponsor activities in fields such as philately, sports, photography and the screening of films; a number of other schemes in the interests of the staff were also initiated.

2.6 Finance, Budget and Accounts

The total obligations incurred on field activities during the last five years, under the Regular budget, UNDP (TA and SF) funds, UNFPA, FlTNDWI and Funds-in-Trust, were as follows: SEA/RC24/2 Page 62

Source of Funds Year Regular(inc1uding UNDP Malaria and Small- UNFPA FmDWI Funds- TOTAL pox Eradication (TA and SF) in-Trus t Programmes) US $ US S us $ us $ us $ us $ 1966 3 123 686 1 355 304 - - - 4 478 990

1967 3 825 114 1 083 696 - - - 4 908 810

1968 4 686 760 1 486 619 - - - 6 173 379

1969 5 010 196 606 765 - - - 5 616 961

1970 5 885 225 1 178 234 36 978 23 707 20 542 7 144 686

The obligations incurred under the Voluntary Fund for Health Promotion were as follows:

Special Account for Year Smallpox &laria Leprosy Yaws Miscellaneous TOTAL Eradication Eradication

us $ us $ us $ US $ US S $ 1966 6 452 - 15 000 9 185 16 595 47 232

1967 53 030 - 34 000 - 9 415 96 445

1968 88 410 14 738 30 667 - 41 943 175 758

1969 38 489 - 30 023 3 686 3 750 75 948

1970 10 778 - 34 897 1 140 46 815 I -

-Note: Figures in respect of Afghanistan have been excluded from the totals; hence figures for 1966-1968 will not conform to the totals given in earlier reports. S~A/Rc24/2 Page 63

2.7 The Regional Office Building

The draft sale-deed and the deed of lease proposed by the Govern- ment of India (and mentioned in last year's report), with mutually agreed amendments, were found acceptable by the Organization, and the Government was infosmed accordingly. It is expected that these documents will shortly be signed by the Government and the Organization, to enable final transfer of the ownership of the building to WHO.

In January 1971, the Minister of Health and Family Planning and Works, Housing and Urban Development of the Government of India visited the Regional Office for discussions on future space requirements. Conse- quent upon this meeting, the Regional Office was given permission to construct an additional 11 per cent of the total plot area.

It is proposed, first, to build a temporary structure to meet the urgent requirements for office space, and funds for this purpose have been sanctioned by the Twenty-fourth World Health Assembly. The question of constructing a permanent annex to World Health House is under study.

3. PROCUREMENT OF SUPPLIES AND EQUIPMENT

During the period under review, supplies and equipment costing US $559 437 and covering 3 565 items were procured. These included laboratory equipment and chemicals, hospital and surgical supplies, drugs, vaccines, biologicals, teaching equipment, transport vehicles and, in a few cases, limited supplies of office equipment and stationery. In addition, 7 890 medical books and periodicals costing $28 886 were procured, including 66 books/periodicals, costing $3 051, provided on a reimbursable basis to a medical college in India.

Supplies provided to a number of research institutions receiving WHO Headquarters' research grants were cleared and sent to the institutions concerned. In addition, during the first six months of 1971, 830 packets, a number of which were intended for Headquarters-assisted research activities, were received and despatched to the ultimate consignees.

Under the Revolving Fund for the procurement of teaching and laboratory equipment for medical and paramedical education and training, four requests were processed, and three new requests were received during the period. Some earlier requests were either awaiting clearance by governments or advance deposits from the institutions concerned.

The folloving quantities of freeze-dried smallpox vaccine were donated by Member Governments to the countries of the Region: Maldives .. 70 000 doses (from the USSR) Mongolia .. 210 000 " ( " " " 1 Nepal . . 1 770 000 " ( " " " ) and -do- .. 250 000 " (from New Zealand) SEA/RC24/2 Page 64

To meet an urgent request for cholera control in Nepal, 1000 bags of rehydration fluid (saline), 300 transfusion sets and 1 000 kgs of bleaching powder were procured in India and sent to Kathmandu.

At the request of WHO Headquarters, the following essential supplies urgently required in areas of East Pakistan devastated by a cyclone were procured in India and despatched:

(1) 180 tons of bleaching powder (by road)

(2) 1 000 ampoules of 10 ml. each of liquid anti-snake venin (procured from the Central Research Institute, Kasauli) and a similar quantity of lyophilized anti- snake venin (purchased from the Haffkine Institute, Bombay) (by air freight).

In the second quarter of 1971, WHO received an urgent request from the Government of India for cholera vaccine and for large quantities of general medical supplies for the East Pakistan refugees in West Bengal (India). The following supplies were provided: 9 110 000 doses of cholera vaccine, 77 690 litres of rehydration fluids, 6 240 transfusion sets with needles, 2 996 600 tetracycline capsules, 76 Ped-0-Jet injectors, 75 000 syringes and 1 300 000 needles.

Most of the supplies were being, or had been, procured through WHO Headquarters from funds made available from various sources and airfreighted direct to Calcutta. The Regional Office has been in liaison with the Government for all medical supplies being brought into India. A portion of the list of the Government's requirements, amounting to approximately $600 000, may be purchased locally in co-operation with the Ministry of Health, New Delhi.

In response to an appeal made by the Director-General of WHO, the Governments of India and Thailand donated cholera vaccine to WHO to form part of the Organization's emergency reserve:

India - One million doses (received from the Central Research Institute, Kasauli, and airfreighted to Riyadh, Saudi Arabia).

Thailand - 300 000 doses (to be made available when needed).

A request for supplies and equipment, on a reimbursable basis, was received from the Government of Nepal for the improvement of water supply and sewerage. The items requested are to supplement the supplies being furnished by WHO under project Nepal 0025. The request was being processed and the Government requested for advance deposit of the amount involved. SEA/RC24/2 Page 65

To meet an emergency request from the UNDP field staff in Bangalore (India), immediate arrangements were made to procure 280 doses of rabies vaccine and a limited amount of rabies serum.

4. COLLABORATION WITH OTHER AGENCIES

4.1 United Nations

Close co-ordination and consultation with the United Nations and the various related agencies continued during the year.

Activities associated with social welfare projects continued in practically all countries of the Region, and close collaboration was maintained with the United Nations Department of Economic and Social Affairs in respect of these programmes.

In connection with the Regional Seminar on Techniques and Procedures of United Nations and Technical Agencies, organized jointly by ECAFE and the United Nations Institute for Training and Research (UNITAR), which was held in Bangkok in March 1971, the WHO Representative in Bangkok and the WHO Liaison Officer to ECAFE attended some of the sessions, to assist in acquainting the participants with the structure and functions of WHO and the methodology of assisting governments in the development of their health services. The Director of Health Services attended a UNITAR Colloquium for Senior Officials in the United Nations System, which was held in Vienna from 10 to 12 June 1971.

The United Nations Joint Inspection Unit visited WHO-assisted projects in Burma and Indonesia towards the end of 1970 and held discussions with the respective WHO representatives and field staff.

4.1.1 United Nations Development Programme (UNDP)

As in the past, during visits to the various countries of the Region, the Regional Director and senior staff of the Regional Office were able to meet the respective UNDP Resident Representatives and review jointly-assisted programmes. Such meetings greatly facilitated mutual understanding. As usual, UNDP continued to finance a number of WHO projects and WHO personnel helped governments to prepare requests for UNDP assistance, or an expansion of such assistance, particularly in the fields of community water supply, occupational health and rehabilitation, vaccine production and quality control of drugs.

Very close co-ordination has been maintained with UNDP and other agencies in relation to the development of the concept of country progrming. The UNDP Resident Representative in India was the chairman of the first meeting on this subject, which was held in the Regional Office in November 1970, at which representatives of all the other agencies as well as UNICEF and IBRD were present. SEA/RC24/2 Page 66

WHO participated in the United Nations Feasibility Mission for the International Population Institute and in a meeting called by the Resident Representative of UNDP in New Delhi in October to discuss this subject. India was included, among other countries, as a possible site for such an institute, which, it was considered, should be an autonomous body within the United Nations system and an area of excellence for consultation by both the United Nations agencies and governments. At this meeting, emphasis was placed on the need for a unified field approach by all agencies to the question of family health.

WHO (the Regional Office as well as Headquarters) was represented at the Third Global Meeting of UNDP Resident Representatives, which was held in New Delhi in February 1971. Advantage was taken of the presence in Delhi of the UNDP Resident Representatives from the various countries in the South-East Asia Region, to arrange for some very useful discussions; several meetings were also held with members of the UNDP Headquarters staff.

In connection with a change in the reporting system of projects financed by the UNDP Special Fund, there were consultations with the UNDP Resident Representatives in the Region.

In June 1971, during visits of the UNDP inter-regional Adviser on Rehabilitation to the Regional Office, Burma and Thailand, discussions were held on the subject of rehabilitation of the disabled.

Liaison was maintained with the Fund of the United Nations for the Development of West Irian (FUNDWI), especially through the WHO Represents- tive in Djakarta.

4.1.2 United Nations Children's Fund (UNICEF)

The usual regular contacts and co-ordination, both formal and informal, were maintained with the UNICEF Regional Offices in Delhi and Bangkok. Both UNICEF and WHO staff members took part in several joint discussions with governments concerning matters of mutual interest. Also, WHO was represented at the UNICEF "preview" meetings held in Delhi and Bangkok in June 1971.

Other matters which formed the subject of discussions between WHO and UNICEF were master plans of operation for India and Nepal and annexes or addenda to existing plans in respect of India and Indonesia. The numerous visits to water supply projects and to training programmes in the environmental health field in India, jointly undertaken by WHO and UNICEF staff, were a notable feature of this collaboration.

The London-Bombay Course for Senior Teachers of Child Health, (now the United KingdonrKampala-India Course), mentioned elsewhere, which WHO organizes in collaboration with UNICEF, was again successfully conducted. All the participants, together with faculty members, visited the UNICEF and WHO Regional Offices during the Indian part of the course. SEA/RC24/2 Page 67

In connection with the Seminar on the Pre-school Child organized by the International Children's Centre in Paris, which was also supported by UNICEF and took place in Madras (India) in December 1970, fellowships for some of the participants were provided by WHO.

4.1.3 United Nations Fund for Population Activities (UNFPA)

There was a considerable expansion of programmes being financed by the United Nations Fund for Population Activities, and WHO has been actively associated with their implementation.

The close contact being maintained with UNFPA in respect of the family planning programmes of several countries was greatly strengthened by discussions during the visits of different senior officials to South- East Asia. For instance, the Indonesian family planning programme was the subject of discussion during the visit to Delhi of the Deputy to the Associate Director of the Population Programme and Projects Office, United Nations Population Division, in July 1970; also, a reviev of the Thai family planning programme was undertaken with the Executive Director of UNFPA and his Special Assistant, who visited Thailand in February 1971, in order to determine the possible role of UNFPA in assisting the Government. In anticipation of this visit a co-ordinating meeting of the various agencies active in the field of family planning was held in Bangkok. At this meeting representatives of UNDP, UNICEF, WHO, UNESCO, USOM and the Population Council were present.

Later, in April 1971, the Senior Administrative Officer to the Executive Director of UNFPA visited the Regional Office to discuss various aspects of the family pLanning programme in India.

4.1.4 World Food Prograwne (WFP)

World Food Programne project requests and reports were regularly scrutinized in the Regional Office and by the WHO Representatives concerned. Advice was given to WHO Headquarters on the health implications, particularly of resettlement and irrigation projects and projects of food assistance to mothers and children. WHO is taking a special interest in the protection of World Food Progranme project areas against malaria.

4.1.5 Economic Cdssion for Asia and the Far East (ECAFE)

Close contact continued to be maintained with ECAFE, where a WIIO Liaison Officer has been in position since July 1970. Together with various other staff members of the Organization, the Liaison Officer attended a nmber of meetings associated with the various ECAFE committees and the Lower Mekong Committee, which were held in Bangkok (for full list, see Annex 4). In addition, he represented WHO at the 27th Session of ECAFE, which took place in Manila in April 1971. SEAIRC24/2 Page 68

At the United Nations Asian Institute for Economic Development and Planning in Bangkok, the WHO public health administrator and the WHO economist continued to assist with the various training courses.

The WHO Representative in Bangkok attended the Third Consultative Committee Meeting of Specialized Agencies and other United Nations Bodies, which was held in December; the main point of discussion at this meeting was the Asian Institute.

Two WHO staff members took part in a Training Course on Fertility and Family Planning Evaluation, organized jointly by ECAFE and the Govern- ment of India and held in Bombay in November-December 1970.

4.1.6 International Atomic Energy Agency (IAEA)

The joint WHOIIAEA studies on "thermoluminescence postal dose inter-comparison" continued. It is likely that a further series of institutions will be invited to participate in this study. Close co- ordination with IAEA was maintained through WHO Headquarters and the Liaison Officer in Vienna.

4.1.7 Office of the United Nations High Commissioner for Refugees (UNHCR)

Planning for the establishment of a tuberculosis control programme for Tibetan refugees in India continued. Joint visits were paid to refugee resettlement areas by the WHO medical officer assigned to the national tuberculosis progranrme and the representative in India of the United Nations High Comissioner for Refugees.

In May, a senior Regional Office staff member was part of a team led by the United Nations Deputy High Commissioner for Refugees, which went to visit refugee camps in West Bengal and, following this visit, took part in discussions on possible assistance to the Indian Government from the United Nations organizations in providing relief to the refugees from East Pakistan. Subsequently, UNIICR, Geneva, established an office in New Delhi for the co-ordination of all such assistance and for liaison with other donor agencies and countries giving bilateral aid. Coardination committees and special sub-committees which were set up by both the Govern- ment and the United Nations in Delhi (and on which WHO has been represented), met almost daily to ensure prompt action on urgently required supplies and medicines.

4.2 Specialized Agencies

4.2.1 United Nations Food and Agriculture Organization (FAO)

Discussions with the FA0 Regional Office and with FA0 staff in India mainly concerned programmes in nutrition and possible new activities in this SEA/RC24/2 Page 69 field. Among the subjects discussed were the applied nutrition programmes in countries of the Region, the training in nutrition at agricultural teaching institutions, and general problems of developing national food and nutrition policies.

4.2.2 International Labour Organisation (ILO)

In connection with the preparation of a government request to the UNDP (Special Fund) for assistance in the development of occupational health services in Indonesia, close contact was maintained with ILO, whose recomendations regarding the possibility of the development of a joint project were awaited. Follow-up discussions with officials of ILO were held in the Regional Office in May.

The WO Representative in Indonesia attended the Fourteenth Session of the Asian Advisory Codttee of ILO, which was held in Bandung in September 1970. Also, WHO co-operated with the ILO multi-disciplinary mission on the Employment Promotion Programe in Ceylon.

The possibilities of initiating joint ILO/WHO projects in a number of countries were pursued.

4.2.3 United Nations Educational, Scientific and Cultural Organization (UNESCO)

In May, a UNESCO consultant to the Asian Institute of Educational Planning and Administration, New Delhi, assigned to collect and analyse data on population dynamics in order to develop a methodology for introducing population dynamics through educational planning, was given some orientation on WHO programmes related to population dynamics and school health education.

WHO provided two consultants to assist with the conduct of the UNESCO Workshop on Population and Family Life Education, which was held in Bangkok in September-October 1970.

Also in October, the WHO Liaison Officer to ECAFE represented the Organization at UNESCO's Regional Meeting of Members of the Asian National Codttees for the International Hydrological Decade, held in Bangkok.

A chapter on "The Use of Television in Health Education" was prepared by the Regional Office for the report of the UNESCO/UNDP Prepa- ratory Mission on Educational Television which had visited India in 1969.

4.2.4 World Bank (IBRD)

The WHO Representative in Indonesia and other staff held technical discussions with an IBRD population project mission, which visited Indo- nesia in November 1970 with the object of identifying and preparing a specific project providing financial and technical assistance to enable SEA/RC24/2 Page 70

the Indonesian family planning programme to operate more effectively. WHO also participated in discussions with a World Bank Mission on Family Planning which visited Indonesia in June 1971.

In August 1970, the Regional Adviser on Environmental Health participated, together with the World Bank, in a sector study in cornunity water supply in Indonesia, and this subject was again discussed in the Regional Office in February 1971, during the visit of the Chief of the Water Supply Section of the World Bank.

4.3 Non-governmental Organizations in Official Relation with WHO

At the twenty-third session of the Regional Comnittee, representatives of sixteen non-governmental organizations in official relation with WHO were present, and, as usual, advantage was taken to hold informal discussions and exchange ideas with them.

During the year, a First Asian Congress of Nutrition was organized and was held in Hyderabad in January-February 1971, under the auspices of the International Union of Nutritional Sciences. At this congress, which was inaugurated by the Director-General of FAO, discussions of considerable technical importance took place.

Regional Office staff also continued to maintain close contact with the national organizations affiliated to the world bodies in the various countries of the Region. WHO was represented in meetings sponsored by these organizations, which included the Tuberculosis Association of India, Trained Nurses Association of India, Indian Academy of Paediatrics, Indonesian Society of Paediatrics, Indian Association for the Advancement of Medical Education, Indian Public Health Association, Indian Council of Child Welfare and Indonesian Radiological Society. A WHO temporary adviser took part in the First International Assembly of the Asian Pacific League of Physical Medicine and Rehabilitation, which took place in Colombo in November 1970 and which was also sponsored by the Ceylon Medical Association

4.4 Inter-governmental and Bilateral Agencies

A number of meetings were held and close co-operation was maintained with US AID, particularly with regard to malaria eradication. The change in US AID'S policy towards assistance to these programes (mentioned in the last Annual Report) became more pronounced with the withdrawal of staff from India and indications that assistance would definitely be limited in the future to the supply of comestibles, with greater reliance on WHO for technical advice.

The Regional Office was in frequent contact with the Norwegian Agency for International Development (NORAD) with regard to the cancer control pilot project in Kancheepuram (India), and, in this connection, SEA/RC24/2 Page 71

a NORAD official visited the Regional Office in November 1970 and again in June 1971 for discussions relating to the provision of supplies and equipment to the project.

In November 1970, during the visit of the Chief Medical Officer of the Overseas Development Ministry of the United Kingdom, who came to New Delhi, fruitful discussions were held at a meeting arranged for the senior staff. Discussions were also held with the United Kingdom High Commissioner in India concerning proposals of mutual interest in various programes. Similarly, contact was maintained with the Danish Embassy in New Delhi regarding Danish Embassy in New Delhi regarding Danish assistance to the Indian veterinary public health programme, with particular reference to the training programme in Calcutta and to the Central Family Planning Institute in New Delhi.

4.5 National and Other Agencies

A number of meetings convened by governmental and voluntary agencies in the various countries were attended by the respective WliO Representatives or other staff.

WHO was represented, as in the past, at the annual meetings of the expert groups/advisory committees of the Indian Council of Medical Research which were held in November-December 1970. WHO representatives also took part in the Eleventh International Congress of Internal Medicine, held under the joint sponsorship of the International Conrmittee of Internal Medicine and the Association of Physicians of India, which took place in New Delhi in October.

Close contact continued to be maintained with the Danish "Save the Children Organization", Emmaus Suisse, the Order of Malta and the Deutsches Aussatzigen Hilfswerk, in connection with leprosy control programmes.

5. PUBLIC INFORMATION

Promotion of Public Health Information

"Informed opinion and active co-operation on the part of the public are of the utmost importance in the improvement of the health of the people."

This quotation from the Constitution of WHO prompted the Regional Office to convene a Workshop on the Promotion of Public Health Information, which was held in New Delhi from 19 to 23 April 1971. The aim of the workshop, which was attended by 16 participants representing health and information departments from five countries of the Region (Ceylon, India, Indonesia, Nepal and Thailand), was to review current practice in the compilation and distribution of public health information and to provide SEA/RC24/2 Page 72 an opportunity for an exchange of views on the important role in this connection being played by officials in ministries of health and information. It was hoped, likewise, that the suggestions which were made at this workshop would provide guidelines for public information activities to be undertaken by the Regional Office in the future. -Press In all, 40 press releases, features and notes were issued, covering various public health topics, WHO-sponsored educational meetings. the twenty-third session of the Regional Committee, appointments of WHO Representatives and other staff, and other significant events. Headquarters releases were re-issued on only two occasions, since those of regional importance found their way into the press through the wire services represented in Geneva.

Collaboration with an important wire service in India resulted in a wide coverage of WHO activities in diversified fields. The largest Hindi weekly in Delhi brought out a special issue on medicine and health, for which the Regional Office supplied a number of photographs and background material for specially-written articles. Press interviews with numerous WHO consultants as well as with national participants in meetings held in the Regional Office were arranged. The response of the press to the material supplied by the Regional Office was considered satisfactory, on the whole. On many occasions individual editors and reporters called to obtain background material on specific subjects, and some interesting articles have resulted.

Publications

An anthology of articles from "World Health" and of selected press features issued by the Regional Office (mentioned in last year's report), entitled "War Against Disease - On the Health Front in South-East Asia", was brought out by a New Delhi publisher. A contract for a similar anthology in Hindi was concluded with a local publisher of popular science books. This book, under the title "guest for Health", is scheduled for publication towards the end of 1971.

A number of specially-written articles on the work of WO in South- East Asia were supplied to various "Souvenir" publications, special issues of monthlies and bi-weeklies and a pamphlet to be issued by the United Nations Development Prograame in India in October 1971.

Plans for the publication of "World Health" in Hindi (reported last year) materialized in August 1970, when the first issue came out. Anti-malaria measures under way in Maldives, the smallat Member State in the Region, with a population of approximately 100.000. Blood samples are taken and prophylactic treatment is given in Male. the main atoll.

In the Indonesian Province of West Irian, with difficult terrain and communications, the introduction of modern health services offers a real challenge. A WHO consultant reaches a remote area in the Central Highlands by a single-engined plane (above) and is then introduced to a case of goitre by a former WHO fellow (right). The work of the Regional Office and its field staff in the eight countries of South-East Asia is reflected in the numerous reports which are processed in World Health House.

In order to enable it to function smoothly, the Regional Office is linked by teletype with WHO Headquarters in Geneva as well as with other parts of the world.

A Hindi edition of "World Health", the magazine of WHO, is now being published in India in collaboration with a local ~ublisher. Below, copies being delivered to World Health House by the traditional horse-drawn tonga. SEA/RC~~/~ Page 73

World Health Day

Not only was the World Health Day material supplied by Head- quarters widely picked up by the daily press and periodicals but it stimulated the production of numerous articles on this year's theme, "A full life despite diabetes". Material was distributed in three Indian languages, in addition to English, and the countries in the Region, including India, came forward with additional language versions of the articles provided. The celebrations of World Health Day by national governmental and non-governmental organizations throughout the Region were unprecedented. The press and also radio and television played an important role in carrying the World Health Day message to millions of people.

Radio and Television

Radio and television provided coverage for such events as the twenty-third session of the Regional Committee, the visit of the Director-General to this region and the press conference arranged for him in New Delhi, and World Health Day.

Collaboration with Headquarters

The collaboration with the Division of Public Information at Head- quarters continued to be excellent. The World Health Day material supplied from Geneva included a contribution from the Regional Office on diabetes in India. During the period under review, "World Health" published two photo stories supplied by the Regional Office - one on trachoma in India and the other on rural health in Indonesia; also, an article on the WHO Regional Reference Centre for Air Pollution at the Central Public Health Engineering Research Institute in Nagpur (India) is scheduled for publication in the AugustlSeptember 1971 issue. Several issues of this periodical contained photographs from this region on diabetes and hospitals.

Photographs and Exhibits

The visits to WHO-assisted projects resulted in some worthwhile additions to the photo library of the Regional Office as well as to the photo files at Headquarters. Photographs were taken of most of the WHO- sponsored educational meetings taking place in New Delhi, and the pictures of participants were sent for distribution to the press in their respective home countries. WHO field staff as well as consultants made significant contributions to the photo library; important among the items thus covered were the goitre survey in West Irian (Indonesia) and the malaria control prograunue in the Maldives. On behalf of Headquarters, pictures were taken of the disinsection of aircraft at Delhi Airport, as part of a global coverage. SEA/RC24/2 Page 74

Two major exhibits were prepared - one a photo exhibit on smallpox containment measures undertaken in a village in Rajasthan (India), and the other on schools of public health throughout the world, with the photographs on public health activities embellished by an artist in multi-coloured designs.

Other Activities

Visitors to World Health House continued to be briefed on the activities of the Organization and were provided with information material. Written requests for such material, which showed a steady increase, were complied with promptly. SEA/RC24/2 Page 75

ACTIVITIES UNDERTAKEN BY GOVERNMENTS WITH THE HELP OF WHO SEA/RC24/2 Page 77

PROJECT LIST

This part of the report contains a list of the projects for which WHO has given assistance during the whole or part of the period under review, listed by country. Inter-country and inter-regional projects are listed at the end.

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

In the first column (under "Project No., Source of Funds, Co- operating Agencies") "R" means the Regular budget; UNDP(TA) and UNDP(SF) mean the Technical Assistance Fund and the Special Fund respectively of the United Nations Development Programme; "UIiFPA" the United Nations Fund for Population Activities; "FUNDWI" the Fund of the United Nations for the Development of West Irian; "UNICEF" the United Nations Children's Fund, and "US AID" the United States Agency for International Development. Names of co-operating agencies, except for UNICEF, whether or not they have contributed funds, are given in parentheses. In the second column, under the title of the project, the starting and, where relevant, finish- ing dates are shown within brackets.

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

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

It should also be noted that there are a number of projects not included in the list for which UNICEF is furnishing supplies and WHO technical advice only (with no special personnel being provided). SEA/RC24/2 Page 79

1. BURMA

PROJECT LIST

Project No. Source of Funds Co-operating kencies Title

Burma 0006.2 Maternal and Child Health R (June - Aug. 1969; Aug. 1970; Oct. - Dec. 1970; - ) UNICEF

Aim of the protect. To strengthen the departments of paediatrics and obstetrics of major hospitals and to improve and expand maternal and child health services as part of the general health services.

Assistance provided by WHO during the year. (a) A consultant; (b) four fellowships - two for twelve months for study in the United Kingdom and two for two months for studies in the United Kingdom and India; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1973.

Work done during the year. A WHO consultant was assigned during October-December 1970 to study and advise on strengthening the organization and management of maternal and child health services in the country. In his report, the consultant has, among other things, proposed pilot schemes for the decentralization of out- patient services from hospitals to peripheral centres, a system of priorities for admission to maternity hospitals and units, mobile obstetric emergency units, improvement and development of rehydration centres attached to all paediatric units, registration of maternity and nursery homes and day nurseries, and closer co-operation among them. The consultant's report has been forwarded to the Government.

In April 1971, another consultant (provided under project Burma 0079) took upaneleven-month assignment to assist with, and advise on, the organization and conduct of the first Diploma Course in Child Health at Institute of Medicine I, Rangoon. He is also assisting with the undergraduate paediatric course of studies at the Institute of Medicine, Mandalay.

Buraa 0017 Leprosy Control R (April 1960 - ) UNICEF

Aim of the project. To intensify the leprosy control programme, to extend it to cover all endemfc areas, and to train personnel.

Assistance provided by WHO during the year. (a) A leprologist; (b) a nine-month fellowship for studies in Czechoslovakia and India; (c) supplies and equipment.

Probable duration of assistance. Until 1973.

Work done durinn the year. The control activities continued to develop satisfactorily, covering the whole country. Field trials in integration (of the SEAlRC2412 Page 80

programme into the basic health services) methodology are in progress, and the results are encouraging. In 1970, a total of 53 full-time medical officers, 71 leprusy inspectors, 20 assistant leprosy inspectors, 464 junior leprosy workers and 45 laboratory assistants worked in the leprosy control programe, which had 228 499 registered cases as on 31 March 1971. Intensified case-finding activities were carried out in the project areas, and regular refresher courses were held for various categories of workers.

Bu~nw0028 Institute of Medicine I and School of Preventive LlNIlP(TA) and Tropical Medicine, Ran~oon (Feb. 1955 - Feb. 1959; Feb. 1961; Sept. 1963; Aug. 1966 - Jan. 1967; Dec. 1967; July 1968 - )

Aim of the oroiect. To assist the Institute of Medicine I in improving undergraduate teaching and to promote research in post-graduate study; to assist the School of Preventive and Tropical Medicine in developing a diploma course in academic and field trsining areas.

Assistance provided by WHO during the year. (a) A profeseor of epidemiology and a professor of public health administration, with assistance from the professor of sanitary engineering assigned under Burma 0089; (b) supplies and equipment.

Work done during the year. In the final examination for the Diploma in Preventive and Tropical Medicine, held in September 1970, 11 out of 12 candidates were successful. The course included joint staff-student research projects, involving the students in the collection of data in the field and in analysing the material. These learning-by-doing experiences are considered valuable.

One of the graduates of the School has been appointed full-time assistant lecturer in epidemiology and will be, after further training abroad on a WHO fellowship, the counterpart of the WHO professor of epidemiology. It is noteworthy that so far all graduates of the School have been able to get jobs appropriate to their training, i.e., as epidemiologists. public health administrators or teachers.

A short course on research methodology was introduced recently and includes field visits to health institutions in and around Rangoon.

Burma 0031 Malaria Eradication R (May 1954 - )

Aim of the project. To eradicate malaria from the country in progressive stages.

Assistance provided by WNO during the year. (a) A laboratory technician and a consultant/laboratory specialist; (b) a thirteen-month fellowship for study in the United Kingdom (extension); (c) travel expenses of national staff attending training courses; (d) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. The Government continued to intensify anti-malaria activities. The population under the various phases of the programme is as follows: 3.012 million in maintenance, 7.875 million under consolidation, 4.903 million under attack, and 6.441 million in areas with a wide availability Of anti- malarial drugs. SEA/RC24/2 Page 81

The draft plan of operation for the years 1972-1974 was prepared. A full- time WHO laboratory technician was assigned in October 1970.

During 1970, a total of 340 954 blood slides were examined, out of which 7 053 (2.1%) were found positive; 2 332 of these were from areas in the consolidation phase, 68 from the maintenance phase and 4 653 from the attack phase.

Burma 0037 Mental Health, Rangoon R (Oct. - Dec. 1955; April 1965 - April 1968; March 1971; - )

Aim of the proiect. To train personnel for strengthening health services and to develop separate departments of psychiatry in medical institutes.

Assistance provided by WHO during the year. A twelve-month fellowship for study in the United Kingdom.

Burma 0044.2 Stren~theningof Wealth Services (Epidemiology) UiDP(TA) (Feb. - May 1968; Jan. 1969 - )

Aim of the project. To strengthen the Epidemiological Unit in the Directorate of Health Services; to study the prevailing pattern of communicable diseases and to provide information for sound public health planning and control measures; also to develop public health laboratory services in support of the Epidemiological Unit.

Assistance provided by :.TI0 during the year. (a) A microbiologist; (b) a two-and-a- half-month fellowship for study in Singapore; (c) supplies and equipment.

Probable duration of assistance. Until 1977.

Work done durin~the year. A training course in the bacteriological diagnosis of some important infectious diseases was held at the National Health Laboratory, Rangoon, with the assistance of a member of the Regional Epidemiological Surveil- lance Team and resulted in increased co-operation between the divisional laboratories and the National 1.abaratary. With the recent expansion of its diagnostic services, the National Laboratory has increased its area of operation, involving the servicing of several divisional and district laboratories. The Entero- bacteriology Laboratory has attained a good standard of competence in the typing of Salmonella typhi and vibrio-cholera. With the provision of reference reagents to the National Health Laboratory, plans are in hand to initiate serological studies in arbovirus infections, starting with denguelhaemorrhagic fever.

The WHO microbiologist completed his assignment in October: a sumoary of his recommendations was sent to the Government. His replacement is under recruitment.

Burma 0056.2 Nursing Advisory Services R (March 1959 - April 1966; June 1969; Oct. 1970 - Jan. 1971; May 1971 - )

Aim of the project. To develop nursinglmidwifery education and services.

Assistance provided by WllO during the year. Two nurse consultants.

Probable duration of assistance. A number of years. SEA/RC24/2 Page 82

Work done during the year. Assistance was given in the conduct of two short courses for nurses, one in the nursing care of orthopaedic patients and one in the care of patients with neurological conditions. The course in orthopaedic patient care was of nine weeks' duration and was attended by twenty nurses. The six-month course in neurological patient care began in June 1971.

Planning was done for courses to be assisted in 1972-1973. The co-operation between project SEARO 0139, "Short Courses for Nurses and Other Health Personnel", and this project continues.

Burma 0065 Tuberculosis Control UNDP(TA) (Jan. 1964 -) UNICEF

Aim of the project. To develop community-oriented tuberculosis control services.

Assistance provided by WHO during the year. (a) A medical officer; (b) supplies and equipment.

Work done during the year. The activities progressed satisfactorily during the year.

In the 158 peripheral health agencies which are participating in the national tuberculosis programe, passive case-finding is carried out as a routine. The Union Tuberculosis Institute, Rangoon, continued to give training to various categories of workers, including township health officers, health assistants, nurses, lady health visitors, microscopists and others.

After necessary preparations, an assessment of the programe by the inter- country tuberculosis training and evaluation team (SEARO 0113) was expected to start early in July 1971. Plans were made for a national seminar, to take place after the assessment.

Burma 0069 Trachoma Control R (March 1966; Sept. 1966; May 1967; UNICEF Nov. 1967; Feb. 1970; Aug. 1970; - )

Aim of the project. To continue the trachoma control programme.

Assistance provided bv WHO during the year. Two twelve-month fellowships for study in the United Kingdom and a three-and-a-half-month fellowship for study in Singapore.

Probable duration of assistance. Until the end of 1973.

Burma 0072 National Community Water Supply and R Sanitation Programme (Oct. 1969; Aug. 1970; Nov. 1970; - )

Aim of the project. To plan, organize and administer a national environmental health programme, more specifically to strengthen the Division of Environmental Sanitation of the Directorate of Health; to assist the government agencies concerned in the elaboration of a comprehensive long-term programne of ~OQmunity water supply and waste disposal.

Assistance provided by WHO during the year. A twelve-month fellowship for study in the United Kingdom and two ten-week fellowships for studies in India, Malaysia. Singapore and Australia. SEA/RC24/2 Page 83

Burma 0074 Strengthening of Laboratory Services R (May - June 1967; April 1968; June 1968; Aug. - Oct. 1968; UNICEF April 1969; April 1970 - Jan. 1971; - )

Aim of the project. To strengthen laboratory services and to promote their development at central and peripheral levels.

Assistance provided by WHO during the year. (a) A laboratory technician and assistance from the microbiologist provided under project Burma 0044.2; (b) two fellowships - one for twelve months for study in the United Kingdom and one for three months for study in India; (c) supplies and equipment.

Probable duration of assistance. Until 1977.

Work done during the year. A draft plan outlining the activities of the project for the next five years was prepared. The WHO laboratory technician introduced new procedures for specimen collection and prepared reference notes on theoretical and practical bacteriological methods. The need to maintain established standards in the use af the limited equipment available was stressed. The WHO laboratory technician left in January 1971 on completion of his assignment.

The National Health Laboratory received assistance from the Regional WHO Reference Laboratories in the form of supplies and reference services for rabies diagnosis, salmonella identification and typing, plague diagnosis by the immuna- fluorescent technique, and cholera typing. A WHO electro-mechanical engineer surveyed the equipment at the Laboratory and assisted in recommissioning some items. A consultant advised on improving the existing facilities for the breeding of small laboratory animals, and another reviewed the procedures for rabies diagnosis; the fluorescent antibody technique and the biological test on mice are now well established.

UNICEF provides assistance to divisional and district health laboratories.

Burma 0075 School of Preventive and Tropical Medicine UNDP (TA) (Feb. 1970)

WHO assistance to the project ended in December 1968, since when activities have been carried on under project Burma 0028. In February 1970. a twelve-month fellowship (extension) was awarded for study in the United Kingdom.

Burma 0077 Burma Pharmaceutical Industry (Production of Biologicals) R (Feb. 1964; July 1964; Aug. 1968; Feb. 1969; July 1969; UNICEF Feb. 1970; Sept. 1970 - March 1971; May 1971; - )

Aim of the project. To assist the Biological Division of the Burma Pharmaceutical industry, Rangoon, in modernizing methods of production and assaying of bacterial and viral vaccines and anti-sera preparations.

Assistance provided by WHO during the year. (a) Three consultants; (b) five fellowships - two for eleven months for studies in Israel and Iran, two €or six months for study in India and one for twelve months for studies in the United States of America, Australia and India; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1977. SEA/RC24/2 Page 84

Work done during the year. For four weeks during October-November, a consultant visited the Burma Pharmaceutical Industry to advise on the maintenance and breeding of small laboratory animals. In this connection, certain items of supplies recornended by the consultant are being procured and his report was fowarded to the Government. In January-February, another consultant reviewed the status of production of tetanus vaccine. He found the location of the tetanus laboratory in the block for biologicals unsuitable, and has recommended isolation of the laboratory from the rest of the block until better facilities are provided. His recommendations are being implemented and reference material as well as certain items of laboratory equipment to improve the vaccine yielding capacity are being procured.

A third consultant, in March 1971, reviewed the status of rabies vaccine. He demonstrated the technology of inactivating vaccine brain emulsion by beta propio- lactane and helped in running the first two experimental batches of freeze-dried vaccine, which proved highly potent on being tested by the WHO International Reference Laboratory at the Pasteur Institute, Paris. The recommendations of this consultant were forwarded to the Government.

Burma 0078 Pla~ueControl R (Dec. 1966; June 1970; Sept. 1970; Nov. 1970; - )

Aim of the project. To identify the factors responsible for the persistence of foci of plague and to train personnel in the epidemiology and control of the disease.

Assistance provided by WHO during the year. (a) Two consultants; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1974.

Work done during the year. In September 1970, a WHO consultant visited Burma to discuss with the national authorities problem connected with international quarantine and port health, with particular reference to plague control. In his report, which has been sent to the Government, he suggested measures for the further improvement of these services, including the training of staff and surveillance,

Two members of an inter-regional plague team visited Burma in October in order to review plague control and surveillance and to discuss future plans for the development of plague surveillance. The report emanating from this visit contains recommendations for further development, including a plan for the current and future activity of the Plague Special Unit Myingyan. The report has been forwarded to the Government. Plans were made for further assistance through a consultant as well as by the organization of a training course in the near future.

Burma 0079 Medical Education R (Dec. 1964 - Peb. 1965; March 1966 - Jan. 1967; Dec. 1967 - )

Aim of the project. To improve undergraduate and post-graduate medical education, train teaching staff, develop curricula in keeping with modem concepts, and initiate and guide research at the Institutes of Medicine.

Assistance provided by WHO during the year. (a) A professor of pharmacology, a professor of paediatrics and four consultants; (b) five fellowships - one for four months, one for six months, one for ten months, one for eleven months and SEA/RC24/2 Page 85

one for twelve months - for study in the United Kingdom, two twelve-month fellowships for study in Ireland, and a two-month fellowship for studies in Denmark, the United Kingdom, France and Switzerland; (c) supplies and equipment.

Work done during the year. The WHO visiting professor of pharmacology left at the end of 1970; fully-trained national staff are in position. During the period of his assignment the WHO professor introduced integrated teaching and objective methods of evaluating students performance; the Institute has been strengthened considerably. A WHO visiting professor of paedistrfcs was provided in April 1971 (see Burma 0006.2), and a visiting professor of anatomy took up a three-month assignment in May.

During the year, WHO consultants in biochemistry, clinical/tropical medicine and a dean of a medical school visited all three Institutes of Medicine in Burma. The whole field of medical education, both undergraduate and post-graduate education, was surveyed, with the aim of further developing the three Institutes. The reports of the consultant in biochemistry and the combined report of the professor of clinical/tropical medicine and the dean were studied and comented upon by the Regional Office and WHO Headquarters. A Headquarters staff member visited Burma and, based on these reports, has prepared a draft report for UNDP (Special Fund) assistance for the development of health manpower.

Burma 0080 Smallpox Eradication (including Smallpox Vaccine Production1 R (Jan. 1967 - )

Aim of the project. To assist the maintenance programme and, in particular, the surveillance component.

Assistance provided by WHO during the year. (a) Two consultants and assistance from one of the medical officers provided under SEAR0 0030; (b) supplies and equipment .

Probable duration of assistance. Until the end of 1971.

Work done during the year. A joint Government/WHO assessment of the programme was conducted in October-November 1970. The assessment team stressed the achievements of the Government's successful smallpox eradication effort, carried out as an integrated programme within the general health services. The team has recommended improved surveillance, introduction of the multi-puncture technique of vaccination by means of the bifurcated needle, and strengthening of supervisory activities.

WHO provided facilities for the examination in its Reference Laboratories of specimens from suspect smallpox cases.

Burma 0083 Education in Dentistry UNDP ( TA) (Jan. 1967: Nov. 1967 - Jan. 1968; '.Ian. 19691 Sept. 1970; - )

Aim of the project. To strengthen dental education in the country.

Assistance provided by WHO during the year. A twelve-month fellowship for study in the United Kingdom. SEA/RC24/2 Page 86

Burma 0085 Traininp, of Electro-medical Technicians* R (March 1969; Sept. 1969; March - May 1970; UNICEF Aug. - Sept. 1970; May 1971; - 1

Aim of the project. To establish a school for the training of technicians for the maintenance and repair of X-ray and electro-medical equipment.

Assistance provided by WHO during the year. (a) A consultant; (b) a six-month fellowship for study in India; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1971.

Work done during the year. The first course for the retraining of technicians employed in hospitals in the maintenance and repair of hospital equipment, which had started in April 1970, was completed at the end of September. The WHO consultant who had assisted with the course at the beginning, visited Burma again in September to give lectures during the last weeks of the training. His report was forwarded to the Government.

The same consultant was provided again during February-April to assist with the commencement of the second six-month course.

Burma 0086 Goitre Control R (March 1971; - ) UNICEF

Aim of the project. To undertake the evaluation and surveillance of the goitre control programe.

Assistance provided by WHO during the year. (a) A three-month fellowship for study in Thailand; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1972.

Burma 0087 Filariasis Control R (Dec. 1969 - Jan. 1970; July 1970 - )

Aim of the project. To apply filariasis control methods.

