OFFICIAL RECORDS OF THE WORLD HEALTH ORGANIZATION No. 51

THE WORK OF WHO 1953

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

WORLD HEALTH ORGANIZATION PALAIS DES NATIONS GENEVA

March 1954 ABBREVIATIONS

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

ACC - Administrative Committee on Co-ordination CIOMS - Council for International Organizationsof Medical Sciences ECAFE - Economic Commission for Asia and the Far East ECE Economic Commission for Europe ECLA Economic Commission for Latin America FAO Food and Agriculture Organization ICAO --- International Civil Aviation Organization ICITO Interim Commission of the International Trade Organization ILO - International Labour Organisation (Office) ITU - International Telecommunication Union OIHP - Office International d'Hygiène Publique PASB Pan American Sanitary Bureau PASO Pan American Sanitary Organization TAA Technical Assistance Administration TAB Technical Assistance Board TAC Technical Assistance Committee UNESCO United Nations Educational, Scientific and Cultural Organization UNICEF United Nations Children's Fund UNKRA - United Nations Korean Reconstruction Agency UNRWAPRNE - United Nations Relief and Works Agency for Palestine Refugees in the Near East WFUNA World Federation of United Nations Associations WMO World Meteorological Organization

PRINTED IN SWITZERLAND TABLE OF CONTENTS

Page Introduction y

PART I - GENERAL REVIEW

Chapter 1. Communicable Diseases 3 Chapter2.The Tuberculosis Research Office 18 Chapter 3.Public -HealthServices 20 Chapter4.Education and Training 36 Chapter 5.Epidemiological and Health Statistical Services 42 Chapter 6. Drugs and other Therapeutic Substances 49 Chapter 7.Procurement of Supplies 55 Chapter 8.Publications and Reference Services 57 Chapter 9.Public Information 59 Chapter 10.Constitutional, Financial and Administrative Developments 62

PART II - THE REGIONS

Chapter 11.AfricanRegion 67 Chapter 12.Region of the Americas 71 Chapter 13.South -East Asia Region 77 Chapter 14.EuropeanRegion 84 Chapter 15.Eastern Mediterranean Region 97 Chapter 16.Western Pacific Region 105

PART III - CO- OPERATION WITH OTHER ORGANIZATIONS

Chapter 17.Co- ordination of Work with other Organizations 115 Chapter 18.Expanded Programme of Technical Assistance for Economic Development 122

PART IV - PROJECT LIST

Projects Completed and Current in 1953 129

MAPS

1. International Sanitary Regulations :Position at 31 December 1953 44 2.The African Continent 67 - III - ANNEXES

Page

1. Membership of the World Health Organization 155 2.Membership of the Executive Board 156 3. Expert Advisory Panels and Committees 157 4.Conferences and Meetings organized by the World Health Organization, or with its Help, in 1953 162 5. International Seminars and Training Courses 164 6. Conferences and Meetings of the United Nations and Specialized Agencies at which WHO was represented in 1953 168 7. Conferences and Meetings of Non -Governmental and other Organizations at which WHO was represented in 1953 171 8.Tentative Schedule of WHO Organizational Meetings in 1954 174 9.Non -Governmental Organizations in Official Relationship with WHO 174 10. Regular Budget for 1953 175 11. Status of Contributions and of Advances to the Working Capital Fund 176 12. Structure of the Headquarters Secretariat 181 13. Senior Officials of the World Health Organization 182 14. Numbers and Distribution of Staff 183 15. Composition of Staff by Nationality 185 16. Fellowships awarded in1953 186 INTRODUCTION

THE year 1953 must be viewed as still partofthe early historyofthe World Health Organization and hence as a yearofgrowth, adjustment and consolidation.On all organizational levels, at headquarters and in the regions, further efforts were made to study -and apply as much as possible -the lessons which resulted from the trials and errors as well as from the achievements which characterized the first yearsof WHO'sexistence. I am sure that, as this Report for the year 1953 unfolds, its readers will find increasing evidenceofactivities having been planned and having been more adequately adapted to what has been emerging as oneof WHO'smost important goals: to contribute by all available means to the strengtheningofnational health administrations.

Indeed, there can be no doubt that mostofthe projects developed during 1953 have a more concrete and a sharper definition than thoseofthe early yearsofthe Organization. It is also obvious that the criteria of realism have been guiding us more and more in the selection of techniques and methods through which these projects have been carried out. Above all, there is revealed a growing awareness in all of usofthe need to plan WHO's role in promoting world health as comprising only one part- although admittedly a vital and central one -of the general framework gf all national and international efforts to improve social and economic conditions throughout the world. In this process of the shifting of emphasis from activities designed to meet emergency situations to well -balanced programmes destined to satisfy long -term needs, some of the projects executed during 1953 may have lost part of the dramatic appeal which the earlier ones of the Organization had for both the technical and the lay public.But that loss is, in my opinion, largely compensated for by the increased efficiency the Organization has gained, thanks to a better understanding of the various types of contribution it can make to the improvement of health and the attainment of greater prosperity. This new fact is, to a varying degree, reflected in many of the results achieved by WHO in 1953. That such advances could be made, despite the extremely serious and prolonged financial crises WHO had to face during the year, is further proofofits strength and dynamism.

In an attempt to summarize briefly the major new trends and developmentsofWHO's work during 1953, Ishould like first to give a few examplesofdirect assistance rendered by various partsofthe Organi- zation to national health administrations. A striking achievement in that field was the survey the Regional -V- Office for South -East Asia carried out at the request of the Government of Burma for a complete reorgani- zation of its Central Health Directorate. The recommendations submitted to the Government were accepted without delay.For the first time in the same region, a certificated course in public- health nursing has been organized and completed. Generally through all regions, and most particularly in the Americas and the Eastern Mediterranean, integrated health projects (for example in El Salvador, Egypt and Peru) are beginning to have beneficial effects on the development of local health administrations.Indeed, by demonstrating both the possibility and the value of co- ordination, such projects are stimulating governments to undertake better planning of their programmes in advance, while at the same time they are encouraging countries in which systems of public- health administration are still at the formative stage, to build up sound and integrated health services. It has become abundantly clear that WHO will have to make use of all its ingenuity to devise means through which the extremely complex and necessarily slow -moving machinery of co- ordination and integration can be perfected. It is our best -and perhaps our only -hope that more and more governments will come to realize that, in order to be effective, health work must be carried out as part of an organizational whole and that the progress in any country implies simultaneous advances in the closely interrelated fields of health and of social and economic development.

In all regions, efforts were intensified in 1953 to promote by all available means the education and training of competent professional and auxiliary workers for various types of health services.In the Americas, for example, the Regional Office has given assistance to schoolsofpublic health receiving international students in order to improve their courses and extend their facilities so that they may be used to train workers in environmental sanitation from all countries of the Region. Through an increasing number of conferences and seminars, up -to -date scientific information continued to be made available to many countries. The African regional conference on nursing education, which was attended by delegates from 20 countries and territories, was regarded as a first step in the interchange of information on nursing problems in Africa. Discussion centred on the types of nursing services required at the present stage of development, and on the methods of training best suited to available recruits, both male and female. WHO's interest in promoting health education of the public was high- lighted in 1953 by two conferences organized on that subject in London and Mexico City.The purpose of these conferences was to bring together, for exchange of experience, medical administrators and persons actively engaged in health education, and to assist in the development of health education within the countries of the respective regions. Participants in these conferences underlined the extremely important work school -teachers and education officers can do to develop desirable health practices in children of school age, in parents and in village groups. The First World Conference on Medical Education, held in London under the auspices of the World Medical Association and with the support and participation of WHO, brought to the attention of medical educators such essential topics as: selection of students for the study of medicine; the aims and objectives of medical education; techniques and methods; and the inclusion of preventive and social medicine in the curriculum. The first Asian malaria conference, which was held in September at Bangkok, is an excellent example of exchange of scientific and technical information on an inter- regional level. Representatives of countries

- VI - ofthe South -East Asia and Western Pacific Regions andofPakistan examined at that conference the way in which an integrationoflocalized efforts can best be achieved in the future, so that control zones which are now scattered might be merged into a connected whole, both within countries attending the conference and beyond their borders. The conference also helped to show how WHO could henceforth more effectively assist the countriesofthat partofthe world in a malaria control programme covering the entire subcontinent.

Malaria was also the topicofanother important meeting arranged by WHO. The early experienceof southern European countries in malaria eradication was the focal point for a symposium in Rome on insect control, with particular emphasis on current problemsofresistance to insecticides.

In viewofthe increasing numberofinter- country programmes being carried out by WHO, it might be useful to give some attention to the trend this operational method has taken in 1953 in oneofthe regions, Europe.In the lightofexperience gained in that Region in connexion with seminars and conferences, it appears that, in order to be really effective, such meetings should be preceded by preliminary studiesof health problems and services in the participating countries. It is equally clear that WHO must be prepared to help in translating the general conclusionsofa conference or seminar into terms applicable to the needs and resourcesofthe individual countries concerned.

The chapters dealing with the workofthe headquarters technical units bear witness to the efficiency with which the Organization continued in 1953 to fulfil oneofits fundamental functions: to collate and extend knowledge on the theory and practiceofhealth work with a view to its international application. Several developments deserve to be mentioned here. The Committee on International Quarantine, which met in Geneva in the autumn, noted with satisfaction that the operative phaseofthe new comprehensive Sanitary Regulations had been implemented with a surprising absenceofdifficulties throughout the world, no single international quarantine dispute requiring reference to the committee having occurred during the year.

WHO's efforts towards the improvement and uniformityofpresentationofstatistics were greatly advanced by the conferenceofNational Committees on Vital and Health Statistics, which was held in London with the co- operationofthe United Nations. The recommendations resulting from that conference should beofgreat value to the National Committees, which are attempting to stimulate within countries the collectionofhealth statistics carried out by the various health services.

While continuing its workofpreparing and reviewing biological standards, WHO was able, at least in oneofits regions, to assist countries in arrangements for national useofthese standards.

The first editionofthe World Directory of Medical Schools has been cited as a good illustrationof useful work being performed by WHO.

In these introductory remarks about the work accomplished by WHO in 1953, I should like to pay tribute to the many outstanding personalities in the fieldofhealth who, during that year, have contributed to the extremely valuable role the membersofour expert panels and committees are playing in promoting

VII- our objectives. I am glad to report that for the first time rheumatic diseases, poliomyelitis, health education of the public and onchocerciasis were among the subjects studied by our expert committees.

In view of their implications for the future, it is, I believe, my duty briefly to enlarge on the financial crises I referred to in the beginning of this introduction.Because of a substantial reduction in the funds which were expected to be available under the United Nations Expanded Programme of Technical Assistance, WHO programmes have had to be twice curtailed during the year, once in February and again in August.Willingness on the part of UNICEF's Executive Board to meet certain costs for joint project personnel has helped to solve some of the difficulties, but the financial problem remains serious. Savings had to be made, and this could only be done at the expense of recruitment, replacements and extension of staff, fellowships and supplies, as well as of new projects. As the year drew to its close, it became clear that, unless we resigned ourselves to losing the most valuable asset WHO possesses, the confidence of governments that it will live up to its commitments, devices would have to be found to avoid a repetition of such crises. WHO cannot build a strong and lasting foundation for its work if one part of its total programme has a solid, and another part a shifting, basis of support. I am confident that the Seventh World Health Assembly will not fail to give to our Organization the financial meáns it needs to carry out the great task the governments of the world have assigned to it.

The problem of programme analysis and evaluation continued to occupy our attention in 1953.It is obvious that sooner or later the time will come when we must be prepared to find a more specific answer than we have at present to the question which is being more frequently raised today: To what extent are WHO programmes, now covering all the continents, contributing to the improvement of the health of the world ? In addition, if our projects are to be planned in a more precise and more thorough way, we our- selves must know whether work done produces the desired results and, if not, to what the failure was due and how similar errors may be avoided in the future. The preliminary study conducted in 1953 might well turn out to be the first practical step in establishing the new techniques necessary for an appraisal of the hitherto unknown type of international health work for which WHO is responsible.

Nepal and Yemen joined the Organization, raising the number of Member States to 81, while associate membership was extended to the Spanish Protectorate Zone in Morocco. In most of the countries there was manifested a growing awareness and appreciation of the idea of world solidarity in health matters and of the objectives pursued by WHO. An encouraging sign from that point of view was the great number of countries which made arrangements for the celebration of World Health Day in 1953. National and local health administrations made use of " Health is Wealth ", the theme chosen for World Health Day, to bring home to the man in the street the close relation between health and prosperity.

--- VIII - The period covered by this Report is almost equally divided by the last months Dr. Brock Chisholm was in office and the first months of my appointment as Director- General.In spite of this change in the leadership of WHO, I feel there was no rupture of continuity in either the basic policies or the work of the Organization. This in itself is a measure of the wisdom and imagination which enabled my predecessor to succeed in establishing the structure of the Organization on a sound foundation and in recruiting a competent staff, sincerely devoted to the cause of WHO. In presenting this Report, it is my ardent hope that, with the continued guidance of the governing bodies of the Organization and the support of all my colleagues, I shall be able to meet the great responsibilities of my office in some measure comparable to the magnificent record established by the first Director - General of the World Health Organization.

Director - General PART I

GENERAL REVIEW

CHAPTER 1

COMMUNICABLE DISEASES

Communicable diseases still present serious health and economic problems in many parts of the world, particularly in the less developed areas.They cause incapacity, disability and death in all age -groups, but especially in children and young adults, and reduce the working potential of the population. WHO at first concentrated its attention mainly on those diseases for which mass control measures either existed or could be readily developed by applying existing knowledge ;later, widespread interest in other diseases, especially virus diseases, changed the attitude of the Organization, and its function as international co- ordinator in the control of all communicable diseases became more important. The success of the mass control programmes owes much to the co- operation of UNICEF. The formulation of future policy and practice in communicable- disease control requires, among many other considerations : (1)Assessment of the work done. Only by careful assessment of results can repetition of mistakes be avoided, methods successful in one area be adapted for use elsewhere, and technical research be initiated to improve methods and reduce costs. (2)Adaptation of new control methods to mass application in the field.This implies carefully designed field trials, which must be carried out in such a way as to permit of precise assessment.Successful examples of methods that lend themselves to mass campaigns are the use of a single injection of penicillin aluminium monostearate (PAM) for the control of yaws in Haiti and of endemic syphilis in Bosnia, and, for the control of rabies, the single inoculation of dogs with a newly developed chick -embryo vaccine, which has changed a highly enzootic area in Israel into one where the disease has remained at a very low level for an observation period of three years. Mass treatment with antibiotics for trachoma control is also under study. (3)The development of new measures for the control of diseases for which satisfactory methods are not yet available. This requires time -consuming study of world literature, collaboration with international and national institutions and with individual experts, followed by the co- ordination of research and the promotion of special investigations and field trials.The work in influenza, poliomyelitis, brucellosis, Q fever, leprosy, parasitic diseases and other important endemo -epidemic diseases is in this stage. From national research and control efforts, and from the results of the action taken by WHO in the last five years to co- ordinate international research and to assist in its application in the field, three conclusions can be drawn. The first is that certain communicable diseases, of which smallpox is an outstanding example, can be controlled :all the necessary technical knowledge is available, and only national organization is required. Other examples are the enteric diseases, such as typhoid, paratyphoid, dysentery and cholera, which can be controlled if countries, where necessary with international assistance, are willing and able to apply sound sanitation practices. Secondly, other communicable diseases can be brought to a level where they are no longer major public - health problems. In all areas of the world except Africa and part of the Western Pacific, where certain questions of technical control have still to be answered, the elimination of malaria as a public -health problem depends only upon organization and funds ;another example is the treponematoses, such as endemic syphilis and yaws, which can be reduced by successful organization of mass campaigns. -3- 4 THE WORK OF WHO,1953

The third conclusion is that internationally co- ordinated research can sometimes obtain quicker results than national research alone :an example is the co- ordinated studies on hyper -immune serum for rabies, from the results of which it is now possible to state that hyper- immune serum, followed by vaccine therapy, should be used in all human cases of severe exposure, the serum being given within the shortest possible time after exposure. The principles and practice of communicable- disease control have undergone several changes in recent years.For example :

(1)The introduction of antibiotics has made control possible by treatment on a mass scale.Further investi- gations during the year with broad- spectrum antibiotics have not essentially added to the possibilities of control.

(2)The insecticides with residual effect have proved their value, in malaria and vector control in general and specifically in the control of typhus.Studies on resistance of vectors to insecticides and on the sorption of insecticides on mud walls have been continued.

(3) Intuberculosis control, WHO's policy has been directed towards avoidance of the spread of infection. Mycobacterial resistance and side -effects impose caution and discrimination in the use of antibiotics ; experi- ence this year has confirmed the limited applicability of isoniazid.

(4)Although the value of gamma globulin in controlling measles and infectious hepatitis is firmly established, care should be taken to avoid premature conclusions as to its usefulness, on a large scale, in poliomyelitis. Work on developing effective poliomyelitis vaccines is still in the experimental stage.

(5) In leprosy control, the use of sulfones for mass treatment is under investigation.Institutional isolation is no longer considered the only effective method of control :the finding and ambulatory treatment of early cases is sounder public -health practice.

(6)For bilharziasis, it is realized that, although the newer molluscocides are promising, control by mollusco- cides is not sufficient in itself.Further ecological study of the snail vectors is necessary.

(7)The value of internationally co- ordinated research in the control of virus diseases has been proved : through it the type responsible for the1953outbreak of influenza was quickly recognized.It has also been essential to the delineation of yellow -fever areas. Investigations of the temperature resistance of dried smallpox vaccines are being continued. The work on standardizing diagnostic methods and laboratory procedures is also continuing, and simple effective laboratory methods for application in the field are being sought.

(8)For the zoonoses, in addition to the chick -embryo vaccine for rabies, mentioned above, brucellosis vaccines which seem promising are being developed, and a field trial of their use in sheep and goats is under way.

During1953it has become evident that the importance of toxoplasmosis is increasing and WHO has been asked for advice on this disease. The Organization has started work on onchocerciasis.

In1953,in addition to articles in the Bulletin, monographs on influenza, malaria, plague, poliomyelitis, rabies and yaws were published or were in preparation. There were regional and inter -regional conferences or seminars on malaria, insect control, yellow fever and milk hygiene, and meetings of the expert committees on malaria, onchocerciasis, poliomyelitis, rabies and vaccination against tuberculosis and of the sub -committee on serology and laboratory aspects of venereal infections and treponematoses. The technical discussions during the Sixth World Health Assembly, which were devoted to tuberculosis, venereal diseases and the typhoid group of fevers, have contributed to a better international understanding of the different control methods used. The results of these discussions were published in a special number of the Chronicle.'

1Chron. Wld Hlth Org. 1953, 7, 195-216 COMMUNICABLE DISEASES 5

It will be seen from what follows that WHO is working on a large number of communicable diseases. The work of the Organization in assisting Member States in communicable disease control and in the co- ordination of research on the application of new methods has reached a stage where it would be impossible to undertake further major activities with the present staff.In the immediate future, therefore, WHO must confine itself to the most important of the problems on which it is already engaged.

Malaria

WHO has continued its work in demonstration Africa,staffedentirelyby French Government and training projects and in pilot projects of malaria officials, who received technical advice from WHO. control. InNigeriaanother importantprojectisbeing At the beginning of 1953, projects were in opera- launched by the Government, and WHO is providing tion in 20 countries ;in the Terai area in India and an entomologist. in Viet Nam WHO personnel was withdrawn during Late in 1952, visits were made by WHO consul- the year and the work handed over to the Govern- tants or staff members to Gambia, the Gold Coast, ments, which are now developing expanded pro- Nigeria and Sierra Leone. grammes and new projects were started in Brunei, As national programmes have shown so wide a the French Cameroons and Liberia.At the close development, the practical problems of controlling of the year, WHO was assisting in malaria control malaria on a regional or inter -regional scale are being in 21 countries. considered, to consolidate what has been done and The greatly expanded, long -term, national pro- to encourage a yet more comprehensive attack. grammes of malaria control referred to in the Annual These problems were considered in particular at a Report for 1952 have continued to develop most first Asian malaria conference, convened in Bangkok satisfactorily.It is encouraging to note that similar in September by the Regional Office for South - national programmes have begun in many other East Asia, with the collaboration of headquarters countries, as, for example, in the Philippines, where and the Regional Office for the Western Pacific. the WHO- assisted pilot project initiated in 1952 has This conference was attended by delegates of 14 shown that malaria carried by Anopheles minimus different countries of three regions, representatives flavirostris can be effectively controlled by residual of the Foreign Operations Administration who are insecticides.This programme in its second year of conducting programmes in a number of countries, operation has therefore been expanded to cover all of UNICEF and of the South Pacific Commission, the malarious areas of Mindoro and two smaller and staff from WHO field projects (see also page 78). islands, and plans have been drawn up for controlling 1953 may well prove to be a turning -point in the malaria in the whole of the Philippines. In Lebanon, history. of WHO's policy in malaria control, for in where the WHO team completed its work at the end that year, at meetings of experts, consideration has of 1953, the Government, with technical advice and been given to the possibility, recently demonstrated assistance in co- ordination from WHO, has extended in Greece, that, after malaria has been under control malaria control to all affected parts of the country. for a few years, active antimalarial measures can A WHO team has also made a complete survey of be safely withheld, provided that there are sound Taiwan, where control already covers a large area, criteria for deciding when the measures should be and the Government plans to control all malarious discontinued and adequate safeguardsarethen areas in 1954. provided. What were probably the first international The pilot project in Sarawak, where A. leuco- discussions on this subject took place in Istanbul sphyrus is the vector, has given encouraging initial at an informal meeting of members of the Expert results, and investigations are continuing. The Advisory Panel on Malaria, during the Fifth Inter- problem of malaria carried by A. gambiae is now national Congresses of Tropical Medicine and Mala- being examined in the WHO- assisted pilot projects ria ;they were later resumed at the fifth session of in the French Cameroons and Liberia and in two the Expert Committee on Malaria and again at similar projects in different parts of French West the first Asian malaria conference mentioned above. 6 THE WORK OF WHO, 1953

The prospect of discontinuing a residual insecticide co- ordination of malaria- control programmes be- campaign after a few years of malaria control will tween countries.Without such co- ordination, those encourage governmentstoestablishnation -wide countries that have eradicated malaria from their schemes and will perhaps induce others to provide own territories would remain exposed to the danger assistance under international or bilateral schemes. of their neighbours' malaria and would have to Clearly, the larger the area under control, the safer maintain active malaria control at least on their discontinuation would be, and in a control pro- borders.This international co- ordination was also gramme it is therefore technically andeconomically one of the main items on the agenda of the Bangkok desirable to cover all malarious territoriesof a conference. country, and possibly those of adjacent countries. Moreover, the fact that in some countries in 1953 The expert committee also dealt with many other technical matters bearing on malaria control.It thelocalmalariavectors had developed DDT resistance after several years of spraying campaigns reaffirmed its belief in the feasibility of attaining suggests that programmes of malaria control for a WHO's original aim of eliminating malaria from country or group of countries should be planned so the world as a public -health problem, and suggested that the application of the insecticides could be that the Organization could very usefully help to withheld before the time when resistance might reduce the cost of control by encouraging experi- develop (never less than five years, so far as has been ments in organization, in training and in the use reported). Obviously, when malaria transmission of insecticides.Much fundamental research is still has ceased, this does not imply that the anopheline necessary on the physical and chemical properties vector species has been eradicated ;indeed, the of insecticides, on their interaction with wall surfaces, anopheles density may even be nearly as high as on the mechanism of their action on insects, and on before control. If subjects carrying malaria parasites those habits of malaria- carrying mosquitos which come into the country, the transmission may be must be taken into account in residual spraying. started again, but this danger would decrease in After considering a monograph, prepared by a direct proportion to the number of neighbouring WHO consultant, on the toxic hazards of certain countries from which malaria was also eradicated. pesticides to man,2 the committee concluded " that When active malaria control is interrupted, it will DDT and BHC are quite safe in routine use and have to be replaced by a policy of defence against the reintroduction of malaria, and the prevention that dieldrin may well be brought into routine use -or immediate suppression -of transmission.For with some caution until its properties are more fully this purpose, it will be necessary to ensure the ade- understood."The committee discussed at length quate and immediate notification of new cases of recent important advances in the chemotherapeutics malaria and the decentralization of facilities for of malaria and noted the difficulties in obtaining diagnosis and for epidemiological research ;and, some of the newer drugs in sufficient quantity at in case of an epidemic it may be necessary to resume moderate cost.It recommended that WHO should the insecticide spraying (which is why the campaign study whether these difficulties could be eased. should be withheld when the insecticide is still active Malaria control by means other than insecticides on the vector species) and the use of chemothera- was also dealt with, and the committee believed peutics. Fortunately, some modern antimalarials that, although it was clear that the attack on the can guarantee radical cure of the two main malaria mosquito vector must have first place in antimalaria infections in a very high percentage of cases, and campaigns, there was still room for more traditional some others could be of the greatest assistance in the methods, such as constructional or drainage work. event of such an epidemic. It considered that newly synthesized antimalarial The Expert Committee on Malaria, which held drugs might have special control value either where its fifth session in Istanbul in September, just before other methods were for any reason precluded, or for the conference in Bangkok, advised that adminis- epidemics, or if,after residual spraying had been trations should give careful consideration to dis- finished, it was necessary to deal with relapsing cases continuingresidualspraying,with propersafe- a Barnes, J. M. (1953) Toxic hazards of certain pesticides guards,afterseveralyearsof malariacontrol. to man, Geneva (World Health Organization: Monograph Further,the committeestronglysupportedthe Series No. 16) COMMUNICABLE DISEASES 7 or infected persons who had come in from un- In 1953, WHO published a monograph on malaria protected areas. terminology.3Internationally co- ordinated research was encouraged and assisted during the year on WHO hasofferedtrainingofvariouskinds (1) the susceptibility of anophelines to insecticides, to meet the increasing demands for assistance in with a view to determining any development of strengthening national malaria -control organizations, resistance, and (2) the sorption of insecticides on and it has emphasized the functions of teams in mud walls. providing systematic practical training in malaria An account of WHO's assistance to UNRWAPRNE projects.Assistance has also been given to malaria in the control of malaria among the Palestine refugees institutes and centres for training in insect control. is given in the last part of Chapter 3.

Treponematoses and Venereal Infections

Work was continued throughout 1953 in the mass carefully planned and systematically carried out treatment programmes for the control of treponemal project, infectiousness can be completely suppressed diseases and in demonstration and training projects and the incidence of the disease reduced practically which have been undertaken in a number of countries to the point of eradication.This is notably true of with the assistance of the World Health Organization endemic syphilis in Yugoslavia and of yaws in Haiti. and UNICEF. By the end of the year, a total of over In the last three years techniques for mass trepone- 15 million persons had been examined and over matosis control have been developed which can be 4 million had been treated with penicillin.Four widely applied at minimum cost and with maximum programmes -the yaws -control projects in Haiti and use of lay technicians. The cost per person examined the Philippines and those for controlling endemic in the mass campaigns has been approximately syphilis in Yugoslavia and bejel in Iraq- reached 25 US cents, and per person treated with penicillin the phase of consolidation ;the WHO advisers were about US $1.50, including personnel, drugs, trans- withdrawn from the bejel project in Iraq, leaving port and administration and all other expenditure trained national personnel and a strengthened health by health administrations, WHO and UNICEF. service to develop the programme further.Progress Various technical and other problems have been also continues in the yaws -control projects in India, encountered.In spite of evidence that systematic Indonesia and Thailand.New campaigns against treatment of contacts in mass campaigns is epide- this disease were started during the year in Bechuana- miologically necessary, in some areas this principle land, Laos and Liberia, and planned in Nigeria.In is not fully accepted, and a more complex, expensive the last two countries it is estimated that there are and time -consuming machinery has been necessary a million and a half active cases of yaws. A plan for the extinction of new foci and the eventual for a long -term co- ordinated programme in yaws control of the disease. Also, in some areas, there has control for the whole of tropical Africa is also under been reluctance to accept that mass treponematosis consideration.In this area there are believed to be control can be based on a minimum standard dosage 20 to 30 million cases of yaws, representing perhaps of PAM given in a single injection (as recommended half the total world reservoir of this infection. by the WHO Expert Committee on Venereal Infec- The mass campaigns have firmly established that it is possible to control treponemal disease by mass 3Covell, G., Russell, P. F. & Swellengrebel, N. H. (1953) Malaria terminology, Geneva (World Health Organization: treatment. It has been demonstrated that, by a Monograph Series No. 13) 8 THE WORK OF WHO, 1953 tions and Treponematoses),4 although the lasting nature of the venereal- disease problem, a wider effectiveness of this procedure has been repeatedly appreciation of modern diagnostic and therapeutic demonstrated. procedures, cadres of trained national personnel and The opportunities that treponematosiscontrol strengthened health services. offers for the improvement of rural health services WHO has organized an international evaluation also deserve more attention. Plans must be made at of new, long -acting diamine penicillin salts for the an early stage to incorporate yaws control into the treatment of syphilis, yaws, bejel and pinta, which general public -health system :the time for amal- may make it possible to simplify therapy in the gamation is when the programme is reaching the future, both for the individual and for mass cam- stage of consolidation, for by then " the citizens paigns.It has compiled a study of the usefulness of have been alerted, the population has been enume- a recently developed intradermal test in the diagnosis rated, personnel have been recruited, a basic record of yaws, and, with a view to greater uniformity in system is available, and community facilities are at therapy practices and in the management of syphilis, hand in many areas. " 5 has made a survey of the treatment schedules being used by outstandingexpertsinleading There are indications from many parts of the clinics throughout the world. Information on lympho- world, particularly in well -developed countries with active organizations for thecontrol of venereal granuloma venereum and non -gonococcal urethritis diseases, that the incidence of venereal syphilis is has been collected in order to appraise the inter- national public- health importance of these infections. falling.It is believed that the ready availability of penicillin is one of the major causes of this rapid TheInternationalTreponematosisLaboratory decline.In one of the reports on the technical dis- Center at Baltimore, in the United States of America, cussions at the Sixth World Health Assembly it is has continued its investigations into the fundamental said :" The long -term outlook in syphilis control, biology of the treponemal diseases. The pathological despitethe introduction of penicillintreatment, material available in a number of WHO- assisted does not justify any relaxation of vigilanceor field projects has permitted the centre to isolate abandonment of special efforts against this infection various species and strains of treponemal organisms. through general or selective health programmes. On The effects of environmental temperature on different the contrary, penicillin treatment offers an opportu- species of treponemes, the development of new nity to the health administrator for a practical and serological techniques, the anti -treponemal effect of more rational, economic and administrative approach some of the newer antibiotics, and similar funda- to certain phases of mass campaigns against tre- mental problems are under study, and continued ponemal diseases in areas of high prevalence ;in attention has been given to the possible development areas of moderate or low prevalence,it permits of penicillin resistance in treponemal strains.An increased emphasis on other major elements of the important advance has been the development of an control programme (e.g.,case -finding, post- treat- agglutination test, based on killed treponemes, for ment control, etc.)." 6 There is no evidence, however, serodiagnosis. This TPA test, which is both sensitive that the prevalence of gonorrhoea or any of the and highly specific, gives good promise of simplifying minor venereal infections has decreased. laboratory procedures in the future. WHO is arrang- ing to provide a supply of antigen to laboratories in Demonstration, survey and training projects, to certain countries to test its control value, in the assist governments to develop their programmes for hope that the present complex and very costly the control of venereal diseases, have gone forward serologicalprocedures now requiredofpublic - in ten countries.In two, Egypt and India, projects health and laboratory services may be simplified. of this kind were completed, the teams leaving behind them much information on the extent and A co- operative study of the Treponema pallidum immobilization test (TPI test), in which 40 labora- tories in different regions took part, was initiated 4 Wld Hlth Org. techn. Rep. Ser. 1953, 63, 40 during the year. 5 Clark, E. G. Notes on the endemic -syphilis- control campaign in Bosnia, in Wld Hlth Org. techn. Rep. Ser. 1953, 63, 43 -50 The sub -committee on serology and laboratory 6 Chron. Wld Hlth Org. 1953, 7, 210 aspects of venereal infections and treponematoses COMMUNICABLE DISEASES 9 held its third session in Copenhagen, Denmark, in the Statens Seruminstitut to establish three sera of the summer of 1953.It considered the work that different degrees of activity as international reference had been done in serology since 1950, and advised preparations. WHO on plans for future work.For the further Reports received from the laboratories set up by standardizationof reagents,laboratory methods the WHO field teams have shown the value of and procedures, provisional international reference quantitativeserologicaltestinginthediagnosis preparations of cardiolipin and lecithin antigens and follow -up of treponematosis cases. were renewed ;studies of their keeping quality, and investigationsusingcardiolipin antigensto Continuing its special interest in venereal- disease confirmthattestresultsof severalserological control among seafarers, WHO assisted in a port methods can be reproduced in different laboratories, demonstration project in Rotterdam, in which five were begun and will be continued. national study groups completed their work on various aspects of maritime venereal- disease control. Freeze -driedsera on differentlevelsof sero- reactivity, prepared from the blood of syphilitic Reports which they drew up and information which and non -syphilitic donors, have been collected in they collected were used as supporting material for the International Serological Reference Laboratory an international training course completed during the year, the first of several such courses planned. at the Statens Seruminstitut, Copenhagen. Since 1950, a number of these sera have been tested in Two monographs -a report on the campaign of 15 laboratories in different countries, to ascertain mass treatment for endemic syphilis in Bosnia theusefulnessof freeze -dried specimens in the and a collection of papers read at the first inter- comparative evaluation of serological methods be- national symposium on yaws control, held in Bang- tween laboratories. The Expert Committee on kok 8 -were published during the year. Several Biological Standardization atitsseventh session articles on various aspects of treponemal disease studied the progress that had been made in this control were published in the Bulletin of the World field and authorized the Standards Department of Health Organization.

Tuberculosis

Tuberculosis mortality has generally been used Figures for the incidence or prevalence of tuber- as an index of the tuberculosis problem in a country. culosis, as they are given today, are not very useful, The figures for the parts of the world where mortality partly because no clear and generally accepted statistics are reliable suggest that, in the economically definition has been given of what constitutes a and technically more developed countries, the pro- " case ", and partly because the labelling of " cases " blem of tuberculosis has in recent years been rapidly is based more on the judgment of clinicians than on declining in importance.It is, however, becoming objective findings.It is evident that no significant increasingly evident that mortality figures are not comparison of the results of examinations of different adequate either for indicating the extent of tuber- groups can be made until standards for making and culosis in a country or for showing the trend of the interpreting these examinations have been devised problem.In many countries where mortality from and adopted. This problem has to be faced in coun- tuberculosisisrapidlydeclining,the number of triesthat have asked for assistance in starting cases of pulmonary tuberculosis reported for the systematic programmes for tuberculosis control, and first time and the number of known infectious cases WHO has therefore established a standard examina- have not correspondingly decreased. This confronts the health authorities with a real problem and Grin, E. I. (1953) Epidemiology and control of endemic emphasizes the need for obtaining a better public - syphilis;report on a mass -treatment campaign inBosnia, Geneva (World HealthOrganization:MonographSeries health index of the tuberculosis situation in individual No. 11). Also published in Bull. Wid Hlth Org. 1952, 7,1 -74 countries.WHO has taken up this problem for 8 World Health Organization (1953)Firstinternationa- symposium on yaws control, Geneva (World Health Organiza- study, with the aim of obtaining statistics that are tion: Monograph Series No. 15).Also published in Bull. internationally comparable. Wld Hlth Org. 1953, 8,1 -418 10 THE WORK OF WHO, 1953 tion for pulmonary tuberculosis, whichisbeing India, for example, over ten million children and tested in a number of field projects.Standard cards young adults were tuberculin- tested in 1953, and have been prepared and methods for recording, over four million non -reactors to tuberculin vac- compiling and analysing the results of the examina- cinated by about 65 teams, each consisting of one tion of population groups (in chest clinics and in doctor and six " BCG technicians ".The work, surveys) have been worked' out and are under trial. including the tuberculin testing, the reading of the It is expected that the experience so gained in the tests and the vaccination, was done by these techni- next few years will contribute considerably to the cians -lay people without medical or paramedical establishment of an internationally accepted stan- background, who have been given specific training dardizeddiagnosticprocedureasthebasisfor in the technique and the organization of the work. tuberculosis statistics. For this project in India the total expenditure has In 1953 assistance in starting or extending services been about US $350,000 (three and a half cents for the control of tuberculosis has been given to per person tested and ten cents per person vac- 24 countries, most of which are in the tropical cinated), of which US $50,000, or one -seventh of or subtropical zones.Some 37 projects have been the total, came from international assistance.A developed, and in practice these have been of two check system has been established to ascertain the main types :21 BCG vaccination projects, in which result of the mass vaccination in terms of degree of assistance has been given jointly with UNICEF, tuberculin allergy induced by the vaccination and and 16 teaching and training centres, in some of complications resulting from it, and this study is which UNICEF has also worked with WHO. being carried out by a specially trained team. Many of the difficulties in this work are essentially Only by close co- operation with the WHO Tuber- due to the fact that, even in the more developed culosis Research Office (see Chapter 2) has it been countries, tuberculosis has been regarded and handled possible to work out thiseffective and reliable more as a clinical than as a public -health problem. The planning and conduct of control work have method for mass vaccination programmes The often been left to clinicians, with the result that in detailed standardization of techniques that is essential institutions more importance has been given to for this, approach must be based on research into treatment than to prophylaxis.In the assistance each technique and on a study of the influence of WHO is giving, the main emphasis is placed on the variations in techniques which result from the use protection of the healthy people in the community. of non -medical personnel. The primary aim in tuberculosiscontrolisto WHO isfollowingthe same main principles decrease the number of healthy people who contract in attempting to develop other more direct measures a tuberculous disease resulting in temporary or designed to control the spread of tubercle bacilli even permanent disability. and applicable to entire countries at minimum cost Since tuberculosis is a contagious disease caused by and with maximum use of lay technicians. For infection with tubercle bacilli,itisnecessary to revealing the infectious cases of pulmonary tuber- uncover as many as possible of the sources of culosis, the " standard examination " can be used infection -firstofall,peoplewithpulmonary effectively on large population groups at relatively tuberculosis, who excrete tubercle bacilli -and to do low cost. It is based on methods which can be applied something to neutralize or minimize the spread of by lay technicians :tuberculin test (Mantoux 5 infection from these sources.At the same time, International Units), chest x -ray (70 mm film) and efforts must be made to increase resistance to infec- examination of sputum and laryngeal swab for tion among the healthy people in the community. tubercle bacilli.In countries with much sunshine, Only measures applied throughout the population tuberculosis seems to be transmitted mainly or can be expected to have a real effect on the control exclusively indoors, especially at night ;isolation of tuberculosisina country. These measures, of the infectious patients at night may in itself therefore, must be such as can in practice be applied considerably reduce transmission. In such countries on a large scale with the money,facilitiesand WHO is therefore employing home- visitors who, in personnel available. the patient's home, demonstrate methods of collect- In BCG vaccination WHO is now using methods ing and disposing of sputum (such as exposing it that can be widely applied at relatively small expense to sunlight in order to render it non -infectious), and by auxiliary personnel.In the BCG project in and who try to have the patient isolated at night, COMMUNICABLE DISEASES 11 in or near his home.Such methods are under trial culosis control, and their indiscriminate use might in many WHO- assisted projects ;but it is evident even be harmful. that it will take some years before their real effect Experience has shown that the value of assistance can be evaluated. from WHO is limited by the short duration of the Internationalresearchhasbeencarriedout projects which have been and still are being planned. to find a simple but effective method of bacterio- To start an effective control programme in a country logical diagnosis under field conditions ;the results and to train the necessary basic staff require a of these studies were co- ordinated in 1953, and prolonged effort over several years.International the methods suggested will be further tried out by assistance given during a short period of one or two recognized bacteriological institutes and in WHO - years can have little real effect upon the problem. assisted field projects. An Expert Committee on Vaccination against It has been suggested that the newer drugs such Tuberculosis metearlyinDecember. Recent as streptomycin, p- amino -salicylic acid (PAS) and experience and research on different vaccines and isoniazid would be effective in controlling tuber- their modes of administration were reviewed. In culosis in countries where the diseaseishighly general, the committee approved the use of BCG prevalent. Although these drugs may have a definite vaccine and endorsed the methods and techniques effect in prolonging the lives of tuberculous patients, used in the mass vaccination programmes assisted there is so far no indication that they help tuber- by UNICEF and WHO.

Veterinary Public Health and Zoonoses

Work on several projects concerned with animal several of the centres in carrying out regional surveys diseases communicable to man was completed ; of the disease, teaching and fundamental research. new studies were inaugurated, and work in food WHO is collaborating with FAO in the technical hygiene was extended to include, besides meat, milk aspects of a field trial of various Brucella vaccines to and milk products and food additives. WHO carried determine their effectiveness on sheep and goats. out several of these activities in close co- operation This work is being done' in Tunis and will last for with FAO, and maintained collaboration with the two to three years.The Br. melitensis problem in Office International des Epizooties and the perma- man and animals remains the most difficult aspect nent committees of the International Veterinary of the control of brucellosis in large parts of the Congress and the International Congress for Micro- world, and it is hoped to obtain through the work biology. in Tunis a clearer understanding of its epidemiology The importance of zoonoses in health problems and prevention. in rural areas will be considered in the technical discussions to be held during the Seventh World Rabies Health Assembly. The Expert Committee on Rabies held its second session in Rome in September.At this session the Brucellosis resultsofseveral WHO- assistedprojectswere The report of the second session of the Joint analysed, and recommendations based on theiñ were FAO /WHO ExpertCommittee onBrucellosis 9 formulated. It will be recalled that a WHO- sponsored was widely circulated, and has further stimulated field trial of chick- embryo vaccine for the control the activities of the FAO /WHO brucellosis centres. of rabies in dogs was inaugurated in Israel in October An additional centre was established during the 1950, and that in 1952 WHO gave technical guidance year at the Indian Veterinary Research Institute, to the Government of Malaya for the use of this Mukteswar, bringing the total number of centres vaccine to control a severe epizootic.The results to 13.Small financial grants were made to assist obtained in both Israel and Malaya were gratifying : they showed beyond doubt that the chick -embryo 9 Wld Hlth Org. techn. Rep. Ser. 1953, 67 vaccine conferred a high degree of immunity on 12 THE WORK OF WHO, 1953 vaccinated dogs and that this was instrumental in dardization, and work was begun to determine bringing the incidence of rabies in these countries whether the serum would be suitable for the agglu- to the lowest levels experienced in the past 25 years. tination, as well as the complement- fixation, test. WHO also co- ordinated studies of the use of combi- Diagnostic work on Q fever will also be useful in nations of hyper- immune serum and vaccine in the connexion with work on other rickettsioses. prevention of rabies in man. The studies indicated Epidemiological surveys to detect the presence that if the serum is given in addition to vaccine, of Q fever were continued in 28 countries. The it confers an immediate protection which persists Organization made a small grant to the University until the inoculations of vaccine have time to exert of Cambridge to assist in work on producing cheaper their antigenic effect.It seems likely, therefore, that antigens for diagnosis.Co- ordination of research its use in human prophylaxis will prevent vaccine into natural reservoirs of the micro- organism was failures where severe exposure and the resultant started. short incubation period do not allow time for the Further aspects of Q fever that require clarification vaccine to produce immunity.It is expected that are the pathogenesis of the disease in different animal as a result of this research many countries will reservoirs, and its transmission, by arthropods and modify their measures against rabies. otherwise in animals and man. A WHO Manual of Laboratory Techniques in Rabies, which provides the latest information on diagnosticproceduresandtheproduction and Leptospirosis potency testing of rabies vaccine and hyper -immune Work was continued on the clarification of typing serum, was ready by the end of the year for publi- procedures and diagnostic methods in leptospirosis. cation in the WHO Monograph Series. As the infor- It is hoped that the complicated diagnostic methods mation on these subjects is widely scattered and is now necessary may be simplified by macroscopic incomplete in available published literature,itis agglutination tests and complement- fixation tests. felt that this manual will prove extremely useful to all countries where rabies is a problem. A consultant was sent to Spain to advise on epi- demics of leptospirosis among workers in rice fields. Work was started for the eventual establishment (See also Chapter 14, page 92.) of an international standard antirabies hyper- immune serum for use by national laboratories in comparing their locally produced sera. Bovine and Avian Tuberculosis WHO provided a service for testing the potency In collaboration with FAO, WHO has begun a of the vaccines and sera produced by national study to determine the importance of extra -human laboratories and arranged to continue this service sources of infection with tuberculosis in various until national laboratories are ready to carry out countriesof the Eastern Mediterranean Region, their own potency tests. where WHO tuberculosisteamsareoperating. Severaltroublesomeproblemsof rabiesstill This information is needed in order to assess more need investigation.These include neuro -paralytic accurately the results of the tuberculin surveys in accidents in human subjects receiving nervous -tissue man that are being carried out in that Region. vaccines, the control of wild -life reservoirs, local Further steps were taken towards the establish- treatment of wounds, and the extension of bat - ment of an international standard for PPD of transmitted rabies to the North American continent. avian tuberculin.This standard will be applied in WHO continues to co- ordinate research work on the comparative intradermal test used todetect several of these problems. tuberculosis in livestock.

Q Fever Food Hygiene WHO has completed its work on the preliminary WHO sent consultants to Burma, Ceylon, India examination of an international standard Q fever and Costa Rica, to advise on problems of meat serum for veterinary and medical use (see page 50). hygiene. A WHO /FAO seminar on this subject is On the strength of examinations performed by five to be held in Copenhagen in February 1954, to deal collaborating laboratories, this serum was established with problems of meat hygiene in European coun- as an international standard at the seventh session of tries.Later in that year there will be a meeting of a the WHO Expert Committee on Biological Stan- FAO /WHO expert committee on meat hygiene. COMMUNICABLE DISEASES 13

The Organization has also taken part in work on countries on histoplasmosis, toxoplasmosis, trichi- milk quality standards (see Chapter 3, page 22). nosis and tularaemia.Tularaemia was diagnosed for the first time in Yugoslavia with WHO's assis- tance.Toxoplasmosis, a disease which is becoming Other Zoonoses more of a problem in several countries, was included In addition to advising on the zoonoses mentioned in the agenda of the Sixth International Congress for above, WHO has supplied information to several Microbiology, which was held in Rome in September.

Virus and Rickettsia) Diseases '°

Continuing developments in virological techniques a special central laboratory is needed, for others it are bringing closer the time when the virus laboratory is not, and, for some, further laboratories must be will be able to take its place beside the bacteriological added to the network. laboratory as an essential element in the diagnosis and control of communicable diseases. The need is the more urgent because new vaccinesagainst Influenza various virus diseases are being developed, and for Efforts were made to extend and improve the the intelligent application of these vaccines, and of WHO network of influenza laboratories. Experience other control measures that the new techniques gained during the widespread epidemic of influenza A have made possible, the help of the virus laboratory that took place in the northern hemisphere in the is required. early part of the year was particularly valuable. A WHO's programme, which began with the estab- considerable body of epidemiological information lishment of an. international network of influenza was received and published in the Weekly Epi- centres, has now reached a stage at which its scope demiological Record (see page 46),viruses were can be gradually broadened to cover other virus isolated in most of the participating laboratories, and diseases for which international co- ordination of a report on the epidemic, including the preliminary research is needed, so as to provide in each country results of studies on the viruses carried on at the a nucleus which may eventually be developed as World InfluenzaCentre and theStrainStudy part of a public -health laboratory service. In 1952, Center for the Americas, was published in the as a first step towards consolidating this programme, Epidemiological and Vital Statistics Report. Detailed several expert advisory panels on individual diseases studies are still going on and will be reported later. were combined into a single expert advisory panel The controlled field trials of influenza vaccines on virus diseases.In 1953, as recommended by the Expert Committee on Poliomyelitis, certain labo- carried out by national authorities in Canada, the Netherlands, the United Kingdom, and the United ratories within the network were asked to co- operate in work on poliomyelitis.Other diseases on which States of America have been carefully observed. The final results are not yet available, but preliminary selected laboratories are being or will be encouraged information suggests that the protection afforded to co- operate, either for diagnosis or for research, by the vaccines used in some of these trials was includesmallpox,diseasescaused by the lym- disappointing. In others the results were inconclusive phogranuloma- psittacosis -trachoma group, diseases caused by viruses found in the stools, such as the because influenza did not reach epidemic propor- tions in the area concerned.Other results have not Coxsackie group, and virus hepatitis.Flexibility is essential in developing this programme, for the yet been analysed. requirements for various virus diseasesdifferin By the end of the year there was evidence that the detail, though they are similar in principle. For some efforts of the Regional Office for the Americas to increase the number of influenza centres in the WHO 10 Excluding Q fever and rabies, work on which is described network in Latin America had already given results. above. In other regions also the network is being extended. 14 THE WORK OF WHO, 1953

Following a recommendation in the report of the work will be designated in each region or continent. Expert Committee on Influenza, which was published Later the network will be extended and, with due during the year 11 the supply of standard laboratory regard to the differences between the two diseases, reagents to participating laboratories was begun. developed in the same way as the influenza network. WHO has also started a service to facilitate the interchange of reprints of publications on influenza. Yellow Fever A symposium on influenza, containing important reviews of various aspects of influenza, including The immunity survey undertaken by WHO in its therapy, was published in the Bulletin" and in order to delineate the southern boundary of the zone the Monograph Series.13 in Africa in which yellow fever is endemic (see Annual Reports for1950,1951 and 1952) was Poliomyelitis completed during the year..In this survey some twelve thousand samples of human blood were The Expert Committee on Poliomyelitis held its collected in Angola, Bechuanaland, Belgian Congo, first session in Rome in September, primarily to Mozambique,NorthernRhodesia, Nyasaland, consider current views on the essential nature of this Southern Rhodesia, Tanganyika and the Union of disease and the recent advances that have been South Africa, and tested for antibodies to yellow - made, especially in methods of diagnosis and the fever virus by the Virus Research Institute at Entebbe possibility of prevention.The committee outlined and the South African Institute for Medical Research preventive measures which might help to limit the at Johannesburg.The results of the surveys were spread of the infection and reduce the incidence of considered by the Expert Committee on Yellow paralysis. Passiveimmunizationwith gamma Fever, which devoted its second session at Kampala globulin for specific prevention was held to be of (Uganda)inSeptembermainly todelineations limited public- health value, but much was hoped required under theInternationalSanitary Regu- from the vaccines now being developed, though it lations.It made recommendations on the territories was emphasized that they were still in the experi- to be considered yellow -fever receptive areas and mental stage. The tissue -culture method of cultivat- on aredelineationof the yellow -fever endemic ing poliomyelitis virus has revolutionized the study zones in Africa and the Americas (to replace those of the disease, and the committee recommended that previously made by UNRRA).Requests received many more laboratoriesshouldundertakethis from governménts for exclusion from the endemic work, as it might eventually be practicable to trace zones of areas freed from Aëdes aegypti were taken poliomyelitis virus infection in the same way as into consideration.The committee based its sug- typhoid infections can now be traced. As an inter- gested delineation of the southern boundary of the mediate measure the committee recommended that endemic zone in Africa on the results obtained from regional laboratories should be designated for the the immunity survey.For the Americas, the com- identification, typing and further study of polio- mittee recommended that the interim delineation myelitis viruses isolated in all parts of the world, so made by UNRRA under the International Sanitary as to increase knowledge of the epidemiology of Convention for Aerial Navigation, 1933/44, should poliomyelitis and to prepare the way for the intelli- be maintained. The committee finally proposed gent use of vaccines when they become generally some modifications in certain provisions of the available. Virologists working on poliomyelitis International Sanitary Regulations which deal with should also be trained in tissue -culture techniques. yellow fever and recommended a varied programme The committee alsolisteda number of urgent of research on that disease. These recommendations research problems. were considered by the Committee on International The first steps towards implementing these recom- Quarantine, which met in Geneva in October. (The mendations were taken towards the end of the year. work of that committee is described in Chapter 5, Firsta laboratorycapableof undertaking the page 43.) A seminar on scientific information on yellow 11 Wld Hlth Org. techn. Rep. Ser. 1953, 64 fever in Africa preceded the session of the expert 12 Bull. Wld Hlth Org. 1953, 8, 591 -824 committee. 13 World Health Organization (1954) Influenza -a review of current research, Geneva (World Health Organization: The yellow -fever vaccine prepared by the Common- Monograph Series No. 20) wealth Serum Laboratories, Melbourne, and that BILHARZIASIS

No member of this Egyptian family is safe from bilharziasis, for their life revolves around the irrigation canals, infested with the snail vectors of the disease.The man and boy in the foreground are turning the Archimedes screw by which water is raised from the main canal and diverted into the smaller streams which irrigate the fields. As the water flows over the knees of the screw-turners, the minute cercariae shed by the snails may attach themselves to the skin and thence penetrate to the inner organs.The women washing clothes in water from the canal run the same risk. With the help of WHO (which is sending experts and providing, under Technical Assistance, for some of the necessary supplies) the Egyptian Government is undertaking an experimental campaign in the Calioub demonstration area :all methods will be co-ordinated to control a disease which has ravaged the country from time immemorial. THE EGYPTIAN GOVERNMENT, ASSISTED BY WHO, UNDERTAKES A BILHARZIASIS- CONTROL PROJECT

The snailscollected during theday examination bywhichtheparasite is Two of the methods used to collect water, the snails can be pickedoff the are placed in jars of water, which are ex- detected. snails for experimental purposes. In the leaves and placed in canvas bags. amined after 24 hours to seeif the snails At treatment centresin the experi- smaller irrigation streams the snailsare Inthe centre photograph, a snail of have shed cercariae and can be identified mental area (right), samples of urine are caught by hand nets (left).In the larger the genus Planorbis,responsible for the as vectors (left). tested, to determine the incidence of the canals a palm -leaftrapis used(right). urinaryformofbilharziasis, hasbeen disease among the population.Villagers When the branches are removed from the caught. Two members of the control team who are positive for bilharziasis are treated (centre) prepare snails for the microscope in these centres. A CAMPAIGN AGAINST EYE DISEASES IN MOROCCO AND TUNISIA...

A campaign against eye diseases (which are particularly prevalent in Mediterranean countries)is organized by the health authorities in Morocco (French Zone) and Tunisia, with the help of UNICEF and WHO.In Morocco, the Feople of the Ouarzazate district are gathered for a medical examination (left); at Tinerhir, an ophtalmologist treats a young patient (right).

...AND AN OPHTHALMOLOGICAL SEMINAR IN EGYPT

At the Kars el Aini Hospital, Cairo, one of the participants At the same hospital, a pre- operative examination of a case of strabismus. in the seminar on eye diseases, Dr. Karl Lindner, professor of ophthalmology at the University of Vienna, examines a patient. COMMUNICABLE DISEASES 15 prepared by the National Drug Company, Swift- Typhus water, Pennsylvania, were approved by WHO for the issue of international certificates of vaccination A study of typhus in northern India was made or revaccination against yellow fever. with a view to planning control measures.Projects for controlling typhus were continued in Afghanistan CampaignsagainstAëdesaegyptiandother insect vectors of disease were carried out in Gua- and Peru. temala, Honduras, Nicaragua and Panama. At the same time WHO has continued to recommend systematic vaccination of populations exposed to Trachoma the yellow -fever virus. After the publication of the first report of the Expert Committee on Trachoma 16(see Annual Smallpox Report for 1952), an increased number of requests The laboratory investigation of four dried small- came in from governments for assistance in trachoma pox vaccines to determine the rate of loss of potency control. As a consequence, WHO consultants carried has continued during the year.The long series of out a series of important surveys in Iran, Morocco testswas almost completed in1953,butfinal (French Zone), Taiwan and Yugoslavia, and the results will not be available until statistical analysis consultant sent to Taiwan also made preliminary has been carried out. This investigation is preliminary surveys in other countries of the Western Pacific to further laboratory experiments and to field trials Region :Brunei, Cambodia, Hong Kong, Malaya, on man. Work has continued on the field study on North Borneo, the Philippines, Sarawak, Singapore the use of gamma globulin in the seroprotection and Viet Nam.Pilot control projects were started, and serotherapy of smallpox, which is being under- in collaboration with UNICEF, whose Executive taken by the Hooper Foundation of the University Board agreed, during 1953, to include measures of California with the co- operation of the Director - against trachoma among UNICEF's activities.Mass General of Health of the Government of India and treatment projects have also been started on a the health authorities of New Delhi and Madras. limited scale in Morocco, Tunisia and Taiwan.It The results are promising, but more field work must is too early to judge the success of these projects, be done before any definite conclusions are reached. but WHO consultants, who again visited those in The Organization has contributed to this work and Morocco and Taiwan some months after they had is closely watching developments. begun, have given encouraging repórts. Regional committees, panel members and other WHO has stimulated and assisted research in experts were consulted on technical questions which trachomatology,in accordance with the recom- might influence the conduct of a smallpox campaign mendation of the expert committee ;it has started such as was envisaged by the Sixth World Health a programme of co- ordinatedstudies extending Assembly.1d The regional committees have also from virological research to investigations on the beenconsulted,inconformitywithresolution effect of cortisone in cases in which clinical cure has WHA6.18, and a paper was prepared for submission apparently been obtained, with the aim of establish- to the Executive Board at its thirteenth session. ing a possible test of cure, and to histopathological investigations, of practical importance for the solu- Virus Hepatitis tion of pathological and therapeutic problems. The report of the first session of the Expert Com- Another important activity in trachoma which mittee on Hepatitis, held in 1952, was published has been newly started is the exchange of research during the year.15 An investigation was started into workers between Tunisia, Morocco (French Zone), the possibility of collecting infectious material from Japan, Egypt and Iran.Through this programme, different parts of the world, in the hope of finding now under way, it is hoped to clarify many debated a strain of virus that could be studied in the labo- points in the etiology, epidemiology and therapy of ratory. this disease which are essential to better control.

" See resolution WHA6.18, Of Rec. Wld Hlth Org. 48, 23. 15 As Wld Hlth Org. techn. Rep. Ser. 1953, 62 16 Wld Hlth Org. techn. Rep. Ser. 1952, 59 16 THE WORK OF WHO, 1953

Other Communicable Diseases

Diphtheria and Pertussis attention to important problems that would lend The report of the WHO conference on diphtheria themselves to international co- ordination of research. and pertussis vaccination, held in Yugoslavia in These recommendations will be a starting point 1952,17 was published. for work on onchocerciasis. This disease is reported With the support of WHO and UNICEF, im- to affect more than twenty million persons in large munization campaigns were continued inBrazil, endemic areas of Africa and America, and therefore Chile and Colombia, and a campaignagainst represents aserioussocial problem and a real pertussis was started in Mauritius. obstacle to the economic development pf potentially A paper setting out thecriteriaforselecting rich territories. vaccines for use under different circumstances was prepared. A grant was made tothe Medical Research Leprosy Council, London, to support the important field In leprosy control, institutional isolation is being trials of pertussis vaccine that are in progress there. replaced by better organization of health services to ensure the early recognition of cases, and by ambu- Typhoid Fever latory treatment. During the year WHO has assisted the Governments of Burma and Ethiopia with Vaccination against the enteric fevers presents surveys followed by pilot projects of mass treatment, a number of unsolved problems, some of which were on the lines recommended in the first report of the considered during the technical discussions at the Expert Committee on Leprosy, which was published Sixth World Health Assembly. A request from the in 1953.18Because of the nature of the disease, it Government of Yugoslavia for assistance in a field is still too soon to judge of the results. trial of typhoid vaccine provided an opportunity for On the request of the Governments of Turkey and starting work on these problems, and two consultants Thailand, WHO consultants also visited those two visited Yugoslavia to plan the field trial, to be carried countries for surveys and made recommendations on in co- operation with the local authorities.In on organization and methods of control. The coming years further trials will be undertaken in Executive Board of UNICEF accepted in principle, other regions, and the series is being planned as a in 1953, to extend UNICEF's aid to large -scale whole to provide satisfactory answers to the out- modern methods for leprosy control, to be under- standing questions. taken in collaboration with WHO. Due attention has been paid to the suggestions Onchocerciasis of theexpert committee that BCG vaccination Onchocerciasis is a major cause of blindness.In might be used in the prevention of leprosy, and that accordance with the programme approved by the a co- ordinated programme of research should be Fifth World Health Assembly, WHO began its undertaken. The first suggestion was examined work on the control of this disease by convening the by the Expert Committee on Vaccination against first session of an Expert Committee on Onchocer- Tuberculosis at its session in November 1953 in ciasis in Mexico from 23 November to 1 December. Copenhagen,and an internationalco- ordinated The committee discussed advances in treatment study of histopathological material has now been with recently introduced drugs and recent advances started. in knowledge which suggest the possibility of using Collaborationhasbeen maintainedwiththe insecticides to control the vectors at different stages International Leprosy Association, and the Organi- of development. This discussion led to an agreement zation was represented at the Sixth International on standard techniques for surveys of the disease, to Congress on Leprosy held in October in Madrid. At evaluate local problems and to assess the results of thiscongressitwas shown that world interest projects for control. The committee also drew in leprosy has considerably increased ; itwas

17 Wld Hlth Org. techn. Rep. Ser. 1953, 61 18 Wld Hlth Org. techn. Rep. Ser. 1953, 71 COMMUNICABLE DISEASES 17 confirmed that the new methods of treatment and East Pakistan has been delayed by difficulties in the progress made in immunology have offered new recruiting well qualified staff. hopes and permitted the adoption of new policies. The standardization of cholera vaccines and anti- Consequently there has been in many countries gens is described in Chapter 6, under Biological a remarkable revival of activity for the control Standardization. of one of the most ancient and most feared diseases of mankind. Bilharziasis Plague and Cholera Bilharziasis cannot be effectively controlled by The last of the series of articles on plague appeared the health authorities alone ;health work must in the Bulletin during the year ;the series has been be co- ordinated with agricultural development, and collected and will be published, with illustrations, lack of knowledge of the ecology of the snail vectors as a monograph. makesitnecessaryforpublic -healthadvisers, Contact has been maintained with the members malacologists, biologists and sanitary engineers to of the expert advisory panel to obtain their views work as a team.Training of specialists in these on points related to the epidemiology and control different subjects is badly needed. of plague, so that detailed plans may be elaborated WHO is encouraging the revision of the inter- for the research proposed by the expert committee, nationally accepted classification of snails and the whose second report was published during the year.19 setting -up of training courses, and isassisting in An inter -regional programme of co- ordinated fieldtrials. Although the newer molluscocides- research and control is being prepared.It will be especially the halogenated phenol compounds such carried out in Iran, Iraq, Syria and Turkey, and as sodium pentachlorophenate and the dinitrophenol will include a study of the forms of sylvatic plague compounds -give promising results, it is clear that prevalent in those countries. Plans for the plague research project in India, bilharziasis cannot be controlled by molluscocides described in the Annual Report for 1952,20 are being alone. revised and the project for controlling cholera in Control campaigns are under way in Egypt and the Philippines.Research on the newer mollusco- 19 Wld Hlth Org. techn. Rep. Ser. 1953, 74 cides and their application has been fostered, and 20 Off. Rec. Wld Hlth Org. 45, 21 field trials in Egypt were continued. CHAPTER 2

THE TUBERCULOSIS RESEARCH OFFICE

In the early post -war period tuberculosis had shown to be the most important factor in preserving become the major threat to the lives of many people, the allergy -producing properties (see the Annual and international action had to be taken urgently. Report for 1952, Chapter 2) ;the length of time BCG vaccination, conceived by the French and it has been kept in cold storage is relatively un- carried into the international field by the Scandina- important.A vaccine may be recently prepared, vian countries, was seized upon as offering the greatest but, unless it has been shielded from even a short hope for checking the spread of this disease in many exposure to light and heat, most of the organisms afflicted areas, and almost overnight it became a in it may be dead, and it will therefore have lost recognized international public -health operation on much of its potency.These findings have already a large scale. Thousands of persons were vaccinated resulted in new and more economical techniques daily.Naturally, many technical problems arose, for preparing vaccine in the laboratory and for to which there were no ready solutions, and the need handling it in the field. for answers to practical questions, including those The retesting surveys which have followed some of the immediate and the long -range effects of BCG of these mass campaigns in the tropics have shown vaccination, led to the founding of the Tuberculosis that the tuberculin allergy induced by BCG has Research Office in the spring of 1949. been very low compared with the results in the more From itsfirst years of work the Tuberculosis northern countries.Special studies among sample Research Office produced results of immediate and population groups in Egypt, India and Pakistan practical value. have shown that, under carefully controlled condi- Studies in many parts of the world have confirmed tions, BCG can produce an allergy nearly as strong that a single low -dose intradermal tuberculin test as that found among naturally infected persons. may be used to select persons for vaccination ; it is The poor results of some campaigns, therefore, are now known that by measuring the reaction to a not due to any inherent incapacity to respond to dose of 5 IU (international units) of standardized BCG, but most probably to the use of light- killed " Old Tuberculin ", one can separate most persons vaccine. Much earlier than expected, WHO and who have been infected (including those with clinical UNICEF will have to face critical questions from disease) from those who have not, and there is, so many countries about the need for revaccinating far, no indication that the 5 IU test is not equally millions of their people -questions to which no efficient for this purpose everywhere. clear answer can yet be given. Marked geographicalvariationsintuberculin We now know that, within a wide range, variations sensitivity, as shown by pre- vaccination tests, confirm in the technique of the intradermal method have previous indications that the ordinary human (or little or no bearing on the level of tuberculin allergy bovine) type of tubercle bacillus is not the only attained after vaccination, though the size of the source of tuberculin sensitivity in man.The agent vaccinal lesion and the frequency of local abscesses responsible has not yet been identified, but con- increase with depth of injection.It is therefore quite clear that the low level of allergy sometimes siderable progress has been made in distinguishing specific from non -specific reactions to tuberculin found after mass campaigns cannot be attributed both before and after BCG vaccination. to irregularities or variations in the technique of such Such studies obviously have a direct bearing on the efficient vaccination. An important practical implication of these studies is that para- medical personnel can use of the tuberculin test in all kinds of work in tuberculosiscontrol. be trained to give satisfactory vaccinations. The mass vaccination programmes carried out Protection of BCG vaccine from exposure to under the auspices of the International Tuberculosis light and to high temperature has repeatedly been Campaign are described in a series of reports on -18-- THE TUBERCULOSIS RESEARCH OFFICE 19

12 countries covered by the campaign.' These reports the United States Public Health Service laboratory provide a permanent record of the testing of roughly in Atlanta, the capacity of various types of vaccine 21 million persons and the vaccinating of 11 million. to produce tuberculin allergy is being correlated with They give, in a form readily usable for future public - their capacity to confer protection against challenge health work, basic data on the age, sex and residence infection with virulent tubercle bacilli.Blood from of persons vaccinated, and they record epidemio- the large numbers of guinea -pigs used for this work logical information on the tuberculin sensitivity in issent to the Immunization Research Centre in each country at the time of the campaign.This is Copenhagen for serological studies. probably the best single index of the prevalence of There is as yet no indisputable evidence of the tuberculosis that can be obtained for many countries ultimate value of BCG vaccination in public -health in which morbidity and mortality statistics are either programmes.Studies which are now being made absent or unreliable.The value of these reports jointly in Denmark and Finland are expected to give may well increase with time, for the mass vaccination information on certain aspects of the question after programmes have distorted the pattern of tuberculin several more years. For a decisive answer as to the sensitivity for at least a generation to come. value of BCG, however, we must await the results TheTuberculosisResearchOffice,sinceits of the quantitative comparisons of vaccinated and establishment nearly five years ago, has served as an unvaccinated (control) groups in studies now being international centre for discussion and for exchange made by the British Medical Research Council and of information on tuberculosis research. Much of the the United States Public Health Service. time of the staff is spent in discussions with visiting In the future, international agencies will be con- specialists from many countries, which often lead cerned less with emergency measures for controlling to plans for co- ordinated research on various aspects tuberculosis and more with helping governments of tuberculosis.Nearly 60 papers on the results of to develop permanent, well- balanced public- health the office's research programmes have been published. programmes. This broader approach must take into Many problems of BCG vaccination have still account some important changes in the problem to be solved.One of the most critical, whether in recent years.Firstly, mortality from the disease tuberculin allergy may be used as a measure of has been dropping rapidly almost everywhere, for immunity,isbeing vigorously attacked by the reasons that are far from clear. _Secondly, the Tuberculosis Research Office by co- ordinated field advent of potent new antituberculosis drugs may and laboratory studies in man and experimental well lead to an entirely new approach : because of the animals.In the laboratory affiliated to the office, tremendous potentialities of such drugs for rendering the Tuberculosis Immunization Research Centre, active cases non -infectious, it is possible that public - methods developedforstudying theserological health programmes will in future be directed more response to different antigenic components of the to the prevention of infection than of clinical illness. tubercle bacillus are being evaluated on sera from Finally, WHO is now assisting with programmes different population groups :tuberculous patients, in countries where little is known about the frequency tuberculin reactors and non- reactors, and vaccinated and, possibly, the special characteristics of tuber- persons at different periods after vaccination.At culosis.The Tuberculosis Research Office must no longer continue to focus its attention on a limited 1 Reports on the mass vaccination campaigns in Austria, phase of tuberculosis control. International research Czechoslovakia,Ecuador,Egypt,Greece,Israel,Malta, and international health services must respond to Morocco and Tangier, Poland, Syria, Tunisia and Yugo- slavia were published between 1947 and 1953 by the Inter- changing needs and new opportunities -and direct national Tuberculosis Campaign and UNICEF. their programmes accordingly. CHAPTER 3

PUBLIC- HEALTH SERVICES

Strengthening of National Health Administrations

To strengthen nationalhealthadministrations In the year under review WHO has helped Burma, has been the fundamental objective of WHO's Colombia and Panama to survey and improve their assistance to governments. Because of the differences national or local health services.On the basis of in the economic and cultural conditions of countries recommendations of WHO, the Government of and in their social and economic development, a Burma has newly established a Ministry of Health variety of methods must be used for this purpose, and consolidated its national health service. The and the progress may often be slow. Burmese Government has also authorized an increase During the past year, attention has been directed to of 40 per cent in the salaries of medical and para- co- ordinating existing national and international health medical staff in order to encourage them to work full- work, stimulating the improvement and reorganization time in government service. In Colombia, a survey of of health services, and surveying, planning and demon- the municipal health administration in the city of strating integrated health services in local areas. Bogotá was made by a WHO consultant. In Panama, The need to co- ordinate existing national and a WHO team completely reviewed and studied the international health work has been well recognized. rural health services, with a view to their systematic Many countries have set up national co- ordination planning and organization for the whole country ; or planning committees for the purpose, and WHO and, to develop a model health unit in the area of La has assigned to the governments area representatives Chorrera, a wide economic, social and health survey or public -health administrators who take an active was made, in the course of which 400 families in the part in this work. WHO field staff dealing with city itself and others in the adjacent rural district specializedsubjects such as maternal and child were interviewed. health, environmental sanitation, and the control Reports by the health authorities of Belgium, of tuberculosis, venereal diseases and malaria, are France, Norway, Scotland and Sweden on their specially briefed on the importance of considering public -health administration, prepared for the visits each individual project assisted by WHO as an of European senior healthofficers(see Annual integral part of the health service of the country Report for 1952), have since been made available for concerned :the team leader is encouraged not only distribution by the Regional Officefor Europe, to think of his project in terms of developing a together with the observations of the WHO advisers national programme in the subject with which he who accompanied the groups to lead the discussions deals, but to relate that programme to the national on the various health problems.The value of the health scheme.It has therefore been the policy of travelling study groups has been that their members the Organization to recruit specialists with general benefited by the studies made and the discussions public- health training as team leaders. This principle held during the visits and also that the national of integration is making headway in many countries health authorities of the countries visited had the which WHO isassisting.In some countries - opportunity of reviewing the development of their Ethiopia, Indonesia, Iran and Thailand -there is own health services and discussing some of their also at the national level machinery for co- ordinating common problems with public -health administrators the assistance given by WHO with that given under from other countries.Preparations have been made bilateral arrangements by such agencies as the Foreign for another such group to visit Germany and Italy Operations Administration and the Colombo Plan. in April 1954 (see page 93). - 20 - PUBLIC -HEALTH SERVICES 21

In the health demonstration area in El Salvador health administrators and political leaders in the good progress has been made in planning an inte- needforwell -planned,integratedlocalhealth grated health programme in the area.Its admi- services. The expert committee discussed methods of nistration has been unified under a planning board, planning an integrated health programme for local " Junta Planificadora ", on which all the interested areas, and considered that well- balanced services ministriesandinternationalorganizationsare for these areas could be most efficiently provided by represented.Early in the year, a meeting was held organizing local health units.An expert has been to discuss the health programmes which the Ministry invited to prepare a special paper on the organization of Health and Social Welfare and the Ministry of the and operation of rural health units for the technical Interior proposed to develop in the area during 1953. discussions onpublic -healthproblems inrural Responsibilities were gradually decentralized and the areas, to be held at the Seventh World Health services co- ordinated. A series of four health centres Assembly. has been planned, the buildings for which have now The United Nations have issued reports on several been constructed or remodelled with the co- operation missions which they sponsored in 1952 and in which of the people in the communities. One is already WHO participated. The report of the United Nations in operation in the principal city of the area, Quezal- Social Services Mission to Burma recommended tepeque, where a training centre has also been set up, the establishment of rural health centres as the water -supply installed, a sewage system planned, and first step towards bringing essential health services to courses conducted for auxiliaries in public- health the people in rural areas, who constitute 85 per cent nursing and sanitation.UNESCO, FAO and ILO of the total population of that country. The report have made surveys in the area, and UNESCO is on the joint survey carried out by the United assiting the Government with a training programme Nations, ILO, UNESCO, FAO and WHO in the for teachers in primary schools. High Andes contains the recommendation that a rural health centre should be established in each of The programme in the Calioub health demon- the three national divisions (Bolivia, Ecuador and stration area in Egypt was started in March.1 The Peru) of the plateau on which the Indians live, as Egyptian Government, to provide a unified direction a means of eventually providing organized health of policy and operation for this area, has set up the services (for a further report on this survey, see Calioub Health Board, consisting of representatives Part IV, project of AARO 6). A WHO expert will of the different ministries and specialized agencies be recruited for the joint field mission which has concerned, and has contributed Egyptian £250,000 started work in the area on the second part of the for health work in the area. WHO has recruited for programme to improve the economic and social the project two public- health nurses, an epidemio- conditions of the Andean Indians.The reports of logist, a sanitary engineer, a statistician and a health the United Nations community organization and educator. development survey missions to South -East Asia and The discussions at the second session of the Expert to the Eastern Mediterranean in 1952 have shown Committee on Public- Health Administration, held that health work can provide a good basis for com- in September, should stimulate the interest of public- munity organization.

