The Work of Who 1965

OFFICIAL RECORDS OF THE WORLD HEALTH ORGANIZATION No. 147

THE WORK OF WHO 1965

ANNUAL REPORT OF THE DIRECTOR- GENERAL TO THE WORLD HEALTH ASSEMBLY AND TO THE UNITED NATIONS

I The Financial Report, 1 January -31 December 1965, which constitutes a supplementtothisvolume,is published separately as Official Records No. 150.

WORLD HEALTH ORGANIZATION

GENEVA

March 1966 The following abbreviations are used in the Official Records of the World Health Organization:

ACABQ - Advisory Committee on Administrative and Budgetary Questions ACC - Administrative Committee on Co- ordination CIOMS - Council for International Organizations of Medical Sciences ECA - Economic Commission for Africa ECAFE - Economic Commission for Asia and the Far East ECE - Economic Commission for Europe ECLA - Economic Commission for Latin America EPTA - Expanded Programme of Technical Assistance FAO - Food and Agriculture Organization IAEA - International Atomic Energy Agency ICAO - International Civil Aviation Organization ILO - International Labour Organisation (Office) I MCO - Inter- Governmental Maritime Consultative Organization ITU - International Telecommunication Union PAHO - Pan American Health Organization PASB - Pan American Sanitary Bureau TAB - Technical Assistance Board TAC - Technical Assistance Committee UNESCO - United Nations Educational, Scientific and Cultural Organization UNICEF - United Nations Children's Fund UNRWA - United Nations Relief and Works Agency for Palestine Refugees in the Near East UNSCEAR - United Nations Scientific Committee on the Effects of Atomic Radiation WFUNA - World Federation of United Nations Associations WMO - World Meteorological Organization

Q World Health Organization 1966 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. Nevertheless governmental agencies or learned and professional societies may reproduce data or excerpts or illustrations from them without requesting an authorization from the World Health Organization. For rights of reproduction or translation of WHO publications in toto, application should be made to the Division of Editorial and Reference Services, World Health Organization, Geneva, Switzerland.The World Health Organization welcomes such applications.

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- II - CONTENTS

Page Introduction v

PART I - GENERAL REVIEW

Chapter 1.Malaria Eradication 3

Progress of Malaria Eradication 3 Problem Areas 5 General Health Services and the Malaria Eradica -. Research 5 tion Programme 4 Expert Committee and other Meetings, and Publica- Training for Malaria Eradication 4 tions 6 Evaluation 5

Chapter 2.Communicable Diseases 7 Tuberculosis 7 Parasitic Diseases 22 Endemic Treponematoses and Venereal Infections 9 Bacterial Diseases 27 Veterinary Public Health 11 Leprosy 29 Virus Diseases 16 International Quarantine' 30 Smallpox Eradication 21

Chapter 3.Environmental Health 32 Community Water Supply 32 Sanitation Services and Housing 36 Wastes Disposal 33 Environmental Biology 37 Environmental Pollution 33 Vector Control 38

Chapter 4.Public Health Services 42 Public Health Administration 42 Nursing 45 National Health Planning 42 Health Education 47 Organization of Medical Care 43 Maternal and Child Health 48 Health Laboratory Services 44

Chapter 5.Health Protéction and Promotion 50 Cancer 50 Mental Health 54 Cardiovascular Diseases 51 Nutrition 55 Dental Health 52 Radiation and Isotopes 56 Human Genetics 53 Social and Occupational Health 58

Chapter 6.Education and Training 60

Medical Education . 60 Training of Auxiliary Personnel 62 Training in Preventive Medicine and Public Health61 Travel Abroad for Studies and Scientific Exchanges62

Chapter 7.Medical Research 64

Chapter 8.Health Statistics 66

International Classification of Diseases. . 66 Collection and Utilization of Statistics. . 67 National Committees on Vital and Health Statistics66 Statistical Analysis of Research and Technical Pro - Assistance to Governments in the Development of grammes 67 Statistical Services 66 Participation in United Nations Statistical Pro - Statistical Publications 67 grammes 68 - III - 69397 Page Chapter 9.Biology and Pharmacology 69

Pharmacology and Toxicology 69 Immunology 71 Biological Standardization 70 Pharmaceutical Preparations 73

Chapter 10.Publications and Reference Services 75

Chapter 11.Public Information 77

Chapter 12.Constitutional, Financial and Administrative Developments 79

Constitutional and Legal 79 Administration 81 The Financial Position 79

Chapter 13.Co- operation with other Organizations 83

United Nations Development Decade and other Co- operation with Individual Organizations. . . . 85

Co- operative Action 83 Regional Intergovernmental Organizations . . . . 86 United Nations Special Fund and the Expanded Non -governmental Organizations 87 Programme of Technical Assistance for Economic Development 85

PART II - THE REGIONS

Chapter 14.African Region 91

Chapter 15.The Americas 99

Chapter 16.South -East Asia Region 112

Chapter 17.European Region 120

Chapter 18.Eastern Mediterranean Region 125

Chapter 19.Western Pacific Region 132

PART III - PROJECT LIST

Projects in Operation in 1965 140

Africa 141 The Americas 150 South -East Asia 169 Europe 179 Eastern Mediterranean 190 Western Pacific 202 Inter -regional 211 - iv - ANNEXES

Page 1. Members and Associate Members of the World Health Organization 221 2.Membership of the Executive Board 222 3.Organizational Meetings in 1965 223 4.Expert Advisory Panels and Committees 223 5. Scientific Group Meetings in 1965 229 6.Non -governmental Organizations in Official Relations with WHO 230 7.Regular Budget for 1965 231 8. Structure of the Headquarters Secretariat 232 9.Numbers and Distribution of the Staff 233 10.Composition of the Staff by Nationality 235 11. Status of Malaria Eradication 236 12.Fellowships awarded, by Subject of Study and by Region 237 13. WHO Collaborative Research Projects in 1965 239 14. Research Grants for Training and Exchange in 1965 by Subject and Type of Grant 240 15. WHO International and Regional Reference Centres and Institutions where they are located 241

MAP

WHO Regional Offices and the Areas they serve 90

The designations employed and the presentation of the material in the Official Records of the World Health Organization do not imply the expression of any opinion whatsoever on the part of the Director -General concerning the legal status of any country or territory or of its authorities, or concerning the delimitation of its frontiers.

-V-

INTRODUCTION

URING the year 1965 the World Health Organization continued on the one hand to assist its Members to apply to their best advantage the knowledge and means already available and on the other hand to Dstimulate the search for fresh knowledge and the development of new techniques so that they might be better equipped to solve the problems confronting them.

One of the best ways of ensuring that the knowledge and means at present available are put to their best use is through systematic planning. The assistance that WHO has recently been giving to many Mem- bers in drawing up national health plans provides confirmation of the importance it attaches to them. There is an increasing desire to learn more about the methodology of health planning and a growing recognition that health planning is an essential part of general economic and social development. An important conclusion which emerged from the Technical Discussions on " Health Planning", which took place during the Eighteenth World Health Assembly, relates to the nature of planning as a continuing process of vital and immediate importance to organized communities on both the local and the national level. As a corollary, planning- whether in the economic or in the health field -is a social function of concern not only to politicians and health experts at the centre but also to men and women at the local level and to the health workers in the field. It is becoming increasingly clear that current methods of formulating health plans could be much improved through operational research. Governments are anxious to see their public health staff better trained in the methodology of planning. The XVI Meeting of the Directing Council of PAHO f Seventeenth Session of the WHO Regional Committee for the Americas, for instance, requested the Director to study the advantages of establishing a Pan -American Centre for Health Planning. In any plan to establish a network of health services the most important factors are to determine the necessary categories of health personnel and to develop a suitable programme of training. Fact-finding surveys and other studies made in recent years have identified the lack of adequately trained health personnel as the greatest single reason why health levels throughout the world are not rising. No realistic health plan drawn up in Africa, for example, can ignore the fact that in 1965 there were at least fourteen countries with populations far in excess of three million that had no medical school whatsoever. The creation of educational and training facilities must receive the highest priority if the emerging nations are to organize their own medical and public health services.In the developing countries, education and training of health personnel must be conceived as an integral part of the national health plan and every effort should be made to ensure the best possible use of the limited personnel available. There is no ready -made solution for all countries, since for the improvement of each system such matters as the stage of social and economic development of the particular country, the general evolution of the health situation and the potentialities for the future must be taken into consideration. Shortage of funds and lack of well - trained personnel are preventing most developing countries from coping with the increasingly complex and difficult problems presented by changing environmental conditions. Unless some headway is made in these matters the health situation is bound to deteriorate. In the present circumstances in many countries there is little hope that the available environmental health staff can pay adequate attention to the newer problems of fast developing urban communities; training programmes for the requisite personnel have thus become of greater importance. This was the conclusion reached at a symposium held during the year, at which it was also noted that the growing complexity of urban development problems has made it essential fpr all civil engineers, architects, and town planners to be trained in the basic concepts of environmental health. The Report describes various ways in which WHO is attempting to help countries to meet two fundamental and related sanitation needs: the provision of adequate and safe water supplies and the proper disposal of all kinds of waste. WHO has extended its activities considerably in the direction of assisting developing countries to identify and mobilize financial resources for the construction of urgently needed water supply systems.Locally available investment funds are being increasingly utilized, while loans from external sources, both international and bilateral, for the period 1958 to 1965 amounted to over $500 000 000.This rate of progress, although encouraging, is still not sufficient to meet the demonstrated needs for water supplies in developing countries. In addition WHO has been helping its Members 7o prepare and present requests to the United Nations Special Fund for support, not only for water supplies, but also for sewerage and sewage disposal schemes.

More than three -quarters of the populations of the originally malarious areas of the world are now living in places where malaria eradication programmes have been successfully completed or are in full implementation and are advancing towards the consolidation and maintenance phases.However, little progress has been made in extending the programme to new areas. On the credit side it was recorded that in 1965, as compared with 1964, the number of people living in areas where eradication has been completed increased by about 20 per cent., thus amounting to about one -third of the inhabitants of the originally malarious areas. Two countries, China (Taiwan) in the Western Pacific Region and Bulgaria in the European Region, were included in the official WHO register of areas where malaria has been eradicated. But there have been certain disturbing facts such as the first report of resistance to dieldrin in Anopheles gambiae on the eastern side of Africa - in Sudan and Madagascar -an intermediate degree of resistance to malathion in A. albimanus in Nicaragua and Guatemala, and resistance of Plasmodium falciparum to 4- aminoquinolines in various parts of the world. Such cases emphasize the need for urgent research and remedial action.There have also been certain programme setbacks, caused in part by political instability but mainly by administrative, operational and socio- economic factors and lack of continuing financial assistance. The greatest area and largest populations not yet protected by malaria eradication programmes are in the African Region, a situation due to administrative and technical difficulties. A trial of a new organophosphorus insecticide has been carried out in a west African savannah area in an attempt to find an effective means of interrupting transmission of malaria under the special epidemiological conditions there, and further field research is being organized. The success of antimalaria work in Africa also depends on the efficiency and speed with which the task of establishing and strengthening basic health services can be carried out. Endemic foci of smallpox remain in Asia, Africa and the Americas, although the recent downward trend of world smallpox incidence can be considered as partly due to the effort to achieve eradication.There is a constant danger of reintroduction and spread of smallpox in areas where it has been either controlled or eradicated. The status of the smallpox eradication programme and the progress made since 1958, when the Eleventh World Health Assembly unanimously affirmed the desirability of a world -wide smallpox eradication campaign, were considered by the Eighteenth World Health Assembly. The experience gained and the difficulties encountered were examined in detail and the importance of the early establishment of basic health services for the maintenance phase, which would also serve in the eradication of other communicable diseases, was recognized. It is realized that eradication of smallpox is feasible within a reasonable period, provided that the non - endemic countries give substantial assistance to work in the endemic countries and that country programmes are properly co- ordinated one with another and are run simultaneously in groups of neighbouring countries. Operational methodology must be sufficiently flexible and related to the complex epidemiological situation in individual countries or areas.Continuous assessment at every stage of the programme and surveillance should be further intensified. Many endemic countries are preparing to intensify their smallpox eradication programmes with assistance from WHO and from bilateral sources. A plan for an accelerated global eradication programme was accordingly drawn up at the end of the year for submission to the Nineteenth World Health Assembly. Non -endemic as well as endemic countries should make considerable long -term savings once eradication has been achieved.

Since 1961, cholera El Tor has spread from its endemic foci and gradually invaded practically all countries in the Western Pacific and South -East Asia Regions, most of which had been free from cholera for many years.In 1965, cholera continued to spread westwards, reaching West Pakistan, Afghanistan, Iran and Uzbekistan (USSR), and thus appeared again after many decades at the very doors of Europe and Africa. In 1965, numerous field and laboratory studies, organized mostly by the Organization, have shown that control measures are rather ineffective.The anticholera vaccines in current use, when tested in controlled field trials, have protected at most about half of the persons vaccinated and only for less than six months, while some vaccines did not provide any protection at all. It has been proved that the carrier state can occur in 30 per cent. or more contacts and that some of them excrete El Tor vibrio often for as long as three or more years. It has also been found that routine examination may often fail to reveal vibrios in the stool and that therefore the detection of carriers is difficult. In view of these findings, WHO has intensified its research activities particularly in the field of cholera vaccines and in the detection and treatment of carriers.Two large -scale field trials in India and an extensive international collaborative laboratory study of cholera vaccines were carried out to find better methods for the preparation and testing of these vaccines. Field and laboratory studies of carriers were carried out in the Philippines and elsewhere. To assist countries beset by cholera WHO, in addition to organizing an advanced training course on cholera control, towards the end of 1965 sponsored as an emergency measure a course on cholera bacteriology and a travelling seminar to enable senior public health administrators to visit cholera endemic areas. Further- more, a WHO cholera control team, set up in 1964, gave assistance to various countries in emergencies. The declining world trend of plague reached its lowest registered point in 1963. Since then, in 1964 a large outbreak occurred in Tanzania, while in 1965 a relatively higher incidence was observed both in South America and in South -East Asia.This indicates that plague is far from vanishing and that it will continue to present an important problem whenever man has to penetrate into and inhabit areas where enzootic plague exists. In 1965, an inter -regional seminar on plague control was organized in the USSR in order to promote epidemiological and ecological studies of the enzootic foci of plague in the world and assist in the control of this disease.

In the South Pacific, in Africa and the Americas, WHO has continued to assist governments in the field of endemic treponematoses through epidemiological and serological evaluations of the outcome of previous mass penicillin campaigns against yaws. The immunological profiles obtained show that low -level transmission of yaws continues to take place in the younger age - groups.Intensified surveillance is therefore required through the development of basic health services into which the previous yaws control field programmes are being integrated.The large random serum collections obtained from rural tropical populations in these investigations are utilized for multipurpose antibody studies, e.g., in regard to malaria, arboviruses, poliomyelitis, measles, and immunohaematologic and genetic factors in co- operation with the WHO serum reference banks and leading research institutions.This approach is of practical use in some instances for establishing susceptibility characteristics and for defining the age -groups in which vaccination programmes may be focused. The recent upsurge in the incidence of venereal syphilis and gonorrhoea has continued, though possibly at a slower rate. Among the reasons for this increase in incidence are the spread of urbanization, increased mobility of people in many parts of the world, changing behaviouristic patterns, and absence of fear of consequences. Theoretically useful epidemiological methods in venereal disease control are becoming less applicable than before as the social, economic and related non -medical factors dominate increasingly the ecology of these infections. However, a partially effective immunizing agent against syphilis in the experimental animal is in the process of development, an orientation which WHO is pursuing in the treponematoses research programme.

The eighth report of the WHO Expert Committee on Tuberculosis was widely distributed and received much publicity throughout 1965.It has exerted a profound influence on the control policies in almost all countries with strictly limited resources through its emphasis on bacteriological case - finding, ambulatory treatment and direct BCG vaccination, to be carried out by the general health services with a minimum of specialized supervision. WHO's direct assistance to Member States in tuberculosis in 1965 was almost exclusively devoted to training activities. More than 1000 medical officers, BCG technicians, treatment supervisors, laboratory technicians, and X -ray technicians were trained in thirty -two WHO -assisted field projects. Medical officers from twenty-five developing countries took part in the international training courses in the epidemiology and control of tuberculosis organized under the aegis of WHO by the Universities of Rome and Prague and by the Danish Tuberculosis Index. Notable conclusions from the WHO -assisted tuberculosis research programme were that intermittent (twice - weekly) administration of isoniazid and streptomycin is strikingly effective and that the inexpensive combination of isoniazid and thioacetazone has a therapeutic efficacy comp arable to that of the costly standard combination of isoniazid and PAS.

- % - Two developments in bilharziasis control in 1965 deserve special mention and both are likely to give great assistance to campaigns against that disease -an affliction which continues to be one of the major public health hazards in wide areas of the world.First, a non -antimonial drug has been developed that has proved highly effective in controlled trials covering thousands of patients suffering from either the urinary or the intestinal forms of the disease. Second, the possibility of effectively interrupting transmission of bilharziasis at relatively low cost through molluscicide application has been demonstrated for the first time in a UNICEF! WHO -assisted control project in the United Arab Republic in which no new cases of bilharziasis among pre- school children have been reported for the second consecutive year. In spite of these advances, which have yet to be widely applied, bilharziasis still takes a heavy toll in human health and continues to thwart economic development in many countries. As in many other sectors of public health, lack of resources and trained personnel remains the greatest deterrent to the expansion of effective control programmes. WHO is intensifying its efforts against trypanosomiasis (sleeping sickness), which has been spreading in a number of countries in Africa. Effective action against this disease depends upon a deeper understanding of the epidemiological situation.To achieve this, the training of additional specialist health personnel in Africa is essential. A training course was organized by WHO in 1965 for English -speaking countries of Africa, following a similar course in French in 1964; both courses were attended by physicians, veterinarians, agriculturalists and other scientists concerned with various aspects of the fight against this disease. Bancroftian filariasis is an increasing problem in almost all tropical and subtropical areas where rapid urbanization is taking place, and Culex fatigans has become more numerous in many fast- growing towns. The research unit established by WHO in Burma to study the problem has almost completed a three -year study on the ecology and biology of the mosquito and is about to begin an extensive experimental programme of control in the city of Rangoon. Research has proceeded on the exploitation possibilities of genetic control methods. A series of crossing experiments was initiated in 1965 with a C. fatigans strain from Rangoon. A strain of C. fatigans from Fresno, California, has been discovered which is incompatible with this Rangoon strain.When males of the Fresno strain mate with females of the Rangoon strain, no offspring are produced. In cage experiments in the laboratory, various proportions of Fresno males were released into breeding populations of the Rangoon strain.Within a few generations the experimental populations were eradicated. Further experiments using incompatibility phenomena for the control of C. fatigans are planned.

The control of diseases transmitted by Aedes aegypti presents an increasingly important problem. In Senegal, after twelve years without a single reported case of yellow fever, a large outbreak occurred at the end of 1965, in the region of Diourbel. By the end of November more than 230 cases had been reported with 216 deaths, forty-four of which had been confirmed by pathological examination. A. aegypti have been found to be abundant in all the areas affected. The WHO regional reference centre at, the Pasteur Institute, Dakar, took a very active part in the study and control of this epidemic. Although there were no severe outbreaks of haemorrhagic fever in South -East Asia in 1965, the disease continues to constitute a very real threat in that part of the world. In April, May and June an extensive epidemic of dengue -like fever occurred in Nagpur, India; and similar outbreaks occurred towards the end of the year in Visakhapatnan and other cities in the south of India, but no severe cases of haemorrhagic fever were reported. Several strains of chikungunya virus and at least one strain of dengue virus were isolated from patients during these outbreaks. In the Region of the Americas no cases of yellow fever or major outbreaks of dengue fever occurred during the year, but it is unfortunate that the programme for the eradication of A. aegypti has lost some of its momen- tum. Resistance to insecticides remains the most important factor responsible for this. Plans have been made to renew interest in the various territories where the species still exists and the implementation of an eradication programme by the United States of America may have an important influence in this respect. Research on the potential of newly- developed insecticides has been increased and the functions of the WHO /PASB research unitin Jamaica have been extended. Laboratory research on genetics and biochemistry, on vector capacity and biology has been intensified. In Africa as a whole both urban and feral forms of A. aegypti are known to exist but accurate information on their distribution and ecology is lacking. The Organization has initiated a study on speciation and genetics in West Africa and this will be followed by a similar investigation in East Africa in 1966. A global study on the distribution, density, seasonal fluctuation, insecticide resistance and behaviour of A. aegypti has been initiated. An international reference centre which will carry out genetic studies on A. aegypti has been established in the United States of America. In Paris a laboratory is determining levels of resistance of strains of A. aegypti submitted by collaborating countries.This work will permit the Organiza- tion to determine in which areas of the world conditions may favour the transmission of dengue and haemorrhagic fevers. For example, it appears that the species is slowly disappearing from the Mediterranean area, that climatic conditions will probably prevent dangerously high densities being built up west of West Pakistan, and that in the majority of the big cities in the South -East Asia and Western Pacific Regions rapid and extensive development has created conditions favourable to the large -scale breeding of the species and consequently to the transmission of these diseases. These facts were made clear at a seminar on the ecology, biology and control of Aedes aegypti held in Geneva during the year. They have prompted the Organization to establish in Bangkok a research unit which during the next few years will study the ecology and biology of the mosquito, with the objective of bringing about its control. Among objectives of the unit will be to ascertain whether A. aegypti is the only mosquito transmitting the dengue -like diseases and whether it is completely urban in its behaviour.

Influenza, which spread widely during the year in the USSR and neighbouring countries, was due to a strain of virus A2 which showed a considerable antigenic shift away from the original strain responsible for the 1957 epidemic. The antigenic changes underline the need for constant vigilance to ensure that any new strain which may emerge is quickly identified and distributed to the laboratories concerned.

The fundamental importance of research in immunology for future progress in devising effective public health measures for the control of communicable diseases is reflected in the WHO immunology research programme. There are three avenues of immunology research, which may lead to valuable contributions towards the solution of some of the pressing public health problems in the developing countries : the development of immunodiagnostic tests; studies in immunopathology; and research in immunoprophylaxis. For these reasons, the Organization is establishing centres for research and training in immunology to help create the trained scientific manpower essential for promoting regional and local studies in the countries where tropical diseases exist. -XII- The research and training centre in Ibadan, Nigeria, established in 1964, served as a useful prototype and was followed by the establishment of a second centre in Silo Paulo, Brazil, under the aegis of PAHO/ WHO. The system of training research workers locally has a number of advantages: it obviates the risk of loss that occurs in developing countries when scientists trained abroad decide not to return home, and locally trained scientists do not have the difficulties of adjustment and readjustment experienced by those who return after training abroad. In 1965 an expert committee examined the value of the administration of human immunoglobulin and evaluated the conflicting claims for its usefulness in prophylaxis of hepatitis following transfusions and in rubella.Its report contains practical information about the value and dosage of immunoglobulin in many diseases, together with information about the structure and preparation of immunoglobulin, and suggests mechanisms for obtaining supplies of plasma from specifically immunized donors for the preparation of immunoglobulin rich in particular antibodies. In the growing field of research in immunogenetics, a scientific group reached international agreement on a nomenclature for the genetic variants of human immunoglobulin and the international reference centre in Rouen, France, has already begun to meet the need for reference reagents for clinical research.

During the year there was a further expansion of studies on atherosclerosis in several population groups in Europe. Such studies will help in the early diagnosis of ischaemic heart disease and cerebrovascular disorders as well as in the identification of etiological factors. One of the aims is to investigate the relation between the frequency of various forms of cerebrovascular lesions and ischaemic heart disease. An important development was the preparation of a manual specifying methods for epidemiological investigations of cardiovascular diseases. This should facilitate and improve comparison of studies in different parts of the world. In the European Region the importance of cardiovascular diseases was stressed by the Regional Committee, which requested the preparation of a plan for the intensification of the control of these diseases. Furthermore, a regional conference on the prevention and control of cardiovascular diseases was organized in Bucharest to discuss the present situation.It recorded the progress obtained in many European countries and pointed out that prevention and control could be considerably advanced if greater use were made of existing facilities and if the public health and economic value of specialized services for patients with cardiovascular diseases were more clearly recognized.

WHO's work during 1965 continued to benefit from the expanding contribution of its reference centres. In the field of cancer, the number of international reference centres for the histopathology of tumours was increased by two, dealing with the classification of tumours of the skin and of the urinary bladder. Ten such reference centres are now in existence. The most important event in this field in 1965 was the agreement reached on the classification of lung and breast tumours which will enable their publication in the near future. Significant progress has been made in the classification of leukaemias and of bone, ovarian, oropharyngeal, soft tissue, thyroid and salivary gland tumours. There has also been further progress in regard to the epidemiological studies on lung tumours, breast tumours, oropharyngeal tumours and lymphomas. All phases of research related to cancer are expected to be strengthened through the contribution of the International Agency for Research on Cancer at Lyons which is due to start programme activities in 1966. The Agency, sponsored by Me Governments of France, the Federal Republic of Germany, Italy, the United Kingdom of Great Britain and Northern Ireland and the United States of America, came into being following the entry into force on 15 September 1965 of the Statute of the Agency adopted by the World Health Assembly. Participation is open to other Members of WHO and during the year Australia and the Union of Soviet Socialist Republics became Participating States.

The place of mental health activities in public health programmes continued to be emphasized.This was demonstrated during the travelling seminar on mental health services in the Union of Soviet Socialist Republics, where the system of psychiatric care was shown to be closely linked with the work of general health, social welfare and educational bodies. Health administrations are showing increasing concern about alcoholism and drug dependence, mental retardation and juvenile delinquency. During the year WHO consulted experts from many national and international bodies concerned with these problems, with a view to evolving a common policy and defining the role of the Organization. Research on mental disorders is hindered by lack of standardized diagnosis, classification and statistics, and a programme has been initiated with a view to improving understanding among psychiatrists. The accumulated findings from the studies on various categories of mental disorders over the next ten years will be utilized in 1975 in the Ninth Revision of the International Classification of Diseases. In 1965 the focus was on schizophrenia. A long -term programme of research on biological psychiatry and neurology was also started during the year, and a first meeting of a scientific group has dealt with research on genetics in psychiatry.

The welfare of two large groups- seafarers and agricultural workers -was the focus of WHO's activities in social and occupational health. A joint ILO WHO committee on the health of seafarers recommended the publication of the International Ship's Medical Guide, which is to be published in 1966. A seminar on occupational health with special reference to agriculture, held in the Union of Soviet Socialist Republics, covered such important items as inspection of places of work, organization of medical care, epidemiological studies, occupational hazards including those due to the use of pesticides, and accident prevention. An inter -regional seminar held in Alexandria, United Arab Republic, considered the causes of traffic accidents and ways and means of preventing them. These have become all too frequent in highly developed countries, and developing countries in the process of rapid urbanization and industrialization will soon face a similar situation. Particular attention was paid to improved road and vehicle design in relation to driver performance and safety and to the education of road users, both drivers and pedestrians.

Because of the fundamental role played by nutritional factors in health and disease, the Organization's programmes in nutrition over the past seventeen years were reviewed by the Executive Board at its thirty - fifth session in January 1965. Training and research were identified as two essential aspects of the Organiza- tion's continued efforts in this field. The importance of the relationship between malnutrition and infectious diseases was emphasized by the Expert Committee on Nutrition and Infection. The Committee concluded that the planning of health programmes in developing countries would greatly benefit from consultations between technical personnel concerned with nutrition and those concerned with communicable diseases.Co- operation of this type should eventually lead to a substantial reduction of the present high rate of mortality in infants and young children due to various infections that gain hold because of low nutritional standards. During 1965 FAO and WHO continued joint activities designed to reach international agreement on human requirements for various essential nutrients. A joint meeting in Rome dealt with vitamin A, thiamine, riboflavin and niacin, and it is expected that, through further joint FAO! WHO work, countries will have at their disposal a complete internationally accepted guide on the essential nutrients.

The Eighteenth World Health Assembly, in resolution WHA18.49, approved a programme of work and established guidelines for the development of WHO's activities in the field of human reproduction. During the year, four scientific groups met to analyse the knowledge available in this field and to advise on the development of the programme. They dealt with the biochemistry and microbiology of the female and male genital tracts, the immunological aspects of human reproduction, the chemistry and physiology of the gametes and the clinical aspects of oral gestogens. In the field of service to research, arrangements have been made for the preparation of hormone extracts from human pituitaries, and for the introduction of new and reproductively interesting animals into laboratory research.In addition, support has been given to research workers in such fields as population dynamics, and the immunological aspects of spermatozoa as they relate to reproduction. Negotiations were undertaken with a view to giving support to research related to the detection of ovulation in women. WHO's library will serve as a documentation centre for information related to research and to the practical application of knowledge in the field of human reproduction. Work has already begun on an inventory of scientists and institutions actively engaged on work in that subject.

The widening of the scope of WHO's medical research programme is reflected in the number of scientific groups which met in 1965, and in this connexion it is gratifying to realize the extensive use now being made of the published reports of these groups. The Advisory Committee on Medical Research at its seventh session considered the reports of scientific groups dealing with a large variety of subjects, including cholera, dental health, environmental pollution, human reproduction and the monitoring of adverse reactions to drugs. In addition, it reviewed in detail the virus research programme and advised on the development of a research programme on the health aspects of population dynamics. It is pleasing to report that collaborative research projects have greatly increased; in fact more than one - third of the projects in operation at the end of 1965 (143 out of a total of 381) were initiated during the year and many are concerned with such relatively new topics as the biology of human reproduction, human genetics and immunology. In the development of the current programme of medical research, the network of WHO reference centres has also been increased by the establishment of thirteen new centres. -, xv - As a result of a series of studies undertaken with the active collaboration of many experts, WHO was able by the end of 1965 to draw up a realistic and flexible plan for the expansion of its activities in research in epidemiology and the application of communications science.

During the year three former Associate Members which had acceded to independence during 1964 became Members of the Organization : Malawi, Malta and Zambia. The Maldive Islands also became a Member of the Organization in 1965.

- XVI - PART I

GENERAL REVIEW

CHAPTER I

MALARIA ERADICATION

Progress of Malaria Eradication Small persistent foci still exist in Albania and Greece, but are being gradually eliminated.In Turkey, two - During 1965 progress was maintained in the majority thirds of the malarious areas have reached the conso- of programmes in the world -wide effort to eradicate lidation phase, and many of these will be able to malaria.Bulgaria, which had over 400 000 cases of enter the maintenance phase as soon as public health malaria in the ten years 1946 -1955, and China (Tai- service coverage is adequate. wan), where before the eradication programme (see In the Eastern Mediterranean Region further areas also page 137) over 5000 people died each year from in Syria reached the maintenance phase but an out- malaria, were entered in the WHO official register break of malaria was recently reported which may as having eradicated the disease. Jamaica and Trini- make it necessary to re- introduce attack measures in dad and Tobago have been certified as having achieved certain districts.In Pakistan, where the programme eradication. was started in 1961, the first areas entered the con- Although there has been satisfactory progress in a solidation phase; however, for administrative reasons, number of programmes in the Americas, in others and because of the late arrival of insecticide supplies, little or no progress has been made or the position has the expansion of this programme planned for 1965 evendeteriorated. Financialand administrative was not fully realized.Certain areas in Iraq and difficulties have continued to be the main obstacles, Jordan that were iñ the consolidation phase have had and the need to use supplementary measures to to revert to attack measures because of resumption overcome technical problems such as resistance of the of transmission.Much of northern Iran is in the vectors to DDT, or a high degree of outdoor trans- consolidation phase, but reinfection continues to mission of malaria, has further strained the financial occur from the southern part of the country, where resources of the programmes. insecticide resistance of the vector sets a serious Steady improvement has been ,maintained in pro- technical problem. grammes in South -East Asia. In India only one -fifth In the Western Pacific Region the Ryukyu Islands of the population of the originally malarious areas have reached the final phase of the programme, and still remain in the attack phase, while well over one - further progress has been made in Sabah and Sarawak third satisfy the epidemiological criteria for entry into (Malaysia). the maintenance phase.' In the island of Java (Indo- In areas where the programme is not progressing nesia) it has been possible to withdraw spraying opera- according to schedule the usual cause is that it is not tionsinareas covering nearly two -thirdsof the receiving sufficiently high priority. Although the population.In Afghanistan new areas have reached later stages of eradication programmes are in many the consolidation phase. On the other hand, in Ceylon, ways the most difficult, calling for the greatest effort which was entirely in the consolidation phase in 1964, and full financial support, there is a tendency to cut spraying operations had to be resumed in January back on the finances required for this extra effort as 1965 to deal with focal outbreaks involving a popula- malaria morbidity is reduced to low levels. tion of 100 000. In Nepal and Thailand larger areas At the end of 1965, twenty -nine pre- eradication pro- have been covered by spraying during the attack grammes and surveys were in operation- twenty of phase. them on the African continent -and a further nine Most cases of malaria found in Europe are imported programmes were in the planning stage. Every effort from the still malarious areas of the world.Further is being made to speed up the development of rural progress was made in continental Europe, where health services to the level at which they can sustain additional populations reached the maintenance phase. malaria eradication programmes.However, long- term financial assistance from external sources will The successive phases of a malaria eradication programme be required to start such programmes in these coun- are: preparatory, attack, consolidation, maintenance. tries in Africa. - 3 - 4 THE WORK OF WHO, 1965

Further progress has been made in the co- ordinated considerable progress already made in securing this planningof malariaeradication programmesin collaboration is attested by the increased role of general neighbouring countries with a view to synchronizing health servicesinpassive case- detection,thereis programmes in adjacent areas. Such a plan has been still much room for improvement. In countries nearing developed inthe Eastern Mediterranean Region, the goal of eradication, efforts are being made to train where the Malaria Eradication Co- ordination Board themalariaeradicationpersonnelandintegrate for Jordan, Lebanon and Syria held its first meeting them into the rural health services. In India, continued in June. At a meeting of the Ministers of Health of progress is being made in training such staff to become Central America and Panama held in Washington in multipurpose health workers in areas in the main- April it was resolved to develop co- ordinated plans tenance phase, and at the same time public health for all the countries concerned and, in order to assure workers are being orientated in malaria vigilance work their effective implementation, to create a working to be undertaken in this phase.In Turkey, various party comprising the directors of the national malaria public health duties are being assigned to malaria eradication services and representatives of assisting eradication personnel in areas ready to enter the agencies. The first meeting of the working party took maintenance phase. place in August 1965.Dahomey, Ghana and Togo, In some pre- eradication programmes, as for example which are undertaking pre- eradication programmes, in Algeria and Morocco, basic health service staff also held co- ordination meetings. are being trained in polyvalent duties and will even- The countries engaged in malaria eradication pro- tually undertake much of the work of the eradication grammes at 31 December 1965 and those under- programme. taking pre- eradication programmes and other anti - The seminar on the role of the general health services malaria operations with assistance from WHO are malaria eradication, held for countries of South listed in Annex 11. America in 1964, was followed by a second seminar As in the past, many of the malaria programmes were held in Cuernavaca, Mexico, in March 1965.It was assisted by various agencies. UNICEF provided attended by directors -general of the health services, supplies for twenty -nine programmes, nineteen of directors of national malaria eradication services, and them in the Americas; it also assisted the development other senior health officials of seventeen countries of rural health services, thus furthering the progress of and territories of Central and North America and the malaria pre- eradication programmes. The United Caribbean, and by representatives of UNICEF and the States Agency for International Development pro- United States Agency for International Development. vided assistance to fifteen programmes and to the international malaria eradication training centre at Manila. In connexion with the national malaria Training for Malaria Eradication eradication programme in Turkey, the Government's request to the World Food Programme for assistance The five international malaria eradication training in the form of food subsidies, which it is hoped might centres at São Paulo, Lagos, Manila, Lomé and make the employment conditions in the lower paid Maracay have continued to train both national and grades of the malaria service more attractive, has international personnel for the malaria eradication and pre- eradication programmes in various parts of been approved. the world.Apart from the routine courses for pro- A detailed progress report on the malaria eradication fessional and sub -professional staff, special courses programme covering the year 1965 will be presented have been held in epidemiology, entomology and to the Nineteenth World Health Assembly in May administration. A recent innovation has been a course 1966.1 for directors of regional public health services in certain countries to improve their orientation in the concepts and techniques of malaria eradication.It is General Health Services and the Malaria Eradication envisaged that more opportunities will be provided for Programme both senior and junior staff of the general public health services of countries undertaking eradication To achieve success in a mass campaign such as and pre- eradication programmes to follow courses in malaria eradication, the closest participation of the malaria eradication techniques. general health servicesisessential. Although the Most countries undertaking malaria eradication have facilities for training various categories of junior 1 The corresponding report for 1964 has been published in national staff with the assistance of the WHO malaria Official Records No. 143, Annex 11. advisers. MALARIA ERADICATION 5

The national training centres in Ethiopia, India, medicated salt, and in southern Iraq the reorganization Indonesia, Iran, Mexico, Pakistan and Sudan have of the programme effected at the beginning of the continued their work in close co- operation with WHO, year has improved the situation. many of them accepting trainees from other countries.

Research Evaluation The main emphasis in malaria research has been on Inallmalaria eradication programmes regular subjects that have a direct bearing on the technical evaluation is essential to assess the results and enable difficulties encountered in malaria eradication, espe- appropriate measures to be taken in areas falling cially those arising in problem areas.Since some behind schedule, and to provide a basis for the progress strains of Plasmodium falciparum that are relatively of the programme through its various phases. resistant to the 4- aminoquinolines have been found, For a number of years the Indian programme has increased attention has been given to the development been assessed annually with the assistance of WHO and of new antimalarial drugs, and the Organization has the United States Agency for International Develop- provided assistance to research in the screening of ment. The independent assessment team has provided potential antimalarials, laboratory studies in mammals recommendations theGovernment with onthe and trials in the field.In accordance with the recom- operation of the programme and the timing of the mendations contained in the report of the Scientific introduction of the consolidation and maintenance Group on Resistance of Malaria Parasites to Drugs,' phases. In a number of countries in advanced stages studies are also being made on the mechanism of the of malaria eradication similar independent assessment development of drug resistance and on the response has been made by teams composed of WHO consul- of malaria parasites to4-aminoquinolines, mapping tants and staff from other international and bilateral the areas where resistance to these drugs is suspected. agencies. A regular schedule for independent assessment was started during the past year in the Americas. In entomological research,activities havebeen Evaluation teams have also been employed in promoted according to the recommendations con- reviewing data for the certification of eradication of tained in the eleventh report of the Expert Committee malaria in various countries. on Malaria,a attention being paid to the development of methods to be used in the epidemiological assessment of malaria eradication programmes and in the study of refractory behaviour of vectors in problem Problem Areas areas.Further work has been carried out on the identification of the members of vector complexes, As mentioned above, there are a number of countries particularly in Africa, and studies are being made to where the objectives essential to a successful time - develop improved methods for sampling the vectors limited malaria eradication programme have not been attained. In many countries this is due to inadequate in the various phases of the programme. financing, to instability of governments or to admin- The initial screening process by which insecticides istrative and operational weaknessesinthepro- are tested for their suitability in malaria eradication gramme. But there are also " problem areas " where, is mentioned on page39. Field trials of the more in spite of good coverage by the normal methods of promising insecticides have been undertaken in Central attack using residualinsecticides,transmission of America, Iran, Mexico, Nigeria, Pakistan and Uganda. malaria persists owing to resistance of the vector In the last- mentioned country a trial with malathion mosquito to insecticides, behaviour characteristics of which was started in1963was completed in March the vector, or the habits of the people. The solution 1965;the results indicate that this insecticide can be lies sometimes in the intensification of attack measures used as an alternative to the chlorinated hydrocarbons, and case -detection, sometimes in the use of alternative but in areas where a considerable proportion of wall insecticides and other attack measures such as larvici- surface is of mud preliminary trials must be made ding and chemotherapy, and frequently in a com- to determine the duration of its effectiveness. In bination of these methods.In Central America and Nigeria a field trial using folithion (OMS-43)which Mexico, where the largest problem areas exist, shortage was started in July1964is continuing, and an epidemio- of funds has prevented employment of these intensified logical evaluation of the results will be made early measures on a large scale during1965.In a problem area in southern Iran further preliminary work has 1 Wld Hlth Org. techn. Rep. Ser., 1965, 296. been undertaken in trying newer insecticides and 2 Wld Hlth Org. techn. Rep. Ser., 1964, 291. 6 THE WORK OF WHO, 1965 in1966.Fieldtrialsare being undertaken with Other meetings held during the year were the thir- dichlorvos, a fumigant insecticide, in Iran and Pakis- teenth meeting of Directors of National Malaria tan and with OM S-33, a carbamate, in Iran. Eradication Services of Central America, Mexico, Assistance has also been given in studies on plas- Panama and the Caribbean Islands and the fifth modia of small mammals which can be used in the meeting of the Directors of National Malaria Eradica- screening of potential antimalarials, studies on simian tion Services of South America.In addition, there malaria which may contribute to a better under- were ten inter- country border meetings. standing of certain aspects of malaria transmission in man, and the development of immunological tech- A monograph 1 on statistical methods in malaria niques which may be of value in case -detection and in eradication was prepared for publication.It is based the study of human genetic factors in relation to on a two -volume cyclostyled document which was malaria. issued in 1959 under the title " Statistical considerations and methodology in malaria eradication ". The demand from public health workers for these volumes was such that the need for a printed and more up -to- Expert Committee and other Meetings, and Publications date version became clear. In the present edition spe- The Expert Committee on Malaria which met in cial emphasis is laid on aspects of particularly practical Geneva in September 1965 reviewed the methodology importance, and a new chapter is included on the for the early assessment of response to attack measures quantitative epidemiology of malaria. in eradication programmes and made an appraisal of Articles on various aspects of malaria eradication the employment of chemotherapy in malaria eradica- have appeared in the Bulletin,2 and a special issue was tion, including the methods to be used in areas where devoted to malaria and insecticides.3 there is drug resistance.It also studied the organi- Informationontheepidemiologicalstatusof zational, administrative and technical requirements for the maintenance of achieved eradication both in malaria in areas in the consolidation and main- countrieswherehealthservicecoverageiswell tenance phases and on localities where chloroquine- developed and in those where it is inadequate. resistantstrainsof malariaparasiteshave been The Fifth Asian Malaria Conference for countries reported was issued in the Weekly Epidemiological of the South -East Asia and Western Pacific Regions Record with a map for the use of public health and Pakistan was held in Colombo, Ceylon, in October workers showing the epidemiological assessment of 1965, and was followed by a meeting of the Anti - malaria.4 malaria Co- ordination Board for Laos, Malaysia, Thailand and Viet -Nam. 1 Swaroop, S. ed. Gilroy, A. B. & Uemura K. (1966) Statistical The Advisory Committee on Malaria Eradication in methods in malaria eradication, Geneva (World Health Organiza- the Region of the Americas which met in Washington tion: Monograph Series, No. 51). 2 Bull. Wld Hlth Org., 1964, 31, 365 -377, 399 -409; 1965, 32, at the end of August 1965 recommended, inter alia, 149 -173; 33, 435 -470. the expansion of activities in epidemiology, programme 3 Bull. Wld Hlth Org., 1964, 31, No. 5. assessment and research. 4 Wkly epidem. Rec., 1964, 40, 232, 431. CHAPTER 2

COMMUNICABLE DISEASES

This chapter describes WHO's work on the various in the analysis of the actual epidemiological situation communicable diseases and on international quaran- in any particular country and in the establishment of tine- activities containing the elements of a global priorities for control measures. epidemiology, including the accumulation of data The information obtained on the global fluctuation from mass campaigns, prevalence surveys, morbidity in the prevalence of communicable diseases and in the and mortalitystatistics and blood samples from immunological status of the world population has human and animal populations. opened the way to the establishment of a system of With regard to blood samples, the Organization's global surveillance of disease and spread of infections services in treponematoses, virus diseases, malaria, under differentecologicalconditions and central human genetics and health statistical methodology guidance to meet priority needs in various places at are co- operating in the multipurpose investigation various times. of sera from Northern Nigeria with the Institut Alfred Fournier, Paris, the Yale Arbovirus Research Labo- Tuberculosis ratory, New Haven, Conn., United States of America, the Nuffield Institute for Medical Research, London, Discussion of the essential principles of national and the International Blood Group Reference Labora- tuberculosis programmes and a reappraisal of the tory, London. Plans have also been prepared for the methods involved were stimulated by the publication immediate investigation -in co- operation withthe of the eighth report of the Expert Committee on WHO regional serum reference bank at Prague -of Tuberculosis,1 following its meeting in August 1964. sera from Mongolia, Eastern Nigeria, the Philippines, The report was widely reviewed both in general and Thailand and Togo,fordifferentantibodiesof more specialized medical journals. bacterial, virus or parasitic origin.Aliquots of serum The Expert Committee's recommendations -which collections composed of thousands of sera and dried are based to a great extent upon results from the blood specimens are deposited with all three WHO WHO- assisted research programme -have far -reaching serum reference banks -at Yale University, the Insti- implications for the orientation of antituberculosis tute of Epidemiology and Microbiology, Prague, and activities, whether in the clinic or on a public health the South African Institute for Medical Research, scale or as a part of overall social planning, and they Johannesburg -for " posterity " use in WHO's sur- have had a marked effect in 1965 both in the developing veillance programme. The previously tested new and the more economically developed countries. techniques and equipment for the transport of serum Recommendations thatare having aparticular in liquid nitrogen at -196° C or the mailing of desic- influence on national tuberculosis control programmes cated blood on paper rondelles have been put to regular are those relating to the importance of microscopy use during the year by WHO. in diagnosis, follow -up and surveillance; the value Investigation of population blood samples permits of BCG vaccination as a protective measure; the not only studies on antibodies in connexion with development of domiciliary chemotherapy, and the all microbial agents and some parasites, but also giving of priorityattentiontothose consciously biochemical, haematological and genetic studies. suffering from the disease.Concentration on this The collection, storage and investigation of blood group, which is far larger than was realized, is reducing samples from human and animal populations in the costs of case -finding and improving co- operation various parts of the world, in addition to ecological between preventive health services and the public. studies of diseases and " posterity " studies on diseases not yet recognized, play an extremely important role 1 Wld Hlth Org. techn. Rep. Ser., 1964, 290. - 7 - 8 THE WORK OF WHO, 1965

Some reappraisals have been made of BCG vac- and performed, at the request of governments and cination policies following the Committee's recom- WHO, comparative studies of BCG products as a mendation that the mass use of BCG should be con- service to national laboratories. The WHO Tubercu- tinued and expanded in all countries where tuber- losisDiagnosticReferenceLaboratoryrendered culosis is a serious public health problem. A review services to developing countries in identifying myco- of BCG vaccination in the tuberculosis control pro- bacteria and in training national bacteriologists in the gramme was considered in detail by the UNICEF/ WHO Joint Committee on Health Policy at its four- complex techniques involved. teenth session in February. The Committee expressed A review of the tuberculosis programme of WHO its firm conviction of the efficacy of BCG vaccination, during the period 1949 -1964 was published in the its agreement with the emphasis on BCG vaccination WHO Chronicle.'This up -to -date and expanded in UNICEF /WHO- assistedtuberculosiscontrol version of the report submitted to the Executive projects, and its hope that mass BCG campaigns Board in January 1964 appeared in two parts, dealing receiving UNICEF assistance would be integrated into respectively with control programmes and research. the permanent national tuberculosis control scheme as quickly as possible. The simultaneous application of BCG and smallpox vaccinations and the omission Research of the tuberculin test prior to BCG vaccination in Investigations into various aspects of tuberculosis young age -groups were welcomed as developments control continued under the WHO- assisted research likely to facilitate such integration. programme, and some results were published in two Of particular importance to developing countries special numbers of the Bulletin.2These included the has been the confirmation, through research, of the studies of several aspects of intradermal tuberculin value of ambulatory drug treatment. The increasing testing, mostly carried out in human beings because use of domiciliary chemotherapy in preference to results in guinea -pigs are often misleading.3The institutional care is leading to a more rational alloca- problem of stabilizing highly diluted tuberculin was tion of resources in practically all the countries where studied because the detergent at present used for this WHO- assisted projects are in operation.Most of purpose seems to modify the tuberculin reactions; the chemotherapeutic regimens have been standardized a more satisfactorystabilizing agentistherefore after extensivetrials, thus providing the essential being sought.4Another problem investigated was basis for the development of mass chemotherapy as the quantitative comparison of tuberculin products. an integral part of the national tuberculosis control Not only does Old Tuberculin differ from purified programmes. Recently more attention has been protein tuberculin in several respects, but even purified given to the organization of efficientservices for tuberculins prepared in different ways differ markedly follow -up, especially of defaulters. with regard to their potency ratio as estimated in In 1965 WHO provided seventy -five medical officers, different types of population.The ideal tuberculin statisticians, public health nurses and laboratory and would cross -react with the non- specific allergy to X -ray technicians to assist more than thirty countries a lesser extent than the tuberculins used at present and inthe formulation of national tuberculosis pro- at the same time elicit clearly positive reactions in all grammes and in the training of key personnel for persons infected with tuberculosis. Research was them.As in previous years, international training conducted onthisproblem by evaluatingboth courses in the epidemiology and control of tuberculosis were organized by the Universities of Prague and purified fractions of native tuberculin from human Rome and the Danish Tuberculosis Index,with tuberclebacilliand PPD sensitins from atypical assistance from WHO.The courses, which lasted mycobacteria. four months, were attended by medical officers from Analysis of data collected in the WHO- assisted twenty -five countries, most of whom upon their return prevalence surveys in Africa has brought out the were assigned to senior positions intuberculosis ineffectiveness of the X -ray examination alone for control programmes. Studies carried out in a network of co- operating ' WHO Chronicle, 1965, 19, 309 -325; 365 -374. laboratories made possible the use of in vitro methods 2 Bull. Wld Hlth Org., 1964, 31, No. 2; 1965, 33, No. 3. for the quality control of BCG vaccine. Various 3 Hansen, O. G., Lindqvist, K. & Waaler, H. (1964) Bull. Wld filth Org., 31, 171 -182. laboratories undertaking contractual services for the 4 Farah, A. R. & Christensen, O. W. (1964) Bull. Wld Hlth Organization held reference batches of BCG vaccine Org., 31, 151 -159. MALARIA PRE -ERADICATION PROGRAMME IN TOGO

The malaria eradication training centre at Lomé, where staff are Members of an antimalaria team look for mosquito larvae being trained in the techniques of malaria eradication.The Lomé on the banks of a stream. centre serves theFrench -speakingcountriesof theAfrican, Eastern Mediterranean and Western Pacific Regions.

In Togo, as in many other African countries, WHO is helping the Government to build up the necessary technical, operational and administrative facilities for the eventual launching of a national malaria eradication programme.

A WHO malariologist, during a tour of vil- Microscopistsof anantimalaria teamat lages with an antimalaria team, examines a work in a field laboratory. The microscopist child for spleen enlargement. in the foreground is dissecting a mosquito to see if it is infected.

Dissectioninvolves removal of the head, salivary glands and sometimes the stomach of the mosquito. TUBERCULOSIS CONTROL IN AFRICA The governments of several African countries are carrying out, with the assistance of UNICEF and WHO, programmes for the control of tuberculosis, which many of them consider as their main public health problem.

BASUTOLAND The project in Basutoland, which has been in operation since 1962, aims at establishing a pilot area for the development of SWAZILAND control measures that can later be applied throughout the territory. Ina project in Swaziland similar to the one in In this mainly rural area, mobile teams go from village to village Basutoland, villagers are registered for X -ray exam- for case -finding, vaccination and drug administration, under the ination. supervision of the nearest health centre. KENYA 1. The operational centre of a tuberculosis control project. A tuberculosis centre equipped with a laboratory has been established in 2. A mobile X -ray team in operation on the outskirts of a village in a Nairobi.It trains various categories of staff, particularly auxiliaries for high plateau area. the national BCG vaccination campaign.It is expected that it will later 3. The public health nurse working with a WHO mobile team gathers extend its activities so as to serve as a training centre for the English - the villagers together and registers them. speaking countries of east and central Africa.

4. A blood sample is taken as a general check on health. 1. The WHO medical officer ofthe laboratory and his Kenyan counterpart 5. X -ray examination of a child. examine bacterial cultures.

2. Examination of cultures by a WHO scientist and a trainee.

3. A trainee learns to repair X -ray equipment under the supervision of a WHO X -ray technician.

4 5 3 1

MATERNAL AND CHILD HEALTH IN GABON

As part of a national health development scheme, the Government of Gabon has established new maternal and child health services. The School of Nursing of Gabon is training nurses and midwives under a project assisted by UNICEF and WHO.

1. A Gabonese midwife demonstrates infant care to student midwives.

2. Examination of children brought by their mothers to a mobile dispensary touring the Libreville area.

3. The mobile dispensary team, assisted by a WHO nurse, checks the babies' weight.

3 COMMUNICABLE DISEASES 9 detecting suspects.' A large -scale study was begun in Endemic Treponematoses and Venereal Infections co- operation with the International Union against By the end of 1965 the Organization had received Tuberculosis, with a view to improving the interpreta- from thirty -nine Member States extensive documen- tion of X -ray shadows under different epidemio- tation on their programmes and plans to reduce the logical conditions. incidence of the endemic treponematoses and the Further data became available from the WHO - venereal diseases. assisted Tuberculosis Chemotherapy Centre in Madras on the effectiveness of intermittent fully supervised The information was sent in response to resolu- twice -weekly administration of isoniazid and strepto- tion EB34.R25 in which the Executive Board, in mycin.2 Studies were started of the effect on patients requesting Member States to report on the subject, of once -weekly administration of this drug com- also urged them, where indicated, to increase their bination,and alsoof the enhancingtherapeutic efforts at the national level to combat these infections. effect of a short initial period of intensive daily chemo- A preliminary review of the data suggests that there therapy. Data from WHO- assisted research also now exists a growing awareness of the need for im- confirmed that the very cheap oral combination of proving the surveillance of endemic treponematoses isoniazid and thioacetazone produced almost the same and especiallyfor more activecontrol measures satisfactory therapeutic response as the much more against the continued rising trend in the incidence costly standard regimen of isoniazid and PAS. of venereal syphilis and to some extent also of gono- The potency of BCG is measured in the laboratory coccal infections. in various ways; the most important is an estimation WHO has continued toassistseveraltropical of the number of living bacilli by seeding a nutritional developing countries in the control and surveillance medium with a highly diluted vaccine and counting of yaws.Only isolated requests were received for the number of bacterial colonies.On the initiative assistance in strengthening national venereal disease of WHO, such counts were performed for the same control services. vaccine in seven laboratories - -with results that were The Organization has continued to support institu- quite often contradictory. An analysis of these studies tions co- operating in epidemiological, immunological withadetaileddescriptionof thebio- statistical methods developed by WHO for such studies was and other basic and applied research projects (see published in the Bulletin.3 also Chapter 7). In India a WHO -assisted feasibility study was under- Under thetitleInternational Work in Endemic taken as a preliminary to a controlled immunization Treponematoses and Venereal Infections, 1948 -1963, trial which aims at establishing the protective power a detailed review of the Organization's programme in in man of some BCG strains found particularly this field was published in instalments in the WHO promising in laboratory experiments on animals and Chronicle 4 and issued as a reprint in 1965. also at establishing the precise value of BCG in persons with non -specific allergy. The first comprehensive analysis of the WHO - Endemic Treponematoses assisted study of the methodology for tuberculosis Rural mass campaigns against endemic trepone- eradication was completed in Czechoslovakia. It matoses(yaws,pintaand non -venerealendemic shows that administrative reorientation of the pro- syphilis) have continued with WHO assistance in gramme on the basis of epidemiological findings In others, where clinical -by such measures as reduction of hospital stay, some tropical countries. increased domiciliary supervision and more frequent prevalence was reduced to very low levels by previous follow -up of suspects -made it possible over a four - campaigns, WHO's work has been primarily concerned year period to bring about a 60 per cent. decrease in with the integration of the needed epidemiological the number of persons found, by direct smear, to be vigilance activities into the general developing rural excreting mycobacteria, and at the same time to health services. This has been done with some success eliminate the public health hazards caused by chronic in, for example, Nigeria, the Philippines, Thailand, excretors of tubercle bacilli and by secondary drug Togo and Western Samoa. resistance. With the impressive declining prevalence of overt clinical yaws lesions -a result of the wide application ' Roelsgaard E., Iversen E. & Blocher C. (1964) Bull. Wld of long- acting penicillin -health administrations may Hlth Org., 30, 459 -518. 2 Tuberculosis Chemotherapy Centre, Madras (1964) Bull. tend to become indifferent towards the need for Wld Hlth Org., 31, 247 -271. 8 Bull. Wld Hlth Org., 1964, 31, 183 -221. 4 WHO Chronicle, 1964, 18, 403 -417, 451 -462; 1965, 19, 7 -18. 10 THE WORK OF WHO, 1965 maintenance of extensive control measures over many syphilis is a near -specific reference procedure for yaws. years unless epidemiological and serological informa- Moreover, results obtained with the much less complex tion is available on the extent of subclinical latent fluorescent treponemal antibody (FTA) test among infection and the potential for clinical relapses and random samples of tropical populations correlated recrudescence of the disease in the general population. closely with the results of TPI tests (see also page 11). WHO is therefore encouraging surveillance measures A technical basis for recommending the introduction and also collecting epidemiological and serological of FTA as a specific reference test in tropical countries data. Endemic treponematoses campaigns have been hasthusbeenestablishedthroughthese WHO carried out in more than forty countries over the last investigations. fifteen years, and WHO assistance in the epidemio- The inter -regional treponematoses epidemiological logical and serological assessment of the surveillance team is being developed into a multipurpose epidemio- programmes in this field is therefore of a long -term logical and serological survey group, and the current nature. Much of the work is done by teams. Thus, a studies in Northern Nigeria are part of a joint investi- regional epidemiological surveillance team worked gation of immunological and other characteristics during the year in the Western Pacific Region, and by in treponematoses and also malaria and virus diseases, the end of 1965 a similar team had been established for work in the African Region.The WHO inter- and in regard to immuno- haematological factors (see regional treponematoses epidemiological team com- also page7). This broad multiple approach to pleted a survey in Eastern Nigeria.The purpose of epidemiological research coincides with the orientation these teams is to assess the level and extent of trans- emphasized in the WHO epidemiological research mission of yaws following mass penicillin campaigns; programmeprojectedbytheEighteenth World to determine the place to be accorded to further Health Assembly. surveillance work within the national communicable disease programme so as to prevent recrudescence; Venereal Infections and to suggest the nature and extent of local vigilance activities in an integrated general health service. A WHO study on the notification of infectious New knowledge is becoming available from the data diseasesin various countries 1(see also page 67) showed that syphilis was not notifiable in about half obtained in these clinical and immunological investigations which were undertaken in co- operation with the and gonorrhoea in almost two- thirds of the 134 health administrations and WHO serological reference countries taking part in the survey. Data on morbidity centres. On the basis of such studies in Nigeria, the from these diseases in many countries are thus not Philippines and Thailand, it can be stated that, from available, but the very incomplete information on a public health viewpoint, low -level transmission of reported incidences received by the Organization yaws continues to take place in the younger age - indicates that the trend of rising incidence of syphilis, groups ten years or so after mass penicillin campaigns. and to some extent of gonorrhoea, has continued.2 Surveillance measures should therefore be directed One country reported that venereal diseases had particularly towards schoolchildren and adolescents, become the leading cause of morbidity among the and improved public health laboratory facilities and notifiable diseases, and in several other countries serological methods are required locally if such yaws venereal diseases were among the first four or five surveillance is to be meaningful; while ten years ago notifiable conditions.Some countries (including the some 20 per cent. of the young coming to puberty United States of America) are beginning to include had no protectivecross -immunity from yaws to serological tests for prevalence of syphilis in national infection with venereal syphilis, today, as a result of health surveys in order to obtain additional and more the mass penicillin campaigns, up to 70 per cent. of the reliable base -line data on the true prevalence of adolescent age -group in tropical countries are now infection. susceptible to such venereal infection. A regional seminar on venereal disease control Research on aspects of epidemiological and sero- in the Americas was organized by PAHO and WHO logical patterns in tropical areas where yaws was in Washington D.C. in October; directors of health previously widespread has confirmed the reported and communicable diseaseservices from twenty - occurrence of excessive " false " sero- reactivity -or fiveLatinAmericancountriesparticipated. A " false "sero- non -reactivity -to some conventional 1 World Health Organization (1965) Trends in the study of lipoidal antigen tests.It has also been shown that the morbidity and mortality, Geneva (Publ. Hlth Pap. No. 27, 17). Treponema pallidum immobilization (TPI) test used for 2 Epidem. vital Statist. Rep., 1965, 18, 355 -66. COMMUNICABLE DISEASES 11 plan for the use of epidemiological methods in con- of work in Copenhagen. There has been no significant trolling the spread of venereal diseases in the Americas progress in regard to an immunizing agent. was among the subjects discussed (see also page 104). The most important development resulting from This was the second of a series of regional meetings WHO- assisted research was the confirmation that planned by the Organization, a symposium for the dormant attenuated treponemes persistin lymph European Region having been held in Stockholm glands following penicillin treatment of latent and in 1963. latesyphilis and that treponemes could in some The general decline in the incidence of syphilis instances be revived and become fully virulent in and gonorrhoea after 1950 affected the nature and transfer studies. This may account for the persistence extentof teachingof venereologyand venereal of TPI sero- reactivity in previously infected and now disease control in a number of countries and resulted apparently healthy individuals following penicillin in decreased activities and interest in the subject therapy.It may have important public health im- among the medical profession and health administra- plications in view of the large numbers of TPI reactors tions.In order to assess the situation, a survey of intropicalpopulations following masspenicillin teaching on venereal diseases in medical schools was campaigns against yaws.Studies are being made to organized in 1965 by the International Union against clarify this situation. the Venereal Diseases and the Treponematoses, in The continuingsearchforspecificserological co- operation with WHO. About 65 per cent. of all . tests that are simpler than the TPI test has resulted in medical and public health schools in the world pro- the development of a haemagglutination test using the videdinformation,which was analysedforthe pathogenic Nichols treponeme strain as antigen. The preparation of the final report. new FTA- inhibition test as a method for diagnosing The growing use of orally active gestogens and intra- syphilis was described in a paper presented at an uterine devices may lead to an increase in sexual inter -regional training course on immunofluorescent contacts,thusfacilitatingthetransmissionand techniques sponsored by WHO in Copenhagen in spread of venereal disease in the future. Closer August.This method is possibly as sensitive and national and international co- operation is therefore specific as the TPI test. required among the official and voluntary organi- A paper was published in the Bulletin describing a zations working in these fields. one -day TPI test and several other papers on various aspects of treponematosis and gonorrhoea research Research were also published during the year.2 Research work in relation to reagents and control sera continued in1965 at the WHO Serological Veterinary Public Health Reference Centres in Chamblee, Ga, (United States of In veterinary public health major emphasis remained America) and Copenhagen, and at a laboratory in on important zoonoses (brucellosis,rabies,lepto- Paris.In the surveillance programme of changing spirosis,hydatidosis),but workincomparative susceptibility of gonococci toantibiotics,a large medicine and hygiene of foods of animal origin number of strains from different areas were examined steadily increased.In comparative medicine, studies in Copenhagen, and in Atlanta, Ga, United States of on cardiovascular and neoplastic diseases continued, America.Research on gonococcal infection using further progress was made in the characterization and haemagglutination and gel diffusion techniques was classification of animal viruses, and studies were undertaken with a view to the development of sero- started on neurological and auto -immune diseases. diagnostictestsforearlygonococcalinfections. Articles on this work have been published in the Brucellosis Bulletin.' Studies continued on the protection of occupa- Under the research programme, new significant tionally exposed persons by immunization. The knowledge became available from advanced electron controlled field trial of vaccine strain 19 -BA, started microscope studies (in Moscow) of non -pathogenic in Mongolia towards the end of 1964,9 was pursued and pathogenic treponemal strains, whereby the struc- with observation of vaccinated and control groups. ture of these organisms was elucidated indetail. This trial has again shown that rather severe reactions Further purified polysaccharide antigens of the Reiter sometimes develop in persons inoculated subcuta- treponeme were discovered and nucleic acids were neously with this vaccine (500 million viable cells per isolated on a quantitative basis from this organism as well as from pathogenic treponemes, as a result 2 Bull. Wld Hlth Org., 1965, 32, 125-31; 471-6; 477-502; 503- 13. 33, 89-105; 687-703; 705-20; 197-208. 1 Bull. Wld Hlth Org.,1965,32,449 -513. 9 Off. Rec. Wld filth Org. 139, 10. 12 THE WORK OF WHO, 1965 dose). On the other hand, persons inoculated by macroglobulins are almost the only type found. The scarification, in which 11 thousand million viable cells investigation is being extended to serum specimens are deposited on the skin of the arm just before from other parts of the world. scarification,rarely develop any local or general Further work on animal vaccines has brought out reactions.However, the agglutinin response of the some additional significant facts. Rev.! vaccine trials group inoculated by scarification is lower, and about in goats in Malta have shown that immunity lasts for one -fourth of those inoculated by this route show at least two and a half years in animals inoculated at no agglutinins in their blood one month afterwards. the age of four to eight months, and further experi- It is believed that this may be due to irregular absorp- ments are being made to establish the maximum tion-or penetration -of attenuated Brucella through duration of the period of protection. The field vac- the scarified skin. Further observations are in progress cination of goats in Malta and of sheep in Iran with to compare the incidence of infection in the vaccinated this vaccine is being observed for its effects on the and control groups. incidence of the disease, and in Mongolia sheep and In the Stavropol area in the USSR, the effect of goats vaccinated at an early age are being observed multiple vaccinations with strain 19 -BA was studied. in comparison with unvaccinated animals. It was found that on first vaccination 55 to 65 per cent. In experiments on passage of Rev. 1 vaccine strain of inoculatedpersons developed asensitivityto in pregnant goats, the fifth successive passage has been Brucella, the percentage increasing with subsequent reached, and there is no evidence that the virulence of vaccinations. the strain so passed has undergone any modification. Simultaneous vaccination with live vaccines against This experiment is to be continued, and itis also Q fever and brucellosis administered by the sub- planned to try a smaller dose of the vaccine to see cutaneous route or by scarification has shown that whether it would be effective in immunizing goats these vaccines do not interfere with each other. The and at the same time in reducing chances of excretion highestlevelof serologicalresponseinpersons of the organism in milk or genital discharges. inoculated with the two vaccines was observed two or Work has continued on the collaborative study three months after vaccination, as was also the case being made in various brucellosis centres and other collaborating laboratories to standardize the comple- with separate inoculations. Thereisan obvious ment fixation test for diagnosis of the infection in advantage in combining the two vaccines, as the two cattle. The first results show that various laboratories infections may be present in the same flock of animals. have obtained uniform results with a standard serum, In order to improve early diagnosis of brucellosis, and itis hoped that further work will leàd to the two diagnostic tests are being tried at the WHO fixation of a unit of activity and a more precise Brucellosis Centre in Moscow. By using an indirect interpretation of results. haemagglutination technique,ithas been possible to demonstrate specific agglutinins in the sera of Rabies guinea -pigs only five to ten days after infection with B. melitensis, when they were still not detectable by Efforts were continued to improve immunogenicity the tube agglutination test.In another test, small of antirabies vaccines and to achieve freedom from numbers of Brucella have been demonstrated by the paralytic factor. In a collaborating laboratory in the immunofluorescence in the mononuclear phagocytes United States of America hopeful results were obtained and in much diluted suspensions, some of which with an attenuated strain of virus (high- egg -passage contained mixtures of other bacteria. Flury strain) propagated in a human diploid cell culture. Specific diagnosis of chronic brucellosis is often The virus cultivated in this cell system was found to be much more antigenic for rhesus monkeys than the difficult.The agglutination titre may be deceptively low in known infected individuals, and, on the other same strain propagated in embryonated eggs.' Further- hand, it may be fairly high in asymptomatic indivi- more,thereisevidencethatinactivatedvaccine prepared from a strain of fixed rabies virus grown in duals.Following an observation in bovine brucellosis, the FAO /WHO Brucellosis Centre in Minnea- this cell culture is more antigenic than similar vaccine produced with virus grown in avian embryos.In a polis is studying the physico -chemical characterization collaborating laboratory in the Union of Soviet of local human Brucella agglutinins at various stages Socialist Republics phenol- inactivated vaccine pre- of the infection. The results so far obtained indicate that active brucellosis- whether acute or chronic - pared from virus grown in hamster kidneycell can be distinguished from the inactive disease by the culture has been found to be more immunogenic predominance of anti -Brucella microglobulins. In ' Wiktor T. J. & Koprowski, H., Proc. Soc. exp. Biol. Med., asymptomatic infections, on the other hand, the 1965, 118, 1069-1073. COMMUNICABLE DISEASES 13 than vaccine produced with virus grown in nervous zation of man, and various aspects of control of tissue in animals.Further experimental studies on rabies in animals.It made specific recommendations these vaccines are in progress. regarding future research on properties of the virus, In animals, attenuated virus strains propagated in pathogenesis, immunization procedures, ecology and cell cultures have been found to be highly immuno- control, and also regarding quicker exchange of genic, and limited field trials with these strains are information. being undertaken in cattle and some other animals. Studiesontheproductionofnervoustissue Leptospirosis vaccine free from the paralytic factor were also con- Studies of leptospirosis carried out at the lepto- tinued.It has been observed that the factor does not appear in the brain of the albino rat until after the spirosisreferencelaboratoriesandcollaborating eighteenth day of life.' Vaccine prepared from brains institutions resulted in some changes in the existing of suckling rats was found to produce high antibody taxonomy and the finding of some new serotypes. titres in man and animals.By February 1965 more Collaborative tests on serotype specificsera were than 12 000 persons had been vaccinated, with no continued with a view to their establishment as inter- reports of paralytic accidents. national reference preparations. Important findings in the study of the rabies virus Some strains of Leptospira biflexa which are easily itself were reported during the year by collaborating cultured had been reported to show broad cross - reactivityinthe complement- fixationtest.' The laboratories.Concentration and partial purification of the virus have been achieved by precipitation of the WHO /FAO Leptospirosis Reference Laboratory in medium by heavy metals, high -speed centrifugation London has tried this antigen extensively with sera and by passage through a cellulose chromatography from Europe and South -East Asia.False positive column. Attempts are being made to use the concen- reactions have been encountered extremely rarely, trated virus in immunization or as antigen in diagnostic and are much less frequent than in the agglutination serological tests.Some progress has also been made test. The antigen has the advantage of revealing unsuspected cases of leptospirosis which would escape inobtaining a solubleantigen demonstrable by complement fixation in virus -free material. detection with the limited battery of antigens used in A stabilized preparation of dried rabies vaccine routine agglutination testing in clinical laboratories. received during 1964 and subjected to a collaborative A review of recent advances in leptospirosis based on the report of a scientific group has been published assay 2has been establishedasan international reference preparation by the Expert Committee on in the WHO Bulletin.6 In order to arrange for exchange Biological Standardization 2 and is available on request of information on current research in leptospirosis, to national laboratories. requests for information have been sent to collabor- The results of the annual world survey of the ating and other laboratories. incidence of rabies and of the measures being taken A new WHO /FAO leptospirosis reference laboratory against it were circulated. As a first step in a plan for has been designated at the Israel Institute for Biolo- a more active and quicker surveillance programme on gical Research, Ness -Ziona, Israel. a regional basis, consultations have taken place with European authorities concerned with rabies control. Hydatidosis During June the Expert Committee on Rabies met Field control programmes in hydatidosis based on in Geneva to review developments sinceitslast anthelminthic treatment of dogs have demonstrated meeting, in 1959, including recent developments with the need for a drug which will completely free the regardtoimmunofluorescencetechniques,tissue - animal from Echinococcus.WHO is supporting a culture methods, the rabicidal effect of chemicals programme of systematic trials of likely drugs, but so usedin wound treatment, and improvements in far no anthelminthic satisfying all criteria of suitability immunizingagentsand immunizationschedules. has been found. One series of trials has shown that The Committee made a series of recommendations 4 bunamidine hydrochloride is highly effective against on methods of diagnosis, the production and use 6f adult E.granulosus, though relativelyineffective vaccines and sera, pre- and post- exposure immuni- against young worms which may be present at the same time as adults. Studies are therefore being made 1 Svet -Moldayskij, G. Ja. et al. (1965) Bull. Wld Hlth Org., on the physiological and structural differences between 32, 47 -58. 2 Of Rec. Wld Hlth Org. 139, 11. 2 In its eighteenth report (to be published in the WHO Tech- 5 Elian, M. & Nicoará, I. (1964) Bull. WId Hlth Org., 31, nical Report Series). 359-363. 4 Wld Hlth Org. techn. Rep. Ser., 1966, 321. 6 Bull. Wld Hlth Org., 1965, 32, 881-891. 14 THE WORK OF WHO, 1965

adult and immature worms, and further trials in the animals.Information obtained on more than one laboratory and in the field are in progress. hundred isolatesin various laboratoriesisbeing Echinococcus eggs in dogs and in the environment analysed and coded. Pilot studies have been madeon are the infective stage of the worm for man and herbi- the preparation of reference reagents. Referencesera vorous animals. Several hundred chemicals have been against selected strains have been prepared in various tested for their ovicidal properties, but none which laboratory animals, including germ -free pigs, andare would kill the egg without being toxic to man and being subjected to collaborative tests to determine the animals has been found. A technique of sterilization animal most suitable for the preparation of specific of eggs by heat has been developed to combat reference sera against animal viruses. Representatives the serious hazard to workers in laboratories which of both the Eastern and Western Hemisphere Com- keep infected dogs.It has been observed that all mittees eggs present in a room kept at a temperature of on Animal VirusCharacterizationagain 49 °C for several days are destroyed.The details of attended the meeting of directors of WHO virus this method are being worked out, especially with reference centres (see page 16) in order to co- ordinate regard to the efficient and even distribution of heat work on comparative and human virology. throughout the room. A collaborating laboratory in Switzerland reported Immunization studies with antigens derived from the isolation and characterization of a virus from the Taenia hydatigena and T. ovis were continued.It is conjunctival /nasal swabs of a horse. This virus, which possible to induce resistance against Echinococcus has many similarities with the human hepatitis virus, in dogs and against the hydatid cyst in sheep. Efforts isserologically closely related to or identical with are being made to identify the antigens responsible for equine arteritis virus, hitherto known only in the this resistance. United States of America.

Animal Influenza Cardiovascular and Cerebrovascular Diseases of Animals WHO continued to organize and support studies on animal influenza and related viruses to assess their Collaborative investigations in swine to elucidate role in human respiratory illness.Sera from over factors associated with differences in the severity of 300 swine were collected in Switzerland during 1965, atherosclerosis, reported in1964,2 were continued. but none showed evidence of the presence of infection Some differences associated with breed and age were with human or swine influenza viruses. The few sera noticed, but experiments with hard and soft drinking- collected from wart-hogs and wild pigs in East Africa water were not conclusive and are being continued in were also negative. a laboratory in the Federal Republic of Germany. The new equine influenza virus A /Equi -2 was Arterial lesions in fifty old swine (10 -14 years of reported in 1964 as being restricted to the United age) have been studied by a collaborating laboratory States of America. But in 1965 collaborating labora- in the United States of America. Lesions of the cere- tories confirmed its appearance in Austria, France, bral vessels were found in a high proportion and were Switzerland and the United Kingdom.Horse sera often related to cerebral infarction.Old swine may collected in Hungary and the Netherlands, on the therefore serve as an important model for cerebro- other hand, showed no evidence of infection with this vascular disease in man. Another interesting finding, strain.Further work revealed the existence of the observed for the first time, was a myocardial infarction earlier known A /Equi -1 strain not only in Europe but in one of the old swine. Studies in a small number of also in India, Kenya, Pakistan and Singapore. There old swine fed on a diet rich in egg -yolk showed low are indications of a partial antigenic relationship of blood cholesterol levels and rather less vascular disease this equine virus with that of fowl plague. Moreover, than in animals on a normal diet. closeantigenic relationships between influenza A viruses from different avian species -chickens, ducks, Investigations have been carried out on the effect turkeys, terns -have also been found.' of social stress on cardiovascular disease in birds. The coronary vessels have been examined in some 500 chickens which had been housed in groups of Comparative Virology different sizes and with varying proportions of the Further progress was made in the characterization sexes.In groups consisting of males only or females and classification of viruses isolated from non -primate only there was little vascular disease, but in groups

1 Pereira, H. G., Tamová, B., & Law, V. G. (1965) Bull. Wld Hlth Org., 32, 855 -860. 2 Off Rec. Wld Hlth Org. 139, 12. COMMUNICABLE DISEASES 15 containing twice as many males as females there was increase in recent years.Reports from five countries a high death rate and a considerable amount of myo- on autopsies on more than 6000 dogs showed that cardial infarction associated with disease of the intra- 3.3 per cent. were affected with leukaemia. Autopsies mural arteries. Experiments of a similar nature with on cats at one centre (New York) showed that 14 per pigs are now under way. cent. had leukaemia. A few instances have been The effect of diet, growth rate and sex on atheroscle- reported where leukaemia occurred in a human being rosis in turkeys has been studied by a collaborating and in a dog or cat in the same household. More laboratoryinthe United Kingdom.A positive epidemiological data are needed before the significance correlation between rapid growth and atherosclerosis of such incidents can be assessed. was found, and male birds showed more atherosclero- Studies on the etiology of leukaemia have continued sis than females. On the other hand, a rapidly growing in a number of centres. In one collaborating labora- and early maturing bird, the Japanese quail (Coturnix tory there have been several successful transmissions coturnix japonica) developed very few cardiovascular of leukaemia in cats using inocula that contained lesions even when cholesterol was added to the diet. virus -like particles and were thought to be free from These studies are being continued. living cells.Transmission of the bovine disease is An atlas of comparative atherosclerosis consisting being attempted in numerous experiments using a of 416 coloured illustrations has been included in a variety of techniques.There have been as yet no book entitled Comparative Atherosclerosis published unequivocally positive results, but these are necessa- in the United States of America with financial support rily long -term experiments. from a number of sources, including WHO. The extensive bibliography contained in the book is being supplemented at frequent intervals by reference lists Comparative Neuropathology issued by WHO. In 1965 WHO provided financial support in order to enable the Problem Commission for Neuropatho- Comparative Oncology logy of the World Federation of Neurology to Centres for international studies on spontaneous expand itsactivitiesinco- ordinating comparative tumours of domestic animals are being set up with the studies in nervous diseases.Set up in 1959 by the assistance of WHO.The studies by specialists in Federation with a secretariat in Berne, it collects spe- human and animal pathology involve comparison of cimens forstudy,providesfacilitiesforvisiting tumours of the various species, including man, and the workers, maintains a bibliography and reprint collec- development of a classification of animal tumours tion, arranges international meetings, and generally consistent with the classification of human tumours acts as a centre for exchange of information and consul- being established by WHO. Co- operating centres for tation.Specimens of tumours of the central nervous comparative oncology are being designated for the system are collected and studied, as well as specimens following anatomical regions of domestic animals: of infective, toxic and degenerative diseases; it thus the reproductivetract and mammary gland; the serves also as one of the co- operating centres for respiratory tract; the alimentary tract; and the central comparative oncology. nervous system. A preliminary classification has been made of tumours of the mammary gland of the bitch. In order to have better comparable data available Comparative Studies on Rheumatic and Auto -immune in epidemiological studies on cancer in animals, a Diseases system of classifying, recording and analysing data In the search for a spontaneous disease in animals in clinics and laboratories was introduced by WHO to to serve as a model for research on rheumatoid arthritis some of the veterinary schools in Europe for trial. in man, a collaborating laboratory investigated an This system, which was developed in the United States arthritis of goats in Switzerland, but the resemblance of America and sponsored by the National Cancer to the human disease proved to be only superficial. Institute, has already been adopted by a number of A more promising development has been the finding American veterinary schools. ofsystemic lupus erythematosusindogs.This The occurrence of cancer of the lung and leukaemia canine disease, which has all the features of the human in dogs and cats has been studied at several centres in disease, including the presence in the serum of the so- different countries.The incidence of primary lung called rheumatoid factor, is expected to provide a cancer in dogs and cats was found to be low at all useful approach to the study of problems of auto - centres, and there was no convincing evidence of any immune disease in man. 16 THE WORK OF WHO,1965

Non -human Primates in Medical Research Virus Diseases Although non -human primates have long been used The network of international and regional virus in medical research,itis only recently that their reference centres is now well established. The centres special advantages for many branches of research have have been able to increase their contact with national been widely appreciated, and their use is being greatly virus laboratories and to extend to them the services increased. In this connexion, WHO collaborated with now available: help with the identification of viruses; the Zoological Society of London in the organization provision of prototype virus strains and of some of a symposium on the use of primates in medical diagnostic antisera; training of virologists; advice; research -with specialreferencetocardiovascular and help in examining specimens in epidemics.In disease and oncology.Participants discussed the 1965 the Regional Reference Centre for Arthropod - technical problems associated with the breeding and borne Viruses for western Europe was transferred management of the different species, the suitability from the National Institute for Medical Research, of each for various research procedures, and the London, to the Institut Pasteur in Paris. disease hazards to those working with them. They Many national virus laboratories are now collabo- also considered the role of viruses in the etiology of rating with WHO and the virus reference centres leukaemia in man and animals. either in long -term studies, such as the testing of reagents, or in specific projects -for example, studies of the problem of poor " take rates " in poliovirus HygieneofFood ProductsofAnimal Origin vaccination in tropical countries and of the arboviruses The Organization has steadily increased its participa- responsible for sickness in human beings in' certain tion in the food standards programme of the joint areas.National laboratories that contribute to the FAO /WHO Codex Alimentarius Commission (see Organization's programme in these ways have now page 56).It was represented at the meeting in June been termed " WHO virus collaborating laboratories ", of the Codex Alimentarius Expert Committee on and seven laboratories were so designated during the Food Hygiene, which discussed general principles year in Brazil, Canada, India, Nigeria, Romania, for the development of food hygiene standards. At and the United Kingdom. its meeting in May the joint FAO /WHO committee The reagents programme described in the Annual of government experts on the code of principles Report for 19641was continued and extended to cover concerning milk and milk products discussed labelling, more viruses. A special study of the characterization contents and trade designations of milk and milk and classification of the numerous rhinoviruses- products, methods of sampling and analysis, additives viruses of the common cold -now being isolated and milk hygiene requirements,includingspecial has been started in collaboration with the United problems of milk hygiene in developing countries. States National Institutes of Health and with ten Draft standards prepared by various Codex Alimen- other laboratories within and outside the reference tarius committees were examined and commented on network. from the point of view of hygiene. The scheme set up by WHO for the collection and A joint FAO /WHO training course on meat hygiene dissemination of information on virusinfections held in Denmark was attended by eighteen senior diagnosed in the WHO virus reference centres and in workers in meat hygiene from sixteen countries. The certain national virus laboratories has been extended. course included laboratory, abattoir and classroom In 1965, in addition to national laboratories already instruction in recent advances in meat hygiene. taking part in the scheme, five -in Australia, Hong Kong,Ireland,Jamaica and Mexico -agreedto collaborate. Laboratories in Austria, Bulgaria, Indo- Veterinary Education nesia, Romania, Sweden, and Thailand have recently WHO collaborated with FAO in convening the been invited to collaborate. Second International Meeting on Veterinary Educa- A meeting of directors of WHO respiratory virus tion in Copenhagen during August.Seventy -four and enterovirus reference centres, held in Copenhagen veterinary educators from thirty countries attended in October, was attended by the directors of two and discussed the recommendations of the FAO/ national reference centres, in Australia and Austria, WHO Expert Panel on Veterinary Education concern- who took part in discussions on the relation between ing requirements of countries at varying stages of WHO and national virus reference centres. Directors development for veterinarians, and minimum accept- collaborating in the reagents programme discussed able standards of education and training of auxiliary personnel. 1Off:Rec. Wld Hlth Org. 139, 14. COMMUNICABLE DISEASES 17 and reviewed their studies of the past year and formu- Group B arbovirus antisera, prepared in monkeys by lated plans for further studies over the next twelve the WHO Regional Reference Centre for Arthropod- months. borne Viruses, Atlanta, Ga, have been tested by other WHO reference centres and found satisfactory. They are now available to competent laboratories. Variola Reagents Programme (Reference Strains, Antigens and virus antiserum and non -infectious tick -borne encepha- Antisera) litis antigens and antisera have been prepared by the The purpose of the study on the antigenic structure Research Institute of Virus Preparations in Moscow. of rhinovirus strains referred to above is to define the They are now being tested in the reference centres different rhinovirus types (of which there are believed before distribution.Plans for the preparation of to be more than eighty) and to designate prototype dengue and chikungunya non -infectiousantigens strains and prepare suitable reagents for their identi- have been agreed upon with the Ivanovskij Institute fication. of Virology in Moscow. The highly specific and exhaustively tested antisera prepared in monkeys for thirty -six enteroviruses and offered to WHO by the Research Reference Reagents Measles Branch of the United States National Institute of Allergy and Infectious Diseases have already been The analysis was completed of the results of the distributed to the reference centres to be used as recent field trials of measles vaccines sponsored by reference preparations and to be supplied to competent WHO in several countries in order to compare the national laboratories for calibration of the reagents severity of the reactions and the antibody level pro- they prepare. For the same purpose, antisera against duced by the various available measles virus vaccine adenovirus types 1 -18, para- influenza 1, 2, and 3 and strains.'It was found that the Schwarz vaccine Mycoplasma pneumoniae, prepared in horses by the caused less reaction than the others tested and gave a Communicable Disease Center, Atlanta,Ga, and satisfactory antibody response.Further studies to tested by the WHO virus reference centres, have also measure thedurationof immunity provided by been distributed in large quantities to those centres. different vaccines have been planned.Present evi- Following the recommendation of the Expert Commit- dence indicates that the live measles vaccines will give tee on Biological Standardization, these antisera are good protection for years. Despite the pyrexias which now being tested for stability under conditions of they induce, no serious untoward sequelae have been long storage and elevated temperature, with a view reported from their use on a large scale, and there is to their establishment by that committee as interna- good reason for using them for the routine immuni- tional reference reagents. Some of them have already zation of children where mortality from measles is been established as such. high. The results of the individual vaccine trials in Twenty -nine antisera were prepared by the end of Canada, Czechoslovakia, Nigeria and Switzerland 1965 under the extensive programme for the produc- were published in the Bulletin.2 tion in horses of large quantities of hyperimmune antisera for enteroviruses, which is being undertaken by the WHO International Reference Centre for Respiratory Viruses Enteroviruses in Houston, Texas, under the sponsorship of the United States National Institutes of Health. In 1965 influenza occurred in most parts of the world The antisera are being tested for specificity and anti- to a greater or lesser extent.3 In the Americas there body titres in eight virus reference centres and colla- were outbreaks of clinically mild influenza in the borating laboratories, and the results already available eastern and southern central states of the USA bet- show that they are all of very high quality. ween January and March; outbreaks occurred in Coxsackie A7 antigen, prepared in horses with February in eastern Canada, in March in Venezuela, Karaganda strain in the WHO Regional Reference and in April in Brazil.In Europe many countries Centre for Enteroviruses, Moscow,isalso being were affected, and very large outbreaks occurred in distributed to the reference centres for testing. Finland, Hungary, Poland and the USSR. In Asia Co- operative studies are in progress at five virus reference centres for the preparation (in ferrets) and 'See Of Rec. Wld Hlth Org. 139, 16. the testing of reference antisera for the newer respi- 2 Bull. Wld Hlth Org., 1965, 32, 331 -337; 779 -808. ratory viruses, including M. pneumoniae. 3 Wkly epidem. Rec., 1965, 30, 374 -379. 18 THE WORK OF WHO, 1965 cases were reported from Japan and Hong Kong, and ably by reinfection. The presence of neutralizing outbreaks occurred in Mongolia and in a circumscribed antibodies against these viruses in nasal secretions area of New Guinea. seems to be highly correlated with resistance to illness. Some of the smaller outbreaks in Europe and the Recent findings suggest that M. hominis type 1, as Americas were due to influenza B virus, but the great well as M. pneumoniae, may cause disease in man. majority were due to virus A2. In 1964 and 1965 the Progress has been made recently in the development strains from all the outbreaks due to virus A2 were of both a live and an inactivated M. pneumoniae very similar to each other in their antigenic structure, vaccine, and studies in volunteers have shown pro- but though they were basically similar to the original mising results. A2 virus (1957 strain) they differed considerably from Two papers describing the geographical distribution the classical strain. This is an indication that further of respiratory virus and RS virus antibodies were antigenic shiftsare very likely to occur and the published in the Bulletin.' appearance of a completely different strain must be expected. For these reasons a great effort is being Enteroviruses made to encourage national influenza laboratories to send information and isolated strains to the internatio- During the past few years great progress has been nal centres as quickly as possible. A paper describing made in poliomyelitis control with the use of live modifications of the A2 virus noted in the USSR poliomyelitis vaccine, and in several countries where between 1957 and 1962, and the sensitivity of A2 there have been large -scale campaigns -in Canada, strains to inhibitors, was published in the Bulletin.' Japan, the United States of America and most Euro- In the collaborative programme to define by serolo- pean countries, for example -paralytic poliomyelitis gical methods the etiology of severe respiratory virus morbidity has decreased remarkably. infectionsin children intropical and sub -tropical However, paralytic poliomyelitis is -or is likely to areas,297 paired sera from Hong Kong, India, be-a problem in some tropical and subtropical areas. Jamaica, Singapore, Trinidad and the United Arab The results obtained during 1964 and 1965 in a WHO - Republic have already been studied for antibodies sponsored study in Ibadan, Nigeria, showed a signi- against para- influenza 1, 2 and 3, respiratory syncytial ficantly lower level of seroconversion after immuni- (RS), influenza A and B, adenoviruses and M. pneu- zation with type 1 oral poliovirus vaccine than was moniae. Preliminary results show that approximately found in previous investigations in European and 36 per cent. of the illnesses studied were associated North American countries.These results in Nigeria with one or more of these eight agents. They indicate agree with those obtained recently in Brazil. On the that RS virus is a major respiratory pathogen of otherhand,thesharp decrease of poliomyelitis early life in tropical and sub -tropical areas.It was morbidity in Cuba and Hong Kong indicates the associated with about half the illnesses in the first effectivenessoforalpoliovirusimmunizationin six months of life, and with half the cases of bronchio- certain tropical countries. litis and one -fifth of the cases of pneumonia. The WHO is now supporting a project in Nigeria to para- influenza viruses were next in importance. They investigate the efficacy of oral poliovirus vaccine there, appeared to be important lower respiratory tract and plans are being made to carry out similar projects pathogens, but, unlike RS virus, they did not show a in other tropical countries and to elaborate effective predilection for the young infant.They were com- methods for the control of poliomyelitis in . these monly isolated from cases of croup and from infections countries. of the upper respiratory tract. M. pneumoniae seems A paper describing the use of trivalent oral polio- to be a relatively unimportant pathogen of early life. virus vaccine in the control of an epidemic of polio- So far the findings suggest that the pattern of respira- myelitisinBritish Guiana was publishedinthe tory virus infections is similar to that which has been Bulletin.$ observed in temperate climates. Through the WHO virus reference centres and colla- Recent studies of myxoviruses have shown that borating laboratories a programme is being prepared para- influenza viruses, particularly type 1, can produce for a study of the importance of enteroviruses in the extensive epidemics of a mild infection of the upper etiology of some severe but rather uncommon diseases. respiratory tract in older children and adults, presum-

2 Bull. Wld Hlth Org., 1965, 32, 833 -853. ' Bull. Wld Hlth Org., 1964, 31, 755 -760. 8 Bull. Wld Hlth Org., 1965, 33, 1 -11. COMMUNICABLE DISEASES 19

Viruses and Cancer area where the patient had lived, and yellow fever virus was isolated from A. africanus mosquitos taken at To discuss the implementation of a recommendation ground level at about 200 metres from the dead man's in the report of the Scientific Group on Viruses and hut. No yellow fever virus was recovered from pooled Cancer 1a two -day meeting of four experts was A. aegypti or A. simpsoni. These findings emphasize convened in Copenhagen in September 1965.Its the importance of A. africanus as a vector of yellow subject was the need to define the criteria for detecting fever.Agents of the Congo -Segunya group were by electron microscopy particles which have a high associated with four cases of illness in man, one of probability of being viruses in cells from cases of which was fatal.Studies are being made to classify human leukaemia.Criteria were drawn up and cir- these agents, which do not seem to belong to the culated to workers, in this field for comment and cri- arbovirus group. No evidence of activity of o'nyong ticism. nyong virus was found during the year. This suggests Viruses isolated from biopsies of Burkitt's lymphoma that the big epidemic of the disease which spread patients were examined at the Regional Reference through Kenya, Mozambique, Uganda and the United Centre for Arthropod -borne Viruses in Entebbe. Republic of Tanzania may have come to an end. Twenty -three virus strains were isolated from two species of insectivorous roof bats. The fact that some Arthropod -borne Viruses of these strains seem to be identical with a virus isolated Mosquito -borne haemorrhagic fever constitutes an from bats in Senegal is an indication of the large area over which this virus has spread. increasinglyserious probleminSouth -EastAsia. The disease, which was first recognized in Manila in As previous studies carried out at the Regional 1954, has since spread westwards and has now reached Reference Centre in Dakar led to the isolation of the eastern part of India.It is associated with the several strains of arboviruses from roof bats, WHO is dengue viruses and is transmitted mainly by Aedes supporting the development of a large -scale research Chikungunya virus has also been isolated programme to establish the role played by these aegypti. animals in the ecology of arboviruses.The Organi- from sick children with a similar, although less severe, zation is also supporting extensive field studies in the illness, and, from A. aegypti. Plans for studies of the Bandia forest in Senegal to determine the ecology of problem created by the spread of this disease were arboviruses in that area, where there is evidence of discussed at the inter -regional seminar organized by great arbovirus activity. Work has also been started on WHO in Bangkok in 1964, and a programme of the isolation of viruses from the blood of children research is now being developed by the Organization. with febrile syndromes. A special reporting system has been established for The Regional Reference Centre in Tokyo has con- cases and outbreaks of haemorrhagic fever and epi- tinued its studies on Japanese encephalitis.It has demics of dengue -like diseases.Serological surveys carried out epidemiological studies in several areas of in the countries affected and in those considered at Japan, in the Republic of Korea, in Thailand and in risk have been carried out or are being planned by the Okinawa Island. Pigs were used successfully as Organization in collaboration with the health autho- " sentinel " animals to detect the presence of Japanese rities.Sera collected in Ceylon, Pakistan and the encephalitis virus, and studies were continued on the Philippines are being studied in WHO virus reference efficacy of different types of vaccines against Japanese centresand collaboratinglaboratories.Inother encephalitis. A field trial of a mouse -brain, formalin- countries serological surveys are being carried out by killed vaccine has been carried out in China (Taiwan). the health authorities along the lines recommended by Various epidemic control measures against tick - the Organization.Studies have been started on the borne encephalitis have been studied by the Regional best methods for the control of A. aegypti applicable Reference Centre in Moscow. Mass vaccination with to different local conditions. a tissue culture vaccine resulted in a reduction of In Uganda, the Regional Reference Centre in Entebbe 75 to 80 per cent. in morbidity in a trial area. No reported the isolation of yellow fever virus from the paralytic cases of the disease were observed among the serum and blood -stained cerebrospinal fluid of a man vaccinated persons.The efficacy of the vaccine in who died of this disease. No yellow fever in human relation to the non -paralytic forms of the disease was beings had been reported from Uganda since 1952. 62 per cent. when only one inoculation was made, and An extensive search for the vector was made in the 91 to 95 per cent. when two inoculations were given. DDT spraying of large areas of forest led to a marked 1 Wld Hlth Org. techn. Rep. Ser., 1965, 295. reduction in morbidity in those areas. 20 THE WORK OF WHO, 1965

Studies carried out at the Institute of Diseases with Clinical and epidemiological studies have shown that Natural Foci, Omsk, USSR, in co- operation with the TRIC agents capable of producing typical trachoma Bombay Natural HistorySocietyinIndia, have can invade the male and female genital tract, and there shown that some birds caught in Siberia and India isincreasing evidence that a sexually transmitted have antibodies for Kyasanur Forest disease, Omsk infection is the explanation of some sporadic cases of haemorrhagicfeverandRussianspring- summer trachoma recently observed in London and Copen- encephalitis. This is further indication of the possible hagen. While eye to eye transmission of trachoma is importance of birds in the dissemination of arboviruses. probably the rule in areas of moderate and high Ecological studies in a focus of tick -borne encepha- endemicity, information is lacking on the prevalence litis in the Tribemountains in Czechoslovakia have and epidemiological importance in these areas of been made by the Regional Reference Centre in genital infection with TRIC agents. Bratislava.Strains of tick -borne encephalitis were In the absence of an effective vaccine suitable for isolated from Ixodes ricinus ticks, from small rodents mass application, large -scale treatment operations are and from hedgehogs.Serological surveys established stillthe mainstay of most trachoma control pro- that sera from nearly 30 per cent. of the people living grammes.Although much has been achieved by in the area, as well as the sera of 14 per cent. of the antibiotic prophylaxis and therapy,the minimum cattle and 10 per cent. of the goats, had antibodies for course of treatment is long and difficult to apply under viruses of the tick -borne encephalitis complex. field conditions.Moreover, there is evidence,still inconclusive, of diminished rates of cure in some communities which have been exposed to antibiotic Trachoma treatment over a number of years. The need for new The WHO InternationalReferenceCentrefor and more effectivedrugs and simpler treatment Trachoma established at the Francis I. Proctor Foun- schedules is thus as great as ever. dation for Research in Ophthalmology, University of During 1965 WHO continued its support of selected California, began its work in September 1965. It will institutions engaged in research on these problems, soon be in a position to offer its services to more than which directly concern the large -scale control pro- thirty national institutions, about half of them in grammes in operation in many parts of the world. developed countries, which are engaged in research Good progress is being made at the laboratory of the on TRIC (trachoma /inclusionconjunctivitis)and Institute of Ophthalmology, Tunis, where, with WHO related agents and infections, and in training in these assistance, methods and techniques are being developed fields. for differential screening of substances known or A scientificgroup on trachoma research was suspected to have antitrachomatous properties and for convened in August 1965, the fourth meeting of a measuring the degree of sensitivity, and changes in scientific group on this subject in the past six years. sensitivity, of different TRIC isolates to antibiotics As at the earlier meetings on trachoma, the group currently in use. WHO is also supporting studies at recognized advances in many fields of study. These the Virology Department, Hadassah Medical School, Jerusalem,onnutritionalrequirementsof TRIC included refinements in laboratory diagnostic pro- agents in cell culture and the mode of action of anti- cedures, such as the primary isolation of the trachoma biotics and other inhibitors. An attempt is being made, agent in irradiated cell cultures, and more specific as a step between screening in egg and cell culture and fluorescent antibody techniques; further elucidation a full -scale field trial, to develop a standard experi- of the relationships between trachoma and inclusion mental ocular infection in simians and volunteers conjunctivitis; and improvements in techniques for and to measure the rate of disappearance of inclusion laboratory testing of therapeutic agents. The group bodies under treatment with different drugs.The reviewed progress in the preparation of experimental Tunis laboratoryisalsostudying theetiological live and inactivated trachoma vaccines.The main relationships between trachoma and inclusion conjunc- conclusion was that TRIC agents are relatively poor tivitis in ovo and also in volunteers, and plans have antigens and that, although a measure of protection been prepared to extend these investigations to the canbeobtainedagainst both experimental and field. naturally occurring trachoma, a fully effective vaccine WHO has continued its efforts in developing and isnot yetavailable.Nevertheless,theintensive standardizingepidemiologicaltechniquesforthe research being carried out and the increasing funda- study of trachoma. Of particular interest are methods mental knowledge of this group of organisms permits for assessing the relative gravity of the disease, not hopes of developing improved vaccines. only as a measure of its social and economic import- COMMUNICABLE DISEASES 21

ance in a given area or community, but also in pro- cation programme required a much greater measure viding a base -linefortheevaluation of control of support than it had hitherto received, and summa- projects. This would be especially important for areas rizing the requirements for success. Lack of success with high endemicity and limited resources where a can often be traced to inadequate administration reduction in overall gravity and disablement may be, and supervision; programmes in the endemic countries for the time being, the only attainable objective. require help from countries free from smallpox; the maintenance phase (i.e. the routine vaccination and revaccination of the population and the surveillance Human Virus and Rickettsial Vaccines for possible cases) is as important as the attack phase, In October 1965 a scientific group on human virus and can be shortened if the endemic countries co- and rickettsial vaccines was convened in Geneva. ordinate theirefforts and start mass vaccination Discussions centred on present problems and lines campaigns simultaneously. of future development rather than on past successes. In furtherance of the Health Assembly's resolution, One of the main conclusions was that efforts should a ten -year plan for the acceleration of the smallpox be continued to find safe tissues free from extraneous eradication programme was prepared for submission contaminants for the culture of vaccine viruses. The to the thirty- seventh session of the Executive Board need was stressed for continuing immunization pro- in January 1966. By means of campaigns organized grammes once they had been begun, since otherwise initially on a regional basis it aims to eliminate the most of the value would be lost. Anxiety was expressed endemic foci within ten years; it provides for efficient over the present poliomyelitis position in developing maintenance and surveillance activities; its success is countries where the disease is increasing, and the dependent on substantial assistance from countries observations on low vaccination success rates referred where smallpox is not endemic. to earlier were taken as evidence of the need for more A detailed progress report on the smallpox eradi- research into the reasons for the failures- whether cation programme in 1965 will be presented to the interference from other enteroviruses or some other Nineteenth World Health Assembly, and therefore factors -so that effective campaigns could be launched only a summary account of assistance to individual before epidemics occurred. The probability of a great governments is given here. increase in the development of arbovirus vaccines In the African Region, where smallpox is endemic against, for example, haemorrhagic fevers and some in most of the countries south of the Sahara, an inter - of the arbovirus encephalitic diseases was recognized despite the numerous technical difficulties at present country project was started to help in the planning, being encountered.Means for improving vaccines execution and co- ordination of programmes: two by such measures as purification and the use of adju- medical officers have been assigned to this project, vants were discussed, as were means for testing for one stationed in Liberia, for West African countries, unidentifiable contaminants and for ensuring the and the other stationed in Kenya, for countries in highest degree of safety particularly from potentially East Africa.Steps are being taken to develop the oncogenic agents. production of freeze -dried vaccine in the Region. For example, arrangements were made for a laboratory in Kenya to receive equipment from UNICEF and Smallpox Eradication a fellowship from WHO, and similar assistanceis planned for vaccine production in two other countries. In declaring the worldwide eradication of smallpox In Sierra Leone, Mali, Liberia, Togo and Nigeria to be one of the major objectives of the Organization, smallpox eradication or control activities were carried the Eighteenth World Health Assembly in resolution out either in conjunction with WHO- assisted cam- WHA 18.38 requested countries having smallpox to paigns against yaws and leprosy or in independent initiateor intensify eradication programmes, and programmes. However, in general, the progress of the recommended a number of measures designed to eradication programme has been slow in the African mobilize national and international resources for the Region and systematic eradication programmes cover- intensification of the campaign. ing a number of adjacent countries have not yet been The Assembly had beforeita report 1by the developed. Director -General indicating that the smallpox eradi- In the Region of the Americas, where endemic foci still exist in Brazil, Colombia, and Peru and where 1 O,ff: Rec. Wld Hlth Org. 143, Annex 19. cases were reported in the second half of 1965 in 22 THE WORK OF WHO, 1965

Argentina and Paraguay, the need to intensify the nal Certificate of Vaccination or Revaccination against smallpox eradication programmes has been recognized. Smallpox, see page 30. In Brazil, the previous plans were revised and prepa- In order to bring the smallpox eradication pro- rations were made to start a new systematic mass gramme to the notice of the public, the theme " Small- vaccination campaign. Mass vaccination programmes pox, Constant Alert " was chosen for World Health or maintenance programmes with an intensification Day 1965. The broadcasting and other programmes of the surveillance system have been started or planned in connexion with that occasion are described on ina number of countries,including Argentina, page 77. Bolivia, Colombia and Paraguay. In this Region the production of freeze -dried vaccine is satisfactory. In the South -East Asia Region most of the endemic Parasitic Diseases countries - Afghanistan, Burma, India, Indonesia and Nepal -have controloreradication programmes, The recent disquieting spread of some of the para- for which WHO has continued to provide personnel, sitic diseases -occasionally developing into epidemics some transport and equipment, and assistance in -has been accompanied by growing evidence that assessing progress.Assistance for the production of both from the public health and the economic points freeze -dried vaccine was provided to four laboratories of view they are of far greater importance than has in India and to one laboratory in Burma, where hitherto been realized. vaccine production was started on an experimental Technicaldifficultiescontinuetohamperthe basis in 1965. In October, India reported that 80 per control of certain of these diseases. For some of the cent. of the population of the country had been vacci- most common and disabling parasitoses, however, the nated. In both Burma and India the mass vaccination means of control are relatively cheap, and the obstacles programme is due to be completed by 1966.In are essentially lack of financial resources, trained staff Afghanistan and Nepal the WHO- assisted smallpox and appropriate medical equipment, combined in control programmes are encountering various diffi- some instances with the need for an inter -country culties: shortage of field staff and of transport, and approach to the problem. reluctance on the part of certain groups of the popu- In 1965 the Organization gave increased attention lation to be vaccinated. to the preparation of training programmes, particu- In the Eastern Mediterranean Region, an assess- larly in the field of application of modern epidemio- ment of the smallpox situation was carried out with logical techniques, to the dissemination of information, help from WHO in East Pakistan, where the vaccina- and to the stimulation of pilot projects that might tion campaign has been completed. alsoserveforinter -countrydemonstrationand In many countries shortage of freeze -dried vaccine training. More technical assistance was provided to is one of the obstacles to progress in the eradication national surveys or control projects.In the pursuit programme. In 1965 twelve countries offered freeze - of more effective means of control, the Organization dried vaccine to WHO for use in the endemic countries. continued to sponsor research on the epidemiology However, in three cases the vaccine offered failed and pathogenesis of the most widespread diseases to meet the requirements recommended by the WHO and facilitated and organized the screening and field Expert Committee onBiologicalStandardization trials of promising drugs and molluscicides.The and published by WHO.' Of the fourteen million servicesavailable toscientists and administrators doses offered, four million doses were not acceptable. working on parasitic diseases were increased with the Other vaccine offered was being tested at the end of establishment of two further WHO International the year. Reference Centres, and the registration, collection and WHO has continued to support research on small- distributionofbiologicalmaterialnecessaryfor pox. This has included studies on the African smallpox research. strains which appear to have intermediate characters Arrangements have been made for FAO and WHO between variola major and minor and on the chemo- to act jointly in assisting countries to assess the agri- prophylactic and chemotherapeutic effects of certain cultural and health aspects of integrated economic drugs. development programmes to be implemented with For a report on the amendments adopted by the assistance from the United Nations Special Fund. Eighteenth World Health Assembly to the Internatio- In particular, the two organizations have co- operated in connexion with the control of bilharziasis and 'Wld HIM Org. techn. Rep. Ser., 1959, 180; 1966, 323. trypanosomiasis. COMMUNICABLE DISEASES 23

Bilharziasis Several papers describing the results of trials with various molluscicides,' including the WHO- sponsored With a view to assessing the public health importance of bilharziasis, WHO has supported a number of trials in Sudan and the United Arab Republic, and a cross -sectional studies (surveys made at a certain paper describing WHO- supported laboratory studies specific point in time) in the United Republic of on Schistosoma haematobium 9 were published in the Tanzania (where the studies were made by the Ross Bulletin. Instituteof Tropical Hygiene, London), and in A monographs published during the year on snail Nigeria and Senegal. The most striking finding was control in the prevention of bilharziasis brings toge- the high incidence of bilharziallesions(calcified ther information on the most effective procedures and bladder, deformity of the ureter, hydronephrosis) summarizestheexperienceacquiredbyvarious revealed by intravenous urography in the youngest scientists and laboratories as well as in WHO -spon- age -groups; in some localities 45 per cent. of school- sored research programmes. children were affected.In view of such evidence of the occurrence of serious lesions in adolescents and Work has continued in the collaborative programme children and their less frequent occurrence in adults, of screening promising new antischistosomal drugs and the Organization recognized the need for further of relevant studies on the mode of action and toxicity investigations, particularly of the longitudinal type of the compounds. A major event in bilharzial chemo- (covering a certain period) and post -mortem studies, therapy was the announcement of the results achieved to gain a better understanding of the pathogenesis in widespread controlled trials with a new nitrothiazole and prognosis of irreversible bilharzial lesions, and to derivative.The drug was taken by thousands of test the extent to which bilharziasis is an important bilharzialpatientsinvarious countriesin Africa cause of morbidity in the general population and of (where the Bilharziasis Chemotherapy Centre spon- mortality in young people.In this connexion, a sored by WHO and the British Medical Research scientific group was convened in August l 96 to Council at Tanga, United Republic of Tanzania, review the presentstateof knowledge regarding co- operated), and in the Americas, Asia and Europe. bilharziasis and to make recommendations concerning A rate of cure of the order of 95 to 100 per cent. was the general and specific methodology to be used in the obtained for Schistosoma haematobium and S. mansoni investigations, and the Organization has contacted infections, the rate for S. japonicum being somewhat several institutes in various countries that had expressed lower. These trials are now being followed by studies willingness to collaborate in morbidity and post- of the effects of long -term administration. mortem studies of bilharziasis. As part of the bilharziasis sero -immunology pro- An inter -regional bilharziasis research team, based gramme, WHO has conducted a skin test survey in in an endemic area of Africa, has been set up to carry the United Arab Republic and Southern Rhodesia, out comprehensive investigations on the epidemiology 7000 tests having been made in all. of bilharziasis, including clinical aspects of the disease, With a view to standardizing the application to and to try out methods and techniques with a view to bilharzial diagnosis of the complement fixation test recommending standard survey procedures. and fluorescent antibody test, the Organization has The large -scale bilharziasis control project in the started a programme for the collection of serum from United Arab Republic has shown that transmission known cases of bilharziasis -and also filariasis -in can be interrupted by applying molluscicides twice various endemic areas, and has established contacts a year. No new infections were detected in 1964 or with laboratoriesin various countries.Cryogenic 1965 in the area covered, and further trials have been containers are used in the collection of the serum started with molluscicide treatment only once yearly. samples, which are to be serologically evaluated by In the molluscicide screening and evaluation pro- central reference laboratories. gramme, work has been mainly concerned with the The Organization has continued to support research, follow -up of a meeting of investigators held in Novem- in particular comparative studies of antigenic fractions ber 1964, which defined the different phases of laboratory and field testing and recommended studies of of schistosomes and other trematodes by immuno- the possible causes of snail repopulation following withdrawal or interruption of molluscicide treatment. 1 Bull. Wld Hlth Org., 1965, 32, 243 -296, 713 -719; 33, 73 -88. The Organization has continued to sponsor research 2 Bull. Wld Hlth Org., 1965, 32, 755 -778. s World Health Organization (1965) Snail control inthe for the development of a molluscicide that is non -toxic prevention of bilharziasis, Geneva (World Health Organization: to fish. Monograph Series, No. 50). 24 THE WORK OF WHO, 1965 electrophoretic techniques, studies on the behaviour programmes in adjacent countries, and by a serious of schistosome strains in experimental animals pre- shortage of trained staff. senting various degrees of susceptibility, and studies on The Committee recommended that WHO organize heterologous immunity. international training courses to instruct professional Lyophilized preparations of Schistosoma produced personnel in the appropriate techniques of control, for WHO at the United States Army Tropical Research and give assistance particularly where there is a high Medical Laboratory were provided to collaborating rate of blindness.International co- ordination and investigators.Further services to field and research co- operation in the conduct of control campaigns workers were provided by the WHO Snail Identification should be encouraged, and WHO should bring to Centre at the Danish Bilharziasis Laboratory, Copen- the attention of national and international agencies hagen, and circulars were distributed summarizing responsible for development schemes -especially irri- progress achieved in the various WHO collaborative gation and hydro -electric projects -the dangers of bilharziasis programmes. onchocerciasis.The Organization should encourage Several papers on various aspects of bilharziasis- and support research on the epidemiology and natural in addition to those mentioned above -were published history of the disease, including pathological manifes- in the Bulletin.' tations and immune phenomena, especially studies on the establishment of laboratory colonies of Simu- hum vectors and Onchocerca infections in laboratory Filarial Infections animals. Concerning mass therapy, the Committee recognized Recent surveys have indicated that onchocerciasis transmission takes place over wider areas than had that the drug Mel W appears to hold promise as an been suggested by previous reports, and in 1965 a effectivesingledosetreatment.The Committee survey made by WHO in two West African countries advised using wherever possible combined control confirmed the paucity of knowledge of its prevalence methods, attacking both the vector of the disease and and other epidemiological factors in some areas. the parasite in the human host. Such a strategy might Onchocerciasis has been recognized as a major en- consist of vector control measures and denodulization demic disease which, with its associated blindness, in a first phase,continuationofvectorcontrol affects the development of large parts of the African measures combined with macrofilaricidal chemother- continent and of certain areas in the Americas. Some apy in a second phase, and continuation of vector of the most fertile valleys in tropical Africa have been control measures with micro- and, if necessary, macro - abandoned because of infestation by Simulium flies. filaricidal treatment in a third phase. Although considerable progress has been made in the An inter -country onchocerciasis advisory team has development of anti -Simulium techniques, and oncho- been established to work in the African Region.It cerciasis has been successfully controlled in some foci, will assist in the implementation of the first inter - difficulties have been encountered elsewhere. country ochocerciasis pilot project, in the Volta River The discovery of new foci of onchocerciasis, and the Basin, the main elements of which will be the testing growing awareness of the serious effects of the disease of control methods and training of staff. on public health and the economy, were among the The data collected in a WHO- assisted follow -up reasons that led to the convening of the Expert Commit- survey in various areas of Kenya in which transmission tee on Onchocerciasis, which met in Geneva at the had been interrupted nine to eighteen years previously end of June 1965. have been analysed. Although in areas where trans- The Expert Committee, after reviewing the epi- mission had been interrupted eighteen years previously demiology of the disease, discussed its public health no microfilariae were found and all excised nodules and economic importance, methods and techniques for contained dead worms, in areas where only eleven years its control, and research needs.It concluded that, had elapsed since interruption of transmission live although control of onchocerciasis is quite possible adult worms and microfilariae were still found. This at the present time, campaigns are hampered by lack evidence on adult worm longevity is valuable for of funds, by the difficulties of co- ordinating control determining the period during which control measures must remain effective to break the transmission cycle. The Organization has supported transmission exper- ' Bull. Wld Hlth Org., 1964, 31,799 -823, 835 -841; 1965,32, 225 -242, 709 -712; 33, 33 -71. iments in cattle and chimpanzees, histological studies COMMUNICABLE DISEASES 25 of onchocercal nodules in patients treated with single Assistance has been continued to thefilariasis injections of Mel W, and studies on Simulium vectors control project in Ceylon, and UNICEF and WHO (in particular, the investigation of factors influencing are co- operating in the pilot project for filariasis the development of larval stages, and the development control in Western Samoa. of laboratory culture methods for various species of The Organization has provided support for the vectors). preparation of large quantities of filarial antigens for The sero -immunology of filarial infections had until investigations relating to the standardization of intra- recently received little attention because of the frag- dermal and sero- diagnostictests;forstudies on mentary knowledge of the immune response involved, experimental filariasis, particularly on the mode of and the lack of specific antigens. The results obtained action of diethylcarbamazine and Mel W in the treat- from serological and other immunological tests were ment of filariasis, including the effect of therapy on difficult to interpret and were not considered reliable. the infectivity of microfilariae for the vectors, the However, it has been reported from Japan that two mode of destruction of microfilariae and the action different antigens (one for the skin test and the other of these drugs on adult filariae, and methods for for the complement fixation test) have been isolated preventing fever reactions resulting from treatment; from Dirofilaria immitis at the Department of Parasi- for studies designed to find animal Filarioidea phylo- tology of Gunma University, and that satisfactory genically close to Wuchereria and /or Brugia; and for results have been obtained with the skin test antigen studies on host -parasite relationships, the mode of in a limited survey. Sawada's antigens are now avail- entry of infective filaria larvae into vertebrate hosts and able in greater quantities, and WHO has initiated a the fate of infective larvae in susceptible and non - sero -immunology programme for filarial infections, susceptible vertebrate hosts. involving the collection of serum samples and the comparison of serological information with the results Other Activities relating to Helminthic Infections of skin tests. The skin test antigen has already been The methods used and the results obtained in the tried in areas where filariasis is endemic in Burma epidemiological investigations on helminthiasesin (by the WHO filariasis research unit in Rangoon), the South -East Asia and Western Pacific Regions Ceylon, Japan, and New Guinea, and has given good have been assessed, and the Organization has sup- results. A number of tests were also performed on ported controlled clinical and field trials of bithionol onchocerciasis patientsinNigeria, and no cross - for the control of paragonimiasis, and of Hetol for reaction was reported with other unrelated parasite the control of clonorchiasis. species.However, the specificity and reactivity of The WHO- sponsored ascariasis controlled trials in these purified antigens still require thorough assess- China (Taiwan) have demonstrated that the pre- ment in. filarial and onchocercal cases and in persons valence and intensity of Ascaris infection can be harbouring phylogenically related nematodes. reduced in schoolchildren and village populations by The work of the WHO filariasis research unit in repeated mass treatment with piperazine, without Rangoon, Burma, is orientated towards the establish- simultaneous improvement insanitaryconditions. ment of methodology for measuring the level of Cure was effected in 70 to 90 per cent. of the popula- infection in a given population and assessing the tion groups treated, while the worm -load was lowered effects of control. Entomological and vector control by 90 per cent. on the average.Similar controlled activities are reported elsewhere (see page 40).The trials are being made in Ceylon. unit has carried out a number of studies in connexion Following the recommendation of a standing com- with the skin test for filariasis, using Sawada's antigen. mittee on parasite collections of the World Federation The first inter -regional seminar on mosquito -borne of Parasitologists, a register has been compiled of filariasis was held in Manila in November 1965. living strains of helminth parasites being maintained Participants reviewed recent progress and experience inlaboratories and other institutions throughout in the epidemiology and control of filariasis, and the world.Information on these strains and their considered reports on the filariasis work being done availability will be periodically revised and distributed in various countries.They discussed methods and to all collaborating scientists. techniques for control and epidemiological surveys, the training of national staff to carry out filariasis Trypanosomiasis surveys, and the exchange of information between countries and territories where filariasis is a problem of The situation with regard to human and animal public health importance. trypanosomiases is by no means encouraging. The 26 THE WORK OF WHO, 1965 occurrence of epidemic outbreaks and thelatest trypanosomes, and to immunological experiments developments in the epidemiology of sleeping sickness in animals and man, particularlystudies on the -especially the proof that cattle act as reservoirs of possibility of producing immunity forprotection Trypanosoma rhodesiense and thatthisspeciesis against infection with African trypanosomes, bio- also transmitted by Glossina fuscipes -point to the logical,physiologicalandecologicalstudiesof need for increased alertness.There is a particularly adult and pupal stages of Glossina, and studies relating urgent need to investigate the role of pigs as possible to a self -maintaining colony of tsetse (an achievement reservoirs of the parasite, and the extent of occurrence of the Institute for Tropical Diseases in Lisbon) which of acute virulent Trypanosoma rhodesiense -like strains will make it possible to carry out experiments on in typical T. gambiense areas where transmission is transmission of trypanosome strains. by the Glossina palpalis group. The Organization has A joint FAO /WHO African trypanosomiasis service carried out a survey to assess the situation along the has been established with a view to facilitating rapid shores of Lake Victoria in Kenya, Uganda, and the exchange of information among all participants, and United Republic of Tanzania, and also in some parts helping to strengthen surveillance in critical areas. of Burundi. An inter -regional trypanosomiasis study team has Leishmaniasis been established and has started operating in Came - roon and Chad. Its functions are to assess the present A list has been circulated of strains at present situation of both human and animal trypanosomiases available at the WHO International Reference Centre in relation to economic development and resettlement for Leishmaniasis, at the Department of Parasitology of populations in endemic or potentially dangerous of the Hadassah Medical School, Jerusalem. The areas which offer possibilities of rural or industrial Organization has also given support to a laboratory development, to stimulate epidemiological research, in Brazil for collecting, isolating and maintaining test new diagnostic techniques and improve those now human and other mammalian Leishmania strains. available, and investigate immunological aspects of In Syria, WHO is providing assistance for a survey the disease. in connexion with an epidemic of cutaneous leish- The second African training course in trypanoso- maniasis in the environs of Damascus. The effects of miasis was given in English at the Nigerian Institute malaria eradication programmes on the epidemio- for Trypanosomiasis Research, in Kaduna. logy of leishmaniasis are being assessed by WHO in a number of countries of the Eastern Mediterranean The East African Trypanosomiasis Research Organi- Region, and in Turkey. zation, Tororo, Uganda, has been designated as a WHO International Reference Centre for Trypano- The Organization has provided support for studies somiasis. of the immunological and serological characteristics of strains maintained at low temperatures, with the By applyinggel- diffusionand immuno- electro- prospect of immunizing people with heterologous or phoretic techniques it has been demonstrated that sera formsofLeishmaniaspeciesagainst and cerebrospinal fluids of patients infected with attenuated infections due to L. braziliensis; studies of the clinical T. gambiense show an increase in yM immunoglobulin features of American leishmaniasis in relation to the up to eight times the normal level,this increase behaviour of strains of Leishmania in Brazil; research rapidly disappearing after treatment.In order to on wild animal reservoirs and the ecology of leish- evaluatethesefindings, WHO issupporting an manial infections; and studies on the vector role and investigation among 15 000 people residing in endemic bionomics of Phlebotomus species. areas of Senegal, using the newly developed " im- munoplate " technique as well as classical parasito- logical methods for the diagnosis of trypanosomiasis. Mycoses Another WHO- supported study has shown that the A survey on subcutaneous and systemic mycoses in yM immunoglobulinlevelwas alsoraisedcon- Africarevealedthat,untildiagnosticlaboratory siderably in sera of patients infected with T. rhode- facilities are much more widely available, only a very siense. However, further studies are required to small proportion of the mycoses which occur will be simplify the technique and reduce its cost for applica- recognized.Mycetomas present the most severe and tion in mass surveys. (See also page 71.) extensivemycologicalhealthprobleminabelt Support has also been given to various research extending across Africa between latitudes 5 °N and projects on chemotherapy and the metabolism of 20 °N. COMMUNICABLE DISEASES 27