Assistance provided by WHO during the year. (a) An epidemiologist and temporary assistance from an entomologist provided under Inter-regional 0271; (b) two three- month fellowships for studies in India and Ceylon; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1977.

Work done during the year. The activities of this control project, which began early in 1970, now cover 16 townships in Rangoon Division, where spraying is carried out at weekly intervals. Spraying has resulted in a rapid reduction in the density of Culez mosquitoes. Blood surveys are also being carried out. Necessary preparations were made for the intensification of case-finding in respect of microfilaria and filariasis, and treatment.

*Previous title: Maintenance and Repair Workshop for Health Equipment. SEAlRC2412 Page 87

Burma 0088 Rehabilitation of the Handicapped R (Oct. - Nov. 1969; July 1970; - )

Aim of the project. To expand medical rehabilitation services at the central and peripheral levels and to improve workshop facilities for the manufacture of orthopaedic and prosthetic appliances.

Assistance provided by WHO during the year. (a) Two six-month fellowships for study in the United States of America; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1973.

Burma 0089 Institute of Technolo~v, KanRoon R (May 1969 - ) UNDP (TA)

Aim of the project. To teach sanitary engineering to undergraduate and graduate civil engineering students.

Assistance provided by WHO duriny the year. (a) A professor of sanitary engineering; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1973.

Work done during the year. In the final examinations of the 1969-70 academic year, 104 fifth-year students were successful, with five students obtaining distinction in sanitary engineering. All the 51 final-year students passed and one received distinction in sanitary engineering. In the 1970-71 academic year, which started on 1 September, sanitary engineering subjects taught to fifth-year and final year students were sanitary biology and sanitaryfpublic health engineering. A consultant, assigned in February-March under an inter-country project (SEAR0 0150, "Education and Training in Sanitary Engineering"), gave lectures on sanitary chemistry and laboratory techniques and facilities.

At the School of Preventive and Tropical Medicine, Rangoon, the teaching programe in environmental health continued as planned.

Burma 0091 Radiation Health R (June 1970; Jan. 1971; - )

Aim of the project. To strengthen the radiation protection services in the health institutions, first by the development of film-badge monitoring services in Rangoon and gradually expanding the coverage to peripheral hospitals; to train staff.

Assistance provided by WHO during the year. Two twelve-month fellowships for study in New Zealand.

Probable duration of assistance. Until the end of 1975.

Burma 0092 Quality Control of Drups R (March 1970; May 1970; Aug. - Sept. 1970; Nov. - Dec. 1970; - )

Aim of the project. To formulate new legislation and develop laboratory competence in the field of quality control of pharmaceutical and biological preparations. SEA/RC24/2 Page 88

Assistance provided by WHO during the year. Six fellowships - three for six months, one for five months, one for three months and one for two months - for study in the United Kingdom, and a three-month fellowship for study in Denmark.

Burma 0094 Stren~theningof Health Services R (May - Aug. 1969; Jan. - March 1970; Nov. 1970; - ) UNICEF

Aim of the project. To strengthen health services, with particular emphasis on the development of a comprehensive health care service; to implement a national health plan, and also to train health personnel for basic health services, particularly auxiliary personnel.

Assistance provided by WHO during the vear. Assistance from the public health administrator and the economist provided under project SEAR0 0102.

Probable duration of assistance. A number of years.

Work done during the year. A draft master plan of operation was prepared and sent to the Government for review. Following the visit of a short-term consultant in early 1970, health assistant orientation courses were organized, with WHO assistance. From 5 to 26 November, a country-level course on national health planning was held in Rangoon. This course, which was planned and organized with the help of the WHO public health administrator and the WHO economist provided to the Asian Institute for Economic Development and Planning, Bangkok, was attended by 13 participants and 9 observers.

Burma 0200 Fellowshi~s R

Virology. A one-month fellowship for studies in Thailand and India (extension). SEA/RC24/2 Page 89

PROJECT LIST

Prolect No. Source of Funds Co-operating Title

Ceylon 0005.2 Venereal-Disease Control R (Sept. 1964; Sept. 1966; Oct. - Dec. 1967; July 1968; March - May 1969; Sept. - Oct. 1969; Aug. 1970; Dec. 1970; - ) Aim of the project. To develop laboratory diagnostic facilities for the national venereal-disease control programme.

Assistance provided by WHO during the vear. Two one-month fellowships for study in the United States of America.

Ceylon 0026.2 Leprosy Control R (Oct. - Nov. 1967; Dec. 1968 - Aug. 1969; Nov. 1969 - Sept. 1970; Jan. 1971 - ) Aim of the proiecr. To assess the extent of leprosy, develop an integrated control programme, and to train staff.

Assistance provided by WHO during the year. (a) A consultant leprologist;(b) two three-month fellowships for studies in India, Burma, Thailand and the Philippines; (c) suppliw and equipment. Probable duration of assistance. Until 1975

Work done durine tw. The leprosy control programme has been making satisfactory progress, particularly with regard to case-detection. Following a meeting of all medical officers connected with the programe, held early in 1971, school surveys are being extended to more areas and have been intensified to certain areas where the prevalence rate is high.

Ceylon 0037 Mental Health R (Nou. 1955 - Jan. 1956:. Aue.- 1960: Nov. - Dec. 1961: Jan. - May 1963; June - July 1966; March 1967; Sept. 1969; Nov. 1969; Aug. 1970; Oct. - Dec. 1970; Feb. 1971; - ) Aim of the project. To develop mental health care within the framework of comprehensive health services, to strengthen the teaching of mental health in the undergraduate medical curriculum and to train various categories of health personnel.

Assistance provided by WHO during the year. (a) Two consultants; (b) three fellowships - one for seven months for studies in the United Kingdom and the United States of America, one for three months for study in the United Kingdom SEAjRC2412 Page 90

and one for eleven months for studies in the United States of America, the United Kingdom, Denmark, Switzerland and Yugoslavia; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. Two consultants, teachers of psychiatry and clinical psychology, undertook a joint two-month assignment during October-December 1970. They advised on building up undergraduate teaching of the subject in the medical schools and on further developing the recently established Department of Psychiatry at the Faculty of Medicine, Colombo.

During a visit to Ceylon in March 1971, a medical officer from the Mental Health Unit at WHO Headquarters discussed developments in the extension of mental health services to peripheral health services and gave advice on a WHO-supported epidemiological research project.

The teachers of psychiatry at the two medical faculties attended the Seminar on the Teaching of Psychiatry (SEAR0 0172) held in New Delhi in September 1970.

Ceylon 0038 Strengthening of Health Services (Epidemiolo~y) R (Feb. 1956 - Sept. 1960; Feb. - March 1962; Aug. 1962; Aug. - Nov. 1964; June 1967; July 1968; July 1970; - ) Aim of the project. To establish an epidemiological unit in the Directorate of Health Services, and to train personnel in epidemiology.*

Assistance provided bv WHO during the year. A three-month fellowship for studies in the United States of America, the United Kingdom, Switzerland. Czechoslovakia and Yugoslavia.

Ceylon 0045 Health Statistics lNDP(TA) (April 1957 - Dec. 1961; Sept. 1964 - Dec. 1966; March - April 1967; June 1967; Aug. - Oct. 1967; Sept. 1968 - Dec. 1969; Dec. 1970; - )

Aim of the project. To develop an information system geared to the requirements of national health planning and to monitoring the performance of the health services; to train staff.

Assistance provided by WHO during the year. A twelve-month fellowship for study in Australia.

Probable duration of assistance. Until the end of 1975.

Ceylon 0047 Medical Education R (June - AUP. 1959: Nov. 1963 - A~ril1964: Oct. 1964 - '~ec.1965; sept.-1966; Nov. 196;; Sept. i968 - Aug. 1969; Jan. - March 1970; May 1970; Aug. 1970 - March 1971; May 1971; - )

Aim of the project. To strengthen the teaching programmes in the Faculties of Medicine at Colombo and Peradeniya.

*Set up within the Division of Conmwnicable Diseases in the Directorate of Health Services in 1959. SEA/RC24/2 Page 91

Assistance provided by WHO during the year. (a) Two consultants; (b) three fellowships - two for twelve months and one for four months (extension) - for study in the United States of America, a three-month fellowship for study in the United Kingdom, a ten-week fellowship for studies in the United Kingdom, Sweden and Denmark, and a six-month fellowship for study in India.

Probable duration of assistance. A number of years.

Work done during the year. A consultant in pharmacology and biomedical engineering was assigned to the Faculty of Medicine, Peradeniya, from October 1970 to March 1971. Besides participating in the undergraduate and post-graduate teaching of pharmacology, he worked with a national committee set up to review and revise the list of pharmaceutical preparations used in the country. He also held a course on "Mathematical language for physicians", which found wide interest among the teaching staff. Advice was also given on planning future research projects of more than national interest which can be handled with available resources and for which the country offers particular opportunities.

The consultant in medical pedagogy who had been assigned to Ceylon in early 1970 returned for a five-week assignment in FebrusryIMarch 1971. The purpose was to follow-up one of his earlier recommendations, viz., to evolve the protocol and schedules for a proposed study on the role and functions of doctors. This study is designed to provide a basis far curriculum revision and adjustments. The consultant worked in close collaboration with staff members from WHO Headquarters and from the inter-country project SEARO 0148 in order to integrate the study in an overall plan for a comprehensive health manpower study.

Ceylon 0053 Nursing Advisory Services R (July 1960 - Feb. 1966; Aug. - Oct. 1966; Sept. - Dec. 1967: Dec. 1969; Feb. 1970; May 1970: ~uly1970; Sept. 1970; Feb. - .June mi; - )

Aim of the project. To develop nursing and midwifery education and services.

Assistance provided by WHO during the year. (a) A consultant; (b) two fellowships, one for six weeks and one for three months, for study in the United Kingdom, a twelve-month fellowship for study in Australia and a three-month fellarship for study in the United States of America.

Probable duration of assistance. Until the end of 1974.

Work done during the year. A nurse consultant was provided for five months during February - June 1971 to study and prepare a report on the feasibility of starting university courses for nurses and for the preparation of nurses. Her report is under review.

A consultant (nurse-midwife tutor) to assist the Post-basic School of Nursing, Colo&o, in the further development of the midwifery programme for nurses is under recruitment.

The urgent need to revitalize the eight hospital nursing schools in Ceylon received attention, and proposals for a new project to assist these schools are under study.

The co-operation between project SEARO 0139, "Short Courses for Nurses and Other Health Personnel", and this project continued. SEA/RC24/2 Page 92

Cevlon 0056 Filariasis Control UNDP(TA) (Dec. 1959; April - Julv 1961; Sevt. 1961; Aug. - ~ept.-1963; ~uni1965.- )

Aim of the project. To control filariasis.

Assistance provided bv WHO durinp, the vear. (a) An epidemiologistlparasitologist and an entomologist; (b) a twelve-month fellowship for studies in the United Kingdom, India, Burma and Malaysia; (c) supplies and equipment.

Work done durinp, the vear. Preparatory work, including the drawing up of plans and maps, was under way in connection with the launching of two pilot projects, one in Moratuwa and the other in Peliyagoda.

An analysis of the large amount of data pertaining to adult and larva collections from previous years has revealed that the main problem is the large amount of breeding in untreated, "temporary" breeding sites.

It has been proposed by the Government that this project should become part of a general vector control programme. Preliminary studies have been made, and the proposal is under review.

Cevlon 0058 Malaria Eradication R (Aug. 1960 - )

Aim of the project. To eradicate malaria.

Assistance provided bv WHO durinn the vear. (a) A malariologist, an epidemiologist, an entomologist, a sanitary engineer, a sanitarian and a clerk-stenographer;(b) two ten-week fellowships for studies in the Philippines and India and a one-month fellowship for study in the Philippines; (c) supplies and equipment; (d) payment of subsidy.

Probable duration of assistance. A number of years.

Work done during the vear. The malaria epidemic which commenced in the last quarter of 1967 continued during the current year; however, signs of an improvement in the situation became apparent in the latter months of 1970. This is shown by the reduction in the number of recorded malaria positive blood slides and in the slide positivity rates, as follows:

Number of Malaria Positive Blood Slidee -Year -Jan. Feb. March April May June July &. w. g.E. a. 1969 61935 39049 43056 31765 30923 36565 36421 30940 31831 39080 63916 93712

Slide Positivitv Rates (X)

1969 29 39 41 31 27 33 26 28 31 34 47 62 SEAIRC24/2 Page 93

Spraying coverage, protecting a population of 6.9 million at the beginning of 1971, has improved owing to the addition of malathion to the DDT suspension in order to deal with the bed bug problem.

The decentralization of the laboratories continued; there are now seven regional laboratories against the eleven planned.

The establishment of eleven regional Anti-Malaria Campaign offices in as many health divisions was completed, thus linking the malaria programme with the basic health services in the "Medical Officer of Health" areas in these divisions.

Since the formal opening of the National Malaria Eradication Training Centre on 1 February 1971, a six-week course for professional staff (regional anti- malaria campaign medical officers and medical officers of health), a five-week course for public health inspectors and a five-week course for microscopists have been held.

Unforeseen circumstances during the early part of 1971 dislocated anti- malaria activities and may adversely affect the course of the epidemic during the year 1971. However, every effort is being made to improve the situation.

Ceylon 0064 Community Water Supply and Sanitation* R (Oct. 1963 - ) UNICEF

Aim of the project. To develop programmes of water supply, sewage disposal, stonn-water drainage and general sanitation, and to train persomel.

Assistance provided by WHO during the year. (a) A sanitary engineer; (b) two twelve-month fellowships for study in the United States of America.two fellowships - one for six months and one for twelve months - for study in the United Kingdom, and a three-month fellowship for studies in India and Australia; (c) supplies and equipment, including a transport vehicle.

Probable duration of assistance. Until 1975.

Work done during the year. A recent decision of the Government in respect of the development of community water supplies has given a fillip to the activities of the project. A new programme and work-time schedule were prepared for the development of 100 community water supply schemes with assistance from WHO and UNICEF. The programme will be spread over a period of seven years, 1972-1976. A revised budget was prepared, and preliminary surveys and investigations and selection of communities for the first group of fifteen community water supply schemes were completed.

As a result of a reorganization of the Ministry of Irrigation, Power and Highways, the overall responsibility for water supplies has been transferred to the Ministry of Public Administration, Local Government and Home Affairs.

Ceylon 0066.3 Strengthening of Laboratory Services R (Aug. 1966 - March 1969; Oct. 1969; Dec. 1969; May 1970; Aug. - Sept. 1970; Nov. 1970; April 1971; - ) Aim of the project. To develop further specialized diagnostic and reference functions in support of communicable-disease control and prevention, and to train staff.

*Previous title: Community Water Supply SEA/RC24/2 Page 94

Assistance provided by WHO during the year. (a) Five fellowships - three for twelve months, one for three months and one for one week - for study in the United Kingdom, and a three-month fellowship for study in Czechoslovakia; (b) supplies and equipment.

Probable duration of assistance. A number of years.

Ceylon 0071 Radiation Health R (Aug. - Sept. 1969; Aug. - Sept. 1970; April 1971; - )

Aim of the project. To train staff associated with radiation protection services.

Assistance provided by WHO during the year. A six-week fellowship for study in India, a six-month fellowship for studies in the United Kingdom. Federal Republic of Germany. the Netherlands and Sweden. and a four-and-a-half-month fellowshirr for study in ;he United Kingdom.

Probable duration of assistance. Until 1975.

Ceylon 0072 Development of Health Education* R (Nov. 1966 - Feb. 1967; Feb. - May 1969; Sept. 1969; June 1970; Dec. 1970; Jan. 1971; March 1971; - )

Aim of the prolect. To evaluate the health education programme, to strengthen health education services, training, communication media and studies.

Assistance provided by WHO during the year. Two fellowships - one for three months and one for thirteen months - for study in India, a twelve-month fellowship for study in the Philippines, a six-month fellowship for study in the United Kingdom and a three-month fellowship for studies in 1ndia and ~epal.

Ceylon 0075 Tuberculosis Control R (Jan. 1966 - ) LNICEF

Aim of the prolect. To control tuberculosis through a community-oriented programme.

Assistance provided by WHO during the year. (a) A medical officer and a consultant; (b) three fellowships - two for one month and one for thirteen weeks - for studies in India and Burma. and a two-week fellovship for study in Norway; (c) supplies and equipment.

Probable duration of assistance. Until 1974.

Work done during the year. The tuberculosis control programme is progressing well, particular attention being given to the training of all echelons of staff.

The incidence of tuberculosis in Ceylon, which was 45 per 10 000 population in 1967, 1968 and 1969, came down to 39 per 10 000 in 1970.

Detailed curricula were developed for the training of various categories of health personnel engaged in tuberculosis control and supervising services.

*Previous title: Health Education. SEA/RC24/2 Page 95

Early in 1971, a consultant visited Ceylon to assist the inter-country tuberculosis training team in connection with the baseline survey of the progranme (see SEAR0 0113).

Ceylon 0077 Quality Control of Biological and Pharmaceutical Products R (March 1966;Sept. 1966; Dec. 1967; Jan. - April 1971; - )

Aim of the project. To strengthen the quality control of pharmaceutical and biological preparations and to train staff.

Assistance provided by WHO during the year. A consultant.

Probable duration of assistance. Until the end of 1975.

Work done during the year. A consultant (pharmacist) was assigned from mid- January to April 1971 to undertake a review of the curriculum at present in use in the training of pharmcists and to assist in strengthening such curriculum to a diploma level in the first instance with a view to raising the standard to a degree level as soon as possible. A summary of his recommendations was sent to the Government.

Ceylon 0078 Stren~thenin~of Epidemiolo~icalServices R (July - Oct. 1967; Dec. 1970; - )

Aim of the project. To strengthen the epidemiological services and to train personnel.

Assistance provided by WHO during the year. A ten-week fellowship for study in Singapore.

Probable duration of assistance. Until 1976

Ceylon 0083 Port Health Services R (Sept. 1969; Sept. 1970; - )

Aim of the project. To strengthen port health services.

Assistance provided by WHO durinp, the vear. A ten-month fellowship for study in the United Kingdom.

Probable duration of assistance. Until the end of 1975.

Ceylon 0084 Maternal and Child Health Services R (Dec. 1968 - March 1969; June 1970; - )

Aim of the proiect. To improve the administration and reorientation of the preventive and curative maternal and child health services, including family planning, and to conduct a series of courses on maternal and child health for nursing and medical personnel at all levels.

Assistance provided by WHO during the year. A wo-month fellowship for study in the United States of America. SEAlRC2412 Page 96

Ceylon 0085 Control of Nutritional Anaemia R (Dec. 1969 - Jan. 1970; - )

Aim of the project. To undertake a pilot project for the control of nutritional anaemia.

Assistance provided bv WHO during the year. Supplies and equipment.

Ceylon 0086 Public Water Supply, Drainage and Sewerage UNDP(SF) for the South-West Coastal Area (Aug. 1967 - )

Aim of the proiect. To plan, develop and extend public water supply, surface drainage and sanitary sewerage facilities in the south-west coastal area.

Assistance provided by WHO during the year. (a) A project manager and two consultants; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1971.

Work done during the year. Most field activities were completed according to schedule and draft reports on various aspects of the project were submitted by the sub-contractor. Most of the reconnnendations of the immediate programe report were accepted and action was initiated to implement them. A panel of the consultants reviewed the work of the project from 26 April to 4 June 1971 and made appropriate recommendations for further improvement.

At a meeting held on 7 March between the Government, UNDP and WHO officials, it was agreed to terminate the project on 17 July 1971 as scheduled and to retain within the present contract one senior engineer on the project for final designs until late September 1971. However, with regard to the training programe, which proved very successful, the Government agreed to approach UNDP for its extension for three years. Accomnodation for the training school was acquired and two assistant training officers, one librarian and a full-rime clerical assistant were appointed. A library was set up with adequate space for reading. In-service training on chlorination was given to the engineers and twelve courses on the subject were arranged on site for the operators.

The fellowship programme was revised and, in general, it was agreed that, where possible, the fellowships should be awarded within the South-East Asia Region and that specialists be recruited to give short practical courses in Ceylon to the staff concerned.

An agreement for a 25-year interest-free loan to cover the foreign exchange component of constructing the Galle water supply project was signed in January between the Governments of Ceylon and the United Kingdom.

Ceylon 0087 Dental Health R (April 1970 - )

Aim of the proiect. To develop further teaching and training programmes for dental personnel and to expand integrated dental health services.

Assistance provided by WHO during the vear. (a) A consultant in dental prosthetics; (b) a three-month fellowship for studies in New Zealand, Singapore and Malaysia; (c) supplies and equipment. SEA/RC24/2 Page 97

Probable duration of assistance. Until the end of 1974.

Work done during the vear. The WHO dental mechanic tutor at the School of Dentistry, Faculty of Medicine, Peradeniya, initiated a formal course for dental technicians of the Department of Health. In addition, he assisted with courses for various levels of technicians, and gave lectures and practical demonstrations. He also conducted refresher courses for post-graduate students in various aspects of modern dental techniques.

Ceylon 0092 National Health Planning (June - Aug. 1970; - )

Aim of the project. To establish and strengthen a health planning unit in the Ministry of Health and to train staff.

Assistance provided bv WHO during the vear. A consultant and a statistician (provided under SEAR0 0178).

Probable duration of assistance. A number of years.

Work done during the vear. The medical consultant on national health planning and the statistician assigned in June 1970 (briefly mentioned last year! completed their work in August. They made recommendations on the health planning process and gave suggestions for a general functional guide on the health planning unit, including its composition, to serve as the starting point for developing guidelines or a "plan for health planning".

Ceylon 0101 Studies of the Activities of Public Health Personnel UNFPA (Feb. - April 1971; - )

Aim of the project. To undertake a study of the activities of personnel employed by the Ministry of Health and delivering health care to the cornunity in the context of family health services.

Assistance provided by WHO during the vear. A nurse consultant.

Work done durin~the year. Early in 1971, initial preparations for carrying out a study of the activities of health personnel were made in the Regional Office, including the drawing up of a study protocol. A nurse consultant was assigned to Ceylon in February to assist with the preparation of the protocol and in the training of the national staff who would participate in the study. A team consisting of Regional Office, Headquarters and field staff members visited Ceylon in March and held detailed discussions with the national authorities and visited several health institutions. It has been decided to extend the scope of the study to include the personnel working in some medical care institutions, with out- patients in hospitals and those working in health units. The study is still in the planning stage.

Ceylon 0200 Fellowships R

Cardiology (Coronary care). Three three-month fellowships for studies in Denmark, Sweden and the United Kingdom.

Diploma in Public Health. A ten-month fellowship for study in New Zealand. SEA/RC24/2 Page 98

Medical Stores ManaRement. Two three-month fellowshipa for study in the United Kingdom.

Oral C~topathololly. A twelve-month fellowship for study in the United States of America.

Vital and Health Statistics. A three-month fellowship for study in the United Kingdom. SEA/RC24/2 Page 99

3. INDIA

PROJECT LIST

Project No. Source of Funds Co-operating Agencies Title

India 0053 Tuberculosis Chemotherapy Centre, Madras UNDP (TA) (Dec. 1955 - )

-eft. To undertake controlled trials to find simple, effective and inexpensive methods of tuberculosis control through domiciliary and ambulatory chemotherapy, and to carry out related research.

Assistance provided by WHO during the year. (a) Four consultants; (b) a three- month fellowship for study in the United Kingdom (extension); (c) supplies and equipment.

Work done during the year. The trials, carried out in close co-operation with the British Medical Research Council, made good progress. A new trial using a once-weekly regimen of treatment has been started.

In December-January, a consultant assisted with the strengthening of the biochemical components of clinical trials and, in February, two further consultants helped with the analysis and interpretation of the results of earlier studies and with the planning of new studies. The report of the latter consultants was sent to the Government, and that of the earlier consultant was under study.

India 0081.1 Leprosy Control (National Prograorme) R (Jan. 1961 - )

Aim of the project. To develop a programme for leprosy control.

Assistance provided by WHO during the year. (a) a leprologist, a consultant and assistance from the statistician provided under SEAR0 0148; (b) a aix-month fellowship for studies in Burma, the Philippines, Malaysia and Thailand, a tvelve- month fellowship for studies in the United States of America, the Philippines. Malaysia, Thailand and Burma, a twelve-month fellowship for study in the United States of America, and a three-month fellnwship for studies in Burma, Thailand, the Philippines, the United States of America and the United Kingdom.

Probable duration of assistance. Until 1973.

Work done during the year. The Government has indicated that fellowships vill be the only form of assistance required after the end of 1971. The processing of data in connection with a longitudinal study has been completed, and the results are under review.

The WHO leprologist left early in 1971.

Case-detection, school and mass surveys, and laboratory and bacteriological examinations continued to be carried out in the two project areas of Pogiri snd Aska. SEA/RC24/2 Page 100

India 0081.2 Leprosy Control. Srikakulam R (Jan. 1962 - Nov. 1966; March 1967 - Feb. 1968; UNICEF Nov. 1968 - Feb. 1969; May 1969 - )

Aim of the project. To provide technical direction for two control projects supported by the Danish "Save the Children" Organization, and to train staff.

Assistance provided by WHO during the year. (a) A leprologist; (b) supplies and equipment.

Probable duration of assistance. Until 1973.

Work done during the year. See under project India 0081.1, above.

India 0103 National Tuberculosis Programme UNDP (TA) (Oct. 1956 - ) UNICEF

Aim of the project. To develop a national tuberculosis control programme by providing technical guidance, based on model tuberculosis control prograrmces, epidemiological findings and operational research; to train sufficient numbers of public health workers of various categories for the tuberculosis control centres at district and State levels, and to develop methods and procedures for assessment of the progr-e.

Assistance provided by WHO during the vear. (a) Two medical officers, an X-ray technician and two consultants; (b) a three-month fellowship for studies in the United Kingdom, the Netherlands, Czechoslovakia, Noway and Yugoslavia, and a three-week fellowship for studies in Korea and Taiwan; (c) supplies and equipment.

Probable duration of assistance. Until 1974.

Work done during the year. The number of district tuberculosis progrsnnws in India at the end of September 1970 was 194.

At the National Tuberculosis Institute, Bangalore, the twenty-second and twenty-third regular training courses for key personnel of district tuberculosis programmes were organized during the period under review. They were attended by a total of 211 participants (medical officers, treatment organizers, X-ray technicians, laboratory technicians and statistical assistants), in addition to eleven WHO fellows from abroad. Besides, three courses were conducted for twelve district public health nurses from different States of India. Preparations were made for the Indian part of the WHO-sponsored International Training Course in the Epidemio- logy of Tuberculosis (Prague-Bangalore), scheduled to take place in July-August 1971.

Two consultants were assigned for six weeks in the first quarter of 1971 in order to assist with an analysis of the material from the longitudinal study undertaken by the Institute, and to make recommendations on the application of the results in respect of a practical assessment methodology for national tuberculosis control prograrmes. Their report is under review.

The WHO X-ray technician provided to the National Tuberculosis Programme visited a number of district tuberculosis centres to guide X-ray technicians on radiographic techniques and procedures, to examine X-ray units and to carry out repairs to them. SEA/RC24/2 Page 101

India 0108 Health Education: Assistance to States* UNDP (TA)

Aim of the project. To establish and develop State health education bureaux on the lines laid down by the Government of India; to integrate andlor co-ordinate health education activities of the general health services vith those of the family planning programme at different levels of the health administration.

Assistance provided by WHO during the year. A twelve-month fellowship for Study in the Philippines.

India 0110 Nursing Advisers to States UNDP (TA) (Dec. 1967 - Dec. 1968; Dec. 1969; Aug. - Sept. 1970; Jan. 1971)

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

Assistance provided by WHO during the year. Two four-month fellowships for studies in Canada and the United States of America, a twelve-month fellowship for study in the United States of America, and a four-month fellowship for studies in the United States of America, Canada and the United Kingdom.

India 0111 Medical Education R (Dec. 1958 - Sept. 1961; Nov. - Dec. 1965; Aug. 1966 -

Aim of the project. To improve the teaching, service and research in medical colleges.

Assistance provided by WHO during the year. (a) Fifteen consultants in various disciplines; (b) two fellowships - one for twelve months and one for three months - for study in the United Kingdom, two twelveloonth fellowships for study in the United States of America, a twelve-month fellowship for studies in the United States of America, United Kingdom and Canada, a twelve-month fellowship for studies in the United Kingdom, Denmark, Canada and the United States of America, a twelve-month fellowship for studies in the United States of America, Canada, United Kingdom, Denmark and Sweden, a two-month fellowship for study in Thailand, an eleven-month fellowship for studies in the United Kingdom,the United States of America, Japan and Thailand, an eighteen-month fellowship for studies in the United Kingdom and Sweden, a twelve-month fellowship for study in Czechaslovakia, a chree-month fellowship for study in Denmark, a twelve-month fellowship for studies in the United Kingdom and the United States of America, a five-month fellowship for studies in the United States of America, Canada, the United Kingdom, Denmark, Federal Republic of Germany, and the USSR, a twelve-month fellowship for studies in Sweden, Ireland and the Netherlands and a ten-veek fellowship for study in Singapore.

Probable duration of assistance. Until the end of 1973.

Work done during the year. During the year, fourteen consultants were assigned to different medical colleges. Assistance was given in the technology of the various disciplines and in teaching methodology, including curriculum development and

*Under this project, which started in March 1958, assistance has been given to the States of Maharashtra, Uttar Pradesh, Bihar, Orissa and Gujarat. SEA/RC24/2 Page 102

integration of teaching with emphasis on co-ordination of clinical and non-clinical subjects, as well as in the introduction of objective evaluation of student performance and achievement. The consultants visited the medical colleges in teams of three or two or individually. Seven of these group or individual assignments were to colleges which the consultants had visited previously, and such repeat visits have been useful in assessing the changes which have been made during the period intervening between the two assignments.

A noteworthy change which has been reported by the consultants is that in some States the junior non-clinical posts in medical colleges which had been lying vacant have been filled because of pressure for jobs resulting from the increased number of medical graduates. Attempts are being made in some medical colleges to integrate the curriculum with regard to groups of subjects. Small group teaching is also more of ten accomplished than before.

There is still a lack of development in some departments due to shortage of suitably qualified staff. Two medical colleges not hitherto assisted were visited by consultants for exchanging views and discussing problems together with some teaching. These were considered valuable by the national staff and consultants alike.

In April, a consultant took part in the teaching during a summer course for teachers of epidemiology from different parts of India. The Course, which was assisted by both h'H0 and UNICEF, was held at the All-India Institute of Hygiene and Public Health, Calcutta.

India 0114 Paediatric Education* R (Aug.. 1958 - ) UNICEF

t\im of the project. To expand and improve undergraduate and post-graduate teaching of paediatrics in selected medical colleges and to develop courses for various categories of personnel in paediatric departments.

Assistance provided by WHO during the year. Four fellowships - two for two months, one for four months and one for six months - for study in the United States of America, two fellowships - one for two months and one for three months - for study in the United Kingdom, two three-month fellowships for studies in the United Kingdom and Uganda, and a three-month fellowship for studies in Canada and the Cnited States a£ America.

Probable duration of assistance. Until the end of 1977.

Work done during the year. A final draft plan of operation for channelizing WHO assistance to the strengthening of departments of preventive and social medicine and to paediatric and obstetric training services through a combined and unified project, was prepared and forwarded to the Government and to UNICEF.

The Government has agreed to select two medical colleges for a trial of the undergraduate paediatric curriculum prepared by the WHO-sponsored Ad Hoc Committee in 1969-1970.

A consultant has been recruited to review the progress subsequent to the study of post-graduate paediatric education in India carried out in 1966-67. He will take up his assignment in July.

*Previous title: Paediatric and Obstetric Training and Services: Assistance to St4tes SEAlRC2412 Page 103

The review of the progress in the teaching of the social aspects of obstetrics and gynaecology in medical colleges (following the recommendations of the Meeting on Teaching of Social Aspects of Obstetrics held in September 1968). which was to have been undertaken by a consultant, was postponed.

A consultant assisted an a contractual basis an Indian editor in a revision of the WHO publication "A Manual of Paediatrics for South-East Asia", in preparation for a Hindi edition sponsored by the Ministry of Education of the Government of India.

India 0114.1 Paediatric Education. Kerala* R (Aug. 1958 - Aug. 1959; March - Sept. 1962; UNICEF May 1963 - Jan. 1965; Jan. 1970 - Jan. 1971)

Aim of the project. To expand and improve undergraduate and post-graduate teaching of paediatrics in selected medical colleges and to develop courses for various categories of personnel in paediatric departments.

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

li'ork done. During the second phase of its assistance** WHO assigned a maternal and child health nurse educator, who was stationed at Trivandrum. She took up her duties at S.A.T. Hospital, Trivandrm, early in March 1970, and assisted in an assessment of the needs and priorities. With the goal of improving patient care through improved cwrmunications, training in skills and on-going education, an in-service education prograrme was started for nurses and auxiliary personnel of the hospital, and its continuation on a regular basis for all personnel was encouraged. An outline for short orientation programmes for all new staff or staff recently transferred to the Hospital was submitted but not implemented.

Although nurses are now readily available, the number of sanctioned posts at the Hospital did not meet the requirements of the Indian Nursing Council. The nurse-patient ratio was therefore slightly increased.

A preliminary plan for an All-Kerala Paediatric Refresher Course was prepared, in collaboration with the faculty members of the College of Nursing, and was submitted to the State Government for sanction.

Monthly meetings with various medical and nursing administrators, bi-monthly meetings of head nurses and monthly ones for staff nurses were established, with the recommendation that they be maintained.

Assistance was given in reviewing job descriptions. Nursing routines, some policies and nursing procedures were formulated for the paediatric ward, the labour room and the premature nursery. It was suggested that a selected group should bring the existing procedure book up to date, but this was not done. The establishment of two model wards for the demonstration of safe basic nursing care (one paediatric and one obstetric) was started but not completed oving to lack of essential equipment.

Although observation visits were paid to various primary health centres there was not enough time to follow up on the observations.

*Previous title: Paediatric and Obstetric Training and Services, Kerala. **The first phase of WHO assistance extended from August 1958 to January 1965, an evaluation was given in the Seventeenth Annual Report. SEA/RC24/2 Page 104

Summary. In this short assignment stimulation was given to the staff through direct assistance to the development of in-service educational programmes and to the paediatric and obstetric nursing services. Several activities for the further development of nursing education and services were started.

India 0114.7 Paediatric Education, Rajasthan R (Feb. 1971 - ) UNICEF

Aim of the project. To expand and improve undergraduate and post-graduate teaching of paediatrics in selected medical colleges and to develop courses for various categories of personnel in paediatric departments.

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

Probable duration of assistance. Until the end of 1977.

Work done during the year. The WHO maternal and child health nurse educator took up her assignment at the S.P. Medical College and Associated Group of Hospitals, Bikaner, in February 1971. Plans for in-service education and review and revision of policies and nursing procedures were initiated.

India 0121 Indian Council of Medical Research (Statistics1 R (Aug. 1962 - Feb. 1963; Dec. 1963 - June 1965; Aug. 1966 - July 1967; Sept. 1967 -May 1968; Oct. 1968 - Jan. 1969; Aug. - Dec. 1969; Nov. - kc. 1970; - )

Aim of the project. To assist the Indian Council of Medical Research in strengthening its statistical unit, and in training staff for medical research.

Assistance provided by WHO during the year. A consultant.

Probable duration of assistance. Until the end of 1975.

Work done during the year. A consultant statistician assisted the Indian Council of Medical Research for one month during October/November in examining the current use of computer facilities, in assessing likely future developments and in determining the best means of meeting these requirements. In his report, which has been sent to the Government, he has pointed out that the main computing needs of the Council are for processing and analysis of data collected from a number of large-scale health surveys rather than for elaborate mathematical manipulation, and that this affected the configuration of computer facilities required. Meanwhile, surveys already planned will produce material requiring computer processing. In reviewing the problem, the consultant has suggested that in the long run a computer administered by the Council could be an economic preposition, and has strongly recommended that the ICMR should build up a programming and statistical group specially directed toward the medical application of computers.

India 0136 Post-basic Nursing Education: Assistance to States* R

*The project started in January 1962 and is expected to continue until the end of 1974. In August 1970, two twelve-month fellowships were awarded to candidates from Uttar Pradesh (extension) and West Bengal for study in the United State6 of America. SEAlRC2412 Page 105

India 0136.2 Post-basic Nursing Education, Gujarat R (Jan. 1963 - Dec. 1966; Dec. 1967; Jan. 1968 - )

Aim of the project. To expand post-basic nursing education, with initial emphasis on post-basic degree programmes usually offering professional specialization in teaching, administration, public health or one of the clinical specialties.

Assistance provided by WHO during the year. Three nurse educators and a consultant.

Probable duration of assistance. Until the end of 1974.

Work done during the year. Curriculum revisions for the first year courses received particular attention, especially since the assignment of a psychiatric nursing consultant during June-September 1970. Placement of a unit in psychiatric nursing was decided upon, and revisions designed to prevent duplication of course materials, especially in public health nursing and comprehensive nursing, were made. The consultant's report was sent to the Government.

New clinical facilities were used. Hospital facilities continued to have many drawbacks, but the public health field practice areas used in Ahmedabad and Kaira districts and the teaching practice areas in Nadiad and Anand proved satisfactory.

A stable faculty from August 1970 to April 1971 did much to strengthen the teaching and allowed for fruitful discussions in the various meetings of the faculty. The senior WHO nurse educator left the project in March on completion of her assignment. Her report has been forwarded to the Government.

The Principal of the College was officially appointed and the Gujarat Government recognized the College.

India 0136.3 Post-basic Nursing Education, Punjab R (March 1964 - )

Aim of the project. To expand post-basic nursing education, with initial emphasis on post-basic degree programnes usually offering professional specialization in teaching, administration, public health or one of the clinical specialties.

Assistance providcd by WHO during the year. (a) Two nurse educators and a consultant; (b) a twelve-month fellowship for study in the United States of America; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1974.

Work done duringthe year. A major activity of the project has been directed towards curriculum evaluation and revision. The philosophy of the College of Nursing was revised to provide for inclusion of the basic, post-basic and master's degree programmes with behavioural objectives developed for all three progrannaes. A curriculum pattern for both the basic and post-basic degree programmes was developed. Individual course outlines were prepared for the post-basic degree and the revised syllabus presented to the Board of Nursing Studies, Punjab University.

The short-term paediatric nursing refresher course is now being offered under the aegis of the College of Nursing. Two courses were conducted with a total enrolment of thirty-six. SEAlRC2412 Page 106

The national nurse faculty was increased by one lecturer and two clinical instructors, and a post for a third clinical instructor was sanctioned. During August 1970 a WHO senior nurse educator with specialization in public health nursing and a consultant to advise on curriculum evaluation were assigned to the College. The consultant completed her work in June 1971 and submitted a report, which is undcr review. One of the WHO nurse educators completed her assignment in January 1971; her report has been sent to the Government.

India 0136.5 Post-basic Nursing Education. Madras R (June 1964 - )

hint of the propct. To expand post-basic nursing education, with initial emphasis on post-basic degree programmes usually offering professional specialization in teaching, administration, public health or one of the clinical specialties.

Assistance provided by WHO during the year. (a) Two nurse educators; (b) a twelve-month fellowship for study in the United States of America; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1974.

Work done during the year. Two WHO nurse educators have assisted the project during the year under review. Two national staff members with Master's preparation are now posted at the College. The Government has deputed one faculty member for Master's study each year since 1969. Two new tutors' posts were sanctioned in Fcbruary, of which one has been filled.

This year, for thc first time, the Director of Medical Education has sanctioned the admission af candidates not belonging to Tamil Nadu service. This, dccision will permit the admission of WHO-sponsored nurses from other countries.

The high percentage of students failing one or more examination papers' indicates a need for selection based on academic qualifications. A study is being made of pre-admission qualifications and failure rate.

The nursing faculty has assumed increasing responsibility for teaching the theoretical content of the nursing courses. The faculty has made suggestions for rcvision of the University Regulations and syllabus, and a cornittee has been appointed by the University to draw up the proposal.

Outstanding needs are as follows: (1) physical facilities; (2) representaLlon of the nursing faculty on the Admission Committee; (3) clearly defined authority tor the administrator of the College; (4) separate budget; (5) additional transport, and (6) additional faculty posts. ..

India 0136.7 Post-basic Nursing Education, New Delhi R (Nov. 1969 -

Aim of the project. To expand post-basic nursing education, with initial emphasis on post-basic degree programmes usually offering professional specialization in teaching, administration, public health or one of the clinical specialties.

Assistance provided by WHO durin~the year. (a) A consultant (nurse educator); (b) a twelve-month fellowship for study in the United Kingdom.

Probable duration of assistance. Until the end of 1974. SEAIRC2412 Page 107

Work done during the year. At the College of Nursing in New Delhi, the new academic year began on 13 July 1970 with 20 students in the Master of Nursing programme, 125 students in the programme of Bachelor of Science (Hons.) in Nursing and 58 students in the post-certificate courses. The restructured Master of Nursing programme went into effect for this class.

The faculty decided on the courses and placement of courses in the new curriculum being developed for the Bachelor bf Science (Hons.) programme starting in July 1971.

Assistance was given in the teaching of the final year course in nursing education in the Master of Nursing programme.

The WHO senior nurse educator completed her assignment at the end of August 1970. Her report has been forwarded to the Government.

From February to June 1971 a consultant in public health nursing education assisted with the review and further development of the teaching of public health nursing, particularly in the Master's and post-certificate programmes. A series of faculty meetings were conducted for those teaching public health nursing in the various programmes of the College - the first time the public health nursing faculty has met as a group. Visits were made by the WHO consultant and her counterpart to the All-India Institute of Hygiene and Public Health, Calcutta. and to the Rural Health Research Centre, Narangwal, to locate possible field placement areas for Master's students.

Guidance was given to Master's students in the analysis of data and writing of theses. The consultant participated in a workshop for these students on "Methods of Research". She completed her assignment in June and submitted a report, which is under study.

India 0136.8 Post-basic Nursing Education, Bombay R (Nov. 1970 - )

Assistance provided by WHO during the year. (a) A nurse educator; (b) a nine- and-a-half-month fellowship for study in the United States of America (extension); (c) supplies and equipment.