Environmental Sanitation

TheOrganization'senvironmentalsanitation concern to several governments, disseminate tech- work widened considerably in scope during 1953, nical information and stimulate the interest of pro- mainly through an increase in services of a regional fessional groups. Activities in the year under review or worldwide character. A substantial amount of included : the work was done in collaboration with United (1)The study of sanitation problems of rural Nations agencies and other organizations. The objectives of WHO, in this aspect of the areas and small communities ; programme, are to study major problems of common (2)Preparations for the establishment of inter- national standards of water quality and standard 1See Off. Rec. Wld HIM Org. 45, 130. methods of water examination ; 22 THE WORK OF WHO, 1953

(3)Preparatorywork,incollaborationwith In order to make recommendations to governments the International Civil Aviation Organization (ICAO) on the important place which should be given to for a manual of sanitation practices at airports ; rural sanitation in the future programmes of their healthadministrations, WHO convened athird (4)Susceptibility of lice to insecticides -a study session of the Expert Committee on Environmental undertaken in close collaboration with Member Sanitation in July. Members of the Expert Advisory governments, to develop reliable methods for the Panel on EnvironmentalSanitationandother control of louse -borne diseases ; specialists in sanitation helped in preparing for this (5)The effect of storage under tropical conditions session, to which 35 experts from different countries on various water -dispersible insecticides ; contributed working papers.The report of the session, which contains practical suggestions for (6)Problems of housefly control in the countries actionin.ruralsanitation, will be submitted to of the Eastern Mediterranean ; the Executive Board atitsthirteenth session in (7)Participation in preparations for the sympo- January 1954. sium on insect control, which was held in Rome The Expert Committee on Environmental Sanita- in October under the sponsorship of the Regional tion at its first session in 1949 had recommended Office for Europe and the Istituto Superiore di that WHO should give early consideration to inter- Sanità ; national standards for evaluating the bacterial content and chemical and physical qualities of drinking - Help in planning and organizing a group (8) water.2During the latter part of 1952 the Organi- training course on the control of milk quality and on zation received requests from two different sources to milk processing. This course, planned in detail by the sponsor an international standard of drinking -water FAO /UNICEF /WHO Inter -Agency Working Group quality and to study the related subject of standard on Milk and Milk Products, also held in Rome, was methods of water examination. One request came as attended by 40 milk officials and milk -plant managers a result of the Third Seminar for European Sanitary from 11 countries of the European and Eastern Engineers ;the other from the International Water Mediterranean Regions (see also page 13). Supply Association.In response, the Organization (9)The training of all kinds of national workers called an informal meeting of several European in sanitation. waterworks experts and engaged a special consultant. Notes on water quality were also prepared for the In all this work WHO has received the ready co- manual on the hygiene and sanitation of airports, operation of governments, which have supplied the on which WHO is working with ICAO. After these basic data required,of members of the expert preliminary moves, WHO, at the beginning of 1953, advisory panels on insecticides and environmental canvassed most of the countries of the world to sanitation, and of other experts and organizations in determine whetherofficialstandardsof quality many countries. were in use, and what the existing standards were. In recent years, increasing attention has been This canvass has shown that the principle that there given to the improvement of sanitary conditions in should be official standards of water quality is rural areas and small communities, in which two - generally accepted, but that there is little uniformity thirds of the world's population live. In some in the standards applied, except in the Americas populous regions more than 80 per cent of the and in countries of the British Commonwealth. The people live in rural districts where there is little or no replies to the preliminary canvass were summarized provision for even the most elementary sanitation at headquarters and distributed tothe regional needs.Similar conditions often occur in the rural offices.At the end of 1953 the Regional Office for areas near towns, where they are a danger not only Europe convened a group of public- health specialists to the inhabitants of those areas, but also to the and experts on waterworks to consider the informa- neighbouring townspeople. In such regions the tion on water standards that was already available death -rates for children in the 1 -4 age -group may and to prepare comments on it for the guidance of be 30 to 40 times as high as in countries with good WHO. Another group will meet in 1954, and two sanitation. An indication of the importance that is or three other regions will probably convene similar now attached to this problem is that the technical meetings.After the regional discussions WHO will discussions at the Seventh World Health Assembly - call a meeting of experts from the different regions on public- healthproblemsof ruralareas -will include rural sanitation. 2 Wld Hlth Org. techn. Rep. Ser. 1950, 10, 15 PUBLIC -HEALTH SERVICES 23 to consider the situation and to prepare a draft advanced study abroad have been awarded. Projects international standard for submission to Member of this type were the training course for sanitary States with the recommendation that it be adopted, inspectorsinLiberia,which was completedin particularly in airports handling international traffic. March 1953, and the programme for the training of In the meantime, since the need is urgent, WHO is environmental sanitation personnel in Brazil, Chile drafting a provisional standard which can be used and Mexico, which began at the end of 1952. These until an acceptable international standard is finally are projects listed in Part IV. agreed upon. WHO has also assisted governments with specific Another significant example of the year's work is sanitation problems, such as fly and insect control, the survey of the susceptibility of lice to insecticides. garbage disposal, and the study of sanitary conditions Reports that certain insect vectors of disease are in and around airports.Malaria teams sent out by developing resistancetoinsecticidesare causing the Organization have included sanitarians who, by concern to many health workers.During the past their work, have shown the place of sanitation in decade, DDT powder and other insecticides have national programmes for malaria control. Altogether, been used with great confidence for the control in 1953, WHO assisted with 35 projects in which of disease -carrying lice.There is now a danger that 42 sanitation specialists were working in 37 countries. the lice may be slowly developing resistance, which As may be seen from the above outline, special may produce a serious public- health problem of world attention has been given during the year to those significance. WHO has begun a world survey of the branches of environmental sanitation in which WHO susceptibility of lice, to obtain the fullest possible can best develop a programme in co- operation with technical information, and has sent a circular to all governments and other international organizations. Member governments giving the detailed plans for This practice will be continued and increased in the this survey : in order that all tests may be conducted future. There are other aspects of sanitation, in a uniform manner with the same materials, a however, on which only a beginning has been made special kit has been prepared containing powders -such as the exchange of technical information, of DDT, BHC and pyrethrins.The data thus the health aspects of housing and town planning, and from different areas will be comparable of rural sanitation. and will be carefully analysed. It is expected that WHO will continue to advise The aims of direct assistance to governments in and assist governments in initiating, developing or environmental sanitation are to improve teaching strengthening services in urban and rural sanitation and training, to strengthen national health admi- and in integrating them into their expanding national nistrations by advisory services, and to demonstrate public -health programmes. In many countries, accepted proceduresinsanitationand modern thescarcityof qualifiedauxiliarypersonnelin methods of insect and vector control. WHO has sanitation and allied subjects will remain an obstacle been particularly concerned with the training of to the development of these programmes for several national workers of all kinds during the past three years to come, and there are therefore strong reasons years ; international experts have been provided to for continuing to give high priority to the environ- start training schemes or toassist in improving mental sanitation projects which will train workers those which alreadyexist,and fellowshipsfor to carry on services in public health and sanitation.

Nutrition

Two important meetings on nutrition were held indications as to the form of its future activities in in November and December 1952 under the auspices these two fields of nutrition, and much time has of WHO. A joint FAO /WHO meeting in the since been devoted to following up their recom- Gambia, West Africa, dealt with protein malnutrition mendations. in the mother, infant and young child as a world In 1953 WHO participated with FAO in two problem.The other meeting, held in London, was regional conferences -one in Bandung, Indonesia, a WHO study -group on the control of endemic attended by delegations from countries of South - goitre. Both groups provided WHO with clear East Asia, and the other in Caracas, Venezuela, to 24 THE WORK OF WHO, 1953 which countries in both the Western Pacific and the opportunities for this function of WHO :not only Americas sent delegates.The findings and recom- is there now much research into the diseases caused mendations of both groups were presented to the by protein malnutrition inthe widely scattered tworegional conferences ;and leading workers, countries in which it exists, but studies are also going delegated by their countries, thus had the opportunity forward on protein metabolism in countries with todiscussat length reports resulting from the higher standards of living, where the disease is not meetings of world authorities.From this point to be found. These two fields of research are com- of view alone, such conferences are of great value. plementary, and willbenefit from being closely How the findings fit into the pattern of disease in co- ordinated. the individual country, and how the measures for The Josiah Macy Jr. Foundation of New York is control recommended can best be applied,are interested in the work on protein malnutrition and clearly subjects for this kind of discussion profitable donated a sum of money which enabled WHO and both to the delegations and to WHO. FAO to invite six workers from different parts of the At both regional conferences much interest was world to attend a meeting, held in Jamaica in No- shown in the problem of protein malnutrition, and vember. It was thus possible to bring leading research delegateshad valuablecontributionstomake. workers together to exchange views, learn of new Although the same %undamental disease is found in developments as a whole and consider the advances the malnourished peoples throughout the world, the likely to result from them. manifestations differ in the various regions,the The study group which met in 1952 was able to staple foodstuffs being perhaps the most important give a clear directive as to the prevention of goitre causes of these differences, which may be of great in countries where only crude sun -dried salt is used. assistance in indicating the parts played by various It has been established that iodine given in the form factors in. the etiology of the condition.In Asia of iodate is available to the thyroid gland, and important investigations and surveysarebeing field trials have indicated that endemic goitre can be carried out, generally by the countries themselves. In controlled by the use of iodates.Iodates are much Indonesia, however, where the disease appears to more stable in crude salt than iodides, the use of be one of the most important public -health problems, which requires stabilizers and for which the total WHO hassuppliedconsultantstoassistin cost of the chemicals is somewhat higher than for establishing its incidence.Reports on all this work iodates.Also, simple machinery has been designed were presented at the meeting in Bandung. Reports for crushing the crude salt and enriching it with on surveys made in Central America and Brazil, with iodate. This knowledge may go a long way towards assistance from WHO and FAO, were submitted solving the problem of preventing endemic goitre to the Third Latin American Nutrition Conference in large areas of the world.It has certainly aroused in Venezuela. These reports, together with the fresh interest, and it appears likely that a number publicationsofthecountriesthemselves,have of countries using crude salt will attempt to exercise shown that in some countries protein malnutrition the same control as has already been achieved in is of prime importance as a cause of morbidity and countries where free -running saltisused. The mortality in the younger age -groups. Means of delegate of India informed the conference in Bandung control were the subject of much discussion at both that a State in his country in which endemic goitre conferences. is of major importance -economically and socially, At its 1952 session, the Joint FAO /WHO Expert as well as medically -is preparing to try out on a Committee on Nutrition recommended thatthe limited scale the techniques recommended by the twoorganizationsshouldconveneindifferent study group, namely the use of iodate for iodizing regions periodic small joint meetings of experts on crude sun -dried salt.This preliminary work will protein metabolism, who " should review progress be done in close co- operation with WHO. and recommend lines of research which might be The field trials referred to above were carried out supported by research foundations and other appro- in Central America under the sponsorship of the priate bodies ".3 WHO accepted this recommenda- Instituteof Nutritionof Central America and tion as being in line with the Organization's policy Panama, and were reported at the regional nutrition ofstimulatingandco- ordinatingmedicalor conference in Caracas.They have created a wide scientific research rather than itself directly under- interest in the control of endemic goitre in the Region, taking such work. Such joint meetings offer unique and a number of countries are taking steps to try out this new method.At the meeting in Caracas, 3 Wld Hlth Org. techn. Rep. Ser. 1953, 72, 19 therefore, the matter was discussed at length, and PUBLIC -HEALTH SERVICES 25 recommendations were made on surveys of endemic morbidity and mortality.This can be done by the goitre, and on levels and methods of iodization of salt, public- health nurse if she herself is properly educated etc., based on experience in Latin America. WHO in these matters and understands the people among will keep in close touch with developments in this whom she works. A consultant with wide experience field, and plans have been made to send a consultant in paediatric practice in tropical countries visited on the technical aspects of salt enrichment to a the Eastern Mediterranean, South -East Asia and number of countries in Latin America. WesternPacificRegions and reported on this In both the regional meetings, attention was important aspectof maternal and child health concentrated on techniques of education in nutrition, work. and the Bandung conference recommended that In order to change the food habits of rural com- international agencies should consider holding a munities, so that they may make the best use of all seminar to improve methods of imparting informa- foods which are or might be produced, it is essential tion to the public in such places as maternal and child to know what the habits and customs in such com- health centres and schools. munities are. WHO is therefore summarizing the In many countries throughout the world, WHO, existing literature on nutrition problems and dietary with UNICEF help, is building up maternal and customs in different regions of the world. A consul- child health services ;one aspect of this work tant who herself worked in Africa for a number of appearstomeritparticularattentionhere -the years has compiled a manual on dietary practices education innutrition given to the public -health and customs in Africa south of the Sahara. nurse, upon whose training and personality the At the request of the Chief Medical Officer of effectivenessoftheseserviceslargelydepends. UNRWAPRNE an expert from headquarters visited Nutritional deficiencies in the infant and young child the Eastern Mediterranean Region, where he made are among the most important causes of sickness in a survey of the state of nutrition of the Arab refugees many countries, and education of the mothers (see page 34).This is the third such survey which in proper feeding practices can do much to reduce WHO has made.

Mental Health

It becomes increasingly evident that the methods each country, make any simple transplantation of which WHO has used to support the traditional techniques by demonstration teams unlikely to be branches of public -health work are not wholly successful for mental health. appropriate for developing an international pro- The use of short -term consultants enables the gramme in mental health.In mental health, the Organization toput an expertof international Organization inherited from the permanent and standing temporarily at the disposal of a Member emergency international health organizations which State, where he can assist the national experts to preceded it no secure foundations on which to build. survey the country's problems and plan services In its first few years, therefore, it has been attempting to meet them.Those services, it becomes evident, to evolve methods which are appropriate to inter- can in the long run be developed only by the nationals national action in this field. of the country itself, but WHO can provide fellow- One traditional method of assisting governments ships, and the visiting short -term consultant can has proved most valuable -the use of short -term help to select the nationals to whom they should be consultants.Long -term international staff, on the given, as has been done in 1953 in Guatemala, other hand, appear to be much less appropriate for Japan, Lebanon, the Sudan and Syria.It should be use in demonstration or teaching projects in mental remarked that the length of fellowship which is health than in traditional public -health activities. necessary for postgraduate training in psychiatry The shortage of first -class mental -health workers, or a related subject is often grossly underestimated. eveninwell -developedcountries,and theun- Such activities, however, benefit only one country. desirability of recruiting for the Organization any In 1953 there has been an increase in inter -country who are less than first -class, the impediment that a activities, in the form of seminars on mental- health foreign language presents to mental- health practice, projects, to benefit all the countries of a region. A and the extent to which psychiatric problems are South American seminar on alcoholism was held influenced by the social and cultural pattern of in Argentina ;one on the mental -health problems 26 THE WORK OF WHO, 1953 of childhood was held in Australia for countries of the concernedwithnurseryschools,nursery -school Western Pacific Region ; the Lebanese Government teachers and their training,the implications for acted as host to a WHO seminar on the development such work of modern knowledge of child psychiatry of psychiatric services for the Eastern Mediterranean and child psychology. This report has been published Region, and in the Netherlands there was a seminar in the UNESCO series, Problems in Education. for European countries on the mental -health aspects The third report of the WHO Expert Committee of public -health practice. The success of these on Mental Health, which was also published during seminars suggests that this type of activity is parti- cularly appropriate to WHO's mental -health pro- the year, was devoted to community mental -health services.5This report summarizes for the benefit gramme. The presence of international experts brings to such meetings new knowledge which is of the health administrator the consensus of opinion ripe for application ;the participation of workers of a group of international experts on the role, from the different countries of the region provides function and administration of the modern com- not only a forum in which the application of that munity mental hospital, a subject much neglected knowledge is discussed by national representatives even in some of the most developed countries. who are well acquainted with the regional back- For certain types of study, however, the use of a ground, but also a stimulus for applying that know- short -termconsultantwithan unusually good ledge and experience in the countries to which they knowledge of the subject concerned proves more return.It has already been possible, for example, to appropriate than an expert committee. An example see the after -effects of the Scandinavian seminar on of this was the monograph, published in1953, child psychiatry (referred to in the Annual Report entitled The African Mind in Health and Disease.° for 1952) in a national seminar since organized in Besides bringing together much material which has Norway, at which participants in the WHO seminar never before been reviewed initsentirety,this were able to share the results of their experience with monograph poses questions which may stimulate colleagues in their own country.In the same way, further investigation of a subject of wide significance. the experts who participated in the South American Its interest extends beyond the scope of the psycho- seminar on alcoholism are already planning to logist and psychiatrist : it has implications for all who continue the interest which it stimulated by making are concerned with Technical Assistance to under- co- ordinated surveys of alcoholism in their own developed areas. A further study, which was begun countries. r in 1952 in an attempt to correlate current findings If the main function of a regional programme in on child development and its disorders, derived from mental health is to spread knowledge which has electrophysiologicalandpsychologicalresearch, reached the stage where it can be applied in a public - has developed into a general examination of current health programme, the mental -health work at head- trends of research in all the different disciplines that quarters is chiefly devoted to helping the development deal with the psychobiological development of the of knowledge toa point where itwill become child. applicableinanationalhealthadministration. An inquiry on legislation affecting the treatment Several reports published during 1953 illustrate this of mental disorders was sent to Member govern- role of the Organization.The report of the joint ments, from which details of existing legislation United Nations /WHO meeting on the mental health were obtained. A critical survey of this legislation aspects of adoption,4 for instance, provides a concise is now being undertaken, with a view to putting statement by experts on this subject, for the benefit forward guiding principles for consideration by the of national administrators concerned with legislation many governments that are proposing to replace and procedures of adoption. In its own field it may obsolete laws on this subject. well have as much influence as the monograph A considerable amount of material has been Maternal Care and Mental Health has had in many collected on alcoholism, in preparation for a series countries on the legislation and practice of general of national studies. Preliminary work has been child care. begun on a study of electrophysiological and psycho- Mental Hygiene in the Nursery School, the report of a meeting of experts held jointly by WHO and UNESCO, summarizes, for the benefit of those 5 Wld Hlth Org. techn. Rep. Ser. 1953, 73 6 Carothers, J. C. (1953) The African mind in health and disease, Geneva (World Health Organization :Monograph 4 Wld Hlth Org. techn. Rep. Ser. 1953, 70 Series No. 17) PUBLIC -HEALTH SERVICES 27 logical changes in children suffering from kwashior- it can be applied to the local needs, conditions and kor, a condition which produces marked psycho- possibilities in particular countries, and when it logical retardation at a critical period of a child's facilitates the interchange and distribution of that development. knowledge.Studies at headquarters, meetings of The lesson to be drawn from the first five years of experts, regional seminars and consultants to assist WHO's work in mental health is therefore that the countries in studying their problems are the essential programme is most likely to be successful when it components of such a programme. helps to develop new knowledge to the point where

Maternal and Child Health

Many of the countries that ask WHO for help on WHO has often emphasized the need for inte- problems relatedtomaternal and child health grating health work for mothers and children into require, in. the first place, advice on how to improve thegeneral healthservicesforthe community. their existing services.For this purpose, WHO has This need is particularly great in projects in environ- assigned consultants to some countries, and the mental sanitation,the control of communicable special advisers appointed to the regional offices diseases, the improvement of nutrition, and health have made visits to many others. education, for these factors have great influence on All too often countries lack both trained personnel childhood mortality and morbidity. During the year and essential equipment.The aim of WHO has, progress has been made in combining such projects therefore, been to build up national training pro- with services for mothers and children, particularly grammes in maternal and child health for doctors, in the health work in rural areas that is going on in nurses, midwives and others concerned with the Ceylon, El Salvador, India, Taiwan and Thailand. health of mothers and children in the community. School health services are poorly developed in International teams of doctors and nurses have been many countries, and WHO has encouraged the working with national staff in maternal and child co- operation between health and education authori- health demonstration centres in 20 countries. Most of ties which isnecessary to improve them. The the work has been undertaken with UNICEF, which WHO Expert Committee on School Health Services, has provided equipment and supplies both for the in the report on itsfirst session, held in 1951,7 main centres and for the expansion of services to emphasized that for a well -balanced health pro- smaller centres, which are set up in other parts of the gramme the most effective planning of school health country when trained staff is available to serve in services combines these services with others, such as them.In Pakistan, for example, the Government, thoseforinfants and pre -school children, and with international aid, has established four training co- ordinates them with the work of public -health centres of this type. The first of these, in Lahore, is departments and the services of general practitioners now continuing its work under national supervision, and hospitals. the WHO team having been withdrawn after working Manycountriesareconsideringintroducing there for two and a half- years. The Lahore project measures to provide for the care of children who is of particular interest because the type of training areparticularly vulnerable because of physical, for community health visitors, which is now being mental or emotional handicaps. WHO has from time carried out in the other training centres in the country, to time given guidance on these problems both by was started there.The aim of this training is to visits of individual experts and by recommendations provide, in as short a time as possible, a sufficient in the published reports of such expert committees number of health workers who, without having as the Expert Group on Prematurity,8 the Joint general nursing training, can undertake the care Expert Committee on the Physically Handicapped of mothersbefore,during andafterdelivery, Child,8 and the Joint UN /WHO Meeting of Experts and are capableof supervisingthehealthof 7 Wld Hlth Org. techn. Rep. Ser. 1951, 30, 8 mothers and children and of the other members 8 Wld Hlth Org. techn. Rep. Ser. 1950, 27 of the family. 9 Wld Hlth Org. techn. Rep. Ser. 1952, 58 28 THE WORK OF WHO, 1953 on the Mental- Health Aspects of Adoption.1° During with the International Paediatric Association, WHO 1953, a WHO consultant visited Japan and the is now carrying out a study of paediatric education Philippines to advise on the care of premature infants, in most of the countries of Europe and may extend and a meeting of experts was called by the United it to other regions. Nations, WHO, ILO and UNESCO to discuss the Although midwifery training has, on the whole, mentally subnormal child. received more attention than paediatrics, the practical An improvement in the teaching of paediatrics training of medical and midwifery students has largely been given in hospitals ; WHO is now en- to doctors, nurses, and medical and nursing students couraging the development of domiciliary midwifery is regarded as urgent.In some cases, WHO has services and training. recommended that governments should encourage the establishment of departments of paediatrics The many interrelated problems in the broad field of child welfare have resulted, in some countries, in in medical schools. At the same time it is necessary the overlapping and duplication of different services toensure a close working relationship between for children ; in others, there are deficiencies which paediatric teaching centres and the public -health might be remedied by increased co- operation be- authorities responsible for prophylactic services for tween the authorities concerned. During 1953 WHO, children.This is not always easy : medical schools with the United Nations and the other specialized are often under a separate administration, and in agencies represented on theTechnical Working many countries the link between preventive and Group on Long -Range Activities for Children, took curative medicine has not yet been established. part in an assessment of services for children in The WHO- assisteddemonstrationandtraining several countries.The results of this survey should projectstrytoforgethislink by encouraging help governments to take stock of their existing medical students to visit or attend courses at the services, and to plan a well- balanced scheme for their maternal and child health centres.In co- operation development.

Nursing

The provision of adequate nursing servicesin phasized as an immediate need the establishment or hospitals and in private homes is a complex problem development of at least one professional school in which few health administrations have yet solved to each country, to provide a nucleus of nurses with a their own satisfaction.It involves both an under- broad training for the future guidance of auxiliary standing of local needs and the efficient use of many grades. WHO is assisting these governments to types of skilled personnel. develop such schools and to include in the curricula The objective of the WHO nursing programme some provision for the teaching and supervision of isto help Member governments to assess their auxiliary workers. particular needs and resources and to provide an The rapid advance of medical science and the increasing number of adequately trained nurses increased possibility of preventing both physical capable of carrying out the essential functions of and mental breakdown are changing the emphasis of their profession. During 1953, the Organization has health services.Throughout the world there is an assistedsixgovernments- Burma,Iran,Libya, urgent need to bridge the gap between scientific Pakistan, Syria and Thailand -to establish or extend researchinhealth anditsgeneralapplication. the nursing divisions in their health administrations In this, nurses and midwives can play an important and to study their countries' immediate and long- part as health educators. Their varied opportunities term needs for nursing services. for frequent and sustained personal contact with A comprehensive nursing service involves the people, and the very nature of their personal and employment,underprofessionalleadership,of professional relationship with children and adults, several different kinds of nursing workers, each place them in a position to win confidence and to with its place in the complete service.The govern- understand the individual, family and community ments that have asked WHO for help have em- problems of the people amongst whom they work. Of the 144 international nurses now employed in 10 Wld Hlth Org. techn. Rep. Ser. 1953, 70 WHO field programmes, 54 are working in schools PUBLIC -HEALTH SERVICES 29 of nursing and 90 in field demonstration and training consideration.What the conferences do is to give centres. The assistance to nursing schools has been a stimulus which may lead governments to take action provided by WHO nursing education teams, one of to improve the nursing services in their countries. whose members is always specialized in the teaching One of the most acute of the difficulties encountered of public -health nursing.Through the work of the by governments in extending and improving their teams, the nursing schools are brought into close schools of nursing is the lack of qualified teachers. co- operation with neighbouring health centres and The Organization's activities in 1953 have included dispensaries and are often able to draw on the various programmes to help to meet the immediate resources of demonstration and training centres also shortage. The fellowship programme has been receiving international assistance.This has been widely used to give the experienced nurse an oppor- done, for instance, in connexion with the work in tunity to train for teaching and administration.In Afghanistan, Burma, Cambodia, Costa Rica, Malaya, Burma,India,Malaya,Mexico,Thailandand Syria and Taiwan. Turkey courses of from three to 12 months have been In nursing, as in. many aspects of public health, organized for local nurses with the assistance of conferences -both national and international -are WHO nursing instructors ; in Israel, a WHO nurse - recognized to be a valuable method of imparting teaching mission gave a six -week course to137 new knowledge and of encouraging the exchange of selected nurses. The medical faculty of the University information and experience.In 1953 WHO helped of Alexandria has, with the assistance of WHO, to organize conferences on nursing in the American, developed plans for a regional college for the pre- European and African Regions.In Rio de Janeiro paration of teachers and administrators, which will 272 nurses from 16 North, Central and South be opened in 1954 (see Chapter 15). American countries met to discuss two problems The availability of local instructors must also be of major concern to them - legislation for nursing taken into account in planning training courses for and education for nurses.Nursing education was auxiliary nurses and midwives, and WHO has started also discussed by representatives from 21 European to train such instructors in certain countries where countries, at a conference held in Switzerland in they are not available locally- Brunei, Ceylon, Costa October. This group of 47 nurses from the hospital Rica, El Salvador, Pakistan, Paraguay, Peru, Taiwan and public- health services was concerned and Thailand. with methods of co- ordinating those two services, WHO teamsassignedtodemonstration and of strengthening team -work and of providing staff training centres in maternal and child health and in education.At the regional nursing conference in the control of tuberculosis and venereal diseases are Kampala, Uganda, in September and October, the helping to train " on the job " local nursing personnel development of nursing education in the African for auxiliary services with the centres. The future of Region was studied by representatives from 20 such personnel will depend on the possibilities for States and territories.For this conference WHO their continued employment and supervision, and prepared a report, on the basis of a consultant's difficulties may arise unless this type of training is survey of the training of nurses and midwives and closely linked with plans for developing nursing and various auxiliaries in the health services of Equatorial midwifery services, as has been done in Burma and Africa.This report and supplementary information Thailand. provided by the delegates enabled the conference to WHO has broken new ground in its examination consider how to adapt teaching to the special qualities of recent nursing legislation and in assisting health and abilities of African nursing students and how to administrations to draft nursing laws. As mentioned provide nursing -school programmes geared to their above, the regional nursing conference in Rio de level of education and cultural development.This Janeiro devoted much of its time to the study of was the first opportunity for representatives of such nursing legislation.Advice on the drafting of new a large number of territories to meet in Africa for the laws was given to countries in the Americas and in the exchange of information on the nursing problems of Eastern Mediterranean Region. On the recommenda- their territories. tion of the Expert Committee on Nursing at its The conferences were organized in such a way as second session," a survey was made of recent legisla- to give to all those attending them the maximum tion in 22 countries. This survey shows that legis- opportunity for active participation.The purpose lators have naturally hesitated to restrict the practice was not to solve any particular national problems ; these are too numerous and, because of the social and cultural factors involved, require individual 11 Wld Hlth Org. techa. Rep. Ser. 1952, 49, 19 30 THE WORK OF WHO,1953

of nursing to legally qualified practitioners before the paration of the report, but it should be available in functions of a nurse can be strictly defined and before 1954. there are enough qualified persons available to Further work on the definition of the function of undertake the necessary work.It points out the nurses is clearly necessary, and the International interdependence of the medical and nursing functions Council of Nurses has recently decided to call an and the tendency, as medical science progresses, for international working conferenceatwhichthis the nurse to undertake new functions. Powers have, subject will receive special attention. however, been given to ministers of health or ad hoc Throughout the year the Organization has main- nursing registration councils to approve schools of tained its close co- operation with the International nursing and their programmes, and to protect the Council and with the Florence Nightingale Inter- titles of nurses who satisfy the conditions of entry nationalFoundation,an endowed international into the profession. The Organization published this survey during the year 12 and distributed offprints trust within the Council dealing with all long -term to interested health and nursing administrators. educational activities.In 1953, on the request of With opinion as to the proper functions of the WHO, which made a grant for the purpose, the nurse still fluid, too rigid a control of her training and Council made a study of advanced programmes in preparation (as was pointed out by the Working nursing education, and an international list of the Conference on Nursing Education in 1952 12) might advanced programmes in 127 educational institutions prejudice development.Recent legislation in some was prepared for publication.The guides followed countriès permits of wide variation in educational in making the study in five of the schools, located programmes for nursing. in different geographical and cultural areas, and The study of the functions of the " assistante illustrations describing the method used, were com- sociale " in France and the " health visitor " in piled in the form of a report, which is also to be England (see previous Annual Reports 14) was com- published. The Council has also done valuable pleted during the year.The regretted death in work on the economic welfare of nurses and on September of Dr. René Sand, who was directing acceptable standards of nursing service in various the study for WHO, will inevitably delay the pre- special fields.

Social and Occupational Health

The rapid industrialization of many under -deve- Body of ILO, and has been published.15 It contains, loped countries, due often to various internatio- among other things, recommendations for measures nal schemes of Technical Assistance for economic to be taken at places of employment to protect and development, has brought with it many problems promote thehealth of workers.The measures affecting the health of workers, and the conservation discussed concern nutrition, communicable- disease of health for efficient working capacity has thus control, environmental sanitation, mental health, become an important consideration in the develop- health education, and health protection for women ment of industrial projects.With this in mind, the and children. Executive Board at its twelfth session (resolution WHO has been helping Egypt, Finland, Iran, EB12.R23) asked the Director - General to study, in Turkey and Yugoslavia to assess their health prob- collaboration with ILO, how activities in occupational lems and to develop suitable programmes to meet health might be strengthened. At the end of the year, them.Plans for assisting these countries to follow a study had been completed for submission to the up industrial surveys made in 1952 had to be con- Board at its thirteenth session. siderably curtailed owing to the financial difficulties The second report of the Joint ILO /WHO Com- of 1953. In some cases there could be no follow -up mittee on Occupational Health was submitted to the at all ; in others the projects could be only partially Executive Board of WHO and the Governing carried out. For the occupational health programme planned for Egypt, for example, it was not possible 12 Int. Dig. Hlth Leg. 1953, 4, 463 to do more than provide three fellowships. 13 Wld Hlth Org. techn. Rep. Ser. 1953, 60, 15 14 Off. Rec. Wld Hlth Org. 38, 22 ;45, 28. 13 Wld Hlth Org. techn. Rep. Ser. 1953, 66 PUBLIC- HEALTH SERVICES 31

A European seminar on occupationalhealth, WHO has begun studies of these diseases, and has on similar lines to the one in Leyden in 1952, was been greatly assisted in this work by the International held in Milan in September (see also page 95). These League against Rheumatism. The Expert Committee seminars are an effective way of stimulating interest on Rheumatic Diseases, convened for the first time among professional people by enabling them to at the end of August, made a general review of the exchange information and experience ;the same chronic rheumatic diseases of aiticular and non - method might with advantage be used in other articular types :its discussions covered nomenclature regions. and classification, incidence and prevalence, pre- Close liaisonhas been maintained with ILO vention and treatment.The committee concluded throughout the year.With the object of improving that because of the lack of precise knowledge of the the procedures for the selection of migrant workers, etiology and pathogenesis of this group of diseases, WHO prepared, with ILO, a draft report on medical specific measures could not at present be laid down criteria for the selection of migrants for ordinary for their prevention and control.Further funda- and heavy work and for work requiring special mental research was recommended. physical ability.In December the two organizations Several countries have asked WHO for assistance called a meeting of experts to put the report into final form, for submission totheir governing bodies. on questions of medical care and hospital administra- A second session of the Joint ILO /WHO Committee tion, but the project in Turkey dealing with hospital on the Hygiene of Seafarers, which was to have been construction and administration was the only one convened in 1953, was postponed till 1954 at the of its kind to be started with Technical Assistance request of ILO. funds during the year. The project for reorganizing medical store management in Ceylon continued WHO continued to collaborate with the United according to plan ;in Peru, the programme of Nations and other specialized agencies on questions assistance to medical records libraries (described in The Organization parti- of medical rehabilitation. detail in the Annual Report for 1952, Chapter 12) cipated in the fourth session of the ad hoc Technical was completed.A study on rural hospitals as Working Party on the Rehabilitation of the Physically community health centres was undertaken by a Handicapped, set up by the Administrative Com- WHO consultant, in order to ascertain what medical mittee on Co- ordination. services are required in rural areas, particularly Projects in medical rehabilitation were continued in under -developed countries, and how they might be in India, Japan, Greece and Yugoslavia -the last provided or improved. This study is being published two with UNICEF, which also provided supplies as a monograph.16 In May, WHO was represented and equipment for the project for the rehabilitation at the Eighth International Hospital Congress, in of physically handicapped children started in Israel. London, at which preventive medicine as a major A preliminary study by a WHO consultant on the function of the hospital, and its implications, was the international co- ordination of the production, fitting central theme for discussion.Many countries will and use of prostheses shows that standards for the be spending large sums in building hospitals of production of limb prostheses are badly needed and various types for many years to come, for the needs that existing requirements are inadequately catered are enormous, and there is an acute shortage of for in many countries. WHO is preparing to convene beds for medical care.The economy and efficiency a meeting of experts in 1954 to consider the problem of such hospitals will be greatly facilitated if the of prosthetic appliances from an international stand- initial planning is carefully done. WHO can help point. The Organization has also held consultations countries in this planning. on the subject with the International Society for the Welfare of Cripples. In connexion with the work of the United Nations for the prevention of road- traffic accidents, WHO has The more effective control of most of the major undertaken to prepare, for the guidance of medical acute communicable diseases and the greater average practitioners, a handbook on the medical examination expectancy of life have increased the relative im- of applicants for motor driving licences. portance of many chronic diseases.Among them, thechronic rheumaticdiseasesareparticularly significant because of their cripplingeffect,the 16 Bridgman, R. F. (1954). L'hôpital rural- Sa structure et prolonged suffering caused to the victim and their son organisation, Genève (World Health Organization: Mono- serious social and economic implications. graph Series No. 21) (English edition in preparation) 32 THE WORK OF WHO, 1953

Dental Health

A dental health consultant was attached to WHO of this study is expected to be published early in for five months early in 1953, to make studies on 1954. dental services for expectant and nursing mothers The consultant also assisted in planning a dental and children, who are particularly vulnerable to health seminar to take place in New Zealand in dental caries and require special dental care.This March 1954.The seminar will last two weeks ; consultant made a comprehensive study on the use of fluoride in the prevention of dental caries, and for all Member governments in the Western Pacific, this purpose visited the United States of America South -East Asia and Eastern Mediterranean Regions and several countries in Europe, where he gathered have been invited to take part and 30 fellowships information on the fluoridation of water and on other will be awarded to participants. Four dental health ways of using fluoride for this purpose. The report consultants will act as discussion leaders.

Health Education of the Public

Noteworthy developmentsin1953inhealth attention was also devoted to the planning and use education of the public included the first two regional of various conference methods which might serve conferences on this subject to be organized by WHO to facilitate discussion and exchange of knowledge in Europe and the Americas.Both were planned, and experience. The response to these inter- country prepared and conducted with the assistance of WHO conferencesandseminars,and thestimulation short -term consultants. afforded to further action within the participating The European conference was held in London in countries, suggest that this type of activity can be of April, 18 countries being represented by leaders in considerable value to the Organization's future work medical administration, nursing, health education, in health education of the public. general education and the social sciences. Represen- One of the most important needs in many countries tativesofvoluntaryhealthorganizationsalso isto provide courses in the methods of health attended.The main purposes of this conference educationformany categoriesofprofessional were to bring together for discussion and exchange health and social workers, for teachers, and for of experience medical administrators and persons leaders in such fieldsas adult and agricultural actively engaged in health education ;to determine education.In recognition of this need the health some of the important constituents of a programme administrations of some countries, in co- operation of health education of the public, and to assist in with faculties of institutes and schools of public the development of health education within the health, are planning to incorporate such training countries of the Region.This conference, like the courses in the regular curricula for medical officers, national meetings held in 1950 and 1952 in the nurses, workers in environmental sanitation, health Netherlands, has already stimulated further develop- education specialists and those engaged in various ments in the countries represented. types of teaching and training. Throughout the year The conference for the Americas was held in the Organization again provided the services of a full - Mexico City in September.The participants, from timelecturerattheUniversityof Malayain 11countries, represented many fieldsof work : Singapore, to assist in developing training courses in public- health administration, health education of the health education.Consultants were also appointed public, nursing, environmental sanitation, cultural to help to start similar courses at the school of public anthropology, general education, psychology, and health in Ankara, Turkey. teaching of agriculture. A point emphasized by the participants in both A feature of both of these conferences was the regionalconferencesmentioned above was the special emphasis given to preliminary consultation important work that school- teachers and education and planning with health authorities, technical health officialscan doindevelopingdesirablehealth experts and other co- operating agencies and indivi- practices in children of school age, parents and duals within the participating countries.Particular village groups. Sometimes through national initiative, PUBLIC- HEALTH SERVICES 33 sometimes stimulated by the demonstration pro- generally of little value for health education, besides grammes and the conferences in which WHO has being expensive.The Organization has, therefore, taken part, school -teachers have been given some encouraged the production of inexpensive material training in health problems and health education. locally. In August and September, the Organization For thistype of activity the Organization has took part in an international seminar inSicily, assigned consultants to co- operate with the national sponsored by UNESCO, on visual aids in funda- authoritiesinCeylon,Honduras, Sarawak and mental education, at which various methods for Singapore. producing suitable illustrative and visual material The need for training not only health workers but were considered. those in allied fields was also considered at the first Early in the year, WHO helped the Interim Com- session of the Expert Committee on Health Educa- mission of the International Union for Health tion of the Public, held in Paris in December. The Education of the Public to plan the second inter- report on the session suggests basic principles about national conference on health education, which the way people learn, the role of the educator in the was held in Paris.At this meeting, attended by health education programme, planning and organi- about 200 representatives from countries in Europe, zation of health education as an integral component Asia, Africa, and North and South America, the of health programmes, training of personnel and Union was established as an international non- evaluation. governmental organization. Through its co- operation in the work on funda- mental education that certain Member States are The Organization has again provided the services doing with help from UNESCO, the Organization of threeexperienced anthropologists, who have has been able to give to many different types of helped health administrations in two regions to students both instruction and practice in the methods study the cultural characteristics of selected popu- and procedures of health education.Most of the lation groups and, on the basis of their findings, to students attached tothe fundamental education plan and administer health services,train health project have been school- teachers, school admi- personnel, and establish guides for health education nistrators and workers in adult education ; but some work with families and village groups. training in health education methods has also been Some health administrations are becoming more giventonurses,sanitary inspectorsand rural conscious of the need for planning and developing development officers.The Organization has con- health education as an integral part of health pro- tinued to co- operate in the fundamental education grammes for the village or community. It is also being training programmes in Mexico and Ceylon, and in more clearly recognized that much more attention 1953itassigned an internationalpublic -health should be given to finding the educational methods administrator and a health education specialist to and materials most appropriate to the interests and the Fundamental Education Centre for Arab States problems and to the psychological and cultural in Egypt. characteristics of the people concerned. WHO has WHO, with some help from short -term consultants, assigned two Arabic -speaking workers in health has assisted some Member countries in making education to assist with the maternal and child plans for the preparation and production of illustra- health programmes in two provinces of Libya. This tive and audio- visual material and for its use in is a pioneer effort to find out how far workers educational programmes for the general public. trained in education,social sciences and public In these countries, because of differences in language health can helpvillage women, by educational andineducationalandculturalbackground, methods, to accept and to carry out simple procedures imported illustrative materials, such as films, are of housekeeping and personal and family hygiene.

Health Work among Palestine Refugees 17

The agreement with the United Nations Relief Near East (UNRWAPRNE) 18was extended to and Works Agency for Palestine Refugees in the 30 June 1954 by the Sixth World Health Assembly (resolutionWHA6.25). TheOrganizationhas 17 Full accounts of the health work of UNRWAPRNE can accordingly continued to plan and direct the health be found in the annual report of its Health Division, obtainable from its office in Beirut, Lebanon. 78 Off. Rec. Wld Hlth Org. 35, 376 34 THE WORK OF WHO, 1953 work of the Agency's programme and to provide provided by WHO started a training course for a full -time medical officer, a malariologist and a students selected from among the refugees.This public- health engineer and consultants, as described work is expected to have a wide influence throughout in the Annual Report for1952." A grant of the areas in which the refugees live. US $42,857 was again made to the Agency. In the prevention and control of infectious diseases During the 12 months from 1 July 1952 to 30 June the widespread programme of prophylactic immuni- 1953, the total cost to UNRWAPRNE of the health zation played a large part.During a twelve -month and camp maintenance programmes for refugees period, some 261,200 smallpox vaccinations, 253,800 was $3,294,000. This sum includes salaries, medical TAB inoculations, and 269,300 diphtheria inocula- supplies,subsidiesformedicalinstitutions,and tions were carried out. public- health and sanitation services.Part of the total expenditure was forthe maintenance and The malaria -control programme was continued on improvement of living accommodation in camps. a maintenance basis in the Gaza district.In the other districts, work has been concentrated on regions Some 1,800 workers were employed by the Agency's known to be malarious. DDT residual spraying Health Division, 18 being international staff members. hasbeenused,and has provedveryeffective In addition to the help provided for the Agency except in the villages in the north -east Jordan valley, by the host governments, various voluntary societies where complete protection was not afforded because gave assistance in the running of hospitals, poly- the local mosquito vectors began to shun DDT - clinics and maternity and child health services, and sprayed surfaces and took to natural caves and in organizing various training programmes. cracks in the hills as their daytime resting places. Throughout 1953 the general health of the refugees To bring this area under effective control, it has been remained good.There were no major epidemics, necessary to attack the larvae, drain marshy areas apart from a sharp outbreak of measles among the and carry out a supplementary spraying of frontier susceptible child population. Except for one case of villages. This has been part of the campaign launched louse -bornetyphus,noneofthequarantinable by the Yarmuk Agency, which is planning a hydro- diseases was reported.There were 83 cases of tick - electric and irrigation scheme for the Yarmuk and borne relapsing fever, mainly in Jordan and Gaza, Jordan valleys. The technical part of this anti - and 43 of poliomyelitis (40 from Lebanon, Syria malaria work is guided by the WHO malariologist, and Jordan, and three from the Gaza district). who is assisted by a group of malaria technicians Entericfevers and reported casesof dysentery selected from the refugees and trained by him. At decreased ;the incidence of the former was parti- the end of 1953 the Agency recruited an entomologist cularly low among refugee camp residents, who had to work under the malariologist. all been protected by prophylactic immunization. Surveys show that the nutritional level of the The reported number of cases of tuberculosis fell refugees has remained substantially the same as in to half the figure for the previous year, mainly 1952.The FAO and WHO consultants found the because of the development of the tuberculosis main problem to be that of the weanling, who tends services, with a stricter control of cases and more to show signs of malnutrition secondary to the accurate diagnosis, but hospital facilities for this gastro -intestinal disturbances common in this age - disease are inadequate and unsatisfactory. Trachoma group.By the end of the year, food management isstill widespread ;prevention by the raising of surveys had been completed and a beginning was standards of hygiene and health education appears made to improve both the normal food ration and to be the most hopeful approach to this problem. the special food programmes.A nutritionist was A sharp decline in the reported incidence of sero- added to the Health Division, to ensure that the logically diagnosed syphilis -over 50 per cent on the incidence of the previous year- appears to be due best use was being made of the available rations. to the good control provided by the polyclinics and The number of beneficiaries under the supplementary antenatalclinics. feeding scheme has doubled, 6 per cent of the Health education of the public has been recognized registered population being now eligible. as an important means of approach to the public - The training of selected refugees as paramedical health problems of the refugees.A programme, personnel has been continued :they have been sponsored jointly by UNRWAPRNE and WHO, trained in general nursing or as public -health nurses, began at the end of the year and a health educator midwives, nurses for mental -health work, medical orderlies, childbirth attendants, laboratory techni- 19 Off. Rec. Wld Hlth Org. 45, 161 cians, malaria technicians, sanitarians or pharmacy PUBLIC -HEALTH SERVICES 35 attendants.Courses have been run either directly The provision of adequate shelter and water supply by UNRWAPRNE or in conjunction with other and the safe disposal of wastes are the responsibility bodies, such as universities, voluntary societies, and of the Camp and Sanitation Branch of the Health the United States Technical Co- operation Administra- Division. Of the total refugee population of approxi- tion.In 1953, 147 refugees were trained or were mately 871,000, some 242,000 live in 58 camps, the being trained in paramedical subjects. remainder being accommodated in villages and towns. Eighty -one UNRWAPRNE clinics now serve the Accommodation has improved, particularly in Gaza, refugees -an increase of two over 1952 -and there where many huts have been built.In general the are now over 2,000 hospital beds.The numbers of water supply to camps has been adequate, though refugees per available hospital bed in Lebanon, there are local problems. A development in 1953 Syria, Jordan and Gaza are 420, 477, 497 and 311 was the gradual replacement of pit latrines by the respectively.Laboratory facilities have been ade- septic tank types. quate ; they are provided directly by UNRWAPRNE During the year the procurement of medical in Syria and Gaza and by the university or the supplies for the Agency was transferred from WHO Government in Lebanon and Jordan. to UNICEF. CHAPTER 4

EDUCATION AND TRAINING

The education and training programme of the Organization 1 was specially studied by the Executive Board at its eleventh session, held in January 1953, and the Sixth World Health Assembly endorsed the Board's report.2The study, and the discussions of both the Board and the Health Assembly, gave guidance and directives for the development of this programme, the main objectives of which are to assist governments in training their health personnel for work in various branches of public health and for teaching positions ; to help them to develop their own teaching institutions ;to promote the international exchange of experience, and to stimulate interest in modern methods of education and training. WHO's work in this subject falls under three main heads :fellowships, assistance to educational institu- tions, and exchange of scientific information -three aspects of an integrated educational programme. The need for revision of present systems of medical education -a subject of discussion in many countries - is reflected in the second report of the Expert Committee on Professional and Technical Education of Medical and Auxiliary Personnel,3 which was published during the year. The question was also considered at the First World Conference on Medical Education, held in London in August under the auspices of the World Medical Association with the support and participation of WHO. WHO staff and some members of the Expert Advisory Panel on Professional and Technical Education of Medical and Auxiliary Personnel helped to plan and organize the programme of the conference and took part in the proceedings. WHO continued to organize conferences and discussions for the study of regional and national problems of medical education. A European conference on postgraduate training in preventive and social medicine was held in Goteborg in July. In the South -East Asia Region, during the visits of WHO's teams of medical scientists to the universities of Madras and Bombay (India) and of Jakarta (Indonesia), informal discussions on medical education were organized ;they provided a useful exchange of information, experience and ideas, and usually led to an analysis of training problems, in relation both to the country's needs and world trends. The results of earlier programmes of this kind in other countries suggest that these discussions will stimulate the develop- ment of national policies and long -term plans for professional education in medicine and related subjects. Plans were made to hold a seminar on the teaching of preventive medicine and hygiene in 1954 in one of the countries of South America. Similar methods have been used to promote training in environmental sanitation, nursing, health education of the public, health statistics and other subjects :regional and national seminars have been organized on those subjects with the help of visiting teams and consultants.More specialized group- training in various public- health subjects, organized in order to meet the particular needs of countries and regions, is described in detail in other parts of this Report. A list of the international seminars and training courses organized by WHO, or with its help, is given in Annex 5 and Table I, page 87. In many countries where the needs are great and resources scant, WHO has encouraged medical educators and medical and public -health groups and authorities to co- operate in planning and introducing the type of education best suited to the conditions and resources of the country concerned. WHO has now seven years of experience in helping to bring new skills, techniques and developments from the countries where they are available to those that lack them.Either students travel to the teacher

1 Off. Rec. Wld Hith Org. 46, 131 2 Off Rec. Wld Hlth Org. 48, 24 (resolution WHA6.21) Wld HIM Org. techn. Rep. Ser. 1953, 69 - 36 - EDUCATION AND TRAINING 37

(through fellowships) and thus learn in a foreign environment, or the teachers (consultants, teams) themselves go to teach the students in their own country. Both approaches have their merits, and they are complementary rather than alternatives. To an advanced and well -prepared student, travel to foreign countries and acquaintance with teaching and research institutions are, as a rule, both stimulating and illuminating. On the other hand, it is an obvious advantage for the teacher to have first -hand acquaintance with the conditions in which the new knowledge has to be applied, since he can then adapt his teaching to those conditions.If both of these types of benefits are to be secured the two methods must be judiciously combined. WHO has given help in establishing advanced training institutions in some countries where they were lacking or insufficient. In other countries, particularly those without facilities for training in medicine, nursing or sanitation, WHO has helped to prepare long -term plans to increase the nucleus of trained personnel and has granted fellowships for undergraduates in medical or related subjects. In 1953, 51 such fellowships were given to undergraduates of Bolivia, Ethiopia, Laos, Liberia, Libya and Saudi Arabia. WHO's programme in education and training is being developed both on the regional level and in individual countries.The appointment of advisers in education and training to the staff of three regional offices (to South -East Asia in 1952, to the Western Pacific in 1953 and that to be made soon to the Eastern Mediterranean) should contribute towards this objective in regions where there is a pressing need.

The Fellowships Programme

For the first time in seven years, there has been The operation of the fellowships programme has no increase in the yearly number of fellowships been completely decentralized.By the end of the granted by WHO. From a modest beginning of 199 year, two of the regional offices were employing fellowships in 1947 4 the number rose to 1,147 for special medical officers to deal with fellowships ; 1952,5 but was only 894 in 1953.6 The break in the in two others, fellowships were the responsibility upward trend in 1953 is partly due to restrictions of the adviser in education and training, and in each in funds ;it is also due to the fact that those who of the remaining two there was a fellowships assistant participate in conferences, seminars and similar or clerk helping the other medical officers.Head- educational meetings (where no distinction is made quartersstaff, which has been reduced by half, between teachers and trainees) are no longer reported advises on placement for study outside the region as Fellows. The number of persons in this category of origin of the Fellow. In 1953 a list of institutions was 287 and this figure should be added to that for in which training is given was prepared for distri- the 1953 fellowships in order to arrive at a total bution to the regional offices. comparable with that reported in 1952.7 This change Selections of general interest from some of the affects not only the total number of fellowships final reports prepared by WHO Fellows were again shown in Tables 1 to 4 of Annex 16, but also the published in the WHO Chronicle.All Fellows who statistics on distribution and average duration of have contributed to the Chronicle in the past have fellowships, which are therefore not quite comparable been asked to write a short report on their work with those for previous years. since completion of the fellowship,for possible publication. A special article on fellowships in the November issue deals, under the heading " Problems 4 Of Rec. Wld Hlth Org. 46, 140 5 Off. Rec. Wld Hlth Org. 45, 37 of the Fellowships Programme ", with three essen- 6 See Annex 16, Tables 1 to 4 tials for success in this work :the proper selection of 7 I the tables for previous years, they have been classed Fellows, arrangements for study, and the subsequent under" group- trainingfellowships "- usuallyveryshort fellowships for study within a region, financed mostly from use of their services. A directory of former Fellows regular funds and especially concentrated in Europe. is being prepared. 38 THE WORK OF WHO, 1953

Evaluation of the fellowships programme was are now obtained, the subjective elements of appraisal begun through a preliminary experimental study remain :such elements can, however, now furnish of some of the early fellowships.The data were data of greater value, since their interpretation is obtained from the student's application form, the based on accumulated experience in the various notice of award, the final report of the Fellow, his aspects of the fellowships programme. follow -up reports, and the " utilization statement " It will be noted that a high proportion of the sent to WHO by the government two years after students have, after completing their fellowships, hisreturn. The Fellow's contribution towards trained others -and many indeed are still doing so. strengthening the health services of his country was The figures here are impressive because, of all the taken as the basic criterion of the success or failure types of activity listed above, the training of others of the fellowship. may be considered the most fruitful, for thus the The study showed that of the 650 fellowships educational benefit of the fellowship is multiplied awarded between 1947 and 1949, follow -up was many times. possible on 325 ;and data on 140 of these were The information studied also showed that many availableforthecompilationof thefollowing of the contacts which Fellows established while information (the figures are too small to permit of studying abroad have lasted long after the fellow- subdivision by region or country). ship. A number of Fellows have found that these Of the 140 fellowships during 1947 -9 which were contacts help them both to keep abreast of develop- studied, nine were regarded as " wasted " and 131 ments in their specialties and to obtain advice on as " successful ". problems. Reasons for wasted fellowships were that one The above is only a first attempt at evaluation, recipient did not complete his fellowship studies and itis hoped to develop a more satisfactory and five did not return home after their fellowships. method. All the United Nations agencies could Three others were not given employment appropriate contribute to this end, if widely acceptable criteria to their studies. for a successful fellowship could be agreed on.In Holders of the 131 successful fellowships made the at a meeting of the Technical Working following types of contributions to the strengthening Group on Fellowships, held in connexion with the of health administrations :52 carried more respon- 26th meeting of the Technical Assistance Board, it sibility than before ;21 engaged in new types of was agreed that all the agencies would use the forms activity for which they had specialized when abroad ; and try out the procedure of appraisal employed by 95 passed on to others information on the knowledge WHO. they had acquired when abroad ;84 took part in It is perhaps appropriate here to recall a statement schemes for the systematic training of other per- made by Chester I. Barnard, when President of the sonnel ;69 introduced new methods ;15 established Rockefeller Foundation :" Fellowships are uncon- new services and 49 carried out research. trolled experiments in the sense that the kind of Sixty -five of the 131 were considered to have made record that might have been established without definitecontributionstointernationalcontacts, the fellowship remains unknown.Since the aim because 58 had contacts with officials abroad or initially is to choose outstanding individuals, it is with other Fellows ;and 7 were assigned for inter- safe to assume that many of these young persons national service abroad. would have had distinguished careers even without the help of a fellowship. It would therefore be wholly These figures result not from a systematic case - unwarranted to credit to the fellowship itself the by -case survey but from data collected by routine. proud record made by many scores of Rockefeller Their value is dependent upon the degree of interest Foundation Fellows. Fellowship holders themselves of the individual Fellow and upon the completeness affirm,however, thatthefellowship experience, and accuracy of reports from health administrations. wisely planned and coming at a crucial develop- Account must also be taken of the personal factor mental juncture,can contributesignificantlyto of appraisal ;and there is always the question future achievement."8 whether some of the results might not have been obtained without the fellowships. Although the use 8The Rockefeller Foundation (1951) Directoryoffellow- of a standard form ensures that more uniform reports ship awards, 1917 -1950, New York, p. xi EDUCATION AND TRAINING 39

Exchange of Scientific Information

In its work over the last four years to promote the posed of specialists in the basic medical sciences, the exchange of scientific information, WHO has con- clinical disciplines and the public -health specialties, centrated chiefly on what may be called the direct and they endeavoured to illustrate what contributions methods -by which scientists from various countries each specialty could make to the development of are brought together to exchange information on curricula for undergraduate and postgraduate medi- important current problems.Seminars, symposia, cal education so that more emphasis should be and visiting teams of medical scientists were most placed on preventive medicine and public health. in demand and were therefore most frequently used. The team normally concludes its work in each centre In the Americas, the Eastern Mediterranean, Europe, by holding a conference on medical education, and South -East Asia, projects of this type have mainly to discuss how the methods demonstrated by become a significant part of the health programmes. the team can best be applied to local conditions. At All these projects have been carried on in close the conference in Madras, for instance, representa- co- operation between regionaloffices and head- tives of 18 Indian universities exchanged views with quarters,with headquartersattimesacting on the team and were able thus to obtain information behalf of the regional offices and providing the on educational trends in each of the seven countries necessary staff.As in many education and training from which the team members were drawn.The activities, a great number of organizational units of technique of using a visiting team of scientists for headquarters and the regional offices have been the exchange of information is the outcome of years involved in the planning and implementation. of experiment. The response in the countries visited International scientific congresses -a time - by the teams has been most encouraging :specialists honoured method of direct exchange of scientific from all parts of the country have attended the information -have begun to give attention to pro- lectures, demonstrations and seminars, and high- blems connected with the training of graduates and ranking government officials have availed themselves even of undergraduates.WHO, as a matter of of the opportunity todiscusshealth problems. policy, takes no direct responsibility for such con- Interest among the general public has also been gresses but, by its financial support to and close considerable.Particularly gratifying has been the collaboration with the Council for International close co- operation between health administrations, Organizations of Medical Sciences (CIOMS),it at all levels, and medical faculties, both of which helps to co- ordinate them and improve conference have shared fully in the work of the team. techniques. A useful development in 1953 was the The scientific proceedings of the teams are usually convening by the Council of two meetings at which published as a volume (as in Indonesia) by a govern- organizers of international congresses pooled their ment agency or professional organization ;other- experience anddiscussedthemost appropriate wise they are printed in the medical periodicals of means of planning and organizing congresses. the country (as in India).Lectures given by the A modest start has been made in a new form of team that visited Iran in 1951 were published in exchange -thatofresearchworkers -to enable 1953 in Persian by the University of Teheran. scientists engaged in related types of public -health A group of six professors of ophthalmology, from research tovisit one another's laboratories and five countries, went to Egypt in February, when exchange ideas. most of the ophthalmologists of the region were in The work of the teams of medical scientists sent Cairo for the Jubilee Congress of the Ophthalmo- to India and Indonesia in 1953 (also described in logical Society of Egypt. A two -week regional PartII)provided apractical demonstration of demonstration course and seminar on recent ad- the principles advocated by the Expert Committee vancesinophthalmology -a subjectof prime on Professional and Technical Education of Medical importancetotheEastern Mediterranean -were and Auxiliary PersonnelsThese teams were corn- organized. An advisory group on public -health education and training composed of three professors, " Wld Hlth Org. techn. Rep. Ser. 1950, 22 ;1953, 69 in public -health administration, epidemiology and 40 THE WORK OF WHO, 1953 environmental sanitation respectively, also visited of teaching aids, especially of teaching and docu- Egypt for a month.These two smaller groups of mentary films, among educational and research consultants are examples of the type of project institutions -a service in which international assist- referred to as a " special demonstration team ", ance could be valuable -and (2) the exchange of in the Executive Board's study of the education and samples or drawings of instruments and scientific training programme. Their work isin line with apparatus or of modifications made by individual the suggestion made in that study that a smaller workers and teachers, particularly where the use number of subjects should be covered by visiting of the apparatus is now confined to a very limited teams.10 These smaller groups have also previously circle or even to one department or institution. been used successfully for other specialties. WHO has made a modest start in the latter type of In accordance with another suggestion made in exchange. the Executive Board's study, the reports of the The Regional Office for the Americas has started members of the teams which visited India and an information bureau on medical education, and Indonesia, and those of the advisory group on other regions may follow its example. public -health education which went to Egypt, were The exchange or distribution of the proceedings transmitted to the governments concerned.These of medical congresses and of scientific societies is reports provide comprehensive surveys of the coun- a standard method of exchanging scientific infor- tries' medical and public -health educational structure. mation and could be further developed.As a pre- As examples of more indirect methods of exchang- liminary step WHO is compiling a list of national ing information may be mentioned :(1) the exchange scientific societies.

Assistance to Educational Institutions

The assistance given by WHO to professional professional education -is being developed. The educational institutions,first,in providing them importance of improving thecurriculaof such with teaching personnel, and, second, in sending institutions, their teaching methods, qualifications equipment and supplies for teaching purposes, has for teachers and administrative practice, as outlined been expanded in 1953.Professors of anatomy, by the Expert Committee on Professional and Tech- bacteriology, pharmacology, pharmacy, pathology, nical Education of Medical and Auxiliary Personnel preventive medicine and biostatistics were assigned in its second report,'1 has been emphasized in the respectively to Afghanistan, Ecuador, India, Indo- WHO programme. nesia, Pakistan, Paraguay and Malaya (Singapore), The First World Conference on Medical Educa- and in each case teaching materials were supplied. tion, mentioned above, was valuable in bringing In all,16 professors and one dean were working to the attention of medical educators everywhere in.medical and public -health schools on WHO some of the problems connected with the four topics appointments during the year :two of them, the discussed :the selection of students for the study professor of parasitology in Egypt, and the professor of medicine ;the aims and objectives of medical of hygiene in Lebanon, completed their assignments. education ; techniques and methods ; and the Though the appointment to Lebanon was only for inclusion of preventive and social medicine in the one year, its primary objective -to help in preparing curriculum. a national of the country, in installing him as suc- Schools of public health rank high among the cessor to the consultant and in establishing a depart- types of institutions which WHO is interested in ment of preventive medicine based on modern improving.Several countries have been encouraged principles -was attained.There were also in 1953, toestablishsuchschoolsforthepostgraduate 51 instructors in nursing education, appointed by instruction of medical officers of health, public- WHO, working in 19 national educational projects. health nurses, sanitary engineers and other categories Another form of assistance -the giving of advice of health workers, and for this purpose, in India, to educational institutions on various aspects of Japan, the Philippines, Singapore, and the Scandina-

10 Off Rec. Wld Hlth Org. 46, 145, 154 11 Wld Hith Org. techn. Rep. Ser. 1953, 69 EDUCATION AND TRAINING 41 vian countries, WHO arranged for an exchange clarify views on the role of auxiliaries in the pro- of professorships in1953,and sponsored seminars grammes of the United Nations for " community and courses. The first course in public health organization and development ", and it is expected for Scandinavian countries, organized with WHO that the continuation of the work will result in a assistance, in Goteborg in August and September, comprehensive publication. WHO took part in was the result of co- operation of the Scandinavian a regional meeting held in Beirut in September countries and WHO in pooling the resources for which was convened by the United Nations, on the modern postgraduate training of public -health per- training of auxiliary and community workers, for sonnel in that part of Europe.It is expected that the Eastern Mediterranean area.Moreover, the other courses will follow. field projects in which the Organization has assisted The Organization has prepared, and transmitted in several regions have been developed in such a way to UNESCO for publication, alistof material as to furnish further experience as to how best to apply necessary for teaching in medical schools the subjects international assistance to this important problem. of anatomy and histology, bacteriology, biochemis- WHO took an active part in two ad hoc meetings try, hygiene, morbid anatomy, physiology and phar- on community organization and development con- macology.Specifications are included, as a help to vened by the Administrative Committee on Co- professorsinre- equipping theirdepartmentsor ordination in Geneva during the summer. At these purchasing new equipment, and the approximate the scope and objectives of current programmes prices given for the items should be of use to insti- were defined ;information was exchanged on plans tutions that have monetary problems. The list also for1954and1955,and definitions of " community provides indirectly information on the type and organization and development ", " auxiliary wor- content of the teaching of these subjects in various kers " and " community workers " were agreed on. medical schools.For the preparation of the lists, The shortage of senior staff for teaching auxiliary the collaboration of129professors in92medical health personnel has been one of the main difficulties schools was obtained. in many countries.Conclusions reached after a WHO has now published adirectory of the study of the problem are that (1) auxiliary health 568medical colleges in the world. The information workers should have a status of their own in order was collected in co- operation with the International to avoid confusion with fully qualified workers in Association of Universities, which has continued the same field, and (2) auxiliaries should be trained to work closely with WHO on this subject. To for well- defined functions within a clearly developed ensure that the information is kept up to date and organizational scheme and only to the number that where necessary completed, revised editionswill can be absorbed by that scheme, which must provide be issued from time to time.For this purpose a forsupervision by fullyqualifiedstaff.Recom- questionnaire was sent out with the Directory to mendations along these lines have been supported every institution listed. by the Expert Committee on Public -Health Admi- The Organization has also continued its analysis nistration,which,atitssecond session held in of the use, functions and responsibilities, and training September, studied the problem of local health of auxiliary health workers.This has helped to administration. CHAPTER 5 EPIDEMIOLOGICAL AND HEALTH STATISTICAL SERVICES

The First Year of the International Sanitary Regulations

The preparation and entry into force of the to be amended or suppressed entirely ;national International Sanitary Regulations were described legislation in almost ail countries had to be revised. in the last two Annual Reports :1 1953 saw the There was much correspondence between ad- completion of what might be called the introductory ministrationsand theOrganization aboutsuch phase, during which the Sixth World Health Assembly difficulties ; and it should be recorded that, almost completed the legal process of their adoption by without exception, the advice and opinions given by considering the rejections and reservations submitted the Organization and the requests that it has made by Member States on behalf of their overseas and to Member States to alter procedures or modify outlying territories. measures have been so acted upon as to show Althoughseven MemberStatesnotifiedthe clearly the desire and intention of States throughout Director - General that they reserved the right to the world toapplytheInternationalSanitary submit such rejections or reservations, only three Regulations inaspiritof mutual co- operation, did so.A working party of the whole Health understanding and goodwill. Assembly studied the 26 reservations submitted on Not one dispute as to the application of the behalf of 19 territories.Four were considered to Regulations had to be referred to the Committee be in fact rejections, which it is hoped will prove onInternationalQuarantineforconsideration. to be temporary ;14 were accepted by the Health There were, indeed, several points on which the Assembly with or without modification ; four were committee was asked for interpretation or recom- refused, and in four instancesit was considered mendation ;but none called for" arbitration ". that no reservation was necessary. Thisalsoshowsthefriendlyandco- operative The decisions of the Sixth World Health Assembly attitude which has been apparent in this introductory on this subject 2 were communicated to all Members, phase of the Regulations and which augurs well for in order that the States concerned could notify their success. theDirector - Generaloftheirdecisionsunder Article 107 of the Regulations. Several of the American countries understood All but six of the active Member States of the that separate action was required by States parties Organization are now parties to the International to the Pan American Sanitary Code, in order to SanitaryRegulations. The position of several abrogate those of its provisions which referred to overseas and outlying territories with regard to the international traffic and quarantine. A protocol for Regulations is still to be defined. The position at 31 this purpose was drawn up for signature at Havana on 24 September 1952, and the practical enforcement December 1953 isillustrated by Map 1 and its accompanying table (pages 44 -5). of the Regulations was retarded in some of the The first year of virtually worldwide application Central and South American countries because it of the Regulations was completed on 1 October 1953. was necessary to await the ratification of this protocol. This initial period must have been a difficult one This caused some difficulties,particularlyasto for national administrations, local authorities, trans- bills of health, with other Statesparties to the port companies and individual travellers : procedures Regulations. and practices which had been followed for a century The matters referred to above, which required or more had to be changed; measures hitherto interpretation of the Regulations or amendments to thought necessary for the security of a country their text, were considered by the Committee on from the importation of quarantinable disease had International Quarantine, which met in Geneva from 19 October to 4 November.The committee 1 Off. Rec. Wld Hlth Org. 38, 41 ;45, 41 considered the first report of the Director- General 2 Off Rec. Wld Hlth Org. 48, 33, 371 on the working of the Regulations and a series of - 42 - EPIDEMIOLOGICAL AND HEALTH STATISTICAL SERVICES 43 observationssubmittedbyMemberStateson excluding those countries or areas that had recently difficultiesexperienced in theirapplication, with been freed from Aëdes aegypti. It falls to the Seventh requestsforclarificationor amendments. The World Health Assembly to adopt or modify these committee had the benefit of technical advice given proposals. by the expert committees on plague, cholera and TheCommitteeonInternationalQuarantine yellow fever.The Expert Committee on Yellow further recommended that the validity of the yellow - Fever, at its second session, held in Kampala in fever vaccination certificate should be nine instead September, delineated yellow -fever endemic zones of six years ;that no certificate of vaccination and yellow -fever receptive areas.The work of the against cholera should be required of children under expert committee and the survey which preceded one year, and that, in notifications of rodent plague, it are described in detail in Chapter 1, page 14. " sylvaticrodent plague ",which involveslittle TheCommitteeonInternationalQuarantine risk to international traffic, should be distinguished approved the delineation of the yellow -fever endemic from " domestic rodent plague ". zone in Africa proposed by the expert committee, Finally, the committee, taking into account the subject to the agreement of the countries concerned. increasedefficacyofinsecticideswithresidual For the Americas, it suggested an interim delineation action, decided not to propose at this time additional based on that made under the International Sanitary regulations for the control of insect vectors in Convention for Aerial Navigation,1933/44, but international air traffic.

