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WORLD HEALTH ORGANIZATION REGIONAL OFFICE FOR SOUTH-EAST ASIA TWENTY-FIFTH ANNUAL REPORT OF THE REGIONAL DIRECTOR TO TI-IE REGTOXilL COMMITTEE FOR SOUTH-EAST ASIA 1 JULY 1972-30 JUNE 1973 SEA/RC26/2 Page iii TABLE OF CONTENTS Introduction PART I - GENERAL REVIEW OF ACTIVITIES Public Health Administration Planning and Strengthening of Health Services National Health Planning Organization of Basic Health Services Operational Studies and Health Manpower Family ~ealth Nursing Environmental Health Health Education Nutrition Mental Health Dental Health Occupational Health and Rehabilitation Radiation Health Cancer Cardiovascular Diseases Pharmacology and Toxicology Quality Control of Pharmaceutical and Biological Products Drug Dependence Food Safety: Hazards to Man from Pesticides Medical Stores Management Communicable Diseases Malaria Tuberculosis Diseases Subject to the International Health Regulations and Epidemiological Surveillance Smallpox Cholera Plague Bacterial Diseases Leprosy Venereal Diseases and Treponematoses Diphtheria, Tetanus and Pertussis Virus Diseases Trachoma Poliomyelitis ~engue/~aemorrhagicFever Influenza and Other Respiratory Viruses SEA/RC26/2 Page iv 2.6 Parasitic Diseases 2.6.1 Filariasis 2.7 Veterinary Public Health 2.7.1 Rabies 2.8 Immunology 3. Health Laboratory Services 4. Vaccine Production 5. Health Statistics 6. Education and Training 6.1 Medical Education 6.2 Paediatric and Obstetric Education 6.3 Teaching of Human Reproduction, Family Planning and Population Dynamics 6.4 Fellowships 6.5 The Regional Office Library 7. Technical Information and Reference Services PART I1 - ORGANIZATIONAL AND ADMINISTRATIVE MATTERS 1. The Regional Cormnittee Administration General Organizational Structure Personnel Staffing Briefing Staff Training Employment Conditions Finance, Budget and Accounts The Regional Office Building 3. Procurement of Supplies and Equipment 4. Programme Support and Co-ordination 5. Collaboration with Other Agencies 5.1 United Nations 5.1.1 United Nations Development Prograwne (UNDP) SEA/RC~~/~ Page v United Nations Children's Fund (UNICEF) United Nations Fund for Population Activities (UNFPA) World Food Programme (WFP) Economic Commission for Asia and the Far East (ECAFE) International Atomic Energy Agency (IAEA) Specialized Agencies Food and Agriculture Organization of the United Nations (FAO) International Labour Organisation (ILO) United Nations Educational, Scientific and Cultural Organization (UNESCO) International Bank for Reconstruction and Development (IBRD) Non-governmental Organizations in Official Relations with WHO Inter-governmental and Bilateral Agencies National and Other Agencies 6. Public Information PART 111 - ACTIVITIES UNDERTAKEN BY GOVERNMENTS WITH THE HELP OF WHO Project List Bangladesh Burma India Indonesia Maldives Mongolia Nepal Sri Lanka Thailand Inter-country Inter-regional (Projects Within the Region) Inter-regional (Projects Outside the Region with Participants from the South-East Asia Region) ANNEXES 1. Organizational Structure 225 2. Geographical Distribution of International Staff Assigned to the South-East Asia Region as of 30 June 1973 226 SEA/RC26/2 Page vi 3. Meetings and Courses Organized by WHO and Held in the South-East Asia Region 4. Conferences and Meetings in the South-East Asia Region Called by the United Nations and Its Related Specialized Agencies at Which WHO was represented 5. Conferences and Meetings of Governmental, Non-governmental and Other Organizations Held in the South-East Asia Region at Which WHO was Represented 6. Fellowship Tables 7. List of Technical Reports Issued by the Regional Office GRAPHS 1. Population at Malaria Risk in the Areas Under Various Phases of the Malaria Eradication Programme in the South-East Asia Region (1964-1973) 2. Fellowships Awarded by WHO in the Last Five Years (1968-1972), South-East Asia Region SEA/RC26/2 Page vii INTRODUCTION This year WHO completes the first 25 years of existence in South- East Asia. Although the achievements of the past are well known, I neverthe- less feel it is useful for us to take note of the tremendous strides that have been made in the last quarter of a century, as well as to highlight the problems that still face us in this region. We can justly look back with pride on our accomplishments, but not with complacency, for much remains to be done. Initially comprising a population of 500 million, this region nm has over 850 million people - over one fifth of the world's population. During these years, new disciplines, such as health education, public health engineering, health planning and post-graduate nursing education, have been established as an integral part of the health services and educational system. Starting with an annual budget for field activities of $376 