Bacterial Diseases 1 aimed at developing satisfactory potency tests for cholera vaccines.The tests were carried out in six Cholera laboratories, and itis expected that the results will Cholera remained endemic in 1965 in South -East be known early in 1966.These studies will facilitate Asia and cholera El Tor invaded new territories in the improvement of production, control and standard- this area, spreading northwards and westwards to ization of cholera vaccines. Afghanistan, Nepal, Iran and the USSR. WHO WHO continued to support the studies being made assisted the first three countries in cholera control in Japan and the Philippines on the survival of vibrios, by providing vaccine, and in epidemiological and with particular reference to contamination of food bacteriological work. and water and their disinfection, and the studies on The WHO inter -regionalcholera control team the role of carriers. The latter indicate that the carrier provided assistance in Afghanistan and Iran during state in cholera El Tor is common and it has been the recent outbreaks, and in India and the Philippines found in about one -third of household contacts. in connexion with studies on cholera vaccines, the Some carriers harbour the organism for as long as carrier state and therapeutic methods, and also in the three years.In order to obtain further knowledge of control of cholera.The team also assisted the joint the role of carriers in transmission of the disease, Philippines /Japan /WHO cholera study projects. quantitative studies are being made on excretion of During May WHO organized an inter -regional vibrios and the effect of microbial drugs in the treat- training course on cholera control in Calcutta, with ment of carriers. Among other results important from participants from the South -East Asia and Western the practical angle is the finding made in the controlled Pacific Regions.In addition, in order to prepare clinical trials in Iran that the purging of stool negative countries still free from cholera for possible future convalescentswith magnesium sulphate provokes outbreaks, an advanced course for bacteriologists excretion of a large number of vibrios. in the Eastern Mediterranean Region was organized Epidemiological studies have been assisted by the in Teheran in October. work of the WHO International Reference Centre for The WHO cholera research programme was further Vibrio Phage Typing, in Calcutta, which examined developed, and vaccine studies viere continued in the strains isolated in all recent epidemics. The results field and in laboratories.A large controlled field of studies of experimental cholera in young rabbits trial of vaccines prepared from Vibrio cholerae and have been applied in the evaluation of cholera vaccines, Vibrio El Tor on over half a million people in the hut the value of this technique is still not known for Philippines was completed, and a preliminary report certain.Geneticstudiesof vibrios were further was published in the Bulletin.a This study, supported promoted with a view to improving methods of by Japan, the Philippines and WHO, has demon- diagnosis. The preliminary results of genetic studies strated that liquid vaccine prepared according to of V. cholerae and V. El Tor and of their genetic requirements for cholera vaccine published by WHO,a recombinations indicatethat variations, mutations either from V. cholerae or V. El Tor, give about 50 per and resistance to drugs occur, and that differentiation cent. protection against El Tor infection for a period betweenV. cholerae and V. El Tor isa complex of about six months. A much increased and longer - problem. lastingimmunity was achievedwithoil- adjuvant vaccine with, however, a somewhat higher incidence of undesirable side -effects. A similartrial on over Plague 50 000 people in India with vaccines prepared from During 1965 greater attention was devoted to plague V.cholerae indicated that some of the vaccines in view of the increased incidence of this disease prepared according to requirements published by (see also page 30). WHO a do provide protection against infection with V. cholerae.New controlled field trials have been In order to prepare to meet the challenge should the undertaken in India and the Philippines on about incidence of plague continue to increase, an inter- 400 000 people, and the preliminary results have regional travelling seminar on plague control was confirmed the earlier findings. held in the USSR in September.Special emphasis A number of laboratories collaborated in studies was laid on improving study of the ecology of the disease and on the development of an effective surveillance system for sylvatic plague. 1 For work on leprosy and tuberculosis, see pages 29 and 7. 2 Bull. Wld Hlth Org., 1965, 32, 603 -625. The Organization has continued to support the Wld Hlth Org. techn. Rep. Ser., 1959, 179. studies of endemic foci of plague in India. 28 THE WORK OF WHO, 1965

Enteric Infections given in prophylactic measures and treatment, and in promoting studies. A stock of sulfonamides provided The WHO diarrhoea)diseasesadvisoryteam by UNICEF has been kept ready in Africa for possible completed its work in Venezuela.Its studies confirm emergency use. a direct correlation between low standards of water An InternationalReference Centre for Menin- supply and high incidence of diarrhoea, but indicate gococci has been established in Marseilles. It will the absence of correlation between housing standards assist laboratories in Africa and elsewhere in the and incidence of diarrhoea. identificationand typingofstrains,studytheir An inter -regional training course on enteric infec- resistance to microbial drugs, and facilitate the collections was held in Budapest during November, with tion and study of strains of meningococcus isolated twenty -four participants from all regions. in various parts of the world. Pilot projects for the study and control of enteric In the effort to develop an effective vaccine for the and diarrhoeal diseases were further developed in the prevention of cerebrospinal meningitis, immunological African, South -East Asia, Eastern Mediterranean and and vaccine studies have been initiatedin three Western Pacific Regions. laboratories. At one of these, recent efforts have been The International Reference Centres for Entero- directed towards the production of lysed (somatic bacteriaceae have provided assistance to a number of antigen) vaccines, and a paper describing the method national centres in order to facilitate epidemiological of preparation of these vaccines was published in the studies of these infections. Work was discontinued Bulletin.' atthe WHO InternationalSalmonella Centrein Copenhagen, and the Salmonella Laboratory of the Diphtheria, Pertussis and Tetanus Institut Pasteur in Paris was designated as the new WHO centre. WHO has assisted some countries in the South - The results of controlled fieldtrials of typhoid East Asia and Western Pacific Regions in developing vaccines in Poland and the USSR, as well as a paper and improving their production of diphtheria, tetanus defining the present status of WHO- sponsored field and pertussis vaccines and in developing mass cam- and laboratory studies of typhoid and paratyphoid paigns for the immunization of children. vaccines, were published in the Bulletin.' New field A review of the available data on the global incidence trials have been organized in Iran and Tonga to of tetanus has been completed.The data indicate evaluate the effectiveness of a single dose of acetone - that this disease is more widespread and prevalent dried typhoid vaccine -the vaccine that proved most in many areas than is shown by routine health sta- effectiveinearlierstudiessponsored by WHO. tistics, and that immunization campaigns may be Laboratory studies of typhoid vaccines have been needed in such areas. The immunological and field analysed and further studies have been planned. studies of the effectiveness of various types of tetanus In addition to the papers mentioned above, the toxoids and immunization schemes have been conti- following were published in the Bulletin: a survey of nued, and a paper was published in the Bulletin the laboratory potency studies of two international describing the results of studies in New Guinea.b reference preparations of typhoid vaccine;2 and a paper describing studies on the influence of the route Streptococcal and Staphylococcal Injections of immunization in the active mouse protection test with intraperitoneal challenge.' An international survey of streptococcal infections was initiated. Sera collected in Pakistan and Thailand Plans have been made for further studies on the for streptolysin O titres were studied by a co- operating live dysentery vaccine that has been developed. laboratory in Prague, and results indicate that recent infection with streptococcusis not uncommon in Cerebrospinal Meningitis tropical countries. Preparations have been made for the establishment Cerebrospinal meningitis was relatively quiescent of an International Reference Centre for Streptococcal in Africa in 1965, but there were more cases of this Infections in order to facilitate the study of these disease in other parts of the world.In countries in infections and their sequelae. Africa where the disease is endemic, assistance was The International Reference Centre for Staphylo- coccal Phage Typing has continued to assist national 'Bull. Wld filth Org.,1965,32,1 -36. 'Bull. Wld Hlth Org.,1964,31,761 -791. 'Bull. Wld Hlth Org.,1965, 33,21 -26. 3Bull. Wld filth Org.,1964,31,793 -798. 6Bull. Wld Hlth Org.,1965, 32,683 -697. COMMUNICABLE DISEASES 29 centres in the study of staphylococcal infections, Colombia. The data obtained by the leprosy advisory particularly hospitalinfections commonly due to team in surveys in the Americas, Africa and Asia drug- resistant strains. have yielded valuable information on the prevalence and distribution of leprosy, on clinicalpatterns, Leprosy classification, frequency and type of disabilities, and The total number of leprosy cases in the world clinical and bacteriological results in mass treatment. is estimated at over ten million.During 1965 the As from the end of 1965 the team, to be known as the Organization provided technical advice for UNICEF - leprosy epidemiological team, is to undertake new assisted projects in thirty -seven countries: at the end duties, carrying out field research projects in selected of 1964 over 1 686 500 patients were under treatment areas with a view to developing improved leprosy in these projects, and over 169 200 had been discharged control measures. as clinically cured. In a hyperendemic area in Burma with a population The Expert Committee on Leprosy met in Geneva of about 42 400 the WHO leprosy /BCG team continued in July, and made a thorough review of present the first phase of a trial to ascertain the value of BCG knowledge on epidemiology, chemotherapy, diagnosis vaccination in the prevention of leprosy in children. and classification.1 It discussed the various aspects By the end of August 1965 more than 15 100 persons of leprosycontrolincluding epidemiology,case - had been examined, and some 5890 children had been finding, out -patient and in- patient care, and measures assigned to the BCG and control groups. There will for the protection of the healthy population, with be a five -year follow -up, and at least three years' special reference to contacts and children.It empha- work will be necessary before preliminary results are sized the need to establish priorities according to obtained. The team is also collecting relevant epi- local conditions for the treatment and follow -up of demiological information on leprosy. patients and the surveillance of contacts :in countries The first regional seminar on leprosy control in with limited resources, attention should be concen- the Western Pacific Region was held in Manila during trated on infectious cases and their contacts.The April, with participants from fourteen countries and Committee referred to the need for long -term trials territories in the Region. They discussed case -finding, to determine the minimum proportion of open cases therapy,training,theprotectionof thehealthy to be treated in order to obtain a significant reduction population with special reference to contacts and in incidence, and suggested that in the meantime the children, health education, rehabilitation, the planning, objective should be to have at least 75 per cent. of organization and evaluation of control programmes, open or infectious cases under regular treatment. and the role of local health services in leprosy control. Stress was laid on the importance of preventing The antileprosy campaign is an important aspect physicaldisability and correcting early deformity of the Organization's work in the African Region, by simple treatment in the field; rehabilitation mea- where twenty -three countries are receiving interna- sures should be established as an integral part of tional assistance for leprosy control.In some coun- leprosy control programmes. Health education and tries leprosy case -finding is undertaken in the course training of personnel were also fully considered. The of campaignsforothercommunicablediseases. planning,organization and evaluationof leprosy Visits were made to five countries during the year to control programmes were discussed in detail, and the evaluate the progress made in the control programmes. Committee emphasized the value of pilot projects and For leprosy control work in the Americas, see the importance of integrating leprosy control pro- page 103. grammes into the general health services.It considered WHO continued to provide assistance for research research in microbiology, immunology, pathology, in various fields of leprology. No outstanding results epidemiology, chemotherapy and chemoprophylaxis, have been reported in the cultivation and transmission and concluded that there was a need for intensified of Mycobacterium leprae or the trials of new thera- research at all levels.It was particularly important peutic drugs. On the other hand, good preliminary that leprosy research should be encouraged in general results have been obtained in the chemoprophylaxis research centres so thatit might benefit from the trial which is being made in India. The trial covers assistance of experts in the basic sciences and allied a hyperendemic area with a population of about disciplines. 213 000.Household contacts of some 600 cases, The WHO leprosy advisory team completed its considered to be infectious, were selected for the study: survey in Argentina at the end of 1964, and in April healthy contacts below 15 years of age were divided 1965 began an epidemiological study in Agua de Dios, into two groups, about half being given prophylactic treatment with DDS (diaminodiphenyl sulfone), and 1 Wld Hlth Org. techn. Rep. Ser., 1966, 319. the remainder receiving a placebo.Firstresults 30 THE WORK OF WHO, 1965 would seem to indicate that treatment with DDS Certificate of Vaccination or Revaccination against provideseffectiveprotectionafterthefirstnine Yellow Fever from six to ten years with effect from months. 12 May 1965 -the date of the adoption of its resolution WHA18.5 -the maximum period of validity of certificatesissued beforethisdate also being International Quarantine extended to ten years. The Assembly further amended the International Sanitary Regulations by establishing Changesintheinternationalrequirementsfor a new Article 102, providing for the disinsection of vaccination or revaccination against smallpox and ships and aircraft arriving in or leaving areas where yellow fever were among amendments to the Inter- malaria and other mosquito -borne diseases occur or national Sanitary Regulations adopted in May by could develop from imported vectors. the Eighteenth World Health Assembly. The Additional Regulations amending the Interna- The amendment of the International Certificate of tional Sanitary Regulations will enter into force on Vaccination or Revaccination against Smallpox sti- 1 January 1966 for all States legally bound by the pulates the use of " a freeze -dried or liquid vaccine 1951 Regulations except for the Federal Republic of certified to fulfil the recommended requirements of Germany (pending legislative action). The Additional the World Health Organization ".Also, the origin Regulations have been accepted by States not legally and batch number of the smallpox vaccine used are bound by the 1951 Regulations, the universality of to be recorded on the certificate. The amended form the International Sanitary Regulations thus being of the certificate will be the only form issued as from maintained. 1 January 1967, but it may be used as from 1 January Two booklets dealing with particular aspects of 1966. the Regulations were brought up to date: Vaccination The smallpox vaccination requirements for inter- Certificate Requirements for International Travel and national travel had been discussed by previous Health Yellow Fever Vaccinating Centres for International Assemblies as well as by an expert committee on Travel. smallpox and the Committee on International Qua- In 1965 Africa north of the Sahara, North America rantine, all of which were concerned at the record of and the Western Pacific area remained free of small- importationof smallpoxintocountriesthrough pox. Europe was also free of smallpox except for one international traffic and the secondary cases ensuing. imported case in the Federal Republic of Germany. The Committee on International Quarantine had An outbreak of yellow fever occurred in Senegal and recalled that international vaccination certificates are cases of jungle yellow fever were reported from the issued under the authority of a government, and that endemic areas in South America. consequently governments are responsible for ensuring There were outbreaks of plague in Africa, South the use of potent vaccines and proper procedures, so America and Asia, and several cases were notified that vaccination will result in an adequate immunity in the United States of America (in Arizona, Nevada to smallpox. and New Mexico). Deferred by the Seventeenth World Health Assem- Cholera El Tor was reported in Iran for the first time bly pending a further review, the matter of amend- since 1939, and in Afghanistan, where the last previous ments to the International Certificate was taken up outbreak was in 1960. Cholera was reported in Uzbe- again by the Committee on International Quarantine kistan SSR. One case was also reported in Bahrain. at its session in February 1965.1 The Committee had Some States in this area, disregarding the provisions before it data from field trials of revaccinations and of theInternationalSanitaryRegulations,took observations from Member States.It noted that in excessive sanitary measures, closing land frontiers and trials carried out in India on 2161 persons, the overall cancelling scheduled airline services.Excessive meas- additionalsuccessrate when revaccinations were ures,adverselyaffectingtheeconomyof some repeated on the seventh day was of the order of only countries, were even takenagainstStates which 2.4 per cent., and concluded that this small percentage repeatedly denied the presence of cholera. of additional persons protected did not warrant the The Mecca Pilgrimage in 1965 (year 1384 of the adoption of a procedure for repeated revaccinations Hegira) was again free from quarantinable diseases. after seven days, in view of the many practical diffi- Since January1962 theadministration of the culties both for physicians and travellers. InternationalSanitary Regulations has been fully The Eighteenth World Health Assembly extended centralized in Geneva, with direct communications the maximum period of validity of the International between all health administrations and WHO headquarters. Daily epidemiological radiotelegraphic bulle- 1 For report, see Off. Rec. Wid Hlth Org. 143, 41. tins are transmitted by Radio Suisse from Bern- COMMUNICABLE DISEASES 31

Münchenbuchsee and Geneva -Prangins; except for day. Any additional urgent information is dissemi- Europe, these are beamed transmissions. In October nated directly to interested countries by Standing 1964 two teleprinter transmissions, for automatic Operating Procedure (SOP) cables. reception -one for Europe and one for North America The Organization continued to co- operate with -were substituted for two transmissions which, as ICAO and the International Air Transport Association shown by a survey, were not being well utilized. on matters of common interest concerning the Inter- Twelve radio stations in Asia pick up and retransmit national Sanitary Regulations. It also gave assistance free of charge the radio bùlletins from Geneva. totheInter -Governmental Maritime Consultative Some 4000 copies of the Weekly Epidemiological Organization in connexion with the Convention on Record, now initsfortiethyear,are distributed Facilitation of International Maritime Traffic.This regularly. Dispatched, mainly by airmail,every convention, which contains a number of provisions Friday, the Record contains all information received from the InternationalSanitary Regulations,was up to 1700 hours Greenwich Mean Time on the previous adopted in April. CHAPTER 3

ENVIRONMENTAL HEALTH

Community Water Supply up.Economy and efficiency should be promoted by the use of technically sound simplified designs, Work under the community water supply pro- usinglocally produced materialstothegreatest gramme has again been concentrated on assistance extent possible. Operation needs to be geared to the to developing countries, particularly in the establish- local skills that are either in existence or capable of ment of national policies and goals for water supplies, being developed within a reasonable period within in the improvement of the professional and technical the country. competence of the existing personnel, and in making The tremendous need for water in rural areas provision for the education and training of the addi- remains the largest single problem of water supply. tional personnel required for the expanding national In many countries work on this problem has hardly programmes. progressed beyond the demonstration level.In the After itsearlier emphasis on the promotion of Region of the Americas, however, a determined national and local water supplies, the programme is effort is being made, with the Inter -American Develop- now largely concerned with identifying the obstacles ment Bank, to create programmes for the provision of tothe actual construction of water supplies and water inruralareas. Revolving funds forthe recommending practical ways of eliminating those purpose are initially supplied by the Bank (see also obstacles.Assistance has therefore been given for Chapter 15). engineering and economic studies, as a step towards With the assistance of the United Nations Special the establishment of priorities for the use of available Fund, progress has been made towards the preparation internal and external investment funds. Such studies of projects for the implementation of water supply and have in most cases resulted in a marked shift towards the priority claims of water supply and sewerage, sewerage systems for which banks may be willing especially for metropolitan and other urban areas. to provide loans. WHO is the executing agency for Special Fund projects for the two metropolitan areas In pursuance of the basic aims of the programme, of Accra and Calcutta.For Accra, master plan the Organization has continued its long -term assistance studies for water supply and sewerage have been to seventy -one developing countries by providing completed and construction has already begun of the sanitary engineers or consultants to help in the plan- firststage of the Accra water supply system.It ning of water supplies. The improvement of commun- includes a large water transmission line from the ity water supplies was the major objective of thirty - Volta River to Accra and water distribution within four projects and in a further forty projects it was one of the components. Important elements in these the city.In the survey of water supply resources for long -term projects are the training of local personnel GreaterCalcutta,now nearingcompletion,the and the establishment within the governmental struc- assistance provided through WHO isentering the ture of new agencies to provide for the sound develop- engineering design stage.Funds for similar water ment of future programmes. supply and sewerage studies for Istanbul were approv- As a first step in a programme of assistance to ed by the Special Fund in June. WHO, as executing research and development work in community water agency for the project, is initiating the engineering supply, visits were made to a number of universities and managerial studies required for the preparation and other research institutions throughout the world offeasibilitystudies and master plans. in order to lay the basis for a collaborative pro- Special contingency funds have been made available gramme. by the Technical Assistance Board for expert missions A previous WHO study pointed to the need for to Burundi, Ceylon, Dahomey, Greece, Mali, Nigeria systematic investigation of design practices for water and Uganda. WHO arranged for the governments con- supplyfacilitiesindeveloping countries,sothat cerned to receive specialized advice on specific problems guidelines and criteriafor design may be drawn of water supply and helped some of them in the - 32 - ENVIRONMENTAL HEALTH 33 preparation of requests for Special Fund support for The Organization also assisted the Government of future activities in this field.Similar advice on the Thailand in arrangements with a consulting engineer- preparation of requests to the Special Fund for ing firm to prepare an engineering and economic projects covering water supply and sewerage systems feasibility report regarding drainage, sewerage and was provided to the Governments of Senegal and waste disposal facilities for Bangkok. The Govern- Malta (see below). ment of Thailand has allotted the sum of US $850 000 A series of meetings between representatives of the for the study by an engineering firm, and it is estimated International Bank for Reconstruction and Develop- that construction costs will amount to about US ment and WHO resulted in strengthened co- operation $45 million. between the organizations.In particular, the assist- Reference has been made above in the section on ance to developing countries in water supply and community water supply to the assistance provided sewerage programmes was studied in some detail and to Ghana and Turkey in the planning of water supply satisfactory arrangements concluded. and sewerage systems for Accra and Istanbul. The WHO international standards for drinking -water water supply plan for Dakar, Senegal, also includes have been adopted as a whole or in part as national plans for sewage disposal facilities.During 1965 the standards by twenty -two Member countries, and a Organization also assisted the Government of Malta number of other countries have taken them into in preparing a request to the United Nations Special account in establishing their own standards.The Fund.Thisprojectincludesthe preparationof Government of New Zealand has used the standards feasibilityengineering reports with regard to the to grade the water supplies of 214 cities and towns. treatment of sewage and use of the effluent for irrigation purposes.It provides for combined treatment of sewage sludge and refuse for the production of Wastes Disposal compost to be used as a soil conditioner and fertilizer Assistance by WHO to Member countries with for horticultural development. regard to the satisfactory collection, treatment hind On the basis of information collected during 1964 disposal of sewage, industrial wastes and municipal and 1965, the Organization issued a guide on the solidwastes increasedsubstantiallyduring1965. construction and operation of waste stabilization Countries visited in this connexion included Cyprus, ponds. This has been widely distributed, particularly Ethiopia, Jordan, Lebanon,Syria,Thailand and to institutions and government agencies in charge of several countries in Latin America. the planning and implementation of waste disposal WHO helped the Government of the Philippines programmes. in formulating a request to the United Nations Special Arrangements were made for advisory assistance Fund for support in the preparation of a master to be given to the Sanitary Engineering Research sewerage plan for metropolitan Manila.It includes Centre at the University of Alexandria. engineering and economic feasibilityreports, and Considerable research is needed on many aspects cost estimates of requirements for the most immediate of sanitary engineering, with a view, for example, sewerage and waste disposal needs of the city. Organi- to the evaluation of the polluting effects of industrial zational, economic and legislativeaspects of the wastes; the development of standards for industrial project are also part of the request for assistance, effluent; the improvement of methods for the dis- which was formally submitted to the Special Fund. charge of sewage and industrial wastes into water- The project is designed to complement the work courses and for treatment of industrial and other already being carried out by the Government of the wastes. Philippines, with the assistance of the International The Organization has continued tocollect and Bank for Reconstruction and Development, for the distribute information on technological advances and expansion of the water supply system of metropolitan on the results of research into better methods of Manila. waste treatment and disposal, including the economic Similar assistance was given to the Government of andadministrativeaspectsoflong -rangewaste Western Nigeria in formulating a request to the disposal programmes. Special Fund for the preparation of a master sewerage Here again the project includes plan for Ibadan. Environmental Pollution assistanceforthepreparationof apreliminary engineering report with cost estimates for the most The Advisory Committee on Medical Research immediate sewerage and wastes disposal needs of the at its session in June recommended that WHO should city, as well as subsequent assistance in the managerial support the establishment of international and regional and operational aspects. reference centres to collect information on normal 34 THE WORK OF WHO, 1965 and abnormal constituents of air and water to make relationship of air pollution and respiratory disease qualitativeestimatesof thepollutingsubstances included a study of the possible role of pollen from a present in different parts of the world. The Committee, flowering tree as a cause of asthma. which had before it the reports of scientific groups on Comments received on a preliminary study of research into environmental pollution and on the methods for measuring air pollutants were discussed long -term effects on health of new pollutants, stressed by the Scientific Group on Identification and Measure- the importance of developing sensitive and reliable ment of Air Pollutants at its meeting in November. methods for measuring pollutants and evaluating The Group reviewed the nomenclature used in air their toxicity in laboratory animals and in man.It pollution studies, the units and terms for presenting the considered that research should include epidemio- results of surveys, the methods used for measuring and logicalinvestigationsinareaswhereparticular monitoring several common atmospheric pollutants and pollution problems are known to exist. their suitability for various types of surveys. Sampling Research on environmental pollution was the subject procedures and analytical methods for gaseous and of two ad hoc inter - agency meetings convened by WHO particulate pollutants were discussed.The Group during the year, in connexion with the request of the made specific recommendations on the units to be Economic and Social Council (in resolution 910 used for air sampling and analysis, and also gave (XXXIV)) for a study on " ... national and interna- detailed guidance on methods to be preferred for tional research into pollution of every kind and reporting the results of measurements.Despite the measures for its control ". The meetings were attended existence of a great number of sampling techniques, by representatives of the United Nations, ILO, FAO, analyticalmethods andinstruments,theGroup UNESCO, WMO, IAEA and IMCO. The report concluded that much work was needed to develop outlined the nature and scope of environmental additional methods with increasedspecificity and pollution research and control, measures already in sensitivity.Finally, the Group considered that, as air force or recommended for prevention or abatement of pollution was a hazard to health in many parts of the such pollution, patterns of international collaboration world, WHO had a valuable role to play in encourag- and the role of various international organizations ing the use of reliable methods for the identification working in this field. and measurement of pollutants, the dissemination of technical information, the training of personnel, and research. The Group also advocated the establishment Air Pollution of international reference centres at which techniques Close collaboration has been maintained with could be evaluated, new methods developed and WMO on problems of mutual interest concerning standards prepared and issued. air pollution and meteorology. The Commission for A study was started on the effects on health of Aerology of WMO, after considering a paper presented diesel smoke and the control necessary to minimize by WHO, has decided to set up a working group on such pollution. The study will especially take into atmospheric pollution and atmospheric chemistry. account the needs of developing countries. Coal -fired electrical power plants are among the Papers on various aspects of air pollution control major sources of atmospheric pollution in many were published in the Bulletin.' countries. A paper on the health effects of these pollutants was presented by WHO to an international Water Pollution symposium, held in Czechoslovakia, on the control and utilization of sulphur dioxide and fly -ash from The first expert committee to consider water pollution the flue gases of large thermal power plants. control met in April 1965 in order to assess the magnitude and variety of water pollution problems in the world. The Organization assisted a number of governments in attempting to identify the causes of specific cases It found9 that effective control could be said to exist of air pollution. For example, WHO- assisted investi- only in a few countries, and estimated that waste gations in Iran indicated that air pollution in Teheran water treatment facilities in these countries would was caused mainly by the smoke from ill- constructed have to be at least doubled within the next twenty and badly operated brick kilns and from a large years.It advocated the establishment of river basin authorities with powers to work out and implement a number of small individual sources inthecity, exacerbated by meteorological conditions; in Israel, total water management policy, of which pollution control would be the major part. diesel and other motor vehicle emissions were found Noting that the economic aspects of water pollution were just begin- to be the major source of pollution, but the increasing construction of power plants is giving rise to concern Bull. Wld Hlth Org., 1965, 32, 389 -429. for the future; in Kuwait, an investigation into the 2 Wld Hlth Org. teche. Rep. Ser., 1966, 318. ENVIRONMENTAL HEALTH 35 ping to receive attention, it stressed the value of econo- disseminatedinabulletinpublishedperiodically mic analyses to compare the cost of pollution preven- by the Institute. tion and abatement withthe economicbenefits WHO has started a study on the pollution of coastal involved.Specific recommendations were made for waters and bathing beaches.Evidence of this form research on the health effects of certain substances of pollution has long been manifest, and is constantly contained in surface and ground waters; on determina- increasing.Studies carried out in several countries tion of surface water quality; and on technical and concerning the effects of biological pollution of coastal other methods for water pollution prevention. waters on human health and well -being have resulted The conclusions of this expert committee have in conflicting opinions on the dispersion, survival already been found useful in connexion with the help and pathogenicity of a number of micro- organisms, given to Member countries in preparing applications parasites and viruses. The WHO study, which will to the United Nations Special Fund for financial continue for several years,is intended to provide assistance to certain projects, and with water pollution standards for the quality of coastal waters and methods surveys sponsored in the Regions. for attaining this quality. Early in 1965 WHO helped the Government of Poland to prepare a request to the United Nations Environmental Health Aspects of Ionizing Radiation Special Fund for financial assistance for a project which illustrates the importance of water pollution WHO participated in the symposium organized by control for the health and economic development of IAEA in Vienna, in December, on practices in the large populations. The project was approved by the treatment of intermediate and low -level radioactive Governing Council of the Special Fund, and WHO wastes. At the opening session a paper was presented was appointed the executing agency.Three main by WHO on the degree of treatment required for low - studies are to be carried out simultaneously: on the and intermediate -levelradioactivewastesforthe effects of pollution in the highly industrialized area prevention of hazardous pollution of the environment. of the upper Oder and Vistula basins and possible Many of the known methods were discussed at the control measures; on the protection of river waters symposium, but new examples of operation and appli- against pollution by saline waste drainage water from cation emerged, for instance, in the precipitation or coagulation methods for treating radioactive wastes; mines; and on the pollution of rivers by waste water the emphasis is shifting from general methods such from 'thermal power stations, including research on the as alumina,ferricorphosphate precipitation to detrimentaleffects of such pollution on the self - methods devised for the removal of specific radio - purification capacity of rivers. elements, e.g. ferrocyanide precipitation of caesium. WHO continued to provide the Central Public Health From the environmental standpoint,these newer Engineering Research Institute at Nagpur, India, with methods should lead ultimately to lower levels of technicaladvice. The organization and research contamination. programme of the Institute were reviewed and lists At the request of IAEA the Organization furnished of equipment and instruments necessary to fulfil the detailed comments on a draft addendum for an IAEA entireresearch programme of theInstitute were manual on the management of radioactive waste pro- drawn up. The Government continued to participate duced by radioisotope users, as well as comments on the in the project by furnishing services, funds for supplies Regulations for the Safe Transport of Radioactive and rent -freebuildings, and by constructing pilot Materials. A study is also being carried out on methods plants. On the advice of WHO, arrangements are forthesurveillanceof environmentalradiation being made for simple spare parts and expendable exposure. supplies for the laboratory equipment to be produced locally and for the equipment to be maintained and Co- operation with other Organizations operated with a minimum of imported supplies. WHO continued to collaborate with the Inter- The Institute has also started to work on the problem national Astronautical Federation and the Committee of air pollution.However, full functioning of this on Space Research, established by the International section can be expected only when a sufficient number Council of Scientific Unions.Together with other of staff have been trained in the specialized techniques specializedagencies, WHO collaborated with the needed for sampling and measuring various atmosphe- International Astronautical Federation in the organi- ric pollutants. zation of the second international symposium on The results of research carried out by the Institute basic environmental problems of man in space, and and in the several field stations in the country are contributed a study on the formation of carbon 36 THE WORK OF WHO,1965 monoxide in the human organism, a factor to be neeringeducation and training programmes for considered in space flight. environmental health was held in Geneva in July 1965. The participants from twelvecountriesincluded Sanitation Services and Housing heads of university departments of civil engineering, lecturers in civil and sanitary engineering, the head Sanitation Services of a national school of public health, and government In many of the developing countries the basic officials responsible for engineering education and sanitation needs for the protection and improvement training programmes. There were also four represen- of public health are still far from being met.This tatives from UNESCO and one from the Rockefeller situation, often aggravated rather than remedied by Foundation. social and industrial changes, persists not only in The participants noted the increasing complexity rural areas but also in the newly urbanized districts of public health problems, particularly in the more of large towns and in the sprawling slums surrounding developed countries, and emphasized the need for overpopulated cities. programmes of water supply, waste disposal etc. to Action to solve these problems is hampered almost form part of broader national programmes.They everywhere by shortage of funds, but an even more pointed out that a new category of highly trained common and fundamental obstacle to improvement environmental health engineers would be increasingly is a country's lack of suitably organized sanitation required to work closely with the public health team, services.The requisite qualified personnel- sanitary and suggested that advanced training in engineering engineersandsanitarianscapableof occupying might be provided by university -level programmes responsible posts in the health administration and organized on a regional inter -country basis. other government departments where technical policies are decided upon and budgets allocated -is not available. Housing and Urbanization In 1965 eighty -two WHO- assisted projects for the improvement of sanitation were in operation in sixty - In May 1965 a second WHO inter -regional travelling seminar on the public health aspects of housing was eight Member countries. Impetus was given to the education and training organized in Moscow and Kiev, with a programme of sanitation personnel through the establishment of identical to that of the first seminar held in the Soviet Union in October 1963.1 The 1965 seminar was in new sanitaryengineering educational schemesin Venezuela and Brazil, with the financial assistance of Russian and French, with seventeen participants from the United Nations Special Fund. Under the Vene- as many countries. zuelan project the teaching of sanitary sciences and WHO took part in the third session of the Committee on Housing, Building and Planning of the Economic sanitaryengineeringsubjectsincivilengineering curricula is being strengthened in four universities and Social Council, held in New York in September different parts of the country; a post -graduate 1965, and in the annual meeting of the inter -agency in working group on housing and urbanization held course leading to a Master's degree has been instituted at the Central University of Venezuela in Caracas. before and after the Committee's session. Similarly, the Brazilian project involves the teaching In the Americas a regional seminar was organized of sanitary engineering subjects at both undergra- in November 1965 in Venezuela on the sanitation duate and graduate levels in the State of Guanabara. problems of squatters'settlements aroundcities, and advice was given to health and housing authorities Programmes with important implications for public health -such as schemes for water supply, sewage in several countries. In Iraq, WHO helped in studying disposal, housing, and urban and regional develop- the availability and adequacy of environmental health ment -are sometimes undertaken without reference facilities and services in the areas devoted to the development of large housing schemes, and in drawing to the public health services. It has become increasingly clear that some means should be found whereby up codes, standard designs and specifications applicable under local conditions to such developments. civil engineers,architects, and planners concerned with such programmes can be made familiar with WHO co- operated with the United Nations and the principles and practices of environmental health. the Special Fund in connexion with housing and Unless this is done constructions undertaken by civil physical planning projects in a number of countries, engineers,andhousingorurbandevelopment including Afghanistan, China (Taiwan) and Singapore. schemes, may again give rise to serious public health The Organization participated in the third session of problems. An inter -regional symposium on sanitaryengi- 1 See Off. Rec. Wld Hlth Org., 139, 30. ENVIRONMENTAL HEALTH 37

the International Board of Consultants, sponsored a Scientific Group on Biological Aspects of Micro- by the United Nations, which met in Yugoslavia in chemicalPollutionof WaterSystems,includes connexion with the reconstruction of thecity of detailed information on newly developed European Skopje devastated by earthquake in 1963. The sanitary and North American methods, in which various engineer appointed by WHO to the team of United aquatic test organisms are employed for the detection Nations consultants on city and regional planning of trace amounts of synthetic organic substances reviewed the health and sanitation aspects of the which are increasingly present in natural waters. proposed master plan for the Skopje area and made Another biological problem of concern for sanitary a number of recommendations concerning, among engineering is the infestation of water intakes and other things, air and water pollution problems and distribution systems by Dreissena polymorpha.In the planning and distribution of medical care facilities recent years this freshwater mussel has caused serious in the new city and its surroundings. problems in several countries of Europe and Western Five papers published during the year under the Asia by forming dense aggregations on the interior general title Housing Programmes : the Role of Public surfaces of pipelines.These aggregations not only Health Agencies 1 emphasize that housing should be greatly restrict water flow but may accelerate corrosion considered " as one of the several environmental and give rise to other problems.During the year health problems associated with planning and develop- expert advice on Dreissena control was furnished by ment " and that public health authorities should WHO to the Istanbul Waterworks Administration assume greater responsibility in this field. Two of the and data were collected for a selected annotated papers deal with the general responsibilities of public bibliography on the subject. health administrations in the field of housing and the Investigations in biological control with a view to planning of housing programmes and indicate the theeventual establishment of efficientintegrated contributions that health agencies can make at all methods for vector control were continued in liaison levels and stages of planning.The experience in with FAO and other interested organizations, including individual countries is described in two other papers : the International Advisory Committee on Biological one, on housing hygiene in the USSR, deals primarily Control andtheInternationalOrganizationfor with the problems of industrial development and Biological Control. The survey for potential biological urbanization, giving details of research in connexion control agents has been expanded and accelerated, with noise and air pollution in built -up areas; the thanks to the activities of the International Reference other, on community participation in housing and Centre for the Diagnosis of Diseases of Vectors, environmental hygiene in Ceylon, concentrates on established in 1964 at the Ohio State University, in housing in rural areas, and mentions effective means the United States of America. The examination of of enlisting public participationin housing pro- material sent to this reference centre from many parts grammes. The final paper describes economic and of the world has already resulted in new host and financial problemsassociatedwith housing pro- locality records for many pathogens and parasites grammes. of vectors. Collaborating centres are making further " The Challenge to Public Health of Urbanization " studies on some of the more interesting organisms was selected by the Executive Board as the subject discovered. Twenty -four such centres, in ten Member for the technical discussions at the Twentieth World States and four of the regions, are now participating Health Assembly in 1967. in this work. Replies to a questionnaire distributed at the beginning of 1965 indicated that, during the four years in Environmental Biology which WHO has been developing biological control A compilation of present knowledge of the ecologi- research,specialists in invertebrate pathology and cal effects of microchemical contaminants in natural other aspects of biological control have shown a waters was prepared in summary form as an aid in marked tendency to extend their interest beyond the clarifying research needs related to health. field of economic entomology. Of those questioned, A report on suitable bio -assay procedures for some 200 inthirty -two Member States expressed measuring the microchemical contamination of natural interest in applications of their subject to public waters was prepared for circulation to interested health entomology. These are among the scientists - research workers in many countries.This report, approximately 600 -who receive a series of mimeo- which follows up recommendations made in 1964 by graphedinformationcircularsonenvironmental biology giving findings in current WHO- supported 1 World Health Organization (1965) Housing programmes: research as well as significant " preprints " of other the role of public health agencies, Geneva (Publ. Hlth Pap. No. 25). relevant work. 38 THE WORK OF WHO, 1965

One thousand new WHO pocket -sized kits for the techniques for detecting and measuring resistance. collection and shipment of pathogens and parasites Test methods have been developed for practically all of vectors have been manufactured and are being major vectors of disease.Global surveys on the distributed to entomologists and others engaged in susceptibility of these vectors have been organized operational programmes. systematically. The outbreaks of haemorrhagic fever Biological control activities supported by WHO in the Western Pacific and South -East Asia Regions during the year included an assessment of the signifi- and the recrudescence of plague in certain parts of cance of predators in the natural limitation of rat India have pointed to the need for up -to -date informa- populations in the Caroline Islands (United Nations tion on susceptibility levels of the vectors concerned. Trust Territory of the Pacific Islands), and further A general survey on thesusceptibility of Aedes advice to the Nicaraguan authorities with regard to aegypti and Xenopsylla cheopis was initiated by WHO the implementation of recommendations for research in 1965; all Member States were requested to designate which had been made by WHO in 1964 in connexion research workers and institutions able to collaborate with the control of pest midges (Chironomidae) in in this survey, and test -kits were widely distributed. lakeshore areas. Arrangements were made for colla- Assistance was given to some countries in organizing borating laboratories in several countries to assess surveys of susceptibility levels of A. aegypti and newly developed preparations of " microbial insecti- arrangements were made for a central laboratory to cides " (based on bacteria and fungi), supplied by a undertake susceptibility tests on A. aegypti eggs from private corporation in the United States of America various parts of the world. The results of a second and individual investigators elsewhere. survey of resistance of body lice to insecticides and Further progress was also made in evaluating the resistance of culicine mosquitos and other vectors usefulness of " annual fish " (cyprinodonts which of disease have been published.These and other have desiccation- resistant eggs, and are particularly surveys have made it possible to form an accurate well adapted tolifein temporary pools) for the appraisal of the resistance problem throughout the control of anophelines and other mosquitos utilizing world and to forecast the development trends in temporary pools as larval habitats. An annotated certain species. Work on three new test procedures bibliography, comprising 671 references, was prepared has been initiated. on the use of fish in mosquito control. Vector Control Nature of Resistance It is now twenty years since resistance to an insecticide was first recorded in an insect of public health The long -term research programme initiated by importance -the housefly.Since then, the number WHO in 1957 into the nature of resistance has begun of insect species of public health importance to become to yield practical results.Investigation of the speed resistant to one or more insecticides has increased at which geneticselection takes place ininsects from year to year, and had reached eighty -three by exposed to new insecticides and their cross -resistance the end of 1965. The dynamic nature of this phenome- pattern made it possible to use insecticides of different non has made it necessary for WHO to institute a chemical grouping in a sequence for the control of systematic programme, world -wide in scope, with a certain species for long periods. For example, enough view to the early detection of new cases of resistance information is now available on the development of and the discovery of effective countermeasures. resistance and cross -resistance patterns in body lice Knowledge of resistance has been growing and to ensure an effective control of this species for the progress has been made in understanding the basic next ten to fifteen years in most circumstances. Similar genetic and biochemical factors involved.However, it studies are in progress on mosquitos and houseflies. is clear that vector control and the resistance problems The programme on genetics of vectors and insecti- associated with it are extremely complex and call for cide resistance developed rapidly in 1965. Resistance efforts by geneticists, chemists, engineers, entomolo- to DDT in A. aegypti (which together with resistance gists and other professional workers in many fields. to other insecticides has been a major factor in bring- Since itis necessary to keep ahead of resistance, ing to a standstill the A. aegypti eradication programme research must be continued and satisfactory chemical in the Caribbean area) is due to a gene known to and non- chemical methods of control developed. be present in A. aegypti populations in the southern United States and the Western Pacific Region. Unless Measuring Resistance a thorough control of this species is achieved, a high For many years past, WHO has encouraged and degree of resistance to DDT will also appear in these supported research on the development of standard areas. ENVIRONMENTAL HEALTH 39

Insect strains of known genetic constitution are on ecology and population dynamics in order to essential for studies on vector genetics. A Scientific discover the manner in which mosquitos should be Group on StandardStrainsof Insects of Public released for genetic control. Health Importance was convenedinJune,and reviewed the availablestrains -among them those developed and distributed by WHO. These include an Information on Resistance insecticide reference strain of Musca domestica for The scope of the mimeographed series of informa- basic studies on the genetics and biochemistry of tioncirculars on insecticideresistancehas been resistance, an inbred strain of Culex pipiens fatigans extended to include reports on research on insect for crossing experiments, and sixteen strains of Culex behaviour and vector genetics. Revised versions were pipiens with markers on all three chromosomes. The issued of supplement A, giving abstracts of current Scientific Group recommended that high priority research on the resistance of insects to insecticides be given to the development of an inbred strain and the names of institutes and workers engaged on in each of the important anopheline vectors capable insecticide resistance, and also of supplements B and of being colonized in the laboratory; also that a C, providing complete listsof the resistant and standardized strain of A. aegypti should be made susceptible strains of insects of medical importance available at an early date, in view of the importance which are being maintained in laboratories in different of A. aegypti in the transmission of arboviruses. parts of the world. Action was taken during the year to implement both these recommendations. In 1965 WHO initiated a global programme on the Studying Insecticides mapping of chromosomes of mosquitos, especially important malariavectors,a preliminarysurvey WHO has extended itsservices tolaboratories having shown that work in this field had been mainly performing research in biochemistry, physiology and confined to North American and European species. toxicology relevant to insecticides. The Organization Priority consideration was given to anopheline species now maintains a stock of carbon -14 labelled insecticide that form a complex and are composed of two or compounds which are supplied to laboratories for more sibling species, for example Anopheles stephensi use in these investigations. At the end of 1965, four and A. fluviatilis in South -East Asia and A. gambiae in insecticides and one substrate were available and Africa. Visits were made to some centres in the South - samples had been supplied to laboratories in the East Asia Region in order to establish a nucleus of Netherlands, the United Kingdom and the United researchthere,and the establishment of similar States of America. WHO also maintains stocks of centres in the Western Pacific Region and in Africa some materials for use as standards for analytical is being planned. determination. Under the WHO collaborative programme for the evaluationof new insecticides,which has now Genetic Control of Resistance completed six years of operation, evaluations are Investigations on the genetic control of insects of carried out in eight collaborating laboratories and medicalimportance,especiallyC.fatigansand two WHO research units. By the end of 1965, 1100 new Aedes aegypti, have progressed to a stage where pilot insecticidesprovidedbythirty -sevencommercial fieldexperiments can be considered. WHO has firms and five university laboratories had been screened initiated studies with a view to the genetic control of in one or more of the six evaluation stages 1 In 1965, C. fatigans and the results so far obtained have been sixty compounds were tested in Stages II and III, very encouraging. A strain of C. pipiens (Fresno eight in Stage IV and three in Stage V. In addition, strain) has been discovered which is incompatible with several compounds evaluated in the programme and the natural Rangoonstrainof C. fatigans.In recommended for wider trials were sent to laboratories Aedes aegypti, a strain with a male -producing factor and test stations in Italy, Nigeria, the United States of giving progeny with only about 10 per cent. females has been developed. 1 Thése are: I - initial laboratory screening; II - preliminary A plan has been prepared for a pilot study, to be laboratory evaluation of cross tolerance, toxicity and residual carried out in a tropical country over a period of five effectiveness; III - advanced laboratory and preliminary field evaluation; IV - advanced field evaluation (including formu- years, with a view to the genetic control of C. fati- lation properties and experimental hut trials); V - small -scale gans.Additional research is needed on the genetics fieldtrials (including protective measures and formulation of behaviour and on sexual behaviour and mating storage stability); and VI - pilot field trials, which are designed to provide a large -scale evaluation of the insecticide so that the competitiveness of these strains of mosquito, and also procedure and protocol for operational use may be obtained. 40 THE WORK OF WHO,1965

America, and Upper Volta for tests on houseflies, provided to the unit in Rangoon for advanced labo- mosquitos, tsetse flies, and Simulium larvae. ratory and preliminary field evaluation as larvicides The WHO insecticidetestingunitinLagos for C. fatigans. Samples of various formulations were expanded its village -scale trials of compounds against tested with a view to choosing the most effective A. gambiae and other Anopheles.Small -scale field and long -lived material for application under the very trials were also carried out with an organophosphorus complex conditions of thisstation.Six materials compound (OMS -658) and a carbamate (OMS -33) have shown larvicidal activity at low concentrations in villages in the secondary rain forest in the Lagos for extended periods, and can be considered for possi- area and in the savannah area in Northern Nigeria, ble use as larvicides in Culex larval habitats. With the with highly promising results. Other tests were carried completion of these, the second main phase of the out with one organophosphorus compound (OM S- filariasis research unit's activities will open with small- 658) and two carbamates (OMS -712 and OMS -33) in scalefieldtrialsof the most promising larvicide the Lagos area, and yielded much entomological and formulations. toxicological data. Work on mosquito -borne haemorrhagic fevers has Extensive toxicological examinations were made on indicated that, for the time being, the only effective both spraymen and village residents in order to assess way of controlling these diseases is by the control of the safety of materials.Four biochemical detection the vector -Aedes aegypti.Preliminary studies have methods for cholinesterase activity in blood were been made on strains of the mosquito in South -East examined to determine their reliability and suitability Asia, but in order to expedite the considerable research for detecting absorption of both organophosphorus required, WHO is establishing an Aedes research unit and carbamate insecticides by man. in Bangkok for work on the biology and ecology of Because the appearance of double resistant Ano- the subgenus Stegomyia. pheles albimanus in El Salvador has severely hampered WHO carried on investigations on A. aegypti in the progress of malaria eradication in that country, Venezuela and Trinidad and made proposals for arrangements have been made for the insecticides procedures that might be adopted to solve the problem testing team inEl Salvador to expedite trials of of resistance to DDT and dieldrin in these countries. residualinsecticidesemanating fromthe WHO A seminar on the ecology, biology, control and collaborative evaluation programme. eradication of Aedes aegypti, convened in Geneva in The planning of an extended field trial (Stage VI) August, reviewed existing knowledge on the subject with a carbamate (OMS -33) was begun in a country and the problems that require elucidation. in the Eastern Mediterranean Region. WHO assisted in the planning stage of a trial with dichlorvos dispensers in the problem area of Kazerun, Rodenticides and Pesticides in Iran, by making a preliminary evaluation of the Because of the growing concern in several European ventilation rates in the houses in the problem area and countries as to the emergence in certain species of giving instruction inthis measurement technique. rats of resistance to anticoagulant rodenticides such An accurate knowledge of the air -exchange rates and as warfarin, the Organization has undertaken a study their variation during the transmission seasonis of the results obtained with these compounds in essential to the proper placement and replacement of different parts of the world, to ascertain whether there dichlorvos dispensers. has been any loss of effectiveness in any particular area The WHO filariasis research unit in Rangoon has and, if so, whether it can be associated with resistance. almost completed the first stage of its studies of the A test procedure for determining resistance in rats is basic ecology of C.fatigans in that city, including being worked out and a programme has been started basic studies of the seasonal variations in larval and for the development and evaluation of alternative adult densities and in the different types of larval compounds. habitats. A study on the flight range of C. fatigans The Expert Committee on Insecticides (Chemistry was completed.In addition, extensive tests have and Specifications) which met in October 1965 re- determined the degree of susceptibility or resistance viewed all aspects of the specifications for pesticides to a large number of chlorinated hydrocarbon and now recommended by WHO. The problems and organophosphorus insecticidesin both larval and difficulties encountered with the specifications that adult mosquitos.Eleven compounds selected after have been in use for the past five years were carefully evaluation in the WHO collaborative programme were considered. The report of the Expert Committee will NEW HEADQUARTERS OF THE REGIONAL OFFICE FOR THE AMERICAS The new headquarters building of the Pan American Sanitary Bureau/ WHO Regional Office for the Americas, in Washington, was officially opened in September 1965. PRESIDENT OF THE WORLD HEALTH ASSEMBLY Dr V. V. Olguín, Chief Delegate of Argen- tina, was elected President of the Eighteenth World Health Assembly, heldin May 1965 in Geneva.

BIOLOGICAL CONTROL OF VECTORS

WHO has developed kits specially designed for the collection and preservationofparasitizedarthropodsof public health importance. The kits are issued, in addressed mailing cartons, to those taking part in the biological control research programme and are used for dispatching the material collected to the WHO International Reference Centre for the Diagnosis of Diseases of Vectors.

The contents of the kit (mostly plastic) are: (I) boxes (shown open inII) for the storage of unfixed material at differing levels of humidity; (Ill) cells for very small unfixed specimens -these cells are packed in one compart- ment of a container (V) which also holds paired cover slips (IV) for haemo- lymph- and organ- smears; collecting tubes (6 and 8) in which are packed blood lancets and a pencil (VI), a pipette and a brush (VII), temperature - sensitive papers (VIII), tape for sealing the kit and individual specimen containers before mailing(IX), forceps, and avialwith enough para- formaldehyde powder to make up a preservative solution when filled with water (X). The pocket -sized kit is accompanied by full instructions in English, French, Russian and Spanish. COMMUNITY WATER SUPPLIES

INDIA The provision of drinking -water for Greater Calcutta, with its population of over 5 million, is an urgent task facing the local ;Al Cr11 1/i Gr1IN1i1;3 xxrr:it+r.Rr10ti. authorities in their endeavours to combat a host of endemic and epidemic diseases spread by the polluted water which is all many of the inhabitants now have to drink.With assistance from the United Nations Special Fund and WHO, the West Bengal Government is accordingly developing a comprehensive scheme to improve the water supply system throughout the metropolitan area of Calcutta.

1. Water carts help to meet pressing needs for filtered water during the hours when the general supply is cut off. COSTA RICA 2. A pipe is laid to carry water over a distance of about 15 miles.

1. The water treatment plant at Tres Ríos, in the Province of Cartago, 3. Cleaning sand filters at a water purification works. is being expanded.

2. A new type of valveless filter is being tried out at the Tres Ríos treatment plant.

LATIN AMERICA A large number of programmes for the improvement of urban and rural water supplies are in operation in Latin America. The photographs on this page show the efforts being made in this field by Costa Rica, El Salvador and Panama. PAHO/WHO is assisting the Governments of these countries to establish national water and sewerage services and

to launch water supply programmes. 2 3

PANAMA Drilling a well near Panama City.

EL SALVADOR Pumps have recently been installed to distribute the water from a well dug to supply a suburb of San Salvador. CHOLERA OUTBREAK IN NEPAL

1 When an epidemic of cholera broke out during the summer of 1965 in the Kathmandu valley and other areas of Nepal, WHO sent specialists to help the Nepalese health authorities survey the situation and plan the necessary controlmeasures. The Organizationalso provided emergency assistance in the form of anticholera vaccines.

1. Specimens of water for bacteriological examination are collected from the main irrigation canal of the Kathmandu area.The examination later showed that the water contained cholera vibrios.

2. The immunization programme is launched.The medical officer in charge tries to convince a hesitant subject.

3. Vaccinators prepare their equipment.

4. Two aspects of the cholera vaccination campaign in a Kathmandu street: while a team of vaccinators is at work, Boy Scouts hand out leaflets on cholera and vaccination.

3 ENVIRONMENTAL HEALTH 41 be the basis for a new edition of the WHO publication new compounds and their routes of absorption, and Specifications for Pesticides.' with procedures for determining cholinesterase depres- The intensive work done during the year on the safe sion and the presence of chlorinated hydrocarbons use of pesticides in public health programmes was in the blood. The possible application of compounds concerned particularly with the mode of action of of very low toxicity to water which might be used for domestic purposes, and the hazards associated with ' World Health Organization (1961) Specifications for pesti- the introduction of chemosterilants into field opera- cides, 2nd ed., Geneva. tions, also received attention. CHAPTER 4

PUBLIC HEALTH SERVICES

Public Health Administration on various aspects of the administration and organiza- The notable progress shown in the development of tion of health care. The first field project -a study basic health services, and their extension to rural on research in public health practice carried out by areas, can be attributed mainly to the increased the Ministry of Health and Local Government of recognition by governments of the urgent need to Northern Ireland -has been completed. The purpose provideessentialcurativeandpreventivehealth of this study was to develop a methodology for assess- facilities to all the population, particularly to inhabi- ing the major factors affecting community health and tants of the remoter districts where health services are the extent to which health services meet the needs of so often rudimentary or non -existent. UNICEF and the community. WHO have continued to collaborate in several multi- A study, prepared during the year, of the technical purpose projects aimed at building up the general and administrative aspects of screening for early health services with special emphasis on maternal and detection of asymptomatic diseases was discussed at child health services, which are particularly in demand. a meeting held in Geneva in December. Examples are the project in India for the strengthening A study was made of the problems associated with of district health administration, and that in Afghanis- urbanization and the rapid growth of cities, with a tan for the development of rural health services. view to establishing guidelines for the development In many countries specialized projects have been of urban health services. reorganized to embrace a wider range of health Material was compiled for inclusion in the Third services.In the development of basic health services Report on the World Health Situation, covering the WHO's assistance has included the training of pro- period 1961 to 1964; this will be submitted to the fessional and auxiliary health personnel, the establish- Nineteenth World Health Assembly. ment of an efficient system of administrative and A background paper prepared for the study group technical supervision, and the development of statistical which met in 1964 to discuss the integration into and health laboratory services.Close co- ordination general health services of mass campaigns against is maintained between the basic health services and specific diseases was published during the year in the other aspects of the community development pro- Public Health Papersseries.'Itemphasizes the grammes.The malaria pre- eradication programme interdependence of mass campaigns and the general in Togo (see page 97) is a good example of a specialized health services, particularly in the final stages of a project in which an important aspect is the develop- mass campaign, where surveillance can be carried out ment of the general health services. more economically by the general health services. Projects that have successfully contributed to the Various aspects of this interrelationship are illustrated balanced development of the basic health services indescriptionsof campaigns against tuberculosis withinoverallsocio- economicdevelopmentpro- (in India), trachoma (in China (Taiwan)), malaria grammes are in operation in Afghanistan, Algeria (see (in Togo), and yaws (in Thailand). page 122), Argentina, Brazil, India, Iraq, Lebanon, Madagascar, Malaysia, Mexico, Nigeria, the Phi- lippines, the Republic of Korea, Sudan and Turkey. National Health Planning The progress of pilot rural development programmes The wide participation in the technical discussions and their role in the extension of basic health services on " Health Planning " held at the Eighteenth World in Afghanistan, Eastern and Western Nigeria and the Health Assembly may be considered a reflection of United Arab Republic were evaluated, and in China the interest that governments are taking in the system- (Taiwan), the Philippines and Turkey an assessment was made of the integration of specialized programmes Gonzalez, C. L. (1965) Mass campaigns and general health into the general health services. services, World Health Organization, Geneva (Publ. Hlth Pap. Further progress has been made in applied research No. 29). - 42 - PUBLIC HEALTH SERVICES 43

atic organization and rational deployment of resour- In the Americas there was again considerable acti- ces in the interest of public health. vity in this field. The situation with regard to national The discussions, in which more than 200 persons healthplanning was reviewedata meetingin took part, evoked many suggestions aimed at facilitat- Venezuela, in February, and a number of national and ing the task of the national organizations concerned international courses were organized.This work with health planning.The ensuing report contained a and the progress being made in individual countries number of recommendations for action by the Orga- in the Americas is mentioned in Chapter 15 (see nization. page 99). One of the main topics discussed was the use of The Organization continued to co- operate with the standards and norms for determining the health African Institute for Economic Development and services and facilities to be provided, and their cost. Planning in Dakar, the Latin American Institute for The discussions and the advance information supplied Economic and Social Planning, Santiago, Chile, and by Member States confirmed that developed and deve- the Asian Institute for Economic Development and loping countries differ greatly as regards the application Planning in Bangkok. of standards and norms in health planning. Some of the more developed countries have been able to deter- Organization of Medical Care mine such norms scientifically through research.It was recommended that the World Health Organization In the organization of medical care WHO's work should institute or support experimental research into has been concerned chiefly with assistance to govern- the establishment of norms of provision for use in the ments in the development of hospital services and planning of health services.It was also recommended with research on different aspects of public health that the Organization should institute or support practice. courses of training in health planning, and provide Thus assistance was given with a survey of the exist- guidelines with a view to facilitating planning opera- ing hospitals in Dahomey and Togo; with the training tions in developing countries. of anaesthetists and dressers in Somalia and of hospital The Organization continued to provide assistance administrators in Malaysia; and with hospital admi- in national health planning to individual countries, nistration in Jordan, Laos, and in the Republic of particularly in the African Region and in the Americas. Viet -Nam, where a study on hospital administration It helped the Governments of Gabon, Liberia, Mali, is far advanced and where help has been given in the Niger, and Sierra Leone, to finalize the plans for the preparation of comprehensive health legislation. development of their health services, those for Gabon, The differenttypes of teaching hospitals were Niger and Sierra Leone being published during the reviewed (see page 61) and requests for advice on the year.In each case a comprehensive programme has organization of teaching hospitals were received from been worked out that could be implemented over a Ethiopia, Nigeria, Syria and Switzerland. period of ten years with the resources available. Hospital services in Latin America and their place Cost estimates are given for each stage of the work. in the national health plan were reviewed by an Preliminary studies were also undertaken with regard advisory committee which met in Washington, D.C. to planning projects in other countries in the African in July (see page 100). Recommendations were made continent and assistance was given with the prepara- on desirable standards for hospitals and on improve- tion of a national health plan in Somalia. ments that might be made in the hospital services Participants in an inter -regional seminar held in in Latin American countries with outside financial Addis Ababa in October 1965 discussed the experience assistance. gained in a number of the integrated health planning A study was carried out in the Region of the projects undertaken during 1964 and 1965 in count- Americasontherelationshipbetweenhealth riesintheAfricanRegion,withaviewto programmes -including sickness insurance schemes - its use in the formulation of a general policy and sponsored by social security institutions and those of methodology for the provision of guidanceand ministries. of health and other official agencies. The assistance to the governments of developing countries findings were discussed at a meeting, held in Washing- interested in the preparation of national health plans. ton, D.C. in July, at which recommendations were The participants came from several countries in the made on ways of improving co- ordination among the African and Eastern Mediterranean Regions, and various national agencies concerned with such pro- UNICEF, the Technical Assistance Board, the Econo- grammes (see page 100). mic Commission for Africa and the United States In the study on hospital utilization, answers from Agency for International Development were repre- thirty countries have been tabulated.This study is sented. being supplemented by one on hospital frequentation 44 THE WORK OF WHO,1965 and the distribution of in- patients in selected hospital accounts.The report was adapted to take account regions in the Federal Republic of Germany, Finland, of the suggestions made by the working party. the United Kingdom and Yugoslavia. The aim is to develop a methodology for planning hospital services. Further progress was made inthe pilot study Health Laboratory Services organized by WHO in order to test methods that would be suitable for use in an extensive study of WHO's assistance to governments with regard to different organizational patterns for the provision of health laboratory services was mainly in connexion personal health care. The WHO pilot study has been with organizational and training problems. Assistance concentrated on Utilization of selected health centres was provided to forty -three countries in the planning, inareas withdifferentsocial and administrative organization and expansion of laboratory services, characteristics:studiesintwo urbancentresin the establishment of blood banks, and the training of Yugoslavia and seven centres in urban and rural laboratory personnel. A survey was made of laboratory communities of Israel were completed during the year. facilities in Algeria and Liberia, and a programme Plans were made to test the same questionnaires in prepared for their development. slightly modified form in further trial studies on the In addition to the second regional training course utilization of health centres in Belgium (to be under- for laboratory technician tutors, which was continued taken with the collaboration of Brussels University) in Beirut, the Organization provided assistance for and in Canada. new training courses for laboratory technicians in A parallelinternationalcollaborative study on Congo (Brazzaville), India, Malaysia, and Morocco. medical care utilization is being undertaken in the It has also collaborated with the Organization for United Kingdom, the United States of America, and Co- ordination and Co- operation in the Control of Yugoslavia by a group of investigators under the Major Endemic Diseases (OCCGE) in planning a school for laboratory technicians in Bobo -Dioulasso, auspices of Johns Hopkins University and with some Upper Volta. Fourteen bacteriologists from the South - support from WHO. The methods used for obtaining EastAsia,EasternMediterraneanand Western and processing information are co- ordinated in a Pacific Regions attended a WHO- sponsored inter- series of meetings of the investigators engaged on the regional training course on the laboratory diagnosis various studies : two such meetings were held during of pathogenic Enterobacteriaceae, organized at the the year. London School of Hygiene and Tropical Medicine. The WHO study on the cost and the sources of A meeting was held in December of an expert finance of health services reached the final phase. committee to review the methodology of the training of Twenty -six health and statistical agencies had com- laboratory technical personnel. Four basic levels of pleted questionnaires giving details on the expenditure personnel have been recognized : graduate technician, on health services in 1961. A preliminary report was non -graduate certified technician,certifiedassistant prepared, with tables, summarizing the information technician and non -certified assistant technician. This provided; it indicates that the share of national income personnel constitutes the backbone of every clinical devoted to the provision of health services is larger and publichealthlaboratoryservice.Particular than was generally thought. The report was reviewed emphasis was put on the establishment of formal and in June by an ad hoc inter -agency working party, at well- structured courses of study to be adapted to which ILO, the International Social Security Associa- the needs and potentialities of countries at various tion, the United Nations Economic Commission for stages of development. Such well- organized training Europe, and the United Nations Research Institute systems with specialization schemes will facilitate the forSocial Development, as well as WHO, were official recognition of the profession, create satisfac- represented. The two basic objectives of this study tory conditions of work and make it possible to obtain are to compile information needed by health adminis- better personnel. trators when appraising the financial aspects of their WHO and the International Committee on Labora- overall health programmes, and to develop a standard- tory Animals co- operated in providing advice on the ized framework for national and international health production of laboratory animals fordiagnostic, accounting, for use in countries at different stages control and research purposesinCeylon, India, of socio- economic growth and for incorporation in Iran and Malaysia. WHO also co- operated with the theirroutine nationalstatistical programmes.In International Committee on Laboratory Animals in this connexion, the working party also discussed the the organization of an international symposium on relationship between the study and the proposed laboratory animal husbandry,heldinIrelandin revision of the United Nations system of national September. PUBLIC HEALTH SERVICES 45

Contact has been maintained with the European carespecialities such as paediatric or psychiatric Society of Haematology's International Committee nursing. for Standardization with regard to methodological The United Arab Republic, which has had long problems. experience in preparing nurses at the University of Reports on the activities of the WHO -supported Alexandria, has started a new Higher Institute of International Centre of Information on Antibiotics, in Nursing at the University of Cairo with the Organi- Liège, and the preliminary results of the WHO - zation's support.Israel, Jamaica, Kenya, Nigeria, sponsored international collaborative study on the and Venezuela are considering introducing university methodology for testing the sensitivity of bacteria to education for nurses, and have requested assistance antibiotics, were presented to the joint Fifth Inter - for that purpose. science Conference on Antimicrobial Agents and The University of Ibadan in Nigeria opened its Chemotherapy and IVth International Congress for post -basic degree programme in 1965 with twenty - Chemotherapy, held in Washington in October. fivestudents -twenty -three from Nigeria and two The network of national blood grouping reference from other African countries (see page 97).The laboratories working in collaboration with the WHO eighty -three applications received for these twenty -five International Blood Group Reference Laboratory in places show the interest of nurses in opportunities for London has continued its expansion and now includes further preparation, especially when available close thirty -one countries. at hand.In Ghana, where twelve students have successfully completed thefirst two -year diploma Nursing course for nurse educators at the university, plans are Despite the advances made in recent years and the already being made to replace the diploma by a number of nurses trained, some countries still lack degree course as soon as possible, and also to introduce nurses abletogive leadershiporthenecessary a course in nursing administration. Meanwhile four quality of nursing care; nearly all countries have too second -year students are completing the requirements few nurses to meet the demands for their services. of the degree programme in nursing at McGill Uni- In 1965, a total of 104 countries received assistance versity in Montreal. The advanced courses in Africa from WHO. Much of this assistance was again given are being used increasingly by post -basic nursing for different levels of nursing education.In Niger, students from countries in the Region which are for example, the existing school of nursing is being not yet ready to develop their own university pro- reorganized and developed, with support from the gramme. United Nations Special Fund expected to start in An international advanced school of nursing edu- 1966, in order to improve the education of nurses and cation, established with help from WHO, was opened increase their numbers. The school's new programme, in October in Lyons, France, to prepare nurses from which forms part of the national health plan, will Europe and elsewhere for senior posts in nursing produce auxiliary nurses, qualified nurses and a third administration and education andinspecialized category to be selected from among the qualified branches of nursing. Courses are given in French. nurses and given further training as nurse teachers and Since schools of nursing cannot supply enough supervisors. nurses for the rapidly expanding healthservices, Some countries which previously received assistance many auxiliaries must be trained for specific functions. in developing basic schools of nursing are now plan- Ghana, Kenya, Morocco, Turkey, and many other ning university level education for nurses -through countries are receiving assistance for such training: basic nursing trainingatuniversities or through in fact, wherever WHO nursing personnel are serving post -basic degree programmes. In Iran, for example, assistance is given, either directly or indirectly, for where the Organization helped for some years with the training of auxiliaries.Experience of teaching a nursing school which provides training for the basic and supervising auxiliary personnel forms a part of nursing diploma, plans have now been made to the preparation of every nurse, since in most countries, establish both a collegiate and a post -basic degree afterqualifying,shewillbe working with such programme. In India a post -basic degree programme auxiliaries. has been established in the new University of Chandi- More effective ways of training auxiliaries are being garh with assistance from WHO, and plans are being sought. In Latin America it has been estimated that made forsimilarfacilitiesintheuniversities of large numbers -perhaps as many as100 000-of Ahmedabad, Bombay and Madras. These programmes untrained personnel give nursing care to patients and will enable experienced nurses, trained at the hospital families, and at least half the institutions in which nursing school, to prepare for the increasing number patients are hospitalized have no qualified nurses. of positions in teaching, administration, and patient- More than half the nurses serving as teachers did not 46 THE WORK OF WHO, 1965

complete high school education and an even larger Because sound general nursing preparation isa number are not prepared for teaching.In order to prerequisite, psychiatric and mental health nursing increase the range of influence of a few trained ins- have developed slowly. Assistance is now being given tructors,it was decided to experiment with " pro- in this speciality to Burma, Ghana, Iran, Nigeria, grammed instruction " in the teaching of auxiliaries. Thailand and Venezuela. In each of the two African At a seminar in July 1965, ten nurses from different countries, the WHO psychiatric nurse educator forms countries and international nurse educators discussed part of the team assisting in the post -basic nursing the techniques of this method. A programme has been programme. planned for training more teaching staff in the method, Paediatric nursing is becoming more important as and for the preparation by expert instructors of the health administrations are able to provide more facilities for the special care of children. In the Caribbean necessary texts, giving the essentials of the various area, Colombia, India, and the Philippines, WHO has aspects of nursing and related subjects selected as helped to improve the nursing services for children by priorities at an earlier seminar. Later, the efficiency giving in- servicebasic and post -basic training in of the method will be evaluated. paediatric nursing. Short courses for matrons and ward sisters and in- Faced with a critical shortage of health personnel, service education for staff nurses still form part of particularlynurses,fortheexisting and rapidly nearly all WHO- assisted nursing projects.In Jordan, expanding health and medical care programmes, a assistance was given with a survey of the nursing number of countries are reviewing their nursing service in a hospital which also provides clinical services to ascertain whether the available personnel experience for student nurses, and with planning, in- is being used most efficiently, and how the functions service education and the improvement of nursing of all categories can be redefined to ensure the maxi- practice.In Jamaica a series of working groups of mum quality and quantity of nursing care.Israel nursing personnel were held to show how improved and Switzerland have received assistance in initiating staff education would lead to better care of patients. studies for this purpose, and three selected centres in Severalprogrammesofassistancehavebeen India have carried out studies to determine the best concerned with the revision of curricula for nurses and utilization of existing staff. midwives. In a three -year project nearing completion The first regional seminar on staffing in the Western in India the WHO senior nurse educator worked with Pacific gave the opportunity to thirteen senior nurse the Indian Nursing Council in studying, with all state participants from seven countriestodiscussthe nursing councils, improvements in the content and methodology for conducting staff utilization studies in methods of teaching (see page 116).In the Carib- the hospitals and health centres of their own countries. bean area, a survey was made of all schools of nursing Nursing practice is evolving as some traditional using English and a seminar was held of directors of functions of the nurse are taken over by other workers the nursing schools and representatives of health, in an effort to meet the increasing demand for nursing education and administrative authorities to draw up service, and as a result of changes in medical practice. plans for nursing education in the area. WHO is This has also created an increased demand for nursing helping in Argentina to introduce short courses in personnel, and to meet this demand a wide variety nursing for midwives and in Paraguay to improve the of educational patterns have developed. Not all have post -basic courses in midwifery for nurses. resulted in improvement in nursing practice: a discre- When countries are drawing up national health pancy often exists between nursing practice and the schemes it is now much more usual for one or more educational preparation of the nurse. WHO is there- nurses at national level to participate in the planning fore attempting to develop a methodology whereby of the more important nursing aspects.This has countries can determine this discrepancy and identify become possible only through the attention given over action required to improve education and practice. the years to the improvement of nursing education. Information on trends, on levels of nursing personnel For instance, a decade ago only seven states in India and on needs in research to improve practice has been had a nurse at state level. Now fourteen of the sixteen supplied in reply to a questionnaire by members of the states have a nurse occupying the positions of assistant Expert Advisory Panel on Nursing, and will be used as director of health services (Nursing) and state nursing part of the preparation for the meeting in 1966 of an superintendent. All are well experienced; some have expert committee on nursing. had advanced preparation abroad on WHO fellow- In many nursing programmes UNICEF and WHO ships. Four WHO nurses are assisting in the planning have collaborated in giving assistance.In some, the of nursing services in India: five states and one union Rockefeller and Kellogg Foundations and nurses of the territory have been given such assistance. United States Peace Corps have also co- operated. PUBLIC HEALTH SERVICES 47

The Fourth Quadrennial Congress of the Inter- in water supply projects in Latin America; training national Council of Nurses, held in Frankfurt, Federal courses in the prevention and control of cholera in Republic of Germany, brought together 5500 nurses Malaysia; surveys in the United Arab Republic of from fifty -eight countries. The contribution made by local beliefs and practices relevant to planning the WHO to countries through its fellowships programme educational aspects of campaigns against bilharziasis, and through direct assistance in nursing was evident and the development in Africa of training courses for in the emergence of leaders in nursing in so many of auxiliary health personnel. the developing countries. In Africa, instruction on the health education aspects of malaria programmes was included in the curricula Health Education of the WHO- assisted international training centres for Most of the assistance provided by WHO in health malaria personnel, in Nigeria and Togo. In countries education has been for the purpose of helping the of Central America and in Surinam advisers on health authorities of the countries concerned to plan and education have been attached to the malaria eradica- develop health educationservicesas an integral tion projects assisted by the. Organization. component of public health programmes at various The evaluation of the health education components administrative levels. of applied nutrition programmes was one of the In requesting such assistance from WHO, govern- subjects discussed at a joint FAO /WHO technical ments have emphasized thatadequate and well meeting held in January to consider methods of plan- organized health education services could play a ning and evaluation of applied nutrition programmes. greater part in the planning and development of the Arrangements were completed for publication of the social and educational aspectsof various health source book on " Planning for Health Education in programmes; in education and training programmes Schools ".It has been compiled jointly by UNESCO for health workers, both professional and auxiliary; and WHO for the use of education and health officials and in developing health education aspects of school and others concerned with the planning of the health programmes and curricula for the training of teachers. education aspects of curricula for schools and for the They could also assess the value and effectiveness of training of teachers. various approaches, methods and media in health Advisory services in school health education were education, and give technical guidance where health provided to Afghanistan, India, the Philippines, and educationisan element of activities undertaken the United Arab Republic.In India, WHO helped co- operatively with other agencies, governmental or to develop the health education aspects of a national voluntary.This type of contribution now expected scheme, assisted by UNESCO and UNICEF, for the from the health education services entails the raising reorganization and expansion of the teaching of of thestandardsofrecruitment,training,and general science to all students throughout the school employment of professional health education workers. stages. Assistance was also given to India in a major The services of full -time advisers on health education review of teacher training courses that led to a revision were provided to national, state or provincial health of their objectives, course content, methodology and ministries in Afghanistan, Algeria, India, Malaysia, materials. Nigeria, Republic of Korea, Singapore and Uganda. WHO gave advice for a scheme in which the Govern- The Organization also gave advice to the health autho- ment of the Philippines, with assistance from UNICEF, rities of Ceylon, Costa Rica, Fiji, Portugal, the United is aiming to improve the training of teachers. The States of America, and the Republic of Viet -Nam. Organization also assisted in a national study in the An important part of WHO's work was associated Philippines of requirements for developing the health with the planning and development of the health education aspects of the curricula of all interested educationaspectsof WHO -assistedprogrammes normal schools, colleges and other institutions of and projects, whether concerned with the development higher learning. The study dealt with needs, course of basic health services or with activities in such content, teaching materials and staff. specific aspects as mental health, maternal and child In collaboration with UNESCO, WHO planned and health,dental health, trachoma, tuberculosis and carried out a review of the status of health services and environmental sanitation. Examples of programmes of the health education aspects of school programmes in which WHO advisers on health education took an of governments in the Eastern Mediterranean Region. active part are training courses in India in applied The information compiled will be used in connexion nutrition for health workers; studies in the Republic with a joint UNESCO /WHO seminar on school health of Korea of popular beliefs and prejudices about education to be held in Kuwait in 1966. The Organiza- leprosy; the promotion of national smallpox campaigns tion also provided advisory services in the formulation in Afghanistan; the organization of local participation of a UNICEF- assisted project in the United Arab 48 THE WORK OF WHO, 1965

Republic designed to help extend in- service prepara- theirfive -yeardevelopment programmeforthe tion in school health and health education. Junior Red Cross, and it was agreed that in the first In 1965 UNICEF assistance was extended to several year, starting in 1965, emphasis be placed on health countries in the establishment and strengthening of education. primary and secondary education and teacher training. In this connexion, the Organization is encouraging Maternal and Child Health the health authorities of the countries concerned to In close collaboration with UNICEF, WHO has examine more specifically the need for technical continued to provide assistance for various types guidance with regard to the health aspects of the of maternal and child health programmes in all the programme, particularly those involving health educa- regions.Emphasis has been placed on training in tion, school sanitation, and health services. paediatrics (see page 61) and on the integration The Organization prepared documentation and of maternal and child health services into general participated in the annual session of the American health services.In the African Region priority has Association of Schools of Public Health, at which again been given to the training of staff, including the post -graduate preparation of public health stu- health educators in the rural areas, and in the Region dents in health education and the relevant social of the Americas there has been special emphasis on sciences was a special topic of discussion.Several nutritional aspects.In the Western Pacific Region, of the proposals advanced for improving the relevant following the recommendations made by an advisory admission requirements, studies and field experiences, team in 1963, a medical officer and a public health corresponded substantially to earlier suggestions made nurse /midwife began a series of visitstoseveral by participants at the PAHO /WHO Inter -regional countries and territories in the South Pacific area in Conference on thePost -graduatePreparationof order to assist governments in improving their maternal Health Workers for Health Education, held in 1962. and child health services. The services of a full -time visiting professor were During the last decade midwifery services have provided to the School of Public Health in Venezuela greatly expanded in many countries and the role of the to help in the planning and development of the health midwife in the general health services has changed education and social science aspects of the post- considerably. An expert committee on the midwife graduate curriculum.In addition, WHO assisted in maternity care therefore met in October 1965 to in the planning and conduct of a considerable number review the present situation in the light of those of education and training activities for professional developments and discuss the contribution that can and auxiliary health workers. For example, assistance be made by the midwife not only to maternity care was given to the training course in health education but also to the health of the child and the family. held in France for French -speaking physicians from It considered the training and functions of the mid- eleven European countries; the East African training wife, the auxiliary midwife and the traditional birth course in health education for tutors of auxiliary attendant, collaboration with other health workers, health workers, held under the auspices of the British and the midwife's role in posts of senior responsibility Society for International Health Education; the plan- (in teaching, administration and supervision of staff). ning of health education curricula at the Institute of The committee welcomed the increasingly important Public Health, University of Teheran; the extension part played by the midwife in research in the field of post -graduate preparation for health education of maternity care;it considered that the midwife specialists at the All -India Institute of Hygiene and could make a valuable contribution to studies on the Public Health; the planning and conduct of special effects of local beliefs on the behaviour of the mother training courses for district health education personnel and family, the identification of high risk groups during sponsored by the Central Health Education Bureau pregnancy and lactation, and the action of drugs, of India; and the planning and conduct of in- service particularly analgesics.It emphasized the need for preparationforhealthworkersinAfghanistan, training all categories of midwives, and the importance Malaysia, the Philippines, and in Central America. of support from health authorities. The Organization collaborated with the Interna- More attention is being given to health services for tional Union for Health Education in preparing for schoolchildren, and school health was the topic of the Sixth International Conference on Health and the technical discussions held during the fifteenth Health Education, held in Madrid in July 1965. The session of the Regional Committee for the Eastern main theme of the conference was " The Health of Mediterranean, in September 1965 (see page 129). the Community and the Dynamics of Development ". In collaboration with the International Paediatric The Organization took part in several exploratory Association, WHO sponsored a group panel discussion meetings with the League of Red Cross Societies on on the teaching of nutrition in paediatrics in developing PUBLIC HEALTH SERVICES 49 countries during the XI International Congress of tion WHA18.49. It requested the Director -General Paediatrics, held in Tokyo in November. to develop further the programme proposed in the At its seventh session, in June, the Advisory Com- fields of reference services and studies on the medical mittee on Medical Research discussed the health aspects of sterility and fertility control methods and aspects of population dynamics.It also considered health aspects of population dynamics. the reports of two scientific groups that met during In this connexion, a group of advisers met in Geneva 1964 -on neuroendocrinology and reproduction in in August to discuss the WHO programme in human the human,1 and on the mechanism of action of sex reproduction.Also, following the recommendations hormones and analogous substances 2 -and that of of various meetings of scientific groups and advisers, the Scientific Group on the Biochemistry and Micro- arrangements were made for the collection of human biology of the Female and Male Genital Tracts,3 pituitaries and the preparation of hormones for free which met in April 1965. The discussions of the latter distribution to research workers. The procedure for group indicated the need for more broadly based processing human pituitary glands was discussed by comparative studies on the physiology of reproduction, a group of advisers at a meeting in Geneva in May. and more extensive studies in primates. The Group Arrangements were made for initiating the use of emphasizedthatresearchinreproduction could different species of laboratory animals in research on greatly benefit from the increased use of interdiscipli- reproduction, particularly those animals from which naryandmultidisciplinaryapproaches.Further valuable information might be obtained on certain scientific groups met later in 1965 to consider the peculiarities such as delayed implantation and delayed immunological aspects of human reproduction, the fertilization. The Organization has supported research chemistry and physiology of the gametes, and the on the immunological aspects of spermatozoa in clinical aspects of oral gestogens. relation to reproduction.In addition, preliminary The Eighteenth World Health Assembly,after work was done with regard to initiating studies on detailed discussion of a report describing the Organi- the anticipation and detection of ovulation and on the zation's work on human reproduction since 1963 and effects of certain plants thought to be detrimental to activities in the health aspects of world population the formation of sperm in the male mammal. which might be developed by WHO, adopted resolu- Arrangements were made for WHO to serve as a documentation centre with regard to human repro- 1 Wld Hlth Org. techn. Rep. Ser., 1965, 304 duction, distributing photocopies and other material 2 Wld Hlth Org. techn. Rep. Ser., 1965, 303. requested by scientists.Work progressed on the 2 Wld Huth Org. techn. Rep. Ser., 1965, 313. preparation of a bibliography. CHAPTER 5

HEALTH PROTECTION AND PROMOTION

Under the general heading of health protection and tongue and of the oropharynx are more frequent in promotion is reported the work done in cancer, cardio- smokers. With regard to chewing, the risk of develop- vasculardiseases,dentalhealth, human genetics, ing cancer of the mouth increases in proportion to mental health, nutrition, radiation and isotopes, and the amount chewed. social and occupational health. In preparation for epidemiological investigations on lymphomas in Africa, clinical and epidemiological information and pathological material have been Cancer collected in various parts of Africa and are being The main areas of WHO's work in cancer have been studied at a central processing centre with a view to in epidemiology, pathology and control, as well as obtaining a standardizedclinical and histological research and training. definition. The results of the WHO -assisted study in Norway In the study of the association between breast - and Finland of the higher incidence of lung cancer in feeding habits and cancer of the breast, data have been the latter country were analysed at a meeting of the collected in various parts of the world in areas known workers concerned in February.Various possible to have very high, medium or very low incidence of factors, such as air pollution, heating systems, sauna breast cancer. The data for patients are being com- baths and occupations, had been taken into consi- pared with those for the control groups. deration during this study.It was possible to explain In view of the fact that the epidemiological approach most of the local variations within both countries. is being increasingly used in the study of cancer, a However, although the smoking hypothesis could meeting of investigators was convened in February largely explain the difference between the two coun- in connexion with the preparation of a monograph tries, other factors must also be involved to account on the methodology of cancer epidemiology.It is for the much higher incidence in Finland. intended to serve as a guide for clinicians and patho- The first report on the comparative study on the logists who have had no epidemiological training, and incidence of cancer in various ethnic groups in Israel for social workers and other paramedical personnel had indicated that cancer of most sites was more who might serveas members of epidemiological frequent among immigrants from western countries, research teams. but cancer of the larynx was more common among The material on lung cancer, representing the first immigrants from the east. A further analysis according of theclassifications by the WHO International to country of origin has now been prepared. Cancer Reference Centre for the Histopathology of Lung of the oesophagus is particularly frequent in immi- Tumours, in Oslo, has been prepared for publication grants from Yemen, stomach cancer in those from in the form of a monograph. It is to be fully illustrated Bulgaria, and cancer of the larynx in those from with colour plates and supplemented by a collection Turkey.There were considerable variations in the of 35 mm. diapositives to facilitate use.It will be the incidence of lung cancer; in immigrants from Bulgaria first of a series of such monographs published by it was much higher than the average, while in those WHO for distribution to pathological departments from Iraq and Yemen it was much lower than the of medical schools and, through the International average. Council of Societies of Pathology, to national patho- The epidemiological studies on the relationship logical societies. between cancer of the oropharyngeal cavity and Similar work on histopathological classification is chewing and smoking habits in India and the Central being doneattenotherinternationalreference Asian Republics of the USSR have been continued. centres - namely, those for mammary tumours, in The material available indicates that cancer of the London; soft tissue tumours, in Washington; oro- anterior parts of the mouth is related to chewing, pharyngeal tumours, in Agra, India; ovarian tumours, while tumours of the posterior parts both of the inLeningrad; bone tumours,in Buenos Aires; - 50 - HEALTH PROTECTION AND PROMOTION 51 leukaemias and other neoplastic disorders of the Pathology (as mentioned above).It has also colla- haematopoietic cells, in Paris; thyroid gland tumours, borated with the International Federation of Gyneco- in Zurich; salivary gland tumours, in London; skin logy and Obstetrics in work on ovarian tumours, with tumours, in Perth, Australia; and urinary bladder the International Federation of Surgical Colleges, tumours, in Washington. which was represented at the Expert Committee on A scientific group on histopathological nomenclature Cancer Treatment, and with the International League and classification of skin tumours was held in October, of Dermatological Societies, which participated in withtheparticipationof dermatopathologists,a the work of the Scientific Group on Histopathological dermatologist, general pathologists and a veterinary Nomenclature and Classification of Skin Tumours. pathologist. They proposed a tentative classification For work on comparative oncology and on viruses embracing not only pure morphological types but also and cancer see pages 15 and 19, and for work on certain dermatological entities which should be given cancer immunology see page 72. A brief account of more study by pathologists.They also prepared a the establishment of the International Agency for tentative histopathological classification to be tested Research on Cancer is given on page 79. by the International Reference Centre at the Univer- sity of Western Australia, Perth, and the co- operating Cardiovascular Diseases centres. In 1965 WHO expanded its activities in the field of A second scientific group met in December to cardiovascular diseases by assisting epidemiological consider the problem of classification of urinary studies, the application of preventive and control bladder tumours.It proposed the histopathological measures, and the expansion of training facilities. criteria for diagnosis, grading and staging, including Increased attention was paid to rheumatic fever the correlation with the clinical staging. and rheumatic heart disease. A preliminary analysis The International Reference Centre for the Pro- of the data on the global prevalence of these diseases vision of Tumour -bearing Animals, in Amsterdam, appeared to confirm that they constitute a major and the International Reference Centre for the Pro- health hazard in many areas, and that their patterns vision of Frozen Transplantable Tumour Strains, are changing. Enquiries were made into the immuno- in Stockholm, have continued their activities with the aspects of rheumatic fever Africa.In Iran collaboration of co- operating centres in Santiago de a centre was established for studies of streptococcal Chile, Tokyo and Bombay. infections and their relationship to rheumatic fever An expert committee on cancer treatment was and rheumatic heart disease. The classical diagnostic It reviewed recent convened in Geneva in March.' criteria for rheumatic fever were reviewed in terms of advances and trends in radiotherapy, surgery, chemo- differentregionalpatternstodetermine whether therapy, and treatment with sex hormones, and dis- revision of the criteria was required. cussed the use of combined therapy. Particular In the WHO co- ordinated demographic studies of attention was given to the evaluation of cancer atherosclerosis in coronary arteries and aortae, the treatment. In this connexion, the Committee stressed examination of autopsy material continued in 1965 the importance of cancer registries (with information and by the end of the year material from 13 500 sub- on all diagnosed cases, both treated and untreated, jects had been collected, prepared and graded. Dáta and with provision for long -term follow -up of pa- were checked for repeatability and validity whenever tients),controlledclinicaltrials,and agreement possible, and the data for atherosclerosis, including on uniform classification of the anatomical site of information on age, sex and occupation, were checked tumour origin, the extent of disease, and the histo- continuously during grading sessions.Information logical type of the tumour. The Committee emphasized on myocardialinfarction,degreeof ventricular the need for the careful planning and organization of hypertrophy, degree of stenosis in the coronary vessels, cancer treatment services, with co- ordinated work and extent of cerebral infarct and cerebral haemor- between the surgeon, radiotherapist, physician and rhage was obtained from autopsy material and from other specialists concerned.It also considered what clinical findings prior to death.The results of these recent developments in cancer immunology might and earlier similar studies were published in the contribute towards treatment of cancer. Bulletins, WHO has continued to co- operate with the Inter- Data were also published in the Bulletin 3 showing national Union against Cancer, which participated the correlation of amount and degree of atherosclerosis in the work of expert committees and scientific groups, in the corresponding arteries of different subjects or and with the International Council of Societies of 2 Bull. Wld Hlth Org., 1964, 31, 297 -320. 1 Wld Hlth Org. techn. Rep. Ser., 1966, 322. 3 Bull. Wld Hlth Org., 1965, 33, 741 -760. 52 THE WORK of WHO,1965 different arteries of the same subject.Information cardiographic discriminators of ventricular hyper- obtained in this way has indicated factors to he studied trophy and myocardial damage. A computer pro- in order to identify subjects with ischaemic heart gramme has been developed todefineprecisely disease prior to its marked clinical manifestations. amplitudes and durationsof electrocardiographic In addition, studies have been started on the relation- complexes and to recognize categories within Min- ship between luminal thrombi in coronary arteries nesota coding procedures." These studies will later be and myocardial infarction, between cerebral infarction combined with those on improved diagnosisof and cerebral haemorrhage, according to sex and age, cardiovascular disease in cardiophysiological labo- and between these conditions and myocardial infarc- ratories and with the combined clinical and autopsy tion and atherosclerosisinaortae and coronary investigations referred to above. The studies on signs arteries. in the fundus oculi relating to arterial hypertension Plans have been prepared for studies of the living were continued. Definitions of hypertensive signs have in areas where autopsy studies are taking place. The been developed and tested to determine their diagnostic primaryobjectivesaretoimprove diagnosisof and prognostic significance. atherosclerosis -related disease in the living by relating In addition, WHO supported the following research autopsy findings to clinical findings in living popu- programmes:epidemiologicalstudiesoncardio- lations, regardless of presence or absence of ischaemic vascular diseases in populations in Jamaica,2 Norway, heart disease, and to identify etiological factors in the Uganda, the Polynesian islands, and in populations development of atherosclerosis, coronary heart disease, residing at high altitudes in Peru; studies on improved myocardial infarction and, possibly, cerebrovascular diagnosticcriteriaforprimary venousdiseases; disease. assessment of physical activity in conjunction with A paper was prepared describing a standard pro- rehabilitation; epidemiological studies on chronic cor cedure for international study of cerebrovascular pulmonale and its antecedent conditions; experimental diseases; it includes classifications, definitions, recom- dietary studies of atherosclerosis; and evaluation of mendations for recording personal data after death, results of cardiovascular surgery. and also a model protocol for recording pathological In November a scientific group reviewed the research and clinical data.Studies have been started with a programme in cardiovascular diseases in order to view to finding solutionstocertainparticularly plan future activities and define further studies for important clinical problems, such asthe natural WHO. history of transient ischaemic attacks in various areas A manual on epidemiologyincardiovascular of the world, the relationship of arterial hypertension diseaseshasbeencompiled,specifyingstandard and cerebral haemorrhage and infarction, and the procedures for use in epidemiological investigations. validation in various population groups of " stroke - It will serve as a guide in obtaining and analysing prone profiles " (sets of signs accepted as indicating a comparable data. tendency to strokes). WHO continued to work closely with the Inter- The WHO- supported combined clinical, patholo- national Society of Cardiology in several aspects of gical and epidemiological studies of cardiomyopathies the programme. were expanded. A uniform technique was developed for examination of the heart at autopsy, and pilot Dental Health studies were started in Brazil, Nigeria and Uganda, The present status of research in dental health was at the departments of pathology in RibeirAo Preto, reviewed by a scientific group that met in March. Ibadan and Kampala.Diagnostic criteria for endo- Despite the wide prevalence of dental disease there is myocardial fibrosis, cardiomegaly of unknown origin little internationally co- ordinated research, and the and cardiac manifestations of Chagas' disease were group listed areas in which such research was required. prepared and distributed withinthe countries of These include epidemiology, dental education and co- operating centres, and in other areas where these public health practice.It also pointed to a number diseases might be expected to occur or where further of factors hampering dental health research: the lack studies might be developed on the etiology of these of communication among theresearch workers, diseases.' shortage of trained personnel, and the need for more With a view to achieving an acceptable, standardized knowledge on suitable experimental animals. The methodology forepidemiologicalinvestigationof group recommended that initially the WHO dental cardiovascular diseases, WHO continued to support healthresearch programme should concentrate on studies for the development of improved electro- epidemiological studies, including the classification

1 Bull. Wld Hlth Org.,1965, 33, 257 -265. 2 Bull. Wld Hlth Org., 1964,31, 321 -335. HEALTH PROTECTION AND PROMOTION 53 of dental and oral diseases and the standardization dental health or responsible for children's dental of methods and techniques, and on improving com- services. munications among dentalresearchworkersin The general dental health programme over the last different parts of the world. The group's report was six years was re- examined in detail and plans were presented in June to the Advisory Committee on made for future activities which will deal mainly with Medical Research which endorsed the recommenda- epidemiology, the training of personnel, and the tions, and a start has been made to put them into exchange of information among workers in this field. effect. The WHO Biomedical Research Information Ser- vice will undertake work on communications and Human Genetics exchange of information in dental research as one of The Organization's work with regard to human its routine activities.Questionnaires are being dis- genetics has continued to expand, in line with the tributed in connexion with a survey of dental research rapid developments in this field. personnel and of current dental research projects. A network of WHO international reference centres This survey is being undertaken in collaboration with for the identification of inherited biochemical poly - the International Dental Federation which will be morphisms in human tissues and fluidsisbeing responsible for publishing periodically research direc- established. Thesecentreswillreceivesamples tories. obtained in population genetic studies all over the Since 1957 WHO has been conducting a series of world and provide the technical competence required country studies on the epidemiology of periodontal for the investigation of genetic variants.As a first diseases in Ceylon, India, Iran, Nigeria and Sudan. stage in developing this network, an agreement has At a meeting in August, the experts who carried out been concluded with the British Medical Research these studies discussed their findings which, despite Council's Abnormal Haemoglobin Research Unit, in variations in the methods and criteria used, are strik- Cambridge, which is to act as an International Refer- ingly similar; they all point to the close association ence Centre for Abnormal Haemoglobins. Blood of periodontal disease and presence of tartar with cells and serum collected by various WHO teams -such poor oral hygiene.The experts recommended that as the samples obtained in Northern Nigeria by the community studies should be organized to ascertain the treponematoses epidemiological team (see also page relative value of periodical dental prophylaxis and of 10) -will be tested at the centre for the presence of health education in the prevention of periodontal abnormal haemoglobins and certain enzyme variants. disease. The centre will also develop and test methods for the In the Western Pacific Region an inter -country preservation of human red cellsstored inliquid programmeindentalepidemiologyisproviding nitrogen for future blood grouping. training in epidemiological methods to enable the The International Blood Group Reference Labo- developing countries in the Region to undertake ratory in London continued to receive WHO support. reliable surveys of the extent of dental diseases, as a WHO is participating in the International Biological basis for the planning of dental health services. During Programme -a programme of co- operative research the year a three -month course was held in Suva, Fiji, in basic biology initiated by the International Council for participants from countries and territories in the of Scientific Unions. The theme is " The biological South Pacific (see also page 138). basis of productivity and human welfare ", and one The Organization has continued to assist individual of the objectives is to stimulate studies on the biological basis of human adaptability, both physiological countries in improving dental education. For example, at the University of Antioquia, in Colombia, where and genetic, to changing conditions : there is an urgent need for such studies, owing to the rapid changes in a pilot department of preventive and social dentistry many environments.As part of its contribution to was started four years ago, assistance is being given the Programme, the Organization provided financial to revise the dental curriculum, and in India a long- and technical support for a meeting -held in Warsaw, term project is being started to strengthen the teaching during April -on current progress in human popu- of preventive and public health dentistry at the dental lation biology.The meeting discussed plans from school in Bangalore. Eastern European countries for their participation An international course in child dental health was in the human adaptability project. organized in co- operation with the Government of Genetics were studied in relation to other areas of Denmark.It lasted three months and was attended the Organization's work.Thus, during 1965, WHO by twelve dentists who were either teachers of child convened the Scientific Group on Research on Genetics 54 THE WORK OF WHO,1965 in Psychiatry (see also page55)and the Scientific with inbreeding and theselectivesignificanceof Group on Genes,Genotypes and Allotypesof polymorphic systems in human populations.Special Immunoglobulins (see also page72). attention was given to the procedures for obtaining The Organization has also given attention to the genetic information in epidemiological surveys and use of twins in epidemiological research. WHO, by for linking vital statistics records into family units to co- ordinatingstudies on twins, can make larger facilitate genetic analysis. samples available than hitherto, and facilitate stan- Analysis was completed of the returns from the dardizationof methodology and comparisonof forty hospitals in five continents participating in the results.A survey was therefore made to ascertain WHO- sponsored study of the frequency of congenital where there were large series of twins in different malformations in different parts of the world, and the parts of the world and what data had been collected. report has been prepared for publication as a supple- It was followed by a meeting of geneticists and epi- ment to theBulletin. demiologists who discussed twin study methodology, The Organization alsoprovidedassistancefor including the interpretation of data derived from twin studies on the genetic consequences of consanguineous studies, difficulties in diagnosing zygosity, and plans marriages. for international co- ordination of studies. The haemoglobinopathies and thalassaemia cons- Mental Health titute a major public health problem in some parts of the world where malaria is or has been hyper - A ten -year programme of research in social psy- endemic.It is estimated that in tropical Africa in chiatry and the epidemiology of mental disorders has every generation about one million children will be been drafted on the basis of the recommendations of born affected by sickle -cell anaemia, few surviving to the scientific group on mental health research which adulthood. met in 1964.2 The objective is to obtain comparable Deficiencyoftheenzymeglucose -6- phosphate information on the prevalence and distribution of dehydrogenase (G- 6 -PD), which is associated with mental disorders, the factors affecting their onset and favism and primaquine sensitivity, is also very frequent evolution in different social and cultural settings, and in many parts of tropical Africa. The exact selective the effects of therapeutic intervention. significance of some of the mutant genes involved is Under the first part of the programme, which is not yet clear and so far treatment possibilities are concerned, with the standardization of psychiatric limited. Moreover, the exact extent of the paediatric diagnosis,classification and statistics,aseriesof problems resulting from these hereditary conditions seminars to examine these topics in relation to dif- will be more evident when the malaria mortality rate ferent categories of mental disorders has been planned. is reduced. The Scientific Group on Haemoglobino- The functional psychoses, particularly schizophrenia, pathies and Allied Disorders was convened in Geneva were the subject of the first seminar, which was in December to discuss these questions, and to consider organized in London in October in co- operation with diagnostic methods and the need for and design of the Ministry of Health of England and Wales. Video- surveys in regions where little is known of the incidence tape recordings of interviews with patients were among of these conditions. the tests used to bring out variations in diagnoses The Organization provided assistance in an investi- made by differentpsychiatrists,with a view to gation of the distribution of G-6-PD deficiency and approaching greaterstandardization of diagnosis. thalassaemia in a previously malarious area of Chile, Twelve experts from different countries are to col- and supported research in Nigeria on the molecular laborate together and with observers from the host structure of the G-6-PD enzyme. The report on an country of each seminar, to examine the problems earlier WHO -supported study on G-6-PD deficiency arising and report to subsequent meetings.By the in Nigeria was published in theBulletin.' time the1975Revision of the International Classifi- WHO assisted in organizing a meeting on population cation of Diseases is due, much valuable material genetics at the Second World Population Conference, should be available on which to base a widely accepted convened in Belgrade by the United Nations in co- nomenclature and classification. operation with interested related agencies and the A related project -for comparative research on International Union fortheScientificStudy of specific mental disorders -to be carried out in co- Population. The discussions centred on the genetic operating centres in several regions has also been components in demographic variables, particularly initiated. The long -term planning and specific metho- the increased mortality and morbidity associated dology to be used in a study of young schizophrenics

1 Bull. Wld Hlth Org., 1964, 31, 417 -421. Off. Rec. Wld Hlth Org. 139, 45. HEALTH PROTECTION AND PROMOTION 55

were discussed at a meeting of investigators held in number of meetings. They included a conference on Geneva in September.An advisory team on psy- delinquent and socially maladjusted children and chiatric epidemiology is to assist the co- operating young people, organized by the International Union centres with the research and will also co- ordinate for Child Welfare, a meeting on research in crimino- the work. logy organized by the United Nations, and the Third The experience and results achieved through these United Nations Congress on the Prevention of Crime two projects will be used as a basis for designing and Treatment of Offenders. comparativeepidemiologicalresearchonmental WHO published, under the title of Aspects of Family disorders in geographically defined populations and Mental Health in Europe,' a series of studies on the for an international training programme in psychiatric shift of emphasis in the modern psychiatric approach epidemiology and social psychiatry. towards the individual as a member of the family While epidemiology and social psychiatry have group. Some of the studies had been presented at a had an important place in the mental health pro- seminar on mental health and the family held by the gramme for many. years, attention to biological and Regional Office for Europe in Athens in 1962. They neurological aspects of research is a relatively new deal with the subject in a number of aspects, including development. Preparatory work has started on a the mother and the child within the context of the long -term programme of research to include genetic, family; working women, marriage problems and psychopharmacological, neurophysiological and bio- family psychotherapy; family mental health and the chemical aspects of psychiatric and neuropsychiatric older generation; parent education and child therapy. disturbances. Each of these subjects is to be discussed by a scientific group with a view to planning co- ordinated research and improving arrangements for the exchange Nutrition of information and research workers.A scientific group on research on genetics in psychiatry met in A comprehensive reporton WHO's programme in November and concentrated on clinical and epide- nutrition since 1948 was reviewed by the Executive miological genetic investigations, research on chro- Board at its thirty -fifth session, in January 1965. For mosomal abnormalities and biochemical techniques the future work of the Organization, special attention in genetic investigations. WHO also co- operated in was drawn to problems of nutrition of adolescents, an international interdisciplinary meeting on neuro- industrial workers and the aged, and to the role of physiological mechanisms underlying dreaming and nutrition in chronic non -infectious diseases. states of consciousness, held at the University of The Expert Committee on Nutrition and Infection, Lyons in December. which met in Geneva in March, examined malnutrition in relation to diseases caused by a variety of infectious Assistance to governments in improving the organiz- agents, including viruses, rickettsiae, bacteria, protozoa ation of mental health programmes in relation to and helminths, and the effect of such diseases on the public health services has again formed an important nutritional status of the individual and the compart of WHO's work.A travelling seminar was munity. The Committee recommended 8 that WHO, organized in the USSR to enable psychiatrists and drawing the attention of Member governments to the public health officers concerned with planning mental interaction between malnutrition and infection, should health services in developing countries to observe encourage joint consultation and programme planning the system of psychiatric care and its link with general by technical personnel concerned with nutrition and health services. with communicable diseases; that the training of A survey was carried out in seven African countries professional and auxiliary personnel should include and advice given on the inclusion of mental health teaching on the interaction between malnutrition and activities in their public health programmes. infection; and that WHO should encourage countries Advice has been given to several governments on to provide data on mortality rates by cause in the the organization of services for the care and treatment second year of life, as in many countries this is the of persons affected by mental deficiency, alcoholism age most affected by the interaction between mal- and drug addiction.Representatives of national and nutrition and infection.The Committee particularly international bodies concerned with these problems stressed the need for controlled field studies on the have been brought together in informal meetings to consider future policy and programmes. ' World Health Organization (1965) Aspects of family mental With regard to the mental health aspects of crime health in Europe, Geneva (Publ. Hlth Pap. No. 28). and juvenile delinquency, WHO continued to col- 2 See WHO Chronicle, 1965, 19, 387 -396, 429 -443, 467 -476. laborate with other organizations and took part in a 3 Wld Hlth Org. techn. Rep. Ser., 1965, 314. 56 THE WORK OF WHO, 1965 interrelationbetweenmalnutritionandinfection Food Additives among young children in developing countries, with A number of antimicrobials, antioxidants, emulsi- equal attention being given to the nutritional and the fiers and related substances have been considered by infectious disease components of the studies. One meetings in previous years of the Joint FAO /WHO such research project has already been started. Expert Committee on Food Additives. In December In January, a FAO /WHO expert group discussed the Committee drew up specifications for identity in Rome the evaluation of applied nutrition pro- and purity and made a critical evaluation of the grammes being carried out with joint assistance from toxicological data on some further additives.Acids FAO, UNICEF and WHO. The meeting, in which and bases used as food additives were also considered. UNICEF, the United Nations Bureau of Social The FAO Committee on Pesticides in Agriculture Affairs and UNESCO also participated, recommended and the WHO Expert Committee on Pesticide Resi- practical procedures for the inclusion of evaluation dues, at a joint meeting in March, re- evaluated, in in the plans of operation of applied nutrition pro- the light of new toxicological data, the thirty -seven grammes. pesticides evaluated in1963, and considered five additional pesticides.They also evaluated possible At the fourteenth session of the UNICEF /WHO dangers arising from the use of fumigants on food. Joint Committee on Health Policy, held in Geneva The joint FAO /WHO Codex Alimentarius Com- in February, WHO stressed the need to strengthen mission held its third session in Rome in October, the health components inapplied nutritionpro- thirty -seven countries being represented.The Com- grammes;it recommended that, in the control of mission reviewed the progress made by the various malnutrition, highest priority should be given to the Codex Committees engaged in the elaboration of pre -school child, and that training in nutrition should standards, and made recommendations on the work be given to all health workers. to be undertaken in 1966. Subjects being covered are With a view toattaining further international food additives, pesticide residues, labelling, methods agreementon humanrequirementsforvarious of analysis and sampling, food hygiene and general essential nutrients, a joint FAO /WHO expert group principles to be followed in drafting standards. World- met in September to discuss requirements of vitamin A, wide standards are being prepared on cocoa products thiamine, riboflavin and niacin. and chocolate; fats and oils; fish and fishery products; There is a particular need for training in nutrition, fruit juices; fresh fruit and vegetables; processed fruit and vegetables; meat and meat products; milk based on local conditions, to prepare physicians and and milk products; poultry and poultry meat; quick public health workers for their work in the developing frozen foods; and sugars.At the third session two countries. WHO is increasing assistance in this field, further European Codex Committees were established especially in Africa and South -East Asia. A project -one on dietetic foods, the other on mineral waters. has been initiated in Senegal, where a nutritionist will help to co- ordinate the teaching of nutrition in the medical faculty of the University of Dakar and Radiation and Isotopes assist in post -graduate courses for doctors, nurses and For the safe enjoyment of the benefits that isotopes, other health workers. radiation and nuclear power offerfor economic Continued assistance, in the form of fellowships, development and human welfarenationalhealth was given to the training courses in nutrition in London authorities must take all necessary steps to safeguard public health from radiation hazards.WHO has and Ibadan (English -language courses), and Paris continued to concentrate on the development and and Dakar (in French). strengthening of national radiation protection programmes within the framework of public health services. World Food Programme An inter- regional seminar on public health programmes in radiation protection was organized in The development of the United Nations /FAO Singapore in December for participants from the World Food Programme has been accompanied by Eastern Mediterranean and Western Pacific Regions. closer co- operation on the part of WHO. The Organiz- They discussed the need for radiation protection ation advised on the health aspects of many of the programmes within the framework of public health projects considered for aid under the Programme, services and how such programmes could be organized. experience having shown the need for careful assess- The present status and trends in radiation protection ment of the health implications of such projects. services in different countries, the methods of dealing HEALTH PROTECTION AND PROMOTION 57 withspecificradiation health problems, and the The importance of adequate medical supervision qualifications and training of public health personnel in radiation work is increasing with the growth in for responsibilities in radiation work were among the laboratory and industrial uses of radiation.IAEA, subjects discussed. ILO and WHO therefore jointly prepared a revision With the increasing number of fixed and mobile of the medical addendum to the IAEA manual Safe atomic reactors, processing plants for nuclear fuels, Handling of Radioisotopes. It is broader in scope than and laboratory and industrialactivitiesinvolving the medical addendum published in 1960, and is a radioactive isotopes, advance planning is necessary guide to medical supervision in radiation work in for measures to deal with emergencies that may result general.It deals with the radiobiology, radiopatho- from contamination of the environment by the acci- logy and metabolism of radionuclides, the treatment dental release of radioactive material. of radiation injury and internal radioactive contami- In March the International Atomic Energy Agency nation, and the overall planning of medical facilities and WHO jointly sponsored a symposium on personnel for radiation work within the framework of occupa- dosimetry for accidental high -level exposure to ex- tional health practice. ternal and internal radiation. Its object was to consider Also in co- operation with IAEA, the Organization instruments and methods for determining as rapidly initiatedstudiesof thefeasibilityof establishing as possible after accidental exposure the kind and standards relating to radioactive surface contamination extent of the radiation dose received, whether from in working areas, and began an international survey external radiation, the intake of radioactive materials, of hazardous radioactive goods available to the public. or the deposition of radioactive contamination on the Sound public health radiation programmes must body surface.Knowledge of the radiation dose is of necessity be based on a satisfactory understanding important not only in providing a guide for medical of the somatic and genetic effects of radiation on treatment, if required, but also in determining prio- human beings. Research in this field is thus extremely rities for remedial measures such as decontamination important from the practical point of view. WHO of personnel, and in reducing to a minimum the risks has continued to support the International Commis- run by rescue workers. The symposium stressed the sion on Radiological Protection in the collection of need for immediate systems for use if radia- data on radiation exposure as a basis for recommen- tion levels should become unduly high in a particular dations on maximum permissible exposure levels, and area, and for speed in preliminary dose assessment. the International Commission on Radiological Units WHO co- operated with IAEA in the third meeting and Measurements, in the development of standards of an IAEA panel on permissible emergency doses and units in medical radiology.The Organization to the public, held in Vienna in May.The panel has continued to support the international collabo- considered the safety evaluation of nuclear installations rative investigation on the incidence of leukaemia in in planned activities and emergency situations, and patients treated with radiation for cancer of the cervix the risk estimates associated with different types of uteri, and has supported a pilot study of the incidence exposure to radiation. of leukaemia in patients irradiated for fungus infection The preliminary outline of a manual was prepared, of the scalp.Assistance has also been continued for to provide guidelines and information on public studies in fundamental radiobiology and investigations health measures to avoid or reduce exposure resulting on the action of radiation on genetic material and from radiation accidents under various conditions. cellular mechanisms. An international training course on surveys for In December a meeting on epidemiological studies radionuclides in foods was sponsored jointly by FAO, in human radiobiology was convened by WHO in IAEA and WHO in Seibersdorf, Austria. The course Washington D.C.It reviewed the numerous radio - was designed for technical and advisory officers in epidemiological studies so far carried out and discussed public health, atomic energy, agricultural, veterinary mechanism models in so far as they provide guidance and related services who may be directly concerned in the collection of data.In particular, it discussed with the inspection and control of exposure to environ- in human radio - mental radiation, particularly in connexion with the theestablishmentof priorities and made proposalsfor contamination of food and water, or with the actual epidemiologicalstudies surveys and analyses of foods for such contamination. obtaining the necessary data and for improving Training was given on the basic principles of sampling methodology and approaches to research. procedures and radiochemical methods of analysis In view of the importance of dosimetry in human for the radionuclides likely to be present in accidental radio -epidemiology, a joint IAEA /WHO scientific environmental contamination. meeting was convened in Viennain October to 58 THE WORK OF WHO, 1965 consider the dosimetry and toxicity of thorotrast. The in the guide; and the medical section of the Inter- meeting reviewed experience to date, discussed the national Code of Signals, to be used when asking for additional dosimetric information needed and methods medical advice by radio in cases of emergency. of obtaining it, and considered the related toxicological The replies received to a questionnaire on the pro- and epidemiological problems requiring dosimetric gress made in providing health services for seafarers investigation. have been analysed for presentation to the Executive Apart from natural radiation, medical diagnostic Board in January 1966. The information will serve as radiology still constitutes the major source of radiation a basis for discussion of the organization -possibly exposure of the population, and WHO's programme partly on an international basis -of improved health continues to aim at both the improvement of radio- services for seafarers. logicalservices and the reduction of unnecessary An international study to ascertain the normal exposure. With the co- operation of manufacturers, the values for toxic substances in the human body is Organization has continued to promote the develop- being undertaken by the WHO reference laboratory ment of X -ray units combining high standards of at the Department of Occupational Medicine, at radiation protection and technical performance for Columbia University, New York, in oollaboration use in projects assisted by UNICEF and WHO, and with a number of laboratories in different parts of the at the regional level the training of radiographers and world. The study, which is co- sponsored by the United of equipment maintenance staff has been intensified. States National Institutes of Health and WHO, is In September IAEA and WHO co- operated in part of a programme to determine the maximum sponsoring the First International Conference on allowable concentrationsinthe human body of Medical Physics -which discussed the present status substances such as lead, arsenic and mercury, with a and current trends in radiological and medical physics view to the early detection of toxic exposures.The -and WHO participated in the Eleventh International first stage was to obtain values of lead, mercury and Congress of Radiology, held in Rome in September. arsenicinbiologicalspecimens from individuals living in different climatic and environmental conditions who do not come into contact with compounds Social and Occupational Health of these metals in their work or hobbies, or from drugs. Since health services for workers in large industries Investigators from the laboratories engaged on the already exist in most countries, an important part of study met in Geneva in October to review the results the work in occupational health is to study the health of the analyses made and to adopt international needs of other workers with a view to providing for standards of normal values for lead, mercury and each vocational group suitable health services adapt- arsenic in blood and urine.They also discussed the able to the rapidly changing conditions in many standardization of methods for the analysis of bio- occupations. In modern farming,for example, logical materials and atmospheric contaminants. mechanization and the use of residual pesticides have The Instituteof Occupational Health and Air created new occupational hazards that call for special Pollution Research in Chile, established with assistance preventive measures. from the United Nations Special Fund and with An inter -regional travelling seminar in the Ukrai- WHO as the executing agency, is providing training nian S SR-held mainly in Kiev and the surrounding courses for groups of public health administrators agricultural area -enabled participants from develop- and other specialists from Latin American countries. ing countries to study the health problems that are TheInstitute'sresearchactivitieshaveincluded resulting from the rapid introduction of modern investigations on manganese poisoning and radioactive agricultural methods and the type of health services fall-out. required to deal with them. Organized in August by WHO in co- operation with ILO, the seminar had Medical Rehabilitation participants from twenty developing countries. Further progress has been made with a co- ordinated Assistance in the form of advisory services and scheme for the care of the sick and injured at sea. The training of personnel was provided to a total of Joint ILO /WHO Committee on the Health of Sea- eighteen countries.It included advice on national farers, at its meeting in Geneva in March, recom- programmes for rehabilitation services in Nigeria, mended the publication of an international ship's Chile, Algeria, Jordan and Tunisia, the organization medical guide, consisting of three parts: a medical of training for various types of rehabilitation work guide giving practical information on what to do in in Brazil, Indonesia, Iran, Japan and the Philippines case of sickness; a standard list of contents of ships' (see also page 137), and assistance for the care of handi- medical chests to provide the treatment recommended capped children in Spain and Yugoslavia. HEALTH PROTECTION AND PROMOTION 59