Epidemiological Information -a Requisite for International Quarantine

The success of the International Sanitary Regula- importance may sometimes be found in the press tions, as of any code of practice which, in order to because of the failure of the government concerned control disease, restricts sovereign rights of countries to notify WHO promptly.Early official intimation in relation to international traffic, depends on the of this important information is in every way desir- existence of a spirit of mutual trust and co- operation. able and essential for avoiding criticism of the This spirit can be maintained only by knowledge in internationally adopted system. each country of the presence or absence of dangerous Itisimportantthatnationaladministrations communicable diseases in other countries. should communicate to WHO, asearly and as In thisfieldthe Organization can and does rapidly as possible, all items which they have under- contribute much.The epidemiological information taken to supply to the Organization under the Inter- services which it provides are fundamental to the national Sanitary Regulations and any other informa- success of the International Sanitary Regulations. tion which they judge to be of importance to inter- The system adopted by WHO for collecting and national traffic or of interest to other health admi- disseminating information on communicable dis- nistrations. eases -both quarantinable and non -quarantinable - In order to expedite the handling of information has been described in previous Annual Reports, and ensure that the duties laid on WHO by the and has not changed materially. However, in view of Regulations might be effectively carried out, the the key position of epidemiological information in organization of the epidemiological services was international health and trade relations between thoroughly reviewed before the Regulations came States,itis important to consider the principles into force, and certain changes were made.The on which the epidemiological reporting service is epidemiological and statistical services were merged based. in a single division ; the sections on epidemiological In an epidemiological reportingservicethree information and on morbidity statistics were com- elements have to be taken into account :(1) the bined, and the functions of the Epidemic Watch Unit information sent to it, (2) the handling and study of were transferred to the International Quarantine the information, and (3)itsdistribution to the Section, so as to centralize all " urgent " epidemio- health administrations concerned.It is clear that logical information, whether on quarantinable or non - the Organization can disseminate only such informa- quarantinable diseases. These services are continually tion as it receives officially from national health under critical review, and any adjustments and administrations.It cannot rely on press reports or adaptations found desirable are introduced forth- unofficial information, even though the first intima- with. For example, a recent modification in the tion of an outbreak of a disease of international timing of telegrams exchanged between headquarters MAP 1.INTERNATIONAL SANITARY REGULATIONS Position at 31 December 1953

., . STATES AND TERRITORIES - ETATS ET TERRITOIRES

try77Abound by the Regulations bound by the Regulations position not yet defined Vx /x 1liés par le Règlement \notnon lids par le Règlement dont la position n'est pas encore définie

WHO 4011 I / The map gives a general picture of the position of States and territories with regard to the International Sanitary Regulations as at 31 December 1953.A detailed list of the States and territories bound by the Regulations with and without reservations, of those not so bound, and of those whose position is notdefined, is contained in the following statement. Territories are classified under the names of the State or States responsible for their international relations. BOUND : WITHOUT RESERVATION NOT BOUND Member States Paraguay Italy Kuwait Member States Peru Somalia Leeward Islands Afghanistan Portugal (Montserrat, St. Australia Chile Argentina Spain Netherlands Christopher- Nevis, Burma Austria Germany, Federal Republic 2 Sweden Netherlands Antilles Virgin Islands) Belgium Switzerland Mauritius Bolivia Netherlands New Overseas and Outlying Territories Syria Guinea Malaya, Federation of Brazil Thailand Nigeria Australia Denmark Netherlands Cambodia Turkey New Zealand North Borneo All territories Faroe Islands * Surinam * Canada United Kingdom of Northern Rhodesia Greenland * China Island Territories GreatBritain and Western Samoa Nyasaland Costa Rica Northern Ireland Qatar Non- Member States Cuba UnitedStatesof Portugal St. Helena Denmark Liechtenstein America Angola Seychelles Dominican Republic Uruguay Sierra Leone Sultanate of Muscat and Oman Ecuador Cape Verde Islands Venezuela Macao Southern Rhodesia El Salvador Viet Nam Swaziland Ethiopia Mozambique Yugoslavia Portuguese Guinea Trinidad Finland Trucial Oman POSITION NOT YET DEFINED France Portuguese India Overseas and Outlying Portuguese Timor Sheikdoms Guatemala Territories Uganda Haiti São Tomé and Member States Inactive Member States Principe Windward Islands Honduras Belgium (Grenada only) Egypt * Albania Poland Iceland Belgian Congo Spain Zanzibar Yemen 3 Bulgaria Roumania Indonesia Ruanda -Urundi Byelorussian SSR Iran Morocco (Spanish Ukrainian SSR France Zone) 1 United States of Czechoslovakia Union of Soviet Iraq America Hungary Socialist Republics Ireland Comoro Islands Spanish Guinea Israel French Cameroons Spanish West Africa Alaska Italy French Equatorial American Samoa OverseasandOutlying Territories Japan Africa United Kingdom Guam Jordan, Hashemite French Settlements Aden Hawaii Australia, New Zealand, United Kingdom (continued) Kingdom of the in India Bahamas Pacific Islands (Caro- United Kingdom Fiji (including Tonga) * Korea French Settlements Bahrain line, Marianne and Nauru Island Gambia * Laos in Oceania Barbados Marshall Islands) Gilbert and Ellice Islands * Lebanon French Somaliland Basutoland Panama Canal Zone Egypt, United Kingdom Hong Kong * Liberia French Togoland Bechuanaland Puerto Rico Sudan Leeward Islands (Antigua * only) Libya French West Africa Bermuda Virgin Islands of the Malta * Luxembourg Madagascar and British Cameroons United States United Kingdom Sarawak * Mexico dependencies British Guiana Singapore * Monaco Morocco (French British Honduras France, United British Solomon Islands * Tanganyika * Nepal Zone) " British Togoland Kingdom British Somaliland * Windward Islands (Dominica,* Netherlands New Caledonia and Cyprus New Hebrides Brunei * St. Lucia,* St. Vincent *) New Zealand dependencies Gibraltar Falkland Islands * Nicaragua St. Pierre and Gold Coast Non -Member State Norway Miquelon Jamaica Non- Member States and Territories Panama Tunisia" Kenya Vatican City Andorra San Marino Colombia Tangier, International Zone BOUND : WITH RESERVATIONS Mongolian People's Republic Member States Saudi Arabia (in respect of Articles 61, 63, 64, Ceylon (in respect of Articles 37, 68, 74, 76, 104 69, Al, A6) 1 Associate Member and Appendix 3) Union of South Africa (in respect of Articles 40, 2 A decision is awaited pending the completion of constitutional Greece (in respect of Article 69) 42, 43, 76, 77) procedures. India (in respect of Articles 42, 43, 70, 74, 100 Outlying Territory 3 Signed the Constitution of WHO on 20 November 1953 and Appendix 3) * Rejections or reservations made by territories marked with an Pakistan (in respect of Articles 42, 43, 70, 74, Union of South Africa asterisk have been considered by the World Health Assembly. Com- 100 and Appendix 3) South -West Africa (in respect of Articles 40, 42, munications defining the position are awaited from the governments Philippines (in respect of Article 69) 43, 76, 77) concerned. 46 THE WORK OF WHO, 1953 and the regional epidemiological stations has saved often be done if national administrations made more several days in the issue of information in the Weekly use of WHO's daily epidemiological broadcasts. Epidemiological Record. Surveys have been made and The broadcasts can be picked up in all parts of the steps taken with a view to developing the head- world without any delay beyond the time between quarters' and region' epidemiological and statistical the recognition of the disease by a local health services and integrating them more closely. authority and its notification to WHO by the national Every effort is being made to speed up the disse- health administration.Replies received by the end mination of the information received.The most of the year to a questionnaire on the use made of important information from the point of view of theOrganization'sdailyepidemiologicalradio internationaltraffic -that relatingtoports and bulletin confirm that if fuller use were made of the airports -is broadcast by 15 radio stations :four radio bulletins more effective application of the of them broadcast daily ;the others do so at Regulations would result.This rapid and relatively regular intervals throughout the week. This bulletin cheap method of transmitting epidemiological infor- isconfirmed and complemented by weekly epi- mation will therefore be promoted to the maximum demiological bulletins issued at Geneva, Washington, extent. Alexandria and Singapore, and sent by air to health The new Epidemiological Cable Code (CODEPID) administrations. The Weekly Epidemiological Record, -to which references have been made in former distributed from Geneva, contains information on Annual Reports 8 -was completed during the year quarantinablediseases and the more important epidemics of other diseases such as influenza and and distributed to health administrations throughout poliomyelitis,and now reproducestheformal the world.It is designed to ensure reliable, safe notifications from governments made under the and economical telegraphic transmission of official International Sanitary Regulations.It can therefore notifications, and it will come into general use from now be regarded as the world's official quarantine 1 January 1954.A detailed map supplement is gazette. in preparation. But the speedy distribution of epidemiological During the year, co- operation on quarantine and information by WHO can achieve its aim only in related matters was maintained with the International so far as health administrations use this information Civil Aviation Organization, the Commission for as the basis of their quarantine measures.These Climatology of the World Meteorological Organi- measures would be more effectiveif they were zation, the South Pacific Commission and the South imposed and withdrawn more quickly, which could Pacific Health Service.

Health Statistics

WHO's work in health statistics can be considered on the prevalence of blindness and deaf mutism, under three heads :the collection and publication poliomyelitis, the 1952 -3 influenza epidemic, typhoid of health and vital statistics and of international and paratyphoid fevers, smallpox endemicity, and studies based on them ; action to improve the quality transport fatalities,as well as statistical data on and international comparability of such statistics mortality from several other causes. and studies ; and advice on statistical methods to A study on snakebite mortality in the world was national health administrations and tounitsat also completed ;it will be published in 1954 in the headquarters, regional offices and the field. Bulletin. The epidemiological and statistical studies there- Collection and Publication fore covered a good deal more than communicable diseases. Annual Epidemiological and Vital Statistics, pub- Collaboration with the statistical services of the lished in 1953, included a volume on cases of and United Nations on the collection and publication deaths from notifiable diseases in the period 1947- of statistical data has been improved.To avoid 1949, and another on vital statistics and causes of duplication of requests to national statistical services death in 1950.The monthly.Epidemiological and for information, the United Nations collects popula- Vital Statistics Report contained, in addition to the tion and vital statistics of common interest to the usualtablesofnotificationsof communicable diseases and birth and death rates, special studies 3 Off. Rec. Wld Hlth Org. 38, 44 ;45, 46 EPIDEMIOLOGICAL AND HEALTH STATISTICAL SERVICES 47 several specialized agencies, including WHO, and tion and also to examine the validity of the rules WHO collects information on mortality from causes for classification of deaths.Active work was thus included in the detailed International List. Arrange- carried out for the seventh revision of the Inter- ments have also been made to co- ordinate the publica- national Lists of Diseases and Causes of Death, tion of data of common interest to health and social which is proposed for 1955. workers in WHO's volumes of Annual Epidemiological Staff both in Geneva and at the WHO centre in and Vital Statistics and inthe United Nations London advisedhealthadministrations on the Demographic Yearbook. proper classification of diseases for morbidity and mortality, and in the summer, a WHO staff member gave a course on the subject in the Inter -American International Comparability Center of Biostatistics, in Santiago, which is spon- The work of WHO on the comparability of statis- sored jointly by the Government of Chile, the tics has also been complementary to that of the United Nations and WHO. United Nations, with which active co- operation TheInternationalConferencefortheSixth has been maintained. The United Nations has Decennial Revision of the International Lists of developed recommendations for the improvement Diseases and Causes of Death, held in Paris in and standardization of vitalstatistics -Principles 1948, recommended that national committees should for a Vital Statistics System -and WHO has con- be formed tostimulate and co- ordinate, within tinued its efforts to render mortality statistics more countries, the work on health statistics carried out accurate and valuable for medical and public health inthevariousnationalservices(health,social purposes. security,hospitals,schools,army,etc.) ;these WHO has issued a booklet Supplementary Inter- committees were to draw on the technical advice pretations and Instructions for Coding Causes of of the WHO Expert Committee on Health Statistics Death,4 to facilitate the use of the Manual of the and, in turn, to give the latter the benefit of their International StatisticalClassification of Diseases, experience. The First World Health Assembly Injuries and Causes of Death, and another, Ampli- endorsed these recommendations,6 and countries fication of Medical Certification of Cause of Death,5 implemented them graduallyinthesucceeding to help statistical offices to improve the accuracy of years by setting up national committees on vital and death certificates. health statistics.WHO kept the various national Work was continued on an index of Latin terms, committees informed of each other's work. A most as a supplement to the Manual of the International important step taken in 1953 for the improvement and uniformity of statistics was the conference of StatisticalClassification of Diseases, Injuries and National Committees on Vital and Health Statistics Causes of Death (published in English, French and Spanish), to facilitate the application of the Manual convened by WHO in the General Register Office, in countries of northern and central Europe in London, from 12 to 17 October, with the co- opera- which Latin terminology isstill widely used in tion of the United Nations. medicine. The conferencegave an opportunityforan exchange of views by representatives of these com- The Centre for Classification of Diseases, set up mittees from 28 Member States and Associate on 1 January 1951 by WHO in conjunction with the Members on the ways in which the committees General Register Office of the United Kingdom, has could best carry out their functions. Recommenda- continued to serve as a clearing -house in which tions were made not only on the functions of the proposed changes of procedure in the certification committees, but also on the training of statistical of cause of death and in disease classification are workers and on a number of technical matters tested against many thousands of death certificates. -types of statistics which should be compiled in The material available in the centre and that sent territories at various stages of social and medical by co- operating national health -statistical services development, and methods of securing a greater have made it possible to gauge the probable results appreciation of the value of health statistics and of amendments to the existing international classifica- of encouraging the medical profession to co- operate by supplying data.Other recommendations con- Supplement 6 to the Bulletin of the World Health Organiza- tion cerned the role of the WHO centre in dealing with 5 Supplement 5 to the Bulletin of the World Health Organiza- tion 6 Off. Rec. Wld Hlth Org. 13, 304 48 THE WORK OF WHO,1953

problems relating to the classification of disease, furnished statistical analyses of data, particularly the use of WHO definitions of " live births " and fortheOrganization'sservicesintuberculosis, " foetaldeaths ", and the application of WHO trachoma,cholera,typhoid,malaria and yaws, Regulations No. 1 to the compilation of statistics. and for work in general health demonstration areas. With a view to improving that part of the Inter- Morbidity surveys have also been made. national Classification which relates to cancer and WHO has participated with the United Nations, thus making it possible to assess the value of treat- host governments and other agencies in the training ment of its various forms and stages, the opportunity of statisticians for national health services. Methods was taken of holding an informal meeting of the of epidemiological reporting were taught in a seminar sub -committee on registration of cancer during the on reportingof communicablediseasesinthe session of the Committee on Tumour Nomenclature Americas, held in Santiago, Chile, in December. and Statistics of the International Union against The experience gained by the Organization from Cancer, held in Copenhagen in July. earlier training courses in health statistics held in Santiago, and in Ceylon, Egypt and Japan has Advice on Statistical Methods shown the need for holding such courses in linguis- The value of modern statistical techniques for tically homogeneous areas :accordingly, prepara- assessing methods of treatment and prevention is tions were made to hold, in 1954, a training course now more generally recognized by national health in vital and health statistics in Afghanistan in the administrations and by themedicalprofession. Farsi language. WHO hasincreasinglyused modernstatistical Statistical handbooks forfield and laboratory methods both in the planning and the final evaluation workers are being prepared : that for field workers, of its field demonstration and studies.Thus every primarily intended for the WHO malaria teams, field project, apart from itsdirect benefit to the should alsobe usefulto many national health population concerned, provides data of value for officers.Other statistical studies included a paper research.The technical units at headquarters are requested by the United Nations on measurements making more use of the services of professional of infant mortality rate ; the collection and analysis health statisticians, and regional offices have created of health statistics in rural areas ;and a note on statistical posts to ensure such services. Headquarters, prenatal mortality required for the study group on as part of its work on statistical studies and morbidity problems of the perinatal period, which met in statistics, has provided advice on methods and has Brussels in September 1953. CHAPTER 6

DRUGS AND OTHER THERAPEUTIC SUBSTANCES

Biological Standardization

Work on biological standardization during the reference preparations have been established during year has included the establishment of new inter- the year -aureomycin, bacitracin, chloramphenicol national standards for therapeutic, prophylactic and and dihydrostreptomycin -does not give a complete diagnostic agents, preparatory work for the establish- picture of the work done in this field ; arrangements ment of further new standards and for replacing those are now well advanced for the establishment of a nearly depleted, and a detailed study, in one of the number of other standards -those for aluminium - regions, of the arrangements for the distribution and hydroxideadsorbeddiphtheriatoxoid,purified use of standards under the national control centre proteinderivative(PPD)ofaviantuberculin, system. thyrotrophin, growth hormone, vitamin B12, dextran The work of the International Salmonella and sulphate and oxytetracyline. Escherichia Centre in Copenhagen has continued The projected standard for aluminium- hydroxide toexpand, and theInternational Blood -Group adsorbed diphtheria toxoid deserves special comment. Reference Laboratory in London has completed its Thissubstance,known as" diphtheriatoxoid, first year of operation under WHO sponsorship. adsorbed ", will be a most valuable tool.In most Further steps have also been taken to facilitate countries at the present time statutory obligations (if the sending of biological materials by post. there are any) demand only that a preparation of The seventh session of the Expert Committee on diphtheria toxoid should conform to certain minimum Biological Standardization was held in Geneva in requirements of freedom from toxicity and of pro- October.At this session detailed plans were made phylactic potency.The result is that this toxoid is to continue the work now in progress and to start released for use in man in batches which may vary other related work. in efficacy so much that some may be fifty times as A number of articles on various aspects of inter- potent as others, and there are no regulations or nationalbiologicalstandardizationhavebeen control specifications to show which are the highly published in theBulletinoftheWorld Health and which the less potent ; neither the physician nor Organization.' the parent(foritisusually children thatare inoculated) has any ready means of knowing which is being used. When the international standard for New Standards for Therapeutic and Prophylactic Substances diphtheria toxoid, adsorbed, is eventually established, it will be possible for the producer to calibrate his A list of the few therapeutic and prophylactic preparations, by reference to the standard, in terms substances for which international standards or of international units. He will then be able to give a reasonably precise statement of the potency of 1 Miles, A. A. & Perry, W. L. M. Biological potency and each preparation issued, and the physician will its relation to therapeutic efficacy (Bull. Wld Hlth Org. 1953, 9, 1 -14) ; Humphrey J. H., Mussett, M. V. & Perry, W.L. M. know exactly what he is using.Further, a toxoid The second international standard for penicillin (Bull. Wld preparation calibrated in this way and labelled in Hlth Org. 1953, 9, 15 -28) ;Christensen, P.A. Problems of international units will be described in terms which antivenene standardization revealed by the flocculation reaction (Bull. Wld Hlth Org. 1953, 9, 353 -70) ; Greenberg, L. Inter- will mean the same thing in all parts of the world. national standardization of diphtheria toxoids (Bull. Wld Hlth A point of some historical interest may be men- Org. 1953, 9, 829 -36) ;Greenberg, L. International standard tioned. for tetanus toxoid (Bull. Wld. Hlth Org. 1953, 9, 837 -42) ; In the Annual Report for 1952 it was said Prigge, R. Standardization of diphtheria and tetanus toxoids that that year marked the thirtieth anniversary of the (Bull. Wld Hlth Org. 1953, 9, 843 -9) ;Humphrey, J. H. et adoption of the first international biological standard al. The international standard for aureomycin (Bull. Wld Hlth Org. 1953, 9, 851 -60) ; Humphrey, J. H. et al. The international -one of the earliest formal actions of the Health standard for bacitracin (Bull. Wld Hlth Org. 1953, 9, 861 -9) Organisation of the League of Nations. That - 49 - 50 THE WORK OF WHO, 1953 standard was for diphtheria antitoxin.In these cedure depends on antibody titration in relation to three decades the wheel has turned full circle : work a standard antiserum.It will make it possible to in international biological standardization is again, describe the results of such a diagnostic procedure as in 1922, being focused on a substance to be used in the simplest terms :instead of a cumbersome in combating diphtheria.But now -showing how statement to the effect that a serum under test was the emphasis of modern medicine is shifting from found to be reactive at a certáin titre bearing a cure towards prevention -itisan international particular ratio to the titre observed when testing standard for the prophylaxis of diphtheria that is to the international standard under the same conditions, be established, not, as in 1922, one for treatment. it will now be possible to say simply that the serum In another sense, too, the wheel has turned full was found to contain a certain number of inter- circle. The basic theoretical and practical principles national unitsof agglutinating (or complement - which were followed in establishing the first inter- fixing) activity. national standard were laid down by the famous During the year, international reference preparations pioneer in this work, Paul Ehrlich ;the task of were established for cholera sera and antigens and preparing the new international standard for diph- for cholera vaccines.Further steps were also taken theria toxoid prophylactic has now been entrusted towardsestablishinginternationalstandardsor to the institute which bears his name -the Paul reference preparations for sera used in the diagnosis Ehrlich Institute, at Frankfurt -am -Main. of typhoid and paratyphoid fevers. A study was made of the possibility of establishing an international New Standards for Diagnostic Substances standard of Schick toxin for detecting susceptibility During the year an international standard for to diphtheria infection.Material for a proposed Q -fever serum was established, and an international international standard for anti -D Rh blood -grouping unit for Q -fever complement -fixing activity is to be serum is also being investigated. defined in terms of a specified weight of this standard. An internationalunitforanti - Brucellaabortus Replacement of Existing International Standards agglutinating activity was defined, in terms of a The task of providing international biological specified weight of the international standard for standards does not end with merely establishing and anti - Brucella abortus serum established in 1952. distributing them.Distribution implies depletion, There are two specially noteworthy points about and it is therefore constantly necessary to arrange to these two new standards. Firstly, their establishment replace those of which the stock is nearing exhaustion. demonstrates a lively and growing realization that Standards and reference preparations in this category not the least important way in which the welfare of arethoseforinsulin,foradrenocorticotrophic man is linked with that of his domestic animals is hormone, and for cardiolipin and (beef -heart and that both are susceptible to a considerable number egg) lecithin for the diagnosis of syphilis.Steps to of important infectiousdiseases -the zoonoses- replace the standards for those substances were which each can transmit to the other and which taken during the year. therefore cannot be eradicated except by the joint efforts of medical workers and veterinarians. Among Distribution and Utilization of Standards these diseases are Q fever and brucellosis, and the In all parts of the world there are national control establishment of international standard preparations, centresornationallaboratoriesforbiological in order to give precision to the diagnosis of these standards entrusted with the custody and distribution diseases in both man and domestic animals, is a of biological standards.These centres, established significant advance, achieved by the co- operation of under the auspices of WHO, also give advice, and medical and veterinary workers.This advance, of WHO assists them, especially by advising on the use great importance to human health and welfare, of standard preparations. could not have been made successfully if there had In 1953, by arrangement with the Regional Office not been available to WHO a high grade of veterinary for South -East Asia, a consultant made a tour of that knowledge and experience ; nor could it have been Region toobtain, for headquarters and for the achieved without close liaison with FAO. international centres in Copenhagen and in London, The second point of interest is that, as mentioned a more exact picture of its special needs and problems above, international units of reactivity are being in biological standardization. His mission was also assigned to these two standards. This adoption of a intended to bring to the notice of the regional unit -notation to designate the reactive potency of such administrations and laboratories the most recent sera is a new departure in serodiagnostic work, and it aims and advances in this work at headquarters and can be widely applied wherever a diagnostic pro- in the international centres. DRUGS AND OTHER THERAPEUTIC SUBSTANCES 51

The tour lasted about four months and covered tion under WHO sponsorship, tested 2,894 red cells most of the important production and research specimens from different parts of the world, for all centres for biological materials in all parts of the or most of the known blood -group antigens.The Region. The recommendations that came from the samples were taken mostly from staff members of the tour will be useful, not only in that Region, but in laboratories concerned and will serve as panels of shaping future policy in work on biological standar- blood -group antigens for testing unknown sera.In dization at headquarters, in the two international addition,1,673 red cells specimens, also from all centres and thus, indirectly, in all the WHO regions. parts of the world, were tested for anthropological survey purposes. International Salmonella and Escherichia Centre The laboratory tested 2,287 sera for abnormal The InternationalSalmonella and Escherichia antibodies and supplied blood -groupingserato Centre in Copenhagen has continued toreceive laboratories in 23 different countries. cultures for diagnosis and classification from all During the year itgave two training courses, parts of the world, and to distribute cultures and which were attended by workers from Egypt, France diagnostic sera to the national salmonella centres (and Algeria), the Sudan, Sweden, Switzerland and and other specialized laboratories.The expansion the United States of America. of this service is indicated by the numbers of cultures sent to it for typing in the four years from 1950 to the year under review ; in successive years they have Postal Transmission of Biological Materials been 459, 876, 1039 and 938. Liaison has been maintained with the Universal Postal Union on the transport of biological materials, International Blood -Group Reference Laboratory and the Union is now preparing a compilation, for The International Blood -Group Reference Labora- easy reference, of all relevant national postal and tory, in London, during the first year of its opera- customs regulations.

Pharmaceutical Specifications and Nomenclature

In 1953 much work was done on the text of expert advisory panel. The translation of Volume I Volume IIof the Pharmacopoea Internationalis: into German, under the supervision of another the whole of the English text and part of the French member of the panel, is well advanced. text were in proof by the end of the year.As all Work has been started on the revision of Volume I remaining copies of Volume I in French had been for a second edition, and special care has been taken exhausted, arrangements were made for a second to obtain as wide a consultation as possible. Working impression of 1,200 copies. groups of members of the expert panels concerned are The Expert Committee on the International Phar- being consulted so that this considerable work may macopoeia held its twelfth session from 29 June to be based on the collaboration of many specialists 4 July. Members of the expert advisory panel, other and laboratories. experts in various countries, and members of other Every effort is being made to keep the Pharma- WHO expert panels had been asked for their com- copoea Internationalis as up to date and practical ments on the monographs for Volume II.These as possible. The standards which it sets out will be comments, received by correspondence, were con- such as to secure drugs of high quality, yet not so sidered by the expert committee. stringent as to restrict their availability or substan- Volume II, with the already published Volume I tially to increase their cost.Suggestions as to which and the Addendum now in preparation, will com- pharmaceutical substances should be included have plete the first edition of the Pharmacopoea Inter- been asked for and have been received from various nationalis and should prove of sufficient scope to be sources. of great assistance to many countries. On international non -proprietary names for drugs, The Spanish translation of Volume I, which was WHO has established working relations with the undertaken by the WHO Regional Office for the main groups thatare interested in giving non- Americas, has been revised by a member of the proprietary names to new medicinal substances 52 THE WORK OF WHO, 1953 which may later be included in national pharma- reducingtheconfusionthatariseswhenthe copoeias, in the Pharmacopoea Internationalis or same preparation is known under different non- in other reference books or printed on labels.The proprietary names in various parts of the world. International Union for the Protection of Industrial Proposed international non -proprietary names for Property has also co- operated in this work. pharmaceutical preparations liable to produce addic- A special study was made of the practical results tion are now used by the Drug Supervisory Body of achieved and the experience gained in this intricate the United Nations whenitasksgovernments work, following recommendations of the Health for their estimated requirements of narcotic drugs. Assembly and Executive Board.The Board, at its A listof299proposedinternationalnon- twelfth session, reviewed the system for the selection proprietary names was prepared and published in of international non -proprietary names, and estab- the October issue of the Chronicle of the World Health lishedaconsolidatedprocedureforselection, Organization. drawing a clearer distinction between proposed and During the year,specialists in the control of recommended names.2Work is now being done on this basis, with the collaboration of members of pharmaceutical preparations sent in information on : the expert advisory panel designated for the purpose. the aims of the control of drugs, definitions, prin- WHO submits the names provisionally selected to ciples for setting up a control system, labelling, MemberStates,nationalpharmacopoeiacom- methods of analytical control, control of poisons, missions and other bodies interested in the naming and the best way of controlling pharmaceuticals of drugs, inviting comments and asking that, if a in a country, with suggestions which could serve as name is found acceptable in a country, arrangements a guide for such control.This information will be should be made to introduce it and to protect it as used in preparing for a meeting on these subjects, a non -proprietary name. atwhichspecialistsfrom thenationalhealth - Allthisprocedureissubjecttocontinuous administrations, those working in control labora- study, so that the experience gained may be taken tories, and other persons will study the possibility into account in operating the plan as simply and of establishing more uniform methods in the interests effectively as possible.It is proving very useful in of public health and international commerce.

Drugs Liable to Produce Addiction

In recent years WHO has given much consideration The committee again discussed the draft of the to the use of diacetylmorphine (heroin) in medical single convention on narcotic drugs, which is being practice, and in 1953 an important decision on that prepared by the United Nations, and the advice subject was unanimously taken by the Sixth World which WHO should give on it to the Commission Health Assembly (resolution WHA6.14). The Health on Narcotic Drugs. On the advice of the committee, Assembly recommended that campaigns be under- WHO also reported to the Secretary - General of the taken to convince physicians and governments that United Nations recommendations fortheinter- diacetylmorphine was not irreplaceable in medical nationalcontrolofseveralfurthersubstances practice and that Member Statesthat had not (including a number of synthetic substances with already done so should abolish the importation and morphine -like effect), for the exemption of others This resolution was com- production of the drug. from the obligations of the international conventions municated to the Secretary- General of the United Nations for consideration and appropriate action, on narcotic drugs, and also the committee's decision and the Secretary - General will submit it to the Com- that, although nalorphine is a morphine derivative, mission on Narcotic Drugs at its ninth session in there is no necessity to place it under international April 1954. control. The Expert Committee on Drugs Liable to Produce The attention of governments was drawn to the Addiction held its fourth session in Geneva in June. abuseofamphetaminepreparations,and,to strengthen the control over these substances, measures similar to those already proposed for barbiturates 2 Resolution EB12.R24,Off.Rec.Wld HlthOrg.49, 7, 29 were recommended. DRUGS AND OTHER THERAPEUTIC SUBSTANCES 53

Co- operation was maintained with the Permanent 1953(Professor H.Fischer of Switzerland and Central Opium Board and Drug Supervisory Body Professor S. Tavat of Turkey) were reappointed of the United Nations, and the Organization was for a period ending 1 March 1958. represented at the eighth session of the Commission The Expert Committee on Alcohol met for the on Narcotic Drugs, held in New York in April. first time in October, in Geneva. Among the main Closer co- operation was also established with the topics discussed were :concepts pertaining to the United Nations Division of Narcotic Drugs ;advice pharmacological position of alcohol ;approach to was given and preliminary comments made on memo- alcoholism by experiments in animals ; metabolism randa prepared by that division. of alcohol, including the nutritional involvements At the request of the Economic and Social of alcohol consumption, and alcohol and road Council,3WHO, in consultation with the United traffic.The committee considered the existing state Nations, is compiling information on the scientific of confusion arising out of the indiscriminate use aspects of synthetic drugs.It has begun work on of the term " tolerance " :this term denotes the problems of syntheticdrugs with morphine -like inherent susceptibility of the individual to alcohol, effect : a paper on the chemical aspects of such drugs, but the change of resistance brought about by the first of a series, was written in collaboration with habitual intake should be referred to as " acquired a chemist delegated by the United Nations Division increase of tolerance ".Withdrawal symptoms in of Narcotic Drugs. alcoholism have to be distinguished sharply from WHO has given advice to several governments on those produced by the withdrawal of morphine -type these drugs, on morphine preparations with pro- drugs :in connexion with alcohol, only the term longedaction,and on questionsof treatment. " withdrawal symptoms " is recommended ;" ab- There is no doubt that some of the existing synthetic stinence syndrome " is justified in the case of drug substances have to be considered as a stage in the addiction of the morphine type. Under the heading process of finding analgesics which do not produce " The Approach to Alcoholism by Animal Experi- addiction (or which produce less addiction than ments ", topics such asspecific organogenic ap- morphine). Reasons of national economy might proaches, nutritional deficiencies, endocrine studies also encourage their use. But there is no doubt that and the position of alcohol as a drug were discussed. control of the illegal production of these drugs and The expert committee, basing its statement on the of the illegaltraffic in them will create -and is definition of an intermediate group of drugs con- already creating -new difficulties for the national tained in the third report of the Expert Committee authorities, for some of the components in question on Drugs Liable to ProduceAddiction,4agreed that are relatively easy to produce from basic materials alcohol should be considered as being intermediate in which, because they are also used for other industrial kind and degree between addiction- producing and purposes, cannot be restricted. habit -forming drugs. The expert committee came to Investigations into the effect of khat and its addic- the general conclusion that to solve many of the tion- producing character have been started by WHO. problems of alcohol satisfactorily,the combined The United Nations Division of Narcotic Drugs is efforts of experimental workers and clinicians were also interested in these developments. necessary, and that a joint meeting of both groups Under Article 5, paragraph 6, of the 1931 Con- should be called. vention for Limiting the Manufacture and Regulating Drug addiction, with special reference to hashish, the Distribution of Narcotic Drugs, WHO appoints was discussed at the regional seminar on mental two members of the Drug Supervisory Body.The health, sponsored by WHO and held inBeirut two members, whose terms of officeexpired in in November.

Advice on Antibiotics and Insecticides

During the first half of the year, negotiations insecticides from WHO to the United Nations, in were continued with the United Nations Technical accordance with the resolution WHA5.30 of the Assistance Administration on the transfer of the Fifth World Health Assembly (see also the Annual industrial side of the production of antibiotics and Report for 1952, Chapter 7).

3ECOSOC resolution505 C (XVI) 4 Wld Hlth Org. techn. Rep. Ser. 1952, 57, 10 54 THE WORK OF WHO,1953

These negotiations had a satisfactory conclusion, When the transfer took place, the stage of develop- and the transfer took place on 1 July. The arrange- ment of the penicillin projects was such that their ments with the Technical Assistance Administration success appeared assured. The initial work on covered financial responsibilities, fellowships awarded engineering, planning and designing, was completed, in connexion with production projects, and a re- including the planning of buildings, specifying of distribution of duties so that the United Nations equipment for production and services, preparing takes full responsibility for the actual production and WHO retains an interest in the non -industrial, of process -flowdiagrams and establishmentof public -health, and clinical aspects.Three projects costs.The compilation of technical data was well for the production of penicillin (in Chile, India and advanced, and good progress had been made in Yugoslavia) and four for the erection of DDT training national technical personnel. plants (in Ceylon, Egypt, India and Pakistan) were The development of the DDT plants also had affected by the transfer, to which all the governments advanced to a stage which ensured their successful concerned agreed. completion. CHAPTER 7

PROCUREMENT OF SUPPLIES

Purchases of medical supplies and equipment agencies to make purchases to the value of $438,000 ; for WHO projects financed under the regular and this included a request from UNKRA for purchases the Technical Assistance programmes amounted to amountingto$265,000foranursingproject US $585,000 for the year 1 October 1952 to 30 and a medical college and teaching hospital.The September1953. Although the values involved service charge of 3 per cent is estimated to amount to are not great, a large number of specialized items $9,000 in respect of purchases requested by govern- of supplies and equipment have been purchased ments and the United Nations in the year ending and shipped forprojects throughout the world 30 September.1 under rather more difficult conditions than before. European markets for drugs and other pharma- The difficulties arose principally from the necessity ceuticals have been easier.The reduction in the of using to the fullest practicable extent the currencies price of penicillin noted in 1952 has been substantially contributed to the Technical Assistance programme maintained :in both the United States of America and therefore of placing orders in a number of and Europe the price is about half of what it was countries which do not normally export medical in June 1952, although it continues to be rather equipment and supplies or which produce only a higher in Europe than in the United States.World limited range of equipment. Manufacturers in prices of DDT and BHC remained at about the such circumstances often have a restricted output low level of 1952 until the autumn, when an increase and are sometimes disinclined to undertake com- occurred.On the whole,suppliers in European mitments for export, which they might have to countries were able to deliver at shorter notice than fulfil at the expense of their home markets.Wide in 1952, partly because less severe restrictions on raw market surveys have therefore been necessary to materials have permitted more adequate stocking; but find sources of supply in some of the smaller Euro- those in the United States required slightly longer pean countries and in countries of the Western notice. Pacific, and to search for substitutes which, though Apart from the movements noted above, there have they may differ somewhat in specifications from the been no marked changes in world markets of sup- articles on supply lists,give essentially the same plies and equipment for public -health programmes, results. but the need to make the fullest use of particular Another complicating factor was that a number inconvertible currencies has at times entailed paying of 1953 projects financed from Technical Assistance prices higher than might have been necessary for the funds had to be postponed until it became known purchase of similar goods in other markets had the what funds would be availableto WHO from requisite currencies been available. Technical Assistance, UNICEF and other sources ; firm allocations could not be made in these cases Price Concessions to WHO until April.This hold -up of Technical Assistance projects delayed both the preparation of supply lists An appreciable number of manufacturersin and procurement. Europe now grant special discounts to WHO, and In 1953 a contract was signed with the United a number of them, when quoting net prices, have Nations Korean Reconstruction Agency (UNKRA) certified that they pay no agents' commissions or by which that agency will use the services of WHO intermediary charges on orders placed by the Organi- for the purchase of medical supplies and equipment zation. They find it easier to do this as the orders on the basis of the 3 per cent service charge established bytheExecutiveBoard(resolutionEB9.R90). 1 This charge was again not applied to purchases commis- Supplies for Member governments requested and sioned by UNRWAPRNE, since the agreement with that purchased against prepayment amounted to $35,000 agency was interpreted as precluding such a charge. As mentioned on page 35, UNRWAPRNE has recently in the year ending 30 September 1953.During the decided to centralize all procurement of relief supplies, apart same period WHO was asked by United Nations from local procurement, through UNICEF. - 55 - 56 THE WORK OF WHO, 1953

are placed by WHO headquarters, located outside supplies of the required standards, and others intend the countries of destination.Special rebates granted to do so. by some shipping lines in recognition of the nature Requirements for supplies of procaine benzyl- of WHO's work, and reductions in charges negotiated penicillin in oil for injection are described in Annex 5 with forwarding agents, have also reduced shipping of the Fourth Report of the Expert Committee costs. onVenerealInfectionsandTreponematoses.3 Governments have been advised of the conditions X -Ray Equipment as to conformity and testing which should be attached to contracts for the supply of PAM. To encourage manufacturers to produce x -ray Since the establishment by the Expert Committee equipment better suited for work in under -developed on Insecticides 2 of specifications for spraying and countries, particularly in the tropics, and to ensure dusting equipment for health programmes, some that local personnel receive competent instruction manufacturers in Europe and the United States of in its care and maintenance, WHO arranged that America have re- designed their products, and the some of the principal manufacturers of x -ray equip- equipment now available for insect -control pro- ment should send one of their factory technicians grammes is improving in quality and efficiency. Only with any unit of equipment ordered for WHO - equipment complying with these specificationsis assistedtuberculosisprojectsinsuch countries. now bought for WHO programmes. These technicians operate and service the equipment and also supervise and instruct the local staff.This arrangement should give manufacturers the informa- Check Lists and Inventories tion necessary to enable them to modify the design of their x -ray units for operation in these areas in Additional check lists of basic equipment were accordance with experience in the field. prepared for field demonstration projects, complete with detailed specifications and catalogue references, and some of the existing lists have been revised as Application of Recommendations of Expert Com- the result of experience in the field.Such check mittees lists are almost indispensable for drawing up lists of Manufacturers of DDT water -dispersible powders project requirements and they also make procure- and of procaine benzylpenicillin in oil with aluminium ment much easier.They are used by UNICEF in monostearate (PAM) have shown an increasing preparing lists of supplies, and later, when further interest in the minimum requirements laid down by developed, they may be useful to national health the Expert Committee on Insecticides 2and the administrations. ExpertCommittee on VenerealInfectionsand Treponematoses.All contracts for the purchase of these products by WHO, whether for its own pro- Work with CARE grammes or on behalf of Member governments or The agreement with the Co- operative for American other United Nations organs, prescribe that they Remittances to Europe Inc. (CARE) was continued must conform to these standards, and the products throughout the year. The volume of contributions are subjected to sampling and testing before ship- obtained by CARE for the purchase of medical ment to ensure conformity.Originally, there were supplies and equipment for institutions approved only a small number of suppliers in North and South by WHO has not been as large as was hoped, but America whose products met these requirements, CARE planned a campaign in the winter of 1953 -4 but some European manufacturers are now producing in an attempt to meet the requests for supplies already screened and transmitted by WHO. 2 World Health Organization (1953) Insecticides :manual of specifications for insecticides and for spraying and dusting apparatus, Geneva 3 Wld Hlth Org. techn. Rep. Ser. 1953, 63, 55 CHAPTER 8

PUBLICATIONS AND REFERENCE SERVICES

As indicated in the Annual Report for 1952, the by one agent, and to find and appoint suitable agents Organization's documentation services had by then in countries where there was no regular channel reached maturity, and it was found possible to give for the commercial distribution of WHO publica- more attention to applying them effectively. During tions. the year under review, these services have been WHO held consultations and discussions with increasingly developed to meet the requirements other international governmental and non- govern- of Member countries and of the programmes of mental organizations on problems of documentation WHO. on medical and related subjects.It participated in Monographs and symposia published in 1953 inter -secretariat discussions with UNESCO to deter- have either been the final expression of a programme mine therespectiveresponsibilitiesof the two activity or have been directly related to an important organizations for international work on various technical function of the Organization. One mono- aspects of documentation.The Organization was graph, on toxic hazards of certain pesticides to man,' also represented as an observer at a meeting of was the direct outcome of a Health Assembly UNESCO's Advisory Committee on Bibliography, resolution. Comparative surveys of health legislation, at meetings of working groups of the International which were initiated as a result of discussions in the Children's Centre on publications and on library Executive Board, have also had a specific relation to and documentation services, and at meetings of the programmes.Similarly, there has been a tendency Executive Committee of the Council for International for the human and material Library Organizations of MedicalSciences (CIOMS) at to be applied more directly to the furthering of which possible programme activitiesof CIOMS programme activities. in this field were discussed. Much attention has been devoted to improving WHO participated in a joint CIOMS /UNESCO/ the distribution and sales of publications. The WHO meeting, convened by CIOMS in Geneva Executive Board, after studying this problem at its from 31 July to 1 August, with the object of reviewing eleventh session, authorized (resolution EB11.R43) previous attempts to organize medical documentation the appointment of a distribution and sales officer internationally and of determining whether there was as a charge against the Publications Revolving a clear need for international action and, if so, what Fund.A suitable candidate was difficult to find, activities CIOMS might suitably undertake.It was however, and this officer was not appointed until unanimously agreed that more information was the autumn.Since his appointment, plans for im- needed to determine whether international action provements in the commercial distribution of WHO wasnecessary,anditwas recommendedthat publications have been completed and will come UNESCO, whichhadfundsavailable,should into effect at the beginning of 1954.Following a consider starting a survey, possibly using the ma- suggestion made during the discussion at the eleventh chinery provided by CIOMS, to ascertain how far session of the Board, special rates for global and current secondary publications, such as abstracting block subscriptions have been fixed.In addition, periodicals and published indexes, are used by medical annual subscription rates have been established workers and found adequate.The Director of the both for the Technical Report Series and the Official Armed Forces Medical Library, Washington, and Records series, and the scale of prices for single the Editor of theBulletin del'Institut Pasteur, copies has been greatlysimplified. Steps were Paris, were invited by CIOMS to attend this meeting taken to increase the number of national distributors as consultants. in countries which could not be effectively covered In July an article on " International Medical Documentation and the World Health Organization" 1 Barnes, J. M. (1953)Toxic hazards of certain pesticides was published in the Bulletin of the Medical Library to man, Geneva (World Health Organization:Monograph Series No. 16) Association in the United States of America. - 57 - 58 THE WORK OF WHO, 1953

Publications Handbook of Resolutions and Decisions were published The Bulletin of the World Health Organization -the latter being provided with an index. and the Chronicle have been published regularly, and several numbers of theBulletin have been Translations devoted to symposia on special subjects. The content of the Bulletin is becoming more closely linked to the Because of the exceptionally large amount of Organization's major programme activities. translation which was required during the year, In addition to the periodicals, to a number of new translations of documents sometimes had to be titles in the Monograph Series and Technical Report issued without any revision.In the last quarter of Series, and to supplements to the Bulletin, there were the year it was necessary to recruit four additional published during the year a looseleaf Manual of temporary translators to ensure that demands for Specifications for Insecticides, CODEPID and the translations could be met. firstedition of the World Directory of Medical Schools. Library and Reference Services From1954the volumes of the International Digest of HealthLegislationwillcorrespond with the Since the transfer of the library reading room to calendar year, one number being published at the the secretariat wing of the Palais des Nations, its beginning of each quarter.To make this possible, use by the Secretariat at headquarters, by consultants five numbers were included in Volume4. During and by visiting experts has increased very con- 1953,two comparative studies of health legislation - siderably.Medical librarians from many parts of on communicable diseases in schools and on nursing the world, including some from leading medical -were published. Offprints were made of the second and related libraries, have recently visited the WHO for wider distribution, including members of the Library to find what services it offers and to discuss Expert Advisory Panel on Nursing and participants technical problems.In1953,three medical library at nursing conferences.At the end of the year a Fellows spent part of their time studying and working comparative study of legislation on leprosy was in in the WHO Library. proof, and another on vaccination against smallpox During the year, an annotated list of " Current was in an advanced stage of preparation.Itis Indexing and Abstracting Periodicals in the Medical recognized as desirable that each quarterly number and Biological Sciences " was issued as a supplement of the Digest should contain one comparative study to Library News. This list contains179entries, and of health legislation, but the practical difficulties represents a first step towards making more widely are considerable, particularly as it is necessary to known some of the information and resources which search for, obtain and use source material in a great are available in the WHO Library. variety of different languages. WHO was represented at the First International In addition to the usual numbers of the Official Congress on Medical Librarianship, held in London Records series, the sixth edition of the Handbook in July, and contributed a paper on the World Health of Basic Documents and the second edition of the Organization and medical librarianship. CHAPTER 9

PUBLIC INFORMATION

This year it has been possible to satisfy without technical staff fully occupied with their own work, increased expenditure a large part of the constantly and, with a few exceptions, unfamiliar with the growing demand for information. media of information. An important development has been the distri- In the course of the year,public- information butionofobjectiveinformationabouthealth officers were appointed in the European and African problems themselves, with particular reference to Regions, so that all six regional offices now have national as well as international efforts to deal with active public- information units, in close liaison with them, instead of merely the publicizing of action one another and with the Division of Public Informa- taken by WHO. tion at headquarters. This approach has been well received.It was illustrated in the work of a public- information team, Press which was planned and organized by WHO and sent in October and November to five countries of the The services provided for the world press have EasternMediterranean Region underthe joint included, in addition to the 300 routine press releases auspices of UNESCO, UNICEF and WHO. This issued from headquarters or from regional offices team consisted of an independent journalist,a during the year, a series of special features, signed photographer and two radio specialists.Its work, by WHO experts, which have brought a number of like that of the one that visited South -East Asia important health problems and recent advances in in 1951 -2, was effective in promoting public interest health techniques to the notice of the general public. in social and health problems.The chief merits Several of the series have been reproduced, often of a team of this type are that : in full, in the specialized and general press. The many requests for information and documen- (1)it reports objectively and with a fresh per- spective on the human side of international work tation received from all kinds of publications indicate in the various countries ; that interest in world health is growing.This is shown also by the press clippings which are sent to (2)it provides good distribution channels for headquarters and to the regional offices, although the material produced, through the contacts of its they represent only a cross -section of the world press. members with newspapers, radio- networks and WHO press releasesare now being widelyre- photograph agencies, and produced :sample studies have been made of the (3)the expenses incurred by the international press of 13 European countries in which 20,000 organizations are low because the salaries of the daily newspapers and periodicals are published, and team members are normally paid by the periodicals one such study of only 100 of these periodicals showed and institutions from which they are seconded. that, for World Health Day alone, they had printed articles totalling 300,000 words. As the team is sponsored by several agencies, it brings home to the persons primarily concerned with publicity the co- operation of the various agencies The Newsletter and institutions of the United Nations in Technical To meet the steadily increasing demand for the Assistance work in each country it visits. monthly WHO Newsletter without increasing the In general, the production of material on the cost of production, the Newsletter is now printed Technical Assistance aspects of WHO's advisory well in advance so that bulk supplies no longer have and demonstration programmes was increased during to be sent by air -freight. At the end of 1953, a.further the year, although it has often been difficult to obtain saving was made by concentrating the production vividfirst -hand accounts of fieldactivities from. of the English edition in Geneva instead of dividing -- 59 - 60 THE WORK OF WHO, 1953 itas hitherto between Geneva and Washington. Films are certainly one of the most effective media For the larger combined edition it is now possible of information, but they are normally one of the to use the cheaper rotary printing. most costly. Nevertheless, it was possible during the The present circulation of the Newsletter could year to produce a ten -minute WHO film based on the be usefully multiplied many times, but not without work of the study group which visited the school increasing the cost.Its columns have been opened health services of Denmark in the spring.This to articles by leading health authorities in different film,entitled" Better than Cure ",isdesigned countries, and there has been widespread interest primarily for television in Europe and the United in their accounts of national developments in public States of America. health. WHO also co- operated with the United Nations Films and Visual Information Division and with UNESCO inproducingfilmson international Radio and Television health projects, including WHO- assisted programmes for the control of rabies, tuberculosis and yaws. Relations with important national radio -networks The UNESCO film " World Without End ", which were strengthened.The British Broadcasting Cor- features the essential role of international health poration includedinitsHome, Overseasand work in building a new world, had a most successful European programmes several series of talks dealing with WHO's work.French, Swiss and Belgian première at the 1953 Film Festival in Edinburgh and has been widely shown since. stations broadcast features using material collected by the team that visited Asia in 1951 ;1 in Belgium, theNetherlands,and theFederal Republic of Exhibits Germany WHO subjects have been used in broadcasts for schools.United Nations Radio in Geneva has In 1953, a new and inexpensive travelling exhibit set aside two 15- minute periods each week for broad- was prepared with the co- operation of an. English casts devoted to WHO. firm which has invented a process by which the various exhibit panels (15 inall) can be quickly On special occasions, such as sessions of the World reproduced in any size, colour or language desired. Health Assembly and the Executive Board and the The first sample sets of this exhibit were prepared departure of the WHO visiting team of medical in English, French and Spanish, and it is planned scientists to India, information was broadcast over to circulate them in the regions, under the super- specialshort -wave beams between Geneva and vision of the regional public- information officers. United Nations Radio, New York. WHO co- operated withseveralotherUnited In television, the BBC has made use of the WHO films " Somewhere in India " and " Better than Nationsagenciesin providingalargeexhibit, executed under the direction of UNESCO, for the Cure ", and has had special programmes on WHO " Conquest of the Desert " exhibition in Israel, field projects. which showed recent advances in scientific, social and economic techniques for developing desert areas. Photographs and Films Part of the material prepared for this exhibit is to be adapted for use in other countries in 1954. A service for production and distribution of photo- Exhibits were also prepared for the First World graphs was set up at headquarters, and the existing Conference on Medical Education, held in London, photograph file reorganized.This made it possible and the Sixth World Health Assembly, in Geneva. to increase the distribution of still photographs from 200 to 1,000 per month, from a basic collection which now contains 4,000 pictures. World Health Day

The photograph library was also used to produce " Health is Wealth " was.the theme chosen for four filmstrips on WHO's work in the control of World Health Day in 1953, and national and local malaria and tuberculosis, in mass anti -treponematoses health administrations in. countries of all stages of campaigns, and in the care of premature infants. economic development made good use of it to bring home to the general public the close relation between 1 Off Rec. Wld Hlth Org. 38, 60 health and economic prosperity.In more countries PUBLIC INFORMATION 61 each year, World Health Day programmes are celebration of World Health Day 1954 should be arousingtheinitiativeand ingenuityoflocal asubjectrelatedtonursingservices and their organizers, who are increasingly themselves designing significance for public health.The theme, " The material to suit their local conditions, to supplement Nurse, Pioneer of Health ", was chosen as parti- the basic material issued by WHO. cularly suitable for the year 1954, in recognition of the The Executive Board, at its twelfth session (reso- centenary of the work begun by Florence Nightingale lution EB12.R17), suggested that the theme for the in the Crimean war. CHAPTER 10

CONSTITUTIONAL, FINANCIAL AND ADMINISTRATIVE DEVELOPMENTS

Constitutional

Membership of the Organization Government of France 2which was signed on At the Sixth World Health Assembly Nepal was 1 August 1952 on behalf of the French Government admitted to membership of the Organization, and and by WHO on 23 July 1952, together with the the instrument of acceptance of the Constitution related exchange of notes.The agreement defines was deposited with the Secretary -General of the the legal status, privileges and immunities of the United Nations on 2 September 1953.The Sixth Organization and itsstaff in connexion with the World Health Assembly also decided (resolution Regional Office for Africa in Brazzaville and the WHA6.37) to extend to the territory of the Spanish Organization's regional arrangements in French or Protectorate Zone the effects of the admission of French -administered territories in the African Region. Morocco as an Associate Member (sothat the French and Spanish Zones are now both included), AccessionstotheConvention onPrivilegesand and welcomed the return of China to active par- Immunities ticipation. On 20 November, Yemen became a Member of the Organization by signature of the Two countries acceded to the Convention on the Constitution. Privileges and Immunities of the Specialized Agencies The membership of the Organization is now 84, -Belgium on 1 May (with reservations) and Ecuador including three Associate Members.1A fulllist on 7 July.Eighteen Member States have now of Members and Associate Members appears in acceded to the Convention (some with reservations) : Annex 1. Austria, Belgium, Chile, Denmark, Ecuador, Egypt, Guatemala, Haiti, the Hashemite Kingdom of the Regional Office for Africa :Host Agreement with Jordan, India, Italy, Luxembourg, the Netherlands, the Government of France Norway,thePhilippines,Sweden,theUnited The Sixth World Health Assembly, in resolution Kingdom of Great Britain and Northern Ireland, WHA6.39, approved the Host Agreement with the and Yugoslavia.

The Financial Position

Technical Assistance Funds and Technical Assistance funds should be taken into consideration for carrying out the Organization's One of the major difficulties encountered during plans for1953. The Director - General therefore 1953 was the unexpected shortage of funds under the planned to use those resources to continue with Expanded Programme of Technical Assistance, as programmes already in operation, so that what a result of which the Organization could expect only had already been achieved should not be lost.The some five million dollars from Technical Assistance, UNICEF Executive Board also agreed that UNICEF whereas the estimated cost of the programmes should pay certain costsforprojectpersonnel, planned was some nine and a half million.At its without which joint projects could not go forward. eleventh session, in January 1953, the Executive In the latter half of 1953, the funds available Board considered the resultingseriousfinancial under Technical Assistance were found by the situation and decided (resolution EB11.R57.4) that Technical Assistance Board to be even more limited all resources available under both the regular budget than had been expected when the report was made

1 This figure includes 9 inactive Members. 2 Off Rec. Wld Hlth Org, 46, 192 - 62 - CONSTITUTIONAL, FINANCIAL AND ADMINISTRATIVE DEVELOPMENTS 63 to the Executive Board, and the amount earmarked advances made from it for 1948, 1949 and 1950. A for WHO was reduced from five million dollars table showing the status of contributions asat to$4,593,000. Inevitably,thissituation had a 31 December 1953 is given in Annex 11. considerable effect on the total programme of the The arrangements for accepting a part of the Organization, and it became necessary to reconsider contributions of Member States in sterling have and rearrange the use of the resources available to proved very satisfactory and will be continued in WHO under the regular as well as the Technical 1954. Assistance programme, in order to avoid sudden The Sixth World Health Assembly fixed the assess- and drastic reduction in the Organization's activities ments for 1954 at the same scale and with the same at the end of the year. provisions as for 1953 (but including the assess- It is apparent, from the experience undergone in ment of the new Member, Nepal) and authorized the 1953, as a result both of uncertainty concerning Board to continue its study of the scale of assessments Technical Assistance funds early in the year, and of and to report to the Seventh World Health Assembly. the financial problem which arose immediately the After considering proposals from the Government drastic shortage of funds became clear, that a careful of China as to its financial contribution, the Health study must be made of the desirability of continuing Assembly, in resolution WHA6.6, maintained the the practice, authorized by the Executive Board, of assessment of China at 720 units; but decided to using regular budget and Technical Assistance funds accept an annual sum of US $10,000 until the almost interchangeably forfieldprojects. country's financial situation had improved and a payment of the equivalent of $125,000, to be applied to the arrears due to the Organization. This question The Budget for 1953 was to be reviewed by the Executive Board and the A budget of US $9,832,754 was approved by the Health Assembly in 1954. Fifth World Health Assembly for 1953 ; the assess- The Sixth World Health Assembly, in resolution ments against inactive Members totalled $1,347,659, WHA6.29, decided to maintain the Working Capital and the effective working budget for the year was Fund for 1954 at the same amount as for 1953, therefore set at $8,485,095.3 plus the contributions of Members joining after Annex 10 shows the apportionment of the total 30 April. Several more Members paid their advances budgetary provision for 1953 among the various to the Fund during the year, and by 31 December activitiesof theOrganization and givesdetails only three active Member States(including the of thetransfers made between sectionsof the two new Members Nepal and Yemen) owed a part Appropriation Resolution by the Director - General, of their contributions.The payments of advances with the approval of the Executive Board. to the Fund are shown in Annex 11. The actual expenditure for the year, which will not be known until the closed accounts are available, WHO Seals will be given in the Financial Report, which will be submitted, with the Report of the External The issue of World Health Seals was approved Auditor, to the Seventh World Health Assembly. and a special fund for this purpose was set up by the Fourth World Health Assembly in 1951 (resolu- tion WHA4.48).Eleven countries participated in Contributions, Assessments and the Working Capital the first campaign in 1952 (Afghanistan, Cambodia, Fund India,Indonesia,Israel,Korea, Laos, Panama, Payment of the current year's contributions has Thailand, Viet Nam and Yugoslavia) ; seven in the been very satisfactory.Payment during the year 1953 campaign (Afghanistan, Burma, India, Laos, of arrears of contributions for previous years has Portugal, Sweden and Viet Nam) ; and two (Laos and resulted in a cash balance of approximately $543,000 Viet Nam) will take part in 1954. in the Assembly Suspense Account, and has returned Governments have been slow in notifying . WHO tothe Working Capital Fund the outstanding about the receipts from these sales, and a full report on 1952 has not yet been received.It is evident 3 Off Rec. Wld Hlth Org. 42, 19 (resolutions WHA5.8 that the receipts will be below the amount expected ; and WHA5.9) the income from sales to collectors has been small. 64 THE WORK OF WHO, 1953

Administration

Structure and Staff careforexperts were submitted tothe United Only one change was made during the year in Nations Technical Assistance Board. the structure of the Secretariat at headquarters. In the Department of Central Technical Services, the Headquarters Accommodation completion of CODEPID made it possible to abolish The questions arising from the extension of the the Technological Services Section, which had been Palais des Nations to provide office accommodation a part of the Division of Epidemiological and Health for WHO headquarters are on the point of settlement, Statistical Services ; the other work of the section, and it is now possible, although the final building with appropriate staff, was transferred to the Inter- accounts have not yet been received from the United national Quarantine Section, in the same division. Nations, to give a close estimate of the cost (including The organization of the Secretariat at headquarters internal transformations and administrative expenses). is shown in Annex 12. The total (subject to adjustment when the final No important changes were made in the structure accounts are received) will be about Sw. fr. 4,430,000. of the regional offices. Of this, the Swiss Confederation has contributed The increase in the staff was very slight in 1953, Sw. fr. 3,000,000 and the balance to be borne by as a result of the restriction of funds for the Technical WHO is about Sw. fr. 1,430,000. Assistance programme (see page 62 and Chapter 18) ; At the Fourth and Fifth World Health Assemblies the small increase which did occur was almost creditswere approved tothetotal amount of exclusively in field personnel. Sw. fr. 1,571,681.75, so that there will be an unused balance of about Sw. fr.141,700, which will be The compositionof thestaff bynationality transferred to the Assembly Suspense Account when remained essentially unchanged. Details of the the exact figures are known. composition of theSecretariat are given in the The final cost of the extension of the Palais and tables in Annexes 14 and 15.Annex 13 lists the the savings made on the credits voted by the Health senior officials of the Organization. Assemblies will be shown in the 1953 Financial Report, to be published as a supplement to this volume. Co- operation with the United Nations on Personnel Policy Place of the Regional Offices for Europe and Africa WHO, through the Administrative Committee on The Regional Committees for Europe and Africa, Co- ordination, agreed upon a formula to be used at their September sessions, discussed the location in 1954 for apportioning among the agencies con- of their regional offices. The recommendation of the cerned the expenses incurred in administering the Regional Committee for Europe was due to be Joint Staff Pension Fund.The Fifth Committee discussed by the Executive Board at its thirteenth of the General Assembly at its eighth session recom- session. The Regional Committee for Africa set up mended that after 1954 these expenses should be an ad hoc committee to investigate and report on borne by the Fund itself. the causes of thedifficultiessaid to have been In 1953 the Administrative Committee on Co- experienced in setting up a regional office in the ordination further studied the question of a jointly African area. financed scheme of compensation for death and disability incurred as a result of service on the staff Administrative Supplies of internationalorganizations. Othersubjects Since the beginning of 1953, WHO has purchased which came before the committee were : the annual standard administrative supplies jointly with the review of standard travel per diem rates, cost -of- United Nations and other specialized agencies in living adjustments, termination indemnities, pro- Geneva, to secure lower prices by bulk buying, bationary periods, retirement age and definitions and since 1 October the United Nations has under- of dependency.Joint recommendations on health taken the purchase and issue of these supplies. insurance for Fellows, and social security and medical WHO no longer employs staff for this purpose. PART II

THE REGIONS

CHAPTER 11

AFRICAN REGION

Conditions in Africa Seldom, therefore, can broad campaigns for the control of disease be undertaken with any prospect Conditions are changing rapidly in Africa, but of general success. There is probably more promise it is still a continent very different from civilizations in encouraging smaller health projects that can some which have for years been based on technical develop- day be taken over and maintained by the population ment.The map on this page gives an indication itself--centresin which Africanswill be taught of the vastness of Africa, which is in fact a hetero- and trained, by other qualified Africans whenever geneous continent with hundreds of populations, possible, and from which the new ideas will spread. stillstrictlyseparated by distance anddifficult communications, with differentcivilizations,cus- MAP 2 toms and ideals, living in different climates and with different economic traditions. Generalizations about Africa would therefore be difficult and misleading, but, in most of the countries of the Region, the African village will for a long time to come remain the centre of most health problems. In the village, the sense of community is paramount ;health objectives are accepted only if they contribute to and do not conflict with the objectives of the community as a whole. The village, therefore, and not the " nation ", must be recognized as the unit on which planning must be based ;plans must take account of the local customs and cultures of the people among whom the work isto be done, and methods derived from experience in other countries must be used with caution, with a mind ready to note unexpected reactions and quick to abandon or modify the assumptions on which the work was started, as local conditions and atmosphere may dictate.In most parts of Africa. too, those habits of conser- The immensity of the African Continent is illustrated by these maps of China, India, Pakistan and the United States of vation and maintenance which are taken for granted America, superimposed on that of Africa.All the maps are in many parts of the world and are essential for the drawn to the same scale. efficientrunning of any kind of governmental service are still lacking. Nothing will be gained by pressing the pace : thorough study and research are necessary before attempting Mistakes have already been 1 This region comprises those parts of Africa not included to introduce any plan. in the Eastern Mediterranean Region or among the French made and should not be repeated. Territories of North Africa.It was delineated by the First In Africa WHO, in co- operation with the existing World Health Assembly (see Off. Rec. Wld Hlth Org. 13, health services, some of which have many years' 80, 330).In accordance with resolution WHA6.46, Ascension, British Somaliland, Mauritius, St. Helena, Seychelles, Spanish experience, therefore has the following preparatory Sahara( and itsisland dependencies) ,Morocco ( Spanish tasks :to find out the people's ideas about the Zone), Tristan da Cunha and Zanzibar were provisionally assigned to this region. nature and origin of diseases and the reasons for - 67 - 68 THE WORK OF WHO, 1953 the methods they have adopted to deal with them ; nal Committee, that at its meetings there should to persuade the people that they can receive benefit each year be technical discussions on the topic from new techniques and the discoveries of science ; discussed during the previous World Health Assem- to teach their leaders what is economically practi- bly, and that its fourth and fifth sessions should be cable ;to stimulate the training of Africans, parti- heldrespectivelyatLeopoldville in the Belgian cularly in medicine (and its relation to social and Congo and at Tananarive in Madagascar. economic conditions) and sanitary engineering and in the meantime to select and train non -African The Regional Office doctors willing to assist in the development of the continent ;to co- ordinate the health work that is Intheregionalofficethestaff wasslightly going on, and to prevent the disadvantages which increased. However, the principle of keeping it might followtheindustrialrevolution nowin. small and of sending most of the public -health progress.The regional office has made a beginning officers and other technical personnel into the coun- in these tasks. tries of the Region has been adhered to. The chiefs of the technical sections at headquarters in Geneva The Regional Committee have continued to act as technical advisers for the Region, and this system has worked well. The The Regional Committee held its third session regional health officers' group is composed only of at Kampala, in Uganda, from 21 to 25 September. public- health officers, a social anthropologist and Representatives attended from Belgium,France, a sanitary engineer. This group, in close co- operation, Liberia,Portugal,SouthernRhodesia,and the develops plans and gives guidance to the field staff United Kingdom of Great Britain and Northern in such a way that the methods applied to the improve- Ireland ;there were observers from UNICEF and ment of health will not clash with local customs from four non -governmentalorganizations,and and conditions but will contribute to the social the Director - General of WHO was also present. and mental well -being of the population, as well as Representatives from Spain and the Union of South to the control of disease. Africa were absent from this session of the commit- The social anthropologist arrived in January ; tee.The Government of Uganda helped in every one public -health officer joined the staff in August, way to make a success of the meetings. to assist the Regional Director ;a second such The committee endorsed, with minor amendments, officer, who had been stationed in Monrovia, took the revised programme and budget for 1954, and the up his duties in Brazzaville in November as public - programme and budget proposed for 1955.After health officer for the western zone of Africa, and a studying the report of the Regional Director,it third remained in the field, working mainly in the adopted resolutions :asking the Regional Director eastern zone. to investigate possibilities for closer collaboration In March the Regional Director, in the company with the intergovernmental Commission for Techni- of the Director - General of the health services of cal Co- operation in Africa South of the Sahara French Equatorial Africa, toured the Chad district. (CCTA) ;setting up an ad hoc committee of four Twice during the year he visited the authorities in Members in the Region, to _investigate the factors Paris and once the relevant ministries in London. which gave rise to the abnormal difficulties said to The sanitary engineer went toLiberia and the have been experienced in setting up the regional Gold Coast and made several trips to Nigeria, and office in Africa and to reporttothe Regional the sanitary inspector, initially stationed in Mon- Committee as soon as possible on any steps which rovia, was posted to the Seychelles.The cultural might be necessary to improve the position ;asking anthropologist went to the French Cameroons and the Regional Director to report in future any pro- to Nigeria, and the public- health officer for the jects on which there is a possibility of joint action eastern zone, at the beginning of the year, went to by several countries or territories in the Region ; British Somaliland and, with the chief representative asking the Regional Director to consult with health of UNICEF for the Africa area, made a wide tour administrations in the Region to ascertain whether in the countries of eastern and southern Africa. WHO can give them assistance in their smallpox vaccination campaigns ; and recommending the Work in the Region appointment in 1954 of a Deputy Regional Director. The committee also recommended, among other The publication of the WHO monograph The things, that the Organization should not pay the African Mind in Health and Disease was the first travel expenses of delegates to sessions of the Regio- result of the study made in Africa at the end of AFRICAN REGION 69

1952 by a WHO consultant in psychiatric and In December 1952 a WHO consultant in trepone- psychological problems (see also page 26). matosis completed a study tour in west and central Another study mentioned in the Annual Report Africa, and further studiesare contemplated in for 1952 was followed up during the year :the study 1954. Their purpose is to explore the possibility by a special nursing consultant to ascertain what of establishing a long -range co- ordinated programme types of nursing are most needed in the countries of yaws control in tropical Africa, which is the largest of the Region and how far these countries can at single reservoir of the infection in the world (with present meet those needs.This study, begun in the 20 to 30 million cases). In addition to the yaws and latter part of 1952, culminated in the Conference malaria project in Liberia already mentioned, a on Nursing Education, held at Kampala in Sep- pilot project in the control of endemic trepone- tember (see page 29). matosis was started in Bechuanaland, and in 1954 The Expert Committee on Yellow Fever devoted there will be a project for yaws control in Nigeria, its second session, also held at Kampala in Sep- from which itis hoped that valuable information tember, mainly to delineations required under the will be available for the international yaws con- InternationalSanitaryRegulations(fordetails, ference planned in Africa in 1955. see page 14). Towards the end of 1953 a WHO consultant in At the beginning of the year a WHO consultant tuberculosis made a study tour in western and central in malaria, continuing a survey begun in December Africa, and early in 1954 another will make a similar 1952, visited the Gold Coast and Nigeria. A govern- journey in eastern and southern Africa and in the islands. The purpose of these tours, which have been ment antimalaria campaign was developed in French West Africa (in the territories of Upper Volta and requested by several countries,isto gather the the Ivory Coast) and in French Togoland and the information necessary for any decision as to what French Cameroons, and has been linked with the form of assistance WHO should give in work against pilot project in the Cameroons, with which WHO tuberculosis, and indeed to collect evidence as to whether tuberculosis is, in fact, the growing problem has assisted.This campaign is a good example of the type of concerted planning that is suited to the in different parts of the continent that some reports suggest.Studies on BCG have already been started local structure.The senior adviser of the WHO project in the Cameroons travelled in by the health authorities of some countries and will, November and December throughout theother when evaluated, add to the information obtained in territories, pooling the comments and suggestions the study tours. of his French colleagues on the campaign and pro- Late in 1953 a WHO specialist in vital and health viding when necessary suggestions based on WHO statistics began a series of visits to some African experience in other parts of the world. Useful countries, to meet statistical officers of the local conclusions have been drawn about the typeof authorities, to discuss their problems, and to advise equipment suitable for use in the tropical countries the WHO field staff working on projects. of Africa, and an evaluation is being made of the In April a consultant visited Mauritius to advise kinds and quantities of insecticides to be used in on a contemplated campaign of vaccination against those countries. pertussis and on the most suitable type of vaccine. In this pilot project, and also in the combined The campaign is being undertaken by the Govern- malaria and yaws campaign in Liberia, there has ment with vaccine provided by UNICEF. The beendifficultyin securing suitable counterparts. cultural anthropologist discussed with the health Both in the Cameroons and Liberia a sanitarian authorities of countries in Africa requests that WHO has worked with the WHO team, and constant should undertake public -health surveys based on attention has been given to the need for basing the preliminary socio- anthropological investigations. Such projects on public- health principles suited to local surveys have been undertaken in French and Belgian conditions. A considerable number of persons have territories in Africa -one for example, to determine been treated in the Liberian project, and it has the nature, causes and effects of the attitudes of alreadyyieldedveryinterestingmeteorological, African peoples to the use of the imported powdered entomological and public -health data.These two skimmed milk supplied by UNICEF ;another, to campaigns are progressing well,but otherfield find out the causes of an apparently heavy consump- projects in Africa were either just started or still tion of pharmaceutical products, which bears no in the planning stage at the end of the year. relation to the amounts prescribed by physicians. 70 THE WORK OF WHO,1953

Research has been started to explore the reactions Elisabeth pour l'Assistance médicale aux Indigènes and the psychological attitudes of Africans to the du Congo belge has continued and expanded. A modern medical sciences and to assess the poten- public -healthofficer was appointed to join the tialities, the soundness or the ineffectiveness of the mission, sent out by the International Bank for empirical therapeutic methods and remedies that Reconstruction and Development, whichvisited the people now use. Nigeria late in the year. In 1953, 27 fellowships were awarded, under the The budget of WHO, including both its regular regular budget, to candidates from the Region. and Technical Assistance funds, is very small in comparison with the amounts available in the Bel- gian fund just mentioned, in the French Fonds d'Investissement pour le Développement économique Collaboration with other Agencies and with Govern- et social in the French overseas territories, and the ment Services funds provided by the United Kingdom under the Arrangements for collaboration with other agen- Colonial Development and Welfare Act.This gives cies working in the Region have been consolidated emphasis to the importance of WHO's function as during the year.In Brazzaville, the regional offices a co- ordinator of health work and an instrument of WHO and UNICEF are situated in the same for the collation and exchange of scientific infor- building, which greatly facilitates the exchange of mation.In Africa, more perhaps than in any other ideas and of information of common interest. continent, the need for collaboration and under- UNICEF officers, whenever possible, were accom- standing between those engaged in health work is panied on their field trips by a WHO public -health paramount. officer. Co- operation with the Commission for TechnicalCo- operationinAfricaSouth of the Public Information in Africa Sahara and its technical sub -offices has continued. Plans made by the Inter -Territorial High Com- Contact has been established with government mission include (1) a joint project with WHO and information services throughout Africa, and have UNICEF for a scheme of malaria control, which will articles on the general work of WHO has been include an assessment of the effect which the elimina- published and distributed through thepress of tion of hyperendemic infection may have on the health that continent.News agencies, lay and professional of the population of an area close to the border newspapers, scientific libraries, educational centres between Kenya and Tanganyika ; (2) a project and medical schools will receive information on with WHO, designed to expand the scope and acti- the aims and functions of WHO by press releases vities of the East Africa Malaria Unit.In French and newsletters. West Africa and French Equatorial Africa,the In the celebration of World Health Day on 7 April Servicesmobilesd'HygièneetdeProphylaxie the broadcasting station in Brazzaville gave valuable continued their excellent work, on a front which help by broadcasting several times the addresses of they are pressing steadily inland.In the Belgian the Director -General and the Regional Director, in territories,the good work of the Fonds Reine French, English and Spanish. CHAPTER 12

REGION OF THE AMERICAS 1

Problems of the Region The needforimprovingsanitaryconditions, The socio- economic and health conditions of the particularly in rural areas, continues to be great ; countries of the Americas are extremely varied, but part of WHO's work on this problem is described on the difficulties of adapting the general principles page 73. of public -health administration to these conditions For efficient health work, national or international, are reduced by the growing appreciation that the well- trained personnel is essential. In many countries most important form of international assistance in such personnel, both professional and auxiliary, health is the strengthening of the fundamental public - is scarce ; the training of medical and para- medical health services of national,provincial and local personnel is one of the useful tasks of an international governments. This may mean less success in reducing health agency. disease immediately than direct campaigns would With increased experience, better planning, im- have, but, as the means employed are better adapted plementation and evaluation of WHO's activities to local conditions, there should be a more lasting have become possible. The necessity for co- ordinating effect in the development of well- designed national the activities of various organizations working in health programmes. international health became sourgentthatthe What may be called the " mass diseases " are Regional Committee called for special consideration still great problems in the Region. Gastro -intestinal of the entire problem of these intergovernmental infections, malaria, tuberculosis, bilharziasis, yaws activities. and ankylostomiasis are widespread in many areas and are a serious hindrance to social and economic Regional Committee development. For theircontrol sound public - health programmes are not enough ;related con- The seventh meeting of the Directing Council ditions, such as nutrition, education, and the eco- of the Pan American Sanitary Organization, serving nomic and social environment, must be improved. also as the fifth session of the Regional Committee The continued activity of jungle yellow fever is a of WHO, was held in Washington from 9to permanent potential source of infection for urban 19October. Representatives attended from 15 areas and calls for a continuing campaign for the Member States in the Region ;five were not repre- eradication of Aëdes aegypti throughout the Americas. sented. France, the Netherlands and the United A lasting improvement in public health depends Kingdom of Great Britain and Northern Ireland, upon health education of the public.It is not easy responsible for the international relations of certain to change the attitude of populations of varied territoriesintheAmericas,alsotook part in cultures and traditions, and international aid in the meetings of the Regional Committee. Observers spreading the knowledge of techniques that have were present from FAO, UNICEF, the Organization been found successful is valuable. of American States, and several non -governmental organizations. The Director - General of WHO addressed the 1 In accordance with the decision of the First World Health opening meeting. Assembly (Off. Rec. Wld Hlth Org. 13, 80, 331) this region The Council adopted the 1954 programme and comprises all the Americas.The following countries in the Region are Members of WHO :Argentina, Bolivia, Brazil, budget (US $2,100,000) of the Pan American Sanitary Canada, Chile, Costa Rica, Cuba, the Dominican Republic, Organization, to be financed by contributions from Ecuador, El Salvador, Guatemala, Haiti, Honduras, Mexico, Nicaragua, Panama, Paraguay, Peru, the United States of Member States of the Region. America, Uruguay and Venezuela. At the Sixth World Health The Council, acting as the WHO Regional Com- Assembly, the Falkland Islands and their Dependencies and Hawaii were provisionally added to the Region (resolution mittee, approved the proposed programme and WHA6.46). budget for the Region of the Americas for 1955, to - 71 - 72 THE WORK OF WHO, 1953 be transmitted to the Director - General of WHO for advances made in supply and procurement services consideration in preparing the budget for 1955. were maintained.In spite of the scarcity of some A plan of long -range public- health programmes, critical supplies and the need to make use of certain based on continuous survey and evaluation of the currencies, the number of items handled was greater needs and resources of Member States, was approved. in 1953 than in 1952.Other advances were the The guiding principles of the plan are : to strengthen presentation of a single budget for both the Pan the fundamental health services in each country, American Sanitary Bureau and the regional office, to provide and to develop the training of professional the reorganization of fiscal operations, the improve- and sub -professional personnel forthose health ment of procedures and the introduction of new services, and to co- ordinate and assist in the planning equipment. These measures increased the efficiency and operation of national or regional programmes for of individual employees and thus made possible the control of communicable diseases. not only a reduction of staff, but also economies in The Council considered several subjects at the supplies, materials, equipment and space. request of the World Health Assembly.It made Uncertainty as to the Technical Assistance allot- suggestions about a world -wide campaign against ments made it necessary to recast the total pro- smallpox, recommended that the travel expenses of gramme and budget on several occasions, which took representatives attending sessions of the Regional much of the time and energy of the staff. Committee should be reimbursed, and proposed During the year a number of exhibits, unusual in that no action be taken to change the rights and design and strikingly illustrative of the work of obligations of Associate Members in the Regional WHO and PASB, were very favourably received at Committee for the Americas. the first United States National Conference for World Argentina and the United States of America were Health, held in Washington, at the Seventh Inter- elected by the Council to fill the vacancies on the national Congress on Paediatrics in Havana, at Executive Committee, which is responsible for the showings in the United Nations building in New preparation of the annual budget for the considera- York, and in various other places in the Region. tion of the Council.The other members of the Executive Committee are Brazil, Ecuador, Haiti, Fellowships Mexico and Panama. Work continued in awarding fellowships to can- Itwas resolvedtohold the fourteenth Pan didates in the Region and placing Fellows both from American SanitaryConference, which willalso the Americas and from other regions.In 1953, serve as the sixth session of the Regional Committee, 121 fellowships were awarded under the regular in Santiago, Chile, in 1954, the exact date to be budget, 45 from Technical Assistance funds and fixed later. 7 from UNICEF funds. A table showing the inter- national training courses held in the Region is given in Annex 5. Regional Office Progress was made towards more effective and Technical Assistance Funds economical operation of the programmes of WHO and the Pan American Sanitary Bureau.In pur- The sudden reduction in Technical Assistance funds suance of the policy of delegating certain responsi- resulted in repeated reduction, postponement and bilities to the zone offices, many fiscal, personnel, deletion of the programme for 1953 and succeeding budget, travel, property control, and other services years. The following adjustments were made : are now performed by zone officers.The objective 1. Projectreductions :InJanuary,projects in is to find a balance between the zone offices and the operation for which firm commitments had been Washington office, by which the former will under- made were reviewed, and $164,000 was cut by takedirectliaisonwith governments,andthe delaying recruitment, dispensing with trained staff planning, operation and review of the programme and reducing the number of fellowships and the at local and zone levels, the latter being responsible amount of supplies. for the co- ordination and broad planning of pro- 2.Project transfers :In April, 14 of the Technical gramme and service activities. Assistance projects, costing $200,000, were trans- There were no major changes in the structural ferred to the WHO regular budget, with the con- organization, but efforts were made to implement sequent elimination of new projects from the WHO the plansfor reorganization proposed in1952. regular programme. In order to assure the operation Progress was made in staffing key posts, and previous of joint WHO /UNICEF and other urgent projects, REGION OF THE AMERICAS 73 the Pan American Sanitary Organization (PASO) cuts tends to exaggerate their adverse effect. The most made available over $60,000 for the operation of six urgent and important projects were given priority in projects in the Technical Assistance programme. the readjustment, and the cuts in early 1953, although drastic, left a strong programme with better super- 3.Postponements or deletions: Some 40 Technical vision by the regional staff than would have been Assistance projects, estimated at nearly $1,000,000, possible with the projected programme. Steady were postponed for one or two years or abandoned growth of the regular programme is more important altogether. than temporary contributions. Reductions proposed It is difficult to assess the total effect of the shortage for 1954, however, would cut into the vital pro- of Technical Assistance funds.The mere recital of gramme of the regional office.

