WP/RC14/2

THE WORK OF WHO

IN THE WESTERN PACIFIC REGION

THIRTEENTH ANNUAL REPORT

OF THE

REGIONAL DIRECTOR

TO THE

REGIONAL COMMI'I"I'EE FOR THE WESTERN PACIFIC

Covering the Period, 1 - 30 .rune 1963

World Health Organization Regional Office for the Western Pacific Mmila,

July, 1963 The following abbreviations are used in this Report:

ECAFE Economic Commission for Asia and the Far East

FAO Food and Agriculture Organization of the

MESA Malaria Eradication Special Account

UNICEF United Nations Children's Fund

UNESCO United Nations Educational, Scientific and Cultural Organization

United Nations Korean Reconstruction ~ncy

UNTEA United Nations Temporary Executive Authority

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CONTENTS

JNTRODUCTION ...... ,. .... iii ...... vii

PART I. GENERAL

1. TliE REGIONAL CO~'fl1EE ...... It ...... '...... • ...... • .. .. 3

2.. TlIE REGIONAL OFFICE ...... • .. • .. • • • ...... • .. • .. .. • • .. • • • • • .. .. • • • • • • • • • • • 4 2.1 Organizational Structure 4 2.2 Salaries and Allowances 5 2.3 Regional Office Building 5 3. AGREEMENTS WITH GOVERNMENTS •••.•.•.•...... ••.•••..•.••.•.•• 6

4. CO-ORDINATION OF WORK WITH OTlIER ORGANIZATIONS •••.••••••••. 6

4.1 The United Nations and the Specialized Agencies •••••• .6

4.1.1 United Nations Temporary Executive Authority •• 7 4.1.2 t.JN'ICEF" • • .. • • • • • • • • • • • • • • • • • .. • • • • • • • • • • • '.' .. • • • • 7 4.1.3 Technical Assistance Board/ United Nations Special Fund ••.••.••••••.•.•• 8 4.1.4 F AO ...... 8 4·1.5 International Bank for Reconstruction and Development ...... 9 4.1.6 t..JrlESCO ...... 9

4.2 With other Inter-governmental Organizations 9

4.2.1 South Pacific Commission •.•..••....•••••..•••• 9

4.2.2 ot;her jOint work ...... (> •••••••••••••••••••••• 10

5. PlJBLIC OO"O~TION ...... • . • • • • . • • • . • • • • .. • • • • 11

PART II. GENERAL STATEMENT OF ACTIVITIES IN TlIE REGION

1. PUBLIC HEALTH SERVICES •. • • • • • • • ...... • • • • • • . • • . . • • . • • • • • • 15 1.1 Public Health Administration and Health Labor-atory Services ••••.••.•••.•.•.•••.••.•• 15 1.2 Organization of Medical Care - Hospital Services ..••• 18 1.3 N'Ursing ...... 19 1.4 Health Education ...... 21 1.5 Maternal and Child Health •••.•.••...••••••••••••••••• 24

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CONTENTS

2. HEALTH PROTECTION AND PROMOTION ...... 26 2.1 Dental. Heal. th · ...... 26 2.2 M!ntal. Health ...... 27 2.3 Nutrition ...... 28 2.4 M!dical. Rehabilitation ...... 29 2.5 Radiation Heal.th, Radiation M!dicine and Human Genetics · ...... 30 ... ENVIRONMENTAL HEALTH ...... 30 4. EDUCATION AND TRAINING ·...... 32 4.1 Assistance to Educational. Institutions ...... 32 4.2 Fellowships ...... 34 4.3 Educational. Meetings and Cqurses ...... , ...... 36 MALARIA ...... 38 6. COMmNlCABLE DISEASES ...... 44 6.1 Bacterial. Diseases ...... 44 6.1.1 Cholera ...... 6.1.2 Diphtheria, Pertussis and Tetanus 6.2 Tuberculosis 6.3 Venereal Diseases and Trepqnematoses ...... Venereal Diseases ...... 49 Yaws ...... 49 6.4 Virus Diseases 50 6.4.1 Smallpox ...... 51 6.4.2 Trachoma ...... 51 6.4.3 Poliomyelitis 52 Leprosy 7· HEALTH STATISTICS AND HOSPITAL RECORDS ...... 8. PROGRAMME ANALYSIS AND EVALUATION ...... 55

PART III. SlJMMA.R:Lm OF SELECTED PROJECTS COMPImED DURING THE PERIOD UNDER REVIEW

1. MEDICATED SALT PR<>.J"relI, ...... 61

- iv - CONTENTS

2. PUBLIC HEALTH SURVEY, KOREA ••••••••••••••••••••••••••••••••• 62

3. BILHARZIASIS CONTROL PILOT PROJECT, PHILIPPINES ••••••••••••• 65

4. YAWS CONTROL PROJECT, PHILIPPINES ••••••••••••••••••••••••••• 70

5. YAWS CONTROL PROJECT, •••••••••••••••••••• 0. • • . . • • . • . • • . 72

PART IV. PROJECTS m OPERATION

Projects in operation from 1 July 1962 to 30 77

.ANNEXES

1 LIST OF REGIONAL OFFICE POSTS ...... 101

2 PROJECT AND REGIONAL OFFICE mTERNATIONAL STAFF EMPLOYED AS OF 30 JUNE 1963 ...... 105

3 CONSULTANTS EMPLOYED DURING THE YEAR 1 JULY 1962 .. 30 JUNE 1963 ...... 107 4 LIST OF SUPPLEMENTARY AGREEMENTS SIGNED WITH MEMBER COUNTRIES DURING THE PERIOD 1 JULY 1962 .. 30 JUNE 1963 ...... 109

5 TOTAL NUMBER OF AWARDS (REGULAR AND SPECIAL t;.. FELLOWSHIPS) FOR THE YEAR 1962-1963 ••••••••••••••••••••••••• 117

6 FELLOWSHIP AWARDS ACCORDING TO FIELDS OF STUDY AND COUNTRIES OF ORIGIN - 1 JULY 1962 .. 30 JUNE 1963 ...... 119 y 7 DISTRIBUTION OF VISITS IN ACCORDANCE WITH COUNTRY OF STUDY AND REGIONS ...... 121

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"...' . INTRODUCTION

By way of summary in looking ahead to the future health development in the countries and territories of this region, I should like to re-emphasize the importance of long-range heaJ.th programming as an integraJ. part of socio-economic development, the necessity of establishing a planning body ,in the national health administration, the need of basic statistics and data in health planning and programme evaluation, and the desirability of promoting leadership not only in the health field but also in other fields of national and locaJ. develop­ ment of which health is a vital component and where health contributes to social productivity. There must be realistic planning in ter.ms of manpower needs and, the ways and means by which these can be adequately met, taking into consideration projected population increases and the need to expand health facilities both in quantity and in quality. Strengthening of educational and training facilities as well as stability of staffing are, therefore, basic to an orderly development of a health programme that stands ready to meet the multitudinous needs of the present as well as the challenges of the future. As you know, the services of the Regional Office are at your disposal to assist in these activities. * * * During the year under reView, continued emphasis has been given to assistance in the strengthening of national health administrations and the development of rural heaJ.th services. The need for this assistance is to be expected for a number of years to come in view of the fact that developing countries comprise a large part of the Region.

Events during the year have reflected the increasing efforts of governments to expand their health services. There is also a growing recognition on the part of national health workers at all levels that the organization of local health services is a basic requirement before special health programmes can be successfully consolidated. However, in many instances, the practical. application of this concept is faced with difficulties, such as lack of funds, limitations in personnel and, in some cases, unsettled internal. conditions. In some countries also, the relatively low salaries of national staff force them to undertake private practice and make them reluctant to travel outside their duty station. This, of course, restricts the expansion of health activities at the periphery. The importance of preparing realistic long-range plans for health services at national and local levels in accordance with available personnel and material resources cannot be over-emphasized. Primary attention should be given in developing countries to programmes which will result in an adequate health service and this should come before the planning of expensive specialized programmes. In some countries also, there is an urgent need to strengthen and reorganize the central health services to deal with the planning and supervision of the increasing number of health activities.

- vii - There is ipcreasing recognition of the importance of an epidemio­ logical service which can assess, plan and direct disease control activities and co..ordinate them within the context of the general health programme. Parallel with this trend is the recognition that the establish­ ment of a strong .central health laboratory and the development of a network of health laboratory services is an essential part of any medical care programme .

. The important role of the hospital services in the health programme of the country i's increasingly being recognized. M;)re consideration is being given to questions of hospital planning and organization, as well as to the tra.in1ng of personnel and to proper and efficient administra..­ tion. * * * The year has seen developments in the school health education programmes in a number of countries, a keener co-operation between education and health authorities, as well as growing interest in establishing such programmes. Greater emphasis has been placed on the health education aspects of specialized projects and in developing or strengthening national health education programmes. It is expected that more progress will be made in this field following the reactivation of the post of regional adviser on health education. * * * Nursing education and administration continued to play an important role in the regional. programme. One of the remarkable features of the past year is the replacement of the emergency training of nurses by regular well established courses. Another feature is the efforts made in many countries to review and assess nursing needs and resources, as well as to revise and improve the curricula of nursing schools. There is a growing awareness that lack of well-trained personnel in this important field and inadequate utilization of nursing staff affect considerably the efficiency of other services. * * * As in previous years, considerable assistance has been provided in the field of maternal and child health. Continuing projects have been strengthened and linked with projects in other fields. It is expected that the findings of the assessment team visiting countries and territories in the South Pacific 'Will provide a basis for the further development of maternal and child health services in that area. M:mtion should also be made of the continuing efforts to establish and develop rural maternal and child health services which represent important nuclei for the development of rural public health services. However, there is still need for the broadening of maternal and chUd health services in a number of countries so that more attention is paid to the pre-school chUd. MJrbid1ty and mortality rates in this

- viii - age group have not yet begun to show a downward trend and it is, therefore, essential. that future activities should lay emphasis on this situation. * * * Of vital. importance to the establishment of a nationaJ. dental. heal.th service are data related to the extent and severity of dental. diseases prevalent in communities. A·multi-phased programme is now being planned for the first time in the Region; thus implementing one of the points emphasized during the Technic.al Discussions at the twelfth session of the Regional Committee. * * There has been a marked lack of interest in nutritional matters in many countries despite the efforts made to stimulate action by governments in this field. There are, in fact, many problems of malnutrition, and even undernutrition, in countries of the Region and it is obvious that nutrition has not yet found its proper place in many health programmes. Some applied nutrition schemes to be conducted in rural areas, e. g., the Philippines and French Polynesia, are now being planned. Nutrition education is being fostered in Singapore, Western Samoa, Fiji and and some extension work in the . However, the problems in many countries of the Region are: firstly, lack of knowledge of what problems exist and what can be done with existing resourcesj secondly, failure on the part of many countries to realize what nutrition means in terms of economics, and thirdly, the constant shortage of staff at all levels with knowledge of applied nutrition principles. For these reasons, it is considered that major emphasis in this field must be given to nutrition education. * * * Continued emphasis has been given to assistance in the field of environmental health. The provision of safe water supplies for the people, the training of personnel and the development of environmental health activities have all found a place in the regional programme. An important development is the increasing realization of both the necessity and difficulty of assessing real.istically the existing and developing environmental. heal.th problems. The recent outbreaks of epidemic diseases have certainly contributed to this development and have demonstrated the need for more vigorous and more comprehensive environmental health programmes. The increase and concentration of populations, as well as the development of industries, continuously brings on new problems. The functions of the health department in the field of environmental health are often considered to be only advisory. These must be considerably increased in view of their responsibilities in connection with the prevention of diseases. MUch remains to be done in the proper organization and conduct of comprehensive environmental heal.th programmes as a basis for any constructive public health programme. * * * - ix - The year heralds the birth of a faculty of medicine at the recently established University of M:lJ..aya and. the graduation of the first doctors from the Royal Faculty qf ledicine, Cambodia. Planning has been actively pursued in connection with the organization of a conference of deans of medical schools in the Region towards the end

of 196;. It is anticipated that improvements in both undergraduate ," and post-graduate medical education will have a direct bearing on the quality of a coun:try's :medical service whether it is rend.e;red by the gove~nt or private individuals and groups. Interest in strengthening the teaching of preventive :medicine and. mental health needs to be sustained and further stimulated. * * * With few exceptions, field operations in most of the malaria projects in the Region have proceeded according to the schedules set down in the respective plans of operation. Of the five malaria eradication programmes, t'WO are faced with a critical shortage of gove~nt funds for the implementation of activities during 196; and. 1964; in another, the in:g;>lementation of a new con:g;>rehensive plan of operation is being delayed for financial reasons. Problems of an administrative nature have ha.ng;>ered the progress of some of the pre­ eradication programmes. Encouraging results regarding the interruption of transmission have" however, been obtained from the two malaria eradication pilot projects launched in 1960 and 1961. Regional training at the newly established Malaria Eradication Training Centre in Manila is expected to be reactivated in the latter part of 196;. * * * In the field of communicable diseases, it is significant to note that the initial treatment survey in Tonga, the last of the yaws endemic areas of the Pacific Island Territories,was con:g;>leted in , and that with rare exceptions con:g;>ulsory segregation of leprosy patients has been abolished in Korea. An important programme of communicable disease control is the trachoma control project in () started about a year ago on a community-wide basis following the encouraging results obtained from previous epidemiologicaJ. surveys and clinical trials. This project is outstanding because of its sound planning and its wide coverage, and is probably the biggest UNICEF-supported project of its kind in the 'WOrld. Satisfactory results have been achieved in the DPr immunization programmes in China (Taiwan) and Singapore,and good progress has been made in Viet-Nam under difficult conditions. Interest in poliomyelitis prevention continues to increase in some countries. Cholera appeared and. was placed under control in West New (West Irian) under extremely difficult conditions. Its occurrence in parts of the Federation of Malaya and Singapore received the immediate attention of the Governments concerned. Bubonic plague occurred in Viet-Nam but as a result of the intensive efforts of the Govern.IJent, which 1D:uIediately launched a campaign for the isolation and treatment of cases, DDT spraying and dusting and vaccination, it never reached epidemic proportions. However, sporadic cases in scattered areas have continued to occur and the Permanent Committee for Plague Control has undertaken the necessary

.. x .. '-.. --.-, .._:: :e IIIIIIIIib,

studies and continued the preventive measures. Possibly, as a result of these outbreaks in the last two years, increasing interest has been shown by governments in vaccine production and in the improvement of diagnostic facilities. I would, however, emphasize again the need for intensive environmental health activities, including the provision of a safe and adequate water supply, improved refuse disposal and effective 'control of vectors, to ensure protection from epidemic outbreaks of cQmmunicabie disease. * * * Assistance to national tuberculosis control programmes continues in seven countries in the Region and in six of these there are national BCG vaccination campaigns in operation. Successful efforts are being made to integrate BeG activities into the general health services in a number of countries. Extensive case-finding and dOmiciliary chemo­ therapy are being carried out in all.these countries with varying degrees of coverage. It appears, however, that insufficient attention is being paid to the bacteriological diagnosis of tuberculosis, the supervision of domiciliary treatment, and the case registry of known tuberculous patients. It needs to be re-emphasized that tuberculosis control is one of the regular activities .of the local health units. * * * Delays in obtaining government acceptance of proposed candidates have affected the full utilization of the funds provided and, in some cases, have resulted in the loss of the candidates originally proposed. Another problem is that concerned with the full utilization of the services of international staff through failure or delay in providing appropriate countez:part staff or the basic information needed to enable tl">.e expert concerned to study the health problems involved without loss of valuable time. Finally, there are the difficulties connected with the clearance of agreements or addenda to agreements which are the legal basis for WHO assistance. It is hoped that the year ahead will see improvements in these particular aspects of the regional programme. * * * With the change of status of West New Guinea (West Irian), WHO activities in that area were transferred to the Regj.onal Office for South-East Asia in . * * * It is with regret that I announce the deaths of the following staff members: Dr. F. M. Erhat, Tuberculosis Control Project i Viet-Nam, Mr. C.L. Huang, Translator, Hong Kong; Dr. H. Humann, Maternal and Child Health Project, Viet-Na.mj Miss I. Kneepkens, ~ntal Health Consultant, V1et~Nam and Mrs. R.. paJ.=a, Secretary in the F/agiOOi Ot:fice . /) y;l; {~/·{;0A1l Region~ Director I .,1/ - xi - PART I. GENERAL WP/RC14/2 'f' . page 3

1. THE REGIONAL COMMITTEE

The thirteenth session of the Regional Committee for the Western Pacific was held in Manila, Philippines, from 20 to 25 . The meeting was attended by representatives of all Member states in the Region, except Cambodia, and of the Member States responsible for terri­ tories in the Region, except the Netherlands. Representatives of the United Nations, the Technical Assistance Board, UNICEF, the South . Pacific COmmission, the International Committee of Military Medicine and Pharmacy, and sixteen.non-gove~ntal organizations in official relations with WHO were present. The Director-General attended the session. It was formally opened byMI'. Diosdado Macapagal, President of the Philippines.

The Committee exa.m.ined· in detail the twelfth annual report of the Regional Director, covering the work from 1 to 30 June ·1962. In the course cif the discussion, particular reference was made to the fact that progress in the field of communicable diseases had been over­ shad.o~d by the large-scale outbreaks of cholera El Tor.

The progra:am:e and budget proposals for the Western Pacific Region in 1964 were discussed by the Sub-Committee on Programme and Budget and approved in plenary ~~ssion for transmission to the Director-General.

The Committee reviewed a report presented by the Regional Director on the facilities available for the education and training of health personnel within the Region. Although the Regional Committee had at a number of previous sessions elIq)hasized the ilIq)ortance of intra­ regional training, the requests for such training, particularly at post-basic level, had not been many, one of the rearons being, poSSibly, a lack of information about the regional facilities available. It was suggested that governments should. send to the Regional Director full information on training programmes suitable for foreign students, so that it might be" distributed to Member governments in the Region.

After considering a paper presented by the Regional Director, the Committee made a number of recommendations designed to increase the value of short-term consultantships.

The Committee discussed a report of the stUdies being carried out on cholera El Tor in Manila by the United States Naval Medical Research Unit No. 2 and the Government of the Philippines in order to obtain fUrther information on the treatment and, possibly, the prevention of the disease. Emphasis was placed on the need for further research on cholera El Tor. The Committee, having noted a statement by the Regional Director on the conclusion of inter-country arr~ments under Article 104 of the International Sanitary Regulations, stressed the importance of an early exchange of information, particularly with regard to the 1m.POs1t1on of quarantine restrictions in respect of cholera El Tor. tf7 .. -

WP/RC14/2 page 4

'lhree meetings were. deveted to. technical discussiens en "'!he role of the health' services in the improvement ef community water supplies." "The rele ef the lecal health services in leprosy centrel" was selected as the tepic fer the discussiens in 1963.

2 . THE REGIONAL OFFICE

2.1 Organizatienal Structure

2.1.1 Regienal office staff

'lhe new staff members who. arrived in the ceurse ef the year were the Regienal Adviser en Health pucatien, the Regienal Sanitary . Engineer and the Administratien and Finance Officer.' A candidate has been selected to. fill the positien ef secend nursing adviser and she is expected to. assume her duties shertly. . 'lhe professienal staff ef the Regional Office, inclusive of the above, is now 32. Th.e general services categery including custodial staff is 71. '!here is ene . unfilled prefessienal grade positien, that ef the secend communicable disease adviser.

The PUblic Informatien Officer exchanged positions with his ceunterpart in the Seuth~t Asia Regional Office.

2.1.2 WHO Representatives

On the reassigmnent of the fermer WHO Representative in Saigon, the Medical Officer fermerly attached to. the preventive medicine project in Viet-Nam was prometed to. the vacant post. A country liaison officer was appointed fer Korea under the overall supervisien of the WHO Representative in Taipei. '!he efficer thus designated is alSo. serving as public health adviser to. the Government.

During the meeting ef the WHO Representatives and Ceuntry Liaisen Officers held in the Regienal.office in April, the PrQgramme plaIllling cycle was reviewed and it was reselved that ~n additien to. the meeting i'n April ef each year, ~here weuld be a further meeting each Neveniber in erder to. impreve further the programme planning ef WHO-assisted country and inter-country prejects.

2.1.3 Preject staff

Out ef the 152 positions foreseen fer 'the year 1962 in ,the Regien, 131 had been filled by 31 December 1962. Of the remaining .21, 7 were filled during the first semester of 1963, leaving 14 unfilled positiens. Of these, 7 were fixed-term preject' positiens and 7 were censultants .

Difficulties with recruitment centinue. If clearance ef project staff by gevermnents could be expedited within a few weeks instead ef -.> 1 ,,- ~, ,

REGIONAL COMMITTEE - The 13th session of the WHO Western Pacjfic Regional Committee was h'eld in Manila in 1962. Dr. M. G. Candau, WHO Director-General, attended the meeting. In its technical discussions, the Committee called for teamwork between physician and engineer in the development of water supplies.

SEMINARS - To facilitate the exchange of information on health problems and to encourage greater co-operation in international health work, WHO convenes training courses, conferences and inter­ country seminars such as the Seminar on the Role of the Hospital in the Public Health Pro9ramme at the WHO Conference Hall. WP/RCl4/2 page 5 months, as has often happened in the past, this would greatly improve the situation. Owing to the very limited sources. of personnel qualified to work in international health programmes, delays in clearance have often resulted in the loss of candidates, thus causing further delay in the implementation of the planned progra.mme. The attention of all . governments is, therefore, drawn to. this particular point and the need for their co-operation emphasized. . .

2.2 Salaries and .Allowances

2.2.1 Locally recruited staff

After a comprehensive study of the salaries paid by a number of other employers in Manila, it was found that in conformity with WHO's policy of maintaining a salary schedule based on the best prevailing local rates, the scale of s8J.aries of general service category staff in Manila 'WOuld have to be increased. The matter is now under discussion with Headquarters.

The basis of overtime payment has also been reviewed in the light of current practice among other employers in 1

2.2.2 Professional staff

WHO's official rate of exchange, which had been maintained at 13.48 to the us dollar, was changed to r3.86 with effect from 1 to bring it in line with the free market rate of the peso. Consequent on this increase in the peso equivalent of the dollar-based salaries of the professional staff, the post adjustment was further reduced from Class 3 to Clas.s 8 with effect from .

2.3 Regional Office Building

Additions and improvements were effected· in the Regional Office premises providing extra storage and garage space.

The Conference Hall in the Regional Office bas been made available for fifteen conferences and seminars, eight of which were WHO-sponsored. The largest was the Fourth Asian Malaria Conference held in September i962 , which was attended by thirty-eight partiCipants from twenty-two countries in the South-East ASia, Eastern Mediterranean and the Western Pacific Regions of WHO,.. and seventy-three observers.

Annexes 1-3 give detailed information on the staffing pattern in the Region.

m 2

WP/RCl4/2 page 6

3. AGREEMENTS WITH GOVERNMENTS

Ninety-one supplementary agreements (or exchange of letter) relating to WHO assistance to. governments were signed during the period under review. Thirty-three of these were projects for which assistance in the form of equipment and supplies is being given by UNICEF. A list of the agreements is given in Annex 4. .

As a resUlt of the resolution adopted by the Regional Committee at ·its thirteenth session,l the advance brief-ing of short-term consultants and the provision of well qualified counterparts have been most satis­ factorily arranged by governlnents during the period under review. However, the situation with regard to the Signature of agreements, or addenda to agreements covering the extension of the services of WHO staff already in the field, has not yet reached the stage where it can be considered adequate from the point of view of the legal requirements of the Organization. In some cases, nine to twelve mnths have elapsed before the draft texts have been finally cleared by governments and it has been possible to complete the document for signature. As pointed out in previous reports, the legal basis for WHO assistance is a valid plan of operation or an exchange of letter signed both by the government and the Organization. It would be most unfortunate if well qualified personnel had to be assigned elsewhere simply because the legal requirements had not been met. This matter is again being brought to· the attention of the Regional Committee in the hope that Representatives will do all they can to ensure that the situation will improve in the future.

4. CO-ORDINATION OF WORK WITH

4.1 The united Nations and the Specialized Agencies

Representatives from the Regional Office attended the following metings, and where necessary, presented statements on behalf of the Organization: .

(a) FAO: Sixth Regional Conference for Asia and tb= Far East, held in Kuala Lumpur" Federation of MUaya., 15-29 September 1962;

(b) FAO/WHO/UNICEF Nutrition Seminar for South and East Asia, held in Hyderabad, , 8-15· ;

1 Resolution WP/RCl3.R4, WPR Handbook of Resolutions and Decisions, 1962, 3rd ed., section 1.1.2, page 4. WP/RC14/2 page 7

( c) ECAFE: Asian Seminar on Urban Community Development I held in Singapore, 10-20 December 196~;

(d) ECAFE: Nineteenth Session (plenary) of the Committee ~or Co-ordination of Investigations of the Lower Mekong Basin, held in Vientiane, Laos, 8-14 January 1963;

(e) ECAFE: Nineteenth Session, held in Manila, 5-18 ;

(f) United Nations: Meeting of Expert Group on Housing Management and Tenant Education, held in Wellington, New Zealand, 8-22 March 1963; ..

(g) UNESCO: Meeting of Experts in Teacher Training from Asian Countries, held in Manila, 21-25' .

4.1.1 United Nations Tenworary Executive Authority (UNTEA)

In , an agreement was reached by the Governm:!nts of and the Netherlands concerning West New Guinea (West Irian). Among other things, the agreement provided that the administration of West New Guinea would be turned over to UNTEA on 1 October 1962 and that on 1 May 1963 the Indonesian Gove!'Illlent would take over the administration of the territory. The agreement also specified that the senior posts in West New Guinea, including the directors of the various departments, 1-;auld be filled by non-Dutch and. non-Indonesian officials during the interim period when UNTEA administered the territory.