Probable duration of assistance. Until the end of 1974.

Work done during the year. The project began on 23 November 1970 with the arrival of a WHO nurse educator. The initial weeks consisted of orientation to the health problems and health services in India, with particular reference to Maharashtra State. The patterns of nursing education and nursing practice were also studied.

Following a detailed assessment of the currfculm, a joint plan of action was developed by the Principal of the College of Nursing and the WHO nurse. The faculty were involved in efforts to integrate the various components of the course on "Comprehensive Nursing" and thus to enhance student learning. Several faculty committees were set up. Considerable progress was made in developing a scheduled hour for each class for the term. The medical and nursing faculties collaborated in developing a syllabus for the Post-Certificate Paediatric Nursing Course, which was tentatively scheduled to begin at the College in June 1971. The College was SEAlRC2412 Page 108

expecting to move from the present quarters to the maternity hospital in the J.J. Hospital compound some time during the summer, after the completion of renovations to the building.

India 0153 Malaria Eradication R (Aus. 1958 -

Aim of the project. To eradicate malaria.

Assistance provided by WHO during the year. (a) Three epidemiologists and three consultants and temporary assistance from a malariologist; (b) five three-and-a- half-month fellowships for studies in the Philippines and Ceylon and five onc-month fellowships for study in the Philippines; (c) supplies and equipment.

Probable duration of assistance. Some years.

Work done during the year. The prograrmne has continued to progress despite the continuing problems of operational difficulties, inadequate insecticides and insufficient logistic support.

The annual independent assessment carried out in January-February 1971 recommended 1.18 unit areas for entry into the consolidation phase and 2.03 unit areas for entry into maintenance. The present position is as under: Attack phase - 100.029 units - 132 million population (24%) Consolidation - 67.425 units - 94 million population (17%) Maintenance - 225.796 units - 316 million population (59%) Total - 393.250 units - 542 million population (100%) Non-malarious areas 15 million

In Octoher-November 1970, a multi-disciplinary review (strategy review) of the programme was carried out by an international team composed of WHO and US AID personnel with a national staff member as team leader. Their findings and comments are under active study by the Government.

During the year there was improvement in those maintenance phase areas which had been previously reverted to the attack phase.

There has been some difficulty in filling the vacant posts for WHO epidemiologists due to the non-availability of malariologists with sufficient experience as required by the Indian progrme. US AID advisers to the programme were withdrawn in March 1971, hut the supply element remains.

India 0173 Production of DPT Vaccine. Kasauli R (Jan. - March 1961: Se~t.1961: March 1965: Dec. 1966: UNICEF Aug. 1967; Oct. 1 NOV: 1968; .nay - June 1970; Sept. 1970; Nov. - Dec. 1970)

Aim of the project. To follow up on the WHO-assisted capacity developed at the Central Research Institute, Kasauli, for the production of DPT vaccine and its individual components. SEA/RC24/2 Page 109

Ass1static.- pruvrd~dby WllO during the year. (a) A consultant; (b) a six-month fellowshio far studies in the United Kinndom- and Yuaoslavia- and a seven-month fellowship for studies in the United Kingdom and Hungary; (c) supplies and equipment.

Work done. Following the recommendation of a seminar of State maternal and child health officers held in 1956 on the need for protecting the child population by active immunization, the Government of India sought WHO/UNICEF assistance in studying the epidemiological pattern of diseases and to set up facilities for the production of DPT vaccine.

Assistance to the project, which started in 1961, was initially for a period of three years and was subsequently extended to 1970. During this period WHO provided four consultants and a total of eleven fellowships (including one under another project), while UNICEF supplied equipment to the value of $126 000.

The plan of action envisaged a production of four million doses of DPT vaccine in the first instance (1962-63). to be increased to seven million by 1965-66. Howevcr, in a subsequent review of the project in 1965, the time targets were deferred as follows: two million doses for the year 1966-67 and seven million by 1968-69. In spite of the Government's efforts, however, many difficulties were experienced by the Central Research Institute, Kasauli, such as delay in construction of the new building, damage to the equipment en route to India, lack of foreign exchange for the procurement of essential materials not available locally, and the licensing of the production of DPT vaccine by private manufacturers and sale at highly competitive prices. It was thus only in 1967-68 that the Institute was able to produce two million doses. Even with this modest turn-out, however, it was not possible to secure a regular lifting of vaccine from Kasauli in the absence of a national scheme for the immunization of children. As a result, the accumulating stocks of vaccine created problems of storage, and it became necessary to slow down production to much below the rated capacity.

In late 1969-early 1970. the situation suddenly~. improved as a result of the implementation of a cent;ally-sponsored scheme of immunization under the family planning-. Drogramme. - The vroduction of vaccine at Kaauli vicked up promptl; and the turn-out in 1970-71 touched the figure of over three miliion doses.

WHO has assisted the project throughout. Initially, in 1961, a consultant was assigned to study the feasibility of the project, locate its site, advise on the method of production and testing and reconmend laboratory equipment to be procured by UNICEF. In March 1965, another consultant visited the Central Research Institute to advise on the organization, management and care of laboratory animals. In 1970, two further consultants were provided: a vaccine engineer, who advised on the use of the heavy equipment, including the operation of the fermentors for toxin production, and a vaccine specialist who observed the procedures, reviewed the progress and made a final assessment.

Evaluation. According to the consultant the capacity of the equipment should enable Kasauli to produce 7-8 million doses of vaccine (twice the present turnout) with little adjustment. For further expansion of the production progranrme, some more equipment will have to be provided. However, an important bottleneck was observed in dispensing the vaccine,and a new machine as well as a centrifuge have been recommended in order to remedy the situation.

WHO assistance will continue under the inter-country project SEAR0 0117. SEA/RC24/2 Page 110

India 0174 Production of Freeze-dried Smallpox Vaccine R (Sept. - Oct. 1964; June 1965 - March 1966; Feb. 1967 - UNICEF Jan. 1970; - )

Aim of the project. To increase the production capacity at the four vaccine producing laboratories in India.

Assistance provided by WHO during the year. Supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. The trend over the past three years has been towards a reduction in the output of vaccine at the four producing centres owing to various reasons, and the Government is taking steps to step up production. These include a system of distribution of the vaccine under the direct control of the Central Government, indigenous manufacture of glass ampoules and control assistance to meet the cost of capital investment necessary for stepping up production.

India 0176 Central Public Health Engineering Research Institute, Naypur R (Feb. 1961 - )

Aim of the project. To develop the Institute as a major research centre for environmental sanitation problems; to ca-ordinate research programmes and to train research workers.

Assistance provided by WHO during the year. A consultant.

Probable duration of assistance. Until 1977.

Work done during the year. The Institute has submitted a proposal to develop, in collaboration with the Bombay Municipal Corporation and WHO, a research and training programe on preventive maintenance of water distribution systems. WHO agreed to provide the proposed assistance, consisting of the assignment of consultants and the procurement of supplies and equipment. An agreement between the Water Research Association of the United Kingdom and WHO has been signed whereby the former, on behalf of WHO, will assist the Institute in conducting this programe. An engineer specialist of the Association visited Bombay in April 1971 to survey the available facilities and to assist in the preparation of an eight- week programe, which is expected to take place in September-October 1971.

India 0181 Applied Nutrition Programe K (Oct. 1964 - ) UNICEF (FAO)

Aim of the project. To expand and improve the health component of the Applied Nutrition Programme assisted by FAO, UNICEF and WHO.

Assistance provided by WHO during the year. Supplies and equipment.

Probable duration of assistance. Until the end of 1974.

India 0182 Strengthening of Health Services (Epidemiology) UNDP (TA) (March 1963 - )

Aim of the project. To establish or improve health intelligence units in State health directorates; to train staff in epidemiology, health statistics, microbiology and comunicable-disease control, and to develop the National Institute of Comunicablc Diseases (NICD), Dclhi. SEAlRC2412 Page 111

Assistance provided by WHO during the year. (a) Avirologist and two consultants; (b) two fellowships - one for twelve months and one for ten months - for study in the United States of America, two fellawships - one for nine months and one for six months - for study in Czechoslovakia, and a ten-month fellowship for studies in Czechoslovakia, the United Kingdom, the United States of America and Malaysia; (c) supplies and equipment, including a roller tube incubator, an automatic card punch and an automatic verifier.

Probable duration of assistance. Some years.

Work done during the year. During October 1970 - January 1971 a consultant assisted relevant departments of the National Institute of Comnunicable Diseases, Delhi, with the further development of immunological competence, in relation to both research as well as investigation of the moreprevalentcamnunicable diseases in India. Her report has been forwarded to the Government.

Another consultant, assigned during February-March, helped with the development of a protocol for epidemiological and other studies. His report has also been sent to the Government.

During the year under review work in the virology laboratory focussed on poliovirus: all three types were propagated; type antisera have been raised in monkeys and a study on sero-conversion is being conducted on babies attending the Saran hospital well-baby clinic in New Delhi. The training of the national medical officer continued; he is now in a position to manage the routine activities in the virology laboratory. There is an immediate need for the appointment of regular staff an a full-time basis to the virology laboratory.

India 0185.213 Strengthening of Health Services, Punjab and Haryana K (Jan. 1967 - ) UNICEF

Aim of the project. To strengthen national health services at State, district and local levels, with emphasis on training programmes for health staff, particularly medical officers and assistant nurse/midwives, supervision of auxiliaries by professional staff, and operational studies.

Assistance provided by WHO during the year. (a) A public health officer and a public health nurse; (b) supplies and equipment.

Probable duration of assistance. Until 1974.

Work done during the year. The public health officer and the public health nurse worked closely with the State health authorities of Haryana and Punjab in the standardization and upgrading of health services, particularly at the district level, taking one district as a pilot area. They participated in several conferences, seminars and meetings at State and district levels and also assisted in the organization and conduct of training programmes, including orientation courses. In Jullundur District the municipal health centres were further strengthened and the maternal and child health and family planning activities were organized in co-ordination with the State Maternal and Child Health Organiza- tion. The Bureaux of Health Intelligence in both States widened their spheres of activities and established routine health statistics systems for hospitals. There was a gradual development of the laboratory aspects of district health work.

The project worked in co-ordination with the WtLO tkadquarters-assisted Hospital Utilization Study conducted by the Directorates of Health of the two States; this study made steady progress. SEA/RC24/2 Page 112

India 0187 Training of Radiographers R (March 1967 - )

Aim of the protect. To establish a degree-level training programme for radiographers at the Institute of Post-graduate Medical Education and Research, Chandigarh.

Assistance provided by WHO during the year. (a) A radiography tutor; (b) a twelve-month fellowship for study in the United Kingdom.

Probable duration of assistance. Until the end of 1972.

Work done during the year. The WHO radiography tutor took up his duties in August 1970. Out of the five first-year students at the school in Chandigarh two passed the final examination. In December 1970 re-examinations were held, in which all the remaining three students who had failed in August 1970 were successful. Ten new students were admitted to the school after selection from a list of mre than 200 applicants.

The kW0 tutor prepared two training manuals, arranged in lecture form and based on the curriculum being followed, one to cover the instruction on radiographic equipment and the second on radiographic photography. The students found this helpful in their studies.

A staff member of the Department who had been on a WHO fellowship returned and took over lectures to second-year students on radiotherapy techniques. The first national counterpart to the WHO tutor has also returned after completing his WHO fellowship.

The second national counterpart to the WHO tutor proceeded on a WHO fellowship in January 1971.

There were changes in the staff strength of the Department of Radiotherapy.

Supplies and equipment provided by WHO were received.

An Assistant Director from the Regional Office visited the project and held discussions with the WHO staff member and the national officials concerned.

India 0188 Strengthening of Laboratory Services R (Feb. 1965 - )

Aim of the project. To strengthen health laboratory services in India.

Assistance provided by WHO during the year. (a) A laboratory technician and a consultant; (b) three twelve-month fellowships - two for study in the United Kingdom and one for study in Ceylon; (c) supplies and equipment.

Probable duration of assistance. Some years.

Work done during the year. The project maintained good progress throughout the year. Since the start of the project in Chandigarh, 16 students have successfully completed their B.Sc. course in medical laboratory technology and have found 4 employment as senior technicians at the Post-graduate Institute, Chandigarh. During the year, further major developments in the B.Sc. degree course took place. Twenty-six trainees were enrolled, instead of 12, including six seats which are allocated to the Government of Punjab. Four B.Sc. graduates have joined the first M.Sc. course which started in September - two in histopathology and one each in SEAIRC24/2 Page 113

haematology and biochemistry. Apart from the academic classes, the project assisted in conducting two six-week orientation courses for malaria microScopistS. As a result, the 22 trainees who have so far been so retrained will be appointed for multiple microscopy work and sideroom laboratory services in health centres and district laboratories.

During January-April, a consultant assisted the Department of Microbiology at the Lady Hardinge Medical College, New Delhi, in establishing techdcal competence in, and in standardizing procedures for, the laboratory diagnosis of streptococcus infection. His recmendations have been forwarded to the Government, and his report is being processed. Action is being taken to implement the consultant's recomendations.

India 0190 Training in Health Education R (Sept. 1968; June 1969; April 1970; July 1970; Nov. 1970; April 1971; - )

Aim of the project. To establish and develop three post-graduate health education training centres with rural and urban field practice areas.

Assistance provided by WHO during the year. A twelve-month fellowship for study in the United States of America, a three-month fellowship for studies in Iran, the UAR, Yugoslavia and the United Kingdom, and a two-month fellowship for studies in Taiwan, Thailand and the Philippines.

Probable duration of assistance. Until 1977.

India 0192 Radiation Medicine Centre, Bombay R (Jan. - Feb. 1963; March 1967 - )

Aim of the project. To strengthen the Radiation Medicine Centre, Bombay.

Assistance provided by WHO during the year. (a) A consultant; (b) three fellowships - one for two months, one for six months (extension) and one for twelve months - for study in the United States of America; (c) supplies and equipment.

Probable duration of assistance. Until 1977.

Work done during the year. A WHO consultant was assigned to the project for six weeks during November-December to advise on radiohunoassay. In his report, which has been sent to the Government, he has recommended that an up-to-date automatic well-counter designed to provide high efficiency and low ba~kgroundfor low level 1251 counting should be provided in order that the development of in vitro assays at the Radiation Medicine Centre could be promoted.

India 0194 Medical Rehabilitation R (Nov. 1963 - Feb. 1964; April - June 1967; UNICEF Feb. - June 1969; Oct. 1969; June 1970 - )

Aim of the project. To expand medical rehabilitation services and to establish training schools in the various disciplines.

Assistance provided by WHO during the year. (a) A prosthetics tutor; (b) a six- month fellowship for studies in Switzerland, the United Kingdom. Canada and the United States of America, a one-month fellowship for study in Poland, and a seven- month fellowship for studies in Denmark, Federal Republic of Germany, the United States of America and Canada; (c) supplies and equipment. SEA/RC24/2 Page 114

Probable duration of assistance. Some years.

Work done during the year. The WHO prosthetic tutor, who arrived at the end of September 1970, has been working in New Delhi at the Rehabilitation Departments of the All-India Institute of Medical Sciences and Safdarjang Hospital. He assisted in the preparation of the syllabus of the School for Prosthetic and Orthotic Appliances Technicians, with the aim of upgrading the training of prostheticiaus to diploma level in the first instance and to degree standard later. He is also helping with research into the development of standard components for orthopaedic appliances. The course at the school was preceded by a training course for instructors, which started in May.

India 0197 Occupational Health R (April - Sept. 1964; Aug. 1970; Nov. 1970 - Jan. 1971; - )

Aim of the project. To conduct courses in occupational health related to specific hazards found in industries, and to undertake possible research projects.

Assistance provided by WHO during the year. (a) A consultant; for the symposium (see below) two consultants and two temporary advisers; (b) two six-month fellowships for studies in Yugoslavia, the United Kingdom, the Netherlands and the USSR; (c) cost of attendance of participants.

Bork done during the year. A WHO consultant visited the National Institute of Occupational Health, Ahmedabad, in August 1970 to hold discussions with the Director and to make preparations for the Symposium on Academic Education and Training in Occupational Health and Hygiene, which was held from 8 to 11 November at the Institute.

The same consultant, in cooperation with another consultant, assisted in conducting the Symposium, in which there were twenty-two participants, including professors of various disciplines from different medical colleges in India and one vice-chancellor. The participants presented papers on different aspects of occupational health.

The report on the Symposium was forwarded to the Government.

The Symposium was timed to coincide with the inauguration of the Institute (renamed as the National Institute of Occupational Health) on 8 November.

India 0199 School for Training of Technicians UNDP (TA) (Dec. 1967 - )

Aim of the project. To train technicians in the installation, maintenance and repair of electrical and mechanical equipment found in health institutions.

Assistance provided by WHO during the year. (a) An electro-mechanical engineer; (b) a twelve-month fellowship for studies in Japan, the United Kingdom, the Netherlands and the Federal Republic of Germany; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1977.

Work done during the year. The fifth six-month course which started in July 1970 with twenty-three new students from hospitals all over India ended in January 1971. The students were given both theoretical and practical training with the assistance of the skilled artisans who had had training in Australia. A total of 75 technicians have taken part in the five courses organized so far. SEAlRC2412 Page 115

The maintenance and repair of equipment from various hospitals were carried out, including modifications, for which locally made components were used.

India 0200 Fellowships R

Adolescent psychiatry. A twelvelnonth fellowship for studies in Canada and the United States of America.

Dental public health. Two nineloonth fellowships for study in the United Kingdom.

Dental undergraduate education. A six-month fellowship for study in the United States of America.

Environmental health. Two four-month fellowships for studies in Australia, Malaysia and Thailand.

Immunulo~. A ten-week fellowship for study in Singapore.

Nursing administration. Three four-month fellowships for study in the United Kingdom.

Orthopaedic nursing and operation theatre techniques. A six-month fellowship for study in the United Kingdom.

Public health engineering. Three four-month fellowships for studies in the United Kingdom, the United States of America, Puerto Rico, Japan and Taiwan.

Sanitary engineering design. A six-month fellowship for study in the United States of America.

Surgical nursing care. A four-month fellowship for study in the United Kingdom.

India 0208 Improvement of Dental Education UNDP (TA) (July - Dec. 1966; Sept. 1967 - ) Aim of the project. To improve and strengthen dental education and research in selected dental colleges. Assistance provided by WHO during the year. Two fellowships - one for nine months and one for six months - far study in the United Kingdom, and a six-month fellowship for study in Australia.

Probable duration of assistance. Until the end of 1977.

India 0209 Community Water Supply R (March - May 1964; Oct. - Dec. 1965; Feb. 1968; March 1969; July 1969; Sept. 1969; May - Aug. 1970; - ) Aim of the project. Second phase: To study the feasibility and the financial and managerial aspects of water supply and drainage schemes. Assistance provided by WHO during the year. Four six-onth fellowships - two for study in the United States of America, one for study in the United Kingdom, and one for studies in the United Kingdom, the United States of America and the SEA/RC24/2 Page 116

India 0212 Nursing Administration* R

India 0212.1 Nursing Administration, Chandigarh R (Jan. 1968 - ) Aim of the project. To develop nursing administration in teaching hospitals and to promote in-service training and co-ordination of nursing services.

Assistance provided by WHO during the year. (a) A nurse administrator; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1973.

Work done during the year. A start was made in establishing an In-Service Educa- tion Department with planned programmes for all nurses. Two orientation courses were conducted - one for newly qualified staff nurses and one for senior staff nurses. Plans were for a series of courses for ward sisters. On-going in-service training courses for class IV staff have been conducted, but their effectiveness has been limited by much absenteeism.

Centralizing of services in Nehru Hospital has made some progress but much remains to be done to relieve nurses of non-nursing duties, including the messenger services.

Plans were made for the establishment of a ward unit for demonstrating modern methods of ward administration and clinical teaching in an attempt to improve patient care.

Studies are being undertaken to ascertain the amount of nursing time which is used for non-nursing duties, especially clerical work. These findings are to be related to the nursing time available to patients in various wards and departments of the Hospital.

An assessment of the nursing staff required for the Nehru Hospital was made and submitted to the Director of the Post-Graduate Institute. The document contains proposals for total nursing staff required and details of phased increases in establishment, as well as a planned programme for further education for senior nursing staff.

India 0212.2 Nursing Administration, Guiarat R (July 1968 - ) Aim of the project. To develop nursing administration in teaching hospitals and to promote in-service training and co-ordination of nursing services.

Assistance provided by WHO during the year. (a) A nurse administrator; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1973.

*The project started in January 1968 and is expected to continue until the end of 1973. hring the year five fellowships were awarded - three for four months for study in the United Kingdom, a twelve-month fellowship for study in New Zealand and another twelve-month fellowship for studies in the United Kingdom, the United States of America and Canada. SEA/RC24/2 Page 117

Work done during the year. The WHO nurse arrived in September 1970. Subsequent to assessing the project a suggested programme was discussed with the medical and nursing administrators concerned and the recommendations were supported.

There has been improvement in the hospital environment, including the grounds. The equipment was repaired and replacements were procured. In order to deal with discipline a comittee responsible for all class IV employees was established and has been effective.

A proposed nursing organization structure with staffing requirements was forwarded to the Government. Central delivery services are planned to reduce non-nursing duties; a laundry committee is endeavouring to improve linen services; food services received attention; planning includes control of visitors.

A Nursing Service Committee, representative of administration and education, was established and has worked effectively. Matters arising from this comittee were discussed with nursing staff through staff meetings. Plans were made for a series of discussions on ward management.

Co-operatian from the national staff has been excellent and relationships generally healthy.

Keeping in mind the scope of the project, priorities were set to concentrate on the nursing service in New Civil Hospital, Ahmedabad, in the first instance, with limited attention given to S.S.G. Hospital, Baroda.

India 0214 Virological Techniques R (Sept. 1968; Nov. 1969; - )

Aim of the project. To develop the laboratory capacity for the diagnosis and surveillance of virus diseases, and to establish competence in the production and testing of live poliomyelitis vaccine.

Assistance provided by WHO during the year. An eleven-month fellowship for studies in Czechoslovakia and the United Kingdom and a twelve-month fellowship for study in the United Kingdom.

Probable duration of assistance. Until the end of 1977.

Work done during the year. The status of development of the neurovirulence testing unit at the National Institute of Communicable Diseases, Delhi, was recently reviewed. This assessment will help the neuropathologist consultant who is due to visit the project in late 1971. A consultant is under recruitment to review the protocols and assist the pathologist at the Institute during the break-in period when the first batches of vaccine manufactured in Coonoor will be tested.

India 0218 National Institute of Health Administration R and Education (NIHAE) UNICEF (Sept. 1965 - May 1967; March 1968; Dec. 1968 - Jan. 1971; - )

Aim of the project. To conduct studies in district health administration at Rohtak (Haryana) as a prelude to the promotion and planning of comprehensive health care services at the district level; to formulate research and teaching programmes pertaining to health administration, and to undertake teaching programmes, studies and research in the field of hospital administration. SEAlRC2412 Page 118

Assistance provided by WHO during the year. (a) A specialist in hospital administration; (b) a twelve-month fellowship for studies in the USSR and the United Kingdom and a four-and-a-half-month fellowship for study in the United States of America.

Probable duration of assistance. Until 1974.

Work done durinp, the year. The WHO hospital administrator assisted the Institute till January 1971, when he completed his assignment. He participated in meetings, seminars, conferences and teaching programmes related to hospital administration, and collaborated with the Institute on research, particularly operational studies on hospital administration and with the inter-regional course on Health and Man- power Planning (see inter-regional 0439).

The research project on district health administration at Rohtak began field studies in October 1970, when most of the members of the team were in position. After the collection of baseline data and information and finalization of questionnaires and check lists, the team completed the initial stage of Phase I - interviews of public health centre staff, work analysis of public health centres based on continuous observations, study of hospitals, municipalities and observations of district headquarters' staff.

India 0220 Seminar on the Teaching of Psychiatry R (Jan. - Feb. 1971)

Aim of the project. To organize seminars on various aspects of mental health and to train personnel.

Assistance provided by WHO during the year. (a) Two consultants, three temporary advisers, and assistance from a consultant provided under India 0111; (b) cost of attendance of participants.

Work done. A Seminar on the "Organization and Future Needs of Mental Health Services" was held at the All-India Institute of Medical Sciences, New Delhi, from 1 to 5 February 1971. It was a follow-up of two seminars on the teaching of psychiatry held earlier - one in 1968 and the other in 1970. The Seminar was attended by four Directors of Health Services from different States of India in addition to sixteen other participants who were practising psychiatrists, teachers of psychiatry in medical colleges, clinical psychologists and psychiatric social workers. There were three consultants specialized in academic psychiatry, health services administration and field research. Three temporary advisers (professors of psychiatry in Indian medical colleges) also assisted with the conduct of the Seminar. One of the consultants paid a visit to Punjab State.

The various aspects of the problem of the mentally ill and the delivery of skilled care to this group were discussed, and the Seminar drew up proposals for guidelines for the development of services, training and research.

The report of the Seminar was under review.

India 0221 Seminars and Workshops on Medical Education R (Dec. 1965 - May 1966; Jan. 1967 - )

Aim of the project. To strengthen further medical teaching.

Assistance provided by WHO during the year. (a) Two consultants and assistance from a consultant provided under India 0111; temporary assistance from one of the SEA/RC24/2 Page 119

Regional Advisers on Nursing and two staff members assigned to field projects; (b) cost of atLendance of participants.

Probable duration of assistance. Until 1973.

Work done during the year. A Seminar on "Rheumatic Heart Disease, Epidemiology, Prophylaxis and Clinical Management" was held, in collaboration with the Indian Academy of Medical Sciences, in New Delhi from 22 to 25 February 1971.

The Seminar was attended by 33 participants who were physicians, paediatricians, surgeons, microbiologists, epidemiologists,nurses and cardiologists. The three WHO consultants were a physician, an epidemiologist and a nurse tutor. A cardiac surgeon, a cardiologist and a microbiologist served as temporary advisers.

The Seminar was valuable in bringing together experts from many disciplines to focus on and contribute towards the solution of the many problems surrounding this important and comon group of diseases. It also enabled the participants to realize the importance of inter-disciplinary collaboration for further advances in this field. The report of the seminar was under preparation.

India 0222 Drug Laboratory Techniques and Biological Standardization R (June 1967; Oct. - Dec. 1967; Aug. 1968; July - Aug. 1969; Nov. 1969 - Jan. 1970; Sept. 1970 - Feb. 1971; - )

Aim of the project. To develop services concerned with quality control of pharmaceutical and biological preparations, and to train staff.

Assistancc provided by WHO during the year. (a) Two consultants; (b) five five- month fellowships for studies in the USSR, Switzerland, Italy, the United Kingdom and the United States of America. a ten-week fellowship for studies in Denmark, the United Kingdom, Canada, the United States of America and Japan, a twelve-month fellowship for study in the United Kingdom, a twelve-month fellowship for study in the United Kingdom, Denmark and the United States of America, and two sixloonth fellowships - one for studies in the USSR, Hungary, Switzerland, Federal Republic of Germany, Denmark, the United Kingdom, Canada and the United States of America, and one for studies in the USSR, United Kingdom and the United States of America.

Probable duration of assistance. Until 1975.

Work done during the year. A WLO consultant (pharmaceutical chemist) arrived in India at the end of September and held preliminary discussions with representatives of the Government and the UNDP in New Delhi regarding the development of a Special Fund Project in this field. He also visited the three Central Government laboratories, i.e., those in Ghaziabad, Calcutta and ChandigarhfKasauli, which are to be upgraded during the Fourth Five-Year Plan as part of the Project. His report has been forwarded to tlre Government.

Another consultant, an expert in the quality control of biological preparations, took up a four-month assignment in October and visited jointly with the WHO pharmaceutical chemist, the above-mentioned laboratories. In addition she visited some drug manufacturing units in the private sector in Maharashtra State. Assistance was given in the preparation of a draft government request to the UNDP. The consultant's report was under review.

India 0225 Freeze-dried BCG Vaccine Production R (May - June 1968; June - Sept. 1970; - ) UNICEF Aim of the project. To produce thermostable BCG vaccine. SEA/RC24/2 Page 120

Assistance provided by WHO during the year. A consultant.

Probable duration of assistance. Until 1975.

Work done during the year. The WHO consultant assigned to the BCG Laboratory, Guindy, Madras, in June 1970 completed his work in September. In his report, which has been sent to the Government, the consultant has laid particular emphasis on the reinforcement of aseptic precautions, improvement of the water supply, procurement of glass ampoules from indigenous sources, and the replacement of the hand-sealing procedure by an automatic sealing machine - measures which the consultant considers essential for the expansion of the production programe. Action is in hand for implementing the consultant's recammendations.

India 0226 Water Pollution R (Oct. - Nov. 1969; April 1971; - )

Aim of the project. To provide technical advice on organization and other matters related to the abatement and control of water pollution.

Assistance provided by WHO during the year. (a) A six-month fellowship for study in the United States of America and a five-month fellowship for studies in the United States of America, Taiwan, the Philippines and Thailand.

Probable duration of assistance. A number of years.

India 0228 Registry of Patholoa R (Nov. 1966 - March 1967; April 1969; Dec. 1970; - ) Aim of the pro.ject. To assist the Indian Registry of Pathology in organizing a peripheral centre at Grant Medical College, Bombay.

Assistance provided by WHO during the year. (a) A five-month fellowship for studies in Hungary, Switzerland, the United Kingdom and the United States of America; (b) supplies and equipment.

India 0232 Course in Hospital Physics R (Oct. 1967 - )

Aim of the project. To train hospital physicists.

Assistance provided by WHO during the year. (a) A consultant; (b) supplies and equipment.

Probable duration of assistance. Until 1974.

Work done during the year. A WHO consultant was assigned during January and February to assist with the teaching programme of the fourth course in hospital physics. His report was received and sent to the Government.

India 0233 Smallpox Eradication R (Oct. 1967 - )

Aim of the project. To develop the smallpox eradication programme, carry out periodic assessments and train staff. SEA/RC24/2 Page 121

Assistance provided by WHO during the year. Two medical officers and temporary assistance from the epidemiologists assigned under SEARO 0030, and from three Headquarters staff members; (b) a three-month fellowship for study in Yugoslavia; (c) supplies and equipment, including 30 transport vehicles.

Probable duration of assistance. A number of years.

Work done during the year. The plan of operation was signed in September 1970. Two medical officers were assigned to Uttar Pradesh and Rajasthan. Three consultants assessed and assisted the progrme in Kerala, Rajasthan and Bihar States. The Chief Medical Officer from the Smallpox Eradication Unit at WHO Headquarters visited principal problem areas in Rajasthan and Uttar Pradesh in April 1971 and actively participated in an inter-State border meeting of district and State officials from Haryana and Rajasthan. One of the epidemiologists of th~ inter-country epidemiological advisory team (SEAR0 0030) visited endemic districts in Rajasthan early in 1971 and Mysore in June.

Efforts were directed mainly to improve epidemiological investigation of cases, containment and follow-up measures as well as to ensure the rapidity of reporting at all levels and ta promote co-ordination of small eradication activities among the States and also with the neighbouring countries.

With regard to routine vaccination of the population, special attention wds paid to the stepping up of primary vaccination coverage and to the introducLiun of the multiple-puncture technique of vaccination with the bifurcated needle in those States where the rotary lancet is still being used.

Assistance to the four producing centres of freeze-dried smallpox vaccine has continued (see India 0174).

India 0238 Cancer Control Pilot Project, Tamil Nadu R (July 1968 - )

Aim of the project. To start and develop a pilot project for the early diagnosis and control of oropharyngeal and cervical cancer and to establish a training centre in Kancheepuram (Tamil Nadu) .

Assistance provided by WHO during the year. (a) A medical officer (epidemiologist), a consultant and temporary assistance from a staff member from Headquarters; (b) two six-month fclluwships - one! for study in the United Kingdom and one for study in Australia; (c) supplifs and equipment.

Probable duration of assistance. Indefinite.

Work done during the year. A consultant cytopathologist and a staff member from Headquarters visited thc project in Kancheepuram from 25 November to 5 December 1970. Their report has been fawarded to the Government. The WHO medical officer (epidemiologist) joined the project in February 1971. The national cytopathologist and two cytotechnicians attached to the project were awarded WHO fellowships for further training and are expected to return by December 1971. Action is being taken to draw up protocols and appoint staff for starting the detection of oropharyngeal cancers. The Tamil Nadu Government has plans to draw up a programme for early detection, treatment, education and training in cancer to cover the State's population. The prograime will include the development of treatment facilities in relation to the cases detected in Kancheepuram. SEAlRC2412 Page 122

India 0244 Training in Veterinary Public Health R (Aug. 1969; March 1970; May 1971 - )

Aim of the project. To initiate studies of the zoonoses in various institutions. public health laboratories and medical colleges.

Assistance provided by WHO during the year. A consultant.

Probable duration of assistance. A nder of years.

Work done during the year. In May, a consultant was assigned to assist with the teaching of students taking part in the two-year course leading to a Master's degree in veterinary public health. He is also helping with &he preparation of protocols for theses to be written during the second year of the course.

India 0247 Central Health Education Bureau R (March 1971; - )

Aim of the project. To assist the Central Health Education Bureau in strengthening various aspects of its work.

Assistance provided by WHO during the year. A two-month fellowship for studies in Taiwan, the Philippines and Thailand.

India 0250 Integration of Maternal and Child Health Services R into the General Health Services (Sept. 1967; Nov. - Dec. 1967; June - July 1968; June 1970; Nov. 1970 - Feb. 1971; May 1971; - )

Aim of the project. To integrate maternal and child health services, including family planning, into the general health services in selected States.

Assistance provided by WHO during the year. (a) Three nine-month fellowships for studies in the United Kingdom and Uganda, a twelve-month fellowship for study in the United States of America, a three-month fellowship for study in the United Kingdom, and a three-month fellowship for studies in Yugoslavia, the United Kingdom and Uganda; (b) supplies and equipment.

India 0251 Ground-vater Training Course R (Feb. - May 1970; July 1970; - ) UNICEF

Aim of the project. To train staff in the development and utilization of ground- water for comunity water supplies.

Assistance provided by WHO during the year. An eleven-month fellowship for studies in the United Kingdom, Czechoslovakia, the United States of America and Canada.

Probable duration of assistance. Until 1974.

India 0255 Strengthening of Health Statistics Services R (July - Oct. 1970; - ) Aim of the project. To develop and strengthen health intelligence units in State health departments and to train national statistical staff. SEA/RC24/2 Page 123

Assistance provided by WHO during the year. (a) A consultant; (b) two twelve- month fellowships for study in the United Kingdom.

Work done during the year. A consultant (statistician) was assigned in July 1970 to review the existing training facilities for medical coders and intermediate- grade statisticians at the Model Vital and Health Statistics Training Unit, Nagpur, and to study the syllabus for such type of training.

During her assignment, she assisted with a course in medical coding held from 6 July to 26 September and prepared a revised syllabus for future courses, to take full account of changes resulting from the introduction of the 8th Revision of the International Classification of Diseases. She also reviewed the curriculum of the course for intemediate-grade statistical workers and proposed a detailed new syllabus. The proposed syllabi have been sent to the Government.

She also visited the statistical units in the Directorates of Health Services in Assam, Maharashtra and Punjab and the Central Bureau of Health Intelligence, New Delhi, in order to assess the relevance of the training courses to the work done by those so trained. She recommended an increased intake of students at the Nagpur Centre and also the establishment of another training centre to meet the growing need for personnel trained in medical coding. The report of the consultant, who completed her work in October, has been fawarded to the Government.

India 0257 Physiotherapy School, Baroda R (May 1968; March 1969 - )

Aim of the project. To train physiotherapists to degree standard (Bachelor of Physiotherapy) at the Physiotherapy School in S.S.G. Hospital, Baroda, over a three-year period.

Assistance provided by WHO during the year. (a) A physiotherapy tutor; (b) a twelve-month fellowship for study in the United Kingdom; (c) supplies and equipment, including a transport vehicle.

Work done during the year. The WHO physiotherapy tutor joined the project in July 1970. Discussions were held with the Dean of the Medical School, the Head of the Physiotherapy Department of Shri Sayaji General Hospital and the teaching staff of the school in order to secure better co-ordination and to upgrade the teaching.

The revised syllabus was accepted by the Medical School and Baroda University. The examinations of first and second-year students were conducted in December 1970.

It was hoped that new posts of physiotherapists as teaching staff to supervise the students' clinical work would be created soon so that the teachers would be available for the third group of students entering the school in June 1971.

The end-of-the-year examinations started on 19 March and ended on 22 April.

The WHO physiotherapy tutor's national counterpart proceeded on a WHO fellowship.

The posts of one senior physiotherapist and one physiotherapy tutor were filled. SEA/RC24/2 Page 124

India 0258 Improvement of Hospital Facilities R (Oct. - Nov. 1967; Oct. 1970; - )

Aim of the project. To advise on the design and construction of hospitals, their functional programing and lay-out.

Assistance provided by WHO during the year. A tworeek fellowship for study in the Federal Republic of Germany.

India 0267 Nutrition Training R (Dec. 1970; May 1971; - )

Aim of the project. To support the National Institute of Nutrition, Hyderabad.

Assistance provided by WHO during the year. A three-month fellowship for a study tour of Nepal, Burma, Thailand, Japan, the Philippines, Indonesia. Malaysia and Ceylon, and a twelvemonth fellowship for study in the United States of America.

Probable duration of assistance. Until the end of 1974.

India 0268 Village Water Supply R (May 1971 - ) UNICEF

Aim of the project. To plan and co-ordinate the development of cmmnunity water supplies in rural areas, including the well-drilling programme in areas where hard rocks present special problems and in those where water is scarce; to train professional and drilling staff.

Assistance provided by WHO during the year. Sanitary Engineer.

Probable duration of assietance. Until the end of 1974.

Work done during the year. The master plan of operation for the project, which is an extension of the rural water supply programme started in 1963 with assistance from WHO and UNICEF, was signed in October 1970. Subsidiary plans of operation covering assistance to individual States were initiated in respect of those six States where this progrme has already been implemented.

A WHO sanitary engineer joined the project in May 1971 to provide assistance in the development and implementation of the programme in the States of Andhra Pradesh, Kerala, Maharashtra, Mysore, Orissa and Tamil Nadu. Stepa were being taken to recruit a second sanitary engineer to give similar assistance to the other States.

India 0270 Air Pollution R (Feb. -March 1971; - )

Aim of the project. To study the problems of air pollution connected with industrial development and to promote a control programme.

Assistance provided by WHO during the year. A consultant.

Probable duration of assistance. A number of years. SEA/RC24/2 Page 125

Work done during the year. A consultant was assigned from 3 February to 4 March 1971 to assist the Government in drafting legislation on air pollution control. He visited different places and held discussions with the various authorities concerned, including the Expert Committee on Air Pollution set up by the Govern- ment in May 1970 to study this type of problems and to draft a control act. The consultant's report has been sent to the Government.

India 0275 Strengthening of the Teaching of Human Reproduction. Family UNFTA Planning and Population Dynamics in Medical Colleges (May 1971 - )

Aim of the project. To strengthen the service, teaching and research functions of the departments of paediatrics, obstetrics and gynaecology and preventive and social medicine and of other departments involved in the teaching of human reproduction, family planning and population dynamics in various medical colleges.

Assistance provided by WHO during the year. (a) Two consultants and eight temporary advisers; (b) a nine-month fellowship for study in the United Kingdom and a three-month fellowship for studies in the United Kingdom,- the United States of America and Japan.

Work done during the year. Two consultants - one in paediatrics and the other in obstetrics and gynaecology - were assigned in May and June respectively to review and advise on the teaching of the paediatric, obstetric and gynaecological aspects of human reproduction, family planning and population dynamics in four medical colleges (Nagpur , Gwalior , Osmania (Hyderabad) and Madurai) selected for assistance under the project in 1971.

From 7 to 19 June, eight medical educators (recruited as temporary advisers to the Regional Director) met in the Regional Office in order to draft a plan of operation for the project with the assistance of the two consultants. The draft plan is under review.

India 0278 Integration of Maternal and Child Health (including UNFPA Family Planning Services) into the General Health Services (May 1971 - )

Aim of the project. To plan, organize, operate and evaluate the family health programmes as an integral part of the general health services; to develop and improve further faculties and facilities in the training institutions, to organize training programmes for all categories of health staff in the various aspects of human reproduction, family planning and population dynamics, and to promote field studies and pilot demonstrations of integrated services.

Assistance provided by WHO during the year. (a) Two consultants and 42 temporary advisers; (b) secretarial assistance.

Work done during the year. A Workshop on the Integration of Maternal and Child Health and Family Planning Programmes in Rural Areas was held in the Regional Office from 17 to 22 May 1971. The twenty participants (recruited as temporary advisers) were senior health officials from the Union and State Governments. A WHO consultant was assigned to organize and co-ordinate the proceedings of the workshop. Problem relating to the provision of comprehensive maternal and child health and family planning services in rural areas were discussed and proposals made for improvement.

A group of twelve senior health officials (serving as temporary advisers) met in the Regional Office from 24 May to 5 June to draft a plan of operation for SEA/RC24/2 Page 126

the project with the assistance of the consultant assigned for the above-mentioned workshop. The draft is under review in the Regional Office.

A second five-day Workshop on "Operational Studies related to Integration of Maternal and Child Health and Family Planning" conrmenced on 28 June. The ten participants (temporary advisers) were senior research workers and health administrators experienced in the integration of specialized programes into the general health services. A consultant was assigned to organize and co-ordinate the proceedings of the Workshop.

WHO fellowships in support of this project were awarded under project India 0250, "Integration of Maternal and Child Health Services into the General Health Services". SEA/RC24/2 Page 127

4. INDONESIA

PROJECT LIST

Project No. Source of Funds Co-operating Agencies Title

Indonesia 0032 Malaria Eradication R (May 1955 - )

Aim of the project. To reduce malaria endemicity to the lowest possible level with the ultimate goal of malaria eradication.