Reports on Typical Projects in the Region

Training in Environmental Sanitation Santiago, to improve vital and health statistics in The object of the regional project in environmental Latin American countries so that they may have a sanitation is to train sanitary engineers and auxiliary better knowledge of health needs as a basis for personnel so as to form a nucleus of public- health planning their health programmes.The centre is workers who will staff and strengthen national and jointly sponsored by the United Nations, WHO and local health departments.Assistance is being given the Government of Chile. WHO assists the centre to the schools of public health in Brazil, Chile and in its work on health and hospital statistics ;the Mexico to improve their courses and expand facilities United Nations, under the Technical Assistance so that they may be used to train workers in environ- programme, helps with vital statistics. mental sanitation from all the countries of the In 1953, the work on health and hospital statistics Americas. The project is intended to stimulate interest in the various countries in the training of was as follows. The first training course, covering nine their personnel and to assist them by providing months -six months of academic work and three fellowships for the courses mentioned above.It of practical work in statistical offices -was started includes travel grants to enable teaching staff to in March at the School of Public Health of the obtain further training. The difficulty of recruiting University of Chile.Seventeen students from Chile qualified advisers has delayed this project. and 15 from 14 other countries were accepted as In Brazil, the first course for sanitary engineers, to regular students.Members of the WHO staff gave last nine months, was started at the University of coursesinstatisticalmethods,healthstatistics, Sao Paulo in March 1953.The course proceeded international statistical classification and hospital very satisfactorily ; the students were interested and statistics,and assistedin planning a morbidity enthusiastic, and arrangements were made for field survey. After further study some of the more success- training to follow the academic period. A course for ful students should receive fellowships so that they sanitary inspectors will be held in 1954. The school may qualify for a Master's degree in public health. has reserved 15 places for foreign students. The academic work for 1954 has been planned, and Under the agreement signed with the Government the second course will start in March. of Chile in November 1952, the Organization was to Advice was given by the centre on the organization provide a professor of sanitary engineering, fellow- of the new department of biostatistics for the National ships, travel grants and demonstration equipment. Health Service of Chile. Twelvesanitaryinspectors from eightdifferent countries attended a four -months' course, which A certificate of death conforming with WHO's was started at the School of Public Health in Santiago recommendations and containing instructions on in September 1953. Plans were made for a course in how to use it was issued. sanitary engineering to begin in 1954 if enough lecturers in sanitary engineering can be recruited. Insect Control Vital and Health Statistics A programme of insect control has been going A long -range training programme has been under- forward in Colombia. Its objectives are to eradicate taken at the Inter -American Center of Biostatistics, Aëdes aegypti, the vector of yellow fever, at the same 74 THE WORK OF WHO, 1953 time controlling malaria and other insect -borne expected to run for five years.Funds have been diseases,bysystematicapplicationofresidual providedundertheTechnicalAssistancepro- insecticides and larvicides. gramme. The work in Colombia has been a combined During 1953, the WHO team assigned to the operation in which the Government, assisted by the school of nursing assisted in the administration of Servicio Cooperativo Interamericano de Salud Pública the school as well as in the educational programme. of the Institute of Inter -American Affairs, has been The curriculum was modified to include public health responsible for the administration of the project, and social sciences, and nursing personnel were UNICEF has furnished some supplies and WHO has trained to serve on the staff of the school.Hospital provided technical advice on malaria control and personnel were prepared to assist in the teaching A. aegypti eradication. programme, and hospitals were adapted so that The area chosen for the initial work was the most they could give adequate training.An additional difficult one in the country :the Caribbean zone. Fellow was trained in Portugal in 1953, and one Surveys were made before the spraying was started will be trained in 1954 in the United States of in April 1952 ;a year later, as soon as the first America.The course for auxiliaries was begun in spraying was finished, the second cycle was begun. July 1953 and was sponsored by three national The second operation was not handicapped by the health organizations and the San Juan de Dios difficulties which delayed the first, such as the lack Hospital, all of which appointed nursing instructors. of equipment and of well- trained personnel, and the work was carried out much more quickly.Surveys This project has resulted not only in the reorganiza- were made before and after each spraying to ascertain tion of the basic programme of nursing education but the incidence of malaria and the presence of A. in major changes in the nursing services at the San aegypti. DDT spraying of walls was used where Juan de Dios Hospital, and the inclusion of public - malaria waspresent,whereaswatercontainers health nursing in the basic programme has brought were treated with DDT by the perifocal method for about changes in the procedures of the Health the eradication of A. aegypti. Department.The influence on psychiatric nursing The programme has shown that if work to eradicate has not been so great, but safe nursing procedures A. aegypti isto be successfully combined with have been adopted in the insulin- therapy wards in malaria control, it is necessary to make a close check, the psychiatric hospital. When the programmes for after the DDT spraying, for the presence of A. auxiliary nursing personnel and the training of aegypti and to re -spray if required. nursinginstructorsareextendedtoprovincial It is still too soon for a complete evaluation of the hospitals and thesocialsecurity hospital,itis campaign, since the area has just received its second expected that the effects of the project will be felt spraying, but the results so far indicate that the throughout the country. programme is at least on the way to success.It is believed that the work of eradication of A. aegypti Rural Public -Health Services in Colombia is more than half completed.This programme will be expanded in 1954 and 1955 A project came intooperationinPanama, to other regions of the country where malaria is with joint assistance from WHO and UNICEF, endemic. to strengthen the general public -health services, to extend them to the rural areas, and to train public - health personnel, including auxiliary health workers. Nursing The first phase was started in 1952, when WHO One of the nursing projects in which WHO has made a preliminary survey of the area.Early in been assisting has been the strengthening of the 1953, the existing facilities were assessed, priorities San José School of Nursing, Costa Rica. This were set up, and a plan of operations was developed. project has two aims :to prepare personnel to fill Some professional and auxiliary workers were also key positions in schools of nursing and in the trained at that time :a five -month programme of administration of nursing services, and to train large training for x -ray technicians and a first training numbers of auxiliary nursing personnel who will course for sanitary inspectors were completed ;a staff the nursing services under the supervision of course forpublic- health nursingauxiliarieswas the graduate nurses. started ;and other courses for doctors, dentists, The project was started in 1951 with a survey of nurses and laboratory technicians were in preparation the school of nursing and general planning ;it is during the year. REGION OF THE AMERICAS 75

Work began on the organization and development carried out in sanitary engineering in the area and of the central laboratory in Panama City to provide formulated plans for further immediate work. At the public- healthlaboratoryexaminationsforrural request of the national authorities, and in collabo- health units. ration with sanitary engineers of the Servicio Co- A manual of procedures and techniques for rural operativo InteramericanodeSalud Pública and units and hospitals and for the central laboratory engineers of the country, he studied a plan for the was prepared during the year. establishment of a division of sanitary engineering During 1953, this project progressed very satis- in the Ministry of Public Health. The first course for factorily.The actual field work, to be done by public- health inspectors was held in 1952, the second trained personnel with improved equipment, should was completed in January 1953, and the third was in begin towards the middle of 1954, and the second progress at the end of the year. phase, the reorganization of the rural health services Measures were taken to encourage the participa- and their extension first to selected communities tion of the community in this project, and a pamphlet, and later to the whole country, is expected to start " Campaign againstHookworm in Paraguay ", in 1955. was prepared for use in schools as part of the educa- tion programme in the Asunción- Villarrica area. Parallel Work on Ankylostomiasis and Smallpox A manual of instructions for home visits was also This project, in which UNICEF is also assisting, prepared for health inspectors. was originally started as a programme for the The smallpox vaccination campaign was conducted control of ankylostomiasis in Paraguay. A smallpox by the same personnel as the other part of the vaccination campaign was added in 1952. programme. With a house -to -house campaign, and The programmeforankylostomiasiscontrol, by the use of dried vaccines, it is planned to im- which started in December 1951,includedthe munize 200,000 individuals in the Asunción- Villar- determination of the prevalence and degree of the rica area.During the year a plan for smallpox infestation, mass treatment, environmental sanitation, vaccination was prepared, primarily to train per- health education and evaluation of the results. sonnel, and the training of health inspectors in small- During 1953, studies of the prevalence of ankylo- pox vaccination was completed intheSajonia stomiasis were completed in another part of Asunción and in Mboi -y Itauguá.House surveys and the district. construction and repairing of latrines were continued, In September, adequate supplies of drugs and and several coprological surveys were made. vaccine finally allowed the start of an intensive Treatment with tetrachloroethylene, to demonstrate campaign against these two diseases in Asunción. the efficacy of the drug, was undertaken and completed The unforeseen delays in 1952 in recruiting personnel in the experimental area of Mboi -y Itauguá after and in procuring some of the items of equipment, a survey to determine the prevalence of ankylosto- and the need for smallpox vaccinations in the areas miasis. which were previously covered only for ankylosto- Earlyin1953apublic -healthengineer was miasis, will make it necessary to extend this pro- appointed to the project.He reviewed the work gramme into 1955.

* *

Progress toward Integrated National Health Programmes In the Americas there has been a definite increase factors are a larger number of qualified public - of interest among governments in strengthening and health officers trained under programmes of inter- expanding health services for their people. The causes nationalorganizations,governmentalandnon- would be difficult to identify and evaluate, but among governmental, and now occupying leading posts in the general factors are a substantial increase in their countries, and the stimulus and assistance given industrialization (two- thirds since 1946), the value by international organizations in developing health of industrial production now exceeding that of programmes. agricultural production by 36 per cent, and a general There are many indications of this trend.The increased interest in public services affecting the regionaloffice,for example, now receives more welfare of the people.Among the more specific informalrequestsforadviceontechnical and 76 THE WORK OF WHO, 1953 organizational public- health problems. Most of 73 and 74, the South American seminar onthe these requests are dealt with in the zone offices, some reporting of communicable diseases, held in Santiago, of which report that as much as 60 per cent of the and the assistance given to schools of medicine and time of their technical staff is devoted to advising public health (see the list of projects in Part IV). governments in this way. Zone offices, which consult Plans have also been made for a seminar on the governments about theirhealth programmes in teaching of preventive medicine. connexion with the preparation of the WHO and PASB programme and budget estimates,report that this consultation appears to be stimulating Future Activities governments to better advance planning of their In 1952 the Regional Committee adopted three national programmes. priorities for long -range development : an attack on A study of WHO's programme and budget for communicable diseases susceptible of mass approach, 1954 and the estimates for 1955 shows a definite the training of personnel, and the strengthening of trend towardsintegratedpublic- healthprojects, national health services. which in turn contribute to the development of Previous work on communicable diseases has balanced and co- ordinated national programmes. led to a concentration on those diseases which can Four large projects in public- health administration be either eradicated or reduced to negligible pro- have been operating in. the Region since 1952 or portions. Since many of the national health services earlier : the health demonstration area in El Salvador, were developed primarily to deal with communicable the programme for strengthening rural health services diseases, and because of the international implica- in Panama (described above) and two in Peru --a tions, it is expected that the countries of the Region demonstration and training centre in Callao and the will strongly support this priority.Malaria, yellow project for assisting maternal and child health and fever, smallpox, tuberculosis, yaws and syphilis, in related services in the Lima -Pativilca- Huarás area. particular, will be attacked. Four of the main projects in Paraguay are operated The need for training personnel is also generally through integrated community health centres. admitted, although many problems, such as finding Six new integrated health projects have been suitablecandidatesfortraining,placingthem planned tostartin some future year :one to appropriately, and seeing that theirservices are strengthen local health services in the Petit Goave properly used afterwards, may mean that results area of Haiti, postponed from 1953 ; two for rural will be slow to appear. Nevertheless, recent develop- public- health services (one in Guatemala and one ments are promising. in Nicaragua) ; a programme for the reorganization The strengthening of national health services is a of the health services in Bolivia, and two for the broad notion offering many different approaches. demonstration of localhealthservicesinChile The principle itself is accepted, but as programmes (Concepción) and Venezuela.Two other projects develop itwill be necessary to decide just what in health administration, in Ecuador and Barbados, kind of assistance should be given by the Organi- are in the stage of informal discussion. At least half zation in order to achieve the basic aim. Obviously, the projects, operating or planned, will affect the this will vary from country to country, and it should public -health service of the entire country. therefore be possible to use for this purpose pro- All the above projects include provision for the grammes in subjects other than the control of com- training of public- health personnel, but there have municable diseases -programmes, for example, of been several projects devoted entirely to training, maternal and child health, public- health nursing, which should alsohelp in the development of sanitary engineering, and industrial hygiene.There integrated national health programmes. They include is widespread national interest in the first three of the projects in environmental sanitation, vital and these subjects, and experience in developing them health statistics, and nursing, described on pages all, so steady progress may be expected. CHAPTER 13

SOUTH -EAST ASIA REGION 1

Needs and Problems of the Region three more units is being trained, and itis now The rapid expansion of health work in all the planned to bring under central control the tubercu- countries of South -East Asia has brought with it losis laboratoryservice,thevaccineproduction many problems in which WHO is closely involved. section and the clinical and public -health laboratory Popular demand for direct medical services has forced services, and so provide an integrated laboratory governmentsintoprogrammes forspecialends service for the country as a whole. which may not be the most appropriate step in long- The need for co- ordinating the health work in the term planning.Some countries with scanty local Region is growing, and the role of WHO as a co- resources are overloaded with commitments for such ordinator is also more appreciated.The constant popular programmes, so that the funds and man- presence of the area representatives, who are well power remaining are insufficient for founding a solid acquainted with local circumstances, has been most health service. Unless this tendency is resisted, some useful.Closer liaison with the bilateral agencies, of the mistakes made in the development of public - which areextremelyactiveinthisregion,is health services in Europe in the last hundred years slowly producing a more unified approach to health will be repeated in South -East Asia in the next few planning. In Nepal, for example, there has been very years. good co- ordination with the Foreign Operations WHO must so continue and expand its advisory Administration of the United States of America services that governments can turn to it for support (FOA) :the malaria project that is being planned in long -term planning. Requests for assistance with follows on the hard preliminary work done by FOA's special problems are gradually being replaced by public -health adviser to the Government, and it will others- particularly for help with education and be carried out with the help of WHO staff and with training -that show the importance now attached supplies and equipment provided by FOA. to long -term planning, and the governments in the In some of the better developed countries in the Region are showing an appreciation of the help that Region, theauthorities responsible for planning the Organization can give in this way. realize the danger of the trend towards providing WHO's help has been particularly appreciated in for curative measures at the expense of long -term Burma, where the health services are being rapidly public -health work, but find itdifficult to resist reorganized.In Afghanistan itis hoped that the popular pressure. WHO can strengthen their hands WHO public -health adviser to the Government will by giving technical advice. be able to stimulate the development of balanced Health services can be effectively developed only health services. An illustration of how this can be if the population feels the need for them, and some done is the laboratory which was started three years governments are seeking advice on the best means ago in Afghanistan as a venereal- disease serology of stimulating this desire for improvement. Realistic unit, was developed by WHO and UNICEF, and has health education programmes, too, are badly wanted, been expanded into a central public -health laboratory but WHO still finds it difficult to recruit enough good in Kabul, with a second unit at Kandahar. Staff for health educators. 1 The South -East Asia Region comprises Afghanistan, Certain widespread diseases continue to hamper Burma, Ceylon, India, Indonesia, Nepal and Thailand (see the economic development of most countries in the Off. Rec. Wld Hlth Org. 13, 80, 330, resolution WHA3.118 Region. Now that schemes for malaria control are and resolution WHA6.48).In accordance with resolution WHA6.46, the Maldive Islands were added to the Region wellunder way,basicenvironmentalsanitation provisionally. remains the most important single problem in South- - 77 - 78 THE WORK OF WHO, 1953

East Asia. The Organization is being asked for more The Regional Director's annual report to the assistance in this aspect of preventive medicine, Regional Committee was discussed in detail, and suitably adapted to the needs of the Region ;and the proposed programme and budget for 1955 was it is hoped that by 1955 WHO demonstration and examined and endorsed. The emphasis in the regional training teams in environmental sanitation will be programme on basic public- health activities, including operating in all countries in the Region. work in education and training, environmental sanita- The regional office has given much attention to tion and health education, was approved.The the question of national counterparts for international eventualexpansionof malaria campaignsinto personnel. Althoughcertaingovernmentshave regional programmes of malaria control was given difficulty in furnishing suitable persons, good progress special consideration. Two interesting subjects were has been made during the year.In a few cases, brought up by one delegation :the possibility of however, WHO field staff are working without the interchange of technical experts between Member promised national counterparts ; in other cases, the governments within the Region, and the terms and type of the counterpart staff, their tenure of office conditions of service for personnel engaged in public - and conditions of employment are often unsatis- health services. factory. The chief cause of the trouble is perhaps the The committee examined the question of WHO's low salaries, which compel public- health workers and sponsoring a world -wide campaign against smallpox, even teachers in medical schools to give much of referred to regional committees by the Sixth World their time to private practice. Health Assembly.It considered that WHO should Shortages of trained personnel remain acute in continue to give assistance when needed to national the Region, and assistance to institutions for training efforts for smallpox control. doctors, nurses and all categories of para- medical staff, especially in environmental sanitation, must The committee decided not to recommend at the remain one of the major functions of WHO. Too present time any changes in the rights and obligations many institutions of this kind are now poorly staffed, of Associate Members. The reimbursement by WHO and more are poorly equipped, but the help that of the travel expenses of representatives at sessions WHO can give is limited by the scarcity of suitable of the Regional Committee was discussed, and it WHO consultants and of national counterparts. was decided to recommend such payment, provided A country may be acutely short of doctors and may that it had no adverse effects on WHO's field pro- ask WHO for lecturers to staff a new medical school, grammes.Furthersubjectsdiscussed werethe but it is not practicable for the Organization to do maintenance and travel costs of national candidates this for eight or ten years without any hope of training attending national courses organized with the help local counterparts ; and yet, without WHO's help, of WHO, the problem of leprosy control in South - the new school cannot start and there is no hope of East Asia, and regional dental -health programmes. remedying the acute shortage of doctors.It is not As the committee decided in 1952 to meet at the easy to find the proper point at which to break the regional headquarters in alternate years, the next vicious circle. session will be held in New Delhi in 1954. The session of the Regional Committee was The Regional Committee followed (from 21 to 24 September) by the first Asian malaria conference to be sponsored by WHO. It was The sixth session of the Regional Committee for attended by representatives from most countries South -East Asia was held in Bangkok from 16 to in the South -East Asia and Western Pacific Regions 19 September.Representatives of eight of the ten and one from Pakistan.2There were also repre- Member countries of the Region were present ; sentatives from other United Nations agencies and Nepal and the United Kingdom of Great Britain and from the Foreign Operations Administration.The Northern Ireland were not represented. There were main object of the conference was to discuss the also representatives of the United Nations Technical organization of malaria control and the problems Assistance Board, ECAFE, UNICEF, FAO and of organizing large campaigns (see page 5). UNESCO, and observers for the Foreign Operations Administration of the United States of America and 2 The following countries were represented at the inter- five non -governmental organizations. The Director - regional malaria cpnference :Afghanistan, Burma, Ceylon, General of WHO was present at the early plenary French Settlements in India, India, Indonesia, Portuguese India ;Pakistan ;China, Laos, Malaya, Netherlands New meetings. Guinea, and Viet Nam. MALNUTRITION IN SOUTH -EAST ASIA

This listless child in its hospital cot seems a tragic symbol of the malnutrition that is so widespread in South -East Asia.

During a nutrition survey in Jakarta (Indonesia), a doctor and nurse examine a child, while ina neighbouring village members of the team investigate the diet of the population. At the mothers' club in Huacho (Peru), prenatal and After the first visit of the public -health nurse, the After the mother and the new -born twins, the older Inapplying the elementaryprinciplesofhygiene, infant care is demonstrated by nurses and auxiliary expectant mother goes to the Apopa Clinic (El Salva- children are examined in their turn, for the public - the health visitor must be ready to use whatever nurses under the guidance of a nurse adviser. dor).Thedoctor,whileexaminingher,gives health nurse is responsible for the health of the whole materials are at hand. instructions to the local midwife as to the care she family. requires.

MATERNAL AND CHILD HEALTH IN PERU AND EL SALVADOR

The rural health clinic at Amay (Peru).By the advice The children are not forgotten in the health education On one of her many home visits to the expectant ... and also shows the midwife the routine to be mother, the nurse explains the need for disinfection... followed : taking of temperature, blood pressure, etc. and encouragement of the health visitor, mothers programme : this lesson in personal hygiene is watched are persuaded to attend regularly with their children. attentively by the whole household. ANTITUBERCULOSIS CAMPAIGNS

IN TAIWAN IN HONG KONG

These schoolchildren lining up for vaccination seem to have varied ...whereas the little boy from a Hong Kong orphanage takes his feelings on the subject... tuberculin injection as a matter of course.

IN THE PHILIPPINES IN ECUADOR

During the national antituberculosis campaign launchedby the At the central tuberculosis -control laboratory samples of tissue Government of the Philippines with the help of UNICEF and WHO, suspected of tuberculosis are enclosed in paraffin to be placed in a the director of the BCG vaccine laboratory lectures to student microtome, by which they are cut into thin strips before being finally nurses on the use of the vaccine. mounted on slides. SOUTH -EAST ASIA REGION 79

A WHO staff working party also met in Bangkok UNICEF, with which many joint projects were after the session of the Regional Committee :all the successfully carried on.Examples of interagency field staff and regional officers present in Bangkok collaboration were the continued participation of a met for an exchange of ideas and experience, which WHO representative in the United Nations Social served to bring regional office and field staff closer ServicesMissioninBurma,collaborationwith together and to co- ordinate work in the Region. ECAFE in holding a working party on tropical housing, and consultations with members of the United Nations Mission on Community Organization and Development in South and South -East Asia. The Regional Office In the population studies being carried on in India, The main administrative difficulties in the regional WHO staff has worked closely with representatives office during the year arose from budgetary un- of the United Nations Population Division. certainties. Staff shortages and changes impaired the The year has also seen increasing co- operation work of the office, but the filling of the vacancies for between WHO and the Foreign Operations Adminis- two public- health advisers should contribute materi- tration of the United States of America (FOA). ally to the planning and execution of programmes. There have been frequent consultations and joint The appointment of area representatives in Burma, planning between WHO's area representatives and Ceylon, India and Indonesia has helped national the medical missions of FOA, and governments planning and co- ordination. have been encouraged to undertake national pro- An exchange of public information officers between grammes, to be carried out with technical advice the regional office and headquarters improved the from WHO and with supplies and equipment from co- ordination of this work within the Organization. FOA.There were informal discussions with the As the activities of WHO gradually become better authorities of the Colombo Plan for Co- operative known in the national health services of the countries Economic Development in South and South -East in the Region, more attention is being given to Asia during the meetings, in New Delhi, of its securing the interest and co- operation of other pro- Consultative Committee for Technical Co- operation. fessional groups and of the general public.Basic With their help it is hoped to carry out a project in information is now being issued in local languages, Indonesiaforreorganizingand improvingthe anditsadaptation and reproduction has been quarantine arrangements in the country's ports and encouraged wherever possible. A plan by which airports -for which a survey was made by WHO - journalists of the various countries will work with and to find experts for some other national projects the WHO area representatives in adapting press with which WHO is assisting.Many Fellows are releases and other types of information to local now being placed through the Colombo Plan, and interests will shortly be tried out. otheropportunitiesforcollaborationarebeing To stimulate support for WHO among specialists explored. and health workers of all categories, arrangements Collaborationhasbeenmaintained withthe were made, with the assistance of the area representa- Norwegian authorities assisting with the development tives,tocirculatetothepublishers of selected of fisheries and improvement of health conditions periodicals advance copies of the Chronicle of the in a small area in the State of Travancore. World HealthOrganization and separate feature Co- operation with non -governmental agencies has articles. As a result, articles from the Chronicle and been developed, notably with the Rockefeller and other WHO documents have been widely reproduced. Ford Foundations and with CARE. WHO is co- Liaison between the regionaloffice and other operating in arrangements for an exchange of pro- United Nations and bilateral agencies has been fessors between the Harvard School of Public Health closer : the area representatives have maintained close and the All -India Institute of Hygiene and Public working relations with the resident Technical Assist- Health, Calcutta. ance representatives ; there have been various meet- Action is being taken to encourage the formation ings during the year, at country and regional levels, of a central body to co- ordinate leprosy control in with members of the other specialized agencies, and India, which is at present divided between govern- the fullest collaboration has been maintained with mental, quasi -governmental and numerous voluntary 80 THE WORK OF WHO, 1953

bodies.Liaison has been maintained with the training courses on special subjects in countries Indian Council of Medical Research. in the Region, either as specific projects or as part of the work of demonstration teams. In1953, Fellowships and Training WHO assisted with about 65 courses of this kind, ranging in length from one week to one year, in The regional office awarded 97 fellowships during Burma, Ceylon, India, Indonesia and Thailand. The the year for attendance at international training regional office helped to organize the WHO con- courses and for individual study : 67 financed from ference on malaria just described, a regional seminar regular funds ;27 from Technical Assistance funds, for waterworks operators, attended by 50 partici- and three by UNICEF. In addition, particular pants, and sent participants to the seminars in other attention was given to the organization of national regions (listed in Annex 5).

Reports on Typical Projects in the Region

Malaria Control, Burma Government's five -year plan for country -wide mala- In Burma malaria is among the greatest public - ria control, with which a beginning was made in 1953. health problems and an obstacle tosocial and Malaria control is now popular, and control units economic development.About seven and a half can move freely, even in areas where lawlessness million persons, nearly 40 per cent of the population, prevails. are affected. At the request of the Government a The demonstration phase will be completed early WHO team, including a malariologist, an entomologist in 1954. and a sanitarian, was sent in May 1951 to demonstrate modern methods of malaria control and to help build Maternal and Child Health and Venereal Disease up and train staff for a national malaria organization. Control, Burma Some months were spent in preliminary work and surveys, and the district of Lashio, where the spleen A project was started in September 1950 by the rate among children was 90 per cent, the parasite BurmeseGovernment,assistedby WHO and rate 26 per cent and the infant parasite rate about UNICEF, to strengthen maternal and child health 56 per cent, was selected for the demonstration. services -preventive, curative and teaching -and to Work started in early October 1951. diagnose and treat syphilis in mothers and children. The project has therefore been in operation for a Nursing education was from the outset taken as the little over two years, and is being continued. The key point, and a senior nursing instructor was first four months were spent in epidemiological and appointed to plan and start this part of the project, entomological surveys, an area of 800 square miles which was originally intended to last for two years with a population of about 53,500 was chosen for but is being continued into 1954.By the end of the first year's work, and in the second year the area 1951, the WHO team had ten members : one paedia- was extended to 2,600 square miles, including several trician, four nursing instructors, three public- health small towns, and a population of 110,000. Anopheles nurses, one venereologist and one serologist. Another minimus has been proved to be the vector, and the paediatrician and another public- health nurse were main transmission season appears to be from July added in 1952.This team continued to the end of to December. After the first year's operations, 173 1953 but will be reduced in 1954. The main work was blood smears of infants were examined, and not one centred on Rangoon and Mandalay. was positive ; there was a 26 per cent reduction in When the project started, Burma was struggling spleen and parasite rates, and the vector species was with the aftermath of the war and with internal reduced by about 90 per cent as compared with disturbances, but the full support and understanding unsprayed areas. of the Government and the close co- operation of the This project, by providing training for malariolo- national and international members of the team were gists,entomologists, and malaria assistants and able to overcome most of the difficulties. A complete other auxiliaries, has stimulated and helped the assessment of the project will not be possible for a SOUTH -EAST ASIA REGION 81 few years, but already the following resultsare six -week training course in health education to apparent.(1) Important changes have been made sanitary inspectors, a three -month training course in the organization of the health services in Burma. for rural development officers, a three -week refresher The senior adviser and the nursing adviser helped course for teachers in adult education training centres, to plan this reorganization and are at present work- nine conferences on venereal- disease control for ing in the reorganized health directorate.(2) The over 200 officialsin agriculture and the public assistance given by UNICEF has stimulated the services, and 24 classes for school teachers on planning of a considerable expansion of the services methods of controlling ankylostomiasis.He has in rural areas, where health centres (in which maternal discussed health education with school administrators, and child health work will be included) have been assisted in mass propaganda campaigns, and helped established. (3) Maternity and children's wards have the Central Government to reorganize its health been set up in several provincial hospitals. education centre and to develop a health education The reorganization and expansion of the health programme at the Health Department's training services of the country were made possible by the centre at Kalutara. training given in the maternal and child health part of the project, which provided the personnel necessary Treponematoses Control, Thailand for these developments. Eighteen national counter- parts were trained (two maternal and child health The crippling effect of yaws on the productive officers, two paediatricians, nine nurse educators age -groups of the population and the consequent and five public -health nurses).Ninety -two workers check to the economic growth of the country have were given postgraduate training (six in paediatrics, for some years been recognized by the Government 42 in nursing education and 44 in midwifery) and 722 of Thailand. With help from WHO and UNICEF, students were given undergraduate training (227 a programme of yaws control was started in 1950. medical students were trained in paediatrics, 305 The immediate aim was to reduce the incidence of students in general nursing, 40 in midwifery and 150 yaws to a level at which it can be kept under control as local health visitors).In addition, 81 Let -thes by the general health services of the country. Pro- (untrained indigenous midwives) received training. gress is being made and the programme is increasing the public- health consciousness of the rural popula- tion. Health Education, Ceylon The campaign is controlled from its headquarters In 1952, a fundamental education centre was set at Rajburi, which also serves as a training centre up at Minneriya by the Government of Ceylon, for field and laboratory staff. Both at Rajburi and assisted by UNESCO and by ILO, FAO and WHO. at Korat there are well -equipped laboratories, which This project was planned as a demonstration of can be expanded to undertake general public -health fundamental education among the population of laboratory work. Field teams are carrying out mass some 70 villages in an area of 1,000 square miles surveys and providing treatment when necessary. in north -east Ceylon, and to train workers for the From the start of the campaign to June 1953, nearly entire country. WHO and the government health 2,700,000 persons were examined and over 300,000 authorities have been responsible for the work in cases of yaws were diagnosed and treated. health education ; WHO has also contributed some equipment. The project is to last three years and has now been Development of Department of Pharmacology, in operation for nearly two ; as it was a year late in Bombay starting, it will continue in 1954.Several national As the chair of professor of pharmacology in the government departments and . different agencies are Seth G. S. Medical College in Bombay had been also concerned with this project, and, though there vacant since 1950 and no suitable candidate could has been very good co- operation with the Govern- be found, WHO provided the college with a professor ment, it has taken time to _ define the respective in 1953, to teach medical undergraduates, to develop responsibilitiesand somequestionsstillarise. a department of pharmacology and a teaching pro- Nevertheless, a good deal of work has been done. gramme acceptable to the Medical Council of India, The WHO health educator, in addition to routine and to train a successor. WHO and the Rockefeller health education work in the villages, has given a Foundation have also provided scientific equipment. 82 THE WORK OF WHO, 1953

The professor arrived in February. One of his The international assistance given in this project first recommendations was the revision of the cur- has accomplisheditsobjectives, and the WHO riculum and examination in pharmacology. These personnel attached to the department was therefore changes were accepted by an ad hoc committee, and withdrawn at the end of the year. are now in force.The department is progressing well on the new lines. A successor was appointed, and well before the end of the first quarter a research Rural Health Centre, Thailand programme was initiated. A clinical study of the A rural health centre, in which particular attention treatment of tetanus has now been started. is being paid to maternal and child health and to The co- operation and mutual assistance are very nursing, is being developed in Chiengmai in Thailand. satisfactory. The professor has been given additional This was originally a project for malaria control, to space, funds and technical and professional assistance, which work on maternal and child welfare was later and the changes in curriculum and form of examina- added, and, on a small scale, it is an illustration of tion are appreciated by the students. how the work of the Government, WHO, bilateral and local agencies can be successfully co- ordinated in an urban and rural scheme.It has also achieved Training in Venereal -Disease Control, Madras one other important aim -that of stimulating people Since the latter half of 1952, WHO has been pro- in the community to improve health conditions viding a team, consisting of a serologist, a public - through their own efforts. health nurse and a medical social worker, together This project,still in its initial stages, has as its with necessary supplies and equipment, to help the purpose the establishment of a demonstration cen- Indian Government in its plans for establishing a tre and trainingarea, in which training in rural training centre in the venereal -disease department health and in domiciliary maternal and child care of the Government General Hospital in Madras. will be given to workers, in the northern part of the There was some delay in getting the programme country. The public -health aspects of rural health work started because of difficulties experienced by the are emphasized. School health work is also included, Government in finding matching personnel and in and a refresher course of lectures for teachers in providing a building and furniture, but the training rural centres has been arranged. The Government centre is now well established and suitably staffed. has appointed a dental hygienist to work on this Itis the intention that this centre should provide project and also a nutrition team, which is working postgraduate training within India in all aspects of in the area and is maintaining close relations with the control of venereal diseases.The counterpart the international staff.In 1954, an internationally staff has been trained, and with the teaching and recruited sanitarian is to be added to the team, and clinical material now available at this institution, training in environmental sanitation will also be courses are being conducted which will lead to a given. postgraduate diploma in venereology. Training in Though small, this project has become a centre the various branches of venereal -disease control has for co- ordinating the work of various divisions of also been given to teams appointed by the State the Government medical services and of voluntary governments.The improvement of nursing and and international agencies. the social aspects of venereal -disease control have It is important in such a project to awaken and been given particular attention. maintain the interest of the recipient population, Besides providing training, the centre has served and this is being attempted in Chiengmai by setting as a reference laboratory in two surveys, one spon- up health committees of voluntary workers and local sored by the Indian Council of Medical Research. officials.The members of these committees have The other, sponsored by WHO, was to evaluate the been given the responsibility of interesting the people work being done in some 13 laboratories in different in the activities of the health centre.Meetings are Indian States which had previously received assist- held once a month under the chairmanship of the ance from WHO and UNICEF. district officer for rural areas or the mayor of Chieng- The laboratory, in co- operation with the laboratory mai town. The presence of the team members helps of the Corporation of Madras, is to participate in the to keep the population informed, maintain close programme for the control of venereal diseases relations, and encourage the enthusiasm of the planned in the city of Madras. voluntary workers.The Government has supplied SOUTH -EAST ASIA REGION 83 a medical health unit to carry out work in health to erect a 50 -bed maternity ward at a local hospital. education and togiveinoculationsand minor This will be used in the training of rural midwives. treatment, and it will shortly be strengthened by the Equipment is being supplied by the Foreign Ope- provision of a health education kit from UNICEF. rations Administration of the United Statesof As in many other projects of this type, there are America. not enough trained workers to keep up with the Although the project started modestly, it is slowly needs and desires of the community. beginning to incorporate the main aspects of pre- The interest in health which has been aroused by ventive medicine and at the same time has supplied the Chiengmai project has resulted in the raising a necessary service for the treatment of minor of funds by voluntary subscriptions from the public sickness in rural communities.

Future Trends There is evidence that, in spite of the difficulties purpose short -term consultants of high standing will mentioned earlier, co- ordinated national planning be useful. is developing from the stage of demonstration projects Programme planning for the future must take on which international assistance was at first con- account of the total resources available and ensure centrated ;this was in fact one of the objectives of that they are distributed in accordance with the needs such demonstrations. of the Region, resisting any pressure, national or international, which may tend to accentuate unduly It is still necessary to provide advice and assistance a particular line of health development. with mass campaigns and in training of personnel ; but this function of the Organization will become But on balance it is probably true to say that work in the Region is approaching the stage of getting to lessprominentascomprehensivenationalpro- grips with the more basic health needs of the coun- grammes develop, supported by a body of trained tries, and it is becoming necessary to provide for the national health workers. More emphasis must be greatest latitude in regional programme planning given to long -term planning, to integrating control and for the possibility of making unexpected changes at programmes into the general health services, and short notice, in order to meet changing developments to helping to co- ordinate those services.For this and to fit it into existing or projected national plans. CHAPTER 14 EUROPEAN REGION

The endorsement by the Regional Committee at mend their adoption by the Health Assembly in its second session of long -term objectives defining viewof therelativelyshortdistancesinvolved futurelinesof work has materially helped the in travelling in Europe.The committee further Regional Office for Europe to develop its organiza- studied a proposal, initiated at its second session, on tional structure and to frame programmes suited additional contributions to regional budgets, and to the particular needs of the Region.Progress decided to continue this study at its next session during the second full year of operation of the after the views of individual governments had been Regional Organization for Europe has been satis- ascertained. factory.It must be recorded with regret that the During the session there was discussion on the following European countries have not yet resumed permanent site of the regional office.After review- participation in the work of the Region :Albania, ing the development of the work in Europe and the Bulgaria, the Byelorussian SSR, Czechoslovakia, responsibilitiesplaced on the regionaloffice by Hungary, Poland, Roumania, the Ukrainian SSR the decentralization of WHO's work, the committee and the Union of Soviet Socialist Republics. first decided to recommend that the office should be established separately from the headquarters The Regional Committee office, where it is now provisionally located.Then The third session of the Regional Committee was it considered proposals to set up the regional office held in Copenhagen from 7 to 10 September and in Copenhagen, Nice, Frankfurt, the Hague, and was attended by the representatives of 22 Members Geneva, and decided to recommend to the Executive and Associate Members.Representatives of the Board, for consideration at the thirteenth session, United Nations (including UNICEF), and observers the selection of Geneva as the permanent site. for the Rockefeller Foundation, the International The committee endorsed certain changes in the Children'sCentre,andeightnon- governmental programme for 1954, in the light of events since its organizations in official relations with WHO, were approval by the Sixth World Health Assembly.In also present. examining the proposals for 1955, it paid particular The committee recommendedtotheHealth attention to the staffing of the regional office and Assembly that each regional committee should be tointer -country programmes. To maintain a empowered to grant itsAssociate Members full continued programme the committee gave highest rights of vote. It discussed other problems of priority to those inter -country programmes designed regional interest which had been considered by the to follow up work in which WHO has already been Sixth World Health Assembly, such as the Executive engaged in previous years. Board's study on regionalization.2 It was considered that a proposal to replace the It considered suggestions of the Executive Board existing International Anti -Venereal- Disease Com- on the payment of travel expenses for representatives mission of the Rhine by a commission with wider attending regional committees, but did not recom- responsibilities for the health and welfare of Rhine River boatmen required further study, and for this 1 This region, in accordance with the decision of the First purpose a meeting of the five governments concerned World Health Assembly (Off. Rec. Wld Hlth Org. 13, 80, and interested agencies took place in Antwerp on 330) comprises all Europe. Turkey, by resolution WHA5.46, was admitted to the Region while provisionally suspending 9 and 10 December. its activities in the Eastern Mediterranean.By resolutions In the course of the session of the Regional WHA5.43 and WHA6.46, Algeria,the French Zone of Committee, an extremely valuable discussion took Morocco, Tunisia, Greenland, Gibraltar and Malta were also provisionally assigned to the European Region. In 1953, place on the education and training programme for the following Members or Associate Members participated medical and health personnel in Europe, against in the work of the Region :Austria, Belgium, Denmark, Finland,France,Germany (FederalRepublic),Greece, the background of the Executive Board's organiza- Iceland,Ireland,Italy,Luxembourg, Monaco, Morocco tional study of education and training.3Certain (FrenchZone),Netherlands,Norway,Portugal,Spain, aspects of training of particular interest to the Sweden, Switzerland, Tunisia, Turkey, the United Kingdom of Great Britain and Northern Ireland, and Yugoslavia. 2 Off. Rec. Wld Hith Org. 46, 157 3 Off Rec. Wld Hlth Org. 46, 131 - 84 - EUROPEAN REGION 85

Region, such asstudies on educational trends, office, which now much exceeds what headquarters assistance to training institutions, fellowships, con- can undertake, and the necessary budgetary and ferences and seminars, became the subject of an financial services, the greater part of which has been informal exchange of views.The suggestions made provided with increasing difficulty by headquarters. should contribute materially towards the shaping Demands for public information, on the other hand, of WHO's work in education and training in the were largely met by appointing a regional public Region over the next few years. information officer during the year. The committee decided to hold its fourth session When the permanent site of the regionaloffice inOpatija,Yugoslavia, and itsfifth in Vienna, has been finally approved, an important step will Austria. have been taken towards staff stabilization.

The Regional Office Co- operation with Other Agencies Reference has already been made to the selection Each yearbrings smoother working relations of a permanent site for the Regional Office for between WHO and otheragencieswith health Europe. The close contact with headquarters in the interests in Europe, where, indeed, there are no great early stages was important and helpful, but it has distances to prevent the personal contacts between become increasingly difficult for the office to maintain representatives of these agencies on which effective and develop its regional role while occupying the co- operation depends. The United Nations and headquarters building.Uncertainty as to the per- the regional office each took part in conferences manent site of the office has created many problems and seminars organized by the other. The regional for the staff and has also delayed the establishment office has continued to help with the briefing of of a stable staffing pattern. United NationsFellows. Jointplanning with On the technical side, the objectives in staffing UNICEF has now become routine and works have been fairly clear.To meet the known needs extremely well. The International Children's Centre over the next few years, a medical officer for fellow- provides valuable training programmes in maternal ships, a mental -health officer and a nursing officer and child health, and members of the staff of the are required.These positions were approved for regional office regularly participate in discussions 1953, and the first was filled, but financial and other on the future programmes of this centre.Work difficulties have delayed the filling of the other two. with ILO during the year was mainly on occupational Towards the end of the year, an area health officer health programmes in Europe and on health and was appointed to supervise trachoma -control pro- welfareservicesforRhine River boatmen and grammes in the French Zone in Morocco, in Tunisia their families ;that with FAO, on regional problems and in Yugoslavia.Staff assigned for field work of milk and meat control and on the zoonoses. included 13 on a long -term and 39 on a short - A working arrangement established with the Coun- term basis. cil of Europe in 1952 has led to a regular exchange On many points of administration, the problem of information. has been to decide which services should be provided in the regional office and which borrowed from The well- established co-operation. between WHO headquarters, and the solution has not been invari- and the Rockefeller Foundation has been continued, ably satisfactory.Where headquarters could clearly both on specific programmes, such as those relating not undertake the amount of work required, the to rural health services and the survey on health regional office has rearranged the approved staffing visitors, and in many other matters in which the pattern to meet the greater need. Thus the general long experience of the Foundation has been made services of the regional office were strengthened freely available to the regional office. during the year by the appointment of an admi- nistrative officer responsible for inter -country con- ferences, seminars and symposia, and a technical Technical Assistance for Economic Development assistant to supervise documentation and the repro- As certain European countries were economically duction of reports.Problems still to be solved are retarded by the war and were consequently ready the volume of translation work necessary for the to absorb Technical Assistance in the early phases 86 THE WORK OF WHO, 1953 of the programme, there were in Europe compa- Individual Country Programmes ratively large Technical Assistance projects, which In Europe any separation between theinter - reached their peak in 1952.As economic develop- country and individualcountry programmesis ment improved and as the absorptive capacity of becoming somewhat artificial.In fact, most of the other countries of the world increased, the picture WHO- assisted activities carried out within individual of Technical Assistance in Europe materially changed, countries now increasingly tend to be the national and in 1953 there was a considerable reduction of counterpart of a larger regional programme.All activities under this programme. theactive Member countriesinthe European Throughout most of the year the uncertainty as Region participate in the inter -country programmes ; to Technical Assistance funds gave rise to many nearly all have now acted as host for either a regional serious problems of adjusting country programmes conference, a seminar or a group training course, in Europe.Perhaps even more serious was the and practically all have participated in the pro- recurring need to review both the regular and the gramme of individual fellowships from regular or Technical Assistance programmes with each change Technical Assistance funds. in the state of Technical Assistance resources. Within the countries themselves, there is wide- spreadinterestin programmes for strengthening Inter- Country Programmes national training institutions, particularly in post- graduate public -health training (in Austria, Greece, As in previous years, the main feature of WHO's Italy,the Netherlands, Turkey and Yugoslavia), work in Europe has been inter -country programmes, nurse training (in Turkey) and psychiatry (in Den- of which a tabular statement will be found opposite. mark). WHO helps with these programmes in Hitherto, the emphasis in these programmes has several ways : regional health officersassist in been on the exchange of information, and profes- programme planning and development ; visiting sional education and training.This emphasis has lecturers are provided ;fellowships are awarded to been continued in 1953, but it has become evident members of the teaching faculty ;teaching equip- that a preliminary study of health problems and ment is supplied, and medical library services are servicesisoftenneeded beforereallyvaluable strengthened. A conferences and seminars can be arranged. There isalso wide interest in programmes of greater proportion of time and effort will need to be maternal and child care, which have been closely devoted to these studies in future. related to the inter -country conferences and group New activitiesduring theyear were WHO's training courses, some of which have been organized sponsorship of a study of the effects on child deve- by the International Children's Centre.These are lopment of separation from the mother in early reflected in general programmes of maternal and life, a study group designed to clarify the roles of child health and in programmes for premature paediatricians and child psychiatrists in child care, infants and for the care of handicapped children. and a seminar to define the more important mental - WHO, usually jointly with UNICEF, has helped health aspects of public -health practice. with such programmes in Austria, Finland, France, A group study of school health services in two Greece, Ireland, Italy, Turkey and Yugoslavia. European countries during 1953 will be followed The third main class of country programmes with in 1954 by a European conference on some aspects which WHO assists, again often with the help of of health services for children of school age ;on UNICEF, is the control of communicable diseases, the control of insect vectors of disease there were a especially tuberculosis, trachoma and the common symposium and a group training course, and WHO's communicable diseases of childhood. Help has work inanaesthesiology was expanded by the also been given in the production of vaccines and initiation in Paris of international group training sera. In 1953, programmes in one aspect or another for French -speaking participants, in addition to the of communicable disease control were planned or training centre in Copenhagen, where instruction in operation in eight countries :Austria, Finland, continued to be given in English. A public- health Greece, the French Zone in Morocco, Spain, Tunisia, training course for the Scandinavian countries was Turkey and Yugoslavia. established in Goteborg, and the first European A descriptive list of projects in individual coun- conference on health education was held in London. tries is given in Part IV. EUROPEAN REGION 87

Fellowships Because of financial difficulties, however, there was In 1953, a total of 287 fellowships were awarded a real decline in fellowships awarded from Technical in Europe compared with 592 fellowships for the Assistance funds, with 63 such awards in1953 previous year.This decline is more apparent than compared with 134 for 1952. real, since the figures for the year under review now The fellowship programme remainsacorner- exclude " participants " at inter -country conferences, stone of WHO's work in Europe and merits all the seminars, and symposia of the type shown in Table I. attention that can be paid to it.

TABLE I - INTER -COUNTRY PROGRAMMES IN EUROPE

Government(s) Participants Description of programme Duration principally Other participating countries or Participating agencies and role concerned Fellows § of regional office

Anaesthesiology (a) Fourth basic postgraduate 1 year Austria Italy 7 University of Copenhagen course for anaesthesiolo- June 1953- Denmark Germany, Federal Norway and regional office, which gists ;held at the Anaes- May 1954 Republic Spain provided outside lecturers thesiology Centre, Copen- and some teaching equip - hagen. t ment. EURO 52

(b) Training postgraduate 1 year France Belgium Spain 6 UniversityofParisand course for anaesthesiolo- May 1953- Germany, Federal Switzerland regional office, which pro - gists ;held at the Anaes- April 1954 Republic Turkey vided a technical adviser, thesiology Centre, Paris. f Greece an outside lecturer and EURO 62 some teaching equipment. Environmental Sanitation A study group on standard 3 days NetherlandsBelgium Italy 6 WHO headquarters and the methods for analysing water 8 -10 Dec. France United regional office. and on standards of water Germany, Federal Kingdom quality ;to review present Republic situation in Europe ; held at The Hague. EURO 66 Health Education A conference for public -health 9 days United Austria Italy 40 WHO headquarters and re- administrators and persons 10 -18 April KingdomBelgium Netherlands - gional office, which pro- actively engaged in health- Denmark Norway vided a conferenceor- education work ;held in Finland Portugal ganizer and 5 discussion London. France Spain leaders. (UNESCO was EURO 25 Germany, Federal Sweden represented atthe con - Republic Switzerland ference.) Greece Turkey Ireland Yugoslavia Health Visitors Continuation of the pilot study 3 years France - - - Rockefeller Foundation and to determine the kind of 1951 -3 United regional office, which pro - worker best suited to meet Kingdom vided the technical adviser family health and welfare and the services for the needs. technicaladvisorycorn- EURO 6 mittee.

§ Regional participants or Fellows sponsored by WHO f Although these European inter -country activities were open to participation from other regions, only European participants and fellowships are recorded in this table. 88 THE WORK OF WHO, 1953

INTER- COUNTRY PROGRAMMES IN EUROPE (continued)

Government(s) Participants Description of programme Duration principally Other participating countries and Participating agencies and role concerned Fellows § of regional office

Insect Control (a) A group training course 2 months Italy France Spain 10 Istituto Superiore di Sanità, oncontrolofdiseases 1 June- (Algeria) Tunisia Rome, and regional office. transmitted by insects, for 31 July Morocco Turkey medical and auxiliary per- (French Zone) Yugoslavia sonnel ;held in Rome. t Portugal EURO 46

(b) A symposium on the con-6 days Italy France Spain 12 Istituto Superiore di Sanità, trol of insect vectors of26 -31 Oct. Greece Switzerland Rome, and regional office. disease,for experts and Morocco United public -healthofficers en- (French Zone) Kingdom gaged in this field ;held in Rome. EURO 23 Mental- Health Aspects of Austria Spain Public -Health Practice Belgium Switzerland A seminar on the application 2 weeks NetherlandsFinland Tunisia 18 Government of the Nether - of mental -health principles 12 -24 July France Turkey lands and regional office, in various fields of public- Germany, Federal United which provided 2 lecturers health practice, for public- Republic Kingdom and 8 discussion leaders. health officers and psychia- Italy Yugoslavia trists ; held in Amsterdam. Portugal EURO 14.8 Milk Hygiene A group training course on 4 weeks Italy Austria Greece 5 FAO, UNICEF, WHO milk qualitycontrol,for20 Oct: Finland Yugoslavia headquarters and regional milk plant operators and 13 Nov. France office. representatives of national health services ; held in Rome. t INTER REGIONAL 9 Mother /Child Separation Study A study of the effects on child Since France - - - International Children's development arising from Nov. 1952 United Centre and regional office, separation from the mother Kingdom which contributed to cost in the early years of life. of study teams working EURO 64 in France and England. Occupational Health Austria Morocco (a) A group training course 3 weeks United Belgium (French 11 British Council. on industrial hygiene ; held 8 -26 June KingdomDenmark Zone) at Manchester and Roffey Germany, Federal Spain Park, England. Republic Sweden EURO 57 Greece Switzerland Italy Yugoslavia (b) A seminar on occupational 6 days Italy Austria Portugal 49 ILO andregionaloffice, health and its relationship 28 Sept.- Belgium Spain which provided a seminar to organization of health 3 Oct. France Switzerland organizer and 7 lecturers. services ;held in Milan. Greece Tunisia EURO 32.2 Luxembourg Yugoslavia Morocco (French Zone)

§ Regional participants or Fellows sponsored by WHO t Although these European inter -country activities were open to participation from other regions, only European participants and fellowships are recorded in this table. EUROPEAN REGION 89

INTER- COUNTRY PROGRAMMES IN EUROPE (continued)

Government(s) Participants Description of programme Duration principally Other participating countries and Participating agencies and role concerned Fellows § of regional office

Perinatal Problems (a) A study group on prob- 7 days Belgium Denmark Norway 17 The Government of Belgium lemsoftheperinatal 17 -23 Sept. Finland Sweden and regional office, which period ;held in Brussels. France United provided 2 consultants. EURO 39 Netherlands Kingdom

(b) A group training course 6 weeks France Belgium Portugal 6 InternationalChildren's on perinatal and neonatal 12 Oct.- Netherlands Switzerland Centre. problems ;held in Paris. 20 Nov. Norway EURO 55.4

Preventive and Social Medicine A conference of professors of5 days Sweden Austria Italy 20 WHO headquarters and re- hygiene and public -health 6 -10 July Belgium Netherlands gional office, which pro - administratorsonpost- Denmark Norway vided 3 discussion leaders graduate teaching of pre- Finland Portugal and 4 senior public -health ventive and social medicine ; France Spain administrators. held at Goteborg. Germany, Federal Switzerland EURO 22.3 Republic Tunisia Greece United Iceland Kingdom Ireland Yugoslavia

Public - HealthAdministration A group training course for 2 months Sweden Denmark Iceland 20 Government of Sweden and Scandinavian public -health 1 Aug.- Finland Norway regional office, which con - officers ;held at Goteborg. 30 Sept. tributed tocost of the EURO 60 teaching staff.

Public- Health Nursing A conference for public -health 2 weeks SwitzerlandAustria Morocco 47 Government of Switzerland nurses ;held at Mont Pele- 4 -18 Oct. Belgium (French and regional office, which rin s /Vevey. Denmark Zone) contributed 4 discussion EURO 7.2 Finland Netherlands leaders and a conference France Norway organizer. Germany, Federal Portugal Republic Spain Greece Sweden Iceland Turkey Ireland United Italy Kingdom Luxembourg Yugoslavia

Rehabilitation of Handicapped Children A group training course on 6 weeks France Spain Yugoslavia 2 International Children's the rehabilitation of handi- 16 Feb.- Centre. capped children, for social 28 March workersandspecialists ; held in Paris. EURO 55.2

§ Regional participants or Fellows sponsored by WHO 90 THE WORK OF WHO,1953

INTER- COUNTRY PROGRAMMES IN EUROPE (continued)

Government(s) Participants Description of programme Duration principally Other participating countries and Participating agencies and role concerned Fellows § of regional office

School Health Services A travelling study group for 3 weeks Denmark Austria Netherlands 19 Regional office, which pro - senior school health officers, 9 April- NetherlandsDenmark Norway vided 2 leaders for the in Denmark and the Nether- 1 May France Spain travelling study group. lands. t Germany, Federal Sweden EURO 40 Republic Switzerland Greece Tunisia Iceland Turkey Ireland United Luxembourg Kingdom Morocco Yugoslavia (French Zone) Social Paediatrics A group training course on 12 weeks France Belgium Italy 7 International Children's social paediatrics ;held in 13 April- Germany, Federal Norway Centre. Paris. 4 July Republic Spain EURO 55.3 Ireland Turkey Thoracic Surgery A group training course on 3 weeks NetherlandsAustria Spain 12 UniversityofGroningen certain aspects of thoracic 6 -24 May Denmark Sweden and regional office, which clinicalinvestigationand Germany, Federal Switzerland provided 2lecturers. treatment ;held at Gronin- Republic Tunisia gen t Luxembourg United EURO 27.3 Morocco Kingdom (French Zone) Yugoslavia Norway

Tuberculosis (a) A group training course 8 weeks Turkey Austria Spain 15 Antituberculosis training fortuberculosisspecia- from Finland Trieste and demonstration centre, lists ;held in Istanbul. t 30 Nov. Greece Tunisia Istanbul and regional of- EURO 56 Morocco Yugoslavia fice,which provided2 (French Zone) lecturers.

(b) A group training course 6 weeks France Finland Italy 5 International Children's on the prevention of tuber- 5 Jan.- Germany, Federal Morocco Centre. culosisinchildren,for 14 Feb. Republic (French physiciansandmedical Greece Zone) officersresponsiblefor prevention of tuberculo- sis ;held in Paris. EURO 55.1

Venereal Diseases (a) Continued work of the 4 years Belgium - - - WHO headquarters,ILO intergovernmental com- 1950 -3 France and regional office, which mission established to con- Germany, contributed to the ope- trol venereal diseases Federal rational cost of the corn - among Rhine River boat- Republic mission and financed at- men ;and a meeting for Netherlands tendance at meeting. discussion on the future Switzerland status of the commission. EURO 5

§ Regional participants or Fellows sponsored by WHO t Although these European inter -country activities were open to participation from other regions, only European participants and fellowships are recorded in this table. EUROPEAN REGION 91

INTER -COUNTRY PROGRAMMES IN EUROPE (continued)

Government(s) Participants Participating agencies and role Description of programme Duration principally Other participating countries and concerned Fellows § of regional office

Venereal Diseases (continued) (b) A group training course 12 weeks NetherlandsFinland Norway 11 WHO headquarters and re- on the various aspects of 21 Sept.- France Spain gional office, which pro - venereal- disease control 12 Dec. Germany, Federal Sweden vided 4 lecturers. which are particularly ap- Republic Yugoslavia plicable to maritime popu- Italy lation ; held in Rotterdam at the port demonstration and training centre. t EURO 59

§ Regional participants or Fellows sponsored by WHO t Although these European inter -country activities were open to participation from other regions, only European participants and fellowships are recorded in this table.

Reports on Typical Projects in the Region

It is difficult and sometimes impossible to report have asked for help in developing them further, and adequately on the progress of WHO's activities in fellowships have been awarded to candidates from Europe in terms of a single year. The interrelation- more than half the countries in the Region, for study ship of many projects is not always apparent from inbacterial,virus and rickettsialdiseases both tabular statements, nor is it easy to follow a particular in Europe and in the United States of America. activity over a number of years.The summary Several recently improved laboratories, in Austria statements which follow attempt to overcome this and Yugoslavia,forexample, now provide an difficulty by grouping selected projects in the Region extensive range of tests to assist physicians in exact and describing progress over a period not restricted diagnosis and cure. Former WHO laboratory to the year under review. Fellows in Yugoslavia have conducted epidemio- logical surveys to determine the extent of typhus Communicable Diseases fever, brucellosis and Q fever. Although the malaria of southern Europe is now The second is the zoonoses. In late 1952, a Euro- controlled and venereal diseases are no longer a pean conference in Vienna dealt with five of the 80 major problem in the Region, there is still a threat diseases transmitted to man from animals tuber- from many communicablediseases,particularly culosis,brucellosis,leptospirosis, Q feverand those of virus origin.The work of WHO in the rabies, all important problems in Europe. A report control of common communicable diseases of child- of this conference has been published jointly by hood, such as pertussis and diphtheria, must be left WHO and FAO.' Many European milk supplies for some future report, as must a description of have been unsafe because they transmitted bovine trachoma -control campaigns now under way in tuberculosis and brucellosis, and a joint UNICEF/ three countries in the Region. The field is wide, and FAO /WHO training course on various aspects of only two points on communicable- disease control milk processing and milk -borne diseases .was held will be mentioned at present. in Rome during the year (see Table I). As a result Thefirstispublic -healthlaboratoryservices. Modern public -health practice requires adequate 4 World Health Organization (1953) Advances in the control of zoonoses, Geneva (World Health Organization : Monograph services of this type. In some parts of Europe these Series No. 19) ;also published as FAO Agricultural Series services are well developed, but some governments No. 25. 92 THE WORK OF WHO, 1953 of the eradication of disease in animals, pasteuri- the seminars had encouraged the application of zation, and improved sanitation, milk is beginning technical findings to improve sanitation, and gave to take its place as the most important standard specific instances of such application. article of European diet.Leptospirosis causes much These seminars have also influenced the expansion disability and loss of manpower in the rice fields of regional work in sanitation during 1953.They of Spain,where over60,000hectares(147,000 have periodically brought together highly qualified acres) are under cultivation and it is estimated that experts from all countries in the Region, who discuss the workers number more than 100,000.A WHO common problems, some of which later form part consultant has assisted the Government to define of WHO's regional programme.In this way, two this problem and to improve control measures. international studies were developed, one with the Further WHO assistance in zoonoses will include aim of establishing an agreed English and French a conference on meat hygiene early in 1954, and terminology forsanitary engineering in Europe, later, a meeting of an advisory group to study pro- adaptable also to other languages, the other, begun blems of veterinary public -health. during 1953, on methods for analysing water and on standards of quality for drinking- water, as part of a wider scheme also involving the other WHO Public- Health Services regions.The second study is being conducted in close collaboration with headquarters. The health work most, active in Europe today At the next seminar on environmental sanitation, aims at the reorganization of public -health services to be held in 1954, the problem of pollution of to meet current needs.In future reports an account will be given of the regional nursing programmes ground and surface water will be discussed.This problem is becoming increasingly serious in many and WHO's work on health education of the public ; countries in Europe, where there is a growing demand a future opportunity must also be taken to describe WHO's attempt to adjust services in health and for pure water for domestic and industrial use, which welfare to the needs of the family unit, its work the increase of industrialization is making it difficult to meet.More up -to -date legislation is becoming against alcoholism, its recognition of mental health necessary to protect natural bodies of water from as an integral part of public- health practice, and the pollution so that they will remain safe for domestic steadyprogressinovercomingthewidespread use without the need for costly purification.This shortageof trainedanaesthesiologistsin many problem is of particular concern to a group of coun- countries. This year, however, the following aspects of WHO's work in Europe are described. tries in Central Europe, and, as rivers are often used by more than one country, international action will Environmental Sanitation be required. The varying cultural patterns and the different Public -Health Teaching stages of social and economic development of Euro- Reference has been made above to programmes pean countries largely explain their widely divergent for strengthening national institutions which provide practices in environmental sanitation. WHO is postgraduate training in public health. A high helping to reconcile these practices by promoting proportion of the individual fellowships awarded internationally agreed standards and by encouraging in past years has also been for studies in specific improvements in national services. aspects of public -health organization and services. At an early stage, the Regional Office for Europe Because of the need to review the European teaching developed periodical seminars for European sanitary of hygiene and of preventive and social medicine, engineers. These seminars provedeffectivein the regional office,which had sponsored a con- disseminating knowledge valuable to the individual ference on undergraduate training in Nancy in participants, in promoting a higher professional December 1952, organized another on postgradu- status for specialists in this subject and in producing ate training in Goteborg in July1953. These better co- operation between sanitary engineers and two conferences brought together many European other national public- health workers.The success teachers and senior public -health administrators and of these seminars was recognized at a meeting of gave a unique opportunity of reviewing the present a group of European experts, who found that teaching of public health in Europe, and of consider- EUROPEAN REGION 93 ing future action.At the end of the year a report Medical Library Organization was in preparation. Because of the importance of medical libraries A related activity, based on the recommendations in teaching institutions, a regional programme to made in 1950 by an ad hoc group of European strengthen medical library organization in certain experts, is a series of study groups in public- health European countries was undertaken by WHO.Its administration.These groups are designed to give object was to centralize medical library resources, experienced health administrators the opportunity to improve the qualifications of medical librarians of studying public -health problems in other countries, by awarding fellowships, and to provide the medical and thereby gradually to promote a better under- literature necessary for medical and public- health standing of public- health problems and services in training programmes. Europe. The WHO libraryconsultantvisitedseveral The immediate objectives of these study groups countries where library resources are small, and are :to learn of the health problems, to assess the observed that the difficulties are increased because available resources, to see how the problems are the books and journals are so widely scattered (in being tackled and finally to compare methods of the offices of the teaching staff, for example, in dealing with common problems.The first group, departmental libraries and in small clinic collec- in 1951, visited Sweden, Scotland and Belgium ; tions) without any union catalogue to show where the second, in the autumn of 1952, Norway and they are to be found. This has often caused a needless France ; both were under the leadership of an duplication of purchase, and, because there are few experienced public -health administrator. The central trained librarians in such countries, what is available health authorities in the countries that were visited is often not used to the best advantage.Little is prepared booklets giving such details on the social done in such circumstances to demonstrate to the conditions and the organization and administration medical student the rich resources he can find in of the health services as were needed to enable the medical works of reference and how he should use groups to understand and appreciate what they were the bibliographical tools of his profession. to see and discuss.These booklets already provide a nucleus of information for a report on the organiza- WHO has been abletohelp these countries tion of health services in Europe. Euro- with advice, and with fellowships.For example, pean countries now participate regularly in these in 1952, one Yugoslav medical librarian was awarded study tours, and arrangements, have been completed a fellowship for one year, nine months of which for a group to visit Germany and Italy in 1954. were spent in a basic library training course at Participants and sponsoring governments continu- the Ecole de Bibliothécaires, Geneva, and in supervised ously evaluate this activity, and the amendments they practice work in the WHO Library.This was suggest are incorporated in the arrangements for followed by visits to, and considerable practice work each new tour.This work was reviewed by the in, leading medical libraries in France and the United Regional Committee at its third session, when the Kingdom of Great Britain and Northern Ireland. governments represented were unanimous about This librarian returned at the end of the fellowship its value :they considered that participants had to Belgrade, to conduct short training courses and benefited from studying administration more widely organize a public- health reference service. Two and more objectively and from comparing various medicallibrariansfrom Finland were awarded types of administration.Some of the countries fellowships in 1953 and have studied the organization visited also found that they themselves derived value of leading medical libraries in France, Italy, Switzer- from the intensive preparations made for the visit land and the United Kingdom. of a group of experienced public -health adminis- Assistance and advice on classification schemes, trators, who have to be shown the important aspects medical libraryorganizationand techniques of of health services in a relatively short period of compiling union catalogues and basic lists of books time ;and this applies not only to central health in. various fields, have been requested by librarians departments, but to local physicians and public- inAustria,Finland,Greece,theNetherlands, health administrators as well. Norway and Yugoslavia.Many medical librarians Several governments have commented that such in these countries have also asked WHO to sponsor a group study of public- health administration yields refresher courses or a medical library seminar which better results for all concerned than could be expected would dealspecifically with problems faced by from individual studies. European medical libraries. 94 THE WORK OF WHO, 1953

Following theFirst International Congress on Italy,where seven centres,mainly in university Medical Librarianship, held in London, in July, at hospitals, have been established in the north. Ano- which many leading medical librarians were gathered, ther seven will be provided later in various other the regional office took the opportunity to convene parts of the country. The staff in charge of the pilot an ad hoc advisory committee, made up of eight centres in Italy were given additional training in librariansfromAustria,Norway,Sweden,the Paris at a course organized by the International United Kingdom, and Yugoslavia, assisted by a Children's Centre, at the request of WHO ;staff library expert from the United States of America, from the centres in Yugoslavia also participated. a consultant who had been attached to the Biblio- Although it is too early for statistical evidence, graphic Centre at Ankara, Turkey, a representative there is good reason to believe that these improved from the Division of Libraries, Documents and serviceswill reduce mortality from prematurity. Archives of UNESCO, and the WHO librarian. Prematurity -although important -is onlyone The members of this committee, from their knowledge factor in perinatal mortality.For the exchange of of the 'reds in their own countries and in others information and ideas on the whole perinatal period, they had visited, recommended that a medical which is of special importance to countries with the library teaching seminar should be held in 1955, lowest infant mortality rate, a study group met in with 20 participants, to deal with :(1) the centraliza- Brussels for a week in September.Obstetricians, tion of medicalresources,(2)inter -libraryco- paediatricians, public -health nurses and midwives operation, (3) medical bibliography and reference from eight Western European countries took part work, and (4) public relations, including instruction in the meetings, at which the causes of perinatal of medical students in the use of the library. Detailed mortality were discussed and some general conclu- preparation for this seminar will be made in 1954. sions drawn. It was recommended that close contact should be established between the workers concerned Infant Mortality with national studies on this problem, that clinical With the progressive decline in general infant knowledge and practical experience should be applied mortality rates, prematurity has become one of the in organizing maternal and child health services and most important causes of death in the neonatal in training personnel, and that the effect of social period.In countries with a low infant mortality and economic conditions on stillbirths and prematu- rate, prematurity is responsible for about half, or rity should be studied, and recommendations for more than half, of all neonatal deaths.Over the improvements made.A full report of this study past few years WHO and UNICEF have assisted group is in preparation. in developing or strengthening services for premature infants by training physicians and nurses in their Mental Health and Child Development care and by providing modern equipment. A fully developed programme involves the establishment of WHO programmes designed to protect the mental enough centres to reduce to a minimum the time for health of children in Europe owe much to the taking a premature infant in a portable incubator initiative of headquarters and to the recommenda- from the place of birth to the specialized centre.In tions of the expert committees. The monographs on France, during the last two or three years, with maternal care and mental health and on the psy- international assistance, some forty centres have chiatric aspects of juvenile delinquency have also been createdor strengthened inuniversity and provided clear objectives for a series of projects otherhospitals -in most cases attachedtothe which the regional office, jointly with other agencies, paediatric department.The local response to this has undertaken since 1950. In France and the United programme has been very prompt ;the medical Kingdom, WHO and the International Children's personnel and hospital administrators have done Centre are sponsoring long -term studies on maternal everything to provide suitable premises for this deprivation ; WHO has participated in meetings on purpose ;specially trained staff have been employed, homeless children and foster home care, organized and money has been provided for the running of by the United Nations and the International Chil- the centres, the largest of which provide national dren's Centre, and on the education and mental training.A number of doctors and nurses have health of children, organized by UNESCO. Group been awarded WHO fellowships for study abroad training in child psychiatric work was given in courses to train them for this type of work. organized by the International Children's Centre in The experience gainedinthe programme in 1950 and by the International Paediatric Association France has been useful in developing services in in 1951. In 1952 WHO arranged, at Lillehammer in TRAINING OF NURSES IN BURMA

As health services develop throughout the world, more nurses and nurse auxiliaries are needed as members of the health teams. WHO is helping governments to meet that need.