A second inter -regional course on medical rehabi- the year, reviews evidence that domestic accidents litation began in Denmark in September with the are of great and increasing importance as causes of co- operation of the Danish Board of Technical injury and death in most countries, the most vul- Co- operation and the Universities of Copenhagen nerable groups being very young children, young boys and Aarhus, and will continue until mid -1966. The and the elderly, particularly elderly women. Injuries course, attended by physicians from fourteen countries, in the home are due chiefly to falls, burns, scalds, provides theoretical and practical instruction in basic poisoning (including gassing) and suffocation. Sources and specializedaspects of medical rehabilitation. ofstatisticaldata about domestic accidentsare The social and vocational aspects are also covered. reviewed and shown to be inadequate, especially as A year's course, held in London, for teachers of regards the rapidly developing countries. Control physical therapy, finished in June 1965. The course, and prevention of domestic accidents are discussed: the first of its kind, was organized by WHO in col- by community action through legislation and enfor- laboration with the World Confederation for Physical cement of minimum safety standards in the design of Therapy to meet the needs of developing countries buildings and equipment; and through local pre- that have recently established schools of physical ventive programmes focused on the family. The study therapy but are very short of teachers.There were points to the need for further investigations into the nine participants from seven countries in the course, causes of domestic accidents, with regard both to which provided three months' group training in Lon- environmental factors and to host characteristics don, followed by six months' actual practice in teaching (including risk -taking behaviour and risk -prone indi- in the provincial schools of physical therapy. The last viduals). two months of the programme included further visits to centres of special interest, such as those for limb - making and fitting, paraplegics, and a special course Gerontology and Chronic Non- Communicable Diseases on audiovisual aids. A month's course on the medical and social aspects of the care of the elderly was held in Kiev in May. Accident Prevention WHO provided eleven fellowships to the participants, who came from Bulgaria, Czechoslovakia, Hungary, An inter- regional seminar on the epidemiology, Poland, Romania, USSR and Yugoslavia. The course, control and prevention of road traffic accidents was which was similar to one held in Scotland in 1964, held in Alexandria, United Arab Republic in October, dealt with recent advances in the clinical care of the with participants from twenty -two countries.The elderly, and the contribution that preventive and epidemiology of road traffic accidents, safety problems social services can make to their health and welfare. in relation to road and vehicle design, psychology and At the end of 1965, WHO took part in three meetings behaviour of drivers, medical considerations in the concerned with rehumatology: the XI International issuing of driving permits, the role of public health Congress of Rheumatology, the International Con- and voluntary agencies,and prevention of road ference on the Education and Training of Rheuma- accidents in the developing countries were discussed. tologists, and the Latin American Symposium on Noting that road accidents are an increasingly frequent Rheumatoid Arthritis, held at Mar del Plata, Argen- cause of death and injury, even in the developing tina. countries, the seminar pointed out that the public WHO participated in and contributed a paper to a health authorities can do useful preventive work by colloquium on housing for the elderly, organized by carrying out epidemiological studies of accidents and the Economic Commission for Europe in the Nether- by safety education of the public.It emphasized the lands and Belgium in October.Attention was called need for better co- ordination of efforts at prevention to the special needs of elderly people with respect to among official and voluntary agencies concerned with their psycho -social, hygiene, nutritional and medical road construction, vehicle control, driver training and care problems when planning housing accommodation licensing, safety education and emergency treatment. for them.It was suggested that housing authorities A study on domestic accidents," published during should, as far as possible, obtain advice from medical 1 Backett, E.M. (1965) Domestic accidents, World Health and public health authorities when planning housing Organization, Geneva (Publ. Hlth Pap. No. 26). for old people. CHAPTER 6

EDUCATION AND TRAINING

Medical Education (2) Countries to which assigned

In many countries the expansion of public health Afghanistan 17 Libya 7 work, whether already in progress or planned for Algeria 2 Malaysia 7 British Solomon Islands Mali 1 the near future, has made it necessary to develop at Protectorate 1 Mauritania 3 the same time education and training programmes, Burma 3 Morocco 4 to ensure that the additional personnel will be sufficient Burundi 4 Nepal 4 both in quality and quantity. Cambodia 10 Niger 2 This situation has accentuated the shortage of Cameroon 1 Nigeria 7 Ceylon 2 Pakistan 4 teaching staff, not only in the developing countries, Chad 2 Philippines 3 but also in those normally considered as sources of Chile 3 Republic of Korea . . . 2 recruitment for suchstaff,and the governments China (Taiwan) 1 Republic of Viet -Nam 2 concerned have sought the assistance of WHO and Colombia 1 Senegal 5 Cyprus 1 Sierra Leone 3 other agencies. El Salvador 1 Singapore 6 To meet the problem a double approach is being Ethiopia 4 Somalia 6 used: nationals of the countries concerned are being Gabon 5 Sudan 3 trained as teachers, but since this offers a long -term Gambia 2 Syria 3 solution only, foreign teachers are being provided Ghana 8 Thailand 3 Gilbert and Ellice Islands 1 Togo 2 both to help in such training and also to meet the Guinea 2 Tunisia 6 immediate needs. India 26 Turkey 3 Despite the widening gap between the number of Indonesia 4 Uganda 5 teachers and the increasing demand for their services, Iran 5 United Arab Republic . 9 Iraq 7 United Repulic of WHO has been able to provide teaching staff and Tanzania 2 educational, advisers for some medical schools in Israel 2 Ivory Coast 2 Uruguay 1 Venezuela 3 developing countries. The table below shows: (1) the Jamaica 2 Yemen 8 number of professors, lecturers and other teaching Japan 1 Jordan Zambia 1 staff assigned by WHO to medical schools and to 2 Serving groups of Kenya 4 public health, nursing and other training institutions countries 2 during the period 1 January to 31 December 1965, Laos 10 Lebanon 255 and (2) the countries in which they worked. 2

(1) For training professional personnel * (by subject) In the longer -term aspects of the problem -the training of national personnel for teaching -WHO's Medical sciences 17 support was given in a number of ways, in addition Public health and preventive medicine (including hospital administration and statistics) 23 to the usual pattern exemplified by fellowships for Paediatrics, maternal and child health 18 young teachers for advanced studies abroad.The Other clinical subjects 8 Organization gave supporttopost -basicschools Radiology, laboratory techniques 11 for training teachers of nursing in several countries. Physical therapy 4 Assistance, in some cases in connexion with pro- Environmental health 13 Nursing 107 grammes financed by the United Nations Special Fund (see page 36), was provided to schools of For training auxiliary personnel 54 engineering for training in environmental sanitation, 255 and some of the students will ultimately become Total number of months assigned: 2182 teachers of the subject in their countries.At the Hadassah Medical School, Jerusalem, WHO has given Some instructors were engaged in the training of both professional and auxiliary personnel. assistance for a programme, in English for foreign - 60 - EDUCATION AND TRAINING 61 students, which has been added to the normal medical of health services and their place in national planning, course in order to prepare future teachers in basic and WHO was represented at meetings where this medical sciences for medical schools in Africa. subject was discussed, among them the Governing An expert committee met in Geneva in November Board of the International Institute for Educational to study training and preparation of teachers for Planning (sponsored by UNESCO and some other medical schools, with special regard to the needs of institutions) and the Sub -Committee on Education developing countries. and Training of the Administrative Committee on As the planning of teaching hospitals is important Co- ordination. to the establishment of medical schools, WHO made WHO has taken part in a number of conferences a review of existing types of teaching hospital, with dealing with different aspects of education.At a special reference to their dual (academic and public conference convened by the East -West Center of the health) function and interrelation. University of Hawaii a broad area of health personnel An inter -regional conference on effective teaching education and training was reviewed; WHO con- methods in medical education was held in November tributed particularly to the discussion on international to discuss the merits and limitations of various teaching co- operation. WHO also participated in the rural methods in medical education and review the changing health research conference, organized in Ludhiana, concepts and new means available for teaching. The India, by localinstitutionsinco- operation with conference was attended by participants from eighteen Johns Hopkins University, Baltimore, where medical countries,arepresentativefrom UNESCO and education and social trends was discussed; and in the observers from the World Medical Association and the ConferenceoftheInternationalAssociationof American University of Beirut. Working conferences University Professors and Lecturers, in Vienna, which (or " workshops ") in teaching methods were organized included a discussion on teaching methods. in the South -East Asia Region in selected medical Material for a bibliography on medical education colleges in India. covering the period 1956 -1965 has been evaluated Other activities in the Regions designed to assist and classified up to 1964. national teachers included a meeting of professors of The lack of teachers is the major problem facing paediatrics, held in Kampala, with participants from new medical schools, a problem which time rather the departments of paediatrics of the African Region, than availability of funds can solve.Lack of funds, Khartoum Medical School, and New York University however, is a hindrance in a number of other ways : School of Medicine(see page 98).A European some schools, which may have been able to provide seminar on paediatric education was held in the buildings and other facilities and the teaching staff, Netherlands, at Berg -en -Dal, to discuss the principles still need help in obtaining medical literature and of future paediatric education at undergraduate and equipment.With this need in view, the Eighteenth post -graduate levels and stimulate understanding and World Health Assembly requested the Executive co- operation among teachers of paediatrics in different Board to study a proposal that a revolving fund be parts of Europe. establishedtofinance, on a reimbursablebasis, A new project has been established in the Americas teaching and laboratory equipment for medical and with a view to strengthening medical education in paramedical training; and a report was prepared for Latin America.In seminars and group discussions discussion by the Board at its session in January 1966. assistance is given in reviewing the teaching methods An individual donation has made itpossible to and administrative organization of medical schools. provide five medical schools with visual aids equip- The first of a series of meetings on human relations ment. and medical teaching was held in Chile early in 1965. Advice on new or existing medical schools was pro- Training in Preventive Medicine and Public Health vided to many countries, including Algeria, Cameroon, Ethiopia, Kenya, Morocco and Zambia. The protection and promotion of the health of WHO participated in a meeting of Ministers of studentsinuniversities and other institutions of Educationofcountriesof Asia,sponsoredby higher learning, through their own health services, UNESCO, and the review of the progress and planning was discussed by the Expert Committee on Pro- of educational programmes in that continent has fessional and Technical Education of Medical and provided a substantial basis for WHO's own pro- Auxiliary Personnel, which met in April.' grammes of health personnel training and for national A number of considerations favourable to the programmes. creation of such special university health services were Education authorities are becoming more fully aware of the educational and training requirements ' Wld Hlth Org. techn. Rep. Ser., 1966, 320. 62 THE WORK OF WHO, 1965 discussed by the Committee, not least being the Auxiliary health personnel and their training was adjustment to new conditionsof livingthatis the theme of the technical discussions at the fifteenth necessary for students entering the contemporary session of the Regional Committee for Africa (see university setting.Illness among students frequently page 96). presents problems of a socio- medical nature that Particular difficulties arise in training auxiliaries cannot besolvedeffectivelyby healthagencies whose functions include what are characteristically available to the general population. The Committee medical duties, namely, diagnosis and treatment, felt that it was important that the student group even though limited to the most prevalent conditions should learn to appreciate the value of a well organized and discernible diseases.The various ways in which health service giving due attention to the prevention auxiliaries are used for medical work and the most of illness and the promotion of health as well as suitable forms of training were studied during the to the cure of diseases. Observations were also year in Burma, India, Morocco, Nepal and Sudan; made on the scope of university health services, their the study is to continue in other countries in 1966. contribution to and influence on the teaching of social and preventive medicine, the opportunities for research that they offer, and organizational aspects. Travel Abroad for Studies and Scientific Exchanges A study on training medical students for com- From 1December 1964 to 30 November 1965 prehensive medical practice by providing them with WHO provided assistance to enable 2403 individuals experience outside the hospital, which was published to go abroad to acquire essential knowledge and in slightly shortened form in the Chronicle 1 at the practical experience not availablein end of 1964, attracted considerable attention, and their home countries.There were 1743 fellowships for study many requests were received for copies of the original (as compared with 2407 for the fourteen months version. A second study made in 1964, on the inte- ending 30 November 1964), and 654 for participation gration of preventive aspects of medicine in the in meetings organized by WHO. textbooks of general medicine, was summarized in the The recipients of the fellowships came from 147 Chronicle.2 countries and studied in 90 other countries. The feasibility of establishing a new school of Further information on fellowships awarded in public health in Iran and also in Senegal was studied relation to particular countries and projects may be with assistance from WHO. The study dealt with found in Part III, and Annex 12 summarizes the the action that would be needed to meet the recom- fellowships awarded by subject of study and by mended requirements for schools of public health 8 region.Some other aspectsare analysed below: and the assistance that would be necessary. To familiarize the teaching staff of schools of Occupation of fellows public health with the health problems in countries Teaching 245 (14%) from which some of their foreign students come, a Research 52 ( 3 ° %) number of individual fellowships were granted, and Medical and health services 1194 (68 %) a group of deans of schools of public health in Canada Undergraduate study 258 (15 %) and the United States of America, accompanied by a PAHO staff member, visited Lebanon, Turkey, and Profession of fellows the United Arab Republic during the year. Physicians 815 (47 %) Nurses 210 (12 %) Sanitarians 73 (4 %) Other 648 (37 %) Training of Auxiliary Personnel Type of studies arranged It is being increasingly recognized, in both developed WHO- sponsored courses 598 (34%) and developing countries, that the use of auxiliaries Other courses 606 (35%) for tasks not requiring advanced scientific education Individual studies 545 (31 %) makes for more efficient utilization of highly qualified personnel. Place of study A study of the training of auxiliaries was carried In the fellow's region 964 (55 %) out in five Latin American countries during the year. In another region 785 (45 %)

1 WHO Chronicle, 1964, 18, 423 -424. Nine per cent. of the fellowships, other than those 2 WHO Chronicle, 1966, 20, 19 -25. for nursing, were awarded to women. Of the post- 8 Wld Hlth Org. techn. Rep. Ser., 1961, 216. graduate fellows, only 605 were under forty. EDUCATION AND TRAINING 63

The evaluation of the results of the fellowships completing their complementary medical studies in programme has continued.Because more fellows France. With the two groups who returned in1963 from developing countries are being awarded fellow- and1964,this brings to 128 the number of Congolese ships for basic studies lasting more than one year, doctors trained under this special programme and the number of long -term fellowships granted has now working in their own country. When the remain- tended to increase.Seven medical students studying ing assistants médicaux have finished their studies, it medicine at the Hadassah Medical School in Jerusalem is expected that the total number of Congolese physi- have been granted a special research year in basic cians trained under this scheme will be about135. medical sciences in the hope that some of them may become teachers in this field.Those selected were In all,906fellowships were awarded for participation from the African Region in view of the special need in forty seminars, symposia and other educational for teachers for training institutions in that Region. meetings, organized by WHO to provide an opportu- The special programme for training physicians for nity for exchange of views and experience on specific the Democratic Republic of the Congo is nearing topics.These regional and inter -regional meetings completion.A third group of twenty -one former were held in twenty countries and territories; details assistants médicaux returned home in1965after are given in Part III. CHAPTER 7

MEDICAL RESEARCH

Three resolutions of the Eighteenth World Health the scientific groups are listed in Annex 5.Although Assembly leading to new developments in the Organi- the reports of such meetings are primarily for the zation's research programme have been followed by information of the Director -General, the reports on preparatory work to bring about the necessary expan- the following subjects were considered to be of sion of activities in health aspects of world population, sufficient general interest to warrant publication in the epidemiologyand communicationssciences,and Technical Report Series: integration of mass campaigns cancer research. against specific diseases into general health services; Programme activities in the health aspects of world resistance of malaria parasites to drugs; the effects of population which might be developed by WHO were labour on the foetus and the newborn; protein require- the subject of resolution WHA18.49, in which the ments; mechanism of action of sex hormones and Assembly requested the Director -General to develop analogous substances; neuroendocrinology and repro- a research programme in the fieldsof reference duction in the human; the physiology of lactation; services, studies on medical aspects of sterility and and the biochemistry and microbiology of the female fertilitycontrol methods, and healthaspectsof and male genital tracts.' population dynamics.In resolution WHA1 8.43 the The total number of collaborative research projects development of WHO research activities and services currently in operation has now reached 387. Of these in epidemiology and the application of communica- 143 were started in 1965 (see Annex 13), and include tions sciences and the system of reference centres was projects in immunology, the biology of human repro- endorsed by the Health Assembly as a step for the duction and human genetics, these being fairly new extension of the Organization's activities in the field programmes in the general context of WHO's research of health research, and the Director -General was activities. Work has been accelerated in the fields of requested to take the necessary action. The subject cancer pathology and epidemiology, cardiovascular of the third resolution, WHA18.44, on the establish- diseases and the various aspects of vector control and ment of the International Agency for Research on parasitic diseases, particularly trypanosomiasis. Spe- Cancer, is dealt with in ChapteC 12 (page 79). cial attention has been paid to the bacteriology and In the development of the current programme of epidemiology of cholera. More information on the medical research the network of WHO reference collaborative research projects is given in the appro- centres was extended by the inclusion of thirteen new priate sections of this report. centres for respiratory virusdiseases, arthropod - The Advisory Committee on Medical Research held borne viruses, BCG seed -lots and control of BCG its seventh session in Geneva in June 1965. As usual, products,meningococcalinfections,leptospirosis, the Committee carried out a detailed review of one trypanosomiasis, comparative oncology, histopatho- of the Organization's research programmes -on this logy of skin tumours and of urinary bladder tumours, occasion, the virus research programme -and advised geneticfactorsof human immunoglobulins, and on itsfuture development.The Committee also humangenetics(abnormalhaemoglobin). The discussed research that could be undertaken or spon- reference centres supported by WHO at 31 December sored by WHO concerning the health aspects of popu- 1965 are listed in Annex 15. lation dynamics, and advised on the development of Forty -three scientific groups and other research a research programme in that subject. The reports meetings were held during the year to examine the of thirteen scientific groups, selected for their particular present state of knowledge in the various medical interest, were considered.They dealt with cholera fields, to indicate gaps in research and to help in research, dental health research, the monitoring of adverse drug reactions,threeaspects selecting the subjects which are most suitable for WHO of human collaborative investigation. Mention is made of these 1 Wld Hlth Org. techn. Rep. Ser., 1965,294, 296, 300, 301, 303, meetings in the relevant sections of this report and 304, 305, 313. - 64 - MEDICAL RESEARCH 65 reproduction (neuroendocrinology and reproduction Research training grants and grants for exchange in the human; the mechanism of action of sex hormo- of research workers awarded during the period under nes and analogous substances; and the biochemistry review are listed in Annex 14. and microbiology of the female and male genital The National Institutes of Health of the United tracts), and four aspects of pollution (environmental States Public Health Service continued to support six pollution; the biological estimation of water levels; research projects. The Swedish National Association the biological consequences of microchemical pollu- against Heart and Chest Diseases awarded three tion of water systems; and long -term effects on health research scholarships and the Government of Israel of new pollutants). five research scholarships, as contributions to the The Organizationcompletedthecollectionof Special Account for Medical Research. Other contri- information on current research in cancer. butions to the Special Account amounted to US $5696. CHAPTER 8

HEALTH STATISTICS

International Classification of Diseases and international levels. A review, prepared for the Conference, of the present situation regarding the TheInternationalConferencefortheEighth committees and their activities showed that at the Revision of the International Classification of Diseases, end of 1964 forty -sevennational committees or held in Geneva in July, was the culmination of five equivalent bodies were in existence and the establish- years of preparatory work, both national and inter- ment of eight others was under consideration.The national. Convened in conformity with WHO's committees vary greatly in composition and member- statutory obligation to revise periodically the Inter- ship; the nature of the problems considered by them national Classification of Diseases, the Conference was also varies according to the degree of development of attended by representatives of thirty -six Member the statistical services and the types of numerical data States and one Associate Member, the United Nations, called for by the health services.The committees' ILO and three non -governmental organizations. The reports to WHO cover a wide range of subjects, from Sixth Revision was carried out in 1948, the Seventh basic categories of vital and health statistics to newer in 1955. fields of study, such as statistics on health services or The Conference considered the final proposals of health economics,thechief concern being with the revised classification which had been prepared procedures for producing and improving statistics. by the Expert Committee on Health Statistics, on The most successful committees are those with an the basis of suggestions from its own Sub -Committee active secretariat connected with the vital and health on Classification of Diseases and from a regional statisticalservices,holdingregular meetings and advisory committee on classification in the Americas. working to an established programme. The Conference In its report, which is to be submitted to the Nineteenth expressed its appreciation of WHO's work in promo- World Health Assembly, the Conference recom- ting the establishment of national committees, facilita- mends that the revision proposals, with some amend- ting exchange of information among them and distribut- ments it introduced, be adopted as the Eighth Revision ing to them technical information.Some of the of the International Classification of Diseases.The committees have been in existence for sixteen years report also deals with a number of amendments to and theOrganization hasdistributed some 200 the WHO Nomenclature Regulations, some of them technical documents to them. consequent on the Revision of the Classification, others designed to simplify procedures. The Conference also considered national and inter- Assistance to Governments in the Development of national developments in health statistics in the last ten Statistical Services years.The presence of both statisticians and public Much attention has been paid to the training of health administrators made possible discussions of personnel at all levels.For example, in the South - current problems of common interest: WHO's role East Asia Region a nine -month course for medical indeveloping healthstatistics;hospitalstatistics, records officers -the first of a series -was completed a subject that recently emerged as a profitable area for in March in Bangkok. In the European Region, with international action; the implications for work in the assistance of WHO, three courses were organized health statistics of recent advances in automatic data in English, French and Russian respectively, on the processing; and national committees on vital and application of statistical methods to medicine and health statistics. public health.In the Americas (see page 104), a variety of courses and educational programmes in National Committees on Vital and Health Statistics health statistics, for both professional and auxiliary personnel, have been carried out. WHO also parti- National committees on vital and health statistics cipated in the teaching given at statistical training have contributed appreciably to the promotion and centres established or assisted by the United Nations : co- ordination of the work in statistics at the national a case in point is the Vital and Health Statistics Centre - 66 - HEALTH STATISTICS 67 of the Economic Commission for Africa at Yaoundé. in morbidity surveys and public health investigations. Lectures in health statistics were given in WHO - It discussed the latest techniques and their application assisted courses on tuberculosis, diarrhoeal diseases in the health field.It also discussed the draft for a and trypanosomiasis. manual on sampling in public health. In addition, the training of national staff has been The effective utilization of health statistics and new an important element in the WHO- assisted projects methods of obtaining required data were discussed at in health statistics in individual countries: these have a technical conference organized by WHO in Budapest included projects for the improvement of hospital and attended by health statisticians and public health statistics and medical records in Burma, Ceylon, officers of the European Region. Malaysia and Pakistan ; and for the improvement of Work has continued on the development of a func- health statistical services in the public health admi- tional classification of health expenditure based on nistration in Algeria, Ivory Coast, and Morocco. the national practices, with the aim of producing a classification acceptable to and practicable for the Statistical Publications various countries, and facilitating international comparison. The publication Annual Epidemiological and Vital " Methods of Improving Vital and Health Sta- Statistics was renamed World Health Statistics Annual tistics " was the subject of the technical discussions at as not all its contents, for example statistics on health the 1965 meeting of the Directing Council of the Pan personnel and hospital establishments, were covered American Health Organization /WHO Regional Com- by the former title.This publication also appeared mittee for the Americas. for the first time in three separate parts, thus enabling Preparations were begun for the technical discussions health workers to obtain only the part they are at the Nineteenth World Health Assembly, in 1966, interested in, while also hastening the issue of some of on " The Collection and Use of Health Statistics in the material. National and Local Health Services ". Statistics on various subjects of public health importance (e.g. malignant neoplasms affecting various sites, various types of cardiovascular diseases, oncho- Statistical Analysis of Research and Technical Pro- cerciasis and accidents) are analysed in detail and grammes published in the monthly Epidemiological and Vital An increasing part of WHO's statistical work is Statistics Report, each subject being introduced by related to the planning, execution and evaluation of an explanatory note.The collection and processing medical research and otherfieldand laboratory of statistics on BCG vaccination have been intensified studies.Progress was made in the application of with a view to assessing the value of the work being electronic computers in thestatistical analysis of carried out in campaigns for the control of tuber- WHO research data. During 1965 statistics were used culosis: from 1966 these statistics will be published extensively in connexion with epidemiological and regularly in the Epidemiological and Vital Statistics serological surveys on yaws in Nigeria, bilharziasis Report. skin -test studies in the African and Eastern Mediter- A monograph on statistical methods in malaria raneanRegions,tuberculosisresearchinIndia, eradication was also published (see page 6). onchocerciasis surveys in Kenya, filariasis research in The position in different countries with regard to Burma, epidemiological studies of atherosclerosis in the collection of morbidity and mortality statistics is Europe, studies on the toxicity of pesticides and on summarized in Trends in the Study of Morbidity and vaccines against measles, smallpox and cholera, and Mortality,' published during the year.It consists of the international collaborative assays of biological a series of papers which reveal the great variety of products. The programme of research on the health methods for reporting morbidity and mortality, and aspectsofpopulationdynamicsinvolvesmuch points to the need for international research into statistical work. reporting methods and for some degree of uniformity Statistics have been important in the clinical and in the interests of international comparability. pathological studies of cardiovascular disease undertaken in several countries (see page 52); in a study of Collection and Utilization of Statistics the effectiveness of large doses of Vitamin A as against xerophthalmia;instudiesin The Expert Committee on Health Statistics, which prophylaxis Israel, Northern Ireland and Yugoslavia of patterns met in November 1965, considered sampling methods and utilization of medical care and preventive health 1 World Health Organization (1965) Trends in the study of services; and in studies in three health centres in morbidity and mortality, Geneva (Publ. Hlth Pap. No. 27). India to determine the best staffing patterns for nursing 68 THE WORK OF WHO,1965 personnel (see page 114). Data collected in surveys for inter -agency co- ordination meeting, held in Geneva dental caries in Polynesia and for periodontal disease in August, to discuss the implementation of the long - in Ceylon, India, Iran, and Nigeria have been tabulated range programme of work with regard to population and analysed. growth recommended by the Population Commission and endorsed by the Economic and Social Council. Participation in United Nations Statistical Programmes At the Second World Population Conference in WHO participated in sessions of the United Nations Belgrade (see page 83) WHO was responsible for the Population Commission and Statistical Commission, organization of the meeting on mortality, morbidity held in New York in March and April, and in an and causes of death. CHAPTER 9

BIOLOGY AND PHARMACOLOGY

Pharmacology and Toxicology part in an international system under the aegis of WHO. This invitation was circulated to Member The Organization's activities in pharmacology and States, together with the report of theScientific toxicology have two main aspects: the development Group on Monitoring Adverse Drug Reactions, in of a programme to promote the safety of drugs for which the essentials of drug monitoring are set out. therapeutic purposes, and work in the field of drug In November 1965, a scientific group consisting abuse -including certain functions assigned to the of experts in charge of national services for the Organization under a number of international treaties monitoring of adverse reactions to drugs met in Geneva. for the control of narcotic drugs. It studied the implications of an international system of drug monitoring and formulated basic rules for Safety of Drugs the operation of such a system by WHO. A programme for the promotion of the safety of drugs in general is being developed in accordance with Drug Dependence and Drug Abuse several resolutions of the World Health Assembly In the field of drug dependence and drug abuse, and the recommendations of the Advisory Committee work continuedinclosecollaborationwith the on Medical Research.The International Union of United Nations organs for international narcotics Pharmacology isalso collaborating in this work. control. A paper entitled " Drug Dependence :its This programme includes a communication service - Significance and Characteristics " was published in organized at the request of the World Health Assembly theBulletin'givingconcisedescriptionsof the -by which Member States exchange, through WHO, characteristics of dependence on major groups of information on governmental decisions limiting the substances that are at present widely abused. availabilityof therapeuticsubstances becauseof At its meeting in July 1965, the Expert Committee adverse reactions observed during clinical use. on Dependence- Producing Drugs 2 recommended the The wide divergences in drug safety requirements appropriate status of international narcotics control among countries are often due to lack of a sound for a number of substances, and theSecretary - scientific concept. A scientific group, composed of General of the United Nations was notified of the toxicologists and pharmacists, met in Geneva in decisions taken by WHO on the basis of those recom- August to outline the rationale for the pre -clinical mendations. The Committee expressed its concern phase of testing for drug safety, as a basis for the at indications that increased acreage is to be devoted formulation of general principles for such tests. The to the cultivation of khat (Catha edulis Forssk) in group emphasized that the difficult problems inherent certain areas, and pointed out the risk to public in ensuring drug safety call for the application of health which increased supplies of khat leaves would new ideas and methods.It pointed to the need for involve. The Committee indicated certain weaknesses internationallyco- ordinatedresearch,particularly in international narcotics control, particularly with into long -term effects such as carcinogenicity, and regard to the opium produced in uncontrolled areas complex toxiceffectssuchas variousforms of -a major source of the morphine and heroin in genetic damage. The group's observations are pre- illicit traffic. sented in its report under four main headings: the The increasing frequency of abuse of sedatives and drug to be studied; the animals to be used; the experi- stimulants not classified internationally as narcotic mental investigations required; and ideas for future drugs, particularly the epidemic -like spread of their development. abuse among the young in some countries, caused the The Eighteenth World Health Assembly, in resolu- Eighteenth World Health Assembly (in resolution tion WHA18.42, invited Member States to develop as soon as possible national systems for monitoring 1 Bull. Wld Hith Org.,1965, 32, 721 -733. adverse drug reactions, with a view to their taking 2 Wld Hith Org. techn. Rep. Ser.,1965, 312. - 69 - 70 THE WORK OF WHO, 1965

WHA18.47) to ask the Director -General to study the At its meeting in September 1965,the Expert advisability and feasibility of international measures Committee established the international standard for for the control of sedatives and stimulants.The the antibiotic novobiocin; it also established interna- subject was discussed by the Expert Committee, which, tional reference preparations of colistin, lincomycin, recalling that previous committees had repeatedly cefalotin, hygromycin B, paromomycin and tylosin. pointed to the need for better national control of It considered a number of other antibiotics for possible sedatives and stimulants, recommended a number establishment as international standards or reference of measures, both national and international,to preparations.These included rolitetracycline,rifa- improve the situation.It re- emphasized the earlier mycin SV, semi -synthetic penicillins, and antibiotics recommendations that these substances should be used in cancer chemotherapy.Some of these sub- available on medical prescription only. stances might prove to be additionally useful for In connexion with the increased abuse of cocaine comparison purposes, e.g. when preparations made noted in certain areas, the Committee expressed the by different manufacturers differ widely in composition. view that cocaine was virtually obsolete for medical With regard to a number of hormones and enzymes, purposes, having been replaced by synthetic local the Committee established the international reference anaesthetics. It therefore recommended that the culti- preparation of erythropoietin.Others in this group vation of the coca bush should be controlled in order of biologicalsubstancesconsideredforpossible to reduce the amount of coca leaves and cocaine standards or reference preparations included lysine available for abuse. vasopressin, serum gonadotrophin, human pituitary On the request of the Health Assembly, steps were gonadotrophins, mucosal heparins, human growth taken with a view to amending the Single Convention hormone, human insulin, angiotensins and renins, as on Narcotic Drugs so as to minimize delays that may well as plasminogen, fibrinogen, thrombin and other occurinplacingsubstancesunderinternational blood coagulation and fibrinolytic enzymes.The narcotics control and to ensure prompt governmental use of a reference material which could reduce the action on decisions taken by WHO with respect to variation in results of haemoglobin estimations bet- the need for such control. ween laboratories was also discussed. The Committee considered the progress of the work on a number of immunological substances, establish- Biological Standardization ing the international standard for tetanus toxoid The main responsibilities undertaken within the (adsorbed) and replacing the existing international programme of biologicalstandardizationarethe standard for Old Tuberculin ;it also established the establishment of international biological standards, internationalstandardsforClostridium botulinum reference preparations and reference reagents and type F antitoxin (thus bringing the number of standards the adoption of recommended international require- for the various types of this antitoxin to six), and for ments for various biological substances of importance anti -smallpox serum. This will be useful at the present in prophylaxis and therapy. These tasks are carried time for the assay of vaccinia and variola antibodies in out under the guidance of successive meetings of relation to the WHO smallpox eradication programme. the Expert Committee on Biological Standardization. The Committee also established several international International standards and other reference prepara- reference preparations, namely of BCG vaccine as tions are established by this expert committee. This is well as of rheumatoid arthritis serum, and anti -sta- done on the basis of the results of international colla- phylococcal P -V leucocidin serum for use in diagnostic borative assays organized on behalf of WHO by the laboratory tests. It replaced the international reference three International Laboratories for Biological Stan- preparation of rabies vaccine. dards (at Copenhagen, London and Weybridge) and of Studies were reported on materials intended to serve other available information. as international standards or reference preparations International requirements are formulated on the of influenza virus vaccine for use in laboratory tests, basis of opinions and advice invited from a wide tetanus toxoid for flocculation test, live Newcastle - circle of experts from many Member States.Such disease vaccine, anthrax vaccine, inactivated measles information includes the observations of national virus vaccine and certain antibodies: anti -trichinella control laboratories and individual experts on the human serum, anti -echinococcus serum and anti - substances in question.The Expert Committee on Newcastle- disease serum. Biological Standardization adopts the requirements The Committee concluded that there may be a need which have been formulated ifitconsiders them for an international standard for anti -rubella serum satisfactory and useful for the control of the particular which could be used to assay the potency of human biological substances indifferent countries. anti -rubellaimmunoglobulinsusedforthepro- BIOLOGY AND PHARMACOLOGY 71

phylaxis of rubella in pregnancy.Progress reports Immunology were made on antisera against canine distemper and The growing interest in immunology is partly due canine hepatitis, and snake antivenins (Echis and Buis). to recent research in the hitherto largely unexplored The need for the replacement of the international field of immunization against parasites, as well as standard for anti -Brucella abortus serum was reported. to developments intissuetransplantation, cancer Replacement materials for the international reference immunology, genetics, allergy and immunopathology. preparations of cardiolipin and lecithin had been During the third year of its immunology research obtained and the results of preliminary studies were programme, WHO has tried to meet the most urgent considered. needs for international action in many of these fields. Suitable material for the replacement of the existing internationalopacityreferencepreparationwas available and had been studied; this material was Immunoprophylaxis and Immunotherapy therefore established as such. The first expert committee convened by WHO in The Committee reviewed the information reported connexion with its immunology programme was that on a number of candidate substances for the new on the immunology of parasitic diseases, held in category of preparations called " international bio- Ibadan, Nigeria, in December 1964 with the object logical reference reagents " intended for the identifica- of reviewing the subject jointly and promoting a tion of micro -organisms.Some enterovirus antisera closer relationship between parasitologists and immu- which had been extensively tested and were already nologists. The committee's report 2 includes a review in use in WHO virus reference centres and two anti - of modern concepts and new knowledge of antigens, tick -borne encephalitis sera which had been the subject antibodies, and the mechanisms known to produce of an international collaborative study were established immunopathological changes- subjects of potential as international reference reagents. The establishment importance for parasitic diseases.In addition, the of further preparations inthiscategory, namely, report summarizes available evidenceof immune adenovirus antisera, was also considered. responses in the parasitic diseases and outlines the The Committee considered and adoptedinter- fields in which research is required in order to define national requirements for dried BCG- vaccine and the role immunology can play in diagnosis and control measles vaccines, which had been formulated on the of the protozoan and metazoan parasitic diseases. basis of drafts circulated to experts in a number of Studies were carried out on the marked increase in countries. the serum yM immunoglobulin in human trypanoso- Four sets of requirements -General Requirements miasis which can be measured by a simple agar gel forManufacturingEstablishmentsandControl immunodiffusiontest;encouragingresultsfrom Laboratories, Requirements for Poliomyelitis Vaccine Senegal indicate that the test may be useful in identi- (Inactivated), Requirements for Poliomyelitis Vaccine fying cases of non -apparent human trypanosomiasis. (Oral) and Requirements for Smallpox Vaccine - Initial results of a collaborative study made by labo- which had been formulated several years ago, were ratories in Nigeria and Uganda in co- operation with revised in March 1965 at a meeting of experts on the WHO International Reference Centre for Immuno- international requirements for biological substances, globulins in Lausanne, Switzerland, indicate that a the first meeting of its kind to be held for this purpose.' similar increase in yM immunoglobulin may occur in These were discussed by the Expert Committee and bovine trypanosomiasis, and steps are being taken to considered to be useful revisions for manufacture develop a simple immunodiffusion test to measure and control purposes throughout the world. bovine serum yM immunoglobulin. The formulation and revision by WHO expert In September the Expert Committee on the Use of groups of sets of requirements for biological sub- Human Immunoglobulin met in Geneva.It reviewed stances continue to be of interest throughout the world the recent advances in fundamental research on and and the requirements already published have been clinical use of human immunoglobulins, considered studied by many producers and national control how the increasing demand for human plasma might authorities. The Eighteenth World Health Assembly be met, reviewed the procedures by which plasma is recommended Member States to recognize officially fractionated to yield immunoglobulin preparations, the international standards and units now available, as recommended how these preparations could best be listed in resolution WHA1 8.7, and to apply them in usedinvariousdiseases,and made suggestions nationalpharmacopoeiasandrelevantnational regarding further research in each of these fields.It regulations. proposed a new terminology incorporating terms

1 Wld Hlth Org. techn. Rep. Serv.,1966, 323. 2 Wld Hlth Org. techn. Rep. Ser., 1965, 315. 72 THE WORK OF WHO, 1965 recommended in the nomenclature for human immunology, held in Monte Carlo in February, and co- globulins previously published by WHO; 'in view sponsored by WHO and the Council for International of the increasingly evident heterogeneity of the serum Organizations of Medical Sciences (CIOMS), brought globulin with antibody activity, the more accurate together research workers from many countries to term "immunoglobulin " was proposed to replace review present knowledge and future prospects in this the commonly used, but less accurate, term " gamma field. The WHO International Reference Laboratory globulin ".The Committee strongly recommended for the Serology of Autoimmune Disorders in London that additional supplies of human plasma for frac- has begun to supply much -needed reference sera and tionation should be procured by the routine removal has standardized techniques, and will serve as a centre of a small quantity (75 -100 ml.) of plasma from all for training in diagnosis and research in this field. blood donations to blood banks, and also that means should be considered for obtaining from specifically Tissue Antigens: Transplantation and Cancer Immuno- immunized donors supplies of plasma for the pre- logy paration of immunoglobulin rich in particular antibodies.In addition, it noted that research on the The two approaches which appear to hold most specific separation and concentration of individual promise for overcoming the barriers to organ trans- antibodies from human plasma would allow great plantation are the development of suitable tissue - economy in the use of plasma as a source of anti- typing techniques, the use of which would minimize bodies. histo -incompatibility reactions, and the investigation A grant has been received from the United States of methods affecting that part of the immune response National Institutes of Health for the development of which leads to rejection of homografts. As a step the work of the WHO International Reference Centre toward systematic evaluation of tissue -typing tech- forImmunoglobulinsinLausanne,inparticular niques using human leukocytes and the standardiza- with regard to research projects on the preparation tion of these techniques, WHO helped to organize of purified antibodies and human immunoglobulins atissue -typingworkingmeeting andsupported for intravenous use. research work at the Department of Immunohaemato- logy of the University Hospital in Leiden, Netherlands. Interest has been focused on immunology and cancer Immunochemistry in the past few years with the demonstration of tumour - A scientific group on genes, genotypes and allo- specific antigens in experimental animals, and with types of immunoglobulins was convened in Geneva theincreasing number of experimental tumours at the end of May, and its recommendations on nomen- successfully induced by viruses. In spite of formidable clature for genetic variants of immunoglobulins were difficulties, studies are being continued on the charac- published in the Bulletin.'A WHO International terization of tumour -specific antigens in experimental Reference Centre for Genetic Factors of Human and human cancer and the evaluation of their role Immunoglobulins has been established at the Centre in eliciting immune responses. WHO is supporting départemental de Transfusion sanguine et de Géné- such studies in the Division of Immunology and tique humaine, Rouen, France, to supply reference Oncology, Gamaleja Institute of Epidemiology and sera and antisera in this expanding field of research in Microbiology, Moscow, with the aim of developing immunogenetics, and to complement the functions a reference centre for tumour- specific antigens. Pro- of the WHO International Reference Centre for gress with regard to the purification and characteriza- Immunoglobulins inLausanne, whichatpresent tion of tumour -specific antigens was reviewed at the supplies reference preparations of purified immuno- Fourth International Symposium on Immunopatho- globulins and their monospecific antisera. logy, mentioned above.

Immunopathology ImmunologyResearchandTrainingCentres in Developing Countries There is inadequate knowledge of the mechanism by which antigen- antibody reactions or their immune Immunology research can contribute to the solution reactions produce tissue damage, and of the thera- of some problems of parasitic diseases through the peuticeffectsofanti -inflammatoryagents.The development of immunodiagnostic tests and through Fourth International Symposium on Immunopatho- studiesin immunopathology and immunoprophylaxis.The Organizationisthereforeestablishing ' Bull. Wld Hlth Org., 1964, 30, 447 -450. centres for research and training in immunology in 2 Bull. Wld Hlth Org., 1965, 33, 721 -724. developing countries.This programme provides a BIOLOGY AND PHARMACOLOGY 73 mechanism for training the scientific personnel neces- the rapidly growing number of pharmaceutical prepa- sary to carry out the research in diagnosis, pathogenesis rations- particularlypharmaceutical forms -manu- and immunoprophylaxis of the tropical diseases in facturedwithinthevariouscountries,including their own setting. developing countries. The difficulty of ensuring that The first WHO immunology research and training imported drugs comply with the necessary require- centre,establishedattheUniversityof Ibadan, ments of purity and stability can only be met at present organized a well- attended bi- weekly research seminar by adequate systems of quality control and of regis- and a full -time four -month laboratory course for tration in the importing country. There is also a need Nigerian trainees.The course, leading to a special for proper inspection of pharmaceutical manufacturing university diploma and forming part of a Ph. D. pro- establishments. gramme in immunology for research workers at the In line with the same resolution, which requested doctoral or post -doctoral level, will be given annually. the Director -General " to pursue the establishment The centre also provided technical advice for several of internationally accepted principles and specifica- immunology research programmes at the University tions for the control of the quality of pharmaceutical of Ibadan. preparations ", the Organization continued its work on the preparation of the second edition of the Inter- national Pharmacopoeia. Earlier, specifications for WHO Collaborating Immunology Research Laboratories the pharmaceutical preparations to be included in the Following surveysof immunology researchin second edition of the International Pharmacopoeia Latin America and in the USSR, and in order to had been submitted to Member States, national and meet the need for international co- ordination and private laboratories and individual specialists, and exchange of personnel, WHO is designating a series the comments received were discussed at various of WHO collaborating immunology research labora- expert committee meetings. As a result, the text of tories.In developingcountries,thiswillafford the second edition has been prepared for publication. encouragementandrecognitionforgroupsof It comprises monographs giving specifications for the research workers who are often doing outstanding identity and purity of 555 pharmaceutical preparations, work under difficult conditions.In developed coun- as well as indications of their action and use, and tries, the aim is to establish a series of laboratories sixty -nine appendices dealing with analytical methods which will maintain liaison with the research and (including new techniques in polarography and the training centres in developing countries, exchange determination of infra -red absorption spectra), poso- preparations with the WHO International Reference logy, symbols, and reagents and test solutions. The CentreforImmunoglobulinsinLausanne,and second editionincludes163 monographs on new exchange personnel for training in research in immu- products, while 116 monographs that appeared in nology. A small fund has been used to acquire immu- the first edition have been omitted. nological reagents in order to avoid the delays and An increasing number of countries are using the interruptions in research which so often occur because specifications proposed by WHO as the basis of their relatively minor and inexpensive items are not avai- official national requirements. lable. Work is now proceeding on the preparation of A joint WHO /CIOMS International Liaison Com- specifications for new pharmaceutical preparations mittee for Immunology was establishedin1965. and groups of drugs such as tuberculostatics, radio - Itis to circulate regularly a newsletter describing pharmaceuticals, steroids, radio -opaques, and on the progress in the immunology research programme, a stability of certain important tuberculostatics. calendar of meetings, and résumés of the main develop- Work on chemical reference substances continued ments in research. atthe WHO InternationalReference Centrein Stockholm.More reference chemicals, particularly steroids, are being made available to laboratories Pharmaceutical Preparations for quality control in different countries. A collection The Eighteenth World Health Assembly, inits of thirty -six such reference preparations is to be made resolution WHA18.36, invited governments to take available at the time of the publication of the second the necessary measures tosubject pharmaceutical edition of the International Pharmacopoeia.This preparations, whether imported or locally manufac- work is carried out in co- operation with national tured, to adequate quality control. reference centres in a number of countries. It is clear that such control, to be effective, must be The Sub- Committee on Non - Proprietary Names applied not only to imported preparations but also to of the Expert Committee on Specifications for Phar- 74 THE WORK OF WHO,1965 maceutical Preparations met in November to select A list of201proposed international non -proprietary non -proprietary names for a number of new pharma- names for pharmaceutical preparations was sent to ceuticalsubstances for which requests had been Member States for examination and later published received from private firms and national administra- in the November1965issue of theWHO Chronicle. tions since the Sub- Committee's previous meeting. This follows the publication of fourteen such lists Increasing co- operation on the part of Member since1953,a cumulative list published in1962,and States and pharmaceutical manufacturers has made five lists of recommended international non- proprie- it possible for progress to be maintained in this field, tary names. thus preventing the confusion caused by a multiplicity The International Union of Pure and Applied of names for the same medicinal substances. Increasing Chemistry, the International Pharmaceutical Federa- use is made of these names for labelling and regulatory tion, the European Pharmacopoeia Commission and purposes,incertain cases facilitating the prompt a number of national and private agencies have co- withdrawal of drugs found to have dangerous side - operated with WHO in connexion with nomenclature effects. and symbols. CHAPTER 10

PUBLICATIONS AND REFERENCE SERVICES

Provision was made for a new section of the Twenty -two numbers of the Technical Report Series Bulletin on " Terminology and Nomenclature ", to were published in English,2 including thirteen expert contain contributions resulting from efforts tosti- committee reports and the reports of seven scientific mulate international uniformity in scientific termino- groups and two study groups. All but one of these 3 logies and nomenclatures in fields of interest to WHO. had also appeared in French. Twenty -seven numbers The firstsuch contribution to be published was were published in Spanish.4 entitled " Notation for Genetic Factors of Human In the Public Health Papers series, the following Globulins ".1This memorandum was drafted by the titlesappearedinEnglish:DomesticAccidents signatoriesfollowing discussions held during the (No. 26), Trends in the Study of Morbidity and Morta- meeting of the WHO Scientific Group on Genes, lity (No'.27), Aspects of Family Mental Health in Genotypes and Allotypes of Immunoglobulins.It is Europe (No. 28), Mass Campaigns and General Health intended that the full text of all such memoranda Services (No. 29). The French and Spanish transla- dealingwithterminologicalquestionsshouldbe tions were published of the following titles:The published in the Bulletin in both English and French. Staffing of Public Health and Outpatient Nursing It has been the Organization's practice to publish Services (No. 21); The Nurse in Mental Health Prac- several times a year special numbers of the Bulletin tice (No. 22); Urban Water Supply Conditions and consisting of international symposia or collections of Needs in Seventy-five Developing Countries (No. 23); papers on a selected subject of major public health Care of Children in Day Centres (No. 24). importance. While this practice is considered to serve The fiftieth title in the WHO Monograph Series was a useful purpose, its disadvantage is that it leads to published -Snail Control in the Prevention of Bilhar- considerable delays in publication. Authors of indi- ziasis. vidual papers are usually widely scattered geogra- To the four world directories previously published phically, and publication of such symposia cannot by the Organization was added the World Directory take place until the last author has returned corrected It was therefore decided of Post -Basic and Post - Graduate Schools of Nursing. proofs of his contribution. A chapter describing the functions and activities at the beginning of the year to restrict the number of special issues of the Bulletin until the arrears of some of the WHO Library was contributed to the directory months in its publishing schedule had been liquidated. of libraries of the United Nations and specialized Accordingly, only one such issue was published in agencies, which is to be published by the United 1965, its subject being tuberculosis. By the end of the Nations. year, delay in the publication of the Bulletin had been A Bibliography of Hookworm Disease, 1920 -1962, reduced to one month. compiled with the financial assistance of the Rocke- The number of subscribers to the Bulletin increased feller Foundation, was added to the six bibliographies from 1900 to 2100. This figure, added to the number previously published by the Organization. It contains of copies distributed officially (1310) and in exchange over 4200 references published in different parts of for other periodicals (220), gives a total distribution the world between 1920 and 1962 and thus brings up of 3630. to date the bibliography compiled over forty years ago In the International Digest of Health Legislation a by the Rockefeller Foundation.It is supplemented comparative survey was published of " Legislation with a combined subject and geographical index in on Vaccination in the Member States of the European English and in French. Economic Community ", in which significant diffe- The proceedingsof a joint FAO /IAEA /W.HO rences are pointed out "... in the number of compul- seminar were published under the title: Protection sory vaccinations, the way in which they are regulated and the exemptions from vaccination... ". The cover of this periodical was re- designed. 2Wld Hlth Org. techn. Rep. Ser.,294-315. 8Wld Hlth Org. techn. Rep. Ser.,301. 4Wld Hlth Org. techn. Rep. Ser.,277, 280, 281, 283,284, 1 Bull. Wld Hlth Org.,1965, 33, 721 -724. 286 -298, 300, 302 -305, 307, 310, 312, 313. - 75 - 76 THE WORK OF WHO, 1965 of the Public in the Event of Radiation Accidents. As In preparation for the move into the new building, is mentioned elsewhere in this report, Annual Epide- a vigorous effort was made to prune the collection of miological and Vital Statistics was issued under the periodicals, of old and rarely used literature, particu- new title World Health Statistics Annual, its three main larly that of relatively limited interest to the technical parts being divided into three separate volumes. work of the Organization. Such material was offered In addition to the regular Official Records volumes, to other libraries on the condition that it would be new editions were produced of the Handbook of Resolutions and Decisions and of Basic Documents. made available on loan to WHO should the need arise. Total revenue from the sales of WHO publications Efforts were made, too, to dispose of the large collec- for the financial year 1965 amounted to US $162 000. tion of duplicate periodicals which have been accu- WHO participated in the Third Session of the mulating since the establishment of theLibrary. UNESCO InternationalAdvisory Committee on These were offered on an exchange basis through the Bibliography, Documentation and Terminology held WHO scheme for the International Exchange of in Moscow. The Organization also participated in a Duplicate Medical Literature to medical libraries meeting of an International Group of Experts on throughout the world. Large collections of material Medical Terminology and Dictionaries convened in were sent through these means to a number of libraries, Paris by the Council for International Organizations including the Centrul de Documentare Medicala, of Medical Sciences. Romania; the Statni Lekarska Knihovna (National The collection of current medical and scientific Medical Library), Prague, Czechoslovakia; and the literature available in the WHO Library continued Hacettepe Tip Merkezi (Hacettepe Medical Central to grow. On 31 December 1965 2595 medical and Library), Ankara, Turkey. scientific periodicals were regularly received, of which 687 were acquired by purchase, 1360 in exchange for A second WHO training course in medical libra- WHO publications and 548 by gift.Other serial rianship was held at the American University of publications received by the Library included 1658 Beirut from July to September and was attended by annual reports from governments, medical and health librarians of medical schools or ministries of health institutions, etc. and the calendar and prospectuses from four countries of the Eastern Mediterranean of nearly 650 medical schools and faculties. Region and by a medical librarian from Turkey. CHAPTER 11

PUBLIC INFORMATION

The interest of the public in subjects of concern to WHO commissioned the production in Czechoslo- WHO was reflected in the coverage of the Organiza- vakia of a fifteen -minute animated colour cartoon tion's activities by newspapers throughout the world, dealing with smallpox throughout the ages.This prominent topics being the decisions of the Eighteenth film, entitled " Smallpox, Merciless Traveller ", has World Health Assembly on the health aspects of appeared on several television networks and has been world population, the new International Agency for made available in 35 mm and 16 mm copies in English, Research on Cancer, the growth of cities, and the French and Spanish versions. increase in lung cancer. The spread of cholera and " Man and his Cities " is the theme chosen for the decline of poliomyelitis were also widely reported. World Health Day 1966, to stress the health problems " Smallpox, Constant Alert " was the theme of implicit in urbanization, especially from the viewpoint World Health Day, 7 April 1965.Brochures were of mental health. published for the occasion in some countries, including Press releases issued during the Eighteenth World the Federal Republic of Germany and the Netherlands. Health Assembly again focused attention on health Liberia, Mexico and many other countries organized problems and achievementsindifferentcountries publicmanifestations. TheBritishBroadcasting and on discussions and decisions of the Assembly Corporation produced a thirty -minute programme itself.Sound recordings for radio distributed during in collaboration with WHO for distribution to 122 the Assembly numbered approximately 200, in eight networks in the British Commonwealth and the languages. They were sent to some eighty stations in United States of America. A fifteen -minute pro- all parts of the world at the request of the stations gramme was broadcast to Switzerland on World themselves or of delegations.For the distribution of Health Day direct from Tananarive.The same thismaterial WHO worked closely with various programme wasrequestedbythebroadcasting United Nations information centres and with United corporations of Madagascar and Mauritius and the Nations Radio, New York.Approximately 2000 Swissshort waveservice. Radio Cairobroad- copies of photographs taken during the Assembly cast two interviews and a twenty -minute feature on were distributed. smallpox eradication.At WHO headquarters nine Over sixty press releases and special features were recordings for World Health Day were produced issued during 1965.Three articles on field projects including three thirty- minute programmes in English, supported jointly by the United Nations Expanded French and Spanish. A total of 160 copies of these Programme of Technical Assistance and WHO were programmes were sent out on request to seventy -two provided in connexion with the fifteenth anniversary national networks and radio stations. A set of large of the United Nations Expanded Programme of photographs illustrating WHO's efforts against small- Technical Assistance, at the request of the Technical pox was displayed in Budapest and other cities in Assistance Board. Hungary and was made the basis of a programme In the Americas, distribution rights for the eleven - broadcast on 7April by Hungarian Television. minute WHO colour cartoon on tuberculosis " The Swedish Television sent a team to Geneva to collect Monster and You ", produced in Yugoslavia, have material for a World Health Day programme on been granted to the Center for Mass Communication smallpox. The WHO Liaison Office with the United of Columbia University Press. One hundred 16 mm Nations in New York produced a one -minute film English -language copies were sold during the year for on smallpox which was distributed to some 400 distribution in the United States through the National television stations.About 12 000 copies of photo- Tuberculosis Association. A French -language version graphs relating to the smallpox theme were distributed was completed of the joint UNESCO /WHO produc- from Geneva. A special issue of World Health, the tion " Doctors in the Making ", a thirty- minute film magazine of WHO, was devoted to the history of dealing with the training of Ethiopian and Congolese smallpox and present efforts to eradicate the disease. health workers. - 77 - 78 THE WORK OF WHO, 1965

Following the visit to Africa of a camera crew from number of requests for WHO photographs increased Poland, three ten -minute documentary films were considerably from that date.The total distribution completed.These films are entitled " Speciosa ", of photographs during 1965 exceeded 50 000 copies. " Visit in the Desert " and " Operation Beheira ", The number of WHO photographs published has and concern respectively nurse training in Burundi, been increasing particularly in the United States of trachoma control in Sudan, and bilharziasis control America.For example, Medical Tribune published in the United Arab Republic. They will be available four full cover pages on WHO as well as about a in 16 mm and 35 mm English and French language hundred WHO photographs on inner pages, and versions. seven pages of WHO photographs appeared in the With assistance from the Organization, the United March edition of MD. Much illustrative material was Nations Information Centre inParis produced a also provided to book publishers in various other fifteen -minute film on WHO to show what it is and countries.Some fifteennew photo- storieswere how it works. produced during the year and nearly 3000 new nega- Parts of the film on leprosy shot last year in India tives added to the photo library.Subjects included under the sponsorship of the Danish Save the Children malaria eradication in Taiwan, urbanization in the Organization and WHO were incorporated in a pro- Americas, vaccine production in India, and medical gramme shown on Danish television. research in Hungary. Interest in the film produced by WHO in 1956 on A large exhibit comprising photographs and maps alcohol, " To Your Health ", continued :over 200 illustrating WHO activities in the field of nursing copies were sold during the year. was put up for the Fourth Quadrennial Congress of The WHO magazine World Health was published the International Council of Nurses that took place in English, French, Russian, Portuguese and Spanish in Frankfurt, Federal Republic of Germany. An editions. The overall average number of copies per illustrated bilingual brochure in English and French issue continued at about 120 000.The number of on nursing was published for the same occasion subscriptions has increased from 697 in 1961 to over (see page 47). 5000 in 1965.The January- February issue of the In an effort to give greater publicity to projects magazine was devoted to the International Co- operation financed from the United Nations Special Fund, WHO Year of the United Nations, and was produced with co- operated with FAO in sending a journalist and a assistance from the International Telecommunication photographer to Ghana to report on two projects in Union. An issue on the emigrant as an element of that country for which the two organizations are the international co- operation for economic development executing agencies :water supply and sewerage in was produced at the end of the year with assistance Accra /Terna (WHO) and land and water surveys in from the Intergovernmental Committee for European the upper and northern regions (FAO). Migration.Special issues were brought out on the In addition to the radio material already mentioned Region of the Americas and the Western Pacific over 120 recordings were made during the year and Region. Another special issue was devoted to cardio- distributed to services in all parts of the world, most vascular diseases and WHO's work in thisfield, of them in several copies.In co- operation with the 22 000 additional copies being distributed by the Swiss Broadcasting Corporation, five programmes International Society of Cardiology. lasting approximately twenty -five minutes each were The first illustrated catalogue of the WHO photo produced in French on WHO activities in Madagascar, library was published during the year.It lists about and were broadcast during April and May in Switzer- 200 photo- stories and 12 000 single photographs. land. The Belgian radio and television service also Distribution of the catalogue started in May and the used some of these programmes. CHAPTER 12

CONSTITUTIONAL, FINANCIAL AND ADMINISTRATIVE DEVELOPMENTS

Constitutional and Legal

After their admission to membership in the United having notified the Director -General of their under- Nations, Malawi, the Maldive Islands, Malta and taking to observe and apply the provisions of the Zambia became Members of the World Health Statute. Organization in 1965 by depositing with the Secretary - As provided by the Statute, the Agency is to serve General of the United Nations a formal instrument of as a means through which the Participating States and acceptance of the Constitution. At the end of the year the World Health Organization may co- operate in WHO had 122 Members and three Associate Members. the stimulation and support of all phases of research A list of Members and Associate Members as at 31 related to the problem of cancer. The Agency com- December 1965 is given in Annex 1. prises a Governing Council, composed of one repre- The Eighteenth World Health Assembly adopted sentative of each Participating State and the Director- the proposal for the amendment of Article 7 of the General of the World Health Organization; a Scien- Constitution in order to provide for the suspension or tific Council composed of twelve scientists selected exclusion from the Organization of a Member deli- on the basis of their technical competence in cancer berately practising a policy of racial discrimination. research and allied fields; and a Secretariat headed The amendment will come into force when accepted by the Director of the Agency. The permanent acti- by two- thirds of the Members in accordance with the vities of the Agency will be financed by equal annual provisions of Article 73 of the Constitution. contributions by each Participating State. Kenya, Malawi and Trinidad and Tobago acceded The first session of the Governing Council of the to the Convention on the Privileges and Immunities Agency was held in Lyons, France, on 23 and 24 of the Specialized Agencies together with its Annex VII, September 1965.At thissession,the Governing which relates specifically to the World Health Orga- Council adopted itsRules of Procedure and the nization. Financial Regulations of the Agency; decided that the site of the headquarters of the Agency would be International Agency for Research on Cancer at Lyons, France; appointed the first members of the Scientific Council; adopted a provisional general The Eighteenth World Health Assembly, in confor- programme of work and agreed upon financial mity with the provisions of Article 18 of the Consti- arrangements for the years 1965 and 1966.It also tution, agreed to the establishment of an International admitted Australia and the Union of Soviet Socialist Agency for Research on Cancer to be constituted Republics as Participating States in the Agency. The under a Statute that had been drawn up by the Governing Council adopted an appropriation resolu- Federal Republic of Germany, France,Italy,the tion for 1965 in a total amount of $525 000 of which United Kingdom of Great Britain and Northern Ireland, $350 000 was for the establishment of a working and the United States of America - the countries that capital fund, $100 000 for installations and the balance had sponsored the Agency. On 15 September 1965 of $75 000 to cover the cost of organizational meetings thisstatute entered into force, the five Members and minimum requirements for programme activities which had taken the initiative in proposing the Agency and administrative services.

The Financial Position

Budget for 1965 working budget of U S $38 360 000,i.e. $3 817 250 The Seventeenth World Health Assembly had over the corresponding total of $34 542 750 for 1964. established by resolution WHA17.15 aneffective The approved budget for 1965 was $40 881 370, the - 79 - 80 THE WORK OF WHO, 1965 difference of $2 521 370 between the effective working $8 849 328 as compared with the figure of $8 714 764 budget and the approved budget being appropriated made available to the Organization in 1964. in resolution WHA17.18 as an undistributed reserve, equal to the assessments on China and on the inactive United Nations Special Fund Members (the Byelorussian SSR and the Ukrainian SSR).The Eighteenth World Health Assembly, on WHO was allocated an amount of $1 681 450 the recommendation of the Executive Board, approved during 1965 from the United Nations Special Fund. (inresolutionWHA18.11) supplementary budget This sum, together with an amount of $1 196 463 estimates for1965 amounting to $1 147 000, thus remaining undisbursed from previous years, resulted increasing the effective working budget to $39 507 000. in a total of $2 877 913 available for disbursements. The supplementary estimates were to meet : Voluntary Fund for Health Promotion Us $ (1)Increased contributions to the United Nations Contributions received in 1965 for the Voluntary Joint Staff Pension Fund, calculated on the Fund for Health Promotion amounted to $955 669 basis of gross salaries 185 000 bringing the total value of contributions credited to (2)Increased contributions to the United Nations the Fund to $28 157 836 1 as at 31 December 1965. Joint Staff Pension Fund based on pensionable remuneration, plus 5 per cent. 79 000 These contributions related to the following sub - accounts : (3)Increased United Nations charges for rental and 1. 1. 1965- Total from maintenance of premises, equipment and other 31.12.1965 inception services in the Palais des Nations 110 000 US ; Us $ (4)Increased salary scales for general service staff General Account for Undesignated at headquarters and in Copenhagen, New Delhi Contributions 9 781 29 733 and Washington 119000 Malaria Eradication Special Ac- (5)Increased dependants' allowances for general count 86 890 20 795130 service staff in Geneva 7 000 Special Account forSmallpox (6)Increased post adjustment classification for New Eradication 24 936 835 5001 Delhi 32 000 Special Account for Medical Re- (7)Meeting in 1965 of the Committee on Internatio- search 570 363 5 046 331 nal Quarantine 11 000 Special Account for Community (8)Travelling expenses for attendance at the Eigh- Water Supply 38 519 944 0901 teenth World Health Assembly of a representa- Special Account for Assistance to tive from each of four additional Associate Mem- the Democratic Republic of the bers 4 000 Congo 240 975 (9)African Regional Office Building Fund. . . 600 000 Special Account for Accelerated Assistance to Newly Indepen- TOTAL1 147 000 dent and Emerging States. . 10 500 40 447 Special Account for the Leprosy The distribution of the approved budget among the Programme 36 358 37 740 appropriation sections is shown in Annex 7, which Special Account for the Yaws Pro- gramme 6 918 12948 alsoshowsthetransfersbetweenappropriation Special Account for Miscellaneous sections, made with the concurrence of the Executive Designated Contributions . . 171404 174 942 Board, and the amounts of the approved supplementary estimates. Collection of Contributions and the Working Capital Fund Expanded Programme of Technical Assistance The obligations incurred in 1965 and the status of Under the Expanded Programme of Technical collection of contributions and of advances to the Assistance the amount earmarked for WHO for 1965 Working Capital Fund at the end of 1965 are shown -the firstyear of the1965 -1966 biennium -was in the Financial Report,2 published as a supplement $8 525 201 or 16.4 per cent. of the total funds available to the Annual Report of the Director -General and for the programme.This sum included $1 067 111 submitted with the Report of the External Auditor foradministrative and operational servicescosts. to the Nineteenth World Health Assembly. Contingency allocations in 1965 for WHO projects The Eighteenth World Health Assembly (in resolu- amounted to $311 017 and $13 110 was reallocated tions WHA18.13 and WHA18.14) made decisions to cover contractual commitments relating to the 1961- 1962 programme.The total allocated to WHO in 1965 1 Includes adjustments of previous years' contributions. under the Expanded Programme thus amounted to 2 Off. Rec. Wld Hlth Org. 150. CONSTITUTIONAL, FINANCIAL AND ADMINISTRATIVE DEVELOPMENTS 81

that affected both the composition and the amount Fund at 1 January 1966 in the amount of US $5 000 000, of the Working Capital Fund as from 1 January 1966. thus increasing the advances assessed on Members. In resolution WHA18.13 the Assembly, by amending In the same resolution it decided that Part II of the the Financial Regulations, decided that the Fund Working Capita] Fund should consist of amounts would consist of two parts, Part I being composed of which, in conjunction with PartI,would equal advances from Members, made in accordance with 20 per cent. of the effective working budget for the a scaleof assessment determined by the Health relevant year. The Director -General was authorized to Assembly, and Part II being amounts of casual income transfer the required amounts to Part II from casual transferred to the Fund. In resolution WHA18.14 the income, a first transfer of US $500 000 to be made Health Assembly decided to establish Part I of the immediately and other sums as soon as practicable.

Administration

Structure and Staff eighty -eight compared with sixty -eight at the end of 1962. Nationals of almost 72 per cent. of Member A number of organizational changesathead- quarters were made during the year.One new post States were serving in theSecretariat in 1965 as compared with 61 per cent. in 1962. of Assistant Director -General was created. The existingofficesofResearchPlanningandCo- Refresher briefing and training of WHO technical ordination, Programme Co- ordination, Programme staff continued as in previous years, both in courses Formulation and Evaluation, and External Relations and on an individual basis: twenty -two medical and were placed under this Assistant Director -General, other technical staff followed post -graduate studies in who is also responsible for several programmes and the 1964 -1965 academic year -generally with a view offices outside headquarters not reporting to a regional to acquiring a diploma in public health -and nineteen office. The National Health Planning unit was placed in the 1965 -1966 academic year.Short study tours in the Division of Public Health Services. The Vector were arranged for twelve programme staff in 1965 in Control unit, formerly in the Division of Environmental order to refresh their technical knowledge in their Health, now reports directly to an Assistant Director - own special field by visits to institutions and universi- General. The Data Processing unit was placed under ties or attendance at courses.Three training courses the immediate direction of the Assistant Director - for senior staff were organized in Geneva in 1965 for a General responsible for administrative and financial total of thirty -two staff members -senior regional office services. staff and medical and other technical officers working Three new units were established by transferring in the field; these courses were designed to review new certain staff and functions from existing units. These developments and trends in WHO programmes, and were Human Reproduction in the Division of Public to maintain a unified approach to technical problems Health Services, and Smallpox Eradication and Global by headquarters and the regional offices. Epidemiological Surveillance, both in the Division of In preparation for the use of the Organization's Communicable Diseases.Two units previously not electronic computer in 1966, six courses were organized formally designated have been named the Administra- in Geneva for programme and administrative staff tive Co- ordination and Senior Staff Training units. at headquarters. In all, ninety -six staff members took The structure of the headquarters Secretariat is part. shown in Annex 8. On 30 November 1965 the total staff numbered Data Processing 2955,' (including eighty -six WHO agents on duty in the Democratic Republic of the Congo), as compared A computer feasibility study undertaken in 1963 with 2835 on 30 November 1964, an increase of and 1964 showed that it would be advantageous for approximately 4 per cent. The details of the composi- the Organization to operate its own electronic com- tion of the staff at 30 November 1965 are given in puter, because the conventional punched card equip- Annexes 9 and 10.The geographical distribution of ment hitherto available could no longer cater adequa- staff has widened during the past years and on tely for the data processing. A contract was therefore 30 November 1965 the number of Members whose signed for delivery of an electronic computer in nationals were employed by the Organization was mid -1966; meanwhile preparatory work was undertaken to ensure its effective use by the Organization. 1 Excluding staff of the Pan American Health Organization. The computer will be used principally in medical 82 THE WORK OF WHO, 1965 research,healthstatistics, and administrative and On the advice of WHO, several manufacturers of financial services. X -ray equipment have produced prototypes of general purpose diagnostic units designed to meet the radio- The New Headquarters Building logical needs of the smaller hospitals and clinics Throughout the year the new headquarters building receiving assistance from UNICEF and WHO, and was a centre of great activity as the work moved also meeting the standards recommended by WHO towards completion.Preparations for the transfer with regard to protection against radiation hazards. of the Secretariat included plans for the lay -out of the These prototypes have undergone several inspections offices; arrangements, including recruitment of the by WHO at the manufacturers' premises and twenty - necessary staff, for the servicing of the building and four units were purchased from four manufacturers its installations; and plans for the move. A number at a cost of $250 000, for use in programmes assisted of Member States have contributed to the decoration by UNICEF and WHO. of the building by gifts of money or in kind.The inauguration of the building is to take place in May Emergency Assistance to Member States 1966, during the Nineteenth World Health Assembly. Early in 1965 the Executive Board's Standing Com- WHO made reimbursable purchases of cholera mittee on Headquarters Accommodation considered a vaccine for use in emergency outbreaks in Afghanis- report from the Director -General regarding certain tan, Iran and Bahrain, and of botulinus antitoxin changes in the heating and air- conditioning system for Iran. Cholera vaccine donated by the Government which had been found necessary as a result of inad- of India was used to meet emergencies in Afghanistan equacies in the planning by the original consulting en- (400 000 doses) and in Nepal (100 000 doses). WHO gineers for heating and air -conditioning. These changes provided Somalia with some antibiotics during an involved additional expenditure bringing the total emergency in that country. estimated cost of the building to Sw. Fr. 62 500 000. On the recommendation of the Board, the Eighteenth World Health Assembly agreed to authorize the Organizational Study of the Executive Board on Methods Director- General to proceed with the building project of Planning and Execution of Projects in accordance with this estimate. In January 1965 the Executive Board concluded its organizational study on methods of planning and Supply Services to Member States execution of projects. The Board's report 1was During the period 1 October 1964 to 30 Sep- considered by the Eighteenth World Health Assembly, tember 1965, supplies and equipment purchased by which in its resolution WHA18.37 drew attention to WHO amounted to 20 000 line items with a total certain aspects dealt with in the report and emphasized value of $2 850 000. This figure includes $550 000 for the importance of the Organization's playing an active reimbursable procurement made for Albania, China role in the development of requests for projects and (Taiwan), Greece, India, Jordan, Kuwait, Lebanon, in their planning. Mozambique, Nepal, Nicaragua and the United Arab Republic. Off. Rec. Wld Huth Org. 140, Annex 22. CHAPTER 13

CO- OPERATION WITH OTHER ORGANIZATIONS

For several years the framework for co- operation logy to Development gave particular attention in among organizations of the United Nations system 1965 to problems that might be overcome within a has been under scrutiny by governments.In 1965 a reasonable time by a concerted attack. WHO pre- number of important proposals were formulated pared or collaborated in the preparation of reports during discussions of intergovernmental and inter- on such problems to the Advisory Committee's third agency bodies in which WHO took part.Many of session, held in Paris in March, including, in par- these proposals -relating, for example, to the creation ticular, a report on environmental pollution and its of a United Nations Development Programme, to the controlrequested bythe Economic andSocial co- operative programme for the Development Decade, Council.The Organization took an active part in to evaluation, and to the development and utilization preparing the Second Communication of the Adminis- of human resources -were submitted to the United trative Committee on Co- ordination (ACC) to the Nations General Assembly at the end of the year, Advisory Committee, and took part in the fourth and their full implications for WHO will become sessions of the Advisory Committee and the ACC Sub - more clearly defined in the future. WHO continued Committee on Science and Technology held in Geneva to collaborate in the various inter -agency programmes in November.A meeting was arranged on this and in work with individual organizations of the occasion to acquaint members of the Advisory Com- United Nations system, with regional and other inter- mittee with the work of WHO, stressing the scientific governmental organizations, and with non- govern- and research aspects of its programme. At its fourth mental organizations. session the Advisory Committee requested WHO, in collaboration with FAO, to present to its next session in March and April 1966 a joint report on the expan- UnitedNationsDevelopmentDecadeandOther sion of production and consumption of protein -rich Co- operative Action foods prepared by industrial processing. Midway through the Development Decade, the In the ACC Sub -Committee on Economic and United Nations and specialized agencies reported Social Consequences of Disarmament, WHO took to the Economic and Social Council on the progress part in the drafting of an outline for the studies on made towards reaching the targets of the Decade. this question and of a questionnaire designed to obtain WHO reported that so far the consequences of the additional information from governments. Decade for health had been slight and indeed rather In 1964 WHO started a study on quality criteria disappointing, although some notable results had been for coastal water for bathing and other recreational achieved, particularly in malaria eradication.The uses; in this connexion a representative took part in Organization took part in the initial discussions of the thefifthsession of the ACC Sub -Committee on Sub -Committee on the Development Decade, which Oceanography in March 1965.A review of the was created by the Administrative Committee on available scientific and epidemiological data has been Co- ordination at the end of the year to give effect to prepared which will form the basis for further work in the recommendations of the Economic and Social 1966. Council and the United Nations General Assembly At the Second World Population Conference spon- on the Decade. As one of the agencies concerned with sored by the United Nations in August and Sep- social programmes in the second half of the Decade, tember, WHO arranged forthepresentation of WHO prepared a contribution to discussions with the papers on technical subjects at two meetings, one on United Nations on these programmes and on further population genetics and theother on mortality, co- operation with theSocial Commission of the morbidity and causes of death (see also pages 54 Economic and Social Council. and 68).Resolution WHA18.49 of the Eighteenth The Economic andSocialCouncil's Advisory World Health Assembly, on programme activities in Committee on the Application of Science and Techno- the health aspects of world population which might be - 83 - 84 THE WORK OF WHO, 1965 developed by WHO, was brought to the attention water supplies, wastes disposal and health standards of the Economic and Social Council and of the for building, and WHO is closely associated with its General Assembly during their debates on population execution.Advice was given to the United Nations problems. Statistical Office concerning health aspects of housing Collaboration in the inter -agency water resources censuses. WHO also continued to co- operate with ECA programme, previously effected through the WHO in work on housing and urbanization, which included sanitary engineer assigned to the United Nations a survey on the planning and economics of grouped Water Resources Development Centre, was continued housing in Africa and a study of the cost of water through the ACC Sub -Committee on Water Resources supply and distribution to housing projects under Development. Steps were taken in 1965, in consulta- conditions prevailing in African countries. tion with the United Nations Special Fund, to ensure WHO collaborated with the United Nations, ILO co- ordination at an early stage of these Fund projects and UNESCO in the programme of rural and com- in which several agencies are interested, by ad hoc munity development, as in previous years. meetings,bilateralarrangementsandreviewof In reports to the Economic and Social Council and forthcoming Special Fund projects at the annual in inter -agency discussions on youth and national meeting of the Sub -Committee. development, WHO underlinedtherelevanceof WHO prepared working papers on health aspects of health work to youth programmes. industrializationfortheregionalsymposia on As a sequel to the plans made in 1964 for co- industrialdevelopment tobe organizedbythe operation in an experimental programme for universal Economic Commission for Africa (ECA), the Eco- literacy, WHO took part in the World Conference of nomic Commission for Asia and the Far East (ECAFE) Ministers of Education on the Eradication of Illiteracy and the Economic Commission for Latin America organized by UNESCO in September 1965. The (ECLA) between December 1965 and February 1966; Organization indicateditsreadiness to co- operate it also prepared for participation in the Arab States as appropriate in projects having a health component. conference on industrial development due to take place The expansion and prolongation of the World Food in March 1966.Future collaboration concerning the Programme beyond theinitialthree -yearexperi- health aspects of industrial development in Latin mental period ending 31 December 1965 was recom- America was also discussed with ECLA (particularly mended by the Economic and Social Council at its with regard to occupational health, community health thirty -ninth session in July 1965 and approved later services and social security). in the year by the United Nations General Assembly WHO's interestinthe development of human and the FAO Conference. In its report to the Economic resources was expressed in discussions of the Economic and Social Council on the future of the World Food and Social Council, and in documents for the ACC Programme the United Nations /FAO Intergovern- Sub -Committee on Education and Training and mental Committee, at its seventh session in March contacts were increased with other United Nations 1965, recommended that the Programme be continued bodies with regard to national development planning. under the auspices of the United Nations and FAO WHO continued or expanded its collaboration with with the main objective of assisting the economic and theAsian and AfricanInstitutesfor Economic social progress of developing countries by the pro- Development and Planning and withtheLatin vision of food aid in conjunction, where appropriate, American Institute for Economic and Social Planning. with other forms of available aid.The terms of the It also took part in meetings of the governing bodies Programme now approved allow projects to be planned and advisory committees of the United Nations over a period of five years and therefore provide greater Research Institute for Social Development and the scope than before. Following the seventh session of the International Institute for Educational Planning, and IntergovernmentalCommittee WHO prepared a in consultations with the ACC concerning the pro- statement indicating the health -promoting activities gramme of the United Nations Institute for Training most likely to benefit from the food aid that can be and Research (see also page 61). provided under thesubstantiallyprolonged Pro- WHO took part in the discussions on the five -year gramme, and exploring the areas promising most programme on housing, building and planning for the fruitful collaboration.This was presented to the second half of the Development Decade, which is also Intergovernmental Committee at its eighth session in concerned with urbanization (see also page 36). This Rome in October and substantial developments are programme, which was formulated by the United expected. At the same session the project linking food Nations Centre for Housing, Building and Planning, aid with a malaria eradication programme was for- takes account of WHO's activities in connexion with mally approved (see also page 4). CO- OPERATION WITH OTHER ORGANIZATIONS 85

United Nations Special Fund and the Expanded Pro- Co- operation with Individual Organizations gramme ofTechnicalAssistanceforEconomic Besides taking part in inter -agency programmes, Development WHO continued to work with individual organizations At its January and June sessions, the Governing of the United Nations system on matters of common Council of the United Nations Special Fund approved interest. As most of this work is carried on from year four new projects for which WHO is executing agency, to year, only new developments are reported here. raising the total number of such projects to ten. The new projects are an extension of the survey of water United Nations. WHO took part in the Third supply resources of Greater Calcutta, with advice United Nations Congress on the Prevention of Crime to the Government of India on certain urgent interim and the Treatment of Offenders, held in Stockholm in schemes; a master plan for water and sewerage for August, and in the meeting of the United Nations the city of Istanbul and the neighbouring industrial Advisory Committee of Experts on the same subject. area; protection of river waters against pollution For the Congress, WHO prepared and presented in Poland; and reorganization and development of papers on mental health aspects of crime prevention, the School of Nursing in Niamey, Niger. and of juvenile delinquency in developing countries. oftheEighteenthWorld Other projects of interest to WHO awaiting Special Resolutions Health Fund approval include a project in Argentina aimed Assembly concerning the desirability of amending Article 3 of the Single Convention on Narcotic Drugs at strengthening the Pan American Zoonoses Centre. A number of projects for which WHO assistance has and of adopting control measures for certain depen- been requested are mentioned in Chapter 3: they dence- producing drugs were placed before the United include projects for waste disposal and water supply Nations Commission on Narcotic Drugsatits in Malta, the development of a master plan for a twentieth session in December. The Commission sewerage system for the Manila metropolitan area, recommendedadministrativemeasurestoreduce Philippines, and the preparation of a master plan for delays in drug controls, pending possible amendments water supply and sewerage for Dakar and the sur- of Article 3. rounding areas, in Senegal. Under the agreement with the United Nations Relief and Works Agency for Palestine Refugees in The Organization has continued to advise the Special the Near East, which was extended by virtue of Fund on the health implications of requests being resolution WHA18.24 of the Eighteenth World Health considered by the Fund; such advice was given for Assembly, WHO continued to provide the Director over fifty projects in 1965. During the year WHO was of Health Services and other healthstaff for the often called upon to provide consultants to advise Agency. WHO also collaborated with the United on health aspects of projects being executed by other Nations High Commissioner for Refugees and ILO agencies.Practical measures to ensure such partici- in providing health services to refugees in Africa. pation have been discussed with FAO in connexion with the many projects designed to develop land, WHO's co- operation with regional economic com- water and agricultural resources, and with the United missions and regional developmentinstituteshas Nations in connexion with the public health and already been mentioned earlier in this chapter in the sanitation aspects of urban planning and housing section on the Development Decade. projects. Meanwhile, WHO participatedinfive UNICEF. The UNICEF /WHO Joint Committee on FAO /Special Fund projects, providing a total of Health Policy held its fourteenth session in Geneva seven consultants, and discussions took place with in February. It discussed development of basic health regard to WHO participation in a further thirty -one services, immunization programmes for the control FAO -assisted projects and four projects assisted by and eradication of poliomyelitis, measles and smallpox, the United Nations. a review of BCG vaccination within the tuberculosis In the Expanded Programme of Technical Assistance, control programme (see page 8), a review of jointly the two -year project programming was continued for assisted leprosy control projects, and the need to the 1965 -1966 biennium.The working capital and strengthenhealthcomponentsinnutritionpro- reserve fund was increased to the level of US $13 grammes (see also page 56). million and the contingency allocation for urgént In accordance with revised procedure, only one requests was again authorized at 10 per cent. of the session of the Executive Board of the United Nations estimated resources for the biennium. Children's Fund was held during 1965; it took place Projects financed under the Expanded Programme in New York in June. A number of policy questions and Special Fund are shown in the list in Part III of were considered, most of them in the field of health. the Report. (See also page 80.) These included :" Reaching the Young Child "; the 86 THE WORK OF WHO, 1965 report of the fourteenth session of the UNICEF /WHO Advisory Committee on the Application of Science Joint Committee on Health Policy ;1a review of and Technology to Development. leprosy control projects; the report of the FAO/ A joint meeting of the FAO Committee on Pesticides UNICEF Joint Policy Committee; the use of world in Agriculture and the WHO Expert Committee on food surpluses for the benefit of children; special aid Pesticide Residues was held in Rome in March to to countries lacking the personnel and structure to consider the evaluation of the toxicity of pesticide initiate normal programmes; criteria for emergency residues in food (see page 56), and a meeting of the aid; experience with local costs and research -oriented JointFAO /WHO ExpertCommitteeonFood projects.In addition, discussion took place on the Additives held in December discussed specifications possibility of UNICEF aid to family planning, a for the identity and purity and toxicological evaluation report on which is to be prepared by the Executive ofsomepreservatives,antioxidants,emulsifiers, Secretary, at the request of the Board, for its 1966 stabilizers, bleaching and maturing agents, acids and session. bases. By June 1965, UNICEF was providing aid for a In addition, FAO and WHO collaborated in the total of 543 long -range projects in118 countries, Second International Meeting on Veterinary Edu- including 169 projects in basic health services (mainly cation, and in a seminar on the feeding of industrial maternal and child health), 136 in disease control workers, held in Alexandria (see page 131).Both and ninety -eight in nutrition.Of the total UNICEF organizationsco- operated with UNICEFand allocations approvedat the1965session,about UNESCO inappliednutrition programmes (see 60 per cent. were for health projects, including disease page 56). control, of which US $15 843 500 was allocated to UNESCO. The past eight years have seen a steady cover previous commitments and US $14 716 500 for increase in work with UNESCO in the general field of new projects.The projects in which UNICEF and school health.In 1965 arrangements were made for WHO are jointly providing assistance are among the publication of a jointly compiled source book on those listed in Part III. " PlanningforHealthEducationinSchools ". WHO participated in a UNICEF- sponsored Latin Advisory services in health education were provided American Conference on Children and Youth in to five countries for joint education and health pro- National Planning and Development held in Santiago. grammes, which were also assisted by UNICEF. UNESCO and WHO reviewed the status of health ILO. The Joint ILO /WHO Committee on the services and the health education aspects of school Health of Seafarers met in March (see page 58). programmes in countries of the Eastern Mediter- ILO co- operated with WHO in the inter -regional ranean Region. For further information, see page 47. travelling seminar on health in agriculture, which was held in the USSR in August (seealso page 58). IAEA. Consultationscontinuedbetweenthe WHO took part in ILO meetings of experts concerned Directors - General of IAEA and WHO for the purpose with pneumoconioses, with the health of indigenous of improving co- ordination on health programmes, and populations, and with the revision of the international the exchange of liaisonofficers between the two classification of occupations, in the first ILO Inter - organizations led to increased discussion in the early American Advisory Committee, and in meetings of planning stages of projects of mutual interest. A the International Social Security Association which comprehensive study was startedof methods of is affiliated to ILO. improving overall programme co- ordination with IAEA.For work carried out in co- operation with FAO.Co- operation has continued with FAO in IAEA, see pages 57 -58. many fields of common interest, particularly with WMO. Co- operation with WMO is mentioned on regard to the zoonoses and certain parasitic diseases, page 34. veterinary public health (see Chapter 2) nutrition programmes, food additives and the Codex Alimenta- ICAO and IMCO.Reference to co- operation on rius (see Chapter 5). quarantine matters with the International Civil Aviation Discussions with FAO have led to still closer co- Organization and the Inter -Governmental Maritime operation between the two organizations with regard Consultative Organization will be found on page 31. to Special Fund projects with both agricultural and health implications, and to the preparation of reports Regional Intergovernmental Organizations requested by the Economic and Social Council's As in previous years, a number of projects in the South -East Asia and Western Pacific Regions received 1 Off. Rec. Wld Hlth Org. 145, Annex 4. assistance from the Colombo Plan.WHO again CO- OPERATION WITH OTHER ORGANIZATIONS 87 collaborated with the South Pacific Commission, have been invited to attend meetings of expert com- providing some of the staff for a seminar on village mittees and scientific groups and other technical hygiene and healtheducation sponsored by the meetings organized by WHO. The informal consul- Commission.The WHO liaison officer with ECA tations at secretariat level have also been intensified, continued to maintain liaison also with the Health, and more liaison officers have been appointed by the Sanitation and Nutrition Commission of the Organi- non -governmental organizations. Also, the invitations zation of African Unity. The Organization for extended to WHO to send representatives to various Co- ordination and Co- operation in the Control of meetings of non -governmental organizations have Major Endemic Diseases (OCCGE) collaborated with increased considerably. WHO in work for communicable disease control in During the Eighteenth World Health Assembly, the some African countries. The Council of Europe and representative of the World Medical Association made WHO established the basis for exchange of information a statement in which he spoke of the assistance WHO on pharmaceutical quality control. Co- operation had given to the Association, the International Com- with the Inter -American Development Bank, the Inter - mittee of the Red Cross and the International Com- American Committee of the Alliance for Progress and mittee of Military Medicine and Pharmacy with the Institute of Nutrition of Central America and regard to a problem of international medical law. Panama is mentioned in Chapter 15. In connexion with the scheme of the League of Red Cross Societies for strengthening national societies, Non -governmental Organizations WHO assisted in the development of plans for activ- At itsthirty -fifth session, in January 1965, the ities in health education and related fields,to be Executive Board decided that the World Psychiatric carried out by the Junior Red Cross. As in previous Association be admitted toofficial relations with years there was joint action with the League of Red WHO, thus bringing the total number of non- govern- Cross Societies in assisting countries in emergencies, mental organizations with thisstatus to sixty -six. in particular with regard to the medical needs arising A list of these organizations is given in Annex 6. from the famine in Somalia and an epidemic of Examples of the valuable assistance received from smallpox in the Democratic Republic of the Congo. these organizations during the year are mentioned in Contacts were made with several non -governmental the appropriate chapters of this report. organizations not in official relations with WHO, The non -governmentalorganizationsinofficial including the International Committee on Laboratory relations with WHO were invited, as usual, to the Animals (seepage44),theInternational Dairy meetings of the World Health Assembly, the Executive Federation,theInternationalOrganizationfor Board and Regional Committees. In accordance with Standardization,the InternationalSocialSecurity the recommendations of the Executive Board in its Association and the Union of International Associ- resolution EB29.R56, an increased number of them ations.

PART II

THE REGIONS WHO REGIONAL OFFICES AND THE AREAS THEY SERVE

AREA SERVED, AS AT 31 DECEMBER 1965, BY:

Regional Office Regional Office for Regional Office for the for Africa South -East Asia Eastern Mediterranean O Regional Office Regional Office for Regional Office Regional Office for the Americas /PASB for Europe the Western Pacific

WHO 41515 CHAPTER 14

AFRICAN REGION

Member States in the African Region are fully pre- eradication projects -for example, in Togo (see aware that in the field of health, as in other fields, the page 97). task to be accomplished is a long and arduous one, and that although substantial progress has been made Communicable Disease Control in some directions the attainment of the final goal, Malaria the highest possible level of health, is still a long way off. In 1965 two malaria eradication projects -in Mau- ritius and Zanzibar -progressed towards the consolidation phase; malaria pre- eradication programmes National Health Planning and Integration of Public were in operation in Cameroon, Dahomey, Ghana, Health Services Liberia, Mauritania, Mozambique, Northern, Western One of the obstacles to the development of the health and Eastern Nigeria, Sierra Leone, Togo and Uganda, services is the shortage of trained health personnel and a plan of operations was signed for a similar including that required for setting up permanent programme in Senegal.In these pre- eradication pro- health planning departments at the national level. grammes the aim is to strengthen as soon as possible Requests to WHO for direct assistance in the prepara- the basic health infrastructure whose services will tion of plans for the development of health services undertake specific functions in the later stages of the areincreasing.Advisers provided by WHO are malaria eradication programme, as well as to establish helping, on committees and other national planning a national antimalaria service.Preparatory planning bodies, to implement programmes and to co- ordinate has started for similar programmes in Congo (Brazza- the activities of ministries of health with those of other ville), Gabon, Equatorial Guinea, Guinea, Ivory Coast, ministerial departments (for education, agriculture, Madagascar and Zambia, and a pre- eradication survey and public works, for example).Health plans are has been started in Réunion. also increasingly becoming an integral part of broader The two international malaria eradication training plans for economic and social development. centres,at Lagos and Lomé, continued to train In five countries in the Region- Gabon, Liberia, personnel for these programmes. Beyond that level, Mali, Niger and Sierra Leone -WHO continued to there remains a need to facilitate long -term professio- help in drawing up national health plans designed to nal training, within the world programme for malaria ensure a rational utilization of the resources available eradication but adjusted to the African Region's and the methodical development of health services special requirements in pre- eradication.Large -scale over a period of ten years. experiments with new insecticides undertakenwith WHO public health advisers have also helped to the co- operation of the governments concerned were establish or strengthen the basic structure of rural continued in Nigeria and were completed in March 1965 in Uganda. health services. Such action is, of course, a prerequisite for the success of communicable disease control campaigns.It also marks an important step towards Tuberculosis the integration into the general public health services Twelve countries have continued to receive assis- of programmes and special projects in maternal and tance from WHO in tuberculosis control, emphasis child health, nutrition and health education, and of being laid on the creation of national antituberculosis communicable disease control. services as an integral part of the general health ser- Good progress has been made in such integration vices.Programmes in this field are of three types : in Nigeria, and similar programmes are in operation assistance in the implementation of tuberculosis con- in Burundi, Kenya (see page 96), Madagascar and trol programmes - including prophylactic measures Upper Volta. The strengthening of the basic health (such as BCG vaccination), case -finding and treatment infrastructure is also an important aspect of malaria -and in the promotion of training of all categories of - 91 - 92 THE WORK OF WHO, 1965 professional and auxiliary personnel; surveys leading East African Virus Research Institute acts as Regional to recommendations for the improvement or creation Reference Centre for Anthropod -borne Viruses. of tuberculosis control services (in 1965, for example, an advisory team visited the Central African Republic, Treponematoses Guinea, and Upper Volta); and the analysis and evaluation at the Tuberculosis Epidemiological Centre A number of treponematosis control programmes in Nairobi, Kenya, of the considerable amount of have reached the consolidation and surveillance stages. epidemiological data collected in the various pro- The yaws control programmes are being gradually integrated into existing health services- either the grammes. rural health services or services for the control of the major endemic diseases.Serological and epidemiolo- Leprosy gical evaluation of the results of these campaigns has UNICEF and WHO continued to provide assistance been carried out by an inter -regional epidemiological for leprosy control, twenty -three countries receiving team which has already completed a survey in Eastern such help in 1965. In some, leprosy case -finding has and Northern Nigeria. Arrangements have been made been undertaken during campaigns againstother for a regional advisory team to begin work in 1966 communicable diseases, particularly yaws, treatment in Western Nigeria. being provided by a specialized service. The present policy is to integrate leprosy treatment into the existing Parasitic Diseases health services with a view to overcoming the prejudices Trypanosomiasis, onchocerciasis and bilharziasis that hinder control of this disease, and to reducing the continue to be serious public health problems; know- cost of operations. During the year the Organization ledge of these diseases isstill insufficient and their evaluated the progress in leprosy control programmes incidence may increase as agricultural and industrial in five countries and made recommendations for their areas are developed. WHO is therefore intensifying future development.It also supported research on its activities in this field- assistance is being provided antileprosy drugs at the leprosy research centre at in connexion with training and research and surveys Uzuakoli, in Eastern Nigeria, and the Marchoux are being promoted to determine the repercussions Institute at Bamako, Mali. of social and economic development programmes on health. Smallpox Trypanosomiasis surveys were carried out on the Smallpox is endemic in a number of African coun- shores of Lake Victoria, in Kenya, Uganda and the tries and epidemics still occur in some areas.The United Republic of Tanzania, and also in Burundi, continuing seriousness of the problem in the Region and help was given in the preparation of an application led to the initiation in 1965 of an inter -country project to the United Nations Special Fund for assistance for smallpox eradication. By arranging for the provi- with a project concerning this disease in Kenya. In sion of expert advice for the countries of West, collaboration with the Nigerian Institute for Trypano- Central and East Africa, the Organization is assisting somiasis Research, a training course in trypanoso- in those areas to prepare and apply effective, large - miasis was held in November and December 1965 at scale control measures, and also to ensure adequate Kaduna. ThiswasforEnglish -speakingphysi- co- ordination with such measures in adjacent areas. cians, entomologists, veterinarians and agricultural WHO has also continued to assist in the production engineers from the African and Eastern Mediter- of freeze -dried vaccine, and arrangements have been ranean Regions. Support was given to the Institute for made for the award of fellowships and for the procure- continued studies of the metabolism of trypanosomes ment of the necessary supplies and equipment. and of immunology and chemotherapy problems. In onchocerciasis, the Organization has increased Arboviruses and Enteroviruses its support for research: the Helminthiasis Research Unit at Kumba, Nigeria, and the Muraz Centre at Support has been given to the South African Bobo -Dioulasso, Upper Volta,receivedassistance Institute for Medical Research, in Johannesburg, and for research on transmission cycles, trials of antifilarial the Pasteur Institute of Dakar, for the preparation and drugs and entomological studies of the Simulium testing of arbovirus antisera, and to the East African vectors. An inter -country advisory team was esta- Virus Research Institute at Entebbe, Uganda, for blished and a survey in the Volta River Basin on oncho- research work on tropical virology. The South African cerciasis was planned as the first stage in a pilot control Institute for Medical Research also acts as WHO's project in that area. Implementation was delayed by Regional Reference Centre for Enteroviruses and the recruitment and other difficulties. AFRICAN REGION 93

Inbilharziasis, WHO supportedcross -sectional and in Uganda it participated in preliminary technical studies in Nigeria, Senegal and the United Republic studies for the preparation of a water supply and of Tanzania, a skin test survey in Southern Rhodesia, sewerage plan for Kampala and its suburbs. research at Kampala, Uganda, at Makerere College, In addition to its work in urban sanitation and water University of East Africa, and the screening of anti - supplies, WHO has provided technical advice for schistosomal drugs (see also page 23).In Ghana a thirteen UNICEF -assisted projects for environmental scientist provided by WHO undertook a biogeogra- health in rural areas.All the activities in environ- phical reconnaissance and a survey of the potential mental health make evident the paramount importance snail hosts in preparation for a pilot control project. of collaboration between the Ministries of Public The East Africa Common Services Organization Health and Public Works and other ministerial depart- (EACSO) has asked for assistance in the implementa- ments concerned in such programmes. tion of a pilot project that could later serve as a demonstration area with the support of the Govern- ment of the United Republic of Tanzania.The plan- Maternal and Child Health ning of preventive action is particularly necessary in connexion with development projects involving irriga- In the assistance provided to thirteen countries in tion work or dam construction, which could favour the development of their maternal and child health the spread of the disease. services, emphasis has been placed on integration into the general health services.Priority is given to the training of staff, including auxiliary health personnel. Environmental Health WHO has provided assistance to the departments of paediatrics at the University of Ibadan and Makerere Assistance was continued to many environmental University College, and to the Institute of Social health projects in the Region: new projects were Paediatrics at Dakar, for the training of professional implemented in Madagascar and Mauritius, and a personnel and for biomedical research (on such pro- project in Niger was at an advanced stage of planning blems as sterility and its socio- economic repercussions, by the end of the year.In this field WHO's assistance biogenetic factors affecting growth in the newborn, is directed mainly to the training of sanitation per- immunological problems in the young child, etc.). sonnel, and the provision of urban water supplies. The assistancein maternal and child health has Fellowships for training in public health engineering been given jointly with UNICEF and, often, also have been awarded to nationals of Burundi, Dahomey, in co- operation with the InternationalChildren's Senegal, Chad and Togo.Since itis desirable for Centre. adequate training facilities to be available within the In February 1965, WHO sponsored a meeting of Region, visits were made to Kenya and Madagascar professorsof paediatricsatMakerere University to study how the standard of existing teaching institu- College, the first meeting of its kind in the African tions could be improved or specialized courses in Region (see also page 98). sanitary engineering organized.Internationalaid, both multilateral and bilateral, will be necessary for the creation of a school of sanitary engineering in the Nutrition Region, and the United Nations Special Fund has been approached on this subject. Training for other In nutrition the main emphasis has again been on personnel, such as sanitation or health assistants, the training of personnel in the various categories. was provided in thirteen environmental health projects At the university and post- university level, fellowships in operation in the Region. have been given for attendance at nutrition courses Seven internationally assisted urban water supply organized (in English) in London and Ibadan, and projects were in operation or in preparation in 1965. (in French) in Paris and Dakar; and for personnel at For the largest of these, the water supply and sewerage other levels courses and a seminar were organized by programme for the metropolitan Accra /Tema area, a nutrition adviser based at Dar -es- Salaam (Tanzania). the United Nations Special Fund has agreed to provide Towards the end of the year a second nutrition adviser further assistance, for the expansion of the project. was appointed to organize similar courses at Lomé, The technical studies for a water supply for Cotonou Togo, for countries of West Africa.In Senegal, (Dahomey) were completed forinclusioninthe training in nutrition has been developed at the Institute government application for the necessary funds.In of Social Paediatrics of the University at Dakar and Burundi, WHO helped to prepare a preliminary pro- also at the school of nursing and the school for health ject for the extension of the water supply in Bujumbura, auxiliaries (agents sanitaires). 94 THE WORK OF WHO, 1965

Closer collaboration has been promoted between education methods in the health services. Effort is also the nutrition services and the maternal and child health being made to provide simple and practical educational services with a view to developing nutritional activities material especially suitable for the training of health within maternal and child health programmes. Two auxiliaries in health education techniques and for use experts on nutrition were assigned to maternal and at the village level.Support has been given in the child health programmes in Burundi and in Uganda. organization of seminars; for example, WHO provided Assessment of the nutrition position has been a health educator to help in a six -week training semi- undertaken inseveral countries either by general nar, starting in October1965,to provide information surveys as in Chad and Kenya, or in connexion with on health education methods to instructors and super- specialized investigations such as those on nutritional visors of the health services of Kenya and the United anaemias in Mauritius. Eight countries were visited Republic of Tanzania.The seminar was organized to discuss with the governments future WHO help by the British Society for International Health Educa- in the field of nutrition, and in Madagascar a WHO - tion and was held in Dar -es- Salaam. assisted project was started for the organization of a nutrition section in the Ministry of Health and the development of a nutrition programme. Education and Training of Health Personnel Collaboration with FAO in the field of food and nutrition was further developed.The Joint FAO/ WHO's training activities in the African Region were WHO /STRC 1 Regional Food and Nutrition Com- intensified, particularly with regard to assistance to mission for Africa produced its first bulletins, which educational institutions and fellowships. were distributed in French and English, and special In1965over fifty teachers participated in thirty - files summarizing activities on food and nutrition in five projects for the development and establishment several countries have been compiled. A regional of schools of medicine, nursing and midwifery in the seminar, jointly sponsored by FAO and WHO, on Region: thus,in addition to providing continued the planning and evaluation of applied nutrition assistancetothepaediatrics departments of the programmes in Africa, was held at the end of October University of Ibadan, Nigeria, and of Makerere in Nairobi and was attended by nutritionists from University College, Uganda, the Organization recruited African countries and representatives of international teaching staff in preventive and social medicine for agencies. the latter and in physiology and biochemistry for the medical training centre in Dar- es- Salaam. Arrangements were made to assign an expert to Health Education Cameroon to help the planning committee in preparing Following the technical discussions at the fourteenth for a school of medicine in Yaoundé, following the session of the Regional Committee (September 1964) recommendations of a consultative group on medical on the theme " Health Education in Africa : the Selec- education which had visited Cameroon in1963. Two tion of Appropriate Techniques ", the countries in the experts visited Kenya for further consultations with Region have shown great interest in integrating health regard to a new medical school in Nairobi, which a education with the general health services, particularly WHO team of advisers had discussed with the author- in the rural areas. Lack of trained personnel continues ities in1964. Advice was given in Zambia on the to be a great handicap. Countries have been asked steps to be taken to set up a school of medicine at to recommend candidates fortraininginhealth Lusaka. education at the university level, but suitable appli- The number of fellowships awarded has increased, cants are rare. particularly those for basic medical studies, the fellows WHO is helping governments to incorporate health being placed whenever possible in training institutions education in public healthactivities and training within the Region. The need to train teachers for the programmes -for example, in demonstration or pilot new medical schools is being recognized and a number programmes or in specialized courses, such as those of post -graduate fellowships have been awarded for given at the two international malaria eradication the future teaching staff of a medical school to be set training centres at Lagos and Lomé. Contacts with up at Yaoundé. governments have continued to be as frequent as In the field of nursing, WHO assisted a number of possible, and WHO has assigned health educators to countries in improving national nursing services, and Nigeria and Uganda to assist in extending health in drawing up standards for basic nursing training. Many WHO nurse educators have helped in organiza- 1 STRC - Scientific, Technical and Research Commission tional and teaching work at schools of nursing and of the Organization of African Unity. midwifery in the Region.In Niger, for instance, AFRICAN REGION 95

WHO is helping to develop the school of nursing and projects.Collaboration with FAO has continued in to draw up curricula that are adapted to the needs the fields of nutrition and communicable diseases, of the country.There is a great shortage of nurse and also with regard to certain environmental health educators, and considerable attention has been paid projects. to the strengthening or establishment of schools of Contacts with the Economic Commission for Africa post -basic nursing education: assistance was given were facilitated by the presence at the ECA headquar- in the development of post -basic nursing education at ters at Addis Ababa of WHO's liaison officer; WHO Accra, in the establishment of a school at Ibadan (see again took part in the teaching at the two ECA training also page 97) and in the preparations for a similar centres -the centre for vital and health statistics, at school at Dakar. Yaoundé, and the African Institute for Economic The training of auxiliary health personnel forms Development and Planning, at Dakar. WHO main- part of most WHO- assisted projects in the Region tained relations with theScientific, Technical and and was also the subject of the technical discussions Research Commission of the Organization of African at the fifteenth session of the Regional Committee Unity through the Joint FAO /WHO /STRC Regional (see below). Assistance with the training of community Food and Nutrition Commission for Africa. Contacts health and auxiliary nurses was provided to Ghana, with the Organization for Co- ordination and Co -oper- Kenya, Nigeria and the United Republic of Tanzania. ation in the Control of Major Endemic Diseases (OCCGE) have increased. Finally, in countries receiving assistance from many Assistance to the Democratic Republic of the Congo different sources, the Organization has worked in As in the past, WHO continued to provide the close contact with those responsible for programmes Democratic Republic of the Congo with a team of of bilateral aid in order to ensure the co- ordination consultants, and with teaching and operational per- that is essential if maximum use is to be made of sonnel.In 1965 the plan to reduce operational staff national and international resources. as increasing numbers of national personnel become qualified was put into effect. With the gradual return to more normal conditions, WHO personnel were The Regional Committee able to carry out their duties throughout the country. Teaching programmes and the training of medical The fifteenth session of the Regional Committee and other health personnel continued to receive special for Africa, held in Lusaka, Zambia, from 6 to 16 attention. Twenty -one assistants médicaux completed September1965, was attended by representatives their medical studies by the end of 1965, bringing to of twenty -six Member States in the Region -including, 128 the number of Congolese doctors so trained. for the first time, Malawi and Zambia, which became Four medical students continued theirstudies in full Members in April1965 -and two Associate Europe. Members.Representatives of four European coun- Training of technicians proceeded in the fields of tries attended on behalf of certain territories in the laboratory work, dentistry, radiology, entomology and Region. The United Nations Special Fund and Tech- pharmacy. In addition, WHO has continued assistance nical Assistance Board, UNICEF, ECA, one inter- in the training of nurses and hospital administrators. governmental and three non -governmental organizations were represented. The Director -General was present during the first week of the session. Collaboration with other Organizations The Committee discussed the report of the Regional Relations were maintained with the United Nations, Director on the work of WHO in the Region during therelatedagencies, and withintergovernmental the period 1 July 1964 to 30 June 1965.It welcomed organizations and agencies for bilateral assistance the progress achieved in the integration of specialized that are contributing to social and economic develop- services into the general health services, but noted that ment in Africa.Close co- operation continued with lackofstatisticalinformation hinderedrational UNICEF in the large number of jointly assisted health planning of comprehensive national health services. programmes.Relations with the United Nations The Committee stressed the importance of research Special Fund developed during the year: WHO pro- on communicable diseases, and it was suggested that vided technical advice on health aspects of some consideration be given to the establishment of a regio- projects assisted by the Special Fund and prepared nal institute of biomedical research. With regard to applications to the Fund for its assistance with certain education and training,the Committee accepted environmentalhealthandcommunicabledisease principles for priorities in the award of fellowships, 96 THE WORK OF WHO, 1965

and requested that support for all types of training session in Leopoldville in September 1966; italso programmes be continued and intensified: the develop- decided that the seventeenth session, in 1967, would ment of health services in many countries was being take place at the Regional Office. hampered by lack of qualified personnel, and the assistance of WHO in this field was urgently needed. The proposed programme and budget estimates Administrative Developments in the Regional Office for the Region for 1967 were examined and endorsed Dr Alfred Quenum, who was nominated for the post for transmission to the Director -General. of Regional Director for Africa at the fourteenth With regard to smallpox, after considering resolu- session of the Regional Committee, took up his duties tion WHA18.38 adopted by the Eighteenth World on 1 February 1965 following his appointment by Health Assembly, the Committee made an appeal to the Executive Board. countries in the Region to initiate or intensify national The organization of the administrative and financial campaigns against this disease, and requested that services remained unchanged, but certain modifications more technical guidance and advisory services be were introduced in the health services to strengthen made available and that assistance be given to coun- programme planning. tries in obtaining vaccine, transport and equipment. The award of contract for the extension to the The subject of the technical discussions was " Auxi- Regional Office building was made in October; work liary Health Personnel and their Training in the began before the end of the year and is expected to Development of Health Services in Africa ". Emphasis take eighteen months. The estimated cost is approxi- was placed on the need for training auxiliaries as mately US $1 500 000: contributions from Member clearly distinct members of the health team, with States totalled US $339 301 at the end of October precise responsibilities, not to be confused with the 1965, and a provision of $1 000 000 has been authorized highly trainedprofessional workers in any field. by the Health Assembly. " The Place and Role of Vital and Health Statistics The third and fourth apartment units constructed in the Development and Execution of Health Pro- to alleviate the staff housing problem in Brazzaville grammes " was the subject selected for the technical were completed in July: thirty -six new single and discussions in 1966. family apartments have now been built. In all, eighty - At the invitation of the Democratic Republic of the eight staff housing units, including twenty under lease Congo, the Committee decided to hold its sixteenth or rental agreements, are now available.