Following a visit to Manila by the former Director of Public Health of West New Guinea to discuss the problems connected with the impending departure of Dutch medical and para-medical personnel, the WHO Representative in Sydney was assigned to West New Guinea on 22 September to take over the responsibilities of Director of Public Health until UNTEA was able to assign its own staff. Upon the request of the United Nations, the Regional Office recruited a public health administrator to serve as Director of Public Health during the UNTEA. period of administration. The incumbent reported for duty on 26 October, but the WHO Representative stayed in the territory until 16 November to assist with activities connected with the cholera outbreak and other problems associated with the departure of Dutch personnel. On 1 !By 1963, the administration of West New Guinea was turned over by UNTEA to the Indonesian Government.

4.1.2 UNICEF The closest co-operation has, of course, been with UNICEF which is giving supplies and equipment to forty-one WHO-assisted projects. UNICEF assistance to health projects in the Western Pacific Region continues to expand and it is hoped that this trend will continue

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in the years to come. In 1963, an estimated $1 664 000 will be spent on activities in the field of health, and programmes under consideration for 1964 reach a total o~ $2 131 000 with a further increase in 1965 to $2 265 000. The block allocation of ap~roximately $100.000 to cover new programmes in the South Pacific in 1964 and 1965 has stimulated requests for assistance in the development of rural health, maternal and child health services. and immunization programmes.

UNICEF has also provided assist.ance to a number of social service projects in which the United Nations Department of EconOmic and Social Affairs is the technical agency. WHO has provided guidance in connection with the health aspects.

It would appear appropriate to make reference at this:point to the retirement of Mr. S. Keeny, Director of the UNICEF Asia'Regional Office, whose record of service in connection with maternal and child health in the Region will long be remembered.

4.1.3 Technical Assistance Board/United Nations SPecial Fund Close relationships have continued with the Resident Representatives of the Technical Assistance Board stationed in the different parts of the Region. A new arrangement came into effect during the period under' review whereby all Technical Assistance Representatives are routed via Manila prior to taking up their new assignments. It is felt that this opportunity for discussion with the staff of the Regional Office has done much to strengthen relationships in the. field. Valuable support has been given to governments in connection with requests for assistance from the Executive Chairman I s Working Capital and Reserve Fund and advice provided to both governments and the Organization on the type of programme suitable for implementation from the United Nations Special Fund.

4.1.4 FAO

In November, the Senior Regional Nutrition Officer, FAO, Bangkok, visited Cambodia, where, with the assistance of the M1nistry of Health, meetings were held with the Director of the Department of Agriculture, the Director of the School Health Service and with the directors of the prinCipal hospitals. Besides offering assistance in hospital dietetics and. in food preservation at the village level, FAO is interested in starting a limited combined pilot project to improve the nutritional status of a small population group. It is hoped that the WHO-assisted rural health demonstration project in Talthmau may be linked in with this new proposal as here the possibilities of integration seem favourable.

In February, a Senior Nutrition Officer from FAO Headquarters visited Manila. He accompanied the Regional Nutrition Adviser on a visit to Bayambang, the site of the proposed applied nutrition project. 'l'he officers of the two Agencies produced a draft plan of otleration WP/RC14/2 page 9

'Which has been submitted to the Government for consideration. There are two other combined projects in the planning stage, one in French Polynesia and one in Viet-N~.

4.1.5 International Bank for Reconstruction and Development

Following a request from the International Bank for Reconstruction and Development to the Director-General to arrange for a public health administrator to accompany a m1ssion.und~rtaking a general survey of the Territory of Papua and New Guinea, arrangements were made for the WHO Representative in .Sydneyto join the Mission for a period of about four weeks, sta~ing in early June .

4.1.6 UNESCO

The WHO Representatives and field staff have continued to work with the UNESCO-assisted fundamental education projects in Cambodia, Laos ana Viet-Nam. .

WHO has also provided guidance in connection with the health aspects of education projects in which UNESCO is the technical agency and for which UNICEF is giving supplies and equipment.

4.2 With other Inter-governmental Organizations

4.2.1 South Pacific Commission

The cordial relations which have been built up with the South Pacific Commission have continued. Reciprocal representation at each other's meetings is now an established procedure and the joint projects so far held have been very fruitful. Two more projects are planned - a nursing education seminar for countries in the South Pacific to be held in 1963 and a tuberculosis refresher course for assistant medical officers in 1964. The nursing seminar will be held in Fiji and the Commission will provide a health education officer, a translator/interpreter, secretarial assistance, interpretation equipment and possibly the expenses of same participants. The tuberculosis refresher course will be held in Noumea at the Headquarters of the Commission, which will provide conference and committee rooms, office facilities and transport, staff for inter­ pretation, translation and secretarial worlt and the assistance of its professional staff, who will concentrate on health education and help with administration.

WHO will be responsible in both cases for the travel costs and per diem of participants and consultants.

The Organization was represented at the following meetings of the COmmission: I WP/RC14/2 4 i page 10

(a) Meeting on Rural Health with Particular Reference to Maternal and Child Health, held in Papeete, Tahiti, 18-27 April 19 3; . . .' . .. . 6 . (b) Research COuPCil, twenty-n1nth'session, held-in Papeete, Tahiti, 29· April - 3-May 1963:

4.2.2 other Joint "WOrk' .

Co-operation with the South Pacific Health Service has. continued to be excellent. The attendance' of the Inspector-General at the thirteenth session· of the :Regionai Committee provided an opportunity for detailed discussions on health activities in the South Pacific.

A new agr-eement between the Scandinavian Board and the Government of Korea is under consideration. The Board has' expressed a desire for closer relations with WHO and has hSd discussions with WHO Headquarters in connection with the supplies and equipment for a radiotherapy unit in .

A number of WHO-assisted projec~s in the Region have continued to benefit from the assistance given by the Asia Foundation, the China Medical Board, the Colombo Plan, French Economic 'Aid, the Rockefeller Foundation, and the United States Agency for Internatiorial Development.

The Organization was represented at the following meetings of non-governmental organizations in official relations with. WHO:

(a) Pan-Pacific Seminar on Vocational Rehabilitation of the Disabled (Pre-conference feature of Second Pan-Pacific Conference), held .in Mmila, 28-30 November 1962;

(b) Second Pan-Pacific Conference of the Internat ional Society for Rehabilitation of' the Disabled (Sponsored by the International Society's World Commission on Vocational Rehabilitation in co-operation with the Philippine Government and interested organizations), held in Manila, 3-7 December 1962;

(c) Ninth Congr-ess of the Medical Women I s International Association, held in Manila, 30 December 1962 - 6 January 1963. * * * Many of the countries in the Region are receiving a considerable amount of aid from different countries. Although there is much inter­ agency contact and co-operation, there is not as yet full understanding and appreciation of the imperative need for the establishment of co-ordination committees under the chairmanship of a representative of' the MLnistry of Health. There are very active co-ordination committees '34

WP/RC14/2 page 11

in China (Taiwan) and Viet-Nam and there is no doubt that international and bilateral assistance in the field of health has been more effectively used in these two countries than elsewhere. . other countries have also established, or are planning.to establish, .similar committees. The services of WHO staff members are a:l:-wa.ys··ava1iab~e to assist health authorities in this way, bu~ it is.not always realized that it is the Department of Health which has the responsibility for convening such meetings and of appointing ·one of its senior starf to act as Chairman .

. 5. PUBLIC INFORMATION

In 1962, there was an increase of 60 per cent, compared with the previous year, in the number of written requests for information on WHO received from teachers, stUdents and professional organizations. To supplement the material·produced at Headquarters, a pictorial pamphlet and three informatio~ booklets on the work of WHO in the Western Pacific were issued. These· have been distributed to a number of united Nations Associations, profes~ional societies and information services. Ministries of health have also been notified that this material is available for despatch to their personnel and to education authorities.

A series of five radio talks on nutrition was prepared in collaboration with the Regional Adviser on Nutrition to follow through the interest shown by many governments, the press and radio on the theme of World: Health Day. The script was broadcast in English and Chinese (Mandarin and Aiooy) by the Far East Broadcasting Corporation and by Radio Australia in its Asian programmes; the English recordings were thereafter mad.e available to fourteen other national radio networks. A French text of the scripts was sent to CambOdia, Laos and Viet-Name

The nutrition talks were at the same time issued in the form of feature articles for the press in the Region; a digest of the material will later be released in pamphlet form.

A pamphlet on food and eating habits was prepared by the Education Department of the British Solomon Islands Protectorate and radio talks on nutrition were given by health officers in several South Pacific islands. The theme "Htmger: Disease of Millions" was lllldoubtedly of interest and stimulated feature articles on food and food problems, particularly with reference to their social and economic implications.

News items on WHO seminars and conferences and short feature items carried by international wire services have received a good reception in the Australian and New Zealand press. Leading magazines in the Region continue to receive advance copies of the WORLD HEALTH magazine; these periodicals will continue to be the main outlets for photographic stories and full-length feature articles on health or WHO-assisted projects .

.r- --'#

WP/RC14/2 page 12

Reporters and. magazine writers have recently be-gun to calIon the public information staff for background material and information on health subjects and international publi~ health .work. This is certainly an attitude that should be encouraged and every effort is being made to give journalists all possible assistance in gathering this information.

The Office helped to arrange a programme of work for a photographer sent by Headquarters to obtain photographic stories of trachoma, midwifery training and leprosy activities in China (Taiwan), Korea and the PhUippines. Briefing material was also provided.

Television networks in Manila have, at one time or another, shown all the WHO films available at the Regional Office and recently a number of WHO staff have appeared on progr~s. ." Further evidence of the growing public interest in the Organization, stimulated to a certain extent undoubtedly by press and radio reports, is the stream of visitors, mostly teachers, university students, tourists and health workers, who visit regional headquarters. Talks on WHO and information material are given to the visd.tors. During the school-term, an average of 300 students visit the PUblic Information Office monthly. ' ..

--

PART II

GENERAL STATEMENT OF ACTIVITIES

m THE REGION WP/RC14/2 page 15

PUBLIC HEALTH SERVICES

1.1 Public Health Administration and Health Laboratory Services

Further advances in the field. of public health administration were observed in the countries of the Region d.espite the usual problems of insufficient funds and shortage of health personnel. The d.ifficulties were aggravated in a few countries by the existence of national emergencies.

Depending upon the country, the strengthening of health services has been undertaken at different levels, national, intermediate and/or local. There was greater recognition of the need for an adequate health organization at the local level to ensure the success of special health programmes, such as malaria eradication. The concept and practice of integrating preventive and. curative services gained wider acceptance in the field.. Increased attention was also fp. ven to the need to provide adequate staff to supervise field activities.

Emphasis continued to be placed on the training of health staff at all levels. Fellowships awarded by international and bilateral agencies were supplemented by those granted under national sponsorship. In-service training courses have been established and expanded, and seminars and other educational meetings organized, sometimes with international or bilateral support.

The influence of concerted action in community development has not only brought health a@encies into closer contact with other government departments, but has also provided the local population with an opportunity of learning about their own health problems and of assisting in planning and carrying out their own community health programmes.

The involvement of health ministries in the planning and execution of national social-economic programmes is gaining further acceptance. This attitude, which has been stimulated by international agencies, provides the health agency with a wider perspective for planning and increased resources by undertaking or collaborating in all forms of activities wit~ health implications.

Concurrently with the development of the general health services has been the growth of special services related to the performance of basic health functions. The WHO-assisted epidemiological project in Viet-Nam, after completing the o~ganization at the central level, is now concentrating on the establishment of regional epidemiolOgical units to provide technical guidance in disease control operations and to serve as collecting stations for disease intelligence information. • Two other countries have requested similar assistance from WHO. Health laboratory services are also being developed; activities . have ranged from the establishment of a service where none existed, to the training WP/RCl4/2 page 16 of technical staff, the provision of additional public health and clinical laboratory facilities, and the adoption of a referral system between the various laboratories and the health and medical services.

A review of country activities during the year under review gives the following information:

In Cambodia, the rural health demonstration project has achieved the integration of the previously separate health and curative services in Takhmau Tow. For the first time, there has been community parti­ cipation in a newly introduced sanitation programme in the project area. The WHO expert attached to the Institute of Biology formulated his recoIIDDendations for the strengthening of the Institute and submitted a supply list covering the laboratory requirements of the Institute and two provincial hospitals. Although there is a blueprint for long­ range health programme development, the shortage of funds and staff has deterred its iIrq)lementation. However, a study has recently been initiated by the Ministry of Health with a view to effecting urgent iIrq)rovements in the organization of the national health administration.

The Government/AID/WHO consultant panel, which evaluated and assisted in developing a long-range plan for Korea in early 1962, recommended a reasonable increase in budgetary outlays for health which 'WOuld be comparable with other developing countries. The Panel also suggested the strengthening of certain functional units in the Ministry and made a plea that the salary scheme for health personnel should be raised with a view to attracting and holding them in the service. (See Part III for detailed description of this project.) The government response has been enthusiastic and prompt. A local health demonstration and training project designed to strengthen the basic health services at provincial and local levels is already in oPeration and, as intensive and comprehensive training is required, the WHO-assisted National Institute for Public Health Training has prepared a plan for training local health personnel over a five-year period.

Laos continued to be beset by internal strife. Nevertheless, the year saw the accreditation of new embassies and from them have come offers of assistance in the health field. A long-range health plan intended to serve as a framework for the country's future health services has been drafted by the WHO public health adviser and already this is being used by assisting agencies as a guide to planning. Substantial progress in the field of environmental sanitation and the care of mothers and children was made in the Vientiane Plain area, although the health services were limited geographically because of the national emergency. With the assign­ ment of a WHO medical officer to the project in 1964 , it is anticipated that further progress will be made, and that a pattern for local health services will be developed which will be suitable for adoption in other areas of the country. The Central Health Laboratory has been without the assistance of the WHO medical officer over the past few months WP/RC14/2 page 17 and the national counterpart has' continued to be responsible for its operation. It is hoped to organize laboratory side-rooms in the provincial hospitals when the new WHO medical officer takes up his assignment later in 1963.

The development of health services in the rural areas enjoyed priority consideration in the Federation of Malaya. Additional primary health centres, sub-centres and midwifery clinics are being built in accordance with the.targets set down in the second Five-Year Plan. staffing of the health services has proved a continuing.problem especially for medical officer posts. The Government is endeavouring to solve this by requiring medical graduates to serve one year in the rural areas before they can be accepted for specialization in the government hospitals. There is also a plan to recruit physicians from neighbouring countries on a contractual basis, although this is still at the negotiation stage. Facilities for the education and training of the medical and allied professions are being increased. A training centre has been established in Rembau which will supplement training activities already operating in Jitra. .The Ministry has under consideration a measure to organize a health laboratory system which would link the various laboratory units at national and state levels, and make them accessible to the health and medical services and to the medical profession. Expansion and changes in the organization and policy of the Ministry are expected as a result of the creation in of the Federation of Greater .

In the Philippines, the Government has established a special committee to review the recommendations of the Government/WHO team which evaluated the rural health administration and its programme early in 1962. The recOlmnendations of the WHO consultant on laboratory management and administration have been adopted and used as a basis for the expansion of the laboratory network over the next five years; WHO/UNICEF assistance to this plan was formalized in a recently signed agreement.

The Provincial Health Department in China (Taiwan) is considering certain organizational changes in connection with the national epidemiological and laboratory activities and is also reviewing health administration policies.

In Viet-Nam, as mentioned earlier, the preventive medicine project has developed expansion plans for the establishment of regional epidemiological services. Assistance to strengthen the administration of the distribution of medical supplies at the Central Pharmacy has resulted in additionaJ. recommendations for action. A draft addendum is under consideration to assist the Government in reviewing present procedures and legislation covering the control of drugs, pharmaceuticals and their quality control. The strategic hamlets, which were introduced in response to the current emergency, are developing as nuclei of the future political and administrative units of local government. The role of the Ministry of Health in the selection of sites for these hamlets WP/RC14/2 ... page 18 and in assisting in the health protection of their populations is increasingly being recognized by the military and political authorities. It is estimated that 80 per cent of the country's population will be settled in the strategic hamlets by the end of 1963. The interest of the South Pacific territories in expanding their health services ~s stimulated by the Rural Health Conference held in Tahiti last April, under the sponsorship of the South Pacific COmmission, and UNICEF's decision to grant a continuing block allocation to assist this area. The British Solomon Islands Protectorate has requested WHO/UNICEF assistance in connection with the development of its local health services. other requests from Fiji, Tonga and the New Hebrides lay emphasis on maternal and child health and immunization projects within the context of the overall local health programme. has requested WHO/UNICEF assistance in a rural health development plan covering an eight-year period; this plan was deSigned primarily to take over and continue antimalaria and antituberculosis activities after the present programmes have been terminated. It provides, however, at the same time for an orderly and comprehensive coverage of local health service activities. A similar rural health programme is developing in Sarawak with emphasis being placed on maternal and child health and environmental sanitation.

1.2 Organization of Medical Care - Hospital Services

The planning and organization of hospital services in countries of the Region has continued to receive attention. The hospital administration project in the Federation of Malaya has progressed satisfactorily and more emphasis had been laid on the training of hospital administrators. A national seminar on hospital administration was organized and nineteen medical and lay hospital administrators from general and district hospitals participated. A survey of the staffing of hospitals was started and the data collected will provide a basis for further in-service training of hospital administrators and auxiliary personnel. study material was prepared by the WHO expert and distributed to hospital and health administrators throughout the Federation. A national seminar on hospital administration, assisted by WHO, was held in the Philippines. Forty-five hospital directors and administrators from government hospitals throughout the country participated. The problems of hospital administration were thoroughly discussed and fourteen major policy guidelines were established by the group and submitted to the Department of Health. The seminar obtained nation-wide publicity and similar meetings have been organized by the national.authorities at prOvincial level. A comprehensive and substantial report on the hospital situation in Cambodia was submitted by a WHO expert after a three-month assigD.m9nt. The report has, in addition, provided detailed guidance .for the planning of hospitals and hospital services in the country. Further assistance in this field may be requested in the future. WP/RC14/2 page 21 teaching, supervisory, and administrative positions and for clinical specialties. Courses at this level are not available in most of the countries and are limited even on a regional basis. This kind of preparation has to be obtained outside the home country, hence, a very limited number of the nurses holding positions in the above fields have had special preparation for the job. The expansion and progress of practically all health programmes is dependent on the availability of nursing services. It must also be realized that the quality of these services is dependent on the quality of the facilities, the education programme, the students, the teachers, the supervisors and administrators.

The accomplishments during the past year have been encouraging. There are ~-y problems peculiar to the countries concerned, in addition to the world-wide problems of shortage of staff, faCilities, funds, etc., which have to be faced and solved. The hope for the future lies in the nurses in these countries and it is most gratifying to note that nurses everywhere are becoming more aware of their responsibilities, and the role of the nursing services in national health services is receiving much more recognition and support from national health administrations and others concerned. Assistance in the future will be directed towards helping these nurses and their governments to achieve their objectives of providing their people with quality health services.

1.4 Health Ed.ucation

Primary emphasis in health education is focused on technical assistance and fellowships to support the development of health education leadership and basic health education services in national, state or provincial health administrations, the incorporation of health education in medical and health worker. training programmes, and the development of school health education in teacher training and school health progra.mz::.es.

An increasingnureber of countries and territories are following WHo-rec~nded standards for health education leadership and organization, by establishing, or planning to establish, basic health education services and staffing them with qualified health education personnel. A qualified health education specialist has recently been appointed in China (Taiwan) to direct the health education service of the Health Department. The Federation of Malaya is utilizing WHO assistance to develop a long-range plan for the establishment of health education services and school health education at federal and state levels. A 't-r.-iO health educator has been selected to join the WHO tean working with the health services demonstration and training project in Korea.

The Philippines, which is taking the lead in developing health education leadership at national, regional and provincial levels, has requested WHO assistance in studying the theoretical and practical WP/RC14/2 page 22 aspects of its training prograzmne for health education specialists, and in strengthening the consultant and supervisory functions of its regional and provincial health educators. Health education specialist training leading to a Master of Public Health degree is well established at the Institute of Hygiene, University of the Philippines, which serves as the chief regional centre for health education specialist training. Similar progr~s are being developed in China (Taiwan), Japan and Korea. In Singapore, a medical officer of health has been appointed to take charge of a prograzmne to expand the health education services of the Ministry of Health. Viet-Nam. is ready to evaluate its health education programme with assistance from WHO. A health education officer has been appointed to the government service of Western Samoa.

The Ministries of Health and Education in Singapore have co-operated in sponsoring two school health education conferences duxing the past year, one for school administrators and the other for school teachers. As a result, health education will be incorporated in the curriculum of the primary schools.

The ~partment of Health and the TUberculosis Association in Western Samoa have co-operated in a course called "Tuberculosis School for Women's Committees" which was attended by 250 leaders of the Women IS Committee s. A weekly broadcast sponsored by the Department of Health brings health information to the public. The Federation of Malaya has incorporated health education in the training of women leaders which is part of its rural development programme.

Concurrent with the interest and assistance from WHO, UNICEF and UNESCO in school health education, is the growing co-operation among national health and education authorities and training institutions in co-ordinated school health education programmes. The WHO/UNICEF- assisted training programme for school health education in the Philippines is a notable example of this co-operation. This progr~ has brought school health education training opportunities to approximately 1000 school health personnel, school administrators and supervisors, teacher educators, and school teachers. Two pilot school health education programmes have been in operation in conjunction with the programme. An evaluation task force, with representatives from the co-operating agenCies, is visiting the alumni of the training courses in the field, in order to study the ways in which training has contributed to their effectiveness in carrying out leadership for school-community action programme s.

Australia has carried on a three-year experimental school health education programme in some of the secondary schools of one of the states, involving 4000 secondary schoolchildren. Two in-service training courses were conducted for school teachers responsible for the health education courses in the secondary schools. Each has resulted, not only in an evaluation, but in many cases, a complete revision of teaching content. ~..

NURSING - WHO nursing education teams are assigned in a number of countries to stimulate the growth of the nursing profession and to improve nursing education and services. The photo shows a WHO nurse educator with Laotian nursing students. Nurses also serve as members of WHO teams assisting in other health projects.

c •.

MOTHER AND CHILD HEALTH - Mothers and children are shown visiting the PAKSE MCH centre in Laos where WHO and other international agencies are assisting the Government in the develop­ ment of adequate health care for mothers and children and in the establishment of training prog­ rammes for Laotian health personnel. WP/RC14/2 page 23

China is planning a UNICEF-assisted school health education programme similar to that in the Philippine s, as well as a UNESCO­ assisted primary education programme in which health and nutrition education texts are to be developed for the primary schools. Tonga has included careful planning for the health education aspects of a WHO/UNICEF-assisted school sanitation project.

Inter-ministerial and inter-departmental committees on school health education are reported to .be in operation in China (Taiwan), the Federation of Malaya, New Zealand, the Philippines and Singapore.

Special attention is being given to health education training for maJ..aria eradication workers at the regional maJ..aria eradication training centre in the Philippines and in country programmes in the British Solomon Islands Protectorate, the Federation of Malaya, the Philippines and Viet.. Nam. Singapore has inaugurated a pilot health education community project in a Malay kampong in Singapore and is involving a number of community agencies in the programme.

The South Pacific COmmission has taken leadership in the develop­ ment of health education in the South Pacific area by providing advisory services to the participating governments. It is extending its assistance to cover health education training of medical assistants, nursing staff and teaching staff.

General problems needing attention to facilitate the objectives of WHO assistance are as follows: difficulty in recruiting French­ speaking health education specialists; the need for health education specialist training at the university level in universities where French is the teaching language; difficulty in recruiting school health education specialists; the importance of having well-selected full-time counterparts for WHO advisers in order to make the most of technical assistance.

There is a need to explore ways to offer persons who have shown exceptional aptitudes, but who have been functioning at a sub­ professional level, the opportunity to complete uniergraduate work followed by health education specialist training at the graduate level. This is particularly true in countries where there have not been opportunities for those with requisite personal qualifications to pursue the full recognized academic preparation for health education specialist work.

There is evidence of a great deal of growing support for the part healt;h education can play in facilitating the implementation of public health and related programmes in this region. The development of well-selected and well-prepared health education leadership, along with adequate development ,of basic health education services in the national health authority, will form the foundation needed for integrating effective health ed.ucation in the health programmes of countries of the Region. WP/RC14/2 page 24

1. 5 Maternal and Child Health

Although in principle it is considered that maternal and child health services should be a part of comprehensive and integrated public health services, there are countries where it would seem inadvisable to postpone their initiation until a general public health programme has been established. The developing countries, in particular, may find it difficult to enibark on an extensive public health programme at the present time. They would, however, certainly benefit from a maternal and child health programme which may serve as a starting point for the expansion of public health services. Further, the general interest of governments and the public in maternal and child health may lead to an awareness of the importance of general public health services as a whole, and make a government more prepared to allocate a larger part of its budget to their development.

The existing maternal and child health projects in the Region have all proceeded very satisfactorily. Those in Viet-Nam and Laos, which have been hampered by lack of staff, now have complete teams assigned to them, and as a consequence, the work has improved and progress has been accelerated. The project in Cambodia, which only started a year ago, has also developed satisfactorily and it will be necessary to increase the project staff to deal with the growing amount of work.

The principle that midwives, both fully qualified and "rural ", have an important role to play in maternal and child health programmes, if properly supervised, has been generally accepted. As a consequence, the training, or refresher-training, of midwives forms an iDu>ortant part of every maternal and.child health programme in the Region.