At the School of Nursing, Rangoon General Hospital (Burma), students learn the rudiments of anatomy.

At the same school a nurse educator, herself trained by WHO instructors, demonstrates surgical dressing to the students. HEALTH EDUCATION IN BURMA

At the infants'clinic of the Goodliffe maternal and childhealth A nurse in Rangoon General Hospital attends a baby suffering from centre, near Rangoon, student health- visitors learn how to use the pneumonia... record cards.

At the centre, a student nurse watches the medical examination of The student nurse explains to a mother how to use solid foods in her 14 -day old twins. Behind the mother is the let -the or dai (untrained baby's diet. midwife) who delivered the twins.

A public -health nurse demonstrates to student health- visitors how ...while in the paediatric surgical ward of the same hospital another nurse dresses an eye case. to administer fish -oil capsules to children.

One of the students at the centre weighs a baby, noting its weight The public -health nurse, with two students from the centre, visits a on the record card. mother in her home and examines the children in the family.

A nurse from the Goodliffe centre gives a young mother treatment Postnatal home visit.The nurse gives a mother practical advice on for tuberculosis at home. The treatment is supervised by the tuber- how to look after her baby. culosis clinic. SCHOOL HEALTH SERVICES IN DENMARK AND THE NETHERLANDS

A WHO study group, made up of doctors from the European and Eastern Mediterranean Regions, was shown school health services in Denmark and the Netherlands during a two -week tour.They showed particular interest in educational methods adapted to the special needs of handicapped children.

Members of the study group watch the boys of the Royal Institute for Three members of the group examine a child during the medical the Blind at Refsnaes (Kalundborg, Denmark) during their swimming inspection which every Danish child must undergo at least once a year. period.

The teaching methods employed by the Royal Institute for the Blind, In the nursery school for deaf children in Copenhagen, a little boy Refsnaes, enable blind or partially blind children to follow the normal is learning to speak.He feels the throat and face muscles of his school curriculum. teacher as she pronounces the name of a familiar object and tries to imitate her. EUROPEAN REGION 95

Norway, a seminar on child psychiatry and child The programmes of the two seminars, which were guidance, the report of which has been widely much on the same lines, included such subjects as distributed.Later in the same year, 16 European rehabilitationin industry,mental health,health countries sent teams of workers to a summer school problems of the older worker, industrial health on mental health and child development which services in large and small factories, absenteeism, the World Federation of Mental Health organized trends in occupational health legislation- subjects at Chichester with financial assistance from WHO. which had a special interest for all categories of In 1953, the importance to the child of close working participants.Visits to factories and to their medical relationsbetweenpaediatricians and childpsy- services were included in the programmes. chiatrists was discussed by an ad hoc advisory During the seminars emphasis was placed on the group.This discussion prepared the way for a need for co- operation between the different national study conference on children in hospitals, to be organizations responsible for the health and welfare held in Stockholm in September 1954. of the worker.The immediate results included an During these four years, there has been parallel exchange of information on particular problems of activity in individual countries.The Scandinavian occupational health and the promotion of group countries have conducted national seminars on the interest in this subject and of co- operation between pattern of the Lillehammer meeting ;WHO has the different national organizations concerned. The assisted in the expansion of child guidance services seminars also provided opportunities for collecting in Austria, France and Ireland, and, in general, the information on existing occupational health services proportionate increase in requests for individual in European countries,forfinding experienced, fellowships for studies in problems of mental health influential and reliable people who could participate in childhood reflect the interest of Europe in this in future activities, and for national teams to make aspect of the health of its children. constructive suggestions for future programmes in Occupational Health occupational health, national and international. Although specific problems of human relations It is too early to assess the ultimate results of these in industry have for some time been studied by the meetings, but Finland has decided to organize a regionaloffice,the European seminars on occu- seminar on occupational health for the Scandinavian pational health were the first regional activity in countries, Turkey is planning to set up an insti- this subject. The main purpose of the seminars was tute of occupational health at Ankara, and there to bring together public -health officers, industrial are signs of closer co- operation between services physicians and medical inspectors of factories, and for occupational health and general public- health to reduce the present isolation of industrial health services in at least some of the countries that took services as they exist in many European countries. part. ILO was asked to collaborate, as trade unions, A report of the two seminars, in preparation at managements and social security officials are con- the end of the year, will be sent to all participants, cerned as well as industrial physicians, public- health to governments and to institutes interested in occu- officers, medical inspectors of factories and industrial pational health in Europe.At the same time an nurses. Two seminars were arrangedone in English attempt will be made to evaluate the results further. at Leyden, in the Netherlands, at the end of 1952, For the future it is proposed, in collaboration with and the other in French in Milan in September 1953. ILO, to help to develop and strengthen well -planned All the European nations were invited to attend one and co- ordinated schemes of services for the health or the other. and the welfare of the worker.

Future Developments The co- operation from Member governments in needs a more stable staffing pattern and a permanent programme planning is now extremely active, and home. The solution of these two problems is within the resulting international action is beginning to sight, but the most important need for the future of come much closer to the need. As mentioned above, WHO's work in Europe is budgetary stability, and to develop the work in Europe the regional office achievement will always fall far short of intention 96 THE WORK OF WHO, 1953 so long as the fluctuations of the Technical Assistance to their possibilities for improving techniques.To funds regularly interrupt all WHO's activities.In this extent, some shift in emphasis may be expected Europe, where the outlook for these funds is perhaps in the future towards programmes of direct assistance less certain than in other regions of WHO, the future to countries, which will maintain the most valuable appears to depend largely on whether the Organiza- elements of inter -country work.It is evident that tion will find it possible, technically and financially, the whole process of following through an inter - to absorb the most important of these activities into country activity,untilitis expressed in national its regular programme. action, imposes new tasks and calls for a most The main work of the regional office in the near careful selection of new activities unless established future will doubtless still be in the broad subjects of programmes are often to be interrupted. exchange of information and professional education Much refinement can be foreseen in the pro- and training.More attention will be devoted to grammes designed to promote professional education preliminary studies of health problems or services and training. Certainly, there is much to be done on before they become suitablesubject matter for a teaching standards, although the Nancy and Gote- regional conference or seminar borg conferences on the teaching of preventive and Another conclusion which can now be drawn social medicine were an important beginning.The from the European programme is that there has development of national training institutions, the been too much dispersion of activities in the various joint sponsorship of training centres by two or more health fields in which countries are ready to progress. countries,and theexpansionof group -training The need to elaborate techniques for inter -country programmes, and the demand from governments facilities are all subjects which should occupy WHO for assistance with their national follow -up pro- in Europe for several years.Programmes designed grammes, produced atotal number of regional primarily for the exchange of knowledge, such as activities in 1953 which is beginning to exceed what study groups, conferences, seminars and symposia, the regional office can administer efficiently.The require study and improvement in techniques in emphasis in the future should certainly be on fewer order fully to justify the considerable effort required and better programmes.Of particular importance for organizing them. Even in such a well -established is the assistance which WHO is giving -and will activity as the fellowships programme, there remains increasingly be requested to give -in relating the a range of problems on selection, placement, super- general conclusions of a regional study, conference vision and follow -up which merits the attention of or seminar to the needs of individual countries and Member governments and WHO in the near future. CHAPTER 15

EASTERN MEDITERRANEAN REGION

Needs and Problems merely a temporary solution : only an improvement There are two distinct groups of countries in the in the basic terms and conditions of service can Region :those in which for all practical purposes ensure the continuance of work when international there are no health services and which require WHO's aid is withdrawn. assistance in laying the foundations for such services, A further problem common to most countries of and those in which services exist but which need the Region is that of ensuring the proper use of help in improving and strengthening them.This fellowships. The essential requirement that Fellows means that there must be elasticity in laying down must be selected who will come back and serve their policies for the Organization's work :general prin- government for a reasonable period is often neglected, ciples may need to be greatly modified when they are sometimes because of the poor conditions of employ- applied in the less developed areas, but there are ment mentioned above, but sometimes also because certain problems common to all the countries of the the government concerned has not provided for Region. employing the trainee after he finishes his course. One of these is security of tenure and reasonable Another is that, although most governments can conditions of employment for the officers of public - plan one year ahead, it is difficult for them to plan health services. In the Eastern Mediterranean Region programmes any further in advance ; thus, the cycle such officials are not offered salaries which provide of operations of WHO is not in step with that of them with either a reasonable income or a status governments, as the programmes of the Organization within the community commensurate with their social must be planned two years ahead and many of its responsibilities. The results are that it is difficult to projects may run for several years.Political or obtain suitable recruits for the public- health service financial changes in governments may also hamper and it is not possible to insist on full -time public their continued co- operation. service from employees who have to supplement A trend in the first of the two groups of countries their salaries by private practice. This problem, and mentioned above, those in which no real public - the shortage of technical health staff in many coun- health services have yet been formed, is the increasing tries, have made it difficult for some governments to use of WHO teams to do the initial work on projects, appoint national staff members to work with interna- because the governments are unable to spare staff tional teams. The difficulty can be partially overcome for this purpose. For such projects, it is usually the by the use of more auxiliary staff, but this will be government itself which suggests the work that needs to be done ;it may know how it should be done but i This region,according tothe decisions of the First, not be able to undertake it itself or to provide a Second and Fifth World Health Assemblies (Of Rec. Wld Hith Org. 13,80, 330 ;21,17,53 ;42,31), comprises matching national team at the outset. For example, Aden, British Somaliland, Cyprus, Egypt, Ethiopia, French most governments are well aware of the importance Somaliland, the Hashemite Kingdom of the Jordan, Iran, of training auxiliary staff, but often they cannot start Iraq, Israel, Lebanon, Libya, Pakistan, Saudi Arabia, Syria, Turkey and Yemen.In accordance with resolutions WHA5.46 such projects with their own resources.With the and WHA6.46, Turkey was temporarily transferred to the help of WHO, however, trainees can be sent abroad European Region, British Somaliland to the African Region, for study or be trained on the spot, and in a few and Somalia (Trusteeship), Bahrain, Kuwait, Qatar, and the Trucial Sheikdoms were provisionally assigned to the Eastern years the work becomes a growing project maintained Mediterranean. by the government. WHO's assistance in work of - 97 - 98 THE WORK OF WHO,1953 this kind, in which the principle of matching staff by the Sixth World Health Assembly were able to cannot be fully applied, would be something of a hold meetings in 1953, and work in the Region has departure from established practice, but might often suffered a great deal from this handicap. be the most valuable service that could be given. The project in Lahore for training in maternal and Regional Office : Administrative and Organizational child health is an example of this kind of assistance. Developments If public- health advisers can also be provided for this group of countries, much can be done to help The structure of the regional office has remained the governments tosecure a proper balance of the same as in 1952, without any important organi- expenditure between curative and preventive health zational development. The authorized establishment work, the natural tendency being usually towards too is not yet complete, as it has not been possible to much emphasis on the curative side.In this group recruit the necessary technical staff, and at present of countries also, the budget for health purposes is it does not seem that much can be done to improve usually very inadequate, not more than 5 per cent, the position. The scarcity of technical staff in the and usually 2 per cent or less, of the government's regional office has often made it impossible to keep income.It is therefore important that any project in touch with or give adequate support to field staff in such countries should have a long duration and working in the countries of the Region. There have should not be subject to fluctuations or cancellations, been complaints on this score from the field staff, which have a most discouraging effect on health but the revisions of the programme caused by departmentsin an earlystageof development. fluctuations in the amount of Technical Assistance Fluctuations in WHO staff undoubtedly were partly funds have imposed an additional load on the office, responsible for the early difficulties encountered by which has made a bad situation worse.Further WHO in the project for the control of venereal reference to this matter is made in the paragraph diseases in Egypt (described on page 101). dealing with Technical Assistance funds. For the more advanced countries, WHO can give It has also been difficult to recruit field staff : assistance by providing fellowships and advice to suitable workers are not easy to find, as they need the governments in starting their own plans for more than technical knowledge of a specialty ; they certain types of work.In those countries which must also be adaptable and emotionally equipped already have some public -health system, one of the to work effectively in conditions strange to them and greatest needs is for the development of public- health often very different from those in which they have laboratories -at first centrally, and later in munici- been trained and have worked before. Lack of these palities or provinces. More attention should also be qualifications leads to misunderstandings with govern- given to central statistical services, including those ments and with people, which means a waste of time for public -health statistics. and money and much work for the regional office A comparatively neglected subject in the Region staff in making the necessary adjustments. is school health services. One of the first signs of development in a country is a demand for more Governments have often had trouble in implement- education, and school health work, even of the ing the Convention on Privileges and Immunities, simplest kind, if properly organized, is a most fruitful and there have been consequent delays in securing form of health education of the public. Such work customs clearance, not only of official supplies and can be well combined with school feeding pro- materials for the use of the governments, but also grammes :it would be unfortunate if the countries of the personal effects of staff members. in the Region came to believe that school feeding These administrative difficulties are not perhaps programmes were all that is necessary for the welfare of great importance individually, but their cumulative of schoolchildren. effect produces feelings of annoyance and frustration which may seriously hamper the assistance that the staff, and particularly the field staff, have been asked The Regional Committee to provide. The remedy is no doubt a better mutual Neither the Regional Committee for the Eastern understanding of the needs of the countries concerned Mediterranean nor the two sub -committees proposed and of the aims of the Organization. EASTERN MEDITERRANEAN REGION 99

On the other hand, there has been an improvement popular, illustrated booklet will be produced for during the year in the procurement of supplies for distribution among people whose reading ability is WHO projects. not high.More and better photographs are now

available, and more use is being made of them: General Services provided by the Regional Office several exhibitions have been prepared (including one for the Third Middle East Medical Symposium, In the regional office much work has been done held in Beirut) ;the travelling exhibition produced during the year on the collection and dissemination at headquarters two years ago was shown in various of epidemiological information, on fellowships and forms. More films have been used for propaganda, group training courses and on public information. especially in connexion with World Health Day, now The regional office has maintained co- operation regularly celebrated in most countries of the Region. with a number of other organizations, in particular The governments are co- operating in giving publicity with the United Nations in its meeting of regional to WHO, and limits are imposed only by lack of experts on trainingof auxiliarypersonnel and funds and staff. on administrative and financial matters, with FAO on regional programmes, and with authorities of Technical Assistance Funds both the United Nations and bilateral agencies for Technical Assistance. It has also maintained relations It can be seen from the foregoing paragraphs how with groups such as the Health Committee of the many factors must be taken into account in health LeagueofArabStates,theOphthalmological work in the Region and how carefully the many Society of Egypt, the Franco- Lebanese Society of different considerations have to be weighed.The Medicine, the US naval medical research unit, effect on that work of the curtailments and postpone- many national tuberculosissocieties and several ments imposed in 1953 by the unexpected shortage societies working for child welfare. of Technical Assistance funds will be appreciated. The almost total uncertainty about the Technical Work in public information is progressing. WHO Assistance funds available in 1953 and likely to be is becoming fairly well known in the Eastern Mediter- available in 1954 (see Chapter 18), with the resultant ranean Region, partly through regular channels of cancellations and postponements of regional pro- information but more through the work of the many grammes, has been very discouraging to all concerned WHO teams now in the field, the knowledge of in the Eastern Mediterranean Region -to the public - whose work is spreading by word of mouth. This health officers of the countries, to the WHO staff is particularly important in a region where the press who have had to explain these changes to their is not the chief means of mass communication and national colleagues, to the regional advisers, and to where there are few radio broadcasting stations. the planning and administrative staff.It is difficult The limited contact of the people with the usual media to estimate how much of the progress that had been of public information requires a greater use of visual made ingaining the confidenceof government forms of propaganda -pictures,exhibitions,film authorities and encouraging them to develop their strips and films, and it is on these that emphasis will health services has been or will be offset by these be placed in the future. fluctuations, which, irritating and wasteful as they The regular service of press releases in French, are to the staff of WHO, must have an even more Arabic and English has been maintained, and many serious effect on the governments of the Region. articleshave been prepared bythejournalists themselves. Not enough material has been available Fellowships and Training Courses in Persian, Urdu, Bengali and other languages of the Region, but the situation is improving.Special Up to 31 December, 195 fellowships were awarded : publications on work in the Region have been pro- 137 of them were financed from regular funds, 56 duced, and pamphlets have been translated into from Technical Assistance funds, and 2 by UNICEF. Arabic. The distribution of publications has been The tables showing the distribution of these fellow- improved. If the financial position permits, a simple, ships are given in Annex 16. 100 THE WORK OF WHO, 1953

Seven fellowships were also awarded to participants by the Regional Office for Europe in April (see Table from the Region to attend the course on trachoma I, page 90).Pakistan sent one participant to the which started in February 1953 at the Memorial Malaria Conference held in Bangkok (see page 5), Ophthalmic Hospital in Cairo ; this course was also and fellowships were awarded to 19 participants from attended by five Fellows from the European Region, the Region to attend the regional mental health and all the participants had the opportunity to take seminar held in Beirut in November and December. part in the regional course on eye diseases held in (For details of the seminars held outside Europe, connexion with the Jubilee Congress of the Ophthal- see Annex 5.) mological Society of Egypt in which ten experts from In order to make the best use of certain special nine countries of the Eastern Mediterranean also currencies a greater number of Fellows, with proper participated. The Region sent seven representatives language qualifications, were placed in countries in to take part in the study group on school health which these currencies are used and which had services in Denmark and the Netherlands organized training facilities suited to the needs of the Fellows.

Reports on Typical Projects in the Region

Maternal and Child Health, Pakistan health centres. An area outside Lahore was used In 1947 the new State of Pakistan had very few to give each group of students experience in rural health work. WHO supplied fellowships and six medical or para- medical personnel and quite inade- international staff members, and UNICEF provided quate facilities for training.By 1950, there were only 15 nursing schools and 13 midwifery schools, equipment. The project received the fullinterest of local and few other courses in public- health nursing.In maternal and child health there was on the average authorities at all levels. A co- ordinating committee one trained woman worker for every 150,000 of the of leading health officials, obstetricians, paediatri- cians, nurses and the international team was formed population. and has met regularly, has encouraged developments In this situation the Government gave priority and has followed the progress of the work. It is still to training for work in maternal and child health. active.The attitude of the pupils has been most Few fully trained public- health nurses or midwives encouraging ; the numbers have continually increas- were available, and it was decided to train auxiliary ed ;they have been keen to learn, and, in spite of workers, to be called " community health visitors " the traditionally secluded position of women in most -young women of good education, trained for communities, have become enthusiastic and capable 27 months in maternal health, midwifery, and public - workers, qualified to undertake their responsible health and paediatric nursing. One trained health work. visitor for every 10,000 of the population, and the Schools of nursing, students from medical colleges training of 30 per year, were taken as practicable and university students of political science have used objectives. These auxiliary workers were also given the trainingfacilitiesprovided ;the Institute of instruction in health education and the treatment of Hygiene has co- operated in some of the courses, and disease, as they would work where other services two trainee social workers from a voluntary organi- are rare, and were trained to teach and supervise the zation were attached to the international team. These indigenous midwives (dais). contacts were useful and have shown the influence The first training school for community health that a project in one aspect of health can have on visitors was started in Lahore in 1951, with help from related services :the curriculum for the training in WHO and UNICEF. The project was based on the the centre was adopted by the Central Nursing existing Punjab health school and made use of Council for all Pakistan, and three other projects in several of the Lahore hospitals for women and maternal and child health -also assisted by WHO children ; public -health work, including domiciliary and UNICEF -were planned, closely following the midwifery, was done from two maternal and child pattern developed in Lahore. EASTERN MEDITERRANEAN REGION 101

The project provided many services for the public, team aroused interest in medical and other circles in and the extent of community participation achieved Cairo, and ultimately throughout the country.In is shown by the fact that 91 per cent of the mothers the second year, the international team members contacted paid an average of four visits to the centre ; acted mainly as advisers and left the administration 72 per cent of the infants born were seen during the of the hospital to their national colleagues.The first week of life, and an average of nine home visits interest aroused by this demonstration made possible was paid to every infant contacted. a wider programme of health education ;the team Within a little over two years since the project helped various ministries, universities and voluntary agencies to co- ordinate their work on this subject, started, 137 student nurses and community health and demonstrated that success in a health programme preliminaryschool visitorshave completedthe depends on such co- ordination. The work continued training, 77 the midwifery training and 30 the full on the same lines after the departure of the inter- course for the diploma. The centre has also given national team at the beginning of 1953: the chief short refresher and other courses. medical adviser of the team remained for two When this project was completed, in July 1953, the months as consultant to the University of Cairo. international staff left a fully developed and active In April and May 1953 the Egyptian team trained training scheme, headed by local doctors and nurses. with the international team made a survey in the The only serious problem remainingistofind Siwa Oasis in a way which showed that its members employment for all the graduates. The Government, were well trained in field work and able to carry because of financial stringency, is finding it difficult out a successful study and to collect the necessary to provide annually the 30 posts planned, but it may social and public- health data.Further surveys are be possible in the meantime to employ these auxiliary planned. workers in other branches of nursing. The Government showed great interest in this project, and there was a public demand for the extension of the same kind of work to various groups Venereal- Disease Control, Egypt in the country. The Ministry of Health is launching As the result of a survey made with the help of a mass campaign against venereal diseases and has WHO, the Egyptian Government asked for assist- provided mobile units for the rural areas. ance in reorganizing its venereal- disease services. In 1951, a demonstration programme was planned and put into effect for the first year in Tanta, midway Tuberculosis Control, Syria between Cairo and Alexandria, but that site was A demonstration of tuberculosis control was set found unsuitable, mainly because it lacked teaching up in Damascus with the help of WHO. The purposes institutions.Also, too much attention was given were to advise the Government generally on tuber- to the routine work of setting up a clinic ; there was culosis control, to show the functions of a tuberculosis no internationally recruited chief medical adviser ; dispensary, to establish a diagnostic laboratory, to there were not enough local counterparts, and those ascertain the incidence and epidemiology of tuber- that were assigned were not given a chance to culosis in Syria and to train staff for all types of participate fully in the programme.Nevertheless, tuberculosis work. surveys were made ; a modern venereal- disease clinic During the planning stage the Government had was established ;physicians and serologists were some doubts about committing itself to some of the trained, and a programme in health education was proposals, but from the start of the project it has begun. given enthusiastic co- operation. The building origin- In 1952, the team was transferred to the Hod el ally allocated for the centre was hardly adequate, Marsoud Hospital in Cairo and its laboratory to the and the Government allocated part of a large new government centrallaboratories.University staff hospital, which gave ample room for establishing a were able to participate in the project, which served chest clinic and for demonstration and training. as an excellent training centre ; the Government was In the same hospital there was also adequate space able to recruit an adequate matching staff, and the for the diagnostic laboratory. 102 THE WORK OF WHO,1953

Work in the centre started in 1952. A satisfactory of nursing education and administration until Syrian routine was soon established in the chest clinic, and nurses were trained to take over this work. There the Government's support and encouragement has was then only one recognized school of nursing in increased the number of local staff to twice that Syria, at the university hospital in Damascus, in mentioned in the agreement. The co- operation of which there was theoretical instruction (given by the professors of the Syrian University, Damascus, professors from the university) but littleclinical has helped and broadened the training, and the instruction, because of the lack of qualified nursing interest of the university in tuberculosis control is staff.About 20 nurses graduated each year, after likely to continue. Lectures have been given at the a three -year course. A midwifery school attached centre to varied and influential groups in the city to the university maternity hospitál gave trained and university ; its training facilities have been nurses a year's course in institutional midwifery, used by the two universitiesinBeirut and by but there was no domiciliary midwifery. There was UNRWAPRNE. no nursing section in the Ministry of Health, and The Government realizesthe need toextend no real public- health nursing service. tuberculosis control to the whole country and to establish a chest clinic in each province. A similar The nursing adviser started work in September extension of institutional treatment has also been 1951. Since then, a section of nursing and midwifery contemplated, but may be too costly. There is still has been established in the Ministry of Health, a danger of emphasizing institutional treatment at temporarily headed by a Syrian nurse -midwife. The the expense of home visiting.One of the most permanent appointment will be made later.The difficult problems is to establish some form of control nursing adviser also helped to establish the national in rural areas, and the project will not be wholly association of Syrian nurses and midwives, which, successful until it has been solved : the main obstacle with her help, has revised the Nursing and Midwifery is the extreme shortage of women workers, especially Practice Law of 1949, official approval of which is of qualified nurses.It would perhaps be possible to now awaited. The association is now an associate fill the posts in Damascus with such nurses, but not member of the International Council of Nurses. those in rural areas or even in other towns, and the A survey has been undertaken of the existing best solution would be for the Government to nursing services in Syria, which will help to determine recruit auxiliary nurses from the villages in which the number of nurses and auxiliaries that will be they will serve, and train them, preferably for general needed in the future. public -health work. The national BCG campaign has been integrated The adviser has assisted in planning and equipping with the demonstration project at the centre, although new hospitals and in improving old ones, has helped epidemiological work has been held up by delay in private schools of nursing to revise their curricula so delivery of the mobile x -ray unit. Investigations into that their students may qualify for registration, and bovine tuberculosis have been started with the help has advised the new school of nursing at Aleppo on of FAO. its teaching programme.This school was started There is some difficulty in recruiting senior national bytheGovernmentin1953,anditspresent staff because of the low salaries that can be paid, and director has been studying in Belgium with a WHO there isstill some delay in receiving and clearing fellowship. supplies. Probably the team leader and the public - In 1953, WHO provided two nursing instructors for health nurse will need to stay after the centre is the school of nursing of the Syrian University at established, to advise and help on the extension of Damascus.The curriculum has been revised ;a the service outside the province of Damascus. model ward has been established as a clinical class- room ;public -health nursing was included in the Nursing in Syria basic curriculum and field training given. Late in 1950 the Government asked WHO for the Plans are being prepared for training auxiliary services of a nursing adviser to assist in all questions personnel for hospital and other nursing services. EASTERN MEDITERRANEAN REGION 103

There has been difficulty in selecting national reached by which that agency undertook to support teaching staff for the university school of nursing in the further progress of the campaign, which was Damascus ; admission standards for the school have continued underthetechnicaldirection of the not always been strictly observed because of the Government, with advice and assistance from the pressure for more nurses, and a domiciliary mid- WHO team. wifery course has not yet been established. But the The Technical Co- operation Administration helped improvements achieved are of great importance to also in the establishment of the National Malaria the nursing profession and to general health services Institute in Teheran, which was planned as a centre in Syria. for training and research and for the distribution of information on malaria. The Government, in co- operation with the Tech- Malaria Control, Iran nical Co- operation Administration and WHO, has In February 1950 WHO provided a team of three thus established a sound national organization for to advise the Government on the control of malaria malaria control throughout the country, with malaria and to help to develop a nation -wide service. Surveys centres in the provinces, co- ordination ensured by a were made in all parts of the country ; teams were malaria commission in the Ministry of Health and organized, and spraying with DDT started in 1951 an efficient training and research unit. but was hampered by shortage of supplies.In An outstanding reduction in the incidence of malaria March 1951 the Technical Co- operation Administra- has been achieved, and there is already evidence of tion gave emergency grants of DDT and provided its effect on economic development, particularly in more transport, and in 1952 an agreement was the Caspian area.

Progress towards Integrated Programmes The work of WHO is widely understood by some demonstration area in Egypt, for example, isto countries in the Eastern Mediterranean Region. In attain a similar integration at the local level.This some of the less developed countries there isstill is being rapidly achieved, and, by demonstrating an imperfect understanding of the functions and the possibility of such co- ordination, this project will policies of the Organization. To aid these govern- advance one of the responsibilities of the regional ments and to win their confidence, the elasticity in office -toencouragethosecountriesinwhich programme planning which was mentioned above systemsof public -healthadministrationarestill is extremely necessary :occasionally, programmes fluid to provide a sound and integrated health not strictly in accordance with the normal procedures service. of WHO policy have been justified and have brought The trends in the future will be not so much towards about good relations between the governments con- starting new types of programmes as towards re- cerned and the regional office because they have arranging and stabilizing the present programmes. met a need felt by the country. Most of the countries It is intended that the long -term, fundamental projects in which health services are already established are for assisting governments to improve their public - gradually moving towards integrated national health healthadministrations,particularlyintheless programmes. Traditionally, however, ministries other developed countries,including thetraining and than the health ministry have developed health pro- education of staff for this purpose, should be financed grammes of their own, which it is not easy, or perhaps by the regular budget, which is less subject to changes even necessary, for them to relinquish.But the than other funds.It is believed that most of the establishment of national co- ordination committees regular funds would be absorbed inthis work. is increasing the collaboration between ministries, Further work in education and training would then and one of the main objectives in the Calioub health be undertaken with such resources as are available 104 THE WORK OF WHO, 1953 from the Technical Assistance programme, which lines.The firstwill be assisting governments to will also be used for work such as mass campaigns establish, where necessary,or to improve their and what may be called more " peripheral " work. systemsof public -healthadministration.Closely In this way there should be more security for the connected with this aspect of the work is the need programmes in which the greatest stability is required, to assist governments in planning essential services and WHO will have fuller financial and policy control on which a public -health administration depends : over what it considers the most important part of public -health laboratories, environmental sanitation its regional programme. In joint work with UNICEF, services, dispensaries, etc. Secondly, WHO will help it is hoped to establish projects similar to those at to train the staff required for these services.This present in operation, but with more emphasis on help must be given at all levels and will include school health and the training of auxiliaries. fellowships and assistance in the development of In the Eastern Mediterranean, the work will, training institutions for both professional workers therefore, probably be concentrated along two main and auxiliary staff. CHAPTER 16

WESTERN PACIFIC REGION

Needs and Problems in the Region 1953 ;and other difficulties are the high cost of operating the Regional Office in Manila and the Since the inception of the Western Pacific Region enormous distancestobe covered between the in 1951, there has been a gradual realization of the Regional Office and the Member countries it serves. Some of these needs and problems in the Region. Recently a large number of island territories have others are are common to other regions of WHO ; been included in the Region. peculiar to the Western Pacific. One of the greatest problems in the Region is the need for personnel trained in public health.In one The Regional Committee country, with a population of over a million, thereis only one qualified physician ;in another, with a The fourth session of the Regional Committee population of three and a half million, the personnel was held in Tokyo, from 3 to 8 September.All trained in public health is no more than six.In Member States except Korea and Laos sent represen- several of the territories, practically all the public - tatives.The Governments of France, the Nether- health workers are brought from elsewhere. lands,Portugal,the United Kingdom of Great In contrast to this situation, there exists in some Britain and Northern Ireland, and the United States other countries a great wastage of trained man- of America, responsible for territories in the Region, also participated, and most of them included in their power. Instead of being utilized in government service, many men trained in public health are com- delegationsthelocalhealthadministratorsof pelled to enter private practice because the salaries territories in the Region.A representative of the offered by governments are so unattractive. United Nations and observers from nine non- governmental organizations, from the Foreign Opera- All this explains why the national health admini- tions Administration of the United States of America, strations in many of the countries and territories are and from the Rockefeller Foundation were also weak and understaffed.Even with the assistance present. The Director- General of WHO was in which WHO is able to offer, this state of affairs will Tokyo throughout the session. The Government of probably remain unchanged, or improve only slightly, Japan was a generous and co- operative host. for a number of years to come. The Regional Committee studied the financial The disturbed and insecure conditions in several situation of the Organization ;reviewed the pro- countries and territories in the Region during the gramme andbudgetestimatesandestablished year under review have naturally proved most un- priorities for 1955 ; approved the amendments to the favourable both for the development of health programme and budget for 1954 ;authorized the services as a whole and for the operation of field Regional Director tocontinue in1954 projects projects. already initiated and to establish priorities for others The cuts and restrictions in the programme and of regional significance ; and recommended ways in budget have greatly hampered operations during which Member States of the Region could increase and stabilize the resources of WHO. 1 The Region, as delineated by the First World Health ThecommitteerecommendedthatMember Assembly (Off. Rec. Wld Hith Org. 13, 80, 330) and affected governments in the Region should plan and imple- by resolutions WHA3.118, WHA4.86 and WHA6.46, includes Australia,Cambodia, China,Japan,Korea,Laos, New ment large and long -term programmes for malaria Zealand, the Philippines, Viet Nam and, provisionally, the control and should progressively combine them into followingterritories :American Samoa, British Solomon regional programmes, and instructed the Regional Islands Protectorate, Brunei, Fiji, Gilbert and Ellice Islands, Guam, Hong Kong, Malaya, New Hebrides, New Zealand Director to assist in this integration. Island Territories, North Borneo, Pacific Islands Trust Terri- tory, Sarawak, Singapore, Tonga, and other United Kingdom The committee approved the report of the Regional possessions in the South Pacific. Director and suggested that attention should be - 105 - 106 THE WORK OF WHO, 1953 given in the coming year to encouraging fellowships most understanding.Personnel taking up duties in for study within the Region, particularly in institu- the Region pass through the regional office for tionsassisted by WHO. It recommended that briefing, and, if it is at all possible, are installed in the Associate Members should have full voting rights field by a member of the regional office staff.The at regional committee meetings and that the travelling staff committee is functioning smoothly, and the expenses of representatives attending sessions of personnel of the United Nations Technical Assistance regional committees should be borne by the Member Administration, bf UNESCO and of the UNICEF and Associate Member governments concerned. office in Manila have been admitted to it as associate On the desirability of WHO's sponsoring a world- members. wide campaign against smallpox, a question referred Towards the end of 1952, when the Organization toit by the Sixth World Health Assembly, the was informed that its share of Technical Assistance committee decided that it could give no information funds would be drastically reduced, its part in certain or suggestions until the regional survey authorized projects which were to be initiated in1953 was at its third session had been completed. cancelled, and itsassistance in projectsalready Among the other problems studied by the Regional initiated and to be continued in 1953 was reduced. Committeewerethelong -termprogrammeof In August, further retrenchment became necessary, WHO, co- operation among the countries of the and the regional office had to operate under extreme Region inthe exchange of information and the difficulty. It takes time and thought to plan a provision of regional fellowships, health problems project and nearly as much to revise it, and the of Korean refugees, study tours, the organization of commitments that had been entered into by the a training course in statistical services, and public governments or by other organizations as well as information in the Region. WHO added tothe embarrassments of having Valuable technical discussions were held on health to break off project negotiations or withdraw offers planning.It was decided that the subject for the of assistance, no matter how tentatively they had next technical discussions should be public -health been made. administration,withparticularreferencetothe Throughout the year there was useful co- operation organization of health departments. with the United Nations (particularly UNICEF) The Regional Committee will meet in Manila in and with its specialized agencies. The co- operation 1954 and in Singapore in 1955. of UNICEF was valuable in work for the Govern- During the session of the Regional Committee, ments of Brunei, Cambodia, China, Hong Kong, the United Nations Association of Japan organized Japan, North Borneo, the Philippines and Sarawak. in Tokyo a seminar on world health. A WHO consultant in public -health administration, stationed in Viet Nam, acted also as the UNICEF representative for the Associate States of Indo- China. Regional Office Liaison was maintained with the office of the resident On. 1 September, the regional office had been in Technical Assistance representative assigned to the Manila for two years. A ten -year lease, subject to Philippines. renewal on expiration, for the buildings occupied The Organization was represented by regional by the office was signed on 27 March 1953.Minor staff at two meetings of the South Pacific Com- alterations were made to meet the office needs, but mission in 1953: the Second South Pacific Conference now that the staff is nearly complete the accom- and the fifth session of the Research Council. An modation has become inadequate, and it is proposed account of WHO's activities was given to the Health to erect a prefabricated building nearby. Sub -Committee of the Research Council, so that the Allinternationallyrecruitedstaffmembers - chances of duplication of work might be reduced. 22 officials from ten countries -have now reported Other WHO representatives from the regional for duty at the regional office.In 1953, there were officeattendedthe ILO AsianRegional Con- also assigned to the field 40 internationally recruited ference, which was held in Tokyo in September, and, experts from 17 countries and 17 short -term con- in the discussions on housing, offered WHO's co- sultants from seven countries. The turnover in operationandassistanceinhousingresearch, personnel has been insignificant, and this may be evaluation, the devising of standards and other taken as a sign that the regional office has become advisory services.The office was also represented stabilized.Recruitment of field personnel has been at the second UNESCO Study and Information difficult and has caused delays instarting some Seminar for Leaders of Youth Movements, held in projects, but the governments concerned have been Tokyo in October.In November, further represen- WESTERN PACIFIC REGION 107 tatives were senttothe Eighth PacificScience and Tropical Medicine.The Johns Hopkins Uni- Congress, inManila, where they presented two versity and the Rockefeller Foundation co- operated papers on public health. in the project for assistance to the Institute of Hygiene During the year, there was also much co- operation of the University of the Philippines.The Organi- between WHO and non -governmental organizations zation recruited Johns Hopkins professors of public - in the Region. The United Nations Associations, of health administration and public -health engineering which there are already eight in the Western Pacific as WHO short -term consultants for the institute, to (inAustralia, Hong Kong, Japan, Korea, New advise on the teaching of their specialties.Later, Zealand, the Philippines, Singapore and Taiwan), their associate professors at Johns Hopkins followed helped to make known to the public the aims and them and took charge of the teaching at the institute, work of WHO. so that their local counterparts could take up WHO World Health Day, on 7 April, was observed in fellowships for advanced studies at the Johns Hopkins most of the countries and territories of the Region. University.Three WHO Fellows from Korea were Arrangements were made for the production of enrolled at the Institute of Hygiene.Eight WHO posters, pamphlets, folders and booklets, press inter- Fellows from Laos, which has no institution of its views, school lectures, radio talks, public meetings own for medical education, were enrolled at the and cinema shows.It was encouraging to note that Ecole d'Officiers de Santé in Phnom -Penh. in many countries there was a wider observance of During the year, 115 fellowships were awarded. World Health Day. National committeesforselecting Fellows were The issue of public- information material of all most co- operative, and officers in charge of institu- kinds was increased considerably. The distribution of tionsat which WHO Fellows from the Region the WHO Newsletter rose from 12,000 in 1952 to had been enrolled commented favourably on their 21,000 in 1953 ; over 72 press releases were issued, calibre and the standard of their work. thirteen15- minute broadcasts were recorded in The governments of the Member countries and Manila, and films on WHO were shown over the the institutions in those countries to which Fellows television network newly inaugurated there. The were sent also co- operated generously in arranging public -information officer supervised the preparation for placements, and for hospitality and assistance of the United Nations exhibit for the international to them. WHO was asked by certain governments fair of the Philippines, and assisted in covering the for assistance in formulating requests and in selecting ECAFE conference held in Manila during February. candidatesforfellowshipsprovided by Canada The translation into Chinese of the Chronicle for under the Colombo Plan. the months of April 1952 to May 1953 was completed. A seminar on mental health in childhood -the first seminar conducted jointly by the Australian Government and WHO -met for three weeks in Education and Training August at the University of Sydney.Most of the Assistance was given to several educational institu- discussions dealt with children under seven years of tions in the Region.Lecturers, fellowships, medical age.They covered :(1) the characteristics of child literature and teaching equipment were provided health and development ;(2) the forces in a com- for the Institute of Hygiene of the University of the munity that mould the infant into the cultural Philippines in Manila, the Department of Social pattern of the home and society ;(3) the common Medicine and Public Health of the University of behaviour problems of infants and young children, Malaya in Singapore, and the Ecole d'Officiers de and (4)application ofthisknowledge topro- Santé in Phnom -Penh.In the project for assistance grammes of child welfare, child health and education. to the University of Malaya, the first postgraduate The seminar was planned for people who hold course in public health was begun in October. responsible posts in public health, child welfare and Four lecturers in health education, medical statistics, education, and was considered to be of benefit, appliednutritionandappliedphysiology were particularly to those who are responsible for planning provided to teach, do research and give advice. and developing child health and welfare services and One fellowship in medical statistics was awarded for conducting training coursesfor professional for advanced study at the London School of Hygiene workers in these fields. A strong faculty was formed 108 THE WORK OF WHO,1953 of specialists in paediatrics, child psychiatry, child Kong, Japan, Malaya, New Zealand, the Philippines, psychology, nursing, social work, cultural anthro- Sarawak and Singapore in the Western Pacific, and pology, education and allied subjects.Thirty -seven from Burma, Indonesia and Thailand in South -East participants attended, from Australia, China, Hong Asia.

Regional and Country Projects

In November1953, 39projects were in operation in was given to the quality of teaching and follow -up the Region.During the year12new ones were than to securing large attendances at courses.The initiated, and ten completed. Inall phases of object is to improve the standard of health among development of the projects, the co- operation of mothers and children and not simply to achieve an governments was obtained, and continuation of the increased survival rate.Observation has shown that work by local counterparts upon the withdrawal it is in the weaning stage and at the pre -school age of the international personnel was generally satis- that the child's health most needs improvement, and factory. attention is therefore being given to nutrition and The UNKRA /WHO healthplanningmission general care in those age -groups. As the education concluded its studies of the health needs in Korea of parents is the basis of maternal and child health and submitted its recommendations.These recom- work, and teaching is always a slow process, dramatic mendations have been accepted by the Government, changes in health are not to be expected in a few years. and are to be implemented by UNKRA with the The adviser also studied the maternal and child advice and assistance of WHO. health services in New Zealand, to ascertain the During the year, teams engaged in demonstrating facilities there for placing doctors and nurses from control methods against one disease also concerned other countries in the Region on fellowships. themselves with other diseases prevalent in the area. In Sarawak, for instance, work on yaws control Training of Nurses was combined with BCG vaccination, and the local The seminar in nursing education, held in1952 teams now continuing the project in that territory in Taiwan and described in the Annual Report for are carrying on the combined work.This trend 1952,2 has had far- reaching results. Participants towards combined activities has provided a more reported that the seminar helped them to improve comprehensive service in the areas concerned. their nursing school curricula and their methods of The short -term consultants attached to several teaching, to make better use of visual aids, and to WHO- assistedprojectshelpedthegovernments acquire a better understanding of personal relations. concerned to study their countries' health needs and On their return from the seminar, the nurses from the facilities available for specific activities, advised the Philippines conducted a workshop in Manila on the national organization and supervision of those that was attended by more than 50 nurses from all activities, and helped to bring together various types parts of the country.Participants from Taiwan, of professional workers. Japan, and the Territory of Papua and New Guinea have also discussed plans for local study groups. Maternal and Child Health It is proposed that the next regional seminar should include administrators of schools of nursing, hospital The regional adviser in maternal and child health directors and supervisors of hospital nurses, as well as spent a good part of her first year in reviewing the nursing instructors. maternal and child health services in several countries Projects to strengthen basic schools of nursing were of the Regionfirst, those in which demonstration in operation in Brunei, Cambodia, Malaya, North projects in maternal and child health were in progress, Borneo and Taiwan, and work to improve the and later, those where there were under consideration training of public- health nurses, either as part of training projects for which equipment would be maternal and child health projects or as nursing provided by UNICEF. In the three demonstration projects in operation in the Region, more attention 20,9: Rec..Wld filth Org: 45, 141 WESTERN PACIFIC REGION 109 education projects assisted by WHO, was carried Bangkok in September (see page 5).Five countries out in Cambodia, Hong Kong, Malaya, North in the Region participated. Its purpose was to assist Borneo and Taiwan. indevelopingco- ordinatedplansformalaria control, jointly between countries and eventually, Health Education perhaps, for the entire Regions. As a supplement to this conference, another, on rural malaria control, Health workers have the difficult task of inducing will be held in Taiwan in 1954. people to change their ideas about health and their habits and to take a more active part in improving The malaria and insect control project in Taiwan thehealthof theirneighbourhoods and com- proceeded satisfactorily. During 1953, the houses of munities.In recent years there have been rapid more than1,509,000 people were sprayed with advances in some countries in the science and DDT, and plans were made to protect some 5,300,000, technique of popular education, and many of the the estimated population at risk in the island, in teaching methods still used today are considered 1954.In that year, the operation of the project will antiquated.The regional office staff includes an be transferred to the national team, and the inter- adviser on health education of the public who has national team will provide advice and supervision. visitedvariouscountriestostudytheirhealth This arrangement will give confidence to the local education needs and problems. He has assisted one personnel and enable them to carry out their respon- country to formulate a long -range programme in sibilities when the international personnel is with- health education, and has helped another to plan drawn.It will also permit the international team a country -wide health education conference.The to give more time to the study and control of other WHO health educator who isattached tothe insect -borne diseases in Taiwan. Department of Social Medicine and Public Health in In the Philippines, the results of the malaria - the University of Malaya, in addition to teaching at control pilot project were used by the Government the University, has worked during the past year to plan an extensive malaria -control campaign. The with the Departments of Health and Education, the malaria pilot project in Sarawak was continued and teachers' college, those responsible for adult educa- extended to Brunei, where the first residual spraying tion and for welfare, and other groups in Singapore operations were begun in October, and in Cambodia and in Malaya. This is an instance of how the value WHO's assistance in the malaria and insect control of health education can be brought to the notice of project, which was suspended early in the year, was various official and voluntary health organizations resumed in August.(For further details of these and related groups and how it can become an integral projects, see Part IV.) part of health and medical programmes. A consultant in health education has also been assigned to the venereal -disease control project in Taiwan.It is Tuberculosis hoped that a regional conference on health education, which has been requested by several countries, can An important trend inantituberculosis work be held in 1955. showed itself during the year and was fully discussed at the Pan Pacific Tuberculosis Conference, held in Manila in April. The Organization's direct assistance Environmental Sanitation to governments in BCG programmes in the area The regional adviser on environmental sanitation was largely completed, and the next stage must be to visited some of the countries of the Region and integrate the BCG work into comprehensive pro- helped them to survey and to define their problems in grammes of tuberculosiscontrol,which should sanitation. More interest in environmental sanitation themselves be a part of the overall national pro- has been noted on the part of officials responsible grammes in public health.Requests from several for public health in countries of the Region, and it governments for assistance in such integration were has led to an increase in requests from governments received during the year, and preliminary plans for for assistance in strengthening sanitation services and meeting them are already being made. facilities. The Pan Pacific Tuberculosis Conference, sponsored jointly by the Philippines Government, the Philip- Malaria and Insect Control pines Tuberculosis Society and WHO, was attended A conference on malaria control, organized jointly by participants from 29 countries and by many by the. Regional Office for the Western Pacific and observersfour guest speakers presented special the Regional Office for South -East Asia, was held in papers, which were followed by discussions.The 110 THE WORK OF WHO,1953 discussions resulted in an agreement to use uniform In Taiwan, the WHO consultant helped to start a methods which will ensure not only the most modern pilot project in the treatment of trachoma for which approach to tuberculosis control, but also comparable UNICEF provided the supplies.The results were results inall countries that follow the standard so encouraging that the Government has decided method. This will make it possible to compare and to embark on a three -year project in which all evaluate future programmes much better than has schoolchildren and their contacts on the island will hitherto been possible. The conference was reported be treated. in specialist journals in all parts of the world. BCG campaigns begun with the help of inter- Yaws national personnel in 1953 or previous years were continued by the Governments in Brunei, Hong The work on yaws control carried on with the Kong, the Philippines, Sarawak, and Taiwan.In help of WHO and UNICEF in the Philippine islands Cambodia and Viet Nam the BCG project was of Leyte and Samar was completed on schedule in delayed by recruitment difficulties, but in Cambodia August 1953, and work was undertaken in Mindanao it began in November and in Viet Nam it is expected and Catanduanes in areas reported to have a high to start soon. UNICEF is still providing BCG equip- prevalence of yaws. Another part of the programme ment and suppliestoBrunei, Hong Kong, the will embrace 700 municipalities reported to have a Philippines, Sarawak and Taiwan. A special team low incidence ;the municipalities will undertake will work in various countries in the Region in 1954 the control of the disease themselves when the staff to evaluate the results of the international BCG has been trained and supplies have been provided. campaign. UNICEF assiststhe Government by providing supplies and equipment, and WHO gives technical As regards BCG production, the laboratory unit advicethroughshort -termconsultantsand the at Alabang, near Manila, produced all the vaccine regional adviser. From the start of the programme, necessary for the campaign in the Philippines and local,provincial and municipal health personnel exported to Brunei, Hong Kong, Indonesia, Sarawak have been included in the teams, and on the comple- and Taiwan. The unit in Taipei, which received the tion of the mass campaign have remained to carry official approval of the Organization in March 1953, on the work.Yaws control has thus become an is supplying vaccine for the campaign in Taiwan ; integral part of the routine health work in the areas, the unit in Saigon will provide vaccine for the and the necessary follow -up isassured. Several campaign in Cambodia and Viet Nam. A WHO provincial health officers have used the demonstrable short -term consultant on BCG production visited results of yaws control to advance other health the units at Alabang, at Kyose and Sendai (Japan), activities in the communities, many of which are at Saigon, and at Taipei in February and March. remote and have hitherto been beyond the normal Such visits are valuable in maintaining international reach of the health services.By the end of 1953, standards and in keeping the specialists in touch with about 2,000,000 people had been examined and 75,000 the latest research and discoveries. cases of yaws treated ; mass treatment work had been initiated or completed in all areas of high yaws Trachoma prevalence, and the programme had been started in several areas where the incidence is low. In 1953, a short -term consultant on trachoma In Laos, yaws control, which was started in April visitedseveral countries of the Region to assist 1953, was pushed ahead in the province of Savan- governments in assessing this problem. Information nakhet, as much as was possible with the available was exchanged with local specialists ;lectures were staff, on difficult terrain and in disturbed areas. The given, and operations performed.The opportunity two teams and the WHO expert succeeded in was taken to introduce the methods recommended examining more than 95 per cent of the population by the WHO expert committee for the classification of the areas so far surveyed, and the average pre- and treatment of trachoma.In certain countries valence of the disease was found to be 5.54 per cent. of the Region the incidence of trachoma is very high, Some pockets with a high incidence of yaws were particularly among children, and there is often much found, as in Na Di, where about 14 per cent of the scarring.It has been estimated that in one country total population and over 27 per cent of the children about 60 per cent of blindness is due to this disease. up to 16 years of age have infectious yaws. THE FIGHT AGAINST SYPHILIS IN ETHIOPIA

A campaign against syphilis was started in June 1952 by the Ministry At the Filoha clinic in Addis -Ababa a WHO- trained Ethiopian nurse of Health of Ethiopia with the assistance of WHO. The chief takes a blood sample. medical adviser and leader of the WHO team is here seen examining a child; the male nurse assisting him was trained by WHO.

At the same clinic, the laboratory adviser of the WHO team teaches Theory is followed by practical work.In the clinic's laboratory, young Ethiopian students the various laboratory techniques used in the future technicians carry out tests on blood samples from patients. venereal -disease control. IN INDONESIA THE GOVERNMENT, ASSISTED BY WHO AND UNICEF, IS CONTINUING ITS CAMPAIGN AGAINST YAWS rírrffrrrfrrirfr

PREPARATIONS A TEAM IN ACTION

At the headquarters for the campaign Thetruck, inspiteofobstacles, against yaws in Indonesia,specialized reaches the village wherea member of training is given to the national staff of the the teamexplainsthepurposeof the teams that are to work inthe villages. campaigntothe assembled villagers(7) Photographs,blackboard,lanternslides and (8). Operations begin. Both young and (1), (2) and (3) -are used in lectures on the old are examined (9), blood samples are etiology, epidemiology and symptomatology taken and penicillininjections given (10). of yaws. After the lectures come demons- In thelaboratory theserologicaltests trations of the diagnosis and treatment of are carried out (11). the disease (4). Their work finished, members of the The plan of the campaign having been various teamsdiscuss the problems en- drawn up with the local authorities (5), one counteredinthe campaign (12). of the team -leaders discusses operations with the village council (6). YAWS CONTROL IN LIBERIA

A campaign against yaws is being carried out by the Liberian Governmentwith the help of WHO, of UNICEF, and with Technical As- sistance funds. Left, a Liberian nurse gives an injection of penicillin.

ANTIMALARIA CAMPAIGNS IN LEBANON AND CAMBODIA

*./- IADligolli ile.: Collecting malaria vectors during the WHO- assisted campaign in Members of the WHO malaria teamin Cambodia demonstrate Lebanon. This cone -shaped erection placed over a well traps the methods of DDT -spraying to the future health educators of Cambodia, mosquitos as they emerge from the nymph stage. Viet Nam and Laos. WESTERN PACIFIC REGION 111

The yaws work in Sarawak was done by inter- establishedintheTaiwan Vaccine and Serum national BCG teams with UNICEF supplies, and is Laboratory, the first group of laboratory medical now being continued by the national teams. officersand technicians completed a course of WHO carried out a survey of the States of training in the laboratory methods and procedures Kelantan and Trengganu in Malaya, at the request required for the programme, and the training of a of the Government, and submitted a proposed pro- second group was started.Courses will be repeated gramme for yaws control. Assistance in yaws control at two -month intervals until all the personnel of the was requested for Western Samoa, the Cook Islands participating laboratories has been trained. A com- and Fiji, and the Netherlands New Guinea also prehensive health education programme for elemen- showed interest in such a programme. tary school- teachers was organized.In the port of Keelung, the largest international port in Taiwan, 400 to 500 waitresses and other restaurant employees Venereal Disease Control, Taiwan were examined, and the necessary treatment given. The project in venereal- disease control in Taiwan This group constitutes a special problem in Keelung. was begun in August 1953, with supplies and equip- Plans are being made for an island -wide venereal- ment from UNICEF and assistance from the disease control programme for pregnant women Foreign Operations Administration. Of the team of and their husbands and children, to be carried out four to be provided by WHO, an expert in venereal- with the help of WHO and UNICEF and to start in disease control and a health educator were already Taichung inconnexion withthe WHO- assisted working on the project by the end of the year. A maternalandchildhealthdemonstrationand training project. venereal- disease advisory committee was established. The venereal -disease demonstration and training clinicwas establishedintheprovincialTaipei Hospital Construction hospital, and the administrative centre in the pro- During the year WHO sent a hospital architect to vincial Taipei demonstration and training health Cambodia, Hong Kong, the Philippines, American centre.The counterpart team started its in- service Samoa, Sarawak, and Viet Nam toadvise the training, and good progress was made. Governments on their plans to renovate old hospitals Theserologistprovided by theGovernment or to build new ones.The plans for the 250 -bed carried out a survey of the 20 laboratories selected children's hospital in Saigon are in their final form, for use in the programme. At the reference laboratory and it is expected that construction will soon begin.

* **

Present Trends From the first WHO has emphasized the im- that may be concerned in the particular work under portance of co- ordinating joint work from the earliest consideration. Qualified members of voluntary stages of its planning, and subsequent experience organizations may also be co- opted. has shown that co- ordination between the several This type of procedure appears well designed to authorities concerned in a country is not less im- make clear to all national and international bodies portant than co- ordination between international the long -term implications of particular projects - agencies.In several countries of the Region com- the relation of those that receive international help mittees for this purpose are functioning effectively. with those that are wholly national.It is proposed To ensure that work in particular fields of health is to encourage this method of joint action and it is properly related to the general development of the hoped that it will on the one hand accelerate the country, sub -committees for these special subjects shift of emphasis from individual field projects to are set up under the main co- ordination committee. the general development of public -health services The membersof thesesub -committeesinclude and their national administration, and on the other technical staff from the government, and represen- give a proper weight to WHO's role as the directing tatives of bilateral organizations, of WHO, and of and co- ordinating authority on international health other specialized agencies of the United Nations work.

PART III

CO- OPERATION WITH OTHER ORGANIZATIONS

CHAPTER 17

CO- ORDINATION OF WORK WITH OTHER ORGANIZATIONS

Co- operative Programmes in the Social Field Expanded Programme of Technical Assistance for In the past two years, the Economic and Social Economic Development. Council and the General Assembly of the United The United Nations, in consultation with the Nations have givenparticularattentiontothe agencies concerned,1 presented suggestions for this development and concentration of the efforts of the programme of action to the Council in 1953.The Council recommended (resolution 496 (XVI)), as an United Nations and specialized agencies in the immediate objective, that particular attention should social field.The formulation of policies to improve be given to community development, the training social conditions has been hampered by the lack of of professional andauxiliaryworkers and the comprehensive information on conditions and de- strengthening of national and local administrations. velopments in different parts of the world, and, for It authorized the Secretary - General of the United this reason, the Council endorsed the Social Com- Nations to convene small groups of senior policy - mission's view that the secretariat of the United makingrepresentativesof governments andof Nations and ILO, FAO, UNESCO and WHO members of thesecretariats of the international should prepare alternately, at intervals of two years, organizationsconcerned,toplan concretepro- two reports : one on the world social situation and grammes for the expansion of projects in community the other on national programmes of social develop- development. WHO will give appropriate assistance to governments in connexion with these meetings. ment.This request was made in 1952 following the submission to the Social Commission of the To plan this programme, inter -secretariat consul- Preliminary Report on the World Social Situation, of tations have been held within the framework of the Administrative Committee on Co- ordination : several which WHO contributed the chapter on health. on community development took place during the Work has been started on the first report on national summer session of the Council, and others on social programmes of social development, which will be programmes in general will be convened in the considered by the Council in 1954. summer of 1954.Meetings of the same type were In order to give the greatest practical value to the held toco- ordinate financial and administrative work of the United Nations organizations,the practices and the joint activities mentioned below. Council, in 1952, invited the recommendations and These consultations have produced some useful suggestionsof governmentsandofspecialized suggestions on methods and a fuller understanding agencies on a programme of concerted practical of the aims and activities of the organizations con- cerned, and have illustrated the increasing flexibility action in the social field.Member States of WHO of the inter -secretariat co- ordinating mechanism. were invited to comment on the health component The work of the Technical Assistance Board, the of this programme (resolution EB 11. R40). Although co- ordinating organ for the Expanded Programme nospecific recommendations were received,the of Technical Assistance for Economic Development, Sixth World Health Assembly, as guidance for such is described in Chapter 18. There follows an indica- a programme, endorsed, in resolution WHA6.24, tion of the types of activity in the social field in which resolution642 (VII)of theGeneral Assembly, WHO is co- operating with other United Nations concerning integrated economic and social develop- organizations. ment, and re- endorsed the guiding principles adopted by the Council (in resolution 222 (IX)) for the l UN document E /CN.5 /291 - 115 - 116 THE WORK OF WHO, 1953

Fundamental Education has been collected by field surveys in Asia and the WHO is co- operating with the United Nations and Eastern Mediterranean, in which WHO took part. ILO, FAO and UNESCO on UNESCO's pro- Training of Auxiliary Workers gramme of fundamental education.In this pro- gramme an effort is made to awaken the minds of The continuing studies made by WHO on the people in under -developed countries to the realization functions, responsibilities and training of auxiliary of their individual and communal potentialities and workers have helped to clarify the discussions of to assist them in gaining the elementary knowledge these problems by the United Nations organizations and skills that are prerequisite to their advancement. concerned.WHO has been representedatthe Reference is made in Chapter 3, page 33, to joint meetings of regional experts on this subject which work in regional fundamental education training were convened by the United Nations in Colombia, centres in Egypt and Mexico, and to the national India and Lebanon at the end of 1952 and in 1953. programme in Ceylon. Arrangements were made to There will be further inter -agency discussion on correlate the health education work of the project in common problems. Egypt, which is a training centre for the Arab States, with that of the neighbouring health demonstration Long -Range Activities for Children area at Calioub, which is receiving assistance from Services for the family and the community meet WHO and FAO.The WHO health educator in most of the needs of children, but certain services - Mexico finished his work in the centre for Latin for example, schooling and supplementary feeding- America at the end of the year, and health work need to be organized specifically for children.The there will be continued by the Government. United Nations (including UNICEF), and the four relevant specialized agencies consult regularly, through the Administrative Committee on Co- ordination, on Community Organization and Development long -range activities for children, which are designed At the inter -agency meetings mentioned above, toassistgovernmentsinthe development and communityorganizationanddevelopmentwas co- ordination of these general and special services. defined as a generic term for describing the processes These consultations also permit the co- ordination by which local communities can raise their own of the various technical programmes which UNICEF standards of living.Community development pro- assists with supplies and training facilities. grammes combine assistance from outside the com- Under this co- operative programme, WHO took munity with local initiative and self -help. They seek part in a survey of general social services, including to establish services (such as health and education) services for children, in Burma in 1952, and in an and local enterprises (such as co- operatives and small - assessment of services for children in Syria during scale industries) and to co- ordinate these activities in an attack on the basic problems of the community. 1953.The assessments are still at an experimental The types of health work which are most practical stage.They are designed to assist governments to in programmes for community development are take stock of existing services for children and to environmental sanitation, the organization of local plan the future development of those services, with or health units and health education. without international assistance. The plans for- mulated by the governments on the basis of the The starting point of community development may assessmentswillalsoservetoco- ordinatethe often be a single -purpose project such as a health assistance given by the various international organi- centre, which can serve as a focal point for the zations. WHO will continue to co- operate in these gradual development of other activities. The health assessments if the results of the first studies indicate demonstrationareasassistedby WHO inco- that the experiment is successful. operation with other organizations are examples of this type of project. Rehabilitation of the Physically Handicapped In 1952 and 1953, the United Nations has been Co- operative work on rehabilitation of the handi- gathering information for a report on methods of capped was begun in 1951 by the United Nations, community development which have been proved ILO, UNESCO and WHO with the publication of successful in various countries.Part of the material a technical report on a co- ordinated programme for CO- ORDINATION OF WORK WITH OTHER ORGANIZATIONS 117 the rehabilitation of the physically handicapped, Other Subjects including the blind. WHO has taken part in consultations with the WHO has invited the other organizationsto United Nations, several of the specialized agencies, co- operate in a series of meetings of experts on the and the Intergovernmental Committee for European handicapped child which were organized as part of Migration in the joint programme on migration for WHO's programme of maternal and child health. which principal responsibility lies with the ILO (see The first was the Joint Expert Committee on the page 31). Physically Handicapped Child, the report of which The Organization has also given technical advice 1952.2 The Joint Expert Com- was published in and services in connexion with medical supplies, and mittee on the Mentally Subnormal Child was con- has purchased substantial quantities of such supplies vened in 1953, and a study group or conference on the for United Nations organizations (Chapter 7). deaf child is scheduled for 1955. WHO has awarded fellowships during the year for attendance ata Joint work in public information is described in training course on the rehabilitation of physically Chapter 9. handicappedchildrenorganizedbytheInter- national Children's Centre in Paris (see Table I, United Nations page 89).The Organization has also begun pre- Like other specialized agencies, WHO co- operates paratory work on prostheses, in co- operation with with the United Nations in the collection and the United Nations and the International Veterans publication of statistics and is represented at meetings Federation, for a meeting of experts to be held in of the Statistical and Population Commissions of the 1954, and has assisted national programmes of Economic and Social Council. This work continued rehabilitation in several countries (see Chapter 3, in 1953, and there was further co- operation on the page 31). international comparability of statistics, on arrange- ments for the publication of information and on the Housing organization of training courses.The first Con- The provision of adequate housing raises a number ference of National Committees on Vital and Health of technical problems.In Europe, the Economic Statistics, convened by the United Nations and WHO, Commission for Europe deals with some of these is described in Chapter 5.Liaison was maintained through the Housing Sub -Committee of its Industry with the United Nations on the population conference and Materials Committee ;ithas also established that is to be held in Italy in 1954, and for which a housing demonstration centre.Liaison has been WHO is preparing technical studies. maintained with both these bodies. WHO has continued to advise the United Nations The United Nations has given special attention bodies dealing with narcotic drugs on the control or in recent years to problems of tropical housing.In of certainsubstances ; 1951 the Economic Commission for Asia and the exemption from control Far East, with ILO and UNESCO, established the it has, at the request of the Council, embarked on Inter- Secretariat Working Party on Housing and studies of new synthetic drugs, and has worked with Building Materials in Asia and the Far East, in which the Economic Commission for Europe on the medical WHO has participated. The Organization also examination of drivers for the prevention of road provided a technical paper for a regional symposium, traffic accidents. convened by UNESCO in December 1952, on tro- The Economic and Social Council, through its pical building design in South -East Asia, and is Social Commission, is concerned both with social assisting the United Nations in a seminar and exhibit policy as a whole and with technical programmes on housing to be held at Delhi early in 1954.The in social welfare.It has long been the practice of exhibit will take the form of a model village, for which WHO to combine general preventive work with the WHO has provided the information on sanitation control of communicable diseases whenever occasion and on the organization of a health centre. WHO was offers, for example by attaching public -health nurses also represented at meetings on housing at the ILO On the same principle, Asian Regional Conference, held in Tokyo. to demonstration teams. social welfare workers appointed by the United

2 Wld Hlth Org. techn. Rep. Ser. 1952, 58 Nations were attached to maternal and child health 118 THE WORK OF WHO, 1953 centres assisted by WHO during 1953 and took part independently, and such work has begun.The in the training of counterpart staff. WHO took part Joint Committee on Health Policy also endorsed in several European studies or seminars on different joint work on milk quality control and assistance aspects of health and welfare, organized by the to hospitals under certain conditions, and reviewed United Nations (see Part IV, page 129). theprinciplesgoverning UNICEF assistanceto programmes of leprosy control (see page 16). United Nations Emergency Agencies Joint programmes of assistance to governments, The Annual Report for 1952 described the work for which UNICEF provided supplies and training of the health planning mission which WHO sent to facilities and WHO the technical advice, are referred Korea, at the request of the United Nations Korean to throughout this Report and listed in Part IV. Reconstruction Agency (UNKRA), to advise the Such programmes have been in maternal and child Government of Korea on the rehabilitation and health, nutrition, rehabilitation of the handicapped, development of health services.Conditions during environmental sanitation, malaria, treponematoses, 1953 did not permit action to be taken on these plans. tuberculosis and other communicable diseases. Some provision has been made for assistance to the Liaison between WHO and UNICEF on the Government of Korea in 1954.WHO undertook International Children's Centre in Paris was main- the purchase of medical supplies and equipment for tained. WHO assisted the Centre with advice on a UNKRA (see Chapter 7). number of technical programmes and continued to As in previous years, WHO co- operated with grant fellowships,particularly to European can- UNRWAPRNE ;a description of the health work didates, for study at training courses and seminars done for Palestine refugees will be found in Chapter 3 organized by the Centre. The Organization assisted (page 33). the French Government in the establishment of the Assistance in the control of tuberculosis has been Centre in 1950, and, as this assistance was under- given to the Office of the United Nations High Com- taken for a period of not more than three years, missioner for Refugees, and liaison has been main- continued co- operation was on the agenda for the tained with that office on the resettlement of refugee January 1954 session of the Executive Board. physicians. Specialized Agencies of the United Nations UNICEF ILO The General Assembly of the United Nations in WHO and ILO have continued, and increased, their 1953 reaffirmed the terms of reference of UNICEF co- operation in work on occupational hygiene and without limitation of time. Itrecognized that on medical care and health services.To promote UNICEF's activitiescreate favourable conditions work in occupational health, the Executive Board for the development of the long -range economic and of WHO recommended that WHO should make social programmes of the United Nations and the further and continuousstudiesinthissubject, specialized agencies, particularly WHO and FAO, jointlywith ILO ;areportonmeasuresfor and it commended the organizations concerned for the strengtheningoccupationalhealthactivitieswas close working relations which they have progressively prepared during the year, in consultation with ILO, developed. for submission to the Board in 1954. The name of UNICEF was changed to " United Joint work was continued in the hygiene of Nations Children's Fund ", but the symbol UNICEF was retained. seafarers and the standards for medical selection of migrants, and during the year WHO gave technical Environmental sanitation contributes directly to advice to ILO on the recommendations of the Joint protecting the health of children, particularly by ILO /WHO Committee on Occupational the control of intestinal infestations and infections Health concerning the protection of the health of workers and by reducing the incidence of trachoma.For this reason the Joint Committee on Health Policy, in places of employment (see Chapter 3, page 30). UNICEF /WHO, in May 1953, approved plans for ILO and WHO also continued to co- operate in the work in environmental sanitation, either in con- work of theInternational Anti -Venereal- Disease nexion with maternal and child health centres or Commission of the Rhine (see Chapter 14, page 84). CO- ORDINATION OF WORK WITH OTHER ORGANIZATIONS 119

FAO As in previous years, WHO has taken part in the The contribution of WHO to the joint work with work of the UNESCO Advisory Committee on FAO on nutrition is to identify nutritional problems Arid Zone Research. in public health, stimulate and co- ordinate research on these problems and devise practical measures for Other Specialized Agencies preventing malnutrition. With ICAO, preparatory work was done during The two organizations co- operated in 1953 in the year on a manual of sanitation practices for regionalnutrition conferencesin Indonesia and airports and air travel.WHO again co- operated Venezuela, a meeting of experts on protein meta- with the International Bank by assigning health bolism, practical work on the prevention of protein experts to survey missions.In connexion with the malnutrition and, with UNICEF, in the organization work of the Transport and Communications Com- of a group training course on the control of milk mission and the Economic Commission for Europe quality and on milk processing (see Chapter 3, on the transport of dangerous goods, WHO has page 22).Liaison was maintained with FAO in investigated with the Universal Postal Union the connexion with its work in home economics, which means of facilitating the transport of biological includes education for women innutrition,the substances, and the Union is now compiling the principles of child care and general sanitation and existing postal and customs regulations on this hygiene. subject. The work with FAO relating to veterinary public health and the zoonoses is described in Chapter 1 (page 11). Non -Governmental Organizations It will be recalled that the Executive Board, at its UNESCO ninth session, decided to reconsider completely the In addition to fundamental education, mentioned problem of official relations with non -governmental under the inter -agency social programmes, UNESCO organizations and asked the Director - General to is rapidly developing its work for the extension of prepare a study of the question.The Board, at its free and compulsory schooling,to which WHO eleventh session, considered the study that had been contributed technical advice and co- operation with made, decided that the subject presented aspects regard to training in hygiene for teachers, the teaching on which the Health Assembly alone was competent of health in schools, school health services and the to take a decision, and referred it to the Sixth World sanitation of schools and playgrounds.The report Health Assembly.The Health Assembly did not of the Expert Committee on School Health Services find it necessary to modify the general principles, andtechnicalpapersprepared by WHO were that had been approved by the Third World Health submitted to the annual International Conference Assembly, for the admission of such organizations on Public Education which was convened jointly into relations with WHO, and decided that, according by UNESCO and the International Bureau of Educa- to these principles, there could be no objection to tion.In 1953, UNESCO assigned a staff member plurality of representation of organizations in the to work on school health programmes in the WHO same field of activity (resolution WHA6.49). Four- health demonstration area in El Salvador. teen new applications or reapplications for official There has been reciprocal representation at meetings relations were due to be examined by the Executive on health education of the public (see Table I, Board at its thirteenth session. page 87) and on the use of visual aids in teaching (see Chapter 3, page 33), organized by WHO and The following are instances of co- operation with UNESCO respectively. UNESCO has published some of the 27 non -governmental organizations the report of the meeting of experts on mental hygiene already in official relations with WHO. in the nursery school (see Chapter 3, page 26) and As in preceding years,co- operation with the has also published lists, prepared by WHO, of material Council for International Organizations of Medical necessaryforteachinginmedical schools(see Sciences continued to be extensive.The Council, Chapter 4, page 41). consisting of 42 medical and related international Joint work in medical documentation and biblio- non -governmentalassociationsand groups,was graphy is described in Chapter 8. established under the joint auspices of UNESCO and 120 THE WORK OF WHO,1953