Some Aspects of Work in the Region

A list of projects current during the year will be measures to ensure co- operation between central and found in Part III.The following have been selected local authorities in the operation of a rural health for fuller description. centre. A system of compulsory registration of births and deaths started experimentally in the first quarter of Development of Basic Health Services, Kenya 1963 in two pilot areas has proved satisfactory and is being expanded. The scope of this WHO- assisted project, which was Eleven training courses for staff of several categories started in 1962 primarily for the purpose of developing have been organized at the demonstration centre, maternal and child health.services, has since 1964 where over 250 health workers (providing staff for been expanded into a programme for the establishment nearly sixty teams) have been trained. of comprehensive healthservicesthroughout the Four conferences on community health services have country, to include activities related to the training of been organized for health officers with a view to improv- auxiliary health personnel in nutrition and sanitation. ing their understanding of the basic health services Since 1963 WHO has participated in the work at and the supervision of the activities of health centres. the National Demonstration Centre set up at Karuri WHO staff have taught in government health schools the previous year. The 'centre is used for the practical and have visited areas where staff trained at Karuri training of the various categories of personnel needed are working to assess the quality of their work and for the peripheral health services and for trying out give advice. AFRICAN REGION 97

Centre for Post -basic Nursing Education,Ibadan, transport and some equipment.The Rockefeller Nigeria Foundation is assisting this project by providing for the construction, furnishing and equipment of a build- When a nursing adviser was appointed in the ing for the Department of Nursing. Regional Office for Africa in 1959, the pressing need With a view to overcoming the difficulty of finding was recognized for the development of post -basic nurs- nurse educators with both the qualifications and ing courses in Africa, particularly for the preparation university experience necessary, discussions have been of nurse educators and administrators in all fields of held regarding the establishment of a liaison with the nursing.It was apparent that in many countries it University of Boston School of Nursing. would be some time before there existed either the After the appointment of the WHO nurse educators facilities for such programmes or the number of nurses in 1964 a year was spent planning the programme and qualified to benefit from them. The possibility was visitingallthe regions of Nigeria to explain the therefore considered of helping to develop such pro- project. Eighty -threecandidatesappliedfor the grammes in those countries which could also allow first course, which started in September 1965, and their facilities to be used by others. twenty -five were selected.At present only two of In 1962 the Federal Government of Nigeria reques- these come from countries other than Nigeria, but ted the assistance of WHO in establishing post -basic WHO is planning to make a certain number of fellow- nursing courses and plans were drawn up to start a ships available regularly to enable nurses from other programme in Nigeria, where there existed both the countries to participate in this programme. necessary facilities -at the University of Ibadan -and a sufficient number of qualified nurses to follow the Development of Basic Health Services to support a courses. Malaria Eradication Campaign, Togo The close co- operation of the university authorities and the fact that the nursing students are not isolated As early as 1953 action was taken in Togo to control but participate in the life of an established university malaria, one of the major endemic diseases in the have greatly contributed toachieving the broad country. A control project carried out along the coast objectives of this programme. did not achieve the anticipated success and had to be The purpose of the post -basic programme in nursing, abandoned in 1959.In 1962, an eradication plan which leads to a B. Sc. degree in nursing, is to prepare for the southern half of the country was turned into nurses as teachers and administrators for hospitals, a pre- eradication programme for the whole country, health centres, schools of nursing, and ministries of including the development of basic health services health.The curriculum, which has been developed needed to support eradication inits consolidation with particular reference to the needs of African phase. countries, covers the extent and types of health prob- WHO provided a malariologist, a public health lems likely to be encountered, the cultural and social adviser, an engineer, a laboratory technician and a factors affecting care of patients, the variety of clinical sanitarian. A consultant visited Togo during the last settings in which the nurse serves, staffing patterns, quarter of 1962 and advised on how co- ordinated and existing facilities for nurse training. development could be achieved. The biological and social sciences serve as the basis A demonstration area for public health training and for an understanding of factors affecting health and operational research was established at Vogan in the nursing practice, and clinical courses in psychiatric southern region -the first programme of this kind and public health nursing provide a comprehensive in Africa. basic training for nurses who will later be called upon The objectives are to develop a comprehensive, to work as teachers and administrators. The training efficient and economical health service, to achieve programme includes an introduction to methods and the total coverage needed as quickly as possible, and types of research, and students are helped to identify to facilitate the gradual absorption into the health potential areas for nursing research in Africa. service of a mass campaign against malaria. Progress WHO is providing four nurse educators, one of has been made towards these goals: the health unit whom is Professor and Head of the Department of with its auxiliary posts and the tasks of each health Nursing. They will eventually be replaced by Nigerian worker in the team have been clearly defined and nurses who are studying to qualify for the necessary close co- operation at all levels has been established degrees. UNICEF is providing stipends for Nigerian between those engaged on this and related work, and students covering fees, residence in the university, with the general population.All advisers in other 98 THE WORK OP WHO,1965

WHO- assisted projects in Togo have assisted in this and personnel for preventive and clinical care were project in one way or another, particularly by training inadequate, and that a comprehensive approach to auxiliary health staff for rural centres. child care, covering preventive, curative and social In1965trials were made on ways of integrating aspects, was needed. into the routine work of the demonstration area the In discussing undergraduate training, special atten- surveillanceoperationsof the yaws,leprosy and tion was given to the problem of drawing up a curri- smallpox control campaigns, and of re- orienting the culum which would ensurecontinued recognition staff of specialized mobile teams to the duties of abroad of the medical diplomas of African universities comprehensive rural health units. and at the same time be adapted to local circumstances The demonstration area has been used to provide and to the realities of African life, where at present students of the malaria eradication training centre at the physician is primarily a leader and supervisor of Lomé with practical training during the last three auxiliaries. weeks of their courses. The project was visited by It was agreed that universities should take an interest the members of the Organization for Co- ordination in the training programmes for paramedical and and Co- operation in the Control of Major Endemic auxiliary personnel, and work in close co- operation Diseases (OCCGE) who attended the annual minis- with the ministries concerned. Such training should terial inter -country meeting held in Togo in October be at the simplest possible level compatible with the 1964to discuss the integration of mass campaigns functions of auxiliary health workers. into basic health services. Regarding the training of paediatric specialists, it became apparent that there were considerable diffe- Meeting of Professors of Paediatrics, Kampala, Uganda rences in the number of specialists required and the A meeting of professors of paediatrics, sponsored formulationof recommendationsforspecialized by WHO, was held in Kampala from22to26February paediatric training presented greatdifficulties.A 1965.Participants were from the Faculties of Medicine period of general field work prior to specialization of Lagos, Ibadan, Makerere University College (Kam- was considered necessary. The advantage of training pala), Lovanium (Leopoldville) and Dakar, from paediatric specialists locally with, however, a limited Addis Ababa and New York.Paediatric specialists period of training abroad, was emphasized, and from Dar -es- Salaam and Khartoum also took part. suggestions were made as to how to overcome the The opening address of Dr L. Zake, Minister of problem of governmental recognition and the superior Education of Uganda, set the theme for the meeting. prestige value of overseas qualifications. He emphasized that the basic problem confronting The group discussed the research undertaken at medical schools in Africa was to teach the students the paediatric departments of medical schools in how to adapt the discoveries of modern medicine to Africa. the conditions in rural Africa. The meeting was useful in providing an opportunity Discussion of paediatric problems showed that a for exchange of information on problems of paediatrics preponderance of the infant and child morbidity and existing in the African Region, on the undergraduate mortality in Africa was associated with malnutrition, and post -graduate training of doctors, on research, communicable diseases and parasitic infections, and and on the role of universities in the training of para- could be prevented.It was recognized that services medical and auxiliary personnel. CHAPTER 15

THE AMERICAS

This chapter describes the work done in the Region operation of the Organization: one, in English, in of the Americas, where the Pan American Sanitary Port of Spain, Trinidad, another in Portuguese, in Bureau has a dual capacity as secretariat of the Pan Recife, Brazil, and one in Spanish in Santiago, Chile, American Health Organization and Regional Office for members of the national health services. of the World Health Organization. The Organization participated in the review of national development plans carried out by the Inter - American Committee of the Alliance for Progress. National Health Planning It also maintained close co- operation with multi- The national health planning activities promoted by lateral and bilateral finance agencies providing material PAHO and WHO made appreciable progress in and technical assistance for the implementation of 1965. During the year emphasis was laid on the study development plans. of administrative problems in the preparation and implementation of national health plans, on methodology and applied research, and on training of Strengthening National Health Services staff in both international and national courses. Projects in national health services make it possible By mid -year the initial phase of the national health to study problems prevalent in each country, to pro- planning process had been completedineleven pose appropriatesolutions,and to promote the countries and was fairly advanced in four others. establishment of adequate services, widely distributed Twelve countries had prepared national health plans, over national territory so that preventive and curative and the same number had reached the stage of drawing health care can be brought to an increasing number up " programme budgets ".In eight countries, the of people.During 1965 there were in operation in implementation of the national health plans was fully the Region twenty -nine projects in which the Organiz- under way. ation collaborated with the governments of twenty - The situation with regard to health planning in the four countries and territories to ensure the sound Americas was reviewed at a meeting held in Puerto development of health services.The need to extend Azul, near Caracas, Venezuela, early in 1965.It was the scope of health services was brought out at two recognized that though considerable progress had seminars held in the summer of 1964 in Poços de been made in some countries, in others the planning Caldas, Brazil and in March 1965 in Cuernavaca, process was seriously hampered by lack of adequate Mexico (see also page 111).At these meetings, which information, of suitably trained staff, and of properly were attended by directors and senior staff of health organized and administered healthservices.The services and directors of malaria eradication program- establishment of a regional health planning centre to mes from all the countries in the Americas, a review serve as a focal point for health planning activities in was conducted of all the existing resources in each of the Americas was advocated. the countries of the Region. The discussions brought The third international health planning course, in out the necessity for better co- operation between the English, lasting four months, was held at Johns Hop- general health services and those for malaria eradi- kins University, while the Latin American Institute for cation and the need to increase the scope of general Economic and Social Planning, in Santiago, Chile, health services in ensuring the effectiveness of epi- co- operated with PAHO /WHO in holding the fourth demiologicalsurveillanceduringthemaintenance international health planning course, also for four phase of malaria eradication programmes. months, in Spanish.In Buenos Aires, Argentina, a In seven countries demonstration area projects were seminar on the role of administrationinhealth developed for the testing of health techniques and the planning was attended by representativesof the training of personnel, in the hope that, as has happened countries of the southern part of the continent. Three in similar projects already completed, the standards national courses in planning were given with the co- and procedures initiated in the demonstration areas - 99 - loo THE WORK OF WHO, 1965 would become routine practice in all activities through- programmes was convened jointly by FAO and the out the country. Organization to work outpractical methodsof A meeting to analyse the relationships between the evaluation for field- testing before the regional seminar medical programmes of social security institutions to be held in 1966. and departments or ministries of health and other Work continued on the plans to establish a nutrition governmental organizations was arranged in July, in centre in the Caribbean area. Washington, D.C., jointly by PAHO and the Organiz- Under the auspices of PAHO /WHO, and with the ation of American States.The two organizations assistance of UNICEF, a seminar on iodization of also collaborated in providing advice to the Ministries salt for the prevention of endemic goitre was held in of Health and the social security medical services of Salta,Argentina, with participants from thirteen Costa Rica, El Salvador, Honduras and Nicaragua, countries. A meeting of research workers from the with a view to finding a formula for better co- operation laboratories taking part in the PAHO co- ordinated among those services. research programme on genetic and dietary factors An advisory group on the planning of hospitals and in endemic goitre was held in Mexico to review pro- other health services, which also met in Washington gress achieved and to analyse the findings of the past in July, discussed hospital planning as an integral two years.As a basis for future programmes of part of the national health plans. assistance,information was collected on training The Organizationgaveassistanceinhospital facilities in schools of nutrition and dietetics, and planning to several countries, including Argentina, visits were made to seventeen schools in eight coun- Jamaica, Paraguay, Uruguay, and the Central Ame- tries. rican countries.The rehabilitation centre organized The Institute of Nutrition of Central America and in Santiago, Chile, continued to receive aid from the Panama participated in the planning, organization Organization, which also assisted several Central and and implementation of nutrition surveys in El Salvador South American countries in establishing services to and Guatemala carried out in collaboration with the train staff for physical and social rehabilitation work. United States Interdepartmental Committee on Nutri- tion for National Defence. Maternal and Child Health Research was continued with a view to developing new protein sources and to improving existing sources In maternal and child health, priority continued to and to determining the effect of nutrition status on be given to the integration of paediatric and obstetric the work output of adults.Studies were developed care and nutritional care of mothers and children with on new methods of determining nutrition status. The comprehensive systems of preventive and curative investigation on the relationship between infection medical services.In Panama assistance was given and nutrition continued with special emphasis on with a pilot project in a rural district to serve as a virus diseases. model for other areas of the country. The annual estimated production of the low -cost Facilities for training in maternal and child health vegetable protein mixture Incaparina manufactured and social paediatrics are being developed at the two in Colombia and Guatemala in 1965 was 3 4 million training centres established in Santiago, Chile, and in pounds -an increase of 95 per cent. over the amount Medellín, Colombia, to serve all the countries of the produced in 1964. Region. Both centres organized three -month courses Several training courses for physicians, dieticians on child health services for teachers of paediatrics. and other nutritionspecialists were given at the The Organization also assisted a four -month course Institute during the year. in Guatemala on the growth and development of the child,stressing nutritional aspects and the use of anthropometric data in health programmes; several Mental Health courses on public health nursing for midwives in The Organization continued to advocate the inte- Argentina; and, in Brazil, courses in paediatrics for gration of mental health programmes into national medical practitioners and a seminar on obstetric health services, and to emphasize service to the com- nursing. munity through psychiatric wards in general hospitals, treatment in out -patientclinics,and home care. Nutrition Assistance in the preparation of mental health pro- The regional nutrition programme was concerned grammes was given to the Governments of Colombia mainly with the planning and evaluation of projects, and Jamaica, and to Venezuela, where a psychiatric education and training, and research.A technical nursing consultant helped to organize services and to advisory group on evaluation of applied nutrition train nursing staff in psychiatry. THE AMERICAS 101

The third of a series of Latin American seminars Nursing and Nursing Education on mental health was held in Kingston, Jamaica, with In order to help strengthen and extend nursing thirty -four participants from the Caribbeanarea. Among thesubjects discussed were education in services, a total of twenty -six nursing advisers were psychiatry, psychiatric nursing care and design of provided to countries in the Region for varying periods, mental hospitals. and advice was also given by the nurses attached to The epidemiology of mental disorders in Latin each of the zones. America was discussed at a meeting in Washington, Courses and training programmes for all categories D.C., at which a number of recommendations were of nurses, from graduate to auxiliary,are being developed in all the countries of the Region. made concerning programmes of research in this field In 1965 in the Region.During the year a programme of twenty nurse educators provided by the Organization were working in fourteen Latin American countries research on that subject was started in Chile with the participation of the Organization, special attention and various English- speaking countries and territories of the Caribbean area. being given to alcoholism and epilepsy. The Founda- tions' Fund for Research in Psychiatry continued to Some 100 000 largely untrained nursing auxiliaries are known to be working in the health services of the assist with research being carried out in Buenos Aires, Argentina, on the interactions of schizophrenic patients various countries of the Region, and the need has been and their families. recognized for preparing nursing staff to give such The Latin American Mental Health Information auxiliaries in- service training and to organize pro- Centre continued with the preparation of a directory grammes for training more of them.The approach of psychiatrists and to collect information on facilities to the problem of shortage of instructors for the of psychiatric institutions for a second directory. A training of auxiliaries through " programmed instruction " is described on page 46. survey was started on mental health legislation in the countries of Latin America. Public Health Laboratory Services

Dental Health There was a great demand for assistance from the Organization in the development and expansion of The Organization's work in dental health in the health laboratory services.Advice in this field was Americas has been concentrated on the improvement provided to Argentina, Brazil, Chile, Colombia, Costa of training facilities.Thus, assistance was continued Rica, Ecuador, El Salvador, Guatemala, Haiti, Hon- tothe pilot department of social and preventive duras, Mexico, Panama, Peru, Trinidad and Tobago, dentistryforLatin America of the University of and Venezuela.Assistance was also given for the Antioquia, Colombia, particularly in the organization training of laboratory technicians. of regular courses for auxiliary dental staff and the With the co- operation of the Adolfo Lutz Institute establishment of a new programme of instruction of Sao Paulo, Brazil, the Organization prepared, for reducing by one year the traditional five -year curri- the Tenth Meeting of Ministers of Public Health of culum for the training of dentists. Advice in establish- Central America and Panama, in 1965, draft standards ing or strengthening departments of preventive and for 300 food products, as had been requested at the social dentistry was also given to the University of 1964 meeting. These standards were discussed with a Concepción,Chile,the National Universities of view to their inclusion in the health regulations of each Colombia and El Salvador and the Central University country, in order to facilitate the trade in food products of Venezuela, where advice was also given on the revi- within the Central American common market. sion of the curriculum of the faculty of dentistry.In A seminar on food and drug control was held in Venezuela also, assistance was given in the preparation Guatemala in September to review the standards of a comprehensive study of dental problems to serve recently approved and co- ordinate the activities of as a basis for a national policy on the teaching of the countries of Central America and of Panama in dental health and the practice of dentistry. regard to the laboratory analysis of foodstuffs.This The Organization continued, jointly with the W. K. seminar was attended by laboratory technicians from Kellogg Foundation and the United States Public each of the countries of the area. Health Service, to assist the University of Sao Paulo in A report on the possibility of establishing inter- developing activities in dentistry in the International national reference laboratories for the control of phar- Training Centre of Epidemiology and Research.In maceutical preparations was submitted to the XVI Costa Rica assistance was given in organizing a Meeting of the Directing Council of PAHO /seven- meeting on the teaching of dentistry and other aspects teenth session of the WHO Regional Committee for of dental health. the Americas. 102 THE WORK OF WHO, 1965

Advice was provided to the Governments of Argen- held in Washington, D.C., under the sponsorship of tina and Chile on the organization of laboratory theOrganization and withtheparticipationof services for the control of pharmaceutical preparations. engineers from countries of North, Central and South The Organization assisted countries to control the America, to review water supply programmes in the quality of the biological products produced in their Americas in the light of the goals established by the national institutes by placing at their disposal labor- Charter of Punta del Este, and to plan the work to be atory reference services. accomplished in the second half of the decade, 1961- 1971. Environmental Health In the field of education and training in environ- As in recent years, the main emphasis in environmental health, the chief aim was to establish in the mental health in 1965 was on the promotion and Region a network of universities through which an development of water supplies and waste disposal effective training programme can be developed.By systems, in both urban and rural areas. the end of the year agreements had been concluded It is estimated that during the period 1960 -1965 with thirty -seven universities in eighteen countries. the countries of Latin America received over 350 mil- Under these agreements the Organization is to provide lion dollars from international loan agencies to finance advice on the revision of training programmes and water supply and waste disposal programmes for both on the equipment of sanitary science laboratories as urban and ruralareas,benefitingapproximately well as help in the organization of short courses. 43 million people.It is calculated that the countries Thus the Organization co- operated with local uni- will invest in these programmes an amount of the order versities in seventeen countries in making available of 320 million dollars, not counting sums invested in thirty -six specialized short courses mostly on water local programmes financed exclusively by national supply. These courses were concerned with local funds. The fact is, however, that the loans diminished problems and with specific needs voiced by the national in 1964 and 1965 in comparison to the amounts authorities. invested in previous years. The Organization, together The programmes of training in sanitary engineering with the Inter -American Development Bank, which supported by the United Nations Special Fund in is the largest financial contributor to water supply Brazil and Venezuela became operational in 1965. and waste disposal programmes in the Region, initiated In addition to training activities, these programmes activities to stimulate the preparation of larger numbers include research in the field of environmental health. of projects suitable for loans. The Organization assisted the Centre for Research in During 1964 and 1965 countries have earmarked Environmental Engineeringof theUniversityof for rural water supplies about 20 million dollars, Buenos Aires, Argentina, in the preparation of a which, added to the international loans, brings the request to the Special Fund with a view to an expansion investmenttoapproximately 45milliondollars. of its activities. Considerable progress has been made in the develop- During theyear, PAHO initiatedco- operative ment of suitable organizations to implement water activities with the Economic Commission for Latin supply programmes in rural areas.Several countries America (ECLA) in the fields of water resources, have reorganized the relevant departments of their housing and urbanization by assigning two staff ministries of health; others have established special members to work at the ECLA headquarters at San- departments in the water supply agencies. tiago, Chile; it also participated in two ECLA mis- The assistance given by the Organization to water sions, one to Uruguay, on water resources, and the supply and waste disposal programmes during 1965 other to Argentina and Uruguay, on housing. consisted of advisory services and the assignment of A regional seminar was organized in Venezuela on experts to various countries, the award of fellowships, the sanitation problems of squatters' settlements near and help in the development of training. large cities. Assistance was given to the Government of Hon- Assistance was given to Venezuela in studying rural duras in the organization and administration of the housing development; to Brazil, with regard to wastes central water authority; and to the water authority disposal in the metropolitan area of Sao Paulo; to inManagua, Nicaragua.In Argentina andthe Brazil, Peru and Venezuela in connexion with sewerage Central American countries advisory services regarding in Porto Alegre, Lima and Caracas (see pages 109 to the participation of the community in water supply 110); and to Grenada in reviewing plans for disposal programmes were increased.In Costa Rica food of waste water into the sea. provided by the World Food Programme was distributed in the communities where rural water supply Occupational Health programmes were being developed. The Institute of Occupational Health and Air At the end of October a regional conference was Pollution Research in Santiago, Chile, established THE AMERICAS 103 with assistance from the United Nations Special Fund, methods for solving them.These have included with WHO as executing agency, increased its activities, increasing the number of DDT spraying cycles per with several laboratories in operation and three courses annum, antilarval measures, and the use of mass drug being held in 1965.Advice on the organization and administration, which has given good results, parti- operation of occupational health services was provided cularly in problem areas of Mexico. Use was also to Argentina, Bolivia, Colombia and Venezuela, and made of chloroquinized salt in British Guiana, where to Brazil, where WHO assisted in the planning and it has now been distributed for over four years, and, implementation of programmes to solve the problem on an experimental basis, in Surinam. of air pollution in the metropolitan area of Sao Paulo. In March 1965 the second seminar on the role of The first steps were taken towards the establishment general health services in malaria eradication was of a series of posts to measure air pollution in ten held in Cuernavaca, Mexico, with the participation urban centres of Latin America. of directors- general and officials of health services and directors of malaria eradication programmes from the countries of Central and North America, Radiation Protection and the Caribbean area (see also page 111). The Organization continued its advisory assistance Three films related to programmes of radiation to tuberculosis programmes in Argentina, Bolivia, protection, originally produced in English, were sup- Chile, Colombia, Costa Rica, the Dominican Repu- plied with Spanish sound tracks and were widely blic,Ecuador,ElSalvador,Honduras,Mexico, distributed throughout Latin America, particularly Nicaragua, Peru and Venezuela.Programmes in in schools of medicine and public health. Recreo, Argentina, in Santiago, Chile, and in Queré- A seven -month course was held in Santiago, Chile, taro, Mexico offered comprehensive services to their on the clinical use of radioisotopes for the diagnosis respective communities, including case -finding, chemo- of endocrine,renal,hepatic,cardiac and gastro- therapy and BCG vaccination. intestinal diseases (see page 108). The finalreport on theregionalseminar on The Organization continued its collaboration in the tuberculosis -held latein1964inVenezuelaat programme being implemented jointly by six Latin and Caracas, and attended by tuberculosis and American countries and the United States Public public health specialists of the Region- stressed the Health Service for measuring the radionuclide content need for a community approach to the tuberculosis of the air and of milk and thereby establishing the problem based on epidemiological and socio -demo- degree of risk for the health of the population. The graphic information, and emphasized that a tubercu- United States Public Health Service supplied the losis programme must achieve adequate coverage, necessary equipment for the six stations, which are build up permanent services with uniform procedures, operated by local staff. and be integrated in the general health programme. The distributionof material on recommended Eradication or Control of Communicable Diseases techniques and procedures for tuberculosis control programmes was further increased. During the year the continent -wide malaria era- Plague is enzootic in several countries of South dication programme continuedtoprogressata America.Cases of human plague were reported in satisfactoryrate, although in several countries of Bolivia, Brazil, Ecuador, Peru, and the United States Central America and in Mexico the situation remained of America.The Organization assisted the Govern- stationary. There was some reduction of areas in the ment of Brazil to carry out a survey of the plague consolidation phase in 1964 because a number of focus in the north- western part of the country. In programmes had reverted to the attack phase on Ecuador a control programme was developed in 1965 account of increasing transmission of malaria.The with the assistance of the Organization. countries with the largest proportion of persons living Progress continued in the development of leprosy in areas in the consolidation phase during 1964 and control programmes in the Americas. The leprosaria 1965 were Bolivia, Colombia, Ecuador and Honduras. are being progressively turned intohospitals for Administrative problems continued to hamper the leprosy sufferers. Wherever possible, the patients development of activities in some countries, though receive ambulatory and domiciliary treatment, and substantial progress has been made. During 1965 the the compulsory isolation of patientsis no longer eradication of malaria wasofficiallycertifiedin insisted on.During the year further assistance was Jamaica and in Trinidad and Tobago. given to Member countries in the organization of The technical problems reported in previous years systems of data registration to give information on still caused difficulty, and studies are continuing on the status of the disease, the determination of objectives 104 THE WORK OF WHO, 1965 inthe areas covered by the programme, and the Guadeloupe, Dominica and the British Virgin Islands. development of suitable systems of administration The major difficulty encountered by the campaign and evaluation. in the Caribbean area is the resistance of A. aegypti A course was held in Caracas, Venezuela, on the to chlorinated hydrocarbon insecticides, a problem prevention of deformities in, and the physical rehabi- which exists to a greater or lesser degree in all the litation of, leprosy patients, with emphasis on the countries and territories of this area and in the northern use of non -surgical methods. This course was spon- part of South America.Trials with organophos- sored jointly by the Government of Venezuela and the phorus compounds of low mammalian toxicity have Organization, and was organized in co- operation been planned to start shortly. with the American Leprosy Mission, the New York The laboratory for susceptibility studies on strains Department of Physical Medicine, the World Reha- of A. aegypti established in 1962 in Kingston, Jamaica, bilitation Fund, Inc., and the International Society withassistance from theOrganization,collected for Rehabilitation of the Disabled. valuable information on strains of the mosquito pre- With regard to smallpox, assistance continued both valent in the Caribbean area and on the effects of to countries where cases still occur, with a view to certain insecticides, and this will certainly contribute intensifying eradication programmes, and to countries to solving the problem that has arisen in the eradica- carrying out campaigns to maintain the level of tion of the vector in this area. immunity of the population.The amount of freeze - During the year the Pan American Zoonoses Centre, dried smallpox vaccine produced in the Americas which receives assistance from WHO, started a survey now exceeds the needs of the Region. on fourimportant zoonoses(rabies,brucellosis, Ataseminaronvenerealdiseases,heldin hydatidosis and bovine tuberculosis), in co- operation Washington, D.C., under the joint sponsorship of the with the public health and agricultural authorities of Organization and the United States Public Health the various countries. Service, discussion was concentrated on the following The Centre's work on rabies included continued four subjects: venereal diseases and their epidemiolo- studies on antirabies vaccine for cattle, assistance to gical characteristics; case -finding in the control of countries in the testing of canine and human anti- venereal diseases; clinical and laboratory diagnosis; rabies vaccines, and a training course on methods of education and training of staff.There were thirty - laboratory diagnosis of rabies, for technicians from eight participants from twenty -five countries.Two Argentina, Bolivia, Brazil, Chile, Peru and Venezuela. courses on laboratory techniques for the diagnosis TheCentreprovidedassistancetoArgentina, of venereal diseases were held inSantiago, Chile, Colombia and Chile on programmes for control of with the participation of the Communicable Disease brucellosis and continued its studies on hydatidosis. Center of the United States Public Health Service. Assistance was given to the veterinary schools in The Aedes aegypti eradication campaign made Argentina, Brazil, Chile, Colombia, Ecuador, Gua- limited progress during the year owing to the develop- temala, Mexico, Uruguay and Venezuela in revising ment of resistance and the reintroduction of A. aegypti and strengthening their public health teaching. into areas that had been cleared. In the northern part of South America, the Guianas were still infested, Health Statistics and also Venezuela, where administrative and technical difficulties have hampered the campaign's progress. Work continued on the collection, analysis and In Central America, reinfestation was found to have distribution of morbidity and mortality statistics.In occurred in El Salvador, a country that had been free July, the publication Reported Cases of Notifiable from the mosquito since 1957.Eradication activities Diseases in the Americas in 1963 was printed and were re- started in that country, and at the same time distributed both in Spanish and in English. a survey was launched to determine the precise extent Training activities included the organization of and exact causes of the reinfestation.In the United courses for intermediate -level statisticians in Argen- States of America eradication measures were begun tina, Chile, Colombia and Peru as in previous years; in 1964 in part of the infested area.The campaign in and in Paraguay and Jamaica courses began for the this country is to take in nine south -eastern states, first time. Over a hundred students from eleven coun- Puerto Rico and the Virgin Islands of the United tries and ten territories were trained in these courses. States. Despite the training work carried out each year, In the Caribbean area the campaign was in its final the number of properly qualified statisticians available phase in Trinidad at the end of 1965 and is still develop- in Latin America is still inadequate, particularly with ing satisfactorily in Cuba. However, operations remain regard to hospital statistics. Hence attention has been suspended in Jamaica, Haiti, the Dominican Republic, given to the training of auxiliary staff who could THE AMERICAS 105 collect the basic information, tabulate it, and forward A similar course at the Faculty of Medicine of the itto more highly developed services. In sixteen National University of El Salvador was attended by courses, held in eleven countries during the year, thirtyprofessors, from Costa Rica, El Salvador, instruction was given in basic procedures of collection, Honduras, Mexico, and Nicaragua. registration and notification of information in local The Organization and the Rockefeller Foundation health services and in hospitals. About 500 auxiliaries assisted in organizing courses to train professors of attendedthesecourses. The Organizationalso microbiology and immunology at the Institute of contributed to the training of auxiliaries by helping Microbiology of the University of Brazil. Several with short courses for groups of instructors. faculties of medicine began to send personnel to the The training activities of the Latin American Centre Institute for training. for Classification of Diseases included the organization Two courses in social paediatrics were held for of two courses in Brazil, each with thirty participants; medical officers in maternal and child health services a course in Ecuador with forty -seven students; and and professors of paediatrics from a number of Latin courses for intermediate -level statisticians in the use of American countries with the aim of emphasizing the Classification in Jamaica and in Argentina, with a social and preventive medicine aspects in their acti- total of seventy -five students. In addition, two courses vities.One of the courses was held in the Faculty in hospital statistics were held, one in Chile and the of Medicine of the University of Chile and the other other in Venezuela.The Organization assisted in at the University of Antioquia, Colombia. these activities. In October the Organization co- operated with the The Organization provided advice on various aspects Faculty of Medicine in El Salvador in holding the of health statistics to a number of countries, including first seminar on the teaching of anatomy, which was Colombia, the Dominican Republic, Jamaica and attended by professors from the Central American Paraguay.In Argentina and Trinidad and Tobago it countries and from Panama. gave advice on hospital statistics. Visits were paid to the Schools of Medicine of The last of the data for the Inter -American Inves- Medellín, Colombia, and Monterrey, Mexico, to make tigation of Mortality were received, comprising the final arrangements for the project under which these case histories of more than 45 000 deaths in the schools will organize international courses to train twelve cities included in the study.In February a staff for medical schools in teaching and adminis- meeting of the collaborators in the study from each tration ;and also to twenty -seven departments of of the twelve cities was held to review the findings pathology in eight Latin American countries to explore of the first year and to discuss their analysis and plans the possibilities of selecting a centre for the training to publish the results of this study. of teaching staff in this discipline. The Organization co- operated with the Brazilian Education and Training Association of MedicalSchoolsinorganizing a seminar on the teaching of nutrition in schools of Education and training continued to be basic to medicine, and with the Colombian Association of most of the Organization's programme of assistance Medical Faculties, the International Epidemiological in the Region.Courses, educational meetings, fellow- Association and the Milbank Memorial Fund in ships, assistance to teaching institutions and other organizing a seminar on epidemiology, which was activities of primarily educational character are refer- attended by professors of clinical subjects from the red to in preceding sections -not to mention the seven medical schools of Colombia. numerous projects of which training, though not the The Organizationprovidedsixteenexpertsto primary purpose, is an important element. thirty -three schools of medicine in eighteen countries Between 1 December 1964 and 30 September 1965 in the Region during the year. 633 fellowships were granted in the Region, of these With regard to post -graduate education in public 214 were financed by WHO and sixty -nine by the health, the Organization continued its assistance to all United Nations Expanded Programme of Technical public health schools of Latin America.It sponsored Assistance. a travelling seminar for deans of schools of public Increased emphasis was laid on assistance to medical health of Canada and the United States of America schools for the preparation of teaching staff.Advice tovisit corresponding institutionsin countries of was given in organizing a course on medical teaching the Mediterranean area (see page 62). methods in Caracas, Venezuela, with the participation Assistance was giveninorganizing the Fourth of twenty -five professors from the five schools of Conference of Directors of Schools of Public Health medicine in Venezuela and two professors from the in Latin America held in Puerto Rico in November School of Medicine of the University of Uruguay. 1965.The meeting discussed the teaching of epide- 106 THE WORK OF WHO, 1965

miology in schools of public health.Participating high natural background radiation areas of Brazil; were the deans and professors of epidemiology of the and the studies initiated in 1964 in Venezuela in public health schools of Argentina, Chile, Colombia, connexion with research on the biology and ecology Mexico, Peru and Venezuela and of the three schools of Rhodnius prolixus, the vector of Chagas' disease. in Brazil, as well as of the school of public health in In these studies isotope markers are being used to Puerto Rico. investigate the movement of triatomid bugs in and Work continued on the study of manpower resour- around infested houses. ces for health services that was begun in Colombia in 1964 with the participation of the Government, the Publications Colombian Association of Medical Faculties,the Apart from the monthly Boletín de laOficina Milbank Memorial Fund and the Organization. A Sanitaria Panamericana, which is now in its forty- national morbidity survey was started in mid -1965, fourth year of publication and has a press -run of and progress was made in the census of physicians 11 000 copies, the Organization continued its pro- and nurses and in the study of educational and nursing gramme of publishing various scientific documents, institutions.These studies were expanded to cover particularly those related to seminars held during the dental services, and planning began for the survey of year. Among the publications issued were the Spanish institutional resources. version of Control of Communicable Diseases in Man; Filmstrips and other audiovisual material in Spanish a collection of articles on nursing; a study of plague and Portuguese were also prepared by the Organization in the Americas; a handbook in Spanish on medical and distributed for use in professional education at pedagogy 1 and some publications on health planning. schools of medicine, public health, nursing, etc., and visits were paid to various institutions in the United States of America to study audiovisual methods that The Regional Committee might be useful for medical education in Latin Ame- The XVI Meeting of the Directing Council of the rica. Pan American Health Organization, which was also the Other activities included a study on the training of seventeenth session of the WHO Regional Committee auxiliary health staff, carried out in Brazil, El Salvador, for the Americas, was held from 27 September to Mexico, Peru and Venezuela. 8 October 1965 in Washington, D.C.The session The Organization continued to serve as secretariat was attended by representatives of all the Member of the Medical Education Information Centre. At its States in the Region except Bolivia and by those of 1965 meeting the Centre decided to extend its functions France, the Netherlands and the United Kingdom of to include provision of information on the assistance Great Britain and Northern Ireland. The session was given by countries outside the Region to medical also attended by the Director -General and an Assistant education in the Americas. Director -General of WHO and representatives of the For work in nursing education, see page 101. United Nations, the United Nations Children's Fund, ILO, theOrganization of AmericanStates and Research twenty -one non -governmental organizations. In 1965 the PAHO Advisory Committee on Medical The opening meeting included the formal inaugu- Research and also the XVI Meeting of the Directing ration of the new headquarters building of the Pan Council of the Pan American Health Organization / American Health Organization and the WHO Regional seventeenth session of the WHO Regional Committee Office for the Americas. It took place under the chair- for the Americas, reviewed the progress achieved in manship of the Minister of Public Health and Welfare fifty -five research projects being implemented in the of Mexico, Dr Rafael Moreno Valle, the outgoing Americas, and the Council approved a number of President,2 and was attended by authorities of the others. These include studies on immunology in United States Government, members of the diplo- Latin America and on Chagas' disease in Brazil, matic corps and representatives of international and an extensive study on biomedical research policy in national organizations.Addresses were delivered by nine Latin American countries, and a proposal for Dr Rafael Moreno Valle; the Secretary of Health, establishingaregionalmedical libraryinLatin Education and Welfare of the United States of America. Progress in the establishment of centres to America, Mr John W. Gardner;theSecretary - train teaching staff in the field of population dynamics General of the Organization of American States, was also reviewed. Research projects in progress included the study in Bridge, E. (1965) Pedagogía medica Pan American Health Chile of the effects of manganese poisoning; the Organization, Washington, D. C. 2 Dr Raymundo de Britto (Brazil) was elected President for the biological and physical studies begun in 1963 in the remainder of the session. THE AMERICAS 107

Dr José A. Mora; the President of the W. K. Kellogg ment of the United States of America in 1964; referred Foundation, Dr Emory Morris; the Director -General again to the need for more international technical of WHO and the Director of the Pan American and financial assistance; urged governments to con- Sanitary Bureau/ Regional Director of WHO. tinue voluntary contributions to the PAHO Special To mark the inauguration of the new building Malaria Fund and the WHO Malaria Eradication various scientific and cultural functions were held and Special Account; and recommended PASB to continue gifts by several countries of works of art were pre- negotiations withinternationalcreditinstitutions sented.The first PAHO scientific lecture was given with a view totheirincludingintheirpolicy by Professor René Dubos on the subject of man and financing of malaria eradication programmes through his environment. long -term,low- interestloans. Italso urged the Appreciation was expressed to the Government of rapid implementation of suggestions made during the United States of America for its gift of land, and seminars on the role of the general health services to the W. K. Kellogg Foundation whose grant had in malaria eradication and of recommendations of permitted the construction of the new regional head- the PAHO Advisory Committee on Malaria. quarters building; and contributions were authorized A report declaring Argentina free from Aedes from the PAHO Building Fund to the Special Fund aegypti was accepted; governments of areasstill for Health Promotion -set up to serve the original infested were urged to give a high priority to eradica- purpose of the Kellogg grant. This grant was provided tion campaigns, while others were urged to prevent by the Foundation to permit progress in certain fields reinfestation by maintaining active surveillance proof health work, it being agreed that it would be used grammes, and the Director was requested to help initially to finance construction of the new. building. intensify and accelerate eradication campaigns. The Committee urged governments to continue The Committee reviewed the report of the Director national vaccination campaigns against smallpox, as of PASB /Regional Director of WHO. The PAHO well as maintenance, epidemiological surveillance and budget for 1966, totalling US $8 800 000, was adopted, research activities, requesting those in a position to and the preliminary draft programme and budget for do so to supply smallpox vaccine, resources and spe- 1956 examined.The proposed 1967 WHO budget for cialist services to countries in need of them; it re- the Region was approved for transmission to the quested the Regional Office to assist in obtaining Director -General. financial and material resources and to prepare for The financial report for PAHO for 1964 and the the XVII Pan American Sanitary Conference / eigh- corresponding report of the External Auditor were teenth session of the WHO regional committee an approved.In view of progress made with plans for estimate of the financial and other resources required payment of arrears within a definite period by coun- for the eradication of smallpox. tries subject to the provision for suspension of voting The Committee recommended governments to give rights, their representatives were permitted to vote proper attention toair and water pollution and at the session. requested the Director to study the cost of control The Committee approved amendments to the Con- measures, to seek to determine more feasible and stitution of PAHO providing for the Conference to practical methods of water treatment, and to collect meet every four years at the headquarters, in Wash- and disseminate to governments scientific information ington, but with the possibility of meeting elsewhere on the health and economic implications of air and on the invitation of the government concerned and water pollution and on remedial measures. with the acceptance of the Conference or the Directing After considering resolution WHA18.49 on pro- Council. gramme activities in the health aspects of world popu- Noting the report on voluntary non -governmental lation which might be developed by WHO, the Com- contributions for health work and the agreement of mitteeinvitedthe Directortoprovidetechnical 15 October 1964 between the Director -General of advice, co- operate with the Inter -American Committee WHO and the Director of the Pan American Sanitary of the Alliance for Progress in its studies, conduct Bureau on the World Health Foundation of the studies on population dynamics related to the pro- United States of America, the Committee requested gramme of PAHO and support professional training the Director to continue to co- operate in the plan for activities. world health foundations. The assistance of PAHO and WHO in developing The Committee expressed satisfaction with the effort a co- ordinated research programme for the Americas made by governments to provide resources for the was commended, as were the programmes to deter- malaria eradication campaigns and with the assistance mine present and future needs in respect of medical given by PAHO, WHO, UNICEF and the Govern- and other professional health personnel and auxiliary 108 THE WORK OF WHO, 1965

staff, and to establish American centres for the training administration of hospitals and other health services, of teachers and research workers.The Committee training of staff, and related matters. endorsed the recommendations of the PAHO Advisory Other resolutions dealt with the training of auxiliary Committee on Medical Research concerning a bio- workers; the international transportation of human medical research policy for the Region. remains; epidemiological research on epilepsy; and The Committee expressedappreciationtothe a number of resolutions of the Eighteenth World countries of Central America and to Panama for their Health Assembly and the WHO Executive Board of help, through the Institute of Nutrition of Central interest to the Regional Committee. America and Panama, in solving the problem of With regard to the procedure for presentation of malnutrition, and requested the Director to continue reports to the Directing Council, the Director was support to the Institute. recommended to continue the project evaluation pro- On quality control of pharmaceutical preparations, cess begun in the last two years in order to provide the Committee commended the Regional Office for its the governing bodies with a clearer account of progress prompt collaboration with governments in implemen- made in the development of programmes in which tation of resolution WHA18.36, and recommended the Organization was collaborating with governments. that PAHO continue to study the possibility of es- The Committee approved the annual report of the tablishing international reference laboratories for the Chairman of the Executive Committee, and decided analysis of pharmaceutical products. to establish official relations with the Pan American It recommended that the Organization continue to Federation of Associations of Medical Schools. promoteresearchforimprovingnationalhealth Technical discussions were held on " Methods of planning theory and practice, and tostudy the improving Vital and Health Statistics ".The topic establishment of a Pan American centre for health " Means for promoting and making Effective the planning as a focal point for such activities in the Co- ordination between the Services and Programmes Region. of Ministries of Health, Social Security Institutes and On the basis of a report on the third annual meetings other Institutions that conduct Activities related to of the Inter -American Economic and Social Council Health " was selected for the technical discussions at the Expert and Ministerial Level, the Committee in 1966. endorsed the recommendations on foot -and -mouth disease,ruraland urban watersupplies,health investments and requests for international loans for Administrative Developments in the Regional Office health care activities in land settlement, road building, The new building constructed for the Pan American and urbanization projects. Sanitary Bureau /WHO Regional Office for the Ame- The Committee recommended that the Director ricas in the city of Washington, D.C., was inaugurated promote the development of better co- ordination in September (see page 106). betweensocialsecurity medical programmes and Further progress was made in the simplification those of ministries of health through studies, disse- and modernization of administrative practices and mination of information, advisory services, educational procedures. programmes and joint meetings of medical authorities, Toanalysemodernnutritionalconceptsand ministries of health and social security institutions. methods for including activities in this field in health The report of an advisory committee on planning plans, a seminar on applied nutrition was held at the of hospitals and health facilities was examined. The Institute of Nutrition of Central America and Panama Pan American Sanitary Bureau was recommended to (INCAP) with the participation of fourteenstaff expand its co- operation with regard to the planning members of the Organization, most of them country and organization of national healthservices,the representatives.

Some Aspects of Work in the Region

A list of projects current during the period under countries in the medical use of radioisotopes. Empha- review will be found in Part III. The following have sis was placed on the clinical application of radio- been selected for fuller description. isotopesinmedicinefordiagnosis,therapy and research, and on the control of hazards associated Training in the Medical Use of Radioisotopes, Chile with the use of ionizing radiation, for the patients to Arrangements were started in April 1960 for a five - whom radioisotopes are administered, the personnel year project to train physicians from Latin American handling the radioisotopes and the general public. THE AMERICAS 109

Plans were made to hold annually a course of train- Elsewhere, in the less populated areas, the problem of ing in fundamental radiation physics; in the use of supplying water is complicated by the difficult task of instrumentationfordetectionand measuringof transporting construction materials, equipment and ionizing radiation; in the planning and operation of manpower to districts where roads and communica- clinical laboratories where radioisotopes are stored tions are inadequate. or used; and in the application of various techniques The Ministry of Development and Public Works is using radioisotopes for the diagnosis and treatment responsible for the development and administration of of diseases in the different medical specialties. water supply and sewerage systems in the rapidly The W. K. Kellogg Foundation awarded a year's growing urban sectors and also for co- ordinating fellowship for the Chilean director of the training design standards, construction, and operation of the programme, and gave most of the equipment and programme in both urban and rural areas. Since 1962 supplies (at a cost of $20 000) required for establishing the water supply and sewerage systems in the rural areas the training centre at the Hospital del Salvador in of Peru have been the responsibility of a special Santiago.PAHO assisted with another $8000 of section in the Ministry of Health and Social Welfare. equipment and supplies, with fellowships, and with Hitherto the capital investment in the urban water the necessary radioisotopes for the courses attended supply and sewerage programme has been financed by PAHO /WHO fellows. The balance of the necessary from the annual national budget.However, external material as well as instrumentation was provided by financing is necessary for the intensified efforts being the Government of Chile. The National Health made to cater for the growing needs of the most Service and the University of Chile -and in particular important urban areas, and to reach the objective the Department of Medicine of the Hospital del accepted at Punta del Este of providing adequate water Salvador -provided theservices andfacilitiesof and sewerage for 70 per cent. of the urban population various specialty sections. by 1970. A total investment of US $60 000 000 over the The first course was started in July 1962, when the next five years will be required to meet this objective. necessary equipment and supplies had been obtained. In1963and1964theGovernmentinvested Of the four courses that have been given, those in 1962 $13 450 000 from the public treasury for the cons- and 1963 each lasted for six months; the duration of truction of new facilitiesor the improvement of the 1964 and 1965 courses was increased to seven existing systems in 145 communities, not including the months to allow for additional teaching in mathe- cities of Lima and Arequipa.For 1965 and 1966 an matics and for training in the techniques of handling amount of $9 300 000 was budgeted for water supply radioisotopes. and sewerage with an additional sum of $3 200 000 in By the end of 1965 twenty -one physicians and a the form of loans. medical technician had received training in the courses The Punta del Este objective will be reached before (three each from Argentina, Colombia, Costa Rica 1970 in Lima and Arequipa where autonomous cor- and Peru; two each from Uruguay and Brazil, and porations administer the water and sewerage pro- one each from Bolivia, Ecuador, El Salvador, Mexico grammes and where the works programme has been and Venezuela). As there is a continuing need for such financed in part by loans from the Inter -American training, the Organization's assistance is to be extended Development Bank(IADB),theExport-Import for at least three more years. Bank and the United States Agency for International Development (AID). For Lima, with a population of 1 800 000, $15 100 000 of the investment of $19 000 000 Urban Water Supply and Sewerage Programme, Peru weretheproceedsofloans from theExport - In Peru, the problem of supplying potable water Import Bank and AID.For Arequipa, with a popu- to the population (estimated at 12 million in 1965 and lation of 160 000, $4 000 000 of the investment of forecast to increase to 18 million by 1980) is in many $9 000 000 was a loan from IADB. ways similar to that in other Latin American countries. In 338 other urban communities, 49 per cent. of Itis,however, further complicated by the varied their total population of 2 900 000 are provided with topography, geology and climate, which result in water supplies and 40 per cent. with sewerage services. differing water criteria and requirements and thus To meet the 70 per cent. objective in these commu- affect the types of water systems that are technically nities,it will be necessary (taking into account the and economically feasible. normalpopulationgrowth)tosupply waterto The greatest shortages of water occur where the 1 140 000 and sewerage services to 1 300 000 people. needs are greatest: the coastal zone, where nearly With a view to achieving this objective, the Govern- 70 per cent. of the country's population is concentrated, ment drew up a national sanitary works plan.The has only 5 per cent. of the nation's water resources. firststage, starting in 1965 and involving a total 110 THE WORK OF WHO, 1965 investment of $13 500 000, provides for water supply the Ministry of Public Works. PAHO has assisted and sewerage systems for a hundred communities in in furthering the objective by providing technical the 2000 - 25 000 population group as well as domestic assistance, fellowships and other services. water connexions and water meters in fifty other Among the programmes of INOS one of the most localities. The Inter -American Development Bank has important is that of a water supply and sewerage granted a twenty -five year loan of $8 100 000 from its system for the Metropolitan Zone, which consists of social progress trust fund at an annual interest rate the contiguous municipalities of Caracas and Sucre, of 2.75 per cent. Upon completion of the first stage where there has been an extraordinary growth in 200 000 people will have piped water services for the population overthelasttwenty -fiveyears from first time and about 280 000 will have sewerage ser- 354 000 inhabitants -the official census figure for vices. 1941 -to over1 500 000. The agglomeration of The second stage of the construction programme, shanty towns with no planning whatsoever for street planned to start in 1966 and to last from two to three systems or rational location of the houses or " ran- years, will serve cities of 25 000 inhabitants and above, chos " makes the provision of a water distribution including ten of the largest cities of Peru with popu- system, a sewerage system or any other public utility lations ranging from 80 000 to 120 000.The total to these areas very difficult ; many thousands of people investment is estimated at $26 000 000. An application are living at elevations where water cannot be supplied for a loan of $15 000 000 (or 60 per cent. of the amount without special and very expensive pumping stations. needed) was submitted to the Inter -American Develop- The Metropolitan Zone has two main sources of ment Bank in June 1965. water supply, both of which are surface supplies.In With a view to ensuring the most effective co- addition, a small amount of water is obtained from ordination of all these activities a bill creating a wells,closetoor within the metropolitan area. national institute of sanitary works has been approved Initiated in 1962, the Lagartijo reservoir, built in one by both houses of the Peruvian Congress. Steps have of the major rivers discharging into the Tuy River, has been taken to revise the water rate structures and a capacity of 80 million cubic metres.The pipelines, management procedures in order to place all the water pumping stations and treatment plant that form part supply and sewerage systems on a sound financial of this system were under construction in 1965.The basis. water supplied to the Metropolitan Zone is given WHO and PAHO have provided considerable complete treatment except for a portion of the Macarao assistance to the Government of Peru and the auto- surface supply which receives coagulation and sedi- nomous organizations in connexion with this water mentation treatment without filtration.All the water supply and sewerage programme: sanitary engineers supplied is chlorinated. have been assigned to work in the sanitary division The problems of operation and maintenance in the of the Ministry of Development and Public Works Metropolitan Zone relate to the quantity rather than and the special section of the Ministry of Health and the quality of water, and to the supply and distribution Social Welfare; and advice has been provided on systems rather than to the treatment plants. Because various studies including those on regulations on of the great variation of elevation in the area of the industrial waste, the design of water supply systems in Metropolitan Zone, it is necessary to maintain many small communities, and administrative and accounting storage tanks and booster pumping stations through- procedures.Many fellowships have been and are to out the system and nine different pressure zones or be awarded to enable Peruvian sanitary engineers to levels with a maximum difference in elevation of over study specialized types of programmes in other count- 200 metres. ries and to attend short courses.With assistance It is estimated that the population will double in from PAHO and AID, short specialized courses at the next twenty years and it is therefore planned to university level are being awarded and the regular supply water for twice the present population, i.e., at five -year university course in sanitary engineering is the rate of 320 million cubic metres per year.The constantly being brought up to date with regard to first stage of the construction programme has already latest techniques. been completed; it includes the Lagartijo impounding reservoir which permitted an increase of 500 per cent. Water Supply System of the Caracas Metropolitan in the reserve of water for summer, and the improve- Zone, Venezuela ment of the Tuy No. 1 system -as itis known - To meet the demand for potable water and sewerage through which the pumping capacity was brought up systems for communities with a population of 5000 to 4200 litres per second, as well as improvements in or more is the main objective of the National Institute the distribution system mainlines and in miscellaneous of Sanitary Works (INOS), an autonomous body of items, with a total cost of 48 million bolivars. THE AMERICAS 111

The principal elements of the second stage, already services was not developed enough to be used as begun, are the new intake works and pipelines design- centres for the epidemiological evaluation, and that ated as Tuy No. 2, two new dams at Taguacita and sometimes extensive rural areas were without any La Pereza, the new treatment plant of La Guairita type of health unit.Attempts to use the existing and the extension and improvement of the distribution structure were sometimes ineffectiveforpolitical, system, with an overall cost of 400 million bolivars. administrative or psychological reasons. The limited This extensive development has made necessary the successes obtained were more the result of isolated reorganization of INOS and of the Metropolitan agreements concluded at the local level than of any Zone to improve general administration, to enable effort of a general and collective nature -which is the either agency to obtain the necessary internal or only one that can produce the desired results.Close external loans, to make the enterprises self -supporting, liaison with the general health services and the attempt and to facilitate the repayment of capital investment. to increase gradually their participation in the era- PAHO assistance was requested in securing the dication activities often tended to be neglected. services of a specialized firm to carry out a detailed As eradication advanced, it became increasingly study. An outline, defining the scope of the study, clear that co- ordination between the general health was prepared after consultation with PAHO and the services and the malaria eradication programme had International Bank for Reconstruction and Develop- to be improved. The Organization therefore decided ment.Consultants for specialized aspects of the to hold seminars in which public health administration study were also supplied by PAHO. and malaria eradication experts would have an op- In summary, the aim is to place the Metropolitan portunity to discuss ways of establishing the close and Zone on a self -sustaining basis, so that it can finance effective relationship between the two services that both the water and sewage services and also the long- is so essential, especially in the final phases of malaria term construction programmes independently and eradication campaigns.Because of the large number without recourse to the traditional practice, through of participants, two seminars were organized. INOS, of obtaining funds from the national treasury. The first of these, for participants from eight South Considerable administrative changes will be required, American countries, was held with the co- operation including the unification of Caracas and Sucre as one of the Government of Brazil in Poços de Caldas, Metropolitan Zone; the operational separation of Minas Gerais, in June and July 1964.A second the Metropolitan Zone from INOS and implemen- seminar, with the co- operation of the Government tation of new water rates, and reorganization of the of Mexico, was held in Cuernavaca, Morelos, in Metropolitan Zone to provide functional autonomy. March 1965, with participants from seventeen coun- In a visit made to Caracas by a Bank mission early tries and territories of Central and North America this year the general objectives stated in the PAHO and the Caribbean area. report were emphasized and again recommended to In addition to the working papers prepared by the the INOS and Metropolitan Zone officials. Organization, each country was requested to present The PAHO study has now been completed.All two reports, one on the general health services and the recommendations have been endorsed by PAHO their present role in the malaria eradication campaign, and the Bank and have been accepted by INOS and and the other on the present status of malaria eradi- the Metropolitan Zone.Implementation has begun cation surveillance.For many of the public health of some recommendations after technical studies by administrators it was a good opportunity to analyse the professional staff of INOS. Considerable interest the basic activities of a malaria eradication campaign has been shown in implementing the administrative and to consider in what ways the local health services reorganization, in improving the accounting systems could participate in the campaigns.Decisions about and in seeking a Bank loan, to speed up the construc- the specific participation of the local health services tion programmes called for in the long -range plan in the activities of each phase of the malaria eradi- to create a better water supply system for the Metro- cation campaign were made and a number of general politan Zone. conclusions reached.There was a realization of the need to study thoroughly the rural areas covered by Seminars on the Role of the Local Health Services in local health services in order to plan the progressive Malaria Eradication expansion of these services. The first years of a malaria eradication campaign The seminars contributed to a better understanding are usually given to planning the programme, organiz- of the advantages and the problems of close relation- ing the attack phase, and ensuring efficient coverage ship between general health services and malaria in the spraying. However, on starting field operations eradication services, ranging from simple co- operation many countries found that the network of local health to integration. CHAPTER l6

SOUTH -EAST ASIA REGION

Itis now generally recognized that the practical and freeze -dried BCG vaccine. A start was made in approach to the control of communicable diseases is promoting the production of acetone -dried typhoid by ensuring at the earliest possible stage basic health vaccine in some of the main vaccine -producing centres services that can provide effective coverage to the in India and Thailand. whole population and into which specialized campaigns Three important vaccine field trials were carried can be integrated. out with WHO's assistance: a second large -scale, The fact must be faced that for some time to come controlled field trial of cholera vaccine in Calcutta; the only way in which it will be possible to provide a continuation of trials of measles vaccines in Delhi, effective health services over large areas of the South - and a controlled field trial of Brucella vaccines in man East Asia Region will be by the widespread use of and domestic animals in Mongolia (see pages 11 large numbers of auxiliary health workers supervised and 118). by mobile professionalstaff. WHO isassisting In pursuance of a resolution adopted by the Regional countries of the Region in strengthening their basic Committee at its seventeenth session in 1964, a study health services and is promoting operational studies was made of selected infectious -disease hospitals in designed to determine the coverage that can adequately order to determine the means of improving the be undertaken and the training required by the various laboratory diagnostic services and patient care and health auxiliaries. ofstrengtheningtheireducationalandresearch possibilities. There were epidemic outbreaks of smallpox in Communicable Diseases Afghanistan, India, Indonesia and Nepal and the disease occurred sporadically in Burma.National The need for rapid development and expansion of programmes aimed at smallpox eradication were the general health services is all the more acute because pursued in Burma and India, and there were smallpox adequate vigilance is urgently required to prevent the control programmes in Afghanistan, Indonesia, the resurgence of malaria as eradication programmes enter Maldive Islands and Nepal. In Ceylon, Mongolia and the maintenance phase.Equally, the progress of Thailand, sustained routine vaccination was under- tuberculosiscontrolprogrammes and campaigns taken and freedom from smallpox was maintained. against other communicable diseases such as smallpox, WHO assisted in assessing the programmes in Afgha- yaws and trachoma has emphasized the need for the nistan, Burma, India and Nepal, in order to determine establishment of diagnostic, treatment and preventive the progress made, the speed of the campaigns and services as a part of the general health services from the needs for the future. the outset. Cholera, including the El Tor variety, continued to Communicable- disease control programmes being occur in Burma, India, Indonesia and Thailand, and carried out on a nation -wide scale (as in the case of there were epidemics in Afghanistan and Nepal. malaria, yaws and smallpox) and others which are WHO assisted in a study of the new outbreaks and gradually being extended to larger areas from the provided some of the vaccine required to meet the pilot -control stage (as in the case of tuberculosis, emergency. The WHO International Reference Centre leprosy and trachoma) continued to receive priority for Vibrio Phage Typing, established at the Indian in 1965. Institute for Biochemistry and Experimental Medicine Further progress was made in several countries in Calcutta, continued to help in tracing the progressive towards local production of vaccines prepared in invasion of El Tor vibrio into countries of the Region. accordancewiththerecommendedrequirements Contact was maintained with all governments of the published by WHO, including freeze -dried smallpox Region in assessing the arrangements for a plague vaccine, diphtheria toxoid, tetanus toxoid, pertussis surveillance programme and in promoting a regional vaccine and (in India) also oral poliomyelitis vaccine survey to determine thesusceptibilityof fleasto

- 112 - SOUTH -EAST ASIA REGION 113 insecticides in known or suspected endemic areas. control of tuberculosis, cholera control, the entero -. In India and Burma, epidemiological studies and bacteriaceae, plague control, entomological methods control work in known endemic foci were continued. in vector control, and immuno -fluorescent techniques. In Burma and Ceylon, there was an increase in Shortage of professional and technical laboratory poliomyelitis, and WHO, with collaborating labora- personnel and inadequate planning are still hampering tories, assisted in the planning and conducting of the development of an efficient and co- ordinated investigations.The poliomyelitis immunization pro- system of health laboratory services, at the central and gramme undertaken in Ceylon in 1962 and 1963 was peripherallevels. Much remains to be done in assessed and a much stronger follow -up action was stimulating and co- ordinating suchservices,and recommended. countries have been advised to establish a laboratory Haemorrhagic fever, as well as dengue and chikun- services unit at directorate level under a suitably gunya infections,continued tospread. A major trained officer who would be responsible for planning, dengue -like epidemic with some haemorrhagic mani- administering and supervising national health labo- festations occurred in Ceylon in April1965, and ratories as an integral part of the general health mainly the chikungunya virus was isolated.Hae- services. morrhagic fever, with a fatality rate of from 5 per Further progress was made in the establishment of cent. to 10 per cent., persisted in urban and rural areas efficient systems of hospital statistics. In Afghanistan, in Thailand. WHO is assisting in developing a practi- for example, a start was made in setting up m edical cal methodology forserologicalstudiesof these records departments in two major hospitals, and in diseases and in planning and organizing studies on the Burma thecollectionof administrativestatistics bionomics of Aedes aegypti. from hospitals was reorganized and an instruction Some progress was made in the long -term studies on manual on the subject issued.In most countries of diarrhoeal diseases and ascariasis control being carried the Region inadequacies in the recording and collection' out with assistance from WHO in Ceylon. of data relating to the activities of the rural health As a part of WHO's global epidemiological surveil- services continued to be a major obstacle to public lance programme of diseases of national or interna- health planning. A system for the collection and tional importance - particularly diseases showing a presentation of out -patient morbidity statistics was changing epidemiological pattern, such as cholera, initiated with WHO support, and studies were conti- plague,mosquito -bornehaemorrhagicfeverand nued of a maternal and child health records system. encephalitis,poliomyelitisandinfluenza -contact has been maintained with several collaborating insti- Environmental Health tutes and laboratories. WHO again provided staff to advise on water supply and sewerage programmes in four countries, as well Health Laboratory Services and Health Statistics as help in the preparation of requests for assistance So far only slow progress has been made in develop- from the United Nations Special Fund, in carrying ing within the health administrations the epidemiolo- out pre- investment surveys and drawing up schemes for gical laboratory and statistical services that are essen- submission to international financing agencies. With tial for the effective control of communicable diseases. regard to the two projects already receiving assistance WHO has increased its help in training personnel for from the United Nations Special Fund and for which such services, by providing for basic training locally WHO is executing agency, substantial progress was and advanced study abroad. made in the preparation of a master plan for water During the year, assistance was continued to the supply, sewerage and drainage for Calcutta. At the National Institute of Communicable Diseases, Delhi; Central Public Health Engineering Research Institute to the School of Tropical Medicine and Endemic in Nagpur WHO provided advice regarding the research Diseases, Bangkok, in planning an epidemiology programme and the operation and maintenance of department; and to the Institute of Public Health, scientific equipment provided through the United Kabul, in strengthening its departments of epidemio- Nations Special Fund. In other WHO- assisted pro- logy, statistics and microbiology.Fellowships were jects training in environmental health was continued awarded for training in epidemiology both within and and there was increased activity in the water supply outside the Region and for attendance at seminars on programme being developed in rural areas with assis- varioussubjects,including the epidemiology and tance from UNICEF and WHO. 114 SOUTH-EAST ASIA REGION

Nursing limited impact on the total needs of the Region, where In the nursing services, WHO has concentrated its there are over a hundred medical schools. Therefore, support on the strengthening of nursing administration reliance is being placed more on advisory visits of and the development of post -basic nursing education short -term consultants and on the appointment of designed to produce the large numbers of nursing teams of medical teachers representing various disci- leaders,administrators,educatorsandspecialists plines to demonstrate and promote modern teaching required.The training and utilization of nursing methods.In this connexion, WHO provided staff auxiliaries on a large scale continued to be promoted. to assist with four successive working conferences, A seminar on methods of determining the most effi- held in selected Indian medical colleges, with partici- cient staffing patterns for both public health and pants from all the medical colleges readily accessible clinical nursing was held in New Delhi at the end of to the selected centres. 1964.The methods evolved during the seminar were Continued progress was made during the second afterwards tested in the field.With WHO assistance, year of the medical education project in Gujarat State a curriculum guide for basic schools of nursing in in India, in which WHO, in co- operation with the India was also drawn up (see page 116). A working University of Edinburgh, is assisting in strengthening conference was held in New Delhi on curriculum the faculty of Baroda Medical College. The lack of development in nursing with participants from the local resources and the administrativedifficulties Member States in the Region.The main subjects facing the programme have not, however, been fully discussed were nursing education to meet the com- overcome. munity's needs for nursing services and the relationship The WHO- sponsored series of medical education between nursing education and legislation affecting study tours was continued.The most recent was nursing. undertaken in January and February 1965 by a group of ten senior paediatricians from most of the countries Radiation Protection of the Region, who, with a WHO consultant in paediatrics, visited medical institutes in India and Thailand In Thailand there has been some progress in esta- and made suggestionsfor improvementsinthe blishing a division of radiation protection within the teaching of social paediatrics. Ministry of Public Health (see page 118). WHO has Assistance was given for the establishment of post- continued to support the training of X -ray technicians graduate schools of public health in some countries. in the Region by providing teaching staff and fellow- The National Institute of Health Administration and ships. A radiology tutor was assigned to the School Education in Delhi, which is being assisted by WHO, for Radiological Technology in Bangkok. WHO also promises to develop into a major staff college for the assisted with a course (the third in the series) for training and orientation of senior health administrators training radiological physicists in India. and a focus for the operational study of problems of health administration. Medical Education While the numbers of medical schools and of undergraduate medical students admitted to them are Co- operation with other Organizations continually increasing, the serious lack of medical teachers has continued, being particularly acute in the Assistance to medical education in Indonesia is non -clinical departments. Emphasis has been placed described on page 116. upon the need to strengthen post -graduate medical WHO continued to collaborate through both the education, with a view to producing potential teaching Regional Office and the WHO representatives with the staff, and to introduce adequate incentives to encourage United Nations and the related agencies, as well as with young doctors and scientists to embark upon careers other intergovernmental and non -governmental orga- of full -time academic work. nizations.Thus, WHO took part in the teaching at a Meanwhile WHO, initsassistanceto medical statistical training course sponsored by the Economic education through assignment of teachers, continues Commission for Asia and the Far East (ECAFE) in to be faced with the difficulty of recruiting suitable Bangkok and was represented at many of the Com- personnel. Shortages of medical teachers characterize mission's meetings and conferences.Contact was both the developing and developed countries; expe- maintained with the UNICEF Regional Offices in rienced international teachers are generally unable to Delhi and Bangkok, especially with regard to the be away from their own departments for long; more- developmentofbasichealthservices,including over, the assignment of asingle teacher to one maternal and child health services, and rural water department of a faculty can clearly make only a supply programmes. WHO continued to work with THE WORK OF WHO, 1965 115

FAO in nutrition programmes and has advised on the shortage of health staff that continue to retard the health aspects of UNESCO- assisted education projects development of health services of the countries of the in the Region. Region; the need for studies by WHO on methods of With the United States Agency for International securing further community co- operation in health Development (AID) co- operation continued in some programmes; the need for establishing a comprehensive malaria eradication programmes and there were fre- basichealthstructuregivingtotalcountry -wide quent exchanges of views regarding AID assistance coverage (even with minimum services) with the wider to other health programmes. In India and Thailand, use of health auxiliaries in the staffing of peripheral the Colombo Plan has provided fellowships linked health services; and the need for operational research to projects in which WHO is giving technical assis- to determine the role, the practicable workload and the tance: in Thailand, a joint project was implemented training of the various health auxiliaries. The Com- for developing protection against radiation with help mittee also discussed the problem of reaching the from New Zealand (see page 118).In India, WHO pre -school -age child; the need for financial resources continued to co- operate in the Indo- Norwegian public for environmental sanitation programmes; the insuffi- health project in Kerala State and with the Danish cient attention often given in planning water supply Save the Children Organization in a jointly assisted and drainage schemes to areas where there is a high leprosy project in Andhra Pradesh State. endemicity of communicable diseases that could be The International Committee on Laboratory Ani- eradicated by safe water and proper drainage; ways mals and WHO collaborated in providing advice on of expanding sanitary engineering training, and pro- the management of laboratory animals in India and posals for solving some of the problems in medical Ceylon. and nursing education. The Organization was instrumental in negotiating The Committee emphasized that the success of the assistance by the Order of Malta, Emmaüs Suisse and global smallpox eradication programme was dependent Deutsches Hilfswerk für Ausstzige to leprosy control on much greater budgetary support from the Organ- programmes in Burma and Nepal. ization, especially with regard to supplies and equipment.It noted with concern the rapidly changing epidemiological picture of some major diseases such as The Regional Committee cholera El Tor and the chikungunya / haemorrhagic- The eighteenth session of the Regional Committee fever complex; the resurgence of plague, and the need was held in Kabul, Afghanistan, from 30 October to for greater appreciation of the urgency of rodent 6 November 1965.The session was attended by control, for health and economic reasons; and the representatives of the eight Member countries in the desirability of close follow -up of developments in Region at the opening of the session.The ninth research in rabies control by newer vaccines. Member, the Maldive Islands, which attained inde- The Committee considered that a paper presented pendence on 26 July, became a Member of WHO on to it on planning and evaluation of health education 5 November 1965 and was thus not represented. The was a useful guide to the methodology for planning, session was attended by representatives of the United implementation and appraisal of work in this field.It Nations (and the Technical Assistance Board and welcomed a proposal to hold an inter -country confer- Special Fund), UNICEF, the International Committee ence on health education in 1967, expressing the hope of Military Medicine and Pharmacy, and two non- that all governments would co- operate by forming governmental organizations in official relations with groups of health educators and health administrators WHO. The Director - General was represented by an at the national level to undertake preliminary prepa- Assistant Director -General. rations for the conference. Mr Sayed Shamsuddin Majrooh, Deputy Prime " The Integration of Malaria Eradication into the Minister of Afghanistan, inaugurated the session, General Health Services " was the subject of the tech- and an address was also given at the opening meeting nical discussions; " Health Laboratory Services " was by Dr Mohammed Osman Anwary, Minister of Public selected as the subject for the discussions at the session Health. in 1966. The Committee approved for transmission to the Director -General the proposed programme and budget The question of changing the rules of procedure estimates for the Region for 1967 and reviewed the with respect to the nomination of the Regional Regional Director's seventeenth annual report on Director was considered.The Committee decided WHO's work from 1 August 1964 to 1 August 1965. that it would be advantageous to provide for advance Points discussed during the consideration of that notification of names of candidates to Member govern- report included problems of financial stringency and ments and asked the Regional Director to collect 116 SOUTH -EAST ASIA REGION further information on details of procedure and to Administrative Developments in the Regional Office place the item on the agenda again for the next session. The Committee confirmed its decision to hold its Recruitment difficulties continued, and a number of nineteenth session at the Regional Office in New posts remained unfilled at the end of the year. Delhi in September 1966, and accepted with apprecia- The new office accommodation remains adequate and tion the invitation of the Government of Mongolia to pleasant; it has contributed to the general efficiency hold the twentieth session in Ulan Bator in August 1967. of the Office.

Some Aspects of Work in the Region

A list of projects current during the year will be The WHO nurse visited nursing and midwifery found in Part III. The following have been selected schools in many of the states and held discussions with for fuller description. doctors and nurses on the staff. On the basis of the information obtained from the questionnaires, committee reports and visits, the syllabi Curriculum Guide for Nursing and Midwifery Training, and regulations for courses in general nursing and India midwifery were revised and printed; they were for- WHO has been assisting with nursing projects in mally accepted by the Indian Nursing Council in India since 1952. In 1956 the Trained Nurses Asso- June 1965. ciation of India asked if the Central Government To help the staff to implement the revised syllabi, could provide a curriculum guide that would help a guide was prepared. It contains suggestions for the teachers in the general schools of nursing and mid- sound administration of schoolsof nursing and wifery to develop and implement the syllabi prescribed midwifery in India, the content of the courses pres- by the Indian Nursing Council. On the Council's cribed in the syllabi, and methods of arranging this suggestion WHO's assistance was sought in the pre- content and presenting it effectively.It is of a general paration of this guide; a WHO nurse educator and nature and, with minimal adaptation, should be useful her national counterpart began work at the office of the to nurse educators in India and also in other countries Indian Nursing Council in New Delhi in January 1963. of the Region. A review was undertaken of nursing practice and Nurse tutors in India were informed of the revised nursing legislation as they affect nursing education syllabi and the guide in two recent conferences in throughout the country.In the initial planning it which the new curriculum was discussed. Follow -up was decided that the WHO nurse would work closely action will continue through similar meetings to be with committees to be formed in each of the states of organized in countries of the South -East Asia Region. India.Altogether nineteen such committees were established, one by each of the fifteen states, one each Medical Education, Indonesia by the Mid -India and South India Boards of Exami- ners, one by the Army Nursing Service and one by the Under a project of assistance to medical education, Nursing Education Section of the Delhi State Board WHO is helping to strengthen teaching and research of the Trained Nurses Association.The work of in selected medical colleges in Indonesia, especially in these committees was co- ordinated by a central com- the pre -medical and other non -clinical departments, mittee appointed directly by the Nursing Council, improve the teaching of preventive and social medicine, which met regularly in New Delhi.Altogether, 110 and promote post -graduate education in public health persons were closely involved in the project through in the Faculty of Medicine, Djakarta. these committees, of whichallthestate nursing During the past two decades, medical education in superintendents and representatives of five of the Indonesia has expanded rapidly: in 1950 there were seven university colleges of nursing were members. only three medical colleges (in Djakarta, Jogjakarta Questionnaires designed to obtain essential infor- and Semarang), whereas by the end of 1965 there were mation regarding current nursing and midwifery sixteen - fourteen government institutions and two practices were prepared and sent to 215 nursing schools, private medical colleges -located in towns throughout and a return of 60 per cent. was achieved.Replies the archipelago. came from all states as well as from an acceptable A WHO team of medical scientists who visited cross -section of schools of nursing and midwifery Indonesia in 1953 to study and assess medical educa- associated with medical colleges and district, govern- tion problems made recommendations for improvement and private hospitals. ments.Subsequently, the Medical Faculty of Dja- THE WORK OF WHO, 1965 117 karta convened a commission, which made proposals StrengtheningofHealthServices(Epidemiology), for revising the medical curriculum.An " affiliation " Mongolia programme, linking the University of California with The zoonoses, in particular brucellosis, constitute the University of Indonesia (Djakarta) (from 1954 to a serious public health problem in Mongolia, where 1960) and with the University of Airlangga, Surabaja there are over twenty -four million domestic animals (from 1960 to 1965) was successful in strengthening in the country, and where animal husbandry is of medical education generally and in training a con- paramount importance inthe national economy. siderable number of potential teachers. However, Other communicable diseases receiving priority atten- many of the medical colleges are still understaffed, and tion in Mongolia are tuberculosis, diarrhoeal diseases the staff available are often young and in need of in infants and children, and virus diseases, particularly more experience. viral hepatitis and poliomyelitis. For some time, under four different projects, WHO A WHO epidemiological team composed of an has been providing visiting professors to help streng- epidemiologist,abacteriologist and aveterinary then the teaching in various medical schools in Indo- public health officer was assigned to Mongolia in nesia:ithas assigned professors of biochemistry, 1963 and a mobile laboratory and two vehicles were pharmacy, and paediatrics to Gadjah Mada Univer- also provided, a third vehicle and additional laboratory sity, Jogjakarta (1953 -1957), a professor of preventive equipment being supplied later.National counter- medicine to the Medical School, Surabaja (1956), parts to the WHO staff members wre appointed. professors of anatomy and physiology to the Univer- The broad objectives of the project are to assist sity of North Sumatra, Medan (1956- 1960), and a with epidemiological surveys of the prevalent commu- professor of pharmacology to the University of Air - nicable diseases in order to determine the nature langga, Surabaja (1957- 1960). and extent of the problems which they present and to Assistance under the present project started in plan practical control measures for diseases of the 1964, with the assignment of a professor of physiology highest priority, and to advise on the use of epidemio- to the Medical School of Gadjah Mada University logical methods. The immediate task of the WHO (Jogjakarta).Since then, the teaching of physiology team has been to concentrate on studies of the epi- has been reorganized; interdepartmental collaboration demiology of brucellosis and of preventive measures. has been introduced, and WHO has provided electro- Attention was first given to preparatory and orga- physiological and other teaching equipment. National nizational work, basic training of the staff in the staff have been instructed in research activities, and methodology of laboratory and field epidemiology the Ministry of National Research has made a special and the establishment of co- ordination with the work grant to enable the Physiology Department to carry of the main institutions and laboratories of the out the intensified research programmes.The pro- Ministries of Health, of Agriculture and of Veterinary fessor provided by WHO has also visited medical Sciences.In 1964 and 1965, field epidemiological colleges in Bandung, Semarang, and Solo and made investigations of brucellosis in man and domestic recommendations for strengthening their physiology animals were undertaken in several provinces (aimaks) departments. in areas of differing geographical and ecological condi- In May 1965, a WHO consultant in preventive and tions. The plan of work has been to determine the social medicine was assigned for three months to the prevalence of brucellosis in the entire population Department of Public Health and Preventive Medicine of five or more sub -districts (somons) in each of the of the University of Indonesia in Djakarta. He studied aimaks, covering approximately 5 per cent. of the the teaching of preventive and social aspects of medi- population of the aimak with regard to age, sex and cine and made recommendations on the teaching occupational distribution.Simultaneously, surveys programme and the field training of undergraduates. were undertaken on samples of different kinds of He also advised on the development of a school of domesticanimals -includingcattle,sheep,goats, public health which would provide separate courses of varying length for medical and paramedical profes- horses, yaks and camels. sional personnel and auxiliaries, and made recommen- By June 1965, the investigations had covered a total dations on the organization and use of existing of 12 200 persons and 11 300 animals. The results institutions of public health to secure their collabora- of the surveys confirmed that brucellosis is a serious tion in the school's training programme. On 14 August public health, veterinary and economic problem, with 1965 the school was officially inaugurated as a Faculty high prevalence rates, particularly among children and of Public Health. A fellowships programme has been adolescents and in most herds of domestic animals. planned for training national staff for the Faculty. The prevailing infection was shown to be caused by 118 SOUTH -EAST ASIA REGION

Brucella melitensis, with a minor role attributable to drawing up a programme of work, and training staff. B. abortus. It was agreed that the division would assume respon- In October 1964, WHO helped in planning and sibility for all aspects of protection against the hazards starting a controlled Brucella vaccine field trial in men of ionizing radiation not covered by the Thai Atomic and in animals, in order to test the effectiveness of Energy for Peace Act, in close co- operation with the dried live B. abortus 19 -BA vaccine in susceptible Atomic Energy Commission. The Government also adults living in close contact with farm animals. decided to appoint a national radiation advisory Observations have proceeded satisfactorily, and the council which would advise on all aspects of radiation preliminary results are expected shortly. The WHO team has also helped in planning and carrying out health and on the organization and implementation intensified training in brucellosis and general epide- of radiation protection services and would co- ordinate miology in both Ulan Bator and the aimaks, particu- the activities of the departments concerned.It was larly for the benefit of medical staff of the " sanepid " agreed that WHO would provide an additional consul- (sanitary and epidemiological) stations. tant and that the New Zealand Government would In collaboration with a WHO reference laboratory, award fellowships and provide equipment and addi- epidemiological and immunological surveys have been tionalconsultantservicesifrequired, under the started of diseases other than brucellosis, principally Colombo Plan. poliomyelitis, virus influenza, the arbovirus diseases Radiation hazards from some radioactive sources and rickettsioses. were being controlled through the Thai Atomic An improved notification system for communicable Energy for Peace Act and by regulations issued under diseases is being introduced and a start has been made that Act. Radium and other naturally occurring radio- on the preparation of apractical immunization active substances were not, however, controlled under schedule. the Act, and there was considerable radiation hazard The objectives and activities of this project are close- from diagnostic X -ray sources.It was apparent that ly connected with those of two other WHO- assisted the Division of Radiation Protection would have to projects in Mongolia -one for upgrading health supplement the legal responsibilities of the Atomic laboratories and the other for the implementation of Energy Commission by including as part of its func- a national tuberculosis control programme. WHO tions the care of radium and other naturally occurring fellowships have been awarded to national staff for radioactive substances, as well as the control of radio- training abroad in the epidemiology and control of logical installations. communicable diseases, microbiology (including viro- With the advice of the WHO consultant assigned logy), and health statistics. to the project in February 1965, agreement was reached between the Ministry of Public Health, the Radiation Protection Services, Thailand Atomic Energy Commission and the Radiological Society of Thailand on broad principles of the compo- The need for effective radiation protection services sition and function of the National Radiation Advisory in Thailand has been stressed in studies assisted by Council and on the content of further legislation on WHO and other agencies.In 1962 the Government It was decided to establish a of Thailand recognized the responsibility of health radiation protection. departments for undertaking protection against the division of radiation protection within the Department hazards of ionizing radiation. of Medical Sciences of the Health Ministry. A nucleus In 1963 WHO provided a consultant for one month of the staff for the division was selected and arrange- to advise the Government on the facilities necessary ments were made for advanced training : two key staff for establishing, within the Ministry of Public Health, members were given training in New Zealand under a laboratory in radiation health protection.Discus- Colombo Plan fellowships and two more attended a sions were held between the representatives of the two -month course at the School for Radiological Ministry, the Thai Atomic Energy Commission, IAEA Technology in Bangkok, a school also being assisted and WHO. In 1964 a WHO- assisted project was by a radiology tutor assigned by WHO. Some started with the objectives of establishing a division of important equipment was repaired and readjusted in radiation protection, guiding policy in radiation health, New Zealand. SOUTH -EAST ASIA REGION 119

WHO consultant services were again provided in 1966 and 1967, and the award of additional Colombo October 1965 to follow up the establishment of the Plan fellowships to train staff in New Zealand is National Radiation Advisory Council and to guide the envisaged. Thus, a firm basis has been laid for the development of the Division of Radiation Protection. development of radiation health protection services Further consultant services have been planned for within the Ministry of Public Health. CHAPTER 17

EUROPEAN REGION

During the period under review, greater emphasis In Turkey a project originally limited to maternal has been placed on assistance to individual countries, and child health has been developed into a public as an increasing number of requests are being received health programme, assisting the Government in the from Member States for direct assistance in the form practical implementation of its plans for a national of project staff, WHO representatives, consultants, health service: the Organization has provided a public fellowships and supplies.This is reflected in the fact health administrator, a statistically qualified epidemio- that the number of posts for WHO representatives logist, a sanitary engineer, a sanitarian and a nurse. and project staff was sixty -one at the end of 1965, as compared with forty in January 1964 and twenty -nine Malaria Eradication the previous year. The majority of requests, particularly those for project staff, come from the econo- Progress has continued in the malaria pre- eradic- mically less developed countries.Economic reasons ation programme in Algeria, mentioned above.The are less obvious, however, in requests for other forms programme in Morocco, also closely linked with the of assistance -for example, fellowships- received from WHO- assisted project for the development of public a variety of countries. The number and standard of health services and the training of health personnel, applications received indicate that the fellowships is geared to eradication by phases, as permitted by the programme could with advantage be considerably state of readiness of the basic health services.In the extended if resources permitted. Other forms of direct eradication programme in Turkey steady progress assistancetotheeconomicallymoredeveloped has been made in spite of certain technical difficulties, countries, though not large in volume, are increasing. and malaria staff are being integrated into the general Inparticular,thereisa demand forshort -term public health services as these reach an adequate stage consultants in specialized fields.Similarly, requests of development to undertake surveillance operations. for information and guidance to be given by the A number of countries on the European continent specialized Regional Office staff are growing in number, that have successfully freed themselves from malaria and these services, though not reflected in the pro- have requested certification of malaria eradication gramme and budget, constitute an important part of by the Organization. the activities of the Regional Office. Education and Training Public Health Services The Organization'sactivitiesineducation and The development of integrated multidisciplinary training were expanded. The series of training courses public health projects has been accompanied by on the application of statistical methods to medicine improved co- ordinationof WHO's assistanceto and public health were continued in the English and countries.In Algeria a team headed by a public French languages, and a similar course was given in health administrator is assisting the Government in Russian.Another new Russian -language course, on planning its new national health system (see page 122). the medical and social aspects of the care of the In 1964 the team included a nutritionist, a sanitary elderly, followed a similar English -language course engineer, a health educator, a nurse and an epidemio- held the previous year.The opening in 1964 of an logist specialized in statistics.In 1965 a sanitarian international school of advanced nursing education was added to the team and the malaria pre- eradication at the University of Edinburgh was followed by a team was integrated with it.The latter development similar school, opened at Lyons in October 1965 is significant and also logical, since one of the first and providingtraininginthe French language. objectives of a pre- eradication project is to prepare This should obviate the need for nurses to seek the general health services for the role they must advanced training outside Europe. WHO has con- fulfil when a full eradication campaign is launched. tinued to provide assistance in the training of auxiliary - 120 - HIGHER NURSING EDUCATION

An international school of advanced nursing education was officially opened at Lyons, France, in October.Established with help from WHO, the school is to prepare nurses from Europe and elsewhere for senior posts in specialized branches of nursing and nursing administration.Courses are given in French.

1. A corner of the school on the opening day.

2. The library.

1411 5 n' i CIt.'

ÏMIiNÍi1

31P.,

At the Post -graduate School of Nursing in Colombo, Ceylon, which is administered by the Health Department, students receive training in paediatric nursing. WHO is assisting the School by providing an expert in maternal and child health nursing.

3. A sister tutor takes a group of students round a ward of the Children's Hospital in Colombo.

4. At the same hospital, students attend a demonstration on the proper diet for children.

4 {

DANSK BILHARZIOSE LABORATORIUM'

1 2 Discussion between students and lecturer. A student examines a cast.

WHO SNAIL IDENTIFICATION CENTRE

The Danish Bilharziasis Laboratory in Copenhagen has been able, with WHO assistance, to expand its programme of research on the intermediate snail hosts of bilharziasis.This INTER -REGIONAL COURSE laboratory serves as WHO Snail Identification Centre and supplies research workers with reference strains. ON CHILD DENTAL HEALTH

1. The bas -relief at the entrance to the laboratory. With assistance from WHO the Royal Dental Col- lege, Copenhagen, gave a three -month advanced 2. A section of the laboratory where about a thousand snails are housed in fifty aquaria. course on child dental health during 1965.The 3. A member of the laboratory staff at work. course, which provided specialized training in the teaching and practice of dentistry for children, was attended by twelve participants from as many countries, representing the six regions of WHO.

Lecture illustrated by lantern slides of casts.

The course included some practical work. 1

2 STRENGTHENING OF HEALTH SERVICES IN MONGOLIA

The Mongolian People's Republic is receiving sustained assistance from WHO for the strengthening of its health services.During 1965 a WHO epidemiological research team took part in various surveys and studies on brucellosis, viralhepatitis, diphtheria, pertussis and other diseases (see also page 117).The Organization is also providing advisory services for the strengthening and improvement of the maternal and child health services.

1. The epidemiological research team visits a small rural community.The truck is stopped in front of a group of gers, typical Mongolian steppe dwellings.

2. Collection of serum specimens from families of collective farm workers.

3. Babies are accepted at day nurseries from the age of 40 days.From the age of 21/2 years until they begin their schooling, young children go to kindergarten. 3

PUBLIC HEALTH TRAINING IN ETHIOPIA

1 The Gondar public health training centre, with continued assistance from UNICEF and WHO, runs a model health service and trains various types of health worker.

1. A young mother and her child in the maternity ward of the Gondar hospital.

2. Trainee sanitarians checking a water pump take the opportunity to give health education to the users.

2 EUROPEAN REGION 121 nursing personnel in Algeria, and in Morocco and Environmental Health Turkey, in which two countries it also collaborated WHO has been designated executing agency for two in the establishment of post -basic schools of nursing. In addition, several fellowships have been awarded environmental health projects being financed from for the training of staff of various countries for post - the United Nations Special Fund.The project in Turkey involves the preparation of a master plan for basic schools of nursing.As in previous years, the water supply and sewerage for the city of Istanbul Organization provided assistance for several inter- regional courses financed from the Danish Special and neighbouring areas, and that in Poland is for the development of research work for the protection of Contribution to the Expanded Programme of Technical Assistance. Among these, an important new venture natural waters against pollution in a highly industrialized district (see page 35).Other projects -in Greece was a course on child dental health. and Malta, for example -are in the process of elabora- Reference has already been made to the expansion tion for eventual submission to the Special Fund. of the fellowships programme. In 1965 the Regional Office made arrangements for the placing in Europe of well over a thousand WHO fellows, about half of Collaboration with other Organizations them from other regions.The continued evaluation of the fellowships programme, although indicating The Organization has continued to collaborate that the programme on the whole issatisfactory, with the United Nations, the related agencies and a showed where improvements can still be made, particu- number of intergovernmental and non -governmental larly in the selection of fellows. bodies. Close collaboration has been maintained with UNICEF.

Inter -country Activities

The inter -country programme has ranged over a The Regional Committee wide field of activities, including conferences, seminars and training courses on cardiovascular diseases (see The fifteenth session of the Regional Committee page 123), health statistics, paediatric education, out- for Europe, held in Istanbul from 7 to 11 September patient psychiatric services, and early detection of 1965, was attended by representatives of twenty -nine cancer. In particular, a symposium on the estimation of the thirty -one active Members in the Region, includ- of hospital bed requirements was held in Copenhagen ing Malta, which had become a full Member of the in November. The participants discussed present Organization on 1 February1965.The United methods of assessing hospital bed requirements and Nations Technical Assistance Board, UNICEF and thepossibility of developing a more satisfactory ILO, as well as two intergovernmental and fourteen methodology, taking into consideration the implica- non -governmental organizations and the International tions of new forms of patient care, including compre- Children's Centre were also represented. An Assistant hensive and progressive care. Director -General attended on behalf of the Director - Increased attention has been given to work on General.The Committee observed one minute's cardiovascular diseases. For a number of years several silence in memory of Dr S. Kurasov, Minister of countries in the Region have been collaborating with Health of the USSR and President of the Fifteenth WHO in establishing a uniform methodology for World Health Assembly. epidemiological studies on ischaemic heart disease, In presenting his annual report for the period 1 July hypertension, and respiratory non -specific diseases, 1964 to 30 June 1965, the Regional Director laid stress and a constantly growing number of national labora- on the advances made in the co- ordination of WHO tories and groups have been collaborating in studies assistance through multidisciplinarypublichealth of this kind. As a further step, a working group met projects, on collaboration with the United Nations during 1965 to consider preventive measures against Special Fund, and on education and training, especially ischaemic heart disease and design a methodology in public health and basic sciences. for the objective study of the effect of such measures. The Committee discussed in detail the programme The Organization has been more frequently called and budget proposals for the European Region for upon to help in co- ordinating activities in various the year 1967.After making some modifications- fields.Examples are the studies on the epidemiology mainly in order to lay more emphasis on cardiovascular of home accidents, and on modern methods of medical diseases, dental health, and the care of the elderly education, in addition to those on cardiovascular -it endorsed the proposals for transmission to the diseases. Director -General. 122 THE WORK OF WHO, 1965

The procedure for the nomination of the Regional the organization of centres in the various countries, Director was discussed, and the Committee amended their methods of operation in the collection and its relevant rule of procedure. disseminationof information,and theirrolein After discussing papers on the epidemiology of research.Stress was laid on the need for improved cardiovasculardiseasesand theorganizationof international co- operation. servicesforcardiacemergencies,theCommittee The Committee confirmed that the subject of the recommended that the Organization play an active technical discussions in 1966 will be " The causes and role in encouraging and co- ordinating epidemiological prevention of perinatal mortality ", and selected as studies on cardiovascular diseases and requested that a topic for 1967 " The pattern of active immunization a choice of plans for future intensified activities in against communicable diseases in Europe ". this field be submitted at the Committee's sixteenth The Committee confirmed that its sixteenth session session, with indications of the means required to carry would be held in Rabat, Morocco, in September 1966, out these plans. and accepted the invitation of the Government of The Committee also discussed a report on child Ireland to hold its seventeenth session in 1967 in dental health in Europe and asked the Organization Dublin. to give more attention to dental health activities. A report on the fellowships programme was presented Administrative Developments in the Regional Office to the Committee, which requested that evaluation The management survey in the Regional Office was of the fellowships programme be continued. continued, and has already resulted in the improvement With regard to smallpox, the Committee noted that of procedures and of the distribution of functions. the Eighteenth World Health Assembly had declared The legal difficulties that had delayed the construc- the worldwide eradication of smallpox to be one of tion of a new building for the Regional Office have the major objectives of the Organization, and urged now been largely overcome; the Danish Government Member States to give greater support to the Organi- hopes to start construction in 1966 and has stated zation's eradication programme. that it expects that the new premises will be ready for The subject of the technical discussions was " The occupancy in 1968. In the meantime, the Government organization and functioning of poisons information proposes to erect temporary accommodation in order centres ". The Committee discussed the general to alleviate the growing problem of overcrowded principles involved in the provision of information, premises.

Some Aspects of Work in the Region

A list of projects current during the year will be Personnel provided by WHO include four doctors found in Part III.The following have been selected (specialized in nutrition, health education, malaria for fuller description. and health statistics), a nursing adviser, a sanitary engineer and sanitarians. A public health administrator provided by WHO is assisting at Ministry level in the Development of Public Health Services, Algeria overall planning of the project and is co- ordinating In 1963 an intensive training programme was begun the work in the various specialized fields. in Algeria with the assistance of UNICEF and WHO, In order to carry out the project efficiently, respon- the aim of the project being the development of the sibilities have been centralized.Medical education basic health services.It has become the framework and school, university and occupational health have within which seven related projects (on public health been brought under the direct control of the Ministry administration, environmental sanitation, health educ- of Public Health.The Ministry, previously a purely ation, nutrition, health statistics, nursing and malaria administrative body, has been reorganized as a tech- eradication) are being integrated. It also co- ordinates nical body, concerned particularly with studies and other WHO- assisted activities in Algeria- including planning.Departments dealing with the main public the projects on communicable eye diseases, maternal health activities, as well as a central statistical service, and child health, and hospital administration -and have been set up.The main objectives include the thus marks a new stage in the development of the promotion of preventive medicine and the development country's public health system. of health consciousness through health education; the UNICEF has been furnishing supplies and equip- organization of maternal and child health services in ment, and WHO has been giving technical advice. the urban and rural dispensaries; the development of EUROPEAN REGION 123 work in the fields of sanitation and nutrition; the zation working for the welfare of mentally handicapped organization of health statistics; and preparation for children, so that WHO's assistance was requested a malaria eradication campaign. primarily for services for adults -the prevention of The public health divisions, corresponding to the mental illness and the care and rehabilitation of fifteen administrativedépartements,supervise medico - patients.Later in the year the Organization carried social districts with a population of15000 to 20 000, out a detailed survey, and recommendations were made each having its own rural and urban health centres on the complete reorganization of the Hospital for and dispensaries. In the fifteen public health divisions, Mental Diseases,the provision of legislation on which are responsible for implementing the plans conditions of admission and discharge, the setting up drawn up and supervised by the central administration, of a community care organization to render hospitali- mobile teams carry out epidemiological investigations, zation unnecessary in certain cases and to assist in preventive work and health education. the rehabilitation of patients, and the education and In training, special emphasis is now being laid on training of technical personnel. public health and preventive medicine, and public In1965the Government began to implement many health is included in the training of all health workers, of these recommendations. The superintendent of the including auxiliary staff. The National Institute of Pu- Hospital for Mental Diseases returned after studying blic Health, opened in1964, co-ordinates training in abroad on a WHO fellowship, and in August WHO public health and preventive medicine at advanced and assigned a staff member to assist in the introduction intermediate levels. WHO has collaborated closely in of occupational therapy in the hospital, preparatory the organization of the Institute and in its various to a process of modernization leading to open -door activities, which have included the establishment of treatment and involvement of the community in a school for sanitarians, two public health demons- mental health work. A psychiatric nurse instructor tration areas, a maternal and child health demons- recruited by WHO will assist in the establishment of tration area, and an applied nutrition centre. programmes for the specialized training of psychiatric WHO has also assisted in the reorganization of nurses and auxiliaries and the introduction of psy- paramedical training into three categories -auxiliary, chiatric nursing into the basic training of all nurses. diploma and specialist.Considerable progress has been made in standardizing the various curricula and the conditions of admission to courses. Conference on the Prevention and Control of Cardio- The Organization has also provided personnel to vascular Diseases, Bucharest assist in the teaching of public health at the schools More than half of all deaths in most countries of established at Médéa, Batna and Sidi Bel Abbès for Europe are now due to cardiovascular diseases and the training of health technicians- medical assistants there has been a large increase in recent years in who can be more rapidly trained than physicians and the death rate from heart disease among middle -aged are assigned to work in rural areas. men. With a view to evaluating the present situation Integration is, of course, a long -term task. Much regarding the prevention of certain cardiovascular remains to be done in order to achieve full co- ordin- diseases and promoting international co- ordination ation of all public health activities, and hospitals and in this field, a regional conference organized by WHO health laboratories, in particular, require standardi- was held in Bucharest in March1965. zation and co- ordination in order to play an efficient The conference, which was attended by clinicians, part within the framework of the general health public health administrators and research workers from services.However, the principle of integration has twenty -five countries in the Region, discussed the now been fully accepted and action to apply itis incidence,etiology,treatment and preventionof well under way. rheumatic fever and chronic rheumatic heart disease, congenital heart disease, ischaemic heart disease and arterial hypertension, and chronic cor pulmonale. Mental Health Services, Malta It was stressed that knowledge of morbidity and A particularly pressing health problem in Malta has mortality rates for cardiovascular diseases was very been the need to improve mental health services. incomplete, and measures for improvement were Early in1964a preliminary evaluation of the proposed. situation by the Organization confirmed the need for With regard to rheumatic fever and rheumatic theextensionand improvementofservices -in heart disease, good results have already been obtained particular, the need to bring the Hospital for Mental in most countries as a result of the introduction of Diseases into closer contact with the community. preventive measures. On the other hand, the magnitude There already existed in the country an active organi- and complexity of the problem of prevention and 124 THE WORK OF WHO, 1965 controlofcongenitalheartdisease -which was the training of sanitary engineers.To this end, a discussed mainly from the epidemiological and clinical number of seminars have been organized for the points of view -were fully acknowledged.Stress was discussion of specific subjects. laid on the need for special training and postgraduate In June 1965 the ninth such seminar was held in refresher courses for paediatricians and other per- Naples. The twenty -fiveparticipants came from sonnel engaged in this field of cardiology, and also twenty -four countries of the European Region, the on the need for further studies on the etiology of majority being sanitary engineers holding responsible ischaemic heart disease and arterial hypertension. government posts or working in research centres or Attention was drawn to the role played by environ- training institutions. mental factors in the incidence of chronic cor pul- Subjects discussed included the introduction of monale. The factors provoking chronic bronchitis- new microchemical pollutants into the environment, the main cause of cor pulmonale -are in general well the techniques and economics of sewage treatment in known, particularly the part played by air pollution small towns,special problems of collection and and cigarette smoking; however, it was stressed that disposal of solid waste in urban areas, and the training the problem of eliminating these factors was not purely and employment of sanitary engineers. medical, but entailed co- operation among the various The discussions on microchemical pollutants indi- authorities concerned.It was considered particularly cated the need for continuous documentation on the importantthatcardiologistsreceivetrainingin characteristics of new chemicals and the development pulmonary function techniques and, conversely, that of standard methods for their analysis. It was recognized lung specialists should be trained in cardiovascular that some degree of control had already been achieved diseases. regarding the use of hard detergents, but that similar Regarding the rehabilitation and re- employment measures were required in order to prevent pollution of patients, the conference made recommendations resulting from the use of pesticides, herbicides and on the organization of rehabilitationservicesin related poisons. hospitals and on a nation -wide basis. The conference In connexion with sewage treatment, the discussions also discussed the organization of medical care, both emphasized the need for standardization of methods for chronic and acute cases -including the use of and equipment, the co- ordination of work on a regional special emergency ambulances and intensive care units. basis, and the training of specialized personnel. The value of health education was emphasized. It was recognized that in small communities the The conference stressed the importance of inter- collection and disposal of solid wastes can be carried national co- operation and co- ordination in the study out most economically through co- operative action. of cardiovascular diseases and made several specific The need was stressed for the application of appro- proposals for the future work of the Organization in priate regulations to ensure the proper attention to the European Region. the requirements of hygiene. There was agreement that training in civil, chemical or mechanical engineering was the most appropriate Ninth European Seminar for Sanitary Engineers, Naples background for a sanitary engineer, and that training WHO has constantly stressed the importance of in particular fields of sanitation should also be provided environmental health and has focused attention on for technicians and other auxiliary personnel. CHAPTER 18

EASTERN MEDITERRANEAN REGION

In most countries of the Eastern Mediterranean granted to women students had risen to 20 per cent. Region, WHO has continued to assist in the develop- (as compared with 8.5 per cent. in 1961); slightly ment and expansion of national health services and more than one -third of the awards to women students the co- ordination of health programmes with pro- were for training in nursing, the remainder covering grammes for social and economic development. Health a wide range of subjects, including anaesthesiology, personnel have co- operated with community develop- health statistics, radiation protection, human genetics, ment workers in rural health pilot projects in Iraq, and laboratory techniques. Lebanon, Saudi Arabia, Somalia, Sudan, Syria and Yemen.The normal development of health services is, however, still hampered by lack of medical and Nursing paramedical personnel, and emphasis has continued on medical education and training of all categories The nursing profession is gaining more acceptance and recognition in the Region, and emphasis is being of health personnel. placed on the training of nurse leaders who will ensure the development of nursing as an integral part of the Medical Education general growth of the health services. An inter -country group on nursing has been formed, By the end of 1965 there were thirty -five medical and held its first meeting in August 1965.Its five schools in the Region, compared with eight in 1940. members are from Iran, Lebanon, Pakistan, Sudan WHO has been assisting projects for the development and the United Arab Republic. of medical education in various countries, including The level of technical competence in nursing varies Tunisia (see page 129).The possibility of setting up in the different countries of the Region. With WHO's the first medical schools in Kuwait and Saudi Arabia assistance, nursing in Iran has been developed with is being considered.Under an agreement between due regard to the professional growth of the student, the Haile Selassie I University in Addis Ababa and the conditions in which she works, and the needs of the the American University of Beirut, Ethiopian medical patient. In Sudan, where WHO has provided a nurse students have received preclinical training in Lebanon educator toassist in the overall development of before returning to Ethiopia for their clinical studies. nursing, the Khartoum Nursing College has reached the limit of its enrolment capacity, and selective techniques are being used to ensure higher standards. Librarianship In the United Arab Republic WHO has assisted in The second WHO training course in medical libra- the establishment of a second Higher Institute of rianship was held at the American University of Nursing, at the University of Cairo, modelled on the Beirut as an extension of its regular summer course Alexandria Higher Institute of Nursing.Growing in library science (see also page 76).The ten -week interest has been shown in nursing in countries where course leads to a certificate for those who are actively the profession is a new one: in Yemen, for example, engaged in medical librarianship but have had only forty -six auxiliary nurses have so far been trained at limited formal training. the WHO- assisted health centre and training school at Sana'a.

Fellowships Environmental Health WHO fellowships have been playing an increasing part in the training of all categories of health personnel, The need to improve and extend community water and there has been a fuller use of training facilities supply systems still ranks first among the sanitary within the Region. By 1964 the proportion of awards engineering problems resulting from rapid urbani- - 125 - 126 THE WORK OF WHO, 1965

zation and industrialization, and itisstilldifficult Region. UNICEF and the United States Agency for to secure enough technically competent personnel International Development (AID) have continued their to operate and maintain water supplies.However, assistance to these programmes. governments are also paying increased attention to Co- ordination between neighbouring countries has other aspects of environmental health such as sewerage been continued through border meetings and exchange and sewage treatment, refuse disposal, and air and of epidemiological information.Countries that held water pollution. WHO has provided assistance in such border meetings during the year included Jordan connexion with sewage treatment and refuse disposal and Syria; Jordan and Saudi Arabia; Syria and in Jordan, Syria and the United Arab Republic, and Turkey; and Iran, Iraq and Turkey. Following has assisted in investigations of air pollution in Iran, recommendations made at the inter- regional con- Israel and Kuwait (see also page 34). WHO is also ference on malaria eradication held in Tripoli, Libya, helping to establish and strengthen the sanitation in November and December 1964, an inter -country services of health administrations in Ethiopia, Leba- malaria eradication co- ordination board has been non, Pakistan (see also page 130), Somalia, Sudan, formed for Jordan, Lebanon and Syria; it held its Syria and Tunisia.Institutions in Iran, Israel, Leba- first meeting in Beirut in June 1965. non, Pakistan and the United Arab Republic are now offering post -graduate training for engineers, and many Tuberculosis universities have included an introduction to sanitary engineering and environmental health problems in the Tuberculosis has continued to be one of the main curriculum of engineering undergraduates. health problems of the Region. However, the application of the methods advocated by the Expert Com- Malaria Eradication mittee on Tuberculosis in its eighth report 1 should make it easier for all countries to carry out effective At the end of 1965 malaria eradication programmes and sound tuberculosiscontrolmeasures. For were inoperationinIran,Iraq,Israel,Jordan, example, the direct BCG vaccination of children Lebanon, Libya, Pakistan and Syria, and the United (i.e. without prior tuberculin testing, but after limited Arab Republic was about to start such a programme; preliminary trials on certain samples of the population) there were pre- eradication programmes in Ethiopia, would simplify procedures and permit greater coverage Saudi Arabia, Somalia, Sudan and Yemen. Malario- in countries where BCG vaccination campaigns seem metric and entomological surveys have been conducted to be the best and most practical means of combating in Yemen as part of WHO assistance. tuberculosis. A few countries in the Region -Ethiopia The operational and technical difficulties encoun- and Pakistan, for example -have undertaken such tered over the past few years have caused great vaccination campaigns. concern.Improvements resulted from the positive reaction of national malaria services to the occurrence Smallpox of foci of transmission in areas practically freed from malaria (in Iran, Iraq, Jordan, Libya and Syria, for There has been a decline in the incidence of smallpox example). The WHO regional co- ordination and in Ethiopia and East Pakistan.An assessment in evaluation team, which undertakes on behalf of Dacca indicated that at least 90 per cent. of the governments epidemiological studies in problem areas, 12 800peopleinterviewedhadbeenvaccinated has been strengthened by the addition of two more during the campaign carried out between 1961 and members. 1964. Most of them had been vaccinated three times - The Organization continued to provide assistance in infancy and before and during the campaign. A to the malaria eradication training centres in East and vaccination campaign was started in the southern part West Pakistan, and to the training centres in Ethiopia of Saudi Arabia at the end of 1964, and in Yemen the and Sudan, where the courses are specifically designed health authorities have begun a mass vaccination for the training of auxiliary and technical staff for campaign. thepre- eradicationprogrammes. Althoughthe general situation with regard to the staffing of malaria Trachoma eradication programmes has been satisfactory, there has still been a shortage of qualified personnel for In 1965 the Organization made an assessment of pre- eradication programmes. the prevalence of trachoma and associated infections WHO has again provided advisory services, and in in the Region, and continued to provide personnel 1965 supplied personnel for fifty -two posts in malaria eradication and pre- eradication programmes in the 1 Wld HIM Org. techn. Rep. Ser., 1964, 290. EASTERN MEDITERRANEAN REGION 127 and technical advisory services.The Government of public health laboratory services is now accepted in Tunisia took over responsibility for the virology most countries, the main problem still encountered research laboratory of the Institute of Ophthalmology is the lack of qualified personnel. The series of WHO - in Tunis at the beginning of the year, but WHO assisted regional training courses in Beirut is preparing continued to assist research there (see also page 20). senior laboratory technicians who, on completion of the eighteen -month course, are able to act as tutors in Cholera their respective countries. Early in1965, following the cholera outbreaks More blood banks and blood transfusion centres reported in East Pakistan the previous year, a third are being established; their activities include research assessment was made in the southern parts of the and the preparation of typing antisera and different country which were mainly affected.Fewer cases blood derivatives in addition to the routine work of were found than on previous visits.The laboratory collecting, typing, storing and supplying blood. The of the Dacca Public Health Institute has started Organization has also provided assistance for the working on a complete bacteriophage typing of all improvement of vaccine production in Iraq, Jordan isolated strains of vibrio. and Sudan. The outbreak of cholera El Tor in the eastern provinces of Iran during the summer of 1965 caused Health Education great concern to the Government and the neigh- In health education work has been concentrated on bouring countries, and a series of quarantine and specific fields: for example training in school health preventive measures were taken including, in parti- education has been provided for school teachers in cular, vaccination. A paper on problems of cholera two projects undertaken in the United Arab Republic control in the Eastern Mediterranean Region, with with the material assistance of UNICEF and the special reference to cholera El Tor, was discussed at technical guidance of WHO. Health education has the fifteenth session of the Regional Committee.In again been included in malaria eradication and com- October WHO organized in Teheran an advanced munity development programmes -for instance, in regional training course on the recent bacteriological the projects in Ethiopia, Iran, and Pakistan, and in techniques and methodology for the culture and iden- the training programmes of the Malaria tification of Vibrio cholerae and V. El Tor. Eradication Training Centre, in Sudan, and the Arab States Training Centre for Education in Community Bilharziasis Development, in the United Arab Republic. With the increased development of irrigation, and withagrarianreforms, WHO- assistedbilharziasis Maternal and Child Health projects are receiving strong support from the govern- Countries of the Region have shown an increasing ments concerned. The surveys of the distribution of interest during the year in the development of maternal bilharziasis have been continued in Iraq, and in the and child health services and their integration into United Arab Republic where a study was initiated in the general public health services.In the WHO - schools to determine the extent to which bilharziasis assisted public health and training projects in Ethiopia, in children affected their physical growth rate and Libya, Saudi Arabia, Sudan, Tunisia, the United school performance.Good progress has also been Arab Republic and Yemen particular attention has made in the epidemiological, malacological and chemo- been given to the development and strengthening of therapeutic studies. A new molluscicide tried out in paediatric education and preventive paediatrics.In the United Arab Republic was found very effective the United Arab Republic the Giza maternal and child in killing both Bulinus and Biomphalaria snails at a health centre is being developed into a specialized much lower dose than with Bayluscide, but ineffective home -care centre for premature infants, and a six against snail eggs.In Iraq WHO continued to help months' training course in nursing care of premature in assessing the value of sodium pentachlorophenate infants was held during the year at the premature for snail control, and in the collection of biological, infants' unit at the Maniai University Hospital in ecological and transmission data related to Bulinus Cairo.In Tunisia, training of several categories of truncatus. paramedical personnel continued at the maternal and child health pilot centre in Tunis, and WHO gave Health Laboratory Services assistance to UNICEF- sponsored courses for the In 1965 WHO gave assistance to over twenty trainingofauxiliaries-an imatricessanitaireset projects for the development of health laboratory sociales and assistantes sociales.Training continued services in the Region. While the concept of central at the Benghazi maternal and child health demon- 128 THE WORK OF WHO, 1965 stration and training centre, in Libya. In Sudan WHO departments in ministries of health, and in establishing assessed requirements for the establishment of a nutrition institutes. WHO has also provided assistance paediatric department at the University of Khartoum on nutrition in connexion with various field projects School of Medicine. in maternal and child health, nursing education and rural health.In collaboration with FAO, a regional Health Statistics seminar on industrial -canteen feeding in the Near The Organization has continued to give advice and East was organized in Alexandria in October (see assistance in connexion with the development of page131). vital and health statistics in various countries in the Region; with regard to training, it has provided a Co- operationwith other Organizations number of fellowships and assisted a training course The Organization has continuedtoco- operate for coders in Pakistan. A meeting of chiefs of statistical with other agencies working in the health field, parti- services of ministries of health was held in Alexandria cularly with UNICEF, and to collaborate with FAO, in December 1965; it discussed statistics concerning ILO and UNESCO in joint projects in nutrition, health personnel and health institutions, including occupational health and health education.It has also their utilization and the services provided. collaborated with the United Nations with regard to the health aspects of community development Pharmacy and Medical Stores projects, and has maintained close working relations With regard to pharmacy and medical stores, in with the Technical Assistance Board, the Economic order to overcome the shortage of experienced pro- Commission for Africa, and the Economic Commission fessionalandauxiliarypersonnel,particularlyin for Asia and the Far East. rural areas, efforts have been made to train in each country a few candidates who, on completion of their studies, are in turn able to train more personnel in The Regional Committee their countries. WHO has provided fellowships in Sub- Committee A of the Regional Committee for this connexion and given advice on the quality control the Eastern Mediterranean met in Addis Ababa from of pharmaceuticalpreparationstoIran,Jordan, 20 to 23 September 1965, and Sub- Committee B met Tunisia and the United Arab Republic. in Geneva on 2 and 3 September 1965.Sub -Com- mittee A was attended by representatives of Cyprus, Cancer and Radiation Protection Ethiopia, France, Iran, Iraq, Jordan, Kuwait, Lebanon, Cancer is gradually emerging as a public health Libya, Pakistan, Somalia, Sudan, Syria, Tunisia, the problem in the Region, calling for the setting up of United Arab Republic, and the United Kingdom of Great Britain and Northern Ireland. Sub -Com- comprehensivecontrolprogrammes; WHO has mittee B was attended by representatives of Ethiopia, provided advice in specialized subjects such as tissue culture and laboratory animal breeding, and has France, Israel, and the United Kingdom of Great assisted in the training of staff.The first regional Britain and Northern Ireland.The United Nations, training course on cancer control was held at the the Technical Assistance Board and Special Fund, the Teheran Cancer Institute in order to give cytologists Economic Commission for Africa, UNICEF, the the specialized training needed to organize services United Nations Relief and Works Agency for Palestine for the early detection of cancer in their respective Refugees in the Near East and ILO were represented countries. The course started in June 1965 and lasted it Sub- Committee A, and representatives of two intergovernmental and six international non- govern- four months. mental organizations were also present.At Sub - In view of the continuously increasing danger of Committee B the United Nations, the Technical excessive or inadequately controlled use of X -rays, a regional training course was started in December Assistance Board and Special Fund, and ILO were represented,aswellasseven international non- 1965 at the Radium Institute in Baghdad in order to governmental organizations.The Director -General provide instructors in X -ray techniques with a better knowledge of radiation protection. was represented at both sub -committees by an Assistant Director -General. In pursuance of resolution WHA7.33, each sub- Nutrition committee designated a representative to meet with In several countries WHO has collaborated with the Regional Director to harmonize the decisions and FAO and other agencies in assessing the nutritional prepare the final report on the session. The resolutions status of the population, insetting up nutrition adopted by the sub -committees on subjects common EASTERN MEDITERRANEAN REGION 129 to both agendas were either identical or the same in minor amendments.It was recómmended that a substance.Sub -Committee A also adopted a reso- bronze medal and a prize of Sw.Fr. 1000 be awarded lution on the extension of the use of the Arabic annually to the person- irrespective of nationality language intheRegionalOffice. A resolution or residence -who had made the most significant requesting African Member States in the Region to contribution with regard to any health problem in give all due consideration to their intention to leave the Region. Sub -Committee A further suggested that the Region before taking steps towards implementation any funds in excess be used to award a fellowship to was adopted by Sub -Committee A with seven absten- a candidate from a country of the Region for study in tions. a specialized aspect of public health. The following points were emphasized during the The proposed programme and budget estimates for discussions on the annual report of the Regional the Region for 1967 were considered and endorsed, Director: education and training, with due regard to as presented, for transmission to the Director -General. in- service training of health auxiliaries, should con- In the technical discussions -on the Organization tinue to receive priority,stress being laid on the and Administration of School Health Services - creation of new medical faculties, the revision of priorities were indicated for the improvement of those medical curricula, and the training of teachers in services, and emphasis was laid on the need for spe- basic sciences.Special attention should be paid to cialized training in this field." Health Aspects of the integration of national health plans into plans Industrialization with particular reference to Air Pol- for general socio- economic development, the streng- lution " had previously been chosen by Sub- Commit- thening of national vital and health statistical services, tee A, and was also selected by Sub -Committee B at and the control of communicable diseases (parti- its fifteenth session, as the subject for technical discus- cularly malaria, tuberculosis, smallpox, bilharziasis sions in 1966.Sub -Committee A further selected and trachoma).Concerted programmes for cancer " Review of the Education and Training of Nurses to control should be developed within the public health meet the Needs of the Region " as the theme for the services. Nutrition problems call for special attention, technical discussions in 1967. and work in this field should be linked with health Sub -Committee A had previously accepted the education and school health. WHO's assistance would invitation of the Government of Pakistan to hold its be needed in formulating requests to the United sixteenth session in that country in 1966. During Nations Special Fund with regard to environmental its fifteenth session it accepted an invitation to hold its health and community water supply programmes. seventeenth session in Iran in 1967. Other technical subjects discussed under separate items on the agenda were the epidemiological aspects of malaria eradication in the Region, the statistical Administrative Developments in the Regional Office data required for national health planning, and the The organizational structure of the Regional Office problems of cholera control in the Region with has been maintained, but there has been an excep- special reference to cholera El Tor. tionallyhigh turnover of both professional and Both sub -committees endorsed the creation of a general service staff during the year.This has called Dr A. T. Shousha Foundation similar to the Léon for continuous attention to in- service training, and Bernard Foundation, the statutes proposed for the the employment of short -term consultants in pro- consideration of the Committee being approved with fessional posts.

Some Aspects of Work in the Region

A list of projects current during the year will be to the Government regarding the early establishment found in Part III.The following have been selected of a Faculty of Medicine planned to meet the special for fuller description. needs of the country. By 1963, when a second consul- tativegroup visitedTunisia, good progress had been achieved; existing buildings were adapted to Medical Education, Tunisia provide laboratory and classroom space, and addi- Following a request from the Tunisian authorities tionalhospitals were planned to supplement the for advice on the establishment of the first medical existing clinical facilities.Further recommendations school in Tunisia, WHO provided in 1961 a consul- were made concerning both the academic programme tative group which, after assessing the total medical and the physical facilities. WHO collaborated with needs and resources, made specific recommendations the Faculty in developing the curriculum, in planning 130 THE WORK OF WHO, 1965 the fellowships programme, and in the overall organi- it from public standpipes. In the rural areas supplies zation of the courses of study. were confined to shallow open wells and tube -wells, The first students were admitted in the autumn of many of them liable to contamination. 1964. WHO has provided three professors in basic During the first phase of WHO's assistance the sciences, and is to provide a professor of social and Government formed apublichealthengineering preventive medicine.Further laboratory space will department in the Ministry of Health to assume be available by the time the students enter the second responsibilityforcommunity watersupplies -in year of their medical studies; when they reach their particular, for the investigation, design and construc- clinical training, new specialized hospitals will have tion of any new or extended water supply and sewerage been completed and older hospitals will have been projects in West Pakistan other than those in Karachi adapted for teaching.In November 1965 there were and Islamabad.Later this department also assumed forty -eight second year students and eighty -five had responsibility for the operation and maintenance of been enrolled for the first year; the number will be many of these projects.In the latter half of 1961 gradually increased to a maximum of 200 students a WHO gave advice on the development of a long -term year. programme for the provision of an adequate supply Instruction is in French, and the curriculum is of drinking -waterforthe communitiesin West based on the French system, adapted to the needs of Pakistan. Subsequently, WHO helped in the formula- the Tunisian health services.Students are given an tion of design standards for water supplies of different early introduction to clinical medicine in the hospitals sizes for the use of local engineers in investigating and are familiarized with urban and rural community and designing water supply works. medicine. In January 1963 UNICEF agreed to supply pipes and The graduates -the first of whom will qualify in other equipment to the value of about US $1 250 000 1971 -will be required to serve in the national health to provide piped water supplies in eighty -six towns and villages with populations ranging from 1500 to 30 000. service; some will assist the Faculty of Medicine, but These materials began to arrive in mid -1964, and over most will be assigned to hospitals or health centres water supply systems have now been completed, where they will eventually replace foreign physicians. some of the materials not previously in general use in Some will be given further training in Tunisia or Pakistan -such as PVC (polyvinylchloride) and abroad. asbestos cement pipes- having helped to speed up the At least a decade will have passed before the results work considerably. of investment in terms of money, materials and human TheUnitedStatesAgencyforInternational resources will be apparent, but by that time a body of Development (AID) provided a loan so that necessary competent professional people will have been formed materials could be imported. WHO assisted in the to meet the medical needs of the country. With preparation of feasibility reports and loan applications sufficient trained medical personnel available it would for ten urban and sixty -five rural water supply systems. be possible to implement the plans for a complete In 1964 a loan of US $3 500 000 was made to provide network of rural health centres supported by strategi- funds for materials for five urban supply systems and cally placed reference hospitals. for the services of consulting engineers in the investigation, design and construction of these and twenty - one other water and sewerage projects. Community Water SupplyandRuralSanitation, The Organization is also to help in the preparation West Pakistan of a loan application to the International Bank for In West Pakistan, with a population of nearly fifty Reconstruction and Development for the proposed million, the provision of an adequate supply of safe Lahore water and sewerage project.The feasibility drinking -water presents many problems. report for this project, the cost of which is estimated In 1957 WHO provided advice on sanitary en- at about US $15 million, has been prepared by a gineering, and in 1960 a community water supply firm of consulting engineers. project was started, developing later into a rural WHO is now providing a sanitarian to supplement sanitation programme. the work of the sanitary engineer, helping with rural In 1961 it was estimated that about 65 per cent. of sanitary problems as well as with piped water supplies. the urban population of six million were supplied Since1961, when WHO assistance began, the with piped water, and that half of these had to obtain position with regard to water supplies has improved EASTERN MEDITERRANEAN REGION 131 considerably as a result not only of the construction the surveys, and blood sample testing is being under- of new supplies but also of better management and taken by the WHO Serum Reference Bank in Prague. operation of existing ones.An endeavour is being Following a detailed study of immunization in made to put each supply system on a self -supporting Iraq, recommendations have been made on a national basis through adequate payment by the consumer. vaccination programme.Plans have been drawn up for the establishment of an epidemiological unit in each of the fourteen provinces of the country.This Advisory Services in Epidemiology, Iraq will facilitate the integration of routine control of infectious diseases with the activities of existing health The aim of this project, which started early in1964, is to assist the Government in planning, developing departments or units. and operating the epidemiological services at all levels. Assistance has also been given in designing fifty - Accurate information on morbidity from epidemic bed quarantine stations at important border points. diseases has been lacking, and facilities for laboratory Arrangements have been made for suspected cases examinations needed to be improved and extended. of kala -azartobe reported, and for laboratory The first objective of the project was therefore to examination and hospitalization,if necessary, for establish in the Ministry of Health a department of confirmation of diagnosis. epidemiology with a well- equipped public health laboratory and competent statistical services.This FAO /WHO Seminar on Industrial- Canteen Feeding in department is responsible for developing and improving the Near East, Alexandria the collection of epidemiological information and In1963,FAO and WHO participated in a joint carrying out field surveys to obtain data so that sound survey in five countries of the Region on the nutrition programmes can be established for communicable of workers in factories having more than250em- disease control.It is also to undertake in- service ployees.As a sequel, the two organizations held a training of health personnel through special courses seminar in Alexandria in October1965.The twenty - in epidemiology, co- operating with existing teaching one participants, representing ministries of health, institutions in strengthening training programmes in socialwelfare,agriculture, labour, commerce and epidemiology. industry in eight countries of the Region, were able to After adetailedstudy of theepidemiological make field visits to see canteen feeding programmes in situation of the country and an evaluation of vaccina- factories in the United Arab Republic.Represent- tion programmes and the system of transmission atives from UNICEF and ILO also attended. of epidemiological information from local areas to the The seminar was planned in such a way that the Ministry of Health, WHO has worked out a detailed many aspects of industrial feeding could be presented plan for reforming the system of registration of and discussed. The general purpose was to seek ways infectious diseases. Under this plan only the diseases of improving the nutritional status of workers and that are most important from a public health point their families, through medical and welfare services of view are subject to notification; and separate forms and health education.In the discussions repeated are sent weekly to the Ministry of Health. The reference was made to the improvement of nutrition plan includes a scheme to secure the co- operation of as a health -promoting measure which would also health staff for training in communicable diseases, affect working efficiency and lead directly to increased and to provide country-wide laboratory facilities. productivity and, indirectly, to an improved economic Steps have also been taken to carry out in various potential by reducing absenteeism and promoting parts of the country immunological surveys which better family health and welfare.Participants also will reveal, through blood tests, important infections discussed organizational and management problems as contracted throughout the lifetime of persons examined well as the traditional resistance to changes in food and, thereby, the history of infections in the areas con- habits and the consequent difficulty of promoting cerned. Equipment has been supplied for carrying out canteen feeding. CHAPTER 19

WESTERN PACIFIC REGION

Public Health Planning and Administration in receiving technical advice on the health aspects of human reproduction. In the Western Pacific Region health administrations are showing increasing interest in long -term Nursing health planning as an integral part of social and economic development programmes and in this connexion In nursing, WHO has given assistance with the they are seeking advisory assistance from WHO. planning of curricula for post- basic, basic and auxi- In Western Samoa and other countries receiving liary nurse training;with improving the nursing advice on public health administration, attention has practice by supplementary and refresher courses, and been given to the establishment of national health in- service education for all categories of nursing and policies and to the assessment of continuing health midwifery personnel; and with preparing nurses and activities with a view to strengthening health pro- midwives for teaching, supervision and administration grammes or developing new ones, especially in problem and for public health work.Advice has also been areas.Publichealth demonstration and training provided on legislation and other measures to raise projects, such as those in Cambodia, Laos, Malaysia and maintain standards of nursing and midwifery and the Republic of Korea, are being utilized also for education and practice. studying public health practice and methodology in In 1965 WHO assisted infieldprojects which order to plan improvements. In Laos, considerable included many or all of the above activities in the progress has been made during the past year in the British Solomon IslandsProtectorate,Cambodia, rural development project assisted by the United Gilbert and Ellice Islands, Laos, Malaysia, Philippines Nations, WHO and other related agencies. Commu- and Singapore. An initial survey of the nursing and nity participation has in many instances been initiated midwifery situation in Cambodia has provided much with the assistance of local leaders. information which will be used in improving nursing and midwifery and has brought to light problems Maternal and Child Health requiring further investigation. A survey of the nursing personnel was undertaken in Laos as a preliminary Maternal and childhealthactivitiesare being to the planning of programmes in nursing education developed as an integral part of general health pro- and patient care. In Malaysia, an appraisal of nursing grammes. This trend is particularly noticeable in the resources made by the Nursing Department of the South Pacific area where, in co- operation with the Malayan Ministry of Health isto provide a basis South Pacific Commission, a WHO advisory team has for the estimation of nursing requirements in Malaya started work. It will help the governments concerned for a five -year period and for planning the assignment to put into effect the recommendations made by a of nurses to various services. The first of a series of previous team in 1963. seminars on nurse staffingstudies was organized In the Republic of Viet -Nam, the maternal and child in Manila in August 1965 to help nurse leaders in health service in the Ministry of Health is now well estimating staff requirements for nursing services. established and fully staffed, all the basic facilities are available for the extension of activities to the rural Health Education areas, and it has been possible to withdraw the WHO staff. Further progress has been made in health education. In the Philippines,refresher courses have been The Government of Malaysia has adopted a ten -year organized for doctors and public health nurses work- programme for the newly -established Department of ing in maternal and child health programmes at Health Education in the Ministry of Health. WHO national and provincial levels, and paediatric nursing has also assisted in drawing up plans to strengthen has been strengthened. the health education service in the Republic of Viet - A number of governments have expressed interest Nam, and a new project has been started in Singapore. - 132 - WESTERN PACIFIC REGION 133

Assistance provided for school health education in where eradication of this disease has been achieved. the Philippines is mentioned in Chapter 4 (see page 47). It is the first area in the Western Pacific Region from Health education was the subject of the technical which malaria has been eradicated since the start of discussions at the sixteenth session of the Regional the global campaign (see also page 137). Committee. In Malaysia, the malaria eradication programmes in Sabah and Sarawak have made further progress, although in Sabah further improvement is needed Nutrition of the coverage of the rural health services ; in Malaya, The Organization has provided assistance for nutri- the health infrastructure is being developed satisfaction education in several countries, including Malaysia, torily. The programme in the Philippines continued Singapore, the Republic of Viet -Nam, and Cambodia, to experience delays and the activities need to be where it is included in the maternal and child health, redefined. In the British Solomon Islands Protectorate nursing and rural health projects. and the Republic of Korea the development of the WHO continued toco- operate with FAO and health infrastructure is proceeding satisfactorily but UNICEF in an applied nutrition pilot project in the there has been little progress in this respect in Cambo- Philippines, where personnel are being trained, nutri- dia.In Brunei preparations are being made for a tion education programmes established in schools and malaria eradication programme. In the Republic of communities, school- feeding programmes organized Viet -Nam, activities have been limited by prevailing and food production increased. conditions. Training of malaria staff has been actively continued in all programmes. At the Malaria Eradication Trai- Mental Health ning Centre in Manila, seven courses have been held. The development of community mental health Major difficulties have been of an administrative services in the general health services is particularly and organizational nature.In some programmes urgent in countries where conditions are changing there has been a lack of candidates with a suitable rapidly and where provision is needed to deal with or background to fill posts in the malaria services, and avoid the possible ill- effects of these changes, including others have been hampered by financial limitations. those associated with increasing urbanization. Most of the programmes have shown the need for Good progress has been made towards the develop- improvement of administrative and managerial pro- ment of such services in China (Taiwan) where there cedures.Progress has been retarded in certain pro- is a nucleus of trained psychiatrists, and teachers are grammes owing to the inadequate development of the being instructed on child guidance work so that part rural health services. Technical difficulties have been of the school population is now being reached. WHO few, and all are considered to be surmountable if has given advice in child mental health guidance, thenecessaryoperationalfacilitiesareavailable. psychiatric epidemiological research, mental health Where governments have given strong support to the nursing and psychiatric social work, and has provided campaigns and rural health services have been ade- fellowships on the various aspects of mental health. quate, success has generally been obtained. Community support is now required so that a joint There have been considerable improvements in the effort can be made to embark on a community mental organization of national tuberculosis control services health programme covering the whole island. and almost every country in the Region now has a In the Philippines, which is one of the few developing tuberculosiscontrol programme.Inthe WHO- countries that have succeeded in establishing a Mental assisted project in China (Taiwan) a campaign was Health Division at the central government level, there carried out in 1965 for simultaneous vaccination of is a change of emphasis from institutional to commu- newborn infants with BCG and smallpox vaccine. nity mental health, and the central service is able to This is the first campaign of its kind in the Region, contribute to further development at the community and experience gained may prove to be valuable in level. connexion with mass BCG vaccination programmes in countries with a high incidence of infection. Despite limited finances, progress has continued in Communicable Disease Control the WHO- assisted programme in the Republic of The assessment of the malaria eradication pro- Korea, and tuberculosis laboratories have now been gramme in China (Taiwan) was completed early in established in all nine provinces. A national tubercu- 1965 and Taiwan has now been included in the World losis prevalence survey was carried out during the Health Organization's official register of countries year with the assistance of the WHO regional tuber- 134 THE WORK OF WHO, 1965 culosis advisory team. In the Republic of Viet -Nam not keeping pace with the increasing needs resulting the BCG vaccination campaign is being carried out from population growth, particularly in urban areas. in close co- operation with the school health pro- During 1965 a new WHO- assisted project was gramme. A new project designed to set up a national started in Cambodia for the training of sanitarians. tuberculosis control service has been started in Cambo- In the Philippines, WHO assisted in drawing up an dia with assistance from UNICEF and WHO. application to the United Nations Special Fund for A co- ordinated tuberculosis programme has been the preparation of a master plan for the sewerage planned for the South Pacific. UNICEF and WHO systeminmetropolitanManila. Followingthe have assisted in supplying and distributing, through success of the environmental sanitation project in the Medical Department in Fiji, tuberculin PPD RT23 Tonga (see page 136), requests for similar assistance to all territories in the area.Trial campaigns using have been received from other island territories in the combined tablets of isoniazid and thiacetazone for area. An inter -country project has been started for domiciliary chemotherapy of tuberculosis have been the provision of technical advice on community water conducted in the Philippines, the Republic of Korea supplies and environmental sanitation in the South and the Republic of Viet -Nam, and preliminary results Pacific area. are encouraging. Although the Region remained free from smallpox Education and Training during 1965, governments recognizethepossible danger of infection being imported from other areas, The opening in 1965 of a new medical school, the and have continued their efforts to maintain an effec- Faculty of Medicine of the University of Malaya, at tive level of immunization. Support for the smallpox Kuala Lumpur, brought the total number of medical eradication programme was discussed at the sixteenth schools in the Region to eighty -two, including three session of the Regional Committee (see page 135). for training medical auxiliaries. Results of controlled field trials indicate that, to In the Republic of Korea, a new training programme achieve more effective protection with cholera vaccine, for physicians, nurses, sanitary inspectors and labo- further studies are needed on the choice of strain and ratory aides has been started; activities, particularly method of preparation. WHO- assisted research in the practical field aspects, are carried out in conjunc- this field has been continued (see page 27). Cholera tion with the local health services demonstration control still depends upon a well organized national project in Chungchong Namdo Province. programme andtheeffectiveimplementationof The course in occupational and physical therapy several measures, including the rapid detection and at the University of the Philippines is now well estab- proper treatment of cases, detection and control of lished (see page 137). As a result of the good progress carriers, disinfection of contaminated environment, mide it has been possible to complete assistance to improvement of sanitation, mass vaccination, and the School of Radiography in Singapore earlier than health education. In discussions during the sixteenth originally planned. session of the Regional Committee, the importance of a co- ordinated attack was stressed (see also page 135). Co- operation with other Organizations Countriesare becoming increasingly concerned about the more frequent occurrence of such diseases Close co- operation has continued with UNICEF as Japanese encephalitis, haemorrhagic fever and which again has provided supplies and equipment to poliomyelitis, and interested in developing diagnostic many WHO- assisted projects in the Region in the viruslaboratories,undertakingstudiesofvirus fields of maternal and child health, nursing, rural infections and organizing programmes to control health,environmentalhealthand communicable thoseof immediate importance.Epidemiological disease control. UNICEF is collaborating with WHO studies on Japanese encephalitis have been carried in the publication of a manual on the health aspects out in several areas in the Region (see page 19). of nutrition for doctors, nurses and other personnel. WHO is responsible for writing the manual, and UNICEF will pay for its printing and distribution. Environmental Health Collaboration with the United Nations, UNICEF, WHO has intensified its activities with sanitation ILO, FAO and UNESCO in the rural development and has provided assistance to practically all the deve- project in Laos has been strengthened, and conside- loping countries in the Region.Progress has been rable progress has been made (see also page 132). WHO made in training and in the dissemination of informa- has continued to collaborate with the South Pacific tion on environmental sanitation, but in the developing Commission; early in 1965 the Organization contri- countries the provision of basic sanitary facilities is buted to a training seminar on village hygiene and WESTERN PACIFIC REGION 135

health education, and plans were completed for a After considering resolution WHA18.38 on the joint training course on environmental health to be smallpoxeradication programme,the Committee held in Tonga early in 1966.The Commission also adopted a resolution inviting Member States in the provided administrativeservicesfor the maternal Region to give the fullest possible support to the world- and child health advisory team which visited the South wide smallpox eradication programme, the first step Pacific area. being the development of a global plan containing a systematic analysis showing the difficult areas and the areas where eradication has been achieved. The Regional Committee The Committee approved athird general pro- The sixteenth session of the Regional Committee gramme of work, for the period 1967 -1971. for the Western Pacific was held in Seoul, Republic After considering a report on cholera El Tor in the of Korea, from 16 to 21 September 1965. The meeting Region,the Committee recommended thatthere was attended by representatives of all Member States should be a co- ordinated attack on this disease, with in the Region, by representatives of France, Portugal, theSouth -East Asia and Eastern Mediterranean the United Kingdom of Great Britain and Northern Regions. Ireland, and the United States of America, attending The Committee noted with satisfaction the decision on behalf of certain territories in the Region; and by of the UNICEF Executive Board to assist campaigns an observer from Singapore.Representatives of the against poliomyelitis under certain conditions, and United Nations, the Technical Assistance Board, requested the Regional Director to continue to give UNICEF, the International Committee of Military every possible assistance to Member countries under- Medicine and Pharmacy, the South Pacific Commis- taking such campaigns. sion,and ten non -governmental organizationsin official relations with WHO were also present. The Following the technical discussions -on the use of Director -General attended the session. health education servicesin national health pro- The Committee considered nominations for the post grammes -the Committee adopted a resolution em- ofRegionalDirectorto becomevacantafter phasizing the importance of establishing health educa- Dr I. C. Fang's retirement on 30 June 1966. The tion as integral part of national health names of two candidates were proposed for submission programmes and recommending that Member States to the Executive Board. consider the provision of professionallyqualified health education personnelwithintheirnational The Committee examined the report of the Regional " The Role Director on the first fifteen years of WHO activities health services and training institutions. of the Health Department in Environmental Health in the Region.It also discussed the programme and Activities " was selected as the topic of the technical budget proposals for the Western Pacific Region for 1967 and approved them for transmission to the discussions in 1966. Director- General. The seventeenth session of the Committee will be The Committee reviewed a report on health in held at the Regional Office and the eighteenth session relation to demographic questions.The Director - in Kuala Lumpur (Malaysia). General informed the Committee of the report he had A resolution was adopted expressing appreciation submitted to the Eighteenth World Health Assembly to Dr I. C. Fang for his services as Regional Director, on programme activities in the health aspects of world and commending him for the wise guidance and population which might be developed by WHO, and leadership he had given to health authorities in the drew attention to resolution WHA18.49 adopted by Region. the Assembly. The Committee considered that that resolution provided an opportunity for WHO and all Administrative Developments in the Regional Office the Member States to consider the medical aspects of human reproduction, and expressed the hope of a There has been no change in the organizational clearer definition after the Nineteenth World Health structure of the Regional Office.The office of the Assembly of the various services which might be WHO representative for theSouth Pacificarea, provided by WHO. It also recommended that Member previously situated in Sydney, was transferred to States in the Region should carry out studies to deter- Suva (Fiji) in January, and a WHO representative has mine the best way by which information on family been appointed to the Republic of Korea. The WHO planning could reach the groups requiring this know- representative in Kuala Lumpur is now responsible ledge. for Brunei, Malaysia and Singapore. 136 THE WORK OF WHO,1965

Some Aspects of Work in the Region

A list of projects current during the year will be using water from wells. It was estimated that, in order found in Part III.The following have been selected to satisfy the villagers' wish for a convenient water for fuller description. supply and to ensure that new water points could compete in convenience with the existing insanitary Environmental Sanitation, Tonga wells or rain water cisterns, at least one water point was required for every fifty persons, and no house In 1958, the Government of the Kingdom of Tonga should be more than fifty metres away. The cost of began on its principal island, Tongatapu, an environmental health project with the main purpose of a piped water supply in the trial village was estimated to be no more than that of the number of individual providing good drinking -water for the villages. wells equipped with hand pumps that would be The average annual rainfall at Tongatapu is about required to satisfy these criteria.It was therefore 65 inches, fairly evenly distributed throughout the decided to install a piped water supply in the trial year. However, the soil, subsoil and underlying coral of the island are very permeable, and there are no village from a dug well of large diameter. springs or surface streams.Formerly, rainwater was A well was dug to a depth of approximately sixty caught in holes dug in the ground, and more recently feet, mostly through hard coral.Excavation was it has been collected from roofs and stored in concrete stopped about four feet above mean sea level, so that, cisterns.A few wells were dug, but usually gave even if the well were pumped empty, enough fresh brackish water.In periods of drought, cisterns dried water would remain above sea level to prevent incur- up and many people had to go some distance for sion of salt water. The system was completed with the drinking -waterordrink brackishwellwateror installation of an elevated tank of ten thousand coconut milk. gallons capacity, about twelve thousand feet of pipe, The frequent water shortage and the high incidence and thirty -three public taps each serving an average of water -borne diseases, particularly typhoid fever, led of forty -six people. The villagers, who provided to a request to WHO, which provided an anthro- without pay all the unskilled labour required for pologist and a sanitary engineer. digging the well, digging and refilling the trenches for The customs and traditions of the people in relation the water pipes and constructing the water tank, were to sanitary facilities and water supply were studied; encouraged to make private connexions to the water it was clear that the population was mainly concerned system at their own expense. with convenience of supply, and saw no connexion The trial scheme was completed in March 1961; between bad water and ill health.It seemed possible the piped well water has never had a salinity of more for the villagers to provide free unskilled labour and than fifty milligrams per litre of chlorides, and has contribute towards the cost of construction of their been of consistently good bacteriological quality. water supplies, the Government initiating and organizing the work. The success of this initial trial immediately resulted in requests from other villages, and the Government Preliminary studies of the sources of water supply decided to construct water supplies wherever physically indicated that there was a layer of fresh water floating on the salt water in the permeable substrata of the and economically feasible. WHO has assisted in island.However, two of the principal drilled wells designing and supervising the construction of addi- and many of the dug wells gave saline water which, tional village water systems, and in 1962 UNICEF though usually drinkable, was unpalatable.Investi- provided supplies for twenty village water systems gations suggested that the wells were too close to the and for the construction of sanitary facilities in village seashore, drew water from too deep strata, or were schools. Most of the twenty systems were completed overpumped.It was demonstrated that a bad well in1963, and UNICEF agreed to provide further could be made good by placing nine metres of concrete materials for the construction of eighteen more such and broken stones at the bottom, leaving approxi- systems. In the construction of all these water supply mately three metres of water. After reconstruction the systemsthevillagershavecontributedhalfthe well gave sufficient water of one -tenth the former Government's estimated expenses for skilled labour, salinity. supervision, and materials not provided by UNICEF, The Government therefore decided, with advice and have in addition provided all unskilled labour from WHO, to construct a pilot village water system without pay. rpo/.tNS%¿Sr,Li+./ACí'dX 1 cc7'^"'n, Vd rt GK A,.jloa=A.ílal5. ,^

SMALLPDX ERADICATION CAMPAIGN IN EAST PAKISTAN

The health authorities of East Pakistan are carrying out a 2 large -scale smallpox eradication campaign aimed at providing complete protectionfor the population.WHOassistance includes the provision of experts to help in evaluating the technical and administrative methods used in the campaign. 4 1. A doctor -a former WHO fellow -lectures on smallpox epidemiology at the Institute of Public Health in Dacca.