000 in 1947, WHO nm has a progrme of around $10.5 million, an increase from $0.83 to $10.96 per thousmd population. Although the Member Governments' per capita expenditure on health has risen greatly in the last decade, it is, with a few exceptions (Mongolia, Sri Lanka and Thailand), still less than $1 per capita. The average expectation of life at birth, which, in 1950, ranged between 32 (India) and 54 years (Sri Lanka), by 1970 was between 46 and 66 years. The number of medical colleges in the Region rose from 41 in 1948 to 137 in 1972, with an increase in the annual intake of students from 1 800 to about 16 000. The comparable figures for nursing were 175 schools and 2 colleges in 1948 and 250 schools and 16 colleges in 1971. Scientists in the Region have rendered outstanding service on WHO Expert Advisory Panels as well as in WHO'S Expert Committees and as chairmen of some of the technical discussions held in conjunction with World Health Assemblies. It should also be noted that the only two women to have been honoured in having been elected as Presidents of the World Health Assembly have both come from South-East Asia. This year we have the privilege of welcoming to our Region a new Meniber, the Democratic People's Republic of Korea. I am confident that the experience and participation of this new Member in our deZiberations will greatly contribute to the work of the Regional Conunittee. The problems that still face all our countries are numerous. Although diseases such as typhus, plague and yaws are no longer public health problems, and remarkable achievements have been recorded in the control of malaria, smaZlpox and other commicable diseases, there is still much to be abne in these fields. In smallpox, South-East Asia is likely to be one of the last of the world's regions to achieve eradication. SEA/RC2 6/2 Page viii There are large sections of the population, especially in rural areas, who have no access to even minim health services. Administrative machinery for the provision of health care is unable to meet either the ezisting or the future needs of large populations that are growing rapidly. Ineffective comnity organization and participation and adverse environ- mental factors continue to be major causes of widespread preventable morbidity. Trained manpower to provide efficient services is woefully inadequate. In efforts to reorganize the health infrastructure, it should be kept in mind that the system inherited from developed countries are not always the most desirable ones for adoption by the developing countries but that it is essential to evolve patterns best suited to local needs. The Director-General of WHO has stated: !'In the highly developed countries, there seems to be a persistent belief that systems which have proved their worth can be used, with only slight modification, in quite different circwn- stances. And, surprisingly, this belief is to some extent shared by health leaders in the developing countries. On reflection, this is not unnatural, since many of these leaders were educated abroad, in the exotic environment of the industrially advanced countries. In any event, many of the leaders are resistant to the often profound changes that are required before imported models can meet the real needs of the population to be served. It undoubtedly takes courage to strike out along neu paths in order to discover more effec- tive ways of improving the health of one's people. I' This point was strongly echoed by a number of delegates at the last WorZd Health Assembly. I am glad to report that health plans are being finalized by many countries of the Region for their next five-year periods. There are many conunon objectives within the national health plans; the mqjor emphasis in almost all of them is on the rapid provision of essential health services to populations who have hitherto been deprived of them, especially in rural areas, more effective utilization of existing facilities and resources, the achievement of self-sufficiency in the training of national health manpower taking advantage of recent developments in educational methodology, and greater emphasis on health education and comnity participation. In preparation for achieving these goals, India has alreaa appointed, at a high level, a senior official to be in charge of the deveZopment of ma2 health seruices. In Thailand, a major reorgcmization has resulted in the unification of various divisions under one DirectorGeneraZ. Bangladesh is preparing for a reorganization of the existing administrative structure of its health services and the establishment of a nation-wide health service, particuZar attention being paid to rural areas. In Indonesia, emphasis is being placed on increasing the utilization of existing medical care institutions,
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