WHO in 1949 for co- ordinating and assisting inter- details, see Chapter 4). The World Medical Associa- national congresses of medical sciences. It has mainly tion also continued to give WHO suggestions and concentrated ontheimprovementofcongress advice in its work on the Pharmacopoea Interna- techniques and on the consideration of subjects of tionalis and on international non -proprietary names common interest to several specialties.Direct co- for drugs. ordination as to places and times of congresses has WHO has had consultations with the International been found possible only in very few instances, but Committee of the Red Cross and the League of Red the Council has initiated other activities connected Cross Societies on a variety of subjects, including withtheinternationalaspectsofscientificco- the implementation of theSixth World Health operation ;has held conferences of organizers of Assembly's resolution on the organization of studies international medical congresses in Europe and in the on international medical law, and on measures to United States of America ; and has compiled a manual be taken in Greece after the earthquakes. for congress organizers. The Council provides WHO, by correspondence and informal con- WHO with copies of the proceedings of international ferences, maintains a close relationship with the congresses, which are regularly distributed to libraries Central Council for Health Education, in the United at headquarters and in the regional offices. WHO's Kingdom, upon which it calls for ádvice and informa- relationship with the Council has been reviewed tion.At WHO's request, the Central Council has annually in connexion with discussions on the pro- sent samples of WHO publications to countries and gramme and budget, and WHO has continued to organizations throughout the world.It co- operated subsidize it, although the $35,000 grant for 1952 in the recent regional health education conference was reduced to $29,000 in 1953, and further reduction in London (see page 32), and on several occasions has is envisaged for the future.The joint CIOMS/ prepared study plans for persons interested in health UNESCO /WHO meeting on medical documentation education who have visited the United Kingdom - is described in Chapter 8. among them WHO Fellows and staff members. During the year, close relations have been main- WHO has been consulted about plans for the tained with the World Federation of United Nations Seventh International Conference of Social Work, Associations, which, at the time of the Sixth World which will be held in Canada in July 1954 and at Health Assembly, again organized a seminar on which the Organization will be represented.The world health,attended by 50 doctors,medical Executive Committee of this conference agreed to students and nurses from 15 countries.Lectures on adopt a suggestion from WHO relating health to the WHO were included in the Federation's regional theme of the conference -" Self -Help in Health and seminars on the United Nations, which it organized Welfare ". WHO is preparing a list of documents for teachers, in Monrovia in April and in Mogadishu for those attending the conference. in October 1953.The United Nations Association of Japan held a seminar on world health in Sep- The International Council of Nurses has continued to supply WHO with information and advice on tember ;other associations in the Western Pacific have also been active (see Chapter 16, page 107). The standards for nursing services and nursing education. Italian branch of the Federation held a series of Services given by the Council have included the exchange and lectures on world health problems in Rome from organizationof aninternational placement of nurses (1949 -53) ;a study through 28 October to 15 December.The United Nations its national associations of standards of nursing care Association of Great Britain and Northern Ireland (1951 -3) ;and a detailed analysis of 32 national set up a group on WHO which was inaugurated on reports on economic welfare (1950 -3). Reports on the World Health Day. last two studies are now available. The Council has WHO collaboratedwiththe World Medical also published a study on the basic education of the Association in the organization of the First World nursing instructor, compiled by experts from 21 ConferenceonMedical EducationinLondon. countries, and another on standard equipment for Some 600 participants from over 50 countries and nursing schools. An account of a study on advanced territories, among them representatives of 92 medical programmes in nursing education, started during the schools, registered for the conference (for further year, will be found in Chapter 3, page 30. CO- ORDINATION OF WORK WITH OTHER ORGANIZATIONS 121

The scope of the International Union against in connexion with the protection of international Venereal Diseases is being expanded, and the Union non -proprietary names, and with the International has consulted WHO about a close association of Organization forStandardization and theInter- programmes with a view to (1) stimulating national national Union of Pure and Applied Chemistry on associations in certain countries to obtain voluntary the confirmation of graphic formulae. support for the social aspects of health education ; There has been close co- operation with the Inter- (2) planning, in consultation with WHO, a pro- national Air Transport Association, from which gramme for the next five years ; and (3) distributing valuable advice has been obtained, and WHO has WHO's technical publications to the national bodies kept in touch with the research done by the Associa- affiliated to the Union.Observers from the Union tion in quarantine matters as they concern inter- took part in the technical discussions at the Sixth national airtraffic. World Health Assembly. Finally, WHO's participation in meetings of the The International Union againstTuberculosis Eighth Pacific Science Congress, organized by the has co- operated with WHO mainly on the clinical Pacific Science Association, in Manila (see page 107), aspects of tuberculosis, including the collection of gave an opportunity for discussing further relations informationandthestimulationofresearch, with the Association. especially in treatment with antibiotics. At the Sixth Congress of the International Asso- Intergovernmental Organizations ciation of Microbiologists, held in Rome in September, the Organization's representative reported the action Referenceswill be found in Chapter18 and taken on two requests made by the Fifth Inter- throughout the Report to the co- operation in the national Congress for Microbiology ; these concerned regions with the bilateral agencies for Technical the establishment of international shigella centres, in Assistance, such as the Foreign Operations Adminis- Atlanta, Georgia, and in London, and the unification tration of the United States of America, and the of procedures for postal shipment of biological Colombo Plan for Co- operative Economic Develop- samples. ment in South and South -East Asia. Co- operation with the International League against Responsibility for liaison with intergovernmental Rheumatism and the International Society for the organizations working in particular regions, such as Welfare of Cripplesis mentioned in Chapter 3 the Commission forTechnical Co- operationin (page 31), and the study started in 1952 with the Africa South of the Sahara, the Council of Europe, International Paediatric Associationismentioned the South Pacific Health Service and the South on page 28. Pacific Commission lies with the WHO regional The other organizations in official relations with offices concerned, and a clear definition of this WHO have co- operated fully with the Organization responsibility has been drawn up and communicated in the exchange of information and in ensuring to the Regional Directors and, where necessary, to reciprocal representation at meetings.They have the organizations. There has also been co- operation declared themselves willing to take more part in with the South Pacific Commission and the South WHO's activities when its programme of work is Pacific Health Service on epidemiological reporting extended into their particular field of health. Annex 7 in the Pacific area and on a quarantine code for the gives a list of meetings and conferences convened by protection of isolated communities. non -governmental and other organizations at which WHO was one of the specialized agencies to be WHO was represented, and Annex 9 a list of the consulted about the amendments to be made in the non -governmental organizations in official relations Constitution of the Intergovernmental Committee with WHO in 1953. forEuropeanMigration,andcontactswere Non -governmental organizations not inofficial established with the International Committee on relations with WHO have also co- operated with the Military Medicine and Pharmacy in connexion with Organization :a few examples of this work follow. resolution WHA6.40 of the Sixth World Health WHO has held consultations with the International Assembly on a study of the problems relating to Bureau for the Protection of Industrial Property international medical law. CHAPTER 18 EXPANDED PROGRAMME OF TECHNICAL ASSISTANCE FOR ECONOMMIC DEVELOPMENT

The Expanded Programme of Technical Assistance as compared with 167 at the end of 1952.In 1953, for Economic Development has now passed through 34 projects were completed and nine new ones started, three phases.The first phase, from July 1950 to including those developed with governmentsas December 1951, was essentially one of preparation, part of the effort to use contributions made in certain in which none of the field activities of the participating non -convertible currencies.One hundred and fifty agencies was very large. The second, 1952, was one of experts from 32 countries were recruited by WHO for rapid growth,ata time when the contributing service under the Expanded Programme as against governments, through both the United Nations 220 in 1952. In December 1953, altogether 239 experts Economic and Social Council and the General from 36countrieswereengagedinTechnical Assembly, were urging the specialized agencies to Assistance projects, as against 247 in 1952. In accelerate their activities.During 1953, the third 1953, 238 fellowships were awarded to candidates phase, the financial resources fell far short of the from 69 countries and territories, as compared with requirements of the programme, both for continuing 369 fellowships in 1952. projects from 1952 and for meeting the many urgent The principal types of work in which WHO was requests for new activities which were received from engaged under the Expanded Programme were the the under -developed countries. In 1953,it was same as in the previous year, but with an increased therefore necessary for WHO to revise its plans emphasis on training and on projects considered to drastically,to slow down the rate of assistance have the most direct effect on the social development to governments intheir projects by postponing, and economy of the requesting country. whenever possible, the appointment of experts and the award of fellowships, and in some instances to In accordance with resolution WHA5.30 of the find other sources of funds in order even to continue Fifth World Health Assembly, all activities connected with activities which were actually in operation or for with the manufacture of antibiotics and insecticides, which plans were very far advanced. previously undertaken jointly with UNICEF, were transferred to the United Nations Technical Assis- The shortage of funds for WHO's Technical tance Administration on July (see page 53). Assistance programme in1953 has had serious repercussions on the total WHO programme, since the policy so far followed by the Organization has Organizational Arrangements been to use funds from all sources interchangeably, so as to develop an integrated total health pro- The Technical Assistance Committee, in April, gramme with governments. reviewedtheadministrativemachineryofthe TechnicalAssistanceBoard and instructedthe The financial situation did not permit the expansion Executive Chairman of that body to submit, after of the programme either as it was envisaged when the consultation with the participating organizations, entire scheme was first conceived 1 or as each agency (1) proposals for improving procedures by which later planned its own part in the whole of the work. co- ordinatedTechnicalAssistanceprogrammes In December 1953, there were 121 WHO- assisted might be increasinglydeveloped atthe country projects in operation under the Expanded Programme level ;and (2) a statement of the responsibilities of the Technical Assistance Board's resident repre- 1 In the report on Technical Assistance submitted by the sentatives and the responsibilities of the country Secretary- General of the United Nations to the Economic and Social Council in 1949, it was estimated that the cost of or area representatives of the participating agen- the assistance planned by the participating specialized agencies cies. The Technical Assistance Committee also would amount to $35,900,000 in the first year and $50,200,000 recommended that the resident representatives should in the second.The amounts pledged by the contributing governments during the first three periods have remained continuetosubmit comments on theprojects fairly constant at about $20,000,000 per year. proposed for the countries to which they are assigned. - 122 - EXPANDED PROGRAMME OF TECHNICAL ASSISTANCE FOR ECONOMIC DEVELOPMENT 123

In May, under the chairmanship of the Secretary - Assistance Board to assist the working party in this General of the United Nations, the Administrative task, and in particular to submit to it as full a report Committee on Co- ordination examined the policies as possible on the financial needs of the programme of the Expanded Programme, and, in a special report, for1954and subsequent years. which was forwarded tothesixteenthsession InJuly,the TechnicalAssistance Committee of the Council, made suggestions as to the co- recognized the desirability of providing a more ordination of country programmes, the allocation of stable financial basisfor long -term planning.It resources and the responsibilities of the resident therefore suggested that the Council should invite representatives.It drew attention to the changes such governments as might be in a position to do so introduced into the operation of the programme as to take steps, within their constitutional limitations, a result of the Council's desire to achieve greater to ensure a more permanent financial support of the co- ordination of the programme at the centre and programme. At the same time it decided to appoint increased co- operation in the field,2 but considered a working party to review the financial procedures that these objectives could be better achieved by of the programme, and requested the Technical good programme planning than by the detailed review Assistance Board itself to conduct such a review, and appraisal of programmes by the Technical including such matters as the system of commitment Assistance Board itself and the allocation of the and obligation and the size of the Special Reserve available resources on that basis.It considered that Fund established under resolution519 (VI)of the no true integrated programme of economic develop- General Assembly, and to report to the working ment could result from the activities of the agencies party.The Council, in resolution492 C (XVI), themselves :that could be achieved only if the confirmed these decisions and asked the Technical agencies used their resources to help countries to Assistance Committee to submit any recommenda- plan and implement their own integrated programmes tions it might wish to make to the resumed session of development. of the Council, during or shortly after the eighth The Economic and Social Council at its sixteenth regular session of the General Assembly. session, in the summer, considered the fifth report of In September, the Technical Assistance Board the Technical Assistance Board to the Technical therefore reviewed the financial procedures of the Assistance Committee. programme.It examined two alternative methods The Council also reviewed the situation in the forfuturefinancing,studiedthepossibilityof light of these and other reports, and supported the extending the period during which the approved idea of developing in each recipient country a pro- programme couldbe implemented withoutre- gramme of Technical Assistance in which the projects approval, and considered means for increasing the carried out would be closely integrated with the Special Reserve Fund and the uses which might be government's own efforts and plans for development. made of it.These, and other proposals, were con- It was recognized that the responsibility for planning sidered by the working party of the Technical and integrating such programmes, rests with the Assistance Committee in November, but no decision government concerned. The appointment of resident was reached and the question was referred back representatives was approved by a majority and their to the Technical Assistance Board.In December, functions were more clearly defined. the Technical Assistance Board, with the unanimous supportofalltheparticipatingorganizations, adopted a compromise proposal by means of which, Future Financing through a limited curtailment of expenditure for a In accordance with a directive to the Economic and fixed period, it could build up from income a reserve Social Council in resolution621 (VII)of the General large enough to safeguard against any serious future Assembly, the Council's Technical Assistance Com- financial fluctuations.This proposal will be con- mittee, at its session in March, decided to request a sidered by the working party, to be convened again working party to study the feasibility of working out early in1954. estimates for a period of more than one year.It The essence of the proposal is (1) that in each invited the Executive Chairman of the Technical current year obligations should be controlled by conservative earmarking of funds, thereby avoiding ECOSOC resolution 433 A (XIV) (reproduced in Off. the need for withdrawing programme authorizations Rec. Wld Hlth Org. 46, 115) whereby the Council amended because of delay in the payment of pledges or other its basic resolution on Technical Assistance, 222 (IX). Resolu- financial uncertainties ;(2)that an organization's tion 222 (IX), as amended, is reproduced in the Handbookof Basic Documents, sixth edition. contractual commitments for the future should be 124 THE WORK OF WHO, 1953 controlled by limiting them to an amount not of the Organization for 1953,3 since when preparing exceeding its pro rata share of the sum of 12 million that document the Organization asked governments dollars (of which three million would already be to estimate their own costs. A report, based on an available in the Special Reserve Fund, and nine analysis of some of the replies and made to the million would, over a period of three years, be Executive Board at its eleventh session, showed that, accumulated in the Retained Contributions Account) whereas WHO's Technical Assistance programme as plus its unobligated allocations. planned for 1953 would have cost roughly nine and The use of the nine million dollars in the Retained a half million dollars, the estimated expenditure of Contributions Account would be only (1) for short - governments for the same programme would have term loans to a participating agency pending the been nearly 40 million. receiptofcontributionsfrom governmentsfor The Technical Assistance Board received informa- initiating or continuing approved programmes within tion by September that only a third of the prospective the approved amounts earmarked for the agency ; or beneficiary countries would be ready to implement (2) for improving and facilitating currency manage- the new plan by 1 January 1954.It was therefore ment, for which currencies retained in the Account suggested that it might be advantageous to delay might be bought or sold by an agency within the introducing the new system for a full year, or to limits set by the Technical Assistance Board.The introduceitonly in those countries which had Special Reserve Fund would continue to provide accepted the plan and had paid in advance the sums funds pending the receipt of contributions at the due. In October, however, the Technical Assistance beginning of a financial period and for ensuring the Committee confirmeditsdecision that the new completion of projects extending beyond the end of system should be brought into effect as initially the current period. planned, with a few exceptions. At its December meeting the Technical Assistance Itisalso provided that, within the foregoing Board worked out a method of introducing the new proposals, each agency would be free to manage its own operations so as to achieve whatever further system, with effect from 1 January 1954, for those countries which had indicated their full acceptance, degree of financial security it considered necessary. and deferred the full implementation to 1 April for WHO insisted that this provision should be included. those that had accepted it in principle only.The Technical Assistance Board also ruled that no new Local Costs to Recipient Governments projects could be started unless the government The Technical Assistance Committee, in March, concerned agreed to accept the new system. and the Economic and Social Council, in April, It further decided to retain to itself the authority reaffirmed the principle that governments should for granting local cost waivers for individual Technical make a substantial contribution,eitherinlocal Assistance projects, to extend the waivers in force, currency or in kind, to the Technical Assistance both country and project, to 30 June 1954, and to given them, and adopted a plan, to take effect from reconsider the entire question of waivers in March 1 January 1954, modifying the existing methods of 1954. assessing and paying the local costs of international experts. Financial Arrangements in 1953 These costs are those which have heretofore been The Third Technical Assistance Conference was paid directly to the experts by governments.They held in New York in February 1953.Pledges given cover payments in cash or in kind for lodging, by 70 governments, at and after the conference, travel per diem, postage, telephone and telegraph amounted to the equivalent of US $22,396,313, of services,etc., and are quite separate from, and which $18,939,010 was paid into the Special Account additional to, the expenditure of governments on by the end of the year. These sums were larger than local counterpart personnel, buildings, and supplies the corresponding figures for 1952 of $18,797,232 and equipment of all types, which, in the case of pledged by 65 governments and $16,210,538 paid in health projects at least, is almost invariably more by the end of the year.The amount pledged for than the expenditure of WHO on the same projects 1953 and the carry -over of $3,395,000 from 1952 -often four timesas much.The size6f this enabled the Technical Assistance Board to plan on latter expenditure by governments can be ascertained by a study of the programme and budget estimates 3 Off: Rec. Wld. HIM. Org. 39 EXPANDED PROGRAMME OF TECHNICAL ASSISTANCE FOR ECONOMIC DEVELOPMENT 125 an expected income equivalent to US $25,300,000. measure of success was achieved in implementing Of this amount the Technical Assistance Board projects which met the needs of requesting govern- originally earmarked $5,078,000 for WHO (about a ments and utilized difficult currencies. fifth of the total), if pledges were paid in full. The full implementation of the Technical Assistance programme which WHO had planned for1953 Co- ordination with other Technical Assistance would, however, have required an expenditure of Programmes $9,455,358, and the cost of merely carrying on As more planning and co- ordination were being during 1953 those projects which were in operation done at the country level, more attention was given at31 December 1952,including the continuing during1953tomaintaining and improving co- essential costs for central administration and indirect operation with representatives of other Technical operations, was estimated at $6,550,000.It therefore Assistance programmes, multilateral and bilateral, became apparent that the highest income that WHO who are working in the countries, and with whom could expect would fall$1,472,000 short of its WHO field staff is in frequent contact. immediate needs for Technical Assistance. This Towards the end of 1952 the Government of situation was reported in January to the eleventh Norway establisheda programme of technical session of the Executive Board, which examined assistance for India, and a tripartite agreement was WHO's responsibilities in the Expanded Programme concluded between the Government of Norway, and,inresolutionEB11.R57.4,authorizedthe the Government of India and the United Nations Director - General to revise the programme originally and itsspecialized agencies. Collaboration and planned, and gave general instructionsforthis the exchange of information continue between the revision. The programme was continued by slowing Norwegian mission to India and WHO. WHO has down operations, postponing new activities planned also maintained contact with governments parti- and transferring some activitiestotheregular cipatingin,andtheofficialsresponsiblefor, programme ;arrangementswere made forthe operations under the Colombo Plan, and some action Pan American Sanitary Bureau and UNICEF to has been taken to co- ordinate projects of common accept all or part of the financial responsibility for interest (see Chapter 13, page 79). certain projects. By the middle of the year the financial situation Early in 1953, for the first time, a special meeting was called in Geneva between officials of the United had become so critical that at the August meeting States Technical Co- operation Administration and the Technical Assistance Board decided to withold those of WHO. The presence of representatives of $1,800,000 in 1953 to increase the financial solvency the Technical Co- operation Administration, both of the programme in 1954. In consequence, WHO's from the headquarters in Washington and from the total allocation for 1953 was reduced to$4,600,525,4 field, facilitated a full discussion and exchange of and the Organization had to cut its programme costs information. As a result there has been better under- by another $374,760. standing and co- operation between the two agencies At the same meeting the Technical Assistance at all levels and stages. During the year the Technical Board agreed that the participating agencies should Co- operation Administration became part of the re- examine the administrative costs of the programme and that in their plans for operations during 1954 Foreign Operations Administration. they should seek to reduce administrative and other costs in the headquarters and regional offices,if Plans for 1954 possible by 20 per cent compared with the 1953 estimates. At its sixteenth session the Economic and Social The financial situation also made it even more Council reviewed the programme proposed for 1954 important to make full use of contributions in all and submitted by the Technical Assistance Board, currencies.The agencies therefore increased their and recommended, inresolution 492 C (XVI), effortstopurchase equipment and suppliesin Part A, that, to permit the Expanded Programme to countries whose currencies could not be used else- progress, governments should make contributions where and established a pooling arrangement for to the 1954 programme that would meet the needs for some such currencies.In this way a substantial the year as fully as possible, and in any case would ensure that the available funds should not be less 4This sum includes the amount obligated by WHO to than the amount that the Board had earmarked 30 June for the antibiotics and insecticides projects, but does not include the amount transferred to the Technical Assistance for the approved 1953 programme ($25,300,000). Administration for the latter half of the year. The Council emphasized that it was essential for 126 THE WORK OF WHO,1953 governments to pay their pledges promptly, and The Conference was held on 12 and 13 November, requested that, to enable the participating agencies and representatives of 60 governments pledged a total to plan their final programmes for 1954 with some of US $23,617,000. Twenty -three pledged sums that assurance and by the beginning of the year, (1) the were larger than those previously given. By 31 De- United Nations Negotiating Committee for Extra - cember 1953, the total pledged by 70 governments Budgetary Funds should meet as soon as possible, amounted to $24,321,188.In many cases payment and (2) the Fourth Technical Assistance Conference of the government's pledges is subject to appropriate should be held early in the eighth session of the legislative action, and in some it will be based on a General Assembly. matching system. PART IV

PROJECT LIST

PROJECTS COMPLETED AND CURRENT IN 1953

This part contains a list of the WHO projects, other than fellowships, which are recorded as having been in operation during the whole or part of the 11 months ended 30 November 1953. The operation of a field project is for this purpose considered to start when a senior member of the international team arrives on the site of the project. To save space and avoid repetition, the descriptions of the projects in this list do not include some elements which are common to most WHO projects for assistance to governments in improving their health services. The most usual, and perhaps the most important of these, are the training of local personnel and advice to the government on the utilization of such personnel and the expansion of the work when international assistance comes to an end. There are also some types of project which are undertaken in different countries, or in different parts of the same country, for substantially the same purpose, and which therefore contain elements common to all projects of that type. Work for the control of malaria, for example, or of other insect -borne diseases, ordinarily includes epidemiological and entomological research.Health education is implicit in the great majority of projects and not only in those designated as health education projects. Work against other diseases usually involves both special measures (BCG vaccination for tuberculosis, for example) and the organization of centres and case -finding and treatment facilities.Finally, all work against particular diseases has, as one of its objectives, the integration of the suitable special measures into the general health services of the country. A beginning has been made in this list to summarize the results of some of the completed projects, but this has been possible only to a very limited extent. As is stated in the introduction to the Report, a practicable procedure of evaluation is still being worked out, and not all reports are yet consistently directed to this pur- pose : in some types of project it is not too difficult to see what has been achieved when international help ends ;in others, particularly in those whose main object is education, it may be years before the full effect is produced and then it may be difficult to distinguish the results of the project from the effects of other factors. In others again, any concise evaluation of the many small items that make up the " result " of the project may be impracticable at the present stage. The projects are serially numbered and grouped under the six WHO regions :Africa, the Americas, South -East Asia, Europe, the Eastern Mediterranean and the Western Pacific. Projects that concern several countries in one region appear first and are lettered " AFRO ", " AARO "," SEARO ", " EURO ", " EMRO " or " WPRO ". The other projects, in the alphabetical order of countries, follow.Inter -regional projects are given at the end of the list. In the first column, " Project No. and Source of Funds ", " R " means the regular budget ;" TA " means the Technical Assistance fund (see Chapter 18), and " UNICEF " the United Nations Children's Fund. Projects completed during the year are marked with an asterisk.

AFRICA Project No. and Source of Funds Description Co- operating Agencies AFRO 4 * Nursing and Auxiliary Training Survey (Sept. - Oct. 1953) - R To discover the type of training programmes being carried on and to assess needs for the future. The report was discussed at the regional conference on nursing education, held in October 1953. § AFRO Si Tuberculosis Survey (Oct. 1953 - ) -- R Two experts are conducting a survey of the distribution and intensity of tuberculosis in East and West Africa as a preliminary to a control programme. AFRO S2 * Malaria Survey (1952 - March 1953) - R To determine the distribution and intensity of malaria in British territories in Africa.

* Completed project § For further details, see Annex 5, p. 164. - 129 - 130 THE WORK OF WHO, 1953

Project No. Co- operating Agencies and Source of Funds Description AFRO S8 * Yellow -Fever Surveys (March 1951 - Sept. 1953) R To determine the southern limits of the area in Africa in which yellow fever is endemic, in order to plan effective international control of the disease. §

AFRO S9 * Bilharziasis Survey (1951 - 1953) R A regional survey to determine the extent of endemic bilharziasis in Africa.

Bechuanaland 1 Non -Venereal Treponematosis Control (Sept. 1953 - R A control programme was started with a preliminary survey by a WHO expert.

Belgian Territories 1 Nutrition (Sept. 1952 - ) UNICEF UNICEF Technical advice in organizing the distribution of skimmed milk provided FAO by UNICEF. East Africa S2 * Public- Health Survey (Sept. 1952 - April 1953) R The zone public -health officer made a survey to compile health and general information for each of the British territories in East Africa. In addition to making useful personal contacts he discussed the ways in which the Organi- zation can help these territories.Originally planned for British territories in East and Central Africa, the survey was extended to include the British Protectorates in South Africa, and British Somaliland. French Africa 1 Malaria Control (Nov. 1952 - UNICEF TA Assistance to the French Government in determining, by an international UNICEF pilot project, the most efficacious and economical method of using residual insecticides for malaria control in the Cameroons, and, eventually, in other territories in Equatorial Africa. French Africa S1 Sociological Surveys (March 1953 - R A series of surveys to obtain social, cultural and economic information about the people of French territories and territories under French trusteeship for use in planning and executing health work among them.

French Equatorial Nutrition (Sept. 1952 - ) UNICEF Africa 1 Technical advice in organizing the distribution of skimmed milk provided FAO TA by UNICEF. UNICEF

Kenya 3 Education and Training Supplies (Sept. 1953 - ) R Equipment and supplies for medical training schools. Liberia 1 * General Public Health (Aug. 1951 - March 1953) TA A sanitary engineer was provided to start training courses for sanitary engineers. In the first course of 12 months (March 1952 - March 1953) 19 students were trained as sanitary inspectors, the practical section of the course being used to effect sanitary improvements to the city of Monrovia. The course is con- sidered to have given reasonable elementary training to 19 men, who should be able to improve materially the sanitary conditions of the areas to which they are assigned. A second course is being prepared, for which higher educa- tional qualifications will be imposed. A public -health officer compiled existing and proposed new health legislation. Liberia 3 Yaws Control (April 1953 - UNICEF TA To find and treat cases ; to train local professional and other staff ; in so far UNICEF as possible, to provide modern treatment for other diseases amenable to ambulatory treatment. (This is combined with Liberia 5, as one project.) Liberia 4 * Maternal and Child Health (1951 - 1953) R Supplies and equipment were provided for training at a maternal and child welfare centre.

* Completed project § For further details, see Annex 5, p. 164. PROJECT LIST :THE AMERICAS 131

Project No. Description and Source of Funds Co- operating Agencies Liberia 5 Malaria Control (April 1953 - ) UNICEF TA To assist the Government in determining the most effective and economical UNICEF methods for malaria control, and in epidemiological and entomological inquiries ;to plan an expanding programme of control.(This is combined with Liberia 3, as one project.)

Liberia 6 Health Education of the Public (March 1952 - ) TA Supplies and equipment were provided in preparation for the recruitment of a health engineer to assist in organizing a nation -wide health education programme.

Mauritius 1 Pertussis Vaccination Campaign (April 1953 - ) UNICEF R There was a severe outbreak of pertussis in 1948, with over 1,700 deaths. UNICEF A consultant visited the country in April and found pertussis prevalent in the townships, but no severe outbreak. That of 1948 appears to have been abnormal. His report advises vaccination, not to be combined with immuni- zation against any other disease, and makes some suggestions on procedure. The resources of Mauritius are adequate to carry out the work and to continue the programme after the initial campaign is completed in six to nine months' time. Vaccines and other supplies have been provided by UNICEF. Nigeria 4 Training School for Medical Assistants (Sept. 1953 - ) R Teaching supplies and equipment were provided for a training school for medical assistants at Kano.

Nigeria 5 Training School for Medical Field Units (Sept. 1953 - ) R Teaching supplies and equipment were provided for a medical field unit training school at Makurdi.

Seychelles 1 Public- Health Sanitation (Aug. 1953 - ) R A sanitarian has been assigned to make a preliminary survey and to initiate a training programme for local sanitation staff.

THE AMERICAS

AARO 1 Environmental Sanitation :Training Courses (Dec. 1952 - ) R Lectures, teaching supplies and equipment for training courses for professional and other personnel in schools of public health in Brazil, Chile and Mexico.

AARO 6 Joint Field Mission in the High Andes (July 1952 - ) UN TA * First phase (survey) completed December 1952. ILO To consider means of improving the economic position of the indigenous FAO population of the High Andes districts of Bolivia, Ecuador and Peru. About UNESCO 70% of the population of the three countries is in these districts, whose condi- tions and history have hindered their integration into the national life. The health part of the report on the survey describes what is known of the health conditions and makes recommendations as to the health measures which should accompany and assist economic development. Substantially, it recom- mends a gradual development and spread of health services from three rural health units, with careful attention to the present culture and knowledge of the population.

AARO 7 Insect Control (Oct. 1952 - ) UNICEF TA To protect the population in Guatemala, Honduras, Nicaragua and Panama UNICEF from malaria and other insect -borne diseases, mainly by DDT spraying.

AARO 8 Insect Control (Oct. 1952 - ) UNICEF TA To protect the population of countries in the Caribbean area from malaria UNICEF and other insect -borne diseases, mainly by DDT spraying. AARO 9 * Seminar on Alcoholism, Buenos Aires (May 1953) § R

* Completed project § For further details, see Annex 5, p. 164. 132 THE WORK OF WHO, 1953

Project No. Description and Source of Funds Co- operating Agencies AARO 10 Inter- American Center of Biostatistics, Santiago (Oct. 1952 - PASB TA Permanert training centre for Latin America, in vital and health statistics. UN PASB Existing offices in Santiago, Chile, are to be developed to serve as a model. § AARO 15 * Seminar on Health Education, Mexico City (Sept. 1953) § R AARO 17 * Waterworks Operation (May - Aug. 1953) Institute of Inter - R Improvement of water -supply control in Central America, including a training American Affairs course for this purpose ;integrating with the long -range programme in environmental sanitation for Central America and Panama. §

AARO 18 Assistance to Schools of Medicine (March 1953 - ) R Assistance in the development of professional education through services of a short -term consultant, interchange of professors, fellowships, study tours for senior faculty members, and teaching supplies and equipment. AARO 21 Venereal- Disease Laboratory and Training Centre, Guatemala (Jan. 1952 - R Laboratory and training centre for Central America AARO 23 * Third Regional Nursing Conference, Rio de Janeiro (July 1953)§ PASB R Institute of Inter - PASB American Affairs Rockefeller Foundation AARO 24 * Seminar on Rural Social Welfare in Latin America, Rio de Janeiro UN TA (Feb. 1953) UN The final report of the seminar gives a comprehensive review of the considera- tions to be taken into account in plans for rural welfare, including : community participation ;local leadership ; continuance after international help ends ; the respective functions of the State and the local community ; education ; how, where and when to train. AARO 25 * Third Latin American Nutrition Conference, Caracas (Oct. 1953) FAO R On problems of nutrition in Latin America, including public -health aspects FAO of protein malnutrition and endemic goitre.

AARO 29 Cultural Anthropologist (Jan. 1953 - ) PASB R To investigate cultural and social aspects of public -health services in Central PASB America.

AARO 31 BCG Statistician (Feb. 1953 - ) R To help in training BCG teams.

AARO 34 Consultant in Mental Health (Oct. 1953 - ) R To help to prepare for seminar in 1954. Bolivia 1 Typhus Control (Jan. 1951 - ) PASB PASB Nation -wide control of typhus fever. UNICEF UNICEF Bolivia 5 Nursing Education (April 1953 - R To improve nursing training by strengthening the national school of nursing. Bolivia 6 Study of Water Supply, La Paz (July 1953 - ) R Technical advice on correcting chemical quality of drinking -water : improve- ment generally of water supply.

Brazil 4 Diphtheria and Pertussis Vaccination (Sept. 1951 - ) UNICEF UNICEF Vaccination, and production of an effective combined diphtheria -pertussis vaccine in adequate quantity. British Honduras 2 BCG Vaccination (Sept. 1953 - UNICEF UNICEF

* Completed project § For further details, see Annex 5, p. 164. PROJECT LIST : THE AMERICAS 133

Project No. and Source of Funds Description Co- operating Agencies Chile 3 Diphtheria and Pertussis Vaccination (1950 - ) UNICEF R Vaccination, and production of an effective combined diphtheria -pertussis UNICEF vaccine in adequate quantity ;setting up standards for large -scale control ; evaluation of results. Chile 6 * Penicillin Plant TAA TA (transferred to the Technical Assistance Administration on 1 July 1953) Chile 7 Maternal and Child Health (1951 - ) UNICEF UNICEF Training for work in rural areas.

Colombia 1 Diphtheria, Pertussis and Smallpox Vaccination (June 1950 - ) UNICEF R Vaccination and production of an effective combined diphtheria -pertussis UNICEF vaccine in adequate quantity.

Colombia 4 Maternal and Child Health (Sept. 1951 - ) UNICEF R To assist in developing the department of midwifery in the school of public UNICEF health at Bogotá, in organizing demonstration courses in midwifery for those who are not nurses and in developing the training programme in maternal and child health for medical students at the school of public health.

Colombia 5 Insect Control (April 1952 - ) UNICEF TA With special reference to the control of malaria and yellow fever. Institute of Inter - UNICEF American Affairs Colombia 8 * Hospital Administration, San Juan Hospital, Bogotá - R (Oct. 1952 - March 1953) A consultant for 5 months, to advise the responsible authorities on the administration of the hospital.His report contains much information about the resources and present working of the hospital and makes detailed recom- mendations for the future. It recommends that the Director should have full responsibility for the administration of the hospital in accordance with the general policy determined by the governing body, sketches a hierarchy of control and the functions, under the Director, of the senior staff, of whom the more important should be whole -time. The report includes also recom- mendations as to the relations between the hospital and the school of medicine and for improving the nursing service, with many other details.Most of these recommendations apply also to the municipal hospital of Manizales and the San José Hospital at Popayán.

Colombia 11 Public -Health Administration (Nov. 1952 - ) TA * First phase (survey) completed April 1953. A consultant advised on the development of public -health services. His report describes the existing organization and makes suggestions for its improvement, dealing with such points as :the hierarchy of responsibility, continuity of appointments and policy, training of personnel, priorities and construction of budget. (The second phase of this project has been postponed.) Costa Rica 3 San José School of Nursing (Feb. 1952 - ) TA To strengthen the school of nursing in the San José hospital and to develop the training of auxiliary personnel.

Costa Rica 5 BCG Vaccination (March 1952 - ) UNICEF UNICEF Costa Rica 9 * Construction of Slaughter- houses (July - Nov. 1953) TA Study of problems connected with planning and construction of slaughter- houses and help with construction. Costa Rica 10 Radiography Training Course (Oct. 1953 - ) R To train personnel appointed by the Government. Dominican Republic 2 Insect Control (Sept. 1952 - ) UNICEF TA Programme to reduce the incidence of malaria and to eradicate Aëdes aegypti. UNICEF

* Completed project 134 THE WORK OF WHO, 1953

Project No. and Source of Funds Description Co- operating Agencies Ecuador 5 Tuberculosis Teaching Centre (Sept. 1951 - ) UNICEF R To improve and extend the existing diagnostic and therapeutic services ;to UNICEF co- ordinate the mass BCG -vaccination campaign with the tuberculosis control programme.

Ecuador 6 BCG Laboratory (Aug. 1952 - ) UNICEF UNICEF To set up a laboratory for BCG production. WHO is now giving technical advice only.

Ecuador 7 Venereal- Disease Control, Bahia (Feb. 1952 - ) TA To be extended later to other parts of the country.

Ecuador 11 National Institute of Health (Dec. 1952 - ) TA Assistance in bacteriology and virus study, and in food and drug analysis.

El Salvador 3 BCG Vaccination (Oct. 1951 - ) UNICEF UNICEF To combine BCG work with the scheme for tuberculosis control.

El Salvador 5 Health Demonstration Area (Sept. 1951 - ) ILO TA Programme of health services in a rural area ;field training of professional FAO and other personnel. UNESCO Guatemala 10 Garbage Disposal (April 1953 - ) - R Garbage disposal and fly control in Guatemala City.

Haiti 1 Yaws and Syphilis Control (July 1950 - ) PASB R To eradicate yaws by mass treatment with antibiotics ; to control syphilis in UNICEF PASB rural areas by treatment with antibiotics. UNICEF Honduras 2 * Health Education (May 1952 - April 1953) Institute of Inter - TA A consultant was assigned to the Ministry of Health for 12 months. A survey American Affairs of problems and resources showed that rural schools and teacher- training institutions were most in need of help and plans for strengthening them were submitted to the Government. A summer school for teachers in rural areas was organized and a Fellow selected for training at the School of Public Health in Puerto Rico, who will be employed as a health- education specialist on her return. The Servicio Cooperativo Interamericano de Educación is following up the summer school and will continue the health- education programme outlined.Advice was given on equipment and supplies. Jamaica 1 * Tuberculosis Control (Aug. 1952 - July 1953) UNICEF TA Assistance in developing a scheme of control throughout the island. UNICEF

Jamaica 3 BCG Vaccination (Oct. 1951 - ) UNICEF UNICEF Mexico 3 * Fundamental Education Training Centre (CREFAL) ILO TA (April 1951 - Dec. 1953) FAO Expert in health education for the regional fundamental education centre for UNESCO Latin America at Patzcuaro. Organization of American States Mexico 4 Rabies Control (July 1952 - ) PASB R Vaccination of dogs ; vaccination of cattle against paralytic rabies ; investiga- tion of role of vampire bats and their distribution.

Panama 1 Rural Health Services (Aug. 1952 - ) UNICEF TA Development of rural public- health services ;organization of central public - UNICEF health laboratory.

Paraguay 1 Insect Control (July 1952 - ) UNICEF TA Control of malaria and other diseases transmitted by arthropods. UNICEF

* Completed project PROJECT LIST : SOUTH -EAST ASIA 135

Project No. and Source of Funds Description Co- operating Agencies Paraguay 2 Tuberculosis Control (Aug. 1952 - TA To determine incidence ; to demonstrate methods of control in urban and rural areas ; to integrate with other public -health programmes ;to train personnel.

Paraguay 3 Maternal and Child Health (Sept. 1951 - ) UNICEF R Development of services in the Asunción -Villarrica area. UNICEF Paraguay 4 Venereal- Disease Control (Jan. 1952 - ) - TA To determine incidence and prevalence, demonstrate methods of control and develop services in the Asunción- Villarrica area.

Paraguay 5 Ankylostomiasis and Smallpox Control (Dec. 1951 - ) UNICEF TA Ankylostomiasis and smallpox control in the Asunción- Villarrica area as a Institute of Inter - UNICEF preliminary to a scheme for the whole country. American Affairs

Paraguay 6 School of Medicine, Asunción (April 1953 - ) R Public- health expert for school of medicine.

Peru 5 Insect Control (Nov. 1952 - ) UNICEF TA With special reference to malaria and Chagas disease. UNICEF Peru 7 * Medical Records Libraries (Sept. 1951 - Sept. 1953) R Assistance in organizing medical records libraries in hospitals under the social security administration ; advanced training courses in library techniques.

Peru 10 Maternal and Child Health and Related Health Services (Sept. 1952 - ) TAA TA To develop a maternal and child health programme and integrate it into the UNICEF UNICEF other public -health activities in the area Lima - Pativilca - Huarás - Callejon de Huaylas.

Peru 11 Anthropologist for Ica Health Centre (May 1952 - ) Rockefeller R An anthropologist for the Government's health centre at Ica, to assist in Foundation adapting methods to local culture. Peru 12 * Tuberculosis Laboratory Diagnosis (Dec. 1952 - Oct. 1953) UNICEF TA Assistance to Ministry of Health ;training personnel. UNICEF Peru 13 Public -Health Demonstration and Training Centre, Callao (Oct. 1952 - ) TAA TA UNICEF UNICEF

Trinidad 1 BCG Vaccination (May 1952 - ) UNICEF UNICEF Trinidad 4 * Tuberculosis Bacteriological Diagnosis Laboratory (Aug. - Nov. 1953) UNICEF R Assistance in improving bacteriological diagnostic service. UNICEF Venezuela 1 Demonstration of Local Health Services (Feb. 1953 - ) TA * First phase (survey of the area and its needs) completed April 1953.

SOUTH -EAST ASIA REGION

SEARO * Nutrition Conference, Bandung (June 1953) FAO R This was the third meeting of the FAO /WHO Regional Nutrition Committee in South and East Asia : the first two were held under the auspices of FAO ; this was sponsored by both organizations.Special attention was given to improving the nutritive value of rice as consumed and to improving the nutritive value of rice diets. The lines recommended at the previous meetings were confirmed.

* Completed project 136 THE WORK OF WHO, 1953

Project No. and Source of Funds Description Ca- operating Agencies Afghanistan 2 Venereal- Disease Control, Kabul and Kandahar (Jan. 1952 - UNICEF TA Includes public -health laboratory service. UNICEF

Afghanistan 4 Male Nursing School, Kabul (Oct. 1953 - ) R Assistance in the education and training programme.

Afghanistan 5 Faculty of Medicine, University of Kabul (Jan. 1952 - ) TA Professor of epidemiology and social medicine for the medical faculty, to develop the Department of Social Medicine and to establish a training centre for students.(This is now merged with Afghanistan 13.) Afghanistan 6 Public -Health Survey (Nov. 1951 - ) TA Advice to Government on survey of existing medical and public -health condi- tions, developing teaching and training, improving public -health services and integrating various public -health programmes.

Afghanistan 10 Maternal and Child Health (Oct.. 1951 - ) UNICEF TA Training of general nurses and midwives, including training in domiciliary UNICEF care ;establishment of a school for midwives ;help in the development of paediatric and obstetrical services. Afghanistan 11 Malaria Control (March 1952 - R Technical assistance in planned extension of malaria control ; training local personnel. Team helps in typhus -control work during season. Afghanistan 12 Public Health and Environmental Sanitation, Kabul (Dec. 1951 - R Typhus control in season. Afghanistan 13 Teaching Staff for Medical Faculty of Kabul University (Sept. 1953 - R To assist in developing departments and to train national counterparts. Afghanistan 14 * Survey of Methods of manufacturing Vaccines and Sera (Sept. 1953) R Consultant to examine the existing methods of manufacturing vaccines and to suggest improvements as necessary : to advise on the manufacture of anti - diphtheria and anti -tetanus sera in Afghanistan. Burma 2 Malaria Control (Oct. 1951 - TA Demonstration and training programme.

Burma 3 Tuberculosis Control (July 1951 - ) UNICEF TA Providing a tuberculosis dispensary in co- operation with tuberculosis hospital UNICEF in Rangoon ; branch dispensaries to be set up later ;diagnostic laboratory. Burma 4 Venereal- Disease Control (Oct. 1950 - ) UNICEF TA Country -wide control programme. (This is combined with Burma 6, as one UNICEF project.) - Burma 6 Maternal and Child Health (Dec. 1951 - ) UNICEF

TA Demonstrationandtraininganddevelopmentofhealthcentres; UNICEF instruction to nurses in the Rangoon General Hospital and to general and midwifery student nurses in Mandalay, also assistance in training of public - health nurses and health visitors. (This is combined with Burma 4, as one project.)

Burma 7 Rangoon School of Nursing (March 1953 - ) R Midwifery tutor for the Dufferin Hospital and Midwifery School. Burma 11 BCG Mass Vaccination Campaign (Nov. 1951 - ) UNICEF UNICEF Burma 17 * Leprosy Control (Aug. 1952 - Dec. 1953) R Developing central clinic, Rangoon : training of leprosy workers for national leprosy services.

* Completed project PROJECT LIST : SOUTH -EAST ASIA 137

Project No. and Source of Funds Description Co- operating Agencies Burma 24 * Social Service Mission (Oct. 1952 - April 1953) TAA TA A representative of WHO worked with the United Nations Social Service ILO Mission to Burma and made recommendations, embodied in the report of the UNESCO mission, for improving the health services in that country. The report contains an analysis of the problems of adapting general principles to particular con- ditions in Burma with special emphasis on the establishment of rural health centres. Burma 27 * Food Hygiene (July 1953) FAO R A short -term consultant to advise the Government on modern methods of food inspection, establishing market practices and other questions related to food consumption.

Burma 29 Maternal and Child Health (Nov. 1953 - ) R Three -month refresher course in paediatric nursing.

Ceylon 2 Health Education (March 1952 - ) UNESCO TA Specialist for UNESCO fundamental education project.

Ceylon 4 Maternal and Child Health (April 1951 - ) UNICEF TA Demonstration and training centres, Colombo and Kalutara :to help the UNICEF Government to co- ordinate preventive and curative paediatrics and in teaching of preventive paediatrics ;assistance in basic training in midwifery and paediatric nursing. Ceylon 5 * Venereal- Disease Control (July 1951 - Dec. 1953) R Help in establishing adequate control programme and a training centre. Ceylon 8 Nursing Training, Colombo (Oct. 1951 - ) R Help in the teaching of nursing arts at the School of Nursing. Ceylon 9 Insect -borne Diseases Control, Kurunegala (Nov. 1951 - UNICEF TA To improve standard of training at the centre for the control of insect -borne UNICEF diseases, Kurunegala.

Ceylon 10 Tuberculosis Control, Colombo (July 1951 - ) UNICEF TA To establish a tuberculosis demonstration and training centre. UNICEF Ceylon 15 Nursing Training, Kandy (Feb. 1952 - ) TA Help in developing a new school of nursing. Ceylon 18 * Hospital Dietitian (Sept. 1951 - July 1953) TA Help in improving and organizing scientific dieting of patients in hospitals and other institutions. Ceylon 22 Medico -Legal Consultant (Sept. 1953 - ) R To advise the Government in planning the improvement of the quality of medico -legal work and to train medical officers.

Ceylon 23 Medical Store Management (Nov. 1952 - ) R To study the existing system and help to reorganize it; to train local personnel. Ceylon 24 * Food Hygiene (April -June 1953) TA Consultant to advise on legislation for inspecting food of animal origin, modern slaughter -house practice and food -borne diseases in man.

Ceylon 25 Tuberculosis Control, Galle (July 1951 - ) UNICEF TA To establish a tuberculosis demonstration and training centre. UNICEF Ceylon 33 * Survey of Audio- Visual Aids Production (Nov. -Dec. 1953) R India 2 Maternal and Child Health, Calcutta (June 1953 - ) UNICEF R Assistance to the maternal and child health department of the All -India UNICEF Institute of Hygiene and Public Health, Calcutta.

* Completed project 138 THE WORK OF WHO, 1953

Project No. and Source of Funds Description Co- operating Agencies India 7 & 8 * Maternal and Child Health, Najafgarh (Jan. 1950 - Dec. 1953) UNICEF R Demonstration work in rural area, with emphasis on training programmes. UNICEF India 10 * Malaria and Food Production, Terai and Bhahar (May 1951 - May 1953) TAA TA The first WHO demonstration project.Earlier work was hampered by in- UNICEF UNICEF adequate knowledge of local conditions, but much was learnt from it. In areas FAO sprayed consecutively for two years, malaria transmission was stopped ;in others it became negligible.The success of this campaign was prerequisite for implementation of the Government's proposals for colonizing the area. In Terai, population increased 70% from 1948 to 1951 and the area under cultivation was more than quadrupled. Food production has doubled since 1949.There are several co- operative farms with modern equipment, new factories, some new roads, a hydro -electric power plant and a great increase in trade in neighbouring cities. The Government of Uttar Pradesh is continuing the work and has expanded it to 24 districts of the State, in spite of difficulties in obtaining trained staff. India 11 * Tuberculosis Control, Patna (Sept. 1952 - Dec. 1953) UNICEF TA Prevention, diagnosis and treatment at teaching and training centre. UNICEF India 12 * Tuberculosis Control, Trivandrum (May 1951 - March 1953) UNICEF UNICEF Demonstration project, including prevention, diagnosis and treatment at teaching and training centre ; integration with national health programme.

India 15 Venereal- Disease Control (Sept. 1951 - ) UNICEF UNICEF Supply of equipment to field teams ; cardiolipin production and distribution. India 17 * Antibiotics Production Plant TAA TA (transferred to the Technical Assistance Administration on 1 July 1953) UNICEF UNICEF

India 19 Nursing Training, Calcutta (June 1952 - ) R To assist in developing the school of nursing at the Medical College Hospital, Calcutta, including midwifery and paediatric nursing.

India 24 Yaws Control, Madras, Hyderabad and Madhya Pradesh (Nov. 1952 - ) UNICEF TA Pilot project in Madhya Pradesh to be extended later to other States :to UNICEF improve the health of the tribal people in the area and reduce the incapacity caused by yaws. India 25 * Venereal- Disease Control, Madras (July 1952 - Dec. 1953) R Help in establishing a first -rate venereal- disease department and training centre at the Madras General Hospital. India 26 Medical College, Trivandrum (Aug. 1952 - ) TA Help in developing a medical college at Trivandrum by providing a principal. India 27 * DDT Production Plant TAA TA (transferred to the Technical Assistance Administration on 1 July 1953) UNICEF UNICEF

India 28 BCG Vaccination, Delhi (July 1951 - ) UNICEF UNICEF Continuation of campaign in Delhi State and extending the work to 19 other States in India : to integrate BCG service with the general tuberculosis pre- ventive and control programmes. India 29 Pharmacology, Calcutta (Nov. 1952 - TA To train pharmacologists for teaching and research at the Calcutta School of Tropical Medicine and to develop a teaching and research centre there.

India 30 Pilot Studies in Family Planning (May 1952 - ) UN TA Advice on survey and experimental studies.

* Completed project PROJECT LIST : SOUTH -EAST ASIA 139

Project No. and Source of Funds Description Co- operating Agencies India 31 Plague Control, Uttar Pradesh (Oct. 1952 - R To supplement existing system of survey, study procedures in use, work in selected areas and train local workers. India 34 Industrial Hygiene, Calcutta (Sept. 1952 - R Development of the section of industrial and physiological hygiene in the All -India Institute of Hygiene and Public Health, Calcutta, by providing a professor of physiology and industrialhygiene ;alsoassistance tothe industrial health unit of the Indian Council of Medical Research.

India 40 Nursing Training, Bombay (Sept. 1953 - ) R Assistance in the education and training programme at the J. J. Hospital, including midwifery training. India 41 Establishment of a Physiotherapy School, Bombay (Oct. 1952 - TA Provision of physiotherapy experts and necessary equipment. India 44 * Paediatric Nursing, Madras (Nov. 1952 - Dec. 1953) R Improving nursing and teaching facilities in the paediatric unit of Madras General Hospital. India 46 * Visiting Team of Medical Scientists (Feb. -March 1953) Unitarian R A team of 14 professors of international standing, representing the same number Services of pre -clinical, clinical, and public -health specialties, spent two months in India Committee (mainly Madras and Bombay) conducting postgraduate (and also some under- graduate) lectures, demonstrations and seminars, and exchanging information on recent scientific advances in all the relevant specialties. A two -day con- ference on medical education in which 18 Indian medical faculties were represented was also held in connexion with the team's visit. India 47 * Food Hygiene (March -April 1953) TA Consultant to advise on legislation for inspecting food of animal origin, modern slaughterhouse practice and food -borne diseases in man. India 52 Professor of Pharmacology, Bombay (Feb. 1953 - ) - R For Seth G.S. Medical College. India 58 * Nursing Refresher Courses (Sept. -Dec. 1953) R Three courses, each of 3 months' duration. India 66 * Seminar for Waterworks Operators, New Delhi (Dec. 1953) § - R India 67 * Survey of Audio -Visual Aids Production (Nov. -Dec. 1953) - R Indonesia 1 Treponematosis Control (June 1950 - ) UNICEF TA Country -wide campaign ; strengthening of laboratories ; biostatistical help. UNICEF

Indonesia 2 Maternal and Child Health (Jan. 1952 - ) UNICEF TA To improve and extend child care services and set up maternal and child health UNICEF centres. Indonesia 4 Malaria Control, Tjilatjap (Sept. 1951 - ) - TA Demonstration and training centre ; national personnel to take over the work after two or three years.

Indonesia 5 Nutritionist, Jakarta (Jan. 1952 - ) FAO TA Medical nutritionist and biochemist to advise and assist the Government in organizing effective nutrition education programmes and in strengthening the Nutrition Institute at Jakarta.

Indonesia 8 Tuberculosis Control (Sept. 1952 - ) UNICEF TA Training and demonstration centre at Bandung and BCG mass vaccination UNICEF campaign.

Completed project § For further details, see Annex 5, p. 164. 140 THE WORK OF WHO, 1953

Project No. and Source of Funds Description Co- operating Agencies Indonesia 11 * Visiting Team of Medical Scientists (March -April 1953) Unitarian R A team of 12 professors of international standing, representing the same Services number of pre -clinical, clinical and public -health specialties, spent two months Committee in Indonesia (mainly Jakarta, Sourabaya and Jogjakarta) conducting lectures, demonstrations, seminars and exchanging information on recent scientific advances in all the relevant specialties. A two -day conference on medical education took place in Jakarta in connexion with the team's visit.The scientific proceedings of the team are being published in book form by the Indonesian Ministry of Health.

Indonesia 13 Gadjah Mada University (Sept. 1953 - ) UNESCO R Provision of teaching staff. Indonesia 14 * Environmental Sanitation (July -Oct. 1953) TA Consultant to survey the sanitary and environmental conditions in and around seaports and airports.

Thailand 2 Treponematosis Control (Oct. 1952 - ) UNICEF TA Expansion of existing service ; control demonstration team ; diagnostic service ; UNICEF developing laboratories. Thailand 6 Maternal and Child Health, Bangkok (Sept. 1951 - ) UNICEF TA Establishment of demonstration and training centre at Bangkok and subsidiary UNICEF centres as necessary and feasible.

Thailand 7 Tuberculosis Control (Oct. 1951 - ) UNICEF TA Establishing tuberculosis control service and diagnostic laboratory. UNICEF Thailand 13 Rural Health Unit (Nov. 1951 - UNICEF TA To improve general health conditions, with special reference to maternal and UNICEF child health and environmental sanitation. Thailand 15 Mass BCG Vaccination Campaign (May 1953 - UNICEF UNICEF Thailand 16 * Nursing Adviser (Jan. 1952 - Dec. 1953) TA Assistance in establishing a nursing division in the health directorate. Thailand 18 * Leprosy Survey (Sept. - Dec. 1953) R By short -term consultant. Thailand 22 * Nursing Training (Aug. - Nov. 1953) R Refresher course for nurses ;and to train senior staff in supervision and administration in rural areas. Thailand 23 Consultant on BCG Production (May 1953 - R For the vaccination campaign (Thailand 15).

EUROPE

EURO 5 International Anti- Venereal- Disease Commission of the Rhine (1950 - ILO R EURO 6 Health Visitors (1951 - ) t Rockefeller R Foundation EURO 7.2 * Public- Health Nursing Conference, Mont Pèlerin s /Vevey (Oct. 1953) t R EURO 14.8 * Seminar on Mental -Health Aspects of Public -Health Practice, Amsterdam R (July 1953) t EURO 22.3 * Conference on Preventive and Social Medicine, Goteborg (July 1953) t R

* Completed project t For further details, see Table I on p. 87. PROJECT LIST :EUROPE 141

Project No. Description Co- operating Agencies and SourceofFunds EURO 23 * Symposium on Insect Control, Rome (Oct. 1953)t Istituto Superiore R di Sanità

EURO 25 * Conference on Health Education, London (April 1953)t R

EURO 27.3 * Thoracic Surgery :Training Course (May 1953)t University R of Groningen

EURO 32.2 * Seminar on Occupational Health, Milan (Sept. -Oct. 1953)t ILO R

EURO 39 * Perinatal Problems (Sept. 1953)t R

EURO 40 * School Health Services : Study Group (April -May 1953)t R

EURO 46 * Insect Control : Training Course (June -July 1953)t Istituto Superiore R di Sanità

EURO 52 Anaesthesiology :Training Course (June 1953 - )t University R of Copenhagen

EURO 55.1 * Tuberculosis :Training Course (Jan. -Feb. 1953)t International R Children's Centre EURO 55.2 * Rehabilitation of Handicapped Children : Training Course International R (Feb. - March 1953)t Children's Centre

EURO 55.3 * Social Paediatrics : Training Course (April - July 1953)t International R Children's Centre

EURO 55.4 * Perinatal Problems :Training Course (Oct. - Nov. 1953)t International R Children's Centre

EURO 56 Tuberculosis : Training Course (Nov. 1953 - )t TA

EURO 57 * Occupational Health :Training Course (June 1953)t British R Council

EURO 59 Venereal Diseases (1951 - ) R Continued work in the port demonstration and training centre, Rotterdam, for the control of venereal diseases.

EURO 59 * Venereal- Disease Control :Training Course (Sept. - Dec. 1953)t R

EURO 60 * Public -Health Administration : Training Course (Aug. - Sept. 1953)t R

EURO 61 Public -Health Administration (1950 - ) Rockefeller R Development of the demonstration and training area in rural public health Foundation in Soissons.

EURO 62 Anaesthesiology : Training Course (May 1953 - ) t University R of Paris

EURO 63 Morbidity Survey (1951 - ) Rockefeller R Continuation of the survey carried out in Denmark with the object of reproduc- Foundation ing data of international interest.

EURO 64 Study on Separation of Mother and Child (Nov. 1952- )t International R Children's Centre

* Completed project tFor further details, see Table I on p. 87. 142 THE WORK OF WHO, 1953

Project No. Co- operating Agencies and Source of Funds Description EURO 65 Environmental Sanitation (June 1953 - ) UNESCO R A study of sanitary engineering terms (in English and French), in order to develop an agreed terminology in Europe. EURO 66 * Water Quality and Analysis (Dec. 1953) t R EURO 69 * Social Case -Work (June - July 1953) TAA R Lecturer for a United Nations seminar on in- service training in techniques of working with individuals, held in Paris. EURO 71 * Social Case -Work (July 1953) TAA R Lecturer for a United Nations seminar on services to individuals and families in public and voluntary welfare agencies, held at Dobbiaco, Italy. Austria 4 General Assistance in Public -Health Work (Nov. 1952 - ) TA Under the heads : public -health training school, tuberculosis control, venereal- disease control, environmental sanitation, maternal and child health.

Austria 4.5 Rehabilitation of Handicapped Children (1950 - ) UNICEF R Strengthening and expanding existing facilities. UNICEF Austria 4.6 Assistance to the University Psychiatric Neurological Clinic, Vienna UNICEF R (1950 - UNICEF Supplies, fellowships for the staff of the clinic. Denmark 8 * National Training Courses (Aug. - Oct. 1953) R Assistance to courses, in Copenhagen and Aarhus, for undergraduate and postgraduate psychiatrists.

Finland 4 General Assistance in Public- Health Work (Aug. 1952 - ) TA Under the heads :tuberculosis control, venereal- disease control, communi- cable- disease control, public -health administration, environmental sanitation, nursing, social and occupational health, maternal and child health, education and training.

France 2 Maternal and Child Health (early 1950 - ) UNICEF UNICEF Strengthening services for premature infants.

France 3 Rehabilitation of Handicapped Children (early 1950 - ) UNICEF UNICEF Improving centres, training staff, research.

Greece 3 Rehabilitation of Handicapped Children (Sept. 1952 - ) TAA R Assistance to the Voula Rehabilitation Centre. UNICEF UNICEF ILO

Greece 4 Maternal and Child Health (Sept. 1952 - ) TAA TA Assistance to the maternal and child health services in the Thessaly region. UNICEF UNICEF ILO

Greece 6 General Assistance in Public -Health Work (May 1952 - ) TA Under the heads :tuberculosis control, venereal- disease control, communi- cable- disease control, medical library organization, medical training. Greece 10 * Emergency Relief Programme (Sept. 1953) R For the victims of the earthquake disaster in the Greek islands.

Greece 11 Environmental Sanitation (Oct. 1953 - ) UNICEF R Survey and advice on plans to provide a water supply to 48 villages in northern UNICEF Greece.

Ireland 9 Maternal and Child Health (1951 - ) R Assistance in the establishment of the child guidance clinic in Dublin. Italy 5 Rehabilitation of Handicapped Children (1951 - ) UNICEF UNICEF Assistance to the rehabilitation centres for handicapped children. * Completed project t For further details, see. Table I on p. 87. PROJECT LIST : EUROPE 143

Project No. and Source of Funds Description Co- operating Agencies Italy 7 Maternal and Child Health (1951 - ) UNICEF UNICEF To strengthen and expand services for premature infants in selected areas and to train staff.

Italy 9 Public- Health Administration (Oct. 1952 - ) R Assistance in developing a new school of public health, Rome.

Italy 15 Health Education (1953 - ) R Assistance in a demonstration programme in health education of the public in the province of Perugia.

Morocco 1 Trachoma Control (June 1953 - ) UNICEF UNICEF Ophthalmologist and sanitary engineer helping the Government to expand and improve its arrangements for treatment and control.

Netherlands 4 Public -Health Administration (Oct. 1952 - ) R Assistance to school of public health by provision of lecturers, teaching supplies and equipment and fellowships for staff.

Norway 2 Assistance to Medical Faculties (Oct. 1952 - ) R Provision of medical literature.

Spain 1 Endemo -Epidemic Diseases (1952 - ) TA Advice, fellowships and supplies for improving and expanding the Govern- ment's programme against communicable diseases, including zoonoses.

Tunisia 3 Trachoma Control (Aug. 1953 - ) UNICEF UNICEF Helping the Government to expand and improveits arrangements for treatment and control.

Turkey 6 Maternal and Child Health (Sept. 1952 - ) UNICEF TA Help in establishing demonstration centre, Ankara, and in planning exten- UNICEF sion of maternal and child health work throughout the country.

Turkey 7 Venereal- Disease Control (May 1952 - ) TA Assisting the Government to develop national plans on basis of recent pilot project.

Turkey 8 School of Nursing, Ankara (Aug. 1952 - ) TA Assistance in improving standards of nursing.

Turkey 11 Leprosy Control (June 1953 - ) R Survey to assist in planning national scheme of control. Turkey 12 Public -Health Administration (July 1952 - ) TA Advice on general questions of public -healthadministration, including environmental sanitation. Turkey 13 BCG Vaccination (Dec. 1952 - ) UNICEF UNICEF Turkey 16 School of Public Health, Ankara (July 1953 - ) - R Assistance with lectures for refresher courses. Turkey 22 Hospital Construction (June 1953 - ) - TA Provision of architect, engineer and medical expert to advise on planning, designing and equipping hospitals for the expanding programme of the work- men's insurance scheme.

Turkey 24 Vital and Health Statistics (Aug. 1953 - ) UN TA To assist the Government in developing its statistical organization. ILO Turkey 25 Rehabilitation of the Handicapped (Oct. 1953 - ) - R Expert to make preliminary survey.

Yugoslavia 6 Maternal and Child Health (1951 - ) UNICEF UNICEF Strengthening services for premature infants by supplies and fellowships. 144 THE WORK OF WHO, 1953

Project No. and Source of Funds Description Co- operating Agencies Yugoslavia 7 Rehabilitation of Handicapped Children (1951 - ) UNICEF UNICEF Help in establishing a central unit for the rehabilitation of handicapped children and for extension of the Government's programme. Yugoslavia 10 Plasma Gamma Globulin (Oct. 1952 - ) UNICEF UNICEF Supplies and fellowships to assist the Government to expand its production of gamma globulin. Yugoslavia 16 General Assistance in Public -Health Work (1953 - ) TAA TA Under the heads :communicable- disease control, tuberculosis, trachoma, UNICEF UNICEF public -health administration, maternal and child health. ILO

EASTERN MEDITERRANEAN

EMRO 5 * Regional Nursing College (Oct. 1953) TA To provide for the Region nurses qualified to fill supervisory and training posts. EMRO 6 * Mental Health Seminar, Beirut (Nov. - Dec. 1953) § R EMRO 7 Health Education (May 1953 - ) UNESCO R A public -health adviser and a health educator attached to the UNESCO Fundamental Education Centre at Sirs -el- Layan, Egypt. EMRO 8 * Bilharziasis (April 1952 - Dec. 1953) R Field trials of new molluscocides : The trials were made with sodium penta- chlorophenate (Santobrite) and dinitro -o- cyclohexyephenol (DCHP), both of which had been found effective in laboratory tests. The field experiments were conducted in two sections of canals, closed by mud dams, which were treated with solutions and dusting powders in strengths varying from 1 to 10 parts per million.Comparative tests were made with copper sulphate in similar concentrations. Both substances were found to be extremely effective in concentrations of 5 p.p.m. to 10 p.p.m. The effect was remarkable after the first day and reached its maximum after the third day. Both were more effective than copper sulphate. No living snails were found at the end of the three months' test. The chlorine compounds killed small fish and leeches. They had no effect on aquatic plants, and a negligible effect on cultivated plants. They were not found toxic to animals in the concentrations used. A detailed report will be issued shortly. EMRO 9 Food Hygiene (July 1953 - ) FAO R Consultant visiting Egypt, Syria, Lebanon and Iraq. Egypt 1 * Venereal- Disease Control Demonstration (1951 - Feb. 1953) R To stimulate development of national control scheme ;to train national personnel ; to standardize diagnosis and treatment ; to encourage co- operation between government and private organizations and to encourage research. PAM has been introduced and accepted at the main teaching and training institutions in Egypt and has largely replaced metallotherapy. Newer antigens and serological methods have been introduced and accepted.Forms and records for clinical and laboratory use have been standardized. A teaching and training centre has been established and development of survey technique has given better evaluation of prevalence. National staff have been trained and health education organized and improved. These results have contributed to and encouraged broader developments of the national health programme. Egypt 4 * Public -Health Teaching Mission : Environmental Sanitation (March 1953) TA An advisory group of 3 visited departments and institutions concerned in environmental sanitation and inspected local conditions. Egypt 5 Health Demonstration Area, Calioub (March 1953 - ) UN TA To demonstrate co- ordinated district health services, with training for under- ILO graduate medical students, nurses and sanitarians from Egypt and other FAO countries of the Region. The area is mainly rural but includes a partly indus- UNESCO trialized section. The population is about 300,000.

* Completed project § For further details, see Annex 5, p. 164. PROJECT LIST :EASTERN MEDITERRANEAN 145

Project No. and Source of Funds Description Co- operating Agencies Egypt 6 Trachoma Research (Dec. 1952 - ) - R Virus research, teaching on trachoma and related ophthalmic conditions. § Egypt 10 Bilharziasis Control (Nov. 1952 - ) UNICEF TA Demonstration of control of bilharziasis by snail destruction, health educa- UNICEF tion, environmental sanitation and treatment. Egypt 20 Tuberculosis Centre (Aug. 1952 - ) - TA Co- ordination of existing facilities for tuberculosis control ; setting up training and demonstration centre and diagnostic laboratory. Egypt 22 * Eye Diseases Seminar, Cairo (Feb. 1953) § TA Ethiopia 2 * Leprosy Survey (Feb. 1952 - Jan. 1953) - TA A survey of the incidence of leprosy, the current methods of control and the resources available. The incidence is estimated at about 2.4 %. The report on the survey contains recommendations for better control, including the improvement of leprosaria, social work and employment there, provision for the children of lepers, education of the public and improved methods of treatment.

Ethiopia 3 Public -Health Adviser (Oct. 1952 - ) TA Help in developing a basic public -health administration suited to the needs of the country. Ethiopia 4 Venereal- Disease Control (June 1952 - ) TA Demonstration and training centre.

Ethiopia 8 BCG Vaccination (May 1953 - ) UNICEF UNICEF Iran 1 Malaria Control (Feb. 1950 - ) R Advice on the planning and establishment of a national service of malaria control.

Iran 2 Insect -borne Diseases (Sept. 1953 - ) TA Control in the Hamadan area, including improvement of environmental sanitation and co- operation with the national antimalaria service. Iran 4 Venereal- Disease Control (Oct. 1953 - ) TA Demonstration and training centre, Teheran. Iran 5 Public -Health Administration (Oct. 1951 - ) - TA A team of advisers on public -health, nursing and environmental sanitation, to advise on development of public -health services. Iran 6 * Trachoma Control (March 1953) R To survey the problem in Iran and the existing facilities for control ; to advise on prevention by fly control and improvement of environmental sanitation ; to advise on modern methods of diagnosis and treatment ;to advise on research programme into epidemiology and etiology of other ophthalmias ; to advise on setting -up of a rural campaign against trachoma.

Iran 8 Nursing Training (Nov. 1952 - ) TA To develop the Ashraf School of Nursing in Teheran.

Iran 11 BCG Vaccination (May 1952 - ) UNICEF UNICEF To organize a campaign of BCG vaccination. Iraq 1 * Bejel and Syphilis Control (Oct. 1952 - Dec. 1953) UNICEF TA Extension generally of work to control bejel and syphilis ;establishing a UNICEF laboratory ;teaching and training. Iraq 8 Maternal and Child Health, Baghdad (Nov. 1953 - ) UNICEF UNICEF Demonstration and training centre.

* Completed project § For further details, see Annex 5, p. 164. 146 THE WORK OF WHO, 1953

Project No. and Source of Funds Description Co- operating Agencies Iraq 10 BCG Vaccination (May 1952 - ) UNICEF UNICEF To test 800,000 and vaccinate non -reactors. Iraq 11 Malaria Control (May 1952 - ) UNICEF TA Pilot demonstration ;eventual extension to other malarious areas of the UNICEF country. Iraq 14 * Lecturer in Parasitic Diseases, Baghdad (Dec. 1952 - May 1953) R The consultant gave lectures to fourth -year students on parasitology and to final -year students on tropical diseases, introduced improvements in teaching methods and equipment and started a museum of parasitology and tropical medicine. A new unit for tropical medicine was established at the hospital, and research work has been initiated. The report on the project included suggestions for improving the teaching, including courses for doctors, in Egypt and elsewhere, sending students to Cairo, and meetings of professors of parasitology and tropical diseases in the Region.

Iraq 19 Ankylostomiasis Survey (Oct. 1953 - ) R To survey the incidence of ankylostomiasis and to make recommendations for its control.

Israel 7 Public -Health Nursing (Jan. 1952 - ) TA * First phase completed Aug. 1953. Survey of nursing (Jan. - Feb. 1952), followed by assistance in establishing a basic school of nursing at Sarafand hospital.

Israel 8 Rehabilitation of Handicapped Children (Oct. 1953 - ) UNICEF R To establish a rehabilitation centre to demonstrate modern physiotherapy UNICEF and to establish a national school of physiotherapy.

Israel 16 Zoonoses (Aug. 1952 - ) R Advice on problems of bovine tuberculosis, brucellosis, rabies, etc. ; develop- ment of a veterinary public -health programme.

Jordan 8 BCG Vaccination Campaign (Oct. 1953 - ) UNICEF UNICEF

Jordan 9 Public -Health Laboratory, Jerusalem (July 1952 - ) UNICEF R Two experts for the public -health laboratory in Jerusalem taken over from UNICEF UNRWAPRNE ;training technicians and assisting in vaccine production.

Lebanon 6 Maternal and Child Health Centre, Beirut (Aug. 1952 - ) UNICEF TA Advice and help in setting up a demonstration and training centre for maternal UNICEF and child health. Lebanon 7 * Malaria Control (Aug. 1951 - Dec. 1953) TA Malaria control demonstration and assistance in setting up a demonstration and training team. Lebanon 9 * Public -Health Administration (Sept. 1951 - Aug. 1953) TA To advise the Government on the organization of the public -health service and on training local personnel. Lebanon 12 * Lecturer in Preventive Medicine, French University, Beirut R (Feb. 1952- Feb. 1953) The full value of the project cannot be assessed until undergraduates who have received training go into service. The results to date are the establishment of a Chair of Preventive Medicine, the organization of a village settlement as a practical training area and a generally increased interest in preventive medicine and social health problems. Lebanon 15 * Medico -Legal Consultant (Sept. 1953) R To advise the Government on the organization and operation of the medical legal services and the training of students and doctors.