2. A WHO expert sent to Dacca to discuss vaccine production and assist the Pakistan authorities examines the statistics of the eradication campaign.

3. In the Dacca area, a local community leader explains to the population the advantages of vaccination and introduces a vaccinator.

4. The vaccinator at work.

3 2

MALARIA ERADICATED FROM TAIWAN

A WHO evaluation team visited Taiwan at the end of 1964 to

assess the situation, with a view to certification of malaria era- 3 4 dication.It was considered that all the conditions for certification had been fulfilled (in particular the absence of indigenous cases for three consecutive years), and in November 1965 Taiwan was placed on the WHO official register of countries where malaria eradication has been achieved.Itis the first country in the Western Pacific Region to attain that status (see also page 137). 7

1. Before the eradication campaign, malaria was rife inrural areas, where conditions favoured the spread of the disease.

2. A mosquito collector of the antimalaria service at work in a rural dwelling.

3. During the extensive case -finding operations of the consolidation phase, a member of a township malaria vigilance unit takes a blood sample in the pharmacy where he is employed.

4. Blood slides sent from all over the island are sorted at the Taiwan Provincial Malaria Research Institute.

5. Laboratory technicians at the Institute examine slides for malaria parasites.

6. One of the main tasks is to prevent the reintroduction of malaria: a quarantine officer at the port of Kao- Hsiung questions the crew of a fishing boat that may have called at malarious ports outside Taiwan.

7. The Director of the Malaria Eradication Training Centre in Manila, who led the WHO evaluation team, confers with the Director of the Taiwan Provincial Malaria Research Institute.

5 PHYSICAL AND OCCUPATIONAL THERAPY

IN THE PHILIPPINES

With the aim of building up a nation -wide system of rehabilitation services for the physically handicapped, the Philippine Government is organizing courses at the University of the Philippines for physical and occupational therapists. For this project, described in detail on page 137, UNICEF is providing supplies and WHO technical advice on the training programme. The clinical part of the course is given at the National Orthopaedic Hospital in Manila.

1. A physical therapist demonstrates therapeutic exercises to students.

2. A WHO expert supervises therapeutic exercises given by a fourth -year student.

3. A student exercises a young victim of cerebral palsy.

4. A paraplegic who is a skilled watch repairer and who was treated at the National Orthopaedic Hospital has taught his skill to more than fifty other patients, enabling them to return to their villages with a new craft.

3 4 WESTERN PACIFIC REGION 137

The success of this project has attracted much population of approximately six million.Between attention from other island communities in the area, 1946 and 1949 malaria stations were established in and similar projects are likely to be established in several parts of Taiwan with the assistance of the other parts of the South Pacific. Rockefeller Foundation, and in1949 the Taiwan Provincial Malaria Research Institute (TAMRI) was Physical and Occupational Therapy, Philippines established. With the assistance of WHO and the United States In 1961 WHO was requested to help in establishing Agency forInternational Development (AID),a and organizing the School of Allied Medical Profes- pilot project was started in 1952 in south -west Taiwan. sions at the University of the Philippines, in planning Indoor residual spraying with DDT was carried out, and implementing physical and occupational therapy covering a population of 37 000.In 1953 a residual courses, and in training local counterparts. spraying programme, also using DDT, covered a A lecturer in physical therapy was provided by population of 1 500 000 in areas where the spleen WHO, and after fourteen months of preparation rates were higher than 35 per cent. This programme -including the selection of local teaching staff, the was expanded in succeeding years to cover a popula- completion of the physical facilities to house the tion of 5 000 000, including all malarious townships school, and the development of four -year curricula on the island. in occupational and physical therapy -the school was Encouraged by the results of the control campaign, formally opened in 1962.In May 1965, fourteen which almost eliminated malaria from the whole students graduated in physical therapy and two in island, the Government decided in 1955 to undertake occupational therapy. An occupational therapist pro- a programme aiming at total eradication.This was vided by WHO arrived in 1965, and is engaged in started in 1956: spraying was carried out in all the teaching activities, training counterparts, and develop- malarious areas,covering a population of seven ing field training facilities.Fellowships have been million. awarded for local counterparts to receive advanced On the basis of the results of the epidemiological training abroad. assessment of the 1956 spraying programme, and in The lecturers provided by WHO contributed to the view of the confinement of malaria to certain residual formation of two national associations, one in physical foci,it was decided to reduce spraying coverage therapy and the other in occupational therapy -a progressively and to rely on the surveillance system, development which has served to upgrade and obtain including focal spraying and drug distribution, to recognition for these new professions in the country. deal with the residual malaria.In 1957 the spraying The directors of various hospitals have become programme was reduced to cover a population of aware of the possibilities offered by rehabilitation, only1 500 000, while from 1958 to 1960 -the last and there is a growing demand for trained physical year of the spraying campaign -only 300 000 people and occupational therapists. were covered annually. The consolidation phase The school has received support from UNICEF for started in mid -1960. teaching equipment and supplies and stipends for a A surveillance scheme was started in 1954 and in number of students at the school, and equipment from September 1955 it was expanded from the original the Colombo Plan. thirteento eighty -nine townships. The practical The project is continuing to develop. Well trained experience acquired in surveillance methods made it local teaching staff are employed, and the curricula possible during the consolidation phase -1960 to meet the standard requirements of the World Con- 1964 -to conduct an effective stratifiedsystem of federationforPhysical Therapy and the World surveillance, suited to local epidemiological conditions. Federation of Occupational Therapists.Since 1962 The case -detection coverage during the consolidation there has been a total of 175 students (including phase was of a very high standard, and an average of graduates),ninety studying physical therapy and over 700 000 people was examined every year by a eighty -five occupational therapy. staff of thirty county supervisors, 400 township and 200 village health technicians.These have not only Malaria Eradication, China (Taiwan) been serving as part -time surveillance agents in active During the Second World War severe malaria case detection but have also been co- ordinating the epidemics occurred in Taiwan and a parasite survey work of 4700 voluntary collaborators in passive case conducted in 1946 among schoolchildren in northern, detection since 1963. central and southern Taiwan revealed parasite rates The transfer of surveillance responsibility from of 20 to 40 per cent. In the same year it was estimated TAMRI to the regular health services started in late that there were a million cases of malaria among a 1962, and in1964 malaria surveillance operations 138 THE WORK OF WHO, 1965 throughout the country became the direct responsibi- The second phase in 1963 consisted of visits to lity of the local health services. thirteen countries and territories to discuss further the Satisfied with the results of the eradication pro- objectives of the programme. gramme, the Government submitted a request to WHO The first part of the third phase was a three months' in July 1964 for the certification of malaria eradication. training course on dental epidemiological methods, A WHO evaluation team was therefore assigned to held in Singapore in 1964.There were nine partici- Taiwan from 9 November to 18 December 1964, and pants -from China (Taiwan), Hong Kong, Malaysia, at the end of 1965 China (Taiwan) was certified as Singapore, the Philippines, the Republic of Korea, having eradicated malaria. and the Republic of Viet -Nam. A week's briefing on A variety of favourable factors -technical, adminis- sampling,diagnosticcriteriaandrecording, was trative, financial, and others -have contributed to the followed by a sample survey and daily discussions on success of this programme.However, two features standardization between paired examiners and on the are particularly notable: the availability of an adequate problems encountered during the survey.The par- number of qualified, experienced and devoted malaria ticipants also took part in the analysis and presentation workers, and the whole- hearted support and co- of the survey data. operation of the medical and health services, private The second part of the third phase consisted of a practitioners, armed forces, school- teachers, and the similar three months' training course held in Suva, population in general. Fiji, from February to May 1965 for participants from the countries and territories in the South Pacific. Epidemiological Surveys of Dental Diseases There were six participants -from American Samoa, Fiji, Papua and New Guinea, Tonga and Western The absence of reliable and precise data on the Samoa.Other governments were unable to send extent and severity of dental diseases has been an participants owing to shortage of personnel. With the obstacle in the organization of dental health services sample survey conducted during the training course, in the developing countries and territories of the and the subsequent coverage of other areas by govern- Region.There is also an almost complete lack of ment staff, the survey in Fiji has now been completed dental officers with training and experience in dental and the results are being analysed by WHO. epidemiological methods. The fourth phase consists of surveys conducted by A five -phase inter -country dental health programme was started in 1961. The aim was to provide the necess- the governments themselves, using the criteria and ary training in dental epidemiological methods so methodology recommended by WHO. Singapore that national surveys could be conducted and base- has already initiated such a survey, the Government line data obtained for use also in subsequent evalua- of the Philippines has prepared plans to start a survey tions, and to draw up a plan of development based in one of the health districts, and it is expected that on internationally comparable epidemiological data. some of the territories in the South Pacific will under- The first phase was implemented in 1962 with the take surveys in 1966. completion by each government of a questionnaire Following the completion of epidemiological surveys giving information on dental manpower and dental by governments which now have one or more dental surveyspreviously conducted, and anindication officers trained in dental epidemiological techniques, of its interest in sending a dental officer to attend a recommendations willbe made as to the action dental epidemiology training course before assigning necessary to develop and strengthen dental health him to assist in conducting a survey within the country. services. PART III

PROJECT LIST PROJECTS IN OPERATION IN 1965

This part of the Report contains a list of the projects -country, inter -country and inter -regional -that were in operation during the whole or part of the period from 1 December 1964 to 30 November 1965. Continuing projects for which the only assistance given during the period was technical advice from headquarters or regional offices are not normally shown. In country projects, the purpose for which the government or governments undertook the project is stated. Details of the assistance provided by the Organization and of the work done are given for completed projects and refer to the whole period over which the project was assisted by the Organization. Such details are not given for continuing projects. As in former Annual Reports, an attempt has been made to summarize the immediate results of projects for which the Organization's assistance terminated in the period under review and, where the nature of the work has permitted, to assess or evaluate how far the project has succeeded in the purposes for which it was undertaken. It has not been possible to do this for all completed projects; there has not been time, for example, to assess those that ended late in the period covered. The projects are grouped by region in the following order: Africa, the Americas, South -East Asia, Europe, Eastern Mediterranean and Western Pacific. In order to give a balanced account of the health programme in the Americas, the list for that region includes the projects assisted by PAHO in addition to those assisted by WHO. For each region, projects in individual countries are given in the alphabetical order of countries; the projects that concern more than one country follow, and are lettered AFRO, AMRO, SEARO, EURO, EMRO or WPRO. Inter -regional projects are given at the end of the list. Under the heading " Fellowships " are shown those fellowships awarded during the period 1 December 1964 to 30 November 1965 that do not form part of assistance to a larger project. A table showing all the fellowships awarded during the same period, by subject of study, is given in Annex 12. The starting and finishing dates are shown after the project title; the finishing date of uncompleted projects is indicated, where possible, in italics. Names of co- operating agencies, whether or not they have contributed funds, are given in parentheses after the source "of funds. The abbreviations used include the following: R - regular budget; MESA - Malaria Eradication Special Account; EPTA'- Expanded Programme of Technical Assistance; AID - United States Agency for International Development. Other abbreviations are explained in the list on page 1t.

- 140 - AFRICA

Basutoland 2Tuberculosis Control Cameroon 10 and 24Health Services, Federal Republic (1962 - 1968) EPTA UNICEF (Oct. 1961 - end of 1965) R EPTA To establish a pilot area for the study of standardized and To reorganize and strengthen the health services in West simplified tuberculosis control measures, with a view to finding Cameroon. efficient and economically feasible methods of combating the disease on a country -wide scale. Cameroon 16Nursing Advisory Services (1962 -1968) EPTA UNICEF '4asutoland200Fellowships R: Laboratory techniques (three To develop programmes for the training of midwifery and years), nursing education (three years). nursing personnel and to strengthen nursing services.

Bechuanaland 2Trypanosomiasis Control (1955 -1969) EPTA'ameroon200Fellowships R: Nursing administration (twelve months), public health administration (twelve months), sanitary To study the trypanosomiasis problem in all its aspects and science (twelve months). to plan a pilot control project. 'Cameroon 201Fellowships EPTA: Forensic medicine and Bechuanaland 200Fellowships R: Operating -room tech niques industrial health (four years), laboratory techniques (two years), (ten months). pharmacology (two for three and a half years), physiology (five years).

9 Burundi 2Public Health Administration v\Central African Republic 7Environmental Sanitation " (June 1962 -1968) EPTA (1964 -1968) EPTA UNICEF To plan and organize a national health service, and to tri ain To set up a sanitation unit in the Ministry of Health; to train professional and auxiliary health personnel. sanitation personnels and to plan and develop a long -term sanitation programme. Burundi 3Maternal and Child Health Services k\ (Aug.j 1963 - 1967) R UNICEF Chad 3Maternal and Child Health (Feb. 1965 -1968) EPTA UNICEF To develop the maternal and child health services and to train maternal and child health workers. To improve the maternal and child health services and to train staff for maternal and child health centres, particularly in the rural areas. Burundi 5Environmental Sanitation and Training (Sept. 1963 -1968) EPTA Chad 10Environmental Health To train sanitation personnel and to set up a demonstration (Jan. 1964 -1968) EPTA UNICEF area. To set up a sanitation unit in the Ministry of Health; to train sanitation personnel; and to carry out a sanitation programme covering the whole country. Burundi 201Fellowships EPTA: Sanitary engineering (four years), undergraduate medical studies (two for four years). had 14Nursing Education (Jan.1962 - 1970) R UNICEF

Cameroon 2Malaria Pre -eradication Programme To establish a basic school of nursing and to raise the standard (Dec. 1962 -1972) R MESA EPTA of nursing education to the state diploma level. To develop a network of basic health services based on experience gained in one or more demonstration areas and had 201Fellowships EPTA: Undergraduate medical studies which can provide support for a future malaria eradication (six for six years). programme; to train personnel to form the nucleus of a national malaria service; to undertake a general survey of malaria Congo (Brazzaville) 18Rural Health Services epidemiology and to develop facilities for improving'the diagnosis (1964 -1968) EPTA UNICEF of malaria and for increasing the availability of antimalarial drugs. To organize health services with emphasis on maternal and From 1958 to 1962 a malaria pilot project and pre -eradication childhealth,tuberculosiscontrol,environmentalhealth, survey were undertaken. health education and nutrition. - 141 - 142 THE WORK OF WHO, 1965

Congo (Brazzaville) 200Fellowships R: Anatomy, histology Ghana 1Malaria Pre -eradication Programme and embryology (two and a half years). (Jan. 1963 -1972) R MESA EPTA To develop a network of basic health services based on Dahomey 1Malaria Pre -eradication Programme experience gained in a demonstration area and which can (Dec. 1963 -1972) R provide support for a future malaria eradication programme; to train personnel needed for this programme; to undertake a To develop a network of basic health services based on general survey of malaria epidemiology and to develop facilities experience gained in a demonstration area and which can provide for improving the diagnosis of malaria and for increasing the support for a future malaria eradication programme; to train availability of antimalarial drugs. personnel to form the nucleus of a national malaria service; to This programme supersedes the pilot project that was carried undertake a general survey of malaria epidemiology and to out from 1958 to 1962. develop facilities for improving the diagnosis of malaria and for increasing the availability of antimalarial drugs. Ghana 3Maternal and Child Health Services Dahomey 7Environmental Sanitation (1963 -1969) R UNICEF (Sept. 1961 -1967) EPTA UNICEF To develop the maternal and child health services and to To organize sanitation services. train personnel.

Dahomey 9Hospital Administration (Aug. 1965) EPTA Ghana 5Bilharziasis Control (1960 -1969) EPTA WHO provided a consultant for three weeks to study the To carry out a pilot project for the control of bilharziasis, general principles of hospital organization in Dahomey, in- based on studies of the distribution and biology of the snail cluding the distribution of institutions, legislation, staffing and intermediate hosts.These studies had been almost completed managerial problems of public hospitals, and integration of by the end of the period under review. hospital services in the public health programme, and to advise on future developments. Ghana 11Tuberculosis Control 4ahomey 200Fellowships R: Cardiology (ten months), DPH (1962 - 1968) EPTA UNICEF course (twelve months), nursing (two for one year). To organize a pilot area project in order to determine the best procedures, under local conditions, for case- finding, treatment and follow -up of tuberculosis cases and suspected contacts; S: Gabon 3Maternal and Child Health Services and to train national personnel. (1961 -1970) R UNICEF To develop the maternal and child health services and to train personnel. hana 25Training of Community Health Nurses (1962 -1966) EPTA UNICEF

Gabon 6Environmental Heatlh (1963 - 1968) R UNICEF To train community health nurses who will supplement the work of the public health nurses in organizing a domiciliary To set up a sanitation unit in the Ministry of Health; to %D al health service as part of an overall plan for rural health. sanitation personnel, and to develop a long -term sanitation programme. Ghana 27Post -basic Nursing Education Gabon 8National Health Laboratory (June - Aug. 1962; Sept. 1963 -1970) R UNICEF (April 1965 -1968) EPTA To set up a school for post -basic nursing education pro- To set up a national health laboratory and to train laboratory grammes in the University of Ghana. technical personnel.

Ghana 29Master Plan for Water Supply and Sewerage for )(Gabon16Nursing Education (1962 -1968) R the Metropolitan Area of Accra -Tema (Aug. 1963 -1966) United Nations Special Fund To organize basic programmes for the training of professional and auxiliary nurses. To prepare a water supply and sewerage plan for the metropolitan area of Accra -Tema and to establish the Ghana Water Resources Development Corporation. WHO is assisting with XGambia 3Nursing Education (1962 -1967) EPTA UNICEF engineering studies and the preparation of a feasibility report, To organize programmes fortrainingprofessional and and in training personnel. auxiliary nurses and midwives.

Ghana 200Fellowships R: Bilharziasis control (six months), Gambia 201Fellowships EPTA: Laboratory techniques (two Fellow of the Royal College of Surgeons course (twelve months) years). nursing (eight weeks). PROJECT LIST : AFRICA 143

Guinea 1Maternal and Child Health Services kIvory Coast 8Vital and Health Statistics Services (Jan. 1961 - June 1965) EPTA UNICEF (Nov. 1963 -1968) EPTA The aim was to develop maternal and child health services To organize a vital and health statistics section in the Ministry and to train staff. WHO provided a maternal and child health of Health; to improve the collection and analysis of vital and adviser from January 1961 to April 1965 and a public health health statistical data; and to train medical and statistical nurse from September 1961to November 1963 and from personnel. June 1964 to June 1965. A pilot centre, equipped by UNICEF, was established in Environmental Sanitation Conakry. Maternal and child health staff were trained at Ivory Coast 12 basic and post -basic levels. To enable staff to be trained locally, (Jan. 1963 - 1968) EPTA nurse educators from different areas were prepared to under- To set up a sanitary engineering section in the Ministry of take this work under supervision. Health; to train sanitation staff; and to develop a long -term sanitation programme. Guinea 3Leprosy Control (May 1965) R Ivory Coast 200Fellowships R: Midwifery (twelve months), WHO provided a consultant to make an assessment of the health (twelve months). leprosy control programme. //public '4vory Coast201Fellowships EPTA: DPH course (nine months). `n Guinea 8Environmental Sanitation (Sept. 1960 - July 1965) EPTA UNICEF ,,XKenya 2Environmental Sanitation \\ (Sept. 1960 -1968) R UNICEF WHO provided a sanitary engineer to assist in paining sanitation personnel, in planning an environmental health unit To improve water supplies and excreta disposal systems in the Ministry of Health, and in developing a sanitation pro- and to train sanitation personnel. gramme for the whole country, starting with a pilot demonstration area and giving special attention to the provision of com- Kenya 4Tuberculosis (Chemotherapy and BCG) Centre munity water supplies. (Nov. 1957 - 1968) EPTA UNICEF

To continue tuberculosiscontrol work(includingcase - Guinea 12Onchocerciasis Control (Nov. - Dec. 1964) EPTA finding,contact -tracing,domiciliarytreatment,chemopro- WHO provided a consultant to assess the onchocerciasis phylaxis and other investigations), and to traln medical and problem.He found that the main foci of the disease were auxiliary personnel -particularly the auxiliaries needed for the situated on both sides of the border between Guinea and iïtional BCG campaign. Portuguese Guinea.Further surveys to ascertain the exact location of the main Simulium larval habitats will be required Kenya 9Nutrition Survey and Control of Deficiency Diseases before plans for a control programme can be drawn up. 1 (Feb. 1961 -1968) R UNICEF To ascertain the main deficiency diseases in various areas Guinea 16Public Health Services of Kenya and to study their nature, frequency, severity and (July 1964 - July 1965) EPTA distribution; to determine the place of malnutrition in relation to health and socio- economic conditions; and to train local The aim was to analyse the cost and performance of the personnel for a permanent national nutrition centre. public health services and to reorganize them according to the most economical criteria and the priority needs. WHO provided a public health adviser for thirteen months. Kenya 16Development of Basic Health Services The general health situation in the country was reviewed and (Oct. 1962 - end of 1967) R UNICEF advice was given on the control of some communicable diseases. To strengthen and develop rural health services, with emphasis on maternal and child health; and to train health per- (See page 96) `+ Guinea 200Fellowships R: Dental health (twelve months). sonnel.

Kenya 33Survey of Irrigation Potential of the Lower Tana Xuinea 201Fellowships EPTA: Undergraduate medical studies River (July - Sept. 1965) R (United Nations Special Fund) (ten for six years). (FAO) WHO provided two consultants for six weeks and the services Ivory Coast 3Leprosy Control (May 1965) R of the sanitary engineer attached to project Kenya 2 for three WHO provided a consultant to make an assessment of the months to advise on health and sanitation aspects of the Lower Tana River irrigation scheme -a United NationsSpecial leprosy control programme. Fund project for which FAO is the executing agency. Possible health hazards -particularly the spread of parasitic diseases - Ivory Coast 4Maternal and Child Health Services connected with the scheme were investigated and recom- (March 1964 -1970) R UNICEF mendations made on measures to prevent them, and advice was given on the feasibility of specific designs for water supply To develop the maternal and child health services and to and sewerage systems, housing and environmental sanitation trrsonnel. works. 144 THE WORK OF WHO, 1965

Kenya 34Medical School, Nairobi(Nov. 1965 - 1967) R Madagascar 19Environmental Health (Jan. 1965 - 1968) EPTA UNICEF To set up a medical school in Nairobi. To set up a sanitary engineering unit in the Ministry of Health; to formulate a long -term sanitation programme; and Kenya 200Fellowships R: Environmental sanitation (three to train personnel. months), freeze -dried smallpox vaccine production (six weeks), laboratory techniques (seven months), maintenance of freeze - dried smallpox vaccine equipment (three months), nursing and adagascar 200Fellowships R: Surgery (six months) midwifery (four for one year), nutrition course (eight months).

Madagascar 201Fellowships EPTA: Assistant bacteriologist's Kenya 201Fellowships EPTA: Applied parasitology and course (two years), cardiology (three years) dermato -venereology `entomology (six months), DPH course (twelve months), nursing (twenty months), pneumophthisiology (three years), sanitary administration (six and a half months), undergraduate medical techniques (twenty months). studies (seven years).

Liberia 3Yaws Control (1953 -1968) EPTA UNICEF Mali 9Environmental Health (1963 -1967) R To consolidate the yaws control programme, and to carry To carry out a programme for training assistant health out a programme for the control of other communicable inspectors; to set up an environmental health unit in the Ministry diseases, particularly leprosy and smallpox. The former smallpox of Health; and to plan and develop a national sanitation pro - control project, Liberia 17, has been merged with this project. gramme.

(Liberia15Environmental Health (1958 -1967) R UNICEF Mali 14Nursing Advisory Services To set up a sanitary engineering unit in the national public (Nov. 1964 -1970) R UNICEF health service; to formulate a long -term sanitation programme; To improve the nursing services and nursing education. and to train personnel. Mali 22 Liberia 20Malaria Pre -eradication Programme Smallpox Eradication (Feb. 1965 -1970) EPTA (Dec. 1962 - 1972) R To carry out a smallpox eradication programme. To develop a network of basic health services which can provide support for a future malaria eradication programme; to Mali 200Fellowships R: Undergraduate medicalstudies train personnel to form the nucleus of a national malaria service (eight for six years). and to supplement the personnel available for the basic health services; to make a general survey of malaria epidemiology and to develop facilities for improving the diagnosis of malaria Mali 201Fellowships EPTA: Dentistry (two for five years), and for increasing the availability of antimalarial drugs. undergraduate medical studies (eleven for six years).

Liberia 25National Health Planning (May 1964 - April 1965) Funds -in -trust Mauritania 2Leprosy Control (May 1965) R The aim was to establish a general health programme at WHO provided a consultant to make an assessment of the national level. WHO provided a public health adviser and leprosy control programme. consultants in health statistics and in the cost of health services; staff assigned tothe malariapre -eradicationprogramme Mauritania 3Maternal and Child Health Services (Liberia 20) also co- operated. (Feb. 1963 -1967) R UNICEF A health plan was prepared in four parts: description of the general features of the country and of its economic and social To organize maternal and child health services and train problems; evaluation of the existing health situation; record personnel. of needs and priorities; and actual plan of health development. A provisional planning committee set up in June 1964 held regular sessions to study the problems arising from implemen- uritania 8Nursing Advisory Services tation of the health plan. (Nov. 1963 -1968) R UNICEF To organize nursing services and develop nursing education. Madagascar 17Nutrition (April 1965 -1968) EPTA UNICEF

To develop nutrition work and to organize a nutrition section Mauritania 9Malaria Pre-eradication Programme in the Ministry of Health. (Oct. 1962 -1972) R

Madagascar 18Development of Basic Health Services (Public To develop a network of basic health services which can Health Administration) (Aug. 1963 -1968) R UNICEF provide support for a future eradication programme; to train personnel to form the nucleus of a national malaria service; to To strengthen basic health services within the framework of undertake a general survey of malaria epidemiology and to community development, with emphasis on maternal and child develop facilities for improving the diagnosis of malaria and health. for increasing the availability of antimalarial drugs. PROJECT LIST: AFRICA 145

(Mauritania 201Fellowships EPTA: Cardiology (three years), Nigeria 10Rural Health Services, Eastern Nigeria nursing (fourteen for two years). (Nov. 1957 - 1967) EPTA UNICEF To improve rural health services, particularly in relation to Mauritius 7Malaria Eradication Programme maternal and child health, and to trainparamedical_ and (Jan. 1960 -1968) R MESA auxiliary personnel. To eliminate the remaining focus of transmission on the west coast of the island; to extend the consolidation phase to cover Nigeria 14Tuberculosis control the entire coastal area; to continue vigilance in the central area (Sept. 1961 -1968) R UNICEF under maintenance and to develop methods aimed at preventing To establish pilot tuberculosis control areas, first in the town the reimportation of malaria. of Ibadan, and later in rural areas, for testing tuberculosis control measures suited to available resources and applicable Mauritius 15National Environmental Sanitation Programme under local conditions; and to traja_personnel. (March 1965 -1968) EPTA To organize a central division of environmentalhealth, C. Nigeria 21Rural Health Services, Western Nigeria elaborate a training programme for sanitation personnel and set (1961 -1967) EPTA UNICEF This project will be linked with a up demonstration areas. To assist the development of health services through the project for a land and water survey, financed by the United establishment of a public health engineering unit in the Ministry Nations Special Fund. of Health, of a centre for public health nursing training, and of a demonstration area for the practical training of auxiliary Mauritius 19Nutrition Advisory Services (1965 - 1966) R health personnel; and to develop a network of health centres to provide integrated public health services. To improve the nutritional status of the population; to study nutritional anaemias; and to evaluate the programme of enrichment of food with iron. Nigeria 23Environmental Sanitation, Northern Nigeria (1963 -1966) R UNICEF

Niger 5Tuberculosis Control (1964 -1968) EPTA UNICEF To carry out environmental sanitation work, including the provision of rural public water supplies and the training of To establish a national pilot area in which BCG vaccination sanitation personnel, in the Igala and Idoma divisions. will be carried out and which will be used for training national personnel. Nigeria 26Malaria Pre -eradication Programme, Western Nigeria (Oct. 1964 - 1972) R Niger 8Public Health Administration (1962 - April 1965) EPTA To reorient the network of basic health services to provide support for a future eradication programme; to train personnel WHO provided a public health administrator to assist in to form the nucleus of a national malaria service; to make a planning for the development of the national health services. general survey of malaria epidemiology and to develop facilities He prepared a number of reports, the latest of which, submitted for improving the diagnosis of malaria and for increasing the in July 1964, is entitled " Perspectives décennales 1965 -1974 du availability of antimalarial drugs. développement des services de santé dans la République du Niger ".The report is the result of the work of government teams and of international and bilateral assistance to the Nigeria 28Health Education (1962 -1968) EPTA Government in establishing the socio- economic development To extend the use of health education methods in the health plan for the country. The Government has published the report and plans to implement the public health programme contained services. therein.In this connexion various WHO- assisted projects have been set up, with a view to the integration of all public health Nigeria 32Malaria Pre -eradication Programme, Northern activities in Niger. Nigeria (Nov. 1962 - 1972) R To investigate the methodology of attack operations in the Niger 11Nursing Education savannah areas of West Africa; to develop a network of basic (Nov. 1963 -1971) R United Nations Special Fund health services which can support a future malaria eradication programme; to train personnel to form the nucleus of a national To develop nursing education programmes. malaria service; to make a general survey of malaria epidemiology and to develop facilities for improving the diagnosis of malaria YNiger 21Nursing Advisory Services (1964 - ) EPTA and for increasing the availability of antimalarial drugs. To organize the training of nurses and to develop nursing services in accordance with the country's needs. Nigeria 37 Malaria Pre -eradication Programme, Eastern Nigeria (March 1963 -1972) R MESA

Nigeria 1Yaws Control (July 1954 - 1966) EPTA UNICEF To develop a network of basic health services, based on experience gained in a demonstration area and which can To implement the consolidation phase of the yaws control provide support for a future malaria eradication programme; to campaign. train personnel to form the nucleus of a national malaria service; 146 THE WORK OF WHO, 1965

to make a general survey of malaria epidemiology and develop engineer from July to September 1962 and from February 1963 facilities for improving the diagnosis of malaria and for increasing to March 1965, and a public health nurse from July 1962 to the availability of antimalarial drugs. November 1964. An evaluation of the health situation was made, which resulted Nigeria 43Rehabilitation Services, Western Nigeria in the strengthening of tuberculosis control and of maternal and (Jan. - Feb. 1965) R child health services and the setting -up of WHO -assisted projects in these subjects (see projects Rwanda 1 and Rwanda 3). WHO provided a consultant for three weeks to advise on the Efforts were made to improve training schools and to establish development of medical and vocational rehabilitation services new ones, but training was limited to professional and auxiliary for the physically handicapped. nurses and midwives. Further advice on the development of the national health system is to be provided by the public health adviser who is Nigeria 56Public Health Advisory Services, Mid -west Nigeria being assigned to assist in developing a faculty of medicine at (Sept. 1965 -1968) R the University of Butare. To develop the health services and to train health personnel. Rwanda 3Maternal and Child Health Services 'Nigeria200Fellowships R: Health education (two for thirteen (Feb. 1964 - 1970) R UNICEF and a half months), haematology (twelve months), leprosy (eighteen months), medical registration and medical education To expand the maternal and child health services and to train (six weeks), nursing (two for twelve months), ophthalmology personnel. (two years).

Senegal 3Leprosy Control (May 1965) R Nigeria 201Fellowships EPTA: DPH course (two for twelve months). WHO provided a consultant to make an assessment of the leprosy control programme. Portugal- Mozambique 1Malaria Pre -eradication Programme (Nov. 1962 -1972) R MESA Senegal 4Environmental Health in Rural Areas To develop a network of basic health services which can (July 1960 -1967) EPTA UNICEF provide support for a future malaria eradication programme; to train personnel to form the nucleus of a national malaria To improve environmental sanitation conditions in rural service; to make a general survey of malaria epidemiology and areas; to set up a sanitation unit in the Ministry of Health, and to develop facilities for improving the diagnosis of malaria and to train sanitation personnel. for increasing the availability of antimalarial drugs.Also to plan, carry out and evaluate a pilot project in and around Lourenço Marques. Senegal 11Health Statistics (May 1965 - ) R This programme follows a pre -eradication survey carried out To organize a statistical unit in the Ministry of Health and from 1960 to 1962. to set up a national committee on vital and health statistics; to develop the collection, compilation, presentation and use of 'Portugal-Mozambique 200 Fellowships R: DPH course (twelve statistical material; and to train the necessary statistical per- months). sonnel.

Réunion 7Malaria Pre- eradication Survey Senegal 12Nursing Advisory Services (Oct. 1965 -1967) R (May 1964 -1968) R UNICEF To assess the prevalence of malaria and to prepare a plan of To develop nursing and midwifery education programmes operation for an eradication programme. which will include the teaching of public health.

éunion 200Fellowships R: Leprosy (three months). Senegal 13Malaria Pre- eradication Programme (Nov. 1965 -1972) R Rwanda 1Tuberculosis Control (Oct. 1965 -1968) EPTA UNICEF To develop the network of basic health services which can provide support for the future eradication programme; to train To set up a pilot area in which BCG vaccination and possibly personnel to form the nucleus of a national malaria service; to additional simplified tuberculosis control measures will be undertake a general survey of malaria epidemiology; and to carried out to determine their suitability for application through- develop facilities for improving the diagnosis of malaria and for out the country, and in which personnel will be trained. increasing the availability of antimalarial drugs.

Rwanda 2Public Health Advisory Services (June 1962 - May 1965) EPTA XSenegal 14School of Public Health, Dakar (Nov. - Dec. 1964) R UNICEF The aim was to organize national health services and to train professional staff and auxiliary health workers. WHO provided WHO provided a consultant for three weeks to advise on the a medical officer from July 1962 to March 1965, a sanitary setting -up of a school of public health at the University of Dakar. PROJECT LIST: AFRICA 147

.Senegal 16Nutrition Training (June 1964 - 1967) R Southern Rhodesia 5Malaria Pre -eradication Programme (Oct. 1964 - 1972) R To develop the teaching of nutrition in the Faculty of Medicine of the University of Dakar and in the various institutes attached To develop a network of basic health services which can to it. provide support for a future eradication programme; to intensify the training of personnel for the national malaria service; to undertake a general survey of malaria epidemiology and to Senegal 22Community Water Supply (June - July 1965) develop facilities for improving the diagnosis of malaria and for Special Account for Community Water Supply increasing the availability of antimalarial drugs. From 1957 to 1963 a pilot project and pre -eradication survey WHO provided two consultants to advise the Government were undertaken. on the economic aspects of the first stage of a water supply programme and to assist in preparing a request to the United Nations Special Fund in respect of further study of the water Southern Rhodesia 200 Fellowships R : Anaesthetics (six months), supply and sewage disposal problems in Dakar. anatomy - methods of teaching and research (three months), DPH course (twelve months), preventive ophthalmology (two and a half months), public health (twelve months). Senegal 200Fellowships R: Public health (twelve months), sanitary engineering (four for four years). Swaziland 2Tuberculosis Control (Dec. 1962 -1968) EPTA UNICEF Seychelles 10Venereal Disease Control (1965 -1967) EPTA To set up a pilot area, where tuberculosis control methods will To develop the control of venereal disease through the be introduced in order to study their practicability and accepta- existing health services. bility under prevailing conditions, with a view to using them on a larger scale in other parts of the country.

Sierra Leone 1Yaws Control (1958 - 1969) EPTA UNICEF Swaziland 9Health Education (May - July 1965) R To carry out a yaws control project and to train auxiliary WHO provided a consultant to assist in reorganizing health personnel;to organize treatment and preventive measures against other communicable diseases, such as leprosy and education services in the Department of Health Services. smallpox. 'waziland200Fellowships R: Public health (twelve months), surgery (twelve months), undergraduate medical studies (twelve \Sierra Leone 7Nursing Education (1961 -1966) R months). To establish a school of nursing and midwifery which will provide teaching in public health as part of the curriculum. Tanzania (Zanzibar) 4Malaria Eradication Programme (June 1957 -1968) R MESA EPTA UNICEF Vierra Leone 11Public Health Laboratory Services To eradicate malaria from Zanzibar and Pemba; to develop (1960 -1968) R comprehensive active surveillance operations as a supplement to To organize a national health laboratory service and to train passive case- detection and to initiate measures aimed at reducing laboratory technical personnel. the importation of malaria into the two islands. Tanzania (Tanganyika) 10Eye Diseases (Aug. 1965 -1968) R .)( Sierra Leone 14Environmental Sanitation and Training (Nov. 1961 -1967) R UNICEF To make a survey of communicable eye diseases and to organize and carry out a control programme. To train health inspectors. XTanzainia (Zanzibar) 12Nursing /Midwifery Education Sierra Leone 19Malaria Pre- eradication Programme (May 1965 -1968) EPTA (Nov. 1963 -1972) R To develop midwifery services in rural areas and to integrate To develop a network of basic health services based on public health concepts into midwifery teaching and practice. experience gained in a demonstration area and which can provide support for a future malaria eradication programme for anzania (Tanganyika) 22Medical School, Dar -es- Salaam the whole country; to train personnel to form the nucleus of a (Sept. 1965 -1968) EPTA national malaria service; to undertake a general survey of malaria epidemiology and to develop facilities for improving To develop the medical school in Dar -es- Salaam. the diagnosis of malaria and for increasing the availability of antimalarial drugs. Tanzania (Tanganyika) 23Nutrition Programme (Oct. 1963 -1967) R UNICEF (FAO)

Sierra Leone 26Public Health Advisory Services To make a study of protein -calorie malnutrition throughout (June 1965 -1967) R the country, but in particular in the Dodoma district, which is to be used as a pilot area and studied more extensively, in order To develop the health services within the framework of a to provide information for the implementation of measures to national health plan. prevent malnutrition. 148 THE WORK OF WHO, 1965

Tanzania 200Fellowships R: Nutrition (two for ten and a half Uganda 7Maternal and Child Health Services months), undergraduate medical studies (two for seven years). (1964 - 1970) R UNICEF To expand maternal and child health services and to train Togo 1Treponematoses Control personnel. (1962 - mid -1966) R UNICEF To organize a treponematoses control project and at the same Uganda 12Malaria Pre -eradication Programme time to undertake smallpox and leprosy control. (Nov. 1962 -1972) R MESA To develop a network of basic health services which can Togo 3Malaria Pre -eradication Programme provide support for a future malaria eradication programme for (Feb. 1962 -1972) R MESA EPTA the whole of the country; to train personnel to form the nucleus of a national malaria service; to make a general survey of To develop a network of basic health services based on malaria epidemiology and to develop facilities for improving experience gained in a demonstration area and which can the diagnosis of malaria and for increasing the availability provide support for a future malaria eradication programme; of antimalarial drugs. to train personnel to form the nucleus of a national malaria This programme supersedes the pilot project carried out from service; to undertake a general survey of malaria epidemiology 1957 to 1962. and to develop facilities for improving the diagnosis of malaria and for increasing the availability of antimalarial drugs.(See page 97.) Uganda 24Health Education (Aug. 1965 -1968) EPTA To develop the health education unit in the Ministry of `f Togo 8Public Health Administration Health, extend the use of health education methods in the health (1961 - Dec. 1964) EPTA and other services and expand health education training at the University of East Africa. WHO provided a public health adviser who assisted in preparing a public health programme, covering from five to ten years, based on a comprehensive survey of the existing services. Uganda 30Tuberculosis Control Training of the medical, paramedical and auxiliary staff neces- (Jan. 1965 -1968) EPTA UNICEF sary to implement the programme has begun. To develop a national tuberculosis control programme. Before implementation of the programme on a large scale, the practicability of simplified and standardized tuberculosis control `Togo13Nursing Advisory Services (Aug. 1963 -1968) R measures and their acceptability by the population will be To organize nursing and midwifery education. investigated.

Uganda 200Fellowships R: Nutrition (thirteen months). © Togo 14Health Education (Aug. 1963 -1966) EPTA UNICEF To extend the use of health education methods in the health services, and to improve the training of staff. Upper Volta 3Leprosy Control (May 1965) R WHO provided a consultant to make an assessment of the leprosy control programme. `Togo15Environmental Sanitation Programme (March 1962 - 1967) R UNICEF Upper Volta 7Smallpox Eradication (1961 - 1966) R To train sanitation personnel; to set up a sanitation unit in the Ministry of Health and to plan a long -term environmental To carry out a smallpox eradication campaign. sanitation programme, starting with a pilot project.

)Q Upper Volta 8Public Health Administration Togo 20Hospital Administration (Feb. 1965) R (1961 - 1963; 1965 -1967) EPTA WHO provided a consultant for one month to make a survey To plan the development of the health services in co- ordination of hospitals and recommend measuresfor moreefficient with the socio- economic plan, paying special attention to the utilization of hospital installations and staff, as part of the plan training of staff. for development of the national health services.

XUpper Volta 11Nursing Education Togo 200Fellowships R: Administration and organization of (March 1962 -1968) EPTA midwifery schools (twelve months), undergraduate medical studies (twelve months). To develop nursing and midwifery education.

Zambia 9Community Nurse Training (Oct.1965 - 1971) R Togo 201FellowshipsEPTA:Bacteriology(sixmonths), paediatrics (two years), public health administration (twelve To draw up a programme for training community health months),tropicalophthalmology (twelve months),under- nurses and to organize a demonstration area for teaching the graduate medical studies (four for six years). practical aspects of public health nursing. PROJECT LIST: AFRICA 149

Zambia 200Fellowships R: Leprosy control (four months). pre- eradication and eradication programmes, with increased emphasis on the public health aspects of such programmes. AFRO 53Tuberculosis Epidemiological Centre, Nairobi (June 1960 -1970) R AFRO 130DepartmentofPaediatrics,MakerereCollege, To assist in the technical planning of tuberculosis projects, in University of East Africa, Kampala the preparation of technical protocols and in co- ordinating (1958 - June 1966) R UNICEF project activities; to evaluate, analyse and report on the epide- To assist in strengthening the facilities for teaching paediatrics miological and statistical information received from tuberculosis at Makerere College. projects in the Region; and to assist in planning, co- ordinating and analysing field research work. AFRO 134Department of Paediatrics, University of Ibadan (Oct. 1961 - Sept. 1966) R UNICEF `FRO 87Centre for Post -basic Nursing Education, Ibadan To assist in strengthening the facilities for teaching paediatrics (April 1962 -1974) R UNICEF (Rockefeller Foundation) at the University of Ibadan. To develop the Department of Nursing of the University of Ibadan, which will provide post -basic nursing education facilities AFRO 142Joint FAO /WHO /STRCRegionalFoodand for English- speaking nurses from the countries of the Region. Nutrition Commission for Africa (March 1964 - ) R (See page 97) This commission, jointly sponsored by FAO, WHO and the Scientific, Technical and Research Commission of the Organi- AFRO 88Centre for Post -basic Nursing Education, Dakar zation of African Unity, has been set up with a view to facilitating (Aug. 1963 - end of 1965) R contacts between the different specialists interested in nutrition To assist with the development of programmes of post -basic problems in Africa.The permanent secretariat of the Com- nursing education for countries in Africa where French is mission, which has one FAO and one WHO secretary, is res- spoken, including the organization of adequate facilities for ponsible for the preparation and the distribution in two languages applied teaching and practice for nurse educators (public health of bulletins and news concerning all nutrition work in Africa. and midwifery) and nurse administrators (hospital and public health services). AFRO 143Smallpox Eradication (Aug. 1965 -1970) R To assist with the planning and implementation of smallpox AFRO 101 Cerebrospinal Meningitis (1963 - 1968) R control or eradication programmes; and to co- ordinate the To provide assistance during epidemics to countries of the programmes in neighbouring countries. Region where cerebrospinal meningitis is endemic; to gain more knowledge of the nature and epidemiology of the disease; and AFRO 167Nutrition Advisory Services to devise suitable control measures. (April 1965 -1970) R To assist and advise on the development of nutrition work with- AFRO 105MalariaEradicationTrainingCentre(English in national public health services; to assist in the establishment Language), Lagos (Oct. 1961 - 1970) R MESA of nutrition units, the training of personnel and the development of nutrition education through community health services. To teach professional and auxiliarynational personnel Assistance previously provided under project AFRO 135 is techniques and methods currently recommended for malaria being continued under this project. pre -eradication and eradication programmes, with increased emphasis on the public health aspects of such programmes. AFRO 168 FAO /WHO Seminar on Planning and Evaluation of Applied Nutrition Programmes, Nairobi AFRO 115Tuberculosis Advisory Services (1962 - 1970) EPTA (25 Oct. - 3 Nov. 1965) EPTA (FAO) To assess the tuberculosis situation in countries of the Region A seminar for senior officers concerned with applied nutrition in the light of overall public health problems, and of the programmes in eleven countries of Africa. countries' socio- economic structure and available resources, in order to facilitate the planning of assistance in tuberculosis AFRO 173Training Seminar on Health Education, Dar-es- control. Salaam (4 Oct. - 26' Nov. 1965) R WHO provided a health education adviser for six weeks to AFRO 125Treponematoses Advisory Team assist with a seminar sponsored by the British Society for Inter- (Sept. 1965 - ) EPTA national Health Education in association with the Governments A team to provide the Regional Office with a means of of the United Republic of Tanzania and of Kenya and the evaluating treponematoses (yaws and endemic and venereal United Kingdom Ministry of Overseas Development.The syphilis) control projects in the Region, so as to advise govern- seminar was designed to give tutor staff responsible for training ments on their further development.The epidemiological - and supervision a knowledge of health education methods and serological surveys carried out by this team will also permit techniques. the establishment of age -specific antibody patterns against a number of other important communicable diseases, in co- f1FRO 177Meeting of Professors of Paediatrics, Kampala operation with WHO's serum reference centre programme. (22 - 26 Feb. 1965) R See page 98. AFRO 128MalariaEradicationTrainingCentre(French Language), Lomé (1962 -1970) R AFRO 200Fellowships R: Democratic Republic of the Congo To teach professional and auxiliarynational personnel - surgery (two years), undergraduate medical studies (three techniques and methods currently recommended for malaria years); Madagascar - nutrition (ten months). THE AMERICAS

Aigentina 6Fellowships R: Medical librarianship (thirteen for ten weeks, one for three months), public health nursing weeks), prosthetics and orthotics (six months). administration and supervision (ten weeks), syphilis and gonorrhoea diagnosis (one month). Argentina 13Fellowships PAHO: Dental care and hygiene (eleven months), epidemiology (ten months), industrial hygiene Argentina 3102Health Services, El Chaco and Tucumán (four months), nursing services (ten and a half months), public (May 1957 -1969) EPTA UNICEF health administration (eleven months). To plan and carry out a programme of integrated health services under the provincial health services of El Chaco and Argentina 0200Malaria Eradication Programme Tucumán; to train professional and auxiliary personnel; and (1951 -1970) PAHO Special Malaria Fund UNICEF to draft for each service a health code and supporting legislation. To eradicate malaria from the country, under a phased programme. Argentina 3103Fellowships PAHO: Midwifery education (ten onths), nutrition (six weeks), sanitary engineering (six weeks).

Argentina 0400Tuberculosis Control Argentina 3104Health Services, San Juan and Mendoza (March 1960 - 1967) PATIO UNICEF (1961 -1967) PAHO UNICEF To organize and develop, in the demonstration area of the To carry out an integrated health services programme in Province of Santa Fé, a national tuberculosis control centre for San Juan and, later, in Mendoza. obtaining epidemiological data, applying and evaluating tuberculosis control methods, and training personnel from Argentina and from other countries. Argentina 3500Health Statistics (1960 - ) PARO To improve the collection and publication of health statistical information and to reorganize the central statistical unit in the Argentina 0500Leprosy Control (1960 - 1968) R UNICEF Ministry of Health. To organize and carry out a national leprosy control programme and to lay down procedures for its evaluation. Argentina 3501Hospital Statistics (1960 - ) R To train personnel of low and intermediate levels in hospital Argentina 0900Rabies (June - Aug. 1965) PAHO statistical procedures. WHO provided a consultant for three months to make a study of the ecology of rabies in bats in the northern provinces Argentina 4300Mental Health (1963 - 1967) PAHO of Argentina, in connexion with cases of the disease in livestock To study the programme of psychiatric care of the Province of and human beings. Mendoza, in order to prepare a broad mental health plan including prevention and treatment of mental illness. Argentina 2200 Water Supplies (1961 -1967) PAHO Community Water Supply Fund Argentina 4301Mental Health Research 1964 - 1966) PAHO /Foundations Fund for Research in To prepare and implement plans for the construction and Psychiatry expansion of water supply and sewerage systems. To conduct research on the interaction between family members of schizophrenics. Argentina 2300Aedes aegypti Eradication (1950 - 1965) PATIO Argentina 4800Medical Care Services(1958 - ) PAHO The Organization provided a medical officer and a sanitary inspector, as well as supplies and equipment, to assist the To make studies on medical care problems and resources and Government in the eradication of Aedes aegypti.The 165 on the organization of medical care and health establishments localities found positive at the beginning of the programme and their integration into the general health services; and to were all free from this mosquito by 1962.Verification carried train personnel in hospital organization and administration. out in 1964 confirmed the eradication of the vector. The final declaration of eradication was made in 1965. YArgentina 6100School of Public Health (1958 -1967) R To strengthen the School of Public Health of the University Argentina 3101Fellowships R: Clinical and social paediatrics, of Buenos Aires, in order to enable it to prepare adequately (three for three months), industrial hygiene (fivemonths) professional and auxiliary health workers for the country's medical records (three weeks), nutrition (one for five weeks, one developing health programmes. - 150 - PROJECT LIST: THE AMERICAS 151

\rgentina6200Medical Education (1958 - ) R Bolivia 3101National Plan for Rural Development (1953 - ) EPTA UNICEF (UN) (FAO) (ILO) (UNESCO) To improve the medical education programmes of the schools of medicine by planning of teaching and sientific research so as To promote the economic, social and health development to meet the country's needs for physicians and research workers; of the rural populations of the Andean Highlands, so as to and to improve the organization and administration of the facilitate their integration into the national community. schools.

Argentina 6300Nursing Education (1957 - 1967) EPTA Bolivia 3102Fellowships R :Cardiac surgery(sixweeks), clinical and social paediatrics (three months), orthopaedic brace - To improve teaching in the schools of nursing of the Univer- making (four months), social paediatrics (two for one month). sities of Buenos Aires, Córdoba, Litoral (Rosario) and Tucumán, and in the School of Nursing of the Army. Bolivia 4201Nutrition (1964 -1966) PAHO /Williams Argentina 6301Training of Nursing Personnel Waterman Fund PAHO/ (1960 -1968) PAHO UNICEF Foundation for International Child Health UNICEF (FAO) To give courses for professional and auxiliary nursing per- To carry out an integrated programme of applied nutrition in an area of the country, including training of professional and sonnel in order to improve the country's public health services. auxiliary personnel, laboratory studies, and research on the extent of protein -calorie malnutrition in pre -school children. Argentina 6400Sanitary Engineering Education (1960 -1967) PAHO Bolivia 6400 Sanitary Engineering Education To strengthen the teaching attheSchool of Sanitary (1964 -1967) PAHO Engineering of the University of Buenos Aires. To increase the number of sanitary engineers and improve their training. J( Argentina 6700Training in Statistics (1965 - ) PARO To strengthen the teaching of health statistics at the Sch___QQL.nf Public Health of the University of Buenos Aires, which provides Brazil 28Fellowships PARO: Medical pedagogy (two weeks), courses in health statistics for personnel of various levels in the vital statistics (sixteen months). national and provincial health administrations, including a nine -month annualcoursefortrainingintermediate -level statisticians and personnel responsible for statistics offices and Brazil 0200Malaria Eradication Programme departments of hospital statistics. (1958 -1971) R PAHO Special Malaria Fund (AID) To eradicate malaria from the country by a phased pro- Barbados 2200Water Supplies (1964 - ) EPTA gramme. (Sao Paulo State is covered by project Brazil 0201 - To prepare plans for water supply systems. see below.)

Barbados 4801Hospital Administration (1965 -1967) EPTA Brazil 0201Malaria Eradication Programme, Sao Paulo (1958 -1968) PAHO Special Malaria Fund (AID) To organize and operate the Queen Elizabeth Hospital as the central medical care institution of Barbados and as a teaching To eradicate malaria from Sao Paulo state. hospital for the University of the West Indies.

livia 16Fellowships R: Leprosy and dermatology (three Brazil 0202Training Centre for Malaria Eradication, São Paulo months). (1958 -1966) PAHO Special Malaria Fund To train professional and auxiliary personnel for the malaria eradication programmes of Brazil and other Latin American Bolivia 0200Malaria Eradication Programme (1957 -1969) PAHO Special Malaria Fund UNICEF (AID) countries. To eradicate malaria from the country. Brazil 0300Smallpox Eradication (1956 -1967) PARO (AID) Bolivia 0300Smallpox Eradication (1962 - 1966) EPTA To set up laboratories to produce enough freeze -dried vaccine to meet the needs of the national smallpox eradication campaign. To continue the smallpox vaccination campaign, begun in 1957, until 80 per cent. of the population has been protected. Brazil 0401Tuberculosis Control Bolivia 3100National Health Services (1965 -1968) PAHO UNICEF (1955 -1969) PAHO UNICEF To study the epidemiological factors of tuberculosis in the To improve the national health services at the central and State of Rio Grande do Norte and organize a control campaign local levels; and to train professional and auxiliary personnel. integrated into the local health services. 152 THE WORK OF WHO, 1965

Brazil 0701Rabies Control (1959 - 1967) R Brazil 3302Yellow Fever Laboratory (1950 - 1967) PARO To develop the national and state health services needed for To support the continent -wide campaign against yellow fever producing antirabies vaccine and carrying out rabies control by providing laboratory diagnostic services and supplying yellow programmes. fever vaccine.

Brazil 2100Sanitary Engineering (1952 - ) PAHO brazil 3500Health Statistics (1963 -1967) R PAHO To improve the organization of the environmental sanitation To improve the vital and health statistics services, especially services of the Ministry of Health, and to train professional and those related to the notification of communicable diseases; auxiliary engineering personnel. and to train personnel in vital and health statistics and in medical records and hospital statistics.

Brazil 2101Air and Water Pollution Control (1963 - 1967) PARO kBrazil4200Nutrition (1960 - 1967) R PAHO UNICEF (FAO) To plan and carry out programmes for the control of air and surface water pollution in the state of Sao Paulo, its capital, and To improve the nutritional status of the population of the neighbouring municipalities. north -eastern part of Brazil through the maximum use of locally available foods, nutrition education and the organization of nutrition courses for professional and auxiliary personnel Brazil 3101Health Services, North -Eastern States engaged in health work, education, and agriculture. (1958 - 1968) R PAHO UNICEF (AID)

To promote the development of general health services in Brazil 4201Nutrition Courses (1963 -1967) PAHO certain areas of nine states in the north -eastern part of Brazil. To establish courses for training physicians in public health nutrition at the Institute of Nutrition of the University of Recife. '4razil3102Fellowships PAHO: Epidemiology (four months), medical pedagogy (two weeks), sanitary engineering (eleven and a half months), veterinary public health (twelve months). Brazil 4202Nutrition, São Paulo (1964 - ) PAHO To prepare, in co- operation with the School of Hygiene and Public Health of the University of Sao Paulo, nutrition per- Brazil 3103Health Services, Mato Grosso sonnel for the development of integrated health services. (1959 - 1969) PAHO UNICEF

To improve the public health services of Mato Grosso by Brazil 4203Institute of Nutrition, Recife strengthening the central organization, regionalizing health (1964 -1967) PAHO services, providing adequate technical supervision, and training personnel. To improve nutrition services in the north -east of Brazil, through applied research and training programmes to meet the needs of the area. Brazil 3104Health Services, Sao Paulo (1964 -1967) PARO To improve the organization of the state health services. Brazil 4801Rehabilitation (July 1958 - Dec. 1961; 1963 - 1966) EPTA (UN /Technical Assistance Operations) (ILO) )

Brazil 3301National Virus Laboratory Services Brazil 6100School of Public Health, Rio de Janeiro (1959 - 1967) EPTA PAHO /American Cyanamid Co. \ \\ (1957 -1967) PARO To expand laboratory facilities for the diagnosis of virus To improve the training given by the School of Public Health, diseases, and to develop research programmes and the pro- by engaging full -time teaching staff, providing better practice duction of vaccine at the Oswaldo Cruz Institute. areas and reorganizing the laboratory and library services. PROJECT LIST: THE AMERICAS 153

'(Brazil6101School of Public Health, São Paulo Brazil 6601Dental Education (1958 -1968) R (1958 - 1966) PAHO (Kellogg Foundation) To strengthen the School of Hygiene and Public Health of To provide, for dentists attending the regular public health the University of Sao Paulo, particularly to enable it to be courses at the School of Hygiene and Public Health of the used also as an international training centre. University of Sao Paulo, training in specific fields of dentistry; and to train staff for the School in teaching and research in public health dentistry. Brazil 6201Teaching of Preventive Medicine, University of Ceará (July 1963 - 1966) PAHO Brazil 6700Biostatistics Education (19 - 31 July 1965) R To improve the teaching at the Institute of Preventive Medicine of the Medical School, University of Ceará, revising the curri- A course on the International Classification of Diseases, culum as necessary. organized with WHO assistance, was held at the S_c_hgollif Public Health of the University of Sao Paulo for thirty students -twenty from Sao Paulo city and ten from other parts of Brazil. Brazil 6202Paediatric Education, Recife \\(Oct. 1963 -1968) PAHO UNICEF '4razil6701Biostatistics Education, Belo Horizonte To improve the teaching of paediatrics in the School of (13 - 29 Sept. 1965) R Medicine of the University of Recife, and to provide training in paediatrics, outside the regular medical courses, to pro- A course on the International Classification of Diseases, fessional and auxiliary personnel. organized with WHO assistance, was held at the School of Medicine of the University of Minas Gerais for thirty students.

Brazil 6301Nursing Education, Recife (1963 -1967) R PAHO British Guiana 0200Malaria Eradication Programme To set up in the school of nursing of the University of Recife (1961 -1969) PAHO Special Malaria Fund UNICEF a centre for postgraduate nursing education to serve the northern and north -eastern parts of Brazil. To eradicate malaria from the country.

British Guiana 3100National Health Services Brazil 6302Training of Nursing Auxiliaries (1963 -1967) R UNICEF \\ (April 1963- 1967) PAHO UNICEF To reorganize, expand, and integrate the health and environ- To increase the number and improve the quality of the mental sanitation services in the heavily populated coastal training of nursing auxiliaries. area and in isolated communities in the interior.

Brazil 6400Institute of Sanitary Engineering, Rio de Janeiro British Honduras 0200Malaria Eradication Programme (1964 - 1969) United Nations Special Fund (1956 -1967) PAHO Special Malaria Fund To combine the sanitary engineering laboratory facilities of To eradicate malaria from the country. the Institute of Sanitary Engineering with those of the College of Engineering of the University of Guanabara; and to develop the combined laboratory facilities as a centre for sanitary British Honduras 2200Water Supplies engineering training, research, and service for all the training (1964 - 1967) PAHO Community Water Supply Fund institutions in the Rio de Janeiro area. To organize under a central authority the management of water supply and sewerage services; and to expand the water supply services of Belize. Brazil 6401Sanitary Engineering Education (1965 -1970) PAHO British Honduras 3100Health Services To organize and carry out short courses in connexion with (1962 -1968) R UNICEF water supply programmes in the Universities of Bahía, Paraiba, Paraná, Porto Alegre, Recife, and Sao Paulo. To reorganize, expand, and improve the general health services, including environmental sanitation.

1 LBrazil 6500Veterinary Medicine Education (1960 -1967) PAHO BritishHonduras 3101Fellowships PAHO:Environmental sanitation (two weeks). To improve the teaching of public health and related subjects in the schools of veterinary medicine. ritish Honduras 6300Nursing Education (1964 -1967) PAHO 4\ Brazil 6600Teaching of Preventive Dentistry To study the country's nursing needs and resources, in order (1963 -1966) PAHO to provide at the school of nursing an education programme that will include teacher -training and integration of preventive To develop the training programmes in preventive and social and curative medicine concepts as well as social and community dentistry at the country's dental schools. development aspects of nursing practice. 154 THE WORK OF WHO, 1965

Canada 200Fellowships R: Nursing education (thirteen weeks). Chile 3400Health Teaching in Schools (1962 -1967) PAHO UNICEF To develop the teaching of public health and health education Canada 3101Fellowships R: Health education (twelve months), in the teacher- training institutions and in primary schools. public health administration (three and a half months).

Chile 4601Institute of Occupational Health and Air Pollution hile 26Fellowships PAHO: Epidemiology (three months), Research (1961 -1968) United Nations Special Fund food control (three months), paediatrics (twelve months). To establish an institute of occupational health and air pollution to provide services and training facilities.

kChile 0400Tuberculosis Control (1964 -1968) PAHO UNICEF Chile 4801Rehabilitation Centre (1960 - 1966) EPTA To organize, in La Cisterna (Province of Santiago), a demonstration area in order to obtain epidemiological information on To plan a medical rehabilitation programme for the whole tuberculosis, apply and evaluate practical methods of tuber- country, co- ordinating all available resources; to organize a culosis control, and train medical and auxiliary personnel for rehabilitation centre in Santiago, with a prosthetics workshop the gradual extension of the tuberculosis control programme and facilities for training personnel; and to establish rehabilita- to other areas. tion services in certain provincial cities.

'Chile 6100School of Public Health (1963 -1968) PAHO Chile 0600Venereal Disease Control (Nov. 1965 - ) PAHO To strengthen the teaching at the school of public health of the University of Chile, and to expand its facilities for training To intensify the programme for the control of venereal students from other countries of the Americas. diseases in the light of a rising incidence in recent years. Em- phasis will be on new laboratory methods and epidemiological surveys, and integration of control activities into the regular Chile 6200Medical Education (1962 -1967) PAHO health centres' work. To provide courses in medical teaching methodology at the School of Medicine of the University of Chile, Santiago.

Chile 2200Water Supplies (1960 -1967) PAHO Community Water Supply Fund 'hile 6201TrainingintheMedical Use of Radioisotopes (1962 - 1967) PAHO (Kellogg Foundation) To plan and carry out a national water supply programme and to expand the Santiago water supply system. To set up at Salvador Hospital, in connexion with the University of Chile, a Latin American centrefor training physicians in the medical uses of radioisotopes. (See page 108) Chile 3100HealthServices(1961 -1967) EPTA UNICEF 4hile 6400Sanitary Engineering Education (1964 -1967) PAHO To strengthen the health services in the southern part of the country in order to meet the needs of the population of the To strengthen the teaching of sanitary engineering in the area devastated by an earthquake in 1960 (34 per cent. of the School of Engineering of the University of Chile. total population); and to provide water supply and sewerage services to the 960 000 rural inhabitants of the area. Colombia 21Fellowships PAHO: Anaesthesiology (two months), control of pharmaceutical and biological products (two weeks), immunology (three months), sanitary engineering (one for five hile 3101Fellowships R: Application of electronic computers weeks, one for eleven months). to sanitary engineering problems (two weeks), medical care administration (ten weeks), medical records (three weeks), nursing education (six weeks), paediatrics (six weeks), premature Colombia 200Fellowships R: Dental care and hygiene (eleven infant care (five months), social paediatrics (two for one month). months), hospital administration (sixteen months), veterinary public health (eleven months).

Chile 3102Fellowships PAHO: Rabies vaccine production Colombia 0200Malaria Eradication Programme (ten weeks). (1959 - 1969) PAHO Special Malaria Fund UNICEF To eradicate malaria from the country. Chile 3200National Planning for Nursing (1960 - ) R EPTA UNICEF Colombia 0500Leprosy Control (1958 -1967) PARO UNICEF To improve the quality of the nursing care given by the health To organize a leprosy control programme based on modern services, and to train professional and auxiliary personnel. techniques and procedures. PROJECT LIST: THE AMERICAS 155

Colombia 0900Onchocerciasis (Dec. 1964 - Jan. 1965) R Colombia 6200Health Manpower Studies (1964 -1966) PAHO /Milbank Memorial Fund A consultant was provided for two months to assist in planning the initial phases of an onchocerciasis research programme. To carry out a pilot study of health manpower requirements, taking the available resources into account, and to determine how to plan for increasing these resources in Colombia and Colombia 2200Water Supplies other Latin American countries, as recommended by the Charter (1960 - 1969) PAHO Community Water Supply Fund (Inter - of Punta del Este. American Development Bank)

To plan and carry out a national water supply programme, Colombia 6400Sanitary Engineering Education and to make a study of the planning, design, financing, construc- \\ (1964 -1967) PAHO United Nations Special Fund (UNESCO) tion, and operation of municipal water supply services. To improve the technical training of engineers working in sanitary engineering, and to promote the development of a sanitary engineering research centre in the National University Colombia 2300Aedes aegypti Eradication (1951 - 1967) PARO of Colombia. To eradicate Aedes aegypti.

Colombia 6600Teaching of Preventive Dentistry m kColombia 3100National Health Services (1961 - 1967) PAHO (Kellogg Foundation) (Sept. 1951 -1969) EPTA PAHO UNICEF (AID) To include preventive dentistry in the courses of the School To prepare a national health plan; to strengthen the Ministry of Dentistry of the University of Antioquia; and to establish a of Health and the departmental and local services; to extend centre for research on .dentistry, in which particular attention integrated health services to the entire population; and to train will be paid to the public health aspects. professional and auxiliary personnel. Costa Rica 200Fellowships R: Epidemiology (ten and a half months), health education (twelve months). Colombia 3101Fellowships PAHO: Health planning (three for three and a half months), medical use of radioisotopes (two for seven months), public health nursing administration and super- Costa Rica 0200Malaria Eradication Programme vision (two for eleven and a half months). (1956 - 1969) MESA PARO Special Malaria Fund UNICEF To eradicate malaria from the country. t4lombia3102Fellowships R: Hospital administration (sixteen months), medical care services (three months), medical records (three weeks), nursing education (six weeks), nursing services Costa Rica 2200Water Supplies (ten months), orthopaedic brace- making (four months), paedia- (1960 - 1968) PAHO Community Water Supply Fund tric nursing services (ten months). sanitary engineering (nine months), social paediatrics (one month). To draw up programmes for providing public water supply and sewerage systems to urban and rural communities; and to establish a national water supply and sewerage service. Colombia 3301National Institute of Health (Carlos Finlay) (1950 - ) PAHO Costa Rica 3100National Health Services To strengthen the services (research, laboratory diagnosis, (1959 -1969) PAHO UNICEF and vaccine preparation) which the yellow fever department of the National Institute of Health provides to other countries in To prepare and implement a national health plan as part of connexion with the yellow fever eradication campaign in the the national economic and social development plan; to expand Americas. and improve the administration of the health services, including the medical care services; to train professional and auxiliary personnel; and to carry out an extensive rural sanitation programme. 6 Colombia 4200Nutrition (1961 -1967) PAHO UNICEF (FAO) To improve the level of nutrition in the Departments of Caldas, Cauca, and Norte de Santander, especially in the rural areas,\ \Costa Rica 3101Fellowships R: Administration of water supply in collaboration with the local health, education, and agricultural systems (ten weeks), clinical and social paediatrics (three months), services; to train personnel at the local and intermediate levels; epidemiology (ten and a half months), hospital administration and to establish food- preparation and school garden demons- (four and a half months), medical records (three weeks), nursing tration services in the schools of the area. education (eleven and a half months), nursing services (ten and a half months), public health administration (ten and a half months), public health nursing administration (two for ten weeks). C Colombia 6100School of Public Health (1959 - 1963; 1964 - 1969) R PAHO UNICEF To develop and improve the organization of the school of osta Rica 3102Fellowships EPTA: Hospital administration public health of the University of Antioquia. (sixteen months). 156 THE WORK OF WHO, 1965

Costa Rica 3301Laboratory for Diagnosis of Virus Diseases Dominican Republic 3100Public Health Services (Sept. 1962 -1967) R (1953 -1967) R PAHO UNICEF To organize a section for the diagnosis of virus diseases in To improve the organization of health services at the national the national health laboratory. and intermediate levels; and to expand the local services in order to provide integrated services to the whole country. Costa Rica 6300Advanced Nursing Education (1959 -1968) PAHO Xminican Republic 3101Fellowships R: Public health nursing To set up, at the school of nursing of Costa Rica, an advanced administration and supervision (eleven and a half months). education centre to train nurses in teaching, in supervision, and in other specialities; and to evaluate the work of the school. Dominican Republic 3102Fellowships PAHO: Vitalstatistics (sixteen months). a./CostaRica 6400Sanitary Engineering Education (1965 -1969) PAHO ominican Republic 6300Nursing Education To improve the teaching of sanitary engineering at the (Aug. 1958 -1967) R PAHO University of Costa Rica. To strengthen the National School of Nursing by preparing nurses for the faculty, improving physical facilities and areas X'uba 200Fellowships R: Food science and applied nutrition for field practice, and expanding the curriculum to include public (eight and a half months), nursing education (two for three health nursing and courses in teaching and supervision. months), public health administration (two for ten and a half months). Ecuador 0200Malaria Eradication Programme (1956 -1970) EPTA PAHO Special Malaria Fund UNICEF Cuba 0200Malaria Eradication Programme (MD) (1959 -1968) R UNICEF To eradicate malaria from the country. To eradicate malaria from the country and prevent the re- establishment of transmission. Ecuador 0300Smallpox Eradication (1958 - 1965) EPTA PAHO

Cuba 2300Aedes aegypti Eradication The Organization provided a medical officer and a sanitary (1953 - 1967) EPTA PAHO inspector, and supplies and equipment, to assist the campaign for eradicating smallpox from the country by vaccinating at To eradicate Aedes aegypti. least 80 per cent. of the population. The campaign ended in May 1964, by which time about 3 542 000 persons (85 per cent. of the estimated population) had Cuba 3100Public Health Services been vaccinated. The percentage of the population protected in (June 1959 -1969) EPTA PAHO UNICEF the various provinces ranged from 74.6 to 100. Personnel were given on-the-job training in vaccination techniques, and an To improve the organization of health services at the national, epidemiological surveillance service was organized to study any intermediate, and local levels, and to set up a demonstration and suspected cases that might occur after the end of the programme. training area. Since the completion of the campaign, routine vaccination has been continued to maintain the levelof immunity; over Cuba 3101Fellowships R: Clinical and social paediatrics (three 360 400 persons were vaccinated during the first six months months), food science and applied nutrition (eight and a half of 1965. No case of smallpox was reported in the country in months), vital and health statistics (nine and a half months). 1964 or 1965.

Cuba6300Nursing Education(1961 -1969) EPTA UNICEF Ecuador 0900Plague Control (1965 -1970) EPTA To strengthen the schools of nursing and to train nursing To develop an effective plague control programme in the instructors. endemic areas.

Dominican Republic 0200Malaria Eradication Programme Ecuador 2200 Water Supplies (1957 - 1969) PAHO Special Malaria Fund UNICEF (1961 - ) PAHO Community Water Supply Fund To eradicate malaria from the country. To expand the Quito water supply system and to plan the construction of water supply systems for several other cities.

Dominican Republic 2200Water Supplies (1961 -1969) PAHO Community Water Supply Fund Ecuador 3100National Health Services (1953 - 1969) R EPTA PAHO UNICEF To organize a central water supply and sewerage authority; to design water supply and sewerage systems and to obtain loans To develop integrated public health services at the national for constructing them from international credit agencies. and local levels, and especially in the Province of Manabí. PROJECT LIST :THE AMERICAS 157

uador 3101Fellowships PAHO: Clinical and social paedia- Guatemala 0200Malaria Eradication Programme trics (two for one month), medical use of radioisotopes (seven (1955 -1969) MESA PAHO Special Malaria Fund UNICEF months), public health dentistry (ten weeks). (AID) To eradicate malaria from the country. Ecuador 3102Rural Medical Services (1956 - 1970) EPTA UNICEF (UN) (FAO) (ILO) (UNESCO) Guatemala 2101Rural Sanitation (1965 -1967) EPTA To promote the economic, social and health development of the rural populations of the Andean Highlands, in order to To provide water supplies and sewerage disposal facilities for facilitate their integration into the national community. half the rural population.

Ecuador 6300Nursing Education (May 1957 -1967) R PAHO () Guatemala 3100National Health Services To improve the organization and teaching at the school of tt (Aug. 1954 -1971) R PARO UNICEF nursing of the School of Medical Sciences of the University of Guayas, in Guayaquil, by preparing instructors, broadening the To formulate and carry out a national health plan which will curriculum to include public health nursing and principles of include the extension of health services to cover the whole teaching and supervision, and improving the physical facilities. population; and to train professional and auxiliary personnel.

Fellowships PAHO: Sanitary engineering (eleven 41 Salvador 9 Guatemala 3101Fellowships PAHO: Administration of health months). programmes (five for three months), epidemiology (six weeks), nursing education (six weeks), planning of water supplies (two El Salvador 0200Malaria Eradication Programme weeks), supervision of sanitary inspectors (two for three months). (1955 -1970) R PAHO Special Malaria Fund UNICEF (AID)

To eradicate malaria from the country. Xuatemala 3102Fellowships EPTA: Health statistics (sixteen months). El Salvador 2200Water Supplies (1960 - 1969) PAHO Community Water Supply Fund Guatemala 3300Public Health Laboratories To organize and administer a central water supply and sewage (1964 -1967) EPTA disposal service and to extend the country's water supply systems. To study and evaluate the services provided by the central and local public health laboratories; to plan programmes for the Biological Institute and for all laboratories functioning at other El Salvador 3100National Health Services levels; to set up local laboratories where necessary ; and to train (1963 -1968) EPTA PAHO UNICEF personnel. To plan and carry out integrated health programmes as part of a national health plan. lo Guatemala 6500Veterinary Medicine Education (1962 -1967) PARO "Fil Salvador 3101Fellowships R: Clinical and social paediatrics (three months), sanitary engineering (nine months). To strengthen the School of Veterinary Medicine of the University of San Carlos, especially as regards the teaching of public health and preventive medicine. 1 Salvador 3102Fellowships PAHO: Epidemiology (six weeks), medical pedagogy (two weeks), supervision of sanitary inspectors (two for three months). Haiti 0200Malaria Eradication Programme (1961 -1969) PAHO Special Malaria Fund UNICEF (AID) 'j El Salvador 3300Public Health Laboratory Services "`(1964 -1966) R To eradicate malaria from the country. To carry out a public health laboratory programme covering the whole country and including the setting -up of laboratories Haiti 0600Yaws Eradication (June 1950 -1967) R UNICEF in areas where none exist, the establishment of work regulations and techniques, and the training of professional and auxiliary To eradicate yaws from the country, and at the same time to personnel. vaccinate 80 per cent. of the population against smallpox in four years, beginning in 1962. French Antilles and Guiana 0200Malaria Eradication Pro- gramme (1963 - 1969) PARO Special Malaria Fund Haiti 2200 Water Supplies To eradicate malaria from the departments. (1960 -1967) PAHO Community Water Supply Fund To plan, design, and finance an extension of the water supply Guatemala 12Fellowships PARO:Administrativemethods system of Port -au- Prince and, later, to plan systems for the rest (four months). of the country. 158 THE WORK OF WHO, 1965

Haiti 3100National Health Services onduras 6400Sanitary Engineering Education (1965 - 1970) R (1957 -1968) EPTA PAHO UNICEF To organize short courses on problems related to the water To develop integrated public health services at the central and supply programme. local levels, and to establish an area for demonstration and training of personnel. Jamaica 2200Rural Water Supplies (1963 - ) R UNICEF Haiti 3300Public Health Laboratory (1953 - 1967) PAHO To improve water supply systems and construct new ones in rural areas. To strengthen the organization of the public health laboratory ; to set up subsidiary laboratories in three local areas; and to improve the organization of hospital laboratories and dispensa- Jamaica 3100Public Health Services (1963 -1967) R ries in the region damaged by the hurricane Flora. To make an evaluation of health problems, needs and resources and the cost of public health services; and to prepare and imple- Haiti 4200Nutrition Programme ment a national health plan as part of the plan for social and (1961 -1969) PAHO PAHO /WilliamsWatermanFund economic development of the country. UNICEF (FAO) To carry out a nutrition programme; and to establish an agency to co- ordinate the nutrition work of the Ministries of Jamaica 4300Mental Health (1964 - 1967) PAHO Health, of Education, and of Agriculture. To prepare a national mental health programme, integrated into the general health services, that will include curative and N./Honduras 6Fellowships PAHO: Administrative methods (four preventive services and training of personnel. months), vital and health statistics (ten and a half months).

4amaica 6201Department of Preventive Medicine, University Honduras 0200 Malaria Eradication Programme of the West Indies (Aug. 1963 -1967) R PAHO (1956 -1970) MESA PAHO Special Malaria Fund UNICEF (AID) To improve the courses given by the Department of Preventive Medicine of the University College of the West Indies, and to To eradicate malaria from the country. expand the teaching of medicine in the Caribbean area.

Honduras 2200 Water Supplies (1960 - ) PAHO PAHO Community Water Supply Fund Jamaica 6300Nursing Education (1960 - 1967) PAHO To plan and carry out national programmes for the construc- To improve basic education in the schools of nursing; and to tion of water supply systems and for the improvement of existing organize advanced courses for instructors and supervisors. services. / \(Q Honduras 3100National Health Services Jamaica 6301Advanced Nursing Education, University of the (Aug. 1955 - 1967) EPTA PAHO UNICEF West Indies (1965 -1967) R To organize integrated public health services at the central and To improve nursing education at graduate and post -graduate local levels; to improve environmental health services; and to levels. train professional and auxiliary personnel.

NVMexico 25Fellowships PAHO: Vital statistics (sixteen months). Honduras 3101Fellowships PAHO: Administration of health programmes (six for three months), epidemiology (six weeks), health planning (three and a half months), medical pedagogy Mexico 0200Malaria Eradication Programme (two weeks), public health nutrition (ten and a half months), (1956 - 1970) EPTA PAHO Special Malaria Fund UNICEF supervision of sanitary inspectors (two for three months), water supplies (two weeks). To eradicate malaria from the country.

Honduras 3102Fellowships R: Administration of water and sewerage systems (two months), health statistics (ten and a half Mexico 0201Malaria Eradication in Problem Areas months), laboratory analysis of water (ten weeks), maternal and (1965 - 1967) MESA child health (ten and a half months), nutrition (ten weeks), To study the efficacy of various combined attack measures in sanitary engineering (two and a half months). eliminating persistent low -level transmission in problem areas.

Honduras 4800Medical Care Services (March - Nov. 1965) PAHO (Organization of American Mexico 0400Tuberculosis Control States) (June 1960 - 1968) R UNICEF WHO provided a consultant who worked with the Ministry To carry out a series of epidemiological surveys in various parts of Health and the Social Security Agency and advised on methods of the country; and to demonstrate the effectiveness of tuberculo- of improving co- ordination of their services. sis control measures in a pilot area. PROJECT LIST: THE AMERICAS 159

Mexico 0500Leprosy Control (Nov. 1960 - ) R UNICEF Nicaragua 0200Malaria Eradication Programme (1957 - 1970) MESA PAHO Special Malaria Fund UNICEF To carry out a national leprosy control programme based on (AID) modern methods and techniques. To eradicate malaria from the country.

Mexico 2200Water Supplies (1961 - ) PAHO Community Water Supply Fund Nicaragua 2200Water Supplies (1963 - 1967) PAHO Community Water Supply Fund To plan a national water supply programme. To plan a national water supply programme and to establish a central agency responsible for water and sewerage services. Mexico 3101State Health Services (1954 - 1967) R PAHO PAHO Community Water Supply Fund UNICEF Nicaragua 3100Public Health Services (1963 - 1970) R PAHO UNICEF To improve the organization and co- ordination of health services at the national, regional, and local levels. To draft a national health plan that will serve as a basis for the planning and execution of specific programmes. `exico3102Fellowships R: Brucellosis laboratory services (three months). \Nicaragua 3101Fellowships PAHO: Epidemiology (two for six weeks), medical pedagogy (two weeks), supervision of sanitary inspectors (two for three months). `)xico3103Fellowships R:Communicable disease control (one month), veterinary public health (twelve months). l( Nicaragua 6300Nursing Education (March 1955 - ) PAHO Mexico 3300Public Health Laboratory (1958 - 1966) PAHO To strengthen the teaching at the National School of Nursing by preparing nursing instructors, broadening the curriculum to To expand the services of the national public health laboratory include public health nursing and advanced courses in teaching and particularly those for the control of biological products, food and supervision, and improving physical facilities and clinical and drugs. practice areas in hospitals and health centres.

Q,Mexico 4200Nutrition (1959 - 1967) EPTA UNICEF (FAO),Panama7Fellowships R: Food and drug control (two for ten To carry out a nutrition programme covering the whole weeks). country, using the resources of the National Institute of Nutri- tion.The programme includes nutrition surveys in various regions and training of professional and auxiliary personnel. Panama 8Fellowships PAHO: Industrial hygiene (six months), iraternal and child health (ten months), public health nursing (eight months). )(Mexico6100School of Public Health (May 1954 - ) R To strengthen and expand the teaching programme of the Panama 0200 Malaria Eradication Programme School of Public Health of the University of Mexico. (1956 - 1970) MESA PAHO Special Malaria Fund UNICEF To eradicate malaria from the country. " Mexico 6200Medical Education (1958 - ) R To improve medical education,especially by providing Panama 2200 Water Supplies teaching staff with training in the preventive and social aspects (1960 - ) PAHO Community Water Supply Fund of medical practice. To organize a national water supply and sewerage authority, and to carry out a water supply programme. Mexico 6300Nursing Education (1958 - 1967) PAHO

To improve basic nursing education; and to prepare graduate Panama 3100National Health Services nurses to serve as instructors, and professional nurses for the (Aug. 1952 -1970) EPTA PAHO UNICEF training of auxiliary nursing personnel. To prepare and implement a national health plan providing for reorganization, extension and improvement of the health 3V exico 6400Sanitary Engineering Education (1961 -1967) R services and to train the necessary professional and auxiliary To organize, in the School of Sanitary Engineering of the personnel. University of Mexico and in the School of Engineering of the University of Nuevo León, courses in sanitary engineering and in public health for graduate engineers. anama 3101Fellowships R: Clinical and social paediatrics three months), food and drug control (three for seven weeks), nursing education (one for six weeks, one for twelve months), Netherlands Antilles 3101Fellowships PAHO: Public health psychiatric nursing services (five months), rural water supplies dentistry (twelve months), public health nursing (ten months). (ten for two weeks), social paediatrics (five weeks). 160 THE WORK OF WHO, 1965

anama 3102Fellowships PAHO: Food and drug control (two Peru 3100National Health Services for three months). (Jan. 1956 -1967) EPTA PAHO UNICEF To improve health services at the national, regional and local Paraguay 13Fellowships PAHO: Healtheducation(twelve levels; and to organize health areas, beginning with one in the months), nursing education and midwifery (twelve and a half Department of Junín. months), public health administration (ten and a half months), public health nursing (two for ten months), vital and health statistics (nine and a quarter months). Peru 3101Fellowships R: Application of electronic computers to sanitary engineering problems (two weeks), clinical and social paediatrics (three months), food control (six months), health Paraguay 0200 Malaria Eradication Programme services (one month), laboratory techniques (ten days), medical (Oct. 1957 - 1961; 1965 - 1970) PAHO Special Malaria Fund records (ten and a half months), organization of medical care UNICEF in rural areas (two weeks), social paediatrics (two for one month). To eradicate malaria.The programme was delayed in the preparatory phase from 1961 to 1964, but a new eradication plan Peru 3102 Andean Region Development Programme became operational in 1965. (1955 - ) EPTA UNICEF (UN) (FAO) (ILO) (UNESCO)

Paraguay 2200 Water Supplies To promote the economic, social and health development of (1961 -1967) PAHO Community Water Supply Fund the indigenous populations of the Andean Highlands, so as to facilitate their integration into the national community. To plan and implement a national water supply programme. eru 3103Fellowships PAHO: Chemical analysis in nutrition Paraguay 3100National Health Services (one month), dental public health (ten weeks), dental school (Jan. 1955 -1970) EPTA UNICEF organization (six weeks), health education (eleven and a half months), health planning (three for three and a half months), To plan a ten -year health programme as an integral part of industrial hygiene (ten months), medical use of radioisotopes the national plan for economic and social development; to (seven months), occupational therapy (ten and a half months), develop integrated health services throughout the country; and sanitary engineering (one month). to train professional and auxiliary personnel.

Peru 3104Studies on Promotion of Rural Health and Agriculture 3101FellowshipsR:Sanitaryengineeringtwo /Paraguay (1963 - ) PAHO /Inter -American Development Bank weeks), syphilis and gonorrhoea diagnosis (one month), water services operation (two weeks), waterworks systems (two weeks). To carry out studies to promote the development of agriculture, livestock breeding and rural welfare, in furtherance of the policy of incorporating the protection and promotion of health into Paraguay 3102Fellowships PAHO: Drug control(twelve months), health education (eleven and a half months), health the overall process of socio- economic development. planning (three and a half months), sanitary engineering (two weeks), tuberculosis laboratory techniques (two for two months), Peru 4101Infantile Diarrhoea and Malnutrition water supply systems for small communities (two weeks). (1960 - 1966) PAHO PAHO /United States National Institutes of Health Peru 21Fellowships R: Paediatrics (twelve months). To study the nature of the water metabolism and electrolyte changes in children suffering from diarrhoea and malnutrition X.Peru 25Fellowships PAHO: Medical librarianship (six and a and to determine the best therapy for such children. quarter months), psychiatry (six weeks), water supplies (seven weeks). eru 6100School of Public Health (1963 -1967) PAHO UNICEF Peru 0200Malaria Eradication Programme To establish a school of public health in order to ensure (1956 - 1971) PAHO Special Malaria Fund UNICEF adequate preparation of professional, technical, and auxiliary To eradicate malaria from the country by a phased programme. personnel for institutions that provide health services to the population.

Peru 0900Plague Control (1963 -1967) PAHO Peru 6200Medical Education (1964 - ) PAHO To plan and carry out an epidemiological study of plague, and to implement a control programme. \\To improve the medical education programmes of the country's medical schools.

Peru 2200Water Supplies (July 1960 - 1967) EPTA PAHO Community Water Supply Peru 6300Nursing Education (April 1959 -1968) R Fund (Inter -American Development Bank) N To improve basic nursing education by organizing a school To plan and implement a national programme for the construc- of nursing at the National University of San Marcos, and streng- tion of new water supply and sewerage services, and the extension thening the existing nursing schools so that they may obtain of existing systems. (See page 109.) university recognition. PROJECT LIST: THE AMERICAS 161

Surinam 0200Malaria Eradication Programme United States 3102Medical and Public Health Training (1957 - 1969) PAHO Special Malaria Fund UNICEF 'l(1963 - ) PAHO To eradicate malaria from the country. To enable officers of the Division of International Health of the federal Public Health Services to obtain first -hand knowledge of health conditions and problems in the countries which send Surinam 2200Water Supplies (1964 -1967) R fellows to study in the United States of America. To plan a rural water supply programme. rated States 3103Fellowships R: Community health services Surinam 2300Aedes aegypti Eradication (1952 - EPTA two months), health education (two months), hospital and medical care administration (two months), nursing (two for two To eradicate Aedes aegypti. months), occupational health (two months), organization of medical education (two months). Surinam 3101Fellowships PARO: Healthstatistics(four months). Jruguay 8Fellowships R: Hospital administration (six weeks), medical librarianship (six and a quarter months). Trinidad and Tobago 2200Water Supplies (1963 - 1967) PAHO Community Water Supply Fund To set up a central water supply and sewerage authority, and Uruguay 10FellowshipsPAHO:Chronicdiseases(four prepare plans for water supplies for rural populations. months), epidemiology (ten months), hospital administration (sixteen months), organization of medical education (one for two weeks, one for two months). Trinidad and Tobago 3100Health Services (1965 -1966) PAHO

To improve the administrative services in the Ministry of Uruguay 0900Chagas' Disease (1964 -1967) PAHO Health, particularly as regards supply, management and general services. To plan a programme for the control of Chagas' disease.

Arinidad and Tobago 3103Fellowships PAHO: Environmental sanitation (three weeks), health services organization (one month), Uruguay 3100National Health Services health statistics (three months), quarantine services (two months), (Aug. 1955 -1970) EPTA UNICEF sanitary engineering (twelve months). To organize integrated health services in five departments, and later to extend such services to the whole country. Trinidad and Tobago 4201Pathogenesis and Prevention of Anemias(1963 - 1966) PAHO /UnitedStatesNational Institutes of Health Nforuguay 3101Fellowships R: Medical care administration (two r twelve months), nutrition (ten weeks), sanitary engineering To study the pathogenesis and prevention of anaemias in (one for two weeks, one for one month), social paediatrics (one Trinidad and Tobago, in order to obtain information on the month), virology (six months). main environmental (including nutritional) and hereditary factors involved and their relative importance, for use in determining measures to reduce anaemia prevalence. ruguay 3102Fellowships PAHO: Administrative methods. four months), health planning (three and a half months), medical Trinidad and Tobago 4800Hospital Administration and Medical use of radioisotopes (seven months), nutrition (ten weeks), Records (1965 -1967) EPTA tuberculosis nursing (two months). To organize medical records departments in the hospitals, clinics, and health centres of the Ministry of Health and Housing; Uruguay 3500Health Statistics (1965 -1970) R and to train personnel in medical record keeping. To improve the collection of health statistical information and to train statistical personnel through basic and intermediate - XUnited States 11Fellowships PAHO: Public health laboratory level courses. services (three months).

United States 3100Consultants in Specialized Fields of Public 4ruguay 6100Training of Health Personnel Health (March 1958 - ) R (1960 -1968) PAHO UNICEF To provide consultant services on specialized problems in To strengthen the Dr Carlos Nery School of Nursing, and public health. to train auxiliary personnel for the health services.

XUnited States3101Fellowships PAHO: Disposalof farm Uruguay 6200Medical Education (1964 - 1967) PAHO wastes (seven weeks), hospital environmental health (ten weeks), industrial hygiene (three weeks), mental health (two for two To organize courses on the methodology of medical teaching months), nutrition education (ten weeks). at the school of medicine of the University of Uruguay. 162 THE WORK OF WHO, 1965

`Venezuela 9Fellowships PAHO: Sanitary engineering (two for Venezuela 4600Industrial Hygiene (1962 - 1967) PAHO twelve months). To strengthen the industrial hygiene and occupational health services of the Ministry of Health. XVenezuela 10Fellowships R: Sanitary engineering (two for twelve months). Venezuela 4801Rehabilitation (1963 - 1967) R To provide rehabilitation services, by the establishment of a Venezuela 0902 Diarrhoea) Diseases (1964 -1967) R national rehabilitation institute and rehabilitation units attached to hospitals and health centres. To make a comparative study of the importance of bacterial and viral infections and parasitic infestations in relation to diarrhoeal diseases in population groups of all ages living in Venezuela 6100School of Public Health (1961 - 1967) R communities supplied with water, and in groups living in communities where water supplies are lacking. To broaden the scope of the School of Public Health of the Central University, Caracas, and improve the teaching. Venezuela 2200 Water Supplies (1961 -1967) PAHO Community Water Supply Fund (Inter - Venezuela 6200Medical Education (1958 -1967) PARO American Development Bank) To improve medical education in Venezuela, in particular as To prepare long -term plans for urban water supply pro- regards preventive medicine and the teaching of basic sciences. grammes; to establish water rates for financing the construction of new water supply systems and for expanding the existing ones; and to reorganize the management of the water supply service Venezuela 6300Nursing Education of Caracas. (See page 110.) (April 1959 -1968) EPTA PAHO To establish, at the School of Public Health, advanced courses in nursing education and in administration of nursing services. Venezuela 2201Rural Water Supplies (1962 -1966) PAHO Community WaterSupplyFund UNICEF Venezuela 6400Sanitary Engineering Education To prepare plans for water supply systems in rural areas. (1964-1968) PARO CommunityWaterSupplyFund United Nations Special Fund To strengthen the sanitary engineering courses within the Venezuela 2300 Aedes aegypti Eradication (1958 - ) PAHO regular civil engineering curriculum in four universities; to To eradicate Aedes aegypti. organize a course of post -graduate studies at the Central Univer- sity of Venezuela; and to establish laboratories for research and teaching. Venezuela 2400Rural Housing (1963 -1967) R

To plan rural housing programmes. `i West Indies 4Fellowships PAHO: Barbados - Aedes aegypti eradication (thirteen days), public health nutrition (ten weeks). 'Venezuela3101Fellowships PARO: Health planning (four for three and a half months), maternal and child health services organization (two weeks), medical pedagogy(two weeks), West Indies 5Fellowships R: Barbados - medical technology rodent control (two months). (twelve months); St Lucia -medical technology (twelve months); St Vincent - medical technology (twelve months).

Venezuela 3102Fellowships R: Epidemiology (twelve months), West Indies 0200Malaria Eradication Programme food control (two weeks), health education (twelve and a half (1958 -1966) PARO Special Malaria Fund UNICEF months),orthopaedicbrace -making (four months),social paediatrics (two for one month). To eradicate malaria from the three island groups of Dominica, Grenada and St Lucia, the last two of which are now registered in the list of countries from which malaria has been eradicated. Venezuela 3301National Institute of Hygiene (1964 -1967) PARO West Indies 2200Water Supplies To develop virological studies and the preparation of freeze - (1962 -1968) EPTA PARO Community Water Supply Fund dried vaccines at the National Institute of Hygiene. To plan water supply systems for several islands in the Caribbean. Venezuela 4300 Mental Health (1954 - 1966) EPTA To assess mental health problems and to plan a national West Indies 3101Fellowships PAHO: Montserrat- environmental health programme, integrated into the national health mental sanitation (ten and a half months); St Lucia- environ- plan, and providing for care and rehabilitation of patients, mental sanitation (ten and a half months), laboratory services training of personnel, research, and prevention of mental (nine months); St Vincent - laboratory services (six months), disorders. sanitary engineering (three months). PROJECT LIST: THE AMERICAS 163

West Indies 3102Fellowships R: Antigua -environmental sani- services in malaria eradication programmes.The seminar in ation (ten and a half months), medical technology (eleven Poços de Caldas was attended by seventy -three participants months); Barbados - medical technology (two months); St Lucia from Argentina, Bolivia, Brazil, Colombia, Ecuador, Paraguay, -rural water supplies and waste disposal (one month); St Vin- Peru and Venezuela.The seminar in Cuernavaca had thirty cent- medical technology (four months). participants from British Guiana, Costa Rica, Cuba, Dominican Republic, Grenada, Guadeloupe, Guatemala, Haiti, Honduras, Jamaica, Mexico, Nicaragua, Panama, St Lucia, Surinam, West Indies 3200Nursing Services Trinidad and Tobago, and United States of America. (1959 - 1968) R PAHO UNICEF The Organization provided consultant services, the cost of To improve the nursing services in Barbados, Dominica, attendance of the participants, and supplies and equipment. Montserrat, and St Lucia and, later, in other islands in the (See also page 111.) eastern Caribbean.

AMRO 0212Resistance of Malaria Plasmodia Strains to Drugs AMRO 0102Epidemiology, Zone II (1965 - ) PAHO (1963 - March 1965) MESA AMRO 0103Epidemiology, Zone III (1961 - ) PAHO The aim was to study the Plasmodia strains of human malaria AMRO 0106Epidemiology, Zone VI (1958 - ) PAHO that were reported to be resistant to antimalarial drugs.The To stimulate the development and co- ordination of pro- study was carried out by the Government of Brazil at an institute grammes for the eradication or control of communicable diseases in that country.Strains of malaria parasites from Brazil, in the countries of the zone; to advise the governments on new British Guiana, Colombia and Venezuela reported as resistant methods and techniques of control and on problems related to to antimalarial drugs were tested. the application of the International Sanitary Regulations; and The Organization provided the services of consultants, and to promote better reporting of notifiable diseases. supplies and equipment, and a contractual service grant was made.

AMRO 0200Malaria Technical Advisory Services, Inter -zone (1955 -1967) R MESA PAHO Special Malaria Fund AMRO 0214AdvancedCourseinMalariaEpidemiology, To provide technical advisory services and local training in Venezuela (2 - 30 Nov. 1965) PAHO Special Malaria Fund certain aspects of country programmes for which long -term WHO provided the cost of attendance of fifteen trainees at an appointments of advisers are not necessary. advanced course in malaria epidemiology, held at the international malaria eradication centre, Maracay, Venezuela. AMRO 0201Malaria Technical Advisory Services, Zone I (1957 -1970) PAHO Special Malaria Fund AMRO 0300Smallpox Eradication (1951 - ) R PAHO AMRO 0203Malaria Technical Advisory Services, Zone Ill (1958 -1969) MESA PAHO Special Malaria Fund To co- operate with governments of the Region in the production of smallpox vaccine and advise them on the organization, AMRO 0204Malaria Technical Advisory Services, Zone IV (1958 - 1971) PAHO Special Malaria Fund conduct, and evaluation of national smallpox eradication programmes. To provide technical advice to the countries of the zone and to co- ordinate their malaria eradication programmes; and to co- ordinate the research and training activities of these pro- AMRO 0400Tuberculosis Control, Inter -zone grammes with those of the continent -wide malaria eradication (1957 - ) R (Government of Venezuela) programme. To stimulate the expansion of tuberculosis control programmes in the Region by assisting governments in their planning and AMRO 0209Insecticide Testing Team (1960 - 1968) MESA execution and promoting the convening of technical meetings on tuberculosis. Totestinsecticidesandlarvicidesand evaluatetheir potentialities. (?AMRO 0403Tuberculosis Control, Zone III (1963 -1967) PAHO AMRO 0210Malaria Eradication Epidemiology Teams (1960 -1969) MESA AMRO 0404Tuberculosis Control, Zone IV (1962 - 1967) R To determine the causes of the persistence of malaria trans- To assist countries of the zone in studying, organizing, mission in areas regularly sprayed with residual insecticides, carrying out and evaluating tuberculosis control programmes; and to recommend remedial measures. in training professional and auxiliary personnel in modern techniques of tuberculosis control; and in integrating tuberculosis control work into the work of the general health services. AMRO 0211Seminars on the Role of Local Health Services in the Malaria Eradication Programmes, Poços de Caldas, Brazil (26 June - 4 July 1964), Cuernavaca, Mexico (4 - 13 March'AMRO 0500Leprosy Control, Inter -zone (1958 - ) PAHO 1965) PAHO Special Malaria Fund To determine the prevalence and characteristics of leprosy in Two seminars, attended by the directors of malaria eradication the Americas; and to assist countries in planning and organizing campaigns in the Region and by authorities of the general health leprosy control work and in training professional and auxiliary services, were organized to study the participation of local health personnel. 164 THE WORK OF WHO, 1965

AMRO 0503Leprosy Control, Zone III (1960 - ) PAHO AMRO 0901Bilharziasis Control (1960 - ) PARO AMRO 0504 Leprosy Control, Zone IV (1960 - ) R To help countries to appraise their bilharziasis problem, plan AMRO 0506Leprosy Control, Zone VI (1962 - )R and develop control programmes, and plan research projects. To assist the countries of the zone in studying, organizing, carrying out and evaluating leprosy control programmes; in ( AMRO 2101Sanitary Engineering, Zone I

training professional and auxiliary personnel in techniques of I( (1960 - PAHO leprosy control; and in integrating leprosy control work into the work of the general health services. AMRO 2102Sanitary Engineering, Zone II (1960- R PAHO 1/AMRO 2103Sanitary Engineering, Zone III & AMRO 0507Course onRehabilitationandPreventionof (1960 - R PAHO \ Deformities (Leprosy), Caracas (2 May -18 July 1965) R PAHO 4/AMRO 2104Sanitary Engineering, Zone IV

A course on the prevention of deformities in leprosy patients, I (1960- PAHO and on their physical rehabilitation, in which the emphasis wasiAMRO2106Sanitary Engineering, Zone VI placed on non -surgical methods. There were fifteen trainees from (1960 - PAHO Argentina, Colombia, Ecuador, Mexico, Paraguay and Vene- zuela. The Organization provided the cost of their attendance To assist the governments of countries in the zone in improving and consultant services. the organization of the environmental sanitation services of the Ministry of Health; to advise the agencies responsible for water supply and sewerage services; and to co- operate with universities AMRO 0600Yaws Eradication and Venereal Disease Control, and other institutions in training professional and auxiliary Inter -zone (1961 - ) R PAHO personnel for sanitation work. To meet requests from countries for advisory services on yaws eradication and venereal disease control. AMRO 2107Environmental Sanitation, Caribbean Area (May 1956 - ) EPTA PAHO UNICEF AMRO 0607Seminar on Venereal Diseases, Washington, D.C. (24 - 30 Oct. 1965) R To investigate and evaluate environmental conditions and provide technical advice during the development of extensive The seminar was attended by Directors- General of Health sanitation programmes in the countries and territories of the and other officials from the countries and territories in the Caribbean area. Region. The participants exchanged experience in the control of venereal diseases and discussed the planning of a control campaign for the whole of the Americas. AMRO 2109 Sewage Disposal and Water Pollution Control The Organization provided the cost of attendance of the (1962 - ) PAHO participants and supplies and equipment. To advise governments of the Region on the planning of programmes for the construction of sewerage and sewage AMRO 0700 Pan American Zoonoses Centre, Azul, Argentina treatment plants, and on the solution of specific problems of (1956 - ) EPTA PAHO (Government of Argentina) watercourse pollution. (United States Public Health Service) To advise cou'ountries of the Region on the establishment and AMRO 2110Refuse and Garbage Disposal (Nov. 1961 - ) R improvement of veterinary public health services and control pro- To advise on methods of collection and disposal of refuse grammes; to carry out research on the most prevalent zoonoses; and garbage and on the organization and administration of the and to train technical personnel for zoonoses control work. relevant municipal services.

\O\AMRO 0703Veterinary Public Health, Zone III AMRO 2111Manual on School Sanitation (1962 - 1965) PAHO (Sept. 1957 - ) R A consultant advised several countries on the planning and To assist the countries of Zone III in developing veterinary design of sanitary installations for schools, and a Manual of public health services and activities, especially the study and School Sanitation was prepared and distributed to Member control of zoonoses and the application of protective measures in food control; to promote the teaching of veterinary public governments. health; and to collaborate in the evaluation of veterinary public health and related programmes. AMRO 2200 Water Supplies, Inter -zone (1959 - ) PAHO Community Water Supply Fund AMRO 0800Pan American Foot- and -Mouth Disease Centre, To advise countries of the Region on the planning, financing Rio de Janeiro and carrying out of national water supply programmes and on (1951 - ) PAHO /Organization of American States (AID) the organization and administration of central and local water (Government of Brazil) supply and sewerage authorities. To provide countries of the Americas with technical advisory services for the control of foot -and -mouth disease, for laboratory AMRO 2208Water Fluoridation (1961 - ) PAHO diagnosis of the disease, and for the training of professional and auxiliary personnel; and to carry out research on the preparation To advise countries of the Region on methods of water of modified live -virus vaccine. fluoridation for the prevention of dental caries. PROJECT LIST: THE AMERICAS 165

AMRO 2212Rural Water Supplies AMRO 3107Public Health Administration, Caribbean Area (1964 - ) PAHO Community Water Supply Fund (1963 - 1967) R PAHO To assist countries to meet the goal set by the Charter of Punta To help countries and territories of Zone I to analyse their del Este, by providing them with advice (a) on the planning, health problems, evaluate resources, and prepare plans for financing, and carrying out of national plans for rural water obtaining the maximum results with the human and material supply programmes, emphasizing community organization and resources available; and to co- operate in implementing and participation, and the establishment of national revolving funds; evaluating public health programmes withinthe national and (b) on the development of the administrative structure development plans. needed for carrying out accelerated programmes to meet the growing needs of the rural areas. AMRO 3110Co- ordination of International Research (1962 - ) PAHO PAHO /United States National Institutes of Health AMRO 2213Studies and Investigations of Water Resources (1964 -1967) EPTA (ECLA) To stimulate the development of biomedical research and training of specialized personnel; and to provide for an annual To collaborate with the Economic Commission for Latin meeting of the PAHO Advisory Committee on Medical Research America (ECLA) in a study of Latin America's water resources, to analyse and make recommendations on suggested projects particularly with a view to the provision of adequate water and on those in operation. supplies. AMRO 3201Nursing, Zone I (1959 - ) PAHO AMRO 3202Nursing, Zone II (1962 - ) PAHO AMRO 2300Aedes aegypti Eradication (1954 - ) PAHO AMRO 3203Nursing, Zone III (1963 - ) PAHO To stimulate, co- ordinate, and evaluate Aedes aegypti eradica- Nursing, Zone IV (1952 - ) PAHO tion programmes in the countries and territories of the RegionAMRO 3204 that are still infested with the mosquito. JAMRO 3206Nursing, Zone VI (1963 - ) PAHO To assist countries of the zone in planning and organizing nursing services, in developing educational programmes for AMRO 2301AedesaegyptiEradication,CaribbeanArea professional and auxiliary nursing and midwifery personnel, and (1950 - ) EPTA in promoting research in nursing. To advise Jamaica, Trinidad and Tobago, and the British, French, and Netherlands territories in the Caribbean on Aedes AMRO Courses on Nursing Supervision and Administra- aegypti eradication. tion, Zone I (1965 -1968) PAHO To strengthen nursing services in the Queen Elizabeth Hospital, Barbados, by holding courses in nursing administration and AMRO 2400Public Health Aspects of Housing and Urbaniza- supervision and establishing a permanent in- service education tion (1962 - ) PAHO programme. To foster the participation of health authorities in housing and city planning programmes; and to advise countries of the AMRO 3300Laboratory Services (Feb. 1955 - ) R PAHO Region on the establishment of health standards for houses and To assist governments of the Region in the improvement and urban areas. extension of public health laboratory services; in the production and control of biological products; and the setting -up or expansion of animal colonies. AMRO 3100National Health Planning, Inter -zone (1961 - ) PAHO (Inter -American Economic and Social AMRO 3301Laboratory Services, Caribbean Area Planning Institute) (1964 -1967) PAHO To assist governments in formulating national health plans To develop, at the University of the West Indies, Kingston, and in training personnel for the purpose. Jamaica, a programme for training laboratory technicians for English- speaking countries and territories in the Caribbean area. Emphasis will be laid on the importance of laboratory practices AMRO 3101National Health Planning, Zone I in the curative and preventive aspects of medicine. (1965 - ) PAHO AMRO 3103National Health Planning, Zone III AMRO 3307Vaccine Production and Testing (1965 - ) PAHO (July 1954 - ) R AMRO 3104National Health Planning, Zone IV To provide vaccine -testing services to laboratories preparing (1963 - ) PAHO vaccines in the Americas. AMRO 3106National Health Planning, Zone VI (1963 - 1967) PAHO AMRO 3401Health Education, Caribbean Area (1963 - ) EPTA To assist governments of the countries of the zone in formulating national health plans and in training personnel for the To help the countries and territories of Zone I in developing purpose. health education work and training personnel. 166 THE WORK OF WHO, 1965

\SAMRO3407Community Development Training Centre, AMRO 4200Nutrition Advisory Services, Inter -zone Pátzcuaro, Mexico (1958 - 0000) PAHO (April 1951 - Dec. 1953; 1960 -1970) R (UN) (FAO) (ILO) (UNESCO) (Organization of American States) To provide advisory services in nutrition to meet specific needs of governments. To co- operate in the training of students at the Community Development Training Centre for Latin America. AMRO 4201Nutrition Advisory Services, Zone I (1961 - )R Health Statistics, Zone I (1964 - ) PAHO AMRO 3501 To collaborate with the countries and territories of Zone I AMRO 3502Health Statistics, Zone II (1958 - )R in the study and evaluation of nutrition problems and needs; in AMR() 3503Health Statistics, Zone III (1955 - )R planning, in close co- operation with national and international agencies, nutrition education programmes and programmes to AMRO 3504Health Statistics, Zone IV (1956 - ) R foster the production of protein -rich foods; and in integrating AMR() 3506Health Statistics, Zone VI (1959 - ) PAHO nutrition programmes into health services at all levels. To assist the countries of the zone in improving their vital and health statistics systems; and to advise them on the use of statistical data in national health planning and on the statistical)AMRO 4203Institute of Nutrition of Central America and aspects of projects. Panama, Guatemala City (1949 - ) PARO UNICEF (INCAP Member Govern- ments) (Asssociation for the Aid of Crippled Children) AMRO 3507Regional Development of Epidemiological Studies (English -American School, Guatemala) (Kellogg Foundation) (1961 - 1966) PARO PAHO /United States National Institutes (Massachusetts Institute of Technology) (Milbank Memorial of Health Fund) (Nutrition Foundation, United States of America) (Rockefeller Foundation) (UnitedStates Army) (United To obtain, by special investigations, accurate and comparable States Interdepartmental Committee on Nutrition for National data on causes of death in adults in certain cities of the Americas. Defense) (UnitedStatesNationalInstitutesof Health) (WBZ Radio, Boston, Mass.) AMRO 3600Administrative Methods and Practices in Public Health (1959 - ) PAHO To co- operate in developing the Institute of Nutrition of Central America and Panama (INCAP),which trains professional To help countries of the Region to improve the administrative and auxiliary personnel from its member countries and other practices of national health services at all levels. countries in the Americas and carries out nutrition research for solving the urgent problems created by the inadequate nutritional status of a large part of the population of the Americas. AMRO 3603Administrative Methods and Practices in Public Health, Zone III (1963 - ) PAHO AMRO 3604Administrative Methods andPractices in Public 5kAMRO 4204Nutrition Advisory Services, Zone IV Health, Zone IV (1963 - ) PARO (1956 - ) R AMRO 3606Administrative Methods andPractices in Public Health, Zone VI (1963 - ) PAHO To advise the countries of Zone IV on the development of nutrition programmes, especially at the level of the local health To help the countries of the zone to improve the administrative services; on applied research related to nutrition programmes; methods and practices of their health services. and on the training of personnel.