A new project started in the past year has been that undertaken in co-operation with the South Pacific Commission. A WHO team, consisting of a medical officer and a public health nurse midwife, is visiting Member countries of the South Pacific Commission to investigate the general health of mothers and children, the existing maternal and child health services and to make recommendations on what can be done to iDu>rove and expand tee work in this field. The team was also present at a Conference on Rural Health organized by the South Pacific Commission in Tahiti. Particular emphasis was placed on maternal and child health and the preliminary j.nformation presented on existing services in the South Pacific proved to be very useful for the discussions. Already it has become clear that the majority of the countries visited will need assistance in the organization and administration of their maternal and child health services, and it has, therefore, been suggested that a WHO/MCH team. shOuld be assigned to the South Pacific in 1965 to assist the governments concerned with this work. WP/RC14/2 page 25

There are also a number of other projects in the Region to which WHO gives technical guidance. In the field of school health, for example, one project is already in operation (the Philippines) and otrers are in the planning stage (Cambodia, China (Taiwan) and Viet-Nam). That in the Philippines is described in more detail in the section on health education, as in this field the Regional Advisers in Health Education and Maternal and Child Health work closely together.

WHO also gives teclmical advice on the health components of projects concerned with the social welfare of children. Such projects are in operation in China (Taiwan), Hong Kong and the Philippines, and others are being planned for CambOdia, Korea and Viet-Name

Projects in the field of nutrition are also very important from the point of view of maternal and child health, and there is close co-operation between the Regional Nutrition and Maternal and Child Health Advisers.

An important factor in ensuring the success of maternal and child health programmes is the interest of the mothers. It is, therefore, essential that the attention of governments and the medical services should be constantly focused on the possibilities for health education during prenatal and post-natal consultations, in maternity and paediatric wards, during .child-welfare clinics, through the parent­ teachers' associations in the schools. Only by doing this will the mothers take full advantage of what is being offered and the increasing demand for service in this field will be the best ~ to ensure that each country has an effective programme.

Because maternal and child health activities have been among the earliest programmes of aJ...most every health department, and because this type of work has been easily accepted in every population, there may be a feeling that there are no problems in this field. This is by no means the case. In most countries it has been possible to obtain a considerable reduction in infant and maternal mortality, and maternal and child health clinics exist almost everywhere in some form or other. However, it becomes more and more clear that infant mortality cannot be considered to be an accurate gauge of the health of the children in any country. The morbidity and mortality rates among pre-school children are considerably more important and a look at the statistics for this group reveals that here much has to be done. Whereas tre figures for infant zoortality in the developing countries sometimes come quite close to those in the more advanced areas, the rates for pre-school mortality are still ten to twenty times higher. Intestinal diseases, respiratory diseases, malnutrition, infectious diseases, all continue to take their toll of the pre-school child. There is, therefore, in almost all the countries in the Region a great need for the intensification and. expansion of maternal and child health services, with the greatest need in the field of child health. WP/RC14/2 page 26

Another problem is, of course, the shortage of staff. In only very few countries is there a sufficient number of medical officers who have had. adequate paediatric training to be able to :i..nq;>rove the paediatric services. In obstetrics the situation is better since fully qualified obstetricians can be found in every country. The shortage of public health and paediatric nurses is also very noticeable but here, at least, something can be done locally by training nurses to undertake this specialized work.

All maternal and child health projects receive assistance from UNICEF and there is no doubt that most of these projects would not have been possible had it not been for the very :i..nq;>ortant material contributions from that organization. The very efficient and close co-operation between UNICEF and WHO has made it possible not only to expand existing projects, but also to initiate new ones. WHO could not have' undertaken this aJ.one.

2. HEALTH PRCIl'ECTION AND PROMOTION

2.1 Dental Health

With the possible exception of the more developed countries, most countries in the Region are affected by serious dental health problems. Some have already taken the initiative of training auxiliary staff to remedy the acute shortage of professionally trained dentists. Two such schools have recently been established in the Region, one in the Territory of Papua and New Guinea, which started to train dental assistants in 1961, and the other in Singapore, which started its two-year course for the training of school dental nurses in . Both are patterned after the New Zealand system of training which utilizes school dental nurses.

One of the most effective measures of controlling dental caries is fluoridation of water supplies. Fluor1dation has been successfully carried out in parts of Australia, China (Taiwan), New Zealand and Sarawak, and in the entire water supply of Hong Kong and Singapore. Where comparative studies were made before and after fluoridation, a significant reduction in the incidence of dental caries has been noted without any harmful side-effects. A dental consultant is being recruited to study the problem.in French Polynesia.

Long... range planning should start with an assessment of the problems involved and with the innnediate objective of establishing a dental health service at national or territorial level. To this end, the Regional Office initiated in July 1962 a phased programme with the objective of assisting interested governments to train dental epidemio­ logists so that they could conduct their own surveys, assess the results obtained and make suitable recommendations for the establishment of I

WP/RC~4/2 page 27

a dental health service, including the way in which it may be utilized and expanded in the future to attack the dental heal.th problems encountered. A questionnaire to elicit information on the status of dental. health and manpower was sent out in July 1962. A WHO dental consultant has been recruited. and, with the information already on hand, will visit a number of countries in July and August 1963 for the purpose of gathering further information on local resources and explaining the survey-training project in greater detail. It is anticipated that the training phase will take place in 1964 and national surveys may be conducted in 1964-1965. The assessment of survey findings and the fo~ulation of recommendations will take place at a later date.

2.2 Mental Health

During the past two years, interest in WHO assistance in developing mental health programmes has been shown in four countries. In the Federation of Malaya and Viet-Nam, two consultants c~leted short-term assignments in 1962. The gist of their recommendations is the develop­ ment of various types of mental health units at different levels, partly to reduce the load in mental hospitals, but mainly to cope with the mental health problems at the community level. Both consultants elli>hasized the need for specialized training, as well as the training of medical and nursing undergraduates in the concepts of mental health. It has been reported that much inu?rovement has already taken place in the two mental hospitals in Viet-Nam and the newly assigned professional staff have been vigorous in achieving further inu?rovements.

In China (Taiwan), the community mental health and research project continues with the assignment of a mental health nurse, a short-term consultant each year and the provision of fellowships. It is hoped that as this project progresses, some of the national staff involved will become interested in associating themselves with the Provincial Department of Health, so that they may develop a province-wide community mental health programme integrated with the general health services and the network of provincial hospitals.

In the Philippines, long-range planning for a nation-wide community mental health programme is in process and a WHO .medical officer (psychiatrist) is being recruited to assist the Government in this work.

A total of twenty-four partiCipants from eighteen countries, including ten participants from eight countries in the Western Pacific Region, participated in the Inter-regional Conference on Techniques of Epidemiological Surveys of Mental Disorders held in Manila from 4 to 13 December 1962. The objective of the conference was to provide information on the technical aspects of psychiatric epidemiology, so that more precise data might be obtained on the prevalence and incidence of mental disorders and on their aetiology and pathogenesis in each country. It is to be expected that the stimulation provided by the exchange of information that took place will have a beneficial effect on further studies in this important field. WP/RC14/2 page 28

2.3 Nutrition

The less developed areas of the Region are showing an increasing interest in nutrition, whereas the most sophisticated continue to give little more than superficial attention to this aspect of public health. This latter attitude deprives the less fortunate countries of a possible source of assistance in the ~ of teaching facilities and guidance on policy. In the meantime those wich do seek advice appear to be in general at a loss to understand what can be achieved with existing refJOurces. The past influence of developed countries, with their academic approach and enquiry into nutrition problems in depth, appears to have left an impression on the less developed countries that nutrition work requires enormous expenditure and time-consuming research. There is little wonder that there is limited support in many countries for nutrition programmes except through ad !E.£ supplementary feeding, while the real challenge in nutrition education remains neglected. Even as the stimulation for action arises, inhibitions exist within government administrations as there are acute staff shortages in many of the countries, and, with a few exceptions, promotional channels in medicine are only open to established specialties so that there is little initiative for government staff to make a career in nutrition.

It is apparent that in order to restore a true sense of proportion WHO must extend further its efforts in nutrition education. The actual education of the government itself is of as much importance as education programmes conducted through schools and other training establishments. A considerable atOOunt of time has, therefore, been spent during the year preparing the ground for such activities. Broadcast scripts, press releases, etc. have been prepared outlining current problems and contemporary concepts. Wherever possible, contact has been established with the public information services of Iember governments. The beginnings are small but there is already evidence that this policy is correct and is producing the desired results. As an adjuvant to this, it has been considered essential that wherever teaching in nutrition has been carried out it should be unified, and efforts should be exerted to make sure that those countries embarking on nutrition training are supplied with syllabuses and curricula which will serve as a guide in the preparation of training courses. Particular use is being made of maternal and child health and public health nursing training projects in the Region.

Visits to Member countries have been useful in establishing contacts, in revealing local problems and also in planning future poliCies. Thus in Samoa, there are indications of malnutrition in infants as a result of sophisticated. diet habits. French PolyneSia has committed itself to a programme of nutrition and dental health education which will meet the nutrition problems that are arising. In other countries use has been made of existing WHO programmes. In Singapore, nutrition education is being cOlIlbined with health education in the schools, whlle in the Federation of VAla.ya it is being integrated MEDICAL RESEARCH - A scientist is shown at work in a WHO-coordinated research on arthropod­ borne virus diseases in the jungles of New Guinea. Co-operating in this project is the John Curtin School of Medical Research in Australia. Several laboratories are co-operating with WHO in other research projects.

NUTRITION - Many countries in the· Western Pacific face serious food and nutrition p~oblems and to help governments WHO is participating actively in training programmes for nutrition workers. People in a Cambodian village are shown listening to a talk on the value of local vegetables and fruits in the diet. WP/RCl4/2 page 29 in a general programme of health education. In the Philippines, an applied nutrition project utilizing normal schools as the focal point is developing through the Department of Education. The Governments of Cambodia, Laos and Viet-Nam have also sought advice on nutrition programmes and are being advised to integrate these in the first instance with existing maternal and child health and public health programme s .

Future policies have been to some extent determined by the results of discussions held both within and without the Region. The Conference of the Regional Nutrition and M:l.ternal and Child Health Advisers in and the FAO/WHO/UNICEF Nutrition Seminar for South and East Asia in Hyderabad were most useful in helping to resolve difficulties and formulate new ideas with regard to nutrition work. The Co-ordinating Committee on Food and Nutrition in the Philippines has been of great benefit to the Government in that the activities of one department have been integrated with others so that positive action has resulted. The success of this national committee has been sufficient to stimulate the establishment of co-ordinating committees at the local level. The value of these committees cannot be over-estimated and it is gratifying that there are prospects in the future of several countries in the Region tackling their nutrition problems through such meetings of senior government officials.

2.4 Medical Rehabilitation, Requests for assistance in developing a national medical rehabilitation progra.nnne have come from one country - Japan. A short-term consultant in occupational therapy completed her assignment in January 1963 and the comments of the Government on the observations and recommendations made in her assignment report are awaited. Another consultant in physiotherapy has been recruited for a two-month assignment to assist in strengthening the physiotherapy aspects .of the national medical rehabilitation programme. The modification of a fellowship, for which prOvision has been made in 1964, in favour of a six-month consultant who will advise on the development of a national training programme in both occupational and physical therapy has also been requested.

The rehabilitation of tuberculosis patients will be the terms of reference of another consultant who will start his assignment in the latter part of 1963 in the Philippines.

Assistance to the School of Allied Medical Professions in the Philippines is concerned with the training of physiotherapists at university level. The project may represent a trend towards a more sophisticated approach to the problem of giving adequate professional training to ancillary personnel engaged in medical rehabilitation. WP/RC14/2 page 30

2.5 Radiation Health, Radiation Medicine and Human Genetics

Assistance in these specific fields was provided in the form of fellowships to study the medical use of radiOisotopes and radiography. There has as yet been no regional project in the field of radiation and radiation protection. upon request of the Government of Singapore, a WHO consultant was provided for two months to advise on the establish­ ment of a radiotherapy department. On termination of his assignment a concise and informative report was presented which is expected to serve as a basis for the development of radiotherapeutic services in Singapore.

A WHO lecturer has been assigned to the School of Radiography in Singapore to assist in the training of radiographers.

The project in Korea to establish a radiotherapy department within the National Medical Centre has been abandoned. The Government wishes instead to use the available UNKRA residual funds for the purchase of radiOisotope s and for the strengthening of the provincial hospital services.

3. ENVIRONMENTAL HEALTH

The continuation of environmental health prograJ:IllmS in the Region has shown trends favourable to the development and strengthening of health and sanitation units and has demonstrated the awareness of govermnents of the necessity of providing their peoples with essential sanitation services, such as water supply and other sanitary facilities.

Despite the progress made in this direction, there is also evidence of the failure of national. administrations to cope effectively with the challenge of sanitation problems resulting from population increases, social changes and economic difficulties, particularly in developing countries.

MOst of the activities of the public health authorities have logically centred on the medical-care side with little interest shown or effort put on improved sanitation and the prevention of diseases.

This fact becozres more apparent in countries of the Region where the initiative for the improvement of sanitation and the provision of water supplies and sewerage comes from non-public health agencies. cne of the reasons is, of course, the lack .of trained staff serving in the department of health at all levels.

It is therefore necessary to call attention to the fact that this loss of promotion leaderShip will eventually relegate the public health depa.rtlrent to a situation of mere observers whether they have WP/RCl4/2 page 31

environmental sanitation units or not. To remedy this situation, proper direction and. initiative have to be assumed at the higher echelons of these departmental bodies.

The Organization has continued to receive requests from Member countries in connection with its community water supply progr~. The short-term project completed in China (Taiwan) in 1962 was followed up in 1963 by a new project, at present in operation, to assist the Government to put into effect the recommendations made by the consultant team. The results of this work are demonstrated already by the resolution of the Provincial Government to implement a substantial five-year plan and to spend NT$982.2 million on the development of a community water supply which will serve a population of a.l...Irost two million people. This has also been followed by a request to the Technical Assistance Board to provide funds for the training of planning and design engineers and for managerial and operational personnel.

other governments have also show interest in this programme and requests have been received or are being considered from North Borneo, Korea, the Federation of MaJ..aya and the Philippines. Unfortunately, the first two projects, which were planned to start in 1962, have not yet been implemented because of the unavailability of funds in the Community Water Supply Programme. It is hoped, however, that they may became operational soon.

A short-term consultant was provided to the Territory of Guam in connection with a project on sewerage planning. A detailed report with reconnnendations was submitted to the Government.

other environmental health projects under way show good progress, such as the assistance being given to the Kingdom of Tonga in the field of water supplies for villages and towns and in school sanitation with the aid of UNICEF. This project is receiving the full support of the Government which has requested its continuation for two more years. The provision of adequate water supplies in four villages has had a great impact, not only on their sanitary conditions, but also on the psychology of the people who are realizing the beneficial effects of sanitation. It is necessary to emphasize this fact because Tonga, in the past, has suffered considerably from lack of water and the project bas now brought hope and desire for progress to the population.

Special mention should also be made of the training project for sanitary inspectors which is in operation in the Philippines. So far more than five hundred sanitary inspectors, including a few from other countries in the Regio~ have passed these courses which place emphasis on field and practical work. In addition, this project is concerned with the development of small water supplies for rural health units and schools. Assistance to the environmental health project in the Philippines was reactivated in 1962 through the services of a short­ term consultant whose assignment was extended for three additional. months in 196.3. The Government has requested the continuation of assistance to b,oth of these projects through 1965. WP/RCl4/2 page 32

The environmental sanitation project in West New Guinea (West Irian), which was progressing satisfactorily,has been transferred to the jurisdiction of the South-East Asia Regional Office as a result of the change in sovereignty.

An outstanding feature among the activities in environmental health in the Region was the Regional Seminar on Food Sanitation which was held in Manila frcm 16 to 27 October 1962 and was attended by sixteen participants and five observers from countries in and outside the Region. The results of this seminar can be regarded as most successful.

It is predicted that similar training and advisory projects may be implemented in the near future in other Member countries, but in this connection mention should be made of the difficulties faced by the Organization in obtaining on time the services of consultants and field staff. The Regional Office has, therefore, under consideration the possible creation of a panel of consultants recruited on a more permanent basis, or for longer periods of time, who can be assigned almost inmediately to Member countries requesting specialized technical assistance, particularly in the field of water supplies. This may be a more convenient and perhaps more effective way of dealing with this situation. The immediate problem with regard to this proposal is, of course, the question of finance.

4. EDUCATION AND TRAINING

4.1 Assistance to Educational Institutions

Emphasis has continued. to be placed on assistance to educational institutes in the hope that all undergraduate and post-graduate institutions will be sufficiently well staffed and equipped to meet the manpower needs of each country and territory. This hope has been heightened as new medical schools have been established in the last few years - the latest addition being that in the Federation of M:llaya ... and as more external assistance is given to rapidly developing institutions, a greater degree of self-reliance and vigour is already manifest in many medical and nursing schools and public health training institutions.

Apart from assistance to nursing education programmes, which are described in this Report under the section on nursing, there are at present nine education and training projects, three of which are aimed at strengthening the teaching programmes in medical schools, three are concerned with assistance to schools for training para-medical personnel, and three have the objective of strengthening post-graduate public health institutiOns. ECONOMIC DEVELOPMENT -Improvement in the health of the people contrib\ltes immensely to rapid economic growth and adds to the wealth of the oommunity. Assistance by WHO and other inter­ national agencies in the field of health has helped many Western Padfic countries increase their agricultural production.

EDUCATION AND TRAINING - WHO helps many countries improve education and training of health workers, as in Korea where WHO and UNICEF are assisting the Government in a five-year training programme for public health personnel. Trainees are photographed practicing water analysis at a Seoul laboratory. WP/RC14/2 page 33

In Cambodia, assistance to the Faculty of Medicine, of Pharmacy and Para-medicaJ.. Sciences in 1963 has taken the form of two four-month lecturers in physiology and biochemistry. It is gratifying to note that a competent counterpart was assigned to the physiology lecturer and that a counte:r:part in biochemistry is available, even though he was on a WHO fellowship at the time the WHO biochemistry lecturer was in Phnom-Penh. It appears that satisfactory progress has been made towards the goaJ.. of training nationaJ.. staff to undertake specific fields ot teaching. In 1963, the first full-fledged physicians will graduate in Cambodia. and it is hoped that this event 'Will stimulate the interest of same of the young graduates in undertaking university positions in teaching and research.

In China (Taiwan), assistance is being given to the Institute of Public HeaJ..th of the National Taiwan University through the provision of a short-term consultant in post-graduate public health training and research and fellowships. Another.consultant to advise the Institute and the College of Medicine in the undergraduate teaching of preventive and social medicine will be provided in the latter part of 1963. The strengthening of the Institute to the point where it can offer degree courses in public health is under study and WHO consultants will be assigned to further this development.

In Fiji, assistance to the School of ~dicine is now limited to the prOvision of a long-term fellowship to enable a suitable candidate to quaJ.ify in biology.

In Korea, the Organization has continued its assistance to the Institute for Public Hea.1.th Training by the provision of an expert whose services will be continued until the end of 1965. MUch progress has been made in the curriculum content of new in-service courses which, starting from January 1963, include the training of professional health personnel who 'Will return to their positions in the model provincial demonstration centre where the Organization has already started a programme aimed at the development of local heaJ..th services. UNICEF is also assisting the Institute through the provision of stipends for doctors, nurse midwives, sanitarians, laboratory technicians, honoraria for lect~~rs and supervisory field staff, and saJ..ary subsidies for the teaching staff.

In the Federation of Malaya, the WHO tutor in clinical pathology has continued his active participation in the training of laboratory assistants in laboratory technology. There are now thirty-five students undertaking this basic training.

In the Philippines, the Organization provided the services of the Dean of the Jobns Hopkins School of Hygiene and Public Health on a short-term assigtlIOOnt to the Institute of Hygiene to study and advise on its teaching and research programmes. The WHO consultant was instrumental in advising the Department of Hea.1.th on the creation of a number of committees to study the manpmrer needs in each specific WP/RC14/2 page 34

health field and to define the role of the Institute in ~eting these needs. Although the Institute has made distinct progress in the quality of both its teaching and research over the past ten years, further consultative services and more fellowships will be required before it reaches the degree of excellence which will be comparable to the high standards of schools of public health elsewhere.

The University of the Philippines gave its approval to the creation of a new school for allied ~dical professions which started a training programme in physiotherapy and occupational therapy in November 1962.

A school of radiography has been established in Singapore and a WHO lecturer has been "WOrking there since April 1963. The Organization will also assist the University to develop its cardiology laboratory through the provision of a six-month short-term consultant.

If medical education and research are to be developed to the standard where they can meet the needs of the health and ~dical services properly, the follOwing principles must not be forgotten. The provision of a permanent and stable faculty is essential, as is the assignment of well-qualified counterparts, otherwise the develop. ~nt of activities may.be affected and future training jeopardized following the departure of the international staff.

The stage is now being reached, particularly in the developing countries which can least afford the loss of t~ through poor or no planning, when stock must be taken of present and future ~dical and para-medical manpower needs, and of the ways and means of meeting these needs largely from national resources. Needless to say, this will entail vigorous leadership, adequate financial resources and the fullest utilization of human resources, so that c~tent teaching staff may be organized and suitable trainees attracted to the service. Admittedly, these are problems the solution to which may not easily be found, particularly in a developing country. No country can, however, afford to refuse this challenge. Perhaps, above all, leadership is the most essential element in the promotion and strengthening of educational and training facili tie s and in adopting a teaching programme, broadly conceived and boldly designed, which will meet actual needs and be potentially capable of training people not only for service but also for staffing, teaching and research work in institutions in their own countries. The Organization stands ready to render whatever assistance it is called upon within the limits of its resources, to effect the catalytic action necessary to engender self-reliance and self-sufficiency.

4.2 Fellowships

The fellowship progr~ continues to constitute the major type of assistance extended by WHO to education and training activities in the Region. As mentioned in the Introduction of the WHO Fellowships Info:rmstion Booklet (8th edition), ''the problem of education and WP/RC14/2 page 35 training of health personnel is closely connected with the progress of medical and allied sciences and with the developm:mt of medical and public health techniques and organizational methods," and "the fellow.. ship programme is recognized as one of the most effective ways of promoting international exchange of knowledge . . . it is valuable in improving standards of teaching and training in the health, medical and related fields, in advancing research, and in strengthening national health services. "

During the year under review, two hundred and eighty-one fellowships of all categories -were awarded to participants from the Region (see Annex 5). Of these, one hundred and thirty-one -were in connection with the usual fellowship programme contained in.the regional programme and budget; this shows an increase of 18 per cent over the number (lll) reported for the period 1961-1962. In addition, nine special fellow­ ships -were awarded, namely, seven fellowships from Headquarters Exchange of Scientific Workers (malaria eradication) Scheme and two special fellowships for the Certificate in Public Health Nursing Course in Calcutta. (For the balance of the total fellowships, see Educational Meetings and Courses.)

Long-term fellowships for undergraduate training at the Fiji School of .Medicine are also being provided to Western Samoa under the WHO Accelerated Programme of Assistance to Newly Independent Countries. Eleven such fellowships -were awarded during the year under review.

No less than 50 per cent of the one hundred and thirty-one fellow­ ships awarded under the regional programme and budget were undertaken exclusively within the Region. The remainder -were either for study in other regions or a combination of visits to countries in other regions and the Western Pacific. This increase reflects the response of Member countries to the policy enunciated in past regional committee meetings calling for a greater utilization of training facilities available within the Region. This trend in placement may be expected to contribute to the further development and inU>rovement of regional training institutions.

Arrangements -were also made for the placement of twenty-four fellows from the following regions:

Regional Office for Africa - 1 Regional Office for the Americas ~ 2 Regional Office for the Eastern Mediterranean.. 6 Regional Office for Europe ~ 1 Regional Office for South-East Asia ~ 14

Details related to fields of study, country of origin and the distribution of visits are given in Annexes 6 and 7.

A recurring fellowship problem is that connected with the language proficiency of candidates from non-English speaking countries nominated WP/RC14/2 page 3b for study in English-speaking schools. Delay in the submission of completed application forms of candidates is another. These problems hinge primarily on the early and proper selection of qualified candidates and perhaps it is timely to call the attention of Member countries to the importance of establishing fellowship selection committees as provided in the fellowships manual, viz:

''National health a.d.ministrations should submit applications to a national selection committee which will interview applicants and select suitable candidates. The selection committee should be established by the national health administration, in consultation with the appropriate WHO regional director. The committee should be composed of representatives of the national health administration, the national. body concerned with the education of medical and health personnel, the appropriate professional group, if applicable (e. g., a representative of the nursing profession if nurses are applicants), and to serve in an advisory capacity without vote, a representative of WHO. The committee should have bet-ween three and five voting members. In selecting candidates, the committee should consider the applicant's educational qualifications, his experience in the subject to be studied, his age, his health, his personality and his language qualifications."

Observance of this procedure in candidate selection would undoubtedly reduce problems brought about by the selection of candidates who do not fully meet the reqUirements for a successful fellowship.

Among other fellowship problems are difficulties caused by changes, i.e., non-adherence of a fellow to his schedule of visits as finalized and change or replacement of candidates at a very late date, thus disrupting study progra.rmnes already arranged.

I take this opportunity once again to thank the M:mLber governments for their support of the fellowship programme of the Organization as demonstrated by their w1ll.1ngness and readiness to extend the training facilities in their respective countries to WHO felloWS. Their tolerance and positive contribution to the fellowship effort has enabled the programme to gather momentum in its objective of promoting better health through the education and training of health personnel.