Assistance provided by WHO during the year. (a) Three malariologists, an entomologist and a translator-typist and temporary assistance from the laboratory specialist provided under project SEARO 0094.2; (b) five fellowships - three for fourteen weeks and two for thirteen weeks - for studies in the Philippines and India, and two one-month fellowships for study in the Philippines; (c) supplies and equipment, including two transport vehicles; (d) subsidy.

Probable duration of assistance. A number of years.

Work done durina the year. During the year the integration of the malaria programme into the general health services was completed at the central, provincial and regency levels. Below the regency level, the malaria services continued to be autonomous as in the past.

With the incorporation of anti-malaria activities into the five-year development plan, the financial situation of the malaria programme has improved. The funds allocated for the campaign amounted to Rp. 63 502 900 in 1970171, and the allocation has been increased to Rp. 1033 356 000 for 1971172. On the basis of these allocations, a comprehensive plan of action was prepared for the control of malaria in Java and Bali and also in the other islands. The focal spraying of DDT will be carried out in selected malaria foci,the extent of spraying depending on the availability of the insecticide. Case-detection and treatment will be carried out by the available personnel and passive case-detection undertaken in hospitals, dispensaries and other health institutions. lring the year 1970. some 6 021 858 blood slides were collected and examined, out of which 124 528 were found positive - 117 056 of these came from Java and Bali and 7 472 from the other islands. In 1969, 61 104 positive malaria blood slides were recorded.

The WHO entomologist left early in 1971; his report has been sent to the Government. The laboratory specialist of the inter-country project SEARO 0094 visited Indonesia during the second quarter of 1971 to assist in strengthening the laboratory services.

Indonesia 0036 Paediatric and Obstetric Education and Services UNDP(TA) (Oct. 1956 - Dec. 1957; May 1967 - June 1969; Sept. 1969; UNICEF Nov. 1970; - )

Aim of the project. To expand and improve paediatric and obstetric services and the teaching of medical and nurse students in maternal and child health in a number of medical schools. SEA/KC24/2 Page 128

Assistance provided by WHO during the year. (a) A nine-month fellowship for studies in the United Kingdom, Uganda and India; (b) supplies and equipment.

Indonesia 0050 Tuberculasis Control R (July 1961 - ) UNICEF

Aim of the proiect. To integrate BCG vaccination without prior tuberculosis testing into the work of the maternal and child health clinics and regency polyclinics; to train staff engaged in case-finding by microscopic sputum examination, and to provide ambulatory treatment.

A.S~~SCJII.L.~~ruvlderl by WHO during the vear. (a) A conuultanc; (b) a fourtcen-week fellwship for studies in India and Ceylon; (c) cost of attendance of participants.

Probable duration of assistance. Until the end of 1974.

Work done during the year. A WHO consultant assigned from December 1970 to June 1971 assisted the Government in preparing a feasible country-wide plan of action for tuberculosis control and in strengthening the BCG vaccination programme. In addition, the consultant helped with the preparation and conduct of a training course for provincial tuberculosis control officers. The course, which was held from 22 March to 17 April 1971, was attended by 27 participants.

Indonesia 0060 Laboratory Services R (June 1967; June - Aug. 1968; June 1969; June 1970 - ) UNICEF

Aim of the proiect. To assist in strengthening health laboratory services.

Assistance provided by WHO during the vear. (a) A microbiologiet, a virologist and a laboratory technician; (b) a twelve-month fellowship for study in the United States of America; (c) supplies and equipment, including a transport vehicle.

Probable duration of assistance. A number of years.

Work done during the year. The microbiologist assumed his duties in August 1970 and a virologist joined the team in January 1971. Under inter-country project SEAR0 0159 a consultant visited Indonesia in 1970 to review the progress made in the organization of laboratory services. The construction of the main building of the Central Public Health Laboratory, Djakarta, has been completed and the laboratory was to start functioning in May-June 1971. A smallpox diagnosis laboratory is being set up in Djakarta to support the smallpox eradication programme.

The WHO microbiologist and the WHO virologist also assisted with a survey of laboratory facilities in Semarang and Bojolali, in connection with plague investigation.

The team visited ~rovinciallaboratories in Bandung, Jogjakarta, Semarang, Surahaja, Makassar, Bandjarmasin, Palembang and Medan, most of which have received equipment supplied by UNICEF. The public health laboratories at Medan and Semarang seem to be particularly well organized. All laboratories have the potential to operate as provincial laboratories and are involved in serological surveya.

A large part of the team's efforts was directed towards training programmes. They assisted the provincial, regency and health centre medical officers with a SEA/RC24/2 Page 129

series of cholera workshops. Assistance was also given in the organization and holding of workshops for tutor technicians and medical officers. The team also advised an the control of an outbreak of gas gangrene at Dr Tjipto Mangunkusurn Hospital.

Indonesia 0061 Training in Sanitary Engineering R (Feb. - March 1968; Sept. 1968; May 1969; Aug. - Sept. 1969; July - Oct. 1970 - )

Aim of the project. To train sanitary engineers at the Institute of Technology, Bandung.

Assistance provided by WHO during the year. (a) A visiting professor of sanitary engineering; (b) four fellowships - three for twelve months and one for seven weeks - for study in the United States of America.

Probable duration of assistance. A number of years.

Work done during the year. A consultant (visiting professor of sanitary engineering) was assigned to the Institute of Technology,Bandung,in October 1970 to assist in reorganizing and strengthening the teaching and training programme in sanitary engineering. The Institute has allotted more £unds,particularly for the expansion of laboratory and library services, practical work and for other aspects of the programme. A student workshop was set up and a one-year research programme was developed. The consultant also assisted in the further development of sanitary engineering training facilities at the Institute of Technology, Surabaja.

Indonesia 0062 Medical Education R (May 1964 - )

Aim of the project. To assist in developing the teaching programnes of the medical faculties in keeping with national needs and the progress of educational sciences.

Assistance provided by WHO during the year. (a) Two professors - one of pharmacology and one of histology and embryology - and two consultants; (b) three twelve-month fellowships for study in Australia,two three-month fellowships for study in Singapore, a twelve-month fellowship for studies in the United Kingdom and the Netherlands (extension), and a seven-week travel fellowship for studies in Sweden, the United Kingdom, Poland and the Federal Republic of Germany; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. The WHO professor of histology/embryology, who continued to assist the Faculty of Medicine. Gadiah Mada University, Joniakarta.-" . . aid veriodic visits to ~iponegoro.University, -~ema;ang. The practice of employing student demonstrators for the practical classes conducted by the Department has been discontinued since the permanent staff has been increased to twelve academic members. The WHO professor delivered a lecture on modern teaching of anatomy at the foundation meeting of the Indonesian Association of Anatomists.

A WHO professor of pharmacology took up duties in January 1971 at the Faculty of Medicine, University of Northern Sumatra, Medan. Together with the Head of the Department (who is the Professor of Medicine) and the only lecturer at present in position, he reviewed the syllabus of the theoretical course in pharmacology in the undergraduate curriculum; the teaching has been divided between the two national staff and the WHO professor. No practical classes could be conducted owing to lack SEA/RC24/2 Page 130

of equipment. Tutorials have been introduced as a provisional step to make up this deficiency. Jointly with the Physiology Department bi-weekly seminars were held for the teaching staff of the two departments.

A WHO consultant in physiology who had worked from 1964 to 1967 as WHO professor re-visited Gadjah Mada University, Jogjakarta, during July-September 1970. He has noted with satisfaction that further progress in the development of the Department has been made and that the two senlomost members of the staff who had been on WHO fellowships are maintaining high standards in teaching and research programmes. The consultant also visited the Medical Faculties in Denpasar and Makassar, for which the Physiology Department in Jogjakarta has been designated as the staff training institution.

During October 1970 - March 1971, a WHO consultant in biostatistics undertook visits to seven medical schools to review the teaching of the subject at both undergraduate and post-graduate levels. In February, he organized and conducted in Djakarta a two-week workshop which was attended by fifteen teachers of biostatistics. Modern methods of teaching the subject were discussed and minimum standard syllabus for the medical undergraduate curriculum in health statistics and related subjects was designed. The consultant's report is under study.

Indonesia 0069 Training of X-ray and Electro-medical Technicians* R (March 1966 - )

Aim of the project. To train technicians and radiographers in the use, maintenance and repair of electro-medical equipment.

Assistance provided by WHO during the year. (a) A radiography Tutor and an electro- medical engineer; (b) a twelve-month fellowship for study in India and a six-month fellowship for study in the United Kingdom (extension); (c) supplies and equipment, including a transport vehicle and an oscilloscope.

Probable duration of assistance. A number of years.

Work done during the year. The second refresher training course in radiography for the staff employed in departments throughout the country ended on 25 October 1970 and the participants received certificates of their upgraded position at the closing ceremony. Theoretical planning was done for the third refresher course, tentatively scheduled for October 1971.

At the Academy of Radiography (APRO) 36 first-year students passed the end-of- year examinations and moved into the second year. Under the old system of training 16 second-year students passed their examination and went up to the third and final year.

Out of 111 applicants 50 were selected for admission to the first year of the Academy of Radiography. These students are now proceeding with their first ten weeks of probationary instruction.

Additional construction to the main buildings was made, and this resulted in a reading room to complement the library facilities.

At the Academy for Electro-Medical Technicians (ATRO) eleven students for the three-year course in X-ray and electro-medical engineering started their first semester at the end of February. The syllabi for different subjects are being drawn up within the framework of a general curricula which has been agreed upon.

*Previous title: Training of Radiographers and Electro-medical Technicians SEAlRC2412 Page 131

Four students of ATRO passed their final examinations and graduated with B.Sc. degree in X-ray engineering. It is intended to employ these graduates as in ATRO.

Some X-ray equipment, two complete diagnostic units and one therapy unit have been acquired for the use of ATRO and APRO for training purposes.

Indonesia 0071 National Community Water Supply and Sanitation R (March 1969; June - July 1969; Aug. 1969 - ) UNICEF

Aim of the project. To plan (a) community water supply, sewerage and storm-water drainage systems, (b) water pollution control and general sanitation work, and (c) the training of staff.

Assistance ~rovidedby WHO during the year. (a) A sanitary engineer and two consultants; (b) four fellowships - one for two months and three for one month - for study in Thailand.

Probable duration of assistance. A number of years.

Work done during the year. A consultant was assigned for three months in April to assist in the training of personnel for the implementation of the rural water supply programme.

UNICEF supplies, consisting of equipment for wells, including handpumps, sets of well construction tools and spares for handpumps, were received and distributed to the provinces. A comprehensive programe of work supported by a detailed list of materials was prepared and submitted to UNICEF.

Over 300 wells with handpumps were installed in different provinces. Two of the four piped water supply schemes, which had been started during the first year of the project with UNICEF-supplied materials, were completed and commissioned. Design work on six similar schemes planned for the second year was in various stages of completion. Preparations were made for the implementation of nine piped water supply schemes in seven provinces which would be financed under the 1971-72 national budget. A small demonstration project on latrine construction, which also included the setting up of a sanitation workshop for the fabrication of latrine components, was planned in consultation with the National Health Training Centre, Tjilandak, Djakarta. A provisional organizational chart for the project staff in the Directorate and a sample form for recording the basic technical information on each completed project were prepared.

With regard to training, a four-week in-service training course was organized at the National Health Training Centre, Tjilandak, for 15 instructors and other sanitation staff from the provinces. Steps were taken to plan a sirnilax course at the Institute of Technology,Bandung. In-service training courses were also given in different provinces for 217 provincial sanitarians and assistant sanitarians.

Indonesia 0074 Nursing and Midwifery Education* R (June 1967; Aug. 1967; Jan. - Dec. 1969; April 1970 - ) Aim of the project. To strengthen and further develop nursing and midwifery education.

*Previous title: Nursing Education and Services SEA/RC24/2 Page 132

Assistance provided by WHO during the year. (a) A nurse educator and a nurse consultant; (b) a five-month fellowship for study in New Zealand, a six-month fellowship for study in Malaysia, and a twelve-month fellowship (provided under project Indonesia 0041) for study in New Zealand; (c) supplies and equipment.

Probable duration of assistance. Until 1976

Work done during the year. The relationship of this project with Indonesia 0086, "Strengthening of National Health Services", was better defined, and, as a result, the posts of senior nurse administrator and public health nurse were transferred to project Indonesia 0086. It is hoped that these transfers will allow for the strengthening of both inter-disciplinary team work and WHO assistance to nursing/ midwifery services throughout the country. The plan for this project will be related directly to those elements in the Master Plan which concern the education and training of nursing/midwifery personnel.

Assistance provided by the WHO consultant (nurse educator) working with staff in Bureau V of the Ministry of Health,in genera1,placed emphasis on the development of sound ci~rriculafar the education of nurses and midwives and, in particular, on the conduct of in-service education courses given to nurses and midwives as a part of the Government's programme for upgrading all categories of health personnel. She directly assisted the four-week course on "Management of Hospital Services", which was held in February-March and was attended by thirty-seven nurses. Following this course, a one-week workshop was held for the same group of participants in which a Nursing Service Policy Manual was prepared. Visits were paid and assistance provided to selected nursing schools throughout the country. The consultant's assignment report has been sent to the Government.

The full-time senior nurse educator took up position in the project in early April.

Indonesia 0075 Hospital Statistics R (Nov. 1968; May 1969; July 1969; May 1970; Aug. 1970; - )

Aim of the project. To train medical record officers and hospital statisticians.

Assistance provided by WHO during the vear. An eight-month fellowship (extension) for studies in the United States of America, Ceylon and Thailand.

-indonrsia 0076 Malaria Control, Province of West Irian FUNDWI (Jan. 1970 - )

Aim of the project. To control malaria in West Irian.

Assistance provided by WHO durin~the year. Supplies and equipment, including eleven transport vehicles.

Probable duration of assistance. Some years.

Work done during the year. As recommended by the WHO team which carried out an assessment of the existing anti-malaria programme in West Irian during February - April 1970, supplies and equipment, including insecticides, drugs and vehicles, have been procured, and most of these are already on way to West Irian. Future WHO technical advisory assistance to this project will be co-ordinated with project Indonesia 0032. SEA/RC24/2 Page 133

Indonesia 0078 Health Education INDP (TA) (Aug. - Sept. 1968; July - Sept. 1969; July - Sept. 1970; - )

Aim of the project. To strengthen health education services.

Assistance provided by WHO during the year. A ten-month fellowship for study in India.

Probable duration of assistance. Until the end of 1977.

Indonesia 0079 Dental Health UNDP (TA) (Jan. - April 1968; July 1969; Aug. 1970 - Feb. 1971; - )

Aim of the project. To develop further teaching and training programmes for dental personnel at professional and auxiliary levels, to extend dental health services within the framework of comprehensive health services, and to explore the feasibility of establishing water fluoridation schemes.

Assistance provided by WllO during thc year. (a) A consultant; (b) a four-month fellowship for studies in New Zealand, Singapore and Malaysia; (c) supplies and equipment.

Work done during the year. After the WHO consultant took up his six-month assignment in August 1970, the Dental Faculty, University of Padjadjaran, Bandung, established an integrated clinic for children's dentistry, in which the Departments of Dental Public Health and Orthodontics took part and which was used for the teaching of pedodontics and preventive dentistry. The consultant visited all dental colleges in the country as well as a number of schools for dental auxiliaries and other establishments connected with dental services, and has made recommendations concerning dental education at various levels, dental health services, preventive measures and research on problems of dental public health. His report is under study.

Indonesia 0081 Smallpox Eradication R (Dec. 1967 - )

Aim of the projecl. To eradicate smallpox.

Assistance provided by WHO during the year. (a) Two medical officers,an operations officer. four consultants. and assistance from one of the e~idemiolonistsassinned under *;eject SEAR0 0030; ' (b) a six-month fellowship for st;dy in haila and; (cj supplies and equipment.

Probable duration of assistance. A number of years.

Work done durinn the year. East Java, Jogjakarta and Bali have remained smallpox- free. No cases have been reported from Central Java since April 1970. All efforts are being made to interrupt smallpox transmission in West Java, where only 66 cases have been reported since 1 January 1971. In the Island of Sumatra, the situation has (greatly) improved, only 350 cases having been notified from 1 January to 30 June 1971,as compared with 2 046 cases for the same period in 1970.

The programe is now concentrating on the province of South Sulawesi, where three consultants were sent to assist in problem areas. A fourth consultant has been sent to strengthen the programe in Sumatra. SEAIRC2412 Page 134

One of the epidemiologists of the inter-country team SEARO 0030 assessed the programme in !.lest Java, the southern regencies of the Province of South Sulawesi and the regency of Sumatra Utara.

The Chief Medical Officer of the Smallpox Eradication Unit at WHO Headquarters visited West Java and Sulawesi and reviewed the programe with the national and provincial health officials.

In March, a consultant assigned under the inter-country project SEARO 0030 visited the smallpox diagnostic laboratories in the country as a follow-up of the training ca~irsein the laboratory diagnosis of smallpox, held in Bandung in 1970.

Technical and financial assistance was given to a national seminar on smallpox eradication which was held in Makassar in September 1970.

Indonesia 0083 Vaccine and Sera Production UNDP (TA) (Dec. 1968; Jan. 1969; March 1970; Oct. - Dec. 1970; - ) UNICEF

Aim of the proicct. To improve methods of producing bacterial and viral vaccines, anti-toxins and toxoids; also to devrlap capability of testing vaccines and sera.

Assistance provided by WHO during the year. (a) Two consultants; (b) supplies and equipment, including a cooling cell.

Probable duration of assistance. Some years.

Work done during the year. For six weeks in October-November 1970, a consultant assisted Bio Farma, Bandung, in commissioning the "Bilthoven" unit for the production of DPT vaccine by the fermentation method. Following the consultant's recommendations, technical information and data were collected from UNICEF which will enablc the engineer consultant, under recruitment, to undertake the assembly, installation and operation of the stock "refrigerated supercentrifuge" procured by UNICEF. The twin combine (fermentor plus centrifuge) will make possible the stepping up of the DPT vaccine yielding capacity at Bio Fama to several times the present annual production. The report of the consultant has been sent to the Government.

During a three-week assignmcnt in November, another consultant reviewed the experimental production of freeze-dried BCC vaccine at Bio Farma. The first trial batches, when tested, were found to meet the WHO requirements for potency and stability. The report of the consultant has been forwarded to the Government.

in order to help the laboratory establish consistency in the production of a potent vaccine, arrangements have been made for the periodic testing of further batches of vaccine at the WHO International Reference Centre, Copenhagen. The Government has plans for the expansion of the laboratory, with a view to becoming self-sufficient in the production of freeze-dried BCG vaccine.

Indonesia 0084 Nursing Education and Trainink mTNDWI Province of West Irian (Jan. - March 1970; April 1971 - )

Aim of the project. To strengthen and develop nursinglmidwifery services and education in West Irian. SEA/RC24/2 Page 135

Assistance provided by WHO during the year. (a) A nurse educator/administrator; (b) supplies and equipment, including a transport vehicle.

Work done during the year. The WHO nurse educator reached West Irian in early May. Work began immediately on long-range planning for the direct assistance to be provided to teaching centres and service institutions.

Indonesia 0086 Strensthenins of National Health Services R (Feb. - March 1969; May 1969 - ) UNICEF

Aim o; ~lli.project. To plan, co-ordinate and integrate health services and programmes; to ~Lnndardizeand intensify the training programmes for health staff, and to promote studies of public health practice and organization intended to lcad to the optimal delivery of health care.

Assistance provided by WHO during the year. (a) A public health administrator, a nurse administrator, a statistician, a health educat0r.a nurse educator and thrce consult,ints (tido assigned under SEARO 0178): (b) two ten-month fellowshios for study in the Netherlands, a four-and-a-half-month fellowship for study in the United Statcs uf America, and a two-week fellowship for a study tour of Venezuela, Colombia and Cl~ile; (c) supplies and equipment,including three transport vehicles.

Probable duration of assistance. Some years.

Work done during the year. The scope of this project was extensively broadened during the year in order to enable it to play the role of the central co-ordinating project in Indonesia. The senior public health administrator arrived in August 1970, and tllc pro.jiact was further reinforced with the assignment of more staff during Lhe yr;ir. A nulrbcr of conferences, seminars and courses were organized, the most importilnL being the National Healtll Conference,which was hcld in Dj,~karta from 24 to 27 August. Assistance was given in conducting a "llealth Management" workshop from 8 to 19 March 1971, and plans were made for organizing a health planning course for senior provincial health administrators in August 1971. In addition, support was given in the conduct of several local courses on nursing, family planning, environmental health, the teaching of health statistics, and communicable-disease cantral.

Ihc devclopmcnt of the Bekasi area for practical field training is making steady progress. In addition to regular visits of the team members in the area, studies ai the activities of nurses and midwives and also in-service orientation training courses were organized.

A IqHO consultant visited Indonesia twice during the year to study and advise on various aspects of health planning and administration. During July-September 1970, be assisted with the development of a comprehensive health system and the further dcvi,lopment of the Public Health Institute at Surabaya. In March 1971, he Iirlpcd iri conducting Llic health management workshop mentioned above.

In lN.~rch-April 1971 a consultant studied the existing system for the collection of lnfarmation on health services resources (see SEARO 0178).

Indonesia 0087 Rehabilitation of Hospitals and Polyclinics, FUNDWI Province of West Irian (Dec. 1970; - )

Aim of tile pl-ojecl. To survey existing facilities in hospitals and palyclinics; to trait, n.iLiun;~l staff in hospital administration and in selected fields of comunity health services; to provide supplies and equipment for the upgrading of hospitals and polyclinics.

Assistance provided by WHO during the year. A four-and-a-half-month fellowship for studies in Thailand, Taiwan and Malaysia.

Indonesia 0088 Goitre Control, Province of West Irian FLNDWI (Jan. - March 1971; - )

Aim of the project. To prevent goitre.

Assistance provided by WHO during the year. A consultant.

.:ark done during the year. A consultant visited West Irian in January-March 1971 to assess the feasibility of different kinds of prevention of iodine deficiency in the highlands areas of the province. He has submitted an assignment report, which is under study.

Indonesia 0089 Public Health Laboratory. Province of West Irian FUNDIJI (April - May 1971; - )

Aim of the project. To organize the Public Health Laboratory aL Djajapura and to train laboratory personnel.

Assistance provided by WHO during the year. A consultant.

Work done during the year. In April-May the need for the provision of laboratory services to existing health institutions was assessed by a WHO consultant. He reviewed the blueprint of the Central Public Health Laboratory in Djajapura and advised on the lay-out of its different units, their functioning, staffing and equipment. A plan of action was drawn up with a view to establishing basic laboratory services in order to cater to the medical and health needs of the city of Djajapura and to provide referral services to hospitals and health centres. He also trained the technical staff on the bacteriological testing of water and demonstrated the bacteriological procedures involved in the primary isolation and identification of entero-pathogens. The consultant's report is under review.

Lndones La 0090 Hazards to Man from Pesticides R (Feb. - March 1969; Feb. 1970; April 1970; July - Aug. 1970; - )

Aim of the projcct. To formulate legislation regarding hazards to man from pesticides in use in agriculture; to train laboratory workers in determining cholinesterase levels; to undertake further studies to determine the size of the problem.

Assistance provided by WHO during the year. A consultant.

Work done during the year. The WHO consultant who had been assigned to Indonesia for one month in mid-July 1970 carried out an assessment of the problems surrounding the importation, storage and handling of pesticides, with particular reference to their use in agriculture and public health projects. He has recornended measures to prevent or minimize hazards to man arising from the use of pesticides. The consultant's report was forwarded to the Government. SEA/RC24/2 Page 137

Indonesia 0091 Strengthening of Epidemiological Senrices R (June 1969 - )

Aim of the project. To develop epidemiological units at both central and intermediate levels and to train staff.

Assistance provided by WHO during the year. (a) A medical officer and a consultant; (b) a two-month fellowship for studies in the United Kingdom, Noway and the Netherlands; (c) supplies and equipment.

Probable duration of assistance. Some years.

Work done during the year. A WHO consultant assisted with preparations for, and the conduct of, the Second National Seminar on Epidemiological Surveillance,which took place in Tjiloto from 5 to 24 October. He also undertook an evaluation of the first seminar held in 1969. The report containing his recommendations has been sent to the Government.

A long-term WHO medical officer joined the project in January to continue assistance to the Government in strengthening epidemiological services and epidemiological surveillance activities.

Indonesia 0099 Plague Epidemiolom R (Nov. 1969 - Feb. 1970; March 1971; - )

Aim of the project. To study factors responsible for the persistence of plague.

Assistance provided by WHO during the year. (a) A three-month fellowship for study in Malaysia; (b) supplies and equipment, including a transport vehicle.

Probable duration of assistance. Until 1975.

Indonesia 0105 Occupational Health and Industrial Hygiene Services R (April - May 1970; Sept. 1970 - Jan. 1971; - )

Aim of the project. To develop industrial health and occupational health services.

Assistance provided by WHO during the year. A consultant.

Work done during the year. In September 1970, a WHO consultant in industrial hygiene and occupational health was assigned to Indonesia for four months to assist the Government in further strengthening the country's occupational health services and in preparing a request to the UNDP for the development of a Special Fund Project in this field. He has recommended, among other things, that (1) the ILO conventions and codes should be followed in connection with occupational health and safety until the relevant legislation is strengthened; (2) an industrial hygiene laboratory equipped with simple basic equipment should be established, and (3) health officers, sanitarians and nurses, particularly those stationed in economically productive areas, should be given training in occupational health A sununary of the consulcant's recornendations has been sent to the Government,and the report is under review. SEA/RC24/2 Page 138

Indonesia 0107 Establishment of Cytology Services and Training UNFPA (Sept. - Nov. 1970; - )

Aim of the project. Ta establish laboratory services for cytology as part of the national family planning programme and initially at each of the principal medical schools.

Assistance provided by WHO during the year. (a) A consultant; (b) a twelve-month fellowship for study in Australia.

Probable duration of assistance. Until 1974.

Work done during the year. A WHO consultant in pathology(cyt0logist) was assigned to the project from September to November 1970. He visited eight of the eleven government medical faculties and, in each place, also major service hospitals and public health laboratories, and met family planning authorities. Based on his findings, he has recommended a phased development of the project and proposed, as a first step, advanced training for teams (consisting of a pathologist and a laboratory technologist) from the same medical school and the procurement of equipment and supplies. He also suggested,for later consideration,the establishment of national training centres in cervico-vaginal cytology. The report of the consultant has been sent to the Government. lndonesia 0109 National Plans for Strengthening Family Plannin~ LNFPA in Health Services (Oct. 1970; - )

Aim of the prolect. To keep under review the national plan for strengthening of family planning in health services and discuss future development.

Assistance provided by WHO during the year. A consultant (provided by WHO Headquarters) and nine temporary advisers, and assistance from the Regional Adviser on Maternal and Child Health, the Regional Fellowships Officer and field staff assigned to projects.

Probable duration of assistance. Until the end of 1971.

Work done during the year. A workshop to review the national plan for strengthening family planning in the health services in the light of the United Nations Family I'lanning Mission to Indonesia. was held from 7 to 9 October 1970. The 46 participants were senior health officials and representatives of other ministries and boards concerned with the national family planning programe and representatives of UNICEF, UNDP, US AID and the Ford Foundation. A WHO Headquarters consultant and nine temporary advisers assisted in conducting the workshop. A comprehensive proposal for family planning activities in 1971-72, with projections for the remaining part of the country's Third Five-Year Plan period, was prepared and forwarded to the Government for consideration. It is ~lannedto provide a consultant late in 1971 to review the impact of the workshop's proposals on subsequent development of the family planning programme in Indonesia.

Indonesia 0110 Workshop on Ca-ordination of National and International LN FPA Kusuurccs in tlre Natlonal Family Planning Pro~ramme (Aug. 1970; - )

Aim of the project. To discuss patterns of co-ordinating international and bilateral assistance in the national family planning programme. SEA/RC24/2 Page 139

Assistance provided by WHO during the year. (a) A consultant (provided by WHO Headquarters) and seven temporary advisers; (b) supporting services.

Nark done during the ycar. This workshop was held from 6 to 8 August 1970 with the aim of informing potential donor countries of the national family planning programme and of activating and involving them in its development. The participants were 46 national officials concerned with health and family planning and 22 representatives of 14 internatirnal organizations and donor countries. A WHO consultant and seven temporary advisers assisted with the conduct of the workshop.

The aim of the workshop was achieved and its report was given wide distribution. It is planned to assign a consultant late in 1971 to review the stage of implementation of the recommendations of the workshop.

Indonesia 0111 National Workshop on Training of Midwifery Personnel WFPA (Feb. 1971; - )

Aim of the project. To provide opportunities for nurse and midwife tutors to discuss the training of midwifery personnel in family health.

Assistance provided by WHO during the year. (a) A nurse consultant; (b) cost of attendance of participants.

Probable duration of assistance. Until the end of 1973.

!dark done during the year. A workshop on the Integration of Family Planning into Nurse and Midwife Training was held in Djakarta from 15 to 28 February. Eighteen participants attended the workshop and fifteen national nurses and doctors were involved in the planning and implementation of the programme. The objective of developing course outlines for family planning content to show how these could be integrated into prcsent nursing curricula, was largely met.

The WHO nurse from project SEARO 0192, "Regional Team on Family Health", served as a consultant assisting this workshop. WHO nurses from project Indonesia 0086, "Strengthening of National Health Services", were also involved in the programme.

A similar workshop is planned for 1973. lndoncsia 0112 Course on the Health Aspects of Human Reproduction WFPA (Jan. 1971 - )

Aim of the project. To strengthen family health services as an integral part of the general services; to prepare staff for teaching and organizational responsibilities.

~\ssistanceprovided by WHO during the year. (a) Two temporary advisers and assistance from the staff provided under the Regional Team on Family Health (SEARO 0192); (b) cost of attendance of participants.

Work done during the year. Two courses on the health aspects of human reproductiorl were held - the first from 18 January to 20 March 1971 and the second from 10 May to 8 July. The forty participants were medical officers engaged in the management of family planning services as well as trainers in family planning. The Regional Team on Family Health (SEARO 0192) and two temporary advisers planned, prepared, conducted and assisted in the evaluation of the course. SEAlRC2412 Page 140

The first course provided for two weeks' theoretical orientation in Djakarta. followed by one month of practical training and observation of the various aspects of the family planning programmes in Thailand (Bangkok) and India (Gandhigram, Bombay and Delhi). The remaining part of the course was conducted in Djakarta. During this period the participants attended a workshop on "Health Management" organized by the Ministry of Health and made an analysis of field obsesvafions. weighing the Indonesian family planning programme against the programmes in Thailand and India and assessing the course in general. As a result of the experience gained in the conduct of the first course certain minor modifications were effected in the second course.

Indonesia 0113 Family Health Services UNPPA (Aug. - Oct. 1970; May 1971; - )

Aim of the project. To plan, organize and manage maternal and child health and family planning activities as a regular function of the health services.

Assistance provided by WHO during the vear. Two consultants.

Work done during the year. A WHO consultant was assigned to the project in August-October 1970 to assist in the preparation of a plan of action for an integrated maternal and child healthlfamily planning service project as part of the existing master plan of operation for the strengthening of national health services (project Indonesia 0086). In his assignment report, which has been sent to the Government, the consultant has emphasized the need to (i) expand and strengthen the family planning programme for health workers, especially the bedans (midwives), assistant midwives and health aides; (ii) include simple knowledge of family planning in the training programmes for dukune (traditional birth attendants); (iii) ensure continued and close supervision of family planning acceptors; (iv) establish a chain of referrals from the centre to the provinces and regencies by identifying individuals who are responsible and accountable for the execution of the family planning programme, and (v) improve clinical supervision by the use of simple evaluation measures.

A WHO medical officer is under recruitment (under Indonesia 0086).

In May 1971 a WHO consultant was assigned for one month to make a general review of the WHO/IMFPA-assisted projects under the Ministry of Health and to advise on desirable measures of improvement and programme adjustment for 1972- 1973. His report was under study.

A second consultant to advise on priority areas of operational studies is under recruitment.

Indonesia 0114 Strengthening of the Teaching of Human Reproduction, UNFPA Family Planning and population Dynamics in Medical Schools (Jan. 1971 - )

Aim of the project. To strengthen the services provided and the teaching carried out by the department of paediatrics and obstetrics and other departments concerned in the teaching of human reproduction, family planning and population dynamics in a number of medical schools, and to initiate research on these subjects.

Assistance provided by WHO during the year. (a) Two medical educators and four consultants; (b) two nine-month fellowships for studies in the United Kingdom, Uganda and India. SEA/RC24/2 Page 141

Work done during the year. A team of four consultants in curriculum development (obstetrics and gynaecology, child health and human reproduction) was assigned in February-March 1971 to study and advise on strengthening the teaching of human reproduction, family planning and population dynamics in medical schools. The team visited nine of the eleven governmental medical faculties. The report of the consultants was under review in the Regional Office.

The team also participated in a workshop on the teaching of human reproduction, family planning and population dynamics, organized by the Consortium of Medical Sciences from 12 to 16 March. The workshop was attended by four faculty members each from the Universities of Indonesia, Airlangga, Gadjah Mada and Padjadjaran. The report of the workshop and a sumary of its recommendations were submitted to the faculties and departments who had sent participants and also to the Consortium of Medical Sciences.

A medical educator in obstetrics and gynaecology and one in paediatrics were assigned in March and June respectively to assist with the advise on strengthening the obstetric, gynaecological and paediatric aspects of the teaching of human reproduction in selected medical faculties.

Indonesia 0115 Library Banks in Medical Schools UNFPA (June 1971 - )

Aim of the project. To establish lending and reference libraries for medical students on subjects related to family health.

Assistance provided by WHO during the year. Two consultants.

Work done durinr the vear. At the request of the Ministry of Health the scope of the project was expanded to include a survey of the need for literature related to human reproduction, family planning and population dynamics for provincial departments of health, district health offices, hospitals and training centres of the Ministry.

Two consultants were assigned in June 1971 to survey the collections of literature related to human reproduction, family planning and population dynamics. One is assisting the Ministry of Education in a survey of the collections in medical faculties, and the other will visit the health departments and training centres of the Ministry of Health.

Indonesia 0200 Fellowships R

Occupational health. A nine-month fellowship £or study in Yugoslavia.

Public health administration. A ten-month fellowship for study in the Netherlands. SEA/RC24/2 Page 143

5. MALDIVES

PROJECT LIST

Project No. Source of Funds Co-operating Agencies Title

Maldives 0005 Public Health Administration R (Oct. 1959 - )

Aim of the project. To develop comprehensive basic health services, train personne1,and to strengthen the medical care services provided by the hospital at Male.

Assistance provided by WHO during the year. (a) A public health officer, a sanitarian and a laboratory technician and temporary assistance from the medical officer assigned under SEAR0 0113; (b) a twelve-month fellowship for study in India; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. As of 2 July 1970, the Ministry of Health took over from the Ministry of External Affairs full responsibility for the WHO project. Two new health centres were opened during the year under review, bringing the total number of such centres to 13. Ten nurse aides completed training in July 1970. Plans are being made far the establishment of a training school for auxiliary personnel.

Epidemiological studies and control programmes were organized for a number of communicable diseases, including malaria, tuberculosis, leprosy and filariasis. Direct BCG immunization was given to children under 15 years of age in nineteen atolls covering 46 000 children or 90% of the children in this age group. The medical officer of the inter-country tuberculosis team (SEAFK 0113) visited the islands in September-October 1970 to carry out an assessment of the tuberculosis situation. His report 113s been sent to the Government.

Anti-malaria activities in six out of the 19 atolls, protecting a population of 30 000 out of 110 000, continued during the year. In two atolls mass radical treatment of the entire population was done in combination with DDT residual spraying. Monthly active case-detection was continued in Male Atoll. The intensified activities and the feasibility of eradicating malaria prompted the Government to make further requests to WHO, resulting in the development of a four-year plan of operation for malaria control with effect from 1971.

Maldives 0007 Water Supply and Sanitation R (April 1971 - )

Aim of the project. To develop water supply and sewage disposal systems for Male and an environmental sanitation programme; to train staff.

Assistance provided by WHO during the year. Supplies and equipment. SEA/RC24/2 Page 144

Work done during the year. Pending the recruitment of a consultant for this project, arrangements were made to provide the assistance required through a WHO sanitary engineer working in Ceylon. He visited the Maldives for three days in November 1970 to make preliminary surveys and collect necessary data, and again in January to carry out further surveys and investigations in connection with the preparation of necessary technical documents for the project. He is preparing a draft report to the Government recommending works necessary for the immediate implementation of stage I of the project. Two surveyors, with the necessary supplies and equipment, are being provided in order to complete the surveying and mapping of Male for future design works.

Maldives 0008 Nursing Services and Education UNDP (TA) (Jan. 1970 - June 1971)

Aim of the project. To strengthen nursinglmidwifery services and education with special emphasis on: (1) training programmes for nurse-aides, auxiliary nurse- midwives, and "foolumas" (indigenous midwives); (2) nursing and midwifery services in the hospital in Male; (3) community nursing/midwifery services, initially on the island of Male; (4) long-range planning for preparing nurse-midwives to undergo educational programmes abroad, and (5) sound patterns and plans for the effective administration of nursing services and education.

Assistance provided by WHO during the year. (a) A nurse administrator-educator; (b) a twelve-month fellowship (extension) for study in India; (c) supplies and equipment.

Work done. This project was established in January 1970 to continue the assistance to nursinglmidwifery services and education started under project Maldives 0005, "Public Health Administration".

Following the pattern established under the previous project, the WHO public health nurse administrator organized and conducted two nurse-aide training courses, each of which began in 1968 and lasted for one year. Nineteen nurse-aides were prepared and absorbed into government health services. The programme was discontinued in 1970 because of the limited capacity for employment of trained nursing personnel at this level.

Three-month training programmes were conducted for groups of indigenous midwives (foolumas) from Male and the outlying atolls. Assistance was given to the management and delivery of nursinglmidwifery services in Male Hospital and associated public health programmes. Plans were made for introducing an auxiliary nurse-midwife training programme as a part of a joint auxiliary medical and auxiliary nursinglmidwifery school. Implementation was, however, hampered by the failure of a doctor-nurse consultant team (project Maldives 0005) to reach Male on account of lack of suitable transport services between Ceylon and the Maldives.

The lack of a full-time national counterpart responsible for training was a continuous handicap. The future of training programmes for auxiliary health workers is dependent on the availability of qualified Maldivian nurse-midwifery tutors. Every effort should thus be made to ensure that these staff will be available.

Fellowships associated with this project but provided under project Maldives 0200 were used to prepare nurse-midwives, and the ~ersonnelwere sent to India for training. SEA/RC24/2 Page 145

Evaluation. The project has served, in a transition period, to implement training programmes essential to the development of health services in the Maldives. It has guided the initial establishment of nursingfmidwifery services in Male Hospital and has assisted with the long-range planning of the auxiliary health workers school. The WHO public health nurse administrator completed her assignment at the end of June 1971; the activities will continue under pcoject Maldives 0009,"Training of Auxiliary Health Personnel".

Maldives 0200 Fellowships R

Filariasis control. A six-month fellowship for study in Ceylon.

Nursing and midwifery. A six-month fellowship for study in India.

Maldives 0201 UNDP (TA)

Basic nursing and midwifery. A twelve-month fellowship for study in India (extension).

Undergraduate medical studies. A twelve-month fellowship for study in India. SEA/RC24/2 Page 147

6. MONGOLIA

PROJECT LIST

Project No. Source of Funds Co-operating bencies Title

Mongolia 0001 Strengthening of Health Services (Epidemiolozy) R (July 1963 - )

Aim of the project. To undertake epidemiological surveys of prevailing comunicable diseases in order to plan practical control measures; to advise on the use of epidemiological methods, and to train personnel.

Assista~iceprovided by WHO during the year. (a) An epidemiologist, a laboratory technician and a consultant:, (b).. two six-month fellowshi~sfor studies in the USSR and Bulgaria and a four-month fellowship for studies in the USSR, Bulgaria and llungary; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1972.

Work done during the year. The epidemiological surveillance programe developed satisfactorily and the serological surveys continued. The WHO epidemiologist (replacement), who joined the project at the end of 1970, is assisting with the preparation of a plan of action covering various aspects of the epidemiology and control of communicable diseases. He also assisted with training programmes. The WHO laboratory technician paid visits to various aimaks and somons in order to perform immunological and bacteriological examinations and to give training to the national personnel.

The hWO consultant assigned to the project in April assisted the Government in conducting a seminar on the surveillance of communicable diseases. The seminar, which was held from 21 to 26 June, was attended by 20 participants,wha were senior epideniiologists and public health officials. The programme of the course included theoretical as well as practical problems of the methodology of epidemiological surveillance.

Mongolia 0002 Public Health Laboratory Services LNDP(TA) (May - Aug. 1964; Dec. 1964; Aug. 1965; Oct. 1966 - UNICEF Sept. 1968; Jan. 1969; May 1969; Sept. - Oct. 1969; Feb. 1970 - )

Aim of the project. To strengthen health laboratory services and to train personnel in medical laboratory technology.

Assistance provided by WHO durinz the year. (a) A microbiologist and a laboratory technician; (b) two twelve-month fellowships - one for study in the USSR and one for studies in the USSR and Bulgaria; (c) supplies and equipment, including a transport vehicle.

Probable duration of assistance. A number of years. SEA/RC24/2 Page 148

Work done durina the year. A WHO technician joined the project in August 1970. With the completion of major repairs to the building, the Central Bacteriology Laboratory (CBL) resumed work in its old premises. The work in four departments of the laboratory was reorganized. The functions of the CBL were divided between the first clinical hospital laboratory, which will handle chemical chemistry, and the Central Bacteriology Laboratory, which will cater to the bacteriological needs of the various medical and health institutions in Ulan Bator. A Laboratory Council has been established, which will be responsible for planning, programing and co-ordinating the activities of the laboratory services. The CBL has established capacity to produce and distribute culture media to collaborating laboratories in Ulan Bator.