AMRO 4100Maternal and Child Health Programme Planning and Service Norms (1964 -1967) PAHO AMRO 4207Nutrition, Caribbean Area (1963 -1967) R PARO (FAO) To prepare guides on the establishment of priorities and standards of service in connexion with the planning of maternal To co- ordinate nutrition work in the Caribbean area, in and child health programmes and on the techniques of carrying order to develop a programme that will include training of out surveys and , conducting seminars. personnel and scientific research.

MR0 4108Training in Clinical and Social Paediatrics AMRO 4209Seminar on Prevention of Endemic Goitre, Salta, (1961 - ) R UNICEF Argentina (21 - 26 June 1965) PARO To assist in organizing annual courses on social paediatrics The seminar was attended by twenty -nine participants from for physicians engaged in paediatrics or paediatricians in charge Argentina, Brazil, Chile, Colombia, Costa Rica, Guatemala, of maternal and child health services in Latin America who wish Honduras, Nicaragua, Panama, Paraguay, Peru, Uruguay and to enlarge their experience. Venezuela, and by officials from the Pan American Sanitary Bureau and UNICEF.It discussed the technical, legal and 41R0 4109 Midwifery (1962 -1967) PAHO administrative aspects of large -scale iodization of salt for the prevention of endemic goitre and formulated recommendations To provide countries of the Region with advisory services for on the subject. ,improving their maternity care services and their institutions for The Organization provided the cost of attendance of the the training of midwives. participants, a consultant for one month, and temporary advisers. PROJECT LIST: THE AMERICAS 167

AMRO 4210Evaluationof AppliedNutritionProgrammes AMRO 4600Industrial Hygiene (1961 - ) PAHO (1964 -1967) PAHO UNICEF (FAO) To help to organize or improve the operation of national To evaluate, jointly with FAO and UNICEF, the applied industrial hygiene services by providing technical advice and nutrition programmes operating in sixteen countries of the facilities for training of personnel. Americas. AMRO 4608 Manganese Poisoning and Metabolic Disorders AMRO 4300Mental Health, Inter -zone(1965 - ) PAHO (1964 -1966) PAHO /United States National Institutes of Health To assist mental health programmes in countries of the Region. A conference on the epidemiology of mental disorders was To co- ordinate research on the dynamics of the mental held in Washington, D.C., from 29 March to 3 April 1965. syndrome produced by chronic inhalation of dust containing manganese. It was attended by participants from Argentina, Chile, Mexico, Peru, United Kingdom and United States of America. AMRO 4700 Food and Drug Control, Inter -zone (1959 - PAHO AMRO 4307Seminar on Mental Health, Kingston, Jamaica (5 - 11 Sept. 1965) PAHO To provide technical advice to the national services responsible for the health aspects of production and control of foods, drugs The seminar, at which the mental health problems in the and biologicals, both locally manufactured and imported; and Caribbean area were discussed and analysed, was attended by to assist countries in improving national controlservices. thirty-fourparticipants from Aruba, Bahamas, Barbados, Bermuda,BritishGuiana,Curaçao, Dominica,Grenada, Guadeloupe, Jamaica, Martinique, Puerto Rico,St Lucia, AMRO 4703 Food and Drug Control, Zone III (1964 - ) R St Vincent, Surinam, and Trinidad and Tobago, and by eleven To assist the countries of Zone III in establishing national staff members and temporary advisers of the Organization. food and drug control programmes; and to provide technical advisory services and facilitate training of personnel. The AMRO 4308Mental Health Information Centre of Latin laboratories of the University of Panama will act as reference America laboratories for the quality control of drugs, and the Institute (1963 -1966) PAHO /United States National Institutes of of Nutrition of Central America and Panama as the reference Health laboratory for the control of food products.

To establish a centre to collect and distribute information on AMRO 4707 Food Sanitation (1964 - 1965) PAHO mental health work in Latin America, to serve as a clearing- house for the exchange of information among professionals WHO provided a consultant for two months and supplies and working in this field, and to stimulate relevant scientific research. equipment.The consultant reviewed municipal food control practices in seven countries of the Region and drafted a guide on food hygiene, which was distributed to health authorities for &AMRO 4400Dental Health (1954 - ) PARO their comments and suggestions before preparation of the final To assist countries of the Region in strengthening dental text. services by providing technical advisory services and fellowships for training in public health dentistry. AMRO 4800 Medical Care Services (1961 - ) PAHO To assist countries of the Region with studies associated with AMRO 4407Dental Epidemiology aspects of planning, organization, training, and applied research (1964 -1966) PAHO /United States Public Health Service in medical care services. To develop, at the University of Sáo Paulo, Brazil, a Latin American centre for training and research in dental epidemiology. AMRO 4803Medical Care Services, Zone III (1962 - ) PAHO AMRO 4804Medical Care Services, Zone IV AMRO 4500Health Aspects of Radiation (1963 - ) PARO (1958 - ) PAHO (United States Public Health Service) AMRO 4806Medical Care Services, Zone VI To stimulate the adoption of international standards and (1961 - ) PAHO procedures for radiation protection in connexion with the use of X -rays and radioisotopes and the development of regulations To assist countries of the zone in integrating medical care for the disposal of radioactive wastes; to promote the teaching services into the general health services and in formulating of basic health physics, radiobiology, and radiation protection standards for medical care. in medical, dental, veterinary public health, and other professional schools; to foster the use of radioisotopes for medical AMRO 4807Rehabilitation (1962 - ) PARO diagnosis, therapy, and research; and to collaborate with To advise the countries of the Region on problems of medical countries of the Region in establishing sampling stations for determining the radioactive contamination of air, food and rehabilitation. water. AMRO 4811Advisory Group on Hospital Planning, Washington, D.C. (25 - 30 July 1965) PARO AMRO 4507 Radiation Health Protection (1964 - ) PAHO The advisory group, which was convened pursuant to resolution To provide governments with advice on protection against XXV of the XV Meeting of the PARO Directing Council/ radiation hazards, through a consultant stationed in Lima, Peru. Regional Committee for the Americas, sixteenth session, studied 168 THE WORK OF WHO, 1965

hospital planning as part of national health planning.The X1MRO 6214Faculty Training for Medical Schools present situation in the Region was reviewed and future needs (1964 - ) PAHO /Kellogg Foundation analysed, and recommendations concerning the collaboration To plan centres for training faculty members for medical of the Organization with governments in hospital planning were schools in Latin America. presented to the XVI Meeting of the Directing Council of PAHO /Regional Committee for the Americas, seventeenth session, in September - October 1965. AMRO 6300Schools of Nursing (1962 - ) R To provide advisory services in specialized areas of nursing AMRO 4812Study Group on Relationship between Social education, fellowships for members of nursing faculties, and Security and Health Agencies, Washington, D.C. nursing texts in Spanishlo schools of nursing in Latin America. (12 - 16 July 1965) PAHO (Organization of American States) The study group was convened jointly with the Organization AMRO 6301Nursing Education, Zone I (1963 - 1966) PAHO of American States, in compliance with resolution XL of the To assess the nursing resources in countries and territories XV Meeting of the PAHO Directing Council /Regional Com- of the Caribbean area; and to carry out a long -term plan for the mittee for the Americas, sixteenth session.It considered the improvement of nursing services.This project includes the relations existing between national health services and social former project West Indies 12. security institutions and made recommendations on the improvement of co- ordination between them. O 6310Programmed Instruction for Nursing Auxiliaries (1965 -1969) PAHO Schools of Public Health (1953 - O 6100 ) R To train nurse educators in the technique of programmed To assist schools of public health in the Region, especially instruction for nursing auxiliaries.It is intended to use this the newer ones, to strengthen and improve their organization, method for training the large numbers of untrained nursing administration and teaching. personnel working in medical services in Latin America.

0(MR06107Fourth Conference of Directors of Schools of 1MR0 6400Sanitary Engineering Training Public Health, Puerto Rico (14 - 19 Nov. 1965) PAHO (Dec. 1952 - 1958; 1964 - ) PAHO A conference at which the deans and the chiefs of the epidemio- To assist countries of the Region in expanding their institu- logy departments of the ten schools of public health in Latin tions for training sanitary engineers and in revising the curricula. America discussed problems encountered in the teaching of epidemiology. A consultant and several staff members from AMRO 6600Dental Education (1963 - ) R the Organization also attended the meeting. To co- operate with university authorities of countries of the Region in improving teaching in schools of dentistry. AMRO 6200Medical Education (March 1953 - ) R PARO PAHO /Milbank Memorial AMRO 6607Seminars on Dental Education Fund (1962 -1966) PAHO PAHO /Kellogg Foundation (Government To assist countries of the Region to improve medical education, of Mexico) i eluding the teaching of social medicine. To assess the situation as regards the teaching of dentistry in the Region and formulate recommendations for the solution AMRO 6203Medical Education, Zone III (1960 - ) PAHO of problems. To assist in improving the teaching of medicine in the countries of Zone III. AMRO 6700 Programme for Biostatistics Education (1952 - ) EPTA 41120 6208Teaching of Statistics in Medical Schools To improve vital and health statistics in the countries of the (1961 - ) PAHO Region by training technical and professional personnel in specialized centres. To help to develop medical statistics courses in schools of medicine in the Region. AMRO 6707Latin American Centre for the Classification of / Diseases (April 1955 - ) R PAHO ,k)ÇAMRO 6210Teaching Methods and Administrative Organiza- tion of Medical Schools (1964 - ) R To study problems of medical certification of causes of death; to give training on classification of causes of death in accordance To organize group discussions and seminars for the purpose with the International Classification of Diseases; and to assist of assisting medical schools in the Region to review and improve in revising the Classification. their teaching methods and administrative procedures. AMRO 6708Training Programme in Hospital Statistics ÇAMRO 6213Research Training Institutions in Health Sciences (1961 - ) EPTA PAHO (1964 - ) PAHO /AID To organize training courses in medical records and hospital To establish in Latin America institutions for the training of statistics, in order to improve the collection of essential data for research workers in health sciences. planning health and medical services. SOUTH -EAST ASIA

Afghanistan 11Malaria Eradication Programme Afghanistan 28School for Sanitanians, Kabul (Aug. 1956 - end of 1969) R UNICEF (July 1955 - end of 1965) EPTA To eradicate malaria from the entire country and prevent the To train sanitarians for community health services throughout re- establishment of endemicity. the country.

Afghanistan 13Medical Education (Jan. - Aug. 1952; Sept. 1953 - end of 1968) R Afghanistan 31Institute of Public Health, Kabul (April - May 1956; Nov. - Dec. 1958; March - May 1961; To strengthen departments of the faculties of medicine of the May 1962; Aug. 1962 - end of 1968) R UNICEF Universities of Kabul and Nangarhar and to train staff. To develop the Institute of Public Health for investigations, { Afghanistan 20Vaccine Production, Kabul research and training of public health workers. (Jan. 1955 - Nov. 1960; July - Oct. 1961; Dec. 1962 - Nov. 1964) EPTA UNICEF The aim was to assist the vaccine production centre, Kabul, to Afghanistan 33Tuberculosis Advisory Services organize, expand and improve facilities for producing vaccine June - Dec. 1958; June - July 1961; Nov. 1962 - March 1964; for the national health programme and to train local personnel March 1965 - end of 1968) EPTA UNICEF in the production of biological substances. WHO provided a To expand tuberculosis control services in and around Kabul; bacteriologist from January 1955 to November 1960 and from to establish a pattern for tuberculosis control in the provinces; December 1962 to November 1964, consultants (one for one and to train health personnej employed in tuberculosis control month and one for three months), nine fellowships in bacterio- work. logy and laboratory technology (five for six months, three for twelve months and one for two years) to medical officers and laboratory technicians, and supplies and equipment. Working conditions at the centre were improved and modern ghanistan 35Nursing Advisory Services techniques were introduced, including methods to improve (June 1957 - end of 1969) EPTA sterilization and ensure more economical production of vaccines. To strengthen nursing administration; to develop nursing and The control of vaccines by sterility, and in some cases potency, midwifery traïnin programmes; and to co- ordinate awn expand tests was introduced. Accommodation for laboratory animals nursing education and the nursing services. was expanded. The production of glycerinated smallpox lymph, of rabies vaccines for use in humans and animals, and of TAB and cholera vaccines, was increased. In 1964 the WHO bacteriologist prepared a plan for future expansion of the vaccine Afghanistan 44Trachoma Control production programme and for collaboration between the (May - June 1958; Sept. - Oct. 1962; July 1963; April - May vaccine centre and the microbiological and epidemiological 1964; June 1965 - mid -1967) R departments of the Institute of Public Health, Kabul. The plan includes the establishment of an independent assay and control To study the epidemiological aspects of trachoma in Herat section at the Institute for testing vaccines produced by the Province; to initiate control activities; to develop a programme centre. of health education related to communicable eye diseases; and The bacteriologist completed his assignment in November 1964 in the light of the data and experience so gained, to develop instead of at the end of December of that year. Further assis- such control programmes as may be required. tance to the centre is available part time from the WHO microbiologist assigned to the Institute of Public Health, Kabul. ghanistan 51Training of Radiographers ghanistan 24Health Education (Nov. 1965 - end of 1967) R (Oct. 1958 - Sept. 1959; May 1962 - end of 1967) R To set up a school for the training of radiographers and To set up a health education section in the Institute of Public radiological technicians. Health, Kabul; to develop health education services in the country; and to train teachers and health workers in health education. Afghanistan 54CommunicableDiseaseControl (Smallpox Control) (July 1964 - end of 1968) EPTA Afghanistan 26Rural Health (April 1956 - end of 1968) EPTA UNICEF To carry out smallpox vaccination and develop a smallpox eradication programme; to plan field epidemiological investiga- To further the development of rural health services in which tions of the major prevailing communicable diseases (including effectivelydirected and supervised curative and preventive smallpox) as necessary; and to train personnel in field epidemio- services are integrated at all levels. logy and communicable disease con . - 169 - 170 THE WORK OF WHO, 1965

Afghanistan 59Development of Basic Health Services An epidemiological unit has been established in the Health (April 1965 - end of 1975) R Directorate.Further strengthening of health laboratory and health statistical services throughout the country is required. To establish basic health services to cover the whole country. (The project is to be carried out in close co- ordination with project Afghanistan 26.) $urma56Nursing Advisory Services (March 1959 - end of 1968) EPTA Afghanistan 201Fellowships EPTA: Dentistry (twelve months). To upgrade and co- ordinate tzasiç andp os-bas tc ieducation for nurses and midwives throughout the country m order to establishsatisfactorystandards of nursing and midwifery Burma 17Leprosy Control training and services. (April 1960 - end of 1968) R UNICEF To expand and intensify the leprosy control programme to cover all endemic areas of the country and to train personnel Burma 65Tuberculosis Control for this purpose. (Jan. 1964 - end of 1968) EPTA UNICEF To develop community- oriented tuberculosis control services, 'Q Burma 22Vital and Health Statistics, Rangoon starting with Rangoon, Mandalay and the Taunggyi Division; (Dec. 1955 - June 1961; Jan. 1962 - end of 1967) R and to train health workers for tuberculosis control work. To establish machinery (especially hospital record departments) and to devise forms for prompt notification of health Burma 67Paediatric Education statistical data; to improve processing of the data; and to (June 1964 - mid -1967) R UNICEF train statistical personnel. To strengthen the departments of paediatrics in the country's three medical colleges; to improve the teaching of paediatrics, Burma 31Malaria Eradication Programme particularly as regards its preventive aspects; and to develop (Feb. 1957 -1967) R peripheral services as training fields. To eradicate malaria throughout the country in progressive stages. In accordance with the Government's decision in April 1962 Burma 75School of Public Health and Tropical Medicine to continue the programme without WHO field staff, WHO (Oct. 1964 - end of 1970) R EPTA assistance in the period under review was limited to fellowships. To establish a school of public health and tropical medicine.

Ck Burma 37Mental Health, Rangoon (Oct. - Dec. 1955; April 1965 - early 1967) R Burma 78Plague Control (Aug. 1965 - end of 1967) R To develop basic and post -basic programmes in mental To assess the factors responsible for the persistence of plague nursing, and in -service training, in order to improve nursing in some parts of the country and to train personnel in plague care in psychiatric hospitals. epidemiology and control.

Burma 44Strengthening of Health Services(Epidemiology) Burma 79Medical Education (Dec. 1964 - end of 1970) R (Jan. - Dec. 1961; July 1963 - March 1965) EPTA To improve undergraduate and post -graduatemedical The aim was to set up an epidemiological unit in the Health education by training teaching staff, developing curricula in Directorate; to study further the prevailing pattern of communi- keeping with modern concepts, and fostering research activities. cable diseases in the country in order to provide information for sound public health planning and appropriate control measures; and to develop public health laboratory services toNBurma 201Fellowships EPTA: Clinicalpathology(twelve support the work of the epidemiological unit. WHO provided months),epidemiology(nine months),paediatrics(twelve an epidemiologist from January to December 1961 and a months), physiology (twelve months), radiology (twelve months). microbiologist from July 1963 to March 1965, and supplies and equipment. The epidemiologist assisted in developing co- operation with Ceylon 4Maternal and Child Health EPTA the vital and health statisticsservices and in planning a A ten -month fellowship in public health was awarded under programme for the study of statistical data and of the epidemio- this project, for which staff and fellowships were provided between logical situation in Burma. Investigations on the occurrence of September 1955 and November 1963. plague were carried out and a detailed plan for smallpox control was prepared. At the end of 1961 it was decided to concentrate on the health laboratory aspects of the project. A microbiologist Ceylon 23.2Medical Stores Management (July - Aug. 1965) R was assigned first to Rangoon and later to Mandalay, where she helped to set up basic services in the general hospital laboratory WHO provided a consultant for two months to follow up the and to put the existing equipment into operation. Bacteriological recommendations of the consultant who visited Ceylon in 1958 and serological tests for communicable diseases and examination and to advise on further reorganization and improvement of of water were introduced and staff were trained. the pharmacy and medical stores in the country. PROJECT LIST: SOUTH -EAST ASIA 171

Ceylon 45Health Statistics India 81.1Leprosy Control (National Programme) (April 1957 - Dec. 1961;Sept. 1964 - end of 1968) EPTA (Jan. 1961 - end of 1968) R UNICEF To revise the system of records and reports in the health To carry out a programme of leprosy control covering the services; to establish medical record departments in the hospitals; whole country. and to train national staff in health statistics techniques. Training will be carr?eá out in clóé collaboration with the hospital statistics project (SEARO 72) located in Thailand. India 81.2Leprosy Control, Srikakulam (Jan. 1962 - end of 1968) R UNICEF

Ceylon 47Medical Education To provide technical direction for a leprosy control project (Nov. 1963 - April 1964; Oct. 1964 - end of 1969) R organized and maintained by the Danish " Save the Children " Organization, and to train leprosy auxiliary personnel. To strengthen teaching in certain subjects in the faculties of medicine of the University of Ceylon at Colombo and Peradeniya. India 84Environmental Sanitation, Uttar Pradesh (March 1958 - Dec. 1964) EPTA UNICEF \eylon53Nursing Advisory Services (July 1960 - end of 1968) R The aim was to set up in a rural area a pilot project for improving water supplies and excreta disposal; to plan and To develop all aspects of basic and post -basic nursing educa- carry out a sanitation programme including the design, operation tion through the Nursing Unit in the Department of Health and maintenance of simple, practical and cheap sanitary installa- and to strengthen paediatric nursing programmes. tions; to organize a programme of health education; and to train technicians, sanitarians, and other health personnel. WHO provided a sanitary engineer from May 1958 to December 1964 Ceylon 56Filariasis Control and a sanitarian from March 1958 to December 1962, a twelve- (Dec. 1959; April - July 1961; Sept. 1961; Aug. - Sept. 1963; month fellowship and supplies and equipment. June 1965 - end of 1967) EPTA The project was carried out under the responsibility of the To study the problem of filariasis control, and to strengthen Planning, Research and Action Institute, Lucknow.Latrines the control programme, introducing such new methods as may were designed and installed in the pilot area and a basis was be indicated. laid for extension of the scheme to the whole state.Methods for promoting the installation in rural areas of hand pumps and small piped water supplies, and for ensuring their operation and Ceylon 58Malaria Eradication Programme maintenance, were studied, and some piped water supply (Aug. 1960 -1967) R systems were constructed. Although the project did not accomplish all its objectives, it To eradicate malaria from the entire country and prevent the has contributed significantly to the solution of problems of re- establishment of endemicity. water supply and excreta disposal in rural areas.Plans for constructing latrines and latrine parts and supplying them to villages in community development blocks have been success- Ceylon 64 Community Water Supply fully implemented.A programme for training well -drilling (Oct. 1963 - end of 1967) R mechanics will provide staff for installing hand pumps in small To develop piped water supplies in major towns and other communities and the installation of piped water supplies has community areas. provided experience that will be valuable for the extension of similar systems to other rural areas.

Ceylon 66Study on Diarrhoeal Diseases (Sept. 1963 - early 1968) R India 98Short Courses for Nursing Personnel \ (July 1957 - Oct. 1964; March 1965 - end of 1968) R To make long -term studies of the epidemiology and control of diarrhoealdiseases and to develop the bacteriological To continue and expand programmes to train nurses in the diagnostic facilities for enteric diseases in the main hospitals organization, conduct and evaluation of short courses for nursing and in the field. personnel, and to introduce them to new concepts and practices.

VCeylon 200Fellowships R: Cardiac catheterization (two for India 99.3Integration of Public Health into Nursing Education, six months), tuberculosis control (two weeks). Orissa (May 1958 - Dec. 1964) EPTA The aim was to integrate training in public health into the eylon 201Fellowships EPTA:Nursing(twelvemonths), basic training of nurses and to provide supervised practical radiography (twelve months), sanitary engineering (four months). observation aperience for student nurses in an undergraduate school of nursing. WHO provided two public health India 53Tuberculosis Chemotherapy Centre, Madras nurses -from May 1958 to June 1962 and from March 1962 to (Dec. 1955 - end of 1969) EPTA (British Medical Research December 1964 -and a nurse tutor from November 1959 to Council) (Indian Council of Medical Research) October 1961 to the nursing school attached to the Cuttack Medical College Hospital.A twelve -month fellowship and To carry out controlled trials of domiciliary chemotherapy of supplies and equipment were also provided. ambulant tuberculosis patients in order to find methods that Assistance to the nursing school was directed towards streng- are simple, cheap, and effective in controlling the disease. thening and upgrading all its activities, special attention being 172 THE WORK OF WHO, 1965

paid to including public health nursing concepts and practices plan for health education of the general public. WHO provided in the curricula. In a large measure these objectives have been a health educator for the duration of the project, and teaching attained.Among the important achievements have been the supplies. following: the minimum educational standard for admission The organization of the Health Education Bureau was to the school has been raised to matriculation; the midwifery strengthened and a systematic programme of activities was programme has been placed in charge of a qualified midwifery drawn up.Orientation training was introduced for the staff tutor; the preclinical period of study has been extended to three and their functions defined. A considerable amount of health months; the decision has been taken to admit all students to a education material was supplied to the Bureau, which has single nurse education programme, instead of dividing them been accommodated in a new building. into public health students and general nurse students; the Assistance in health education was provided in connexion content of curricula has been strengthened and their sequence with the programmes for rural water supplies, applied nutrition improved, and new teaching methods have been introduced; and smallpox eradication, and teachers were given health the regular deputationof nursestoadvanced education education training. programmes has been established; and a doctor has been The Health Education Bureau has been established on a appointed to take care of the students'health.Since the sound foundation for future development. project began, 130 students have followed the integrated programme of the school. India 110.3Nursing Adviser to Punjab (Aug. 1961 - June 1966) EPTA I dia 99.5Integration of Public Health into Nursing Education, India 110.4Nursing Adviser to Orissa Goa (Sept. 1963 - end of 1967) EPTA (Oct. 1962 - June 1967) EPTA 110.5Nursing Adviser to Gujarat To introduce patterns of basic nurse -midwife and au .diary (Sept. 1963 - end of 1966) EPTA nurse -midwife education similar to those laid down by the Indian Nursing Council; to arrange in- service training in all To organize and expand nursing education and nursing teaching hospitals; and to improve methods of administration services in the state and to co- ordinate supervisory services so of the nursing component of all health services. as to ensure uniformly high standards of nursing and midwifery in the health programme.

India 99.6Integration of Public Health into Nursing Education, Punjab (July 1965 - end of 1967) EPTA India 110.6Nursing Adviser to Himachal Pradesh (May - Oct. 1965) EPTA To improve the administration of the programme in basic nursing schools used in connexion with the training of nurse WHO provided a nursing adviser to Himachal Pradesh to educators and administrators. assist in organizing and expanding nursing education and nursing services in the state, and in co- ordinating services so as to ensure uniformly high standards of nursing and midwifery India 101National Trachoma Control Programme in the health programmes. (Feb. - May 1956; Oct. 1956 - end of 1967) R UNICEF To reduce the prevalence and gravity of trachoma and India 111Medical Education associated bacterial infections in the project area to a level at (Dec. 1958 - Sept. 1961; Nov. 1965 - end of 1970) R which these diseases will no longer be problems of major public To strengthen selected medical colleges by the provision of health importance; to train ophthalmologists, general physicians teaching staff. and field staff in control measures; to carry out a health education programme at all levels; and to integrate the control of communicable eye diseases into the general health services. India 114.1Paediatric Education, Kerala (Dec. 1964) R UNICEF India 103National Tuberculosis Programme WHO provided a public health nurse to assist in conducting (Oct. 1956 - Oct. 1957; Nov. 1957 - end of 1968) EPTA an all -India refresher course in paediatric nursing at the Medical UNICEF College, Trivandrum.Previous assistance tothisproject, provided from August 1958 to July 1964, was described in the To carry out a national tuberculosis control programme, Annual Report for 1964.1 using the experience gained in model rural and urban programmes and the results of epidemiological findings and operational research; to train nubile health workers of various categories dia 114.4Paediatric Education, Maharashtra for state and district tuberculosis control centres; and to evolve (Oct. 1963 - July 1965) R UNICEF methods and procedures for assessment of the national programme. The aim was to expand and upgrade the teaching of paediatrics in the state medical colleges. WHO provided a professor of paediatrics, who continued the assistance provided (under India 108.5Health Education, Orissa project India 135) between May 1959 and February 1962 to (July 1964 - June 1965) EPTA the paediatric departments of the three medical colleges in the former Bombay State, and also assisted paediatric departments The aim was to develop the Health Education Bureau in the of other medical colleges in Maharashtra and of the Medical Health Directorate along modern lines and to set up a field College in Goa. study and demonstration centre attached to the Bureau; to train health workers and teachers in health education; and to 1 O,ff. Rec. Wld Hlth. Org. 139, 162. PROJECT LIST: SOUTH -EAST ASIA 173

Co- ordination of paediatric education and services was im- India 147Public Health Programme, Kerala proved through the committee set up for the purpose in Bombay. (June 1960 - March 1966) R UNICEF Intra -mural and extra -mural teaching of paediatrics was strengthened and close co- ordination was established between the To train personnel and to expand the health services in departments of paediatrics and of preventive and social medicine community development areas. of the various colleges. The physical facilities of the departments were considerably improved and in some cases extended. The paediatric division and the central laboratory at the Kasturba India 150.2Public Health Programme, Maharashtra and Madras Hospital for Infectious Diseases were upgraded to enable them (April 1963 - end of 1966) EPTA UNICEF to be used in connexion with the teaching of post -graduate and To carry out a rural environmental sanitation programme undergraduate students. The B. J. Wadia Children's Hospital and to improve the training of environmental sanitation staff. was also used for practical training of undergraduates. A comprehensive training programme has been developed for students at all levels, but efforts to introduce a paper in India 153Malaria Eradication Programme paediatrics inthe final Bachelor of Medicine /Bachelor of (Aug. 1958 - end of 1971) R (AID) Surgery examination were unsuccessful. Compromise solutions included assessment and examination of all students after they To eradicate malaria from the whole country and prevent had completed a three -month clinical assignment. the re- establishment of endemicity.

dia 114.6Paediatric Education, Punjab \)dia 155Curriculum Guide for Nursing and Midwifery Training (Oct. 1965 - end of 1967) R UNICEF (Jan. 1963 - March 1966) R To plan and conduct an advanced course in clinical and social To revise the syllabus and regulations for the training of nurses paediatric nursing in the College of Nursing, Institute of Post- and midwives established by the Indian Nursing Council; and graduate Medical Education and Research, Chandigarh. to prepare a guide to the new syllabus, which is designed to co- ordinate, upgrade and standardize nurse /midwife training throughout India.(See page 116.) India 121Indian Council of Medical Research (Statistics) (Aug. 1962 - Feb. 1963; Dec. 1963 - end of 1967) R India 170Survey of Water Supply Resources of Greater Calcutta To set up a statistical unit at the headquarters of the Indian (Oct. - Nov. 1959; Sept. - Nov. 1961; Feb. 1963 - end of 1966) Council of Medical Research; to organize and co- ordinate R United Nations Special Fund medical research work, and to train personnel. To improve the water supply, sewerage and drainage of Greater Calcutta. India 136.2Post -basic Nursing Education, Gujarat (Jan. 1963 - end of 1966) R India 173Production of Diphtheria /Pertussis /Tetanus Vaccine, To expand post -basic nursing education and to upgrade Kasauli public health and institutional nursing services. (Jan. - March 1961; Sept. 1961; March 1965 - end of 1967) R UNICEF India 136.3Post -basic Nursing Education, Punjab To develop the production of immunizing agents against (March 1964 - end of 1970) R diphtheria, pertussis and tetanus. To set up a post -basic school of nursing affiliated to a university. India 174Production of Freeze -dried Smallpox Vaccine (Sept. 1963 - end of 1965) R UNICEF

1/India136.4Post -basic Nursing Education, Mysore To increase the production of freeze -dried smallpox vaccine. (Feb. 1964 - end of 1965) R To expand post -basic nursing education and to upgrade publicv India 175.2Public Health Programme, Gujarat health and institutional nursing services. (Nov. - Dec. 1964) EPTA WHO provided a sanitarian for six weeks toassistthe 136.5Post -basic Nursing Education, Madras Gandhigram Rural Institute, Madras, in organizing a one -year v\ radia (June 1964 - end of 1968) R advanced course for the training of senior sanitary inspectors. The course is being continued by the Government. To set up a post -basic school of nursing affiliated to a university. India 176Central Public Health Engineering Research Institute, \\Nagpur India 137All-India Institute of Hygiene and Public Health EPTA (Feb. 1961 - end of 1967) R United Nations Special Fund Two fellowships -one of seven months in paediatrics and To develop the Central Public Health Engineering Research one of eight months in venereal disease control -were awarded Institute as a major research centre for environmental sanitation under this project, for which consultant services and fellowships problems, to co- ordinate research programmes and to train were provided in 1959 and 1960. research workers. 174 THE WORK OF WHO, 1965

)SIndia 180Health Education in Schools VLia201Fellowships EPTA: Epidemiology (twelve months), \ (July 1964 - end of 1967) R manufacture and assay of freeze -dried smallpox vaccine (six months), medical stores management (three and a half months), To organize training in health education for the staff of physiology (twelve months), testing of drugs (six months), teacher- training institutions, and to include the subject in basic tuberculosis chemotherapy research (five months), vaccine and teacher -training courses. sera production (six months).

India 181Applied Nutrition Programme India 209Community Water Supply (Oct. 1964 - end of 1968) R UNICEF (FAO) (March - May 1964; Oct. 1965 - end of 1967) Special Account for Community Water Supply To expand and improve the health component of the applied nutrition programme, and particularly to improve the health To study the feasibility and the financial and managerial and nutritional status of pregnant and nursing women, infants aspects of water supply and drainage schemes. and children. India 218National Institute of Health Administration and India 182Strengthening of Health Services (Epidemiology) Education, New Delhi (Sept. 1965 - end of 1969) R UNICEF (March 1963 - end of 1968) EPTA To undertake teaching in hospital administration and to plan To establish or improve health intelligence units in state comprehensive district health services. health directorates;to trainstaff in epidemiology, health statistics, microbiology and communicable- disease control; and to develop the National Institute of Communicable Diseases, India 219Venereal Disease Control (Nov. - Dec. 1965) R Delhi. WHO provided a consultant to review the problem of venereal disease control and to advise on future work. VIndia 183Medical Education, Gujarat (Dec. 1962 - end of 1968) EPTA India 223Study of Nursing Services (Oct. 1964 - end of 1966) R To develop medical education and medical research in To familiarize senior nurses with the application of certain Baroda Medical College. managerial techniques to nursing administration; and to prepare a guide for the study of nursing activities in health services. India 185Strengthening of District Health Administration (Jan. 1964 - end of 1969) R UNICEF Indonesia 1Yaws Control (1950 -1966) R To study and develop the organization of district health To expand the yaws campaign, already in the consolidation services so as to provide the maximum possible service to the phase in Java, to the other islands. public with the available resources.

Indonesia 9Leprosy Control India 188Strengthening of Laboratory Services (July - Sept. 1955; Sept. 1956 - end of 1967) R UNICEF (Feb. 1965 - end of 1968) R To develop, within the framework of the general health To strengthen health laboratory services and to improve services, a leprosy control programme in all endemic areas of the training of laboratory technicians. the country.

India 191DevelopmentofHealth Servicesin Community Indonesia 32.1Malaria Eradication Programme Development Areas (Dec. 1964 - early 1968) R UNICEF (May 1955 - end of 1974) R To strengthen the rural health services and to train staff, To eradicate malaria throughout the country in progressive including multipurpose health auxiliaries. stages.

India 195Course in Radiological Physics, Bombay Indonesia 32.2Malaria Pre-eradication Programme, West Irian (April 1962 - end of 1966) R (1962 -1974) R To strengthen the training of radiological physicists. To develop a network of basic health services which can provide support for the future malaria eradication programme; India 200Fellowships R: Dental education (three and a half to train personnel to form the nucleus of a national malaria months), dentistry (twelve months), food hygiene and applied service; to undertake a general survey of malaria endemicity nutrition (six weeks), health education (twelve months), nutrition and to develop facilities for the diagnosis of malaria and for training course (two for twelve months), paediatric pathology increasing the availability of antimalarial drugs. (twelvemonths),paediatrics(sixmonths), pharmacology (twelve months), preventive and social medicine (twelve months), Indonesia 36Maternal and Child Health Services (1962 -1966) R public health administration and planning (two for four months),0 radiological physics(twelve months),refusedisposal and To reorganize maternal and child health services; to integrate mechanical composting (three for three weeks), sanitary engineer- preventive and curative aspects of child care in hospitals and ing (six months). peripheral units; and to train staff. PROJECT LIST: SOUTH -EAST ASIA 175

Indonesia 40Vaccine and Sera Production Mongolia 3Tuberculosis Control (April 1959; June 1960; Feb. - March 1963; Sept. - Dec. 1963; (Dec. 1963- Jan. 1964; Aug. 1965-end of 1967)EPTA Dec. 1964; Aug. 1965 -end of 1966)R EPTA UNICEF UNICEF To improve methods of production of vaccines, antitoxins To study the epidemiology of tuberculosis and to plan a and toxoids. control programme.

XIndonesia 41Nursing Education Mongolia 4Maternal and Child Health Services (Oct. 1957 - July 1959; Nov. 1960 -end of 1968)R EPTA (June 1965 -end of 1967)EPTA To set up a Division of Nursing in the Ministry of Health to To strengthen the maternal and child health services in rural co- ordinate institutional and public health nursing services; and urban areas; to plan for their integration into the general and to upgrade and expand training programmes for nurses health services; and to improve and expand the relevant training and midwives. programmes.

Indonesia 50Tuberculosis Control V Mongolia 200Fellowships R: Medicalstatistics(ten months), (July 1961 -end of 1967)R UNICEF public health administration (six months). To develop the national tuberculosis programme; to train staff in case -finding and ambulatory treatment; and to establish a central tuberculosis epidemiological unit which will direct Mongolia 201Fellowships EPTA: Cardiovasculardiseases the control operations throughout the country. (six months), haematology (ten months), industrial hygiene (six months), neurology (six months).

Indonesia 62Medical Education (May 1964 -end of 1970)R Malaria Eradication Programme To assist certain departments of the faculties of medicine. Nepal 1 (June 1954 -end of 1973)R MESA (AID) (See page 116.) To eradicate malaria throughout the country in progressive stages. Indonesia 65School of Physical Therapy, Solo (March 1963 -end of 1967)R To improve, extend and upgrade the training of physical\(Nepal 2Nursing Education (Nov. 1964 -end of 1968)EPTA therapists and to develop physical therapy and rehabilitation To establish a basic nursing school in order to prepare qualified services. nurse /midwives for the country's health services; and to upgrade and improve nursing services in the Bir Hospital, where student nurses are given practical training. v" Indonesia 200Fellowships R: Public health (nine months).

'Nepal 3Training of Health Assistants, Kathmandu Maldive Islands 5Public Health Administration (June 1955 - Jan. 1962; Dec. 1962 -end of 1972)EPTA (Oct. 1959 -end of 1971)R To train health assistants and to plan for their effective use To develop comprehensive basic health services and to train in the rural health services. health personnel; to undertake a study of malaria epidemiology and to investigate the methodology of eradication of malaria. Nepal 8Maternal and Child Health Services and Training Maldive Islands 202Fellowships MESA: Malaria eradication (Dec. 1963 -end of 1967)R UNICEF (three months). To develop the maternal and child health services and establish referral facilities.

Mongolia 1Strengthening of Health Services (Epidemiology) R (July 1963 -end of 1967) Nepal 9Smallpox Control Pilot Project To carry out epidemiological surveys of the prevailing com- (Feb. 1962 -mid -1967)R municable diseases in order to plan practical control measures; To start a smallpox control pilot project in the Kathmandu to provide advice to all branches of the medical and health valley, and to expand the programme gradually as and when services on the use of epidemiological methods. (See page 117.) the situation permits.

Mongolia 2Public Health Laboratory Services (May - Aug. 1964; Dec. 1964; Aug. 1965 -end of 1967)EPTA Nepal 14Community Water Supply (June 1964 -end of 1967)R To develop the health laboratory services and to train per- To plan and co- ordinate the development of community sonnel in health laboratory procedures and practices. water supplies. 176 THE WORK OF WHO, 1965

Nepal 16Tuberculosis and other Communicable Diseases Thailand 57School of Tropical Medicine and Endemic Diseases (March 1965 - end of 1967) R UNICEF (Aug. - Sept. 1959; June - Aug. 1961; June 1962; June - July 1963; Jan. - May 1964; June 1964 - end of 1968) R To collectepidemiological information on tuberculosis, leprosy, and other communicable diseases in the Kathmandu To strengthen the post -graduate School of Tropical Medicine valley, and to develop services for their control. and Endemic Diseases of the University of Medical Sciences, Bangkok.

Nepal 17Vital and Health Statistics (Nov. 1965 - end of 1968) EPTA 4ailand 60School of Pharmacy, Bangkok (Nov. 1962 - Oct. 1964) R To improve the collection, processing and presentation of hospital statistics for the whole country; to organize hospital The aim was to revise the curriculum of the School of Phar- records departments, and to train personnel. macy, Bangkok, and to improve the techniques used in teaching. WHO provided a professor of pharmaceutical chemistry and pharmaceutical forms for the duration of the project, which was epal 200Fellowships R: Vital and health statistics (two completed in October 1964 instead of continuing until 1967 as and a half months). originally anticipated. In addition to teaching, the WHO professor assisted the School of Pharmacy in revising and developing the curriculum Thailand 2.2Strengtheningof HealthServices(Integration in accordance with modern concepts of pharmaceutical educa- of Specialized Programmes) tion, in instituting improved classroom and laboratory methods, (Jan. 1964 - end of 1968) EPTA UNICEF in introducing courses in drug evaluation and professional communications, and in drafting proposals for post -graduate To integrate specialized programmes for the control of studies and internship programmes. communicable diseases into the general health services and to The project has effected a measurable advance in under- develop the rural health services. graduate and post -graduate training of pharmacists and has provided a stimulus to pharmaceutical research, and particularly to the quality control of pharmaceutical preparations. Thailand 17.2Mental Health Education and Services (June 1963; Dec. 1963 - Feb. 1964; Jan. 1965 - end of 1968) R To strengthen programmes for training psychiatric nurses and Thailand 63Nutrition to improve mental health services. (Aug. 1963 - Aug. 1964; Feb. 1965 - end of 1967) R UNICEF (FAO) To strengthen nutrition education programmes. hailand 21Nursing Advisory Services (April 1954 - Dec. 1957; Jan. 1958 - end of 1968) EPTA Thailand 65Malaria Eradication Programme To set up, in the Ministry of Public Health, a Division of (Jan. 1962 - end of 1972) R MESA (AID) Nursing that will co- ordinate nursing activities and nursing education; and to develop basic nursing education. To eradicate malaria from the entire country.

Thailand 30Leprosy Control Thailand 67Radiation Protection Services (Oct. 1955 - end of 1967) R UNICEF (April - May 1963; Feb. 1965 - end of 1967) R To intensify the leprosy control programme and expand it to To develop radiation protection measures and to establish cover all endemic areas of the country, and to train personnel. a Division of Radiation Protection in the Ministry of Public Health. (See page 118.)

Thailand 42Tuberculosis Control (Oct.1958 - May 1959; Dec. 1959 - end of 1969) EPTA Thailand 70Vector -borneDiseaseControl(Haemorrhagic UNICEF Fever) (June 1963- mid -1967) R To establish a pilot project covering an urban and a rural To study the epidemiological factors responsible for the area, where methods of tuberculosis case- finding and treatment persistence of haemorrhagic fever, and especially the bionomics suitable for application throughout the country can be demon- of the responsible vectors, in order to take effective control strated and personnel trained; and to set up an epidemiological measures. centre for the collection and analysis of information on tuberculosis in the country. Thailand 71School for Radiological Technology, Bangkok (Jan. 1965 - end of 1967) EPTA Thailand 43Trachoma Control (July - Aug. 1959; April 1961; Oct. 1961 - April 1962; June To establish a school for the training of radiographers. 1962 - early 1967) R UNICEF To carry out a trachoma control programme, integrated into Thailand 200Fellowships R: Enteric diseases (two months), the public health services, in the areas where trachoma is known e idemiology (three months), nursing (twelve months), radiation to be endemic. health (one month), venereal disease control (six months). PROJECT LIST: SOUTH -EAST ASIA 177

iailand 201Fellowships EPTA: Neurophysiology (twelve curriculum was studied from the point of view of the com- months), preventive and social medicine (ten months). munity's needs in nursing services and in its relationship to nursing legislation. WHO provided the cost of attendance of the participants SEARO 3.3 BCG Assessment Team, Indonesia and a consultant. A second consultant was provided by the (May 1963 - Feb. 1965) R UNICEF Rockefeller Foundation. The aim was to strengthen BCG vaccination programmes and to introduce the use of freeze -dried BCG vaccine. WHO provided a medical officer, a statistician and a BCG nurse, and 6,SEARO 61Training Course for Medical Records Officers \\ supplies and equipment. (June 1964 - end of 1967) R The WHO assessment team succeeded in introducing the use To train personnel of various grades to work in hospital of freeze -dried BCG vaccine in almost all parts of Java. A study records and statistics departments. was undertaken of the potency of freeze -dried vaccine stored at room temperature for different periods. The study of relationship between tuberculin allergy and development of local BCG vaccination lesions was completed and the results are SEARO 64Development of Community Water Supply Pro- being analysed. gramme (April 1965 - end of 1968) R The team assisted with an evaluation of vaccinations carried To provide governments of the Region with consultant out by three mass campaign teams in Central Java, where services for the development of their urban and rural community freeze -dried vaccine was used.It studied the work of the water supply projects. Jogjakarta mass campaign team with respect to the techniques of testing, reading, reconstitution of freeze -dried vaccine, and vaccination and tuberculin testing of tuberculosis patients, SEARO 72Hospital Statistics (Jan. 1963 - end of 1968) EPTA and carried out tuberculin testing and vaccination of a village population of 1130. From the naturally acquired tuberculin To assist the Governments of Ceylon, India and Thailand allergy in the village, the age -infection rate was estimated. in organizing an efficient system for the maintenance and flow of records in certain hospitals; in collecting, processing and presenting hospital statistical data on a national scale; and in SEARO 7Regional Assessment Team on Malaria Eradication training medical records and hospital statistical personnel. (May 1959 - Dec. 1961; Nov. 1963 - end of 1968) R To make an independent appraisal of the status of malaria eradication, or of any special aspect of it, in countries of the SEARO 76Studies on Filariasis (Nov. 1962 - end of 1967) R Region, as required. To carry out research on filariasis in order to evolve more effective methods of control. SEARO 30Smallpox Eradication (Oct. 1962 - end of 1967) EPTA EARO 81Medical Education Study Tour (Paediatrics) To assist the governments of the Region in carrying out the (25 Jan. - 20 Feb. 1965) EPTA control, and ultimately the eradication, of smallpox. Ten senior paediatricians from medical colleges in Afghanistan, Burma, Ceylon, India, Indonesia and Thailand studied the SEARO 50Reorganization of Rural Health Records and teaching of paediatrics in medical institutes in Bangkok and Reports (Jan. 1961 - end of 1967) R various parts of India, and attended the second All -India Paediatrics Conference in Patna. To organize in certain rural health centres a system of rural WHO provided a consultant for two months as team leader, health service records and reports and to train personnel in the and the cost of attendance of the participants. collection, processing and presentation of vital and health statistics at rural health centre level. SEARO 94Regional Centre for Cross -checking Blood Films (June 1963 - end of 1967) R \( SEARO 51.2Conference on Nursing Administration (Workshop \\ in Curriculum Development- Nursing), New Delhi To provide facilities for the external cross -checking of blood (22 Nov. - 3 Dec. 1965) R films received from malaria eradication programmes in the Region. The workshop was organized to provide schools of nursing in the Region with guidelines for sound curriculum planning and development.It was inaugurated by the Union Minister SEARO 95.2Maternal and Child Health Assessment Team, of Health, Government of India, and there were twenty -six Indonesia (Feb. - May 1965) R participants from Afghanistan, Burma, Ceylon, India, Indonesia, Mongolia, Nepal and Thailand, and four observers from the WHO provided a consultant in maternal and child health International Council of Nurses, the United States Agency for and a public health nurse who studied the organization and International Development and the Rockefeller Foundation. administration of maternal and child health services in Indonesia Staff members from the WHO Regional Offices for the Eastern in collaboration with the Divisions of Nursing and of Maternal Mediterranean and the Western Pacific also attended.After and Child Health of the Ministry of Health. The study covered preliminary discussions the participants were divided into four a number of maternal and child health centres in Java, the groups to take up various items of the agenda. The nursing health services provided in day -care centres, orphanages and 178 THE WORK OF WHO, 1965 treatment centres for handicapped children, and the training SEARO 102Asian Institute for Economic Development and in maternal and child health of various categories of health Planning personnel. Recommendations were made concerning expansion (Jan. 1964 - end of 1969) R United Nations Special Fund of services and training facilities, strengthening of supervision, UNICEF (ECAFE) and extended co- operation between departments dealing with the welfare of mothers and children. To assist with the health aspects of the training in planning and in public health administration, and to co- operate in the total programme of the Institute for Economic Development and Planning. SEARO 96Medical Education (Nov. 1965 - end of 1967) EPTA

To assist selected teaching departments in medical colleges. EARO 115Post -graduate Medical Education (Aug. 1964) R WHO provided a consultant for two weeks to assist in a SEARO 97Nutrition Training review of post -graduate medical education in India. He visited (Dec. 1963 - end of 1967) R UNICEF Delhi, Chandigarh and Lucknow, discussed problems of postgraduate medical education with the national authorities and To assist in giving training in applied nutrition and to support advised on measures for solving them. He also participated the Nutrition Research Laboratories, Hyderabad, India, in in the second Thai National Conference on Medical Education, carrying out the training programme. held in Bangkok from 17 to 22 August. EUROPE

Albania 1Fellowships R: BCG laboratory techniques (two for problems connected with water supply, sewerage and sewage one month), food hygiene (six months), pharmacology (twelve disposal, refuse disposal, urbanization and housing. months). Algeria 11.4Health Education (1963 - ) EPTA UNICEF Albania 5Cancer Control (1962 - ) EPTA To promote health education work; to train personnel of To develop a specialized cancer control programme by various categories in the subject; to develop methods and building up a central institute with up -to -date equipment, and techniques of health education and to prepare material adjusted by training physicians, physicists and engineers for the medical to the conditions in and needs of the country. and technical aspects of the programme. Algeria 11.5Nutrition Advisory Services (1963 - ) R Albania 7Central Institute of Epidemiology, Microbiology and To improve the nutritional status of the population and to Immunology (1965 - )' EPTA deal with the problems arising from malnutrition. To develop the Central Institute of Epidemiology, Micro- biology and Immunology, which is to be established in Tirana Algeria 11.6Epidemiology and Health Statistics to conduct work in microbiology, virology and parasitology, (1963 - ) EPTA produce sera,vaccines,toxoids and gamma -globulins and To organize health statistical services and to train national provide specialized training for various categories of personnel. personnel in health statistics; to use the statistical data collected for determining priorities in public health planning. Algeria 1Communicable Eye Disease Control (1956 - ) EPTA UNICEF Algeria 11.7Nursing (1963 - ) EPTA To carry out a programme for the control of communicable To reorganize and improve nursing and midwifery services. eye diseases. The programme includes a self -treatment mass campaign and the organization of collective treatment in schools, the control of trachoma and related diseases in the family Algeria 11.8Malaria Pre -eradication Programme environment, health education, and the traiig of technical. (1964 - ) R MESA personnel. To prepare technical, administrative and operational services for a malaria eradication programme within the framework of Fl Algeria 6Rehabilitation (1963 - ) EPTA the rural health services; to organize the network of rural 777 health services which, in the course of the preparatory, attack To promote rehabilitation services for the disabled; to make and consolidation phases of the malaria eradication programme, a general rehabilitation plan for the country; and to train will carry out malaria case-finding and treatment and which, national personnel in the techniques of rehabilitation. during the maintenance phase, will be responsible for surveillance and for measures to prevent the re- establishment of malaria Algeria 8Fellowships R: Health education (six weeks), resuscita- in the country. (This project supersedes project Algeria 2.) ion services (six months). ÚkAlgeria 12Maternal and Child Health IppAlgeria 10Community Water Supply (1963 - ) EPTA UNICEF (1963 - 1965) Special Account for Community Water Supply To reorganize and extend maternal and child health work in WHO provided a sanitary engineer to assist in organizing and health centres throughout the country; and to develop training carrying out sanitary engineering work, particularly that con- facilities for maternal and child health workers and related nected with the provision of community water supplies, and in health personnel. training personnel. These activities are being continued under projects Algeria 11.2 and 11.3 (see below). '\ geria 13Medical Schools (1964 - 1965) R Algeria 11Development of Public Health Services WHO provided three consultants to advise on the reorganiza- (1963 - ) R EPTA UNICEF tion of medical training, a one -month fellowship, and supplies. To plan, organize and develop the national public health Algeria 14Nursing Education (1963 - ) EPTA UNICEF services and related programmes. (See page 122, and component projects below.) To prepare nurses for administrative and teaching responsibilities through short intensive courses. Algeria 11.2 and 11.3Environmental Sanitation (1963 - ) R EPTA UNICEF Algeria 15Schools for Medical Assistants (1965 - ) R To organize and develop the environmental sanitation services To plan and organize training for medical assistants (" tech- and programme, concentrating particularly on the public health niciens sanitaires "). - 179 - 180 THE WORKOF WHO, 1965

Austria 11Fellowships R: Bacteriology (one for one month, Denmark 11Fellowships R: Aviation medicine (two for one one for five weeks), drug control (six weeks), food control month), drug control (two months), mentally retarded children (two for one month), food microbiology (six weeks), occupational (two months), physical therapy and rehabilitation (two months), diseases (one month), occupational health (one for one month, pulmonary physiology and pathophysiology (seven months), two for six weeks), sera and vaccine control (two months), radiation hygiene (four for five weeks). virology (six weeks), wine analysis (one month). Finland 12Fellowships R: Air pollution (two months), an- Austria 14Development of Environmental Sanitation Services aesthesiology (sixteendays), education of assistant nursing (1960 - 1965) R personnel(twomonths),environmentalsanitation(three WHO provided eight fellowships -two of three weeks, four months), haematology /genetics (three months), hospital admi- of one month, and two of six weeks -for training health per- nistration (two for one month), medical chemistry (three months), sonnel in environmental sanitation. neurology /rehabilitation (six weeks), obstetrics (two for seven weeks), occupational therapy (two months), radiation protection (two months), sanitary engineering (one month). Belgium 9Fellowships R: Hospital administration and radiation rotection (two months), hospital and medical care administration (three months), otolaryngology (three months), paediatric Finland 14Child Psychiatry (1959 - 1964) R endocrinology (three months), pelvic surgery (one month), poison centres /health education (two months). WHO provided three consultants, four lecturers, and two fellowships of three and six months respectively, to assist in extending and improving child guidance and child psychiatric Belgium 10Mental Health Services (1960 - 1964) R services. WHO provided six fellowships -one of five weeks, two of two months, and three of three, six and twelve months res-`France 28Fellowships R: Air pollution (five weeks), environ- pectively -for training teaching staff of the Universities of mental sanitation (three weeks), food control (three weeks), Brussels and Louvain in specialized fields of psychiatry. hearing defects (three weeks), hospital administration (two for three weeks), hospital organization (one month), mental health/ Bulgaria 7Fellowships R: Allergy (two months), cancer in alcoholism (one for two weeks, one for three weeks), public gynaecology (three months), endocrinology (three months), health administration (four for three weeks), rehabilitation haematology (three months), human genetics (three months), (three weeks), social and health education (three weeks), trau- maxillo- facial surgery (three months), mental health (four matology (one month). months), paediatrics (three months), resistance to insecticides (three months), respiratory lung diseases (two months), surgery of vascular diseases (four months), tropical diseases (three I ermany 16Fellowships R: Biology(six weeks), climatic months), tuberculosis (two months). tolerance (two months), Diploma in Tropical Public Health course (nine months), epidemiology and health statistics (three and a half months), immunological studies on mycobacteria Czechoslovakia 8Fellowships R: Anaesthesiology (sixteen days), (three months), smallpox (two months). bacteriology (three months), biochemistry (one for two months, one for four months), gerontology (three months), haematology (four months), immunology (nine weeks), occupational health Greece 6.1Tuberculosis Control (1952 - 1964) EPTA (three months), paediatrics (two months), pharmacology (three months), radiation (three months). WHO provided six consultants, a medical officer for one year, eleven fellowships of from three to nine weeks, and supplies, in order to assist in the development of a national tuberculosis Czechoslovakia 9Training Institutes (1960 - ) R centre programme. Further assistance in tuberculosis control To assist national institutes in the development of training is being provided as part of project Greece 25 (see below). in medicine and public health. Greece17Nursing Education and Administration Czechoslovalda 10Study on Tuberculosis Epidemiology and (1956 - ) EPTA Control (1960 -1966) R To train nurses abroad for teaching and administrative posts To study the epidemiological characteristics of tuberculosis in a post -basic school of nursing which is to be established to in different population groups, so as to determine which groups prepare tutors and administrators for nursing education pro- should be given priority by tuberculosis control services; to grammes and services. assess the efficacy of various control measures in Czechoslovakia; and to carry out trials for comparing the value of hospital and Mental Health Services (1956 - 1964) R home treatment in Czechoslovak communities. Greece 20 To assist in strengthening psychiatric services, particularly )k 8Post -graduate Training in Psychiatry (1953 - 1964) R as regards mental hospital practice, WHO provided a consultant who helped to draft a new mental health law, and nine fellowships To assist in improving post -graduate training in psychiatry, of from one to six months. WHO provided eleven lecturers and a consultant to the Uni- versities of Aarhus and Copenhagen, three lecturers to the Danish Association for Child Psychiatry and Clinical ChildV(Greece21Fellowships R: Anaesthesiology (four months), Psychology and, to the Danish Psychiatric Society, a lecturer bacteriology (four months), cardiology (three months), cardio- who helped to start a one -year part-time course. In addition, vascular diseases (four months), mental health /public health seven fellowships of from two to six months each were awarded. nursing (three months), traumatic surgery (four months). PROJECT LIST: EUROPE 181

C-\Greece 25Development of Public Health Services and Training Italy 23Nursing Education and Administration (1960 -1967) R of Personnel (1958 - ) EPTA UNICEF To train nurses abroad for teaching and administrative posts To organize comprehensive and co- ordinated health services in the proposed post -basic school of nursing, which is to prepare in a rural area where new methods of public health administra- nurse tutors and administrators for nursing education pro- tion can be tested, all categories of public health personnel given grammes and services. practical training, and demonstration and research carried out. The project includes the organization of a vital and health`/ Luxembourg 4Fellowships R: Health statistics (seven months). statistical service in the demonstration area. Luxembourg 6Hospital Planning and Legislation (1965) R Greece 34Community Water Supply (1963 - ) Special Account for Community Water Supply To follow up the assistance granted in 1962, WHO provided two consultants, in hospital planning and in architecture. To promote community water supplies in an area where general socio- economic development is taking place. Malta 3Fellowships R: Dental health (four months), diabetes (four months), occupational health (five months).

-lungary 6Fellowships R: Antibiotics (two months), audiology Malta 5Sewage Purification Pilot Scheme (1963 -1966) EPTA (three months), chemotherapy of cancer (three months), electro- encephalography (three months), embryology (one month), To study sewage disposal problems and establish a pilot hospital administration (two months), hospital engineering scheme for the treatment of sewage and its use for irrigation (two months), hospital planning and construction (six weeks), purposes; and to study refuse disposal and composting of solid immunochemistry (three months), immunology (two months), wastes. immunopathological investigations (two months), mental health (three months), photophysiology of the lung (three months), Malta 6Chronic Diseases (1965 - ) EPTA rehabilitation of mentally handicapped children (one month), serology (two months), tropical medicine and hygiene (one for To improve services for the control and treatment of diabetes. three months, one for five months), virology (three months). Malta 7Mental Health Services (1965 - ) EPTA ungary 8Training of Sanitary Engineers (1965 - ) EPTA To modernize the psychiatric services, especially those for children. (See page 123.) To organize the training of sanitary engineers and to train sanitary engineers as teachers. Morocco 1Communicable Eye Disease Control (1952 - ) EPTA UNICEF Hungary 9Study of Insect -borne Diseases (1964) EPTA To develop a nation -wide programme for the control of WHO provided two three -month fellowships for the study trachoma and seasonal conjunctivitis, using fully the possibilities of insect -borne diseases. offered by the reorganized rural health services; to carry out field surveys in areas of high endemicity and in schools, to serve as a basis for action in future years. Hungary 11Air Pollution (1965) EPTA WHO provided two three -month fellowships for studyof Morocco 9Development of Public Health Services and Training modern methods of controlling air pollution. of Personnel (1957 - ) R EPTA UNICEF To train public health personnel and to develop the health .Hungary 12Rural Health (1965 -1966) EPTA services in accordance with the plan drawn up as part of the three -year plan for economic and social development. To provide training, in rural health work. Morocco 9.2Nursing Education (1959 - ) R Iceland 7Fellowships R: Drug control and toxicology (three To develop basic nursing education and to establish a post - weeks), nursing education (sixteen months). basic school of nursing to prepare qualified nurses for leading posts in specialized fields, including midwifery and nursing administration and education. reland13Fellowships R: Cardiacsurgery,urology and aediatrics(sixweeks), dental health(five weeks), kidney transplantation (two weeks), neurology (one month), paediatric Morocco 9.3Training of Health Auxiliaries cardiology (one month), pathology (one month), psychiatry (1964 - ) EPTA UNICEF (one month), surgery (one month), urology (one month). To train auxiliary health personnel.

'taly21Fellowships R: Cancer registration (two for three/Morocco12Environmental Sanitation (1958 - ) EPTA weeks), cardiosurgery (six and a half months), haematology (two months), medical use of radioisotopes(six months), To develop a national programme of environmental sanitation neurosurgery (one month), physical therapy (two months), by establishing for the purpose a sanitary engineering section rehabilitation of mentally subnormal children(sixweeks), in the Ministry of Health and training health personnel, includ- speech defects (one month), toxicology (six months). ing auxiliaries. 182 THE WORK OF WHO, 1965

N Morocco 15Fellowships R: Anatomy (eight months), gastro- Health and plans have been prepared for a rehabilitation enterology (six months), parasitology (two months), pathology council. A national rehabilitation centre has also been estab- (six months), waterworks operation (two months). lished, together with four technical services in the provinces.

Morocco 17Health Education Services (1958 - 1964) R Morocco 28Malaria Pre -eradication Programme WHO provided a consultant who paid four visits to Morocco (1962 - ) R MESA to assist in preparing plans for the development of health To prepare for a malaria eradication programme by the education. This is carried out through a nurse or social worker organizationoftechnical,administrativeandoperational attached to each provincial health department to guide other services; and to Iran medical and paramedical personnel of health workers in their health education activities. public health services (especially rural health services) in malaria eradication concepts and techniques. Morocco 21.1Epidemiology and Health Statistics (1961- ) R Morocco 30Community Water Supply To develop the national vital and health statistical services (1962 - ) Special Account for Community Water Supply and to organize statistical courses and lectures for various To draw up a programme for community water supply develop- groups of health personnel and students. ment.

4kMorocco 21.2Training of Statisticians (1964 - ) EPTA Morocco 32 Food Hygiene (1965 - ) EPTA To improve the training of statistical staff, for which purpose a school of statistical personnel is being organized. To take measures against the microbiological contamination of processed foods; and to organize seminars to improve food hygiene practices. Morocco 22.1Public Health Laboratories (1960 - 1964) R

WHO provided three consultants, a two -month fellowship Morocco 34 Water Pollution (1965) EPTA and supplies to assist in the development of public health laboratory services. WHO provided a consultant to advise on the elimination of water pollution caused by wastes from sugar factories. Morocco 22.2Public Health Laboratories (1965 - ) EPTA Netherlands 15Fellowships R: Air pollution (one month), To train laboratory technicians required for the development biometrics and epidemiology (four months), drug control of a public health laboratory system and to prepare tutors (three weeks), epidemiology of nutrition (six weeks), health for an expanded teaching programme. education (four and a half months), hospital administration (three for two weeks), local health services (one month), meat Medical Education (1960 - control /veterinary surgery (two for one month), mental health Morocco 23 ) R nursing (three months), public health administration (one for To further the development of a new medical school. three weeks, one for one month), veterinary surgery (three weeks). Two lecturers were also provided under this project for Morocco 24Rehabilitation of the Physically Handicapped courses in health promotion and in hospital administration, (Sept. 1959 - 1965) EPTA held in Amsterdam. The original aim was to organize rehabilitation services for over10.000 victims of tri-ortho- cresylphosphate poisoning,'/Norway 10Fellowships R: DPH course (ten months), nursing caused by the adulteration of cooking oil with mineral oil. administration(tenmonths), public health dentistry (nine Later it was decided to develop this emergency programme months). into a permanent rehabilitation programme for the general rehabilitation of the physically handicapped. WHO provided two consultant neurologists toassist in Poland 13Fellowships R: Air pollution (three months), epide- establishing the cause of the outbreak of poisoning, and another miology of communicable diseases (three months), food control to assess the extent of the rehabilitation problem. They were (three months), housing and town planning (two months), followed by a team consisting of an administrator and two microbiology (three months), milk control (two months), occupa- physical therapists. In 1960 the team was replaced by a physician tional health (one for three months, one for three and a half for three years and three physical therapists -for five years, months), pertussis vaccine preparation (two for two months), two years and six months respectively -and an ergotherapist pesticide detection (three months), production of medical and was provided from November 1962 to November 1963 and scientific films (two for one month), radiology (one month), from June 1964 to June 1965. One of the consultants returned school hygiene (three months), virology (two months). on two occasions.Five fellowships were awarded, two of twelve months to physicians and three of three months to physical therapists.Supplies and equipment were also provided. Poland 15Training Institutes (1958 - ) R In 1960 a rehabilitation school was set up and forty -five physical therapists have since been trained there. A central To assist national institutes in the development of medical rehabilitation service has been organized in the Ministry of education, especially in the basic sciences. PROJECT LIST: EUROPE 183

Poland 16Tuberculosis Control (1960 - ) EPTA UNICEF Portugal 35Public Health Administration (1963 - ) EPTA To train staff in tuberculosis control; later, to set up a pilot To organize a public health demonstration area and to provide area project for tuberculosis control; to study the epidemiological practical training for health personnel. characteristics of tuberculosis in different population groups, and toassess the efficacy of variouscontrol measures in Portugal 36Health Education Services (1965 - ) EPTA reducing the risk of infection, especially among children. To promote health education as an integral part of the work of the health services throughout the country. Poland 18Occupational Health Services (1960 - 1964) EPTA WHO provided a consultant who advised on medical services Romania 1Fellowships R: Anaesthesiology (three months), for industrial workers and on the work of the Occupational endocrinology (six months), haematology (five months), im- Health Institute in Lodz, and gave a series of lectures on occupa- munofluorescent techniques (three months), malignant haemo- tional diseases to the physicians of the Institute's clinical depart- pathies(three months), microbial genetics(four months), ments.Ten two -month fellowships and supplies were also neurosurgery(threemonths),orthodontics(twomonths), provided. stomatology (one for two months, one for three months, one for four months), tetanus toxoid purification (three months), urology (one for two months, one for three months), virology (three months). Poland 24Health Statistical Services (1963 - ) EPTA To develop health statistical services and improve the national Romania 4Institute of Microbiology, Parasitology and Epide- and international comparability of statistical data; and to miology, Bucharest (1965 - ) EPTA organize a morbidity survey. To strengthen the prevention and control of communicable diseases; and to improve the production of vaccines, sera and Poland 26Protection of Natural Waters against Pollution other biological substances by introducing freeze -drying pro- (1965 - ) United Nations Special Fund cedures.

To develop scientific and research work for the control of Spain 1.2Brucellosis (1965 -1967) EPTA water pollution by domestic wastes, industrial effluents, saline waste waters and waste waters from thermal power stations To study the epidemiological aspects of brucellosis; to start in the Slasko Dabrowskie area. the production of brucellosis vaccine; and to implement a large -scale programme for the vaccination of goats in ten provinces. rtugal 17Fellowships R: Air and water pollution (four months), cardiac surgery (one month), child nephrology (one Spain 8Venereal Disease Control month), food microbiology (one month), paediatrics (one (1955 - 1964) EPTA UNICEF month), premature infant care (one month), public health (six weeks), resuscitation services (one for one month, one WHO provided six consultants to assist in organizing, as for two months). part of the maternal and child health services, the systematic examination of infants, children and pregnant women, and in improving case- finding and diagnosis of syphilis in various Portugal 19Public Health Nursing Education (1961 - 1964) R population groups. Seven fellowships of from two to six months were also awarded. The national health administration has WHO provided four fellowships of three, ten, eleven and established serological reference laboratories at the faculties twelve months respectively to prepare nurses for teaching and of medicine in Madrid, Barcelona and Seville, and local produc- administrative posts in public health nursing. tion of cardiolipin and lecithin has been organized.

Portugal 26Hospital Administration Services Spain 11Communicable Eye Disease Control (1962 - ) EPTA (1955 - ) EPTA UNICEF To develop hospital organization and administration. To learn more of the local epidemiology of trachoma and associated infections in Spain; to develop and apply throughout the endemic area effective methods of case- finding and treatment, Portugal 30Post -basic Nursing Education (1963 - ) EPTA family supervision and health education; and to train personnel.

To set up a post -basic school of nursing in Lisbon. \XSpain 17Fellowships R: Alcoholism (one for two weeks, one for one month), child psychiatry (three and three- quarter months), child tuberculosis (three weeks), mental health/occupa- ortugal 33Mental Health Services (1963 - ) EPTA tional therapy (three months), oncology (three months), social To develop the mental health services and to train mental psychiatric services (two months). health personnel. pain 19Nursing Education (1957 - 1964) R

Portugal 34 Health Education (1962 - ) R WHO provided five fellowships of approximately one year's duration to prepare nurses for administrative and teaching To develop health education services. posts. 184 THE WORK OF WHO, 1965 c- -Spain 22Health Statistical Services (1960 ) R 1964, and a consultant in 1964.Eighteen fellowships were awarded for periods ranging from two weeks to twelve months. To develop national statistical services and to set up a new The maternal and child health division in the Ministry of department of biostatistics in the National School of Public Health was strengthened. A teaching and demonstration centre Health, Madrid. was set up in Ankara, maternal and child health centres were established in the towns, and in rural areas the maternal and child health service facilities within the general health services Spain 23Rehabilitation of Handicapped Children were strengthened. (1959 -1967) EPTA UNICEF Maternal and child health work in Turkey has now been To develop a national programme for the rehabilitation of fully integrated into the project for the development of the handicapped children; to establish training centres and expand health, services (Turkey 40). the services for handicapped children throughout the country. Turkey 11Leprosy Control (1953 - ) EPTA UNICEF Spain 25Epidemiological Studies of Virus Diseases of Public To carry out a leprosy control programme covering the whole Health Importance (1964 - ) EPTA country and to integrate it progressively into the general health To resume the study of methods for the prevention and control services. of respiratory and enteric virus diseases that was started in 1959. Turkey 13Tuberculosis Control (1952 - ) EPTA UNICEF Spain 26Health Education Programme (1960 - 1964) R To continue the mass BCG campaign; to carry out a sample WHO provided two consultants and three fellowships, of prevalence survey on population groups living in different three, eight and ten weeks respectively, to assist in the improve- geographical, climatic and socio- economic conditions; and to ment and expansion of the health education services. establish a pilot area in the Province of Yozgat, where applicable methods of control will be developed within the existing network of general health services. Spain 30Health Demonstration and Training Area (1965 - ) EPTA Turkey 16School of Public Health, Ankara (1960 - ) R To set up, as part of the general plan for economic and social development, a public health demonstration and training To reorganize the School of Public Health in Ankara. area containing a complete network of co- ordinated rural health services. The area will be used for testing administrative and technical methods, for carrying out surveys, and, in Turkey 23Malaria Eradication Programme collaboration with the National School of Public Health, for (1957 - ) R UNICEF training various categories of health staff. To achieve malaria eradication throughout the country.

\)(Sweden 12Fellowships R: Dental health (six weeks), dentistry urkey 29Nursing Education (1955 - ) R (two months), epidemiology (one month), mental health (four months), mental health nursing (one for two months, one for To organize and develop nursing education at all levels, and threemonths), psychosomatic gynaecology(two months), particularly post -basic nursing education, so as to prepare veterinary parasitology (two months). nurses for positions of leadership in specialized fields of nursing, including midwifery, and for the administration of hospital and public health nursing services and nursing education. Switzerland 15Fellowships R: Biometrics and epidemiology (four months), cardiology (twelve months), urology (three months). Turkey 31Communicable Eye Disease Control (1956 - ) EPTA UNICEF

XSwitzerland 18Study of the Functions of Nursing Personnel To continue studies of the local epidemiology of trachoma and (1965 - ) R associated infections; to develop suitable control methods; to train personnel; to introduce and expand progressively a system To determine the responsibilities and differentiate the functions of control of these diseases in the southern provinces of Anatolia. of the various categories of nursing personnel required by the health services. The findings of this study will serve as a basis for planning the different types of training needed and the urkey 36Fellowships R: Cholera bacteriology (two weeks), staffing of nursing services. environmental sanitation (four for one month), mental health (seven weeks), sanitarian' course (eleven months), vaccine production (three weeks), vital and health statistics (one month). Turkey 6Maternal and Child Health (1954 - 1964) EPTA UNICEF vurkey 40Development of Public Health Services and Training The aim was to carry out a long -term programme of maternal of Personnel (1964 - ) R EPTA UNICEF and child health, in order to reduce morbidity and mortality rates in mothers, infants and children. WHO provided three To develop the health services and train health personnel; nurses -from 1954 to 1956, 1954 to 1959 and for six months and to co- ordinate the work of other health and sanitation in 1961, a medical officer from 1954 to 1956 and from 1961 to projects. Pilot areas are to be set up in the provinces where the PROJECT LIST: EUROPE 185 new law on the nationalization of the health services is being USSR 1Fellowships R: Anaesthesiology (sixteen days), bio- applied and in those where the maternal and child health or chemical investigations (three months), chemistry (six months), malaria eradication services have been integrated into the general gynaecological endocrinology(threemonths), haematology public health services. (six months), liver and kidney diseases diagnosis and treatment (four months), medical statistics (three for three and a half months), neuropharmacology (three months), neurosurgery Turkey 40.2Health Statistical Services (1964 ) R (four months), oncology (six months), paediatric nephrology To develop the national, regional and local health statistical (three months), pathology of the respiratory system in children services, in co- ordination with the general project, Turkey 40, (two months). for the development of public health services. Yugoslavia 7Rehabilitation of Handicapped Children (1965 - ) EPTA UNICEF Turkey 40.3Environmental HealthServices(1964 - ) R To improve the care of physically and mentally handicapped To develop the environmental sanitation services and train children. Assistance was previously provided under this project sanitation personnel. between 1950 and 1962.

Turkey 40.4Environmental Sanitation (1964 - ) EPTA Yugoslavia 16.4Tuberculosis Control To promote environmental sanitation work. (1953 - 1964) EPTA UNICEF To assist with the tuberculosis control programme in Yugo- Turkey 44Community Water Supply slavia WHO provided consultants in 1955, 1959 and 1963, and (1962 - 1965) Special Account for Community Water Supply awarded sixteen fellowships, of an average duration of six months, in various aspects of tuberculosis control. The aim was to organize and implement a national water WHO approval was given to a UNICEF -assisted BCG supply programme. WHO provided a sanitary engineer and a vaccination campaign in which it was envisaged to tuberculin - sanitarian, four consultants, three one -month fellowships, and test approximately five million children during the period supplies. 1957 -1960 and to vaccinate with BCG those who were found Studies and surveys on community water supplies in urban eligible. The provision of expert advice on BCG vaccine produc- and rural areas were undertaken.With the help of a firm of tion has enabled the country to maintain a high standard in its consulting engineers, feasibility reports were prepared on the BCG production laboratory, and plans for comparative investi- development of water supply and sewage disposal facilities for gations of BCG vaccines will ensure a regular control of the Adana and Mersin. The necessary data were compiled for the quality of the Yugoslav vaccine. preparation of a request to the United Nations Special Fund for Many features of the national programme were strengthened an engineering and feasibility report for water supplies and and the plan to implement it on the lines of a pilot area was sewerage in the Istanbul area (see project Turkey 46, below). In retained as a basis for further development. order to develop the training of sanitary engineers, contacts were maintained with the University of Istanbul and a sanitary engineering department was set up in the Middle East Technical Yugoslavia 16.9Maternal and Child Health Services University of Ankara. Short courses for the preparation of (1953 - 1964) EPTA UNICEF subprofessional personnel were organized. The aim was to strengthen maternal and child health services, including school health services and rehabilitation services for Turkey 45Public Health Survey, Antalya handicapped children, at republic and district levels. A prelimi- (1963 - 1965) EPTA United Nations Special Fund (FAO) nary visit of a team of three WHO consultants took place in 1952. Three consultants were provided in 1958 to preparé a compre- WHO provided two consultants -a public health administra- hensive evaluation report and a further consultant was provided tor and a sanitary engineer -in connexion with the FAO/ in 1963. Five temporary advisers lectured on social paediatrics United Nations Special Fund project for the economic develop- at national courses.Fifty -one fellowships were awarded for ment of an area of south -west Turkey.They assisted with a periods ranging from one to nine months. survey of the health services in the three provinces covered by Since 1961 efforts have been mainly concentrated on the the project and made recommendations for their improvement. establishment and development of sixty -threeintermediate centres to improve the guidance and supervision of health work at district level. Particular attention has been given to maternal Turkey 46Water Supply and Sewerage for the City of Istanbul and child health work, especially in the rural areas. The service and the Neighbouring Industrial Region (1965 - ) United and training facilities have been considerably increased and a Nations Special Fund network of services has been created that will provide a sound To prepare a master plan, and feasibility and preliminary basis for future development. engineering and other organizational studies for the extension and improvement of the water and sewerage system of Greater Yugoslavia 20Public Health Administration (1956 - ) EPTA Istanbul and the rapidly developing industrial areas in the vicinity. To train various categories of health personnel for the federal and republic institutes of public health. United Kingdom 13Fellowships R: Cardiology (six weeks), ntal care of handicapped children (one month), epilepsy41(Yugoslavia 23Fellowships R:Biochemistry(fourmonths), neurology (six weeks), nursing (six weeks), public health nursing \clinical physiology (one month), dentistry (four months), jaw (six weeks), vascular surgery (six weeks). fracture and deformation (four months), mental health (six 186 THE WORK OF WHO, 1965

months), pathological physiology (one for four months, one forf, URO 77.1Post -BasicNursingandMidwiferyEducation five months). Institutions (1954 - 1966) R To assist with the development of advanced nursing and Yugoslavia 25Nursing Education (1959 - ) EPTA midwifery education programmes in the Region by preparing nurses and midwives, through study abroad, for administrative To improve and expand nursing education programmes and and teaching posts in post -basic schools of nursing. services by preparing nurses for senior posts in nursing education and administration. 1( EURO 77.2International School of Advanced Nursing Educa- \tion (in French), Lyons (1962 -1968) R Yugoslavia 30Malaria Eradication Programme To set up a school of advanced nursing education that will (1959 - end of 1965) R prepare nurses from countries in and outside Europe for posi- To complete the eradication of malaria throughout the tions of leadership in specialized branches of nursing, for nursing country. education and administration and for research in nursing.

Jt Yugoslavia 35Fellowships EPTA: Audiology(sixmonths), EURO 77.3International School of Advanced Nursing Educa- plastic and reconstruction surgery (six months), urology (three tion (in English), Edinburgh (1963 -1966) R months), vascular surgery (two for three months), veterinary To set up in the Nursing Studies Unit of the University of medicine (three months), virology (six months). Edinburgh an international school of advanced nursing education that will prepare nurses from countries in and outside Europe for leading positions in specialized branches of nursing; Yugoslavia 37Chronic Diseases (1965 - ) EPTA and to institute a diploma in nursing education and administration and in nursing specialties. To train health personnel for the chronic and degenerative disease centres that are to be set up in certain republics. EURO 110European Schools and Training Centres of Public Health (1956 - 1964) R Yugoslavia 38Virus Diseases (1965 - ) EPTA The aim was to give support to schools of public health and To carry out, at the Institute of Public Health of the Republic similar training centres in the Region.Ten consultants and of Serbia, an epidemiological study of respiratory virus diseases, fifty -seven temporary advisers were provided, thirty fellowships especially in young children. were awarded, and teaching equipment, books and films were supplied.Assistance was given in a wide range of subjects, including public health, medical care, medical teaching, epidemio- EURO 9.9Ninth European Seminar for Sanitary Engineers, logy, health statistics, parasitology, virology and human gene- Naples (22 - 29 June 1965) R tics. Some twenty countries were served by the project, sixteen of them on a continuing basis. The seminar reviewed the health significance and potential hazards associated with new chemicals (organic and inorganic) present in trace amounts and the viruses present in raw water EURO 115TrainingInstitutionsforSanitationPersonnel used as a source of supply, discussed the effects of conventional treatment processes for their removal and considered special (1956 - 1965) R measures to reduce any health hazards involved. To strengthen the teaching of sanitary engeeringby providing WHO provided seven temporary advisers and the cost of lecturers and awarding fellowships to members of the teaching attendance of twenty -five participants from Austria, Belgium, staff; to organize and promote training courses for sanitary Bulgaria,Czechoslovakia, Denmark, FederalRepublic of engineers. Germany, Finland, France, Greece, Hungary, Ireland, Italy, Malta, Morocco, Norway, Netherlands, Poland,Portugal, Romania, Sweden, Switzerland, Turkey, United Kingdom and EURO 128.5Conference of Chiefs of Virological Departments Yugoslavia. (See also page 124.) of Public Health Laboratories, London (25 - 29 May 1965) R At this conference, which followed up the meetings of directors EURO 61.3Course in Public Health Practice, Bulgaria of public health laboratories convened by WHO in 1957 and (21 Sept. - 15 Oct. 1965) R 1959, virus specialists from public health laboratories discussed, with directors of central public health laboratories, public health A four -week course, in French, for public health doctors administratorsand epidemiologists,thedevelopment and whose responsibilities lie mainly in rural areas or who are future needs of public health laboratories as centres of public concerned with the teaching of public health. The course was health virology. similar to those given since 1955 alternately in French at the WHO provided five temporary advisers and the cost of Soissons Public Health Centre, France, and in English at the attendance of twenty -five participants from Austria, .Belgium, Uusimaa Public Health Research and Training Centre, Finland. Bulgaria,Czechoslovakia, Denmark, Federal Republic of WHO provided two temporary advisers and the cost of Germany, Finland, France, Greece, Hungary, Ireland, Italy, attendance of elevenparticipants from Algeria,Belgium, Netherlands, Norway,Poland, Romania,Spain,Sweden, Bulgaria, France, Greece, Hungary, Poland, Syria, Tunisia, Switzerland, Turkey, Union of SovietSocialist Republics, Turkey and Yugoslavia. United Kingdom and Yugoslavia. PROJECT LIST: EUROPE 187

EURO 134.2Seminar on the Early Detection of Cancer, Oslo EURO 185Follow -up of Inter- country Activities on a National (15 - 19 Nov. 1965) R Basis (1958 - ) R The seminar analysed the factors causing delay in diagnosis To assist governments in developing national activities arising and treatment of cancer and discussed present possibilities of out of the inter -country programmes of the European Region. organizing early detection of different kinds of cancer in Europe. WHO provided a consultant, seven temporary advisers, and the cost of attendance of twenty-one participants from Albania, EURO 192Epidemiology of Mental Disorders (1960 - 1965) R Austria, Belgium, Bulgaria, Czechoslovakia, Denmark, Federal Republic of Germany, Finland, France, Greece, Hungary, Italy, The following work was carried out: Netherlands, Norway, Poland, Romania, Sweden, Switzerland, (1)Two consultants visited various European countries and Union of Soviet Socialist Republics, United Kingdom and prepared working papers for the Technical Meeting on the Yugoslavia.Three fellowships, of nine months, four months Epidemiology of Mental Disorders, held in Copenhagen in and three weeks respectively, were also awarded. July 1961. WHO also provided two temporary advisers for the meeting and the cost of attendance of seven participants from Denmark, Finland, France, Netherlands, Norway, Sweden and UEURO 138.3Course on Hospital and Medical Administration the United Kingdom. (in Russian), Moscow (15 Oct. 1964 - 15 July 1965) R (2)With the assistance of a temporary adviser, a study was WHO provided seven lecturers and fellowships for five made and a report prepared on non -medical psychologists in trainees, from Bulgaria, Czechoslovakia, Hungary, Poland and health services in Europe. Yugoslavia, for the second diploma course in hospital and (3) A consultant prepared details of published statistics on medical administration given in Russian at the Central Institute mental illness in Member States of the Region. of Post -graduate Training in Moscow. In addition, three one- month fellowships were awarded to national staff. (4) A consultant and three temporary advisers were provided to advise or facilitate the exchange of experience on statistics of mental disorders in Yugoslavia, France, Norway and Poland. EURO 151.3Dental Health Services (1964 - ) R

To follow up the Seminar on Dental Health Services for EURO 207Undergraduate Medical Teaching (1961 - ) R Children, held in Goteborg in 1960, by providing consultants `` to survey the progress made, and to assist certain countries To stimulate improvements in undergraduate medical teaching to develop dental health services by means of fellowships for and particularly the introduction of preventive and social teachers in child dentistry subjects. medicine at all stages and in all sections of the curriculum.

EURO 179.3Study on Cardiovascular Diseases (1960 - ) R EURO 211Exchange of Information on Placement, Supervision A study of registration, coding and reporting of deaths from and Follow -up of WHO Fellows (1962 - ) R cardiovascular diseases, including prevalence surveys of ischaemic heart diseases in some European countries showing different To enable national officials supervising WHO fellowship matters to visit each other and the Regional Office in order to mortality rates. compare the work carried out in different countries, and to meet the deans of institutions receiving the greatest number of EURO 179.4Conference on the Prevention and Control of WHO fellows. Cardiovascular Diseases, Bucharest (10 - 18 March 1965) R

The conference reviewed the situation in Europe with regard EURO 215Health Statistical Services (1962 - ) R to the prevention of certain cardiovascular diseases -in particular rheumatic fever,rheumatic heartdisease,ischaemic heart A series of studies on the accuracy and comparability of disease, hypertension (all types), non -specific lungdiseases statistics on causes of death, carried out by national statistical leading to cor pulmonale, and congenital heart diseases. services and co- ordinated by WHO. WHO provided seven temporary advisers and the cost of attendance of twenty -seven participants from Austria, Belgium, Bulgaria, Czechoslovakia, Denmark, Federal Republic of Ger- EURO 216.1Course in the Application of Statistical Methods many, Finland, France, Greece, Hungary, Iceland, Ireland, Italy, to Medicine and Public Health (in English), London (Sept. - Morocco, Netherlands, Norway, Poland, Portugal, Romania, Dec. 1964; Jan. - April 1965) R Sweden, Switzerland, Turkey, Union of Soviet Socialist Repub- lics, United Kingdom and Yugoslavia. (See also page 123.) Two courses -on vital and health statistics, and on biometrics and epidemiology- organized in collaboration with the London School of Hygiene and Tropical Medicine, to give physicians EURO 179.5Study on Emergency Services for Cardiovascular and health statisticians training in the application of statistical Patients (1965) R methods to public health and to epidemiological and clinical A consultant made a study of different types of specialized studies. emergency services for cardiovascular patients in Europe, and For the course on vital and health statistics (September - recommended measures for the organization of such services. December 1964) WHO provided fellowships to three trainees from Czechoslovakia, Poland and Norway, and, for the course on biometrics and epidemiology (January - April 1965) fellow- EURO 183Participation in Seminars and Conferences of the ships for four trainees from the Netherlands, Norway and United Nations and Other Agencies (1959 - ) R Sweden. 188 THE WORK OF WHO, 1965

\D-EURO216.2Course in the Application of Statistical Methods eleven fellowships to trainees from Bulgaria, Czechoslovakia, to Medicine and Public Health (in French), Brussels (Feb. - Hungary, Poland, Romania, the Union of Soviet Socialist June 1965) R Republics, and Yugoslavia. A course, organized in collaboration with the Free University of Brussels, to give physicians and health statisticians training EURO 263.1Study on Health Problems Created by Noise in the application of statistical methods to public health and to (1964) R epidemiological and clinical studies. WHO provided fellowships A consultant visited three countries to review the effects of for trainees from the Federal Republic of Germany and from noise on human health and to study the factors involved and Portugal, and three lecturers. remedial measures.

EURO 216.3Course in the Application of Statistical Methods EURO 270National Seminars on Nursing Services and Educa- to Medicine and Public Health (in Russian), Prague (Sept. - tion (1964 -1966) R Dec. 1965) R To follow up the Symposium on Hospital and Domiciliary A course, in Russian, similar to that described under project Care held in Amsterdam in 1962, by providing support to EURO 216.2 above. WHO provided four fellowships to trainees national seminars for studying the organization and functioning from Bulgaria, the Union of Soviet Socialist Republics, and of home -care nursing services, the categories of personnel Yugoslavia, and five lecturers, a four -month fellowship to a necessary, and the relationship of these services to and their co- national faculty member, and supplies. ordination with hospital and public health nursing services.

EURO 217.2EuropeanConference onHealthStatistics, EURO 272 Symposium on Occupational Hazards in Agriculture, Budapest (26 - 30 April 1965) R Milan (7 - 12 Dec. 1964) R The purpose of the conference was to discuss statistical The symposium studied rural occupational health problems services in health administration and the extent to which requirements in this field were currently being met. WHO provided caused by biological, chemical and physical hazards and discussed information on the relevant services provided in the Region. four temporary advisers and the cost of attendance of twenty WHO provided three temporary advisers and the cost of participants from Austria, Belgium, Bulgaria, Czechoslovakia, attendance of thirteen participants from Algeria, Bulgaria, Denmark, Federal Republic of Germany, Finland, France, Denmark, Federal Republic of Germany, France, Greece, Hungary,Italy,Morocco,Netherlands,Norway, Poland, Hungary, Ireland, Italy, Poland, Spain, Union of Soviet Socialist Romania, Sweden, Union of Soviet Socialist Republics, United Republics, and Yugoslavia. Kingdom and Yugoslavia.

EURO 275Conference Advisory Services (1964 - ) R EURO 232Malaria Eradication Evaluation (1963 - ) R To make preparations and preliminary arrangements for A team to visit countries on request in order to assist in conferences, seminars, etc., to be held in the following year. determining whether eradication of malaria has been achieved. EURO 276.4International Children's Centre Course on Mother EURO 234.2European Seminar on Public Health Aspects of and Child Care, Paris (12 Oct. - 20 Dec. 1964) R: Fellowships Medical Uses of Ionizing Radiation, Lund, Sweden (4 -9 Oct. for three trainees from Austria, Turkey and Yugoslavia. 1965) R The seminar, which followed up a number of earlier meetings EURO 277Seminar on Paediatric Education, Berg en Dal, convened by WHO, considered the public health signifiance Netherlands (22 - 29 April 1965) R of the medical uses of ionizing radiation, which are increasing with the development of medical services and which constitute The seminar discussed how undergraduate and post -graduate the main sources of exposure of the population to ionizing teaching in paediatrics could be reorganized to meet the urgent radiation. Consideration was given to improvements in equip- need for better integrated preventive and curative child care. ment and techniques for decreasing exposure and attention was The participants included professors of paediatrics, experts in drawn to the importance of medical evaluation of the need medical education and leading maternal and child health for irradiation in individual cases, and of the risks involved in workers. and the benefits to be obtained from radiation work. WHO provided eight temporary advisers and the cost of The twenty -six participants came from Austria, Belgium, attendance of twenty -nine participants from Albania, Algeria, Bulgaria, Denmark, Federal Republic of Germany, Finland, Austria, Belgium, Bulgaria, Czechoslovakia, Denmark, Federal France,Iceland,Ireland,Italy, Luxembourg, Netherlands, Republic of Germany, Finland, France, Greece, Hungary, Norway, Portugal, Sweden, Union of Soviet Socialist Republics, Iceland, Ireland, Italy, Malta, Netherlands, Norway, Poland, United Kingdom and Yugoslavia, and the cost of their atten- Portugal, Romania, Spain, Sweden, Switzerland, Turkey, Union dance was paid by the respective governments. WHO provided of Soviet Socialist Republics, United Kingdom and Yugoslavia. a consultant and seven temporary advisers. EURO 288Consultant Study on Health Problems in Regional XURO 259.2Course on the Medical and Social Aspects of the Planning and Urbanization (1965 - ) R Care of the Elderly (in Russian), Kiev (17 May - 12 June 1965) R To study how health authorities can play a more effective A course, for clinical teachers in medical schools, on recent part in regional planning for industrial and economic develop- advances in the care of the elderly, including the preventive and ment and in urbanization, so as to avoid health hazards and social aspects. WHO provided two temporary advisers and take advantage of opportunities for improving health conditions. PROJECT LIST: EUROPE 189

The project constitutes WHO's contribution to a programme EURO 300 Seminar on Outpatient Psychiatric Services, Geneva of the United Nations and various specialized agencies which is (15 - 24 Sept. 1965) R aimed at improving co- ordination between the authorities concerned in regional planning and urbanization. The seminar considered the psychiatric techniques employed by the mental health team in outpatient and dispensary services and in day hospitals and day centres, in the light of the present trend towards treating psychiatric patients whenever possible EURO 294.1Study on Comparative Appraisal of Medical Care outside hospital. The use of outpatient services for case -finding Schemes (1965) R and prevention, and the methods of work in day hospitals and sheltered workshops for the rehabilitation of the mentally ill Two consultants collected information for a comparative were discussed. appraisal of different medical care schemes and for a determina- The thirty -five participants came from Belgium, Bulgaria, tion of methods for measuring and evaluating their efficiency. Czechoslovakia,FederalRepublicof Germany,Finland, France, Ireland, Italy, Netherlands, Norway, Poland, Portugal, Romania, Spain, Switzerland, Sweden, Union of Soviet Socialist Republics, United Kingdom, and Yugoslavia.The cost of EURO 295European Symposium on the Estimation of Hospital their attendance was paid by the respective governments. WHO Bed Requirements, Copenhagen (22 - 26 Nov. 1965) R provided twelve temporary advisers. The symposium discussed present methods of assessing hospital bed requirements and the possibility of developing a URO 302Post -graduate Medical Training (1965 - ) R more satisfactoryscientific methodology for that purpose. 11 Consideration was given to the effects of new forms of patient To stimulate improvements in post -graduate medical training, care, including comprehensive and progressive patient care, and to assist national efforts in this field, mainly by the provision on hospital bed requirements, and of the possibility of relieving of consultants, lecturers, fellowships and suppliesto post- the hospital of certain kinds of patient by home care, inter- graduate training institutes, schools of public health and schools of tropical medicine. is mediary and similar services. It also planned to support small WHO provided a consultant, four temporary advisers and inter -country activities concerned with postgraduate training. the cost of attendance of eleven participants from Austria, The project is a continuation, in a modified form, of project Belgium,Czechoslovakia,Denmark,France,Netherlands, EURO 110- European Schools and Training Centres in Public Norway, Sweden, Union of Soviet Socialist Republics, United which was completed in 1964. Kingdom and Yugoslavia. ,N)(EURO 304 Symposiumon Schools of Public Health in Europe, \\ Rennes (14 - 19 Dec. 1964) R

EURO 299.1International Children's Centre Course on Tuber- A symposium at which the heads of European schools of culosis in Children, Paris (15 March - 11 April 1965) R: Fellow- public health discussed common problems, including how these ships forfivephysicians from Algeria, Greece, Morocco, schools could best help in training health personnel from Portugal and Turkey. developingcountries. WHO provided two temporary advisers and the cost of attendance of twenty participants from Algeria, Belgium, Bulgaria,Czechoslovakia,Federal Republic of Germany, 'URO 299.2International Children's Centre Course on Social France, Hungary, Ireland, Netherlands,Poland, Portugal, Paediatrics, Paris (26 April -4 July 1965) R: Fellowships for Romania, Spain, Sweden, Turkey, Union of Soviet Socialist three trainees from the Federal Republic of Germany, Hungary Republics, United Kingdom and Yugoslavia. and the Union of Soviet Socialist Republics. EURO 305Consultant Services (1965 - ) R i To meet requests- sometimes of an urgent nature -from \ EURO 299.3International Children's Centre Course on Mater- countries in the Region for advice on subjects for which no nal and Child Health, Paris (11 - 19 Oct. 1965) R: Fellowships specialized health officer is available and for which it may be for two trainees from Poland and Spain. impracticable to obtain assistance from headquarters staff.

EURO 319Entomological Services to North African Countries (1965 - ) R EURO 299.4International Children's Centre Course on Public Health and the Child, Tunis (5 April - 1 May 1965) R: Fellow- To provide entomological advicefor malaria projects, ships for three physicians -one from Algeria and two from primarily for those in Algeria and Morocco, but the project Morocco. will also serve Turkey and other countries. EASTERN MEDITERRANEAN

Aden 9Tuberculosis Control (Pilot Area) (March - May 1965) R Ethiopia 6Tuberculosis Control (March 1959 - end of 1968) EPTA UNICEF WHO provided a consultant for one month who surveyed the tuberculosis problem in Aden, the facilities available, the control To test effective and practical methods of tuberculosis control methods applied and the BCG vaccination campaign. He also in the Addis Ababa and Asmara centres and in the mobile units investigated the position of the tuberculosis control service in operating in a pilot area, with a view to extending them to the the general public health services and studied the problems whole country. caused by immigration. / (Ethiopia 9Public Health College and Training Centre, Gondar yprus 1NursingEducation(Aug. 1962 - mid -1966) EPTA (March 1954 - end of 1967) R UNICEF (AID) To promote nursing education and training programmes in To train health personnel to staff the expanding health order to meet the country's needs for nurse educators, administra- services, particularly in rural areas. tive staff and nursing service personnel.

Ethiopia 14.02Malaria Eradication Training Centre Cyprus 15Public Health Laboratory Services (1960 - beyond 1967) R (Jan. - Sept. 1964)1 R To train auxiliary personnel for the malaria eradication The aim was to improve and develop public health laboratory programme. services, to introduce sound technical methods for laboratory investigations and to provide training facilities for technical personnel at all levels. WHO provided a medical officer from Ethiopia 14.03Malaria Pre -eradication Programme January to September 1964, when the project, which was due (1962 - beyond 1967) R MESA EPTA (AID) to continue for two years, was interrupted in view of the political situation. To build up the technical, administrative and operational The WHO adviser made recommendations on the organization facilities for a full -scale malaria eradication programme; and of the laboratory and blood transfusion services.He assisted to develop at the saine time the rural health services so that they with a microbiology course for nurses, started work on a cancer may provide efficient collaboration in the eradication programme. survey,gave routine consultationsinhistopathology and haematology, and made recommendations for extending the Ethiopia 17Medical Education (1964 -1968) R laboratory services of certain hospitals. To set up in the Haile Selassie I University, Addis Ababa, a faculty of medicine, with a department of public health and Cyprus 20Hospital Planning and Administration preventive medicine. (Nov. - Dec. 1964) R

WHO provided a consultant for three weeks to advise on the Ethiopia 25Supervisory Team for Health Centres remodelling of the Nicosia general hospital and to prepare (Jan. 1962 -1968) R UNICEF architectural plans for the new central medical laboratory. To provide technical supervision and guidance to health personnel working in various health centres; to establish a Vyprus 200Fellowships R: Laboratory techniques (one for division of basic health services in the Ministry of Health; and two months, one for twelve months), mental hospital administra- to develop provincial health departments. tion (twelve months), psychological medicine (twelve months), undergraduate medical studies(seven for twelve months). Ethiopia 29Training Course for X -ray Technicians (Jan. 1963 - Dec. 1966) EPTA UNICEF \YCYPNS201 Fellowships EPTA : Mental nursing (twelve months), undergraduate medical studies (four for twelve months). To organize a two -year course to train X -ray technicians for the hospital radiology installations. Ethiopia 3AdvisoryServicesinEpidemiology and Health Statistics (Sept. 1952 - beyond 1967) EPTA Ethiopia 30Nutrition Department To improve and develop the epidemiological and statistical (Dec. 1964 -1967) R UNICEF (FAO) services; to provide for assistance in preparing annual reports; To strengthen the Nutrition Department in the Ministry of to develop routine statistical procedures in hospitals, and to Health, with a view to integrating work in nutrition into maternal improve hospital statistics. and child health and other health work; to assess the nutritional status of the population; and to train public health officers in 1 This project was inadvertently omitted from the list in the nutrition through refresher courses and courses given at the Annual Report of the Director -General for 1964. Public Health College and Training Centre at Gondar. - 190 - PROJECT LIST: EASTERN MEDITERRANEAN 191

thiopia 200Fellowships R: Thoracic surgery (seven and a Iran 38Bilharziasis Control (Nov. 1958 -1967) EPTA half months),trypanosomiasis(sixweeks), undergraduate medical studies (five for twelve months). To carry out field studies on the epidemiology of bilharziasis and on its prevention; to train staff; and to plan a control programme, integrated as far as possible into the programme YEthiopia201Fellowships EPTA:Psychiatric social work (two for economic development. for twelve months), undergraduate medical studies (four for twelve months). (Iran 43Post -graduate Education in Public Health (Oct. 1964 -1968) R Iran 1Malaria Eradication Programme (1957 - beyond 1967) R MESA UNICEF To develop the post -graduate training programme at the Institute of Parasitology, Tropical Medicine and Hygiene in To eradicate malaria progressively throughout the country by Teheran, particularly as regards public health practice and residual spraying and other measures. community medicine.

Iran 7Nutrition Institute Iran 45Air Pollution Control (Sept. 1965 - 1968) R (1963 - end of 1969) EPTA UNICEF (FAO) To identify the causes of air pollution in Teheran and to take To investigate, by field surveys, the nature and incidence of technical and administrative control measures; to study the the main nutritional diseases and deficiencies, especially in effects of air pollutants on the community; to train staff, and to mothers and children in rural and in over -populated areas; to develop techniques for more intensive studies in the future. plan and implement measures for improving nutrition in various population groups (including the assessment of the nutritional value of indigenous foodstuffs, the promotion of Iran 47 and 61RehabilitationandTraining Programmein production and distribution of food, the training in nutrition of Physical Therapy (Second phase: 1965 - beyond 1967) R medical, nursing and other professional staff, and the carrying - out of nutrition education in general health centres, maternal To improve medical rehabilitation by training of physical and child health centres and in hospitals). therapy students at the Teheran school of physical therapy.

Iran 19Leprosy Control (Nov. - Dec. 1965) R Iran 50Training School for Sanitarians, Palasht (Feb. 1964 - Jan. 1965) EPTA UNICEF WHO provided a consultant for three weeks to study the leprosy problem and advise on the organization and implemen- WHO provided a sanitarian to assist in strengthening the tation of measures to control the disease. school at Palasht, Teheran, which trains sanitary aides for provincial, county and municipal health departments.The school has been in operation since 1952 and has received Iran 26Public Health Laboratory Services (Nov. 1965) R assistance from the Near East Foundation, from the United WHO provided a consultant to advise the Government on the States of America under bilateral arrangements, and from the co- ordination of the work of the various laboratory services. American University of Beirut, as well as from UNICEF and WHO. The course, which is open to high -school graduates, lasts nine months and is followed by three months' field training. Iran 28Mental Health (May 1959 - mid 1966) R The sanitarian assisted in revising the curriculum to increase the emphasis on practical work and advised on building up To reorganize and integrate the mental health services at all laboratory and library facilities. levels;to study the feasibility of establishing extra -mural The school is well equipped and has some qualified staff. services and other types of services on a large community scale, Plans have been made to supplement the facilities it provides having regard to the shortage of trained personnel; to train by opening two more training schools in the provinces in 1966. staff at all levels, and to promote the standardization of research on data for the purpose of assessing the value of the existing provisions for care and treatment. Iran 52Post -basic Nursing Education (Nov. 1963 - end of 1968) R Iran 33.01National Blood Transfusion Centre To strengthen nursing services through post -basic nursing (Nov. - Dec. 1965) R education to prepare teachers, supervisors and administrators WHO provided a consultant for two months to assist in for leading posts in nursing. organizing a blood transfusion centre in Iran, in developing technical procedures for blood processing, plasma fractionation Iran 57 High School of Midwifery, Meshed and sera production, and in planning for the training of techni- (Oct. 1963 - end of 1965) R cians. To strengthen and expand midwifery services by training qualified nurses in midwifery and public health as related to Ian 37Nursing Education, Red Lion and Sun School of Nursing, maternal and child health care. Rey (May - Aug. 1965) EPTA

WHO provided a consultant to visit the Red Lion and Sun Iran 58Teaching of Sanitary Engineering School of Nursing, which was assisted from September 1956 (Sept. 1964 -1968) R UNICEF (AID) to June 1963, in order to evaluate the progress made and assess the programme of studies.Some laboratory supplies and To incorporate courses in sanitary engineering in the teaching technical periodicals were also provided. programme of the University of Teheran. 192 THE WORK OF WHO, 1965

Iran 200Fellowships R: Animal experimentation (six months), Iraq 37College of Nursing, Baghdad (March 1962 - 1972) R epidemiology (nine and a half months), industrial hygiene (six \\ months), laboratory techniques and blood transfusion (three To train young women, by means of a collegiate programme, months), master of science in hygiene course, with emphasis on for responsible posts in nursing practice, education and adminis- nutrition (twelve months), mental health (one month), nursing tration, and consequently to raise the standard of nursing in Iraq. education (seven weeks), observation of health programmes and institutions (two months), psychiatry (twelve months), public health administration (twelve months), public health nursing Iraq 38Virology Laboratory (Oct. - Dec. 1964) R (one for two weeks, one for ten weeks), public health practice WHO provided a consultant for two months who made a (one month), radiation and isotopes (twelve months), social survey of public health laboratory services and submitted recom- paediatrics (twelve months). mendations on the establishment of a virology laboratory.

Iran 201Fellowships EPTA: Hospital administration (twelve Iraq 42Advisory Services in Epidemiology months), nutrition (twelve months), public health dentistry (Jan. 1964 - end of 1967) EPTA (twelve months), public health laboratories (twelve months), radioisotopes (ten months). To plan, develop and operate epidemiological services at all levels of the health services. (See page 131.) Iraq 5Leprosy Control (Oct. - Nov. 1965) R WHO provided a consultant for a month to study the leprosy Iraq 46Study of Water Supply Quality problem and advise on the organization and implementation of (Nov. 1963 - Feb. 1964; Dec. 1964 - Feb. 1965) EPTA measures to control the disease. WHO provided a consultant who assisted in improving the operation and maintenance of plants for the treatment of surface water and advised on treatment for improving the Iraq 11Malaria Eradication Programme quality of highly mineralized ground water. (1957 - beyond 1967) R MESA UNICEF In connexion with this project, fourteen Iraqi engineers To eradicate malaria from the whole country, as an extension attended a course on the operation and maintenance of water of the malaria control programme with which WHO has assisted supplies that was given in Baghdad from 9 to 28 January 1965. since 1952. Iraq 47Public Health Aspects of Housing Iraq 15Bilharziasis Control (Nov. 1955 - end of 1966) EPTA (April 1965 - 1966) EPTA To evolve effective methods for bilharziasis control, parti- To study the public health aspects of housing and of public cularly for the prevention of infection in newly developed areas, buildings such as hospitals, schools, colleges and office premises, and to conduct pilot engineering studies in various irrigation and to establish administrative and legal procedures to ensure systems. the maintenance of healthy conditions.

Iraq 18Communicable Eye Disease Control Iraq 49Rural Health Advisory Services (Feb. 1964 - 1968) EPTA (Jan. 1961 - 1966) R UNICEF To plan and develop rural health services and to use them To study the epidemiology of trachoma and of associated for field training of professional and auxiliary health personnel. conjunctivitis in Iraq; to develop, in a pilot sector, effective and practicable methods for their control; and to plan the gradual extension of control measures to obtain full coverage Iraq 200Fellowships R: Administration and organization of of the population. pursing colleges (two months), bilharziasis control (one month), Diploma in Child Health course (twelve months), endemic diseases (four weeks), Master of Public Health course (twelve Iraq 23School Health Services (March - May 1965) EPTA months), public health administration (six weeks), tinca capitis (six months), tropical public health (twelve months). WHO provided a consultant for three months to survey the school health services in Iraq and make recommendations for their development and improvement. Iraq 201Fellowships EPTA : Tuberculosis and animal inoculation (four months). Iraq 33.01College of Medicine, Baghdad (1958 -1968) R To develop the Department of Social and Preventive Medicine Israel 5Malaria Eradication Programme (1959 -1966) R of the College of Medicine, Baghdad, with a view to expanding teaching and research in the subject. To achieve complete eradication of malaria and prevent its re- establishment. raq 35Training of Health Personnel (Jan. 1960 -1968) EPTA UNICEF 1Israel7Nursing Education (Jan. 1965 - 1967) R To train sanitarian to assist in the development of local health To study and evaluate nursing needs and resources in order services. to plan nursing education programmes. PROJECT LIST: EASTERN MEDITERRANEAN 193

Israel 24Child Psychiatry and Mental Health and waste water disposal facilities in a great number of localities, (Oct. 1961 - 1966) Funds -in -trust ranging from large towns to small villages, throughout the country.Supplies and equipment were also provided. To reorganize mental health services, with particular reference The Government has requested further assistance from WHO to psychiatric services for children. for continuation of the project.

"hràel 25Medical Education (1964 - 1967) R Jordan 28Rehabilitation Services (April 1964 -1967) R To assist the Hadassah Medical School, or other related To formulate a programme for the development of physical schools or training centres, in the development of teaching and therapy services in the rehabilitation of the physically handi- research. capped.

N.,(Israe138Air Pollution Survey (1965 -1967) R \\ Jordan 29Tuberculosis Control To assess the importance of air pollutants in selected areas; (Feb. 1964 - end of 1965) R UNICEF to plan a programme of investigation and research, and to train To carry out tuberculosis surveys, community screening and staff. control in the urban districts of Amman, and in some adjacent suburban and rural areas, through the Amman tuberculosis Israel200Fellowships R: Hospital pharmacy administration centre and BCG units; and to integrate tuberculosis control into (twelve months), hospital planning (three months), public health the general public health services. administration (three months), sanitary analysis of water and sewage (four months). Jordan 32Study of Refuse Disposal, Jerusalem (March 1965) R

Jordan 2Nursing Education (March 1965 -1970) EPTA WHO provided a consultant who assisted in studying the nature and quantity of wastes produced and in developing To strengthen nursing education through the extension of procedures for their treatment, and in selecting a suitable site professional training in the Amman school of nursing. for the erection of a treatment plant.

Jordan 6Malaria Eradication Programme Jordan 34Hospital Planning and Organization (June 1958 - beyond 1967) EPTA UNICEF (AID) (Nov. 1965 - Jan. 1966) R To eradicate malaria from the whole country and prevent its WHO provided a consultant to advise on the organization of re- establishment. medical care, the regionalization of health services and the planning of hospital and clinic buildings. Jordan 9Central Public Health Laboratory (Aug. - Nov. 1965) R gJ(Jordan 200FellowshipsR:Electro- encephalography(three WHO provided a consultant to assist in reorganizing the onths), medico -legal serology (three months), physical therapy bacteriology section of the central public health laboratory, in (twelve months), psychiatry (twelve months), radiotherapy evaluating the methods employed, and in improving work on (twelve months), statistics (two for seven and a half months), telecobaltotherapy (ten weeks), toxicology and forensic medicine enterobacteriaceae cultures. (twelve months), tuberculosis and chest diseases (twelve months), X -ray diagnosis (two for twelve months). Jordan 11Communicable Eye Disease Control (April 1960 -1967) EPTA UNICEF Jordan 201Fellowships EPTA: DPH course (twelve months), To study the epidemiological pattern of trachoma and other radiotherapy (twelve months), undergraduate medical studies communicable eye diseases in the Hebron area; to devise (thirteen months). technical and administrative methods for their control, and integrate the control work into the public health organization of the country. Kuwait 11Air Pollution Survey (Feb. - March 1965) R Funds -in -trust

Jordan 23Production of Vaccines A WHO consultant and a member of WHO headquarters (Nov. 1959 -1967) R UNICEF (AID) staff visited Kuwait for two weeks in order to assess the evidence of air pollution and study the cause or causes of asthmatic To develop the production of diphtheria and tetanus vaccines, complaints there. and to train technical personnel. Kuwait 15Insect Control (May - June 1965) Funds -in -trust Jordan 27 Municipal Water Supplies and Waste Water Disposal (June 1962 - Dec. 1964) EPTA WHO provided a consultant for five weeks who made a study of medically important arthropods in Kuwait and the facilities The aim was to carry out an extensive programme of commu- at present available for controlling them.The consultant's nity water supplies and waste water disposal. WHO provided a report records the susceptibility of the prevalent flies to common sanitary engineer who assisted in studies for, and in designing insecticidesand contains recommendationsforimproving and supervising the construction of, community water supplies control measures. 194 THE WORK OF WHO, 1965

Kuwait 17Leprosy Control (Nov. 1965) R X Libya 3Nursing Education, Tripoli "` (Sept. 1955 - end of 1968) R UNICEF WHO provided a consultant for a week to study the leprosy problem and advise on the organization and implementation of To develop a nursing education programme adapted to local measures to control the disease. needs and resources in order to provide professional nurses and assistants for the country's expanding health services.

uwait 200Fellowships R: Anaesthesiology (twelve months), 4public health and nutrition (twelve months), sanitary engineering Libya 7Health Training Institute, Benghazi (nine months), X -ray techniques (nine months). (Dec. 1955 - end of 1968) EPTA Funds -in -trust UNICEF To train paramedical and auxiliary personnel, particularly Lebanon 4Rural Health Unit male nurses and laboratory assistants. (March 1965 -1968) EPTA UNICEF To organize in Halba a model district unit of rural health Libya 9Malaria Eradication Programme services, to be used as a demonstration and training centre for (April 1960 - end of 1967) R Funds -in -trust health personnel of other rural health units. This is a follow -up To eradicate malaria from the whole country. This follows of a project that was carried out in Saida in 1957 and 1958, the pre- eradication survey carried out (under the same project and in North Lebanon from 1960 to 1962. number) from June 1958 to September 1959.