4.3 Educational Meetings and Courses

The following inter-country educational. meetings and courses were held during 1962-1963:

( a) Seminar on Food Sanitation, Manila, Philippines, 16-27 October 1962;

(b) Seminar on Japanese Encephalitis and other Arbovirus Infections, Tokyo, Japan, 5-14 November 1962; FIG. NWvIDER OF FELLOWSHIPS BY RECIPIENT COUNTRY OR TERRITORY NOMBRE DE BOURSES P4'..R Pf,YS OU TERqITOIRE BENEFICl/,IRES

1 JULY 1962 - 30 JUNE 1963 -ler JUILLET 1962 - 30 IUIN 1963

NUMBER OF FELLO-.lSHIPS - NOMBRE DE BOURSES

o o 0 0 1-_____...!- J _____-L- r _____--'-- ______---1.-C"I ___. ___ ._LI ____ ._--' C")

27 Korea. ReJXlblic or - 1-______-1 -l Cor~e. Republique de I------J117 ',"estern Sam:j3 - Samoa -Occidental 115 China (Taiwan) - Chine (Tai\\"an) ~------~ 113 Philippines r------~ I______..-.J!ll Japan - Japon w ~~------o I 8 Viet Nam ....~I------~ 1------. c: J5 Hong Kong tLli------' ~ 1------. g .J 5 North Borneo - Born·~0 du Nord

~ I______-i-ls Singa pore - Singa pour 0. 1------. 14 Cambodia - Cambodge >-01------' 01--'------.1I!! t: ______--' 4 Terntcry of Papua and New Guinea - Territoire de Papua et de N0uvelle-Guinee w~I----'I 3 ;:.ustralia - II ustralie ~I----- c:: 1------, o 13 New Zealand - Nouvelle-Z11ande c:>-0 ___..., ~ 13 Ryukyu ISlands - lIes Ryu -Kyu ::> 0 1--.., U J2 Fiji - lIes Fidji

:J 1 British Solomon ISlands Protect,)r.:lte - Pr:tectorat britannique des l1es Salomon

tJ 1 Cook Isla ods - nes Cook

tJ 1 Federation of Malaya • F~d0ration de Malaisie

p 1 New Hebrides - Nouvelles-H:3>rides tJ 1 Sarawak

W1 Trust Tenitory of the Pacific Islands - Tenitoire sous tutelle des nes du pacifique WP/RC14/2 page 31

(c) First Regional Seminar on Rural Health Services, Taichung, Taiwan, Republic of China, 21 November - 5 December 1962;

(d) Training Course for Supervisors, Inspectors, and/or Senior Squad Leaders in Malaria Eradication Programmes, Philippines, 3-21 December 1962;

(e) First Regional Seminar on the Role of the Hospital in the Public Health Programme, Manila, Philippines, 13-20 May 1963.

A total of seventy-eight participants, all of whom received WHO assistance, took part in these meetings. Details are given in Part IV of this Report.

A total of fifty-seven participants from the Region took part in the follOwing short-term (less than two mnths I duration) inter­ regional meetings ox courses:

(a) WHO/PAHO Inter-regional Conference on Health Education Preparation of Health Workers, , 8-17 July 1962;

(b) Training Course on Natural Foci of Infections, Union of Soviet Socialist Republics, 13 August - 13 September 1962;

(c) Training Course on Enteric Diseases, Atlanta, Georgia, 27 August - 21 September 1962;

(d) Inter-regional Travelling Seminar on Occupational Health, Finland, , Union of Soviet Socialist Republics, and Yugoslavia, 2 September - 25 October 1962;

(e) Fourth Asian Malaria Conf'erence, Manila, 27 September ... 3 October 1962;

(f) FAO/WHO/UNICFF Nutrition Seminar for South and East Asia" Hyde rab ad, India, 8-21 October 1962;

( g) Training Course on Human Genetics for Teachers in Medical Schools, , Denmark, 10 September - 30 November 1962;

(h) Inter-regional Post-Graduate Leprosy Training Course, Bamako, , 12 Novembex - 1 December 1962;

(i) Inter-regional Conference on Techniques of Epidemiological Surveys of .Mental Disorders, Manila, 4-13 December 1962;

( j ) Special Course for Malaria Entomologists, Kuala Lumpur, Federation of Malaya, 21 January ... 16 March 1963; WP/RC14/2 page 38

(k) Travelling Seminar on Training and utilization of Auxiliary Health Personnel, Union of Soviet Socialist Republics, 8.. 25 April 1963;

(1) Training Course on Home Care Nursing Services, Copenhagen, Denmark, 17 April - 28 May 1963.

In addition, there were eighteen fellowships awarded to enable participants from the Region to attend long-term (more than two months' duration) inter-regional courses, namely:

(a) Anaesthesiology Training Courses, Copenhagen, Denmark, January - ;

(b) Training Course on l-Edical Rehabilitation, Copenhagen, Denmark, - ; •

( c) International Training Course in the Epidemiology and Control of Tuberculosis, Prague and Copenhagen, 24 October ... 24- March 1963 j

( d) International Training Course in the Epidemiology and Control of Tuberculosis, Rome, , February .. May 1963;

( e) Malaria Eradication: Training Centre (French Language), :Belgrade, 3 September - 3 November 1962; 25 February - 25 May 1963 and May .. June 1963 j

(f) Training Course for Malaria Eradication, Union of Soviet Socialist Republics, 16 July .. 13 October 1962.

5. lA.ALARIA

During the period under report, still further progress has been observed in the malaria eradication programmes in the Region. About one-third of the 78 million people in the originally malarious areas (excluding Mainland China, North Korea and North Viet-Nam) are now covered by the eradication programme, an increase of 9 per cent over 1961, and in the more advanced programmes, the population coverage in the consolidation and maintenance phase areas reached 57 per cent of the total population covered by the eradication programmes.

However, as yet, there is no country in which the campaign has reached the stage of certification of eradication. Although it was originally planned that the maintenance phase in the malaria eradication programme in China (Taiwan) would have been reached WP/RC14/2 page 39

throughout the country by June 1963, this has had. to be postponed until the end of 1964 because of the recent development of epidemiological conditions. These are described more fully in paragraph (a) below. FollOwing the Director-General's decision to establish a supplementary list to the official register of areas where malaria has been eradicated, in order to include those countries and territories where malaria has never existed, or has disappeared without specific control measures, con:firmation has been obtained from the respective authorities that the following territories should be included in this list: American Samoa, Bonin Islands, canton and Enderbury Islands, Christmas Island, Cocos Islands, , Fiji Islands, French Polynesia, Gilbert and Ellice Islands Colony, Guam, Nauru, New Caledonia, New Zealand, Niue, Norfolk Island, pitcairn Island, Tokelau Islands, Tonga, Trust Territory of the Pacific Islands and Western Samoa.

It is expected that Japan will also soon be added to the supplementary list in view of the extremely low incidence of reported malaria in recent years.

The WHO-assisted malaria projects in the Western Pacific Region are classified as follows: (a) Malaria eradication programmes (MEP)

As in the previous year, five countries in the Region belong to this category, namely, China (Taiwan), North Borneo, the Philippines, Sarawak and Ryukyu Islands. The eradication programme in China (Taiwan) is the most advanced in the Region. However, three well-defined small foci of transmission were discovered during 1962 and also the reactivation of transmission was found in an old focus. It is because of this discovery that the achievement of eradication by June 1963, as originally expected, has had to be deferred until the end of 1964. Nevertheless, the total incidence of malaria remained low during the year; of nearly one million persons examined during this period, through various case­ detection measures, only 69 positive slideS, representing 67 parasite carriers, were encountered. A re-appraisal of the surveillance system is now being undertaken with a view to strengthening the passive case­ detection system throughout the country in order that in:formation may. be obtained for the certification of eradication. In the North Borneo programme, spraying was carried out in 1962 in all malarious areas and a small sector entered the consolidation phase. Periodical assessment has been carried out and results so far indicate that eradication may be achieved as planned, provided the development of the rural health service and its participation in the eradication efforts are expeditiously implemented.

, / I --.:. WP/RC14/2 page 40

In the Ryukyu Islands, efforts were made to improve the surveillance activities and epidemiological assessment. The previous shortcomings in these respects were due mainly to the lack of adequately trained personnel in these fields. WHO provided a short-term consultant in 1962 to assist in this project, and also five fellowships for the national workers for study in China (Taiwan). With the implementation of the reorganized programme the prospects of achieving eradication soon are good.

In Sarawak, the programme has been carried out according to plan and of the 660 000 people of the originaJ.1y malarious population of the country, 505 000 were in the consolidation phase and 155 000 in the attack phase in 1962. However, the progress of the campaign has met with the difficult problem of the importation of malaria from the unsprayed Kalimantan area across the border. Nearly half of Sarawak. is affected and intensive surveillance operations, both in the attack and consolidation phase areas, and spraying of about ten mile s of the border are needed until a spraying programme starts in Kalimantan.

In the Philippines, a new comprehensive plan of operation has been recently completed. It is expected that an extensive reorganization will be carried out from , in line with the new plan which eliminates the shortcomings that have heretofore hampered the progress of the programme.

All these five eradication programmes mentioned have adopted the WHO quarterly surveillance reporting system. These reports have been of considerable value, particularly in those areas which are in the late attack phase, or are still more advanced. The calculation of the annual parasite incidence (API) in most of these countries is based on an adequate number of blood samples collected through routine case-detection procedures; the API is well below 0.5 per 1000 in China (Taiwan), North Borneo and the Ryukyu Islands, in Sarawak, it is just below this figure but in the Philippines, the incidence in the consolidation phase area is still above the maximum permissible level.

(b) Malaria eradication pilot projects (MEPP)

In the Federation of Malaya and the British Solomon Islands Protectorate, MEFPs are in operation. In the Federation of Malaya, where the pilot project entered its third year of operation in 1963, progress during the year has been encouraging. An intensive surveillance mechanism has been established in the project area and the results of epidemiological assessment suggest that transmission has stopped completely since August 1962. The pilot project in the British Solomon Islands Protectorate became operational only in , spraying operations beginning in October 1962. The project area covers the islands of Guadalcanal and the New Georgia group with a total population of about 30 000, where malaria, transmitted by vectors of the "Anophele s punctuJ.a.tus II group, is the largest single cause of hospital attendance. WP/RCl4/2 ~. page 41

(c) Pre-eradication programmes (PEP)

In certain countries of the Region, pre-eradication programmes have to precede the implementation of full e:radication programmes, in order to develop the operational facilities required. Four PEPs started in 1962 in the Region, namely, Brunei, Korea, Cambodia and Viet-Nam.

The main objectives of a PEP are: to promote the development of an adequate public health organization at the local level, and to develop the malaria eradication service. Additional objectives are the e~tablishment of adequate facilities for training of personnel of the various categories needed; the assessment of the malaria situation and the further study of epidemiological conditions; the organization of medical aid, consisting of diagnostic services and the distribution of drugs to people living in the malarious areas, and the study and development of the most suitable approach to ensure the fullest collaboration of the public in the future malaria eradication programme.

It was originally expected that the PEP in Brunei would be completed by the end of 1963, but due to the conditions prevailing at the end of 1962, this may not be achieved.

In CambOdia, there was little progress during the period under report because of various administrative difficulties. Efforts are being made to improve the situation.

In Korea, emphasis has been laid on strengthening the rural health organization and in arousing interest in the malaria proJect. Consequently, a satisfactory passive case-detection system has been gradually developed with the co-operation.of all rural health units throughout the country.

In Viet-Nam, the malaria programme is complicated by areas of inaccessibility. Large-scale field operations were carried out during 1962, which included populations of 6. 5 million under spraying and. 2.2 million under surveillance. The implementation of a fully developed malaria eradication programme depends largely on the question of internal security.

(d) Antimalaria activities in other countries and territories in the Region

The situation in Japan has already been mentioned in the early part of this Report. The Japanese authorities are enforcing a passive case~etection scheme and the epidemiological investigation of reported cases, in order that certification of the eradication of malaria from the whole country may be obtained soon.

In Laos, malaria is widespread. and the possibilities of reorganizing the antimalaria activities, which were suspended in 1961 because of unsettled conditions, are under study. WP/RCJ.4/2 page 42

In the Territory of Papua. and New Guinea, large-scale antimalaria measures are being carried out and considerable success is being achieved.

Preliminary negotiations have begun with the authorities of the New Hebrides Condominium with a view to implementing an eradication project at an early date.

(e) Entomological activities

A WHO short-term consultant on entomology was assigned to the British Solomon Islands Protectorate for three months to assist in the training of national entomological staff and to prepare a programme for entomological investigations in unsprayed and sprayed areas.

In CambOdia, a survey of anopheline distribution, particularly A. balabacensis, has covered a large part of the country. i. balabacensis has proved to be the main vector of malaria. In the early days, A. minimus was considered the most important vector on epidemiological grounds but not on dissection records. This species is now shown as only of secondary importance. A plan is being made to establish a pilot project to investigate the persistence of malaria transmission by A. balabacensis and the method of controlling this mosquito. -

In Korea, experimental infections show that ~. sinensis is susceptible to the local strain of Plasmodium vivax. One wild-caught sinensis was found naturally infected with sporozoites. This is the first positive mosquito infected with malaria parasites found in the country.

In the Federation of Malaya, A. letifer, A. donaldi, A. umbrosus, and~. roperi are most probably not vectors of-human malaria. ~. campestris, one of the human malaria vectors, has been found to be very susceptible to DDT spraying and has disappeared in the sprayed areas. A:. vasu;s, a non-vector of malaria, has been proved to be resistant to dieldrin. .A.letifer has shown an increased tolerance to DDT.

In North Borneo, A. sundaicus has been proved to be resistant to dieldrin. Fortunately, before the discovery of this resistance, DDT had replaced dieldrin in the !',undaicus areas. ~. donaldi (formerly called A. barbirostris and considered as a secondary vector) also seems to be resistant to dieldrin. ~. philippinensis, a non-vector of malaria, is definitely resistant to the same insecticide.

Field trials on the optimum dosage and cycles of insecticide spraying have shown that DDT at the dosage of 2 gm. per square metre, twice a year, is required for the control of local malaria vectors. WP/RC14/2 page 43

M:>re damage on attap roofs by attap-eating caterpillars (Herculia nigrivitta) has been reported in the DDT~sprayed areas but not in the dieldrin-sprayed areas. '

(f) Chloroquine resistance

Recent findings in north Malaya and north-western Cambodia suggest that a local strain of Plasmodium falciparum may be resistant to chloroquine. The matter is being closely watched and investigations are . 1 now in progress in north Malaya in order to collect additional data. Scientists from the Institute for Menical Research, Kuala Lumpur, from the National Malaria Service, from the United states Public Health Service and from WHO are closely co-operating in the stUdies on this problem.

"t-.. (g) Training in malaria eradication techniques

steps have been taken to re-establish the training centre in Manila in collaboration with the Philippine Government and the United states Agency for International Development and the new centre will be opened in the latter part of 1963. During 1962, nineteen WHO fellowships were awarded to candidates from the Region to attend regular and other special courses in malaria eradication. In addition, four observation tours of short duration in selected malaria eradication programmes were undertaken by the senior officers of the malaria services of the British Solomon Islands Protectorate, China (Taiwan), North Borneo and Sarawak. Assistance in national training programmes was also provided by the malaria staff in the Regional Office. In Hong Kong, a refresher course was recently given to the national malaria staff to acquaint them with modern entomological techniques. A special course of eight weeks' duration for malaria entomologists was held in Malaya from 21 January to 16 March 1963. It was attended by twelve partiCipants coming from eight countries of the Eastern Mediterranean, South~East Asia and Western Pacific Regions.

(h) International co-operation and co-ordination

International co-operation and co-ordination have continued as before. Participants .at the Fourth Asian Malaria Conference, which took place in Manila from 27 September to 3 October 1962, included representa­ tives from countries and territories of the South-East Asia and Western Pacific Regions, as well as from in the Eastern Mediterrallean Region. r WP/RCl4/2 page 44

6. COMMUNICABLE DISEASES

6.1 Bacterial Diseases

6.1.1 Cholera Cholera was once more a major communicable disease problem in the Region. As reported last year, the disease occurred for the first time in decades in Hong Kong, Macao, North Borneo, Philippines and Sarawak. These outbreaks, with their serious health and economic results, were fortunately brought under control within a relatively short period of time, except in the Philippines where some cases have continued to occur in scattered areas. However, there have been recurrences during the past year in Hong Kong, Macao and Sarawak and the disease appeared for the first time in decades in China (Taiwan), Federation of Malaya, Japan and. Singapore as well as West New Guinea (West Irian).

Eight months after Hong Kong was declared free of infection, there was a second outbreak with twelve cases and one death reported between August and October 1962. On 28 June 1963, a fresh case of cholera was reported. Eleven months after the end of the first outbreak, the disease reappeared in Macao with three cases reported, including one imported case, between 15 and 27 October 1962. A fresh case occurred on 28 June 1963 with three further cases reported on 29 June. In Sarawak, after one year's freedom from the disease, a fresh outbreak was reported on 15 November 1962 and between this time and 28 December 1962, when the·territory was declared free from cholera El Tor, there were twenty-eight cases and seven deaths. Seven other cases but no deaths occur:t:ed between 30 December 1962 and 12 January 1963.

In China (Taiwan), a sharp outbreak started in July 1962 but was rapidly brought under control by the vigorous action of the Administra­ tion and the country was declared free of infection by 19 September 1962. There were 383 cases with 24 deaths. In May 1963, there was an outbreak in the Federation of Malaya, and by 25 ~y, 181 cases had been reported with two deaths. A single case was reported from S1nga.pore on 18 May 1963. The outbreak in West New Guinea (West Irian) started in October 1962 and lasted until March 1963; there were 1278 cases and. 445 deaths.

The total. number of cases and deaths which have occurred in countries of the Region between 1 JUly 1962 and 30 June 1963 ~ as follows:

China (Taiwan) - 383 cases with 24 deaths to 19 September 1962 Mlla.ya. .. 181 cases with 2 deaths to 25 May 1963 Hong Kong ~ 12 cases with one death to 29 June 1963 Macao ... 7 cases but no deaths to 29 June 1963 Philippines .. 2898 cases with 271 deaths to 22 June 1963 Sarawak .. 35 cases with 7 deaths to 1 Singapore ~ one case but no death to 18 May 1963 1 .". ,:..'. ... ~-.~;... '"''--~ .,.;_ . ...' '\,./ WP/RC14/a page 45

, ." China (Taiwan) wasdecla.r4d free of ip:f,',~(!tion on 19 September 1962 and Sarawak on 1 February 1963. . '" 4

In August 1962, three cases and nineteen carriers of cholera were found among the crew of a ship returning to Japan from China ( Taiwan) • Seventeen other carriers were found among the crews of five other ships which returned to Japan during August and September 1962. The crews had all been vaccinated against cholera. No secondary cases were reported. In May 1963, Japan reported an imported case in a passenger who had visited several places in India before going to Japan. The Administration took strict precautionary measures and no secondary cases have occurred. The discovery of these ing;>orted cases and carriers among the crews of returning ships who had been vaccinated against cholera was the cause of the concern expressed by some countries that the present prOvisions in the International Sanitary Regulations regarding cholera did not offer full protection against the introduction of the disease from an infected area.

During the new outbreaks, the experience gained last year, particularly in the management and treatment of cases, no doubt proved valuable. The co-operation and assistance given by outside agencies and countries to the affected countries were once more impressive. However, the recurrence of this disease in areas which were affected last year, the persistent occurrence of cases in the Philippines, even though in smaJ.l numbers, the outbreaks which have occurred in new areas and the ing;>orted cases and carriers reported, emphasize the need for health administrations to be constantly on guard against the reintroduction of infection and to maintain their drive for improved sanitation and health education and for an effective vaccination campaign, where indicated, so long as the disease is not eradicated from the endemic foci in neighbouring countries. They also stress the need for continued research and study to fill the gaps in our knowledge of the disease and to find more effective preventive measures. ~- 6.1.2 Diphtheria, Pertussis and Tetanus There was continued interest in several countries of the Region in the control of these infections. China (Taiwan) successfully continued its effective province-wide immunization programme with a continued fall in the incidence of diphtheria. Singapore and Viet.. Nam pursued their immunization programmes and in Korea, Philippines and Viet-Nam progress was made with the plans to produce the required vaccines with assistance from UNICEF and the Organization. 6.2 Tuberculosis

Since the advent of chemotherapy, many people, both the medical profession and the public, believe that tuberculosis is no longer a major problem of mankind. Many have based this opinion on the falling WP/RC14/2 page 46

death rates and some also use as an example the developed countries, where sanatoria are being closed, where there is difficulty in filling the beds in tuberculosis hospitals and where the names of tuberculosis societies are being chan~d to chest disease societies. A few experts in the field of public health have even declared publicly that tuberculosis, like malaria and smallpox, can be eradicated in the near future.

It is true that progress has been made in the struggle against tuberculosis and, with the intensive control measures being used, this will continue. Satisfactory results have been clearly obtained in certain countries in the Americas and north-west Europe. In other parts of the world, especially the countries and territories in the Western Pacific Region, advance has unfortunately been slow. Although effective anti-tuberculosis drugs and vaccine are nowadays available, eradication will not occur for many years to come, as all the infectious +- 1 cases in a community cannot be detected and treated at the same time. Nor can the present vaccination campaigns give full protection as they are not always directed to the right group of children early enough. There are still too many unknown cases which are not recognized. until after death. patients have received either inadequate or intermittent chemotherapy, so that drug resistance has been developed even before the patients are seen at the government clinics. In the developing countries in this region, over forty per cent of the children at the a~ of fourteen years are infected by tubercle bacilli, two to five. per cent of the adults have X-ray shadows in their chests, and no less than five per 1000 population.are actually spreading the infection. The average mortality rate is still around 30 per 100 000. Under these circumstances, it seems that the eradication of tuberculosis in this part of the world is still very remote.

Provided efforts against tuberculosis are intensified over the next ten years, the most one can expect is the following:

(a) a reduction in tuberculosis mortality to less than 20 per 100 000;

(b) a reduction in tuberculosis morbidity of infectious cases to less than 2 per 1000;

(c) a reduction in primary infection to below 2 per cent in children under five years of age; 10 per cent in children between 10-14 and 20 per cent between 15-19.

To reach these goals in the shortest possible time, tuberculosis has to be treated as a communicable disease and approached on a community basis. Available resources should be spent economically and effectively in order to obtain the best results. The following principles are recommended in planning a national tuberculosis control programme: ENVIRONMENTAL HEALTH - Trained sanitary inspectors from the WHO-UNICEF assisted train­ ing programme of the Philippine Government playa major role in a nationwide environmental health programme in the country. Photo shows a demonstration for construction of sanitary water seal toilets for homes in rural areas.

I I .... -

TUBERCULOSIS CONTROL - High priority is given to anti-tuberculosis work in the Region in view of the widespread occurrence of this disease. A 18 team member is shown at work in a village in Western Samoa where WHO has assigned a medical officer to help the Government develop its anti­ tuberculosis activities. WP/RC14/2 page 47

1. BCG vaccination has been proved to be effective in preventing the development of tuberculosis. A mass BCG vaccination campaign can be implemented in almost every country even though there is a shortage of trained professional worlrers. Attention has, however, to be directed to the use of a potent vaccine, an accurate technique and. to a high coverage of the most vulnerable group of susceptibles and the population in the selected age-groups. The use of thermo-stable freeze-dried BCG vaccine in tropical.countries, where no fluid vaccine can conveniently be supplied, is recommended.

2. The extensive use of domiciliary chemotherapy for all known cases of tuberculosis is considered the most effective measure to break the chain of tuberculous infection in the community. Combined drugs are recommended for infectious cases, provided. the government can afford to provide all cases with the required drug free; otherwise, isoniazid alone may be given. All anti-tuberculosis chemotherapy should be administered for at least twelve months. The provision of free medication for the second year of treatment should, in general, be unnecessary.

3. Existing hospital beds for the tuberculous should be reserved for emergency and surgical cases, and, if practicable, those in the initial phase of chemotherapy. No case of tuberculosis should be treated, admitted, or even pronounced unless tubercle bacilli are found. For this reason, simple bacteriological diagnostic fac:Uities for tuberculosis should be made available whenever possible. No funds should be diverted from the national tuberculosis control programme for the construction and maintenance of additional institutions for tuberculous patients.

4. Patients who present themselves at the clinics should receive priority for free chemotherapy. Unless all these patients are taken care of, no active case-finding measures should be attempted in the community.

5. If sufficient resources are still available, apart from treating the cases mentioned above, case-finding, using simple methods, such as microscopic examination of sputum, should be applied. to the group of people known to have a high prevalence of tuberculosis, such as family contacts of known index cases and the male population after a certain age. Expensive methods of case-finding, such as mass chest radio-photography, should be avoid.ed in countries where no X-ray machines are manufactured. 6. No funds should be diverted for the purchase of expensive drugs, for providing drugs beyond twelve months of treatment, for mass chemoprophylaxis, for equipping elaborate laboratories, X-ray services and/or surgical services, unless the vaccination and domiciliary chemotherapy services are considered. to be adequately implemented. WP/RC14/2 page 48

7. .An effective pilot area project for the evaluation of the national programme should always be organized in order to ensure that the different phases of the programme are carried out efficiently, both from the quantitative and qualitative pOints of view. The pilot area can also be utilized as a training ground for health workers in the methods of tuberculosis control.

Only through the most efficient use of available resources, which are almost without exception inadequate in this part of the world, can the tuberculosis problem be expected to be reduced in the shortest period of time.

The assistance provided by the Organization to governments in planning and executing a national tuberculosis control programme is governed by this approach. It is firmly believed that if these principles are followed, an efficiently organized and adequately equipped campaign against tuberculosis can be undertaken with the expectation of achieving preventive, therapeutic and. epidemiological successes.