Emphasis continued to be placed on training. Various courses - basic, in- service and inter-laboratory courses - have been designed with a view to promoting technical skill in public health microbiology among the technical and medical staff of the CBL, the aiuk laboratories and the hospital laboratories as well as the Institite of Epidemiology and Microbiology. The syllabus for practical instruction has been revised and the project staff have assisted with the training of medical technicum personnel. A laboratory manual for media preparation is being prepared in the Mongolian language, for use by aimak laboratories. Supplies from UNICEF continued to be received.

Mongolia 0003 Tuberculosis Control UNDP (TA) (Dec. 1963 - Jan. 1964; Aug. 1965 - )

Aim of the urolect. To study the epidemiology of tuberculosis and to organize a national control programme.

Assistance urovided by WHO durinn the year. (a) A medical officer; (b) two fellowships - one for six months and one for four months - for studies in the USSR and Czechoslovakia. and a nine-month fellowshio for studies in Czechoslovakia and India; (c) supplies and equipment, including a transport vehicle.

Probable duration of assistance. Until 1972.

Work done during the year. The project activities developed satisfactorily. The WHO medical officer left in October. His reuort is beina- sent to the Government. In the meantime,steps were taken to recruit two short-term consultants to assist in the improvement of microbiology of mycobacteria and X-ray diagnostics.

Mongolia 0004 Maternal and Child Health Services . UNDP(TA) (June - Sept. 1965; Nov. 1966; July 1967 - ) UNICEF

Aim of the project. To develop maternal and child health services and to establish referral services.

Assistance provided by WHO during the year. (a) A maternal and child health officer; (b) four fellowships - three for six months and one for eight months - for studies in the USSR and Bulgaria; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1974.

Work done during the year. The Government continued to give high priority to the implementation of the imdiate and long-range objectives of the project. During the year additional aimaks became involved in the integration of maternal and child SEA/RC24/2 Page 149

health services into the general health services and in the establishment of effective referral systems for health care of mothers and children. Other major achievements were the full involvement of the Maternal and Child Health Depart- ment in the planning of these services as an integral part of the country's five-year plan. A special care unit for newborns in the First Maternity Home,a residential nutrition centre and a second children's hospital were established in Ulan Bator. The production of rehydration fluids was increased to meet the rapidly expanding rehydration therapy services. Milk farms catering exclusively to vulnerable groups were estaulished in all but two aimak headquarters. The responsibility for full coverage of children by the on-going vaccination programmes was transferred to the maternal and child health centres. The recording and reporting system was improved and more regular feed-back to the services established. A wide range of group educational activities for health personnel and staff of kindergartens and creches were undertaken.

Mongolia 0006 Medical Education R (April - May 1970; Sept. 1970; Dec. 1970 - Jan. 1971; - )

Aim of the project. To develop further and improve medical education.

Assistance provided by I.MO durin~the year. Two six-month fellowships for studies in the USSR and Bulgaria, a three-month fellowship for studies in the USSR and Hungary, and a four-month fellowship for studies in the USSR and Poland.

Probable duration of assistance. A number of years.

Mongolia 0007 Health Statistics R (Aug. - Sept. 1967; Sept. 1968; Jan. - Sept. 1969; Jan. 1970; April 1971 - )

Aim of the project. To develop health statistical services and to train personnel.

Assistance provided by WHO during the year. (a) A consultant; (b) three fellowships - two for six months and one for nine months - for studies in the USSR and Czechoslovakia, and a six-month fellowship for studies in Czechoslovakia,Bulgaria and the USSR; (c) supplies and equipment.

Probable duration of assistance. Until 1975.

Work dune during Ll~eyfdr. 11 WHO consultant was assigned to the project in April for a period 01 four months to review the health statistics services and suggest specific steps for strengthening these services. He is also assisting in the implementation of proposals for strengthening health and hospital statistics services and, in particular, for developing skills in automatic data processing.

Mongolia 0008 Nursing Services and Education R (Dec. 1966; June 1968 - )

Aim of the project. To develop schools of nursing; to strengthen existing training programmes for nursing personnel, and to improve nursing services.

Assistance provided by WHO durin~:the year. (a) Two nurse educators; Cb) four twelve-month fellowships for study in Poland and a three-month fellowship for studies in the USSR and Czechoslovakia; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1977. SEAIRC2412 Page 150

Work done during the year. Efforts were directed mainly to the development of the two-year training course for nurses. The second group of fifty students were enrolled in the school. Particular attention was paid to the identification and development of learning experiences in the clinical practice of nursing in hospital. Emphasis was placed on the fields of paediatric, general medical and general surgical nursing. Teaching facilities in the school were improved by the addition of teaching aids and reference materials. The second WHO nurse educator, who joined the project in October, was involved full-time in this programme.

Efforts continued to upgrade the learning experiences in both the classroom and practice fields of the local nursing schools throughout Mongolia. A revised programme of studies was prepared.

Numerous supplemental-type courses were conducted for groups of nursing personnel already in service. These included (1) a three-week course in medical- surgical nursing for twenty nurses, (2) a three-week course for fourteen nurses in paediatric nursing, and (3) four one-month courses in general nursing care for a total of fifty-eight students. These courses were held in Ulan Bator and in the aimaks outside the Capital. Plans were made for the conduct of six similar one-month courses - two to be held in Ulan Bator and two each in Bulgan and Chentej aimaks.

Planning for the administrative patterns to be followed in order to ensure sound management of the nursing component of health services was started. A part of this planning was the preparation of policies and procedures for the control of nursing practice, to be called "Nursing Rules and Regulations".

Mongolia 0010 Cardiovascular Diseases R (May - June 1967; July - NOV. 1969; ~uly1970; Sept. 1970; March - April 1971; - )

Aim of the project. To study the epidemiology of certain cardiovascular conditions and to advise further on prevention and treatment, with particular emphasis on streptococcal and hypertensive and ischaemic heart diseases.

Assistance provided by WHO durin~the year. (a) A consultant; (b) two two-month fellowships for studies in the United Kingdom, Sweden, Hungary and Yugoslavia, a six-month fellowship for studies in Poland and the USSR and a six-month fellowship for studies in the USSR, Poland and Bulgaria.

Probable duration of assistance. A number of years

Work done during the year. A consultant was assigned for one month during March- April to advise on the curative and preventive aspects of rheumatic heart disease and on the organization of epidemiological studies, treatment and prevention of arterial hypertension. His report is being forwarded to the Government. WHO fellowships were offered to two senior cardiologists to visit institutions in the United Kingdom, Sweden, Hungary and Yugoslavia to acquaint themselves with modern developments in cardiology, cardiological techniques and respiratory pathophysiology. One of the fellows is likely to participate in an international teaching seminar in cardiovascular epidemiology in Sweden before returning to Ulan Bator.

Cancer (May 1968; March - Aug. 1969;Aug - Sept. 1970; Nov. 1970 - )

Aim of the profect. To study and advise on the epidemiology. early detection and treatment of cancer. SEA/RC24/2 Page 151

Assistance provided by WHO during the year. (a) Two consultants; (b) two fellowships - one for twelve months and one for six months - for studies in the USSR and Bulgaria.

Probable duration of assistance. A number of years.

Work done durina the year. The morbidity data for cancer incidence for the last ten years reveal the following rates: cancer of the cervix (20%), oesophagus (2321, stomach (17.1%), lungs (8.5%) and liver (5.4%). A WHO consultant was assigned to the project from November 1970 to April 1971. During the assignment he trained two doctors in chemotherapy, organized the oncological treatment services and planned the medical curriculum with a detailed syllabus for the teaching of oncology. A second consultant to advise on radiotherapy visited Ulan Bator for a fortnight in April. According to him, while the surgical treatment facilities seem to be good, laboratory services for the early detection and diagnosis, radiotherapy and chemotherapy for the treatment of cancer are yet to be organized; teaching in oncology should receive emphasis in the medical curriculum, and there is a need for the promotion of health education in cancer control. The Government has planned to build a cancer treatment centre in Ulan Bator in 1972 with 400 beds.

The recommendations of the consultants have been forwarded to the Government and their reports are being processed.

Mongolia 0012 Strengthening of Radiological Services R (Nov. 1968 - Feb. 1969; April 1971 - )

Aim of the project. To train technicians to undertake the repair and maintenance of electro-medical equipment; to promote radiation protection practices in health institutions.

Assistance provided by WHO during the year. (a) A technical officer (electro- medical techniques); (b) supplies and equipment, including a transport vehicle.

Probable duration of assistance. Until the end of 1974.

Work done during the year. A WHO electro-medical engineer has been assigned to the project since April. He is assisting the Government in the establishment of a school for the training of technicians for the service, maintenance and repair of X-ray and other electro-medical apparatuses, and in the development of syllabi and curricula for training courses.

Mongolia 0013 Brucella Vaccine Production R (May - July 1970; - )

Aim of the project. To produce freeze-dried BruceZZa vaccine and establish laboratory facilities for its testing.

Work done during the year. The final text of the request to UNDP, which a WHO team had helped to prepare in 1970, was forwarded to the Government. The Government has requested UNDPISF assistance in the production and use of BruceZZa Rev.1 vaccine. Because of the high priority attached by the Government to this project,the request was submitted to the June session of the UNDP Governing Council, and, in anticipation of the decision of the Council, action has been taken for the provision of staff and equipment. The feasibility of expanding the scope of the project so as to include other zoonotic infections as proposed by UNDP is being explored. To start with, it is intended to review the work which has been done in connection with tuberculosis control.

>iongolia 0014 Health Education R (Nov. 1970; March 1971; - )

Aim of the project. To develop and implement a health education programme. Assistance provided by WHO during the year. Three three-month fellowships - two for studies in the USSR and Bulgaria and one for studies in the USSR, Poland and Bulgaria.

Mongolia 0016 Quality Control of Drugs R (Feb. 1971; - )

Aim of the project. To develop further the manufacture of pharmaceutical products and upgrade the services associated with their quality control, including the training of staff.

Assistance provided by WHO durin~the year. A three-month fellowship for studies in the USSR and Hungary.

Probable duration of assistance. Some years.

Mongolia 0200 Fellowships R

Artificial circulation of blood. A six-week fellowship for study in the USSR.

(:ynaecology. A twa-month fellowship for studies in the USSR and Bulgaria.

Haematology. A four-month fellowship for studies in the USSR and Czechoslovakia.

Hospital and medical services administration. Four nine-month fellowships for studies in the USSR and Bulgaria.

Public health administration. Three six-week fellowships for studies in the USSR, Romania and Hungary, a two-month fellowship for studies in the USSR and Hungary, and a ten-month fellowship for study in the USSR.

Traunatalogy. A three-month fellowship for studies in the USSR and Poland. SEA/RC24/2 Page 153

7. NEPAL

PROJECT LIST

Agencies Title

Nepal 0001 Malaria Eradication R (June 1954 - ) Aim of the project. To eradicate malaria.

Assistance provided by WHO during the year. (a) A malariologist,an epidemiologist, an entomologist, three sanitarians, a laboratory technician, an administrative assistant, a transport assistant and a clerk-stenographer; (b) six fellowships - four for two months and two for three weeks - for study in the Philippines; (c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. The reorganization of the National Malaria Eradication Organization, aimed at further delegation of authority to the periphery and better co-ordination with the general health services in order to facilitate the eventual integration of the malaria service, was completed during 1970.

A strategy review was completed during the last quarter of 1970. The malaria Eradication Board has followed up the comments and recommendations of the strategy review team and plans to undertake a pilot project to study the feasibility and practicability of integration of the malaria service into the country's general health services. Priority for the development of the basic health services and strengthening of the peripheral health services will be given to areas under the consolidation phase.

In early 1971, an independent assessment team recommended withdrawal of spraying from areas with a population of 307 125 and their entry into the consolidation phase. The present phasing is as follows:

Attack phase - 2.093 million population (33%) Consolidation phase - 3.737 " (59%) Preparatory phase - -,570 " -( 8%) Total -6.400 -(1009.) Non-malariaus areas - 4.600 million population.

During the year, a total of 2 926 malaria positives were recorded, out of which 394 were from areas in the consolidation phase and 2 532 from attack phase areas. The corresponding figures for 1969 were 2 942, 296 and 2 646, respectively.

The progress of the programme in the Western Zone has fallen behind schedule and the Government has revised the target year and envisages that about 75% of the malarious areas will be in the maintenance phase and 25% will be under the consolidation phase by 1975. The Government's Fourth Five-Year Plan includes the establishment of 225 health pasts by 1975 to sustain the vigilance organization in areas under maintenance.

Nepal 0002 Nursing Education and Services UNDP(TA) (Nov. 1954 - ) UNICEF

Aim of the project. To assist the Directorate of Health Services in co-ordinating nursing activities; to set up a basic nursing school, organize courses for assistant nurse-midwives, upgrade nursing services in Bir Hospital; to improve rlinicnl facilities for student nurses.and develop public health nursing services which will provide teaching practice far nursing and assistant nurse-midwife studrnts.

Assistance provided by WHO during the year. A nurse adviser, a nurse educator- administrator and a public health nurse.

Probable duration of assistance. Until the end of 1976.

Work done during the year. The functions of the Nursing Section at the Directorate of Health Services continued to grow. The appointment of an administrative assistant has greatly helped the WHO nurse adviser in the many clerical activities. 'The Section is heing used increasingly as a centre far information regarding nursing and nursing personnel. At the end of April, there were 153 nurses in Nepal, 106 of whom are pasted in Kathmandu: the number af assistant nurse-midwives in the country is 189, and 50 of them are working in Kathmandu.

Short courses for nursing personnel continued to be given, with assistance from UNICEF.

WHO fellowships continued to be awarded to national nurses, and some former fellows returned after completion of their studies. Two nurses attended the US AIO- sponsored three-month course in family planning in the USA.

The curriculum for the training of assistant nurse-midwives was revised and a master rotation plan made for the new two-year programme which commenced in May. Students will be enrolled annually, and it is hoped to recruit 80 students per year for the three schools. The midwifery unit at Biratnagar is now open and it is planned to make this experience available to the other two schools, also in the near future, with the appointment of additional midwifery tutors to the schools. The new two-year programme is aimed at increasing the experience in public health and midwifery.

A full-time matron has been appointed to Bir Hospital. This should result in the improvement of both nursing service and nursing education.

The current enrollment at the nursing school is 82, and it was expected that, subject to hostel accommodation, 40 students would be admitted to the new class in May. Funds have been made available under the Fourth Five-Year Plan for the construction of a hostel and a school. The WHO nurses discussed the plans with the WHO consultant architects (project Nepal 0021) and made suggestions. Construction was expected to begin by mid-1971.

Two WHO nurses serve on the Nepal Nursing Council and the Examination Committee. Plans were being made for the revision of policies regarding examinations. SEA/RC24/2 Page 155

The Trained Nurses Association of Nepal is holding regular meetings; standing committees have been appointed, and the WHO nurses are participating in all committee and association work.

Nepal 0003 Strengthening of Health Services UNDP (TA) (June 1955 - Jan. 1962; Dec. 1962 - Dec. 1968; UNICEF Jan. - Dec. 1970)

Aim of the project. To develop effectively directed and supervised health services in which curative and preventive services are integrated at all levels, and which are able to provide adequate technical guidance to field activities and staff and also in the training af health staff required to man the basic health services.

Assistance provided by WHO during the year. A medical officer.

Work done. The project started in 1955 under the title "Training of Health Assistants, Kathmandu", which was later changed to "Strengthening of Health Services". In the earlier phases, assistance was given in establishing a School for Health Assistants, later renamed as "School for Auxiliary Health Workers". WHO assistance has consisted of staff, fellowships and supplies. A phased development af comprehensive health care for the community was initiated, starting with the pilot area in Narayani Zone. Following a survey and definition of duties and functions of health workers, zonal health offices based at the zonal hospital were established. These offices serve as focal points for health services in the zone, through the district health office and, at the peripheral level, health posts. The project came to a close at the end of 1970, with its merger into project Nepal 0021, "Public Health Administration".

The data collected and the experience gained, as well as the principles of regionalization initiated under this project, are being considered as a basis for the future development of health services in Nepal.

The WHO medical officer completed his assignment in June, and his report was under study.

Nepal 0008 Maternal and Child Health Services R (DEc. 1963 - Jan. 1968: Julv 1968:. Mav. - Se~t.1969: UNICEF April - Dec. 1970; - )

Aim of the project. To develop maternal and child health, including family planning services, to establish referral facilities and to conduct refresher and orientation courses for nurses and medical personnel at all levels.

Assistance provided by WHO durin~the year. (a) A public health nurse; (b) a two- month fellowship for study in the United States of America and a twelve-month fellowship for studies in the United States of America, Republic of Korea. Taiwan, Hong Kong, the Philippines and Singapore; (c) supplies and equipment.

Work done during the year. The main activities concerned the provision of public health nursing experience in Kathmandu Valley for the assistant nurse-midwifery students from Nepalganj and the planning of an eight-week experience for student nurses during the final part of their midwifery course. The field work for the assistant nurse-midwifery group emphasized selection of experiences appropriate to the level of their future activities. The local staff required assistance in supervising this experience. The need to integrate public health nursing content throughout the nursing course was discussed with the staff of the nursing school. SEA/RC24/ 2 Page 156

The WHO public health nurse was reassigned to project Nepal 0021,"Public Health Administration", on 1 January 1971.

Nepal 0009 Smallpox Eradication and Control of Other R Communicable Diseases UNICEF (Feb. 1962 - Dec. 1963; Aug. 1966 - )

Aim of the project. To assist witn the national smallpox eradication programme and in developing the Comunicable-Disease Control Unit in the Directorate of Health Services.

Assistance provided by WHO during the year. (a) A public health officer and an operations officer; (b) a three-month fellowship for study in India and four ten- week fellowships for studies in Burma, India and Indonesia; (c) supplies and equipment, including two transport vehicles.

Probable duration of assistance. Some years.

Work done during the year. The programme was extended to Rapti and Mechi Zones, and is now in operation in 10 out of the 14 zones.

Emphasis has been laid on stepping up the surveillance activities, especially in the Terai region, where 97 cases were reported from 1 August 1970 to 30 June 1971. Improvement of epidemiological investigations and control of outbreaks are also receiving attention.

Measures were taken to reinforce the supervisory element of the programme, and four training courses, each of one week's duration, were conducted for the zonal and district supervisory staff. These courses were assisted financially and technically by WHO; additional technical assistance by one of the medical officers of the inter-country team SEAR0 0030 was also provided for the course held in October 1970. This medical officer subsequently undertook field visits and reviewed the programme with the national authorities.

Nepal 0010 Health Laboratory Services R (May 1967 - ) UNICEF

Ain of the protect. To develop health laboratory services to support an epidemiological unit, and to train personnel.

Assistance provided by WHO durina the year. (a) A microbiologist and a laboratory technician; (b) a twelve-month fellowship for study in the United Kingdom; (c) supplies and equipment.

Probable duration of assistance. Until the end of 1974.

Work done during the year. Several changes took place during the year: the clinical diagnostic services of the Central Health Laboratory (CHL) have been taken over by the Clinical Laboratory of Bir Hospital; the national microbiologist, who had returned from WHO fellowship, took charge of the microbiology section of the CHL; six peripheral units are being set up in district hospital laboratories in six zones which are earmarked for assistance by UNICEF.

The WHO laboratory technician, who arrived in September 1970, is paying particular attention to the Government's five-year training programme (1969-74), which aims at turning out 60 qualified laboratory assistants. Of the first SEA/RC24/2 Page 157

(1969-71) group of students who completed the course 11 laboratory assistants have been posted to different hospitals. The second group of 13 completed their first year, and 12 have enrolled in the third (1971-73) course. The laboratory curriculum for auxiliary health workers was reviewed.

Working in co-operation with the Epidemiological Unit, the entero-bacteriological laboratory competently handled the 1970 cholera outbreak; 11 samples of water collected from Patan and other rural areas were tested and the presence of pollution was confirmed only in one.

Nepal 0013 I.eprosy Control R (March 1967; Dec. 1968; Sept. 1969; July 1970; - )

Aim of thc projpct. Ta develop leprosy control services and to train health personnel.

Assistance provided by WHO during the year. A twelve-month fellowship for study in the United States of America.

-Ncpal 0014 Community Water Supply R (June 1964 - June 1967; March - May 1968; UNICEF Sept. 1968 - June 1970; Oct. 1970; - )

Aim of the proiect. To plan and co-ordinate the development of community water supplies.

Assistance provided by WHO during the year. (a) Two twelve-month fellowships for study in the Netherlands; (b) supplies and equipment.

Nepal 0016 Tuberculosis Control R (March 1965 - Sept. 1970; April 1971; - ) UNICEF

Aim of the project. To develop a tuberculosis control programme as part of the basic health services, and to train personnel.

Assistance provided by WHO during the year. (a) A BCGIpublic health nurse; (b) a three-week fellowship for a study tour of the Republic of Korea, Taiwan and India; (c) supplies and equipment, including a transport vehicle.

Probable duration of assistance. Some years

Work done during the year. The BCG/public health nurse completed her assignment in September.

Nepal 0019 Health Education R (May - Aug. 1967; Sept. 1968; Nov. 1968 - Feb. 1969; UNICEF Sept. 1969; April - May 1970; July 1970; Dec. 1970 - Jan. 1971; May 1971; - )

Aim of the project. To plan health education in the basic health services and special projects, and to strengthen health education in schools and teacher crain- ing institutions. SEA/RC24/2 Page 158

Assistance provided by WHO during the year. (a) A consultant; (b) two four-month fellowships - one for study in India and one for studies in India and the United Kingdom - and a three-month fellowship for studies in Thailand, Malaysia and India.

Probable duration of assistance. Until the end of 1974.

Work done during the year. A WHO consultant assisted with the preparations for, and conduct of, a one-week workshop for teacher educators in Kathmandu, which was attended by 39 participants. The report on the workshop is being sent to the Government, and that of the consultant has been forwarded. The consultant's recommendations included; (i) organization of a follow-up workshop on school health education, and (ii) assignment of a school health education specialist to the Department of Education and of a long-term WHO consultant in school health education to assist in planning, developing and implementing various health educational activities in Nepal.

A consultant in school health education has been recruited and was expected to arrive in Kathmandu in July 1971.

Nepal 0021 Development of Health Services* R (Sept. - Nov. 1968; Jan. 1970 - )

Aim of the project. To strengthen the development of the basic health services in conformity with the development plans of the Government, placing particular emphasis on the training of all categories of health workers and eventually leading to the establishment of an integrated comprehensive health care service; to conduct health surveys on a sampling basis; to co-ordinate associated projects operating in the country.

Assistance provided by WHO during the year.(a) Two medical officers,a public health nurse and three consultants.

Probable duration of assistance. A number of years.

Work done during the year. Intensive preparations were made to draw up the master plan of operation for the development of health services in Nepal, together with the various plans of action. In collaboration with other associated projects demonstration pilot areas were being developed in Narayani and Gandeki Zones and in Kathmandu Valley, with emphasis on the maternal and child health and family planning component. A consultant (statistician) is assisting with the collection of baseline data and information on health and health services as well as with preparations for the establishment of a simple record and reporting system for the basic health services. Two further consultants, working as a team, reviewed the architectural aspects of hospital administration and gave advice on the subject. The team produced a number of standard blueprints for hospital buildings.

Nepal 0025 Water Supply and Sewerage for Greater Kathmandu UNDP(SF) and Bhakta~ur (July 1969; Nov. 1970 - )

Aim of the project. To prepare a plan for the development of water supply and sewerage in Greater Kathmandu and Bhaktapur.

Assistance provided by WHO durinn the vear. (a) A sanirary engineer; (b) supplies and equipment.

*Previous title: Public Health Administration SEA/RC26/2 Page 159

Work done during the vear. The plan of operation and the agreement with the consulting firm were signed on 29 November and 17 December respectively. The project was officially declared operational on 10 December. An interim project manager was assigned on 18 November pending the arrival of the project manager, who assumed duties on 11 January. The sub-contractors started their work on 8 January.

The main activities of the project, which has maintained satisfactory progress, were: preparation and suhmissioir of an "initial water resources report" and a draft work plan; preliminary organizational studies; collection of data for water demand projections, preparation for studies of the present water distribution system. and for leak detection; collection of information on the recent improvements made to the Bhaktapur and Lalitpur water supplies; investigations of existing boreholes and preliminary work for the establishment of gauging stations; a resistivity survey in connection with the location of test bores, and studies to formulate a plan for training and fellowships.

Equipment ordered for the project was received and most of it put to use. Requirements for additional equipment and supplies were assessed, and procurement action was initiated.

A WHO hydrogeologist visited the project from 25 to 28 March to discuss with the project manager technical aspects of ground-water investigations and exploration.

Nepal 0029 National Community Water Supply and Sanitation R (Feb. 1971 - ) Aim of the project. To plan, organize and administer a national environmental health programme and, more specifically, to provide technical guidance in the strengthening of the Sanitary Engineering Bureau of the Department of Irrigation and Water Supply of the Ministry of Irrigation and Power; to assist the government agencies concerned in the planning,organization and implementation of a long-term comprehensive national programme of community water supply and waste disposal.

Assistance provided by WHO during the year. (a) A sanitary engineer; (b) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. The project started in February with the assignment of a WHO sanitary engineer. A national counterpart and other project staff were appointed.

The WHO sanitary engineer reviewed the progress of the various community water supply schemcs in different areas and provided technical advice wherever necessary. He assisted in carrying out a survey in Pyutan in connection with the 1971-72 programme.

Nepal 0200 Fellowships R

Cardiology. A three-month fellowship for study in the United Kingdom.

Health statistics. A twelve-month fellowship for study in New Zealand. SEA/RC24/2 Page 160

Nurse tutor course. A ten-month fellowship for study in India.

Nursing. Four twelve-month fellowships for study in New Zealand.

Paediatric nursing (post-operative care). A four-month fellowship for study in India.

Public health administration. A twenty-one-month fellowship for study in the United States of America.

Public health nursin~ Five fellowships - four for ten months and one for twelve months - for study in India.

Undergraduate medical education. A three-month fellowship for study in India. SEA/RC24/2 Page 161

8. THAILAND

PROJECT LIST

Anencies

Thailand 0002.2 Strengthening of Health Services (Integration of LJNDP(TA) Specialized Programmes) UNICEF (Jan. 1964 - Dec. 1968; Feb. 1969; July - Sept. 1970; - )

Aim of the project. To promote the integration of specialized communicable- disease control programmes into the general health services.

Assistance provided by WHO during the year. Three consultants.

Work done during the year. A critical assessment of the project was made in 1970 by a consultant team (briefly reported last year). The team, consisting of two public health administrators and a public health nurse, visited Pitsanuloke and other areas of the country from July to September 1970. The project was appraised in the context of the development of health services in the country.

Recommendations were made on the organizational structure of health services, the health situation, training of health personnel, the functions and staffing of health centres, including the reporting and recording system, and equipment and supplies. The report is being sent to the Government.

The leprosy control (Thailand 0030) and tuberculosis control (Thailand 0042) projects are being integrated into the basic health services with the technical guidance of consultants provided under project Thailand 0098 (Health Planning and Administration).

Thailand 0030 Leprosy Control R (Oct. 1955 - ) UNICEF

Aim of the project. To expand and intensify the leprosy control programme to cover all endemic areas; to train personnel.

Assistance provided by WHO durin~the vear. (a) A leprosy control officer; (b) supplies and equipment.

Work dune durina the year. The integration of leprosy control activities into the general health services is making progress; the Leprosy Control Division plans to bring ab~utintegration in eleven provinces of the country by October 1971, and the required training is being given to the various categories of health workers (see also Thailand 0098). The methodology for integration was worked out by the Government with the assistance of WHO. SEA/RC24/2 Page 162

Thailand 0037 Vital and Health Statistics R (Aug. 1957 - July 1969; Oct. 1959 - April 1960; Nov. 1968 - Jan. 1969; Feb. 1971 - )

Aim of the project. To develop a co-ordinated health statlsLics systcuc and to tr.iin the staff required for this purpose and for the development of medical record offices.

Assistance provided by WHO during the year. A consultant.

Probable duration of assistance. Until the end of 1975.

Work done d.. ing the year. A consultant (statistician) was assigned to the project In February 1~rsix months to review the organization of health statistics in the Ministry of Public Health, with particular reference to the provision of data needed for health planning. He is examining the present organization of all statistical work within the Ministry with a view to suggesting a phased programme whereby existing separate activities could be co-ordinated or amalgamated.

Thailand 0042 Tuberculosis Control LNDP (TA) (Oct. 1958 - May 1959; Dec. 1959 - Dec. 1968; hug. 1969 - UNICEF March 1970; July 1970; Dec. 1970; - )

Aim af the project. To develop an integrated national tuberculosis control programme based on the experience gained in urban and rural pilot projects and to train health personnel in WHO-recommended tuberculosis control techniques.

Assistance provided by WHO during the year. (a) Two fellowships - one for one month and one for three months - for study in India, and a thirteen-month fellowship for studies in India and Ceylon; (b) supplies and equipment.

Thailand 0043.2 Trachoma Control R (Nov. - Dec. 1967; Feb. - March 1969; Feb. - March 1971; - ) LNICEF

Aim of the project. To evaluate the progress of the trachoma control programme and to plan future development.

Assistance provided by WHO during the year. (a) Temporary assistance from a scnff member from WBO Headquarters; (b) a two-month fellowship for studies in Burma and Taiwan.

Work done during the year. A medical officer from WHO Headquarters visited Thailand for three weeks in February-March and carried out an assessment of the programme. His report as well as recommendations have been forwarded to the Government.

Thailand 0051 Hospital Administration R (Oct. - Nov. 1968; Feb. 1969; June 1969; Jan. 1970; May 1970; July 1970; Jan. - Feb. 1971; - f

Aim of the project. To improve the administration in hospitals, particularly teaching hospitals.

Assistance provided by WHO durin~the year. Four fellowships - three for three months and one for four months - for study in the United Kingdom, two fellowships - one for one month and one for three months - for study in the United States of America, and two three-month fellowships for studies in Papua and New Guinea, Australia and Singapore. SEA/RC24/2 Page 163

Thailand 0057 Faculty of Tropical Medicine R (Aue.. - Sent. 1959: June - Aue.- 1961: June 1962: June - July 1963; Jan. - Dec. 1964; Jan. 1967; Aug. 1967; July 1968; June - Dec. 1969; May 1970; July - Sept. 1970; Dec. 1970; March - June 1971; - )

Aim of the project. To continue to strengthen the Faculty of Tropical Medicine of Mahidol University.

Assistance provided by WHO during the vear. (a) Two consultants; (b) three ten- week fellowships for study in Singapore, two twelve-month fellowships - one for study in the United Kingdom and one (extension) for study in the United States of America, a fifteen-month fellowship (extension) for study in Australia, a threc- month fellowship for study in India, and a six-month fellowship for studies in the United States of America, Guatemala, St. Lucia, Venezuela, Brazil,the United Kingdom, Federal Republic of Germany, Italy and India.

Probable duration of assistance. Until the end of 1974.

Work done during the year. The consultant on the teaching of entomology (mentioned last year) completed his assignment in September 1970. In his report, which h~s been sent to tll? Government, hc has stated that while, in general, entomology has its proper place and wcixht in Lhe diploma course conducted by the Faculty of Tropical Mcd~cine, certain changes are advisable in the emphasis laid on particular aspects of medical entomology. According to him, shortcomings in research projects are mainly due to a shortage of staff in the Department.

A consultant on the teaching of preventive and social medicine was assigned from early April to the middle of May 1971. During this period he took over a series of lecturcs in the absence of the Head of the Department of Clinical Tropical Medicine and participated in clinical teaching as well. He also gave advice on current and planned research projects where, in his opinion, there is scope for extensive inter-disciplinary co-operation in longitudinal studies of diseases which are of particular importance to tropical countries. His rcport is under study.

Thailand 0058.2 Paediatric and Obstetric Education and Services K (Aug. - Nov. 1967; May - July 1970; Nov. - Dec. 1970; - )

Aim of the project. To appraise the development of social paediatric and obstetric teaching programmes in the d~partmentsof paediatrics and obstetrics of medi~al schools.

Assistance provided by WHO during the year. A four-month fellowship for studies in India, Israel, Denmark, the United Kingdom, Switzerland and the United States of America, a twelve-month fellawship for study in the United States of America, ;I six-month fellowship for studies in the United Kingdom and the United States of America, a five-and-a-half-month fellowship for studies in the Unites States of America, the United Kingdom and Sweden, and a three-month fellowship for studies in the United Kingdom, Sweden and France.

Thailand 0059 Epidemiology* UNDP (TA) (Oct. 1966; Dec. 1966 - Aug. 1967; July 1968; Aug. 1969; May - June 1970; June 1971; - )

Aim of the project. To organizc and strengthen a national epidemiological service, undertake studies of specific health problems and train personnel.

*Previous title: Strengthening of Health Services (Epidemiology) SEAIKC2412 Page 164

Assistance provided by WHO during the "ear. (a) A consultant; (b) supplies and equipment .

Probable duration of assistance. A number of years.

Work done during the year. In June, a WHO consultant assisted in the further strengthening of the epidemiological services at the central level and in the training of surveillance workers for the provinces. His report is under review.

Thailand 0065 Malaria Eradication R (.Ian. 1962 - )

Aim of the project. To eradicate malaria.

Assistance provided by WHO during the year. (a) A malariologist, an epidemiologist, an entomologist, a sanitary engineer, a laboratory technician, four sanitarians and a translator-typist; (b) eight three-week fellowships for study in Pakistan and a fourteen-week fellowship for studies in the Philippines and India; (c) supplies and equipment, including two transport vehicles; (d) payment of subsidy.

Probable duration of assistance. A number of years.

ir'ork done during Lhe year. The programme has faced several difficulties sincc tllc cessation of US AID support for operational costs, supplies and equipment at tlic end of fiscal year 1969170. Consequently, a six-year plan of action has been drawn up by the Government, with a view to achieving malaria eradication without a fixed time limit and carrying it out within the available local resources.

An internal assessment of areas by a national team based on local criteria advanced a population of 3.6 million into the consolidation phase in 1971. Thus the phasing for 1971 is as follows:

Attack phase - 12.48 million (364) Consolidation - 21.79 " (64%) Total - 34.27 " (100%)

During the first nine months of 1970 there were 148 926 malaria positive blood slidcs, as compared with 86 987 malaria positives in 1969. The increasing number <,f malaria positives has 1,een due to restrictions in spraying operations because of financial difficulties and inaccessibility of some of the highly malarious areas on intc~rnatianal borders.

It is t~opedthat with the implementation of the six-year plan of action - augmentation of attack measures in the so-called "hard core" areas in the hilly and forest areas and reduced level of active case-detection in the plain areas - the level of malaria incidence already achieved will be contained or reduced to an cxtent which would no longer be a public health problem.

Food Control Administration* (Aug. - Oct. 1964; Feb. - April 1971; - )

Aim of the project. To assist the Department of Medical Sciences, Ministry of Public Health, in establishing a national food control administration and in tr'3lning staff in food control.

.2ssistance provided by WHO during the year. A consultant

*Previous title: Food Control SEA/RC24/2 Page 165

Probable duration of assistance. Until 1976.

Work dune during the ycar. During February-April, a WHO consultant advised the Covcrn%!lk~nt on tlic establishmen t of a National Food Control Administration and tile strengthening of necessary legislatlon,and recommended lines of future development. A summary of his findings was forwarded to the Government, and his report is under study.

Tlldll~ndOilb7 Kadlation Protection Services I< (April - May 1963; Feb. - March 1965; Nov. - Dec. 1965; Dec. 1966 - Feb. 1967: Nov. 1967 - Feb. 1968: Feb. - May 1969; ~uly1969; Sept. - Dec. 1969; Aprii - June 1970; Scpt. 1970; - )

Aim of Llle pl-oject. To establish a radiation protection service in the Dcpartmcnt of Medical Sciences, Ministry of Public Health, and to train staff.

Assistance ~rovidedby 1,110 durinp the year. Six fellowships - three for twclve montiis, ilnc for two months and two for four months - for study in the United king dun^.

I'rol~.ible duration of assistnnrc. \Inti1 the end of 1972

Vector-Borne Disease Control (June 1963; June 1964; March - May 1965; June 1967; Dec. 1968; Feb. 1970; - )

Aim of ti~cproject. To assist the Department of Medical Scicnces in t~-.iini~,i; staff in medical entomology and vector-borne disease control.

Assistance provided by hWO during the vear. A six-month fellowship for studv in tlir Unitcd States of America.

Thailand 0071 LNDP(TA) (.Jan. 1965 - )

Aim of thc proic~t. To train radiographers.

i\isisLJnc~providcd ily idti0 during the year. (a) A radiography tutor; (I,) .I tw~~lv~~- aontl, fcllowsl~ipfor study in the United Kingdom; (c) supplies ,md t.quipn~cnt.

i'robablc duration of assistance. Until the end of 1972.

Work done during the year. The training of first and second-year students was continued and their examinations took place at the end of February. The resuLts uf 40 first-year students werc processed and evaluated. Out of the total of 37 sc,cond-yc;ir students, 29 studcnts in diagnostic radiography and 8 in rirdiu~r.xplty were absorl,c,d in 'Thai government medical service. The third course staricil in Junc 1971, with 30 students.

Nt,w manuals on radiographic anatomy and X-ray techniques were prepared and distributed to all students.

The MHO tutor's counterpart proceeded on a WHO fellowship for one-year trainini: in X-ray techniques, departmental management and organization, and teaching methods and procedures applied to radiography, and a second counterpart was appointed. Tllc services of personnel from photographic and X-ray equipment companies, together with those of graduate radiographers from other hospitals in Bangkok, were obtained to provide instruction to the students. SEAlRC2412 Page 166

The construction of new classroom acconnnodation provided a major improvement in the facilities at the School.

The Chief of the Radiation Health Unit at WHO Headquarters visited the project in November 1970.

Thailand 0075 Strengthening of Laboratory Services R (April - May 1968; March 1969; Sept. 1969; Dec. 1969; UNICEF March 1970; Oct. - Dec. 1970; May 1971; -

Aim of the ~~roject.TO assist the Department of Medical Sciences, Ministry of Public Health, in organizing national health laboratory services.

Assistance provided by WHO during the year. (a) Two consultants; (b) a seven-month fellowship for st~cdicsin the United Kingdom and India.

Probable duration of assistance. Until the end of 1977.

Work done during the vear. A consultant provided under an inter-country project (SEAR0 0159)visited Thailand in September and reported on the status of the laboratory services in the country. Based on his findings, which have been sent to the Governaent, action is under way for the provision of a microbiologist to assist the Department of Medical Sciences in the organization and functioning of the Division of Provincial Laboratories and in strengthening the Department's bacteriological and serulogical laboratories.

In October, a consultant visited Thailand for a few days to assess the need for establishing a central farm for small laboratory animals. The report containing his findings was sent to the Government.

I'or three weeks during Novrmber-December, another consultant reviewed the chemistry syllabus at the Faculty of Technology with a view to suggesting measures for strengthening automated chemistry and enzymology. His report was also forwarded to the Government.

Thailand 0076 Health Education K (kc. 1166; Sept. 1969; Jan. 1971; - )

Aim ui tile proicct. To develop further health education serviccs in the country and strengthen tircir functioning.

Assistance provided by WHO during the year. A two-month fellowship for study in India.

Ijuality Control of Pharmaceutical Preparations* (May 1970; Sept. 1970 - )

Aiin of the project. To assist the Department of Medical Sciences, Ministry of Public Health, in strengthening legislation and laboratory competence of the quality control of pharmaceutical preparations and in training drug analysts and drug inspectors.

Assistance provided by WHO during the year. (a) A pharmaceutical chemist; (b) a six- month fellowship for studies in Australia and India.

*Previous title: Quality Control of Drugs S~A/Rc24/2 Page 167

Prubable duration of assistance. Until the end of 1976.

Woth done during tile year. The WHO pharmaceutical chemist, who was asslgned in October 1970, prr,pared a plan of work far the project, which has been submitted to the authorities concerned. His recommendations included (1) early on-the-job training; (2) appointment of one person to be trained as a specialist in the examination of industrial quality control laboratory records; (3) increase in the number of samples submitted for true quality control purposes, and (4) creation of small sections within the laboratory to be concerned solely with the quality control resting of specialized groups of pharmaceuticals such as antibiotics, vitamins, ctc.

s , first step towards greater specialization, two pharmacists wt3rc .~ppoinLed to thc newly-formrd sntihiotic chemical testing section.

The WHO phanc~ceuticalchemist assisted in the preparation and conduct of tlic WHO-sponsored Seminar on the Quality Control of Drugs at Inspector Level, held in Bangkok from 25 January to 6 February (see SEAR0 0154). Following the Seminar the WHO chemist, jointly with the WHO consultant for the Seminar, conducted a one-week course for Thal drug inspectors.

'Tl~di1 :ln~i \$.lti,r I'ollution It (kc. 1966 - Jan. 1967: Oct. 1967:. Scot.. - Oct. 1968: Jan. 1969; May 1969; Aug. 1969; Oct. 1969; Jan. - Feb. 1970; April 1970; June 1970; Nov. 1970; Jan. 1971; - )

Aim of the project. To provide technical advice on organizational and other problems related to the prevention and control of water pollution.

Assistance provided by WHO during the year. (a) A consultant; (b) a twelve-montl~ fellowship for study in the United Kingdom and a three-month fellowship for studies in Australia and Japan.

Work done durinp, the year. The WHO consultant who visited the project for two weeks in November as a follow-up on his earlier assignment, reviewed the progress of the water pollution control programme in the light of his previous recommenda- cions and assisted the Government in its further development. His rrport was forwarded to the Government.

Thailand 00R2 Venereal-Disease Control R (Feb. - hug. 1967; Oct. - Dec. 1967; May 1969; Aug. 1969; Jan. 1970; Nov. 1970; - )

Aim of the eroject. To control venereal diseases and to train staff in the clinical and laboratory aspeccs.

ilssistance provided by WHO during the year. A tlrree-month fellowship for studies in India, the United Kingdom, Sweden and the Netherlands.

Probable duration of ~ssistance. Until 1973.

Thailand 0086 Dental Health R (Jan. 1967; Nov. 1967 - April 1968; April 1969; Aug. 1969 - .luly 1970; Feb. 1971; April 1971; -

Aini of the prujec~. To improve dental services and to train dental health oersonnel. SEA/RC24/2 Page 168

Assistance provided bv WHO during the year. A twelve-month fellowship for study in the United States of America and an eleven-month fellowship for studies in New Zealand, Australia, Singapore and Malaysia.