Lebanon 7Malaria Eradication Programme (1957 - 1967) R ibya 12Maternal and Child Health, Cyrenaica To achieve complete eradication of malaria and prevent (Sept. 1956 - end of 1967) R Funds -in -trust its re-establishment. To establish a centre for demonstrating modern methods of maternal and child care and for training community midwives banon 10Nursing Education (April 1964 - 1966) R to serve in rural and urban maternal and child health centres throughout Cyrenaica. To strengthen nursing services and to co- ordinate nursing education projects. Libya 20Nutrition Unit (1965 -1970) EFTA (FAO)

Lebanon 17Environmental Health To establish in the Ministry of Health a nutrition unit which (March 1964 -1968) EPTA UNICEF will evaluate the nutritional situation in the country and advise on the development of a nutrition policy. To strengthen the Division of Public Health Engineering in the Ministry of Health; and to develop trainiin environmental health, particularly in rural areas. Libya 21Maternal and Child Health Advisory and Supervisory Services (Nov. 1965 -1970) Funds -in -trust

Lebanon 31Rehabilitation of the Physically Handicapped To improve and expand maternal and child health services (Second phase: April 1963 -1967) R as an integral part of the general health services, with special emphasis on reducing pre -natal, infant and child mortality; To develop physical therapy services at the rehabilitation to give health education to mothers and children; to increase centre at Ouzai, Beirut. the efficiency of all maternal and child health workers; and to strengthen and co- ordinate the organization, administration and operation of all services related to the care of mothers and Lebanon 41Blood Bank (June 1965 - 1967) R children. To organize a blood transfusion service for the whole country. In 1963, in preparation for this project, WHO provided supplies Libya 22Tuberculosis Control and equipment for a blood bank. (March 1963 -1967) EFTA Funds -in -trust To set up a tuberculosis centre in Benghazi to train staff and Lebanon 200Fellowships R: Maternal and child health (six demonstrate tuberculosis control techniques and to serve as the months), public health administration (one month), radio- centre of operations for a pilot area project; to plan a national isotopes (one for six months, one for nine months). control programme on the basis of the results of the pilot area / project. Lebanon 201Fellowships EPTA: DPH course (twelve months), ospital administration (twelve months). '4ibya200Fellowships R: Midwifery (twelve months), snail control (two months), surgical and operating theatre nursing (twelve months), undergraduate medical studies (three for Libya 2Maternal and Child Health Demonstration and Training nine months, one for eleven months, five for twelve months, Centre, Tripoli (Nov. 1965 -1970) Funds -in -trust one for thirteen months). To strengthen and expand maternal and child health services in Tripolitania; and to train various categories of health per-4'fbya 201Fellowships EFTA: Undergraduate medical studies sonnel in maternal and child health and midwifery work. (one for nine months, one for twelve months). PROJECT LIST: EASTERN MEDITERRANEAN 195

N Pakistan 30Nursing Education, East Pakistan Pakistan 50Tuberculosis Control (Jan. 1958 - end of 1968) R UNICEF (Jan. 1963 - end of 1967) EPTA UNICEF To strengthen education and training programmes for nursing To determine the methods of tuberculosis control which and midwifery personnel. would be effective in implementing the national plan. (The BCG mass vaccination campaign -project Pakistan13 -and the Rawalpindi pilot area have been merged in this project.) Pakistan 33Public Health Institute, East Pakistan (Oct. 1961 -1968) EPTA Pakistan 51Public Health Advisory Services, East Pakistan To develop epidemiological and bacteriological departments (1963 - Sept. 1965) R UNICEF in the Public Health Institute, Dacca, East Pakistan. The original aim was to improve the rural health services. In 1964 it was extended to cover the development of all health Pakistan 36Malaria Eradication Programme services in East Pakistan.WHO provided a public health (1961 -1975) R MESA UNICEF (AID) adviser in 1963 and from September 1964 to September 1965. In 1963 a preliminary study for the development of the rural To eradicate malaria from the whole country, by stages. health services was made. Beginning in September 1964, a study The eradication programme follows a pre -eradication survey was carried out of the health problems in East Pakistan, and of carried out with assistance from WHO in 1959 and 1960. the administrative organization of the health services.Assist- ance was given in the operation of a smallpox eradication programme, in the development of a pilot area for rural health Pakistan 39Leprosy Control (Nov. 1961 - end of 1967) R services in Dinajpur, and in co- ordinating the WHO programmes To control leprosy, which is endemic in both East and West in East Pakistan.Collaboration was maintained with other Pakistan. agencies providing assistance to the province in the health field. The duration of the project was too short to enable its objectives to be fully met. Pakistan 41Evaluation and Assessment of Smallpox Eradica- tion, East Pakistan (Nov. 1964 - Feb. 1965) R Pakistan 52Public Health Advisory Services, West Pakistan (Sept. 1964 -1966) R UNICEF WHO provided a consultant in epidemiology for three months to assess the technical and administrative methods employed To plan and organize health services in West Pakistan. in the smallpox eradication campaign which was launched in East Pakistan in 1961. Eighty per cent, of the population of Pakistan 54Community Water Supply and Rural Sanitation, East Pakistan has been revaccinated, and the Government is West Pakistan (Nov. 1964 -1968) R continuing the revaccination programme and the evaluation and assessment of the project. To develop the organization and management of community The WHO epidemiologist and public health adviser, attached water supply programmes and study their technical, legal and to projects Pakistan 33 and Pakistan 51 respectively, assisted in financial aspects; and to improve rural sanitation. (See page 130.) the preparation of the mass vaccination programme and in the evaluation and assessment operations in Dacca. Pakistan 55Environmental HealthServices(1964 - 1970) R To establish, in the Ministry of Health, a department of Pakistan 42Orthopaedic Workshop environmental health responsible for planning and administering (Feb. 1961 - end of 1965) EPTA UNICEF a national programme. To set up a prosthetics workshop and to train workers in the manufacture of braces and prosthetic appliances. Pakistan 59Course in Coding of Medical Records, Islamabad (15 March - 31 May 1965) R ' akistan 44Nursing Education, West Pakistan The course was attended by twenty -seven trainees. It covered (Sept. 1961 - end of 1965) EPTA UNICEF instruction in the use of the International Classification of Diseases and in interpretation of the rules for selecting the To improve and develop nursing education.Under this underlying causes of death, and included practical exercises in project WHO gives assistance in the administration of a model coding and visits to various hospitals for inspection of medical school of nursing set up by the Government. records. WHO provided a teacher (consultant in medical coding) for the duration of the course. Pakistan 48National Health Laboratories, Islamabad (Nov. 1964 -1970) R Pakistan 200Fellowships R: Diploma in psychological medicine To establish national health laboratories in Islamabad, with ourse (fifteen months), health laboratory organization and a view to centralizing laboratory research for both West and methodology (five weeks), physical therapy (twelve months), East Pakistan. rabies vaccines and sera (four months), rural health (two weeks), sanitary engineering (twelve months), tuberculosis (one for nine months, one for twelve months). Pakistan 49Malaria Eradication Training Centres (Nov. 1960 - beyond 1967) R akistan 201Fellowships EPTA: Bacteriology (twelve months), To train in malaria eradication techniques technical staff of PH course (twelve months), hospital administration (twelve all levels for the national malaria eradication service. months). 196 THE WORK OF WHO, 1965

star 200Fellowships R: Sanitation (two for six months). Saudi Arabia 34Advisory Services for Health Programming (Aug. 1963 - 1966) Funds -in -trust Saudi Arabia 4Malaria Pre -eradication Programme To provide assistance in health programming to the Supreme (1962 - beyond 1967) R MESA Planning Board. To build up the technical, administrative and operational facilities for a full-scale malaria eradication programme, and Saudi Arabia 35Training of Medical and Health Personnel at the same time to develop the rural health services, so that (Feb. 1964 - end of 1967) Funds -in -trust they may provide efficient collaborationin the eradication programme. The programme follows the pre -eradication survey To set standards for the education and training of health carried out with the assistance of WHO from July 1959 to personnel and define the technical responsibility of each category; to carry out manpower surveys of health personnel and determine March 1962. short -term and long -term needs; and to develop educational facilities for professional health personnel, particularly with Saudi Arabia 7Public Health Laboratory a view to the establishment of the country's first medical school. (Aug. 1964 - end of 1967) R EPTA Funds -in -trust To set up a national health laboratory in Riyad. Saudi Arabia 38Sanitary Engineering and Municipal Pro- gramming (Oct. 1963 - 1967) Funds -in -trust To draw up a municipal programme, with emphasis on Saudi Arabia 13Tuberculosis Control (National Pilot Area) environmental sanitation, to be carried out by the Ministry (Feb. 1963 - end of 1967) R of Interior. To test, through the tuberculosis centre in Riyad and the mobile BCG vaccination units, practical and effective methods Saudi Arabia 200Fellowships R: Biochemistry (twelve months), of case- finding, and of treatment and follow -up of tuberculosis DPH course (twelve months), undergraduate medical studies patients, to be extended later to the whole country. (three for twelve months).

'4udiArabia 15Health Assistants' and Sanitarians' Institute, Somalia 2Malaria Pre -eradication Programme Riyad (Feb. 1959 - end of 1966) R Funds -in -trust (May 1962 - beyond 1967) R MESA EPTA To train health assistants and sanitarians for work under To build up the technical, administrative and operational the supervision of professional staff; and to provide in- service facilities for a full -scale malaria eradication programme and training facilities for health personnel already employed. at the same time to develop the rural health services, so that The long -term objective of this project is to expand and they may provide efficient collaboration in the eradication improve the public health services throughout the country. programme.This programme followsthepre -eradication survey carried out with the assistance of WHO from 1955 to 1962. Saudi Arabia 29Basic Public Health and Medical Care Services (Aug. 1963 - end of 1967) Funds -in -trust .Somalia 8Training of Health Personnel To set up a provincial health organization, a model com- '(Jan. 1959 - 1968) R UNICEF munity health centre and a base hospital in the eastern province To train various categories of health auxiliary personnel, of the country. including health officers, sanitarians and public health nurse/ midwives; and to provide in -service training and refresher Saudi Arabia 31Nursing Advisory Services courses to health personnel. (Sept. - Nov. 1964) Funds -in -trust WHO provided a nursing adviser who made a study of nursing Somalia 11Tuberculosis Control needs and resources and of the prerequisites for setting up a (March 1960 - end of 1968) EPTA UNICEF nursing section in the Ministry of Health. The Government To test, in certain areas, simple, practical and effective methods has decided to defer the establishment of such a unit. of tuberculosis prevention and treatment, such as BCG vaccination and sputum examination; to study the possibility of extending these methods to the whole country and their integration Saudi Arabia 33Community Water Supply into the work of basic health centres. The project is operated (May 1964 - May 1965) Funds -in -trust from the tuberculosis centre at Mogadishu, which is also used The aim was to plan and organize a community water supply for training. programme. WHO provided a sanitary engineer for one year. He reviewed the work of the firm of consulting engineers which Somalia 13Basic Health Services prepared the plans and design for a water supply system for (March 1962 -1968) EPTA UNICEF Riyad and took part in the work of the advisory committee set up by the Government to consider the firm's report. He also To set up a rural demonstration and training area which made a study of the water supply and distribution facilities at will provide practical training for the students of the WHO - Jeddah and submitted recommendations for their improvement, assisted project Somalia 8 (Training of Health Personnel) and as well as general recommendations on the development of experience of the development of an integrated public health water supplies in the country. service in a rural area. PROJECT LIST: EASTERN MEDITERRANEAN 197

Somalia 15Nursing Education in the eradication programme. The programme follows the ' (Sept. 1961 - end of 1969) EPTA UNICEF pre -eradication survey carried out with the assistance of WHO from January 1961 to December 1962. To strengthen the nursing services of the country by establishing a pattern of nursing education suitable for adoption throughout the country. Sudan 7Nursing Education, Khartoum (Oct. 1955 - mid -1967) R Somalia 18Environmental Health (Jan. 1965 - 1970) R To establish a college of nursing, providing a course of basic professional education, that will train nurses for leading posts To organize and carry out a national environmental health in the country's health programme. programme, in which particular attention will be paid to the provision of community water supplies. Sudan 15Communicable Eye Disease Control (Dec. 1960 - end of 1967) EPTA UNICEF Somalia 20Organization of Medical Care N (May 1962 - ) EPTA To make a survey of communicable eye diseases and to carry out a control project, starting in the Atbara Berber area and To improve the medical care services, particularly as regards extending progressively to highly infected areas of the Northern surgery and anaesthesiology; and to provide clinical training Province. facilities for health personnel, especially student nurses. Sudan 19Rural Health Demonstration Area Q Somalia 21Management of Pharmacy and Medical Stores (Nov. 1961 -1966) EPTA UNICEF (Oct. 1962 - end of 1965) EPTA To establish a rural health demonstration area at El Huda To systematize medical supply procedures and to prepare in the Menagil extension of the Gezira irrigated area, as part training courses forauxiliary personnel in pharmacy and of a pilot scheme of community development; and to organize medical storekeeping. health and vital statistics services in the country.

Somalia 27National Health Planning Sudan 22Hospital Planning and Administration (June 1964 - May 1965) EPTA (Jan. 1965) R EPTA The aim was to prepare a plan for the development of national WHO provided a consultant (architect) for three weeks to health services,co- ordinated with plans for the country's advise on a long -term programme of hospital organization and general economic and social development. WHO provided a on the training of the necessary staff. public health administrator, a public health nurse and a sanitary engineer. Sudan 26Onchocerciasis Control An inventory of the health facilities and a survey of the (March 1963 - end of 1967) R health situation were made, after which a health plan, covering fifteen years and divided into three five -year periods, was To carry out a survey of onchocerciasis infection in the main prepared. section of the Nile north of Khartoum and in Bahr -el- Ghazal Assistance in the planned development of the health services and Equatoria Provinces, so as to determine the reasons for is being provided under separate projects. the prevalence of the infection, in particular the relationship between the disease in man and the breeding places of the insect vector; to develop a programme for the control and & omalia 200FellowshipsR:Bilharziasiscontrol(twelve prevention of onchocerciasis; and to train personnel. months),hospitaladministration(threemonths),nursing (twelve months), public health nursing (twelve months), public health nursing and maternal and child health programmes Sudan 28Smallpox Eradication (Jan. 1962 - end of 1966) R (six months), study of teaching institutions (one for one month, To carry out a mass vaccination campaign against smallpox, three for twelve months), undergraduate medical studies (one aiming at the eventual eradication of the disease. for three months, one for nine months, eleven for twelve months), undergraduate nursing studies (twelve months), undergraduate pharmacy studies (three for twelve months). Sudan 30Cancer Control (1963 - 1967) R To develop, in Khartoum Hospital, radiation and isotopes omalia201FellowshipsEPTA:Undergraduatemedical services for the treatment of cancer patients. studies (one for ten weeks, one for five months, one for twelve months), undergraduate nursing studies (twelve months). Sudan 32Malaria Eradication Training Centre (May 1963 - beyond 1967) R Sudan 6Malaria Pre- eradication Programme To train technical staff for the malaria eradication programme. (1963 - beyond 1967) R MESA

To build up the technical, administrative and operational Sudan 36Environmental Health (Jan. 1965 - 1970) R facilities for a full -scale malaria eradication programme and at the same time to stimulate the development of the rural To plan and administer a national environmental health health services, so that they may provide efficient collaboration programme. 198 THE WORK OF WHO, 1965

0 Sudan 38Vital and Health Statistics Advisory Services Syria 45Tuberculosis Control (National Pilot Area) (Jan. 1965 - 1966) R (1965 - ) R UNICEF To strengthen vital and health statistics at the Ministry of To develop, in a pilot area, tuberculosis control measures Health level and to train medical and non -medical personnel that can be applied throughout the country in a national pro- in statistics. gramme.

Sudan 42Community Water Supplies, Gezira Syria 52Refuse Disposal (Nov. 1965) R (Aug. 1965 -1967) R WHO provided a consultant to advise on problems concerning To study the problems of water purification in the villages refuse collection and disposal for the city of Damascus. of the Gezira area, with a view to altering the present plants and designing new ones. Syria 200Fellowships R: Applied nutrition (ten months), DPH course, with field training in maternal and child health udan 200Fellowships R: Analytical chemistry (twelve months), (fifteen months), public health (twelve months), public health DPH course (three for twelve months), medical entomology administration (twelve months), public health practice (one (two for twelve months), nutrition (one for six weeks, one for month), statistics (two for seven and a half months, one for thirteen months), parasitology(twelve months), psychiatry twelve months), statistics and epidemiology (six months). (twelve months), statistics (two for seven and a half months), trypanosomiasis (ten weeks). \Yyria201Fellowships EPTA: Statistics (twelve months).

Syria 2Malaria Eradication Programme Tunisia 3Communicable Eye Disease Control (March 1956 -1967) R MESA EPTA UNICEF (Nov. 1953 -1966) EPTA UNICEF To eradicate malaria from the whole country, where over To carry out a mass campaign against seasonal conjunctivitis, two million people out of a population of nearly six million collective treatment of trachoma in schools, and a programme live in areas which were originally malarious. of research on communicable eye diseases.

Syria 4Bilharziasis Control (Nov. 1964 - 1967) R isia 6Maternal and Child Health (Second phase: May 1959 - end of 1966) EPTA UNICEF To assess the situation as regards the prevalence and control of bilharziasis, especially in the Kamichlie area; to devise new To establish a maternal and child health demonstration and methods for controlling the intermediate hosts; to improve training centre in Tunis; to expand the maternal and child health education, environmental sanitation and the treatment health programme as an integral part of the general public of bilharziasis; and to draw up a programme for training health programme; and to train professional and auxiliary professional and auxiliary personnel. personnel.

Syria 16Rural Health Unit (Jan. 1958 - 1968) EPTA Tunisia 15Favus Control (Nov. - Dec. 1965) R To establish in a rural area a model health service that will WHO provided a consultant for one month to assist the be used for demonstration and teaching, with a view to the Government in studying the problem of tinea capitis (favus) and future expansion of rural health services. the use of griseofulvin in its control, particularly in schoolchildren.

Syria 30Public Health and Endemic Diseases Laboratory Tunisia 18Environmental Health (Oct. 1959 -1967) R (May 1962 - end of 1970) EPTA UNICEF To develop the services of the public health and endemic To develop a national programme of environmental health diseases laboratory, and particularly the food microbiology and to train personnel for the purpose. section.

Tunisia 22Institute of Ophthalmology, Tunis yria 37Nursing Education, Damascus (Nov. 1957 - Dec. 1964) R (Nov. 1960 - end of 1970) R UNICEF The aim was the establishment of a virology research labor- To set up a national school of nursing that will provide the atory at the Institute of Ophthalmology, Tunis, the formation country with better -qualified nurses and thus contribute to and training of laboratory staff and the development of a raising the standard of nursing education and nursing services. programme of research on the causal agents of trachoma and related infections. WHO provided a virologist from November- 1957 to December 1964 and a laboratory technician from yria 39Training of Sanitarian November 1959 to July 1961.In addition to the in -service (July 1962 - end of 1967) EPTA training they received in the laboratory, key members of the national staff, including a physician -virologist and laboratory To provide a training course for sanitarians. technicians, were awarded fellowships for training at the Pasteur PROJECT LIST: EASTERN MEDITERRANEAN 199

Institutes in Paris or Lille. WHO also provided supplies and Tunisia 201Fellowships EPTA: Nursing education (twelve equipment. \months), sanitary engineering (three months). The programme of research was planned and implemented in accordance with the development of the laboratory installa- United Arab Republic 25Malaria Eradication (Preparatory tion and training of the staff.It included the isolation and Stage) (Oct. 1965 -beyond 1966)MESA culture in embryonate eggs of thirty -six Tunisian strains of the trachoma agent and of one strain of sheep abortion agent, a To undertake the preparatory work prior to implementing closelyrelated member of the psittacosis -lymphogranuloma a malaria eradication programme. venereum- trachoma (PLT) group of organisms; studies of the etiologic relationship between trachoma and inclusion con- 1 United Arab Republic 27High Institute of Public Health, junctivitis and of techniques for the serologic diagnosis of Alexandria (Jan. 1958 -end of 1968)R these diseases; studies of techniques for laboratory screening of therapeutic agents, etc.Several reports on these studies To develop the High Institute of Public Health so that it have been published in the WHOBulletin. may achieve its main objectives of advancing the knowledge and In January 1965 the Government took over full responsibility training of professional level health workers in all fields of for the functioning of the laboratory and entered into an agree- public health, promoting research and field work, and solving ment with WHO for the development of a trachoma research practical health problems in the United Arab Republic. programme of internationalinterest, supplementary to the national research programme of the laboratory. This constitutes United Arab Republic 30Premature Infants' Unit the new project Inter -regional 231, for which WHO is providing (Feb. 1964 - Dec. 1965) R UNICEF a virologist, equipment and supplies. To improve health services for infants and children, and particularly the care of the new -born and of premature infants, VTùnisia 27Medical Education (Jan. 1961- 1968)R EPTA by helping mothers to understand and meet the health needs of their new -born infants and training health personnel in the To set up the first medical school in Tunisia, and to organize care of premature infants in hospital and at home. a medical course, starting with the preclinical sciences.(See page 179.) United Arab Republic 37Virology Research Laboratory (April 1963 -1967)R Tunisia 29Readaptation and Medical Rehabilitation Centre `ç To develop the Central Virology Research Laboratory at (Feb. 1961 -1967) EPTA the Agouza Laboratories in Cairo. To set up a medical rehabilitation programme for the physically handicapped; and to train medical and paramedical per- United Arab Republic 38Centre forSanitary Engineering sonnel. Research, University of Alexandria (Oct. 1958 -end of 1969)EPTA

/Ç Tunisia 31Training of Health Personnel (June 1964 -1970)R To organize a laboratory and centre for sanitary engineering research and to strengthen the teaching of the subject. To prepare qualified nurses for nursing instructor posts in order to meet the demand for education and training pro- United Arab Republic 44Concentrated Sera Production Plant grammes. (1957 -1967) EPTA To set up a purified and concentrated sera production unit 'Tunisia 33Training Centre for the Repair and Maintenance of in the central laboratories in Agouza. Medical Equipment (Jan. 1963 -end of 1967)EPTA To train personnel in the repair and maintenance of medical United Arab Republic 49Bilharziasis Control Pilot Project and apparatus. Training Centre (Jan. 1961 -end of 1968)R UNICEF To test measures for controlling bilharziasis, so as to find Tunisia 34Nursing Education (Oct. 1965-1970)EPTA those cheapest and most effective under conditions in the United Arab Republic. The project is to be developed to serve To organize courses to prepare qualified nurses for adminis- as a field demonstration and training centre for the Region. trative posts in nursing services. United Arab Republic 50Nursing Education Tunisia 35Cancer Control (May 1964 -end of 1967)R (Aug. 1961 -end of 1967)EPTA UNICEF To set up in Tunis a Cancer Institute for the diagnosis, treat- To prepare graduate nurses to assume responsibilities for ment and follow -up of cancer cases in the whole country. improving nursing services and nursing education throughout the country by a pilot project at the Ahmed Maher Hospital and School of Nursing. Tunisia 200 Fellowships R: Anaesthesia of children (six months), encephalography (twelve months), morbid anatomy (twelve United Arab Republic 59Sewage Disposal months), nursing (two for twelve months, one for fourteen (Nov. 1964 - Feb. 1965) EPTA months), plasma freeze -drying (six months), pneumo- phthisio- logy (three months), public health practice (one month), radio- WHO provided a consultant in sanitary engineering who isotopes indiagnosis(sixmonths), undergraduate sanitary visited the sewage disposal works of the principal cities of engineering studies (three months), urology (twelve months). the United Arab Republic and studied some of them in detail. 200 THE WORK OF WHO, 1965

He made recommendations for improving the operation and Yemen 201Fellowships EPTA:Sanitation(sixmonths), maintenance of sewage -disposal works, for the design of new undergraduate medical studies (two for twelve months), under- works, and for a model sewage -disposal and water -supply graduate pharmacy studies (twelve months). project for Aswan and Luxor. N`CEMRO 7Arab States Training Centre for Education in Com- United Arab Republic 60Higher Institute of Nursing, Cairo munity Development, Sirs -el- Layyan University (Sept. 1965 -1970) R (Jan. 1953 - end of 1968) EPTA (UN) (FAO) (ILO) (UNESCO) To develop a four -year degree programme in basic nursing, so as to prepare nurses for leading posts in nursing education, To integrate training in the health education and public administration and services. health aspects of community development into the programme of the Centre, which trains community development workers United Arab Republic 200Fellowships R: BCG vaccine produc- from Arab States.Emphasis is given to the preparation of tion (three months), human genetics (six months), nutrition physicians, nurses, sanitarians, teachers and agricultural and diploma course(thirteen months), preparation of tetanus social workers. This is primarily a UNESCO- assisted project, cultures and tetanus toxoid (four months), public health nutrition in which WHO collaborates and provides training in health (twelve months), public health planning (one month), radiation subjects. protection (three months), tuberculosis (five months). EMRO 23Dental Health (1964 -1966) R United Arab Republic 201Fellowships EPTA: Epidemiology To advise various countries in the Region on the establishment two months), medical documentation and libraries (two months), of dental health and dental care programmes. occupational health (two months), rural health (two months), school health services (two months), training of medical, paramedical and auxiliary personnel (two months). EMRO 43Advisory Services (1958 - beyond 1967) R To provide countries of the Region with consultant services Yemen 3Public Health Adviser (Jan. 1961 - beyond 1967) R on subjects for which there is no regional adviser, in cases where To organize health and medical care services at the central it is impracticable to obtain assistance from headquarters staff. level and to improve the public health services generally. EMRO 45Participation in Educational Meetings Yemen 4Malaria Pre -eradication Programme (April 1959 - end of 1966) R (Oct. 1964 - end of 1965) R MESA To enable countries of the Region to participate in seminars, To undertake the gradual development of the network of conferences and training courses organized in other regions rural health services and the building -up of the technical, and by other agencies. administrative and operational facilities required for a malaria eradication programme.This project, which was suspended EMRO 51Epidemiological and Statistical Centre at the end of 1965, will be reactivated when the administrative (Jan. 1960 -1967) R situation permits. WHO provided a malariologist, fellowships, supplies and To assist in carrying out surveys in connexion with tuberculosis equipment, and assistance with local costs. and other projects in the Region and in analysing their results, and to advise on the planning and assessment of health programmes. Yemen 8Health Centre and Training School, Sana'a (July 1956 - end of 1968) EPTA EMRO 55.01 Medical Libraries To establish a health centre and training school in Sana'a (Dec. 1960; March - June 1961; Nov. 1962 - end of 1966) R in order to provide training for auxiliary health personnel (including assistant sanitarians, assistant nurses and laboratory To provide books and periodicals to meet the most urgent assistants), to demonstrate modern practice in the prevention needs of medical libraries in the Region. and cure of some diseases and the control of communicable diseases, to assist the promotion of health, and to facilitate the`Ç$MRO 55.02Course for Medical Librarians (1964 -1966) R organization of public health services. To provide persons engaged in medical library work with - Yemen 15Local Health Services, Hodeida and Tain training in general and medical librarianship. (Nov. 1963 -1967) R UNICEF In 1965, a ten -week course was organized at the American University of Beirut. WHO provided lecturers and fellowships To organize two health centres -one in Hodeida and one in to ten trainees from Iran, Iraq, Pakistan, Turkey and the United Taiz -to provide integrated health services to the community, Arab Republic. and to train various categories of auxiliary health personnel. EMRO 56Community Water Supply (tv,,,emen 200Fellowships R: Hospital administration (three for (Oct.1961 - Dec. 1964)Special Account for Community elve months), laboratory techniques (three for nine months), Water SupplyUNICEF nursing (three for twelve months), sanitation (three for six months), statistics (two for seven and a half months), tuberculosis The aim was to assist in developing the organization and (three months), undergraduate medical studies (nine for twelve management of community water supply programmes and to months), undergraduate pharmacy studies (one for nine months, provide advice on the technical, legal, financial and administrative three for twelve months). aspects. WHO provided to West Pakistan a sanitary engineer PROJECT LIST: EASTERN MEDITERRANEAN 201

for two years, a sanitarian for one month, three consultants, helping the inhabitants to accustom themselves to new facilities, eachfor two months, and supplies and equipment. Pipes and and increasing the participation of the health authorities in other equipment for rural water supplies were provided by the planning of housing programmes. UNICEF. In 1961, advice was given on the setting -up of a community water supply organization. No authority has yet been estab-r-- EMRO 76Pharmaceutical and Medical Stores Adviser (Jan. 1963 -end of 1966)R lished, but many of the suggestions made have been followed. Advice was also given on the design and construction of water To assist governments of the Region in organizing medical supplies. New design standards for community water supplies, stores and pharmacy services for the whole of their countries. which took into account the need for different design standards Under this project help is given in training pharmacy attendants according to the size and sanitary development of the towns and medical storekeepers, improving the procedures for procuré- and villages concerned, were approved early in 1962. Assistance ment, storage and distribution of medical stores and pharma- was rendered in the preparation of a loan request to the United ceuticals, drafting pharmaceutical legislation, and improving States Agency for International Development in connexion the quality control and the local production of pharmaceuticals. with urban water supplies. The loan, which was approved in 1964, covers the purchase of pipes and other equipment for EMRO 84Medical Education (Jan. 1965 -1967)R five urban water supply systems and the services of a firm of consulting engineers to assist in their design and supervise their To assist countries in the Region in developing undergraduate construction, as well as to assist in the study and design of and post -graduate medical education, and in establishing new over twenty other water supply and sewage disposal projects. medical faculties. Assistance to West Pakistan in the development of water supplies and sewage disposal facilities is being continued under vC EMRO 90Regional Courses on Cancer Control project Pakistan 54 (see above). (April 1964 -1966)R

EMRO 58Malaria Eradication Evaluation Team To organize for cytologists, at the Cancer Institute of Teheran, a regional course in the early detection of cancer. A preliminary (April 1961 -beyond 1967)R MESA study was made by a consultant in 1964. The first course took To assist the Governments of Cyprus, Iran, Iraq, Jordan, place from June to September 1965 and another course is Lebanon and Syria to evaluate their malaria eradication pro- planned for 1966. grammes and to co- ordinate their activities, particularly with regard to frontier malaria problems. EMRO 100Joint FAO /WHO Seminar on Industrial Canteen Feeding in the Near East, Alexandria , \ EMRO 61Courses for Laboratory Technicians (1I -24 Oct. 1965) R (FAO) (May 1962 -end of 1967)R See page 131. To prepare laboratory technicians from a number of countries of the Region for teaching and supervisory responsibilities.' EMRO 123Advanced Course on Cholera Bacteriology, Teheran

The second course, which started in October 1964, is being (2 -1I Oct. 1965) R held in Beirut, where the first course was also given. To train leading bacteriologists and public health workers from Eastern Mediterranean countries in the latest methods of EMRO 62Regional Course for Medical Radiology Technicians detection, diagnosis and treatment of cholera. (Nov. 1965 -end of 1967)EPTA WHO providedthreeconsultantsinepidemiology and To train instructors in X -ray techniques. The course is being microbiology, supplies and equipment, and the cost of attendance held at the Radium Institute, Baghdad. of twelve participants from Iran, Iraq, Jordan, Kuwait, Lebanon, Sudan and Turkey. An additional participant from Turkey attended at the expense of his Government. EMRO 63.02Training Course for Psychiatric Nurses (Jan. 1962 -end of 1966)R EMRO 200Fellowships R To train nurses of the Region in psychiatric patient care and mental health techniques at the Lebanon Hospital for Mental (a)International Children's Centre Courses and Seminars and Nervous Disorders, Asfourieh, Beirut. Course on Public Health as applied to Infancy, Tunis (5 April -

1 May 1965): Two four -week fellowships for trainees from EMRO 66Health Aspects of Housing (Sept. 1962 - Dec. 1964) R Syria and Tunisia. Seminar on Nutrition in Infancy, Teheran (10 - 14 April 1965): The aim was to study the health aspects of housing pro- Three one -week fellowships for trainees from Lebanon, Syria grammes, to determine the role of the health authorities in and Tunisia. housing matters, and to make general recommendations for Seminar on Tuberculosis in Infancy and Childhood, Damascus future action. WHO provided two consultant engineers who (1 - 8 Sept. 1965): Two one -week fellowships for trainees from made surveys, lasting one month in each country, in Ethiopia, Iran and Lebanon. Iran, Iraq, Sudan and the United Arab Republic. On the basis of their findings, the consultants advised the (b)Sanitary Engineering Training countries concerned on such matters as the planning of rural Two twelve -month fellowships for trainees from Iraq and housing so as to ensure adequate sanitation as well as comfort, Sudan and a sixteen -month fellowship for a trainee from Syria. WESTERN PACIFIC

ustralia 200Fellowships R: Clinicalpathology(twelve Brunei 3Malaria Pre -eradication Programme months), nursing education (three months), virus vaccine testing (May 1962 - end of 1965) R (twelve months). To build up the operational facilities for a full eradication programme, which is planned to start in 1966. British Solomon Islands Protectorate 2Malaria Eradication Pilot Project (Sept. 1961 - Dec. 1964) R EPTA (South Pacific Commission) Cambodia 1Malaria Pre -eradication Programme (July 1962 -1968) R MESA EPTA The aim was to demonstrate the feasibility of interrupting transmission of malaria by the use of residual insecticides and To build up administrative and operational facilities to the drugs. WHO provided a malariologist, an entomologist and an level required for the implementation of a full malaria eradication engineer, and fellowships, supplies and equipment. programme; to complete an epidemiological survey of malaria; The project covered a population of 35 000 in the islands of and to train national technical staff for the eradication pro- Guadalcanal and New Georgia. DDT was applied at 2 grams gramme. per square metre twice a year, starting in February 1963. The pre -eradication programme continues the antimalaria Chloroquine combined with pyrimethamine was given at the operations with which WHO has been assisting (under the same time of spraying and for presumptive treatment.It appeared project number) since October 1950. that interruption of transmission was achieved in New Georgia by the end of 1963, at which time active and passive case - Cambodia 3Nursing Education, Phnom -Penh detection of malaria cases was instituted.Similar results were (Dec. 1951 -1966) R UNICEF (Asia Foundation) (Colombo recorded in several areas of Guadalcanal, although trans- Plan) mission persisted elsewhere in the island, owing mainly to the importation of parasite carriers from unprotected areas outside To establish a school of nursing in Phnom -Penh; and to the project.The training of national staff was carried out organize nursing and midwifery training. locally by the WHO staff and abroad through WHO fellowships.The South Pacific Commission assisted in the health education aspects.The participation of the public was good. Cambodia 4Maternal and Child Health Advisory Services There were some initial drawbacks, caused mainly by communi- (Second phase: May 1962 -1968) EFTA UNICEF (Asia cation difficulties and the scarcity of local staff. Foundation) The results achieved indicated that under the local epidemio- To develop a national maternal and child health programme logical conditions interruption of transmission was feasible. and to improve school health services. On completion of the pilot project, the Government embarked on a pre -eradication programme (see below). imbodia 5Royal Faculty of Medicine, Pharmacy and Para- medicalSciences,Phnom -Penh(July1953 - April1965) British Solomon Islands Protectorate 2 Malaria Pre- eradication EPTA (French Economic Mission) Programme (Jan. 1965 -1969) R EPTA (South Pacific Com- mission) The aim was to raise the standard of medical teaching at the Faculty to professional level and to increase facilities for the To develop the operational, technical and administrative training of auxiliary personnel. WHO provided fourteen facilities of the malaria and public health services, so that a consultants, in biochemistry, clinical medicine, medical physics, country -wide malaria eradication programme can be imple- morbid anatomy, ophthalmology, physiology, radiology and mented later. school health, for periods ranging from two to eleven months. Four long -term and three short-term fellowships for study abroad were awarded to faculty members, and fifty local fellowships were Iritish Solomon Islands Protectorate 3 Nursing Education awarded between 1955 and 1958. Supplies and equipment were (Nov. 1959 -1971) R UNICEF (South Pacific Commission) also provided. To carry out a basic programme of general nursing for nurses The Faculty developed from a health officers' school, set up and medical assistants, and a programme of midwifery and in 1946 to help to overcome the shortage of medical personnel. maternal and child health combined with the nursing programme In 1953 this school was upgraded to become the Royal School. for women nurses. of Medicine, which, in March 1962, was transformed into the Royal Faculty of Medicine, Pharmacy and Paramedical Sciences, offering five courses- degree courses in medicine and pharmacy, ritish Solomon Islands Protectorate 7Rural Health Services and diploma courses in medicine, pharmacy and dentistry for (Oct. 1965 -1971) EPTA UNICEF auxiliaries. The main problem is lack of adequate human and material To expand and strengthen the network of local health services resources, creating difficulties particularly as regards staffing and to train auxiliary health personnel. and the provision of adequate facilities and equipment for - 202 - PROJECT LIST: WESTERN PACIFIC 203

teaching purposes. The teaching staff consists of visiting profes- economic development plan, and that the training of health sors provided by the French Economic Mission or by WHO, laboratory technicians willstartas soon as administrative and Cambodian and expatriate physicians. The acute shortage arrangements have been completed and statutory requirements of doctors and the great demand for medical care, which result satisfied. in lucrative private practice, make recruitment of full -time staff difficult.Most of the local staff are part time and the school, unlike most medical schools, is not organized into departments. Cambodia 19Environmental Sanitation Training The first group of fully qualified doctors graduated in 1963 and (April 1965 -1968) EPTA it is expected that, as the number of graduates increases, further To train a cadre of sanitarians for environmental sanitation expansion and upgrading of the country's medical and health work in the viirgiiiira towns. services will become possible.

China 7Malaria Eradication, Taiwan Cambodia 7Tuberculosis Control (May 1952 - Dec. 1964) MESA (May 1965 -1969) R UNICEF To complete the eradication of malaria from Taiwan by the To set up the nucleus of a national tuberculosis control service use of residual insecticides and antimalarial drugs and by an with emphasis on preventive and public health work; and to effective surveillance system. (See page 137.) carry out an effective control programme, so as to reduce, and finally to eliminate, the infection as a public health problem. China 20Mental Health Programme, Taiwan (Second phase: March 1965 - ) R (AID) (Asia Founda- Cambodia 9Rural Health Training Centre, Takhmau tion) (Jan. 1957 -1967) EPTA UNICEF (UNESCO) (Asia Founda- tion) To establish a post -basic training programme for psychiatric social workers as an integral part of a mental health programme. To plan and implement a comprehensive provincial health programme; to build up model public health services in Kandal Province; and to give field training to all categories of profes- China 27Institute of Public Health, Taiwan sional and auxiliary health personnel at the Takhmau centre. (Aug. 1958 - 1967) R (China Medical Board) To strengthen the training at the Institute of Public Health, Cambodia 13Nursing Administration (Nov. 1963 - 1970) R particularly in epidemiology and public health practice. To survey and evaluate training resources, and prepare short- term and long -term plans for meeting the nursing needs of the China 34Trachoma Control, Taiwan health services; to organize and improve nursing services and (Jan. 1960 -1968) R UNICEF education programmes throughout the country; and to review nursing legislation, personnel policies, and terms of service. To carry out an island -wide study of the prevalence, distribution and relative gravity of trachoma, and of environmental and other factors influencing the transmission of the disease; to \iSCambodia 14Institute of Biology, Phnom -Penh develop a comprehensive control programme based on existing (Aug. 1962 - Dec. 1964) EPTA (Asia Foundation) health services with the objective of reducing trachoma to a level at which it will no longer be a major public health problem, The aim was to strengthen the Institute of Biology, to plan and of preventing disabling complications and sequelae. the expansion of health laboratory services and to organize training courses for various categories of laboratory personnel. WHO provided a medical officer (public health laboratory China 36Community Water Supply and Sewerage, Taiwan adviser). (Jan. 1963 -1968) EPTA A plan for reorganization of the health laboratory services of the Institute of Biology was drawn up. It included provision To follow up the recommendations made in 1961 by a WHO for the construction of building annexes as envisaged in the team of water supply consultants in connexion with the improve- Government's first five -year plan.Plans were made for the ment of community water supply and sewerage; to review and installation of side -room clinical laboratories in provincial amend as necessary national and provincial legislation pertaining hospitals and four such laboratories were equipped with to community water supplies; to develop techniques for financing UNICEF assistance. A proposal was prepared for the establish- and administering water supply and sewerage programmes, so ment of a course for training a cadre of health laboratory as to make the programmes self -supporting; to stimulate regional technicians.In -service training was given to health laboratory planning of water supply schemes; to initiate training pro- personnel at the Institute of Biology, the rural health training grammes; and to co- ordinate activities relating to community centre at Takhmau,- and provincial hospital laboratories. A water supply with other sectors of the nation's economy (industry, laboratory manual for the use of health laboratory staff of the agriculture, etc.) which are directly concerned with the use and Institute and of provincial laboratories was prepared and is allocation of water resources. being published with the help of the Asia Foundation. Technical assistance was given in the conduct of microbiological work of China 45RehabilitationProgrammeforDisabledLeprosy the Institute. Patients, Taiwan (Nov. 1965 - 1966) R WHO assistance permitted the detection of the El Tor cholera outbreak in 1963 and the provision of laboratory support during To assess the rehabilitation services needed for leprosy the epidemic. patients; to establish a training and demonstration pilot project It is expected that laboratory facilities at the Institute of for rehabilitation; to prepare a plan for a national rehabilitation Biology will be expanded under the second national socio- programme; and to train personnel. 204 THE WORK OF WHO, 1965

China 46PublicHealthAdministrationAdvisoryServices, Japan 200Fellowships R: Airport quarantine services (three Taiwan (July 1965 - 1968) R months), blood bank services (three months), care of mentally retarded adults (three months), chronic disease control (ten To set up in the Provincial Health Department an epidemio- weeks), community health organization and health centres logical service that will include laboratory facilities; to study (three months), fluorescent antibody techniques (nine months), local epidemiological patterns of prevailing causes of morbidity food poisoning control (three and a half months), health and mortality, in order to establish a basis for planning specific education(three months), healthservicesinplanning of disease control programmes; and to develop procedures, suited new towns (three months),hospital administration -chest to local conditions, for the investigation, diagnosis, control and disease hospitals (three months), medical electronics- applica- prevention of the most prevalent communicable diseases. tion in medical services (three months), medical and psychological treatment of delinquent girls(three months), mental health- diagnosis of mental retardation (three months), narco- \ISZChina47Occupational Medicine, Taiwan tics control (four months), protein deficiency research (three (Nov. 1965 - March 1966) R months), social insurance (three months), virus disease control To assess present and potential occupational health hazards (three months), vital and health statistics (four months), waste and plan for their prevention and control; to develop the and garbage disposal in urban areas (three months), water supply Division of Occupational Health in the Provincial Health and water pollution control services (three months), water Department; and to plan a training programme for officers in supply planning (three months). the occupational health service. Korea 4Leprosy Control (Nov. 1961 - 1967) EPTA UNICEF `r China 200Fellowships R: Drug control (four months), food To improve the leprosy control programme by co- ordinating and drug control(six months), industrial hygiene (twelve the present control work, providing health education, and months), microbiology -bacterial flora and bacterial diseases training medical and other personnel concerned with leprosy of mosquitos (six months). f control. Cook Islands 200Fellowships R: Paediatrics (six months). Korea 13Malaria Pre -eradication Programme (Jan. 1962 -1967) R Fiji 2Fiji School of Medicine, Suva (Feb. 1955 -1967) R (China To survey the malaria situation, organize a national malaria Medical Board) service and train staff, so as to enable an eradication programme To train assistant medical officers for government service in to be planned and implemented. Fiji and adjacent territories, and to strengthen the staff of the This programme follows the pre- eradication survey that School of Medicine. began in June 1959.

Korea 15National Institute of Health, Seoul Fiji 200 Fellowships R: Nursing administration (twelve months), (Dec. 1960 -1967) R UNICEF physical therapy (two for twelve months). To strengthen the Department of Training and Surveys of the National Institute of Health (formely the National Institute Gilbert and Ellice Islands 4Nursing Education (Feb. 1964- for Public Health Training) which trains staff for the local 1968) EPTA UNICEF health services. To develop training programmes for preparing nursing and midwifery personnel for the hospital and health services. Korea 19Tuberculosis Control (March 1962 -1968) EPTA UNICEF `)`Hong Kong 200Fellowships R: Communicable diseases (three To develop an effective and comprehensive tuberculosis months), dental nursing (one for sixteen months, two for twenty - control programme, so as to reduce, and finally to eliminate, eight months), diarrhoeal diseases (three months), infectious the infection as a public health problem. diseases -cholera, plague and smallpox (three months), public health administration (twelve months). Korea 25Local Health Services, Chungchong Namdo (March 1963 -1968) R UNICEF NO\Japan23Medical Rehabilitation (Oct. 1962 - Aug. 1963; May 1964 -1969) R To strengthen the organization of the health services at variouslevelsina demonstration province (Chungchong To raise the standard of teaching at the physical and occupa- Namdo), with the ultimate objective of strengthening the tional therapy school set up in 1963; to give in- service training country's local health services. to physical and occupational therapy personnel; to train a nucleus of senior physical and occupationaltherapists,in conformity with internationally accepted standards, for teach- Korea 200Fellowships R: Food sanitation (six months), leprosy ing posts in other similar schools to be established in the control (six months), nursing (six weeks), public health adminis- future; to modify procedures for the admission and classifi- tration (three for twelve months), reconstructive surgery in cation of patients at rehabilitation centres to enable rehabili- leprosy (twelve months), tuberculosis control (twelve months), tation measures to be undertaken more quickly. X -ray techniques (two for six months). PROJECT LIST: WESTERN PACIFIC 205

Laos 2Central Public Health Laboratory, Vientiane Malaysia 20Malaria Pre -eradication Programme, Malaya (Jan. 1953 - Aug. 1959; Nov. 1960 -1968) EPTA (July 1964 -1968) R To establish a public health laboratory service and train To build up administrative and operational facilities to the laboratory personnel. level required for the implementation of a full malaria eradication programme; to complete an epidemiological survey of malaria; and to train national technical staff for the eradication pro- Laos 6Maternal and Child Health Services gramme. (Sept.1959 -1969) R UNICEF (AID) (Asia Foundation) The pre -eradication programme continues the antimalaria (Colombo Plan) (Tom Dooley Foundation) operations with which WHO has been assisting (under the same project number) since February 1960. To ascertain the principal maternal and child health needs in Laos and set up training programmes; to expand and improve maternal and child health services as an integral part of the general health programme. Malaysia 21Training Institutions (Clinical Pathology), Malaya (Nov. 1960 - 1966) R To raise the standard of training in clinical pathology at the Laos 9Public Health Administration Advisory Services Institute for Medical Research, Kuala Lumpur, and to train (April 1961 - end of 1965) EPTA at the Institute sufficient laboratory technicians for the research To survey health conditions and prepare long -range national institutes and thé clinical and diagnostic laboratories of the health plans; to develop a programme of work appropriate to larger hospitals. local conditions, and to organize the operation of the national health administration at the central and local levels. Malaysia 30HealthEducationAdvisoryServices,Malaya (Jan. 1962 -1969) R Laos 10Rural Health Development (March 1961- 1972) EPTA UNICEF (UN) (FAO) (ILO) To survey the health education work at the national and state (UNESCO) (Colombo Plan) levels, in order to evaluate the effectiveness of present methods of health education and recommend improvements. To provide practical training courses in nursing and midwifery and in sanitation; to promote and develop environmental sanitation; and to carry out maternal and child care, and Malaysia 32Nursing Education, Malaya nutrition and health education activities adapted to the local (Aug. 1962 - 1970) EPTA conditions. Work carried out under this project is a part of the programme, To assess the education programmes for nurses and nursing assisted by the United Nations, for the economic and social needs and resources; to develop the programme and the associa- development of the rural population.It is planned to set up ted clinical practice fields so as to meet the country's require- four centres in rural areas, with staff from the participating ments in nursing personnel; and to improve the quality of agencies. nursing education by in- service training, refresher courses, special courses for local registered nurses and courses to prepare nursing personnel for administrative and teaching posts. aos 12Nursing Education (March 1962 -1968) EPTA UNICEF (AID) (Asia Founda- tion) (Colombo Plan) 4alaysia 34Environmental Health (Nov. 1965 - 1968) EPTA To set up a school of nursing and midwifery for training To establish sanitary engineering services in the Ministry of personnel for the country's hospital and health services, which Health, and advisory and supervisory services in the medical are to be extended and improved. and health offices of the states of Malaysia; to carry out environmental health programmes in urban and rural areas; and to train personnel. Laos 13Hospital Administration (April - June 1965) R WHO provided a consultant for ten weeks to advise on hospital administration practices and to assist in drawing up plans Malaysia 35Strengtheningof RuralHealthServicesand for the construction of hospitals. Training of Health Personnel (Jan. 1964 -1968) R UNICEF To strengthen the organization and administration of the Malaysia 14Hospital Administration, Malaya rural health services and to expand facilities for training staff (May 1956 - June 1966) EPTA for them; and to plan a comprehensive environmental health programme. To review the hospital administration system and to provide training for non -medical hospital administrators.. Malaysia 39Community Water Supply Programme, Malaya Malaysia 15Hospital Records and Health Statistics (Jan. - March 1965; Nov. 1965 - Jan. 1966) Special Account (May 1957 - ) EPTA (Colombo Plan) for Community Water Supply To reorganize the hospital records system; to develop vital Two consultants provided by WHO from Januaryto and health statistical services on a trial basis; and to train medical March 1965 assisted the Public Works Department to review records officers through courses and fellowships abro - the operation of water treatment plants, to assess their effective- 206 THE WORK OF WHO, 1965

ness and to make recommendations on any improvements Philippines 4Mental Health Advisory Services required. Courses for water treatment works operators were (Nov. 1949 - Jan. 1950; Jan. 1953; Feb. 1957 - Dec. 1960; also arranged. Sept. 1963 -1968) R In November 1965 a team of three WHO consultants started a three -month assignment, during which they will provide advice To develop a mental health programme for the whole country. and assistance in connexion with water purification. Philippines 43Environmental Health Advisory Services laysia 40University of Malaya(Sept.1965 -1970) R (June 1955 - March 1961; Sept. 1962 - March 1963; Dec. 1963 - 1967) R To strengthen the teaching staff of the Faculty of Medicine of the University of Malaya, particularly in the fields of preven- To reorganize the central and regional environmental sanita- tive medicine and public health. tion services.

Malaysia 42Malaria Eradication Programme, Sabah Philippines 43 -FManila Sewerage (July 1961 - 1968) R EPTA UNICEF (May 1965) Special Account for Community Water Supply To eradicate malaria from Sabah. The eradication programme WHO provided two consultants to assist the Government in follows antimalaria operations for which WHO has provided preparing a request to the United Nations Special Fund for the assistance since July 1955. preparation of a master sewerage plan for the Manila metropolitan area. These sewerage facilities are more urgently required in Malaysia 43Malaria Eradication Programme, Sarawak view of the recent increase in the metropolitan area water supply, (Oct.1961 - 1968) R EPTA UNICEF which will result in an increase in the amount of waste water. To eradicate malaria from Sarawak. This follows the malaria pilot project started in 1952. Philippines 50Virology Centre (Sept. 1965 -1966) EPTA UNICEF Malaysia 56 Community Water Supply Programme, Sabah To build up a diagnostic laboratory and referral centre for the (March - June 1965) Special Account for Community Water identification of viral agents of disease; to extend technical Supply services to the Disease Intelligence Centre and other units of the Department of Health in connexion with the epidemiological WHO provided a consultant to advise on community water study and control of virus diseases; to train professional and treatment problems, to organize and conduct training courses non -professional workers in virology; and to strengthen the in the operation and control of water treatment works, and to Alabang laboratory to enable it to function as a control labora- assist in the design of specific treatment plants. tory for the production of virus vaccines.

Malaysia 67Medical Library Services, Malaya Philippines 51Environmental Sanitation Training (Nov. 1965 - Feb. 1966) R (June 1958 -1966) R UNICEF (AID) To set up a co- ordinated medical library system at the levels To organize an advanced training programme forni of the Ministry of Health and the chief medical and health inspectors and to demonstrate environmental sanitation work officers of the states and at certain hospitals. in a selected area.

Fellowships R: Malaya - paramedical staff train- ysia 200 Philippines 53Malaria Eradication Programme ing (two weeks), public health nursing (six months). (Aug. 1956 -1969) R (AID)

ysia 201Fellowships EPTA: Malaya -general medicine, To implement the plan for eradicating malaria from the with emphasis on clinical cardiology (six months), traumatic country. surgery and recent advances in general surgery (six months). Philippines 59Paediatric Nursing New Hebrides 4Tuberculosis Control (March 1962 -1966) EPTA UNICEF (June 1964 -1966) EPTA UNICEF To extend and improve the health services, particularly as To expand and improve the tuberculosis control service; to regards the promotion of health and prevention of disease and carry out a systematic tuberculin testing and BCG vaccination the provision of adequate nursing care for children; to establish campaign throughout the Condominium; to treat all cases, closer co- ordination and integration of the promotional, preven- mainly at home under supervision; to take measures to protect tive and curative services at all levels. the healthy; and to provide chemoprophylaxis for tuberculin reactors among family contacts under five years of age. Philippines 69Tuberculosis Control (Oct. 1963 -1968) R UNICEF 4 ew Zealand200FellowshipsR: Public Health administration To determine whether tuberculosis control plans based on the two for four months). data already obtained are practical, productive and suitable for local conditions; to investigate, in controlled groups, specific Papua and New Guinea 200Fellowships R: Health education developments in BCG vaccination, case- finding and chemo- (twelve months), surgery of oral cancer (four months). therapy, particularly as regards their economy and acceptability; PROJECT LIST: WESTERN PACIFIC 207

to provide facilities for training various categories of health Ryukyu Islands 1Malaria Eradication Programme personnel; and to obtain data on which to base the integration (July 1962 - April 1965) R of tuberculosis control work into the national public health programme. The aim was to complete the eradication of malaria from the country. WHO provided assistance through the visits of regional advisers, by the assignment of a short -term consultant in 1962, Philippines 71Physical Therapy and Occupational Therapy, and by awarding fellowships for malaria workers to study modern Manila (July 1961 - Dec. 1966) EPTA UNICEF eradication techniques abroad. Before and immediately after the Second World War, the To organize, at the University of the Philippines, collegiate malaria incidence in the Ryukyu Islands was very high. Following courses for trainin h sical therapists and occupational thera- the implementation of antimalaria work, the disease gradually pists, and toevelop professional standards; and to provide decreased in the Okinawa and Miyako groups of islands. In 1957 in- service training for sub -professional workers. (See page 137.) a malaria scheme aiming at eradication was initiated by the Government in Yaeyama. Insecticide spraying as well as drugs were used intensively and the results were very successful. The b Philippines 73School Health Education whole country is considered now to be in the maintenance phase. (Oct. 1963 -1967) EPTA UNICEF A WHO certification team, consisting of a malariologist, an entomologist and a public health administrator, carried out To carry out a co- ordinated school health education pro- between February and April 1965 the investigations required gramme; to train staff for the programme, and to promote closer prior to registration of eradication of malaria. The report of the co- operation among the various official and voluntary agencies team confirmed the absence of malaria in Yaeyama and Okinawa, concerned. but the data for Miyako were not considered sufficient to assess whether malaria had been eradicated. Certification of eradication for the Ryukyu Islands was therefore deferred until the absence Philippines 75Social Paediatrics (Aug. 1963 - Dec. 1967) R of malaria from the whole group of islands can be proved. To strengthen the organization of maternal and child health services at national and regional levels. Ryukyu Islands 2 Public Health Administration Advisory Services (Jan. - April 1965) R Philippines 80Pilot Project in Applied Nutrition (March 1964 -1970) EPTA UNICEF (FAO) WHO provided a consultant for three months to review the progress made by the health services and make recommendations To train personnel for an applied nutrition project; and to on their future development, and to assist in promoting maternal carry out nutrition, education programmes in schools and and child health services as an integral part of the basic health communities and through the health services. services.

Q Philippines 82National Seminar . on Public Health Administra- yukyu Islands 200 Fellowships R: Public health nursing (twelve tion, Tagaytay City (1 -12 Feb. 1965) R months), radiological techniques (twelve months). Fifty -five provincial health officers and the eight regional health directors took part in the seminar. The subjects discussed included recent trends in public health administration, adminis- " 1Smgapore 3Nursing Education (June 1952 - 1966) EPTA trative and working relationships of the provincial health officers, integration of the basic health services, personnel To improve the standards of nursing education and nursing management, supervision, technical training of staff, administra- service. tion of special disease programmes, health la of story and vital and health statistics services, programme planning and implementation, hospital administration, legal considerations in public Singapore 4Nursing Administration and Practice health practice and international collaboration. Representatives (Jan. 1956 -1968) R UNICEF of the United States Agency for International Development, the Colombo Plan and UNICEF participated in the discus- To develop programmes to prepare nursing personnel for sions on international collaboration. administrative posts in hospital and public health services and WHO provided consultants in public health administration to improve the quality of nursing practice, patient care and and public health nursing, and WHO regional office and field clinical teaching. staff led some of the discussions.

Singapore 6Midwifery Education Programme Philippines 200FellowshipsR:Immunopathology(twelve (Jan. 1959 -1966) R months), hospital administration (three months), public health To study and improvethebasicmidwiferycurriculum, administration (twelve months), public health administration, particularly as regards the clinical, public health and health edu- with emphasis on vital and health statistics (twelve months), cation aspects; to organize supplementary and refresher courses public health nursing (fifteen months). for practising midwives; to co- ordinate training programmes for midwifery students in district hospitals and to arrange facilities for their practical training; to revise the Midwives' Ordinance Philippines 201Fellowships EPTA: Dental school organization and the Rules of the Midwives' Board; and to plan and organize (three months), public health dentistry (twelve months). midwifery services. 208 THE WORK OF WHO, 1965

Singapore 10School of Radiography officer from December 1954 to July 1962 and from January 1963 (April 1963 - Aug. 1965) R (Colombo Plan) to June 1965, a public health nurse /midwife from October 1959 The aim was to set up a school of radiography in order to to August 1961 and from May 1963 to March 1964, and between meet the demand for well- trained and qualified radiographers. one and three public health nurses between February 1955 and WHO provided a lecturer in radiography and three fellowships. July 1964.Six twelve -month fellowships were awarded -two The WHO lecturer assisted in planning and organizing the in midwifery, three in public health administration with emphasis two -year course offered by the school and took part in teaching on maternal and child health, and one in maternal and child the first group of students, which was admitted in 1963. health nursing. The school has excellent classroom and library facilities. Work started with the improvement of clinical maternal and Facilities for field practice are also most satisfactory.Local child health services in Saigon, and was extended gradually, faculty members are available for teaching all phases of the first to Hué and then to the provinces. The emphasis on preven- course.It is planned to admit students from surrounding areas tive services was progressively increased.In view of the great in the near future. The school has been given temporary recogni- shortage of staff, much attention was given to training various tion by the Society of Radiographers in the United Kingdom and categories of health personnel.These included midwife tutors itis expected that full recognition will be granted shortly. to take charge of provincial schools for rural midwives (such Since the project is well established, it was possible for the schools have already been established in thirty-five of the forty- WHO adviser to complete his assignment earlier than originally five provinces), midwife supervisors for provincial hospitals, mid- lanned. wives, rural midwives and paediatric nurses. Refresher courses in paediatrics were arranged for provincial medical officers. 91 12Health Education Advisory Services With the assistance of UNICEF, maternal and child health (Aug. 1965 -1967) R services have been upgraded. By the end of June 1965 this work had covered the thirty -five schools for rural midwives, fifty -six To evaluate the health education programme, and to plan and provincial and district maternity hospitals, twenty -five paediatric carry out an expanded programme, particularly in schools, departments in provincial hospitals, six paediatric out -patient maternal and child health centres, teacher training centres and departments and fifty -three maternal and child health clinics institutions, and centres for the traíninof health and medical attached to provincial or district hospitals. A maternal and workers. child health division has been set up in the Ministry of Health, with a staff of one medical officer and five midwives and nurses, V Singapore 200Fellowships R: Food and drugtechnology who will be responsible for continuing the project. This division (twelve months), keratoplasty(sixmonths),publichealth also gives technical advice to the nutrition centre that was nursing (twelve months), radiotherapy (six months), tuberculosis established in Saigon in 1964 for the treatment of malnourished statistics (six months). children. The results of the project, which received strong support from Tokelau Islands 200Fellowships R: Public health administra- the Government, have been very satisfactory. It has been possible tion (six and a half months). to upgrade the maternal and child health services and to extend them to nearly all the provinces, where there were practically 41'onga 1Environmental Sanitation no services before the project began.The various training (March 1958 -1966) EPTA UNICEF programmes are well established and will continue under the guidance of the maternal and child health division. To strengthen environmental sanitation services; particularly to study the problems of rural and urban environmental sanitation and the social, economic and cultural factors affecting them; to plan, execute and evaluate a pilot environmental sanitation Viet -Nam 7Tuberculosis Control project and to train personnel. (See page 136.) (Jan. 1958 -1968) EPTA UNICEF To set up the nucleus of a national tuberculosis control service, Tonga 8Study and Control of Diarrhoeal and Enteric Diseases with emphasis on preventive and public health work; to complete (Oct. 1965 - ) R a national tuberculosis centre in Saigon and to integrate it in To study the etiological agents of enteric and diarrhoeal the existing facilities; to continue the UNICEF /WHO- assisted diseases in the population, and especially in young children, and BCG vaccination project and integrate it in the national tubercu- to assess their relative importance. losis control service.

\/>ronga200Fellowships R: Bacteriological techniques in the laboratory diagnosis of typhoid fever (five months), mental Viet -Nam 14Preventive Medicine health (six months), nursing administration and education (Jan. 1960 -1967) R UNICEF (twelve months), obstetrics, gynaecology and paediatrics (six To set up a communicable- disease control service, study the months), paediatrics (twelve months), public health administra- ion (six and a half months). local pattern of communicable diseases, organize a system of notification and routing of reports, and draw up a long -term plan for the control of the major communicable diseases. Trust Territory of thePacificIslands 200Fellowships R: Leprosy control (three months).

ÁViet-Nam 3Maternal and Child Health Services Viet -Nam 15Hospital Administration (Dec. 1954 - June 1965) EPTA UNICEF (AID) (Aug. 1960 - Jan. 1961; June - Aug. 1962; July 1963 -1968) R The aim was to strengthen the maternal and child health To develop a hospital system throughout the country; to service by improving and extending the existing facilities, and prepare hospital legislation and regulations to standardize to train personnel for the service. WHO provided a medical hospital records; and to implement a case registration system. PROJECT LIST: WESTERN PACIFIC 209

Viet -Nam 16Malaria Pre -eradication Programme Western Samoa 7Filariasis Control (March 1959 - 1968) R (AID) (July 1965 -1967) R UNICEF To train national staff and to make preparations for the To determine, by a pilot project, the best way of controlling implementation of a malaria eradication programme. filariasis, mainly by drug treatment, in Western Samoa; to prepare a filariasis control programme for the whole country, based on the results of the pilot project; and to train staff in let-Nam 18Health Laboratory Services filariasis survey and control techniques. \\(Feb. - June 1962; Nov. Dec. 1964; Jan. 1965 -1967) R To establish a central health laboratory service and to train health laboratory workers; later,to organize regional and Western Samoa 200Fellowships R: Assistant dental officers' peripheral health laboratory services. course (two for twelve months), assistant medical officers' course (four for twelve months), health inspectors' course (seventeen months), nursing (four for twelve months), public health Viet -Nam 20Health Education Advisory Services administration (eight months). (Jan. - May 1965) R WHO provided a consultant for five months to assist the Government in planning and organizing a national health WPRO 22Inter -country Treponematoses Team education programme; to review the health education services (Aug. 1964 -1966) R and activities, and to advise on their integration into the public To carry out an assessment of the yaws control projects in the health programmes; to recommend measures for introducing British Solomon Islands Protectorate, the New Hebrides and health education work into community health programmes; Western Samoa. and to advise on the training and functions of health education personnel at various levels. WPRO 39Antimalaria Co- ordination Board, Seventh Meeting, Viet -Nam 21School Health Ceylon (28 Oct. 1965) R (Dec. 1964 - Jan. 1965) EPTA UNICEF The meeting was attended by eight participants from Laos, A consultant was provided for two months to follow up the Malaysia, Republic of Viet -Nam, and Thailand and by observers recommendations made in a previous visit and to make a study from the United States Agency for International Development of the difficulties involved in carrying them out. He also assisted and WHO malaria staff of the South -East Asia and the Western in the preparation of a plan of operation and in the finalization Pacific Regional Offices who are assigned to the countries of arrangements for the implementation of a school health concerned. The co- ordination of the malaria the project. member countries was discussed and the action taken on the recommendations made at the sixth meeting of the Board was reviewed. iet -Nam 24Public Health Administration Training (Jan. -July 1965) R UNICEF WHO provided a consultant for seven months to assist in WPRO 72Malaria Eradication Training Centre, Manila drawing up a long -term plan for in- service training in public (Apri11959 - June 1961; Sept. 1963 - ) R (AID) health of provincial medical officers and other health personnel To provide training in the theory and techniques of malaria of the Ministry of Health. The plan included provision for a eradication for various categories of personnel needed by health demonstration centre, to be used for teaching and field countries of the Western Pacific Region and other regions. practice. The consultant also assisted in planning a national seminar on public health administration for provincial medical officers. The seminar, which was held from 22 June to 7 July 1965, was WPRO 75Regional Tuberculosis Advisory Team attended by fourteen medical officers, by twelve observers from (July 1961 - ) R UNICEF government health agencies in Saigon and the United States To assist countries of the Region in assessing their tuberculosis Agency for International Development, and by students attending programmes. a hospital administration course organized in connexion with project Viet -Nam 15.It was concerned particularly with the general principles of public health and with the relations between WPRO 79Advisory Services (1961 - ) R the different disciplines in the public health services. To meet requests from countries of the Region for advisory Viet -Nam 200 Fellowships R: Health education (twelve months). services in connexion with the planning of long -term projects or with specific problems. The following assistance was provided during the period under review: Western Samoa 6Public Health Administration Advisory Ser- vices (Aug. 1963 - end of 1965) R China (Taiwan) -Virus and Serological Work. (1) A consultant for two weeks in March 1965 to review the plans for the new To survey health conditions and prepare long -term national virus laboratory, and for three weeks in October 1965 to advise health plans, in accordance with available resources and taking on its further development; (2) a consultant from July to into account the country's overall economic and social pro- October 1965 to demonstrate and train personnel in the diagnosis gramme; and to strengthen the organization and administration of virus infections, particularly Japanese encephalitis, and to of health services at all levels. assist with diagnostic work. 210 THE WORK OF WHO, 1965

Republic of Korea -Maternal and Child Health. A consultant and administrative measures, and rehabilitation.There were for three months from December 1964 to March 1965 to assist twenty -three participants from Australia,BritishSolomon with plans for improving and developing maternal and child Islands Protectorate, Fiji, French Polynesia, Hong Kong, Japan, health services in urban and rural areas and to plan programmes Laos, Malaysia, New Caledonia, New Hebrides, Philippines, for training professional and auxiliary personnel. Republic of Korea, Ryukyu Islands and Viet -Nam, and thirteen Papua and New Guinea- Rabies Control. A consultant for four observers from Guam, the Philippines, UNICEF, the South weeks in September and October 1965 to study the rabies pro- Pacific Commission, the United States Agency for International blem and advise on a control programme, and to assist in Development, the Leonard Wood Memorial and the Inter- preparing for a seminar on rabies. national Leprosy Association. WHO provided the cost of attendance of the participants, Republic of Viet- Nam -Leprosy Control. A consultant for ten three consultants, three temporary advisers and supplies and weeks from January 1965 to review the leprosy programme and equipment. prepare plans for future work. Nutrition Manual.Production of a nutrition manual for doctors, nurses and other personnel engaged in nutrition work. WPRO 121Regional Nursing Studies Seminar, Manila The publication and printing costs of the manual were met by (2 - 30 Aug. 1965) R EPTA UNICEF. The aim of the seminar was to facilitate the solution of problems encountered in the staffing of out -patient and public health WPRO 83Maternal and ChildHealth AdvisoryServices, nursing services. The subjects studied included the principles of South Pacific Area (April 1962 - Aug. 1963; Sept. 1965 - ) staffing and the conditions influencing staffing patterns, methods EPTA (South Pacific Commission) of estimating staff requirements in local situations, and their application in determining the numbers and composition of A maternal and child health team, based in Fiji, to undertake staff necessary to implement the nursing programmes of selected assignments as required in territories of the South Pacific area. health agencies. There were thirteen participants from Australia, China (Taiwan), Japan, Malaysia, New Zealand, Philippines and Republic of Korea, and an observer from the Rockefeller WPRO 115Epidemiological Surveys of Dental Diseases Foundation. (June 1963 -1967) R WHO provided the cost of attendance of the participants, a consultant, a temporary adviser, six seminar staff members To assess the situation as regards dental diseases and resources and supplies and equipment. in dental personnel and to give training in survey methods; to analyse the data obtained in national surveys; and to make recommendations on the establishment or strengthening of dental services. (See page 138.) WPRO 135Environmental Health Advisory Services, South Pacific Area (Oct. 1965 -1968) EPTA To assist countries and territories in the South Pacific area to WPRO 120Regional Seminar on Leprosy Control, Manila improve community water supplies and environmental sanitation (21 - 28 April 1965) R in general. The seminar provided for the exchange of experience in leprosy control in the Region. In the plenary sessions lectures were given on the leprosy problem in the Region, the present WPRO 200Fellowships R To increase the number of assistant situation as regards therapy and control, leprosy epidemiology, medical and dental officers, health educators and other health the planning, organization and evaluation of control programmes, workers in the South Pacific Island territories by awarding and health education.Subjects discussed in working groups fellowships for study at the Fiji School of Medicine and other included case -finding, treatment of in- patients and out -patients institutions; and to award fellowships for studies leading to the and evaluation of progress during treatment, protection of the Diploma of Public Health in the Universities of Singapore, healthy population, the role of the health services in leprosy Otago or Sydney or to the Certificate of Public Health in the control, traini of personnel, health education, social, legal University of the Philippines. INTER- REGIONAL

Inter -regional 51Treponematoses Epidemiological Team the surveys made and follow -up programmes have been (1959 - ) R developed in several countries. To study the nature, extent and significance of treponemal infectionsbyepidemiological /serologicalrandomsample Inter -regional 70Malaria Eradication :Pool of Advisers surveys, in order to provide data for planning communicable (1961 - ) R MESA disease control and estimating the emphasis needed in con- To have available malariologists and entomologists who can tinued surveillance activities after mass treponematoses control be assigned at short notice to assist governments in planning programmes, particularly campaigns against yaws; to study and implementing eradication programmes,toadvise on and evaluate the application of diagnostic techniques in trepone- particular problems or to replace WHO advisers who are matoses to populations in tropical countries, in order to obtain away ill or on leave. information for the selection of practical and specific tests, which in turn can lead to new knowledge on the nature and extent of infection;to undertake epidemiological research, Inter- regional 71Meeting of Regional Malaria Advisers including research for the improvement of methodology and (1956 - ) R operation systems analysisin multipurpose immunological To hold an annual meeting of the regional malaria advisers, random sample surveys (e.g., malaria, virus diseases, inununo- so as to ensure a co- ordinated technical approach to malaria haematology, etc.) in co- operation with national laboratories eradication planning and methods. and WHO reference centres. Inter- regional 78Malaria Eradication :Technical Consultants Inter- regional 52Bilharziasis Research Team (1959 - ) R (Jan. 1965 - ) R To provide expert advice on the preparation of malaria To carry out investigations on the epidemiology of bilhar- eradication programmes, to assist governments to assess such ziasis, including the clinical aspects, in representative com- programmes and to advise on special technical problems. munities.Activities under the project will include the training of research workers, the evaluation of assessment methods and techniques, and the checking of research information. Inter- regional 79Malaria Eradication :Training Programme The research team replaces the bilharziasis advisory team for International Recruits (1958 - ) R provided (under the same project number) from 1959 to 1964. To train in malaria eradication techniques malariologists, entomologists,sanitaryengineers,sanitariansandother Inter- regional 54Leprosy Advisory Team (Feb. 1960 - ) R categories of staff, in internationally assisted malaria eradication trainingcentres and subsequentlyinmalaria eradication To implement, in selected areas, field research projects with projects. the following objectives: to undertake epidemiological investigations; to study operational methods and to adapt them to local conditions; to study practical problems of leprosy therapy Inter- regional 81Study Tours of Malaria Eradication Projects in the field; to study bacteriological problems in the field; and for Advisers (1960 - ) R to give practical training in leprosy control to national per- To enable malaria advisers to undertake visits to malaria sonnel. eradication programmes in operation in order to study their organization and functioning; and to assist in training team Inter- regional 58Diarrhoea' Diseases Team leaders and advisers in eradication. (1959 - 1965) EPTA Inter- regional 107.5Course on Enteric Infections, Budapest The aims were to assess national programmes for the epidemio- (3 - 30 Nov. 1965) EPTA logical study of diarrhoeal diseases and for their control; to assess the public health importance of these diseases, their The course was held at the State Institute of Hygiene, Buda- effect on the people's health and the efficacy of treatment and pest. It was the fifth and last of a series of inter -regional courses preventive measures;torecommend appropriatecontrol on enteric infections.The programme was similar to that of measures; to advise governments on the planning of compre- the previous courses and comprised lectures, practical work and hensive diarrhoeal disease programmes in relation to their field visits.There were twenty -four participants from Brazil, medical and public health laboratory facilities; and to stimulate Bulgaria, Cambodia, Ceylon, Ghana, Hungary, India, Indonesia, studies on specific problems connected with diarrhoeal diseases. Iran, Iraq, Japan, Malta, Mexico, Nigeria, Peru, Singapore, A team, consisting of an epidemiologist, a bacteriologist, a Sudan, Thailand, Tonga, Uganda, United Arab Republic, parasitologist and a sanitary engineer, made surveys of diarrhoeal Venezuela and Yugoslavia. diseases in Ceylon, Iran, Mauritius, Pakistan, Sudan, Tonga, WHO provided an adviser and the cost of attendance of the United Arab Republic and Venezuela and visited Iraq, Israel and participants, and four WHO staff members assisted with the Yugoslavia for short periods.Reports have been prepared on course. - 211 - 212 THE WORK OF WHO, 1965

iter- regional 110Training Programme for French- speaking Indonesia, Philippines, Poland, Portugal, Spain, Turkey and Nurses (1962 - ) R Yugoslavia. To prepare French -speaking nurses and midwives for teaching and administrative positions in post -basic and other nursing inter- regional 120.1Anaesthesiology Course, Copenhagen education programmes in various countries. (Jan. - Dec. 1965) EPTA A course, similar to those that have been held yearly since Inter -regional112MalariaEradication :TeamforField 1956 at the Anaesthesiology Training Centre, Copenhagen, for Research on Special Epidemiological Problems (1961 - ) R training medical personnel. WHO provided fellowships for twenty -seven trainees from To undertake studies on the factors causing persistent trans- Afghanistan,Argentina,Bulgaria, China (Taiwan),Costa mission of malaria; and to carry out field research for the Rica, Dominican Republic, Greece, Guatemala, Hong Kong, development and demonstration of new techniques to interrupt Hungary, Iran, Iraq, Japan, Lebanon, Pakistan, Philippines, such transmission. Poland, Portugal, Republic of Korea, Spain, Sudan, Thailand, Turkey, United Arab Republic and Yugoslavia.In addition, fellowships previously awarded to trainees from China (Taiwan), Inter- regional 113.1International Course in the Epidemiology Iraq, Poland and Thailand were extended for periods ranging and Control of Tuberculosis, Prague from six weeks to five and a half months. (18 March - 21 Aug. 1965) R EPTA One of a series of courses organized in co- operation with the Post -graduate Medical School in Prague, to teach modern "Inter- regional 120.2Third Refresher Course in Anaesthesiology, methods of controlling tuberculosis as a public health problem Copenhagen (7 - 20 June 1965) EPTA to physicians who will be key organizers of tuberculosis pro- A course for previous WHO trainees having attended one of grammes. There were thirteen trainees from Argentina, Bulgaria, the annual courses at the Anaesthesiology Training Centre, Ceylon, Iceland, Indonesia, Iraq, Japan, Mauritius, Nigeria, Copenhagen. Pakistan, Uganda, United Arab Republic and United Republic WHO provided a lecturer and twelve fellowships for trainees of Tanzania.The course included lectures, discussions and from Bulgaria, Greece, India, Iran, Iraq, Israel, Japan, Jordan, practical demonstrations in Prague, followed by a month of Lebanon, Pakistan, Republic of Korea, and Yugoslavia. additional theoreticaltrainingatthe Danish Tuberculosis Index, Copenhagen. WHO provided fellowships for the trainees, nine lecturers Inter- regional 137Course on Human Genetics for Teachers in (including five WHO staff members) and some equipment. Medical Schools (Oct. 1965) EPTA WHO provided four temporary advisers to lecture at a Inter- regional 113.2International Course in the Epidemiology national course on human genetics at Haceteppe Medical and Control of Tuberculosis, Rome School, Ankara. (1 March - 8 May 1965) R EPTA

One of a series of courses, organized in co- operation with Inter - regional 140Joint FAO /WHO Course on Meat Hygiene, the Carlo Forlanini Institute, Rome, to teach modern methods Roskilde, Denmark (30 May - 3 July 1965) EPTA (FAO) of controlling tuberculosis as a public health problem to physicianswhowillbekeyorganizersof tuberculosis The course was attended by eighteen senior workers in meat programmes.There were twelve trainees from Afghanistan, hygiene from Afghanistan, Chile, Ecuador, Ghana, Greece, Algeria, Argentina, Brazil, Dahomey, Democratic Republic of India,Iran,Malaysia,Nigeria,Peru,Philippines,Sudan, the Congo, Ecuador, Iran, Madagascar, Mexico, Spain and Thailand, Turkey, Venezuela and Yugoslavia.It was mainly Yemen. The course included lectures, discussions and practical concerned with problems related to fresh meat, including meat demonstrations in Rome, followed by one month's practical inspection, and provided laboratory and classroom instruction training in Tunisia. in recent advances in meat hygiene. WHO provided fellowships for the trainees, eight lecturers WHO contributed towards the cost of the course and a (including three WHO staff members) and some equipment. WHO staff member lectured on the epidemiology of meat - borne infections and intoxications.

Inter- regional 117Course on Medical Rehabilitation, Copen- hagen and London (2Sept. 1965 -31 May 1966)EPTA Inter- regional 149Joint FAO /WHO Technical Meeting on (Danish Board of Technical Co- operation) (Universities of Methods of Planning and Evaluation in Applied Nutrition Copenhagen and Aarhus) Programmes, Rome (11 - 16 Jan. 1965) R (FAO) A course for qualified physicians who have been working in The meeting was attended by ten experts in social anthro- rehabilitation for at least two years and who wish to study pology, sociology, agronomy, public health, and education medical rehabilitation in general or to specialize in rehabilitation -five of whom were invited by FAO and five by WHO -and as applied to geriatrics, orthopaedics, neurosurgery, rheuma- by staff members from the United Nations Bureau of Social tology, etc.It provides theoretical and practical instruction in Affairs, FAO, UNESCO, UNICEF and WHO. The methods basic and specialized aspects of medical rehabilitation; the and techniques currently in use in the planning and evaluation social, vocational and industrial aspects are also dealt with, in of applied nutrition programmes were reviewed and suggestions collaboration with the United Nations and ILO. made for their improvement.The report of the meeting is WHO provided fellowships for twenty -one physicians from intended,inter alla,for use in the preparation of a manual on Brazil, Bulgaria, Ghana, Greece, Hungary, Iceland, India, the planning and evaluation of applied nutrition programmes. PROJECT LIST: INTER- REGIONAL 213

Inter- regional 156Integrated Public Health A pilot project is being carried out in the district of Mainpuri (March 1962 - ) EPTA in India and a similar undertaking is being planned in the Central Asian Republics of the Union of Soviet Socialist Republics. A service of experts to help governments in strengthening and integrating their health services, covering a wide variety of public health activities, including public health administration, maternal and child health, nutrition, epidemiology, statistics, Inter- regional 222.2Travelling Seminar on the Public Health health laboratory services,etc. The experts are available, Aspects of Housing, Union of Soviet Socialist Republics individually or as a team, for any requesting country, and also (17 May - 8 June 1965) EPTA provide a complementary service for field projects. The seminar was similar to the one held in the Union of Soviet Socialist Republics in October 1963, but was conducted Inter- regional 172Field Trials of New Insecticides and Anti- in French and Russian.The aim was to study the environ- malarial Drugs (Second Team) (1962 - ) MESA mental health aspects of housing in the USSR (including the public health and sanitation aspects), the environmental health To carry out field trials of new insecticides and drugs that aspects of neighbourhood planning, and scientific research on are of potential value in malaria eradication. hygienic housing.There were seventeen participants from Brazil, Congo (Brazzaville), Greece, Guinea, Hungary, Iran, Inter- regional 177Course on Home Care Nursing Services, Laos, Lebanon, Madagascar, Mali, Mexico, Mongolia, Romania, Copenhagen and Aarhus (12 Sept. - 23 Oct. 1965) EPTA Syria, Tunisia, Turkey and Yugoslavia.They visited large - scale housing projects, health centres, and scientific institutes The course, which was organized for experienced public dealing with the construction of dwellings, the public health health n»__ rseç from countries interesteiciestablishing or control of buildings and the inspection of new housing estates, developing home care nursing services, covered the organization, in Moscow and Kiev. management and staffing of such services, their functions, and WHO provided the cost of attendance of the participants their co- ordination with other health services.There were and two consultants from France and Yugoslavia. nineteen trainees from Bulgaria, Ceylon, Fiji, Greece, Hungary, Indonesia, Iran, Lebanon, Poland, Portugal, Republic of Korea, Spain, Sudan, Thailand, Turkey, United Arab Republic, and Yugoslavia. WHO provided fellowships for their attendance, a 17ter- regional 228Course on Cholera Control, Calcutta consultant to assist in organizing and conducting the course, and (10 May - 8 June 1965) R two temporary advisers for one week to help with special The course was held at the School of Tropical Medicine in aspects of the programme. Members of the staff of the Regional Calcutta. The programme comprised lectures on bacteriology, Office for Europe gave introductory lectures and acted as epidemiology and control of cholera, practical work and field group discussion leaders. visits. There were eleven participants from Burma, China (Taiwan),India,Indonesia,Malaysia,Nepal,Philippines, Inter- regional 190Leprosy/BCG Trial Team, Burma Republic of Korea, and Thailand. (April 1964 - end of 1969) R WHO provided a consultant and the cost of attendance of the participants, and a WHO staff member assisted with the course. To carry out a trial of BCG vaccination in the prevention of leprosy. Inter- regional 231Assistance to Trachoma Research Inter - regional 200Seminar on Filariasis, Manila (Jan. 1965 - ) R (22 Nov. - 1 Dec. 1965) R To assist national laboratories in developing their research The seminar discussed the knowledge and experience, parti- potential and in carrying out studies on specific aspects of the cularly in the epidemiology and control of filariasis, that has trachoma problem that are of international interest and practical accumulated during recent years. There were thirty -two partici- importance. pants from American Samos, British Solomon Islands Protec- torate, Ceylon, China (Taiwan), Fiji, French Polynesia, Gilbert and Ellice Islands, India, Japan, Madagascar, Malaysia, Mauri- tius, Papua and New Guinea, Philippines, Republic of Korea, Inter- regional232Seminar on National HealthPlanning, Ryukyu Islands, Singapore, Sudan, Thailand, Tonga, Trust Addis Ababa (11 - 22 Oct. 1965) R Territory of the Pacific Islands, United Arab Republic, Viet - The aim of the seminar was to discuss the experience gained Nam and Western Samoa. WHO provided the cost of their in health planning projects carried out with WHO assistance in attendance and four consultants. Gabon, Liberia, Mali, Niger and Sierra Leone, and to consider the possibility of formulating a general policy and methodology Inter -regional 212Field Trials of New Insecticides and Anti- for the provision of guidance and assistance to governments of malarial Drugs (First Team) (1962 - ) R. developing countries that are interested in preparing a national health plan. The national and WHO staff members who had To carry out field trials of new insecticides and drugs that are worked on the health planning projects in the five countries of potential value in malaria eradication. attended,together with participants from Ethiopia,Iran, Ivory Coast, Somalia, Sudan, United Arab Republic and Inter- regional 218Cancer Advisory Team, Asia (1963 - ) R United Republic of Tanzania, and observers from UNICEF, the Economic Commission for Africa, the United States Agency To study the epidemiology of oropharyngeal tumours, and for International Development and the United Nations Technical particularly their relation to chewing and smoking habits. Assistance Board. 214 THE WORK OF WHO, 1965

The five planning teams reported on their country plans and exchange information and experience, and to formulate practical papers were presented and discussions held on the following measures for dealing with the road -accident problem, especially subjects: preconditions and prerequisite data for health planning; in developing countries.There were twenty -six participants standards and norms of provision for ensuring health care, fromAustralia,Austria,Brazil,Ceylon,Czechoslovakia, staffing of institutions etc.; some new techniques in public Ghana, Iran, Iraq, Japan, Kenya, Kuwait, Lebanon, Nigeria, health planning; population in relation to the health plan; Philippines, Saudi Arabia, Sudan, Sweden, Thailand, Turkey, concept and content of economic and social planning; financial United Arab Republic, United Kingdom, and United States resources and cost estimation of health plans. of America, and observers from Italy, the United Arab Republic The participants emphasised the necessity for an adequate and the League of Arab States. Five experts acted as discussion administrative machinery for preparing and implementing a leaders and presented working papers. national health plan, and drew attention to the fact that an WHO provided the cost of attendance of the participants, estimate of possible financial resources is essential in the for- and a consultant and a temporary adviser to assist in preparing mulation of the plan and to the need for periodic revision of for and running the seminar. costs during the implementation.It was generally agreed that norms, based on careful study, needed to be separately deter- Inter -regional 240Seminar on Occupational Health, emphasizing mined for each country, and that, in preparing a health plan, especially Health in Agriculture, Moscow and Kiev attention should be given to the demographic evolution of the (16 - 28 Aug. 1965) EPTA (ILO) country concerned. It was recommended that WHO should prepare simple metho- The aim of the seminar, which met in Moscow from 16 to dological techniques for use in planning and organize or support 18 August and in Kiev from 19 to 28 August 1965, was to courses of training in health planning, some of them in Africa. stimulate interest in occupational health services, to promote co- ordination between public health and labour inspection Inter- regional 233Course on the Laboratory Diagnosis of services, and to study the organization of occupational health Enterobacteriaceae, London (30 Aug. - 24Sept.1965) R services in different places of employment, especially in agri- (London School of Hygiene and Tropical Medicine) culture.There were twenty -one participants from Argentina, Bulgaria, Brazil, Colombia, Cuba, Iran, Iraq, Japan, Kenya, The object of the course was to provide advanced training Malaysia, Mexico, Pakistan, Poland, Romania, Sudan, Turkey, in the diagnosis of pathogenic Enterobacteriaceae to bacterio- United Arab Republic, United Republic of Tanzania, Venezuela logists engaged in this work. It was held at the Department of and Yugoslavia. A staff member from ILO attended and an Bacteriology and Immunology of the London School of Hygiene ILO temporary adviser presented a working paper. and Tropical Medicine and was organized and directed by the WHO provided two consultants, one for two weeks and one Director of that department, assisted by ten specialists from for one month, a temporary adviser (discussion leader) and the Public Health Laboratory Service of England and Wales. the cost of attendance of the participants. There were fourteen participants from Burma, Ceylon, China (Taiwan), Ethiopia, Indonesia, Iran, Iraq, Malaysia, Pakistan, Inter -regional 242Cancer Advisory Team, Africa Philippines, Republic of Korea, Thailand and United Arab (1965 - ) R Republic. WHO provided fellowships for the participants, honoraria To study the epidemiology of lymphomas and other tumours for consultants, lecturers and technicians, and supplies and in Africa.As an initial stage, a study has been designed for equipment. arriving at an acceptable working definition of Burkitt's tumours; it involves the collection, processing and diagnosis of pathological Inter- regional 234Economic Commission for Africa material from the several research centres involved. (1964 - ) R Inter -regional 250Symposium on Sanitary Engineering Training WHO is providing a sanitary engineer having specialized Programmes, Geneva (6 - 12 July 1965) R knowledge of the public health aspects of housing, attached to the Housing, Building and Planning Section of the Economic A symposium at which civil and sanitary engineers exchanged Commission for Africa, to deal with the environmental health information on the special academic preparation needed by aspects of the housing and physical planning programmes being engineers for the solution of environmental health problems, developed in Africa. reviewed training programmes, and considered methods that might be used to stimulate interest in and support for educational Inter -regional 237International Conference forthe Eighth programmes in environmental health. There were twelve Revision of the International Classification of Diseases, Geneva participants from Argentina, Ceylon, France, Ghana, Guate- (6 -12 July 1965) R mala, Indonesia, Madagscar, Malaysia, Nigeria, Republic of Korea, Turkey and Union of Soviet Socialist Republics, a The conference, which is described on page 66, was attended representative from the Rockefeller Foundation and four by representatives of thirty -six Member States from all six representatives from UNESCO. WHO regions, of an Associate Member, and of the United WHO provided a consultant, three temporary advisers, and Nations, ILO and three non -governmentalorganizations. the cost of attendance of the participants. WHO provided secretarial and conference services. \Inter- regional 251Conference on Effective Teaching Methods in Inter- regional 238Seminar ontheEpidemiology,Control \\Medical Education, Geneva (2 - 8 Nov. 1965) R and Prevention of Road Traffic Accidents, Alexandria (25 Oct. - 1 Nov. 1965) R A conference at which specialists in medical education reviewed the developments and recent progress in teaching A seminar to stimulate the interest of public health agencies methods and examined the advantages and limitations of the in the prevention of motor -vehicle accidents on the road, to various methods under different teaching conditions, in order PROJECT LIST: INTER -REGIONAL 215 to provide a basis for selection of those most effective.The Inter -regional 258Meeting on Current Progress in Human conference also provided an opportunity for an exchange of Population Biology, Warsaw (26 - 30 April 1965) R (Special views on the promotion of teaching methods and the measure- Committee and Polish National Committee of the Inter- ment of students' performance. There were twenty participants national Biological Programme) from Brazil, Ceylon, China (Taiwan), Czechoslovakia, France, WHO provided fifteen temporary advisers and interpretation India, Indonesia, Iran, Israel, Madagascar, Philippines, Poland, services for the meeting, which discussed the problems of human Singapore, Thailand, United Arab Republic, United Kingdom, physiological adaptation and population genetics outlined by United Républic of Tanzania, and United States of America, the International Biological Programme's working group on and representatives and observers from UNESCO, the World human adaptability. The temporary advisers came from Medical Association and the American University of Beirut. Australia, Belgium, Brazil, Bulgaria, Czechoslovakia, Hungary, WHO provided three consultants, the cost of attendance of India, Japan, Norway, Romania, South Africa, Union of nineteen participants, and conference staff and facilities. Soviet Socialist Republics, and Yugoslavia.

Inter- regional 261International Course on Surveys for Radio- Inter -regional 252Course on Immunofluorescent Techniques, nuclides in Food, Seibersdorf, Austria Copenhagen (11 - 25 Aug. 1965) R (8 Nov. - 17 Dec. 1965) R (FAO) (IAEA) The course, which was held at the Statens Seruminstitut, The course was jointly organized by FAO, IAEA and WHO. Copenhagen, provided training in the basic aspects of fluorescent It was attended by technical and advisory officers in public antibody techniques, their application for diagnostic purposes health,agricultural,veterinary, atomic energy and related in microbiology, virology, parasitology, etc., and their use in services who are directly concerned either with the inspection immunological surveys and epidemiological studies.There and control of exposure to environmental radiation from any were nineteentrainees from Argentina,Austria,Ceylon, source or with surveys and analyses of foods for radioactive Colombia, Czechoslovakia, Ethiopia, Finland, India,Iran, contamination.Training was given in the basic principles of Japan, Malaysia, Nigeria, Peru, Republic of Korea, Senegal, radiationfield sampling procedures and inradiochemical Thailand, Turkey, Union of Soviet Socialist Republics, and methods of analysis for the most important radionuclides United Republic of Tanzania. likely to be involved. There were eighteen trainees from Austria, WHO provided fellowships for the trainees, twelve lecturers Bulgaria, Czechoslovakia, Finland, Iran, Japan, Philippines, (including one WHO staff member) and some material for Poland, Republic of Korea, Spain, Tunisia, Turkey and Union practical training. of Soviet Socialist Republics. IAEA and WHO jointly provided the lecturing staff, fellowships for the trainees, and supplies and equipment.

Inter -regional 255Meeting B.3: Mortality, Morbidity and Inter -regional 262 Meeting B.12: Population Genetics, Second Causes of Death, Second World PopulationConference, World Population Conference, Belgrade (31 Aug. 1965) R (UN) Belgrade (1Sept. 1965) R (UN) (FAO) (ILO) (UNESCO) (FAO) (ILO) (UNESCO) (International Bank for Reconstruc- (International Bank for Reconstruction and Development) tion and Development) (International Union for the Scientific (International Union for the Scientific Study of Population) Study of Population) WHO made the arrangements for Meeting B.3, on mortality, WHO provided three temporary advisers, from India, the morbidity and causes of death, of the Second World Population United Kingdom and the United States of America, and made Conference, organized by the United Nations with the co- the arrangements for Meeting B.12, on population genetics, operation of FAO, ILO, UNESCO, WHO, the International of the Second World Population Conference (see project Inter- Bank for Reconstruction and Development and the Inter- regional 255).Meeting B.12, held on 31 August 1965, was national Union for the Scientific Study of Population, and held concerned with genetic factors which affect mortality, fertility from 30 August to 10 September 1965.Meeting B.3, held on and population growth and structure, and with the collection 1 September 1965, was concerned with patterns of causes of of data for population genetic studies. death and their relation to levels and trends of mortality, and conditions and trends of morbidity and their relation to levels Inter -regional 269Epidemiological Studies on Xerophthalmia and trends of mortality.The meeting was attended by six and Keratomalacia, Jordan (Sept. 1963 - Aug. 1966) Special WHO staff members from headquarters and regional offices. Account for Medical Research WHO also arranged Meeting B.12, on population genetics To carry out surveys and clinical studies to determine the (see project Inter -regional 262) and was a co- sponsor of the prevalence of signs and symptoms of vitamin A deficiency in conference as a whole, taking part in all the preparatory meetings. Jordan.

Inter- regional 270Insecticide Testing Unit, Lagos Inter -regional256 FAO /WHO Expert Group onVitamin (1960 - ) Special Account for Medical Research Requirements, Geneva (6 - 17 Sept. 1965) R (FAO) To evaluate new insecticides in the field and determine whether they are suitable as substitutes for DDT, HCH and dieldrin The expert group, which was composed of specialists from in malaria eradication programmes. Canada, Denmark, France, Guatemala, India, Netherlands, Union of Soviet Socialist Republics, United Kingdom and United States of America, was convened to discuss requirements Inter -regional 271Research Unit for the Control of Mosquito of vitamin A, thiamine, riboflavin and niacin and to prepare Vectors of Filariasis, Rangoon a report for international use. The group recommended levels (1962 - ) Special Account for Medical Research of intake of vitamins desirable for the maintenance of good To carry out research and field trials on the control of mos- health and indicated areas where research is needed. quitos, particularly the vectors of filariasis, using organo- 216 THE WORK OF WHO, 1965

phosphorus and other new insecticides,biological control Inter -regional 289Course on Child Dental Health, Copenhagen procedures, and other techniques. (1 March - 29 May 1965) EPTA The purpose of the course was to improve the teaching and Inter -regional 273Seminar on Psychiatric Diagnosis, Classifi- practice of dentistry for children by providing advanced training cation and Statistics, London (11 - 15 Oct. 1965) R in the subject to teachers of pedodontics and administrators of children's dental health services.The course was given at The seminar was the first of a proposed series of annual the Royal Dental College, Copenhagen, by the faculty of the meetings, the aim of which is to develop a classification of College, and was attended by twelve trainees from Brazil, mental disorders that will be internationally acceptable and that Colombia, Greece, Hong Kong, India, Iraq, Japan, Nigeria, can be applied in a uniform manner. The work includes studies Poland, Singapore, Thailand and the United Arab Republic. of variation in diagnosis by psychiatrists of different countries WHO provided fellowships for the trainees and two lecturers. presented with similar clinical material, and preparation of glossaries. Another objective is the standardization of procedures for recording psychiatric statistics.The seminar was Inter -regional293TravellingSeminar on PlagueControl, attended by twelve psychiatrists and biostatisticians from Union of Soviet Socialist Republics Austria, France, Japan, Norway, Peru, Union of Soviet Socialist (2 - 23 Sept. 1965) EPTA Republics, United Kingdom, and United States of America, The seminar took place in Moscow, Stavropol, Alma -Ata who are expected to continue assisting with the work for the and Leningrad. Lectures were given in Moscow at the Gamaleja whole period of the project. A group of psychiatrists from the Institute of Epidemiology and Microbiology, in Stavropol at host country was invited to attend by their Government. the Affiliated All -Union Scientific Research Institute of Plague Control, in Alma -Ata at the Central Asian Institute for Plague Cholera Control Team (1964 - ) EPTA Control, and in Leningrad at the Pasteur Institute. In addition Inter- regional 276 visits were made to the field and to laboratories to acquaint A team, consisting of an epidemiologist, a bacteriologist and participants with the practical aspects of plague study and a clinician, to assist countries in developing and improving control. There were seventeen participants trom Brazil, Burma, their programmes for the control of cholera; to assist, when Ecuador, India, Indonesia, Iran, Iraq, Japan, Kenya, Madagas- required, in dealing with cholera epidemics; and to advise on car, Mongolia, Pakistan, Peru, United Republic of Tanzania, epidemiological, laboratory and clinicalaspects of control and Venezuela. and treatment. WHO provided the cost of attendance of the participants two consultants, a medical officer, and administrative and secretarial staff. Inter -regional 282Symposium on Personnel Dosimetryfor Accidental High -levelExposure to External andInternal Radiation, Vienna (8 - 12 March 1965) R (IAEA) Inter- regional295TravellingSeminar onEntomological The symposium, which was organized in collaboration with Methods in Vector Control, Union of Soviet Socialist Republics the International Atomic Energy Agency, was concerned with (20 Sept. - 16 Oct. 1965) EPTA the assessment of the doses received by persons who have been The purpose of the seminar was to review information on accidentally irradiated by exposure to external radiation fields, entomological methods used for guiding vector control pro- by the intake of radioactive materials, or by the deposition of grammes, including methods of surveying the biology and radioactive contamination on the surface of the body. Topics number of arthropod populations before and after control discussed included various measurement techniques, the assess- operations as a guide to effective pesticide usage.There were ment of dose from results of measurements, current practice in twenty -one participants from Afghanistan,Bolivia,Brazil, various types of establishment, and experience gained as a Ceylon, Cuba, Ghana, Greece,India,Iran,Israel, Japan, result of previous accidents. Special attention was given to those Kenya,Pakistan,Poland, Turkey, Uganda, United Arab devices and techniques for personnel dosimetry which are Republic and Venezuela.They were acquainted with current designed primarily for the rapid determination of high -level aspects of vector control activities in the Union of Soviet exposure and intakes and for the assessment of the resulting Socialist Republics, including both applied and fundamental dose.There were 179 participants from Algeria, Argentina, research programmes. Austria, Belgium, Bulgaria, Canada, Czechoslovakia, Denmark, WHO provided the cost of attendance of the participants, FederalRepublicof Germany, Finland,France,Ghana, two consultants, and conference staff. Greece, Hungary, India, Italy, Japan, Luxembourg, Monaco, Netherlands, Nigeria, Norway, Poland, Portugal, Romania, Inter- regional 299Fifth Asian Malaria Conference, Colombo Spain,Sweden,Switzerland,Tunisia, Uganda, Union of (20 - 27 Oct. 1965) R Soviet Socialist Republics, United Kingdom, United States of America, and Yugoslavia, and from five international organi- The conference was organized to review and discuss progress zations. in malaria eradication and to exchange information and expe- IAEA and WHO jointly provided the costs of organizing the rience on related technical, operational and administrative mat- meeting. ters and on programme co- ordination between countries. There were twenty-nine participants -directors of health services and directors and staff of national malaria eradication services - Inter -regional 283Improvement of AnaesthesiologyServices from Afghanistan, Australia, Brunei, Ceylon, China (Taiwan), (Oct. - Nov. 1965) EPTA India, Indonesia, Japan, Laos, Malaysia, Maldive Islands, As a follow -up to the anaesthesiology courses given every Nepal, Pakistan, Papua and New Guinea, Philippines, Republic year atthe Anaesthesiology Training Centre, Copenhagen of Korea, Ryukyu Islands, Thailand and Viet -Nam. Thirteen (see project Inter -regional 120.1 above), WHO provided two observers from the Ceylon Health Service and representatives consultants to assist in improving anaesthesiology services in of UNICEF and the United States Agency for International Iran and Iraq. Development also attended. PROJECT LIST: INTER -REGIONAL 217

WHO provided the cost of attendance of the participants, a slovakia, Denmark, Finland, France, Israel, Italy, Netherlands, consultant, and conference staff and other services. Norway, United Kingdom, United States of America, and Yugoslavia. WHO provided the cost of attendance of a number of the Inter -regional 300Trypanosomiasis Study Team participants. (Jan. 1965 - ) R To assist in surveying areas where trypanosomiasis is endemic and to collaborate in exchanging epidemiological information, in Inter -regional 367Meeting on the Dosimetry and Toxicity of order to obtain a clear picture of the present endemic foci Thorotrast, Vienna (4 - 7 Oct. 1965) R (IAEA) potentially dangerous for a flare -up of the disease, both human and animal, and of the distribution and changes in advance of The purpose of the meeting, which was organized jointly with the International Atomic Energy Agency, was to collect the fly belts; also to propose co- ordinated measures and to up -to -date information on thorotrast dosimetry, to consider promote the use of modern techniques and methods for trypano- what additional information was required and how best to somiasis control. obtain it, to obtain suggestions regarding desirable inter -laboratory comparisons in dosimetry, and to survey the related toxicological and epidemiological problems which require or Inter- regional 307Seminar on Organization of Mental Health justify dosimetric investigations.There were twenty -two partici- Services, Union of Soviet Socialist Republics pants from Austria, Denmark, Federal Republic of Germany, (14 June - 2 July 1965) EPTA France, Italy, Japan, Portugal, Union of Soviet Socialist Repu- The purpose of the seminar was to show leading psychiatrists blics,United Kingdom and United States of America, and and public health officers from developing countries, who will from the International Commission on Radiological Protection. be jointly responsible for the organization of national mental IAEA and WHO jointly provided the cost of attendance of health services, how a network of psychiatric services has been the participants. established in urban and rural areas, its links with general health, social welfare and education services, and the implications in terms of training of staff and provision of facilities.There Inter- regional 370International Atomic Energy Agency Panel were twenty -one participants from Burma, Ceylon,Chile, on Permissible Emergency Doses to the Public, Third Meeting, Ghana, Indonesia, Iran, Japan, Lebanon, Nigeria, Peru, Sierra Vienna (10 - 14 May 1965) R (IAEA) Leone, Sudan and Venezuela.They visited Moscow and Leningrad and urban and rural services in the Stavropol Kraj WHO provided four consultants, from Australia, Canada, and Armenia. Denmark and the United States of America, for the third WHO provided a consultant and the cost of attendance of the meeting of the International Atomic Energy Agency panel, participants. which was concerned with risk evaluation in relation to the protection of the public in the event of radiation accidents. ..The meeting recognized the importance of advance planning Inter- regional 336Study Group on Planning of Radiotherapy for action in the event of contamination of the environment from Facilities, Geneva (15 - 19 Dec. 1964) R (IAEA) the accidental release of radioactive material, especially in view of the increase in the number of fixed and mobile reactors, The study group, which was organized in collaboration with of processing plants for nuclear fuels, and of laboratory and the International Atomic Energy Agency, discussed the planning industrial activities involving radioactive isotopes, and considered of radiotherapy facilities, including the construction of premises the risk estimates associated with different types of exposure to the equipment required, organization and staffing.The main radiation. emphasis was on the needs of developing countries. There were ten participants from Australia, Chile, India, Southern Rhodesia, Sweden, Union of Soviet Socialist Republics, United Kingdom and United States of America.The cost of their attendance Inter -regional 371Third United Nations Congress on Pre- was provided jointly by IAEA and WHO. vention of Crime and Treatment of Offenders, Stockholm (9 - 18 Aug. 1965) R (UN) The congress discussed the mental health aspects of the Inter- regional 366Conference on Radiation and the Immune prevention of crime and the treatment of offenders, with special Response, London (26 - 28 April 1965) R (IAEA) (Chester reference to problems of juvenile delinquency in developing Beatty Research Institute) (CIBA Foundation) countries.WHO provided two consultants for one month; The purpose of the conference, which was organized by the they each prepared a paper on the subject and attended the Chester Beatty Research Institute in collaboration with the congress, together with an official from WHO headquarters. International Atomic Energy Agency and WHO, was to define the manner in which ionizing radiations interfere with the immune response. The conference was organized in three Inter- regional 372Revision of the Medical Addendum to the parts: a review of what is known of immunological processes; IAEA Publication " Safe Handling of Radioisotopes " a consideration of what is known of the effects of radiation on (1965) R (IAEA) (ILO) these processes; and discussionof various immunological problems of irradiated organisms. Emphasis was given to the Two meetings of consultants, jointly organized by the Inter- exchange of information on radiation effects on the immune national Atomic Energy Agency, ILO and WHO, were held in response and to directing attention to new and relevant facts, connexion with the revision of the Medical Addendum, published as well as to gaps in knowledge where further research is required. in 1961 by the International Atomic Energy Agency, to the There were about eighty participants from Australia, Czecho- IAEA Manual on Safe Handling of Radiosisotopes. The first 218 THE WORK OF WHO, 1965 meeting, which took place from 15 to 19 March 1965 in Vienna, status and current trends in medical physics.Scientific sessions drew up an outline of the work, and the second, held in Geneva were held on solid state dosimetry, scanners, physiology and from 19 to 23 July 1965, considered the draft chapters prepared medicine, microwave absorption,particle beam dosimetry, by the consultants in the intervening period.The revision is biological system and measurement, uses of isotopes, isotope intended as a guide to medical supervision in radiation work, dosimetry, neutron activation, computer applications in therapy, and will deal with radiobiology, radiopathology and meta- radiation biology, X- rays -spectra and diagnostic applications, bolism of radionuclides as necessary for the physician's under- and ultrasonics and optical techniques. standing of the problem, with the medical supervision of radia- WHO provided the travel costs of six participants from tion work in general, with the treatment of radiation injury Czechoslovakia, Italy and Poland. and internal radioactive contamination, and with the overall planning of medical facilities for radiation work integrated into occupational health practice. WHO provided a consultant for the meetings and facilities for the second meeting. `Inter- regional 378 IAEA /WHO Meeting of Consultants on an International Centre for Training and Research in the Medical Applications of Radioisotopes, Geneva (2 -5 Nov. 1965) R Inter- regional 374Community Water Supply (IAEA) (Sept. 1965 - ) EPTA To advise governments on problems of watersupply and A meeting of consultants, jointly convened by WHO and waste disposal and to assist in the preparationof requests IAEA, to consider the need for increased international effort for funds for planning or construction of watersupply and for training (including training in research) physicians and sewerage facilities. medical physicists from developing countries in the medical applications of radioisotopes.In particular, to consider the desirability and feasibility of establishing an international centre Inter- regional 376International Conference on Medical Physics, for this purpose, with due regard to opportunities and methods Harrogate (8 -10 Sept. 1965) R (IAEA) of training presently available. The conference, which had approximately four hundred IAEA and WHO jointly met the costs of attendance of the participants from twenty-eight countries, considered the present participants. ANNEXES

Annex 1

MEMBERS AND ASSOCIATE MEMBERS OF THE WORLD HEALTH ORGANIZATION at 31 December 1965

At 31 December 1965 the World Health Organization had 122 Member States and three Associate Members.They are listed below, with the date on which each became a party to the Constitution or the date of admission to associate membership.