National tuberculosis control programmes receiving assistance f'rcm the Organization are operating in China (Taiwan), Federation of Malaya, Korea, Philippines, Singapore, Viet-Nam and Western Samoa. Apart from the last, all have active BOG vaccination progranm:es in progress, although the coverage, the post-vaccination allergy and the age group receiving primary attention vary from country to country. Case-finding and domiciliary chemotherapy are being carried out in all these countries with a varying degree of coverage.

During the year, much progress was made in the tuberculosis control programme in Korea. The number of tuberculous patients under free drug treatment increased from 17 000 in July 1962 to 106 656 in April 1963. There are twenty-one BOG teams working throughout the country and approximately 200 000 vaccinations were given in the month of M:l.y 1963. In the Federation of M3J.a.ya, an intensive training programme for nurses, X-ray operators and laboratory assistants is in progress. A tuberculosis pxevalence survey was concluded in Saigon in the latter half of 1962 and the second tuberculosis prevalence survey in China (Taiwan) is close to completion. Western Samoa successfully carried out a national tuberculosis case-finding programme in which 312 infectious adult cases, 1128 suspects of tuberculosis and 2466 tuberculin reactors under 15 years of age were detected. The infectious cases have been given combined drug treatment and the suspects and tuberculin reactors isoniazid alone.

Australia, China (Taiwan), Federation of Mliaya, Hong Kong, Japan, Korea, New Zealand, Philippines, Singapore, Viet-Nam and Western Samoa have participated in co-operative bacteriological studies.

During the period under review, the main base of the Iegional Tuberculosis Advisory Team was the Federation of M:I.laya. Individual members, however, visited Korea, the Philippines and Viet-Name WP/RC14/2 page 49

Venereal Diseases and Treponematoses

Venereal Diseases

Precise information on the incidence of the venereal diseases is not available for the majority of countries and territories, but the WHO study of world trends of early syphilis and gonorrhoea during the period 1950-1960 confirmed that there has been a significant persistent increase in the incidence of these infections during the latter years of the decade in all regions. There has been no major change in the social and economic factors which favour the spread of the infections and the concern expressed by some health administrations and the steps taken to strengthen venereal disease control appear to be well justified. However, greater awareness on the part of all health administrations and the public of the possible increasing danger of the venereal infections is needed, as well as greater efforts to use presently available tools to control these preventable infections.

steps to make the health education of the public more effective were taken in Hong Kong and Viet-Nam and valuable work to prevent the infections in pregnant wo~n and .children was started in CSmbodia and Viet-Nam. In China (Taiwan), the island-wide control programme was continued. The Organization has recruited a short-term consultant who will assess the project later in 1963 and advise on future activities. He will also advise the Government of Viet-Nam on its control programme.

The mass treatment survey of the population in the Kingdom of Tonga was completed during the past year so that all the know yaws .. endemic areas in the Pacific area of the Region, except Portuguese Timor, have now been covered by mass treatment. The prevalence of yaws was found to be 2.2. per cent of active yaws including 0.03 per cent of infectious yaws. (See Part III for a full description of this project.)

Western Samoa carried out the fifth Yaws Week successfully in October 1962 when 60 622 children under fifteen years of age were surveyed. One case of infectious yaws was found in each of two villages in areas where infectious yaws cases were discovered in 1961, and juvenile mass treatment was immediately undertaken. Thus the progressive fall in the incidence of yaws has continued and Western Samoa can be said to be on the verge of eradicating this disease. A considerable number of '~seudo-byperkeratoses" and other skin infections were also discovered during the yaws week. No report of any recrudescence of the disease was received from the other former yaws endemic areas in the PaCific, but it is believed that there are still pockets of yaws in some of the remoter areas and WP/RC14/2 page 50 the problem of the persistent recurrence of a few infectious cases remains to be solved before eradication of the disease can be achieved. It is planned that the Inter-country Treponematoses Team should assist the governments further in their efforts to solve the above problems.

In Cambodia, the combined yaws control/smallpox project continued to make good progress. The initial treatment-survey of 171 025 people (88 per cent of the population in the 641 villages covered) revealed 1.68 per cent of active yaws, including 0.3 per cent of infectious yaws. A resurvey of 64 337 people in the high prevalence areas showed that the prevalence of active yaws had fallen from 5.7 per cent, including 1.09 per cent of infectious yaws, to 0.54 per cent of active yaws, including 0.08 per cent of infectious yaws, after an interval of twelve to thirty-six months, a remarkable response to the campaign. The field teams at the same time gave 15 c:i)7 primary smallpox vaccinations and 190 737 revaccinations. The WHO medical officer carried out reconnaissance surveys of the other yaws-endemic provinces +- and collected epidemiological information on other health problems. He has prepared plans for the continuation and extension of the project by the Government after his services are withdraw. later in 1963. UNICEF has continued to provide supplies and equipment.

In the Federation of Malaya, the Government continued its eff'~ctive yaws control programme with survey-treatment of the remaining endemic areas and the surveillance and consolidation of the areas aJ.ready covered. The field teams continued to record and report other diseases and during the past year 800 cases of malaria, 381 cases of elephantiasis, 208 cases of endemic goitre and 7 cases of leprosy were discovered. They also undertook the treatment of minor illnesses.

In the Philippines, the WHO Treporiematoses Advisory Team successfully completed ~ random sample surveys planned. The report of the team has yet to be completed. However, although little clinical yaws was found in the sample of the population examined, the very few cases of infectious yaws discovered indicated the existence of small pockets of yaws in some of the remoter areas. The fluorescent treponemal antibody test was successfully carried out under field conditions. The surveys received the full support of the national health services concerned. (See also Part nI.)

6.4 Virus Diseases

The Organization continued to assist with technical training in the virus diseases. The seminar on Japanese encephalitis and other arbovirus infections was successfully concluded in Tokyo in November 1962. The final report, which has been widely distributed, contains a recommendation that it 'WOuld be useful to hold an inter-regional seminar on ha.emorrhagic fevers which constitute a health problem in some of the countries of the Region in the near future. Plans are being made accordingly. Fellowships were granted to 'WOrkers from two countries to enable them to obtain training in virology and in WP/RC14/2 page 51 poliomyelitis vaccine production respectively. Further progress was made in the establishment of the virus laboratory of the Department of Health, Philippines, which is expected to go into operation later this year.

6.4.1 Smallpox

Although the countries of the Region remained free of smallpox during the past year, governments recognized the possible danger of the introduction of the infection from still infected areas and continued efforts to maintain an effective degree of immunization of their populations. Cambodia continued its combined yaws ... smallpox campaign effectively and the Philippines embarked on an intensified vaccination campaign, importing a quantity of freeze-dried vaccine to supplement the locally produced vaccine.

6.4.2 Trachoma

The redefined trachoma control project in China (Taiwan) made notable progress during the past year, the first year of its planned six-year duration. This project has the follOwing objectives: to reduce the prevalence of trachoma in areas of low endemicity to less than 4 per cent in the age-group shOwing the highest prevalence (at present the 15-20 year~age-group with 23.4 per cent); to reduce the prevalence and incidence in areas of moderate and high endemicity to a level at which the disease will no longer be a public health problem, and to prevent disabling complications and sequelae. It is aimed at 2.2 million people in 400 000 households with a prevalence of less than 16.5 per cent, 7 million people in 1 120 000 households with a prevalence of between 16.5 and 40 per cent, and 861 000 people in 127 000 households with a prevalence of 40 per cent or more. In addition, clinical trials to establish the relative merits of erythromycin and achromycin are being carried out.

In preparation for the start of field operations, all procedurea were tested in four trial areas and, although these trials were interrupted by the emergency created by the outbreak of cholera in July 1962, much valuable experience was gained. The information thus collected was used as a basis for certain modifications to the approach and plan of action, for determining the counties and cities to be brought into the programme in successive years and for the preparation of a comprehensive manual for field workers, which has since been reproduced and may be adopted for use in trachoma control programmes in other countries.

For the first year, 1962-1963, four counties and one city with a total population of 2.4 million have been included. in the programme. The training carried out included refresher courses in case-finding for 720 health station physicians and health workers connected with the school mass campaign, and courses for 102 community examiners and 113 community workers connected with the community control programme. WP/RC14/2 page 52

Case-finding and treatment were progressively extended and although many .difficulties were encountered at tbe start, activities have progressed smoothly and satisfactorily. Of those requiring treatment in the school mass campaign, more than 99 per cent have received more than six consecutive applications of ointment and less than 0.5 per cent less than six consecutive applications; a remarkably low percentage, 0.2 per cent, withdrew or were absent from treatment. In the community control campaign, the co-operation of the population has been excellent, practically 100 per cent of the households having been examined and the treatment rate being over 98 per cent.

This extensive project will require the participation of about 2500 medical and para-medical personnel, 47 000 school-teachers, 2000 school-principals and 1100 community workers. It Deceives technical assistance from the Organization and supplies, equipment and subsidies from UNICEF. The co-operation between the Government, the WHO personnel and the UNICEF personnel has been very· close and productive.

6.4.3 PoliOmyelitis

With the exception of the more highly developed countries where vaccination progra.nJZOOs have been carried out, poliomyelitis remained endemic with a relatively small number of cases reported, chiefly among the younger children. However, it is probable that countries in which the standard of environmental health is improving will find a considerably higher incidence among younger children in the next few years unless vaccination programmes are set up.

Several governments, including China (Taiwan), Fiji, Philippines and Viet-Nam, have given consideration to the organization of vaccina­ tion programmes and WHO has provided advice on request. However, the cost of the vaccine and the resources needed to carry them out have posed problems difficult to solve. Hong Kong and Singapore joined the countries which have undertaken vaccination programmes on their own. Campaigns were also carried out in Laos and the United states Trust Territories follOwing localized outbreaks.

6.5 leprosy

Several countries, including Cambodia, China (Taiwan), the Federation of Mllaya, Singapore and Viet-Nam, have shown increasing concern regarding their leprosy problem•. The Organization provided the services of a short-term consultant to survey the leprosy situation in Singapore and the same consultant is now in Malaya. The Governments of Cambodia and Viet-Nam are preparing new plans for their leprosy control programmes and information on the public health approach to leprosy control, as recommended by the WHO Expert Committee, was provided. It is hoped to provide advice on rehahilitation in leprosy control to China (Taiwan), where a progr8JlllIe is now being planned. TRACHOMA - Mass treatment in schools and in the community is being carried out in conjunction with research on the trachoma problem in Taiwan. The Government, with WHO and UNICEF assistance, now seeks to reduce trachoma incidence to a level where it would cease to be a public health problem throughout the island.

MALARIA - WHO continues to sponsor in-service training programmes for various categories of malaria workers in the Region in order to ensure their efficiency and keep them abreast of the latest technique of antimalaria work. Vietnamese spraymen are photographed during a spraying demonstration in Saigon. WP/RCl4/2 page 53

The leprosy control project in Korea, which receives assistance from WHO, UNICEF and other agencies made considerable progress. A total of 7646 persons, who were formerly patients in national leprosaria or leprosy colonies and institutions and who were considered negative and capable of working, have been provided with land, housing and assistance to enable them to be self-supporting. Two general hospitals have started the physical rehabilitation of selected patients with a view to restoring their working capacity so that they may be resettled later. A leprosy co-ordinating cOmmittee, composed of representatives of the Government and of all the private national and foreign agencies concerned with the disease, has been set up. The WHO medical officer and the Co-ordinating Committee assisted the Government to establish an extensive education programme in leprosy for medical officers, nurses, health technicians and other health personnel, as well as for the general public. A pilot project was established to demonstrate early case-finding, follow-up and domiciliary treatment of cases, the integration of the work into the existing health services and to train staff. The law of compulsory segregation of leprosy patients has been amended.

However, there are still many problems. The economic situation of the former patients who have been resettled has not yet been satisfactorily solved, the major part of the education of the health personnel has yet to be undertaken, the goal of persuading the general public to abandon all prejudice against the patient and the disease is as yet far from being achieved, and the basic health services will need to be further developed and expanded before the leprosy control work can be effectively assimilated. Nevertheless, an impressive start has been made in tackling the national leprosy problem. In the Philippines, the well-established leprosy control programme was continued, with increased emphasis placed on early case-finding and domiciliary treatment, training of health personnel in leprosy control, planned research and attempts at integration of the work into that of the established health services. Satisfactory progress continued to be made generally, but the physical and social rehabilita­ tion of the large number of patients accumulated. in the leprosaria and effective integration of the work into the local health services are among the problems still to be solved, as well as the completion of the surveys of all endemic areas. The Organization has recruited a short-term consultant to assess the programme during the second half of -1963 and to advise on the future activities. The WHO Inter­ regional leprosy Advisory Team will also carry out a complementary assessment through a random sample survey of a formerly high endemic area where the programme has been in operation for some time. WP/RCl4/2 page 54

7. HEALTH STATISTICS AND HOSPITAL RECORDS

It is encouraging to note that the need for adequate vital and health statistics in health planning and progra.nme evaluation is increasingly recognized by national health administrations in the Region, and some progress in their development and improvement can be reported.

A hospital records project was initiated in the Philippines during the past year with the ultimate aim of producing reliable statistics on hospital morbidity and hospital utilization, which would form. the basis for the planning and assessment of the national medical service. A medical records officer was awarded a t-welve­ month fellowship in September 1962 for training in the United states of America and, after completion of study, she will collaborate with the WHO expert in the training of medical records personnel.

The health statistics project in the Ph1l1ppines, which commenced in July 1961, has been proceeding satisfactorily. A field survey was made of procedures for the collection of basic vital and health statistical data at the local level. New forms for accurate and prompt recording and reporting of vital events and health activities were designed on the basis of the survey results. These are now being used at selected health centres and will gradually be introduced in all health centres and rural health units. A national staff member was awarded a twelve-month fellowship in September 1962 for advanced training in health statistics in the United States of America and the national counterpart received a four-and-a-half-month fellowship for study of health statistics in Europe,. the United States of Alrerica and Japan.

steady progress is being made with the vital and health statistics project in Viet-Name Statistics on mortality and causes of death for Saigon and Cholon have been compiled for 1961 and useful information on infant mortality, maternal mortality and leading causes of death has been made available for the first time. A training course on vital and health statistics for local personnel was conducted in ley 1963.

The hospital records project in the Federation of Malaya, which had as its original objective the improvement of the medical records system of government hospitals, is now in the course of developing into a hospital records and health statistics project, which aims at izqproving health service records and developing health statistics which will serve as a sound basis for the planning and execution of effective programmes. This is evidently a desirable expansion of the project, as the greater part of its original objectives has already been achieved. A twlve-month fellowship was awarded in July 1962 to a medical records officer for advanced study in medical records in the United KinsdOm. WP/RC14/2 page 55

It has not been possible to recruit a suitable expert for the continuation of the hospital records project in Singapore owing to the shortage of experts in this field. Arrangements were, however, made for the WHO expert assigned to the Federation of Malaya to visit Singapore for three weeks in the second half of 1962 to assist with the improvement of the medical records system in government hospitals. It is gratifying to record that the work carried out during this short­ term assignment could be considered as equivalent to what would have been done by a full-time project officer.

An epidemiologist/statistician has been working with the trachoma special study project in China (Taiwan) since and is adVising on the collection, tabulation and analysis of epidemiological data relating to trachoma on the island. A statistician is assigned to the WHO tuberculosis advisory team to assist in the statistical planning of tuberculosis surveys in a number of countries and in the compilation and analysis of the data collected.

During the period under review, preparations were made for a regional seminar on health surveys and reporting, which will be held in the Regional Office from 21 October to 8 . Methods of health surveys and national annual health reports, including statistical planning of sa.zqple surveys and preparation of survey reports will be discussed, and many governments have expressed interest in sending participants. Epidemiological and vital statistics for countries and territories in the Region are being regularly collected and classified at the Regional Office in order to permit the study of health problems and the planning of health projects in the countries concerned. It is hoped that governments will continue to stress the ~ortance of such statistics in the planning, implementation and evaluation of public health progr~s, as apart from a few countries in the Region, the statistical services are, in general, weak. The development of a well organized vital and health statistics unit is essential in any public health programme.

8. PROGRAMME ANALYSIS AND EVALUATION

Programme analysis and evaluation continued to represent an important regional activity during the past year. It cannot be over-emphasized that without the regular analysis and evaluation of existing projects it is impossible to prevent the repetition of mistakes and failures, and this is certainly one of the most important ways to gain the experience and knowledge necessary for the planning and operation of future projects and programmes. Staff members in the Regional Office, as well as in the field, have been committed to the evaluation of the projects under thejr responsibility, WP/RC14/2 page 56 and it is gratifying to note that national health administrations in the Western Pacific Region are increasingly interested in the assess­ ment of their public health programmes. The WHO.assisted projects are, in fact, periodically assessed by the international staff in collabora­ tion with their national counterparts and the results included in their quarterly reports.

As in the previous year, newly-appointed project staff were thoroughly briefed on methods of project evaluation and were specifically requested to collect baseline data to permit the measurement of the quantity and quality of project achievements by the use of statistical methodology.

During the period under review, nine field staff members, on completion of their assignments, submitted reports with a broad review of project activities and a critical assessment of the results so far achieved. During the same period, forty-five field reports were prepared by the regional technical staff following visits to various countries in the Region. Copies of all these reports were sent to the governments concerned, and in many cases attention was drawn to specific recommendations aimed at increasing the effectiveness of the field programmes. The bilharziasis and treponematoses control projects in the Philippines were specifically visited and evaluated by inter­ regional advisory teams. Details of five selected projects, fo~ long-term and one short-term, which were completed during the period under review, are given in Part III.

Arrangements were also made for twenty-nine short-term consultants in specialized health fields to visit countries and territo~ies to advise on or evaluate particular aspects of health problems: A number of governments are using the recommendations contained in their assignment reports as a basis for further planning of specific activities.

Since the last meeting of the Regional Committee, four inter­ country group educational projects have been arranged, and their organization, operation and achievements were assessed on the basis of specially designed questionnaires completed by the participants. Six inter-country meetings, which had taken place one to three years previously, were also evaluated on the basis of the contributions made by the participants to their countries as a result of their attendance. Where recommendations were made at an inter-country meeting, the follow-up evaluation was mainly based on the extent to which these had been implemented. by the participating countries. It should be pointed out that the response rate of the participants to the follow-up questionnaire was generally low in spite of repeated reminders, so.that the eValuation of inter-country meetings was consid.erably delayed, and the actual long-range achievements of the projects could not be properly and satisfactorily assessed. With the co-operation and assistance of governments, it is hoped that this situation will improve. WP/RC14/2 page 57/58

A detailed plan has been drawn up so that all country projects can be routinely evaluated one to two years after their completion. It is hoped that with the agreement of the governments concerned, it will be possible to put this plan into effect in the near future. The informa­ tion provided by this follow-up of past assistance will be USeful both to governments and to the Organization when planning future programmes. WP/RC14/2 page 59

PART III

SUMMARIES OF SELECTED PROJECTS COMPLETED

DURING THE PERIOD UNDER REVIEW SUMMARIES OF SELECTED PROJECTS COMPLETED DURING THE PERIOD UNDER REVIEW

A conv;>lete list of projects current during the year will be found in Part IV. The following projects are described in fuller detail as they were cOllij;>leted during the year.

Project number Title

WPRO 68 Medicated Salt Project, Cambodia

Korea 18 Public Health Survey

Philippines 9 Bilharziasis Control Pilot Project

Philippines 15 Yaws Control Project .~ ~ I Tonga 2 Yaws Control Project I I

I WP/RC14/2 It'- .page 61

1. MEDICATED SAm PROJECT, CAMBODIA

In certain parts of Cambodia where Anopheles balabacensis is the main vector of malaria, residual spraying with DDT at a dosage of two grams per square metre, one spraying a year, has not produced satisfactory results. The main problems were as follows. Because of the difficulties connected with accessibility and the special type of farm huts, it was not possible to achieve total coverage. Moreover, because of the exophilic habits of the malaria vectors, it was difficult to control the mosquito by the conventional method, that is, DDT residual spraying. Therefore, an experiment based on the distribution to each household of salt containing anti-malarial drugs was canied out in the Battambang area (5000 square kilometres and with a population of about 20 000) in .~. the north-western part of cambodia fram 1959 until the end of 1962. Two WHO eJqlerts, a malario.logist and a laboratory technician, were assigned to the project.

The distribution of refined COOking salt mixed with either pyrimethamine or chloroquine was effected free of charge to a11 house­ holds in the experimental area. The pyrimethaminized salt was used at a concentration of .05 per cent of pyrimethamine basej its distribution was on the basis of fifteen grams of salt per adult person per day. After the development of resistance to pyrimethamine was confirmed in the local strain of Plasmodium falciparum, the distribution of pyri­ methaminized salt was discontinued and, instead, chloroquinized salt was used, the latter containing chloroquine at a concentration of .6 per cent base and its distribution being based on 10 grams of salt per adul.t person per day. The monthly distribution of either pyrimethaminized or chloroquinized salt was based on the "total coveragell of the population in the experimental area either through the district chiefs or directly by the personnel employed by the project. In some inaccessible districts he.licqpters were used to deliver salt by parachute air-drops.

This experiment produced a considerable reduction in the parasite index amongst the local population without, however, giving any assurance of effective control, much less, of an interruption in transmission. The failure in producing satisfactory results could be attributed to the following:

(1) inadequate local facilities and means to ensure uninter­ rupted "total coverage" distribution of medicated salt to the peqple throughout the experimental area;

(2) insufficient and irregular daily consumption of salt by the local population;

(3) cammon use of salted food stuff with non-medicated salt; . (4) development of resi.stance to pyrimetham1 ne in the local strain of P. falciparumj w~jRC14/2 page 62

(5) inf'lux of ordinary table salt to certain parts of the project area;

(6) constant movement of certain groups of people in the project area. In conclusion, the use of medicated salt as a sole attack measure against malaria cannot be expected to stop transmission under the local conditions prevailing in the A. balabacensis inf'ested areas in cambodia. A pilot project is being planned to apply DDT residual spraying of optimum dose, repeated at proper intervals, in order to establish the technical feasibility of malaria eradication in such problem areas.

2. PUBLIC HEALTH SURVEY, KOREA

The objectives of this project were: to assess the country situation and services available for the health protection of the popu­ lation and to develop a long-range national health programme which would take account of the country's health needs and the resources that could be applied, including those available from external sources.

In preparation for the project, the Government of Korea organ­ ized in 1961 a Fact Finding and Co-ordinating Committee consisting of staff of the Government and of the~ssion of the United states Agency for International Development (AID) in order to collect information and data concerning the country's health services. In , AID provided consultants in public health adminis­ tration, sanitary engineering and public health nursing, in addition to its public health staff in the Korea Mission Office. The period of their assignment was one month. WHO provided a consultant for three months. These experts formed a joint AID/WHO panel to study the report prepared by the Fact Finding and Co-ordinating Committee and to review the organization and operation of the medical and health services. Technical personnel from the Ministl1f of Health and Social Affairs and affiliated institutions provided the panel with assistance as required. The AID/WHO consultant panel submitted recommendations covering the following areas:

(1) Organization - creation of a dir~ctorate of health services to be responsible for carr,ying out overall health activities in the Ministry of Health and Social Affairs; establishment in the Ministry of technical units for maternal and child health, nurSing, health statistics, health education and health evaluation. WP/RC14/2 page 63

(2) Administration - phased increases in the health budget up to five per cent of the national budget (exclusive of defense) within a five-year period; development of a uniform policy for the granting of a national subsidy for health and medical services in the provinces; the introduction of salary inducements for health and medical personnel in government service; and strengthening the supervision of the health and medical services.

(3) Programming - strengthening and extension of the local health services throughout the country; development of a comprehensive environmental health programme; reviewing the tuberculosis and leprosy programmes with a view to placing less emphasis on institutional and more on modern out-patient care; provision of a modest outlay for medical and public .health research under the sponsorsh:ip of the Ministry of Health; increase in the support for health and medical personnel training and the opportunities for public health orientation of students of medical and related disciplines.

As the organization and activities of the local health services are fundamental to the development of a sound comprehensive national health programme and to the success of the present government effort to provide health services for the people living in the rural areas, the WHO consultant, who remained in the country after the departure of the AID consultants, considered it necessary to examine the problem further and show how the local health services could be re-organized and strengthened on the basis of the practical capabilities of the central and local governments. A special trip was, therefore, made to the province of Chungchong-Namdo with the Director of the National Institute of Public Health Training and the former Chief of the Health and Sanitation Branch of the AID Mission in Korea. The group visited the four provincial hospitals, the Provincial Health Laboratory, nine of the fifteen health centres and the new National Tuberculosis Hospital in Kongju. A particular province was selected in order to simplify the method of approach and develop the practical steps necessary to bring about the desired changes and improvements. It was felt that fram the experience gained in one prOvince, it should be possible to apply the scheme rapidly in others, thus saving much time in the long run.

The survey revealed that the health services in the province needed improvements. Although the facilities and personnel were limited, they were far from being fully utilized. The health centres were not properly oriented to carry out the main function of preven­ tive work, the various services were not co-ordinated and integrated so they could not support one another, too little was being done for the people living in the rural areas, the health officers and staff lacked public health training. In his report the HHO consultant discussed the health units one by one, reviewed their problems and the changes required and made recommendations on how each of them could be strengthened and brought together as an organized health force to serve the people of the province better. WP/RC14/2 page 64

As the national budget ~or the health services ~or the past ~ew years had been too low to meet the minimum health needs of the country, it was obvious that the provincial health budget required to be sub­ stantially increased i~ the proposed plan o~ strengthening and extend­ ing the health services was to be carried out. Suggestions were, therefore, made as to the estimated amount re~uired to implement the plan. The other consideration of great importance was the need to co-ordinate the assistance provided by bilateral and international agencies which had played a substantial role in the improvement o~ health in Korea. It was suggested, therefore, that the Ministry o~ Health and Social Af~airs should establish an Advisory Committee, consisting of representatives ~rom the Ministry, AID, the Scandinavian Mission, WHO, UNICEF and the Korean Association of Voluntary Agencies, to co-ordinate international, bilateral and voluntary assistance, so that these contributions were used in the best way possible to further the development o~ the national health programme.