Probable duration of assistance. Until the end of 1974.

Thailand 0089 Nursing Education and Services R (.Ian. 1968 - )

Aim or Ll~cproject. To study nursing needs and resources; to strengthen nursing services a8.l rdrlcation; to develop university-level courses for nurses, and to arganizc and conduct studicv related to nursing services and cducation.

Assist,~n~.eproviduil by WllO durinx Lhr year. (a) i\ nursing ndviscr, two nursc cducators, n public health nurse, an adviser in psychiatric nursing, and two consultants; (h) eight twelve-month fellowships - five for study in New Zealand and three for study in the United States of America, a three-month fellowship for studies in Malaysia and Singapore, and a three-month fellowship (provided under project Thailand 00i7.2) for studies in Austria, Norway, the Netherlands and the llnitcd Kingdom; (r) supplics and equipment.

Probable duration of assistance. A number of ycars

ldork done durin): the venr. A study of the activities of health personnel working in health centres in Thailand was desjgned and carried out, in order to obtain basic information needed for planning future health services in rural areas. Data were obtained through direct observations of health personnel ai iirst-class, second-class, and midwifrry centres in a stratified random sample of six districts of the cuuntry. l'lle report is being processed.

A preliminary estimate of the total nursing pt,rsonncl needed far the country was made by thc Nursing nivision. The assessment was based on a bricf survey of the nursing needs of patients in three hospitals, the findings of the study of activities of nursing personnel in general hospitals(1969-1970),current staffing patterns, and standards set up by the Health Department for personnel of health centres.

An oiltlin~.fur clic structure of a national nursing council was developed, and will hc prcscnted for tltc cnartmcnt of necessary legislation.

Full-Limr assistance to the Department of Nursing Education, Faculty of Education, Ct,ulalo,~gkornUniversity, was continued up to December 1970, when the senior WHO nurse educator completed her assignment. Some revision of the programmr for the preparation of nurse teachers was planned and a programme for the preparation of nursing service administrators outlined. The WHO nurse educator in medical- surgical nursing continued to assist with the practice teaching of the post-basic students, and the psychiatric nursing adviser with the development of both the theoretical course and clinical experience in psychiatric nursing and with the preparation of instructors.

Twenty-two students graduated from the Chulalongkorn University programme in June, seven with medical-surgical nursing as their area of emphasis, twelve in maternal and child health nursing, and three in psychiatric nursing. Thirty-six students remain for the second year of the programe (maternal and child health - 11; medical-surgical - 19; psychiatry - 6).

The WHO psychiatric nurse adviser also assisted in the teaching of basic nursing students in psychiatric nursing, the preparation of instructors for this programme and the improvement of nursing services in the psychiatric hospital. SEA/RC24/2 Page 169

The WHO nurse educator provided assistance in improving nursing service and education at the Infectious-Disease Hospital, Nontaburi, the Provincial Hospital and new School of Nursing in Nakorn Suwan. Under project SEAR0 0139, "Short Courses for Nurses and Other Health Personnel", she also helped in conducting twu thrcc-week courses on "Planning for Patient Care" in October and November.

Assistance was given to the development of the curriculum of a new school of nursing to be started within the Medical Sciences complex of the Khon Kaen Provincial Hospital.

Together with the instructors of the Public Health Nursing Course, Faculty of Public licnlth, Malridol University, the WHO public health nursc helpcd in the developmclit of d Eldnu,ll for Public Health Nursing Supervisors.

Concentrated work on the development and implementation of the "Srtldy of Activities of liealth Personnel Working in Health Centres in Thailand" cnccupied several months of the time of the WHO public health nurse.

A study of central sterile supply services in Chulalongkorn Red Cross Hospital was undertaken by a WtlO nurse consultant, and the report was sent to thc Government. The consultant also produced o general report putting forward recommendations for devi~lapmi,nt of ccnLral sterile supply services in hospitals and among groups of I~ospit~rls.A spcr ial advisory comittce has been set up by the Ministry of Puhlic Ilc.~ltit to crlnsidcr tit', hest methods of meeting these needs.

Thailand 0090 National Community Water Supply, Drainage, Sewerage LINDI' (TA) and I'ullution Control* UNICEI: I 1969 - )

Aim ut thc pruieiL. 'To i,lan, organize and administer a national enviroiii~cnt:ll health prilgramlc and,more specific.~lly,to provide technical advice anit guid:~nr.r for thc expansio~iof tllc nationz1.1 comnlunity water supply and othrr cnvironmc.nt~~l health programmes.

Assist.incc provided l~y1J110 duri~li;thc year. A sanitary engineer and a consultant.

Probable duration or assistance. llntil the end of 1975.

Wark done duriup, tile year. Constructio~rwork on four water supply spstenls in the northern region and one in tlir sootlicrn region continued as planned. A new wa~er treatment pl~ntwit11 ;i capiicity of 500 cubic metres per hour was approvcd for Khon Kaen City. Standard concrete casing was designed far wells 2m and 1.50a in diameter. The iJH0 sanitary engineer reviewed from time to time the progress of UNICEF-assisted schemes and provided technical advice wherever possible, and also assisted in the selection of sites far further schemes.

A coiisult;~ntwas assigned in May for threc months to assist in the develapnwnt of a storm-watcr drainage and sewerage unit in the Division of Provincial Water Supply of tllc Department of Public .ind Municipal Works, and in developing training courses in community w;iter supply design and ground-water engineering at Khan Knen University.

Four sanitary engineers who had been studying abroad returned after obtainins their master's degree in sanitary engineering.

"Previous title: National Comiunity Water Supply SU\/KC24/2 Page 170

Thailand 0093 Medical Rehabilitation R (Oct. 1968 - )

Aim of the project. To develop rehabilitation services in selected hospitals in the provinces and in Bangkok, and to train staff.

Assistance provided by WHO during the year. (a) A physiotherapy tutor; (b) two twelve-month fellowships - one for study in the United Kingdom and one for study in Isracl, a four-month fellowship for study in the United States of America and a one-mootti €ellotuship for study in Poland.

Frobable duration of assistance. Somc ycars.

Work done during the year. Tile students from the School of I'l~ysiotheranr cndrr- took practical work in several hospitals in Bangkok from November 1970 until February. 1971.

A weekly "Rehabilitation Conference" was started and held regularly. The nlceting is conducted by the WHO tutor's counterpart. At Lerdsin Hospital the students also attend and contribute to this meeting.

'l'i~crchilbilitatic,n scheme started at Lerdsin Hospital had to bc suspendcd in I'cbruary 1971 an account of the shortage of personnel. However, the sudden inLakc of qualified physiotherapists permitted the immediate resumption and expansion of the rchabilitacion srheme. In March, two Thai physiotherapists who had had training and expcriencc abroad joined the hospital, in addition to a New Zealand volunteer i~hysiatherapist. Also, some of the newly graduating physiotherapists became available in April.

Efforts were made to find Lwo suitable consultants for the prajcct - a medical social worker and a specialist in the manufacture of prosthetic and orthotic appliances. In addition, a consultant in occupational therapy was under recruitment in order to study the existing situation and made recommendations for setting up training programmes at both professional and sub-professional levcls in occupational Llicrnpy.

Educai ion in Public iicnlth (ner. 1968 - Jan. 1969: Oct. - Nov. 1969; Jan. 1970; Nov. 1970; - )

Aim of the project. 'To assist the Faculty of Public Health, Mahidol University, in further developing its teaching and training programmes.

Assistance provided by WHO during the year. Two twelve-month fellowships for study in Israel.

Prubable duration of assistance. Until the end of 1975.

Thailand 0098 Health Ylanning and Administration K (Oct. 1970 - )

Aim of the project. To assist in national health planning and in health administration, an a broad basis, with primary emphasis on the phased integration of disease- control and special health programmes, eventually leading to the development of a comprehensive health care service in the country. SEA/RC24/2 Page 171

Assistance provided by WHO during the year. (a) Two consultants; (b) a twelve- month fellowship for study in the United States of America;(c) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. A consultant public health administrator is assisting the Government in health administration, primarily concentrating on the co-ordination and integration of disease-control programmes into the general health services, particular attention being paid to the leprosy control programe.

During December 1970-February 1971, a consultant (statistician) reviewed the data collected in the health manpower study which is being conducted with WHO assistance. He made recommendations for improving the study design and prepared a framework for the further development of the study. His report has been forwarded to the Government.

Plans are being made to assist the Government in conducting medical anthro- pological studies and in training national staff in anthropology.

Thailand 0109 School for Medical Physicists R (Jan. 1971 - )

Aim of the project. TO teach and train medical physicists.

Assistance provided by WHO during the year. A medical physicist.

Probable duration of assistance. Until the end of 1974.

Work done during the year. The WHO medical physicist recruited to assist the Government in the establishment of a school and training programe for medical physicists took up his assignment in January. He reviewed the staffing and physical facilities available for establishing the school in the Faculty of Medicine, Ramathibodi Hospital, which is temporarily housed in the Department of Radiotherapy. Facilities within the Department will be used for the on-the-job training of the students.

The WHO staff member also prepared, on request, plans and specifications for the proposed new building for the school, consisting of a teaming and demonstration laboratory, electronics laboratory, tutors' room and store-room, and the design of the furniture and fittings.

The first one-year post-graduate course leading to a Diploma in Medical Physics commenced on 1 June.

Thailand 0115 Teaching of Human Reproduction, Family Planning and LNFPA Population Dynamics in Uedical Schools (Nov. - Dec. 1970; - )

Aim of the project. To strengthen the teaching, research and service functions in departments of paediatrics, obstetrics and gynaecology, preventive and social medicine and in other departments involved in the teaching of human reproduction.

Assistance provided by WHO during the year. Three consultants (provided under project Inter-regional 0568).

Probable duration of assistance. Some years SEA/RC24/2 Page 172

Work done during the vear. In preparation for the development of the project, three consultants - in curriculum development, child health and obstetrics and gynaecology - were assigned under project Inter-regional 0568, "Planning and Organization of Training and Research in Human Reprodcuction in Medical Schools", to study and advise on the teaching programme in these subjects in medical centres and in areas in need of further investigation. Steps were taken to prepare a plan of operation for the project.

Thailand 0200 Fellowships R

Biochemistry of the thyroid hormones. A twelve-month fellowship for study in the United Kingdom.

Environmental health. A twelve-month fellowship for study in the United States of America.

Healtb education. A three-month fellowship for study in the United States of America (extension).

Huspital administration. A three-month fellowship for study in the United Kingdom.

National health plannix. A twelve-month fellowship for study in the United States of Anerica.

Nutritional anaemia. A twenty-four-month fellowship for study in the United Kingdom.

Nutrition and food sciences. A twenty-two-month fellowship for studies in the United States of America and Guatemala.

Obstetrics (education and servicesL. A four-month fellowship for studies in Nigeria, the United Kingdom, Ireland, the United States of America and Japan.

Reproductive biology. A six-month fellowship for study in India.

Social paediatrics. A one-week fellowship for study in India.

Thalland 0201 Fellowships UNDP(TA)

General surgery. A twelve-month fellowship for study in the United Kingdom. SEA/RC24/2 Page 173

PROJECT LIST

Project No. Source of Funds Co-operating Agencies Title

SEARO 0007 Regional Assessment Team on Malaria Eradication R (May 1959 - Dec. 1961; Nov. 1963 - )

Aim of the project. To make an independent appraisal of the status of the malaria eradication progrme, including any special aspects in countries of the Region.

Assistance provided by WHO during the year. Three consultants.

Work done during the year. A mnlariologist was assigned to Nepal for thrce weeks in October-November 1970, as one of the four members of tltc nlalarin strntcgy revicw team in connection wit11 the revised global stratcgy for malaria eradication progrmes. The revicw was submitted to the Government, and the comments and recommendations are undcr active study by the concerned authorities.

In January-February, two WHO malariologists were assigned to Nepal to participate in an independent assessment of the malaria eradication programme in order to determine areas for advancement from the attack to thc consolidation pltase.

SEAR0 0030 Smallpox Eradication and Epidemiological Advisory Team K (Oct. 1962 - )

Ainl of the project. To assist in the smallpox eradication programme, in the development of epidemiological services, and in training.

Assistance provided by WHO during the year. (a) Two epidiwiolafiists, n consuitant and a clcrk-stcnagraphcr.

Probable duration of assistance. Several ycars

Work done during the year. The two medical officers of the team visited Burnla, India, Indonesia and Nepal, where they assisted the national smallpox eradication programmes, assessing the programme in specific areas and reviewing the findings with the national authorities, checking the methodology for the control of outbreaks, investigating the reporting system at all levels, co-ordinating inter- country exchange of epidemiological information, carrying out scar surveys and helping in the training of national staff.

Discussions were held with governments as regards provision of supplies, equipment and vaccine, utilization of WHO financial subsidies and preparation of training courses.

*This list includes same meetings, seminars, etc., with participation from other regions but for which the Regional Office had the main administrative and financial respc,nsibility. SEA/RC24/2 Page 174

The two medical officers took an active part in the preparations for, and c~mnduct of, the inter-regional Seminar on Surveillance and Assessment in Smallpox Eradication, wliicll ~iosheld in the Regional Office from 30 November to 5 Dcccnlber 1970, and also in the meeting of WllO Regional Advisers on Smallpox Eradication, whicll Look plncc Cram 6 Lo 8 December.

As a follow-up of the training coursc in the laboratory diagnosis of smallpox held in Bandung, Indonesia, in February 1970, a consultant visited the sn~allpox diagnosLic 1,~bor~toriesin Ceylon, Indonesia and Thailand in Elarch-April 1971.

SEAR0 0038.2 Production uf Frceze-dried Smallpox Vaccine K (Nov. - Uec. 1967; Nov. - Dcc. 1968; Dec. 1969 - Jan. 1970; l!Kl(:l;l: Uec. 1970 - Jan. 1971; - )

Aim of tl~eproject. To assist with thc production of freeze-dried smallpox vaccine.

Assistance provided by WHO during the year. A consultant.

Probable duration of assistance. Until 1974.

Work done during thr year. Thc status of production of smallpox vaccine in Indonesia and Thailand was reviewed by a consultant in the period December 1970 - Ja~u~ary1971. The vaccine produced in both countries is of good quality and meets the TJHO requirements for potcncy, stability and bacterial purity. Quality assay is undertaken regularly and the results of testing are periodically checked by the independent testing of random samples at the WHO Smallpox International Reference Centre, in the Netherlands.

In Indonesia, according to the consultant, ample scope exists for producing a good vaccine at less cost if ampoules of better quality are used and contamina- Lion of the pulp could be controlled. The quarantining of vaccinifers should take place under qualified veterinary surveillance at the premises of the institute. The proximity of tlic smallpox diagnosis laboratory to the vaccine production laboratory is undesirable. Arrangements are being made to shift the diagnostic laboratory to some other safer area. Adequate safeguards are being taken to protect Llle area wherc thc vaccinc is being produced. Efforts are being made to develop tile local production of glass ampoules. Trial runs were made using the local ampoules, ril>icll comparc favourably with the imported ones.

In Thailand, observance of the standard procedures recomnended by WliO for tl~chandling of vuccinifers was emphasized.

The reports of the consultant have been sent to the two governments.

Developlncnt of Community Water Supply Programne (April 1965 - )

Ai1.1 cf the project. To assist countries of the Region in developing urban and rural cornunity watrr supplies.

Assistance provided by hW0 during the year. (a) Four sanitary engineers, a sanitary engineering consultant and two clerk-stenographers; (b) supplies and equipment.

Prubable duration of assistance. Some ycars SEAlRC2412 Page 175

Work done during the year. The senior sanitary engineer assisted the Regional Advisers in Environmental Health with UNDP(SF) projects. In addition, he visited Burma, Thailand and Nepal to review the progress of WHO-assisted programmes in environmental health in thesc countries and to hold discussions on these and other related matters with the authorities.

The second sanitary engineer continued to give technical advice in the execution and development of the WHOIUNICEF-assisted rural water supply schemes in several States in India in the course of regular visits. He visited the Rajasthan Ground Water Baard, Jodhpur, and the Central Ground Water Baard, Faridabad, to explore the possibility of planning and organizing short courses on ground-water development for engineers and technicians, including drilling operators. He also visited Burma to discuss iJHO assistance to the government's proposed rural water supply pilot project. Ln May, he was transferred to Bangkok, from where he will assist in the planning and implementatio~~of the inter-country programmes in Burma, Indonesia and Thailand, and provide tecllnical advice and assistance to the governments in the promotion and implementation of community water supply and sanitation programes, including the training of staff.

A third sanitary engineer, temporarily assigned to the project, assisled in reviewing the proposals far a water pollution control pragrame in the State uf Maharashtra (India), and in the camunity waler supply programme in Thailand.

A WHO consultant (hydrogeologist) was assigned to Thailand from 5 January to 25 March to assist the Government in ground-water development techniques.

SEAR0 0066 Conmunity Water Supply Special Account (March 1971 - ) for Community Water Supply

Aim of the project. To assist countries in the Region in the managerial, financial and design aspects of community water supply programmes.

Assistance provided by WHO during the year. Two sanitary engineering consultants

Work done during the year. Two consultants were assigned to Indonesia, one from 13 March for three months and the other from 15 April for six months. They were attached to the Ministry of Public Works and Electric Power to assist in carrying out feasibility studies of municipal water supplies and in the preparation of a long-term programme for the improvement or the construction of urban water supply systems. Steps were also taken to recruit two consultants to be assigned to the Ministry of Health to provide assistance in the improvement of rural water supplies and in the development of a long-term programme in this field.

SEARO 0094.2 External Crass-Checking of Blood Films R (Sept. 1968 - )

Aim of the project. To develop facilities in the countries of the Kcgion for independent cruss-checking of blood films from malaria progrmes.

Assistance provided by WllO during the year. A laboratory specialist.

Probable duration of assistance. Until tile end of 1977.

Work done during the year. The WHO laboratory specialist stationed in Colombo continued to assist the Government of Ceylon in establishing additional regional SC\/RC24/2 Page 176

laboratories and a laboratory at the national malaria eradication training centre. He participated in the training of microscopists and laboratory technicians as well as medical officers and public health inspectors at the training centre.

At the beginning of 1971, the use of wide-angle lenses for cross-checking was introduced at the cross-checking laboratory, and the preliminary findings appear to be satisfactory.

The laboratory specialist visited Indonesia in April-May to assist in strengthening the laboratory services (malaria). A visit to Burma during the year is also planned.

SEAR0 0096.2 Medical Education UNDP (TA) (March 1969 - )

Aim of the pro3ect. To develop medical education at all levels; to adjust teaching and training progrmes to the needs of the countries in the Region and to the progress of educational science; to train medical educators, with particular emphasis on educational science, and to promote inter-country exchange of experience in educational matters.

Assistance provided by WHO during the year. (a) Eight consultants and a temporary adviser, and temporary assistance from one of the Regional Advisers on Medical Education and two staff members assigned to field projects; (b) cost of attendance of participants; (c) secretarial assistance; (d) supplies for the course (see below).

Probable duration of assistance. A nder of years.

Work done during the year. A Seminar on Problems of Health Care and Medical Education in the Tropics was held in Ceylon from 24 August to 1 September in conjunction with the Centenary Celebrations of the Colombo Medical School. WHO provided a faculty of three consultants and one temporary adviser and invited participants from Burma (21, Ceylon (IS), India (5). Indonesia (4). Nepal (1) and Thailand (3). The topics covered were recent work on malaria, nutritional disorders in childhood, filariasis and occult helminthiasis, acute abdomen in the tropics, and medical education.

The second "Medical Teachers' Training Course" to be organized by WHO in the South-East Asia Region was held at the Faculty of Medicine, University of Ceylon, Peradeniya, from 14 November to 4 December. It was planned and conducted by a group of four consultants (all from the Division of Research in Medical Education, University of Southern California School of Medicine). The participants came from Burma (2). Ceylon (12), Indonesia (1) and Thailand (2). The programne of the course was so adjusted as to deal with the major problems faced by the participants in their own schools. However, the basic outline was adhered to in order to cover all major areas of educational science. Practical exercises were undertaken by small groups, and each participant selected an individual project to work out under the guidance of a faculty member.

A consultant on the teaching of preventive and social medicine and public health, assigned to Ceylon for a week in Ekrch 1971, discussed with the Government and the authorities at the tvo medical faculties plans to establish diploma course in public health. He also delivered a guest lecture at the annual session of the Ceylon Medical Association. SEA/RC24/2 Page 177

SmO 0097 Nutrition Training and Advisory Services R (Dec. 1963 - ) UNICEF

Aim of the project. To assist with the training in nutrition of medical personnel and to advise on public health measures in nutrition.

Assistance provided by WHO during the year. (a) Two guest lecturers; (b) ten three- month fellowships for candidates from Ceylon (4), Indonesia (1) and Thailand (5) for participation in the certificate course in nutrition; (c) two three-month fellowships for candidates from Ceylon for study in India.

Probable durmn of assistance. Until the end of 1974.

Work done during thc year. The third nine-month degree course and the eighth three-month certificate course in nutrition at the National Institute of Nutrition, Hyderabad, India, ended in February. Two WHO guest lecturers assisted with the conduct of the courses for two w~eks. In the degree course, there were seven participants - six from India and one from Indonesia (on WHO fellowship). The certificate coursc had eleven participants on WHO fellowships (4 from Ceylon, I from Indonesia, 5 from Thailand and 1 from Papua and New Guinea [western Paciiir Region]), in addirion to six Indian candidates. The participants from India in both courses were paid stipends by UNICEF. The fuurttl degree coursc commenced on 1 June 1971.

One of the guest lecturers visited the nutritional rehabilitation centre at the Madurai Hospital in Tamil Nadu, India, and boch attended the First Asian Congress of Nutrition held in Hyderabad from 28 January to 2 February 3s observers.

SEAKO 0099.3 Epidemiology of Virus Diseascs R (Aug. - Oct. 1967; Jan. 1969; Aug. - Sept. 1969; Feb. - March 1971; June 1971; - )

Aim of the project. To assist in the development of regional epidemiological surveillance of haemarrhagic fever and in national and international studies to find effectivi. rnctf~ods of control.

Assistance FL~vidcdi,y~,~V-

Work done durin~tI1c E. During February-March 1971, a staff member irom WIO Headquarters carried out an assessment of the trachoma control programme in Thailand. His reoort has been forwarded to the Government (see also Thailand 0043.2).

in June, a consuitant visited Burma to evaluate the current status of ~hc diagnosis, treatment, preventiiln and control of haemorrhagic fevcr caused by nrtl~ropod-burnr virusv:,. Ile also went to Thailand to review the progrcss in the devclopnient uI i,l,iJrn~i<,logicalservices in that country (see also TIlailand 0059)

SEAR0 0102 Asian Institute for Economic Development and R Planning, Bangkok UNDP(SF) (Jan. 1964 - ) ECAFE UNICEF

Aim of the project.. To assist the faculty of the Asian Institute for Economic Development and Planning with the health component of training courses and research. SEA/RC24/2 Page 178

Assistance provided by WHO during the year. (a) A public health administrator and an economist; (b) supplies and equipment.

Work done during the year. The two WHO staff members continued to assist with the general programme of work of the Institute, including the regular training courses. The WHO public health administrator was responsible for the organization and conduct of the Second Regional Course on National Health Planning (see under SEARO 0178, "National Health Planning and Manpover Studies"). The faculty of the Institute conducted sessions on basic economics, the development process and developmental planning.

A national course on national health planning was held from 5 to 26 November 1970 at Rangoon (see Burma 0094). The course was planned and organized by the WHO public health administrator in collaboration with the WHO economist and two temporary advisers from Burma.

During the year, the public health administrator participated in the 15th International Conference on Social Welfare held in Manila and attended various meetings at ECAFE. The WHO economist visited Kabul (Afghanistan) in October 1970 in order to conduct a number of sessions dealing with the relationship between health and development and on health planning methodology at a provincial health officers' training course.

SEAR0 0104 Organization and Administration of Hospital and K Medical Care Services* (Aug. - Oct. 1968; Dec. 1968; Feb. 1969; July 1970 - Jan. 1971; - )

-Aim of the prolect. To assist in the development of regionalized health services, in thc organization of systems of medical care, and in hospital administration, including the planning and development of facilities for the diagnosis, treatment, care and rehabilitation of the sick.

Assistance provided by WHO during the year. (a) A consultant and temporary assistance from a hospital specialist assigned under another project; (b) four three-

month fellowshi~sfor candidates from Ceylon (2)~ ~ and India (2)~ ~ for studies in Papua and New Guinea, Australia and Singapore, a three-month fellowship for a candidate from India for studies in the Federal Republic of Germany, the United Kingdom and the United States of America, and two nine-week fellowships for candidates from Indonesia and Nepal for studies in Australia and Singapore.

Probable duration of assistance. A number of years.

Work done during the year. Two consultants studied the planning, organization and administration of hospital services. During July-December 1970 they visited various institutions in Ceylon, India and Thailand and prepared a guide on the functional programming of hospitals. As a follov-up, it is planned to organize a seminar on the subject in October-November 1971.

SEAR0 0113 Regional Tuberculosis Training and Evaluation Team R (Dec. 1967 - )

Aim of the project. To provide training in tuberculosis control; to assist with operational research related to the assessment and evaluation of integrated tuberculosis control programmes in the Region and to give practical assistance to national tuberculosis programmes.

*Previous title: Planning and Design of Hospitals and Health Centres SEAlKC2412 Page 179

Assistance provided by WHO during the year. (a) A medical officer, a statistician, a laboratory technician, a consultant (provided under Ceylon 0075), a nurse- consultant and temporary assistance from the statistical assistant in the Regional Office; (b) supplies and equipment.

Probable duration of assistance. Until the end of 1971.

Work done during the year. During most of the year under review, the team was in Ceylon, where it assisted with an evaluation of the tuberculosis programme, including a baseline survey. The tabulation of data collected in the survey was under way. A WHO consultant visited Ceylon in January and March to assist the team and to hold discussions on its activities.

The medical officer of the team visited Rangoon in April to make preparations for a similar evaluation of the programme in Burma. The team will be assigned to that country in July far this purpose.

Malaria Advisory Services (Jan. - Feb. 1969; Oct. 1969 - Dcc. 1970)

Aim of the projcct. To assist the malaria eradication programmes in the Region in planning and organizing all operational aspects, including their evaluation.

Assistance provided by WHO during the year. A sanitary engineer.

Work done. The project started in January 1969, when a WHO team consisting of a malariologist, an entomologist and a ~ublichealth administrator was assigned to Indonesia fur two munths to carry out an assessment of the malaria eradication programme. The rccr,mendations of tile team were accrpted by the Government and fumed thc basis a1 a plan of ;action for malaria rontrol activicics in Java and Bali during the ycar.

A sanitary fngincer (malaria) was assigned to Ceylon in October 1969 to assist the Anti-Malaria Campaign in training spray teams in the techniques of spraying and supcrvision. Ice also participated in the training of public health inspectors in geographical reconnaissance.

The project was tcrminatfd at the end of 1970, wticn the sanitary engineer completed his assignment.

Training Courses in the Management of Infectious- Disease Hospitals* (Oct. 1967 - ) him of the project. To assist in improving infectiaus-disease hospitals so that they may provide adequate facilities for the diagnosis, treatment and teaching of infectious diseases.

Assistance provided by WHO during the year. Two consultants.

Probable duration of assistance. Until 1977.

Work done during the year. In October-December, two W1tO consultants, a specialist in infectious diseases and a nurse, visited Infectious-disease hospitals in Burma, Ceylon, India and Thailand as a follow-up of the Training Courses on the Management of Infectious Diseases, held in Bombay in 1967 and in Bangkok in 1968.

*Previous title: Infectious-Disease Hospitals SEA/RC24/2 Page 180

The recommendations made by the consultant following these visits were sent to the governments concerned; the reports on Burma, Ceylon and Thailand were forwarded to the zespective governments.

Development of Health Education (Junc 1967 - )

Aim of the project. To arrange workshops and other educational group meetings for national leaders in health administration and health education and for other key personnel, for the study of subjects such as (1) the training in health education given to various kinds of health workers; (2) hcalth education in the curricula far lnedicul students; (3) school hcalth education and teacher training, and (4) methods of curriculum development; also to conduct a study of field training practices.

.-Assistance provided by WtlO during the year. (a) Three consultants; (b) cost of attendance of participants; (c) secretarial assistance.

Xork done during the year. An inter-country Workshop on Health Education in Schools was held in Bangkok fram 16 to 27 November. It was the third in a series planned to focus attention un l~ealtheducation in the Region and the first on school health cducaLion. The 28 participants came fram Burma (2). Ceylon (5), India (3). I~idonesia(7), Nepal (5) and Thailand (6) and represented both thc education and hcalth ministries. Kepresentatives from UNESCO, UNICEF, FA0 and ECAFE also participated. Three consultants assisted, and the Regional Adviser on Health Education and a IJHO health educator assigned to a field project also attended. Tlie Regional Office provided secretarial assistance.

The ubjectives were to: (1) ascertain the current level of health education programmes in schools; (2) identify the needs and problems in the planning. implementation and evaluation of these programmes, and (3) develop guidelines and suggest ways and means of implementing them in the cauntrics of the Kegion. The guidelines prepared covered six areas: curriculum planning, preparation of personnel, teaching and learning activities, selection and use of materials and teaching aids, co-ordination in planning and implementation, and evaluation of health education in schools. The country groups formulated plans for follow-up action in their respective countries.

The canrlusione of the workshop included suggestions for conducting country worksllops and seminars an school health education, organizing an inter-country workshop on the training of school health education personnel, developing demonstration progr-es in selected schools in each country, and exchanging information on school health education and health education in general.

The report of the workshop is being processed.

Seminar on Water Pollution Control (4 - 14 Nuvemher 1970)

Aim of tlte p<~icg. To discuss and review problems of water pollution and their saluticn.

Rssistancf provided by WHO during the year. (a) Two consultants and assistance from the Regional Adviser on Environmental Health and a staff member from liead- quarters; (b) cost of attendance of participants; (c) secretarial assistance. SEA/RC24/2 Page 181

Work done. Thc above-mentioned seminar was held in Bangkok from 4 to 14 November with the Government of Thailand acting as host. The purpose of the seminar was to assess the present situation in the countries of the Region and to provide an opportunity for tllc participants to exchange information on ways and means of implementing water pollution control programmes.

Thcrs were thirteen participants from five countries of the Region (2 from Ceylon, 3 from India, 2 from Indonesia, 2 from Nepal and 4 from Thailand). In addition, there were observers from Thailand as well as from other agencies. Two consultants assisted in organizing and conducting the seminar, for which the Regional Office provided secretarial assistance.

The main conclusions of the seminar were that there was a recognition of the urgent need to (1) devclop vigorous programmes for safe water supplies for rural areas; (2) expand sanitation education to encourage sanitation practices; (3) control new sources or wastes resulting from the trend towards rapid indus- trialization, and (4) strengthen educational and training facilities for professional workers.

The report of thc seminar has been distributed.

SEAR0 0139 Short Courses for Nurses and Other Health Personnel* R (Jan. 1967 - ) UNICEF

Aim of the project. To assist in conducting short courses for nurses and other health personnel in order to develop new concepts and skills with particular reference to patient care and family health; to assist in preparing reference and teaching materials; also to assist in areas requiring study in nursing services and education.

Assistance provided by hTO during the year. (a) Four nurse educators, two cunsui- rants and one temporary adviser; (b) mo clerk-stenographers; (c) supplies and equipment.

Probable duration of assistance. A number of years.

'n'ork done during the year. During the period under review, five courses were held in three countries of the Region; one course was inter-country and four national, and one of the latter was assisted by UNICEF. The length of the courses varied from three to five weeks. The subjects were: (i) Organization and Planning of Patient Care (three courses), (ii) Hospital Housekeeping, and (iii) Guidance and Counselling in Schools of Nursing. A total of 108 persons attended these courses and they consisted of nurses, physicians and surgeons. The participants came from Ceylon, India, Indonesia, Nepal and Thailand. In addition, assistance was given to several courses conducted under various country projects.

A temporary adviser to the Regional Director was recruited to assist with the inter-country course on hospital housekeeping. A fourth and final course in this subject will be held in 1971. These courses have been the subject of evaluation by the national authorities, and it is now felt that this subject can be taught by national teachers at regular intervals, the teachers being selected from participants in IJHO-sponsored courses.

The data from the courses that have been conducted from the beginning of the project up to the end of 1970 have been tabulated and are being analysed in order

*Previous title: Short Courses for Nursing Personnel SEA/RC24/2 Page 182

to produce participant and course profiles. This information will be useful for planning the development of course content, improvement of teaching methods and evaluation of courses.

Plans were made for the development of a cyclical type of group educational activity, to be started early in 1972, for personnel representing the various disciplines forming the health team. The overall purposes will be to assist in the development and strengthening of the clinical services in the Region and to provide a wider knowledge for participants in the area under study.

Two short-term consultants were recruited to assist with the inter-country course on neurological patient care and rehabilitation to be held in Thailand at tt~cbeginning of July. They prepared teaching material and developed the clinical arcas to be used by the participants.

An increasing number of requests for reference material are being received from national and WHO staff, and the team has suggested suitable material, which has been made available to those concerned. A bibliography of reference materials available in the project has been compiled.

Kchydration Therapy (Feb. - March 1967; March 1970; March 1971 - )

Aim of the Project. To assist in producing rehydration fluid and in establishing rehydration centres in children's hospitals and at peripheral centres, and to train staff.

Assistance provided by WHO during the year. (a) Thrcc consultants; (b) cost .,i :~llk'nd.an(:r of participants; (c) supply of a double distillation uniL to Ceylon.

Probable duration of assistance. Until the end of 1974.

Work done during the year. A course on "Rehydration Therapy Centres" was held at Surabaja (Indonesia) from 12 to 16 April 1971. The 27 participants were senior paediatric teachers in medical faculties and paediatricians in charge of major paediatric units of non-teaching hospitals. A consultant and a national temporary adviser organized and conducted the course. The consultant also participated in three two-day workshops on cholera, organized by the Connnunicable-Disease Control Board of the Ministry of Health and held in Semarang, Makasar and Denpasar from 24 March to 3 April 1971. He also prepared and presented a paper entitled "Recent Advances in the Pathogenesis of Diarrhoea1 Diseases: Relation to Treatment and Prevention" at the National Paediatric Congress held in Bandung from 21 to 25 April. His report was under review in the Regional Office.

In the middle of April a consultant was assigned to Burma for three months to review the status of rehydration fluids. The production is estimated at 600 000 units annually as against the demand for 1.3 million units. The consultant's preliminary findings indicate that the machinery is worn out and needs to be replaced by modern equipment.

In Mongolia, a consultant assessed existing facilities for the production of rehydration fluids and held discussions with the authorities on the feasibility of a central plant in order to meet the requirement of the health and pharmaceutical sectors. SEAlRC2412 Page 183

SEARO 0148 Strengthening and Development of Health Services R (June 1970 - )

Aim of the project. To constitute a resource group and field arm for the Programme Support and Co-ordination Unit of the Regional Office, which will (1) assist in the analysis of WHO-assisted health projects and programmes; (2) help to identify areas in which operational and cost-benefit studies are needed; (3) participate in the design, conduct and evaluation of such studies, and (4) assist in co-ordinating all operational studies undertaken by the Regional Office.

Assistance provided by WHO during the year. (a) Two medical officers, a statistician and a nurse educator; (b) a clerk-stenographer; (c) a ten-day fellowship for a candidate from India for a study tour of Thailand; (d) supplies and equipment.

Probable duration of assistance. A number of years.

Work done during the year. The medical officer joined the project at the end of 1970 after attending the meeting of a scientific group on the development of studies in health manpower in Geneva as part of his briefing at WHO Headquarters. The team reviewed WI-10-assisted projects in which operational studies were planned or were being conducted. Assistance was given to project Thailand 0089, "Nursing Education and Services", in connection with the study of the activities of public health personnel, and for this purpose an orientation visit was paid to Thailand and to the United Nations Asian Institute for Economic Development and Planning in Bangkok.

A model for planning an operational study was developed.

The statistician on the team helped to prepare a summary of 1970 data processing and a plan of analysis for project India 0081, "Leprosy Control", and in this connection spent some time with the project in Pogiri.

Early in 1971, the team also visited Ceylon together with two WHO consultants and a medical officer from WHO Headquarters, to collect preliminary information and to prepare for the planning of a comprehensive health manpower study, to be conducted in co-operation with Headquarters, and of a study of the activities of public healLh personnel in Ceylon. At a meeting called by the Permanent Secretary, Ministry of ilealth, Government of Ceylon, which was attended by the Director of the Divis~onof Organization of Health Services from WHO Headquarters and the WHO Representative Lo Ceylon, Lhc proposal for these studies was approved.

The team also participated in a two-day discussion on the functional analysis of health needs and services organized by the Johns Hopkins University School of Hygiene and Public Health and held at the India International Centre, New Delhi, in January.

SEARO 0150 Swninars and Training Courses in Sanitary Engineering* R (Sept. 1970 - April 1971; - )

Aim of the project. To assist in training sanitary and civil engineers in specific aspects of environmental health requiring urgent attention.

Assistance provided by WHO during the year. Three sanitary engineering consultants.

Probable duration of assistance. A number of years.

*Previous title: Education and Training in Sanitary Engineering SEAlRC2412 Page 184

Work done during the year. Under this project assistance was given to Burma, Nepal and Thailand in different aspects of environmental health. The consultant assigned to Thailand from mid-September to mid-December assisted in the development of courses on storm-water drainage and sewerage at the University of Khon Kaen and in the establishment of n storm-water drainage and sewerage unit in the Division of Provincial Water Supply oi the Department of Public and Municipal [Jerks. tlis report is being sent to the Government.

The consultant posted to Nepal in November-December carried out a study of the solid wastes disposal situation in the country and provided assistance in the plon- ning nnil ~lcvelopmcntof a more effective refuse disposal system and in organizing short CI)L!~S~.Son this srlhject. llis report has been forwarded to the Government.

The cnnsciltant assigned to the Institute of Tcchnology, Ihngooo, Ourira, ltclpcd in org;mlzinl: :i training roursr ii~sanitary cngincering chemistry and in l;~borntory n~c,ll>odsand tc,cl~niqiies. llis rcpilrl- is under study.

-Training in ImunoLogy (ilcl. - kc. 1969; Nov. 1970; - )

Aim-. of 111~.project. To revicw progress in immunology, particularly as rcialrd to coomu~iicilblrdiseases; to strengthen training in this specialty.

Assistance provided by WHO durins the ycar. Two consultants.

Probable duration of assistance. A number oi years.

Work donc during tllc ycar. In November 1070, two consultants (on? uf tlte~llChief i,T Llii, 1lmnunolo~:y Unit front Wit0 licadquartcrs) undertook a review of insLitutcs rc,ndur.~- ing ialmum,lugicnl studirs wilhin tlbc Region, with particular reference to ro~lm~uni- cablc discascs. Initial steps were taken to set up a WHO Imunology Researrll ,111cl Training Centre.

Quality Control of Biological and Pharmaceutical i'roducts (Oct. - Nov. 1968; Jan. - Aug. 1969; Jan. - Feb. 1971; - )

i\im of thc project. To assist countries of the llegion in esLablisi,ing or strcng- tilening thcir quality control services and in improving laboratory competenrc, and to organize seminnri on tile qudlity control of biological and pharmaceulic.11 products.

Assistance provided by 1.ill0 during the year. (a) A temporary adviser and assistancc from a staff member assigned to an inter-country project; (b) cost of attendance of participants.

Probable duration of assistance. Some years.

Work done during the ycar. Thc Seminar on the Quality Control of Drugs at Inspector Level was held in Bangkok from 25 January to 6 February. The WllO temporary adviser who took up his assignnlcnt in the first week of January conducted the procr,rd- ings of the Seminar witlr the assistance of a field staff member.

The fifteen participants came from the drug quality control and pharmacy departments in Ceylon, India, Indonesia, Nepal and Thailand. The progr-e of the Seminar consisted of plenary sessions in the mornings wherein papers prepared by various drug manufacturing undertakings and officials from the Ministry of Public Healtll in Bangkok were presented and discussed. The afternoons were devoted to visits to drug factories. SEA/RC24/2 Page 185

The report on the Seminar was under preparation.

After the Seminar a one-week course for 35 drug inspectors was conducted by the WHO temporary adviser and the field staff member.

Health Laboratory Services (Aug. 1970 - )

Aim of the project. To review the progress achieved in the reorganization of national health laboratory services; to consider the administrative and technical operation and management of these services; to determine ways of standardizing methods, equipment, teaching, recording and reporting in order to formulate guidelines far co-ordination with recipient services such as epidemiological and health services, and to assist in the training of laboratory personnel.

Assistance provided by WHO during the year. (a) A consultant; for the meeting (see below), three consultants and two temporary advisers; (b) cost of attendance of participants.

Probable duration of assistance. A number of years.

Work done durin~the year. During August-November 1970, a WHO consultant visited Burma, Ceylon, India, Indonesia, Nepal and Thailand to review the status of public health laboratories, in preparation for a regional meeting on health laboratory services (see below). His reports were sent to the respective governments.

The Regional Meeting of Technical and Administrative Staff in Health Laboratory Services was held in the Regional Office from 16 to 20 November. Twenty-seven participants from five countries of the Region - Ceylon (2). India (17). Indonesia (3). Mongolia (2) and Thailand (3) - attended. The meeting, vhich was conducted by three WHO consultants (including the consultant mentioned above), and two temporary advisers, reviewed the various aspects of laboratory services, such as administration, organization and promotion, coardination with veterinary public health, maternal and child health and family planning, the legislative aspects of the practice of laboratory medicine, etc. It also discussed the findings of the hWO consultant on the visits mentioned above.

During fifteen plenary sessions and five study group sessions the participants highlighted the following points: (I) Laboratory services cannot be developed unless they are backed by a strong administration at the central level under qualified leadership and with a special budget; (2) Laboratory services, which are an integral part of the health services, should be developed pari paesu with other basic health services; (3) A definite career structure and a definite staffing pattern should be established; (0) Conferences should be organized at the national level, and (5) Consideration should be given to the organization of an inter-country workshop on teaching methodology in laboratory technology.