* Completed project PROJECT LIST :EASTERN MEDITERRANEAN 147

Project No. and Source of Funds Description Co- operating Agencies Libya 1 * Public -Health Administration :Survey on Nursing (June 1953) UN TA The report on the survey describes the organization, standard and status of nursing in Libya and makes recommendations for their improvement, including a demonstration programme in the Tripoli Government Hospital and one at the Barce Hospital in Cyrenaica. Libya 4 Health Education (June 1953 - ) TAA R To improve individual and community health by health education methods. ILO UNESCO

Libya 5 BCG Vaccination (Jan. 1953 - ) UNICEF R Among the settled population of Tripolitania, the Fezzan and Cyrenaica. UNICEF Pakistan 2 Tuberculosis Control, Karachi (Feb. 1951 - ) UNICEF TA Demonstration and training centre. UNICEF Pakistan 3 Maternal and Child Health, Peshawar (April 1952 - ) UNICEF TA Demonstration and training centre. UNICEF Pakistan 5 Cholera Control (Aug. 1952 - ) TA Assistance in organizing measures for cholera control in delta area of East Bengal. Pakistan 7 Venereal -Disease Control, Karachi (Nov. 1952 - ) TA Demonstration and training centre. Pakistan 10 Maternal and Child Health, Dacca (June 1953 - ) UNICEF UNICEF Demonstration and training centre. Pakistan 12 Tuberculosis Control, Dacca (May 1953 - ) UNICEF TA Demonstration and training centre. UNICEF Pakistan 13 BCG Vaccination (Oct. 1951 - ) UNICEF UNICEF Continuing the work of the International Tuberculosis Campaign. Pakistan 18 * Maternal and Child Health Centre, Lahore (Jan. 1951 - June 1953) UNICEF TA An international team of 6 worked from January 1951 to the end of June 1953, UNICEF mainly on training of community health visitors and the establishment of the first central preliminary training school. Attendance at clinics in the demon- stration area and the percentage of the population served have shown an increasing appreciation of the services ; 244 students have passed through the training school. There are now in the training school, schools of midwifery and the domiciliary midwifery service Pakistani nurses who can organize their departments and give a sound education up to the standard required. Pakistan 19 Nursing Training, Dacca (Sept. 1952 - ) UNICEF TA Assistance to nursing training school. UNICEF Pakistan 20 Medical College, Karachi (March 1952 - ) R Professors of physiology and pathology for the medical college, Karachi, to lecture and develop practical undergraduate teaching, advise and train subordinate staff. Pakistan 21 Nursing (July 1953 - ) - R Adviser to assist the Government in the development of the nursing services and nursing education. Saudi Arabia 1 Quarantine Station, Jeddah (Jan. 1953 - ) Foreign TA Assistance in extending the quarantine station, Jeddah, for pilgrims to Mecca ; Operations advice on bacteriological methods and procedures. Administration Saudi Arabia 2 Veneral- Disease Control (Nov. 1952 - TA Demonstration and training centre.

* Completed project. 148 THE WORK OF WHO, 1953

Project No. and Source of Funds Description Co- operating Agencies Saudi Arabia 3 Public -Health Adviser (June 1953 - ) R To advise on strengthening health services ; to make a survey and study before programmes are started. Saudi Arabia 4 Malaria Control (March 1952 - TA Demonstration and training project. Sudan 3 BCG Vaccination Campaign (Nov. 1953 - ) UNICEF UNICEF Syria 2 Malaria Control (Oct. 1952 - ) UNICEF TA Demonstration at Horns. UNICEF Syria 3 Bejel /Syphilis Campaign, Deir- ez -Zor (Nov. 1953 - ) UNICEF TA Campaign against bejel and syphilis in northern Syria ;training personnel UNICEF and advising Government as requested. Syria 4 Bilharziasis and Malaria Control, Jezireh Area (Nov. 1953 - ) FAO R To demonstrate and initiate methods of control and to educate the local population. Syria 5 Maternal and Child Health, Damascus (Sept. 1952 - ) UNICEF TA Demonstration and training project, to assist the Government in extending and UNICEF developing maternal and child health services. Syria 6 * Nursing Training, Damascus (Aug. 1953) TA Advice on nursing training in the University of Damascus. Syria 10 Tuberculosis Control, Damascus (May 1952 - ) R Establishment of a demonstration centre.

WESTERN PACIFIC

WPRO 8 * Regional Seminar on Mental Health in Childhood, Sydney (Aug. 1953) § R WPRO 10 * Trachoma Survey (Aug. 1952 - Feb. 1953) - R A WHO consultant visited 10 countries in the Region to survey the incidence of trachoma and its clinical and epidemiological characters, and to discuss with local authorities and ophthalmologists plans for future work.The surveys confirmed the great social importance of trachoma in these countries and the need to keep local ophthalmologists in touch with the latest work on pathology and treatment. The amount of new epidemiological data collected, the contribution to specialized training of local staff and the plans laid down for future work -some of it already started -are satisfactory results of these surveys. Some encouraging results are available. A survey of two schools in Taiwan showed an average of 46% cured cases and 46% improved after two months' treatment. Brunei 1 School of Nursing, Brunei (Jan. 1950 - ) TA To assist and advise the Government in training of assistant nurses ; to provide in- service training ;to assist in evaluating the training programme in terms of local resources and local needs. Brunei 2 * BCG Vaccination (Feb. - April 1953) UNICEF UNICEF A scheme of BCG vaccination was started with international assistance. Out of a total population of nearly 41,000 (1947 census), over 26,000 have now been tested : nearly 10,000 were found negative, and about the same number vaccinated. Local staff were trained, who are continuing the work on lines recommended in the report.Routine vaccination of young children will continue when the mass campaign is completed. Brunei 3 Malaria and Insect Control Pilot Project (Oct. 1953 - ) TA An extension of the Sarawak malaria project (Sarawak 5).

* Completed project § For further details, see Annex 5, p. 164. PROJECT LIST :WESTERN PACIFIC 149

Project No. Description and Source of Funds Co- operating Agencies Cambodia 1 Malaria and Insect Control (Aug. 1951 - ) - TA * First phase (demonstration) completed March 1953. A demonstration in an area of about 1,022 square kilometres with some 20,000 population.Spraying was done twice yearly, 2 grammes per square metre. Surveys before and after the operations showed a reduction of spleen rate among children from 57.4% to 25.2%; of the infant parasitic rate, from 31.1% to 16.4%. The check area selected was invaded by rebels and was not available for comparison. No entomological evaluation was made because no trained personnel were available in Cambodia. The population covered was limited by security requirements and for the same reason the demonstra- tion area was divided into four parts. The project was revived in August 1953 and it is hoped that improved conditions will permit its extension. Cambodia 2 Public- Health Administrator (Nov. 1953 - R To help co- ordinate the health programmes of the Government ;to survey health conditions ;to advise and assist with long -term programmes ;to co- ordinate work of international agencies and to collaborate with United Nations and specialized agencies. Cambodia 3 School of Nursing, Phnom -Penh (Dec. 1951 - ) - R To develop a basic school of nursing in Phnom -Penh -the first in the country. Cambodia 4 Maternal and Child Health (Jan. 1952 - ) TA Educational and demonstration programme ; advice on extension and develop- ment of services. Cambodia 5 Ecole d'Officiers de Santé (July 1953 - ) - R School for partly qualified physicians.

Cambodia 6 & 7 BCG Vaccination (Nov. 1953 - ) UNICEF UNICEF China 1 Venereal- Disease Control, Taiwan (Aug. 1953 - ) UNICEF TA Demonstration project, in the Taipeh area initially, to be extended later. UNICEF China 2 * Trachoma Pilot Project, Taiwan (Sept. 1952 - March 1953) UNICEF UNICEF Survey of incidence and types of trachoma infection in schools in Taiwan ; treatment by different methods, including trials with newer remedies. To set up trachoma control centre and standardize methods.

China 3 Maternal and Child Health, Taiwan (July 1952 - ) UNICEF TA To provide an efficient maternal and child health service throughout Taiwan ; UNICEF training local personnel ;health education. China 6 Nursing, Taiwan (May 1952 - ) - TA To assist the Government in improving the standards of nursing education and the quality of nursing services in Taiwan. China 7 Malaria and Insect Control Project, Taiwan (May 1952 - ) TA To assist the Government in the control of malaria and other insect -borne diseases in Taiwan.

China 10 BCG Vaccination, Taiwan (April 1951 - ) UNICEF UNICEF Expansion of programme in Taiwan : to test age -groups up to 20 years (about 3,700,000) ;to vaccinate negative reactors and treat as many as possible of the cases found ;to assist the health authorities.

Hong Kong 3 Diphtheria Immunization (Aug. 1952 - ) UNICEF UNICEF Technical advice and guidance from WHO. TA Hong Kong 4 Maternal and Child Health (April 1953 - TA Training in paediatrics, in public -health nursing and paediatric nursing.

* Completed project 150 THE WORK OF WHO, 1953

Project No. and Source of Funds Description Co- operating Agencies Japan 1 Rehabilitation of Crippled Children (Nov. 1952 - ) R A short -term consultant to advise the Ministry of Health and Welfare on the development of services for handicapped children (including child victims of poliomyelitis) ; to interview applicants for training for that purpose ; and to advise on equipment. Japan 2 Maternal and Child Health (March 1953 - ) R A short -term consultant to assist the Government in a survey of the causes of prematurity and extent of the problem ; to assess the existing facilities and to advise on development of services for premature infants. Japan 4 Mental Health (June 1953 - R Assistance in surveying the present state of mental -health work in Japan ;in developing the National Institute of Mental Health, and in selecting can- didates for WHO mental -health fellowships. Korea 5 Public -Health Administration (Aug. 1953 - ) R Assisting the Government to establish an adequate health administration, model national health unit, vaccine laboratory, tuberculosis pilot project ; and help with BCG vaccination. Laos 2 Venereal Diseases and Treponematoses Control (Dec. 1952 - TA Pilot project with a view to mass control. Malaya 1 Nursing Training, Penang and Kuala Lumpur (June 1950 - TA To assist the Government to improve standards of nursing and nursing education. North Borneo 6 Nursing Training (1950 - TA Development of nursing school in Jesselton and of midwifery instruction : development of postgraduate education (continuation of North Borneo 1). Philippines 1 Treponematoses Control (Aug. 1951 - ) UNICEF UNICEF Yaws -control demonstration in 9 provinces. Philippines 2 Mass BCG Vaccination (late 1951 - ) UNICEF UNICEF Philippines 4 Child Guidance Clinic (Nov. 1952 - R Mental health consultant supplied. Philippines 9 Bilharziasis Control Pilot Project (Oct. 1952 - TA Pilot project on Leyte.

Philippines 12 Assistance to University of the Philippines (Sept. 1953 - ) Rockefeller TA Foundation Philippines 14 Malaria Pilot Project, Pinamalayan (Feb. 1952 - ) TA To help the Government to determine the most effective and econ omical means of malaria control. Philippines 22 * Pan -Pacific Conference on Tuberculosis, Manila (April 1953) § TAA TA Philippines Tuberculosis Society Sarawak 4 * Mass BCG Vaccination (July 1952 - April 1953) UNICEF UNICEF There is little satisfactory information on incidence, but the tuberculin testing by the BCG teams confirmed the previous assumption that the incidence of tuberculosis is high, especially in urban areas.In the mass campaign, of a population estimated at nearly 600,000, over 116,000 have been tested, nearly 95,000 completed the tests, over 40,000 were found negative, and nearly 41,000 have been vaccinated. The Government has asked UNICEF for supplies and equipment to continue the campaign. It has not been easy to find suitable local personnel for training and the difficulties of reaching all the local popula- tion are serious. The BCG teams helped in the UNICEF /WHO yaws project (Sarawak 10). Sarawak 5 Malaria and Insect Control Pilot Project (July 1952 - TA Pilot project extended into Brunei 3.

* Completed project § For further details, see Annex 5, p. 164. PROJECT LIST: INTER -REGIONAL PROJECTS 151

Project No. and Source of Funds Description Co- operating Agencies Sarawak 6 * Health Education (Nov. 1952 - June 1953) - TA Advice and training in health education ; development of syllabus ;develop- ment of health museum and outdoor demonstration area. Sarawak 10 * Treponematoses Control (Feb. - April 1953) UNICEF UNICEF The BCG team (Sarawak 4) was employed in this project also. Singapore 2 University of Malaya (Sept. 1952 - ) - TA To develop the teaching of preventive and social medicine in the Faculty of Medicine ; eventually to establish a postgraduate school of public health. Singapore 3 Nursing Training (June 1952 - ) - TA To assistin reorganizing midwifery instruction andin developing the curriculum of training. Viet Nam 1 * Malaria and Insect Control (Dec. 1950 - July 1953) TAA TA Most of the work was done in Gocong. Spraying was done once a year, in October, before the transmission season, 2.8 grammes per square metre. Surveys before and after the operations showed a reduction of spleen rate from 33.5% in July 1951 to 7.7% in December 1952 and of parasite rate from 19.1% to 5.1% in the same period. Control work was also done in other provinces, including the southern hill country (P.M.S.), for which precise data are not available. The Government plans to continue and expand the work on the lines developed in this project ; the surveys and spraying will be done under the supervision of the technicians of the American Mission. Viet Nam 2 Public -Health Administration (Feb. 1951 - ) - TA To assist the Government in long -term planning of health services.

INTER -REGIONAL PROJECTS Inter -regional 5 * Rabies Control (Oct. 1950 - June 1953) - R Field trial and demonstration of rabies control in Israel, using chick -embryo vaccine for mass vaccination of dogs. Inter- regional 6 International Blood -Group Reference Laboratory, London (1951 ) Medical Research R At the Lister Institute. To collect, check and distribute to national centres Council blood -grouping sera of a minimum standard, especially of the rarer blood groups. Inter- regional 7 Rabies Control (Nov. 1952 - R Laboratory and field trials of hyper- immune serum- vaccine in Iran and other countries. Inter- regional 8 Joint FAO /WHO Brucellosis Centres (1950 - ) FAO R These centres study therapy in man ;test antigens and other methods of FAO diagnosis ; make bacteriological studies ; make local surveys to determine the extent of brucellosis infection in animals and organize control campaigns. Inter -regional 9 * Milk Study Group, Rome (Oct. - Nov. 1953) t UNICEF UNICEF FAO FAO Inter- regional 10 Influenza Centres (1948 - R To collect, evaluate and study strains of influenza virus from different parts of the world ; to watch for outbreaks and to classify the type of virus so that protective sera may be prepared in advance of its spread to other countries. Inter- regional 12 * Malaria Conference, Bangkok (Sept. 1953) - R For countries of the South -East Asia and Western Pacific Regions, and Pakistan. To assist Member countries to develop co- ordinated planning of malaria control, jointly between countries or groups of countries. The con- ference adopted recommendations for this purpose, to be circulated to all governments that participated. Completed project t For further details, see Table I on p. 87.

ANNEXES

ANNEX 1 155

Annex 1

MEMBERSHIP OF THE WORLD HEALTH ORGANIZATION (31 December 1953)

States which have accepted or ratified the Constitution of WHO, signed in New York on 22 July 1946, and territories admitted to associate membership :1

Member States Date of acceptance Member States Date of acceptance or ratification or ratification Afghanistan (37) 19 April 1948 Lebanon (58) 19 January 1949 Albania (13) 26 May 1947 Liberia (7) 14 March 1947 Argentina (56) 22 October 1948 Libya, United Kingdom of (79) 16 May 1952 Australia (28) 2 February 1948 Luxembourg (63) 3 June 1949 Austria (15) 30 June 1947 Mexico (35) 7 April 1948 Belgium (49) 25 June 1948 Monaco (53) 8 July 1948 Bolivia (68) 23 December 1949 Nepal (80) 2 September 1953 Brazil (39) 2 June 1948 Netherlands (12) 25 April 1947 Bulgaria (41) 9 June 1948 New Zealand (5) 10 December 1946 Burma (50) 1 July 1948 Nicaragua (69) 24 April 1950 Byelorussian SSR (34) 7 April 1948 Norway (18) 18 August 1947 Cambodia (72) 17 May 1950 Pakistan (48) 23 June 1948 Canada (3) 29 August 1946 Panama (75) 20 February 1951 Ceylon (52) 7 July 1948 Paraguay (57) 4 January 1949 Chile (55) 15 October 1948 Peru (67) 11 November 1949 China (1) 22 July 1946 Philippines, Republic of the (54). 9 July 1948 Costa Rica (60) 17 March 1949 Poland (38) 6 May 1948 Cuba (70) 9 May 1950 Portugal (29) 13 February 1948 Czechoslovakia (30) 1 March 1948 Roumania (40) 8 June 1948 Denmark (36) 19 April 1948 Saudi Arabia (14) 26 May 1947 Dominican Republic (45) 21 June 1948 Spain (77) 28 May 1951 Ecuador (59) 1 March 1949 Sweden (19) 28 August 1947 Egypt (25) 16 December 1947 Switzerland (8) 26 March 1947 El Salvador (47) 22 June 1948 Syria (6) 18 December 1946 Ethiopia (11) 11 April 1947 Thailand (21) 26 September 1947 Finland (22) 7 October 1947 Turkey (26) 2 January 1948 France (42) 16 June 1948 Ukrainian SSR (33) 3 April 1948 Germany, Federal Republic of (78) . 29 May 1951 Union of South Africa (16) 7 August 1947 Greece (31) 12 March 1948 Union of Soviet Socialist Republics (32)24 March 1948 Guatemala (66) 26 August 1949 United Kingdom of Great Britain and Haiti (17) 12 August 1947 Northern Ireland (2) 22 July 1946 Honduras (61) 8 April 1949 United States of America (46) 21 June 1948 Hungary (43) 17 June 1948 Uruguay (62) 22 April 1949 Iceland (44) 17 June 1948 Venezuela (51) 7 July 1948 India (27) 12 January 1948 Viet Nam (73) 17 May 1950 Indonesia, Republic of (74) 23 May 1950 Yemen (81) 20 November 1953 Iran (4) 23 November 1946 Yugoslavia (24) 19 November 1947 Iraq (20) 23 September 1947 Ireland (23) 20 October 1947 Israel (64) 21 June 1949 Associate Members Date of admission Italy (10) 11 April 1947 Morocco (2) Japan (76) 16 May 1951 French Zone 12 May 1952 Jordan, Hashemite Kingdom of the(9) 7 April 1947 Spanish Zone 20 May 1953 Korea (65) 17 August 1949 Southern Rhodesia (1) 16 May 1950 Laos (71) 17 May 1950 Tunisia (3) 12 May 1952

1 The chronological order of acceptance, ratification or admission is indicated by the figures in parentheses following the name of each country. 156 THE WORK OF WHO, 1953

Annex 2

MEMBERSHIP OF THE EXECUTIVE BOARD

After the election at the Sixth World Health Assembly (May 1953- resolution WHA6.12) of six Member States entitled to designate persons to serve on the Executive Board in place of those whose term of office had expired, the 18 designating countries (May 1953 -May 1954) were as follows :

Designating country Unexpired term Designating country Unexpired term of office 1 of ofce1 Austria 3 years Iran 2 years Belgium 1 year Iraq 3 years Brazil 2 years Lebanon 1 year Canada 2 years Liberia 1 year Ceylon 1 year New Zealand 2 years Costa Rica 3 years Switzerland 3 years Cuba 1 year United Kingdom of Great Britain and Northern Denmark 2 years Ireland 2 years Greece 1 year United States of America 3 years Indonesia 3 years

The Executive Board, reconstituted after the election at the Sixth World Health Assembly, had the following membership at its twelfth session (May 1953) :2

Designated by: Designated by: Dr.MelvilleMACKENZIE,Principal Dr. C. VAN DEN BERG, Director- General Medical Officer, Ministry of Health, forInternationalHealthAffairs, London, Chairman United Kingdom of Ministry of Social Affairs and Public Great Britain and HealthoftheNetherlands,The Northern Ireland Hague Belgium Dr. F. HURTADO, Professor of Paedia- Dr.M. J.FERREIRA,Professorof trics, School of Medicine, University Hygiene,MedicalSchoolof the of Havana, Vice -Chairman Cuba State of Rio de Janeiro Brazil Dr. W. A. KARUNARATNE, Medical Dr. H. M. JETTMAR, Head of the Insti- OfficerforInternationalHealth, tute of Hygiene and Professor at the Ministry of Health, Colombo, Vice - University, Graz Austria Chairman Ceylon Dr. O. J. LEROUx,3 Assistant Director, Dr. S. HAYEK, Director of Technical Department of National Health and Services, Ministry of Health, Beirut, Welfare, Ottawa Canada Rapporteur Lebanon Dr. H. B. TURBOTT,4 Deputy Director - Dr. H. HYDE, Chief, Division of Inter- General of Health, Wellington New Zealand national Health, Public Health Ser- Dr. M. A. MALEKI, Professor of Vene- vice, Department of Health, Educa- reology, Faculty of Medicine, Uni- tion and Welfare, Washington, D.C., versity of Teheran Iran Rapporteur UnitedStatesof Dr. J. N. TOGBA, Director -General of America National Health Services, Monrovia Liberia Dr. G. P.ALIVISATOS, Professor of Dr.O.VARGAS -MÉNDEZ, Director - Hygiene at the Medical Faculty and General of Health, San José Costa Rica Professor of Epidemiology atthe Dr. P. VOLLENWEIDER, Directeur du School of Hygiene, Athens Greece Service fédéral de l'Hygiène publique, Dr. O. ANDERSEN, Professor of Paedia- Berne Switzerland trics, University of Copenhagen Denmark Dr.S.AL- WAIIBI, Director, Karkh Dr. S. ANWAR, Director, Public -Health Hospital, Ministry of Health, Service, East Java, Sourabaya Indonesia Baghdad Iraq

1 As from the end of the Sixth World Health Assembly (May 1953) 2 For membership of the Executive Board at its eleventh session (January- February 1953), see Off. Rec. Wld Hlth Org. 46, Annex 1. 3 Dr. Leroux relinquished his place on the Board on his appointment to the staff of the Organization on 29 September 1953. 4 Replaced by his alternate, Dr. F. S. Maclean. ANNEX 3 157

Annex 3 EXPERT ADVISORY PANELS AND COMMITTEES

1. EXPERT ADVISORY PANELS

To supply the Organization with technical advice by correspondence and to provide the membership of its expert committees (and of the Committee on International Quarantine), panels of experts have been established for each of the following subjects : Antibiotics Nursing Biological standardization Nutrition Brucellosis Parasitic diseases Cholera Plague Drugs liable to produce addiction Professional and technical education of medical Environmental sanitation and auxiliary personnel Health education of the public Public -health administration Health statistics Rabies Insecticides Rickettsioses Social and occupational health International pharmacopoeia and pharmaceutical Trachoma preparations Tuberculosis International quarantine Venereal infections and treponematoses (including Leprosy serology and laboratory aspects) Malaria Virus diseases Maternal and child health Yellow fever Mental health Zoonoses

Geographical Distribution of Membership of Expert Advisory Panels at the End of 1953

Region and Country Number Regional Region and Country Number Regional of Members Total of Members Total Africa The Americas (continued) Belgian Congo 4 Ecuador 5 Gold Coast 2 El Salvador 5 Kenya 1 Guatemala 6 Nigeria 6 Haiti 2 Portuguese Guinea 1 Jamaica 1 Sierra Leone 1 Mexico 24 Southern Rhodesia 3 Nicaragua 2 Tanganyika 2 Panama 10 Uganda 2 Paraguay 3 Union of South Africa 15 37 Peru 7 Puerto Rico 3 Trinidad 2 The Americas United States of America 225 Argentina 17 Uruguay 11 Bolivia 1 Venezuela 15 463 Brazil 38 British Guiana 2 South -East Asia British West Indies 2 Afghanistan 1 Canada 44 Burma 1 Chile 22 Ceylon 10 Colombia 4 India 63 Costa Rica 2 Indonesia 7 Cuba 4 Thailand 3 85 Dominican Republic 6 158 THE WORK OF WHO, 1953

Region and Country Number Regional Region and Country Number Regional of Members Total of Members Total Europe Eastern Mediterranean Austria 6 Cyprus 3 Belgium 31 Egypt 29 Czechoslovakia 1 Iran 7 Denmark 28 Iraq 2 Finland 16 Israel 14 France 1 122 Lebanon 6

Germany, Federal Republic . . 14 Pakistan 12 Greece 14 Sudan 3 76 Hungary 2 Iceland 2 Western Pacific Ireland 5 Italy 34 Australia 7 3 Luxembourg 1 China Netherlands 35 Hong Kong 1 Norway 14 Japan 12 Poland 1 Malaya 1 Portugal 6 Netherlands New Guinea 1 Spain 15 New Zealand 9 Sweden 32 Philippines 11 Switzerland 30 Tahiti 1 46 Turkey 16 United Kingdom of Great Britain Territory not assigned to Region

and Northern Ireland 137 Tangier 1 1 Yugoslavia 15 577 GRAND TOTAL 1,285

2. EXPERT COMMITTEES

The membership of the expert committees which met in 1953 was as follows :

Expert Committee on Alcohol Dr. N. K. Jerne, Department of Biological Standards, Statens First Session Seruminstitut, Copenhagen, Denmark M. L. Dontcheff, Docteur ès Sciences, Laboratoire de Phy- Dr. O. Maaloe, Chief, Department of Biological Standards, siologie générale de la Faculté des Sciences, Université de Statens Seruminstitut, Copenhagen, Denmark Paris, France Professor A. A. Miles, Director, Lister Institute of Preventive Medicine, London, United Kingdom of Great Britain and Dr.L.Goldberg, Associate Professor of Pharmacology, Northern Ireland Karolinska Institut, Stockholm, Sweden Professor A. B. Nichols, Secretary, United States Pharma- Dr. E. Lundsgaard, Professor of Physiology, Medical Faculty, copeia) Convention Inc., New York, N.Y., United States University of Copenhagen, Denmark of America L. D. MacLeod, B.Sc., Burden Neurological Institute, Staple- Dr. W. L. M. Perry, Director, Department of Biological ton, Bristol, United Kingdom of Great Britain and Northern Standards, National Institute for Medical Research, Mill Ireland Hill, London, United Kingdom of Great Britain and Northern Ireland Dr.J.Mardones,Professorof Pharmacology,Medical Professor R. Prigge, Director, Paul- Ehrlich Institute, State Faculty, University of Chile, Santiago, Chile Institute for Experimental Therapy, Frankfurt -am -Main, Dr. H. W. Newman, Associate Professor of Medicine, Stan- Germany ford University School of Medicine, San Francisco, Calif., Dr. A. W. Stableforth, Director, Ministry of Agriculture and United States of America Fisheries Veterinary Laboratory, New Haw, Weybridge, Surrey, United Kingdom of Great Britain and Northern Expert Committee on Biological Standardization Ireland Seventh Session Professeur J. Tréfouël, Directeur de l'Institut Pasteur, Paris, Mr. J. Gibbard, Chief, Laboratory of Hygiene, Department France of National Health and Welfare, Ottawa, Canada Dr. P. M. Wagle, Director, Haffkine Institute, Bombay, Dr. E. Grasset, Directeur de l'Institut d'Hygiène ; Professeur India de Bactériologie et d'Hygiène à l'Université de Genève, Dr. W. G. Workman, Chief, Biologics Control Laboratory, Geneva, Switzerland National Microbiological Institute, National Institutes of Health (US Public Health Service), Bethesda, Md., United 1 Including the French Union States of America ANNEX 3 159

Expert Committee on Drugs Liable to Produce Addiction Dr. C. E. Turner, Assistant to the President, National Founda- tion for Infantile Paralysis, New York, N.Y., United States Fourth Session of America Dr. N. B. Eddy, Chief, Section on Analgesics, Division of Chemistry, National Institute of Arthritis and Metabolic Expert Committee on the International Pharmacopoeia Diseases, National Institutes of Health (US Public Health Twelfth Session Service), Bethesda, Md., United States of America Dr. H. Baggesgaard Rasmussen, Professor of Organic Che- Dr. G. Joachimoglu, Professor of Pharmacology ; Chairman, mistry, Royal Danish School of Pharmacy, Copenhagen, Superior Health Council, Ministry of Hygiene, Athens, Denmark ; Member of the Danish Pharmacopoeia Com- Greece mission and of the Scandinavian Pharmacopoeial Council Dr. J. La Barre, Professeur de Pharmacologie à la Faculté de Dr. T. Canbáck, Director, Pharmaceutical Control Laboratory, Médecine et de Pharmacie, Université libre de Bruxelles, Stockholm,Sweden ;Vice -ChairmanoftheSwedish Brussels, Belgium Pharmacopoeia Commission ; Member of the Scandinavian Pharmacopoeial Council Dr.B.Lorenzo -Velázquez,Professorof Pharmacology, Faculty of Medicine, University of Madrid, Spain Dr. H. Flück, Professeur de Pharmacognosie à l'Ecole poly- technique fédérale, Zürich, Switzerland ;Membre de la J. R. Nicholls, D.Sc., Deputy Government Chemist, Govern- Commission fédérale de la Pharmacopée ment Laboratory, London, United Kingdom of Great Dr. C. H. Hampshire, formerly Secretary, British Pharma- Britain and Northern Ireland copoeia Commission, General Medical CouncilOffice, Dr. V. Zapata Ortiz, Professor of Pharmacology, Medical London, United Kingdom of Great Britain and Northern Faculty, National University of San Marcos, Lima, Peru Ireland Dr. R. Hazard, Professeur de Pharmacologie et de Matière Expert Committee on Environmental Sanitation médicale à la Faculté de Médecine, Université de Paris, France ; Membre de la Commission de la Pharmacopée Third Session française Mr. M. Aziz, Visiting Associate Professor of Public Health, Dr. C. Heymans, Professor of Pharmacology and Toxicology, School of Medicine, American University of Beirut, Lebanon Faculty of Medicine, University of Ghent, Belgium Mr. M. D. Hollis, Assistant Surgeon General, US Public Dr. T. Kariyone, Professor of Phyto -pharmacy ;Director, Health Service, Department of Health, Education and National Institute of Hygiene, University of Kyoto, Japan ; Welfare, Washington, D.C., United States of America Member of the Japanese Pharmacopoeia Commission Professor G. Macdonald, Director, Ross Institute of Tropical Dr. L. C. Miller, Director of Revision of the Pharmacopeia Hygiene, London School of Hygiene and Tropical Medicine, of the United States of America, New York, N.Y., United London, United Kingdom of Great Britain and Northern States of America Ireland Dr. D. van Os, Professor of Pharmacy and Toxicology, University of Groningen, Netherlands ; Chairman, Nether- Dr. R. M. Morris, Secretary for Health, Division of Health, lands Pharmacopoeia Commission Salisbury, Southern Rhodesia Dr. E. Sellés, Professor of Galenical Pharmacy, Faculty of Mr. L. Pachon- Rojas, Sanitary Engineer, National Federation Pharmacy, University of Madrid, Spain ; Member of the of Coffee -Growers, Bogotá, Colombia Spanish Pharmacopoeia Commission Mr. PurtejSingh, Public Health Engineer,State Health Department, State of Madhya Pradesh, Nagpur, India Expert Committee on Malaria Fifth Session Expert Committee on Health Education of the Public Dr. M. K. Afridi, Director of Health Services of the North - West Frontier Province, Peshawar, Pakistan First Session Major -General Sir Gordon Covell, Adviser on Malaria, Miss M. Andrell, Chief Nursing Officer, Royal Medical Ministry of Health ; Director, Malaria Laboratory, Horton Board, Stockholm, Sweden Hospital, Epsom,Surrey,United Kingdom of Great Britain and Northern Ireland Dr. J. Burton, Medical Director, Central Council for Health Education, London, United Kingdom of Great Britain and Dr. S. Rajendram, Superintendent, Antimalaria Campaigns, Northern Ireland Department of Health Services, Colombo, Ceylon Dr. P. F. Russell, Division of Medicine and Public Health, Dr. M. Derryberry, Chief, Division of Public Health Educa- Rockefeller Foundation, Paris, France tion, US Public Health Service, Department of Health, Education and Welfare, Washington, D.C., United States Dr. M. A. Vaucel, Inspecteur général des Instituts Pasteur of America d'Outre -Mer, Paris, France Dr. I. Vincke, Directeur de la Section d'Etudes et de Recher- ProfessorJ.Koekebakker, Head, Department of Mental ches antimalariennes, Elisabethville, Belgian Congo Health,InstituteforPreventiveMedicine,Leyden, Netherlands Expert Committee on Onchocerciasis Professeur J.Parisot, Doyen de la Faculté de Médecine, First Session Université de Nancy, France Professor P. C. C. Garnham, London School of Hygiene and Dr. O. J. da Silva, Director, Health Education Division, Tropical Medicine, London, United Kingdom of Great Serviço Especial de Saúde Pública, Rio de Janeiro, Brazil Britain and Northern Ireland 160 THE WORK OF WHO, 1953

Dr. J. R. De León, Institute for Scientific Investigation, Dr. S. L. A. Manuwa, Inspector -General of Medical Services, Botanical Gardens, University of San Carlos, Guatemala Lagos, Nigeria City, Guatemala Mr. D. J. Lewis, Entomologist, Ministry of Health, Wad Expert Committee on Rabies Medani, Sudan Second Session Professor L. Mazzotti, Parasitology Laboratory, Institute of Dr. M. Baltazard, Directeur de l'Institut Pasteur de l'Iran, Health and TropicalDiseases,Santo Tomás Colony, Teheran, Iran Mexico, D.F., Mexico Dr. K. Habel, Chief, Laboratory of Infectious Diseases, Professeur P. F. Toulant, Institut du Trachome et d'Ophtal- National Microbiological Institute, National Institutes of mologie, Hôpital civil de Mustapha, Algiers, Algeria Health (US Public Health Service), Bethesda, Md., United Dr. L. Vargas, Professor, Institute of Health and Tropical States of America Diseases, Mexico, D.F., Mexico Dr. H. N. Johnson, Virus Research Centre, Poona, India Professeur M. Wanson, Institut de Médecine tropicale Prince Dr. A. Komarov, Director, Government Virus Diseases Léopold, Antwerp, Belgium Laboratory, Haifa, Israel Professor W. H. Wright, Chief, Laboratory of Tropical Dr. H. Koprowski, Assistant Director, Section of Viral and Diseases,NationalMicrobiologicalInstitute,National Rickettsial Research, Lederle Laboratories, Pearl River, Institutes of Health (US Public Health Service), Bethesda, N.Y., United States of America Md., United States of America Dr. P. Lépine, Chef du Service des Virus, Institut Pasteur, Paris, France Expert Committee on Poliomyelitis Dr. F. Pérez Gallardo, Chief, Virus Laboratory, National First Session School of Health, Madrid, Spain Dr. H. Bernkopf, Head of the Virus Laboratory and Lecturer Dr. N. Veeraraghavan, Director, Pasteur Institute of Southern in Bacteriology, Hadassah Medical School, Hebrew Uni- India, Coonoor, India versity, Jerusalem, Israel Dr. T. Francis, Jr., Professor of Epidemiology, School of Expert Committee on Rheumatic Diseases Public Health, University of Michigan, Ann Arbor, Mich., First Session United States of America Dr. W. S. Copeman, Physician in Charge, Department of Professor S. Gard, Professor of Virus Research, School of Rheumatic Diseases, West London Hospital, London, Medicine, Karolinska Institut, Stockholm, Sweden United Kingdom of Great Britain and Northern Ireland Dr. J. H. S. Gear, Director of Research, Laboratories of the Dr. F. Coste, Professeur de Clinique de Rhumatologie à la Poliomyelitis Research Foundation, South African Institute Faculté de Médecine, Université de Paris, France for Medical Research, Johannesburg, Union of South Dr. Africa Director, Department and Clinic for Rheumatic Diseases, Professeur P. Lépine, Chef du Service des Virus, Institut University Hospital, Lund, Sweden Pasteur, Paris, France Dr. J.Goslings, Department of Rheumatology, University Dr. F. O. MacCallum, Director, Virus Reference Laboratory, Hospital, Leyden, Netherlands Public Health Laboratory Service, London, United Kingdom Professor A. Ruiz Moreno, Director, Anti -Rheumatic Centre, of Great Britain and Northern Ireland Faculty of Medical Sciences, National University of Buenos Dr. J. R. Paul, Professor of Preventive Medicine, Yale Uni- Aires, Argentina versity School of Medicine, New Haven, Conn., United States of America Expert Committee on Vaccination against Tuberculosis Dr. A. J.Rhodes, Director, The Research Institute, The First Session Hospital for Sick Children, Toronto, Canada Dr. W. S. Copeman, Physician in Charge, Department of Medicine, Rio de Janeiro, Brazil Expert Committee on Public -Health Administration Dr. E. J. Aujaleu, Directeur de l'Hygiène sociale, Ministère de Second Session la Santé publique et de la Population, Paris, France Dr.F.GarcíaSánchez,Director -General,Co- ordinated Dr. P. V. Benjamin, Adviser on Tuberculosis to the Director - Health and Welfare Services, Ministry of Health and Wel- General of Health Services, Ministry of Health, Government fare, Mexico, D.F., Mexico of India, New Delhi, India Dr. R. H. Hazemann, Directeur départemental de la Santé de Dr. P. D'Arcy Hart, Director, Tuberculosis Research Unit, la Seine, Paris, France Medical Research Council, London, United Kingdom of Dr. L. Kaprio, Chief, Public Health Section, State Medical Great Britain and Northern Ireland Board, Helsinki, Finland Dr. A. Frappier, Professor of Bacteriology,Institute of Dr. H. R.Leavell, Professor of Public Health Practice, MicrobiologyandHygiene,UniversityofMontreal, Harvard School of Public Health, Boston, Mass., United Canada States of America Professor A. Giovanardi, Director, Institute of Hygiene, Dr. J. Leimena, Chief Adviser, Ministry of Health, Jakarta, University of Milan, Italy Indonesia Dr. H. Kumabe, Director, Research Institute, Japan Antitu- Dr. J. M. Mackintosh, Professor of Public Health, London berculosis Association, Tokyo, Japan Schoolof Hygiene and TropicalMedicine,London, Professor A. Wallgren, Children's Clinic, Karolinska Institut, United Kingdom of Great Britain and Northern Ireland Stockholm, Sweden ANNEX 3 161

Expert Committee on Venereal Infections and Treponematoses : Dr. K. V. Venkatraman, Serologist to the Government of Sub -Committee on Serology and Laboratory Aspects India, School of Tropical Medicine, Calcutta, India Third Session Expert Committee on Yellow Fever Dr. M. Aly, Director -General, Laboratories Department, Ministry of Public Health, Cairo, Egypt Second Session Mr. A. Harris, Assistant Director in Charge Serology Section, Dr. C. Courtois, Directeur du Laboratoire médical de Stanley- Division of Venereal Disease, US Public Health Service, ville, Belgian Congo Department of Health, Education and Welfare, Chamblee, Médecin -Général C. Durieux, Directeur de l'Institut Pasteur Ga., United States of America de Dakar, Senegal, French West Africa Dr. F. Márquez, Chief, Serology Laboratory, Central Military Dr. A. Gast -Galvis, Director, Carlos Finlay Institute, Bogotá, Hospital, Mexico, D.F., Mexico Colombia Dr. I. N. Orpwood Price, Director, Venereal Diseases Refe- Dr. A. J. Haddow, Director, Virus Research Institute (East rence Laboratory (Public Health Laboratory Service) St. Africa High Commission), Entebbe, Uganda Peter'sHospital,London, United Kingdom of Great Professor M. R. Pinto, Institute of Tropical Medicine, Lisbon, Britain and Northern Ireland Portugal Dr. R. Pautrizel, Professeur, Faculté de Médecine et de Phar- Dr. R. M. Taylor, Director, Department of Virology, US macie, Bordeaux, France Naval Medical Research Unit No 3, Cairo, Egypt

Joint Expert Committees

Joint Expert Committee on the Mentally Subnormal Child Dr.L.T.Hilliard,PhysicianSuperintendent,Fountain First Session Hospital, London, United Kingdom of Great Britain and UNESCO Northern Ireland Dr. R. Lafon, Professeur de Clinique des Maladies Mentales et Mr. J. Lumsden, H. M. Inspector, Staff Inspector for Special Nerveuses à la Faculté de Médecine de Montpellier; Pré- Educational Treatment, Ministry of Education, London, sident de l'Union Nationale des Associations Régionales United Kingdom of Great Britain and Northern Ireland pour la Sauvegarde de l'Enfance, France Professor F. J. T. Rutten, Professor of Psychology, University H. M. Skeels, Ph.D., Community Services Branch, National of Nijmegen, Netherlands Institute of Mental Health, National Institutes of Health (US Public Health Service), Bethesda, Md., United States WHO of America Dr. M. J. Farrell, Superintendent, Walter E. Fernald State Dr. C. Steketee, Medical Superintendent, Dr. Mr. Willen van School, Waverley, Mass., United States of America den Berghstichting, Noordwijk -Binnen, Netherlands

3. COMMITTEE ON INTERNATIONAL QUARANTINE 2

The first session was held from 19 October to 4 November 1953.

Members Dr. H. N. C. V. Kelaart, Senior Medical Officer of Health The committee was composed of the following members : (Epidemiology), Colombo, Ceylon Dr. A. J. Boyer, Médecin Inspecteur de la Santé, Chef du Lt -Col.C. K. Lakshmanan, Director -Generalof Health Service de Contrôle sanitaire aux Frontières, Ministère de Services, Ministry of Health, New Delhi, India la Santé publique et de la Population, Paris, France Dr. F. S. Maclean, Director, Division of Public Hygiene, Department of Health, Wellington, New Zealand Mr. H. B. Calderwood, Office of the United Nations Economic and Social Affairs, Department of State, Washington, D.C., Dr. M. T. Morgan, Medical Officer of Health, Port of London United States of America Authority, London, United Kingdom of Great Britain and Northern Ireland Dr.A.Castro,Director,National Anti -PlagueService, Dr. M. A. Sanchez- Vigil, Technical Assistant to the Minister Ministry of Education and Health, Rio de Janeiro, Brazil of Public Health, Ministry of Health, Managua, Nicaragua Dr. M. Jafar, Director - General of Health and Joint Secretary Mr. K. Stowman, International Health Representative, US to the Government of Pakistan, Ministry of Health and Public Health Service, Department of Health, Education Works, Karachi, Pakistan and Welfare, Washington, D.C., United States of America

2 The Committee on International Quarantine, while governed by the Regulations for Expert Advisory Panels and Committees, has special functions which have been defined by the Health Assembly in resolution WHA6.20. 162 THE WORK OF WHO, 1953

Special Advisers Mr. S. W. Simmons, Scientist Director, Chief, Technology The committee had, during its consideration of " Control Branch, Communicable Disease Center, US Public Health of insect vectors in international air traffic ", the specialized Service, Department of Health, Education and Welfare, advice of : Atlanta, Ga., United States of America Major -General Sir Gordon Covell, Adviser on Malaria, Ministry of Health ; Malaria Research Laboratory, Horton SirHarold Whittingham, Director of MedicalServices, Hospital, Epsom,Surrey,United Kingdom of Great British Overseas Airways Corporation, Brentford, Middx, Britain and Northern Ireland United Kingdom of Great Britain and Northern Ireland

Annex 4

CONFERENCES AND MEETINGS ORGANIZED BY THE WORLD HEALTH ORGANIZATION, OR WITH ITS HELP, IN 1953

12 Jan. - 4 Feb. Executive Board, eleventh session Geneva 26 -30 Jan. Study Group on the Psychobiological Development of the Child Geneva 6 -7 Feb. Ad hoc Advisory Committee on Relations between Paediatricians and Child Psychiatrists Geneva 12 -19 Feb. Technical Co- operation Administration /WHO Conference Geneva 16 -21 Feb. United Nations /ILO /UNESCO /WHO : Joint Expert Committee on the Mentally Subnormal Child Geneva 2 -4 March International Paediatric Association /WHO : Joint Working Conference of National Representatives of European Paediatric Associations on Paediatric Education in Europe Zurich 1 -2 May UNICEF /WHO :Joint Committee on Health Policy, sixth session Geneva 5 -22 May Sixth World Health Assembly Geneva 28 -30 May Executive Board, twelfth session Geneva 22 -27 June Expert Committee on Drugs Liable to Produce Addiction, fourth session Geneva 23 -30 June FAO /WHO : Regional Nutrition Committee in South and East Asia, third meeting Bandung 29 June - 4 July Expert Committee on the International Pharmacopoeia, twelfth session Geneva 27 -31 July Expert Committee on Environmental Sanitation, third session Geneva 28 -29 July Ad hoc Advisory Committee of Medical Librarians Geneva 31 July -1 Aug. CIOMS /UNESCO /WHO :Joint Meeting on Medical Documentation Geneva 24 -29 Aug. World Medical Association /WHO : First World Conference on Medical Education 2 London 31 Aug. - 4 Sept. Expert Committee on Rheumatic Diseases, first session Geneva 31 Aug. - 5 Sept. Expert Committee on Venereal Infections and Treponematoses ; Sub -Committee on Serology and Laboratory Aspects, third session Copenhagen 3 -8 Sept. Regional Conunittee for the Western Pacific, fourth session Tokyo 7 -10 Sept. Regional Committee for Europe, third session Copenhagen

1 This list does not include meetings of committees of the Health Assembly or Executive Board convened in conjunction with their sessions, nor all of the secretariat meetings with the United Nations and its specialized agencies. Seminars and training courses organized by WHO in co- operation with governments or with other organizations, and for which WHO gave fellowships or travel grants, are listed, with greater detail, in Annex 5 and in Table I on p. 87. 3 CIOMS and the International Bureau of Universities also contributed. ANNEX 4 163

7 -12 Sept. Expert Committee on Malaria, fifth session Istanbul 14-19 Sept. Expert Committee on Poliomyelitis, first session Rome 14-19 Sept. Expert Committee on Rabies, first session Rome 14-19Sept.. Expert Committee on Yellow Fever, second session Kampala, Uganda 16 -19 Sept. Regional Committee for South -East Asia, sixth session Bangkok 21 -24 Sept. Malaria Conference Bangkok 21 -25 Sept. Regional Committee for Africa, third session Kampala, Uganda 21 -26 Sept. Expert Committee on Public -Health Administration, second session Geneva 5 -10 Oct. Expert Committee on Alcohol, first session Geneva 9 -19 Oct. Regional Committee for the Americas, fifth session, and Directing Council, PASO, seventh session Washington, D.C. 12 -17 Oct. United Nations /WHO : International Conference of National Committees on Vital and Health Statistics London 19 -29 Oct. FAO /WHO : Third Regional Nutrition Meeting for Latin America Caracas 19 Oct. - 4 Nov. Committee on International Quarantine, first session Geneva 26-31 Oct. Expert Committee on Biological Standardization, seventh session Geneva 2 -6 Nov. FAO /WHO /Josiah Macy Jr. Foundation : Meeting on Protein Malnutrition Kingston, Jamaica 23 Nov. -1 Dec. Expert Committee on Onchocerciasis, first session Mexico, D.F. 30 Nov. - 4 Dec. Expert Committee on Vaccination against Tuberculosis, first session Copenhagen 7 -11 Dec. Expert Committee on Health Education of the Public, first session Paris 8 -11 Dec. ILO /Intergovernmental Committee for European Migration /WHO: Meeting of Experts on Medical Criteria for Selection of Migrants Geneva 9 -10 Dec. International Anti -Venereal- Disease Commission of the Rhine, third session Antwerp 14-15 Dec. Technical Advisory Committee on the Pilot Study of Family Health and Welfare Workers London 164 THE WORK OF WHO, 1953

Annex 5

INTERNATIONAL SEMINARS AND TRAINING COURSES

This annex lists the seminars and training courses organized by WHO in co- operation with governments or with other organi- zations in five out of the six regions of WHO, and for which WHO has given fellowships or travel grants. Similar information for the European Region is given in Table I on page 87.

Government Participants Description of programme Duration principally Other participating countries or Other participating agencies concerned Fellows §

Africa Nursing Education Conference to discuss deve- 10 days Uganda Belgian Congo Mauritius 40 - lopment of nursing edu-28 Sept.- British Mozambique cationinthe Region ;7 Oct. Somaliland Nigeria held at Kampala f Cape Verde Northern AFRO 4 Islands Rhodesia French Nyasaland Equatorial Portuguese Africa Guinea French West Ruanda - Africa Urundi Gold Coast Sao Tomé Kenya Southern Liberia Rhodesia Madagascar Tanganyika

Yellow Fever Seminar on scientific infor- 5 days Uganda Angola Liberia 19 East Africa Interterritorial mation on yellow fever in 7 -11 Sept. Bechuanaland Mozambique Commissioner ; South Africa ; held at Kam- Belgian CongoNigeria African Institute for pala f Ethiopia Nyasaland Medical Research AFRO S8 Gold Coast Sierra Leone French West Southern Africa Rhodesia Kenya Tanganyika The Americas Alcoholism Seminar on thetraining3 weeks Argentina Brazil Paraguay 37 - of personnel and the treat- 3 -23 May Chile Uruguay ment and care of alcoho- lics ; held in Buenos Aires AARO 9

Environmental Sanitation Training course in water-1 month Honduras British Guatemala 18 Institute of Inter -American works operation ;held 1 -27 June Honduras Nicaragua Affairs at Tegucigalpa Costa Rica Panama AARO 17

Health Education Seminar held in Mexico 3 weeks Mexico British El Salvador 37 - City 18 Sept.- Honduras Guatemala AARO 15 1 Oct. Costa Rica Haiti Cuba Honduras Dominican Nicaragua Republic Panama

§ Regional participants or Fellows sponsored by WHO f Open to participants from other regions ANNEX 5 165

Government Participants Description of programme Duration principally Other participating countries or Other participating agencies concerned Fellows §

Foot and Mouth Disease Pan -AmericanFootand Organization of American Mouth Disease Center : States ; FAO (assisted in 2 training courses each choice of candidates) of 2 months on the labo- ratory,epidemiological, preventiveandcontrol aspects of foot and mouth disease ;held in Rio de Janeiro 1st course28 April- Brazil Costa Rica Guatemala 8 25 June Cuba Panama Dominican Republic

2nd course 1 Oct.- Brazil Bolivia Peru 9 AARO 77 28 Nov. Colombia Venezuela Ecuador

Health Statistics Seminarforstatisticians 12 days Chile Argentina Paraguay 27 - andepidemiologistsof30 Nov.- Bolivia Peru the ministries of health 11 Dec. Brazil Uruguay of the countries of South Colombia Venezuela America, to develop pro- Ecuador cedures and make appro- priate recommendations for local,national and international reporting of communicable diseases ; held in Santiago AARO 44

Insect Control A series of three training 3 weeks Colombia Cuba Jamaica 11 - courses in insect control, 16 Nov.- Dominican Mexico each of one week's dura-5 Dec. Republic Netherlands tion ;held at Barran- Haiti Antilles quilla AARO 71

Nursing ThirdRegionalNursing1 week Brazil Argentina Mexico 166 Institute of Inter -American Conference ;to discuss 19 -23 Bolivia Panama Affairs ;Rockefeller nursinglegislationandJuly Canada Paraguay Foundation the training of nurses ; Chile Peru held in Rio de Janeiro Colombia United States AARO 23 Costa Rica of America El Salvador Uruguay Haiti Venezuela

§ Regional participants or Fellows sponsored by WHO 166 THE WORK OF WHO, 1953

Government Participants Description of programme Duration principally Other participating countries or Other participating agencies concerned Fellows §

Vital and Health Statistics Further course for vital and9 months Chile Argentina Haiti 33 United Nations health statisticians at the2 March- Colombia Mexico Inter -American Center27 Nov. Costa Rica Nicaragua of Biostatistics, Santiago Cuba Panama AARO to Ecuador Paraguay El Salvador Peru Guatemala Uruguay South -East Asia Environmental Sanitation Seminarforwaterworks 2 weeks India Burma Indonesia 50 - operators ;held in New 2 -15 Dec. Ceylon Delhi INDIA 66 Eastern Mediterranean Mental Health Seminar for discussion of4 weeks Lebanon Egypt Pakistan 19 - professional training for3 Nov.- Iran Sudan mental -health work ;de- 5 Dec. Iraq Syria velopment of treatment Jordan facilitiesandinfluence of cultural factors in psy- chiatry ;held in Beirut EMRO 6 Ophthalmology Lectures,operationsand 10 days Egypt Aden Lebanon 10 - demonstrations of latest 19 -28 Feb. Cyprus Pakistan advances in ophthalmic Iran Sudan surgery,byavisiting Iraq Syria group of 6 ophthalmolo- Jordan gists(The group parti- cipatedintheJubilee Congress of the Ophthal- mological Society of Egypt) ; Giza, Cairo * EGYPT 22 Trachoma Inter -regional training2 months Egypt Iran Pakistan 7 Memorial Ophthalmic Labo- course ;held atGiza, Feb. -April Iraq Syria ratory, Giza Cairo t Lebanon EGYPT 6 Western Pacific Mental Health in Childhood Seminar to discuss various 3 weeks Australia China Papua and 32 - aspectsofthemental 10 -28 (Taiwan) New Guinea health and developmentAugust Hong Kong Philippines of children, and the appli- Japan Sarawak cation of present know- Malaya Singapore ledge on the subject to New Zealand programmesforchil- dren'shealth,welfare and education ;held in Sydney t WPRO 8 § Regional participants or Fellows sponsored by WHO * In addition to those from the countries in the Region, participants from Greece and Turkey attended these lectures and demonstrations. t Open to participants from other regions ANNEX5 167

Government Participants Description of programme Duration principally Other participating countries or Other participating agencies concerned Fellows §

Tuberculosis PanPacificTuberculosis 1 week Philippines Australia Netherlands 18 PhilippinesTuberculosis Conference -to discuss 13 -19 April Cambodia New Guinea Society the control of tubercu- China New Caledonia losis in the Western Paci- (Taiwan) New Zealand fic ;held at Manila f Fiji North Borneo PHILIPPINES 22 Hong Kong Trust Territory Japan of the Pacific Korea Islands Macao Sarawak Malaya Singapore Viet Nam

§ Regional participants or Fellows sponsored by WHO Open to participants from other regions 168 THE WORK OF WHO, 1953

Annex 6

CONFERENCES AND MEETINGS OF THE UNITED NATIONS AND SPECIALIZED AGENCIES AT WHICH WHO WAS REPRESENTED IN 1953

5 -16 Jan. FAO : Special Rice Meeting Bangkok - 19 -21 Jan. Economic Commission for Asia and the Far East :Inland Transport Committee, Bandung second session 19 -30 Jan. Economic and Social Council :Population Commission, seventh session New York 19 -30 Jan. WMO :Regional Association I- Africa, first session Tananarive 26 Jan. - 2 Feb. Economic Commission for Asia and the Far East :Committee on Industry and Bandung Trade, fifth session 2 -3 Feb. Economic Commission for Europe :Industry and Materials Committee, Working Geneva Party on Housing and Building Statistics 2 -4 Feb. Economic Commission for Europe :Industry and Materials Committee, ad hoc Geneva Working Party on Contract Practices in Engineering 2 -11 Feb. Economic and Social Council :Transport and Communications Commission, sixth New York session 2 -13 Feb. Economic and Social Council :Statistical Commission, seventh session New York 3 Feb. Administrative Committee on Co- ordination :Technical Working Group on Geneva Migration, fifth session 6 -14 Feb. Economic Commission for Asia and the Far East, ninth session Bandung 9 -10 Feb. United Nations : Second Conference of Non -Governmental Organizations New York interested in Rehabilitation of the Physically Handicapped 11 -13 Feb. Administrative Committee on Co- ordination :ad hoc Technical Working Party New York on Rehabilitation of the Physically Handicapped, fourth session 17 -19 Feb. Economic Commission for Europe : Inland Transport Committee, Sub -Group on Geneva Physiological and Mental Standards for Drivers 23 -28 Feb. UNESCO:Advisory MeetingofRepresentativesofInternationalYouth Paris Organizations 24 Feb. - 23 April United Nations General Assembly, seventh session (resumed) New York 26 -27 Feb. Third United Nations Technical Assistance Conference New York 2 -11 March Technical Assistance Committee, Working Party (on local costs to be borne by New York governments) 3 -6 March ILO :Governing Body, 121st session Geneva 3 -18 March Economic Commission for Europe, eighth session Geneva 12 -15 March WMO :Commission for Climatology, first session Washington, D.C. 16 -25 March Technical Assistance Board, 23rd meeting New York 16 March - 3 April Economic and Social Council :Commission on the Status of Women, seventh New York session 19 -26 March UNICEF :Executive Board, 103rd -110th meetings New York 21 -24 March UNICEF :Programme Committee, 158th -161st meetings New York 23 March - 2 April Technical Assistance Committee, 29th -37th sessions New York 30 March - 3 April United Nations/UNESCO :Joint Conference to discuss Social Problems of New York executing Technical Assistance Programmes 30 March - 24 April Economic and Social Council :Commission on Narcotic Drugs, eighth session New York 31 March - 28 April Economic and Social Council, 15th session New York 7 April - 1 June Economic and Social Council :Commission on Human Rights, ninth session Geneva ANNEX 6 169

8 -14 April Administrative Committee on Co- ordination :Consultative Committee on Admi- Rome nistrative Questions, 14th session 8 -18 April UNESCO :Executive Board, 33rd session Paris 9 -25 April Economic Commission for Latin America, fifth session Petropolis, Brazil 13 -18 April Economic Commission for Europe :Inland Transport Committee, Working Geneva Party on Transport of Dangerous Goods by Road, fourth session 15 -24 April United Nations Joint Staff Pension Board :Standing Committee, fourth session Rome 20 -23 April UNESCO :International Advisory Committee on Bibliography, first session Paris 20 -24 April Economic Commission for Europe :Inland Transport Committee, Working Party Geneva of Experts on Statistical Information 22 -23 April Administrative Committee on Co- ordination :Consultative Committee on Public Rome Information, 18th session 27 -30 April United Nations High Commissioner's Advisory Committee on Refugees, third Geneva session 27 April - 8 May Economic and Social Council :Fiscal Commission, fourth session New York 4 -20 May Economic and Social Council :Social Commission, ninth session New York 11 -14 May UNESCO :Advisory Committee on Arid Zone Research, fifth session Paris 18 -20 and 22 May Administrative Committee on Co- ordination : Preparatory Committee, 23rd session Geneva 18 -27 May Technical Assistance Board, 24th meeting Geneva 25 -27 May Administrative Committee on Co- ordination, 16th session Geneva 29 -30 May ILO :Governing Body, 122nd session Geneva 4 -25 June ILO :International Labour Conference, 36th session Geneva 8 -26 June United Nations /ILO /UNESCO (with the co- operation of FAO and WHO) : New York Meeting of Experts on International Definition and Measurement of Standards of Living 15 -19 June Economic and Social Council :Statistical Commission /Economic Commission Geneva for Europe, Third Regional Meeting of European Statisticians 15 -20 June FAO :Near East Meeting on Animal Health Prodhromos, Cyprus 16 June - 21 July Trusteeship Council, 12th session New York 18 -19 June Administrative Committee on Co- ordination : United Nations Film Board, Geneva 20th session 30 June - 5 Aug. Economic and Social Council, 16th session Geneva 6 -15 July UNESCO /International Bureau of Education : XVIth International Conference Geneva on Public Education 6 -18 July Permanent Central Opium Board and Narcotic Drugs Supervisory Body, ninth Geneva joint session 9 -11 July Administrative Committee on Co- ordination :ad hoc meeting on international Geneva social programmes at the community level 16 July - 6 Aug. Technical Assistance Board, 25th meeting Geneva 22 -30 July Technical Assistance Committee, 38th -51st sessions Geneva 27 July - 21 Aug. UNESCO :Seminar on the Development of Public Libraries in Africa Ibadan, Nigeria 30 July Administrative Committee on Co- ordination : Preparatory Committee, 24th Geneva session 3 -4 Aug. Administrative Committee on Co- ordination :ad hoc meeting on 1954 -55 pro- Geneva grammes for community organization and development 11 -15 Aug. United Nations /ILO :Fourth Conference of Non -Governmental Organizations Geneva interested in Migration 18 Aug. - 8 Sept. United Nations : Committee on Information from Non -Self- Governing Territories, New York fourth session 31 Aug. - 25 Sept. UNESCO :Seminar on Visual Aids in Fundamental Education Messina, Sicily 1 -8 Sept. FAO :Third Near East Regional Conference on Food and Agricultural Cairo Programmes and Outlook 170 THE WORK OF WHO, 1953

3 -5 Sept. UnitedNations : RegionalConferenceofEuropean Non -Governmental Geneva Organizations 8 -16 Sept. UNICEF :Executive Board, 111th -117th meetings New York 9 -11 Sept. Technical Assistance Committee :Working Party (on local costs to be borne by Geneva governments) 9 -18 Sept. United Nations :Regional Meeting on Training of Auxiliary and Community Beirut Workers in the Middle East 10 -14 Sept. UNICEF :Programme Committee, 163rd -169th meetings New York 14 -15 Sept. Technical Assistance Board, 26th meeting Paris 14 -16 Sept. United Nations :World Population Conference, Preparatory Committee, second Rome session 14 -25 Sept. ILO :Asian Regional Conference Tokyo 15 Sept. - 9 Dec. United Nations General Assembly, eighth session New York 16 -17 Sept. Technical Assistance Board :meeting of the National Committees on Technical Paris Assistance 29 Sept. - 1 Oct. Administrative Committee on Co- ordination : Preparatory Committee, 25th New York session 5 -6 Oct. Economic Commission for Europe :Industry and Materials Committee, Housing Geneva Sub -Committee, Working Party on Cost of Building 5 -8 Oct. Economic Commission for Asia and the Far East :Committee on Industry and Bangkok Trade, Sub -Committee on Electric Power, third session 5 -14 Oct. ILO :Asian Maritime Conference Nuwara Eliya, Ceylon 6 -8 Oct. Administrative Committee on Co- ordination, 17th session New York 6 -26 Oct. WMO :Executive Committee, fourth session Geneva 6 -27 Oct. UNESCO :Study and Information Seminar for Leaders of Youth Movements Tokyo 7 -10 Oct. Economic Commission for Europe :Industry and Materials Committee, Housing Geneva Sub -Committee, seventh session 14 Oct. United Nations :Meeting of Non -Governmental Organizations interested in New York Migration 27 Oct. UNICEF :Executive Board, 118th meeting New York 3 -6 Nov. UNESCO :Advisory Committee on Arid Zone Research, sixth session Montpellier, France 5 -6 Nov. Administrative Committee on Co- ordination :United Nations Film Board, New York 21st session 7 -10 Nov. UNESCO :International Symposium on Arid Zone Plant Ecology Montpellier, France 9 -11 Nov. Administrative Committee on Co- ordination :Consultative Committee on Public New York Information, 19th session 12 -13 Nov. Fourth United Nations Technical Assistance Conference New York 16 -20 Nov. Technical Assistance Committee, working party New York 23 Nov. - 11 Dec. FAO :Conference, seventh session Rome 24 -27 Nov. ILO :Governing Body, 123rd session Geneva 30 Nov. -1 Dec. andEconomic and Social Council, 16th session (resumed) New York 7 Dec. 30 Nov. - 11 Dec. UNESCO :Executive Board, 36th session Paris 1 -12 Dec. United Nations :Regional Meeting on Training of Auxiliary and Community Bogotá Workers in Latin America 4 Dec. Administrative Committee on Co- ordination :Technical Working Group on Geneva Migration, sixth session 5 -17 Dec. United Nations :Regional Consultative Group on the Prevention of Crime and Cairo the Treatment of Offenders 7 -19 Dec. ILO :Committee of Experts on Social Policy in Non -Metropolitan Territories, Lisbon third session 7 -18 Dec. Technical Assistance Board, 27th meeting New York ANNEX 7 171

Annex 7

CONFERENCES AND MEETINGS OF NON -GOVERNMENTAL AND OTHER ORGANIZATIONS AT WHICH WHO WAS REPRESENTED IN 1953

3 -6 Jan. Indian Leprosy Association, first biennial meeting Puri 8 -9 Jan. International Children's Centre, working party (ICC /UNICEF /WHO) to discuss Paris the programme of the Centre 28 -31 Jan. Conference of Central Health Council of India Hyderabad 31 Jan. - 1 Feb. Council for International Organizations of Medical Sciences, Bureau of the Paris Executive Committee 1 -6 Feb. World Federation for Mental Health, Executive Board, 13th meeting London 2 Feb. Tenth Tuberculosis Workers Conference of India Mysore 8 Feb. International Children's Centre, working party on training Paris 13 -14 Feb. New York Academy of Sciences, Conference on Nutritional Factors and Liver New York Diseases 16 -19 Feb. Ophthalmological Society of Egypt, Jubilee Congress Cairo 17 -20 Feb. Comité d'entente of Schools of Nursing of France and the French Union : Training Sèvres, France School for Red Cross Officers, seminar 27 -28 Feb. Social Science Research Council, conference on public health and area research New York 27 -28 Feb. Council for International Organizations of Medical Sciences, Executive Committee, Paris 13th session 28 Feb. - 3 March Scientific Council for Africa South of the Sahara Kampala, Uganda 7 -8 March Institute of Law Studies of Nice, meeting on international medical law Nice 8 -12 March Uruguayan Society of Rheumatology, meetings on rheumatology Montevideo 19 -20 March World Medical Association, First World Conference on Medical Education, London Organizing Committee, fourth session 22 -27 March World Medical Association, Council, 17th session Lisbon 24 -26 March National Centre for the Co- ordination of Research on Food and Nutrition, seminar Paris 27 -28 March International Union against Tuberculosis, Executive Committee Paris 4 -6 April Indonesian Dental Association, third annual convention Jogjakarta 6 -7 April National Citizens Committee for the World Health Organization, national Washington, D.C. conference on world health 7 -15 April World Federation of United Nations Associations, seminar for teachers on teaching Monrovia on the United Nations and specialized agencies 8 -10 April United States /Mexico Border Public Health Association, eleventh annual meeting El Paso, Texas 9 -17 April World Federation of United Nations Associations, first seminar on human rights Geneva 14 -27 April South Pacific Commission, Second South Pacific Conference Noumea 16 -24 April Intergovernmental Committee for European Migration, fifth session Geneva 17 April Parasitologists' Association of Egypt, semi -annual session Cairo 19 -26 April Philippine Medical Association, 50th anniversary annual convention Manila 21 -26 April International Union against Venereal Diseases, general assembly Rotterdam 25 April European Association against Poliomyelitis, general assembly Rotterdam 172 THE WORK OF WHO, 1953

28 April - 1 May Royal Sanitary Institute, health congress Hastings, England 30 April - 1 May American Venereal Disease Association, 15th annual session, and Symposium on Washington, D.C. Recent Advances in the Study of Venereal Diseases 4 -8 May American Psychiatric Association, 109th annual meeting Los Angeles, Calif. 4 -9 May Office International des Epizooties, 21st annual general meeting Paris 4 -14 May World Federation of United Nations Associations, fifth seminar on world health Geneva 25 -30 May Eighth International Hospital Congress London 27 -31 May International Union for Health Education of the Public, second conference Paris 29 -30 May Council for International Organizations of Medical Sciences, meeting on congress Paris planning 5 June International Children's Centre, working party on library and documentation Paris services 7 -18 June South Pacific Commission, Research Council, fifth meeting Sydney 20 June International Children's Centre, working party on publications Paris 22 June International Organization against Trachoma, council meeting Paris 22 June League against Trachoma, general assembly Paris 24 -27 June International Council of Nurses, Florence Nightingale International Foundation, London council meeting 25 -30 June International Council for Building Research, Studies and Documentation, first Geneva general assembly 29 -30 June International Children's Centre, working party on vaccination against tuberculosis Paris 29 June -1 July Consultative Non -Governmental Organizations, fifth general conference Geneva 1 -4 July BritishTuberculosisAssociation /Tuberculosis SocietyofScotland,annual Edinburgh conference 5 -10 July International Federation of Business and Professional Women, sixth triennial Stockholm congress 6 -7 July International Children's Centre, Technical Advisory Committee, seventh session Paris 6 -10 July Cambridge University, Department of Human Ecology /Rockefeller Foundation : Cambridge, seminar on human ecology England 7 -10 July International Conference of Social Work, executive committee Brussels 9 -10 July International Council of Nurses, grand council Sao Paulo 12 -17 July International Council of Nurses, tenth quadrennial congress Petropolis,Brazi 13 -18 July Family Planning Research and Programme Committee of India Bombay 14 -20 July International Union against Cancer, Committee on Tumour Nomenclature and Copenhagen Statistics 19 -24 July Seventh International Congress of Radiology Copenhagen 20 -23 July American Veterinary Medical Association, 90th annual meeting Toronto 20 -25 July First International Congress on Medical Librarianship London 26 July - 1 Aug. International Dental Federation, 41st annual meeting Oslo 27 -28 July International Union against Venereal Diseases, Executive Committee, special Geneva meeting 28 July - 5 Aug. World Federation of United Nations Associations, seventh annual summer school Geneva 30 July Association for Moral and Social Hygiene in India, Health Sub -Committee New Delhi 9 -15 Aug. Fifteenth International Veterinary Congress Stockholm 12 Aug. Commission on Plasma Fractionation and Related Processes, meeting of the ad Boston, Mass. hoc committee 12 -23 Aug. Associated Country Women of the World, seventh triennial conference Toronto 16 -22 Aug. World Federation for Mental Health, sixth annual meeting Vienna 17 Aug. World Medical Association, First World Conference on Medical Education, London Organizing Committee, fifth session 18 -21 Aug. World Medical Association, Council, 18th session London ANNEX 7 173

24 -28 Aug. Eighth International Congress on Rheumatic Diseases Geneva 27 Aug. - 6 Sept. Pro Juventute, Fifth International Congress, 1953, for School Building Problems Zurich and Open -Air Education 28 Aug. - 4 Sept. Fifth International Congresses of Tropical Medicine and Malaria Istanbul 31 Aug. - 5 Sept. World Medical Association, seventh general assembly The Hague 1 -5 Sept. Third International Biometric Conference Bellagio, Italy 2 -4 Sept. World Federation of United Nations Associations /United Nations Association of Tokyo Japan :regional seminar on WHO 6 -12 Sept. International Statistical Institute, 28th session Rome 6 -12 Sept. Sixth International Congress for Microbiology Rome 7 -12 Sept. World Confederation for Physical Therapy, first world congress London 7 -13 Sept. World Federation of United Nations Associations, eighth plenary assembly Paris 10 -12 Sept. International Union against Tuberculosis, meeting of the Council and scientific Paris session 13 -20 Sept. International Pharmaceutical Federation, fifteenth general assembly Paris 15 -17 Sept. Symposium on Industrial Health Bombay 21 -23 Sept. Fourth International Congress of Mediterranean Hygiene and Medicine Barcelona 24 -26 Sept. National Society for Children, congress on perinatal mortality Brussels 27 Sept. - 3 Oct. International Association of Criminal Law, Sixth International Congress of Rome Criminal Law 28 -30 Sept. League of Arab States, Health Committee Cairo 3 -10 Oct. Sixth International Congress on Leprosy Madrid 5 -8 Oct. Pan American Sanitary Organization, Executive Committee, 20th meeting Washington, D.C. 8 -16 Oct. World Federation of United Nations Associations :seminar for teachers on Mogadishu teaching on the United Nations and specialized agencies 12 -17 Oct. Seventh International Congress on Paediatrics Havana 14 -18 Oct. International Office of Documentation on Military Medicine, 16th session Rome 22 Oct. Pan American Sanitary Organization, Executive Committee, 21st meeting Washington, D.C. 24 -25 Oct. American Medical Association /American Psychiatric Association, conference on Washington, D.C. mental health 26 -27 Oct. International Children's Centre, Technical Advisory Committee, eighth session Paris 26 -29 Oct. Association of American Medical Colleges, annual meeting Atlantic City, N.J. 28 Oct. - 15 Dec. World Federation of United Nations Associations /Italian Society for International Rome Organization, seminar on international organization and health problems 5 -6 Nov. New York Academy of Medicine, conference on the convergence of viewpoints New York on the etiology of mental disease 6 -7 Nov. Council for International Organizations of Medical Sciences, Executive Committee, Paris 14th session 7 -8 Nov. American Public Health Association, sub -committee on communicable disease New York control 9 -13 Nov. American Public Health Association, 81st annual meeting New York 9 -14 Nov. Trained Nurses Association of India, 42nd annual conference Nagpur 9 -16 Nov. International Leprosy Conference Lucknow, India 10 -11 Nov. Congress of the Franco- Lebanese Society of Medicine Beirut 16 -19 Nov. World Veterans Federation, fourth general assembly The Hague 16 -28 Nov. Eighth Pacific Science Congress Manila 20 -21 Nov. Dairy Industries Society, International, World Congress for Milk Utilization Washington, D.C. 22 Nov. - 1 Dec. Indian Council of Medical Research, meeting of Advisory Board and its Advisory Gwalior Committees 6 -19 Dec. Africanistes de l'Ouest, fifth international conference Abidjan, French West Africa 174 THE WORK OF WHO, 1953

Annex 8

TENTATIVE SCHEDULE OF WHO ORGANIZATIONAL MEETINGS IN 1954

12 January Executive Board, thirteenth session Geneva 4 May Seventh World Health Assembly Geneva End of May Executive Board, fourteenth session Geneva 13 -16 September Regional Committee for Europe, fourth session Opatija, Yugoslavia Third week of September Regional Committee for Africa, fourth session Leopoldville September Regional Committee for South -East Asia, seventh session New Delhi September Regional Committee for the Western Pacific, fifth session Manila October Regional Committee for the Americas, sixth session, and Directing Council PASO, eighth meeting Santiago, Chile September Regional Committee for the Eastern Mediterranean, fourth session (or first session of its sub -committees) (Unscheduled)