Apart ~rom strengthening the Provincial Bureau of Health and Social Affairs, it was proposed that WHO and UNICEF should assist in the strengthening and development of the health centres, WHO providing an international team to advise on the planning and implementation of the rural health programme and on the training o~ local health person­ nel, and UNICEF supplying equipment and supplies as required.- It is hoped that the re-organization of the Provincial Health Bureau and the health centres can be effected within a period of two years and the international team can spend part o~ its time studying the problems of the health services in some other provinces.

It was also suggested that the Scandinavian Mission should be invited to participate, through the National Medical Centre, by assisting in the re-organization and strengthening of the Taejon PrOvincial Hospital~ which would serve as the main re~erral hospital of the province, and o~ the three smaller hospitals, which would act as district re~erral hospitals and receive patients sent by the health centres and the public doctor's clinics. This would enormously strengthen the curative arm o~ the provincial health services and contribute to the co-ordination o~ hospital and health centre activities. -- It is di~ficult at this stage to evaluate the long-range impact of the project on the national health services, but the following immediate e~fects have been noted:

1. The interest of the staff of the Ministry in expanding health activities has been greatly stimulated.

2. The adoption of the recommendations of the AID/WHO cons~tant panel will no doubt strengthen the service potential of the Mi~stry, but in view of the presently limited resources, which are be~ng used for economic development, the Ministry is considering WP/RC14/2 page 65 the gradual implementation of the proposals made based on what is presently feasible. 3. The strengthening of the local health services as recom­ mended has, however, found immediate government response and within a short period of time the Government and WHO had made budgetary provi­ sion for their development. A local health services project was initiated in Korea in April 1963 with an expected duration of five years. WHO has assigned a medical officer and a nurse/midwife, and a health educator and a sanitarian will be appointed later in 1963. Fellowships will aJ.so be provided by WHO to enable local health per­ sOlmel to undertake training overseas. UNICEF has agreed to furnish supplies and equipment for the health centres and stipends for the refresher training of health centre staff.

3. BILHARZIASIS CONTROL PILOT PROJECT - PHILIPPINES

Bilharziasis is an important public health and socio-economic problem in the Philippines where the first case of the disease was reported in 1906 but the intermediate snail host was not discovered until 1932, when the Bureau of Health took the first steps in the fight against the disease. Field surveys were organized in 1940 but the outbreak of the war in the Philippines in 1941 brought the work to a standstill. The epidemic of the disease among the allied forces who landed in Leyte in 1944, involving 1700 persons, focused attention on the problem once more and stimulated surveys and research by the armed forces and the Government. The Division of Laboratories, which was created in the Depart­ ment of Health in 1947, continued the surveys and with the growing awareness of the importance of the disease a Division of Schistosomiasis Control was created in 1951. From the data obtained f'rom the surveys carried out between 1947 and 1952, it was concluded that the disease was endemic in fourteen prOvinces of the Philippines, including Leyte, Samar, Bohol, Mindoro, Sorsogon and all the provinces of Mindanao, except Oriental Misamis, and that of the more than one million people living in these areas and exposed to infection, no less than 300 000 were infected. At the request of the Government, a WHO bilharziasis team, consisting of a parasitologist, a malacologist and a public health engineer, made a survey and study of the disease in the Philippines fram 20 June to 30 September 1952. On the recommendation of' the team, the Government set up a bilharziasis control pilot project for which WHO provided three experts, supplies and equipment. Additional sup­ plies and equipment were furnished by the Fbreign Operations Adminis­ tration of the United States of America and the Philippine Council for United states Aid provided some additional personnel and the local costs of the project. WP/RC14/2 page 66

The project was planned for six years and the objectives included: (a) baseline studies on the human, gastropod vectors and domestic. animal reservoirs of bilharziasis; (b) field studies on the ecological and biological factors involved; (c) evaluation of methods of control developed by analysis of basic data; (d) training of local technical personnel; and (e) development of plans and procedures for nation-wide control of this disease in the Philippines.

Palo, in Eastern Leyte, where the disease has long been known to be high~ endemic, was selected as the area of operation of the pilot project. Suitable office and laboratory accommodation, animal houses and other buildings needed were constructed on a one-hectare site donated for the purpose and the Government provided a national counterpart and other staff who, with the international team, pursued the objectives during the ensuing period.

B.y 1957, significant progress had been made and the work was reported on ~d discussed ful~ in the Bulletin of the World Health Organization. As the activities cannot be described adequate~ in the space available in a summary report the above publication should be consulted for detailed data. However, since the establishment of the Bilharziasis Pilot Control Project in Palo, Leyte, in 1953, a mass of new knowledge and information on bilharziasis control has been accumulated from the basic research and fundamental investigations carried out, not on~ on the epidemiology of the disease, the human and other reservoir hosts of the parasite but, more particularly, on the snail intermediate host. The knowledge gained of the biology and bionomics of the snail host was the basis of experiments on snail control at first tried out on a small scale and later replicated on a great number of snail colonies within the pilot area. Among the successfUl measures tested were the drainage or channelling of waterlogged areas, filling and grading of low places or depressions, digging of fishponds and to a lesser extent, clearing and remOving of vegetation. In most of these experiments, the snail populations were greatly reduced and in some places have camplete~ disappeared. It was found in snail-positive rice fields that improved agricultural practices not only increased the harvest two or three times but also markedly reduced the snail population. In many instances, the lands reclaimed by the operations were utilised and made agriculturally productive. In addition, it was recognised that transmission of the paraSite to man can be reduced through hygienic practices such as proper waste disposal and the development of sanitary measures for supplying safe water for drinking, bathing and washing.

I Bull. Wld Hlth Or~. 1958, 18, No. 3, pp. 275-480 Bull. WId Hlth Or~. 1958, IS, No. 4, pp. 481.,684 Bull. Wld Hlth Or~. 1958, 19, No. 2, pp. 223.,400

'4"' WP/RC14/2 page 67

If, therefore, effective snail control and hygienic environ­ mental practices can be introduced into a population and applied on a community-wide scale there would result not only a healthier population but also an improvement of their economic conditions. In the trials at Palo, the success of the snail control measures was in no small measure attained through the help of such agencies as the Bureau of Highways, the Bureau of Public Works, the Division of Irrigation and the Bureau of Agricultural Extension. In future pro­ grammes, it would seem that the support of these agencies would not only be invaluable but essential.

In December 1957, a vraO consultant visited the project to assess the progress and provide material that could be used as the basis for making pl.a.nS that would apply to the shift from the "pilot" to the "operationaJ." phase. The consultant made recommendations for a short. term plan, which included the extension of the pilot project for two years until , to enable certain obj ectives to be attained before embarking on the long-range plan proposed, and the evaluation of the project every two veru::s~

In 1959, agreement was reached on the extension of the project with the follOWing objectives:

(1) conducting studies and observations on S. japonicum and its hwnan, vertebrate and snail hosts with a view to employing the information gained for deviSing control procedures;

(2) designing and testing control measures derived from basic studies and field observations; (3) testing on a pilot basis in three areas a community-wide integrated bilharziasis control programme which would involve provincial and local health services and other government agencies;

(4) training and organizing one bilharziasis control advisory team for at lee,.st each of the four endemic regions of the country and preparing a national programme of bilharziasis control, with particular emphasis on the four known endemic regions. Thus the pilot project was to be continued but, in addition, pilot integrated programmes to attempt community-wide bilharziasis control through environmental, medical and other ..measures, including health education, emphasis being placed on snail control, and the training of personnel for regional bilharziasis advisory teams, whi.ch would be assigned to the endemic regions, were undertaken. For the extension of the project, WHO provided the services of an epidemiologist, a sanitary engineer and a short-term consultant biologist, some equipment and supplies and two fellowships to enable personnel of the project to receive advanced training in epidemiology and malacology. WP/RC14/2 page 68

During 1959, the WHO consultant biologist assisted with an evaluation of the project with particular reference to the snail control measures tested. FAO also provided an agricultural expert to advise on and organize experiments designed to discover techniques assisting schistosomiasis control and simultaneously improving and diversifying agricultural production, and to advise the Department of Agriculture on ways in which its various units and specialists might contribute to the success of the pilot project. These experts found that the snail control programme had resulted in the elimination of 85.7 per cent of the snails within the area under control operation and of 95 per cent of the snails, if four snail habitats where no control was attempted, were excluded. Of the various methods used, complete eradication of snails was achieved only by those methods where water was controlled completely - drainage by interception chan­ nels, ponding and filling. The urgent .need for legislation dealing with proper drainage and irrigation was stressed and the difficulties of successfUl integration of schistosomiasis control at the municipal level were indicated. It was recommended that an international agri­ cultural engineer should be provided to train the staff assigned for drainage and irrigation control and to advise on the efficiency of the schemes proposed for the control of schistosomiasis. An agricultural engineer of FAO joined the project in , and in 1961 agreement was reached on the continuation of the activities and stUdies of the pilot project and the integration programme, and the establisbment of integrated bilharziasis control programmes on a municipal and province-wide scale. WHO provided a short-ter.m fellowship in molluscaciding and some supplies and equipment, and UNICEF agreed to provide supplies and equipment for two regional bilharZiasis advisory teams (RBAT). In 1962, UNICEF provided the equipment and supplies for additional EBATs and WHO agreed to arrange for an evaluation of the project by the WHO Bilharziasis Advisory Team (BAT) and a consultant on public health administration.

The WHO personnel were all withdrawn from the project at the end of 1960, the FAO agricultural expert completed his assignment at the end of 1961 and the Government continued the work planned. The WHO/BAT and the consultant in public health administration carried out an eValuation of the project during the latter part of 1962. Although the evaluation report is not yet released, the conclusions and recommendations proposed have been discussed with the Government. These included the follOWing: the magnitude and seriousness of the bilharziasis problem in the Philippines was believed to justify a greatly increased budget for the work; there should be a continued search for improvement of control measures and for trial of other methods; the national control activities should be separated from the research activities of the Palo laboratory and the research acti­ vities should be upgraded, possibly with the partiCipation of an international expert; the bilba.rziasis campaign should take advantage of the work of other campaigns, such as health education, sanitation and malaria, and be integrated at the regional rather- than at the local unit level. WP/RC14/2 page 69

With regard to control activities, the team advocated that prime emphasis should continue to be placed on water management although other control measures should not be neglected and the continuation of research on molluscacides was especially recommended. Because of the magnitude of the problem, it we suggested that attention should be focused on endemic areas with the greatest potential, both economic and social, to profit from the improvements made. Self-help projects should be encouraged as they offered hope for long-range progress and full use should be made of the support of regular and special national agencies with the development of a broad programme with a clear demonstra­ tion of the role of each agency. The continuation of FAO collaboration should be sought in connexion with a large-scale field demonstration of the economic advantages of bilharziasis control through water management and agricultural improvements.

CONCWSIONS

The project plans have been substantially met and the accom­ plishments have been generally satisfactory in terms of the increase of ~cientific knowledge, which may prove to be of world-wide significance, and the improvement of the quality of professional, auxiliary and ancillary personnel.

The control measures devised and tested have indicated that the ecological methods of control aimed at the snail host appear to offer the greatest likelihood of achieving effective control, although other methods, including health education and environmental sanitation, can playa useful part. The finding that the eradication of snails can be achieved by the complete control of water, which, when combined with improved agricultural practices, greatly increased production and also reduced the snail population, is a significant one.

The accomplishments were attained through the co-operative efforts of the Department of Health not only with the international agencies, including WHO and FAO, and bilateral agencies, such as the United States Agency for International Development, but with other governmental agenCies, including the National Economic Council, the Bureau of Highways, Bureau of Public Works, the Bureau of Irrigation, the Bureau of Agricultural Extension, the Department of Education, the Social Welfare Administration and the Office of the Presidential Assistant on Community Development. However, the trials of control measures on a community basis to find out if the measures for control were effective in controlling the infection in man, were econOmically feaSible, and were acceptable to the community, were inconclusive.

The studies undertaken have shown that bilharziasis constitutes an extremely complex bio-social problem in the Philippines incapable of solution by medical means alone. The hope of finding comparatively easier methods of control directed against some vulnerable point in the life cycle of the parasite or of its inter-mediate host has not been realized. The problem will have to be solved the hard way involving the sustained and co-ord;inated ef':forts of the several agencies involved. WP/RC14/2 page 70

In the light of present knowledge, the basic concept developed has been that the control of bilharziasis should be planned in a broad context of rural and economic development, and that a co-ordinated and inter-departmental programme in the endemic areas offers the best approach to the solution of the problem. In the choice of control methods, special emphasis has been laid on the simultaneous benefits of improved land and water use and increased food production. These can become an integral and vital part of a larger programme of economic and social reconstruction compatible with the declared government policy and programme of community development and self-sufficiency in the Philippines.

Much has been learnt and achieved in the pilot project but much remains to be done to achieve the desired control of bilharziasis. This will require the Department of Health to seek and obtain the support of the other regular and special government agencies concerned as well as that of the international and bilateral agencies.

4. YAWS CONTROL PROJECT, PHILIPPINES

Field work started in August 1951 when demonstration yaws control projects were organized in the provinces of Samar and Leytej six specialized teams were trained and carried out treatment-surveys. By August 1953, the teams had examined about 1 300 000 people and treated about 55 000 cases of yaws. Repeated resurveys followed by treatment were then undertaken.

The decision to embark on the expansion phase was based on the experience gained in the demonstration project and in September 1952 field work to cover the nine known provinces of high prevalence of yaws in Mindanao and Catanduanes was started. The specialized field teams were increased to twelve.

In September 1953, the integration phase, which provided for the expansion of activities to 700 additional municipalities and the integration of yaws control work into that of the health services of these municipalities, began.

B,y September 1956, the consolidation phase had been reached. This provided for the further expansion of the proj ect to cover all the remaining yaws endemic prOvinces of the Philippines, through the co-ordinated work of the rural health units and the specialized yaws control teams.

Specialized teams were utilized to carry out the treatment­ surveys and to undertake the early resurveys of areas of high yaws endemicity. Later, during the integration phase, they carried out reconnaissance surveys of the new areas, completing the treatment­ surveys of those with a relatively high prevalence of yaws, and arranging for the rural health units to undertake the survey and HP/RC14/2 page 71

treatment of those municipalities with a low prevalence. With the start of the consolidation phase, the specialized team remaining on the project concentrated on the difficult areas with a relatively high prevalence and assisted the rural health units to maintain the yaws control activities. Further yaws co-ordinators, who were at the same time medical officers of the provinces, and surveillance teams were assigned to promote the sustained efforts required to control the disease, to maintain the training of field personnel, to ensure adequate reporting of activities and to stimulate the intcnsif:j.ed efforts in areas '\-There inCl,icated.

As a result of these efforts, a reported 16 960 594 people have been examined (including those seen in the resurveys) since the begin­ ning of the campaign and a total of 339 403 cases of yaws have been treated. According to the reports received fram the rural health service, into which the yaws control programme has been completely integrated, the prevalence of yaws has been reduced to the point at which the disease is no longer a public health problem and is approach. ing the stage of near eradication.

The development of the extensive rural health unit programme, which started in 1954, was of great significance in the development and ultimate success of the yaws control project, since the establish­ ment of 1300 rural health units provided a health service for every municipality and barrio in the country and permitted the integration of the work into that of the rural health service.

The WHO Treponematoses Advisory Team (TAT) carried out an assessment of the yaws control project by means of a clinico-serolo­ gical survey of a random sample consisting of about 0.05 per ,cent of the population from Jo.nuary 1962 to April 1%3. The sampling design was prepared by the Statistical and Venereal Disease and Treponematoses Control Sections of WHO Headquarters. Apart from the clinical examination of the sample population, children under fifteen and 20 , per cent of the adults were blood-tested and the field laboratory car. 1'iOO out theVDRL and FTA (fluorescent treponemal antibody) tests on the specimens. A portion of the blood specimens was sent to the WHO Reference Serological Laboratory, State Serum Institute, Copenhagen, for cross checking and some were also sent to the World Serum Bank. It is expected that the results of the clinical and serological examinations will provide a satisfactory basis for an assessment of the present and past yaws endemicity.

The data collected have not yet been fully tabulated nor analyzed but the clinical findings and the available serological findings have indicated that yaws in the Philippines has been reduced to a very low level and the rural health service should be able to keep it under full control and ultimately achieve eradication of the disease.

UNICEF provided equipment and supplies for this extensive programme and WHO gave technical advice in connectiOl with the plan­ ning of the programme and with assessment by the --assignment of short­ term consultants and the TAT. WP/RC14/2 page 72

5. YAWS CONTROL PROJECT, TONGA

The yaws control project of the Kingdom of Tonga was started in May 1962 and completed in January 1963. A medical officer/serologist was provided by WHO and equipment and supplies by UNICEF. The objectives were: to train national personnel in the techniques of yaws control, to reduce the prevalence of yaws by mass examination and treatment with penicillin, and to encourage the development of an effective rural health service so that it could continue the surveil­ lance and follow-up activities in order to secure the control and eventual elimination of the disease. A pilot area project was first established in which the national personnel were trained in the epidemiology, diagnosis and treatment of yaws and in the recommended techniques of yaws control. A clinical survey was made of the population of 5875 in the pilot area, as well as a serological survey of the children between 2 and 14 years and about 20 per cent of those over fifteen; 1.71 per cent of active yaws, including 0.07 per cent of infectious yaws, was found in the population examined (91.5 per cent coverage), and an average sero-reactor rate of 19.4 per cent was found among the 2650 blood-tested, with 12.8 per cent among the 2103 children between 2 and 14 years. The high sero­ reactor rate among the older age groups showed that yaws had been prevalent in the past, the number of infectious cases suggested that active transmission was still occurring, while the number of high-titre reactors indicated the existence of latent cases liable to relapse.

The mass campaign was then carried out. A total of 61 887 people, including those in the pilot area, were examined and treated, a coverage of 89.9 per cent; 2.2 per cent of active yaws, includir~ 0.03 per cent of infectious yaws, was found. Apart from dealing with yaws, the teams treated minor ailments among the people and also reported a large number of cases of non-yaws hyperkeratosis, 164 cases of elephantiasis and 2294 cases of other skin diseases.

The good co-operation of the people was secured by the extensive health education and propaganda carried out through the Tongan Broad­ casting CommiSSion, the Fonos and church groups. The discussions with various groups, the effective administrative support given by the national director, the keenness of the national personnel and the interest of the various government officials concerned all contributed to the successful completion of the campaign.

It is believed that the national teams and local health person­ nel obtru.ned not onl7 useful technical knowledge of yaws control but also valuable acquaintance with a nation-wide campaign. The people also gained renewed confidence in the health programme carried out by the Gover:rment. The mass treatment of the population will reduce the prevalence of yaws to a level at which the rural health services shOUld be able to deal With it, but continued surveillance and follow­ up will be required to secure the eventual elimination of the disease WP/RC14!2 page 73/74 fram the Kingdom. It is planned that the Inter-country Treponematoses Team will return to the South Pacific to assist.not only Tonga but the other for.mer yaws-endemic Pacific Island Territories, to achieve full control and ultimately the eradication of yaws. PART IV

PROJECTS IN OPERATION PROJECTS IN OPERATION

This part of the Report contains a list of the projects - country and inter-country - that were in operation during the whole or part of the period from 1 July 1962 to 30 J~~e 1963. Continuing projects for which the only assistance given during the period was technical ad,vice from the Regional Office are not shown.

In country projects, the purpose for wr~ch the government under­ took the project is stated. Details of the assistance provided by WHO and work done are given for con:pleted :i.nter-country projects. Such details are not given for continuing projects.

Under the heading ''Fellowships'' are shown those fellowships awarded during the same period that do not form part of assistance to a larger project. A table showing all the fellowships awarded, by subject of study, is given in Annex 6. The starting and finishing dates are shown in parenthesis after the project title; in some cases the finishing dates are still tentative. Names of other co-operating agencies, whether or not they have contributed funds, are given after the source of funds.

The abbreviations used include the following: R - regular budget; MESA - Malaria Eradication Special Account; ~A - Expanded Programme of Technical Assistance. other abbreviations are explained on page ii.

.. WP/RC14/2 • ... page 77

WERO 22 Yaws Control, Tonga (May 1962 - Jan. 1963) R UNICEF See Part III for a summary of this project.

WPRO 40 Seminar on Food Sanitation, Manila (16-27 Oct. 1962) TA A seminar to provide administrators of food sanitation programmes, food sanitation workers and those responsible for the training of health and sanitary inspectors with information on food sanitation methods and to enable them to exchange experience, with the object of stimulating the health administrations of countries of the Region to undertake improvements. The subjects discussed included food-borne illnesses; foods and food practices in the countries of the Region and factors that govern them; hygiene of food processing, storage, distribution and sale; the influence of environmental sanitation on food hygiene; present food sanitation programmes in the Region and how to improve their effective­ ness. There were sixteen participants from China (Taiwan), Federation of Malaya, Hong Kong, Japan, North Borneo, Philippines, Republic of Korea, Republic of Viet-Nam, Sarawak, and Singapore, and five observers - three from the Philippines and two from the United States Agency for International Development (AID) mission to Viet-Name

WHO provided the costs of attendance of the participants, two short­ term consultants and supplies and equipment.

WPRO

To increase the number of assistant medical and dental officers in the health services of the islands of the South Pacific by providing fellowships for undergraduate studies at the Fiji School of Medicine.

WPRO 68 Trial of Medicated Salt (Pinotti's Method), Pailin, Battambang Province, Cambodia (; Ju~ 1959 - Dec. 1962) MESA See Part III for a summary of this project.

WPRO 70 First Regional Seminar on Rural Health Services, Taichung, Taiwan, Republic of China (21 Nov. - 5 Dec. 1962) TA A s°eminar to review concepts and practices and to exchange views on the administration of rural health services within the Region; to develop guiding principles for their planning, administration and evaluation; to explore available resources which might help rural health development (local, national, or external) and to identify areas for co-operative action between health and other agencies operating at the local level. WP/RC14/2 page 78

The subjects discussed included the extent to which the total health needs of the rural population were being met and the direction of future developments; the principal problems involved in providing family health services in rural areas; the role of the health services in the improvement of sanitation in rural areas and the steps necessary to achieve this improvement; the most effective methods of ensuring community participation in rural health progrowmmes, and the fields where such participation would be most useful, including co-operative action at the local level between health and other agencies, local, national and international; the extent to which rural health services should participate tn special programmes; and the extent to which the training needs of the rural health workers were being met and the methods by which training should be developed.

There were twenty partiCipants from the follOwing countries: China (Taiwan), Federation of Malaya, Fiji, Japan, North Borneo, Philippines, Republic of Korea, Republic of Viet-Nam, Ryukyu Islands, Sarawak, Singapore, Papua and New Guinea and Western Samoa. In addition, there were eight observers from the AID missions to Cambodia, Laos, the Republic of Viet-Nam, Ryukyus and Thailand, the South Pacific Commission and UNICEF. The Chinese Government also sent three observers. WHO provided the costs of attendance of the participants, two short-tennconsultants and supplies and eqUipment.

WERO 2 Traini Personnel - MESA Steps are being taken to re-establish the malaria eradication training centre as a government project supported by AID and WHO. It will provide training in the theory and techniques of malaria eradication for staff from inside and outside the Region. It is anticipated that the first formal course will take place during the second half of 1963. A limited training course was given from 3 to 21 December 1962 at the headquarters of a malaria unit of Region 3, Department of Health, Philippines, to seven partiCipants from the Philippines, three from the Republic of Korea and two from North Borneo. The course was mostly devoted to geographical reconnaissance and tech­ niques of spraying and included discussions in the classroom and practice in the field. General discussions on malariology, epidemiology, entomo­ logy, logistics and health education were also conducted. Faculty participants were: two from AID, two from the Government and two from WHO.

WPRO 75 Regional Tuberculosis Advisory Team ( - 1966) R J.

To assist countries of the Region in assessing their tuberculosis ) Pirotgrammes. During the period under review the team was mainly based n he Federation of Malaya I d' id 1 t 1 the Republic of Viet Na.m t' n J. v ua eam members, however, visited prevalence survey in~Sai~on~Ch~~set~he~~ collected on the tuberculosis . ~ e ppines, to train workers .;.. WPj RC14j2 page 79

and technicians in the regional health laboratories in two regions and the Republic of KOrea, to review available X-ray facilities and make recommendations regarding ways in which the service could be improved.

WPRO (9 AdviSO~ Services l~l- R

To provide advisory services to countries of the Region on subjects ~- for which no regional adviser is available and for which it is not practicable to obtain assistance from headquarters staff. During the period under review advisory services were provided to Hong Kong (hospital records), Malaya (hospital administration), the Republic of Korea (BOG vaccine production), the Republic of Viet-Nam (public health laboratory and tuberculosis) and Singapore (radiothe~apy).