The report on the meeting has been forwarded to governments as well as to the participants.

Hospital Statistics and Medical Records (Jan. 1969 - )

Aim of the project. To assist governments of the Region: (i) in organizing an efficient system for the maintenance and flow of records in selected hospitals, (ii) in the collection, processing and presentation of hospital statistical data. and (iii) in training medical records and hospital statistics personnel. SEA/RC24/2 Page 186

Assistance provided by WHO during the year. (a) A statistician and a clerk- stenographer; (h) supplies and equipment (provided under project SEARO 0050)

Work done during the year. A statistician joined the project in November 1970 and is stationed in the Regional Office. He studied the background material pertaining to hospital statistics in the countries of the Region and prepared a draft plan of action for strengthening the collection, processing and presentation of data for use in planning national health services and in monitoring new activity.

The statistician visited Burma, Indonesia and Thailand. In Burma, he acquainted himself with statistical activities in the hospitals in Rangoon and reviewed and assisted in data processing. He also went to Mandalay to assess the feasibility of developing a medical record department in the General Hospital. In Indonesia, he reviewed the hospital statistics and medical record activities in Dr. Tjipto Hospital with a view to its development as a possible future training centre for hospital record officers and technicians. In Thailand, he studied the present system of collection, processing and analysis of data with a view to suggesting measures for their speedier publication and greater usefulness for health planning purposes.

The project will be merged with SEARO 0220, "Health Statistics, Records and Reports", in 1972.

SEAKO 0163 Course for Senior Teachers of Child Health R (June - Oct. 1970; - )

Aim of the project. To supplement assistance provided for the UNICEF-sponsored Course for Senior Teachers of Child Health.

Assistance provided by WHO during the year. (a) A consultant; (b) supplies and equipment for Burma.

Work done during the year. The WHO consultant assigned in June 1970 (briefly mentioned last year) to carry out an assessment of the benefits derived by participants from the Sauth-East Asia Region from their attendance at the WHO/ UNICEF-sponsored Course for Senior Teachers of Child Health completed her work in September 1970. She concluded that the course had considerably improved the performance of participants, but that encouragement of parent facultles and the support of governments in terms of more adequate staff, transport and equipment were essential to enable returning participants ta apply their new knowledge and skills. Her report has been forwarded to the institutions concerned and to UNICEF.

Another consultant was assigned for six weeks in September-October, to advise and assist in the conduct of a field study designed for the participants in the 1970 course, the scope of which was broadened to include an additional area - Africa. Based on past and present experience, he suggested a revisad curriculum for the Indian part of the course. His report has also been distributed.

A memorandum on the need for strengthening the Indian part of the course was prepared by the Regional Office for presentation at a review meeting held on 2 and 3 December 1970, attended by representatives of WHO, UNICEF and the institutions involved in the course.

SEARO 0169 Port Health R (Feb. - April 1969; Feb. - Sept. 1970; - ) Aim of the project. To assist in strengthening port health services. sEA/~C24/2 Page 187

Assistance provided by WHO during the year. A consultant.

Work done during the year. The WHO consultant assigned to Indonesia in February 1970 completed his work in September. He assisted the Government in the devclop- ment of an outline for a model port health service in Djakarta (Tandjong Priok) and in Denpasar (Bali), to serve the requirements of both an international seapurt and airport. He recommended, among other things, that (1) the international sea and airports should be provided with safe and sufficient water supply; (2) in- service training courses should be conducted for the staff of the port health service; (3) medical officers in charge of important sea and airport health services should be sent abroad to observe ports with modern facilities, and (4) there should be better cn-ordination between the quarantine unit and other health department units such as those dealing with smallpox and malaria eradication.

The report of the consultant has been sent to the Government

SEAKO 0172 Training in Mental Health R (Sept. 1970; - )

Aim of the project. To organize seminars on various aspects of mental health and to train personnel.

Assistance provided by WHO during the year. (a) A consultant, two temporary advisers and assistance from a staff member from Headquarters and one of the Regional Advisers on Medical Education; (b) cost of attendance of participants; (c) secretarial assistance.

Probable duration of assistance. Until 1977.

Work done during the year. A Seminar on the Teaching of Psychiatry was held at the All-India Institute of Medical Sciences in New Delhi from 17 to 19 September 1970. Two participants came from Burma, four each from Ceylon. Indonesia and Thailand, and seven from India. WHO provided a consultant (a professor of psychiatry), and a staff member frm Headquarters took part in the Seminar. The objectives were to take further the work initiated by the Seminar held in Agra in March 1968. In reviews made of developments in the countries of the participants, it was shown that the previous seminar had been a considerable stimulus to progress in all countries. The Seminar reaffirmed and extended the recammendations of the Agra seminar, discussed undergraduate and post-graduate training in psychiatry and emphasized its importance as a discipline in studying the normal and abnormal behaviour of man. The report is being sent to governments.

SEAR0 0174 Rehabilitation of Handicapped Children R (Oct. 1968 - Jan. 1969; April - June 1970; March - April 1971; - )

Aim of the project. To study the problems relating to handicapped children and the facilities available for rehabilitation, and to advise on the importance of these services.

Assistance provided by WtLO during the year. A specialist in medical rehabilitation (assigned to the Regional Office).

Idark done during the year. The specialist in medical rehabilitation visited various institutions concerned with this subject in Burma, Ceylon, Indonesia and Thailand for six weeks in March-April 1971, and held discussions with the staff of these institutions. His reports are being forwarded to the governments concerned. SEA/RC24/2 Page 188

SEARO 0176 Courses on Health Laboratory ~echniques* R (April 1969; Sept. - Oct. 1970; - )

Aim of the project. To assist with courses in health laboratory techniques.

Assistance provided by WHO dur~&thc year. (a) A consultant; (b) suppliea and equipment.

Probable duration of assistance. A number of years.

Work done during the year. During a six-week assignment in Ceylon, India, Indo- nesia and Thailand, a consultant paid a follow-up visit to the participants in the Seminar on the Fluorescent Antibody Test in the Diagnosis of Rabies (held in Coonoor in April 1969). lle has reported that the fluorescent antibody test (FAT) for the diagnosis of rabies is being very well performed in India (at the Central Research Institute, Kasauli, and the Pasteur Institute, Coonoor), Ceylon (Department of Virology, Medical Research Institute, Colombo), and mailand (Virus Research Institute, Department of Medical Sciences, Bangkok). Most of the laboratories are self-dependent, as they produce their own reagents. The same consultant visited Burma in March 1971 (see under Burma 0077).

Following the consultant's recommendations, which were sent to the governments concerned, action is being taken to institute a proficiency testing programme between the collaborating laboratories which use the FAT technique in the diagnosis of rabies, and to introduce a reference programe sponsored by the International Reference Centre to check the potency of rabies vaccine produced by the countries of the Region. The holding of a seminar on rabies vaccine (production, control and uses) is being discussed with governments.

Preparations are undcr way for holding a second course in laboratory techniques in Bombay in November 1971, on the topic "Immunohaematological Procedures in Blood Banking".

SEAR0 0178 National Health Planning and Manpower Studies UNDP (TA) (March 1969; July - Sept. 1969; Nov. 1969 - Feb. 1970; June 1970 - )

Aim of the Droject. To assist in the further development of national health planning in the countries of the Region through regional and national training courses, meetings and study groups and consultants to assist in the formulation of national health plans in delineating the health aspects of development plans, and in strengthening health planning units.

Assistance provided by WHO during the year. (a) Three consultants and assistance from the public health administrator assigned under SEARO 0102; (b) seventeen thirteen-month fellowships for candidates from Ceylon (2). India (6). Indonesia (5), Nepal (1) and Thailand (3) to follow the Second Regional Course on National Health Planning in India and Thailand; (c) cost of attendance of participants; (d) secretarial assistance.

Probable duration of assistance. Some years.

Work done during the year. A meeting of senior officials from ministries of health in the countries of the Region was held in Bangkok in October 1970. The meeting reviewed the progress made towards the development of planning cells in health ministries. The participants also discussed regionalization of health services, progrming of hospitals and the desirability of developing a charter for health

*Previous title: Seminar on Fluorescent Antibody Technique in Diagnosis of Rabies SEA/RC24/2 Page 189

for the countries in tile Region. It was proposed that baseline data should be collected and goals for achievement set. The report on the meeting has been distributed. A meeting of health ministers is planned for 1972.

The Second Regional Course on National Health Planning was held from 4 January to 2 April 1971. There were 18 participants, of whom 13 were public health administrators, two economists, two public administrators and one sanitary engineer. They came from Ceylon (2), India (6), Indonesia (5). Nepal (1) and Thailand (4). During the first two weeks, the participants made field observation studies in New Delhi. The remainder of the course, which took place at the Asian Institute for Economic Development and Planning, Bangkok, consisted of four parts: planning and development; interaction between development and health; planning for health, including tbc development of a health plan, and local field abserva- tion visits.

In the firi,t quarter of 1971, a consultant visited Indonesia to participate in, and assist in the conduct of, a course on the management of health services. A second consultant advised on the preliminary steps necessary for the development of ongoing registers of different categories of health personnel, training schools for such personnel and medical institutions such as hospitals and health centres; his report has been sent to the Government.

SEARO 0183 Teaching of Human Reproduction in Medical Schools R (7 - 11 December 1970)

Aim of the proiect. To assist governments having family planning as a national policy in strengthening the teaching of human reproduction, family planning and population dynamics in medical schools.

Assistance provided by WHO during the year. (a) Four consultants and assistance from the Regional Advisers on Medical Education and Maternal and Child Health; (b) cost of attendance of participants; (c) secretarial assistance.

Work done. A Meeting on the Teaching of Human Reproduction in Medical Schools was held in the Regional Office from 7 to 11 December 1970. There were 17 deans and principals or their designated representatives, from medical schools in Ceylon, India, Indonesia and Thailand. Four WD consultants (in curriculum development, human biology, obstetrics and child health), and two Regional Advisers organized and conducted the meeting. Agreement was reached an a series of measures required to strengthen Lhe teaching of human reproduction, family planning and population dynamics as a part of the medical curricula. The report has been distributed.

SEARO 0184 Seminar an School Health R (8 - 13 February 1971)

Aim of the proiect. To enablt school health officers, public health administrators and maternal and child health officers to discuss together and suggest Easures for improving scliool health services in the Region.

Assistance provided by WO during the year. (a) Three consultants; (b) cost of attendance of participants.

Work done. The Seminar was held from 8 to 13 February 1971 in Rangoon, Burma. The 20 participants were senior health officials concerned with school health progr-es in Burma (9). Ceylon (I), India (3). Indonesia (4) and Thailand (3). In addition, there were nine resource persons and twenty observers from the departments of health, education and social welfare of Burma. SFA/RC24/2 Page 190

Three consultants in school health administration, nursing and health education and a national temporary adviser on school health planned, prepared, conducted and evaluated the seminar, in which views were exchanged on recent trends and the status of the health of the school-age child in the Region, and agreement was reached on priority areas in need of improvement and measures to be adopted for this purpose.

Thr report of the seminar is being distributed to the governments concerned.

SEARO 0185 Education in Public Eealth R (Jan. 1971; March 1971; - )

Aim of the project. To promote post-graduate education in public health.

Assistance provided by WHO during the year. (a) Two consultants and a temporary adviser; (b) cost of attendance of participants; (c) secretarial assistance.

Work done during the year. The Fourth Meeting of Directors or Representatives of Schools of Public Health was held in the Regional Office from 24 to 29 March. Twenty-nine participants from four WHO Regions (Africa, Eastern Mediterranean, South-East Asia and Western Pacific) representing 20 countries attended the meeting. There were also four observers. The WHO Regional Directors for the Eastern Mediter- ranean, South-East Asia and Western Pacific also attended, together with several staff members from the three Regional Offices. The Regional Director for Africa, who could not attend owing to indisposition, was represented. Four staff members from WHO Headquarters also participated in the meeting, which was assisted by two consultants and a temporary adviser. The temporary adviser paid a preparatory visit to the Regional Office in January.

This was the fourth in a series of such meetings to promote post-graduate education in public health, and following important discussions and recommendations made at these earlier meetings, a Regional Association of Schools of Public Health had been established, the First General Assembly of which was held during this meeting.

The following were among the subjects discussed: (1) New developments in research and the teaching of epidemiology, with particular reference to human ecology; (2) The relationship and functions of schools of public health and departments of social and preventive medicine in undergraduate medical education; (3) Training of specialists in public health with comparable status to specialists in other medical fields; (4) The role of schools of public health in the training of auxiliaries; (5) New directives in training for public health and the establishment of new schools of public health on a national or regional basis, and (6) Teaching techniques and the place of audiovisual aids in public health cducation.

The report was being processed.

SEARO 0191 Regional Serum Reference Centre R (Feb. - April 1971; - )

Aim of the project. To build up competence in serum reference procedures in the Region, and ultimately to assist in establishing a regional centre.

Assistance provided by WHO during the year. A consultant. SEA/RC24/2 Page 191

Work done during the year. During February-April, a specialist on serum reference banks undertook a six-week survey of selected institutions in Ceylon, India and Thailand with a view to exploring their potentialities for regional serum reference activities.

According to the consultant, the establishment of a regional serum reference bank, which is an integrated system involving an intricate mechanism and requiring a complex multi-disciplinary organization, will take some time. Meanwhile, efforts should be focussed on establishing, in every country, adequate facilities for the long-term storage of individual and small collections of sera. The designated laboratory will handle such sera, distribute them to collaborative laboratories as necessary, and provide the necessary documentation. Assistance will be required in training staff.

The report of the consultant was under study.

SEARO 0192 Regional Team on Family Health UNFPA (Aug. 1970 - )

Aim of the project. To support country and inter-country activities in family health with regard to services, training, evaluation and research embracing family health.

-.Assistmce prpvrded by WO during &Its year. (a) A medical officer, s health .?ducator, a statisLicinn and a nurse; (b) supplics and equipment.

Work done during the rear The recruitment of the regional team was completed during the year. The health educator and the medical officer took up duties in August and September 1970 respectively, the nurse in January 1971 and the health statistician in Februacy. The main activities of the team, on bath a joint and an individual basis, included orientation visits to various institutions and discussions with health officials concerned with family health in India, Indonesia and Thailand; assistance to two training courses for medical officers (Indonesia 0112) and to the workshop for the training of midwifery personnel (Indonesia Olll), and attendance at selected national and international meetings and group educational activities related to family health. In the Regional Office, the team worked in close collaboration with the Regional Advisers on Health Education, Health Statistics, Nursing and Maternal and Child Health.

SEARO 0193* sonal Epidemiological Surveillance Team R (Scpt. 1966 - )

Aim of the proiect. To assist in strengthening epidemiological surveillance programmes directed towards priority diseases, in introducing epidemiological surveillance activities into the normal functions of local health services, and in training staff.

Assistance provided by WHO during the year. (a) An epidemiologist, a bacteriolo- gist and a clerk-stenographer; (b) supplies and equipment.

Probable duration of assistance. A number of years.

Uork done during the year. Early in 1971, the team shifted its base to the National Institute of Communicable Diseases, Delhi. It undertook a study of the

*Previous number: SEAR0 0146 SEA/RC24/2 Page 192

incidence of various communicable diseases in the Region; the collection of baseline data in respect of the more important diseases was completed. Most of the countries of the Region were visited and epidemiological surveillance facilities reviewed. One of the medical officers assisted with a cholera course held at the Haffkine Institute, Bombay, and a seminar on cholera which took place at Tirunelveli (India). The team leader participated in a symposium on "Basic Principles and Practice of Immunology", which was organized in Bandung (Indonesia) in April. He also accompanied the Chief of Epidemiological Surveillance from WHO Headquarters on visits to various institutions in Delhi and Bangkok to review the progress of epidemiological surveillance activities.

SEARO 0194 WHO-sponsored Training Centre for Nurses R (Wcllington, New Zealand) (Jan. 1970 - )

Aim of the project. Ta provide a training progrme for nurses from the Region who cannot obtain admission to other post-basic courses because of lack of the secondary education and/or the language skills required for admission.

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

Work done during the year. The first group of eight students completed their course in December and all of them returned to their respective countries to take up work in government health services. Plans were prepared for follow-up of the five students coming from countries of the South-East Asia Region.

The second course began in January, with ten students enrolled - one from Indonesia, four from Nepal and five from Thailand.

Renovations of the Centre's building were completed. Supplies and equipment provided by WHO were arriving.

Work continued on the development of the curriculum. The identification of effective learning experiences meeting the needs of individual students received particular attention. Hospitals, public health centres and educational institutions in various parts of New Zealand responded with interest to requests to help provide these experiences, and both students and staff expressed appreciation of the co-operation received.

The health of the students on arrival at the Centre continued to prcsent problems. All students were provided with free health examinations and services by the New Zealand Government.

The Principal of the School of Advanced Nursing Studies, under whose overall direction the Centre operates, visited the Regional Office in the last quarter of 1970, when discussions were held regarding the curriculum.

At the request of countries sending students to the Centre, the admission requirements were changed to allow enrolment of nurses who have had post-basic studies in their own country but who are not eligible for admission to regular post-basic programmes abroad.

SEAR0 0195 Regional Symposium on Vesical Calculus R (Feb. - March 1971; - )

Abof the project. To review present knowledge on vesical calculus and explore means of preventing it. SEAlRC2412 Page 193

Assistance provided by WHO during the year. A consultant

Work done during the year. A WHO consultant visited Thailand to make preparations for this symposium, which is to be held in Bangkok early in 1972.

SEARO 0198 Regional Documentation Centre - Human Reproduction, UNFPA Family Planning and Population Dynamics (Jan. 1971 - )

Aim of thc project. To set up, in the Regional Office, a regional centre to reproduce basic reports and documentation on various aspects of human reproductiun, family planning and population dynamics for wide distribution, particularly to schools for professional and auxiliary health workers, to the health services and to the main hsalth institutions in the Region.

Assistance provided by WHO during the year. Supplies, including photocopier.

Work done during the year. The recommendations of the consultant assigned in May-August 1970 (under project SEARO 0173) to prepare a plan for setting up a regional documentation centre on human reproduction, family planning and population dynamics were accepted in principle. The project remained in its initial stage of implementation on account of the time involved in the recruitment of a suitable candidate for the post of documentation officer (head of the centre). Orders were placed for books, for subscriptions to journals, and for the photo- copying machine recommended by the consultant, and the material was beginning to arrive.

SEARO 0211 Public Health Advisory Services, Mekong Committee R (Sept. 1968 - )

Aim of the project. To provide technical advice to the Co-ordinating Committee for the Development of Lower Mekong River Basin; to advise on the prevention of comunicable diseases resulting from the changes in environment due to man-made lakes and other irrigation works.

Assistance provided by WHO during the year. A sanitary engineer.

Probable duration of assistance. A number of years.

Work done during the year. The WHO sanitary engineer (malaria) continued to carry out studies and observations of public health problems connected with water resources development in the Lower Mekong Basin, especially in respect of malaria in North-east Thailand.

He has developed a model for investigations of malaria control measures on water development projects, which is now being used as a guide in the implementation of the various activities in the area.

He has completed three reports on the series of studies on malaria potential in selected tributary projects - the first was issued in October 1970 on the multi-purpose project at Nampong,the second in December on the Nam Phrom hydro- electric scheme, and the third in early 1971 on the multi-purpose project at Lam Dom Noi. SEA/llC24/2 Page 194

Workshop on the Promotion of Public Eealth Information (19 - 23 April 1971)

Nm of the project. To strengthen the impact of public health information on regional media such as press, radio and television.

Assistance provided by WHO during the year. (a) Two temporary advisers; (b) cost of attendance of participants.

IJork done. The Workshop, held in New Delhi from 19 to 23 April, was the first of its kind organized by WHO. The 16 participants, from Ceylon, India, Indonesia, Nepal and Thailand, were information officers of ministries of health and information, health educators, and programme directors of radio and television services. The agenda included statements by the participants on the objectives of thcir national information policies in the field of public health and on the use of material provided by WHO. Two temporary advisers, representing national as well as internatioaal experience in information work, made suggestions as to methods by which to strengthen the impact of public health information on the public in general. A stimulating discussion ensued.

The workshop yielded worthwhile recommendations which might become future guidelines for all those engaged in national as well as international endeavours towards the promotion of public health information. A report on the workshop is under preparation. SEA/RC24/2 Page 195

10. INTER-REGIONAL (PROJECTS WITHIN THE REGION)*

PROJECT LIST

Project No. Source of Funds Co-operating A~encies Title

Inter-regional 0188 Economic Commission for Asia and the Far East R (.July 1970 - )

Aim of tlri, project. To carry out liaison functions with ECAFE.

tlsslstancr provided by WHO during the year. (a) A liaison officer; (b) supplies and equipment.

Probable duration of assistance. Some years.

\?ark done during the year. The liaison ~ificerattended numerous meetings of ECAFE as well as the Mekong Secretariat and Committee on behalf of WHO, presenting the Organization's policies and views. He also facilitated exchanges of views and co- ordination of activities of mutual interest, and advised on the health aspects of jointly-assisted projects (see also paragraph 4.1.5 in Chapter 4, Part 11).

Inter-regional 0190 LeprosyIBCG Trial Team, Burma R (April 1964 - )

Aim of the project. To carry out a trial to assess the value of BCG vaccination in the prevention of leprosy and obtain information on epidemiology, immunology, bacteriology, therapy and clinical aspects of leprosy.

Assistance provided by WHO during the year. A leprologist, a scientist and a statistician.

Probable duration of assistance. Until 1974.

Work done during the year. The team continued its work according to plan. The groups of vaccinated children have been carefully followed up and periodically examined for signs and symptoms of leprosy.

It is still early to draw conclusions as to whetlier BCG gives a protection against leprosy, but it is expected that, in a few years, the information collrctrd by the project will be sufficient to give a definite reply.

xThis list includes meetings and seminars held within the Region for wlricll the main responsibility was that of k'H0 Headquarters. However, assistance in their organization has often been given by the Regional Office, which also has some- times financed its own participation. Meetings of this nature for which the Regional Office has the main responsibility are listed in Section 9. SEA/RC24/2 Page 196

Inter-regional 0306 Aedes Research Unit, Bangkok Special Account (April 1966 - ) fir Medical Rcsearch

Aim of the projcct. To carry out research on the ecology and population dynamics of the Aedes vectors of haemorrhagic fever and dengue, particularly A. aegypti and A. albopictus, with the objective of developing effective methods of interrupting transmission of these diseases; also to carry out field trials on the control of A. aeg~pt,i,using organa-phosphorus.carbamate and other insecticides and biological control procedures; and to examine new techniques which are now only at an cxperimcnt;~l stage.

Assistance provided by WllO durinr; the year. A medical officer, an cntomolagiet and a consultant.

Work done during the year. The research activities in Aedes species continued according to plan. New knowledge about the ecology, bionomics and resistance of these mosquitoes has been acquired, and techniques for ultra-law volume aerial and ground spraying have been developed. It has been observed that by new spraying techniques a gross reduction of adult mosquitoes can be quickly achieved; however, if this is not comhined with adequate larvicidal action, the density tends to be quickly restored.

These and other observations represent a solid ground for the planning and implementation of efficient control of outbreaks of diseases transmitted by Aeifes mosquitoes.

1nli.t-rcpiorial 0439 Coursc on Health and Manpower Planning I< (12 Oct. - 27 Nov. 1970)

Aim of the project. To give orientation to teachers in medical schools or institutions providing post-graduate education in preventive and social medicine dnd in public health and ta professors of public health engineering and public il~~ithnursing, with a view to encouraging the introduction of health and manpower planning as an integral component of the public health curriculum in their respective schools.

Assistun~cprovided by WHO during the year. (a) Wo consultants; (b) cosl of attendance of eartici~ants:. (c).. grant to the National Institute of Health AdministraLion and Education, New Delhi.

Work done. This inter-regional course was held at the National Institute of Health Administration and Education, New Delhi, from 12 October to 27 November 1970. There were 19 participants from five WHO regions (the Americas, South-East Asia, Europe, the Eastern Mediterranean and the Western Pacific). The course comprised three phases - health and development, health planning for development, and development of health planning curricula - during each of which several topics were considered.

Inter-regional 0445 Inter-regional and Regional Cholera Teams UN DP (TA) (Aug. 1970 - )

Aim of the project. To assist in organizing epidemiological and other studies on cholera, and to advise the health authorities of countries where the disease is prevalent on the application of control measures and on new techniques of diagnosis and treatment. SEA/RC24/2 Page 197

Assistance provided by WHO during the year. ltro consultants and temporary assistance from Headquarters and field project staff.

Work done during the year. Assistance was provided to the countries of the Region in studies on the effect of improvements in the environment on the spread of cholera, in controlling cholera outbreaks, and in improving microbiological and epidemiological investigations. Four WHO consultants visited India, Indonesia and Thailand for chis purpose as well as to observe their laboratory facilities for increasing vaccine production as necessary.

Inter-region. Research Unit on the Genetic Control of Special Account Culicine Mosquitoes, India for Medical (Oct. 1969 - )

Aim of the project. To conduct research into the feasibility of controlling CuZex fatigans and Aedes aegypti on an operational scale by genetic manipulation.

Assistance provlded by WHO during the year. A medical officer, an entomologist, an ecologist, nine consultants, an administrative assistant, a senior assistant and four assistants.

liurk done during the year. The sccond and third meeting of the Technical Planning and Review Croup of the Unit were held in New Delhi from 9 to 14 November 1970 and 29 March to 2 April 1971 respectively. Representatives of WHO, the Indian Council of Medical Research, the United States Public Health Service and the National Institute of Communicable Diseases, Delhi, attended both meetings. In addition, eight consultants from Australia, France, the Federal Republic of Germany, Uniti,d Kingdom, and tile USA wcre present at the third meeting.

Progress in all phases of Culer fativans research is in most cases ahead of schedule with significant advances in the areas of estimation of absolute populations, determination of reproductive potential of field populations, induction of translocations for semi-sterility and development of mass rearing methods. For the first time it was possible to introduce sterility successfully in a natural population by the release of irradiated males.

The staff is now in full strength, with a project leader, an entomlogist, an ecologist and consultants providing assistance to over 50 national staff intimately involved in the research.

In Warch, twu consultants initiated a field investigation in the State of Gujarat to study the effects of DDT on the human population.

Incer-regional 0539 Seminar on Surveillance and Assessment in R Smallpox Eradication Programmes (30 Nov. - 5 Dec. 1970)

A:f I tot. 'To strengthen the reporting, surveillance/containoenL activities of the sn~allpoxeradication programmes in the Eastern Mediterranean and South-East. Asia Kegions and to study border problems, assessment methods and recent technical developments in the field of smallpox.

Assistance provided by WtlO during the year. (a) Six consultants and assistance from the Chief and two other staff members of the Smallpox Eradication Unit, Headquarters, and from several other staff members from different Regional Offices and field projects; (b) cost of attendance of participants. SEAlRC24/2 Page 198

Work done. This inter-regional seminar was held in the Regional Office from 30 November to 5 December. Besides national representatives from Afghanistan (4), Burma (1). India ~ ~. (13), Indonesia (lo), Nepal (1) and Pakistan (6), WHO staff from Headquarters and the Eastern Mediterranean and South-East Asia Regions participated in the Seminar. A number of smallpox eradication programme officers from the various States in India also attended as observers.

The papers presented and the subsequent discussions centred mainly around problems of smallpox surveillance, epidemiological field investigations. methodology of containment of outbreaks, border problems, assessment of the progress of the programmes and recent technical developments in the field of smallpox.

Those attending the Seminar also participated in a field teaching exercise, The final discussions were concerned with the formulation of recornendations by representatives of the various countries.

Inter-regional 0568 Teaching of Human Reproduction in Medical Schools R (Nav. 1969 - March 1970; Nov. - Dec. 1970; - ) Aim of the project. To advise an the teaching in medical schools of human reproduction, family planning and population dynamics, and to assist in incorporating, integrating or ca-ordinating such teaching within the mcdical curriculum.

Assistance provided by WHO during the year. (a) Three consultants; (b) supporting services.

Work done during the year. During November-December 1970,a team of three consultants (in curriculum development, child health and obstetrics/gynaecology) studied and advised an the teaching of human reproduction, family planning and population dynamics in medical schools in Thailand. The report of the team emphasized the need for including behavioural sciences in the medical course of studies from the first year and onwards; close collaboration among all departments, both preclinical and clinical, cancerncd with the teaching of human reproduction; organization of workshops for faculty members on teaching methods related to human reproduction; close working relationship between the faculties of medicine and the Ministry of Public Ilcalth, especially in field practice areas, and the purchase and distribution of selected textbooks on loan or on sale to medical students at low prices. Other recornendations related to the establishment of an Association of Medical Schools in Thailand and international assistance to strengthen the teaching of human reproduc- Lion in medical schools under the WHO/UNFPA-assisted project. "Teaching of Human Reproduction, Family I'lanning and I'apulation Dynamics in Medical Schools"(Thai1and 0115).

The report of the consultants is being forwarded to the Government.

Aim of the project. To present recent advances in the biological, physiological, clinical and public health aspects of human reproduction, including family planning.

A~sistance providcd by WHO during the year. (a) Four consultants and assistance from the Regional Adviser on Maternal and Child Health; (b) cost of attendance of participants; (c) secretarial assistance. SEAlRC2412 Page 199

Work done. The Regional Office collaborated with WHO Headquarters in the organization of wo seminars, held in Bangkok (12-15 October) and Bangalore (19-22 October). The faculty consisted of four consultants - in the disciplines of child health, obstetrics, gynaecology and reproductive physiology. Thirty- four participants from Thailand and six from Malaysia attended the Bangkok seminar, and 49 from all parts of India attended the seminar held in Bangalore.

A wide range of subjects related to the aims of the seminars was covered in the discussions and in the final presentation. The seminars provided an opportunity for key personnel in the fields of public health administration, teaching and research to become acquainted with the most recent advances in their own areas of interest. SEA/RC24/2 Page 201

11. INTER-REGIONAL (PROJECTS OUTSIDE THE REGION WITH PARTICIPANTS FROM THE SOUTH-EAST ASIA REGION)

Project No. and Number of Source of Funds Title Participants

Inter-regional 0113 Tenth Course on the Epidemiology and 4 (1 from India, UNDP (TA) Control of Tuberculosis, Czechoslovakia 2 from Indonesia & and India 1 from Thailand) (1 April - 1 July 1971)

Inter-regional 0120.1 llienty-first Anaesthesiology Course, 2 (1 from Indonesia 6 UNDP (TA) Copenhagen 1 from Thailand) (18 January - 11 December 1971)

Intcr-regional 0239 Fourth Advanced Course in Clinical 2 (1 from India & UNDP (TA) Chemistry, Copenhagen 1 from Thailand) (1 April - 15 June 1971)

Inter-regional 0473 Fourth Advanced Training Course in 7 (3 from India, Regular Maternal and Child Health, Warsaw 1 from Indonesia 6 (7 September - 26 October 1970) 3 from Thailand)

Inter-regional 0479 Course on Diagnostic Techniques for 2 (1 from India 6 Regular Haemoglobinopathies and Allied 1 from Thailand) Disorders, Accra (19 October - 3 November 1970)

Inter-regional 0492 Training Course on In-service Education 2 (1 from India & Voluntary for Nursing Personnel, Copenhagen 1 from Thailand) Fund for Health (5 September - 17 October 1970) Promotion

Inter-regional 0493 Travelling Seminar on Mental Bealth 1 from India UNDP (TA) Services. USSR (1-21 September 1970)

Inter-regional 0496.2 Inter-regional Travelling Seminar on 2 from Mongolia UNDP (TA) the Organization of Refresher Courses for Medical Staff, USSR (12-30 October 1970)

Lnter-regional 0537.2 Seminar on Methods of Epidemiological 4 (1 from Ceylon, Regular Surveillance of Communicable Diseases, 1 from India 6 Prague 2 from Indonesia) (5-17 October 1970)

Lnter-regional 0548 Seminar on Control of Echinococosis 1 from India Regular (Hydatidosis), Buenos Aires (14-19 September 1970)

Inter-regional 0557 Meeting on "The Midwife in Maternity 3 (2 from Ceylon & Regular Care", Singapore 1 from Indonesia) (26-31 October 1970) SEAlRC2412 Page 202

Project No. and Number of Source of Funds Title Participants

Inter-regional 0567 Course at the WO International 2 (1 from India & Regular Reference Centre for inrmunoglobulins, 1 from Thailand) Lausanne, Switzerland (7-26 September 1970)

Inter-regional 0592 Seminar on the Control of Biological 3 (1 from India, Regular Substances. Tokyo 1 from Indonesia & (1-24 October 1970) 1 from Thailand

Inter-regional 0600 Seminar on the Use of Medical 7 (1 from Ceylon, Regular Radiological Apparatus and Facilities, 2 from India, Singapore ? from Indonesia & (9-21 November 1970) 2 from Thailand)

Inter-regional 0631 Travelling Seminar on the Purification 3 (1 from India, UNDP (TA) and Disinfection of Drinking Water, USSR 1 from Nepal & (6-28 Play 1971) 1 from Thailand)

Inter-regional 0664 Seminar on Organization of Cholera 5 (1 from Burma, Voluntary Fond Control Programmes, Manila 2 from Indonesia, for Healtlt (6-9 October 1970) 1 from Nepal 6 Promotion 1 from Thailand) SEA/RC24/2 Page 203 REGIONAL CWMITFE3 I REGIONAL DIRECTOR

I PUBLIC INFWMATION

DIRBCMR, ElFALlB SERVICES

I I Mi0 OPFICB m CFIIW. ASSISTAm DIRBCTCRS EDUCATION AND TMUiING -ATI'LM ~,"~~~~~," AMINISTIUTION & EmAWE

, I I 0 I I I 1 I I I I I

0 I I 1 I TEHNICAL SPBCIALISPS I I I I nMnic &-generative Diseases Malaria I I Cmmxdcable Diseases Maternal and Child Health (Family Health) I I :mmnlty Health Services Medical Education I I____ Pnvix-mme"tal Health Numing I I Health Education Nutrition I Health Iaboratory Services Public Health I Health Statistics S~11pox I I I > I I rnICAL SUPPLIBS I I I I I I I I I I I RDMINISTMTNE I I 1 I I I I I I 1 I I I I------FIELD PROORAVME ------1 - h C. Poll. Co=mftl Wfb I I2 U. KOM - DC 0.B. J[illcri FnVlrmnCU Wfh - b Z.J. BIZ0 -I&- 9. Un3UI - Dr R. ww - h- v. Pasek?1em - h 0.9. Tk.11 m1m plsnine -Wr noluit.8t) I Hrlth St.tistlca - S%- R. Padlw - )ba 0.c. he& - fi F.R.S. MIIett - h 0. Darn* .. - m 5. wenre1. - h O.L. I\- mte-1 k Child hlth - h P.J.Hwtin&omm - Dr "t. PPm- - Dr E.O. -1 - I2 A.R. WlLS - Nlss D.C. R.11 SEAlRC2412 Page 207 Annex 2

GEOGRAPHICAL DISTRIBUTION OF INTERNATIONAL STAFF ASSIGNED TO THE SOUTH-EAST ASIA REGION (AS ON 30 JUNE 1971)

Regional Office Field Country including WRs Advisers staff

Afghanistan Australia Austria Belgium Bolivia Brazil Bulgaria Burma Canada Ceylon Czechoslovakia Denmark Ecuador Finland France Gcrmanv. Federal Re~ublicof Greece Guatemala Guyana India Lndones ia Ireland Italy Jamaica Japan Korea, Republic of Mexico Morocco Nepal Netherlands New Zealand Philippines Poland Sweden Tanzania Thailand Union of Soviet Socialist Republics United Arab Republic United Kingdom of Great Britain and Northern Ireland United States of America Viet-Nam Yugoslavia Zambia

Total I 19 SEA/RC24/2 Page 208 Annex 3

MEETINGS AND COURSES ORGANIZED BY WHO AND HELD IN THE SOUTH-EAST ASIA REGION* (1 August 1970 - 30 June 1971)

6-8 August Workshop on Co-ordination of National Djakarta and International Resources in the National Family Planning Programme (Indonesia 0110)

24 August - Seminar on Problems of Health Care Colombo 1 September in the Tropics (SEAR0 0096)

17-19 September Teaching of Psychiatry in Medical New Delhi Colleges (SEARO 0172)

5-22 October Short Course on Planning for Patient Bangkok Care (SEARO 0139)

12-14 October Discussion Group Meeting on National Bangkok Health Planning (SEARO 0178)

12-16 October Seminar on Advances in Physiological, Bangkok Clinical and Public Health Aspects of Human Reproduction (Inter-regional 0569)

19-22 October Seminar on Advances in Physiological, Bangalore Clinical and Public Health Aspects of (India) Human Reproduction (Inter-regional 0569)

2-27 November Short Course on Hospital Housekeeping Hyderabad (SEAR0 0139) (India)

4-14 November Seminar on Water Pollution Control Bangkok (SEARO 0132)

8-11 November Symposium on Academic Education and Ahmedabad Training in Occupational Health and (India) Hygiene (India 0197)

9-27 November Short Course on Planning for Patient Bangkok Care (SEARO 0139)

*~xcludin~national courses or meetings in which WHO assistance was restricted to the provision of consultants. SEA/RC24/2 Page 209 Annex 3

14 November - Medical. Teachers' Training Course Peradeniya 4 December (SEAR0 0096) (Ceylon)

16-20 November Meeting of Technical and Administrative New Delhi Staff in Health Laboratory Services (SEARO 0159)

16-27 November Workshop on School Health Education Bangkok (SEARO 0130)

30 November - Seminar on Surveillance and Assessment New Delhi 5 December in Smallpox Eradication (Inter-regional 0539)

7-11 December Meeting of Deans and Principals on the New Delhi Teaching of Human Reproduction in Medical Schools (SEARO 0183)

4 January - Second Regional Course on National New Delhi & 2 April Health Planning (SEAR0 0178) Bangkok

18 January - Organization of Patient Care in the New Delhi 12 February Ward (SEARO 0139)

18 January - Training Course on the Health Aspects Indonesia/ 20 March of Human Reproduction (Indonesia 0112) Thailand/ India

25 January - Seminar on the Quality Control of Bangkok 6 February Drugs at Inspector Level (SEARO 0154)

1-5 February Seminar on the Organization and Future New Delhi Needs of Mental Health Services (India 0220)

8-13 February Seminar on School Health (SEAR0 0184) Rangoon

8-22 February Teaciiing of Health Statistics in Djakarta Medical Schools (Indonesia 0062)

15-27 February National Workshop on the Training of Djakarta Midwifery Personnel (Indonesia 0111)

22-25 February Seminar on Rheumatic Heart Disease, New Delhi Epidemiology, Prophylaxis and Clinical Management (India 0221) SEA/RC24/2 Page 210 Annex 3

12 March - Guidance and Counselling in Schools of Colombo 7 April Nursing (SEARO 0139)

24-29 March Meeting of Directors or Representatives New Delhi of Schools of Public Health (SEARO 0185)

5-17 April Course on Rehydration Therapy Centres Djakarta (SEARO 0144)

19-23 April Inter-country Workshop on the Promotion New Delhi of Public Health Information (SEARO 0218)

10 May - 1 July Training Course on the Health Aspects Indonesia/ of Human Reproduction (Indonesia 0112) India

17-22 May Workshop on the Integration of Maternal New Delhi and Child Health and Family Planning Services in Rural Areas (India 0278)

28 June - Workshop on Operational Studies Related New Delhi 3 July to the Integration of Maternal and Child Health and Family Planning Services (India 0278) SEA/RC24/2 Page 211 Annex 4

CONFERENCES AND MEETINGS IN THE SOUTH-EAST ASIA REGION CALLED BY THE UNITED NATIONS AND ITS RELATED SPECIALIZED AGENCIES AT WHICH WHO WAS REPRESENTED (1 August 1970 - 30 June 1971)

7 September - UNESCO: Regional Workshop on Popula- Bangkok 7 October tion and Family Education

14-25 September ILO: Fourteenth Session of the Asian Bandung Advisory Committee (Indonesia)

5-11 October UNESCO: Regional Meeting of Members Bangkok of the Asian National Committees for the International Hydrological Decade

2 November - ECAFE and Government of India: Sub- Bombay 12 December regional Training Course on Fertility and Family Planning Evaluation

9-16 November ECAFE: Amplified Basin Plan Seminar Bangkok of the Mekong Committee

30 November - ECAFE: Meeting of the Expert Group on Bangkok 5 December Social Development

8-15 December ECAFE: Meeting of the Working Party Bangkok on Social Development

18-30 January ECAFE: Regional Seminar on the Inter- Bangkok relation between Population and Manpower Problems

29 January - ECAFE: Committee on Industry and Bangkok 6 February Natural Resources, Twenty-third Session

8-9 February UNFPA: Meeting of the Executive Bangkok Director with United Nations Agencies in8 Government of Thailand

14-28 February United Nations Development Prograrmne: New Delhi Global Meeting of Resident Representa- tives SEA/RC24/2 Page 212 Annex 4

8-26 March ECAFE/UNITAR: Regional Seminar on Bangkok Techniques and Procedures of United Nations Technical Assistance

22-27 March ILO: Seminar on Population and Family New Delhi Planning

18-20 May ECAFE: Second Meeting of the Bangkok Preparatory Committee for the Second Asian Population Conference SEA/RC24/2 Page 213 Annex 5

CONFERENCES AND MEETINGS OF GOVERNMENTAL, NON-GOVERNMENTAL AND OTHER ORGANIZATIONS HELD IN THE SOUTH-EAST ASIA REGION AT WHICH WHO WAS REPRESENTED (1 August 1970 - 30 June 1971)

22-29 August World University Service: General Madras Assembly Session, 1970 (India)

31 August - Indian Council of Medical Research: Nsw Delhi 10 November Annual Meeting of Groups Established by the Scientific Advisory Board

5-6 October Trained Nurses Association of India: Lucknow Meeting of the Council (India)