Afghanistan 19 April 1948Honduras 8 April 1949Republic of Korea .... 17 August 1949 Albania 26 May 1947Hungary 17 June 1948Romania 8 June 1948 Algeria 8 November 1962Iceland 17 June 1948Rwanda * 7 November 1962 Argentina * 22 October 1948India * 12 January 1948 Saudi Arabia 26 May 1947 Australia * 2 February 1948Indonesia 23 May 1950 Senegal 31 October 1960 Austria * 30 June 1947Iran 23 November 1946Sierra Leone * 20 October 1961 Belgium * 25 June 1948Iraq * 23 September 1947 Somalia 26 January 1961 Bolivia 23 December 1949Ireland 20 October 1947South Africa 7 August 1947 Brazil 2 June 1948Israel 21 June 1949Spain 28 May 1951 Bulgaria 9 June 1948Italy * 11 April 1947Sudan 14 May 1956 Burma 1 July 1948Ivory Coast * 28 October 1960Sweden 28 August 1947 Burundi 22 October 1962Jamaica * 21 March 1963 Switzerland 26 March 1947 Byelorussian SSR 7 April 1948Japan' 16 May 1951 Syria 18 December 1946 Cambodia * 17 May 1950Jordan * 7 April 1947Thailand ' 26 September 1947 Cameroon 6 May 1960Kenya * 27 January 1964Togo * 13 May 1960 Canada 29 August 1946Kuwait * 9 May 1960Trinidad and Central African Laos * 17 May 1950 Tobago 3 January 1963 Republic * 20 September 1960Lebanon 19 January 1949Tunisia * 14 May 1956 Ceylon 7 July 1948Liberia 14 March 1947Turkey 2 January 1948 Chad 1 January 1961Libya * 16 May 1952Uganda 7 March 1963 Chile 15 October 1948Luxembourg * 3 June 1949 Ukrainian SSR 3 April 1948 China 22 July 1946Madagascar * 16 January 1961 Union of Soviet Colombia 14 May 1959Malawi * 9 April 1965 Socialist Republics 24 March 1948 Congo (Brazzaville) 26 October 1960Malaysia 24 April 1958United Arab Congo, Democratic Maldive Islands 5 November 1965 Republic 16 December 1947 Republic of,' 24 February 1961Mali 17 October 1960United Kingdom of Costa Rica 17 March 1949Malta 1 February 1965 Great Britain and Cuba 9 May 1950Mauritania 7 March 1961 Northern Ireland 22 July 1946 Cyprus' 16 January 1961Mexico 7 April 1948 United Republic Czechoslovakia 1 March 1948Monaco 8 July 1948 of Tanzania * 15 March 1962 Dahomey 20 September 1960Mongolia 18 April 1962United States of Denmark * 19 April 1948Morocco * 14 May 1956 America 21 June 1948 Dominican Republic 21 June 1948Nepal * 2 September 1953 Upper Volta * 4 October 1960 Ecuador * 1 March 1949Netherlands * 25 April 1947Uruguay 22 April 1949 El Salvador 22 June 1948New Zealand * 10 December 1946 Venezuela 7 July 1948 Ethiopia 11 April 1947Nicaragua' 24 April 1950 Viet -Nam 17 May 1950 Federal Republic Niger 5 October 1960Western Samoa 16 May 1962 of Germany * 29 May 1951Nigeria' 25 November 1960Yemen 20 November 1953 Finland * 7 October 1947Norway * 18 August 1947Yugoslavia 19 November 1947 France 16 June 1948Pakistan a 23 June 1948Zambia 2 February 1965 Gabon 21 November 1960Panama 20 February 1951 Ghana * 8 April 1957Paraguay 4 January 1949 Associate Members Greece 12 March 1948Peru 11 November 1949 Guatemala * 26 August 1949Philippines * 9 July 1948Mauritius 9 May 1963 Guinea 19 May 1959Poland 6 May 1948Qatar 5 March 1964 Haiti * 12 August 1947Portugal 13 February 1948 Southern Rhodesia 16 May 1950

' Member States that have acceded to the Convention on the Privileges and Immunities of the Specialized Agencies and its Annex VII. - 221 - 222 THE WORK OF WHO, 1965

Annex 2

MEMBERSHIP OF THE EXECUTIVE BOARD

1. Thirty -fifth Session (Geneva, 19 -28 January 1965)

Designated by Designated by Dr A. ABDULHADI Libya Sir George GODBER United Kingdom of Dr J. AMOUZEGAR Iran Great Britain and Dr A. C. ANDRIAMASY Madagascar Northern Ireland Professor E. J. AUJALEU France Dr V. T. Herat GUNARATNE Ceylon Dr A. K. EL -BoRAI Kuwait Dr J. -C. HAPPI, Rapporteur Cameroon Dr A. DALY, Rapporteur 1 Tunisia Dr J. KAREFA- SMART, Vice -Chairman Sierra Leone Dr B. D. B. LAYTON Canada Dr M. DIN BIN ARMAD Malaysia Professor P. MUNTENDAM Netherlands Dr S. Do Lo Mali Dr C. L. PRIETO Paraguay Dr A. ESCOBAR- BALLESTAS Colombia Dr Hurustiati SUBANDRIO, Rapporteur Indonesia Dr K. EVANG Norway Dr H. B. TURBOTT, Chairman . . . New Zealand Dr L. FAUCHER 2 Haiti Dr T. VIANNA Brazil Dr N. H. F5WK 6 Turkey Professor V. M. 2DANOV Union of Soviet Professor R. GERM Yugoslavia Socialist Republics

2.Thirty -sixth Session (Geneva 24-25 May 1965)

The Eighteenth World Health Assembly in resolution WHA18.18 elected Czechoslovakia, Guinea, India, Mexico, Morocco, Peru, the United States of America, and Yemen to designate persons to serve on the Board in place of the retiring members - designated by Canada, Ceylon, Colombia, France, Haiti, Madagascar, Tunisia and the Union of Soviet Socialist Republics.This resulted in the following composition of the Board at the thirty -sixth session: Unexpired term of office at the time Designated by of closure of the Eighteenth World Health Assembly Dr A. ABDULHADI Libya 2 years Dr A. R. M. AL- ADWANI Kuwait 2 years Dr J. AMOUZEGAR Iran 1 year Dr A. BENYAKHLEF Morocco 3 years Dr M. DIN BIN ARMAD Malaysia 2 years Dr S. DoLo Mali 1 year Dr K. EVANG, Chairman Norway 1 year Dr N. H. FI$EK Turkey 2 years Professor R. GERIE Yugoslavia 2 years Sir George GODBER 6 United Kingdom of Great Britain and Northern Ireland2 years Professor D. M. GONZALEZ TORRES Paraguay 2 years Dr J. -C. HAPPI, Rapporteur Cameroon 2 years Dr J. KAREFA -SMART Sierra Leone 1 year Dr O. KEITA, Vice - Chairman Guinea 3 years Dr D. P. KENNEDY New Zealand 1 year Professor P. MACÚCH Czechoslovakia 3 years Dr P. D. MARTINEZ Mexico 3 years Professor P. MUNTENDAM Netherlands 1 year Dr C. Qumós, Rapporteur Peru 3 years Dr K. N. Rao India 3 years Dr Hurustiati SUBANDRIO, Vice- Chairman Indonesia 1 year Mr A. TARCICI Yemen 3 years Dr T. VIANNA Brazil 1 year Dr J. WATT United States of America 3 years

1 As Dr Daly was able to attend only until 21 January, 8 Dr T. Alan, Vice -Chairman, alternate, attended the session. Dr Happi was elected Rapporteur in his place on the following day. 4 Dr A. Diba, alternate, attended the session. 2 Absent from the session. 6 Dr J. H. F. Brotherston, alternate, attended the session. ANNEXES 3 AND 4 223

Annex 3

ORGANIZATIONAL MEETINGS IN 1965

Executive Board, thirty -fifth session: Standing Committee on Administration and Finance Geneva, 11 -18 January Executive Board: Standing Committee on Headquarters Accommodation, tenth session Geneva, 18 -19 January Executive Board, thirty -fifth session Geneva, 19 -28 January Executive Board, thirty -fifth session: Léon Bernand Foundation Committee Geneva, 23 January Executive Board, thirty -fifth session: Standing Committee on Non -governmental Organi- zations Geneva, 23 January UNICEF /WHO Joint Committee on Health Policy, fourteenth session Geneva, 8 -10 February Executive Board: Standing Committee on Headquarters Accommodation, eleventh session Geneva, 19 February Executive Board: Ad Hoc Committee Geneva, 3 May Eighteenth World Health Assembly Geneva, 4-21 May Executive Board: thirty -sixth session Geneva, 24-25 May Regional Committee for the Eastern Mediterranean, fifteenth session: Sub -Committee B Geneva, 2 -3 September Sub -Committee A Addis Ababa, 20-23 September Regional Committee for Africa, fifteenth session Lusaka, 6 -16 September Regional Committee for Europe, fifteenth session Istanbul, 7 -11 September Regional Committee for the Western Pacific, sixteenth session Seoul, 16-21 September Regional Committee for the Americas, seventeenth session/Directing Council of PAHO, XVI Meeting Washington, D.C., 27 September - 8 October Regional Committee for South -East Asia, eighteenth session Kabul, 30 October - 6 November

Annex 4

EXPERT ADVISORY PANELS AND COMMITTEES

1.EXPERT ADVISORY PANELS

The expert advisory panels in existence at 31 December 1965 were on the following subjects:

Air pollution Health of seafarers Occupational health Antibiotics Health statistics Organization of medical care Biological standardization Human genetics Parasitic diseases Biology of human reproduction Immunology Plague Brucellosis Insecticides Professional and technical education of Cancer International pharmacopoeia and phar- medical and auxiliary personnel Cardiovascular diseases maceutical preparations Public health administration Cholera International quarantine Rabies Chronic degenerative diseases Leprosy Radiation Dental health Malaria Rehabilitation Drug dependence Maternal and child health Trachoma Enteric diseases Medical research Tuberculosis Environmental health Mental health Venereal infections and treponematoses Food additives Nursing Virus diseases Health education Nutrition Zoonoses Health laboratory services

1 See resolution WHAl2.17. 224 THE WORK OF WHO, 1965

2.EXPERT COMMITTEES

The membership of the expert committees that met in 1965 was as follows:

Expert Committee on Biological Standardization Expert Committee on Dependence -Producing Drugs 3

Geneva, 27 September - 2 October Geneva, 19 -24 July Dr D. R. Bangham, Director, Department of Biological Stan- Dr N. B. Eddy, Consultant on Narcotics, National Institutes dards, National Institute for Medical Research, London, of Health, Bethesda, Md., United States of America England Dr L. Goldberg, Professor of Research on Alcohol and Anal- gesics, Karolinska Institute, Stockholm, Sweden Dr H. H. Cohen, Director, National Institute of Public Health, Utrecht, Netherlands Dr E. Hosoya, Professor of Pharmacology, School of Medicine, Keio University, Tokyo, Japan Dr J.Desbordes, Director, Microbiology Section, National Laboratory of Public Health, Paris, France Dr H. Isbell, Professor of Medicine and Head, Section of Clinical Pharmacology, Department of Medicine, University Professor G. Heymann, Acting Director, Paul -Ehrlich Institute, of Kentucky, Lexington, Ky., United States of America Frankfurt am Main, Federal Republic of Germany Dr G. Joachimoglu, Professor Emeritus of Pharmacology; Dr P. Krag, Director, Department of Biological Standards, formerly Chairman, Superior Health Council, Athens, Greece Statens Seruminstitut, Copenhagen, Denmark Dr P. Kielholz, Professor of Psychiatry, University of Basle, Dr A. Lafontaine, Director, Institute of Hygiene and Epidemio- Switzerland logy, Brussels, Belgium Dr A. D. Macdonald, Professor of Pharmacology, University Dr R. Murray, Director, Division of Biologics Standards, of Manchester, England National Institutes of Health, Bethesda, Md., United States Dr Valentina V. Vasil'eva, Professor of Pharmacology, Second of America Moscow Institute of Medicine, Union of Soviet Socialist Dr J. B. Shrivastav, Deputy Director -General of Health Services, Republics New Delhi, India Dr G. V. Vygodéikov, Head of Department, Gamaleja Institute of Epidemiology and Microbiology, Moscow, Union of Expert Committee on Health Statistics (Sampling Methods in Soviet Socialist Republics Morbidity Surveys and Public Health Investigations) Dr A. E. Wilhelmi, Division of Basic Health Services, Depart- Geneva, 23 -29 November ment of Biochemistry, Emory University,Atlanta, Ga., United States of America Dr P. Armitage, Professor of Medical Statistics, Department of Medical Statistics and Epidemiology, London School of Hygiene and Tropical Medicine, London, England Dr F. E. Linder, Director, National Center for Health Statistics, Expert Committee on Cancer Treatment United States Public Health Service, Department of Health, Education and Welfare, Washington, D.C., United States of Geneva, 9 -15 March America Professor A. L. About Nasr, Director, Cancer Institute, Faculty Dr J. N. Manceau, Director, Special Service for Public Health, of Medicine, University of Cairo, United Arab Republic Rio de Janeiro, Brazil Professor N. N. Blohin, President, Academy of Medical Sciences Dr K. K. Mathen, Professor of Statistics, All -India Institute of of the USSR; Director, Institute of Experimental and Clinical Hygiene and Public Health, Calcutta, India Oncology, Moscow, Union of Soviet Socialist Republics Dr V. K. Ovéarov, Head, Health Statistics Department, Semalko Dr P. F. Denoix, Professeur agrégé; Director, Gustave- Roussy Institute of Public Health Administration and History of Institute of Cancer Research, Villejuif (Seine), France Medicine, Moscow, Union of Soviet Socialist Republics Dr V. Dvolák, Chief, Follow -up Department, Oncological Mr D. Schwartz,2 Director, Statistical Research Unit, National Institute, Prague, Czechoslovakia Institute of Health and Medical Research, Gustave -Roussy Institute of Cancer Research, Villejuif (Seine), France Dr E. C. Easson, Director of Radiotherapy, Christie Hospital and Holt Radium Institute, Manchester, England Dr M. Vacek, Statistical Department, Institute for Research intothe Organization of the HealthServices,Prague, Dr F. Gentil, Chief, Surgical Service, Cancer Institute, São Czechoslovakia Paulo, Brazil Dr S. Krishnamurthi,2 Director, Cancer Institute, Madras, India Expert Committee on Insecticides (Chemistry and Specifications) Professor G. T. Pack, Attending Surgeon Emeritus, Memorial Geneva, 19 -25 October Hospital for Cancer and Allied Diseases, New York, United Dr E. Paulini, Chief, Chemical Laboratory, National Institute States of America of Rural Endemic Diseases, Belo Horizonte, Minas Gerais, Brazil 1 Report published as Wld Hlth Org. techn. Rep. Ser., 1966, 322. 3 Report published as Wld Hlth Org. techn. Rep. Ser., 1965, 2 Unable to attend. 312. ANNEX4 225

Dr G. W. Pearce, Chief, Chemistry Section, Communicable Miss L. Cells, Chief Midwife, Maternity Unit, Catholic Univer- Disease Center, Savannah, Ga., United States of America sity of Chile, Santiago, Chile Mr J. Prat, Inspecteur général, National Institute of Applied Miss Lau Koi Eng, Nurse /Midwife Tutor, School of Midwifery, Chemical Research, Vert -le -Petit Research Centre (Seine - Kandang Kerbua Hospital, Singapore et- Oise), France Professor R. Merger, Obstetrics Clinic, University Hospital of Mr A. K. Sengupta, Deputy Director, National Malaria Eradi- Saint -Antoine, Paris, France Instituteof Communicable cation Programme, National Dr D. Morley, Lecturer in Tropical Child Health, Institute of Diseases, Delhi, India Child Health, London, England Dr M. T. Shafik, College of Agriculture, Alexandria University, United Arab Republic Dr Eugenia Pomerska, Chief, Department of Maternal and Child Health, Ministry of Health and Social Welfare, Warsaw, Dr E. M. Thain, Assistant Director, Tropical Products Institute, Poland London, England Mrs K. A. Pratt, Chief Nursing Officer, Federal Ministry of Dr J. Treboux, Research Laboratory, J. R. Geigy A. G., Basle, Health, Lagos, Nigeria Switzerland Mrs M. Slajmer -Japelj, Director, School of Health Workers, Expert Committee on Leprosy1 Maribor, Yugoslavia Geneva, 27 July - 2 August Expert Committee on Nutrition and Infection 2 Dr J. Convit, Chief, Division of Dermatological Health, Ministry of Health and Social Welfare, Caracas, Venezuela Geneva, 23 -29 March Dr Dharmendra, Director, Central Leprosy Teaching and Dr A. Delaunay, Head, Experimental PathologyService, Research Institute, Chingleput, Madras, India Pasteur Institute, Annexe de Garches (Seine -et- Oise), France Dr R. S. Guinto, Leonard Wood Memorial Cebu Skin Clinic, Professor J.C. Edozien,3 Head, Department of Chemical Cebu City, Philippines Pathology, University of Ibadan, Nigeria Dr J. H. Hanks, Johns Hopkins- Leonard Wood Memorial Leprosy Research Laboratory, Department of Pathobiology, Dr Z. Farid, Director, Clinical Research Division, Medical School of Hygiene, Baltimore, Md., United States of America Department, United States Naval Medical Research Unit No. 3, Cairo, United Arab Republic Dr P. Laviron, Marseilles, France Dr B. G. Maegraith, Professor of Tropical Medicine, School Dr R. J. W. Rees, National Institute for Medical Research, of Tropical Medicine, Liverpool, England London, England Dr N. N. Plotnikov, Marcinovskij Institute of Medical Parasito- Expert Committee on Malaria logy and Tropical Medicine, Moscow, Union of Soviet Socialist Republics Geneva, 21 -27 September Dr N. S. Scrimshaw, Professor of Nutrition, Head, Department Dr G. R. Coatney, Chief, Laboratory of Parasite Chemo- of Nutrition and Food Science, Massachusetts Institute of therapy,NationalInstitutesof Health,Bethesda,Md., Technology, Cambridge, Mass., United States of America United States of America Dr B. Vahlquist, Professor of Paediatrics, Paediatric Clinic, Dr M. E. Farinaud, Paris, France University Hospital, Uppsala, Sweden Dr A. Gabaldón, Consultant, Bureau of Malariology and Dr P. S. Venkatachalam,3 Assistant Director, Nutrition Research Environmental Sanitation, Ministry of Health and Social Laboratories, Indian Council of Medical Research, Hyderabad, Welfare, Caracas, Venezuela India Professor G. Macdonald, Director, Ross Institute of Tropical Hygiene, London School of Hygiene and Tropical Medicine, London, England Expert Committee on Onchocerciasis Dr A. P. Ray, Director, National Malaria Eradication Pro- Geneva, 29 June - 5 July gramme, Delhi, India Professor F. J. Aguilar, Director- General of Public Health, Professor B. Richter, Andrija Stampar School of Public Health, Guatemala City, Guatemala Zagreb; Faculty of Medicine, University of Zagreb, Yugo- Dr B. O. L. Duke, Director, Helminthiasis Research Unit, slavia Federal Centre of Medical Research, Kumba, Cameroon Professor P. Sergiev, Director, Marcinovskij Institute of Medical Parasitology and Tropical Medicine, Moscow, Union of Dr J. Gillet, Chargé de cours and Director, School of Public Soviet Socialist Republics Health, University of Louvain, Belgium Dr F. A. Wickremasinghe, Superintendent, Antimalaria Cam- Professor P. J. Janssens, Director, Prince Leopold Institute of paigns, Colombo, Ceylon Tropical Medicine, Antwerp, Belgium Dr G. K. Noamesi, Senior Research Officer, National Institute Expert Committee on the Midwife in Maternity Care of Health and Medical Research, Ghana Academy of Sciences, Accra, Ghana Geneva, 19 -25 October Dr A. C. Barnes, Director, Department of Gynecology and Dr M. M. Ovazza, Inspecteur général de Recherches, Office of Obstetrics, Johns Hopkins University School of Medicine, Overseas Scientific and Technical Research, Paris, France Johns Hopkins Hospital, Baltimore, Md., United States of America 2 Report published asWld Huth Org. techn. Rep. Ser.,1965, 314. 1 Report published asWld Huth Org. techn. Rep. Ser.,1966, 319. 3 Unable to attend. 226 THE WORK OF WHO, 1965

Dr L. Vargas, Head, Entomological Laboratory, Institute of Dr R. A. Goldwasser, Director, Israel Institute for Biological Public Health and Tropical Diseases, Ministry of Public Research, Ness -Ziona, Israel Health and Welfare, Mexico City, Mexico Dr K. Habel, Chief, Laboratory of Biology of Viruses, National Dr A. W. Woodruff, Professor of Clinical Tropical Medicine, Institutes of Health, Bethesda, Md., United States of America London School of Hygiene and Tropical Medicine, London, Dr H. Koprowski, Director, Wistar Institute of Anatomy and England Biology, Philadelphia, Pa., United States of America Expert Committee on Professional and Technical Education of Dr P. Lépine, Head, Virus Diseases Service, Pasteur Institute, Medical and Auxiliary Personnel (University Health Services) 1 Paris, France Dr A. Málaga Alba, Atizapán de Zaragoza, Mexico State, Geneva, 27 April - 1 May Mexico Professor R. Debré, Member of the Academy of Sciences, Paris, Dr M. Selimov, Head, Rabies Prophylaxis Laboratory, Institute France of Poliomyelitis and ViralEncephalitides, Academy of Professor V. V. Kovanov, Rector, First Moscow Medical Medical Sciences of the USSR, Moscow, Union of Soviet Institute, Union of Soviet Socialist Republics Socialist Republics Professor T. A. Lambo, Department of Psychiatry and Neuro- Dr N. Veeraraghavan, Director, Pasteur Institute of Southern logy, University Hospital, Ibadan, Nigeria India, Coonoor, Madras, India Dr L. S. Melki, Professor of Hygiene and Public Health, French Faculty of Medicine and Pharmacy, Saint- Joseph University, Expert Committee on Specifications for Pharmaceutical Pre- Beirut, Lebanon parations : Sub -Committee on Non -Proprietary Names Dr Josefina Rodrigo Ayuyao, Director, University Health Geneva, 2 -5 November Service, University of the Philippines, Quezon City, Philippines Mr T. C. Denston, Secretary, British Pharmacopoeia Com- Dr K. Savonen, Director, Finnish Student Health Service, mission, London, England Helsinki, Finland Dr J. B. Jerome, Assistant Secretary, Council on Drugs, American Expert Conunittee on Professional and Technical Education of Medical Association, Chicago, Ill., United States of America Medical and Auxiliary Personnel (Training and Preparation Dr P. Lechat, Professeur agrégé, Faculty of Medicine, University of Teachers for Medical Schools with special regard to the of Paris, France Needs of Developing Countries) Professor K. O. Moller, Director, Department of Pharmacology, Geneva, 30 November - 6 December Faculty of Medicine, University of Copenhagen, Denmark Dr L. C. Brumpt, Professor of Parasitology, Faculty of Medicine, Professor V. V. Zakusov, Director, Institute of Pharmacology University of Paris, France and Chemotherapy, Academy of Medical Sciences of the USSR, Moscow, Union of Soviet Socialist Republics Dr J. Charvat, Professor of Internal Medicine, Charles Uni- versity, Prague, Czechoslovakia Expert Committee on the Training of Laboratory Personnel Professor A. Hurtado, Dean, Cayetano Heredia Faculty of (Technical Staff) Medicine, Peruvian University of Medical and Biological Sciences, Lima, Peru Geneva, 7 -13 December Dr M. Prywes, Professor of Medical Education and Associate Dr O. Adeniyi -Jones, Medical Officer of Health, Public Health Dean,HadassahMedicalSchool,HebrewUniversity, Department, City Council, Lagos, Nigeria Jerusalem, Israel Dr A. Buller Souto, Director, Adolfo Lutz Institute, Sao Paulo, Professor M. L. Rosenheim, Director, Medical Unit, University Brazil College Hospital Medical School, London, England Dr R. Buttiaux, Assistant Director, Pasteur Institute, Lille, Dr B. L. Taneja, Director, Indian Council of Medical Research, France New Delhi, India Professor J. Hofejlí, Charles University; Director, Institute of Dr C. E. Taylor, Director, Division of International Health, Haematology and Blood Transfusion, Prague, Czechoslovakia Johns Hopkins University School of Hygiene and Public Professor J. F.Murray,8 Deputy Director, Health, Baltimore, Md., United States of America South African Institute for Medical Research, Johannesburg, South Africa Professor H. O. Thomas, Dean, University of Lagos Medical Dr R. E. Nassif, Associate Professor, Chairman, Department School, Lagos, Nigeria of Clinical Pathology, School of Medicine, American Univer- sity of Beirut, Lebanon Expert Committee on Rabies 2 Dr K. B. Rogers, Clinical Pathologist, Children's Hospital, Geneva, 1 -7 June Birmingham, England Dr M. K. Abelseth, Research Associate, Connaught Medical Professor J. F. Sejc, Head, Biochemical Laboratory, Institute Research Laboratories, Toronto, Ont., Canada of Haematology and Blood Transfusion, Leningrad, Union Dr M. Bahmanyar, Pasteur Institute, Teheran, Iran of Soviet Socialist Republics Dr G. Z. Williams, Chief, Clinical Pathology Department, 1 Report published as Wld filth Org. techn. Rep. Ser., 1966, Clinical Center, National Institutes of Health, Bethesda, Md., 320. United States of America 2 Report published as Wld Hlth Org. techn. Rep. Ser., 1966, 321. 8 Unable to attend. ANNEX 4 227

Expert Committee on the Use of Human Immunoglobulin Dr O. G. Fitzhugh, Deputy Director, Division of Toxicological Evaluation, Food and Drug Administration, Department of Geneva, 7 -13 September Health, Education and Welfare, Washington, D.C., United Professor J. C. Edozien, Head, Department of Chemical Patho- States of America logy, University of Ibadan, Nigeria Professor A. C. Frazer, Department of Medical Biochemistry Dr A. Hissig, Swiss Red Cross Blood Transfusion Service, and Pharmacology, University of Birmingham, England Berne, Switzerland Dr C. L. French, Mallinckrodt Chemical Works, St Louis, Professor E. A. Kabat, Department of Microbiology, Columbia Mo., United States of America University, New York, United States of America Dr D. W. Kent -Jones, Kent -Jones and Amos Laboratories, Professor S. Krugman, Department of Pediatrics, New York University School of Medicine, New York City, United Dudden Hill Lane, Willesden, London, England States of America Dr K. Kojima, Assistant Chief, Food Chemistry Section, Dr J. J. van Loghem, Central Laboratory of the Netherlands Ministry of Health and Welfare, Tokyo, Japan Red Cross Blood Transfusion Service, Amsterdam, Nether- Professor K. Lang, Director, Department of Physiological lands Chemistry, University of Mainz, Federal Republic of Germany Dr W. d'A. Maycock, Lister Institute of Preventive Medicine, Professor J. F. Reith, Department of Food Chemistry and Elstree, Herts., England Toxicology, University of Utrecht, Netherlands Dr E. A. Paktoris,l Clinical Department, Institute of Virology, Professor S. W. Souci, Director, German Food Chemistry Academy of Medical Sciences of the USSR, Moscow, Union Research Institute, Munich, Federal Republic of Germany of Soviet Socialist Republics Professor A. I. gtenberg, Head, Food Hygiene Department, Dr M. Raynaud, Pasteur Institute, Annexe de Garches (Seine - Institute of Nutrition, Academy of Medical Sciences of the et- Oise), France USSR, Moscow, Union of Soviet Socialist Republics Professor R. Truhaut, Director, Toxicological Research Centre, Expert Committee on Water Pollution Control2 Faculty of Pharmacy, University of Paris, France Geneva, 6 -12 April Mr N. J. de Baenst, Head, Department of Sanitary Engineering, Joint ILO /WHO Committee on the Health of Seafarers Ministry of Public Health and Family Welfare, Brussels, Belgium Geneva, 1 -5 March Professor S. N. terkinskij,l Chair of Community Hygiene, First Dr D. J. Amah, Principal Health Officer, Federal Ministry of Moscow Medical Institute, Union of Soviet Socialist Repu- Health, Lagos, Nigeria blics Dr R. Cévaër, Head, Seamen's Health Service, General Secreta- Dr L. Coin, Head of Department, City of Paris Hygiene Labora- riat for the Mercantile Marine, Paris, France tory, France Dr C, R. Garfield, Chief, Medical Service, United States Public Dr F. Guimari es, Assistant Director, State of Guanabara Health Service Hospital, Norfolk, Va., United States of Institute of Sanitary Engineering, Rio de Janeiro, Brazil America Mr H. G. Hanson, Assistant Surgeon General, United States Mr W. Hogarth, General Secretary, National Union of Seamen, Public Health Service, Washington, D. C., United States of London, England America Captain O. I. Loennechen, Shipowner, Tdnsberg, Norway Dr A. Key, Senior Chemical Inspector, Ministry of Housing and Local Government, London, England Dr J. R. Myhre, Head, Laboratory of Clinical Physiology, University Clinic, Haukeland Sykehus, Bergen, Norway Mr R. S. Mehta, Director, Central Public Health Engineering Research Institute, Nagpur, India Dr J. J. M. Rychard, Director, Public Department of Epidemio- Mr J. M. Paz Maroto, Director of Sanitary Engineering. logy and Hygiene, Ministry of Health and Social Welfare, Municipality of Madrid, Spain Warsaw, Poland Dr S. R. Sayampanathan, Senior Health Officer, Quarantine and Epidemiology, Public Health Division,Ministry of Joint Committees Health, Singapore Joint FAO /WHO Expert Committee on Food Additives (Specifica- Sir Richard Snedden, General Manager, International Shipping tions for the Identity and Purity and Toxicological Evaluation Federation, London, England of some Preservatives, Antioxidants, Emulsifiers, Stabilizers, Mr P. de Vries, General Secretary, International Transport Bleaching and Maturing Agents, Acids and Bases) Workers' Federation, London, England Rome, 13 -20 December Dr D. G. Chapman, Assistant Director- General, Food and Joint Meeting of the FAO Committee on Pesticides in Agriculture Drug Directorate, Department of National Health and and the WHO Expert Committee on Pesticide Residues Welfare, Ottawa, Ont., Canada (Evaluation of the Toxicity of Pesticide Residues in Food) Dr G. Della Porta, Section of Experimental Carcinogenesis, National Institute for the Study and Treatment of Tumours, Rome, 15 -22 March Milan, Italy Professor F. Bir, Max von Pettenkofer Institute, Berlin Dr V. Bene?;, Institute of Hygiene, Prague, Czechoslovakia i Unable to attend. 2 Report published as Wld Hlth Org. techn. Rep. Ser., 1966, Mr W. Bums- Brown, Pest Infestation Laboratory, Slough, 318. Bucks., England 228 THE WORK OF WHO, 1965

ProfessorS.Dalgaard -Mikkelsen,RoyalVeterinary and Dr H. Hurtig, Research Branch, Canada Department of Agri- Agricultural College, Copenhagen, Denmark culture, Ottawa, Ont., Canada Dr H. Drees, Federal Ministry of Food, Agriculture and Dr H. A. U. Monro, Agricultural Research Institute, Research Forestry, Bonn, Federal Republic of Germany Branch, Canada Department of Agriculture, London, Ont., Canada Dr G. J. van Esch, National Institute of Public Health, Utrecht, Netherlands Dr Y. K. Subrahmanyam, Directorate General of Health Services, New Delhi, India Dr R. Goulding, Ministry of Health, London, England Professor R. Truhaut, Director, Toxicological Research Centre, Dr W. J. Hayes, jr., Communicable Disease Center, United Faculty of Pharmacy, University of Paris, France States Public Health Service, Atlanta, Ga., United States of America Professor S. E. Wright, University of Sydney, Australia

3.COMMITTEE ON INTERNATIONAL QUARANTINE 1

Geneva, 22 -26 February Dr J. Lembrez, Director of Sanitary Control at Frontiers, Dr J. C. Azurin, Director of Quarantine, Manila, Philippines Marseilles, France Dr M. S. Hague, Director- General of Health; Joint Secretary, Dr V. V. Olguín, Director, International Health and Welfare Health Division, Ministry of Health, Labour and Social Relations, Ministry of Social Welfare and Public Health, Welfare, Islamabad, Pakistan Buenos Aires, Argentina Dr L. Jacobs, Medical Director, Division of Foreign Quarantine, United States Public Health Service, Department of Health, Dr G. D. Ostrovskij, Section Chief, Central Directorate of Education and Welfare, Washington D. C., United States of Sanitation and Epidemiology, Ministry of Health of the America USSR, Moscow, Union of Soviet Socialist Republics

4.ADVISORY COMMITTEE ON MEDICAL RESEARCH

The Advisory Committee on Medical Research was established pursuant to resolution WHAl2.17.

Seventh Session, Geneva, 21- 25 June Dr N. K. Jerne, Professor of Microbiology; Chairman of the Department of Microbiology, University of Pittsburgh School Dr S. Adler, Professor of Parasitology, Hadassah Medical of Medicine, Pittsburgh, Pa., United States of America School, Hebrew University, Jerusalem, Israel Sir Aubrey Lewis, Professor of Psychiatry, University of London Professor C. H. Best,2 Charles H. Best Institute, University of Institute of Psychiatry, London, England Toronto, Ont., Canada Sir Samuel Manuwa, Federal Public Service Commission, Lagos, Dr O. Bier, Professor of Microbiology, School of Medicine, Nigeria São Paulo, Brazil Professor S. R. Mardaev, Member of the Academy of Medical Professor N. N. Blohin, President, Academy of Medical Sciences Sciences of the USSR; Department of Biological and Organic of the USSR; Director, Institute of Experimental and Clinical Chemistry, First Moscow Medical Institute, Union of Soviet Oncology, Moscow, Union of Soviet Socialist Republics Socialist Republics Dr R. Courrier, Professor at the Collège de France; Permanent Dr W. McDermott, Professor of Public Health and Preventive Secretary, Academy of Sciences; Member of the Academy Medicine, Cornell University Medical College, New York, of Medicine, Paris, France United States of America Dr W. R. S. Doll, Director, Statistical Research Unit, Medical Dr C. Puranananda, Director, Queen Saovabha Memorial Research Council, London, England Institute, Bangkok, Thailand Dr B. N. Halpern, Professor at the Collège de France; Member Professor B. Rexed, Science Advisory Council, Stockholm, of the Academy of Sciences, Paris, France Sweden Professor H. Hamperl, Director, Institute of Pathology, Univer- Professor I. Rusznyak,2 President of the Academy of Sciences; sity of Bonn, Federal Republic of Germany Director of the Academy's Central Institute of Medical Research, Budapest, Hungary Professor B. A. Houssay, Director, Institute of Biology and Experimental Medicine, Buenos Aires, Argentina Professor A. Vartiainen, Department of Pharmacology, Univer- sity of Helsinki, Finland For report, see Of Rec. Wld Hlth Org. 143, 41. Professor A. Wolman,2 Johns Hopkins University, Baltimore, s Unable to attend. Md., United States of America ANNEX 5 229

Annex 5

SCIENTIFIC GROUP MEETINGS IN 19651

Scientific Group on Research in Dental Health Geneva, 29 March - 2 April Scientific Group on the Biochemistry and Microbiology of the Female and Male Genital Tracts Geneva, 20 -26 April

Scientific Group on Genes, Genotypes and Allotypes of Immunoglobulins . Geneva, 31 May - 5 June Scientific Group on Standard Strains of Insects of Public Health Importance Geneva, 28 June - 2 July Scientific Group on the Rationale of Drug Testing: Pre -clinical Safety Studies Geneva, 2 -7 August Scientific Group on Research in Bilharziasis: Measurement of the Public Health Impor- tance Geneva, 9 -14 August Scientific Group on Trachoma Research Geneva, 9 -14 August Scientific Group on Human Virus and Rickettsial Vaccines Geneva, 4 -9 October Scientific Group on Immunological Aspects of Human Reproduction Geneva, 4-9 October Scientific Group on Histopathological Nomenclature and Classification of Skin Tumours Geneva, 18 -23 October Scientific Group on the Cardiovascular Research Programme Geneva, 1 -6 November Scientific Group on the Chemistry and Physiology of the Gametes Geneva, 2 -8 November Scientific Group on Research on Genetics in Psychiatry Geneva, 8 -13 November Scientific Group on International Drug Monitoring Geneva, 15 -20 November Scientific Group on Identification and Measurement of Air Pollutants Geneva, 16 -22 November Scientific Group on the Clinical Aspects of Oral Gestogens Geneva, 30 November - 6 December Scientific Group on Histopathological Nomenclature and Classification of Urinary Bladder Tumours Geneva, 6 -11 December Scientific Group on Haemoglobinopathies and Allied Disorders Geneva, 14 -20 December

1 Details of seminars and training courses organized by WHO in co- operation with governments or with other organizations are given in the Project List in Part III. 230 THE WORK OF WHO, 1965

Annex 6

NON -GOVERNMENTAL ORGANIZATIONS IN OFFICIAL RELATIONS WITH WHO at 31 December 1965

Biometric Society International League against Rheumatism Central Council for Health Education International Leprosy Association Council for International Organizations of Medical Sciences International Organization against Trachoma Inter- American Association of Sanitary Engineering International Paediatric Association International Academy of Legal Medicine and of Social Medi- International Pharmaceutical Federation cine International Society of Blood Transfusion International Air Transport Association International Society of Cardiology International Association for Child Psychiatry and Allied Pro- International Society for Criminology fessions International Society for Rehabilitation of the Disabled International Association of Logopedics and Phoniatrics International Association of Microbiological Societies International Union of Architects International Association for Prevention of Blindness International Union against Cancer International Astronautical Federation International Union for Child Welfare International Brain Research Organization International Union for Health Education International Commission on Radiological Protection International Union of Local Authorities International Commission on Radiological Units and International Union of Pure and Applied Chemistry Measurements International Union against Tuberculosis International Committee of Catholic Nurses International Union against the Venereal Diseases and the International Committee of the Red Cross Treponematoses International Confederation of Midwives International Water Supply Association International Conference of Social Work League of Red Cross Societies International Council on Jewish Social and Welfare Services Medical Women's International Association International Council of Nurses Permanent Commission and InternationalAssociation on International Council of Scientific Unions Occupational Health International Council of Societies of Pathology World Confederation for Physical Therapy International Dental Federation World Federation of the Deaf International Diabetes Federation World Federation for Mental Health International Federation of Gynecology and Obstetrics World Federation of Neurology International Federation for Housing and Planning World Federation of Occupational Therapists International Federation for Medical Electronics and Biological Engineering World Federation of Societies of Anaesthesiologists International Federation of Sports Medicine World Federation of United Nations Associations International Federation of Surgical Colleges World Medical Association International Fertility Association World Psychiatric Association International Hospital Federation World Union OSE International Hydatidological Association World Veterans Federation International League of Dermatological Societies World Veterinary Association ANNEX 7 231

Annex 7

REGULAR BUDGET FOR 1965

Transfers Appro- Original concurred Supplemen- Revised priation Purpose of appropriation amount In by the tary appro- section voted I Executive estimates 3 priations Board2 US$ US$ US$ US$ PART I : ORGANIZATIONAL MEETINGS

1. World Health Assembly 365630 15200 380830 2.Executive Board and its Committees 2014.40 11300 212740 3.Regional Committees 99200 6300 105500

Total - Part I 666270 6300 26500 699070

PART II: OPERATING PROGRAMME

4.Programme Activities 23580936 (159009) 115300 23 537227 5.Regional Offices 2859260 119139 18900 2 997299 6. Expert Committees 231600 - 11000 242600 7.Other Statutory Staff Costs 7503543 52094 287950 7 843587

Total - Part II 34175339 12224 433150 34 620713

PART III: ADMINISTRATIVE SERVICES

8.Administrative Services 2242355 (14953) 55000 2 282402 9.Other Statutory Staff Costs 676036 (3571) 32350 704815

Total - Part 111 2918391 (18524) 87350 2 987217

PART IV : OTHER PURPOSES

10.Headquarters Building Fund 500000 500000 11.Reimbursement of the Working Capital Fund 100000 - 100000 12.African Regional Office Building Fund . . . - 600000 600000 Total - Part IV 600000 600000 1200000

SUB -TOTAL - PARTS I, II, III AND IV 38360000 1147000 39 507000

PART V: RESERVE 13.Undistributed Reserve 2521370 - 2 521370 Total - Part V 2521370 - 2 521370

TOTAL - ALL PARTS 40881370 - 1147000 42 028370

1Resolution WHA17.18. 2 Resolution EB35.R7. 8 Resolution WHA18.11. Annex 8 STRUCTURE OF THE HEADQUARTERS SECRETARIAT at 31 December 1965

OFFICE OF THE DIRECTOR -GENERL

DIVISION OF PUBLIC INFORMATION

Z ASSISANT ASSISANT ASSISTANT DIRECTORGENERAL/ DIRECTORGENERAL jDIRECTOR GENERAL %/,DIRECTORGENERAL] i / j 5

DIVISION OF DIVISION OF SENIOR STAFF LIAISON OFFICE WITH EXTERNAL EDITORIAL ANO DIVISION OF VECTOR CONTROL LEGAL OFFICE INTERNAL AUDIT ENVIRONMENTAL TRAINING UNITED NATIONS RELATIONS REFERENCE HEALTH STATISTICS HEALTH SERVICES

LIAISON OFFICE PROGRAMME ADMINISTRATIVE DATA PROCESSING WITH ECA CO -ORDINATION CO-ORDINATION DIVISION OF DIVISION OF DIVISION OF DIVISION OF DIVISION OF DIVISION OF DEVELOPMENT OF HEALTH COMMUNITY EDUCATION AND HEALTH PROTECTION PUBLIC HEALTH BIOLOGY ANO COMMUNICABLE MALARIA HEALTH STATISTICAL LEGISLATION WATER SUPPLY TRAINING AND PROMOTION SERVICES PHARMACOLOGY DISEASES ERADICATION SERVICES

PROGRAMME LIAISON OFFICE FORMULATION DIVISION OF WITH IAEA DIVISION OF AND EVALUATION ADMINISTRATIVE LIBRARY AND DISSEMINATION BUDGET AND ENVIRONMENTAL MANAGEMENT REFERENCE OF STATISTICAL EDUCATION IN BIOLOGY HEALTH BIOLOGICAL EPIDEMIOLOGICAL FINANCE SERVICES INFORMATION MEDICINE AND CANCER BACTERIAL DISEASES AND PERSONNEL EDUCATION STANDARDIZATION 1 ASSESSMENT ALLIED SUBJECTS RESEARCH PLANNING WHO CHIEF MEDICAL AND ADVISER TO UNICEF CO -ORDINATION ENVIRONMENTAL EPIDEMIOLOGICAL OFFICIAL RECORDS HEALTH GLOBAL POLLUTION STUDIES CARDIOVASCULAR PLANNING AND ADMINISTRATIVE FELLOWSHIPS LABORATORY IMMUNOLOGY EPIDEMIOLOGICAL BUDGET DISEASES PROGRAMAD MANAGEMENT SERVICES SURVEILLANCE HEALTH PROGRAMME OF UNRWA SANITATION HEALTH TECHNICAL SERVICES STATISTICAL PUBLIC HEALTH RESEARCH AND PUBLICATIONS HUMAN INTERNATIONAL CONFERENCE AND FINANCE AND AND HOUSING METHODOLOGY EDUCATION DENTAL HEALTH PHARMACEUTICALS TECHNICAL REPRODUCTION QUARANTINE OFFICE SERVICES ACCOUNTS AND TRAINING INTELLIGENCE

TRANSLATION WASTES DISPOSAL MATERNAL AND PHARMACOLOGY JOINT MEDICAL HUMAN GENETICS LEPROSY CHILD HEALTH AND TOXICOLOGY SERVICE

MENTAL HEALTH NATIONAL HEALTH PARASITIC DISEASES PERSONNEL PLANNING

SMALLPDX NUTRITION NURSING SUPPLY ERADICATION

RADIATION ORGANIZATION OF TUBERCULOSIS O Dr. F. GRUNDY ANO ISOTOPES MEDICAL CARE 0 Dr. P. M. KAUL 0 Dr. L. BERNARD VENEREAL DISEASES SOCIAL AND PUBLIC HEALTH AND OCCUPATIONAL ADMINISTRATION Q Mr. M. P. SIEGEL HEALTH TREPONEMATOSES QS Dr. N. F. IZMEROV

VETERINARY PUBLIC HEALTH

VIRUS DISEASES *Also responsible for WHO activities in the Democratic Republic of the Congo December 1965

WHO 5150 ANNEX 9 233

Annex 9

NUMBERS AND DISTRIBUTION OF THE STAFF at 30 November 1964 and 30 November 1965

...Staff as at 30 November 1964 Staff as at 30 November 1965

Distribution I Regular TechnicalVoluntary Regular TechnicalVoluntary Total - Budget Assistance Funds TOE BudgetAssistance Funds

Headquarters'

Internationally recruited . . . 359 - 381 Locally recruited 437 '' " 460

796 761 12 23 841 808 14 19 Regional Offices

Africa

Internationally recruited . . 44 45

Locally recruited 156 - 180

200 200 225 225 The Americas -- --

Internationally recruited . . 36 33 Locally recruited 42 41

78 78 74 74 South-East Asia -- --

Internationally recruited . . 33 34 Locally recruited 136 _ 138

169 169 - 172 172 Europe - --

Internationally recruited . . 43 45 Locally recruited 87 84

130 130 129 129 - Eastern Mediterranean -- -

Internationally recruited . . . 42 41 Locally recruited 92 96 134 134 137 137 - Western Pacific -- -

Internationally recruited . . . 31 31 Locally recruited 72 72 103 103 -- 103 103 -- WHO Representatives' and Zone Offices

Internationally recruited . . . 30 35 Locally recruited 66 76 96 96 -- 111 111 --

' Including Liaison Offices. 234 THE WORK OF WHO, 1965

Staff as at 30 November 1964 Staff as at 30 November 1965 Distribution Regular TechnicalVoluntary RegularTechnicalVoluntary Total Budget Assistance Funds Total BudgetAssistance Funds

Field Staff in Countries

Internationally recruited . . 872 885 Locally recruited 36 35

908 436 467° 5 920 473 4226 25

Other Offices

InternationalChildren'sCentre, Paris Internationally recruited . . 1 - 1 - 1 - 1 - Inter -regional activities Internationally recruited . . 56 55 Locally recruited 4 2 --60 33 12 15 57 30 15 12 25`15 2140 492 43 2770 2262 452 56 Staff on loan to WHO, or on leave without pay 46 56 Short -term consultants 114 129

WHO GRAND TOTAL 2835 2955

PAHO GRAND TOTAL 723 798

4 ° Including 121 agents in the Democratic Republic of the Congo. b Including 86 agents in the Democratic Republic of the Congo. ANNEX 10 235

Annex 10 COMPOSITION OF THE STAFF BY NATIONALITY at 30 November 1965

Country I WHO PARO Total Country WHO PAHO Total

Afghanistan 2 - 2 Nicaragua 2 2 4 Nigeria 1 1 Algeria 1 - 1 - Argentina 15 9 24 Norway 12 - 12 Australia 20 - 20 Pakistan 13 - 13 Austria 11 - 11 Panama 2 4 6 Belgium 36 3 39 Paraguay 5 1 6 Bolivia 12 8 20 Peru 8 16 24 Brazil 27 38 65 Philippines 22 - 22 Bulgaria 4 - 4 Poland 20 - 20 Cameroon 2 - 2 Portugal 9 1 10 Canada 56 3 59 Republic of Korea 8 1 9 Ceylon 14 - 14 Romania 2 - 2 Chile 20 20 40 Sierra Leone 1 - 1 China 27 2 29 Singapore 1 - 1 Colombia 5 16 21 Somalia 1 - 1 Costa Rica 2 7 9 South Africa 5 - 5 Southern Rhodesia 2 2 Cuba 2 1 3 - Cyprus 2 - 2 Spain 13 6 19 Czechoslovakia 19 - 19 Sudan 6 - 6 Dahomey 2 - 2 Sweden 16 1 17 Denmark 31 - 31 Switzerland 50 - 50 Dominican Republic 4 2 6 Syria 11 - 11 Ecuador 7 5 12 Thailand 4 - 4 El Salvador 2 8 10 Togo 1 - 1 Trinidad and Tobago . . . 1 1 2 Ethiopia 1 - 1 1 Federal Republic of Germany 40 1 41 Tunisia - 1 Turkey 3 3 Finland 7 - 7 - France 104 1 105 Union of Soviet Socialist Ghana 2 - 2 Republics 35 - 35 Greece 19 - 19 United Arab Republic . . . . 33 - 33 Guatemala 1 35 36 United Kingdom of Great Haiti 19 - 19 Britain and Northern Ireland 217 13 230 United Republic of Tanzania . 1 1 Honduras 1 1 2 - Hungary 4 - 4 United States of America . . 132 65 197 India 45 3 48 Upper Volta 1 - 1 Indonesia 2 - 2 Uruguay 4 4 8 Iran 10 - 10 Venezuela 5 4 9 Iraq 5 5 Viet -Nam 2 - 2 - Yugoslavia 20 20 Ireland 13 1 14 - Stateless 3 3 Israel 6 1 7 - Italy ...... 46 - 46 Jamaica 1 1 2 TOTAL 1457 298 1755 Japan 17 - 17 Jordan 12 - 12 Lebanon 23 - 23 The above table does not include Luxembourg 2 - 2 the following: Madagascar 2 - 2 Malta 1 - 1 Language staff 93 3 96 Mauritius 2 - 2 Short -term consultants . . . 129 31 160 Mexico 20 9 29 Agents in the Democratic Morocco 1 - 1 Republic of the Congo . . 86 - 86 Nepal 2 - 2 Staff locally recruited . . . 1190 466 1656 Netherlands 39 3 42 New Zealand 14 1 15 GRAND TOTAL 2955 798 3753 236 THE WORK OF WHO, 1965

Annex 11

STATUS OF MALARIA ERADICATION

1.COUNTRIES IN WHICH CERTIFICATION OF ERADICATION OF MALARIA HAS BEEN COMPLETED FOR THE WHOLE TERRITORY

Region of the Americas European Region Western Pacific Region Grenada and Carriacou Bulgaria China (Taiwan) Jamaica Hungary St Lucia Spain Trinidad and Tobago

2.COUNTRIES IN WHICH MALARIA ERADICATION PROGRAMMES WERE IN OPERATION AT 31 DECEMBER 1965

African Region Region of the Americas

Mauritius United Argentina British Dominica French Honduras Paraguay South Africa Republic of Bolivia Honduras Dominican Guiana Mexico Peru Swaziland Tanzania Brazil Colombia Republic Guadeloupe 1Nicaragua Surinam (Zanzibar) British GuianaCosta Rica Ecuador Guatemala Panama Venezuela Cuba El Salvador Haiti

South -East Asia Region European Region Eastern Mediterranean Region Western Pacific Region

Afghanistan Indonesia Albania Union Iran Lebanon Malaysia Philippines Burma Nepal Greece of Soviet Iraq Libya (Sabah andRyukyu Ceylon Thailand Portugal Socialist Israel Pakistan Sarawak) Islands India Romania 1 Republics Jordan Syria Turkey Yugoslavia

3.COUNTRIES ASSISTED BY THE ORGANIZATION IN 1965 WITH ANTIMALARIA OPERATIONS OTHER THAN ERADICATION PROGRAMMES 8

African Region South -East Asia Region

Cameroon Nigeria Indonesia (West Irian) Dahomey Réunion Maldive Islands Ghana Senegal Liberia Sierra Leone Mauritania Southern Rhodesia European Region Mozambique Togo Algeria Uganda Morocco

Eastern Mediterranean Region Western Pacific Region

Ethiopia Sudan British Solomon IslandsMalaysia (Malaya) Saudi Arabia Yemen Brunei Republic of Korea Somalia Cambodia Republic of Viet -Nam

1 Whole country in maintenance phase of malaria eradication programme. 9 Preparatory planning has been done for programmes in Aden and Protectorate of South Arabia, Comoro Islands, Congo (Bra77aville), Equatorial Guinea, Gabon, Guinea, Ivory Coast, Madagascar, United Arab Republic and Zambia. ANNEX 12 237

Annex 12 FELLOWSHIPS AWARDED, BY SUBJECT OF STUDY AND BY REGION 1 December 1964 - 30 November 1965

Region

Subject of Study Total South -East Eastern Africa The Europe Mediter- Western Americas Asia ranean Pacific

Health Organization and Services

PUBLIC HEALTH ADMINISTRATION Public health administration 14 18 8 47 23 22 132 Hospital and medical care 3 12 1 16 5 5 42 Construction of health institutions - 1 - 4 -- 5 Medical librarianship - 10 -- 10 - 20

Sub -total - Public Health Administration 17 41 9 67 38 27 199

ENVIRONMENTAL HEALTH Environmental sanitation 15 40 7 22 12 6 102 Housing and town planning - 2 - --- 2 Food control - 4 - 16 - 3 23

Sub -total - Environmental Health 15 46 7 38 12 9 127

NURSING Nursing 64 20 9 19 25 15 152 Public health nursing 8 18 1 2 8 5 42 Medical social work ------

Sub -total - Nursing 72 38 10 21 33 20 194

MATERNAL AND CHILD HEALTH

Maternal and child health 1 4 - 8 5 1 19 Paediatrics 3 39 4 10 2 5 63

Sub -total - Maternal and Child Health 4 43 4 18 7 6 82

OTHER HEALTH SERVICES

Mental health 6 3 5 25 21 8 68 Health education 1 6 1 16 2 4 30 Occupational health 3 8 2 16 6 5 40 Nutrition 8 8 9 3 7 2 37 Health statistics 7 16 3 25 10 5 66 Dental health 4 5 3 15 3 15 45 Rehabilitation 1 8 3 25 5 4 46 Control of pharmaceutical and biological preparations - 5 1 6 1 6 19

Sub - total - Other Health Services 30 59 27 131 55 49 351

TOTAL - HEALTH ORGANIZATION AND SERVICES 138 227 57 275 145 111 953

Percentage 50 73 38 58 48 47 55 238 THE WORK OF WHO, 1965

Region

Subject of Study Eastern Total Africa The South -East Europe Mediter- Western Americas Asia ranean Pacific

Communicable Diseases

Malaria 22 3 33 26 30 74 188 Venereal diseases and treponematoses 3 3 2 - 1 1 10 Tuberculosis 8 10 7 16 13 4 58 Other communicable diseases 8 18 16 14 8 7 71 Laboratory services 8 14 15 26 22 9 94 Chemotherapy - - - 1 - - 1

TOTAL - COMMUNICABLE DISEASES 49 48 73 83 74 95 422

Percentage 18 15 49 18 21 40 24

ClinicalMedicine,BasicMedicalSciencesand Medical and Allied Education

CLINICAL MEDICINE Surgery and medicine 47 - 2 22 9 4 84 Anaesthesiology - 5 3 19 12 4 43 Radiology 1 2 4 5 17 5 34 Haematology 1 - 1 6 2 1 11 Other medical and surgical specialties 9 - 5 30 8 3 55

Sub -total - Clinical Medicine 58 7 15 82 48 17 227

BASIC MEDICAL SCIENCES AND MEDICAL AND ALLIED EDUCATION Basic medical sciences 5 - 3 22 7 3 40 Medical and allied education 6 28 - 9 4 7 54 Undergraduate medical studies 22 - 2 - 24 5 53 Sub -total - Basic Medical Sciences and Medical and Allied Education 33 28 5 31 35 15 147

TOTAL - CLINICAL MEDICINE, BASIC MEDICAL SCIENCES AND MEDICAL AND ALLIED EDUCATION 91 35 20 113 83 32 374

Percentage 32 12 13 24 31 13 21

GRAND TOTAL 278 310 150 471 302 238 1749 ANNEX13 239

Annex 13

WHO COLLABORATIVE RESEARCH PROJECTS IN 1965

Region

Subject of Research Eastern Total Africa The South -East Europe Mediter- Western Americas Asia ranean Pacific

Virus Diseases 3 1 5 2 12

Bacterial Diseases 4 1 6 Tuberculosis 1 1 1 6 9 Leprosy 4 2 7 Treponematoses 1 6 7

Neisseriae 1 1

Malaria 4 1 1 5 1 13 Parasitic Diseases 5 2 5 1 14 Veterinary Public Health 2 3 3 8 Cancer 2 2 3 7 Cardiovascular Diseases 6 9 2 2 19 Nutrition 1 2 2 5

Haematology 1 1 Human Genetics 1 1 5 7 Radiation Health 1 2

Human Reproduction 1 1

Immunology 5 1 6

Biological Standardization 1 5 6

Evaluation of Drugs 1 1 2 Environmental Health 1 1 5 7 Neurology 2 2

Rheumatic Diseases 1 1

Endocrinology 1 1

TOTAL 14 26 7 76 10 11 144 240 THE WORK OF WHO, 1965

Annex 14

RESEARCH GRANTS FOR TRAINING AND EXCHANGE IN 1965 BY SUBJECT AND TYPE OF GRANT

Training grants Exchange Subject of research Total workers grants Junior Senior

Virus Diseases 2 2 4 Bacterial Diseases 1 7 8 Tuberculosis 1* 1 2 Malaria 1 1 Parasitic Diseases 3 2 6 11 Cancer 1 4 2 7 Cardiovascular Diseases 2 2* 4 8 Dental Health 2 1 3 Public Health Practice 1 4 5 Maternal and Child Health 1 3 4 Human Genetics 1 2 3 Mental Health 2 2 Environmental Health 2 3 5 Immunology 2 1 1 4 Biological Standardization 1 1 Pharmacology 1 1 Rheumatic Diseases 1 1 Endocrinology 1 2 3 Nephropathy 2 2 Radioisotopes 1 1 Veterinary Public Health 1 1 2

TOTAL 16 22 40 78

* Grants supported by the Swedish National Association against Heart and Chest Diseases. ANNEX 15 241

Annex 15

WHO INTERNATIONAL AND REGIONAL REFERENCE CENTRES AND INSTITUTIONS WHERE THEY ARE LOCATED at 31 December 1965

VIRUS DISEASES Section de Virologie, Laboratoire national de la Santé publique, INFLUENZA Lyons, France Department of Enteroviruses, National Institute of Health, World Influenza Centre Tokyo, Japan National Institute for Medical Research, London, England Department of Bacteriology, University of Singapore, Singapore (61 collaborating laboratories) South African Institute for Medical Research, Johannesburg, WHO International Influenza Centre for the Americas South Africa VirologySection, Communicable Disease Center,Atlanta, Institute of Poliomyelitis and Viral Encephalitides, Moscow, Georgia, United States of America (16 collaborating labora- Union of Soviet Socialist Republics tories) ARTHROPOD -BORNE VIRUS DISEASES

RESPIRATORY VIRUS DISEASES OTHER THAN WHO International Reference Centre for Arthropod -borne Viruses INFLUENZA Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut, United States WHO International Reference Centres for Respiratory Virus of America Diseases other than Influenza Common Cold Research Unit, National Institute for Medical WHO Regional Reference Centres for Arthropod -borne Viruses Research, Harvard Hospital, Salisbury, England Queensland Institute of Medical Research, Brisbane, Australia Laboratory of Infectious Diseases, National Institute of Allergy Department of Microbiology, John Curtin School of Medical andInfectiousDiseases,NationalInstitutesof Health, Research, Australian National University, Canberra, Australia Bethesda, Maryland, United States of America Institute of Virology, Czechoslovak Academy of Sciences, Bratislava, Czechoslovakia WHO Regional Reference Centres for Respiratory Virus Diseases other than Influenza Service de la Fièvre jaune et des Arbovirus, Institut Pasteur, Epidemiological Research Unit, Fairfield Infectious Diseases Paris, France Hospital, Victoria, Australia Department of Virology and Rickettsiology, National Institute of Health, Tokyo, Japan Institute of Epidemiology and Microbiology, Prague, Czecho- slovakia Institut Pasteur, Dakar, Senegal Respiratory Virus Laboratory, National Institute of Health, East African Virus Research Institute, East African Common Tokyo, Japan Services Organization, Entebbe, Uganda South African Institute for Medical Research, Johannesburg, Viral Encephalitides Section, Institute of Poliomyelitis and South Africa Viral Encephalitides, Moscow, Union of SovietSocialist Ivanovskij Institute of Virology, Moscow, Union of Soviet Republics Socialist Republics VirologySection, Communicable Disease Center,Atlanta, Georgia, United States of America Respirovirus Unit, Virology Section, Communicable Disease Center, Atlanta, Georgia, United States of America TRACHOMA

ENTEROVIRUS DISEASES WHO International Reference Centre for Trachoma Francis I. Proctor Foundation for Research in Ophthalmology, WHO International Reference Centre for Enteroviruses University of California, San Francisco, California, United Department of Virology and Epidemiology, Baylor University States of America College of Medicine, Houston, Texas, United States of America RICKETTSIOSIS WHO Regional Reference Centres for Enteroviruses WHO Regional Reference Centre for Human Rickettsiosis Enterovirus Department, Statens Seruminstitut, Copenhagen, Rocky Mountain Laboratory, Institute of Allergy and Infectious Denmark Diseases, Hamilton, Montana, United States of America 242 THE WORK OF WHO, 1965

SERUM REFERENCE BANKS WHO Serological Reference Centres for Treponematoses World Serum Reference Bank Treponematoses Research Laboratory, Statens Seruminstitut, Copenhagen, Denmark Department of Epidemiology and Public Health, Yale Uni- versity School of Medicine, New Haven, Connecticut, United Venereal Disease Research Laboratory, Communicable Disease States of America Center, Chamblee, Georgia, United States of America WHO Regional Serum Reference Banks Institute of Epidemiology and Microbiology, Prague, Czecho- ZOONOSES slovakia BRUCELLOSIS South African Institute for Medical Research, Johannesburg, South Africa FAO /WHO Brucellosis Centres Department of Zoonoses, Department of Agriculture and Animal Husbandry, Buenos Aires, Argentina BACTERIAL DISEASES CommonwealthSerumLaboratories,Parkville,Victoria, Australia ENTERIC INFECTIONS State Veterinary Serum Laboratory, Copenhagen, Denmark WHO International Salmonella Centre Central Veterinary Laboratory, Ministry of Agriculture, Fisheries Institut Pasteur, Paris, France and Food, Weybridge, England Centre de Recherches sur la Fièvre ondulante, Institut Bouisson- WHO International Escherichia Centre Bertrand, Montpellier, France (one collaborating laboratory) Statens Seruminstitut, Copenhagen, Denmark Veterinary Microbiological Institute, Athens, Greece (one col- WHO International Shigella Centres laborating laboratory) Central Public Health Laboratory, London, England Indian Veterinary ResearchInstitute,Mukteswar -Kumaon, Uttar Pradesh, India Communicable Disease Center, Atlanta, Georgia, United States of America Centre for the Study of Brucellosis, Institute of Hygiene and Microbiology, University of Florence, Italy (one collaborating WHO International Reference Centre for Enteric Phage Typing laboratory) Central Public Health Laboratory, London, England (67 col- National Institute of Animal Health, Tokyo, Japan laborating laboratories) Medical Research Institute, General Hospital, Mexico City, Mexico (one collaborating laboratory) WHO International Reference Centre for Vibrio Phage Typing Onderstepoort Veterinary Laboratory, Onderstepoort, South Indian Institute for Biochemistry and Experimental Medicine, Africa Calcutta, India Institut Pasteur, Tunis, Tunisia Institute of Veterinary Bacteriology and Serology, Istanbul, STAPHYLOCOCCAL INFECTIONS Turkey WHO International Reference Centre for Staphylococcal Pliage Department of Medicine, University of Minnesota, Minneapolis, Typing Minnesota, United States of America (one collaborating Central Public Health Laboratory, London, England (32 col- laboratory) laborating laboratories) BrucellosisCentre,State Laboratory of Hygiene,Rijeka, Yugoslavia MENINGOCOCCAL INFECTIONS WHO Brucellosis Centre WHO International Reference Centre for Meningococci Gamaleja Institute of Epidemiology and Microbiology, Moscow, Laboratoire de Microbiologie, Centre de Recherches du Service Union of Soviet Socialist Republics de Santé des Troupes de Marine, Marseilles, France LEPTOSPIROSIS TUBERCULOSIS WHO /FAO Leptospirosis Reference Laboratories WHO Tuberculosis Diagnostic Reference Laboratory Laboratory of the Department of Health and Home Affairs, Tuberculosis Research Institute, Prague, Czechoslovakia Brisbane, Australia WHO International Reference Centre for BCG Seed -Lots and London School of Hygiene and Tropical Medicine, London, Control of BCG Products England Israel Institute for Biological Research, Ness -Ziona, Israel BCG Department, Statens Seruminstitut, Copenhagen, Denmark Istituto Superiore di Sanità, Rome, Italy TREPONEMATOSES National Institute of Health, Tokyo, Japan Institute for Tropical Hygiene and Geographical Pathology International Treponematosis Laboratory Centre (Royal Tropical Institute), Amsterdam, Netherlands Johns Hopkins University, Baltimore, Maryland, United States Division of Veterinary Medicine, Walter Reed Army Medical of America Center, Washington, D.C., United States of America ANNEX 15 243

WHO Leptospirosis Reference Laboratory WHO International Reference Centre for the Histopathology of Gamaleja Institute of Epidemiology and Microbiology, Moscow, Mammary Tumours Union of Soviet Socialist Republics Bland Sutton Institute of Pathology, Middlesex Hospital, London, England (five collaborating laboratories)

PARASITIC DISEASES WHO International Reference Centre for the Histopathology of MALARIA Oropharyngeal Tumours WHO International Malaria Reference Centre Sarojini Naidu Medical College, Agra, Uttar Pradesh, India (six collaborating laboratories) Laboratory of Parasite Chemotherapy, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Maryland, United States of America WHO International Reference Centre for the Histopathology of Ovarian Tumours WHO Regional Malaria Reference Centre Institute of Oncology of the Academy of Medical Sciences of National Institute of Communicable Diseases, New Delhi, India the USSR, Leningrad, Union of Soviet Socialist Republics (six collaborating laboratories)

BILHARZIASIS WHO International Reference Centre for the Histopathology of WHO Snail Identification Centre Salivary Gland Tumours Danish Bilharziasis Laboratory, Copenhagen, Denmark Bland Sutton Institute of Pathology, Middlesex Hospital, London, England LEISHMANIASIS WHO International Reference Centre for the Histopathology of WHO International Reference Centre for Leishmaniasis Skin Tumours Department of Parasitology, Hadassah Medical School, Jeru- Pathology Department,UniversityofWesternAustralia, salem, Israel Perth, Australia

TRYPANOSOMIASIS WHO International Reference Centre for the Histopathology of Soft Tissue Tumours WHO International Reference Centre for Trypanosomiasis Armed Forces Instituteof Pathology,Washington, D.C., East African Trypanosomiasis Research Organization, Tororo, United States of America (five collaborating laboratories) Uganda WHO International Reference Centre for the Histopathology of ENVIRONMENTAL BIOLOGY Thyroid Gland Tumours DISEASES OF VECTORS University Institute of Pathology, Cantonal Hospital, Zurich, Switzerland WHO International Reference Centre for the Diagnosis of Diseases of Vectors WHO International Reference Centre for the Histopathology of Department of Zoology and Entomology, Ohio State University, Urinary Bladder Tumours Columbus, Ohio, United States of America Armed Forces Instituteof Pathology, Washington, D.C., United States of America NON -COMMUNICABLE DISEASES CANCER WHO International Reference Centre for the Provision of Frozen Transplantable Tumour Strains WHO International Reference Centre for Comparative Oncology Departmentof Tumour Pathology,KarolinskaInstitute, Armed Forces Institute of Pathology, Washington, D.C., Stockholm, Sweden United States of America

WHO International Reference Centre for the Histopathology of WHO International Reference Centre for the Provision of Tumour - Bone Tumours bearing Animals Latin American Registry of Bone Pathology, Osteo -articular Netherlands Cancer Institute, Amsterdam, Netherlands (three Pathology Centre, Italian Hospital, Buenos Aires, Argentina collaborating laboratories) (seven collaborating laboratories) ANAEMIAS WHO International Reference Centre for the Histopathology of Leukaemias and other Neoplastic Disorders of the Haemato- WHO Reference Centres on Anaemias poietic Cells Department of Haematology, Post -graduate Medical School, Centre de Recherches cancérologiques et radiopathologiques London, England de l'Association Claude -Bernard, Hôpital St- Louis, Paris, France (nine collaborating laboratories) University of Witwatersrand, Johannesburg, South Africa 244 THE WORK OF WHO, 1965

OTHER FIELDS IMMUNOLOGY INFORMATION ON ANTIBIOTICS WHO International Reference Centre for Immunoglobulins International Centre of Information on Antibiotics Institut de Biochimie, Lausanne University, Switzerland Laboratoire de Microbiologie générale et médicale de l'Univer- sité de Liège, Belgium WHO International Reference Laboratory for the Serology of Autoimmune Disorders BLOOD GROUPS CourtauldInstituteof Biochemistry,MiddlesexHospital, London, England International Blood Group Reference Laboratory Medical Research Council Blood Group Reference Laboratory, WHO International Reference Centre for Genetic Factors of Lister Institute of Preventive Medicine, London, England Human Immunoglobulins Centre départemental de Transfusion sanguine et de Génétique BIOLOGICAL STANDARDIZATION humaine, Rouen, France WHO International Laboratories for Biological Standards Statens Seruminstitut, Copenhagen, Denmark WHO Regional Reference Laboratory for Genetic Factors of National Institute for Medical Research, London, England Human Immunoglobulins Central Veterinary Laboratory, Weybridge, England Department of Medical Microbiology, University of Lund, Sweden PHARMACEUTICALS HUMAN GENETICS WHO International Reference Centre for Chemical Reference Substances WHO International Reference Centre for Abnormal Haemoglobins Centre for Authentic Chemical Substances, Apotekens Kontrol- Abnormal Haemoglobin Research Unit, University of Cam- laboratorium, Stockholm, Sweden bridge, England OFFICIAL RECORDS OF THE WORLD HEALTH ORGANIZATION No. 147

THE WORK OF WHO, 1965

ANNUAL REPORT OF THE DIRECTOR -GENERAL

TO THE WORLD HEALTH ASSEMBLY AND TO THE UNITED NATIONS

INDEX

WORLD HEALTH ORGANIZATION

GENEVA

May 1966 OFFICIAL RECORDS No. 147

Annual Reportofthe Director -General for 1965

Corr. 1

CORRIGENDUM

Page 107, left -hand column, twenty -sixth line:

delete 1956

insert 1967 INDEX

Main references by subject, and main references to the project list by country, are in heavy type.

Accident prevention, 59, 121 Bacterial diseases, 27 -29 road traffic, seminar, Alexandria, 59, 214 training course on the laboratory diagnosis of Enterobacte- Aden, 190 riaceae, 44, 214 Administrative Committee on Co- ordination (ACC), 61, 83 Bahrain, 30, 82 Advisory Committee on Medical Research, 33 -34, 49, 53, 64-65, Barbados, 151 69, 228 Basic Documents, 76 Aedes aegypti, 19, 38, 39, 40, 104, 107, 113, 165 Basutoland, 141 Argentina, 150; Caribbean area, 165; Colombia, 155; Cuba, BCG, assessment team, South -East Asia Region, 177 156; Surinam, 161; Venezuela, 162 trial team (leprosy), 29, 213 seminar, Geneva, 40 vaccination and vaccines, 7, 8, 91, 103, 126, 133, 143, 177, see also Haemorrhagic fevers; Yellow fever 184, 185, 190, 195, 196, 206, 208 Afghanistan, 3, 22, 27, 30, 36, 42, 47, 48, 82, 112, 113, 169 -170 Bechuanaland, 141 African Institute for Economic Development and Planning, Belgium, 44, 180 43, 84, 95 Bibliography of Hookworm Disease, 1920 -1962, 75 African Region, 91 -98, 141 -149 Bilharziasis, 23 -24, 47, 93, 127, 164 Air pollution, 34, 35, 37, 103, 107, 124 Ghana, 142; Iran, 191; Iraq, 192; Syria, 198; United Arab Brazil, 152; Hungary, 181; Iran, 191; Israel, 193; Kuwait, 193 Republic, 199 research institute, Chile, 58, 102 -103, 154 research team, 23, 211 Aircraft and ship disinsection, 30 Biological standardization, 70 -71 Albania, 3, 82, 179 Biomedical Research Information Service, 53 Alcoholism, 55, 101 Blood banks and transfusion centres, 44, 127 Algeria, 4, 42, 44, 47, 58, 61, 67, 120, 121, 122 -123, 179 Iran, 191; Lebanon, 194 American Association of Schools of Public Health, 48 Bolivia, 22, 103, 104, 151 Americas, Region of the, 99 -111, 150 -168 Brazil, 16, 17, 18, 21 -22, 26, 36, 42, 52, 58, 100, 101, 102, 103, Anaemias, 54, 94, 161 104, 105, 106, 151 -153 Anaesthesiology, 216 British Guiana, 18, 103, 104, 153 training courses, Copenhagen, 212 British Honduras, 153 Andean region development programme, 151, 157, 160 British Solomon Islands Protectorate, 132, 133, 202 Annual Epidemiological and Vital Statistics, see World Health Brucellosis, 11 -12, 104 Statistics Annual Mongolia, 117 -118; Spain, 183 Antibiotics, 20, 45, 70 Brunei, 133, 202 Argentina, 21 -22, 42, 46, 85, 100, 101, 102, 103, 104, 105, 106, Budget for 1965, 79-80, 231 107, 150 -151 Bulgaria, 3, 16, 50, 180 Arthropod -borne virus infections, 19 -20, 39, 92 Bulletin, 75 Ascariasis, 25, 113 Burma, 22, 25, 29, 46, 62, 67, 112, 113, 115, 170 Asian Institute for Economic Development and Planning, 43, Burundi, 26, 32, 91, 92, 93, 94, 141 84, 178 Aspects of Family Mental Health in Europe, 55 Cambodia, 732, 133, 134, 202 -203 Associate Members, 79, 221 Cameroon, 26, 61, 91, 94, 141 Asymptomatic diseases, study on early detection, 42 Canada, 16, 17, 18, 44, 62, 154 Atherosclerosis, 14-15, 51 -52 Cancer, 19, 50 -51, 64, 69, 72, 79, 128, 129, 201 Australia, 16, 202 Albania, 179; Sudan, 197; Tunisia, 199 Austria, 14, 16, 180 advisory teams, 213, 214 Auto -immune diseases, 15 comparative studies, 15, 16 Automatic data processing, 66, 67, 81 -82 international agency for research, 79 Auxiliary health personnel, 45 -46, 62, 95, 96, 104 -105, 106, 112, seminar, Oslo, 187 114, 115, 120 -121 training course, Teheran, 128 Algeria,179; British Solomon Islands Protectorate, 202; Cardiovascular diseases, 51 -52, 121, 122, 187 Cambodia, 202 -203; Iraq, 192; Kenya, 143; Libya, 194; comparative studies, 14-15, 16 Morocco, 181; Nepal, 175; Saudi Arabia, 196; Somalia, conference, Bucharest, 123 -124, 187 196, 197; Uruguay, 161; Yemen, 200 Central African Republic, 141 - 1 - 2 THE WORK OF WHO, 1965

Ceylon, 3, 19, 25, 32, 44, 47, 53, 67, 68, 112, 113, 115, 170 -171 Dental health, 52 -53, 101, 121, 122, 164, 167, 168, 187, 200, 216 Chad, 26, 93, 94, 141 Brazil, 153; Colombia, 155 Chagas' disease, 52, 106, 161 epidemiological surveys, Western Pacific Region, 138, 210 Chikungunya, 19, 113, 115 training course, Suva, 53, 138 Children, dental health,122, 187 Deutsches Hilfswerk für Aussatzige, 115 training course, Copenhagen, 53, 121, 216 Diabetes, 181 mental health, 55 Diarrhoea) diseases, 28, 67, 113 Finland, 180; Israel, 193; Malta, 181; Yugoslavia, 185 Ceylon, 171; Peru, 160; Tonga, 208; Venezuela, 162 rehabilitation, 58, 184, 185 advisory team, 28, 211 see also Maternal and child health; Paediatrics; School health Diphtheria, 28 Chile, 54, 58, 100, 101, 103, 104, 105, 106, 108 -109, 154 Disarmament, 83 China (Taiwan), 3, 19, 25, 36, 42 82, 133, 137 -138, 203 -204 Domestic Accidents, 59 Cholera and cholera El Tor, 27, 30, 47, 112, 115, 127, 129, 134, Domiciliary care, seminars, European Region, 188 135 Dominica, 104 control team, 27, 216 Dominican Republic, 103, 104, 105, 156 training course on bacteriology, Teheran, 27, 127, 201 Dr A. T. Shousha Foundation, creation, 129 training course on control, Calcutta, 27, 213 Drinking -water, fluoridation, 164 Chronic and degenerative diseases, 15, 54, 55, 59, 181, 186 standards, 33 CIOMS, see Council for International Organizations of Medical Drug dependence and abuse, 55, 69 -70, 85 Sciences Drugs, safety and quality control, 69, 101, 167 Codex Alimentarius Commission, 16, 56 Colombia, 21 -22, 29, 46, 53, 100, 101, 103, 104, 105, 106, 154 -155 East Africa Common Services Organization, 93 Colombo Plan, 86, 115, 118, 119, 137, 207 Eastern Mediterranean Region, 125 -131, 190 -201 Committee on International Quarantine, 30, 228 Economic and Social Council, 34, 68, 83, 84, 86 Communicable diseases, 7 -31, 95, 103 -104, 111 -112, 129, 131, Committee on Housing, Building and Planning, 36 149, 163 Economic Commission for Africa (ECA) 43, 67, 84, 87, 95, 128, Afghanistan, 169; Brazil, 152; China (Taiwan), 204; Guinea, 214 143;Liberia,144; Mongolia, 117 -118; Nepal, 176; Economic Commission for Asia and the Far East (ECAFE), Republic of Viet -Nam, 208; Romania, 183; Sierra Leone, 84, 114, 128 147; Thailand, 176; Yemen, 200 Economic Commission for Europe (ECE), 44, 59 Communicable eye diseases, 20 -21 Economic Commission for Latin America (ECLA), 84, 102, 165 Algeria, 179; India, 172; Iraq, 192; Jordan, 193; Morocco, Economic development and planning, regional institutes, 43, 181; Spain, 183; Sudan, 197; Tunisia, 198 -199; Turkey, 84, 95, 99, 178 184; United Republic of Tanzania, 147 Ecuador, 101, 103, 104, 105, 156 -157 see also Trachoma Education and training, 60 -63, 72 -73, 94-95, 96 -97, 105 -106, Community development, 42, 84, 125, 127, 144 120 -121, 129, 134, 200 training centres, 165, 200 see also Auxiliary health personnel; Fellowships; Medical Community water supply, see Water supplies education;Medical schools; Nursing; Public health Computer, 67, 81 -82 training Congenital malformations, 54 El Salvador, 40, 100, 101, 103, 105, 106, 157 Congo (Brazzaville), 44, 91, 141 -142 Emergency assistance, 82, 87 Congo, Democratic Republic of, 63, 87, 95 Emmaus Suisse, 115 Constitution of WHO, proposal for amendment (Article 7), 79 Encephalitis, 19 -20, 134, 209 Contributions, payment, 80-81 Enteric diseases, 18, 28, 92, 208, 214 Convention on Facilitation of International Maritime Traffic, 31 training course, Budapest, 28, 211 Convention on the Privileges and Immunities of the Specialized see also Diarrhoeal diseases Agencies, 79, 221 Environmental biology, 35, 37 -38 Cook Islands, 204 Environmental health, 32 -41, 93, 102, 113, 121, 125 -126, 134, Co- operation with other organizations, 31, 35 -36, 51, 55, 68, 74, 210, 214 83 -87, 95, 114, 121, 128, 134 Chad, 141; Gabon, 142; Guinea, 143; Honduras, 158; see also under names of individual organizations Lebanon, 194; Malaysia, 205; Mali, 144; Pakistan, 195; Costa Rica, 47, 100, 101, 102, 103, 105, 155 -156 Philippines, 206; Saudi Arabia,196;Somalia, 197; Council for International Organizations of Medical Sciences Sudan, 197; Tunisia, 198; Turkey, 185 (CIOMS), 72, 73, 76 see also Sanitation Council of Europe, 87 Environmental pollution, 33 -36, 37, 57, 58, 83, 124 Cuba, 18, 104, 156 see also Air pollution; Water pollution Cyprus, 33, 190 Epidemiological and Vital Statistics Report, 67 Czechoslovakia, 9, 17, 20, 34, 76, 180 Epidemiology, 7, 10, 54, 64, 105, 113, 163, 166, 200, 213 Albania, 179; Algeria, 179; Burma, 170; China (Taiwan), 203, 204; Ethiopia, 190; India, 174; Iraq, 131, 192; Mongolia, 117 -118, 175; Morocco, 182; Romania, 183 Dahomey, 4, 32, 43, 91, 93, 142 Epilepsy, 101 Danish Save the Children Organization, 78, 115, 171 Equatorial Guinea, 91 Data processing, automatic, 66, 67, 81-82 Ethiopia, 5, 33, 43, 61, 125, 126, 127, 190 -191 Democratic Republic of the Congo, 63, 87, 95 European Region, 120 -124, 179 -189 Dengue, 19, 113 European Society of Haematology, International Committee Denmark, 20, 121, 180 for Standardization, 45 INDEX 3

Executive Board, membership, 222 Foot -and -mouth disease, 108, 164 organizational study, 82 Foundations' Fund for Research in Psychiatry, 101 Standing Committee on Headquarters Accommodation, 82 France, 14, 63, 180 Expanded Programme of Technical Assistance, 77, 80, 85,105,121 French Antilles and Guiana, 104, 157 Expert advisory panels, 223 Expert Committee on Biological Standardization, 13, 17, 22, 70, 224 Gabon, 43, 91, 142 Expert Committee on Cancer Treatment, 51, 224 Gambia, 142 Expert Committee on Dependence -Producing Drugs, 69 -70, 224 Germany, Federal Republic of, 14, 30, 43-44, 180 Expert Committee on Health Statistics (Sampling Methods in Gerontology and geriatrics, 59, 121 Morbidity Surveys and Public Health Investigations), 67, training course on the care of the elderly, Kiev, 59, 120, 188 224 Ghana, 4, 32, 33, 45, 46, 91, 93, 95, 142 Expert Committee on Insecticides (Chemistry and Specifications), Gilbert and Ellice Islands, 132, 204 40 -41, 224 -225 Goitre, endemic, seminar on prevention, 100, 166 Expert Committee on Leprosy, 29, 225 Gonorrhoea, 10,11 Expert Committee on Malaria, 6, 225 Greece, 3, 32, 82, 121, 180 -181 Expert Committee on Nutrition and Infection, 55 -56, 225 Grenada, 102 Expert Committee on Onchocerciasis, 24, 225 -226 Guadeloupe, 104 Expert Committee on Professional and Technical Education of Guatemala, 100, 101, 104, 157 Medical and Auxiliary Personnel, Training and Prepara- Guinea, 91, 143 tion of Teachers for Medical Schools with special regard to the Needs of Developing Countries, 44, 61, 226 University Health Services, 61 -62, 226 Haemorrhagic fevers, 19, 20, 38, 40, 113, 115, 134, 176 Expert Committee on Rabies, 13, 226 Haiti, 101, 104, 157 -158 Expert Committee on Specifications for Pharmaceutical Pre- Handbook of Resolutions and Decisions, 76 parations, Sub -Committee on Non -Proprietary Names, Headquarters, new building, 82 73 -74, 226 Secretariat, structure, 81, 232 Expert Committee on the Midwife in Maternity Care, 48, 225 Health demonstration areas, Lebanon, 194; Republic of Viet - Expert Committee on the Training of Laboratory Personnel Nam, 209; Somalia, 196; Spain, 184; Sudan, 197 (Technical Staff), 226 Health education, 29, 47-48, 53, 94, 115, 124, 127, 131, 132 -133, Expert Committee on the Use of Human Immunoglobulin, 135 71 -72, 227 Afghanistan, 169; Algeria, 179; Caribbean area, 165; Chile, Expert Committee on Tuberculosis, eighth report, 7 154; India, 172, 174; Malaysia, 205; Morocco, 182; Expert Committee on Water Pollution Control, 34-35, 227 Nigeria, 145; Philippines, 207; Portugal, 183; Republic Expert committees, 224 -228 of Viet -Nam, 209; Singapore, 208; Spain, 184; Swaziland, Export- Import Bank, 109 147; Togo, 148; Uganda, 148 Eye diseases, see Communicable eye diseases seminar, Dar -es- Salaam, 94, 149 Health legislation, 43, 101 Health planning, see National health planning FAO see Food and Agriculture Organization Health protection and promotion, 50 -59 FAO /WHO Expert Committee on Food Additives, 56, 86, 227 Helminthiases, 24 -25 FAO /WHO Expert Group on Vitamin Requirements, 215 Honduras, 100, 101, 102, 103, 105, 158 FAO /WHO Expert Panel on Veterinary Education, 16 Hong Kong, 16, 18, 204 FAO /WHO SecondInternationalMeeting on Veterinary Hospital statistics, 54, 66, 67, 104, 105, 113, 150, 168, 177 Education, 16, 86 Hospitals, administration and planning, 43 -44, 100, 108, 112 FAO /WHO /STRC Regional Food and Nutrition Commission Argentina, 150; Barbados, 151; Cyprus, 190; Dahomey, 142; for Africa, 94, 95, 149 India, 174; Jordan, 193; Laos, 205; Luxembourg, 181; Federal Republic of Germany, 14, 30, 43-44, 180 Malaysia, 205; Portugal, 183; Republic of Viet -Nam, Fellowships, 47, 62 -63, 95 -96, 105, 120, 121, 125, 187 208; Sudan, 197; Togo, 148; Trinidad and Tobago, 161 numbers awarded (1 Dec. 1964 - 30 Nov. 1965), 237 -238 advisory group, Washington, D.C., 43, 100, 167 -168 Fiji, 47, 204, 210 symposium on the estimation of hospital bed requirements, Filariasis, 23, 24 -25, 177 Copenhagen, 121, 189 Ceylon, 171; Western Samoa, 209 training course, Moscow, 187 research unit, Rangoon, 25, 40, 215 -216 Housing, 28, 36 -37, 59, 84, 85, 165, 201, 214 seminar, Manila, 25, 213 Iraq, 192; Venezuela, 162 Finland, 17, 43-44, 50, 180 travelling seminar, USSR, 36, 213 Food additives, 56, 86, 227 Housing Programmes: the Role of Public Health Agencies, 37 Food and Agriculture Organization (FAO), 34, 37, 78, 83, 84, Human genetics, 53 -54, 69, 83, 215 86 training course, Ankara, 212 jointly assisted activities, 85, 95, 134, 227 Human reproduction, 49, 132, 135 food standards and nutrition, 16, 56, 94, 100, 114 -115, 128, Hungary, 14, 17, 181 131, 133, 149, 167, 212, 215 Hydatidosis, 13 -14, 104 parasitic diseases, 22, 26 veterinary education, 16 Food and Nutrition Commission for Africa, Joint FAO /WHO/ IAEA, see International Atomic Energy Agency STRC, 94, 95, 149 ICAO, see International Civil Aviation Organization Food standards and hygiene, 16, 27, 56, 57, 101, 167, 182, 198, Iceland, 181 215 ILO, see International Labour Organisation 4 THE WORK OF WHO, 1965

ILO /WHO Committee on the Health of Seafarers, 58, 86, 227 International Institute for Educational Planning, 61 IMCO, see Inter -Governmental Maritime Consultative Organi- International Labour Organisation (ILO), 34, 44, 66, 86, 128 zation jointly assisted activities, 57, 58, 84, 85, 134, 212, 227 Immunology, 10, 71 -73, 105, 106, 179 International League of Dermatological Societies, 51 training course on immunofluorescent techniques, Copen- International non -proprietary names for drugs, 73 -74 hagen, 11, 215 International Organization for Biological Control, 37 Incaparina, 100 International Organization for Standardization, 87 India, 3, 4, 5, 9, 14, 16, 18, 19, 20, 22, 27, 29, 30, 32, 38, 42, International Paediatric Association, 48-49 44, 45, 46, 47, 48, 50, 53, 62, 67 -68, 82, 85, 112, 113, 114, International Pharmacopoeia, 73 115, 116, 171 -174 International quarantine, 30-31 Indian Council of Medical Research, 173 International Sanitary Regulations, 30, 31, 163 Indian Nursing Council, 46, 116, 172, 173 International Social Security Association, 44, 86, 87 Indonesia, 3, 5, 16, 22, 58, 112, 116 -117, 174 -175 International Society for Rehabilitation of the Disabled, 104 Industrialization, see Urbanization International Society of Cardiology, 52, 78 Influenza, 14, 17, 18 International Telecommunication Union, 78 Insecticides, 38-41, 91, 104, 112 -113, 193 International Union against Cancer, 51 field trials and testing teams, 5 -6, 40, 163, 213, 215 International Union against the Venereal Diseases and the resistance, 38 -39, 104 Treponematoses, 11 Institute of Nutrition of Central America and Panama (INCAP), International Union against Tuberculosis, 9 100, 107, 166, 167 International Union for Child Welfare, 55 Inter -American Committee of the Alliance for Progress, 99, International Union for Health Education, 48 107 International Union for the Scientific Study of Population, 54 Inter -American Development Bank, 32, 102, 109, 110 International Union of Pharmacology, 69 Inter -American Economic and Social Council, 108 Iran, 3, 5, 12, 27, 28, 30, 34, 40, 44, 45, 46, 51, 53, 58, 62, 68, Intergovernmental Committee for European Migration, 78 82, 125, 126, 127, 128, 191 -192 Inter -Governmental Maritime Consultative Organization Iraq, 3, 5, 36, 42, 50, 125, 126, 127, 131, 192 (IMCO), 31, 34 Ireland, 16, 181 International Advisory Committee on Biological Control, 37 Israel, 34, 44, 45, 46, 50, 65, 67, 126, 192 -193 International Agency for Research on Cancer, 79 Italy, 39-40, 181 International Air Transport Association, 31 Ivory Coast, 67, 91, 143 International Association of University Professors and Lecturers, 61 Jamaica, 3, 16, 18, 45, 46, 52, 100, 103, 104, 105, 158 International Astronautical Federation, 35 Japan, 18, 19, 25, 27, 58, 204 International Atomic Energy Agency (IAEA), 34, 35, 57, 58, Joint Committee on Health Policy, UNICEF/WHO, 8, 56, 85, 86, 118, 215, 216, 217 -218 86 panel on permissible emergency radiation doses to the public, Joint committees, 227 -228 Vienna, 57, 217 Joint FAO /WHO Expert Committee on Food Additives, 56, 86, International Bank for Reconstruction and Development, 33, 227 111, 130 Joint ILO /WHO Committee on the Health. of Seafarers, 58, 86, International Biological Programme, 53, 215 227 InternationalCertificateof VaccinationorRevaccination Joint Meeting of the FAO Committee on Pesticides in Agriculture against Smallpox, 30 and the WHO Expert Committee on Pesticide Residues, International Certificate of Vaccination or Revaccination against 56, 86, 227 -228 Yellow Fever, 30 Jordan, 3, 4, 33, 43, 46, 58, 82, 126, 127, 128, 193 International Children's Centre, 93 Juvenile delinquency, 55, 85, 217 training courses and seminars, 189, 201 International Civil Aviation Organization (ICAO), 31 International Classification of Diseases, 66, 105, 153, 168, 195 Kellogg Foundation, 46, 101, 107, 109 Eighth Revision Conference, Geneva, 66, 214 Kenya, 14, 19, 21, 24, 26, 45, 61, 67, 91, 92, 93, 94, 95, 143 -144 Ninth Revision (1975), 54 Korea, Republic of, 19, 42, 47, 132, 133, 134, 204 International Commission on Radiological Protection, 57 Kuwait, 34, 82, 125, 126, 193 -194 International Commission on Radiological Units and Measure- ments, 57 Laboratories, 42, 44-45, 101 -102, 113, 127, 165, 167, 186, 213 International Committee of Military Medicine and Pharmacy, 87 Argentina, 102; Brazil, 152; Burma, 170; Cambodia, 203; International Committee of the Red Cross, 87 Caribbean area, 165; Chile, 102; China (Taiwan), 204, International Committee on Laboratory Animals, 44, 115 209; Costa Rica, 156; Cyprus, 190; El Salvador, 157; International Co- operation Year, 78 Gabon, 142; Guatemala, 157; Haiti, 158; India, 174, 178; International Council of Nurses, Fourth Quadrennial Con- Iran, 191; Iraq, 192; Jordan, 193; Laos, 205; Mexico, 159; gress, 47, 78 Morocco, 182; Pakistan, 195; Republic of Viet -Nam, International Council of Scientific Unions, 35, 53 209; Saudi Arabia, 196; Sierra Leone, 147; Spain, 183; International Council of Societies of Pathology, 50, 51 Syria, 198; Venezuela, 162 International Dairy Federation, 87 Laboratory animals, 16, 44, 115 International Dental Federation, 53 Laboratory technicians, training, 44, 101, 201 International Digest of Health Legislation, 75 Caribbean area, 165; Gabon, 142; India, 174; Malaysia, International Epidemiological Association, 105 205; Morocco, 182; Republic of Viet -Nam, 209; Sierra International Federation of Gynecology and Obstetrics, 51 Leone, 147 International Federation of Surgical Colleges, 51 tutors' training course, Beirut, 44, 127 INDEX 5

Laos, 43, 132, 135, 205 Malaysia, 3, 42, 43, 44, 47, 48, 67, 132, 133, 205 -206 Latin American Centre for the Classification of Diseases, 105, Maldive Islands, 112, 115, 175 168 Mali, 21, 32, 43, 91, 92, 144 Latin American Institute for Economic and Social Planning, Malnutrition, see Nutrition 43, 84, 99 Malta, 12, 33, 85, 121, 123, 181 League of Red Cross Societies, 48, 87 Manganese poisoning, 58, 106, 167 Lebanon, 4, 33, 42, 62, 82, 125, 126, 194 Mass Campaigns and General Health Services, 42 Leishmaniasis, 26 Leprosy, 21, 29 -30, 47, 92, 103 -104, 163 -164 Maternal and child health, 48-49, 55, 93, 94, 98, 100, 105, 115, Argentina, 150; Burma, 170; China (Taiwan), 203; Colombia, 127 -128, 132, 166, 189, 213 154; Guinea, 143; India, 171; Indonesia, 174; Iran, 191; Algeria, 179; Burundi, 141; Cambodia, 202; Ceylon, 170; Iraq, 192; Ivory Coast, 143; Kuwait, 194; Liberia, 144; Chad, 141; Ethiopia, 190; Gabon, 142; Ghana, 142; Mauritania, 144; Mexico, 159; Nepal, 176; Pakistan, Guinea, 143; India, 174; Indonesia, 174, 177 -178; Iran, 191; Ivory Coast, 143; Kenya, 143; Laos, 205; Libya, 194; 195; Republic of Korea, 204; Republic of Viet -Nam, 210; Madagascar, 144;Mauritania,144;Mongolia,175; Senega1,146; Sierra Leone,147 ; Thailand, 176; Turkey,184; Nepal, 175; Philippines, 207; Republic of Korea, 210; Upper Volta, 148 Republic of Viet -Nam, 208; Rwanda, 146; Ryukyu Islands, advisory team, 29, 211 BCG trial team, 29, 213 207; Tunisia, 198; Turkey, 184; Uganda, 148; United Arab Republic, 199; Yugoslavia, 185 seminar, Manila, 29, 210 see also Children Leptospirosis, 13 Leukaemia, 15, 16, 19 Mauritania, 91, 144 -145 Liberia, 21, 43, 44, 91, 144 Mauritius, 91, 93, 94, 145 Libraries, medical, 106, 200, 206 Measles, 17 course for librarians, Beirut, 76, 125, 200 Meat hygiene, 56 Library, WHO, 75, 76, 78 FAO /WHO training course, Roskilde, 16, 212 Libya, 126, 127 -128, 194 Mecca Pilgrimage, 30 Luxembourg, 181 Medical care, 37, 43 -44, 46, 124, 167, 189 Lymphomas, 19, 50 Argentina, 150; Costa Rica, 155; Honduras, 158; Jordan, 193; Saudi Arabia, 196; Somalia, 197; Yemen, 200 Medical education, 60-61, 94, 98, 105, 106, 114, 115, 121, 125, 134, 168, 177, 178, 187, 189, 201 Madagascar, 42, 91, 93, 94, 144 Afghanistan, 169; Argentina, 151; Burma, 170; Caribbean Malaria, 3-6, 10, 26,30, 39, 47,54, 83, 84,91, 103, 107,111, area, 158; Ceylon, 171; Chile, 154; Czechoslovakia, 180; 120,126,133,163,177,189, 209,215, 216 -217,236 Democratic Republic of the Congo, 95; Ethiopia, 190; Afghanistan, 169; Algeria, 179; Argentina, 150; Bolivia, 151; India, 172, 174; Indonesia, 116 -117, 175; Israel, 193; Brazil, 151; British Guiana, 153; British Honduras, 153; Mexico, 159; Peru, 160; Poland, 182; Saudi Arabia, 196; British Solomon Islands Protectorate, 202; Brunei, 202; Tunisia, 129 -130, 199; Uruguay, 161; Venezuela, 162 Burma, 170; Cambodia, 202; Cameroon, 141; Ceylon, conference on effective teaching methods, Geneva, 61, 214 -215 171; China (Taiwan), 137 -138, 203; Colombia, 154, 155; see also Medical schools Costa Rica, 155; Cuba, 156; Dahomey, 142; Dominican Medical physics, international conference, Harrogate, 58, 218 Republic, 156; Ecuador, 156; El Salvador, 157; Ethiopia, Medical research, 16, 64-65, 67, 72 -73, 81 -82, 106, 107 -108, 165, 190; French Antilles, 157; French Guiana, 157; Ghana, 142; Guatemala, 157; Haiti, 157; Honduras, 158; India, 168, 213 173; Indonesia, 174; Iran, 191; Iraq, 192; Israel, 192; collaborative projects, 64, 239 Jordan, 193; Lebanon, 194; Liberia, 144; Libya, 194; grants for training and exchange, 240 see also Advisory Committee on Medical Research Malaysia, 205, 206; Maldive Islands, 175; Mauritania, Medical schools, 60 -61, 94, 98, 105, 114, 125, 134, 168, 177 144;Mauritius,145;Mexico,158;Morocco,182; Mozambique, 146; Nepal, 175; Nicaragua, 159; Nigeria, Algeria, 179; Argentina, 151; Cambodia, 202 -203; Ethiopia, 145 -146; Pakistan, 195; Panama, 159; Paraguay, 160; 190; Fiji, 204; India, 172 -173; Indonesia, 116 -117, 175; Peru, 160; Philippines, 206; Republic of Korea, 204; Iraq,192;Israel,193; Kenya, 144; Malaysia,206; Republic of Viet -Nam, 209; Réunion, 146; Ryukyu Islands, Morocco, 182;Saudi Arabia,196;Thailand,176; 207; Saudi Arabia, 196; Senegal, 146; Sierra Leone, 147; Tunisia, 129 -130, 199; United Republic of Tanzania, 147 Somalia, 196; Southern Rhodesia, 147; Sudan, 197; see also Medical education Surinam, 161;Syria, 198; Thailand, 176; Togo, 42, Medical supplies and equipment, 61, 82, 128 97, 148; Turkey, 184; Uganda, 148; United Arab Repub- Ceylon, 170; Somalia, 197; Tunisia, 199 lic, 199; United Republic of Tanzania, 147; West Indies, Member States, 79, 81, 221 162; Yemen, 200; Yugoslavia, 186 Meningitis, 28, 149 consultants and advisory services, 163, 211 Mental health, 46, 54-55, 77, 85, 100- 101, 133, 167, 187, 189, 201, drugs 5, 6, 163, 213 216 epidemiology, 129, 163 Argentina, 150; Belgium, 180; Burma, 170; Caribbean area, eradication programme, status, 236 167; China (Taiwan), 203; Greece, 180; Iran, 191; evaluation teams, 5, 126, 138, 177, 188, 201 Jamaica, 158; Malta, 123, 181; Philippines, 206; Portugal, PAHO seminar, Cuernavaca, 4, 99, 103, 111, 163 183; Thailand, 176; Venezuela, 162 training, 4 -5, 47, 91, 97 -98, 126, 211 information centre, Latin America, 101, 167 centres, 4, 5, 47, 91, 98, 126, 127, 133, 149, 151, 190, 195, travelling seminar on organization of services, USSR, 55, 217 197, 209 see also Psychiatry Malaria Eradication Special Account, 107 Mexico, 5, 16, 42, 101, 104, 105, 106, 158 -159 Malawi, 95 Microbiology, 35, 37, 71, 105, 179, 183 6 THE WORK OF WHO, 1965

Midwifery, 46, 48, 94 -95, 100, 132, 149, 166, 186, 212 Nursing (continued) Afghanistan, 169; Brazil, 152; Burma, 170; Cambodia, 202; auxiliaries, programmed instruction, 46, 101, 168 Gambia, 142; Gilbert and Ellice Islands, 204; India, 116, conference on nursing administration, New Delhi, 114, 177 172, 173; Indonesia, 175; Iran, 191; Laos, 205; Libya, 194; Expert Advisory Panel, 46 Morocco, 181; Nepal, 175; Pakistan, 195; Republic of international schools, Edinburgh and Lyons, 45, 120, 186 Viet -Nam, 208;Sierra Leone, 147;Singapore, 207; post -basic education centres, Dakar and Ibadan, 45, 95, 97, Somalia, 196; Togo, 148; Turkey, 184; United Republic 149 of Tanzania, 147 seminar on nurse staffing studies, Manila, 46, 132, 210 Milbank Memorial Fund, 105, 106 training course on home care services, Copenhagen and Milk hygiene, 56, 103 Aarhus, 213 Molluscicides, 22, 23 training courses on supervision and administration, Region Mongolia, 7, 11, 12, 18, 112, 117 -118, 175 of the Americas, 101, 165 Morocco, 4, 44, 45, 61, 62, 67, 120, 121, 181 -182 Nutrition, 47, 48 -49, 55 -56, 84, 93 -94, 100, 105, 108, 128, 129, Mortality, morbidity, and causes of death, 68, 83, 215 133, 134, 149, 166, 167, 178, 210, 213, 215 Inter -American investigation, 105 Algeria, 179; Bolivia, 151; Brazil, 152; Caribbean area, 166; see also Statistics Colombia, 155; Ethiopia, 190; Haiti, 158; India, 174; Mozambique, 19, 82, 91, 146 Iran, 191; Jordan, 215; Kenya, 143; Libya, 194; Mada- Mycoses, 26, 198 gascar, 144; Mauritius, 145; Mexico, 159; Peru, 160; Philippines, 207; Republic of Viet -Nam, 208; Senegal, Narcotic drugs, 69, 70, 85 147; Thailand, 176; United Republic of Tanzania, 147 National health planning, 42-43, 46, 47, 91, 99. 108, 129, 132, FAO /WHO technical meeting, Rome, 47, 212 165 planning and evaluation of applied nutrition programmes, Burundi, 141; Colombia, 155; Costa Rica, 155; Guatemala, FAO /WHO seminar, Nairobi, 94, 149 157; India, 174; Jamaica, 158; Laos, 205; Liberia, 144; seminar on industrial -canteen feeding, FAO /WHO, Alexan- Nicaragua, 159; Panama, 159; Republic of Viet -Nam, dria, 86, 128, 131 209; Saudi Arabia, 196; Sierra Leone, 147; Somalia, 197; Western Samoa, 209 Occupational health, 57, 58 -59, 84, 86, 102 -103, 131, 167 seminar, Addis Ababa, 43, 213 -214 China (Taiwan), 204; Poland, 183; Venezuela, 162 Near East Foundation, 191 institute, Chile, 58, 102 -103, 154 Nepal, 3, 22, 62, 82, 112, 115, 175 -176 symposium on hazards in agriculture, Milan, 188 Netherlands, 14, 39, 182 travelling seminar, USSR, 58, 86, 214 Netherlands Antilles, 159 Onchocerciasis, 24, 25, 92 Neuropathology, comparative studies, 15 Colombia, 155; Guinea, 143 New Hebrides, 206 O'nyong nyong, 19 New Zealand, 33, 115, 118, 119, 206 Ophthalmias, see Communicable eye diseases Nicaragua, 38, 82, 100, 102, 103, 105, 159 Order of Malta, 115 Niger, 43, 45, 85, 91, 93, 94 -95, 145 Organization for Co- ordination and Co- operationinthe Nigeria, 5 -6, 7, 9, 10, 16, 17, 18, 21, 23, 25, 32, 33, 39 -40, 42, 43, Control of Major Endemic Diseases (OCCGE), 44, 87, 95, 97 45, 46, 47, 52, 53, 54, 58, 67, 68, 73, 91, 93, 94, 95, 97, Organization of African Unity, 87, 94, 95, 149 145 -146 Organization of American States, 100 Noise, 37, 188 Organizational meetings in 1965, 223 Nomenclature Regulations of WHO, 66 Non -governmental organizations in official relations with WHO, Pacific Islands, Trust Territory, 38, 208 87, 230 Paediatrics, 45, 48-49, 54, 93, 94, 100, 105, 114, 127, 128, 149, Norway, 50, 52,182 166, 177 Nursing, 45 -47, 85, 94 -95, 100, 101, 114, 115, 120 -121, 125, 132, Brazil, 153; Burma, 170; India, 172 -173; Philippines, 206, 165, 168, 186, 188, 212 207; Republic of Viet -Nam, 208 Afghanistan, 169; Algeria, 179; Argentina, 151; Brazil, 152, meeting of professors, Kampala, 61, 93, 98 153; British Honduras, 153; British Solomon Islands seminar, Berg -en -Dal, 61, 188 Protectorate, 202; Burma, 170; Cambodia, 202, 203; university departments, Ibadan and Kampala, 93,94,149 Cameroon, 141; Caribbean area,168; Ceylon, 171; see also Maternal and child health Chad, 141; Chile, 154; Costa Rica, 156; Cuba, 156; Pakistan, 3, 5, 14, 19, 22, 28, 67, 126, 127, 128, 130 -131, 195 Cyprus, 190; Dominican Republic, 156; Ecuador, 157; Pan American Federation of Associations of Medical Schools, Gabon, 142; Gambia, 142; Ghana, 142; Gilbert and 108 Ellice Islands, 204; Greece, 180; India, 116, 171, 173, 174; Pan American Foot -and -Mouth Disease Centre, 164 Indonesia, 175; Iran, 191; Iraq, 192; Israel, 192; Italy, Pan American Health Organization (PAHO), 48, 99, 100, 101, 181; Jamaica, 158; Jordan, 193; Laos, 205; Lebanon, 194; 102, 106, 107, 108, 109, 110, 111 Libya, 194; Malaysia, 205; Mali, 144; Mauritania, 144; Advisory Committee on Malaria, 107 Mexico, 159; Morocco, 181; Nepal, 175; Nicaragua, Advisory Committee on Medical Research, 106, 108, 165 159; Niger, 145; Pakistan, 195; Peru, 160; Philippines, Pan American Sanitary Bureau /WHO Regional Office for the 206; Portugal, 183; Republic of Viet -Nam, 208; Saudi Americas, 107, 108 Arabia, 196; Senegal, 146; Sierra Leone, 147; Somalia, Pan American Zoonoses Centre, 85, 104, 164 197; Spain, 183; Sudan, 197; Switzerland, 184; Syria, Panama, 100, 101, 105, 159 -160 198; Thailand, 176; Togo, 148; Tunisia, 199; Turkey, Papua and New Guinea, 18, 25, 28, 206 184; United Arab Republic, 199, 200; United Republic of Paraguay, 21 -22, 46, 100, 104, 105, 160 Tanzania, 147; Upper Volta, 148; Venezuela, 162; West Parasitic diseases, 22 -26, 71, 92 Indies, 163; Yemen, 124; Yugoslavia, 186; Zambia, 148 Pertussis, 28 INDEX 7

Peru, 21 -22, 52, 101, 102, 103, 104, 106, 109 -110, 160 Public health training (continued) Pesticides, 40 -41, 56, 58, 216 203; Colombia, 155; Czechoslovakia, 180; Ethiopia, 190; see also Insecticides India, 171 -172; Indonesia, 117; Iran, 191; Kenya, 96; Pharmaceuticals, 73 -74, 101, 102, 108;128, 176, 201 Malaysia, 206; Mexico, 159; Pakistan, 195; Peru, 160; Pharmacology, 69 -74 Republic of Korea, 204; Senegal, 146; Spain, 184; Togo, Cambodia, 202 -203; Thailand, 176 97 -98; Turkey, 184 -185; United Arab Republic, 199; Philippines, 7, 9, 19, 27, 33, 42, 46, 47, 48, 58, 85, 132, 133, 134, United States of America, 161; Venezuela, 162 137, 138, 206 -207 fourth conference of directors of schools of public health, Physical therapy, Indonesia, 175; Iran, 191; Japan, 204; Jordan, Puerto Rico, 105 -106, 168 193; Lebanon, 194; Philippines, 137, 207 symposium on schools of public health in Europe, Rennes, 189 training course, London, 59 Public information, 77 -78 see also Rehabilitation Publications, 67, 75 -76, 106 Plague, 27, 30, 38, 103, 112 -113, 115 Puerto Rico, 104, 106 Burma, 170; Ecuador, 156; Peru, 160 travelling seminar, USSR, 27, 216 Qatar, 196 Pneumoconioses, 86 Quarantine, see International quarantine Pneumonia, 18 Poland, 17, 28, 35, 85, 121, 182 -183 Rabies, 12 -13, 104, 115 Poliomyelitis, 18, 113, 134, 135 Argentina, 150; Brazil, 152; Papua and New Guinea, 210 Population, health aspects, 49, 64, 83 -84, 86, 106, 107, 135, 215 Radiation medicine, 57 -58, 82, 114, 128, 201, 218 see also Human genetics; United Nations, Second World Afghanistan, 169; Chile, 108 -109, 154; Ethiopia, 190; India, Population Conference 174; Singapore, 208; Sudan, 197; Thailand, 176 Portugal, 47, 183 conference on radiation and the immune response, London, Preventive and social medicine, 53, 59, 61 -62, 94, 98, 105, 187 217 Brazil, 153; Ethiopia, 190; Iraq, 192; Jamaica, 158; Malaysia, scientific meeting on dosimetry and toxicity of thorotrast, 206; Republic of Viet -Nam, 208 IAEA /WHO, Vienna, 57 -58, 217 Programme and budget estimates, regional, 96, 107, 115, 121, seminar, Lund, 188 129, 135 study group on planning of radiotherapy facilities,Geneva, Protection of the Public in the Event of Radiation Accidents, 75 -76 217 Psychiatry, 54, 55, 100, 101 Radiation protection, 35, 56 -58, 103, 106, 108 -109, 128, 167, 188, China (Taiwan), 203; Denmark, 180; Finland, 180; Israel, 193 215 nursing, 45, 46, 100, 101, 123, 201 Thailand, 114, 118 -119, 176 seminar on diagnosis, classification and statistics, London, 54, seminar on public health programmes, Singapore, 56 -57 216 symposium on personnel dosimetry for accidental high -level seminar on out -patient services, Geneva, 189 exposure, IAEA /WHO, Vienna, 57, 216 see also Mental health training course for X -ray technicians, Baghdad, 128, 201 Public health administration, 37, 42, 67, 114, 132, 166, 178, 213 training course on surveys for radionuclides in food, FAO/ Burundi, 141; Caribbean area, 165; China (Taiwan), 204; IAEA /WHO, Seibersdorf, 57, 215 India, 174; Laos, 205; Madagascar, 144; Maldive Islands, Reference banks, serum, 7, 131 175; Niger, 145; Philippines, 207; Portugal, 183; Republic Reference centres and laboratories, 64, 108, 241 -244 of Viet -Nam, 208, 209; Ryukyu Islands, 207; Togo, 148; antibiotics, 45 Upper Volta, 148; Western Samoa, 209; Yugoslavia, 185 bacterial diseases, 8, 10, 11, 27, 28 -29, 112 Public health laboratories, see Laboratories biological standardization, 70 Public Health Papers, 75 blood groups, 7, 45, 53 Public health services, 29, 36, 42-49, 55, 94, 99, 103, 111, 120 cancer, 50 -51 Afghanistan, 169; Algeria, 122 -123,179; Argentina, 150; diseases of vectors, 37 Bolivia, 151; Brazil, 152; British Guiana, 153; British human genetics, 53 Honduras, 153; British Solomon Islands Protectorate, immunology, 71, 72, 73 202;Cambodia, 203; Cameroon,141;Chile,154; parasitic diseases, 22, 24, 26 Colombia, 155; Costa Rica, 155; Cuba, 156; Dominican pharmaceuticals, 73 Republic, 156; Ecuador, 156; El Salvador, 157; Ethiopia, virus diseases, 14, 16, 17, 19, 20, 92 190; Greece, 181; Guatemala, 157; Guinea, 143; Haiti, meeting of directors of virus reference centres, 16 158; Honduras, 158; India, 173; Jamaica, 158; Kenya, zoonoses, 12, 13 96, 143; Mauritania, 144; Mexico, 159; Morocco, 181; Reference services, 75 -76 Mozambique, 146; Nicaragua, 159; Nigeria, 145, 146; Region of the Americas, 99 -111, 150 -168 Pakistan, 195; Panama, 159; Paraguay, 160; Peru, 160; Regional Committee for Africa, 95 -96 Republic of Korea, 204; Rwanda, 146; Saudi Arabia, 196; Regional Committee for Europe, 121 -122 Sierra Leone, 147; Somalia,196; Southern Rhodesia, 147; Regional Committee for South -East Asia, 115 -116 Thailand, 176; Togo, 97 -98, 148; Trinidad and Tobago, Regional Committee for the Americas, 106 -108 161; Turkey, 184 -185; Uganda, 148; United States of Regional Committee for the Eastern Mediterranean, 128 -129 America, 161; Uruguay, 161; Yemen, 200 Regional Committee for the Western Pacific, 135 study on cost and financing, 44 Regional Office for Africa, 96 see also National health planning; Public health administra- Regional Office for Europe, 120, 122 tion; Rural health Regional Office for South -East Asia, 116 Public health training, 48, 61 -62, 105 -106, 114, 168, 186, 189 Regional Office for the Americas/Pan American Sanitary Bureau, Afghanistan, 169; Algeria, 123 ; Argentina, 150; Brazil, 152-153; 107, 108 Burma, 170; Cambodia, 203; Chile, 154; China (Taiwan), Regional Office for the Eastern Mediterranean, 129 8 THE WORK OF WHO, 1965

Regional Office for the Western Pacific, 135 Scientific Group on Haemoglobinopathies and Allied Disorders, Rehabilitation, 29, 52, 58 -59, 100, 104, 124, 137, 164, 167, 189 54 Algeria, 179; Brazil, 152; Chile, 154; China (Taiwan), 203; Scientific Group on Histopathological Nomenclature and Indonesia, 175; Iran, 191; Japan, 204; Jordan, 193; Classification of Skin Tumours, 51 Lebanon, 194; Morocco, 182; Nigeria, 146; Pakistan, Scientific Group on Histopathological Nomenclature and 195; Tunisia, 199; Venezuela, 162 Classification of Urinary Bladder Tumours, 51 training course, Copenhagen, 59, 212 Scientific Group on Human Virus and Rickettsial Vaccines, 21 see also Physical therapy Scientific Group on Identification and Measurement of Air Reported Cases of Notifiable Diseases in the Americas in 1963, Pollutants, 34 104 Scientific Group on Immunological Aspects of Human Repro- Republic of Korea, 19, 42, 47, 132, 133, 134, 204 duction, 49 Republic of Viet -Nam, 43, 47, 132, 133, 134, 208 -209 Scientific Group on International Drug Monitoring, 69 Respiratory viruses, 14, 17 -18, 186 Scientific Group on Research in Bilharziasis: Measurement of Réunion, 91, 146 the Public Health Importance, 23 Rheumatic diseases, 51, 59, 123 Scientific Group on Research in Dental Health, 52 -53 comparative studies, 15 Scientific Group on Research in Genetics in Psychiatry, 53 -54, 55 Rhinoviruses, identification and classification, 16, 17 Scientific Group on Standard Strains of Insects of Public Health Rockefeller Foundation, 36, 46, 75, 97, 105, 137 Importance, 39 Romania, 16, 76, 183 Scientific Group on the Biochemistry and Microbiology of the Rural health, 3, 4, 9, 61, 84, 91, 92, 111, 125, 177 Female and Male Genital Tracts, 49 Afghanistan, 169; Bolivia,151; British Solomon Islands Scientific Group on the Cardiovascular Research Programme, Protectorate, 202; Cambodia, 203; Congo (Brazzaville), 52 141; Ecuador, 157; Ethiopia,190; Ghana,142; Guatemala, Scientific Group on the Chemistry and Physiology of the Gametes, 157; Hungary, 181; India, 171, 174; Iraq, 192; Kenya, 49 143; Laos, 205; Lebanon, 194; Malaysia, 205; Morocco, Scientific Group on the Clinical Aspects of Oral Gestogens, 49 182; Nigeria, 145; Pakistan, 195; Peru, 160; Saudi Scientific Group on the Rationale of Drug Testing: Pre- clinical Arabia, 196; Somalia, 196; Sudan, 197; Syria, 198; Safety Studies, 69 Yemen, 200 Scientific Group on Trachoma Research, 20 Rwanda, 146 Scientific groups, 64, 229 Ryukyu Islands, 3, 19, 207 Seafarers' health, 58, 86 Secretariat of WHO, structure, 81, 232 Senegal, 19, 23, 33, 56, 62, 85, 91, 93, 146 -147 Safe Handling of Radioisotopes (IAEA manual), medical adden- Sera production, 13, 17 dum, 57, 217 -218 Albania, 179; Indonesia, 175; Iran, 191; Romania, 183; Sanitarians, training, Afghanistan, 169; Cambodia, 203; Iran, United Arab Republic, 199 191; Iraq, 192; Saudi Arabia, 196; Somalia, 196; Syria, Serum ieference banks, 7, 131 198; Yemen, 200 Sewage disposal, 32, 33, 36, 85, 93, 102, 113, 115, 124, 164, Sanitary engineering, 32, 33, 36, 37, 60, 85, 93, 102, 115, 164, 200 -201, 218 168, 186 Argentina, 150; British Honduras, 153; Chile, 154; China Algeria, 179; Argentina, 151; Bolivia, 151; Brazil, 152, 153; (Taiwan), 203; Costa Rica, 155; Dominican Republic, Chile, 154; Colombia, 155; Costa Rica, 156; Honduras, 156; El Salvador, 157; Ghana, 142; India, 171, 173, 174; 158; Hungary, 181; Iran, 191; Ivory Coast, 143; Lebanon, Kenya, 143 -144; Malta, 181; Nicaragua, 159; Panama, 194; Madagascar, 144; Malaysia, 205; Mexico, 159; 159; Peru, 109 -110, 160; Philippines, 206; Senegal, 147; Pakistan, 130 -131; Peru, 109 -110; Saudi Arabia, 196; Trinidad and Tobago, 161; Turkey, 185; United Arab Turkey, 185; United Arab Republic, 199; Venezuela, 162 Republic, 199 -200; Venezuela, 110 ninth European seminar, Naples, 124, 186 Seychelles, 147 research institute, Nagpur, 35, 113, 173 Shousha, Dr. A. T., creation of Foundation, 129 symposium on training programmes, Geneva, 36, 214 Sierra Leone, 21, 43, 91, 147 Sanitation, 36, 93, 115, 134, 210 Singapore, 14, 18, 36, 47, 132, 133, 138, 208 Afghanistan, 169; Algeria, 179; Austria, 180; British Guiana, Single Convention on Narcotic Drugs, 70, 85 153; Burundi, 141; Cambodia, 203; Caribbean area, 164; Smallpox, 21 -22, 47, 70, 77, 92, 96, 104, 107, 112, 115, 122, 126, Central African Republic, 141; Costa Rica, 155; Dahomey, 135, 149, 163, 177 142; Guinea, 143; India, 171, 173; Ivory Coast, 143; Afghanistan, 169; Bolivia, 151; Brazil, 151; Ecuador, 156; Kenya, 143; Liberia, 144; Madagascar, 144; Mali, 144; Haiti, 157; Liberia, 144; Mali, 144; Nepal, 175; Pakistan, Mauritius, 145; Morocco, 181; Nigeria, 145; Pakistan, 195; Sierra Leone, 147; Sudan, 197; Upper Volta, 148 130, 195; Philippines, 206; Senegal, 146; Sierra Leone, Snail Control in the Prevention of Bilharziasis, 23, 75 147; Togo, 148; Tonga, 136 -137, 208; Turkey, 185 Social and occupational health, see Occupational health seminar on problems of squatters' settlements near large Social security institutions, relationship with official health cities, Venezuela, 36, 102 agencies, 43, 100, 108 see also Sanitary engineering; Sewage disposal; Waste disposal Somalia, 43, 82, 87, 125, 126, 196 -197 Saudi Arabia, 125, 126, 127, 196 South Pacific Commission, 87, 132, 134, 202 Schizophrenia, 54-55, 100, 150 South -East Asia Region, 112 -119, 169 -178 School health 48, 49, 86, 133, 164 Southern Rhodesia, 23, 93, 147 Cambodia, 202; Iraq, 192; Republic of Viet -Nam, 209; Spain, 58, 183 -184 Yugoslavia, 185 Special Account for Medical Research, 65 Scientific Group on Genes, Genotypes and Allotypes of Immuno- Specialized agencies, 85-86 globulins, 54, 72, 75 see also under names of individual agencies INDEX 9

Specifications for Pesticides,41 Tuberculosis(continued) Staff of WHO, 81 SaudiArabia,196;Somalia,196;Swaziland,147; composition by nationality, 235 Syria, 198; Thailand, 176; Turkey, 184; Uganda, 148; numbers and distribution, 233 -234 Yugoslavia, 185 Statistical Methods in Malaria Eradication,6, 67 advisory teams, 92, 133 -134, 209 Statistics, 54, 66-68, 81 -82, 95, 104 -105, 106, 113, 128, 129, 166, chemotherapy centre, Madras, 9, 171 168, 187, 213 epidemiological centre, Nairobi, 92, 149 Algeria, 179; Argentina, 150, 151; Brazil, 153; Burma, 170; training courses, Prague and Rome, 8, 212 Ceylon, 171; Ethiopia, 190; India, 173; Ivory Coast, 143; Tunisia, 58, 125, 126, 127, 128, 129 -130, 198 -199 Malaysia, 205; Morocco, 182; Nepal, 176; Pakistan, 195; Turkey, 3, 26, 32, 33, 42, 45, 50, 62, 76, 85, 120, 121, 126,184-185 Poland, 183; Republic of Viet -Nam, 208; Senegal, 146; Typhoid and paratyphoid, 28, 136 Spain, 183; Sudan, 198; Turkey, 185; Uruguay, 161 conference, Budapest, 67, 188 Uganda, 5, 19, 26, 32, 47, 52, 91, 92, 93, 94, 148 training courses, London, Brussels and Prague, 66,120, see 187 -188 UNESCO, United Nations Educational,Scientific and Cultural Organization see alsoHospital statistics Streptococcal and staphylococcal infections, 28 -29, 51 UNICEF,seeUnited Nations Children's Fund Sudan, 5, 23, 42, 53, 62, 125, 126, 127, 128, 197 -198 UNICEF/WHO Joint Committee on Health Policy, 8, 56, 85, 86 Supply services,seeMedical supplies and equipment Union of International Associations, 87 Surinam, 47, 103, 104, 161 Union of Soviet Socialist Republics, 12, 17, 18, 20, 27, 28, 30, Swaziland, 147 50, 73, 185 Sweden, 16, 184 United Arab Republic, 18, 23, 42, 45, 47-48, 62, 82, 125, 126, Swedish National Association against Heart and Chest Diseases, 127, 128, 131, 199 -200 65, 240 United Kingdom of Great Britain and Northern Ireland, 14, 15, Switzerland, 14, 15, 17, 43, 46, 184 16, 20, 39, 42, 43-44, 67, 185 Syphilis,10, 11 United Nations, 34, 44, 54, 55, 56, 66, 75, 77, 83-85, 95, 114, 121, Syria, 3, 4, 26, 33, 43, 125, 126, 198 128, 187, 189 jointly assisted activities, 36-37, 66-67, 83 -84, 85, 134, 205, 212 Second World Population Conference, Belgrade, 54,68, Tanzania, United Republic of, 19, 23, 26, 91, 92, 93, 94, 95, 83 -84, 215 147 -148 Third Congress on the Prevention of Crime and Treatment of Technical Assistance Board, 43, 77, 95, 128 Offenders, Stockholm, 55, 85, 217 discussions, at Health Assemblies, 37, 42-43, 67 United Nations Bureau of Social Affairs, 56 at regional committees, 48, 62, 67, 94, 95, 96, 108, 115, 122, United Nations Centre for Housing, Building and Planning, 84 129, 135 United Nations Children's Fund (UNICEF), 43, 85-86, 95, 114, Technical Report Series,75 121, 128, 203, 207 Tetanus, 28 jointly assisted activities, 47-48, 58, 82, 95, 122, 127, 134, Thailand, 3, 7, 9, 16, 19, 28, 33, 42, 46,112,113,114,115,118 -119, 135, 137 176 -177 communicable diseases, 8, 21, 25, 28, 29, 134, 208 Third Report on the World Health Situation,42 environmental health, 93, 113, 130, 136, 191 Togo, 4, 7, 9, 21, 42, 43, 91, 93, 97, 98, 148 malaria, 4, 107, 126 Tokelau Islands, 208 maternal and child health, 42, 48, 93, 208 Tonga, 28, 136 -137, 208 nursing, 46, 97 Trachoma, 20-21, 126 -127, 213 nutrition, 56, 100, 133, 167, 210 Afghanistan, 169; China (Taiwan), 203; India, 172; Iraq, 192; United Nations Commission on Narcotic Drugs, 85 Thailand, 176; Tunisia, 198 -199 United Nations Development Decade, 83-84 Trends in the Study of Morbidity and Mortality,10, 67 United Nations Educational, Scientific and Cultural Organi- Treponematoses, 9 -11, 92, 148 zation, 36, 56, 61, 76, 77, 86, 115 advisory teams, 149, 209 jointly assisted activities, 34, 47, 84, 128, 134, 200 epidemiological teams, 10, 53, 92, 211 United Nations /FAO Intergovernmental Committee on the see alsoYaws World Food Programme, 84 Trinidad and Tobago, 3, 18, 40, 101, 103, 104, 105, 161 United Nations High Commissioner for Refugees, 85 Tropical medicine, 18, 73 United Nations Information Centre, Paris, 78 Burma, 170; Thailand, 113, 176 United Nations Institute for Training and Research, 84 Trypanosomiasis, 25-26, 67, 71, 92, 141 United Nations Population Commission, 68 study team, 26, 217 United Nations Relief and Works Agency for Palestine Refugees training course, Kaduna, 26, 92 (UNRWA), 85 Tsetse, 26, 40 United Nations Research Institute for Social Development, Tuberculosis, 7 -9, 67, 91 -92, 103, 126, 133 -134, 149, 163, 189, 200 44, 84 Aden, 190; Afghanistan, 169; Argentina, 150; Basutoland, 141; United Nations Special Fund, 22,32 -33, 35, 36, 58, 60, 78, 80, Brazil, 151; Burma, 170; Cambodia, 203; Chile, 154; 84, 85, 86, 93, 95, 102, 103, 113, 121, 134 Czechoslovakia, 180; Ethiopia, 190; Ghana, 142; Greece, United Nations Statistical Commission, 68 180; India, 172; Indonesia, 175; Jordan, 193; Kenya, 143; United Nations Statistical Office, 84 Libya, 194; Mexico, 158; Mongolia, 175; Nepal, 176; United Republic of Tanzania, 19, 23, 26, 91, 92, 93, 94, 95, New Hebrides, 206; Niger, 145; Nigeria, 145; Pakistan, 147 -148 195; Philippines, 206 -207; Poland, 183; Republic of United States Agency for International Development (AID), 4, Korea, 204; Republic of Viet -Nam, 208; Rwanda, 146; 5, 43, 109, 110, 115, 126, 130, 137, 201, 207 10 THE WORK OF WHO, 1965

United States of America, 10, 14, 15, 17, 18, 30, 38, 39-40, 44, Waste disposal, 33, 35, 36, 84, 85, 102, 124, 164, 218 47, 62, 100, 103, 106, 107, 161 Jordan, 193; Syria, 198 National Institutes of Health, 58, 65, 72 Water pollution, 27, 28, 34 -35, 37, 57, 107, 164 United States Peace Corps, 46 Brazil, 152; Morocco, 182; Poland, 35, 85, 121, 183 Upper Volta, 39-40, 91, 92, 148 study of coastal waters, 35, 83 Urbanization, 36 -37, 42, 77, 84, 85, 108, 133, 165, 188 -189 Water supplies, 32 -33, 36, 47, 84, 85, 93, 102, 108, 113, 115, 134, Uruguay, 100, 102, 104, 105, 161 164-165, 177, 200 -201, 210, 218 Algeria, 179; Argentina, 150; Barbados, 151; Brazil, 153; Vaccination and vaccines, 21, 30, 70 -71, 75 British Honduras, 153; Ceylon, 171; Chile, 154; China brucellosis, 11 -12, 112, 118, 183 (Taiwan), 203 ; Colombia, 155; Costa Rica, 155 ; Dominican cholera, 27, 82, 112, 127, 134 Republic, 156; Ecuador, 156; El Salvador, 157; Ghana, dysentery, 28 142; Greece, 181; Guatemala, 157; Haiti, 157; Honduras, encephalitis, 19, 21 158; India, 171, 173,174; Iraq,192; Jamaica, 158; haemorrhagic fevers, 21 Jordan, 193; Kenya, 143 -144; Malaysia, 205 -206; Mexico, measles, 17, 112 159; Morocco, 182; Nepal, 175; Nicaragua, 159; Pakistan, meningitis, 28 130 -131, 195; Panama, 159; Paraguay, 160; Peru, 160; poliomyelitis, 16, 18, 21 Saudi Arabia, 196; Senegal, 147; Somalia, 197; Sudan, rabies, 12 -13, 104, 115 198; Surinam, 161; Tonga, 136; Trinidad and Tobago, smallpox, 8, 21, 22, 30, 107, 126, 133, 156, 157, 169, 195, 197 161; Turkey, 185; United Arab Republic, 200; Venezuela, trachoma, 20 110 -111, 162; West Indies, 162 typhoid, 28 conference, Washington, D.C., 102 yellow fever, 30, 152 Weekly Epidemiological Record, 31 see also BCG; Vaccine production West Indies, 162 -163 Vaccination Certificate Requirements for International Travel, 30 Western Pacific Region, 132 -138, 202 -210 Vaccine production, 112, 152, 165, 169, 175, 179, 183 Western Samoa, 9, 25, 132, 209 brucellosis, 183 Working Capital Fund, 80-81 cholera, 27 World Confederation for Physical Therapy, 59, 137 combined diphtheria, tetanus, and pertussis, 28, 173 World Directory of Post -Basic and Post - Graduate Schools of diphtheria, 193 Nursing, 75 rabies, 13, 152 World Federation of Neurology, 15 smallpox, 21, 22, 92, 104, 151, 173 World Federation of Occupational Therapists, 137 tetanus, 193 World Federation of Parasitologists, 25 yellow fever, 155 World Food Programme, United Nations /FAO, 4, 56, 84, 102 Vector control, 37, 38, 215 -216 World Health, 77, 78 Kuwait, 193; Thailand, 176 World Health Day, 22, 77 travelling seminar, USSR, 216 World health foundations, 107 Venereal diseases, 10-11, 104, 164 World Health Statistics Annual, 67, 76 Chile, 154; India, 173, 174; Seychelles, 147; Spain, 183 World Medical Association, 61, 87 seminar, Washington, D.C., 10 -11, 104, 164 World Meteorological Organization (WMO), 34 Venezuela, 17, 28, 36, 40, 45, 46, 48, 100, 101, 102, 103, 104, 105, World Psychiatric Association, 87 106, 110 -111, 162 Veterinary medicine, Brazil, 153; Guatemala, 157 Second International Meeting on Veterinary Education, Yaws, 9 -10, 11, 21, 92, 164 Copenhagen, 16, 86 BritishSolomon IslandsProtectorate,209;Haiti,157; Veterinary public health, 11 -16, 104, 164 Indonesia,174;Liberia,144; New Hebrides,209; Viet -Nam, Republic of, 43, 47, 132, 133, 134, 208 -209 Nigeria, 145; Sierra Leone, 147 Virgin Islands, 104 Yellow fever, 19, 30, 152, 155 Virus diseases, 10, 16 -21, 100, 134, 184 see also Aedes aegypti comparative studies, 14 Yellow Fever Vaccinating Centres for International Travel, 30 diagnostic and research laboratories, Brazil,152; China Yemen, 50, 125, 126, 127, 200 (Taiwan), 209; Costa Rica, 156; Iraq, 192; Philippines, Yugoslavia, 37, 43 -44, 58, 67, 185 -186 206; Tunisia, 198 -199; United Arab Republic, 199 reagents programme, 16, 17 Viruses and cancer, 15, 16, 19, 21, 72 Zambia, 61, 91, 94, 95, 148 -149 Voluntary Fund for Health Promotion, 80 Zoonoses, 11 -14, 104, 117, 164