WPRO 81 Seminar on Japanese Encephalitis and Other Arbovirus Infections, Tokyo (5-14 Nov. 1962) R The purposes of the seminar were to exchange information on Japan­ ese encephalitis and other arbovirus infections in the Western Pacific and South-East Asia Regions, to present information on the findings of the rese~ch work being done in a number of countries, to discuss the methods of solving outstanding problems and to consider the control of these infections. There were twenty-one participants from Australia, Cambodia, China (Taiwan), Federation.of Malaya, Hong Kong, India, Japan, North Borneo, Papua and New Guinea, Philippines, Republic of Korea, Republic of Viet-Nam, Ryukyu Islands, Singapore and Thailand. Nineteen observers attended - six from Japan, two from the United states Naval Medical Research Unit No.2, China (Taiwan), two from the 406th Medical General Laboratory, Japan, three from the General Headquarters, Far East Land Forces, Singapore, and one each from the SEATO Medical Research Unit, Bangkok, the Institute for Medical Research, Federation of Malaya, the Medical Service Group and the 6332nd United states Air Force Dispensary, Ryukyu Islands, the First Cavalry Division, Republic of Korea, and the Pasteur Institute, Saigon. WHO provided the costs of attendance of the participants, four consultants, three temporary advisers and supplies and equipment.

WPRO 83 Maternal and Child Health Advisory Services in the South Pacific ( - 1963) TA (South Pacific Commission) To study provisions for maternal and child care in certain territories in the South Pacific area with a view to determining the principal health problems and the extent of preventable mortality and morbidity among mothers and children, and of suggesting public health programmes to improve the situation, adapted to the social and economic possibilities of each territory. The team visited American Samoa, British Solomon Islands Protectorate, Cook Islands, Fiji, Gilbert and , Ellice Islands New Caledonia, New Hebrides, Papua and New Guinea, I 4 Tonga, Western'Samoa and West New Guinea (West Irian). l

WP/RCl4/2. page 80 ~ J

f WPRO 88 First Regional Seminar on the Role of the Hospital in II the Public Health Programme, Manila 1.1 (13-2.0 May 1963) R A .seminar to review the changing role of the hospital during its history and its actual role in countries of the Region; to discuss the potential functions and the desirable utilization of hospital services within programmes of community health protection. The seminar was conducted in plenary sessions. Participants presented short statements on the organization of hospital services in their respective countries and analysed the potential fUnctions of the hospital in public health programmes. The necessity of adapting such functions to new needs ariSing from the change in the social and economic structure of the society and the growth of population was stressed. Emphasis was laid on the need for comprehensive and long-term planning of health services, including hospital services. There we~e eighteen participants from China (Taiwan), Federation of Malaya, Fiji, Hong Kong, Japan, Laos, North Borneo, Philippines, Republic of Korea, Republic of Viet-Nam, Ryukyu Islands and Singapore.

WHO provided the costs of attendance of the participants, three short-term consultants and supplies and equipment.

s of Dental Diseases

A multi-phased programme with the following objectives: to survey dental resources and to give training in dental epidemiology survey methods in 1964; to analyze the data gathered through national surveys in 1965 and to make recommendations on the establishment or strengthening of dental services. A two-month WHO consultant is now visiting countries in the Region.

Australia 2.00 Fellowships R: Health education (twelve months), public health administration (three months), tuberculosis control (eight months).

British Solamon Islands Protectorate 2. Malaria Eradication . Pilot Pr~ect (Sept. 1 1 - 1964) MESA TA (South Pacific Commission)

To find a method of interrupting malaria transmission in the Protectorate and collect the data needed for planning malaria eradication; and to train staff in preparation for an eradication programne.

It is planned to follow the pilot project with a pre-eradication survey in 1964. WP/RC14/2 page 81

British Solomon Islands Protectorate 3 Nursing Education (Nov. 1959 - 1971) R UNICEF (South Pacific Commission)

To carry out a basic programme of general nursing for nurses and medical assistants, and a programme of midwifery and maternal and child health combined with the nursing programme for women nurses.

British Solomon Islands Protectorate 200 Fellowships R

Public health administration (six months).

Brunei 3 Malaria Pre-eradication Programme (May 1962 - 19(4) MESA

~.- To build up the operational facilities for a full eradication programme, which is planned to start in 1964.

Cambodia 1 Malaria Pre-eradication Programme (1962 - 19(4) MESA TA (AID)

To build up administrative and operational facilities to the 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 programme, which is planned to start in 1964.

The pre-eradication programme continues the anti-malaria operations with which WHO has been assisting (under the same project number) since October 1950.

Cambodia 3 Nursing Education, Phnom-Penh (Dec. 1951 - 1965) R UNICEF (Colombo Plan AID)

To set up a school of nursing in Phnom-Penh; to organize nursing and midwifery training.

Cambodia 4 Maternal and Child Health ( Second phase: May 1962 - 1966) TA UNICEF

To develop a national maternal and child health programme and to improve school health services.

Cambodia 5 and Para-medical Sciences, Phnom-Penh AID French Economic Mission) To raise the standard of teaching at the Faculty of Medicine, Pharmacy and Para-medical Sciences to professional level and to increase facilities for training hospital assistants. WP/RC14/2 page 82

Cambodia 8 Treponematoses Control (Sept. 1959 - 1963) R UNICEF To train professional and auxiliary medical personnel in yaws control methods; to reduce the incidence of yaws by mass treatment with penicillin and eventually to eliminate the disease; to organize in the project area a rural health service which will also continue the yaws control work; and to carry out a smallpox eradication campaign in the area as part of the acti vities of the yaws team.

Asia Foundation) To plan and implement a comprehensive provincial health programme; to build up model public health services in Kanda! Province; and to give field training to all categories of medical and health personnel at the Takhmau centre.

Institute of Biolo )

To establish a central health laboratory at the Institute of Biology; to plan the expansion of health laboratory services in accordance with the Govermnent I s five-year development plan; to prepare for the Institute a manual of.operations that will include standard laboratory procedures and techniques; and to plan and operate training courses for different categories of laboratory personnel and for medical and nursing stUdents. cambodia 15 Hospital Administration and Architecture (June - Aug. 19(2) TA A WHO consultant advised the Government on the preparation of a programme and an administrative plan for the Preah Ket Mealea Hospital, Phnom-Penh. The capacity of this hospital is to be increased to 1200 beds, -which will make it the largest hospital and university training centre in cambodia. Plans for a preventive medicine dispensary, for an institute of forensic medicine and for a dental school have been prepared. Assistance was also given in planning projects in hospital administration and architecture as part of the national health plan. Further assistance in this field is under consideration.

China 1 Venereal Disease Control, Taiwan R UNICEF One six-month fellowship was awarded under this project, for which staff and other assistance were provided between 1953 and 1962. WP/RC14/2 page 83

China 6 Nursing Education, Taiwan (May 1952 - 1966) TA ( China Medical Board) To improve the standard of nursing education and the quality of nursing services by establishing a school of nursing at the University Hospital in Taipei.

China 7 Malaria Eradication, Taiwan (May 1952 - 1964) MESA) (AID)

To complete the eradication of malaria from Taiwan by the use of residual insecticides and anti-malarial drugs and by an effective surveillance system.

China 17 Tuberculosis Control, Taiwan R UNICEF

A twelve-month and a six-month fellowship were awarded under this project, for which staff and other assistance were provided between 1956 and 1960.

China 20 Mental Health, Taiwan (Oct. 1955 - 1966) R To carry out a mental health programme with particular attention to child guidance and community mental hospitals.

China 27 Institute of Public Health, Taiwan (Aug. 1958 - 1964) R (China Medical Board AID) To strengthen the training at the Institute of Public Health, particularly that in epidemiology and public health practice. Assistance consists of short-term consultants and fellowships.

China 34 Redefined Trachoma Control, Taiwan (1960 - 1967) R UNICEF To reduce the prevalence of trachoma in areas of low endemicity to less than 4% in the age-group showing the highest prevalence (at present the 15-20 year age~group with 23.4%); to reduce the prevalence and incidence in areas of moderate and high endemicity to a level at which the disease will no l-onger be a public health problem, and to prevent disabling complications and sequelae.

r WP/RC14/2 page 84

China 36 Communi t~Water Supp:J.y and Sewerage (Jan. 1963 .'1 6)· TA

To follow up on the broad recommendations made by a team of WHO water supply consultants in the autumn of 1961 in connection with the improvement of the community water supply and sewerage; to review and amend as necessary national and prOvincial laws and other legislation pertaining to community water supplies; to develop techniques for financing and administering water supply and sewerage programmes, which would enable those programmes to be self-supporting; to stimulate regional planning of water supply schemes; to initiate training pro­ grammesj and to co-ordinate activities relating to community water supply with other sectors of the nation's econany (such as industry, agriculture, etc.), which are also directly concerned with the use and allocation of water resources.

China 200 Fellowships R: Public health administration (one for twelve months, one for six months), public health nursing (two for twelve months), laboratory (twelve months).

China 201 Fellowships TA: Environmental health (two for six months), laboratory (twelve months).

Cook Islands 200 Fellowships R: Mental health (four months).

Fiji 2 Fiji School of Medicine, Suva (Feb. 1955 - 1965) R (China Medical Board) To train assistant medical officers for government service in Fiji and adjacent territories, and to strengthen the staff of the School of Medicine. .;.. I

Fiji 200 Fellowships R: Laboratory (twelve months).

Guam 1 Sewerage Planning ( July - Oct. 1962) Reimbursed by Government A consultant was provided for two months to prepare an engineering feasibili ty report for sewerage in the Agana urban area of Guam. He also surveyed the topography of the area, assisted government engineers in designing the sewers, and advised on their construction. The con­ sultant's conclusions and recommendations included the following. The four principal areas requiring sewerage should be considered as one problem and a single sewerage system should be constructed to serve them. all; more topographical surveys would have to be made before a detailed sewer design was possible; current studies must be carried out in and near Agana Bay before a decision can be made as to the necessary amount of sewage treatment and length of outfall sewer WP/RC14/2 page 85

required; a section ~or water supply and sewerage should be created in the of~ice o~ the Director of Public Works. This section should be in charge o~ a competent and experienced sanitary engineer specialis~ an area sewerage district should be created ~or the Agana urban area, and additional districts should be created ~or certain other communities. an industrial waste survey should be made of all commercial and in- } dustrial establishments; bacteriological studies o~ shore waters for the recreational areas of Agana and Tamuning bay should be completed.

In addition, the consultant also prepared a sewer layout on a large­ scale map for the communities of Sinajana and Tamuning, for which topo­ graphical surveys were available.

HOng Kong 200 Fellowships R: Dental Health (two first-year and two second-year awards), hospital and clinic buildings (four months).

Hospital Administration 195 - Nov. 1959; Oct. 1962 - Jan. 1963) ~ R

A three-month ~ellowship in hospital administration was awarded to this project, for which staf~ and other assistance were provided between 1956 and 1962.

WHO provided a consultant from October 1962 to January 1963 to assist in planning the extension of the national programme for the rehabilitation of the physically handicapped, in improving and expanding the occupational therapy services for the more severely disabled adults and in training sta~f in occupational therapy. The consultant visited adult centres for the physically handicapped, centres for physically .k disabled children and psychiatric and tuberculosis institutions in different parts of the country. Her report contained recommendations on the establishment of an occupational therapy school, the need for co-ordinated development of occupational therapy in the areas o~ physical disabilities and psychiatry, in tuberculosis sanatoria, in general hospitals and in the growing realm of geriatrics. The importance of increasing the number of trained specialists was stressed. In May 1963, WHO provided a second consultant to assist the Government in working out a rehabilitation programme based on physical therapy most suited to the country and to organize a training programme for the phySiotherapists from all the prefectural rehabilitation centres.

Japan 200 Fellowships R: Dental health (six months), drug control (three months), environmental health (five months), hospital adminis­ tration (three months), mental health (three months), nursing (three months) • 411&.....,·1

WPjRC14/2 page 86

Japan 201 Fellowships TA: Mental health (twelve months), nutrition (twelve months), rehabilitation (six months), public health administra­ tion (six months).

KOrea 4 Le~OSy Control (Nov. 1 1 - 1966) TA To improve the leprosy control programme by co-ordinating the present control work, providing health education, and training medical and other personnel concerned with leprosy control.

KOrea 13 Malaria Pre-eradication Programme ( - 1964) MESA To survey the malaria situation, organize a national malaria service and train staff, so as to enable an eradication programme to be planned and implemented.

KOrea 15 National Institute for Public Health Training (Dec. 1960 - 1967) R UNICEF To set up two demonstration centres, one for urban health services and the other for rural health services; to implement pilot projects for disease control and health promotion, in which trainees of the National Institute for Public Health Training may gain practical experience; to organize short-term pre-service, in-service and re­ fresher training for government health.workers.

Korea 16 Public Health Administration Advisory Services (March 1963 - 1968) R To conduct surveysaf the health conditions in the country which will serve as a basis for assessing current progress and undertaking further planning; to strengthen the organization and administration of health services at all levels; and to develop and evaluate the national health programme which will be planned consistently with available resources, taking into account the country's overall economic and social programme. .. <

KOrea 18 Public Health Survey (May - July 1962) R (AID ) See Part III for a summary of this project.

KOrea ~ Tuberculosis Control ( rch 1962 - 1966) TA UNICEF , To develop an effective and comprehensive t~berculosis control programme, so as to reduce, and finally to eliminate, the infection as a public health problem. WP/RCI4/2 page 87

Korea 25 Assistance to Local Health Services (March 1963 - 1968) R UNICEF To strengthen the organization of the health services at different levels in a demonstration province at Chungchong Namdo with the ultimate objective of strengthening the country's local health services.

Korea 200 Fellowships R: Control of parasitic diseases (twelve months), drug control (three months), laboratory (three months), public health administration (twelve months), public health nursing (twelve months), quarantine procedures (four months), tuberculosis control (six months).

Korea 201 Fellowships TA: Control of parasitic diseases (twelve months).

Laos 2 Central Public Health Laborato;y (Jan. 1953 - Aug. 1959; Nov. 1960 - 1966) TA To establish a public health laboratory service and train laboratory personnel.

Laos 6 Maternal and Child Health ( Sept. 1959 - 1965) R UNICEF To ascertain the principal maternal and child health needs in Laos and set up training programmes; to improve maternal and child health services as an integral part of the general health programme.

Laos

To survey health conditions and prepare long-range national health plans; to develop a programme of work appropriate.to local conditions, and to organize the operation of the national health administration at the central and peripheral levels.

Laos 10 Rural Develo~ent in Public Health ( - 197 TA UNICEF (UN FAO ILO UNESCO Colombo Plan)

To provide practical training courses in nursing and midwifery and in-service training; to promote and develop environmental health; and to.carry out health education, particularly as regards home sanitation, maternal, infant and child care and nutrition. Work carried out under this project is a part of the programme, assisted by the United Nations, for the economic and social develop­ ment of the rural population. It is planned to set up four centres in rural areas, with staff from the participating agencies. -

WP/RC~4/2 page 88

Laos 1.2 Nursing Educa.tion (March 1962 - 1970) TA UNICEF To set up a school of nursing and midwifery for training personnel for the country's hospital and health services, which are to be extended and improved.

Malaya 3 Yaws Control R UNICEF

A one-month fellow'ship in treponematoses control was awarded in 1962 under.this project, for which consultant services were provided in 1953-54 and 1960.

Ma~ 14 Hospital Administration May 1956 - 1968) TA To review the hospital administration system and to provide training for non-medical hospital administrators in the Federation or overseas.

Ma~ 15 Hospital Records Nov. 1956 - 1966) TA To review and reorganize the hospital records systems in the Federation and to train local personnel.

Mala¥( 20 Malaria Eradication Pilot Project Feb. 1960 -' ) R MESA. To find a method of interrupting the transmission of malariaj to collect the data needed in order to plan for malaria eradication and to train personnel.

Clinical Patholo

To raise the standard of training at the Institute for Medical Research and to reorganize its course in clinical pathology.

Public Health Administration 1 0 - Dec •.1963) R To extend and improve health services, particularly in the rural areas. WP/RC14/2 page 89

Malay( 29 Lepros~Control May - Nov. 1 3 ) R A WHO consultant to carry out a survey of the existing leprosy problem and the present leprosy service in the Federation of l~laya; to advise on the major problems encountered during the survey, including those connected with the rehabilitation of cured patients and the local problems in respect of the present leprosy institutions, and on the national expansion of the present leprosy service; to prepare a report which will include recommendations for strengthening the leprosy control programme.

MalaY( 30 Health Education Advisory Services Jan. 1962 - 1965) R To survey the health education work at the federal and state levels, in order to evaluate the effectiveness of present methods of health education and recommend improvements.

Malaya 32 NurSing Education (Aug. 1962 - 1966) TA To assess the educational programmes for nurses and nursing needs and resources; to develop the programmes and the associated clinical practice fields so as to meet the countryts requirements in nursing personnel; and to improve the quality of nursing and nursing education by in-service training, refresher courses, special courses for local registered nurses and courses to prepare nursing personnel for adminis­ trative and teaching posts.

New Hebrides 200 Fellowships R: Health education (twelve months).

New Zealand 200 Fellowships R: Health statistics (four months), hospital administration (four months), nursing (four months).

North Borneo~ Malaria Eradication ( 1 - 1968) MESA TA UNICEF To eradicate malaria from the whole country. This is a conversion of the malaria pilot project started (under the same project number) in 1955.

North Borneo 200 Fellowships R: Environmental health (four months), nursIng (three months), public health administration (four months). WP/RC14/2 page 90 '.'

Phili Control Pilot TA UNICEF To work out measures for controlling bilharziasis, and to test them by application in a community; to train personnel to give technical guidance and to carry out the control measures; to plan a national bilharziasis control programme for the endemic areas. See also Part III.

Phili ines 12 Institute of of the Philip ines, Manila July 1953 - 1 University '-. Rockefeller Foundation)

To strengthen the faculty of the Institute of Hygiene by providing it with additional teaching experience through exchanging members of the teaching staffs between the Institute and the Johns Hopkins University School of Hygiene and Public Health.

Phili ines 43 Environmental Sanitation Adviso Services June 1955 - March 1 1; Sept. 1 2- R To reorganize the central and regional environmental sanitation services.

Phili Courses

To organize an advanced training programme for sanitary inspectors and to demonstrate environmental sanitation work in a selected area.

PhilifPines 53 Malaria Eradication Aug. 1956 - 1969) MESA (AID) To revise and implement the plan for malaria eradication.

Phili Pines 5§6e Paediatric Nursing 1March 1 - 1966) TA UNICEF To extend and improve the health services, particularly as regards the promotion of health and prevention of disease and the prOvision ot adequate nursing care for children; to establish closer co-ordination and integration of the promotional, preventive and curative services at all levels.

PhilitPines 60 Nutrition Survef and Education 1960 - 1963) TA UNICEF FAO ) To determine, by region, the dietary habits and nutritional status of the people of the Philippines with particular attention WP/RC14/2 page 91 to maternal and child nutrition; to establish causes, whether specific or contributory, of nutritional diseases and conditions observed in the population, particularly those affecting mothers and children; and to gather data and establish baselines for the planning, execution, and evaluation of nutritional programmes, including measuresto improve maternal and child nutrition. WHO has provided two twelve-month fellow­ ships, one in nutrition biochemistry and the other in nutrition education.

Philippines 62 Health Statistics (July 1961 - 1964) R To review and reorganize the health statistical services of the Department of Health and at provincial and local levels, and to train personnel; to develop and improve vital statistics.

PhilifPines 63 Hospital Records Dec. 1962 - 1965) R To review and reorganize the hospital records systems and to train local personnel.

Phili

A national seminar for forty-eight directors of government and private hospitals, to inform them .of recent trends and techniques in hospital administration and enable them to exchange opinions and analyse cammon problems. The discussions were led by three WHO conSUltants and by local lecturers. The programme included plenary and working group meetings and field visits. Three special committees were appointed to present appraisals of the architectural floor plans of three types and sizes of hospital under consideration by the Department of Health. The recommendations of the seminar on the main policies that should govern hospital administration in the Philippines have received wide publicity in the country.

Phil! tional Thera

To organize, at the University of the Philippines, collegiate courses for training of phySiotherapists and occuPational ther.ap1sts, and to develop professional standards to ensure a high qua.lity of service; to provide in·service training for .sub-professional workers.

Philireines 76 Laboratory Management and Administration Feb. 1962 - 1964) TA To strengthen laboratory organization and administration. Two six-month and two four-month fellowships were awarded under this project for which consultant services were provided in 1962. WP/RC14/2 page 92

Philippines 200 Fellowships R: Is.boratory (twelve months), nurSing ( twelve months), public health administration (three months).

Malaria Eradication Programme May 1962 - ) MESA To organize the eradication programme, improve field operations and laboratory techniques and co-ordinate the activities of the programme with those of the rural health services; and to train staff in malaria i- eradication techniques.

A WHO consultant carried out a short-term consultantship in the Ryukyu Islands, where the malaria eradication programme is in an advanced stage. The work is carried out by national personnel, with technical and financial assistance fram the United States Civil Administration of the Ryukyu Islands (USCAR). Very few cases of malaria were reported in 1961 and early 1962. The consultant reviewed with the national staff the present epidemiological situation, assisted in the training and made suggestions regarding the intensification of case detection measures, improving of reporting and preparation for certification of the eradi­ cation of malaria.

Sarawak 5 Malaria Eradication

( Or'~ J. 1961 - 1968) MESA TA To eradicate malaria from the whole country. This is a conversion of the malaria pilot proj ect started (under the same proj ect number) in 1952.

Singa 0re 4 Institute of Health . 1Jan. 1956 - 1966) R UNICEF To provide maternal and child health services, school dental services and health education for the population (about 125 000) living near the Institute; and to train at the Institute undergraduate medical and post-graduate public health students of the University of Singapore (including students fram other countries of the Region), and health visitors, health inspectors and other auxiliary personnel.

Singa 0re 8 Nursi~ Education 1June 1962 - 1 6) TA To improve the standards of nursing education and nursing service in Singapore by developing (a) the clinical teaching units and the educational programme in the Singapore General Hospital; (b) clinical fields and educational progrwmnes in psychiatric nursing and mental health; (c) in-service education, refresher courses and speCial courses for local registered nurses; and (d) the training of local nurses for administrative and teaching posts. WP/RCl4/2 page 93

Singapore l4 Island-Wide Domiciliary Midwifery Service (Jan. 1959 - 1965) R To extend the supervision of midwifery practice to the whole island; to give refresher courses for qualified midwives; to integrate institutional midwifery at Kandang Kerbau Maternity Hospital with the domiciliary services in urban and rural areas; to give midwifery trainees more domiciliary experience, particularly in rural areas.

Singafore 15 School of Radiography A.pril 1962 - 1965) R To set up a school of radiography in order to be able to meet the demands for well-trained and qualified radiographers. '-,r

Singapore 17 Leprosy Control (Feb. 1963 - Oct. 19(3) R The organization provided a three-month consultant (leprologist) to assist with planning and executing an epidemiological leprosy survey; to review the legislation dealing with leprosYj to advise on the planning and organization of a pilot project to demonstrate the techniques of field work for case-finding, treatment and follow-up; and to advise on the problem of rehabilitation and the training of.personnel in leprosy control. During the period of his assignment, the short-term consultant reviewed the leprosy situation, trained a number of.health personnel in leprosy control, submitted proposed amendments to the leprosy ordinance, organized with the national personnel, a pilot demonstration leprosy field project, and submitted a report which included recommenda­ tions covering all aspects of leprosy control in Singapore. The Medical Superintendent of the Trafalgar Home has now proceeded on the leprosy fellowship provided by WHO.

Singatore 22 Assistance in Radiotherapy Dec. 1962 - Feb. 19(3) R A consultant was provided for two months to advise on the estab­ lishment of a radiotherapy department and on the develqpment of radio­ therapy services. The concise and factual report submitted contains an evaluation of existing services and recommendations on their further develqpment. A detailed account was given of the various requirements of an X-ray department for kilo voltage and mega-voltage therapy and of a radioactive clinical laboratory, including the equipment and staff required. Detailed estimates and costing schemes were submitted permit­ ting immediate action on the part of the Government. Some emphasis was laid on planning for a potential expansion of the proposed services in view of the formation of Malaysia with its increasing demands on the health services of the country. WP/RC14/2 page 94

Singapore 200 Fellowships R: Nursing (four months).

Singapore 201 Fellowships TA: Nutrition (weIve months).

Tonga 1 Environmental Sanitation (March 1958 - 1966) TA UNICEF To strengthen environmental sanitation services; particularly to study the problems of rural and urban environmental sanitation and the social, econanic and cultural factors affecting them; to plan, execute and evaluate a pilot environmental sanitation project and to train personnel.

Trust Territo of the Pacific Islands 200 Fellowshi s R: Public health administration twelve months •

Viet-Nam 3 Maternal and Child Health .(Dec. 1954 - 1966) TA UNICEF (AID) To set up a maternal and child health service as part of the general public health and medical care services by improving and extending exist­ ing facil1 ties; to train personnel for the service; and to train staff from neighbouring countries with maternal and child health problems similar to those of Viet-Name

(AID French Econanic Aid)

To set up the nucleus of a national tuberculosis control servicel with emphasis on preventive and public health work; to canplete a tuber­ culosis dispensary in Saigon and to integrate it in the existing facili .. ties; to continue the UNICEF/WHO-assisted BOO vaccination project and integrate it in the national·tuberculosis control service.

Viet-Nam 11 Vital and Health statistics (Dec. 1960 - end of 1964) R To develop and improve health and vital statistics.