25-30 October International Committee on Internal New Delhi Medicine/Association of Physicians of India: XI International Congress of Internal Medicine

2-6 November Government of Thailand: National Bangkok Seminar on Children and Youth in National Economic and Social Development

26-28 November Asian-Pacific League of Physical Colombo Medicine and Rehabilitation and Ceylon Medical Association: First International Assembly of the League

1-9 January Indian Science Congress: 58th Session Bangalore (Section on Medical and Veterinary (India) Science)

2-5 January Tuberculosis Association of India: Bangalore 26th National Conference on Tuber- culosis and Chest Diseases

4- 7 January Indian Academy of Paediatrics: Eighth Vellore National Conference (India)

8-10 January Indian Association for the Advancement Tirupati of Medical Education: Tenth Annual (India) Conference sEA/~C24/2 Page 214 Annex 5

19-20 January The Johns Hopkins UniversityIRural New Delhi Health Research Centre: Functional Analysis Project Conference

22-24 January Indian Public Health Association: Allahabad Fifteenth Annual Conference (India)

28 January - International Union of Nutritional Hyderabad 2 February Sciences, Nutrition Society of India (India) and Indian National Science Academy: First Asian Congress of Nutrition

22-24 February Trained Nurses Association of India - New Delhi Council Meetings

8-9 April Institution of Engineers (India): Roorkee Seminar on Water and Sanitation (India) Problems of Urban Areas

21-25 April Indonesian Paediatric Society: Second Bandung National Paediatric Congress (Indonesia)

17-19 June Indian Institute of Public Adminis- New Delhi tration: Seminar on Family Planning Policy and Administration sEA/~C24/2 Page 215 Annex 6

RESEARCH ACTIVITIES IN THE SOUTH-EAST ASIA REGION SUPPORTED BY WHO GRANTS MADE DURING THE PERIOD 1 AUGUST 1970 - 30 JUNE 1971*

Research Institution I Air pollution Central Public Health Engineering I Research Institute, Nagpur (India) I Studies on snake antivenins 1 Queen Saovabha Memorial Institute, I Bangkok

Studies on the epidemiology Veterinary and Agricultural and pathogenesis of Scientific Research Institute, brucellosis Ulan Bator

1 Studies on the arboviruses 1 Virus Research Centre, Poona I I (India) Study of the genetics of Central Drug Research Institute, vaccine strains of V. choZerae Lucknow (India) I Epidemiological studies on Division of Comunicable Diseases cholera for evaluation of Control, Ministry of Public Health, various sanitary facilities Djakarta for cholera control

Studies on carriers and Indian Council of Medical immunology of cholera Research, New Delhi

Study of cholera vaccines Haffkine Institute, Bombay on animal models I I Studies on human chromosome Institute of Genetic Studies, anomalies in Bangalore Bangalore (India)

The status of health National Institute of Health education in teaching Administration and Education, hospitals and associated New Delhi health-centre set-ups

Epidemiological studies of Institute of Rural Health and human reproduction Family Planning, Gandhigram, Madurai (India) I I I *Research activities supported by previous grants only, even though they might have been continued during the period under review, are not included in this list. SEA/RC24/2 Page 216 Annex 6

Research Institution

Biomedical research on Central Family Planning Institute, problems associated with the New Delhi use of modem contraceptives in India

Studies directed towards The Bose Institute, Calcutta the development of an immunochemistry unit

Research in immunochemistry Department of Biochemistry, and cell-mediated immunity All-India Institute of Medical Sciences, New Delhi (WHO Collaborating Laboratory)

Cultivation of M. Zeprae Tata Department of Plastic Surgery, J.J. Group of Hospitals, Bombay

Immunology Department of Biochemistry, All-India Institute of Medical Sciences, New Delhi

Anti-leprosy drug trials Central Leprosy Teaching and Research Institute, Chingleput (India)

Chemoprophylaxis of leprosy

The mechanism of haemolysis Division of Haematology , in Ptasmodiwn faZciparwn Department of Medicine, Bangkok infection

Investigations of simian Department of Parasitology, malaria in Ceylon Faculty of Medicine, University of Ceylon, Peradeniya (Ceylon)

The behavioural responses National Malaria Eradication of A. balabacensis to DDT- Programme, Ministry of Public sprayed houses under local Health, Thailand housing conditions in the forest fringe in Thailand

Pilot study on the use of University of Ceylon, Colombo follow-up data in psychiatric epidemiology SEA/RC24/2 Page 217 Annex 6

I Research Institution

International Pilot study Mental Hospital, Agra (India) of schizophrenia

International study on Directorate of Health, Punjab hospital utilization State, Chandigarh (India) I Directorate of Health, Haryana State, Chandigarh (India)

Comprehensive health man- Ministry of Health, Government of power study Ceylon, Colombo

Studies on inter-action of Indian Council of Medical Research, malnutrition and infection New Delhi

Studies on the prevention All-India Institute of Medical of iron-deficiency anaemia Sciences, New Delhi in pregnant women

Studies on the prevention Christian Medical College and of iron-deficiency anaemia Hospital, Vellore (India) in pregnant women

Studies on rabies vaccines WHO International Reference Centre and anti-serum inapparent for Rabies, Coonoor (India) infections in animals and other activities

Small water supply units - All-India Institute of Hygiene field testing of hand-pumps and Public Health, Calcutta

Transmission studies on Department of Microbiology, human influenza viruses Medical College, Calicut, in domestic animals Kerala (India)

Orientation-cum-training Central Family Planning Institute, course in family welfare New Delhi planning and human reproductive biology for doctors in medical schools SEA/RC24/2 Page 218 Annex 7

FELLOWSH-LP TABLES

Table 1. Fellowships Awarded by Sources of Funds, Type of Fellowship and Country of Origin of the Fellow (1 August 1970 - 30 June 1971)l

1970 42 12 54 11 43 Indonesia 1971 9 6 15 5 10 Total 5 1 18 69 16 5 3 1970 3 - 3 3 - Maldives 1971 - - - - - Total 3 - 3 3 - 1970 25 7 32 - 32 Mongolia 1971 13 3 16 - 16 Total 38 10 48 - 48 1970 23 2 25 8 17 Nepal 1971 5 - 5 4 1 Total 28 2 30 12 18 1970 64 8 72 14 5 8 Thailand 1971 13 3 16 2 14 Total 77 11 88 16 72

Grand Total 40 7 67 474 85 389 - l~hefigures do not include the extensions of previous' years' fellowships.

he figures for the reporting year are broken down into two parts: for the periods 1 August to 31 December 1970 and 1 January to 30 June 1971 SEA/RC24/2 Page 219 Annex 7

Table 2. Fellowships Awarded by the WHO South-East Asia Region, by Subject of Study and Country of Origin of the Fellow (1 August 1970 - 30 June 1971)

- rd d 0 .rl V) rd Q Z V1 m C 0,:: 2 Subject 0C.dOi U 9. i.ioawm.4 0 h 71 a rd o L4 zwcZ2g r3 rnuHHxx2& H

1 Public Health Administration

Hospital administration Medical library Medical stores management National health planning Public health administration

Total

2 Sanitation

3 Nursing - 318 2 13610 43

4 Maternal and Child Health 4 - 13 6 - 6 1 11 '$0

- SEA/RC24/2 Page 220 Annex 7 Table 2 (continued) - m rl .rl m m u m .?4 m ag-4 5 Subject a g m o rl rl Y uhuudcamBrl.dgaOm.rl ?o o Y c.) 2:22g2i28 c+

5 Others

Dental health 1-61--- 19 Health education -544-23119 Health statistics -261-31-13 Medical rehabilitation --3---- 14 Mental health 232----- 7 Nutrjtion 1612--- 7 17 Occupational health 2-41--- 2 9 Quality control of drugs 3 -11 - -21219

Total 9 16 37 9 - 7 5 15 98

6 Communicable Diseases and Laboratory

Malaria 1310 6 - - 2 9 31 Epidemiology 212-- 2 - - 7 Filariasis 2---1--- 3 International quarantine ---2--- - 2 Leprosy control -23--- 5 - 10 Port health - 1 ------1 Smallpox eradication ------4- 4 Tuberculosis control -415-3-417 Trachoma control ------2 2 Tropical public health -1-3--- 3 7 Veterinary public health --- I---- 1 Laboratory techniques 9 912 4 1414 44 Medical entomology ------1 1 Thyroid hormones ------1 1

Total 14 21 28 21 2 9 12 24 131 - SEA/RC24/2 Page 221 Annex 7

Table 2 (continued) SEA/RC24/2 Page 222 Annex 7

Table 3. Fellowships Awarded by the WHO South-East Asia Region for Study in Other Regions and Vice Verea (1 August 1970 - 30 June 1971)

African Region European Eastern Western Total Region of the Region Mediter- Pacific Americas ranean Region Region

From South- East Asia Region to: 11 96 243 15 93 458

To South- East Asia Region from: 16 4 2 29 40 9 1 SEA/RC24/2 Page 223 Annex 7

Table 4. Utilization of Former WHO Fellows by Country (Analysis of 117 reports received from 1-August 1970 to 30 June 1971)

I I Number of Fellows I SEA/RC24/2 Page 224 Annex 7

Table 4 (continued)

I Number of Fellows SEA/RC24/2 Page 225 Annex 8

LIST OF TECHNICAL REPORTS ISSUED BY THE REGIONAL OFFICE (1 August 1970 - 30 June 1971)

Do cumen t Title Author

Cancer

SEAfCancerl6 See SEA/Med.Educ./l45

SEA/Cancer/7 Report on a visit to the Dr G. Riotton and Rev.1 cancer control pilot project, Kancheepuram, Tamil Nadu (India 0238). 25 November - 5 December 1970

Cholera

SEA/Cholera/l9 Report on a training course Dr Soemiatno and Corr.1 on cholera control held in Thanjavur, Tamil Nadu (India) (SEARO 0146). 11-17 January 1970

SEA/Cholera/20 Report on seminar on cholera -do- control held in Bhopa1,Madhya Pradesh (India) (SEARO 01&6), 31 August - 2 September 1970 I SEA/Cholera/21 A review of enteric infections, -do- including cholera - report on a visit to Burma (SEARO 0146), 19 May - 30 July 1970

Communicable Diseases

SEA/CD/27 Assignment report on port Dr J. Lembrez and Rev. 1 health and quarantine, Indonesia (SEARO 0169), February - 5rptember 1970

SEA/CD/28 Assignment report on port -do- and Rev. 1 health and quarantine, Burma (Burma 0078), 6-15 September L1970 SEA/RI:24/2 Page 226 Annex 8

Document Title Author

SEA/CD/29 Field visit report on communi- Dr B. Ignjatovic cable diseases (surveillance and epidemiologyj in Burma, 27 January - 4 February 1971

SEA/C~/30 Assignment report on infec- Dr W.M. Jamieson 6 tious-disease hospitals,India Miss M.M. Morrison (SEARO 01281, 6 October - 1 November 1970

SEA/CD/31 Assignment report on infec- -do- tious-disease hospitals, Ceylon (SEARO 0128). 30 November - 12 December 1970

SEA/CD/32 Assignment report on infec- -do- tious-disease hospitals,Burma (SEARO 0128),2-15 November 1970

SEA/CD/33 Assignment report on infec- -do- tious-disease hospitals, Thailand (SEARO 0128), 16-29 November 1970

Dental Health

SEA/DH/18 Assignment report on improve- I Dr A.J. Held ment of dental education, Government Dental College. Bangalore(1ndia 0208). January - March 1970

SEA/W/19 Assignment report on dental Mrs B.J. Krijns health, Thailand (Thailand 0086). August 1969 - July 1970 Drugs

SEA/Drugs/8 Assignment report on drug Dr T. Canback laboratory techniques and biological standardization (India 0222), 14 September - 13 November 1970 A 4 SEA/RC24/2 Page 227 Annex 8

Document Title Author

Economics

SEA/Econ./l Analysis of the need for Dr R.N. Grosse & establishing a post of Dr A.P. Ruderman Economist (Economic Adviser) in the Regional Office, March 1971

Education

SEA/E~UC/~~ Assignment report on training Mr C. Hutchinson rchool for technicians for the repair and maintenance of hospital equipment (Burma 0085), 28 August - 26 September 1970

SEA/~duc/l2 Assignment report on training -do- of electro-medical technicians in Burma (Burma 0085), 28 August - 26 September 1970

Environmental Health

SEA/Env.San/76 Assignment report on cornmunit) Mr V.J. Emmanuel & water supply (Nepal 0014). Mr Hiranya Jit Malla 1 September 1968 - 15 June 1970

SEA/Env.San/89 Assignment report on hazards Mr J.A.R. Bates to man from pesticides (Indonesia 0090). 15 July - 15 August 1970

SEA/Env.San/gO First report on public water WHO Consultant Panel supply, sewerage and drainage (Drs A.E. Berry & for the south-west coastal H. Rohde) area, Ceylon (Ceylon 0086), 1 June - 8 July 1970

SEA/Env.San/91 Assignment report on develop- Mr A.J. Moller ment of community water supply programmes (groundwater sources, Thailand) (SEAR0 0064), 11 December 1969 - 3 March 1970 SEA/RC24/2 Page 228 Annex 8

Document Title Author

SEA/Env.San/32 Assignment report on urban Mr M.W. Lieberman and Corr.1 public health administration (Thailand 0069), 1 February - 4 April 1970

SEAjEnv.Sad93 Assignment report on water Mr C.D. Parker pollution, Thailand (Thailand 0081),16-28 November 1970

SEA/Env.San/94 Assignment report on water Dr S.H. Jenkins pollution control in Maharashtra (India 0226), 3-26 November 1969

SEAIEnv. San/95 Assignment report on water Mr D.H.A. Price pollution, Maharashtra State (India 0226), 27 October - 23 November 1969

SEA/Env.San/96 Report on Regional Seminar on Regional Office Water Pollution Control held in Bangkok, Thailand (SEARO 0132), 4-12 November 1970

SEAIEnv.Sanf97 Assignment report on legisla- Dr G.A. Persson and Corr. 1 tion on the control of air pollution in India(1ndia 0270), 8 February - 4 March 1971

SEA/Env.San/98 Assignment report on solid Mr F. Flintoff waste management in Kathmandu (SEARO 0150), November - December 1970

Epidemiology

SEA/Epid/35 Assignment report on streng- Drs S.B. Halstead & thening of health services R. S. Desowitz (epidemiology), (Thailand 0059), 1 May - 15 August 1970 SEA/RC24/2 Page 229 Annex 8

Document Title Author

SEA/Epid/36 Assignment report on streng- Dr M.B. Gregg thening of epidemiological services, Indonesia(1ndonesia 0091) .6-24 October 1970

SEA/Epid/37 Assignment report on streng- Dr J. Pecenka and Corr.1 thening of health srrvices I (epidemiology) in Burma (Burma 0044), 2 March - 19 May 1970

SEAIEpidf38 Assignment report on streng- Dr J.J. Cervenka thening of epidemiological services (Nepal 0026), 16 April - 16 July 1970

Filariasis

SEAIFilI9 Assignment report on Dr J.J. Lartigue and Corr. 1 filariasis in Maldives (Maldives 0005), November - December 1969 SEA/Fil/lO Assignment report on filariasis -do- control in Ceylon (Ceylon 0056), June 1970

Health Education SEA/HE/39 Assignment report on assistance Miss M.F. Patterson by non-medical health educators in planning, conducting and evaluating a course for physicians (SEAR0 0177), 12 April - 27 May 1969 SEA/HE/40 Assignment report on health Dr J.T. Fodor education (Nepal 0019), 4 December 1970 - 25 January 1971 SEA/HE/41 Report on Workshop on Health -do- Education held in Nepal from 29 December 1970 to 8 January 1971 (Nepal 0019) SEA/RC24/2 Page 230 Annex 8

Document Title Author

SEA/HE/42 Assignment report on health Prof. H.J. Weddle education in Indonesia and on a workshop on the administration of provincial health education units held in Djakarta from 6 to 15 August 1970 (Indonesia 0078), July - September 1970

Health Laboratory Methods

SEA/HLM/ 43 Assignment report on produc- Mr N. Skarica tion of DPT Vaccine, Kasauli (India 0173), 5 May - 1 June 1970

SEA/HLM/42 Assignment report on health Dr R.J. Henderson laboratory services in Ceylon (SEAR0 0159), 23-31 October 1970

SEA/HLM/43 Assignment report on research Dr C.R. Coid institutes with laboratory animal facilities in Bangkok (Strengthening of Laboratory Services, Thailand 00751, 26-30 October 1970

SEAIHLMI44 Assignment report on the -do- status and management of laboratory animal facilities in Burma (Burma Pharmaceuti- cal Industry), (Burma 0077), 9-23 October 1970

SEA/HLM/45 Assignment report on streng- Mr B.T. Suitters thening of laboratory services, Kerala (India 0188). 3 February 1965 - 8 June 1970 SEA/RC24/2 Page 231 Annex 8

Document Title Author

SEA/HLM/46 Report on Regional Meeting Regional Office and Corr .l of Technical and Administra- tive Staff in Health Laboratory Services (SEARO 0159) held in the WHO Regional Office, New Delhi, 16-20 November 1970

SEA/HLM/47 Assignment report on health Dr R.J. Henderson laboratory services,Thailand (SEARO 0159), 4-18 September 1970

SEA/HLM/48 Assignment report on health -do- laboratory services, Nepal (SEARO 0159). 2-5 November 1970

SEA/HLM/49 Assignment report on health -do- laboratory services,Indonesia (SEARO 0159), 22 August - 4 September 1970

SEA/HLM/~O Assignment report on health -do- laboratory services, India (SEARO 0159), 5-23 October 1970

SEA/HLM/51 Assignment report on health -do- laboratory services, Burma (SEARO 0159),18-28 September 1970

SEA/HLM/52 Report on the health laboratory -do- services in South-East Asia (SEARO 0159) (presented to the Regional Meeting of Technical and Administrative Staff in Health Laboratory Services held in the Regional Office from 16 to 20 November 1970), August - November 1970

SEA/HLM/ 53 Assignment report on streng- Dr Sven Gardell thening of laboratory services in Thailand, (Thailand 0075), November - December 1970 SEA/RC24/2 Page 232 Annex 8

Document Title Author

SEA/HLM/54 Assignment report on Tuber- Dr Leslie Eidus SEA/TB/~~~ culosis Chemotherapy Centre, Madras (laboratory aspects) (India 0053), 23 December 1970 - 20 January 1971

Immunology

SEA/Immun./3 Assignment report on streng- Dr (Mrs) E.Simpson thening of health services (epidemiology) (Training in Immunology) (India 0182), 21 October 1970 - 27 January 1971

Leprosy

~EA/Lep/41Add.1 Report on a visit to Valrag Dr E.A. Blum Leprosy Training Centre, Guttierrez Sholapur District, Maha- rashtra State (India 0081), 17 August 1970

SEA/Lep/46 Assignment report on leprosy Dr J. Walter control, Thailand (Thailand 0030), December 1967 - April 1970

SEA/Lep/47 Report on the Third Regional WHO Faculty Seminar on Leprosy Control (SEAR0 0138) held at the Danish Centre, Aska (Orissa), India, 12-30 January 1970

Malaria

SEA/Ma1/77 Assignment report on malaria Mr M.F.H. Raghab eradication, Nepal (Nepal 0001),May 1966 - October 1969

SEA/Ma1/78 Assignment report on labora- Miss M. Beckert tory aspects of malaria eradication (Burma 0031), 24 June - 10 October 1970 SEA/RC24/2 Page 233 Annex 8

Document Title Author

SEAfMalf79 Assignment report on malaria Dr T. Kurihara and Corr. 1 eradication, Indonesia (Indonesia 0032), 8 January 1970 - 31 January 1971

SEAIMalI80 Assignment report on malaria Dr R.O. Darwish eradication Ceylon (Ceylon 00581, December 1968 - December 1969

SEA/Mal/81 Assignment report on malaria Dr H.D. Grasshoff eradication programme in Thailand (Thailand 0065), November 1967 - December 1970

Maternal and Child Health

SEA/MCH/65 Assignment report on school Dr P. Henderson health (SEARO 0175), 9 October 1969 - 10 January 1970

SEA/MCH/65 Add.1 Assignment report on school -do- and Corr.1 health (Indonesia) (SEAR0 0175), 9 October - 10 November 1969

SEA/MCH/~~Add.2 Assignment report on school -do- health in Thailand (SEARO 0175), 10-23 November 1969

SEA/MCH/65 Add.3 Assignment report on school -do- health in Burma(SEAR0 0175), 24 November - 5 December 1969

SEA/MCH/65 Add.4 Assignment report on school -do- health in Nepal (SEARO 0175). 5-14 December 1969

SEA/MCH/65 Add.5 Assignment report on school -do- health in Ceylon (SEAR0 0175), 20 December 1969 - 10 January 1970 - SEA/RC24/2 Page 234 Annex 8

Document Title I Author - - Assignment report on paedia- Dr W.B. MacDonald tric education (Burma 0079), June - August 1969

Assignment report on the Dr P. Robinson education field study in Hyderabad, India (Course for Senior Teachers of Child Health) (SEARO 0163), 12 September - 25 October 1970

Assignment report on Course Dr M. E. Robowska for Senior Teachers of Child Health (SEARO 0163), 8 June - 3 September 1970

Report on a Workshop on the Regional Off ice Teaching of Maternal and Child Health in Field Practice Areas of Medical Schools held in Bangkok from 14 to 24 April 1970 (SEARO 0171)

Maternal and Child ahealth I and Family Planning I Assignment report on establish- Dr Estelle Brodman ment of Documentation Centre in Family Planning (SEARO 0173 and SEARO 0198), 9 May - 6 August 1970

Report on the Meeting on Family Planning Documentation held in World Health House, New Delhi, on 30 and 31 July 1970 (SEARO 0198)

Report on a survey of the Dr Helen M.Wallace, teaching of human reproduc- Dr John Lesinsky & tion in medical colleges in Dr B.L. Taneja India (Inter-regional 0568), January - March 1970 SEA/RC24/2 Page 235 Annex 8

Document Title Author I I I SEA/MCH/FP/7 Assignment report on family Dr Ralph R. Sachs and Corr.1 I health services (Indonesia I I 0113), 4 August - 6 October 1 1970 I Report on the Meeting of Deans and Principals on Teaching of Human Reproduction in Medical Schools, New Delhi, 7-11 December 1970 (SEAR0 0183

Assignment report on the plan- Drs D. Llewellyn ning and organization of Jones, training and research in human R. Paredes and reproduction in medical T. Stapleton schools in Thailand (Inter- regional 0568), 19 November - 21 December 1970

Medical Education

SEA/Med.Educ./l26 Assignment report on medical Dr E.M. Backett Add. 3 education (Department of Preventive and Secial Medicine, Mahatma Gandhi Memorial Medical College, Indore) (India 0111). 23 October - 31 December 1968 I Report on Seminar on the Role Dr A.O. Lucas & of Epidemiology in Community Dr J. Pemberton Medicine, Lucknow, India (India 0221), 24-28 November ' 1969

Assignment report on medical Drs P.E.C. Planson- education, Burma (Burma 0079), Bahr *9 January - 12 March 1969; J.H. Pinkrrton* & **9 January - 28 March 1969 P.G. Bevan** j SEA/Med.Educ./l38 Assignment report on tropical Dr P.E.C. Manson- j Add. 1 medicine and public health Bahr aspects of medical education I (Burma 0079), 7 November 1968 - 26 April 1969 I i SEA/RC24/2 Page 236 Annex 8

Document Title Author

S~A/Med.~duc./l38 Assignment report on general Dr P.G. Bevan Add. 2 surgical aspects of medical education, Burma (Burma 0079), 9 January - 12 March 1969

SEA/Med.Educ./l38 Assignment report on obstetric Dr J.H.M. Pinkerton Add.3 and gynaecological aspects of medical education, Burma (Burma 0079), January - March 1969

SEA/Med.Educ.1139 See SEA/MCH/66

SEA/Med.Educ./l41 Assignment report on the Prof. J.D. Gillett and Rev. 1 reaching of medical entomology at Mahidol University, Thailand (Thailand 00571, 19 July - 24 September 1970

SEA/Med.Educ./l42 Assignment report on Medical Dr Jacobs, College, Aurangabad (India Dr J.J. Rippey & 0111). 9 September - Dr E. Hauptmann 27 November 1968

SEAfMed.Educ.1143 Assignment report on King Dr E. Hauptmann. George's Medical College, Dr B. Richter, Lucknow (India 0111), Dr Z. Jacksic & February - April 1970 Miss A. Masic SEAIMed.Educ.1144 Assignment report on Maulana Dr P.B.B. Gatenby Azad Medical College, New Delhi (India Olll), 8-29 September 1970

SEA/Med.Educ./l45 Assignment report on establish- Dr R.A. Barter SEA/Cancer/6 ment of cytology services and training as part of national family planning programme (Indonesia 0107), 1 September - 13 November 1970

- SEA/RC24/2 Page 237 Annex 8

Document Title Author

SEAIMed.Educ.Jl46 Report on a visit to Thailand, E.G. Kapal and Corr.1 22-29 January 1971

SEAIMed.Educ.1147 hssignment report on medical j J.W.G. Smith education (Faculty of 4.1. Walter & Medicine,Peradeniya [Ceylon]) J. Woodruff (SEAR0 0133), December 1967 - February 1968

SEA/Med.Educ./l48 Assignment report on assistance to the Department of Pharmacology, Institute of Medicine 11, Mingaladon (Burma 0079). 18 December 1967 - 31 December 1970

SEA/Plsd.Educ. 1149 Report on a visit to Punjab K.E. Schmidt in preparation for the Seminar on the Organization and Future Needs of Me~tal Health Services (held in New Delhi in February 1971), 16-25 January 1971 j SEAIMed.Educ. I150 Assignment report on medical W.A. Kohlmeyer education (psychiatry), College of FIedical Sciences, I Banaras Hindu University, Varanasi (India Olll), 13 Nc)vember - 12 December 1970

Assignment report on medical R.G. Grenell education (College of Medical Sciences, Varanasi) (India Olll), 11 January - 8 February 1971

SEAIMed.Educ. I152 See SEA/MCH/FP/~

SEP./?!ed. Educ. I153 Assignment report on medical Brian Spencer education (biochemistry) (Maulana Azad Medical College, Ncw Delhi) (India Olll), 20 August - 27 September 1970 SEA/RC24/2 Page 238 Annex 8

1 Document Title Author

SEA/Med.Educ./l54 Report on a survey of medical Mr S.C. Dhir school libraries in the countries of South-East Asia (1969-70) (based on an analysis of replies to a questionnaire)

Nursing

SEA/Nurs/l62 Assignment report on nursing Miss K. Feisel Add. 1 administration (India 0212), January - December 1968

SEA/Nurs/l93 Assignment report on integra- Miss A. Klimenko tion of psychiatric nursing into the curriculum of the College of Nursing, Ahmedabad (India 0136), 21 June - 8 September 1970

SEA/Nurs/l94 Report on the short course Mies Rachel Ask on clinical teaching orthopaedic nursing, held at the Central Institute of Orthopaedics, Safdarjang Hospital, New Delhi (SEARO 0139), 24 November - 19 December 1969

SEA/Nurs#l95 Assignment report on nursing Mrs I.G. Harter administration (India 0212). 11 July 1968 - 24 September 1969

SEA/Nurs/l96 Information on short course Miss Rachel Ask on guidance and counselling for student nurses, held at Psychiatric Affiliation School of Nursing,Mullariyawa (Ceylon) (SEARO 0139), 7 April - 4 May 1970 SEA/RC24/2 Page 239 Annex 8

Document Title Author

SEA/Nurs/l97 Information on short course Miss I.M. Lovedee on teaching and supervision for public health nurses held in Kathmandu (Nepal 0008), 6 April - 8 May 1970

SEA/Nurs/l98 Information on short course Mr A.R. Bubb for nursing personnel in Ward Administration, held at Yadana House Post-basic School of Nursing, Rangoon (SEARO 0139), 4 May - 13 June 1970

SEAINursll99 See SEA/TB/103 SEA/TB/103

SEA/Nurs/200 Information on short course Miss I. Bjorkroth for nursing personnel on planning for patient care held in Women's Hospital, Bangkok (SEARO 0139), 5-22 October 1970

SEA/Nurs/201 Report on a study of nursing Miss M. Reid and Rev. 1 personnel in general hospitals of the Medical Services I Department in Thailand (SEARO 0160), July 1969 - April 1970

SEA/Nurs/202 Assignment report on post- ! Dr(Miss) Charlotte basic nursing education, Seyffer New Delhi (India 0136), 1 December 1969 - 31 August 1970

SEA/Nurs/203 Report on the Inter-country Regional Offici Workshop on the Control and Management of the Nursing Component of Health Services, held in New Delhi (SEARO 0116), 3-4 November 1969 SEA/RC24/2 Page 240 Annex 8

Do cumen t Title Author

SEA/Nurs/204 Assignment report on nursing Mr A.R. Bubb education and training in West Irian (Indonesia 0084), 30 January - 18 March 1970

SEA/Nurs/ 205 Assignment report on central Miss Sheila B.R. supply room, Chulalongkorn Scott Red Cross Hospital, Bangkok (Thailand 0089), June - November 1970

SEA/~urs/206 Report on central supply rooms and Corr.1 and steam sterilization practices in Thailand (Thailand 0089), 4 June - 29 December 1970

SEA/Nurs/207 Information on short course Miss I. Bjorkroth for nursing personnel on planning for patient care held in Royal Thai Army Hospital, Bangkok (SEARO 0139), 9-27 November 1970

SEA/Nurs/208 Information on short course Mr A.R. Bubb on hospital housekeeping held in Hyderabad (India) (SEARO 0139), 2-27 November 1970

SEA/Nurs/209 Assignment report on post- Miss M. Brown basic nursing education, Chandigarh (India 0136), 4 November - 31 December 1970 SEA/Nurs/210 . Assignment report on post- Miss A.C. and Corr.1 basic nursing education, Beckingham Ahmedabad (India 0136). January 1968 - March 1971

SEA/Nurs/211 Assignment report on nursing Miss C. Walsh education and services, Indonesia (Indonesia 0074). April 1970 - March 1971 SEA/RC24/2 Page 241 Annex 8

Document Title Author

SEA/Nurs/212 Information on short course Miss Rachel Ask on organization of patient care in the ward, held at the All-India Institute of Medical Sciences, New Delhi (SEARO 0139), 18 January - 12 February 1971

Nutrition

SEA/Nut/28 Assignment report on nutri- Dr Romeo de Leon tional rehabilitation and rehydration centres, Ceylon (SEARO 0179), 17-30 September 1969

SEA/Nut/29 Assignment report on nutri- -do- tional rehabilitation and rehydration centres,Thailand (SEARO 0179), 13-26 August 1969

SEA/Nut/30 Assignment report on nutri- -do- tional rehabilitation and rehydration centres, Indonesia (SEARO 0179), 27 August - 16 September 1969

SEA/Nut 131 Assignment report on nutri- -do- and Rev. 1 tional rehabilitation and rehydration centres, Burma (SEARO 0179), 3-12 August 1969

SEA/Nut/33 Assignment report on control Dr S.K. Sood of nutritional anaemia (Ceylon 00851, 23 December 1969 - 17 January 1970

Occupational Health

SEA/Occ.Hlth/6 Report on the Symposium on Regional Office Academic Education and Training in Occupational Health and Hygiene held in Ahmedabad (India 0197), 8-11 November 1970 SEA/RC24/2 Page 242 Annex 8

> Document Title Author

Physiotherapy

SEA/PT/8 Assignment report on Physio- Miss L.M. Prior therapy School, Baroda (India 0257), 18 February - 7 April 1970

Plague

SEA/Plague/8 Assignment report on plague Dr Mansour Chamsa epidemiology, Boj olali , Java (Indonesia 0099). November 1969 - February 1970

SEA/Plague/9 Assignment report on plague Dr M. Bahmanyar control in Burma (Burma 0078), 7-18 November 1970

Public Health Administration

SEA/PHA/83 Report to the Regional Director Dr D.J.M.MacKenzie on the Strengthening of the. National Health Services, Indonesia (Indonesia 0086). 10 February - 2 May 1970

SEA/PHA/84 Assignment report on public Dr P.R. Dutt health administration (Maldives 0005), 9 June - 20 September 1969

SEA/PHA/85 Assignment report on the Dr M.A.C. Dowling training programme for auxiliary health workers in Nepal: the role of Auxiliary Health Workers' Training School, Kathmandu (Nepal 0021). 3-27 April 1970

SEA/PHA/86 Assignment report on public Dr D. Flahault and Corr. 1 health administration (Nepal 0021), 7-26 April 1970 SEA/RC24/2 Page 243 Annex 8 - Document Title Author *

SEA/PHA/87 Notes on Discussion Group Regional Office Meeting on National Health Plaraing held in Bangkok from 12 to 14 October 1970 (SEARO 0178)

SEA/PHA/~~ Assignment report on national Dr H.L. Blum health planning and manpower studies, Ceylon (SEARO 0178), June - August 1970

SEA/PHA/89 Assignment report on the Dr R.L. Chopra strengthening of health services, West Irian (Indonesia 0072/FUNDWI 33). 26 January - 25 April 1970

SEA/PHA/90 Assignment report on streng- Dr W.L. Barton thening of national health services (Indonesia 0086), 9 July - 17 September 1970

SEA/PHA/ 91 Notes on the Introductory Dr D.H.S. Griffith course in Development and Health Planning held in Burma (Burma 0094), 4-27 November 1970

SEA/PHA/93 See SEAIVHSI122

SEA/PHA/94 Assignment report on national Mr M. Wheeler health planning and manpower studies in Indonesia (SEARO 0178/Indonesia 01191, 11 March - 9 April 1971

SEA/PHA/95 Assignment report on public Dr M.Sathianathan health administration, Maldives (Maldives 0005), January 1965 - September 1970 SEA/RC24/2 Page 244 Annex 8

> Document Title Author

Radiation

SEA/Rad/51 Assignment report on radia- Mr C. Nelson tion protection in Nepal (SEAR0 0042), 22 April - 15 May 1969

SEA/Rad/52 Assignment report on the Mr R.B. Webb SEA/TB/104 radiological aspects of the . national tuberculosis programme, India (India 0103), December 1967 - March 1970

SEA/Rad/53 Assignment report on course Dr N.Suntharalingam in hospital physics (India 0232), 17 February - 31 March 1970

SEA/Rad/54 Assignment report on radia- Mr B.D.P.Williamson tion protection services (Thailand 0067), 20 April - 3 June 1970

SEA/Rad/55 Assignment Report on Radia- Dr Solomon A.Berson tion Medicine Centre, Bombay (India 0192), 18 November - 28 December 1970

SEA/Rad/56 Report on a visit to Rohtak, Mr C. Nelson Narnaul and Gurgaon(Haryana1 (India 0103), 9-11 November 1970

SEA/Rad/57 Assignment report on training Dr George Cowper course in hospital physics held at the Bhabha Atomic Research Centre, Bombay (India 0232), 13 January - 28 February 1971 SEA/RC24/2 Page 245 Annex 8

Document Title Author

Rehabilitation

SEA/Rehab/9 Assignment report on rehabili- J.D. Kershaw and Corr.1 tation of handicapped children, Bangkok (SEARO 0174), 24 April - 19 May 1970

Assignment report on rehabilitation of handicapped children, Ceylon (SEARO 0174), 20 May - 25 June 1970

hssignment report on medical J.A.E. Gleave rehabilitation, Ceylon (Ceylon 0063). 13 February - 16 June 1970

Smallpox

Assignment report on smallpox eradication (Indonesia 0081), 6 November 1969 - 31 January 1970

Assignment report on smallpox Gordon eradication programme in North Meiklejohn Sumatra (Indonesia 0081), 16 June - 31 July 1970

Report on a visit to smallpox A.J. Oles eradication programme in Maharashtra State (SEARO 0030), 11-19 January 1970

Report on a visit to smallpox eradication programme in Andhra Pradesh (India 0233), 20-25 May 1970

Smallpox Eradication - brief guidelines for field workers SEA/RC24/2 Page 246 Annex 8

Do cumen t Title Author

SEA/Smallpox/45 Report on the training course Dr A.J. Oles for smallpox outbreak containment teams, Kathmandu (SEAR0 0030), 31 May - 5 June 1970

SEA/Smallpox/46 Report on a visit to Rajasthan Dr A.J. Oles & (India 0233), 21-27 August Dr Mahendra Singh 1970

SEA/Smallpox/47 Report on a visit to smallpox Dr A.J. Oles and Corr.1 eradication programme in Nepal (Nepal 0009). 21-30 October 1970

SEA/Smallpox/48 Report on an assessment of A Joint Government the smallpox eradication of Burma/WHO programme in Burma (Burma Assessment Team 0080), 21 October - 21 November 1970

Trachoma

SEA/Trach/27 Report on a visit to the Dr F.A. Assaad trachoma control project, Thailand (Thailand 0043). 17 February - 10 March 1971

SEA/Trach/28 Report on a visit to the -do- trachoma control project, Burma (Burma 0069), 10-27 March 1971

Tuberculosis

SEA/TB/103 Assignment report on tuber- Miss L. Grasmo SEA/Nurs/l99 culosis control (Indonesia 0050), 17 January - 2 April 1970

SEA/TB/104 See SEA/Rad/52 SEA/RC24/2 Page 247 Annex 8

Document Title Author -

SEA/TB/105 Assignment report on the Mr A.G. Beer and Corr. 1 laboratory work of the Tuberculosis Chemotherapy Centre, Madras (India 0053). October 1964 - December 1969

SEA/TB/106 Assignment report on the Dr K. Toman Indian Chapter of the Eighth International Training Course in the Epidemiology and Control of Tuberculosis, Prague (1969) (Inter-regional 01131, 21 July - 20 August 1969

SEA/TB/107 Assignment report on national Dr L.A. Simeonov and Corr.1 tuberculosis programme, India (India 0103), November 1967 - October 1970

SEA/TB/lO8 Assignment report on tuber- Dr K. Toman culosis control in Thailand (Thailand 0042), 8 October 1969 - 19 February 1970

SEA/TB/109 Field visit report on tuber- Dr R. Krzysko culosis control in the Republic of Maldives (SEAR0 0113), 12 September - 12 October 1970

SEA/TB/110 Assignment report on the Drs W. Fox & Tuberculosis Chemotherapy G.A. Ellard Centre, Madras (India 0053), 7-23 February 1971

SEA/TB/~~~ See SEA/HLM/54

SEA/TB/~~~ Assignment report on tuber- Dr S. Grzybowski culosis control, Ceylon (Ceylon 0075/SEARO 0113), 9-18 January 1971 and 2-19 March 1971 SEA/RC24/2 Page 248 Annex 8

Document Title Author

Vaccine

SEA/Vaccine/37 Assignment report on diph- Dr A.F.B. Standfast theria, tetanus and pertussis vaccine production in Burma (SEARO 0117) , 18-26 February 1970

SEA/Vaccine/38 Assignment report on produc- Dr A.A. Ardalan and Corr.1 tion of BmceZZa Rev.1 vaccine (Mongolia 0013), 7 May - 26 June 1970 and 8-29 July 1970

SEA/Vaccine/39 Assignment report on diph- Dr A.F.B. Standfast theria, tetanus and pertussis vaccine production, Thailand (SEARO 0117), 31 January - 17 February 1970

SEA/Vaccine/40 Assignment report on vaccine Mr P. van Hemert and sera production (Indonesia 0083), 31 October - 2 December 1970

SEA/Vaccine/41 Assignment report on freeze- Dr T. Hashimoto dried BCG vaccine production (India 0225), 10 June - 10 September 1970

SEAIVaccinel42 Assignment report on freeze- Miss K. Bunch- and Corr.1 dried BCG vaccine production. Christensen Indonesia (Indonesia 0083), 9-28 November 1970

SEA/Vaccine/43 Assignment report on produc- Dr C. Kaplan tion of freeze-dried smallpox vaccine, Bangkok (SEARO 0038), 31 December 1970 - 5 January 1971 s~A/RC24/2 Page 249 Annex 8

I Document Title Author

SEAIVaccinel44 Assignment report on the Dr W.E. Parish production of therapeutic antisera and tetanus toxoid vaccine in Burma (Burma 0077), 6 January - 4 February 1971

SEAIVaccinel45 Assignment report on produc- Dr A.F.B. Standfnst tion of diphtheria, pertusis

and tetanus vaccine, Kasi!,li ! (India 0173), 23 November - I 21 December 1970 i SEA/Vaccine/46 Assignment report on freeze- Dr C. Kaplan dried smallpox vaccine production, Indonesia (SEARO I 0038), 6-13 January 1971 I Veterinary Public Health I \ SEAlVPH19 Report on the First WHO Dr C.W. Schwabe Regional Seminar on Veteri- nary Public Health held in Mukteswar, India, from 8 to 18 April 1970 (SEARO 0168)

Vital and Health Statistics

SEAIVHSI117 Report on training course in Dr M. Cakrt medical coding held at the Model Vital and Health Statistics Unit, Nagpur (India 0255), 9-18 July and 12 August - 11 September 1970

SEAIVHSI118 Report on training course in -do- and Corr.1 general statistics held by the Model Vital and Health Statistics Unit, Nagpur, 9-18 July and 12 August - 11 September 1970 I SEA/VHS/119 Assignment report on streng- -do- 1 thening of health statistics services (India 0255), 1 July - 8 October 1970 SEA/RC24/2 Page 250 Annex 8

I Document Title Author

SEA/VHS/120 Assignment report on re- Dr D. Daniel organization of the Medical Gaj araj Record Department, Bir Hospital, Kathmandu, Nepal (SEARO 01611, 14 April 1969 - 14 January 1970

SEA/VHS/121 Assignment report on the Dr C.C. Spicer and Add. 1 present and future computing needs of the Indian Council of Medical Research (India 0121), 17 November - 16 December 1970

SEA/VHS/122 Assignment report on health Dr G. Llanos SEA/PHA/93 manpower studies in Thailand (Thailand 0098), December 1970 - February 1971

SEA/VHS/123 Assignment report on health Dr H.B. Messinger statistics for planning in Ceylon (SEARO 0178), July - August 1970