Annex 9

NON -GOVERNMENTAL ORGANIZATIONS IN OFFICIAL RELATIONSHIP WITH WHO

American College of Chest Physicians, International Hospital Federation, Chicago, Illinois, United States of America London, United Kingdom Biometric Society, International League against Rheumatism, New Haven, Connecticut, United States of America Philadelphia, Pa., United States of America Central Council for Health Education, International Leprosy Association, London, United Kingdom London, United Kingdom Council for International Organizations of Medical Sciences, International Paediatric Association, Paris, France Zurich, Switzerland International Pharmaceutical Federation, Inter -American Association of Sanitary Engineering, Amsterdam, Netherlands Rio de Janeiro, Brazil International Society for the Welfare of Cripples, International Academy of Forensic and Social Medicine, New York, United States of America Bordeaux, France International Union against Cancer, International Association for the Prevention of Blindness, Paris, France Paris, France International Union against Tuberculosis, International Association of Microbiologists, Paris, France Rome, Italy International Union against Venereal Diseases, International Committee of the Red Cross, Paris, France Geneva, Switzerland International Union for Child Welfare, Geneva, Switzerland International Conference'of Social Work, Columbus, Ohio, United States of America League of Red Cross Societies, Geneva, Switzerland International Council of Nurses, World Federation for Mental Health, London, United Kingdom London, United Kingdom International Dental Federation, World Federation of United Nations Associations, London, United Kingdom Geneva, Switzerland International Federation for Housing and Town Planning, World Medical Association, The Hague, Netherlands New York, United States of America ANNEX 10 175

Annex 10

REGULAR BUDGET FOR 1953

Original Transfers Appropriationi Purpose of appropriation authorized Revised section amount by Executive appropriation voted I Board 2 US $ US $ US $ PART I : ORGANIZATIONAL MEETINGS 1. World Health Assembly 154,400 12,900 167,300 2.Executive Board and its Committees 77,680 8,270 85,950 3. Regional Committees 34,750 8,650 43,400

Total - Part I 266,830 29,820 296,650

PART II : OPERATING PROGRAMME 4. Central Technical Services 1,563,866 (62,707) 1,501,159 5. Advisory Services 4,285,141 64,520 4,349,661 6. Regional Offices 1,052,371 63,224 1,115,595 7. Expert Committees and Conferences 184,178 - 184,178 Total - Part II 7,085,556 65,037 7,150,593

PART III :ADMINISTRATIVE SERVICES 8.Administrative Services 1,132,709 (94,857) 1,037,852

Total - Part III 1,132,709 (94,857) 1,037,852

SUB -TOTAL - PARTS I TO III 8,485,095 8,485,095

PART IV :RESERVE 9. Undistributed Reserve 3 1,347,659 - 1,347,659 Total - Part IV 1,347,659 - 1,347,659 TOTAL --- ALL PARTS 9,832,754 9,832,754

1 Voted by the Fifth World Health Assembly (resolution WHA5.37, Off. Rec. Wld Hlth Org. 42, 28) 2 Transfers authorized by the Executive Board at its eleventh session (resolution EBI1.R36, Off. Rec. Wld Huth Org. 46, 14) and by correspondence with the individual members of the Executive Board, in accordance with paragraph IV of the Appropriation Resolution for 1953 (resolution WHA5.37) 3 This amount equals the sum of the assessments of inactive Members. 176 THE WORK OF WHO, 1953

Annex 11

STATUS OF CONTRIBUTIONS AND OF ADVANCES TO THE WORKING CAPITAL FUND (as at 31 December 1953)

1. STATUS OF CONTRIBUTIONS IN RESPECT OF THE 1953 ASSESSMENTS (Expressed in US dollars)

Members Cash receipts Assessments and credits given Balances due

I. Active Members A.Current assessments Afghanistan 4,201 4,201 - Argentina 155,432 - 155,432 Australia 158,723 158,723 - Austria 11,903 11,903 - Belgium 113,423 113,423 - Bolivia 7,002 - 7,002 Brazil 155,432 155,432 - Burma 4,201 4,201 - Cambodia 3,501 3,501 - Canada 268,854 268,854 - Ceylon 3,501 3,501 - Chile 37,807 28,734 9,073 Costa Rica 3,501 3,501 - Cuba 24,505 - 24,505 Denmark 66,513 66,513 - Dominican Republic 4,201 4,201 - Ecuador 4,201 - 4,201 Egypt 66,513 66,513 - El Salvador 4,201 4,201 - Ethiopia 7,002 7,002 - Finland 11,903 11,903 - France 504,102 501,538 2,564 Germany, Federal Republic of 270,955 270,955 - Greece 14,002 14,002 - Guatemala 4,201 4,201 - Haiti 3,501 3,501 - Honduras 3,501 3,501 - Iceland 3,476 3,476 - India 273,055 273,055 - Indonesia 28,006 28,006 - Iran 37,807 - 37,807 Iraq 14,002 14,002 - Ireland 30,106 30,106 - Israel 9,802 - 9,802 Italy 176,436 176,436 - Japan 149,830 149,830 - Jordan, Hashemite Kingdom of the . . . 3,501 3,501 - Korea 3,501 - 3,501 Laos 3,501 3,501 - Lebanon 4,901 - 4,901 Liberia 3,501 3,501 - Libya, United Kingdom of 3,501 3,501 - Luxembourg 4,201 4,201 - Mexico 53,211 53,211 - ANNEX 11 177

Cash receipts Members Assessments and credits given Balances due

I. Active Members (continued) A.Current assessments (continued) Monaco 3,476 3,476 - Morocco,* French and Spanish Zones . . 2,101 2,101 - Nepal 6,952 - 6,952 Netherlands 117,623 117,623 - New Zealand 37,735 37,735 - Nicaragua 3,501 - 3,501 Norway 42,008 42,008 - Pakistan 58,812 58,812 - Panama 4,201 4,201 - Paraguay 3,501 - 3,501 Peru 16,803 - 16,803 Philippines 24,505 24,505 - Portugal 32,907 32,907 - Saudi Arabia 7,002 7,002 - Southern Rhodesia * 2,101 2,101 - Spain 92,418 - 92,418 Sweden 139,544 139,544 - Switzerland 84,017 84,017 - Syria 9,802 - 9,802 Thailand 22,404 22,404 - Tunisia * 2,101 2,101 - Turkey 76,315 76,315 -- Union of South Africa 93,819 93,819 - UnitedKingdomof Great Britain and Northern Ireland 964,796 964,796 - United States of America 2,993,400 2,993,400 - Uruguay 15,403 - 15,403 Venezuela 22,404 22,404 - Viet Nam 17,504 17,504 - Yemen 3,476 - 3,476 Yugoslavia 28,006 28,006 - TOTAL A 7,647,757 7,237,113 410,644 (= 4.57 %)

B.Special assessments China 504,102 - 504,102 TOTAL B 504,102 - 504,102 (= 5.61%) TOTAL I 8,151,859 7,237,113 914,746 (= 10.18%) II. Inactive Members Albania 3,501 - 3,501 Bulgaria 11,903 - 11,903 Byelorussian SSR 18,203 18,203 Czechoslovakia 75,615 - 75,615 Hungary 16,803 - 16,803 Poland 79,816 - 79,816 Roumania 29,406 - 29,406 Ukrainian SSR 70,714 - 70,714 Union of Soviet Socialist Republics . . . 532,808 - 532,808 TOTAL II 838,769 - 838,769 (= 9.33 %) GRAND TOTAL 8,990,628 7,237,113 1,753,515 (= 19.51%)

* Associate Member 178 THE WORK OF WHO, 1953

2. STATUS OF ADVANCES TO THE WORKING CAPITAL FUND (Expressed in US dollars)

States Assessments Amounts received Balances due

I. Active Members A.Current advances Afghanistan 1,506 1,506 - Argentina 55,715 55,715 - Australia 59,228 59,228 - Austria 5,521 5,521 - Belgium 40,657 40,657 - Bolivia 3,203 819 2,384 Brazil 55,715 55,715 - Burma 1,506 1,506 - Cambodia 1,602 1,602 - Canada 96,371 96,371 - Ceylon 1,255 1,255 - Chile 13,552 13,552 - Costa Rica 1,471 1,471 - Cuba 11,212 11,212 - Denmark 23,841 23,841 - Dominican Republic 1,506 1,506 - Ecuador 1,765 1,765 - Egypt 23,841 23,841 - El Salvador 1,506 1,506 - Ethiopia 2,510 2,510 - Finland 4,267 4,267 - France 180,696 180,696 - Germany, Federal Republic of 97,598 97,598 - Greece 5,020 Guatemala 1,922 1,922 - Haiti 1,255 1,255 - Honduras 1,471 1,471 - Iceland 1,255 1,255 - India 97,877 97,877 - Indonesia 12,813 12,813 - Iran 13,552 13,552 - Iraq 5,020 5,020 - Ireland 10,791 10,791 - Israel 4,485 4,485 - Italy 63,244 63,244 - Japan 53,969 53,969 - Jordan, Hashemite Kingdom of the . . 1,255 1,255 - Korea 3,203 3,203 - Laos 1,602 1,602 - Lebanon 2,059 2,059 - Liberia 1,255 1,255 - Libya, United Kingdom of 1,261 1,261 - Luxembourg 1,765 1,765 - Mexico 19,073 19,073 - Monaco 1,255 1,255 - Morocco,* French and Spanish Zones . . 757 757 - Nepal 2,522 - 2,522 Netherlands 42,163 42,163 - New Zealand 15,058 15,058 - Nicaragua 1,602 1,602 - Norway 15,058 15,058 - Pakistan 21,081 21,081 - Panama 1,922 1,922 -

* Associate Member ANNEX 11 179

States Assessments Amount received Balances due

I.Active Members (continued) A. Current advances (continued) Paraguay 1,471 1,471 - Peru 7,688 7,688 - Philippines 8,784 8,784 - Portugal 11,795 11,795 - Saudi Arabia 2,510 2,510 - Southern Rhodesia * 961 961 - Spain 33,289 33,289 - Sweden 61,486 61,486 - Switzerland 30,116 30,116 - Syria 3,514 3,514 - Thailand 8,031 8,031 - Tunisia * 757 757 - Turkey 27,355 27,355 - Union of South Africa 33,629 33,629 - United Kingdom of GreatBritainand Northern Ireland 345,832 345,832 - United States of America 1,201,378 1,201,378 - Uruguay 6,472 6,472 - Venezuela 8,031 8,031 - Viet Nam 8,009 8,009 - Yemen 1,261 - 1,261 Yugoslavia 10,038 10,038 - TOTAL A 2,904,016 2,897,849 6,167 (= 0.18 %) B. Special advances China 180,696 - 180,696 TOTAL B 180,696 - 180,696 (= 5.34 %) TOTAL I 3,084,712 2,897,849 186,863 (= 5.52 %)

H. Inactive Members Albania 1,255 679 576 Bulgaria 4,267 2,310 1,957 Byelorussian SSR 6,525 - 6,525 Czechoslovakia 27,104 14,673 12,431 Hungary 6,023 3,100 2,923 Poland 28,610 15,488 13,122 Roumania 10,541 5,706 4,835 Ukrainian SSR 25,347 - 25,347 Union of Soviet Socialist Republics . . 190,985 - 190,985 TOTAL II 300,657 41,956 258,701 (= 7.64 %)

GRAND TOTAL 3,385,369 2,939,805 445,564 (= 13.16 %)

* Associate Member 180 THE WORK OF WHO, 1953

3.ARREARS OF CONTRIBUTIONS DUE FROM ACTIVE MEMBERS 1 FROM 1948 TO 1952 (Expressed in US dollars)

Balances due

1948 I 1950 1951 1952 Total

I. Active Members Argentina - 25,554 131,371 161,336 318,261 Bolivia - 5,870 5,917 7,267 19,054 Cuba - - 10,548 25,436 35,984 Ecuador - - 3,261 4,359 7,620 Iran - - 6,216 39,244 45,460 Israel - - - 7,675 7,675 Paraguay - - 2,959 3,634 6,593 Peru - 2,211 14,202 17,442 33,855 Spain - - 77,265 93,896 171,161 Uruguay - 12,345 13,019 15,988 41,352

II. Non- Member Colombia 7,504 - - - 7,504

TOTAL 7,504 45,980 264,758 376,277 694,519 (= 0.24 %) (= 0.64 %) (= 3.53 %) (= 4.19 %)

1The table also shows the arrears due from one non -Member.

4.ARREARS OF CONTRIBUTIONS DUE FROM CHINA FROM 1948 TO 1952 (Expressed in US dollars)

1948 1949 1950 1951 1952 Total

China 57,073 288,515 422,702 426,070 523,250 1,717,610 (= 1.80 %) (= 5.72 %) (= 5.95 %) (= 5.68 %) (= 5.83 %)

5. ARREARS OF CONTRIBUTIONS DUE FROM INACTIVE MEMBERS FROM 1948 TO 1952 (Expressed in US dollars)

Balances due Members

1948 1949 1950 1951 I 1952 Total

Albania - 2,004 2,935 2,959 3,634 11,532 Bulgaria 3,304 6,812 9,980 10,060 12,355 42,511

Byelorussian SSR . . . 6,575 10,418 15,265 15,386 18,896 66,540 Czechoslovakia - 39,927 63,406 63,911 78,488 245,732 Hungary 6,069 9,617 14,090 14,202 17 ;442 61,420 Poland - 45,681 66,928 67,462 82,848 262,919 Roumania - 15,857 24,658 24,855 30,523 95,893 Ukrainian SSR 25,541 40,472 59,296 59,768 73,401 258,478 Union of Soviet Socialist Republics 192,440 304,945 446,772 450,333 553,045 1,947,535

TOTAL 233,929 475,733 703,330 708,936 870,632 2,992,560 (= 7.37 %) (= 9.42 %) (= 9.91 %) (= 9.46 %) (= 9.70 %) ANNEX 12 181

Annex 12 STRUCTURE OF THE HEADQUARTERS SECRETARIAT

-Division of Public Information -Office of External Relations THE DIRECTOR - GENERAL - Offices of the Director- General -Office of Technical Assistance -Office of Reports and Analysis

Departments Divisions Sections -Malaria and Insect Control -Communicable -Disease -Tuberculosis Services -Venereal Diseases and Treponematoses -Endemo- epidemic Diseases

-Maternal and Child Health -Mental Health -Advisory -Nutrition Services -Organization of Public -Health --Public -Health Administration Services -Nursing -Health Education of the Public -Social and Occupational Health -Environmental Sanitation -Fellowships -Education and Training Services -Exchange of Scientific Information -Assistance to Educational Institutions

-EpidemiologicalInformation andMorbidity - Statistics -International Quarantine -Epidemiological and Health -Statistical Studies Statistical Services -InternationalClassificationof Diseases and Causes of Death -Singapore Epidemiological Intelligence Station

-Biological Standardization -Central -Pharmaceutical Technical -Therapeutic Substances -Addiction -producing Drugs Services -Antibiotics and Insecticides -Tuberculosis Research Office, Copenhagen

-Technical Publications -Health Legislation -Editorial and Reference Services --- Documents and Official Records -Translation -Library and Reference Services

-Administrative Management -Administrative Management -Personnel and Personnel -Conference and Office Services

-Administration Legal Office and Finance Supply Services Office of Internal Audit - Budget -Budget and Finance -Finance and Accounts 182 - THE WORK OF WHO, 1953

Annex 13

SENIOR OFFICIALS OF THE WORLD HEALTH ORGANIZATION (31 December 1953)

M. G. Candau Director -General Pierre Dorolle Deputy Director -General

OFFICES OF THE DIRECTOR -GENERAL

J. HANDLER Director Division of Public Information P. M. KAUL Director Office of External Relations P. M. KAUL Director Office of Technical Assistance N. SINAI Director Office of Reports and Analysis

DEPARTMENT OF ADVISORY SERVICES

V. SUTTER Assistant Director -General W. BONNE Director Division of Communicable- Disease Services J. S. PETERSON Director Division of Organization of Public -Health Services H. G. BATTY Director Division of Environmental Sanitation E. GRZEGORZEWSKI Director Division of Education and Training Services

DEPARTMENT OF CENTRAL TECHNICAL SERVICES H. S. GEAR Assistant Director -General M. PASCUA Director -Consultant Health Statistics Y. BIRAUD Director Division of Epidemiological and Health Statistical Services W. TIMMERMAN Director Division of Therapeutic Substances N. HOWARD -JONES Director Division of Editorial and Reference Services

DEPARTMENT OF ADMINISTRATION AND FINANCE M. P. SIEGEL Assistant Director -General H. C. GRANT Director Division of Administrative Management and Personnel E. RENLUND Director Division of Budget and Finance

REGIONAL OFFICE FOR AFRICA - BRAZZAVILLE

F. DAUBENTON Director

REGIONAL OFFICE FOR THE AMERICAS - WASHINGTON, D.C. F. SOPER Director

REGIONAL OFFICE FOR SOUTH -EAST ASIA - NEW DELHI C. MANI Director S. CHELLAPPAH Deputy Director

REGIONAL OFFICE FOR EUROPE - GENEVA (provisionally) N. BEGG Director G. MONTUS Deputy Director

REGIONAL OFFICE FOR THE EASTERN MEDITERRANEAN - ALEXANDRIA A. T. SHOUSHA Director A. H. TABA Deputy Director

REGIONAL OFFICE FOR THE WESTERN PACIFIC -MANILA I. FANG Director T. GAN Deputy Director ANNEX 14 183

Annex 14

NUMBERS AND DISTRIBUTION OF STAFF 1

1952 -1953

Staff as at 30 November 1952 Staff as at 30 November 1953 Organizational breakdown Technical Regular Technical Regular Total AssistanceUNICEF Budget Total AssistanceUNICEF Budget

Headquarters

internationally recruited . 199 198 locally recruited 228 226 427 64 - 363 424 67 - 357 Regional Offices Africa

internationally recruited . 9 10 locally recruited 7 13 16 -- 16 23 1 - 22 The Americas

internationally recruited . 31 27 locally recruited 40 34 71 20 - 51 61 14 - 47 South -East Asia

internationally recruited . 22 19 locally recruited 74 76 96 25 - 71 105 29 - 76 Europe

internationally recruited . 16 18 locally recruited 16 23 32 10 - 22 41 14 - 27 Eastern Mediterranean

internationally recruited . 22 29 locally recruited 56 60

78 18 1 59 89 21 - 68 Western Pacific

internationally recruited . 18 22 locally recruited 43 48 61 22 - 39 70 22 - 48 Field staff in countries

internationally recruited . 330 378 locally recruited 2 5 332 235 43 54 383 241 60 82 United Nations Liaison Office, New York

internationally recruited . 3 3 locally recruited 6 5 9 2 - 7 8 1 - 7 UNICEF Liaison 3 -- 3 4 - 1 3

1 Excluding consultants 184 THE WORK OF WHO, 1953

Staff as at 30 November 1952 Staff as at 30 November 1953 Organizational breakdown Total Technical Regular Technical Regular AssistanceUNICEF Budget Total AssistanceUNICEF Budget

Epidemiological Intelligence Sta- tion, Singapore

internationally recruited . 1 1 locally recruited 13 13 14 -- 14 14 -- 14 TuberculosisResearch Office, Copenhagen

internationally recruited . 5 4 locally recruited 52 47 57 - 10 47 51 - 10 41 UNRWAPRNE 2 ---- 4 -- 4 WHO Centre for Classification of Diseases, London . . . 1 -- 1 ---- 1,197 396 54 747 1,277 410 71 796 Staff on loan, onpayrollof the Pan American Sanitary Bureau, and without pay . 6 9 GRAND TOTAL 1,203 1,286

2 I 1952, the staff of UNRWAPRNE was included in the figures for field staff in countries. ANNEX 15 185

Annex 15 COMPOSITION OF STAFF BY NATIONALITY 'as at 30 November 1953

Grades Grades Technical Regular Country P.5 P.1 TOTAL UNICEF Budget and above to P.4 Assistance

Argentina 1 4 5 2 - 3 Australia 1 11 12 6 - 6 Austria - 7 7 3 1 3 Belgium 1 10 11 4 - 7 Bolivia - 2 2 2 -- Brazil 1 8 9 8 - 1 Canada 2 41 43 26 - 17 Ceylon 1 3 4 3 - 1 Chile 3 8 11 7 - 4 China 4 8 12 6 1 5 Colombia 2 - 5 5 3 - 2 Costa Rica - 1 1 -- 1 Czechoslovakia 3 1 1 2 -- 2 Denmark 1 41 42 13 22 7 Ecuador - 2 2 1 - 1 Egypt 1 18 19 10 1 8 El Salvador 1 - 1 -- 1 Finland - 3 3 3 -- France 4 51 55 12 9 34 Germany, Federal Republic of . - 3 3 2 1 - Greece - 9 9 4 1 4 Haiti - 1 1 -- 1 Hungary 3 - 1 1 -- 1 India 5 17 22 13 - 9 1 1 2 1 - 1 Ireland - 9 9 5 - 4 Italy 1 16 17 8 1 8 Japan - 1 1 -- 1 Jordan, Hashemite Kingdom of the - 1 1 -- 1 Korea - 1 1 1 -- Lebanon - 2 2 1 - 1 Luxembourg - 3 3 2 - 1 Mexico - 9 9 7 - 2 Netherlands 4 26 30 10 3 17 New Zealand 1 9 10 3 2 5 Norway 1 15 16 2 10 4 Panama - 1 1 1 -- Peru - 3 3 2 - 1 Philippines 1 5 6 5 - 1 Poland 3 1 2 3 -- 3 Portugal - 3 3 3 -- Roumania 3 - 1 1 -- I Spain 1 3 4 1 - 3 Sweden 1 9 10 5 1 4 Switzerland - 34 34 5 1 28 Syria - 2 2 - 1 I Union of South Africa 2 9 11 5 1 5 Union of Soviet Socialist Repub- lics 3 - 1 1 -- 1 United Kingdom of Great Britain

and Northern Ireland . . . . 11 130 141 66 2 73

United States of America . . 17 92 109 44 2 63 Uruguay - 1 1 -- 1 Yugoslavia 1 2 3 1 - 2 Stateless - 1 1 1 -- TOTAL 70 647 717 307 60 350

1Excluding consultants and staff locally recruited, on loan, on the payroll of the Pan American Sanitary Bureau, and without pay 2 Non -Member 3Inactive Member 186 THE WORK OF WHO, 1953

Annex 16

FELLOWSHIPS AWARDED IN 19531

1.DISTRIBUTION BY COUNTRY OF ORIGIN, SOURCE OF FUNDS AND TYPE OF FELLOWSHIP 2

Source of funds Type of fellowship Region and country of origin Technical TOTAL Inter- Individual Group WHO Assistance UNICEF regional Regional training training 2

Africa Bechuanaland 1 -- 1 1 - 1 - Belgian Congo 2 - - 2 2 - 2 - French West Africa 1 - - 1 1 - 1 - Kenya 1 - - 1 1 - 1 - Liberia 9 (9) - - 9 8 1 9 - Nigeria 2 - - 2 2 - 2 - Southern Rhodesia 1 - - 1 1 - 1 - Tanganyika 1 - - 1 1 - 1 - Uganda 1 - - 1 1 - 1 - Union of South Africa 7 - - 7 7 - 7 - Zanzibar 1 - - 1 1 - 1 -

TOTAL : AFRICA 27 - - 27 26 1 27 -

The Americas Argentina 6 - - 6 2 4 4 2 Bolivia 11 (8) 1 - 12 - 12 12 - Brazil 4 - - 4 1 3 4 - British Guiana -- 2 2 - 2 - 2 British West Indies A - 5 - 5 - 5 - 5 Canada 5 - - 5 1 4 5 - Chile 8 2* - 10 3 7 8 2 Colombia 3 2 - 5 1 4 1 4 Costa Rica 4 3 - 7 1 6 2 5 Cuba 6 1 - 7 - 7 5 2 Dominican Republic 6 - - 6 - 6 2 4 Ecuador 3 3 - 6 2 4 5 1 El Salvador 5 1 - 6 - 6 3 3 Guadeloupe - 1 - 1 - 1 - 1 Guatemala 7 1 - 8 - 8 5 3 Haiti 7 2 - 9 - 9 1 8 Hawaii - 1 - 1 1 -- 1 Honduras 1 - - 1 - 1 1 - Jamaica 5 - - 5 - 5 1 4 Leeward Islands - 3 2 5 - 5 - 5 Martinique - 1 - 1 - 1 - 1 Mexico 5 3 - 8 1 7 3 5 Netherlands Antilles 1 - - 1 - 1 - 1

1 All fellowships administered by WHO, including those from WHO, Technical Assistance for Economic Development, and UNICEF funds 2 Figures in parenthesis indicate fellowships for undergraduate studies. 2 Includes short fellowships of less than a month. 4 Bahamas and Barbados * One of these was transferred to the United Nations Technical Assistance Administration on 1 July 1953. ANNEX16 187

Source of funds Type of fellowship

Region and country of origin Individual Group Technical TOTAL Inter- Regional WHO Assistance UNICEF regional training trainings

The Americas (continued) 5 2 3 Nicaragua 4 1 - 5 - Panama 3 4 - 7 - 7 4 3 Paraguay 5 2 - 7 - 7 6 1 6 2 4 Peru 5 1 - 6 - Surinam - 1 - 1 - 1 - 1 Trinidad and Tobago 2 2 - 4 - 4 1 3 9 9 9 United States of America . . . 9 - - - - Uruguay 3 - - 3 1 2 2 1 Venezuela 3 -- 3 - 3 1 2 Windward Islands - 4 3 7 - 7 - 7

TOTAL : THE AMERICAS 121 45 7 173 14 159 89 84

South -East Asia 4 8 Afghanistan 7 1 - 8 4 - Burma 10 6 - 16 7 9 13 3 Ceylon 7 6 - 13 11 2 11 2 India 14 9 t 3 26 26 - 20 6 2 2 2 India, French Settlements . . . . 2 -- - - India, Portuguese 3 - - 3 2 1 3 - Indonesia 13 4 - 17 14 3 14 3 Thailand 11 1 - 12 6 6 10 2

TOTAL : SOUTH -EAST ASIA 67 27 3 97 70 27 81 16

Europe Austria 8 12 1 21 5 16 15 6 Belgium 6 - - 6 - 6 2 4 Denmark 13 -- 13 4 9 6 7 Finland 8 10 1 19 5 14 11 8 3 17 17 3 France (including Algeria) . . 17 - 20 3 19 12 8 Germany, Federal Republic of . . 20 - - 20 1 Greece 3 5 1 9 - 9 3 6 Iceland 3 - - 3 2 1 2 1 Ireland 7 - - 7 2 5 6 1 Italy 7 - 2 9 1 8 5 4 Luxembourg 1 - - 1 - 1 - 1 . . . 9 5 4 Morocco (French Zone) . 8 1 - 9 - Netherlands 10 - - 10 1 9 9 1 Norway 15 - - 15 2 13 4 11 Portugal 7 - - 7 - 7 5 2 Spain 15 8 - 23 2 21 9 14 Sweden 15 -- 15 1 14 6 9 Switzerland 10 -- 10 1 9 5 5 Trieste - 6 - 6 - 6 5 1 Tunisia 9 2 - 11 1 10 7 4 Turkey 14 8 - 22 2 20 17 5 United Kingdom of Great Britain

. . 5 2 1 and Northern Ireland . . 5 -- 3 4 Yugoslavia 12 11 3 26 2 24 14 12

TOTAL: EUROPE 213 63 11 287 38 249 169 118

1 Includes short fellowships of less than a month. f Seven of these were transferred to the United Nations Technical Assistance Administration on 1 July 1953. 188 THE WORK OF WHO, 1953

Source of funds Type of fellowship Region and country of origin WHO I Technical UNICEF TOTAL Inter- Regional Individual Group Assistance t regional training training 2

Eastern Mediterranean Aden - 1 - 1 - 1 - 1 Cyprus - 2 - 2 - 2 - 2 Egypt 24 9 - 33 28 5 24 9 Ethiopia 16 (16) -- 16 5 11 16 - Iran 25 8 - 33 26 7 22 11 Iraq 10 8 1 19 10 9 14 5 Israel 10 3 - 13 13 - 11 2 Jordan, Hashemite Kingdom of the 3 1 - 4 1 3 2 2 Lebanon 13 6 - 19 16 3 14 5 Libya, United Kingdom of . . . 3 (3) 5 (2) - 8 2 6 8 - Pakistan 9 6 1 16 11 5 10 6 Saudi Arabia 5 (5) -- 5 - 5 5 - Sudan 7 1 - 8 1 7 5 3 Syria 12 6 - 18 10 8 11 7

TOTAL: EASTERN MEDITERRANEAN 137 56 2 195 123 72 142 53

Western Pacific Australia 15 1 - 16 2 14 2 14 Cambodia 1 1 - 2 1 1 1 1 China 8 16 - 24 3 21 19 5 Fiji 4 1 - 5 3 2 4 1 Hong Kong 3 3 - 6 4 2 4 2 Japan 11 1 - 12 8 4 9 3 Korea 4 1 - 5 2 3 4 1 Laos - 8 (8) - 8 - 8 8 - Macao - 1 - 1 - 1 - 1 Malaya 2 1 - 3 1 2 1 2 Netherlands New Guinea 1 2 - 3 2 1 2 1 New Caledonia - 1 - 1 - 1 - 1 New Zealand 6 1 - 7 1 6 1 6 North Borneo - 1 - 1 - 1 - 1 Pacific Islands, Trust Territory . . - 1 - 1 - 1 - 1 Papua and New Guinea . . . . 1 1 - 2 1 1 1 1 Philippines 8 2 - 10 6 4 6 4 Sarawak 2 1 - 3 1 2 1 2 Singapore 1 2 - 3 1 2 1 2 Viet Nam 1 1 - 2 1 1 1 1

TOTAL : WESTERN PACIFIC 68 47 - 115 37 78 65 50

TOTAL : ALL REGIONS 633 238 23 894 308 586 573 321

Percentage 71% 26% 3% 100% 35% 65% 64% 36%

1 Figures in parenthesis indicate fellowships for undergraduate studies. 2 Includes short fellowships of less than a month. ANNEX 16 189

2.AVERAGE DURATION OF FELLOWSHIPS

Number Average length Region of origin of fellowships Number of months in months

Africa 27 184.50 6.9 The Americas 173 932 5.3 South -East Asia 97 766 7.8 Europe 287 966.50 3.4 Eastern Mediterranean 195 1,301.30 6.6 Western Pacific 115 589.25 5.1

ALL REGIONS 894 4,739.55 5.5

3.DISTRIBUTION OF FELLOWSHIPS BY SUBJECT OF STUDY

Subject of study Number of fellowships Percentage

HEALTH ORGANIZATION AND SERVICES Public -Health Administration Public -health administration 114(8) Hospital and medical care administration 9 Hospital and clinic buildings - Medical librarianship 2

Sub -total 125 14% Sanitation Environmental sanitation 52(5) Housing and town planning 1 Food control 12

Sub -total 65 8% Nursing Nursing, including midwifery 46(13) Public -health nursing and health visitors 35 Medical social work - Sub -total 81 9% Maternal and Child Health

Organization of maternal and child health services . 46 Paediatrics and obstetrics 25

Sub -total 71 8% Other Health Services Mental health and child guidance 82 Health education 7 Occupational health 20 Nutrition and dietetics 12 Health statistics 20 Dental care and hygiene 3 Rehabilitation 15 Drug control 3

Sub -total 162 19%

TOTAL : HEALTH ORGANIZATION AND SERVICES 504 58%

1 Figures in parenthesis indicate fellowships for undergraduate studies. 190 THE WORK OF WHO, 1953

Subject of study Number of fellowships Percentage

COMMUNICABLE- DISEASE SERVICES Malaria 55 Venereal diseases and treponematoses 41 Tuberculosis 86 Other communicable diseases, epidemiology and quarantine 59 Laboratory services 41 Chemotherapy, antibiotics 10 TOTAL : COMMUNICABLE- DISEASE SERVICES 292 32%

CLINICAL, MEDICAL SCIENCES AND EDUCATION Clinical Medicine Surgery and medicine 25(25) Anaesthesiology 17 Radiology 6 Haematology, blood bank 1 Other medical and surgical specialities 40

Sub -total 89 9%

Medical Sciences and Education Anatomy and histology 2 Physiology - Biophysics, biochemistry, chemistry - Pathology 2 Pharmacology 2 Medical personnel educational methods 3

Sub -total 9 1%

TOTAL :CLINICAL, MEDICAL SCIENCES AND EDUCATION 98 10%

GRAND TOTAL 894 100%

4.DISTRIBUTION OF FELLOWSHIP VISITS TO COUNTRIES BY REGION OF ORIGIN AND REGION OF STUDY

Region of study Total number of Region of origin visits to South-East Eastern Western countries' Africa Americas Europe Medi- Pacific Asia terranean Pacific

Africa...... 64 1 12 - 50 1 - The Americas . 220 - 168 - 46 - 6 South -East Asia . . 142 - 19 30 65 4 24 Europe 403 - 34 - 363 6 - Eastern Mediterranean 266 5 18 - 156 79 8 Western Pacific. . . 138 - 22 4 29 - 83

TOTAL 1,233 6 273 34 709 90 121

1 The same Fellow may visit more than one country. OFFICIAL RECORDS OF THE WORLD HEALTH ORGANIZATION No. 51

THE WORK OF WHO, 1953

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

INDEX

WORLD HEALTH ORGANIZATION PALAIS DES NATIONS GENEVA INDEX

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

Administrative Committee on Co- ordination, 41, 64, 115, 116, Belgian territories in Africa, 130 123 BHC, 6, 23, 55 Adoption, mental -health aspects, 26 See also Insecticides Advisory Committee on Arid Zone Research (UNESCO), 119 Bilharziasis, 4, 17 Advisory Committee on Bibliography (UNESCO), 57 Africa, 130 ;Eastern Mediterranean, 144 ;Egypt, 145 ; Aëdes aegypti, 14, 74 Philippines, 150 ;Syria, 148 See also Insect control Biological materials, transport by post, 49, 51, 119, 121 Afghanistan, 15, 40, 77, 136 Biological Sciences, Current Indexing and Abstracting Perio- African Mind in Health and Disease, The, 26, 68 dicals in the Medical and, 58 African Region, 67 -70, 129 -30, 164, 186 Biological standardization, 9,12, 49 -51 Air Transport Association, International, 121 Biological Standardization, Expert Committee on, 9,12, 49 Airports, hygiene and sanitation, 22, 119 membership, 158 Alcohol, Expert Committee on, 53 Biostatistics, Inter -American Center of, 47, 73, 132, 166 membership, 158 Blood -Group Reference Laboratory, International, 49, 51, Alcoholism, 53 151 Americas, 25, 26, 164 Bolivia, 37, 76, 132 American Samoa, 111 Americas, Region of the, 71 -6, 131 -2, 164 -6, 186 -7 Bovine tuberculosis, 12, 102 Amphetamine preparations, 52 Brazil, 16, 132 Amplification of Medical Certification of Cause of Death, 47 environmental sanitation training, 23, 73, 131 Anaesthesiology, 86, 87 British Honduras, 132 Ankylostomiasis :Iraq, 146 ;Paraguay, 75, 135 British territories in Africa, 130 Annual Epidemiological and Vital Statistics, 46, 47 Brucellosis, 4, 11, 50 Antibiotics, 4, 53 -4 joint FAO /WHO centres, 151 production :Chile, 133 ;India, 138 Brucellosis, Joint FAO /WHO Expert Committee on, 11 See also Penicillin Brunei, 5,15, 29, 108, 109, 110, 148 Assembly Suspense Account, 63 Budget - Assessments, 63 for 1953, 63, 175 See also Contributions regional, contributions to, 84 Associate Members, rights and obligations in regional com- See also Contributions ; Programme and budget mittees, 72, 78, 84, 106 Bulletin of the World Health Organization, 58 Audio -visual aids production :Ceylon, 137 ;India, 139 Burma, 12, 16, 28, 29, 116, 136 -7 Austria, 86, 142 malaria, 80, 136 Auxiliary health workers, 41, 116 maternal and child health and venereal disease control, See also Education and training ; Medical and auxiliary 80 -1, 136, 137 personnel ;Nursing reorganization of health services, 20, 77, 81, 137 Avian tuberculosis, 12

Barbados, 76 Cambodia, 15, 107, 108, 109, 110, 111, 149 BCG, 11, 16, 18 -19 Cancer, 48 Americas, 132 ;British Honduras, 132 ;Brunei,110, Cancer, International Union against, 48 148 ; Burma, 136 ; Cambodia, 110, 149 ;Costa Rica, Cardiolipin, 9 133 ; Ecuador, 134 ; El Salvador, 134 ; Ethiopia, 145 ; Central Council for Health Education, 120 Hong Kong, 110 ;India,10,138 ;Iran,145 ;Iraq, Centre for Classification of Diseases, 47 146 ; Jamaica, 134 ; Jordan, 146 ; Libya, 147 ; Pakistan, Ceylon, 12, 27, 29, 31, 137 147 ;Philippines, 110, 150 ;Sarawak, 108, 110, 111, health education, 33, 81, 137 150 ;Sudan, 148 ; Taiwan, 110, 149 ; Thailand, 140 ; Chemistry, International Union for Pure and Applied, 121 Trinidad, 135 ;Turkey, 143 ;Viet Nam, 110 Children - production, 110 long -range activities for, 28, 116 See also Tuberculosis mental health, 26, 27, 28, 117 Bechuanaland, 7, 69, 130 Europe, 86,88, 94 -5 ;Philippines, 150 ;Western Bejel :Iraq, 7, 145 ;Syria, 148 Pacific, 107, 166 - 1 - 2 INDEX

Children (continuation) - Diacetylmorphine (heroin), 52 rehabilitation of handicapped, 31, 117 Diagnostic substances, standards, 50 Austria, 142 ; Europe, 86, 89 ; France, 142 ; Greece, Dieldrin, 6 142 ; Israel, 146 ;Italy, 142 ; Japan, 150 ; Yugo- Diphtheria, 16, 49 -50 slavia, 144 vaccination campaigns :Brazil, 16, 132 ;Chile, 16, 133 ; See also International Children's Centre ; Maternal and Colombia, 16, 133 ; Hong Kong, 149 child health ; School health services Dominican Republic, 133 Chile, 16, 76, 133 Drinking -water :Bolivia, 132 environmental sanitation training, 23, 73, 131 standards, 21, 22, 87, 92 vital and health statistics, 73 Drivers, medical examination, 31, 117 See also Inter- American Center of Biostatistics Drug Supervisory Body of the United Nations, 52, 53 China, 149 Drugs - contributions, 63, 180 and other therapeutic substances, 49 -54 See also Taiwan liable to produce addiction, 52 -3 Cholera, 17, 50 non -proprietary names, 51, 52, 121 Pakistan, 17, 147 synthetic, 53, 117 Chronicleofthe World Health Organization, 58, 79, 107 Drugs Liable to Produce Addiction, Expert Committee on, Classification of diseases, centre for, 47 52, 53 CODEPID, 46, 58 membership, 159 Colombia, 16, 133 insect control, 73 -4, 133 Eastern Mediterranean Region, 97 -104, 144, 166, 188 reorganization of health services, 20, 133 tuberculosis studies, 12 Colombo Plan for Co- operative Economic Development in Economic and Social Council, 117, 123, 124, 125 South and South -East Asia, 79, 125 See also Transport and Communications Commission Commission for Climatology (WMO), 46 Economic Commission for Asia and the Far East, 117 Commission for Technical Co- operation in Africa South of Economic Commission for Europe, 117, 119 the Sahara, 68, 70 Ecuador, 40, 76, 134 Commission on Narcotic Drugs (United Nations), 52, 53 Education, International Bureau of, 119 Committee on International Quarantine, 14, 42, 43 Education and training, 36 -41 membership, 161 -2 Europe, 84 ;Western Pacific, 107 -8 Committee on Tumour Nomenclature and Statistics, 48 See also Educational institutions ;Maternal and child Communicable diseases, 3 -17 health ;Medical and auxiliary personnel ;Medical Americas, 76 ; Europe, 86, 91 ;Palestine Refugees, 34 ; education ;Nursing ;Seminars and training courses Spain, 143 Educational institutions, assistance to, 40 -1 reporting, 48, 165 Afghanistan, 40,136 ;Americas, 132 ;Austria,142 ; See also Epidemiological information Cambodia, 107, 149 ;Denmark, 142 ;Ecuador, 40, Community organization and development, 21, 41, 115, 116 134 ;India, 40, 138, 139 ;Indonesia, 40, 140 ;Iraq, Conferences and meetings - 146 ; Kenya, 130 ; Lebanon, 40, 146 ;Nigeria, 131 ; non- governmental and other organizations, 171 -3 Norway, 143 ; Pakistan, 40, 147 ; Paraguay, 40, 135 ; United Nations and specialized agencies, 168 -70 Philippines, 40, 107, 150 ;Singapore, 40, 107, 151 WHO, 162 -3, 174 See also Nursing ;Schools of public health Congresses, planning and organizing, 39 Egypt, 17, 30, 33, 39, 40, 144 -5 Contributions, 63 health demonstration area, 21, 144 status, 176 -7, 180 venereal diseases, 8, 101, 144 Convention on Privileges and Immunities of the Specialized Eighth International Hospital Congress, 31 Agencies, 62, 98 Eighth Pacific Science Congress, 107 Cook Islands, 111 El Salvador, 27, 29, 134 Co- operative for American Remittances to Europe (CARE), 56 health demonstration area, 21, 134 Co- ordination of work with other organizations, 115 -21 Endemic goitre, 23, 24, 25 Costa Rica, 12, 133 Endemo -epidemic diseases, see Communicable diseases nursing, 29, 74, 133 Environmental sanitation, 21 -3, 118 Council for International Organizations of Medical Sciences Afghanistan, 136 ;Americas, 132, 164 ;Bolivia, 132 ; (CIOMS), 39, 57, 119 -20 Brazil, 23, 73, 131 ;Chile, 23, 73, 131 ;Egypt, 144 ; Cripples, International Society for the Welfare of, 31 Europe, 87, 92, 142 ;Greece, 142 ;Guatemala, 134 ; Cultural anthropology :Central America, 132 ;Peru, 135 Indonesia,140 ;Mexico,23,73,131 ;South -East See also Sociological survey Asia, 77,166 ;Thailand, 82, 140 ;Western Pacific, Current Indexing and Abstracting Periodicals in the Medical 109 and Biological Sciences, 58 See also Drinking -water ;Sanitary engineering Environmental Sanitation, Expert Advisory Panel on, 22 DDT, 6, 23, 55, 66 Environmental Sanitation, Expert Committee on, 22 production, 54 membership, 159 India, 138 Epidemiological and health statistical services, 42 -8 See also Insect control ;Insecticides Epidemiological and Vital Statistics Report, 46 Demographic Yearbook, 47 Epidemiological Cable Code (CODEPID), 46, 58 Denmark, 141, 142 Epidemiological information, 43 -6 Dental health, 32 See also Communicable diseases INDEX 3

Escherichia Centre, International Salmonella and, 49, 51 Health education of the public, 32 -3, 116, 120 Ethiopia, 16, 37, 145 Americas, 164 ;Ceylon, 33, 81, 137 ;Eastern Mediter- European Region, 84 -96, 140 -2, 187 ranean, 33, 144 ; Europe, 86, 87 ; Honduras, 33, 134 ; Exchange of scientific information, 39 -40 Italy, 143 ;Liberia, 33, 131 ; Libya, 33, 147 ; Mexico, Executive Board, membership, 156 33, 134 ;Palestine refugees, 34 ;Sarawak, 33, 151 ; Expanded Programme of Technical Assistance for Economic Singapore, 32, 33, 109 ; Turkey, 32 ; Western Pacific, Development, 122 -6 109 See also Technical Assistance Health Education of the Public, Expert Committee on, 33 Expert advisory panels- membership, 159 list, 157 -8 Health Education of the Public, International Union for, 33 See also under subject Health legislation, 58 Expert committees - Health statistics, 46 -8 membership, 158 -61 Americas, 165 See also under subject See also Inter -American Center of Biostatistics ;Vital Family, planning, India, 138 and health statistics FAO, 11, 21, 23, 24, 50, 85, 99, 102, 116, 119 Health Statistics, Expert Committee on, 47 FAO /WHO brucellosis centres, 151 Health visitors, 27, 30, 87, 100, 147 FAO /WHO Inter- Agency Working Group on Milk and Milk Hepatitis, 15 Products, 22 Hepatitis, Expert Committee on, 15 Fellowships, 37 -8 Heroin (diacetylmorphine) 52 Africa, 70 ;Americas, 72 ;Eastern Mediterranean, 97, Histoplasmosis, 13 99 -100 ; Europe, 87, 93 ; South -East Asia, 80 ; Western Honduras, 15 Pacific, 106, 107 health education, 33, 134 list, 186 -90 Hong Kong, 15, 110, 111, 149 Fifth International Congresses of Tropical Medicine and Hospital Congress, Eighth International, 31 Malaria, 5 Hospitals, 31 Fiji, 111 administration, Colombia, 133 Finland, 30, 86, 95, 142 construction : Turkey, 31, 142 ; Western Pacific, 111 First International Congress on Medical Librarianship, 58, 94 dietetics, Ceylon, 137 First World Conference on Medical Education, 36, 40, 60, 120 Host Agreement with Government of France, 62 Florence Nightingale International Foundation, 30 Housefly control, 22 Fluoridation of water, 32 Housing, 117 Fonds ReineElisabethpourl'Assistancemédicale aux Western Pacific, 106 Indigènes du Congo Belge, 70 Hygiene of seafarers, 31, 118 Food and Agriculture Organization, see FAO Hygiene of Seaferers, Joint ILO /WHO Committee on the, 31 Food hygiene, 11, 12 -13 Burma, 12, 137 ; Ceylon, 12, 137 ; Costa Rica, 12, 133 ; ILO, 21, 30, 31, 85, 95, 116, 117, 118 Eastern Mediterranean, 144 ;India, 12, 139 Asian Regional Conference, 106, 117 See also Meat hygiene India, 7,10, 12, 15,17, 27, 29, 31, 40, 79, 137 -9 Foot and mouth disease, Americas, 165 malaria, 5, 138 Foreign Operations Administration, 77, 79, 125 pharmacology, 81 -2, 138, 139 France, 142 venereal diseases, 8, 82, 138 care of premature infants, 94, 142 visiting team of medical scientists, 39, 40, 139 Host Agreement on Regional Office for Africa, 62 Indian Council of Medical Research, 82 French Africa, 130 Indian Veterinary Research Institute, 11 French Cameroons, malaria, 5, 69, 130 Indonesia, 7, 24, 40, 79, 139 -40 French Equatorial Africa, 130 visiting team of medical scientists, 39, 40, 140 French Togoland, 69 Industrial hygiene, India, 139 -: See also Social and occupational health French West Africa, 5, 69 Industrial Property, International Bureau for the Protection Fundamental education, 33, 81, 116, 134 of, 121 Infant mortality, 94 Goitre, endemic, 23, 24, 25 See also Premature infants Gold Coast, 69 Influenza, 13 -14 Greece, 31, 86, 142 centres, 151 Guatemala, 15, 76, 134 Influenza, Expert Committee on, 14 Insect control :Americas,131,165 ;Brunei,109,148 ; Haiti, 7, 76, 134 Cambodia, 109, 149 ;Ceylon, 137 ; Colombia, 73 -4, 133 ; Handbook of Basic Documents, 58 Dominican Republic, 133 ;Europe, 86, 88 ;Iran, 145 ; Paraguay, 134 ; Peru, 135 ; Philippines, 109 ; Sarawak, 109, Handbook of Resolutions and Decisions, 58 150 ; Taiwan, 5,109, 149 ;Viet Nam, 151 Hashemite Kingdom of the Jordan, 146 See also Insecticides ; Malaria Headquarters accommodation, 64 Insect vectors in international air traffic, 43 Health demonstration areas :Egypt, 21, 144 ;El Salvador, Insecticides, 4, 22, 23, 53 -4, 56, 58 21, 134 See also Insect control ;Malaria Health Education, Central Council for, 120 Insecticides, Expert Committee on, 56 4 INDEX

Institute of Inter -American Affairs, 74 Italy, 142 -3 Institute of Nutrition of Central America and Panama, 24 care of premature infants, 94, 143 Inter- American Center of Biostatistics, 47, 73, 132, 166 Intergovernmental Committee for European Migration, 117, Jamaica, 134 121 Japan, 28, 31, 40, 150 Intergovernmental organizations, 121 Johns Hopkins University, 107 International Air Transport Association, 121 Joint Committee on Health Policy, UNICEF /WHO, 118 InternationalAnti -Venereal- DiseaseCommissionofthe Joint expert committees, see under subject Rhine, 84, 90, 118 Jordan, Hashemite Kingdom of the, 146 International Association of Microbiologists, 121 Josiah Macy Jr Foundation, 24 International Association of Universities, 41 International Bank for Reconstruction and Development, Kenya, 130 70, 119 Khat, 53 International biological standards, see Biological standardiza- Korea, 108, 150 tion Kwashiorkor, 27 International Blood -Group Reference Laboratory, 49, 51, 151 International Bureau for the Protection of Industrial Property, Laboratories, see Public -Health laboratories 121 Laos, 37, 150 International Bureau of Education, 119 yaws, 7, 110 International Children's Centre, 57, 85, 86, 94, 117, 118 League of Red Cross Societies, 120 International Civil Aviation Organization (ICAO), 22, 46, 119 Lebanon, 5, 40, 146 International Committee of the Red Cross, 120 Lecithin, 9 International Committee on Military Medicine and Pharmacy, Leprosy, 4, 16 -17, 118 121 Burma, 16, 136 ; Ethiopia, 16, 145 ; India, 79 ; Thailand, International Conference of Social Work, 120 16, 140 ;Turkey, 16, 143 International Conference on Public Education, 119 Leprosy, Expert Committee on, 16 International Congress for Microbiology, 11, 13, 121 Leprosy Association, International, 16 International Council of Nurses, 30, 120 Leptospirosis, 12 International Digest of Health Legislation, 58 Spain, 12, 92 International Labour Organisation, see ILO Liberia, 23, 37, 130 -1 International League against Rheumatism, 31 malaria and yaws, 5, 7, 69, 130, 131 International Leprosy Association, 16 Libraries, medical, 31, 58, 93 -4, 135 International Lists of Diseases and Causes of Death, 47 Library and reference services, 58 International medical law, 120 Libya, 28, 37, 147 International Organization for Standardization, 121 health education, 33, 147 International Paediatric Association, 28 Malaria, 5 -7, 78, 105 International pharmacopoeia, 51 Afghanistan, 136 ;Africa, 5, 69, 129, 130 ;Brunei, 5, International Pharmacopoeia, Expert Committee on the, 51 109,148 ;Burma, 80,136 ;Cambodia, 109,149 ; International quarantine, see Quarantine India, 5, 138 ;Indonesia, 139 ;Iran, 103, 145 ;Iraq, international Quarantine, Committee on, 14, 42, 43 146 ;Lebanon,5,146 ;Liberia,5,131 ;Palestine membership, 161 -2 refugees, 34 ;Philippines, 5,109, 150 ;Sarawak, 5, InternationalSalmonella and Escherichia Centre, 49, 51 109, 149 ;Taiwan, 5,109, 149 ;Viet Nam, 5, 151 InternationalSanitary Regulations, 42 -3, 44 -5 conference, Bangkok, 5, 109, 151 See alsoQuarantine See also Insect control InternationalSerological Reference Laboratory, 9 Malaria, Expert Advisory Panel on, 5 Internationalshigella centres, 121 Malaria Expert Committee on 5, 6 membership, 159 InternationalSociety for the Welfare of Cripples, 31 Malaya, 11, 15, 29, 108, 109, 111, 150 InternationalTreponematosis Laboratory Center, 8 Manual of Insecticides, 58 InternationalTuberculosis Campaign, 18 Manual of Laboratory Techniques in Rabies, 12 InternationalUnion against Cancer, 48 Manual of the International Statistical Classification of Diseases, InternationalUnion against Tuberculosis, 121 Injuries and Causes of Death, 47 InternationalUnion against Venereal Diseases, 121 Maternal and child health, 27 -8 InternationalUnion for Health Education of the Public, 33 Afghanistan, 136 ; Burma, 80 -1, 136 ;137 ; Cambodia, InternationalUnion for Pure and Applied Chemistry, 121 149 ;Ceylon,137 ;Chile,133 ;Colombia,133 ; InternationalVeterans Federation, 117 Europe, 86 ;Greece, 142 ; Hong Kong, 149 ;India, InternationalVeterinary Congress, 11 137, 138 ;Indonesia, 139 ;Iraq, 145 ;Ireland, 142 ; Iran, 15, 17,28, 30, 145 Japan, 150 ;Lebanon, 146 ;Liberia, 130 ;Pakistan, malaria,103, 145 27, 100 -1, 147 ; Paraguay, 135 ; Peru, 135 ; Syria, 148 ; Taiwan, 149 ; Thailand, 82, 140 ; Turkey, 143 ; Western Iraq, 7,17, 145 -6 Pacific, 108 Ireland, 142 See also Children ;Premature infants Isolated communities, protection of, 121 Mauritius, pertussis vaccination, 16, 69, 131 Isoniazid, 4 Meat hygiene, 92 Israel, 11, 29, 31, 146 See also Food hygiene INDEX 5

Medical and auxiliary personnel, training, 41, 116 National health administrations, see Public -health services Americas, 71, 73, 74, 76 ;Eastern Mediterranean, 104 ; Nepal, 77 Europe,86,87 -91 ;South -East Asia,78,80,81 ; Netherlands, 143 Western Pacific, 105 Netherlands New Guinea, 111 See also Education and training ; Educational institutions; New Zealand, 108 Maternalandchildhealth ;Medicaleducation ; Nicaragua, 15, 76 Nursing Nigeria, 5, 7, 69, 131 Medical and BiologicalSciences,Current Indexing and Non -governmental organizations, 79, 107, 119 -21 Abstracting Periodicals in the, 48 conferences and meetings, 171 -3 Medical documentation, 57 in official relationship with WHO, list, 174 Medical education - Non -proprietary names for drugs, 51, 52, 121 first world conference, 36, 40, 60, 120 North Borneo, 15, 108, 109, 150 information bureau, 40 Norway, 143 See also Education and training; Educational institutions; Norwegian mission to India, 79, 125 Medical and auxiliary personnel Nurses, International Council of, 30, 120 Medical examination - Nursing, 28 -30, 102, 120 drivers, 31, 117 Afghanistan, 29, 136 ;Africa, 69, 129, 164 ;Americas, migrants, 31, 118 165 ;Bolivia, 132 ;Brunei, 29, 148 ;Burma, 28, 29, Medical law, international, 120 136 ; Cambodia, 29, 149 ; Ceylon, 29, 137 ; Costa Rica, Medical Librarianship, First International Congress on, 58, 94 29, 74, 133 ; Eastern Mediterranean, 144 ; Europe, 89 ; Medical libraries, 31, 58, 93 -4, 135 India, 29, 138, 139 ;Iran, 28, 145 ;Israel, 29, 146 ; Medical library organization, 93 -4 Libya, 28, 147 ; Malaya, 29, 150 ; Mexico, 29 ; North Medical records libraries, 31 Borneo,150 ;Pakistan,28,147 ;Singapore,151 ; Peru, 135 Syria, 28, 29, 102 -3, 148 ; Taiwan, 29, 149 ; Thailand, See also Medical libraries 28, 29, 140 ;Turkey, 29, 140 ;Western Pacific, 108 Medical Research Council, 16 Nursing, Expert Committee on, 29 Medical schools, directory, 41, 58 Nursing legislation, 29, 30 Medical Sciences, Council for International Organizations of Nutrition, 23 -5, 119 (CIOMS), 39, 57, 119 -20 Americas, 23, 24, 25, 132 ; Belgian territories in Africa, Medical scientists, see Visiting teams of medical scientists 130 ;French Equatorial Africa, 130 ;Indonesia, 24, Medical store management, Ceylon, 31, 137 139 ;Palestine refugees, 34 ; South -East Asia, 23, 24, Medical supplies, procurement 35, 55 -6, 99, 117, 118 25, 135 Medico -legal services :Ceylon, 137 ;Lebanon, 146 Nutrition, Joint FAO /WHO Expert Committee on, 24 Membership of the World Health Organization, 62 list, 155 Occupationalhealth,seeIndustrialhygiene ;Social and Mental health, 25 -7 occupational health Americas, 132 ;Eastern Mediterranean, 166 ;Europe, Occupational Health, Joint ILO/WHO Committee on, 30, 118 86, 88 ;Japan, 150 Office International des Epizooties, 11 See also Children ;Psychiatry Official Records of the World Health Organization, 57 Mental Health, Expert Committee on, 26 Onchocerciasis, 4, 16 Mental Hygiene in the Nursery School, 26 Onchocerciasis, Expert Committee on, 16 Mentally Subnormal Child, Joint Expert Committee on the, membership, 159 -60 117 Ophthalmological Society of Egypt, 39 membership, 161 Ophthalmology, Eastern Mediterranean, 39, 166 Mexico, 29, 33, 134 Opium Board, Permanent Central, 53 environmental sanitation training, 23, 73, 131 Microbiologists, International Association of, 121 Pacific Science Association, 121 Microbiology, International Congress for, 11, 13, 121 Pacific Science Congress, Eighth, 107 Midwifery, 28, 102 Paediatric Association, International, 28 See also Nursing Paediatrics, 28, 90 Migrants, medical selection, 31, 118 See also Maternal and child health Migration, 117 Pakistan, 17, 28, 29, 40, 147 Migration, Intergovernmental Committee for European, 117, maternal and child health, 27, 100 -1, 147 121 Palais des Nations extension, 64 Military Medicine and Pharmacy, International Committee Palestine refugees, 25, 33 -5 on, 121 Pan American Sanitary Bureau, 72, 125 Milk hygiene, 13, 22, 88, 91, 118, 119 Monograph Series, 58 Pan American Sanitary Code, protocol, 42 Morbidity survey, Denmark, 141 Pan American Sanitary Conference, 72 Morocco (French Zone), 15, 86, 143 Pan American Sanitary Organization, 71, 73 Pan Pacific Tuberculosis Conference, 109 Nalorphine, 52 Panama, 15 Narcotic drugs, 117 rural health services, 20, 74 -5, 76, 134 See also Drugs Paraguay, 29, 40, 76, 134 -5 Narcotic Drugs, Commission on, 52, 53 ankylostomiasis and smallpox, 75, 135 National Committees on Vital and Health Statistics, 47 Parasitic diseases, Iraq, 146. 6 INDEX

Penicillin, 7, 8, 54, 56 Q fever, 12, 50

Chile, 133 Quarantine, 14, 42 -6, 121 See also Antibiotics Indonesia, 79 ;Saudi Arabia, 147 Perinatal problems, 89, 94 Permanent Central Opium Board, 53 Rabies, 4, 11 -12, 151 Pertussis, 16 Mexico, 134 vaccination campaigns :Brazil, 16, 132 ;Chile, 16, 133 ; Rabies, Expert Committee on, 11 Colombia, 16, 133 ;Mauritius, 16, 69, 131 membership, 160 Peru, 15, 29, 31, 76, 135 Radiography :Costa Rica, 133 Pharmaceutical standards and nomenclature, 51 -2 Red Cross, see International Committee of the Red Cross ; Pharmacology, India, 81 -2, 138, 139 League of Red Cross Societies Refugees, 118 Pharmacopoea Internationalis, 51 - Philippines, 15, 17, 28, 110, 150 See also Palestine refugees assistance to educational institutions, 40, 107, 150 Regional Committee - malaria, 5, 109, 150 Africa, 68 yaws, 7, 110, 150 Americas, 71 -2 Physically Handicapped Child, Joint Expert Committee on Eastern Mediterranean, 98 the, 117 Europe, 84 -5 Physiotherapy, India, 139 South -East Asia, 78 -9 Western Pacific, 105 -6 Plague, 17 Regional Office - India, 17, 139 Africa, 64, 68 Poliomyelitis, 4, 13, 14 Americas, 72 Poliomyelitis, Expert Committee on, 13, 14 Eastern Mediterranean, 98 -9 membership, 160 Europe, 64, 84, 85 Preliminary Report on the World Social Situation, 115 South -East Asia, 79 -80 Premature infants, care of, 28, 86 Western Pacific, 106 -7 France, 94, 142 ;Italy, 94, 143 ;Yugoslavia, 94, 143 Rehabilitation of the physically handicapped, 31,86,89, Preventive and social medicine, 40 116 -17 Europe, 36, 89 ;Lebanon, 146 Turkey, 143 Professional and Technical Education of Medical and Auxiliary See also Children Personnel, Expert Advisory Panel on, 36 Research workers, exchange, 39 Professional and Technical Education of Medical and Auxiliary Rheumatic diseases, 31 Personnel, Expert Committee on, 36, 39, 40 Rheumatic Diseases, Expert Committee on, 31 membership, 160 Programme and budget :Africa, 68 ; Americas, 71 : Europe, Rheumatism, International League against, 31 84 ; South -East Asia, 78 ; Western Pacific, 105 Rickettsial diseases, 13 -15 See also Budget Rockefeller Foundation, 85, 107 Prostheses, 31, 117 Rural health services, 21, 27 Protein malnutrition, 23, 24 Burma, 81 ; Panama, 20, 74 -5, 76, 134 ; Thailand, 82 -3, Psychiatry, 26 140 Africa, 69 ; Denmark, 142 See also Public -health services See also Children ;Mental health Rural social welfare seminar :Latin America, 132 Public Education, International Conference on, 119 Public -health administration, see Public -health services Salmonella and Escherichia Centre, International, 49, 51 Public- Health Administration, Expert Committee on, 21, 41 Sanitary engineering :Liberia, 23, 130 ; Paraguay, 75 membership, 160 See also Environmental sanitation Sanitary Regulations, International, 42 -3, 44 -5 Public- health laboratories : Afghanistan, 77 ; Eastern Mediter- ranean, 98 ;Europe, 91 ;Jordan, 146 ; Panama, 75 See also International quarantine Sarawak, 15, 33, 111, 150 -1 Public -health schools, see Schools of public health malaria, 5, 109 Public -health services, 20 -35 yaws control and BCG vaccination, 108, 110, III, 150 Afghanistan,77,136 ;Americas, 76 ;Austria,142 ; Saudi Arabia, 37, 147 -8 British territories in Africa, 130 ; Burma, 20, 77, 81, Scale of assessments, 63 137 ;Cambodia, 149 ;Colombia, 20,133 ;Eastern School health services, 27, 82, 86, 90, 98, 119 Mediterranean, 97 -8, 104 ; Ethiopia, 20, 145 ; Europe, School Health Services, Expert Committee on, 27, 119 86, 89, 92 -3, 141 ; Finland, 142 ; Greece, 142 ; Indonesia Schooling, free and compulsory, 119 20 ; Iran, 20, 145Korea, 150 ; Lebanon, 146 ; Panama, Schools of public health, assistance to, 40, 41 20, 74 -5, 76, 134 ; Paraguay, 76 ; Peru, 76, 135 ; Saudi Italy, 143 ;Netherlands, 143 ;Turkey, 143 Arabia,148 ;South -East Asia, 78 ;Thailand, 20 ; Scientific information, exchange of, 39 -40 Turkey, 143 ;Venezuela, 76, 135 ;Viet Nam, 151 ; Seafarers, hygiene of, 31, 118 Western Pacific, 105 ; Yugoslavia, 144 Seafarers, Joint ILO -WHO Committee on the Hygiene of, 31 See also Health demonstration areas Secretariat at headquarters, structure, 64, 181 Public information, 59 -61 Seminars and training courses, list, 87 -91, 164 -7 Africa, 70 ;Americas, 72 ; Eastern Mediterranean, 99 ; Serological Reference Laboratory, International, 9 South -East Asia, 79 ; Western Pacific, 107 Servicesmobilesd'HygièneetdeProphylaxie(French Publications and reference services, 57 -8 territories in Africa), 70 INbEX 7

Servicio Cooperativo Interamericano de Salud Pública, 74, 75 Technical Working Group on Fellowships(of Technical Seychelles, 131 Assistance Board), 38 Shigella centres, international, 121 Technical Working Group on Long -Range Activitiesfor Singapore, 15, 151 Children (of Administrative Committee on Co- ordination), assistance to educational institutions, 40, 107, 151 28 health education, 32, 33, 109 Technical Working Party on the Rehabilitation of the Physi- Sixth International Congress for Microbiology, 13 callyHandicapped(ofAdministrativeCommittee on Sixth International Congress on Leprosy, 16 Co- ordination), 31 Sixth World Health Assembly, technical discussions, 4 Technical Report Series, 57, 58 Slaughterhouses - Tetanus, 82 construction, Costa Rica, 133 Thailand, 16, 27, 28, 29, 140 See also Food hygiene rural health centre, 82 -3, 140 Smallpox, 4, 15 treponematoses, 7, 81, 140 campaigns, 68, 72, 78, 106 Third Latin American Nutrition Conference, 24, 132 Paraguay, 75, 135 Thoracic surgery, 90 Social and occupational health, 30 -1 Toxoplasmosis, 4, 13 Europe, 88; 95 ' Trachoma, 15 See also Industrial hygiene Eastern Mediterranean, 166 ; Egypt, 145 ; Iran, 15, 145 ; Social case -work, Europe, 142 Morocco (French Zone), 15, 143 ;Taiwan, 15, 110, Social medicine, 36, 40, 89 149 ;Tunisia, 15, 143 ;Western Pacific, 15, 110, 148 Social services, 115, 116, 120 Trachoma, Expert Committee on, 15 Social Work, International Conference of, 120 Transport and Communications Commission, 119 Sociological survey - Treponematoses, 7 -9 French territories in Africa, 69, 130 Africa, 69 ;Bechuanaland, 69,130 ;Indonesia, 139 ; See also Cultural anthropology Laos, 150 ; Philippines, 150 ; Sarawak, 151 ; Thailand, South -East Asia Region, 77 -83, 135, 166, 187 7, 81, 140 South Pacific Commission, 46, 106, 121 See also Yaws South Pacific Health Services, 46, 121 Treponematoses, Expert Committee on Venereal Infections Spain, 86, 143 and, 7, 56 leptospirosis, 12, 92 Treponematosis Laboratory Center, International, 8 Staff, 64, 68, 79, 84, 85, 98, 106 Training, see Education and training ;Educational institu- composition by nationality, 185 tions ;Maternal and child health ;Medical and auxiliary numbers and distribution, 183 -4 personnel ; Medical education ; Nursing senior, 182 Training courses and seminars, list, 87 -91, 164 -7 Standardization, biological, 9,12, 49 -51 Trichinosis, 13 Standardization, International Organization for, 121 Trinidad, 135 Statistical services, 98 Tropical Medicine and Malaria, Fifth International Con- See also Health statistics ;Inter -American Center of gresses of, 5 Biostatistics ;Vital and health statistics Tuberculosis, 4, 9 -11, 121 Strain Study Center for the Americas, 13 Africa, 69, 129 ; Burma, 136 ;Ceylon, 137 ;Ecuador, Sub -Committee on Serology and Laboratory Aspects (of 134 ; Egypt, 145 ; Europe, 90 ;India, 10, 138 ; Indo- venereal infections and treponematoses), 8, 161 nesia, 139 ;Jamaica, 134 ;Pakistan, 147 ;Paraguay, Sudan, 148 135 ;Peru, 135 ;Syria,101 -2,148 ;Thailand, 140 ; Supplementary Interpretations and Instructions for Coding Trinidad, 135 ; Western Pacific, 109 -10, 167 Causes of Death, 47 See also Avian tuberculosis ;Bovine tuberculosis Supplies - Tuberculosis, Expert Committee on Vaccination against, II, 16 administrative, 64 membership, 160 medical, see Medical supplies Tuberculosis, International Union against, 121 Synthetic drugs, 53, 117 Tuberculosis Campaign, International, 18 Syphilis :Haiti, 134 ;Iraq, 145 ;Syria, 148 ;Yugoslavia, 7 Tuberculosis Immunization Research Centre, 19 See also Venereal disease Tuberculosis Research Office, 10, 18 -19 Syria, 17, 116, 148 Tularaemia, 13 nursing, 28, 29, 102 -3, 148 Tumour Nomenclature and Statistics, Committee on, 48 tuberculosis, 101 -2 Tunisia, 15, 86, 143 Turkey, 16, 17, 29, 30, 31, 32, 86, 95, 143 Taiwan, 27, 29, 108, 109, 110, 149 malaria and insect control, 5, 109, 149 Typhoid fever, 16 trachoma, 15, 110, 149 Typhus, 15 venereal disease, 111, 149 Afghanistan, 136 ; Bolivia, 133 See also China Technical Assistance, 62 -3, 72 -3, 85 -6, 98, 99, 122 -6 UNESCO, 21, 26, 33, 41, 57, 60, 116, 117, 119 Technical Assistance Administration, 53, 54 UNICEF, 3, 10, 15, 16, 27, 31, 62, 69, 70, 74, 81, 85, 86, Technical Assistance Board, 122, 123, 124, 125 100, 106, 108, 110, 116, 118 Technical Assistance Committee, 122, 123, 124 financing of Technical Assistance projects, 125 Technical Co- operation Administration, 103, 125 See also Joint Committee on Health Policy, UNICEF Technical discussions at Sixth World Health Assembly,4 WHO 8 INDEX

United Nations, 21, 46, 47, 48, 60, 64, 85, 99,106, 116, Veterinary public health, 11 -13, 92 117 -18 Viet Nam, 5, 15, 110, 111, 151 missions - Virus diseases, 4, 13 -16 Americas (High Andes), 21, 131 Virus hepatitis, 15 Burma, 21, 116, 137 Visiting teams of medical scientists, 36, 39, 40 See also Commission on Narcotic Drugs ; Drug Super- India, 39, 40, 139 ;Indonesia, 39, 40, 140 visory Body of the United Nations ;Economic and Visual aids - Social Council ; Economic Commission for Asia and in fundamental education, 33 the Far East ;Economic Commission for Europe ; See also Audio -visual aids production Technical Assistance Vital and health statistics, 117 United Nations Children's Fund, see UNICEF Africa, 69 ;Americas, 73, 166 ;Turkey, 143 United Nations Educational, Scientific and Cultural Organi- national committees, 47 zation, see UNESCO See also Health statistics ;Inter -American Center of United Nations High Commissioner for Refugees, 118 Biostatistics United Nations Joint Staff Pension Fund, 64 United Nations Korean Reconstruction Agency (UNKRA), Water - 55, 108, 118 fluoridation, 32 United Nations Relief and Works Agency forPalestine pollution, 92 Refugees in the Near East (UNRWAPRNE), 33 -5, 118 See also Drinking -water Universal Postal Union (UPU), 51, 119 Waterworks operation :Americas,132,164 ;South -East Universities, International Association of, 41 Asia, 166 Weekly Epidemiological Record, 46 Vaccination against Tuberculosis, Expert Committee on, 11, 16 Western Pacific Region, 105 -11, 148, 167, 188 membership, 160 Western Samoa, 111 Vaccines - WHO, senior officials, 182 and sera- - WHO Newsletter, 59, 107 manufacture : Afghanistan, 136 WHO seals, 63 rabies, 4, 11, 12 Working Capital Fund, 63 brucellosis, 4, 11 status of contributions, 178 -9 influenza, 13 World Directory of Medical Schools, 41, 58 poliomyelitis, 4, 14 World Federation of United Nations Associations, 107, 120 smallpox, dried, 4, 15 World Health Day, 60 -1, 70, 99, 107 typhoid, 16 World Health Organization: Monograph Series, 58 yellow fever, approval, 14 World Influenza Centre, 13 Venereal disease, 7 -9 World Medical Association, 36, 120 Afghanistan, 136 ;Americas, 132 ;Burma, 80 -1,136 ; World Meteorological Organization (WMO), 46 Ceylon,137 ;Ecuador, 134 ;Egypt,8,101,144 ; Ethiopia, 145 ;Europe, 9,84,90,91,141 ;India, X -ray equipment, procurement, 56 8,82, 138 ;Iran, 145 ;Laos, 150 ;Pakistan, 147 ; Paraguay, 135 ; Saudi Arabia, 147 ; Taiwan, 111, 149 ; Turkey, 143 Yaws :Haiti, 7, 134 ;India, 7, 138 ;Laos, 7, 110 ;Liberia, See also International Anti- Venereal- Disease Commis- 7,69,130 ;Nigeria,7,69 ;Philippines,7,110,150 ; sion of the Rhine ;Syphilis Sarawak, 108, 110, 111, 150 ; Western Pacific, 110 -11 Veneral Diseases, International Union against, 121 See also Treponematoses Venereal Infections and Treponematoses, Expert Committee Yellow fever, 14 -15, 43, 69, 71, 130, 164 on, 7, 56 Yellow Fever, Expert Committee on, 14, 43, 69 Sub -Committee on Serology and Laboratory Aspects, membership, 161 membership, 161 Yugoslavia, 7,15,16, 30, 31, 86, 94, 143 -4 Venezuela, public -health services, 76, 135 Veterans Federation, International, 117 Zoonoses, 4, 11 -13 Veterinary Congress, International, 11 Europe, 91 -2 ;Israel, 146