Viet-Nam 14 Preventive Medicine ··(Jan. 1966 - 1965) R UN!CEF

To set up a cammunicable~disease control service, study the local pattern of communicable diseases, organize a system of notification and Touting of reports, and draw up a long-tenn plan for the control of the major communicable diseases. WP/RCl4/2 , ,.- page 95

Viet-Nam 15 Hospital Administration .(Aug. 1960 - Jan. 1961; June - Aug. 1962) R The WHO consultant who carried out a hospital administration survey in the Republic of Viet-Nam in 1960 made a further review of the situa­ tion in 1962. His terms of reference during the second visit were to advise on the fUrther development of the Five-Year Plan for the expansion and upgrading of the hospital system, with particular reference to the implementation of the recommendations made in 1960, and to advise on hospital planning and construction.

In close co-operation with the various government authorities concerned, the consultant evaluated the progress made since his last visit. The standardization of hospital buildings, for which pertinent r plans were prepared, was one of the main topics discussed. Detailed studies and suggestions were made covering the establishment of hospital records and the actual position of the hospital within the health services of the country was critically evaluated. In addition, the consultant produced detailed plans with explanatory comments covering services for the acutely sick, the establishment of regular clinical departments, maternity wards, blood bank and other specialized hospital services. A programme for a 500-bed surgical hospital was drawn up and recommenda­ tions made covering the establishment or extension of various provincial hospitals. The findings, as well as various plans and sketches, were personally discussed with the government officials concerned, hospital superintendents and architects. Subsequent discussions have revealed that the work of the consultant has met with the desired response and it can be assumed that this project will have an influence on the fUrther development of hospitals and hos­ pital services in the country. The Government has requested further assistance in this field in 1963 when a hospital administrator will start a three-year assignment.

Viet-Nam 16 Malaria Pre-eradication Programme ( - ).MESA (AID) To train national staff and to make preparations for the implementa­ tion of a malaria eradication programme.

Distribution of Pharmaceuticals 1 - end of 1 R To improve the distribution of medical supplies and pharmaceuticals to hospitals, health centres and similar establishments, and the arrange­ ments for the maintenance of medical eqUipment; to organize a central purchase system for medical supplies and prepare standard lists of medical supplies, equipment and pharmaceuticals. WP/RC14/2 page 96

Viet-Nam 19 Mental Health (Jan. - Aug. 1962) R f 1 WHO provided two consultants - one in psychiatry from January to June and one in mental nursing from June to August - to assist in improving mental health services. The consultant in psychiatry studied the conditions in the two mental hospitals in the country and the handling of mental patients in rural areas, visited the medical faculties at Saigon and HUe, and investigated the possibilities of support from certain profes­ sional and non-professional groups for a future mental health programme. His report contained recommendations on the establishment of a national mental health service and on the training of psychiatrists and medical students in the psychiatric aspects of general medical practice. The mental nursing consultant gave clinical demonstrations of nursing care and started a course of in-service training. She helped to enlist the co-operation of governmental and international agencies in organizing ag~icultural and handicraft projects for the rehabilitation j of psychiatric patients in the mental hospitals, and to set up in those hospitals a tuberculosis service with a mobile X-ray unit. Further assistance to this project is planned for 1964. J Viet-Nam 200 Fellowships R: Quarantine procedures (two months). 1 Prc~eradication Pro e I To build up the operational facilities for a full eradication programme.

Sanitation

" , I To carry out a pilot project of rural environmental sanitation, I including a study of relevant technological, social, economic and cul­ ~ tural factors (particularly those affecting village water supply and human excreta disposal), and to train government employees through village demonstration work. , Western Samoa 3 Tuberculosis Control ( - 1963) R UNICEF 1 To expand and improve the chest clinic in Apia Hospital and to make it the headquarters of the national tuberculosis control programme and the main service unit for Western Samoa; to carry out a case-finding programme (by a mobile team based on the national headquarters) and a programme of prevention. '-

Western Samoa 200 Fellowships R: Dental health (two ~irst-year awards), environmental health (two first-year awards), laboratory (first­ year award), medicine (one ~or tweleve months, four ~irst-year awards), nursing (two first-year awards), ophthalmology (twelve months). ANNEXES WP/RC14/2 page 101

ANNEX 1

LIST OF REGIONAL OFFICE POSTS

Organizational Unit Post Nationality

OFFICE OF THE I - Regional Director China REGIONAL DIRECTOR I - Liaison and Reports Officer U.K. L ~ Administrative Assistant Philippines L - Records Clerk Philippines Public Information I - PUblic Information Officer U.K. L - PUblic Information Assistant Philippines L - Secretary Philippines BUREAU OF HEALTH I - Director of Health Services Philippines SERVICES I - Assistant Directors of Health (1) China Services (2) (1) Germany L - Secretaries (3) Philippines L - Clerk/Stenographer Philippines L - Clerk/Typists (3) Philippines Advisory Services I - Regional Adviser on PUblic Health Administration Philippines I - Regional Statistician and Programme Evaluator China I - Regional Adviser on Maternal and Child Health Netherlands I - Regional Adviser on Nursing I ~ Regional Adviser on Nursing VACANT-A* I - Regional Adviser on Communicable Diseases U.K. I - Regional Adviser on Communicable Diseases VACANT-A I - Regional Adviser on Environmental Health U.S.A. I - Regional Sanitary Engineer Bolivia I - Regional Adviser on Nutrition U.K. I ~ Regional Adviser on Tuberculosis China I - Regional Adviser on Health Education U.S.A. I - Senior Regional Adviser on Malaria Italy I - Regional Adviser on Malaria China I - Regional Entomologist China I - Regional Sanitary Engineer Philippines I - Administrative Officer U.K. ;------' I - Internationally recruited L - Locally recruited * - Candidate selected WP/RCl4/2 Annex 1 page 102

Organizational Unit Post Nationalitl

Fellowships I .. Regional Adviser on Education Training Philippines L .. Technical Assistant Philippines L .. Secretary Philippines L ~ Clerk/Stenographer Philippines

Secretarial Pool for L .. Secretary Philippines Advisory Services L .. Clerk/Statistician Philippines L ... Clerk/ Stenographers (11) (lO) Philippines {I} China

OFFICE OF ADMrNISTRA­ I .. Chief, Administration and Finance Japan TION AND FINANCE I - Administration and Finance Officer Ceylon I .. Administrative Officer I .. Translator I ... Translator Belgium I .. Administrative Assistants (2) L ... Secretary Philippines L .. Clerk/Stenographer Philippines

Budget, Finance and I .. Budget and Finance Officer U. S.A. Accounts I - Finance Officer U.K. L .. Assistant Accountant Philippines L .. Budget Analyst Philippines L .. Cashier China L ... Accounts Clerks (5) Philippines L .. Budget Clerks (3) Philippines L ... Clerk/Stenographer Philippines

Personnel I .. Personnel Officer France L ~ Personnel Assistant U.S.A. L .. Clerk/ stenographer Philippines L .. Clerk/Typist Philippines Administrative Services I ... Administrative Services Officer Netberlands L ~ General Services Assistant Philippines L .. Registry Assistant Philippine s L " Registry Clerk Philippines L .. Travel Clerk Philippines L .. Supply Clerk Pbilippines L .. Librarian Philippines L ~ Assistant Library Clerk/Typist Philippines L .. Mail Clerk Philippines

I - Internationally recruited L • Locally recruited WP/RC14/2 '" Annex I page I03/l~

Organizational Unit Post Nationality

Administrative Services (continued) L - Mail and Registry Clerk Philippines L - Junior Registry Clerk Philippines L - Clerk Typist Philippines L - Building Maintenance Custodian Philippines L - Mimeographers (2) Philippines L - Telephone Operator Philippines L - Driver/Messengers (2) Philippines L - Driver/Customs Clerk Philippines L - Driver Philippines L - Messengers (2) Philippines L - Messenger/Janitors (2) Philippines L .. Carpenter Philippines

WHO REPRESENTATIVES Phnom-Penh (Cambodia) I - Medical Officer Netherlands L - Secretary France Saigon (Laos, Viet Nam) I - Medical Officer U.K. L - Administrative Assistant Viet Nam L - Secretary Viet Nam

Sin~ore (Brunei, I - Medical Officer China Feder~t1on of Malaya, L - Administrative Assistant U.K. North Borneo" Sarawak" L - Administrative Clerk India Singapore) L - Senior Messenger U.K. L - Messenger U.K.

~ (South Pacific I - Medical Officer U.K. Area) L - Administrative Assistant Australia L - Clerk/Stenographer Australia Taipei (China (Taiwan), I - Medical Officer Australia Japan, Hong Kong, L - Clerk/Stenographer China Korea, Portuguese L - Driver/Messenger China Territory, United States Territories) OFFICE OF CauNTRY LIAISON OFFICERS Seoul (Korea) I - Medical Officer U.K. Vientiane (Laos) I - Medical Officer L - Secretary Viet Nam

, I - Internationally recruited L - Locally recruited WP/RC14/2 page 105

ANNEX 2

PROJECT AND REGIONAL OFFICE INTERNATIONAL STAFF EMPWYED AS OF 30 JUNE 1963

Countr;t Regional WHO Repre- Field Total Office sentatives

Argentina ...... - - 1 1

Australia e· •••••••• " • - 1 .. 1 Belgium ·... " ...... 2 - 2 4 Bolivia ·...... " .... 1 - 1 2 Canada ·" ...... " ...... 1 - 8 9 Ceylon ·...... 1 - 1 2 China ·...... 6 1 10 17 Denmark ·...... " - - 1 1 ." .... " .. " . " ... - - 1 1 France " ...... 3 - 5 8 Germany ·...... 1 - 2 3 Haiti ...... " .. -- 1 1 1 1 .' .. ~ .... " .... -- Israel ·...... - - 2 2 Italy ·. " ...... 1 - 5 6 Japan ·...... 1 - 3 4 Korea ·...... - - 1 1 Lebanon ·...... - - 1 1 Mexico ·...... - - 2 2 Netherlands ...... 2 1 4 7 New Zealand ." ...... - - 4 4 WP/RC14/2 Annex 2 page 106

Count!:l Regional WHO Repre- Field Total Office sentatives

Philippines •••••••• 4 - 6 10 Rhodesia ••••••••••• - - 1 1 South Africa ...... - - 1 1 SWitzerland ...... 1 - - 1 Sweden ...... - - 2 2

Thailand •••••••••• - - 4 4 .' ..... 6 2 16 24 United states of America ••••••••• 3 - 7 10

'I'OTAI.E3 •••••••• 33 5 93 131 WP/RC14/2 page 107 ~""'<"

ANNEX 3

CONSULTANTS EMPWYED DURING THE YEAR 1 JULy 1962 - 30 JUNE 1963

ProJect Title Number Nationalitl

BSIP 2 Malaria Eradication Pilot Project 1 China -A_ Cambodia 5 Royal Faculty of Medicine Biochemistry 1 Belgium Physiology 1 France r,-_ Cambodia 15 Hospital Administration and Architecture 1 France China 21 Institute of Public Health Post-graduate Public Health 1 New Zealand

Guam 1 Sewerage Planning 1 Switzerland

Japan 23 Rehabilitation of the Physically Handicapped 2 U.S.A.

Korea 19 Tuberculosis Control Bacteriology 1 U.K. statistics 1 Denmark

Malaya 29 Leprosy Control 1 Philippines

Philippines 9 Bilharziasis Control 1 Brazil Philippines 1.2 University of the Philippines Public Health Administration 1 U.S.A. Irl- Philippines 43 Environmental Health 1 Israel

Philippines 10 National Seminar on Hospital Administration 3 U.S.A.

Ryukyu Islands 1 Malaria Eradication Programme 1 China ::"- Singapore 11 ~prosy Control 1 Philippines

Viet-Nam 15 Hospital Administration 1 France

Viet-Nam 19 Mental Health (Nursing) 1 Netherlands.

WPRO 40 Food Sanitation Seminar 2 U.S.A.

WPRO 10 Seminar on Rural Health Services 1 U.K.

WPRO 19 (Korea) Public Health Survey 1 China

t 1- - WP/RC14/2 Annex 3 page 100

ProJect -Title Number Nationalitl

WPRO 79 (Korea) BOG Advisory Services 1 Philippines WPRO 79 (Malaya) Hospital Administration 1 France WPRO 79 (Singapore 22) Assistance in Radiotherapy 1 U.K. .A,

WPRO 79 (Viet-Nam) Tuberculosis Control Advisory Services 1 Switzerland WPRO 81 First Regional Seminar on Japanese Encephalitis and other Arbovirus 7' Infections 4 (1) Japan (1) New Zealand (1) USSR (1) U.S.A. WPRO 88 First Regional Seminar on the Role of the Hospitu+ in the Public Health Programme Public Health Administration 1 Canada Hospital Administration 1 Israel Public Health Nursing 1 U.S.A. WPRO 115 Epidemiological Surveys of Dental Diseases 1 New Zealand WP/RC14/2 page 109

ANNEX 4

LIST OF SUPPLEMENTARY AGREEMENTS SIGNED WITH MEMBER COUNTRIES DURING THE PERIOD 1 JULY 1962 TO 30 JUNE 1963

CountI'l Project Title WHO Number ~-

British Solomon Malaria Eradication Pilot Project BSIP 2* Islands (exchange of letter) Protectorate Malaria Eradication Pilot Project BSIP 2* 'V- (exchange of letter)

Malaria Eradication Pilot Project BSIP 2* (exchange of letter)

Malaria Eradication Pilot Project BSIP 2* (first addendum)

Nursing Education BSIP 3* (exchange of letter)

Brunei Malaria Pre-eradication Programme Brunei 3 (plan of operation)

Cambodia Malaria Pre-eradication Programme Cambodia 1 (exchange of letter)

Malaria Pre-eradication Programme Cambodia 1 (plan of operation) ~"- Treponematoses Control Cambodia 8* (first addendum)

Hospital Administration and Cambodia 15 Architecture ~ (exchange of letter)

China Maternal and Child Health China 3* (ninth addendum)

Maternal and Child Health China 3* (exchange of letter)

Malaria Eradication Programme China 7 (exchange of letter)

~ *Joint with UNICEF wp/RC~4/2 .Annex 4 page 110

Country Project Title WHO Number

China Environmental Sanitation China 14 (continued) (exchange of letter)

Tuberculosis Control China 17* (plan of operation)

Re-defined Trachoma Control Project China 34* (exchange of letter)

Re-defined Trachoma Control Project China 34* ~I (plan of operation)

Community Water Supply and Sewerage China 36 "' (plan of operation)

Water Supply and Sewage Disposal China 38** for Health Stations (plan of operation)

Water Supply and Sewage Disposal China 38** for Health Stations (first addendum)

School Health Education China 41** (plan of operation)

Guam Sewerage Planning Guam 1 (exchange of letter) , Japan Rehabilitation of the Physically Japan 23 ~ Handicapped: First Phase •• • (exchange of letter)

Rehabilitation of the Physically Japan 23 Handicapped: Second Phase (exchange of letter) -. Korea Malaria Pre-eradication Programme Korea 13 (plan of operation)

Public Health Administration Korea 16 Advisory Services )1 (plan of operation) ~ I *Joint with UNICEF **UNICEF supply programme I ..J WP/RC14/2 Annex 4 page III

Country Project Title WHO Number

Korea Tuberculosis Control Korea 19* (continued) (first addendum)

Production of DPT Vaccine Korea 23** (plan of operation)

Assistance to Local Health Services Korea 25* (plan of operation) Laos Central Public Health Laboratory Laos 2 (re-defined plan of operation)

Maternal and Child Health Laos 6* (first addendum) Malaya Treponematoses Control Malaya 3** (first addendum)

Rural Health Training Centre Malaya 9** (firth addendum)

Rural Health Training Centre Malaya 9** (sixth addendum)

Hospital Administration Malaya 14 (exchange of letter) Malaria Eradication Pilot Project Malaya 20 (second addendum) Malaria Eradication Pilot Project Malaya 20 (third addendum) Assistance to Training Institutions Malaya 21 (Clinical Pathology) (exchange of letter) Public Health Administration Malaya 24 (exchange of letter) Leprosy Control Malaya 29 (exchange of letter) Nursing Education Malaya 32 (plan of operation)

*Joint with UNICEF **UNICEF supply programme WP/RCl4/2 Annex 4 page 112

Country Project Title WHO Number

North Borneo Malaria Eradication Programme North Borneo 5* (second addendum)

>.-~ Malaria Eradication Programme North Borneo 5* (exchange of letter)

Malaria Eradication Programme North Borneo 5* (third addendum) Malaria Eradication Programme North Borneo 5* v1 (fourth addendum)

Philippines Mental Health Philippines 4 (exchange of letter)

Bilharziasis Control Pilot Project Philippines 9* (exchange of letter)

University of the Philippines Philippines 12 (exchange of letter)

BCG Vaccination Philippines 17** (seventh addendum)

MCH Services and Training Programme Philippines 40** (eighth addendum)

Environmental Sanitation Advisory Philippines 43 Services ~. , (exchange of letter)

Environmental Sanitation Training Philippines 51* (exchange of letter)

,...;., Environmental Sanitation Training Philippines 51* (first addendum)

Malaria Eradication Programme Philippines 53* (exchange of letter) Vital and Health Statistics Philippines 62 (exchange of letter) Tuberculosis Control Philippines 69 (first addendum) j *Joint with UNICEF ,..~ I I **UNICEF supply programme I

J WP/RC14/2 Annex 4 page 113

Country ProJect Title WHO Number

Philippines Physiotherapy and Occupational Therapy Philippines 71* ( continued) (first addendum)

School Health Education Philippines 73* ~r- (second addendum) Social Services for Children Philippines 74** (second addendum)

Laboratory Management and Administration Philippines 76 ~ y (exchange of letter)

Laboratory Management and Administration Philippines 76 (plan of operation)

Laboratory Management and Administration Philippines 76 (exchange of letter)

Assistance to Alabang Laboratories Philippines 79** (plan of operation)

Sarawak Malaria Eradication Programme Sarawak 5 (first addendum) Singapore Institute of Health Singapore 4* (exchange of letter)

Child Jinmunization (MCW) Singapore 16** (plan of operation)

...... ,.- Leprosy Control Singapore 17 (exchange of letter)

Assistance to the University of Singapore Singapore 20 ~cardiovasCUlar Laboratory) ~ - exchange of letter) Assistance in Radiotherapy Singapore 22 (exchange of letter) School Dental Services Singapore 24** (plan of operation) Tonga School Sanitation and Connnunity Tonga 3** Water Supply (plan of operation) *Joint with UNICEF **UNICEF supply programme .','1- WP/RC14/2 Annex 4 y page 114

Country Project Title WHO Number

Viet-Nam Maternal and Child Health Demonstration Viet-Nam 3* (third addendum)

Maternal and Child Health Demonstration Viet-Nam 3* :.J (fourth addendum)

Preventive Medicine Viet-Nam 14* (first addendum)

Hospital Administration Viet-Nam 15 T ~ (exchange of letter) Malaria Pre-eradication Programme Viet-Nam 16 (plan of operation)

Distribution of Pharmaceuticals Viet-Nam 17 (exchange of letter)

Western Samoa Tuberculosis Control Western Samoa 3* (plan of operation) Public Health Administration Advisory Western Samoa 6 Services (plan of operation) Inter-country Medicated Salt Trial WPRO 68 (exchange of letter) Medicated Salt Trial WPRO 68 (exchange of letter) .- 1

Malaria Eradication Training Centre WPRO 72 (plan of operation)

Regional Tuberculosis Advisory Team WPRO 75 (Philip- r_ (plan of operation) pines)*

Regional Tuberculosis Advisory Team WPRO 75 (Viet- (second addendum) Nam)*

BCG Advisory Services WPRO 79 (Korea) (exchange of letter) Nutrition Advisory Services WPRO 79(Singapore) (exchange of letter)

*Joint with UNICEF -'. WP/RC14/2 Annex 4 page ll5/116

Count!7 ProJect Title WHO Number

Inter-country Public Health Laboratory WPRO 79 (Viet- (continued) (exchange of letter) Nam)

'r Venereal Disease Control WPRO 79 (Viet- - (exchange of letter) Nam}

Maternal and Child Health Advisory WPRO 79 (Viet- Services: School Health Nam) (exchange of letter) ~ ~ Community Water Supply Programme WPRO 84 (North (exchange of letter) Borneo) Inter-regional Treponematoses Advisory Team Inter-regional 51 (plan of operation) (Philippines) WP/RC14/2 page 117/118

ANNEX 5

TOTAL NUMBER OF AWARDS (REGULAR AND SPECIAL FELLOWSHIPS) FOR THE YEAR 1962 - 1963

1. Fellowships awarded under the Western Pacific Region programme and budget

Total fellowships 131

( i) Non-project fellowships ...... 69 (ii) Project fellowships 62

2. Participation in ed,ucational meetings, courses and conferences

(a) Inter-country programmes Number of participants 731 Number of seminars, conferences, etc ....•.• 5 (Please see WPRO 40, 81, 70, 72 and 88)

*Figure excludes five fellowships which are financed from country allotments and, therefore reported under 1.

(b) Inter-regional programmes (less than two months) Number of participants 50* *Figure excludes seven fellowships which are financed. from country allotments and therefore reported under 1.

(c) Inter-regional programmes (two months or more)

Number of participants 18

Number of seminars, conferences, etc...... 6

3. Other special fellowships Total fellowships • ...... • ...... • ...... • • • 9

( i) HQ Exchange of Scientific Workers (Malaria Eradication) .•...... •..• 7

( ii) Special UNICEF fellowships for CPHN course, Calcutta ....••.•.•..... 2 GRAND TOTAL 281 ======i -, i·' 1\ ,~ (\ ..\ '"

FELWWSHIP AWARDS l1uly 1962 to 30 June 1963 According to Fields of Study and Countries of Origin

C/) ~C/) 0 0 C/) 0 0 a I C/) ~ 0 Z F-IZ 0 ~ ~ Z t:) C/) :s -< i • ~ ~ §. C/) ~:s C/) I OF S Z ~ .... FIELD STUDY ....J :S Q ;:,.,:: ~ ~~ :2: C/) i <: 0 F-Iu -< .... ~ ~ ~ 0.. Z 2 ~ ~ :I: ~ ~ f-< .... ru 0.. <: ;:,.,:: Z :I: N ~ <: f-< t:) ~. ;:,.,:: • f-< C/) .... ~ Z :s b2 t:) :gof-< C/) ::;J ... Z ~ ~ ~ a ::;J 2 Z ~ ~ en <: :I: 8 S 0 0 <: ~ 0 ~ :I: <: .... 0::<: .... <: ;:,.,:: C/) C/) u 1%.4 Z 0.. ~ f-< 0.. :> ~ III U U :r: ~ ~ Z Z Ut:-:~ !" " Public health administration e • •• • ... • • • • I •• ~ Hospital and medical cnre administration I •• • I I Hospital and clinic buildings i • I I Environmental sanitation • e.• I • • • •• I Nursing and midwifery o • I • • • • • •• I Public health nursing •• f • I Paediatrics • M ental health " •• 0 •• Healili education • • • - Nutrition • •• • - Health statistics • • •• Dental health 0.1 ..~ i~ • ~!l:I •• •• Q I 1-'1-' Rehabilitation 0\ • "D~ f\) Drug control • • •• I Includes two second'j'ear awnrds 2 Includes two fellowships awarded under WPRO 59 (second-year awards) i~~ ~ ~~ < ~~ z 0 I-' I-' <: (/) (/) Q 0 z Oz Q w Z :s f-o:s P5O\.:f:: ~ Z (!) QU1 (/) I\) FIIiLO Ofi ;$ z ~ ~ Ii(/) ~ STUDY ...:I < :S Zz ~ ~ w .... ::i!1 f-o :l 0 ~ ~ <: 0 f-oU a. a ~ ~ w ii3

TOTAL ...... •...... 3 1 4 15 I 2 5 11 27 1 1 5 3 4 13 3 1 5 1 8 17 1 Fellowship awarded under WPRO 37 210cludes one fellowship awarded under WPRO 59 (third-year award) Notea Not included in the Table are fellowships awarded for participation in educational meetings or training courses gr31lted under (a) inter-country programmes.

(b) inter~egionalprogrammes, 31ld (c) other special fellowshipS, i.e., HQ Exchange of Scientific Workers (malaria eradication) and special UNICEF nursing fellowships for study in Calcutta. These are mentioned elsewhere in this Report (see page 35 and Annex 5).

1 \ T ,~ .. J 1 \ (\\! \ " ... WP/RC14/2 page 121

ANNEX 7

DISTRIBUTION OF VISITS IN ACCORDANCE WITH COUNTRY OF STUDY AND REGIONS

Country of Study AFRO .AMRO EMRO EURO SEARO WPRO TOTAL

Australia - - 2 - 1 12(7) 15(7) China - 1 - - 1 28 30 Fiji - - -- - 13(13) 13(13) Hong Kong - - 2 - 1 12 15 Japan - - 1 - 2(1) 29(8) 32(9) Malaya - 1 1 1 - 15(2) 18(2) New Zealand - - 2(2) 1 5(4 ) 8(6) 16(12 ) North Borneo - - - - - 2 2 Papua and New Guinea - - - - - 1 1 Philippines - 2 3 - 2 30(3) 37(3) Sarawak .. - - - - 2 2 Singapore i 1 -- 2 9(3) 13(3) Viet-Nam - 1 - -- 2 3 Western Samoa -- - - - 1 1 Total number of visits •••••••• 1 6 11(2) 2 14(5) 164(42 ) 198(49) ------=------.. _ i wa==

The figures in brackets ( ) represent the number of visits of not less than three months' duration.

This tabulation includes only visits which were begun during the period and excludes those Which, although continuing in the present period, were begun dur­ ing the previous one. One fellow may visit more than one country in the cour se . of a fellowship and the tabulation merely indicates the number of fellows a country has received during the period. The figures refer only to individual fellowship visits and do not, therefore, include group visits to sites of educational meetings and group training, courses or activities.

l __